ºuatais-Peninsuu-AMoe - GE sº - iſ: * - é / os- ----------→ / "Quantam ego quidem video motus morbosi fere omnes a motibus in systemate nervorum ita pendent ut morbi fere omnes quodammodo Nervosi dici queant.”-Cui LEN's Nosol ody: Book II. P. 18.1– Enix RURG, Ep. 1780. THE 'lierist and ſºedrologist A JOURNAL -—O F-- Scientific, Clinical and Forensie NEUROLOGY AND PSYCHOLOGY, . PSYCHIA TRY AND NE URIA TRY - . - - - -- - - .2 --- 2- - + -" " 2 :::ez: aed e3ve,'...t..:” ſo 3:33.7:'' ºre tºº::. . . ….' ... } Gezier... .';...t.c. ::: ºne; º' Yedic: e. VOLUM E XXI. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGH ES, Associate Editor. HENRY L. HUGHES, Manager and Publisher. 385; Olive Street, ST. LOUIS, MO. CONTRIBUTORS AND, COLLABORATORS TO VOLUME XXI. C. WERNICKE, Breslau. MARTIN W. BARR, Penn. v. KRAFFT-EBING, Vienna. CH. FERE, Paris. C. H. HUGHES, St. Louis. GUISEPPE LEVI, Italy. E. C. SPITZKA, New York. HAVELOCK ELLIS, London. ADOLPH CALMANN, Hamburg. JAS. G. KIERNAN, Chicago. T. D. CROTHERS, Conn. WM. W. IRELAND, Scotland. AUG. HOFFMANN, Düsseldorf. PAUL GARNIER, Paris. WM. C. KRAUSS, New York. JULES VOISIN, Paris. A. MARRO, Italy. G. E. SHUTTLE WORTH, England. F. B. BEACH, London. ARTHUR E. MINK, St. Louis. INDEX TO VOLUME XXI. ORIGINAL CONTRIBUTIONS. Brain Destroying Policy of Railways........689 Can Syringomyelia be Diagnosei Ante-mor- tem? … … … 683 Circumscribed Median Nerve Digital Neu- ritis—Sequent to La Grippe Degeneracy Stigmata............................... Diagnosis of Raynaud's Disease ... .......317 Epilepsy Modified by Treatment and Envir- onment, with Some Notes of Two Hundred Cases..................... ..... .85 Extension of Psychiatry in the American Army ........................... ...................... 477 Forensic Aspect of Sexual Pervert Impulses and Obsessions. ... ... ....................... 681 Hungry Evil in Epileptics. ... ... ...........74 Inebriate Criminals and Their Treatment.437 Increase of Diseases of the Nervous System ..... ............... .. - - ------- 460 Influence of Age upon Nervous Diseases. 642 Inter-Relation of Gynecology and Neurol- ogy....... … … … … 455 Legal Disabilities of Natural Children ...661 Nature and Evolution of Folie Du Doute .432 Outline of Psychiatry in Clinical Lec- tures ~~~~~…! Outline of Psychiatry in Clinical Lec- tures … …266 Pathologic Anatomy of Idiocy.................... 677 Physiological Common Sense and the Drink- ing of Alcohol............ ….....................70 Psychoses of Puberty.................................658 Puberty Psychoses ..................................... 653 Research in Comparative Cytology of the Nervous System of the Vertebrates...96 Research in Comparative Cytºlogy of the Vertebrates... .............. Samuel Henderson, Murderer... . ... ......... 24 Sexual Pervert Impulses and Obsessions..634 Simulation of Organic Disease.................. 590 The Analysis of the Sexual Impulse … 247 The Legal Disabilities of Natural Children Justified Biologically and Histori- cally ~… … 111 Transitory Mental Disorder in Hemi- crania ----------------------------- 41 Treatment of Nervous Diseases........ ..... 557 1 wº. Index. SELECTIONS. - * CLINICAL PSYCHIATRY- A Case of General Paralysis of the Insane in a Child ....... - - - - - ------- . . 165 Aphasia and Testamentary Powers . . . 375 La Maladie De Blaise Pascal ........... . ... 166 Mental Disturbance During Acute Rheumatic Chorea ...... .... . . ..... ... .. 168 New Features of Folie Circulaire ... ... 375 Paretic Dementia and Interstitial Gingi- vitis ........ . . . . .......... . ....... . . . 167 Psychologic Study of Jurors . . .... 166 Sadism from Traumatism . . 371 Sexual Functions and Forensic Psy- chiatry . . ... ... ............ . . . . 370 Suggestion and Mental Instability ........703 Theft During Epileptic Unconscious States.......... ... .... . ... ...... ... 168 PSYCHIATRY- begeneracy or Occupation Stress. ... 169 Effeminate Men and Masculine Women .504 Genius . . . . .......... ... ... ..... 501 Raynaud's Disease in the Insane "... 502 NEURO-ANATO MY - Cortex Stimulation . . . . ........ . . 174 Nerve Cells in the Cerebral Cortex of Man ...... 174 Phonation Center . . . - - - - - 174 The Corpora Quadrigemina - 175 NEUROPATHOLOGY - Athetosis . --- - ... 379 Diseases of the Pineal Body .......... . . 505 Chronic Bulbar Paralysis 389 Neoplasm of the Left Third Frontal Convo- lution in a Right-Handed Individual, Without Aphasia ... . ........ ...... 175 NEURO-PHYSIOLOGY — Capsular Hemianesthesia . ... ........ 378 Function of the Thyroid Gland. ... 178 Lung Reflexes. ..... ... ...... .......... 179 Partial Transverse Section of the Spinal Cord ... ....................... . . . ........... 180 Spinal Muscular Atrophy. ... . ...... . 179 - NEUROTHERAPY- Alcohol as a Food....... ... . ... . . . .... 183 Antikamnia and Influenza . ... 183 Apomorphine as an Hypnotic ... ....... 376 Hot Air in the Neuroses . . . . . . .699 Hyoscine Hydrobromate in Chorea ........ 182 Intestinal Therapy … . - . . 489 Methylene Blue in Insanity. . . . ...... 185 Nacke. ... ... ... ... ...... . . ... ........... ..... .. 703 Paralysis Agitans - - - 185 Rhythmical Traction of the Tongue in Typhoid Fever …....…701 Some of the Mental Conditions in Fasting and Abstinence .......... . . . 377 spermotoxin and Antispermotoxin .......... 487 The Treatment of Trigeminal Neuralgia with Galvanism - ---------- . . .. 702 Untoward Effects of Sodium Eosinate 375 NEURO-DIAGNOSIS- Arterial Pressure Gauge, a New Instru- ment . . . - - - - - - - - ------- - - ----- 186 CLINICAL NEUROLOGY- A Case of Exophthalmic Goitre and Myxe- dema - ------------ - - - 199 Addison's Disease in a Young Girl.... 191 Index. Auto-Intoxication in Paediatric Neurol- (**Y.-----------... 694 Bertillon's Mistakes............ ......... 194 Brain Fatigue ...... … … 195 Cases of Hemiatrophia Linguae 192 Cataleptoid Lethargy With Simulation of Chyluria ............ . ---- - - ... 190 Complications of Neurasthenia ... 695 Crossed Paralysis 698 Death from Prolonged Laughter... ....... 190 Gastro-Intestinal Tract and the Neu- TOSes .......... ....... ... 367 Heart Disease and Epilepsy. ........... ..... 499 Hydatid Cysts of the Brain 499 Hysterical Aphonia Lasting for Eleven Years ...... - ------ 101 Peroneal Progressive Muscular Atrophy. 368 Pre-Epileptic Bulimia. .......... ........... 367 Pure Motor Aphasia ..................... ... 692 Recurrent Trance .......................... ... 697 Renal Inadequacy and Neuropathy. 492 Some Present Phases of Neurology .188 Spasmus Nutans.......... ........... ...... ......... 367 The Auditime Center as a Language inhibi- tor.......... ... 692 The Central Nervous System in Acute Malarial Infection. ........................... 186 The Pituitary Body and Acromegaly....... 695 The Treatment of Cerebral Tumors. ... 195 The Westphal–Piltz Pupillary Reflex...... 698 ...495 Unilateral Facial Paralysis for Emotional Hysterical Disturbances of Vision ... ... 497 Movements. ........... ... 360 Hysteria Lethargy. ......... ........... 361 X-Ray and Head Injuries .498 Improvement of Gait in Tabes 698 NEURO-ANATOMY – Knee-Jerk and Gross Lesions of Prefrontal Some Objections to the Neurone Theory. 369 Brain ... ......... . . ...... ...... .......... 192 NEURO-SURGERY- Mirror Writing ... ..... . . . . . . . . 693 Excision of the Superior Ganglion of the Neuroses Sometimes. Following Oophorec- Sympathetic for Glaucoma ... 708 tomy—Their Duration and Treat- Relief of Intercranial Pressure..….... 707 ment. … … . … ….. 191 Surgery. Among the Insane................... .. 706 Nerve Suture and Transplantation ... 490 CEREBRO-PATHOLOGY- Parallelokinesia.................' .......... 694 Bone Formation in the Brain. ..................709 - EDITORIALS. A great Head on Him............ ... ...... 3-3 Alma Sanitarium....... . . .......... 532 A Good Law Misapplied ... ..... ... 534 Annual Index for Volume Twenty … ... 403 A Serious Practical Joke or a Malicious Announcement ... ....... . ......... 721 Calumny ... ... . . . . . . . ........ ........... 402 Are Americans Becoming Indian Degen- Abdominal Celiotomy. 383 erates?.... ... .......... ... . ... ............. . 710 Abnormality as a Factor of Advance ...... 519 Barkers Nervous System ... 210 Alcohol and Suicide... ... ...... . . . . ...... 520 Belittling the Opium Habit . … ... 392 Alienist and Neurologist. -- - ------ 201 Britain's Inheritance Tax. … 511 vi. Index. Chairs. for Tropical Diseases ... .. .720 Death ... .......... . . . ... ..... ... . .722 Death of Sir James Paget. .................... 209 Degeneracy From the Great Contagions. 397 Dr. C. B. Burr................. .......... ... ...... 214 Dr. Butler, Superintendent of the Alma.382 Dr. Samuel G. Gant. ........ . ......... ... ... 722 Dr. W. W. Ireland...... ..... .... ..... . ......... 529 Dr. A. Jacobi's Anti-American Address.720 Dr. J. N. Love . . ..... . .................. 718 Dr. J. N. Love ... ... ... ... ...... . ....... ....... 716 Dr. J. H. McBride. 384 Dr Mulhall. Dead... . . ..................... ........ 216 Dr. John B. Murphy ... . . ...................... 721 Dr. St. George Mivart ....... ... ... 400 Dr. Benjamin Rush and the Temple of Fame. ........... .................. . ... 718 Dr. Russell’s Gift and Hartford Retreat’s Good Fortune .......... - ------- ---- 719 Hºmotion and the Vaso-Motor System..... 394 Epileptic Double Consciousness and Mem- ... 202 ... 388 ories of Pre-existence . Extirpation of Degeneracy. Hxposition Universelle Internationale de 1900.......... ............ ....... 403 For Sale....... . . . ...... . . ...................... 211 Handwriting and the Expert in Chirog- raphy ... 718 Honor to Dr. W. W. Ireland....... ... 215 Insanity in the Jury-box . ... ....... 208 Landon Carter Gray . .532 “Legal Disabilities of Natural Children Justi- fied Biologically and Historically''... 533 Love's Mirror and Tuberculosis . . . .404 Maternal Impressions ... ... ... . 203 Magnetic Healing 207 Medico-Legal Society............ . .................400 Mental Symptoms from Tuberculosis........ 394 Mental Status of Ruskin......................... 384 Mind Power, Mental Suggestion an Chris- tian Science............ .391 Missouri State University............. .......... 717 Monsieur and Madame Raymond............. 722 Morphine Using from Imperative Concep- tions. … ........…................... ... 510 Mr. Havelock Ellis’ Work on Sexual Per- version .................. ........................... 210 New Hospital for the Convict Insane at Fish- kill Landing, New York.................... 719 Our Visit to Hartford ..................................721 Paretic Dement Painters . . ................ 523 Parisian Courtesies Acknowledged.......... 720 Post-Mortem ‘’Healing’’...................... ... 522 Psychopathic Suggestion of an Intaglio .713 Rabies Occurring Long After a Course of Pasteur Treatment ....... .. 511 Rank of Army Medical Staff. ...213 Self–Accusations of Immodesty ..... ..... 515 Sir Dyce Duckworth ......................... . . 202 State Boards of Health and Medical Educa- tion … … … … 530 Suicide by the Mortally Wounded........... 3S4 Syrup Hypophos Compound, P.D. & Co...215 Temperature in the Psychoses ... ....... 512 The American Medico-Psychological Asso- ciation ... 382 The American Medical Editors’ Associa- tion ... 537 The Antikamnia Chemical Co........... ..... 533 The Arsenic in Chorea Folly . .......... 216 “The Crystal Water”.............................. 217 The Chesapeake and Ohio Railway ...... 539 The Cocainization of the Cord. ...... .......713 The Death of Doctor Mudd .... ............ 217 The Didactic Lecture........ ..... ... ....... .... 215 The Essentials of Hematology................ 538 The Fifty-sixth Annual Meeting............ 538 The Following Letter..... ............... ......... 211 The Gynecologic Considerations of the Sexual Act ............................ ...........616 The Heart-Foot Impulse................... 208 The Hunt Memorial Building ......... ....... 715 The Impending Election Crisis. .............722 The Marion County (Indiana) Medical Society ...................... … ... … 202 The Pan-American Medical Congress at vii. t - - - ------- ------------ 726 The Source of Congenital Alcoholism .....714 The Physician...... Transitory Frenzy: Under the Title of Ephe- --------- 390 Tropical Climate and Suicide ... ......... 525 - meral Mania ....... . . . . . . . Ueber eine Bildungsanomalie am Acqueduc- tus Sylvii........... ......... ---- - 402 “Vitriol Throwing” and “Hair Clipping” Sadism 524 Walnut Lodge ...... … . . . . . . . .721 Walnut Lodge Hospital . . ......... ....... . 217 Weismannic Heredity 508 W. B. Saunders ........ - - - - - ... 533 IN MEMORIAM. Havana ....... … 722 In the Death of Dr.William A. Hammond 218 RE/IEWS. A Case of Large Tumor of the Brain. .. 546 Dr. Gould's Pocket Medical Dictionary 40s A Case of “Family Periodic Paralysis”.547 Evolution by Atrophy 540 A New Auto-Extension Fenestrnm Splint. 548 Eleven Cases of Castration 547 A New and Valuable Medical Dictionary. 733 From the Greeks to Darwin . 54() A Primer of Psychology and Mental Hay-Fever and its Successful Treat- Disease. 406 ment ... ........ . . ........... 220) A Treatise on Mental Diseases............ 734 Hinshelwood on Letter, Word and Mind Another Edition of Psychopathia Sexualis Blindness ..... ... ....... ... - ------- 409 ------ - - - - - - 736 Krankheiten de Peripherischen Nerven. 221 Atlas of Legal Medicine wº Injuries to the Hve in Their Medico-Legal Alcohol and Alcoholism....... . . . . .548 Aspect 543 Bulletin of the Laboratory of Mount Hope Retreat . . ---- 221 Case History and Photograph . . .548 Cholangiostomie - ---- - 547 Congenital General Paralysis … 221 Diseases of the Nose and Throat .......... 407 Diabetes Mellitus ... ... . . . . . ...... 517 Deutsche Stimmen aus Deutschen Lan- dern....... . . ........... . . ... 547 L'instinct Sexuel: Hvolution et Dissolu- tion . .......... ...... ..... 542 La Pratique des Accouchements 546 Lessons on the Anatomy, Physiology and Hygiene of Infancy and Childhood 73. Le Delire de la Jalousie . . . . . 405 Neurasthenia ... .... --~~~~… . . . 220 New Edition of Copp's Settler's Guide 409 Non-Malignant Gastric and Duedenal Ulcers ....... ......... 54t, viii. - Index. w Our Many German Readers.......... ... ... ". 546 The Archives of Neurology and Psychopath- ology ..... - - - - - - - - - ----- - - - ---- 544 The Experiments of Prof. Atwater - 544 Ovarian Pregnancy ...... ........ . .. 547 s Potts’ Nervous and Mental Diseases..... 405 Progressive Medicine ......... . ....... . . . . 405 The Home Modification of Cow's Milk . .221 Progressive Medicine -- . . . 219 The Nervous System of the Child........... 545 Progressive Medicine ... .. ...... ... ........... 735 The Pathological Supplement....... … . 41).7 Psychological Problems ......... ....... .... 546 The Relation Between Trigeminal Neuralgias Recollections of a Rebel Surgeon .... . . .405 and Migraine........ ---------- ------- - - ... .. 5-47 Shuttleworth: Mentally Deficient Chil- The Surgical Diseases of the Genito-Urinary dren - - - - - - - - - - --------- - ----------- 408 Tract, Venereal and Sexual Diseases. 219 Some of the Aspects of Renal Inadequacy Thyroid Medication --- - - - - - - - - - - - 5-4S from a Neurotic Standpoint ..... . . 545 Vient de Paraitre....... .......... . . ...... 5-46 Some Points ... ... ... ... .... - -- ... 547 Vivisection .......... ..... ..............5-47 Studies in the Psychology of Sex . . ..... 733 You should Make it Your Business ... 737 Subnormal Temperature ... , 547 The Anatomy of the Brain . . . . 545 THE ALIENIST AND NEUROLOGIST. VOL. XXI. ST. LOUIS, JANUARY, 1900. No. 1. ORIGINAL CONTRIBUTIONS. oUtline of PsychiATRY IN clinical LECTURES.* PARANOIAC STATES. By DR. C. WERNICKE, Professor in Breslau. X}. INTIMATE RELATIONSHIP OF THE SO-CALLED “OLD” TERAMINAL CASES AND THE CHRONIC PSYCHOSES. EXPLANATORY DELUSIONS OF AUTO-PSYCHICAL, ALLO-PSYCHICAL AND SOMATO-PSYCHICAL ORIGIN. AUTOCHTHONIC IDEAS AND HALLUCINATIONS. Ere we make the acquaintance of new patients, it is necessary to tarry somewhat with those already presented, while they are fresh in your memory. We will first con- sider the matter of nomenclature. According to the termi- nology now in vogue all these patients would be instances of chronic delusional insanity or paranoia. If we should thus imply that paranoia should be a well characterized clinical type of disease, it would pave the way to the greatest confusion of conceptions, for the cases differ so *Translated by Dr. W. Alfred McCorn, Resident Physician "River Crest,” Astoria, L I., New York City. [1] 224034 2 C. Werniche. much from each other. We obviate this incongruity when we speak of paranoiac states and include among them all those chronic mental derangements, in which a falsification of the contents of consciousness confronts us, while the action of consciousness is well, maintained. Consequently we believe the view generally held by the older authors to be right, that by paranoia should be understood a predominant derangement of the intellect. It is very con- sistent with this extremely broad definition, that the cases possess such marked diversities, not only with respect to the present condition, but also in their genesis. As to the variation of the present disease types, we could readily characterize them more accurately by appropriate names, so we will employ the terms autopsychosis, allopsychosis and somatopsychosis and their combinations. For a falsification of the contents of consciousness embracing all three of its parts the name total psychosis would be suitable, then for one of these, in which one part is prominently affected, the respective name combined with the proper corollary. Accord- ing to this terminology the gardener Rother first pre- sented would be an example of total chronic psychosis, Mrs. Reisewitz would have to be designated as chronic auto-allo- psychosis, Tschieke as chronic auto-somatopsychosis, Mrs. Reising as chronic allopsychosis, Biega as pure chronic Soma- topsychosis, Mrs. Schmidt as combined chronic allosomato- psychosis. By the corollary “residuary” that group of cases in which the disease process is to be regarded as termina- ted either recently or long ago, and to which belong the recoveries without appreciation of the disease, would be given their special significance. . . The necessity of this last distinëtion may however lead us afield in the choice of another somewhat simplified no- menclature. Perhaps it would be proper to reserve the name chronic mental derangement exclusively for the residuary cases and to employ that of psychosis with the proper qualifications to the mental derangement still active. If we favor this nomenclature, all the cases of relative recovery (without appreciation of the disease) and the two patients Rother and Tschieke belong in the group of chronic resid- Outline of Psychiatry in Clinical Lectures. 3 uary mental derangement, all the others presented or merely mentioned in that of the true chronic psychosis. All psy- choses, which have not recovered, but are stationary, come under the group of chronic mental derangement according to this conception. lf such a distinction, for we might admit it as a clinical requirement, must be made, you will ask, if it would not be more proper to treat separately from now on the terminal cases and the chronic psychoses. But my introductory remarks will remind you that the sign of falsi- fication of consciousness occurs in both categories of mental derangement, and as you become acquainted with all the inmates of our Clinic, you will find a very large number of patients in which an immediate decision as to which of the two categories they belong, is impossible, for we have no account of their past. But when complete data are to be obtained, they often extend so far back that inaccuracies and falsifications seem unavoidable, and therefore, just as owing to the comprehensive faultiness of observations by laymen, the subsequent determination and decision between the two groups are not attainable. Hence it is a practical necessity to unite all these “old cases” in a single large group, that of the paranoiac states. But if we go more fully into the matter we understand the reason of this intimate connection unquestionably pres- ent. Permit me to allude briefly to the point of view deci- sive to my mind, as it is impossible to discuss it now as fully as it deserves from its theoretical interest. The contents of our consciousness have been repre- sented to you in the introductory lectures as something acquired, and surely acquired by the function of the organ of consciousness. Each new acquisition corresponds to a very definite arrangement of jointly functionating associative elements. The stability of these functional colligations we had found to vary, according to the frequency with which their function is exercised. But that this stability occurs in a proportionately high degree in the most complex associa- tive colligations, we might then conclude that we could very generally allow to the intellect of a person normally 4 - C. Werniche. developed a settled, systematic action and conformity to law. Accordingly we will not be too bold, if we assume that in the rise of the same combination of associative ele- ments, the same psychical process always follows and that in this respect the proposition of the specific energy of the sense elements might be transferred to the whole organ of association. The way, in which the function of these local- ized associative colligations is set in operation, is then relatively of no account, under certain circumstances a morbid internal stimulus may cause different psychical processes according to its localization. From this view all changes in the contents of consciousness attain the value of focal symptoms, which naturally vary in clinical dignity, according as they correspond to states of irritation or paral- ysis, but however will behave just like the familiar focal symptoms in brain disease. Take an example from the province of brain diseases. A large cerebral hemorrhage from the marginal artery of the lenticular nucleus or an embolism of the Sylvian artery causes, besides a hemiplegia, at the time of the acute illness a number of grave attendant symptoms, which are to be regarded as collateral effects of the local brain injury. As a result of the direct destruction the hemiplegia continues as the residuary state, but the collateral effects disappear. But exactly the same sort of a hemiplegia may occur, when a tumor of slow growth or a chronic encephalomalacia destroys the same locality, usually in the way that a monoplegia comes on gradually, e.g., of the leg, then a monoplegia of the arm and finally of the facio-lingual region, so that a hemiplegia at last exists. Corresponding to this chronic course severe general symptoms may be completely lacking. But the location of the brain destruc- tion is the same in both instances, and hence the right is proven to compare the residuary focus with the chronic focus. We have equally the right to compare the residuary changes of the contents with respect to the localization of the process to the changes of the contents in chronic psychoses. As instructive as has proven the comparison taken Outline of Psychiatry in Clinical Lectures. 5 from the province of brain diseases, the analogy leaves us in the lurch, when we will employ it in another important question, which we now cannot avoid. When is a mental disease, except in cases of recovery, to be regarded as terminated, when as still active or progressive? In the residuary hemiplegia a doubt cannot exist in this respect, while in mental disease there is often actually great diffi- culty in deciding and I have already referred to the fact,” that in cases, which otherwise could be considered termi- nated, new psychotic symptoms, relative to the explanatory delusion, may occur and practically be of great importance. I must now remark, that this explanatory delusion is rarely limited to the delusion once entertained (usually that of persecution, see above), but is often consistently elaborated and new delusions may ever arise from it. This is the process, which as so-called systematization, has always been regarded as a sign of incurability-if incorrectly, as we shall see later. Shall we believe that this progression of the delusion runs parallel with a progression of the dis- ease process? As I have already intimated above, this is not to be assumed off-hand, we must rather admit that a change of the contents of consciousness once effected may have the most portentious consequences for all the rest of the individual’s mental life, without new morbid processes needing to occur in the brain, perhaps to the contrary, because a normal action of the intellect and strict logic is retained by the individual. We must soon give proper attention to this effect of a change of the contents of con- sciousness, the origin of explanatory delusions. It would take too long and actually anticipate a great part of clinical pathology, should I here under- take to discuss the explanatory delusion in its entirety. The hint is sufficient, that almost every one of the acute symptoms, which we will later become acquainted with, may be the source of explanatory delusions. Of the explanatory delusions of the paranoiac states only certain categories are here suggested. - We follow the point of view, that they are essential in part for the comprehension of the *See Alienist and Neurologist, Vol. XX, p. 552, 6 C. Wernicke. cases presented, will lead in part to the cognition of a pathological principle, a hypothesis essential and indispens- able for the clinic of mental diseases. The province of somatopsychical explanatory delusions is of an almost indescribable variety. We have made the acquaintance of an example in the patient Tschieke. Form- ulated at the time the supposed changes in the body are felt, they rarely remain so harmless as in the artless admirer of Haeckel. The changes, which the body has supposed to have undergone, are very generally regarded as the effect of external influences and turn the patient’s ill- will and hatred against persons and institutions. I remind you of Mrs. Schmidt. Another patient of this kind, whom l have recently presented, manifests his indignation very drastically, in that he thinks he is degraded to a hog by this usage, he repeatedly calls himself a hog, without hav- ing a doubt that he does not think somewhat of a real change in his body, but only combines with it the trans- ferred significance above intimated. The real change in the body, of which he chiefly complains, was that his head would be split open by the blows of a hammer; his face was to be pushed down and the crown of his head shoved up, so that his whole head would be broader. The whole change could be effected quite quickly in one night. These changes have been undertaken; how they are to be effected he must leave to the physicians, for he is a layman. You clearly remember with what distinctness this intelligent patient, a merchant 27 years old, who has been insane for three years, developed his explanatory delusion with respect to its motive. He hesitates between three different assump- tions. It seems the most probable to him that he was to be made insane and in this way gotten rid of. To my question, if he is insane, he replies, as you recollect, that he considers this very possible. The other explanation, to which he inclines, was that the bodily abuses could be for the purpose of testing him and to prepare him for a higher calling. Perhaps the distortion of his head should espe- cially serve to give the external appearance of a nobleman, the Duke of Sagan. He adds indignantly: “But I do not Outline of Psychiatry in Clinical Lectures. 7 take the name, for then I would really be a hog at the bottom of my heart.” A third possibility is also vaguely entertained by the patient, namely that the purpose of such manipulations is to amuse other people. “Perhaps the whole affair is a comedy or a farce.” In the assertion of these three possibilities he reckons with the cer- tain assumption, that there is an intrigue against him. There is no question but that I will be able to pre- sent the same patient to you for several semesters and in possession of the same well retained logic and dialectics, and that he will then no longer vacillate between different possibilities, but present a well-founded single delusional system. Whether this will correspond to one of the possi- bilities now in doubt, or rather be a new, more complex delusional structure, cannot now be decided. The latter assumption is the more probable, for we now see the patient still susceptible to the constant correction of new psychotic data. The opportunity is not always afforded us to contemplate in a certain measure the process of systema- tization, as it is possible in this patient owing to his degree of education, his well retained logic and self-possession and his readiness to communicate his ideas. We generally have merely the completed fact of the explanatory idea, but without being permitted a doubt of its significance beyond its purport. I will now call attention to one of the most fre- quent somatopsychical explanatory delusions, because of its great practical importance. It is usually the persons in the nearest relation (e.g., the relatives) or the officers of the asylum, who are to blame for the bodily torments. In a patient of this kind, in whom the change of the contents of consciousness was of such an extent as to lead many phy- sicians to regard him as a hypochondriac, i. e., suffering with a neurosis instead of psychosis,” his wife was to blame, and she must finally leave him on account of his insults and actual assaults. In another patient the unques- tionable indisposition was charged to the officers of the asylum, and consequently he directed all his efforts to secure a transfer to another institution, for he still felt too *More of this case later. 8 C. Wernicke. ill to dispense entirely with hospital care. Of autopsychical explanatory delusions we have an example in the patient Tschieke. She claims to think double since her illness, by which she understands having acquired the ability to talk about scientific, political matters, etc., as well as those relating to her cooking. One of the most important series of explanatory delu- sions of autopsychical origin, starts from the phenomena of autochthonic ideas, as we will call them. The patients notice the appearance of thoughts, which are felt to be foreign, not belonging to them, i. e., not occurring in the usual manner of association. The explanation of this symptom offers no difficulties, for it is exactly what we can expect from a morbid irritant acting on a definite locality of the organ of association. We may assume that such a morbid irritation is stronger than the normal process of excitement in the function of association, that it consequently usurps the crest of the wave of psycho-physical excite- ment, and deranges the otherwise systematic and normal train of thought. At any rate the attention is forcibly directed to the autochthonic ideas and they are felt to be annoying intrusions. In this respect they are closely rela- ted to the so-called imperative conceptions, also felt to be annoying, yet differ from them in that the latter are never sensed as foreign, not belonging to the personality, and consequently do not acquire the portentious importance in the whole mental life, as do the autochthonic ideas. Irre- spective of the fact that the derangement of association due to the autochthonic ideas of many patients particularly those finely organized, is felt to be annoying and often more annoying than bodily sensations and pains, they are almost without exception a fertile source of autopsychical explanatory delusions. There are only exceptionally such objective observers among the insane, who feel the strange- ness of these thoughts and do not give them any peculiar significance.* These thoughts are almost always “created, forced, suggested,” also “diverted,” by whom and in what *Still there are such, as a case recently taught me. The autochthonic ideas were the only psychotic symptom and disappeared without giving rise to explanatory delusions. Outline of Psychiatry in Clinical Lectures. 9 way, depend wholly on the patient’s individuality and the purport of the autochthonic ideas. Religious thoughts are suggested by God, evil ones by the devil, enlightened minds use physical agencies, whose manipulations they usually credit to the physicians. That was the case with the merchant whose somatopsychical explanatory delusion has occupied itself with us, he complains of “foreign thoughts,” from which his mind suffers, and very especially, that his sleep is disturbed and in the beginning of his illness had been unable to attend to his business. Also the direction from which the thoughts are “forced” upon him, he says is from above, from the ceiling, probably in conse- quence of simultaneous abnormal bodily sensations. The patient points to the acme of the situation, in so far as he conjecturally explains the thoughts by suggestion and hyp- notism, only that the act of hypnotism was unobserved and performed counter to his will. You will remember how hard it was for me to get the patient to tell of these thoughts, after long solicitation only did he yield. The reason of his refusal was, that his thoughts must have been known to me. We will come across this symptom of so-called “thought-utterance” “Gedankenlautwerdens” from another source. It belongs to the most frequent explanatory delusions for the symptom of autochthonic thoughts, that the patients perceive in the physician the author of these thoughts and therefore suppose they must be known to him. The answer so often heard from taciturn patients: “You know that already” or “You know much better your- self” generally has this purport. You can see from this example, what an in- fluence the age in which we live must have on the spe- cial purport of all explanatory delusions. We have now no less than three chronic patients at the Clinic, whose explanatory delusion is based on hypnotism and suggestion. In the Middle Ages, when religious ideas, belief in miracles and superstition controlled the mind, a corresponding pur- port of the explanatory delusion was the rule, of which you *This accepted term originated with Cramer. Die Hallucinationen im Muskelsinn die Geisteskranken, Freiburg, 1889. 10 C. Werniche. can find the most striking examples in the extorted confes- sions of the unfortunate victims of the numerous trials for witchcraft. The same dependence of the special purport of delu- sions on the prevailing ideas of the age, we find especially pronounced in the allopsychical explanatory delusions. The elementary symptom, which here forms the most frequent starting point for explanatory delusions, is that of the sense deceptions, by which is understood illusions as well as hallucinations. In our sense the sense deceptions are to be defined as psychosensory hyperesthesias and paresthe- sias, but must defer the description of further particulars until later. Their effect is always to add to the contents of consciousness a number of false components, which belong to the allopsychical sphere and thus falsify it. By the patients they are usually regarded as singular phenom- ena requiring explanation, yet their reality is usually unquestioned, for reasons we will become acquainted with later. The explanation generally occurs by the assumption of physical agencies, of which some enemy and persecutor, in more rare cases a friend and protector, make use. These agencies vary in kind according to the individuality, and the system thus constructed corresponds exactly to the patient’s degree of education. For the explanation of acustic hallucinations ignorant people most commonly make use of an arrangement, which corresponds to the simple speaking-tube: Holes are either bored through the wall or the walls are hollow, subterranean passages exist, etc. For a time the telegraph played the same role in all who had heard of it, and now it is almost universally replaced by the telephone. For those versed in physics the absence of perceptible wires no longer offers any objection, for Herz's experiments have demonstrated the conduction of electricity through empty space. Optical sense deceptions are traced to more or less complicated optical instruments, simple arrangements of mirrors and projection appliances being the most common. Tactile hallucinations lead to the idea of being sprinkled or powdered, usually of course with perni- cious substances, and if there are prickling sensations, the Outline of Psychiatry in Clinical Lectures. 11 majority know that it is a matter of the effect of electricity. Also the sensation of stabs, of being exhausted, touched on different parts of the body, etc., is projected outward by the patient. Deceptions of taste and smell will vary according to the knowledge and direction of the individual’s thoughts and the supposed effects, but are generally interpreted as pernicious or poisonous. The so-called delusion of physical persecution, of which you have an example in the patient Schmidt, depends, as you see, on those explanatory attempts, we will therefore not admit it to be a clinical form of disease or at least only in the same sense as every other kind of explanatory delusion. It must be entirely different criteria, which assign to the thus established delusion of persecution its definite position in pathology. This arises from the fact, that in more rare cases the same hallucina- tions may be construed favorably as means to impart advice, to exercise surveillance, to protect the body, to inure, steel it against villainy, etc. This cannot alone depend on the variously colored individual purport of the hallucinations, for we will learn by and by that this purport is not accidental, but varies according to the exisfing form of disease and thus is determined according to law. XII. SEJUNCTION HYPOTHESIS AND ATTEMPT TO EXPLAIN THE SYMPTOMS OF PATHOLOGICAL IRRITATION. EXPLANATORY DELUSIONS IN CONSEQUENCE OF MOTOR SYMPTOM'S AND FUNCTIONS IN THEMSELVES NORMAL. The discussion of the allopsychical explanatory, delusions was not to be evaded here, because a great part of the chronic psychoses, whether temporary or permanent, is burdened with sense deceptions, in the first case at least they have the significance of corresponding to disease peri- ods of somewhat more acute complexion. But still, the second reason is to be added, that in cases of residuary chronic mental derangemeut the sense deceptions may be either permanent, only temporary or occur from definite 12 C. Werniche. causes. This seems to contradict all our premises, for in sense deceptions the action of consciousness is extremely deranged and we had accepted that in residuary paranoiac states the action of consciousness has returned to the normal. Should it not be, we will ask, the certain sign of a disease process still active, in the course of development, when a chronic mental derangement is accompanied by sense deceptions? That this question may be asked proves the difficulty which often actually prevents us from deciding between a residuary mental derangement and chronic psychoses. It will be well to avoid answering this until I have spoken of a hypothesis, which, in my opinion, can alone disclose the true meaning of the nature of all mental diseases. I begin with the first patient, the gardener Rother, who, as first stated, has at any rate occasionally, if only very rarely, sense deceptions. How is it possible, we ask, that such a large number of false ideas and opinions can exist in the same brain, which are so glaringly contradictory to the reality as well as to each other, and then with well retained formal logic, apparent self-possession and on the whole correct comprehension of the situation? In the face of the fact, which is undeniable, and according to the gen- esis of the present state, the answer may undoubtedly be: It was an acute mental disease, which has caused this looseness in the established structure of association. We will designate this process of disjointing by the correspond- ing name of sejunction and will not be able to help seeing in it a defect, a breach of continuity, which must correspond to the abrogation of certain functions of association. Because in the brain the different ideas and complex of ideas are not merely co-existent with each other, but are formed into large combinations and finally into the unit of the ego, may depend solely on the function of association. The fact that the patient is unconscious of the incongruity of his various false ideas, indicates that the combination of all higher unions into a unit, the ego, has ceased. If the man consists simultaneously in a certain measure of a number of different personalities, we may aptly designate Outline of Psychiatry in Clinical Lectures. 13 his state as “disinterigation of the individuality”. That this appears so little in his external manner, particularly in his occupation, is accidental and due to the slight demands which his work places on the whole personality. The monotonous employment of the gardener is closely allied to other kinds of work, like that of the farmer, many factory hands and persons engaged in manual labor after definite patterns. If it is the matter of an occupation requiring a very complex personality, like that e. g. of the judge, physician, master mechanic, the disinterigation of the per- sonality would be continually manifested in the vocation. We will see later, that the majority of all those signs of deranged secondary identification, which form the symp- toms of the acute mental diseases, are explainable by the same process of sejunction. Also the changes in the con- tents of consciousness, which may remain as sequela of these derangements of identification, hence be traced to sejunction. But we further know, that besides recovery and the residuary changes in contents, there is a third termination of acute mental diseases, that of dementia or mental enfeeblement of various degrees. But, as we will see later, we shall have to deduce dementia from the sejunction pro- cess. for we can define it only as an abrogation or blunting of the act of association. Before the termination in definite recovery a shorter or longer stage may be frequently observed in acute mental diseases, which after the decline of the acute period repre- sents in a certain measure its product in form either of a change in the contents or a quantitive diminution in the function of association. This stage of the acute mental disease, whether paranoiac or demented, is capable of restitution. All these considerations force us to perceive in the sejunction hypothesis the real nature of the acute mental diseases. As the example of Rother teaches, sejunction is demonstrable at once in many old cases. In other cases the unmistakable progression in the change in the contents, may lead to the same chronic terminal process, although it 14 C. Wernicke. is less conspicuous. On the extent to which sejunction occurs, will then depend, whether the disease type finally passes into a state of defect, dementia. So we see that the sejūnction hypothesis affords us the key to the comprehension of the chronic as well as the acute mental derangements, at least their most important symptoms, which we may compare to the phenomena of abrogation in brain diseases. But it is unmistakable that another series of symptoms is not explained, I mean those which we have comprehended as symptoms of irritation, like the hallucinations. Of these the better investigated pathol- ogy of organic brain diseases gives us no information, for the most familiar symptoms of irritation in this province, localized spasms and contractures, are completely unknown to us with respect to their genesis. We only learn from the brain diseases, that these symptoms of irritation are almost exclusively associated with phenomena of abrogation and thus gain their clinical dignity. In some form therefore a causal connection between symptoms of irritation and the phenomena of abrogation might be assumed. Yet in our province it is different, in so far as certain phenomena of irritation, like the halluciations, belong to the most impor- tant and often apparently independent symptoms of mental diseases. Should not the attempt be justified to demon- strate of them a definite dependence on symptoms of abrogation, i. e., here the process of sejunction? This is in fact a requirement, which is forced upon us by the experi- ences of the clinic; for we know of mental diseases, which present almost exclusively and in their whole course only these symptoms of irritation and still attain the same fatal termination of falsification of contents or dementia. With the extinction of the symptoms of irritation a defect is then revealed to us of an often unexpected extent. Therefore with all circumspection it may at least be said that the process of sejunction may be accompanied by symptoms of irritation and masked by them. It is now entirely within the range of prevailing opinions of disease processes, which destroy the nerves, that they also act as irritants to the nerves: the prevailing theory of the effect of irritation rests Outline of Psychiatry in Clinical Lectures. 15 entirely on this basis. The same opinions now obtain for the ganglion cells. The temporary result of the process leading to the death of the nerves would then have to have weight as decisive for the origin of irritative effects. But perhaps a somewhat more definite, purely mechanical comprehension of the irritative effect is possible. As you remember, we have considered the act of thinking as a form of movement, which proceeds in the endless associa- tion chain SAzm of our scheme. The memorial images were stations of stored energy, which are constantly charged from the centripetal tracts passing into the projection fields. A discharge of this energy continually occurs, as we may assume, and thus finally the charge of the projection field m, which qualifies it for its manifestations of force. This con- tinual equalization of energy is disclosed by the so-called unconscious action of thought and by the fact that one always awakens from sleep with some idea. According to the general principles of mechanics, it would be expected that the interruption of this current of energy by sejunction causes its regurgitation and thus a local increase of the process of excitement. If the “nerve current” was directly comparable to the movement of fluids, a reflected wave of the nerve current could be spoken of. But even yet in the ganglion cells, as the chief storehouses of energy, an increased tension is to be expected in deranged discharge and continual influx, which may readily, run up the psycho- physical movement to a wave crest.* In this sense it is not perhaps too hazardous to speak of an arrest of nerve energy. The site of the sejunction process would then be decisive for the resulting symptom of irritation, and the occurrence of hallucinations would permit the conclusion of sejunction of the tracts sa, or at least in a tract relatively near the projection fields of the senses, for instance in the area of the terminal ideas A. In the case of the autochthonic ideas a symptom of pure irritation seems to be present. However the comparison with imperative conceptions shows particularly that this assumption is insufficient for the explanation of the phenom- *See Alienist and Neurologist, Vol. XX, p. 538. 16 C. Wernicke. enon. The patients actually distinguish very accurately between their own thoughts, which in the case of impera- tive conceptions are forced upon them against their will, and those that are Strange and unexplainable, the autoch– thonic ideas. The assumption is obvious, that the distinguishing sign is to be sought in sejunction, so that first—in imperative conceptions—it would be a matter of a process of irritation in retained continuity, the other, in the autochthonic ideas, of such in partly interrupted continuity. The inner relationship between hallucinations and autochthonic ideas is placed in the proper light by this consideration. Both depend on sejunction processes, both seem to the patient like strange intrusions and are usually projected outward. We will have to seek the real distinc- tion between them in the difference of locality at which sejunction occurs, in hallucinations it is the tract SA, in autochthonic ideas the tract AZ of the psychical reflex arc. It is now comprehensible that the two symptoms of irritation are very closely related to each other clinically, and that transitions between both symptoms are found. This I can prove to you, e. g. in the case of a mechanic, 24 years old, who has interpreted his autochthonic ideas soon after the beginning of his illness as inspirations of the Holy Spirit, but for several weeks hears the voice of the Holy Spirit speak. Also in the patient Bohm, according to his exact statement, a stage of autochthonic thoughts has preceded the hearing of “voices.” The fact, that the patients do not exactly know whether they have heard voices or only had the corresponding thoughts, agrees further to a transition stage between autochthonic thoughts and hallucinations. This uncertainty of the patients as to their own perceptions is met with very frequently. A second inference from our consideration relates to the position of hallucinations in pathology. If our hypothesis is correct, hallucinations may arise without a real morbid process existing, merely by the arrest of the nerve current by sejunction. In front of the site of the interruption of continuity an increase of the amount of irritation above the standard and consequently an excitement of the sensory Outline of Psychiatry in Clinical Lectures. 17 brain regions in S may be expected without external irrita- tion, especially when the same process has frequently occurred and has thus become habitual. I remind you of what I have said in my introduction about memory and training of the nervous system. Hence I have finally suc- ceeded in giving you a basis for our presumption above alluded to, that under certain circumstances the hallucina- tions cannot claim the significance of an active disease process, but are to be regarded as pure sequela of terminated disease processes. A clinical fact, which will occupy us later, appears in an especially interesting light after this discussion. It quite frequently occurs that the recovery from acute mental diseases is retarded by an intermediate stage, often unfortunately of very long duration, in which they besides the delusion of relatively—present no psychotic symptom other than the hallucinations. I call this condition residuary hallucinosis and for years at every semester have presented one or more examples of it. You will comprehend how we will have to regard this condition. The acute dis- ease processes are past, but perhaps the multi-topical sejunction has not been completely adjusted, or the patho- logical habit has so facilitated the recurrent movement, that normal amounts of irritation are discharged into the projec- tion fields of the senses. In such patients all intense affects generally produce hallucinations, exactly in harmony with our comprehension of the symptom. It seems to be in such cases in which an intercurrent, mild febrile disease may induce a rapid recovery. An example of the kind is a gentleman, who had vivid hallucinations for a long time after a severe acute mental disease, so that he had been regarded as incurable. He became perfectly well in a few days from influenza. After this digression into theory, we again return to the purely practical matter of symptomatology by taking up a further extensive group of explanatory delusions. The special kind of explanatory delusions, which arise from elementary derangements of the motor reactions*, *The merit belongs to Kahlbaum of having first referred to the special derangements of movement in the insane; a merit, which is equivalent to that of the description of progressive paresis. Klinische Abhandlungen uber psychische Krankheiten, I heft: Die Katatonie, Berlin 1874, 18 C. Wernicke. deserve an intermediate position between the autopsychical and Somatopsychical, in so far as a person’s motility is expressed in perceptible changes in the body, but on the other hand with progressive degrees of adeptness attained enters the more and exclusively into the service of the personality. At least the so-called actions, but also the most simple movements, which are consciously performed, may therefore be regarded as a function of the consciousness of the personality. The common hyperkinetic states need not now engage our attention, as they exclusively occur in the acute psychoses or at least not rarely in acute excerba- tions of the chronic psychoses. While parakinetic and akinetic states are quite common events in the chronic psy- choses, and their more isolated occurrence (limited to definite muscular areas) then corresponds to a slow aggregate of focal symptoms. At present we will discuss the subject only so far as it is essential for the comprehension of the explanatory delusions thus originating. The independent origin of symptoms of akinetic and parakinetic motility induced by the normal mechanism of association, belong to the most instructive examples of the sejunction process. What was said of autochthonic ideas and hallucinations, namely that they are sensed as processes foreign to the personality, affords us a key to the explanatory delusions of this origin. I remember an old patient, whose constant occupation consisted in walking in a circle of a few feet in diameter and in turning corresponding to its axis. The explanatory delusion combined with it was that she was the earth and must turn. Such a fanciful delusion adhered to in states free from affect, we will naturally meet with only in patients of long standing with variously changed contents of consciousness. But is it very much less strange, when a very recent patient claims it must be a machine hidden within him, which continually turns him around in a circle? Of course in such cases magnetic and electrical forces are especially charged with being the operative agent. Much more rare, but just as evidential are the parakinetic symp- toms described by the patient, without an explanatory delusion being associated with it. Thus a patient began to Outline of Psychiatry in Clinical Lectures. 19 sing during the clinical presentation, and you remember how clearly she expressed herself, that it was against her will and she could not help it. It is the same patient, in whom I could demonstrate another interesting phenomenon: she usually presented the faulty type of respiration, which I designate as insufficiency of the phrenics, i. e. her epigas- trium is retracted during inspiration and the normal expan- sion of the lower chest wanting. While in singing she presents all at once the normal type of respiration. That the interpretation of this symptom on the basis of the Sejunction hypothesis is possible, I believe I demonstrated to you then. Similarly conspicuous by the absence of an explanatory delusion is the example of a lady, whom l am now treating. She has to cry periodically, as well as laugh, without the corresponding affect, and especially complains of . the “silly laughing”, during which she might be really considered demented. In these cases it is a matter of the decline of a subacute psychosis which was distinguished by a sort of mutual disjointing of psychotic symptoms following each other and advanced to the delusion of retrospective relativity”. These examples, although not related to our theme, may still be given a place here, to show you the symptom in its purity. They are very frequently express- ive movements, which occur in the way, then simpler ones, like the facial distortions of anger, menaces with the fist, ejaculation of plaintive tones, wringing the hands, etc., but often complex attitudes and movements, like the attitude of prayer, movements of attack of all kinds, dancing and the like. Such complex kinds of movement, like those of drill- ing, describing a circle, (see above) fall more into the category of initiative movements. As soon as such move-. ments are permanently established, corresponding explana- tory delusions seem to always originate, and these form the rule, as I have already intimated. The purport of the explanatory delusion is either more dependent on the fact or on the form of the movement. The delusion of physical persecution derives its material in part from these paraki- netic states, then the belief in supernatural agencies, either *See below 20 C. Werniche. good or evil, of being possessed, quiet frequently also the idea of being transformed into an animal. The latter idea leads especially to the utterance of inarticulate growling, movements of biting and contortions of the face and an animal-like use of the extremities, e.g., walking on all fours. In the chronic psychoses, when these parakinetic states occur only for a short time, the explanatory delusions are likewise of short duration, at most it occurs that sub- sequently the memory of such explanatory delusions occasionally reappears in the form that the patient believes he has passed through some animal transformations. It quite often occurs that wholly isolated movements, generally of the character of the reactive, have become fixed and habitual in the patients, so that they cling to them all the rest of their life. The more or less silly, eccentric expressions and gestures of the old insane cases often depend on such acquired habits. I know an old patient, who, when conversing, turns up the right upper eyelid with the index finger of the right hand, evidently the residue of an original parakinesis due to abnormal sen- sations, then psychosensory. Another patient, whom you have recently seen on the ward, generally places the hand to the side of the head while talking, and you remember still another, who has the habit of holding the hand over the mouth while speaking. In all these cases the move- ment is wholly unconscious, at any rate motiveless, and the patients can give no reason, when their attention is called to it. The "crazy” appearance of many old insane (apparent to the laity) depend on such peculiarities. Explanatory delu- sions of various sort may start from them. Of alcinetic states the same is true with respect to the extent of the phenomena as of the hyperkinetic, i. e., states of general immobility should occur only very exceptionally in the chronic psychoses, while they seem to be the pre- rogative of the acute and subacute. When they occur they seem to be of psychosensory origin, as in the well-known example in literature of the man, who avoided every movement, because he believed he had an infernal machine in his body, which might be thus exploded, and similar Outline of Psychiatry in Clinical Lectures. 21 seems to be the example of the woman who claimed she was of glass and feared being broken by movement. But perhaps it is merely a matter of residues of acute motor psychoses in these notorious cases. Whereas in the chronic psychoses parts of motion are seen to be quite often affected. These partial akineses are largely of psycho- sensory origin, like the inability to swallow, which may produce the symptom of refusal of food in cases of an entirely chronic course. The attendant sensation is gener- ally described as closure of the throat, and to it independent explanatory delusions of somatopsychical sort may be added. Next to the refusal of food, mutism is the most frequent form of circumscribed akinesis, and also of psychosensory origin in a part of the cases. Such patients occasionally commu- nicate in writing that their tongue seems to them entirely gone, or that it is swollen, paralyzed, withered or perfectly stiff, but the sensation extends beyond the tongue, for in such cases the accompanying movements of the lips are often absent also. Another time the symptom is of pronounced psychomotor sort, for sensations like those first described are expressly contradicted. Mutism and refusal of food often occur in combination. These circumscribed akineses of psychomotor origin are often due to prohibiting “voices,” and that here the hallucinations have no other significance than of terminal ideas put into words, is shown by instructive examples, in which the force of direct phys- ical influence on these movements is ascribed to the voices. The explanatory delusions following, that certain persons, whose voice they recognize rob them of speech or prevent the taking of food, then seem readily comprehensible. Although the diffused states of immobility, as I have intimated, do not really belong here, yet as the source of various explanatory delusions, they therefore deserve a pre- liminary consideration, because they occur preferably in the acute excerbations of the chronic psychoses. The supple- mentary explanation of such states very commonly is, that the patients believe they have once been dead and again returned to life. The restoration of the ability to move is generally conceived as a matter of resurrection, and all 22 C. Werniche. these explanatory delusions of a religious nature, which are suggested by the comparison with the sufferings and death of Christ, are associated with it. The patients often con- sider themselves the returned Messiah. If it does not amount to this idea, the related one of prophecy readily originates: the task of redeeming the world by reason of the Supernatural occurrence presumed to be so similar to the passion of Christ. In other cases the fanciful explana- tion of the akinetic states is especially colored by the memory of visions and vague hallucinations, which have existed during them and usually have an ecstatic, religious purport. It does not need to be especially emphasized, that the state of consciousness at the time of the akinetic states cannot be directly established, but is subsequently to be disclosed by the communications or conduct of the patients. Still so much is certain, that it is a matter of very different states, among which the akinetic phenomena may take a perfectly independent position. In other cases one hears from the patients, as soon as they have awakened from their motionless state, that they were subjected to the most heterogeneous morbid sensa- tions, pains of unbearable intensity, cessation of the heart’s action, suffocation, stagnation of the blood in all the veins, etc. It is then a matter of a state of psychosensorially induced akinesis. Occasionally the patients describe their sensations as a continual death struggle. The hypochon- driacal feelings are quite often accompanied by adequate cutaneous sensations and hallucinations of sight, as e. g., the feeling of dying from hemorrhage and the visual hallu- cination of pools of blood in the bed. These combined hal- lucinations are, as we shall see later, quite common in all states of blunted sensorium. It is conceivable what a fer- tile source of explanatory delusions is afforded by one of these periods of suffering. Here the comparisons with the sufferings of Christ or some martyr immediately follow and most commonly the grandiose delusion of being a savior or prophet is associated. It is not always true psychotic symptoms, which cause explanatory delusions, it may be the normal processes of Outline of Psychiatry in Clinical Lectures. 23 the organism, some real functional derangements, which of themselves would be of only slight importance. The inti- mate relation is here displaced, in so far as the explanatory delusions then have no independent significance, but occur only in conjunction with other delusions already existing, and in a certain measure serve for their elaboration. Of the wholly normal processes sleep is to be mentioned first of all. A profound sleep, which happens at the time new changes in the contents occur, is very often regarded by the patients, that they could have been stupefied to permit such manipulations. The feeling of pregnancy manifesting itself may in part be interpreted in this way, and the counter idea, that a cohabitation has not occurred, may thus be explained. But allopsychical changes in the contents of consciousness also lead to delusional interpretation of sleep: the patient has been stupefied and in this state taken into strange surroundings. It is very similar, when the experi- ences of a dream are recognized as such, but are still held to be divine inspirations. Of the actual functional derange- ments, but delusionally interpreted, the disturbances of menstruation and pregnancy deserve special mention, then intercurrent dyspepsias and digestive derangements, as well as the constipation often actually present in the hypochon- driacal. You see the tendency once present to systematiza- tion of a delusion is abundantly supplied with material for utilization by the normal or approximately normal processes, and that here also the occurrence of explanatory delusions furnishes the means to fill the consciousness with a number of false ideas. (To be Continued.) SAMUEL HENDERSON, MURDERER: Responsible or Irresponsible 2 By MARTIN W. BARR, M. D. Chief Physician, Pennsylvania Training School For Feeble Minded Children. Elwyn, Pa. HE host of juvenile offenders filling our police courts, and the startling accounts with which the daily papers teem of disasters traceable to youth of tender age, is attracting the interested study of criminologists and drawing many thoughtful minds to the consideration of cause producing such effect, and to careful pondering upon the degrees of responsibility and irresponsibility of this class. The trial and conviction of Samuel Henderson, aged fifteen-years, of the murder of Percy Lockyer, aged five, makes a valuable addition to the annals of criminology and of sociology, as showing the possibility of crime absolutely motiveless, beyond the momentary impulse of a nerve storm, and the danger to society, of an uncontrolled irre- sponsible element in its midst. The extreme youth of both parties appeals to one not less than the sense that each was, in a measure, the victim of ignorance and of circumstance. The scene of the tradgey was Glackin's woods, in the suburbs of Philadelphia, and the details are these: On the afternoon of Friday, January 14th, 1898, Percy Lockyer, playing in an adjoining yard with Willie Addison, the son of a neighbor, wandered off with his little playfellow. At half past five, the parents sending for him, were alarmed to learn that both children had been down in the woods with a boy who had hidden Percy’s clothing in a tree, and that [24] SAMUEL HENDERSON. HENDERSON'S PALATE. --- - - - - :::HENDERSON'S UPPER AND LOWER TEETH. Samuel Henderson, Murderer: 25 Willie had returned leaving Percy there. Mr. Lockyer, an engineer by trade, being incapacitated by temporary lameness, sent his older son with a friend to investigate the matter. They returned with no definite tidings, and the family growing more frightened and anxious as night came on, determined to at once notify the police. A young girl, Bridget Foley, over- hearing the conversation at the patrol box, said that she had seen Percy Lockyer and Willie Addison about two o'clock talking with Samuel Henderson at the school gate; later they had crossed the fields in the direction of the woods, Henderson, the path being muddy, carrying little Percy on his shoulder and between four and five o’clock she saw Henderson returning alone. The officer in company with young Lockyer, went immediately to the Henderson home and questioned Samuel, who denied the story in toto, saying that he had been at school all that afternoon. His manner, however, excited the suspicions of both, and Lock- yer reported to his father that Sam appeared to hesitate, as if he knew more than he cared to tell. During the night a fruitless search was made through Glackin’s woods by sympathizing friends and the distracted and disabled father. The next morning, Bridget Foley, care- fully interrogated, adhered to her original statement, while Henderson was as vehement in disclaiming any knowledge of, or even an acquaintance with Percy Lockyer. In the afternoon, Mr. Lockyer went again to the woods with a police sergeant and Willie Addison, hoping to locate the tree where the clothing was said to have been hidden. This the child failed to do, but just as they were separat- ing the officer discovered, lying in the fork of a tree, a coat and hat which the unhappy father recognized at once. All day the search was continued through the woods, farm- houses and neighboring villages without result. On Sunday morning, January 16th, two police officers again going over Glackin's woods, at Reddy’s Run, noticed a bit of plaid in the stream, and further examination revealed Percy’s body in about fourteen inches of water. It lay face down, hands extended, left leg straight and the right bent, with a large rock on the right hip and one on the back of the head. A 26 Martin W. Barr. red handkerchief tied around the neck with a double knot under the left ear, was tight enough to have impeded cir- culation without , arresting respiration. Superficial cuts, lacerations and contusions disfigured the face and hands. There was a stab wound on the shoulder and one under the fifth rib, penetrating the left lung, with some hemorrhage, but death was evidently caused by drowning. Samuel Henderson, when later confronted by Bridget Foley, still denied having been with the children. “I knew you by your cap and coat,” she said. “I did not have this coat on,” quickly replied the boy. “What coat did you have on?” questioned the officer. “My light one,” he answered. “Then she did see you?” “Yes.” In response to closer questioning and adroit suggestions, he went on to tell how Percy had fallen from a tree on some broken sticks and branches (even demonstrating) and that he afterwards ran down the hill in the direction of the creek, and that was the last he saw of him. Continuing his contradictions, however, he gave yet another version, and averred that they were playing Wild West, saying: “I was sharpening a stick at the foot of the hill with a potato knife, and as Percy ran down, it stuck in his heart, and the blood came squirt- ing out, and he fell on his back and didn't speak a word when I called him.” He acknowledged that after this, becoming frightened, he put the body in the creek, after mutilating it to prevent recognition, placing Stones on it to keep it down, and on this confession, was committed to the Philadelphia County Prison to await trial. Being called as an expert for the defence, I made careful examinations of the boy, and in frequent conversa- tions with him and his parents, gathered the following data: Maternal great-grandfather died of cancer in the throat. Maternal grandfather and his two brothers died of paralysis. Paternal grandfather was a moderate drinker and received while in the detective service, a blow on the head from which he never wholly recovered; had “flighty spells,” was erratic and peculiar and died during a paralytic seizure. Mother's nephew is an epileptic, and two cousins died of phthisis. Samuel and his parents are natives of Pennsylvania, as Samuel Henderson, Murderer: 27 are also two other children, a boy and a girl aged respec- tively eight and fourteen years, both of whom are said to be mentally defective. - The mother keeps a little variety store—the father, who is a ventriloquist, has a punch and judy show, and both have at various times traveled with Buffalo Bill. Father, decidedly under par mentally, aged twenty-eight years at time of boy’s birth, and the mother nineteen. She, possessed of an attractive personality, intelligent and remarkably well educated for one of her class but extremely nervous, has been a sufferer from trifacial neuralgia for years. Was troubled with dropsy previous to the birth of each of her three children, of whom Samuel was the first. During the sixth month of this gestation she was ill for six weeks, suffering severely from gastric disturbance. The child Samuel, born at full term, without instruments, though the labor was extremely difficult lasting for three days, was what is known as a blue baby and had a caput succidinium. Nourished by mother, he was healthy up to six months, when an attack of cholera infantum lasting six days was followed by men- ingitis, lasting six weeks, during which time ice was constantly applied to his head; he lay in spasms for five hours, form rigid, eyes set, and supposing him dead prep- arations were begun for his funeral. He has had almost every disease known to childhood—measles, whooping cough, varicella; during a severe attack of scarlet fever when four years old was unconscious for a long time; later he has had two attacks of typhoid fever—one when ten, the other when thirteen years of age—and after each illness his deterioration both mental and physical was such as to occa- sion remark. He suffers now with frequent headaches. With that uncertain memory peculiar to imbeciles—phenom- enally accurate in Some respects, absolutely unreliable in others—he memorized his lessons with difficulty and while studying would frequently beat his head and say: “the man who made this book tried to confuse me. Some day I will run against a stone and bump my brains out.” He reads the daily papers understandingly, and delights in dime novels, adventures of Indians and of Jesse James. 28 Martin W. Barr. He recognizes form, colors, tints and shades and can count to the hundreds and appreciates values. Writes fairly well but is unable to draw; hands not being properly trained he cannot drive a nail, though his powers of attention and imitation are good and he has learned to do simple housework. His table manners are fair—he is not glutton- ous, masticates properly, uses both knife and fork and can wash, dress and care for himself in every way. Addicted to cinaedia, but otherwise his personal habits are cleanly. Choreic movements of the face betray an exceedingly nervous temperament evidenced further by paroxysms of laughing and weeping without cause or at the slightest provocation, and in sulky spells of several hours duration. Both obstinate and passionate he will destroy clothing and furniture under the influence of nerve storms. Understand- ing commands, he can be trusted, if willing and interested, to do an errand. Obedient when so disposed, affectionate at times, he is simply the slave of a highly emotional nature without the controlling power of the moral sense in which he is absolutely lacking; we find him therefore, cunning, untruthful, vulgar, careless with fire, heedless of danger, and a tramp continually straying from home. He is fond of music, of animals, of boys' games such as shinney, marbles and kites, and also of dolls. He is devoted to babies whom he will nurse fondly yet pinch at the same time. He also likes to play with little children whom nevertheless he will terrorize, but older boys tease and enrage him. The physical examination, made in company with my assistant, showed the boy undersized, height 61% inches, of slender build, but body well nourished and muscular development good. Weight 98 lbs. Muddy complexion; sullen expression when features are at rest but at other times pleasant. Eyes dark brown, (maroon) bright, restless and alert. “Thumb-sucking mouth,” 1% inches in length and # inches in breadth; lips full, thick and apart with slight protrus- ion of tongue and marked sialorrhea. Teeth fairly regular and in good condition in superior maxilla, but somewhat decayed in the inferior; upper teeth protrude noticeably—the lower Samuel Henderson, Murderer: 29 also but in a less degree. Hard palate, wide, fairly well formed, and but slightly corrugated. Post nasal adenoids; tonsils somewhat enlarged; uvula Small and pointed; tongue clean. Stammers slightly, articulation defective and pronunci- ation careless, invariably substituting “f” for ‘‘th” as “fink” for “think”, “fought” for “thought” and “fird” for “third.” Asymmetry noticeable on left side of face; slightly fuller on left side along ramus of inferior maxilla, and fuller on left side at angle of mouth; infraorbital region, left side, slightly fuller than right. Small scar over right eyebrow and several small scars on forehead. Hair dark chestnut, coarse, thick, wiry and stubborn, so that examination of head and measurements were made with some difficulty. Head narrow through occipital region and compressed and flattened at parieto-occipito junction. Frontal bones somewhat receding; parietal region flat and narrow with slight tendency to prominence of parietal cornu. Temporal bones fairly good, The head measurements, while showing nothing so pronounced as to attract the attention of the ordinary observer, are yet far from normal. Bimastoid 14 in. ; binaural 14 in. ; greatest circumference 21} in...; trachelo-bregmatic 22in. ; glabella to occipital protuberance 12 in. Right ear, double tragus; length 2 ſº in., breadth 1.1% in. Unusually large lobule, corrugated and square; length # in., breadth 1 in. Rudimentary tubercle of Darwin. Angle 45 deg., plus. Left ear, double tragus; length 2 's in., breadth 1 °s in. Lobule not so large and thick as the right; length ; in., breadth #4 in. No tubercle of Darwin. Angle 45 deg., plus. Circumference of chest at nipples 29 in. ; circumference of chest at xiphoid 28 in. ; circumference of abdomen at umbilicus 27% in. ; circumference of right arm 8 in. ; circum- ference of left arm 8% in. ; length of right arm 10 in. ; length of left arm 10 in...; circumference of right forearm 8 in. ; circumference of left forearm 8 in. ; length of right 30 Martin W. Barr. forearm 16% in. ; length of left forearm 16% in...; circum- ference of right thigh 16 in. ; circumference of left thigh 16 in. ; length of right thigh 15 in. ; length of left thigh 15 in. ; circumference of right leg 11% in...; circumference of left leg 11% in. ; length of right leg 18 in...; length of left leg 18 in. Right handed. The hands which are bathed constantly in perspiration are slightly asymmetrical. Little finger of right hand shorter than the left. Index finger of right hand has cicatrix on palmar surface. Small scar on dorsum of left hand. Sensation normal. Sight normal; pupils equal and react to light; focal distance about fourteen inches. Hearing normal; tested with watch, etc. Smell normal. (tests with mustard, cloves, pepper, camphor, vinegar and ammonia.) Said of the mustard: “it is some of that cheap mustard,” and of the cloves “I do not know the name, but they are black things that you put in the catsup.” - Taste normal. (tests with sugar, vinegar, salt, alum and quinine.) He said “that is quinine, I hate it—had to take it for a year,” and of alum: “white like a rock, bitter,” and after awhile he remembered its name. Said of tannic acid, “it is bitter like a root.” Gait sluggish and slightly shuffling, stamps in going up or down stairs. Perfect co-ordination; station good. Knee- jerk increased. - Slight dilatation of the capillaries. Temperature 98 deg. in both axillae; mouth 99 deg. Pulse 96. Heart normal in position, size and action. Respiration 24 per minute. Appetite and digestion good. Liver, spleen, kidneys and bladder normal. On my first visit to the prison, I found the boy dull, . but evincing in conversation that erratic and contradictory tone peculiar to the imbecile. Wishing to test his memory and articulation, I asked him to repeat the sentence, “Around Samuel Henderson, Murderer: 31 the rugged ruin the ragged rascal ran,” which he did fairly well, and chatting further with him on general subjects l asked him if he could make a kite. “Yes,” he replied, “but it is cheaper to buy one; you can buy one for a penny, but when you make it you have to buy your paper and get your string and paste, and you might cut your finger while you are cutting your sticks, for a knife often slips.” At my next visit, in company with his counsel, some six weeks later, Sam had forgotten me until I repeated “Around the rugged ruin, etc.” when he smiled and bright- ened up. No allusion had been made on the previous occasion to the crime, but now I broached the subject. He replied quite readily to my interrogations but with his usual contradictions until sharply rebuked by the lawyer, and out of the tissue of mingled falsehood and illogical admissions was his confession drawn. “Sam, I want you to tell us all about killing Percy Lockyer.” No answer. “What are you here for?” “Killing Percy Lockyer.” “When did you kill him?” “Fourteenth of January, this year.” “How did you kill him?” “Just killed him.” “With what did you kill him?” “With a knife.” “Where did you strike him?” “Right here.” (placing his hand over the praecordial region.) “What sort of a knife did you use?” “Potato knife.” “Why did you kill him?” “For calling names.” “What names did he call you? “Indian, Possum-law, Nigger lip.” “Sam, what do they mean by possum-law?” “Oh! They just put the law to it.” “When you struck Percy what did he do?” 32 Martin W. Barr. “He dropped.” “I thought you tied him to a tree.” “I didn’t tie him to a tree.” “Why did you kill him?” “For calling names?” “What did he do when he fell ?” “Just lay there, stretched.” “Did you mark him?” “Marked him in the face.” “How did you mark him?” “Hit him with the knife.” “Where did you hit him?” “Hit him here and here.” (Placing his finger on the parts of his face.) “And then he stretched.” “Why did you mark him?” “To disfigure him.” (Sam has a peculiar slurring way of enunciating the word disfigure.) “Why did you disfigure him?” “Because they couldn’t tell him.” “What did you do with him after that?” “Put him in the creek.” “And then what did you do?” “Put a rock on him.” “What did you do then?” “Went home.” “What did you do when you went home?” “Just the usual way.” “What did you do when you went home?” “Cut sticks, made supper, spread the table, made coffee.’’ “Tell me how you make coffee.” “Just put—you know there are five in the family—five or six table-spoonfuls of coffee in a kettle—some put coffee essence in, some people don't—we always do put coffee essence in; then after awhile put a cup of cold water in it, put a rag over it because it won’t lose strength.” “What happened after you went home? “They were looking for him over the street.” “Where did you go?” Samuel Henderson, Murderer: 33 “Stayed around the house.” “Who came to see you?” “Sergeant Murphy.” “What did he ask you?” “Do you know where the boy is?” “What did you tell him?” “Yes. He took me over to show. I didn't show him. right.” - “What did Sergeant Murphy do then?” - * “Took me down and locked me up. I did not tell the truth.” - - “Why did you show him the wrong place?” “To get out of it.” “Now tell me why you showed him the wrong place?” “Four policemen told me not to tell. They were all good friends of my father.’’. “Will you ever do anything so wrong again?” “Pennsylvania won’t hold me once I get out.” “Where will you go?” “Out West, to my aunt.” In direct contrast to the apparent callousness shown in this narration, we note his fondness for dolls, his love of babies, his care for children, (manifested in his lifting the little boy on his shoulder over the muddy fields) and his love of animals evidenced in a story of a pet squirrel that had escaped. He told me how it stopped now and then to look at him as it leaped from tree to tree in its efforts for freedom. “My sister wanted me to hit it, but oh, I couldn’t, I couldn't. But she did,” and his eyes grew large and misty as he told me how “it dropped and didn’t move any more.” “But you killed little Percy,” I said. “Oh-yes—that—that—was different.” He had learned all the argot of the prison: told how he amused himself by putting pepper on candy, lowering it through the window by a string to the prisoner in the cell below, and how intensely he enjoyed it when the man swore at him; how he talked to the other prisoners through the closet pipes and registers and how in this way news 34 Martin W. Barr. was transmitted from cell to cell; also how he had been initiated into the mysteries of the “wall telegraph,” another means of communication; that the first night he came, the prisoners were all anxious to know who he was, and finally the inmate of the cell adjoining had taught him the tele- graph taps and that they bade each other good-night by this means, through wall after wall, and tier above tier. He said this was against the rules, and he would get a “flamming” if caught, but would give me an example if I would watch so that the keeper might not surprise him— indeed he himself kept a furtive eye on the door. When his dinner came, he showed me how he piled up his boxes of playthings in front of the radiator to keep it warm, say- ing, “I always do this on Sunday with half my dinner, as they don’t give us any supper Sunday night.” On the occasion of my next visit, I found him very much distressed and anxiously searching for something, which at last, to his great delight, he found. It proved to be only a small card—an advertisement of playing cards— which he valued very highly. Politeness with him seemed in a measure, intuitive, rough as he was at times. Once while making the examinations, in turning suddenly we came in contact, and he said, “Excuse me.” Twice I dropped my pencil which he immediately picked up. Asking if he would like to have a book, he replied “no, my lawyer told me not to read much.” “I get the Sunday World, that gives me more news than any other paper. But,” he continued, “I don’t read about the blowing up of the Maine. It makes me nervous, and I can’t sleep.” I asked him if he played with dolls, and he looked at me in a cunning way, and replied “Mother told you that;” then crossing the cell to a table where lay three paper dolls, his eyes suddenly filled with tears and his lips quivered when he found the dress of one torn. His egotism, in common with all imbeciles, is intense. He asked, “did you see anyfing in the papers about me?” “What?” I answered. “I’ll show you, I cut them out,” and he proudly exhibited a number of newspaper clippings Samuel Henderson, Murderer: 35 in regard to his first appearance in court, which were care- fully put away in his little note-book. “I went to plead guilty and I fought maybe you was there.” The papers said the boy was insane, and he called my attention to it. “But Sam you are not insane, are you?” He laughed and replied, “I don’t know, but I’m sorry I’m the fellow as done it.” “Would you do the same thing again if you were let out?” “No, I’ve had lesson enough.” As I turned to leave him, he said, “I want to tell you somefing: When I went to court—after l got home I sweat awful and I have slept worse at night since I went to court. I had the headache,” pointing to his forehead, “there all day yesterday. The people are so dreadful here, yelling and knocking, and then the cats outside are so bad. I wish I had a pistol so as I could kill them,” and then he laughed. The trial was a speedy one, covering in three days the examination of thirty-three witnesses on the part of the Commonwealth, including expert testimony, and three for the defense—the writer, his personal assistant, Dr. Frank White, and the mother of the prisoner. Exhaustive argu- ments were made by the lawyers on both sides and after a thoughtful and impartial summing up in the charge to the jury, a verdict was returned of murder in the second degree, based on irresponsibility. The judge deferred sentence, but finally after consideration, sent the boy to the penitentiary for twenty years, as the only means of protection alike to society and for the poor unfortunate. This verdict is clearly defined in a subsequent opinion given upon it by Mr. W. G. Keir, the defendant’s counsel: “The law of Pennsylvania has made no provision for the conditions of limited respons- ibility in individuals as regards criminal liability. There is only one verdict that may be rendered in relation to a con- dition of mental weakness and that is, ‘Not guilty, on the ground of insanity.” In the Henderson case such a verdict was not rendered, but a verdict of ‘Guilty' of ‘murder in the second degree.” The Commonwealth pressed for a verdict of murder in the first degree and if the jury had believed the evidence produced by the Commonwealth to be 36 Martin W. Barr, true there was no other course for them but to render such a verdict. Their four or five medical experts testified as to the full sanity of the defendant, and as the evidence further showed, if such was the condition of his mind, the murder was willful, deliberate and premedi-, tated. Therefore, under the statute the . defendant was guilty of murder in the first degree. The jury undoubt- edly failed to believe the testimony of the medical experts , , for the prosecution, but certainly did consider as true, the testimony offered for the defendant, as they rendered a . verdict in accordance with the evidence of the defense. “This testimony indicated a limited responsibility on the part of the defendant. The testimony did not show that he was totally irresponsible but that there was a lack of full mental power owing to a congenital weakness. The jury believing that the boy was weak minded, thought it would be exceedingly unsafe to set him free and rendered a verdict of ‘Murder in the second degree’ with the thought undoubtedly in their minds that it would mean custodial care for some years to come, as finding him ‘Not guilty on the grounds of insanity’ would probably give him entire freedom, and juries only, as a rule acquit on the ground of insanity where the defendant is plainly a raving maniac.” In the impaneling of the jury it was difficult to find"twelve good men and true,” who either had not formed a previous opinion or who were not at once prejudiced by the appear- ance of the boy. The District Attorney outlined for them the different degrees they were to consider. “The law, 'he said, “divides the age of responsibility into three parts. Under seven years no one can commit a crime. Between the ages of seven and fourteen the law takes a step forward, and says one may commit a crime, even of the highest kind, but, the burden of showing capacity to commit crime, rests on the Commonwealth. From the age of fourteen to twenty-one, another step forward is taken. Then the presumption of the law is that a person is responsible and capable of committing crime, The prisoner had passed the age of fifteen by a few months, “In his case, therefore, is a presumption of santy Samuel Henderson, Murderer: 37 until the contrary is proved, and a presumption of his inno- cence until he is proved guilty.” He then explained that under the indictment, four verdicts could be found: Not guilty, on the ground of insanity, murder in the first or second degree, and manslaughter. If there was a specific intent to take life, it was murder in the first degree, and he hoped to prove to the jury that this boy was guilty of murder in the first degree, or that he was innocent because he was insane. The expert witnesses for the prosecution included a well-known specialist in insanity, a neurologist, a surgeon of international reputation, who had had some experience with the insane, and the physician of the jail. These, each eminent in his own particular line, yet claimed no specific experience in idiocy or imbecility. Opportunity they may have had for a comparative study of mental diseases of children in cases occurring in their practice, but they could not be as familiar with the signs as one who has made it a life study. Their testimony agreed as to finding the boy untruthful, vulgar and profane with criminal tendencies, but in their opinion, judging from his own version he could not have been insane at the time of the commission of the crime, nor did he, during the examinations exhibit any signs of imbecility. The head measurements they affirmed to be normal— they had found no asymmetries other than those often met with in normal people and no evidence why the prisoner should be considered irresponsible. This opinion was adhered to in full view and presence of the mal-formed head, drooling mouth and idiotic grin of the boy who leered from the prisoner’s dock even when the verdict was rendered. During my study of the case I was careful to secure the head measurements of eleven boys—ages ranging from thir- teen to fifteen-selected at random by the principal of a public school as average types, and in no single instance did they correspond with those of Henderson. I have too much confidence in the judgment and in the integrity of these gentlemen to even think they would will- 38 Martin W. Barr. fully deceive, but their specialties lay in other directions, and imbecility is a sealed book to those who are not actually engaged in the work and brought into daily contact with it. It is impossible to comprehend or apprehend the eccen- tricities, the vagaries, the thousand and one contradictions, the infinite phases of abnormality, that shade off and merge so as to render difficult even a broad classification of some cases of imbecility after weeks, often months of careful observation. It is not to be wondered at therefore, that the experts for the defense in common with the general public, refuse to accept the many contradictions which are included in our daily experience, namely—that a defective may have a phenomenal, but no residual memory, that often more clever than a normal child, he may develop capacity for music, drawing or painting to an unusual degree, and yet be absolutely lacking in ability for the simplest primary school work; that he may be trained to work in one line or routine in which he may even be trusted with a certain degree of responsibility, while outside of that one thing his childish heedlessness may cause ruin or disaster; that a certain inhibition to pain peculiar to his class may permit one to watch with perfect coolness the amputation of his own finger, yet on account of a certain lack of quality in his general physical make-up he would succumb readily to any trivial ailment. In the same way an emotional nature is coupled with an utter lack of will power, and poor judg- ment makes him the victim of nerve storms, alternating between tenderness and cruelty without logical cause or reason, amounting often to an utter absence of moral sense—a nature therefore, anchorless. These are but a few of the facts familiar to us, which the world in general, including many scientists, cannot grasp. Careful anthropometric examinations, and subsequent study of the family history, together with repeated conver- sations with the boy and his parents, convince me that even had he not committed the crime there are yet sufficient proofs to class him as an imbecile. Granted that there Samuel Henderson, Murderer: 39 are no striking asymmetries and that similar stigmata may be met with in normal people, never could such a combina- tion be found in any one normal person. Thus, it is impossible to picture a healthy, happy, well-balanced boy, within six years of his majority, who laughs and weeps many times a day without cause, who finding in little children his dearest playfellows, could calmly recite the murder of one while shrinking at the thought of the death of a squirrel which for him to kill was an impossible thing; who, indifferent to the loss of home and friends, listening with a leer to a verdict which might bring to him life imprisonment, would yet shed copious tears over the torn dress of a paper doll. The boy, like so many of his class, is a series of contradictions: he is tender and cruel, ingen- uous and crafty, phlegmatic and nervous, unfeeling yet affectionate; he is open, frank, artless, secretive, shy, deceitful, truthful in many ways but also an accomplished liar. Thus atavism and environment have combined to form a moral imbecile, in whom the moral sense or moral faculty is obstructed or altogether absent. He may intellectually discriminate between right and wrong, but absolutely destitute of will power, is utterly unable to resist evil impulses. Such theory, derived from and verified by actual investi- gation of thousands of defectives in every stage of existence, demonstrates a dangerous element in our midst, unprotected and unprovided for. The safety to society, therefore, demands its speedy recognition and separation in order to arrest rapid and appalling increase and furthermore, its permanent detention lest it permeate the whole body social- istic. So much for self-preservation—the egotistic side of the question—but there are also altruistic considerations; the duty of society toward the unfortunate and innocent perpetra- tions of motiveless crimes of whom this boy is a fitting type. By what right, human or divine, does society in this age of civilization first prepare and educate him for the highways of vice, placing in his hands instruments of ill, for that is what the co-education of abnormal and normal does do– then after the deed, which is but the natural outcome of 40 Martin W. Barr. this abnormal ignorant training and neglectful care—by what right, I repeat, does society place this innocent irre- sponsible in an environment which can only foster evil tendencies? The penitentiary is for him but an advanced training school for vice, from which after a term of years he goes out branded, with no other inclination, too often with no other resource, but to repeat a former experience being now in tenfold degree a menace to the social welfare. It is not the mother whose child is dead for whom we feel the deepest sympathy, but for her who lives in the valley of sorrow who never can bury her dead out of sight nor know true peace until her boy has passed to that far country where dreams come true, and griefs are changed to joys and hopes to realities. Would that some philanthropist bound by ties of love and kinship to one of these unfortunates would build to that loved one a fitting and enduring memorial and form a Colony of Workers, where, sheltered and protected from evil apart from the world, might grow and labor together in a city of refuge—these, whom the French have so touchingly named “Les Enfants du bon Dieu.” TRANSITORY MENTAL DISORDER IN HEMICRANIA. By Prof. v. Krafft-Ebing.” O Möbius belongs the honor of first having called atten- tion to the evident relation between psychical disorder and hemicranial attacks by his remarks on migraine in his monograph in Nothnagel’s Handbook. He speaks (p. 29) of “confusion quite often accom- panying the attack of migraine, when the patients say: their head is in a whirl, their thoughts are disconnected, they do not know what they want, so that occasionally they give perverse answers or none at all.” Möbius speaks of a case in his practice, in which the migraine always began without other aura than sudden fear. He refers to Liveing, who has observed many such attacks, further those of mental depression, which continue during the whole attack. I have often heard similar complaints from my patients. In many a true psychical aura in the form of “excitement,” “fear” exists. One says that for hours before the attack he is nervous, excited, fidgety, irritable. It may be hard to decide, whether, the merely elemen- tary disturbances of psychical function in such cases are simple mental reaction of the neuropathic patient to the expected or existing hemicranial crisis, or are directly related organically to the symptom complex of migraine. *English by Dr. W. Alfred McCorn, Resident Physician "River Crest,” Astoria, L. I. New York City. [41] 42 v. Krafft-Ebing. This possibility is not to be proven, a priori in view of the fact, that migraine may be a cortical affection, which, corresponding to its severity, is complicated by even more extensive symptoms of inhibition or irritation of cortical areas. In my prior experience I find psychical disturbance, ulterior to the elementary, only in cases of ophthalmic migraine or combined with sensory Jacksonian. It is very possible, that it results in a diffuse cortical disturbance in the sense of a psychosis from or through the change, which must be assumed in the cortex during the attack of migraine, for migraine patients are always neuro- pathic individuals, in whom abnormal susceptibility of the central organ and abnormally ready irradiation of processes of irritation must be admitted. The following case is an evidence for the authority of the above assumption. Mrs. N., 55, laborer's wife, apparently healthy, without epileptical or hysterical antecedents, very well preserved, has had ophthalmic migraine since her climacteric 11 years ago. She asserts that she never had such attacks prior to that time. She knows nothing of the health of her parents long deceased. Primarily she had left ophthalmic migraine. Three years later a similar trouble affected the right side the most. The attack was very readily induced by slight physical stress. It begins with a black vertical streak about a finger wide, which disappears after about ten minutes, soon spreading out into a black Scotoma filling the whole right visual field. Bright yellow rays of light and stars then appeared and lasted from 7% to 1 hour. She can shorten this stage by lying down at once. The scintillating scotoma are increased by closing the eyes. The stars first become larger, then smaller, until they become very small and dis- appear. Violent, boring, piercing pain then occurs in the right temple, which passes to the right eye. “Caricatures” faces, forms, pagodas, (which are in constant motion) also appear and last about ten minutes. If she closes her eyes they still continue. If the left eye alone is closed, she sees Transitory Mental Disorder in Hemicrania. 43 the figures on the dark visual field. The golden stars then usually appear in a short time. - While the scotoma disappears and the violent headache continues the “curious” stage appears, which lasts about five minutes and has existed for two years. During it she feels as if out of her mind, she does not know herself nor her husband, has a vague feeling of impending insanity, is greatly confused, does not utter a word (form of amnestic aphasia), has the feeling that she is persecuted by someone. She does not lose conscious- mess in this episode, but the condition is extremely painful from the feeling that she is losing her reason. Vomiting occurs in this condition. Her head is perfectly clear, but the pain regularly passes into the cheeks and lower jaw and then ceases. This decline of the hemicrania in the form of a neuralgia of the second and third right trige- minal areas continues for two days. I saw the patient repeatedly at this stage and found all the areas of the second and third branches of the right trigeminus intensely sensitive to pressure, while the left was insensitive to extreme pressure. The most careful examination was unable to discover any symptoms of an organic brain or cord affection in the tardive case of hemicrania ophthalmica. An ophthalmoscopic examination yielded a negative result. Under continued administration of sodium bromide 4, 0, antipyrine 1, 0 pro die the attacks of hemicrania have not returned in more than twelve weeks. Such cases are rare within the scope of complicated migraine. Their rarity in view of the enormous frequency of migraine may presuppose special dispositions and possibly accidental contributing causes, by reason of which hemi- cranial psychoses occur. With regard to the latter psychical traumas, caloric injuries, also excesses in potu may play a part. As to special disposition the clinical relationship of opthalmic migraine and epilepsy must be borne in mind. In previous literature transitory psychoses are only 44 v. Krafft-Ebing. specified in connection with an attack of migraine and as inter or post-hemicranial phenomena. Hence the important and interesting question is raised, whether it is here a matter of peculiar psychoses in the sense of a hemicranial, or if not perhaps a masked epilepsy is such that the psychical portion of the attack amounts to this neurosis. The answer to this question is very difficult in the present state of our knowledge, for the forms, under which the so-called psychical epilepsy occurs, are polymorphic, yet in no way completely established and possibly lack patho- gnomonic signs. Under all circumstances it seems to me demanded, in view of the clinical relationship of ophthalmic migraine and epilepsy, to first think of the existence of a transitory psychosis exclusively united to hemicrania, when all possibility for the assumption of an epileptic significance of the case has proven tenable. The connection between hemicranial psychoses and epilepsy may be represented in the following manner. 1. The patient has (simple) hemicrania and epilepsy besides. The hemicranial attack is merely agent provocateur of a convulsive seizure. 2. Both neuroses are closely related clinically. The (ophthalmic) migraine is merely symptomatic. It replaces an epileptic seizure and added to this symptomatic attack of migraine a (post-epileptic) psychical disorder. If these well-known forms of epileptic insanity correspond in the sense of petit or grand mal or of stupor, etc., the point of view is thus afforded for the symptomatic epileptic signifi- cance of the psychical symptom complex; if this is not so, in our uncertainty of diagnosis quoad psychical epilepsy, the possibility of a hemicranial psychosis existing, i. e. inde- pendent of epilepsy, is afforded. Future investigation can alone decide this. As is shown by the following casuistics the previously known forms of peracute psychosis attendant on an attack of migraine only exceptionally correspond to the known and very commonly Transitory Mental Disorder in Hemicrania. 45 observed so-called psychical epilepsy or psychical equivalent of this neurosis. Whenever it is possible to trace each of these to an epileptic basis, it must always be admitted, that the (symptomatic) migraine evidently influences the form of these psychical pictures. Still clinically the possibility must be borne in mind, that the relations of the psychical attack to the hemicrania are hidden, in so far as the latter may be abortive and only manifested as migraine scotoma. That would be an ana- logue of the epileptic seizure with visual aura and, in my opinion, the diagnosis of a transitory psychosis would decidedly favor the assumption of a psychical equivalent, assure it when the scotoma was a play of red colors. Yet finally the possibility exists, that the psychical disturbance in conjunction with hemicrania may be an equivalent of an abortive attack of hysteria gravis. If we search previous literature for psychical disturb- ances in connection with hemicrania, Mingazzi’s papers are chiefly considered. This author published the following cases in the Rivista Sperimentale, XIX, 2, 3. 1. F., 24, single, soldier, of a very neuropathic family, masturbated from 7 to 16, suffered an injury to the head from a blow at 9. From 16 abuses, coitus and passive fellatio, Psycho- patic inferiority. Tendency to suicide. Irritability, incorrigibility, insubordination, frequent punishments. Ethi- cal defectiveness. - For some months attacks of left ophthalmic migraine, with visions of a black man, who threatens to attack him. At the moment he is thus affected in the breast or left arm, he loses consciousness with a slight cry and swings his arms for an instant. In a few moments he is himself again, has torpor and a formication in the left upper extremity, which then passes to the left lower. During the attack the supraorbital arches are sensitive to pressure and the left side of the forehead warmer than the right. Amnesia exists only during the unconsciousness. A small adherent cicatrix exists over the left side of the 46 v. Krafft-Ebing. frontal bone. Left hyperasthesia is proven to be a constant symptom. Green is mistaken for light blue by both eyes. Concentric contraction of the visual field exists in the left eye. 2. G., 31, married, of a very neuropathic family, is a constant masturbator. At 9 (1870) losses of consciousness began, which lasted about a quarter of an hour and occurred every two or three months. As an aura of such attacks he at first heard a noise like the approach of a train. Subse- quently only a slight roaring in the right ear, immediately followed by ophthalmic migraine. At 16 the attacks of hemicrania became more violent and attended by torpor, paresis of the right arm and mutism. During such an attack he murdered his mistress with more than one hundred stabs of a knife. He then eat calmly and lay down to sleep. Taken to an insane asylum he presented a dazed condition (Dämmerzustand) with amnesia for six months. He then had frequent attacks of petit mal and on account of them was repeatedly sent to the insane asylum. At 25 (1886) he had his first classical epileptic seizure, which frequently recurred from the effect of alcoholic excesses. On December 1st 1892 he was arrested on the street in a profoundly dazed condition (Dämmerzustand) “is God, Emperor, will go to America.” Two days after he came to himself, with amnesia as to what had transpired. G. is a psychical degenerate, ethically defective, inverted sexually. 3. V., 34, single, of an inebriate family, masturbator since 13, later drank to excess, was sent to the insane asylum in 1881 on account of alcoholism, in 1889 owing to hallucinatory melancholia. Since 1889 (31) he has often had attacks of ophthalmic hemicrania (left eye) lasting from 7-8 minutes with formi- cation in the left upper extremity and motor aphasia. On August 25th 1892 a violent attack of left ophthalmic hemicrania. During its continuance until the 27th depress- ed, restless, vomiting, slept poorly with bad dreams. Transitory Mental Disorder in Hemicrania. 47 On the morning of the 27th a peculiar psychical condi- tion occurred. It came on in church, he began to preach, reviled the catholic religion and the priests. He fancied an image of the Madonna looked at him reproachfully, began to sob, implored the Madonna for protection. Taken to the insane asylum immediately he came to himself and was amnestic for all that had transpired. Plagio-microcephalic skull (circumference 52,5). Sensory attacks. Concentric contraction of the visual field. 4. O., 34, father an inebriate, mother periodically psychopathic, has an insane brother. Since 10 he has had attacks of right “cephalaea.” They last 24 hours, recur two or three times a month. At the acme of the attack his consciousness is clouded and he has an impulse to kill him- self. He has attempted it three times with sublimate, four times given, himself up to the police owing to taedium vitae in such attacks. His memory of events in such a state is summary. He came to the insane asylum in one of these attacks on December 20th 1892. A scar over the right parietal bone. Concentric contraction of the visual field. Rachitic skull. The preceding cases do not favor the assumption of a special hemicranial transitory psychosis, for they present as well after the psychical as also the somatic symptom complex epileptic and hysterical clinical signs. Case 2 is doubtless epilepsy. M. himself recognized this in the remarks on his case and raises the question, whether these attacks of transitory psychosis during or after the hemicrania are not psychical equivalents of epilepsy. He likewise adheres to the assumption of the existence of a special transitory hemicranial psychosis and tries to explain it by the fact, that a vasopastic state of the cortex at the base of the hemicranial attack causes the occurrence of such a psychosis by its irradiation to other areas. Mingazzi reports six more cases in the Rivista Spermen- tale XXI. 4, in support of this view. 5. Soldier, 22, apparently untainted, formerly had malaria. Since 18 (1891) persistent frontal cephalaea. 48 . v. Krafft-Ebing. In 1892 with its excerbation, symptoms of optical irritation (stars in the visual field of both eyes, scintillating scotoma). During such an attack in 1893 terrifying hallucinatory delirium for one day. Amnesia. In November 1894, in an attack of ophthalmic hemi- crania hallucinatory delirium again. On February 20th 1895 third attack (tried to kill him- self, delirious one day, amnesia) which took him to the insane asylum. During this a constant mild frontal headache, emotion- alism, irritability. Now and then slight vertigo with dimness of vision, but without clouding of consciousness. Chronic concentric contraction of the visual field of the right eye. 6. B.,50, neuropathic, became melancholy after an ill- ness in May 1894. He likewise had violent frontal pain and was troubled with phosphenes on excerbations of the pain. Visions of forms, general tremor and loss of consciousness occurred temporarily. Correcture of these hallucinations was generally wanting. Examination revealed right hemihyper- aesthesia, right amyosthenia, absence of the right pharyn- geal reflex. - A marked concentric contraction of the visual field was found after the attack. Blunting of the senses of smell and hearing on the right. Intellect intact. Great emotionalism. Frequent recurrence of attacks of cephalaea with terrifying hallucinatory delirium, always preceded by phosphenes. Recovery after months. - 8. Girl, 20, untainted. From 5 to 17 frequent convul- sions, from then on classical epileptic seizures. At 19 attacks of hemicrania began. When these are violent, symptoms of optical irritation (stars) appear 2 to 3 hours after the beginning of the headache. Visions (para- dise, angels, the virgin Mary) then appear, as well as hemianopsia of persons about. Vomiting is frequent. Patient recognizes the hallucinations as such. Brief outbreaks of hallucinatory delirium (hell, flames which the patient feels on her skin, meanwhile visions of the Madonna, ecstacy). Transitory Mental Disorder in Hemicrania. 49 In one of these she was taken to the insane asylum. She has numerous sensations, just the same as usually occur as an aura of her epileptic seizures. She fancies she has animals in her body, wishes her abdomen cut open, is fearful, cries, sobs from violent headache for hours. Sudden cessation of the attack. On March 6th 1895 an epileptic seizure with temporary sensations in the body, which were interpreted to be animals. - º On March 7th a similar attack, this time with globus as an aura. Then automatic acts, stupor. The whole attack lasted only a few minutes. 8. Woman, 39, untainted, never had convulsions. Married at 21, three-parturitions. Attacks of mild cephalaea for years. These have recently become more frequent, violent pain, bilateral, with a throbbing sensation. In these violent attacks outbreak of delirium (people crowd into the room to kill her, she has bought a horse, and is riding it around the mountains etc.). During the attack dimness of vision, roaring in the ears, flashes of heat in the face. Sudden cessation of the attack. No amnesia. Recently, in a very violent attack the patient was very confused for two or three days, delirious, sleepless. Besides sensitiveness of the right ovary nothing of note. Hemicrania improved under bromide. 9. A., 26, single, mason, does not drink, infected with syphilis years ago, has been in the insane asylum three times from 1884 to 1885 for melancholia, twice from 1885 to 1889 with an unknown diagnosis, since childhood has had frequent and violent attacks of diffuse cehpalaea of two hours to three days duration, with slight confusion, phosphenes (lights, shining zig zag appearances) and vision (terrifying forms) with amnesia for the events of the attack. A. had three similar attacks in the insane asylum. Besides bilateral contraction of the visual field nothing abnormal. 10. Mrs. C., 37, untainted, has no children, was well formerly, with the exception of several attacks of colic. In 50 - v. Krafft-Ebing. May a violent, stabbing pain over the eyes from no cause, soon followed by vertigo. She then remained in bed four months owing to violent cephalaea in the neck and occiput. The pain now lessened and only occasionally excer- bated. In January 1895 during the acme of such an attack of pain flashes of light (stars) for several minutes, but no scotoma. Only once did vomiting accompany the violent pain. Visions of horrible forms repeatedly occurred at the acme of the attacks, still the patient was conscious of the morbidness of these phenomena. - The lambdoid suture is sensitive to pressure, but not the fifth. Vertebral pain also existed during the attack, which extended to the epigastrium and ended in nausea. Signs of a hysterical or epileptic neurosis are not discover- able, only very slight neurasthenic stigmata. This recent series of (six) cases leaves the question of a special hemicranial psychosis undecided. In case 7 it is certainly a matter of epileptic phenomena; in 8 and 10 the hemicranial purport of the cases does not to me seem thor- oughly established to assume in 10 a cephalaea neurasthenica. In 5, 6 and 7 hysterical stigmata are present and relations of the psychical phenomena to hysteria are not proven. The author himself recognizes, that in his cases symp- toms of hysteria, neurasthenia and epileptoid phenomena are present, but also believes he is justified in assuming a “Disfrenia emicranica transitoria,” which he traces to arteriospasm in the cortex, induced reflexly by the irritated sensory nerves of the dura. He points to the fact, that in his casuistics the headache was always diffuse, bilateral, usually combined with ophthal- mic symptoms (bilateral phosphenes, scotoma several times), that here the headache preceded the optic phenomena contrary to the usual cases of (ophthalmic) migraine. He found that the photopsias, as well as the visual hallucinations developing from them, ran parallel to the degree of intensity of the headache, and considers the periodical occurrence of pain, phosphenes, hallucinations, development of hallucina- Transitory Mental Disorder in Hemicrania. 51 tory delirium at the acme of the pain to be typical of his cases of “Disfrenia emicranica.” Of other literature to be mentioned are: 11. Sciamanna, Nevrosi emicraniche, Atti dell' XI Congresso med. internaz. Vol. IV, 1895. Letter carrier of 32. Attacks of “cephalaea” for years. During a specially violent attack a state of confusion. Subsequently two more attacks, during the latter frenzy. Through the whole duration of the cephalaea formication and aphasic speech disorders had preceded the maniac seizure. Afterwards several milder attacks of cephalaea without attendant psychopathic symptoms. 12. Zacher, Berliner klin. Wochenschrift. 1892. 28. B., 17, very neuropathic, mother had migraine, he had convulsions in childhood. From 14 a period of somnambul- ism. Migraine for years. In violent attacks of migraine, which are frequently preceded by eye symptoms (bright circles of different colors before the left eye, gradually becoming larger and then disappearing or also trembling or vibration of objects on their left half) since 16 during or following the attacks of migraine even for several hours mental derangement (clouded consciousness, confusion, great irritability even violence, episodical horrifying visual hallu- cinations), which cease with sleep and leave amnesia. Violent attacks of ophthalmic migraine almost exclusively induce them. Both kinds of attacks gradually disappeared under bromides. Z. expressly designates his case as one of “mi- graine ophthalmique with transitory epileptoid mental derangement,” but will not actually identify it with epilepsy and regards it as a transitory psychosis arising on the basis of the hemicranial constitution analogous to post-epileptic attacks. 13. Löwenfeld, neurolog. Centralblatt. 1882, p. 268. Woman, 27, hemicrania since childhood, formerly men- tally normal, physically well, mother of four children, on February 3rd, 1889 at 9 A.M., in the midst of perfect health, - visual disturbances (film scotoma) to complete inability to recognize objects; then violent pain affecting the whole head, S2 - v. Krafft-Ebing. followed by vomiting and other visual hallucinations (many persons in the room). About 12 o'clock her husband came home and recognized it was necessary to send for a physi- cian immediately. On his visit about half past twelve, L. found the patient collapsed, pale instead of her usual rosy countenance, yet with injected conjunctiva. She has no fever, talks incoherently, confused, mistakes persons, com- plains of headache, but is cheerful. With increase of confusion amnestic ataxic aphasia. Womiting on attempt to sit up. The confusion disappeared about 3 P. M. The headache continued, constantly lessening, until February 6th. - - Complete amnesia for all the time of the psychical dis- turbances. ... " Patient had never had such a psychical attack before at the time of her migraine. Epilepsy and hysteria seem excluded. Whether she had had the ophthalmic form of migraine is unknown. L. attempted to regard the psychosis as “an equivalent of the hemicranial attack (corresponding to the psychical equivalent of the epileptic attack”). 14. Brackmann, “Migraine and Psychosis,” Zeitschr. f. Psychiatrie 53, p. 556. - - S., merchant, 26, single, very neuropathic (mother had severe migraine), weakly, talented, active, excited, suffering from diabetis insipidus and cephalaea since early youth, no epileptic or hysterical signs, at 9 had a cerebral concussion without any recognizable consequences. Since 15 typical attacks of migraine without eye symptoms. A dazed con- dition (Dämmerzustand) after mental alteration. Then a psychosis (false hearing and delusions of persecution) of 1% years duration. In convalescence during attacks of migraine delirious states of 34 to 7% hours duration occurred, passing into sleep and leaving amnesia. The purport of the delirium terrifying (“now they come and will kill me; my parents are here and have given money for you to kill me”) or regarding ordinary events of a harmless kind. Severe attacks of migraine after feeling well for five months, dazed condi- tion (Dämmerzustand) with amnesia from February 20th to Transitory Mental Disorder in Hemicrania. 53 March 7th 1895, then terrifying hallucinatory delirium until March 18th. Afterward irritability without symptoms. In June 1895, attacks of simple migraine recurred. On closing the eye on the affected side color sensations occasionally in the visual field of the same side. Recently in connection with such an attack of migraine attacks of psychical depression lasting three days, with hallucinations of hearing of insulting voices and ideas of persecution by certain per- sons. Memory is not impaired in these conditions. Has never had epileptic or epileptoid attacks. The author considers it possible that these transitory states of psychical disturbance, which he is not able to recognize as epileptic, thus it is that attacks of ordinary migraine suffice in the very neuropathic individual and low- ered power of resistance by cerebral concussion, to induce these. In “Feestbundel der Nederlandsche Vereeniging voor Psychiatrie” s’Hertogenbosch 1896 Buringh Boekhoudt speaks of the probable psychical equivalents of migraine. a) X., 42, teacher, mother had migraine. He has had ophthalmic migraine since his fifth year. At 31, from constant mental stress, neurasthenic troubles, atony of the stomach and intestines, with flatulency, occurred. Episodically states of fatigue, which pass into somolency and from which the patient comes to himself slowly, momentarily disoriented as to time and place, quasi somnolent. These states, occur regularly after eating, preceded by a heaviness in the occiput, and without any relation to attacks of hemicrania. Since the occurrence of these neurasthenic troubles and their relief, the migraine has almost entirely disappeared. The author regards the intestinal and somnolent states (Traumzustände) as equivalents of the hemicrania and with respect to the first refers to a case reported by Barry (neurolog. Centralblatt 1895, 6), in which (equally unjusti- fied) attacks of epigastric pain, which episodically replace a simple migraine existing since childhood, are regarded as its equivalent. b) O., medical student, 23, simple migraine since early youth, from which his mother suffered. 54 v. Krafft-Ebing. For the past month occasionally momentary confusion and disorientation, without accompanying migraine, further elementary psychical symptoms of depression and quarrel-º' someness complicating the attacks of migraine. -- The author here also speaks of “somnolent states” (“Traumzustánden”) and is inclined to regard them as equiva- lents of migraine. As the clinical history is extremely aphoristic, a better interpretation of these disorders of con- sciousness is impossible. c) Merchant, 26, mother had cephalaea, patient simple hemicrania since 6, masturbated since puberty. At 23 fright- ened by the remark of an acquaintance that masturbation caused premature senility. In connection with this anxiety with fear of senium praecox, depression and self accusations for several days. These attacks recur every few weeks and are relieved by hydriatric procedures. During these epi- sodes there are only traces of the migraine. Because the dysthymic states (apparently) replace them, the author considers them equivalents of the migraine. - These are all the cases I am able to discover in literature. I will now consider my own cases. Case 15. M., 18, apprentice in a hat factory, was admitted on February 7th, 1895 to the psychiatric Clinic of the general hospital in Vienna through the intervention of the police. On that morning, while wandering about the streets, he had asked protection of a policeman from the persons and spirits pursuing him. On being taken to the police station he seemed anxious, inhibited, saw evil persons following him, constantly heard his name “August” called. He could only tell his first name, having forgotten everything else, even his family name. When admitted to the Clinic on the forenoon of the 7th he was anxious, inhibited, consciousness seriously dis- ordered. He assumed to be from Austria, believed he was in a government office, had 5+5=9, later 11 fingers. He did not comprehend very simple questions, e.g. did sº not know what “profession” “religion” meant when asked. He did not know the money in common use, was unable to tell its value. He is unable to tell anything of his vita Transitory Mental Disorder in Hemicrania. 55 antiacta, has no interest in the present, in his surroundings, .. does not try to locate himself, lives entirely in the moment, apathetic, quiet, does not wish to speak or move. That afternoon a little brighter, but remains disoriented without . appreciation of time. Many ideas are wanting, others extremely vague. Judgment, reasoning, acquired knowledge (e.g. computation) entirely gone. Even mechanical memory is seriously impaired (poorly enumerates the days of the week and the months in very unusual order). But memories are slightly roused, as well as associa- tions when a part of an idea or sentence is given him. He knows he must “work,” but is unable to tell his trade. When it was mentioned he denied it. He often recoiled, for he suddenly heard “August” called. His sweetheart called to him. He abruptly asked if he might write to her, and then wrote without difficulty the following correct letter: “My Dear Miss: I wish you to explain why you con- stantly call my name; it is painful to me. You are too serious a girl to perpetrate such a cruel joke on me. There- fore I anxiously await your explanation. Yours truly, A. M. Patient is of vigorous physique. Cranial circumference 53 cm., palate high. Slight anemia, pulse 80, temperature normal, urine free from albumen and sugar; pupils of medium size, equal, react somewhat sluggishly. Deep reflexes nor- mal, vegetative organs normal, complains of boring frontal headache, no stigmata hysteriae and neuratheniae. The head is sensitive to neither percussion or pressure. In the course of the 7th, after his memory returned, M. knew he “went home” last night. A crowd of men armed with canes and sabres came toward him and attacked him. He fled through many streets, remembered passing through Ringstrasse, the Votivkirchenplatz, everywhere threatened and , followed by the crowd. He then fled back through Ring, wandered about several hours until he asked protection of a policeman. From then on he had only a summary memory of 56 v. Krafft-Ebing. gentlemen in a light room (police station), a ride in a wagon (to the hospital), room where a gentleman was writing (hospital). That night he slept restlessly for a few hours. - - • * - February 8. Unchanged. Some memories of the previ- ous day, but they are falsely located in the past by about a day. He thinks the other patients ars priests, believes he is in Heaven, dead, but does not know when he died. He still hears his name called, is exhausted, weak. He has partial mental blindness, does not recognize a metal button e.g. but the acustic memorial image is immediately awak- ened when the name is spoken. - - - After the medical visit in the morning M. wrote to his mother, giving her correct address. - - “Dearest Mother: I beg you to visit me as soon as possible, for I feel so lonesome and am very melancholy. It is a long time since I have seen you. I do not know where I am, I also have violent headaches. - Your dutiful son, - - - - A.” His mother visited him for a short time in the after- noon. He was pleased to see her, but very dull and,according to his mother's statement, entirely different than when well. She knows of nothing in the way of an explanation of his condition. - - - February 9. Slept well last night. He is somewhat more clear to-day. Does not complain of frontal headache. Fails to remember his mother's visit of yesterday, disoriented as to time and place, mentally dull, even to partial word deaf- ness, mental blindness, hallucinations. In this condition the patient was presented to the Clinic as a case of transitory mental derangement, with reference to the similarities, as well as differences, which the condition offers to certain types of transitory psychosis from neurasthenic and epileptic neuroses. He did not change until the 10th of February. That day at 4 o'clock in the afternoon the dream-like state sud- denly ceased. He became perfectly clear, completely oriented and coordinated. He has a summary memory of Transitory Mental Disorder in Hemicrania. 57 the actual and delusional events from February 6th to the 10th, everything during that time seems like a dream, until the afternoon of the 10th he still heard “August” called. This of course is an illusion. The establishment of the vita praemorbida and the premonitory symptoms of his attack is interesting in M. proving perfectly normal in the following case and exempt from relapses. From 18 to 36 his mother often had parox- yŠmal unilateral headache with nausia, but without aura. Her mother had attacks of migraine with occasional vomiting. When small M. had rachitis and convulsions; he was fee- ble, did not learn to walk until 16 months, was a bright, excel- lent scholar, has never been seriously ill, of a somewhat choleric temperament. According to an anamnesis repeatedly taken, symptoms of a neurasthenic, epileptic or hysterical neurosis have never been observed in M. before. While since childhood he has had paroxysmal, violent headache localized in the forehead and between the eyes, preceded frequently by scintilla- ting scotoma. But in these attacks of migraine, which disap- pear as soon as he can go to sleep, nausia or vomiting, paraes- thesia, hemianopsia have never occurred. These attacks, quite similar in their intensity, are of very irregular recurrence. For some years the attacks have always been preceded for about three minutes by scintilating scotoma as an aura; this consists of all colors of the rainbow, yet violet is the most common. - * * * For 1% years the patient has been an apprentice in a hat factory. He has in no way been subject to stress, but he was dissatisfied with his position, long desired a change, had finally decided to give up his place, when , he became greatly excited, on February 4th wrote a letter to his master announcing his departure, and on the 5th visited a friend, to whom he appeared cheerful and much as usual. Toward evening of February 6th M. noticed on the advent of scotoma scintillans the recurrence of an attack of migraine, which soon became of unusual violence. For this reason he desired to go home to his mother. About half an hour after the occurrence of the aura the hallucinatory delirium might have set in. * - - - 58 v. Krafft-Ebing. Unfortunately M. cannot definitely state when the migraine ceased. It can only be definitely stated that on the afternoon of the 8th he still complained of it. The attack of transitory mental disorder, which accompanied an unusual, because abnormally intense, long continued attack of migraine, not relieved by sleep as usual, then outlasted it by about 36 hours. When I published the case I said: “I believe 1 am justified in assuming a clinical relation between the symptom groups of the migraine and the psychical seizure. The most probable interpretation is the evolution of circumscribed disorder of the function of the cortex (migraine) into a diffuse one (psychosis) under exceptionally peculiar conditions. (Patient, who has since been free from psychosis, asserts that he had never before had a psychical attack from his frequent migraine.) - - “If my assumption is true, it would be a transitory hemicranial mental disorder, similar to the neurasthenic, epileptic and hysterical.” Soon after the patient’s discharge attacks of somnolency occurred two to three times a day, even while conversing, which lasted about a quarter of an hour and apparently were always preceded by migraine. About a fortnight later while he was in this somnolent state, general tonic clonic convul- sions of several minutes’ duration occurred, epileptic according to the description. The somnolent attacks lasted about an hour. - He became morose, irritable, unreasonably accuses his mother of being against him, because he can earn nothing. Cessation of these attacks since August 1895, as also of the hemicranial symptoms. He now secured a position as secretary. - - ". On March 7th 1896 he had some trouble with his employer. At 5 o'clock in the afternoon he seemed perfectly well and natural to his friends. From that time all trace of him was lost. - During the night of March 9th the patient was brought to the police station, for, while wandering about the streets, he had asked for protection of a policeman from imaginary persecutors. Transitory Mental Disorder in Hemicrania. 59 He was admitted to the Clinic in a profoundly dazed condition (Dämmerzustand). He was wholly disoriented, stupid, physically and psychically exhausted, shrank when spoken to, talked foolishly about persons, who might have threatened him, otherwise gave correct, yet scanty informa- tion, constantly believed it was March 7th, complained of diffuse frontal headache, lay quietly in bed, half asleep, feverless, with dilated pupils and pale face. Visual field not contracted, trigeminus nowhere sensitive to pressure. On the evening of March 10th he came to himself. He has only a summary memory that on the 7th when he heard that his mother was worried about him (he had recently spoken of weariness of life), he would go home, on the way his headache came on,' became anxious, confused wandered about with the idea of saving himself by going to the railroad track. He actually went to West Neustadt, spent the night out doors, on the forenoon of the 8th went into a church for several hours, as he was cold. He then asked a man where he was and learned that he was ten hours dis- tant from Vienna. He was astonished, and decided, as he had no money, to walk to Vienna. On the way he heard a great noise in the distance, saw a crowd of people armed with canes and sabres, who were after him and called “we will stab you.” He fled, finally reached Vienna, on the 9th wandered about the streets, constantly saw at the same distance persecutors and finally asked a policeman for pro- tection. Since the evening of March 10th the patient has pre- sented no psychopathic symptoms and was discharged after a few days. - Case 16. Kr., 46, mechanic, came into the reception room of the general hospital of Vienna on the morning of January 15th 1896, according to the police report, and requested that a large stone he had in his head be removed, for otherwise he could not eat. - - Taken to the Commissioner he repeated this statement, appeared very depressed and confused. He also said he is 300 years old, born in the promised land, where he made the acquaintance of many saints. During the police surgeon's 60 v. Krafft-Ebing. examination he placed a lamp shade on his head for a hat to go to a ball, etc. Admitted to the Clinic on the evening of January 15th, he seemed morose, taciturn, wholly disoriented as to time and place, talked foolishly about a stone in his head, which must be removed (frontal region).. He stated he had violent headache at this place. . It is insensitive to pressure and percussion, temperature and vegetative functions normal. Patient slept some during the night of the 16th, again com- plained of pain and the stone in the head, remained quietly in bed during the day, apathetic and confused, claimed he had seen spirits all dressed in white, and among others St. Peter. - - - - In the evening about 9 o'clock the patient came out of this dazed coudition (Dämmerzustand) and with the aid of an attendant became oriented as to his surroundings. On the morning of the 17th, he was found to be per- fectly clear mentally. He knows nothing of the occurrences during his condition of psychical derangement. - Kr. tells of attacks of headache on the right, side occurring now and then, which last for two days. They begin with black spots in the visual field which disappear when the pain commences. During , these attacks, he has optical and acustic hyperaesthesia, nausia, malaise, yet without vomiting occurring. He is able to work, but forget- ful and sleeps poorly. Such attacks, from which his father also suffered, recur every few months, especially after drinking, to which he is not excessively addicted. - The next day he was perfectly clear and had no headache. In the present state neither signs of alcoholism nor of neurasthenia are to be discovered. The investigation for epileptic or hysterical relatives proved to be negative. Four years ago he received a blow on the head leaving a scarcely perceptible scar over the right superciliary arch about 2 cm. long, but which is not sensitive to pressure and, according to his statement, has never been the starting Transitory Mental Disorder in Hemicrania. 61 point of the headache. The ophthalmoscope reveals a slight optic neuritis on both sides. Otherwise nothing pathological is to be found in the vigorous man. The drinking of many. quarters of wine on the evening of the 14th had preceded the psychical disturbance. Kr. awoke on the morning of the 15th with headache on the right side. Discharged recov- ered January 18th 1896. Case 17. St. M., widow, 36, domestic, was brought to the Commissioner on May 30th 1896 at quarter to eleven in the evening by a policeman as being probably insane He had found her sitting in front of G. church, where she claimed she was waiting for her husband (deceased), who had promised to meet her at 12 o'clock. At the station she became restless, called to her Philipp, who said he would bring the child with him. She has begged her husband who died in 1891, to come to her, for everyone called a thief and and pointed their fingers at her. She has a thirteen year old daughter, who is at her villa. She is engaged at a hotel as a chamber maid. No further accurate statements are to be gotten from the wholly disoriented patient. She is constantly excited, pulls out her hair and in the greatest impatience awaits her Philipp. - Admitted to the Clinic on May 31st, she was greatly confused, fancied she was at the hotel where she had worked, complained of intense headache, anxiously waited for her Philipp and cried because he did not come. The persons about she mistook for the hotel servants. Said she is 48 years old and believed it to be April 1880. She complained that everyone considered her a thief. She has no fever, the right temporal bone and the bor- der of the parietal are extremely sensitive to pressure and the site of spontaneous pains. She slept several hours after an injection of morphine, became clearer, knew nothing of what had transpired, except the headache, became oriented, but remained morose, com- plaining of headache, periodically confused. Menses on June 2nd. On June 3rd again disoriented and delirious from violent headache. She again complained that her husband remained away so long, at the same time stated 62 v. Krafft-Ebing. she is a widow without recognizing the contradiction. Also complained that she was wrongfully considered a thief. On June 5th she became clear. She said she had often had such attacks of headache, but never so severe. They begin with scintillating scotoma before the right eye, then headache on the right side, malaise. Her hemicrania began at 19 with tempore primae men- struationis. Of her family and possible family disposition she is only able to report that a sister has migraine, her daughter is nervous and a cousin epileptic. The violence of this attack of migraine she ascribes to a severe emotion. On May 22nd she was accused of theft, at the hotel where she worked, and her effects were searched by a policeman. This incident greatly excited her. On May 23rd she was , arrainged before the magistrate, when an unusually violent attack of ophthalmic migraine with amnesia for several hours occurred. Since then she has been in a status hemicranicus with daily excerbations accompanied by psychical disturb- ance and imperfect memory during the remissions. She remembers of May 26th that she was greatly dis- turbed by the injustice done her, that she had intended visiting her husband’s grave and cry it out there, but must turn about when half way, owing to the headache and the spots before her eyes. On the 27th and 28th her head was somewhat better and she thought of looking for another place. She remem- bers but little of the 29th and 30th, among other things of her sorrow over being regarded a thief, and violent migraine. Complete amnesia from May 29th to June 5th. She came to herself quite suddenly and it was almost simultaneous with the visit of her cousin, who told her the thief had been found and that she was innocent. Mrs. St. remained perfectly well until a mild attack of migraine from emotion on June 10th. The most full anam- nesis and examination failed to demonstrate either hysterical or epileptic signs. On July 30th she was sent to the psychiatric clinic the second time. The police surgeon's report contained only Transitory Mental Disorder in Hemicrania. 63 the statement that she was very excited, wanted to go to her castle and to have all her servants about her. When admitted to the clinic she was disoriented, con- fused, talked foolishly about her castle, large property, yet believed she was at present in a hospital, on account of her violent headache. . She failed to recognize the persons and surroundings she knew on her former residence. Face very pale. The entire right side of the head and face very sensitive to pressure. Slept some during the night of the 30th. On May 31st about 5 o'clock, on cessation of the headache she suddenly came to herself, was immediately oriented, stated that she had menstruated without pain since the 27th, awoke on the 30th with her migraine, went about her duties with difficulty, vomited several times. About half past nine the psychical trouble began, during which until the afternoon of the 31st she was completely amnestic. This time the attack had been unusually violent. She ascribed this to the intense heat of the summer and her work in the close, hot kitchen. The preceding attack of migraine from July, 12th to 13th was unaccompanied by a psy- chical disorder. - On her discharge (August 3rd) she was advised to take potassium bromide 5, 0 pro die premenstrually and phena- cetine 1, 0 when an attack threatened. - Case 18. H. Th.,21. peasant’s wife, whose mother had much cephalaea. Nervous diseases, especially epilepsy and hemicrania, have never occurred in the family. Patient was formerly healthy, menstruated years ago for the first time with no pain, regular since then, married six months ago. Two months ago she had a violent attack of headache, which has since recurred about every fourteen days, and this time was preceded by anxiety and fear. Boring pains occurred over both eyes. These pains are not the chief symptoms during the two day's duration of the attack. Episodically she sees bright gray clouds before her eyes. This symptom is frequently repeated during the attack and coincident with the excerbations of pain (status hemicranicus ophthalmique). - She feels very miserable during the attack, complains of 64 " . . v. Krafft-Ebing. intense coldness of the hands aud feet, is very restless and sleepless, cannot bear light or noise and prefers to remain alone in a dark room. She sleeps well in the daytime and gets slight relief by it. Vomiting has only occurred once. For some time these attacks have become worse, begin with anxiety and last four days. The last two attacks at the end of July and August 14th to 18th were especially severe. They began with psychical disturbance, which preceded the headache by one or two days and last for two days afterward. She was very confused, gave perverse answers, laughed and cried for no reason, would wander away and could only be restrained by force. Memory of these periods very summary. . - - - - She claims to have become forgetful since the beginning of her illness. She has said and done things of which she knows nothing afterward. Petit mal-like conditions have never been observed by the relatives, also all reasons for assuming an epileptic or hysterical neurosis are wanting. She remained under observation at our clinic from August 17th to 28th, 1896. . - • * Intelligent woman, skull normal, central nervous system and vegitative organs normal. Marked sensitiveness to pressure over the first left and first and second branches of the right, trigeminus. On August 17th a violent boring headache for one hour. Menstruated August 19th. No other attacks occurred during the brief period of observation. Case 19. Mr. F., 48, merchant, of a very nervous family, yet in which migraine and epilepsy have never occurred. He was of a decidedly nervous constitution, had overworked in his business since youth, for six years markedly neuras- thenic. No epileptic or hysterical antecedents. He has never had any severe illness, particularly not lues. For the past five years he has had periodical attacks of violent unilateral headache, particularly after working hard or emo- tion, which begin on awaking in the morning and last until afternoon. Often, but not always, the feeling as though a veil was before the right eye precedes them. Scotoma Transitory Mental Disorder in Hemicrania. 65 scintillans have never occurred. The paroxysmal occurrence of the veil before the right eye often happens without being followed by an attack of headache. During it there is anorexia, slight nausea, but vomiting has never occurred. For two years, owing to worry about his business the attacks have become more violent and frequent. Owing to his neurasthenia he decided to live in the country, merely for his health, when these attacks ceased, but as often as he tried to engage in his business again they returned. Since October 1893 disturbances of the mental functions have repeatedly shown itself at the time of such attacks. I saw him the first time in such a condition on January 9th, 1894. He lay in bed, his face was pale, no fever, pulse 56. Consciousness was markedly deranged. He did not respond to commands. Complained of violent headache on the left side. Pressure over the left temporal bone was painful. An ice-cap was taken for a stiff hat and would not be tolerated. His wife stated the attack came on as usual after sleep- ing. Her husband had suddenly collapsed, knew nothing more and then became delirious. He raves about his busi- ness, fears financial ruin. He accused his wife and children, who have purchased the property, complains of his head- ache, desires to go to the hospital, but being impoverished, there is nothing for him to do but kill himself. The attack lasted nearly eight hours, terminated in sleep, from which he awoke with complete amnesia of all that had transpired while delirious, free from headache and felt well with the exception of a sense of “hollowness” in his head. . During the intervals he is perfectly well, if he takes care of himself. On February 9th I had occasion to observe an attack like the former. He complained of his head, which was extremely sensitive to pressure and percussion in the left temporal region, ardently desired to go to the hospital to avoid trouble, was wholly disoriented as to his position, did not recognize his surroundings, groaned for hours. This attack lasted until the afternoon of February 10th 66 v. Krafft-Ebing. ceased suddenly, this time without sleep. Complete amnesia for the whole attack. In the intervals he presented no pathological symptoms, with the exception of mild neurasthenic troubles. I now gave sodium bromide 3, 5 and antipyrine 1, 0 pro die and learned in 1895 that he, although having returned to the management of his business, has had no recent at- tack of his disease. Case 20. On May 13th, 1895 a fifteen year old school boy accompanied by his mother consulted me, who, like her husband had migraine. At 11 the disease of the parents also appeared in the son as ordinary migraine. For six weeks the migraine has been associated with scintillating scotoma and become extremely violent. It occurs every few days, but only lasts about one and one half hours. As with the first attack of hemicrania ophthalmigue, which now apparently is preceded by hemiopia, very pecu- liar symptoms of psychical reaction occur. As long as the attack lasts the patient acts as if ‘‘mad,” it is impossible to “do anything with him.” He “raves and fumes,” strikes and tears whatever he can get his hands on, beats his head against the wall until it bleeds, bites his hand. Complete amnesia for all that transpires during the attack. He is extremely dolichoceph- alic, the skull plainly rachitic. He was nervous, irritable, choleric from childhood. All evidences of epilepsy are wholly wanting. Neither are there any epileptics among his progenitors or relatives. His forehead is deformed. My advice, to leave him at the clinic for the determination of the diagnosis, was accepted, but not followed. The psychical condition of this degenerate seems to me to be a reaction to the pain of the migraine, but it is very peculiar and to be characterized as a pathological affect. Case 21. P., 17, confectioner’s apprentice, has an asymmetrical, submicrocephalic (53 cm.), rachitic skull. His maternal grandmother’s sister committed suicide. Mother’s sister has had simple migraine since childhood. Since the climacteric at the acme of especially severe Transitory Mental Disorder in Hemicrania. 67 attacks of migraine she has been unconscious without con- vulsions, which lasted two hours. Her son has typical migraine. The patient is quite talented, but since 15 has had attacks of migraine every eight to fourteen days, beginning early in the morning on awaking with vertigo and vomiting, which symptoms last about five minutes. Then occur acustic hyperaesthesia, boring bifrontal headache and sudden loss of strength in both upper extremities, which become insensible from the periphery to the shoulders; if the patient bends the head forward vomiting immediately occurs. The attack ends about noon. In the intervals he is perfectly well. On January 6th, 1896, such an attack was over by noon. On the evening of January 7th his master reprimanded him and gave him a light blow on the back of the head. He became very excited, had a slight pressure pain in the occiput, but not the usual frontal headache of the attack of migraine. He soon went to bed, slept restlessly for some time, awoke in the night, manifested great fear of strange men, who would rob, burn and beat him. Taken to the Commissioner he was frightened, com- plained of men following him with threats the same as above, will assault him with knives and sticks. He will take the matter to the police and then flee to Italy. On being taken to the hospital on the evening of the 8th the psychosis suddenly ceased and he became perfectly clear. He has a summary memory of the events of his ill- ness—he saw men in a threatening attitude, who told him they would beat and burn him. He only vaguely remembers being brought to the hos- pital. During the whole duration of the hallucinatory delirium he had no headache, no symptoms of his attack of migraine. This attack of delirium is the first in his life. He after- wards presented no morbid symptoms. He has no stigmata hysteriae nor epileptic antecedents and was discharged after a few days. The preceding casuistics embracing case 11–21 afford 68 v. Krafft-Ebing. no certainty of there being a true psychosis transitoria hemicranica. I might claim case 11 to be a symptomatic hemicrania (sensory Jacksonian') with a subsequent state of post-epi- leptic excitement. Also 12 (amnestic facts suspicious of epilepsy-convul- sions in childhood, somnambulism) is conceivable as a psychical epileptic equivalent. Case 14 from frequent dazed conditions (Dämmer- zustände) is likewise suspicious of epilepsy. The post- hemicranial hallucinatory delirious states are of two-fold character, the one lasting one fourth to one half hour, with amnesia, the other for three days without memory defect. The first may be of epileptic purport, while the other of simple migraine could have been the agent provocateur; the latter may be related to the hemicranial attack in the reac- tive manner, as the author tries to explain it. I believe case 15 to be an epileptic psychical equiva- lent for the hemicrania later induces attacks of epileptic stamp (attacks of somnolency, those with convulsions, dazed conditions (Dämmerzustände) with deambulatio and terrifying hallucinations of sight) equivalent to the psychical seizure. Besides the hallucinations in the last attack are con- gruent to the first, apparently hemicranial. In the other cases the clinical basis of the epileptic neurosis disappears. Case 17 might be a mere affect delirium, which is coincident with a premenstrual hemicrania, at least there are enough such cases without hemicrania complication. In the second attack of an entirely different nature (grandoise delirium) all relations to an affect is wanting and a possible connection of the psychosis with hemicrania is not to be precluded”. *While this paper was in the press the patient was again admitted to the clinic (De- cember 23rd, 1896): essentially in the same condition (transitory mental disorder and hemicrania) as the other two times. But this time the evidence of a hysterical neurosis was secured (left hemianaesthesia, left ovarian tenderness, marked concentric contraction of the left visual field as permanent symptoms, right ovarian tenderness, right hemihyperalgesia lavue temper. insultus) so that possible relations of the transitory psychosis to the hysteri- cal neurosis are not to be rejected for a recent anamnesis renders prior attacks of lethargy probable. Transitory Mental Disorder in Hemicrania. 69 Case 19 (nihilistic delirium at the acme of the hemi- cranial attack) permits a relation to this neurosis. The “how” is questionable, possibly by the affect delirium induced by the physical pain. Case 20 scarcely permits other interpretation than that of a psychical reaction to the pain in the way of a patho- logical affect. Case 21 (simple hemicrania, one day after its termina- tion, in connection with an affect, terrifying hallucinatory delirium) is the most simply explained by the assumption of an affect delirium. There remain as incontestable examples of cases in close clinical connection with migraine and particularly ophthalmic, only 13, 16 and 18. In 13 there is confusion with hallucina- tions of sight, in 16 a dazed condition (Dämmerzustand) with religious delusions, in 18 confusion. Therefore no certain etiologico-clinical conclusions can be drawn. The similarity to certain psychical epileptic types is not to be be mistaken. If the theory of the epileptic significance of ophthalmic migraine (Fere) was proven, these cases could be claimed to be psychical equivalents. PHYSIOLOGICAL COMMON SENSE AND THE DRINKING OF ALCOHOL.* By Prof. C. H. HUGHES, M. D., BOUT the close of the year 1898 the London Lance! contained the following: “At the meeting of the Paris Hospitals' Medical Society, held on December 15th, M. Legendre, alarmed by the ever increasing amount of drunkenness, asked if it would not be possible to withstand this by means of meetings, insistence on the dangers of alcohol, and by what he considered an even better method, that of getting up for the instruction of patients lantern shows with exhibitions of anatomic prepara- tions to show the dangers of alcohol. M. Legendre has had printed for the use of all his patients a little leaflet, the text of which runs as follows: “Most of the diseases treated in the hospitals arise from alcoholic drinks—that is to say they are either caused or aggravated by the abuse of alcohol. All alcoholic drinks are dangerous, and the most harmful are those which contain aromatics in addition to alcohol—as, for instance, absinthe,” etc., etc. Alcoholic drinks are more dangerous when taken on an empty stomach or between meals. A man necessarily becomes an alcoholic—i.e. slowly poisoned by alcohol—even *Contributed to the late Congress of Temperance, held at Paris, May, 1899, [70] The Drinking of Alcohol. 71 if he never gets drunk, when every day he drinks alcohol in the form of liquor or too much wine, more than one liter per diem. “Alcohol is a poison, the habitual use of which destroys more or less quickly, but none the less certainly, all the organs most necessary to life—the stomach, the liver, the kidneys, the blood vessels, the heart and the brain. Alcohol excites man, but does not strengthen him. It is no substitute for food, but it takes away the taste for it. Those who often drink alcohol or too much wine (more than one liter a day) are much more liable to illness, and when ill are much worse, for the disease is often complicated with fatal delirium. “Alcohol is a frequent cause of consumption by its power of weakening the lungs. Every year we see patients who attend the hospitals for alcoholism come back some months later suffering from consumption. Fathers and mothers who drink often have children who are deformed or idiots or who die from epilepsia.” This is a conservative view of the destructiveness of alcohol, to which even the advocates of alcohol as a food can not object. The wine referred to in the foregoing extract is the vin ordinaire of French tables, whose strength is the least of all table wines. The facts set forth in the foregoing extracts are familiar to all sensible users of alcoholic drinks. Resistance to disease is impaired by drink and an empty stomach, and fortified by food. But with all precautions the drink habit makes its fatal inroads on organism. Hyperemias and finally anemias, cacemias and destructive changes set in, the vis- cera, the nerve centers, and in the peripheral nervous system and the motor nerves. The psychic nerve centers swell and then contract. The powers of speech, of percep- tion, of intellection and of motion fail and destruction and decadence follow. The degeneration of the individual and the degeneracy and decadence of his progeny are the final sequel. The researches of Morel, of Magnan, and hosts of 72 C. H. Hughes. others in this line of observation, and the testimony of the asylums for the insane, the homes for the idiotic and imbecile, the colonies for epileptics, and the eleemosynary institutions of the state for alcoholic detention, including the inebriate asylums, poor-houses, etc. are monumental testi- monials to the giant evil of alcohol in its destructive power over the human race, threatening its destruction. Assaulting this monster of destruction by outcries of alarm has not conquered it. The drink habit continues to be formed by daily indulgence in drink, as a beverage, by the world’s unthinking millions. The question is how shall we avert the formation of the destructive habit or at least reduce it to minimum proportions. To this l briefly answer as a practical man who has had some experience in drink- ing, not much however, and whose daily vocation has brought him for over a third of a century in constant con- tact with the evil—l answer as a physician and psycholo- gist, an alienist and neurologist: It is to be cured by substitution and avoidance. The substitution is in the cultivation of the use of the other beverages that cheer without producing inebriety—the tea, coffee, cocoa, chocolate, etc. Teach the young to use them. Regulate the sale of alcoholic liquors of all sorts, so that the places where they are dealt out by the drink, shall also invariably have on sale, by the drink, the other and harm - less beverages, so that the drinker may have a rational option of substituting the milder or non-intoxicating drinks. By this substitution, avoidance may be practiced by the prudent and the cautious. In every place where strong drink is retailed make the sale of luncheon with the coffee or tea, etc., obligatory on the part of the proprietor; license no drinking shops apart from restaurants, though the restaurant patron may be restricted to a moderate luncheon menu. This would abolish the bar or saloon as such, and substitute in its place the sanitary Cafe or Buffet, where something to eat and drink, besides an alcoholic drink, might always be had at the choice of the drinker. This would be the sanitary regulation of the dram-shop. Such regulation would violate no man’s right, and it would The Drinking of Alcohol. 73 be to the interest of sound public policy, morals and health. This, I conceive from a standpoint of practical observation of the evil all good men wish to remedy, at least one good reason which would tend toward its mitigation. We should help where we can, though we cannot cure. I offer this as a suggestion in the line of inebriate legislation. It would prevent the formation of inebriate habits in some and longer postpone the acquirement of this vice in others. Strong coffee or tea drinkers are less liable than water drinkers to become inebriates. Whisky drinkers are fond of water when not indulging in alcoholics, in preference to the cup that cheers. Another substitutive treatment is timely medication. The man who periodically or regularly craves an alcoholic beverage needs a physician and his nervous system needs strychnia and the bromide of sodium or of ammonium with gastric pallatives and good nutrition, predigested or other- wise, as the state of his digestion suggests to his medical advisor. The nerve centers are tired or unstable when they crave alcoholic stimulants. A sound philosophic therapy based on what we know of alcoholism is in the diseased craving for alcohol; hereditarily transmitted, or acquired through long indulgence, suggest nerve tranquilization first, nerve nutrition, nerve support and temporary substitutive stimulation. This neurological and psychiatrical science now enables our pro- fession to furnish. We should announce this and all other facts tending toward the sanitary salvation of the inebriate to the sober citizen, imperiled with impending inebriety through a vicious heredity or otherwise. The sanitary salvage of the people from this pathological sin belongs to our era and our profession. If we cannot entirely quarantine the world against this dan- gerous disease of alcoholism, we can at least inoculate it with scientific truth and vaccinate it with proper sanitary safeguards, so that the violence of the disease may be less- ened and its power of destruction may be abridged. Our profession first struck the shackles from the enchained lunatic and reformed the management of insanity. It should now break the chains of the enthralled inebriate. HUNGRY Evil IN Epileptics.” By Ch. Féré, Physician to Bicêtre, Paris. Y the name of Faim-Valle, hungry evil, heiss hunger, male dell, orzuolo, we generally mean a neurosis peculiar to horses characterized by sudden hunger, its etymology probably derived from “fames cavallina,” that is hungry like a horse. Littre defines it from the Briton adjective “gwall” bad hunger. Bouchut and Desprès define it “an irresistible desire to eat, not unlike boulimia and a symptom of a nervous affec- tion of the stomach.” Some writers ascribe to the term a permanent phenomenon in certain kinds of dyspepsias. Veterinary surgeons have described it as a paroxysmal phe- nomenon. Hurtrel d’Arboval defines it in the following manner: “A sudden hunger extremely rare usually found only in the horse. This condition will cause the animal to stop all of a sudden. He will be unable to walk and he may fall, being unable to go forward or backward, his body remaining immobile in spite of whipping and bad treatment. If food is given to him his hunger will cease as well as the phenomenon that accompanied it. After the appetite is partly satisfied, then the animal is ready to go on his jour- ney. “This condition is so rare that no detailed description of it is anywhere to be found, and in the latter part of the last century, a writer has said: “I do not know of any contemporary veterinary surgeon who has observed it. This sickness has seemed so incredible that recent books hardly make mention of it.” The fear of the disease is legendary in some countries, for instance, in Caux, peasants will not undertake a journey i. *Translated by Dr. Marie Louise Benoit. [74] Hungry Evil in Epileptics. 75 unless the horse has been well fed for fear of hungry evil. They believe the horse may die of hungry evil but no cases of death have been reported. I have questioned many learned veterinary surgeons who seemed very much sur- prised about this matter. From the fright that my country- men have of the disease, I thought it might be a sort of epilepsy. Vitet defined Faim Valle a sudden spasm. The immobility of the horse not unlike mental confu- sion described in men and found in a paroxysmal form in hungry evil has been observed in connection with epilepsy. Lafosse has seen epileptic horses become immobile after- wards. The fact that this paroxysmal immobility may have been due to hunger may be explained from the fact that inanition has been given as causation of epilepsy. As a matter of fact animals are frequently subject to morbid manifestations of the appetite. Birds often introduce in their digestive apparatuses things that have nothing to do with nutrition. The magpie by its aptitude in that direc- tion has given its name to pica. Mammiferous also mani- fest the same depraved tastes under the influence of certain tubercular or intestinal diseases, of worms, hydrophobia and amongst herbiverous, the female in gestation often presents attacks of this kind in an impulsive paroxysmal form. After delivery, it is not rare to see cows devour the foetal mem- branes. The museums of veterinary schools contain a large number of foreign bodies found in the digestive tract of herbivorous. Many a bather has found at his expense that cows are capable of swallowing a suit of clothes. Physicians are not prolific in their writings upon hungry evil or Faim Valle. Avicenne spoke of limbs being hungry with satiety of the stomach. Gallien spoke of lypothymias caused by hunger, but he did not differentiate it from bou- limia or pica. Sauvages described as Faim-Valle a cardial- gic boulimia accompanied by cardialgia and frequent syncopes. Leroux, who was the first to use the word “Fringale” as synonymous of hungry evil does not differ- entiate it from boulimia. He described such an acute attack in a man seemingly caused by the odor of bread removed from the oven. This man after eating a great 76 Ch. Féré. quantity of bread started to eat the leaves from the trees. J. Franck reported the case of a professor who was liable to attacks of boulimia under the influence of prolonged chastity and whose hunger was satisfied by his wife’s caresses. In his definition of boulimia, Franck associated to hunger a feeling of lipothymia. Boulimia is an unnatural hunger not explainable by the normal needs of nutrition. Whilst appetite may be the manifestation of taste for a special food, hunger is a general sensation of need of food without distinction. Boulimia does not call for a particular food and it is an habitual condition which may be congenital or allied to morbid conditions. It is often seen in pregnancy, idiots, demented, maniacs, general paralytics, diabetics, rachitics, (Sauvages) phthisical (Guersant). An unusual voracity for food is sometimes seen after splenectomy (Péan), or follow- ing the administration of lodine (Magendie) and lodide of Iron (Natalis Guillot). Boulimia often coincides with gastric disorders, sometimes it is associated with vomiting after which the patient begins to eat again, (cynorexiá, fames canina), at other times with diarhroea (lycorexia, fames lupina). The characteristic feature of boulimia is that it is a need relative to quantity. On the contrary, pica or malacia is characterized in the quality of food which excites the appetite. Pica is often seen in neurotics and weak people, in hysterics, in chlorotics. Some writers have differentiated the malacia of pica in that in the first, the choice is made from food very rarely used but containing some nutrition whilst in the second, the choice is for food altogether unfit to nutrition (geophagia, coprophagia) sometimes the patient suffering from boulimia has a marked preference for certain food, to raw meat for instance (Percy’s omophagia). Bou- limia, a need in the quantity of food, may coincide with other anomalies of the appetite characterized by the quality of food needed. In dyspeptics boulimia, which is sometimes the leading feature (boulimic dyspepsia) may alternate with anorexia and appear in a paroxysmal appearance of unnat- ural and morbid appetite. Among the different perversions Hungry Evil in Epileptics. 77 of hunger observed in man, cardialgic boulimia of Sauvages with a tendency to lipothymia and syncope is the only one very much alike the epileptiform faim-valle of the horses, and no concrete instance of such is found in literature. However, hungry evil taken in the sense of an imperative need of food, expressed by sudden attacks with sensation of anxiety and tendency to spasms is not very uncommon, and is manifested in quite different conditions. Under the influence of habit, which is a second nature, it may mani- fest itself in a periodic manner in chlorotics, hysterics, neurasthenics and the insane. In all of these cases, it may coincide with anorexia. Bernstein reports the case of a female patient suffering from melancholia, who in spite of being disgusted of food had impulses to devour things not needed for nutrition. In neuropaths, the faim-valle may appear in a depressing or anxious form similar to morbid needs and impulsions in general. Among the psychic par- oxysms of epileptics, impulsions are often spoken of as phobias with anxiety. They appear frequently subject to impulsions in a form of boulimia or pica but in similar cases that I have observed, they were permanent or durable anomalies or attacks of pica occurring in epileptics so feeble-minded that their symptomatic value remained doubt- ful. Excessive hunger and voracity are usually the case in epileptics. Witmer classifies the appetite in one hundred epileptics in the following manner: Appetite voracious in eight; appetite excessive in sev- enty-five; appetite medium in four; appetite variable in six; appetite poor in seven. Hunger may be manifested in epileptics very much in the same manner as the faim-valle of the horses. I have observed it in very young patients, but it is certain that when these cases will be thoroughly understood, they will be met oftener. - Case 1st: Neuropathic heredity, teratological stigmatas, transitory changes of sensation of weights, erythropsy by spells, faim-valle, convulsive attacks with gastric aura. Elisa B., 14 years old. Father died three years ago at the age of 68 from pneumonia. At the age of 40 he had 78 Ch. Féré. an attack of melancholia with , attempt to commit suicide for which he was incarcerated in an insane asylum. Mother is now 40 years old, subject to vertigos with loss of con- sciousness. One sister, 27 years old, is well, married and has two healthy children. One brother 22 years old, is a soldier. One brother, 18 years, had convulsions and St. Vitus dance, and to-day, he has incontinence of urine. He has strabismus. One sister, 17 years old also had convul- Sions when a child and has strabismus. E., born at full time, labor normal, quite strong but had numerous pigment spots upon the trunk and the legs which have become prominent and hairy. Pre-auricular folds are marked. She has a well marked cubital oligodactylie. The palate is ogival and the teeth are malposed. The lower median incisors are separated by an interval of three milli- meters. Since the age of 8, she has a left inguinal hernia. She had no convulsions in infancy, walked and talked at the usual age. At the age of 9, the first nervous symptoms were noticed. If she carried something heavy, she would say all of a sudden—the weight is all gone. This illusion of weight lasted a few minutes. She noticed that the weight she carried became heavy once more, then a few minutes later she would repeat: “How unfortunate I am,” and would complain of her fate, relatives, father, brothers and sisters. She often would cry. These spells of melan- cholia lasted one-half hour or one hour. They were less frequent than the illusions of weight but never occurred without them. These paroxysms occurred at variable inter- vals of one week to a month and lasted about two years. Sleep had remained good. One night she dreamt about a fire and she awoke in the midst of it very much frightened. Since then the illusions of weight have been replaced by spells of erythropsia. All of a sudden the space as well as the objects around her would appear red. The intensity of the phenomenon varied but most of the time the colors would gradually become darker. When the phenomenon was well marked, it was accompanied by a sensation of weakness, and the mother noticed that whilst the cheeks were very red there was a livid hue around the mouth. Hungry Evil in Epileptics. 79 These spells of erythropsy occurred in the same frequency as the illusions of weight and lasted one year. At the time of menstruation, 12 years old, both spells of erythrop- sia and melancholia disappeared. Six months later she happened to be out with her mother; about two o'clock in the afternoon she had taken her dinner with a good appetite and seemingly was not hungry. All of a sudden she said: “I am so hungry.” “I must eat,” and instantly she walked into a butcher’s shop near by. Her mother tried to stop her, but in the meantime the patient had fallen and had lost consciousness. She became con- scious almost at once, rubbed her eyes, and wanted to leave. Hunger had passed away. Two similar attacks occurred on the streets at one month’s interval. A fourth attack occurred at home, the child at that time taking hold of a piece of cheese which she ate greedily. Loss of con- sciousness did not appear. At the time of her twelfth menstruation, she had her first epileptic attack ushered in by a gastric phenomenon, but very different from the first. The child became pale, put her hand in the epigastric region and said, “I am going to vomit.” She vomited some clear fluid, and fell backward and remained rigid, rolled her head, the arms and legs convulsed. After a while she stopped, her tongue was bitten and she had urinated. Since then and during the eight months which followed the con- vulsive attacks, with nauseous aura, the spells of hungry evil have irregularly alternated with the same character- istics. For the last four months, under bromide treatment, the convulsive attacks alone have recurred. This case presents many interesting features. The sensation of lessening of weight of objects is not a rare thing in epileptics. Larcher showed me a young boy, a victim of grand mal attacks who, when going to college, all of a sudden would feel his school bag lose its weight. This illusion may easily be accounted for by a sudden increase in the tension of the muscles. We know, for a matter of fact, that the sensation of weight may vary with the energy of the movement. The alternative of the phe- nomena of excitement characterized by the temporary 80 Ch. Féré. increase of motor energy either by erythropsy and phenom- ena of exhaustion is found in epileptics in many instances. It may be found in the same delirious attack. Paroxysmal erythropsia has occurred after dreaming about fire. This dream may be interpreted as a variety of attacks. The dream of convulsive attacks sometimes pre- cede the true attacks. As for the spells of faim-valle, they occur with the same characteristics as those peculiar to horses. It is a sudden need leading to loss of consciousness if not relieved at once by eating. It seems as if the nauseous aura of convulsive attack makes up another form of gastric irritant. Case 2. Alcoholic heredity, teratological stigmatas, con- vulsions in infancy, spasmodic cough, headaches, localized spasms, hungry evil, general convulsive attacks. Jules J., 15 years old; father aged 48, tanner, inebriate, four children younger than Jules died in convulsions in their first year of life. Jules walked and talked late, had a num- ber of convulsions and urinated in bed until the age of 6. He is quite well developed for his age, but he has a deformed chest; no descent of the left testicle. He has many pigmentary naevi on the back and toward the exter- nal angle of the right eye three erectile spots about one centimeter in diameter. At the age of 8 he was feverish at times; often awoke in the middle of the night very restless; skin burning, complained of headache, then, after a half hour he would go to sleep, and no trace of this indisposition would appear the next day. Sometimes, he had spells of spasmodic cough lasting about the same length of time. These spells occurred only at intervals of a num- ber of days, and independent of any local lesions. His aunt, in whose care he was, had him carefully examined during the few months that these attacks lasted. Seem- ingly, they disappeared spontaneously but they have been replaced by other accidents. In the middle of the day as well as at night he would put his hand to his head sud- denly after uttering a cry as if receiving a shock in the frontal region, remaining exhausted as if a heavy weight were on his head. This pain lasted two or three minutes Hungry Evil in Epileptics. 81 and left him very much wearied. For about a year these shocks have recurred. They ceased after an extensive burn caused by spilling some boiling water upon his left thigh. At that time he was a little over 10 years old. Shortly afterwards, he was taken with involuntary contractures of the left thigh involving at times the abduc- tors and at other times the extensors. These spasms were painful. He could stand on his right leg but was unable to walk. While he suffered from these contractures and this exhaustion, he had his first epileptic attack ushered in by sudden desire to eat. The head turned to the right, the upper extremities became rigid upon the lower ones. Then the head rolled from side to side and the convulsions became general. The attack terminated in a stupor lasting one hour. He did not bite his tongue, but he urinated during the attack. These spells have occurred since every fortnight, always ushered by the same sentence: I am hungry. But he cannot get to the food early enough to abort the attack. His aunt noticed that the erectile spots of the right temple became red sometimes before the attack, and they became pale at the time of losing con- sciousness. Jules J. came to the consultation for the first time in November, 1898. He was given bromides in doses of six grammes. For two months the attacks stopped, then there recurred incomplete attacks constituted by the old aura, saying: I am hungry; looking for something to eat and trying to put in his mouth all kinds of things and would lose consciousness without convulsions. He had six attacks of the same nature. One was aborted by eating a few mouthfuls of bread. Since then he had two other con- vulsions preceded by the old aura. The important features of this case are the febrile crises and those of spasmodic cough so frequent in children who will develop epilepsy. These spells are peculiar on account of not being connected with any local pathological condition, by their sudden appearance and their brevity, by their mode of onset at long intervals. In nervous patients slight lesions of the respiratory tract, pharynx, larynx, bronchi or nasal fossae may cause the nocturnal 82 Ch. Féré. attack of spasmodic cough. Headaches constitute the epi- leptic equivalents seemingly more frequent in children. Faim-valle first appeared as aura of grand mal, then was isolated under the influence of treatment which modi- fied the frequency of the convulsive attacks. We know that the isolation of the aura is one of the frequent effects of treatment and often it is an early sign of being efficacious. In a similar case in a young girl 15 years old, faim- valle instead of constituting an aura, constituted a precur- sory sign. On the day before she had the attack, she experienced an imperative necessity for food but without syncope or loss of consciousness. These attacks of hungry evil are accompanied by salivation and coryza. However, there does not seem to be any relation between salivation and the need of eating in epileptics, because in many of those afflicted with paroxysmal sialorrhoea, this need is not noticed. In those facts just presented we have seen faim- valle occurring in the form of hunger of a general need without preference for a special kind of food. This is not always the case. A boy 12 years old had attacks which were ushered by a sudden well developed appetite in the afternoon at an hour he never before felt any need of eating, saying: “I would like to eat sauer kraut.” The obsession lasted fifteen or twenty minutes, then disappeared without causing any true uneasiness. The mother was all the more astonished of this appetite that the boy was unaccustomed to eat between meals and manifested no special taste for this special food. This attenuated form of faim-valle has not recurred since the attacks have been modified by treatment. It is important to differentiate faim-valle, which is an epileptic equivalent occurring isolately or in the form of aura with the different kinds of greediness, boulimia and pica seen in epileptics. If these latter forms have an impulsive character they are not accompanied by anxiety or loss of consciousness which is necessarily the case in epi- eptic faim-valle if the desire is not satisfied, Faim-valle Hungry Evil in Epileptics. 83 is also differentiated from paroxysmal voracity occurring in Some epileptics after attacks. Case 3. Periodic epilepsy, amnesia, post paroxysmal voracity. Mrs. B., 34 years of age. Father died from cancer of the rectum. Mother died of phthisis. She has a son 14 years old who is healthy. She lost a daughter at the age of eighteen months. This child was puny and weak at birth. She had had convulsions in infancy at the time of den- tition but was free from them until she was 31 years old. At that time she lost her husband. She then had many annoy- ances and trouble which brought an unusual disordered sleep, being the whole night frightened by nightmares. One morning at four o’clock she awoke with such a feel- ing of hunger that she went to the kitchen and ate one pound of bread in a few minutes. She noticed then that she had urinated, the chemise being wet and the tongue was sore. This was the last day of her menstruation. After the attack she had lost the memory of faces, hesita- ting to recognize her son and his nurse. As for those who did not live with her it took her many days to recognize them, although her memory for ordinary things seemed intact. She could recognize the shops but not the shop- keepers. Since then, Mrs. B. is liable to the same attacks with the same results always occurring at the same hour and after menstruation which have not been modified in any way. Her attack was ushered by a cry consisting of a tonic period followed by a clonic stage with general convulsions and followed by a stertorous stage lasting from twenty minutes to a half hour, this sleep being interrupted by sud- den awakening with great hunger. Many times this hunger could not be satisfied on account of having no food at hand. Then she would calm it by drinking some wine or water, but hunger persisted until the hour when it could be satis- fied, and kept her awake. This hunger without anxiety, without tendency to lipothymia or syncope, without loss of consciousness when not satisfied, is different from faim-valle otherwise than by the conditions in which it occurs. 84 Ch. Féré. Epileptic faim-valle is in no way like the psychic disorders arising from abstinence from food which differ according to its duration. At first there occurs an excite- ment of the imagination with slight irritability and uneasi- ness followed by apathy with loss of memory and initiative, a tendency to impulses and sometimes acute delirium. These phenomena are so closely allied to those due to toxines that autointoxication has been given as the cause. EPILEPSY MODIFIED BY TREATMENT AND ENVIRONMENT, WITH SOME NOTES OF TWO HUNDRED CASES.* BY MARTIN W. BARR, M. D., Chief Physician, Pennsylvania Training School for Feeble Minded Children, Elwyn, Pa. Almost coeval with the history of man is that of this dread disease. The haunting shadow that dogs the footsteps of excess, brings retribution in one generation or another, and be it hut or palace, on the lintel is found the stain. Time, which modifies all things, makes no change here; the description of Hippocrates is as true to-day as it was in the time of the ancient Greeks, and the victim sends forth the same cry and wallows foaming now, as he did of old at the feet of the Great Physician. Cause and cure have been the subject of research throughout the ages, but the effort to subdue, only tended to reveal a hydra-headed monster, until physician and philanthropist, alike tempted to exclaim with Sysyphus, “Mine is at most but an everlasting hope,” sought other expedients. Out of 700 cases brought under my observation, I have been able to accurately study 200. This experience but verifies the axioms of the past, and I find no warrant for departing from the opinion of Hippocrates: “The prognosis in epilepsy is unfavorable when the disease is congenital, where it continues to manhood, or where it occurs in an adult. We may attempt to cure the young but not the old.” May attempt, mark you, but I find nothing to justify any hope of ultimate and positive cure, even in a radical *Read before the Baltimore Neurological Society, June 21st, 1899. [85] 86 Martin W. Barr. change of life and constitution. The evil like mental defect, with which it is so frequently associated, clings, ready for reappearance in full force at the least provoking cause, or in that reversion to original type so often noted in what we call “second childhood.” Two such cases I have met with recently, where epilepsy traceable to convul- sions in infancy, has reappeared after a cessation of sixty years. Another enjoying entire immunity for three years, during which time treatment and regimen were continued— for I never considered him cured—died finally, in a spasm, before I could reach him, although responding immediately to the summons. Trosseau states that out of 150 cases of epilepsy he had twenty recoveries, and Beau and Maisonneuve give their recoveries as four per cent. The Craig Colony reported last year seven patients discharged after two years of release from attacks, though still held under observation and continuing prescribed treatment. The colony at Bielefeld, Germany, claims, during twenty years, to have discharged six and one half per cent cured. Release for even a term of years from such a malady cannot but be accounted a boon and that treatment and environment should accomplish this, is surely a sign of prog- ress and a victory for science—but I have no faith in absolute recovery. I too, have had many cases of exemption for varying periods of duration. I have now under my care, a man aged 33, with a record of convulsions at two and one half years, who, within the past few months, has developed epileptic seizures which steadily increase in frequency and force. Another, a boy of 18, imbecile, epileptic and hydrocephalic, with a family history of alcoholism on both sides. Responding to treatment, change of environment, development in school leading to congenial and constant occupation, during four years of complete immunity from attacks, he has made wonderful progress in free hand draw- ing, painting, sloyd and wood-carving, and bids fair to become a capable carpenter and painter; but l shall not be surprised any day to learn of a return of the spasms, in Epilepsy Modified by Treatment. 87 which event he will deteriorate rapidly, both physically and mentally. No, epilepsy is a poison too subtle to reach—if indeed it is not being continually renewed—its antidote is not yet known to the medical profession, and that which the cradle rocks, the spade will eventually cover. I believe in the majority of cases, judging from those presented to me, the disease to be prenatal. In many where epilepsy appeared late in life without apparent cause, investigation has revealed its presence soon after birth, one or more convulsions which had been overlooked being recalled by the mother. I am confident that a large proportion of the spasms of early infancy are epileptic, that the malady is mainly due to heredity, and its most frequent cause, the concentration of neuroses in families tending to intensify and produce epilepsy. That many forms of epilepsy admit of home care and treatment without forbidding the pursuit of business or the performance of daily avocations, is proven in the experience of many. Two of my former employees, an attendant and a shoemaker, were epileptic, and found but little inter- ruption in their regular duties. Again, a lady, a leader of society in one of our large cities, was not infrequetly carried from a dinner party in one of her “fainting spells,” only to reappear at a ball or theatre later in the evening. An extraordinary example is noted in the British Medical Journal.” A man was a confirmed epileptic for fifty-seven years, during which time it was estimated that he must have had more than 60,000 fits without any general impairment. By trade, a basket-maker, he would be interrupted by attacks, varying in number from five to thirty per day, going on with his work after one until another came on, with so little inconvenience, that his wife and himself, accustomed to their occurrence, came to regard them as part of their daily life. He died finally at the age of 71, during an epileptic seizure. But if there may not be a cure, there may be ameliora- tion, first of the condition of the individual, and thus, •April 28, 1860: p. 139. 88 Martin W. Barr. naturally of his disease. The treatment, which in my experience, has best tended to relief, and in some few cases to suspension of the malady, is briefly summed up thus: Regular habits and a carefully selected diet with fre- quent baths are most essential. I am not, however, an advocate of the cold bath if the patient is adverse to it, as in many cases an attack may be induced by the shock, and this should therefore be as carefully adapted to the patient as the diet, which, largely vegetarian, may include all simple foods milk, eggs, broth, cereals, bananas, both raw and cooked, indeed most of the fruits well ripened—avoiding those with small seeds—and withdrawing any article as soon as it appears to disagree with the patient. The remedies upon which I mainly rely are the bromides suited and adapted to individual needs, combined with arsenic to guard against acne, omitting doses one week in every eight so as to allow the system to recuperate. Last year the fluid extract of solanum carolinense was highly recommended, and one writer claims wonderful results in eight cases. I placed twelve boys and twelve girls on it, and the increase of spasms in force and frequency was alarming. I tried hydrastin in full doses on twelve cases with the same result. I placed one hundred cases on the fluid extract of eupatorium perfoliatum in doses of one half to one drachm, according to age, in combination with from ten to fifteen grains of bro- mide of sodium. This acted well for a time, but on withdrawing the bromide, the second state was far worse than the first. In nocturnal epilepsy, I have obtained good results from the combination of a single bromide with a small dose of chloral. In anemic cases, I find arsenic, tincture of chloride of iron, and bromide efficacious, and not infrequently with girls, bromide and belladonna. I have never met with much success in the use of nitro-glycerine, cannabis indica, of zinc or of borax. . Nitrate of silver in one case proved beneficial for a time. In status epilepticus, I first try chloroform, and if this does not act, I give a hypodermatic injection of morphia and atropia, repeated if necessary, or a hypodermatic of pilocarpin, Epilepsy Modified by Treatment. 89 but the depressing effects of this drug are so pronounced that l am very careful in its use, fearing fatal results. Surgical interference in epilepsy is much vaunted, but in my experience of nine cases only the results are ques- tionable. One sad case, a bright lad of fifteen, an apt Greek and Latin scholar studying for the priesthood, who had been troubled with petit mal and later with an attack of grand mal lasting several days, was trephined and transformed to an excitable idiot, unable to care for himself in any way. For eight years he had no spasms but they returned and he finally died during an epileptic seizure. The etiology of the 200 cases studied by me, shows in sex, male 122, female 78, which represents a proportion 3-5 to 2-5. Age, tabulated in hemidecades, shows a similar pre- ponderance of appearance of disease in the first five years of childhood over the number in other periods. Thus, from birth to five years we have, out of the 200, eighty-two males and fifty-four females; from the fifth to the tenth year, fifteen males and seven females; from the tenth to the fifteenth year, two males and three females; from the fif- teenth to the twentieth year two males and one female. The age of twenty-one males and thirteen females is not stated. In the much debated subject of cause, I find 126 cases ascribed to hereditary and 74 to exciting influences, the balance of heredity over accident, it will be seen, largely preponderating. I note a yet greater preponderance in weighing the force of the inheritance of mixed neuroses against that of direct transmission: thus, we have heredity of various neu- roses, ninety-three cases, or forty-six and one-half per cent. of the whole—while that of direct transmission combined (epilepsy, sixteen, or eight per cent., alcoholism fifteen, or seven and one half per cent., and syphilis two, or one per cent) amounts to thirty-three, or sixteen and one-half per cent. of the whole. Under the exciting influences we have: traumatism, twenty-nine cases, or fourteen and one- half per cent., injury to mother during gestation twenty, or ETIOLOGY OF 200 CASES. Age Period of S CAUSES. ex. Appearance | PREDISPOSING. EXCITING. in HEREDITY. Injury to - | Male. | Female. Mixed Traumatism. . Dentition. s: Hemidecades. Nº.es, Epilepsy. Alcoholism. Svphilis. gºn. ckness. 5 82 54 || 65 10 10 1 19 12 9 10 5 - 10 15 7 4 4 2 5 3 4 10 - 15 2 3 2 3 15 - 20 2 l 2 1 Not Stated 21 13 20 2 3 1 l 5 2 TOTAL. 122 78 93 16 15 2 29 20 9 16 200 126 74 3 : Epilepsy Modified by Treatment. 91 ten per cent., dentition nine, or four and one-half per cent, and acute sicknesses sixteen, or eight per cent. The chief premonitory symptoms observed in my cases are maniacal violence in periods varying from a few hours to several days, this in about ten per cent. of both sexes; rapid debilitation up to the moment of seizure, followed by recuperation equally rapid in about seven per cent. also of both sexes; running and clutching, in about five per cent. male and three per cent. female; and the epileptic cry in about sixty per cent. of both sexes. There are also sev- eral individual cases worthy of mention: One boy rotates rapidly on one foot, and another on both feet before falling; a boy who professed to have no fear of thunder and light- ning was always seized at the approach of a storm, with spasms, which continued throughout its duration. Gowers says that aura occurs in one-half of all cases of epilepsy, but this I believe to be too high an estimate, and that it is more rare than is supposed. In the 200 cases I can find only twenty-nine aurae, as follows: MALE FEMALE TOT. Pain in praecodia and sharp stinging sensation traveling from left hand upward, and down left leg.................... l l Extreme nervousness, .......................................................... 1 1 Tickling in palm of left hand............................................... 2 2 Pain in the head...................................................................... 1 2 3 Stinging sensation in right arm............................................. 1 1 Stinging in right toe and foot................................................ l l Burning in face..................... 3 3 Nausea and vomiting.... 1 2 3 Sensation of suffocation... 1 1 Peculiar sensation in feet....................................................... l l Rigors ................................ ... 1 l Sleepiness ...…...........….......…................ -------- 1 1 Tinitus aurium.…..............................................…................. l 1 Pain in abdominal region, traveling upward....................... 4 4 Tingling sensation in both hands.......................................... 1 1 2 Peculiar cold feeling in breast................... ... 1 l Before spasm everything grows black 1 l Numb feeling in left foot....................... l l 16 13 29 - *_ 92 Martin W. Barr. From my own, and other records placed at my disposal, numbering some 500 cases, and covering a period of forty- five years, I gather the following data of deaths from epilepsy: AGE PERIOD. MALE. FEMALE. TOTAL. 5 0 0 0 5-10 7 1 8 10-15 7 3 10 15-20 17 4 21 20-25 11 4 15 25-30 0 1 1 30-35 0 0 0 35-40 2 0 2 40- 0 l 1 Total, 44 14 58 The excess of males—forty-four, against fourteen females--is noticeable. The periods of greatest mortality are from fifteen to twenty and from twenty to twenty-five years for both sexes. That epileptics have filled exalted stations in life, and that many noted men of affairs have belonged to this class, is well known. To the wealthy or to the fortunate is opened every amelioration, even that of occupation and the many social diversions, but it is to the family of moderate means, to the bread-winner, or to the very poor, that the burden of such a member proves insupportable, more espe- cially, when to the mother this added care brings all the nameless terrors of ills threatening children coming to the birth. A source of daily anxiety to others, the unfortunate is himself, in many instances, gradually forced into a life apart. Cut off more or less from school companionship and association, opportunities narrow for discovering that occu- pation for which he is best fitted, and consequently, means of training also. Indeed, however well prepared he may become, his infirmity must always prove an impediment in securing positions of trust and responsibility. An object thus of terror or of pity and commiseration, he gravitates to a life of self indulgence or of monotony and loneliness tending greatly to mental deterioration; a deterioration fur- thered by temptation to deviate from the regular routine and special diet, prescribed though it may be by a family Epilepsy Modified by Treatment. 93 physician in whom he places the utmost confidence. Not only this, but various phases of the disease are character- ized by wanderings, delusions, or even violent acts, of which the patient may be oblivious at the time, but which render him none the less dangerous because irresponsible. I recall one young man most violent during seizures which were unfailingly characterized by a desire to kill his mother; another, ordinarily quiet and inoffensive, having delusions of persecution, would alarm the neighborhood at night by running out half nude and holding conversations with the Deity, and finally in great bites, began literally, to eat himself up at''the command of God;” a woman, twice poisoning herself with Paris green, would swallow whole boxes of buttons, and at last committed suicide by leaping from a third story window; yet another, a woman of means—gentle, refined and cultivated —capable of managing her own business affairs, I saw not long since in the streets of Philadelphia, kicking, scleaming and struggling with a policeman while surrounded by a jeering crowd. - Both home and community life revolt from such disturb- ance of equilibrium. An effort to escape from these condi- tions—conditions intensified by rapid increase, as yet unre- strained by suitable marriage laws—led to the crowding of these unfortunates into alms-houses; these in turn, seeking relief, found it only in insane hospitals or in institutions for the feeble-minded. Here again, was a double wrong; to the institutions, a care quite apart from their legitimate aims—to the individual, a palpable injustice, not only plac- ing him in a false position, but condemning him to an asso- ciation which could not conduce to his advancement. Treat- ment he received, and that of the best, but in hospital or institution wards he was more lonely than at home, with no added motive for active pursuits, no incentive to arouse a sluggish will. Something better therefore, than asylum life —which offered no training to children and nothing to able- bodied men and women beyond mere physical care—was needed, and the century so fertile in philanthropic meas- ures, proved ready to meet the demand. Following close upon the interest in mental defectives, came efforts for 94 Martin W. Barr. relieving the conditions of epileptics, finding their best and truest fulfillment in the development and perfection of the colony plan. In this, as in the rescue of the imbecile, France led the way in a refuge for young epileptics at Laforce, near Bordeaux, founded in 1862, by the Reverend John Bost, and this example was quickly emulated by Ger- many which, in the “Bethel Colony” at Bielefeld, gives to-day a model to the world. Since then Germany and Switzerland show together some twenty-eight institutions for this class of unfortunates, France two and England three. Prussia has made provision for nearly 1,000, while with us, thirteen states—Maryland, Illinois, Pennsylvania, Wisconsin, Minnesota, New York, New Jersey, Ohio, Mich- igan, lowa, California, Virginia, and Massachusetts—are pressing forward in the work, each having special homes in addition to the epileptic wards found in most alms-houses, hospitals for the insane, and for those classes of defectives with whom epilepsy is variously associated. Valuable as has been to science the massing of the afflicted in asylum wards, facilitating the collection and comparison of data, it cannot be denied that it does not attain the end desired for the individual. With all the benefits of skilled treatment and multiplied creature com- forts, a life of invalidism with nothing to divert one from the shadow of coming ill, is at best but a maimed exist- ence. Without the stimulus of congenial employment and the continued awakening of the powers within, one loses the sense of “going on and on and ever to be,” and sinks into a dull apathy which can hardly be termed living. It was the knowledge of this, as well as the conviction of the certainty of ends to be attained even by a child, putting forth his best efforts and working among his peers in fair and equal competition that has been at once the inspira- tion and the success of Bielefeld, and of the Craig Colony, which is so rapidly following a noble example. It is related of the good Pastor von Bodelschwingh, that, wishing to extend the work begun at Bielefeld with four epileptics, he issued a circular, asking of every mother in Germany, a penny as a thank offering for each perfect, Epilepsy Modified by Treatment. 95 healthy child. The pennies came showering in, and among them, five from a sorrowing mother, who gave thanks for two infants gathered safely in the arms of “Him who lov- eth children.’’ From this small beginning, Bielefeld has grown, in thirty years, to a village community numbering 3,000 prosperous, industrious, happy citizens. Men, women and children are being educated and trained for the many avocations which render the community largely self- supporting. Bound together by a common tie, a sorrow thus shared is more than halved. A sense of mutual dependence, for them is more to be desired than independ- ence. A friendly guardianship leaves the individual untram- meled in all that does not interfere with healthful living and one may judge of the many opportunities open for choice, from the fact that thirty callings. for men are provided, many of which women may share in addition to the occu- pations of the household. Not alone their own, do they consider, but another’s good; medicines are sent on application, with or without payment all over the world, regardless of sect or nationality, and not less than 50,000 epileptics have been benefited by this charity. The Craig Colony in New York, beginning with a larger area—nearly 2,000 acres—and working on much the same lines, may yet surpass even this, ample space giving opportunity for the development of many industries. The substitution of home for institution life by division into small families, according to condition, social standing, sex or previous occupation; the opportunities, of schools for the young, of training for all according to indi- vidual proclivity, and the many avenues opened for indus- trial pursuits and definite aims in life; and lastly, the scien- tific investigations leading always to greater ameliorations, are the essential principles of these splendid organizations which may well be emulated by all future communities of defectives. RESEARCH IN COMPARATIVE CYTOL- OGY OF THE NERVOUS SYSTEM OF THE VERTEBRATES.* By GUISEPPE LEVI, M. D. (Continued from July, 1899). FISHES. In this sub-class I have only studied Petromyzon planerii. Ventral Cells of the Medulla. These are spindle-shaped (with arrow-like sections): The nucleus is in the center of the spindle whose apices are prolonged into two dendrites. Their internal structure appears in different ways according to the method of staining adopted. In Nissl's preparations they seem to be formed of a chromophil sub- stance with minute granules, either round or slightly elon- gated; very diffuse, and more aggregated toward the cen- tral part of the cell; less in the distal portion of the den- drites. These granules are arranged in longitudinal fashion and are scarcely perceptible in the center of the cytoplasm, but are more distinct in the two dendrites. Besides these minute granules in the dendrites I have often found spher- ical chromophil granules deposited along the greater axis of the dendrite. In specimens stained with fuchsin, (Biondi's method) these granules take the color poorly; but one may see with much greater distinctness fine fibrils that wave in and out in a twisting manner and split into a Y and then reunite in bundles in a straight line. In this section I found that quite often the two dendrites were in the same Translated by Smith Ely Jeiliffe, M. d. Ph.D., and Helena Leeming Jeiliffe. [96] Comparative Cytology of the Nervous System. 97 plane and toward the poles of the cell, so I could follow easily the course of the bundles of fibrils and thus see with certainty that there was no direct passage of a single fibril from one dendrite to another. In order to assure myself that the fibrils took this course, I made some com- paratively thick (8–10 u) sections, and in these preparations also, found the evidence of the discontinuity of the fibrils. In the distal portions of the dendrites the fibrils are straight and parallel and do not anastomose. I ought to add that in any section of cells, l have noticed some parallel fibrils that do not anastomose, reaching as far as the neighbor- hood of the nucleus. In preparations stained by hematox- ylin neither fibrils nor chromophil granules are to be seen, but the whole cell appears to be finely granular. The nucleus is spherical with a large acidophil nucleo- lus without any basophil granules in the periphery. Scat- tered through the nuclear reticulum were to be seen large irregular acidophil masses. Giant Cells. As many of these are found in the brain as in the medulla. They are those that give rise to the fiber of Mauthner. They contain powdery chromophil granules which give a somewhat homogeneous appearance to the cell. Nevertheless on staining with fuchsin, one can make out short fibrils which go in all directions; in the den- drites the fibrils take a rather irregular course and are more evident. In the mid- and fore-brain we see other cells without cytoplasm, whose nuclei have acidophil reticula and small nuclei. Granules of the olfactory bulb. They have a nuclear acidophil membrane, which contains a reticulum and small acidophil granules. In these elements, as in the preceding, there is no basophil substance to be seen. Ependyma Cells. They have a very scant cytoplasm; the nucleus has little nucleoplasm with a few basophil granules. I append to this description an examination of the two diameters of the cell and of the nucleus, in micro- millimeters. The measurements were made by preference on preparations, according to Nissl (Sections of 8-12 u) 98 Guiseppe Levi. but sometimes, nevertheless the specimens were stained according to Biondi. I used an ocular micrometer (Oct. 2 and 3, Zeiss homogeneous Immersion ſº, Tube 160 m, m). From the numerous measurements made on each kind of cell, I have reported in this table the maximum measure, the min- imum and 33 between, according to whether the difference in volume was greater or less. In this table the measurements are lacking of the cells of the spinal ganglia of the ox, the bat, the frog, of Scyl- lium, and of Petromyxxon; because l was not able to obtain them in a good state of preservation; in the same way those of the Urodele which were too much altered by their passage through nitric acid. In the Urodeles instead of the granules of the cerebellum I measured the granules of the olfactory bulb, which, as I have said, have a struc- ture identical with the first, and proved to be better fixed. In the cells in which the cytoplasm was very scant, I omitted to give the diameter of the nucleus, as the differ- ence between the diameter of the nucleus and the cytoplasm was hardly worth mentioning. - l will add that I do not give to these measurements an absolute value, as they have been made on sections of cells and not on entire cells, but as all the specimens have been taken from about the same thickness, they have a certain relative value. We will now see if it is possible to correllate these scattered data. The best method to pursue seems to me to be the following: to bring out distinctly first those charac- teristics which are common to all the cells, or at least to some of them, and then look for differentiated characteristics. There is no important cytological characteristic that enables us to clearly separate nerve cells in general from all other elements of a non-nervous character. There is some such character, in fact, several, in a group of elements which in the description I have called large cells, and which correspond to the somato cells (or somatochrome) cells of Nissl. These same characteristics are much less clearly, marked in another group of elements, Nissl's Kernzellen. In a third group of cells called by Nissl, Granula, Granules of Spinal Ganglion Cells. Anterior Horn Cells. Dorsal Cells Purkinje Cells º: ſpallium cells Basal Meuroglia actory - bulb Of Cytoplasm. Mucleus Cytoplasm Nucleus Cytoplasm Nucleus Cytoplasm Nucleus Urodeles). Cytoplasm. Mucleus Ganglia ... 23x19 13x8 ... ... 6x5.5 17x12 10x7 5.5x3.5 19x12 13x11 7x2 Pipistrello 21x20 11x10 . 16x13 7x7 4x3.8 14x9 10.5x7 5x2 - . 15x14 . 7x5.5 7x5.5 * * * 35x20 25x17 14x12 6x5 * * *. 5.5x3.5 * * * 22x17 Cavia-(Guinea Pig) #:# 85x63 76x70 17x17 7.6x6.5 6.5x6.5 5.5x5.5 * - Cane. (Dog) 17x10.5 7.6x7.6 * * * * Bue 21x21 13x9.5 29x2 19x19 7.6x5.7 - -- 50x30 19x1 1}ºio '#3 9. #: X. x17 .5x .5x9.5 5x7 x Testudo (Turtle) $7.3; 133.9's 36.13 sº." 3.5.3.5 19x17 ... . 19x9.5 .... 70x47 29x19 Zamenis 60x49 16x16 28x12 47x32 12x12 17x11 21x21 13.5x9.5 17x12 8x6 7.5x57 15x9.5 9.5x9 76x60 23x19 46x26 Rana (Frog) 55x48 19x13 30x14 25x20 14x12 7.2x6 14x11 11.3x9.5 5.7x4 13x9.5 -- 15.5x12 14x14 13x10 10.5x7 3.5x11.5 10x10 .. - 13.5x10 17.5x15 9.5x2.5 18x24 ------------ 16x14 12x9.5 23x21 18x16 19x13 21x20 19x14 18x12 20.5x19 11x8 13.5x12 7.5x7.5 Tritone (Triton) 1 Proteus (Salamander) Spelerpes (Salamander) .. --- º:::::::::::::::::: TInca (Tench) 3:#; º:: - 14x7 ................................................... " -- - 57x21 20x18 1. - Raja (Ray) 29x23 13.5x13 łłºś ----------------------- ----- XI 1-> -------------- 95x48 32x33 . 6x5.5 6.5x55 23x22 ... 47x42, 18x18 ... Petromyzon (Lamprey) 23x23 100 Guiseppe Levi. (adopting a name already in use) these characteristics are seen no more. There are, however, others of a non- cytological nature to be found, by which they may be distinguished from the cells which are not nerve-cells. Naturally in this category we find many steps of transition. I shall treat separately these three groups of cells, but only from this synthetic point of view and not with the idea of making a classification of nerve cells. These have been studied too little to make a classification possible in this day. I will, for convenience, keep to Nissl's nomen- clature, although it is but little used, and although the object of my distinguishing points differ from those of Nissl. Beside Nissl, Ramon y Cajal has also compared the cyto- logical characteristics of nerve cells, but he did not estab- lish the fundamentally differential characteristics of the cells, and confined himself to distinguishing among them three kinds of nuclei: 1st, nuclei in which the nuclein is collected in a homogeneous nucleolus; 2nd, nuclei in which this is deposited in granules of different sizes; 3d, nuclei in which the nuclein forms anastomozing trabeculae. In the résumé of my observations I shall seek to establish whatever there is in common between my distinc- tions and those of Ramon y Cajal. 1. Somatozellen. To this group will belong all the large and medium-sized cells of the spinal ganglia, of the anterior horn (and their homologues in the lower vertebrates) the cells of the cords of the medulla, the Purkinje cells of all the animals I have studied; in addition, the large and giant pyramidal cells of the cortex of mammals, the larger cells of the pallium of some reptiles (Testudo), the large cells of the convolutions of the hippocampus of mammals, the mitral cells of the olfactory bulb and the more important ganglion cells of the retina. First to speak of the structure of these cells, I will say a few words on their coarser characters of shape and size. The form varies not only in the different elements in the same animals but also in the homologous elements in dif- ferent animals. The cells of the spinal ganglia are round in all the mammals and have the nucleus in the center; in Comparative Cytology of the Nervous System. 101 Zamenis, in the frog, in Bufo, in Tinca, they are elongated, and have a decidedly eccentric nucleus. This difference in form and in the position of the nucleus is certainly in accordance with the special arrangement of the chromophil granules, and the fibrils of the cytoplasm; the impression is given that the nucleus may have been pushed to the per- iphery of the central part of the cell; and indeed the mar- gin of the nucleus turned toward the outer appears to be buried; it may therefore be stated with certainty that the differing forms of the cells and the eccentricity of the nucleus is connected with the presence of special structures. In Testudo Graeca the cells of the spinal ganglia are lobed. The nucleus is found in the center and forms only a small part of the total volume of the cell, and is con- nected by means of a narrow bridge with two or three triangular lobes (Fig. ll). On two occasions I have hap- pened to see a division of the cell in two parts joined by a bridge, in each of which there was a nucleus of normal appearance. I believe that in this case it was a cell with two nuclei (an exception for the spinal ganglia) which was divided into two lobes. The connective tissue capsule always follows exactly the irregular outline of the cell. Any morphological significance that I can give to this strange form of cell, can be presented only as an hypothesis. Concerning the form of the cells of the anterior horn (and of the ventral cells in the lower vertebrates) I can say that every class shows some diversity. The condition which more than any other modifies the shape is the man- ner in which the dendrites arise. While in the mammals, one can make a pretty sharp distinction between the cell body and the dendrites, since the diameter of these is, at their point of origin, comparatively small when compared with the cell body (in Raja more than twelve mikra); in Teleostei in the reptiles and amphibians, the cell body continues indistinctly in one or two large dendrites which become very much attenuated. In Selachiens and in Cyclo- tomes the size of the cell body diminishes still more when compared with the size of the dendrite, especially in Scyl- lium, where the dendrites preserve a size which is remark- 102 Guiseppe Levi. able for its extent, tapering off only at a great distance. The differences in size are therefore noteworthy between homologous cells of different animals. A compar- ison of their diameters (see table) authorizes the following conclusions: 1st, that there is a direct connection between the size of the cytoplasm, the nucleus, and the nucleolus in all these animals, except the Urodeli, in which the nucleus is much larger in relation to the scanty cytoplasm; 2nd, that the difference in size which we find between the homologous cells of different animals bears no relation to the position which the animal occupies in the zoological scale, but are, instead, in direct proportion to the size of the animal; for example, although there is a difference in size between the cells of the anterior horn of a bat and those of a dog (of double diameter) or those of an ox (four times the diameter), there is almost no difference between the cells of the guinea-pig and those of Scyllium. At the first glance it would seem that the cells of mammals are much larger than those of the lower animals. But in the comparison, another point must be considered; the size of the dendrite. I have said that in mammals these are not only more attenuated than in the lower vertebrates, but they have a different structure from the body of the cell, while, on the other hand, in the lower vertebrates the proximal part of the dendrites is larger, and has much the same structure as the cell body. I must however admit, that for morphological reasons, of which we are ignorant, the cyto- plasm, instead of remaining around the nucleus may be spread out in large (appendages) rays, which then imper- ceptible are continued into true dendrites which thus give rise to a decentralization of the cytoplasm. In comparing the size of the Somatozellen in the differ- ent classes of vertebrates, it is necessary to take into consideration, especially in the lower vertebrates, the space occupied by the perinuclear portion of the cell, also that from which the dendrite springs. Let us go on then to examine the internal structure of these cells. Cytoplasm. We can here distinguish with proper meth- ods, a certain part which takes any coloring substance Comparative Cytology of the Nervous System. 103 readily, and which I have called the chromophil part, and another which in the presence of such a substance remains pale, and which may be called achromatic. This part I have indicated by the name fundamental substance. The test adopted to distinguish these two parts of the nerve cell, is the difference in their action with the Nissl method; I united under the name of chromophil substance all the parts of the cytoplasm which remained brightly colored with thionine (or with methylene blue), resisting the decolorizing action of analine oil. I called the funda- mental part, that which remains pale, or is very faintly stained. Moreover, this difference in the micro-chemical action shows also with other methods; with Delafield’s hem- atoxylin diluted with iron, hematoxylin of Heidenhein, the granules and the chromophil grainlets are intensely colored. They constitute the fundamental substance. Chromophil part. I have already spoken of the micro- chemical reaction. The strong affinity for thionine, a sub- stance which is not so strongly basic as is, for example, methyl green, and the fact that in staining with Biondi's method, they are tinted, although very faintly, with acid color, and not with basic dyes, enables us to state that they have weak basophil properties. It is not my intention to discuss their nature, but only to describe the principal morphological characters. I will cite only the work of (1) Benda (2) Nissl, (3) Held, which deal especially with this question. The hypothesis of Held that it does not pre-exist in the shape of large masses in the living cell, but that the aforesaid masses are formed artificially by virtue of the fixation of the agglomeration of granules, has not met with much favor; and on the other hand, the already numerous studies upon the pathology of the nerve cell tend to completely overthrow it. The forms that the chromophil substance assume are very different. It may appear in form of powdery granules (in Petromyzon in Tinca) or of larger granules, (in the ox and (1) Benda, Neur. Centralblatt. 14, No. 17, 1895. (2) Nissl, Neur. Centralblatt, 15, No. 3-4, 1896. (3) Held, Arch. f. Anat, u Physiolog., 4-6, 1895. 104 Guiseppe Levi. dog). Concerning the fine structure of these granules I ought to remark that Flemming (4) had always found them (at least in the spinal ganglia) in the shape of little granules. I have also stated elsewhere (5) that the granules have often a homogeneous appearance. I believe I was able to reveal this diversity in results, for specimens fixed by Hermann's fluid were rendered homogeneous, while in specimens fixed in sublimate, they quite often had a granular structure. The different appearance of the chromophil substance caused by the diffusion, compactness and arrangement of it, is noticeable also in animals that are closely related; still more, in different elements of the same animal, there is a certain uniformity of type preserved, especially between the cells of the anterior horn, and of the ganglia, according to the degree of variation in structure in the cell; for example, in the guinea-pig as many cells of the anterior horn as of the spinal ganglia have large isolated chromophil granules; in the dog and in the ox small scattered granules; in the dormouse, thick spindles, etc. In the dendrites, and in the peripherical part of the cells of the anterior horn in mammals, the chromophil granules always have an elongated somewhat fibrillary appearance. I have already indicated their size and number in the descriptive portion—l will say only that these filaments are always arranged along the greater axis of the dendrite and grow less in size and number according to the increasing distance from their point of origin. Paladino (2) calls them chromophil fibrils, distinguishing them from the true chromophil substance, and from the non- chromophil fibrils of the fundamental substance. I do not see the reason for this distinction. What test have we to distinguish these filaments of the chromophil substance from the parts deeper in the cell, which can take, as we have seen, such a variety of shapes? In the dendrites of the cells of the anterior horn of Scyllium (and in some species of the lower vertebrates) the granules are remarkably thick, and present this thickness (4) Flemming. Arch. f. mik. Anatomie, Vol. 36. (5) Levi G., Riv. di Pat. nervos e mentale, I, 1896, p 5. Comparative Cytology of the Nervous System. 105 for a long distance throughout the length of the dendrite. Many dendrites are almost wholly lacking in chromophil granules; for example, those of the large pyramidal cells of the cortex. Fundamental Part. I will confine myself to a reference to the literature of the last two years on the subject. Nissl (3) at first attributed a granular structure to the fundamental substance, but in following up some work of Becker (4) he was persuaded that fibrils were present in it. Lenhossek (1) attributed a spongy structure to it in consequence of his observations on the ganglia of the ox and of the frog. In a communication of April, 1896 (2) he then stated that he had found structures in the dendrites of the cell of the anterior horn of the frog, and in the Purkinje cells of mammals—which continued in the fundamental sub- stance from the chromophil granules, and which had the appearance of (or imitated) a fibrillar structure, but they could not be interpreted as fibrils. Flemming published two works on the subject; in the first (3) he confirmed his research of 1882, by which he was led to admit in the cells of the spinal ganglia of mammals, the presence of short wavy fibrils, which con- tinued into the granules, and probably formed a net-work; in the second (4) he claimed to have seen in the cells of the anterior horn of a Teleost (Gadus) fibrils which were intertwined in the middle of the cells and parallel in the dendrites. He was not in a position to decide whether the chromophil granules bore any relation to the fibrils; at any rate the number of these is much larger in comparison with that of the granules. Dehler (5) observed in kindred cells of the frog a thick close network in which the chromophil granules were suspended. Held (6) denies the presence of fibrils in the fundamental substance. (2) Paladino, Rend. R. Acad. di Sc. di Nap., fasc. II, 1896, November. (3) Nissl, Allg. Zts.sff. f. Psych., Vol. 52. (4) Nissl, Neur. Centralbl., 3-4, 1896. (1) Lenhossek, Derfeinere Bau., etc., 1895 (2) Lenhossek, Pºrh. d’Amat. Gesellsch., Berlin, 1896, p 15, ap. (3) Flemming, Arch. f. mik. Anat., 46, 1895. (4) Flemming, Anatomische Hefte, 1896, hf. 3. (5) Dehler, Arch. f. mik. Amat., Vol. 26, 4, 1895. (6) Held, Arch. f. Anat. u Phys., 4-6, 1895. 106 Guiseppe Levi. Ramon y Cajal (7) believes that not only the funda- mental substance of nerve cells, but also the axis cylinder may be formed of colorless spongy substance, in which the longitudinal trabeculae are larger than the transverse ones, and that fibrillary appearances, seen by many authors, might be due to a retraction of the cytoplasm, by which only the longitudinal trabeculae were seen. In a previous work of mine (8) I was able to confirm the result of Flemming on the spinal ganglia. Lugaro (9) proved it in connection with the cells of the anterior horn of mammals. Dogiel in the ganglion cells of the retina (10) and by means of staining, in life, brought out, beside the chromophil granules, large fibrils which ran through the cell, lying across them, and passed by a dendrite into another. In the spinal ganglia of mammals fibrils are seen which all describe a regular curve. (11) Pflücke, in the nerve cells of invertebrates found chromophil granules joined together by filaments; he holds that the granules and filaments are formed from the same substance. MacClure (2) on the other hand, on the same material, has noticed that the fibrils and chromophil granules have a very different micro-chemical relation. Paladino (3) in a Selachian (Alopias vulpes)saw what he called non-chromophil fibrils that were uniform and contin- ued through the whole body of the cell, and which he was able to follow as far as the branches of the dendrites. From these bibliographical data it is seen that the large majority of these writers agree in admitting a fibrillar structure in the nerve cell; there are, however, many differences in the particulars concerning the direction and structure of these fibrils. Nor would it cause astonishment that so many are interested in this discussion if one could realize its great importance, from the physiological deductions that can be drawn from it. (7) Cajal, Revist. trimest Micrograf., Vol. I, No. 1, 1896. (8) Levi. l. c. (9) Lugaro, Riv. di Pat. nerv. e mentale, Vol, I. 8, 1896. (10) Dogiel, Arch. f. mik. Amat., 46, 3, 1895. (11) Anat, Anxieger, 12, No. 6, 1896. (1) Pflucke, Zeit. f. Wiss. Zoologie, 40, 1895. (2) MacClure, Princeton College Bulletin, Vol. VIII, 1896. (3) Paladino, l.c. Comparative Cytology of the Nervous System. 107 I believe it to be opportune, just here, to point out an error into which those writers have fallen, who state that Flemming was not the first to demonstrate the presence of fibrils in the nerve cell; but that he only confirmed a previous (old) discovery of M. Schultze (4). As has been noted, this author believed that the fibrils were continued in the cell, and converged in such a way that they radiated from the dendrite towards the nucleus, without anastomozing, and that they contin- ued then into the cylinder axis, thus being unable to go cross-wise in the cell. Just to what the fibrils seen by M. Schultze correspond we cannot exactly say. It is probable that a large part of the striation described by him was, as Flemming believes, given (caused) by the chromophil gran- ules of the dendrites. In any case it is evident that this structure has nothing in common with that recently described in the nervous system, and is a thing which only tends to cause a deplorable confusion. I have been able to study thoroughly on my large quantity of material the fundamental substance of the nerve cell. The cells best adapted to this study are those of the spinal ganglia in Bufo and Zamenis and the ventral cells of the medulla in Scyllium. The constituents of the fundamental part, unlike the chromophil substance, takes the coloring matter with difficulty, and it is necessary to stain it very intensely to bring them out. I would add that they stain more easily with acid than with; aniline colors. They therefore differ in their micro-chemical relations, from the chromophil granules. This characteristic would not be enough to exclude the possibility of fibrils and chromophil granules being formed from the same substance; but as we shall see, we can resort to other arguments. The arrangement and structure of the fundamental substance in the central cells (anterior horn) show consider- able variation in the different animals. In the mammals in the deeper part of the cell, it is impossible to distinguish fibrils on account of the abundance (4) schultze, strickers Handbuch, 1871, Vol. i. p. 131. . 108 Guiseppe Levi. of chromophil substance, but in the part, nearer the surface the chromophil granules being scarcer, one can see slightly twisted fibrils, which have the same direction as the fibrils of the nearest dendrite, except that it is not the single fibrils, for these are discontinued, but the bundle of united fibrils, that is continued in the dendrite; but it gives one the impression that the dendrite goes to reinforce the cell. (1) What relation exists between the fibrils proceeding from the dendrite and the deeper part of the cell, I have not been able to establish. In the lower vertebrates (I turned my attention more especially to Scyllium, because its cells offer the best opportunity for this study) one may see this difference in structure, between the superficial and deeper areas of the cell, but much less marked; by reason of the distance which separates the chromophil granules, one can distinguish a few short isolated fibrils, of no particular direction, in the deeper portion of the cell; in the superficial region, on the other hand, the fibrils, though isolated and few, do not point in different directions but are all turned" together with the granules toward the dendrites. But what relation the fibrils of the periphery bear to these of the deeper area, it was not in my power to ascertain with any certainty in Scyllium. Given this structure, they are probably related to each other in the following way. The bundle of fibrils in the dendrite would go to supply the superficial portion of the cell, now continuing from one dendrite into the other, now turning around toward the interior of the cell, where the fibrils crossing each other in every direction, would form a net with large meshes. Flemming (2) had a little different conception of the behavior of the fibrils in the center of the cell; perhaps in the cells of Gadus, selected by this author, the conditions are different; he believes that the fibrils go in netted lines from the dendrite into the center of the cell where they take an irregular course. He does not point out the fact of the spreading out of the fibrils of the dendrites at the periphery (2) Flemming, I. c. Comparative Cytology of the Nervous System. 109 of the cell which I have observed in mammals and in the Selacians. I will say a few words on the fibrils of the dendrites: in mammals they are rather long and serrate: and only slightly twisted, therefore I think I can safely conclude that they are independent; however, it would have been impos- sible to see them anastomosing. I believe that they form very long meshes, in the Silachii the more remote they are from the perinuclear portion of the cells, the fibrils gradually became longer, straighter and more crowded, and anastomose less frequently, so that here, by reason of the lessened crowding of the fibrils they can be seen distinctly; then when the dendrite loses the chromophil substance the fibrils can scarcely be differentiated from those of the cylinder axis. We thus see that while in the mammals the structure of the cytoplasm changes distinctly from the dendrites to the center of the cell, in Selachii it has a gradual transition. And this agrees with what I said on the relationships between the size of the central part of the cell and the extent of the dendrite, and goes to confirm my hypothesis that in the central cells of the lower animals, there is a decentralization of that part of of the cytoplasm of the nerve cell which is devoted to the higher functions. A very instructive material for the study of the funda- mental substance of the central cells of the medulla of Petromyzon, the study of these elements show: 1st. That we can bring out the fibrils even in these elements in which the chromophil substance is scattered in minute granules, when it is not very abundant, by immers- ing in acid fuchsin, which stains the fibrils more deeply than the minute chromophil granules. 2nd. That the fibrils may in any case be independent of the chromophil substance, and it is therefore improbable that they are formed of the same substance, for in Petromyzon we see that the chromophil granules are arranged in longitudinal series and are not suspended on the fibrils as is usual. 3rd. That in the center of the cell the fibrils not only 110 Guiseppe Levi. form a net, but that bundles of fibrils, disconnected, but parallel, can go through the entire longitudinal axis from one dendrite to another, remaining parallel. We have then, in these elements, a lesser complexity in structure, which is perhaps in proportion to the fewer number of dendrites that they possess. In the other central cells the fibrillar structure of the fundamental substance is rarely thus marked, as in the central cells of the medulla. In the dendrites of the pyramidal cells of the cortex, destitute of chromophil substance I was able to follow the fibrils much better for a considerable distance (as far as 20 u) from the distal portion. (To be Continued). THE LEGAL DISABILITIES OF NATURAL CHILDREN JUSTIFIED BIOLOGIC- ALLY AND HISTORICALLY.” By E. C. SPITZKA, M. D., New York. (Continued from July and October, 1899.) The superiority of natural children magnifies their po- tency for evil by endowing the vicious propensities, growing out of an egotism as intense as it is unscrupulous, with greater and pernicious executive power. Primitive society'" must have early been compelled to resort to restraints or remedies, as retaliatory and cruel in appearance as the con- duct of bastards was provoking by aggression, reckless of consequences in its atavistic, and hence, also, savage robustness. Multiplied and repeated reactions of the com- munity against individuals, gradually grew into a public policy against bastards as a class and in their entirety. This policy found its formulated expression in the laws relating to this subject. These have two aims: one, the restraining of the excesses by which a community is liable to suffer at the hands of the infelicitous creatures of offend- ing already accomplished; the other is the prevention of a spreading evil by checking repeated, multiplied and like offending 2 Practically the proper pursuit of the first object accomplishes the second also, though indirectly! The discouragement of the procreator is effected by the discour- agement or—if you will-persecution of those natural children already born to others. The Law’s harsh dealing with such natural children is an object lesson of deterrent effect on potential producers of other such children; a posi- tion happily illustrated by one who, both historian and poet, had paid some attention as barrister-at-law to the subject *All Tables to be found at end of article. [111] 112 E. C. Spitzha. of bastardy. Walter Scott"' represents Quentin Durward and his wards, as hopelessly lost, had their salvation depended on the manhood or justice of the ferocious “Boar of the Ardennes.” But he seizes on the latter’s bastard, and hostage-holding Wolf Ebersohn extorts his party's Safety at the point of a dagger held to the latter's throat. In like way, Justice holds the procreator—otherwise beyond her reach—in terrorem by her sword poised before his eyes over the bastard alter ego, “sinless child of sin” though it be! The Cuckoo had become extinct in the “Contest for Existence,” had he encountered uncompromising exclusion of his eggs from the nests of others, instead of the foster parents whose indulgence encouraged the loss of a funda- mental instinct. It is the paternal partiality to which I have for a reason now made evident, directed attention in opening the subject, which law operates through. That man whom any appeal can touch, must feel apprehensive mis- givings as to begetting children, who, as the evidence before his eyes may show him on any day and on every hand, are doomed to obloquy and ostracism. He will not feel encouraged thereto by the spectacle of a father of a filius nullius vainly struggling, by every scheme despair may suggest and any device the loop-hole finding pettyfogger’s rascality can contrive, to provide for his offspring. He must reflect seriously before entailing, like that father, bickerings at home during his life and litigation in court after his death. Even if these warnings did not suppress illicit indulgence, and instead merely drove its practitioners to resort to expedients for preventing the results of the latter, something fundamentally much more important than such suppression is accomplished: The object lesson effectually checks the shamelessness and provoking audacity with which bastardy would be otherwise paraded, and by being so paraded insensibly but surely obliterate the traditional and custom-sanctioned demarcation between legitimacy and illegitimacy. Were this once broken through, the vitiating influence of living examples of an equality or preferment enjoyed by the offspring of indulgent and infatuated fathers, such as have been hereinbefore adverted to, would infect The Legal Disabilities of Natural Children. 113 the rising generation,” entirely pervade the next and finally one of the later would see the Strumpet placed on the same level with her whose name has too solemn a sound to her offspring and too sacred a one to her partner, to be mentioned in the same breath. That the Law may exert a direct prohibitory influence, is shown by an instance in ecclesiastical history. At a council held in London, 1278, Archbishop John of Tours ordained that clerics, (specializing those who had been con- secrated) shall not presume to bequeath to children born unto them while they were or had been in holy orders. Any bequests made in violation of this were declared forfeit to the church of the testator. It is to be carried in mind, that celibacy had not yet become the universal practice; that the decree was well calculated to enforce and maintain it, there can be no doubt. It laid the ax at the root of license, by the deterrant spectacle of deprived and homeless children, whom their fathers would have attempted and would have failed to guard against want. Were there no proof of this, it is found in the energetic endeavors made by those violating ecclesiastical discipline, to have the law abrogated. In one case such efforts were, in a way, even crowned by success.” With the introduction of Christianity, legitimacy was made one of the conditions of taking holy orders. Bastards were at first declared ineligible to the priesthood. Later, when the Pontiff exercised the power of dispensation, exempting can- didates from this restriction, a special reservation still entailed disability for the higher canonical degrees. This ordinance does not appear to have been repealed with the establishment of the Anglican Church; but if it survived, it was to become a dead letter. Such it became temporarily, through flagrant violation, and with disastrous results at two periods'' of the history of the hierarchy of the original Church. To sympathetic minds, irreconcilable to the abstract injustice done the bastard-injustice which neither is nor can be disputed—l would suggest that there are other sufferers at the hands of the law, at least as much if not 114 E. C. Spitzka. more deserving of sympathy; that the names of these is legion; and that not legal wisdom, nor other kind of human wisdom is able to devise remedies compatible with the practical operation of any system of human laws whatever. The disgrace, humiliation and shame incurred by the sen- tenced criminal are more keenly felt by his guiltless kin than by himself. The judge, who imposes a term of imprisonment or sentences to felon death a criminal, prac- tically punishes with worse than imprisonment an innocent family deprived of its supporter; with worse than death the unarraigned, often the unborn bearers of the name, branded in the punishment of the one condemned. For one misdemeanor committed by a married man, or any member of good family, if there be not twenty offenses potential, but which remain uncommitted because of the deterrant influence wielded by law, through the picture of disgrace it threatens, then those of either profession, who have discussed the question of criminality on this floor, must plead guilty to ignorance of the motive- springs of human action; and l beg to be allowed to join in that plea. It seems, however, to be generally agreed that it is precisely through such influences as those just men- tioned—higher ones they may be called, in contrast with those of physical fear or mystical awe-that law consciously or unconsciously appeals and operates to-day. Unmistakable is the language and Draconian seems the spirit of the old Civil Law. It neither permitted the spu- rious born to inherit from nor bequeath to kin. That is, he could not inherit at all, and could not bequeath, if it involved any assumption on his part that the beneficiaries were kin or heirs of his person. This was indeed a realiz- ing of the legal designation adopted in English Law: filius nullius. The more liberal law of the later days of Rome allowed one-sixth of the estate of a father who had died intestate, to go to his illegitimate offspring, provided no legitimate heir existed. How far this and like modifications apparently in the direction of humane equity, but substan- tially in the direction of laxness, opened the door for inno- vations to eventually lead to demoralization, has been The Legal Disabilities of Natural Children. 115 indicated in mentioning the allowing bastards to inherit from brothers. The prejudice underlying statute and code laws so unfavorable to natural children, evident in Justinian's, as in all its outgrowth codes, was also manifest in the unwritten behests of popular usage and general custom. Those who as burghers of the Free Towns were the very bone and sinew of Europe in their day, closed the doors of their guilds,” and in some cases the gates of their towns against those of illegitimate or doubtful birth. In many places bastards were not allowed to appear in courts of law at all; in others, if they were permitted to give testimony, it was not privileged inasmuch as the bastard was inter- dicted the making oath; lacking that sacramental sanction his evidence was of only relative value; it was never allowed to weigh, when contradicted by a legitimately born witness or, on the other hand, uncorroborated by such. A man of legitimate (as it was significantly styled in Ger- many, “honest”) birth was not bound to give a bastard Satisfaction in duello; and where the symbolic meaning of the bar-sinister was strictly interpreted the bearer of the taintured shield could not figure in tournament. In hum- bler life, exclusion was carried into the place of worship. If allowed to attend divine service, his place was one remote from the altar, where fallen women, the hangman'." and others of “dishonest” birth, life or occupation were tolerated. While these humiliating cruelties have become obsolete, a remnant of their spirit survives in the German Law. When an accident occurs to a female member of the nobility, in the shape of a bantling; the latter does not inherit the nobility of the mother’s family; he therefore may use neither that family’s crest nor name.'" As society became more firmly established, the gross features of bastardy appeared less obtrusive, and its influ- ence if not less harmful, less conspicuously so. An incli- nation to temper with leniency the stern aspect which law presented to the mothus resulted. No longer was the Commonwealth disturbed by spurious claimants, false imper- sonators, assassin plotters and adventurous invaders.’" Bas- ards figured in the less tragical if not less contentious - : 116 E. C. Spitzka. battle-fields of the Law. As claimants of estate and title, or as exhibits in divorce proceedings, and such alleging crim. con., their situation invited rather an interested atten- tion than an antagonism by Law's representatives. They provoked entanglements which the ingenious delighted to unravel—or the reverse—and furnished forensic gladiators opportunities for display of dialectic prowess,” and oratorical outbursts anent the “wandering heir” and “discarded love pledge born by an humble but trusting victim to the purse proud patrician seducer.” The historic and romantic associations of the subject of natural children attracted the philosophical and literary among a profession deservedly celebrated for its many members who have ornamented other pages than those of the Calendar and Trial Record. To these particularly appealed the spectacle of the poor outcast, “Desdichado,” standing in the shade of poverty and contempt, watching anxiously a chance to take a place in a line of inheritors, thinned by a rapid succession of deaths. That vacancy after vacancy occurred, only to be filled by younger brothers, cousins and eventually, nephews or relatives so remote that their very existence may have been unknown to the former head of the House, seemed sufficiently bitter to justify pity. Pity became a stronger feel- ing, when the long procession of heirs of a family concluding it by the dying out of all its legitimately born members, the mothus attempting to assume their place and continue an apparently natural, and actually undisputed succession, the Law rudely brushes him aside and seizes as the estate of the Crown by right of Statute Law what would seem the child’s right by Natural Law. Sentiment might weep, abstract Equity plead, still the conservatism of those whose legal system our own is founded on so obstinately resisted innovation that the con- cessions to be mentioned were either shorn of any force or proved in effect quasi ironical affirmations of the contempt in which bastardy was held. The Common Law of Eng- land proclaims the high regard for legitimacy which seems to have been developed at an early period as a character- istic feature of Anglo-Saxon public and private policy. His- The Legal Disabilities of Natural Children. 117 torians have laid special stress on the reconciliation to Plantagenet rule, as cemented by the strain of legitimate blood in the veins of Henry II. This sovereign was the undoubted heir of a long line, beginning with the Con- queror. But the latter had been not only usurper in England, but filius nullius in his own land and disputed patrimony. The regard for Henry’s title was due to his descent from another line, a fact which, aside from its being flattering to Anglo-Saxon pride, gave him a faint halo of legitimacy. He was the great-grandson of Margaret, Scotch Malcolm's queen, in whom, as the granddaughter of Edmund Ironsides, the true hereditary right to England's throne resided. While this but instanced popular feeling, another transaction served to embody it in parliamentary record, as testifying to the jealousy with which legitimacy once estab- lished became and remained guarded."" Had the spirit, dictating it, prevailed throughout, at least one phase, if not the whole War of the Roses, had been avoided: The victor of Bosworth field set up a claim to the throne, characterized by Blackstone as “the most remote and unac- countable ever set up,” and which nothing could have given success to, but the universal detestation of Richard the Third.” The usurper and—as red-handed violator of the laws of the realm–outlaw had, in addition to commit- ting treason and rebellious invasion, violated a pledge of a solemn and momentous nature; when through the generos- ity of Parliament his illegitimate ancestor had been exempted from the severities of the laws on bastardy, and permitted to succeed to the titles and estate of John of Gaunt, exclu- sion from the crown succession was expressly stipulated in the clause: exceptio dignitate regali. The Damocles-like position in which this placed him, caused him to attempt obtaining special acknowledgment of the possessing de jure the throne he occupied de facto. But threats and cajolery, bribery, direct and through his agents were in vain; and Parliament remaining honorably firm, the usurper sought and found a better title to power than would have been the one thus obtained, by marrying the surviving represent- ative of the legitimate line. This made him King Consort 118 E. C. Spitzha. by right. As if to historically emphasize the fact that Henry VII was in no way the legal sovereign, but only a stranger welcome to a land he had been—as dispossessor of its lawful but unpopular king—an invader of, William of Orange was not alone crowned as King Consort only and not as king, but his coronation jointly with Mary was conducted exactly after the precedents, with the same cere- monies, and the employment of the precise formulas of a coronation which had taken place several centuries before. Aside from the “Greek Gifts” to be mentioned the Law of England gives the illegitimate child no other rec- ognition than the title “filius nullius,” which literally means the “son of no one” or “of nobody.” This is a fit pendant to the word “natural,”" which at once designating a simpleton when used as a noun, and qualifying the illegitimately born when used as an adjective, iillustrates how ludicrously figu- rative expressions of conceptions, having most remote starting points, may meet on common ground in speech. The doubtful privilege granted the filius nullius in the laws of England is his exemption from having to obtain that parental sanction of a contemplated wedlock which under certain circumstances is an indispensable condition imposed on legitimates. Free from parental restraints as regarded consent, the nothus however, could not marry without further ado. He had to assume the status of a “Ward in Chancery,” and an appointed guardian was empowered to grant consent to contemplated marital union. Lacking such guardian he could, after involving himself in the beautiful intricacies of Chancery, have “bans pub- lished.” It would appear reasonable for the nothus legally without honorable standing or kinship” and this privative status repeatedly reaffirmed, directly or by the implied sense of edicts, to regard himself reciprocally as free from the obligations to kin as he is deprived of their support and counsel. But notwithstanding this, and after his compliance with all the routines of chancery, if he undertake to marry, the law, for that nonce, does recognize the one it makes the son of nobody and regards without kin on any father’s side, as the brother of that father’s children, and the cousin The Legal Disabilities of Natural Children. 119 of that father's brother’s children ' It does this in forbid- ding his marriage with such. State, Medicine, Biology, Political Economy and Medical Psychology can afford to overlook the inconsistency and contradiction in the letter of a law, which in spirit is so intelligently provident against the danger of incest; a danger which is not at all an imag- inary one; for incest having been knowingly committed with and by bastards, is conceivable as occurring under legal sanction, negative at least, were no such provision existing. That incestuous marriage has taken place where a brother and sister, like DeFoe's adventuress, lived in ignorance of their kinship is notorious.** That such would be planned and consummated knowingly and deliberately if no injunction forbade, no one familiar with the bastard's character and with Egyptian and Syrian history may doubt. Among the provisions of our Revised Statutes, relative to the inheriting Real Estate, Section 19 declares that chil- dren and other relatives, who are illegitimate, shall not be entitled to inherit under any provision of the relating chapter. Section 14 provides that in case of an illegitimate dying intestate, the estate passes to the mother, and in the event of her death, to her relatives; as in the case of estate whose deceased possessor had been of legitimate birth. “In 1855 the Revised Statutes were amended, per- mitting illegitimate children, in default of lawful issue, to inherit real and personal property from their mother, as if legitimate (Law of 1857 c. 547 § 1). The Statute of Dis- tribution of personal property of decedents follows the same rule as in Section 14 above referred to “except that the widow of the illegitimate deceased takes precedence.” These latter provisions** appear simple equity; and do not violate any rights, natural or acquired, of legitimates. As regards the mother’s inheriting, our State code had been long anticipa- ted in the Common Law of England, where it is laid down specifically; it appears to me an alternative between a a beggar's consolation, and an irony of the Law, which as it were, makes an exclusively privileged person of the unfortunate mother by offering a premium or a token con- gratulatory of the departure of a living evidence of her error. 120 E. C. Spitzka. The Old Roman Law seems to me to have been delib- erately and with strong reasons so uncompromising and harsh in its attitude to the nothus. Even the charitable dispensation of alimony was not provided for in the Civil Code; it is to be credited to the Canonical Law. Juris- consulists may have feared that recognition of bastards in Law would open a by-way, permitting their approach to, and consequent encroachment on the patrimony and privi- leges of the legitimately born, if it granted them any rec- ognized status whatever. The only safeguard evidently was absolute exclusion and non-recognition; this, as a prin- ciple, was therefore adhered to. On the other hand, these legislators could not consistently provide for alimony; not alone because so doing had been violating the principle just stated; the compelling a citizen to support an illegiti- mate child, would have recognized an obligation, which, no matter how slight, in comparison with that involved in the care and control due to and held over legitimate chil- dren, could have been enforced on no other ground than a recognized paternal relationship. How could Law without stultification call for the appearance, even fractionally, of parents, whose very existence, in a legal sense, it had denied? It had so denied the paternal existence not alone by implication in calling the natural child a filius nullius, but also directly in the words to be shortly cited. What- ever experience the framers of the code may have had with bastards; either through personal forensic contact with such in the capacity of litigant claimants; or, through perusal of older records** and statutes, of which but a shadowy mem- ory survives to our day; it is certain that their rigid restraints appear to have been wisely imposed, in the light of subsequent events. As stated in its place, whenever they were materially relaxed, sinister results ensued. The gradual encroachment on the Old Law may be traced under the following captions, in part explanatory of the text of decisions made in the Court of the Rota: Legitimitatio probatio mon resultat ex probatione filiationis Zacchias Decisio Rotae, Rom. p. 128, No. 2. Filius natus ex concubine domi retenta, praesumitur ipsus The Legal Disabilities of Natural Children. 121 concubinarii, Ibidem, No. 4. (The English Law, formerly at least, denied legal recognition of the fact and, of course, any locality for such relations). Legitimatus per subsequens matrimonium admittitur ad successionem ad quam fuerunt vocati concepti ex legitimo matrimonii, Ibidem p. 9, No. 16. A feeling of jealous distrust against and an appreciation of the bastard as a cuckoo-like intruder, menacing the future prosperity of the legitimate, seems to have been almost instinct deep in the mothers of the earliest generations that tradition and history preserved memory of. Certainly the first maternal premonition, on record, was imposingly justified in the expulsion of the descendants of a legitimate Isaac, by those of an illegitimate Ishmael. A parallel, indeed, but on a colossal scale, and in the direction of hereditary transmission, of what has been predicated for the individual bastard, was the outpour of the hand-maiden Hagar’s issue crushing or driving out the issue of Sarah, the wife! Truly did the Saracen show the Ishmael hand which was “against every man as every man was against him,” for having swept over the land of his half brethren, he dashed against and nearly overwhelmed the land of the latter’s Occidental persecutor. Proverbial sayings, dating from days of yore, show recognition of the bastard character, its restlessness, its ambition and its sensuousness; as folk-lore is filled with tales pointing to the vitality and survivability of natural children generally, evidenced in Ishmael’s living through the crisis of the Desert; as Hiero, Alembert and Lamissio”" survived similar trying exposures. Wherever the nothus appears in sacred history; whether an Ishmael or an Abimelech, a Jephthah or an Absalom; he becomes if not a “wild man,” a sojourner on the borderland. As later with Romulus, Pizarro, Mansfeld and Verhuell, “there were gathered vain men unto them,” or “vain and light persons which fol- lowed” had “been bribed” by them.”" That which made of primaeval man a hunter, and of this hunter a warrior, is reproduced in the inclination to and adoption by bastards of the military profession. They do not always require encouragement by such surrounding 122 E. C. Spitzha. conditions as the anxious father contemplates providing for Tamora’s mongrel: “I’ll make you feed on berries and on roots,” “And feed on cuds and whey, and suck the goat,” “And cabin in a cave, and bring you up.” “To be a warrior, and command a camp.” Aggressively active by nature and endowed with a caution-tempered boldness which reflects union in their “first causes” of temerity and secretiveness, natural chil- dren here found at all periods a most tempting field. From Langside to Hoormuz, and Antiochia to Peru; dating from the remote day of the “Shibboleth” down to the compara- tive yesterday of Slivnitza; the geographical and chrono- cical charts are dotted thickly with the sites and dates of victories, achieved under bastard commanders. Well might Norseman and Parthian rue the day when the bastards of Karlman and Sassan entered the lists! They there” broke the records of uninterrupted triumph of these two warrior nations. The shore set no limits to their exploits. From Salamis to Lepanto and from Aegospotamos and the Arginusae to the harbor of Cartagena, the Mediterranean bore the victorious fleets of bastard-born admirals; the same sea saw the flag of Rooke droop before that of Thoulouse, as the Ocean saw that of Eustace the Monk go down before that of the bastard Plantaganet.** Their robust aggressiveness and temerity; perhaps reflecting the defiant spirit of their procreation; was respon- sible for many of those decisive moves of which one, who gained many of his great—but also lost thereof the greatest —battles by such, said: “ce n'est pas que les grands coups qui se font respécter.” The euthanasia of Roland and Man- fred's warrior death was shared by Tancred of Bethune and impetuous de Longueville; by the last Pippin and the first (and last) Griffo; Phillipsburg's siege marks the fall of the last Stuart King's natural son, as Grafton Street to-day commemorates that of his predecessor’s, Fitzroy. Unequitably was it the fortune of corrupt and cruel Lysander and Borgia as of the brave Gherardesca and Archelaus, the adulterine son of Mithridates. The first shot fired in the Huguenot wars, killed the bastard of Moret; as one of the last strokes The Legal Disabilities of Natural Children. 123 of Winkelried’s comrades killed the gigantic bastard of Brandis, whom his reputed strength “of twenty men,” could not save from the common fate of Austrian chivalry on Sempach’s bloody field. Vitality, manifested both in its outbursts of energy, and unyielding elastic persistency, enabled many to snatch vic- tory from the jaws of defeat; as did he, whom the Great Frederick gave the first place to, for having won, while at death's door, the first triumph over an English army by a French one, under the eye of its sovereign since sinister succession of Cressy, Poictiers and Agincourt had dis- couraged the royal presence. The same land which had seen a bastard born Admiral maintain its flag afloat in the preceding reign, as it witnessed the victory under the German Saxon’s bastard in the North, saw another one under the English Saxon’s bastard at Almanza —the first and I believe last occasion, where an English Colonel made his former regiment lower its standard before him.” The bribery and, when needed, domineering and “brus- quing” to which the mother succumbed; the cajolery, flattery and artfulness to which the father yielded; or the “personal magnetism,” exercised on either or mutually; are not diffi- cult to identify in their reproduction by leaders of men, idols of the populace and perpetrators of rebellion, schism and usurpation. From Scriptures hordes of the “vain men” referred to, and the rag-tag and bob-tail, gathered by the founders of Rome; through the days of the migration of Nations, Free Companies and Condottieri, down to the Wer- huel pirates of Mexico; is told the tale of organizing power out of apparent nothings and of that singular affiliation of bastards in groups; almost, as stated, characteristic of certain historical epochs."" Their interesting histories tell not alone of the generalship of bastard captains, forwardness in times and places of strife, and rapacity on occasions of conquest and plunder; they exhibit a copy of the familiar picture of pike in a carp-pond. As long as the keeper retains the single pike under observation, lest he grow too large or happen to be a brood pike, all goes well. If several pike obtain access, the course of events runs equally smoothly— 124 E. C. Spitzha. that is, for the pike-till the supply of carp gives out. In that event an Esociphagic tragedy ensues! So occurred the Xerxes–Sogdianus—Arsites—Ochus chain of fratricides," "the Gandia–Biseglia–Manfredi—Borgia series, the Almagro I- Pizarro 1–Almagro II–Pizarro II dissolution of partnership by assassination and retributive executions. Sometimes like these animals, instead of indulging in inter- tribal war, they seek and find new feeding grounds. Yes- terday the Free Companions battled and triumphed for Pedro of Castile; to-day they discover that after he pays their bounty his exchequer is at ebb; to-morrow they shall join, battle and triumph for his (bastard) opponent Henry of Transtamare; * 'the latter by the way transacting the previ- ously stated alternative on a more moderate scale, against his legitimate half-brother. How frequently a Mansfeld, Sforza, Malatesta and Borso could rupture leagues, break oaths, betray allies and sell trusts, wasted Bohemia and Milan or Florence could have shown, and Pontiff or Count Palatine related. As regards two discriminations made in Table VIII that between the military leaders of royal affili- ation and those without, and that between those who served their native land or prince and did not hire out to the highest bidder, the object becomes patent on studying the individual characters making up the aggregates of supe- rior ratio. It is found that meretricious considerations prevailed to a greater extent with Group II; this is evi- denced in the greater number of Condottieri and other soldiers of fortune, as compared with that of those in more patriotic and loyal employment—Mansfeld’s and Sforza’s for example, contrasted with Wasaburgs and Graftons. The larger proportion of military adventurers of royal blood, nearly double that of the First Group, is an index of greater cupidity, unscrupulousness and aggression on the part of those in the Second Group; it is paralleled in its larger proportion of assassins, usurpers and seditious princes—Mon- mouth, Dom Antonio, Perseus, Antiochus the Cyzician, Aristonicus, Magas, Montjoie, Clovis—in contrast with a Dunois, Guy of Flanders, Charles Martel, Vologeses, The Legal Disabilities of Natural Children. 125 Mudarra, Reinet and “Longsword” Salisbury. The like of the former are numerous enough in the first group; as a Genseric, Zwentibold, Bernhard of Italy and Harold Harefoot show; but their proportion is outnum- bered nearly as two to one (1,8 to 1,0) in the second group. In addition to showing the intensification of unde- sirable characteristics in the “intenser” forms of bastardy; while the general figures indicate the proclivity of the nothus for military life, the ratios of the merit-roll” suggest anything else than merit intrinsic to bastardy, for in Group Second it is reduced to one-half the relative length of that in Group First. A lesser discrepancy is found with regard to extensity of tainture, but still in the same direction: dis- advantageous to any claim of essential merit as growing in extent with the “extent” of the bastard taint. On the whole the proportion of doubly taintured is remarkably higher among the military than among the non-military in the bastard community of my tables; for the total it is pro mille 236; for the non-military 140, for the military, 429; among those of the latter on the military roll of honor, the doubly taintured are as 348, against 440 among these of obscure merit or uniformly unsuccessful, a ratio of 1,0:1,3. This class is worthily represented in one who exhibited in unex- celled perfection; a union of the worst passions which incline their possessor to a military career; with as absolute a dearth of the nobler ones of chivalry, bravery, patriotism and strategic genius of the field as ever existed in one com- bination. Nevertheless Caesar Borgia succeeded; not alone in his immediate objects; he also through his “steerer” Macchiavelli snared a great English historian” into the one puerility of his immortal essays and over two hundred years after his death. A thorough student, the latest and best historian of Borgia’s period, pronounces this verdict: “For his cunning and not for his soldierly qualities was he dreaded, and although half of Italy owned his rule, it was through sieges conducted under his orders and not through stricken fields—for of such he had not seen even one.” When a powerful king invaded his native land this Borgia followed the standard of the stranger, but not as lion or 126 E. C. Spitzha. eagle of the field, rather as a “ravenous vulture.” Else- where the same writer says: “Again to Caesar (Borgia) now the most formidable man in Italy f f iſ mercenaries and condottieri flocked to his standard to follow his luck. f f Whatever was accomplished, he owed not to his bravery or military ability, but exclusively to crime and treachery; therein he was the great master of an age whose entire policy his poison pervaded.” Of the Condottieri class several have furnished histo- rians an opportunity for transmitting portraits of bastard character, three of which I reproduce, as their value in con- firming the picture of bastard character is enhanced by the fact, that the artists were unconscious of any purpose pre- supposing a bias; at least in the third instance, where the painter of a most typical bastard character, was a bastard himself. It was in searching among the annals of the Free Companions and Condottieri (involving many disappointments owing to reasons, doubtless satisfactory to themselves, which induced these gentry to leave their pedigrees “at home”) that with a bastard Habsburg, Ambrosio Wisconti and Montjoie l found this chip—both of the old block and the obliquely fractured kind: Froissart begins by relating how the mercenary adventurers under the Earl of Cambridge mutinied (1380) owing to failure to get their pay; whereupon Soltier, son of Edward the Black Prince, is represented to have made the following address: “‘I counsayle let us be alle of one alliance, and of one accorde, and let us among ourselves reyse up the baner of St. George, and let us be frendes to God, and enemyes to alle the worlde; for without we make ourselfe to be feared we gette nothynge.’ ‘By my fayth’ quod Sir William Helmon, 'ye saye right well, and so let us do.’ They all agreed with one voyce, and so regarded among them who shulde be their capitayne. Then they advysed in the case how they coude not have a better capitayne than Sir John Soltier. For they sulde than have good leyser to do yrel, and they thought he was more metelyer thereto than any other.” The account concludes with the relation of Sol- tier's unanimous election, as leader, with the acclamation: The Legal Disabilities of Natural Children. 127 “A Soltier! a Soltier! the valyaunt bastarde! frendes to God and enemies to alle the worlde!” This second splendid silhouette is from a writer on the Thirty Years' War, and of the bastard Mansfeld. “His talents which enabled him to collect an army with meagre means, and maintain it by plunder, are as indisputable as his personal courage of which he gave splendid proofs on several occasions. * * * * * On his character one cannot pass So favorable a judgement; in his plundering vocation he developed every vicious trait and his selfish- ness made him as injurious to the interests of friends as to those of foes. He could not be depended on by the former, for his repeated negotiations with the emperor are explic- able on no other ground, than that good faith to his party, was not a point of honor with him. The disturbed state of affairs largely contributed to forcing him into this adventur- ous career; but equally true is it that he had a natural predisposition therefo, and no repugnance for the filth with which he therein smirched himself.””” The happy definition of History as “Retrogade Proph- ecy”; in its converse, naturally making of prophetic art an expression of ability to project into and apply to the future the teachings of history and the observation of character; is illustrated in the following gem of a prediction made of a bastard military adventurer’s deeds to come; by another illegitimate; among its noblest, wisest and bravest representatives; and if an adventurer in one sense himself, in the very best sense of the word. Ghislain says” “Balagny is in command of the citadel and garrison and he is not the sort of man to surrender the town to anyone, even though Alençon (his chief) himself should give the order.” The fulfillment of the prophecy may be read in Motley and con- firms a trait found—with few exceptions, the prophet in this case being one of them—that any principle, any flag and any master might claim the bastard’s services; for to him a flag was no more sacred than to the shameless bastard who proclaimed “un mouchoir” to be “un drapeau dans la poche.” Flags, chiefs, allegiance, principle, were naught but opportu- nities for their chameleon adaptability; but when a situation 128 E. C. Spitzha. had once been gained, a flag with the motto of Soltier “friends to” their “God” Ego, and “enemies to alle the worlde beside” was drawn out of the “poche” a la Girardin. “What I have I hold” was the usual corollary, and whether it was a robber castle in the Apennines, a storm beaten isle in the Orcades, a principality in Italy, a fair valley of the Rhine or an oasis in the remote Orient, nay, even the presidency of a republic,"* the bastard invader or trusted ally became a tyrannical fixture, or, fertile of new complications and broils, an incumbrance as difficult to shake off, as the insinuation and growth had been facile and imperceptible. Love of adventure and a hankering after fame, expres- sive of the aesthenic, often leads to the recognizing in peaceful occupations of mistaken ones. Bastards, above all, have this experience and abruptly abandon the rut, in which chance or patrons have placed them, to enter the military career. When unable to do this in the usual ways, demagogue instinct in exuberant recklesness has driven them to excite rebellion or to throw themselves into such excited by others, to be borne on in tumultuous rush for a brief “moment of glorious strife;” preferable for them, to a life, which if longer, would have been one of irksome duty and monotonous citizenship. So intensely ingrafted is this tendency in them, that even those, who for long years had walked in paths as remote from those of strife as may be, have not been able to refrain from casting 'sheeps eyes’ at the coveted career of the soldier. True it is that an occasional bishop or so, of legitimate birth, whose spiritual, was encumbered with the burden of temporal sovereignty, donned the cuirass in emergencies; it is also true that besieged Saragossa and Prague saw communities of monks transform themselves into companies of musketeers. But it required no emergency, nor could mere inclination have sufficed to provoke such startling metamorphoses as Borgias and Medicis accomplished, had they not, as bastards, been possessed of phenomenal temerity and effrontery. After having worn the purple for years, Caesar Borgia obtained dispensation to doff the hat of the cardinal and don the The Legal Disabilities of Natural Children. 129 helmet of the soldier. On this occasion he spoke, what was perhaps the one truth in his monster life, that he had never felt a real vocation for religion. The bastard Giuliano Medici marched with the troops which besieged, captured and ruined the city of his birth. Another illegitimate Medici, the Cardinal Hippolitto, may be seen in the painting by Tizian, at the Palazzo Pitti, in the same city. He is pictured in the rich costume of a general of that day; his right hand on a marshal’s baton, the left on the handle of a sword. He would have followed the example of Cardinal Borgia, had he not been assassinated by the bravo, whom a third bastard Medici had employed to remove this incon- venient relative. It had been remarkable, if this noteworthy feature had escaped Shakespeare, in making one of his characters of an historical bastard prince of the Church. Accordingly we find in his second Henry VI, that son of John of Gaunt whom elsewhere the good Humphrey denounces “thou bastard of my grandfather” and whom I have had other occasion to mention (Note 32) thus depicted: “Oft have I seen the haughty Cardinal,” “More like a soldier than man o’ the church,” “As stout and proud as he were lord of all,” “Swear like a ruffian f { } f f : ” Among military leaders of bastard birth, diplomatic talent or the related intrigant disposition were often marked. The monotonous accounts of battles, marches and sieges, conducted by “blunt and plain soldiers” are in their cases refinedly diversified by interwoven secret compacts, “succession powders,” “golden keys” and a little down- right treason or assassination now and then. Considering that of the combining “first causes” one operated through cajolery or bribery, and the other attractively or surreptitiously; as long as denouement was unsafe, or fulfillment of promise might yet be extorted; the bantling's inheritance of the diplomatic faculty need not astonish us; nor that the diplomatic and political fields are, next to the military, favor- ites with them. Accordingly we find every grade, from the patriotic statesman to the vulgar intriguer, playing every game of politics transacted on the chess board of skill, or by 130 E. C. Spitzka. the shuffling of marked cards and loaded dice. The spy and the forger conclude another series whose more elaborate type one finds in “Il Principe,” the model"." for which was the monster Caesar Borgia aforementioned, who had had numer- ous predecessors, from Perseus, Beltram Poggetto, and Wil- liam the Conqueror down to Cibo and Beaufort of Win- chester. It is different with the professions which call into activity those functions which are the perfection of citi- zenship, or in which industry or inborn talent for produc- tive labor and genius for creative art are made manifest. Here the aggregate of the professional, poetic and artistic is over twice as great in the first group; in the domain of manual and mercantile skill it is nigh three times as great. In significant contrast the opposite is found with the unskilled laborer, vagabond, and law-breaking occupations, whose representatives are seven times greater in the group of clandestine, meretrix and adulterine procreated than in those born as “love children”, in concubinage or in morganatic wedlock. What an enormous difference do the figures (Table X.) representing the number of literary, artistic and skilled arts show with those of the soldier, adventurer and fraud? The number of famous writers and those sufficiently noted to figure in literary biography is absolutely a remarkably small one; for example, it is only six in contrast with the twenty-nine per cent of military occupations. But, while the soldier is equally represented in both groups, writers are three or four times more numerous in the better Group. (92 and 24 per mille respectively, a ratio of 1,00:0,26). The doubly taintured, represented in over one-third the number of military individuals, contributed only one-ninth to the total of writers (4 of 26 or 153 pro mille). It is not alone numerically that the more base compare unfavorably with the benign Classes in the professions which indicate usefully productive tendencies. Taking the one field of Literature, a mere mention"' of its representatives—at the same time, a majority of them adulterine and meretrix-born —is sufficient to characterize them: Pietro Aretin, Richard The Legal Disabilities of Natural Children. 131 Savage, Emil Girardin and Alexander Herzen. Each and all appear in other categories of the tables; such as forgery, swindling, intrigue, blackmailing, manslaughter and profes- sional adventury. Six categories to accomodate these versatile gentry! Place side by side the names of Boc- caccio, Luttrel, Pomponius, Dumas the Younger, Fair- fax, and the superiority of the “benign” Group becomes more convincingly expressed than in the mere superiority of numbers—remarkable as this is."* Just as we find the fewer in number also the less meritorious in quality in the schedules of merit; we find the smaller number on the roll of criminality, to include those offenders guilty of less moral turpitude than those in the voluminous corresponding catalogue of Classes E and F. The homicides of Group I were mostly due to political and dynastic motives or prompted by false but credited accusations. Of the first the starvation of the Duke of Rothsay with the connivance of the post legitimatus Albany; of the second, Mudarra’s revenge, and of the third, the secret assassination (or exe- cution) of Crispus by Constantine, are instances. The corresponding performances of adulterine and meretrix-born murderers show, many of them a venality of motive and perfidious cruelty in execution, as to have rendered them the most fertile contributors to Clio’s “Chamber of Hor- rors.” The first utilizing, then murdering Syagrius and Ragnecaire; the causing of parricide by a bad son, to kill him by means of the very bribe that prompted the act; were accomplished by a single nothus, and are but a frac- tion of the known achievements of a like kind to which the son of Childeric owes his place in history. To remove the last legitimate heir of Peter the Great (Iwan VI) by having him slain on the pretext of an armed attempt made for his liberation; was the project worthy of one represent- ing the class, whose shining examples like Cardinal Beau- fort, William the Conqueror, Perseus, Verhuel, Esterhazy, Morny and such understood the art of creating mirages to deceive the confiding and unwary; or false appearances, to secure removal of inconvenient witnesses, through the safest of all channels of diabolism, judicial murder! It was a pro- 132 E. C. Spitzha. ject fit to stun an average mind the inciting an officer to provoke tumult, which might justify the killing of Russia’s heir as per programme; that officer to receive an immense reward, merely going through the form of decapitation. His pardon was to be announced the moment he laid his head on the block. A truly sublime height did the “Semiramis of the North” attain, when she with little effort stifled the sense of “honor” said to exist “among thieves;” and calmly allowed the axe to drop, which separated the head contain- ing the tongue that might have told tales, from the body of Mirovitch. Well has the relator" of the incident anticipated a clause of the contemplated definition of bastard character in these two quotations. “She possessed the faculty of appearing to serve others, while in fact she made these others serve her or at least serviceable to her purposes; and like all great possessors of the Genius of Unscrupulousness, she understood to perfection, the art of selecting her tools, and as soon as they had become worn out, to cast them away.” “One knows not at what to wonder more, at the genius like intuitions of this child of sixteen, or at the accomplished art and remarkable energy of that villainy which ensured for these instinctive promptings an unexampled triumph.” If we omit the intermediate classes for a moment—they form as connecting a transition in the figures indicating benig- nity and malignity, as they do in the range of presumable tur- pitude of the parents—the difference great as it is between the two Groups in the former respect, becomes a startlingly significant contrast in the latter. Again l lay stress on the compensation for the defect of numbers, in the harmony shown not only in parallelism of similar, but also in the balancing of the anticlinal factors. Thus the figures on the female side, representing chaste marriages, exceed as much in the one group, as those of illegitimate births do in the other. Among the males, the ratio of artists and scientific or literary productive writers is in Classes A plus B, 266: 1,000; in Classes E plus F, 32:1000. But of adventur- ers, false claimants, forgers and criminals, the former show but 83:1000 the latter, 3.94:1000! Of forgers alone, using the term in the wider sense which includes all knowing The Legal Disabilities of Natural Children. 133 manufacturers of false appearances for injury to others or benefit to self, is 33:1000 and 219:1000 respectively. Pur- suing the matter in detail it was found that the numerical equality even in aggressive occupations, is far from indicating a corresponding representation of the nobler meritorious qualities. The Classes A and B the morganatic, secret marriage and amatory offspring show an enormous contrast in all these respects with the Classes E and F. The latter as offspring of the adulterine, meretrix- and “vulgivatrix”- born may be regarded as the opposite extreme of the series, measured by the degree of presumable parental tur- pitude. Per mille the ratio of those in useful, productive or, at least, peaceful walks of life is as uniformly higher in the former, as the ratio representing the turbulent, destructive and disorganizing ferments of communities is higher in the latter. There are six times as many literary and scientific writers, artists, skilled mechanics and statesmen in Classes A and B aggregated, than in the aggregate Classes E and F. There are however, five times as many criminals, with six times as many false claimants, not to mention eight-fold the number of professional adventurers in the latter, as compared with the former. The aggregate of forgers, for example, in the wider sense, is pro mille 27: 1000 in the former, and 219:1000 in the latter, while the aggregate of authors of Scientific and literary repute and of exponents of the fine arts is respectively 266:1000 and 32:1000. This is one of the few tables in which figures repre- senting felonious tendencies in the female approach or exceed the corresponding ratios of males. They however, in one respect, harmonize with the majority; they show that the turpitude of the female is relatively greater in the benign, than in the second group. Although absolutely fewer “Goddess Hygeia” posers, “spook pitture” swindlers and other “Becky Sharps” occur in Group First, yet the proportion to male offenders of the same group is of less disparity than that in the second. There are two hundred and thirteen percent more male swindlers, forgers and frauds in Group Second, but only fifty per cent more of female such. The figures are small in the first group, it is 134 E. C. Spitzka. true, but it is noteworthy that while of eighteen males not one figures in more than one schedule of swindling, the versatility entitling to a multiple position, was possessed by four of , the five females; here the ratio actually exceeds that of the second group (Table XI. Schedule 8); while the relation to the male ratio is also the converse- 800 to 1000 in the first, 789 to 886 pro mille, in the Second Group. - - - In noting the relatively few exceptions, where the character assigned the nothus, is found in one legitimately born; and, on the other hand, where qualities resemble such but the parental union lacked the ceremonial sanction, I found them—provided data were obtainable— uniformly exceptions of the kind which prove rules. Where marriage is a sine qua non of a libertine’s attaining an object; which, to his mind, is but a unit in a chain of liai- sons, lacking the parchment, one need not be surprised at the procreation, in wedlock, of a Nimon d' Enclos; whose vitality carried her to the nineties and protracted the dura- tion of charms, which in at least one authentic instance, laid prostrate at her feet admirers of three generations in one and the same family. That one, cast in the same mold de facto if not de jure, as bastards, should with the graces and physique share their imperturbable effrontery and instinct for intrigue; even to the extent of rivaling the cor- responding make-ups of a Dubarry, Hamilton or Lais is not alone not surprising; it were strange were it otherwise! On the other hand, a union, to which all the higher motives and circumstances of ideal wedlock contribute, but, which lacks the formal sanction, may bring forth an Eras- mus, Manfred, Colon or Smithson, the equals of the most favored offspring of legitimate unions; and superior—incom- parably superior—to those, the marriage tie of whose parents, had been, not only a mercantile desecration and travesty of the Sacerdotal, but a defiance of the laws of Nature. The wedlock born of couples at whose union neither Plutus nor “Venus vulgivaga” presided, serve as one stand- ard. The typical mothus is combined from the offspring of The Legal Disabilities of Natural Children. 135 clandestine and meretricious intercourse; or such in breach of wedlock, as the Roman law-givers termed them, respectively, “ex poelice natus,” “ortus de scortum,” and “adulterinus;” the latter term limited to the offspring of wifely frailty. Outside of bastardy in its restricted legal sense, the con- ditions involving lewd or questionable wedlock, and in one sense resembling it, are fruitful in like results; howbeit the parental union be no violation of the conventional and legal systems of the community in which they occur. Oriental harems have brought forth strange representatives of cruelty, fickleness, lasciviousness and half insane conceit; nor is much to be discovered in the circumstances of these institutions tending to ensure other results. But great as their vices were, they were eclipsed in the monsters occu- pying Persian, Armenian, Parthian and Syrian thrones; whose mothers were, in the majority of cases, Athenian or lonian Hetairae. The cupidity of a maternal adventurer, the hypocrisy and simulation employed in ousting and destroy- ing rivals, are reflected in such monsters as Phraates II. The offspring of lovers deeply attached to each other, are, caeteris paribus, males in so overwhelming a majority that I assume such preponderance incontestable. The excep- tions are many of them, those proving the influence of excep- tional conditions such as an unusual disparity in relative age of parents as a factor determining sex.'" Among the crowd of names represented on the male side are such prominent ones as Albuquerque, d'Alembert, Astrolath, ""Bärenhorst, Barnim, Boccaccio, Busbecq, Carey, Championnet, Colon, Constantine I, Constantine Porphyrogenitus," "" Cor- vinus, Dumas I, Dumas III, Erasmus, Fairfax, Giberti, Hippolytto Medici, Montagu (Basil), Nithard, Hartlib, Alden- burg, Pericles II, Pomponius, Santi, Sforza II, Smithson, Wasaburg, and Witte. The first born daughters of Shake- speare, Petrarca, Byron and Sir William Temple disappear in so large an assemblage, as it were; doubtful even as it is, in the absence of positive information, whether I am right in placing, the last three in class “B,” rather than ‘‘D.” - Far different is it in the Adulterine group! Beltranja, *_ 136 E. C. Spitzka. Bobrinska, Bronte, Claudia, Drisilla, Honoria, LaQueue, Montijo, Mammoea, Felice Orsini, Pamela, Prodgers Ruperta, Charlotte Sturt, Soamis, Lucilla Vera not to men- tion those who escape registry '"" because “la recherche de la paternité est interdite,” culled from the pages of history and causes celebres, in their proportion of the sex total, as contrasted with that of adulterine males, are a demonstration itself: 295 per mille or nearly thrice the male figure of 112 per mille. The “cupidogene” class B shows the corre- responding female ratio, 57, and male 148. Assuming the male figure an equal one in both classes, the proportion of females in the adulterine is six times that of the one in the other group. Striking as is the numerical and relative preponderance of females among the classes including those most deeply taintured, the preponderance of the number of procreators of illegitimate children of a second generation among them, is even more so. The adulterine class alone furnishes as many such as all the others aggregated, for of thirty-five adulterini, and eighty-five non-adulterine illegitimates it happens that precisely the same number: thirteen, had procreated children out of wedlock; respectively, 15 #, and 37 º'o per cent, or roughly expressed a ratio of 5:12. The adulterines procreated illegitimately in nearly two and a half times as many cases as the other group. The mere figure of illegitimate births is not in all places, nor at all times in the same locality, an absolute criterion of feminine virtue. Sight should not be lost of the fact that Messalinas are seldom prolific; and if so, in a degree below what a naive expectation, which presumes effects proportionate to evident causes, is surprised not to find it. That the indis- cretion, perhaps a single one in the career of her whose offspring 1 speak of, is not necessarily the outcome of moral turpitude, it is unnecessary to discuss. Indeed the living corpus delicti, by the very fact that it figures in the census at all, proves the non-interception of procreation and non- interruption of foetal development, which are due to a non- censurable ignorance of or laudable unwillingness to resort to means which are as brazenly employed as they are The Legal Disabilities of Natural Children. 137 familiar to adepts in indulgence and crime. After all, though, this factor is not a very disturbing one. Here the statis- tical student is in the position, for example, of a marine zoologist. When the latter sifts the contents of a dredge employed in the sublittoral zone of some marine fauna, he may and often does find a few individuals of species, proper to deep sea and littoral belts. But those species which are represented by the hundred and thousand, and so represented in the result of repeated hauls, he terms characteristic of that particular zone. Similarly in our field are found, included among the mothers of natural children, a stray Eloise, a Blanca Lancia or one like the physician’s daughter of Sevenbergen. But for one such, we shall find scores of Lucy Walters, Gwynnes, Querouailles, Lolas, Caesonias, Jumels, Mammoeas, Russian Catharines, Valois Margarets and Bona Sforzas. The increase of illegitimate births, in special aggregates, may hence be regarded as an, at least approximate, indication of greater sexual immorality; that is to say, either increased vigor in instinctive impulses on the somatic side, diminished inhibition on the psychical side, or both combined. Had I limited myself to this criterion, the resulting conclusions drawn would have been the same as those formulated. But as notorious apostles of the liberal creed, to which they owed their own and illegitimate exist- ence, like Lais, Dubarry and Montijo are not known to have borne children "", they would under the limitation to that criterion have had to be classed with those leading moral lives. Hence Table VI contains another rubric, inclu- ding those, who while not having had illegitimate offspring, yet either “professionally” or otherwise were of loose morals. By aggregating the two, as good a gauge is obtained—how far from an accurate one, I am well aware— as the nature of the enquiry admits. The first fact developed in these tables is the great preponderance of procreations of the same sex and in cases where bastardy was parental, that such parentage was also more frequently of the same sex. Seventy-three per cent of the aggregate of the bantlings of bastard parentage are of the same sex* as the bastard parent; the remarkably 138 E. C. Spitzka. close figure of seventy-five per cent of the known procrea- tions were likewise homosexual. The second fact is the excess of the male influence in determining such homosex- uality; being in a ratio of about 16:13. The most striking development: the third fact, is the similarity of both sets of figures, as these summaries show: MALES FEMALES TOTAL Were procreated illegitimately by bastard parent of the same sex................. 79 ºn 61 ſo 73 to Procreated illegitimate descendants of their own sex........... ........78 "o 64 ºn 75 'o We have seen that sexual immorality as indicated in the figure of illegitimate births added to the number of notorious profligates is four times as great in the 'second group as in the other [Table VI. shows the ratio 417:100] Taking the figure of procreation of illegitimate children by female bastards alone, we find none, as a standard for comparison, in the first group; it is 33% per cent in the second. If we assume the former figure, the one represent- ing sexual immorality in general, as a gauge of the likelihood of bastardy reproducing bastardy in each group, there would then be four times as many pro rata in the second one; this including three times as many persons; the probability is that twelve bastards would be procreated by the females of group II for every unit added to the census of bastards by the members of group I. In addition is found the noteworthy circumstance that the sex-determining influ- ence of one sex, exclusively or chiefly, happens to be almost equal in each sex. The predominance of homosexual births was with males, in 72%, with females, in 62%. Taking into consideration the fact that in a case of bastards procreating bastards, there was often but a single offspring, to be reckoned. I compared lists in which the first born, whether single or first of a series, alone figured; the variation was found too slight and the total so spare, that neither calls for special mention. The following propositions are supported by my figures, and I venture to anticipate their confirmation; perhaps mod- ified in the degree of contrasts; but still contrasts in the same direction - The Legal Disabilities of Natural Children. 139 1. Natural children have a greater homosexual determining power than others. 2. The male exceeds the female in this respect, and rela- tively more so, than among the legitimately born. 3. When both parents had been illegitimately born, the male’s influence preponderates in the majority of cases. 4. The procreation of males chiefly, by male illegitimates; and of females, by female such; is observed both in wedlock aud illegitimate unions; but it is more pronounced in the latter; the disparity is greater in the case of females than males. Taking the aggregate of classes A and B and that of the two at the other extreme of venality: E. and F., there is a ratio of females to males of respectively , 158 and ,341: an excess in the baser classes expressed in the proportion of 1,0 for A plus B. against 2, 18 for E plus F. Now, as in the aggregate of the classes, (respectively 82 and 196) the latter outnumbers the former 2 ſº times, the number of females of bastard birth procreated in adultery and other nefarious conditions, would be the multiple of the two figures, or 41% times as great. This is on the assumption that a collection of 555 cases (at the moment of revision) can represent the average conditions. They do not, how- ever. Collected from the sources mentioned, the proportions of morganatic and amatory liaisons, here is notably larger than in general statistics. As an assumption of the concrete relation were mere guess work, I shall content myself with the concession that the error of any conclusions thereon based must be in favor of and not to the prejudice of the classes on which those conclusions fix a greater onus. The aggregated classes, except the two baser ones E and F; 64 females have 5; the 67 of E and F, 26 reprocreators in bastardy; five times as many' Bearing in mind the sex determining power of illegitimately born individuals; namely for female bastards that seven of the same sex are procreated for three of the opposite, and that this is not neutralized by the greater sex determining power of the male nothus, because in these classes as contrasted with the higher ones, the females outnumber the males, we can recognize a factor ceaselessly at work in creating a disparity in favor of female 140 E. C. Spitzha. *– births as compared with the general census. The conflicting of this, with the biological presumption is one in appearance only; in truth it is another exception which on analysis proves a rule that on the mere face of its figures it appeared to invalidate. Assuming the aggregate of males of the meretrix, vulgivatrix and adulteress-born as equal to the aggregate of those born in concubinage or the offspring of morganatic and clandestine unions otherwise; which is certainly remain- ing far below the mark of the actual predominance of the former; the proportion of females in the baser classes thus appearing nearly thrice that in the better four, (Table Schedule 1, Columns I. and IV.) and their percentage of propogators of illegitimacy being five fold (same table same column, schedule 2.); it follows that thirteen times as many illegitimate procreations occur as in classes A, B, C and D. That these figures represent a constant factor is evidenced by the similar preponderance in the same direction and similar overwhelming proportions of transmitted illegitimacy both received and propagated. Thirteen times as many of the females in classes E and F had procreated illegitimate children; eight-fold is the figure of those ascertained to have had illegitimate parents; twelve times as many had been both inheritors of a first taint, individualizations of a second, and bequeathers of both to a generation they pro- created with a third taint of bastardy; that is to say, those who, illegitimately born themselves, had both illegitimate parents and illegitimate offspring. The relations are best summed up thus: there being 100 males and 62 females in the better, and 100 males and 166 females in the baser series, there would be represented bastardy of one genera- ation in the former by 53, in the latter by 71 females; two generations in respectively 7 and 95, exclusive of respec- tively 2 and 23, representing three generations. The preponderance of double and treble tainture is so enormous that the figures representing single tainture after subtract- ing the others from totals originally contrasting as 1:3 approach equality (53:7.). Of 35 meretrix-born and 35 adulterine female natural The Legal Disabilities of Natural Children. 141 children; that is 70 out of a total of 126; 26 procreated bastard children themselves, 21 had had one or both parents illegitimate and 12 appear in both columns, transmitting a treble tainture to their offspring; it follows that 35, or exactly one half represented the first or second link in a succession of bastard generations inclusive of 12 who were the central ones of three such linked generations. In addition 17 who had not been known to have born illegiti- mately, were of morals so notoriously bad, that, compared with them, some of those who merely continued the ances. tral occupation of increasing and multiplying illegitimately seemed, comparatively at least, unsophisticated, naive and physiologically sound, if not morally respectable. The total of inherited double taint and of smirched or impaired repute in sexual morality is 72 ºper cent in classes C and D 3 had procreated illegitimately, 5 had had one on both parents illegitimate, two belonging to both groups; so that six indi- viduals of 39 in the two classes had the double tainture. In addition six had had liaisons or “adventures” of notoriety. If less venal on the whole, than the corresponding pecca- dilloes of the last two classes, I have reckoned them in the same category; so that a percentage of 385% or about half the proportion of the other sub-group obtains. In the seventeen of the Classes A and B there are no procreations nor double taintured, and two of fallen character—the Prin- cess of Ahlden'"" being one, a daughter of the house of Wied the other—the percentage is enumerated for the sake of uniformity, the figures being inadequate for any purpose; but aggregating the four classes, the fact remains, of an enormous preponderance of sexual laxity in the most numer- ous classes of female natural children. Taking this fact in connection with the sexual determining power of bastard children; for of the classes E and F, 19 procreated only females (illegitimately), 2 only males, and 5 of both sexes (3 more girls than boys, 2 an equal number) and adopting this proportion, the female offspring would be about 84, the male 16, an excess of 68 per cent of female births. There are represented among the parents of the bas- tards, in the exact series, no less than 92 themselves ille- 142 E. C. Spitzka. gitimately born, 62 fathers and 30 mothers, which latter figure raised to the sex ratio of the births in the general population: 106 males: 100 females, would become 283 (assum- ing the ratio of 416 males to 126 males as proportionate standard for raising the figure in the ratio required to equal the ordinary census ratio). The third generation is repre- sented by 130 males and 77 females; the latter figure, raised in the same way, would become 238. These numbers in the case of the first generation may be impugned since ille- gitimacy in paternity is more difficult to establish than is the like in maternity; but the figures of the third genera- tion certainly cannot be criticised on any other ground than the one admitted as common to those herein offered: their small numbers. All however, run in one direction of accounting for a relatively firmer hold of transmitted bas- tardy on the female sex as most pronounced in those sombre fields of bastardy in which accessory factors tend to assure female preponderance: Ratio in First Generation, male to female...............................106 : 198. -- ‘‘ Second Gen'n, (advanced standard) male to female 106 : 100. -- ‘‘ Third Generation, male to female. ................ ............106 : 201. A large proportion of illegitimate procreations of the opposite sex might have been excluded from computation as they practically neutralized each other. For example, Charlemagne procreated Emma'"" who, in time bore Egin- hard—if not all three illegitimate, the , first and last certainly. The question of atavistic influence presents itself as worth considering, in view of the rarity of a mothus pro- created by one of the opposite sex, procreating in the own and not the illegitimate grandparent’s sex. A similar relation is found where a series of bastards had been inter- rupted by a generation illegitimately born. A notorious example is that of Bertha of Provence, her son in wedlock Hugo, and her granddaughter Eudoxia-daughter of Hugo's concubine “Venus.” Ptolemy mothus had in wedlock the great (so-called) Cleopatra–this daughter had a number of children out of wedlock with Julius Caesar and Mark Antony. Of the four only one was a female, and she was one of twins (referred to in text as “Selene”). An excep- The Legal Disabilities of Natural Children. 143 tion, the only notable one occurring to me at this moment, of two successive bastard generations being followed by a predominance of male births in a third one—legitimate in this instance—is that of Moll Davis, whose daughter by Charles II had chiefly sons (See Note 30). Let the sociologist bear in mind that these figures indi- cate not alone a cumulative bastardization prepondering in a sex, of which it has been truly said that while as a whole it is morally better than our own, its exceptions give evidences of viciousness which out-Herod Herod. There are immensely more bad men than bad women; but a female, once emancipated from the commonly good character of the sex, outstrips her fellow in the paths that lead astray. The classes of illegitimately born females, having a relatively larger representation in the general population, are shown to contribute ten times as many illegitimate children as the other four less deeply taintured classes. Parallel with this we find four times as many taintured doubly, in the sense of illegitimacy having occurred in the generation immedi- ately preceding their own; and, seven times as many moth- ering a third doubly or trebly taintured generation. The sex-determining power is shown in the procreation of sev- enty-four per cent of female bastards as already shown. As there are at least two-fold as many illegitimates procreated in the Second Group as in the First, and the absolute number of females therein is greater, the propor- tion of bastard procreators also relatively larger, and finally the percentage of female procreations by them in the sec- ond and third generation overwhelmingly in excess of that of the other sex—it need not surprise, that the general statistics reveal a lessened preponderance of births of males as contrasted with that found in the series of births of legitimate children. This circumstance would appear con- tradictory to a generally accepted view of vigorous sexual union—being more likely to engender masculinity than fem- ininity—and to sustain some more modern theories conflict- ing with the traditional one, but for the explanation previ- ously suggested. The superiority in physique of bastards is not suscep- 144 E. C. Spitzha. tible of demonstration by the statistical method, except as evidenced in the duration of life. I rely on instances where the bastard and legitimate offspring of the same parent could be compared. Enzio though dungeon-kept, surviving legitimate Konrad, is an instance typical of the results of such comparison. The traditional view' "" regarding the intense vitality of bastards, is borne out by the survival of d’Alembert, when he had been regarded as moribund, and in all reason unable to recover from the vicissitudes to which a parent driven to conceal disgrace, had left him exposed. It is paralleled by that of Hiero II, who, though left several days to the resources of a neonatus, survived to reach his ninetieth year through a life of restless activity and an unusually critical period in Sicily’s history. While not found dogmatically expressed in biological treatises, it is hinted in several, as it is more loudly pro- claimed by the advocates of certain social remodelings that sexual union “by affinity” would result in a healthier off- spring, and give promise of a higher race development. The vigor of the males, the beauty of the females and general high vital standard of both sexes among bastards have been cited in support. On the contrast they exhibit with the offspring of marriages de convenance and of other unions of ill-mated couples, have been based conclusions which on first sight appear most natural, if not unanswerable. If the rules of rational breeding could be applied to the propo- gation of a given community of human beings, its event- ual and exterminating triumph over the remainder of the race would with signal and awful impressiveness vindicate the fundamental principles of Sexual Selection. But knowledge of such rules is as yet as hypothetical as the observations on which they would have to be founded are fragmentary. We are ignorant of the very details, the mas- tering which might justify their promulgation and the gaug- ing of their application. The indisputable correctness of those principles does not justify their dogmatic formulation into laws nor allow, at present, other than tentative appli- cation and that to lower animals. To apply them to our species, were to hazard consequences, of which mere failure The Legal Disabilities of Natural Children. 145 were the least sinister. The transfer of the experience of breeders, leaves the fact out of account, that in the procre- ation of a human being there cooperate the conditions of two imaginative and impressionable minds, and this before and during that epochal transaction; and in addition a con- tinuous state of one of the procreators, the female, beginning with that initial event. It is assumable that the physiological transmission of parental characters, if not limitedto, is chiefly one of aggregated character developed in the parent from the latter’s to the offspring's birth. The culminating act of procre- ation can be only conceived as an explosion of an uncon- sciously operating power. Naturally'"" its energies find their vent in an automatic mechanism, which must, for the time being overwhelmingly exclude the influence of the voluntary and reflective. Such influence at the best would operate as inhibitory; and conceive of inhibition at the very initiation of individual career! Tristam Shandy’s case has roused more laughter than reflection; yet this instance from fiction, but expresses a homely tradition, verified by actual observation, as in the following case: Hear Gibbon’s brief but pragmatic statement' "" of the circumstances: “Basina escaped from her husband's bed to the arms of her lover, freely declaring that if she had known a man wiser, stronger or more beautiful than Chil- deric, " ' " that man should have been the subject of her preference. Clovis was the offspring of this union.” Let the Queen be taken at her word. Singular as it may appear; and notwithstanding the likelihood of her having omitted stating a deeper motive, which the average interpretor would attribute her experimental adventure to; there are circumstances," "" which can be accounted for in no other way, than one which leaves it plausible that she told at least a part of the truth! - More crucial, however, than any reasoning or experience based on what is after all, a most uncertain factor, the allegation''" of intentions after the fact, is the examination of the influence which bastard ingrafting has on the status of a given and observable family line. There has arisen an impression on surface view, that the percentage of survivals of noble families, in the branches 146 E. C. Spitzha. taintured by bastard blood is so great in proportion to the relatively small number of . those acknowledged and legiti- mated, that it potently indicated the latter to have a supe- rior vitality. This conclusion too, is in harmony with the superiority observed in bastards otherwise; it seems to render a recurrence to any general principle, such as the invigorating influence of “crossing” superfluous! Without questioning the correctness of this impression, I would state that its apparent natural sequitur : the utilization of such experience, is not! The critical study of later generations of lines commencing illegitimately or re-started with bastard infusion, does not justify any principle, formulative of; any policy, inculcating; or any procreator, imitating its essential facts or following any method modeled on analogy with them. In the first place, the general fact of bastard sur- vivorship, unquestionably true as it is, has been overstated. The number of sinister-barred, for example, among the English nobility, is not a true indication of actual numbers and hence not of the surviving proportions thereof. Those who have reasoned in the way indicated, had forgotten the Lenox, Northumberland, Southampton and other lines dying out with the first bastard of the name, not to speak of a numerous series enduring only to the second or third gener- ation. The oldest (I mean genuinely oldest, not wealthiest nor highest in rank) in England have in the overwhelming majority, spotless escutcheons. The taintured ones show degeneracy in as many forms, as large a proportion and as intense development, as the untaintured. Take one of their very best representatives, the Byrons! But for a mantle- child, the family had become extinct (in great part, through unusual vicissitudes, however). In the poet, it rose to a high level mentally—for I doubt whether a spark of the fire of true genius could be justly denied him—but before, in and after his person, unsoundness was manifest, and I still doubt whether at the present time its representatives rank in any respect above the degenerate, but equally bas- tardized, Butes. They certainly can not be compared with the Argyll-Campbells, whose unusually long descent is on the male side-I believe on both—free from blemish. The The Legal Dis abilities of Natural Children. 147 average rate of passage into mediocrity, of sinking below that level, and of eventual extinction, does not seem to have been materially, if at all, retarded by bastardization. It has, even in that event, often been abrupt. The Dunois de Longueville and other illegitimate branches of royal houses withered, as soon as, or soon after the parent trunk. One of the most favored off-shoots from the Stuarts, the Fitzjames, after having favorably contrasted with the orig- inal line, to the time when its representative gallantly, if unsuccessfully, met Nelson at sea; the legitimate Stuarts meanwhile ending in a bankrupt adventurer; is last heard from in a characteristic Stuart situation—as satellite in the Vendée escapade of the Duchesse de Berry. It could be pertinently interposed here, that the very return of an illegitimately founded line to the principle of legitimacy, makes this comparison valueless. To test the relative merits of bastard crossing, it may be demanded, that it should be, if not continuously repeated, repeated at intervals, or represented on both sides of the house! Cases answering such requirements might be quoted; and where these very conditions have been fulfilled, as in surprisingly numerous instances, an analysis of the result fortifies the conclusion, just expressed, beyond peradventure. The Carlovingians—not to mention the Merovingians—had seldom three, scarcely ever four, legitimate successions; not infrequently mantle-children, or such born of concubines, intervened in regular alternation; occasionally they followed in uninterrupted succession. The débacle of this family, almost simultaneously in all its ramifications, is notorious. The corresponding fate of the Ptolemies, Seleucides, and Caesars may be rejected as tests, owing to the complicating factor of incest, but this can not be done with the Castilian and two Portugese dynasties. These began in or were influenced by bastardy on both sides of their houses and recurrently, either in direct or descended tainture. The early appearance, firm hold and final triumph of degeneracy is illustrated, in both. Margaret, Charles the Fifth's natural daughter; after her first marriage to the bastard descended bastard quadroon, 148 E. C. Spitzka. Alessandro Medici; married Ottavio, son of another bastard Pierluigi Farnese. Their son, who inherited two taintures, became the celebrated conqueror of Antwerp. Successor after successor sank lower and lower in perversion and incapacity; until after several lurid flashes, in the shape of moral monstrosities, extinction ensued. A two-edged weapon were argument based on compari- son of the Berwicks and legitimate Stuart posterity. The former began illegitimately and continued able and . prosperous for at least three generations under strict adherence to the principle of legitimacy; the latter began, as it had for several generations been, legitimate; but its representative departed from the path of legitimacy and in the persons of illegitimate descendants the direct Stuart line ended. Charles J. Fox, son of the First Lord Holland, was on the maternal side a great-grand-son of Charles ll; but the dilution here is so great that if a deduction is to be drawn it could just as well read: that the successive infu- sion of three legitimate generations on the tainted side, had sufficed to eradicate illegitimacy as a temporary blotting intrusion. - The reappearance of characteristic bastard features in a wedlock born Second generation, when such had been unrecorded —either because absent, latent or unobserved in the first– is so frequent, as in itself to constitute a weighty objection to the realization of any other than Malthusian theories as far as bastardy is concerned. Numerous examples of infusion of illegitimate blood– and some of them in such chronological juxtaposition and number as to constitute the experiment one conducted on a large scale—may be found in the annals of that land of which Lever says: If the moral geography The verdict of results has seldom found opportunity for more dramatic expression than in this passage, concluding almost anathematical of bastardy. The historian of medi- aeval and renascent Rome, says: Giuliano Medici (assassina- ted in the conspiracy of the Pazzi) had been the idol of Florence; dying unmarried he left a bastard child, but a few months of age and named Giulio. * * * Accident so The Legal Disabilities of Natural Children. 149 fated it, that this bastard mounted the papal throne and thereupon, as if to justify the Pazzi revolt, overthrew Flor- ence; to subject it to the completely degenerated bastard sept of the Medicis. Apologists for bastard crossing will find little consolation in the house of Lusignan, whose last flickerings in Cyprus, illumined the deterioration in bastardization of that once noble house. A new dynasty had been founded at Milan in 1450, by the natural son of a Cotognola peasant, who married the also illegitimately born daughter of the last duke of the preceding dynasty. Here was double bastard origin, and in addition as marked “crossing of caste”—if I be per- mitted to extemporize a term—as could have been suggested by the most extreme advocates of such procedure. Theresult is thus to be summarized: The only one of the new dynasty to make a name for himself was Francesco, its founder. The Sforzas sank into obscurity and became extinct, not only in a much less period than the preceding Viscontis, but also more ingloriously. The second of the line the son of bastards on both sides, was the matricide Gian Galeozzo; himself the victim of enthusiasts who in emulation of Harmodius and Aristogiton, freed Milan from its tyrant and mankind from this reproach, by a method not rarely resorted to in Italy with less palliating circumstances. The degenerating of prominent families with bastard infusion, is actually best shown in the Farneses, where that infusion was a double one; the natural daughter of Charles V, marrying the son of the bastard Pierluigi Far- nese. The issue, the celebrated Alexander, captor of Ant- werp had a son Ranugio I, who contrived a fictitious con- spiracy, making it a pretext for executing, and confiscating the property of the wealthiest in Parma. His successor Oduardo had already fallen so far below the grandfather that his war against Urban WIll is remembered in military 150 E. C. Spitzka. history only, where it occupies the distinguished position of being regarded as the deepest point in the decline of Ital- ian warfare. Thence the decline also in moral and mental degradation followed with the rapidity of that of the Spanish Habsburgers. A fact in harmony herewith is the apparent lessening preponderance of the same sex in transmitted bastardy. It remains low, but much below that noticed in the first and second generation; that is, it seems less after the third of a successive series of generations of bastards. A combination of remarkable similarity of its factors occurred in the marriage of Laura Orsini and Nicolaus Rovere. Through this marriage the blood of the more or less illegitimate Medicis, Roveres and Farneses streamed into one channel, (accurately speaking the Borgia blood should be also enumerated, as Roderigo Borgia, the paramour of Julia Farnese, was the real father of the bride). The result is that union was represented in descendants of the degenerate sort noted in the Sforza, Farnese, Este and Medici stock does when left to their own respective tendencies unacceler- ated by duplication of the evik and with about the same features quantitativaly and qualitatively. 51. The exposure, prosecution and extirpation of the Order of Illuminat in Bavaria involved episodes recalling what at that time, 1784–85, had already become the ancient history of the Tour de Nesle, Wehmique and “Eiserne Jungfrau.” It was also made a pretext for worrying, persecuting and ruining all that presented the slightest suspicion of independence of thought or uprightness of spirit. The active agent in this renaissance of the ‘‘Darkest Europe” was one Franke, sycophant to the Elector's bastards and hence confidante of their father. Among the natural children acknowledged by Elector William II of Hessia, was the Haynau mobbed by the draymen of Barclay and Perkins in 1850 and the people of Brussels in 1852, because of his part in the transactions mentioned in Note 28. Another, his oldest brother, recalls the characteristic feature of unscrupulous effrontery exemplified by Montauban, (Note 25) McMahon, (Note 37) Mareuil (Note 28) and Richard Plantagenet; (when he acted as hangman to the captive Eustace) and which enabled them to undertake with serene audac- ity, what was too dirty for even more than ordinarily elastic consciences. Wil- liam Haynau accepted, what in the entire body of Hessian officers not one could be found sufficiently perjured to undertake, namely the breaking the very con- stitution which the army had been sworn to maintain, Both the prime mover, The Legal Disabilities of Natural Children. 151 detested Hassenpflug (“Hass und Fluch” anglice: “Hate and curse” the Hessians read this name) as well as his tool Haynau had to fly before the storm of indignation thus aroused. However the end of bastardy was not yet for the victimized Hessians; and if the event proved anything but hurtful to their true interests, it was owing to no good motive on the nothus' part or on the part of their breeder; in short, the finale of Hessian bastardy was the finis of the Hessian Electorate : cotemporary statesmen were dumb-founded, when the last elector, with his patrimony at Prussia's mercy and opportunity offered to retrace his course, nothing more than neutrality being required of him, obstinately adhered to Austria. That 1866 saw his exile and the end of the dynasty was the well-known result. Less well known is the cause of the apparently unreasonable stubbornness that led to it: Frederick William the First (and Last) had had for years one darling wish; the legitimization of the Counts of Hanau, to that full extent, which would admit them to suc- cession as Electors. The realization of this wish by the Emperor was the bait, held out to and swallowed by him. Thus our own day saw Louis XIV’s drama of paternal infatuation re-enacted—not without corresponding scenic background; for Wilhelmshöhe aped Versailles as its occupant imitated the creator of the latter. The Hessian Montespan was a born Falkenstein, mar- ried to an officer, Lehman; from whom she, like her French predecessor, had become divorced to facilitate the princely purpose. 52 Rulers of illegitimate birth have been equally as stern to their wed- lock born children as others; instanced in the cruel treatment and death of Crispus by Constantine the Great’s, and the execution of Berenice by Ptol- emy Auletes’ orders. Of the two victims, the former was surely an inno- cent one; the latter a mere emulator of paternal example. 53 The chronicler Frizzi, after detailing the mental torture undergone by the unhappy father, and the David-Absalom cry following the news that the son’s life was past recalling, goes on to say that many thought it singular that the Duke, in view of his own origin and procreations, should have become so unmercifully severe to those guilty of adultery. Surprising it may be, but far from the exceptional; as witness the laws of Canute, father of bastard Harold Harefoot, who however was outdone by Pericles; for whereas the former reformed after having been a violator and made laws to reform others after having begun at home; Pericles first made, then violated and finally had the law he himself had made abrogated (Note 43). But both cases are mild as compared with that of Constantine. His birth was so obscure, accompanied by such doubtful circumstances—the only proof of his mother's marriage, post-natum, resting on the allegation of subsequent divorce, presup- posing a previous legal union—and the accounts so colored by servile writers, that I have possibly erred in assigning him to the group of mantle and mor- ganatic children. His laws, not against adultery alone, but any illicit inter- course, were so monstrous in their severity and brutally refined in cruelty, that it was simply impossible to carry them into effect. Such laws, had they been in force at the time of his birth, would have done away with him- self, for his edicts affected the offspring as well as the parents. (See Gibbon 152 - E. C. Spitzka. I, Chapter XIV). The definition of rape covered seduction and fornica- tion; the offender was burnt alive or thrown to wild beasts; the victim shared his fate, in case she admitted consent; the parents were exiled if they declined to prosecute; servants accessory to an assignation were burnt alive or had molten lead poured down their throats and ‘‘the consequences of the sentence were extended to the innocent offspring of such an irregular union.” On the other hand, some of Constantine's edicts were framed to prevent infanticide—then a common act of parents of legitimate children. 54 One may, without condemning Chesterfield as an entirety yet from blunt Johnson's polnt of view, endorse as one of that original’s happiest sallies, his characterization of the Letters of a Gentleman as teaching ‘‘the manners of a dancing master and the morals of a !” A sad materi- alization of those teachings, realized at a time they were at the zenith of avor, was the downfall of the Duke of York as Commander-in-chief of the British army. As a boy—and a very bright boy he certainly was—he had been overheard saying to the later crowned Turveydrop, “Brother, when you and I are men grown, you shall be married and I will keep a mistress.” Instantly rebuked and reminded that he had “more need to study his gram- mar,’’ he was asked, as a poser, to define a pronoun The ready reply came from the irrepressible youth: “Why? It is what a mistress is to a wife, a substitute and representative.” Now mark the promise of the youth as kept by the man! Mary Anne Clarke substituted, not alone a wife but the commander-in-chief of the army. She sold commissions, promotions (probably plans) and, when exposure took place, a parliamentary inquiry showed that other‘‘nouns” were to have been “substituted” by this versatile “pronoun.” She had established a branch office for the sale of church livings! 55 Kiernan, in an editorial of the Medical Standard, refers to an oath analogous to the Hippocratic, which was taken by midwives in England; its spirit would have been violated by the innovation which Louis’ sub- servient Chancellor Harlay made. (Note 47). King Louis systematically undermined marriage institutions. Maundering sentimentalists have found an affecting episode in the King’s keeping an officer employed at the front after his leave of absence had expired, in order to oblige the petitioning wife, who needed time to mature and dispose of the evidence of adultery. To just minds the affair smacks of Uriah; and high time were it, that, like another atrocious episode where a father gives up his wife to his son, it were expunged from the tales instancing alleged royal magnanimity. 56 Described in almost the words of Sueton anent Drusilla, is a child which, owing to its unmanageableness, had to be slain and whose mother was that Theudelinda, in whose behalf, on Giannone's authority, Gibbon falls foul of Boccaccio, accusing the latter of laese majestatis, committed in a tale of the Third Night of the Decameron. Gibbon's chivalry for once was mis- placed. From the same sources, whence he derives his estimates of other Longobard rulers, converge rays of information harmonizing with the general tint of Longobard morality and which place the ‘‘pious Theudelinda” in as urid a light as the one in which the mother of Commodus stands revealed. The Legal Disabilities of Natural Children, 153 While all other instances, where alleged bastardy rests on court-gossip or popular rumor, have been discarded from my list, I have admitted Commodus with as little hesitation as those whose bastardy is attested by official document and parental confession. I believe every reader of Gibbon will regard such an ingenious tale as that told to account for the notorious resemblance of the emperor gladiator con amore to the gladiator ex-officio as too elaborate and as reminiscent of the “qui s'accuse” adage; thus constituting it as strong circumstantial evidence as needbe. Like Fausta, Theudelinda in legend also had a theory and based a plausible tale thereon; not with the refinements of the belle-esprit Roman, but rather with a primaeval simplic- ity, reflected from the corresponding balneological experiment related by Mer- ovig's mother. Just as Clodion was sufficiently near (like Mark Twain in the Sandwich Islands) to watch the bather's garments while the queen took her “dip’’; yet not near enough to prevent the maritime monster procreating Merovig; so a courtier was near enough to testify to Theudolinda's non vult; sufficiently remote to disclaim agency in consummation; and too much so to have rendered aid, preventing this latter sad event. The only gap in the leg- end is its silence as to the identity, or no, of this ready-tongued and conven- ient witness with that quick-witted groom, who, betrayed by accelerated pulse-rate and “marked for identification” by the royal scissors; marked with the same mark, a hundred others; thus escaping a quandary provided for (I believe) in only one code of laws: Alabama's, which make personation of a husband under such circumstances, a capital offense. 57 The studied advancement of his son's interests was on the latter’s political apostasy taken up for the also illegitimate grandson, Wm. Temple Franklin—who, like Colon and Albuquerque (Note 1) became his sire's bio- grapher. The transfer of affection to the grandson reminds one of the elder Andronicus, who when his favorite son had been slain by another member of the family, transferred his affection to his bastard grandson, Michael Cath- arus, whom he destined for his heir–a disposition not realized. If anyone searches for the origin of favoritism of the kind which made an administra- tion within memory of the reader compared to a dented kettle, he will find something suggestive of it, in the source of the serious disagreement between the Father of his Country and his able coadjutor. This grew out of the lat- ter’s fierce office-seeking; above all reason and out of all harmony with Benjamin's general character; in behalf of his grand-son. To accomplish his appointment he stooped to what he had never stooped to on his own behalf. He wrote: I am surprised to hear that my grandson, Temple Franklin being with me, should be an objection against me, and that there is a cabal for removing him. Methinks it is rather some merit that I have rescued a val- uable young man from the danger of being a Tory, and fixed him in honest republican Whig principles. * * * It is enough that I have lost my son; would they add my grandson? " * * Possibly the “cabal” did not merit that harsh title. How seriously an insinuating bas- tard could affect the welfare of nations as shown by the betrayal of Spain's intention regarding her fleet to Nelson by “Lady Hamilton,” the indiscreet Queen of Naples having made the latter a confidante. A similar betrayal of 154 E. C. Spitzha. the allies of Ferrara was made by the bastard daughter of Aragon, Leonora. The interests of our colonies could not well afford experimental hazards with the young son of a “Tory,” whose real allegiance turned out to be English after all! Wm. Temple is the lad in the well-known illustration of the first instance of what underlies the “erupuit coeli fulmen” half of the celebrated euiogy. For the source cf the letters quoted in the text and this note, see Paul Leicester Ford’s article in the Century, December, 1898, et seq. 58 The Spartans were sufficiently familiarized with bastardy. The mothers of their two greatest generals, Lysander and Gylippos were Helots; they both closed their careers “umbered” with bastard crime; the former formenting a forgery-founded intrigue, discovered post mortem; the latter tap- ping the money bags of the State; both by the way, illustrating the sterling truth that every fraud is a fool, some puerile error or omission usually proving fatal to such. The effrontery side of bastard character is amusingly shown in Lysander's opposing Leiotichides succession (although Agis had recognized this as his son) on the ground of illegitimacy. His own differed from the latter's only in shade; one being of the clandestine; the other, of the adulterine variety. Lacedemon contributed to the subject in a more interesting manner and on an unprecedented scale. The results of the breeding experiment were qualified as Partheniae i. e., maid-children (maid- bairn, Ochiltree terms “Malcolm the Misbegot), and their restlessness and popularity were so great at Sparta, that permission to emigrate was expedi- tiously and enthusiastically granted their petitioner Phalanthus. As pirates, hostage-breakers, fomentors of discord and inviters of foreign invasion the descendants of the Partheniae proved worthy of their origin and did credit to the sinister baton, as may be read in the annals of Tarentum, which city the emigrants founded. Another Spartan king was displaced as an alleged illegitimate like Erichson of Sweden: Demaratus. 59 Frederick II, undoubtedly the greatest figure of his age, a scien- tist (he wrote on the osteology of birds) a statesman and a military leader so brilliant, that he accomplished against the formidable opposition of his most natural ally, the Pope; what the united sovereigns of Europe had failed in; the conquest and safe access of pilgrims to Jerusalem; had, besides legiti- mate offspring, Manfred of Tarent; Enzio, captured by and dying after thirty years confinement in the dungeon of the citizens he had endeavored to sub- jugate; and Frederick of Antiochia, so named, because he had conquered and established an independent government there. Manfred (by the beautiful Blanca Lancia) he regarded as practically legitimate and in his will made a distinction in his favor—as Abraham did for Ishmael against the “sons of concubines.” In addition, the emperor had other natural children, a count- ess of Caretta among them. 60 It may not be out of place, in view of the singularity of the theme, to state how its material came to be collected. In one of the scheduled sub- . divisions of a chapter on heredity, part of a long contemplated, but still unfinished, treatise, I had for years registered the pedigrees and peculiarities of prominent personages of history as well as of the more striking instances The Legal Disabilities of Natural Children. 155 within cotemporary observation, in practice or otherwise. I became at first strongly impressed with the superiority of bastards to the legitimate in these lists, and as the views growing out of such impression were in great part similar to the very ones which this paper combats, I may fairly claim exemp- tion to being considered as biased a priori. It was in collating the material of other chapters, “Maternal Impressions,” “Consanguinity” and “Deter- mination of Sex,” that I encountered facts which, without demolishing the observation and first conclusion, rendered its apparent sequitnr questionable. Further inquiry and an enlargement of a list of originally only 284 persons to over 600 (at the date of the reading 519) showed what had begun to appear problematic, even in theory, to be fallacious in practice. The mul- tiplicity and variety of sources from which I obtained the material may in the eyes of some constitute an objection. To my mind figures, derived from a single class of society and the same historical period although intrinsically most valuable, would be, as basis of general conclusions, manifoldly more objectionable. In factors of such universality and continuance, a just appreciation-involves the survey of the widest field on, and time in which it has been or is operative. That the female sex is poorly represented is due to the small representation of female characters in general and literary his- tory; a glance at the accompanying figures shows that as we approach the period of cotemporary observation and of memoirs the female figure more nearly approaches the statistical. However profound the influence on events of the feminine, has been and continues to be, it is not exerted in a way to leave the impress of its individual representatives as extensive, as deep or as enduring as that of the representatives of masculinity, on the annalist's pages. This accounts for the progressive shrinkage in the number of females as we pass backward to thc earliest days of authentic record. MALES. FEMALES. TOTAL. Ancient Times to the abdication of Romulus Augustulus to Odoacer............................. 98 16 114 From the latter date to the Discovery of America......................................................143 27 170 From 1492 to the Great Revolutions of the Colonies and France................................120 52 172 Later, exclusive of Cotemporaries... ... 30 19 49 Cotemporaries deceased................. ... 21 7 28 Do. living on January 1st, 1899...................... 26 20 46 438 141 579 As a glance at the tables in the text show, the various occupations and conditions of life are generally, if not in due proportion, represented. The nativity of 578 had been as follows: MALES. FEMALES. TOTAL. Asiatic lands (Ancient).................................... 21 1 22 * * “ (Modern). ... 5 0 5 African ‘‘ (Ancient)............................. ... 11 2 13 Greek “ Colonies and Islands (Ancient) 23 5 28 “ (Modern) including Byzantine and Turkish ...................................................... 7 0 7 Italy (Ancient: Rome and Roman Colonies) 31 8 29 Italy (Modern: including Venetian posses- 156 E. C. Spitzha. sions) … 89 47 136 Iberian (Ancient)............................................... 2 O 2 Iberian (Modern)................................................ 24 6 30 Spanish-American Countries. ... S 1 9 France ................................ . 74 24 98 Scandinavia .......... ... 2 3 5 Batavian Counties .......................................... 9 2 11 Russo-Sarmato-Hungarian Countries ......... 15 7 22 Germany (Including German Austria, Ger- man Switzerland, and excluding the Netherlands .................. …....................... 40 9 49 Scotland ........................................................ 19 0 19 England . 44 19 63 Ireland........................... ...................... ... 3 0 3 English America (U. S. and Canada)............ 20 7 27 437. 141 578 Small as the totals are, the more important races are fairly represented, as are also several mongrel ones; there being seven of mingled Caucasian and Indian, and five of mingled Caucasian and Negro blood. Those enumer- ated as from Africa are not to be confounded with the latter, having been Hellenic, Numidian or Schemitic. The reader may judge of the nature of the material, as of 382 bastards referred to in the paper, 319 (83 females, 236 males,) are included in the tables. 61 It is notorious that Louis XI of France brought about the ill-sorted marriage of his successor deliberately and with a view to ensure barrenness. Obviously if he bore in mind that some slighter degree of bioplasmic inactiv- ity, than is expressed in absolute sterility, might have resulted in evolving an imbecile or cripple; he would have contemplated such possibility with the imperturbability the “universal Spider,” (as he had been nick-named), pos- sessed to perfection. It is in reference to this marriage that Scott places the fictitious,but happy, response to a supposed taunt against his father's illegit- imacy, in the mouth of the younger Dunois: “Since your majesty has alluded to the birth of my father, I must needs own that setting the frailty of his parents on one side, he might be termed happier and more fortunate as the son of lawless love than of conjuga hatred.’’ As if to bear out the claim made in the paper that bastardy and related questions exerted and exert as great influence in recent and cotemporary history, as at certain earlier periods, King Louis Philippe of the same land enacted the same intrigue with a similar purpose in the case of the marriage of the since notorious Isabella. It is amusing to follow the wretched Guizot through his floundering attempts to combine the Historian and Cabinet-apol- ogist, as he proceeds to relate the facts and tone down the criminality of the king-jobber, his master’s schemes; which nigh brought about a Franco- English war. 62 Ireland W. W. : The Blot on the Brain. 63 Aside from its sycophancy, the Absalom and Achitophel of the author of the passage, in its opening lines contains a fair exposition of the popular The Legal Disabilities of Natural Children. 157 and correct view on the reasons for bastard superiority. In referring the reader to them, it may be superfluous to recall that Dryden represents Charles II, as David, and, as Absalom, his natural son by Lucy Walters. Somewhat in the same vein is a passage in Lemmnius, which, for obvious reasons, I leave, as quoted from Burton “* * * quod persolvant debitum (conjugale) languide, et oscitantur, unde foetus a parentum generositate decis- sit.” This were a worthy finale to that richly humorous monologue, anent sexual determination, delivered by Falstaff after Prince John's back has been turned. (Henry IV, Act II, Scene III). º 64 St. Simon lays stress on the high regard in which the Germans held legitimacy. Their descendants would have reason for pride, if this taken together with the sentiment of the Anglo-Saxon branch expressed through Par- liament (vide supra) were found due to that racial factor referred to by Tac- itus as the remarkable sexual purity of the Germans. Possibly close inquiry, if not at, shortly after Tacitus' day, would have led to such disappointment as Albert Smith encountered on the Rhine when seeking to identify Byron's pretty and smiling peasant, girls who present the welcomed traveler with flowers and fruit, but whose good nature seemed to have departed with their ‘‘blue eyes” and blonde hair. Probably in long established communities con- ditions—if not Utopian—far purer than in Italy and Gaul prevailed. But on the borderland where tribes mingled and outcasts sought refuge, combinations would have been made, whose members were vigorous, crafty, unscrupulous, and, like most mongrels, possessing the vices in more impartial distribution than the virtues of their respective parent peoples. Thus arose the Franks,” and Longobards, as is evidenced by the fact that no less than, nine tribes are mentioned as associated in one of the first migrations of the former. Their enterprises entailed confusion and demoralization at home, and ruin on the lands they migrated to. After their departure a tendency to re-establish legitimacy as a principle manifested itself; in contrast with France, where inroads were too serious and followed in too rapid succession to allow its vindicators as much as a breathing spell, while in Italy legitimacy had become crowded to the wall; as to have become an almost excep- tional condition and, even then, apparently a fortuitous one. In one emergency Germany chose Carlmann’s son as sovereign, the distin- guished Arnulf; but the electors drew the line there and Arnulf failed to secure the throne for a second bastard succession represented by his son Zwentibold. (See Note 40). In Italy, however, the bastard daughter of bastard Ferrante of Aragon, became the Duchess of Ferrara; bastard Mala- testa succeeded bastard Malatesta; and at one time legitimate rulers were actually in the minority, even the Vatican having become invaded. (Note 38). 65 Not by partial fathers alone are natural children preferred. They seem to have the unfathomable qualities which cause the common people to “almost invariably choose their favorites so ill that their constancy” becomes “a vice and not a virtue.” Absalom, Dom Antonio, Bockold, Proli the false Dimitris, Angouleme, Elagabal, Lysander, de la Marle, Mansfeld, Narbonne, and notable Monmouth, to whom Macaulay refers in the above 158 E. C. Spitzha. citation are examples. As regards the opportunities afforded natural children, these have often been even better than those given their legitimate relatives. Paternal solicitude secured them the best instructors available, and if the selection was exceptionally such as that of Barére for Pamela (Adulterina of Phillip Egalite and Madame Sillery) it was due to the excep- tional obliqueness of the patron’s mind and the kinship of spirit with the patronized tutor; not to a sinister intention. In the list of tutors to natural children are Rousseau to Princesse de Conti Il and Ugoletti to John Corvinus, (natural son of the Hungarian King Mathias), some name Galiani. 66 The transmission of the bastard’s mental characteristics to his wedlock-born offspring is one of the more important, as it is one of the most striking facts in this field. The typical nothus was faithfully reproduced in the following: Cleopatra, both whose parents (Ptolemy Auletes and Cleo- patra Tryphaena) were illegitimate; Henri Beaufort, roi des halles, son of Caesar Vendome, who had been the nothus of Henry of Navarre by Gabri- elle, d’Estrées (Note 12); Bothwell, not Mary Stuart's but the rebellious, intrigant and exiled professional turn-coat, son of James the Fifth's bastard the Prior of Coldingham; the executed robber and pirate son of the Earl of Orkney, a bastard Stewart;-the Duke of Rothsay, son of the legitimatus Robert III; Galeozzo Sforza and Antipater, matricides of illegitimately born Blanca Sforza, daughter of the last Visconti, and of Thessalonica, daughter of Phillip of Macedon; Lady Maria Herbert, daughter of Lady Powis, a natural child of the last Stewart on the throne; the Duchesse de Berri daughter of Louis XIV’s brother, the later regent, and of the former's illegitimate daugh- ter a “Mademoiselle” de Blois of the Montespan vintage (there was another de Blois of “Sun-King” paternity; she was of the la Vailiére series). Hugo, son of Bertha of Provence (Note 85) and Langrand Dumanceau, who a worse Law, was the son of a foundling. After “improving” half Europe, he served in jail a convict, and on emerging from that chrysalis stage appeared as Belgian Count flourishing as such in Belgium a few years ago, if not at this moment. One of the best illustrations is Jugurtha. In some histories spoken of as illegitimate, as I followed it in opening the subject, I have become sat- isfied that this is inaccurate and based on misconstruction of Sallust, who speaks of the illegitimacy of his succession—not of that of his person. Jugurtha's father was the bastard of King Miscipsa. The selfish cruelty with which the son of bastard Mastanabal exterminated those who appeared in the way of his ambition; the ingratitude to a benefactor who entrusted his orphans to him; the callousness with which he, instead of guarding, destroyed them; his system of bribery and above all the brazen effrontery with which in the very hotbed of danger, Rome itself, he had opposing Numidian agents assassinated and bribed Senators; are paralleled in the bastard Ptolemy Auletes and Perseus of Macedon particularly the former. Exactly so had the former corrupted the powerful at Rome, and purchased Julius Caesar body and soul! With the same thick-skinned effrontery he had nigh an hundred noble Egyptians who had come to Rome to complain of him, assassinated on their way to, and even in that appellant sanctuary The Legal Disabilities of Natural Children. 159 itself. The sanctuary sacerdotal ceased likewise to be a protection with Perseus. It is difficult to conceive the mental processes of this wretch. While he had taken sanctuary himself, he took the life of Evander to make it appear the latter had slain himself on account of remorse for an act, impu- ted to and really committed by Perseus; but which the pseudo-suicide—a la Pichegru–could be plausibly made the scape-goat of! Thus did the monster rid himself of an accusation and the only witness to its truth—for Evander had been the accomplice of Perseus—at one blow. Making one's very vices a source of profit this is indeed; it reminds one of the Borgia-Djem affair. (Note 50). The relapsing of bastardy is frequently in more than one branch of a divided descent. In the Carlovingian family aside from single recurrence in lines extinct with the individual named; such as Griffo, the last Pippin and Bernhard of Italy; Arnulf and Bertha of Provence are examples; Ratbod being issue of the former directly, Endoxia, grand-child of the latter. The Castilian, Plantagenet, Merovingian, Bourbon, Norman and Stewart dynas- ties furnish confirmation. It may be objected to an inference based on these cases, that temptations and opportunities for following them are dispropor- tionately great among the royal. It is to be admitted that the extrinsic conditions of bastardy when associated with royalty are such involving unusual vicissitudes of career; incitive to its extravagances on the one hand and jeopardizing it on the other. But making due allowance for this and comparing only with those of the same class and age, recurrence of bastardy is as remarkable a fact as is the excess of crimes committed by, and violent deaths undergone by, those of their kind. Rather than to environment must we look to the intrinsic characters—characters less useful than interesting —which render bastards equally prominent in all these fields. 67 The same parental care became manifest in the marriage alliances contracted in their behalf, and which not infrequently involved a doubling of the tainture. Thus Anne of Constanz was by Frederick ll affianced to the Emperor of the East; the morganatic daughter of Frederick William III to the Prince of Anhalt (Coethen); Lucrezia Borgia, after two marriages to equally illegitimate spouses, concluded her experiences as duchess of Ferrara; as had Leonora of Aragon, the bantling of bastard Ferrante, in a previous generation. Her sister had been likewise provided for with an illegitimate partner. The “Selene,” of Mark Antony became Juba's queen; Constantia married the heir of Castile. (Note 21). Phillip of Macedon secured crowns for both daughters of his courtezans: for Cyane, as well as for the victim of her matricidal son, Thessalonica. Hugo’s daughter, by his concubine “Venus,” was prevented by an early death from mounting the Byzantine throne. The Dane provided for his Florentine as Lady of the Lord of the Isles. Verneuils, La vallettes. Montmorencis, Elboeufs, and others of France's aristocracy united themselves with the bye-blows of royalty a step which Orange (Note 46) refused to take. If none else offered, a claimant like the King of Ireland (Lord Fitz- gerald) might aspire to the hand of a Pamela, and the Stuart of a second bastard generation was considered good enough for a Ratcliffe; a royal bye- 160 E. C. Spitzha. blow of the first generation, George the Fourth’s, could not stoop lower than to become a Marchioness Huntley and a Lord Mount Charles. 68 I must admit inability to comprehend many of the modes of reasoning adopted by this school. After some labor, I believed to have accumulated data justifying the conclusion that the higher moral standard among morgan- atic and love-children as contrasted with the adulterine and meretrix-born is refera ole to the higher ethical parentage expressing the mutual integrity of procreators whose association is practically in the same good faith as in formal wedlock. Among my grounds was that, where the parents of love- children had regarded themselves as husband and wife before their consciences, the offspring differed in no wise, or unappreciably so, from the first-born issue of love-marriages. Alas! A prominent writer on degen- eracy, the chief mover of the uomo delinquente propaganda has included among his reasons for pronouncing Columbus abnormal, the latter's intention to marry the mother of his son before mentioned. (Note 1). 69 The anger of Jehovah is represented to have been kindled against mankind at the time of those visits to the ‘‘daughters of men,” resulting in Hercules and Theseus—like “mighty men which " were of old, men of renown.” Considering, how much less exceptional, illegitimacy must have been in early as compared with later times—for the allegiance of man was tribal before it became parental; and, as Lubbock showed, paternal before it became alike to both parents; there must have been something intrinsic to bastardy to call for so early a discrimination as in the first acknowledged extant genealogical record. Even excluding the product of the aforesaid ‘‘visits” and the cases of Ishmael, Moab and Ben-Ammi; the following sons of concubines and one of a ''Canaanitish woman’’ occur in Genesis: Tebah, Gaham, Thahash, Maachah, (XX. 24) Amalek, (XXXVI, 12) and Shaul (XLVI, 10; Exodus VI, 15). Like Lupanilla and Cleopatra VI, Tamar bore twins, Pharez and Zarah, as a result of her clandestine venture. (Genesis lxxxviii, 18 and 30). Mamser is used in modern Hebrew vernacular as an approbious designation for natural children. 70 The Peruvians of Inca days dealt with the question from this point of view most radically. Contemplators of illicit intercourse beheld the deter- rant spectacle of a death penalty, unrelentingly inflicted on like offenders. Their bastard offspring on the other hand were made a public charge and taken care of in an institution corresponding to the Ekthetotropheum of the Greeks. 71 The enthusiasm of those who have affected to discover the most accurate delineations of insanity, even to the details of its special clinical forms, in Shakespeare, has led them—inclusive of several alienists—far beyond reasonable limits. To judge from some of their writings, one, to whom his works had been unknown; might infer that Shakespeare had had as chief object the furnishing a gallery of types of the psychoses. The fact is that insanity had a fascination for one of as unexampled power of insight into character, as remarkable fidelity in portrayal, and in search of materia The Legal Disabilities of Natural Children. 161 for development of tragical catastrophes. So far as the “clinical picture” could be adapted to his purposes nothing was or could have been better portrayed But when the exigencies of Drama demanded a deviation, or a crisis could thereby be more drastically precipitated, Shakespeare hesitated no more, than a dramatist should, to sacrifice technicality to convenience. Nevertheless the faithfulness of his sketches of human character normal or abnormal, ideal or perverted, like those of male personages made by one who may be regarded his pupil as he was his worshiper—Scott—is such, that it is a satisfaction to the compiler of details and figures, to find his conclusions anticipated by their sketches. The bastard character as delin- eated in the present paper has, in all salient points, been recognized and portrayed by both writers. That actual personages were presumably their sources of portraiture only adds to the weight of the confirmatory bearing. The episode of the sealring presented by Middlemas (The Surgeon’s Daugh- ter) to the object of his suit, is so exquisite an exemplification of the “parvenu adventurer variety” of bastards that it must have been drawn from Scott's personal observation or knowledge. In addition to this and others already referred to, (Note 10, where Roland Avenel is errone)usly designated by his father’s first name) as well as actors in brief episodes like the Hermit in “The Lady of the Lake,” and a Bertram Hewitt who appears as the deus ex machina in ‘‘Guy Mannering,’’ an excellent example of the bastard is the false Lord Ethering- ton (St. Ronan's Well) the Whistler (Heart of Midlothian and Francis Stewart, (Old Mortality); whose speech on the subject of his ancestor's bastardy is a worthy pendant to that of Dunois (Note 61) as well as a fair characterization of a monarch who made ribald jests, while dissecting his own aborted offspring; “dropped,’’ as Pepys has it, at a court-ball. 73 Several Swiss cantonal governments, in conflict with the canonical ordinance, did recognize as legal such testimentary provision. The ground for this abrogation of a law, elsewhere obeyed, is stated in one instance of the Fourteenth century to have been neither religious nor sentimental but a representation made by the parish clergy that the edict was not carried out bona fide but used as a means of extorting indulgence money on behalf of ecclesiastical princes. 74 whenever the church departed from its natural and consistent standard, its discipline became impaired and the fabric tottered; whereas, on the other hand, the highest enconiums passed on its establishment by historians—among them several without its pale—have rested on its uncom- promising adherence to that standard and the wisdom of such adherence as confirmed or illustrated by the event. The maintainance of the Canonical law, excluding bastards from higher degrees, even to but such extent, as would have preserved appearances, would have rendered the monstrous fungous growths in the College of Cardinals and in Bishoprics impossible. The successor of Roderigo Borgia or Alexander VI, was compelled to repeal almost all the ordinances of his predecessor—for almost all of them had been promulgated in the interests of bastard children, whom he loved (with 162 E. C. Spitzha. a “demonic love” Gregorovius terms it) to the extent of ruining Italy and jeopardizing Christendom in their behalf. An example in so high a place could not but be followed in a hot-bed of bastardy. On all sides rose inde- pendent governments of all sizes; from the stately kingdom of Naples and Sicily and the Duchies of Ferrara and Rimini, down to mushroom and Lilipu- tian Forlis and robber burghs in the Appennines. Two-thirds of them were ruled by bastards or the sons of bastards; Rome itself heading the list when the wretched Clement VII saw unmoved that transaction, indelibly graven on the record of Historical Bastardy, the second ‘‘Sacco” of Rome; second I say, because the Vandal “Sacco” (Part 1) was conducted, as the Bourbon was provoked, by a bastard. The liberty of free cities was crushed; either by insinuating betrayal through a bastard Sforza, or open brutality as that of the mongrel and bastard Medici, (Note 27); foreign and native merce- naries were called in, fair provinces wasted, cities razed from the ground and a people, scarcely recovered from the ruin and corruption inflicted by a like bevy of a former era of bastardy, were exterminated or impoverished, expatriated or corrupted by those of another era, in those favorite occupations which offered play for the military and diplomatic proficiency of the class. Mark these words from the leading historian of Mediaeval Rome! “Naught was stranger in Rome than this matter of illegitimacy. As popes succeeded popes, their nepotes—as a fact in most cases their bastards --appeared on the scene to develop; overnight, as it were; into Vatican- Princes, tyrannizing the city, even the Pontiff himself " * * * and, though their power might wane and vanish, they added new families to a growing papal nobility.” No more drastic illustration of the malign results which a breach of the law entailed, is required than the enumeration of those nominated and pro- moted in violation ot it. Here is a list hap-hazard! Guilio Medici, Hippolytto Medici, Pietro Riario, Caesare Borgia of one epoch; Maximilian Sittig, the third Sergius, one John his predecessor; and one, successor; with Beaufort of Winchester of an earlier one. Of the nepotes suffice it to say, that in addi- tion to Francessetto Cibo and Girolamo Riario there is one whose biography bears a title, itself speaking volumes: “La sceleratissima di Pietro Luig Farnese.’’ How saturated with illegitimacy Italy had become will be appreciated by readers of Benvenute Cellini's auto-biography. His first employer has a bastard ward; one of his statues is tampered with by a bastard of the sculp- tor Ammanati; he is employed to work for bastard Clemens the Seventh, as well as by the other bastard Medici who ruled Florence. The bastard daughter of Pompeo endeavors to procure Cellini’s assassination; and as she is married to a hanger-on of bastard Pietro Luigi Farnese, is hounded to prison by that person. Escaping, the writer owes his protection to a bastard daughter of the Emperor;and, to make the decade (or dozen 7 I forget which, as there are other natural children referred to and I reckon at the moment from memory) complete, Benvenuto acknowledges a natural son in Italy—whose death is the greatest blow he mentions—and a like daughter in Paris. (See also Notes 64 and 74. The Legal Disabilities of Natural Children. 163 75 In Germany Burgundy and neighboring lands a distinction was made between two classes of persons to whom the carrying out of judgment award— ing capital punishment was entrusted, a higher and a lower. The former was distinguished as “Nachrichter” (literally: After-Judge); his “trade” was classed as “hynest” and if, mayhap, of noble blood; he did not forfeit his nobility, because of his profession. The latter, on the other hand, were “anruechig” (Infamous), their occupation regarded as “unehrlich’’ that is dishonorable and termed hangmen (“Hemker” resp. “Henkersknechte,” the latter being the title of the assistants of the former, as well as of those doing the menial service required in aiding the “Nachrichter”). It was particularly stipulated that the Nachrichter be of legitimate birth; a bastard could only aspire to become a hangman, with which office the function of public knacker (Wasenmeister) was , usually amalgamated; it also being reckoned among the trades not honest. This latter term is to be under- stood in its original Latin sense, which signified rather honor and dignity in general, than integrity specifically. A similar distinction between two classes of executioners in France was that of “Executeur de la haute jus- tice, (also “du Prevot) corresponding to “Nachrichter” from the common hangman, who was termed “bourreau.” As the “Henker” was “unehrlich.” in Germany, the “hourreau” was “vilain” in France. 76 Max Ring states that illegitimately born parvenus in Berlin and other cities purchase “adoption,” from impoverished bearers of unstained names, sometimes a noble one! One instance he cites, where a gallery of paintings, representing a long line of noble ancestors, was included in the bargain. This is a manifestation of the vanity of bastards of which other instances are referred to in the sequel. - 77 How deceptive appearances in this respect were, the sequel shows. Even at the time when a tendency to liberal construction of the laws became evident, the memory of Monmouth's raid, entailing the misery of a noble peasantry through the “Bloody Circuit” had not faded. That serious complica- tions did not ensue at the beginning of this century; in Great Britain, was fortuitously due to the fact that Lady Fitzherbert did not become with child by the Prince Regent. The offspring of secret and left-handed marriages do not—as hundreds of cases show—regard themselves bound by the parental abdication entailed in concluding such unions. Not to mention Juan of Austria, the brother of Philip II, and his ambition to become named Infanto, the similar intrigues of the second bastard of the same name (Son of Philipp IV by the actress, Maria Calderon) and of the Duc de Maine under the Regency, England itself had a comparatively recent warning in the attempts made by Augustus Frederick of Este to have his legitimacy acknowledged; his prospects of mounting the throne 'appearing stronger and stronger with the rapid dying out of the issue of the legitimate sons of George III; a last one was made as late as 1843. Failing through the firm adherence to the Statutes, regulating marriages of members of the royal family, the Colonel (for this son of the Duke of Sussex had joined General Lambert and served as adjutant at the battle of New Orleans, subsequent to which defeat he 164 E. C. Spitzka. became promoted to a colonelcy) attempted to have his succession right recognized for the Hanoverian throne, at least; and of four eminent legal authorities, two gave favorable opinions in a matter which appears to have furnished fewer grounds for ‘‘doctors disagreeing” than certain doubtful mental states anent whose varying interpretation by physicians the brethren of the other profession are inclined to affect much sarcastic humor. 78 See an instance of this in the case of Charles Sturt against the Marquis of Blandford for crim. con, with plaintiff's wife where Erskine, placed in the unpleasant predicament of finding his client convicted of the same offense which the defendant was accused of having committed with the wife of that client, nevertheless gained a forensic victory and vindicated the on first sight strange attitude of the Civil Law, that only the wife can commit adultery. Adulterini solo ex-connubia foemina procedere possint Jus. Rom. It was the Church's; abstractly considered, more equitable view of the offense; as of equal turpidity when the husband was unfaithful to his wife; as when the latter was so to her husband, which led to application of the term to all illicit intercourse whatever. By thus extending the field it attenuated the legal gravity of adultery, and with the resulting milder construction the obligation of alimony (aliment i. e., support) was incurred. 79 One of the few privileges reserved by the Imperial Court of the “Holy Roman Empire” on the establishment of the judicial tribunals super- ceding it generally and known as “Reichsgerichte” was that of legitimating natural children—a function performed through the comes palatinus; not to be confounded with the Electoral Count Palatine. The latter owed the title to having originally held the office of “count of the palace” retaining the title on the original holder's giving up its functions and becoming a fief- holding prince. By a singular fate the end of the Palatine house involved circumstances which did call or might have called into requisition the offices of the official successors; for the Palatine princes died out in the legitimate lines, the last, Rupert, leaving illegitimates; among these Lady Ruperta in England, who he had by “Desdemona” (Mrs. Mary Hughes). An earlier prince, from whimsical motives, married morganatic and left two sons, one of whom founded the flourishing house of Lowenstein. (To be continued; Tables and balance of Foot-Notes in next number.) SELECTIONS. CLINICAL PSYCHIATRY. A CASE OF GENERAL PARALYSIS OF THE INSANE IN A CHILD.—John Thompson and L). A. Welsh. Hugh T. Patrick in Journal of Nervous and Mental Diseases abstracts from the British Medical Journal, No. 1996, p. 784, April 1, 1899, this interesting case: The patient was a girl and there was distinct evidence of hereditary syphilis. When she was between ten and a half and eleven years of age it was observed that she was not improving in her school work, and seemed to be getting stupid and irritable at home. No further change was noted in her mental condition until she was about twelve, when fits set in, and she became steadily less intelligent. Her speech was characteristically affected by the time she was twelve and a half years of age, and her knee-jerks were greatly exaggerated when she was thirteen years of age. When about fourteen years of age she had several distinct hallucinations. Between eleven and fourteen years of age she became unnaturally fat, but afterwards she steadily emaciated. The fits continued at varying intervals during her whole life. Six months before her death she had an attack of subacute periostitis over the right tibia, which was greatly relieved by iodide of potash. She died in a state of extreme debility of mind and body, aged sixteen years and eleven months. The post-mortem examination showed no trace of sub- dural membrane, but an opaque and milky pia-arachnoid everywhere adherent to the brain and an excess of cerebro- spinal fluid. The cerebral convolutions were greatly atro- phied, being small, narrow, and separated by dilated sulci. Atrophic changes were general, but most marked in frontal [165] 166 Selections. and parietal regions of each side. On section the cortical gray matter was found to be extremely atrophied, its layers indistinct, and its consistence tougher than normal. The white matter showed irregular patches of congestion and increased toughness. The basal ganglia were also congested. The lateral ventricles were somewhat dilated, and their ependyma showed fine scattered granulations; more numer- ous and more prominent granulations were present in the fourth ventricle. The choroid plexus showed no obvious change. Microscopic sections of the cortex from various regions showed changes characteristic of general paralysis in the nerve cells in the neuroglia, and in the vessels. LA MALADIE DE BLAISE PASCAL (Blaise Pascal's Disease). Binet Sanglé (Annales medico-psychologique, 1889, March). This psychological study of Pascal here brings out a number of interesting facts. The family his- tory, as to his ancestors, is lacking; yet it is certain that brothers and sisters were decidedly neurotic and hysterical and were all short-lived. - It seems evident that Pascal suffered from severe neu- rasthenia, in that he complained frequently of transitory paraplegias, general prostration, persistent digestive disturb- ances and obstinate headache. He was extremely emotional, at times hypochondriacal, and had a number of phobias with hallucinations. Moreover, he had distinct periods of disordered judgment, which coincided with grave alterations in his general health.-Benoit in Journal of Nervous and Mental Diseases. PSYCHOLOGIC STUDY OF JURORS.—A timely paper upon this interesting phase of modern justice is contributed by Dr. T. D. Crothers in the Medical Record, October 21, 1899, which would not be without effect were it brought before our law-makers. The necessity and urgency for reform in this particular are clearly brought out by the arguments of the writer. The uncertainty of jurors and the capricious, whimsical character of their verdicts are accepted as inevitable, and explained as part of the natural weak- ness of the mind. From a medical and scientific point of view, the average twelve men are usually incompetent nat- Selections. 167 urally and are generally placed in the worst possible condi- tions and surroundings to exercise even average common sense in any disputed case. These men are placed in the most adverse hygienic conditions for healthy brain and func- tional activity. They are confined in a close, badly-venti- lated court room and are obliged to sit in one place five or six hours a day; changed sleeping rooms, imperfect exercise, continuous mental strain. They become listless, abstracted and finally fall into a state of veritable mental confusion. PARETIC DEMENTIA AND INTERSTITIAL GINGIWITIS. —Dr. Raoul Baudet about a year ago (La Presse Medicale, 1898) described a trophoneurosis characterized by shaking and falling out of the teeth by alveolar resorption and gingival ulceration, by perforation and at times necrosis of the maxillary. This condition has long been recognized by alienists as causing the fall of the teeth, which occurs in paretic dementia. About two decades ago, Dr. J. G. Kier- nan in an article on trophoneuroses of the insane called attention to it (Journal of Nervous and Mental Diseases, April, 1878). Dr. E. S. Talbot, in his recently published work (Interstitial Gingivitis or So-Called Pyorrhoea Alveo- laris) says that the influence of the nervous system on the processes of growth and repair which is called its trophic function, has been shown to play a part in both the etiol- ogy of the disease and its progress. This function has received but little attention from dentists, albeit its influ- ence has been recognized in dental pathology in connection with great neuroses like paretic dementia and locomotor ataxia, in which gum disorder occurs, followed by loosening of the teeth. Dr. Chagnon has recently reported the case of a paretic dement (American Journal of Insanity, October, 1899) which illustrates this position. The case was that of a forty-four year old man who about ten years ago con- tracted syphilis. Two years later he married and had healthy children. In June, 1895, he was admitted to an insane hospital under intense maniacal excitement which subsided to give place to the usual symptoms of paretic dementia. The psychosis followed its course without any remarkable incident until about September, 1897. At this 168 Selections. time Dr. Chagnon found that the two incisors, the canine, two premolars and the first molar of the left upper maxil- iary, were very loose. The teeth on being picked out were absolutely sound. The ulceration which affected the surface of the alveoli following the loss of the teeth, did not heal. About the middle of September a sequestrum in which the work of alveolar resorption was not much advanced became detached. The palate roof forming the anterior border of the auxiliary sinus was part of the sequestrum. Two months later the ulceration had healed. In June, 1899, when Dr. Chagnon reported this case to the Quebec Medico-Psychologic Society all the teeth in the lower jaw were sound. The two premolars and the right canine of the upper jaw were decayed. The second and third left molars as well as the first right molar were loose but per- fectly sound. There existed no alveolar pyorrhoea. Neither did any trace of ulceration appear except a small opening which would not admit a probe. THEFT DURING EPILEPTIC UNCONSCIOUS STATES. —Dr. A. Heym reports (Chicago Clinic, September, 1899,) the case of a nineteen-year-old well educated refined woman, usually of a happy disposition who was, about thrice yearly, suddenly overcome by deep mental depression without apparent cause. This depression passed into periods of unconsciousness, during which complicated actions were per- formed. On one occasion, after these periods she awoke to find herself far from home clad in dirty rags without know- ing how she came in this condition. On another occasion she awoke in a forest during a cold November morning. Another time she awoke in jail having been caught stealing in a dry goods store, tried and sentenced, without her men- tal state being discovered. From the jail she was sent to an insane hospital where she was found to be a nocturnal epileptic. MENTAL DISTURBANCE DURING ACUTE RHEUMATIC CHOREA.—Dr. Jastrowitz describes (Deutsche Med. Woch., Aug. 24, 1899,) the case of a twenty-five-year-old girl of neurotic ancestry of extremely irritable temperament who had never menstruated. The uterus was infantile. About Christ- Selections. 169 mas, 1898, she complained of pains in the arms which continued, and which later grew so severe as to interfere with exercise. The pains appeared first in one joint, then in another, were accompanied by tenderness and some swelling, and were improved after the use of salicylates. No member of her family had acute rheumatism, but there was a limited epidemic in the town in which she lived. In February she showed choreiform movements and a few days afterward had maniacal attacks with great excitement. The choreiform movements continued and became extremely severe. She had some fever and the pains in the joints continued; there was later a purpuric eruption, and a bed- sore developed after she had been confined to bed for some time. The temperature continued marked until the middle of March, and thrombosis of the femoral artery appeared. From this time on there was a decrease in the severity of the symptoms, but the patient was apathetic and appeared septic. She would take little nourishment. The tempera- ture soon reached normal, but the condition remained severe, and after repeated rises of temperature and the develop- ment of abscesses the symptoms continually improved, and by the end of spring she had become practically entirely well with the exception of a murmur over the mitral region which was believed to be organic. Jastrowitz attributes the psychoses to the direct action of the “rheumatic toxin.” on the cortical cells. The literature of rheumatism far from infrequently contains such, as Kiernan and Kråpelin (Journal of Nervous and Mental Diseases, 1881) pointed out nearly two decades ago. PSYCHIATRY. DEGENERACY OR OCCUPATION STRESS.—Recent analyses of prominent literati and scientists exhibit a tend- ency to confuse the neuroses arising from acquired neuras- thenia with the neuroses of a similar type produced by degeneracy. The discussions of Zola's mental and physical constitution by Lombroso, Nordau and Arthur Macdonald betray traces of this confusion between congenital and 170 Selections. acquired nervous states. The imperative ideas or obsessions are common to both, and it is on these that most stress has been laid as evidence of degeneracy. The occurrence of obsessions is largely due to the disturbance of the ego; that co-ordination of clear states of consciousness, of obscure states of consciousness and of physiologic states which, though unaccompanied by consciousness, are not less but even more effective than the conscious states. The auto- matic mental inhibitions last mentioned exercise an enor- mous influence in removing to the unconscious mental background ideas foreign to the general training of the individual or to his sense of major or minor morality. Many of these ideas are, however, mentally registered, unconsciously to the individual, to be reawakened in states of nerve tire produced by physical exhaustion or disease. In this way is produced the so-called subliminal consciousness of the psychologist, which is a lower and not a higher phase of consciousness. Many of the linguistic and other marvels narrated of this subliminal consciousness fall under the category of automatic remembrance, like the case narrated by Coleridge: A twenty-four-year-old servant was seized by a nervous fever with delirium, during which she inces- santly spoke Latin, Greek and Hebrew with a very distinct enunciation. The girl, before her illness, had been a simple, unlearned, harmless creature. The attendant priest referred her case to “possession of a very learned devil.” This explanation did not suit the attending physician, who found that she had been for several years after the age of nine an inmate of the family of a Protestant clergy- man, whose constant nightly habit was to read passages corresponding to the girl’s ravings, from his favorite books, walking up and down a narrow passage near the girl's kitchen. Not only during states of delirium, but also during states of adynamia which precede delirium, do such ideas rise into consciousness and trouble the possessor as being foreign to his own mentality. In ordinary life much is unconsciously assimilated by the mind, which remains with- out association with the daily life of the assimilator. This Selections. 171 is shown in the use of coarsely obscene terms by refined modest women during the emotional disorders produced either by pregnancy or menstrual disturbance. The occur- rence of the various phobias and other obsessions, with their resulting imperative acts, are an expression of this condition. Indeed, the mental processes, of whose operation as well as their results the mind is conscious, are really an expression of the same defect. The conscious mental pro- cess betrays, as Herzen has shown, an imperfection of the cerebral organization, for it indicates the presence of a new unusual activity which deranges the equilibrium, the innate or previously acquired automatism, and which did not find a well-formed mechanism ready to discharge it. The con- scious mental process is the transitory phase of an inferior to a superior cerebral organization. It expresses novelty, incertitude, hesitation, groping, astonishment, imperfect asso- ciation and incomplete organization, a want of promptitude and exactness in transmission, a loss of tenure in the phe- nomena of reaction. It indicates that the nervous paths are not sufficiently cleared or distinctly enough traced to permit, without destruction in the final effect, reflex movements or reflex ideational sensations. A sudden shock, therefore, whether mental or physical, whether occurring in a degenerate or in neurasthenia which has been acquired, may lead to imperative conceptions. As these are accompanied by cerebral circulatory disturbances and by states of anxiety and uncertainty, there is likely to be irregular cardiac action and with it irregular action, noticeably of the liver, kidneys and gastro-intestinal tract. It is a matter of commonlobservation that the kidneys react to this condition. The frequent passage of pale urine in anxious states is a common observation. These conditions however, must be referred to a physical cause in the shape of vibrations of the nerves of sensation and to the physical reactions produced by these vibrations. Through these cir- culatory psychic and nervous interactions, a vicious circle is set up and the ordinary gastro-intestinal, hepatic, renal and genital phenomena of neurasthenia of temporary duration occur. The appearance, therefore, of obsessions 172 Selections. and of other neuropathic phenomena may be purely a product of causes arising in an individual from over- work, mental or other shock, and in no way indicate degeneracy, This last view that such phenomena must be the product of degeneracy, vitiates many valuable researches on the subject. Indeed, the whole Lombroso school is per- meated by errors of this kind. These errors are the more striking since a century ago Tissot laid great stress on the factor which produced in literati what have been excellently termed occupation disorders, Many of the nervous phenom- ena occurring in men of letters were referred, and with reason, to worry and uncertainty produced by circumstances connected with finance or their family life, and entirely dis- associated from either their genius or from their heredity. The secondary influences of this acquired neuropathy, how- ever, may produce, as Dr. E. S. Talbot says, a neurasthenia. Practically the neurasthenic in regard to his organs has taken on a degenerative function, albeit not degenerating in structure, since the restlessness of the organ is a return to the undue expenditure of force as it is unchecked by the central nervous system. Through the influence of various exhaustion agencies the spinal cord and the brain lose the gains of evolution and the neurasthenic is no longer adjusted to environment. Since the reproductive organs particularly suffer, children born after the acquirement of nervous exhaustion more or less checked in development, as the influence of atavism is healthy or not, repeat degen– erations in the structure of their organs, which in the parent were represented by neurasthenic disorders in function. As the ovaries of the neurasthenic woman generally exhibit prominently the effects of the nervous exhaustion, the offspring of these do not retain enough vigor to pass through the normal process of development. For this reason genius very frequently leaves no posterity. The influence of the acquired “occupation disease” comes into play. Burns' genius led to dinner invitations, whence alcoholism. His sexual excess arose from the fact that hysterically senti- mental females are attracted by the glare of genius and notoriety, like birds by a lighthouse lantern. From this Selections. 173 Springs sexual excess and abnormal marriages. The tend- ency to regard genius as irresponsible, based on the morbidity theory, tends to increase these factors of “occu- pation disease.” In dealing, therefore, with the question of degeneracy in any person, care should be taken to demar- cate it and its stigmata from acquired neurasthenia and its stigmata. The error has been made of attempting to separate mechanical genius from that of literati in respect to degeneracy. Dr. H. Gradle, at the Chicago Evolution Club, in 1894, asserted what was subsequently re-echoed by Dr. James Wier that (a fact not noticed by Lombroso or any other writer) “mechanical geniuses or those who for the most part deal with material facts do not as a rule show any signs of degeneration. Darwin, Galileo, Edison, Watts, Rumsey, Howe and Morse prove the truth of this assertion. It is only the genius of estheticism, the genius of emotion, that is generally accompanied by unmistakable signs of degeneration.” This error is an a priori one not based on a study of the authors quoted, or the lives of the geniuses cited. Lombroso points out that Darwin, among other Stigmata of degeneracy, had a cretin-like physiognomy; that he stammered and that also in other respects he was a neuropath. Nisbet points out that the genealogy of Charles Darwin illustrates many of the neuropathic aspects of genius. He also shows that Galileo was a victim of neuropathy and at times suffered from melancholia, and cites stigmata in the family of Watts. Enough has been cited to show that the mechanical genius and man of science suffers as well as the esthetic class. This error is con- stantly made in discussing the nature of genius. Neither mechanical ability nor scientific acumen is an impenetrable cuirass against hereditary defect or occupation stress. Although science is less likely to lead to defect than the emotional state of the poet, still the great element of defect in poet and scientist alike has been financial anxiety or worry over success. Where these are removed, poets and scientists enjoy comparatively long life and good health when these are not interfered with by hereditary defect or acquired disease. The error involved in this confusion has 174 Selections. a serious clinical aspect. From the notion that obsessions or imperative ideas are products of degeneracy alone, arises too often the ominous prognosis given to neurasthenics, which is fatal to their recovery.—Editorial Journal A. M. A., July 22d. - NEURO-ANATOMY. NERVE CELLS IN THE CEREBRAL CORTEX OF MAN. —The most recent estimate of the number of cortical nerve cells places it at 9,200,000,000, an estimate about eight times as large as that published by Meynert in 1872. CORTEX STIMULATION.—Dr. H. E. Hering made experiments on dogs and monkeys by dividing the pyra- midal tracts, etc., and which demonstrated (Wien. klin. Woch., Aug. 17, 1999) that the nerves which produce con- tractions in muscles also relax them. He was unable to find any inibiting tracts inhibiting centers. He was also unable to find any specific routes for transmission of clonic contraction. All the corticofugal nerve-tract capable of producing move- ments can also produce the cortical clonic contractions, but all are not equally excitable, the pyramidal tracts transmit the impulses to clonic contraction relatively much more readily than the others. He found that in the monkey the pyramidal tract plays a more important part than in dogs in isolated movements of the contra-lateral extremities in men still more than in monkeys. The dog, on the other hand, possesses a contra-lateral tract transmitting impulses for isolated movements which functionates. Associated with the homolateral tract in the monkey has a much more detailed function and is more readily excited than in the dog. PHONATION CENTER.—Dr. Onodi some time ago established a phonation in dogs between the posterior quad- rigeminal tubercles and the nucleus of the vagus. His recent studies (Rev. Hebd. de Laryng. Aug. 12, 1899) on monsters and foetuses whose skulls have been perforated by those Selections. 175 who have cried tend to confirm the existence in man of the same phonation center previously found in dogs. THE CORPORA QUADRIGEMINA.—Dr. J. Prus from experiments on dogs, concludes (Journal of American Medi- cal Association, Dec. 2, 1899): 1. The motor centers chiefly affected by optic stimulation are located in the anterior lobe of the corpora quadrigemina, while these centers of the pos- terior lobe are chiefly stimulated by acoustic impressions. 2. There is a center in the anterior lobe. which, in patho- logic conditions, induces tonic contractions, while a similar one for clonic contractions is located in the posterior lobe. 3. There are reflex tracts in the anterior lobe, for the res- piration, the vagus and the vasomotor nerves, and in the posterior additional centers for the co-ordination of reflex movements and a sound-forming center. These facts explain the clinical observation that with lesions of the corpora quadrigemina there appear disturbances in the movement of the eyes, inco-ordination of the muscles used in standing or walking, trembling, dilatation of the pupils, exophthal- mus and disturbances in the sight with lesions of the ante- rior lobe, and disturbances of the hearing with lesions of the posterior. NEUROPATHOLOGY. NEOPLASM OF THE LEFT THIRD FRONTAL CONWO- LUTION IN A RIGHT-HANDED INDIVIDUAL, WITHOUT APHASIA.—Experience is constantly teaching the medical man to be surprised at nothing and always to be prepared for the unexpected. Didactically we recognize types of disease, but clinically we encounter the greatest diversity of symptom-groupings. In connection with no condition per- haps is this statement better illustrated than with tumor of the brain. It is not an uncommon experience for such a lesion to be diagnosticated during life and not be found after death, and vice versa, and even when the presence of a growth has been recognized, its situation and histological constitution may baffle the highest diagnostic skill and acu- 176 Selections. men. A slowly growing tumor may give rise to few or no Symptoms, while a large neoplasm may, by reason of the physical conditions present within the cranium, occasion symptoms by disturbance of the function of parts remote from the seat of actual disease. Further, there may be aberrations not only in structure but also in function. For instance, the motor tracts may in large part fail in their usual decussation; then it is surmised that certain parts of the brain acquire special functions in accordance with the uses to which the peripheral organs they govern are put. Thus it is agreed that the nervous motor mechanism con- trolling speech is located in the left third frontal convolution in right-handed persons, although it is believed to be have also a latent or undeveloped representation on the right side of the brain. In the same way the mind-auditory center is located in the left first temporal convolution, and the mind- visual centre in or about the angular gyrus. Of the uncertainty of diagnosis of brain tumor and of cerebral localization additional evidence is afforded by the report by Collier (The Lancet, March 25, 1892) of a case in which complete destruction of the third frontal convolution on the left side of the brain by a neoplasm in a right- handed person was unattended with aphasia. The patient was an unmarried woman, twenty-three years old, whose mother had died from carcinoma, and who, a year and a half before death, while walking with her sister, suddenly, and without warning, fell and became unconscious for a few minutes. The face was pale, but there was no convulsion or biting of the tongue or involuntary passage of urine. In the following fortnight two attacks of similar character took place, although in the second the teeth were clenched, and slight convulsive movements, with foaming at the mouth, occurred. Subsequently there were frequent sudden attacks of giddiness, pallor, and faintness, which were not followed by any notable speech defect. Examination at this time failed to disclose evidence of organic disease, and under treatment with bromides the attacks of giddiness, pallor, and faintness, which were not followed by any noticeable speech defect. Examination at this time failed to disclose evidence Selections. 177 of organic disease, and under treatment with bromides the attacks of giddiness became much less frequent. After some seventeen months the patient was thought to be a little dull mentally, and she complained sometimes of slight headache. On one occasion she was noticed to mumble in her speech and to use wrong words for a period of half an hour. A little later she became heavy and som- nolent and finally comatose. Ophthalmoscopic examination now revealed recent optic neuritis. There were also complete palsy of the right sixth nerve and almost complete palsy of the left sixth nerve; and the lower portion of the left side of the face did not move quite so well as the right. There was neither hemianopsia nor word-blindness. The patient was right-handed, and there was no history of left-handedness in the family. Motility and sensibility in the trunk and limbs were natural. There was no headache or tenderness. The knee-jerks were not exaggerated, although the left was rather the more readily elicited. The wrist-jerks and the elbow-jerks were active and equal. The plantar reflexes exhibited a flexor response on either side. The stupor gradually deepened, the breathing became ster- torous, the temperature ranged between 100° and 102° F., and death resulted from respiratory failure. Upon post-mortem examination the dura was found adherent to the anterior part of the left temporo-sphenoidal lobe over a small area. The pia-arachnoid at the base exhibited considerable old patchy thickening. There was slight recent meningitis over the posterior extremities of the second and third left frontal convolutions and over the ante- rior part of the left temporo-sphenoidal lobe. The cortex of the posterior end of the third frontal convolution, including that part between the ascending and posterior limbs of the Sylvian fissure and the contiguous part of the left temporo- sphenoidal lobe, presented a gray, jelly-like aspect, suggesting the presence of a glioma. On the inferior aspect of the brain was a growth, arising from the posterior part of the orbital lobule and filling the left Sylvian fissure. After the brain was hardened in formalin the neoplasm was found to involve the inferior margin of the left second 178 Selections. frontal convolution at about its middle, the posterior part of the orbital lobule, and to a small extent the anterior gyrus of the island of Reil. For some distance around the growth the white matter of the centrum ovale was softer than else- where. The ascending frontal convolution was uninvolved and the whole of the right hemisphere appeared healthy. . On microscopic examination the growth was found to consist of small round-celled tissue, the cells being densely aggre- gated around the blood-vessels, which were greatly thickened. This case shows among other things that the nervous motor mechanism governing the function of speech may be primarily developed in the right hemisphere, even in right-handed persons. Such development takes place in varying degree after aphasia due to destructive lesions of the left third frontal convolution, but there was no evidence, clinical or pathological, congenital or acquired, in the case reported of such structural disturbance.—Editorial in New York Medical Record, July 1, 1899. NEURO-PHYSIOLOGY. FUNCTION OF THE THYROID GLAND.—According to Dr. A. Oswald, the albuminoids are the iodine containing substances in the thyroid gland. The extract after the albuminoids have been removed (Muenchen. Med. Woch., Aug. 15, 1899) no longer contains any iodine. He has iso- lated from the aqueous organ extract two distinct albumi- noids. One resembles globulin but is precipitated by acetic acid, although dissolving again with an excess. This he calls “thyreoglobulin.” It contains 1.6 per cent iodine and is much more abundant than the other albuminoid which contains phosphorous but no iodine and is essentially a nucleo-proteid. He found by numerous tests on pigs that the specific effect of the thyroid on metabolism is due to the thyreoglobulin. The colloid substance is a combination of these albuminoids (thyreoglobulin and the nucleo-proteid) hence the colloid is the effective element of the gland and its “specific secretion.” The thyreoglobulin probably gives up its iodine when it has accomplished its purpose and the Selections. 179 iodine circulating in the blood is in turn retained by the thyroid to make new thyreoglobulin. Oswald claims that administration of thyreoglobin is not a reliable method of testing its action on the organism since it probably loses some of its properties during digestion. LUNG REFLEXES.–Dr. Marion K. Bowles describes (Journal American Medical Association, December 2, 1899) a case apparently of asthmatic nature, co-existing with, and as she thinks, depending on the rectal irritation from old abscess and stricture. She has noticed similar cases as far as the lung is concerned, one or two of them denying all knowledge of having a heart or lung complication. She believes that slight trouble in some other part of the body, notably in the sphincter muscles may cause contraction of the finer bronchioles, and the adventitious sounds thereby produced may lead to unjust rejection of applicants for life insurance. So far as she is able to learn, the literature of these reflexes is limited to contributions by Abrams of San Francisco and Moccuci, both since 1890. Abrams speaks of dilatation and contraction of the lung due to nasal reflexes, but not apparently to the special form occurring from the regions here credited with their causation. SPINAL MUSCULAR ATROPHY.-(Archiv. fur Psychi- atrie, vol. 30, 1898-99, No. 1) gives history and microscopi- cal findings in a case of this rare form of muscular atrophy in a young man twenty years of age. At five years there commenced an atrophy of the small muscles of the lower extremities, two years later involving the hands. At the age of thirteen he was unable to walk. He later developed hypochondriasis. Intelligence was fair; some immobility of pupils to light, no changes in fundus, extreme atrophy of the muscles of all four extremities. Knee-jerks absent. The right leg was contracted at knee joint. He had complete paralysis in lower extremities, less in upper. Fibrillary twitchings of the intercostal muscles, loss of elec- trical contractility for both galvanic and faradic currents. Marked hypochondriacal depression with delusions. Patient died in collapse. The microscopical analysis showed degen- 180 Selections. eration of the posterior and lateral columns, especially in dorsal and lumbar regions, atrophy of the anterior horns, Clarke's columns, and anterior roots. Posterior roots were intact extramedullary and in some parts of their intramed- ullary course. There was simple degeneration of the sensory and mixed nerves with atrophy of the musculature. Disease of posterior columns, most marked in the lower dorsal regions. In upper dorsal and cervical regions almost total degeneration of the central part of Goll’s column. In the columns of Burdach the degeneration became markedly less as the upper cervical region was reached. Degenera- tion of the lateral columns posteriorly and partly of the anterolateral columns. Lesions most marked in the lower dorsal and lumbar regions and decreasing upward. Cere- bral ganglion cells showed no alterations. The muscles of the lower extremities were in a condition of extreme degen- eration, the gastrocnemius showing advanced fatty changes. All of the peripheral nerves examined, namely the brachial, radial, median, ulnar, sciatic, crural, peroneal, and Saphenous nerves were markedly degenerated. The author believes the disease is one of intramedullary origin, the posterior roots being affected after their entrance into the spinal cord but admits a peripheral origin. PARTIAL TRANSWERSE SECTION OF THE SPINAL CORD.—Schäfer has been carrying on some interesting and important investigations on the functions of the spinal tracts, which he presents in a preliminary note (Journal of Philsi- ology, vol. 24, 1899.) Most of the investigations were carried on on the monkey, a few on the cat. His phyiologi- cal results following hemisection of the cord agree mainly with those of Mott made 1892. He found that in the first few days there was complete motor paralysis of all parts supplied with nerves below the section. The limb or limbs on the paralyzed side were swollen and warm (vasomotor paralysis and lessened outflow of lymph) and the skin dry (diminution of sweat). The knee-jerk was exaggerated. Sensation was not lost on the same side as the lesion, but at times appeared dulled. After a few days, unmistakable signs appeared of feeling and localizing even a slight touch, Selections. 181 and this long before the motor paralysis had passed away. He stated that he has seen no sign of paralysis either motor or sensory on the side opposite the hemisection in any case in which the section had been strictly confined to the one-half of the cord. Sometimes the adjacent posterior column of the other half is injured, and in that event there is impairment of sensation for a time on both side below the lesion. The motor paralysis, at first complete, becomes incomplete and finally is difficult to determine. But purely voluntary movements are not recovered or but very imper- fectly, although all the ordinary associated movements of the limbs are recovered. After three or four weeks it is difficult to detect any sort of paralysis, but the limb which has been paralyzed is thinner than the other. If the hemi- section is made above the level of the eighth cervical nerves, the pupil on the same side is relatively contracted and so remains. The dilator fibres and the pilomotor fibres in the cervical sympathetic do not degenerate but remain excitable. The pupil reacts to light and shade in spite of its being persistently smaller than the other. Excitation of the motor cortex of the opposite cerebral hemisphere produces as a rule no movements in the limbs which have been paralyzed, even if the associated movements have long re- turned. Lesions of the cerebellar tracts, either of the dorsal alone or with the ventral tracts, did not produce any obvious symptoms. Sensation and motion seem unimpaired and the pupil is unaffected. Even when some of the fibres of the pyramidal tract are involved in the lesion, no obvi- ous symptoms are noticeable. The histological results in the light of modern methods of interpretation of degenera- tive processes are of great interest. He shows that after hemisection the cells of Clarke's vesicular column below the lesion undergo chromatolysis, and eventually (two or three months) almost completely atrophy. The atrophy of these cells is equally complete if the lesion is confined to the dorsal and ventral cerebellar tracts. The atrophy of Clarke’s column is less complete if the section is confined to the dorsal cerebellar tract, though the author was not able to prove this experimentally. No other cell groups 182 Selections. below the lesion show atrophic changes. It is therefore to be inferred that Clarke’s column gives origin not only to the dorsal cerebellar tract (tract of Flechsig) as shown by Mott, but also, to the ventral cerebellar tract (column of Gowers). Clarke's column has also an important relation- ship to the fibres of the pyramidal tract. After lesions involving these fibres degenerated fibres are seen in large numbers passing from the pyramidal tract toward Clarke's column. No degenerated fibres are traceable from the pyramidal tract into the anterior horns or into any part of the gray matter other than the base of the posterior horns and Clarke's columns. In a further communication to the society (Journal of Physiology, vol. 24, 1899), Schäfer states that the descending anterolateral tract (tract of Lö-. wenthal) passes its fibres into the anterior horns, and apparently, for the most part, they end by arborizations about these cells.-Medical Record, August 19, 1899. NEUROTHERAPY. HYOSCINE HYDROBROMATE IN CHOREA.—Hyoscine hydrobromate has been tried by A. C. Rendle, of Madras, India, (British Medical Journal, No. 2013, 1899), on a bad case of chorea in a youth of sixteen years. He was thin and anemic; the temperature was slightly raised; the tongue was dry and coated with a brownish fur; the pulse was weak and the respirations irregular; there were constant involuntary movements. Albumin was present in his urine. Potassium bromide, chloral hydrate, and increasing doses of arsenic gave no relief. He was very restless at night, and morphine eased him slightly. Hyoscine hydrobromate in doses of ##5 of a grain was injected hypodermically twice a day. On the day following the first injection there was marked improvement in the choreal movements. The dose was increased to Tºw of a grain and given three times a day. In a week the movements had almost entirely ceased. The hydrobromate was then discontinued and the arsenic treatment resumed. The patient made an excellent recov-. ery. Chorea is an extremely fatal disease in India. Selections. 183 ANTIKAMNIA AND INFLUENZA.—To relieve quickly, our Antikamnia friends think nothing will do this quite so well and effectively as the following “Antikamnia and Quinine Laxative Tablets”: Antikamnia...................................... Quin. Bisulph ----------------- Cascarin................................ Aloin........................ Ext. Belladonna... - ---- Podophyllin...................................................................... ALCOHOL AS A FOOD.—The advocates of total absti- nence are somewhat chagrined over the fact that recent experiments made at their suggestion to determine whether alcohol could be considered a food or not resulted in the affirmative. It was determined that its effect upon the system was closely allied to food, viz., tending to sustain life and prevent tissue waste. Whisky is also a valuable stimulant and medicinal agent. It must certainly be classified as a foodstuff under certain conditions. The numerous theories advanced con- cerning its deleterious influences upon the system are all worthless when compared with the actual results following its use. The value of alcohol as a food and a preventive of tissue waste was fully demonstrated during the polar expe- dition of Peary and Greely. For days before the rescuing parties reached the stranded survivors the latter subsisted on a small daily allowance of alcohol and glycerine. It is certain that in this instance the vital spark was kept alive by these agents, and most likely by the alcohol. The chemical compositions of alcohol and glycerine are not so very materially different as regards the primary elements that enter into their composition, both containing carbon, hydrogen, and oxygen. These are the primary elements that go to make the great bulk of all of our food, as starches, sugars, and fats, and while the arrangement of these primary elements in the different foodstuffs varies in quantity, they are split up and form new compounds in the body, and in fact undergo an unlimited number of changes —but in the final wind-up their purpose is served by 184 Selections. giving up to the tissues what is needful to them, and so it is with alcohol-it gives up what is necessary to support life and prevent tissue waste, and after all this is the only thing accomplished by any foodstuff. º Dr. Mitchell Bruce, in his admirable work on materia medica and therapeutics, in speaking of alcohol, says: “It may now be accepted as proven that, when taken, in suffi- ciently small quantities, alcohol is oxidized in the tissues; and that it only passes out of the body unchanged through the lungs and kidneys, etc., when so freely given that excretions occur before oxidation has had time to take place. This decomposition of alcohol must necessarily develop vital force and heat like the oxidation of sugar, fat and albumen. Alcohol belongs to that class of foods which do not become an integral part of living cells or tissue proteids, as do much of the albumen salts, etc., but remain in the plasma which bathes the cells, are oxidized there and constitute their pabulum, the materials which thus supply the active elements with much of their energy, the ‘circulating pro- teids,’ carbo-hydrates, etc. Thus it happens that alcohol can for a time sustain life when no food (so-called) is taken, as in confirmed drunkards and some cases of severe illness. “Professor Binz, of Bonn, who has studied this ques- tion with great industry and success, has calculated how much energy is contained in a gramme of alcohol, and finds that two ounces of absolute alcohol yield about the same amount of warmth to the body as supplied by an ounce and a half of cod-liver oil.’’ - This is sufficient to show beyond all doubt that alcohol is a valuable foodstuff if properly used. Everybody knows that the excessive use of alcohol is injurious and shortens life, but, taken in moderation in the shape of good whisky, it will not materially injure the body and is healthful to many. Three ounces of whisky in twenty-four hours, well diluted, is within safe limits, if the “morning toddy” is avoided. No whisky should be taken as a beverage before the noon hour or twelve o'clock in the day. When taken before breakfast or on an empty stomach it irritates that organ too much, and is taken directly into the liver and Selections. 185 general circulation, and must prove harmful in many cases if used in this manner. At noon the morning meal has been disposed of to a degree, but the liver at this time contains many things that are not found in it after the long rest at night, and in addition the noonday meal usually follows the use of whisky at this time; if it does not, it should do so, so that the liquor may be mixed with the food, as this does much to counteract any harmful influences that it would be liable to produce, as , congestion of the stomach and liver. * * *—American Practitioner and News. PARALYSIS AGITANS.—The drugs which are in use for paralysis agitans, and from which some benefit in dissipa- ting symptoms and fulfilling indications may be expected, are hyoscyamus and duboiscine, Indian hemp, opium, haema- togenous agents such as arsenic and iron, and occasionally gelsemium and veratrum viride. Of these, the most impor- tant by far are the first mentioned. Given hypodermatic- ally, which is the preferable way when possible, or by the mouth, they promptly mitigate the severity of the tremor, and have a pronounced tendency to relax muscular rigidity. They are both powerful toxic agents, and must, therefore, be given with care.—New York Medical Journal, July 8, 1899. METHYLENE BLUE IN INSANITY. —The action of methy- lene blue in various psychoses is reported upon by P. Bodoni, of Genoa, in the Klinisch-therapeutische Wochen- schrift, 1899, No. 21, May. He has found that intramuscular injections of from 0.8 to 0.1 gm. (gr. i. to iss.) produced markedly quieting effects in many forms of psychical excitement. He gives the clinical histories of cases of mania of various types, melancholia, dementia, paranoia, and hystero-epilepsy. Most of the cases were infiuenced by it, and he claims that it should take an important place, ranging with the more usually employed hypnotics, chloral, amylene, hydrate, sulphonal, bromoform, and others.—N. Y. Med. Record, Aug. 19, 1898. 186 Selections. NEURO-DIAGNOSIS. ARTERIAL PRESSURE GAUGE, A NEW INSTRUMENT.- Prof. G. Gartner, of Vienna describes(Munch, Med., Woch., June 27), a “Tonometer,” consisting of rubber tubes, with the three ends of a T-shaped tube, a pneumatic ring 1 cm wide, that fits over the finger, a manometer and a rubber bulb, forming a hermetically closed hole with a metal tube inserted at one point, a thin membrane drawn air-tight over the inner end. The ring is fitted over the second phalanx of a finger or end phalanx of the thumb. The blood is then expelled from the first phalanx by means of a thimble-like contrivance, and pressure is produced in the pneumatic ring by pressure on the bulb. The thimble is then removed, leaving the finger pulp empty of blood. The pressure on the bulb is then grad- ually suspended, and at a certain moment the blood rushes into the tip of the finger, when the degree of pressure can be read on the manometer. CLINICAL NEUROLOGY. THE CENTRAL NERVOUS SYSTEM IN ACUTE MALAR- IAL INFECTION.—At a meeting of the New York Neuro- logical Society held on October 3d, (the editor of this journal being present), Dr. James Ewing introduced this interesting subject with a report of three cases, one with marked cerebral symptoms and infection with a single well defined group of parasites, a soldier, just returned from Cuba. Thirty-six hours stupor prior to death. Ring-shaped organisms in the blood. Stupor twelve hours after sporula- tion. Viscera showed lesions of severe malarial infection. Capillaries of the cerebrum, cerebellum, medulla, and cervical spinal cord harbored parasites in large number. Many capillaries occluded by thrombi. The ganglion cells reduced in size, irregular and splitting. The second case was a tertian, pulse of 110, much prostrated. Insomnia, then delirium and finally there was coma and death. Temperature 108°F. shortly before death. The blood contained enormous numbers of ovoidal, spherical Selections. 187 and crescentic bodies. Eight hours before death, very few crescents could be seen. None of the younger forms were found. The autopsy showed moderate oedema of the brain; the basal vessels were normal and very few parasites were present. The deposit of pigment in the brain was slight. Throughout the cortex the cells showed no marked change further than a uniform diminution in the chromatic subs- tance. In many of the extracellular lymphocytes there were peculiar structures—elongated fibres or rods with tapering ends—of undetermined nature. The chief features of this case were the prolonged delirium and coma; yet the post- mortem examination showed far less change in the kidneys than was usually seen in profound malarial infection. The third case was also fatal malarial infection associ- ated with haemoglobinuria. Patient contracted malaria in Santiago in July, 1898. Comatose, emaciated, anaemic and jaundiced. The dura and pia distinctly jaundiced. The cerebrum, cerebellum, and medulla showed the usual injec- tion of vessels with blood, but the vast majority of the vessels were free from the parasites. An abundant deposit of haematoidin was in the kidneys. The speaker said that when the brain cortex was decidedly brownish it indicated usually the presence of a large number of parasites, but this was not an invariable rule. The majority of cases of malarial coma did not exhibit the massing of the parasites in the brain. Of eight cases in which he had examined the brain after death, in none had there been a distinct brownish discoloration of the brain. Haemorrhages had been found in some cases, as had also a moderate degree of Oedema. Usually the parasites were uniformly distributed in the brain and spinal cord, but a case has been reported in which they had been localized in the medulla. The number of these parasites was often enor- mous, and complete occlusion of the vessels was not at all uncommon. To the general condition of the obstructed cir- culation he referred the cerebral symptoms observed in these severe cases of malarial infection. The ganglion cells, in cases of malarial coma, had been studied, and the changes found to consist chiefly in the various degrees of chroma- 188 Selections. tolysis. The dendrites were usually involved before the cell body. The parasites in the tissues seemed to exert no bad influence except in a mechanical way. In one of the cases reported the deepening of the coma could be apparently connected with the progressive filling of the capillaries with the parasites and the formation of thrombi. In the two other cases the parasites were few and the pigment was scanty. These cases showed that the comma of malaria was not always referable to the presence of of the cerebral parasites. Of the writer’s sixty-four reported cases of malarial coma, there were five simple tertian infections. Coma appeared to be rather frequent in cases showing only crescents in the blood. Crescents did not exhibit such a tendency to unequal distribution as the fertile forms did. From the conditions of the viscera found in the second and third cases reported—and this variety occurred especially in cachetic individuals in whom the disease had existed for some weeks—it seemed probable that the coma was the result of the general and profound malarial infection. The speaker did not attach much importance to the condi- tion of the ganglion cells in malarial infection. When the coma resulted from the massing of the young parasites in the brain, it was generally in onset, and the prognosis was very unfavorable. An embolic process was concerned in their causation. 1. The mechanical obstruction of the cere- bral capillaries by young parasites. 2. Embolic process causing occlusion of some vessels (usually temporary) by parasites or pigmented leucocytes. 3. General toxaemia, such as might occur in other infectious diseases, the blood showing few, if any, autumnal rings. SOME PRESENT PHASES OF NEUROLOGY..—Neurology had grown somewhat luke-warm with reference to the revelations of bacteriology as affecting problems arising in its own domain. From a therapeutic standpoint the returns had been coming in rather slowly from the bacteriologists, and we are not prepared yet to say that we had a reliable serum treatment for many nervous diseases. If the hypo- dermic syringe loaded with animal serums of every grade and variety was to do all this, let us bid God speed to the Selections. 189 day when neurology would be but the handmaiden of her younger sister, bacteriology, aud the syringe would have usurped the place of the microscope in our affections. In pathology, however, there was no occasion for disappoint- ment, for it seemed almost certain that we were at least on the threshold of a wide new field in cytology, in which much that would be done would probably owe much to our advanced knowledge of infection and of vito-chemistry. While fully in sympathy with much of the enthusiasm which at present marked the study of the nerve cell, he thought he could see in this enthusiasm some of the extremes which periodically marked the progress of the medical sciences. We moved in cycles and epicycles in medicine, and like some primitive tribes we always worshiped the new moon. We were just now engaged in the cult of Nissl; we were at the high tide, as it were, of methylene blue. At another time it was the neurone theory which threatened to redeem our Science. Again, we were called to trace the invisible fibrils of Apathy, which we were assured would yet bind together not only a disjointed nervous system but also a fragmentary science. He made no doubt that some of us were too much given to extremes in some of these matters, and might see more promise through the small end of a microscope than Moses saw from Pisgah. It was not exactly a good thing to use the lamp of Aladdin to illuminate the field of a microscope. We should never forget that in our histological researches we were simply numbered among those who from time immemorial had been seeking to read in dead matter the mysteries of life. The problem which had forever refused to give an answer to the Hindu and the Greek, to a Newton and a Leibnitz, would probably not yield to our more importunate appeals, and the dead would continue to refuse to give up its secret of life. The fact that we had a new stain that would depict the contours of chromophilic bodies, did not alter the fact that those chromophilic bodies were still without assured physiological value, and that when we looked upon them we might be merely looking upon the products of our own clumsy handiwork. We might think that we were detect- 190 Selections. =- ing life in its innermost recesses, whereas we were merely gazing upon the wreckage of the temple. This was not merely the pessimism of a despairing medical philosophy. Such considerations, if rightly appre- hended, might serve to remind us of our true functions as investigators of disease. Pathology, it might be rightly con- tended, was not the science of life, but of disease; and we accomplished our true aims if we, like the archaeologists, could point out unerringly what had been the normal structure from a study of its remains, and could do some- thing to reconstruct the ruins, even if we were not able to grasp all the mysteries of the original creative force. In the domain of the nervous system this was surely a fascinating study, for in that tissue were manifested the highest func. tions of organic matter.--Dr. James Hendrie Lloyd, president of the American Neurological Association, in his presidential address. Journal of Nervous and Mental Disease. DEATH FROM PROLONGED LAUGHTER.—Wachholz (Przeglad lekarski) relates the case of a peasant girl, 18 years old, who was seized in a field by two fellows and tickled violently on the breast. She died as a result of laughter produced by the tickling. The author explains the occurrence of death from laughing as follows: Laughter consists of an inspiration followed by short and more or less deep expirations. In forcible expiration the abdominal muscles contract and compress the intestines and the diaphragm. Long-continued pressure on the diaphragm acts upon the vagus and diaphragmatic nerves, exciting them and finally paralyzing them. We are not convinced that this is an altogether satisfactory explanation. Certainly the me- chanism of death from laughing, if it ever occurs in a healthy person, is worthy to be studied by the physiolo- gists.--N. Y. Med. Jour. CATALEPTOID LETHARGY WITH SIMULATION OF CHYLURIA.—The devises to which hysterical patients some- times resort in the attempt to simulate some grave disease are apt to be grotesque. For example, Rothmann and Nathanson (Archiv fur Psychiatrie, xxxii, 1; Fortschritte der Selections. 191 Medicin, September 20th) relate a case in which the patient injected milk into the bladder to counterfeit chyluria. There were lethargic and cataleptic paroxysms sometimes lasting as long as twelve days, with a rise of temperature to almost 108° F., acute diminution of the area of hepatic dullness, decrease of urea, and ammoniuria. Surely this patient need not have simulated an additional malady. ADDISON'S DISEASE IN A YOUNG GIRL.-M. Haus- halter (Gazette hebdomadaire de médecine et de chirurgie, September 14th) recently exhibited to the Medical Society of Nancy a young girl, ten years of age, affected with Addi- son's disease. The affection was of about two months’ standing and was marked by lassitude, melancholy, and an abnormal pigmentation of the face, neck and back. HYSTERICAL APHONIA LASTING FOR ELEVEN YEARS. —Lennox Browne (Jour. Lar., Rhin. and Otol., June, 1889). After a severe mental shock, the patient, a woman, became suddenly mute, and continued so for three or four years. She then commenced to whisper. After three or four years more a deep, rough voice was developed by vibration of the ventricular bands, as seen by the laryngoscope. Different methods of treatment were tried without avail. Finally, after exposure to intense excitement, the voice suddenly returned and remained normal ever afterwards.-J. Price Brown, Periscope in Canadian Practitioner and Review. NEUROSES SOMETIMES FOLLOWING OOPHOREC- TOMY-THEIR DURATION AND TREATMENT.-Davis (Vir- ginia Medical Semi-Monthly, July 7, 1899) says that although nearly all cases suffer from some nervous disturb- ance, such as hot and cold flushes, palpitation, etc., the distressing symptoms following many operations for the removal of the ovaries, are due to defective technique, and not the loss of the organs. The depressed mental state sometimes following this operation is due to the patient’s knowledge of having lost the reproductive function. A por- tion of the ovaries should be left, and the nature of the operation withheld wherever possible.-Drs. Norbury and Fell, Neurological Excerpts in Medical Fortnightly. 192 Selections. CASES OF HEMIATROPHIA LINGUAE.-E. Wiersman, (Med. Rev.-Neurol. Centralblt) describes six cases of hemia- trophia linguae, some of peripheral and some of central origin. A half sided atrophy of the tongue can originate as a result of a lesion of the hypoglossus extra, or intra-cranial, or in its centre, in the medulla oblongata. An atrophy which is not distributed equally over the whole half of the tongue speaks more in favor of a bulbar lesion than for a peripheral. Koch and Mariè, in their study of cases, have agreed that a paralysis of the soft palate and of the vocal cord, on the same side, occurs in all cases where the paraly- sis is due to a bulbar lesion. They think that this may be taken as a diagnostic point. The explanation of this connection is the proximity of the nucleus of the hypoglos- sus, the vagus and accessorius in the medulla. In the second case the cause of the atrophy is syringomyelia. Such cases have often been reported. In case three, a fibro-sarcoma, involving the medulla and the pons, is the cause. In case four, a swollen lymph gland, which became purulent and pressed upon the hypoglossus, caused the paralysis. In case five the lesion is peripheral. In case six the seat of the lesion is undetermined. KNEE-JERK AND GROSS LESIONS OF PREFRONTAL BRAIN.—The Boston Medical and Surgical Journal Novem- ber 30th, quotes this: Dr. R. T. Williamson, of Manchester, Eng., contributes a short paper to the Glasgow Medical Journal for November, 1899, which we quote in part: “The object of my note is to draw attention to the fact that, in tumor and abscess of another region of , the brain—the prefrontal region—the knee-jerks are sometimes lost, just as in cerebellar tumor. In such case, there is usually nothing to account for the loss of the knee-jerks, except the lesion of the prefrontal region. The knee-jerks were lost in three out of five cases of tumor or abscess of the prefrontal region which I recorded in 1896. - “The first case was one of sarcoma of both prefrontal regions. I examined the knee-jerks almost every day for four weeks, but always found them absent. The tumor growths were limited to the prefrontal regions, whilst the Selections. 193 ascending frontal convolutions and the motor area of the cortex, the motor fibres in the white matter and the basal ganglia were not invaded by the growth. The cerebellum, medulla and pons were also normal. There were no symp- toms of spinal cord lesion during life, but in order to be sure that no spinal pathological changes were present, l examined the spinal cord carefully. Both macroscopically and microscopically it was normal. “The second case was one of abscess of the right pre- frontal region. The knee-jerks were both absent. There were no symptoms indicating any lesion of the spinal cord, and also there was no brain lesion, except the abscess in the prefrontal region. “In the third case the knee-jerks were absent, and post-mortem a tumor was found limited to the right pre- frontal region. Other parts of the cerebrum and cerebellum were normal. “In the paper referred to l analyzed the condition of the knee-jerks in fifty cases of prefrontal tumor or abscess (forty-five from medical literature and five recorded by myself). In twenty of these cases the knee-jerks were not mentioned; in the other thirty cases the condition was as follows: Knee-jerk absent on both sides in six cases; knee-jerk very feeble on both sides in two cases; knee- jerks normal or increased in sixteen cases; knee-jerk very feeble on side opposite to tumor in four cases; knee-jerk very feeble on side of the tumor in two cases. The knee- jerks were both absent, therefore, in six out of thirty cases of tumor or abscess of prefrontal region (verified by post- mortem examination)—that is in 20 per cent. of the cases. In all of the cases in which the knee-jerks were absent there was no indication of lesion of the spinal cord or peripheral nerves; but only one of the cases (the first which I have recorded) was the absence of microscopical changes in the spinal cord shown by pathological examination. In tumor growths involving the motor region of the brain, the knee-jerk on the side opposite to the lesion is generally increased, and on the side of the lesion normal or increased. In thirty cases of tumor of the motor area of the brain 194 Selections. (taken for comparison with the thirty cases of gross lesion of the prefrontal region analyzed above) the knee-jerks were both present in all except one, and in this case the growth was very extensive, and had invaded the basal ganglia. “In a case of a tumor of the second left frontal con- volution, recently recorded by Dr. Gordinier, it is stated that “the most careful reinforcement failed to elicit the presence of patellar tendon reflexes.” Yet at this time there was no other affection of the legs. The autopsy revealed nothing to account for the loss of the knee-jerks except the prefrontal tumor. “Apparently in tumor or abscess, in two regions of the brain especially—the cerebellum and the prefrontal region— the knee-jerks are sometimes both absent; whilst in tumor or abscess in other parts of the brain loss is exceedingly rare.’’ BERTILLON'S MISTAKES.—The Society of Medical Jurisprudence held its 144th regular meeting on Monday evening at the Academy of Medicine, the topic for discus- sion being presented by Dr. Edward C. Spitzka, in a paper entitled “Extremes in Anthropometry with reference to the Bertillon System.” He criticised that system of measure- ment of habitual criminals quite severely. By way of illus- tration he adduced the testimony of Bertillon in the Dreyfus court-martial in which he had treated of the Esterhazy forgery of the incriminating document. This incident he used as the groundwork of an attack on the theories of Bertillon and Lombroso, saying with much warmth of feel- ing, “If that expert is the one responsible for the so-called accurate measurement system now being introduced into this country, then God help us!” He declared that there exists no data in the measurement of the human skull, ears and fingers, on which to found any revelation of the moral traits of the individual. It is to be noted that in this country those police officials who have their bureaus equipped with the appliances of the Bertillon measurement system claim for it nothing more than a means of identifi- cation. An effort is being made for the establishment of a Selections. 195 central Bestillon bureau in New York, to which duplicate cards from every section of the country shall be contributed. –Philadelphia Medical Journal. THE TREATMENT OF CEREBRAL TUMCRS–Diagno- sis.--Dr. Philip Coombs Knapp of Boston, Clinical Instruc- tor in Diseases of the Nervous System, Harvard School states at the end of an article on the above subject in the Boston Medical and Surgical Journal of October 12th, says: “With regard to the nature of the growth we are at once confronted with a difficulty. Our ability to diagnosticate the existence of a brain tumor or even its exact situation may be fairly good, but our ability to diagnosticate the nature of the growth must be regarded as distinctly poor. More than one case of glioma, for example, has been recorded where the patient has had syphilis, or even puru- lent otitis, so that the physician has suspected gumma or abscess. Our diagnostic skill is not yet sufficiently exact to enable us to say concerning two tumors in the same region, “This is a fibroma; operate. The other is a gumma; let it alone;” and in the majority of cases we cannot even make a probable guess. The discussion of whether to operate on gummata and tubercular growths is therefore somewhat aimless. The only rule that we can lay down is that when we have evidence of malignant disease else- where in the body, as in two cases recently under my observation, we should refrain from attacking the growth in the brain. BRAIN FATIGUE–While reading the diary of Sir Walter Scott recently, I was specially interested in a passage describing one of his nervous conditions, since a patient presented himself at my office at this time, complaining of similar sensations, which he described with considerable difficulty. As I believe such a mental condition is seldom, if ever, described in medical literature, I will first quote from the diary and then describe the sensations of my patient, which I think agree with the description given by Scott. All know the tremendous tension that Scott was under; 196 Selections. all know the result of this tension was the earning of six hundred thousand dollars—the amount of his indebtedness. A few quotations will enable us to appreciate the one ruling thought of Scott's brain—a thought that must have kept his brain “congested” for several years. “I will die a free man if hard work will do it— “The best o't—the worst o't ls only just to die, and die I think l shall, though I am not such a coward as mortem conscire me ipso, but I gin to grow weary of the sun, and when the plant no longer receives nourishment from light and air, there is a speedy prospect of its withering.” “I have been stupefied all day, and could not gather my spirits—this is nonsense and contrary to my system, which is of the Stoic school and pretty well maintained. . . . Once drawn upon the beach, I would soon break up, so I continue my exercise.” “The point in this world is to do what we ought and bear what we must.’’ “My nerves weak—the beauty of the evening—the sighing of the summer breeze, bring the tears, but I must harden myself—it is not the law we live on.” “If I were capable, in a moment of weakness, of doing anything short of what my honor demanded, l would die the death of a rat in a hole, out of a mere sense of my own degradation.’’ Appreciating the fine calibre of the man as well as the tension he was under, from these quotations, we are pre- pared for the following nervous condition: “A kind of a cloud of stupidity hangs about me as if all were unreal that men seem to be doing and talking about.” “A day of hard work, being, I think, eight pages before nine. I cannot, I am sure, tell if this is worth marking down, that yesterday at dinner time, I was strangely haunted by what l call the sense of pre-existence, videlicet: a confused idea that nothing passed was said for the first time; that the same topics had been discussed, and the same persons had stated the same opinions on the same subjects. It is true there might have been some ground for Selections. 197 recollections, considering that three at least of the company were old friends, but the sensation was so strong as to resemble what is called a mirage in the desert, or a calen- ture on board ship, when lakes are seen in the desert, and silvan landscape in the sea. It was very distressing yesterday, and brought to my mind the fancies of Bishop Berkeley about an ideal world. “There was a vile sense of want of reality in all I did and said. It made me gloomy and out of spirits, though I flatter myself it was not observed. “The bodily feeling which most resembles this unpleas- ing hallucination is the giddy state which follows profuse bleeding, when one feels as if walking on feather beds and could not find a secure footing. I think the stomach has something to do with it. I drank several glasses of wine, but this only augmented the disorder. I did not find the in vino veritas of the philosophers. Something of this insane feeling remains to-day, but a trifle only.” My patient is a sensitive man of sixty, who has been carrying a load for a good many years—a sensitive man who all his life has been struggling up the hills of life which he expected to fly to in the dreams of youthful enthusiasm; he is a man of fine calibre, and should be a man of wealth, for an oversensitive man of fine calibre is not at his best but at his worst when the day’s life means a day’s struggle for mere existence. Such a struggle is best maintained by a man of really coarse calibre who is skilled at acting the part of a gentle- man, and knows how by polished manners to force from environment the best possible. My patient was seriously handicapped by his sensitive temperament, so he carried his load under great tension, and silently endured the “whips and scorns of time.” He tells me that six months before consulting me, after a trying week, he noticed a dizziness and an uncomfortable sensation in the head, which increased for several days, until one morning, while writing a letter, he found he could not remember the name of his little town, though he had lived there some long time. Being an intelligent man, he 198 Selections. readily diagnosticated this symptom as brain fatigue, and, resting from his work a few days, found complete relief. Such an experience, however, aroused his curiosity, and made him an observant student of his mental condition. Six months after this brain fatigue, the tension of climbing up the hills of life with difficulty became severe and interesting symptoms followed—a feeling of mental weariness after a few hours of brain work; then a tendency to stagger while walking, which seemed to increase if noticed carefully. Though he knew he was “all right,” he felt he was “almost all wrong”; everything said and done by others seemed “queer”; conversation was exceedingly disagreeable and flat, especially since those conversed with seemed to be in a “haze.” No one noticed the condition of my patient, especially since he knew he was alright in the eyes of his friends, because he knew his symptoms were purely subjective, and not observed by his friends. He acted so naturally that the only flaw his friends could find in him was an “unnatural seriousness” which he avoided “by trying hard to be cheerful.’’ He knew his symptoms were due to “nervousness and mental fatigue,” so he tried to control as well as to study himself. He tells me his life during this was and always has been regular in every way; that he ate and slept well and was well in every way save for these symptoms. After he had been under a severe mental strain for a few weeks, his symptoms, which had decreased in severity, increased until he became a little alarmed, as “everything seemed so queer and hazy.” He would think of or hear of some trifling incident, and at once his mind would say, “I’ve heard that before,” and then would follow a mental hunt for the time and place; this hunt would last possibly fifteen minutes and end with little satisfaction, only to be followed by “another hunt.” This seeking for the “previous time and place” seemed to give a mental sensation “vibrating” in character, and not as disagreeable as unsatisfactory. This mental condition would last possibly three or four hours in its intensity, and then Selections. 199 slowly pass away. During this time, satisfactory mental application was not possible, so the patient, realizing rest was his best medicine, decided he would first consult me and then rest in the mountains. I found him a bright, active gentleman in literary life, with too much work amid too many cares and responsi- bilities—a man of too fine a calibre for some of the rough- and-tumble contests he had been engaged in. He gave a good, clean history in every respect, and correctly diagnos- ticated his trouble as “brain fatigue,” due to too much mental work and worry. A vacation of a few weeks completely restored his nervous tone and he returned well. I believe his mental condition to have been as Scott’s was—a condition produced by too much work and worry. I have written this brief paper because I do not remem- ber to have read anywhere of that mental condition which Scott calls “a strange sense of pre-existence.”—R. Ellis, A. B., M. D., Utica, N.Y. in N. Y. Med. Jour., Nov. 11, 1899. A CASE OF EXOPHTHALMIC GOITRE AND MYXEDEMA. —Maurice Faure, La Presse Medicale, Sept. 23, 1899, reports the following: Mrs. D., with negative personal and family history, began in 1886, when 32 years old, to com— plain of palpitation; after four years exophthalmos appeared and she became very irritable. In 1892 she noticed that she could not button her collar on account of a goitre the size of a small orange. After this patient began to complain of headaches, sweating spells and flashes of heat. The exophthalmos became markedly increased. Menstruation became irregular and diminished and diarrhoea made its appearance, and during 1892 and 1893 it was almost incessant. In 1891 dyspepsia developed, the ankles were swollen at night and patient had attacks of oppression and restlessness and slept very poorly. Symptoms kept on with periods of improvement and exacerbations until 1896, when new symptoms appeared. Her face and neck showed myxedematous enlargement and she became sleepy, easily tired, dull. Her mental faculties were not so active as before, and she was greatly worried on account of loss of 200 Selections. memory and loss of will power. An examination in 1896, when patient was seen for the first time, showed her to be very nervous, face large, skin and connective tissue thick- ened and hard. Marked exophthalmos and some nystagmus. Carotid pulsations were very marked. Pulse was strong and regular, 100 to the minute. Heart was enlarged; apex on sixth intercostal space. No murmurs. There was rude respiration in both infraclavicular regions. Patient was given thyroid extract, digitalis, bismuth, bicarbonate of soda, as indicated. She improved for a while, but gradually grew weaker, and on the 6th of January, 1898, her pulse became almost imperceptible, and the heart's action weak and tumultuous. In addition there were marked dyspnea and edema; coldness and cyanosis of the extremities; abdominal walls swollen and distended, and there was some ascites. She died on January 8, 1898. A post-mortem examina- tion showed lungs congested at the base and some tubercles on both apices in front. Heart dilated to double its normal size. Liver, spleen and kidneys congested. Brain normal, slightly congested. Thyroid gland enlarged to three times its normal size; weight one hundred grammes; appeared to be hypertrophied only, without any other changes. Sympa- thetic nerve at the neck as well as the pneumogastric nerve normal. Eyes were not prominent and orbital cavities were normal. Cellular tissue of the face was thick, hard, and did not pit on pressure. All others normal.–Medical Review. THE ALIENIST AND NEUROLOGIST. WOL. XXI. ST. LOUIS, JANUARY, 1900. No. 1. Subscription $5.00 per Annum in Advance. $1.25 Single Copy. CHAS. H. HUGHES, M. D., Editor. HENRY L. HUGHES, Manager and Publisher. Editorial Rooms, 3857 Olive Street. Business Office, 3857 Olive Street. Subscribers failing to receive the Journal by the 20th of the month of issue will please notify us promptly. EDITorial. [All Unsigned Editorials are written by the Editor]. The Alienist and Neurologist greets you and the new century with congratulations and good wishes for a happy new year. May your prosperity in the coming year equal that of the ALIENIST AND NEUROLOGIST during the year that has passed. Two decades and the first year of the third have gone in the eventful history of the ALIENIST AND NEUROLOGIST since its foundation in 1880. Since its advent psychiatry and neurology, (or more properly neuriatry,) in America have made astonishing advances and gained most remarkable recognition before the profession and the world at large. American contributors to both departments of scientific labor have given the American Neurologist and Alienist cosmopolitan fame. Neither psychiatry nor neuriatry is now terra incognita to the general practitioner of medicine and the ALIENIST AND NEUROLOGIST is now probably read by more medical men in general practice than any other journal dubbed a special journal. It is a journal for the general practitioner and aims to place psychiatry and neuriatry where they belong in general practice. [201] 202 Editorial. Sir Dyce Duckworth has made inoculations to de- velop the Widal reactions in healthy soldiers. Healthy young men, in his experience, after inoculation develop vigorous reaction within a week. It has been decided to try this upon the troops sent to South Africa. This is significant and may be a suggestion of a possible immunity to this army pestilence which still walketh in darkness to so many commissaries quartermasters and others in military authority. - The Marion County (Indiana) Medical Society Held an interesting meeting December 5, 1899, at the Central Hospital for Insane, partaking of the hospitality of Superintendent Geo. F. Edenharter. An address was made by Dr. C. B. Burr, of Flint, Michigan, on “The Care of Recent Cases of Insanity.” Epileptic Double Consciousness and Memories of Pre-Existence.—About half a century ago an extraor- dinary (as it was called at the time) case of epileptic double consciousness was reported, in which the memory of the epileptic period was preserved as a belief that the patient had lived in a different historic period. On this case the character of the Count of Rudolstadt of George Sands’ “Consuelo” was founded. The Count has memories of his pre-existence as a Hussite leader. The same machinery was used in Maurice Sands’ “Callirhoe.” Here the hero has memories of pre-existence as a chief of the Gauls. While complete cases of the type utilized in fiction are compara- tively rare, still the delusions of memory of a more or less imperfect type are frequent in epileptic and even in other mental states. As Kiernan remarks (ALIENIST AND NEU- ROLOGIST, 1884): “Cases occur where epileptics recollect hallucinations occurring during the attack.” These seem to indicate the occurrence of consciousness during the epileptic attack, but such recollections are really the results of a different cause, and one which gives rise to the so-called delusions of memory. As Meynert has shown these remembrances have the following pathogeny: An epileptic attack occurs in consequence of an arterial spasm of a hemisphere. It may readily happen that this spasm may Editorial. 203 occcur in but part of a hemisphere. When this spasm pro- ceeds to the extent of complete occlusion, collateral hyperasmia will result, engendering an irritation, a pro- nounced contraction of a vessel, leading to a diminution of pressure in collateral branches. These phenomena do not produce an hallucination; but the hyperaemia in question may produce a delusion of memory at the time the halluci- nation occurs, by causing the subjective sensation to receive such color that the sensorium retains the imprint of it. While this is not a true memory, it approaches so closely to it that differentiation by an unskilled observer is impossible. The case lately reported by Havelock Ellis of memory of pre-existence which has created discussion of these con- ditions (New York Medical Journal, Dec. 16, 1899) is refer- able to these delusions of memory. Far from exceptionally the religious visions of hysterics are also remembered as actual occurrence. A study in hagiology of sundry female saints (St. Theresa for example) will reveal many instances of this type. Like the so called sub-liminal consciousness of the occult psychologists, these memories of pre-existence are a morbid phenomenon. Maternal Impressions.—The subject of maternal impressions is a perennial one, and the view taken of it by the profession sways between the extremes of credulity and scepticism. At a recent meeting of the Chicago Academy of Medicine the subject was brought up for discussion since, at a previous meeting the sceptical spirit had shown itself in denial of facts authenticated by embryologists and ornithol- ogists of unblemished repute. The case was further sup- ported by teratologic specimens in the British Museum. Spitzka had his skepticisms as to maternal impressions shaken by these specimens, which were newly-hatched chicks with a curved beak like a parrot and the toe set back as in that bird. The hens in the yard where these monstrosities were hatched had been frightened by a female parrot which, having escaped, fluttered among them before the eggs were laid and greatly frightened the hens from whose eggs the malformed chicks were hatched. This 204 Editorial. would seem at first sight to confirm the photographic theory of maternal impression. Dr. Kiernan points out, however, that these malformations are simply arrests of development. Birds, being aberrant reptiles, belonging to the Sauropsidae. During their embryonic development birds pass through a reptilian phase. It was at the end of this phase that the chicks were arrested in development, producing the parrot like malformation. It is precisely for lack of logical ex- planation like this that modern obstetricians are sceptical. In a general way cases reported of maternal impressions may be divided into two classes: 1. Those in which an arrest of embryonic development has occurred, which may or may not be traceable to the alleged impression. 2. Photographic impressions charged to a factor utterly incapable of producing them because of the late period in embryonic life at which the impression is alleged to have acted. Of one case presented, Dr. Kiernan said: “It might be a basis for a myth like that of Europa and the Bull, or that of the extravagant antics of Pasiphae, which produced the Minotaur.” Although the physicians did not accept the explanation the gossips of the neighborhood charged the monstrosity to a fright by a bull which occurred at the eighth month of pregnancy. The bull-like face of both heads is the result of an arrest of development at a much earlier period. It is obvious that no force could so turn back the clock of embryonic development as to produce in the eighth month of intra-uterine life, changes which must have been based upon arrests of development established during the first. In the second instance—which is also of a double monster—there would seem to have been indicated possibilities of superfetation. Of this there is no evidence. The condition was charged to a fright during the seventh month of pregnancy at an engraving of a double-headed monster, seen in a traveling show. It is perfectly clear that this fright could have had no influence whatever in the pro- duction of the monstrosity. The next case is a cyclops. Cyclopia is a result from arrested development of the later acquired paired eyes and undue development of the middle eye, which ordinarily becomes the pineal body. Editorial. 205 The condition here found is practically the condition which exists in the provertebrates, like the ascidians. The eye of the ascidian tadpole agrees fundamentally with the type of eyes peculiar to the vertebrates, since the retina is derived from the wall of the brain, and is therefore called myolonic. The pineal boy is a remakable rudimentary struc- ture whose constant presence in all vertebrates forms such an eminently characteristic median outgrowth from the dor- sal wall of the brain. The distal extremity of this dilates into a vesicle and becomes separated from the proximal por- tion. The distal vesicle becomes entirely constricted from the primary pineal outgrowth of the brain. The remote ancestor of the vertebrates had a median unpaired myolonic eye which was subsequently replaced in function by the evolution of the paired eyes. This is shown by study of ascidian and lancelet eyes collated with cyclops and trioph- thalmos in man, the normal eye and the third eye of reptiles like the hateria of New Zealand. As Daresta has shown, production of a single eye, the changes in the structure of the mouth, the atrophy and the change of nor- mal situation of the olfactory apparatus, and of the vesicle of the hemispheres, result from an arrest of development. The determining influence must be exerted very early in the life history of the embryo. In this case the mother, a girl of 17, during the eighth month of pregnancy read a book on Africa. This was followed by a dream anent animal mons- ters, and to this dream was ascribed the monstrosity. It is obvious that this dream could have exerted no influence whatever. The last case is one which might have been produced by a maternal shock. The condition of meningo- cele here presented could have been produced by an alteration of cerebral pressure, which again might result from a disturbance of the maternal blood pressure, through a shock. The fact that mental shocks can only act on the organization in a purely physical manner is equally ignored by opponents and advocates of the psychic theory of mental impression. All that is kown of mind is known of it as related to purely physical conditions, and it is through pure physical conditions that it must act, whether its action be 206 Editorial. initiated by conditions affecting physically the various sense organs or not. There is no doubt that the fetus is liable to mental effects from the mother, since as Féré has shown (Sensation et Mouvement) it often exhibits very decided reaction to sensory impressions on the mother. Women in the midst of an ordinary dream, producing only very moderate excitation, not generally interrupting sleep, are often awakened by fetal movements. These dreams need have nothing of the nightmare which would cause sudden contraction under the influence of a terrifying idea with its resultant cardiac disorder. They may be merely the ordi- nary phenomena of sleep. Mental changes of the mother hence excite motor reaction in the fetus and, as with sen- Sorial excitation, the reactions are stronger in the fetus than in the mother. The mechanism of these motor reactions is obviously the unconscious and involuntary movement of the uterine walls. Dr. A. Lagorio, some sixteen years ago, brought before the Chicago Medical Society, several cases in which maternal impressions had produced decidedly abnormal births, with deformities resembling those feared by the mother. In discussing these Dr. Kiernan (Chicago Medical Journal and Examiner, 1883-4) pointed out that they were all instances of checked development, and advanced the opinion that normal shock generally directed, played the chief part in maternal impressions through checking development and causing either general or local reversion. Here the statistic method can be applied. Of ninety-two children born in Paris during its last siege, sixty- four had slight mental or physical anomalies. The remain- ing twenty-eight were all weakly; twenty-one were imbecile or idiotic, and eight were morally insane. These figures of Legrand du Saulle justify the characterization by the work- ing class of Paris of children born in 1871 as “doomed children.” In Berlin the financial crisis of 1875-80 was followed by an increase in the number of idiots born. It must be remembered that profound mental shock can so alter nutrition that the mother shall furnish poisonous products in lieu of nutriment. That such poisonous products would tend to check fetal development no one will deny. While reject- Editorial. 207 ing the photographic phase of maternal impression it must be admitted that there exists a class of cases showing arrested development which is due to the effects of mental shock upon the mother. In the light of the discoveries anent the neuron the absence of neural connection between mother and fetus has not its former significance. - Magnetic Healing.--According to the Journal of the American Medical Association (Oct. 7, 1899) the Appellate Court of the Third District of Illinois has decided as follows in a suit brought by the State Board of Health for practic- ing medicine without a license: A “magnetic healer” of Bloomington claimed to effect marvelous cures without medicine or surgery by magnetic treatment. The method of treatment was by rubbing the parts of the body supposed to be affected. The man who was treated for sunstroke was to pay $30, $15 in money and $15 in hack hire, all but $2 of which had been paid. It was claimed by the appellant (magnetic healer) that these facts did not show that he was practicing medicine within the meaning of the act: “who shall treat, operate on, or prescribe for any physical ailments of another.” In answer to this question the court says: “If to treat or operate upon a person for a physical ailment by rubbing the part affected is not a treat- ment or operation for a physical ailment what is it? It seems to us that the mere statement of the question demonstrates the absurdity of every opposite position.” The decision of the lower court was affirmed. The practice of medicine, like that of law, includes counsel. Advice is a part of the medical prescription as well as the drugs directed to be taken. If this magnetic healer had not put hands on the victim he would, according to this ruling, have escaped the penalty of prac- ticing medicine unlawfully. Courts sometimes view matters medical through strange optics. When medical men take more interest in the affairs of men and seek to exert their proper influence over the world’s affairs like other people they will get more justice and proper recognition by courts and governments. The dicta of the courts in matters medical 208 Editorial. should conform to medical science, medical interest and medical common-sense. Insanity in the Jury-box is made the subject of very pertinent editorial comment by the Philadelphia Medi- cal Journal of November 18th, referring to the alleged insanity of one of the jurymen in the recent Ingham-Newitt trial in that city. A member of the jury in that trial became violently insane eight days after the rendering of the verdict and was takén to an asylum. One of the asylum physicians says that the man when received was very insane, that he was the subject of delusions and audi- tory hallucinations, and that during the last ten years he had been admitted to the asylum five or six times with similar attacks, and that his periods of maniacal excitement lasted from three to six months. So far as we know, the Journal remarks, the case is unique in the annals of medi- cal jurisprudence. The case is one evidently of folie circu- laire or recurrent insanity and the insane juror was probably at the time he was chosen and throughout the trial in the prodromal stage of an exacerbation and not, therefore per- fectly sane while serving on the jury. Psychological science at all events would doubt his perfect sanity and some one in the cause should have legal benefit of this scientific doubt. The Heart-Foot Impulse or “The Foot Sign and Dreyfus.”—The New York Medical Journal discussing the familiar fact that a man sitting with one leg thrown comfortably over the other, the foot hanging loose, shows foot movement corresponding to each heart beat, says: “While the charge against Captain Dreyfus was pending, the Marquis du Paty de Clam made a psychological study of the prisoner. Among other things, he suddenly asked Dreyfus a question calculated to arouse emotion in him if he was guilty. Dreyfus was in the posture mentioned, and the movements of his foot were suddenly intensified. The marquis urged this as a proof of the prisoner's guilt, and it really seems to have played a part in securing his convic- tion. Dr. A. Lutaud combatted the marquis’s inference at Editorial 209 the time, and quite justifiably, we think, but we can not agree with Dr. Lutaud when he says now, in a sarcastic article reflecting on du Paty de Clam (Journal de Medicine de Paris, June 4th), that such movements of the foot, which he calls “instinctive,” have nothing to do with the movement of the heart. The movement has been called “the sign of the foot,” but Dr. Lutaud proposes to call it"du Paty’s sign.” Richerand was the first physiologist, so far as the Editor of the ALIENIST AND NEUROLOGIST can now recall, to call attention to the fact and measure the force of the heart foot impulses. It was most natural that Dreyfus should on the witness stand, under all the circumstances of this remarkable trial, have had an accellerated heart foot impulse. It would not be strange from a patho-physiological stand- point if the overstrained and maltreated man should have betrayed morbid nervous excitability in his extremities and shown abnormal kneejerks, muscular twitchings and spas- modic jerks in many parts of his exhausted anatomy, under the unprecedented ordeal. It would be interesting to know how M. du Paty de Clam, with his pseudo-psychological and physiological expert pretensions, would have acted under the strain put on the prisoner of Devil’s Island. But with due deference to the Marquis’s startling expert con- clusions, the exaggerated heart foot impulse is not a guilt engendered sign. It may represent increased heart action. It and other intensified movements of the foot may show emotion, nervous agitation, debility or disease. They have never yet been shown to have been necessarily associated with wrong or self-accusing emotion. Psychic inhibitions may be impaired under such a strain and tendon reflex might be increased below the knee, or Jandrassack’s reinforcement, and yet no self-accusing criminal emotion exist. This false expert conjecture is not a brilliant one. Death of Sir James Paget.—Sir James Paget, F. R. C., LL.D., D.C.L., Bart., former President of the Royal College of Surgeons, England, died in his eighty-sixth year. He was born in Yarmouth, Eng., January 11, 1814. He studied at St. Bartholomew’s Hospital in London and in 1836 became a member, and in 1843 a fellow, of the Royal 210 - Editorial. College of Surgeons. He was then surgeon and consulting surgeon at St. Bartholomew's, sergeant-surgeon to the Queen, surgeon to the Prince of Wales, vice-chancellor to the University of London, and president of the Royal College of Surgeons. In his earliest studies he paid special attention to Pathology. His most important contribution was “Lec- tures on Surgical Pathology.” It became a text book in medicine and invaluable in surgery. Mr. Havelock Ellis’ Work on Sexual Perver- sion.—“In two of the June numbers of the Maryland Medical Journal Dr. William Lee Howard of Baltimore, blames the unwillingness of some medical men to treat patients whose symptoms, whether bodily or mental, are related to the sexual organs or functions, and he vigorously denounces the prosecution last year of the London agent for the sale of Mr. Havelock Ellis's book, Sexual Inversion He maintains that a recognition of the pathological states of the sexual centers as demonstrated in certain psychical conditions and morbid acts, together with a full comprehen- sion of the power of association and suggestion in the adolescent sexual neuropath, are essential for medical practi- tioners, and he argues that if a pathological state such as congenital sex perversion is too disgusting to be recognized, then a pathological state producing syphilitic Sores of the genitals ought by parity of reasoning to be too filthy to be treated. He had been hoping that Mr. Havelock Ellis's pro- hibited book would have had the effect of bringing English medical men and publicists to understand that a human being is just as liable to have the growth in the cells mak- ing up the sexual center disturbed and distorted as in the cells making up any other center, physiological or psychi- cal, from which it follows that it is unreasonable to send a man to prison because he is deformed in certain psychical centers. Mr. Ellis’ book he describes as a classic, saying that it is cleaner, has more of the scientific atmosphere, and shows greater study and research than any of the works hitherto published on the subject, not excepting those of Krafft-Ebing or Schrenck Notzing–London Lancet, July 15. Editorial. 211 And we cordially endorse the same and so does the Southern California Practitioner. For Sale.—Cne large physician’s galvanic-faradic battery (Henne) in first-class condition; cost $250. Will sell for one-third–Contemporary Journal. Price reduced because the doctor is immense? we sup- pose! The following letter has been forwarded by the Woman’s Committee of the Psychological Section of the Medico-Legal Society, in response to her appeal for aid in fitting out a Hospital Ship for South Africa wounded soldiers. - - - - - - NEW YORK, November 6th, 1899. LADY RANDOLPH CHURCHILL, Honored Madam: –The undersigned Woman's Committee of the Psy- chological Section of the Medico-Legal Society note with pride and pleasure your praiseworthy efforts to furnish and dispatch a Hospital Ship for the relief of the wounded soldiers of the Nation, of which you have become a citizen, by your marriage to a subject of the English throne; and we have heard your appeal to the women of the country of your birth, to aid you in a work of philanthropy and charity for the benefit of the soldiers and sailors of the country of your adoption, in the unfortunate war now going on in the South African Republic. We beg to remind you that there is now an American lady languishing in an English prison, who is universally believed by her countrymen and countrywomen, to be entirely innocent of the crime with which she is charged; who was sentenced to death; whose sentence was commuted, on the advice of the Judge who tried her, by the English Home Secretary, on the ground that a doubt existed as to whether the death of her husband was caused by, or due to, arsenic; and who has, as we believe, suffered an unjust imprison- ment for more than ten years. That this is despite the petitions and appeals of thousands of her countrymen and countrywomen; of the strong and urgent appeal of the Lord Chief Justice of England, who believed her innocent; of the personal urgent appeal of President Benjamin Harrison and the members of his Cabinet; of the strong letters of the wife of the Presi- dent, and the views of the American Cabinet Ministers, appealing to the Queen of England in her behalf; all of whom urged her release, because they believed her to be innocent; and for whom the Hon. William McKinley, President of the United States, with a firm conviction of her innocence, has asked release from the English Government, as an act of international comity, between two great nations, whose people are now anxious to see a strong feeling of amity cemented between these nations of a common blood and origin. We ask you to seize the present occasion to urge upon the Home Secre- 212 Editorial. tary for England, the release of this American lady, who, less fortunate than yourself in her marriage with an Englishman, has, since his death stoutly claimed her American citizenship, as she has the legal right to do, under the English law, and which she never surrendered under the American law; who is now suffering a terrible, cruel and long continued imprisonment, longer than any woman has endured under the English law, as we believe, and longer than any English woman of a similar social position would have suffered, if believed by the English authorities to be guilty; who, reared as a lady, and the daughter of one of our best families in her feeble and deli- cate health, has maintained and preserved the rank of a Star Prisoner by her good behavior. We urge upon you to explain to the English Home Secretary that his refusal to recommend Florence E. Maybrick to the clemency of the Queen of England, now so earnestly desired by the American President and people; so stoutly and constantly urged by the American Ambassador, Hon. Joseph H. Choate; is not only a source of constant irritation to our people in Amer- ica, but that it disturbs and prevents that sincere friendship, which has been made more necessary by the progress of recent events, involving the inter- ests of both countries, growing out of the recent war between America and Spain, and the present conflict in South Africa; and that it also stands in the way of our cooperation with you in your humane endeavors, because of a feeling of just resentment and extreme annoyance at the continuance of a punishment, against an American citizen, whom we believe innocent of the offense for which she has been tried, that is more terrible and severe to endure than was that of Dreyfus. Aid us, dear Lady Churchill, in securing the release of this innocent lady, and we will pledge the women of America to double the effort you are now making for the wounded in South Africa. We remain, Very faithfully yours, CAROLINE J. TAYLOR, Chairman, M. LOUISE THOMAS, THE COUNTESS BETTINI Di Moise, FLORENCE DANGERFIELD Potter, ROSALIE DAILEY, PHOEBE A. HANAFORD, IDA TRAFFORD BELL, SOPHIA MCCLELLAND, ANTOINETTE BROWN BLACKWELL, C. WAN D. CHENOWETH, Composing the Woman's Committee of the Psychological Section of the Medico-Legal Society of New York. We take pleasure in publishing the above from advance sheets Medico-Legal Journal with our emphatic endorsement. How an English jury could have failed to give this unfor- tunate woman the benefit of the reasonable doubt, in a case Editorial. 213 of death resulting apparently from arsenical poisoning in a chronic victim of the arsenic habit who had reached a period of non-resistance in his career, as these victims almost invariably do as age advances, when the ordinary dose becomes a fatal poison, is beyond our comprehension when we consider the well-known reputation of our English cousins for fairness. Their proverbial chivalry towards the sex as well as their fairness appears to have forsaken them in the unrighteous verdict of mere presumption and suspicion against an innocent woman. Rank of Army Medical Staff.-Surgeon-General Sternberg has wisely recommended the increase of the Army Medical Staff, but, with undue modesty, omitted to recommend exalting the rank of Surgeon-General to that of Major-General. The present rank of the Surgeon-General is a degradation when the duties and great abilities of the office are considered. Five thousand five hundred dollars, the present pay of the position, is too insignificant to be longer tolerated. The whole profession should protest against it. Who among ten thousand medical men in the United States could accept this pay and emolument, if called on to fill an equivalent position with that of the Surgeon-General, without great pecuniary sacrifice? Besides the regiments as now constituted, should have a chief- surgeon with the rank of Lieutenant-Colonel, one chief- assistant with rank of Major of Cavalry, and two assistants with respective ranks of Captain and Lieutenant, to be respected and obeyed accordingly in all matters of sanita- tion, sanitary transportation and supply, as well as direct treatment of the sick and wounded. Sanitation and proper medication ranks with ammunition and the commissariat in the efficiency of armies. A wise physician, skilled our wounds to heal, Is more than armies to the public-weal - and about as important in time of war as the commissary or quartermaster, and the right sort of Surgeon-General is worth about as much in the direction of army efficiency as a chief of ordnance; for of what use are guns without healthy men to handle them? The medical department 214 Editorial. takes care of the men behind the guns and of those who fall before them. Healthy men make an army strong— healthy minds and bodies make a people great. Dr. C. B. Burr, Medical Superintendent of the Oak Grove Hospital at Flint, Michigan, was honored November 20th by his medical brethren and patrons of the institute with the presentation of a loving cup. Dr. Edwards, of the Kalamazoo Asylum; Dr. Christian, of the Eastern Michigan Asylum; Drs. Hurd of Johns Hopkins, Baltimore; Morse, of Eastern Michigan; Munson, of Traverse City; Mann, Brodie, Longyear, Hitchcock, Remick, Baldwin, Pitts, Shaw, Hughes, Warren, Venton, Jennings and others, par- ticipated in the well deserved testimonial. Dr. Burr grad- uated from the college of Physicians and Surgeons in New York in 1878. Six months after his graduation he became connected with the Eastern Michigan Asylum for the Insane at Pontiac, where he remained until five years ago, when he came to Flint to take charge of Oak Grove Sanitarium, Dr. Burr has done credit to his profession, and in doing him honor his former professional associates honor themselves. “Barkers Nervous System and its Constituent Neurones,” briefly noticed in our last edition, brings modern Neurology with its marvelous progress fully up to date, and is an especial credit to American, as is creditable to cos- mopolitan, Neurology. The architecture of the nerve center is elucidated in such a manner as to display to , the searcher after neurological truth, new fields under new illumination. The history of the development of the neu- rone concept, the external morphology of neurones, the histogenetic relations of the neurones, the neurone as the unit in physiology and pathological processes “and the grouping and chaining together of neurones of the nervous system of man and mammals, embraces the several sub- captions under which the author has studied and presented his work. Barker leads us not only to the mountain top, but far down into the valley of new Neuro-anatomical and into a vast domain of novel and fruitful Neuro-physiological fact and speculation. - : Editorial. 215 Syrup Hypophos Compound, P. D. & Co.— One of our contemporaries is under the delusive impression that to nine people out of ten hypophosphites means Fellows Comp. Syr. Not by a jug full, doctor. Fellows has been largely superceded in many sections of this country by Parke, Davis & Company’s Haematic Syrup of the Hypophosphites. We have prescribed no other for many years. Our results with the Haematic Syrup of P. D. & Co. have been quite as satisfactory, and the Syrup. Hypophosphites haematic of Parke, Davis & Company is a home product, and, I be- lieve, it is put down to the retail pharmacist at less cost, though quite as good in composition as any other hypo- phosphite syrup on the market. Honor to Dr. W. W. Ireland.—The Societá Fren- iatrica Italiana has nominated Dr. Ireland, Mavisbush House, Polton, Scotland, as a corresponding member. The Didactic Lecture.—The Boston Medical and Surgical Journal, commenting on a recent address of Prof. Osler, says, in full accord with what has before been said in these editorial pages: “We are glad to see that Osler still holds out for the didactic lecture, which from various sources has of late been so vigorously attacked. There will, he says, always be men who can present a subject in a more lucid and attractive manner than it can be given in a book. The place of the didactic lecture, as we have previously had occasion to say, is, in our opinion, one of growing rather than decreasing importance, only modified to meet the more stringent demands of the future.” The didactic lecture rounds off the instruction of the laboratory, the clinic and ward, the microscope and the dissecting room, and makes the cultured physician. The didactic lecture makes the logical thinker, the systematic observer, the cultured doctor, shows the student what and how to study, how to generalize and mass facts, and fits him better for practice than their abstract gleaning alone. The didactic lecture carries him along gracefully, and places him on a par with the master mine owner, who has risen from the wielder of the pick and shovel to his place of promotion. The didactic lecture aggregates, segregates, compares and 216 Editorial. deduces conclusions. It is the complement or summing up of all work. It corrects discrepancies, reduces discordances and makes of the student, a polished, potent physician, as the lapidary does the brilliant gem out of the rough dia- mond. Doctor Mulhall Dead.—I knew him in the bouyancy of his earlier professional life soon after his return from the hospitals and universities of Europe well equipped for his profession. Ambitious, hopeful, energetic and capable, he felt like an Achilles and therefore acted like a Sampson How soon do the energetic fail and the strong get tired of this life. They pile on its burdens, augment its responsi- bilities and in an evil hour, to give them the feeling but not the fact of renewed strength, resort to that mockery stimulation, so called, and try to go on when imperious Nature wills a halt. They fail and they fall. He meant well in the battle of life but maneuvered unwisely under its severest strain and was decoyed and ambushed by the enemy of over effort and thus we lament"one more unfortu- nate weary of breath;rashly importunate, gone to his death.” Doctor Mulhall committed suicide. The Arsenic in Chorea Folly.—For many decades arsenic has been the constantly proclaimed remedy for chorea. Now nature’s best remedy for chorea is from six to ten weeks rest, diversion and forced extra nutrition and those agencies that promote these conditions. In many years of treatment of this disease we recall but few failures and arsenic has not been our main reliance. Moderate doses, three to five minims of the Liq. Pot. Ars. combined with hyphosphites, muriated tincture of iron and the bromides with attention to digestion, assimilation, rest and general re- cuperation and mental diversion have brought about the cure. The nature of childhood is bouyant. Remove the burden that oppresses which in this disease is usually inadequate sleep, a mentally overstimulated life or brain and body under- nourished with a superadded fright or violent discipline or school strain and the physiological rebound sets in and six weeks will do for the little choreiac what Abernethy said it Editorial. 217 so often did for rheumatism, viz. bring about a cure for that time anyway. “The Crystal Water” will possess a new in- terest to the water drinkers of St. Louis, now that the Chicago drainage canal is pouring its diluted filth into the source of our water supply. The only immediate safe guard in sight of the wise citizen from this Stygian pollution is thoroughly filtered or boiled and sanitarily aerated water. This is Crystal Water. Walnut Lodge Hospital, Hartford, Conn., is worthy of special mention to the friends or guardians of inebriates from the fact that in addition to the eminence and competency of its accomplished medical head, Dr. Crothers, the law of Con- necticut gives the inebriate a better chance than those of any other state in the Union. In this state, we are informed, the inebriate wishing to be cured may sign away his rights of habeas corpus for a period of six months. This gives medical science the chance to cure, sometimes, required in extreme CaSeS. The Death of Doctor Mudd.—The following tribute to the deceased from the Kansas City Medical Record we from long acquaintance heartily endorse: “DR. H. H. MUDD, who died recently at his home in St. Louis, was one of the best known physicians in the State of Missouri. His reputation was also national and international. Dr. Mudd belonged to the class of typical surgeons of honesty and integrity. He was decidedly conservative in this, that he had the courage of his convictions; always operating when he thought it was necessary, and refusing to operate: for the sake of cutting. |N MEMORAM. In the Death of Dr. William A. Hammond, ex- Surgeon-General, U. S. A., retired and full of years, the country has lost a man who, in his prime, was one of the most vigorous-minded and well-informed members of the American medical profession. As a pioneer American neu- rologist, after he left 'the army, he adorned the ranks of medicine and enriched its literature. “His unfortunate con- troversy with the indomitable willed Secretary Stanton during the Civil War, resulted in his dismissal from the army. But he was subsequently re-instated, after the pas- ..sion of the Civil War period had subsided, and placed on the retired list. Hammond’s Hygiene, written when he was Surgeon-General, was, one, of, the best books for army use of the Civil War period; saving the young surgeons of that time from many a fatal blunder in camp location and camp and hospital management. It was a timely and meritorious anticipation of and provision for the then rapidly-forming army of volunteers. ... " , Hammond subsequently enriched Neurology by the dis- covery of Athetosis and other newly described nervous states, the publication of the Journal of Psychological Medicine and his great book on Diseases of the "Nervous System. This book was translated into every modern language. Hammond wielded a trenchant literary pen. He is the au- thor of"Hal”, Robert Severne and other literary works of merit. We consider Robert Severne, his friends and his enemies, the best of his literary productions. It is true to life and was inspired by the earlier ordeals of his life. Hammond was genial, cordial and hospitable to his friends; a royal enter- tainer, and, in his later years, charitable to his enemies. His social qualities cemented friendships, but his sarcasm in controversy widened breaches of that animosity which once made was seldom healed. Hammond was often victimized by men professing friendship to him and suffered from entangling business alliances, secured through the warmth of his friendship. Designing business sharks and promoters sought him out and entrapped him into unprofit- able ventures, using the influence of his name in the promotion of money making schemes which were profes- sionally and financially disastrous to him. . He was foremost in the founding, if not the original founder, of the post-graduate medical school and lectured with distinction for many years in the New York Post- graduate school. He founded and was an ex-president of the American Neurological Society. [218] Raº wº M6 tº PROGRESSIVE MEDICINE–Vol. IV. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences, Edited by Hobart Amory Hare, M. D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo, handsomely bound in cloth, 398 pages, 51 engravings and 5 plates. Lea Brothers & Co., Philadelphia and New York. In purpose and method “Progressive Medicine” radically departs from the lines pursued by the customary Year Books and Annuals. It records the practical advance in each branch of medicine and surgery, by a strong corps of contributors, narrative in form and practical from standpoints of clinical experience. The chaff has been winnowed from the grain and the material prepared for easy assimilation and guick application. Following are the subjects: “Diseases of the Digestive Tract and Allied Organs, the Liver, Pancreas and Peritoneum,” by Charles G. Stock- ton, M. D.; “Genito-Urinary Diseases in the Male, and Syphilis,” by William T. Belfield, M. D.; “Fractures, Dis- locations, Amputations, Surgery of the Extremities, and Orthopedics,” by Joseph C. Bloodgood, M. D.; “Diseases of the Kidneys,” by John Rose Bradford, M. D., F. R. C. P.; “Physiology,” by Albert P. Brubaker, M. D.; “Anatomy,” by Frederic H. Gerrish, M. D.; “Hygiene,” by Henry B. Baker, M. D.; “Practical Therapeutic Referendum,” by E. Q. Thornton, M. D. - - THE SURGICAL DISEASES OF THE GENITO-URINARY TRACT, VENEREAL AND SEXUAL DISEASES. A Text- book, for Students and Practitioners. By G. Frank Lydston, M.D., Professor of the Surgical Diseases of the Genito-Urinary organs: Syphiolcgy in the Medical 220 Reviews, Book Notices, Etc. Department of the State University of Illinois; Professor of Criminal Anthropology in the Kent College of Law; Sur- geon-in-Chief of the Genito-Urinary Department of the West-Side Dispensary. Fellow of the Chicago Academy of Medicine; Fellow of the American Academy of Political and Social Science; Delegate from the United States to the International Congress for the Prevention of Syphilis and the Venereal Diseases, held at Brussels, Belgium, September 5, 1899, etc. Illustrated with 233 Engravings. 6%x934 inches. Pages xvi-1024. Extra cloth, $5.00, net. Sheep or Half-russia, $5.75 net. The F. A. Davis Co., Publishers, 1914-162Cherry St., Philadelphia. Lydston is an intellectual athlete with the pen as he is physically. He is an acute observer and an accurate clini- cian. His book is all it claims and worthy the place it aspires to in professional esteem. NEURASTHENIA by Savill. We take pleasure in acknowledging with the compliments of the publishers, Messrs. William Wood & Company, 51 Fifth Avenue, New York, this inter- esting brochure on an always interesting subject. Time was, but is no more when a precedent visceral or blood disease was esteemed the cause and neurasthenia the resultant symptomatic expression. The author in his final reference to writers on this subject, omits, as Beard did, to give the American Van Deuscen the credit to which he is entitled as the pioneer American discoverer of this condition of the nervous system. The rapidity with which “Progressive Medicine” has gained the widespread acceptance of the profession is the strongest endorsement of its practical value to the busy practitioner. HAY-FEVER AND ITS SUCCESSFUL TREATMENT. By W. C. Hollopeter, A.M., M.D. Second edition, revised and enlarged, Philadelphia. P. Blakiston's Son & Co., 1899. . Pp. 151; price $1.00. - A demand for a second edition of a book within a year is sufficient proof that it contains something worth reading, and that this is true of Dr. Hollopeter’s work on hay-fever will be testified to by those who have read it. In the Reviews, Book Notices, Etc. 221 present edition the author has developed the special treat- ment of each of the various types of hay-fever cases, and has brought the bibliographic section up to date. KRANKHEITEN DER PERIPHERISCHEN NERVEN von Geh. Medicinalrath Prof. Dr. A. Eulenberg in Berlin; mit Abbildungen. Separat-Adbruck aus Handbuch der Prak- tischen Medicin unter Redaltion von Dr. W. Ebstein und Dr. J. Schwalbe, Geb. Medicinalrath, O. Prof. Herabs- geser der Deutschen med in Gottingen Herangegesen von Wochenschrift. Werlog von Ferdinand in Stuttgart, W. Ebstein. THE HOME MODIFICATION OF COW’S MILK is an artist- ically illustrated description of the Mellin's Food, highly instructive and creditable to the enterprising firm whose authorized name it bears. It will interest mothers, babies and doctors. BULLETIN OF THE LABORATORY OF MOUNT HOPE RE— TREAT 1899, contains the following valuable contributions to Clinical Neurology and Psychiatry: The Secretions in the Insanities, by Dr. Richardson; Indol; its Clinical Significance and its Estimation, by Dr. Richardson; The Pathology of Epilepsy, With an Introduction to a New treatment, by Charles G. Hill, M. D. CONGENITAL GENERAL PARALYSIS. By P. W. Macdon- ald, M.D., and A. Davidson, M.B., C.M. Being a Preliminary Communication in the Section of Psychology at the annual meeting of the British Medical Associa- . tion, August, 1899. P. Blakiston’s Son & Co’s. Physicians’ Visiting List for 1900 is on our review table. This is the forty-ninth year of its publication and notwithstanding the competition that has sprung up during the last few years it still holds its place as the most popular Physician’s Diary now in use. The Criminal Insane in the United States and in For- eign Countries. Report by S. J. Barrows, Commissioner for the United States on the International Prison Com- mission. 222 Reviews, Book Notices, Etc. Pachymeningitis Spinalis Externa. Recovery Complete. By F. W. Langdon, M.D., Professor of Nervous and Mental Diseases, Laura Memorial Woman's Medical College; Clin- ical Professor of Nervous Diseases, Miami Medical College; Neurologist to the Cincinnati Hospital; and by Albert H. Freiberg, M. D., Professor of . Surgery, Laura - Memorial Woman’s Medical College; Orthopedic Surgeon to the Cin- cinnati Hospital, Cincinnati, Ohio. . ; : The Propagation of Diseases by Means of Insects, with Special Consideration of the Common Domestic Types. Address in Hygiene. Delivered before the Pennsylvania State Medical Society, at its Annual Meeting, Johnstown, Pa., Wednesday, May 17, 1899. By W. M. L. Coplin, M. D., Professor of Pathology and Bacteriology, Jefferson Med- ical College. * - - * Les Troubles Mentaux de L'Enfance. Précis de Psy- chiátrie Infantile Avec les Applications Pédagogiques et Médico-légales par le Dr. Marcel Manheimer, Ancien interne - * des Asiles de la Seine et de la Clinique des Maladies men- tales à la Faculté Médecin des Bureaux Bienfaisance de Paris. Préface de M le Professeur Joffroy. - The Providence Medical Journal Vol. 1. January 1900, No. 1, is before us with an interesting table of contents consisting of Editorial, Original Communications and Hospital Reports. It is edited and published by the Providence Medical Association. We wish it the success its able mana- gers and backers so well warrant. A Case of Diabetes Mellitus Quickly Following Mumps, On the Pathological Alterations of the Salivary Glands, Closely Resembling Those Found in the Pancreas, in a Case of Diabetes Mellitus. . By H. F. Harris, M.D., Associate Professor of Pathology at Jefferson Medical College Hospital, Philadelphia, Pa. Thyroid Extract—A Review of the Results Obtained in the Treatment of One Thousand Thirty-two Collected Cases of Insanity. By William Mabon, M.D., Superintend- ent St. Lawrence State Hospital, and Warren L. Babcock, M.D., Assistant Physician, St. Lawrence State Hospital. Reviews, Book Notices, Etc. 223 Facial Paralysis, Congenital, unilateral and of Unique Distribution. By F. W. Langdon, M.D., Professor of Nerv- ous and Mental Diseases, Laura Memorial Woman's Medical College; Clinical Professor of Nervous, Diseases, Miami Medical College; Neurologist to the Cincinnati Hospital. Sinus-Thrombosis; Cure Without Opening the Sinus.… " By Robert Levy, M.D., Denver, Colo., Professor of Physi-. “ ology and Laryngology in Gross Medical College; Laryng- ologist to Arapahoe County, St. Anthony's and St. Luke's Hospitals, etc. * * * * * - - Typhoid Fever in Very Young Children, With a Report of Three Cases With Unusual Complications. By E. B. Montgomery, M.D., of Quincy, Ills., Ex-Surgeon to the Illi- nois Soldiers' and Sailors' Homes, and Surgeon to the Bless- ing Hospital. - • * . . . . . " - Ein vereinfachter Apparat zur Bewegungstherapie. Von" A. Eulenburg, Sonderabdruck aus der “Deutschen Medicin- ischen Wochenschrift” 1899, No. 31. Redaction: Geh. Med.- : Rath Prof. Dr. A. Eulenburg und Dr. Jul. Schwalbe. The Disease of Convulsive Tic (Gilles de la Tourette’s Disease), with special reference to a Hypothesis as to Eti- ology. By Bernard Oettinger, M.D., Clinical Instructor in Neurology, Gross Medical College, Denver, Colo. The American Soldier and Venereal Diseases. A Refu- tation of Some of the Statements of Mr. Edward Atkinson. By William A. Hammond, M.D., Brigadier-General and Sur- geon-General U. S. Army (retired). Pulmonary Tuberculosis. Report of Cases Treated with Intra-pleural Injections of Nitrogen, with a Consideration of the Pathology of Compression of a Tuberculous Lung. A. F. Lemke, M.D., Chicago. Akromegaly, With Report of a Case Presenting Some Unusual Features; Height of Patient, Eight Feet and Six Inches. By William Nicholas Lackey, M.D., of Gallatin, Tennessee. Five Hundred and Fifty Surgical Operations without Alcohol. By Chas. Gilbert Davis, M.D., Chicago. 224 Reviews, Book Notices, Etc. Acute Gastro-Intestinal Affections in Children. By George M. Wells, M.D., Professor of Diseases of Children in the Medical Department of the University of Oregon. Traction Plasters for Temporarily Contracting an Affected Lung, in Lieu of the Murphy Operation. By Chas. Denison, A.M., M.D., Denver. The Use of Ice-cream as Nourishment in Pharyngeal Paralysis. By Chas. H. Cargile, M.D., Bentonville, Ark. Brain in Relation to Mind. By Dr. Sanderson Christi- son, author of “Crime and Criminals,” Etc. The Tuberculosis Crusade and Its Problems. By Chas. Denison, A.M., M.D., Denver, Colo. The Present State of the Treatment of Tabes. By Professor Eulenburg of Berlin. Prognosis of Laryngeal Tuberculosis. By Robert Levy, M.D., Denver, Colo. Cocoa and its Therapeutic Application. By Angelo Mariani. THE ALIENIST AND NEUROLOGIST. WOL. XXI. ST. LOUIS, APRIL, 1900. No. 2. ORIGINAL CONTRIBUTIONS. * THE ANALYSIS OF THE SEXUAL IMPULSE.* By HAVELOCK ELLIS, M. D., London, Eng. Honorary Fellow Chicago Academy of Medicine, etc. LTHOUGH it is by no means difficult to define the physiological sexual act, the definition of the psycho- logical impulse, or, as some term it, instinct, which prompts that act is beset by so many difficulties that there is still no agreement even among those who have most carefully investigated the matter. I propose to consider briefly what appear to be the three chief theories of the constitution of the sexual impulse, and then to define that impulse in what seems to me the most accurate manner. The first definition of the sexual impulse we meet with is that which regards it as an impulse of evacuation. The psychological element is thus reduced to a minimum. It is true that, especially in early life, the emotions caused by forced repression of the excretions are frequently massive or acute in the highest degree, and the joy of relief corre- *This article is an abstract of a chapter which will appear in Vol. III of the author's Studies in the Psychology of Sex. [247] 248 Havelock Ellis. spondingly great. (I recall the remark of a lady that in childhood the long-delayed opportunity of emptying the bladder was often “like Heaven”). But in adult life, on most occasions, these desires can be largely pushed into the background of consciousness, partly by training, partly by the fact that involuntary muscular activity is less impera- tive in adult life; so that the ideal element in connection with the ordinary excretions is almost a negligible quantity. It is true that this theory of the sexual instinct is that which has most popular vogue, and the cynic delights to express it in crude language. It was also the view implic- itly accepted by mediaeval ascetic writers who regarded woman as “a temple built over a sewer”, and from a very different standpoint it was concisely set forth by Montaigne. It would, however, scarcely deserve serious consideration if various distinguished investigators, among whom Féré may be specially mentioned, had not accepted it as the best and most accurate definition of the sexual impulse. “The genesic need may be considered,” writes Féré, “as a need of evacuation; the choice is determined by the excitations which render the evacuation more agreeable.” Certain facts observed in the lower animals tend to support this view. Thus, while Goltz, by methodically removing various parts of the body in frogs, found not only that all the parts of the body of the female exert an attraction on the male, but also that sexual desire still persisted in the male what- ever parts of his body were removed, Tarchanoff made an experiment of a somewhat crucial character. He found that extirpating the heart, lungs, even the testicle, of a frog, had no effect, but that extirpation or even simple puncture of the seminal vesicles at once stopped coupling or pre- vented it from taking place; while filling the vesicles with milk produced sexual impulse. It is sufficiently clear that there is a very striking analogy between sexual desire and the impulse to evacuate an excretion, and this analogy is *Féré, "La Predisposition dans l'etiologie des perversions sexuelles,” Revue de Mede- cine, 1898. In his recent valuable work on the evolution and dissolution of the sexual instinct Fere has perhaps slightly modified his position by stating that "the sexual appetite is above all a general need of the organism based on a sensation of fullness, a sort of need of evacua- tion,” L'Instinct Sexuel, 1899, p. 6. The Analysis of the Sexual Impulse. 249 not only seen in the frog, but extends also to the highest vertebrates. It is quite another matter, however, to assert that the sexual impulse can be adequately defined as an impulse to evacuate. To show fully the inadequate nature of this conception would require a detailed consideration of the facts of sexual life. That is, however, unnecessary. It is enough to point out certain considerations which alone suffice to invalidate this view. In the first place, it must be remarked that the trifling amount of fluid emitted in sexual intercourse is altogether out of proportion to the emotions aroused by the act and to its after effects on the organism; the ancient dictum “omne animal post coitum triste” may not be exact, but it is at least certain that the effect on the organism is far more propound than that pro- duced by the far more extensive evacuation of the bladder or bowels. Again, this disposition leaves unexplained all those elaborate preliminaries which, both in man and the lower animals, precede the sexual act, preliminaries which in civilized human beings sometimes themselves constitute a partial satisfaction to the sexual impulse. It must also be observed that unlike the ordinary excretions the discharge of the sexual glands is not always, or in every person, necessary at all. Moreover, the theory of evacuation at once becomes hopelessly inadequate when we apply it to women; no one will venture to claim that an adequate psychological expla- nation of the sexual impulse in a woman is to be found in the desire to expel a little bland mucous from the minute glands of the genital tract. We must undoubtedly reject his view of the sexual impulse. It has a certain element of truth and it permits an instructive and helpful analogy; but that is all. The sexual act presents many characters which are absent in an ordinary act of evacuation, and on the other hand it lacks the special characteristic of the evacu- ation proper, the elimination of waste material; the seminal fluid is not a waste material, and its retention is in many cases, perhaps, rather an advantage than a disadvantage to the organism. Eduard von Hartmann long since remarked that the 250 Havelock Ellis. satisfaction of what we call the sexual instinct through an act carried out with a person of the opposite sex is a very wonderful phenomenon. It cannot be said, however, that the conception of the sexual act as a simple process of evacuation does anything to explain it. We are at most in the same position as regards the stilling of normal sexual desire as we should be as regards the emptying of the blad- der, supposing it were very difficult for either sex to effect this satisfactorily without the aid of a portion of the body of a person of the other sex acting as a catheter. In such a case our thoughts and ideals would center around the opposite sex, and we should court their attention and help precisely as we do now in the case of our sexual needs. Some such relationship does actually exist in the case of the suckling mother and her infant. The mother is indebted to the child for the pleasurable relief of her dis- tended breasts; and while in civilization more subtle pleasures and intelligent reflection render this massive phys- ical satisfaction comparatively unessential to the act of suckling, in more primitive conditions and among animals the need of this pleasurable physical satisfaction is a real bond binding the mother to her offspring. The analogy is indeed very close, though I do not know, or cannot recall, that it has been pointed out: the erectile nipple corresponds to the erectile penis, the eager watery mouth of the infant to the moist and throbbing vagina, the vitally albuminous milk to the vitally albuminous semen. The complete mu- tual satisfaction, physical and psychic, of mother and child, in the transfer from one to the other of a precious organized fluid, is the one true physiological analogy to the relation- ship of a man and a woman at the climax of the sexual act. Even this close analogy, however, fails to cover all the facts of the sexual life. A very different view is presented to us in the defini- tion of the sexual instinct as a reproductive impulse, a desire for offspring. Hegar and Eulenburg have accepted this as at all events a partial definition of the sexual impulse. No one, however, would argue that it is a com- plete definition, although a few writers appear to have The Analysis of the Sexual Impulse. 251 asserted that it is so sometimes in women. There is, how- ever, considerable mental confusion in the attempt to set up such a definition. If we define an instinct as an action adapted to an end which is not present to consciousness, then it is quite true that the sexual instinct is an instinct of reproduction. But we do not adequately define the sex- ual impulse by merely stating its ultimate object. The object of reproduction certainly constitutes no part of the . sexual impulse whatever in any animal apart from man, and it reveals a lack of the most elementary sense of bio- logical continuity to assert that in man so fundamental and involuntary a process can suddenly be revolutionised. That the sexual impulse is very often associated with a strong desire for offspring there can be no doubt, and in some women, especially, the longing for a child—that is to say the longing to fulfill those functions for which their bodies are constituted—may become so urgent and imperative that we may regard it as scarcely less imperative than the sexual impulse. But it is not the sexual impulse, though intimately associated with it, and though it explains it. Even in women, in whom the maternal instincts are so strong, it may generally be observed that, although before a woman is in love and also during the later stages of her love, the conscious desire for a baby may be strong, during the time when sexual passion is at its highest the thought of offspring, under normally happy conditions, tends to recede into the background. Reproduction is the natural end and object of the sexual impulse, but the statement that it is part of the contents of the sexual impulse, or can in any way be used to define that impulse, must be dis- missed as altogether inacceptable. Although, indeed, the term “reproductive instinct” is frequently used, it is seldom used is a sense that we need take seriously; it is vaguely employed as a euphemism by those who wish to veil the facts of the sexual life; it is more precisely employed mainly by those who are unconsciously dominated by a superstitious repugnance to sex and blinded to the facts of life. I now turn to a very much more serious and elaborate 252 Havelock Ellis. attempt to define the constitution of the sexual impulse. Moll of Berlin is at present engaged on a work, Untersuch- ungen uber die Libido Sexualis, which, so far as can be judged from the portion yet published, is perhaps the most thorough attempt yet undertaken to investigate the funda- mental problems of the sexual impulse. At the outset he begins by defining the sexual impulse, and finds that it is made up of two separate components each of which may be looked upon as an uncontrolable impulse. One of these two instincts is that by which the tension of the sexual organs is spasmodically relieved; this he calls the instinct of detumescence” and he regards it as primary, resembling the impulse to empty a full bladder. The other impulse is the “instinct to approach, touch and kiss another person, usually of the opposite sex,” and this he terms the instinct of contrectation, and he includes under this head not only the tendency to general physical contact but also the psychic inclination to become generally interested in a person of the opposite sex. Each of these primary instincts Moll regards as forming a constituent of the sexual impulse in both men and women. It seems to me undoubtedly true that these two instincts do correspond to the essential phenomena. The awkward and unsatisfactory part of Moll's analysis is the relation of the one instinct to the other. He quotes Hartmann’s observation regarding the inexplicable mystery by which sexual satisfaction is only attained by con- tact with a person of the opposite sex, and regards it as just. It is true that he traces both instincts back to the sexual glands, that of detumescence directly, that of con- trectation indirectly; but evidently he does not regard them as intimately related to each other; he insists on the fact that they may exist apart from each other, that they do not appear synchronously in youth; but the contrectation instinct he regards as secondary; it is, he states, an indirect result of the sexual glands, “only to be understood by the developmental history of these glands and the object which *Moll adopts the term, "instinct of detumescence" (Detumescenztrieb) instead of "instinct of ejaculation," because in women there is either no ejaculation or it cannot be regarded as essential. The Analysis of the Sexual Impulse. 253 they subserve;” that is to say that it is connected with the rise of the sexual method of reproduction and the desira- bility of the mingling of the two sexes in procreation, while the detumescence instinct arose before the sexual method of reproduction had appeared; thus the contrectation impulse was propagated by natural selection together with the sexual method of reproduction. The instinct of contrecta- tion is secondary, and Moll even regards it as a secondary sexual character. While, therefore, this analysis seems to include all the phenomena and to be worthy of very careful study as a serious and elaborate attempt to present an adequate psy- chological definition of the sexual impulse, it scarcely seems to me that we can accept it in precisely the form in which Moll presents it. I believe, however, that by analyz- ing the process a little more minutely we shall find that these two constituents of the sexual impulse are really much more intimately associated than at the first glance appears, and that we need by no means go back to the time when the sexual method of reproduction arose to explain the significance of the phenomena which Moll includes under the term contrectation. To discover the true significance of the phenomena in men, it is necessary to observe carefully the phenomena of love-making not only among men but among animals, in whom the instinct of contrectation plays a very large part, and involves an enormous expenditure of energy.” Darwin was the first to present a comprehensive view of the phe- nomena of contrectation in animals; on his interpretation of those phenomena he founded his famous theory of sexual selection. We are not here concerned with that theory, and it would be in any sense impertinent to set down an offhand acceptance or rejection of a theory regarding which the most competent zoologists have still failed to come to any agreement. But the facts on which Darwin based his theory lie at the very roots of our subject and we are bound to consider their psychological significance. In the *I refrain in the brief space at my disposal here from presenting any of these facts. 254 Havelock Ellis. first place, since these phenomena are specially associated with Darwin's name, it may not be out of place to ask what Darwin himself considered to be their psychological significance. It is a somewhat important question, even for those who are mainly concerned with the validity of the theory which Darwin established on those facts, but so far as l know it has not hitherto been asked. I find that a careful perusal of the Descent of Man reveals the presence in Darwin's mind of two quite distinct theories, neither of them fully developed, as to the psychological meaning of the facts he was collecting. The two following groups of extracts will serve to show this very conclusively. “The lower animals have a sense of beauty,” he declares, “powers of discrim- ination and taste on the part of the female” (p. 211);* “the females habitually or occasionally prefer the more beautiful males,” “there is little improbability in the females of insects appreciating beauty in form or color” (p. 329); he speaks of birds as the most aesthetic of all animals excepting man, and adds that they have “nearly the same taste for the beautiful as we have” (p. 359); he remarks that a change of any kind in the structure or color of the male bird “appears to have been admired by the female” (p. 385). He speaks of the female Argus pheasant as possessing “this almost human degree of taste.” Birds, again, “seem to have some taste for the beautiful both in color and sound,” and “we ought not to feel too sure that the female does not attend to each detail of beauty” (p. 421). Novelty, he says, is “admired by birds for its own sake” (p. 495). “Birds have fine powers of discrimination and in some few instances it can be shown that they have a taste for the beautiful” (p. 496). The “aesthetic capacity” of female animals has been advanced by exercise just as our own taste has improved (p. 616). On the other hand, we find running throughout the book quite another idea. Of Cicadas he tells us that it is probable that “like female birds they are excited or allured by the male with the most attractive voice” (p. 282); and coming to Locustidae he states that “all observers agree that the sounds serve either *I quote from the second edition, as issued in 1881. The Analysis of the Sexual Impulse. 255 to call or excite the mute females” (p. 283). Of birds he says, “I am led to believe that the females prefer or are most excited by the more brilliant males” (p. 316). Among birds also the males “endeavor to charm or excite their mates by love-notes,” etc., and “the females are excited by cer- tain males, and thus unconsciously prefer them” (p. 367), while ornaments of all kind “apparently serve to excite, attract or fascinate the female” (p. 394). In a supple- mental note, also, written in 1876, five years after the first publication of the Descent of Man, and therefore a late statement of his views, Darwin remarks that “no supporter of the principle of sexual selection believes that the females select particular points of beauty in the males; they are merely excited or attracted in a greater degree by one male than by another, and this seems often to depend, especially with birds, on brilliant coloring” (p. 623). Thus on the one hand Darwin interprets the phenomena as involving a real aesthetic element, a taste for the beautiful; on the other hand, he states, without apparently any clear perception that the two views are quite distinct, that the colors and sounds and other characteristics of the male are not an appeal to any aesthetic sense of the female, but an appeal to her sexual emotions, a stimulus to sexual excitement, an allurement to sexual contact. According to the first theory the female admires beauty, consciously or unconsciously, and selects the most beautiful partner; according to the second theory, there is no aesthetic question involved, but the female is unconsciously influenced by the most power- ful or complex organic stimulus to which she is subjected. There can be no question that it is the second and not the first of these two views which we are most justified in accepting.” Darwin, it must be remembered, was not a psychologist and he lived before the methods of comparative psychology had begun to be developed; had he written twenty years later we may be sure he would never have used so incautiously some of the vague and hazardous *The mere fact, if it be a fact, recorded by careful observers (the brothers Müller) that among many birds pairing is arranged at an early period of their lives, before the sexual liveries and special accomplishments of the males are developed, shows that here at all event aesthetic discrimination is excluded. 256 Havelock Ellis. expressions I have quoted. It is, however, interesting to observe that though Darwin failed to see that the love- combats, pursuits, dances and parades of the males served as a method of stimulating the impulse of contrectation- or, as it would be better to term it, tumescence—in the male himself, he to some extent realized the part thus played in exciting the necessary activity of tumescence in the female.* Espinas, in 1878, in his suggestive book Des Sociétiés Animales, describes the odors, colors and forms, sounds, games, parades and mock battles of animals, approach- ing the subject in a somewhat more psychological spirit than Darwin, and he somewhat more clearly apprehended the object of these phenomena in producing mutual excitement, and stimulating tumescence. He notes the significance of the action of the hermaphroditic snails in inserting their darts into each other’s flesh near the vulva in order to cause preliminary excitation. He remarks of this whole group of phenomena: “It is the preliminary of sexual union, it constitutes the first act of it. By it the image of the male is graven on the consciousness of the female, and in a manner impregnates it, so as to determine there, as the effects of this representation descends to the depths of the organism, the physiological modifications necessary to fecundation.” Beaunis, again, in an analysis of the sexual sensations, is inclined to think that the dances and parades of the male are solely intended to excite the female, not perceiving, however, that they at the same time serve to further excite the male also.f The psychological signifi- cance of these facts has been more carefully studied and *I am glad to find that Prof. Lloyd Morgan has recently made some remarks on the psychological side of the theory of sexual selection which generally support the view I have here taken, though Prof. Morgan fails to realize that that view had been vaguely embodied in Darwin's statements. "The question (of sexual selection)," says Morgan,"has been unduly complicated and placed in a false light through the introduction of the unnecessary supposi- tion that the hen bird must possess a standard or ideal of aesthetic value, and that she selects that singer who comes nearest to her conception of what a songster should be. One might as well suppose that a chick selected those worms which most nearly approached the ideal of succulence that it had conceived. The chick selects the worm that excites the strongest impulse to pick it up and eat it. So, too, the hen selects that mate which by its song or otherwise excites in greatest degree the mating impulse," (C. Lloyd Morgan, Habit and Instinct, chapter on"Habits and Instincts of the Pairing Season,” 1896). #Beaunis, Sensations Internes, ch. V, "Besoins Sexuels,” 1889. The Analysis of the Sexual Impulse. 257 admirably developed by Groos in his classic works on the play instinct in animals and in men.” The denial of con- scious sexual selection, Groos points out, by no means involves the denial of unconscious selection in the sense that “the female is most easily won by the male who most strongly excites her sexual instincts.” Groos further quotes a pregnant generalization of Ziegler: “In all animals a high degree of excitement of the nervous system is necessary to procreation, and thus we find an excited prelude to procreation widely spread.”f Such a stage, indeed, as Groos points out, is usually necessary before any markedly passionate discharge of motor energy, as may be observed in angry dogs and the Homeric heroes. While however, in other motor explosions the prelude may be reduced to a minimum, in courtship it is found in a highly marked degree. The primary object of courtship, Gross insists, is to produce sexual excitement. If, in the light of the foregoing statement, we examine such facts as those collected by Darwin in the Descent of Man and W. H. Hudson in The Naturalist in La Plata, we may easily trace throughout the perpetual operations of this instinct. It is everywhere the instinctive object of the male, who is very rarely passive in the process of court- ship to assume by his activity in display, his energy or skill or beauty, both his own passion and the passion of the female. Throughout nature, we must remark, sexual conjugation only takes place after much expenditure of energy. We are deceived by what we see among highly fed domesticated animals, and among the lazy classes of human Society, whose sexual instincts are at once both unnaturally stimulated and unnaturally repressed, when we imagine that the instinct of detumescence is normally ever craving to be satisfied, and that throughout nature it can always be set off at a touch whenever the stimulus is *K. Groos, Die Spiele der Thiere, 1896, Die Spiele der Mensches, 1899. tdie Spiele der Thiere, p. 241. 1 Prof. H. E. Ziegler, in a private letter to Prof. Groos, Spiele der Thiere, p. 202. This preliminary stage, Groos adds, being a hindrance to a too facile accomplishment of the sexual act. which might be injurious to the species, makes sexual selection really a special case of natural selection. 258 Havelock Ellis. * applied. So far from the instinct of detumescence natur- ally needing to be crushed, it needs, on the contrary, in either sex to be submitted to the most elaborate and pro- longed processes in order to bring about those conditions which detumescence relieves. A state of tumescence is not normal and constant and tumescence must be obtained before detumescence is possible. The whole object of courtship, of the mutual approximation and caresses of two persons of the opposite sex, is to create the state of sexual tumeScence. It is clear, therefore, why the evacuation theory of the sexual impulse must necessarily be partial and inadequate. It leaves out of account the whole of the phenomena con- nected with tumescence, and these phenomena constitute the most prolonged, the most important, the most significant stage of the sexual process. It is during tumescence that the whole psychology of the sexual impulse is built up; it is as an incident arising during tumescence and influencing its course that we must probably regard nearly every sexual aberra- tion. It is with the second stage of the sexual process, when the instinct of detumescence arises, that the analogy of evacuation can alone be called in. Even here, that analogy, though real, is not complete, the nervous element involved in detumescence being out of all proportion to the extent of the evacuation. The typical act of evacuation, however, is a nervous process and when we bear this in mind we may see whatever truth the evacuation theory possesses. Beaunis classes the sexual impulse with the “needs of activity,” but under this head he co-ordinates it with the “need of urination.” That is to say that both alike are nervous explosions. There appears, indeed, to be a special and intimate connection between the explosion of sexual detumescence and the explosive energy of the blad- der, so that they may re-inforce each other and to a limited extent act vicariously in relieving each other’s tension. In men distension of the bladder acts as a merely physical hindrance to sexual detumescence; but in women, whether from physical or nervous causes, or both, a full bladder increases sexual excitement and pleasure, and I have been The Analysis of the Sexual Impulse. 259 informed by several women that they have independently discovered this fact for themselves and acted in accordance with it. Conversely the sexual excitement increases the explosive force of the bladder, the desire to urinate is aroused and in women the sexual orgasm when very acute and occurring with a full bladder, is not infrequently accom- panied, alike in savage and civilized life, by an involuntary and forcible expulsion of urine.* In some observations which are still unpublished I have shown that of all the influences which increase the expulsive force of the bladder sexual excitement is the most powerful. There is also reason to suppose that the nervous energy expended in an explosion of the nervous tension of the sexual organs relieves the bladder; it is well recognized that a full bladder is a main cause—if not, as some believe, the chief cause—in pro- ducing sexual emissions during sleep, the explosive energy of the bladder being inhibited and passing over into the sexual sphere. Conversely it appears that explosion of the bladder relieves sexual tension. There is reason to believe that an explosion of the nervous centres connected with the contraction of the bladder will relieve nervous tension gen- erally; there are forms of epilepsy in which the act of urination constitutes the climax, and Gowers, in dealing with minor epilepsy, emphasizes the frequency of micturition, which “may occur with spasmodic energy when there is only the slightest general stiffness,” especially in women, adding the significant remark that it sometimes seems to relieve the cerebral tension”f If micturition may thus relieve nervous tension generally it is not surprising that it should relieve the tension of the centers with which it is most intimately connected. Sérieux records the case of a girl of twelve, possessed by an impulse to masturbation which she was unable to control although anxious to conquer it, who only found relief in the act of urination; this soothed her and to some extent satisfied the sexual excite- *See e.g., Fere, L'Instinct Sexuel, pp. 222-3: Brantoine was probably the first writer who referred to this phenomenon. +Sir W. Gowers, “Minor Epilepsy," Brit. Med. Journal, 6 Jan., 1900: see also H, Ellis, art. “Urinary Bladder. Influence of the Mind on," Tuke, Dict. of Psych. Med. 260 Havelock Ellis. ment; when the impulse to masturbate was restrained the impulse to urinate became imperative; she would rise four or five times in the night for this purpose, and even urinate in bed or in her clothes to obtain the desired sexual relief.” I am acquainted with a lady who had a similar but less intense experience during childhood. This mutual interaction is easily comprehensible when we recall that the sexual center in the spinal cord is situated immediately above the micturition center; for though the usual reflex center of the bladder is in the brain, the center in the cord, as Mosso and Pallacani have pointed out, comes into action in states of abnormal excitability such as we are here concerned with. Nor are such relationships confined to these two centers; in a lesser degree the more remote explosive centers are also affected; the convulsion of laughter, for instance, seems to be related to the sexual center, and Groos has suggested that the laughter which, especially in the sexually minded, often follows allusions to the genital sphere is merely an effort to dispel nascent sexual excitement by liberating an explosion of nervous energy in another direction.f Nervous discharges tend to spread, or to act vicariously, because the motor centers are more or less connected. Of all the physiological motor explosions, the sexual orgasm, or detu- mescence, is the most massive, powerful and overwhelming. *Sérieux, Recherches Cliniques sur les Anomalies de l'Instinct Sexuel, p. 22. fit is a familiar fact that, in women, occasionally, a violent explosion of laughter may be propagated to the bladder center and produce urination. Prof. Bechterew has recorded the case of a young married lady who from childhood, wherever she might be—in friends' houses, in the street, in her own drawing room-had always experienced an involuntary and forcible emission of urine, which could not be stopped or controlled, whenever she laughed: the bladder was quite sound and no muscular effort produced the same result, (W. Bechterew, Neurolog. Centralblatt, 1899). In women, these relationships are most easily observed, partly because in them the explosive centers are more easily discharged and partly, it is probable, so far as the bladder is concerned, because the vesical sphincter experiences more difficulty in controlling the short and broad female urethra than the long and narrow male urethra. t"Every pain,"remarks Marie de Manacéine, "produces a number of movements which are apparently useless: we cry out, we groan, we move our limbs, we throw ourselves from one side to the other, and at the bottom all these movements are logical, because by inter- rupting and breaking our attention, they render us less sensitive to the pain. In the days before chloroform, skillful surgeons requested their patients to cry out during the operation. as we are told by Gratiolet, who could not explain so strange a fact, for in his time the antag- onism of movements and attention was not recognized,” (Marie de Manaceine, Arch. Itali- ennes de Biologie, 1894, p. 250). This antagonism of attention by movement is but another way of expressing the vicarious relationship of motor discharges. The Analysis of the Sexual Impulse. 261 So volcanic is it that to the ancient Greek philosophers it seemed to be a minor kind of epilepsy.* The relief of detumescence is not merely the relief of an evacuation; it is the discharge, by the most powerful apparatus for nervous explosion in the body, of the energy accumulated and stored up in the slow process of tumescence; and that discharge reverberates through all the nervous centers in the organism. It seems unprofitable at present to attempt any more fundamental analysis of the sexual impulse. Beaunis, in the work already quoted, vaguely suggests that we ought possibly to connect the sexual excitation which leads the male to seek the female with chemical action, either exer- cised directly on the protoplasm of the organism or indi- rectly by the intermediary of the nervous system, and especially by smell in the higher animals. Clevenger, Spitzka, Kiernan and others have also regarded the sexual impulse as protoplasmic hunger, tracing it back to the pre- sexual times when one protozoal form absorbed another. In the same way Joanny Roux, insisting that the sexual need is a need of the whole organism, and that “we love with the whole of our body,” compares the sexual instinct to hunger and distinguishes between “sexual hunger,” affecting the whole system and “sexual appetite,” as a more local- ized desire; he concludes that the sexual need is a modality of the nutritive need.t Useful as these views are as a protest against too crude and narrow a conception of the part played by the sexual impulse, they carry us into a speculative region where proof is difficult. We are now, however, at all events, in a better position to define the contents of the sexual impulse. We see that there are certainly, as Moll has indicated, two constituents in that impulse, but instead of being unrelated, or only distantly related, we see that they are really so intimately *“the sophist of Abdera said that coitus is a slight fit of epilepsy, judging it to be an incurable disease,” Clement of Alexandria, Paedagogus, Bk. II, ch. 10. Fere has pointed out that these two forms of nervous storm are sometimes accompanied by similar phenomena, by subjective sensations of sight or smell, for example; and that the two kinds of discharge may even be combined. (Fere, Les Epileptiques, pp.283-284;also"Exces Veneriens et Epilepsie,” Comptes Rendus Soc. de Biologie), Apr., 1897, and the same author's Instinct Sexuel, p. 221. +Joanny Roux, Psychologie de l'Instinct Sexuel, 1899, pp. 22-33. 262 Havelock Ellis. connected as to form two distinct stages in the same pro- cess: a first stage in which images, desires and ideals grow up within the mind, while the organism generally is charged with energy and the sexual apparatus congested with blood; and a second stage in which the sexual apparatus is dis- charged amid profound sexual excitement followed by deep organic relief. The first process creates, or at all events intensifies, the tension which the second relieves. It seems best to call the first impulse in the process the instinct of tumescence, the second the instinct of detumescence.* The first, taking on usually a more active form in the male, has the double object of bringing the male himself into the con- dition in which discharge becomes imperative, and at the same time arousing in the female a similar ardent state of emotional excitement and sexual turgescence. The second instinct has the object, directly, of discharging the tension thus produced and, indirectly, of effecting the act by which the race is propagated. It seems to me that this is at present the most satis- factory way in which we can attempt to define the sexual impulse. *If there is any objection to these terms it is chiefly because they have reference to vascular congestion rather than to the underlying nervous charging and discharging which I regard as fundamental, CIRCUMSCRIBED MEDIAN NERVE DIGI- TAL NEURITis—sequent to LA GRIPPE. By C. H. HUGHES, M. D., St. Louis, Professor of Neurology and President of Faculty Barnes Medical College. HE post grippal neuroses are numerous as Gowers and myself were the first to note, and as numerous other observers have subsequently affirmed. Whether or not the view that la grippe is itself a toxic neurosis as was long ago asserted by the English neurologist and modestly maintained by myself, may not be regarded as an univer- Sally accepted fact of clinical observation in the profession, this fact cannot be gainsaid, viz., that it has a train of grave neuropathic sequellae, not the least of which are toxic neuritides of sensory nerves and psychoses. Some years ago, vide ALIENIST AND NEUROLOGIST, p. 201, vol. viii, No. 2, 1887, Art. Neuritis Plantaris, I had occasion to record an interesting case of plantar neuritis following the neuro-toxicity of so-called mountain fever, the patient a young man coming to me, in a state of extreme prostration and pain, from the state of Colorado, the pain being circumscribed to that portion of the toes— the first, second and third, innervated by the internal plantar, a continuation of the posterior tibial where it proceeds onward to the foot from the popliteal and great sciatic. In the case we are considering a young lady from Texas, who previously had been stricken with grip and malarial toxhaemia, the most intense pain was in the thumb, [263] BRacilial PLexus 1,2, 3, Location of Pain, Other Fingers Free From Pain. (Drawing Modified from Flower.) Circumscribed Median Nerve Digital Neuritis. 265 index and index finger aspect and tip of the middle finger, the middle finger on its ring finger aspect was painful but not severely so, and the ring and little finger were en- tirely free from pain. There was some pain in the thumb, side of the left palm over the area supplied by the palmar cutaneous which branches from the median, but no pain on the area of the palmar cutaneous branch of the ulnar. There was no pain to indicate that the communicating branch from the ulnar branches to the ring finger prolongation of the median nerve was involved. The central innervation of the affected nerves in this case came possibly from the fourth, fifth, sixth, seventh cervical and first dorsal, but the seat of pain was confined only to the sensory portion of the median nerve supply. There was no local nerve injury in this case and the mysterious thing is the selection of the sensory distributions to the terminal palmar phalangeal distributions of the median nerve, while the ulnar distributions of the brachial plexus showed no signs of painful involvement and all this apparently dependent upon a previous general blood toxicity, as in the case of neuritis plantaris, heretofore reported by me as limited exclusively to the internal plantar branches of the posterior tibial nerve. This girl came under my observation and treatment early in October, 1899, and recovered completely after about ten weeks of treatment. No relapse has occured up to the present date—St. Louis, April 15th, 1900. OUTLINE OF PSYCHIATRY IN CLINICAL LECTURES.” (CONCLUDED). PARANOIAC STATES. By DR. C. WERNICKE, Professor in Breslau. HALLUCINATIONS OF WOCAL SOUNDS OR PHONEMES. DELUSIONS OF RELATIVITY OF AUTOPSYCHICAL, ALLOPSYCHICAL AND SOMATOPSYCHICAL ORIGIN. - * XIII. In the large role, not readily overestimated, which the sense deceptions play in the symptomatology of mental diseases and, as you have seen, in part in the terminated, it will be permitted to take up the theory of sense decep- tions first, that which is the most essential for their under- standing and clinical valuation. We still hold to the above explained sejunction hypothesis, without thus wishing to claim, that this is the only mode of origin of sense deceptions. On the contrary we will later encounter sense deceptions which very probably owe their origin to a primary stimulation of the projection fields of the sense centres, and will have to admit that the real causa efficiens and the point of attack of the stimulus must be sought in the projection fields, no matter whether these are primarily affected by a morbid irritation or first in consequence of a sejunction process and the hypothetically tenable, thus resulting regurgitation of the nerve current from complex *Translated by Dr. W. Alfred McCorn, Resident Physician “River Crest,” Astoria, L. I., New York City. [266] Outline of Psychiatry in Clinical Lectures. 267 associative structures. But we may now claim that the sejunction hypothesis is probably accepted for the large majority of sense deceptions, which here chiefly occupy us, those of the paranoiac states. Certain fundamental attributes of hallucinations may be directly derived from our hypothesis. The first of these is the incorrigibility of hallucinations. We see that the reality of a sense deception is adhered to against the evidence of all other senses and that ere the fanciful explanatory attempts are made and the truth of the sense perception is doubted. This phenomenon is perfectly comprehensible, when it is realized, that once the morbid irritation engages the attention, i. e. monopolizes the wave crest of the psychophysical movement, which in itself owing to the narrowness of consciousness renders the momentary correc- tion impossible, but besides that the only means which is at command for correction through the other senses, the association with the normal ideas excited by them, or in other words the awakening of remonstrances, is made diffi- cult by sejunction or entirely impracticable. Exactly the same consideration also explains the cogent character of such hallucinations, which have an imperative or prohibitory purport. Here also the remonstrances are inaccessible through the fact of sejunction, so that the nerve current, confined in a narrow preformed channel, is discharged with elementary force to the motor projection fields. Yet I cannot forego remarking, that the cogent character of this sort of hallucinations is usually overesti- mated, and that often enough patients are found, who resist the hallucinated demands and even complain about them. So e. g. the hallucinated challenge to strike the physician rebounds harmlessly owing to the patient’s attachment. But this circumstance may be explained, as very evident, by varying extent of the sejunction. A second remarkable fact is the predominance of the acoustic hallucinations and those of speech exclusively termed “voices” by the patients, for which owing to their special clinical dignity the special name of phonemes is justified. On 268 C. Werniche. the other hand acoustic hallucinations may not occur more frequently than those of the other senses; but that the patients in a large number of cases exclusively hallucinate the vocal sounds, and in all with hallucinations, with few exceptions,” the hallucinated vocal sounds dominate, must be considered one of the most fundamental attributes of sense deceptions and may finally be traced to the mechanism of their origint. We remember we have evolved the nature of secondary identification in the example of the sensory projection field of speech. The clang image of a word heard does not suffice for its comprehension, but by it first the memorial image constituting the concept must be excited, thus secondary identification occurs, i. e. the sense of the word is understood. Although we have generalized this one example, it cannot be misconstrued, that the sensory speech center has especially intimate relations of association to the components of the simplest associative connections, the concrete concepts. It has gone so far as to put clang image and concept on a par. But for a mechanical comprehension of the processes taking place in hallucinations, it must be immediately evident, that with no other sense does there exist such an intimate colligation of some concrete concepts, as with the sensory speech centre. The experiment teaches that the time of a concrete thing which, as we will assume, possesses five different sense qualities, can be immediately found by each of these with exclusion of all the other senses. If we then assume the existence of suitably worn associations between the acoustic speech centre, and each of the five sense projection fields, we will comprehend, that by a central excitation of the concept by arrest of nerve energy the process of excitation encroaches on the sensory projec- tion field, will here be increased five fold and in this way *These relate to certain toxic psychoses, like delirium potatorum and several others. tin my opinion there is no occasion to refer the explanation of "hearing voices” to hallucinations of the muscle sense, as Cramer does. The symptom of "thought utterance'' (ALIEN 1st AND NEUROLOGIST, vol. xxi, p. 9) should be restricted as much as possible and understood in the sense that the patients' own thoughts recognized by them as such become audible on definite occasions, as e.g. when they read or write. Cramer and his followers have unfortunately carried the symptom so far that it has entirely lost the original value of an elementary symptom and now always needs an explanation according to its mode of origin. Outline of Psychiatry in Clinical Lectures. 269 that intensity of morbid irritation gained, which we must demand for the occurrence of a hallucination. Like favor- able conditions are again found in no other sensory projec- tion field. - In the psychophysiological introduction you were told that individual variations may be assumed in the respect that, first more the meaning, then more the thought prevails in words, i.e., vocal sounds. Yet I believe I must caution you against assuming that thought only occurs in vocal sounds, as is claimed by many. But if we grant the probability of such an individual difference in thought mechanism, we have the key to the comprehension of an important clinical fact, namely the almost universally recognized experience that one and the same form of disease, e. g., a simple acute depressive psychosis, in which a definite purport of the intellect is correspondingly conditioned, produces in one individual only ideas of this purport, but in another phonemes of like purport. In our example then first exist only ideas of anxiety or ideas of fear, as I call them, another time alarming and threatening phonemes, i. e. the same ideas are in a certain measure put into words. But by no means do we meet with this experience only in the acute psychoses, but equally in those of slow, chronic origin and course. The increased nerve energy in individuals disposed to hearing voices, incidentally the largest number, in a certain measure meets with a greater excitability of the sensory speech field and the tracts uniting in it. In many chronic insane the hallucination of vocal sounds of special form is observed: they believe they hear long conversations. The patients often have a certain fondness for such hallucinations, evidently finding in them the best amusement and occupation. Probably there are always individuals, whose intellectual action habitually happens with the rise of word clang images. I have repeatedly intimated that the purport of halluci- nations is not usually accidental, but dependent on other conditions more or less familiar to us. This is especially true, as was to be expected, of the phonemes. As I have 270 C. Werniche. already mentioned, the ideas of fear, commands and orders, which are usually embodied in “voices,” so we will later meet with the grandiose ideas of maniacs and the self-accusations of melancholiacs in the form of sporadic voices. It is very similar with the explanatory delusions of the paranoiac states. They very commonly occur in form of voices and make us understand that the purport of the voices is very often threatening, insulting, thus corresponding to the ideas of persecution, which so often form the contents of the explanatory delusion. No less do we meet phonemes of the purport of grandiose delusions, when the need of explanation has led to the evolution of a consecutive grandiose delusion. The same phenomenon of sense deceptions, which we formerly became acquainted with as a source of the explanatory delusion, meets us here in the entirely different significance, that it puts the explanatory delusion into words and forcibly supports the sense perception. The delusional conception of the world thus gains new roots for its energy. Still the same elementary symptom of the phonemes acts more portentiously in the frequent cases, in which it is not recognized as something strange, requiring explanation and not designated as a"voice,” but is projected to persons about. This severe stage of phonemes seems especially to be the expression of the delusion of relativity, of which I will soon speak. Although this is not the place to go into the theory of sense deceptions fully, I must yet say in anticipation, that we have to think the process of irritation, which here takes place as encroaching on those elements of the sense projec- tion fields, which we have formerly distinguished as perception cells* and belong to the consciousness of the body. Only by the fact that these cells, always belonging to a definite area of surface of the body, are excited, can we explain the chief attributes of hallucinations to be studied later. The distinction then from the true sense perception *See alienist and Neurologist, Vol. XX, p. 364. Outline of Psychiatry in Clinical Lectures. 271 is limited to the fact, that in this the cause of the irritation lies in the periphery, in hallucinations in central-transcor- tical–stations, while its real point of attack is the same in both cases. We have seen in the introduction, that all intense sense excitations coming from the periphery are simultaneously accompanied by a tone of feeling, and under- stood as the sign of an affection of the body.” The movements of defense, which follow the sense irritation accompanied by an intense tone of feeling, we have become acquainted with as a means for protecting the body, which in part indicate a very remote derivation. It is now of great interest to learn, that in the chronic psychoses some- thing very similar occurs, only that the tone of feeling is not thus conditioned by the intensity of the sense irrita- tion—on the contrary it is a matter of the most ordinary sense perceptions and most reliable according to their purport—but very probably forms the element superadded by the mental disease, accessory to the sense perception in itself normal. This tone of feeling of indifferent sense perceptions leads to a falsification of secondary identification in the sense, that under all possible explanations is favored with respect to their own person–Neisser’s morbid relation to self—and in this way to the origin of delusions of relativity. The so-called delusion of relativity is, somewhat like the delusion of persecution, only a collective name for a copious assortment of delusions, but which are here regularly united to the act of perception and occur with it; it consists in a falsification of the perceptions themselves. Examples may illustrate the symptom. A person on the street finds the doings of others natural and of no importance. But the insane person with the delusion of relativity, observes that persons stop on his account, step aside, make some gestures. If they spit, they do so in front of him, if they speak, they speak about him, if they wait, they wait for him. The person coming wants to meet him, the one behind is following him, accidental glances, the actions of strangers refer to him. Undoubtedly the sense perception is correct, *See Alienist and Neurologist, Vol. XX., p.356. 272 C. Werniche. only the relation to themselves, which inseparably adheres to the perception, is morbid, like sense irritations accom- panied by intense tone of feeling. With respect to the explanation of the symptom, we will follow the path which has led us to the comprehension of hallucinations. With these the symptom has evidently a close relationship, and the relation to them may perhaps be expressed: that delusions of relativity depend on an increase of morbid irritation, which acts on the same area as in hallucinations, but does not become as intense as is essen- tial for the production of hallucinations, therefore the symptom is always manifested in connection with true sense perceptions. We will naturally derive the increase of irritation from sejunctive processes of the some locality, but of less intensity than in hallucinations. For such a concep- tion the experiences of the clinic afford us the best proof. In wholly chronic psychoses of an ascending course the first stage usually consists of such a delusion of relativity, it is then followed by a stage of hallucinations and largely of phonemes and it is very characteristic that the purport of the phonemes consists in by far the greater part of delusions of relativity. At any rate the delusions of relativity do not generally cease as soon as phonemes of like purport have been associated, but they usually continue in like intensity. But it now follows that the increase of morbid irritation exists permanently, but the phonemes, which in such cases generally occur only intermittently, require a special augmentation of the quantity of irritation for their manifestation. The residuary hallucinosis” accom- panying the delusion of relativity is likewise evidential. Here also the purport of hallucinations of hearing is largely derived from the delusion of relativity, and after the decline of the phoneme the delusion of relativity may continue alone for a time. The conditions for the occurrence of delusions of rela- tivity are not entirely peculiar to mental diseases alone. Very typical examples may be drawn from normal mental *See Alienist and Neurologist, Vol. XXI.. p. 17. Outline of Psychiatry in Clinical Lectures. 273 life. The novice, who appears for the first time in a dress suit and white gloves, may readily believe all eyes are fastened on him, and it is similar with the young man when he enters the ball room for the first time, and there- fore behaves so awkwardly. An excellent example of this sort of the delusion of relativity is drawn in a masterly manner by Dostojewski’s pen when his hero Raskolnikow, conscious of the murder perpetrated, finally betrays himself by the references to this act, which he finds in unimportant expressions and meetings. When anyone perceives inten- tional discourtesy in an omitted salutation, it is the rise of a delusion of relativity. The first cited examples of delusions of physiological relativity—or ideas of relativity, if it is wished to dispense with the term delusion in this connection-show us the self- perception of a change in the personality to be the originating cause; this mode of origin we may distinguish as the allopsychical mode of origin of the delusion of relativity. It is an emotional state, which seems to be essentially dependent on the fact that the contingent change in the contents of consciousness is felt to be somewhat strange, not belonging to it, is not assimilated, digested (sit venia verbo), in a word, that the new experience meets with difficulties in association. The mental condition of a Ras- kolnikow would be impossible in a brutal habitual criminal. As in these examples taken from the normal, the delusion of autopsychical relativity of the insane also shows the pecu- liarity, that it is manifested preferably with respect to very definite ideas or groups of ideas. There is then a delusion of circumscribed relativity of autopsychical origin. In certain quite frequent cases of chronic mental diseases, one of these delusions of circumscribed relativity besides a definite quantivalent idea form the only two psychotic symptoms decisive for the origin of the mental diseases to which subsequently a long chain of explanatory delusions and analogous secondary symptoms may be added. I will return to these cases later. We meet with an extended delusion of autopsychical relativity, when the patients think the 274 C. Wernicke. occurrences of the world, which they see, or spoken sounds, which they hear, relate to their thoughts. Instead of actual sense impressions optical hallucinations or phonemes may be the basis of this delusion, and preferably the explanatory delusion, that their thoughts are uttered, i. e. have been heard, without their having been spoken, follows. The patients very readily come to this conception, when the phonemes represent answer to interrogatory thoughts or relate to answers only thought of. According to the state- ments of good observers, it is unquestionable among the insane that the phenomenon of “thought utterance” quite often has this origin. Analogous to the delusion of autopsychical relativity we may then speak of a delusion of allopsychical relativity, when the consciousness of the world is proven to be changed. We will take up these cases under the acute psychoses. Another time an allopsychical falsification of consciousness is not directly demonstrable, but the symptom characterized in that the allopsychical mode of origin is not to be doubted. The recently mentioned examples are included here. We finally properly distinguish a delusion of somatopsy- chical relativity, when unimportant sense perceptions are referred to subjective perceptions of morbid sensations or other changes in the body. The examples here included may in part be also referred to the somatopsychical explan- atory delusion, but in part differ from it, when the assump- tion of a special tone of feeling to the unimportant sense perceptions seems requisite for the comprehension of the accomplishment. A typical example of this has become known to me by an opinion presented for revision, which I will briefly cite to illustrate the symptom. A young man was brought before the court for having made a murderous attack on his father while he was asleep in bed. He frankly admitted being extremely embittered against his father and had intended to actually injure him without murdering him. The cause of his exasperation consisted of the observations, *See note on page 268. Outline of Psychiatry in Clinical Lectures. 275 which he described as follows. It was quite common, while they sat at the table to get into a quarrel, in which the rest of the family had taken first his part, then the father’s. It then often happened that his father rapped on the table and he was thus violently excited sexually. Also in the fields, while at work, his father had now and then appeared, and thus excited him sexually. The sight of his father was evidently accompanied by a morbid tone of feeling, which in this case started from definite, but in themselves uncertain morbid bodily sensations. These examples have been well designated reflex hallucinations (Kahlbaum)* and the best known are those in which the insane claimed in the dishing out and division of the soup, they were dished out, in lighting the fire, they were burned, etc. The name seems to me but little adapted, because morbid bodily sensations are states analogous to hallucinations, but yet must be differentiated from them practically.t The delusions of somatopsychical relativity are very frequently found in acute psychoses, but they play a large role in the chronic, be it that they are previously connected with a chronic somato- psychoses, be it that in the subsequent course of a chronic progressive psychosis, somatopsychical symptoms are added or an otherwise stationary state experiences an acute excerbation by the intercurrent appearance of morbid bodily sensations. The so-called hypochondriacal delusion of persecution, to which a consecutive grandiose delusion may be subsequently associated, springs from these delusions of somatopsychical relativity. In every insane asylum there is a number of these patients, who by occasional outbreaks of violent curs- ing, disturb the quiet and are proven to be due to delusions of somatopsychical relativity. *Die Sinnesdelirien. Allr. Zeitsch. f. Psych. Bd. 23, p, 1–86. #This same objection may be raised against Cramer's so-called hallucinations of the muscle sense, 276 C. Wernicke. XIV. THE RETROSPECTIVE EXPLANATORY DELUSION. THE FALSIFICATIONS OF MEMORIES. The sejunction hypothesis evidently shows us the way to acquire a mechanical understanding of the psychotic symptoms. As in brain diseases, it comes to light on deeper penetration into the nature of mental diseases, that the abrogation of function offers us the most valuable means for the understanding, while the processes, of morbid irritation underlie the complex conditions and must be considered somewhat dependent on the phenomena of abrogation. We will not be able to too carefully bear in mind the theory of brain pathology in this relation. In the light of our hypoth- esis, the case, with which I began our clinical demonstration, becomes clear and with the mechanical conception of morbid processes in the organ of consciousness, exclusively composed of nervous elements, appears more consistent. We had designed to study next the changes of con- sciousness with respect to contents. As the process, by which they arise, we had designated the acute and chronic mental diseases, and estimated its reciprocal position to the facts of brain pathology. We now believe to know that sejunction or disjointing of association is the chief process in changing the contents of consciousness. We may now define mental disease as the time in which by disease of the nervous parenchyma disjointings of associations occur. Thus the destruction of nerve structures, symptom of abrogation, is put in its proper place, without the possibility of restoration by regeneration, which occurs very frequently in the peripheral nervous system, being anticipated, or by commencing new associations. On the contrary, we will have to consider the curable acute mental diseases as instances of such restoration or re-adjustment. Evidently the disjointing of association under certain circumstances is equal to the destruction of certain psychological unions. So we will subsequently be able to maintain a loss in concepts or, in other words, a reduction of the number of concepts as Outline of Psychiatry in Clinical Lectures. 277 a state of defect occurring in consequence of mental diseases. But we have next to become acquainted with and understand by the sejunction hypothesis other clinical symptoms, which we observe daily in the so-called old cases. To these belong first of all the subsequent correc- tion of the contents of consciousness or the retrospective explanatory delusion. In terminated cases, those chronic from the beginning or finally in acute mental diseases, which have reached a chronic stage, we see this process being constantly consummated in the same way. The changed contents of consciousness must be brought into harmony with the old, still unchanged possession, corre- sponding to our controlling requirement of causality. The more self-possession is again attained or, in the chronic psychoses, retained, the more the intellect acts along the lines of the strict standard of logic, then the more impera- tive is the necessity of emphatic, decisive arrangement being established in the structures deranged by the disease. In the complex brain mechanism not the remotest corner shall normally exist, which does not functionate under its influence in harmony with the function of all the other parts. An example will best illustrate the process, which then occurs. You remember the patient, a Doctor of Philosophy, whose explanatory delusion was constructed on the theory of sug- gestion and hypnotism. This patient has passed through an attack of mental disease eight years before, but had so far recovered, that for many years he had perfect apprecia- tion of the symptoms of his acute mental disease. When I recently presented him in a new attack, to my great sur- prise, the curious phenomenon presented itself, that his appreciation of his illness was entirely lost, so that he now claimed the elementary symptoms of his first sickness, chiefly phonemes, had not been the result of a disease, but the hypnotic influences of some persecutor. But of the circumstance that he had for many years regarded his hallucinations of hearing to be manifestations of disease, he remembered perfectly, but he very correctly remarked, that such a fanciful appreciation of disease could be explained by 278 C. Werniche. the action of suggestion. You perceived from this example, with what readiness opinions, which could have been so firmly held for years, as they were difficultly acquired and the product of a complex intellectual process, can be over- thrown by a presumable new insight, but which is morbid. Nevertheless if we, as I do not question, must conceive this process not to be morbid in itself, but merely as the reaction of a normally functionating brain mechanism to the once existing change as to contents, you will not think it strange, if very commonly the defective physical knowledge of the majority of the insane does not hold out in the hallucina- tions against the evidence of their senses, when the assumption of a supernatural action, subterranean passages, hollow walls, etc., which is made for the explanation of strange subjective sense perceptions, loses the peculiar and grotesque character, which they would have according to the judgment of the same person when well. Previously acquired facts are quite often modified in the way, that hindrances, which heretofore oppose the solution of a prob- lem, e. g., perpetual motion, like the assurance of the constancy of energy, are now null and void, and so are explained many wholly insane inventions and discoveries. The previous personal experiences generally form the special object of these interpretations. Under the newly acquired, presumably better insight evidences of favor appear like hypocrisy and cunning calculation, hostile acts as deeds of benevolence, non-essential occurrences as extremely important events, an accident as intentional action of some patron or adversary. This process of subsequent correction attains a special importance, as soon as it is not limited to facts, opinions and complex conclusions, but is extended to the memorial images of previous perceptions and in this way effects a subsequent falsification of secondary identification. This sort of subsequent correction of former memories we will dis- tinguish as delusion of retrospective relativity. - It is hence a matter of occurrences, which at any rate have analogies in normal mental life. It may happen to anyone, that he first Outline of Psychiatry in Clinical Lectures. 279 subsequently believes to remember having met an acquaint- ance, who was not noticed at the time because he was inwardly occupied. This subsequent identification may be false as well as correct as to its contents, and normally this fact is to be taken into account. Among the insane there are often persons, who are subsequently identified, in whom the most superficial similarities generally suffice for the explanatory requirement. In patients with fixed grandiose delusions these interpretations are observed very frequently, even in the memories of youth. The patient remembers, e.g., when a boy of having been once spoken to by an officer; this officer was, as he has subsequently recognized from the resemblance, Emperor William, Emperor Frederick or some other noble and popular person. At the same time he had been asked by the teacher at school, if he still had a father or grandfather. This question is referred to the same person and should intimate where he is to look for his father or grandfather. The reply, that this might have been an indifferent question, these patients confute by referring to a meaning glance or significant movement of the teacher’s hand on this occasion, a clear evidence that the perception has been falsified in the memory. From patients of this category stories for hours are often heard of their youthful remembrances, which in the greatest part are related just as they have been experienced. But the perceptions universally present that coloring, which a dis- tinguished psychiater has aptly described by the words “tua res agilur.’’ In ignorant and undiscriminating persons, who are not accustomed to separating their subjective impressions from the material of objective perceptions, the delusion of retro- spective relativity may readily lead to wholly false repre- sentations, and it will often be hard, under these conditions, to ascertain the fact, as it has really happened. Still the clinical requirement demands the accurate differentiation of delusions of retrospective relativity from another elementary symptom, which is observed in the same category of insane, that of the so-called falsification of memories. This symp- 280 C. Wernicke. tom may occur in two equally significant modifications, a positive and a negative. The positive form of the falsifi- cation of memories* is also called confabulation and consists in the appearance of remembrances of events and occur- rences, which have never happened. If the purport of this confabulation is generally so significantly colored, that it corrresponds to the prevailing delusion, it then affords, e.g., in the cases of fixed grandiose delusion citedt a great part of the evidence, on which the claim of descent from nobility or the relation to such, is based, in cases of systematized delusions of persecution (often directed against one person), it contains the strangest persecutions claimed to have been endured. In other cases the symptom reflects the incohe- rence of the contents of consciousness (disintegration of the individuality, see above), as in the case of Rother and very frequently also in the fanciful and peculiar narrations of paretics. On the whole an inner connection with the disorders of memory, which is to be presumed a priori, is also established by clinical experience, for the symptom belongs to the almost never failing phenomena of the three mental diseases characterized by temporary occurrence of memory defects; hebephrenia, presbyophrenia and progres- sive paresis. No less remarkable is the negative modification of the falsifications of memories, the occurrence of circumscribed gaps in the otherwise well retained material of memory, without there being an indication, that a clouding of the sensorium or loss of the ability to attend could have existed at the time of the event in question. For the correct con- ception and description of this symptom the greatest value must be placed on these preliminary conditions. No one will wonder, if a patient with the initial symptoms of typhoid or meningitis has completely lost the remembrance of hours and days, for instance of a journey from Rome to Berlin while in this condition. Just as little do we wonder #Kraepelin: Ueber Erinnerungsfalschungen, Arch, f. Psych., Bd. 17, p. 830, *See page 278, Outline of Psychiatry in Clinical Lectures. 281 at the complete loss of remembrance in the post-epileptic state, of the fanciful events of delirium tremens, other toxic deliriums, hysterical delirium, a state of profound inebriation or finally of normal trauma. Also for those events of a mental disease, in which at the same time a loss of the ability to attend could be established, the complete extinc- tion of memory thus seems comprehensible. But it is entirely different with the symptom of negative falsification of the memories. Here individual actions and occurrences, which have happened apparently in perfect mental clearness, are effaced from the memory, while events closely related in point of time are accurately remembered. But there are two circumstances, which do not seem to be wanting as characteristic signs of the symptom and might serve to pave the way for its explanation; the occurrence concerned as to the action seems always to happen at the time of intense emotion, and besides it is connected with a definite quanti- valent idea, and so that it either appears as their result and so induced or would serve for their invalidation and refutation. The most typical examples have occurred for me in the so-called querulant insanity and related states of chronic partial psychoses. To illustrate what has been said, I could cite the case of a master tradesman, living here, committed, but still busy with his work, who has been proven to have insulted a policeman publicly on the street by indecent words and gestures and afterwards swore he did not do it. This man under the influence of a quantiv- alent idea, which for a time decided his whole conduct, held the officer to be his personal enemy and spy, for shortly before he had been injured according to this idea, and without doubt at the time of the offense he acted under the influence of an intense emotion. But just as little could a doubt exist from the exact knowledge of the person and the whole affair, that the respectable and religious man was wholly averse to committing a conscious perjury, while he had actually sworn falsely. Of etiological factors merely a marked family tendency to mental disease was to be dis- covered in the man of middle age. 282 C. Werniche. The last three symptoms mentioned are connected in so far with the subsequent correction of the contents of consciousness as they evidently represent the excess of such a correction, and its morbid excess, while the process of correction in itself could be regarded as normal. All three symptoms evidently belong to each other, and their mutual relation may be expressed, that we subordinate the first to the qualitative falsification of memories, the other two to the quantitative. Instead of the expression positive and negative we might perhaps rather designate the two latter as additive and substractive, so that we would now have the uniform nomenclature to distinguish three forms of falsification of memories, a qualitative, an additive and a substractive. If we will now undertake to make an explanation, it will be best to treat all four symptoms collectively. Next in regard to subsequent correction it would soon occur to you how closely related this symptom is to that of the explanatory delusion so long familiar. Only the subsequent correction perhaps corresponds more to the refined psycho- logical requirement, while the explanatory delusion to a cruder mechanism. The explanatory delusions are generally obtruded on the consciousness by unconscious process of deduction and therefore with such elementary force, while the subsequent correction occurs slowly, it is a conscious, actual mental operation, which reaches its conclusion after long deliberation, that the patient becomes clear over a number of things, which had previously seemed incompre- hensible. The patient Böhm, whom you remember, was in such a process of clarification and stated, he could not decide at the time which of the various assumptions was correct. But it shows that the slowness and profoundness of this subsequent correction must lead to an irreparable falsi- fication of the mental possession, so that the disappearance of the elementary symptoms, e.g., the phonemes, which called for the explanatory delusion, the confusion, which has been once caused, cannot be repaired. Explanatory delusion Outline of Psychiatry in Clinical Lectures. 283 and subsequent correction are the two fundamentals of this so-called systematization, and therefore it is not strange, if you find the proposition universally accepted, that systema- tization is equivalent to incurability. Still the proposition in this generality is not correct, and surely not for the majority of those systems in acute mental diseases, which usually depend so largely on explanatory delusions. As we shall see later, there is on the contrary one of the most curable mental diseases, in which temporary systematization is the rule, the acute hallucinosis, and the same seems to be true in the simple acute psychosis of fear. While for the chronic psychoses the proposition might have unlimited application. But how much more favorable in these are the conditions for subsequent correction in morbid senses! In the acute diseases mentioned there are weeks and months in which an accession of morbid compo- nents stream into the consciousness in such abundance, that one displaces the other. The elementary symptoms are afterwards silenced, and what has remained of them, no longer have the power to correct the former mental posses- sion, but rather succumbs to the united force of the again normally functionating process of identification and the previously acquired ideas. While in chronic cases the new. acquisition bears very much the stamp of the normal event, so that the old possession should behave toward it differ- ently than to the new normal acquisitions. As we have seen above, the processes of irritation, which are at the base of the elementary symptoms of the chronic psychoses, may all be regarded as a consequence of sejunction; we will therefore have to consider the explana- tory delusion and subsequent correction in the paranoiac states as unavoidable, if also merely direct consequences of sejunctive processes. Whereas the symptom of the delusion of retrospective relativity may be credited an indirect con- nection with the sejunction. We have seen that we must trace the delusions of relativity chiefly to a process of irritation being manifested in secondary identification. If we have have once accepted this view, then there is nothing 284 C. Werniche. against the further assumption, that the same quantity of irritation which is associated in the acts of perception with the peripheral excitation of a projection field, may also cause the excitation of memorial images by the way of association and thus delude the relation to their own person. But the accession in the quantity of irritation so required may be due, as we have seen, to the arrest of nerve energy in consequence of sejunction. That the positive or additive form of the falsification of memories has to presume a prior dissolution of association, needs no further discussion. The stability and reliability of our memories depend in great part on the collegation strictly accomplished between them in point of time, and so we may say that the memories are so closely united by the threads of time that foreign elements find no place between them. This association in point of time then must be broken through, if the pseudo-events of confabulation shall be held to be true. This only is the possibility for the occurrence of the symptom explained, therefore the real mechanism of origin still remains obscure. But the mode of origin and occurrence of the symptom need to be discussed. The first assumption that it is a matter of memories of the pseudo-events in an acute mental disease, is evidently untenable, for all those confabulations which occur without a preceding acute stage of the disease, and these we here have in mind and might exclude the others from the concept of confabulation. But from whence must these events clearly described in all detail, which have never been experienced, and for anyone versed in the matter the assumption seems wholly excluded, that it is a question of vol- untary productions, intentional deceptions or lies in ordinary parlance. The confabulations are not lies, because the patient is fully convinced of their truth. As the contents of this confabulation very often have a fanciful stamp, similar to the events of the dream, I regard it very possible that they are real memories from dreams. The following might be cited in favor of this possibility. It is occasionally found that the sane person on awaking Outline of Psychiatry in Clinical Lectures. 285 from a dream believes for a short time the occurrences during the dream. But that only occurs when the contents of the dream are not too contradictory to the laws of real- ity, and when they are readily joined to the last events in point of time. The latter condition would be fulfilled, e.g., when in consequence of a mild intoxication the remembrance of the last events of the previous evening is lost or can only be vaguely recalled. The insane patient may be wholly deprived of both these corrections. The continuity of his memories in point of time is neither so stable, that foreign terms could not be inserted, nor are the laws of reality so inviolable for him as for the sane person. It is evidently the fact of sejunction, which removes the hin- drances to the reception of dream events into the store of memories. But perhaps something else may be necessary to lead to the occurrence of confabulation, e. g., an abnor- mal vividness of the dream events. However it would take too long for us to go further into the conditions, which are certainly not inaccessible. For the negative or subtractive form of the falsification of memories there is a common analogue in the post- hypnotic phenomena. Commands may be given a person hypnotized, which he later performs while awake, without remembering the command. For our consideration the performance of the command is unessential and merely an indication that the consciousness was affected at the time the order was given. Whereas essential for us is the complete absence of memories of the command, while on the other hand the action surely cannot be regarded as really voluntary. As we are compelled to trace this effect of suggestion to the fact that foreign components are implanted in the organ of consciousness, without their entering into association with its other contents, a circum- stance which also may seem comprehensible grossly mechanical for the cogent influence of these transplanted components of a foreign consciousness on motility—so we will have to admit for the gaps in memory in this symptom the absence of associative collegations for the explanation 286 C. Werniche. of the circumstance, that real occurrences may not be remembered. Still the close relations which these gaps in memory with respect to contents show to the quantivalent idea, intimate that the associative collegation is not entirely absent, but is only a very biased idea and limited to the quantivalent, otherwise the occurrence of the apparently conscious acts would not be explicable. It is then prob- ably the matter of a limitation of consciousness, as it is known only from states of intense affect. As the actions, which occur during the lapses of memory, often seem due to affects, a factor favorable to subsequent forgetfulness may be perceived. But this factor cannot be exclusively utilized, for otherwise it is inexplicable why only certain kinds of the insane present this symptom. XV. REVIEW OF THE ELEMENTARY SYMPTOMs PREVIOUSLY DISCUSSED. THE QUANTIVALENT IDEA. A review of the elementary symptoms occurring in the paranoiac states permits us to make the following distinc- tions. We found changes in the contents of consciousness, i. e., delusive ideas and erroneous opinions, with unimpaired action of the consciousness, in so far as it is expressed in formerly retained logic, attention and ability to attend, and finally with the ability of adjustment to surroundings. But the intact possession of the abilities does not prevent the specially dormant contents of consciousness from seeming to fall to pieces in a certain measure, a fact which we indicated as sejunction, i. e., disjointing of the several com- ponents. These components were firmly united structures, namely complete experiences, but the sejunction is shown by the fact that the most contradictory of these memories could coexist. The sejunction hypothesis then leads us to the better understanding of certain symptoms of irritation Outline of Psychiatry in Clinical Lectures. 287 and thus to symptoms of deranged action of the conscious- ness, next of the autochthonic ideas and imperative conceptions* then of hallucinations and the delusion of relativity. The explanatory delusions which occupied so much of our discussion, could, as normal manifestations of the action of consciousness, be confronted by the direct psychotic symptoms previously mentioned. As very closely related to the explanatory delusion we have become acquainted with the subsequent correction of the contents of consciousness, the most essential condition for the so- called systematization, and so found a process which is to be attributed to the reactive manifestations of normal action of consciousness toward false intrusions, while we again might perceive psychotic symptoms in the different kinds of falsification of memories, which in themselves morbid, yet seem to have definite, conformable relations to the existing derangements of the contents of consciousness, mostly in such a manner that the range of their occurrence seems dependent on the extent of the change as to contents. In the train of these psychotic symptoms three different modes of origin would have to be differentiated at least, for they appear in part as reaction of a well retained action of con- sciousness to the change in the contents of consciousness: these include the explanatory delusion and subsequent correction; in part as direct consequences of sejunction; the contradictory contents of consciousness of many old cases, the additive and subtractive form of the falsification of memories; finally as processes of irritation, which are dependent on sejunction; the hallucinations, the delusion of relativity and retrospective relativity, finally the autoch- thonic ideas. *Imperative conceptions are very rarely an essential element of the paranoiac states if the cases of inveterate, habitual control of the actions by imperative conceptions are attributed to the limnal states of mental derangement, where they belong in my opinion. Therefore I do not disclaim that between the autochthonic ideas, quantivalent ideas and imperative conceptions transitions exist, in which it is difficult to give the symptom its cor- rect position. But in general the three symptoms may be readily differentiated. When Friedmann: Ueber den Wahn, Wiesbaden 1894, recently in his ingenious paper attributed the imperative conceptions to quantivalent ideas and denoted the latter as the chief element in the formation of the delusion, he pays me too much honor and leaves the basis of clinical experience. 288 C. Wernicke. The quantivalent ideas, which might be repeatedly mentioned, are naturally attached to the last group men- tioned, they are apparently closely related to the imperative conceptions and autochthonic ideas, and it is a question, whether they can be separated from these symptoms, and whether a sharp boundary line is possible. The quantiva- lent ideas are sharply separated from the autochthonic by the fact, that they are in no way judged by the patients as foreign intrusions in the consciousness; on the contrary, the patients perceive in them the expression of their most personal nature, and in the struggle for them very truly carry on a conflict for their own personality. Nevertheless they are often felt to be annoying and the patients frequently complain that they can think of nothing else. But they must ever remain far separated from the impera- tive conceptions, because they are regarded as normal and justified, completely explained by the mode of origin, while the imperative conceptions are recognized as unwarranted and often as directly absurd. If therefore clinically the differentiation of the symptom from the two others related to it is readily accomplished, its mode of origin is still unexplained. In this respect it is to be remarked, that in general we may define the quantiva- lent ideas as memories of some especially emotional event or a whole series of such connected events. Thus for instance were the following occurrences, which lead to the origin of quantivalent ideas; the discovery of a man who has undertaken the administration of an estate and had shared as an heir, that he had been essentially wronged in the division; the report of the suicide of a dear friend, the death of the husband, the perception of an old maid that a gentleman pays her attentions, the observation of a wife, that her husband takes a great deal of snuff in spite of her opposition; finally, one of the most common cases, the con- demnation or decision of superiors, which is felt to be unjust. The emotion thus arising therefore bears a very different stamp and may either be designated more as anger or vexation, more as sorrow or disgust or sexual excitement. Outline of Psychiatry in Clinical Lectures. 289 At any rate you infer from this enumeration, that almost every event may lead to the origin of a quantivalent idea, that it does not at all depend on the kind of emotion, and there must be quantivalent ideas which belong wholly to the norm, but nevertheless the individual’s mode of action may be so designed that it has a morbid stamp. Who, after the loss of his property, after condemnation to disgraceful punishment, after the death of a dear friend, takes his own life, surely acts under the influence of a quantivalent idea, and we will have to designate the mode of action as abnormal, although it is not to be traced to a mental disease. It may then have to be ascertained in any individual case whether a morbid quantivalent idea or one within the domains of health exists. You will be inclined to rest the decision of this question on the fact, whether the motive is sufficient or not for the dominating emotion inherent in the remembrance. But this criterion fails us completely, as the example of the querulant proves; a part of these patients had actually been wrongfully condemned and had every reason to revolt. More reliable is the crite- rion, that in the cases with morbid quantivalent idea, this symptom is not alone, but a series of other psychotic symptoms is soon added. So especially is the delusion of circumscribed relativity characteristic of these cases.* The following is a typical example of a morbid quan- tivalent idea. A gentleman 61 years of age, who was recently presented to you, gives as the reason for his admission “the annoyances,” to which he has been sub- jected outside of the asylum. In the asylum he is entirely free from them and feels so well that he has been here four years and expects to remain. Several attempts to discharge him have been a failure, because the same annoyances have led to the intervention of the police and his return. Originally it was a certain man, only known to him by name, who resided in the vicinity and whom he therefore met frequently on the street. He noticed how *See page 275. 290 C. Wernicke. this gentleman stopped and waited for him, but acted as though he counted the windows of a house. He therefore went to the other side of the street, but the next time observed how this gentleman spoke to an acquaintance at the same place and about him, as he is convinced, although he could not hear it. He consequently passed close to the two gentlemen and said: “Perhaps you want some- thing of me?” He then went to his residence and noticed that the gentlemen followed him and stopped before his house. Arrived at his residence, he went to a window, flourished his cane and exclaimed: “Come in here, I will be at your service.” A similar meeting another time resulted that the gentlemen actually followed him home, ascertained his name and made a complaint to the police. That was the circumstance that led to the patient’s first admission. I presented him in the clinic then, ascertained that the patient’s delusion of relativity was exclusively directed against the person of one of these gentlemen, a contractor, and then asked the patient: “But why should this gentleman annoy you?” The answer was extremely characteristic. He could only think of the following. He knows the brother of this gentleman very well, who, like himself, had been a regular customer of a wine merchant six years ago. The patient for a year had been interested in the merchant’s daughter and proposed to her, but broke off the engagement, because he learned that her father was in a poor financial condition. The contractor had probably said to the other gentleman: “There goes the rascal who jilted the girl.” The most careful examination and obser- vation of the patient did not reveal any psychotic symptoms, other than that he claimed his perceptions were correct. He was therefore discharged at his request after a few weeks, but was soon readmitted and this happened a second time. Since then he will not try it again. The annoyances to which the patient was subjected outside, were both times far more numerous than before, other per- sons and the police had taken part, but it was all traced back to the one contractor, who in the meantime had told Outline of Psychiatry in Clinical Lectures. 291 the old story to others and instigated the police to watch him for insanity. In the asylum never an indication of a delusion of relativity or other signs of a mental disease has been observed in the patient. In this typical case of circumscribed autopsychosis we see the quantivalent idea combined with a wholly circum- scribed, but later broadened delusion of relativity, which in the asylum where the patient only meets strangers, is never manifested. The basis of the quantivalent idea is the contrast, which the not perfectly honorable mode of action described forms with the patient’s otherwise upright char- acter. It is to be assumed that the patient at the time of the first meeting described was thinking of his former experience and felt it to be a stain on him. A glance that he caught, the waiting attitude of the man who could know about the matter, then led to the permanent association with the temporarily dominating train of thought, not falsi- fied as to its contents, but as to its value, a very similar act to falsified secondary identification, as was at the foundation of the delusional formation in the young assailant previously described.* As you recollect, exactly the same happens in the delusions of physiological relativity, as it is so aptly described in Raskolniknow. But it is not an acci- dent, that Dostojewski’s hero is previously depicted as a person morbidly nervous and of the weakest, most sympa- thetic spirit; under these circumstances, the remembrance of the murder perpetrated must remain an unassimiliable novum in the consciousness, so to speak, and so we found in all cases of delusion of autopsychical relativity the difficulty of association with the old contents of consciousness to be the basis of the quantivalent idea. To follow the indications of the preceding case we will reach the proposition, that such events especially will lead to the origin of a quantivalent idea, which from their con- tents are very hard to assimilate, i. e., to be made consistent with the present contents. As such events may happen to the soundest mind, we will have to demand special conditions, *On page 275, - 292 C. Wernicke. by which the quantivalence is shown to be of a morbid character. Normally there are remonstrances, which gradu- ally lead to a correction of the quantivalence. In morbid quantivalence these remonstrances prove to be inaccessible, and likewise the clinical sign of the delusion of relativity occurs, corresponding wholly to the hypothesis of irritation previously found joined to the Sejunction process. lf we will pursue the clinical signs farther, it will be proven that the perniciousness, which is due to this symp- tom, is well known and must be sought in the extremely intense emotion, which accompanied a certain event. As such a known cause is not to be ascertained for other psychotic symptoms, this serves to characterize the morbid quantiva- lent idea. - As in the case described, so also in a series of similar cases, a stable, tolerably permanent disease type is shown, which gains its partiality from the traditional name of fixed idea. Still in the most of the cases explanatory delusions are added, which may ever increase in extent. Subsequent correction of the contents of consciousness and the different forms of the falsification of memories may also be added, and thus a firm delusional system arises, whose complex contents do not at all correspond to the relatively simple and often very insignificant causes of origin and is apt to conceal and mask them. In old cases it is easy to ascer- tain these delusional structures, but we are often limited to conjecture with respect to the real fundamental quantivalent idea and the events from which it started. It is compre- hensible that recovery is out of the question in all cases of this kind, as in all other cases of extensive systematization. While if the extent of the disease is limited to the first psychotic elements, recovery is possible by the gradual occurrence of vigorous remonstrances. Two cases, in which recovery has occurred, were typical types or the so-called querulous insanity.” The clinical presentation of such *One of them was refused restoration to citizenship by the experts, because querulous insanity is known to be incurable! Yet the patient's conduct showed that he had actually recovered! Outline of Psychiatry in Clinical Lectures. 293 patients has often proven beneficial, as well as the commit- ment in itself, the consciousness of being considered insane and permanently under guardianship, are vigorous and “helpful remonstrances. The recovery is always very gradual by the avoidance of the causes for revival of the affect, the affect gradually disappears. It would take too long for me to cite here all the details of the quantivalent idea, nevertheless I would not be able to be exhaustive, for naturally there must be, according to contents, almost infinite varieties of this well character- ized form of chronic autopsychosis. For practical reasons I will only permit myself to hint that the possibility of acquiring an accident annuity may readily become a quan- tivalent idea. Finally I will not omit stating that, like almost every other psychotic symptom, the quantivalent idea may form the initial stage of a progressive acute or subacute psychosis including progressive paresis, and that it is a symptom rarely absent in melancholia. In concluding this discourse, I will report a case pro- gressing to systematization. A maiden lady about forty years old, teacher of physics in a young ladies' seminary, very capable, zealous and greatly interested in her work, believed to observe, that one of her unmarried male asso- ciates, with whom she had been on friendly terms for years, had earnest intentions with respect to her. She noticed that he often stood by a window while teaching, where he could look into her class-room, that at recess he frequently stood in the corridor, through which she must pass with her scholars to her class, that he saluted her very defer- entially. This perception, which she found confirmed by various accidental meetings, caused her great emotion, she spent hours and nights in inward struggle as to how she should act, and especially how to behave the most incon- spicuously, so that the scholars and her associates did not notice it. As she believed she was no longer a master of her feelings, she tried to avoid these meetings, and even went so far as to intentionally cut him. About this time, 294 C. Werniche. she observed, that her pupils seemed to know of it, remarks were noticed, which related to the matter, perhaps sporadic phonemes also occurred, for she heard: “How troubled he looks.” Associates, who formerly had been rather distant," now visited her oftener and very frequently spoke of the young man, while her real friends withdrew and appeared to disapprove of her “affair.” Even the director interfered, in that during the recess he talked to the teacher and kept him at another place, farther from her, than he generally occupied. After some time this teacher left the school to study abroad. On his farewell visit he was extremely confused, changed color, and particularly a long look betrayed to her, that he well knew how she felt and reciprocated her affection. After he had gone, she observed that part of her associates were scornful and malicious toward her, a part sympathetic and considerate, at any rate their relations were generally known and any mention of this teacher contained allusions to them. The director must have made the matter the subject of a discussion in the conference; she could perceive it from the manner of all those present when she came in. All these events took two years. Direct reports did not come to her from the teacher, and she began to doubt if he was an honorable' man. She must admit that her behavior toward him had been reserved, but she still believed he should have declared himself, like an honorable man. Completely engrossed in the sacrifice she had made by her conduct for the sake of the discipline of the school, she once had a passionate scene with the director, whose rude meddling she had not forgotten, and was given a six months' leave of absence with the advice to go to a sanitarium. The superintendent of the institution to which she went, found delusions of grandeur and perse- cution and pronounced her incurably insane. When I saw the patient three years after the beginning of her illness, she was the guest of friends and occupied herself in teach- ing the children. Neither in her manner nor in her talk was there anything peculiar, so the report that she had been pronounced incurably insane by the superintendent of Outline of Psychiatry in Clinical Lectures. 295 the institution, must of course excite surprise, therefore the patient was led to seek my advice. I found her an educa- ted, refined lady, who was also perfectly clear, that she had the right to arrange her relations to the young man accord- ing to her own discretion, but her sense of duty to the School had left her no choice, “she had sacrificed her right to her duty.” She had no doubt of the young man having intended to propose. Still she must admit, that he had never said a word that could not be interpreted indifferently. If he had not declared himself, what she considered not quite fair on his part, this was principally due to the intrigues and rude interference of the director and teachers. She did not believe my assurances, that all her fancied perceptions were to be explained by a morbid, biased opinion and depended on delusions, yet she was induced to go to a Sanitarium voluntarily, where she remained however only a few weeks. I now learn two years later, that the patient has resumed her calling in a private school and is perfectly capable, but in the meantime she has fallen out completely with all her relatives and blames them in part that she has been robbed of her life’s happiness. Explanatory delusions and falsification of memories may have been the components of her now completed system. I cannot help adding a brief remark. If instead of a delicate and educated lady it had been a matter of a some- what indiscreet person, she would certainly have energetic- ally asserted her claims to the teacher and been a typical example of the persecuted persecutor, so much talked of recently.” In my opinion the most of the cases are to be traced to some morbid quantivalent idea, only that this peculiar basis of the system often remained hidden to the biased observers.f Also the superintendent, whose opinion had produced the lady’s not wholly unjustified indignation, *Magnan, Psychiatrische Vorlesungen, German by Möbius, Leipzig, 1891. +In these cases the prejudices relate to the partiality of the disease claimed by me and often misunderstood. As to the sense in which I comprehend this partiality is very eviden by this representation, so that I may well refrain from a detailed refutation of the attacks recently directed against me by Hitzig: Ueber den Quârlantenwahnsinn, Leipzig, 1895. 296 C. Werniche. only saw the surface of the matter and had no presentiment of the real nature of the disease. A psychopathic foundation, from which the quantivalent idea might have arisen, does not exist in the lady. But it will not be wrong to consider her “critical” age, combined with an excess of mental efforts and the thus induced improper mode of life, to be ample ground for the occurrence of a sexually colored quantivalent idea. XVI. WHEN IS A MENTAL DISEASE TERMINATED2 The question whether and when a psychosis, which has not recovered, is to be considered terminated, is, after all that we know at present, one of the hardest that can be asked, and still in like manner of theoretical as well as of practical significance. Theoretically its importance is evident from the fact, that in the autopsy of terminated cases, we will expect to find only the residues of morbid changes in the organ of association,” no longer the changes themselves. Practically the real terminated cases could be compared to recoveries with defect in other pathological provinces. Nothing stands in the way of the discharge of certain cases from the asylum, as soon as the change in the contents of consciousness is of a harmless nature, as e. g., is so often met with in the fancied inventors and found- ers of new views of life. The points, which we have for the judgment of this question, are of course to be sought exclusively in the province of symptomatology. Our task then consists in examining the psychotic symptoms we have become acquainted with from the point of view, whether and in how far they are the expression of a disease process still active. Of greater importance owing to their paramount signif- *I. e., proliferations of neuroglia. Of epochal importance in this respect seems to me the work of C. Weigert: Beiträge zur Kenntniss der menschlichen Neuroglia, Frankfort of M., 1895. We may hope that a pathological anatomy of the psychoses will be erected by him. Outline of Psychiatry in Clinical Lectures. 297 icance in almost all paranoiac states, will this be especially true of the explanatory delusions. These often actually represent an endless series, in that one may always be produced by the other, and so the process of delusion form- ation goes on indefinitely. While in other cases we see the same change as to contents continue and an explanatory delusion follow only by intimation. An obvious difference is certainly to be maintained in this diverse mode of reaction; only the question is, whether it is due to real pathological conditions. I have above intimated, that an energetic reaction to the once instituted change in the Contents of consciousness is to be considered in itself a normal action, and that then the explanatory delusion, as well as the intrinsically related process of subsequent correction of the contents of consciousness, may not depend on pathological processes. This subsequent correction always presumes that the alteration of consciousness, as to contents, remains of dominating interest to the patient. The simplest example, which is here offered is the delusion of a patient failing to appreciate his disease, that at the time of his illness he has been wrongfully impris- oned and robbed of his freedom. We may assume, that such a patient in resuming regular work and returning to settled conditions meets with so many other normal interests, that he must have an especially unfortunate temperament if his chief interest continues engaged with his fancied wrong. But if we assume a jurist, impregnated with the idea of justice, could have met with this fate: then the dominant interest devoted to the wrong done him and thus the acquirement of new explanatory delusions, would be com- prehensible. He will make charges and institute claims for damages. But “what happens to the one, happens to the others,” then nothing is more evident than the thought that the same injustice has happened to others also. If he is now dismissed with his complaints, he perhaps believes that it is not only due himself, but also his fellow-sufferers, that he press his claim further. The repeated adverse decree shatters his faith in the administration of justice, he 298 C. Wernicke. comes to the suspicion that the judges are bribed, perhaps by those who originally had an interest in putting him in the insane asylum, or that justice is warped to hush up the probable blunder on the part of the asylum. This Special experience is also generalized. All legal processes he now considers from this point of view and so constantly forms false opinions. He may make the readily possible assumption, that the wife has caused the commitment to the asylum. In the asylum he fancies she has taken up with another, who has fought and crushed him for the time being. But now outside of the asylum, the suspicion again arises, he begins to watch all his wife’s movements from this point of view, notices things he had never considered before, gives expressions a false interpretation, etc. If, in consequence of this, the affects normally to be expected occur, morbid jealousy arises, the insane jealousy, with all the conflicts, which finally terminate in the patient’s recommitment. In all these affairs and calamities he will misjudge according to his biased point of view his relations to other persons and the regulations of society, whether they uphold him or the opposite side. So we see a whole chain of false opinions formed, pure delusions, each suc- ceeding link the logical sequence of the preceding, and any station of the whole road may be the starting point of quarrels, affronts and violence. In fact there is no account- ing for the actions of these uncured insane. We will now investigate what the conditions are, which in spite of the mental disease being really passed, induce such an incurable termination. That the real individuality plays a great role, has already been hinted at. Also the importance of a suitable occupation I have emphasized, for it may divert the patient’s interest largely into normal paths. But of still greater significance will be the surroundings and social medium, in which the patient is thrown. If he is associated with imprudent people, who believe his false conception of the past and confirm him in it, if he becomes engrossed in the equally imprudent newspaper accounts of his companions in fate, he is again excited and will Outline of Psychiatry in Clinical Lectures. 299 Scarcely escape a renewed formation of delusions, while every day, every week, which elapses after his discharge, without the patient asserting his fancied claims and think- ing of them, is a great gain for him and favors the fading of this range of interests false as to contents. So an affective conative state must be regarded as the most com- mon preliminary condition of the explanatory delusion. The patients gradually and in favorable cases observe, that the revival of the time of their illness acts on them unfavorably, and I can show you many patients of the kind now actively engaged and self-sustaining, who speak of their illness very reluctantly, and this puts many obstacles in the way of a medical examination. From this consideration it practically follows, that we cannot be too circumspect in the discharge of improved insane, while on the other hand, as a means of strengthening the patients’ normal interests by an inde- pendent, busy life and thus afford the possibility of further restitution later, it cannot be withheld. Again unfortunately it will often be unavoidable, that the patients are discharged without entering into regular work and settled social rela- tions; under these conditions then, which are not only pernicious by the absence of normal interests, but must even dispose to the origin of depressing effects. The dominating interests may then continue to be engaged in the injustice suffered, an affective state occur and the further formation of delusions is not lacking. So we see individual relations may decide the termination, another evidence of the correctness of our view, that the formation of explanatory delusions may not depend on an existing disease process. A further evidence lies in the fact, that in certain acute diseases the absence of explana- tory delusions is characteristic and accompanied by a pro- nounced defect, an apparent negation of intellectual action. In these cases the formation of delusions does not occur, because the normal elaboration of the changes in contents by the mechanism of association is lacking. Wholly different than with the explanatory delusions is it with the majority of the other symptoms familiar to you. 300 C. Wernicke. Here as the chief means of systematization are to be con- sidered the additive and subtractive falsification of the memories and the delusion of retrospective relativity. They seem then only to make their appearance, as has been shown, when the extremely firm structure of association is loosened by sejunctive processes. But also in the presence of this preliminary condition, the same symptoms may be absent, without a real state of defect affording the explana- tion, so we are still led to the assumption, that the se symptions so essential for the construction of a delusion system must have another basis of origin. The next assumption is, that not the past sejunction, but that still present, then the disease process still active, is essential. At least this view is the most probable for the three other symptoms: the autochthonic ideas, hallucinations and delu- sions of relativity, of course with a certain qualification. I then remind you that in residuary hallucinosis, we have made the acquaintance of a stage of disease, which with the attending delusion of relativity of its time, we have essentially considered as a sequence of terminated sejunctive processes. The representation is perhaps to be modified somewhat in the fact that it corresponds to a stage of decline, of the remission of the sejunctive processes to a stage then, in which the most acute sejunctive processes and thus all other severe symptoms of an acute psychosis have disappeared, on account of which the afore- said elementary symptoms may stand preeminent in their whole clearness. It was assumed above, that a habit could occur for the excitation by regurgitation of the nerve current, and thus these symptoms become habitual, while the pathological process might cease. Evidently this assumption would only apply to those cases, in which phonemes and delusions of relativity had existed very long, also at the time of the acute stage of the disease, and for such cases the possibility will have to be admitted, that in a certain measure they are perpetuated as purely function derange- ments. Without mentioning this consideration, it will always be justified at least to perceive in these symptoms Outline of Psychiatry in Clinical Lectures. 301 the signs of a still existing disease process, if under certain circumstances comprehended in the decline. The occurrence of the delusion of circumscribed relativ- ity, as we have made its acquaintance on page 298, forms a second assumption. In the wholly stable condition, which these patients present, and from the appearance of delu- sions of relativity only in very definite situations or at the sight of certain persons, we will have to consider the delusions of relativity as something fixed, habitual, then merely as the result of a fundamental change. The reflec- tion is immediately forced upon us, that these delusions of relativity are nothing new as to contents, then do not really represent an elaboration of the delusion. And if we apply the same criterion to the habitual phonemes and the delusion of relativity in the aforesaid cases, we may be able to expect, that they are characteristic as to contents and in the way, that they may be regarded as the expression of existing delusion, but do not lead to their elaboration or association of new delusions. In fact there are cases of this kind, in which, in spite of the continuance of hallucinations and delusions of relativity, a real systematization will never Occur. In the affect generally a sign will be possessed, whether the hallucinations and delusions of relativity run in habitual channels or contain a novum. The fading of the affect is therefore often of favorable significance, for it proclaims an abatement of the hallucinations and the delusions of rela- tivity and then their gradual cessation. An inner connection between the affect and the occurrence of these active psychotic symptoms cannot be mistaken; for affects, which according to their mode of origin must be designated as normal, often form evidently the exciting cause for the sporadic occurrence of phonemes annd delusions of relativity in otherwise wholly stable states. We have made the acquaintance of an example in the rare case of the occurrence of sporadic phonemes in querulants. That is the reason why patients with sejunctive processes of only limited extent are often doomed to live in the asylum after their 302 C. Werniche. relative recovery. Every attempt to take up the hard struggle for existence results in a return of the psychotic symptoms and only a well conducted asylum offers the patients constant consideration and kind treatment, but also the freedom from material want, which for these patients forms the preliminary condition of their permanent psychical equilibrium. The proposition may be advanced in general, that a fine gauge of the more or less robust constitution of a brain is to be found in its ability to resist affects of especially depressing sort. Apparently able men, who have never passed through a mental disease, are occasionally seen to shun with nervous timidity the occasions of intense affects, which are unavoidable in psychical elaboration of annoying occurrences. On the other hand nothing is more evident to me of the partiality of the derangement and the normal condition of the brain, contrary to the claimed degeneration, than the exalted disposition and enjoyment of contest, with which many querulants carry their struggle for right to the limit, in spite of all disappointments and adversities. As the chief guide, that the disease process has actually terminated, we next have to consider the experiment, whether the return to civil life is successful. Therefore this experiment should be made when possible, and it is the duty of the asylum to provide an active and freer life for those invalids who cannot live otherwise. A second test is equally important, but occasionally out of the question in some cases. It consists in the state of the general health. Its grossest expression is the maintenance of a relatively high weight. Derangements of sleep and appetite are thus excluded. The great influence exercised on nutrition by the brain, which is hardly credited by the laity, will be encoun- tered especially in the acute psychoses. But it is shown in the chronic psychoses and principally in the paranoiac states, that any acute excerbation and all morbid affective states are accompanied by loss of weight, which can only be explained by specific trophic influences and is often in striking contrast to the apparently unaltered balance between Outline of Psychiatry in Clinical Lectures. 303 imports and exports. Experiments in metabolism here offer a grateful task which would undoubtedly lead to interesting and instructive results. XVII. COURSE OF THE CHRONIC PSYCHOSES. ETIOLOGICAL CLASSIFICATION. GRIESINGER'S PRIMORDIAL DE- LIRIUM. The summary knowledge of the paranoiac states we have now acquired, does not of course complete the matter, for you have only become acquainted with certain dominant symptoms, while a large number of others, which may occur intercurrently, will first be met with in the acute psychoses. However you will be able to discover the chief traits of the great majority of paranoiac states, and so satisfy the requirement, which, for instance, must be coin- cident with any psychiatric opinion, namely that the psychiatric symptoms, which constitute the mental derangement of a certain case, are to be accurately enumerated in detail, a requirement unfortunately not often complied with in the opinions of so-called authorities. I cannot sufficiently impress the fact upon you, that you only have the right to declare a person insane when you can prove it by the establishment of certain psychotic symptoms: thus only will you be spared the humiliation of having your opinion subjected to justified criticism by the laity. The “general impression,” on which even well known repre- sentatives of our specialty occasionally depend, when unable to elicit definite psychotic symptoms, is a mere phrase and must rouse the greatest mistrust, if the diagnosis of a par- anoiac state is to be established. The sharpest rebuke is deserved when in cases of the kind, it is claimed it is a matter of a well-known and relatively simple morbid state, to which the name simple chronic paranoia is applicable. Judges, like laymen, may then readily gain the impression of intentional deception and so the standing of all alienists 304 C. Werniche. is damaged. To avoid such blunders it must be considered, that the most evident egotism is far from being a delusion of grandeur, while mistrust, suspicion and hatred of one or Several persons is not a delusion of persecution, or that the paranoiac states are mental derangements relatively easy of demonstration by very definite psychotic symptoms. In some of our most familiar text books you find par- anoia divided into simple, chronic and hallucinatory. How far, or rather how little, such a distinction is justified may be inferred from my descriptions. An independent significance does not fall to the lot of hallucination, at least of the almost ever dominating phonemes. A certain apology is perhaps required, for my having chosen the term paranoiac states to designate all chronic mental derangements with marked change in the contents of consciousness. It might at least be desirable that I attempt to clearly outline the seemingly well known simple chronic paranoia. I purposely refrain from such an attempt, for, in my opinion, there is no well known disease of the sort, if the name is not monopolized for a very small number of cases. I will soon take these up again." With respect to these paranoiac states, the defectiveness of our knowledge is especially manifest, when we attempt to classify them according to their development and subse- queht course. Only certain borderland cases are well known to us. I will briefly recapitulate them according to the data I have so often alluded to. Among the residuary mental derangements there are a certain number, which we have become acquainted with as stable conditions, generally characterized by slight dissemination of the symptoms and integrity of the other functions. Then there are a number of cases far better known, characterized by a very gradual, insidious development and equally slow uniform course, in which true acute paroxysms or marked excerbations never occur. For both types of disease, as for all changes as to contents, a disease curve may be constructed which corre- sponds to the extent of the disease state. The form of the *See page 305. Outline of Psychiatry in Clinical Lectures. 305 curve in the first would run parallel to the axis of the absciss, in the second rise uniformly and slowly from the axis of the absciss. A few remarks are to be devoted to these latter states of extremely chronic course. They correspond to the some- what common type of delusions of persecution of slow origin, to which after a long time a consecutive delusion of grandeur may be added. The period of slow and imper- ceptible development of these cases, owing to which it is often very hard to determine the exact time they begin, is characterized by the occurrence of delusions of relativity and then sporadic phonemes of like purport. A quantivalent idea may be the first symptom to appear and determine the trend of the delusion of relativity. Phonemes gradually become prevalent, and hallucinations of other senses and abnormal sensations are associated. The delusion of persecution is then systematized in two ways. First by explanatory delu- sions, which are related to the fact of the hallucinations: the so-called delusion of physical persecution; then by those, which refer to the author and motive of the persecution. The delusion of grandeur is usually attached to the last series of explanatory delusions, owing to the logical neces- sity of explaining the display of such large force, the demand for so many men. With well retained self-posses- sion and formal action of thought, technical expressions of more or less peculiar sort are finally formed, often first arising as phonemes, which induce the patients to coin words. These patients’ mode of expression thus becomes extremely characteristic. Owing to their well functionating logical apparatus, the whole conception of the world is gradually transformed, and, according to the individual’s mental possession, philosophical systems of more or less peculiar construction may be formulated. Formally correct logic and unmistakable mental fertility are retained to the last. In the philosophical literature of the last century a work of several volumes by a scholar, evidently insane, may have astonished you and led you to shake your head. The final result of the whole disease process is a change in the 306 C. Werniche. contents of all three parts of consciousness, for the change in their own body sooner or later attracts the patient's attention; were a name to be chosen for these cases, it would be a matter of a chronic total psychosis, in the later stages at least. But just as unduestionably the initial symptoms exclusively, and largely the whole first period of the disease is to be sought in the allopsychical part. The delusion of relativity, alone demonstrable for a long time, has the above described allopsychical character, the halluci- nations with the following explanatory delusions effect a gradual, but steady new interpretation of the world, and so for these first years of the disease the designation chronic progressive allopsychosis is proper or chronic hallucinosis. The epithet progressive amply implies, that the psychosis finally becomes total, as it involves the autopsychical part from the time of the delusion of grandeur. It further seems to be characteristic of these cases, that serious motor symptoms never occur. If relatively frequent” still the absolute number of these cases of purely chronic progressive course is small. It is these, which most correspond to seemingly so frequent and common chronic paranoia. The two female patients Schmidt and Reising are examples, the latter also had a quantivalent idea from the first. A third kind of course of the paranoiac states has become familiar to me by a number of cases. It develops in the special way, that it represents a continuation of an attack of acute psychosis, after several attacks of the same have occurred in former years and terminated in complete recovery. I have observed this course to follow acute hal- lucinosis or acute hallucinatory allopsychosis, and generally in alcoholics. The progression of the chronic state, which as to contents always occurs as a delusion of physical per- secution seems to be far more rapid and deleterious, than that of the preceding chronic form. A fourth kind of course of the paranoiac states l can only speak of here in anticipation. In the acute psychoses we will become acquainted with the depressive state of *See All ENIST AND NEUROLOGIST, vol. xx, p. 564. Outline of Psychiatry in Clinical Lectures. 307 melancholia, an acute general disease, which is characterized by the complex affect and the general akinesis intrapsy- chically conditioned. Such a melancholic state may simulate a true melancholia for a long time, until the altered conduct of the patient shows that the intrapsychical derangement of function abates and simultaneously delusions of relativity and corresponding phonemes have made their appearance. It is usually an outbreak of anger, which causes the patient to talk, and now in an instant a picture wholly changed is revealed. The paranoiac state, now evident, is usually equally composed of delusions of persecution and grandeur, outbreaks of violent cursing and tendency to deeds of violence accompany it in almost characteristic manner, and a falsification of the contents of consciousness, even to their confusion, occurs quite quickly. The patients seem to be able to tarry for a long time in this stage of confusion as to contents, with lowered energy in their actions, but without real dementia. I am not clear as to the final termination. Not to be mis- construed, I will remark, that the confusion as to contents does not occur in this kind of course alone, but represents the sequel of any extensive falsification of . consciousness. The patients finally use a train of concepts, which are peculiar to them individually, so that they become incom- prehensible to other individuals and other individuals are misunderstood. The confusion as to contents is only apparent and would not be noticed by another individual with exactly the same falsification of the consciousness. Undoubtedly it will be possible later to determine a series of well characterized types of course among the paranoiac states, other than the four mentioned, but at present I must be satisfied with these allusions and limit myself to the problem here awaiting us. It will consist in ascertaining the laws governing the several psychotic symptoms and the changes as to contents; the combination of the symptoms cannot be mere accident, any more than that in general nervous diseases definite, well characterized groupings of the symptoms are so common. In the latter the reason is evident, owing to the definite arrangement of 308 C. Werniche. the nerve tracts in definite areas. If I now remind you, that in a certain sense we might consider the changes in the contents of consciousness as focal symptoms, we may apply this consideration to them and regard certain groups of symptoms as the expression of definite anatomical arrangements in the association tracts. At present, as stated, we are only on the threshold of our knowledge, and I ought to warn you especially of regarding the types of course above outlined as the ones particularly frequent. In fact they form only a fraction of the many varieties of unknown kind, which are contained in the very numerous paranoiac States. It may perhaps seem strange to you, that in the task of arranging the protean paranoiac states, I seem to disre- gard the etiological principle of classification. If I really did, I would be on the wrong track; but you will observe that I have expressly mentioned the etiology of alcoholism in the psychoses beginning in paroxysms and of progressive course and with the delusion of physical persecution. In fact the question of etiology forms the second equally important problem to be solved. But it would be amiss to talk about lead palsy ere its most common type, bilateral radial paralysis, had become familiar, so also would it be wrong to base the classification of the psychoses wholly on their etiology. Its bias can be shown by the fact, that the acute hallucinosis of the dipsomaniac also occurs in those who do not drink. We now hold that the psychoses are brain disease, and may presume that one and the same focus always produces the same symptoms. A province accessible of investigation is thus offered. Still we cannot expect from definite causative agents, that they will always be manifested at the same focus, any more than that a cerebral hemorrhage is always located at the same place in the brain. The etiological factor therefore will always have to be secondary in the question under consideration. At the same time I am well aware that, under certain circum- stances, the locality affected may be ascertained by the etiology, of which the lead palsy above referred to, as also Outline of Psychiatry in Clinical Lectures. 309 the disease of the posterior columns from alcoholism and syphilis, finally the most common type of progressive pare- sis are examples. In the acute hallucinosis of the dipsomaniac, in hebephrenia and presbyophrenia we will later become acquainted with psychoses, in which it is very similar. But in general it cannot be too strongly empha- sized, that our best principle of classification must be that of the anatomical arrangement, in other words, that of the natural grouping and sequence of the changes with respect to contents. At present I must be satisfied to define my standpoint in these important questions, but reserve the privilege of returning to them more fully later, for the acute psychoses unconditionally demands a definite attitude toward these questions. But a brief mention of this point was not to be avoided; the chronic psychoses are largely the terminations of acute psychoses. But then in the face of certain state- ments of current literature it seems demanded of me not to simply keep silent as to these tendencies.* The writings of a prominent French psychiater, Magnan, have turned the vascillating public opinion in this direction in Germany. You would therefore readily get the impression, that a new, better name had been discovered for a number of generally known clinical facts, and there are really only two large groups of diseases to be differentiated in the province of chronic mental derangements; those of degenerates on one hand and a mental disease not etiologically characteristic, but well pronounced clinically, which the French author terms “Délire chronique à evolution systèmatique,” or “Paranoia completa” by the German translator. As you see, I must contest such a classification on principle, for it practically amounts to the same thing as opposing to all the other mental diseases a form of chronic mental derange- ment, presumably well known clinically, and recognizing for the former only one etiology, that of so-called degeneration. *I am greatly pleased to say that in my critical review of Magnan's theory I encounter Hitzig. But still I believe I perceive a satisfactory agreement in the fundamental views he advances in his excellent book on querulous insanity, in spite of all his polemics against me. 310 - C. Werniche. In my opinion we are here confronted by the same extrav- agance as has frustrated every previous attempt to classify the psychoses. This standard type of an entirely chronic paranoia is carried much too far, as I think, and embraces a large number of psychoses differing from each other and yet to be differentiated. And only thus could the author have arrived at the idea of contrasting it with the whole large province of psychoses occurring in “degenerates.” With respect to these latter cases, I do not doubt that this etio- logical point of view will prove just as useful as many others; but it has been greatly over-rated by Magnan, yet I believe you will be able to learn one fact from it: that psychotic symptoms are prone to occur in “degenerates,” which remain isolated, like the quantivalent idea, or only attain a slight degree of intensity, so that it must still be questionable whether such an individual is to be considered really insane. That such borderland cases are very often met with in “degenerates” is nowhere demonstrated by such evidence as in Magnan’s studies; but it is an exag- geration if the author seems to think that cases, like those I have termed circumscribed autopsychosis or quantivalent idea, occur only in “degenerates.” That is wholly out of the question, unless the presence of the psychosis itself is to be accepted as an evidence of the degeneration. In concluding this discussion, permit me still one remark for the purpose of preventing possible misconceptions. I am well aware that l have very unsatisfactorily performed the task I outlined for myself in giving a faithful descrip- tion of the paranoiac states. You will find later that I have wholly omitted a number of important symptoms, while on the other hand I have mentioned many that really belong to the acute mental diseases. But the diffi- culty here lies in the affair itself. It is really impossible to clearly describe one province alone, as I have attempted, without encroaching on the whole domain and giving it some attention. But this impossibility has proven to be very much greater in the acute mental diseases, so that after many years' work I must finally change entirely the Outline of Psychiatry in Clinical Lectures. 311 plan of my labor and discuss the acute mental diseases, which are the chief source of the paranoiac states, after these. And this also applies to the individual symptoms. Every new symptom appearing spontaneously may give a mental disease an acute character. The majority of the chronic mental diseases are distinguished by acute par- oxysms of new symptoms, which occur at some period of their course. I have intentionally avoided as much as possible a description of these states, because they will form a special chapter in speaking of the acute psychoses; but it was impossible to separate these paroxysms from individual symptoms appearing for the first time, for, as universal in Nature, there are imperceptible transitions. The history of psychiatry is a topic of extreme interest to the expert, but for you, who yet need to be instructed in its rudiments, it must be subordinated to the urgent requirements of the present. Nevertheless I must not omit mentioning one point, whose importance in the history of our science is beyond question. It is the matter of Gries- inger’s primordial delirium. As you will hear so much of this great clinician, it will not seem strange that his text book is still one of those most read and has wrought a marvelous effect in its time. In this book Griesinger takes a standpoint alone and one not shared by well known older authors, in that he contests the occurrence of primary changes in the contents of consciousness without prior melancholic depression, and in 1867* he was converted to a more correct conception in the statement of his “Primordial delirium,” after Snellf had taken the lead in his paper on “Monomania as a primary form of Mental Derangement.” Owing to the dominating position, which is inherent to Griesinger’s personality, you can fancy that the theory of primordial delirium now proclaimed by him agitated all minds and was greeted as a great advancement in our science. I very clearly remember at the time of beginning *First published in 1870 in his "Vortrag zur Eröffnung der psychiatrische Klik, in Arch. f. Psych., 1. +Allg. Zeitsch. f. Psych., Bd. 22, 1865. 312 C. Wernicke. my psychiatric career in 1871, that this point was ever uppermost in the discussion of psychiatric topics. At any rate it was one of the undesigned effects of the book and Griesinger’s teaching, that this only rarely happened, for the interest of all young psychiaters was largely devoted to brain and nerve diseases. In this state of affairs you will be surprised that I have not spoken of “primordial delirium” among the psychotic symptoms, which are to be considered the basis of the paranoiac states. This I will immediately explain. But first permit a remark as to Snell's situation, to whom priority to Griesinger undoubtedly belongs. Why is not Snell’s name instead of Griesinger's united with the famous conception of primordial delirium? The answer is very simple; while the same phenomenon is discussed by both authors, the versatile clinician, skilled in clinical methods only had occasion to reduce it to a definite, elementary psychotic symptom, which he called primordial delirium. Both authors proceed from the same clinical experience, that in a certain kind of insane, whom Gries- inger calls primary paranoiacs, Snell monomaniacs, delusions of persecution appear in exalted, self-conscious disposition, without preceding melancholia,” hence apparently primary. But while Snell was satisfied to grossly outline the course of these cases, the integrity of the intellect, the frequent complication of consecutive delusions of grandeur, Griesinger tried to penetrate deeper into the nature of the affair and find the source of the delusions of persecution and grandeur in primary false ideas, or more definitely, false judgments. To make my meaning clear, l cite some of these judgments. In a patient (a case of a psychosis of fear, e. g.,) the thought arises that his parents, his wife, and children are dead, and he is at once convinced of it. The thought comes to another, that he will be executed, to a third, that he is a millionaire or of noble descent. It is a matter of these “spontaneous thoughts,” which are held to be true, a phenomenon reminding you of imperative conceptions and autochthonic ideas. *In the conception of the older authors, Outline of Psychiatry in Clinical Lectures. 313 Thus at least can I now understand Griesinger and so I perceive his real merit. We see, how he expresses him- self in this respect from his address at the opening of the Psychiatric Clinic on May 4th, 1867.* “According to our present assumption the processes, which result in ideas, occur in the ganglion cells of the gray cerebral cortex. As abnormal gait results from the spinal disease of tabes dorsalis, so by abnormal action of these cortical cells, images, words, ideas, which do not correspond to the reality, must be immediately produced.” We see that Griesinger takes a standpoint very similar to our own. Still the diffi- culty has not escaped him, that irrational judgments might be produced from the preformed material organs of the process of thought. To explain this he points to two series of phenomena. First the derangement of the ganglion cells may be purely functional and excited from other remote places. He names this phenomenon, in which the first excitement may be due, e.g., to sensations in the intes- tines, concurrent ideas. We may at once accept this view and, as you remember, I have repeatedly alluded to such an origin of definite ideas under the term of ideas of fear. The place to discuss this fully will be with the acute psychoses. The second series of clinical phenomena, which he perceives to be analogous to the primary occurrence of certain false judgments in the insane, is the occurrence of imperative conceptions in neurasthenics and the great fre- quency of zoanthropy in delirium potatorum, finally the subjective sensation of a well-defined color, red, in certain pathological (e.g., epileptic) brain states. Here a connection with the regular false judgments of the insane is only to be established with respect to imperative conceptions. So then Griesinger did not understand how the conformibility of these contents, delusions of grandeur and persecution, occurs, which perhaps “in five out of ten patients form the chief purport of the delirium during the whole course of the disease.” We now know, thanks to Meynert, that *Arch..f. Psych., 1 p. 143. 314 C. Wernicke. there are attributes of the primary ego, of the child and primitive man, which are reflected in this conformity, and 1 only need refer you to his essay “Ueber den Wahn” to make it perfectly clear. Man in the primitive state will interpret as actions those events effecting his weal and woe as actions; on this basis delusions of persecution and gran- deur are developed as the two fundamental forms of the individual’s reaction, like that of men to the impressions of the world. But we will now have to ask: Is there actually such a primary origin of the delusions of persecution and gran- deur, as Griesinger thinks? This question I can only affirm conditionally. According to my information the pre- sumably primary delusion of persecution for the chronic psychoses is generally developed either from delusions of relativity, as above described, or as an explanatory delusion, and any mode of origin, in my opinion, is out of the ques- tion for the paranoiac states, if we will not include the delusion of persecution of dementia. The same is true of the delusion of grandeur.t. Still I admit, that besides the consecutive delusion of grandeur, which is developed as the logical sequence of the delusion of persecution, besides the delusion of grandeur of dements, which will be spoken of later, there are still two sources of the so-called delusion of grandeur, which may be readily overlooked and then the occurrence of a primary delusion of grandeur might be sim- ulated. The one is a somatopsychical change in the contents, a hypochondriacal feeling of well-being localized in the chest, like the feeling of fear, and alternating with it. It is usually related to the process of respiration and described as particularly easy respiration. Thus it was for instance in the patient Schulz previously mentioned, Í who fancied he was filled with the Holy Ghost, addressed inspired sermons to the people and traveled to a neighbor- *Sammlung von populär-wissenchaftlichen Vorträgen, 1892, p. 83. *Consequently I believe I am in accord with Snell, who essentially contests the primary occurrence of delusions of grandeur. Die Ueberschätzungsideen der Paranoia. Allr. Zeitseh. f. Psych., Bd. 46, p. 446. IALIENIST AND NEUROLOGIST, vol. xxi. p. 16. Outline "of Psychiatry in Clinical Lectures. 315 ing city to take holy orders from a bishop. The delusion of grandeur is then only a case of my so-called ideas of well-being and forms the counterpart of the feelings of fear already mentioned. The second source is again the delusion of relativity, often in combination with certain quantivalent ideas, another time with the above described hypochondriacal feeling of well-being. The autochthonic ideas arising in cases of the kind, falsification of memories and the delusion of retrospective relativity then serve for embodiment in facts, the completion of the scheme, which is supplied by the exalted disposition and the increased self-feeling. I should expressly mention one exception, so as not to do violence to the clinical facts. A chronic mental disease, developing early in life, Sander’s” “primary paranoia,” seems to occur, in which primordial delirium forms the original source of the grandiose ideas, according to Griesinger. Still pure cases of the kind are only very exceptionally observed. A careful study of these cases almost always permits the delusion of grandeur being traced to one of the elementary psychotic symptoms already mentioned. Except that an early essential mental weakness is peculiar to the majority of these cases of so-called primary paranoia, for the so-called primary paranoia and hebephrenia, to be described later, have many similarities and can be distinctly differentiated only in certain extreme, indisputable cases. According to my experience the most of these cases, in which not one of the real psychotic elements above men- tioned is provable, belong to hebephrenia owing to their early pronounced mental weakness. I cannot conclude this historical excursion without mentioning an important literary production, in which Gries- inger’s primordial delirium has found an eloquent champion, but unfortunately one overshooting the mark. Friedmann in his book “Ueber den Wahn”f seeks the peculiar char- *For a special form of primary paranoia see Arch. f. Psych., I, p. 378. The remarks as to the grandiose delusion on pages 278 and 279 relate to examples of so-called primary paranoia. +Wiesbaden, 1894. 316 C. Wernicke. acter of the delusion—we say the falsifications of consciousness as to contents—in the paranoiac states in those false judgments manifested according to the type of the primordial delirium. The closely related imperative conceptions are therefore regarded as a fundamental symp- tom of “paranoia” accepted by him, but understood in a far different sense. We will see later that his assumption for the acute mental diseases is often true, but his attempt at generalization must be repudiated. In the chronic it is disproven by experience, and we will not go wrong if we charge this one-sided view of the careful investigator to his want of large experience with the insane. DIAGNOSIS OF RAYNAUD’S DISEASE. By DR. ADOLF CALMANN, Hamburg.” HEN Raynaud published his paper on the type of disease, which in its totality has since been named after him, he expressed his opinion, that these symptoms could only be traced to a disease of the nervous system, and he believed it could be located in the spinal cord. He had already had opportunity to separate from the previously observed cases of the symptom complex a number, which had followed some constitutional disease, usually an affec- tion of the kidneys or of the circulatory apparatus. Less frequently of late are cases published as Raynaud’s disease, which are to be traced to the lesion of Some non-nervous organ. Still if we leave this out of consideration at present, almost all recent authors are unanimous in regarding Ray- naud's disease as a nervous affection in and of itself or as one of its symptoms. In the course of time the boundaries for the localization of the causes of the disease have been further fixed, in that the peripheral nerves will be given a share in the etiology of Raynaud’s affection and on the other hand, irrespective of an anatomical cause of the trouble, considered as a purely functional disease, as a neurosis. First Moun- steint, then Pitres and Vaillardt found in all of three cases, which had been made certain by autopsy, a severe degen- erative neuritis in the affected organs; in one of the cases of these authors there was also discovered a slight diffuse sclerosis in the dorsal and lumbar regions of the cord. *English by Dr. W. Alfred McCorn, Resident Physician, “River Crest,” Astoria, New York City. +Ueber spontane Gangrân und Infarcte. Inaugural dissertation. Strassburg, 1884. *Archiv de Physiologie, 1885, Series III, Bd. V. [317] 3.18 Adolf Calmann. Affleck’s” observation supplements these conditions, who was able to demonstrate an almost complete destruction of the plantar nerve by neuritis in a foot amputated for sym- metrical gangrene. The opinion of these four authors, that lesion of the nerves could produce the Raynaud symp- tom complex, soon encountered decided opposition. Dehio, f who likewise had occasion to study degenerative changes of the nerves in the amputated leg of a woman suffering with symmetrical gangrene, emphatically opposes regarding this damage of the nerves as a consequence of the gangrene and the nutritive disturbances of the organ appearing with it. As he was unable to demonstrate a cause for the disease in his case, he joined those who regard Raynaud’s disease to be a trouble of purely neurotic origin. Those who assume an immaterial trouble of nervous nature in all of the Raynaud cases, far overshoot the mark. Opposed to such a partial opinion is a not inconsiderable number of observations, which demonstrate in vivo or by obduction an anatomically developed disease process to be the cause of the local asphyxia and its sequela. Still the further fact speaks with much greater weight, that in all previous cases coming to the autopsy table, as far as I can learn from my review of literature, an organic disease of the nervous system, could not once be excluded. To the three cases above reported, of which two at least are not to be considered in the matter according to Dehio's opinion and those who share it, the following are to be added. As fourth Hochenegg's case, f whose cause was syringo- myelia. The fifth we owe to Fagge, who found as cause of a symmetrical gangrene in a lady of 26 a mediastinal tumor which, anterior to the vertebral column, had grown about the first dorsal nerves and the trunk of the splanch- nic. Further, as sixth the case of tabes dorsalis, combined *British Medical Journal, December 8, 1888. tdeutsche Zeitschrift fur Nervenheilkunde, 1893. 1Wiener Medicinische Jahrbucher, 1885, p. 569, FSee Thiersch, Ein Fall von symmetrischer Gangrán der Extremitäten, Münchener Med. Wochenschrift, 1895, p. 1120. Diagnosis of Raynaud's Disease. 319 with acute neuritis of both peronei in which Kornfeld* had observed a pronounced Raynaud symptom complex. As seventh case is the observation of Hubertus Bervoets:f An inebriate with dementia and symptoms of softening in the left cerebral hemisphere had symmetrical gangrene of the toes. The autopsy revealed softening in the left cerebral hemisphere and extensive arteritis, apicitis, degeneration of the posterior tibial nerve and collateral nerve of the great toe on both sides. Arteritis of the posterior tibral artery. In this case at any rate the arterio-sclerosis on the one hand could have produced the focal diseases in the cerebrum, on the other the symmetrical gangrene with secondary neuritis; but Bervoets demonstrated by vivisection, that a destruction of the nerves results in a disease of the arterial walls, which then in his opinion would be the indirect cause of symmetrical gangrene. Hence, in his case, the degeneration of the nerves could be regarded as the funda- mental cause of the Raynaud symptoms and admit its relation to this compilation. With greater precaution should the case of Warfvinge? be utilized, in which the course of the disease and autopsy findings speak for a severe infectious disease, complicated by local asphyxia, where further only macroscopic changes of the nerve centres are found, which the microscopical examination does not confirm. Whereas Thiersch's|| observation is to be entirely excluded, who in a case of symmetrical gangrene found an arterio-sclerosis on the autopsy, regarded it as the cause of the vasomotor disturbances, but still denoted it as Ray- naud's disease. lf these autopsy findings, as stated, speak so much in favor of the assumption of an anatomically demonstrable cause of the symmetrical gangrene, we must still admit its conception as a pure neurosis. We must otherwise disre- gard the relatively large number of observations on the living, in which the most careful examination of all the *Wiener, Medicinische Presse, 1892, No. 50, 51. #See review in Neurologischen Centralblatt, 1895, No. 10. 1See Review, Schmidt's Jahrbücher, 1890, No. 228, p. 113. Münchener Med. Wochenschrift, 26 November, 1896, p. 7. 320 Adolf Calmann. organs with all the means of our modern diagnosis cannot elicit the evidence of an organic change; and to assume that in all these cases an existing anatomical lesion of some organ has not been discovered, is to place a doubt on the value of our diagnosis! To bring this question, which in greater part is subject to purely theoretical reflections, to the level of incontestable facts and by these to attain a definitive solution, there are simultaneously two ways open to us: vivisection and Statistics. The first would be obliged to demonstrate, that by injury of the peripheral nerves or the central nervous system the Raynaud symptom complex could be produced. As I have above indicated, Bervoets” experiment was successful in this direction: the section of the sciatic caused a marked change in the arteries, thickening of the arterial walls at the expense of the lumen, atrophy of the peripheral muscle cells, increase of the central muscle cells of the media even to rupture through membrana elastica, by which an aneurysm may also originate. In these extremities a gangrene had developed, for which Bervoets made respon- sible as immediate cause the disease of the arteries. Still, in this way only would the evidence be adduced that Raynaud’s disease is the sequel of an organic disease of the nervous system; it thus can neither be excluded or admitted to be a purely functional neurosis. Here now statistics should be taken account of, which by the greatest possible number of thorough and careful observations, com- pleted whenever possible by an autopsy, could supply a decided explanation. If these always show an organic disease of the nervous system to be the basis of symmetri- cal gangrene, we must finally desist from regarding it a neurosis, while inversely a single negative autopsy finding would suffice to establish once and for all the possibility of an immaterial foundation of Raynaud’s disease. From this point of view I permit myself to publish a series of pertinent cases, one of them with a report of the *Owing to my ignorance of the Dutch I must be satisfied with the notices in their reviews, Diagnosis of Raynaud's Disease. 321 autopsy; I feel myself the more justified in this, for all the cases are characterized by a series of extremely rarely observed symptoms and complications. Case 1.* Compression of the spinal cord in the lumbar region by a tumor. Raynaud’s Disease, Erythromelalgia. Jacob F., 24, day laborer, admitted to the III medical clinic in August, 1893, for years has had lumbago, pains and weak- ness in the legs. For three months disturbances of sensibility of an objective nature have existed in the legs. The vasomotor disturbance the patient has noticed for Several months. An examination showed as follows: vesical and rectal disturbances with involuntary passage of urine and feces. Paralysis and marked atrophy of the extensors of the lower extremities. No contractures. Disorders of sensation, and lowered sensibility in both lower extremities, increasing in intensity from the periphery toward the centre. Above the knee-joints no disorders of sensibility. The disorders of sensibility are the same for all qualities. Patellar reflexes absent. During the entire hospital residence vasomotor disturb- ances constantly occurred. Once both feet were markedly swollen, without albumen or casts being demonstrated in the urine, or symptoms of heart weakness being evident. This oedema was very transient, often continued only a few hours to suddenly disappear, then to recur and persist for a longer or shorter period. Alternating with these phenomena the symptom com- plex of Raynaud's affection occurred, and only in the lower extremities, these symptoms not once being observed in the upper. First pallor of the feet, the toes in particular, occurred, then an intensely blue color of the feet followed. The latter attacks recurred twice to three times a week and always lasted for several hours. Until February 7th these were the only symptoms; on this day after one of the attacks a gangrenous spot the size of a dollar, occurred perfectly symmetrical on the dorsum of the skin of both feet. The next day the attack recurred, and the symmet- *This case has been fully worked up by Dr. Schlesinger, owing to especially interest- ing symptoms. From his clinical history only the data are taken, which are of value to this "paper. 322 Adolf Calmann. rical gangrene occurred again, which was especially localized on the terminal phalanges of the large and small toes. (Bed pressure could not have been the cause of these symptoms, for the bed covers were supported by hoops). Besides these disturbances during the first months of the hospital residence the typical symptom complex of erythro- melalgia existed. The patient finally succumbed to pneumonia. During the last few days a cystitis developed, during the last fourteen days albumen and cylinders had been found in the urine, of which previously in spite of the most careful examination nothing could be demonstrated. Autopsy findings: Tumor extending from the nerve roots of the Ill and IV lumbar nerves, which had produced an intense compression of the spinal cord. The tumor was 7,5 cm. long and 1,5 cm. thick. The histological examination by Doctor Schlesinger revealed a small celled sarcoma. The examination of the peripheral nerves showed considerable degeneration, corresponding to the severity of the change in the spinal cord. The vessels were normal, the walls on histological examination only unessentially changed. Case 2. Compression of the lumbar cord and the cauda equinea; Raynaud's disease. Rosa K., 13, school girl. (Under observation in the summer of 1893). No nervous diseases in the family. Patient had had no infectious disease recently, particularly not diphtheria. For two years the patient has had urinary troubles, the urine often passing involuntarily. For six months paraesthesias in both legs, as well as a girdle sensation have occurred. Since then she has complained of pains in the feet, further of weakness in the right foot. During the last week before her admission to the lll medical clinic in Vienna intense vasomotor disturbances in the feet occurred, for eight days pains in the knee. Status praesens: Pupils react well, of equal size, no double vision. Corneal reflex prompt, fundus normal. No disturbances of sensibility in the face, tested for all qualities. The same is true of the upper extremities, where the gross strength is unweakened; muscles not atrophied. Diagnosis of Raynaud’s Disease. 323 A kyphosis in the lower segment of the dorsal vertebrae, marked lordosis of the lumbar vertebrae (no signs of tuber- culosis on repeated examination). The vertebrae are not sensitive to pressure and sudden contact. Slight contact is not recognized on the thigh, needle pricks are usually felt. Temperature impressions are poorly felt on the left espe- cially. On the leg hypalgesia from the knee downward, more marked on the external than on the internal surface. Marked hyperaesthesia of the feet; deep incisions even were not felt. The plantar reflex on both sides entirely absent; everywhere contact is felt from the knee down- ward, the pain sense is markedly lowered. On both legs, especially on the external side, great differences in temperature are often only recognized. Feet completely thermoanaesthetic. Passive movements of the toes not recognized on the right. The same disorders exist in both ankle, knee and hip joints. In a triangle, whose base is above the anus, the right and left sides extend down to the middle of the inner sides of the thighs, the sense of pain and for temperature is wanting. Anal reflexes are not present. Active extension is well executed in the knee joints; after their flexion the strength in the right leg is lowered. Movements are execu- ted in the ankle joints with sufficient force. The gait is extremely unsteady, the legs are thrown outward, marked swaying on turning around quickly. Romberg’s symptom well marked. Patellar reflexes absent. In the atrophied muscles material lowering of the faradic and galvanic excitability, still all the muscles are excitable directly as well as by the nerves. The cathodal closure contraction prevails everywhere. The twitchings follow instantly, no reaction of degeneration. The vasomotor disorders began in the feet, which became blue under all possible conditions. During the observation of the patient they presented the following: In the legs and most pronounced in the feet a marked swelling with oedema on the dorsal surface of the feet was first observed, then a strikingly livid color without oºdema. 324 . Adolf Calmann. This discoloration and the Oedema were never observed simultaneously. The livid discoloration, which was often a very dark blue, always occurred after a stage in which both feet had been strikingly white. This condition lasted several minutes as a rule, rarely longer than a quarter of an hour, and then the blue color occurred, which persisted for hours. Then for a longer time, often several days, no attack was to be observed. In this way the vasomotor disorders constantly alternated with normal conditions of the skin during a treatment of many months. They were always independent of the temperature, for the local asphyxia occurred in cold as well as in warm rooms. The gait gradually became more unsteady, the bladder disturbances more pronounced, the livid discoloration of the legs remained stationary; it never amounted to a gangren- ous condition. Likewise every indication of erythromelalgia was wanting. During the whole period of observation the urine was never found to contain albumen, casts or Sugar. The diagnosis of compression of the lumbar cord and cauda equinea with periodical manifestation of Raynaud's symptom complex was made. Further observation of the patient was refused. Several months later it was learned from a letter from the attending physician a pronounced kyphosis of the lumbar vertebrae had been determined. In these two cases, perfectly congruent in their clinical manifestations, the examination in vivo showed the inter- esting result: that the manifestations of symmetrical local asphyxia and gangrene were produced by a severe injury of the spinal cord, the site of the disease focus could be accurately determined, whose nature was explained in case two by the deformity of the spinal column, in case one by the autopsy. The changes of the nerves in case one could be claimed as support of the opinion of those, who seek the cause of Raynaud’s phenomenon in a neuritis. Surely in these cases the degeneration of the nerves is not to be regarded as a consequence of the vasomotor disturbances, they are rather to be considered as an attendant condition of the severe lesion of the spinal cord. But whether they Diagnosis of Raynaud's Disease. 325 directly cause the symmetrical disturbances and likewise take the part of mediator for the spinal cord, is still very questionable, if the insignificance of the nerve change, to which the clinical history expressly points, is considered. In such cases the original Raynaud theory seems to correctly exist, which assumes a morbid contraction of the small, perfectly, normal vessels excited from the spinal cord. I might still emphasize that in both cases the vasomotor disturbances occurred paroxysmally and represent the differ- ent stages of syncopy, asphyxia and gangrene described by Raynaud; these phenomena then have nothing in common with the stationary circulatory disorders produced by com- plete vascular paralysis, which may be observed in severe lesions of the spinal cord. The following four cases may be comprised in one group, for they agree in their essential symptoms and cannot be separated from each other from the etiological standpoint, except perhaps case six. Case 3. Marcus B., 26, apothecary from Charcow, was admitted in August to the Ill medical clinic. With regard to hereditary conditions it is to be mentioned that a grand- mother of the patient had had the same disease. For seven or eight years the patient has had attacks of Raynaud’s disease, which were manifested first in the winter only, but later in the summer also. Since then he has a constant feeling of coldness in his hands, so that he has worn winter gloves in the summer. In the course of the last years these very painful and severely dessecting panares followed the attacks of local asphyxia, so that he was incapable of work for nearly two years owing to the con- tinued inflammatory processes in the fingers. The panares were perfectly symmetrical, if, e.g., it began on the left index finger in two or three days it also showed itself on the right index finger. In the course of time a striking change of form of the hands, to be more fully described later, occurred. Lues was neither to be demonstrated anamnestically, nor was a careful examination at the clinic of Prof. Kaposi able to establish any indications of it. Potus is denied. 326 Adolf Calmann. Ergotin poisoning has never occurred in the vicinity where the patient resides. His occupation offered no occasion for his affection. The most careful, repeated examination of the patient found perfectly normal conditions with respect to the respiratory as also to the circulatory tract. No phenomena of the nervous system. Both hands at the two terminal phalanges of the fingers have a strikingly smooth skin. The wrinkles on the fingers are completely effaced; the skin gives the impression of being too short for the fingers; at other places on the fingers and on the hands extremely delicate and thin, and is nowhere raised into wrinkles. On all the finger tips on both sides are a multitude of small, irregular scars from old panares. The fingers are of peculiar form, strikingly tapered toward the tips, the last phalanges as though they had been bitten off, the nails are extremely short, cracked, exfoliated, bent down at the sides, similar to birds’ claws. At the finger ends numerous deep defects are to be seen (from panares). Nothing striking is to be noticed in the skin of the palms. If the patient’s hands are immersed in cold water a very intense attack of local asphyxia occurs immediately. With formication both hands become snow white (syn- copy); at this time the skin is perfectly insensible, deep needle pricks produce no sensation of pain, no hemorrhage. A short time after becoming white a deep blue color of the hands and fingers occurs, which continues several hours and very tormenting parassthesia (formication) follows. Gangrene has never occurred. In the lower extremities similar attacks occur in the feet and toes. Still they are less intense than in the hands. The skin is changed to a less degree, is smooth and shortened, yet in no way to the extent as in the upper extremities; a striking change of form has not occurred in the toes. No abnormal secretion of perspiration exists. During the attack sensibility for all qualities is greatly lowered, in the intervals it is perfectly normal. Frequently repeated examinations of the urine disclosed no pathological components. In spite of all medication, faradization, galva- Diagnosis of Raynaud’s Disease. - 327 nization, internal administration of arsenic, nitrate of silyer, etc., no improvement could be attained. Case 4. Barbara B., 48, operator. Patient has had no Serious illness, has aborted twice, otherwise no anamnestic indication of lues. At 23 the first symptoms of her present trouble manifested themselves. After getting cold a com- plate whiteness of the fingers occurred, which was followed by a blue color. These symptoms recurred paroxysmally and increased in cold weather especially. After these attacks the patient had been troubled many years by very painful panares occurring in the fingers frequently. Vasomotor dis- turbances likewise manifested themselves in the feet, yet never amounted to panares. Status praesens: Extensive vitiligo about the eyes and head; the balance of the skin of a dark color. Extensive choroidal changes in the fundus. No sensory or motor disturbances in the face, shoulder and arms. In the hands the livid discoloration is marked, which is the most pronounced in the fingers. The skin over the metacarpal eminences is white (vitiligo). The skin of the fingers of both hands is stretched perfectly smooth and wrinkleless, only in the second and third fingers as well as the thumb of the right hand at the first intraphalangeal joints wrinkles are perceptible on the flexor surface. Over the second intraphalangeal joints the skin is perfectly smooth. The smooth skin nowhere shows a trace of hair; perspiration is completely absent. The form of the fingers is markedly changed, the fingers are pointed at the end, the terminal phalanges being especially rounded. Owing to the tense skin the movements of the fingers are materially limited, they can only be imperfectly rolled up in fist; spreading the fingers is only imperfectly accom- plished. The nails on both hands, but especially of the right, are very small, ridged longitudinally, greatly arched, readily broken; the nail of the index finger of the left hand is greatly affected. On the flexor surface of the hands the changes are less pronounced; on the terminal phalanges they are more marked. In each terminal phalangus slight defects are seen which have arisen from the panares. 328 Adolf Calmann. Consequently the finger tips look as if pricked. Slight contacts to the hands are everywhere felt and correctly located. Pain and temperature senses are perfectly intact. The toes also are of an intense livid color, yet the skin is not so much changed as in the hands, especially not so smooth and shortened. No signs of panares in the feet. Senses of touch, pain and temperature retained; no muscu- lar atrophies. - The patellar reflexes are somewhat exaggerated; the peripheral nerve trunks are not sensitive to pressure. Radial artery on both sides small, yet not thickened. No sugar, albumen or casts in the urine. Case 5. Marie B., 31, domestic. Admitted April 26th, 1894. For eight years a bluish discoloration of the fingers has manifested itself, especially under the influence of cold. Painful panares are very frequently associated with a burning sensation in the fingers. Menses occasionally irregular, no bladder or intestinal disturbances. Status praesens: Radial artery on the two sides unequal. At the apex of the lungs a difference in resonance and a few rales on the right. Heart tones clear; no dullness over the sternum. Subclavian artery the same on both sides. In the face the naso-labial wrinkles very especially marked on both sides. The facial expression is mask-like, the play of the mimic muscles almost abolished, the nose attenuated, the nostrils slightly drawn upward, so that the septum seems prominent. Otherwise no changes in the face. Sensation retained for all qualities. On the trunk and extremities slight contacts are everywhere promptly felt; pain sense is present. The nerves are nowhere sensitive to pressure. Temperature sense on the extensor surface of the hands and fingers good, on the flexor somewhat blunted. Sense of position good. Neither in the shoulder nor in the arms and hands are muscular atrophies present. The grip of the hands is very weak with respect to musculature. Flexion and extension of the forearm, pronation and supination are unimpaired; at the wrist flexion is bad, extension good. Biceps and triceps reflexes somewhat exaggerated, Diagnosis of Raynaud’s Disease. 329 In the lower extremities the senses of touch, pain and temperature are everywhere normal; the nerves are not sensitive to pressure. The motor strength corresponds to the musculature, the patellar reflex exaggerated, foot clonus indicated. The vasomotor disturbances are as follows: the whole backs of the hands and the lower fourth of the forearm are swollen, the skin is raised with difficulty, as well as on other parts of the forearm. The feeling of oedema is thus present without the finger impressions being retained in the skin. The forearm is so deformed by this swelling that it is thickened distally, instead of being attenuated. The depressions between the bones of the metacarpo- phalangeal joints are almost effaced; the fingers thickened, dirty livid blue on the volar and dorsal surfaces. The wrinkles over the first intraphalangeal joints are entirely effaced, only here and there is a wrinkle retained. The nails are deformed, wrinkled, especially on the left middle finger irregularly arched and flattened. The surface of the nails of the right hand is markedly furrowed, the nail of the middle finger greatly shortened, overgrown by the skin of the root of the nail. On the fingers are seen several rhagades several milli- meters long, covered with crusts, which correspond in part to the fissuring of the skin. The fingers feel cold to them- selves. In the pulp of the right and left ring fingers are atrophic spots covered with crusts or open the size of half a lentil. The skin of the third phalanges is scarcely to be raised, on the other phalanges this is wholly impossible. No bone thickening, no abnormal perspiration exist. The livid discoloration extends over the lower fourth of the forearm. On the trunk the skin is hyperaesthetic, opening the dress immediately excites cutis anserina. In the lower extremities the foot is strikingly large, especially very plump about the ankle. The skin feels doughy, as though oedematous; yet firm pressure fails to produce pitting. On top of the left foot there are irregular spots of livid blue, mostly isolated, occasionally confluent, 330 Adolf Calmann. which become white on pressure. Slight formation of varices. No pathological constituents in the urine. Case 6. Marie F., 42, seamstress. Father died of apoplexy, mother of tabes. Patient has never given birth to a child nor aborted. Potus is denied, no indications of lues. Four years ago the fingers became perfectly white for some time. For six years the patient has noticed that when she comes into a warm room from the cold, her hands are blue and swollen, so that she cannot double up her fist. Similar symptoms also occurred in the feet. Soon after all the fingers, with the exception of the fifth of the left hand began to ulcerate with great pain. For six months the ulceration has been very intense, the patient also notices that her hands have become somewhat awkward. The face, especially the lips and tongue, became slightly blue, the tongue entirely immovable. On Christmas night of 1893 she had an attack of erysipelas, at the same time Oedema occurred in the trunk and legs, yet not in the arms; likewise she could not uri- nate. These symptoms soon passed away completely. For four years she has frequently had headache and vertigo, yet never double vision. Status praesens: In the face no nerve troubles. The left radial artery is somewhat weaker than the right, but not rigid, the temporal arteries are not tortuous. Both hands are of an extreme blue color, the fingers are perfectly blue and feet cold. The forms of the fingers are not essentially changed, especially the nails; while the phalanges seem only somewhat shortened, they are very much shorter, very scaly and striated. The finger tips in part have lost their roundness from marked loss of sub- stance and scars. The left index finger seems the most deformed, on which the nail is very greatly shortened. On the right thumb there is a small loss of substance, which is sharply defined; the bottom of this loss of substance is in a state of dry gangrene; it extends under the bed of the nail. (It is probably the result of the application of grabolic compresses). Diagnosis of Raynaud's Disease. 331 The pains are very intense in the development of a panaris. Otherwise no changes are to be seen in the skin of the fingers. There are no muscular atrophies in the hands, the smaller muscles are wholly intact. Active move- ments are possible to their fullest extent, corresponding to the strength of the muscles. Tactile sense is somewhat blunted in the cyanotic finger tips, senses of pain, temper- ature and position are normal. In the feet livid discoloration is found, which is the most marked by far in the great toes. There is no striking deformity of the toes, only the fourth right toe is somewhat swollen. (In this toe very painful panares, combined with lymphangitis have developed four times apparently without cause). Contacts to the feet are felt, pinching folds of skin is painful, the thermic sensibility is blunted, only at the time of the attacks, the patellar reflexes are markedly exaggerated, as well as the biceps, triceps and periosteal reflexes. The nerve trunks are nowhere sensitive to pressure. Romberg’s symptom is slight, otherwise no symptoms which indicate a spinal trouble. No abnormalities in the organs of the chest and abdomen. The urine contains no pathological constituents. I will add to these clinical histories, that all the cases were treated with the usual remedies, faradization, galvaniz- ation, arsenic, full diet, etc., without more than a temporary improvement being attained, apparently wholly independent of the therapy. In the cases just described, especially the third, fourth and fifth, a double symptom complex excites our attention, which in all the clinical histories is described almost exactly the same and point to a perfect type. Except the well-known Raynaud type, the syncopy, local asphyxia and gangrene, of which the several stages are not all perfect in the cases, the occurrence of so many often recurring panares, which according to the statements of the patients are extremely painful, surprise us. Of late diseases, in which the occurrence of multiple, constantly recurring panares play an important part, have been carefully studied. It is 332 Adolf Calmann. well known that by reason of clinical observations with respect to otherwise peculiar conditions Morvan has set off from all others a group of these cases as a really new disease and advanced the opinion that this disease had a nervous basis. All the cases of Morvan were distinguished by the peculiarity, that the so frequently recurrent panares were always painless. These interesting conditions were soon subjects of active discussion; Bernhardt,” later Hoff- mann'ſ declared that these cases were identical with syrin- gomyelia. A greater part of the French school claimed on the contrary that Morvan's disease is identical with lepra, on the strength of Zambacos' findings.: According to Schlesing- er’s investigations this symptom complex would apply as well to lepra as also syringomyelia. In all these papers and in all these discussions the rare condition had always attracted attention, that the panares were painless, that then likewise in the analgesia a certain factor of explanation was simul- taneously afforded for the occurrence of panares. The assumption might be accepted that injuries in these individuals are not so readily noticed, borne longer and more readily infected. - But in our cases it is not a matter of painless panares; on the other hand the patients unanimously state that the inflammatory processes were very painful. From considera- tion of a larger number of cases it is shown that also in syringomyelia at first panares may occur, which are very painful and very often recur; the subsequent purulent foci are painless.S But in our cases the purulent inflammatory processes have recurred for a number of years in like intensity and painfulness, hence every reason for assuming a syringomyelia is wanting; lepra could scarcely be thought of, for all the patients, with the exception of the apothecary, came from regions free from lepra and have only lived in such; the apothecary came from Russia, had also lived for a long *Ueber die sogenannte Morvan' sche Krankheit. Deutsche med. Wochenschrift 1891, No. 8. †Zur Lehre von der Syringomyelie. Deutsche Zeitschrift fur Nervenheilkunde, Bd. III IMaladie de Morvan, Semaine medicale, 1893, p. 289. |Die Syringomyelie, 1895. #See Schlesinger, Die Syringomyelie, p. 41. Diagnosis of Raynaud’s Disease. 333 time in a leprous vicinity, but on a careful examination by Professor Kaposi, he as well as the other patients espe- cially examined in this respect, did not present the least sign of lepra. Consequently l believe I am justified in regarding the occurrence of these multiple panares as a peculiarity of the spontaneous Raynaud symptom complex heretofore insufficiently valued. But I cannot bring myself to trace these symptoms to the same nervous condition as the vaso- motor disturbances; I believe rather, that these suppurating foci are produced by external infection which can the more readily occur, for the anaesthesia accompanying the attacks favor the origin of slight injuries and their presence may escape the patient’s notice. Besides, the tissues, which are in a poor state of nutrition, offer favorable soil for infectious germs. In this opinion the fact cannot make me hesitate, that in one of the four cases (case 3) the panares were symmetrical; I believe that the patient has laid stress on the oft-recurring accident; in the other three cases at least nothing is said of such symmetry of the panares. I believe I may also utilize the fact for my opinion, that the suppurations of the cellular tissue occur preferably in the hands, which are subject far more than the feet to mechanical and chemical injuries. As a farther differential symptom of great importance I might refer to the changes in the skin and their sequela, developed to the fullest in cases 3, 4 and 5. The skin of the affected fingers is dry, rough, harsh, it cannot be sep- arated from its subcutaneous tissue, not raised in folds, it seems shortened, the joint folds are in great part effaced especially on the backs of the fingers, the movements of the fingers are limited, in short we have the pronounced picture of scleroderma, respectively sclerodactylia. We may even study the different stages in the several cases. While in cases 3, 4 and 5 especially the shortening of the skin on the fingers, the effacement of the folds, etc., represents the developed process, the condition, in the upper and especially the lower extremities (in case 5) the boggy condition of the skin, which still pits only partially and 334 Adolf Calmann. then on long pressure, indicates the process just developing. The spots of vitiligo (in case 4) on the head and over the metacarpal joints are simply the residues of an already terminated sclerodermic process. The peculiar changes in the finger nails, their scaliness, the longitudinal ridging, their curvature, the intensification or abolition of their normal development have apparently been produced in common as well by the panares and the loss of substance and pro- duction of scars thus arising, as also by the scleroderma, which is likewise characterized by cicatricial tissue. The question whether both affections can be traced to one and the same cause, we must unconditionally affirm, even if for the scleroderma as for Raynaud's disease an affection of the nervous system is accepted as a causative factor. It was M. Ball,” who first stated in general that Raynaud’s disease offers so many analogies to certain cases of sclerodactylia, that it is treated by several authors as one and the same disease. Faviert sees in both diseases vasomotor disturbances, produced by an exaggeration of the reflex excitability. Eulenburg, f who for years has held to the idea that scleroderma is a nervous disease, recentlyl explained it directly as a trophoneurosis and mentions in this connection a case with the complicated symptom complex of scleroderma, elephantiasias and Raynaud’s disease. Almost convincing of the nervous foundation of the two diseases seems to me Chauffard'ss observation, who saw scleroderma occur with unilateral atrophy of the tongue in connection with the Raynaud symptom complex. Still it should at least be considered that the sclero- derma is a direct result of the nutritive disturbances composing the Raynaud symptom complex, then is not a disease coincident with it on like basis, but is a secondary manifestation of the local asphyxia. But I do not perceive why the disturbances accepted by Raynaud in the inner- *See Legroux: Asphyxia locale et sclerodermie, Gazette des hospitaux, 1880, No.100 +Ouelques considerations sur les rapports entre la sclerodermie spontanee, et la gangrene symmetridue des extremities, These, Paris, 1880. IZeitschrift fur klinische Medicin, Bd. V. Heft 5. Deutsche med. Wochenschrift, 1894, No. 21, 22. 3Gazette des Hospitaux, 1895, No. 82. Diagnosis of Raynaud’s Disease. 335 vation of the vessels should not be able to produce on long continuance, except the more transitory manifestations of syncopy and asphyxia, the remaining tissue changes of scleroderma as well as a gangrene; I therefore continue to regard the scleroderma as a condition etiologically equivalent to Raynaud’s affection and not subordinate to it. In cases 1 and 2 it did not perhaps reach the development of sclero- derma, because the vasomotor disturbances lasted only a relatively short time; possibly their longer duration would have had the same result, just as in the large majority of Raynaud's cases now observed, which occur without the complication of the scleroderma. This combined disease then seems justly to be regarded as a functional neurosis, and so far as l can ascertain, no case has been known, in which an organic lesion of the nervous apparatus could be proven, that could be claimed to be the cause of these two processes occurring together. Hence I believe I am justified in considering for the present at least, cases 3, 4 and 5 as pure neuroses; the incipient disease of the apex of the lungs in case 5 is scarcely con- nected etiologically with the vasomotor disturbances—whereas case 6 is characterized by few abnormal manifestations on the part of the central nervous system (slight manifestation of Romberg’s symptom, significant exaggeration of the reflexes), these are insufficient to permit the assumption with any probability of a spinal or other organic nerve trouble, on the other hand they may be provided for with- out great difficulty in the picture of a neurosis. If we embrace the six cases described, they on the one hand again confirm the opinion, that the Raynaud symptom complex may occur without demonstrable anatomical disease of the central nervous system, on the other they enrich the casuistics of cases, in which the Raynaud manifestations are only symptoms of an affection of the central nervous organs, especially of the spinal cord. They afford no grounds for considering a disease of the peripheral nerves as the cause of the symmetrical gangrene, equally little for hysteria, the only neurosis, which many authors would regard as the cause of Raynaud’s disease. Further I have gained 336 Adolf Calmann. the impression from these cases, that the Raynaud manifes- tations on a neurotic basis have an entirely different character than those occurring only symptomatically. In these the symptoms of local asphyxia and syncopy are not so intense as in the former. In the cases in which the spinal cord was affected the vasomotor disturbances were limited to one part of the body (the feet), without tendency to extend to larger parts of the body, at first they occur only temporarily, permanent paraesthesias were absent, in short all these manifestations are in the background in com- parison to the typical symptoms in spinal cord trouble. In both our cases the temporary oedema was remarkable, which preceded or alternated with the Raynaud symptoms. This occlema is to be regarded as a spinal oedema, as it has first been described by Remak.” There was no sign of a permanent deformity from scleroderma. How differently are the vasomotor disturbances in the four other cases! The typical local manifestations are complicated by the occur- rence of numerous panares; the morbid phenomena spread from the upper extremities to the lower, the face did not escape; they led to severe disorders of sensation, preferably of a subjective nature; finally the symptom type of sclero- derma was associated to induce severe and scarcely reparable changes in the skin and striking deformities of the affected limbs. In conclusion I might still add that l have intentionally avoided taking up the question by what means the mani- festations of local syncopy, asphyxia and symmetrical gangrene are directly produced, whether by trophoneurotic or angioneurotic influences. Opinions here are in general very divided and my cases in no way contribute to the explanation of this question, hence l have been necessitated to pass over it entirely. *Berliner klinische Wochenschrift, 1889, No. 2, Oedema der oberen Extremitat en auf spinaler Basis. - RESEARCH IN COMPARATIVE CYTOL- OGY OF THE NERVOUS SYSTEM OF THE VERTEBRATES. By GUISEPPE LEWI, M. D.* [Concluded from page 110, Volume XXI, January, 1900.] N summing up, I think I have shown in the central cells the existence of fibrils in the fundamental substance, not long and independent but forming anastamoses which cannot be readily observed, because hidden by the fibrils which are interwoven in every direction. The anastomoses tend to occur more rarely in those portions of the cell that are devoted more especially to conduction than to specific functions, and finally become parallel in the parts that are exclusively conductive, as in the ends of the dendrites. How can we reconcile these results with those of Dogiel and Paladino who saw continuous fibrils? Is it possible that the technic employed by these authors, (staining during life, with Müller’s fixative) produces an agglutination of the delicate fibrils into larger continuous bundles? Or else, perhaps, does fixation with corrosive sublimate or with Hermann's fluid cause the fibrils to break up into frag- ments in such a way as to make them appear discontinuous? In case this were so, how could the anastamosing fibrils spread out as I have certainly observed? It will fall to the lot of later observers to decide whether the technic adopted by me and by others, is the one that from the best figures in many tests, gives the most vivid and accurate picture of the nerve cell; or whether on the other hand preference should be given to the older technical procedures. A few words on the axis cylinder. It generally springs *English by Smith Ely Jelliffe, M. D. [337] 338 Guiseppe Levi. from the center of the cell in a cone of acromatic fibrils, which, however, have nothing to do with the parallel fibrils in the periphery of the cell. I incline, therefore, to the opinion of Lugaro* that the fibrils of the axis cylinder have their origin in the network of fibrils in the deeper part of the cytoplasm. The fibrils of the axis cylinder are, however, parallel, straight, or but slightly undulating. They are more readily stained than the fibrils of the dendrites. In the cells of the spinal ganglia the fundamental sub- stance shows considerable variation. I shall not describe the fibrils of the cells in mammals, for I have already done so elsewhere; it is sufficient to say that they form a network with a rather large mesh. In Zamenis and Testudo the fibrils are not isolated as in the mammals, but appear in the form of bundles, concentric to the nucleus, and formed of anastomosing fibrils; there is thus formed a net- work, but of long and narrow meshes. The course of the fibrils in the ganglion cells of Bufo is much more interesting. They form, in the periphery of the cell a typical small-meshed network. In the central part they tend to become individual and converge from the periphery to the center with only a few branchings; and in the axis of the cell they form a true bundle which takes a special course. While in the greater number of cases, however, the fibrils form a network throughout the whole cytoplasm, (the meshes being larger in mammals, and nar- row and long in reptiles) in Bufo this netted structure is found in part of the cell only; in the remaining part the fibrils tend to become individual, and follow the special course that has already been described. An analogous individualization of the fibrils is found in the ganglia of Testudo.f We find an analogous individuali- *E. Lugaro, Monitor Zöologico Italiano, Anno viii, N 4, 1897. #1 should note the fact that this material (Bufo) was collected during the winter, and that the only specimen obtained in the spring showed a larger amount of chromophil sub- stance. My observations are too incomplete to be able to make any positive statement at present, on this subject, concerning what I have already noticed in Zamenis; viz., that in cold-blooded animals, the chromophiſ substance tends to shrink up in winter time. At any rate the scantiness of the chromophil substance which I have noticed in Bufo vulgari whether it be due to hibernation, or to a permanent morphological characteristic, is valuable for the study of the complicated structure of the cytoplasm in these animals. Comparative Cytology of the Nervous System.. 339 zation of the fibrils in the ganglia of Testudo, in the bridges that unite the lobes to the center of the cell. While in the central cells it was easy to explain the different con- tents of the fibrils, the dendrites and the center of the cell so that it was possible to state with certainty that the dendrite’s principle function was to conduct, we can offer no explanation, but merely an hypothesis, concerning the cells of the spinal ganglia. Regarding the bridges that unite the different parts of the cells of Testudo, they may be considered as organs of conduction, intended to unite those different parts of the cells devoted to specific func- tions, for it is probable that the lobes have the same functions as the central portions of the cells, having the same structure. But what significance have the vortices in the cells of Bufo? I have already said that I will treat this more fully elsewhere; I cannot, however, set this question entirely aside. In the literature on the subject we find that Lenhossék” describes, in the spinal ganglia of Rana some figures which have a slight resemblance to those observed by me in Bufo, and gave to the central point the signifi- cance of a centrosome, to the clear space which surrounded it, that of a sphere. Dehlert found like figures in the sympathetic of the frog, and, without describing them minutely accepted the interpretation given to them by Lenhossék. I have been able to confirm the presence of these figures in the ganglia of the frog and in Zamenis, but in these animals I have not distinguished all the details described by Lenhossék, as I did not employ the same technic. I found the arrangement of the granules described by this author, and I may add, of the fibrils also, but in the center, I was not able, except in a few cases to distinguish the sphere of Lenhossék, but instead the centro- some ; in the center, I found for the most part, chromophil granules, and granules of pigmentation. At the first glance it would seem that the figures *M. v. Lenhossek. Centrosom und Sphare in den Spinal ganglien des Frosches. Arch. f, mikr. Anat., bd. xxxvi, 1895. tDehler, (loc. cit). 340 Guiseppe Levi. described by Lenhossék, Dehler and myself in the frog" and those which I found in the ganglia of Bufo, had nothing in common; but on a closer examination the conviction grows that in the first the arrangement is identical to the vortices of Bufo, but much less pointed; thus, therefore, in Zamenis, we see that the more central fibrils are in a deeper plane than the peripherical ones; and that this is not very evident, only because the central fibrils are less distinct than those of the periphery. Thus, between the same figures of Lenhossék and those that can be seen in my preparations of Bufo, it is possible to find some analogies; the clear central zone called by Lenhossék, the sphere, because with the methods he adopted this appeared to be homogeneous, and in one plane. This zone has, in the cells of Bufo, the appearance of a spiral vortex formed of more compact fibrils; therefore the central granule (the centrosome) that can be stained, in the cells of hufo is found in at least two or three sections of the same cell, and would consequently form a good portion of the axis of the vortex, which runs throughout the length of the cell. From what I have said, it is evident that this figure cannot be considered either as a centrosome or a sphere, especially in the way I saw it, in close connection with the origin of the axis cylinder. This does not agree with the meaning that we are accustomed to give to the word, cen- trosome. . Here it is a formation that at least in a certain period of ontogenetic development, took an active part in the reproduction of the cell. It is therefore none the less impossible for me now, to give a morphological significance to these vortices, and much less am I able to reply to the question that was put to me, for what functional reason do the fibrils in the cells of Bufo become more compact, and tend to become individuals? Seeking now to apply the generalization of these *Many confirmations of the report of Lenhossek followed that of Dehler: Schäffer in the nerve cells of Petromyzon (Wiener Sitz. Ber., Bd. 105, Abth., 3, 1896). Buehler in the cells of the cortex of the lizard, Nurnbürger Verhandl., Bd. 29, N 6, 1895) found figures similar to those of Lenhossek, not to speak of observations made upon invertebrates (Mac- Clure, Margaret Lewis). Comparative Cytology of the Nervous System. 341 results to all the somatic cells, we are able to conclude that in the fundamental part of these cells, there is a net- work of fibrils, and if it were not always possible for me to show it, I believe that this should be attributed to the excessive diffusion of the chromophilic substance, or differ- ences due to fixation (the sublimate being an uncertain reagent, which does not give perfect specimens in all cases). And also that the chromophilic substance may form an obstacle to the study of the fundamental substance as has recently been demonstrated by Lugaro,” who has observed in the cells of the spinal ganglia of the dog, in which, under normal conditions, it is difficult to see fibrils, that when there is a process of peripheral chromatolysis, there is a very perfect network of fibrils distinctly brought out in the peripheral zone of the cell. In regard to the relation between the fibrils and the chromophil substance, it is probable, at least in the great majority of cases, for the fibrils to form a web that com- pletely stretches across the chromophilic granules; as to this we often see in our specimens that the fibrils continue into the granules. That the fibrils and granules are quite different in character, I have shown not only from histochemical data but also the fact that in one instance I saw these two constituents completely separated from each other (in Petromyzon). These, however, are the data furnished by experimental pathology. I have not been able to determine what other constit- uents exist in the fundamental substance. It is, however, probable that those processes of exchange that I described (loc cit.) between the fibrils in the cells of the spinal ganglia of mammals, and in those of Zamenis, can be discovered by like methods, in all nerve cells. NUCLEUS. The variations in structure of the nucleus in the somatochrome cells are much less noticeable than changes of the cytoplasm. The nucleus is round in all the animals *E. Lugaro, Sulla alterazione degli elementi nervosi avvelenamenti, per As. e. per Pb. (Rivisti di pat. nerv. e ment, fasc. 2, 1897). 342 Guiseppe Levi. except the tailed amphibians (Urodeles) where as we shall see, other characteristic differences may be found. The bibliographical data upon its structure are quite scarce; Cajal (loc. cit.) is the only one who has treated the subject to any extent. He believes that in the large cells the nuclear contents may be deprived of nuclein, but that instead, the nucleolus may be entirely formed of nuclein. In a note* published contemporaneously with that of Cajal, I endeavored to show that in all the somatochrome cells of the guinea-pig the nuclear contents are wanting in nuclein and that this is collected in the peripheral part of the nucleus, while the central part of this small body is acido- phil. In addition I can confirm this observation, and in fact, extend it to all the species that I have studied. I also found in the nuclei of all the animals l have studied, the following common characteristics; a delicate acidophil membrane, and a large acidophil nucleolus to which two to four rather delicate basophil granules adhere. First to pass to other peculiarities of the nucleus I believe I can firmly establish these two facts. The mem- brane is a true nuclear membrane, and not a part of the nuclear stroma which is the case in many other cells, such as cells of the neuroglia, many epitheelial cells, etc. In addition to its microchemical reaction it is distinguished by other characteristics; it is very fine, has no thickening, and does not bear a close relation to the contents of the nucleus. It is easily wrinkled in folds if the specimen is not well fixed. The nucleolus has an intense acidophil reaction in its central part; it, however, stains also with a basic color; the basophil granules, for the most part crescent-shaped, which we see in its peripheral portion, do not stand out with such distinctness in all the elements; in some animals, all the cells (if we adopt Biondi's method of staining) a deep azure-blue (in guinea-pig, ox, rat, frog, Urodele's and Raja) a rather paler blue (in the dog, bat, Testudo, Tinca). In some elements in which I did not succeed in distinguishing them with Biondi's method, I had *G. Levi, Riv, di Patol. nerv. e ment, vol. I, fasc. 4, 1896. Comparative Cytology of the Nervous System. 343 recourse with success to fixation in Hermann’s fluid. I am able, in conclusion, to state that this structure of the nucleus is general in all the somatochrome cells; and I believe, that if there are exceptions (Petromyzon) they should be attributed to differences in technic.” I cannot help but point out the relation existing between the size of the nucleolus and the shape and size of the granules. Judging from the cells of the spinal ganglia, on the ground of physiological experience, I thought to show that the modification of the size of the nucleolus during its function, was accompanied by a dimin- ution in size of the granules. I have however, up to the present time, added no further data on the subject, and can therefore add nothing to the proposition. I can only state that in the same animal, the larger the nucleolus is, the more delicate and elongated the granules will be. Such a comparison cannot be made between different animals, as I have already said. In some animals, for reasons that are unknown to us, because they are technical, the basophil granules stain badly, and it is not possible to determine their size. This question now presents itself to me. Do these granules which are arranged along the periphery form an intrinsic constituent of the nucleus, or are there two distinct substances which only come in close contact with each other? I have observed that while the outer margin of the granule is always quite distinct, this is not the case inside; so much so that it is often impossible to define the exact limit of the acidophil and basophil granule. I believe that the reason for this is as follows: The basophil granules do not cover the whole surface of the acidophil sphere, but only a part; therefore the point of the insertion of the granule does not come under observation, as it is covered *I noted that it is enough to prolong the action of the corrosive sublimate, a little onger than necessary, because fine basophil granules lose their power to become stained by the methyl green in Biondi's solution. Fºr the rest, when the fixation is also adapted to Nissl's metald, the center of the clear nucleus and two or three dark-blue granules, on the periphery may be made out with Weigert's method for neuroglia, I have been able to dis- tinguish the same structure in the cortex of man, 344 - Guiseppe Levi. by the acidophil part, and appears rather distinct; or else . the granule cannot be distinguished at all because it is completely covered by the acidophil part, which takes a deep stain. And for this same reason I believe that the basophil granule is not easily distinguished with Biondi's double stain in the nucleoli of those animals in which they are very small; in such nucleoli they show better with a stain, that while coloring the granules themselves intensely, yet leaves the acidophil part very faint, such, for example, as Fleming's safranin. I am of the opinion, also, that the small spherical body which takes a uniform stain with the more common methods and which we find in the somatochrome cells of all animals, and which has been called the nucleolus, may not be composed of one substance only, as has been believed until the present time, but may be formed of two substances, that are not only different in their histo-chemical reaction, but also morphologically different. I will not try to settle what the two substances signify. The acidophil substance is quite difficult to under- stand. We find that the ideas concerning the nucleolus in general, are rather vague. Hertwigº holds that on it depend the physiological activities of the nucleus. Flemingt that it may be the seat of the accumulation and reproduction of the nuclein. In studying the karyokinesis of nerve cells, I have noticed that the acidophil part of the nucleolus is transformed into the centrosome and spindles of the cell.f When my observations on this subject are completed, I will give an ample demonstration of the facts. At present, I must confine myself to simply touching upon them. The small basophil granules that form the periphery of *O. Hertwig, Die Zelle und die Gewebe Jena, 1892. +N. Fleming, Zellsubstanz, Kern und Zelltheilung, Leipsig, 1882. 1G. Levi, Richerce sulla capaci a proliferateri della cellula nervosa. (Riv. di Pat. nerv, ement., vol. I, fasc. 10, 1896) The name more frequently used for this substance is chromatin. I have adopted that of nuclein to avoid confusing it with the chromophil of the cytoplasm, that some authors incorrectly call chromatin. Comparative Cytology of the Nervous System. 345 the nucleolus are easier of comprehension. Not to repeat all the arguments jotted in my note-book during the past year, I will simply state that their decided basophil charac- teristic and the strong refraction that these granules assume after the action of acetic acid, (in preparations fixed in Hermann's fluid) enables us, without further question, to class them as formed of a constituent of nuclein. We also see that in all the somatochrome cells, the nuclein of the nucleus is always connected with the acidophil sphere, which I believe is destined to form the centrosome, and the spindles of the cell, when it is about to be in a state of active reproduction. There is in these cells a centralization of nuclein, to use a phrase which Cajal has introduced, but which he interprets, as I have said, in a different sense from mine. Having thus pointed out the characteristics common to all these cells, we will pass to those that vary in different animals. The nuclear reticulum of linin, according to the nomenclature most in use, in mammals is much looser and less easily stained. It is denser in the vicinity of the nucleolus. I believe that this substance has no other func- tion than to act as a mechanical support to the nucleus. In the lower vertebrates (Reptiles, Anura, Teleosts and Selachians) in the meshes of the linin reticulum, acidophil granules are found, sometimes in such large numbers as to completely hide the reticulum. It is not possible to say anything definite concerning the morphological significance of these granules, but by analogy with other elements we may suppose that they represent materials of nutrition and products of metabolic exchange. In some nuclei of these lower animals, I have noticed, in addition, scattered among these granules, a few very small basophil granules, which, for the reasons I have already given, I believe, without doubt, may be called granules of nuclein. In the Urodeles the linin reticulum cannot be distin. guished. In the interior of the nucleus (fig. 13, 17, 19) we See acidophil granules and nuclein granules in moderate number. I think I ought to call attention to this fact, that while in the mammals the centralization of the nuclein is 346 Guiseppe Levi. complete in all the lower vertebrates, and especially in the Urodeles, while the greater part of the nuclein is central- ized, a certain amount of it is diffused. KERNZELLEN. (Cytochrome Cells). In this group belong: The cells of the substantia gelatinosa of Roland, in the mammals and reptiles; many elements of the posterior horn of the Aneura (tailless amphibians); the cells of the molecular layer of the cerebellum of mammals; the small and medium-sized pyramidal cells of the cortex of some small mammals (guinea-pig and rat); the cells of the fascia dentata of mammals, a great many cells of the anterior and posterior corpora quadrigemina of mammals; the optic lobe, the basal ganglia of reptiles, amphibious-born fishes and sharks. The differences in size in these cases, however, bear no relation to the position that the animal occupies in the zöologic scale, but rather to the size of the animal; but these differences are much less noticeable than between the somatochrome cells. CYTOPLASM. On the subject of its structure very little can be said; it is as a rule, very scarce; a few very small, scattered chromophil granules may be distinguished in it, so that it is not possible here to draw a sharp line of distinction between the chromophilic substance, and the fundamental substance. The dendrites contribute little to a cytological study, because they are so very attenuated; however, the medium-sized pyramidal cells of the cortex of mammals have a large dendrite in which may be seen fibrils similar to those of the somatochrome cells. NUCLEUS. The common characteristic here is the presence of a fine acidophil nuclear membrane. The nucle- olus on the other hand is much less typical than in the somatochrome cells, and undergoes distinct variations. (Figs. 6, 7, 9, 12). I shall not explain these variations now; for them one should consult the parts already described. I shall only point out the fact that the nucleus is small, is not spheri- cal, but generally has an irregular outline, and is always formed of two substances, the nuclein, which for the most part predominates, and of acidophil granules (single or Comparative Cytology of the Nervous System. 347 double). Therefore, only in some cells (fig. 7, 12) the nuclein has that characteristic arrangement which l described in the somatochrome cells; sometimes it is surrounded by an acidophil ring, sometimes it has the form of a large granule adhering to an acidophil granule. (Fig. 6). In these cells, moreover, we see a centralization of the nuclein which for the most part is incomplete. Since we almost always find (with the exception of some mammals, the guinea-pig, for example) nuclein dispersed in the nucleus, under the form of granules, or of a loose network with enlargement at the nodes; and in general the amount of dispersed nuclein, is in direct proportion to the quantity of centralized nuclein. This centralization then, is not constant; in the smaller elements of the tailless amphibians, Aneura (fig. 12) and in all the Kernzellen of the tailed amphibians (Urodeles, fig. 14, 18, 21) and of the shark (Raja, fig. 22, 25) there is no indication of this process, the nuclein in these elements appears now in the form of little granules, situated in the nodal points of the linin reticulum, as in the cells of the pallium of the Urodeles, (fig. 14, 21); now in the form of large granules separated from one another by acidophil granules. A very distinct localization of nuclein may be seen in the shark (Raja). It appears in the form of gran- ules, united by granular acidophil substance which forms a spherical granule separated by the nuclear membrane. (Fig. 22, 25). Does this granule represent a special nucleolus? Did it exist before in the living cell? I believe not. The fact that the space between it and the membrane is not filled with a linin reticulum leads me to believe that in the living cell, granules of nuclein and of acidophil substance were scattered in the nucleus as in the homologous cells of the tailless amphibians (Aneura), and that the fixative, owing to some special condition of these cells (greater water-richness of the nuclear contents) may have joined them together to form this central mass. Ramon y Cajal, l.c., who, as I have said, has made a distinguishing feature not of cell types, but of nuclei, has 348 Guiseppe Levi. created a group of nuclei with central nuclein arranged in granules, some large, the others small. In an enumeration of the cells in which he found these nuclei, it is understood that he emphasizes the Kernzellen. But his description does not altogether agree with mine. He does not call attention to the presence of a nucleolus formed by nuclein and by acidophil substances; he speaks of three to four masses of scattered nuclein. Such masses l have found only in a few nuclei. In the lower animals he observed on Some occasions, a large number of granules of nuclein; in other cases a true reticulum, and in this my results agree with his. To sum up: The principal characteristics of these cells in comparison with the somatochrome cells lies in the fact that the cytoplasm is very scanty, and poor in chromophil substance and that the centralization of the nuclein is not so complete, is more one-sided and is not constant. GRANULES. Included in these 'elements are the granules of the cerebellum and the olfactory lobes of all animals; the external and internal granules of the retina of mammals, (the only ones that I have studied). Their most prominent characteristic in comparison with those cells last described, is the extreme poverty of the cytoplasm, which is lacking in nearly all that have been observed. The nuclei are spherical or polygonal, in the Urodela they are oval, their size varies within very narrow limits; the variation bears no relation either to the size of the animal or to its position in the scale of development. In all cases the nuclei are always much smaller than the nuclei of the somatochrome cells and the Kernzellen of homologous animals. The nuclear membrane is generally acidophil, therefore in some cases it appears azure and it is not easy to decide whether the basophil reaction is owing to the granules of nuclein adhering closely to the inner surface of the mem- brane, or to a property of the membrane itself. The contents always consist largely of nuclein, which is invariably more abundant than in the nuclei just described. Comparative Cytology of the Nervous System. 349 The contents, for the most part, form a network with little granules in the nodal points; only in some granules of mammals, (guinea-pig and ox) the nuclein is collected into a single central granule, seldom a double one; in Scyllium there is a small granule much larger than the other, formed by acidophil substance and nuclein. Moreover, the Urodela, through the characteristics of these cells, are exceptional; in these animals, the granules are oval and contain large granules with a distinct but irregular outline, separated by a little acidophil substance; they resemble the cells of the basal ganglia of these animals, only they are smaller. The acidophil substance is always present, but is very scarce, and is only distinguishable with high magnification; in Testudo only, did I find a noticeable linin reticulum. These nuclei Cajal (l.c.) calls “nuclei with reticulated nuclein.” From what has already been said such a disposi- tion of the nuclein substance is not a constant feature. I found it a difficult thing to select any one important characteristic common to such different cells, which would justify me in placing them together in a group. I am obliged to enumerate many that are, however, not as fund- amental as are found in the case of the other cells, such as the scarcity of the cytoplasm, the small size, the great scarcity of acidophil substance in the nucleus, and the greater amount of nuclein. The cells of the neuroglia and of the ependyma must still be described. In these there is no marked centraliza- - tion of the contents of the nucleus, the nuclein forms a network that is always thicker (closer) than in the granules; uniform, and formed from the nuclear membrane. We have no exact differential standards by means of which we might distinguish these granules; we can only claim that the smaller size and the oval form, and the characteristics of the nuclear membrane. - On a synthetic examination of these three types of cells we may see by comparing them whether the differ- ences in their characteristics are sufficient to establish distinctions, and whether in the second place there are gradations of difference between them. If we take as 350 - Guiseppe Levi. a comparison of somatochrome cells and Kernzellen (cyto- chrome cells) two cells that stand at the extremes of such a comparison (as for example the cells that are reproduced in figs. 1 and 3, and those in figs. 17, 18 and 21) we see that the difference is enormous; and the differential charac- teristics are so fundamental as to fully justify such a distinction. But between the two extremes the steps of the gradation are very numerous; for example in the cells of the cord of the small mammals, (guinea-pig) the granules of nuclein are thicker, and the acidophil substance of the nucleus more scanty than in the cells of the anterior horn; in some large cells of the spinal ganglia the nucleoli are two or three and have not the usual typical appearance. The cells of the pallium of Testudo have a scanty and simple cytoplasm (while the nuclein is almost completely centralized). In these cells, moreover, the process of differ- entiation has not attained as high a degree as in others. Other elements that we have included with the Kernkellen, such as the cells of the substance of Rolando of the ox, the cells of Golgi in the cerebellum of the mammals, have a comparatively abundant cytoplasm and centralized nuclein (in the form, however, of large granules) and are therefore to be classed with the somatochrome cells. Between the somatochrome and the cytochrome cells we find, moreover, numerous steps of gradation, which shows us that while this distinction serves for extreme cases, it by no means holds good for the intermediary steps. For the Kernzellen (cytochrome cells) and the granules (caryochrome cells) the differential characteristics are sufficiently marked between the extremes of comparison (compare side by side figs 7, 9, 12, with fig. 4, 5, 15, 20, 23); but here, never- theless there are numerous steps of gradation, as for example, some cells of the Urodela (fig. 19) can with diffi- culty be distinguished from granules (fig. 15); the cells of Cajal of the cortex. The basket cells of the cerebellum of mammals might, by many characteristics be classed among the granules. I have classed under the name of granules, those espe- cial cells to which in times past the anatomists have given Comparative Cytology of the Nervous System. 351 this name, on account of their small size and in which the silver reaction enables us to discern marked peculiarity in the course of their prolongations. In conclusion the follow- ing characteristics may be established. Small size, extreme scarcity of cytoplasm and a larger quantity of nuclein. It is more difficult, if not impossible, to establish the important differential cytological characteristics between the granules and cells of the neuroglia; the difference in the constitution of the nuclear membrane is more constant; this is always acidophil in the granules, while in the cells of the neuroglia it is formed by nuclein and bears a close relation to the nuclear stroma; but in many cases, never- theless, if it were not for the data that the silver reaction furnishes us, we would be unable to say with certainty, if depending solely on cytological characteristics, whether given elements of this group were of a nervous nature or not. Another question that arises is the following: Do the homologous cells in different animals present identical cytological characteristics? For some cells, one can without hesitation reply in the affirmative; the large cells of the spinal ganglia, the ventral cells of the medulla and of the bulb, the cells of the cord, the Purkinje cells, in all the animals are represented by somatochrome cells. And in the same manner the granules of the cerebellum and of the olfact- ory bulb have the character of granules in all the animals. The dorsal cells of the medulla in all the animals have the characteristics of the Kernzellen, but to this cytological homologue (which we see, is only relative, because there are marked differences between the various Kernzellen) may there possibly be a homologue, of coarser characteris- tics? It seems that it exists in the mammals, reptiles and tailless amphibians (Aneura) but is not well established in the Urodeles and Selachians. In the cells of the pallium any cytological homology between the different animals ceases completely, while in the larger mammals the somato- chrome cells are found to be numerous, and in the smaller mammals they are much scarcer and less characteristic. In the reptiles, the cells of the pallium approach more nearly 352 Guiseppe Levi. to the Kernkellen; in the amphibians they acquire these characteristics very decidedly. In conclusion we may say that while some nervous organs preserve cells of the same type in all animals, in others the homology does not hold at all. After having determined the cytological character- istics that enable us to distinguish many different kinds of nerve cells, one might inquire whether there be any important cytological characteristic common to all by which we could distinguish nerve cells from others. From what I have said it has been clearly proved that such a character- istic does not exist. Indeed while on one side we have no critical test that serves to distinguish some cells (the granules) from the cells of the ependyma and the neuroglia, on the other hand there is no cytological characteristic common to a somatochrome cell and to a granule. Instead the characteristics of some of the nerve cells (somatochrome cells) are unquestionably distinctive; but in other elements of a non-nervous character (cells of the ovary of the inver- tebrates and amphioxus) the nucleus is quite similar to that of the somatochrome cells; although there is not the especial arrangement of the nuclein in these cells, the cytoplasm is rich with a substance that has micro-chemical characteristics that are identical with those of the chromophil substance. But the means that we now possess do not permit us to distinguish anything with absolute surety in the minute structure, not only of the nerve cell in general, but not even of those nerve elements that are the furthest removed from all the others. Nevertheless although there are no specific isolated characteristics of these cells, the reunion of numerous characteristics, which occurs in the somatochrome cells, makes the nerve cells, or at least some forms of them, the most complex of all the elements. The nerve cells in their ontogenetic development have lost the common characteristics of the cells of the first embryonal stages, by acquiring others which serve to relieve it of some of its complex functions; if it is differentiated through its function. In general by the word differentiation, is meant the Comparative Cytology of the Nervous System. 353 progressive loss of the different potentialities of the cell in favor of a single one. This gradually develops, and the morphological criteria which enable us to detect the differ- ences are, according to the theory of epigenesis, the formation of relatively homogeneous protoplasm of cellular organs; on the other hand, according to the preformation theory, the rendering visible of different parts that were pre-existing in the protoplasm, and at first non-distinguishable. The question is still much debated in what philogenetic epoch of development, the process of differentiation is ren- dered visible. According to the experience of Driesch” and of Hertwigſ in the eggs of Echinodermata and of the frog there is no process of differentiation to be noted before the formation of the thirty-second blastomere; Delageſ holds that the process of differentiation takes place at different times of ontogenetic development in the single elements, in some cells (nervous system, muscle) very early, in others much later (connective tissue and bones). But in proportion to the degree attained, one may state with certainty that in all the cells destined for a well-marked function, the process of differentiation reaches a very high point, although the whole capacity of the cell is merged into the bringing forth of the special function which will be the chief property of the element. Now it is possible for the process of differen- tiation to reach a very great degree without the structure of the cell becoming any more complex, unless it may appear in the protoplasm of the cellular organs; in other cells, however, the reverse may happen, and the high degree of differentiation, reached may be associated with a great complexity of structure by reason of the higher functions that the cell performs. This is the case in nerve cells. And it is the long development that in this case the pro- cess of differentiation must necessitate, that this takes place so markedly. In any case, however, the anatomical characteristics that enable us to distinguish the processes of *H. Driesch, Zur velagerung der Blastomeren, des Echidneneies, Anat. Anzeiger, Bd. viii, 1883. to. Hertwig, Zeit und Streitfragen der Biologie, 7 and 6, Jena, 1894. fDelage, La Structure du protoplasma et les theories sur l'heredite, etc., Paris, 1895 354 Guiseppe Levi. differentiation are: the development of a cell of very simple construction, which is that of the embryo in the first stage, to an element with a very highly complex structure. Let us now consider some of the characteristics that accompany the process of differentiation in the nerve struc- ture and the functional reason for the same. 1. The most conspicuous is the extension of the cyto- plasm which is quite noticeable in the cells with a very simple structure, while the granules (the dendrites of course being regarded as making up part of the cytoplasm) are very large in cells whose structure is very complex. It is easy to demonstrate a functional reason for this; it is natural that the larger the sum of energy that the cell receives and transmits, the larger its own size ought to be. 2. The subdivision of the cytoplasm in arborization is more extensive and complicated; as the functional devel- opment of the cell is greater the functional reason for this is plain. - 3. The formation in the cytoplasm of fine fibrils (cellular organs) has a more complicated course in the more complex cells and tends to distribute the stimuli into differ- ent parts of the cell. 4. The formation of a special substance, chromophil substance, whose nature is comparatively unknown, but which certainly bears an important relation to the function of the cell, so much so that its amount is in direct propor- tion to the degree of morphological complexity reached by the cell. 5. The special structure of the nucleus consists in a centralization of its constituents which is constantly asso- ciated with a great scarcity of nuclein. This special structure ought to be considered not only as a process of differentiation, but I believe it to be the indication of height of functional activity in the cell, for the centralization of the constituents of the nucleus is so much more complete, when the development of the cytoplasm is greater and the structure more complex. It seems to me that this intimate relation that exists between the cytoplasm and the nucleus may be of impor- Comparative Cytology of the Nervous System. 355 tance from a general biological point of view; so much the more that this process of differentiation concerns the nuclein, the hereditary substance (Weismann) which must necessarily be of great importance in the process of differ- entiation.* But does the special differentiation of the nucleus, other than the fact that it accompanies the differ- entiation of the cytoplasm, signify any important function as does the latter? - Recent researches, (Mann,t Lugarot), have proved that the nucleolus undergoes marked modification in size while functionating; and I have observed that the granules of nuclein following these modifications are long drawn out and contracted. Maginill has observed a complete eccentricity of the nucleolus in the cells of the electric lobe of the torpedo after discharging. These facts make us believe that the nucleolus, which is the result of the differentiation of the nucleus may have a very important function, but they do not point out to us in just what way it contributes to the function of the cell. In summing up we see that the special struc- tures to which the process of differentiation of the nerve cell leads, although they do not in themselves show any characteristics, yet taken as a whole, they are the indication of the morphological and functional advance- *The scarcity of the nuclein in the cells that I considered more highly differentiated leads me to suppose that in these elements the reproductive capacity, like other capacities may be slowly lost, in favor of a single one which must be evolved in the fulfillment of the cells particular function. All the authors that find karyokinesis in the nerve cells of the cerebral cortex omit to say in which elements in the large or in the small pyramids) it has been observed. As my researches are not yet complete, I have seen karyokinesis only in the small and medium-sized pyramidal cells of the guinea-pig (Kernzellen); Caporaso (Ziegl. Beltr., Bd. v., 1889) has seen the complete regeneration of the medulla of Triton; here the m dium-sized and small pyramadal cells as well as that the greater part of the nerve cells are but slightly differentiated. On the other hand, the researches on the regeneration of some somatochrome cells, among which were the cells of the spinal ganglia (Tirrelli, Annali di freniatria, Torino. 1895) and the cells of the , simpalica. (Monti e Fieschi, Arch. It. de Biologie, T. xxiv, fasc. iii, 1895), have given negative results. It is probable however, that the reproductive capacity may be reserved in the less differentiated nerve cells, although it is extinguished in those that are more highly differentiated. +Mann. Histological changes induced in sympathetic, etc.,Journal of Amat. and Physiol, vol. xxix. IE. Lugaro, Sulle modificazioni delle cellule nervose nei diversi stati funzionali, (Speri- mentale, annoxlix, fasc. 2.) |G. Magini, La diversa ubicazioni del carioplasma, etc., (Rendi conti della R. A cead. dei Lincer, vol. vi. Sem. 1, fasc. 10. 356 Guiseppe Levi. ment to which some types of nerve cells attain. These processes reach many different degrees of advancement in the various nerve cells, retaining, however through each type almost the same identity in the zöologic scale, with only rare exceptions. After having fixed the principal cytological characteris- tics of the nerve cells, and having sought to determine their importance, there remains for me to establish whether there is any connection between these characteristics and those that are grosser, and that until now were the only means by which they could be distinguished. In literature we find no attempt of this kind. Cajal only has made a note that in the cornu Ammonis and in the cerebrum, in speci- mens stained in bichromate, the granules and the cells with short axis cylinders of the cornu Ammonis remain faint, while cells with long axis cylinders are intensely colored; he concluded that this difference in staining depended upon differences in the functional condition. He called the first chromophobic and the second chromophilic according to the distinction of Flesch, a distinction that roughly speaking corresponds to my facts of the case; the somatochrome cells, which indeed being rich in chromophil substance, with a poorly adapted technic, appear uniformly obscure and correspond to the chromophil cells of Flesch; while the Kernkellen and the granules correspond to his chromophobic cells. Now I will try to see by a review of various cells, whether one may raise the statement of Cajal's to the importance of a general law; and this would be of no little interest having been able to establish not simple differences in staining, but fundamental differences between these cells. It would not be hard for me to show that the somato- chrome cells in all the animals are cells of the Golgi, type I. whose axis cylinder preserves a distinct individuality and ends at a great distance. It is quite unnecessary to men- tion examples, for it is now well known what cells belong to type I. In the cells of the spinal ganglia, although they cannot be called Golgi’s cells of the type I, the two branches of the long axis preserve their own individualities through for a long distance. Comparative Cytology of the Nervous System. 357 Moreover, I may add that the axis cylinder of these cells always ends a great way off from its origin; this always helps to establish a long tract. I will mention the cells of the spinal ganglion, which with the two branches of their prolongative form two very long tracts, the cells of the anterior horn, the Purkinje cells, the large pyramidal of the cortex of mammals, the large cells of the cornu Ammonis, the initial cells of the olfactory bulb, the ganglion cells of the retina. We have seen that in the somatochrome cells there is a diversity concerning the degree of differentiation attained by the cell, which is chiefly manifested in the varying amount of space occupied by the cytoplasm, and in the size and structure of the nucleolus; their variations bear a relation to the length of the tract originating in the different cells. The diameter of the cells of the anterior horn, for example, vary quite widely, and we find the largest cells in the cervical and lumbar enlargements whence they go to the longer fibres, that go to the limbs; and it is therefore evident that among these cells those that give rise to the longer axis cylinders are larger than the others. The cells of the cord, the cells of the olives—as I have already shown, have no such great difference in their characteristics, as have the cells of the anterior horn and of the spinal ganglia, they have an axis cylinder which runs through a tract that is much shorter than those of these last mentioned cells. Some cells in the lower verbetrates apparently have cyto- plasm that is comparatively scanty, considering the length of their cylinder axis; but the diameter of the central part of the cytoplasm, the only thing I have been able to count on is not a sufficient standard to judge of the degree of differentiation of the cell. Since in these animals there is a decentralization of the cytoplasm, as I have said in these cases, a safe test is the diameter of the nucleus. Homologous cells of different animals also present marked differences, especially concerning the differentiation of the cytoplasm, and in their relation to the size of animals, differences that do not exist between the elements of other organs. We cannot compare the differences with the vary- 358 Guiseppe Levi. ing distances that the cylinder axis may traverse in a small or a large animal. Besides, in addition to the length, other elements must be taken into consideration; such as the multiplicity of connections that the axis cylinder may have, numerous collateral, the thickness of the axis cylinder (the giant fibre of Mauthner which we find in the Petroyzon and in other fishes take their origin in the giant cells of 115 x 85 mikra.) In the Kernzellen it is difficult to lay down an exact general law, for not having the coarse differential character- istics of these elements, they cannot be recognized; while the somatochrome cells may easily be recognized in Golgi's preparations, from their prominent size, from their general characteristic forms and from their large dendrites. Never- theless it is possible in some cases among the Kernzellen, although in the anterior horn, for example, cells of a differ- ent cytological character are found, it is without doubt that the small cells of the substances of Rolando that are included among the Kernzellen, are cells of Golgis’ type II., the same may be said of the cells of the moleculer layer of the cerebellum. The cells of the (fascia dentata) corre- spond to the cells of type I ; but their axis cylinder suddenly acquires an enormous quantity of collaterals, and terminates at no very great distance. The cells of the pallium in the amphibians that have the characteristics of the Kerznellen are certainly cells of type I., but their axis cylinders do not traverse very long tracts, there being, as has been mentioned, no cortico-spinal tract in these animals. We may, however draw the conclu- sion, that some of the Kern.