PRESERVATIKE SITION N91 * 2 - 3 4 12-IGAL PRESERVATIVE Mol. 12-1 GAL. SPAR COMPOSITION VO01 OMPOSIZ POSTAGPAN GR WOOD The Alienist and neurologist 6/4: s THE ALIENIST AND NEUROLOGIST. VOL. XXI!. ST. LOUIS, JANUARY, 1901. No. 1. ORIGINAL CONTRIBUTIONS. THE EMPLOYMENT OF PHYSICAL METHODS IN THE TREATMENT OF NERVOUS DISEASES.* By DR. AUG. HOFFMANN, Of Diisseldorf. (Conclusion.) THE MECHANICAL REMEDIES. Massage and gymnastics have been employed in the treatment of nervous diseases from the earliest times. The first is used especially by uncivilized ,peoples for the cure of disease. There have been times when both, as curative measures, have passed into oblivion; gymnastics were re- vived somewhat about the middle of the 16th century by Merkuriali and Verono, and in the 18th and 19th centuries were further developed and more widely disseminated by Rousseau, Pestalozzi, Nachtigall and Ling. -In Germany gymnastics were perfected by Jahn in the form of turning, but more for education than therapeutic purposes. Spies developed this educational factor to the present system of calisthenics. Therapeutic gymnastics with •Translated bv Dr. W. Alfred McCorn, Resident Physician, "River Crest," Astoria, L. I.. New York City. «T672 [1] 2 Aug. Hoffmann. massage were systematized by Ling, a Swede, into remedies capable of localization and dosage by introducing combined movements of resistance and various selected initial posi- tions. In France massage was again brought into therapeutic use by Tissot, Bonnet, Pierre, Nelaton. Estradere's book (1863) first treated massage as an independent branch of therapeutics. Of late it has been chiefly Metzger, Mosen- geil, Zabludowski, Reibmeir, Schreiber, Kleen and others, as well as a large number of eminent surgeons, who have contributed to the advancement of this mode of treatment. Massage as employed to-day, consists chiefly of four manipulations: 1. Effleurage, i.e., stroking the skin from the periphery toward the centre with the flat hand. Its physiological action consists in accelerating the circulation of the blood and lymph in the skin and superficial tissues. 2. Friction, or rubbing consists of vigorous, circular rubbing and pressure with the hand or thumb and index finger. Its purpose is to assist in the absorption of morbid growths and swellings. 3. Petrissage, or kneading. Large amounts of tissue are taken up and rolled between the hands. This serves to improve the circulation in the tissues, in the muscles particularly. 4. Tapotement, or tapping with the hand, its edge or the finger tips. Kneading and tapping, besides having a "detergent action" are also stimulating. The muscles tapped are excited to contraction, even when no longer subject to the will (mechanical muscular excitability); pain may also be re- lieved by them, owing to their paralyzing sensation. They also cause cutaneous hyperaemia. When large areas are subject to massage metabolism is stimulated. A special sort of tapotement, a rapid sequence of "concussions", which are given mechanically (Ewer's concussor, Liedbeck's vibra- tion apparatus) is also employed in nervous diseases, owing to its anodyne effect. Therapeutic gymnastics are of a far more complicated Treatment of "Nervous Diseases. 3 technique than massage. They consist of active, and passive movements. As to the effect on the nervous and muscular systems by passive movements the muscles are alternately stretched and relaxed and changed in their mutual relations. Hence it is a sort of massage. The active movements, in so far as they refer to the general musculature, have, besides the mechanical effects peculiar to passive move- ments, a general stimulating action on metabolism. The muscle regularly exercised increases in size and strength, at any rate its state of nutrition, if it is not completely paralysed, is generally improved. The muscle becomes more plethoric, a fact on which the revulsive action of muscular exercise depends. By accelerating the circulation metabolism and the generation of heat are increased, which are beneficial to the general condition; on these effects depend the therapeutic indications. The technique of gymnastics falls into two groups: the German and the Swedish. German gymnastics consist merely of simple active movements, which are chiefly exercises with dumb-bells, the bar, etc. I must refer to the proper text-books for the. more exact technique (e. g. Schreber). Anyone, who has practiced systematic muscular exercise, either at school or in the army, knows the greater part of those most useful. A fault of the German gymnastics is that the exercises cannot be so well localized and dosed as the Swedish, yet for many of the purely functional diseases of the nervous system they are especially adapted for home use, provided the movements are properly selected. The general practitioner is scarcely able to give Swedish gymnastics. They consist, as arranged by Ling, of a very complicated system of movements, which by varying the initial positions, whose number is about 100, with very difficult uneuphonious names, are almost infinite. They are in part free movements of the head, trunk and extremities, in part against resistance from the hands of the operator. The individual movements are not materially different from those of German gymnastics, in part more complicated. The passive movements have fewer initial positions; they 4 Aug. Hoffmann. consist essentially in the execution of all possible active movements of the different joints by the operator, with- out the patient's cooperation. Massage is included in Swedish gymnastics and not regarded as an independent branch of therapeutics. Various ingenious appliances have been devised for mechanically replacing the operator in these complicated movements. Numerous appliances are constructed, in which the resistance is effected by means of cords with suspended weights over pulleys, rubber bands, or by brake-like (Nycander) or lever and eccentric contrivances. Of all these, Zander's apparatus constructed on the last principle, is the most commonly used. Its merit consists in being able to exactly adapt the resistance to the physiological condition. The instrument, which consists of about 70 appliances, is too expensive for general use. By simpler means Otto Thilo seeks to meet the same physiological principles by using a series of pulleys which can be readily changed to suit the purpose. A full description of these exercises would require too much space, yet in special cases, when the patient cannot be sent td a Zander institute, they seem to be useful in nervous diseases. The simple apparatus of Stanislaw Sachs, constructed of rods with movable weights, one end resting in a ball and socket joint, is to be recom- mended on account of its cheapness and great adaptability (Eulenburg). The physician, in case he wishes to employ gymnastics in nervous diseases, may use the German and the Thilo or Sachs methods. With respect to the numerous indications, which hydrotherapy and electrotherapy have in nervous diseases, massage and complicated gymnastics are of far less importance. In bone and joint diseases, the latter attain their triumph; in the treatment of accidental injuries special institutes with gymnastics arrangements have become indispensable. The apparatus designed for the exercise of definite muscle groups like a rowing apparatus, Gartner's ergostat, Largiarder's arm strengthener, several of Sachs' appliances and the like may be recommended as suitable for home use. As to who may give massage, it may be said: In all Treatment of Nervous Diseases. 5 finer operations in which it is a matter of local effects, the physician shall give it. The manipulations of massage of the body may just as well be given by laymen instructed for the purpose, still, as in hydrotherapy, the physician should personally supervise its performance. Gymnastics should also be definitely ordered in each case and be con- vinced that they are properly given, when it is important that the physician understand the technique, in so far that he can give, i. e. demonstrate each movement. Besides gymnastics there are several therapeutic pro- cedures still to be mentioned, which cannot be called gymnastics strictly, yet must be included among the mechanical remedies. These comprise FrenkeFs treatment of ataxia by continued exercise of coordination, called com- pensatory exercise therapy by Leyden, as well as the suspension treatment and similar methods. Frenkel's treatment is based on the opinion, that in several nervous diseases, especially tabes, the disorders of motion are to be relieved by practice.' In that Frenkel accepts the anaesthetic theory of ataxia in tabes, he assumes that it is possible for the patient to com- pensate for the want of feeling in his movements by continued and properly supervised practices. Ac- cording to Goldscheider's theory the excitability is increased in certain undamaged neurons, and so the defect in the degenerated tracts is compensated. The performance of these exercises is comparatively easy, the physician must merely familiarize himself with their purpose and method. The kind of exercise depends on the degree and location of the ataxia. Treatment of the ataxia of the upper extremities absolutely demands the employment of simple appliances, while in that of the lower extremities Frenkel does not use any apparatus. At Leyden's clinic (Jacob), as well as at the Moabite Hospital (Goldscheider) certain simple appliances are used in the treatment of the lower extremities. Past experiences speak in favor of this method, yet it must not be forgotten, that it certainly requires the expert and personal supervision and direction ot the physician. The results are not very promising in 6 Aug. Hoffmann. lowered muscular tone, flaccidity of the joints; overfatigue is to be avoided under all circumstances; these movement cures are also contra-indicated with exhausting baths. As this movement cure has generally met with favor and not as yet succumbed to the Moloch"suggestion", a more exact description of its technique will be proper, it never having been definitely described in English. The movements are practiced in part in bed and in part while standing and walking. Frenkel insists on having the exercises in bed made by all patients, even the mild cases. The patient lies with his head somewhat elevated, so that he can see his legs and then successively makes the following movements at the physicians discretion (R. Hirschberg): 1. Flexion, extension, abduction, adduction of one foot, then of the other, followed by the same movements of both feet together. 2. Rotation of the foot at the ankle joint, the toes describing a circle. , 3. Flexion of the knee, keeping the thigh in a per- fectly straight line with the body. 4. Flexion of the thigh on the pelvis with the knee berit. 5. Adduction and abduction of the thigh with the knee flexed, the foot resting on the mattress and the pelvis fixed. This movement must be executed in four parts: adduction, back to the median line, abduction and again back to the median line without jerking. 6. Elevation of the leg as a whole, without zig-zag movements. 7. Adduction and abduction at the hip with the leg elevated. 8. Rotation of the elevated leg at the hip, the foot describing a circle. 9. With the legs extended and together require the patient to sit up in bed, without supporting himself on his hands and without flexing his legs. 10. The same movement with the patient lying per- fectly flat. Treatment of Nervous Diseases. 7 The purpose of these exercises is to teach the patient to again control his muscular contractions, and so be able to perform all these movements with normal regularity. At first the patient must attentively watch his movements, but after he is able to perform them quite accurately, require him not to look at his legs during the exercises, and finally he must try to perform them with his eyes closed. The exercises in bed form the first part of the treatment. With patients who are unable to Walk, the exercises in bed must be continued longer of course, than with those who can walk. Even in a high degree of motor incoordination most patients are benefited by the exercises. Exercises in the upright posture. For these select a large, well lighted room, with little furniture and a not too smooth, uncarpeted floor. The pafient is to be lightly clad, women should wear a sort of gymnasium suit, for in the beginning of the treatment it is very essential that they see their legs. Exercises in static equilibrium. The patient stands erect, the physician at his side. If he is unable to stand alone, support him by means of Frenkel's belt about his waist and provided with hand loops. If he can stand by the aid of a cane, permit him to use it at least in the beginning of the treatment. The proper exercises are: 1. Stand motionless, the feet somewhat separated, the hands at the side. Maintain this position for 1-2 minutes. 2. Repeat with the feet together. 3. Stand with the feet separated and perform easy gymnastic exercises with the arms (extending them forward, upward and backward). 4. Repeat with the feet together. 5. Bend the body forward, to the left, backward and to the right; describe a circle with the head. 6. Repeat with the feet together. 7. Stoop over slowly and straighten up again. 8. Repeat with feet together. 9. Bend the body forward so as to touch the toes with the tips of the fingers. 10. Repeat with the feet together. 8 Aug. Hoffmann. 11. Raise on the tips of the toes. 12. Repeat with the feet together. 13. Squat down by flexing the knees. 14. Repeat with the feet together. 15. With knees flexed perform the gymnastic exercises with the arms. 16. Stand on one leg. 17. Stand on one leg with knee slightly bent. Exercises in locomotion: 1. Stand erect and slowly advance one foot the length of a step. Bring it back to its place quickly. Carry the same foot forward, then to its first position. Move the foot to the side the length of a step and then back to its place. To have these exercises performed with precision, it is well to outline with chalk the exact place the patient should place the foot. These exercises are to be repeated alter- nately with each foot. 2. Place one foot before the other in a straight line and maintain equilibrium. 3. Take twenty steps forward,planting the feet gently and touching the floor with their whole surface. The patient should count his steps aloud. 4. Walk a crack. 5. Walk backward. 6. Walk sidewise. 7. Walk with long strides. 8. Walk with knees bent. 9. Walk on the tips of the toes. 10. Walk at command, stopping and changing the direction quickly. 11. Walk over obstacles. Place pieces of wood on the floor at equal distances. The patient must step over these without disturbing them. 12. Rise from a chair without the aid of the hands; sit down slowly without dropping. 13. Practice ascending and descending stairs, with and without holding to the rail. Treatment of Netvous Diseases. 9 Exercises while sitting: 1. • Raising the foot on the heel and then on the tip of the toes. 2. Touching definite points with the tip of the toes. 3. Tracing circles, rectangles, octahedra with the tip of the toe. 4. Stop swinging balls with the tip of the toe. For the treatment of ataxia of the upper extremities Frenkel has prescribed a series of movements, which are mostly effected by suitable appliances. These, will rarely be required in general practice. "They are individual movements of the fingers and hands: flexion, extension, spreading. Touch the several finger tips with the thumbs, crossing the fingers at the same time. Trace outlined figures. Guide a pencil in a small furrow, finally along an edge. Draw lines, circles, figures on paper from copy. Strike at suspended objects. Catch swinging balls. Touch several blocks or spots on a board in different order at command. Stick pegs into holes. Sort splinters of wood or pieces of money. Finger exercises like playing the piano or sorting money. Finally writing and drawing exercises". (Erb). Goldscheider very earnestly recommends these exercises, as Frenkel did at one time. Jakob, who has constructed an apparatus for the lower extremities, similar to Frenkel's for the upper, believes, like Frenkel of late, that the treatment should be confined to special institutions. Owing to the simplicity of the several exercises, which 1 have almost completely enumerated, the procedure seems to me well adapted for general use, yet only by frequent repetition of the exercises are permanent benefits to be expected. Of the 4 cases 1 have treated in this way, 3 at least are greatly improved. Nageli has specified a number of "manipulations", which he has perfected to a therapeutic method. Its prin- ciple is a forcible stretching of the diseased or painful parts by the operator's hands, which must be continued for a certain time. They are recommended for the most diverse conditions and act in part by promoting the circulation, in part by pure mechanical pressure and traction. For details 10 Aug. Hoffmann. 1 must refer to his monograph, published in 1894. A part of their effects depend on suggestion, while in many cases a material action due to the nerve stretching, facilitated circulation, etc., is not to be denied. I have often used them, but without particularly encouraging results. Suspension is another operation useful in the treatment of nervous diseases, which, like the above has been used in a certain class of cases of diseases of the spinal cord. The appliances are simple. Sayre's, suspension apparatus is used, in which the axillary braces are replaced by Mitchell's elbow supports. Formerly the patient was swung free from the floor, but this has been abandoned of late and suspension preferably given sitting, which is much pleasanter for the patient, the duration of each treatment can be materially lengthened and any danger that might be incurred by the former method is avoided. For measuring the amount of traction used many cumbersome appliances (Sprimon's by Bechterew and Worotnysky) have been used. The simplest way of measuring the force employed is to place a spring balance between the pulley and the cross bar (Aug. Hoffmann), which I do not increase over 40 kg. The duration of the sitting at first is two minutes and may be increased to 20, yet I have found those of 6-7 minutes the most beneficial, longer applications occasionally causing cerebral congestion and great fatigue. Suspension must always of course be given and supervised by the physician and is compatible with general practice. It is contraindicated by organic changes in the vascular system and acute spinal and meningeal processes. The favorable effects frequently observed are said to be due to the facilitated circulation in the vertebral canal. Giles de la Tourette and Chipault have recently devised a special kind of "spinal cord stretching" by forcible flexion of the spinal column. By experimental investigation they have become convinced, that by vigorous flexion the spinal cord and cauda eguina are actually stretched. The extension amounts to about 1 cm., and affects the posterior parts of the cord especially. In giving it the authors place the patient on a table with a back, to which the pelvis is Treatment of Nervous Diseases. 11 strapped and the thighs to the table, then by a system of braces fastened to the upper part of the body it is drawn well over the thighs by means of a set of pulleys. The traction force, measured by a dynamometer, varies between 60 and 80 kg. The results of this treatment are greatly extolled by its originators, who claim there are only 25% of failures with it, against 35-40% with suspension. My own experience is limited to one case, in which 8 sittings effected no improvement, but rather the ataxia became much worse. Yet the functions of the bladder were bene- fited. In any case it is not advisable to use such heroic treatment in ordinary practice. The method must be further tested before it is possible to decide whether it is to be given or denied a place among therapeutic methods, for Eulenberg is the only German observer who has spoken well of it. The flexion methods employed by Bonnuzzi, Blondel and Benedikt for nerve stretching may be passed over, for their effects are uncertain and they are not without danger to the patient, as well as unsuited to general practice. SUGGESTION AND HYPNOTISM. Rossbach places suggestion and hypnotism among the physical remedies, and hence they may be spoken of here, although as psychical remedies they have a very special position. Employed by the laity since the last century as a means of cure under the names of magnetism, Braidism, their introduction into therapeutics really dates from the appearance of Bernheim's book on suggestion, as well as since Charcot's exhaustive studies of hypnotism. If the question as to the reality of the phenomena of hypnotism in the positive sense may to-day be regarded as settled, especially after Haidenhain's experiments, still the matter of its employment in.practice is the subject of controversy. While on the other hand there are brilliant panegyrists, who believe they are able to favorably influence by hypnotism even "the secreting glands of the intestine, on the other there are those who are skeptical of its therapeutic action. For 12 Aug. Hoffmann. ethical reasons F. Schultze regards the use of hypnotism inadvisable. My. opinion, formed after employing it therapeutically for years, is that hypnotism is well adapted- to act favorably on some symptoms as well as to radically benefit many cases of hysteria, particularly in children. According to Goldscheider's theory, the attention directed to a nerve arc will alter the "liminal value" of the neuron, as he calls it, and so explains the real action of suggestion. But in the majority of cases the result is not permanent. The effects of hypnotism may also be sufficiently attained by well directed suggestions while awake. In morbid states, where we have a very strong autosuggestion as in neuras- thenics, hypnotism promises the most. The procedure as generally practiced to-day is simple. The physician must act with perfect confidence and not betray a trace of doubt as to any of his assertions, a preliminary condition, to whose non-fulfillment the failure to hypnotize is often to be as- cribed. The patient is placed in an easy chair or on a couch in the quietest possible room, not too light. Either previous to the subjective phenomena his attention is called to the heaviness of his eyelids, etc., and then for a time he may fix his eyes on some object held slightly above them, or during the hypnotization the phenomena of sleep may be suggested. Bernheim gives the following directions for hypnotizing. "'Look.at me closely and only think of going to sleep. You will soon feel that your eyelids are heavy, then your eyes are tired; you already blink, your eyes are already suffused; you no longer see distinctly,now your eyes close.' With some this occurs at once, they close their eyes and go to sleep. With others I must repeat these assertions and earnestly; I add some manipulation, which may vary as to kind. I bring, e.g., two finger of my right hand before the person's eyes and let him gaze at them, pass both hands downward many times over the eyes, or request him to look me steadily in the eye while at the same time I try to direct all his thoughts to the idea of going to sleep. I do this somewhat in this manner: 'Your lids close, you cannot now Tieatment of Nervous Diseases. 13 open them; your arms and legs feel heavy; you no longer hear; your hands feel as if they are paralysed; you can no longer see, you are going to sleep,' and I then add in a commanding tone: 'Sleep!' This order is often decisive, the patient closes his eyes, sleeps or is at least suggestible." The patient may be hypnotized in this or some similar manner. During the hypnotic state the necessary sugges- tions may be made, i. e. the patient is told in an impressive voice of the phenomena that are expected on awaking, as the remedial action of hypnosis, like the disappearance of pain, etc. If the patient cannot be hypnotized the first time, it will perhaps succeed on the second effort, but do not forget that every failure to hypnotize essentially lessens the patient's respect for the physician's authority, and so his further efforts are regarded with greater mistrust. From this unpleasant fact it can be readily seen that the use of hypnotism has its own shady side for the physician. Ex- citable, readily and profoundly susceptible patients should only be hypnotized before witnesses. As light sleep usually suffices for remedial purposes, the inability to open the eyes when told they cannot, profound hypnotism as a rule may be dispensed with. That the practice of hypnotism for remedial purposes should be left to the physician alone is shown by the many pernicious after effects from awkward application. Under all circumstances try to get along with ordinary suggestion, which experienced physicians have employed for ages, and only use true hypnotism in special cases. THE EMPLOYMENT OF PHYSICAL REMEDIES IN SOME DISEASES OF THE NERVOUS SYSTEM. After the preceding description the employment of physical remedies will offer no insurmountable difficulties to physicians outside of institutions, who are familiar with their technique. It has been shown how, under certain conditions, when complicated apparatus and appliances are needed and are not to be procured, they may be improvised by the simplest means, for a greater part of the practical methods can be given the patient with unpretentious 14 Aug. Hoffmann. instruments. Of course knowledge and dexterity are required to thus attain really beneficial results, as well as a some- what greater sacrifice of the physician's time. With regard to indications- in detail, it is evident after what has been said of the physiological action of the several methods, that no general scheme, applicable to every case, can be formulated. It is a peculiarity of these methods, that for each case a special program is demanded and to be modified according to the patient's individuality. It is common to all, that their employment must be free from all routine; to treat two persons with the same disease exactly alike, will almost always result in failure. As in internal medicine, individualization is and ever will be the physician's chief art, is especially true of the employment of physical remedies. All that is essential has been mentioned under the several headings and 1 will now take up the various forms of nervous disease and the physical remedies applicable to them, where all these assertions hold good, if the phy- sician selects, varies and combines them properly, according to the nature of the case. These are matters taught by practice and experience. Make it a rule in every case to begin always with the mildest application and as the patient bears it, pass on to the stronger. So at least no harm will be done and in their more frequent use the certainty of judgment will be made keener. If I classify the nervous diseases in the usual way, the employment of physical remedies is to be considered in: 1. Diseases of the peripheral nerves. 2. Diseases of the spinal cord. 3. Brain diseases (except mental disorders). 4. General neuroses. DISEASES OF THE PERIPHERAL NERVES. The diseases, respectively morbid phenomena, of the peripheral nerves are divided into those of the sensory and those of the motor nerves. The first are the neuralgias, anaesthesias and paresthesias, the latter the spasms and palsies. In neuralgia the physical remedies have been used Treatment of Nervous Diseases. 15 successfully for a long time. With respect to the employ- ment of hydrotherapy, warm compresses and packs are anodyne, while the action of intense cold is beneficial under certain conditions. Runge and Romberg regard cold to be contraindicated, yet others, like Erb, Edinger, Debanvais and Reddard take the opposite view. In neuralgia they recommend the use of intense cold to lessen the excitability of the nerves. For this purpose is particularly recommended, besides the ice-cap and cold douches, those remedies recently introduced into therapy, which produce cold by their rapid evaporation. Besides ether spray, these are chlormethyl and chlorethyl, the first being chiefly used in neuralgia of nerves distributed to a large area (sciatica, Steiner), the latter to superficial nerves. Both remedies are obtainable in tubes, i. e. syphons, from which they may be sprayed on the skin. The other methods of hydrotherapy are less used, only in sciatica packs, warm baths of long duration, brine baths have been beneficial. This is due to the general improvement of metabolism, as well as facilitation of the circulation in the skin and so unloading the deeper vessels. Doubtless electricity is the most effectual means for combating neuralgia. Those admit this, who merely recog- nize a suggestive action in this therapeutic measure. The mode of employment is preferably the stabile application of the anode to the pain and pressure points. The electrode should not be too small, daily sittings of 3 20 minutes aie to be recommended. On the other hand a vigorous stimula- tion by the faradic current is recommended, using a flat or pencil electrode (Frank!-Hochwart). The effect of the galvanic current is due in part to its polar action (anelectro- tonus), in part to the "cataleptic", as well as to its action on the vasomotors. Both currents "inhibit" the excitement of the neurons. The weak galvanic current is always to be selected. The strong faradic with rapid interruptions. Gymnastics now and then act well in neuralgia of the extremities, especially in its chronic stage. Old neuralgias may be treated with massage, particularly when due to pressure from muscular infiltrations. As the veins of the 16 ^H£. Hoffmann. , muscles are connected with those of the nerves, massage will always aid in unloading the circulation of the nerve trunks. Nageli's manipulations, particularly in neuralgia of the head, are to be considered; they facilitate the circulation. Anaesthesias and paresthesias, as results of peripheral disease, yield to treatment by warm, local baths, com- presses, as well as by cutaneous stimulation with the faradic current of moderate intensity. The anode treatment with the galvanic current, as well as faradic baths, may be tried. Spasms confined to single nerve areas form a frequent, but often unfortunately a very thankless' incentive for the use of the physical remedies. Warm baths (32-35°C) for 20-40 minutes, or warm compresses and packs may be tried. Now and then I have had good results from vigorous cold douches, as in a case of spasm of the muscles of the shoulder. Electricity has always been recommended for localized spasms. The point of origin of the nerves, whose area of distribution is affected with spasm is subjected to a moderate current (2-7 MA) from quite a large anode (25-50 scm.) for about five minutes. The cathode is placed on the sternum; at the conclusion of the treatment the anode is removed after the current has been gradually reduced. Strong faradic stimulation is rarely beneficial. Massage and special gym- nastics act very uncertainly, on the contrary, as voluntary movements occasionally excite spasm, they are to be avoided in most cases. Still a trial of exercise therapy may be made. No permanent results are to be expected from sug- gestive treatment. Palsies from destruction of continuity of peripheral nerves form an important chapter. It may be questionable as to the way physical remedies act for restoration of a nerve from its ganglion cell in regeneration of the axis cylinder, but it is certainly established by unbiased obser- vations and experiments, that by the use of physical remedies curative results are more quickly attained, which directly prove their favorable action (E. Remak). Treatment of Nervous Diseases. 17 While hydrotherapy is mostly employed in the form of compresses or long lukewarm baths, electrotherapy offers a rich, fruitful field of labor. At any rate for estimating the gravity of disease of the peripheral nerves, electricity has become indispensable from the reactions discovered by Erb and v. Ziemssen. For the purpose of diagnosis in paralysis of the motor nerves an electrical examination of the area supplied by them is imperative. As already stated, the reaction of degeneration occurs in severe disorders of the primary neurons. The occurrence of the reaction of degeneration is also extremely important in prognosis, for palsies with the reaction of degeneration require months at least for their recovery, while those without it generally improve materially and recover within a few weeks. The curative effects of electricity, which were somewhat overestimated after Duchenne's and E. Remak's researches, must to-day claim certain recognition from the severest critics. E. Remak's recent communications on electrical treatment of radial palsies are evidences, that it favorably influences the period of recovery. The methods, which may be used for the treatment of peripheral palsies, are the localized applications of the faradic current, as well as the stabije and labile cathodal treatment with the galvanic. The current intensity of the latter should be 5 MA with an electrode of 9 scm. The paralysed muscles are stroked with it, or it is placed for a time (2-3 minutes) at the point of the lesion. This treatment may be varied infinitely, yet it is best to follow a definite method. I have usually succeeded with the above method used for 6 minutes on alternate days. Under certain circumstances the treatment of severe paralysis must be continued for months. While it often seems as though the beginning of restitution is not essentially accelerated by electrical treatment in severe paralysis, yet it is very rapid after it once begins. The employment of the galvanic current, to which under all circumstances the greatest effect is to be ascribed, in severe palsies, the only one, prevents further degeneration of the muscles. The effect of the current is explained by its "accelerating" and exciting action, . 18 Aug. Hoffmann. thus relieving the fatigue and weakness, as well as its so- called catalyptic action. Simple and multiple neuritis deserve special mention. Electrical treatment is to be used after the acute symptoms have subsided. Only the galvanic current is proper, for the manifestation of pain and irritation after the use of the faradic prove that it is injurious. DISEASES OF THE SPINAL CORD. Diseases of the spinal cord are eminently suited to physical therapy. First of all the most common spinal disease, "tabes dorsalis,"is of special interest in treatment. All that is said of its treatment, may be applied, mutatis mutandis, to the other chronic diseases of the cord. The acute diseases of the cord are rarely subject for active therapy. In the secondary stage physical treatment first becomes affective for the same reason as in chronic diseases. In tabes, particularly in the so-called second stage, that of beginning ataxia, the requirements for a consistent physical treatment exist, and it is almost strange that this time is denoted as the most favorable to the action of this celebrated remedy, from which it is to be concluded with great prob- ability, that the period of beginning ataxia is the one most favorable for spontaneous remission. Be that as it may, from this time on in chronic tabes, the question will always present itself to the physician: "What else is to be done?" Such patients cannot spend their life at baths and sanita- riums, but must be treated at home. So in this disease it is especially incumbent on the physician to be familiar with the physical remedies and their use, and to employ them according to the state of the case. While part of the cases have a tendency to run an acute course, which is especially frequent in less well situated surroundings, from inability to arrest the disease in its beginning, our methods of treatment, like all others, leave us in the lurch, yet in chronic cases great benefits are to be derived from them. Hydrotherapy is effectual in the employment of especially mild procedures: cold friction and half baths. The latter may be given daily for a long time, and at their conclusion Treatment of Nervous Diseases. 19 cool effusions over the back are requisite. The use of warm and steam baths is inadvisable. Many investigators are not convinced of the action of electrotherapy in chronic diseases of the cord, but Erb, who has the most experience in the matter calls electricity "a powerful physical remedy" in his latest discussion of the treatment of tabes. While there are no definite ideas as to the way a diseased cord is effected by the galvanic current, benefit is often derived from it. The treatment consists in giving the current with an electrode 6x12 cm., placed on the sternum or back of the neck, one equally as large about four inches below it on the neck, which after one minute is pushed downward its width three times. A case of tabes has been instructive to me as to the effect of this treatment, and in which I have em- ployed no other than that described. The intestinal crises were especially benefited. As the case seems adapted to demonstrate the direct curative action of electricity on the central nervous system, it may be briefly reported. L., 40 years old, a merchant for 13 years, after having had "sciatic" pains in his legs for several years, became troubled four years ago with severe and very sudden attacks of diarrhoea, which came on so quickly, especially at night, that he could not get up soon enough. This gentleman, who had kept account of his bowel movements for three years, had not been free from these tormenting attacks for more than seven days on the average during this time, in spite of the most diverse bath and dietetic methods,—one ordered 14 meals a day—suggestive and medical treatment. The tabes had been overlooked by all who had examined him. When I first saw him there was slight difference in the pupils and fixity. Absent patellar reflex, as well as slight ataxia, was also to be observed, and he had had palsy of the eye muscles for a year. As all aggressive measures, especially hydrotherapy and baths, had shown that any intense physical excitement increased the attacks, 1 was led to treat him expectantly at first, and employed the mildest remedy: galvanization of the back. Immediately after beginning the treatment an interval of more than forty days occurred, then five weeks followed, during which there 20 Aug. Hoffmann. were several relapses, but from that time on under contin- uation of the treatment, which was later interrupted by a six weeks' sojourn at the baths of Nauheim, a period of 280 days elapsed without a single attack of diarrhoea. Here is a case materially and permanently improved in a scarcely perceptible way by the use of electricity, on which sugges- tion had previously acted intensely. Besides galvanization of the cord, which may be used for a long time without injury to the patient, although in most cases it is advisable to dispense with it for a time after 4-6 weeks, the faradic treatment, first used by Rumpf, is to be recommended, which consists in applying to the patient's back and legs the faradic brush for 10-20 minutes with a current able to excite powerful muscular contractions. Thus will be attained the reflex effects in the cord in the sense of facilitation and inhibition (Erner and Goldscheider), as well as vascular dilatation. Such intense stimulation of sensation in the legs is often beneficial in tabes, as I observed that every time a patient's sensation was carefully tested by many pin pricks, he was able to walk better. How large a role suggestion plays cannot be stated. A local galvanic or faradic treatment often benefits the laryngeal, gastric and intestinal crises of tabes. Massage is occasion- ally beneficial by its action on the nutrition of the muscles, especially when they are very flaccid and weak. Gymnastics, in so far as they consist of vigorous exercises and resistive movements, are generally inadvisable in incipient ataxia. Now and then favorable results from such methods are reported, yet as Frenkel, Leyden and Gold- scheider state, the tabetic is inclined to use more strength than required in every movement and so is injured by the exhaustion occurring in these exercises, owing to the occasional absence of the sense of fatigue. It is entirely different with the Leyden-Frenkel compensatory exercise therapy, according to generally accepted views, as well as in advanced cases. Suspension, in the mild form now generally used, yields decidedly favorable results. I know of a large number of cases benefited for many years, as I reported to the Society of Natuial Research in Braun- Treatment of Nervous Diseases. 21 c hweig. Improvement of the ataxia, the bladder trouble and pains are to be thus attained. 1 have seen favorable results in chronic myelitis. Forcible stretching of the cord, according to Gilles de la Tourette is advisable in general practice. The use of support jackets must be left to expert orthopcedic specialists. In all chronic diseases of the cord it is of prime impor- tance, that the methods be changed, baths at Oeynhausen, Nauheim, etc., may, under certain conditions, be replaced by artificial aerated baths at home, while careful observa- tion of the patient, regulation of the diet and mode of life must be kept in mind especially. Of the acute diseases of the cord, infantile anterior poliomyelitis is to be especially mentioned, which demands the use of physical remedies in its secondary treatment. I would advise beginning 8-10 days after subsidence of the acute symptoms with labile application of the cathodal gal- vanic current to the palsied muscles, by placing an indifferent electrode of 5x10 cm. over the presumed lesion, also luke- warm baths daily or every other day and, if the patient's intelligence permits, active and passive gymnastics. The two easels, in which I began the treatment very early (in the first week), the first with complete monoplegia of the right arm, the second with total paraplegia of both legs, recovered without any defect, a result, which has led me to begin the treatment as early as possible. In the later stages the treatment must be mostly orthopoedic, which, supported by electricity, gymnastics, especially those of Thilo, and massage, often attain only indifferent results. The diseases accompanied by muscular atrophy are still to be considered: spinal, neural and myopathic atrophies, respectively distrophies. Owing to their progressive char- acter the treatment is purely symptomatic and conservative. Galvanization and local faradization of the diseased muscles seem to benefit their nutrition and so arrest the disease. Now and then massage and gymnastics are beneficial, yet exhaustion is to be avoided. 22 Aug. Hoffmann. BRAIN DISEASES. The brain diseases suited to treatment by the physical methods are the hemiplegias especially, whether due to infantile, cerebral paralysis, embolism, thrombosis or cerebral hemorrhage. In the acute stage of these diseases, physical treatment, except the ice-cap, is out of the question, but after 5-6 weeks, when the patient is convalescent, they are proper. Of hydrotherapeutic procedures, hike-warm baths only are to be considered,during which a cold compress is to be kept on the head. Further treatment is for the special purpose of restoring and increasing the functions of the muscles and nerves. For this electricity, gymnastics, as well as massage, are especially adapted. Galvanization of the head, once so often recommended, which consists in placing a 7x14 cm. anode on the forehead, an equally large cathode on the neck, with a current intensity of not over 2 MA, and con- tinued not more than 3 minutes, I consider harmless, yet of little use. More is to be expected from local treatment of the muscles and nerves of the palsied extremities with the faradic or galvanic current in sittings of 5-20 minutes daily or on alternate days. Besides the relief of the symptoms of congestion, the counteraction of beginning contraction is also to be attempted by various passive and, if possible, active gymnastics, whose administration may be left to a relative after receiving full instruction. In the treatment of mental diseases the use of lukewarm baths is to be considered, particularly in the mild forms of melancholia, suitable for home treatment under certain conditions (see Prof. Ziehen's Treatment of Melancholia; American Journal of Insanity, Vol. LIV., p. 543), yet even when circumstances permit, it will usually be better for the physician to send these patients to a special institution. For if convalescence does not occur after a time, the deter- mination for a change of residence is always harder, and the patient and relatives are disappointed. Only a physi- cian well versed in psychiatry should undertake, in my opinion, to treat the mildest forms of mental disease at home. If he is not, he should secure at least the advice of a Treatment of Nervous Diseases. 23 psychiater, to escape the danger of having overlooked something, if the disease proves to be periodical (see Dr. Hoche's paper; ALIENIST AND NEUROLOGIST, Vol. XIX., p. 193) and relapses occur. • GENERAL NEUROSES. The so-called functional neuroses, whose anatomical basis is unknown, especially neurasthenia and hysteria, form a special domain for the physical remedies. In these diseases suggestive influence may be given the most credit for curative effects, yet it is at least known that hypnotic and purely suggestive treatment attain permanent results only in the rarest cases, while properly conducted hydro- pathic, electric and mechanico-therapeutic measures very often improve and permanently cure many cases. And quite often it is these methods, where only a slight externa! effect is perceptible, e. g. galvanization with weak currents, which, according to all that has been said, should have the least suggestive action, that often attain the greatest success in functional diseases, greater than those procedures combined with the most mysterious and striking phenomena, e.g. Franklinization (Friedlander). If suggestion is especially decisive in the cure of these diseases, so one should suc- ceed either with hypnotism, i. e. suggestive treatment, or that combined with the greatest possible display of showy instruments, for acting more on the mind and ideas of the patient. Yet both have been in no way satisfactory; the results of purely suggestive treatment are neither so alluring, that other remedies should be abandoned, nor does the employment of some complicated, striking method offer any demonstrable advantage. We do not know the anatomical basis of these diseases, but may assume they consist of changes in excitability (liminal neuron, Goldscheider),perhaps also in the structure or chemistry of the nerve cells, respectively neurons. These changes perhaps lead to objective disorders, exaggeration of the reflexes, pupillary phenomena (A. Westphal), further to changes in the circulatory organs, which often become a serious factor, as well as frequently to severe disorders of 24 Aug. Hoffmann. the general condition. As often as 1 have tried to benefit these conditions by hypnotism, as I have for years, 1 have never been able to attain more than temporary success. Simple psychical treatment is able to accomplish much under certain conditions, yet not as much as when supported by physical and medicinal remedies. That psychical treatment is still of the greatest impor- tance is evident, confirmed by the fact, that the "liminal neuron" may be changed by psychical irritation (Gold- scheider). To this psychical treatment belongs chiefly the most careful examination, as well as the avoidance of everything that is apt to make the patient anxious and especially destroy his confidence, be it in the physician, who advised him, or in the one who is to undertake some special treatment, requirements, which are alas too often neglected, to the patient's injury. When the value of a remedy is subjected to discussion, a justified doubt expressed as to its action or employment, if only by a shrug of the shoulders the want of confidence in the simple remedy is shown, it is seriously damaged for the neurasthenic under all circumstances. This practical side of comprehending the value of physical remedies must be the rule of action, and not whether this or that remedy only acts suggestively in certain cases, but if it will only benefit the patient, it serves both the patient and the physician. All else are purely scientific and theoretical questions, which must be kept out of the sick room. If 1 have here given psychical treatment a prominent place, it shows how highly 1 esteem it. That it must run like a bright strand through the use of every remedy, how it must be adapted to the individual and often in the choice of a curative method is decisive, if we indi- vidualize, are facts always to be considered. Of the physical methods, hydrotherapy is first to be considered, and cold morning frictions are to be especially employed. At first they are to be given at moderate tem- peratures and gradually made colder, if well borne. They have an invigorating and refreshing effect, rousing the patient's energy. The wet pack is a sedative. Insomnia is often benefited by it. But half baths, whose action may be Treatment of Nervous Diseases. 25 greatly varied by the temperature used, the length of their duration, as well as by the mechanical procedures accom- panying them, are very useful in neurasthenia and hysteria. These methods, in part sedative, in part exciting, form a very special adjuvant in the treatment of such patients. In those weak and debilitated exciting measures must be avoided at first. Besides general treatment, symptomatic procedures are needed to combat pronounced local symptoms. Cold sitz baths of 8-29°C. for 5-10 minutes cause conges- tion of the abdominal organs and so unload the others, as well as an adjuvant to digestion and sexual potency. For sexual irritability warm, long continued sitz baths are indi- cated. Short, cold foot baths, as well as other cold stimuli to the feet (Kneip treatment) serve as derivatives in con- gestions of the head so common, and also as a general invigorant of the whole nervous system. The psychrophore is indicated in states of sexual weakness, spermatorrhoea, pollutions nimi. In this and similar ways various localized troubles are treated symptomatically. Saline, as well as carbonic acid baths are indicated under certain conditions. In congestion' of the head do not fail to counteract the hypostatic, first of all bathe the face and neck with cold water, in severe cases an ice-cap or cold compress may be employed. Electricity is especially useful in the treatment of functional neuroses in sanitariums. Beard and Rockwell introduced general faradization, i. e., the application of the faradic current to the whole body, whose intensity depends on the sensitiveness of the several cutaneous areas, as well as central and general galvanization. Both may be used. Sleep and the general condition are often benefited by their frequent employment. Galvanization of the head with weak currents D=0 5-6:90, chosen according to the patient's individuality, for }4-3 minutes, relieves many cases of cere- brasthenia. According to Lowenfeld in brain anemia arrange the electrodes so that the cathode is on the forehead and the anode in the neck, or inversely. Galvanization of the neck is very often recommended and even by Mobius (especially in Basedow's disease, where it seems to be 26- Aug. Hoffmann. extremely beneficial in many cases). The treatment of states of sexual excitement, as well as of depression, by localized currents is often commended. One pole of 18-25 scm. may be placed on the perineum, or over the symphysis, or introduced in the urethra in form of an insulated bougie provided with a metal tip. Both currents may be employed externally, only the faradic internally. The treatment of dyspeptic disorders by electrization of the stomach seems to afford favorable effects in cases with anomalies of the gastric secretion; constipation may also be treated with electricity. The abdominal walls are energetically faradized by two electrodes, both placed on the abdomen or one introduced into the rectum. The faradic pencil is often very beneficial in relieving hysterical palsies, whatever their location, whose effect surely depends on its facilitating and suggestive action on the will, and this method of attaining a suggestive effect may often be em- ployed as the most practical. It is to be stated, that it is not necessary to produce pain, but merely the idea of effecting a cure. The latter is suggestively effectual. The employment of electrical baths is to be mentioned, which in hysteria and neurasthenia have a general tonic action, similar to general faradization. Massage and gymnastics are symptomatically indicated in states of muscular weakness, and form a part of the Weir-Mitchell and Playfair rest treatment of the neuroses. It consists of forced nutrition according to definite rules, and the patient is kept in bed and isolated, milk forming the special article of diet. Still the nutriment must be suited to each case. At first the patient is not to talk or have any mental occupation, while the food is daily increased as much as possible. Besides increasing the amount of food, metabolism is facilitated by general massage, passive gym- nastics, localized faradization. After one to two weeks active gymnastics are gradually introduced and later mental occupation, until the patient returns to his usual mode of life. This treatment, which often effects an enormous gain in weight in a short time, depends essentially on suggestive action, besides the improvement in the general physical Treatment of Nervous Diseases. 27 condition. It is not a specific for nervous diseases, only for emaciated and debilitated individuals, and its employment demands a careful selection of the cases. Gymnastics may occasionally be advantageously pre- scribed to overcome the apathy often found in these patients. The method depends very essentially on endeavoring to promote the energy of innervation and general vigor of the muscles. Young, vigorous persons may be benefited by German turning, calesthenics (Schreber) offer a multitude of exercises, which may be selected according to the pur- pose of the gymnastics and their symptomatic action, in case it is a matter of constipation, revulsion from the head, etc. Hence, according to the effect desired, one of the many gymnasium appliances may be prescribed, like the rowing apparatus, Sachs', etc. The Zander gymnastics are little used in neurasthenics, owing to the complicated apparatus and the noise, dust, etc. incident to their use. The routine employment of this treatment is to be guarded against in weak, overworked and fagged individuals. According to my experience the state of exhaustion will often be only inten- sified. Whereas moderate indulgence in sports, like riding, rowing, bicycling may be permitted under certain conditions, the patient being thus gotten into the open air. Of the functional neuroses the traumatic are. still to be specially considered, in which physical remedies are employed along the same lines as in neurasthenia and hysteria. Epilepsy is occasionally benefited by mild, cold water treatment, by lukewarm half baths and friction com- bined with the other essential remedies, also under certain conditions cautious galvanization of the head, neck and back may be given, yet no great benefit is to be expected. In chorea warm baths have a sedative action, cautious gymnastics are occasionally able to relieve the restlessness, yet as we have more effectual means, we need not promise ourselves very much from the exclusive employment of the physical remedies. Tetanus, myoclonia, myolonia rarely indicate the use of physical remedies. In paralysis agitans good results are often attained from warm baths, and electrical baths in particular 28 Aug. Hoffmann. (Erb). Electrotherapy is of no special benefit and only acts in a suggestive way, like the mechanical remedies. Suspension, formerly recommended in paralysis agitans, now has no advocates. Of the vasomotor, trophic neuroses Basedow's disease and migraine are to be mentioned. That Basedow's disease is often benefited by electrical treatment has been stated, also friction, packs and invigorating genera! treatment have good results. Gymnastics may occasionally be beneficial, if cautiously employed, yet suggestion here plays a part, if trifling. Migraine is occasionally benefited by galvanization of the neck, also by friction and sitz baths, while revulsive foot baths are also indicated. A number of diseases are called occupation neuroses, which are generally observed after and during excessive demands on certain groups of muscles in certain unilateral functions in predisposed individuals. Neuralgia, cramps and palsies are observed. The therapy of these conditions agrees with that in diseases of the peripheral nerves. Occupation cramps, particularly writer's cramp, have special importance. Complete recovery from this very stubborn disease is rare. Massage, gymnastics, exercise therapy (Goldscheider) of the affected extremities are recommended by many as especially effective, as well as treatment with the galvanic current, applied to the muscle groups affected by the cramps. The faradic current is now and then recommended for local treatment. In this, as in all convul- sive diseases, whose exact localization we do not know, the therapy is in the dark. It is extremely probable that all convulsive diseases have a central, if not cerebral, localiza- tion, hence in their treatment that of central organs, respectively general treatment, is never to be neglected. A case of writer's cramp of 20 years standing in a gentleman of 52, treated by celebrated masseurs, led me to think a great deal about the localization of this disease. It entirely prevents him from writing. He also has arteriosclerosis with myocarditis, and in the summer of 1895 had a mild stroke of apoplexy, causing a temporary paresis, respectively weakness, of the right side of the lower part of the face, as well as of the arm and leg of the same. side. The Treatment of Nervous Diseases. 29 paresis almost completely disappeared from the arm and leg, but what was the strangest was that he could again write perfectly normally and easily with the hand previously affected with writer's cramp and afterward paralysed. This case speaks much for the probable central origin of the trouble in many instances, where the knots and infiltration in the muscles found by the masseurs had nothing to do with it, and in spite of their alleged removal the cramp often continues. These symptoms of excitement in this case were benefited by the inhibition induced by the apoplexy. In conclusion we find on reviewing the physical remedies, that: 1. A large number of the physiological effects of physical remedies are established. 2. A large number of reliable observers have derived the same benefits from their rational employment, and so often that they are regarded as dependent on them; their general organic action must be regarded as the greatest part of their cause. 3. These observations provide the reason for the opin- ion, that but a small part of the results attained are due to suggestion. 4. It is further established that physical remedies em- ployed with competent experience, according to decisive principles, cannot injure the patients. 5. In the most modest practice the employment of the largest part of these methods, which are chiefly prescribed for a curative effect, is possible and practical. But unfortunately, anything more positive cannot be said of the other remedies in nervous troubles. Greater advancement in the knowledge of their action is to be expected from their more general employment at the clinic, and thus more general scientific work. Waldeyer's neuron theory has proven of benefit, in that Goldscheider first tried to explain the import of stimulation in the light of the neuron theory. The theory of the "neuron liminal" introduced by him is at least able to trace back the greatest part of the curative effects to amplification, respectively, 30 Aug. Hoffmann. derogation of the liminal altitude (inhibition and facilitation). This is not the place to more fully discuss these interesting matters. It follows from all that has been said, that to-day we are in position to employ the physical remedies with benefit to our nervous patients, not only in sanitariums, but also in general practice. THE APPLICATION OF ELECTRICITY IN THE TREATMENT OF SOME DISEASES OF THE NERVOUS SYSTEM.* By DR. ALEX. L. HODGDON, Baltimore, Md. Professor of Nervous Diseases and Diseases of the Mind,Maryland Medical College; Neurologist to the Home for the Aged. DURING late years a great amount of skepticism seems to have been indulged in by many members of the medical profession in regard to the use of various forms of electricity and the magnet, in the treatment of disease; many, 1 understand, believing that no benefit whatever accrues to the patient, others that the influence is purely psychical, and still others who believe that psychical in- fluences do not play a part in the results achieved. Some of these may think there is little good accomplished outside of the galvanic current with its direct chemical action; others may include the faradic as worthy of notice; still others may deign to admit the virtues of static electrifica- tion, while only a few seem disposed to ascribe any virtues whatever to the magnet. But why should not all of these therapeutic agents be used in appropriate cases? Because opium is good, in certain disorders, why limit ourselves to its exclusive use? There is another aspect to this subject —that is, should only one drug be used, opium probably is the most generally useful, and if only one form of elec- tricity be administered, due possibly to lack of time or in- clination on the part of the general practitioner, then it may be well to possess either a galvanic or faradic battery, as being the most generally useful. •Read before the Clinical Society of Baltimore, Md., ut Its meeting. November 16, 19O0. [31] 32 Alex. L. Hodgdon. Of all the various diseases of the nervous system, there is probably none in which electricity is more gener- ally useful than in the treatment of neurasthenia, or nerv- ous exhaustion, with its many psychical and other symp- toms, simulating at times, grave organic trouble. In this disorder we have many distressing features, such as the lightning-like pains, resembling those of locomotor ataxia, the cold extremities, the tremor, headache, and gastric symptoms; the latter predominating in many cases; the cardie palpitation may even be so great as to cause the patient to fear that he is the victim of an incurable heart lesion. The great feeling of exhaustion present, either mental or physical, as the cerebral or spinal form of the trouble predominates (cerebrasthenia or myelasthenia),. also the morbid fears to which some of these victims are sub- ject, as agorophobia (fear of open places), topophobia (fear of places in general), claustrophobia (fear of closed places), anthrophobia (fear of man), gynephobia (fear of women), all of which, with sometimes many other symptoms pres- ent, but too numerous to mention, paint a graphic picture of neurasthenia. This literally being a condition of nervous exhaustion, what would be the treatment indicated? I shall not mention the administration of drugs (of which there are many good ones) in this article, as it is only upon the subject of the electro-therapeutics of the diseases' men- tioned; therefore the treatment should be, one or all of the following methods: Central galvanization, the object of which is to bring the nervous system, the spinal cord, brain, and sympathetic, as well as the pneumogastric and depressor nerves under the influence of the galvanic current; the method of performing which is, to place the negative pole on epigastrium, the positive on cranial centre, passing it over forehead and top of head, by inner border of sterno-cleido-mastoid muscles, from fossa to sternum, at nape of neck, and down entire length of spine. General faradization may advantageously be practiced, by placing the feet on a large wet cloth electrode, and passing the roller electrode over nearly the whole extent of the body. Static electricity is probably better adapted to the treat- Diseases of the Nervous System. 33 ment of this condition than any other form of electrical applications, and it may be administered by either insulat- ing the patient negatively or positively, according to his various symptoms, the negative insulation being suitable for the greater proportion of neurasthenics. It must be re- membered that the population of this earth is constantly in an electric bath, on clear days, the atmosphere being positive, and the earth negative, while on cloudy days the conditions are different, as the earth may be either nega: tive or positive; therefore clear weather producing, in most neurasthenics, the greatest sensations of bien etre, they should be negatively insulated, while a positive breeze, spray, roller discharge, or marked sparks, are ap- plied; being careful to avoid the region of the eyes while administering sparks. The static breeze and spray are better adapted to the treatment of the neurasthenic than any other form of administration; this, 1 believe, being acceptable to about all, but a certain number are very susceptible to the action of the sparks, which may produce disagreeable sensations in the patient. A few in whom extreme excitement prevails may be better treated by the cathodal rather than the anodal discharge. I consider the prognosis of neurasthenia very bright when treated by electricity. In the various forms of sexual neurasthenia in the male electricity may be applied to the genitals of the individual either externally or by intra-urethral application, by insulated electrode or ordinary metallic sound. This ap- plies also to cases of impotency, but when loss of sensation exists in the mucous membrane of the glans and foreskin the faradic wire brush from the secondary coil should be passed over the surface of glans, and internal portion of foreskin, every day or every other day, or the galvanic current may be applied, taking care not to make it too strong (remembering that electrical resistance of mucous membranes is slight), or in some cases which may not yield to any other treatment, the static spray or sparks may give relief. The sparks can be administered by using the Morton pistol electrode, separating the brass balls, and placing the sponge end over the glans penis; this treatment it seems 34 Alex. L. Hodgdon. to me is a great deal more scientific than a great deal of drug administration for this class of diseases. In general atonic impotency sparks may be drawn from the lower por- tion of the spine as well as treatment addressed to the parts themselves. In exophthalmic goitre, I consider elec- tricity to be one of the best remedies of which we know. The negative sponge may be placed below auriculor-max- illary fossa and the positive over sixth and seventh cervical .vertebra, using the galvanic current, and thus galvanizing the cervical sympathetic, or one pole may be placed over heart. A current of from 3 to 8 milliamperes can be used, or the fafadic current be applied directly over enlarged gland. Remedies may be applied directly to enlarged gland by means of cataphoresis. I have used a mixture of about equal parts of Liq. lodin. Comp. and Ergotole in this way, in a cataphoric cup attached to the anode directly over the gland. Generally speaking, the iodine should be placed under the cathode, as it is electro-negative, and would be attracted' toward the positive pole, but by remaining there, for sometime, it becomes polarized and in that way, after be- coming of the same polarity is expelled, and passes through the tissues with the ingoing current. Static electricity is of great value as a general tonic, and may even be of benefit in a certain number of cases by administering direct sparks over the seat of the enlarged gland. It must be remembered that the resistance of the skin to the electric current is greatly diminished in many cases of this kind, being due probably to the dilatation of the capillaries with blood. The normal resistance of the body being from about 4000 to 8000 ohms, it is found that in exophthalmic goitre the resistance may be 800 ohms or even as low as 300 ohms; this is a valuable point in diagnosis. A great many of the spinal cord cases are apparently hopeless, especially in their later stages, but in posterior spinal scleroses, hered- itary ataxia, and the combined scleroses of the cord, as well as disseminated sclerosis, are there many things which hold out any better hope for a cure, or for an amelioration of the symptoms, than electricity? The static breeze in the headaches accompanying locomotor ataxia, is probably the Diseases of the Nervous System. 35 best agent which can be used. In neuralgia of the fifth nerve, sometimes one form of electricity may relieve, and sometimes another, hut it is well to always remember that the positive, or anode, is the sedative pole, and the negative or cathode the irritant, and that descending currents are sedative and ascending of a stimulating, or irritant nature; also that the current from a long or high tension coil is sedative, while that from a short coil is irritant. A test for high tension may be made with a Geissler tube, the tube being glowed by the high tension coil, as 1 will illustrate; the battery here, being a chloride of silver battery, which is one of the best made;'the cells having a wonderfully long life. • ,,' -i i Some-forms of chorea and neuralgia seem to be greatly benefited by the use of-the magnet. I have a permanent one in my office, made for me in France, capable of sup- porting about 180 pounds. Always remember that the south pole is sedative, while the north pole is irritant; the polarity may be determined by the compass, hi nearly all forms of headache electricity comes nearer to being a spe- cific than any other form'of treatment; all of the various forms of electricity being useful. The static applications are probably of greater service than any other kind; the positive breeze or spray, or even head bath electrode, being brought near to the painful portion, allowing the spray or breeze to play generally over the head, taking care to keep out of sparking distance. The cataphoric administration of cocaine may be practiced over the painful neuralgic portion of the head, the cocaine being carried down to the nerve by the anodal or ingoing current, and should be in solution and if possible a cataphoric electrode should be used. This has proved itself very valuable in neuralgia. In hysteria, static and faradic electricities are probably the most valuable remedies which can be used, and should be administered in the form of the breeze, spray and roller, and the faradic by general faradization, using the roller electrode. In all of the diseases before mentioned the use of electricity should never be neglected; and in the various 36 Alex. L. Hodgdon. forms of paralysis it is the most generally useful form of treatment of which I can conceive. Both the faradic and galvanic currents as well as the static may be passed through the ground and in that way be administered to the patient. A comparatively low tension medical induction coil would seem to be transformed into a high tension coil by creating a ground circuit, as 1 will illustrate, by grounding the wires, placing my bodylin circuit.lpassing the voltage through my body, with itsjthousands of ohms of resistance, and yet causing the Geissler tube to glow brilliantly by means of the voltage passing through my body. I have never seen anything'written upon the subject of increasing the tension by grounding almedical induction coil, but as you see, it can be accomplished. Nor .have 1 seen any reference to grounding the medical galvanic current. SOME OF THE MEDICAL AND LEGAL PHASES OF INSANITY* By CHAS. O. MOLZ, M. D., Bedford, Ind.t IN ATTEMPTING to prepare a paper for the edification of the learned men constituting this medico-legal meet- ing, I have fully realized the herculean task which has presented itself to me, and although 1 may enter largely upon the domains of medical study 1 ask the pardon of the legal men present for it is necessary that I do so in order that I may be able to more fully and clearly elucidate the medical and legal phases of the subject, which I have attempted to handle. In discussing the subject of insanity from a medico-legal standpoint we enter upon a study that is to-day more fully understood than it was a few years since, and will in the next decade be still more clearly understood. The conception constituents of what to-day comprises our nervous system is vastly different from that which supposedly constituted it only five years since. When we then had the cell, nerve fibre and terminals we to-day have the hystologic element under the name of the neuron, con- sisting of cell, neuraxon, collaterals, and terminal filaments, or dendrites, and where in former years the weight and size of the brain was supposed to be a criterion by which we could judge of a man's intellect, we to-day judge it by the number and conditions of the neurons. This neuron concept, as it is called, is now generally accepted by *Read before a joint meeting of the physicians and Lawyers of Lawrence Co., Indiana May 5th 1900. tThe author acknowledges his Indebtedness to the current literature of Psychiatry for many facts and'conciusions contained In this contribution. [37] 3$ Chas.O. Moli. physiologists, and ev£ry day brings forth new and valuable information on the subject. The biain is that portion of our cerebrospinal system of neurons situated in the calvarian and the study of its pathological conditions and diseases is to-day an important branch of medicine, and one upon which modern science is directing'her search, lights, with assiduous, attention. The.brain is rightly called the Colonel of the nervous system and is the seat of intelligence, will, understanding, reason and memory, and it is easy to perceive how an abnormality of any one of these functions may cause such a change in a person that: the question of his sanity or insanity may readily arise. Insanity is a disease of the brain and not of the mind as is commonly supposed and demands as much attention- as any other disease of that organ. While it is a disease of the brain, it does not in-' variably, start in that organ. Indeed it may originate almost anywhere else,-- as in the uterus of the female or a diseased colon and with proper treatment of these organs the insanity may be caused -to disappear. •'"',',* •'• Insanity is more frequently secondary than primary and when a man is insane, there is always a disturbance of trie- normal working powers of the brain, and this secondary prominence constitutes one step towards the proper elucida- tion of the subject, for it emphasizes the fact that it is not necessarily a stigma, as was formerly supposed, and is yet considered by so-many, nor is it, metaphysically speak- ing, a disorder of the mind with accompanying mental disturbance of a mysterious character. It is an affection of the brain which, though not always, originating there invariably has its seat there. This is easily understood when we consider that there is no part of the human economy, however infinitesimally small it may be, but which is connected with this great cerebro-spinal center, and is dominated by influences which emanate from it. For this reason we can readily understand that the functions of the brain may be impaired by the presence of disease, especially when the predisposition to insanity exists. Medical and Legal Phases of Insanity. 39 Predisposition exists toward insanity as it does toward other diseases and some are very much more predisposed to it than others, and always labor under a highly unstable condition of the nervous system. People subject to the same influences and surroundings undergo different changes and while one may go insane another may not suffer the slighest change of his intellectual functions. If an inquiry is made of the insane the fact is nearly always elicited that this predisposition does not originate with the person himself, but is hereditary and transmitted. Insanity literally means deprivation of reason, deviation from normal health, unsoundness of mind. Now is it possible to form a definition of insanity? "Can a line be drawn so sharply between reason and insanity that on one side all the phenomena found shall be compatible with reason and on the other with insanity?" This is impossible and as one great author says: "The shades of variation in eccentricity, between sartity and in- sanity, are so slight and numerous that it is exceedingly difficult to state where reason ends and insanity begins." "This we have all observed in some of our friends, whom if we had not known all our lives we would be ready to pronounce insane." "This too is made prominent because at times one's deportment may not be compatible with sound mental health, while at other times he entirely removes our apprehension. This class of cases may be said to live constantly upon the "border line of insanity" and are apt at times to cross the line and then return." "Many learned and eminent men occasionally cross the line and make excursions into the labyrinths of intellectual abberation. These are the cases which require months of study to arrive at a definite conclusion, and even then we may be baffled." No two persons' intellectual faculties are exactly alike; we differ in this as we differ in all other things, and if we differ so much physically and mentally in health, how much more will we differ in disease! Our mental faculties 40 Chas. O. Moli. are blunted by neglect of education or they are sharpened by mental gymnastics. In men who study habitually, and who constantly think, there is, figuratively speaking, a constant mental absorption going on, to which Dr. Carpenter has applied the term "Unconscious cerebration" and with which each of us has had some experience. Can we not recall the time when we were perplexed by some legal or medical question, racking our brains for its solution, burning mid-night oil that we might solve it and finally gone to our beds to sleep and wake up the next morning with the solution plain when a few hours before all was dark? We were appropriating knowledge uncon- sciously and after an invigorating rest, the mind manifested what had been acquired without perception. To formulate a definition of insanity which would be comprehensive is a task that is nearly an impossibility on account of the protean character of the disease and of the wide dissimilarity that exists between normal minds, which dissimilarity is necessarily widened by disease. There are no constant characteristic phenomena which may be said to be attendant upon mental alienation, and any physician is justified upon the witness stand to refuse to define insanity. Shephard gives a definition as follows, "Insanity is a disease of the neurine batteries of the brain". This defini- tion, he states, will puzzle the lawyers. In cases in which medical testimony is desired, lawyers possessing a knowledge of medical jurisprudence and some smattering of medicine formulate definitions of their own, knowing how incomplete they must be, and then attempt to entangle the medical witness in their meshes. For this reason the shorter the definition the better. Maudsley says "Insanity is a morbid derangement, generally chronic, of the supreme cerebral centers, the gray matter of the convolutions or the intellec- torum commune, giving rise to a perverted feeling, defective or erroneous ideation and discordant .conduct, conjunctly or separately and more or less incapacitating the individual for his due social relations". This definition is voluminous and yet inefficient. It is comprehensive and does not cover all cases. It has however one advantage, it states that insan- Medical and Legal Phases of Insanity. 41 ity is a chronic disease, for all cases existing three months are considered chronic. It is a,popular belief among the laity that a man to be insane must be a raving maniac; while just the opposite condition may exist. He may be courteous.intelligent, polished and affable and yet be hopelessly deranged: Some times it is most difficult to determine the exact mental condition of insane persons, because some of them possess such perfect control over themselves. Cases are on record in which insane persons at their own "de lunatio inquirende" have obtained per- mission to address trie jury and after doing so have been released leaving the impression with the jury that judge, law- yers and doctors were doing an injustice and that the alleged lunatic was of greater intellectual acumen than those trying to incarcerate him in an asylum. Personally I can recall several cases in which after six months constant contact as physician, I failed to discover an insane word, delusion, or act, and yet some of these patients had been inmates of the asylum for ten years or more, and were considered incurable. "An insane person does not cease to be human, and it should not be forgotten that the insane are just as liable to commit crime as the sane. The propensities, motives, schemes, peculiarities,, eccentricities, disposition, moods, and general characteristics of sanity frequently coexist with insanity. The insane just as often commit crime as the sane, and the determination of a man's freewill is no easy matter and one that can not be determined by one or two inter- views. Man's free will is not the property of any substance which can be demonstrated by chemistry, physiology or microscopical research, but it is the result of a combined action of a whole group of functional activities the very relation of which to each other are as unknown as their method of action." The legal conception of insanity is a condition of the mind with reference to certain conduct. "An insane person is simply non-compos-mentis. Insanity is irresponsibility." A lawyer's idea of insanity is narrower than that of the phy- sician, regarding it as he does, with reference to a certain 42 Chas. 0. Moli. act or series of acts. Folson holds that "an insane person in any insane asylum may be a party to a valid contract" or make a will that will hold in law. In this opinion he is in accord with many of the highest authorities on medical jurisprudence and to quote him further he says "A man is not insane in law unless his act is traceable to, or its nature has been determined by mental disease affecting his free agency. In other words, unless insanity causes his act either wholly or in great part." The medical man should always remember that there may be, as regards some particular person a wide difference between medical insanity or mental disease and legal insan- ity or irresponsibility. He does his duty when he confines himself to the explanation of the changes caused by disease, leaving the question of guilt or responsibility to the judge's charge and the jury's verdict. It is entirely out of the province of a medical expert- to pass upon the question of guilt and responsibility, for when he does so he encroaches upon the domains of judge and jury. No medi- cal witness should prostitute his calling by having any interest in the case either financial or otherwise. Nor should he be biased in his opinion either before, during or after the trial. He is there to tell the truth, the whole truth, and nothing but the truth, and he should not accept any contingent fee or one which has any relationship to either]jside of the case. He is in a false position if he places himself in the attitude of an advocate, as he is interested solely in explaining and supporting the unvarnished facts,ras they are tabulated and presented for analysis by those whose duty it is to arrange them in their proper order. The individual on trial must be compared to himself at some previous time and not some ideal standard of mental health which never existed. Folson most correctly states: "If we could measure nicely, no two of us could be held to the same degree of accountability". He also states: "The degree to which the individual deviates from the path of the law may depend more upon his training and surroundings, than upon his disease. Points which also must be considered Medical and Legal Phases of Insanity. 43 in establishing a definition for insanity in obscure cases. Most authorities emphasize the fact that it is not the doctor's province to punish for crime but to treat disease, and that the doctor fails to appreciate this distinction. Medical definitions of insanity in text books and on the witness stand fail to state clearly enough how far the medical and how far the forensic meaning of the word insanity is implied. What seems to be a wide difference of opinion regarding responsibility for crime as given in the courts is often due to different ways of stating the question and nothing more. Boileau said that,"All men were insane, the only difference being the skill by which some could conceal the crack." Montesqieu says, "that insane asylums are built in order that the out-side world may believe itself sane." Haslam in 1832 who was one of the first experts on mental disease in England testified that he had never seen a sane person in his whole life, adding: "I presume the Diety is of sound mind and He alone." Savage in his treatise on insanity and allied neuroses remarks: "The first question naturally is, what is meant by insanity?" It has been clearly proven that no standard of insanity as fixed by nature can under any circumstances be consid- ered to exist. Sanity and insanity as used by physicians and public are words of convenience. No person is perfectly sane in all his mental faculties any more than he is per- fectly healthy in body. Spitzka is more nearly correct when he says, that with our present knowledge it is impossible to correctly form a definition of insanity, which, while it meets the practical every day requirements is constructed on scientific principles. As it is to-day, scientific definitions must rest upon hypotheses." Insanity is a disease that interests us all because it may at any time invade the sacred precincts of our own home. It is a disease that is becoming exceedingly rife, keeping pace some authors hold, with advancing civilization, and clinical observations prove that the wear and tear, the 44 Chas. O. Moll. stress, the contentions, troubles, of every day life engulf many minds, so weakly constituted that they are not able to resist such inevitable influences. Modern science has accomplished one achievement, in dismissing the old mythical theories of the metaphysi- cians, which taught that in dealing with insanity we were witnessing or combating nonentities, shadows, spiritual pro- cesses, or mystical conditions of still obscurer origin, and that the insane should be forever ostracized, though predju- dice still exists among many, however much science has progressed. Another accomplishment of science is in the fact, that there is nothing in the aspect or appearance of the insane to lead us to be able to at once diagnose the disease by a casual observation of the physiognomy. In medico-legal contests you frequently hear lawyers use the expression, "the wild eye of the insane" and yet there is no physician who has had any experience in insanity who does not fully appreciate the fallacy of such a statement. There are some forms of insanity which present a very marked characteristic expression, for instance, the dement, but in passing through an asylum, where we may observe others, who may be playing cards, billiards, chess, perusing periodicals, and then listen attentively to their conversation or study their features, and we will find that we have a task that is herculean in character. We can not diagnose insanity without careful subjection of data which should mould our opinions to the laws of diagnosis governing the recognition of other diseases. To the community at large the plea of insanity is one of the utmost importance. The medical witness therefore has a double duty to perform, justice to the community and justice to the prisoner at the bar. Society demands pro- tection against crime and violence, while the prisoner if insane has not forfeited his claims upon humanity. The plea of insanity is abused and fraught with great evils, and the plea itself is derided by press and public. None will dispute the fact that where real insanity \i proven to exist, it would be most unjust to subject such a person to the penalties of the law, when his volitional Medical and Legal Phases oj Insanity. 45 powers are morbidly impaired or destroyed, and who there- fore must be morally irresponsible. Forbes Winslow, an eminent authority thinks "such cases should be left to a commission of medical experts for adjudication." One authority ho!ds"That simple justice requires, when- ever a man after committing a homicide is liberated upon a plea of insanity 'ipso facto' he should be sent to an asylum for life, because in cases of supposed recovery no one could assume the responsibility of affirming that sooner or later his dangerous disease would not recur." On the contrary every physician knows that one attack of insanity predisposes to subsequent attacks, therefore from the character of the act, and the probability of its recurrence, from the very nature of the disease, if a man has once deliberately taken the life of a fellow creature, in conse- quence of want of proper volitional control due to the disease termed insanity, then for and during his life he should be deprived of liberty and never again be afforded a chance to perpetrate similar deeds. It has been held that physicians alone should pass upon the plea of insanity, because the psychological physician is more familiar with all the phases and complications of mental alienations than his professional brother, the lawyer or the judge. The irreconcilable antagonism that exists upon the plea is widening more and more each day because the physician who makes this a life, study is opposed and thwarted by minds more guided by legal acumen than en- lightened by the scientific status of the question involved. The nonprofessional observers of the contest day by day grow more skeptical, humanity suffers and the discoveries of science are rendered less available. The question of motive always arises, whether the act be done by the sane or by the insane. If a child kill its parent, not influenced by passion, the desire of inheritance, or any other discoverable cause, a strong suspicion and pre- sumption of insanity will arise. If a mother destroys her children to send them to heaven, the same doubt 'of her sanity will suggest itself. But even in cases where no motive is determinable, it is 46 Chas. O. Moll. well known that the insane are influenced by motives equally with persons of incontestible sanity. The successful treatment in modern institutions to-day for the treatment of the insane is that of parent towards child, rewarding or punishing as indicated. -"Kindness but firmness" with the insane should never be forgotten, for they allow themselves to be swayed by motives the same as other people. There are sane people the interpretation of whose motives are inexplicable mysteries and we would have to penetrate deeply into the labyrinths of the innermost soul to be successful in this direction. "It is assumed or im- plied, "says Dr. Taylor, "that sane men never commit a crime without an apparent motive or of a delusive nature only in the perpetration of the act." If these positions were true it would be very easy to distinguish a sane from an insane criminal, but- the rule wholly fails in practice. In the first place nondiscovery is assumed to be a proof of the nonex- istence of a motive. It is undoubted that motives may exist for many atrocious crimes without our being able to discover them, a fact proven by the numerous recorded confessions of criminals before execution, in cases of which until these confessions were made no motive for the perpetration of the crime had appeared to the most acute minds. Of late years the study of epileptic insanity has received the attention from writers on forensic medicine that it has deserved. In the criminal records of civilized countries there are very few cases in which this disease has received the con- sideration it deserves in fixing the responsibility of the accused. The medico-legal students of epilepsy heretofore have paid too little attention to the conditions allied to and dependent upon it and which require special treatment and demands the serious attention of every medical jurist. It is a common opinion of many authorities that epilep- tics with exception of just before, and, after an attack, and included in it, are sane from a medical, and competent and responsible from a medico-legal standpoint, unless they are Medical and Legal Phases of Insanity. 47 chronically demented. This view is held by many general practitioners and by most English medico-legal authorities, while on the other hand, certain authorities hold that on the slightest indications of epilepsy the subject can not be of sound mind or responsible for any action whatsoever. Spitzka however holds that both of these opinions are extreme and damaging to the cause of justice because interested and unscrupulous medical experts may fortify themselves by such opinions in support of testimony too ofen successful in defeating the legitimate purposes of the law. Fredericks, a noted German authority, says "That crim- inal responsibility is absent in epileptics even should it be proven that the determination to commit a criminal action resulted from revenge or malignity." This, however, is not upheld by American authorities. Trosseau, the eminent French neurologist, says in strong language: "It may be said almost without fear of making a mistake, that if a man suddenly commits murder, without any previous intellectual disturbance, without having up to that time shown any signs of insanity and if not under the influence of passion, alcohol or any poisonous substance which acts with energy on the nervous system, it may be said, 1 repeat, that the man is afflicted with epilepsy, and that he has had a fit, or more usually an attack of epileptic vertigo." The question is much discussed, and many eminent authorities have taken sides upon the subject, but the fact still remains to unprejudiced and attentive observers that there is a fatal influence of epilepsy upon the intellectual faculties, especially of epileptic vertigo. Epilepsy assumes many forms and presents many phases, but after all it is a form of insanity. "Should lunatics be hanged" is a question that does not seem to need discussion in this enlightened age, and yet it is agitated and reagitated notwithstanding its sense- less barbarity. Some hold that as lunatics are dangerous, expensive and of no possible benefit to the community pro bono publico, they should be hanged as soon as they 48 Chas. O. Moh. committ a crime. The atrocious inhumanity of such a senti- is as disgraceful as it is brutal. As regards the plea of insanity Lord Hale's views were extreme. He held that "There must be a defect of the under- standing unequivocal and plain." Lord Coke held "That whoever by sickness, grief or other accident, wholly loses his memory and understanding is 'non compos mentis'." Lord Chief Justice Mansfield in the trial of Bellingham, charged that "The single question was whether at the time the act was committed he possessed a sufficient degree of understanding, to distinguish good from evil, right from wrong, and whether murder was a crime not only against the laws of God but the laws of his country." Lord Erskine considers "Delusion where there is no frenzy" to be the true characteristic of insanity." Viewed however as a principle of law the delusion and act should be connected." But this eminent Lord's view can not be upheld, for while delusions are a most frequent accompani- ment of insanity, there are many forms in which delusions are entirely absent. Dr. Haslam says "That it is not the province of the medical witness to pronounce an opinion as to the prisoner's capability of distinguishing right from wrong. It is the duty of the medical man, when called upon to give evidence in a court of law to state whether he considers insanity to be present in any given case, not to ascertain the qualtity of reason which the person imputed to be insane may or may not possess." As regarding the recognition of right and wrong it is now an indisputable fact that nearly all the insane make this distinction without difficulty. Lord Bramell once said "that insanity is a strong but not conclusive evidence of innocence" and Lord Blackburn has stated "That the jury must decide in each individual case whether the disease of the mind or the criminal will was the cause of the crime." Sir Jas. Stephen in his history of criminal law in Eng- land says: "No act is a crime if the person who does it is, at Medical and Legal Phases of Insanity. 49 the time when it is done, prevented, either by defective mental power, or by disease affecting his mind from con- trolling his own conduct,.unless the loss of power of control has been produced by his own fault." Baillarger states that "the essential element of insanity is loss of free will." Ball of Paris describes an insane man as "one who in consequence of profound disturbance of the mental faculties has lost more or less completely his free will and has ceased thereby to be responsible for his actions." The Supreme Court of U. S. in a decision maintains, "That the presence or absence of will power, in the plea of insanity is the question upon which the existence of criminality or responsibility exclusively depends." The volitional centers are invariably affected in all forms of insanity, hence in every judicial charge the question to be determined is as to whether or not the criminal pleading insanity, while recognizing the difference between right and wrong, is able or unable to control his actions. The fashion prevails to-day of attempting to shield criminals under the protective aegis of insanity. This plea is too often used to defeat the ends of justice and in exten- uation of fearful crimes. Insanity is recognized as a cause of impulsive crime and a suspicion of its existence should excite care and full research, but the fact that it is so often used to protect criminals, should not affect the public mind so that persons morally irresponsible suffer any penalty. Christian charity or even common humanity should make us fair and just in our dealings with, this class of criminals, for it would be much better that many guilty should go free than one inno- cent man should unwarrantably suffer the extreme penalty of the law. DEGENERACY STIGMATA AS A BASIS OF MORBID SUSPICION.* A STUDY OF BYRON AND SIR WALTER SCOTT. By JAS. G. KlERNAN, M. D., Chicago. Fellow of the Chicago Academy of Medicine; Foreign Associate Member French Medico-Psychological Association. ACCORDING to Lady Blessington, a keen observer, who evidently understood Byron better than other per- sons of her time, Byron's eyes were asymmetrical and were unequally placed. There was a difference in the pupils as well. Stigmata of the eyes have not received as much attention as those of the ear, despite the fact that they far from rarely crop up in degenerates. Guiteau, as 1 pointed out nearly two decades ago.t had a similar asymmetry of the orbits and pupils. Aught that affects deeply the development of the eye naturally tends, accord- ing to Talbot,+ to evince itself in other anomalous states in that organ. Since excessive asymmetry of the body is one of the most noticeable of the stigmata of degeneracy, it is not astonishing to find that this asymmetry expresses itself both in the position as well as in the size and struct- ure of the eye. As 1 pointed out more than twenty years ago§ asymmetrical irides are exceedingly frequent in the tvpes of insanity due to hereditary defects. This observa- tion has since been confirmed by Fere and Woodruff || as to 'Continued from the July, 1900. Alienist and Neurologist. tCii'cafo Medical Review, December 15. 1881. JDegeneracy: Its Causes, Signs and Results. ^Journal of Nervous and Mental Diseases, 1898. , }American Journal of Insanity.No. 2, 19U0. [50] Degeneracy Stigmata. 51 all classes of degenerates. Microphthalmia (small eyes), macrophthalmia (big eyes) are quite frequent in degenerate families. Corectopia (displacement of the pupil so that it is not in the center of the iris) often exists. Coloboma (eye fissure) is also not infrequent among the degenerate. These vary greatly in situation and general results. The iris is sometimes completely absent on one or both sides. Besides the anomalies, diseased conditions like retinitis pigmentosa, congenital cataract and mascular degeneracy reported by C. P. Pinckard, of Chicago, are far from in- frequent expressions of degenerate taint in the eye; the organ in this particular obeys the general law that de- generacy may show itself in the minute change resulting in disturbance of function or in that producing disease, or finally in atavism. Defects of the eye requiring glasses are exceedingly frequent in degenerates and often aggravate their morbidity. Dr. L. W. Dean* has confirmed the results of Talbot in a series of examinations made at the Iowa College for the Blind. He cites the case of two brothers married to two sisters who were their cousins. As a result of .these unions there were seven children, five of whom had retinitis pigmentosa. This condition Dr. Dean has found associated with polydactylism, micropthalmus, colobomata, cleft palate, etc., in the same individual and other members of the family. According to Roberts Bartholow, when Byron and Scott met in London at the house of Murray, the publisher, the conversation between them concerned every topic other than their mutual lameness. There was neither humorous nor serious allusion to their physical limitation. . Byron guarded his secret with exquisitely sensitive apprehension of .expos- ure and permitted no reference to it even by his most intimate friends, and was quick to resent even a look of inquiry directed toward his deformity. Scott was never reticent about his lameness and gave in an interesting autobiographical fragment the following clinical history of his ailment: "I showed every sign of 'OpktkaImic Record. September. 1900. tNcw York Medical Journal, November 4. IK1)?. , , 52 Jas. G. Kiernan. health and strength until 1 was about eighteen months old. In the morning 1 was discovered to be affected with the fever that often accompanies the cutting of teeth. It held me three days. On the fourth, when they went to bathe me, as usual, they discovered that I had lost the power of my right leg. There appeared to be no discoloration or sprain. Blisters and other topical remedies were applied in vain. When the efforts of regular physicians had been ex- hausted without the slightest success, my anxious parents during the course of many years eagerly grasped at,every prospect of cure which was held out by empirics, or ancient ladies or gentlemen who conceived themselves entitled to recommending various remedies, many of which were suf- ficiently singular." When he was four years old he was sent to Bath, where for a year he "went through all the usual discipline of the pump room and baths, but he be- lieved without the least advantage to his lameness." He was treated by the celebrated electrical quack, Dr. Graham, whp made a great parade of electrical appliances, but he was not benefited in the least by the magnetic touch of the splendid quack or by the electric current. Scott's maternal grandfather, Dr. Rutherford, professor of medicine in the University of Edinburgh, sent him into the country to rough it, and made efforts to call into action the affected muscles by the will. This method consisted in placing bright objects or things that the boy especially de- sired in such a position that he could get them only by the most powerful efforts, in which the affected member par- ticipated. By the persistent use of this plan of "natural exertion" there ensued a great gain in the power of the will over the muscles, and they increased in size and in the range of their actions until the limb ultimately became quite useful, although always lame. This method of dom- inating the paralyzed and wasted muscles by the forcible action of the will is only possible in those cases in which a little voluntary control was still preserved. Some response to the. will may be present, Bartholow claims, when the faradic or interrupted galvanic currents have no longer any power to excite muscular contraction. That this was the Degeneracy Stigmata. 53 case with Scott is shown by the results of the method of "natural exertion." As he writes in his autobiography: "My frame gradually became hardened with my constitu- tion, and being both tall and muscular, I was rather dis- figured than disabled by my lameness. The personal advantage did not prevent me from taking much exercise on horseback and taking long journeys on foot, in the course of which 1 often walked from twenty to thirty miles a day." Graham, the quack, mentioned by Dr. Bartholow, was one of the fashionable medical fads of the late eighteenth and early nineteenth century. He was partly educated in the University at Edinburgh, when he left for America, where the newspapers gave him a great boom as a phil-' anthropic physician traveling for the benefit of mankind, to administer reljef in desperate cases which had baffled ordinary practitioners. His advertisements celebrated his nostrums and medical skill in religious poems. By this means he obtained a considerable reputation in Connecticut and Massachusetts. Just before the Declaration of Inde- pendence he found it necessary to return to England, where he began practices similar to those which the Chicago Clinic has lately permitted a female Christian Scientist to advocate in its columns. Under the title of, a Temple of Hymen, and under the pretense of instructing persons of both sexes who were willing to sacrifice to Venus in its sacred domes, he engaged to teach "the art of preventing barrenness and of propagating a much more strong, beautiful, active, healthy, wise and virtuous race of human beings than the present puny, insignificant, foolish, peevish, vicious and nonsensical race of Christians who quarrel, fight, bite, de- vour and cut one another's throat over they know not what." Such was the language of more than one of his eccentric advertisements in the London papers. He erected the most elegant and superb bagnio invented since aboli- tion of public worship of Aphrodite in Paphos and Cythera. All the exertions of the painter and sculptor, all enchant- ments of vocal and instrumental music, all the powers of electricity and magnetism were called in to aid, enliven and 54 Jas. G. Kiernan. heighten the voluptuous scene.* The most sacred shrine, called the great Apollo, was 30 feet long by 20 wide and 15 feet high. According to Graham, no words can convey an adequate idea of "the astonishment and awful sublimity which seizes the mind of every spectator. The first object which strikes the eye, astonishes and expands the mind and ennobles the soul of the beholder, is a magnificent temple sacred to health and dedicated to Apollo. In this tremendous edifice are- combined or singly dispensed the irresistible and salubrious influence of electricity or the ele- mentary fire, air and magnetism, three of the greatest of those agents of universal principles which, pervading all created being and substance that we are acquainted with, connect, animate and keep together all nature, or, in other words, principles which constitute as it were the various acuities of the material soul of the universe: the Eternally Supreme Jehovah Himself being the essential source—the Life of that Life—the Agent of those Agents—the Soul of that Soul—the all-creating, all-sustaining, all-blessing God —not of this world alone, not of the other still greater worlds which we know compose our solar system." The temple was the auditorium where Graham delivered what he called eccentric lectures on generation, which were illustrated by handsome nude females. He displayed crutches, ear trumpets and spectacles over the outer door of the Temple of Health as evidence of his skill. Amongst the furniture of the Temple of Health was a celestial bed, provided with costly draperies, standing on glass legs. It was prescribed to married couples as a cure for sterility, at a cost of £500 per night. Graham was an alcoholophobiac and a vegetarian. He anticipated Kneipp in all particulars of the "cure," including the walking on grass with bare feet. Graham, like Dowie, posed as a new Messiah, and calling himself the servant of the Lord O. W. L., claimed to inaugurate a new era. He prescribed mud baths, cover- ing the patient completely to the neck. He was a great favorite among the quack-ridden nobility and enjoyed, in •Jeafferson. "Book About Doctors." Degeneracy Stigmata. 55 consequence, the fees of the shopkeeping class who courted to the nobility. The employment of a quack like this by the paternal relatives of Scott would indicate that belief in the occult in medicine which characterizes degeneracy in people of un- equally balanced culture. What has been entitled the re- crudescence of superstition as exemplified in faith healing, "Christian Science," and other phases of folklore, is often the result of financial conditions which place people, both American and foreign, of superficially high but judicially low grades of culture in commanding position because of their financial status. The witchcraft delusion maintains its hold among the Pennsylvania Dutch, in certain districts of New Hampshire, Vermont and Maine, as well as in the South. When people of this grade of culture emigrate (in consequence of increased wealth due to the accidental dis- covery of petroleum, mines and lumber, etc.) to the cities, they exercise an intellectual influence on newspapers, mag- azines, etc., out of all proportion to their own mental calibre and directly due to their financial status and resultant social advantages. The emigration from the British Isles and the continent of Europe bring people of the same grade of culture who likewise rise in financial status, retaining full belief in all their folklore. Some American types of this grade of culture naturally gravitate to "Christian Science" as they previously did to "metaphysical medicine" and Hahnemannia. Indeed the great apostle of "Christian Science," "Mother" Eddy, began thirty-three years ago as a "metaphysician." Many American and European phases of folkmedicine retained prehistoric characteristics. Thus "Dr." Paul Wachter was sentenced to the penitentiary in Chicago in 1894 for obtaining money from wealthy North Side Germans to cure disease by putting it in a magic tree. As he em- ployed the money in worship of Gambrinus rather than of the dryads, his dupes had him arrested and imprisoned for obtaining money under false pretenses. His detection, however, failed to destroy superstition among the class gulled. An individual was recently arrested 56 Jas. G. Kiernan. for trying the same confidence game on exactly the same class of people. This new aspirant for magical fame claims to possess a magic mirror given him by the Devil by which he is able to cast a spell over the people who fail to be- lieve in his pretensions or to comply with his demands for money. A sixty-year old woman paid him twenty dollars under threats of a "spell" and promises to cure blindness. His usual method of operating was to call at houses of Germans or Poles in North Chicago and ask if anyone were ill. To the invalid he would show a small mirror, bidding him look therein and be healed. The procedure in this particular resembled certain methods adopted by hypnotists. If the individual claimed to feel better, money was de- manded with a threat to cast an evil spell if the demand were not complied with. In one instance the mirror man threatened to kill chickens by a spell and to poison a hus- band if his demands were not met. He also claimed to exercise considerable influence with the Devil. He excited the neighborhood against people who refused to comply with his demands by claiming they were guilty of witch- craft, causing disease. Some of the "Pennsylvania Dutch" "witch doctors," by such accusations, more than once caused riot and at- tempted homicide. This was notoriously the case with the famous "Witch Doctor Amend," of Pittsburg, Pa., who died in 1895. These wizards among the Italians of New York are "Devil's Doctors," who treat disease as follows: They first blow in the patient's face and afterwards scarify his hands, feet and body with a razor until the blood flows freely. This blood is rubbed over the chest or other part affected. Then the patient's hair is cut off and a letter is written to "Satan, Prince of Hell." The letter and the hair are then burned. These procedures are repeated for four days. In Paris, France, Satanism of this type described a few years back was a fashionable cult and had its cere- monies with a ritual resembling the famous "Witches Sab- bath" so vividly pictured by Hawthorne. About a year ago both West Virginia and some other states had witch- Degeneracy Stigmata. 57 i craft epidemics among the whites. In West Virginia the epidemic required governmental interference. These recru- descences of fetichism do not illustrate that either the age or the race is degenerating, but that commercial changes are placing people at a low grade of culture in positions where their superstition and fetichic creeds receive support. It is a singularly excellent illustration of Scott's mental balance that, despite this fetichic element in his early environment and despite its presence in his Highland Scotch surroundings, he never became superstitious. Indeed, he lamented to Washington Irving his inability to throw him- self intellectually into popular superstition. Byron, how- ever, despite his comparative freedom of thought in religious matters, retained throughout life the occult degenerate fear of the unknown which made him singularly susceptible to primitive beliefs like the evil eye. (To be Concluded in April.) MEDICAL JURISPRUDENCE IN THE NINE- TEENTH CENTURY.* By CLARK BELL, ESQ., LL.D. President of the International Medico-Legal Congress of New York, June, 1889; Delegate from the Government of the United States to the Thirteenth International Medical Congress ot 1900.t MEDICAL jurisprudence is more greatly indebted to the Italian scholars of the 16th century and the preceding centuries than to those of any other land. That splendid diplomat, scholar, statesman, musician and physician, Paul Zacchias, was the physician to the Pope in 1620. His treatise, now in the library of the Medico-Legal Society in New York, could be read with profound interest, to see hew far advanced was this learned and gifted man, in the elementary and fundamental truths of the science, as recognized to-day. From the 12th to the 16th centuries, Italy stood pre- eminent in every field of scientific study, and especially in medicine. Prior to 1500 there were sixteen universities in Italy; while in France there were but six; in Germany, eight, in Great Britain, only two; so that Italy had then as many as England, France and Germany combined, and the su- premacy of the Italian universities was beyond all compari- son with the others. This Italian superiority continued until after the 16th •Abstract of Paper. ^Contributed to the Thirteenth International MeJical Congress of Paris, 1°^>0. [58] Medical Jurisprudence. 59 century, and it existed when Zacchias wrote and flourished. It has been well said that "medical jurisprudence owes its power to knowledge derived from every branch of med- icine; but the law determines how far this power shall be utilized in the administration of justice." For more than two centuries Germany has had an or- ganization of medico-legal officials, who are required by law to be qualified by an especial education, not only to procure the medical facts needed by the courts, but to estimate their weight for the benefit of the courts. In 1650 Machiavelie delivered the first course of lectures on legal medicine at the University of Leipzic, and he was succeeded by Bohn; and as early as 1720 professor- ships of forensic medicine were erected by the government of Germany. The literature of the science was enriched, in the 18th century, (1725), by the celebrated authors Valentini, Teichmeyer and Albertus, one hundred years later than the writings of Zacchias. These writers laid the founda- tion of that literature of forensic medicine for the German scholars, exceeding that of nearly every country, and which, in later years, in the 19th century, has been quick- ened by the clinical schools, the first of which was estab- lished at Vienna, about 1830; at Berlin in 1833; at Munich in 1865. Germany owes her great advancement to the fostering hand of the government, and to favoring legislation. France, from 1570 to 1692, also enacted laws which favored the study, culture and advancement of legal medi- cine, and the science progressed; but at the close of the 17th century, the medico-legal officials became hereditary, and the science languished until after the French Revolution. Since 1790, however, no nation on the globe has sur- passed or even equalled France in the culture and advance- ment ot medical science and the arts; and from the era of the French Revolution, and under the reign of the great Napoleon, and those who have succeeded him, France advanced, until she became the seat and center of the highest civilization in the nineteenth century, which proud position she has continued to occupy. 60 Clark Bell, Esq. The Exposition of 1889, and the splendid one which marks the close of the nineteenth century, well illustrate her place in the world of science and arts, and the advanc- ing civilization of the world, as the 20th century opens its portal to the brotherhood of man in all countries upon the globe. During all these years of advancing supremacy in France, all was due to the splendid support given by the government, and by the generous laws of France for- ensic medicine has kept pace with the sister sciences there. Chasseur, in 1790, was the first lecturer in legal medi- cine, and Mahon, in 1795, was the first professor of medical jurisprudence. In Great Britain very little attention was paid to medi- cal jurisprudence in the 18th century, and she transmitted to her American colonies laws, that have been well stated by Prof. Stanford E. Chaille, in his centennial address be- fore the International Medical Congress of September, 1876, intended as a review of the preceding one hundred years of forensic medicine, as: "barbarously conspicuous for the absence of provisions to apply medical knowledge to the administration of justice, and Anglo-American law continues to be, in large measure, hostile to medical juris- prudence." These words were spoken in 1876—twenty-six years ago.. They properly describe the state of the law of Great Britain at that date, and show why, in the American states the 19th century opened in America with the standard of forensic medicine trailing in the dust. When contrasted with France, Germany and Italy, but America, with this sad inheritance from the mother country, has not remained where she was placed in the first fifty years of the Ameri- can national life. Scotland should be exempt from these criticisms. In 180.5 a chair of forensic medicine was founded in the Uni- versity of Edinburgh. Dr. Duncan, the elder, was the first lecturer on medical jurisprudence, in 1801; and his son the first professor, in 1802. While this University was chartered in 1682, it was not Medical Jurisprudence. 61 until 1726 that an English medical faculty was established, with lawful authority to confer degrees. Before 1726, and after 1705, a few honorary degrees had been conferred, but not by legal authority. In each of the twenty-three medical colleges existing in England, Ireland and Scotland, in 1875, there was a regu- lar teacher devoted to forensic medicine, on whom legal authority to confer a degree in state medicine was conferred, upon those at Cambridge, Oxford, Edinburgh and Dublin; but it cannot be said that medical jurisprudence, as a science, was practically taught outside of the University of Edin- burgh, if there, except as to toxicology. Scotland has kept alive, on her altar at Edinburgh, the science, and Prof. Ogston, and the Scotch scientists, have been among the foremost of medico-legal jurists of Grwat Britain in the earlier years of the century. The Registration Act was not passed in England until 1858, and "Glenn's Manual of the Laws Affecting Medical Men," London, 1721, cited by Professor Chaille, in his ad- mirable address, from which 1 quote, freely states and details thirty-six laws, from 1850 to 1870, of which twenty - five were passed in the twenty years between 1850 to 1870. The medical profession never had legal recognition under English Laws until 1858. No laws existed for the prepar- ation of official medical experts. The British bench never held medical men or medical expert evidence with the respect with which it was received in France, Germany and Italy, under the provisions of law; and there has been no legislation in England tending to utilize the aid of competent medical knowledge, in aid of the administration of justice, in the British Islands, save in Scotland. At the opening of the 19th century, the science of medical jurisprudence, upon the American Continent, did not command that recognition in either profession of law or medicine that its importance demanded. At this era, the science may well be said to be at its decadence in all the English speaking peoples of the world. In England, the works of Farr, Dease, Male and Haslem 62 Clark Bell, Esq. may well be said to reflect the progress and state of the science and the American states cannot be said to have made any substantia! advances in forensic medicine, hav- ing but recently emerged from that revolutionary struggle which established the American nation upon the principles of human rights enunciated in the Declaration of American . Independence. Dr. Benjamin Rush, of Philadelphia, one of the signers of that Declaration, was one of the most conspicuous of those who gave the science attention. He was Professor of Chemisty in the Philadelphia College of Medicine and the University of Pennsylvania, and his labors extended from 1769 until his death in 1813. He held the chairs of Theory and Practice of Medicine, and of the Practice of Physics. He left sixteen lectures, the last of which was delivered in 1810 at the University of Medicine, and v/as devoted to the science of medical jurisprudence. Its chief features relate to mental states, testamentary capacity and legal responsibility in cases of crimes committed. Dr. Thomas Cooper, who had jeen a judge in the courts of Pennsylvania, was a Professor of Chemistry and Miner- alogy in the University of Pennsylvania, and published "Tracts on Medical Jurisprudence." In 1829 Dr. J. Bell, also of Philadelphia, published an address upon the same topic, and he delivered a course of lectures on medical jurisprudence in the Philadelphia Medi- cal Institute, of which he published a syllabus. Professor Robert Hglesfield Griffith, M. D., of the Uni- versity of Maryland, and Lecturer in the University of Virginia in 1832, edited with notes and additions the first American edition of the work of Michael Ryan on Medical Jurisprudence, which was published by Carey & Lea, at Philadelphia, where Professor Griffith then resided, and where he died in 1850, at the close of the first half of the century. But there is no American name to whom the science of medical jurisprudence is more indebted than that of Prof. Theodore Romeyn Beck, M. D., LL. D. He was born at Schenectady, N. Y., August 11, 1791, and he died Novem- Medical Jurisprudence. 63 ber 19, 1855. He graduated at Union College at the age of sixteen years and took his degree in medicine at the New York College of Physicians and Surgeons in 1811. Mercersburg College, Pennsylvania and Rutgers College of New Jersey, conferred the degree of L.L. D. upon him. In 1815 he was made lecturer on medical jurisprudence in the College of Physicians and Surgeons of New York, and in 1826 he was made Professor of Medical Jurisprudence in that college, and held that chair until 1840. In 1823 he published "Beck's Medical Jurisprudence," which passed through many American, English and German editions, and which was universally acknowledged in its day, to be the leading work on the science, and was found as often upon the shelves of the lawyer's library as those of the medical man. For forty years of his life this illustrious man devoted himself to the advancement of the science, and most of it in the latter part of the first half of the century. » In 1853, at Albany, the capital of New York, in address- ing the legislature of his native state upon the proposed establishment of a university, he demanded "the appoint- ment, under public authority, of a Professorship of Medical Jurisprudence or Forensic Medicine." and in support of it said: "There is a person now living (Orfila), the subject of whose knowledge on the power of poisons is such that he is not only called to examine cases in any part of France, but not long since was summoned to Belgium in one, which at the time attracted the attention of all Europe. I hold that there should be two or three persons of this character appointed and paid by the government, to perform this important duty." The most illustrious name in forensic medicine, after that of Beck, in the department of the medical jurisprud- ence of insanity, was that of Isaac Kay, M.D. He stands at the very head of American alienists. His treatise on "The Medical Jurisprudence of lnsanity"has never been surpassed, in the century in which he lived and acted, in any country, and no work of the century produced a more profound or lasting impression upon the mind of man. 64 Clark Bell, Esq. He lectured on insanity at the Jefferson Medical College, Philadelphia, and his contributions to Mental Pathology, published in 1873, enriched the literature of this branch of forensic medicine. In considering medical jurisprudence from this stand- point, we should classify it into general divisions, and as one of these: "The Medical Jurisprudence of Insanity," Dr. Ray stands pre-eminent. Witli his name should be mentioned some of the earlier alienists: Pliny Earle; Allan McLane Hamilton; Henry P. Stearns; Dr. John P. Gray, of Utica, N.Y.; Prof. Chas. H. Hughes; William A. Hammond; Prof. Charles K. Mills, of Philadelphia, Pa.; Dr. W. W. Godding; Dr. Geo. M. Beard: Dr. Nichols, of Bloomingdale Asylum, New York City; and a great body of earnest students and workers among the superintendents of American asylums and hospitals for the insane, with many names of merit among the students of neurology and psychiatry that have adorned the brilliant galaxy of American students of mental medicine. Perhaps no work of recent date exercised a greater in- fluence in the nineteenth century in America than did the work of Dr. Alfred Swayne Taylor, on medical jurisprudence. The work had a greater influence than the volumes put out by John C. Bucknill and Dr. Hack Tuke, which was a work of great value and entitled to high praise. The splendid work of Chaude and Briant, which was also a con- temporary, being in the French tongue, could not rival these publications. "Taylor's Medical Jurjsprudence"was universally recog- nized as the model standard, and superceded Beck, who had so long stood at the very front. It passed through a large number of American editions, and its 12th American edition was completed in 1897. Amdng medico-legal jurists, who have been prominent, I should name in the last third of the century: Chief Justice Charles Doe, of the Supreme Court of New Hampshire, to whom (more than all other American jurists combined) we are indebted for the overthrow, in many of the American states, of the innovation made in the law of England Medical Jurisprudence. 65 after the McNaughten case, making the. knowledge of right and wrong the test of criminal responsibility of the insane. His associate, Judge Ladd, of the Supreme Bench of New Hampshire, and Judge H. M. Somerville, of the Su- preme Bench of Alabama, who wrote the prevailing opinion of the court of that state, asserting what has come to be known as the New Hampshire doctrine, is entitled to our tribute of praise and commendation. Among the eminent men of the bar, who have taken part in the labors of the Society and in advancing its work, may be named: Hon. David Dudley Field; Hon. E. A. Stoughton; Judge A. L. Palmer, of the Supreme Court of New Brunswick; Sir John C. Allen, Chief Justice of that bench; Judge W. D. Har- din, of Savannah, Ga.; Judge Charles P. Daly, and Mr. Austin Abbott. Of those whose labors have ceased, not to mention the lustrous and brilliant names of those still living, and among medical men: Dr. James C. Wood; Dr. Frank H. Hamilton; Dr. Carnochan; Dr. S. W. B. McLeod and Dr. Fordyce Barker. Consider the views of Chief Justice Charles Doe, of the Supreme Court of New Hampshire: Associate Justice Ladd of the Supreme Bench of that State; Judge Mont- gomery, of the Supreme Court of the District of Columbia, and Judge Dillon, of Iowa, all members of the Medico-Legal Society; Shaw of Massachusetts, Edmonds of New York, Bell and Perley of New Hampshire, in contrast with the language of the Lord Chancellor of England as late as 1862, who, in referring to insanity in the English House of Lords, declared that"The introduction of medical opinions and medi- cal theories into this subject has proceeded upon the vicious principle of considering insanity as a disease," and he con- demned the"evil habit that has grown up of assuming that it was a physical disease." And it was less than 100 years prior to this utterance (1769) Lord Chancellor Blackstone said; "To deny the possibility, nay actual existence, of witch-craft and sor- cery is to at once flatly contradict the revealed word of God," and also added, "And the thing itself is a truth to 66 Clark Bell, Esq. which every nation in the world hath in its turn borne testimony." The following are among the eminent French collabor- ators in the work of the Medico-Legal Society; Dr. T. Gallard, Ex-Secretary of the Medico-Legal Society of France; Dr. Louis Penard, Ex-President of the Medico-Legal Society of France; Dr. Devergie, Ex-President of the Medico-Legal Society of France; Mr. Ernest Chaude, Ex-President of the Medico-Legal Society of France; Dr. Devilliers, Ex-Presi- dent of the Medico-Legal Society of France; Prof. Dr. Benj. Ball, author; Dr. Emile Hourteloup; Dr. Lunier; Dr. Briere du Boismont; Dr. Chevalier; Dr. Legrard du Saille; M. Hemar, Ex-president of the Medico-Legal Society of France; Dr. August Voisin; Dr. Carpentier; Prof. Dr. Luys; Marcel Briand and Dr. Foville. Living members of eminence identified with the progress of medical jurisprudence in America: Prof. Brouardel; Dr. Motet; Dr. Lutaud; Dr. A. Leblond; Dr. Magnan; Dr. Ritti; Dr. Christian; Dr. Bertillon and Dr. Forel. The following are deceased honorary members of the Medico-Legal Society: Prof Francis Wharton, writer on Legal Society of France; M. Barnier, President High Court of Cassation of France; Dr. Louie Penard, Ex-Presi- dent of the Medico-Legal Society of France; Prof. Charcot, Paris; Sir James Fitz James Stephen, of London, England; Visitor in Lunacy, London; Dr. D. Hack Tuke, of London and Dr. Fordyce Barker, of New York. • WORKS ON MEDICAL JURISPRUDENCE. Besides those already named, Prof. James J. Elwell, of the Cleveland, Ohio, bar, contributed a volume, "Elwell's Medical Jurisprudence" which had a large sale among lawyers and jurists. Prof. J. J. Ordnoux was the author of a treatise entitled "The Jurisprudence of Medicine," which was pub- lished in 1869, and which was greatly used at that time and influenced public opinion and legislation at that period. Medical Jurisprudence. 67 Allan McLane Hamilton, M. D., published a work in 1894 entitled "Hamilton's System of Legal Medicine." Francis Wharton, M. D., published in 1885 a small work on "Mental Unsoundness," which was followed in the same year by a work entitled "A Treatise on Medical Jurisprudence," by Francis Wharton and Morton Stile, M. D. This was an elaborate work of 815 pages and suc- cessive editions were published in 1860, 1872 and 1873; and in 1882 a fourth edition was published. The work is a valuable contribution to the science. Prof. William A. Hammond published several works and edited a journal of Psychological Medicine for several years. Dean's Medical Jurisprudence was published early but did not supercede Beck or attain as much prominence as Prof. Elwell's work. He was a contemporary of Beck. The most complete bibliographical contribution relating to the works on American Medical Jurisprudence, and also the best enumeration of the general treatises of Italy, Ger- many, France and Great Britain, up to September, 1876, is that made by Prof. Stanford E. Chaille in his masterly address to the International Medical Congress in Philadel- phia in 1876, to which I refer the student with great confidence. If my time permits I will submit an appendix of the later works in America, since September, 1876. TRANSACTIONS OF THE MASSACHUSETTS MEDICO-LEGAL SOCIETY. VOL. 1. 1878-1888. CONTENTS. The Law Concerning Medical Examinations and In- quests. 1877. Constitution and By-Laws of the Massachusetts Medico- Legal Society. Officers and Members of the Massachusetts Medico-Legal Society, 1878. Introductory Address. By Alfred Hosmer, M.D.,President. The Relation which Chemistry bears to Forensic Medi- cine. By E. S. Wood, M. D. 68 Clark Bell, Esq. The Value of Anatomical Appearances. By R. H. Fritz, M. D. Concerning Coroners and the Theory and Practice of Inquests. By T. H. Tyndale, Esq. Cases Illustrating the Work and Duties of the Medical Examiner. By F. W. Draper, M. D. A Case of Arsenical Poisoning, with Fatty Degeneration of the Liver, Kidneys and Gastric Glands. By J. G. Pinkham, M.D. The work of the Medical Examiners in 1877. The Evidence of Still-Birth. By S. W. Abbott, M. D. The Anatomical Changes Caused by Septica,mia and Pyaemia. By R. G. Cutler, M. D. A Medico-Legal Case of Abortion, followed by Convic- tion of the Accused Abortionist. By J. C. Gleason, M. D. The Duties of Medical Examiners Considered in their Practical Relations. By Asa French, Esq. Clinical and Anatomical Evidences of Abortion. By C. C. Tower, M.D. The Work of the Medical Examiners in 1878. Medical Expert Testimony: What it is and what it should be. The Metric System in Forensic Medicine. The Collection of Data at Autopsies. By H. P. Bow- dith, M. D. Death by Lightning. By J. L. Sullivan, M. D. What Constitutes the "Dead Body of a Person"? By A. F. Holt, M. D. The Medico-Legal Relations of Alcoholism: Its Patho- logical Aspects. By G. K. Sabine, M. D. On Points of Interest in the Jennie P. Clark Case. By J. G. Pinkham, M. D. The Work of the Medical Examiners in 1879. Address on the History and Work of the Society. By Robert Amory, M. D. In What Cases Shall the Medical Examiner Decline to View a Dead Body? By Alfred Hosmer, M. D. Ignorance as a Legal Excuse for Malpractice. By A. E. Pillsbury, Esq. Medical Jurisprudence. 69 Conditions and Circumstances Which Should Induce the Medical Examiner to Employ a Chemist. By E. P. Miller, M. D. The Work of the Medical Examiners in 1880. What Constitutes a Medico-Legal Autopsy? By S. D. Presbrey, M. D. On the Habitual Use of Poisons. By A. H. Johnson, M. D. The McCornish Homicide Case. By C. C. Tower, M.D. The Medico-Legal Relations of Chronic Alcoholism: Its Pathological Aspects. By G. K. Sabine, M. D. The Medico-Legal Relations of Insanity. By Ira Russell, M. D. The Work of the Medical Examiners in 1881. The Gunn Homicide Case. By A. E. Paine, M. D. Infanticide by Drowning. By J. G. Pinkham, M.D. A Strange Case: Suicide by Blows on the Head. By O. T. Howe. M. D. A Case of Delayed Putrefaction. By W. H. Taylor, M. D. The Work of the Medical Examiners in 1882. The External Appearances of Pistol-Shot Wounds. By D. B. N. Fish, M. D. Medico-Legal Features of Life Insurance. By Max F. Eller, Esq. Cases of Death by Drowning and by Hemorrhage. By S. D. Presbrey, M. D. Homicide by a Wound of the Vulva. By F. W. Draper, M. D. A Case of Death by Drowning. By George Stedman, M. D. The Work of the Medical Examiners in 1883. Infanticide by Suffocation. By VV. H.Taylor, M. D. On Death by Drowning. By F. W. Draper, M. D. A Case in Doubt. By W. M. Wright, M. D. The Work of the Medical Examiners in 1884. The Dunbar Case. By F. K. Paddock, M. D. The Dunbar Tragedy: Was it a Murder or Was it a Suicide? By D. E. N. Fish, M. D. 70 Clark Bell, Esq. Notes on the Lawton Murder. By W. H. Taylor, M.D. Case of Poisoning With Oil of Gaultheria. By J. G. Pinkham, M. D. Notes on an Anomalous Arrangement of the Large Veins of the Neck. By J. G. Pinkham. A Case for the Medical Examiner. By S. Q. Presbrey, M. D. The Work of the Medical Examiners in 1886. By S. W. Abbott, M. D. APPENDIX. A—Scotch Regulations Relating to the Medico-Legal Examination of Dead Bodies. B—Letter from Attorney-General Concerning Fees of Witnesses at Autopsies. C—Extract from the Society's Records, 1878-1879. D—Decision of Postmaster-General concerning Blanks. E—Extracts from the Society's Records 1879-80. F—On the Collection of Data at Autopsies. G—Report on the definition of "Violence." H—Two Medico-Legal Decisions of the Supreme Court of Massachusetts, affecting Medical Examiners. I—Extract from the Society's Records, 1883. J—Massachusetts Laws Relating to Medical Examiners, compiled from Statutes in Force October 1, 1886. K—Amendment of the Law Relating to Burial of Un- claimed Dead Bodies. L—Members and Officers of the Society in October, 1887. TRANSACTIONS OF THE MASSACHUSETTS MEDICO-LEGAL SOCIETY. VOL. II. 1888-1898. CONTENTS. Historical and Statistical Facts pertaining to the Use of Arsenic as a Poison. By S. W. Abbott, M. D. Clinical History of Arsenical Poisoning. By A. F. Holt, M. D. Anatomical Appearances resulting from Poisoning by Arsenic. By. F. W. Draper, M. D. Medical Jurisprudence. 71 The Chemistry of Arsenic. By W. B. Hills, M. D. The Robinson Cases of Arsenic Poisoning. By T. M. Durell, M. D. Arsenic in the Courts. By F. A. Harris, M. D. Accidental Drowning. By F. Winsor, M. D. A Murderer's Dying Confession Disproved by Surgical and Anatomical Facts. By B. E. Cotting, M. D. Medico-Legal Examinations in Cases of Alleged Injuries to the Brain and Spinal Cord. By P. C. Knapp, M. D. Medical Testimony from a Legal Stand point. By H. N. Sht-ldon, Esq. Was it Murder or was it Suicide? By F. W. Draper, M.D. Sudden Death from Diseases of the Organs of Circula- tion: A Discussion. Abdominal and Pelvic Emergencies Causing Sudden Death. By J. C. Irish, M. D. Affections of the Nervous System Causing Sudden Death. By P. C. Knapp, M. D . The Coy Moy Murder Case. By F. K. Paddock, M. D. Identification of the Human Skeleton. By S. W. Abbott, M. D. Sudden Death Due to the Heart. By W. T. Council- man, M. D. The Rights and Duties of Medical Examiners in Homicidal Cases. By W. A. Dolan, M. D. The Leach Case (Abortion). By T. M. Durell, M. D. Pancreatic Hemorrhage as a Cause of Sudden Death. By W. F. Whitney, M. D. What Cases shall a Medical Examiner "View"? By J. A. Mead, M. D. Suicide or Homicide? A Case for Medico-Legal Diagnosis. By C. S. Holden, M. D. A Case of Homicide, with Comments. By A. L. Hodg- don, M. D. Death "Supposed to have been Caused by Violence." By Z. B. Adams, M. D. Was it Murder or Suicide? By E. P. Hurd, M. D. The Farror Murder Case. By J. A. Mead, M. D. 71 Clark Bell, Esq. The Post Mortem Signs of Drowning. By G. de N. Hough, M. D. A Case of Criminal Abortion with Peculiar Features. By W. S. Birge, M. D. The Gilbert Murder Trial: — A Medico-Legal Review. By F. W. Draper, M. D. The Defendant's Mental Condition. By G.F.Jelly.M.D. The Microscope as a Witness. By W. F. Whitney, M. D. A Case of Homicide Without any External Marks of Violence. By S. D. Presbrey, M. D. A Murder by a Stab-Wound of the Pulmonary Artery. By O. J. Brown, M. D. The Crosby Homicide Affair. By J. F. Croston, M. D. Two Cases of Medico-Legal Interest. By J. G. Pink- ham, M. D. Identification of a Human Skeleton. By Robert Burns, M. D. Concerning Criminal Abortion. By E. G. Hoitt, M. D. Legal Value of Dying Declarations. By Daniel March, Jr., M. D. Three Deaths from Head Injury. By F. H. Baker, M.D. The Iodine Test for Semen. By Wyatt Johnson, M.D. The Duties of a Medical Examiner. By H. M. Knowl- ton, Esq. The Medical Examiner as a Witness. By Sherman Hoar, Esq. The Identification of Seminal Stains. By W. F. Whitney, M. D. Sudden Death by Alcoholism. By E. P. Hurd, M. D. A Case of Gun-Shot Wound of the Head. By W. D. Swan, M. D. The Kaiserling Method of Preserving Anatomical Speci- mens. By W. F. Whitney, M. D. The McCloud Murder Case. By F. S. Ganedy, M. D. Contre Coup and its Relations to Head Injuries. By B. H. Hartwell, M. D. Carbolic Acid Poisoning. By Frank Holyoke, M. D. The Butters Murder Case. By G. E. Titcomb, M. D. Medical Jimsprudence. 73 Cholin in the Iodine Test for Semen. Bv W. F. Whit- ney, M. D. THE RHODE ISLAND MEDICO-LEGAL SOCIETY. Was organized June 11th, 1885. No published work con- taining a record of its transactions or a list of the papers read before it. THE CHICAGO MEDICO-LEGAL SOCIETY was organ- ized in the City of Chicago in the year 1886. There were eighty-four physicians upon its first roll as announced by the Chicago Legal News. This body has since maintained a thorough and active organization and its officers have been selected from the prominent men of both professions. The papers read before it have been of a high character by distinguished members of the bench, bar and of the medical profession. I have been unable to find any volume of them. PHILADELPHIA SOCIETY OF MEDICAL JURISPRUDENCE was organized more than twelve years since in the City of Philadelphia and had a large and influential roll of member- ship. The papers read before it were of a very high order and were valuable contributions to the literature of the science of forensic medicine. DENVER MEDICO-LEGAL SOCIETY. In 1890 the Denver Medico-Legal Society was organized iireatly through the efforts and labors of Prof. J. T. Eskridge and Dr. Donald McLennan. SOCIETY OF MEDICAL JURISPRUDENCE OF NEW YORK CITY, was organized and incorporated March 5th, 188.?. The following papers were read and discussed before the Society in 1898-1899: Address by the President-elect, S. B. Livingston, Esq., on the "Profession of Law and Medicine, a Comparison and Contrast." "Circumstantial Evidence," by E. H. Benn, Esq. "Expert Evidence from the Standpoint of the Witness," by F. X. Dercum, M. D., Ph. D. "The Legal Disabilities of Natural Children, Justified Biologically and Historically," by Edward C. Spitzka, M. D. 74 Clark Bell, Esq. "The Development of Mental Competency from a Pre- sumption of Law into a Question of Fact." By Hon. John Dewit Warner. "The Status and Legal Rights of the Soldiers," by J. Hampton Dougherty, Esq. "Apparent Death," by Henry J. Garrigues, M. D. "Expert Medical Testimony, a Defense of the Present Procedure," by Hon. John Woodward, Justice Supreme Court, Appellate Division. Address by the President, S. B. Livingston, Esq., on "Citizenship and the Age of Maturity." The Medical and Legal Aspect of Hysteria Induced by Injury," by Pearce Bailey, M. D. "Unreliability of Drugs," by Edmund J. Palmer, M.D., Commissioner of Quarantine. "Natural Law vs. Statutory Law," by Gino C. Speanza, Esq. "The Logical Character and Function of Opinion Evi- dence," by William Allaire Shortt, Esq. "Extremes in Anthropometry with Reference to the Bertillon System," by Edward C. Spitzka, M. D. "The Medico-Legal Autopsy, a Plea for Medical Preci- sion and Legal Recognition," by Hugh Hamilton, M. So, M. D., Harrisburg, Pa. "The Law and Science of Capital Punishment by Electricity," by Roger M. Sherman, Esq. NOTE—This paper will appear in full In the Medico-Legal Journal AUTOPSYCHORHYTHMIA OR REPETITION PSYCHO-NEUROSIS. Morbid Rhythmic Forms of Automaticity and Rhythmic Forms of Mental Alienation. By C. H. HUGHES, M. D., St. Louis. TH h pathetic story of the accountant who, in a state of nervous exhaustion and cerebrasthenia, was car- ried to Bethlehem Hospital pitifully repeating, "once one is two, once one is two," the mistaken calculation having ruined him, is well known in the literature of nerve pertur- bation. The record is a story of brain exhaustion often repeated in other forms, the real nature of which is often not well understood in time, either by the family medical adviser or the public, to avert disaster. There are other phases of this morbid mental state in which a fear of mathematical inaccuracy or mental agitation on account of the interrupted rhythm are not characteristic, but where simply an insistant impulse to automatic repetition exists that will not readily down at the bidding of the normal will, even though regard for the proprieties of environment demand suppression. The constant repetition of a rhythmical move- ment in the mind, regardless of time or place or cir- cumstance and which an enfeebled volition can not regulate to conform to the requirements of environment, characterizes this symptom of brain overstrain and psycho-motor auto- matic impulse. Neuropathic and consequent psycho-motor •Presented to the Section on Nervous and Mental Diseases of the Third Pan- American Congress at Havana. Cuba. February. 1900. [75] 76 C. H. Hughes. neurasthenia appear to be at the bottom of this condition, or have probably been, at some time in life of the nervous mechanism, before the inception of the morbid automatic repetitional impulse. It is as much a symptom as the ill at ease, restless, tired and fidgety state and morbid phobias of neurasthenia are. Tuke (Psychological Dictionary) touches this subject closely under the discussion of imperative ideas, cor- prolalia and obsession, and mentions the instance of a friend who wrote him after composing a poetical work, say- ing in his letter he longed to get the poetical work out of his brain and begin on "fresh fields and pastures new," but found it "difficult to make the vibrations cease when the intellectual chimes have been set to a particular tune," recognizing the brain automaticity which is an essential feature of what we are attempting to describe. We would take this case from the class of imperative ideas and place it in a new psychologic class like the following, to which we would apply the new term we coin —autopsychorhythmia or repetition psychosis or psycho- neurosis. A handsome, bright and accomplished young lady of eighteen years, with a maternal unstable nerve heritage but a healthy father, a student of music, advanced and promising, came to me from a distant city suffering with exaggerated reflexes, insomnia, hyperideation, troublesome illusional fancies and a musical rhythm continually running in her mind. Day and night the automatic repetition of tunes and musical cadences ran constantly through her mind. Upright or recumbent, in waking state or in her fitful sleep, the automatic rhythm persisted. She thought and dreamed of music and felt its rhythmical influence con- tinually throughout her nervous organism. Her pulse was rapid, her heartbeats overforceful, her pupils were abnor- mally mobile and dilated, her digestion was tardy but finally adequate, bowels torpid, skin relaxed and she felt continually tired. She recovered under rest, change of environment, cessation of study and piano practice, withdrawal from Repetition Psycho-Neurosis. 77 musical companionship, brain tranquilizing galvanizations, aether menthol evaporating lotions to head, chemical brain restraint and pepsines and laxatives. Had she continued much longer in her vicious course of incessant overstudy, this handsome and promising girl would have passed from the morbid psychic automatism of cerebral fatigue excitability into positive insanity as 1 have seen others pass, especially ambitious, self-sustaining teachers, beyond the line that marks the morbid psychic automatism of incessant overaction into the realm of actual insane aberration. These cases can be saved, if treated in time by the alienist and neurologist, but not by any local treatment outside of the brain, unless, perchance, the change of environment and its influences are so tranquilizing, diverting and restful a kind as to bring about through nature's unaided resources, the needful recuperation of the nerve instability and morbid automatism of brain overtax. If these unfortunates get only throat treatment they are likely to be lost, unless perchance, the brain rest from cessation of work and changed environ- ment should bring about a cure. A young unmarried man who speedily became hope- lessly insane and soon after died demented, displayed the beginning of his breakdown by exclaiming sotto voce, while riding with me, "Beethoven! Beethoven! "This he would continually repeat. An aged lady over seventy years of age, who became somewhat demented soon after and senile, would often repeat, "Yes, I love God! Yes, I love God!" in the midst of conversation and when alone. A music teacher and composer of great genius, and now perfectly well, could not refrain when he first saw me, from going through the movements of fingering the key- board of the piano and a tra la la accompaniment. He had just finished a Herculean task and was on the verge of a disastrous breakdown characterized by profound in- somnia, marked general restlessness and psychical excita- bility. A charming young lady patient of mine at the asylum at Fulton, Mo., in 1870 first attracted attention by repeating a call to the chickens, of which she was very fond at home. 78 C. H. Hughes. "Chicky, chicky, chicky," she would repeat, and as her insanity became pronounced she would say "Chicky" all day and far into the night until put to sleep on hypnotics. A suppression of the menses accompanied or preceded her insanity and returned with her return to sanity. She was recovered at the end of six weeks' treatment with bromide of potassium, timely hypnotics, tonics, aloetic laxatives and gelsemium. Another patient of mine at Fulton, a man of upwards of fifty years of age who had gone insane and turned gray in a few weeks time under the strain and misfortune of the civil war, having lost most of his property, principally in slaves, and become suddenly bankrupt, assumed a bent- over attitude as he walked about night and day exclaiming", "My God, how can I stand it; how can a man carry the world on his shoulders?" This man, who was possessed of good physical vigor for his years and was an excessive user of tobacco, reminded me of the mythological pictures of the mythical Atlas. After the acute stage of his malady had . passed he would repeat only the words "How can 1 stand it?" and this utterance l>e would make years after the inception of his insanity, even at times when provoked to smile or when asking for a chew of tobacco, after the fires of the early mental conflagration had gone out and his life seemed to be no longer one of psychic pain. The scar remaining among the cerebral cinders kept up the automatic cerebral refrain, "My God, how can I stand it? How can I stand it?" long after he had ceased to feel the poignant mental pain of the acute stage of his disease. The peculiarity of Samuel Johnson who, after a good deal of mental strain, could not pass a single one of the stone posts which stood at regular intervals along the pavement of the streets in his native town of Litchfield without laying his hand on the top of each one is also apropos to our subject. Fortunately Johnson never broke down seriously in his nerve centers. His repetition auto- maticity did not pass to an extremely morbid stage. Under the caption of "Letter Counting," the Paris correspondent of the British Medical Journal mentions a case Repetition Psycho-Neurosis. 79 in point reported to a Bordeaux society by Dr. Ginostos. The subject was a young man who has, since the age of ten years, had an irresistible impulse to count the letters in a word or phrase that he hears, sees, speaks or thinks. At night he sleeps without dreaming. When he does not talk, he invents phrases and counts the letters in them. Thirty-two is a number that gives him satisfaction; thirteen displeases him, but nevertheless he does not recoil from arranging phrases with thirteen letters in them. This unceasing automatic operation does not in any way interfere with his daily work, or reading or carrying on a conversation. A reference to this interesting case appears in the columns of a number of the New York Medical Journal, which, I do not at present recall. Echolalia, copro- lalia, etc., are likewise somewhat germane to this subject, as showing a similar but graver state of repetitional impulse and obsession, but rhythmic repetitional automaticity is what we are now considering. There are likewise references of interest, not wholly malapropos, in Forbes Winslow's Obscure Diseases of the Brain and Mind. Indeed they may be found in many books of the literature of psychiatry. 1 have heard a chronic alcoholic repeat over and over through the day, "Little Bo Peep, he lost his sheep, and doesn't know where to find them," etc., and have known chronic lunatics who would repeat some long-ago-learned distich or rhyme or some insanely-constructed jingle' of words in maudlin monotone, from the day's beginning to •the ending thereof, in all their waking hours, some of them singing their' peculiar song, like the dying swan, to the end of their unfortunate lives. Some would alternate their phrases backward, a transposition from the way the verses were written. If we carefully scan the speech and song of the insane we will find much not yet recorded and many forms of this morbid psychic display of automaticity. It has as many peculiarities of expression as the singularities of autograph and speech in agraphia and amnesia and other forms of aphasia. More extended rhyming forms of speech or song, evinc- ing mental spontaneity and sometimes marked ability of 80 C. H. Hughes. improvisation among the insane, are interesting and common in the psychiatric hospitals, but they do not strictly belong to our present subject. "A lady who had been eighteen months insane detailed to Forbes Winslow, after recovery, the symptoms of her derangement. She informed him that for nine months previous to her being considered mentally afflicted, she was fully aware that she was not 'quite herself.' '"My general health'she said 'became much out of order, and I had a severe attack of English cholera, followed by great debility, which confined me to my bed for several weeks. It was during this illness that my foolish fancies began to annoy me. At this time 1 used to talk out loudly to myself, a thing 1 never did before. This was irresistible. I ejaculated the most foolish remarks, and at times too with wonderful volubility of speech. I did my best to con- trol myself, in this particular, but found it difficult to do so. I was quite conscious that my mind was affected, and yet no delusion had taken possession of my intellect. For several days 1 succeeded, by strong efforts of thought, in checking this ridiculous inclination to utter absurd expres- sions, but 1 awoke one night in an excited state, from a troublesome dream, and 1 began then to vociferate a number of most incoherent expressions to this effect: "You shall do it." "No you sha'n't." "He is like Satan." "Why don't you say the devil?" "Ah! Ah! Ah!" "it is beauti- ful." "No he devils." "I can't be saved." "You have no hope." "Suicide." "Poison." "Hang yourself.-" "They are after you." These strange remarks continued for nearly two hours, when 1 fell asleep, and arose much relieved. My mind, however, was for sometime afterward not in a right state, although I had intermissions from the misery 1 suffered. Eventually I became quite insane, and I am informed, remained so, for nearly eleven months. During the whole of that time, 1 fancied I was in hell, and tormented by evil spirits. 1 thought every person near me to be a devil. My mind was gradually restored to a healthy state. 1 cannot say when 1 first began to feel that 1 was recovering.'" Repetition Psycho-Neurosis. 81 I should like as forcefully as possible to call your atten- tion, as I think Forbes Winslow has done before me, to the significance of absent-mindedness, abstraction, inattention and what, since Carpenter, we have called psychic automaticity, as precursors of mental aberration. Of course these states signify little, unless they are pro- gressive or until they have reached the verge of morbidity with profound and uncontrollable disregard of the proprieties and .harmonies of environment. Nevertheless they are worthy of note and mean much, very often, to the closely observant alienist clinician. They may serve to start him in the right direction of search for grave impending psychical malady in its avertable stage. I saw once a charming-voiced lady suffering with this form of cerebrasthenia and neurasthenia, who, subsequently while abroad cultivating her voice, developed a condition of rhythmical chanting psychic aberration, folie chantant, while mistakenly having her throat and vocal cords treated. She once consulted me. I saw the impending catastrophe and could have averted it, but was not asked to treat her further and my further advice of prompt brain rest and nerve recuperation was not followed and the catastrophe came. Her trouble began with musical cerebrasthenia. A young manustupral neurasthenic was brought to me by his father some years ago. During my first examina- tion of him he interrupted the proceedings, saying often "It don't correspond." He had been a studious youth of good morals, and his mind was probably vaguely reverting in automatic manner to some problem in mathematics worked at in other days. I could not get him 'to say what he meant or to take treatment. After that he passed speedily into stuporous dementia and soon died. His mother was neurotically enfeebled at the time of his birth and his malady was evolutionally predestined,the masturbation having been an incidental developmental sequence probably, as well as contributing cause. A gentleman of extensive business affairs who came to me on the verge of financial and business bankruptcy, but now after many years of health, successful in a new but 82 C. H. Hughes. less harassing line of business, would continually say to himself, "Too many irons in the fire, too many irons in the fire." His intellect was clear but his brain was jaded and unstable, in that stage of cerebrasthenia that so often pre- cedes the final brain-break of insanity. The closing out and winding up of his business saved him for recuperation and another and less harassing and more successful career. These cases are significant to the neuropsychologic clinician and amenable to cure if timely treated and if we are not misled from the brain, ivhich is the central origin of the trouble, to the peripheral symptomatic expression. Insomnia and other forms of restlessness precede and accompany their expression, as likewise do disturbed visceral states depend- ent upon vagus innervation. Like most voice failures and many altered chirographic expressions, the autographs of morbid brain and nerve states, as in general paralysis, disseminated and posterior spinal sclerosis, the disease is not in the organs of expression in which the symptoms show, but chiefly in the brain, the allied peripheral neural mechanism only subserviently participating. Other clinical illustrations might be cited from the author's experience, as, for example, some forms of choristers' and pianists' palsy, etc., but these are omitted for the sake of essential brevity and to avoid possible coniention. To an audience of savants like that before me one word will suffice for many. This morbid state of the nervous system is so distinc- tively peculiar as to be entitled to distinctive designation. All have observed it, especially those who have added to their neurologic experience opportunities for extensive ob- servation in psychiatry. It is a symptom and precursor, if unarrested, of insanity, and though it may stop short of the greater denouement, by fortuitous change in the life habits or thorough, timely, skillful treatment of the individual, it is a serious condition of the brain, demanding our best thought and effort for its prompt relief and calling for cautious, forceful admonition as to the impending peril of its persist- ence. I have used, for want of a better term, autopsy- Repetition Psycho-Neurosis. 83 chorhythmia, since under the dominance of this morbid state of brain and mental expression the mind loses to a degree its volitional spontaneity and becomes abnormally automatically rhythmical in psychic feeling and expression. And when the stage of insanity is reached, the mind so expresses itself, regardless of the proprieties of place or occasion and out of normal harmony with rational environ- ment. The distinction between morbid and normal autopsy- chorhythmia is in the persistent and inopportune obtrusion of the rhythmic repetition in manner not in harmony with the environment of the individual. The will does not attempt its suppression, or if it does, it cannot, when and where the proprieties demand it, whereas, so long as this symptom phenomenon remains within normal limits, it selects suitable occasions for permitting the rhythmic repe- titions that run through the mind, to go on uninterruptedly and can effectually check them on proper occasions. All perfected education of the psychic neuron centers develops an automatic aptitude for easy repetition. I his is not a morbid feature of mental action and is not what I have attempted to describe. It is the morbid aspects of this mental state, when normal regulated control is im- paired and, in the graver conditions, lost, to which I invite attention as of significance to the neurologist and alienist. It is evidently a lesion, more or less grave, of the psychic inhibition centers that claims ours consideration and demands attention from the profession that it has thus far not ade- quately received. There is a neuriatric with a psychiatric, as well as a psychologic side to this interesting and im- portant subject. It is the latter to which I would call professional attention. Involuntary psychic automaticity in many forms, includ- ing the feature we are now discussing, is a forerunner of grave insanity which displays itself paramountly in lessened inhibitions of normal mental action as well as impulsions to erratic conduct and in the many forms of automatic mental aberration revealed in the actions and speech of the acknowledged insane, both within and without asylums. 84 C. H. Hughes. All symptoms, therefore, which point in that direction even though remotelv, claim thorough investigation and prompt remedial endeavor. Brain strain like that under discussion passing the line of morbid autopsychorhythmia is always a matter of gravity and solicitude. It is the limp that pre- cedes the paralysis of the mental gait. The beginning spasm of overuse that may end in wrong movement. The brain thus going wrong should be made to rest and be brought back by neuropsychological treatment into habit of normal action. Dr. Martin W. Barr in the January, 1898, number of the Jour, of Nerv. and Ment. Dis. discusses an interesting subject akin to our theme and rather more germane to it than the various forms of aphasia under which it is gener- ally considered, namely, echolalia. Hammond, copying from Winslow, gives the case of a woman who always said at her prayers "our Father which art in Hell," meaning to say Heaven, and the case of a man from his own observation who said automatically "saw my leg off" to any question asked. There is no connection, in my judgment, between my subject and any form of hypothetical transcortical aphasia or to the motor aphasia of Broca's speech center. It is neither echolalia nor corprolalia, though I agree with Tuke that echolalia and corprolalia as some forms of apha- sia and other speech defects do, portend, like autopsycho- rhrthmia, insanity. They are morbid impulsions, and morbid impulsions are lesions of inhibition not far in ad- vance of oncoming psychic aberration. Corprolalia, a tendency to express as well as to repeat foul language, is often heard among the insane, even among naturally mod- est and cleanly minded women. Mills* records the case of a refined and cultured lady who would suddenly swear and gesticulate, and a boy who would suddenly utter filthy language and move his head, shoulders and arms violently. These are common symptoms in the observation of insanity. These two cases are quoted by Barr as combining palmus or myriachit and corprolalia, as they undoubtedly do. •Review of Inwnity and Nervous Diseases. September and December. 1891. Repetition Psycho-Neurosis. 85 The Jumpers of Maine are victims of impaired volition and morbid psychomotor irritation and impulse, some of them not far removed from insanity. Mills then very properly classes echolalia under morbid impulse rattier than aphasia* and had he rested there he would have remained on undebatable ground but in a later article, as Barr observes, he classes true echolalia as a characteristic symptom of transcortical or suprapictorial sensory aphasia.t A similar but not the same state of mind to that of autopsychorhythmia may be seen in the feeble-minded as in the volitional repetitions of Ban's pupils at Elwyn, Pa., which he discribes as echolalia. The boy Kirtie repeating "Kirtie, come to school tomorrow; Kirtie, come to school tomorrow morning," etc., is similar but not the same. It is the voluntary habit of a feeble mind to fix a mental im- pression. Something similar is sometimes also the habit of the infantile mind when learning to speak. The feeble and the morbid brain sometimes come in close touch in mental operation. ADDENDUM. The form of insanity in my observation to which autopsychorhythmia tends is that in which imperative con- ceptions predominate or have predominated in the initial stage of the mental disease. In aggravated form it is an imperative, resistless impulse to repetition of psychic im- pression in the form of verbal expression. In the Dictionary of Psychological Medicine Tuke broaches this subject under the definition of imperative ideas, but he does not compass it. He briefly discusses there under echolalia and certain of the morbid fears of neurasthenia, but my subject does not include morbid fears, illusions or hallucinations, though they may coexist with it. It means a tendency of the mind more or less resistless to continually and non-volitionally •American Text Book of Diseases of Children; Speech Aspects and Anomolles, i. 663. quoted by Barr. tEci o ilia. By Martin W. Barr. 6th page. Dercum's Text Book on Nervous Dis- ease, p. 440, lit Edition. 86 C. H. Hughes. repeat its once volitional actions even at inopportune time and place. It is a habit volitionally induced which has passed into a too often invoked normal mental morbid auto- matic impulse of over brain strain or excitation. The habit excites the patient's concern and sends him, if he is an intelligent man, familiar with the possible resources of neuriatry, to seek relief in neurological medical advice and remedy. When this condition displays itself in unrestrained im- pulse of speech or song to the chagrin of the individual and surprise of his friends, it is an act out of harmony with his rational character and environment and is then initial in- sanity. Another feature of our subject is shown in a tendency . to imitative acts, such as grimaces and stuttering and spinal cord and motor center movements (Jumper's palmus), which by often and long repetition have become organized automatic impulsions no longer volitional with the individual and which sometimes are seen to pass into the acts of the insane. To discuss these now in externa would make this paper too prolix. In the ALIENIST AND NEUROLOGIST for January, 1897, under the caption Imperative Conceptions, I have dis- cussed more in externa this subject. I have there recorded the case of a victim of corprolalia, who upon being advised to quit breaking out with sudden profanity, said: "I can't; I would that I could. I go about my work crying and talking. 1 will say, 'I will not do that any more,' and it will not be five minutes until I will be at it again," etc., etc. "1 think and say such awful things. I never did so before and do not believe I want to now." Discussing echolalia, Martin W. Barr records a case under his observation of a beautiful and refined girl attend- ing a boarding school who would at intervals give sudden expression to three words successively, the first vulgar, the second foolish and the third profane.* This condition, in some of its features, is related when in intense morbid degree, to our subject and proves its psy- chopathic relation and grave alliance. •Echolalia. Jour. Ntr. and Mcnt. Dis., Jan., 1898. ». ». Repetition Psycho-Neurosis. 87 Morbid autopsychorhythmia has relation to the spasmodic word outcries of the insane, (corprolalia and echolalia, etc.). similar to the rhythmic spasm of athetosis in comparison with the jerky spasm of tetanus, chorea or the spastic movement of lateral sclerosis. The pathological lesion of autopsychorythmia is evidently in the mind area of the brain cortex. It is truly transcor- tical and not focalized exclusively in the speech area. It is a psychical and not purely psychomotor involvement. A psychical lesion shown in peculiarity of psychomotor ex- pression. If in "this frame the bearings and the ties, strong con- nections, nice dependencies," an ancestral "blot upon the brain," has left for transmission a latent hereditary scar of aberrant mental action, we may expect to see the psychic perversion of insanity develop under stress of brain and mind, such as destroys or weakens its normal regulating power. "That way madness lies; let us shun that." It may show in obscure, if not in plainer form or in mental eccentricity, to mark and mar the after life. A STUDY OF FOUR CASES OF MENTAL DIS- EASE AND FOUR INTRACRANIAL TUMORS CONNECTED THEREWITH. By J. W. BLACKBURN, M. D. Pathologist to the Government Hospital for the Insane.* CASE I. Hemorrhagic spindle-celled sarcoma of the cerebellum and mul- tiple soft fibromata of the skin. AB.; AGED 61; white; single; laborer; late soldier; • nativity, Pennsylvania. Mental disease, chronic epileptic mania; duration over four years. The patient was admitted to the Central Branch National Home for Disabled Volunteer Soldiers, September 2, 1892. Medical history of chronic rheumatism, hemorrhoids and epileptic seizures. He had fits of violence at intervals of four or five days, in which he tried to injure his attendants, break furniture, etc. Mental power weak when admitted to the Soldiers' Home. On admission to the Government Hospital for the In- sane, May 4, 1893, he was weak; was soon confined to his bed; moderately demented; memory, perceptions and comparative faculty all impaired, but he could talk rationally, for the most part. He had no delusions, but showed pro- gressive dementia, with occasional attacks of impulsive fury, in which he would beat his bed and attack anyone coming within his sight or reach, at the same time uttering inar- ticulate cries of rage. These furors were of brief duration, •Abstracted from the Forty-fourth Annua] Report of this Institution. [88] Four Cases of Mental Disease. 89 and were followed by short periods of confusion, with rapid breathing from excitement and exertion, to pass into the usual state of quiet dementia. The whole body was covered by soft fibrous tumors of the skin, varying in size from the smallest visible nodule to the size of a walnut, and in certain regions the skin hung in pendulous masses of the same character as the tumors. His general health was fair, aside from weakness, and there was no evidence of organic disease other than of the brain and the dermal growths. He had no paralysis nor altered sensations other than impairment of acuteness, though the mental dullness of the patient made the physical examination difficult. The patellar reflex was somewhat exaggerated. There was no appreciable affection of the cranial nerves; no head- ache; no neuralgic pain; sight was not appreciably affected. He had occasional attacks of vomiting, and suffered from vertigo on assuming the erect posture. No convulsions occurred for more than a year after his transference to the Toner Building, August 14, 1894, ex- cept the psychical attacks of rage and violence. In the summer of 1896 the first epileptic convujsion occurred, after which the psychic attacks were completely superseded by those of distinct epileptic character. Dementia progressed rapidly during the last few months of his life, and death occurred suddenly November 13, 1896. The progressive impairment of the cerebral functions and the degree of physical and mental failure suggested organic disease of the brain, but otherwise there were no symptoms to differentiate the case from one of chronic epilepsy. Autopsy six hours after death.—Rigor mortis not de- veloped. The whole body was covered with soft fibrous growths of the skin, which varied in size from an inch in diameter to a pin-head size. Some of the growths were pedunculated; all were very soft; some were a little darker than the surrounding skin, and some the same color. The forehead was thickly studded with the growths, and they were especially numerous on the arms. Over the right 90 J. IV. Blackburn. gluteal region, outer and lower portion of the right thigh, and outer aspect of right leg below the knee, the skin seemed to hang in large masses, which appeared to be of the same character as the tumors. On the right leg, just below the knee, was a somewhat more tumor-like mass nearly three inches in diameter. The large pendulous masses are of the same nature as the circumscribed growths, but are less sharply defined from the normal skin. By some pathologists they are regarded as continuous outgrowths, closely allied to elephantiasis; by others they are believed to be diffuse hypertrophies of the skin. They are frequently associated with soft fibromata of the skin, and must be re- garded as due to the same cause. Section of the tumors showed them to be very soft and succulent, somewhat less fibrous than the dermis and a little less elastic, so that the tumor tissue projected from the cut surface as the skin retracted. In hardening, the skin over the tumors became greatly wrinkled and shrank away from the tumor mass, and the whole growth was greatly reduced in size. Cranium; Antero-posterior diameter of skull, 7% inches; transverse, 6 inches. Skull a little thicker than the average; shape symmetrical; sutures rather indistinct. On the outer surface were a number of small nodular ex- ostoses slightly raised from the surface of the bone. The dura mater was not abnormally adherent to the bone, ex- cept over a small area in the anterior part of the left cerebellar fossa, where it was also adherent to a tumor, which was imbedded in the left hemisphere of the cere- bellum. The general surface of the dura at this situation was smooth, and there were no indications of the growth having originated from the dura mater. Brain: Weight of right hemisphere, 23>^ ounces (666.2 grams); left hemisphere, 2Z% ounces (673.3 grams); cere- bellum, pons and medulla with the tumor, 8 ounces (226.8 grams). The subdural space was dry and there was a marked degree of intracranial pressure indicated by flatten- ing of the convolutions against the dura over the whole convexity. Embedded in the outer anterior part of the left Four Cases of Mental Disease. 91 cerebellar hemisphere was a hemorrhagic tumor about an fnch and a half in its long diameter and an inch and a quarter in transverse diameter. The growth was irregularly oval in shape, with its long axis parallel with the horizontal plane of the cerebellum. Incision into the growth showed the greater part of the mass to be blood clot, the remainder of the tumor tissue of moderately firm consistence. Though the blood had coagulated into a firm clot it did not appear to be of long standing, as no degenerative changes had taken place in the blood. A firm capsule had retained the extravasation and the hemorrhage did not appear to have added much to the size of the growth. It was therefore supposed to consist for the most part of infiltrated tissue, and such the microscope proved it to be. The fifth nerve was stretched over the superior surface of the tumor, show- ing that it started at the extreme lower and anterior portion of the cerebellum. The pons was displaced toward the right, and the growth encroached upon the seventh and eighth nerves at the upper part of the medulla. Where the growth was embedded in the- cerebellum it had caused loss of substance and some softening. The vessels at the base of the brain were not diseased; ventricles greatly dilated; brain substance oedematous and soft; perivascular spaces enlarged; no gross lesions in any part of cerebrum, except some induration of the hippocampi and uncinate gyri. The cerebellum, pons and medulla were preserved in- tact as a museum specimen, and therefore were not ex- amined by section. Thorax: Some bands of chronic pleuritic adhesions were found on the right side. At the apices were found some old pleural scars and some small grayish nodules, supposed to be tubercular deposits. Large hemorrhagic areas were scattered throughout the other portions of the lungs. The left lung weighed 19 ounces (538.6 grams); the right, 24 ounces (680.4 grams. Heart: Weight, 12 ounces (340.2 grams). Pulmonary valves normal; tricuspid a little thickened; aortic valves were a little thickened and showed some adhesion to each 92 J. IV. Blackburn. other at their attached edges. Mitral valve slightly thick- ened at its edges. Heart muscle firm; aorta normal. Abdomen: The spleen weighed 12^ ounces (347.2 grams); capsule wrinkled; pulp very dark, full of blood and soft. Kidneys: Weight of right, 4% ounces (120.4 grams); left, 4K ounces (134.6 grams). The organs contained more blood than normal; capsules slightly adherent; surfaces showed some depressions and were a little granular; cortex was somewhat reduced in thickness. The urinary bladder showed some hypertrophy and enlargement of the middle lobe of the prostate gland. Liver: Weight, 48J4 ounces (1375.9 grams). The tissue showed slight passive congestion. Gall-bladder con- tained a small quantity of dark bile. The other abdominal organs were apparently free from disease. MICROSCOPICAL EXAMINATION. Tumor of brain: The greater portion of the bulk of the tumor was composed of blood and tissue so infiltrated with blood that it was impossible to make sections of it. The greater part of the tissue which remained outside the hem- orrhage area was composed of spindle cells in close prox- imity to each other arranged in wavy or curved bands running in every direction. The spindle cells were delicate, and closely applied to each other, so that it was difficult to see the cells except in very thin sections and where acci- dentally torn apart, and the direction and arrangement of the cells was mainly indicated by the nuclei. Some fields were found in which round cells predominated, lying among delicate connective tissue fibrils. These fields were found most frequently near the seat of hemorrhage, and it is possible that many of the round cells were leucocytes. In the midst of masses of spindle-celled tissue groups of round nuclei were often found; these were supposed to be transverse sections of the nuclei of spindle cells. In the purely cellular portion of the growth no connective tissue was visible, but in certain fields the process of fibrillation Four Cases of Mental Disease. 93 was far advanced, and in some of the round-cell areas the intercellular substance was distinctly fibrillated. Some areas were found in which the structure resembled the early stages of granulation tissue, and indeed there may have been some reactive inflammatory tissue formation. The structure of the growth was in fact very confusing, and diagnosis was only made by examination of large areas composed exclusively of spindle cells. The blood vessels in the cellular tissues were of the type found in all sarco- mata; they had imperfect walls composed of flattened cells, and ran as mere channels through the tissue; in a few, however, hyaline change had thickened the walls and even obliterated the lumen. In the fibrous tissue some of the vessels had thick fibrous or hyaline walls and some weie mere channels in the tissue lined with flattened cells. No vessels with perfectly developed walls were found in any of the tumors of this class, and, in fact, it seemed that per- fect vessels are not developed in the low grade of connective tissue found in these neoplastic structures. Large blood- channels lined with flattened cells were found in the tissue adjoining the hemorrhagic portion of the growth. Though the structure of the growth was somewhat perplex- ing and the origin uncertain, it was diagnosed a spindle- celled endothelial sarcoma, probably of the membranes of the cerebellum. The soft fibromata of the skin: These tumors presented the usual appearances of such growths. They consisted of delicately fibrillated connective tissue richly nucleated with small, elongated, or rod-like nuclei, frequently curved or twisted. In all parts of the sections brightly stained round nuclei were seen, which were transversely cut sections of the rod-like form. In certain places groups of round nuclei were found, probably centers of growth. In some parts of the sections nuclei of both forms were very numerous, giving the tissue a general resemblance to spindle-celled sarcoma; but careful examination would show that in the fibroma the nuclei are among the fibers and not within spindle cells, and that in the fibrous tumor the tissue is more mature and dense than in fibro-sarcoma. For com- 94 J. W. Blackburn. parison with the brain tumor I have drawn two fields from the fibromata—one showing a richly nucleated field, the other the more typical appearance of the growth. The blood vessels in the denser and older portions of the tumors were not numerous, and many presented the appearance of mere channels in the tissue lined with endothelium. In the more cellular part of the tissue many new-formed blood vessels were found in all stages, from capillaries to fully developed arteries and veins. On the borders of the tumois adjoining the true skin the deeper parts of coil glands, sebaceous glands, and deep-hair follicles were included in the new tissue. Peripheral nerve trunks were found occasionally within the tumor tissue, and though there was undoubtedly some increase of the con- nective tissue of the nerves, especially of the epineurium, there was no other evidence of connective tissue of the nerves entering into the formation of the growths. Brain: The pia mater was thickened; the bloodvessels of the brain were tortuous and lay in wide perivascular spaces with much altered blood pigment around them. The nerve cells were granular and excessively pigmented; peri- vascular and pericellular spaces enlarged. The cerebellum, pons and medulla were not examined. Lungs: The sections from the apices showed chronic tubercular deposits in the alveolar walls and around the bronchi. The tubercular nodules were surrounded by dense masses of round cells in which were many blood vessels. The central portions of the nodules were composed of epithelioid cells of various sizes and shapes apparently in the early stages of tissue formation. No vessels were found in the central cell masses, but degeneration had not taken place on account of the vascular supply to the peripheral parts of the nodule. Very few giant cells were found. Some of the alveoli were narrowed by thickening of their walls and contained a few epithelial cells. In the hemor- rhagic areas the alveoli contained blood and the vessels were engorged. Spleen: The capsule was thick, the trabecular promi- nent. The pulp showed great engorgement, large areas contained nothing but blood. Four Cases of Mental Disease. 95 Liver: the tissues showed nothing abnormal except slight passive congestion and some pigmentation of the cells. Kidneys: There was a slight increase of the connective tissue, mainly around the glomeruli. The tissue contained more blood than usual; the tabules were slightly dilated; the epithelium granular and somewhat disintegrated at the inner margins, and the tabules contained granular matter probably derived from the cells. The other organs were not examined with the micro- scope, but were apparently normal. CASE II. Spindle-celled endothelial sarcoma of the dura mater and soft carcinoma of the stomach. J. L).; aged 59; white; single; shoemaker; late soldier; nativity, New York; mental disease, chronic mania; dura- tion, twelve years. No history of the patient previous to his admission to the hospital could be obtained. It was improbable that oc- cupation or habits of life could have had any influence on the development of the tumors, though the condition of some of the organs may have been due to the abuse of stimulants. The dural tumor was probably of long stand- ing; the carcinoma was of uncertain duration. The tumor of the dura gave rise to no characteristic symptoms, and the presence of the cancer was only indicated by some gastric pain and occasional vomiting after eating. It is al- most certain that the vomiting was due to the gastric tumor rather than that of the dura, as the latter was of small size and all other symptoms of intracranial growth were absent. The mental disease beginning with maniacal ex- citement gradually gave way to terminal dementia of a moderate degree, and for some time previous to his death the patient was employed at light work about the kitchen. He gradually failed, and died from exhaustion and inanition due to the condition of the stomach. Autopsy eighteen hours after death.—Body small, greatly emaciated, rigor mortis disappearing. Cranium: Antero- 96 J. W. Blackburn. posterior diameter of skull, 7-'h inches; transverse, S}& inches. Shape, asymetrical, the left side being the larger; sutures partially obliterated; bone of normal thick- ness. The outer surface of the skull bone was roughened and irregular in patches and showed a number of irregular depressions to which• the pericranium adhered. In the occi- pital region some of these depressed areas yet remained soft and could be penetrated with the knife. The dura mater was adherent to the bone, but perhaps not abnorm- ally so for a man of his age. On the inner surface of the dura over the anterior part of the right third frontal convolution was a small globular tumor mass about three-fourths of an inch in diameter, firmly adherent to the dura mater and also attached to the pia, so that it could not be removed without tearing the latter. The tumor had made a slight depression in the convolution, but there was no loss of substance. The other portions of the dura seemed a little thickened, and a small nodule similar to the tumor described above was found on the inner surface over the left occipital region. This nodule had caused no depression in the brain. Section showed the tumor to be fibrous in structure, grayish-red color, firmly united with the dura and pia, but evidently derived from the former. The tissue was moderately firm, and slight grittiness was noticed on section. Brain: Weight of each hemisphere, 21 ounces (595..55 grams); cerebellum, pons and medulla, 5% ounces (163 grams). The pia mater showed a moderate degree of vas- cular engorgement and some oedema, but no opacity or other alteration except as mentioned above. Arteries at the base not diseased. The brain tissue was very soft and (edematous and section showed enlargement of the perivas- cular spaces everywhere. The ventricles were moderately enlarged; ependyma smooth. Cerebellum, pons and medul.la were oedematous and soft; a small congested area was found in the right side of the pons, exposed by middle transverse section. • Thorax: Limited chronic pleuritic adhesions on both sides, and a small quantity of fluid in each plural cavity. Four Cases of Mental Disease. 97 Lungs. Weight of each, 20% ounces (581 grams). Posterior portions of both lungs showed oedema and some hypostatic exudate in patches. Over the lower lobe of the left was a thin deposit Qf lymph. Heart: Weight, 6% ounces (191 grams). The superficial arteries were very tortuous and calcified; opaque patch over wall of right ventricle; valves of right side normal; aortic valves normal; mitral valve a little thickened at its edges. Heart muscle brownish and superficial adipose tissue atrophied and oedematous. Aorta atheromatous throughout. Abdomen: The abdominal cavity contained 112 ounces of straw-colored fluid. The appendix veriformis was turned upward and backward and was adherent to the peritoneum. Spleen: Weight, 7}i ounces (219 grams); capsule wrinkled and cartilaginoid in patches; pulp, slate-colored, rather pale, and fibrous. Small supernumerary spleen near the hilus. Kidneys: Weight of left, 4'/i ounces (127.5 grams); right, 4 ounces (11J.4 grams). The organs were somwhat indurated; capsules adherent; surfaces slightly granular; cortex rather thin; apices of pyramids whitened by urate deposits. Urinary bladder normal. Liver: Weight, 47l/i ounces (1346.62 grams). The surface was slightly granular; edges somewhat rounded; upper surface of right lobe covered by a thin layer of ap- parently organized lymph, but it was not adherent to the diaphragm. The capsule showed some radiating scars over the superior surface; there was some general thickening of the capsule in the region of the gall-bladder, and a large depressed scar was found in the under surface of the right lobe. The tissue was tough and leathery, and the cut surface was almost homogeneous in appearance, without any trace of lobulation, or bands of connective tissue, such as are usually seen in common cirrhosis of the liver.* The gall-bladder was normal. Stomach: At the pyloric end of the stomach was a large fungoid growth, which bordered upon the pyloric •The condition o( the bone of the skull and the peculiar variety of cirrhosis of the liver suggested syphilis, but as there was no proof of the existence of specific disease it was not mentioned In the history of the case. 98 J. W. Blackburn. orifice, but did not obstruct it to an appreciable degree. The growth was nearly two inches across in its greatest diameter and about three-fourths of an inch in average thickness. The surface was ulcerated and hemorrhagic; tissue was soft and juicy on section. The general surface of the stomach showed a granular condition and some opacity of the mucous membrane. Intestines: No lesions were found in the intestines; mesenteric glands slightly enlarged but not cancerous. Other abdominal organs were normal. No trace of secondary tumor deposits was found. MICROSCOPICAL EXAMINATION. Dural tumor: On superficial examination the tumor much resembled a hard fibroma, but on careful study it was found that the fibrous-looking tissue could be resolved into spindle cells with oval and elongated nuclei arranged in wavy bands, whorls, and concentrically arranged cell spherules, such . as are commonly found in tumors of this class. The cell nuclei were very hard to stain and the cell bodies could not be distinguished when in masses. There was undoubtedly a considerable development of actual fibrous tissue and some hyaline change, which gave the tissue the peculiar appearance of a dense fibroma. The closely packed cell masses of various sizes were very nu- merous in some parts of the sections. In many of these the cellular structure could hardly be determined, owing to fibrous and hyaline change, and in some the degeneration had reached the stage of formation of the concentrically - striated hyaline and calcareous spherules. Besides these spherules, large irregular areas of the same degenerative product were found in the large tissue masses where the cell structure was unusually dense. Blood vessels were not numerous, and those in the sarcomatous tissue had imperfect walls, though some fully developed vessels were found in masses of connective tissue, apparently derived from the dura. Hyaline change in the vessels was not marked. The histogenesis of such tumors is certainly very ob- scure, but they are generally supposed to be derived from Four Cases of Mental Disease. 99 the endothelium of the brain membranes, and are therefore called endotheliomata by many pathologists. On account of the shape of the predominating type of cells, which are spindle-shaped and not endothelioid, I have named this and other like tumors, spindle-celled endothelial sarcoma. The presence of the hyaline and calcified spherules being only accidental, should not warrant the use of such terms as psammoma, acervuloma, etc., especially as the identity of these bodies with "brain sand" is not established. Cancer of stomach: The cancer of the stomach was of the soft variety, and probably originated in the fundus cells of the pyloric glands. The cells were rather small, with prominent nuclei, and, where not influenced by mutual pressure, round. The growth was mainly in the mucosa, and no trace of gland-like tissue remained, except a tendency of some of the peripheral cells to arrange them- selves in a single layer along the walls of the aveoli and to assume columnar shape by mutual pressure. The growth had penetrated very little into the muscular coats of the organ, but a few cancer cell-nests were found in the con- nective tissue trabecular separating the muscular bundles of the circular layer. These cancerous masses were always surrounded by dense, small cell infiltration. The growth had not invaded any other organ or tissue. Brain: The brain tissue was unfit for the more minute study of structure, on account of decomposition at the time of the autopsy. In ordinary sections the cells showed granular pigmentary degeneration; the pericellular spaces were large; the blood vessels had large perivascular spaces, but showed no disease of their walls. The cells of the spinal cord were granular and pigmented. The lungs showed some exudation in the alveoli of the dependent portions. The kidneys showed a moderate in- crease of connective tissue in the vicinity of the glomeruli and between the tubules. The cells of the convoluted tubules were crumbled, and granular matter tilled the lumen of the tubules. The spleen showed enlargement of the venous sinuses,- and swelling and proliferation of the endothelium. -The 100 J. IV. Blackburn. connective tissue was increased; the capsule much thickened, especially in the cartilaginoid patches. Liver: The microscopical appearances of the liver were very unusual. There was a moderate increase of the con- nective tissue between the lobules and in the portal canals. This tissue was richly nucleated in patches, and at the borders of these areas the tissue extended for some distance between the cell columns and the individual cells. There was no unusual proliferation of the bile ducts in the new connective tissue. In some places patches of new con- nective tissue were found among the cells, which were widely separated, misshapen and atrophied. Occasionally isolated groups of leucocytes were found among the cells, without any relation to the connective-tissue areas. They were supposed to be centers of the new growth. In general, the liver cells were atrophied and the cell columns were widely separated by dilated capillaries. In some places this dilation was excessive and had almost reached the angiomatous stage, the cells having completely disappeared. The diagnosis of the condition of the liver was difficult, but taken in connection with the naked-eye appearances, specific cirrhosis would certainly be suggested. The mesenteric glands seemed to be merely hyper- plastic, as no cancerous deposits were found in them. Other abdominal organs were not examined with the microscope. CASE 111. Spindle-celled endothelial sarcoma of the dura mater, pene- trating the brain. J. E.; aged 68; colored; widower: laborer; late sol- dier; mental disease, senile dementia; duration, three and one-half years. The patient was admitted to the Western Branch, National Home for Disabled Volunteer Soldiers, October 2, 1893, with left hemiphlegia, convulsions, and was almost helpless. He was admitted to the insane ward April 27, 1897, with a history of advanced dementia, complete left herr»iplegia and general prostration. Four Cases of Mental Disease. 101 On May 4, 1897, he was admitted to the Government Hospital for the Insane with the above mental and physical symptoms somewhat advanced. May 30, 1897, he died suddenly, apparently from an apoplectiform seizure. From the recorded symptoms the tumor had apparently existed over three and one-half years. Autopsy seventeen hours after death.—Body fairly well nourished; rigor mortis present; signs of commencing de- composition over lower part of abdomen. Cranium: Antero-posterior diameter of skull, 7% inches; transverse diameter, • 5% inches. The skull was rather thick and dense; shape asymmetrical, the occipital pro- tuberance being situated to the left of the median line. Sutures visible externally, but indistinct in inner table. On the right side in the parietal region a marked elevation ex- isted on the inner surface. There were no signs of external injury, and the elevation of the inner surface was probably related to the dural growth afterward described. Section of the bone through this protuberance showed nothing ab- normal but unusual vascularity of the tissue; both tables and the diploe were intact and the thickening seemed to be mainly of the cancellous tissue. . Brain: Weight of right hemisphere with the tumor, 19# ounces (545.73 grams); left hemisphere, 18 ounces (510.3 grams); cerebellum, pons and medulla, S% ounces, (155.92 grams). Before opening the dura mater a depression was observed in its outer surface in the parietal region corre- sponding with the elevation of the inner surface of the skull, and adhesions to the bone were firmer here than elsewhere. On lifting the dura from the brain a large tumor was found beneath it embedded in the brain, but apparently raised above its general surface by the dropping away of the soft and oedematous cerebral substance. The tumor was adherent to the dura, so that the membrane was left attached to it. The growth was 3% inches broad in its antero-posterior diameter; i'/i inches in its verticle diameter, and was exactly \7/u inches in thickness. The growth occupied almost the whole of the parietal lobe, had crowded forward the central convolutions and the fissure of 102 J. W. Blackburn. Rolando, and the ascending parietal convolution was en- croached upon and nearly destroyed by the pressure of the tumor. It extended vertically from the upper border of the posterior end of the fissure of Sylvius to the median edge of the hemisphere, and antero-posteriorly from near the fissure of Rolando to the anterior border of the occipital lobe. A section was made through the center of the growth, and it was then found that the tumor had pene- trated the brain as far as the ependyma of the ventricles and nearly to the median surface of the hemisphere. On the median surface the tumor had not reached the cortex, though probably pressure had destroyed brain function over the advancing growth. The quadrate lobe was greatly damaged and the paracentral lobule was practically destroyed. The consistence of the tumor was quite firm, but the brain tissue surrounding in was soft and pulpy, so that the brain had to be handled with extreme care to avoid enucle- ation of the tumor while making the necessary sections. The growth had firm adhesions to the dura mater and it had apparently carried with it the pia mater as it pene- trated the brain, and traces of membrane and even cortex could be distinguished around the boundaries. The tumor had a reddish-gray color; the surface looked a little granular but no gritty particles could be seen or distinguished by cutting. Bands of connective tissue could be distinguished radiating from the origin of the growth and intersecting it in every direction. The pia mater of the left hemisphere was cloudy over the convexity, and the convolutions showed the effects of pressure. There was some atrophy of the convolutions and one case a semi-malignant spindle-celled endothelial sarcoma was found in the cerebellum and benign multiple soft fibromata of the skin. In another case a spindle- celled endothelial sarcoma was found on the dura mater and soft cancer was present in the stomach.* *In a case reported In 1894, round-celled sarcoma of the testicie, adenoid carcinoma of the ■ tomach and endothelial sarcoma of the dura mater were found In the same Individual. MALTHUS1ANISM AND DEGENERACY.* By HARRIET C. B. ALEXANDER, A. B., M. D., Chicago. Fellow of the Chicago Academy of Medicine. TH E Malthusian doctrine is essentially that old principle of which Schiller sang: "What grave professors preach, The c/owd may be excused from knowing, Meanwhile, old Nature looks to each, Tinkers the chain, and mends the breach, And keeps the clock-work going. Some day, Philosophy, no doubt, A better World will bring about; Till then the old a little longer, Must blunder on through Love and Hunger." Hunger (of which love was then a part) formed the primitive appetite, the moving impulse of the amoeba, later to give birth to that political economy whereby, after their courtship of the queen, male drones are killed off to save their sustenance to the bee community. This necessity of adjusting population to food supply expressed itself in a primitive human tendency, a direct evolution from the seemingly blackest fact in natural history; that instinct whereby the wounded, dying and vicious are driven from the herd by the social animals. Wolves and wild dogs de- vour a badly wounded comrade. Deer butt the wounded from the herd into the jaws of pursuers. Elephants and crows drive the "rogues" as well from their midst. From this resulted savage exposure of the aged and weakly, often at their own request, as well as the less brutal methods of •Rend Before the Philosophy and Science Department Chicago Woman's Club. [112] Malthusianism and Degeneracy. 113 tribes as low in evolution as the Australian,* which, by a surgical operation, prevent 95 per cent of their males from becoming fathers, in some tribes immediately after birth; in others not until two children are born. In certain African tribes women are subjected to a similar operation to prevent motherhood before a certain age. This principle of protection of the state by sacrifice of the weakly ran through all phases of government evolution from the an- archic horde to the socialistic village community, thence to shaman rule (during peace) with elective war chieftains, to mixed religious and temporal rule (like that of the Mikado and Shogun), finally to the divine right of kings; or from the village community to socialistic, federal, centralized or individualistic republics or constitutional monarchies. Races as relatively high in evolution, as the Spartans,exposed the weakly and encouraged suicides in those mutilated by wounds. The Scandinavians preferred death in battle or suicide to death in bed. A fetichic belief (whose highest later evolution is the modern doctrine of degeneracy) was often the directing principle. Children with well-marked stigmata of degeneracy were exposed because branded'" by nature as dangerous. The principle of regulating population for benefit of the state expressed in the political axioms of Lycurgus, Solon, Aristotle and Plato exerted an influence on Machiavelli, and he in his turn on the Jesuit Ortes, who, eight years before Malthus, gave forth, in obscure language, because of dread of the Inquisition, the basic principles of the epoch-making, "Essay on Population." Plato's principles, modified by Celto-Teutonic usages and Christain ethics, appear in Sir Thomas More's Utopia, in Harrison's Elizabethan England, in Hobbes' Leviathan and in Sir William Petty's political writings. The necessity for regulating population was summed up, so far as the seventeenth century is concerned, by the anatomist of melancholy, Burton, who remarks: + "So many several ways are we plagued and published for our father's defaults; in so much that as Fernelius •Humboldt's Traveis in Australia. tThistleton Dyer. Folklore of Shakespeare. JArutomy of Melancholy. 1652. 114 Harriet C. B. Alexander. truly saith: 'It is the greatest part of our felicity to be well born and it were happy for human kind if only such parents as are sound of body and mind should be suffered to marry.' An husbandman will sow none but the best and choicest seed upon his land; he will not rear a bull or a horse except he be right shapen in all parts, or permit him to cover a mare except he be well assured of his breed; we make choice of the best rams for our sheep, rear the neatest kine and keep the best dogs quanto id diligen- tius iu procreandis liberis observiiinhtm. And how careful then should we be in begetting of our children. In former times some countries have been so chary in this belief, so stem, that if a child were crooked or deformed in body or mind, they made him away; so did the Indians of old by the relations of Curtius and many other well-governed commonwealths according to the discipline of those times. Heretofore in Scotland, saith Heatt Noethius, if any were visited with the falling sickness, madness, gout, leprosy, or any such dangerous diseases which was likely to be propa- gated from the father to the son, he was instantly gelded, a woman kept from all company of men and if by chance having some such disease, she was found to be with child, she with her brood were buried alive and this was done for the common good lest the whole nation should be in- jured or corrupted. A severe doom you will say, and not to be used among Christians, yet more to be looked into than it is. For now by our too much facility in this kind in giving way for all to marry that will, too much liberty and indulgence in tolerating all sorts, there is a vast con- fusion of hereditary diseases, no family secure, no man almost free from some grievous infirmary or other when no choice is had, but still the eldest must marry as so many stallions of the race; or if rich, be they fools or dizzards, lame or maimed, unable, intemperate, dissolute, exhausted through riot, they must be wise and able by inheritance. It comes to pass that our generation is corrupt, we have many weak persons both in body and mind, many feral diseases raging among us, crazed families; our fathers bad and we are like to be worse." Malthusianism and Degeneracy. 115 While the authorities summed up by Burton aimed at removing defects by Spartan method almost as injurious to the community through their deteriorating effects on altru- ism as the defects they were intended to cure, there is suggested for the first time by Burton a more logical, humane method of removing these defects. Burton while biased rather too much by belief in the omnipotence of statutes, did not underrate the value of logic addressed to the individual. His views were beneficially modified by the growing, though feeble, beliefs in the right of the individual which marked the period of the British commonwealth dur- ing which he wrote. Thus modified, they found their most lucid individual- istic exponent in one who, like the self-denying, humane Epichrus and the philanthropic pioneer criminologist Guil- lotin, has been singularly maligned by erroneous distortions of his doctrine. Of the multitudes who have denounced Malthus on Population and the Malthus Doctrine, Bettany* remarks, very few have read his book or know anything of the life and character of its author. Many who advocate what is termed neo-Malthusianism would appear either to be in'the same case or to have conveniently forgotten what Malthus really thought. A work of deep philosophic thought, of wide and careful research, teaching a doctrine pure, self-denying, prudent and wise, the "Essay on Pop- ulation" has been denounced as unholy, as atheistic, as subversive of social order. In view of the "Essay's" evolutionary tone, such de- nunciation will not surprise those who have witnessed early vituperation of the Darwinian doctrine glide into pu-ans of praise. Charles Darwin has eulogistically acknowledged his debt to Malthus, but how greatly this debt, can be realized only from perusal of the "Essay on Population," wherein are decided evidences, not merely of the recognition of disproportion between food supply and human increase, with resultant struggle for existence, but of the value of natural selection in securing advance in evolution. Evil, according to Malthus, exists not to create despair, but ac- •Ufe of MiitJras. 116 Harriet C. B. Alexander. tivity. Nature sends all sentient creatures through a long and painful process by which they gain new qualities and powers. This life is the mighty process of God for creat- ing and forming the human mind out of the torpor and corruption of dead matter existing, to sublimate the dust of the earth into soul, to elicit an ethereal spark from the clod of clay. The first awakeners of the mind are the wants of the body, and by arranging that the earth shall produce food only in limited quantities as a result of labor, God has provided a continual spur to human progress. Population tends to increase faster than food that men may be roused to save themselves from suffering for lack of it. Life is, generally speaking, a blessing independently of a future state. The impressions and excitement of this world are the instruments with which the Supreme Being forms mat- ter into mind. Malthus, like Emerson, saw that. ,"The fiend that man harries Is Love of the Best. Yawns the Pit of the Dragon, Lit by rays from the Blest. The Lethe of Nature Can't trance him again, Whose Soul sees the perfect His tres seek in vain." Effort to both mean self-help, that redemption of man from the moral and physical degradation of parasitism, that accumulation of checks which constitutes the essential line of ethical evolution. Development of a complex mental state tends to control a simple explosive prosperity in ac- cordance with the law that evolution proceeds from the simple indefinite homogeneous to the complex definite heterogeneous, with a loss of explosive force. The fore- brain, which increases in size with evolution, is a checking apparatus against the lower, 'more destructive natural im- pulses. The higher its development, the greater is the tendency to subordinate the particular to the general. Even in the lower animals a high state of social growths occur, as in the bee and ant communities. The same is the case in the development of man; in the infant a being entirely Malthusianism and Degeneracy. 117 wrapped up in its instincts of self-preservation, the primary ego is predominant and the child is an egotistic parasite. As evolution proceeds this standpoint is passed, conscience assumes its priority, the forebrain acts , as a check on purely vegetative functions and the secondary ego takes precedence over the primary. This is the usual order of civilization in its advance. That Malthus clearly contemplated this development is evident, not only from the passage quoted, but from other elucidatory remarks in his "Essay." These evolutionary principles, advanced by St. Augustin and Thomas Aquinas, were later obscured by the special creation dogmas of the Jesuit Saurez which long dominated Christendom. Despite brutal misrepresentation, Malthus' views were accepted by Pitt the younger, the great theologist Paley, Bishop Otter, Bishop Copleston, Hallam, James Mill, Ricardo, Macaulay, Brougham, Harriet Martineau, the Edinburgh and Quarterly Reviews. Bishop Otter undoubtedly expressed the sense of most coeval thinkers in Malthus' epitaph in Bath Abbey: "One of the best men and truest philosophers of any age or country. Raised by native dignity of mind above the misrepresentation of the ignorant and the neglect of the great, he lived a serene and happy life, devoted to the pursuit and communication of truth supported by a calm but firm conviction of the usefulness of his labors, content with the approbation of the wise and good. His writing will be a lasting monument of the extent and correctness of his understanding. The spotless integrity of his princi- ples, the equity and candor of his nature, his sweetness of temper, urbanity of manners and tenderness of heart, his benevolence and his piety are still dearer recollections of his family and friends." To the hysteric philanthropist who believes that evil is best dealt with in ostrich-like fashion by shutting one's eyes to its real nature, then evolving it and a spasmodic remedy from a distracted inner consciousness, Malthus was repellant. To the great coeval woman thinker, Harriet Martineau, he was a motive for her tales and one of the noblest of mankind. "A more simple-minded, virtuous 118 Harriet C. B. Alexander. man," she writes, "full of domestic affections than Mr. Malthus could not be found in all England. Though the best abused man of the age, I saw in him one of the serenest and most cheerful men that society can produce. 1 asked Mr. Malthus one day whether he had suffered in spirit from the abuse lavished on him. 'Only a little at first,' he answered. I wonder whether it ever kept you awake a minute. 'Never after the first fortnight,' was his reply." To Malthus there was good and evil in the universe, but what that good and what that evil could only be de- termined by a study of their relations, since each shaded into the other. Study of these relations would, to minds filled with the fetichic dualism of good and evil, be as re- pugnant as to Carlyle who, in the shallow optimism of the Gospel of Force, denounces political economy as the "dis- mal science," forgetting his own truth that "nature, as green as she looks, rests every where on dread founda- tions, and Pan, to whose music the nymphs dance, has a cry in him that can drive all men distracted." To Car- lyle's greater contemporaries, Goethe and Emerson, spas- modic remedies had the abhorrent aspect voiced in Faust: "Nature, the living current of her powers, Was never bound to Day and Night and Hours, She makes each form by rules that never fail, And it is not Force even on a mighty scale." To them political economy was a science of human weal. Malthus was singularly fortunate in his ancestry and environment, including the period at which he was born. It was an age which began to recognize that the proper study of mankind was man in the sense of the Golden Rule. It saw prison reform under Howard, Guillotin and Elizabeth Fry; lunacy reform under Giarrurgi and Pinel; deaf mute care under Abbe Sicard, the onslaught on the slave trade Jefferson tried to insert into the Declaration of Independence and did insert into the Northwest Territory law, the bourgeoning of chemistry and biology under Priest- ley Lavoisier and Buffon, the evolution doctrine under La- marck, Erasmus, Darwin, Goethe, von Buch and Geoffrey Malthusianism and Degeneracy. 119 St. Hilaire, the reblossoming of individualism against tyr- anny of the state, the giant growth of electricity under Franklin, Volta, Galvini and Faraday, of steam under Watt, Fulton and Stephenson and of literature under a host of giants. It saw Media?vel fetichism loom under the paranoiac George III, the epileptic Napoleon, the morally degenerate Bourbons and Hapsburgs as a breakwater against human progress, but "While the tired wave vainly breaking, Seemed here no painful inch to gain, Far back through creeks and inlets making, Came silent flooding in the main." While Malthus passed into youth great industrial dis- coveries had been made. Roebuck had begun to separate iron from scoria? by coal; Brinsley had begun his system of canals; Wedgewood had begun to make good china, cheap; Hargreaves had invented the sewing machine, Arkwright the spinning jenny, Crampton the cotton loom and Cartwright the power loom. Up to the reactionary time to which reference has been made the outlook for the close of the century seemed pro- pitious. The United States with their enormous gains in fecundity added to popular belief in the happiness resultant on growth of population. John Adams in 1769 was sure the population of the United States would exceed that of all Europe in another century. In less than three decades things changed. Life in England as beheld by Malthus during his early manhood was, as Notti remarks, saddening. Successive seasons of scarcity swept over English agriculture. The wealthier classes, under the plea of setting an example of economy, without reducing rents, cut down their retinue of employes and expenditures while ostentatiously doling out charity to one-sixth of the population. Village industries were dis- couraged. The unemployed were given parish aid and the wages paid laborers by parsimonious squires were eked out by public funds. The miserable roads and diffculty of in- tercommunication doubled the effects of scarcity. An abundant harvest rotted ere it could supply a deficiency a 120 Harriet C. B. Alexander. few miles away. Tariffs on food starved the town popula- tion while bounties on wood and herds encouraged the farmer to cut down his laboring force, whose wages were already reduced because of poorhouse aid which thus en- couraged pauperism and parsimony. Hundreds of the Eng- lish squirearchy saw these things without comprehending them or sympathizing with the sufferers otherwise than by cant about the wills of God or the effects of drunkenness. The parentage of Malthus implied a deep logical sym- pathy with humanity. Daniel Malthus, his father, was one of those rare types of English Squire actively interested in human progress. Although an Oxford graduate, he was an admirer of Godwin of Condorcet, and most significantly, of Rousseau, of whom he was an executor. Rousseau was a direct evolution from Locke, whose original contract ideas, derived from Hobbes' modification of the Puritan, Anabaptist and Lollard school of politics, appear in the Declaration of Independence. Thomas Robert Malthus was born February, 1766. Up to the age of ten his father trained him. He was then taught Latin and good behavior by the parish rector, the Rev. Richard Graves. He saw that his pupil, though most peaceably inclined, loved fighting for its own sake, having desperate fights with the school boy to whom he was most attached. At fourteen Malthus was placed with the Rev. Gilbert Wakefield, who, dissenting from the thirty-nine articles, had become classical master of the famous War- rington Academy, where Liberal Churchmen and Dissenters were educated together. Here young Malthus learned to exercise his own powers and to develop his faculties. Wakefield induced his pupil to enter the Jesus College, Cambridge, in 1785, who there took up a wide range of study in addition to the classical course. About this time his father saw in him the most unexpectedly stable char- acter, the sweetest manners, the most sensible and kindest conduct. Uniformly making everybody easy and amused. In 1797 Malthus, elected Fellow of Jesus College, became an M. A. He devoted the intervening year to a study of political economy and politics. In 1796 he wrote a pamphlet Malthusianhm and Degeneracy. 121 (The Crisis) against Pitt's reactionary government, which, by his father's advice, he did not publish. As it advocated the old republican spirit which triumphed in 1688, and as Pitt was maintaining the crazy absolutism of George III, his father's advice was excellent. Pitt would undoubtedly have sent Malthus, as he did thinkers of like views, to herd, as Macaulay says, with the felons at Botany Bay. Malthus, although an English Churchman, was in favor of abolition of the Test that excluded Dissenters and Roman Catholics from office. He warmly approved Pitt's Poor-law Reform Bill. Soon after he took orders and held a curacy near Albury. In "The Crisis" occurs a remark which shows that he was then pondering on the subject of population. He ob- serves: "I cannot agree with Archdeacon Paley, who says that quantity of happiness in a country is best measured by the number of people. Increasing population \i the most certain possible sign of happiness and prosperity of a state, but the actual population may be only a sign of the happi- ness that is past." In 1797, while staying with his father at Albury, both keenly discussed Godwin's ideas of human quality and perfectibility and the influence of government on misery. The younger Malthus, for argument sake, attacking Godwin's position found that this was more vulnerable than he had supposed. Shortly afterward he published the first edition of the "Essay on Population" in 1798. This anonymous volume in large type covered but a part of later editions. Although more rhetorical and appealing less to facts than they, it grasped the principle that population tends continually to outstrip the means of subsistence and is prevented from so doing only by checks involving misery and vice, which, however, lead often to human advance through the introduction of self-restraint by man. Numerous "replies" and "refutations" appeared. The most noted was that of Sadler, less because of its intrinsic value than on account of its castigation by Macaulay, of the frantic attempts of the Frailer Magazine clique, headed by Maclise, the artist, to inflate Sadler to the size of Malthus 122 Harriet C. B. Alexander. and because of the "Siamese Twins" satire of Lytton, which Malthus' fame now alone keeps alive: "So far so good, the Siam Nation Is somewhat thin of population, And (there, as here, two sects are clamorous, The Economic and the Amorous). It must have charmed the Siam Sadlers To see this doubling on the Malthus Twaddlers." Each successive edition of the "Essay," enriched by personal researches, grew less rhetorical and more judicial. In 1800 Malthus published (anonymously) a tract "On High Price of Provisions." After the peace of Amiens he visited France and Switzerland to accumulate further facts. In June, 1803, he wrote the preface of the second edition, softening some unduly pessimistic features of the first. Moral restraint became more prominent. One of its expressions, civilization, was shown to have sensibly alle- viated the pressure of population in modern times. Every man had in himself the power of avoiding the miseries due to over population by being continent before marriage and not marrying till he could support a family. Because Malthus described their effects, he was accused of defending smallpox, slavery and child murder, and was denounced as an atheist, immoral, revolutionary, hard- hearted and cruel. In 1805 he was appointed Professor of History and Political Economy at Hailebury College, where the cadets of the East India Company were trained. He married (March 18, 1804) Miss Harriet Eckersall. In 1807 appeared the third edition of his "Essays" in two volumes. A fourth appeared in 1808, when he also published a letter to Samuel Whitebread on his bill for amending the Poor Law. • At Hailebury Malthus found a spot where he could pursue his life-work, disturbed only by the turbulence of the students. This was notorious. Sydney Smith in 1810 wrote "the season for lapidating the professor is now at hand. Keep Mackintosh (a new professor) quiet at Holland House till all is over." Malthus in 1812 wrote "Observa- Malthusianism and Degeneracy. 123 tions on the 'Corn Law,' Grounds of an Opinion on the Policy of Restraining Importation," and the "Nature and Progress of Rent." In 1817, after visiting Kerry and Westmeath, he published the fifth edition of the "Essays." In 1819 he became Fellow of the Royal Society. In 1820 he" published "Political Economy." In 1822 joined with Mill and Ricardo in establishing Political Economy Club, and wrote "Measures of Value." The article on population then written for the Encyclopaedia Brittanica Supplement did not appear till 1830. In 1825, broken down by the death of a daughter to whom he was much attached, he went with his wife to the continent. In 1826 he published the sixth edition of his "Essays." In 1827 his "Defini- tions of Political Economy" appeared. His later years were largely occupied with revising his "Political Economy," of which a second edition appeared in 1836, with a memoir by Bishop Otter. He helped to found the Statistical Society just ere his death from heart disease in 1834. The "Essay" was the outcome of a study of vice and misery existing in England in the eighteenth century and the coeval remedies therefor. From this standpoint it first merits analysis. The English at this period, as today, were inclined to regard increase in population as an increase in national happiness. To maintain this was for the inter- est of the agriculturist, since labor by an entire family brought children and women strongly into competition with men. It was for the interest of the mine-owner, because children, women and men labored in mines at any price the owner chose to pay. Only two decades ere Malthus' birth had serfdom among miners been abolished by statute. It was for the interest of clothing manufacturers, since "sweating" was as well understood in England in the eighteenth century as it is today. The truth of overpopu- lation dangers, fought by these vested interests, was dawning on thinkers. The remedies proposed varied. Pauperization by charity, of almshouses of the type satirized by Dickens in "Hard Times," by hospitals, by dispensa- ries, by parish relief, by bounties on large families of children, were methods proposed by the plutocratic classes 124 Harriet C. B. Alexander. really for the maintenance of statu quo, theoretically for the relief of misery. Another class of plutocrats, charging all vice and misery to drunkenness, proposed to remedy this not by individual reformation but by repressive law, making it a felony and pauperizing families for the benefit of the King. The same class advocated the tariff on grain and the bounty on cattle already described. Emigration was proposed by well-meaning persons who fully recognized the evil and really wanted to remedy it. Godwin's school, seeing the evil effect of the press gang system, of judicial punishment of laborers seeking in- creased wages, for contempt of court, of the pauperizing influence of the felony laws whereby all goods were for- feited by the felon to King George III (whose avarice so encouraged these laws that more offences were made fel- onies during his reign than at any time before or since), of the seizure of village commons by enclosure acts at the instance of neighboring land owners, proposed to remedy these evils by immediately limiting government to police powers, strictly defined. Another set of thinkers proposed socialistic and communistic remedies. Condorcet, later imitated by Robespierre, by the French Republic of 1848, by Bismarck and his pupil Miquel of Prussia, proposed a system of pensions to disabled and aged workmen, with private almshouses similar to those already existant in England. Malthus, discerning at once the worse than use- lessness of governmental interference and, like Emerson, the error of charging all crime, misery and poverty to drunkenness, perceived biology gave more logical explana- tions. Buffon laid it down as an accepted principle that the general course of all living nature is constant and the same. Its regular movement turns on two fundamental points: the unlimited fecundity of all specie, and (second) the factors which reduce this fecundity to a determinate amount. The most perfect, most delicate, most clumsy, least active species, hence, have disappeared or are disap- pearing. Malthus, applying this principle to man, investi- gated the causes that had hitherto impeded human progress toward happiness with a view of determining how far such Malthusianism and Degeneracy. 125 causes could be removed. The great cause was the relation of human increase to food supply. With Benjamin Frank- lin he was of opinion that there is no bound to the prolific- ness of life but what is made by interference with the means of subsistence. The increase of man is, however, interrupted by his reason through the query whether he should bring beings into the world whom he cannot support. If man heed this natural query, restriction frequently produces vice. If he heed it not the race constantly tends to increase beyond the means of subsistence. As population can never actually increase beyond the lowest nourishment possible for life, a strong check on population from the difficulty of acquiring food must constantly be in operation. This difficulty must be severely felt in some of the various forms of misery or dread of misery by mankind. Under the most favorable circumstances population doubles in twelve years, while food supply at best doubles in but twenty-five. Population, therefore, tends to increase in geometrical ratio, but food in arithmetrical ratio only. Malthus believed that he had discovered the great source of misery in the relation between overpopulation and deficient food supply. He proceeded to analyze the conditions which act as checks on overpopulation, with a view of determining how far these checks can be applied in an ethical manner for the relief of suffering. The great ultimate check on overpopulation is famine. Interdependent of this are checks like customs and diseases germinated by scarcity, and weakened systems thereon resultant. The other checks he finds to be divisible into two classes, those altogether under control of the individual preventive checks, and those not, positive checks. Preventive checks consist in moral restraint and vice. Moral restraint is restraint on marital indulgence and postponement of marriage from prudential motives, with conduct strictly chaste while unmarried. The preventive checks that come under the head of vice are promiscuity, unnatural passions, violations of the marriage bed and improper acts to avoid and conceal the consequences of either marital or irregular relationships. The positive checks are unwholesome trades, exhausting toil, extreme 126 Harriet C. B. Alexander. poverty, bad nursing, excesses, epidemic and endemic dis- eases, war, as well as the great check already mentioned, famine. The preventive and positive checks act in inverse ratio. Malthus carefully analyzed these checks as found in the primitive communities, in ancient communities and the Europe of his day, as well as those from standing armies, religious celibacy, government regulation of marriage and emigration. He finds that while in all these communities all other factors play a part in determining the relations of population and food supply that there has been, on the whole, a steady increase in the influence of moral restraint which, though less prevalent in men, was more prevalent in his day than of old, and in Europe than elsewhere. Among women its influence was still greater. Discussing the various socialistic methods to reduce misery already de- scribed, he points out that in time all of them, by lessening the powers of self-help, would,like most socialistic remedies, prove ultimately plutocratic in result. He points out that Godwin's remedy must be a matter of evolution, and if immediately attempted would produce anarchy, resulting in greater governmental control than had originally existed. In the whole of these remedies by the power of the state he sees but an illustration of Johnson's apothegm: "How small of all that human hearts endure, That part which Kings or laws can cure." Emigration, Malthus admits, is a check to population, and has more than once proved an enormous factor in ele- vating the race. He points out that the incursions of the Vikings and Gothic tribes were due largely to overpopula- tion. Emigration, however, cannot be a remedy to all classes and continuously; the poorest classes "cannot emi- grate for lack of means or want of energy. Love of country and other factors will play a large part in decreasing emigration and preventing its application." The great defect in the various remedies adopted under the guise of charity at the close of the eighteenth century, according to Malthus, was that they increased the evil they were intended to relieve. The pauper class, supported at the expense of the community, inclusive of the working class upon whom Malthusianism and Degeneracy. 127 taxation ultimately fell, competed with this very working class and reduced its remuneration. On the other hand, the food consumed in almshouses, workhouses and outdoor relief decreased the food supply and increased its cost. Malthus would abolish almsgiving and methods of relief which destroy self-respect by degrees, restricting their ap- plication meanwhile to special exigencies. The methods of parish relief encourages the poor to marry without prudential considerations as to support of offspring. Legal attempts to suppress this by regulating marriage are immoral and useless, since, like all legal regulation of marriage, they produce irregular but protracted relationships with at least equal progeny. Restriction of parish relief is hence at once efficacious and ethical in its stimulation of self-help. These methods of parish relief destroy thrift, self-respect and prudence among the poor by inoculating practically the theologic theory that it is the duty of the poor to increase and multiply without regard to the future well-being of their offspring. Since all the checks on population are, Malthus remarks, resolvable into moral restraint, vice and misery, the former only is indicated. Of the value of moral restraint, Malthus was furnished with a striking example in the army of the British Commonwealth. This, drawn in the main from the working classes and subjected at once to severe military and moral discipline, was discharged without pensions by Charles II at a time when begging was honorable and when more than one-sixth of the population were recipients of public charity. As Macaulay remarks, fifty thousand men, accustomed to the profession of arms, were at once thrown on the world; and experience seemed to warrant the belief that this change would produce much misery and crime; that the discharged veterans would be seen begging in every street, or that they would be driven by hunger to pillage. But no such result followed. In a few months there remained not a trace indicating that the most formid- able army in the world had just been absorbed into the mass of the community. The royalists themselves confessed that in every department of honest industry the discharged 128 Harriet C. B. Alexander. warriors prospered beyond other men, that none were charged with theft or robbery, that none were heard to ask an aim, and that, if a baker, a mason or a wagoner at- tracted notice by his diligence and sobriety, he was, in all probability, one of Oliver's old soldiers. England, financial and intellectual, bone and sinew, were drawn from the descendants of the army of the Commonwealth. Malthus believed, as Emerson later, that: "Fear, craft and avarice Cannot create a state. When the church is social worth, When the statehouse is the hearth. Then the perfect state is come." That against the principle of moral restraint three ob- jections may be urged, Malthus admits. First, that wages may be increased. Second, that population will diminish. Third, that vice will increase. The first objection Malthus deemed hypocritical and disregards. Diminution of popula- tion would be purely relative and food supply would soon overtake it if industry were well directed. Great Britain under a proper social system could treble its population, which still would be better fed, clothed and housed. In reply to the third objection he points out, as was demon- strated later by modern criminologists* that misery causes more vice and crime than sexual passion and conduces far more to sexual vice than does moral restraint. Abject poverty is most unfavorable to modesty and chastity. According to Malthus and Hogarth, Tennyson could ask with greater emphasis a century ago 'Is it well that while we range with Science, glorying in the Time. City children soak and blacken Soul and Sense in city slime? There among the gloomy alleys Progress halts on palsied feet, Crime and hunger cast our maidens by the thousand on the street. There the master scrimps his haggard sempstress of her daily bread, There a single sordid attic holds the living and the dead. There the smoldering fire of fev«r creeps acrois the rotted floor. And the crowded couch of incest in the warrens of the poor." The truth of the century-old position of Malthus on the •Ferrl: Criminal Sociology. Malthusianism and Degeneracy. 129 relation of abject misery to crime is shown by the single fact that, according to the 1891 report of the New York City Board of Health, improvement in tenement house sanitation had reduced the saloons in the improved districts one-third and the arrests in proportion. According to Malthus, the sociologist who accepts the principle that over- population should be checked but disregards moral restraint is compelled to encourage the other checks. Such is the Malthus doctrine, tersely summarized, with- out" its statistical proof. Malthus' figures and the opposing statistics of Sadler were carefully contrasted five decades ago by Macaulay and the first shown to be correct. So far, therefore, as the data at his command permitted, Malthus was justified in his dicta. The question now arises, how far the Malthusian doctrine influenced the vice and misery of its time? How far it is justified by the biologic data of today. How far it has influenced current thought; and, finally, how far it is applicable as a remedy to modern evils. The error of the late eighteenth and early nineteenth century in dealing with vice, pauperism, misery and crime was, as has been abundantly shown, the attempt to aid people without en- couraging them to aid themselves and thereby retain their powers of self-help, without which the human being becomes a parasite. Further error, then also existed, of booming population under pretense of obeying a divine command, but really for the purpose of using passion under forms of law to grind out material for plutucratic uses. The direct influence of the Malthusian doctrine was not so quickly demonstrable as its indirect. It almost immediately met with favor at the hands of the leading sociologists, however contrasted their views. It dealt what proved to be a~death blow to legalized mendacity. It made parish relief a stigma to the self-respecting poor of the high type which Dickens has drawn in Betty Higden of "Our Mutual Friend." It dealt a blow to child labor through the influence it exerted on Macaulay, which led to parliamentary regula- tion. By stigmatizing the desire for post mortem notoriety evidenced in almshouses, hospitals and refuges it checked 130 Harriet C. B. Alexander. the increase of them. Its direct influence was, therefore, enormous. It undoubtedly stimulated, by its prudential teachings, the poorer classes to self-help. Nitti, despite his socialistic bias, which leads him to make a malign fetich of everything that seems to favor individualism, admits that as late as the sixties of the present century Malthusian doctrine exerted a beneficial influence on the working class because it was a brutal affirmation of egotistic individualism. Well-conditioned workingmen, seeing in the absence or scarcity of children a means of putting an end to the difference between them and the lower class, who, knowing that they had to rely upon a small income, feared that a large family might reduce them to the condition of workingmen: people who were independent, desirous of maintaining their social position, all accepted it enthusi- astically. Nitti here completely disregards, in his designation of the doctrine as brutal egotism, the fact that, according to his admission, it restrained but did not suppress an ex- plosive appetite. Restraints of this kind constitute the basis of ethics, especially restraint on the sexual appetite, since, as Maudsley has well said, in language paraphrased later by Henry Drummond, were men robbed of the instinct of procreation and of all that spiritually springs therefrom, that moment would all poetry, and, perhaps also, his whole moral sense, be obliterated from his life. This Tennyson's Evolutionist saw: "If my body come from brutes, my soul uncertain, or a fable, Wny not bask amid the senses while the sun of morning shines, I, the finer brute, rejoicing in my hounds and in my stable, Youth and health, and birth and wealth, and choice of women and wines. 11 my body come from brutes, though somewhat finer than theirown, I am heir, and this my kingdom. Shall the royal voice be mute? No, but if the rebel subject seek to drag me from the throne, Hold the scepter. Human Soul, and rule thy province of the brute I have climb'd to the snows of Ages, and 1 gaze at a field in the Past, Where I sank with the body at times in the slough of a low desire, But 1 hear no yelp of the beast, and the Man is quiet at last As he stands on the heights of his life with a glimpse of a height that Is higher." Malthusianism and Degeneracy. 131 Nitti's position is that of one who would maintain that the negro was a higher being when, immediately after the war, he increased, under the pauperizing influences of the Freedmen's Bureau, 33}3 per cent, than now when his decimal increase is but W1/- per cent, albeit his powers of self-help and sense of morality are increasing. The influence of the Malthusian doctrine in increasing the checks of what Malthus calls the vice type, by pre- venting conception or destroying its product does not seem very demonstrable among the working classes when the persistence of fetichic customs of this- type among even civilized people of the lower grades of culture is re- membered. On the whole, therefore, the influence of the Malthu- sian doctrine, directly and indirectly, on the misery of its time must be regarded beneficial, especially when, it is re- membered that through a psychologic law we underestimate the evils of the past and overestimate those of the present. Society, as Macaulay remarks, while constantly moving forward with eager speed should be constantly looking backward with tender regret. But these two propensities, inconsistent as they may appear, can easily be resolved into the same principle. Both spring from our impatience of the state in which we actually are. This impatience, while it stimulates us to surpass the preceding generation disposes us to underrate their happiness. It is in some sense unreasonable and ungrateful in us to be constantly discontented with a condition which is constantly improving. But in truth there is constant improvement precisely be- cause there is constant discontent. If we were perfectly satisfied with the present we should cease to, contrive to labor and to save with a view to the future. And it is natural that, being dissatisfied with the present, we should form a too favorable estimate of the past. In truth, we are under a deception similar to that which misleads the trav-1 eler in the Arabian Desert. "Beneath the caravan all is dry and bare; but far in advance and far in the rear is the semblance of fresh waters. The pilgrims hasten forward and find nothing but sand where an hour before they had 132 Harriet C. B. Alexander. seen a lake. They turn their eyes and see a lake where an hour before they were toiling through sand. A similar illusion seems to haunt nations through every stage of the long progress from poverty and barbarism to the highest degree of opulence and civilization." Shelley more tersely says: "We look before and after, And pine for what is not, Our slncerest laughter With some pain is fraught: Our sweetest songs are those That tell of saddeit thought." For these reasons the amount of misery which existed in the past is not completely discernible. This unrecognized misery soon renders deficient an ample provision for the defective classes which seemingly underestimates rates of increase, but really ignores an amount of existing misery the product of several generations. Life seems to increase at a rate which is the despair of thinkers like Tennyson: "Are God and Nature then at strife? That Nature lends such evil dreams, So careful of the type she seems, So careless of the single life. That 1 consider everywhere Her secret meaning in her deed, And finding that of fifty seeds She often brings but one to bear. So careful of the type, but no, From scarped cliff and quarried stone She cries, 'A thousand types are gone: I care for nothing, all shall go.'" It was a feeling of this kind which led Malthus to enunciate, after careful examination of the data at his dis- posal, the following three propositions. First—Population is necessarily limited by the means of subsistence. Second— Population invariably increases where the means of sub- sistence increases unless prevented by some very powerful and obvious check. Third—These checks and the checks which repress the supreme power of population and keep Malthusianism and Degeneracy. 133 its effects on a level with a means of subsistence are all resolvable into moral restraint, vice and misery. The first proposition, as Nitti suggests, makes the fundamental error of confusing real and potential increase. The error that with improvement in the environment the birth rate will increase indefinitely. It is peculiarly true here, as has been said by Herbert Spencer, that every vertebrate is an aggregate whose internal actions are adapted to counterbalance its external action, hence, the preservation of its movable equilibrium depends upon its development and the proper number of these actions. The movable equilibrium may be ruined when one of these actions is too great or two small and through deficiency or need of some organic or inorganic cause in its surroundings. Every individual can adapt itself to these changeable in- fluences in two ways, either directly or by producing new individuals who will take the place of those whom the equilibrium has destroyed. Therefore there exists forces preservative and destructive of the race. As it is impossi- ble that these two kinds of force should counterbalance each other, it is necessary that the equilibrium should re- etablish itself in an orderly way. Since there are two pre- servative forces of every animal group, the impulse of every individual to self-preservation and the impulse to the production of other individuals, these faculties must vary in an adverse ratio. The former must diminish when the second augments. Degeneration constitutes a process of disintegration, the reverse of integration. Hence, if the term individuation be applied to all the process which com- plete and sustain the life of the individual and that of generation to those which aid the formation and develop- ment of new individuals, individuation and generation are necessarily antagonistic. In the phenomena of unisexual generation the larger organisms never reproduce themselves in the unisexual way, while the smaller organisms reproduce themselves with the greatest rapidity by this method. Between these two ex- tremes reproduction decreases while the size increases. In the history of all the plants and animals is evident the 134 Harriet C. B. Alexander. physiological truth that while the general growth of the individual proceeds rapidly the reproductive organs remain imperfectly developed and inactive. On the contrary, the principle of reproduction indicates decrease in the intensity of growth and becomes a cause of cessation. Great fecundity is always attended by great mortality. Each superior degree or organic evolution is accompanied by an inferior degree of fecundity. The greater the germs the less is the individualization, and vice versa. The greater and more complex the organization the less is the power of multiplication.. As animals rise in evolution, egg and foetal life become longer, while on the other hand progeny natur- ally become fewer. It is a long way from the ten million codfish born from one female in a minute period to man with the single offspring born after a period of foetal life that is increasing in duration. The progeny are much better fitted to survive, albeit so much fewer in number. Man in colonies, as Hawthorne* remarks, reverts at first one step backward in barbarism. There is at first an in- crease in frequency of birth and the number born at a birth. Both of which phenomena are expressions of degen- eracy. The degenerates are, moreover, from various causes drawn to colonial life and increase this reversion. Degen- eracy through its tendency to generalize rather than special- ize function causes too rapid development of cells, which tend to extinguish each other, thus preventing proper ovu- lation. The same condition prevents proper development of the ovum if formed and fecundated; and finally causes too stimultaneous development of ova, which tend to destroy each other. The same cause produces also premature ex- trusion of ova. Under given conditions this principle tends to produce reversions in type in the shape of too frequently repeated and abnormally multiple births. It has been noted that even the ancestors of those predisposed to phthisis have numerous families and many children at a birth, albeit most of these die ere reaching the sixth year. Marandon de Monteyel finds that multiple and frequently repeated pregnancies often occur among the families of •Scarlet Letter. Malthusianism and Degeneracy. 135 hereditary lunatics. This has been corroborated by my own researches. I found that ninety families of the hereditary insane averaged eleven children each. Six families had five children, four had seven children, eight had eight, ten had nine, fourteen had ten, eight had eleven, four had twelve, four had thirteen, four had fourteen, three had six- teen, three had seventeen, four had eighteen, three had nineteen, five had twenty and one had twenty-one. Twins, triplets and quadruplets were six times as frequent as among normal families. Manning has found similar conditions among the hereditary insane in Australia. Valenta, of Vienna, who has also noted this among epilep- tics, reports the case of an epileptic mother who had thirty-six children, including six twins, four times quad- ruplets, twice triplets. Her daughter, also an epileptic, bore thirty-two children before she was forty, including quadruplets twice, triplets four times and twins once. It is obvious, therefore, that while the rate of increase becomes larger with the rise in evolution, the increase is as to quality and not quantity. And furthermore, the struggle for existence occurs on a higher plain. The contest is not between simple physical force or low cunning, but between intellect. This is further aided by certain consequences thereon resultant. Malthus in his second proposition ignores that law of evolution on which the loss of explosive force depends; animals with a rise in evolution waste less food. Man has developed, with his rise in evolution, a tendency to utilize food to a greater degree by wasting less, by em- ploying new articles, by new methods for obtaining and distributing food. The invention of the canoe by the low Fuegians when driven from their forests trebled their food supply. When man learned to cook he diminished waste by putrefaction enormously. The food waste of nomad races, whether pastoral or not, is greater relative to that, of the men of the pile dwellings, while their waste is still more enormous as compared with European nations. Mod- ern chemistry is continually decreasing waste directly from the food itself and by increasing its production. Malthus, from recent researches, evidently underrated 136 Harriet C. B. Alexander. the influence of his checks and failed to detect others. As the study of folklore has shown, primitive beliefs as to prevention of conception, abortion, infanticide, exposure of deformed children, the legality of euthanasia for incurable diseases still have to be reckoned with in civilized life. While the force of Malthus' propositions has been somewhat weakened by the biologic data of today, still the rate of increase undoubtedly justifies the application of his check for the benefit of mankind. There are some other factors connected with the regu- lation of populist increase which justify the position of Malthus. Although it has been claimed that polygamy tends to increase, this increase has not been adjusted to the comparative decrease caused by the greater proportionate death rate of children under five in polygamous countries. Herbert Spencer is fully justified in the position that he takes as to the influence of monogamy in the decrease of infantile mortality. Bertillon has shown that in France in every age the celibate population is struck by a mortality nearly twice as great as the other; that its births merely make up 45 per cent of its annual losses; that it counts every year twice as many cases of madness, twice as many suicides, twice as many attempts on property and twice as many murders and acts of personal violence. Consequently, the state has to maintain for this celibate population twice as many prisons, twice as many asylums and hospitals, twice as many undertakers, etc. The desir- able age for marriage is from twenty-two to twenty-five for men and from nineteen to twenty for women. In Eng- land more than half the marriages of men (504 in 1000) and nearly two-thirds of those of women are contracted before the age of twenty-five. Now, this is only the case in France for .29% and in Belgium for .20% of the mar- riages. A demographical phenomenon of the same kind is observed in Italy, where only 111 men out of 1000 marry before the age of twenty-five. At Paris, where the strug- gle for existence is more severe and where the care for money is more predominant, late marriage abounds, and it is only above the age of forty for men and thirty-five for Malthusianism and Degeneracy. 137 women that the marriage rate equals and even exceeds that of the whole of France. It is self-evident that the re- sult of this must be a decrease in the total of births by marriage. Whether these facts proceed from the growing difficulties of existence or from fear always augmenting, also of trouble and care, or from these two causes combined and mutually strengthening each other, the consequence is the same, marriages are becoming more and more simple com- mercial transactions, from whence arises that worse and most shameful of selections, Letourneau remarks, selection by money. As a moral demographer, A. Bertillon thunders against what he calls "the system of dower," more peculiar to the Latin races, who get it from Rome, where recourse was doubtless had to it in order to emancipate patrician women from strict conjugal servitude. But the remedy has become an evil, and it is surely to the love of. the dower' of the "beautiful eyes of the casket" that must be at- tributed a whole list of true marriages by purchase, much more common in our own country than elsewhere. Sometimes it is old men who conjugally purchase young girls, and sometimes old women who buy young husbands. As regards them, France is unworthily distinguished beyond other nations. In our tables of statistics, for example, the proportionate number of marriages between bachelors from eighteen to forty years and women of fifty years and up- wards is ten times greater than in England. MARRIAGES WITH WOMEN OF FIFTY YEARS AND UPWARDS. (In a million marriages.) IN FRANCE IN ENGLAND. Number of Number of Age of Bachelors. Marriages. Age of Bachelors. Marriages. 18 to 20; years 64 18 to 20 years 0 20 to 25 11 109 20 to 25 (4 5 25 to 30 11 151 25 to 30 t . 12 30 to 35 • i 138 30 to 35 , I 11 35 to 40 " 257 35 to 40 . 1 40 769 79 138 Harriet C. B. Alexander. The first group, including the married men from eight- een to twenty years with women of fifty and upwards, is unknown in England; and that the second group, that of the married men of twenty to twenty-five years with women of fifty years and upwards is scarcely represented. It is important to note also that these figures only refer to first marriages. Tables of the same kind showing the marriages between young girls and old men, or between aged widows and young men would add up to confusion. MARRIAGES WITH MEN OF SIXTY AND UPWARDS. IN FRANCE Number of IN ENGLAND. Number of Age of Girls. Marriages. Age of Girls. Marriages. 15 to 20 years 94 15 to 20 years 2 20 to 25" 139 20 to 25" 15 25 to 30" 176 25 to 30" 32 30 to 35" 242 30 to 35" 49 651 98 The fact that among the English-speaking people in whom neither religious cehbacy nor the celibacy resultant on standing armies has obtained to any great extent the marriage age is continuously rising, and the fact that the educated, refined woman after twenty-five has a greater chance of matrimony than the uneducated class, signifi- cantly indicates that the influence of Malthus has been a decidedly potent factor in the advance of the race. And this, despite the fact that he underestimated the increase of subsistence resultant on the utilization of waste and overestimated the human rate of increase. DANGEROUS PARANOIACS—WITH AUTO- BIOGRAPHY OF ONE. By J. E. COURTNEY, M. D., Poughkeepsie, N. Y. IN VIEW of the comparative frequency with which the world is shocked by what appears a rather purposeless attempt upon the life of some well-known person, it ap- pears to me that some account of the individuals who commit such assaults, and particularly the autobiography of one, would not be uninteresting. The difference in the station in life of the assailant and assailed, the seemingly studied publicity and sensa- tionalism of the attack, the primitive weapon often em- ployed, the evident neglect of means of concealment or escape, the bravado with which the act is defended even to the gallows, must awaken in the normal mind a suspi- cion as to the sanity of the party. The term paranoia means to understand a thing in the opposite way, to put a false interpretation on things. It was used by Dr. Bernard Van Gudden, physician to Leopold the Second of Bavaria,to describe the vagaries of that eccentric monarch; and here there is a grim association of events, for Leopold, as if in fierce acknowledgment of the distinc- tion, drowned Dr. Van Gudden and himself, in the lake near the villa where the doctor was treating him. The persons who become paranoiacs have inherited an instability of the emotional nature, and are usually stamped with some abnormality of physical development. When the numerous stimuli of life impinge upon this too irritable brain, it has not the power to convert these impressions into normal thoughts and actions. The brain and nerve mechanism fail in adjustment to the complex conditions of [139] 140 J. E. Couittiey. life, and an elaborate fabric of delusion grows up, often quite logically and ably supported, but from false premises. For one to become an interesting paranoiac one must be of good native intelligence, and educated along certain lines at least. Eccentricity, fanaticism and nihilism are not true paranoia; but where the crank stage of this disorder ends and the paranoiac begins is often one of the most perplex- ing questions which the science of medical jurisprudence has to settle. The conditions, then, to produce a danger- ous paranoiac are an excessively irritable brain, ambitions far beyond capacity to obtain, a sensitive and suspicious nature, a tendency to moodiness, solitude, introspection and dreaming; an exalted egotism, demanding recognition and unearned preferment in the world's great affairs. To the mind so constituted, the only explanation of failure is ad- verse and systematic conspiracy. Then comes the delusion and hallucination; the flight from the imaginary enemies, the pursuit by them, the appeal to the highest authority for protection and revenge; and failing to find relief, the desperate act; and the world is horrified by the murder or attempted murder of the president of a republic, a dis- tinguished clergyman, the mayor of a great city or an empress traveling incognito. History and our own times abound in most interesting instances. I believe that a better understanding on the part of the public of the symptoms of this trouble will lead to the timely apprehen- sion and examination as to sanity, of some .so-called "harmless cranks," and so save valuable lives. Cambyses of Persia and Nero of Rome each murdered several members of their families. Charlotte Corday studied a pagan type from Plutarch's Lives, took the book with her to Paris and was anxious to stab Marat while in the convention, and waited about several days before going to his house. She gloried in the act, asked to have her portrait painted and refused to make any defense at her trial. Justin McCarthy, in his History of Our Own Times, says of the half dozen or more attempts of this kind on Queen Victoria: "It is proper to say something of them, Dangerous Paranoiacs. 141 although not one possesses the slightest political importance or could be said to illustrate anything more than sheer lunacy or that morbid vanity and thirst for notoriety that is nearly akin to genuine madness. "One of the men, Edward Oxford, was an absurd creature with a longing to be a political prisoner and to be talked of. In the trial of an other, John Francis, it ap- peared doubtful whether the pistol was loaded, and the whole performance seemed merely a piece of play acting, done out of a longing to be notorious." This sort of com- ment is applicable to the whole list. John Clark Ridpath, in the Life and .Works of James A. Garfield, speaking of Chas. J. Guiteau, says: "He was a mixture of fool and fanatic, but had managed to build on a basis of total depravity a considerable degree of scholar- ship; he advanced a claim to be consul general at Paris, and so conceived the hatred for the President. He was tried and executed, though much doubt of his sanity exists. A few years ago an educated young English woman shot at the Irish patriot O'Donovan Rossa in New York City. Her subsequent history showed her to be a typical paranoiac. Most alienists and many laymen believe that Prender- gast, who murdered Mayor Harrison, of Chicago, was insane and a paranoiac. A study of the lives of these characters show a striking general uniformity of mental trend and motive. In the autobiography of J. G. R., the delusive con- trolled his actions. The facts can be verified from the court records of the City of New York. He was arrested and tried for firing at a clergyman on the steps of the Fifth Avenue Tabernacle. AUTOBIOGRAPHY OF J. G. R. "I call attention to a great crime, which has hardly its equal in history. "I came from Germany to this country, to try my luck here, numerous as were the obstacles. In time I succeeded 142 J. E. Courtney. in entering into business connections which, enabled me to earn on the average as much as ten dollars a day. My earnings increased, in the course of time, and 1 hoped to establish, after a few years, a business in which thousands could be made, and which I thoroughly under- stood. Naturally 1 felt quite happy, the more so because I could support my aged father and my eldest sister, who cared for him. Fate, however, is fickle and deceitful. A conspiracy was inaugurated against me, unparalleled by anything heard of before. It was conducted by cunning and un- scrupulous emissaries or agents who considered me a means by which they could extort money from wealthy people. So cunning is their work that no one can ever find them out. Even honorable people without the least knowledge on their part of their infamous purposes, are in- directly used by them as assistants in their ignominious endeavor to keep me in poverty and distress. The question must naturally arise: How in all the world is it possible that such a conspiracy, which is a real mockery of all human and divine laws, could exist in the nineteenth century for fully ten years, and in a civilized common- wealth at that? In answering, I have the following to say: I was then, as people often assured me, of very good appearance and in the best of health, for which I was generally envied. As a matter of course, but unfortunately for me, wealthy gentlemen and ladies took a lively interest in me, and sought my acquaintance. Naturally, the gentlemen were anxious to find out all particulars about me before they gave me an introduction to their families. It is a custom in this country to use for this purpose the services of so-called private detectives, male and female, nine- tenths of whom are heartless and unscrupulous, who will ruin a man if they can only profit by it. These agents saw at once that there was money in this thing if only artfully managed. They organized themselves into a permanent, regular Dangerous Paranoiacs. 143 corps of observation, watching all my steps and doings by day and night, and succeeded in running, and keeping me down. In the first place, they persuaded other people that I was a man afflicted with all possible bad passions and faults. Whenever one or the other desired to convince himself by personal observation whether the agents were repeating the truth, the latter enacted a farce calculated to mislead and create a false impression. It is one of the favorite tricks of these emissaries to divide themselves into several parties in order to create this impression, that they are working one against the other. Knowing that 1 was a native of Germany, the principal agent employed chiefly German men and women, who un- derstood how to persuade the Germans with whom I asso- ciated, that they were commissioned to watch me for my own safety, and to defend me whenever and wherever it was required. I was often kept in a state of stupor, which deprived me -of power of acting and thinking. Often had I been wondering why I did not do what 1 ought to have done or the reverse, and what it was that could cause such a con- dition. They must have given me internally some chemical mixtures, and I have reason to believe that also hypnotism or something similar was brought into use against me. 1 remember distinctly, for instance, that one evening when, on a visit in the Catskill Mountains during the summer, I tried to get up in order to join a party, I was powerless to do it. I have often been trying to greet some person or speak to him, but, as if my arms and tongue were paralyzed, I was not able to take off my hat or to utter a single word. 1 soon observed that 1 was closely watched by agents. 1 was given to understand from different sides that the proprietor of a hotel would like me to marry his daughter. I would have liked to, may be, but as the girl was rather sickly I declined the offer. On a certain occasion I had a talk with the proprietor, 144 J. E. Courtney. and told him that a man of my age, honest and sober, should think of creating a home for himself, but never would tie himself to a woman unless previously well ac- quainted. The proprietor answered that he would consider it a great honor, were 1 to become a member of his family. Suddenly a man appeared at the door and said he wanted to speak to the proprietor; the latter begged my pardon for interrupting the conversation and rather showed a great deal of inclination to resume the same, but now comes a second man, and between themselves they took the proprietor out. The eldest man's name was H. He was an agent, and 1 by a special chance overheard one of his conversations with the proprietor. Said H.: "There must be put a stop to the renewal of the visits of this fellow to this hotel." The proprietor answered: "I don't see how to prevent his coming." H. resumed: "Make him big bills, and give him a cold shoulder and he certainly will feel it and not come again." H. always seemed to keep himself in the background and direct, the movements of the agents, for 1 only saw him once. Maybe he put on a false beard, so I would not, know him. I had previously seen him in Germany; and later, in New York City, he had the nerve to answer an advertise- ment inserted by me in some paper. Twice did 1 see H. in Germany. In a court room I saw one of the agents dressed or disguised as a day laborer. The same man followed me west, the same I saw in Ger- many; a young man with an elderly-looking woman and a young girl. 1 saw the same persons here, but one at a time, and never the three together. When 1 lived in Nineteenth Street there were three men just under my room, and I think 1 had seen the three in Germany; before, I had seen one at the Shakers, at Mount Lebanon, N. Y.; the third, aged thirty-five or there- about, 1 saw in different dresses, once as a laborer, once as a tramp and another time as a policeman. At this time I took my morning coffee with my land- Dangerous Paranoiacs. 145 lord and lady;also my tea in the evening. After a while I noticed a breaking out on my face; having not had any trouble of the kind before I did not. quite understand how this now happened. I used all kinds of internal and ex- ternal remedies, but all was in vain. The pimples were the size of a pea. I thought at first it was erysipelas. 1 moved. Again I took coffee and tea. All of a sudden 1 threw away the coffee and the tea and promptly the pimples disappeared. So soon as 1 started tea or coffee again out they broke. On some business, I once met some gentlemen in an office on Broadway, but suddenly one of those crafty em- issaries or agents caused some chemical odors to penetrate into the room. Owing to this mean trick I began to stammer like a drunken man, and was unable to utter a distinct word or grasp a single thought. Thus, this time again my plan for building up a future for myself was shamelessly destroyed by the combined effects of these agents. Now, wherever I go, these diabolical agents are fol- lowing me. They not only injure me in business, but are molesting every one who may come in contact with me. They place chemical odors in every room where 1 may be. The effects of these odors upon my system are as numerous as they are painful. Now and then I lose, almost, my consciousness, and with the utmost efforts can keep my eyes open. Often, again, I experience a feeling as if my whole body was pierced with needles. At night, especially, these merciless agents pour such chemical odors or gases into my room that I have a choking sensation, and 1 am unable to breathe. Pain seems to squeeze my eyes out of the sockets, and visions arise before me. The sufferings 1 endure can be felt and not described. I have no doubt that by such means a man can eventually be made insane. These heartless persons seem also to use electricity, as I often felt electrical shocks, especially on my head. 1 remember on one such occasion I felt within a few minutes four or five so powerful shocks on the right 146 /. E. Courtney. side of my head that I had pains all day. On another occasion something like a spark of electricity went through the little finger of my right hand, in which 1 felt for several days an unusual itching. Where the itching began the skin hardened and an abscess formed, similar to a carbuncle, which I had to have cut. To make it impossible for me to work up my business, or to flee from my tormentors, or to enter into family ties, these agents have the assistance of mind-readers, who re- veal to them my thoughts and movements. Thus,, they constantly receive information as to what I am about to do or where 1 intend to go. In consequence of which they can precede me every- where. Thus, they not only burst all my plans, but even remain hidden until I am away again. Besides, I can hardly write a single word without hearing it loudly an- nounced by some mind-reader. To make things worse,they often use profane language, as if the same were emanating from me. As to themselves, they try to appear as innocent and harmless fools. Their talk, their laugh, their language and their jokes only tend to delude. These agents and mind- readers are secretly laboring to keep me down and ruin me entirely. That mind-readers are a dangerous element of society in general, can no longer be doubted, since Washington Irving Bishop, the well-known mind-reader, gave his famous performance during the months of February and March, 1887. It would now be simply ridiculous to deny that there are persons endowed with the gift of reading the thoughts of others. Let us, therefore, be on our guard regarding the serious danger menacing society. The first thing to be done should be to warn the public against this new danger, and when the opportunity offers, proceed against the scoundrels. For whenever, as in my case, they combine their own efforts with those of other cunning, unscrupulous people they may bring grave misfortunes and distress upon fami- lies as well as upon individuals. What happened to me is Dangerous Paranoiacs. 147 likely to happen some day to somebody else. Every man would, by a similar conspiracy, under like circumstances, be ruined financially, physically and mentally, and his life become a burden. At the time when this conspiracy began 1 was in the prime of life, with a bright future before me. Though endowed by nature with all that is required to make a man happy and successful in life, 1 had to endure for ten long years the pains and privation of a wretched life, ruthlessly persecuted from one end of the world to the other by the most cruel and heartless agents that ever existed. If it were not for the conspiracy I would have today a family of my own, money in abundance, and be as happy as man could be. But what is my lot now? My life is a failure and will probably remain so, if some one does not put a stop to the evil doings of these agents.. But if they should continue their abominable course there is little doubt that my whole future will be destroyed. The horrible feelings which men experience when their eyes open, and they can see before them their future hope- lessly destroyed, can be imagined better than described. I would, therefore, in the name of humanity, appeal to all citizens who have a moral sense of justice, to use their influence so that the negligent authorities of this community may put an end. to this ignominious work by arresting all agents and their accomplices and placing them on trial. Some time ago I read in the New York Herald the subjoined remarks, called forth by the arrest of a dangerous criminal, and applicable to this case: "When rascality amounts to almost genius, and particularly when it is accompanied by indomitable will, rare courage and delibera- tion, its suppression is indeed a public necessity." There is sufficient direct and indirect evidence to proceed against these emissaries, as a warning for other land sharks. The peril of these combinations of unscrupulous agents who torment a man with exquisite cruelty, must not be taken too lightly. Laughingly they stab their victims in the back, and so secretly that no one but the victim can notice and feel it. The worst is that these wicked 148 J. E. Courtney. scoundrels have at their disposal all possible new inven- tions, by which they can in time ruin even the strongest man, mentally and physically. No one who is not initiated in their mysteries can imagine by what means these mod- ern assassins gradually ruin their victims. I owe it only to my marvelously good health and stout constitution that I still live without having lost my senses. Furthermore, 1 will say that these cunning emissaries try to acquire for their schemes the aid of respected and wealthy persons, so that the latter may become their ac- complices without knowing it. 1 would, therefore, say to all citizens and authorities who have, directly or indirectly, aided these hardened, unscrupulous agents, or who are about to aid them, in the immortal words of the great German poet: "Such is the course of evil deeds, that other evils fol- low in their train." If you earnestly propose to put a stop to the wicked doings of these fellows, you should take the work in hand earnestly and at once; there should be no compromise whatsoever, but the Gordian knot must be cut by a de- cisive stroke. I ask nothing but to be left in peace, so that I may pursue my business like any other citizen of this free and blessed country. I will add that in my despair 1 attempted three times to flee from my tormentors, but it was in vain. 1 left New York for the West. I had no means and had to return when 1 was 300 miles from New York City. The next time I went to Germany, but the diabolical agents were always after me like so many bloodhounds. In my despair I determined to join the Shaker Community at Mount Lebanon, N. Y., but I could remain there only a few days; the agents by their infernal machinations again drove me away. I published a circular, stating that a conspiracy had existed against me for ten years, and promising to publish the history of it, and asked the public to subscribe. Dangerous Paranoiacs. 149 THE SHOOTING AFFAIR. I could now see that there was nothing before me but ruin, with the death watch behind me. 1 concluded to appeal to the authorities, to investigate my case and rid me of those cruel criminals. I wrote to the Grand Jury, stating my case and asking that body for justice. I wrote two registered letters to the District Attorney to the effect that I was now desperate, and that if he denied me justice and did not proceed against my persecutors 1 would shoot at somebody. My complaints were ignored. To the same effect I had complained to the police authorities. I wrote a letter -to an eminent clergyman about the middle of November, to the effect that if he and his wealthy friends would not do something to stop the conspiracy I would shoot him in the course of eight to fourteen days. I of course expected this to be handed to the police, I ar- rested and the case investigated. Nothing of the kind happened. I concluded to force the authorities by aiming at Dr. H. with a revolver, but had 1 done only this the whole effect of the affair would have been spoiled. 1 postponed the shooting, afraid I would shoot somebody accidentally;but one day late in November the avenue was empty, and no body between me and my poor victim, so when he came out of the Tabernacle I fired the first shot; the next when he had ascended a few steps. 1 held the pistol so the ball struck about the middle of the steps, and not the window facing, as I read in the papers. He opened the door and disappeared. To use his own words, 1 "fired the third and last shot after he had passed through the door." Everybody can see that I had no intention of killing him. I waited ten minutes for an officer, and then allowed the janitor to hold me till some one brought one. I think the officer on duty was kept away by an electro- magnetizer and accomplices who knew that I wanted to be arrested to end the conspiracy. I was arrested and the case heard, but alas, I was simply declared insane. POSSIBLE CAUSE OF INSANITY AMONG AMERICANS IN THE ORIENT.* DR. ALBERT B. ASHMEAD, New York. PERHAPS Dr. Abernethy, whose letter in the Philadel- phia Medical Journal September 8 ("Does Life in the Philippines Produce a Species of Insanity Due to Physical Distress?") I have read with deepest interest, might find a more reasonable cause for "the species of insanity pre- vailing among the troops in the Philippines" in the life they may lead there.t What my venerable German col- league, Dr. Wernicke, said of foreigners in Japan may be true of us in the Philippines. 1 do not know whether it, is or not. But I know that the life of the foreigners (not only Americans but all nationalities) in Japan twenty-five years ago, shortly after it was opened to Europeans, was as bad as Wernicke said it was, and worse. The happy divergence from dreary American life, which consists in making the beverage further and cheer the meal, leads to its peculiar excess. But even worse than these is our detestable American abuse of drinking and treating; it has been preserved there, and its worst form is the so-called "cock-tail." The craving to introduce into the stomach, shortly be- fore a meal, a certain quantum, even if it be moderate, of distilled liquors, is so unphysiological, not to say loathsome, •A letter from Dr. Ashmead. late of Tokio, now of New York. Late Forlegn Medical Director. Toklo Hospital. Japan, and physician in charge of the Yoihiwara (Licensed prostitutes of Toklo.'. tNorE. Now that the election is over we may admit that soldiers are not Sunday School scholars. [150] Insanity Among Americans in the Orient. 151 that it is well worth while to say a few words about the custom in the Orient. The "cock-tail," like many other inventions of idleness, blase by drunkenness, is prepared wilh some solemnity in the East. Into a glass tumbler is poured a quantity of gin proportioned to the number of the partakers, a much smaller one of that extractive, which, under the name of "bitters," is imported in large quanti- ties, and, at the best, a glass of water and a moderate quantity of sugar in powder, is added to this mixture. This mass is stirred with an instrument looking very much like a twirling wire, until a loose foam accumulates hand- high over it, when it is drunk out of tumblers, immediately before a meal, more especially the warm lunch, or tiffin, of the East. The water can be replaced by champagne, another kind of liquor may be chosen, instead of gin, and gives then its name to the mixture. The chief name is derived either from the various liquids, which remind one of the many colors of a cock's tail, or, according to another version, from the feather which was formerly used in fixing it. However many there may be who deny it, whosoever is in the habit of taking his cock-tail before his meals (and only Americans do), falls irretrievably into the power of drunkenness. Of course, regular appetite is out of the question with such persons, the assimilation is, in a meas- ure, lowered, and if the alcohol does not display its de- structive effects as rapidly as under the tropics, this is to be attributed to some peculiarities of the climate. It has been asserted by friends of spirituous liquors, as an absolute truth, that, owing to the relaxation (as we will say for shortness) caused by the moist climate, a cer- tain quantity of alcohol is indispensable as a stimulant. They have ready to hand manifest proofs; how this or that habitual tippler is in much better health than others of the same age and same constitution; they point to the rapid loss of bloom of the abstemious women; they insist upon the fact that the natives themselves, even those who live temperately, have of yore countenanced the general use of an alcoholic beverage. I cannot say that this theory has 152 Albert B. Ashmead. absolutely no leg to stand on. There is especially one fact that is beyond all doubt; that women in the Orient (1 mean foreigners) have found themselves much better when allowed the use of red wine, when a strong break- fast wine was medically prescribed for them. However, even these reasons are not sufficient to make us disregard entirely all discrimination between spirituous drinks,or sanc- tion their use at a time of day in which the empty stomach, in strong congestion of the mucous membrane, prepares itself for the reception of food. It is a bad sort of distilled drink, call it by what name you will, that is sold to soldiers, sailors and loafers in the common bar-room, kept by foreigners, and in the native pleasure houses. In the summer of 1876, the events caused thereby, which took, frequently enough, a character shameful for Europeans and Americans, created a very great sensation. "Could not the Consuls in common with the representants of the foreign powers and the Japanese authorities, contrive some means, if not to destroy, at least to attenuate this great nuisance, which the Consul General of the United States, at Yokohama, has so often pointed out—the sale of really poisonous kinds of brandy, of such kinds as lead to deathly intoxication and insanity? The horrible scenes to be witnessed every day on the streets and the cases which are continually brought before the Consuls, cry aloud for a remedy, for a systematic measure, if such a measure is possible, to protect the sailors from these terrible places. To see splendid young fellows, and old experienced sailors lie about the streets, surrounded by staring natives, or dragged to the Consulates in their drunken helplessness, is a scandal of the worst sort, shameful for them and for us. Would it be impossible to make the 'Temperance Hall' useful in this direction, or to organize the 'Sailors' Home,' as a help to our sailors against this contemptible degradation?" Thus spoke Captain Brinkley, of the Japan Weekly Mail, in a long editorial, very properly. The behavior of those intoxicated sailors, not only in Insanity Among Americans' in the Orient t 153 Yokohama, but also in Nagasaki, the latter the wickedest city in the whole Orient, was more than bestial; they had themselves carried by twos or threes through the streets in a jinricksha, howling like mad men, and treating the poor natives, even then polite and self-controlled, to brutal kickings, often the only payment he obtained. Every white man blushed for those countrymen; and for many cases "the poisonous liquors" were but a weak excuse. What the Oriental must have thought of their models of civilization is not the least interesting question in a study of the conditions. Himself sober, conscientious, tem- perate, as the Buddhist tea drinker presents himself.he sees his European master, at perfect ease, at a certain degree of intoxication. While singing and dancing in Japan is left to women, the Europeans dance in a promiscuous whirl, altogether; singing, even screeching, seems to be the be- ginning of the end of every festival. He could watch other Europeans playing dice or cards by the hour, while the throat, fatigued by talking and smoke, had to be moistened strenuously. While the Japanese satisfies his craving for a smoke by six or eight whiffs from his small pipe, he sees often his illustrious, highly civilized master, hardly take the cigar out of his mouth, and mix liquids with smoke, until he goes to rest with a heavy step, blood-shot eyes and a disposition to use bad language. These are the pictures presented, not in all houses, of course, but yet too often, throughout the foreign colonies of the East, not to make you hesitate, if you are asked whether we Europeans civilize the Asiatic by our example. We are also reminded of the number of young men who groan under the burden of miseries of their own seek- ing, so lamentably great throughout the foreign settlements of the Orient; of those questions well known in the history of syphilis, whether its especial variation, its sometimes endemic malignity, may not be due to the mixture of two races. The Spaniards and Portuguese were said to have contributed "the great ill" of the fifteenth and sixteenth centuries through their all too ardent love for the hot- blooded Indian women; thus, many Europeans declare that 154 Albert B. Ashmead. they have been infected by their contact with apparently quite healthy Japanese women. Little heed as has been given to these assertions; little as we ourselves, when we were there, countenanced these theories, they might yet contain a grain of truth. I said "apparently healthy" advisedly; for, like many other physicians, I have been often surprised at the difference of symptoms which appear in the infected foreigner and in the woman who is guilty of the infection. The inculpated woman of the Orient was hardly aware that anything was the matter with her; to be sure, she remembered that three or four years ago she had required some medical attendance, for a little while; on the other side, the man, after the meeting, showed in due time the worst secondary symptoms which are possible in a dangerous infection. This latency is sometimes really phenomenal, and not seldom perfectly sufficient to teach even conscientious and experienced doctors. The subject, although it is by no means a new one, is very important in the life of the young men in the Orient. In the East, the foreigners' interest in things going on in the Mother Country, or in the world at large, is di- minished in a lamentable way. Every thing of any im- portance is known by telegram, three days after the event. Then come, for six weeks, the newspapers, unsuspecting of what is known, with their surmises, their incomplete premises, their conclusions, long ago refuted by the facts, and which appeal rather to our pity than our interest. Also, the slow progress of the sciences, the special works of industrious investigators, appear from that far-off per- spective, at that small angle, little — microscopic. And what, after the labor and heat of .the day, does the hour of recreation offer him? At the best, a comfortable conver- sation, with such as are still capable of such exertion; the consolation of music, as far as the accomplishments go, or else shallow amusements, poor artistic productions, brandy and water, beer, tobacco and dice or cards are there to remind the European of "his nobler origin." SELECTIONS. NEUROTHERAPHY. TREATMENT OF TINNITUS AURIUM.—Drs. Cuvillier and Vassal. (13th International Medical Congress.) The subjective noises designated commonly tinnitus are the re- sult of irritation of the auditory nerve in its terminal laby- rinthine ramifications, in its course or at its central origin. They can also exist without lesions of the auditory appara- tus, as in anemics, neurasthenics, or after the absorption of medicaments, such as salicylate of soda, sulphate of quinin, etc. The nature, quality, intensity and duration are vari- able. They are manifested sometimes without any deaf- ness; they may precede it. Generally they come on and augment simultaneously with it. They constitute-one of the most painful symptoms of auricular affections. Tinnitus aurium occurs: (1) Inflammatory and traumatic lesions of the external ear and middle ear. (2) In sclerotic otitis media. (3) In infection of the internal ear. Tinnitus aris- ing from the canal occurs when a foreign body or a mass of cerumen obstructs it, in otitis externa and furuncle. The treatment employed for these will cause the tinnitus to cease. In acute diseases of the middle ear it is the same. If the tinnitus persists after cure of the initial affection, douches of air by Politzer's method combined with massage of the drum are the best methods to employ. In dry or sclerotic otitis, tinnitus exists in the majority if not in all cases. Treatment should tend: (1) To diminish the irri- tabilty of the nervous centers by internal revulsive medica- tion. (2) To combat ankylosis of the ossicles, adhesion of stirrup and fenestrum ovale and dimish intra-labyrinthine pressure. Internal Medication and Revulsion: Painting the [155] 156 Selections. skin of the canal, tampons of cotton saturated with medica- ments, lotions of narcotic solution such as quinin, cocain, etc., have a good effect. Revulsion to the mastoid process by applications of tincture of iodine, friction with Fioraventi balm, small flying blisters, above all the actual cautery, often procure a sensible amelioration. Of the extolled in- ternal remedies we retain only the iodid and bromid of potassium, valerianate of ammonia and quinin. Cimicifuga which has been much vaunted of late has not given any durable effect in numerous cases where we employed it; it ought to be abandoned. Bromide and iodide of potassium together are the medicaments of choice in tinnitus due to sclerotic otitis. In tinnitus and vertigo provoked by lesion of the internal ear, quinine certainly gives good results. If the tinnitus is of reflex origin (affections of the stomach or uterus, dental caries, etc.), the treatment should be directed to the cause. Electricity (induced current, positive pole to the mastoid or canal, negative to the neck) has also been advised, but should be used with prudence because of the brain's proximity. Besides, the results obtained do not justify expectation. Mechanical treatment: The most im- portant thing is to diminish the compression of the laby- rinth which tends to force the stirrup into the fenestrum ovale. If the patient can be seen regularly catheterize the eustachian tube every other day and insufflate air directly into the tympanum. In case of very intense tinnitus it will be beneficial to charge the insufflated air with vapor from chloroform, ether or bromide of ethyl. If the patient connot be treated regularly, air douching by the Politzer method is better. The insufflation of the eustachian tube should be combined with massage of the tympanum and rarefaction of the air in the external auditory canal in order to keep the ossicle mobile. Siegle's speculum or other masseurs for the drum may be employed. The affection being tenacious and having no tendency to spotaneous cure, the treatment, both internal and mechanical, ought to be be continued with patience and perseverance and in many cases the tinnitus will diminish and disappear.—A. M. in 5/. Louis Medical Review. Selections. 157 PHYSIOLOGICAL AND ARTIFICIAL SLEEP, AND THE NEW HYPNOTIC—CHLORETONE—Chloretone being spar- ingly soluble and readily absorbed into the blood is carried in considerable quantities to the cerebral tissue, and the individual falls into a profound sleep. After a time the Chloretone is gradually carried away from the nervous tissue, chemical activity is renewed in the cerebral cell and fibers, and the condition of being awake is restored. When ad- ministed internally Chloretone produces not only profound sleep, but complete anesthesia can be made to last for days. It has been my privilege to use Chloretone in quite a variety of dissimilar conditions. The first instance was in a case of interstitial induration of the lungs with most per- sistent insommia. The next case was one of insomnia in connection with nervous exhaustion from over anxiety, and followed by acute alcoholism. In this instance the results were all that could be desired: the remedy seemed to have a very soothing effect upon the irritable gastric mucous membrane. In a case of very pronounced insomnia of long standing, the patient secured eight hours of very refreshing sleep from two doses of six grains each, taken two hours apart. The second night the same amount of sleep was secured after one dose of six grains. The patient awoke thoroughly refreshed and with no unpleasant effects so often witnessed with many chemicals used for producing forced sleep. This lack of after-effect is one of the strong features in connection with the use of Chloretone. In a case of acute mania following a slight operation upon the eye, twelve grains of Chloretone produced a peace- ful night's sleep, with the disappearance of delirium the next day. In the acute infectious diseases it has in a very large majority of instances produced the desired effect. The best results seem to follow the administration of two doses of ten grains each, about two hours apart. If Chloretone is to be administered in capsules it should not be made up into a mass, but rather put into the capsules dry. In the course of the discussion which followed the read- ing of Dr. Porter's paper, the latter said: "The fact that 158 Selections. Chloretone is an anesthetic to the stomach make it pe- culiarly valuable, for most of our hypnotics have a strong tendency to excite more or less gastric irritability, and in this respect do harm as well as good. In the case of acute alcoholic gastritis reported, in spite of the vomiting of food the patient was able to retain even the first dose of Chlo- retone without any difficulty and steadily improved under its influence." The speaker stated that he had injected several ounces of a one-per-cent solution of Chloretone into irrita- ble bladders and found that it had a very quieting effect. He had not observed the slightest evidence of cyanosis while patients were under the influence of Chloretone. He had used it freely in all kinds of cardiac lesions, and in some instance had continued the administration in small doses for several weeks, put had never observed any de- pression of the heart from its action.—By William Henry Porter, M. D., Professor of General Medicine and Pathology at the New York Post-Graduate Medical School and Hos- pital in The Post-Graduate, May, 1900. ANIMAL EXTRACTS IN INSANITY.—Dr. Parry agrees (The Therapist, Oct. 19, 1900) with Dr. Esterbrook that Brown-Sequard's generalization ("that all glands and all tissues have an internal secretion; which injected subcutan- eously has a tonic effect") undoubtedly requires modification. From investigations on the insane he is of the opinion that those animal extracts which mainly consist of simple pro- teids (albumins and globuline) and albuminoids merely have dietetic effect. Those animal extracts which are rich in nucleins and nucleo-proteids produce when given by the stomach in sufficiently large doses (as 60 grs. per diem of the dried extract and upwards), temporary stimulation or all metabolism with subsequent anabolic reaction; this being evidenced by the common increase of the water, total solids, urea and prosphoric (and uric) acid of the urine, by the general tendency to a sub-febrile pyrexia, and most impor- tant of all by the initial loss of weight followed by a gain- This initial metabolic stimulation with its resulting anabolic reaction is, the explanation of the physical improvement or Selections. .159 "tonic effect" which occurs .in a fair proportion of cases (usually under 50 per cent) and which if pronounced may be accompanied by mental improvement or even mental iecovery. In this sense therefore these substances may be termed metabolic tonics. It is probable that in the living body these organs (cellular in type which are naturally rich in nucleins and nucleo-proteids) produce, in virtue of the metabolis of these substances similar distant "tonic" effects upon the general cell metabolism. In the administration of animal extracts in these diseases generally it is of the ut- most importance to recognize that many of them (apparently those rich in nucleins and nucleo proteids) may produce this tonic effect. This explains many of the discrepancies in the result obtained by workers in the various fields of disease. It should save one from attributing to various ex- tracts specific effects in disease in which a priori on the "internal secretion" hopothesis their use seems to be specially indicated; these effects being in reality the general tonic effect on cell metabolism, it is extremely doubtful whether each organ possesses a specific internal secretion in the sense intended by Brown-Sequard. Some organs prob- ably have such an internal secretion, for example the active principle of suprarenals (sphygmogenin which powerfully increases muscular contractions and apparently diminishes tissue oxidation). So also the thyroid has an active prin- ciple (iodothyrin), whose specific effect is to stimulate cell metabolism or tissue oxidization for in this respect thyroid extract stands far above all others. When it is administered in large doses the anabolic reaction never sets in until after the cessation of the drug whereas in the case of all other metabolic extracts which have been used an anabolic rebound generally sets in during the continuance of the drug. Of all the various extracts thyroid, parathyroid, thymus, pituitary body, cerebral substance, choroid plexus, suprarenal extract, splenic orchrtic, ovarian, uterine and mammary substance which were employed. Thyroid extract is the only one by which any decisive therapeutical results were obtained. It should be most certainly tried in all cases which threaten to become chronic. The other animal 160 Selections. substances are of very little if of any use in the treatment of insanity with the possible exception of that of cerebral substance. DORMIOL.—Under this title is sold a compound; dimethglehylcasbinol-chloral devised by Dr. Fuchs (Therapist, Oct., 1900) which is a water-like liquid of the pungent menthol odour with a burning-cooling taste. It mixes in every proportion with alcohol, ether, chloroform, benzol, and fatty and ethereal oils. If it be left standing for some time with an equal quantity of water, it produces on shaking a clear solution. This watery solution is, with very few ex- ceptions, readily taken by the patients there being but rarely any necessity of adding a vehicle, milk proving very suitable in the latter case. When given in this form the remedy seems to develop its action most promptly probably due to more rapid absorption. In its concentrated form it can be given in capsules or enema with gum arabic. When given subcutaneously a somewhat severe irritation takes place at the point of injection. YOHIMB1N.—According to Dr. Mendel, yohimbin (a prin- ciple obtained from a bark used in the Cameroons as a remedy against impotence) has some value in cases of irritable weakness or paralytic impotence. In one case this action was almost immediate after giving the remedy; in other cases after some weeks use, erections took place which had previously not occurred for a long time, and which after the time of abstinence led to regular coitus. In half of the cases the remedy did not exhibit any noticeable action. FISH-DIET AND LEPROSY.—A correspondent of the Medical News writes that at the polyclinic Mr. Jonathan Hutchinson showed a case of recovery from leprosy. All evidence of active disease had been absent for six years. The words "cure" and "recovery" meant ces- sation of disease processes, not absolute restoration to normal condition. He mentioned another case of a florid, healthy-looking man quite blind from leprosy, whose hands Selections. 161 were to some extent helpless from anesthesia and muscular atrophy. But for fifteen years he was free from aggressive symptoms. In the first case mentioned when the patient came under treatment he had patches on the arms and legs, enlarged ulnar nerves and dusky hands and feet from passive congestion. The treatment consisted in small doses of arsenic, liberal diet and abstinence from fish. In about eighteen months all traces of patches had disappeared from his hands and feet. From that time unusual slow restora- tion progressed, the hands became less dusky and somewhat less numb, and the ulnar nerves smaller. The patient • enjoyed good health except that he suffered from dyspepsia. As long ago as 1879 Mr. Hutchinson published a case of recovery from leprosy. A woman returned from Barbados with leprosy in the most severe form—the tubercular. In the course of years, whilst residing in England, she recovered, but her hands remained numb and crippled. She was enjoined to abstain from fish. Mr. Hutchinson has since then seen many cases of recovery of lepers who have come from abroad to reside in England. The same observation has been made in America as to Norwegian lepers. Mr. Hutchinson attributes the fact that little or nothing has been heard until lately from leper establishments as to recovery to the fact that fish has been an important element in their dietary. Quite recently Norwegian author- ities have asserted the curability of leprosy. Dr. Hansen has seen many cases, principally of the anesthetic form, but a few of the tubercular. In some a necropsy failed to reveal the bacillus in any viscus. ORGANO-THERAPEUTICS IN MENTAL DISEASES. C.C. Easterbrook.—The origin of organo-therapeutics dates from Brown-Sequard's experiments in 1889 and the doctrine of internal secretion formulated by him that "all glands and all tissues have an internal secretion and all injected sub- cutaneously have a tonic effect" is taken as the text of this article. During the past five or six years Easterbrook has administered to various forms of insanity extracts of the following animal organs: The thyroid gland, the parathyroid 162 Selections. \ bodies, the thymus, the pituitary body, the brain, the choroid plexus, the spleen, the suprarenal bodies, the testes, the ovaries, the uterus, and the mammae. With the excep- tion of the thyroid, none of these have been very generally employed by alienists, and parathyroid, extract so far as he knows has not been employed before at all. He carefully selected his cases among patients not progressing toward recovery under other treatment, and sougrjt to avoid the fallacies of calling temporary remissions recoveries, or to attribute to the drug any improvement or change that might be due naturally to the course of the disease aiQd he has also excluded all psycho-therapeutic influences in »ny form so far as possible. His patients were first weighed an%d put to bed on a diet sufficient to maintain the body temperature and body weight, careful notes made of the state of ths, bodily and mental functions, the excretions, the blood, urine, etc., with careful quantitive and qualitative examinations and microscopic studies. Sphygmographic tracings and obser- vations of the blood pressure with sphygmometer were also made in some cases. In the one hundred and thirty cases tested with the thyroid extract, including a large number of forms of insanity and almost the whole range of symptoms of the disease, large and small' doses were given separately and effects noted as producing changes in the temperature, circulation, nervous system, urine, etc. Small and moderate doses were tolerated well by all. Large doses were badly borne by those under twenty and over sixty years. Easter- brook suggests that, in the old, the thyroid gland is feebly functional and the system is not prepared for much thyroid secretion, while in the young it is freely active and the system well supplied, therefore any addition is superfluous. In the one hundred and thirty cases there are twelve re- coveries which he thinks can be attributed to the drug and twenty-nine cases were improved. All the recovered cases had been selected as failures from former treatment,the average Puration of treatment before thyroid medication having been eight months. Several cases that had been treated, recovered some time after, which indicates that a patient not cured by the thyroid method may still recover by other means. Selections. 163 Nevertheless his experience is that if the patient is going to recover under this drug it will be done with the first few large doses. When used in chronic insanity temporary im- provement is common and he has found it useful in aborting periodic attacks of violence. The therapeutic effects of parathyroid were negative, the same is true as regards mental symptoms with thymus and pituitary extracts, though there was in some cases temporary improvement with both. Brain extract was used in nineteen cases, of which two recov- ered and three were improved. Choroid plexus extract was negative in its results. Suprarenal extract he thinks had some effect in increasing the blood-pressure and he would advise a systematic trial in maniacal cases. It seems also to produce a specific diminution of tissue oxidation. With the splenic extract there was in two cases temporary improvement physically and mentally with subsequent relapse. Of the eight cases treated with orchitic extract three were improved mentally while two others were physically benefited. Thirty- six cases were treated with the ovarian extract; two of the patients recovered long after the treatment, probably inde- pendently of it and four cases, Twainly stuporous, were improved. Two of the patients in whom the ovaries had been extracted or destroyed by disease were unimproved either mentally or physically by large doses. Uterine ex- tract was negative. The two cases treated by the mammary extract were affected with a rise in temperature and loss in weight, but no change in other respects; both however fully recovered, one after a careful thyroid treatment. In conclu- sion, he states that Brown-Sequard's generalization needs some modification. His own investigation led him to con- clude that those animal extracts which consist mainly of simple proteids and albuminoids have merely a dietetic value, but those that are rich in nucleins and nuclein pro- teids produce when given in sufficient doses a temporary stimulation of cell katabolism and subsequent anabolic reaction. It is important to recognize this tonic effect. Apart from this it is extremely doubtful whether each organ possesses a specific internal secretion in the sense intended by Brown-Sequard. Some organs, however, as the 164 Selections. thyroid with its iodothyrin and the suprarenal bodies with their active principle have a decided special effect. Thyroid extract stands far and above all others in stimulating tissue oxidation, and anabolic reaction never sets in until after the cessation of the drug, which is not the case with other extracts. ANESTHESIA BY SPINAL COCAINIZATION.—By Carl E. Black, M. D. of Jacksonville, 111., in Medical Fortnightly. Surgeon to Passavant Memorial Hospital, and Our Savior's Hospital. The discovery of the anesthetic properties of cocaine was a great advance in surgery, and permits us to perform many minor operations under its influence with safety, yet the extended use of cocaine in large quantities and over large areas has long been known to be very un- safe. In fact cocaine is recognized as a treacherous drug, not always effecting patients in the same way, indeed not always effecting the same patient in the same way. Still its use is greatly extending. The eye surgeon could do little without it, and Schleich by his method of infiltration greatly extended its range of usefulness. Yet infiltration anesthesia has some objectionable features. First, it is of short duration. Second, it distends and disturbs the tissues operated on; and third, it has to be repeated in order to prolong the effect. As far back as 1885 J. Leonard Corn- ing, of New York, published (New York Medical Journal, Vol. 42, page 483) his experiments in local anesthesia. In these first experiments he did not introduce a cocaine solu- tion directly into the spinal canal, but injected it into the tissues about the Cauda equina. Later, he carried his experiments farther and injected the cocaine solution directly into the spinal cord, and demonstrated conclusively that efficient anesthesia without unconsciousness can thus be produced. His second article was published in the Medical Record in 1888 (Vol. 23, page 291). In his first report published in 1885, Dr. Corning concluded with the following: "Whether the method will ever find an application as a substitute for etherization in genito-urinary and other branches of surgery further experience alone can show." By the testimony and Selections. 165 the observation of what it may do has seemed to me on the whole worth reporting. Thus we see that Dr. Corning, of New York, deserves full credit for having experimentally and practically demon- strated the anesthetic power of cocaine injected into the spinal canal. Just why his valuable observations, which now appear to have been absolutely complete should have been so long overlooked by the surgical world, is difficult to understand. His observations were published in our best and most widely distributed journals, and yet more than five years elapsed before attention was again called to this matter by A. Bier, of Germany. Bier's experiments seem to have been carried on inde- pendently of those of Dr. Corning, and to him much credit is due for calling prominent attention to this as a new method of anesthesia in surgery. Quicke's method of puncture was used. The needle is kept plugged until the point enters the spinal canal; the plug is then removed and a few drops of spinal fluid are allowed to escape. The syringe is then attached and a dram of a two per cent solution of cocaine is injected into the spinal canal, after which the needle is withdrawn. Of course this whole procedure must be carried out under the strictest aseptic precautions. Following Bier's publication in the Deutsche Zeitschrift fur Cliirurgie in 1889, a number of experimenters and prac- titioners took the matter up. The experiments of Corning and Bier were quickly confirmed by other observations. Tuffier (La Semaine Medicate, 1899, page 363, May 16, 1900), of Paris, was one of the first surgeons of prominence to bring this method into general use. He reported a large number of cases with almost uniformly good results. He usually makes his injection between the fourth and fifth lumbar vertebra, but gives little preference to exact location, sometimes selecting as high as between the first and second lumbar. For practical purposes, an imaginary line drawn between the crest of the ilia will pass over the center of the fourth lumbar vertebra. From this point it is very easy to 166 Selections. locate any space desired. Injection is easiest with the patient sitting on the edge of the table. ANTAGONISMS OF CHLORAL-HYDRATE AND COCAINE. —The experiments of Gioffredi (Mkhc/z. Mediiinische IVochen- schrift) show that while chloral-hydrate in large (% grs.) doses acts as an effectual antidote in cocaine poisoning, cocaine has no s'uch effect in chloral-hydrate intoxication. The same observations have been made with paraldehyde and sulphonal.—Stylus. ELECTRICITY IN BRAIN FAILURES. Reported to American Electro-Therapeutic Association—Dr. D. R.Brower, Chicago, read a paper on the above subject. He finds that these cases are very often associated with a dilated stomach, and here he strongly advises the daily use of intragastric galvanization, using Einhorn's electrode. In addition he resorts to galvanization of the brain, using a current of one or two milliamperes for two minutes. This is followed by transverse and bulbar galvanization, and lastly by static insulation. ELECTROTHERAPY OF INSANITY. —Reported to Amer- ican Electro-Therapeutic Association.-Dr.Alfred T.Livingston, Jamestown, N. Y., described his very favorable experience with the use of electricity in cases of melancholia—a method almost unknown to those who have most to do with insanity. The treatment is founded on the theory that insanity is largely dependent, in the first instance, on circulatory changes in the brain. A current of ten to fifteen milliam- peres is used on the lower pair of sympathetic cervical ganglia, one of eight or ten milliamperes on the second pair, and one of five or eight milliamperes on the upper pair, the electrodes being carefully slid along so as not to produce a break in the current. THE QUESTION OF THE TRANSFORMATION OF CAL- OMEL INTO CORROSIVE SUBLIMATE IN THE ORGANISM.— This question was raised not long ago in the Paris Therapeutical Society. M. Pateni stated that such a transformation in the presence of sodium chloride, accepted Selections. 167 by Mialhe, was a fable; it was not true that calomel was changed into corrosive sublimate on contact with the alka- line chloride or with the gastric juice. M. Pouchet added that the bromide and the chlorides were powerless to convert calomel into corrosive sublimate; such a change took place only on contact with the alkaline iodides. If it did take place in the presence of chlorides, he said, it could not be avoided by the patient simply abstaining from salted articles of food; it would be necessary to remove all the chlorides from the organism.—H. J. C. SIEVING, in March 1900. Stylus. CLINICAL NEUROLOGY. EXOPHTHALMIC GOITRE.—According to Dr. English, of Detroit, exophthalmic goitre arises from the entrance into the blood of an altered secretion of the thyroid gland. The normal secretion is an enzyme affecting the tissue growth. In this disease a poison is secreted having an elective action on the nervous system, especially the sympathetic. In the common cases with early thyroid enlargement the gland is diseased and its toxic secretion irritates the gland itself. In the rarer cases without enlargement the gland is not so directly affected by its abnormal products. ADIPOSIS DOLOROSA. PITUITARY TUMORS.—Dr.C.B. Burr of Flint, Michigan reports the case (Jour, of Nervous and Mental Diseases, Oct. 1900) of a woman thirty-six years of age, weighing three hundred pounds, with symptoms of lethargy,weakness and spinal paralysis who had lost control of the bladder and rectum. She was in the hospital in a semi- conscious condition for several weeks and then died with pulmonary cedema and acute nephritis. At the necropsy a tumor of the pituitary body about as large as a walnut was found involving the optic chiasm and penetrating upward into the ventricle. There was a marked internal hydrocephalus. The thyroid gland was normal in size and contained a secretion about as large as a chestnut. The lungs were oedematous and the ovaries small and hard. Microscopic 168 Selections. examination showed a high grade of intestinal neuritis in the nerve filaments and muscles and in the various nerves examined. At the seat of the pituitary body was a glioma. There was marked degeneration of the thyroid gland and absence of the secreting cells. The ovaries were non-func- tional and sclerotic. The case is of interest as showing the combination of adiposis dolorosa with neuritis and organic brain disease together with ovarian complication which may have had a bearing on the beginning of the trouble. HAEMATOMYELIA.—Dr. J. Hendrie Lloyd reported a case of this affeciion (Jour. Amer. Med. Asso., Vol. XXXIV) in a woman of middle life, who had received an injury to the spine from a fall down stairs followed by symptoms of injury to the third, fourth and fifth cervical segments. The patellar reflexes were exaggerated. There was complete paralysis of the respiratory muscles and the patient died on the ninth day. It was noticed that at one time there was a slight return of sensation, thermal, and pain in one leg. Regarding the etiology of this condition hiematomyelia might result from diseased blood vessels or from trauma; most frequently from the latter. In this patient there was no alteration in the bony structures of the spine and the spinal membranes were found intact. At first sight the cord looked normal but microscopic sections showed that there had been an extravasation of blood into the lateral. In the anterior horns it was found that certain cells had undergone luemo- chromatolysis. TRANSVERSE MYELITIS.—Dr. A. W. Dunning has re- ported a case (Jour. Amer. Med. Ass., Vol. XXXIV) of transverse myelitis in a twenty-year-old colored man of excellent family and personal history. He gradually devel- oped the symptoms of a transverse lesion of the spinal cord at about the level of the fifth dorsal segment and his condition became progressively worse until about five weeks from the onset there was complete inability to walk, slight involvement of the sphincters and anaesthesia of the lower extremities of the trunk to the nipple line. There was then a period of three weeks in which the condition remained Selections. 169 unchanged followed by gradual improvement until six months later when he was able to walk with the aid of canes; the sensory symptoms were greatly improved and general nutri- tion was excellent. At this, time however he suddenly developed a pneumonia and died ten days later. Within the year prior to the onset of the myelitis the patient suffered from an attack of gonorrhea which had not been cured. Immediately preceding the onset of the myelitis the patient stated that for two days he had been engaged in work in which he had been thoroughly wet and cold al[ . day. Formerly this of itself would have been deemed suffi- cient cause for the lesion in the cord, but in the light of the present teaching of pathology we can not have an inflammation in these parts without infection of some sort. Doctor Dunning was of opinion that in this instance since there was no other apparent source of infection, the neurosis was due to gonorrheal infection and that protracted exposure to wet and cold simply favored the introduction and devel- opment of infection in the cord. ON THE PATHOGENESIS OF CHOKED DISC—(Experi- mental Choked Disc)—Berry and Sym present this subject in the Edinburgh MeUical Journal as follows: Dr. Merx of St. Petersburg has made (Arch. f. Angenh., Wiesbaden, Bd. xli. Heft 4) an extensive experimental investigation, with the object of discovering the cause of encephalopathy neu- ritis. The subject is one which has been much discussed and experimented upon, but which is still unsettled. The two main views are those of Manz and Schulten (the so-called mechanical theory), and the inflammatory theory of Lebes. Each has had not a few supporters. Merz's investigation leads him to support in the main the mechan- ical view. He experimented on dogs and rabbits, and came to the following conclusions:—An increased intracranial pressure is sufficient to cause a choked disc. All that is necessary is, that this pressure should be continuous, and should exist for a certain length of time. A transient increase of pressure, even though frequently recurring, only gives rise to venous congestion and arterial constriction in 170 Selections. the fundus of the eye. A very small degree of increased intracranial pressure (8 to 15 mm. of mercury) is sufficient though the greater the pressure the more rapidly do the various successive changes take place in the eye. It is much easier to produce both the clinical and anatomical changes characterizing choked disc in dogs than in rabbits. As others have mainly experimented on rabbits, Merz supposes this to be the reason of the different results at which they have arrived. The first clinical symptoms in the eye, of increased intracranial pressure, are vascular— first, dilatation of the veins, then narrowing of the arteries; and these changes are met with earlier, the nearer to the eye is the point of entrance of the vessels through the sheath of the nerve. The author considers that in his experimentally produced choked disc the increased pressure causes, first, a compres- sion of the venous sinuses, and that this, notwithstanding the presence of anastomosis between the ophthalmic and facial veins, must at first, at all events, influence the circu- lation in the eye. Further, a stasis takes place in the liquids in the subvaginal space, producing, too, a compres- sion of the vessels at their point of entrance into the sheath of the optic nerve. Finally, the pressure on the nerve itself creates a disturbance in its lymph circulation, and this leads to oedema of the nerve fibres, with consequent further com- pression of the vessel. When this interference in the blood and lymph circulation has lasted some time, it results in inflammatory changes in the nerve, nerve sheath, and papilla. Merz considers that the similarity between the human eye and the eye of the dog justifies one applying the results obtained in fhe dog to explain the cause of optic neuritis in man. THE PUPILLARY MOVEMENTS have awakened renewed interest in the minds of Drs. Berry and Syms in the Edin- burgh Medical Journal and following are their comments on this subject in review of Angelucci's recent work on the subject. (Angelucci Arch. diottal., Palermo, tome vii.). The experiments upon which his conclusions are based have Selections. 171 been many and various, namely, removal of the superior cervical ganglion, an operation which he has performed not only in animals, but in man (for the treatment of glaucoma); removal of the ciliary ganglion; stimulation of the nucleus of the third nerve, and of the corpora quadrigemina; section of the third nerve combined with section of the sympathetic in the neck, and also with the fifth nerve; stimulation of the anterior and posterior twigs of the ansa Vieussenii and long ciliary nerves; stimulation of the cerebral cortex, and others. Angelucci believes that the iris is moved by only one non-striped muscle, the sphincter pupilla?. This muscle is innervated by two antagonistic sets of nerve fibres, the one of which stimulates it to contract, the other being inhibitory in its action. These different nerve fibres are contained in the trunks of the third, fifth and sympathetic nerves. The third nerve nucleus (probably the so-called Edinger-Westphal nucleus of its anterior part) must be looked upon as undoubtedly a pupil-contracting centre. No similar cortical centre has been discovered. Section of the third nerve causes dilatation of the pupil. The dilatation occurs also if the sympathetic is at the same time sectioned in the neck. This proves that the third nerve centre has not only a reflex but also an independent action, an action causing tonic contraction of the sphincter. A second pupillary contracting centre exists in the anterior quadrigemina. When they are stimulated superficially, miosis is the result. The axis cylinders of the contracting centre end in the ciliary ganglion. These axis cylinders constitute the first or central neuron, the second pupillary contracting neuron is repre- sented by the short ciliary nerves. Stimulation of the first neuron does not cause miosis until the stimulation takes place in the neighborhood of the sinus cavemosus. Stimu- lation of the second neuron does, however, cause miosis. Reflex contraction of the pupil is due to peripheral irritation of the first neuron, which reacts then on the second and third neuron (the ganglion cells of the ciliary muscle). Reflex mydriasis, on the other hand, from irritation of sensory nerves, is due to inhibition of the first contracting neuron. 172 Selections. The fifth nerve does not, as such, contain any fibres connected with pupillary movement, though on section miosis results. This depends upon an interference with the dilating sympathetic fibres which course in its first division. Therefore, no further pupillary change takes place when the superior cervical ganglion is removed and the third nerve cut. The movements of the pupil are due, therefore, to the tonic action of the third nerve and the antagonistic action of the sympathetic. Many other points in connection with the physiology of the pupil are referred to in Angelucci's work. These are, however, of minor importance, or refer to modifications of the experiments which have led to the above conclusions. SYPHILIS PRECEDINC TABES.—In a brief account by Paul Heiberg, entitled "Some Remarks on the Syphilis Preceding Tabes," published in the Revue Neurologique, of January 15, 1900, the question is considered whether there is any essential difference between the syphilis preceding a tabes and the syphilis after which no tabes develops. This question is not a new one. It was first brought to the attention of the scientific world by P. Marie, who described the case of two men, both of whom acquired syphilis from the same source at the same time. They both became tabetic, the one twenty-two and the other twenty-three years afterwards. The question then arose: Are there reasons for supposing that there is a form of syphihs, which may be spoken of as a nervous syphilis, that is one which shows an especial tendency to attack nervous tissues? As a means of studying this question, the syphilitic symptoms of nine cases, which afterwards developed tabes, were studied, and compared with the symptoms of an equal number of syphilitics in whom no tabetic symptoms ever developed. The symptoms were studied from the standpoints of initial lesion, skin manifestations, throat, length of time of various stages, reaction to mercury, etc. It was found that no differences could be discovered at all. In every case it Selections. » 173 was impossible to say that the syphilis producing tabes differed in any essential from an ordinary syphilis.—Sidney 1. Schwab, in March Stylus. THREE RECENT NERVOUS SYMPTOMS.—There are three nervous symptoms. which have been more or less frequently discussed in neurological literature during the past year or so. Two are in the nature of reflexes, and one is a c-efinite clinical symptom. In the order of their importance they are, first, Kernig's sign in meningitis; second, Babinsky's plantar reflex, or Phenomene des Orteils; third, the imagine reflex in the pupil of the eye. Kernig's sign is due to the increased rigidity of the muscles so frequently found in meningitis, in both the epi- demic and other forms. It consists in an inability of the patient to fully extend the lower leg. The method of obtaining the symptoms is as follows: Place the patient on the edge of the bed, with the leg hanging over the edge and attempt to extend the legs fully. The resistance of the upper leg muscles will be -felt and will prevent the patient carrying out this maneuver. The value of this sign is very great, though it is not limited altogether to meningitis; any diseased condition producing rigidity of the muscles in general might very well cause it; hysterica! contractures could simulate it very easily. As a diagnostic aid to men- ingitis, in the presence of other symptoms, it is very useful. The plantar reflex of Babinsky has only a relative value as yet. The phenomenon is as follows: When the sole of the foot in a normal individual is stimulated, there results a reflex action of the toes. This motion is always a flexion of the toes in the metatarsophalangeal joint. While this reflex may be absent altogether in some people, never in normal individuals is an extension of the toes observed. If the extension movement is found, it points to a lesion of the pyramidal tract or cerebral region, by which this tract is placed out of action. Furthermore, it is asserted that this symptom is a very early one and may be observed before other signs of the disease have appeared. This symptom has been the subject of much investiga- 174 Selections. tion since its discovery. The general opinion seems to be that it is by no means so constant a symptom as its dis- coverer would have us believe. Dr. Martin Cohn, in an article in the Neurologisches Centralblatt of July, 1899. arrived at the following conclusions: In the majority of individuals, a flexion of the toes follows the stimulation of the sole of the foot. In lesions of the lateral tract of the cord, whether functional or organic in nature, an extension of the toes follows this stimulation in the majority of cases. In no way, however, can this symptom be regarded as. pathognomonic of such lesions. A further utility of this symptom may be found in the fact that Babinsky has never found the extension reflexes in functional diseases. This is denied by Cohn and asserted as true by Schuler. The latter claims that this phenomenon can be of use in differentiating a functional from an organic- lesion affecting the pyramidal tract. It certainly seems a valuable addition to the means we already have of differ- entiating a hysterical hemiplegia from an organic one. The last of these reflexes has at present only a psychological interest. The imagination reflex of the pupil was studied and observed as long ago as 1855. It consists of the narrowing of the pupil if one imagines a well-lighted place and a widening of the same when a dark place is visualized. In blind individuals the same phenomenon has been observed.—SIDNEY I. SCHWAB, in March Stylus. LOCOMOTOR ATAXIA AND SYPHILIS.—Dr. Albert S. Ashmead, referring to a statement that "Professor Erb, from his researches in one thousand cases, believes that 'tabs' (locomotor ataxia) is almost without exception due to syphilis," asks how Professor Erb would explain the fact that in Japan, where syphilis has scourged the population for thirteen hundred years, locomotor ataxia is unknown. In a venereal clinic of ten thousand cases Dr. Ashmead did not find a single case of locomotor ataxia, nor did he meet a native physician who knew of such a disease as "tabes." Opposed to this opinion of Professor Erb, says the author, in Germany there stands that of Professor Virchow, Selections. 175 who believes that syphilis has no relation to locomotor ataxia. Upon this the editor of the Journal comments as follows: "Apropos of the above from Dr. Ashmead, we quote the following abstract from the August number of the Journal of Nervous and Mental Disease, referring to a paper on Tabes Dorsalis and Syphilis, by A. Guttman: The reaction evident of recent years, against the view of the etiological signifi- cance of syphilis in tabes is made more pronounced in the statistics of the author. In all, some one hundred and thirty-six cases of tabes were closely studied, and of these, deducting six doubtful cases, 28.6 per cent had had the syphilis, while 71.4 per cent were nonsyphilitic' The author also considers the evidence derived from the fruitful- ness of syphilis medication, and gives his approval of the general methods used to strengthen the body—baths, massage and electricity."—Kansas City Index Lancet. THE ELEVATOR DISEASE—The London News is re- sponsible for the following warning, which we believe may have an element of truth: "It looks as though people with weak hearts had, after all, better climb ten flights of stairs than effect the ascent by means of the lift. This convenient institution is becoming ubiquitous. We soar up to the top- most story of the sky-scraping flat, we descend through geological strata to the twopenny tube by its assistance. We thought we were thereby saving our vital energies and lengthening our lives. The doctors seem to hold another opinion. Lift attendants have died sudden deaths; people with weak hearts have noticed ominous sensations when in the elevator. We are told the sudden transition from the heavier air at the foot to the lighter air at the top is extremely trying to the constitution. Even millionaires and bishops and aldermen are now voluntarily tramping upstairs and avoiding the swifter but insidious route. In fact, a new disease has swung into our ken, 'liftman's heart.' We have all of us been risking this malady without knowing it. It is true most people have experienced the singular sensa- tion of internal collapse when the lift floor sinks beneath 176 Selections. the feet, but none of us suspected the results might be so serious. Every new notion for health and comfort seems to bring its particular Nemesis." —Bos/on Medical 6r Surgical Journal. BIAS IN CLINICAL MEDICINE.—Under this heading Dr. Judson S. Bury, of Manchester, according to the Lancet, has recently delivered an address before the Medical Society of University College, London. After describing the errors into which a diagnostician is likely to fall, through poor equipment or one-sided training, he concludes as follows: "A patient was not an automatic machine into which a penny could be dropped to pull out a particular disease ready for treatment. On the contrary, the organs by which he moved and lived were composed of living tissues which had a past history and a future development, both of which required consideration before the case could be properly grappled with. The thoughtful qualified man began to find out that he must study other things than mere medicine to acquire that knowledge of humanity so essential to a just appreciation of the many ills to which flesh was heir. The man who got into the habit of regarding every patient as merely a "case" and who ignored the look of feebleness or of distress, or the expression of anguish, and thought only of physical examination, was not well equipped for the diagnosis of obscure disease—he became a machine which was totally unable to unravel the complicated problem of human pathology. Three things were essential for the pre- ventive treatment of the disorder known as bias—namely, care, doubt and truth, and if one thing helped more than another to avoid the pitfalls of bias and of hurried unscien- tific work, it was that practitioners should put themselves in sympathy with their patients and that they should care for them in the way that Dr. James Jackson, the hero of Oliver Wendell Holmes, cared for his patients. Jackson would have it that to cure a patient was simply to care for him. Such devotion was only to be looked for in the man who gave himself wholly to medicine, the noblest of arts, which the gods of ancient religions did not disdain to practice and to teach.—Boston Medical &, Surgical Journal. Selections. 177 SKIN CHANGES IN PARALYSIS.—The change is readily noticed in the skin of the forehead. Ask the patient to look upward and then downward for two minutes. In this disease three or four minutes elapse before the wrinkles disappear. Fraenkel, who first called attention to the skin changes, attributes them to a thickening and loss of elasticity. A microscopical examination of a case showed an increase of connective tissue. — Reuling in Maryland Medical Journal, March, 1900. VISUAL DISTURBANCE AFTER LIGATION OF THE CAROTID.—(Centralblatl f. d. Med. Wissenschaften). Liga- tion of the common carotoid artery was followed by total blindness of the eye of the side upon which the ligature had been placed in two cases observed by Siegrist. In both cases he found an embolus of the central artery of the retina and a slowly progressing thrombosis of the ciliary vessels which supply the arterial wall. The visual disturbances after ligature of. the carotid are not caused by the ligation of the vessel, but must be considered as complications which are caused by the pathological conditions for which ligation is made necessary or which may exist when ligation is performed. ACROMEGALY WITH DIABETES-TUMOR OF THE PIT- UITARY GLAND.—The patient presented the classical symptoms of acromegaly, and suffered from this disease for six years. He was attacked with intense headache, ocular disturbances, especially in the left eye, and at the same time polydipsia and polyuria. The examination of urine revealed the presence of sugar. The polyuria was to the extent of twenty litres, and the glycosuria to Ihe extent of 1200 grains of sugar in the twenty-four hours. This severe diabetes lasted six and half months, the polyuria and the glycosuria maintaining the same proportions. Mean- while there occurred crises of diabetic coma, relieved on every occasion by large doses alkalines. The patient died of pneumonia. At the autopsy, in the position usually occupied by the pituitary gland there was found a lobular 178 Selections. tumor, soft, of a reddish-brown color, composed of a number of vegetations forming a hernia through the left cavernous sinus and a portion of the dura mater which covers the sella turcica. Histologically this tumor, in some of its parts, resembles the normal pituitary gland, but in others it pre- sents the appearance and the elements of sarcoma. All the other viscera were increased in weight and size—Translated from Giornale Internationale delle Science Mediche, by HARLEY SMITH.—Canadian Practitioner &, Review. THE ETIOLOGY OF ANTERIOR POLIOMYELITIS.—The resemblance in onset to certain of the acute infectious diseases together with the fact that this disease often occurs in groups of two or three cases has for some time past led to the hypothesis of a specific organism as the etiological factor. That it often follows other diseases, most frequently diarrhoea, scarlet fever, or measles, according to Holt, has lead to the belief in the minds of some that the degenera- tive changes in the anterior horns of the gray matter of the spinal cord are due to the toxins of various diseases. Others have been inclined to regard these changes as due to infec- tious embolism or thrombosis of the blood vessels. The fact that other diseases of the nervous system, such as meningitis or measles, have been observed in some individ- uals while others in the same locality were at' the same time suffering from anterior poliomyelitis has lead to the hypothesis that these several conditions might be the results of the same cause acting on one or another part of the ceretro-spinal system. In a recent article on the etiology of this disease, Auerbach states that while only eleven cases were seen in the Frankfort Polyclinic from 1892 to 1897, between May and December, 1898, fifteen new cases were admitted. Two occurred on the same street at Frank- fort. From the occurrence of cases in which there is extension of the changes to the brain, from the detection by Schultze, of the Weichselbaum-Jager meningococcus in the fluid removed by lumbar puncture and from the occa- sional presence of acute meningitis always with the spinal changes, Auerbach is inclined to believe that meningitis, Selections. 179 poliomyelitis, and encephalitis are often due to the varying intensity of action of the same micro-organism.—Editorial by T. in Pediatrics, Nov. 15th, 1900. t THE NERVOUS SYMPTOMS AND SEQUELAE OF IN- FLUENZA.—At the recent meeting of the British Medical Association, held at Ipswich, a very important discussion took place in the Section of Medicine on "Influenza as it Affects the Nervous System." Dr. Judson S. Bury, of Manchester, opened the discus- sion. He considers that the nervous disturbances produced by the influenza bacillus and its poisonous products may be broadly separated into two groups. In the first group he places nervous diseases which develop during or shortly after the febrile stage, instancing meningitis and hemorrhagic encephalitis as the most marked examples of this group. In the second group are included the nervous troubles which are usually met with after the attack has subsided, neuras- thenia and multiple neuritis being mentioned as good examples. It is assumed that the toxins produced by the bacilli are more dilute and less virulent in the second than in the first group, being sometimes sufficiently powerful to initiate degenerative changes in the nerve tissue, whereas in other cases they appear to simply bring about functional disturb- ances without giving rise to any recognizable anatomical changes. As a good example of the first group he narrates the particulars of a case of meningo-encephalitis, characterized by headache, pyrexia, and a rapidly developing coma, death occurring a week after the onset of the symptoms. The post-mortem showed a hemorrhagic meningo-encephalitis chietly affecting the frontal lobes of the brain. Although the presence of the influenza bacillus was not demonstrated in the brain, still Dr. Bury considers that there was strong presumptive evidence, in the absence of disease elsewhere, that the meningitis was influenzal in its origin. Meningitis may exist alone, but is probably more fre- quently attended by inflammatory disease in the brain itself. 180 Selections. Mention is made of the not infrequent condition of a men- ingitis being set up by a streptococci or staphylococci in the course of an influenza, sometimes the bacillus of the latter disease being present and sometimes absent. The menin- gitis may be secondary to a purulent otitis set up by influenza, or to a suppurative condition of the nasal cavities. There would appear to be a little doubt that influenza is not an infrequent cause of meningitis and of meningo-encepha- litis. Another cerebral complication of a grave character occurring after influenza is cerebral abscess. Dr. Bury refers to a case occurring in the practice of one of his colleagues, where it was secondary to a collection of pus in the ethmodial cells consequent on an influenza. An abscess was found in the right frontal lobe and a small collection of pus in the upper ethmoidal sinuses on the right side. The great frequency of suppurative middle-ear disease during either the course or after the subsidence of an influenza is an every day experience of the practitioner during an influ- enza epidemic. It is, therefore, not surprising that cerebral abscess now and then follows. The writer, at the late meeting of the Canadian Medical Association, described a case of abscess of the temporo-sphenoidal lobe, consequent on a suppurative otitis media coming on during the course of an attack of an influenza. The first definite cerebral symptoms were observed some three mo'nths after the in- fluenzal attack. Reference was made by Dr. Bury to cerebral abscess following influenza when no definite suppurative focus of origin was to be met with at the autopsy. The post-influenzal nervous disorders are very numer- ous, nearly all forms of inflammatory and degenerative lesions being met with. Not only do we find lesions in the brain and cord, but also in the cerebral and spinal peripheral nerves. As regards the cord, almost every variety of myelitis or of degeneration of its various tracts may occur. Among the cerebral sequela;, we meet with the various functional dis- turbances, as neurasthenia, hysteria, epilepsy, various forms Selections. 181 of psychosis, etc. Among the inflammatory diseases of the cerebrum, we have the various types of encephalitis as well as general and local meningitis. The peripheral lesions in- clude almost every known form of neuralgia and multiple as well as local neuritis. Particular attention is called by Dr. Bury to the strik- ing peculiarities of the action of the influenzal poison on the bulbar nuclei. Thus, "While, as in diphtheria, there may be paralysis of accommodation associated with paralysis of the palate, there is a greater variety in influenza than in diphtheria as regards the grouping of muscles affected with paralysis. Thus we meet with isolated paralysis of the superior rectus, or of the internal or external recti, with transitory dilatation of one pupil, with intermittent paralysis of accommodation, with paralysis of both thirds or both fourths, or of both sixths, or of both sevenths, or with paralysis of one side of the tongue." Recovery is looked upon as almost invariable in these, hence the conclusion that the disturbance is of a functional character, or, at least, due to slight changes. Dr. Bury concluded his careful paper by narrating a number of interesting case's of nervous sequels of influenza. One case in particular is worthy of mention. It was a form of widespread atrophic motor paralysis without any sensory involvement. The patient, a girl aged fifteen years, presented all the symptoms of an influenza at the onset of her illness, the paralysis soon developing, and in a short time after the most profoundly affected muscles presented the reaction of degeneration. The knee jerks were absent and although a year after there was a complete recovery as far as the loss of motion was concerned, the knee jerks did not return. Such cases are not uncommon. They may be due either to a poliomyelitis or a peripheral neuritis, or both these conditions may be present. It is likely that in the great majority of cases the paralysis is peripheral and not central in origin. Otherwise recoveries would neither be so frequent nor so complete as they usually are. Dr. Bury and the speakers who followed him pointed 182 "Selections. to the difficulties in recognizing an influenza, ami conse- quently the probability of numerous errors. The diagnosis of influenza is based more on negative than positive facts. The sudden advent of a febrile illness during an influenzal wave is about all the positive evidence usually considered necessary to establish a diagnosis. While our knowledge is so limited we must of necessity be prepared for numerous errors in diagnosis, and consequently in judging of the nature and cause of the complications and sequela of febrile diseases—-James Stewart, retrospect in Montreal Medical Journal. NEUROSURGERY. RESECTION OF THE CERVICAL SYMPATHETIC — Jonesco, of Bucharest (International Medical Congress), gave statistics of one hundred and twenty-six such resec- tions, of which ninety-seven were in epilepsy, fifteen in exophthalmic goiter, twelve in glaucoma, one in vertigo due to cerebral anemia and one in essential migraine. The speaker has modified the operatic technic so as to remove the whole cervical chain, and in the last four cases even the first thoracic ganglion, while preserving intact the su- perficial cervical plexus and the facial nerve. He performs the entire operation at one time. The therapeutic results of the cases detailed were as follows: Of thirteen cases of epilepsy operated on in 1896, five have since died, three were absolutely cured, one improved and four were unsuc- cessful; of seventeen cases in 1897, six were cured, two improved, five unsuccessful and four disappeared from view; of twenty-seven cases in 1899, two were improved, one unsuccessful and twenty-four disappeared from view; of twenty-one cases in 1900, one was cured, two improved, one unsuccessful and the result of seventeen is not known. Of fifteen cases of Basedow's disease, six were entirely cured; four decidedly improved and three, though cured, have been operated on too short a time to be included. The migraine cases are also too recent to give the results. Selections. 183 Chipault, of Paris, said he had done forty resections of the cervical sympathetic; twenty-three for epilepsy, three of which were cured, the remainder being uncertain; two for exophthalmic goiter; five or six for glaucoma; three for facial neuralgia, all being cured; and one for spasmodic torticollis, which was cured. The intracranial resection ac- cording to Krause's method was done twice with success, but the speaker considers it a serious operation which should, therefore, be limited to very special indications.— Medical News. THE TECHNIQUE OF LUMBER PUNCTURE.- The lo- cation for entering should fulfill three requirements: (1) Where the needle could fine a ready entrance; (2) the tip should point in such a way as least likely to produce dam- age; (3) the fluid obtained should be rich in sediment. Any one of the three lower lumbar spaces should be chosen. At the lumbo-sacral space the fluid should be richer in sediment. The sitting position should be assumed, but in the delirious or comatose, there is greater difficulty in operating in the sitting position. The upright position is generally confined to small children. An essential point to remember is that Ihe greatest degree of flexion should be maintained; if the child is sitting it should be bent well forward; the operator should stand on the right side of the patient and bend over the body. Anesthesia.—General anesthesia is entirely unnecessary in most cases. The skin should be anesthetized with cocaine to permit the needle being introduced without dis- comfort. Asepsis.—The same care is demanded here as in the operation of opening any serous cavity. Landmarks.—It may be well to count the spinous processes from the twelfth dorsal, to which is attached the last rib, downward; or we may take a line across the highest points on the iliac crests; this passes nearly the upper edge of the fourth spine. 184 Selections. NEUROPHYSIOLOGY. THE NEURON IN ANATOMY AND PHYSIOLOGY.—M. Verworn. This summary of the facts on which the neuron theory is founded was presented at the Congress of Physi- cians and Naturalists which met at Aix-Ia-Chapelle, Sep- tember 19. Nissl believes that the theory of the neuron as a unit is untenable, but Verworn claims that all the latest researches have merely confirmed this theory. He admits that the neuron is not the same thing everywhere that we see in Golgi's pictures of the cells of the anterior cornua. The neuron is of many varieties and shapes, ac- cording to its location and its functions, as Nature never works by an exact pattern. Modern research has led to further and freer evolution of the conception of the neuron as a cellular unit. lie reports experiments which show that the metabolism in the central nerve-centers is incompara- bly more intense than in the peripheral nerves, also that the centers pass through stages of fatigue and exhaustion the same as the mucles; fatigue from autointoxication and exhaustion from using up the reserve supplies, especially of oxygen. Mis pupil, Baglioni, is soon to publish an ac- count of researches which show that strychnine injected into the spinal cord affects exclusively the sensory elements of the posterior horns, increasing excitability to an enormous degree, while carbolic acid in certain solutions affects merely the motor elements of the anterior horns, increasing their excitability.—Deutsclic Medicinische Wochenschrift (Leipsie), September 22. CLINICAL PSYCHIATRY. ACUTE DELIRIOUS MANIA.—John Turner believes that all forms of acute delirious mania are of toxic origin, some being caused by the introduction of a poison from without, others by the absorption of septic material, while a third class is due to autointoxication. As regards the action of a possible poison on the nerve cell and its functions the Selections. 185 subject is too speculative for any advantage to be derived from discussing it. In cases with high delirium and a rap- idly fatal termination there is generally a condition present in which all the giant cells are profoundly altered, and probably the inspection of a section in such cases would furnish a tolerably accurate diagnosis of the mental state preceding death.—Medical Record Abs. from British Medical Journal, September 22, 1900. PARETIC DEMENTIA.—According to Dr. C. G. Chad- dock, (Medical Review, Dec. 8th, 1900.) this disease is uniformly fatal. It varies in the rapidity of its course, but in every case the end is no less certain. There are occasional remissions, but they never last longer than a few months. There is a great liability to apoplectiform and epileptiform attacks, and the patient grows progressively weaker mentally and physically; if death has not occurred before, he becomes helpless and bedridden. The end is usually brought about by an apoplectiform or epileptiform attack, or a continued series of them, which ends in ex- haustion. Some years back it was pointed out in the ALIENIST AND NEUROLOGIST that there was a distinction between paretic dementia attacking one already disordered by heredity or disease. The normal organism furnishes the typical paretic dementia. The organism in which a neurosis has been set up by phthisis, gout, rheumatism, traumatism, lead or brass poisoning, insolation, heredity, ataxia or other cause furnishes a typical case of paretic dementia present- ing many features in common. I he rheumatic and gouty type have prolonged remissions which may be as Spitzka, Regis, and Kiernan have shown (ALIENIST AND NEUROLO- GIST, 1893), pass into recoveries. In the other types there is a long-lasting, querulent, paralucid condition, in which the patient while retaining to a limited degree his former exalted opinion of himself, conceals this under resentment evinced in law-suits or fault-finding. The exalted opinion is often the result of a delusion of memory. The same is true of the depressional delusions, which are sometimes so retained as to affect business transactions. THE Alienist and Neurologist. VOL. XXII. ST. LOUIS, JANUARY, 1901. No. 1. Subscription $5.00 per*Annum In Advance. $1.25 Stn£le Copy. CHAS. H. HUGHES. M. D., Editor. HENRY L. HUGHES. Manager and Publisher. Editorial Rooms, 3H57 Olive Street. Business Office. 3857 Olive Street. Subscribers falling 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.] New Year's Greeting.— Twenty-one years have passed since the ALIENIST AND NEUROLOGIST first en- tered the field of Scientific Medical Journalism with intent to popularize for the general practitioner and savant, as well as to epitomize, and with plainness and brevity, pre- sent the leading facts and discoveries in Neurology, Psy- chiatry and Mental Neurologic Forensic Medicine, so that the student on these lines of the world's work and progress might economize time while gleaning the essential knowledge. The success of the ALIENIST AND NEUROLOGIST in securing professional and financial support from the interests to which it has steadily catered has been exceedingly satisfactory to its founders and collaborators. Having reached full maturity of years and experience, it confidently hopes to better subserve its many patrons in the years before it even than in the years that are passed so profitably in its career. [186] Editorial. 187 With hearty thanks to all who have helped to make it the foremost periodical of its kind in the world, and cordial greetings to its friends everywhere, it hopefully enters upon the duties of the new year of the new century with inspiration and courage born of its useful and suc- cessful past. The Insane Epoch and the Last Lucid Inter- val of Oscar Wilde.—Our esteemed contemporary, the Literary Digest, summarizes some of the press opinions on this talented but morbidly erratic child of genius and vicious neuropathic heritage, and refers to some of his literary work and two of the best poems of his better days, writ- ten before his latent inherent tendency to decadence had become active and after the temporary reaction and recu- peration in brain and consequent moral tone following his sequestration and enforced rest. Like many other persons of erotopathic perversion, in- tense religious, emotional life, not usually within the pale of the normal, either precedes or alternates in mental dominance, and thus Oscar Wilde enters the church and writes the Ballad of Reading Goal, his last poem, which will be read after the immoral episode of this unfortunate, organically degenerate child of erratic genius shall have been forgotten. An over-educated, overworked, ambitious, flattered young man of intellectual aptitude and unstable, neurotic inherit- ance weakens and breaks in brain under the strain and goes entirely to pieces in paths of folly. The broken brain and latent degeneracy of psychic neuron is revealed in morbid erotic perversion. The genesic sense morbidly misdirected and deprived of normal inhibi- tion goes wrong and the robust world's anathemas are heaped upon the doomed mental cripple. Had this un- fortunate psychopath taken to kleptomania as others have done or a purer form of erotomania as Kelvin and Abelarde, or pyromania and destroyed his house instead of his char- acter, or dipsomania and destroyed his character in another way, there would have been found enough intelligence in 188 Editorial. the non-neurologic and non-psychologic world to have con- sidered this unfortunate man's entire life and ante-natal history, and pitied its fatal ending, and he might have fortunately found a fortuitous refuge, or mayhap a cure, in a sanitarium for the brain-broken and the mentally-maimed. Society with its large allotment of neuropaths and psycho- paths mildly waltzing near the crater's edge of mental alienation, only for the time being an apparently extinct volcano, and chasing one psychopathic fad after another; it and his fatal hereditary endowment are responsible for this unfortunate psychopath's sad and morbidly disastrous career. Where now are the sunflower and the calla lily, em- blems of perfect propriety of color and the other vagaries of aestheticism which wildly enraptured the crank's follow- ers, who socially apotheosized him, and astonished the level- headed onlookers of the Wilde pageantry of his singular career two decades agone? Gone into oblivious history, like the thousand and one fads psychopathically inspired, which, before the advent of Wilde, had come and gone their abnormal way in the world's record. Poor, unfortunate, pitiable Wilde. Through the neuro- pathic obscuration of your closing days you seemed to have discerned in part your sad undoing. Poor victim of a vicious heredity. Your faith in the Lord Christ is not misplaced. He will do what man has not done. "He will consider your frame" and "remember that you are dust," neuropathic dust, predestined under ad- verse mental environment, to wear and break, what steadier brains, more stably endowed in hereditary nerve element, would have built for enduring fame a beautiful monument of high ideals. But the psychopathic rot of a wrong heredity has ruined all. The wide, wide world does not see that neural strands, paternally and maternally strained to weakness, have broken in you, but the alienist and neurologist discerns the fatal fact. Public Neglect of American Medical Immor- tals is strikingly illustrated by the oblivion assigned them in Miss Gould's Temple of Fame. Editorial. 189 The name of Benjamin Rush, foremost discoverer in psychiatry and who also, as Surgeon-General of our patriot army, substituted the flowering Mayapple of our fields and forests for mercury at a critical time in American history and thereby ameliorated the struggle for American independence, in addition to his fame as a deviser and signer of the Declaration and patriot member of the Continental Congress, and Horace Wells, the immortal discoverer of anaesthesia, have been assigned no place among the worthies of our new pantheon. Nor has Ephriam McDowell, whose successful pioneer penetration of the human abdo- men blazed a pathway to fame for home and foreign surgeons and robbed unnumbered graves. And the bust of Marion-Sims, likewise, whose perineal skill made the domestic hearths of royalty and poverty alike places of painless happiness, where painful misery was before, will be a stranger there. The rescuers of the human race from maladies and miseries have not an equal place with those who invent sewing machines or arms of destruction. The diplomat, the framer of fine phrases, the pedagogue, the preacher and the statesman, the merchant and the mechanic are there but the best friend of mankind in its hour of distress are not deemed worthy a place among these lesser beneficiaries of the people. How passing strange! How strangely ungrateful, forgetful and incon- sistent! Insanity in A dors.—Nearly two years ago the ALIENIST AND NEUROLOGIST remarked that in modern life there are many willing spirits among ambitious mental toilers who, seeking fame and realizing that labor only brings success, are unremitting workers, still Nature sue - cumbs and the struggling brain breaks down in insanity under great pressure. The individual is fortunate if he have no more vicious inherent aptitude than to take on nervous depression, or neurasthenia, under pressure, ami if he have added none of the usual vices of public life, of alcoholic stimulants, late suppers, to hasten collapse of 190 • Editorial. nervous energy under high professional pressure. For to be dowered with a bad brain heritage—heritage of tendency to instability—and to add to that vicious brain-break indul- gences, is to doom one's intellect to destruction. Recuper- ation is often possible after the first breakdown, if vice have not added to the breaking pressure and inherent weakness. Poor McCullough and' J. K. Emmett in the dramatic profession are conspicuous and warning illustrations, while bright, brilliant, beautiful little Victoria Bateman is an example of pure and simple brain-break under crushing overwork and brain-strain that ought to have been spared her. The sordid avarice of the box office killed her; inno- cent, perhaps, of the certainty of collapse, but all the same, it killed her— "For evil is wrought by want of thought, As well as want of heart." But the box office is not the only cause of actors' and actresses' breakdown. They drop out under the dissipating pace that kills. Long hours of social dissipation after the play, stimulant drug habit from self-medication to postpone the headache and tired feeling and overcome the exhaustion temporarily of their strained lives. In this category fell Courtney Barnes, whose last act, like McCullough's, was _ in an asylum for the insane, and hosts of others equally unfortunate, who lived if they did not love, not wisely but too fast. The willing horse was worked to death, or, what is near the same, to perilous brain-break, with a possibility of mental aberration and probable finale of dementia or total obliteration of mind. These opinions seem to be em- phasized by the recent death of Hoyt, the playwright, from paretic dementia. In his case, however, facts compel a critical examination from another standpoint. Over three decades ago Kjiellberg claimed (Hospitals Tidende, 1868) that paretic dementia never occurred in a subject free from inherited or acquired syphilis. Mendel later showed that syphilis in the parent (Archiv. f. Psychiatrie B. II) may produce a predisposition to insanity in the offspring, such insanity occurring long after the usual syphilitic congenital Editorial. '191 manifestations attain their full development. The father of Hoyt had locomotor ataxia for thirty years, the disease having begun before the birth of Hoyt, the playwright. Locomotor ataxia is very frequently a parasyphilosis. In- deed, the vast majority of cases occur in syphilitics. Paretic dementia in the majority of cases is also a para- syphilosis. It would seem probable, therefore, that the predisposing factor in Hoyt was a congenital parasyphilosis. Cases of this kind are much more frequent than is usually supposed. In a family coming under Dr. Moyer's observa- tion a woman had had, by a first husband, a perfectly healthy child. She married a second time a man who died suddenly. By him she had four children, three of whom (two boys and one girl) suffered from juvenile paretic dementia. In this case infection of the mother had clearly resulted in a congenital parasyphilosis in the child which had produced during puberty stress breakdown into paretic dementia. It was long ago noticed that psychoses and neuroses in actors were principally paretic dementia and locomotor ataxia, as well as progressive muscular atrophy. Actors are not only exposed to the mental overstrain, but also are exposed to both sexual and innocent syphilis in the course of their avocation. K. The Eye-Strain Headache. Fad and Fact.— O. Landman in Medical Record recommends the instillation of atropine in the eye for the diagnosis of certain forms of persistent headache as valuable for headaches associated with eye-strain. The pains, he says, are usually, when due to ocular defects, superciliary, occipital, occipito-frontal, vertex and temporal. One type of diagnostic headache of eye-strain he locates on the top of the head and gives it an area of about the size of a silver dollar; it is circum- scribed and the scalp is tender. He uses a solution of one- fourth of a grain of atropine sulphate dissolved in two drams of water. Three drops of this are instilled three times a day. If the headache disappears under this mode of test- ing, it is probably due to eye-strain and is best relieved by glasses. 192 Editorial. Our ophthalmologic friends are bent on taking the whole field of neurology and general medicine. If there is any one type of headache that is characteristic of anaemic neurasthenia'it is the circumscribed vertex cephalalgia above described, and for any kind of pain few remedies are better than hypodermic atropine, and ophthalmologic instillations ought to be equally effective. Atropine was one of Austie's chief and favorite remedies. To make the relief of headache superciliary, occipital, occipito-frontal, vertex or temporal by atropine diagnostic of eye-strain and calling for glasses is an exceedingly special specializing of diagnosis. Why not try the glasses first? Most oculists do this. It is of the hop, skip and jump kind of conclusion. Some ophthalmologists always "have their nerve with them," in their thoughts the ophthalmic nerve. We hope the ophthalmologists of the above type will call a timely halt and leave a little something to neurology. The Influence of Morphine on Gastric Secre- tion.—F. Riegel in Leitschrift fur Klinische Medicin, dis- cussing this subject, says: In view of extensive experiments on men and animals, that the universally accepted belief that the secretion of gastric juice is inhibited by the administra- tion of morphine rests on errors of observation, and that the therapeutic use of this agent in conditions in which the object is to diminish the secretory activity of the stomach is ill-advised. On the contrary, morphine given during fast- ing or with the food causes an increase of gastric juice, though there is a considerable latent period before this re- sult is manifest. His conclusions apply to recent cases, not to chronic habitues of the drug. A fuller abstract may be seen in Medical Record, October 6, 1900. Our Genial Friend Dr. I. N. hove, the talented editor and proprietor of the St. Louis and New York Medical Mirror and member of the faculty of the New York Post- Graduate Medical School and Hospital, was the recipient of Editorial. 193 well-deserved testimonials of appreciation from the Missis- sippi Valley Medical Association at its late meeting in North Carolina, in addition to the honor of delivering the annual oration. Psychic Transitions in Play Presentations.—It is an interesting matter to know that the "Punch and Judy" show, so popular at English and American children's Christ- mas and Easter entertainments, as well as at carnivals, circuses and fairs in Italy, France, England and America, is only a degraded travesty and last survival of one of the old "Mystery" or "Sacred Plays," of which the Bavarians retain one in the now world-renowned "Passion Play" at Ober-Ammergau. The name "Punch and Judy," is from the two chief characters, "Pontius" and "Judas." "Punch" as a Roman, speaks with a foreign accent, has a Roman nose, and on his back a hump. This is in consequence of the tradition that after the condemnation "Pontius was haunted by the idea that "the evil one" sat upon his back. In his exile he was always followed by a black dog. Hence the introduction of "Tobey" so named from the dog "Tobias" in the "Apocrypha." "Judas" has been transformed into a woman because she was dressed in a flowing robe after the fashion of the East, The child was our Lord, chucked about from "Pontius" to "Herod." The play of "Pontius" was popular in the middle ages and Chaucer alluded to it. This, and all "The Mystery" plays, were performed in the streets. The players had carts for their properties, upon which they placed boards for a stage and erected wings and a top—a hanging—covering up the wagon. During the per- formance the players who were not "on" mixed with the crowd and collected money. The comic man or "Jack Pudding" (as he was termed) always a chartered libertine, sold quack remedies, drew teeth and bled patients. From his appearing on the stage he gained the name of "Mounte- bank". An engraving of the Coventry and Chester plays is to be found in "Houe" and in the "Pictorial History of England," where the ante pendium, or hanging over the wheels, is decorated with the symbols of "The Passion," 194 Editorial. indicating that "Pontius and Judas" was the play depicted. The whole thing is very like the present "stage" of" Punch" only with altered proportions. There is a little ladder at the end for the actors to ascend by, and the call boy to summon each, as wanted. During the Commonwealth the laws were so severe against actors, as may be seen in "Scobels' acts" that plays ceased almost and the present "Punch" arose as a fantoccina to answer a demand for amusement. Of course it is only a degraded travesty of the original play. "Punch" as "Polichinello" is a favorite in Italy and France. Beautiful Oak Grove.—A series of handsome photos of this charming sanitarium at Flint, Michigan have come into our possession for which we return thanks. We have shown them with pride and they have been inspected with pleasure by numbers of people. An American Physician in the English House of Lords was the late Dr. Fairfax of Maryland," says the Medical Standard for November. Dr. Fairfax was the eleventh Baron Fairfax of Cameron in the peerage of Scot- land. The only title by which he cared to be known was that of Doctor, which he held as a graduate in medicine of the University of Pennsylvania. The Missing Sponge.—STRING YOUR COTTON AND YOUR TOOLS.—Our excellent contemporary the South- ern California Practitioner, has an editorial on this subject, referring to one hundred and eight cases of sponges, gauses, napkins, instruments, irrigation tubes, seal rings, etc., among them a fatal case in the practice of Dr. Skene. There is a psychical lesson in all this, a lesson of avoidance. Avoid haste in operating save when haste is imperative, avoid operating when the brain is fagged, at the close of the day or after a weary waking night. Be as sure of the tone of your brain, brother surgeons, as of the quality and condition of your instruments and of the aseptic environment of your patient. Of what use are sanitary precautions when per- Editorial. 195 sonal psychical precautions are neglected. The horrible record is worth reading for instruction. It is reproduced from Neugebauer's Brief Report of One Hundred and Eight Cases in which Foreign Bodies were Left in the Abdominal Cavity After Operating" in Monatschrift fuer Gebuntshulfe und Gynekologie, April. 1900. Read this record, brother surgeon, and henceforth deal more gently with the neurologists and when disposed to twit them for their failures to cure remember they do not often kill. Tea Neurasthenia.—A recent suicide of a tea taster in Chicago has called attention to the toxic influence of tea. Professional tea-tasters, as Talbot remarks (Degeneracy: Its Signs. Causes, and Results) have long been known to suffer from nervous symptoms. Very early in the practice of their occupation the head pressure symptoms of neuras- thenia occur. Tremor also occurs early. While changes in the optic nerve have not been demonstrated beyond a doubt, still eye disorders have been observed in the pauper tea drinkers of the United States and in the tea-tasters of Russia thus indicating that changes similar to those produced by tobacco and alcohol are likely to occur in the optic nerve from tea. Bullard has found that tea has a cumula- tive effect. In his experience toxic effects are not produced by less than five cups daily. The symptoms manifested are those of nervous excitement resembling hysteria, at times almost amounting to fury, nervous dyspepsia, rapid and irregular heart action, neuralgia of the heart, helmet-like sensation on the head and tenderness along the spine. James Woods of Brooklyn found that ten per cent of those under treatment at the city hospital exhibited similar symp- toms. Of these sixty-nine per cent were females. Every symptom ascribed by Bullard to tea was found by Wood in his cases. Women manifested irregularities in menstruation of neurasthenic or hysteric type. These symptoms were produced by one-half of the quantity of tea charged with them by Bullard. The Lancet several years ago, discussing tea-tippling took the position that in no small degree ner- 196 Editorial. vous symptoms occurring in children during infancy were due to tire practice of the mothers, both of the working and society class indulging in the excessive use of tea, excess being judged by its effects on the individual and not by the amount taken. Convulsions and resultant infantile paralysis were frequently noticed among the children of these tea tipplers. Observation among the factory pop- ulation and the workers in the clothing sweat shops show that tea neurasthenia presenting all the ordinary symptoms of nervous exhaustion is especially common among these. It is evident hence that tea produces a grave form of neurasthenia readily transmissible to descendants. In addi- tion to its effects directly upon the nervous system tea tends to check both stomach and bowel digestion and thus increase the auto-intoxication which is so prominent a cause, consequence and aggravation of these nervous con- ditions.—J. Marriage and Suicide.—One of the Chicago news- papers claims that marriage has a determining influence in the production of suicide. Throwing aside the influence of race and periods of stress, the facts as to the relation be- tween suicide and marriage remain as they were laid down by Morselli ("Suicide") about two decades ago. The study of the social status ought to follow that of sex and age, with which it is intimately connected. The usual error has been to infer the more or less favorable influence of celibacy and marriage from the absolute numbers of suicides, with- out taking into account the numerical difference in popu- lation between unmarried and those who are or have been in the conjugal state. It is necessary to keep count of the great preponderance of the single under twenty years of age, to attain an exact proportional comparison. Among the English scarcely 36 per 1000 men are married before their twentieth year, while among women at that age already 151 per 1000 are married. The advice of Oettingen to eliminate all the individuals under twenty years of age should not be followed, since by so doing almost two-tenths of the married would be excluded, at any rate where there Editorial. 197 is a tendency to early marriage, as in England. It is better to limit the exclusion to all children and young peo- ple under fifteen years of age, and then to proceed to the proportional calculation per million of the remaining indi- viduals. But statistics containing information on this important element of social life are most complete in this direction in Italy. These show that, as at all times it has been admitted, celibacy has a disadvantageous influence in comparison with marriage. Marriage has the most beneficial influence on man's vitality, and that which happens to mortality in general is repeated as to suicide except that the effects, as might naturally be foreseen, are still sharper particularly in widowhood. But the most, marked divergence from the normal is the state of widowhood; in all countries the proportional relations between the widows and widowers exceed that between the spinster and the .bachelors, between the mar- ried women and married men, so that evidently widowhood brings the woman nearer to man than any social condition. A fact which might be conjectured even before it was con- firmed by statistics, although, according to researches of Bertillon, the mortality of widowers everywhere, but es- pecially in France and Belgium, surpasses that of widows. It is a fact that wars making great number of widows always raise the annua! number of their suicides. G. Effect of Alcohol on the Brain -Nix. Victor Horsley, F. R. S., London, Surgeon to University College Hospital, in a recent lecture "demonstrated by means of lantern slides the disappearance under the influence of alcohol of the granular masses in the Purkinje nerve cor- puscles, and how the protoplasm of the body of the corpuscle lost its characteristic structure and and the nucleus became altered in shape. The toxic influence of chronic alcoholism on the pyramidal cells was also demonstrated in a similar manner, and the effect of alcoholic poisoning on the normal pigmentation in nerve cells was illustrated by a slide representing degenerated nerve cells, from the Archives of 198 Editorial. Neurology, edited by Dr. Mott, and published under the auspices of the London County Council. Mr. Horsley con- cluded his lecture by stating that from a scientific stand- point the contention so often put before them that small doses of alcohol, such as people took at meals, had practically no deleterious effect could not be maintained." Such object lessons constitute the right sort of temperance lectures. Some day the scientific world, as well as the world in general will awaken to the fateful fact that the medicinal and other virtues of alcohol have been rated without reason, woe rather than weal of the world walks in its wake. Corning's Subarachnoid Cocaine Anaesthesia.— Dr. J. Leonard Corning the original American discoverer and devisor of this method has written a timely letter to the Editor of the Medical Record partly claiming the laurels justly due him for this method of spinal anaesthesia lately revised by Bier and Tuffier and others abroad as follows. Addressing Dr. Wm. J. Robinson to same journal Nov. 10th: "It is the method of subarachnoid anaesthesia that promises to work a revolution in general surgery and obstetrics, and the credit of the method undoubtedly belongs to two men—to Prof. August Bier and to Professor Tuffier: to the first as the discoverer of the method, and to the second as its popularizer." Had the author looked into the subject more carefully, he would have found that in my book on "Pain" (J. B. Lippincott Company, Philadelphia, 1894) I have, under the head of "Irrigation of the Cauda Equina with Medicinal Fluids" (pp. 247-254), devoted six pages to the consideration of subarachnoid anaesthesia, which I devised and executed in 1888, and published five years before either Bier or Tuffier entered the field. Bier's paper was published in 1899 and Tuffier's in 1899 and 1900. Be patient Dr. Corning! Honor will come home to you where it belongs as honor of priority has finally come to others. The original discoverer of general anaesthesia (Wells) was served the same way, so was McDowell, so was Rush and some others. There are a kind of medical men in Editorial. 199 America who think no good can come out of American Nazareth and accept nothing not of foreign extraction or foreign en- dorsement. Such men are about to reach the conclusion that quinine is a prophylactic against malaria now that Koch says he has discovered a preventive remedy for malarial disease in which quinine is the chief ingredient. This foreign en- dorsement by the discoveries of the comma baccilus will put a period to all controversy now and confirm the skeptical in the prophylactic power of quinine, salicin and the cinchona bark derivatives. The combined testimony, to this effect, of the medical men of the Mississippi Valley and Gulf States, the surgeons of the civil war and planters of the South will soon pass as of some value. Koch in Germany has made the discovery! Even the testimonies of our British army medical brethren in Africa and the English tropical possessions will now be accepted for Koch has made the discovery! Again. Coming's Cord Cocainization has come to the front and now Tuffier of Paris approves and uses it. Tuf- fier's contribution may be found in La Semaitie Medicate for May, 1900, and an excellent article on this subject also appears in the Medical Fortnightly for November, 1900, by Dr. Carl Black, of Jacksonville, Ills. Third Pan-American Medical Congress. Officers of Section Neurology and Jurisprudences on Mental and Nervous Diseases. — President, Dr. Gustavo Lopez; secre- taries, Dr. Jose A. Malverti, Dr. Aristides Mestro, Dr. Rafael Perez Vento, Dr. Chas. H. Hughes, 3857 Olive, St., St. Louis, Mo. Medical Jurisprudence.—President, Dr. Jos. M. Cespedes; secretaries, Dr. Juan Gomez de la Naza, Dr. Ernesto Sana, Dr. Alvarez Ortiz. Meet at Havana, Feb. 4-8. Effect of Intense Electric Light Glare on the Retina and Optic Nerve.—A peculiar accident occurred at Middleport about Oct. 6, (recorded in the Scientific American, Oct. 27th, 1900.). The big iron safe in the 200 Editorial. Middleport shoe factory refused to open, and the bookkeeper, Louis Jaquith, and Engineer Walter H. Rice conceived the idea that they could burn out the combination by use of carbon and electric wire. It took several hours to accom- plish their purpose. They finally succeeded, but not until they had stood for several hours in the glare of the electric light, taking turns at holding the wire and carbon. When the work was over both complained of a dizziness and pain in the head, which increased as the hours passed, and in a short time both went suddenly blind at about the same time. All efforts to restore their sight have been unavail- ing, for while the eyeballs appear all right the sight is destroyed. These cases should not be lost sight of but followed to ascertain how permanent the damage may be. The Prussian Blue Treatment of Epilepsia.— When the editor-in-chief of this journal was a first year medical student he became familiar with this and the nitrate of silver treatment for epilepsia. Prof. McGugin, at that time dean of a medical school at Keokuk, Iowa, employed the following formula for epilepsia: Ferri Cyanuret, gr. xx Pulv. Valerian, "xx Ft. Mass. Secund. Art. Ft. Cap. No. xx. S. One three times a day after meals. This preparation of iron as well as valerian were in use in that day. Old U. S. dispensatories mention it. Subsequently the editor modified the formula of Dr. McGugin to read as follows: Ferri Cyanuret (Tilden's), gr. xxx Ex. Gentian, "v Ex. Valerian, v Pepsin Scale, "xx Ex. Pancreatis (Fairchild's), " xx Ferri -pyrophos, "xx Aq. Menth. pp. q. s. ft. Mass Ft. Cap. No. xx. Sig: One or two early every morning and at night and after the noon meal daily. This is a valuable combination for regular use with or Editorial. 201 without the bromide treatment, whose properties are appar- ent at a glance to the neurologist in the management of epilepsia. The cyanuret of iron may be largely increased. Latterly I have substituted half a grain of Gardner's hypoquinidol for the ferri-pyrophos and under certain cir- cumstances (as anaemic cachexia) have added one twenty- fourth of a grain of chloride of gold and sodium and made the whole into a mass with arsenaura, giving a course such as twenty-four capsules would make, and repeating as might be indicated. The Journal of Mental Pathology makes its debut January, 1901, to continue monthly thereafter. It is edited by Louise C. Robinovitch, M. D., and published by the State Publishing Company, 32 Broadway, New York. It will publish researches on mental clinic, cere- bral pathology, neurology in its relation to mental clinic, alcoholism, morphinism and the allied diseases, criminology, anthropology and other researches in the auxilliary branches of the sciences relating to or bearing on the study of the mind; from time to time space will be devoted to medico- legal analyses and a column will be reserved for bib- liography. News of the asylums in the United States and abroad and personal intelligence will also receive attention. It will be ably managed by a distinguished editorial board and corps of contributors. The editor is an indefatigable and well-known worker in the field chosen for the new journal. Her acquaintance is large among home and European psychiatric scientists, who will take an active interest in promoting the success of the new enterprise, which the versatile genius of the able editor will appreciate and utilize. We wish prosperity and long life to both the periodical and its charming and accomplished proprietor and editor. Dr. R. W- Gardner, of single syrup hypophosphite fame, has written a commendable article, of interest to all physicians, on the subject of designating preferred manu- facturers of prescription ingredients. Reliable caterers to 202 Editorial. the profession are entitled to be preferentially designated in prescriptions, that the standard of purity and strength, so essential to safe and successful prescribing, may be secured with certainty for the welfare of our patients. When pharmacists are thus forced to give us the best medicines we will do better in practice and the 'just as good' abuse will cease. Among the Beat Contributions to the December number of the Bulletin of the Johns Hopkins Hospital is an article on "Theodore Billroth as a Musical and Surgical Philosopher." We wish to compliment Dr. John C. Hem- meter upon the excellent manner and skill with which he treats and presents this interesting subject. "Microscopical Reproductions of the Blood and Bacteria," sent out by Reed & Carnrick, is a work of merit, worthy of the consideration of every physician. ANNOUNCEMENT. THE ALIENIST AND NEUROLOGIST, edited by Drs. C. H. and Marc Ray Hughes and an associate corps of col- laborators, will post you in the briefest way in Insanity and Neurology in general, as well as special practice and in their medico-legal aspects. Neurology in general medicine is a special feature of the ALIENIST AND NEUROLOGIST, and its Selection and EJitorial Departments will inform you thoroughly in all diseases where the nervous system is involved or ought to be treated in practice, and give you the latest advances in the most important field of medical discovery and practice. No one whose aim is to be a thoroughly enlightened practitioner of Medicine, or competent when testifying in Court on Neurology or Neural aspects of Medical Practice, can afford to do without THE ALIENIST AND NEUROLOGIST. Terms, $5 per year in advance. Address HENRY L. HUGHES, J857 Olive Street, St. Louis, Mo. REVIEWS, BOOK NOTICES, ETC DISEASES OF THE NERVOUS SYSTEM. By H. Oppenheim of Berlin. This interesting book by the distinguished Professor at the University of Berlin, appropriately dedi- cated by its eminent author to the memory of that Prince of German Neurologists, Carl Westphal, comes to us in authorized translation by Edward E. Mayer of Pittsburg, Pa. and from the well-known publishing house of J. B. Lippin- cott Co., Philadelphia and London. The translator has done his part of the work well. The name of the well-known author needs no further commen- dation to American neurologists than the mention of his distinguished name and we have so often hitherto commended the excellent work of the Lippincott Company as to make further commendation from us at this time superfluous. The book is designed as a text book for students and practitioners will well fulfill the author's design. It contains two hundred and ninety-three illustrations. We are pained to note, however, the absence of due recognition of American writers in the book. For instance the name of Hammond does not appear in connection with athetosis which he named and was the first to describe. The author adopts the Charcot narrow view of post haemiplegic chorea as the basis of this condition and ignores the many cases, including our own recorded in this country, some of them bilateral, reported in the United States in support and satisfactory confirmation of Hammond's discovery. This ignoring of American contributions to the literature of neurology and psychiatry is somewhat too common abroad. JAHRESBERICHT uber die Leistungen und Fortschritte auf [203] 204 Reviews, Book Notices, Etc. dern Gebiste der Neurologie und Psychiatric Published by S. Karger, Karlstrasse 15, Berlin. This great , resume of the world's literature in two great depart- ments of medical research and thought comes annually to our sanctum laden with the skillfully epitomized work of a thousand of the world's best workers in the ranks of medi- cal study. Graced and embellished by the industrious cullings of eminent leaders in the literature of German and European medicine. The volume should be in the library of every savant and student. Last year the page fronting the title page was decorated with the handsome and intellectual face of our brilliant and learned friend, Mendel, the distinguished neurologist of Berlin, a fitting frontispiece to this important work of which he is an eminent collaborator. This great book of reference should be in all the great libraries of the world and especially in the Congressional Library at Washington. It is a great annual Neuriatric and Psychiatric Index Medicus. PROGRESSIVE MEDICINE, Vol. IV., December, 1900, comes to us with the following table of contents: "Diseases of the Digestive Tract and Allied Organs, The Liver, Pancreas and Peritoneum," by Max Einhorn, M. D., "Genito-Urinary Diseases and Syphilis," by William T. Belfield, M. D., "Fractures, Dislocations, Amputations, Sur- gery 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., "Hygiene" By Henry B. Baker, M.D., "Practical Therapeutic Referendum" By E. Q. Thornton, M.D. "Progressive Medicine" was awarded grand prize at the Paris Exposition in 1900. THE DIGESTIVE POWER OF PEPSIN.—By Benjamin T. Fairchild, New York. Reprinted from the Western Druggist, Chicago. This is a clear and convincing presentation of the subject by one who knows whereof he speaks and as a member of a firm that has put the best Reviews, Book Notices, Etc. 205 pepsin and pancreatin products and preparations on the markets of the world. This is too late a day in progress of the chemistry of digestion for Mr. Perry, or any o'ne else to maintain or assert that dilate hydrochloric acid is the diges- tor sine qua non of the gastric juice. Dilute Muriatic acid has its place and so has pepsin in the stomach. Read the paper and see the proof. Fairchild Brothers & Foster have done an inestimable service to Medicine in popularizing, practicalizing and cheap- ening good American pepsin, and as capable pharmaceutical caterers as Mr. Benjamin Fairchild is a valliant defender of the value and utility of Pepsin. Stand back Mr. Perry. THE MARYLAND HOSPITAL NEWS, Christmas Number is an interesting one. The story of the Darlington Divorce Case is a charming Christmas story illustrating the Shakesperean motto "All's Well that Ends Well." "Midsummer Night's Dream" is another attractive story. The editorial selections and brevities are all meritorious. The home comfort and happiness of the hospital are reflected within this monthly paper. The whole make up of this handsome periodical is as beautiful in design as a daisy. RESULTS OF FIVE YEARS' EXPERIENCE WITH CO-OPER- ATION BETWEEN STATE HOSPITALS FOR THE INSANE. —May it be Profitably Extended to other Charitable Institutions? P. M. Wise, M. D. A good paper which may be read with profit by all medical officers of institutions and if read will bring conviction in the affirmation of the able author's interrogation: "Co-operation between State Hospitals: May it be Profitably Extended to other Charitable Institutions? Retinitis Albuminurica with Report of Cases. By Fran- cis W. Alter, M. D., Toledo, Ohio, Late Resident Surgeon New Amsterdam Eye and Ear Hospital, New York City; Member of the Lucas County Medical Society; The Ameri- can Medical; Northwestern Ohio; and Toledo Medical Associations. Enzymes in the Treatment of Nasal Polypi, Angioma of the Nose, and Chronic Otitis. By Talbot R. Chambers, M. D., Surgeon in Charge of the Eye, Ear and Throat Departments of the City and Christ's Hospitals;Consulting Ophthalmologist, Orange Memorial Hospital, Jersey City,N.J. Value of Prostatic Examination. By J. Leland Boogher, B.S., M.D., Genito-Urinary Surgeon Barnes Medical College, St. Louis, Mo. 206 Reviews, Book Notices, Etc. Railway Surgery in America. By Clark Bell, Esq., LL.D., President International Medico-Legal Congress of New York, 1889; President Medico-Legal Society of New York; Dele- gate from the Government of the United States to the International Medical Congress of Paris, 1900. Aseptic Minor Gynecology, with demonstrations. By Augustin H. Goelet, M. D., Professor of Gynecology in New York School of Clinical Medicine; Consulting Professor of Gynecological Electro-Therapeutics, International Corre- spondence Schools, Scranton, Pa., etc. Locomotor Ataxia. By Hugh T. Patrick, M.D., Professor of Neurology in the Chicago Policlinic; Associate Professor of Nervous Diseases in the Northwestern University Medical School: Neurologist to the German and Maurice Porter Hospitals, etc. Maladministration of Public Medical Affairs in the State of Texas. By H. A. West, M. D., Secretary of the Texas State Medical Association, Galveston, Texas. Some Thoughts Relative to the Etiology of Degenera- tion. By Chas. E. Woodruff, M. D., U. S. Army, Fort Riley, Kansas. Report of the Surgeon-General, U. S. Navy, Chief of the Bureau of Medicine and Surgery, to the Secretary of the Navy, 1900. Report of the Committee on a State Board of Health, Texas State Medical Association, Waco, Texas, April 26, 1900. Eleventh Annual Report of New York State Commission on Lunacy Oct. 1, 1898 to Sept. 30, 1899. The Public Health and the State's Duty to Protect It. By M. M. Smith, M. D., Austin, Texas. Report of the Government Hospital for the Insane to the Secretary of the Interior, 1900. Local Application in Medical Practice. By Jos. E. Chambers, M. D. Stump Pregnancy. By John C. Morfit, M. D., of St. Louis, Mo. The Etiology and Cure of Hysteria. By F. Walter, M.D., Perry, Mo. A New Nasal Splint. By Francis W. Alter, M.D., Toledo, Ohio. Michigan Asylum News, Kalamazoo, Michigan. MELLINS food FRESH COWS MILK Simple dilution of cow's milk with water is with- out avail in obviating the tendency of the milk to form tough and more or less indigestible curds. PROFESSOR CHITTENDEN The use of a natural cereal extractive containing saccharine and gummy matters and soluble albu- minoids as well, such as our great and inspired teacher Liebig himself advocated, is in accordance with the developments of science since his time. Mellin's is a genuine Liebig's Food. PROFESSOR LEEDS melon's food COMPANY. BOSTON,MASS PUBLISHERS' DEPARTMENT. Insanity in Lead Workers; Acute Delirious Mania.—Robert Jones concludes: (1) That lead poisoning is a contributory factor in the causation of insanity, and that in lead workers there is a higher average number of general paralytics than in others of the population; (2) that there is a tendency in these cases to cardiac, renal and arterial degeneration with complications due to syncopal or epileptic fits; (3) that most cases present marked signs of anaema and ill-health, with unsteadiness of gait and general impairment of muscular strength and very frequently a history of temporary failing vision; (4) that the mental symptoms may be grouped among one or other of the fol- lowing varieties: (a) those in the nature of toxaemia and with sensory disturbances, and which tend rapidly to get well; (b) those with hallucinations of sight and hearing more chronic in their nature, and which may be irrecover- able. The delusions in this class are almost invariably those of being poisoned or followed about, and are in the main persecutory; (c) those resembling general paralysis with tremors, increased knee jerks, incoordination, and ac- companied with listlessness amounting to profound demen- tia, but which tend to get well; (5) and that in most lead cases presenting mental symptoms the tendency is to re- covery unless the patient dies early.—Medical Record Ab- stract from British Medical Journal, September 22, 1900. Moral Idiocy; Its Frequency in the Descen- dants of the Insane.—Morel has shown that medical maladies are aggravated from one generation to another, and that moral insanity is often met with in the children [2r7] Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Hellanthus annuus [sunflower.] Fr. root, bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism, is in- dicated In a I cases complicated with Malaria, Scrofula, im- poverished Blood, Anaemia, etc.. etc.,In conjunction with Pil Orient- alls (Thompson), will control the most obstinate cases of Impo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotency. and were poisoned with Phosphorus compounds readily yield to this treatment. Pil Orientails (Thompson) contains the Extract Ambrosia Orientails. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In uoth Sexes, cannot be over-esti- mated. It is not an Irritant to the organs of generation, but a RECUPERATOR and supporter, and has been known to he native Priests of India. Burmah and Ceylon for ages, ard has been a harem secret In alt countries where the Isiam has planted the standard of Polygamy. It is Impossible to send free samples to exhibit in Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation (with formulas ind med'Cal testimonials) to physicians who are not acquainted with their merits. p; I Helantha Compound, $1.85 per oz. Powder or Capsules, rnces. j pj| OrlentallslThompson)$1.00 per box. WASHINGTON, D. C. THE IMMUNE TABLET COMPANY, AGENTS: Meyer Bros. Drutf Co., St. Louis. Lord, Owen A Co., Chicago, bvans-Smith Drug Co., Kansas City. Redlngton & Co., San Francisco. J. L. Lyons & Co., New Orleans. ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST M I LWA U KEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING WtSMmifrtk ORIGINAL DESIGNERS & ARTISTS ★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ * ★ ★ ★ ★ ★ * * ★ * Laxative Logic To induce catharsis without the objectionable sequalae common to a majority of laxatives, no remedy responds to the need of the physician with more satisfaction and celerity than SYRUP OF FIGS. As made by the California Fig Syrup Co. from the highest grade Alexandria Senna, SYRUP OF FIGS has achieved a potency and recognition as an agent of established therapeutic worth. There is no preparation that simulates Nature so well in its effect. No other is better suited to the permanent relief of intestinal inactivity, a functional derangement directly respon- sible for the condition described as constipation. Its gentle effect upon the intestinal mucous membrane and the natural peristalsis which follows the administration of SYRUP OF FIGS gives to it a unique value as a laxative, and suggests its adaptability to women and children because of its agreeable taste and persuasive action. It is invaluable to persons who through in- firmity or occupation are committed to a sedentary life. It is simple, safe and reliable, and possesses the particular merit that its use does not induce the cathartic-taking habit, and in all cases where a laxative is indicated it is a help and not a hindrance. SPECIAL INVESTIGATION IS SINCERELY INVITED. *' Syrup of FigB " is never sold in bulk. It retails at fifty cents a bottle, and the name of "Syrup of Figs." as well as the name of the "California Fig Syrup Co," is printed on the wrappers and labels of every bottle. CALIFORNIA FIQ SYRUP CO., San Francisco; Louisville; New York. ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ * ★ * * * * ★ * ★ ★ ★ ★ * 208 Publisher's Department. of the insane. The truth of these two facts, which are fundamental in the study of alienation, is incontestable, and I have verified it myself. The expression 'moral in- sanity' designates a great moral perversion, which renders the individual in whom it exists incapable of adapting him- self to the social order. It is improper, because it appears to suppose that this perversion is accompanied with deliri- ous ideas, which is not so. The term 'moral idiocy,' employed by some authors, and under which Krafft-Ebing describes it with such precision, fits much better. The same as in intellectual idiocy, there may be admitted, ac- cording to the degree of perversion, a moral idiocy proper —an imbecility and a moral debility. In twenty-five hereditarily insane patients treated at the asylum of Evreux moral idiocy was found in seven, which shows its fre- quency. As for moral debility, it is almost constant in the descendants of the insane, even when they appear to enjoy normal cere'jral faculties. It seems that this insanity is ordinarily produced by an excitation, vivid or prolonged, of the egoistic instincts, excitation which persists not only during the intellectual troubles, but persists for some time after their disappearance. The excitation develops these instincts, and the morbid development is yet augmented by hereditary transmission, which is progressive. Moral idiocy is a cerebral degenerescence which in no way resembles the savage state of our ancestors. They were not lacking, like moral idiots, in altruistic instincts, without which they would have been unable to live in association. Moral idiocy is often accompanied by a certain intellectual weakness, but is also met with in persons of the highest intelligence. Individuals who are tainted with it constitute a permanent danger to society, and should be placed in special refuges, from which they should not go out until their moral amelio- ration, established by a competent commission, permitted giving them liberty. Their place is not in insane asylums, where they spread disorder by their vicious instincts, and where, to prevent their frequent attempts to escape, very rigorous measures of surveillance must be employed, which aggravates their condition. To prevent the children of the FAST TRAIN "The Katy Flyer" BETWEEN ST. LOUIS, KANSAS CITY, CHICAGO, Has Through Sleepers TO. GALVESTON, SAN ANTONIO AND AUSTIN, TEX. Also Intermediate Points. Excursion Sleepers leave St. Louis for Texas, New Mexico, Arizona and California every Tuesday, 8:16 p. m. C. HA1LE, Traffic Manager. JAMES BARKER, General Passenger and Ticket Agent. ST. LOUIS, MO. 1 209 Publisher's Department. insane from becoming tainted with insanity, it is best by long education, well directed, to repress their selfish feel- ings, which are too mnch excited, to develop their social sentiments, and give them plenty of quiet work.—Abstract by A. M., in Weekly Medical Review, Dr. Daniel Brunei, International Medical Congress. The Prophylaxis of Insanity.—Although last in point of deliverance at the recent meeting of the Canadian Medical Association, the paper by Dr. R. W. Bruce Smith, on "Mental Sanitation," was probably first in point of im- portance. As the alienist, Dr. Smith speaks with no little weight; and the question is one which can well afford to be considered with care by the thoughtful sanitarian, who, for the time being, is the general practitioner. There is no class of the community who should command the attention of the physician, in the way of bettering their conditions and environment, more than the unfortunate who loses the proper conception of things in general; and this, in a large measure, they have received, as is evidenced in the splen- did hospital facilities erected for their care and comfort all over the land. But in the endeavor to offset the tendency towards insanity, there is yet a wide field for enterprise and prudent forethought. In no direction can the mind of the physician be exercised to more advantageous work than that of devising ways and means for lessening the tendency towards insanity, which Dr. Bruce Smith, speaking with the authority of years of experience and close and direct observation, tells us is on the increase throughout the length and breadth of Canada. He points out that some- thing like fifty per cent, of these cases is due to hereditary influence, and that efforts ought to be put forward to counterbalance that influence on those so disposed. In the other half much could, no doubt, be done in the way of prophylaxis; but they are generally allowed to drift until too late, and they then become wards of the government. The question of intermarriages amongst families having the same blood in their veins, and amongst people who are tainted with heredity, is an all-important one; and, even The Treatment of T^OTT TT'TZ>CrV AND THE E/r lLrlVr O X NEUROSES SUCCESSFULLY ACCOMPLISHED ...BY THE USB OF... sV HYDROCYANATE OF IRON (TILDEN'S) A STANDARD NEUROTIC REMEDY, INDICATED IN EPILEPSY LOCOMOTOR ATAXIA HYSTERIA NEURASTHENIA MANIA NEURALGIA CHOREA MIGRAINE DOCTORS, INVESTIGATE! Write us for literature and clinical reports on the treat- ment of EPILEPSY and NEUROSES. We have on file In our office hundreds of testimonials from men of prominence and ability in their chosen profession, who have employed HYDRO- CYANATE OF IRON (Tilden's) with unvarying success in the treatment of EPILEPSY. Copies of same cheerfully mailed upon application. Prepared Exclusively for Physicians' Prescriptions. SOLD ONLY IN OUNCE CARTONS, 1/2 AND 1-6RAIN TABLETS. $1.00 PER OUNCE. PREPARED ONLY BY THE TILDEIVJ COMPANY, Manufacturing Pharmacists, NEW LEBANON, N. Y. ST. LOUIS, MO. The Western Clinical Recorder (BI-MONTHLY). A Pithy, Practical Periodical for Practicing Physicians *r that will keep a man fully abreast of the times, if he can afford but one, and one that the practitioner who takes twenty cannot afford to do without. The RECORDER will be found to be an original, clean, ethical, inexpensive periodical; a continuous post-graduate course in all departments of medicine and surgery. THE USEFUL JOURNAL FOR THE BUSY MAN, $1.00 Per Year in Advance; which subscription may be sent to the office of publication, Lakeside Press, Chicago, or to the Editorial Office, Ashland, Wisconsin. 210 Publisher's Department. at the risk of being considered officious, the family physi- cian ought to deem it wise and prudent to counsel against the undying wrong which is about to be perpetrated to- wards the unborn innocent. Rural life, with all its charms, has many idle and monotonous hours. Idleness and mo- notony, without the charm and buoyancy of social life, may lead to melancholy and mental depression, which will in- evitably lead to mental ruin and decay. The prevention of these depressed states ought, in a measure, to be within the province of the mental sanitarian, to teach—to educate the follower of the plow and the tiller of the soil and his careful and frugal housewife to participate more in the en- joyments provided by a bountiful nature. Insanity may be on the increase in this country, as well as in all other countries, because of the stupendous impetus given in the last two decades to mental activity. Education has revolu- tionized the world, and the cerebral organ is being worked as it never was before. Is it little wonder that there should be many wrecks by the wayside, where formerly they might weather the storm? "Give your boy an educa- tion" has resulted in crowding all professions and walks of life. Competition has become keen, and the struggle after the "almighty dollar," and even the bare existence, causes untold worry, which, two or three decades ago, was dis- counted by a more even distribution of the fruits of labor. Then the unwholly craze to be in the swim, to be well dressed, to appear well and keep up appearances must all be counted in as factors in producing worry and uneasi- ness, fraught with dire consequences to an already over- wrought organism. These are weighty problems, productive in the end of untold misery and unhappiness; and in "that they are such must surely command the attention of us all in an endeavor to stay the grim hand from gathering others within his clutches. Where to begin is the problem which confronts us as physicians.—Dr. R. W. Bruce Smith before Canadian Medical Association, 1900; Dominion Medical Monthly. The Mosquito and Malaria.—No more interesting WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR. WM. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED. ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AT THE WM. BARR goods COS NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL.RRnni^r a private hospital "riwwrxt., For Mental and Nervous Diseases CASES OF ALCOHOLISM AND DRUG HA8IT. An Inviting quiet hospital for the careful medical care of acute mental diseases, with a refined congenial home for the chronic mental Invalid. The location is unsurpassed for healthfulness and charming environment. Cases of aicoholism and drug habit may commit themselves. For information and rates address Dr. D. W McFARLAND, New York Office with Dr. LAWRENCE, GREEN'S FARMS, CONN. 55 East 65th St. Hours. 12-1 and by appointment. New York Telephone 591-79th St. 211 Publisher's Department. fact in the etiology of disease has been discovered than the part the mosquito plays in the transmission of malaria. It has stimulated the study of this disease, which seemed to have ceased after the discovery of the different forms of the Plasmodium, and has aroused such scientific enthusiasm as to bring to its investigation many distinguished workers and to make the consideration of tropical diseases of the highest importance. Many novel experiments have been made in medicine but none more so than the two suggested and carried out by Manson, who first conceived the relation of the mosquito to this disease. One consisted in having mosquitoes, which had fed on a malarial patient in Italy, brought to London and placed so as to bite a healthy individual, free from malaria and thus develop in this subject malarial fever. The other, which was the complement, sought to keep Europeans, who had never had malaria, free from malaria in an intensely malarial region, where all the inhabitants and visitors suffered from malaria, simply by avoiding the bite of the mosquito. For the first experiment Manson used his son who after having been bitten by infected mosquitoes had chills, fever as high as 103.6° and sweats. The spleen was palpable on deep inspiration and many tertian para- sites were found in the blood. The other experiment took place in the Roman Cam- pagna, near the mouth of the Tiber, in a wooden hut con- structed in England. The only protection for the inmates was mosquito netting, wire screens in doors and windows and netting about their beds. They went about the coun- try freely in the day time, avoiding the anopheles quadri- maculatus, and remaining in their hut from sunset to sunrise, as this species of mosquito, which is the carrier of the malarial parasite, bites only at this time. During the four months of their stay in this intensely malarial region the experimenters, five in number, enjoyed perfect health and had no sign of malaria. The experiments prove that a distinct species of the mosquitoes, the anopheles, is the carrier of the malarial parasite from man to man and that with care malaria, even where it is most prevalent, may TO GUARD THE HEART In the treatment of Febrile, Nervous and Chronic Diseases, and as a Remedy in Functional Disorders of the Heart and Circulation. Each Fillet represents one one- hundredth of a grain of Cactina, the active proximate principle of Cere us Grandlflora (Mexicnna). Dose—1 to 3 plllets. USE Cacttsa is no longer an experi- ment. Physiological writers and the medical profession recognize In It the safest heart tonic In many con- ditions. CACTI NA PILLETS. Sample mailed free to physicians. Artificial digestive agents, such as pepsins and pre-digested foods, are temporary expedients. In treating chronic dyspeptics increases the secretion of the digestive fluids, relieves congestion of the mucous coats of the entire alimentary canal and restores the assimila- tive processes. Dose—one teaspoonful before meals; the dose before breakfast preferably in hot water. Samples to physicians who will pay express charges. SULTAN DRUG CO., Manufacturers of Cacti na Pillets and Seng, St. Louis. PEACOCK'S BROMIDES YOU USE THE BEST. luiddrachm, represents 15grains of 1 Put up in half-pound bottles only. Full blnedC. P. Bromides of Potassium, size sample to physicians who will pay Caicium,Ammonium, and Lithium. | express charges. Chionia lmf bromides £ Chionia Chionia WHEN YOU USE PUIflHlA AN HEMTIC STIMULANT, 0 II I U H IA NOT A CATHARTIC. (From Chlonsnthus Vlrglnlca.) Stimulates portal circulation, strengthens the lymphatics, and remotes Chronic Const!, nation and Sluggish Conditions of the Liter by Its general tonic action on that organ. Put up in half-pound bottles only. Full size bottle to any physician who will pay express charges. PEACOCK CHEMICAL COMPANY, St. Louis. Peacocks Bromide;. Peacock's Bromides Chionia 1__! Peacocks Bromides 212 Publisher's Department. be avoided. This discovery is likely to prove of incalcula- ble benefit not only medically but also politically. The next century will'probably see darkest Africa a thing of the past and malaria medical curiosity.—Editorial in Albany Medical Annals. The Typhoid Bacillus and Drinking Water. At this time of the year when typhoid fever is at one of its two periods of increase many questions of interest arise regarding the disease. One of them, regarding which, the laity and even the general run of the profession seem to be somewhat confused, is the question of the isolation of the typhoid bacillus from drinking water. Apparently many hold the view that to the skilled bacteriologist the matter is a simple one. This is far from being the case. The suspected water is not submitted for examination until the outbreak of typhoid fever is well under way, whilst the infection of the cases occurred three weeks previously, al- lowing this time for the average period of incubation. The amount of water examined is of necessity small, so that bacilli, which are not evenly distributed through it but are present in groups or clumps, can easily be missed even if several samples are taken. Finally the typhoid bacillus is necessarily always associated with the colon bacillus, which rapidly outgrows and destroys it. As the result of these factors it is almost an impossibility to isolate the typhoid bacillus from water, and the presence or absence of the colon bacillus is usually regarded as the index of fecal contamination.—Editorial in Albany Medical Annals. The Physician who is compelled to study, think and work incessantly to keep up with the competitive race, who has superfluous knowledge and skill stored away as reserve forces, whose business methods have given him relief from financial anxiety, whose willing acceptance and discharge of all his responsibilities has set conscience free to enjoy life, will be the most sympathetic, charitable, helpful, hopeful and faithful counsellor and friend man ever had in the dark days of disease.—Dr. Lawrence. "RIVER CREST," (UNDER STATE LICENSE.) ASTORIA, L. I., NEW YORK CITY. FOR MENTAL AND NERVOUS DISEASES. Separate detached building for Alcoholic and Drug Habitues. Splendid location. Overlooks East River and the City. Address J. JOS. KINDRED, M. D., Physlclan-in- Charge. City Office. 1125 Madison Avenue Cor. 84th Street, 2 o p. m. daily. Sanitarium telephone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md. References—Dr. Henry M. Hurd, Dr. Win. Osier, Johns Hopkins Hospital, Baltimore, Md. Dr. Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. Dn Horace Wardner's Sanatorium, DELIGHTFUL TA prtPTO TATTi EVERY HOME ^A ruillii' ±au. CONVENIENCE. l.vrtBLAkfc.N. Nervous and Mental Diseases. Alcoholic and Drug; Habitues. 28S Feet Above WRITE FOR FULL INFORMATION, Mentioning this Lake Michigan. TERMS, ETC. Journal. DR. WN|. B. FLETCHER'S SANATORIUM. For treatment of Nervous and Mental Diseases. Special treatment of Diseases of Women by DR. MARY A. SPINK. 218 H. ALABAMA ST., • - - INDIANAPOLIS, IND. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIER SUDDUTH, M. P., zoo State St., CHICAGO. Mention this Journal when writing to Advertisers. 213 Publisher's Department. "The Hand That Holds the Pencil,"—At a recent meeting of the South Dakota Press Association, Mr. M. C. Brown, editor of the White Lake Wave, read a bright effusion with the foregoing title. We quote two of the four stanzas: We read of mighty powers That are felt for right or wrong; We have had them kept before our minds In poems, prose and song. There's the hand that rocks the cradle, And the hand that writes the dun; There's the man before the public, And the man behind the gun; There's the boy that minds his mother, And the Jack that takes the pot; While the hand that wields the slipper Seldom fails to touch the spot. Strong and potent are the forces That against our lives are hurled, But the hand that holds the pencil Is the hand that prods the world. Pencil pushers of the nation, In whose hands the weapon lies, Ponder well the aim and object Ere the pointed arrow flies: Dealing gently with the erring— Still, denouncing all the wrong,— Ever just in condemnation, And in virtue ever strong.' Let your shafts be keen, yet kindly, Never venom-tipped nor vile; Seeking where a teardrop trembles To replace it with a smile. And while o'er our smiling planet Heaven's azure is unfurled, Let the hand that holds the pencil Be the hand that helps the world. THE HYGEIA SANITARIUM, Astoria, Long Island, New York City. A rest and health resort, magnificently situated in an elevated park overlooking East River and New York City. For Alcoholic and Narcotic Habitues and a// disorders excep- ing Contagious diseases. Address, J. J. KINDRED, M. D., Astoria, L. I., N. Y. Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, MJ>. City Office, 21 East 44th St,, SING SING, P. O., N, Y. Mondays and Fridays, 3:30 to 4:30,p.m. Long Distance Tel., Hart, 140A,Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, M. D. FALKIRK. JAMES FRANCIS FERGUSON, M.D. M. LANGDON BIRD, M.D. On the Highlands of the Hudson, near Central Valley, Orange Co., New York. A Home for treatment of nervous and mental diseases, and the alcohol and opium habits. Falkirk is 800 feet above the sea level; the grounds cover over 200 acres; are well shaded and command a magnificent view. The buildings are steam heated and lighted by gas, the water supply from pure mountain springs. All the rooms face the southwest, the best methods in sewerage have been followed, and the arrangements for comfort and recrea- tion include a sun-room, steam-heated in winter. Dr. Ferguson may be consulted at his office, 168 Lexington Avenue, New York City, Tuesdays and Fridays, between 11:30 a. m. and 12:30 p. m., and by appointment, or may be addressed at Central Valley, Orange County, New York. Long Distance Telephone, "Central Valley, New York." SANITARIUMS and DOCTORS CAN OBTAIN SPECIAL RATES for CARD ADVERTISEMENTS We have a few bound copies of the ALIENIST AND NEUROLOGIST on hand. Price, $6.50 Prepaid. Mention (his Journal when writing to advertisers. 214 Publisher's Department. A Valuable Hypnotic.—Every progressive physician recognizes the necessity of overcoming the insomnia attend- ing certain diseases. At this season of the year, when pneumonia is so prevalent, probably nothing will so satis- factorily relieve the distressing symptoms of sleeplessness as Bromidia. By the use of this reliable preparation we can obviate the effects of losing sleep, and at the same time feel that the heart's action is unimpaired, a dire calamity in a pneumonic process.—Vermont Medical Monthly. Physiological Standardization.—What right has any firm, whose business is to furnish the physician with his principal weapons, to place upon the market pharma- ceutical preparations of unknown medicinal value? Should we not expect, yes, even demand, that the producer of fluid extracts make his products conform to some standard of excellence—that he shall indicate what effects his fluid extracts may be expected to have ere he sends them forth from his laboratory? It has been shown that even drugs selected with care vary most extraordinarily in their percentage of active prin- ciples. Witness, for example, this statement by the editor of a leading pharmaceutical journal (Bulletin of Pharmacy, January, 1899) who knows whereof he speaks: "Prof. Puckner assayed nineteen samples of belladonna leaves procured, mind you, from dealers who were told that only the best was wanted, and that purchase would depend upon the results of the assay. He found these nineteen samples to range in alkaloidal content from .01 to .51 per cent! The strongest sample fifty-one times as strong as the weakest." The most careful treatment of such drugs, with the choicest menstrua, and by the most approved processes, will yield preparations that may be fair to look upon, but in medicinal value they will vary just as much as the crude drugs from which they are made. The compensatory rem- edy for this unfortunate condition is standardization— chemical standardization—when practicable, and when that method is inadmissible, as it often is, physiological stand- ESTABLISHED 1870. RIVERVIEW SANITARIUM. For the private care and treatment of Nervous persons, Mild mental cases, Opium and select Alcoholics. Thoroughly equipped with modern Electrical and Hydriatlc devices, Turkish baths, etc. Arrangement for the reception of patients can be made any hour of the day or night by means of a long distance telephone from any point. Our number is 46-2 Fishkill. ADDRESS P. O. BOX, 694. W. S. WHITWELL, M.D. FISH-K1LL-ON-HUDSON, NEW YORK. theT WESTPORT santtarium, WESTPORT, CONN. A Private Institution for the Care of Mental and Nervous Diseases. Pleasantly Situated. Extensive Grounds. Fifty Acres. Beautiful drives, walks and grove of pine trees. Careful Medical supervision, Kind and Reliable attendants. Bowling Alley, Croquet, Tennis and frequent entertainments. Cottage care with private attendants if desired. Terms Moderate. Applications can be made at 979 Lexington Avenue, New York.City, (Wednesdays from 10 a. m. to 12:30 p.m.) Address F. D. RULAND, Medical Supt., Telephone D 13. WESTPORT SANITARIUM, WESTPORT, CONN. THE "MUNSON" No. 2, Munson No. 2. The Latest Model Steel Typewheel. Changeable Instantly to any Language, any Style of Letter Or to the Medical or Mathematical Characters. Universal Keyboard, 32 keys print go different characters. Write for artistic Catalog. EDGAR A. HILL, Manufacturer. 94-96 Wendell Street, CHICAGO. Terms to Agents on Application. Mention this Journal when writing to Advertisers. 215 Publisher's Department. ardization. It has been found that certain important drugs cannot be assayed chemically, as their medicinal virtues reside in unstable bodies, and these are readily decomposed in the analytical processes. For this reason the strength of such powerful and useful drugs as digitallis, aconite, con- vallaria, strophanthus, ergot, cannabis Indica and many others cannot be determined satisfactorily by the analytical chemist. However, the problem which proved to be an in- surmountable difficulty to the chemist, was solved by the pharmacologist with ease. He tests upon living animals all drugs that cannot be assayed chemically. Dogs, rabbits, fowls and guinea-pigs receive doses of the preparations under examination. Accurate observations of their physio- logic effects are made, variations are noted and corrected, until the preparations correspond in medicinal strength with the adopted standard extracts. Formerly the physician was obliged to make his own physiological tests of ergot, digitalis and so on; not upon dogs and guinea-pigs, however, but upon his patients. The old way was to begin with small doses of powerful drugs and then to push them until the desired effect was produced. The new way is a much better one: it is safer for the patient, more satisfactory to the physician, and it is more scientific. Prompt results are assured, for the physician knows just how much fluid extract of ergot, aconite or cannabis Indica he need include in his initial dose to secure a definite result. The name of the greatest pharmaceutical manufacturing house in this country is so closely linked with the phrase, "drug standardization," that the mere mention of one sug- gests the other. Parke, Davis & Co. began years ago to manufacture a full line of standardized fluid extracts that are guaranteed to be of definite and uniform strength. More recently they devised and perfected methods for standard- izing physiologically those important drugs that are incapa- ble of analysis by chemical processes. Parke, Davis & Co. have done a great deal for the medical profession and for humanity, and standardization, more especially physiological standardization, is one of their greatest achievements. SYRUP HEMATIC HYPOPHOSPHITES (IMPROVED). FORMULA. Fach lluld ounce contains: Potassium Hypophosphlte, 11-2 grains. Iron Hypophosphlte, 11-4 grains. Manganese Hypophosphlte. 1 grain. Caicium Hypophosphlte. 1 grain. Strychnine Hypophosphlte, 1-8 grain. Quinine Hypophosphlte, 7-16 grain. It will be remarked that the medical constituents of the syrup are present in very small proportion. In rtie debilitated conditions in which the preparations of the hypophosphites are usually prescribed, minute doses often exert a more favorable influence than the full doses which the physician is tempted to prescribe. In cases of nervous exhaus- tion especially, recuperation is necessarily slow, and medica- tion to be successful must be based on the maxim festina lente. The combi ation of remedies is one adapted to a great variety of diseased conditions. It is likely to prove useful wherever there is debility or depraved nutrition, but it is spec- ially appropriate in cases of anaemia and nervous prostration. It will be found a general Tonic-stimulant of unusual value DETROIT. PARKE, DAVIS & CO., NEW YORK, KANSAS CITY. 216 Publisher's Department. Hunter McGuire's Opinion.—The late Hunter McGuire, the most celebrated surgeon of his time in the United States, if not in the world, was asked for his opinion of antikamnia by Dr. Thos. C. Haley, of Riceville, Va. Dr. Haley, in writing of this circumstance to The Antikamnia Chemical Company, says as follows: "I recently wrote to Dr. McGuire and gave him my experience with antikamnia in my own case and that of others. Of myself, 1 said that I had been using the'five- grain tablets for four or five years consecutively, and al- ways with great and signal relief to my sufferings. I vouched for it as being the grandest succedaneum for mor- phia. While I entertained these opinions personally, I still felt that the quantity taken should be justified by consulta- tion. Hence, the letter to Dr. McGuire, and 1 am pleased to hand you herewith his reply. The following is Dr. McGuire's reply: ST. LUKE'S HOME, RICHMOND, VA., Nov. 8, 1894. THOS. C. HALEY, M. D. My Dear Doctor:—1 don't see any reason why you shouldn't continue to take the remedy (Antikamnia Tablets) of which you speak and which has done you so much good. I don't believe it will do you any harm. With kind regards and best wishes, Very truly yours, (Signed) HUNTER McGUIRE. "Les Enfants du Bon Dieu."—Our much es- teemed editorial cotemporary, Dr. Warren B. Outten, friend of our early manhood's days, in his valuable periodical, the Interstate Medical Journal, of this city, thus refers to an excellent and timely article of one of the many distinguished contributors to the ALIENIST AND NEUROLOGIST: "The responsibility or irresponsibility of the imbecile for crimes which he commits is well discussed by Martin W. Barr in the ALIENIST AND NEUROLOGIST for January, 1900. This author takes up the case of one Samuel Henderson, aged fifteen years, who on January 14, 1898, killed Percy.Lockin, aged five years. The deed was com- mitted one afternoon in a wood near Philadelphia. The BELLEVUE PLACE SAniTARIUM 35 Miles from Chicago. Esubiish,* by DR. R. 3. PflTTERSOl) m W67. for the treatment of NERVOUS AND MENTAL DISEASES OF WOMEN. A massive stone structure with spacious rooms, electric llght and steam heat, large greenhouses, extensive grounds and beautiful country drives. Private and retired, with home comforts, restful surroundings and skillful medical treatment. Terms moderate* Address for circular, f. H. MDIELS, m. I)., or BELLEVUE PLACE CO., BATAVIA, ILL. OAK GROVE HOSPITAL For Nervous and Mental Diseases. * Grounds comprise sixty acres of stately oaks, and are picturesque and secluded. Buildings roomy, homelike, free from nstitutional feat- ures, and erected with especial reference to the care of nervous and mental invalids. » Interiors Bright and Cheerful, Luxurious Fur- nishings, Superior Appoint- ments, Skilled Attendance, First-class Cuisine. Equipment for hydro- therapeutic and electric- al treatment complete and modern—Static, Galvanic and Faradic Apparatus, Electric Bath, Baths and Massage. Noyes Amusement Hall in connection with the Hospital, containing gymnasium, billiard room, bowling alley, hall for assemblies, sitting room, lounging room and library, furnishes ideal facilities for indoor sports and diversion. Carriages for the daily use of patients free. For terms, address DR. C. B, BURR, Medical Director. FLINT, MICH. 217 Publisher's Department. murderer stabbed his young victim with a potato-knife, and then attempted to sink the body in the river. • The body was afterwards found, and a confession was obtained from young Henderson of his guilt. Barr, an expert for the defense, made a careful study of the boy's case, and upon good grounds made a diagnosis of imbecility. The jury returned a verdict 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, the only means of protection alike to society and for the poor unfortunate. The outcome of this case is. very strange, and but illustrates the peculiar pot-pourri which is occasionally compounded by a court of what is commonly known as justice. It is plain to us alJ that in this case judge and jury alike were quite convinced of the irresponsibility of this boy for the murder. For the reason that the boy showed some traits of reason, for instance, a good memory, an aptitude for remembering faces, etc., these jurors could not understand that the prisoner was absolutely irresponsi- ble, for did he not have a ray or two of reason left, else how could he remember anything? As Barr truly says, it seems well-nigh hopeless for the alienist to make the gen- eral public understand that an imbecile, for instance, may be vastly more clever than a normal child along certain lines, that he may have a phenomenal though not residual memory, that he may have a capacity for music, drawing or painting to an unusual degree, and yet be absolutely lacking in ability for the simplest primary school work. In other words, the lay mind and many of the minds of pseudo-medical experts, for that matter, absolutely cannot compass what daily clinical experience teaches the observ- ant alienist—that it is not the capacity along certain lines which alone will give us grounds.for judging of the sanity or insanity of a given case; it is a careful study of the whole personality of the individual, and especially is this true when we come to deal with the imbecile. We can only arrive at an intelligent idea of the true nature of a mental affection by taking the case and studying it from The David B. Crockett Company, Manufacturers.of FINE VARNISH SPECIALTIES. Leaders In oar line during thirty years past. Five Practical Reasons why Architects, Builders, Government and State Institutions should use THE DAVID B. CROCKET CO.'S PRESERVATIVE: 1ft.—It develops and preserves the different kinds of wool In their natural beauty. 2d.— It is not affected by hot or cold water. M.—Will not crack, blister or turn white. 4U.—Us surface Is not Impaired by contact with soap, grease, or by the ammonia generated In THE DAVID B. CROCKETT COMPANY, Bath Rooms, Stables, Hospitais, or other public bulld- Ings. 5th.— As a finish In Dining Rooms. Kitchens, Hallways, Bath Roomsand Interiors of Railway Cars,over grained work or on hard wood It is superior to any articie In use. Nothing eise will stand on Refrigerators. Water Proof Floor Finish For Interior Floors. Oil Cloths, or Linoleums. Can be rubbed and left with an egg shell gloss, whi h is superior to waxfinish- Ing and costs less. Bath Room Finish. A new specialty for varnishing Toilet. Bath, Engine. Refriger- ator, and More Rooms. Boat Houses, Yacht Cablns and Sal- oons, Breweries, Stables. Lab* oratories, Kitchens. Pantries and Water Closets. Not affect- ed by frequent contact with chemical gases. Immersion In salt water, or washing with hot or cold water and soap. Five Practical Reasons Why Archi teets, Builders, florern. ment and State InstlTuTTons should use the David B. Crockett Co/s. Spar Composition: Our "Architectural Hand Book," giving prices and full Particulars, sent free on application. Mention this Journal when The only genuine articie of Its kind In the market. 1st.—As a finish on exterior wookwork on Yachts. Steam- boats and Railway Cars It has no equal. 2d.—On Front or Vestibule Doors, over grained work or on natural woods, it will outwear all other materiais used for such purposes. 3d.—It will not crack, turn white or blister. 4th.—It will stand washing with hot or cold water and soap 6th.—The extreme toughness and durabllity of Spar Compo- sition make It superior to any articie ot the kind ever offered. All our goods can be rubbed and polished or left with an egg shell gloss. If local dealers cannot supply you, send'direct to Bridgeport, Coon., U.S.A., SAMUEL SWAN, President. W. B. LENT, Vice-President. CH AS. P. TOWNER, Sec. & Treas. writing to Advertisers. 218 Publisher's Department. "start to finish;" it is the tout ensemble that tells the tale. And so, in this instance, it is truly a matter of regret that a supposedly intelligent judge and jury should consign an imbecile, such as this boy clearly was, to a life in the convict's garb. Not only does it signify an act of injustice to the boy and to his people, from a humanitarian stand- point, but it also signifies a culpable act, a menace to the future of society; for certainly when such a man is turned adrift at the end of his twenty years' confinement in prison, he will be a veritable fire-brand to the light superstructure of society, so that it will only be a question of a few hours of freedom before he will again be hounded to death for another crime for which he is assuredly irresponsible. As Barr says: "Would that some philanthropist, bound by ties of love and kinship to one of these unfortunates, would build a place of refuge for these unfortunates, these, whom the French have so touchingly named 'Les Enfants du bon Dieu.'" Mt. Tabor Nervous Sanitarium, Portland, Oregon, begs to announce to its medical friends that Dr. Alicia F. Jeffery has accepted the position of superintendent of the Sanitarium. Dr. Jeffery has had an extensive hospital ex- perience, including two years as superintendent of St. Mark's Hospital, Grand Rapids, and three years of St. Luke's Hospital, Denver. HENRY WALDO COE, M. D., Medical Director. Three String Corsets.—Among the many novelties referred to in the January number of the Delineator is a very simple device whereby any make of corset can be fitted with three strings, so as to assist in producing the upright form now so eagerly sought by athletic girls and women, and women and girls who ought to be athletic. The Golden Ages of the world are so called for their culture, art and literature—not for their vast accumulations of wealth.—Saturday Evening Post. BARNES flEDICAL COLLEGE,s,Km.. Prof. C. H. Hughes. M. D.. Pres. Chas. R. Oatman. M. D. W. C. Day, M. D. Jno. H. Duncan. M. D. Edwin R. Meng. M. D. M. D. Jones. M. D. J. T. Jelks, M. D. IFACULTY. Prof. A. M. Carpenter. Vice-Pres. "S. C. Martin. M. D. "W. L. Dickerson. M. D. "G. M. Phillips. M. D. F. L. Henderson, M. D. "A. R. Keiffer, M. D. . J. H. Tanquary, M. D. "Jno. W. Vaughan, M. D. BOARD OF TRUSTEES. JOHN D. V1NCIL, D. D.. President. Grand Secretary Masonic Grand Lodge of Missouri. JOHN C. WILKINSON. Vice-President. Hargadine-McKlttrick Dry Goods Co. GEO. A. BAKER, President Continental National Bank. A.M. CARPENTER, M. D., Vice-President of the Faculty. A. R. KIEFFER. M. D.. Assistant Secretary. WM. T. ANDERSON. Treasurer. President Merchants Exchange and Director St. Louis National Bank. J. B. LEGG President Lege Architectural Co. C. H. HUGHES. M.D.. President of the Faculty. JOHN H. MARMADUKE, Cashier Mexico Sav- ings Bank. HON. JNO. M. WOOD. ex-Atty.. Gen'I. Mo. PINCKNEY FRENCH, M. D., Secretary. Prof. C. M. Riley. M. D. "A. W. Fleming. M. D. "R. C. Blackmer M. D. "C. H. Powell. M. D. "M. Dwight Jennings. M. D. J. Leland Boogher, M. D. Pinckney French, M.D.. Secretary. -%-A FOUR-YEARS' GRADED COURSE OF INSTRUCTION.-*. Season of 1899-1900 commences September 11th. and continues seven months. Instruction, especially practical: new and spacious building, located in the heart of the city and within five blocks of the new station: modern in all appointments; ample ciinical and laboratory facilities; course of study conforms to the require- nents of all health boards: tuition moderate: ho pital and dispensary privileges free. Special terms to sons and brothers of physicians, sons of the ciergy and graduates of pharmacy and dentistry. For announcement or information, address BARNES MEDICAL COLLEGE, ST. LOUIS, MO. OXFORD RETREAT, A private Institution for the treatment of Insanity, Nerrous Disorders, Inebriety and Opium Habit. Facilities and advantages are unsur- passed for the proper care and treatment of all forms of the above' named disor- ders. Attention is given to the proper ciassification of patients. Average one attendant to every four patients. Care- ful supervision at all hours. Every needed convenience, and any accommo- dation that may be desired. Retired and homelike. Site elevated, beautiful and salubrious. Thirty-nine miles from Cin- cinnati. Eighty-four miles from Indian- apolis. Eight trains daily. Terms mod- erate. For references, terms, etc., address G. M. COOK, M. D., Superintendent, OXFORD, BUTLER CO., OHIO. 219 Publisher's Department. It Is Not Generally Known that Dr. George F. Butler, Medical Superintendent of the Alma Sanitarium, Alma, Michigan, is Professor of Materia Medica and Thera- peutics, College of Physicians and Surgeons, Chicago, formerly Professor of Internal Medicine, Chicago Clinical School, and author of an admirable work on Materia Medica, Therapeutics and Pharmacology, a volume which, within the brief period elapsing since its publication, has passed through three editions and has been cordially received by the medical profession at large, as well as adopted as a text book in important seats of learning, both in the United States and in Canada. It is not surprising that under the competent direction of so noted a medical authority the Alma Sanitarium should exhibit the soundest and most salutary treatment of its guests. The New York School of Clinical Medicine has opened up a new department of neurology, namely, the study of the neuroses and psychoses of spirit and drug diseases. Dr. T. D. Crothers, of Hartford, Conn., has been elected professor, and will deliver lectures and give clinical instruction on inebriety from alcohol, opium,cocaine, and other narcotics, particularly on the symptomatology, treatment and medico-legal relations. These lectures will begin February 18, 1901, in the lecture room of the college, 328 West Forty-second Street, New York City. This is the first effort to give special systematic instruction in this new field and raise the subject to the level of scientific medicine. A good move and a good man selected. We regret notice of this worthy appointment had not come to hand sooner for better space. When We Learned, while abroad, of our talented artist friend Crusius' death, we wondered what might have been the cause of his sudden taking off and could not ex- plain until each year after his death we continued to see the ghastly products of his brilliant brush in the perpetually appearing Antikamnia Almanacs. We shall never see the like of Crusius again nor of the Antikamnia Calendars. Naming the Manufacturer.—Dr. R. W. Gardner, of Syrup Hydriodic Acid fame, among "A Few Thoughts for Medical Editors," contributed to the Medical Journalist, truly speaks as follows: "In view of the fact that the described results have been secured by the use of some particular manufacturer's product, the failure to designate such product does not ac- curately explain the writer's method, does not enable the professional reader to duplicate described results, and consequently, fails to accomplish one of the principal objects of its publication, viz., to disseminate useful details of clinical practice in such form that it may be of practical use to the reader. . * * * 'i "The elimination of the manufacturer's name from the publication is based upon the presumption that all pharma- ceutical preparations, called by the same name and made by different persons, possess equal therapeutic value, and are equally reliable. "That this presumption is false is well known. "Even the ordinary Galenical preparations of the phar- macopeia, made according to rules laid down (or supposed to be), differ materially according to the skill and intelli- gence of the manipulator. "In the process of displacement, for example, the value of the product depends upon the proper packing in the percolator, the degree of fineness, the rate of speed with which the percolate is allowed to pass, etc. "In the hands of a careless, incompetent, or unfaithful operator, the liquid may be allowed to run too freely, form channels between the particles of the drug, and thus largely fail to properly exhaust it of its medical matter. "If this is the case with the ordinary preparations of the pharmacopeia, for which distinct rules are laid down, and complete directions formulated, is it supposed that improved forms of medication, especially studied, and peculiarly adapted to special morbid conditions, and which have been proven to possess superior value ia these cases can be successfully imitated by every corner druggist? "Consequently, if any physician has demonstrated that some particular pharmaceutical product is far superior to others in therapeutic action and can be depended upon for more successful effects in the treatment of disease, I sub- mit, is it not the duty of the physician to designate such particular preparation by the name of its manufacturer? "And is it not also the duty of those conducting med- ical journals, whose office it is to spread valuable knowledge in clinical medicine, to faithfully publish all de- tails so contributed, for the benefit of the patient, for whose sake the profession exists, for the advancement of medicine, and in ordinary justice to the writer of the con- tribution, whose experience cannot otherwise be verified, and whose reputation for competency and honesty is con- sequently injured?" A Psycho-Physical Laboratory. — A Senate amendment to the Sundry Civil Bill, for a Psycho-Physical Laboratory, etc., to be a part of the Department of the Interior, has been introduced. The measure ought to pass, and Dr. Arthur MacDonald, whose enthusiasm and laborious researches in this field entitle him to the thanks of all anthropologic scientists, should be placed at the head of it. The United States government has done too little work in this direction, being far behind private psycho-physical and anthropological work and behind European governmental effort in this direction. Glycobenphene.Heil THE NEW REMEDY FOR ECZEMA and kindred skin diseases, it i» a powerful, *,•'-•. reliable, non-lrrltatlog and pleasant antl§eptlc, and owing to proper combination of varlooi chemical compounds It bos greater healing powers than any other preparation. It relieves the Intense Itching almost Instantly, and by nslng It freely, without friction, the most severe cases of Eczema can be cured In a short lime. It li for external nse only, and being a mixture and not a notation, It should always be shaken before applying It. It Is an excellent dressing for wounds and heals the old- est sores within a rew d.13 s. In the treatment of ulcen and abecsses It Is Invaluable. It can be used freely with absolute safety. In fact, It should be used freely to obtain (be best results. Glycobeophene Ib aiso Indicated In facial eruption, erysipelas, hives, burns, scalds, mosquito and other Insect bites, and It Is a positive remedy for dandruff. We furnish an original bottle, holding 1-2 pint, gratia to any physician wishing to try It. Simply make application by postal card and we shall send It at once. Henry Heil Chemical Co. Borobenphene.Heil THE NEW ANTISEPTIC AND GERMICIDE. It has the antiseptic properties of Boracle Acid, sub- limed Benxole Acid from Siamese Gum Bensolo, Phenol, etc.. and Is prepared by a. special process, by which a powerful, safe, reliable, non-Irritating and pleasant antiseptic Is produced. It mixes In all proportions with water, glycerine and alcohol. It prevents the development of bacteria and decomposi- tion of animal and vegetable matter and destroys bacteria In every form, Is a valuable remedy for the treatment of affections of the ear, nose, throat and mucous membranes of the human body, whenever an anUsepUc Is Indicated, and Is of great benefit In the treatment of bronchitis by Inhalation. It aiso possesses powerful healing properties and may be applied locally to wounds, ulcers, abeesses, etc., or used as a gargle, Inhalant or Injection, la full strength or diluted to salt the varied conditions, Borobenphene can bo used freely with absolute safety externally, and Its pleasant odor and agreeable taste rec- ommends It as an Internal antiseptic In the treatment of the digestive organs, as In Dysentery, Diarrhoea, etc*, Dose Internally 1 For adult*. Id to 60 drops, 3 times a day In a wlnegla&sful of water. As an antisepUc In Dental Surgery It has no equal. We furnish an original bottle, holding 1 glnt, gratis to any physician wishing to try It. Imply make application by postal card and we shall send' It. Henry Heil Chemical Co. 212 S. FOURTH ST., ST. LOUIS, MO. ESTABLISHED 1866. 212 S. FOURTH ST., ST. LOUIS, MO. ESTABLISHED 1866. jUxf THE ALIENIST AND NEUROLOGIST. VOL. XXI!. ST. LOUIS, APRIL, 1901. No. 2. ORIGINAL CONTRIBUTIONS. FRIEDRICH NIETZSCHE: A STUDY IN MENTAL PATHOLOGY* By WILLIAM W. IRELAND, M. D., SCOTLAND. FRIEDRICH NIETZSCHE was descended from a noble Polish family which had sought refuge in Germany from religious persecution. His ancestors on both sides are reported to have been healthy and long-lived. His father was a Lutheran clergyman; his mother the daughter of a clergyman. He was born on the 15th of October, 1844, in the village parsonage of Rocken, in Prussian Saxony. When Friedrich was five years of age he lost his father, who had labored under a cerebral affection for eleven months. His daughter, Frau Forster-Nietzsche,t insists that this was the consequence of a fall on the head; but Friedrich stated his belief that his own nervous disorders were inherited from their father. Olla Hanssont learned from a family who knew Friedrich Nietzsche from childhood that a disposition This article appeared incomplete In the Journal of Mental Science having been cur- tailed in that excellent journal on account of a plethora of other papers. At the authors request we print the entire article, it contains some omitted passages the author much desired should be presented to the public. IDas Leben Friedrich Nietzsche's von Elizabeth Forster-Nietzsche, Leipzig. 1895. XOtla Hansion's Friedriche Nietzsche, quoted by Dr. Hermann TGrck In his pamphlet Fr. Nietzsche und seine Philosophischen Irrwcgc, Jena und Llepzig, 1891. The author has made a careful study of Nietzsche's writings and his criticisms are judicious. He furnishes no fresh medical details. His knowledge of Insanity seems mainly derived from the Hand- book of Schule. [223] 224 William IV. Ireland. to insanity had been inherited for several generations both on the father's and the mother's side. We have another from Frau Andreas Salome,* who had acted as secretary to Nietzsche for five months in 1882 and afterwards kept up a correspondence with him. Her estimate differs from the fond appreciation of his sister, who passionately accuses her of misunderstanding or mis-stating her brother's character. Frau Andreas, founding upon her personal knowledge and a warm friendship for the philosopher, has given an ex- planation of his aberrations, which she pursued through all his writings. In this she shows much analytical skill, though her book is somewhat too disquisitional and contains few of those traits which female observers are apt to record. 1 As a child nothing particular is recorded of his health, save that he was two and a half years old before he began to speak. In boyhood he was fond of solitude, shunning other children, and nice in his habits. From his pious and studious ways he was called the little parson. At the end of his school education he studied at the Universities of Bonn and Leipzig. He disliked the noisy, drinking and smoking habits of the students. He must have gained great reputation in the study of languages, for he was ap- pointed professor of philology in the University of Basle when twenty-four years of age. Nietzsche had none of the struggles which sometimes beset the early life of the student. He stepped at once into a good position with a moderate income. On the strength of this promotion he was made doctor of philosophy by the University- of Leipzig without examination or thesis. The young professor now gave himself up to his duties, lecturing at the University and giving lessons in Greek at the Upper School of Basle. Enjoying the friendship of Richard Wagner, he spent much of his leisure time at the house of the great composer at Lucerne. Nietzsche was himself an enthusiast for music, and some of his compositions are given in the biography by his sister. He had a keen appreciation of poetry and wrote verses which are difficult to read or understand, a smoulder- ing of poetic fire giving forth much smoke and rarely bursting into flame. *Freidrich Nietzsche in leinen Wtrkcn von Lou Andreas Salome, Vienna, 1894. A Study in Mental Pathology. 225 His peaceful life was broken by the war of 1870. He had never completed his service as a soldier, owing to an injury received in springing upon an unruly horse, nor would the Swiss state have' allowed him to take part as a combatant, so he went to serve in an ambulance corps. With the invading army he entered France, when he was seized with diphtheria and cholera nostras. He managed to reach Erlangen, there to fall prostrate. Perhaps, as his sister remarks, he returned too soon to his duties at Basle. At any rate he never quite recovered his health. He used to suffer about every two or three weeks from attacks of migraine, violent headaches, sickness, narrowing of the field of vision, and sleeplessness. These attacks were often accompanied by mental distress. Frau Forster says her brother had, naturally a good constitution; he was broad and muscular, and suffered from no defect save that he was very short-sighted. This both he and his sister seem to have inherited from their father. Though retiring and undemonstrative to those whom he did not know well, he was naturally very sensitive, accessible to pity, and mild and gentle in his manners. In the sum- mer of 1875, after an unusual time of suffering, he wrote to a female friend: "Such as we (I mean you and !) never suffer in the body alone: all is intergrown with mental crises, so I have no conception how I could again become sound through medicine and cookery. The secret of all recovery for us is the acquirement of a certain toughness of skin against our great internal sensitiveness and irrita- bility. Nothing from without may now hurt or bruise us. At least I no more suffer as if fire scorched me from within and without." In 1876 Nietzsche got a year's leave to re- cruit his health. He spent the winter at Sorrento; but his malady followed him everywhere, and in the beginning of 1879 he was forced to resign his professorship. His friend Burckhardt, the professor of the history of art, said that Basle had never enjoyed such a teacher, and he is said to have had great influence over the young men. He had filled the chair for ten years, and was allowed to retire upon a pension of 3,000 francs. 226 William W. Ireland. Nietzsche now led a wandering life amongst the Swiss mountains, principally' in the Engadine and in Genoa. During the first year his health scarcely improved. In 1880 he wrote: "There lies a heavy, heavy load upon me. Last year I had one hundred and eighteen days of distress. I still lived, but I could not see three steps before me." He struggled manfully with his malady, and in 1882 his condition began to improve, when he formed a plan to study the natural sciences in Vienna, Paris and Munich. This, if executed, might have steadied his restless thoughts and inured him to a strict method of investigation. His studies had principally lain in Greek literature, music and of the renaissance. A man versed in such subjects has the name of being learned, and yet may be very ignorant. Nietzsche himself thus bewailed the time he had spent at Basle: "There ten years of my life have fled, ten years in which the nourishment of the mind has been suspended, where I learned nothing useful and forgot very much. For some old ware of dusty learning I crept tortoise-like among Greek versifiers with my bad eyesight. With pity I saw myself so emaciated. There were no realities in my budget of the sciences, and the realities were worth nothing. Sickness gave me a right to a complete change in all my habits; it allowed, it prescribed to me, forgetfulness; it granted me the necessity of repose, of idleness, of waiting and of patience. But that means thinking. On account of my eyes it was impossible for me to be a bookworm, in German a philologist; 1 was released from 'book.' I read nothing for years. This relief was the greatest boon which I have ever accorded to myself. This undermost Self, smothered and stilled under the continuous 'must listen' of other Selves (and that is reading), slowly awakened, bashfully, doubtfully, but at last it speaks again. Never have I had so much happiness in myself as in the years of my life when suffering from sickness and pain: one has only to glance at 'The Morgenrothe' ('The Dawn') or 'The Wanderer und Seine Schatten' ('The Wanderer and His Shadow') in order to comprehend that this 'return to myself was the highest kind of recovery. The other fol- lowed upon it.' A Study in Mental Pathology. 227 Unable to read, Nietzsche took to writing, and as he used no restraint in giving his opinions, the procession of his published volumes form a consecutive record of the changes of his beliefs and mental states. While it was his destiny to study, teach and speculate upon languages, his natural bent swayed him to inquire into the problems of philosophy, and his material wants having now been provided for, nothing hindered him from giving way to these tastes. For some men the restraint of circumstances, of other men's opinions and the necessity for work are salutary. Living in the atmosphere of the college, surrounded by cultivated friends and overlooked by the state authorities, Nietzsche was fenced in by environment which was both a restraint and a support. But his self-conceit, naturally large, was swelled by being steeped for ten years in the admiration of his students. In his solitude there was now no one to check or criti- cise him. His only sister had married and gone to Para- guay. In his tastes and mental processes, in his whole nature, there was something eccentric and perverse; his thoughts did not seem to follow the same associations as other men; they were vehemently pitched, and this di- vergence from normal mental processes went on taking sharper and sharper curves. He parted with all the religious faith in which he had been nurtured by his pious mother. This separation was mainly through intellectual difficulties; as he himself said, the Christianity of his parents' parson- age had Iain upon him smooth and soft, like a skin, and he had no difficulty in keeping its commandments.* For some years he entertained a deep reverence for two masters in philosophy and art, Schopenhauer and Wagner. In 1865 he lighted upon the works of the great pessimist philosopher in an old book-shop, and adopted his views with enthusi- asm; but there was an ardour, a restlessness, a disinte- grating force in Nietzsche's mind which soon made him throw off all authority and disengage himself from all beliefs. His attitude to received social and political views became more and more belligerent. He took no pleasure, •Andreas Salome, p. 48. 228 William W. Ireland. as weaker souls may do, in following the heterodox views of others. He himself said: "My mode of thought requires a warlike mind, a desire to give pain, a pleasure in saying No." He delighted in smashing new idols as much as throwing stones at the old ones. He professed a great desire for the truth and enjoyed the right of proclaiming his opinions all the more when they were hostile to the many. He wrote that he would not be ready to be burned for his opinions, he was not so sure about them; but he might, perhaps, have gone to the stake for the right of holding his opinions and changing them. Though no man ever put people's toleration to greater strain, Nietzsche took with ill-humor the dissent of his friends from his own notions. He said that he could bear that worthy people should hold fast to the creed in which they had been reared, but when one who had once parted from the faith again became a believer he could not contain his indignation and disgust. He well describes the devouring restlessness of his mind in these verses: "Jat Ich weiss woher ich stammel Ungesattigt gleich der Flamme Gluhe und ver^ehr ich mich. Licht wird alles das ich fasse, Kohle alles was ich lasse; Flamme bin ich sicherlich." "Yes, 1 know whence 1 arise; insatiate like the flame, I glow and consume myself. Light is all that 1 produce; blackened ashes all I leave. I am flame assuredly." Perhaps one source of the attraction which his writings have for some people consists in his scornful denunciations of the besetting weaknesses of the day. Whatever the explanation may be, Nietzsche's name is now often quoted in the periodical literature of Europe. In Germany a host of articles and even some books have been written about or upon him, and we are told that he has a great and in- creasing influence with che young men, especially with artists and literati. His admirers call him the greatest of recent German stylists. Several books have been written A Study in Mental Pathology. 229 upon him in France, and we are told in the Nuova Antologia* that his name is popular in Italy, as elsewhere. A course of lectures has been delivered upon his works by Prof. George Brandes, Copenhagen, and several volumes of his books have been translated into English. The Nietz- schians have, or had, a special organ called The Eagle and the Serpent. Mr. Seth Pringle-Pattison has written articles upon Nietzsche in two popular magazines,! though he seems to have no sympathy with his views. Perhaps Mr. Patti- son's remark "that originality in philosophy is not easy of attainment" may be the explanation. The learned professor has found in Nietzsche "passages which in their lucid simplicity seem to reflect something of the serenity and purity of the mountains and the stars; and when more rarely an elegaic note mood is touched the words fall with a haunting beauty of cadence." On the other hand I may quote what one of the ablest German authors of the day has written about Nietzsche's compositions. In his well-known book on Degeneration Max Nordau says: "From the first to the last page of Nietz- sche's writings the careful reader seems to hear a madman, with flashing eyes, wild gestures and foaming mouth, spouting forth deafening bombast, and through it all, now breaking out into frienzied laughter, now sputtering ex- pressions of filthy abuse and invective, now skipping about in a giddy, agile dance and now bursting upon the auditors with threatening mien and clenched fists. So far as any meaning at all can be extracted from the endless stream of phrases, it shows as its fundamental elements a series of constantly reiterated, delirious ideas, having their source in illusions of sense and diseased organic processes." "It is essential," Nordau observes on another page, "to become habituated to Nietzsche's style. This, I admit, is unnecessary for the alienist. To him this sort of thing is well known and familiar. He frequently reads writings (it is true, as a rule, unprinted) of a similar order of thought and diction, and he reads them, not for his pleasure, •16 Mario, 1900. ^Blachwood's Magazine. Vol. CLXII. 1897. and Contemporary Review. 1898. 230 William W. Ireland. but that he may prescribe the confinement of the author in an asylum. The unprofessional reader, on the contrary, is easily confused by the tumult of phrases." This denunciation is, in my opinion, too sweeping if applied to Nietzsche's earlier writings, in which the style is much soberer and the connection more rational. Though paradoxical, one can hardly describe them as the effusions of a wandering mind. Sometimes, too, there flashes out an idea both original and true, clothed in language quaint and droll. Those who wish to know more about Nietzsche's writ- ings should get the two books of Henri Lichtenberger: La Pkilosophie de Nietzsche,* in which he gives an account of his life and a resumS of his opinions; and Friedrich Nietz- sche, Aphorismes et Fragments Choisis (Paris, 1899), in which he gives in clear French out of cloudy German the best of Nietzsche's passages, selected out of what may be called the refuse. Our task, however, is to consider Nietzsche as a case of mental pathology and to trace the steps of the descend- ing process to the denouement. The first separate book which he gave to the world (at the end of 1871) was entitled Die Geburt der Tragodie aus dem Geiste det Musik (The Birth of Tragedy from the Soul of Music). In this work he brings out the correspondence which he had con- ceived between Aeschylus and Wagner. The chorus played a most important part in the old Greek tragedies, which thus resembled operas, like those of the German composer, founded upon old legends, more than ordinary dramas. Nietzsche thought that he had gained a conception of the character of the ancient Greeks through the few fragments of their literature. He caught glimpses of their joyous and natural life; but his own individuality was too intense to reflect the tone of bygone times, hence the book savoured strongly of paradox. Like most first efforts, it excited little attention save amongst the author's friends. Frau Forster- Nietzsche remarks that before its publication her brother This book has been transiated IntolGerman bv Elizabeth Forster-Nletzsche (Dresden und Leipzig, 1899). Frau FSrster has added a preface of sixty-nine pages, giving some farther Information about her brother's studies and the growth of his opinions. A Study in Mental Pathology. 231 had a good reputation, and had been offered places in Griefswald and in Dorpat; but, after The Birth of Tragedy became known in philological circles, there was a marked estrangement, a dull, painful silence, and no journal vouchsafed any notice of it. But Wagner and his wife were enthusiastic in their praises. In the year 1873 Nietzsche attracted notice by a vehe- ment attack upon a contemporary literary celebrity under the title: David Strauss der Bekenner und Schriftsteller (the avower and author), and later as David Strauss and Other Philistines. Surely Nietzsche might have seen an ally in the author of The Leben Jesu and of Der alte und der neue Glaube, but Strauss, though a foe of the Christian faith, was an optimist; so was Socrates, hence both the modern and the ancient philosopher were attacked by the pugnacious disciple of Schopenhauer. In quick succession there ap- peared under the title of Un^eitmassige Betrachtungen (Un- seasonable Considerations) three more essays upon "The Use and Disadvantages of History for Life,'' "Schopenhauer as an Educator," and "Richard Wagner in Bayreuth." In the skilful analysis which Nordau gives of Nietzsche's character there is one passage from which I must dissent, "that the real source of Nietzsche's doctrine is his Sadism." He is subject to erotomania, a veiled form of a psychopathia sexualis (folie amoureuse chaste). The few passages culled from the mass of his writings do not sufficiently support this theory, and from my own study of the same writings I have gathered quite a contrary belief. Amativeness seems to have been decidedly weak with Nietzsche. He coldly writes: "The best friend will likely be the best wife, as a happy marriage rests upon the talent for friend- ship," then further on, "On entering upon a marriage one should consider the question: Do you believe that you can well entertain yourself up to old age with this woman? Everything else in marriage is transitory," but the most time of their intercourse belongs to conversation. Evidently Nietzsche had no idea of the sweet sympathy of a loving wife, which goes far beyond friendship and conversation. Lichtenberger writes: "His only passion was the search for 232 William W. Ireland. truth; for every other object he only felt very moderate impressions. He was vexed later on that he never could rise to the passion of love; all his inclinations to a person of the other sex, however charming she might be, were soon transformed into a kindly and cordial friendship." Frau Forster tells us that there were physicians who thought that the cause of his headaches lay in his chastity: "They urgently advised him to marry; but for a man of the refined feelings of my brother, who thought friendship the best thing in wedlock, that was a painful reason for marrying. To sexual intercourse in another way my brother was averse." His friend, Freiherr von Seydlitz wrote: "Where lives the man who could show a stain in him? His life was pure and clear, like the water of a mountain brook." He makes Zarathustra say: "Never have 1 found the woman from whom 1 should have desired children save that woman whom I love, for I love thee, Oh Eternity!" Nietzsche's remarks about women are commonplace enough and quite devoid of the affectation besetting Euro- pean literature in treating of this subject, nor is there any trace of the unconscious gratification of the sensuous. Clearly, he had no dislike to women like Schopenhauer, though he looked with disgust upon the women who seek to escape natural vocations to compete with men. He would have women to remain in the place heretofore assigned to them, but neither oppressed or depressed. In despite of his bitter and restless hatred of Christi- anity Nietzsche was averse to the idea of women becoming free-thinkers as something absolutely repugnant or ridiculous. This is a sentiment common enough in countries like France, where so many of the men are sceptics and so many of the women are Catholics. Nordau says that Nietzsche's Sadism was confined to the intellectual sphere which he satisfied by ideal de- bauchery. But, though in his writings Nietzsche is often arrogant, abusive and profane, he is never obscene. Nordau was misled by the desire to label and classify a man who does not belong to a class, but who is a case per se. In the essay upon history, the soberest of Nietzsche's A Study in Mental Pathology. 233 writings, there are some acute original observations. He pronounced that there was too large a dose of history in German education, and that the study of the records of bygone ages had a benumbing effect upon the mind, weak- ening the plastic powers of men and of nations. As sub- stitutes he proposes the study of the unhistorical, things nearer daily life, not giving so wide a horizon, and of the over-historical, that is, art and religion. He denounces the superficial character of a modern education. The young man is made to gallop through history as he hurries through museums, and such a mass of unassimilable knowl- edge is heaped upon him that his only defence is indiffer- ence or the disgust of satiety. On the other hand, the writer of history takes a particular chapter of the past and works at it after a formal method. In the same way laborers in the sciences are early set to work upon a par- ticular corner. They are instructed upon only one point; on this point they are better informed than the men of the past, but in all the others they are sadly different from the wise men of the ancient models. He derided the idea that history could be reduced to anything like a science. Its main use was to show some great men who, solitary, hail one and another through the intervals of time over the heads of crowds of dwarfs. "The knowledge of history should be made subject to the uses of life," and so it can be, especially to the life of nations, and in sustaining the spirit of patriotism. The danger of too much history is too fine a fear. It never appeared to me that your German doctors of philosophy were in danger of being crushed by the weight of their historical erudition, though they may be better versed than your English and Scottish M. A.s, which is easy. One of the uses of history comes to the point. It shows that every age has its own peculiar errors and that it is difficult for us to avoid being carried away by the current of them; thus history gives a standpoint where we may take refuge from the tyranny of the present. As Castelar said: "Those who look upon life from one' side, upon time from one age, the doctrines of one's religion only, humanity from one people, will never understand the 234 William W. Ireland. human mind." Nietzsche had gained little from foreign travel, and he lived in an atmosphere which had been breathed and re-breathed by professors, students and artists. As Riehl* observed: "Nietzsche esteemed the influence of professors and learning upon the life of the times to be much higher than it really is. If Nietzsche had read some- thing of history, he never understood its application, using it merely to illustrate his own notions. He saw himself and his own environment everywhere, as the gliding stream still retains the standing images of the trees which grow by its sides. When he talked of the struggle of in- coherent ideas, of the chaos of strange knowledge, he drew this danger from his own feelings; as he himself said in the preface to the work upon the use of history: 'I shall not conceal that I have taken the experience which aroused these painful impressions, mostly from myself, and only from comparison of others.' As Frau Andreas remarks: 'What he found within himself that appeared to him a danger to the whole age, and later on rose to be a deadly peril to the whole human race which called on him to become their redeemer and rescuer." In these early essays we find the beginning of two conceptions, the genie-cultus, or worship of genius, and the decadence theory, which play so large a part in Nietzsche's later speculations. Those whom he first delighted to honor were great philosophers, great teachers or great artists. In his book, Menschliches All^umenschliches, he says: "The man of genius differs from the mass less through the dif- ference of his nature (Wesenverschiedenheit), than through the openness of his nature (Wesenenthullung), through 'a divine nakedness,' a power of throwing off old habits and conventions, and old callosities and reacting to fresh im- pressions." If the great thinker despises men, it is their indolence which he despises. A man only requires to cease to mind his own ease in order to separate himself from the many. Thus Nietzsche recognizes at least potential great- ness in many. "Artists," he writes (Menschliches, 155), *Fricdrich Nietzsche der Kunstler und der Dcnker, ein Essay von Alois Riehl. Stuttgart, 1898. This Is an able critical review of Nietzsche's life and opinions. A Study in Mental Pathology. 235 "have an interest in making men believe in sudden inspira- tions, as if the idea of works of art, of poetry, and the leading conceptions of philosophy flashed like a gift from heaven. In truth the fancy of the true artist or thinker produces good, middling and bad work, but his powers of judgment, highly sharpened and exercised, rejects, reflects and combines together, as may be seen from the note- books of Beethoven, that in composing his finest melodies he has gradually brought together and chosen them out of many pieces. All great men were great workers, un- wearied, not only in finding but in rejecting, sifting, altering and arranging." In another place he says: "Cease to speak only of gifts, of inborn talents. Great men of all kinds might be named who are moderately endowed with gifts; but they all had that earnest of thorough work which learns first completely to form the parts till they dare to make a whole." Then again: "Men much overvalue everything great and prominent; extreme natures attract far too much attention." These sentiments have nothing of the vitriolic scorn which a few years later Nietzsche threw at the human kind. Menschliches Alliumenschliches, ein Buck fur freie Geister (Human, all too Human, a Book for Freethinkers) was written at Sorrento, in the company of Wagner and other German authors. It was published in 1877, that is, before he gave up his chair at Basle. The book, which has nearly eight hundred pages, is made up of a series of aphorisms and short essays, after the manner of La Bruyere or Rochefoucauld. It deals in a broken manner with familiar topics, such as morals, religion, art, culture, women and child. It is dedicated to Voltaire on the centenary of his death. Nietzsche's hatred to Christianity is bitter. He admits that it had a cleansing action on the corrupt old Roman world, though he says that it acted like poison upon the fresh Germanic peoples. The most amiable passage in the book is the following: "The best way to begin each day is on waking to consider whether we can on this day do a pleasure at least to one man. If this took the place 236 William W. It eland. of the customary religious exercises, humanity would reap advantages from the change." The following is characteristic: "We criticise a thinkei the more sharply, if he advances an opinion displeasing to us; but it would be more reasonable to do this, if the opinion were pleasing to us." In the Morgenrothe he says: "Some think that the reality may be hateful; but do you not think that the recognition even of the most hateful reality is a fine thing? Moreover, that he who often recognizes truth at last comes far from the notion that he will find the great whole of reality, whose discovery ever gave him pleasure, to be hateful? Two such thoroughly different men as Plato and Aristotle, considering what made the highest happiness, both agreed that it lay in the activity of a well exercised, searching and finding intellect." No man who has prayed to God as the great Father of all can renounce his belief in Him without a sense of desolation. The atheist feels himself the chance product of-something different; he stands alone amidst the sense- less worlds of matter, the victim of the play of forces which have neither where nor whither. It was, therefore, not without deep sadness that Nietzsche came to think that religious education was all wrong. The very violence of his denials betrayed the tumult in his mind. We should scarcely repeat language shocking to a pious mind were it not to exhibit the workings of a self-torturing intellect which felt the need of leaning upon God and yet the im- pulse of denying Him. Frau Andreas emphatically says* that a right study of Nietzsche must be of a religious- psychological study, and it is only so far as this domain is cleared up that bright side lights fall upon the significance of his being, his sorrows and his self-worship. All the changes in his mind are referable to his lost faith, from- the emotion over the "death of God"—that profound emo- tion which vibrates even to his last work and brought him to the threshold of delusion. Read the impressive outburst of feeling of the madmen in Frohliche Wissenschaft: •Op, cit. pp. 38-39. A Study in Mental Pathology. 237 "Where is God?" he cried. "I shall tell you. We have killed him, you and I. We all are his murderers: Do we hear nothing of the grave-diggers who are burying God? How shall we console ourselves, the murderers of all mur- derers? The holiest and mightiest that the world has hitherto possessed has bled to death under our knives. Who will wash his blood from us? With what water can we cleanse ourselves? Is the greatness of this deed too great for us? Must we not become gods ourselves solely in order to appear worthy of it? There was never a greater deed—and whoever is born after us comes on this account to a higher history than all the former histories." By this wild language Nietzsche meant to say that the belief in God was dead. He reckons that the number of such un- believers in Europe was about twenty millions. There is, of course, no trustworthy data for such an estimate, and it is foolish to assume that all who do not accept as historical truths the events related in the Gospels are atheists. We have seen that Nietzsche suffered from migraine, with a diminution of visual power, darkening at times almost into blindness, with nausea and catarrh of the stomach. Migraine is a functional disease, not very liable to develop into deeper affections, and has none of the ominous sig- nificance of epileptic seizures. It is often accompanied by great depression of spirits, as was the case with Nietzsche, and sometimes, though rarely, it is the prelude of brain disease and of insanity. One word is frequently reproduced in his writings (Ekel) disgust, generally repeated thrice. He viewed all things through a perpetual nausea, as a sufferer from sea-sickness looks at food. "He that is giddy thinks that the world turns round." His sense of smell was morbidly acute. He hated the smell of human beings, the stink of the rabble of shopkeepers; even superior men did not smell nice. He deemed it foolish to feel indignant against wickedness, since men are but the tools of a blind necessity; but in his mind disgust was used to replace moral indignation. It seems to have been excited mainly by hypocrisy, religious faith and pety. It 1882 there came a modification of his sufferings, longer intervals of ease> 238 William W. Ireland. during which he felt the glow of recovered health. Wan- dering alone amidst the high valleys and mountain lochs of the Engadine, or by the sunny waters of the Mediterranean, he drank the joy of the earth's beauty and condescended to admit that the world might be justified as an aesthetic phenomenon. He found that grumbling about general in- felicity only made him less able to support real pain; he felt that life was worth living, so he parted with pessimism and from Schopenhauer as a guide. He thus pithily disposes of the formula so much used by that philosopher: Wille zum Dasein. "There is no such will: how could that which is not in existence will to exist? Only where there is life is there will; not will to live, however, but will for power." As he had parted from Wagner, he now thought that the time was come for him- self to set up as an independent thinker and teacher. So, during his days of relief from headaches, volume after volume was written and given to the world. Though Nietzsche had few readers, this did not abate his huge self- conceit. In time the extravagance of his utterances and the arrogance of his style gained for him some followers. He boasts that he had readers in Vienna, in Copenhagen, in Stockholm, in Paris and in New York. In the preface to the "Anti-Christian" he proclaims that the book was writ- ten for the few, perhaps none of them yet live. "The day after tomorrow," quoth Nietzsche, "belongs to me. These alone are my right readers, my predeterminate readers. What about the rest? The rest are merely mankind." Unhappily he was losing the faculty of concentrated and sustained thought; his books are now in the form of broken aphorisms, sentences in which we can trace the associations, sometimes of words, sometimes of ideas, un- guided by sense or judgment. He utters Pythian oracular phrases, mixed with raving nonsense. The deists of the seventeenth and eighteenth centuries, with one exception, while attacking Christianity respected morals; indeed, they were anxious to prove that morality would not be injured with the fall of revealed religion, and sought to show that the best moral precepts in the gospels A Study in Mental Pathology. 239 could be found in the writings of the ancient sages. Tindal, one of the most learned of the English deists, wrote a book to prove that Christianity was "as old as the creation." Volney, one of the learnedest of the French deists, wrote a catechism of the laws of nature, based on self-preserva- tion, by which men were to be taught to lead virtuous lives. Whether duties were regarded as founded on the moral sense, sympathy, utility or the divine command, all inquirers, though working by different methods, brought out the same sum. There were discrepancies here and there; but on the whole the ethical code was recognized in its main features. The principal difference was in the view men and nations took of sexual relations, which are more or less based upon conventions and state regulations. In 1714 Bernard Mandeville, a Dutch physician set- tled in London, published his Fable of the Bees; or, Private Vices Public Benefits, in which he sought to show that our notions of morality were originally contrivance of artful and ambitious men who, in order that they might reap the fruit of the labor and of the self-denial of others, and at the same time indulge their own appetites with less dis- turbance, agreed to call everything which, without regard to the public, man should commit to gratify any of his ap- petites, VICE, if in that action there could be observed the least prospect that it might be injurious or render himself less serviceable to society, and to give the name VIRTUE to every performance by which men, contrary to the im- pulse of nature, should endeavor for the benefit of others or the conquest of his own passions or the rational ambi- tion of being good. Without any idea of a separate morality for each, Mandeville explains how the same ethical notions were rendered acceptable. Taking advantage of some points in political economy not then clearly understood, and with the help of a lively and vigorous style, the free-thinking Dutchman made a plausible book which attracted much attention at the time, and which Bishop Berkeley and Adam Smith thought worthy of refutation. The Fable of the Bees was condemned by the presentment of the grand jury of Middle- 240 William W. Ireland. sex, and it was clearly licentious, though the author offered himself to burn the book should it be proved to contain anything tending to immorality or the corruption of man- ners. Mandeville is content with people's virtues, and their vices too, and his book is quite a reasonable production, compared with Nietzsche's reckless diatribes. There is as much difference between the Dutch physician and the re- tired German professor as between a thief who quietly enters your house to make away with your goods and a madman who bursts in to smash and tear everything. There were, however, some signs which portended a re-examination of practical ethics. A serious disturbance of the moral persuasions of the time was made in the begin- ning of the nineteenth century by the Rev. Thomas Malthus, who showed the dangers of charity in keeping alive human beings who had been brought into the world regardless of the geometrical ratio of increase laid down by that political economist. It is well known that Darwin took from Malthus the formula of the survival of the fittest, to which he gave a new and wider application. By his speculations on the origin of species and the descent of man the English naturalist occupied a position which threatened many re- ceived beliefs in religion, philosophy and science, he brought many old problems within the domain of zoology and dissolved the cohesion of time-honored doctrines, as in the "Arabian Nights" the magnetic mountain attracted the nails away from the ship of Sindbad, the Sailor, so that the planks fell asunder, to be scattered by the waves. Apparently the Protestant theologians of today have shunned to declare war upon the views of the origin of man quite different from what they used to preach, and Darwin him- self seems to have thought that his doctrine of the survival of the fittest was compatible with Christian morality. Huxley, especially, soon pointed out how our democratic humane ideals ran in the teeth of what leads and has led to victory in the struggle for existence. How can we reconcile the maxim that it is good that the strong should survive with the help rendered by the state to the weak and unfit, enabling them to continue an unhappy being and A Study in Mental Pathology. 241 bring into the world children as weak, or weaker and more diseased than themselves? "Where,"asks Mr.Tille,* "does man take the right to style this compassion for other's pain, this so-called unselfishness, a higher aim than the following of the natural process which leads to the eleva- tion of the human species? In fact, with the aid of public and private charities, the weak are sometimes made more powerful than the strong who are forced to support them. Why not push the doctrine to its logical consequences? Force and Fraud have brought us so far in the ascent of the ladder of evolution, why should a foolish sentiment of pity interfere? Let us rather crush the weak, for it is good that the strong should prevail and take the room they encumber." As a general rule, however, the British fol- lowers of Darwin seem more bent upon evading these con- sequences than on proclaiming much less acting upon them. Huxley himself admitted that we cannot give up the defense and support of the weak without dissolving the bonds by which society is held together. Haeckel was content with recommending people to seek suitable partners and to avoid marrying into unhealthy families; but Tille proclaims Nietzsche as the philosopher who inaugurated a new mor- ality, founded upon the doctrines of evolution. Tille ob- serves that this valuable ethical discovery, which for the first time gave a clear survey of the ethical views of all times and races, was only possible for a thinker who placed himself upon the ground of biology. Tille, for his own part, proposes the abolition of inheritance, so as to give the strong an equal chance in gaining the race, and thus reaching positions to both the governing class and to the multitude. I am not sure that the Darwinians will accept Nietzsche as the legitimate successor of Darwin. Two men more unlike never lived. Darwin was well aware that what seemed good for man individually might not be good for man collectively, and that the only way to raise the human type was to raise the whole level of humanity. *Von Darwin bis Nietzsche, tin Buch Entwichlungsethik von Alexander Tille, Leipzig, 1895. 242 William IV. Ireland. In one of his earlier writings, the first "Unseasonable Considerations," Nietzsche pushed the logical consequences of the survival of the fittest against the humanistic views of Strauss; later on he styled Darwin an estimable, though mediocre Englishman. "Darwinism," he wrote,* "with its incredibly one-sided theory of the struggle for existence, is explained by Darwin's origin. His ancestors were poor and humble persons who were only too familiar with the diffi- culty of making two ends meet. Around the whole of English Darwinism there floats, as it were, the mephitic vapor of English over-population, the odor of humble life, of pinched and strained circumstances"—an absurd error, for Darwin was always in easy condition from inherited wealth. It seems to me, however, that Nietzsche was right in treating of the survival of the fittest as an insuffi- cient explanation of the endless variety of structure found in animate beings. I believe that no system of morals which men are now willing to accept can be founded upon this hypothesis. We are not obliged to explain the origin of species upon the earth; but we must have some code of morals by which to conduct our lives. Moreover, one can reasonably admit the historical succession of living beings rising from the lowest to the highest organisms without being able to explain the causes of such an evolution. Frau Andreas tells us that as late as 1879 Nietzsche had a great admiration for English learned men and philoso- phers. In "Menschliches All^umenschliches" they are still the complete, full and filling natures, and in a letter he names the English writers of the day as the only good philosophers, but, as Riehl tells us, towards the end of his career Nietzsche "came to hate unsympathetic England with his whole soul." This means that he found no readers for his crazy books in Great Britain. The eminence of a nation in philosophy depended upon the notice they took of Nietzsche. He thus made out that the French were much the greatest psychologists, after them the Russians; "the German flat land" stood low on the scale; England nowhere. Nietzsche had much admiration for French writers. He defended with *Dit Frohliche WUinschtfl, s. 272 (published In 1882). A Study in Mental Pathology. 243 warmth the claims of Racine, Corneille, and Moliere above Shakspere, and pronounced Voltaire to be the last of the great dramatists. Of British authors he most admired Sterne and Byron; but it appears he could not read our language fluently since he preferred German translations of English works. In the Morgenrothe Nietzche takes a different view of the end of evolution from what he afterwards proclaimed. "Formerly," he writes,"they ought to sustain the sentiment of the lordship of man by assigning to him divine origin. This is now a forbidden way, for at the gates stands the monkey with other frightful beasts, showing his teeth as if to say, no further in this direction. Now they try the opposite way, the path on which man is advancing, for proofs of his relationship to God. Here also there is none; however high man has developed, and perhaps he will stand lower at the end than at the beginning, there is for him no passage to a higher order. As little as the ant and the earwig at the end of their earthly path will amount to kin- ship with God and eternity. The future drags the past behind it, why should it make an exception to this eternal drama for a little planet and a petty species?" It does not appear that Nietzsche's knowledge of zoology was any- thing else than superficial, but here he was right. Man from his structure seems to be the last of the vertebrate type which began during the paleozoic age in the prone fish and culminated in an erect body with a lofty forehead and a gaze that sweeps the horizon. One cannot see how the human organism can be more complete, and there is no proof that it has improved for twenty thousand years. Also Sprach Zarathustra, (Thus spoke Z. i. e. Zoroas- ter) is regarded by Nietzsche's admirers as his most im- portant work. One of them has called it the greatest poem which Germany has produced since the time of Schiller. It consists of four parts which came out separately in 1883 and 1884, so many leaves or chapters with little or no apparent connection with one another. Much of the best is in the form of aphorisms or oracular speeches. The author uses a great variety of words, piling synonym upon 244 William W. Ireland. synonym, and phrase upon phrase. Now and then there is a pithy remark which anon is spoiled by some bombast or nonsense dragged on to it. But it is impossible without specimens to give an idea either of Nietzsche's prose or of his verse, and for a foreign tongue this is difficult. The translator must have some sense in his mind ere he tries to render a passage. The reader will find attempts at doing into English some of the most incoherent passages from Zarathustra in Nordau's book on Degeneration. In Nietzsche's later works a want of measure and a want of taste prevades all his pages, often we can find nothing but a clatter of words. Though it has gone through at least three editions, Also Sprach Zarathustra is to me a most tiresome book. It thus begins: "When Zarathustra was thirty years old he left his home and the lake by his home and went into the mountains. Here he remained in the enjoyment of his mind and his solitude, and for ten years was not weary. At last his heart changed and one morning he got up with the dawn and standing before the sun thus spoke: 'Thou great star! Thou wouldst be ill off if thou hads't not something to shine upon. For ten years thou eamest to my cave and wouldst have been tired of thy light and way, without me, my eagle and my serpent. But we waited upon thee every morning, partook of thy overflow, and blessed thee therefore. See, I am overburdened with my wisdom like the bee who has collected too much honey. I need hands stretched out to me.'" We learn farther on that Zarathustra's chief companions in his cave were an eagle, the proudest, and a serpent, the wisest of animals. Now and then these two creatures make philosophical remarks to Zarathustra in the style which no doubt they have learned from their master, and indeed in all the con- versations the speakers use the same abrupt, cynical forms of expression as Zarathustra himself. Zarathustra determines "again to become a man," descends from his mountain, and falls in with an old hermit who tries to dissuade him from leaving the forest. "Rather go to the beasts. Why wiliest thou not be like myself, a bear amongst the bears, and a bird amongst the birds?" "And what does the holy man do A Study in Mental Pathology. 245 in the forest?" asked Z. The hermit answered, "I make songs and sing them, and when I make songs, I laugh, weep and mutter. So I praise God, etc. When Zarathustra had parted from the hermit he said in his heart: "Can it be possible this old saint in his forest has never heard that God is dead?" Zarathustra goes on and comes to the nearest town where he finds a crowd assembled in the market place to see a rope dancer perform. He at once addressed them: "I teach you something about the over man. Man is some- thing that should be surpassed. What have you done to surpass him?" All beings have done something beyond themselves and you would be the ebb of this great place and rather fall back to the beast than overpass men. What is the monkey to man? An object of laughter and scorn. Even so will man be for the over man, an object of laughter or scorn." "You have traversed the way from the worm to man and there is still much of the worm in you. Once you were monkeys, now has man more of the monkey than any monkey." Zarathustra goes on to preach the Gospel of the over- man whom he defines the thought (Sinn) of the earth. "I entreat you, my brothers, remain true to the earth and do not believe those who speak of hopes beyond the earth." They are mixers of poisons whether they throw it or not. They are despisers of life, dying men, poisoners of themselves, of whom the earth is weary." He goes on with his discourse which naturally was not found agreeable to an audience assembled to see a rope dancer. In this spectacle Zarathustra sees an allegory; "man is a rope, stretched out between the beast and the over man, a rope over an abyss, a dangerous setting out, a dangerous passage, dangerous to turn back, dangerous to shudder and remain standing." He goes on with some more of this preach- ing, at which the people become impatient, and begin to laugh and mock him. Zarathustra said to his heart: "They do not understand me. I am not the mouth for these ears." He does not abide in his self-confidence. "Unmoved is my soul and bright like the mountain at noon." All eyes are now 246 William IV. Ireland. turned to the rope-dancer whose cord was strung between two high towets. He had scarcely reached the middle of his pas- sage when a buffoon comes out of the tower and after roundly abusing the rope-dancer, the mountebank followed him on the rope and with a devilish cry sprang over. How the clown managed again to gain a footing upon the other side of the rope is not clear, at any rate the unfortunate dancer lost his head, dropped his pole and fell quicker than it to the ground. Every one cleared from under except Zarathustra, who knelt beside the unfortunate rope-dancer, bruised, broken and unconscious. After a little he comes to himself, and seeing Zarathustra kneeling beside him, he said: "What are you doing here? 1 knew that the devil would get me. Now he is dragging me to hell. Will you defend me from him?" "Upon my honor," answers Zarathustra, "all that you speak of has no reality. There is no devil and no hell. Your soul will be dead sooner than your body. So fear no more." "If what you say be true," replied the man, "i lose nothing when ! lose life. 1 am little more than a beast that has been taught to dance through blows and morsels of food." "Not so," answered Zarathustra, "for you have made your calling out of danger. On this ac- count Z. promised to bury him. The market people walked off, leaving Zarathustra sitting beside the dead man. At length the night came, when the philosopher indulged in those reflections which some think so profound. "Zara- thustra has caught a fine fish; no man but a corpse. Dismal is a man's existence, and ever without sense. A buffoon can bring him to destruction. 1 will teach men the meaning of their being, who is the over-man, the lightning out of the dark human cloud. 1 am still far from you, and my thoughts do not speak to your thoughts. I am a me- dium between a fool and a dead body. Dark is the night; dark are the ways of Zarathustra. Come, you cold and stiff comrade. I will bear you hence, where I will bury you with my hands." Zarathustra then takes the dead body on his back; the buffoon steps up to him and whispers in his ear, warning him to leave the place, where he was not liked. At the gate of the town Z. meets the A Study in Mental Pathology. 247 grave-diggers, who held a torch to his face and jeered at him. Zarathustra made no reply and walked for two hours in the forest. He heard the hungry cries of the wolves, and seeing a solitary house, knocked at the door. An old man appeared with a light. "Who comes here to dis- turb my bad sleep?" A living man and a dead one," an- swered the philosopher. "Give me something to eat and to drink. I forgot about it during the day, but he who feeds the hungry, quickens his own soul; such is the voice of wisdom." Satisfied with this profound explanation, the old man soon came back and gave Zarathustra bread and wine. "It is a bad neighborhood for hungry people," observed the hermit. "On this account I live here. Beasts and men come to me. But call your companion to eat and drink; he is wearier than you." Zarathustra answered, "My comrade is dead. It would be difficult to make him eat." "That won't do," said the old man, in a surly tone, '.'he who knocks at my house must take what I offer him. Eat and walk off." It seemed unreasonable to be discon- tented because a dead man would not eat; but the reader has, perhaps, by this time begun to doubt whether any of these people are of the reasonable, though of the reasoning sort. Zarathustra now takes up the dead body and bears it another two hours into the forest. Though apparently he had no other luggage, he was wearied after carrying this uncomfortable load for four hours. He laid it down on the moss, and slept till noon of the next day. Then Zarathus- tra heard the sharp cry of a bird, and overhead was his tame eagle, carrying the snake round his neck, who now approached him and kindly inquired how he did. Zarathustra gets disciples, with whom he emigrates to the Fortunate Islands, which after a time he quits to wan- der about the world. He then returns to the cave, where he was joined by the eagle and the serpent. One morning Zarathustra, springing from his couch Hke a madman, cried out with a fearful voice and behaved as if some one still lay on the couch who would not get up. Zarathustra's voice so resounded that his animals seemed to him afraid, and from every hollow and hiding place 248 William W. Ireland. about the beasts were aroused, creeping, jumping, flying, fluttering, with feet or wings, as the way of each was. But Z. spoke these words: "Mount, abyssmal thoughts, from my depth. I am your cock and morning horror. Up, up, drowsy worm. My voice ought to crow you awake. Unloose the fetters from your ears. Hark! Then 1 shall hear you. Up, up. Here is thunder for the grave, to learn to listen. Wash away sleep, and everything stupid and blind from your eyes. My voice is a remedy for the born blind, and if you be once awake, you will, always remain awake for me. It is not my wont to waken up great- grandmother and then to tell her to fall asleep again. You rouse yourself, stretch yourself, gurgle. Up, up, do not gurgle, but speak to me, Zarathustra, the godless, calls to you. I, Zarathustra, the advocate of life, the pleader of suffering, the pleader of the circle, I call you my deepest thought. Hail to me; thou comest, 1 hear thee. My abyss speaks. My last depth have 1 turned up to light. Hail to me. Forward! Give thy hand. Let go! Ha! ha! Dis- gust! Disgust! Woe to me!" Scarcely had Zarathustra spoken these words when he fell down like a dead man and remained long like a corpse, and when he came to himself he was pale, trembled, lay prostrate and would neither eat nor drink. During the seven days that Z. thus remained prostrate in his cave we are told that the faithful creatures never left him day nor night, save that the eagle sometimes took flight to seek food. When Z. came to himself he found his bed covered with grapes and other delicacies, and at his feet two lambs which the eagle, with trouble, had torn from the shepherds. In the fourth part years are supposed to have passed', and the hairs of the sage have whitened. The fame of his wisdom brings to his cave an interesting circle of "superior men" out of employment, one retired pope, two retired kings with their traps upon a donkey, an old magician, the ugliest of men, the shadow, the voluntary beggar and the man of scrupulous mind who has devoted his life to the study of the brain of the leech. These gentlemen take up their abode in the cave with A Study in Mental Pathology. 249 Zarathustra, though he sometimes treats them cavalierly and lectures them unmercifully. Forgetting the peculiarities of the host, they indiscreetly indulge in a little distraction of their own, which is thus related. Zarathustra's ear was suddenly startled, i The cave, before full of noise and laughter, became all at once still, and his nose sniffed a fragrant odor of the burning of fir cones. He stole to the entrance so that he might see his guests without being himself noticed. But wonder upon wonder. What must he see with his own eyes! They have all again become pious; they are praying; they are mad. And insooth all these higher men, the two kings, the retired pope, the wicked wizard; the voluntary beggar, the wanderer and shadow, the old soothsayer, the scientist and the ugliest man, all lay like children and believing old wives, upon their knees, and worshipped the ass. Likewise began the ugliest man to snort and blow, as if something unspeakable was coming out of him; but when it came to words, see, there was a rare pious litany to the praise of the adored and incense- feted ass. Amen! And glory and honor and wisdom and thanks and praise and strength to our God from eternity to eternity. To this the ass cried 1—A. He bears our loads, he took on himself the form of a servant, he is patient of heart and speaks not, and he who loves his God chastises him. But to this the ass cried 1—A. He speaks not to the world which he created, he always says yes. Thus he glorifies his work. It is out of his cunning that he does not speak, so he is seldom in the wrong. To this ass cried 1—A. Humbly goes he o'er the earth. Grey is the color in which he hides his worth; what intelligence he possesses he conceals; but everyone believes in his long ears. To this the ass cried 1—A. What hidden wisdom is it that he bears long ears and always says aye and never nay. Has he not created the world in his image, namely as stupid as could be? 250 William W. Ireland. Thus it goes on for half a page or more. At last Zarathustra could no longer restrain himself, he sprang amongst his guests, plucked them up from their knees and remonstrated with them for their stupidity. To this they severally gave foolish answers. This impious rant like the abuses and curses which come from a maniac was intended to give vent to his own wrath and provoke and shock others. At the end of the chapter the ugliest man says: "Once I learned from thee, oh Z. that he laughs who will kill outright. Not with rage but with laughter one kills. So spoke you once, oh Z. you hidden one, you destroyer without anger, you dangerous saint, you are a rogue. And thus Nietzsche flattered himself that he had slain religion with his subtle wit. He thought to continue the work of Voltaire whom he pronounced to be a great master- mind, "just what I am," he added. Here is something tasteful from the German Voltaire, "To the pure all things are pure, so says the people, but I say to you. To the swine is everything swinish." (Dem reinen ist Alles rein, dem Schweined wird Alles schwein) there- fore the fanatics and hypocrites whose heart is also law (Kopf-hanger denen auch das Her% niederhangt) thus preach. The world itself is a filthy monster (Ein Kothiges Ungeheuer.) For all these are of an unclean spirit; but all those who have neither quiet nor rest they see the world from behind, the behind worldlings. To them I say in their faces, although it does not sound well, "The world is like to men in this that it has a kinder part, so much is true. In the word there is much filth! So much is true. But the world for all that is no filthy monster. Here is wisdom that much in the world smells badly; disgust makes wings for itself and steam fore- boding strength. "In the best there is still something of disgust, and the best has still something of disgust, and the best has still something which must be overcome. Oh my brothers,there is still much wisdom in this that there is much filth in the world." Here is an attempt at an amatory passage which for A Study in Mental Pathology. 251 an author accused of erotomania is pretty flat. One even- ing went Zarathustra with his young people through the forest and comes upon a green meadow, in which some girls were dancing with one another. When the girls recognized Zarathustra they ceased dancing. Z. stepped forward with friendly gestures and spoke these words, Do not stop danc- ing, you lovely maidens. No spoiler of play has come to you with evil eye, no girl's enemy. 1 am God's advocate before the devil; he is the spirit of heavenness. How should I, you nimble ones, be an enemy of godlike dances, or of girl's feet with fine ankles. It is true I am a forest and a night of dark trees! but he who sees into my gloom finds clusters of roses under my cypresses, and he will find a little god that is dearest to girls lying beside the fountain with shut eyes. In truth he fell asleep in bright day; the day thief has tired himself with catching butterflies. Do not be angry you beautiful dancers if 1 chastise the little god a little. He will cry and weep, but mingle laughing with his tears, and with tears in his eye he will ask you to dance and 1 myself will sing a song to his dancing. And so Cupid after being whipped, where and" how is not mentioned, dances with the girls, and Z. prints his song which is in prose, neither rhyme nor reason. Lichtenholder tells us that the poem of Zarathustra was never completed. The author proposed that the philosopher should perform a grand act of effacement in giving birth to the over man. We are not surprised to learn that Nietzsche found difficulties in coming to particulars about this process. It recalls the bull of Castlereagh in the House of Commons. "The Herculean labor of the honorable gentleman; but the gentleman will be surprised when he has brought forth his Hercules." From 1882 to 1886 he sketched five plans for the denouement, but was not satisfied with any of them. In the last plan Z. conducts his disciples always higher, passes his grotto, ascends the mountains, he blesses the tombs, the isles, and the caves. It seems as if his face reddened slightly (perhaps a faint blush) then he shook his head (he well might) voluntarily shut his eyes, and died, and so ended Zarathustra, the insufferable. 252 William W. Ireland. Those who sum up Nietzsche's views in a consecutive form give him a great advantage, at least in the eyes of those who have not tried to read his works in the original unshapely form. Although he had a few leading ideas, he could not be said to have a system of morals worked out by induction or deduction. As for assigning plausible reasons for what he arrogantly asserted, he had got far beyond that, and many inconsistencies start up in the same books and even in the same page. In the Menschliches he accepts the morality of the day which later on he stigmatises as in- jurious to the loftiest types of humanity as he observed. "The serpent that cannot change its skin perishes and the minds who are hindered from changing their opinions cease to be mind at all." He was very proud of what he called the inversion of moral values, in which the old virtues were turned topsy- turvy and some of them were changed into vices. The first men who dictated a moral code were warriors and con- querors, with them good and right meant to be strong, hardy, courageous and severe. They were true to another, but to the subjugated mass below them there was no obligation save the will of conqueror. Bad meant to be weak, mean, abject, and cowardly. The vanquished looked upon these qualities from a different point of view. It was the Jews who constructed a "slave morality" in which the cardinal vir- tues were humility, pity, forgiveness of injuries and patience; the worst vices pride, violence and cruelty. They looked to another life for redress for the miseries of this world. Con- science was but a manifestation of the suppressed desire for cruelty and revenge, turning upon and tormenting itself. Christianity, he assures us, was an invention of the Jews, a subtle attack upon the "master morality" of the Romans. "Jesus of Nazareth," he writes "the embodied gospel of love, the Redeemer bringing blessedness and victory to the poor, the sick, and the sinful; was he not the reduction in its most uncomfortable and irresistible form of the Jewish change of moral values and renewal of ideals?" Has not Israel, goes on Nietzsche, by the round about way of this Redeemer, this seeming adversary and destroyer of Israel, actually A Study in Mental Pathology. 253 reached the final goal of the sublime quest for revenge? Does it not belong to the secret black art of a truly grand policy of vengeance, of a far-sighted, underground, slowly- grasping, calculative vengeance, that Israel itself should deny the very tool of its vengeance, before the whole world, as something to which it bore a deadly hatred, and should nail him to the cross in order that the whole world, i. e., the enemies of Israel, might thoughtlessly bite at this very bait? Nietzsche based these unheard of doctrines upon some frail speculations on the derivation of the oldest words for good and bad, and upon a transparently false rendering of history for the Jews at the time of the origin of Christi- anity, though they shared the fate of the rest of the world in acknowledging the supremacy of Rome, were far from being a down-trodden or broken-spirited people. As a na- tion they rejected the Gospel of Jesus and continued to in- dulge in dreams, not of meekness and submission, but of a Messiah who was to come with might and make the Chil- dren of Israel rulers of the earth. The doctrines of sub- mission, charity, pity and renunciation extended to all living creatures, had been preached in an extreme form six hundred years before the Christian era by Sankya Muni, the founder of Buddhism, who was not a slave or a low man, but of the Cshatriya, or warrior caste, and the son of a king. Of this, as a historical fact, Nietzsche was well aware, but, like a man in a dream, his mind was not startled by incongruities. As the maniac whets his wrath in violent words and threats, Nietzsche delighted in hurling obnoxious opinions at men and in contradicting their fond- est beliefs in the most provocative terms. He boastingly calls himself Nietzsche the Godless, and Nietzsche the Im- moralist, and at last arrived at the formula of the assassin: "Nothing is true; all is permitted save mercy to the weak." His chief commandment was: Werdet hart. Be hard, sup- press pity. The criminal type, he wrote, is the type of the strong man under favorable conditions, whose virtues are condemned by society. Nevertheless, we know that the habitual criminal is not so strong as the normal mem- bers of society. 254 William W. Ireland. For what he believed to be the truth Nietzsche had professed steadfast devotion. For the right of proclaiming it he had given up the faith of his fathers, his belief in God, the hope of a future life, the good will of many friends and the morality common to the whole world. At last he came to doubt whether truth itself was of any value. "The falsehood of an opinion," he wrote, "is for us no objection to it. The question is, How far does it uphold life? It is possible that a higher value may be as- signed to appearances, to the will to deceive, than to what is true. It is even possible that the worth of a good and honored thing may consist in its being entangled or hooked on to something bad. It is the power of sustaining a lie which lifts the artist high above the scientific man and his search for truth." We may, perhaps, grant that if the world be constructed on a reasonable and coherent plan, the finding of truth will be useful, but if it be a mere chance product of unconscious forces, a knowledge of the reality of things may be something unpleasant. In the birth of tragedy (1872) Socrates was denounced as the prime factor in the decadence of the Greeks. It was he who by his perplexing questions spoiled the simple, heroic life of Hellas. Formerly the Greeks followed their instincts, did what they had a mind to, which of course was right; whereas, Socrates introduced a taste for dialectics, and caused them to reflect upon what they were doing, which was wrong. He introduced a bad system of philosophy, which has come down to our own times. In the "Wanderer and His Shadow," written seven years after, Socrates had come into great favor. Nietzsche looked for- ward to the time when men would rather take the Memorabila of Xenophon in hand than the Bible. To Socrates lead all the streets of the diverse philosophies. He directed men's thoughts to the pleasures of life, and had something to suit all temperaments. Compared with the founder of Christi- anity, Socrates had a light vein in his seriousness and that wisdom full of strokes of comedy which constitute the best mental condition in man. Moreover, he had more under- standing. A Study in Mental Pathology. 255 Nine years later the emeritus professor of philology published an essay on the problem of Socrates, in which detection came at last. The wisest of the Greeks was a monster, a decadent, a typical criminal. He came of the lowest people; he was vulgar; he was a merry Andrew, he was very ugly, a rare thing with his countrymen; per- haps he was not wholly of Greek descent. Socrates and Plato were false Greeks, Anti-Greeks. A stranger who was skilled in physiognomy, when he saw Socrates, said that he was a monster who concealed all bad vices and desires. This, Socrates admitted, though with qualifications, which Nietzsche does not mention. The Socratic morality, like the Christian morality, was a misunderstanding, so, after all, Melitus and Anytus were right, and Xenophon was a fool. Richard Wagner at Lucerne had enjoyed the admira- tion of his young friend all the more that Nietzsche had given much time both to the theory and practice of music. If he thought that Wagner was destined to be the tone poet who was to restore the grand old Greek drama, he himself was to be the philosopher of the new era. In 1876 Nietzsche accepted a pressing invitation to Bayreuth, where he- found the composer much favored by King Lud- wig II, and the center of an admiring throng, directing the rehearsals of the Nieblungen Ring to a large company of actors, choristers and players in the orchestra. Nietzsche was observed to be sad and taciturn. He looked embarrassed when they spoke of the pamphlet in praise of the master, which he had published five weeks before. The new opera was not to his taste. He now discerned that the real Wagner was not his ideal one. He was displeased with the mystical tendency of the composer towards Catholicism. As he expressed it, Richard Wagner, apparently in the full career of victory, but in truth a rotten, despairing decadent, suddenly sunk, helpless and broken before the Christian Cross. Was he, he asks, the only one in Germany who suffered from this frightful spectacle which filled him with disgust at the idealized lying and weakening of conscience which had gained the victory over one of the bravest? They never met again. Wagner would not allow Nietzsche's 256 William W. Inland. name to be mentioned in his presence, and Nietzsche shed tears by the Lake of Lucerne when he recalled the happy days of their former friendship. Twelve years after their separation Nietzsche published a bitter diatribe against the composer, who was now dead. Wagner was the modern artist par excellence, because he knew how to mix in the most seductive manner the three grand stimulants for ex- hausted nerves, brutality, artifice and innocence. Here we have Nietzsche's usual want of measure, for granting that Wagner's operas have an over-exciting effect on some sus- ceptible people, the stimulus is too transient and too rarely renewed to cause any harm worthy of such violent denun- ciation, nor is there any danger of the creed or no creed of the most enthusiastic lover of the Wagnerian operas being altered by the fantastic religious sentiments of Parsifal. For democracy socialism, the happiness of the greatest number.Nietzsche had an ostentatious scorn. He proclaimed that the mass of people should be kept in slavery. Man- kind was merely a passing stage in the ascent of evolution. Their function was to generate the Uebermensch. This over- man was but the shifting conception of a delirious brain; in turns an artist, a composer, a philosopher and lawgiver; in the end a warrior, strong as brave and pitiless as strong, a blond beast of prey, obeying all his instincts, and tramp- ling on the rest of mankind, without the restraints of mercy and justice. As prototypes of the overman Nietzsche delighted to cite the treacherous murderer and poisoner, Caesar Borgia, and Napoleon Bonaparte, laying approving stress on the worst qualities of the Corsican. It was at once the duty and the destiny of humanity to sacrifice itself to half-a-dozen of this new species of great men, and Nietzsche himself, proclaimed the duty of self-abnegation to make way for the overman as his simian ancestors had made way for the human species. To the women he says, "Let it be your hope to give birth to the overman." He dreamed of the day when Zarathustra would de- scend among men, when the grand noon would come, the hour when man would march joyously to his effacement to to give birth to the overman, the hour when all wouldlbe A Study in Mental Pathology. 257 united in a common will. "All the gods are dead, we now wish that the overman should live." Yes, but the religious sentiment still lived and fell down before the image of the overman. Nietzsche came at last to worship this hideous creation of his own fancy, not through fear as the Hindu offers sacrifices to Kali, the goddess of destruction, or as the Aztec tore out the hearts of his captives for an offering to Quetzalcotl; but as the triumphant being who has put his foot on the neck of mankind. A weird fancy which was first broached as a paradox in the Frohliche IVissenschaft takes a serious form in the third part of Zarathustra. The sage's two domestic animals, the snake and the eagle, ventured to approach "the subject. As these worthy beasts are as long winded as their master.we take the liberty of condensing their speeches. We know who you are Z. and what you must become: You are the teacher of the eternal return. We know you teach that all things will return during eternity and we ourselves with them, and that we have already lived countless times before and all things with us. As an hour-glass is turned again and again so we through eternity renew our existence in the greatest things as in the smallest. You would say I die and disappear, and become nothing. Souls are mortal like bodies; but the meshes of causes in which we are entangled still again return, you will come again with this sun, with the earth, with the eagle, with this snake, not to a new life or to a better life but to the very same life in every particular, great and small. This dream of the destruction and the renewal of the world in successive cycles appears in the Indian mythology It belongs to the infancy of philosophy in which imagination was the leader of reason. The notion once implanted grew and occupied Nietzsche's mind with the strength of a dominant idea. He thus sought to prove this myth. The forces which sus- tain the universe are fixed and determinate. If they had been diminishing they would have come to naught through the past eternity, nor can they have increased without some nourishment to draw upon. In the infinity of time it must happen that the same combination will not be repeated and 258 William IV. Ireland. then this combination will inevitably bring after it the old series of events. But space is infinite as well as time, and though the play of forces may go on for ever, they will never bring about the same combinations. In the Anti-Christian, his last finished work, (1886) Nietzsche gives vent to his hatred of Christianity without either argument or measure. "It is not respectable to be a Christian. Christianity is the worst kind of corruption, it means the neglect of common sense, gratitude, and re- gard for the public weal. Christianity and alcohol are the two grand agents of corruption. Christianity is the worm which comes in mist and night to suck out the desire for truth, the instinct for" love, for death, the instinctive love for reality. This cowardly effeminate sugary sweet crew es- tranged the souls of the ancient world and led to the down- fall of its civilization. Christianity was the vampire of the Roman Empire." Much might have been expected from the Renaissance when some enthusiasts for ancient culture actually talked of restoring the old gods. On this subject Nietzsche has the following wonderful passage: "Caesar Borgia as pope. With that Christianity was abrogated. What happened? A German monk, Luther, came to Rome. This monk with all the revengeful instincts of an unsuccessful priest mutinied in Rome against the Renaissance. Christianity sat no more on the papal throne, but life, the triumph of life, the great yea to all that was high, beautiful and dar- ing, and Luther lifted up the Church anew. He attacked the Renaissance,a senseless thing done in mere wantonness." What a vicious jumble of history and nonsense have we here. Caesar Borgia never was pope, after getting his brother murdered, he threw off the habit of an ecclesiastic, and became the armed tyrant of the Papal States. On the death of his father, Alexander VI., he was chased out of Italy and perished in a skirmish in Navarre, four years before Luther came on a pilgrimage to Rome, and ten years before he broke with the Pope Leo X., about the sale of indulgences. It was the Renaissance that lighted the way to the Reformation. A Study in Mental Pathology. 259 Nietzsche declares that Islam had a right to despise Christianity which ruined the fine culture of the Moriscos as it had destroyed the culture of the ancient world. He says that Buddhism is a hundred times truer, and has more objective reality than Christianity. He finishes the Anti- Christian with these words: '-I shall write this eternal impeachment of Christianity upon all walls where walls are. I have letters which will make the blind to see them. 1 call Christianity the one great curse, the one great, inmost depravity, the one great instinct of revenge, to which no means are venomous, stealthy, underground, petty enough. I call it the one last- ing stain on humanity. And they reckon the time from the dies nefastus on which this fatality arose. From the first day of Christianity! Why not rather from its last day? From today? The inversion of all values." In the same volume he thus finishes the "History of an Error:" mid- day, the moment of shortest shadow; the end of the longest error, the highest point of humanity! Incipit Zarathustra. To criticise such notions would be like drawing the sword upon a still-born infant. The reptiles of the Jurassic "tore each other in the slime," and the panthers, wolves and hyenas of the Tertiary ruthlessly pursued their prey and left the hurt and feeble of their kind to die, but with man pity was born, compassion and help for the weak and mercy for the vanquished. Man rose above other creatures, not by obeying his instincts, but by subjecting them to his reason, by regulating and restraining them. Men became the lords of creation, not by warring on their kind, but by gathering together to act for common objects, by collective help and mutual trust; and this mad speculator would make it the duty of mankind to resign themselves to be effaced by a new being who should go back to the brutes, as if it were the duty of any creature to yield without a struggle in the battle of the survival of the fittest. Civilization does not make men weak and tame, as Nietzsche asserted; but by teaching them to concentrate and direct their powers it multiplies their strength a hundred fold, as a charge within the tube of a cannon will carry destruction for miles, while 260 William W. Ireland. if exploded in the ground, its effects would be exhausted within a few yards. In some parts of Zarathustra the author imitates the style of the Bible or Koran. He evidently considers it a book which in the end would be read with devotion. Z. is the prophet of the second translation of values as Jesus is the first. Of him he thus speaks: "In truth he died too soon, this Hebrew to whom give honor the preachers of a slow death. It was a fatality that he died too soon. Jesus only knew the tears and the melancholy of the Hebrew, and the hatred of the good and just, and so the desire of death suddenly seized him. Why did he not re- main in the desert far from the good and the just? Per- haps he would have learned to live, to love the earth and to laugh. Believe, my brothers, he died too soon. He would have retracted his doctrines himself, if he had lived to my age. He was noble enough to retract." Lichten- berger tells us that Nietzsche appeared to himself as both the destroyer and the continuator of the work of Jesus. Like him he had known solitude and suffering, and the hatred of the good and just, and like him, he is a fatality for innumerable generations to come. Through him Christi- anity should perish by self-effacement in giving place to something superior. During the last weeks of his con- scious life this ideal relationship which he fancied between Jesus and himself presented itself to his mind with a clear- ness and evidence that was always increasing. There was produced in him, under the influence of morbid causes no doubt, an exaltation of his whole being. He felt himself happy, light, soaring into infinite heights above life and men. He believed his creative thought; it is all-powerful, and announces that in two years all the earth will writhe in convulsions. Across the ages he stretches the hand to his predecessor Jesus, whose work he completes in de- stroying it. He gives the title of Ecce Homo to his auto- biography, written during the autumn of 1888, at the moment when the abyss of madness opens suddenly before him. He signs his last letter to Brandes "The Crucified One." A Study in Mental Pathology. 261 It is too bold that his admirers should persist in repeat- ing that Nietzsche passed from sanity to insanity without any transition. As we have seen, his derangement was of slow growth, though the bounds of external restraint may have abruptly given way, so that his madness became manifest even to the ignorant. It should be borne in mind that Nietzsche led a wandering life, with no one to observe his doings. His sister had gone to Paraguay with her husband in 1880. His letters to her were full of heart- rending complaints against the want of love, the universal ingratitude and the vileness of mankind (whom he ostenta- tiously pretended to dispise). There were bitter charges against his friends and reproaches against her husband for taking his sister so far away. After the death of her hus- band Frau Forster found amongst his papers a letter in which Nietzsche accused him of writing a critique against him and getting it published anonymously, and of having poisoned the mind of his sister against him. He added: "I am taking hypnotic upon hypnotic, but cannot get sleep. Today I shall take so much that I will lose my under- standing." His sister attributes his insanity to attacks in the public press, to the strain of overwork from his cease- less writings and to the excessive use of chloral. He never used opium. The sleeplessness was probably due to arterial degeneration which must have been going on in the brain. Of his private conduct or nervous symptoms during those years we have no precise information.* We know that he parted or broke with most of his old friends, and that some may have shunned him, owing to the extrava- gance of his opinions. In 1887 he writes to his sister, "Life becomes heavier from year to year. The saddest and the most painful did not seem to me so dismal, so void of hope as my present existence. What has •Dr. Turck has a story that while staying at Slis Maria, In the Engadlne, Nietzsche used to sit and meditate on a tongue of land which ran Into the lake. Returning one spring to his belcved mountain solitude, he found that a bench had been erected on the spot for the convenience of visitors; he turned away, never again to put his foot on the spot. My friend, Dr. W. H. Huggard. who is a resident physician at Davos-Platz, caused Inquiry to be made about Nietzsche at the time of his death. He writes to me: "Very little appears to be known here as to his residence In Slis Maria. He seems to have passed a very quiet life there, without making his crankiness conspicuous to the world." 262 William W. Ireland. happened? Nothing but the inevitable. The differences which separate me from all the men who have given me their confidence are patent, and from one side and the other one notices that he is despised. Oh heavens! how solitary I am to-day. I have no one with whom I can laugh, no one to drink a cup of tea with, no one who will give me friendly consolation." In 1888 he writes, "During ten years no one in Germany has made it a conscientious duty to defend my name against the absurd conspiracy of silence under which it is buried." This is a not uncommon delusion with authors who believe that nothing short of a plot is capable of a keeping their books from bursting into celebrity. What was apparently the first open outburst of in- sanity is described by Frau Forster in a paper entitled Die Krankheit Friedrich Niet^sches in the Zukunft of 6th January, 1900. In Turin about the end of December, 1888, he fell down at the gate of the house where he was living. On being assisted into the house he lay on the sofa motionless and speechless for two days. On coming out of this leth- argy he spoke in a loud voice to himself, sang and played much and noisily and showed that he had lost the proper knowledge of money, paying for trifles with twenty-franc pieces. He covered some sheets with writing, full of strange fancies, mixing up the characters in the Greek mythology with personages in the Gospel and those of our own time. He accused some of his nearest friends of injuring him. He fancied that God, torn to pieces by His enemies, was wandering by the banks of the Po. During this time he signed his letters Dionysos or Der Gekreuqigte. One of these letters having reached Professor Overbeck in Basle, he travelled to Turin in the first week in January, and finding his friend quite insane he took him to Basle, from where he was soon removed to the private asylum of Dr. Binswanger, at Jena, where he remained for sixteen months. After this his mother took him to her house at Naumburg, where he was affectionately tended by her and his sister, now a widow. On the mother's death Frau Forster took him to a house at Weimar. The first excitement calmed down within a year; but the hopes of recovery kept up by A Study in Mental Pathology. 263 occasional rallying were dashed by repeated paralytic at- tacks (Scklaganfalle). Frau FQrster tells us that the physi- cians styled his malady an atypic form of paralysis (eine atypische Foim der Paralyse). There seems to have been some degree of aphasia, and it was difficult to say in the end how much intelligence was left. Lichtenberger came from Nancy to see him and staid a week. "Perhaps," says his admirer and commentator, "here he has preserved a vague memory of his life of thinker and poet. 'Have I not myself written good books?' said he, when they put into his hand a new book. At any rate he is conscious of the affection with which his sister surrounds him; he fol- lows her with his eyes when she comes and goes, and it is touching to see when she comes to sit beside his couch the awkward and slow action with which he manages to take the hand of that sister formerly the confidant of his youth, now the last consoler of his years of decline." He who had scorned mankind had sunk below the lowest; he who had told men to banish pity from their hearts had now in his helplessness to depend on the pity of others, and while he lay in a state of death-in-life, his mischievous writings were scattering the germs of moral evil wherever they lighted upon a fitting soil. While this paper was being completed Friedrich Nietzsche died on the 25th of August, 1900. According to a correspondent of the Kolnische Zeitung, who was with him at the last, he suc- cumbed to an attack of cerebral hemorrhage which had supervened twenty-four hours before. The tender care of his sister had tided him over a similar seizure about three months earlier. From the obituary notices in the principal French, German and English newspapers it appeared that Nietzsche's views were known at least, to journalists. A writer in the Berliner Tageblatt, who went to Weimar to see what re- mained of Nietzsche after eleven years' insanity, compares him with Goethe and Bismarck. He was buried in the resting-place of his fathers near Lfltzen. The pastor was absent; a layman pronounced the funeral oration. Nietzsche has left a number of manuscripts, the publi- 264 William W. Ireland. catien of which is threatened, though his works already form eight volumes. His admirers remark that the personal character of Nietzsche is an important part of his philoso- phy, and this we accept, though not in the same sense. His writings are only serviceable to indicate his mental aberration; as a contribution to psychology they are worth nothing. He never proves anything, never, indeed, tries to prove anything, contents himself with arrogant and absurd assertions. "My judgment," he writes, "is my judgment, and to this another man has scarcely any right." Never- theless, he often changes his opinion. The devil himself would not have Nietzsche for an advocate. There is a progressive wildness, a deepening lack of restraint, a swell- ing conceit in each successive publication.* Frau Andreas thus describes this literary anarchist's appearance during the period between 1879 and 1889, when his stormy writings were given to the world: "He is a man of middle size, plain but neat in his dress. His large forehead was rendered the more prominent by smooth brown hair brushed backward. The region of the head in front of the ear is large in proportion to the occipital portion. The lips are covered by a thick mustache. In his physi- ognomy there is an air of reticence, aloofness, strange- ness. He had a quiet laugh, a noiseless way of speaking and a heedful, meditative gait, with a slight stoop. He had finely formed hands, of which he is proud." M. E. Schure, who saw Nietzsche at the first representations of the Nieblungen Ring at Bayreuth, in 1876, describes him in much the same terms.t "The thick, hanging mustache and the bold profile might have given him the air of a cavalry officer had it not been for something at once timid and haughty in his approach. The musical voice and slow speech denoted his artistic organization, and his wary and thoughtful gait showed the philosopher. Nothing was more deceptive than the apparent calm of his expression; the •Professor Theobald Zlegler, of Strasburg, who has pored through Nietzsche's works, line by line, in chronological order, finds the first signs of Insanity is Zarathustra (written •nd published In 1883). 'In all the subsequent works he finds much that marks the overstrung, distorted, coarse and glaring, the loud and shrieking In increasing Intensity. tin Rtvuc Jis Deux Momtts, 15 Aout., 1895, A Study in Mental Pathology. 265 fixed eye betrayed the painful working of his thoughts. It was at once the eye of an acute observer and of a fanatic visionary. This gave him something unquiet and disquiet- ing, especially as his looks seemed always fixed upon one point. In moments of excitement his looks softened, soon again to appear hostile." The expression in all the por- traits given of Nietzsche is fierce and aggressive. One of the portraits given by Frau Andreas, a full front one, seems to be an evil face. Frau Andreas lets us know, what would scarcely be expected from his writings, that Nietzsche was distinguished by a great politeness and almost feminine gentleness of demeanor. To use her own expression, he habitually wore a mask and mantle to cover an inner life scarcely ever re- vealed. He himself writes in the Ecce Homo: "To suffer from solitude is an inferiority. 1 have never suffered save from the crowd. At seven years, an age absurdly tender, 1 already knew that never a word of man would reach me. Have they ever seen me afflicted by it? Even today 1 have for all the same affability, 1 am full of deference for the most humble, and in all my bearing there is not an atom of pride nor of secret scorn. He whom 1 despise guesses that he is despised by me; with my simple presence I put out of sorts any one who has vitiated blood in his veins!" In another place Frau Andreas tells us "wherever he speaks of lord and slave-natures one must be mindful that he speaks of himself." Driven by the longing of a suffering and unharmonious nature to its opposite, and moved by the desire to look upon such a one as his god he portrays his own self when he says of the slave: "his mind loves hid- ing-places, secret paths and back-doors, all that is covered he relishes as his own world, his security and his recrea- tion, and in the practical, joyous, simple, lord-nature of the original men of action he describes his opposite." It is common enough for men to see their ideal in a character opposed in every respect to their own. We have for example, Thomas Carlyle, greedy of talk, lavish of words; a sceptic in most things, a man who never acted, and who was always fretting and grumbling about trifles, who took for 266 William W. Ireland. his heroes men of deeds rough and unscrupulous, of strong convictions, but fonder of using blows, than words. Or take Macaulay, healthy, cheerful, pleasant and vain, a fine talker, a book in breeches, who could not ride a horse or handle a gun; he chose for his favorite the sour asthmatic Dutch- man, William of Orange, with no taste for literature, spar- ing of speech, but a daring rider, an intrepid general and a great statesman. The unfortunate Neitzsche was born with an hereditary tendency to abnormal mental action; in infancy he was backward; in childhood he was shy and solitary; in youth he took no pleasure in the sports and amusements of young men but was quick at book learning and literary aptitude with a love for straying away from beaten paths. A careful education by a good mother helped to keep down his lower propensities, and the early dignity of a responsible position and academic surroundings made him give hostages to behavior. But he soon showed an irrepressible combative- ness and an excessive self-conceit. The connection of the nervous sufferings with the mental derangement is not clear but no doubt these sufferings exasperated his mind and in- creased his discontent with life. Few men and only the best of men are made better by sickness. This was the condition described as Grubelsucht, folie de doute, the anguish of doubt. Talking of the mental changes which lay behind him, Nietzsche once said to Frau Andreas, half in jest, "Yes, the course has begun and will go on—but whither? When all has been rung through whence will one start? When all possible complications are exhausted, what will follow? How? Must one not again arrive at faith? per- haps at a Catholic faith? In any case a circle is more likely than a standing still." The restless working of his intellect was always ac- companied by exaltation of the affective faculties, the power of correct reasoning slowly decayed and the bonds of restraint became weaker. His aggressiveness and egotism came more and more prominent. With no pole star to guide him he was insensibly drifted by the current of the desires and longings which he fancied were suppressed, and so it came A Study in Mental Pathology. 267 around that in place of the aspiration for a future life he accepted "the eternal return of all things" and for the religious sentiment he had the worship of that mons- trous fantasy of his own mind, the 'over man.' The peculiarity of Nietzsche's insanity seems to have been that while he long retained sufficient powers of self-restraint to refrain from breaking through outward rules of conduct within his limited sphere of intercourse with other men, he gratified his extravagant propensities by writing reckless and provocative books against the beliefs which were most cherished by those amongst whom he dwelt. To use his own expression he philosophised with a hammer. As Byron said of J. J. Rousseau: "But he was frenzied by disease or woe To that worst pitch of all which takes a reasoning show." We might inquire why books like those of Nietzsche which might be expected to shock even a not over-fastidious taste, should be so far relished as to pass through several editions and to become the subject of commentary of apology, and even of praise? No doubt there are literary chiffoniers who seeing that the public will have carrion to feed on, are eager to serve it up, and ready to also disguise too rank a taste by their own culinary arts, but they generally wait for some signs of a morbid appetite, before they fetch such wares to market. We are living in a time of great decline of literary taste. Something is due to the overpowering momentum of the many who now amuse themselves with reading. There are people leading outwardly decent lives who indulge in literary license, gratify the sensuous cravings in their nature by gloat- ing over coarse descriptions and read filthy books for their filth. Apparently there is also a demand somewhere for philosophical profanity and speculative immorality. THE SUCCESSFUL MANAGEMENT OF NEURALGIA. BY C. H. HUGHES, M. D., ST. LOUIS. THE surgical treatment of neuralgia is a reproach to neuriatry and stigmatises modern neurotherapy with opprobrium. To give over the treatment of a morbidly af- fected nerve to the surgeon's knife is a confession of incom- petency and a surrender to anatomical destruction. The neuralgias are generally capable of remedy and the conditions that engender them are not ordinarily reme- diable by the knife. The neuropathic nerve state is usually a result and not a cause—and the cure is not complete when the nerve is removed, though the cure may follow the operations and conditions of relief, rest and re- cuperation which" follow the surgery and with which the patient would not surround himself till he has consented to the necessary operation. The hope inspired, the anaes- thesia, the operation, the freedom from pain, the break in the business, care or worry or grief. The more or less prolonged rest, and the entire break and changed environ- ment in the life of the suffering neuralgic make a combi- nation of favoring therapeutic influences which give us a valuable lesson of treatment in the direction of its treat- ment which ought to be put in practice, coupled with a proper and persistent medication, before at least some of the graver destructive and deforming operations should be undertaken. If we except those locally engendered forms of peripheral neuritic trifacial neuralgias which the sur- [268] The Successful Management of Neuralgia. 269 geons recognize but which are by no means all the forms of trigeminal neuralgias the rapidly alternating forms are not of local origin. There are many forms but few pathological varieties of neuralgia. Unique among them and requiring the dis- tinctive treatment which only the thoroughly experienced alienist can best apply is the phrenalgia of the melanchol- iac, the pain of the sorrow bruised brain, the wounded in spirit and broken hearted, the hurt mind, morbid, black and dreadful, which requires distinctive and elaborate considera- tion and will not be here discussed. Nor will the varieties of cephalalgia, including the migraine, though the latter, in remedial aspect, may well be regarded in the light of some forms of ordinary neuralgia. Our task to-day takes up the neuralgias that taunt the profession with its frequent failures in treatment, and we shall endeavor to outline for them the principles and pre- scriptions of their successful therapeusis. First and most provokingly confronts us the so often intractable trigeminal neuralgia, then the neuralgia of the sciatic or sciatica, then the neuralgia of the labia, the ovaries and testes, the neuralgia of the heart with or without coronary artery implication, true neuralgic gastralgia neu- ralgic enteralgia and all the viscera (Tenalgia, cystagia, etc.,) which the surgeon can not reach, the neuralgia of the extremities, (plantar, palmar, et id orme genus). We must learn to successfully treat them therapeutically sans cuto, for the surgeon can not reach them all with his destroying knife, and if he could, we should so master them by medication that the knife will not be needed. In the consideration of this subject we take up first that form of algic neuropathic implication which all clinicians have conceded to be the most distractingly painful and which the daring surgeon like the dashing general likes most to attack, the neuralgia of the trigeminus and the thera- peutic principles involved in its medical management will largely apply to the other forms, for in soul distracting and system shattering severity it leads all the rest.* •Much of the matter touching the consideration of trifacial neuraigia was present- ed In the discussion on this subject before the St. Louis Medical Society, January 1901. 270 C. H. Hughes. In its effort at radical remedy of this formidable malady bold and daring surgery has gone on step by step cutting off peripheral outposts until it has reached what it deems the morbid citadel of the disease within the en- cephalic sanctuary. If the peripheral operations fail to cure a case of trigeminal neuralgia, the formidable bloody re- moval of the Gasserion ganglion is performed, though Tif- fany, Keene and Spiller as late as November 1898 (Amer. Jour. Med. Sciences) say twenty-two and two-tenths per cent of the recorded operations up to that date were mor- tal and Carson has found as late as October 1899 a mor- tality of twelve cases out of one hundred and one operat- ed upon (Med. Weekly Review, Mar. 1899), and this ex- clusive of the recurrences of the neuralgia on the opposite side and elsewhere, of corneal ulceration, conjunctual and corneal anaesthesias, the loss of the eye, deafness, im- paired deglutition, face deformity, hideous scars, bone ne- crosis, paralysis of the eye muscles and of mastication, changes of disposition and continued ill health and the in- sanities, which are not uncommon sequels. Besides all this the pathology of trifacial neuralgia has not been located exclusively in the ganglion. Its paroxys- mal and recurrent character can not be explained by a per- sistent lesion there, and such morbid changes as have been found, microscopically, in the Gasserion ganglion have been likewise found in the ganglia of the aged and are the result probably of the violent peripheral shocks trans- mitted to them through the violent molecular disturbances and advancing neuritis and continuous peripheral central shocks of pain in this disease, making the nerve center prematurely old and broken and diseased from its repeat- ed horrible assaults. This view is confirmed by the well- known beginnings of so many of these attacks from ave- olar osteitis, dental caries, rhinitis, cold, etc., to say noth- ing of the brain strain, worry, alcohol, syphilis, rheuma- tism, malaria, grippal toxhemia, profound anemia and that grave hyperemia which prompted Ricketts to tie the carotid for this form of tic. The general peripheral neural origin of neuralgia (supra-orbital maxillary, intranasal, etc.,) The Successful Management of Neuralgia. 271 strengthens the view that the envolvement of the ganglion is a secondary matter. Discussing the operations for trigeminal neuralgia J. Chalmers DaCosta in the March 1899 number of Pro- gressive Medicine says: "Before concluding that medical treatment is futile we should be sure that massive doses of strychnin are given after the method of Dana. In a recent case of violent tic in which we had determined to perform resection of the Gasserian ganglion, the strychnin treatment was employed by my friend Dr. Chas. S. Potts with the result that the pain ceased completely." To this statement 1 wish to add that this formidable operation should never be done for tri-facial neuralgia until after thorough trial of the many efficient resources of neurologic medicine applied by skillful neurologic hands and not alone by the surgeon or the general practitioner and particularly not until a thorough and heroic anti-malarial treatment has been employed in certain cases and if the history warrants, a complete syphilitic and anti-anaemic treatment, coupled with the heroic use of green root tincture of galsemium and the moderate but persistent employment of galvanism from the cerebral center to the peripheral, through the head and over each affected nerve tract with static elec- trization added through the system generally. This view however is subject to future possible mod- ification since it is based on the fact mainly of my own personal observation in which, during a period of forty years, daily practice, no case that I know of when I had a fair chance at steady treatment has passed from my hands to the surgeon and no case of which I have record in my own practice has failed of final relief under persevering treatment. Strychnin however, in large doses, has not been my main reliance. In moderate doses however (one- sixtieth to one fortieth of a grain), it has not in any case, I believe, been omitted by me or has atropin or belladonna been neglected. In fact I have had to withdraw the larger doses of strychnin, (as high as one twentieth to one tenth of a grain in anaemic form) where I had ventured to use them. The cases that tolerated best large doses of strych- 272 C. H. Hughes. nin were those cachemic states of chronic malarial poison- ing of the blood, viscera and nerve centers so often met with in these Mississippi, Missouri, Wabash, Gasconade, Desmoines, Illinois, Tennessee, Ohio, St. Francis and other river valleys and tributaries to this Mississippi valley region. My chief reliance in the management of all neu- ralgias especially in sciatica prosopalgia has been belladonna or its active principle atropin, aconite,strychnin, large doses of quinin, preferably the bi-sulphate and more recently hypoquinidol which is a phosphate of quinin. This treat- ment I have invariably supplemented with persistent gal- vanization of the effected nerve tracts with some form of bromid, the hypophosphites of iron and gelsemium in green root tincture for direct anodyne effect, with locally ether, menthol, heat and electricity. I have no faith in the as- serted efficacy of any dry root preparation of gelsemium. I have used in many cases at the same time minimum tri- daily doses of Fowler's solution or Arsenauro and such coal tar anodynes as may be indicated. In the progress of some cases I have found it necessary to employ large doses of muriate of ammonium after Anstie's method (30 grains ter die). And when I have done this, as I have quite often, I have blended it in an agreeable solution with the bromid of ammonium. The strontium and sodium bromids have likewise been of service to me for alternative treat- ment, the former with pepsin essence and pancreatin as solvent (Fairchild's preferred), but in England and with patients going abroad and to Paris I have used, the officinal wine of the respective pharmacopoeias of these countries. For local arrest of pain we should use menthol and camphor dissolved in sulphuric ether and chloroform and other anodynes locally hot or cold to suit the sensitiveness of the patient. I treat a neurologic patient all over, ascer- tain the possible causes of the disease and treat them and the entire patient. The nervous system is always out of order elsewhere than in the local pain tracts. Some of his disorder is precedent, some coincident and some sequent to the local neuralgia. All forms of neuralgia are sources of irritation and interfere with nerve rest or nerve repair. The Successful Management of Neuralgia. 273 The sensory nervous system too is generally shocked and it is out of repair in other parts. It is often toxically in- volved and molecularly disturbed and it must be treated in general as well as special. A new molecular activity must be set up and normal trophic changes established in the affected nerves and nerve centers involved and they must be soothed into their best state for repair and cure. Sensory nerve tranquility affords the best condition of repair to a damaged and painful peripheral sensory nerve as it does to an over-worked or over-excited or poisoned nerve center. Neural metabolism has gone wrong in neuralgia, and metabolism elsewhere, and whether the disease we dis- cover is the result or the cause of neuralgia or both, the nerve pain must be relieved to give the recuperative powers the best aid and chance. Anstie thought anemia was the principal cause of neuralgia, especially tri-facial. It is undoubtedly often a causal condition, so are all forms of cachemia (septicemia for example) and many other varieties of toxemia, (alcohol, syphilis, uric acid, grippe, malaria and post febrile toxins.) The surgeons say cold and ascending neuritis, caries, etc., cause tri-facial neuralgia; so they do excite it, but it has other causes. The surgeon looks for local causes, constitutional causes do not so much engage his attention as they do the physician. His resource is the knife. He can not remove a diathesis. Nor is surgery the best resource for a neuritis or other inflammation. Ricketts, another surgeon would ligate the carotid, for to him tic douloureux is either a hyperemic or anemic state, most fre- quently the former and the ligation of this artery lessens the blood supply to the ganglion of Gasser (Jour. A. M. A. Oct. 16, 1897). The partial compression of the carotid on the side of the operation might be a good thing if cautiously and skillfully employed, as suggested to me by Dr. Meisenbach, to diminish hemorrhage during the opera- tion. The danger of disturbing the cerebral blood equili- brium of circulation must be considered ifjthis is attempted. The carotid should be cautiously and gradually compressed, if compressed at all. 274 C. H. Hughes. In neuralgia a peculiar state of special aptitude of the nervous system exists either through heredity or later acquisition, which predisposes to the current paroxysmal features of this singular disease. There is a weakness and proneness of the sensory nervous system to become thus affected by cold, aveolar ostitis, dental caries, rhinitis, periostitis neuritis, worry, grief, bereavement or other local cause affecting the peripheral nerve ends. Disappointed ambition or financial remorse, syphilis, alcohol and post- febrile polyneuritis and the various toxaemic states already hinted at, can not escape our consideration in the manage- ment of the causative or complicating features of neuralgia, but I draw the line on uterine diseases as a direct cause. Some of my patients have had a good deal of this treatment ineffectually before reaching me. I would as soon regard appendicitis as a cause. It might more likely bring it on if surgically neglected to septic infection and constitutional undermining. Why does the peculiar paroxysmal neuralgia come on in one individual from the same causes that develop the persistent pain or tenderness of neuritis in another, or why does neuralgia coexist with the neuritis in one while another only has neuritis from the same cause? Evidently some peculiar molecular nerve alteration exists in one that does not in the other. I will not say without qualification, that the Gasserian ganglion should never be removed but 1 do say, when we consider the gravity of the procedure, the loss to the patient, the shock, hemorrhage and accidents, brain viol- ence ensuing from surgical manipulation in the dark, the chances of fatal issue, the after danger to the eye and ear, the recurrences and the chances of cure of neuralgia without the knife under proper persevering and persistent neurologic treatment, its removal should seldom be at- tempted and the decision to operate should never be made upon surgical judgment alone as to the efficiency and completeness of the previous medical treatment. The operation itself is a surgical procedure. The value of the treatment is a matter of medico-surgical judgment, based The Successful Management of Neuralgia. 275 upon the broadest clinical experience and most skilled neuriatric effort, and only the most thoroughly skilled sur- geon, anatomically and dexterously skilled should attempt it. It is not a play for fame for the tyro chirurgeon. The centers of life in this formidable operation are close to the best wielded and directed knife. The best surgeon gropes in the dark in this operation. A few millimeters from the pontal emergence of the nerve root to be severed are the tracts and superficial origins of the third and fourth nerve in one direction and the course across the medulla of the sixth, seventh and vagus or tenth in another with the latter's important inhibitory relations to the vasomotor center of the cord and its connection with and influence over so many vital organs and processes, the cardiac, respiratory, laryngeal, pharyngeal, gastric, intestinal, etc., branches of the basilar artery are so near that they can escape only the skillful surgeon's knife. With all this and the tentorium to be cut, and the unavoidable venous hemorr- hage, is it a wonder so many surgeons have to say, as Victor Horsley had to say concerning his first case in 1890 and the first case operated on by any surgeon, "unfortunately the patient did not survive the shock of the operation?" The shock of the operation is generally the brain and nerve bruising and lacerating, death dealing pressure, vio- lence or other destruction of vital areas in this murderous delving in the dark with pressure of fingers, prick of scal- pel, thrust of forceps, or clip of scissors so close by where the life source is centered. Were I a surgeon as 1 am a neurologist I am sure I would wish to traverse the dark and bloody ground at least just once, but I would try and find a way to get there with a chance for more light on my bloody way. Later surgeons are doing better as re- gards light, however, than former operators. In such a contemplated grave procedure all neurologic and therapeutic resource should be exhausted. The neu- rologic clinician as well as the operative surgeon should then decide the question and the conclusion to operate should not be reached till neurology had failed. The surgical records of the subsequent life history of 276 C. H. Hughes. this operation are not so complete as one might wish to have them and recurrences on the opposite side of the face are not recorded as frequently as they occur. This fact of recurrence on the opposite side when the incision of the ganglion has been made complete is inexplicable on the theory that the fountain source of the trouble is always and exclusively in the Gasserian ganglion and how the trouble can recur on the same side,as one surgeon has stated, after a complete Gasserian extirpation I can not comprehend as a neurologist. Another fact noted by surgeons as a post operative sequel of this operation is insanity. The sur- geons have recorded this as a sequence due to the opera- tion but 1 have seen it occur in one case after recovery by electro-medical treatment. This patient had suffered for nine years, receiving gynecologic treatment ad nauseum all the time for endocervicitis, ulceration, sutured cervix, etc. When the pain finally ceased she passed into a state of acute delirious insanity from which she only emerged after about six weeks, treatment for her mental malady. She was then recovered of both her mental and neurologic troubles. I treated this patient about eight months. The recurring neuralgic shocks sent to the cerebrum maintained the patient's normal vigilance and kept the patient psychic- ally alert. When pain ceased the delirium of the cerebral exhaustion set in, there being no longer the recurring arousing to consciousness. A long rest of brain and daily enforced sleep, reinforced nutrition resulted in her cure. This subject has always been peculiarly attractive to surgeons Hartley, Andrews, Tiffany, Parkhill, Carson, Ross, DaCosta, Carnochen, Mears, Luecke, Krause, Hors- ley, Keene, Murphy and a host of others because as ordinarily treated it has been regarded as a medical bete noire and.'.extirpation of the ganglion of Gasser has been looked upon as the inevitable dernier ressort of medical remedy. Victor Horsley's hope that excision of the Gass- erian ganglion would prove a bar to the future progress of the disease, has not been realized, though the nerve and brain rest following the operation and the removal of the nidus of the disease in some instances with ganglion extirpation re- The Successful Management of Neuralgia. 277 moves a central source of irritation, while the loss of blood dissipates congestion for a time and gives further chance for the morbid irritation to cease and the post operation rest gives chance for the disturbed nervous sys- tem to regain its normal metabolism and that healthy equipoise which makes the peculiar pain of neuralgia an impossibility. Not only the sensory root going to the Gasserian ganglion, but the opposite side has become af- fected, nevertheless the surgeons maintain the operation to be a justifiable one. Dr. N. B. Carson, who read a valu- able paper before this society February 18th, 1899, made the mortality appear about eleven per cent, a reduction in the death rate of about one-half since 1896. Carson's first case was attacked in November 1895 and operated on in August, 1898, was somewhat more irritable afterward than before the operation, had some paralytic sequelae but had no pain up to Feb. 1899 (though a typographic error makes the date appear 1898 in his paper.) A subsequent operation by Carson proved promptly fatal. The technique is so well set forth in this paper of Carson's and in that of the essayist of last evening, Dr. Willard Bartlett, and in so many late works on surgery that I need not here reproduce it, at least in extenso. My objection to the extirpation of the Gasserian ganglion for tri-facial neuralgia is: First. Because of the curability of the disease by medication if rightly and vigorously enough employed. It is curable in every case, I think, where sufficient vital stamina remains such as would withstand the ordeal of ganglion extirpation as practiced by any present operative method. Second. Because tri-facial neuralgia is not a disease exclusively of the ganglion. Third. Because it appears to be a disease not ex- clusively confined to the fifth nerve and when apparently so confined it does not stop at or begin in the gan- glion of Gasser. It is a morbid state of the sensory nerv- ous system with the characteristic trigeminal pain man- ifestations. It is and is not a local disease. 278 C. H. Hughes. Fourth. Because medical effect equal to that of the operation may usually be secured by absolute rest and recuperation and restoration of the nervous system involved by other remedial measures. The brain is often chiefly at fault, in some cases due to bereavement, worry, brain fag, etc. Fifth. Because of the trophic irritative or paralytic sequences to the cornea and face, the herpes, ear and jaw involvement, the ptosis and general fourth and sixth nerve paralysis, and finally as so often follows, the certain mor- tality of the operation in so many cases, the infection which so often follows the perforation of the antrum, a frequent accident of the operation, and the shattered health of many who survive the operation, would seem to forbid it. The fact that power of tension of the tympanum comes from the fifth nerve and otic ganglion is not considered as it should be by surgeons contemplating this operation. If I were the affected one and allowed to counsel and treat the patient I would advise against the operation in my present light and prefer even the relief of opium if nothing else sufficed, with the prospect of final, fatal euthanasia rather than to submit to the chances of this formidable and terrible procedure. I would rather prefer the constant current battery applied at every paroxysm and the con- stant smell of mentholated ether spray, a daily diet of gelsemium, ammoniummuriate and coal tar derivatives or to become a drug fiend in any form, than take my chances of being one of the twenty per cent of surgical science made immortals. If 1 had continued in surgery as in the first decade of my professional career my ambition would probably have been as it is with so many of our surgeons today, to have scaled the neural heights to the summit of surgical pos- sibility, to have gone beneath the tenent chamber of the highest neural life and have snatched, by skillful gang- liectomy, this great ganglionic servant of the brain's sensory life and facial motion from its lair, so near to the pons variolus and the great centers of life and the great blood flow of the brain. But now, if I were a surgeon as The Successful Management of Neuralgia. 279 I am a neurologist, with the discerning Warning of wider neural knowledge to restrain, 1 would advance with caution to the giddy heights of glory and destruction, in view of the indubitable fact that death to patient and damaged reputation to the surgeon, are too often the penalty of surgical temerity without due neurologic restraint. Neuralgia means an individual with neural idiosyncracy to be treated, not alone a neural section of the individual's anatomy to be exsected. Before attempting this formidable operative procedure I would be assured that all the per- ipheral branches of this nerve had displayed the neuralgic trouble and that previous peripheral neurectomies had fail- ed. I would be assured that neuralgias elsewhere, of other nerves and nerve centers did not alternate with the facial trouble, such as sciatic, femeropopliteal, ilioscrotal, mammary, plantar, brachial, angina pectoris, gastrodynia, etc. I would aim first to secure a change in the neuralgic habit by thorough neurologic observation and neuriatric treatment through hand accustomed to master these con- ditions. Surgery in this formidable condition should be the last resort of the highest neuriatric and medico-therapeutic skill, baffled and at bay, in its treatment. The chronic neuralgic is a broken human neural or- ganism to be made over; a human being to be thoroughly treated before we may safely say with our knives "out damned spot" and safely hope with them to be rid of all trouble. A neuropathic degeneracy, often awakened from latency into active mobid life, is often the bottom of the neuralgic habit which the knife may relieve, but may not eradicate. Peripheral surgery in local neural sources can be done in this form of neuralgia even while the constitutional treatment goes on and the patient should be treated to thorough nerve health after neurectomy. If 1 should finally decide upon the extirpation of the ganglion of Gasser I would not esteem my patient cured be- cause the pain ceased and the wound healed and life per- sisted, but would give him or her (and the case is more often a woman than a man) the best neurological after treatment, Neural and constitutional rebuilding to eradN 280 C. H. Hughes. cate, if possible,, the neuropathic state and guard against the vicious vicarious return of this formidable malady in other sensory nerve areas, for while the tic douloureux is the most painful of all nerve diseases, its extirpation by the knife is not always the end of the patient's suffering, except in the nerve tracts and center destroyed. This formidable operation is so daring and dangerous that it fascinates the surgeon to its performance. Modern surgery now displays skill hitherto unknown in any de- partment of human technique and with antisepsis to as- sure immediate immunity from death, will not be barred from entering, for rescue, even the hitherto safe and sacred precinct of the vital centers where even the God- like mind may dwell. After this bloody procedure and the penetrations of the great cavities, with immunity we may say to surgery as Job said to the Almighty "We know that thou canst do everything." But what neurology wants to know of the surgeons is the full and complete record of the sequences of this formidable Gasserectomy. Many surgeons in this as in other formidable and dar- ing surgical procedures consider the operation a success when the victim survives the knife and the particular trouble for which the operation is performed does not reap- pear; whenever the undertaker has not reaped the opera- tion's immediate or nearby fruition. What neurology would like to know of surgery is the post operative history of these victims of their skill. Neurology would like to decide from the standpoint of neurological observation some time after the wound has healed, how many have escaped other neuropathic display, vicarious neuralgias, vertigos, deca- dence and changes of mentality, not even so marked as commonly recognized insanity and death, not immediately but one year or more after the operation. Many lost eyes have been sequences of ulceration (as given by Keene, Krause, Tiffany, Kronleinn, Carson and others.) Other trophic changes result also, shock, brain bruises, nerves stretched, etc. The surgeons try to persuade themselves that only anaesthesia causes the destruction of the eye by permitting irritation and infection, but the eye would be The Successful Management of Neuralgia. 281 better resistive to destruction of irritation if in normal trophic condition. The shock of this operation, the lifting and disturbance of the under surface of the brain, the hemorrhage, sponging, stretching, tamponing and other operative procedures can not fail to disturb the normal conditions of the brain and cranial nerves even when the knife is wielded truly. To determine the full value and harm of this opera- tion these cases should be followed to their death, as Pheneas P. Gage was, after the accidental capital opera- tion Nature performed upon him. Gage's was an acciden- tal invasion of the brain territory as it had never before been penetrated without death follows, but Gage lived for years with one eye gone and intellect for a time undis- turbed, finally to die of epileptic coma. To see what has to be done, to get there and qut safely, that is, with the patient reasonably safe, let us run over briefly the method of procedure beginning with the Hartley-Keene method. First, semicircular integument flap, base at zygoma, next corresponding bone excision with chisel, Gigli saw or surgical engine, then prying up- ward and outward the bone, separating dura from middle fossa, dura from third division at oval foramen, the second at the rotundum, cutting through at its respective fora- men, tracing these nerves to ganglion, grasping gang- lion with forceps and twisting it out, bringing out usually the sensory root. Then comes the flow of hemorrhage from the middle meningeal artery or the veins of the base of the skull, unless by the Doyen method the internal maxillary is tied before entering the skull, the torrent of blood may be lessened to a more manageable shower. But while all this is going on what damage is done to the delicate texture of nerve, brain membrane and brain suffer- ing from surgical manipulation, bloody overflow and shock? But let us look at the Doyen method as preferred by Dr. Carson and other surgeons a little better, we think, than the Hartley-Krause method because it gives more room for entrance and better precaution against intercranial bleeding by tying the internal maxillary early in the proceeding. 282 . C. H. Hughes. A similar integumented and bony semicircular incision is made in the temporosphenoidal between the external angular process and the auditory meatus 15mm below. Zygomatic arch resected, temporal fossa exposed, lingual and dental nerve brought in sight, cut, and internal max- illary ligated, inferior maxillary found, traced up to the foramen ovale and the trephining is done on a line with the temporosphenoidal suture,superior npaxillary nerve drawn upon and followed until ganglion is reached. The superior maxillary is cut at the foramen rotundum. The ganglion is reached with ease as Chalmers DaCosta says, whose description I have abridged and somewhat embellished. This operation offers points of advantage, according to DaCosta who had never tried it, and is the method briefly detailed which Carson has more fully described and performed with and without fatality and about the plan of procedure of Drs. Bartlett and McCandless. Of course the brain and special nerves proceeding from it are suffering, a little, while this attack upon them is going on. What I, as a neurologist wish to learn is to what extent the patient is affected in the years and dec- ades which follow in the life of those who escape for any considerable length of time the undertaker or the lunatic asylum. That some do appear to withstand the sur- gical shock and survive to tell the truthful tale of the surgeon's marvelous skill 1 am assured from the records of reliable men, but I would like to look with neurological eye and psychiatric vision upon them yet awhile in their career after the surgeon's knife and forceps have done their destructive saving work. The ganglion and nerves are gone. Of course there will be no more trouble there but what of the patient's nervous system including the brain elsewhere. The neuropathic neuralgic will remain more or less a neuropath after the operation. Here's the field for future observation. My chief contention is that the final operation when- ever decided upon, whether rightly or wrongly, should not be considered the finale of treatment, nor should the more justifiable and always advisable previous exsection of the, The Successful Management of Neuralgia. 283 trigeminal branches be so considered. Neuriatric treat- ment should be kept up after the surgical procedure, for sixty or ninety days or more until reasonable assurance appears that the damaged nervous system is reconstructed and the patient appears to be no longer an actively neurotical- ly crippled man. The neuralgic condition does not develop in a day though it may locally appear suddenly, neither can it be immediately conquered, though a surgical operation may cut out the seat of pain and the consequent nerve and mind rest of a neurectomy or gangliectomy may give and does give, sometimes, to vigorously reactive constitu- tions, all the help they need for complete return to normal nerve tone. Such vigor of constitution however is excep- tional. But if proper neuriatric treatment is kept up after resections I do not believe gangliectomy would even be necessary. My suggestion for a neuro-surgical plan of successful treatment of tri-facial neuralgia, when neurotherapy fails would therefore be this: Mentally prepare the patient for its radical relief by securing hopeful consent to a combined surgical and neurological treatment. Put her or him to bed, give chloroform, extirpate the involved peripheral nerves if you wish, keep both eyes closed (not necessarily by stitching) for the same length of time as one is kept closed by stitching to keep the eyes from the sloughing so likely to follow Gasserian gangliectomy without it. Keep the eyes closed to secure brain and nerve center rest. Keep visitors away from the patient. Maintain absolute brain and neural quiesence, such as follows the operation, by appropriate medication and maintain a six to ten weeks treatment on the lines above indicated. A neuralgic should be under medical observation and more or less treatment all his life like an epileptic and should be plainly told so. We should not temporize in treatment but treat the patient internally and constitutionally as well as locally. The surgery of the ganglion of the trigeminus is con- fessedly I think, in surgical* as it is in neurological esti- *A. E. Haistead. after his first operation with patient, free from pain and well In every way following it, considered the dangers of this operation so great and the disadvan- tages so apparent that It has been generally abandoned. He performed the subsequent operations with one of them comatose after forty-eight hours and dead on the fourth day.— Chicago Medical Rtcord, December, 1897. . 284 C. H. Hughes. mate "the boldest" and "most adventurous" operation of the century just closed, as Matas Annual of Universal Medical Science said in 1893. It only remains for surgery now in this dawning twentieth century to "Raze out the written troubles of the brain And pluck from the memory a rooted sorrow," ignoring the "sweet oblivions antidote" suggested in the question of Macbeth to his physician. ADDENDUM. N. B. Carson (Weekly Medical Review, March, 1899) calls attention to the fact that John Parmenter, of Buffalo (Transactions American Surgical Association, 1896), reports return of pain three months after the operation in a woman aged fifty-four. The pain returned in Clayton Parkhill's only case. Great immediate, but only partial subsequent relief, followed in D. W. Cheevar's case of Gasserian re- section, and Lanphear has reported the return of pain in one case of Gasserian removal. Fleeting pains in the gum of the lower jaw of the operated side evanescent and trifling three years after operation are reported by L. S. Pilcher. Weeks makes the singular record of a case in which, after exsection, pain on the operated side continued for a few months and then disappeared. These cases are all noted by Carson. He also notes the return of pain two months after the operation in one of D'Antona's cases of partial resection reported by Tiffany as entirely relieved and a similar case by Swartz. In the same record also is abridged one of Angelo Magnai's report of a resection of the Gasserian ganglion in which sensibility without pain returned incompletely in the second and third branches of the trigeminas. On October 21, 1895, the superior maxillary nerve from infraorbital foramen to grand foramen in exit, was ex- sected with result of - immediate relief but return of pain The Successful Management of Neuralgia. 285 after the lapse of about thirteen months, so violent that radical gangliectomy was performed. The return of pain after complete excision of the Gas- serian ganglion can only be explained on the hypothesis of central origin of the disease and the vicarious sensory function of contiguous nerves and the supplemental morbid implication of near by nerve centers. How otherwise are we to account for normal sensibility returning in the cut away peripheral nerve tracts with the ganglion also removed, as in Angelo Magnai's case. The appearance of pain in the vicinity of the tri-facial branches and over vicarious nerve tracts to the brain is possible and quite probable in cases where enormous doses of opium or the salts of morphia have been used up to the time of the operation, the opium habit and its attendant neurotoxicity and consequent nerve and muscle pain, ap- pearing in these cases from the abrupt withdrawal of the drug, as happens in attempted treatment of the chronic opium neuroses after sudden withdrawal without compensa- tory medical nerve impression. Here is an operation in which a fifteen or twenty-two per cent mortality is a certainty, if we except Carson's record of about half this ratio and Victor Horsley's of two deaths out of twenty-one, or about nine and two-tenths per cent, advised and undertaken for a painful affection which recovers in more than fifty per cent of cases under medical treatment by ordinary methods and may almost in- variably recover under good neurological management. This is holding life cheaply when opium will keep it in abeyance and aconite, or aconitia, strychnia, quinine, gelsemium, belladonna, iodides, salicylates, mercurial and other remedies cure it. I think with Landon Carter Gray that the ex- cision of the Gasserian ganglion is more justifiable as an autopsic performance than as a remedial one, and with Senn that the operation will become obsolete, and with Phillip Coombs Knapp, 1 have not yet been compelled to advise it. Victor Horsley and Krause (Practitioner, Septem- ber, 1900) have never seen a recurrence after the removal of the ganglion. 1 do not see how it could recur as true 286 C. H. Hughes. trigeminal neuralgia when the tri-facial ganglion itself is removed. Sciatica is curable by medical and electrical means, why not other neuropathic algias without the knife? The knife is not here available and the disease itself compels to rest of limb and nerve. Prosopalgics do not rest the face enough. They talk, attend to business and eat food that requires maunching. They prod the crippled nerves to action yet expect the repair that comes, in part, of rest. Give the neuralgic the same chance as a sprained ankle or broken limb and supplement the adequate rest with the treatment I have outlined and surgical destruction of nerve will seldom be required. Though there will yet remain, sometimes, conditions of nerve in neuralgia which will re- quire surgical as the only relief. When only the surgeon stands between neurology and the undertaker he should be summoned. The plaint of this paper is that the neurologist should oftener than he does stand between the surgeon and the undertaker, especially in neuralgia trigeminalis. DEGENERACY STIGMATA AS A BASIS OF MORBID SUSPICION.* A STUDY OF BYRON AND SIR WALTER SCOTT. By JAS. G. KIERNAN, M. D., CHICAGO. Fellow of the Chicago Academy of Medicine; Foreign Associate Member French Medico-Psychological Association, IN MARKED contrast with Scott and Byron stands a contemporary of equal fame: one of the greatest of English poets, Shelley, who, as Harriet Alexander has pointed! out, was an excellent instance of the so-called senile arrest of childhood. He had a sub-microcephalic skull. The circumstances of his obsequies prevented any determination as to brain type. He was somnambulistic from his sixth year. From very early childhood "he was an imaginative and restless child." Trifles unnoticed by most children, seem to have made keen permanent impres- sions upon him—the sound of wind, the leafy whisper of trees, running waters. The imaginative faculties came so early into play that the unconscious desire to create re- sulted in the invention of weird tales of legendary creatures, tales sometimes based on imperfectly noted facts, on at- tempted delusion of neighbors and on the experience of more or less definite hallucinations. His memory surprised many of his friends. He delighted in "weird and sombre tales of the supernatural and horrible." He was extremely desultory in all his habits. His room was a chaos of 'Continued from the ALIENIST AND NEUROLOGIst, January, 1901. tALIENIST AND NEUROLOGIST. 1894. [287] 288 Jas. G. Kiernan. scientific instruments, chemicals and books. "From think- ing the best of friends and acquaintances, he could of a sudden and with inefficient cause, pass over to the other side and think the worst." Like most neuropaths he was easily hypnotized. He was a great hypochondriac. On one occasion, meeting a woman with large legs, he was seized by the notion that she had elephantiasis and had infected him. Medical examination demonstrated the falsity of this notion, but it persisted for several days. "One evening he actually arrested the dancing of a line of pretty girls, pro- ceeding to examine their arms and necks with such woe- begone gravity that they were terrified and their angry partners silent." He suffered frequently from the topoalgias so frequent in neurasthenics and hypochondriacs. His flagrant violations of social conventionalities were notorious. Many of these, however, had, as Symonds* has shown, logical bases from the Shelleyan standpoint of reaction against social tyranny not unnatural to a mind early sub- jected to the brutal "fagging" of English school boys and brutality of school masters who found a "voluptuous ecstacy" in flogging boys ere entering on the "feast of reason, flow of soul," of a banquet whereat the flogger was the "genial humorous" host. Shelley, however, violated his own code most capriciously. An avowed athe- ist, he took the sacrament in a blatantly audacious manner for interested reasons. He reverted to fetichism and argued for the existence of ghosts. He denounced legal marriage, but married Harriet Westbrook twice; once by the simple Scotch common law ceremony and once by the English Church rite. The constant nagging of his intriguant sister- in-law, which drove Harriet into "nerves and him into home hatred," led to the estrangement of wife and hus- band. The hysteric insensibility of the wife to her own children fostered this. Shelley's temperament, however, aided this tendency. He "took strange caprices, unfounded frights, vain apprehensions and panic terrors, and therefore absented himself from formal and sacred engagements." In a month after the English marriage he deserted Harriet and •English Men of Letters: Shelley. Degeneracy Stigmata. 289 her unborn child, to elope with Mary Godwin. Even Symonds, the most logically psychological of Shelley's analysts, fails to justify this act from Shelleyan principles. ,yin Shelley's case hereditary degeneracy existed. He nor- mally reacted against school tyranny, hence it alone does not account for the defects and peculiarities of his career. It is a singularly excellent illustration of the truth of the proverb.^Like clings to like," that Byron, Scott and . Shelley should have married neurotic women.^That there n / \ * is often a superficial attractiveness in the neurotic woman is undeniable. Especially is this true of the cerebral type of Des Champs,* particularly when to the cerebral element ^ is united the genital and neuropathiCj/^The general char- acteristics of the neurotic women are an absolute want of equilibrium in sensibility and will power. There exists mobility of humoi in direct relation with facile impression- ability to external influence or to internal states. The nerves vibrate to all sentiments coming from within or without, and all are registered without proper relation. One fact chased by another is forgotten. Another produces a mo- mentary hyperexcitation which takes place bf the truth, whence it is that falsehood is instinctive, but the patient protests her good faith if accused of the same. This lack of equilibrium leads to a decided modification of the mental faculties. Intellectual activity is over-excited, but in diverse degrees and variable ways, according to the particular tendencies adopted. Absorbed by a preoccupation or con- trolled by an idea, they become indifferent to all else. Their ideas are abundant, and they rapidly pass from the idea to the act. Their vivid imagination, coupled with a bright intelligence, gives them a seducing aspect, but their judgment is singularly limited, attenuated or false. They judge from a non-personal standpoint excellently. They are quick at discovering the faults of even their own rela- tives, but faults rightly attributed to themselves are repu- diated. Their memory is capricious. They forget their faults and their acts under impulse, albeit, these may be consciously done. •ALihMst anp Neurologist, 1895. 290 Jas. G. Kiernan. The cerebral type is led by the intelligence. She has little or no coquetry; what, there may be is the result of intention and temporary. There is an ethical sense, frank- ness and nobility in her ideas, disinterestedness and tact in her acts and she is capable of friendship. Her tastes carry her to male pursuits, in which she succeeds. She becomes often what is called a "superior woman" and too often what is called an "incomprehensible woman." She has but little guile. To the sensual type voluptuousness is the aim of life and the center of her acts and thoughts. She is well en- dowed with guile and extremely diplomatic. She is full of finesse, but not very delicate. Her lack of scruple often spoils her tact. She is ruseful, dissimulating and uncon- sciously mendacious. She despises friendship and needs watching. If circumstances permit she loses all delicacy, reserve and modesty. She is destitute of scruples. Her crimes are coolly remorseless. The neuropathic type is one to which the grasshopper is a burden. Her nerves are always on edge.' She is a heroic invalid'who displays the air of a martyr about trivialities. The character of the neurotic recalls the observation of Milne-Edwards concerning the monkey character. Levity is one of its salient features and its mobility is extreme. One can get it to shift in an instant from one mood or train of ideas to another. It is now plunged into black melancholy and in a moment may be vastly amused at some object presented to its attention. // Byron did not have the intense egotism so often found in the cripple, and especially in the victim of club-foot. fl+ At school he interfered to protect one of his juniors, lame like himself and otherwise much weaker, from the ill-treat- ment of some hulking tyrant. Byron's friendships seem to have been intensely passionate. His friendship with Lord Clare was as intense as that of a love affair. In 1821 Byron was unable to hear the name Clare without a beating of the heart. On this friendship seems to have been based the poem "Friendship Is Loye Without Wings," Degeneracy Stigmata. 291 Byron's earlier experience was emphasized by the training he received from Dr. Drury. For later in dealing with the question of the Greek and Latin classics Byron remarks that school boys become "tired of the task before they can comprehend the beauty; that they learn by rote before they get by heart; that the freshness is worn away and the future pleasure and advantage deadened and destroyed at an age when they can neither feel nor understand the power of composition, which it requires, an acquaintance with life, as well as Latin and Greek, to relish or to reason upon. In some parts of the continent young persons are taught from common authors and do not read the best classics till their maturity." Comparatively slight stress was then laid on modern languages. Byron learned to read French with fluency and made himself familiar with the great French works of the eighteenth century. He spoke it with so little ease or ac- curacy that his speech was a stumbling block to his French acquaintances. Of German he had a slight smattering. Of Italian he was a master. The extent and variety of his general reading was remarkable. His list of books, drawn up in 1807, includes more history and biography than most men of education read during a long life, a fair load of philosophy, Demosthenes, Cicero and Parliamentary De- bates from 1688 to 1742; theology (Blair, Tillotson, Hooker). The last he finds: "Very tiresome. I abhor books of religion, though I reverence and love my God without the blasphemous notions of sectaries." Under "Miscellanies" the list gives the Spectator, Rambler, World, etc. Under fiction. Cervantes, Fielding, Smollet, Richardson, Mackenzie, Sterne, Rabelais and Rousseau. Burton's "Anatomy of Melancholy," according to Byron, is the best storehouse for second-hand quotations, as Stearne and others have found. The greater part of the books named were perused at fifteen. Byron was an omniverous reader, who read eating, read in bed, read when no one else reads, and having a memory only less retentive than that of Macaulay, acquired so much general information as •English Men of Utters: Byron. 292 Jas. G. Kiernan. ^£r v to be suspected of picking it up from Reviews. However, Byron never read a Review till he was eighteen years old, when he wrote a review utterly worthless, on Wordsworth. Before leaving Harrow, Byron passed through a psycho- logical experience which deepened the suspicional condition resultant on his deformity. Byron met Miss Mary Ann Chaworth, the heiress of the family whose estates joined his own; a kinswoman by blood and a descendant of the man who had been killed by his collateral ancestor, the "Mad Lord." For her Byron developed an intensely pas- sionate attachment and wished to marry her. This, as he says, "would have joined broad lands, healed an old feud and satisfied at least one heart." Mary Chaworth was a neurotic flirt who behaved with intense cruelty to Byron; witness her heartless speech to her maid in his hearing, "Do you think I could care for that lame boy?" which drove Byron like a hunted creature to Newstead for refuge. A young lady, two years his senior, of a lively and volatile temper, she enjoyed the stolen interviews at the gate be- tween the grounds and laughed at the ardent letters re- ceived through a confidant of the still awkward youth whom she contemptuously regarded as a "lame boy." She did not divine the genius of Byron, nor any ambition to ally herself with the wild race of Newstead. She preferred a hale, commonplace, fox-hunting squire, and after an un- happy life, became, a few years after marriage, a demon- strable case of chronic hysteric insanity and died demented. The attraction of the neurotic for the neurotic perverts v ,., the principle of avatism, as E. S. Talbot remarks, to the V. i; assistance of degeneracy. As Roler, de Monteyel, H. M. Bannister, Manning and myself have shown, this tendency of neurotics to intermarriage is exceedingly common in Germany, France, the United States and Australia. Ban- nister* puts the statistical proof of this tendency very forcibly as follows: "There are in Illinois, according to the most recent estimate, in round numbers about six thousand insane, or one to a little over five thousand of the popula- tion. Even if we double, treble or quadruple this frequency 'Journal of Nervous and Mental Diseases, 1883. Degeneracy Stigmata. 293 to include all that have been or are to be insane as well as those insane at the present time it would not appear that there was much probability of two insane persons being married according to any ordinary law of chance. In fact, we find four out of the one hundred and four with insane heredity had both father and mother insane. In one of these cases the insane heredity involved both parents and grand parents on each side, though in the case of the latter the histories show it only as collateral. Beside these, three patients had direct paternal and collateral ma- ternal heredity; two had direct maternal and collateral paternal heredity, and in one case there was collateral heredity of insanity on both sides. This makes, altogether, nearly ten per cent of those with insane heredity with it on both sides, maternal and paternal, and thus favored with a double opportunity to inherit mental disease. If we add to this the instances where with insanity of one patient there is reported either epilepsy, hysteria, or drunkenness, brain disease, nervousness, etc., of the other the ratio of double inheritance rises to over twenty per cent." Byron's career at Cambridge was very unsatisfactory, although he did take his degree. The English Universities of that time, and the same is in no small degree true now, were better adapted for the creation of that learned mon- strosity, the English Don (who closely resembled in men- tality the idiot savants elsewhere described), than the production of active, working scholars. The defects of the English Universities in this particular are of very old date, albeit denied by some English men of letters like Nichol.* "A good German critic dwelling," Nichol remarks, "on the comparatively narrow range of studies to which the energies of Cambridge were then mainly directed, adds somewhat rashly that English national literature stands for the most part beyond the range of the academic circle." This statement is reiterated with persistent inaccuracy. "The most casual reference to biography, "Nichol states,shows us that "at least four-fifths of the leading statesmen in England were trained within the walls of her universities and cherished a portion 'English Men ol Letters: Byron. 294 Jas. G. Kiernan. of their spirit. From them have sprung the intellectual fires that have at every crisis of our history kindled the nation into a new life; from the age of Wycliffe through those of Latimer, Locke, Gibbon, Macaulay to the present reign of the Physicists comparatively few of the motors of their age have been wholly 'without the academic circle.' Analyzing with the same view, the lives of the British poets of real note from Barbour to Tennyson the proportion of university men increases. If the demands of technical routine have sometimes tended to stifle the comparative response of a seclusion 'unravaged' by the fierce activities around it, the habit of dwelling on the old wisdom and harping of the ancient strings is calculated to foster the poetic temper and enrich its resources. This discouraging effect of a sometimes supercilious and conservative criticism is not an unmixed evil. The verse writer who can be snuffed out by the cavils of a tutorial drone is a poetaster silenced for his country's good. It is true, however, that to original minds bubbling with spontaneity or arrogant with the consciousness of power the discipline is hard and the restraint excessive, and that the men whom their col- leges are most proud to remember have handled them ^severely. Bacon inveighs against the scholastic trifling of his day; Milton talks of the waste of time on litigious brawling; Locke mocks at the logic of the schools; Cowley complains of being taught words, not things; Gibbon re- joices over his escape from 'the port and prejudice' of Magdalen; Wordsworth contemns the 'trade in classic niceties and roves in magisterial liberty,' by the Cam, as afterwards among the hills?" Turning, however, to one of the instances quoted by Nichol in favor of the university system it is found that his experience, fully demonstrating the position of the Ger- man critic, tends to show (as do the biographies of the other instances Nichol cites) that only those who escape university influenc.es were of any value to their age. "The bad effects," Macaulay* remarks, "of the English uni- versity system may be traced to the very last in many •Essays: London University. Degeneracy Stigmata. 295 eminent and respectable men. They have acquired great skill in business. They have laid up great stores of infor- mation. But something is still wanting. The superstructure is vast and splendid but the foundations are unsound. It is evident that their knowledge is not systematized; that, however well they may argue on particular points, they have not that amplitude and intrepidity of intellect which it is the first object of education to produce. They hate abstract reasoning. The very name of theory is terrible to them. They seem to think that the use of experience is not to lead men to the knowledge of general principles but to prevent them from ever thinking about general principles at all. They may play at bo-peep with truth, buti they never get a full view of it in all its proportions. The cause is that they have passed those years during which the mind frequently acquires the character which it ever after remains in studies which, when exclusively pursued, have no tendency to strengthen or expand it." As Macaulay would be considered a university success from the standpoint of college standing, his testimony is as destructive of the position taken by Nichol as that of Bacon, Milton, Locke, Harvey and hundreds of other Eng- lish leaders in the world of thought. The influence of the Oxford Don in deadening the human intellect at its most plastic period cannot well be underestimated. Nichol's use of unanalyzed statistics illustrates once more that nothing lies like them. The great creations of the English univer- sities and too often of America under plutocratic domain are the philistine and that bright blossom of philistinism.the Don. Lady Caroline Lamb like Miss Chaworth died insane. Her cousin (Miss Milbanke) was introduced to Byron by Lady Melbourne, who managed to make the unfortunate match which afterwards marred Byron's life. This cousin (afterwards Lady Bryon) had every characteristic of a borderland hysteric, especially those which make hysterics most prominent among so-called reformatory movements born of the morbid desire for notoriety. She had the hysteric prudish pruriency which finds sexual gratification in seeing the coarse in sex affection and in gloating over sexual im- 296 Jas. G. Kiernan. morality delusively conceived to exist in others. She had the hysteric tendency to pose which led her first to refuse Byron, then to accept him, and then to separate from him with a great deal of publicity. Byron at the time of the marriage was still under the halo of society popularity, due to the success of "Childe Harold." He had intended this poem to be what "IVahrheit und Dichtung," was to Goethe; a poetic account of his life and travels with a lit- tle more tint than would have been needed in autobi- ography. He had called his hero "Childe Burun" in the first draft of the poem which contains probably more truth than Rousseau's "Confessions" but less of the darker phases. Byron, with all the posing tendencies forced on him as a defence against attack, still retained the healthy reticence anent the innate personality which separates health from morbid egotism. Rousseau had all the obtru- sive anthropocentic egotism of the hebephreniac which makes him with his vices and his woes the center of the universe. Despite all his environment and his physical deformity, Byron never sounded the depths of morbid sus- picion reached by Rousseau. Byron ridiculed Lady Byron's attempt to have him declared insane. Yet there were times when he doubted the integrity of his own mental state. This doubt occurs far more frequently in neurasthe- nia without evolution into the psychoses than it does in the psychoses themselves. The victims of obsession in whom the obsessions seriously disturb consciousness and create mental states of uncertainty are much more apt to be alarmed at their mental state than are the insane. Not unfrequently however a paranoiac attacked by neurasthenia regards the obsessions of neurasthenia as evidence of a morbid state while he resents any implication to the same effect on the systematized delusions of his psychosis. In New York a paranoiac suffering from distressing obsessions secured release from the insane hospital by habeas corpus, claiming that this demonstrated the sanity of his systematiz- ed delusions and then went back to the insane hospital to be treated for his obsessions. Dr. C. H. Nichols* the *American Journal oj Neurology and Piychialry, Vol. III. Degeneracy Stigmata. 297 superintendent was obliged to secure a writ of ouster as Qf-j^l he had no legal right to retain the patient. To a certain -- extent Byron believed himself like Rousseau to be the victim of what he called "reasoning insanity." Like an insane poet under care of Dr. Brigham, Byron felt insanity was a disturbance of mental balance irrespective of how the disturbing obsession was regarded. "If understood, the truth is this, The mind has many faculties, And one distinct may be deranged, And from its proper order changed, Whilst all the rest do sound remain In that alone the man's insane. Imagination thus diseased, Whatever violently seized, Produces things within the mind, Which are not easily defined."* At the time Mrs. Byron did what Byron so hum- orously describes Inez as doing, in "Don Juan", "For Inez called some druggists and physicians, And tried to prove her loving lord was mad, But as he had some lucid intermissions She next decided he was only bad, And when they asked her for her depositions, No sort of explanation could be had, Save that her duty both to man and God Required this conduct—which seemed very odd," she was pregnant. She showed the caprice of a preg- nant woman on the occasion when she made the charges that led to the medical examination. She had just before written a playful letter inviting Byron to join her at a cer- tain place and arranged] that his half-sister should urge him to go. The physicians called in decided on the facts laid before them that Byron was not insane. Byron had been brought up a Calvinist which would naturally pro- duce the egotistic religiosity which gloats in a conversation from fancied wickedness of an extreme type. This condi- tion would naturally lead to a state of doubt such as has been noted in the history of Bunyan, Milton, Cromwell and Rousseau. Byron like Bunyan, Milton and Cromwell mAmerican Journal of Insanity, Vol. III. Pafce 190, 298 Jas. G. Kiernan. wouldl'naturally express himself in strong but vague terms. A hysteric like Mrs. Byron would take such con- fession'literally, especially when laboring under the men- tal state produced by pregnancy. Pregnancy as Harriet Alexander* had pointed out, must under the Virchowan definition of pathologic as a new force introduced into the organism which disturbes its balance, be regarded as pathologic. As Harriet Alexander has shown in the vast majority"xases of so-called normal pregnancy a suspicious capricious emotional state generally results. The suspic- ions of the first pregnancy may remain permanently with hysteric and neuropathic women; indeed many of the in- curable types of insanity in puerpuero are due to per- sistence of such suspicianal states in neuropathic or de- generate women. The influence of this factor is so pal- pable to layman that Noelt remarks: "But was Lady Byron quite reliable in her statements as to details? Women in a delicate situation sometimes get strange fan- cies. May not the delusions of such a time occasionally remain with them or recur later? Might this partly ac- count for what Lady Byron so many years after told Mrs. Stowe? Byron as Jeaffersont remarks, with women was what they pleased to make or take him for. But he /was most pleased with them when they treated him as nearly as possible like "a favorite and sometimes forward sister." As "a favorite and sometimes forward sister" he was thought of and treated by male friends. To be received by them on this footing he would leave his bed early so that he might breakfast with them, open their letters for them, chat with them, fondle their children in their boudoirs, for an hour or two at a time, before less privileged visitors dropped in for lunch. As a candidate for the place of a sister in her affections he sat for an entire hour with Lady Caroline Lamb, nursing her baby, without speaking a word above a whisper least the sleeping infant should be aroused to consciousness. As "a favorite and sometimes forward •Alienist and Neurologist 1887. tGrest Writers Series: Byron. JThe Real Lord Byron. Degeneracy Stigmata. 299 sister" he hung about the skirts of the Countess of Ox- ford, playing with her beautiful little girl Charlotte, (pre- cisely of the same age as Margaret Parker, whom as a school boy he loved so passionately). In the capacity of the countess "sister" and the little Lady Charlotte's aunt he wrote the verses to Ianthe, with: "that eye, which wild as the gazelle's Now brightly bold or beautifully shy, Wins as it wanders, dazzles where it dwells." If Ianthe had innocently put the forbidden question to her mother's "sister" and asked, "Why to one so young his strain he would commend?" the unspoken answer would have been, "Because you remind me of my boyish passion for my cousin Margaret, of* whom I thought tear- fully and wretchedly, and yet not altogether unhappily, when I wrote my beautiful poetry to Thyraza." When a young man is allowed to play the part of a "sister" to a beautiful woman, the position, as Jeafferson remarks, is dangerous both to the one and the other. For the man, who is sympathized with and treated like a sister, whilst feeling and acting like one, may in a moment be stirred by masculine impulses to feel and act like a man,—in which case, he feels and acts like a man without self-control, and the woman remains what she has been all along—an excited and weak woman. One factor of morbid suspicion was always present to serve as a powder magazine responsive to any assumed slight. In 1812 Byron walking up a street had his compas- sion aroused by a wretched woman lying on a doorstep. The act of charity to which pity moved him had a startlingly painful result; for, instead of taking the shillings he offered her, the miserable creature sprung to her feet, and uttering a drunken yell of derision began to mimic his lame gait. Bryon said nothing either to the woman or the friend on whose arm he was leaning, but the latter felt the violent trembling of his companion's arm as they walked back to the house. The poet's lameness was seemingly to obviously noticeable to casual passers, not to create annoyance at the attention they paid to his deformity: "This way, my lord," 300 Jas. G. Kiernan. -h cried a link-boy as Byron was stepping with Rogers to his carriage from the doorway of the house they had shown themselves at a ball. "He seems to know you," said Rogers. "Know me," was the bitter reply; "every one knows me,—1 am deformed." At this particular time Byron was at the acme of his personal attractiveness, according to Jeafferson. He was not a handsome man,—he was beautiful. The glowing fire over- powered the brownness of his auburn hair, that gradually deepened almost to the deepest and richest brown of auburn hair, before it turned gray. The blue-gray eyes were eloquent of emotion through their long, fine almost black lashes. The brow over and about which the feathery auburn curls played in tiny wavelets was white as marble; his usually pale complexion was delicate even to trans- parency, and at moments of joyous excitement was touched with the faintest sanguine glow. His mouth with its white and dainty teeth, with its lips of feminine sweetness and something of feminine voluptuousness and his delicately modeled chin, strong enough for fascination,—far, far too weak for moral robustness,—were the lips and chin of a lovely, sensitive, capricious, charming woman, rather than the lips and chin of a man. His countenance especially in the mouth and eyes was remarkable for mobility and expressiveness—in harmony with the quick- ness and vehemence of his emotional temperament. His long, broad throat, broad chest, and square set shoulders were however abundantly expressive of masculine strength. Byron's voice was, in his ordinary conversation, perhaps more musical than the voice of any other man or woman of his period. To the children of the houses where he was a most frequent and familiar guest he was the gentleman "who speaks like music." Genius, as I pointed out about a decade ago,* attracts ,„i hysterically sentimental females as light-house lanterns do | birds. Burns, as Robert L. Stevensont has shown, owed a good deal of his misfortune to this. "It was upon love and •Alienist and Neurologist, 1891. tFamillar Studies of Men and Books. Degeneracy Stigmata. 301 ^ flirtation that a local society among the Ayrshire Hills was built. Burns was constantly the victim of some fair en- slaver," at least when it was not the other way about; and there were often underplots and secondary fair enslavers in the background. Many of these affairs were entirely arti- ficial. One he began out of "a vanity of showing his parts in courtship." But,however they began, these flames of his were fanned into passion ere the end and he stands unsurpassed in his power of self-deception and positively without a competitor in the art, to use his own words, of battering himself into a warm affection, a debilitating and futile exercise. Once he had worked himself into the vein, the agitations of his mind and body were an astonishment to all who knew him. Such a course as this, however pleasant to a thirsty vanity, was lowering to his nature. He sank more toward the professional Don Juan." Byron passed through a seemingly similar experience, totally unlike in essence to that of Burns, soon after the appearance in March, 1807, of "The Hours of Idlenesss." With passions which he compares to the fires of Vesuvius and Hecla, Byron was, on his entrance into social life which his rank helped to surround with temptations, un- conscious of any sufficient motive for resisting them. He had no one to restrain him from the whim of the moment or with sufficient authority to give him effective advice. The degenerate temperament of general despondency, re- lieved by reckless outbursts of animal spirits, is not favorable to habitual self-control. Just before this he and his mother had had an intensely disagreeable time.^She exhibited violence which, in Nichol's opinion, suggests insanity. After one squabble more outrageous than usual mother and son went to a neighboring apothecary, each to request him not to supply the other with poison. On a later occasion, when he had been meeting her outbursts of rage with stub- born mockery, she flung a poker at his head and narrowly missed her aim. Upon this he took flight to London and his Hydra or Alecto, as he calls her, followed. On their meeting a truce was patched up and they withdrew in op- posite directions. Under such circumstances it is hardly 302 Jas. G. Kiernan. astonishing that Byron should have rushed about between London, Brighton, Cambridge and Newstead shooting, gam- bling, swimming, alternately drinking deep and trying to starve himself into elegance, green-room hunting, traveling with disguised girl companions, patronizing D'Egville, the dancing-master, Grimaldi, the clown, and taking boxing lessons from Jackson. Byron's tendency to dwell blatantly on amours devoid of romance proves that he never trenched on what the common code of the fashionable world terms dishonor. From his later assertions and the absence of evidence to the contrary (very significant as to a man so decried) it is clear that Byron had never been the first means of, leading any one astray. A fact worthy, as Nichols remarks, the attention of those moral worshippers of Goethe and Burns who hiss at Byron's name. Goethe's amours were similar to those of Burns.* His treatment of the daughters of the French pastor with whom he lived showed a cruelty in regard to woman like to that displayed as a matter of bravado by Burns. As Havelock Ellist points out, Goethe,! (describing his student life at Leipzig and his loss of Aennchen owing to his neglect of her), tells how he revenged that neglect on his own physical nature by foolish practices from which he thinks he suffered for a considerable period. Goethe must have early abandoned masturbation. While the evil effects of this have been over estimated it must be admitted that so far as the ro- mantic aspect of love is concerned, masturbation is peculiarly injurious because, as Stefanowski§ points out, of the com- plete moral isolation in which it plunges the masturbator. To him is lacking the most necessary element of love—the real being of a woman which he attempts to supplant by chimeras and phantoms. The voluptuous sensation is pro- duced under abnormal conditions. It is accompanied by a polyideac state in lieu of an aideac one, as in normal, where the real sensation is so strong as to afford no place for play of imaginary lubricity-/Masturbation produces ex- •Famlllar Studies of Men and.Books. ^Psychology of Sex, Vol. II. »<-t.u {Truth and Fiction. {Alienist and Neurologist. 1893. Degeneracy Stigmata. 303 fpansion of egotism. Little by little, follows the habit of \ regarding the physical pleasure as the end without regard J to the female from whom the pleasure is to be procured. The /\ evil habits of youth appear, as Bourget says, under the I form of abominable vices in the man as he ages. It is very probable that almost all the neuroses have their origin in erotic disorders and these last originate in the bad hygiene of puberty. Such a condition reverses the evolution of romantic love. Goethe seems, however, never to have (despite the seeming evidence to the contrary in Faust and Werther,) ex- perienced romantic love. His amours were destitute of this factor. His marriage with the dipsomaniac servant girl, Christina Vulpius, who had been his mistress, w^s in part the seeming expression of a need for a nurse. One most emphatic instance of attraction of a hysteric toward Byron was that of Lady Caroline Lamb who, according to Nichol, "was one of the few women of a temperate clime who by their romantic impetuousity recall the Children of the Sun." She read Burns in her ninth year. In her thirteenth she idealized William Lamb, (afterwards Lord Melbourne) as a statue of liberty. In her nineteenth (1805) she married him. She lead with him for some years there- after (during which she was a reigning belle and toast) a domestic life only marred by occasional eccentricities. Rogers, whom in a letter to Lady Morgan she numbers among her lovers, said she ought to know Byron, who was three years her junior. The introduction took place, March, 1812. After the meeting she wrote in her journal. "Mad — bad — and dangerous to know"; but when the fashionable Apollo called at Melbourne House she ''flew to beautify herself." Flushed by his conquest he spent a great part of the following year in her company. During this time the apathy or self-confidence of the husband laughed at the worship of the hero. "Conrad" detailed his travels and adventures, interested "Medora" by,his "woes, dictated her amusements, invited her guests; and seems to have set rules to the establishment. 'Medora" on the other hand made no secret of her devotion, declared that 304 Jas. G. Kiernan. they were affinities and offered him her jewels. After the first excitement he began to grow weary of her talk about herself. He found himself unable to praise her indifferent verses. "He grew moody and she fretful when their mutual egotism jarred." Byron at length concurred in her being removed for a season to her father's house in Ireland, on which occasion he wrote glowing farewell letters. When she came back matters were little better. The would-be Juliet beset the poet with renewed advances, on one occasion penetrating to his rooms in the disguise of a page, on another threatening to stab herself with a pair of scissors, and again, developing into a Medea offering her gratitude to any one who would kill him. (To be continued.) MEDICINE IN 1800.* By Samuel l. Mitchell, m. d., NEW YORK. AN ATTEMPT has been made in the first part of Zoo- nomia to investigate the complex laws of animal causation. These are deduced from the contractions and relaxations performed by the living fibers which constitute the muscles and organs of sense. Fibrous contractions seem to constitute all the functions of animated bodies and, indeed, all we know both physiologically and medically concerning life and its functions. They are arranged into four classes of motions which from the foundation of all just nosology and practice are detailed in the second great division of the Zoonomia. Vital motions are thus called ir- ritative, sensitive, voluntary and associated, and accordingly the parts of the body in which they exist are endowed with irritability, sensation, volition or sympathy. This quadruple allotment of functions forms a strong and peculiar character of Zoonomia. The distribution of the almost endless vari- ety of animated phenomena into the fourfold and lucid ar- gument is a clear proof of the discrimination and general- izing mind of Erasmus Darwin. But in all these conditions of the system, whether influenced by the vis infita or the vis nervea by voluntary or sympathetic energy, the sensorial powers are sustained by the unceasing operation of stimulants. The theory of these in the twelfth chapter of the first part exhibits very advantageously the doctrine of stimulus and exertion, or as it has been more generally called, excitement. •Being the Preface to the American Edition of Erasmus Darwin's Zoonomia. [305] 306 Samuel L. Mitchell. There is a striking analogy between these fundamental doctrines of Dr. Erasmus Darwin and those contained in Dr. Brown's Elements of Medicine. Darwin was aware of this, and to guard himself against the imputation of having borrowed Brown's ideas without knowledge or of being merely his imitator, he observes that "the coincidence of some parts of this work with correspondent deductions in the Brunonian Elementae Medicinae, a work (with some ex- ceptions) of great genius, must be considered as confirma- tions of the truth of the theory, as they were arrived at by different trains of reasoning." In respect to originality there is'great difficulty in sett- ling claims. In this case, however, there is not even a suspicion that Brown derived anything from Darwin. Both might, indeed, have come to similar conclusions, by the independent exercise of their reason, without any commun- ication or intercourse. And yet an impartial observer, prone neither to obloquy nor flattering, would not forfeit his candour in suspecting that a writer of Darwin's acute- ness might have gathered something from Brown, who published fourteen years before him. Considering the Brunonian-Darwinian systems as rest- ing upon the same pillars, there may be both usefulness and curiosity in searching and digging about the ground on which they stand. In performing this task it has been expected there should be a statement showing how far these doctrines of the Scottish and English physicians are themselves novel or modern or whether they are both of the old school and derived from remote and ancient sources. By deciding in favor of their modernity it will be likewise expected that a view should be given of the Brunonian system, that it may be compared with the contemporary doctrines of Cullen and Darwin. In this comparison it will be found that Brown's merit is very conspicuous. The three distinguished authors have finished their earthly ca- reer. They and their writings may now be considered without envy or partiality. To those who are curious to trace the progress of these opinions which exert such ex- pensive dominion over the mind, these introductory remarks Medicine in 1800. 307 may, perhaps, afford some gratification. Others who pos- sess not the taste or leisure for such inquiries may pass them over. In the progress of observation and experiment in physics within the course of a few years such a number of new and important facts have been brought to light that many philosophers have believed the people of the present day are possessed of a great deal more knowledge than the moderns of the three last centuries or their ancient prede- cessors. This opinion in particular has been deemed well founded and true in respect to medicine, which, at this time, is not only considered susceptible of new expositions and interpretations, but of being greatly improved and enlarged both in theory and practice. And although among those who think thus are reckoned most of the original and clear-sighted geniuses of our time, yet there are not want- ing men of talents and reputation who are in the habit of thinking that, while the ancients knew quite as much as ourselves, yet their writings contained the leading hints or great outlines of almost everything discoverable, either directly expressed or signified in allegorical terms. This literary superstition has been carried a great way. Had it stopped at declaring the Iliad the best of possible poems or the Philipics the most finished of the rhetorical productions I should not trouble myself to contradict it. But when these enthusiastic admirers of antiquity declare that in matters of science as well as of letters the subjects of inquiry have been exhausted two thousand years ago and that no idea can be started which is not an imitation of something that a Greek or a Roman or somebody else had brought out before, 1 own I am a little disposed to believe their assertions are grounded neither in truth nor in the nature of things. For why must we resort to the Platonists, Stoics or Peripatetics for doctrines which the Academy, the Porch and the Lyceum never knew? These remarks are made in consequence of an opinion propagated and believed that a certain method of reasoning upon medical subjects and medical practice introduced of late, as many believe that ideas which are already pretty 308 Samuel L. Mitchell. well established and acquiring rapidly more and more ad- herents are, in fact, but a revival and new modeling of the opinions and procedure of the Methodic Sect founded by Asclepiades, the contemporary of Mithridates and Crassus. In order to know whether this opinion is well founded it is necessary to inquire what the philosophy of the Methodic Sect was. Its founder, Asclepiades, adopted that philosophy whose foundation had been laid by Anaxagoras, Empedocles and Heraclitus and which was afterwards wrought up into the Atomic System by Leucippus and Democritus of the Eletic Sect; who rejecting all metaphys- ical explanation of the causes of things, undertook to inter- pret nature from the laws of matter and motion. This was afterwards commented upon, enlarged and so adorned by Epicurus as to form what was afterwards called the Epicu- rean Philosophy. What the details of this are may be seen in Diogenes Laertius Bucker and his translator En- field as well as the poem of Lucretius who has confessedly attempted a poetical display of these very doctrines. An Epicurean would explain himself thus: "It is clear from the changes which natural bodies undergo that there is a perpetual formation and destruction of them going on." There must then exist matters of which these things are formed and into which they are resolved and hence pro- ceeds the conclusion which is the ground work of the sys- tem that a thing can neither be made out of nothing or reduced to nothing. The universe therefore as to its con- stituent atoms or particles was always as it is at present and consequently matter is eternal. The workman cannot perform anything without materials. These self-excitent materials in the decay and renovation they undergo, ac- count for the phenomena of nature and of art. If things were created out of nothing then every kind should pro- ceed from each and the greatest confusion ensue. Men should be produced in the sea, fish on the land and cattle in the clouds; generation would be useless and food un- necessary. If they returned to nothing, then in the course of past ages through waste, consumption and loss, much must have vanished to non-existence and have been com- Medicine in 1800. 309 pletely annihilated. But neither of these suppositions is true since out of the wreck or ruin of one being or exis- tence, nature without an act of creation or annihilation can not work up the old materials into a new fabric. All ex- istences in nature are referable to two kinds. First, bodies; and second, the inane or void in which they exist. Our senses satisfy us of the existence of bodies as also do their actions, passions, and resisting powers; particularly as they operate upon each other and upon our touch. "For nothing but a body can touch or be touched"— Lucretius: "From the existence and motions of bodies is in- ferred the existence of space, and the effect of bodies operating upon each other is denominated 'an event,'" and if there was not a void there would not be a possibil- ity of motion, for if a plenum existed, then every portion of space being closely impacted and wedged with solidity the most uniform rest and dead stillness would pervade the whole of nature. As to bodies they either consist of elementary atoms or of substances formed from these; and these primordial particles, notwithstanding some appearances to the contrary, are simple, solid and indivisible. Lucretius: "Therefore elementary bodies are solid and destitute of vacuity." All these atoms possess the same general properties and do not differ from each other in any essential respect. Though from their different operations upon the senses is inferred a difference among them as to size, shape and heaviness. Their figures in particular are varied in an endless manner so as to take on every mechanical form; but in all these cases they are still in- frangible and incapable of farther division. Each atom contains within itself an active energy or internal force by which it is either constantly in motion or making an effort to move; and this is denominated gravity. These atoms impelled by gravity through void space in curvilinear courses striking against each other exercise repelling powers and produce vibration or agitation; and as this gravitating power is essential to matter it can never be inactive but must be always at work and has been so from eternity. 310 Samuel L. Mitchell. Every compound body being made up of individual atoms therefore possesses the united energy of them all which energy is the sole agent in nature; but by reason of their different figures their varied magnitudes and par- ticular situations, it is variously modified, as when the atoms are hooked, or rough motion will be retarded among them and be facilitated when they are round and smooth, as in the principles of fire and animation. Bodies thus being composed of atoms derive their actions from the energy inherent in and proceeding from these atoms. All alterations happening in bodies whether in their shape, hardness, sweetness, etc., are ascribable to the change taking place in the arrangement, disposition, etc., of the constituent particles; and thus profity, transparency, elasticity, malleability, etc., are to be accounted for in the same way. Gravity being an essential property of matter all corpuscles and all bodies formed of it must be heavy. Thus from these properties of bodies, their several combi- nations and mechanical operations arise, other more com- plex phenomena referable however to the principle of motion such as the heating of bodies from the influx of soft, round and smooth particles; the cooling of them form the ingress of atoms of opposite and irregular figures even sensations both to the pleasurable and painful kinds, motion, rest and time itself are contingences to bodies. In short the whole phenomena of the production, growth, nutri- tion, decline and dissolution of bodies to be ascribed to an alteration of arrangement in the particles as to their ad- dition or subtraction. Minerals, plants and animals were thus produced in the beginning according to these mechanical laws of matter and motion and so was the world they compose and inhabit. They continue to propogate their kind in regular ways because nature has become accustomed by habit to produce them in an order so uniform as to look like design. The eye however was not made for seeing nor the ear for hearing but having been acciden- tally formed in such a way as to answer these pur- poses, the sentient principle within, which is co-existent Medicine in 1800. 311 with the organization, finding them fit for the purpose of sight and hearing makes use of them accordingly. Sensation proceeding from the arrangement and texture of particles to be ascribed to their peculiar magnitude,shape, combination so that instead of being an original property of matter, it is in fact only an occasional quality. Death is the privation of sensation in consequence of the separation of the sentient principle from the body. This sentient principle when a man dies is decompounded into its simple atoms, loses its sensitive powers and goes into other forms and combinations. The soul in this respect resembling the eye which is no longer capable of performing its functions than the connection of its organized texture with the bodies lasts. What Asclepiades did was to apply the principles of the Epicurean Philosophy to medicine which was done with much ingenuity and acuteness. Building upon that hypothesis he supposed the human body composed of Epicurus's ultimate atoms, which, by their figure, proximity and arrangement, enabled it to perform its functions in a particular manner. Health consists in the symmetrical permeability of certain passages through the firm parts, which he called pores; and the closing up, or obstruction of these constitute disease. He imagined the fluids to be formed of particles varying in figure and size and thus making all the varieties of them, from the thickest blood to the most attenuated animal spirits. And when these fluids move freely through their pores the body was sound but when they were so narrow as to produce stagnation or so oblique as not to be readily passable then indisposition ensued. Such were the leading principles of Asclepiades. He had many followers among whom Themison of Laodicea was the most eminent. The latter rejected most of the subtle and labored reasoning of his master and declaring such minute investigations was useless affirmed without descend- ing to particulars and burthening himself with details, a physician need only make himself acquainted with the general principles of disease. These he said belonged to two 312 Samuel L. Mitchell. classes, first, those proceeding from laxity: second, and such as were caused by stricture. All that was necessary to be done therefore was to ascertain to which class any given disease belonged and then if to the former to prescribe astringent; if to the latter relaxing remedies. The regular and systematic plan which Themison and his numerous fol- lowers adopted in their practice differing very widely from the conjectural and uncertain mode of other physicians caused them to be called Methodists. They are known in history by the name or the Methodic Sect. While Themison was reflecting upon his system and endeavoring to advance it to maturity he died. The unfinished work was taken up and finished by his follower, Thessalus, who lived in the time of Nero. Having rejected as frivolous all the opinions of his predecessors he declaimed with vehemence and fury against the physicians of all ages and offered to instruct a beginner in the art of medicine in the short duration of six months. Then with a degree of arrogance and impudence no parallel of which is known to have existed in ancient times, nor can be found in the history of modern quackery, (1800) he took upon himself the appellation of the "death conqueror.'! After Thessalus, the Methodists began to decline and dwindle. Although Soranus, Julian and Moschion retarded for a while its downfall, yet it was totally unobserved and lost in the Galenic Doctrines which followed. In the Methodic System it is evident the explanation of everything in the animal economy is attempted upon principles of mechanism only. The first notion of anything else requisite to give life and regulate functions seems to have occurred to Hippocrates, the contemporary of Democritus and Leucippus. The archceus of this sagacious observer, as the interpretation of the word imports, obviously means an exciting power in animals. In the effects of animation resulting from this imperfectly known and badly explained power doubtless give rise, according to the opinion and judgment of the different writers to the nature of Sydenham, the aura vitalis of Van Helmont, the vis nature medicatrix of Gaubius, the anima medica of Stahl Medicine in 1800. 313 and the designation in a learned and curious treatiset of the impetum faciens of Boerhaave. It is worthy of remark that from Hippocrates to Brown writers entertained the opinions of a principle of power within existing as the cause of life. The idea of the Brunonians is that the organized animal solid possesses no internal energy and would always remain inactive unless excited by stimuli from without and the Brunonians therefore speak of the vital capacity in the passive voice as only suscep- tible of being acted upon. Herman Boerhaave in his account of the diseases of a lax and of a rigid fibre seems again to relapse into the mechanical consideration of these things but Halter by his numerous and luminous experiments on sensibility and irritability led the way to a right mode of pursuing and understanding such inquiries. The attention of Hoffman had been turned to the con- sideration of the nervous system as influencing diseases more particularly than any other person. From his writings were probably taken the hints which terminated in Cullen's doctrine of Excitement and Collapse and enunciated first in his Physiological Tract afterwards enlarged and applied to practice in his chapter on vesanise (First Lines 1544 and seq) as well as the observation in his letter on the re- covery of persons drowned (P. 4.) Though the circulation of the blood is necessary to the support of life, the living state of animals does not consist in that alone, but especially depends upon a certain condition of the nerves and muscular fibres by which they are sensible and irritable and upon which the action of the heart itself depends. To the same effect are the remarks on the effects of stimuli in keeping up the action and energy of the brain at all times in his treatise upon the materia medica. John Hunter had been speculating too on this subject. In his experiments on animals with respect to their powers of producing heat he has brought curious and important facts to view. His reasoning on them is in some instances inconclusive and exceptionable, in others quite unphilosophical. This inquiry was intended as a counterpart to the experiment 314 Samuel L. Mitchell. of Blagden and his associates in the heated chamber on the power of the human body to produce cold in high tempera- tures. He ascribes a great deal throughout his performance to the stimulant action of cold and to the exhaustion of the power of life in freezing animals by their efforts to produce heat. He even ascribes the attempt of his poor victim, the dormouse, to get out of the vessel in which he was to be frozen to death to the rousing of animal action by cold. He seems to take little notice of the vital organs, the fire place whence the constitution receives its warmth; nor regard much the condition of the respiratory function in any of the creatures he operated upon nor the pain they endured and the changes in their economy consequent upon. The experiments on an egg, frog, eel and snail may be as well explained on the idea of the increased susceptibility to im- pression produced by the subduction of stimuli and by an extraordinary exertion of the respiratory organs causing a greater evolution of heat as upon Hunter's hypothesis which may be summed up in this general conclusion that cold produces its effect in suspending the voluntary actions though as a sedative to a certain point beyond which it seems to act as a stimulant, exciting the animal powers to exhort themselves for self-preservation. It will be evident that the Epricurean Sectaries en- tertained no other than mechanical notions concerning the production, action and changes of bodies; and that Hippocrates and his followers though considerably more advanced toward the truth had gone no farther than to observe solitary and individual facts, arrange these into detached sentences or insulated aphorism sometimes entirely true and sometimes containing only a mixture of truth; or frame strange and whimsical hypotheses by aid of which as general principles they attempted to explain things. The most forward of them seems to have done little more than trace the corporeal- functions by partial in- duction to the common sensory. Such was the condition of medical science until al- most twenty-five years ago (1775) when in that very place where spasm, reaction and vis medicatrix nature Medicine in 1800. 315 were flourishing in full vigor under the assiduous culti- vation of Cullen, they were nipped and cropped in the blossom, and nearly eradicated by the improving hand of Brown, from the intimate acquaintance which Brown or Bruno as he called himself had with the published writings and probably with the private opinions of Cullen. From his academic habits, his erudition and knowledge of every thing passing at the University of Edinburgh, Brown must have had great opportunities as well of learning all that was printed in physic as of studying the defects and detecting the weakness of Cullen's doc- trines. He ventured one day to talk to Cullen on the incomprehensible ideas of atony and spasm existing in the same vessels of the body at the same time; and thereby provoked him to manifest signs of impatience and displeasure. A coolness took place immediately which increased at last, by successive and mutual ag- gravation to rooted aversion and deep opposition. To this irritated state of Brown's mind, indignant with the sense of unbecoming treatment, is to be ascribed no small portion of that resolution and energy with which he labored out a system of Medical Philosophy which, though not free from errors, borrows, however, none from Cullen. The Elementa Medicina, published in 1780, was dedi- cated to Sir John Elliot, but this dedication was withheld from the second edition. After stating his twenty years labor in learning and teaching physic he observes, it was not until the fourth lustrum that some dawning of light broke in upon him. The opinion that in the phlegmasae of nosologists, local affection was not the cause of pyrexia, but on the contrary a symptom consequent upon a previous excitement of the whole constitution, appears to have been early adopted by him, from his own personal sufferings in erysipelas cynanche, tonsillaris, catarrh and synocha, and from his perusal of whatever had been written by Morgagni, Triller and other candid authors on these subjects and on pneumonia he was confident his ideas were right. He, at this time, proposed the doctrine of cold predis- 316 Samuel L. Mitchell. posing the body to be operated upon in a powerful manner and to a morbid degree by subsequent heat; which, indeed, may be regarded as one of the most important practical truths in medicine. He calls in question the propriety of forming opinions of the nature of diseases by their symptoms merely and bodily adopts the method of judging from the "laedentia" and "juvantia." He offers well-founded criticism on nosological arrange- ment and shows wherein through want of distinction between universal and local diseases a number of these had been classed wrong. On examining the phlogistic exanthemata he contends that in measles and scarlet fever as well as in smallpox, the general indications of cure is to diminish the inflammatory diathesis without the least regard to the peculiar nature of the contagion or the stage of eruption. These are, however, carefully to be distinguished from the plague and other eruptive diseases of totally opposite character. Without reference to the peculiarity of the respiration or the specific nature of the morbific cause, the certain things to be at- tended to are, how far the diseased condition deviates from health; and in what degree the living body approximates toward death. The exanthematous symptoms in the two classes of complaints varying in each, their forms only and not their nature. Having proceeded thus far, he declares that diseases of the same type or class are to be relieved or cured by the same mode of treatment. That the volumes of diagnosis and the endless distinctions of nosology in spite of the authority even of Baglivi and Sydenham, when opposed to clear reason and matter of fact, ought to be disregarded. He expresses apprehension lest the infinite distinction of diseases should lead to a mode of practice equally diversified and have a very baneful effect upon materia medica and prescription. In his remarks upon predisposition to bad health he avers that no person ever suddenly became sick, but that gradually a predisposition was created by the agency of the Medicine in 1800. 317 exciting powers and out of this predisposition grew the dis- ease. Of this he gives an example in the phlogistic exan- thementa wherein he says a high degree of excitement produces the disease, a lower predisposition and a lower health: the means, therefore, conducive to the latter of these he thinks so simple that the use of the common nosology is entirely superceded. Proceeding upon this plan, he distinguishes local from universal ailments; both of which are confusedly classed together in the different nosological arrangements. This lead him to an examination of hemorrhage, which, if attended in the beginning with phlogistic diathesis, he thought always became eventually asthenic. In this, on inquiry, it was that he was induced to call in question the existence of plethora as a cause of hemorrhage and to reject altogether the notion of a vis medicatrix naturae as an agent in the animal system. This first edition of the Elementa is an unfinished work and comprehends the details of his doctrine rather than the sthenic form of diseases. Among these he ranks hemorrhage, especially menorrhagia, hiemorrhois, epistaxis and apoplexy, an arrangement which he afterwards considered wrong and altered accordingly in the following editions by placing them in the asthenic class. Such was the strain of ideas passing in his mind as he reflected upon the animal economy, and upon these consid- erations did he judge himself warranted in undertaking an explanation of the subject different in many respects from any thing done before him. He declares throughout the whole he never descends beneath his dignity to animadvert upon particular persons. In certain cases where almost implicit faith and idolatrous reverence had been given to certain authors he as freely attacked and refuted their opinions. He apologizes for the plainness of style and manner with which the performance is written, especially since to avoid the contagion of opinion he had read no medical book for five whole years and had scarcely consulted the monuments of ancient ele- gance for twenty. There is a great deal of animation and 318 Samuel L. Mitchell. force in his argument against plethora, from the ninety- fourth to the ninety-eighth section. In the hundred and fourth section he opposes in de- cided terms the tonic or astringent operation of cold, par- ticularly as causing constriction of the skin; and repeats the same in several places (180-182), denying that it acts as a stimulant. In his reasoning against lentor in the fluids as a cause of disease he rejects the pathology of the fluids and declares that cool water, pure air, wine and peruvian bark resists putrefaction in no other way than by keeping up excite- ment. In remarks upon spasm he endeavors to show that it cannot be a cause of disease either of the sthenic or asthenic kind and ought, of course, tob e rejected from both, as should also what has been called the reaction of the system in fever. He is everywhere opposed to that classification and arrangement of disease which has so much obtained of late and closes his work with the words "Nosologia delenda." He published a second edition in the year 1788 adding thereto the asthenic class of diseases. Taught by exper- ience and observation in the different forms of the gout and asthenia, of the benefit of stimulant remedies, he had no hesitation in considering them among the effects of weak- ness; as were likewise fevers strictly so called (febres) both intermittent and continued and all kinds of hemorrhage. In short the consideration of the diseases not belonging to the sthenic class convinced him they must be referred to the asthenic. Such were all spasmodic or conclusive ail- ments, dyspepsia and other like affections of the alimentary canal and the greatest part of the maladies of children. In this performance too he contends against the advo- cates for sedatives. Opium he declares has a stimulant operation; cold or catanh are produced by heat succeeding to cold and not to heat or vice versa. He extends his laws of animation to the vegetable creation. There was in the medullar nervous matter and mus- cular solid or living bodies, which have been generally Medicine in 1800. 319 called the nervous system, a property by which they could be affected by outward agents as well as by their own functions in such a way as to produce the phenomena peculiar to the living state. This capacity of being acted upon is termed excitablity and the agents are all denomi- nated stimulants while the effect produced by the operation of stimulants upon excitability is called excitement. Excitement terminated in two ways. 1st. By the exhaustion of excitability through the violence or continu- ance of stimulus which is called indirect debility. 2nd. By the accumulation or excitability through deficient stimulus which is termed direct debility. Between the two extremes of indirect and direct debility are exper- ienced both health and diseases of the sthenic kind, of those febrile complaints (pyrexia) accompanied with what had been called phlogistic diathesis, wherein though the excitement considerably exceeds the healthy rate, still it does not reach the limits of indirect debility. Stimuli lose their efficacy after long and frequent application but even then the excitability exhausted in relation to one stimulus is capable of being acted upon by another. Therefore the waste of excitability after exhaustion of one stimulus after another is very hard to be repaired by reason of the difficulty of access to fresh stimuli to work upon the languishing excitability which by being applied strong at first and gradually weakened afterwards answers the purpose. The superabundant ex- citability left by subduction of one stimulus after another, produces such an excitable condition of the system that much nicety is requisite to wear it gradually away by application of very weak stimuli at first and by degrees stronger and stronger until the accustomed ones can be comfortably borne. According to the Brunonian doctrine diseases appear under various modifications. Thus they may be: Universal, such as primarily affect the whole con- stitution, as fevers, etc. Local, where, from limited morbid affection, a particular part labors without dis- ordering the entire habit; as trifling wounds, phlegmons, etc. Loco-universal when from a local affection the whole 320 Samuel L. Mitchell. body is eventually brought into a diseased condition; as in lues originating from chancre, small-pox from inocula- tion, etc; universo-Iocal, as if, after a general ailment any particular part or organ is affected in a secondary way, as the eruption of exanthematous pyrexiae, syphil- itic blothes, etc. And each of these forms of diseases either in direct debility; as in scurvy, hunger, cold, etc. Sthenic diathesis; as in pleurisy, other forms of synocha, etc. Indirect; as in old age, intoxication, fati | gue, etc. Direct debility added to indirect; as in gout very often and in many diseases of advanced life. In- direct debility added to direct, as in overfeeding a. fam- ished person, etc., do in most diseases of infants and young persons. Comparing this view with the opinion of the old Methodists can it be said to be a mere revival of the practice of Themison and Thessalus? Surely they who have so asserted can never have given themselves the trouble to examine. Yet with all this novelty about it, Brown's doctrine proceeds not far enough beyond general principles which by reason of their abstract or speculative nature have not been found closely enough applicable to the sub- jects of pathology and physiology. He takes for granted that the nervous system is always one and the same excitable thing. He says scarcely any thing accurate on the different qualities of the blood and circulating fluids and of the secretions, and gives no specific detail concern- ing the mighty influence of the respiratory and digestive processes upon the animal economy. He passes over en- tirely the chemical composition of food and drink, of in- halations and excretions of gases breathed and remedies swallowed. He has not a sentence on the composition of bone, muscle, vessel, fat, lymph or gluten nor how vari- ously these are affected by the disease, nor in what their healthy differs from their morbid state, nor by what means the alterations they undergo are brought about. These and other omissions and defects in the Bruno- nian System called for amendments which was begun by Medicine in 1800. 321 attending to the varying conditions of the living solid and the concomitant state of the fluids. The establishments of the new nomenclature of chem- istry in France in 1787 may be considered as forming a new epoch in science. Since then language has been adapted with greater accuracy to the expression of ideas and philosophical investigation conducted with superior advantage and success. Lavoisier in his Elements of Chem- istry has attempted the explanation of the putrefactive as well as the fermentative process in the organized forms of animals and of plants upon the modern principles and in a natural and convincing manner has proceeded a great way beyond any one who undertook the explanation before. Spallanzani in Experiments on the Concoction of food in the stomach and Crawford in application of the Principles of Combustion to the function of lungs in breathing, had given excellent specimens of this mode of reasoning on physiological subjects. Great progress has been made since in detecting the nature and properties of the atmosphere, the gases and aeriform fluids; and the right knowledge of these derived from experiment and observation, has fur- nished the means of expounding many of the animal func- tions in a plain happy manner. We do not merely know at present this, their gaseous production (pure air), is necessary to the preservation and continuance of animal life; but that it is a compound sub- stance and what its compound ingredients are. It can be made artificially and nature is doing so incessantly. The term "dephlogisticated air" is not accurately nor logically applied. Judging from its tendency to produce sourness when combined with other bodies, we call the basis of it "the acidifying principle" and the combination of that base with light and caloric or the matter of heat "oxygen, gas or air" or more properly "gaseous oxyd of light." From knowing the operation of this oxygen or princi- ple of souring upon various bodies we know the composi- tion of acids and have made out a considerable list of acidisiable bases so that the formation of fixed air from oxygen and carbone or charcoal, of nitrous acid from it and * 322 Samuel L. Mitchell. azote, of vitriolic acid from the same and sulphur, and phosphoric acid from its union with phosphorus seem to be well established truths. A certain other class of bodies capable of combining oxygen but not to the point of acidity forms thereby half acid or oxyds; thus the calces of metals, animal blood and secretions as well as the far- inaceous, gummy and mucilaginous parts of plants are formed. The composition of water is understood. Instead of being an elementary body as was formerly believed it is but the oxyde of hydrogen or a combination of this latter substance with the principle of acidity but not to the souring point. It is considered also that more is known concerning the composition of irritable fibre, of adipose matter and of bones. The effects produced upon the circulation fluids by breathing, and through them upon the solids of the animal body in health and the alterations too that the liquid and firm parts undergo by impeding, vitiating or obstructing that function, in ordinary cases as well as in gravid females, are now better comprehended than they used to be. In as much that after the great light thrown upon the subject succeeding authors have been enabled to dress up the Brunonian System in the more recent fashion and to sup- ply and adorn it with almost all that was wanting to make it additionally engaging and attractive. Drowning, suffoca- tion, scurvy, stone, dysentry, pestilence, ulcers and fever have already received great elucidation both in theory and practice from the application of chemical principles. Before many years elapse better and more correct ideas will be entertained of many articles of the materia medica and of their manner of operating. A new medical nomenclature (than which nothing in science is more wanting) will be made out. From the ascertained condition of the body and the known composition and operation of remedies, physi- cians may prescribe fairly for the actual state of the con- stitution and the removal of the present malady, without being misled as too often happens at present by specious words and idle or deceitful names. Medicine in 1800. 323 But notwithstanding the many and beautiful applica- tions of chemical principles to the explanation of the animal functions we are not to imagine everything in life sus- ceptible of chemical interpretations. What it is that enables the atom composing a muscle to cohere and the muscle to contract and perform great exertions of strength we know not; but we can never form a muscle by synthesis or the putting together in any artificial form those substances which appear from analysis to constitute a muscle. There is something in animated existence which eludes our most active researches and which denies submission to either mechanical or chemical laws. With respect to chemical modes of- reasoning upon these subjects it is observable that they apply with their greatest extent and accuracy to such parts of the body as have the lowest degree of ani- mation, as the contents of the intestines, teeth, bones, fat, substances adhering to the skin and, generally speaking, the circulation and secreted fluids; while the qualities of muscular fibers by which they become contractile, and of nervous expansions whereby they take on sensation with the whole of the functions arising from irritability and sensibility are referable to other and different laws. The investigation of these laws of organic life is at- tempted by our learned and ingenious Dr. Erasmus Darwin in Zoonomia, which, though not exempt from fanciful and visionary doctrines, presents considerations of the first im- portance both to the speculative philosopher and the practical physician; to him who contemplates the operation of mind as a science or to him that attends to the corporeal func- tions as an artist. The second part of this work is also engaged in an arrangement of diseases, with their remedies and modes of treatment, and will be very acceptable to the practical as well as the theoretical physician. After the different projects for methodizing this department of knowl- edge which have successively been offered to the public with so little advancement of true science the friends of medical improvement and of the healing art will joyfully accept of something that promises to lead them from arbitrary system 324 Samuel L. Mitchell. to natural methods. And as the distinctions are founded upon the increased, decreased or diverted actions of the moving machinery of the body, it will instantly be perceived how closely the Brunonian doctrine is interwoven with the whole subject. It is, however, to be always borne in mind that in American diseases the physicians of this country have generally written the best. MORPHINISM AND CRIME.* By T. D. CROTHERS, M. D., HARTFORD. Superintendent Walnut Lodge Hospital, Hartford, Conn.; Professor of Diseases of Brain and Nervous System, New York School of Clinical Medicine, Etc. IT IS estimated that there are over a hundred thousand morphinists in the United States and Canada. Some of the evidence on which this is based comes from the in- creasing demand for morphia and sales beyond the legitimate requirements of medicine. Also on the rapid growth of the number of morphinists seen in both private and hospital practice. Many of these cases are secret users of the drug, whose addiction becomes apparent from accident or disease. Morphinism appears more frequently among the better classes of society and those who have been successful, and particularly among the brain and nerve exhausted, and those who have suffered from excessive strain and drain. The morphinist is perpetually seeking relief from states of discomfort and pain, and every impulse turns on this fact in his life. This impairs his reliability and sanity, hence he is unable to describe accurately events and his relation to them. His conceptions of pain are largely imaginary and anticipative. The mind is impaired and the ability to analyze the impressions, both from objective and subjective conditions, is enfeebled. Facts and conditions become ex- aggerated and distorted, hence cannot be discriminated accurately. Sometimes his mind may act logically from 'Read it thelPan-Amerlcan Congress at Havana, February 4, 1901. [325] 326 T. D. Crothers. given premises but his inability to determine the accuracy of the impression is followed by error. In addition there is an increasing egotism, which makes him dangerous as a witness. False impressions are accepted without question, and grow to be realities in his mind; as an example, sus- picions of infidelity, intrigue and attempted injury are ac- cepted as facts from which he may reason naturally. This incapacity to discriminate is marked in many examples of persons who swear to injuries which are found not to have occurred; also in the making of wills, selling of property, execution of papers—all may be based on faulty impres- sions which the brain is unable to determine. Often under those delusional states assaults may be committed, which seem to be justifiable or else are denied as not having occurred. The morphinist has a feeble ethical sense; his conceptions of truth and consciousness of right and wrong grow weaker with the continued use of the drug. This failure is first in regard to the addiction, then later it re- lates to matters outside of his own life. Most morphinists exhibit the most childish prevarications and misrepresenta- tions concerning their use of the drug. Along with this are associated perverted conceptions of their relation to others. It is said that morphin taken by the needle leaves the mind more debilitated in the higher relations than when taken by the mouth. Dr. Guimbail, in a study of some criminal morphinists, drew the following conclusions: First, morphia causes defects of attention and paralysis of the will. Second, the ethical sense to distinguish between good and evil is blurred. He is unable to discriminate; this sense is lost in many cases and the victim is unable to act from any moral basis. Third, his free will is lost and power of control over the impulses is lessened, hence he is dominated by morbid impulses, both physical and mental. Fourth, the morphinist is a genuine lunatic, as much so as the dipsomaniac, only more subtle and con- cealed. Fifth, the responsibility is always impaired because of the intellectual enfeeblement and diminution of the moral sense. This is very apparent when associated with de- Morphinism and Crime. 327 lusions and mental disturbance. There is no border line between responsibility and irresponsibility in morphinism. Each case must furnish the facts from which it is judged. In a discussion which followed these conclusions it was asserted that criminality in morphin cases could be traced to some established predisposition and was not easily created in a healthy brain. In reply to this it was asserted that morphin destroyed the capacity of the victim to judge of his condition and relation to others; hence, the criminal tendency as well as to act in an unreasoning way was inevitable in all cases. The crimes for which morphinists are noted are usually against property and character, and seem to be based upon impulse, selfishness, skepticism and credulity. The action of morphin on the brain is so markedly a narcotic and depressant that few crimes of vio- lence are committed. Kleptomania, forgery, swindling and misdemeanors of this class are most common. The impulse to procure morphia in any way and under any conditions, no matter how much suffering or pain follows to others, is dominant. In some cases the criminal instincts seem to have this as the one central motive of their life. Thus, in one instance, a morphinist stole, committed forgery, sought every method possible to take advantage of for the purpose of securing the means to procure the drug. There are many physiological reasons for the criminality of morphinists. First, The continuous narcotism and blunting of the sensory centers impairs the power of reasoning by obscuring and narrowing the impression of the senses. Second, The ob- jective world is not correctly seen. The functions and organic activities of the brain are diminished and their vigor and acuteness lessened. Third, the waste products of the system are increased, and the power of elimination is retarded, and favorable soils are formed for the growth of toxins and poisons which are in themselves new sources of depression. These are clear from the facts that all morphinists have disturbed nutrition, anemia and exhaus- tion. Egotism and pessimism are the two conditions which obscure the meaning of things and make it impossible to 328 T. D. Crothers. accurately judge of the nature and quality of acts. The selfishness and avarice of many morphinists seem the lead- ing motive in their criminality. Their conceptions of life all seem to be controlled by acquisitiveness. Such persons are always slanderous, untruthful and take advantage with every opportunity, and the boldness and assertiveness of their statements give evidence of the weakness of the brain. Other persons show cunning in a studied appearance of honesty and efforts to cover up their acts and conduct. Like others of this class their efforts will lack consistency and soon betray themselves by the foolish disregard of some essential particulars. A morphin criminal will always show defects of reasoning which will betray his conditions, and particularly if he has reached the chronic stages of the dis- ease. Capital crimes are rarely committed, and are usually associated with morbid impulses that reveal the morphin state. In the exhilarated stage noted in some cases of morphinists a sudden furious impulse may result in crime, but after this stage of exhilaration has passed the criminal impulse will take on the form of intrigue and cunning to secure the same end. This first stage is of such short duration and so uncertain in many cases that it cannot be depended upon for criminal purposes. Thus, a man who was given morphin and told to go out and shoot a supposed enemy started out with this impulse, but before he reached the place concluded it would be better to burn his house. The first impulse merged into the second stage of intrigue and cunning. Some morphinists show the very curious state of double personality. While fully under the influence of the drug they may act and talk as honest and innocent men, and when studied exhibit all the marks of dangerous, unscrupulous swindlers. Some of these morphin criminals are bold, audacious and cunning to the last degree when fully under the influence of the drug, but when the drug is withdrawn are cringing and childish in a marked degree. Many of the most dangerous criminal morphinists exhibit this strange combination of insanity and sanity in their conduct. At one time honest, frank and open, at another, cringing, tricky and idiotic. Morphinism and Crime. 329 Another class of criminal morphinists enjoy deception and take keen pleasure in efforts to conceal their motives and conduct. They have veritable manias for leading a double life. There are no theories which explain this con- dition other than that of some obscure palsy which breaks up certain brain centers, leaving other parts of the brain intact. Some of these cases manifest very curious delu- sions, which merge into criminal acts, but these are readily discovered from the want of cunning in their execution. Opium is rarely used for distinct criminal purposes unless in case of seduction. Here the general stupor and absence of sense impressions favor this result. Persons under the influence of morphin have less power of resistance to both physical and mental impressions, and will easily succumb if tempted. Sudden manias and deliriums followed by criminal acts should always suggest inquiry concerning the habits of the person. If morphine is used the irresponsi- bility can be established. Strange theories of motive and conduct, unsupported by facts and natural conditions, are often found to arise from concealed morphinists. Thus, witnesses on the stand will give extraordinary testimony, at variance with the natural order of events, and believe that they are correct. Later it will be found that this evi- dence is the result of delusions. As a witness the mor- phinist is a very dangerous one. His memory, sense impressions and reasoning are so inharmonious and feeble that his impressions of an event will always be open to doubt. As a criminal he is not to be governed by the general rules of crime. There is a strange compound of delusion, morbid impulse and sense hallucinations which make the crime peculiar and readily apparent from careful observation. He is practically incapacitated to realize his condition and adjust himself to his surroundings. The fine shadows, uncertainties and doubts which attend the ordi- nary human transactions do not appeal to his brain, hence he imagines they do not exist. Questions of duty, of ob- ligation and law are vague, uncertain and doubtful qualities. They never appear absolute and positive to him. His 330 T. D. Crothers. egotism rises above all considerations, and the more de- fective he becomes the more positive his convictions of strength and ability. This is practically paralysis of the ethical brain and the centers of volition associated with weakness, prostration and debility; hence, the criminality of the morphinist differs from that of all other criminals. The continual enfeeblement of the coordinating brain centers deepen with the continued use of morphia, and with this all distinctions of duty and consciousness of right and wrong fade away. This is one of progressive degeneration while the coarser organic operations of the body may be little disturbed. Crime is, in these cases, simply the suppression of the higher coordinating centers. While the intellect may not be disordered to the extent noted among the insane of large asylums, there is a paralysis present which makes them even more dangerous than the insane because of the confusion of motive and thought. The legal responsibility of these cases is misunderstood and seldom realized in court. The superstition that demands a full measure of accountability and assumes that the use of morphia is a voluntary act in which the patient is conscious and capable of control is contradicted by all study and experience. Crime is a natural outcome of the anaesthesia of the brain, and curiously this fact is sometimes realized by the victims themselves. Thus, an eminent judge, who was clearly a morphia-taker, charged the jury that morphinism was a disease and all persons using it were incompetent in all matters requiring judgment and skill. Also that they were irresponsible and should not be punished as other persons are. An expert physician, who was a secret user of mor- phin, swore positively to the insanity of a criminal who was a morphia-taker, and sustained a very minute cross- examination while he himself was under the influence of the drug. The fact that the criminal uses morphia should be taken as evidence of his mental disability, the treat- ment for which should not be punishment in jail but con- fined in an asylum until recovered. There is a large class of morphinists who use alcohol alternately. They are still Morphinism and Crime. 331 more dangerous and irresponsible. In the near future they will be recognized and treated as insane. It is one of the great problems which confronts our new civilization, to deal practically with these drug-takers, not only for the protec- tion of the community, but for the prevention of crime through their disability. Crime in morphinism must be studied from the physical side and not as a question of theory or rulings of law or judges, but as a question of fact. A new jurisprudence is demanded, and a new scientific study from a higher plane is called for most urgently today. THE LEGAL DISABILITIES OF NATURAL CHILDREN JUSTIFIED BIOLOGIC- ALLY AND HISTORICALLY* By E. C. SPITZKA, M. D., NEW YORK. 80 One cannot but sympathize with the "gentleman moving in good, and even high society—as thorough a man of the world as any in London— who had the misfortune to be a natural son" and who called on Macaulay "to make a formal remonstrance on his having used the term 'bastard' in his 'history' and earnestly entreated him not to sanction so cruel an epithet with his immense authority" (Trevelyan's Life and Letters, etc., 11, 381). But what was Macaulay to do? Certainly a most ill-chosen Instance with which to institute the more sanctioned usage of natural, had been the Duke de Maine,of whom the passage in Macaulay's book speaks, to whose circum- stances and those of his parents certainly any other term had been more "natural." To maintain relations with the later titled Montespan, to employ all the forces of a king to separate her from her husband, to have Harlay prostitute his chancellorship in behalf of the children but against their mother, (Note 55) to discard her in favor of her own beneficiary the Maintenon, were conceivable only under conditions involving the highest refinement of artifice and widest departure from nalurt. In addition Maine was that sort of a son to whom as the Duke of Richmond the term "unnatural son" was eminently applicable, since the former willingly—even anxiously—consented to be the messenger of his mother's disgrace; while the latter turned his back on his, after having gotten all out of her he could. See H. Forner on Louise de Queronaxlle Duchess of Portsmouth. How the Duke of Richmond Gained His Pension, London, 1887. Strictly nolhus signified an illegitimate child whose father was identifiable and known as such. One born of a low woman was characterized as "poelice ortus" or "ex poelice genitus," A nothus became legitimatus when acknowledged and adopted by his father. Zacchias (Questiones medico-legalis, p. 254) treats •Continued from October 1900. Notes referred to"ln text of preceding numbers X [332] The Legal Disabilities of Natural Children. 333 of the children born of a strumpet under the declaratory caption "Ex publics mtrttrici nati dicuntur vulgo concepti;" and says of them that they are not privileged to claim any particular one whatever, as their father, not being— as it were—able to designate such a one. "Meretrices publicae Filii cerium patrem ostendere nequent." (Regarding the interpretation of those terms in Zacchias obsolete or rarely used I am indebted to Professor Charles Herber- man of New York College). Spurius was applied to bastards whose parents had not lived in regular concubinage; or, as the Romans expressed it. had met in the baser walks in which "increase and multiplication" is possible; such were vulgo quaesiti. Those still more unfortunate in having for mother a meretricious woman were designated as ex poelice natus. The first, the "clandestine"; the third, the meretrix born of my tables corresponds to —with this addition, that I had included in one class with the meretrix-born those born under the constellation of Venus vulgivaga. I became aware of the need of a separation too late, although the figures had become large enough. I would in case of repeating this study separate; (a) The offspring of Hetairae; (b) those born of actresses, who seemed to have realized repeating in real life the career of their favorite roles, like the Cleopatra-caricature, mother of Damala. (See also Note 13, Rahel). The two tragical suicides from virtuous motives; a brother of Laboissiere, like him illegitimate son of Ninon d'Endos killed himself in making the horrible discovery too notorious to detail; the daughter of the Roman belle esprit "Imperial" did the same to escape the annoyances of an ardent rake, were born of mothers representing an intermediate class (c) the courtezan in the strict sense of the term (d); the "common-la'w wife" (e) the fille de pare. 81 Or kinship strangely and wonderfully made I For example, let us follow up the ancestry of that Caesarion, summarily executed by order of Octavius, and whose parents were Caesar and the notorious Cleopatra. Caesarion was half-brother to the illegitimate twins "Sun" and "Moon" and to another Ptolemy, (See text, October fascieulus). His mother was the legitimate daughter of parents both illegitimate: Ptolemy Nothus and Cleopatra Tryphaena (her natural half-sister). Cleopatra herself had suc- cessively married both her brothers, poisoned one brother-husband, caused the downfall of the other, and procured the poisoning of her sister Arslnoe. Her bastard father's parent, Ptolemy Lathyrus, was the offspring of a rape ("made good" by later marriage) committed by Ptolemy Physcon on Cleopotra 111. The latter had been previously his step-niece and full niece, later his step-daughter; for he had first married Cleopatra II, mother of the Third by her first husband-brother of the full-blood, Ptolemy Philometor. The relations are sufficiently complicated, and to remember a diagram were desirable; but as it would require three dimentions of space, paper allowing but two, 1 shall try to make it clear by symbols. Let A represent Ptolemy Philometer and B, Ptolemy Physcon; C and Y respectively Cleopatra II and III; O and R the brother and sister, parents of A and B. A is at once nephew and son each, of C and R; he is brother and husband of C; and leaving relict C, she is at once niece and daughter Y, B, his brother previously 334 E. C. Spitika. brother-in-law and brother also of C; marrying C, made A his deceased brother also his posthumous brother-in-law and C his wife, his sister-in- law, when the latter became his sister-in-law in one person with wife. He discards her, marrying Y, his niece, step-daughter and step-niece; making her the sister-in-law of her mother (who had been married to brothers of the same generation) and making his first wife his mother-in-law and aunt- In-law in addition to her other positions. As C had had children by both fraternal husbands, the reader may conceive the further entanglements of their relationships and difficulties of realizing all those of the children of C and Y to each other, for Physcon had such by both wives—and murdered a few of them I 82 There are a number of casees among the Ptolemies and Selucldes; one among the latter, though attributed to another than the notorious real offender, is referred to in the play, Pericles Prince of Tyre. Casanova In his memolrcs relates his all but consummating a like union with his daughter Leonida. The case of Lake, who procreated a bastard daughter (and grand daughter in one person) as well as four other children with his natu- ral daughter, led to the commitment of the two mentally unsound victims to the Middletown Asylum during the superintendency of its present chief, Dr. Selden H. Talcott. 83 It is my agreeable duty to acknowledge a summary of the laws and decisions affecting succession and property in connection with illegitimacy as they stood up to the date of the reading of the paper, kindly furnished by Mr. Charles McGregor of the New York Bar. 1 have not at hand this moment more than the skeleton of an interesting decision in re State v. Schoemaker, Supreme Court of Iowa, which is to this effect: "Where a man marries a woman, knowing that she is already with child by another man, he Is held to adopt the child into his family and the law holds him liable for its support, as one standing in loco parentis. No action can, therefore, be maintained against the natural father for its support as a bastard." The decision was in 1883. The practical reasons underlying this seem to have been, the marrying of adventuresses to persons bringing bait in their name of a speculative nature against wealthy fathers to whom the procreation of pre-connubial children was imputed. It also disposes of some complications arising from substitution of children—one such, recently brought to me for an opinion, hinged on the simple question whether negroid characters could be detected in a very young infant. 84 What a prominent topic illegitimacy must have been in the earliest period of a municipality whose very senate was compelled to recruit itsei (Patres eonscnpti) from the ranks of those who could not mention thelf fathers, may be inferred from the frequency with which certain names recur. The dictionary signification of "Tullius" corresponds accurately to the origin of that king, whose appearance in the house of the Tarquins required an apparatus of legerdemain and miracle which constituted It a veritable The Legal Disabilities of Natural Children. # 335 transition between the tale of Rhea and that of Fausta. Had a Roman City Directory been materialized, its pages of Spurii and Varii would have not added to it; as honest Smith and Brown make ours bulge to-day. Varii was originally Valius and In what sense used, is shown in the case of Ela- gabal; whose nickname at school it was owing to the variety of paternity he might have claimed: "Quod vario semine di metetrict utpott conceptus videtur." Whoever wishes to locate the Spurii will find- them mentioned whenever the spoils of office were divided, after civic commotion or other crisis—about forty may be thus found In Llvius' history. Perhaps the remarkable number of Posthumii is not altogether unconnected with our subject. Curious combinations resulted from the Roman system of naming, such as Spurius Spurius and Spurius Posthumius. While the name of Ali- mtnlus (Marcus Cinclus A., in Livy Hi; and Lucius A., ib. li) is suggestive enough, yet In cynicism the old were outdone by the later Romans. There is a document extant, relating to Forfa (a city, by the way, abandoned to the Mohammedan invaders through nepotic neglect, but treated by them with care of the beautiful buildings which were ruined by the bantlings on evacuation by the "heathen"); it is a Placitum of Nicholas II, dated April 28th, 1060 A. D. and one of the signatures appended is that of a Roman nobleman: Ratterius Adulterinusl The nearest approach to this in more recent nomenclature, occurs In Holland and England; the navy of the former had an Admiral Bankert; that of the latter, a Captain Bastard. 85 The Franks, with whom the question of bastardy seems to have been one of uncommon prominence, had among their legal tests the ordeal of the shield. The concave buckler of the father, the child born to whom was of disputed legitimacy, was used as a float—if it remained on the surface of water with the child, it was pronounced legitimate; if it sank, spurious. This seems (?) a recognition of the greater weight of natural children, and of the wisdom displayed by the mothers of Kama, Sargon and others In giving extra depth to and protecting against leakage their bantling-bearing craft. There must have been some reasons for regarding as crucial and dreading this test on the part of the worthy descendants of Basina and Clovis. Fredegunde when the legitimacy of Chlotar II, who was posthumous to her husband Chilperlc, became doubted, did not appeal to the ordeal. Instead she had three hundred Frank champions make common and solemn oath to Chlotar's legitimacy (We are not informed where the Court Jester was the while). Transmitted bastard character was well illustrated by Hugo of Provence as exhibited in this field, wishing to marry Marozla (his first wife obligingly dying shortly after this wish took form) he could not do so on canonical grounds, as Marozla had been married to his brother. He therefore imputed unchastlty to his mother and asserted the illegitimacy of her three other children. One of these, Lambert, appealed to the ordeal of combat and obtained the victory. Hereupon Hugo had him privately made away with; married the second Messalina; but encountered a superior antag- onist In her son by another marriage, Alberich. The latter's own son and 336 E. C. Spitzka. successor was the third of the series of consecrated criminals beginning with Sergius II and continued by John XI, as John XII. 86 Bribery, direct or indirect frequently an Ingredient of the "first causes;" bribability and bribing, like vanity and sycophancy, as comple- ments of each other, become consequential features in the "results." See also Note 66. 87 la addition to those named in the text and Arthelaus, slain against Consul Gabinius, Caesar Borgia, Berwick, Griffo, Lysander, Manfred, Tancred of Bethune and Visconti (Ambrosio), mentioned in other relations, the victims of the battlefield include: Zierotin (of Russian not of the Czech family); Colonna (Geronimo); Sulkowsky, and the Pipin referred to (clerically erroneous) in Note 40. This should read "Zwentibold who en- gaged In rebellion like the nothus of the third Pipin (Bernhard, King of Italy) and perished in tumult like the other son of Charlemagne of the same name." This fourth Pipin was by the concubine Rothrud. 88 A victory nigh as far-reaching In result as Lepanto's was that off the isle of Monte Christo gained by Enzlo (Note 59). The eccentricities of sailors have at all times been regarded with good-humored indulgence, as the recognition as inheritors of Sir Edward Spragge's ihree illegitimate children by Parliament (Pepys) and the treatment of Nelson's daughter Bronte show. 89 Examples besides several cited in the text, are Tancred of Lecces a second Manfred; Matthew the bastard of Bourbon, spoken of as the bravest knight in the army which included Bayard; Antony, the bastard of Burgundy; Count Burgau, an Austrio-Welser; Richard Sam-Peur, known as "Long- sword" and to be distinguished from another "Longsword" with whom he had chivairic courage and Illegitimate birth in common, William of Salisbury, born by "Fair Rosamond"; Count Nassau of Beverwort; Vaudemont; Mar- shall Augereau, who was thanked for services somewhat like Morny's to Verhuel Napoleon, by being denounced for a second treason in Bonaparte's manifesto on his return from Elba. If Claudius, the later emperor (A. D. 268-270) was a natural son of the younger Gordian, the victor of Naissus would have to be included here also. Archelaus, tyrant of Agae and Pelia, showed exceptionally high talents as a military road constructor (on the excellent authority of Thucydides; History of the Peloponeslan war). But this assassin of the legitimate successor of Perdiccas II and sycophant- seeking patron of Euripides, Agathon and Zeuxis, was In his turn assassi- nated (B. C. 399) before he had an opportunity to exhibit much strategy In the field. Marshall Beresford, the hero of Portugal and Albnera, was also a natural son; likewise Richmond "Red Alan" and the victor of Lincoln (A.D. 1139) Robert Earl of Gloucester. 90 Among other marital affiliations of this strange period were that of The Legal Disabilities of Natural Children. 337 Sancia of Aragon and Jofre Borgia, both illegitimate. What the outcome of such alliances was likely to be when genuinely consummated Gian Galeozzo Sforza and Pompea showed. What they resulted in, when regarded as a mere cover of other relations, may be inferred from such facts as that the above Sancia (there was another natural child of the same Christian name, whose putative father was Charles VIII. of France) when the Borgias with Cardinal Sanseverino and the Prince of Squillace had to fly Rome, preferred "allowing" herself to be abducted by Prospero Colonna to Joining the second, her husband. Notwithstanding such experiences of others, J. J. Orslni, after the death of his first illegitimately-born wife, Maria Cecelia of Aragon, mar- ried a bastard daughter of Rovere (Julius II.) who as Felice Orsinl became renowned for as adventurously spirited a career as the mother of another Orsini (Laura, niece of Alexander Farnese and adulterine daughter of Rod- erigo Borgia) Julia Farnese. Laura married at the same place and time (1506) Nicolaus Rovere, nephew of Felice's father. This Felice exemplified the rapacity and unfilial calousness of bastards. Taking advantage of her father's being in a moribund state, she endeavored to extort a cardinal's bat for a uterine brother. Thus also Teodorina Cibo and Franchessetto, her brother elsewhere referred to, (Notes 50 and 74) acted to Innocent VIII. Curious complications and more grave results grew out of these bastard groupings: Henry the Second of France, in his ceremonial relations with the Court of Florence, had the choice of addressing its prince as his half brother-in-law or as his uncle-in-law; the alternative of the paternity of Aleassandro Medici lying between his wife's father and her grand-uncle Gtuliano, also a nothus. In this predicament of affiliation with either the singly or doubly taintured he might find consoling companionship with impe- rial Maximilian, who took as his second wife the bastard descended Blanca Sforza. The world saw the symbolic number in the Medici coat of arms In complete repetition; a "third pill" had to be swallowed by France In the shape of a second queen in whose veins flowed Medici blood, she being descendent of the half military, half diplomatic adventuress, half man and half woman: Catherine Sforza. Her second marriage had borne as fruit that Medici known as leader of the "Black Band" who died in the arms of the nothus Aretln I His great-grand-daughter Maria Medici shared the throne with King Henry of Navarre. This king's ancestry had come into previous contact with the bar sinister; Caesar Borgia, after having been peddled around the royal marriage mart and rejected by all possessing a trace of self-respect (as was Louis Napoleon under like circumstances) married an Albret. The Maria Medici afore-mentioned is not to be confounded with another Maria Medici, who was an illegitimate in her own person, and a daughter of Lorenzo, the "Magnificent." A role similar to that played by the Medicis in France, was enacted also In Poland by the similarly taintured Sforzas. A grand-daughter of the, in birth, symmetrical couple Francesco and Bianca: legitimate daughter of their natricidal son, Glan Galezzo, was the second spouse of Sigismund I. This "covetous and corrupt Italian" was the source of endless mischief. Among other performances she loaned Philip of Spain several hundred thousand 338 E. C. Spitzka. florins which the latter never repaid; Bona, however, was not the loser, for she had merely taken the money from the Polish treasury. After a career of like criminal presumption and intrigue she returned to Barl in her native Italy; here she was poisoned by one of her paramours. In mentioning her Visconti grandmother as illegitimate, it is to be stated that the latter, aside from a remoter precedent In bastardy, the Condottlerl Ambrosio (ALIENIST AND NEUROLOGIST, January, 1900, pp. 126,148,149 and Note 87) had such in an uncle Gabrielli, who was nothus of the first Duke (1396 not to be confounded with Matteo I. the first "Lord" Gian Galeozzo Visconti 1332). When in 1473 bastard Ferrand of Naples' natural daughter, Leonora, passed through Rome on her way to meet her bridegroom Hercules of Ferrara (Este) the bastard Pietro Riario entertained her with a Lucullian feast. At the table were seven guests whose names I subjoin, the Illegitimately born distinguished by capitals: 1, LEONORA OF ARAGON; 2, GIROLAMO RIARIO; 3, DUCHESS MARIA OE AMALFI nee Maria of Aragon; 4, Sigis- mund of Este; 5, ALBERTO OF ESTE; 6, Duke of Andria; 7, PIETRO RIARIO. (Gregorovius, History,etc., WI, p. 2J5). Similarly was Leonora's successor, Lucrezia Borgia, entertained, when on her way to wed her third (or fourth) husband Alfonso of Ferrara; but on this occasion the Riarios were outdone by Guidobaldo of Urbino; he received Lucrezia with proces- sions, songs of welcome and an allegorical Judgment of Paris; the denoue- ment of this was that, turning from the Goddesses, Paris gave the Apple to Lucrezea. This apple reminds one of the "Rose of Virtue" which has been in our day (1869) granted to Isabella II, whose legitimacy is generally declared to be like her morality in the same light as Lucrezia's. On the arrival at Ferrara, she stopped at the palace of nothus Alberto, to be received by a bevy of "Dames of Honor" whose selection had doubtless been determined by a desire to make Lucrezia feel comfortable; for the fol- lowing «mong them were of illegitimate birth: Lucrezia, Countess of Carrara, Diana Countess Ugozini, Bianca of Sanseve>ino and Lucrezia Bentlvoglio—making up with guest and host an even half dozen. In thus providing for the bride's reception Alfonso may have been mindful of other considerations than mere hospitality; at all events the personnel har- monized with the traditions of the House of Este. We have seen that the history of this ruling family of Ferrara was under auspices of illegitimacy. Of Nicolo's bastard sons occasion has been had to mention Ugo (executed, see Note 57) and Borso the "Magnificent." A third nothus—Lionello— reigned a short period before the latter. Nicolo's leaving legitimate posterity had been Jeopardized by the identity of the already mentioned (Note 53) heroine of Byron's Parisina, who was of a house as distinguished in the person of Francesca di Rimini, henine of a similar episode Immortalized by Petrarch, as through its two able, attractive romantic, treacherous and sacriligious bastard representatives, Gismondo and Robert Malatesta (Notes 39, 65 and Vol. XXI, p. 124) and in addition the Iatter's Herculean son Car- dinal Sanseverino. Borso's ducal successors, Hercules 1 and Alfonso I, married natural daughters of Aragon and Borgia respectively; both their consorts had been married before—Leonora to Sforza Maria, third son of the The Legal Disabilities of Natural Children. 339 illegitimately born couple, Francesco Sforza and Bianca Vlsconti; Lucrezia timet to natural sons, Giovanni Sforza who was Constanzo of Pesaro's son, and Alfonzo of Blseglia (murdered by Caesar Borgia). Furthermore, there was the illegitimate Giuliano of Este (Note 91, Julian Estt) and later still the ducal throne became an object of dispute when Caesar, the son of Alfonso a nothus of Lucrezia's husband by Laura Dianti (who also bore a brother Alfonsino) seated himself on it against the Interdict of Clement VIII. There was hence nothing derogatory to Este dignity in having as sisters-in-law the illegitimate Maria Cecelia of Aragon, Sancia of the same house, and a Girolama Borgia (married to Gianandrea Caesarina). It was consistent with the origin and custom of the Estes that the second Alfonso marry Hippolyta, a daughter of the illegitimate couple who were parents also of the aforesaid Sforza Maria. Nor needed the succeeding generation have been at a loss for material to follow these precedents. There was a second illegitimate Lucrezia Borgia, daughter of Caesar. As the Borgias, by the time she had reached maturity, were no longer in the ascendant, she entered a cloister, while her equally illegitimate brother—that Is, illegitimate in a second gener- ation—Girolamo Borgia became a priest who degenerated into mendicancy. Coincidences while like the synonomy of the first and last emperors of both Roman and Byzantian Empire were altogether fortuitous, have also played their pranks in the annals of bastardy. When Philip II married Mary of England, two claims to the English crown were represented In the couple, and would, had they had a child, have united in one person. One was through illegitimate channels, Mary's claim being derived from John of Somerset (brother of Cardinal Beaufort), Exeter and that Joan of Beaufort, who became the grandmother of Warwick and ancestress of the Abergevannies: see also Notes 22 and 32. Philip's claim originated in one and the same person, John of Gaunt, father of aforesaid Somerset, who had as daughter by his first marriage, Philippa, wife of Portugal's John I "The Spurious," son of Pedro by the beautiful Inez de Castro, the victim of one of the foulest assassination plots chronicled. Thus Philippa was ancestress of the first- named, and as she went to the Peninsula might be confounded with another daughter of Gaunt's (by second marriage) who was born there and likewise had an illegitimate parent, her mother, Constanzia being a daughter of concubine Maria Padilla. Her father was Pedro, victim of his bastard half- brother Henry. (Note 21.) Both claims, it will be seen, though equal as to legitimacy in so far as they start in their descents from the person of Gaunt, are taintured on one side at least—Gaunt's son-in-law being a nothus and usurper of rights of the legitimate Beatrix of Portugal and Cas- tile in the extra-territorial, as his son Somerset was in the domestic Lancastrian line. If not making strange bed-fellows, illegitimacy has mated blood, whose original carriers would have experienced strange sensations had they pos- sessed prescience. In the memoirs of a Hannoverian (Hannover, Germany, not Hanover, Ky.) officer, two W ns are referred to. The mother was clandestinely conceived by a palace attendant at the Hessian Elector's 340 E. C. Spitzka. palace during its occupation by Jerome as King of Westphalia; he being her father. The prince of the restored Electoral House became father of a son W n by this daughter of Jerome. Both were born at Versailles duplicate palace, Wilhelmshohe near Cassel (Note 51). A greater antithesis than Jerome Bonaparte and the exiled and restored Elector cannot be con- ceived. An illegitimate granddaughter of Jerome is still living, as wife of an adventurer who played a questionable role In the troubles of 1866, she being suspected as the channel of Napoleonic Intrigue, like the Illegitimate daughter of an English Premier who about this period had her fingers In most of the intrigues connected with the Anglo-Austrian Bank and "1866": Madame De Bxxy. Similarity of situation and Inclination lead to aggregation In groups of kin spirits, a fact as true in the field of psychiatry of paranoics, persons of "insane temperament" and those instinctively perverted, as it Is in life's field generally, even in its extremes, such as aestheticism and criminality. Equally does this apply to bastardy whose historical associations concentrate around special centers sometimes aided by circumstances more fortuitous than "like cleaving to like"—important factor as this remains. Strange series of bastardy's accidental associations may be traced, its links uniting across distant space and time. Two cavaliers visiting the salon of Madame Du Deffant, smitten with the charms of the actress Clarion—who was destined to follow one of them to his electoral capital, Munich—encounter that illegiti- mate daughter of Countess Albon, who was to illustrate bastard ingratitude by establishing a rival salon, and deprive her generous friend of influence and following. One of the cavaliers was Poniatowski, the father of adulter- Bobrinska (97) and the other an elector of Bavaria, of Lady Keppel's son, who, more fortunate than the organ grinder "Viscount Hinton," inherited the title of Lord Keppel, despite the disclaimer of the mother's husband. The Intimate friend of the Espinasse was philosopher d'Alembert who as Presi- dent of the French Academy delivered the eulogy referred to ht Note 57, on a grandfather of one and father of two natural children. From Russian Bobrinska, English Keppel, French Espinasse and d'Alembert the chain of associated names thus extends to America's Franklin. (To be Continued in July, 1901.) SELECTIONS. CLINICAL PSYCHIATRY. PSYCHIC SHOCK.—What is generally known to the alienists as mental shock is now revived by the surgeons under the title "psychic insult" and used in explanation of sudden mental disorders resultant on psychic causes. Pagenstecher has called attention to (New York Medical Journal, July 28, 1900), a case of this kind in which a patient died from the assumption that he had contracted blood poisoning. Long ago Budd called attention ("Diseases of the Liver") to the fact that jaundice, following mental shock, long continued anxiety, or grief is often unattended by any alarming symptoms, "but now and then after it has existed for some time without any symptoms indicative of especial danger, disorder of the brain, which proves rapidly fatal comes on. After death, portions of the liver are sometimes found completely disorganized. It would seem that some virulent poison is generated in the liver, which deranges and then paralyzes the brain and after death come softening and disorganization of the liver it- self." Tuke pointed out ("Influence of the Mind upon the Body") that the emotions powerfully excite, modify or al- together suspend organic functions. This influence is in all probability, transmitted not only through vaso-motor nerves but through other nerves also,namely, those in close relation to nutrition and secretion (e. g. chorda tympani etc.) As when the excitement is of peripheral origin (a sensory or afferent nerve excites their functions by reflex action) so when emotion arises, it may excite the central nuclei of such afferent nerve, and this stimulus be reflect- [341] 342 Selections. ed upon the afferent nerve; or it may act directly through the latter. In regard to the processes of nutrition, the pleasurable emotions tend to excite them. Hence the ex- citement of certain feelings may, if definitely directed, re- store healthy action to an affected part. Violent emotions may modify nutrition. Various forms of disease originat- ing in perverted defective or inflammatory nutrition are caused primarily by emotional disturbance. As respects secretion, the emotions, by causing a large amount of blood to be transmitted to a gland, increase sensibility and warmth, and stimulate its functions, or they may excite the process by their influence on nerves supplying the glands. Painful emotion may modify the quality (*'. e. the re- lative proportion of the constituents) of the secretions. The emotions may check secretion, either by extreme accelera- tion of the blood through a gland, by unduly lessening its afflux or by direct influence upon the gland. Although, as a rule, the activity of those glands which bear special re- lation to an emotion, is in a direct ratio to its force, the secretion is checked when the emotion is excessive. The pleasurable emotions tend to act only in one direction, that of increased activity of the secretions, but the painful emotions act both in stimulating and arresting secretion. Thus grief excites the lachrymal and rage the salivary gland. Excess of grief checks the lachrymal and fear the salivary glands, while anxiety suspends the gastric. Extreme fear induces perspiration. Practically these phe- nomena described by Dr. Tuke result from the arrest of control of the cerebral spinal system over the nervous sys- tem of the different organs. The condition known as "psychic insult" was long ago recognized by surgeons like Ambrose Pare who insisted on measures calculated to quiet the patient precedent to an operation. As Tissot pointed out a century ago: "The pained face of pity- Creates in the wound morbidity." The recognition of the influence of so called "psychic in- sult" was quite frequent among the surgeons of the first Selections. 343 four decades of the last century as Billroth has pointed out. They called the condition delirium traumaticum ner- vosum. The surgeons of the last half of the nineteenth century, relying too much upon the sedative influence of anaesthetics, ignored psychic symptoms until forced to re- cognize the formidable types of psychoses occurring after operations because of the operative furor due to anaesthesia and antisepsis. One result of"psychic insult" is lyssophobia which mimics to the full "even to fatality" the nosologic picture of hydrophobia. "Psychic insult" has long been recognized by alienists as a serious factor in the production of the fatal psychosis, typhomania or Bell's disease. SEXUAL PERIODICITY IN A PARETIC DEMENT.—Some years ago Perry—Coste (Psychology of Sex Vol. 11) dis- cussing the fact that there was a clear monthly rhythm in the pulse of a man suggested that this seemed to point strongly to existence of a sexual periodicity in males. Of course this is in accordance with the general law that an action once occurring in a nerve tends to repeat itself. Fere admitted (St. Paul Medical Journal February 1901) that facts bearing upon the so-called sexual periodicity in men being rare, claims that pathologic cases are of importance in interpreting this condition. He cites two cases illustra- tive of this in paretic dements. A forty-two year old in- coherent paretic is confused, stammering and mostly unin- telligible in speech. He is paraplegic: the pupils are im- mobile and contracted, tongue and lips tremulous, hands trembling and incoordinate in their movements. General sensibility is irregularly effected: the knee-jerk is absent. The present condition followed apoplectiform attacks six months ago. The disease first showed itself in lapse of memory a little more than three .years ago. The dement- ed calm is broken by fits of periodic excitement remarkable for the character of their manifestations. Every twenty- eight days lewd words occur in his incoherent mutterings, followed by significant gestures. He endeavors to reach the genital organs of those about him. There is priapism and he masturbates unless prevented. Prevention of mas- 344 Selections. turbation produces furor during which he regains the power of pronouncing very distinctly erotic words. These periods usually last three days, generally beginning in the morn- ing. During this time agitation is constant and insomnia complete. In the intervals there is excessive sleep and no sexual excitement is ever noticed. These attacks antedate the demented state. They have existed not only from the beginning of the disease but during his whole life even before puberty. Dr. Fere's second patient had some "ec- centric" paternal relatives. The patient had suffered from morbid fears since childhood. Since his seventh year he had in every month one disturbed week during which he was incorrigible, agitated, irritable and would disappear from home without explanation. He married at 26. From the first his wife noticed periods of sexual ardor which for several days was constant night and day in marked con- trast to the rest of the month when it only appeared under exceptional sexual excitement. Some years before the in- ception of the psychosis the monthly attack was attended by great irascibility. A craving for alcohol also showed it- self. This patient had presented from childhood marked neuropathy. Are these phenomena of periodicity? asks Fere to be considered as pathologic symptoms, or are they reversal in a degenerate to a primary physiological type? EROTIC HALLUCINATIONS.—Dr. E. Bellamy, of Bor- deaux, states (New York Medical Journal, February 2, 1901) that erotic hallucinations constitute a frequent and im- portant phenomenon of the neuroses and psychoses. They may be divided into genital and extragenital, according as they are occupied with the genital sense or with other senses. The first class is manifested by all kinds of par- ticular sensations, from the impression of contact or of the slightest friction up to the most acute orgasm of normal or abnormal sexual act, the most horrible pains of violent sadism or the most complete symptoms of pregnancy and parturition. The second class is manifest by visual, olfac- tory, gustatory or tactile sensations of an erotic character. Erotic hallucinations are found in hysteria, in systematized Selections. 345 insanities, alcoholic delirium and among the degenerate. In hysteria they are as often extragenital as genital. The sense of sight is most frequently affected. Hallucinations occur in the dream state or in the subconscious condition either by day or by night. Frequently painful, they may be accompanied by voluptuous sensations. Related by the subjects with a luxuriance, a precision of detail capable of investing them with an air of reality, they have often served as a starting point for self-accusation or caluminous denunciation. They have a quasi-infectious property of communicating themselves. In the systematized insanities erotic hallucinations are capable of affecting all the senses. Those of sight are the most rare and imply hysteropathic or alcoholic basis. Those of smell and taste and especially of hearing are the most frequent and varied. There are also genital hallucinations, properly so-called, in which all possible sensations may be encountered. The erotic hallu- cinations of persecutor and delusional insanity, the type of systematized insanities, are especially painful and induce in the part of the subject when of the genital type, charac- teristic defensive actions, such as crossing thighs, covering of the sexual organs, stuffing of the vagina with rags, paper, etc. The subjects of toxic delirium, particularly alcoholic, frequently have erotic hallucinations; visual hal- lucinations, colored, mobile, multiple, most often tending to ideas of jealousy, visions of a wife or a mistress in indecent postures in the arms of a lover. The degenerates are rarely subjects of hallucination. An exception must be made of the mystics whose mental state, like that of the hysterics with which it may have much in common, is accompanied by a great number of cases of erotic hallucinations. These hallucinations, essentially of dream-like character, are genital or extragenital, and either voluptuous or painful, respect- ively regarded as a mark of divine favor or torture, accord- ing- as they are attributed to celestial or diabolical agency. A CASE OF DEATH FROM PSYCHIC INSULT.—With Remarks upon Delirium Nervosum Dupuytren, and Opera- tien-Psychoses. F. Pagenstecher (Philadelphia Medical 346 Selections. Journal, Vol. V, 1900, p. 863). The results of psychic in- sults have been known to surgeons for some time under the name of delirium nervosum Dupurtren, and, more recently, of operation-psychoses. Pagenstecher reports a case, which he believes to be the first of the kind reported, in which death was the out- come of a psychic insult. He gives the history of the case in detail, of which the following are the essential features: The patient was a merchant fifty-one years of age, who had never been ill or injured in any way. He was not a drinking man. One day while at his desk sharpening a pencil he cut his thumb and his pen fell from his ear upon the wound, staining it with ink. His nephew tried to wash off the ink and then the man went to a physician near by. He was very much excited and told the doctor that he was much worried for fear of blood-poisoning, as his ink was so poisonous. He complained of pain in his left arm and was anxious to notify his accident insurance company. The physician found, on the ball of the left thumb, four small vertical scratches, though all extended only to the true skin and could scarcely have bled. These scratches were each about one cm. long, and one of them was stained with ink. The patient wanted the doctor to amputate his arm if he thought it necessary. A dressing was put upon the thumb and the man went back to his factory. Later in the day he went home and complained of the pain in the arm. Then he went to see his family physician, who scraped away the ink with a knife and used bi-chloride solution on the thumb and put on a fresh dressing. The patient felt the poison working its way up to the axilla, and told his physician also to amputate the arm if it was necessary. After this dressing was put on the patient fell in a fainting fit, with profuse perspiration, and, because of this and because he thought he felt enlarged axillary glands, this physician thought that there were perhaps symptoms of blood-poisoning, but not enough to justify amputation. The patient passed a bad night and was very much excited when his physician called the next morning with an associate. He demanded amputation of his arm, Selections. 347 was delirious, had auditory hallucinations, made arrange- ments for his own funeral, complained of headache, and tossed restlessly about in bed. At this time his pulse was seventy, soft and regular; his temperature was not taken. After the doctors left, a nurse being with him, his face and mouth twitched and he crouched in the corner. When quieted he began to tell the nurse all about his private affairs. Then the twitching of his face and his nervous- ness began anew. The patient's face was yellowish-white and the pulse was regular. At 4 P. M. Pagenstecher was called to operate, and found the patient free from delirium, but most positive that he was going to die and that his arm must be amputated. He was fearful of the pain which would be caused by the removal of the dressing on his thumb, but said nothing when it was taken off. There was no sign of irritation in the wound, nor any appearance of infection or granular enlargement. The statement about the painful areas on the arm were very contradictory. The patient appeared weak when he sat up, and the twitching of the face and mouth was striking. He also demanded amputation from Pagenstecher. An hour later his pulse was seventy-two, soft and full. Two hours later the patient was in a moribund condition, the heart's beat being scarcely audible. Death was sudden and wholly unexpected. The heart continued to beat for one and a half minutes after respiration ceased. Blood-poisoning was ruled out by the results of the necropsy, but no real cause of death was found. Pagenstecher's opinion is that the case was one of traumatic neurosis which developed into an acute psychosis. He thinks that death probably resulted from inefficiency of the heart, and doubts that it beat after respiration ceased. Two perfect examples of Dupuytren's delirium nervosum are cited in detail as illustrating less severe results of psychic insults. Pagenstecher also discusses the predisposing causes of delirium nervosum and operation-psychoses and the cause of death in this case, and cites a number of writers who have written on these subjects. This patient had a large 348 Selections. amount of accident insurance, and the insurance company presented three theories against the claim, i. e.: (first) that the patient committed suicide by curare poisoning, (second) that it was a case of tetanus, and (third) that it was a case of acute hysterical psychosis. Pagenstecher agrees with the last theory, except in regard to the term hysterical.—Bonar in Journal of Nervous and Mental Diseases. MENTAL SANITATION.—Smith (The Canadian Journal of Medicine and Surgery, December, 1900,) calls attention to the marked influence which heredity has in producing in- sanity, and charges that so much of the so-called literature of the present day conduces to an unsettled mental state. He concludes as follows: First, The public should be en- lightened with regard to the nature of insanity in order that they may properly estimate the influence of heredity as the most potent factor in the causation of disease. Second, As a preventive measure the public should be taught that as the development of the morbid disposition is most insidious and is seldom recognized until late, the con- sideration of the family and personal, history of the in- dividual should demand and receive early and careful attention. Third, There must be full recognition of the variability of individuals for bearing burdens and enduring strains. Fourth, Many cases of insanity are justly chargeable to the imposition of burdens beyond the capacity of the individual. Fifth, The prevention of insanity is not promoted by merely studying the phenomena of the disease. Sixth, Public sentiment must be enlightened before any restric- tive measures can be beneficially enforced. Seventh, If the conditions under which many cases of insanity originate were properly understood, many attacks of the disease might be avoided. Eighth, The study of child character and the careful consideration of the variability in the development of mental phenomena during the period of growth in the child are all important. Ninth, The steps necessary to secure the adoption of these and all other precautionary measures must first be taken by the family physician, who in the future must be prepared to advise, caution and restrain in Selections. 349 exercising his influence in the prevention of mental diseases. Tenth, The burden must be adjusted to the capacity of the individual in order that it can always be carried with safety when this is possible; and when it is not possible that the line of descent of every such defection shall terminate with the individual himself.—Philadelphia Medical Journal, Ab- stract. MAZOCLASM [MAZOCLASTIA].—(Arch. di Psichiat., vol. xxi, fasc. 3. Mariani, C. E. This is a reference to a recent work of De Blasio (fnciurmatori, maghi, e streghe di Benevento,) in which that author publishes, from the judicial records of the middle of last century, an accusation brought against a priest of imposing mutilation of the breasts by the introduction of pins as a penance on the women frequenting his confessional. Mariani supposes that the priest suffered from a form of sexual perversion com- pounded of sadism and fetishism, and with De Blasio suggests the name of "mazoclastia" for the condition—a somewhat superfluous addition to the technical vocabulary.— IV. C. Sullivan's Epitome Excerpt for Journal of Mental Science, January. MURDERED WIFE AND THREE CHILDREN on ac- count of the Amish religion. Under the impulse of impera- tive idea he thought his whole family would be better off dead and he killed them and attempted to kill himself. This is the history of Samuel Moser, murderer of his wife and three young sons last May at his rented farm resi- dence near Tremont, Tazewell County, 111. Moser's coun- sel plead insanity for his client. Moser confessed to the crime. Moser claims the church is in the fault. He says the church persecuted him in many ways; that it would not allow him to love his family, and he decided to.kill his wife, children and himself. NEUROSURGERY. BRAIN TUMOR OPERATION AND RECOVERY.—Dr. A. 350 Selections. W. Dunning, of St. Paul, Minn., reports the case (St. Paul Medical Journal, February, 1901,) of a sixty.-two years old physician, actively engaged in practice. In June, 1898, he became conscious at times of loss of motivity in his left leg to which his attention was first called during a G. A. R. march; he being unable to keep step. Early in July he was seized suddenly with a very severe cramp in the left foot. This recurred at intervals within the four weeks fol- lowing. By August there was involvement of the left hand and arm. He had several general convulsions. There was slight loss of power in both the arm and leg. The knee- jerk was exaggerated, especially on the left. Sensation was unimpaired. There was a slight daily rise of temperature. A diagnosis of tumor in the right upper Rolandic region was made and an operation for its removal advised. After some weeks of hesitancy the patient consented. By this time he had lost nearly all power of movement of both arm and leg. Convulsions had been frequent, both general and Jacksonian. There was great irritability of temper and con- siderable interference with mental processes in general. Dr. C. A. Wheaton operated September 3, 1898. A tumor weighing seven drachms was removed from the upper portion of the fissure of Rolando. It was so high up that it was found difficult to remove it without injury to the superior longitudal sinus. It was distinctly perpendiculate, the pedicle arising from the pia at the bottom of the fissure. Miscroscopic section revealed a large celled sarcoma. There was no return of power for three weeks. There was a slight infection of the scalp. A cranial wound delayed in healing necessitating a second operation in January follow- ing to secure closure of sinus which had formed. Three weeks after the first operation there was steady improve- ment. There were occasional convulsive seizures in the hand and arm, immediately on awakening, for some months. There were a very few general convulsions within the first eight months but for the last year and a half there have been none whatever. The power returned in the leg more rapidly and more completely than in the arm owing.at least in part, to unavoidable traumatism of the arm cortex in re- 'Selections. 351 moval of the growth. The mental symptoms disappeared entirely and for the past year the patient has been follow- ing the usual vocation in every way, performing the arduous duties of the busy country practitioner. The only evidences of disability in 1900 which Dr. Dunning could discover were a slight hitch in his gait necessitating a cane, part of the time, and some loss of the power and useful- ness of the left hand. In this case the influence of the operation per se as it has been called by J. Williams White cannot entirely be excluded since recurrence of the symptoms has occurred at even a longer interval than that here reported. CLINICAL NEUROLOGY. BABINSKI'S PHENOMENON.—Morton Prince claims (Bos- ton Medical and Surgical Journal January 24, 1901) that the frequency of the plantar (spinal) reflex, so far as it concerns the toes, has been exaggerated owing to several sources of fallacy being overlooked, namely: (First,) mis- taking the cerebral for the spinal reflex; (Second,) in stroking the sole it is not difficult by moderate pressure over the first phalanges to cause a purely mechanical flex- ion of the toe; (Third,) if the stroke is made from the toe toward the heel pulling on the skin when inelastic will do the same. Morse concludes (Paediatrics January 1, 1901,) that there is no constant plantar reflex during the first year, and that while the reflex approaches the adult reflex during the second year it is still inconstant. It is also evi- dent that since there is no constant reflex under normal conditions during the first two years no conclusions can be drawn from the presence or character of the reflex in the diagnosis of abnormal conditions of the nervous system at this age. Further observations are necessary to show at what age the normal reflex is established. It is undoubted- ly later than the second year. PAR/ESTHESIAS AND INTERNAL ORGAN AFFECTIONS. 352 Selections. —Haenel reports (Journal of the American Medical Associa- tion February 2. 1901) certain circumscribed zones of hyp- eralgesia in cases of affections of the internal organs espec- ially with gastric disturbances. They are evidently reflex and suggest an explanation for some of the nervous, rheu- matic or hysterical symptoms of which patients complain. When found they substantiate the patient's assertions and confirm the existence of an internal affection. POLIOENCEPHALITIS SUPERIOR.—At the December 1900 meeting of the Chicago Neurological Society Dr. Archibald Church reported a case of this disorder in a thirty-one-year-old cashier without hereditary taint or ven- ereal infection according to the history .# The patient for sev- eral years had used tobacco and alcohol freely (Chicago Medical Recorder, February 1901) working very hard, with short hours- of sleep but indulging in considerable outdoor athletic exercise. August 19, 1899 in a very hot sun he played golf all day without a head covering. His fore- head, face and scalp were severely burned and the hair bleached by the sun. On the second day thereafter he noticed dimness of vision in both eyes, was compelled to hold a book at a distance and there was also a double vision. Competent ophthalmologists failed to detect any trouble in the fundus. There was however a tendency to outward squint and some rigidity of the ipupils. He was given mercury by inunctions. Two weeks later he came under observation showing a slight ptosis on the lelt side, outward deviation of both eyes and the pupils rigid to light and accomodation. Headache, vomiting, dizziness and other subjective disturbances were absent. The temperature, pulse, respiration, urine and blood were normal. He show- ed a littte tendency to oversleep and during the day would drop asleep while driving. He also impressed others as be- ing a little indifferent to subjects of ordinary interest and was so as to the gravity of his condition. After twenty daily inunctions a slight amount of green disturbance ap- peared and the mercury was discontinued. On the thir- tieth day after the onset of the symptoms his speech was a Selections. 353 little muffled. There was some incoordination when walk- ing with the eyes closed. The tendon reflexes which pre- viously had been normal showed increase. There was a slight ankle-clonus on each side. During the night he had involuntary urination. On the thirty-first day the diver- gent squint subsided, apparently through paresis of the ex- ternal recti or involvement of the nuclei of the sixth nerve and the pupils commenced to dilate. Vision for distance was still normal but there was no accomodative capacity and the pupils responded to neither light nor accomodation. Static ataxia was decidedly pronounced. The temperature had a slight sub-normal tendency. There was mental hebetude. On the thirty-third day he was unable to stand, his pupils were dilated to the maximum, the eyes perfectly immobile and ptosis on both sides partially developed the temperature ran up to 100° 2. The next day double ptosis was complete and reflex excitability greatly increased so that the patient was almost tetanized as he lay apathetically in bed. Babinski's sign was noticed on both sides. The tem- perature was 101° 2 and the pulse 120. The next day all conditions were worse. There was some difficulty in swal- lowing, with coma most of the day. The following day the temperature rapidly ascended to 108" with at the same time a falling pulse and he died after twenty-four hours of absolute coma. The necropsy was absolutely negative except that there were healed foci of tuberculosis in each apex about as large as a walnut. On examination by Dr. Futterer areas of more or less well outlined softening in the corpora quadragemina, pons, peduncles, internal and exter- nal capsule principally on the right side were found. The area in the external capsule involved the claustrum in its anterior portion with an upward extension to the lower level of the cortex. The lesion in the peduncles are con- fined to their lower parts and are small while others in- volve the nuclei of the oculomotoris trochlearis and ab- ducens. Changes are decidedly inflammatory. The blood vessels thickly surrounded by masses of leucocytes appear- ing in the midst of areas of degeneration. Here and there is also well developed hyaline degeneration of the walls of 354 Selections. the blood vessels. Dr. Church called attention to the fact that a series of cases showing graduation between acute polioencephalitis and asthenic bulbar paralysis or myas- thenia gravis could be given from experience and the liter- ature. In this case the sequence of events might be con- sidered to be as follows: A tubercular lesion inducing some hyaline degeneration in the cerebral vessels, subse- quently traumatism in the shape of sunburn, the action of toxic or infectious agencies producing inflammatory changes in an area of lowered resistance and polioencephalitis with additional foci of the inflammatory disturbance. DIE URSACHE DES NEURASTHENIE.—(The Origin of Neurasthenia). L. Hoflmayr (Deutsch. Archiv. f. klin. Med., Vol. 66, December 13, 1899, p. 492.) The author is not satis- fied that neurasthenia is a form of nerve fatigue, and does not believe that severe nervous exertion produces a chronic effect in healthy persons, any more than a severe physical exertion does. He calls attention to the fact that epidemics of neurasthenia are not common after arduous campaigns, although, if the current theories are accepted, they cer- tainly should be. He therefore falls back upon the auto- intoxication theory, believing that there are two sources from which the poison may be derived; either from the respiratory tract as a result of imperfect exchange of the gases, and he instances in proof of this the readiness with which neurasthenics become fatigued in impure air; or from the gastro-intestinal tract, as the result of the formation of poisons during fermentation of the food.—Sailer in Journal of Nervous and Mental Diseases. UEBER DIE BEDEUTUNG DER ZEHENREFLEXE.—(The Significance of the Toe-Reflexes.) Martin Cohn (Neurolo- gisches Centralblatt. No. 13, 1899. p. 580.) In line with the investigations of Babinski, Cohn examined the toe- jerks of a large number of healthy individuals and also those of persons affected with nervous disease. In adults without lesion of the nervous system, the plantar reflex elicited in 66 per cent, of the cases flexion, in 20 per cent. Selections. 355 extension of the toes, while in 10 per cent, there was no movement of the toes at all. In young children the toe reflex was mostly absent, while in infants, extension chiefly resulted, which was especially marked in the big toe. In paralysis due to apoplexy, in cerebral tumor, and in amyotrophic lateral sclerosis there was extension of the toes. In spastic paraplegia the reflexes varied. Menin- gitis gave an active arching reflex, while tabes and poly- neuritis showed no toe-reflexes whatever. In a case of paralysis of one leg there was a reflex of extension of the toes on the affected side, whereas on the sound side the reflex was one of flexion. Cohn therefore concludes that a reflex of extension of the toes cannot be said to be of ab- solute pathognomonic significance.—Jelliffe in Journal of Nervous and Mental Diseases. RELATION BETWEEN THE OCCURRENCE OF APPEN- DICITIS AND THE PRESENCE OF A NEURASTHENIC TEN- DENCY.—Schaumann (Deutsche Medicinische Wochenschrift) refers to this. He has frequently observed appendicitis in general members of neurotic families, and in a number of instances has seen appendicitis appear without any very apparent reason after severe neurasthenia had existed for some time. The fact that appendicitis is not infrequently combined with mucomembranous enterocolitis in his belief shows also some relation between appendicitis and neurosis; likewise neurasthenia is frequently combined with ptosis of one or more of the abdominal organs, and it may readily be believed that alteration in the position of the abdominal organs may lead to appendicitis and that the apex itself may be out of position and thus be more subject to inflam- mation; it is well known that in appendicitis the appendix is not infrequently found in peculiar positions. Also, certain authors have expressed their belief that chronic appendicitis is a very frequent result of movable right kidney. Schau- mann does not insist that he has proved a direct relation- ship between neurosis and appendicitis, but he does believe that appendicitis may in some instances be the result of 356 Selections. general neurosis, usually indirectly.—D. L. E., Philadelphia Medical Journal. HEREDITARY EPILEPSY OF FIFTY YEARS DURATION CURED BY AN ATTACK OF HEMIPLEGIA.—Brunet relates the following case in the Archives de Neurol, 1900, (LX), March, p. 224: Patient a female, born in 1812. Entered Charite as insane in 1857; father was an epileptic in the same asylum. First convulsion occurred when seven years of age and after scarlatina. In the observation period she had convulsions every week or fortnight, followed by de- lirium. In 1857 she suffered an incomplete left hemiplegia. During the next three years her convulsions gradually diminished, and from 1860 to 1877 she had no attacks; in 1877 she died of apoplexy. In 1871-1872 she was very carefully watched by both day and night for the seizures. Her mental state improved at this time, dating from cessa- tion of attacks.—Journal of Nervous and Mental Disease. GASTROPTOSIS AND NEURASTHENIA.—Dr. R. G. Lockwood, of New York, after an analysis of forty-five cases, arrives (Medical Record, December 1, 1900) at the following conclusions: (First) In the majority of cases an adequate cause is not discoverable. (Second) Gastroptosis does not of itself, in an uncomplicated form, produce symp- toms. (Third) The displacement of the stomach, however, is a predisposing cause of a variety of gastric neuroses, of sensation, motion and secretion. (Fourth) These neuroses are usually induced by some definite mental or physical strain. (Fifth) The displacement of the stomach is a strong exciting cause for muscular atony; that atony is the most common cause for the symptoms presented. (Sixth) A complicating atony is associated with a more or less pro- found neurasthenia, and direct relation exists between these two conditions. (Seventh) Gastric acidity is increased in direct proportion to the atony, unless counteracted by gastritis. (Eighth) Mild degrees of gastritis are apt to occur in stomachs that are displaced, but the symptoms are neither severe nor persistent. (Ninth) Gastritis occurring X Selections. 357 in atonic and displaced stomachs, reduces the excessive acidity of these cases and seems to modify the severity of the symptoms. (Tenth) Atonic dilatation without mechanical hindrance is exceedingly rare. (Eleventh) Dilatation or, better, muscular inefficiency may occur in gastroptosis from duodenal kinking, from arterio-mesenteric constriction or from pyloric spasm. (Twelfth) Pyloric spasm is common in displaced atonic stomachs with hyperacidity, and may lead to a temporary dilatation. (Thirteenth) In a large number of cases inattention to the conditions of atony, of neuroses and of gastric secretions has led to an unsuitable, insufficient diet, which reacts both on general nutrition and on local conditions within the stomach. (Fourteenth) Sur- gical intervention is applicable only to cases in which dilatation exists. LOST PERSONAL IDENTITY.—The Boston Medical and Surgical Journal, October 11, 1900, describes a case of this kind at the White Plains Hospital, Westchester county, New York, caused by a stroke of.lightning which was ex- amined by H. E. Schmidt; the entire left side was para- lyzed after an electric storm. Knowledge of his identity was lost. On the night of the accident his muscles twitched. On the following day, if touched, he after some delay put his hand to that part of the body touched, if stroked he would stroke that part and if slapped, would slap him- self. If roused and questioned sharply, he would reply, "I—1—I." After three months he improved in strength, the paralysis disappeared, and the muscular system was built up by calisthenics. He is not reported as having re- covered his self identity. NEUROTHERAPY. UNTOWARD AND FATAL SUB-ARACHNOID ANESTHE- SIA.—The Railway Surgeon writes and translates as follows: In view of the great interest aroused by Bier and Tuffier by their use of cocaine for producing intra-spinal anesthesia, 358 Selections. the report of a case ending fatally is important. Goilav of Bucharest, Roumania, had this experience, which he nar- rates in a recent publication. (Bull, et Mem. Soc. de Chirurg. de Bucarest, 1900, p. 119.) The author had two old men under observation suffer- ing from senile obliterating arteries, evinced by loss of arterial pulsations, livid skin and violent itching, so that the patients got no rest either by day or night. There was no albuminuria. As neither hot baths, iodide of potash, eleva- tion of the limbs nor injections of morphine had any effect on the pain, Goilav injected 1 per cent solution of cocaine between the fourth and fifth lumber vertebra. Anesthesia ensued in twelve minutes and lasted twenty-four hours. As a result of the injection the patient had headache, nausea, vomiting, intense chills; the pulse and temperature were also elevated. These symptoms lasted for nearly three days, during which time caffeine and ether were re- peatedly injected. In the second case amputation of the leg was decided on, and \% centigrams of a 1 per cent solution of cocaine were injected again between the same vertebras. Anesthe- sia followed in fifteen minutes and was perfect. The operation lasted for forty minutes and the patient was then put to bed, surrounded by hot water bottles, etc. In two hours intense chills came on, the temperature and pulse rose, and in spite of all remedial measures, the patient succumbed twenty hours after the operation. The author remarks that while he has had but these two cases, his results, can not be said to be very brilliant, for in one the symptoms of intoxication showed danger was imminent and in the other death ensued. He believes that the intra-spinal injection of cocaine is contra indicated in cases of old obliterating arteritis, and that chloroform or ether are not relatively more dangerous than cocaine. ELECTRICITY IN RESPIRATORY AND CARDIAC FAIL- URE.—(Dr. A. D. Rockwell, New York Medical Record.) Direct electrization calls into activity the physiological func- tions of the pneumogastric. Selections. 359 Percutaneous applications in therapeutic doses, especially with the faradic current, readily affect the respiration through the phrenic nerve. In respiratory failure, whether due to the poison of opium, aconite, or in apparent death from drowning, elec- trization is a powerful antidote. In heart failure, from chloroform narcosis, also, the faradic current is a legitimate method of resuscitation, by keeping up the respiration without depressing the heart. THE SLEEP REMEDY IN DISEASE.—Sleep has two offices, both fulfilled in the long sleep of night, which it is our usual endeavor to secure for our patients: namely, that of favoring the slow changes of repair, and that of in- terrupting consciousness by uncoupling the chain of neurons, or by relaxing protoplasmic tension or tone. This relief of tension is, it would seem, the only office performed by the shorter spells of sleep, and therefore the two forms of sleep suggest two therapeutic objects. The night's sleep which comes without any drugs may need to be bettered, and in improving the quality of spontaneous sleep our help is often of value. It might also need to be prolonged. The systematic prolongation of sleep for the cure of disease is one of our opportunities hitherto little used. In chorea, sleep entirely subdues the muscular agitation, and this observation has led to the attempt to arrest the disease by prolonging sleep for considerable periods. A complication arises in connection with alimentation which in this disease, as in most other nervous troubles, is of primary importance. Partly for this reason, and because more than rest may be needed for a cure, the results hither- to reported have not sufficiently recommended the method. Prolonged narcosis has also been suggested in excessive wear and tear of the nervous system; and in various nervous affections, including the mental, its renewed trial, combined with suitable methods in feeding, might lead to encouraging results. , Best suited, perhaps, to our everyday needs is a system- atic resort to the shorter sleep. Like the light installments 360 Selections. of food which restore the lost function of appetite and digestion, short sleep in the day may be essential to the cure of nocturnal insomnia. Our growing wealth in hypnotics warrants a hope that a suitable agent may yet be found which in that direction would minister to the health of the invalid, and might command the luxury of sleep at any opportune time for the convenience of the worker. Body rest as a systematic therapeutic agent has long found its place in our treatment for patients whom weak- ness alone, in the absense of medical advice, would not have compelled to take to their bed. To that class be- long the frail women in whom the debility of amemia, of dyspepsia, and of over-fatigue develop symptoms often mistaken for hysteria. Rest in bed is their first need. In the treatment of chlorosis this is now recognized as the essential element for a rapid recovery. Its methodical em- ployment forms a part of the Weir-Mitchell plan. But its most striking instance is that of the open-air rest cure for phthisis, which within quite recent years has largely re- placed at foreign sanitaria the previous method by muscular exercise.—Disease and its Treatment, by Wm. Evart, an address before the Harveian Society of London. TONGUE TRACTION FOR HICCOUGH.—Noir (Johns Hopkins Bulletin) after referring to obstinate galvanization of the phrenic nerve, faradism to the epigastrium, compres- sion of phrenic tractile elevation of the hyoid and tongue traction prefers the latter for its simplicity and efficiency and record convincing confirmatory results. THE LAXATIVE ANTIKAMNIA AND QUININE TABLET is a tonic-laxative, analgesic and antipyretic combination of merit containing: The value of this combination is apparent in many nervous conditions. Cascarin Aloin Ext. Belladonna Podophyllin Quin. Bisulph Antikamnia gr. }i gr. 1-32 gr. 1-32 gr. 1-32 gr. 1H gr. 3 Selections. 361 SOUKHANOFF.—(Archiv. de Neurol. April 1900, trans- lated and abstracted for Journal Mental Science January) has observed marked swellings on the cortical dendrons in the following pathological conditions: First—Poisoning by arsenic, alcohol, sulphonal, etc. Second—Urasmia, cachexia strumipriva, etc. Third—Ligation of the carotids and experimental em- bolism of the cerebral arteries (Monti's experiments.) The drug which Soukhanoff found to produce this moniliform appearance most rapidly was trional (one and a half to two and a half days.) CONTRA INDICATIONS OF IOD1N AND SULPHO-CY- ANIDE.—Under the caption of "Iodism and Sulphocyanide in the Saliva" the Edinburgh Medical Journal abridges from Munk an interesting communication(A/«ncA««. Med. Wochn- schr., 1900, No. 50) on this subject. While systematically testing saliva for sulphocyanides, he was struck by the fact that patients who showed a large amount in their saliva, almost without exception suffered from severe iodism if po- tassium iodide was administered to them; while patients who gave no sulphocyanide reaction bore iodides well. If the saliva gave a deep brownish read colour with a solu- tion of ferric perchloride slightly acidulated with HCI., it is rich in sulphocyanides; but the contrary, if, on adding the reagent, the colour is no deeper than that got on adding it to an equal amount of water. Iodism may be due to the fact that sulphocyanide in solution is able to form free iodine from potassium iodide. It is to be noted that iodism effects only those mucous membranes which secrete sulpho- cyanide, while the intestinal and genito-urinary membranes never seem to be effected. Munk thinks that the presence of a strong reaction in the saliva might contra-indicate iodides being administered in cases where iodism might prove dangerous. He instances a case of paralysis of the abductors where iodism might have seriously impeded the breathing. BROMIDES IN EPILEPSY—Dr. L. Pierce Clark con- 362 Selections. eludes (Buffalo Medical Journal, February, 1901) that: Bromides still hold an important place in therapy in epilepsy. Tonics must be given constantly during their administration. Bromide salts should be given gradually to find the epileptic's sedative level. Baths, high enemata, alimentary antiseptics, massage and electricity are absolutely essential to successful bromide medication. Bromine is a worthy successor to the bromides in many cases. Salt starvation or semi-salt starvation is a great adjuvant to the the bromide treatment. UNTOWARD EFFECTS OF SODIUM CACODYLATE— According to Dr. W. Murrell (Lancet, January 26, 1901), French statements to the contrary notwithstanding, it pro- duces all the untoward effects of arsenic in a marked and decided manner. THE TREATMENT OF SYPHILIS.—A new and tolerable form of administering mercury, with report of sixty-five cases treated at Bellevue Hospital. By Winfield Ayers, M. D., New York City, instructor of genito-urinary sur- gery at the New York Post-Graduate Hospital, and attend- ing genito-urinary surgeon at Bellevue Hospital, Out-door Patient's Department. (Abstracted from the author's orig- inal paper in the Philadelphia Medical Journal, November 10, 1900. The writer states that when his attention was called to mercurol as an antiseptic of special value in the treat- ment of gonorrhoea, it occurred to him that it would be a first-class preparation for the treatment of syphilis. Some time was necessarily spent in determining the proper dosage. At first one-eighth of a grain was given three times daily, and this dose was gradually increased until it was found that three grains was the average quantity re- quired to control the malady. The highest amount given was seven grains and the lowest amount that exerted a controlling influence upon the disease was one-half grain. In starting a patient on a course of mercurol the author advises beginning with half-grain or grain doses. Salivation Selections. 363 has been produced by two grains, and yet as much as six grains has been taken with no disagreeable symptoms. The objections to the use of unguentum hydrargyri as a remedy in secondary syphilis are referred to; and while the popularity of mercuric protiodide is conceded, the irreg- ularity of its action and its tendency to cause gastric and intestinal disturbances are not everlooked. In the writer's experience thirty-three per cent of his cases were not benefited by this drug. Mercurol is a nucleid of mercury, and was discovered by Karl Schwickerath, of Bonn, Germany. Kopp, director of the Royal Polyclinic for genito-urinary diseases at the University of Munich, uses mercurol in smaller doses, which leads the writer to remark: "He will find, as 1 have done, that it is desirable to use a much larger dosage." Mercurol should not be given in solution with potassium iodide. In all, sixty-five cases received mercurol at the Bellevue clinic, sixty of which had not had previous treatment. Of these, thirteen did not return after the first or second visit; fourteen did not remain long enough under treatment to give the preparation a fair trial; and thirteen may be de- scribed as new patients. Deducting these forty cases, there remain twenty-five cases that have been sufficiently long and regular in their attendance to supply data from which definite conclusions may be deducted. The detailed histories of these twenty-five cases are included in the paper. In summarizing the author remarks that while two months' treatment of syphilis is insufficient to determine absolutely the value of any remedy, the marked improve- ment shown by many of his cases makes it certain that mercurol is of great value. Its superiority to mercuric chloride in controlling the symptoms of syphilis is proved. Like all internal remedies it has very little effect upon the internal lesion; still it has hastened the healing slightly. None of the cases required treatment with potassium iodide to control secondary manifestations. To recapitulate: First, Mercurol causes less disturbance of the gastro-intestinal tract than any other preparation of mercury used internally. Second, It controls skin eruptions 364 Selections. and pains much better than any other preparation, while it controls mucous eruptions as well as any other, and has equally as good an effect upon the chancre. Third, It is an advantage that it can be taken in pill form. A FATAL DOSE OF MORPHINE AND ATROPINE PROVES INNOCUOUS.—Reported by Goodrich, in the Philadelphia Medical Journal of November. A middle-aged man at- tempted to end his life. He had suffered from financial and social reverses and insomnia. He had taken morphine and atropine for his troubles but not habitually. At the crisis of his depression he dissolved eighty-one tablets, each containing % grain of morphine and ih, grain of atropine sulphate, in a glass of water, and drank the whole quantity. He slept forty-eight hours and with a feel- ing of soreness and pain when attempting to move. The aggregate amount taken was twenty grains of morphine and nearly one-half grain of atropine. Recovery is attri- buted to the antagonistic properties of atropine and mor- phia but probably tardy absorption was also an important factor. NEUROPHYSIOLOGY. GAINS OF THE CENTURY IN NEUROLOGY. — Dr. Eugene G. Carpenter, Superintendent State Hospital for the Insane, Columbus, Ohio, gives the following interesting resume in the Columbus Medical Journal: It was not until the beginning of the present century that real advancement in nervous anatomy began. About this time Reil pointed out the arrangement of the corona radiata and the relation of the brain fibres to the Island convolution which bears his name. In 1819 Burdach published "The Structure and Life of the Brain", which was a compendium of all the knowledge on the anatomy of the subject at that time. Until 1842 the best methods known for investigation were those of dissection of hardened specimens and the Selections. 365 process of teasing out the fibres by the aid of forceps. It was in 1842 on the twenty-fifth of January, that Shilling first froze pieces of spinal cord and with a scalpel made cross sections of them. In his own words he says: "When 1 placed these under the microscope and with a power of fifteen diameters saw the beautiful transverse striations, I found a key which would reveal the wonderful structure of the spinal cord. Not more joyfully did Archimedes cry out 'Eureka!' than 1 at the first sight of these fibres." It was his brilliant discovery which suggested to Schill- ing the making of serial sections with the common razor, and without further preparation examining them with the microscope. All that Schilling discovered was found by this simple means. This has been called the comparative method of serial cross sections. Since Schilling's time much has been added to this method of investigation to en- hance its usefulness. Hanover and Eckhardt made the important discovery of the use of chromic salts for hardening, which has not yet been displaced by any other process, although of late a five per cent solution of formalin has been extensively used for microscopical examinations. The virtue of the most staining agents is dependent upon the specimens being saturated with chromic salt during the process of hardening. Upon this especially depends the use of haematoxylin as a stain, introduced by Weigert, of Frankfort, which yet holds a -high place among the myriad of other stains now employed. By the Weigert Haematoxy- lin method the medullary sheaths of the nerve fibres are stained a deep blue-black color, which outlines the nerve fibre districts distinctly from the gray matter, and also the line is clearly drawn between normal and degenerated tissue, which it but palely stains. For this reason is the Weigert especially adapted to any degenerated changes which we may suspect to exist in the cerebro-spinal axis. Pahl's modification of Weigert is another haematoxylin stain giving a bright blue color to the tissues, and besides being a good substitute for the Weigert is especially adapted for the staining of normal nerve tissue, which it 366 Selections. not only sharply defines, but brings into better relief those fibres penetrating the gray substance and ganglionic centers of the cord and brain. In this latter respect it is a method of inestimable value. Marchi's method, based on a stain of osmic acid one part and Miller's fluid two parts,colors the medullary sheaths of degenerated regions a distinct black, leaving the con- tiguous regions a pale gray. Two methods of special importance have sprung into prominence within the last decade. 1 refer to those of Golgi, of Turin, and Ramon y. Cajal, of Madrid. Both are based on a deposit of silver salts in the cells and on the processes, and for this reason specimens thus pre • pared give us the best photographic view of the relation of cells and fibres, and their intricate connections with each other. The anatomists, Golgi and Ramon y. Cajal, each by his individual method pushing his researches in the van of all other investigators, have done more than all others toward unraveling the intricacies of the anatomy of the brain and cord, and, in fact, seem to promise us a solution of the entire subject. The methyline blue method first published by NissI in 1880, is the best for the individual study of ganglion cells. It is a delicate process requiring great pains and skill. With carefully prepared specimens under a lens of about 500 diameters, the anatomy of the cell, including the nucleus, nucleolus and the processes can be studied better than by any other method. Almost all we have learned of the ganglion cell has been through this method or modifications of it. While the serial section method, aided by staining processes, has done much and promises much more, as yet it has not proved itself sufficient. By it the course of the nerve fibres can be traced with certainty only so long as they remain in the plane of the section. It fails us when the fibres become interrupted by ganglion cells, enter a plexus of fibres, or split into innumerable Selections. 367 fibres to be scattered in all directions.when the end sought for must be attained by some other means. In 1852 Walter discovered that when a nerve center or nerve path was injured, degeneration took place along the line of its physiological function — ascending degeneration occurring in case of an injury to a motor path. The dis- covery of this principle has suggested to anatomists a num- ber of methods of investigation. First. The pathological anatomy method, where the material for histological examination contains an organic lesion, the result of an apoplexy, hemorrhage or injury whereby the conductivity of nerve energy has been in- terrupted. Through this method much that is known of the course of the fibres in the cord and brain has been obtained. Second. The method by faulty development. This consists in the histological investigations of the nerve paths and centers of the new-born, in which some organ or member of the body has not developed in utero as fol- lowed by Edinger. Third. The artificial production of faulty development in the animal, as originated by Scieffendecker and Singer, and pursued by Gudden in 1870. Fourth. The embrylogical method represented by Flezig of Leipzig, and Edinger of Frankfort, is based on the fact that the fibres take on their medullary sheaths during different stages of development of animal life. What we know of the human embryology of this subject has been contributed chiefly by Kolliker and His. Fifth. Some efforts have been made to establish a method by the injection of different coloring agents into living animals with the hope that special agents might be found which would elect special regions, and then on post- mortems the course and limitations of the various nerve tracts would be indicated by the different colors. Thus far this line of experiments has not met with any marked success. Sixth. The physiological, or vivisection, method has added much valuable knowledge in experimental research, and as now pursued is destined to yield rich results. 368 Selections. Though the desired end has not as yet been attained by our present system of investigation, it may be safely prophesied that through these methods and the employment of the more perfect of the future the greatest problems of anatomists to-day will have been solved. The great battle-ground at present is the ganglion cell and its connections. A thousand microscopic barrels all over the world are pointed toward it. The methods of Nissl and Golchi have given us the dendrites, neuraxion, and axis-cylinder. Waldeyer has elucidated some mooted questions by propounding the neuron theory, which seems to be an anatomical fixture. In our own country a debate is taking place over the retraction theory of the dendrites. On the one hand Dercum and Van Geisen favor the theory that the dendrites possess power of movement; that they extend, making contact with other dendrites, while Stewart Paton of Johns Hopkins and others refer to the experiments of Apathy in which it is found that in certain lower animals the axis-cylinders do not end in the ganglion cell, but pass on through, all making exit by some other dendrite to join another neighboring cell. This is one of the questions to be settled in this country. ARE ALL NERVE-CELLS IN DIRECT CONNECTION WITH BLOOD VESSELS?— [Stehen alle Ganglien^ellen mit den Blutgefassen in directer VerbindungY\ (Neur. Cbl., Jan- uary 1901.) Adamkiewicz. From theoretical considerations, the author of this paper came to the conclusion that such im- portant structures as nerve-cells must be incapable of ob- taining sufficient nutriment in the same simple way as other tissues, and that there must be a more intimate relation- ship with the blood-vessels in the case of nerve-cells than in other tissues. He then describes what he claims to be the fine anat- omy of the blood-vessels of the large intervertebral ganglia of the brachial plexus. The ordinary arterial capillaries give off finer capillaries—vasa serosa,—which are so fine as to transmit only the fluid constituents of the blood and none Selections. 369 of the corpuscules. Each of these vessels makes its way to a nerve-cell, spreads out and envelops the cell like a glove, then narrows down to its original size again, and finally opens into another arterial capillary. Whatever may have been the method by which these structures have been demonstrated in the intervertebral ganglia, it appears to have been inadequate to demonstrate them in the central nervous system. In support of the view that the nerve-cells in the cor- tex cerebri are similarly situated with regard to the blood- stream, Adamkiewicz adduces two observations, one physiolo- gical and one anatomical. He points out that the exposed cortex is perfectly tolerant of a forcible stream of distilled water injected into the carotid will immediately produce nystagmus, extensor spasm all over the body, and distur- bance of the pulse and respiration. His anatomical argu- ment is that the vascular network in the cortex, as dem- onstrated by injection of carmine gelatine, is much closer in those parts of the cortex which are rich in ganglia than elsewhere. The author concludes as follows:—All articles which en- ter the brain and spinal cord of man and of animals, at least of the higher animals, end on the further side of the capillaries in a very fine plasma vessels, which contain ganglion cells in diverticular expansions.—IV. H. B. Stod- dart, Journal Mental Science January. HISTOLOGICAL EXAMINATION OF A SPINAL CORD AFFECTED BY SYRINGOMYELIA AND MULTIPLE HETERO- TOPIA— [Ricerca istologica d' un midollo spinalo affeclo da sitingomielia ed eterotopie multiple.'} (Ann. di Nervol., fasc. i, ii, 1899.) Lombardi, G. The patient, aged sixty, general paralysis. Fibrillary tremors of tongue and face mucles, and oscillatory movements of the fingers. Pupils myotic, unequal, fixed. The plantar and patellar reflexes normal, cremasteric and abdominal increased. The sensory phenomena not tested owing to mental condition. The hands and feet showed trophic changes. The nails atro- phied; skin greyish white; phalanges wasted. Retroflexion 370 Selections. of distal phalanges and flexion of the second upon the first. Post-mortem examination showed hypostatic pneumonia and heart failure. Hyperostosis of the cranial bones; atrophy of the brain, increase of the subarachnoid and intra-ven- tricular fluid. Spinal cord showed thickening of the pia mater throughout its whole length and arterio-sclerosis. Occlusion of the central canal and diffuse sclerosis of pos- terion columns. In cervical and lumbar regions were syr- ingomyelic cavities of new formation. These contained vessels which markedly dilated perivascular spaces, and an amorphous substance which was to a certain extent dis- integrated nervous matter. These were situated in the grey matter surrounding the central canal. There was also displacement of the posterior cornua and of the anterior commissure, and asymmetry of the an- terior columns. These anomalies of conformation support the embryonic origin of the syringomyelia.—Abstracted epitome of J. R. Gilmour, Journal of Mental Science Jan- uary. THE PSYCHOLOGY OF ALCOHOL— (American Journ. Psych., Vov. xi, No. 3, April 1900.) Partridge, G. E. This is a study not merely of the effects of alcohol, whether as manifested in inebriety or when taken for experimental purposes, but of the intoxication impulse generally. The author believes there is a danger of regarding natural phe- nomena too readily as abnormal. He considers that the methods used by many who have been inspired by Lom- broso illustrate this, and remarks that the conclusion of Nordau that all society is pathological is the logical result of an indiscriminate search for abnormalities. Thus we must beware of too hastily regarding the intoxication im- pulse as abnormal. It has played a part of the first im- portance both among uncivilised and civilised peoples. "In- deed, it is hard to imagine what the religious or social consciousness of primitive man would have been without them [intoxicants]." The first part of the paper is devot- ed to an account of the part played by this impulse in the religious and social life of early civilisation. This is follow- Selections. 371 • ed by an analysis of the state of intoxication, accounts of experiments with intoxicating doses of alcohol, and observa- tions on a series of inebriates. The author's experiments show that in intoxication, unless well advanced, the rapidi- ty of simple mental processes is not decreased. The rapid- ity of tapping was most affected. Ability to control a re- flex wink was greatly increased. There is increased activ- ity of the associations, emotions and sensations which make up the self. The increase of self-confidence and the diminution of suspicion are important points in their social bearing. "The intimate relation of intoxication to the so- cial impulse undoubtedly accounts—in part at least—for the wide-spread and persistent use of intoxicants. Doubtless is made possible wider social relations than could otherwise have been maintained. Partridge does not find that the craving for drink is common among drunkards except when there is a decided neurotic taint. In fifty-eight out of the sixty-five cases he studied, there was no evidence of any conscious craving after the first few days. There was a much more marked craving for tobacco. Partridge is decidedly opposed to Arch- dall Reid's views concerning the existence of any specific craving for alcohol eliminated by selection, and regards these views as built up on a false analogy with zymotic diseases. After summarizing the previous work of Kraepelin and others, Partridge finally gives the results of his own ex- periments on two subjects as regards the effect of alcohol in small doses on ability to do muscular and mental work. In one subject muscular work (as measured by the ergog- raph) was decidedly decreased; in the other subject there was no alteration in the work-curve—i. e. there was an increase in the first half hour, and then a progressive de- crease. In the psycho-physical tests there was like effect. In addition there was a slight quickening, lasting nearly to end of second hour; in reading and writing a period of quickening followed by retardation. The depressing effect of the alcohol could never be traced on the following day. These results do not altogether confirm Kraepelin's.—Have- lock Ellis' epitome, Journal Menial Science. 372 Selections. NEUROPATHOLOGY. ON VARICOSITY OF THE CORTICAL DENDRONS.— [Sur I' Stat variqueux des dendrites corticales.] (Arch. de Neur., April 1900.) Soukhanoff. Perhaps the most strik- ing characteristic of the protoplasmic processes of the nerve-cell is the presence of the g«mmules. A further characteristic, which is the least marked in a healthy adult brain, is the presence of varicosities of these processes. Now between these two elements there is a rough inverse relationship; the larger the number of varicosities on any given dendron, the smaller will be the number of gem- mules, and vice versa. There are indeed some few cortical neurons, the dendrons of which have a markedly beaded aspect and are entirely devoid of gemmules, and it is prob- able that these neurons form quite a distinct class of ele- ments in the nervous system. The beaded appearance of the dendrons is most mark- ed in the brains of new-born animals, in the brain of ani- mals which have undergone degeneration in consequence of experimental interference, and in the brains of the insane. Among new-born animals this varicose condition is seen at its best in those which at birth are unable to walk (mouse, kitten, jackdaw, etc.,) while it is ill-marked in those animals which are able to walk or even run instantly after birth (guinea-pig, chick etc.). The assertion is, then, that marked varicosity of the dendrons is found in the brains of ill-developed new-born animals and in brains which have undergone degeneration. From these data the author concludes that varicose or mon- iliform atrophy is to be looked upon as an expression of the dissolution of the nervous system, the neuron having returned to a condition similar to that of one of its stages of evolution. Varicosity of the dendrons is, as a rule, a recoverable condition. The lesion of the cell body is only to be re- garded as grave when the varicose state involves a large number of the dendrons and approaches closely to the cell Selections. 373 body itself.—Abstracted by W. H. B. Stoddart, Journal Mental Science, January. COARSE AUTOPSIES AT NEW HAMPSHIRE ASYLUM FOR THE INSANE.—Of ten autopsies performed at this in- stitution there were two cases of sudden death from rup- ture of the wall of the left ventricle. In one case this was due to fatty degeneration following calcareous degeneration and occlusion of the left coronary artery. In the other case the coronary arteries were atheromatous and the wall of the ventricle in the neighborhood of the rupture was in- filtrated with leucocytes and was the seat of numerous minute abscesses. The patient, a chronic maniac, who appeared to be in good physical health, suddenly dropped dead while making a violent demonstration toward another patient. Another case of interest was one of sarcoma of the small spindle cell variety involving the right frontal lobe of the brain. The tumor was firmly adherent to the dura mater and replaced the anterior two thirds of the frontal lobe, compressed the remainder, and indented and com- pressed the left frontal lobe. Several specimens have been sent to Dr. W. L. Wor- cester, pathologist at Danvers Lunatic Hospital, Massachu- setts, for microscopical examination.—Reported by Frederick L. Hills. THE Alienist and Neurologist. VOL. XX11. ST. LOUIS, APRIL, 1901. No. 2. 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, .1857 Olive Street. Business Office. 3857 Olive Street Subscribers falllng 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.] INSANE JUDGES AND INSANE JURORS.—The recent agitation anent the pardon of Mrs. Maybrick has called at- tention to the fact that Judge Stephens, who presided at the trial, was insane. Insane judges and insane jurors invariably lean against the axiom of the common law that everybody is innocent until proven guilty beyond a reason- able doubt, which also requires that every fact that can be reasonably explained on the theory of innocence must be so explained. This is the foundation of all law and all constitutional principles in the English-speaking countries. The Roman law, however, starts from an opposite theory, that of the right of the government, not the right of the individual freeman, whence it was that judicial torture, the disgrace of the Roman law, was never part of the English common law. Insane jurors and insane judges, however, always lean to the suspicional theories of primitive man and the Roman law and against the plea of innocence, [374] Editorial. 375 particularly when this involves the element of insanity. Two of the jurors who convicted Guiteau were subsequently proven insane and became inmates of an insane hospital. One of the jurors who convicted Pendergast showed him- self to be a demonstrable paranoiac and later committed suicide .under persecutory delusions. A New York Recorder (noted for the illegal severity of his sentences in cases where insanity was a plea) was demonstrably insane for several years before being retired from the bench. Many of the English "hanging judges" in addition to evidences of morbid mentality have showed evidences of sexual per- vert habits. Insanity often brings to the surface the suspicional tendencies of primitive man to whom no death was natural but was due in one stage of culture to witch- craft or in_ a higher to murder by poison or otherwise. K. ALLEGED INCREASE OF INSANITY IN THE BRITISH ISLES.—The claim has been repeatedly made that insanity is increasing in the British Isles from intrinsic causes dis- proportionately to the increase of population. In 1899 Eng- land, (Journal of Mental Science, January, 1901) whose population is estimated to increase 1.17 per cent per annum added only 1.45 per cent to its total insane population and while its first admissions are greater by 1.53 per cent its total admissions are less by 0.13 per cent. In Scotland the record is more favorable still, for while its estimated annual increase of population is 0.76 per cent its total lunatics are increased by only 0.17 per cent and there is a decrease in the total admissions and of first admissions equivalent to 2.33 per cent and 0.56 per cent re- spectively. In Ireland, with a population that is estimated to be diminishing at a rate of 0.28 per cent per annum, the record for 1900 shows an increase in the total number of the insane of 2.75 per cent in the total admissions of 2.16 per cent and in the first admissions of 6.07 per cent. The increase in Ireland and to no small degree the increase in Scotland and England is due to the rigidity with which the American emigration laws are enforced. A great increase has been noted in all the countries which formerly shipped 376 Editorial. their insane population into the United States without hindrance. There is a growing tendency in consequence of these laws to leave the insane hitherto cared for at home to the care of the county authorities. This factor while not really increasing insanity in a given district has forced increased provision for it. As the urban population of all countries increasing, of necessity a seeming increase in insanity must occur, since in the first place an urban atmosphere is more irritating to the insane who have been permitted to be at large and in the second urban popula- tions are less tolerant of annoyances by the insane. G. WOMEN SEXUAL INVERT MARRIAGES.—The American Journal of Insanity reviewing Finck's Primitive Love and Love Stories, remarks: "Were kissing all the joys in bed, One woman would another wed." Sexual invert marriages however, with women as has been shown lately by the case of Murray H. Hall the Tam- many official who died from cancer of the breast.far are more frequent than is usually expected. Hall was an employ- ment agent for thirty years, a Tammany Hall precinct captain, a professional bondsman and frequenter of saloons and disreputable resorts. "He" had dressed in male attire for thirty years, had married a "wife" (who died three years ago) and had adopted a daughter who never suspected "his" real sex. "He" was especially partial in literature to sentimental stories like those of Bertha M. Clay and Laura Jean Libby. "He" was not suspected as to sex by anyone since his manners were those of a coarse man. "He" had neither the voice nor the walk of a man. In the case re- ported by Dr. P. M. Wise nearly two decades ago (ALIENIST AND NEUROLOGIST 1883) two women formed a similiar relationship. The mother of one had a neurotic ancestry, but was brought up in refinement. She fell in love with a farmer and married him against her parents' wishes. The match proved unfortunate. He was prudent, did not give his wife the comforts of life to which she had been accus- Editorial. 377 tomed. She finally became demonstrably insane, deserted her home and was found one morning behind a pile of wood clasping to her bosom a new-born babe. The child was taken care of by friends until the mother died, and grew up a beautiful girl, but when about seventeen years old ex- hibited an errabund tendency. She displayed a great liking for boyish games and attire, but a repugnance to suitors. She was persuaded into a marriage with a man to whom she became so repugnant that he deserted her, whereupon she sought refuge in a Pennsylvania almshouse, where she met the second case who came under Dr. Wise's immediate observation. This last woman had an insane ancestry on the maternal side. She preferred muscular sports and labor. She was averse to the attentions of young men and pre- ferred the society of her own sex. She was forced into a marriage with a man to whom she bore a female child, but who deserted her, relations with her husband being distaste- ful. On being abandoned by her husband she went West, assumed a masculine attire, became a hunter, and spent several years among the Indians. On her return she pub- lished a very quaint description of her hunting life. Be- coming reduced in circumstances she sought refuge in the almshouse with the first patient, who became strongly attached to her. The attachment proving mutual the two took up their abode in the woods as husband and wife. The second patient assumed the name of "Joe," and pro- vided for the two by hunting and trapping. In 1876 the two returned, the wife introducing her "husband" to her uncle. She was kindly received, and her husband was hired to work about the place. One day "Joe" was found to be a woman in disguise, whereupon the uncle was so indignant that he caused "Joe's" arrest. She was imprisoned for four months, during which time the "wife" visited her and carried delicacies to her. At length the neighbors prevailed upon the uncle to have the young woman released. When she came out of prison she lived with her "wife" again. At that time the estate of the "wife's" mother was settled, and real estate valued at several thousand dollars became hers. This property she has not claimed, but still leads 378 Editorial. her old curious life. Her "husband" died in the Willard Hospital for the Insane. She is about forty-six years old, while her "husband" was a few years her senior. The "husband" was admitted to the Willard Hospital for the Insane in consequence of a maniacal attack. After admis- sion "Joe" tried to have sexual intercourse with her associate. "Joe" said that with her husband she had never had anything but repugnant sexual relations, but with her "wife" sexual satisfaction was complete. She had an enlarged clitoris, covered with a large relaxed prepuce. She had periodical attacks of sexual furor. In a case reported by Kieman (Chicago Medical Re- cord, 1892) divorce was granted a husband of a sexual in- vert on the ground of inversion. The woman immediately formed a marital relationship with another woman. In three other cases reported by Kiernan elopements by married women with female inverts occurred. In a case reported by Montaigne one girl resolved to dress like a man and began as a weaver. She was looked upon as a well-conditioned young man whom every one liked. At Vitry she became betrothed to a woman, but a quarrel arising no marriage took place. Afterward she fell in love with a woman whom she married, and with whom she lived for four or five months to the wife's great contentment. Having been recognized by some one from Chaumont she was condemn- ed to be hanged. She preferred this to living again as a girl and was hanged for using illicit inventions to sup- ply the defects of her sex. In 1721 Catharine Margaret Lincken married another woman after the fashion of the Countess V., in 1886 and was tried and executed for sodomy at the age of twenty- seven, (F. C. Muller, Freidrieh's Blatter 1891.) In 1731 (James Payn, Sunny Stories and Shady Ones) Mary East was engaged to a young man, for whom she entertained the strongest affections. Upon his being hanged for high- way robbery, she determined to run no risk of any such disappointment from the opposite sex in future. A female friend having suffered similarly and being of like mind they agreed to pass for life as man and wife. The ques- Editorial. 379 tion of which should be the husband was decided by lot in favor of Mary East who accordingly assumed the mas- culine habit. Under the name of James How she took a small public house at Epping for self and consort. Here and subsequently at other inns they lived together in good repute with their neighbors for eighteen years— during which neither experienced the least marital jeal- ousy. They realized considerable money. The alleged James How served all the parish offices without discov- ery and was several times foreman of juries. While oc- cupying an inn "his" secret was discovered by a woman who had known him in "his" youth. Henceforth she blackmailed the happy couple. First $25 then §50 then $500 were demanded as a price of silence. Even these bribes were found insufficient. At last, however the per- secutor pushed matters too for. "James" brought the whole matter before a magistrate and, attired, awkwardly enough in the proper garments of her sex, witnessed against the offender, who. was imprisoned for a considerable term. Exposure followed .upon the trial. The White Horse had to be disposed of. The landlady retired from pub- lic life. After thirty-four years of "matrimony" "Mrs." How died. The disconsolate widower survived long after- wards but never again took to "himself" another spouse. Neither "husband" nor "wife" had ever been seen to dress a joint of meat, nor did they give entertainments to their friends. Although in excellent circumstances (hav- ing acquired between $15,000 and $20,000 neither man- servant nor maid was kept, Mary East served custom- ers and went on errands while the "wife" attended to household affairs. It is, as Havelock Ellis' remarks (AL- IENIST AND NEUROLOGIST 1895) noteworthy that women with special frequency fall in love with disguised per- sons of their own sex. This was the fact with many of the Amazons who have assumed male attire for other reasons than inversion. Miss Mary Ann Talbot (a natural daughter of Earl TalboU assumed male attire to accompany her lover. Later she continued it as a means of subsis- tence. She engaged herself at one time as steward on 380 Editorial. board the Ariel, Captain Field of the vessel entertained so high a regard for his steward that he took him to his own home in Rhode Island. Here Miss Field a niece of the Cap- tain became passionately enamoured of his favorite and offer- ed to marry "him" although it was not leap year; when "he" departed to join the ship she "went into convul- sions" so that "he" had to be recalled to bring her to again. At last "he" was only permitted to depart under the solemn promise to come back after a single voyage and make Miss Talbot "his" wife. Dr. "James" Barry (the famous woman who served as surgeon in the British Navy for years without her sex being suspected) fought several duels with men because of rivalry in female affec- tion. "He" was accused by women of great fickleness. Mrs. Welsh who enlisted in the British Army during the Eighteenth Century and served for several years had a similar experience. Her solicitude for the concealment of her sex led her to pretend to be a gay Lothario. She chal- lenged and dangerously wounded a rivaj suitor for the hand of a Burgher's daughter. For this she was discharged from her regiment. Enlisting in another regiment paternity was sworn upon her by an untruthful damsel. She paid for the infant's maintenance without grudging since such a charge established her reputation as a man. Joan of Arc wore male attire for modesty. This was one of the heresies with which she was charged. She was placed in a dun- geon on her capture, her jailor was ordered to insult her. In consequence she could not restrain herself from putting on male armor ensnaringly placed in her dungeon although she knew that she would be burned for so doing. Joan of Arc while not an invert was not entirely normal since she had never menstruated. Among the legal questions arising from these "marriages" is that of divorce by a real husband and that of alienation of the wife's affection by an invert. That inversion was a valid cause for divorce was decided in the Chicago and Indiana cases cited. In a recent case (Rodney vs. Cole) in Washington the husband alleged that under domination of the accused woman his wife went through and consummated a mock marriage some Editorial. 381 time before the real marriage. In this case although suit was brought a compromise was affected. There is no doubt however but that a suit for damages for aliena- tion of a wife's or husband's affection by a invert would hold. J. FANATICISM OR INSANITY.—When some years ago an Irishman attempted to burn the fairy changeling (into whom he claimed his wife had been turned by typhoid fe- ver) back into a human being, the courts held that this was no evidence of insanity but the result of imperfect train- ing for which the accused was held responsible. Similar conditions seem to exist in the case of Mosher,lately accused of burning and torturing his step child by fire. He alleges that the homicide was due to the charge of the preacher of the Omish church that he was guilty of idolatry in lov- ing the child so much. Neither the cruelty of the crime nor the motive alleged can be considered evidence of in- sanity per se. From an ecclesiastic standpoint burning is not as great a crime as shedding blood. The Inquisi- tion and the church invariably turned its adjudged here- tics over to the state with what was called a merciful prayer to spare the effusion of blood. This was a' euphemism for burning at the stake. Burning at the stake is therefore to the ecclesiast a merciful method of punishment. These notions about the merciful nature of burning as compared to shedding blood are survivals of very primitive race notions. Among the Ossetes, a Circas- sian tribe when a child is born deformed or when the fam- ily has grown too large the father is permitted and even commanded by race custom to kill the child by pouring live coals down its throat. If he kills it in any other way he is held to be brutal and guilty of murder. Sacrifices by the insane of their infant children very frequently take the form of burnt offerings. In 1882 (American Journal of Neu- rology and Psychiatry Vol. I, P. 336) a resident of Provi- dence, Rhode Island, under a delusion consequent upon a hallucination that God had commanded him so to do, built a pyre of wood in his home, saturated it with oil, bound his 382 v Editorial. infant son, and placed the child upon the pyre while he himself knelt down to offer up a prayer for blessing on the intended sacrifice. He was discovered and arrested before he could strike a match. In a similar case in Pennsylvania an insane man bound his daughter hand and foot and car- ried her to a lonely place in the forest, where hundreds of cords of wood were piled. An altar was quickly built and upon it he secured his child. In judging whether certain cruelties are the product of fanaticism or insanity the stage of culture of the accused must be taken into account—K. THE PAN-AMERICAN EXPOSITION TO BE MAGNIFI- CENT AND UNEXCELLED IN BEAUTY.—It is promised for the Pan-American Exposition that it will surpass in beauty any previous exposition in the world's history. It is also expected that it will outrival its predecessors in many other ways, for at no time have such wondrous achievements in all arts, such perfection in the hundreds of trades, been at- tained. We say this after examining the pictorial representation of its handsome buildings and ground and comparing them with the Chicago and the two Paris expositions. SEX BY SUGGESTION.—Dr. Schenck, of Vienna, still persists in his theory dietary predetermination of sex, which is nothing more nor less than the insidious psychic sugges- tion. Stock breeders in this country have been seeking for many years to accomplish the predetermination of sex by feeding but have thus far failed. Here is his ante fecund boy baby dietary. After a preliminary albuminous dietary the following meals are prescribed: First Breakfast—Cup of milk, with no sugar, and biscuits. Second Breakfast—Lean ham, underdone, and a roll. Dinner—A little soup, a quantity of roasted meat; no potatoes, peas, beans or lentils as vegetables; no pudding or fruit; some cheese, a little salted. Supper—Fresh roast meat, cheese, a little bread and an apple; three glasses water daily with a little white wine. A boy.baby nourished in utero on so lean and limited Editorial. 383 a bill of fare supplied to the mother's blood ought to come forth lean and hungry and no embryo Hercules. Girl babies according to Dr. Schenck's private scheme are given the best chance. We have promise in their mother's preconception dietary of less puerility at birth. DR. GUSTAVUS BLECH has been appointed professor of casualty surgery in the Jenner Medical College. This is the first institution in the West to establish a chair for this branch of practical surgery and medicine. Mark Twain's bad break regarding oste- opathy. — Because Clemens belongs to the Bonaparte family of wits is no reason why he should seriously advo- cate Osteopathy. Twain has missed the mark in his recent defense of the bone twisters. Like the Journal of the Am- erican Medical Association, the profession generally and the people will scarcely take the great American humorist seri- ously on this subject. Mark Twain is a capital iconoclast of popular idolic falacious fads. He must have had an at- tack of break bone fever and championed the Osteopaths in his delirium. He has been "taking life easily of late." Perhaps he thinks every one should be licensed to do so. WATCH YOUR GOVERNORS DOCTOR.—The late Gov- ernor of Missouri officially favored Osteopathy and medical pathies in general and the present Governor of Washington has just vetoed a medical practice bill excluding the Osteo- paths from practice, accompanying his veto message with an insulting reflection on the medical profession. That is what medical men get for ignoring politics. It is the duty of the profession to make itself felt in politics for self-pres- ervation and for the welfare of the people. CONTRACTS WITH GOD AND SANITY—A man recent- ly arrested for non support of his wife and family plead- ed that he had made a contract with God which de- barred him from supporting his family. Doubt was rais- 384 Editorial. ed as to his sanity but the symptoms described would be perfectly consistent with the sanity of an imperfectly educated fanatic. Contracts with God have often been made by sane people, thus Dr. Chatelain (Annates Medico- Psych. July 1866) reports the case of a notary who died at Neufchatel who everybody supposed to be perfectly sane, but among whose papers was found a document nothing less than a regular drawn up partnership contract between himself and God. Isaac Vigneaux believed that God was his partner in the liquor business. The Almighty was to give His blessing in lieu of capital, and His share of the profits was to be given to the poor. Isaac prospered, at all events; and every year regularly distributed 7,323 francs, 35 centimes to the poor of the city. Dr. Ball re- gards this man (L'Encephale 1883) as at least of doubtful mental condition, biased evidently by the agnostic spirit so prevalent at present. It is scarcely scientific to look upon the case from this standpoint and Dr. Chatelain who view- ed it from the standpoint of religious people, regarded the man as sane. The truth about this case is, that the man was a devout individual who had the highest respect for business forms and made a covenant with the Diety in this manner. As Dr. Ray says (Mental Pathology) the proced- ure other than its name was a measure adopted by very religious people of unquestionable sanity. A partnership was the man's idea of the proper method of doing business. He did not imagine God was partner with him other than in the sense He was partner with every Christian who covenanted with him; but this idea of partnership was Vigneaux's way of expressing intimate relationship. It was, as Ray says, only an eccentricity in the true sense of that term; doing a very proper thing in an unusual manner. This man was, however a notary and it may be asked: Why did he expose his will to the possible chance of re- jection by such a procedure if he were a sane man? Here curiously enough turns up a circumstance creditable to his acumen as a lawyer. In the fourth volume Cause CiUbris published in Paris in 1736 by Jean de Nully is to be found a similar case in which the court decided that such a con- Editorial. 385 tract was no evidence of insanity. As Ray ("Mental Path- ology") says, it can scarcely be doubted that Vigneaux's professional studies included the Causes Celebres, which are well known to the French lawyer. Vigneaux did not en- tirely disinherit his heirs, and on his will being refused probate they disposed of the property as he directed. With the growth of a fanatic communistic set like that of "Zion" contracts with God will often be pleaded for non support of family and as such non support is best reached for the benefit of the family through civil procedures, examination into the sanity of the contractor will become more frequent. It should be remembered that no religious claim is by itself evidence of insanity. K—3. SUICIDE DURING ADOLESCENCE.—A recent case in Chicago has raised the question of the liability of children through suicide. A boy of sixteen was found hanging dead. While some of the police advanced the hypothesis of sui- cide or accident others leaned to the theory of homicide on the ground that the boy was too young to commit sui- cide. The mobility of temperament which decreases the Celtic suicide rate decreases the child suicide rate. Suicide in children is less than one half the very low Celtic rate in the United States. In the fourteen months ending De- cember 1891 sixty-two children committed suicide in Berlin (Ger.) The youngest had not reached the age of seven. The per centage there is higher for the same reason which will increase it here; increase of school over-pressure. The exciting cause of the suicide is usually a trivial one. One boy killed himself to get rid of "so much dressing and un- dressing." No less than five attempts at suicide were made during 1887 by children under fourteen years of age, resident in a Philadelphia district less than a mile square. In three cases the attempts were successful. In three of the five cases the moral epidemic nature of suicide was shown in the fact that one suicide was an exciting cause of two suicides and one attempt. In all five cases the ap- proach of puberty had produced its usual emotional distur- bances. The immediate causes were, as in most child sui- 386 Editorial. cides trivial. Hanging was the favorite method although one girl (who seems to have formed the melancholic de- lusion that she had hanged one playmate who committed suicide) took laudanum. She recovered from the poisoning and the melancholia. With the increasing social tendency to expose children to financial and other mental stress at the critical period antecedent to puberty, suicide, insanity and criminality among children must in the nature of things increase. The hold on life, as Strahan remarks, lessens with advancing age and self-destruction increases proportionately as age advances. During the first five years of life it is extreme- ly rare, though not unknown. During the second five years it is less rare and in recent years suicide during this period has been increasing in frequency. From youth it increases steadily. As to the causes influencing suicides in children and youth it must be remembered that the influ- ence of puberty cannot be excluded from and mental or moral change. There is very little doubt but that child labor influences the increase of child suicide. Sanitarians should pay a little more attention to the labor demanded from children. It is a disgrace to American civilization that the almighty dollar Moloch should require so many infantile sacrifices. G—2. GOUTY INSANITY AND THE AMERICAN REVOLU-' TION.—Lord Rosebery in a recent address before the Uni- versity of Edinburgh claimed that William Pitt's accept- ance of an Earldom broke down his intellect and lead to the severance of the ties between Great Britain and her Am- erican colonies now constituting the United States. The suggestion of Lord Rosebery that the English House of Lords is a potent cause of insanity has rather a humorous aspect coming as it does from one of its most noted mem- bers. Unfortunately for Democratic beliefs the instance cited does not bear out the conclusion. As Kiernan point- ed out in a paper read before the Chicago Medical Society nearly two decades ago, the crisis between Great Britain and our colonies was created by gout (ALIENIST AND NEU- Editorial. 387 ROLOGIST 1883) and not by the evil influence of the House of Lords. The mental phenomena manifested under the in- fluence of gout by one of the greatest English statesmen, William Pitt, soon after the repeal of the Stamp Act, had no little influence on the future of the race. The elder William Pitt, the idol of the American colonists, whom he had protected against the French and Indians and whose views as to taxation he had adopted and supported, because insane from gout at a very critical period of his own career, and of the relations of Great Britain to America. The Stamp Act had been repealed, Pitt's policy had triumphed and his policy was the correctness of the view adopted by the Americans anent the unconstitutionality of the Stamp Act and taxation without representation. He formed a ministry and then became insane, in a manner described by Macaulay (Essays: Earl of Chathar's) in his inimitable pellucid style. Pitt's insanity led him to fall into the snares of that cunning paranoiac, George III. Pitt at this time was as eloquent as ever, and no one suspected him of mental disorder, but his habits became more and more eccentric. A horror of loud sounds grew upon him. Though the most affectionate of fathers, he could not bear to hear the voices of his children and laid out great sums buying up houses adjacent to his own at Hayes, merely that lie might have no neighbors to disturb him with their noise. He then sold Hayes and took a villa at Hampstead where he again began to purchase houses right and left. At Burton Pynsent he ordered a large extent of ground to be planted with cedars which had to be collected all over England and were, by his orders, planted by torchlight. No man was notoriously so abstemious as Pitt, yet at this time, the profusion of his kitchen was the marvel of epi- cures. Dinners were always dressing, as he had a caprici- ous and fanciful appetite and when he felt inclined to eat, everything must be on the table. In the true spirit of an alienist, Macaulay remarks, setting an example which could be followed to advantage, by both lawyers and physicians, that other circumstances could be detailed, which, separ- ately and singly, were of little moment, but, combined 388 Editorial. and contrasted with surrounding circumstances, and with Pitt's previous and after character, justified a diagnosis of insanity. While in this fit of planting, Pitt was summoned to form an administration, and his notes to his colleagues in posse were so arrogant that even the despot, Louis XIV, would have deemed them unfit to use in correspondence with a French nobleman. The ministry then formed by Pitt displayed anything but sagacity. In it irreconcilably bitter personal and party enemies were so mingled that they could not but conflict with each other. Pitt with an equal abandonment of his sagacity for the sake of rest from House of Commons turmoil and in contrast with the course of the old English fam- ilies from which he sprang, accepted an earldom, thus ruin- ing for the time being his popularity in England and his influence on the continent. Up to the time of the appear- ance of the phenomena already detailed, Pitt had been tor- mented with hereditary gout. The disease had been sup- pressed by remedies whereupon the psychical symptoms de- scribed suddenly appeared. He became melancholy, irritable and fanciful. The state of public affairs was embarrassing; his colleagues were in constant dispute; his opponents were clamoring against him, yet he, the clear-headed statesman; the man of whom Frederick the Great said, "England has been long in labor, but she has brought forth a man," whined that he could be saved from all these misfortunes only by repurchasing the house he had so capriciously and hastily sold. This fancy accomplished, he was somewhat easier, but when business was mentioned, Pitt, the ener- getic ally of Frederick the Great, the dictator of Europe, trembled and burst into tears. He passed twenty-one months in gloomy seclusion, while his colleagues carried out the measures proposed by that morally imbecile para- noiac, George III, under, as it were, Pitt[s sanction but in total contradiction to his policy and wishes. During this time American colonies were taxed, in defiance of Pitt's stirring denunciation of even the theory of such practices, but even this could not call him from his morbid seclusion. He at length resigned his office. Nine months thereafter "V .Editorial. 389 the gout reappeared and with it Pitt's intellect. He was once more buoyant, hopeful and self-confident, but his at- tack of insanity had, as Macaulay says, enabled the gov- ernment formed by him, to violate every principle of for- eign, domestic and colonial policy dear to his heart. It is by no means improbable that, as Lord Rosebery recog- nized, but for this attack of insanity the colonial relations of the United States to Great Britain might not have been severed. J.—2 "REDEMPTIONERS" AND DEGENERACY.—From the early settlement of what are now in the United States un- til just before the opening of the controversy which led to the Declaration of Independence, people were sold in the United States as convicts, "kids" and "redemptioners." These were persons who either voluntarily, through kid- naping or through sale as a political or other convict be- came bond servants of a planter or farmer for a term of years. After the various English revolutionary attempts large numbers were sold into servitude by court offic- ials. After the defeat of Monmouth, William Penn pur- chased men, women and children to stock his colony. A large number however of the persons sold were "redemp- tioners" and criminals whether social or anti-social. Many escaped from servitude to form communities of "poor whites" in the South. Perhaps the largest of these communities are to be found in the mountains of Tennessee, Kentucky, West Virginia and North Carolina. Dr. C. B. Burr of Flint, Mich., has recently studied ("Doctors' Magazine October 1900") the mountaineers of North Carolina from the standpoint of sociologic psychiatry. Among them cous- ins, and double cousins marry and natural defects are di- rectly transmitted and intensified. The men only are ex- ceptionally of commanding stature, of good physique. In one locality two-thirds of the children were imbecible. In one family four of the children and grand-children had club foot; one, infantile paraplegia, one spinal curvature and one epilepsy. Mere girls and boys marry. "The Bible says better marry than burn, and that is the reason of 390 Editorial.. it" said a mountaineer. "Resentment for the other sex" occurs early and one night's courting has sufficed for en- gagement especially as "bundling" (Knickerbocker) is a custom. Menstruation is frequently established at twelve. Girls of thirteen -and fourteen often marry. The climacteric super- venes not infrequently between thirty-five or forty. The women do most of the farm work which in the North is as a rule allotted to the male. The women are extremely fer- tile but there are few old people. One woman, upwards of seventy, living in the end of a double cabin, there cared for her grayheaded son, who was an insane imbecile. In- sanity is frequent and while the mountaineers are not averse to placing their relatives in institutions for the in- sane, (Morganton N. C, is the most convenient), still many are cared for at home and many roam the country •and are more or less a nuisance. There will doubtless be an enormous "increase" of insanity when the next hospital for the insane is built, owing to the gathering in of these last. There is much sexual laxity. Lovers are apt to bear the relation o"f man and wife. In accordance with the "bund- ling" custom, children are born out of wedlock so frequent- ly that this excites no surprise and little comment. In one family Dr. Burr found under the same roof six illegiti- mate children. The mistress of the house who had been married twenty years, had two unmarried daughters each of whom had given birth to two children. A third daughter had had several illegitimate children previous to her mar- riage to a respectable farmer and mica dealer. There is little social ostracism of girls who have yielded to their men friends. A child born out of wedlock is granted equal consideration with one whose parents have married. Belief in witchcraft and sorcery is as, among the West Virginia mountaineers universally prevalent. In West Vir- ginia three years ago a serious witchcraft epidemic broke out which was only quelled by the interference of the Gov- ernor. Liquor drinking is very common among the men. Editorial. 391 Almost without exception they chew tobacco. Women chew tobacco, smoke and '-dip" snuff. Girls, six to eight years old, are occasionally seen with "snuff sticks" in their mouth. As a rule they begin to "dip" as soon as they are old enough to get from the woods a tooth-brush of birch or dog-wood. This stick is bitten and frayed at the ends, saturated with saliva, rolled in snuff and inserted into the mouth. The sociologic influence of the bond servant class among the New England states has yet to be precisely de- termined. While the comparatively cultured individualism of the puritan communities was somewhat hostile to the degeneracy factor from defectives bought as servants, still the dominant prying theocracy stimulated mean hypocrisies which tended to develop the primary "ego" at the expense of the secondary. As prison criminals are par- ticularly good religious hypocrites such persons would be peculiarly apt to flourish in the strenuous religious atmos- phere of the puritan states. This is probably the reason why (in Connecticut in particular) commercial honesty was at the low grade shown in the sale of "cork hams," "wooden nutmegs," and "shoe-peg oats." It is also the reason why Connecticut was famed for plutocratic legislation which the English Commonwealth had repudiated. For more than fifty years after the end of the American Revolution there was in Connecticut an underground prison which surpassed in horrors the Fleet under Bamborough. This den (known as the Newgate prison) was in a worked-out copper mine. The only entrance was by a ladder down a shaft which led to the caverns under ground. There in little pens of wood, from thirty to one hundred culprits were immured, their feet made fast to iron bars, and their necks chained to beams in the roof. The darkness was intense; the caves reeked with filth; vermin abounded; water trickled from the roof and oozed from the sides of the caverns; huge masses of earth were perpetually falling off. In the dampness and the filth the clothing of the prisoners (Mc- Masters' History of the people of the United States, Vol. 1, Page 98) grew mouldy and rotted away, and their limbs be- 392 Editorial. came stiff with rheumatism. In such pits all classes of offend- ers of both sexes were indiscriminately thrust. They became seminaries of every vice and epidemic centers of venereal disease. Prostitutes plied their calling openly in the pres- ence of men and women of decent station, guilty of no crime but inability to pay debts. Bond-servants consisted as already stated, of three classes; convicts; (political, social and anti-social criminals), "free willers" or "re- demptioners" and "kids" (as children were then called) who had been stolen, sent to the new world and sold for, at least, a ten year's term of service. One great potential element of defect arising from these classes was the bond- women brought over who afterwards became the wives and mothers of the community. To Virginia in particular com- panies sent out wives as a speculation. Sandys of the London Emigration Society, the Earl of Southampton, (Alice Morse Earle: "Colonial Dames and the Good Wives") and friend and patron of Shakespeare planned "as an anchor in the new land, -to send out a cargo of wives for these planters that the plantation might grow in gen- erations and not be pieced out from without." In 1720 the "Jonathan" and the "London Merchant," brought ninety maids to Virginia at what proved to be a most successful venture. These women were carefully chosen and war- ranted to be "young, handsome, honestly educated maids, of honest life and carriage." The husband paid to the Emigration Company one hundred and twenty pounds of leaf tobacco, (about $80) as passage money for the wives. Many of the women "redemptioners" married into the families of their employers. Daniel Defoe's niece ran away from a marriage entanglement in England and sold herself on board ship as a "redemptioner" when but eighteen years old. She was bought by Mr. Job of Cecil County, Maryland, and soon married her employer's son. According to Defoe so many good maid-servants were sold to America that there was a lack for domestic service in England. In Louisiana and the Canadas the class of women sent as wives was as a rule of the type depicted by Abbe Prevot in "Manon Lescaut." In 1721 eighty young girls sent to Editorial. 393 Louisiana as wives were taken from the French House of Correction. Considering the elements of degeneracy thus imported into the United States and the conditions there- from resulting as late as the third decade of the last cen- tury, present conditions furnish a decidedly optimistic out- look for the Twentieth Century. K.—4. WIDEN THE AIRGATES OF THE CITY.—The present and prospective growth of this rapidly developing Metrop- olis, with a World's Fair begun and a fifteen million dollar expenditure provided for in honor of the Louisiana purchase Centennial, presents new sanitary problems. The narrow streets laid out, close communion of its peo- ple for defense of its people when St. Louis was a little Span- ish fortified town, from time to time attacked by Indians and perpetuated from the time when the French held sway and later when the Americans took possession under the deed from Napoleon I, to Jefferson's administration, should be changed to broader avenues, as the last Louis Napoleon under the wise and broad engineering skill of Baron Haus- man widened the little overcrowded, unhealthy thorough- fares of Paris into those magnificent health-giving and and pleaure and comfort promoting Boulevards which are the glory of the French capitol and excite the admiration, if not the envy, of the world. The Boulevards of Paris are veritable parks and they cover acres where qualor, pover- ty and the diseases of congested populations once existed. What is to hinder St. Louis from similarly widening her down town streets? If St. Louis is to go on building gigantic sky scrapers for the modern business cliff dwellers, to meet the demands of her rapidly increasing business, she should look the sanitary situation squarely in the face and provide by widening her thoroughfares for more sun- light and air around her great buildings. The millions who walk her down town streets now and the millions more of the world's people who will come within her borders in 1903 to do business in her places of trade will need more air space. There will be breathing room enough always in her magnificent parks and in her West End Boulevards and 394 Editorial. Avenues, but the majority of her immense population will not there abide or do business on these newer air spaces and pleasure grounds. For health's sake,for comfort's sake, for business' sake and for the future glory of this great central metropolis of the country widen the streets. Market Street when the World's Fair crowds come will be too narrow from Union Station down town and west to Grand Avenue and likewise 18th and 19th Streets will prove too narrow to contain them. IT IS PAINFUL TO THE PATRIOT STUDENT of American political history to note the dangerous degeneration in political methods and the apathy among the best people of the Republic toward the progress of the vicious methods which now prevail and pollute the pool and fountain source of this great country's political safety. Contrast, for ex- ample, the course and career of the Tammany Society to-day with the lofty patriotism and noble purpose of its early days, and compare the polluting party politics now ruling the policies of the other great cities and many of the state governments of our day with the broad and generous concern for the welfare of all the people, coupled with the elevated and manly statesmanship displayed by the founders of the original thirteen states of this Republic. Tammany is like an old man degenerate, who in youth was .upright and true, now gone into the decline of life, with the higher aims and inhibitions of his early career gone from him—dissolute, degenerate and damned. THE TECHNICAL COMPOSITION of the coroner's office and coroner's jury should be representative of the interests involved. It should include a medical man, always, as coroner, and medical men as his assistants, and the composition of the coroner's jury should represent at least one good chemist, and good attorney, one undertaker ac- customed to viewing ordinary dead bodies and several skilled physicians, including a surgeon, a neurologist, a practitioner of inner medicine and a specially skilled anat- omist. Editorial. 395 Such a jury should, of course, be better compensated than* the present coroner's juries are. With such a jury murders would be more often detected and more murderers would be brought to justice. DR. LEWELLYS F. BARKER.—The Journal of Com- parative Neurology will have the editorial collaboration of Dr. Lewellys F. Barker, professor of anatomy in the Uni- versity of Chicago and Rush Medical College and author of the best books extant on the nervous system. The de- partment of neurology of which Dr. Barker will have especial editorial supervision is the Neurone Systems and Conduction Paths, a department which Dr. Barker is pre- eminently well qualified to conduct. Much of our exact knowledge of anatomical fact has in large measure been acquired through Dr. Barker's researches in this field, in which he stands so deservedly high. JUSTICE BROWN ON TOBACCO.—In his opinion, says the Chicago Clinic, in the "Tennessee cigarette case," Justice Brown champions the use of tobacco, and speaks with some enthusiasm of its good properties. He refuses to indorse the opinion of the Supreme Court of Tennessee, "that cigarettes are inherently bad, and bad only." While cigarettes are not worse ordinarily than the tobacco they contain and not worse than the average cigar, tobacco is a vital depressent, as ample experiment on in- ferior animals and personal human experience has indubitably proven. The egotism of courts in regard to questions of med- ical opinion has not yet fallen under the restraint of reason and experience down in Tennessee. From the times of Hale, Erskine and Tracy eminent jurists have delighted in interpreting disease and expounding their views of subjects bearing medical aspects for the enlightenment of medical men and all mankind. And notwithstanding the steady, resistless advance of scientific light into the shaded realms of judicial decision and the final reluctant yielding and recognition by the 396 Editorial. judiciary of its historic medical error, the paranoiac egoistic delusion of the bench every now and then reappears in absurd judicial judgment on matters medical which the higher court of science must inevitably reverse. It required a century of judicial murders and of strenu- ous effort on the part of the medical profession to clear the judicial mind of the shadowy misconception that only de- lusion constituted insanity. It will require a good many decades yet to convince the courts that human beings may be irreparably damaged by concussional railroad injury, mental and physical, without a perceptible break in the anatomy of the cranium or spinal vertebrae, but the serious condition of intangible injury that sometimes results from these accidents will some day be so plainly proven that even railway surgeons, railway attorneys and the wearers of the judicial ermine will discern them. THE APHORISMS OF HIPPOCRATES are good reading and some of them not mal apropos in practice at the present time, more than two thousand years since the death of the Father of Medicine, and the Liquid Peptonoid people have conferred a benefit on the profession in repro- ducing them translated into the English language and send- ing them out in the form of a neat pocket brochure with the medallion imprint of the ancient physician on the outside front cover. This is commendable enterprise in advertising. DEATH OF T. B. WHEELER.—We regret to have to announce the death on January 10, of T. B. Wheeler, M. D., whose ability and character have been the principal agents in giving to Wheeler's "Tissue Phosphates" their well merited high repute. It is announced that the busi- ness will be carried on without change and all contracts, checks, etc., are to be made out as formerly to T. B. Wheeler and all communications so addressed. AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION. —The next annual meeting of the American Medico-Psycho- Editorial. 397 logical Association will be held in Hotel Pfister, Milwaukee, Wis., June 11, 12, 13 and 14, 1901. The date has been placed a little later than usual that this deservedly popular convention city may be visited at a pleasant season. Warren P. Lombard, professor of physiology in the Uni- versity of Michigan, will deliver the annual address. Sub- ject, "Reinforcement and Inhibition of Nervous processes." JUDGE WlLTBANK should be made to feel the wither- ing scorn of that humanity he has violated in fining a tardy Pittsburg doctor, detained by a dying patient, for contempt of court. His cruel dictum, that "it were better that the patient should die than that the court should be in contempt," is yet more contemptible than the fine, which he later remitted. This vicious ruling will find place among the brutal judicial annals with the heartless utter- ances of the crazy Judge Jefferies of the English Bench. HOW WE ARE PROGRESSING.—An advanced oph- thalmologist has found eneuresis due to eye strain. One of our neuropaths who had been an inmate of Kirkebride's and of Utica was once told by a nose and throat specialist that the subsequent nasal catarrh from which she suffered was the cause of her insanity, and now supra-renal capsule is pronounced to be a remedy for snoring. Modern medicine marches on to glory. SENSIBILITY AND PSYCHIC FUNCTIONS OF PHAGO- CYTES.—A. K. Federolff, discusses "lowered sensibility in the causation of infectious diseases," in Vratch. St. Petersburg, for December 29 and January 5, (vide Journal A. M. A., February 23), believes that the reason why the chemical products of the vital activity of pathogenic microbes in some cases attract and in others repel the white corpuscles (varying chemotaxes) is due to the physio- logical condition of the phagocytes rather than to any special properties of the bacterial products, and he attributes sensibility and psychic functions to the phagocytes, dis- played in their purposeful movements, in their selections of 398 Editorial. food materials and in their aggressive seizure of the casual agents of the infection. If they are benumbed or diseased, then the products elaborated by the bacteria or resulting from their dissolution, fail to incite the phagocytes to their normal aggressive activity. Tests of the effect of narcotic substances on the white corpuscles have demonstrated that their tactile and chemical sensibility are diminished by an anesthetic, exactly as the general sensibility is depressed and the reflexes are abolished by anesthesia. When, from any cause, the products of metabolism accumulate in the blood and lymph spaces, they probably exert a narcotizing influence on the cells and especially on the sensitive pha- gocytes. As the latter become benumbed and remain passive under this action, their physiologic faculty of pro- ducing the alexins—which some claim are bactericidal sub- stances poured out into the blood plasma—is also reduced in proportion. The bacterial products may irritate the blood-producing organs, and so induce leucocytosis, but this is no criterion of the power of the organism to resist in- fection. The resistance depends on the physiologic condition of the leucocytes rather than on their numbers. In short, Federolff believes that depression from any cause may lead to accumulation of the products of metabolism. These in turn are liable to narcotize the cells—especially the pha- gocytes—check their functioning, assimilating, odidations, etc. This allows the germs of infection to develop and elaborate their toxins, unhindered, entailing in consequence some infectious disease. HEREDITY.—The Philadelphia Medical Journal notes the fact that Thomas Oliver (Lancet, November, 10, 1900, p. 1335) pointed out that the Derby has never been won by a horse that was not a thoroughbred, and the same statement is practically true of the other great English races, the St. Leger and the Oaks. It appears, further, that the Derby has never been won by a gelding. Mares, also, have won races far less frequently than stallions. With the object of maintaining the high standard of the English racehorse, close breeding in and in is practiced, Editorial. 399 and as a result of this practice, it is thought by many, the animal is degenerating. To overcome such a result infusion of fresh blood becomes necessary from time to time. ARCHIE, the youngest son of Dr. Wm. W. Ireland, well known to the readers of the ALIENIST AND NEU- ROLOGIST, who is a civil engineer, has been called to go to South Africa, with the second company of the Royal Scots Volunteers. He was a first lieutenant in the Volun- teers, and had put down his name as willing to go for foreign service at the beginning of the war. The other son of Dr. Ireland is in medical charge of the penal settle- ment at Masseruni, British Guiana. ENTRANCE AND EXIT MEDICAL GRADUATE QUALI- FICATIONS.—The entrance examination of medical colleges is not so important to the aspiring junior medico as the exit examination. It is not so much what he knows when he begins as when he finishes that will effect the patient. If he makes a good finish he will be less likely to finish his patient. He should get in at the finish with a good deal of knowledge. His period of preparatory study should never be less than four years. An ambitious, studious and diligent medical student can make up deficiencies in the interim of his college med- ical study, but it will be too late for the storing of medical facts and the training of medical judgment if he waits till the undertaker is on his track and the sexton's predestined victim is in his hands. Great medical men have been fashioned out of material not previously moulded in literary colleges, but never out of men who did not work hard and acquire well the essen- tials of medical knowledge and every other essential of a a well developed observation and judgment after they began study. The royal road to medical success is to be flush in medical knowledge and judgment—a well stored and logical mind trained to make the best use of medical knowledge and observation. 400 Editorial. HYPNOTIZING AGAINST HYPNOTISM.—Liegeois in a recent article proposes to prevent hypnotism by hypnotizing the person likely to be exposed and suggesting that the subject cannot be hypnotized. It is perfectly possible to effect this by suggestion without hypnotism. In 1890 a professional hypnotist was to deliver a lecture before a club of very susceptible subjects of the newspaper persuasion. A physician suggested to the president and secretary of the club that no person healthy mentally and physically could be hypnotized. This suggestion spread round the club, and in consequence the hypnotist failed completely in his at- tempts. Ever since the time of Father Kirchner it has been known that, as Westphal later more completely dem- onstrated, animals cannot be frequently hypnotized without dangerous results. Dr. Charles Howard reported some years ago (ALIENIST AND NEUROLOGIST, 1895) a case in which he had caused an honest man to commit theft. The man was accused after he had become restored to his normal condition, protested his innocence most honestly, but the stolen property was found on him, whereupon the man was so shocked that he went into a cataleptic condition, in which he remained for some days. Dr. Howard naively added that the man's brain was, he believed, permanently injured, and that as a physician he had employed greater precautions in his experiments since that time. Dr. E. C. Spitzka testified in the Guiteau trial that, while no person not predisposed, could be made insane by hypnotism, no person could be frequently hypnotized without being injured. The cerebral vasomotor disturbance concomitant on hyp- notism must inevitably produce local secondary changes. As the ALIENIST AND NEUROLOGIST has frequently re- marked, undue tendency to hypnotic experiment deserves severe rebuke. KIDNAPING OF CHILDREN BY THE INSANE.—The present general alarm about kidnaping seems to revive memories of the time when the comprachicos or child buyers were the terror of Europe. Although the child buyers strictly purchased children they were not over and Editorial. 401 above rigid as to the persons from whom they purchased them. They usually purchased children for manufacture into deformities, dwarfs, and other curiosities not excluding double monsters. Other children were turned into cripples to be used by professional beggars in their occupation. This industry still obtains in France and Italy although it was crushed out in England early in the present century. The last to indulge in it in England was a "Dr." Harper, who for a long time practiced unmolested, and turned out various monstrosities, at a fixed price to showmen. Victor Hugo made in "By Order of the King" a very thrilling use of a monstrosity manufactured by the comprachicos. While some of the comprachicos were paranoiacs still the majority were sane. In Victor Hugo's picture of the com- prachicos occurs one figure which seems to belong to the paranoiac category. The motives of the insane for kid- naping vary from the ordinary motives which govern the same to delusional motives and finally to an expression of the collectionism tendency which makes so many of the de- teriorated insane gather up anything that strikes their fancy irrespective of property rights or of value. It was from such motive that Maggie Keppel gathered up a young child playing some distance away from its home and took it on an irregular, purposeless wandering through New York and Brooklyn. As Dr. L. C. Gray has pointed out this class of people cannot give any clear account of the kidnaping (Ameiican Journal of Neurology and Psychiatry, Vol. II, page 19, 1883) and are when questioned very liable to sugges- tion by leading questions. Sometimes they are prompted by an imbecile pity to take care of a child in an indefinite fashion whom they find crying. In this case they do not endeavor to ascertain the child's residence or parents but simply wander off with it wholly unconscious of the pain they may be creating by carrying it off. SKULL DEFORMATION IN INFANCY AND INSANITY. —It has been claimed by Dr. R. Peterson and others that the practice of artificial distortion of the cranium exists only among the lower races of mankind. This is in decided error, 402 Editorial. since as Barnard Davis showed many years ago (Anthro- pology, 1856) the practice is far more wide-spread than is usually expected. It was common all over Europe and was practiced by the Turanians, by the Slavs, by the Scan- dinavians, Anglo-Saxons and Celts. Less than half a cen- tury ago Foville proved that the nurses in Normandy were still giving children's heads a sugar-loaf shape by bandages and a tight cap. In Britanny they preferred to press it round. Morton and Catlin state that while the artificial distortions of the cranium may play a part in developing synostosis, these have no effect upon the intellectual func- tions, and that there are no mental data as to the effect of artificial malformation of the skull during child develop- ment. As Talbot remarks, (Degeneracy, Its Causes, Signs and Results), this opinion has no analytic basis. Foville described many years ago cases whose heads were of a very peculiar formjmoreor less perfectly approaching the pyram- idal; the face might represent the base, and the occiput the apex. Their foreheads were particularly flat and nar- row. In the district where these heads are found more children die at an early age than in any other; the diseases being principally convulsions and other maladies of the brain. More insane come from this than from any other quarter of France in proportion to the population; and finally more cases of idiocy, epilepsy, and the like, than elsewhere. The peculiar shape of the head pervades the people of that whole region who all (American Journal of Insanity, January, 1848) participate in this deformity in a greater or less de- gree, without exception. So universal is it indeed that some painters and sculptors regarding it as the natural head of man, have drawn from this source their beau ideal of beauty; and fixed upon the sloping shoulders of their Venuses and Apollos, heads gracefully rising in tapering pyramids. The Flat-Head Indians were known to alter the forms of their infants' heads by pressure of the skull when its bones are in a more or less cartilaginous state, and not yet firmly united. From this it was suspected that some such prank was practiced on these children of France; it was found that mothers and nurses had been employed for cen- Editorial. 403 turies in the wholesale business of driving mad, maiming and murdering children by putting a peculiar cap upon the heads of their tender offspring and fastening it tightly there by means of a strong band. This simple cord has killed its hundreds and diseased an entire region. Dr. Foville in a necropsy on one of these country women found the venous circulation so impeded that a large plexus was formed for the accommodation of which a deep cavity was sunk in one of the lobes of the brain. Such customs like these survive in folklore long after the original superstitions which gave them birth; it is exceedingly probable that such crop out in descendants of these races to the present day, to confront the anthropologist with some remarkable crania. Tylor (Anthropology) is of the opinion that disrespecting the repressive action of the Government, the Bretons and Normans secretly continue this practice. SCENES OF BEAUTV AND HOMES OF HEALTH.—The pages of the ALIENIST AND NEUROLOGIST are graced by many handsome home-like hospitals and sanitariums whose buildings and grounds are pictured on our advertising pages. There is beautiful and charming Oakwood and High Oaks, the Ozark Sanitarium and the Baptist Hospital, Oak Lawn, Burn Brae and Bellevue, Riverview, River Crest, and West- port, Greenmont-on-the-Hudson, The Hygeia, Falkirk and Crestview, the Richard Gundry Home, the Horace Wardner Sanatorium, William B. Fletchers and the Alpha, Gray Towers, Walnut Lodge and Waldo Coe's Cottage Homes, the Alma Sanitarium, Smith's Home for the Feeble Minded, Mayfield's, Patterson's Home for the Nervous, Interpines, Kensett, The Hudson Sanatorium, The Blue Hills Sanitarium and Hall-Brook. All of these places are efficient and well adapted to their purposes. Some of them are like homes in dreamlands of beauty and all have the appointments and comforts of well-ordered homes. Located in different sections of the country you may choose them according to accessability or remoteness or according to climate and the sort of social and natural environ- ment you may deem your patient needs for cure. 4C4 Editorial. Communicate with them, visit them, learn all about their doctors and your consultation services will be all the more valuable to your patient. OAK GROVE HOSPITAL CALENDAR is one of the handsomest pictorial calendars of the new year of the new century. Its attractiveness is due to the artistic presenta- tion of the building and grounds of this well known home for the nervous. HYSTERIA, profound hallucinations and delusions have many times in the world's history influenced normal minds as well as the hysterical to wrong action. The morbid emotionalism of hysteria, the illusions and auto-suggestion of its dream sphere, its imperative self-suggestion, its egoistic craving for attention, its morbid envy and jeal- ousy, its caprices of erotism and dominance, like its paroxysms of causeless weeping and smiling, crying and laughing, its alternating anesthesia and its psychical exaltation and depression, its crises, its paralyses, its convulsions and spasmodic rigidity, as in hystero-epilepsy, its moral perversions, its beatific or diabolic visions, all these and the many more bizarre features of this singular mental affection, cause the alienist to consider with caution the statements of the gravely hysterical and weigh with allowance their asseverations in matters where they themselves are vitally concerned and they are the pivotal figures round which their romance revolves. Grave hysteria in the family councils and in court is the gravest of sub- jects for adjudication. Its visions have lead armies, founded religions, perverted faiths and bred crime. The question of hysteria is likely to become a theme for judicial investigation as the outgrowth of a murder done at the instigation of a woman, either spurned or actually wronged, the murderer her husband, the victim a much- respected clergyman. When the trial is over the American public will know more than it does now, of the capacity of hysteria for inciting to crime. Hysteria and the delusions of its gravely exalted states Editorial. 405 has much to answer in the world's record of excited crime, as it has also sometimes incited its moral reforms and often its religious morbid exaltations of life. MEDICAL GENERALS.—The Boston Transcript thus dis- courses: "Apropros of the nomination of General Wood to be a brigadier general in the regular army, it is an interesting fact that he is not the first surgeon who has made a high military reputation on being transferred from the staff to the line. General Samuel W. Crawford at the outbreak of the Civil War was a captain and assistant surgeon stationed at Fort Sumter. As one of Major Anderson's officers he took more than a surgeon's share in the defence of the fort, actually commanding one of the batteries that responded to the Confederate fire. Transferred to the line of the regular army, he ac- cepted a brigadier's commission in the volunteers and sub- sequently rose to the command of a division, serving with distinguished credit at Gettysburg and in Grant's Virginia campaign. After the war, in which he won brevet-general rank in the regular army, he long commanded a regiment stationed in the South, actively engaged in the enforcement of the reconstruction laws. General Crawford was generally esteemed a most capable officer, though he did not escape the prejudice line officers have against officers who come into the line from a staff corps, as the Medical Department is. Sheridan at one time protested against Crawford's selection for a high command on the ground that he had been a 'pill-roller,' but had to admit that Crawford was at least an exception. At no time was general Crawford.likely to succeed to the command of the army, and therefore he did not chal- lenge line sentiment to the extent General Wood challenges it. In the natural order of promotions and retirements, Brigadier-General Wood, if confirmed as such, will become Lieutenant-General Wood in 1909, and will not attain re- tiring age until 1924. It is the prospect of the army being commanded for fifteen years by a lieutenant-general who began his military career as a surgeon that ruffles every feather in every chapeau of the army." 406 Editorial. SLIGHTING THE ARMY MEDICAL STAFF.—Apropos of General Wood's and of General Crawford's well-merited promotion it is well to note of what stuff the medical staff of armies is often made. Baron Lowey, Napoleon's chief surgeon, was in many respects that great general's equal. His skill had much to do with the welfare and efficiency of Bonaparte's army. A silly and unjust disposition to ignore the claims of the medical staff to equal rank and emolu- ment still persists in the army and navy, which must pass away before the highest efficiency in service can be obtained by our armies on land and sea. The patriotic and compe- tent medical man foregoes the thrill of fighting while the battle is on and calmly works in danger's way to suc- cor and save, by skill of science. The army surgeon must have quite as much natural ability and study quite as long to prepare himself in these days of astonishing scientific progress as the cadet who graduates at West Point or Annapolis. Why, therefore, should not his opportunity for advance in rank and honor be the same? He makes more sacrifice, if he be made as other men and with ambition for fame and glory, than the rank and file in infantry, cavalry or on the sea. "A wise physician Skilled our wounds to heal Is more than armies To the Public Weal." What is a well manned, well officered or well am- munitioned and provisioned army without sanitation and without provision for minimizing the impedimenta of casual- ties, sickness and death? The possibilities of increased efficiency in our army and navy lie as much in the advancement and proper recognition of its surgical, medical and hygienic service as in the cour- age on soil of officers and men and the power and per- fection of its guns, gunboats and forts. A MILITARY MEDICAL SCHOOL for an extra course in military medicine, hygiene and surgery would be a wise endowment of the Government in connection with West Editorial. 407 Point and Annapolis. With provision for proper promotion and higher rank for the medical staff America should have the best organized army in the world if not the largest, and it is incentive to promotion and liberal provision for its members in all of the essentials of efficiency and advance- ment that makes an army great. No aspiring, ambitious and competent man with the elements of greatness in him should be kept out of the Medical Staff by the knowledge that there is only a limited •chance for medical promotion. The medical man of knowl- edge and power should have opportunity to go to the top and not have to forsake the medical staff to get there. The present army medical rank and recognition is too low for the best service. A SYMPOSIUM between distinguished Alienists and others on the Sanity or Insanity of Saul of Tarsus, based on H. W. Southworth's book, "To Nazareth or Tarsus," especially chapter XVIII, is contemplated as a feature of the July number of the Alienist and Neurologist. WANTED STATESMEN FOR THE PEOPLE.—Without being at all partisan it is plain that the American Congress should re-enter now upon an era of statesmanship in which the whole interests of all the people and the welfare of al| the country should be considered. The country, the constitution and the flag claim con- sideration above the personal interests of Legislatures or the money-making schemes of the Congressional Lobby. Congress should concern itself with what every well wisher of his fellow man is certainly interested, namely, the wel- fare of industry and labor. Labor well organized and well conducted in the interest of a good wage and fair service and respectful of the rights of man in all it does should have the ear and thought of Congress. The grasping capacity also of combined capital needs to be met and thwarted at the threshold of the Lobby. Organized oppression either of capital or labor needs to be dealt with by the strong arm of law. The rights of industry as well as of capital should 408 Editorial. be sacredly guarded. Both should be made mindful of the rights of others. Injustice defeats -the best interests of combined capital and labor alike, violence estranges public sympathy and oppression, kills the cause that employs it, whether of combined labor or of pushed capital. A just cause pushed forward with injustice stained with oppression and blood puts obstacles in its own way. Truth is mighty and will prevail. There is room for the right to triumph in every contest of labor and capital. Overbearing capital can and must be righted now as in the past when usury laws were placed on the statutes of the nations and poor men were saved from the unjust grasp of the money power in the time of Licurgus, Henry the Eighth and between these historic epochs. The rights of workmen to a fair wage, sanitary length of daily service and surroundings must be secured to them by law as well as the right of any man to enjoy the privilege of employ- ment when he wants it without interruption from his fellows. The national prosperity of a people is largely con- ditioned upon the physical satisfaction of both employer and employed, the contentment and tranquility of both capital and labor. Justice in legislation will accomplish both and all. A PSYCHIC ALTERNATIVE.—It is natural for the nor- mal mind to turn from scenes of sadness to those of mirth. Healthy minds, grief burdened, turn after a time of grief to scenes provocative of mirth. Those whose callings are habitually grave if well endowed mentally naturally seek the reaction of levity—"A little nonsense now and then is rel- ished by the wisest men" etc. The alternating phenomenon of laughing and crying in certain phases of hysteria exhibit the alternating tendency, but it is not often that we see recorded the voluntary seeking of the house of mourning for relief from over pressure of mirth making, as in the follow- ing confession made by a theatrical employe to a represent- ative of the Philadelphia Record. It is, says the theatrical, such a pleasant change in my employment. 1 must wear a gala smile at the theater at all times, and the gaiety there, Editorial. 409 the mirth and light-heartedness prove very monotonous. I long for something in gloomy black, with a look of gloom in my eyes, and the sobs I hear, the groans, lamentations and the lugubrious music are very soothing to me after the eternal heartless jollity of the play house. The two kinds of work diversify my life; 1 touch on two extremes. "Spring would be but gloomy weather If we had nothing else but spring." Long residents of California from eastern localities have told me they longed for alternating changes of clouds and sunshine as a relief from the perpetual bright rays of that sunshine state. THE TRANSACTIONS OF THE SECTION OF NEURO- LOGY. XIIITH INTERNATIONAL MEDICAL CONGRESS, Paris, 1900, have been published with unusual promp- titude. The Secretary General, M. A. Chauffard and his collaborators and publishers, M. Pierre Marie, Secretary of the Committee of Publication, M. E. Dupre, A. Songues, and E. Feiendel, Secretary of the Seances, and Henry Meige the publisher, are entitled to the approbation of all interested. Without going into detail we may safely say from what we saw and heard of the papers and descriptions supplemented by an examination of the volume before us, that no more instructive volume has ever emanated from the neurologic section of any previous congress. MEDICAL RANK AT VICTORIA'S OBSEQUIES.—The Canadian Practitioner and Review experienced something like a shock on reading the following in the British Medical Journal of February 9th: "We understand that no officers of the Royal Army Medical Corps, except those with the men, were told off to take part in the Queen's funeral procession. The director- general of the Army Medical Service had no place in the procession, although the heads of the other departments, for instance the inspector-general of ordnance the inspector- general of fortification and some others were assigned places. Moreover honorary physicians and surgeons to the Queen, 410 Editorial. who rank as majors-general, were not given places, while A.D.C.'s to the Queen, who are colonels, took part in it. Is it possible that the services of the medical officers during the war in South Africa are forgotten already? Or is the precedent of the Wolseley-Buller administration, so hostile to our brothers in the army, to be followed? We look for better things of Lord Roberts, who, if rumor speaks truly, has no reason to thank the Wolseleyites, and of whose kindness of heart and interest in medical affairs we have heard much. Let us hope that when the coronation occurs the head of the medical service, as representing not merely the army, but the profession, will receive the honor due to his position." We are likewise surprised that such an indignity should have been given to the representatives of the noblest of professions, not, in any respect, beneath the army in worth and dignity and honorable desert. Medical men must mingle more in public affairs and assert their rights more vehe- mently, more forcibly or they will in the march of the world's progress be left to admire their own faces in the glass. AN INTERESTING DISCUSSION on Trifacial Neuralgia and Gasserian Gangliectomy was a feature of a recent meeting of the St. Louis Medical Society. Neurology agrees with Matas that the surgery of the ganglion of the trigeminas is "the boldest and most adventurous operation of the century" just closed. It and cephalectomy and ven- tricular paracenteses are the marvels of nineteenth century surgical daring. It only now remains for the surgery of the twentieth century to "raze out the written troubles of the brain and pluck from the memory a rooted sorrow" to make its triumph complete and final. THE STYLUS has been merged with the Interstate Medical Journal of St. Louis. W. B. Outten, Otho F. Ball, and Dr. William Porter will edit the Interstate, and Dr. George M. Gould's new weekly is to be called American Medicine. H. D. Reynolds is business manager. - Editorial. 411 THE TERM PSYCHIC INSULT, which the surgeons pro- pose to substitute for the term mental shock, by which neurologists and alienists recognized the cerebro-spinal and sympathetic nervous system injury sequent to psychical and physical violence not accompanied by tangible structural solutions of continuity of texture and which the surgeons are just beginning to understand and acknowledge, especially railway surgeons, is an abominable substitute. All insults are psychic and the older terms, psychic shock and psychic violence, are far better. Let them stand, gentlemen of the knife. Accept the facts, they are incontestable, and the better terms that designate them. INTRODUCING THE EDITOR IN CHIEF, Doctor Charles Hamilton Hughes. So many years have passed since this journal was founded and so many have become acquainted with the editor who have never met him in person, that we have deemed it our duty to show our face to our friends and patrons in this issue. We should like to make a custom of presenting in each issue the faces of the journal's friends, collaborators and contributors. They would make an interesting array of faces, familiar in psychiatry, neurology and forensic medicine. NUMEROUS EXCERPTS from the press reflecting on Dr. P. M. Wise have come to this office. An animus appears behind them. The State of New York loses an excellent and long tried medical executive officer in Dr. Wise's removal from its service. Dr. Wise makes the following statement in his own behalf in reply to Governor Roosevelt's charges, which he characterizes as groundless: "I have never used the state's credit and my official opportunities for personal gain, but on the contrary I have sacrificed what was to me an embar- rassing amount to avoid even the appearance of this. This covers the whole case." REVIEWS, BOOK NOTICES, REPRINTS, ETC. SUICIDES ET CRIMES ETRANGES, by Dr. Moreau (de Tours), Paris, France. Societe d'Editions Scientifiques, 1899. This is a valuable discussion and history of peculiar suicides and strange crimes. It is interestingly written. The author, however, leans too much to the hypothesis that the strangeness and atrocity of a crime independently of motive, proves the irresponsibility of the criminal. The majority of alienists are agreed, however, that neither atrocity nor seemingly trivial motive by itself is evidence of insanity, since the varnish of the twentieth century covers a prehistoric folklore tendency which tends to make many seemingly trivial motives of great importance to the perpetrator of a crime. It is only a few years since the fairy changling notion led to a uxorcide in Ireland and the witchcraft notion some years later led to homicides in West Virginia. The book is well issued. SULLA ORIGIN INFETTIVA DEL DELIRIO ACUTO, by Dr. L. Cappelletti Ferrare, Italy, Brecciania, 1899. Of all the psychoses delirium grave, Bell's disease of typhomania seems the most probable to have a mycrobic origin because of the furibund character of the cerebral pathologic changes. It is true that the majority of these changes are demonstrably due to the violent action of moral causes. Still this was not irreconcilable with microbic origin, since the moral causes might furnish the suitable culture medium for the microbe. As Dr. Cappelletti has proven by the application of Koch's law no pathogenic microbe is to be discovered. Of course microbes in abundance in a [412] Reviews, Book Notices, Reprints, Etc. 413 given disorder prove nothing unless the action of Koch's law demonstrates their pathogenic importance. Cappalletti leans to the opinion that, as the old clinicians surmised, the mental perturbations produced some violent toxin, whence the furibund nature of the pathologic changes. This psy- chosis needs demarcation in practice from the acute con- fusional insanity of exhaustion, with which it is often confounded. LE SYSTEME NERVEUX CENTRAL, by Dr. Jules Soury, Paris, France, Georges Carre & C. Naud. This is an interesting critical history of the theories of the structure and function of the central nervous system brought down to date. It discusses the hystory and prin- ciples of the cerebral localization, of neurons, of centers of projection and association as well as of intellection. It is issued in two volumes, large octavo, and is well illustrated. PERVERSION SEXUELLE A FORME SADIQUE, by Dr. E. Regis, Lyons, France, A Storck & Cie., 1899. This a discussion of fetichic sadism centered around a case whose sexual life was determined by witnessing the spanking of a fourteen year old sister, when about five years old. The nates henceforth were the chief center of his sexual imaginings. Indirectly the evolution of homicidal sadism is portrayed in this case. Dr. Regis believes that predisposition has much to do with the circumstances of the sexual appetite and their direction. SANITY OF MIND, by D. F. Lincoln, M. D., New York and London, G. P. Putnam's Sons, 1900. This is one of the many monographs issued by a firm which has, as its advertisement states, great facilities for issuing monographs at the expense of the author. The book contains a number of valuable quotations injured by their misapplication and conjunction with puerile lucubrations. The author fails to grasp in toto the modern conception of degeneracy, and confines this entirely to the moral side. The book deserves criticism as tending to increase the al- 414 Reviews, Book Notices, Reprints, Etc. ready confused notions of the public on a very confused subject. In his discussion of Weissmann he fails to recog- nize that Weismann's admission of a "habit" produced by tuberculosis in the parent vitiates the validity of his abso- lute position as to the non-inheritance of acquired characters. He is, moreover, unacquainted with the researches at the Naples Aquarium, which have demonstrated that the very bases of the Weissmannian doctrine as to a distinction in in the ovum between the germ plasm and the body plasm is non-existent. The author ignores many American re- searches on his subject, but ostentatiously quotes certain society physicians who have written nothing. The book is well issued by the publishers. MEMORY, by F. W. Colegrove, Ph. D., DD., New York, Henry Holt & Co., 1900. This is a very weak rehash of Ribot, dashed with an obscuring metaphysical sauce. It contains nothing especially new or newly put, and is so far inferior to Ribot's work that the two do not deserve to be mentioned in the same category. FLATAW & JACOBSON'S HANDBOOK OF CENTRAL NERV- OUS SYSTEM ANATOMY. We are indebted to that excellent Berlin book store to the profession, under the management Herr S. Karger, No. 15 Karl Street, Berlin, N. W., for the the Handbuch der Anatomie une Vergleich-enden Anatomie des Central Nerv- ensystems der Saugetiere von Dr. Edw. Flataw in War- schaw, and Dr. L. Jacobson in Berlin, with one hundred and twenty-six illustrations of the text and twenty-two Anatomical plates and seven tables "I Makroskopisher Teil." Our tardy acknowledgement of the receipt of this mer- itorious book is due to its having miscarried in coming earlier to our notice. But the lapse of a little time does not dim the luster of such an advanced work. Nay, the lapse of decades will not destroy its great value. The fame of the book will be cosmopolitan and immortal, notwith- standing our temporary neglect to give it earlier notice. Its Reviews, Book Notices, Reprints, Etc. 415 text is concise, its teachings accurate and advanced and its illustrations so perfect that they will be imperishable. If the forthcoming microscopical part equals in merit the present macroscopical (and who can doubt it will?), the thanks of posterity as well as of our day will herald the names of the authors in immortal fame. The book is appropriately dedicated to Professor Wal- deyer, the author's instructor in "Dankbarheit Gewidment." PHYSICIANS' MANUAL OF THERAPEUTICS, Referring es- pecially to the Products of the Pharmaceutical and Biological Laboratories of Parke, Davis & Co. Flexible Morocco, 12 mo., pp. 526, Detroit, 1900. In his preface to this excellent little book, the author says "There has been much well-meaning derision of 'elegant pharmacy' but we do not sympathize with it; and the products enumerated in this volume are deliberately made as sightly, palatable and inviting as possible without sacrificing any of that therapeutic efficacy which is the supreme end of medication." That sentence contains as in a nutshell, the whole secret of the great success of Messrs. Parke, Davis & Co. While their pharmaceutical prepara- tions are elegant, they are honest, and always up to the required standards of medicinal strength. The Physicians' Manual has evidently been brought forth under the same conditions. It has a handsome cover, it is durably bound, and an examination of its pages discloses the fact that it is full of "meat." This Manual will be sent free to any physician who will send address to Parke, Davis & Company, Detroit, Michigan. PRELIMINARY REPORT with Projection Drawings, illustrat- ing the Topography of the Paracoeles in their Relation to the Surface of the Cerebrum and Cranium: Dr. E. A. Spitzka, New York City. (Illustrated by drawings and diagrams.) Since the tapping and injecting into the ventricles have become definite procedures in surgery, it would greatly aid 416 Reviews, Book Notices, Reprints, Etc. the operator to have a more accurate conception of the ex- tent, depth and contour of the cavities, with their variations, than can be had from the bare rules and measurements set forth in most surgeries. With this view the author utilizes the entire head, hardened by injection of, and submersion in, formal. After a time the cranium is opened and the brain is accurately sliced, correct drawings being made at each step and projected for the delineation of the final plates. Two heads have so far been completed. It is pro- posed to decalcify the skulls of subsequent material, the entire head being then subjected to the slicing method. [Published in New York MedicalJournal, February 2, 1900.] THE THIRD EDITION OF CHURCH & PETERSONS, just from the press, presents many new and valuable features to enhance our already high appreciation of the book. Among them the new addition presents the fol- lowing modifications from the previous issues. The chapter on Cerebral Meningitis is entirely rewritten. The section on Localization or the Functions in the Segments of the Spinal Cord will contain an additional tabular exposition upon the Monograph of Wichmann, with diagramatic demonstrations of areas of anesthesis and parathesia that should be very valuable in making topical diagnoses of cord lesions. New sections are supplied on the subject of Family Tremor and Family Periodic Paralysis. About twenty new illustrations of a clinical character are added, in addition to numerous diagrams. Double page modifications of Fowler's plates showing the distribution of nerves to muscles and skin, which are of very great use in the diagnosis of peripheral lesions, are added. The book should be on every Neurologist's book shelf. STR1NGTOWN ON THE PIKE. Price $1.50. Dodd, Mead & Co., New York. Publishers. Besides containing considerable information concerning the "Stringtown" county, of Kentucky, this book puts you in touch with an interesting chemical fact which for a long time was differently interpreted. It contains a valuable Reviews, Book Notices, Reprints, Etc. 417 lesson in toxicology and is an interesting.and romantic story of Kentucky life with a chemico-medical moral and the proof that truth in chemistry is even stronger than fiction. In "Stringtown on the Pike," by John Uri Lloyd, an interesting point of early law is mentioned in the trial of "Cupe" where he takes advantage of what was then known as the "Right of Clergy" it being the privilege of the Negro about to be sentenced to enter such a plea and if the Negro could read the Constitution of the United States, he was allowed his freedom after being branded on the palm of the hand, in order to prevent his exercising the right on more than one occasion. The last time this plea was allowed in Kentucky was in the Barren Circuit Court, where a Negro was on trial for rape and as the prosecutrix was a white woman he was sentenced to death, although the evidence was clearly insufficient. The judge,sympathizing with the prisoner, instructed his attorney to bring in this plea as a means of saving him. The Negro on being tendered the Constitution of the United States and being found able to read it, was branded in the hand and set free. The plea was in 1847 abolished by the legislature.—Sixth Kentucky Law Repotter, p. 508. This statute was carried into Kentucky law from England where it was known as the Right of Clergy and it was allowed but once to a claimant who was then branded in the palm or ball of the thumb to prevent a second appeal. Few Americans are aware that this law ever obtained a footing in this country. See "Neck Verse" usually Psalms, LI: 1, which if the prisoner could read entitled him, after branding, to his freedom, thus saving his neck. JAHRESBER1CHT UEBER DER LEISTUNGEN UND FORT- SCHRITTE auf dem Gebeidete der Neurologie and Psy- chiatric Edited and published by Dr. E. Flataw and Dr. L. Jacobson and with the editorial approval and collaboration of Professor E. Mendel, of Berlin. With these eminent names as sponsors for this great and valuable work no further commendation is necessary to the zealous investigator in neurology and psychiatry. The 418 Reviews, Book Notices, Reprints, Etc. book is indispensable to whoever aspires to scholarly acqui- sition in these great fields of scientific neurological research and practice. TRANSACTIONS OF THE IOWA STATE MEDICAL SOCIETY 1900. This valuable book, especially interesting to the ALIEN- IST AND NEUROLOGIST, in the following particulars: The papers are all advanced and creditable to their authors and several of these authors are known to the readers of the ALIENIST AND NEUROLOGIST already through their previous good work. Dr. Boody's illustrations of [Catatonia, Dr. Bennett's Brain Findings in Epilepsia, Dr. Styner's Move- ments of the Neuron, Dr. Littig's Etiology of Neurasthenia, Dr. Hill's Dementia Praecox, and the President's address on Mental and Nervous Disease would all make good read- ing in the ALIENIST AND NEUROLOGIST. BRAITHWAITE'S RETROSPECT OF MEDICINE, for January, 1901, (Vol. CXX1I.) is on our table presenting its accustomed time-saving and choice epitome of the literature of the profession. Its possession will prove a time-saving, economical in- vestment. In it, as you can in your daily rounds, doctor, you may read the doings of the day in medical practice. It's a snap shot epitome of real value to you. Putnam's Sons, New York and London, Publishers. THE MARCH NUMBER of Progressive Medicine comes to our table laden with the following attractive list of con- tents: Surgery of the Head, Neck and Chest, by J. Chalmers Da Costa, M.D.; Infectious Diseases, including Acute Rheumatism, Croupous Pneumonia and Influenza, by by Fred. A. Packard, M.D.; Diseases of Children, Floyd M. Crandall, M.D.; Pathology, by Ludwig Hektoen, M.D.; Laryngology and Rhinology, by A. Logan Turner, M.D., Edin. F. R. C. S.; Otology, Robt. E. Randoph, M.D. The book keeps up to date in the record of medical and surgical progress. -'' Reviews, Book Notices, Reprints, Etc. 419 THE MENTAL SYMPTOMS OF CEREBRAL SYPHILIS, by James H. McBride, M. D., member Congress of Amer- ican Physicians and Surgeons; American Academy of Sciences, etc. Reprinted from the Journal American Medical Association, February 2, 1901. This is a good clinical presentation of the subject by a practical alienist, well qualified to write upon it. The author on page three makes the diagnostic point that incon- gruity between conduct and pretensions (delusions) charac- terizes syphilitic more than other insane persons. We have ourselves observed this. The fact is true of chronic forms of syphilitic insanity especially and exists in some long- standing paronoiacs. DRUG STANDARDIZATION AGAIN. This editorial in Buffalo Medical Journal, January, 1901, pays Parke, Davis & Co. the following well-deserved compliment: "The well-known house of Parke, Davis & Co., who were the pioneers in drug standardization, have for many years marketed a trustworthy line of assayed fluid extracts which are made to conform rigidly to fixed standards of alkaloidal strength." This editorial concludes as follows: "The manufactur- ing pharmacist should do this work for us. He has facilities that are not available to the physician and the dispensing pharmacist. Let the manufacturer of drug extracts standard- ize his preparations by chemical assay when possible, and by physiological assay when the older method is inexpedi- ent. Then the physician will be spared the humiliation of palpable impotence in the face of danger; there will be no occasion for needless experiment at the bedside, where so frequently prompt drug action saves lives that are too valu- able to be imperiled by unscientific methods in pharmacy or therapeutics." The day of the dispensing pharmacist as a manufacturer is as certainly passing as old methods in other spheres of human effort. Selected trial and standard preparations made by men of repute whose reputation and capital and business success are all staked upon accuracy, quality and unvarying 420 Reviews, Book Notices, Reprints, Etc. purity and strength are coming on to take the place of the uncertain compounds made for our ancestors by dispensing druggists and called officinal. The preparations of many reliable pharmacists may be found in our advertising pages, all equally reliable. The manufacturing pharmacist today who makes special compounds relieves the medical man of much doubt as to the quality of his prescribed medicine, i. e., manufacturing pharmacists whose products are an- nounced in our pages. SOME REMARKS ON THE PLANTAR REFLEX, with Especial Reference to the Babinski Phenomenon, by J. T. Esk- ridge, M. D., Denver, Colorado. Reprinted from the Journal American Medical Association, January 19 and 26, 1901. This is an exhaustive, painstaking and meritorious pre- sentation of the subjects embraced in the above caption by a reliable observer and able neurologist, already well known to our readers. The author's conclusions are drawn from observations made on three thousand three hundred and eighty cases, eight hundred and thirty cases having been studied with reference to the Babinski phenomenon. The following are the author's conclusions: First—The Babinski phenomenon is an extremely valu- able sign in diagnosis, and probably in progress and pre- vention. Second—It is not a pathognomonic sign of organic dis- ease of the lateral tract. Third—We shall learn by subsequent observations that several poisons or conditions so irritate the lateral tract as to cause a pseudo-Babinski phenomenon, or an apparently genuine one temporary in character. Fourth—Greater care should be used by the investigator, and the carefully studied cases should be much more numerous. This is the most complete study of this interesting sub- ject to be found up to the present time in the literature on this subject. We regret that we have been compelled to abridge it in its presentation. Reviews, Book Notices, Reprints, Etc. 421 The neurological reader will note with interest and recall Cohn's conclusions that the extension reflex of the toes is not an absolute pathological sign. SYMMETRICAL DEVELOPMENT of School Children is the subject of a valuable and timely paper by E. Stuver, M. S.. M. D., Ph. D., Fort Collins, Colorado, in which the author asks the important question, "Does our present school system develop the highest powers of the pupil?" and justly answers the same in the negative. He calls at- tention, none too soon, to the following errors: (first) dur- ing the early, plastic years of childhood young children are given too many studies; (second) the daily sessions are too long; (third) recitations are generally too long; (fourth) intermissions or periods of relaxation are not frequent enough, and the children do not have enough exercise in the open air, with free spontaneous, unrestrained play; (fifth) pupils are frequently deprived of the privilege of at- tending to the calls of nature; (sixth) the system of ex- aminations generally followed is attended by many evil results; (seventh) many teachers resort to cruel, dangerous and harsh punishments, instead of whipping, when corporal punishment is necessary, and sustains his statements. The tender nervous systems of growing children are roughly handled by modern school methods, and the naturally active brains of our children are prodded to over action, which brings brain-stunt and brain-break and weakens organic resistance to mortal diseases. CLINICAL STUDY OF THYROID EXTRACT, by Wm. F. Drewry, M. D., and J. M. Henderson, M. D. Reprinted from Proceedings of the American Medico-Psychological Association, Richmond, Va., 1900. "Of the animal extracts, thyroid was the first to at- tract the attention of the medical profession. Its usefulness has been tested by capable investigators in the treatment of cretinism, myxoedema, catalepsy, tetany, torticollis, epi- lepsy, Graves' disease, some skin diseases, uterine fibroids, amenorrhcea, insanity, etc., with varying degrees of satis- 422 Reviews, Book Notices, Reprints, Etc. faction to the patient and the experimenter," and though its therapeutic value has not yet been definitely determined, it has found a valued place in the therapy of neuropathic and arrested and perverted developmental states. The authors have further elucidated the subject in relation to the insanities in manner profitable to study. The authors present a table of clinical study of ninety cases which will interest and instruct the many psychiatric clinicians who read the ALIENIST AND NEUROLOGIST. A PRELIMINARY COMMUNICATION, with Projection-Draw- ings, illustrating the Topography of the Paracoeles (lateral ventricles) in Their Relations to the Surface of the Cerebrum and the Cranium, by Edward A. Spitzka, New York, student of medicine, College of Physicians and Surgeons. Reprinted from the New York Medical Journal, February 2, 1901. We acknowledge receipt, with the author's compliments, of this praiseworthy, practical and very successful effort to classify a hitherto not over-clear subject, viz.: the correct location and way to the lateral ventricles. The author's diagrams and text will entertain and profit the reader, the former being especially instructive to the brain surgeon. This preliminary communication of the author is warrant of much further promise. Edward A. is likely to become as distinguished a cerebro-anatomist as his eminent father, E.C. CHLORALAMID, by S. V. Clevenger, M. D., of Chicago, author of Medical Jurisprudence of Insanity, etc. Re- printed from the Medical News, December 8, 1900. This is a good clinical review of the subject, giving much therapeutic information. BIBLIOGRAPHISCHER SEMESTERBER1CHT der Erscheinungen auf dem Gebiete der Neurologie und Psychiatric Von Dr. med. et. phil. G. Buschan. Funfter Jahrgang, 1899. Zweite Halfte. Jena, Verlag von Gustav Fischer. This is an excellent bibliography for the German and cosmopolitan medical writer and investigator and should Reviews, Book Notices, Reprints, Etc. 423 have a place in the library of every advanced student of medical literature. Its appropriate motto is Semper Bonis Artibus. TURERCULOSIS OF THE TESTICLE, with special Consider- ation of Its Conservative Treatment, by John B. Murphy, Chicago. This is the best monograph on this subject that has come to our review table. It bears the impress of a mas- ter's hand, both in description and technique. The ski- agraphs of the vas and mercury injected tube and of spermatic artery, figures 1 and 2, will especially interest the genital surgeon. All the twelve illustrations are inter- esting, lil0-\7 AN NEUROSES EPILEPSY AND THE SUCCESSFULLY ACCOMPLISHED ...BY THE USE OF... HYDROCYANATE OF IRON(TILDEN'S) A STANDARD NEUROTIC REMEDY, INDICATED IN EPILEPSY LOCOMOTOR ATAXIA HYSTERIA NEURASTHENIA MANIA NEURALGIA CHOREA MIGRAINE DOCTORS, INVESTIGATE! Write us for literature and clinical reports on the treat- ment of EPILEPSY and NEUROSES. We have on file in our office hundreds of testimonials from men of prominence and ability in their chosen profession, who have employed HYDRO- CYANATE OF IRON (Tilden's) with unvarying success in the treatment of EPILEPSY. Copies of same cheerfully mailed upon application. Prepared Exclusively for Physicians' Prescriptions. SOLD ONLY 15 OUNCE CARTONS, 1/2 AND 1-ttRAIN TABLETS. $1.00 PER OUNCE. PREPARED ONLY BY THE TILDE1IM COMPANY, Manufacturing Pharmacists, NEW LEBANON, N. Y. ST. LOUIS, MO. The Western Clinical Recorder (BI-MONTHLY). A Pithy, Practical Periodcial for Practicing Physicians *" that will keep a man fully abreast of the times, if he can afford but one, and one that the practitioner who takes twenty cannot afford to do without. The RECORDER will be found to be an original, clean, ethical, inexpensive periodical; a continuous post-graduate course in all departments of medicine and surgery. THE USEFUL JOURNAL FOR THE BUSY MAN, $1.00 Per Year in Advance; which subscription may be sent to the office of publication, Lakeside Press, Chicago, or to the Editorial Office, Ashland, Wisconsin. 430 Publisher's Department. tinued, varied and judicious use of expectorants. "The cough," says one prominent physician, "hangs on, harasses the patient with its frequency and severity, and is exceed- ingly liable to recur every winter—to become a regular 'winter cough'—with its sequela; of emphysema, asthma and ultimately, dilatation of the right heart." Dr. Milner Fothergill of London insisted that cough of this character is due to lack of tone, not only in the general system but in the blood vessels of the bronchioles. This authority demonstrated that the only successful method of treating this form of cough is by means of appropriate systemic and vascular tonic medication. It is particularly in this class of cases that Gray's Glycerine Tonic Comp. has gained a most enviable reputation. This remedy, which is a mbst palatable and agreeable one, not only has a selective tonic and anti-phlogistic action upon the respiratory mucous membrane, but it removes the ever-present ele- ment of systemic depression. The beneficial effects of Gray's Glycerine Tonic Comp. even in rebellious cases, are invariable and most pronounced. AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION. —Office of the Secretary, Oak Grove Hospital, Flint, Mich. To Members: The next meeting of the Ameri- can Medico-Psychological Association will be held in Milwaukee, Wis., June 11, 12, 13, and 14, 1901. The date has been placed a little later than usual that this deservedly popular convention city may be visited at a pleasant season. Hotel Pfister, selected for the meeting of the Associa- tion, has ample accommodation for all members and offers special rates. Its rooms are airy, spacious, and well furn- ished; it has an excellent auditorium, a pleasant restaurant, and a large banqueting hall. A full attendance at the meeting, which promises to be one of unusual interest, is earnestly desired. Will those members expecting to read papers, kindly send titles thereof to the secretary as early as possible. It is announced with much satisfaction that Dr. War- WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR. WM. BARR oggSs CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. 8EDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AT THE WM. BARR goods GO'S NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... St. LOUIS. P. S. Write and find out our special terms to Hospitais. NAI I -RROOI^F A private hospital n ***-■- DHVUrVt, For Mental and Nervous Diseases CASES OF ALCOHOLISM AND DRUG HABIT. An inviting quiet hospital for the careful medical care of acute mental diseases, with a refined congenial home for the chronic mental invalid. The location is unsurpassed for healthfulness and charming environment. Cases of alcoholism and drug habit may commit themselves, f-or information and rates address DR. D. W McFARLAND. New York Office with Dr. LAWRENCE, GREEN'S FARMS, CONN. 59 East 65th St. Hours, 12-1 and by appointment. New York Telephone 591-79th St. 431 Publisher's Department. ren P. Lombard, Professor of Physiology in the University of Michigan, will deliver the annual address. This will have to do with Re-enforcement and Inhibitation of Nerv- ous Processes. Very Respectfully, C. B. BURR, Secretary. DR. T. D. CROTHERS' Quarterly Journal of Inebriety, January, 1901, endorses "Antikamnia as one of the stand- ard remedies in Influenza. He has never seen a case of addiction to antikamnia, hence he prizes it very highly as one of the most valuable remedies for diminishing pain without peril, especially the pain following the withdrawal of morphia. 'Laxative Antikamnia & Quinine Tablets' be- sides its antipyretic and analgesic effect, is without griping, nausea and other unpleasant effects generally produced by purgatives when administered alone." THE USE OF BROMIDES IN HYSTERIA, DELIRIUM, ETC., by J. S. Murphy, M. D., Sullivan, lnd. Consider- able has been written on this subject which has all the re- spectability of ancient lineage. And like most other ob- scure things, has received no stint of authoritative atten- tion. The aetiology of hysteria has never been satisfactorily explained. For a long time it was thought to be in~-some way related to uterine disturbances. But while it is not denied that sexual disorders may have a bearing on the primal cause of the phenomena, still it is also claimed that the ailment attacks both sexes. We have progressed not further than this. The treatment at best has been attended in most cases with disappointing results. We are confronted with a "loss of due balance between certain of the high func- tions of the brain, spinal cord and sympathetic system." The treatment obviously should be, then, to restore this balance. Rest is a very essential feature. By rest is meant restraint of overaction of certain of the spinal nerve TO GUARD THE HEART In the treatment of Febrile, Nervous and Chronic Diseases, and as a Remedy in Functional Disorders of the Heart and Circulation. Kach Pillet represents one one- hundredth of a grain of Oactina, the active proximate principle of Cereus Gratidlflora (Mexicana). I >os*:—1 toVpllleU. USE Cactina Is no longer an experi- ment. Physiological writers and the medical profession recognize in it the safest heart tonic In many con- ditions. I CACTINA PILLETS. Sample mailed free to physicians. Artificial digestive agents, such as pepsins and pre-digested foods, are temporary expedients. In treating chronic dyspeptics increases the secretion of the digestive fluids, relieves congestion of the mucous coats of the entire alimentary canal and restores the assimila- tive processes. Dose—one teaspoonful before meals; the dose before preferably in hot water. Samples to physicians who will pay express charges. SULTAN DRUG CO., Manufacturers of Cactina Pillets and Seng, St. Louis. jftf Chionia [mf Chionia J™* Chionia „PBDCOfs Hromides , aromides Bromides 'Bromides PBnCOCkS Phinnin PBaCOCkS Phinnin Bromidesi Lhiania Bromides LLh,0niD WHEN YOU USE PEACOCK'S BROMIDES YOU USE THE BEST. Each fluid drachm, represents lSgrainsof I Put up in half-pound bottles only. Pull the combined 0. P. Bromides of Potassium, size sample to physicians who will pay Sodlum,Caiclum,Ammonium, and Lithium. | express charges. Chionia Chionia P U I 0II I A AN HEPATIC STIMULANT. U 11 I UIIIM NOT A CATHARTIC. Chionia; i 1 Peacocks Bromidesj (From Stimulates portal rIrrulutIon. strengthens the lymphat Irs, and removes Chronic Consti- pation and Sluggish Conditions of the Liver by Its general tonic action on thatorgan. Put up In half-pound bottles only. Full size bottle to any physician who will pay express chargos. PEACOCK CHEMICAL COMPANY, St. Louis. Chionia 432 Publisher's Department. centers. My experience has taught me that nothing gives better results than the combined bromides; and these should be of the very purest obtainable. For this reason 1 have availed my professional self of Peacock's, not only for their purity—freedom from bromates and carbonates so common to the commercial bromides—but on account of their ideal synergic effects and the fact that they are neu- tral in reaction, which permits of combining certain alkaloids in the solution without fear of danger of precipitation. In various forms of neurosis I have found Peacock's Bromides invaluable as an all-round agency of alleviation and cure. They have never disappointed me. In obstinate cases of epilepsy, where the treatment is necessarily pro- tracted, 1 find them particularly useful in that their admin- istration is not followed by the too common symptoms of bromism. And 1 would specially urge their utility in in- stances of delirium following alcoholic excesses. Anything that conserves the vital forces, that does not depress any organ, as for example, the cardiac centre, anything that gives the rest or normal sleep when repair is greater than waste, anything that tends to restore the nervous equilibrium, soothing the exciting centres, what- ever they may be, must benefit the entire organism when each separate organ, then, of course, will receive its need- ful quota of help. And since local treatment is out of the question, I cannot conceive of better procedure, or one more infallible to the successful management of hysterical cases. MAL-ASSIMILATION.—I have prescribed Seng for in- digestion and mal-assimilation and find the improvement marked from the beginning of its administration. I have prescribed it very successfully in a number of cases. When- ever 1 meet the two above conditions 1 never failed to use it. J. H. LAWRENCE, M. D., Smithfield, Va. HAGEE'S CORDIAL of Cod Liver Oil with Hypophos- phites of Lime and Soda is the remedy for Grippe. It re- "RIVER CREST," (UNDER STATE LICENSE.) ASTORIA, L. I., NEW YORK CITY. FOR MENTAL AND NERVOUS DISEASES. Separate detached building for Alcoholic and Drug Habitues. Splendid location. Overlooks East River and the City. Address J. JOS. KINDRED, M. D., Physician.In- Charge. City Office, 1125 Madison Avenue Cor. 84th Street, 2 o p. m. daily. Sanitarium telephone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Aico- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore. Md. Dr Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. THE BLUE HILLS SANITARIUM MILTONMassachusetts A PRIVATE HOSPITAL AND IDEAL RESORT. All classes of patients admitted. Separate department for the victims of ALCOHOL. OPIUM. COCAINE AND OTHER DRUG HABITS. All desire for liquors or the baneful drugs overcome within three days after entrance, and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hvelenic treatment; also a Ten-plate Static Electrical Machine, with X-Ray, and all the various attachments. J. FRANK PERRY. M. D.. Supt,, 2 Park Square. Boston. Mass. DR. WM. B. FLETCHER'S SANATORIUM. For treatment of Nervous and Mental Diseases. Special treatment of Diseases of Women by DR. MARY A. SPINK. 218 H. ALABAMA ST., • - - INDIANAPOLIS, IND. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIBR SUDDUTH, M. P., 100 State St., CHICAGO. Mention this Journal when writing to Advertisers. 433 Publisher's Department. stores health, and has the further effect of curing the disagreeable post-grippal symptoms so often seen. Thus, night sweats, loss of weight, and the entire train of nervous symptoms, such as intestinal neuralgia, head- ache, brain fag, eye strain, etc., quickly yield to its action. It is pleasant to take, efficient in action, and a great builder of all the tissues. CARBUNCLES.—Creel has relied on Ecthol given in- ternally, in doses of a teaspoonful, in cases of carbuncle, flax-seed poultices applied locally, emptying of pus, scrap- ing out of dead tissue and cleansing with peroxide of hydrogen; after this a topic application of Ecthol or absor- bent cotton every hour to eight hours. The average dura- tion of this treatment in his cases was ten days.—Journal . American. Medical Association. NEW REMEDIES.—Probably no other remedy has been appreciated and become popular by and with the medical profession in such a short time, as "Borobenphene" and "Glycobenphene," manufacutured by the old and reliable firm Henry Heil Chemical Co., of this city. This firm has built up, in the course of a generation, a reputation for furnishing only high grade goods, and fully guarantees every article it sells. We therefore take pleasure in call- ing the 'attention of those physicians, who are not yet using these preparations, to them. If they do not care to prescribe these remedies without having personally tried them, they should avail themselves of the firm's offer to furnish an original bottle of either or both of them gratis. Borobenphene-Heil is a powerful, safe, reliable, non-irri- tating and pleasant antiseptic. Glycobenphene-Heil is the new remedy for Eczema and kindred skin diseases. If it is not convenient for physicians to call for the samples, they only need to write the firm and they will be promptly sent. THE PORTRAITS OF OUR PRESIDENTS, with biograph- ical sketches, by General Charles H. Grosvenor; title page ACtTYLtNr. BUILDINO r»»i PAN-AMERICAN EXPOSITION Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, MJD. City Office, 21 East 44th St,, SING SING, P. O., N, Y. Mondays and Fridays, 3:30to4:30,p.m. Long Distance Tel., Hart, 140A,Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, M. D. FALKIRK. JAMES FRANCIS FERGUSON, M.D. M. LANGDON BIRD, M.D. On the Highlands of the Hudson, near Central Valley, Orange Co., New York. A Home for treatment of nervous and mental diseases, and the alcohol and opium habits. Falkirk is 800 feet above the sea level; the grounds cover over 200 acres; are well shaded and command a magnificent view. The buildings are steam heated and lighted by gas, the water supply from pure mountain springs. All the rooms face the southwest, the best methods in sewerage have been followed, and the arrangements for comfort and recrea- tion include a sun-room, steam-heated in winter. Dr. Ferguson may be consulted at his office, 168 Lexington Avenue, New York City- Tuesdays and Fridays, between 11:30 a. m. and 12:30 p. m., and by appointment, or may be addressed at Central Valley, Orange County, New York. Long Distance Telephone, "Central Valley, New York." SANITARIUMS and DOCTORS ~^ CAN OBTAIN SPECIAL RATES for CARD ADVERTISEMENTS We have a few bound copies of the ALIENIST AND NEUROLOGIST on hand. Price, $6.50 Prepaid. Mention this Journal when writing to advertisers. 434 Publisher's Department. designed by Tiffany. This Inaugural year, when the public mind is aroused over Presidential questions, is a fitting time to issue General Grosvenor's book. Its sale is already tremendous, and will perhaps exceed that of General Grant's Personal Memoirs. Every patriotic American desires to read what General Grosvenor has to say of George Washington, Thomas Jefferson, Andrew Jackson, Abraham Lincoln, President McKinley and other Chief Executives of the Nation. Every- body desires to read what General Grosvenor, the staunch old Republican leader in Congress, will say of that staunch old Democrat, Andrew Jackson, the Father of the Democratic Party. General Grosvenor has thrown into his sketch of Jackson all the fire and energy of his nature. The biography of Thomas Jefferson is grand. The biography of Lincoln is as beautiful as a sunrise over the hilltops. General Gros- venor has personally known all the Presidents since the time of James Buchanan. The General's book will there- fore contain history which has never before been published, written from his own personal observation of these great men. General Grosvenor has served in Congress for nearly twenty years, and he has served his country in war and in Congress for nearly forty years. The book contains twenty-four large Photogravure Etchings as fine as Steel Plates, printed by hand, on heavy plate paper made especially to order. These 24 Photogravure Etchings are in different tints, and are well worth $2 each. These portraits are made from the Paintings endorsed by the family and near relatives of the Presidents. Two year's time and a fortune have been expended in securing these reproductions. The complete book is well worth J550, but the price has been placed so low that the most humble American citizen can own it. The biographical sketches are printed in large open type in two colors; the work is so beautiful that when people see it they want it. The advance sale is very large. President McKinley was the first subscriber. There is one edition known as The President Edition de Grand Luxe, initial letters hand painted, Portraits hand colored, title page hand illuminated, registered and numbered; subscription ESTABLISHED 1870. RIVERVIEW SANITARIUM. For the private care and treatment of Nervous persons, Mild mental cases, Opium and select Alcoholics. Thoroughly equipped with modern Electrical and Hydrlatic devices, Turkish baths, etc. Arrangement (or the reception of patients can be made any hour of the day or night by means of a long distance telephone from any point. Our number is 46-2 Fishkill. ADDRESS P. O. BOX, 694. W. S. WHITWELL, M.D. FISH-KILL-ON-HUDSON, NEW YORK. THE WESTPORT SANITARIUM, WESTPORT, CONN. A Private Institution for the Care of Mental and Nervous Diseases. Pleasantly Situated. Extensive Grounds. Fifty Acres. Beautiful drives, walks and grove of pine trees. Careful Medical supervision, Kind and Reliable attendants. Bowling Alley, Croquet, Tennis and frequent entertainments. Cottage care with private attendants if desired. Terms Moderate. Applications can be made at 979 Lexington Avenue, New York.City, (Wednesdays from 10 a. m. to 12:30 p.m.) Address F. D. RULAND, Medical Supt., Telephone D13. westport Sanitarium, westport, conn. , 435 Publisher's Department. price, $250. Orders and applications for territory are com- ing in rapidly. A high class man or woman of good social standing can soon make a small fortune taking orders in this community. Send reference and apply for terms quick, as the territory will be assigned soon. Address, The Con- tinental Press, Corcoran Building, opposite United States Treasury, Washington, D. C. ,AN EXPOSITION BOOKLET.—Another beautiful produc- tion from the Bureau of Publicity of the Pan-American Exposition at Buffalo, is on our review table. It consists of sixteep pages and a cover in light green. The unique feature of it is the miniature production of the famous poster, "The Spirit of Niagara," which has had a most remarkable demand. The booklet is a popular picture book, the first page having an engraving of the magnificent Electric Tower, which is three hundred and ninety feet high, and which will form the glorious centerpiece of the great Exposition. The center of the booklet shows a birdseye view of the Exposition, and gives one some idea of the great extent of the enterprise upon which $10,000,000 is being expended. The grounds contain three hundred and fifty acres, being half a mile wide, and a mile and a quarter long. Other pages show horticulture, graphic arts and mines, manufac- tures and liberal arts, the Music Temple, the Plaza and its beautiful surroundings, the Stradium or athletic field, the agricultural, live stock and ethnology features, and a few of the thirty or forty ingenious and novel exhibits which promise to make the Midway the most wonderful that has ever been prepared for Exposition visitors. The railroads will make low rates from all parts of the country during the Exposition, which opens May 1 and continues six months. "Any one desiring a copy of this booklet may have it free by addressing the Pan-American Bureau of Publicity. :, YOU MUST BE AWARE that in Herpes Zoster, all so- called ointments, paints etc., are not of the slightest use, and that the disease runs its painful course in spite of treatment internal or external. Having a severe case of CHLORETONE HYPNOTIC LOCAL ANESTHETIC ANTISEPTIC 1 Physicians have made favorable re- ports of its use in Insomnia, Epilepsy, Asthma, Nausea of Pregnancy and Anesthesia, Seasickness, Chorea, Alco- holism, Headache, etc., etc. . ti | In minor surgery and dentistry it has many advantages over cocaine and the like, in that it is markedly antisep- tic as well as anesthetic, and does not depress the heart We supply Chloretone in 3- and 5-gr. Sugar-coated Tablets, in bottles of 100; also in crystals in ounce and half-ounce vials. Sample and literature sent free on application. Parke, Davis 6 Co., Home Offices and Laboratories, DETROIT. MICHIGAN. and Montreal, Ouebec. , Branch Laboratories: LONDON. ENG., AND WALKE.RVILLE., ONT. 436 Publisher's Department. Herpes where the chest, back and arm was affected, and the patient's pain unbearable, and knowing the value of Ecthol, I ventured to give it a trial. I applied Ecthol on pieces of lint, and strange to relate within twenty-four hours, the pain had mostly subsided and the pustules had quite a shriveled appearance. This was the third or fourth day of the disease. The patient made a painlesj recovery thenceforth. I am giving it extensive trials now in all cases where there is any pus. D. P. SETHNA.'L. M. and S., Ill Gorgaum Road, Chandarnwady, Bombay.' Bombay, Dec. 23rd, 1900. THE LIGHT OF THE WORLD, or Our Saviour in Art costs nearly $100,000 to publish. Contains nearly one hun- dred full page engravings copied direct from the World's Greatest Paintings of our Saviour and His mother. Con- tains History of Painting, Biography of Painter, and the Galleries in Europe where the Original Painting may be seen. The most beautiful publication ever issued. The strongest hearts weep at the sight of these wonderful pic- tures of Jesus and His Mother. Everybody says they are grand, sublime, matchless, magnificent, beautiful, inspiring and uplifting. The sale is unprecedented. The presses are running day and night to fill the orders. Twelve carloads of paper were required for the last edition. Small fortunes are being made by the thrifty with this marvelous work. Contains also a childs story beautifully written to fit each picture. This wonderful book, matchless in its purity and beauty, appeals to every mother's heart and in every Christian home, where there are children it sells itself. A Christian man or woman can soon clear one thousand dollars ($1,000) taking orders in this community. Others are doing this. Why not you? We are advertising in nearly ten thousand newspapers in this country, Canada, England, and Australia. Shipping books to every English- speaking country in the world. We shall promote our best workers to positions of State Managers, Correspondents and Office Assistants. We also own and publish large Photo- gravure Etchings of the great paintings in the Galleries of BELLEVUE PLACE SAMTARIUm 35 Miles from Chicago. Established by DR. R. J. PflTTERSOIl In 1867. for the treatment of NERVOUS AND MENTAL DISEASES OF WOMEN. A massive stone structure with spacious rooms, electric light and steam heat, large 1 greenhouses, extensive grounds and beautiful country drives. Private and retired, with home comforts, restful surroundings and skillful medical treatment. Terms moderate. Address for circular, ?. H. MINEES, m. D., or BELLEVUE PLACE CO., BATAV1A. ILL. OAK GROVE HOSPITAL For Nervous and Mental Diseases. Grounds comprise sixty acres of stately oaks, and are picturesque and secluded. Buildings roomy, homelike, free from rtstitutional feat- ures, and erected with especial reference to the care of nervous and mental invalids. « Interiors Bright and Cheerful. Luxurious Fur- nishings, Superior Appoint- ments, Skilled Attendance, First-class Cuisine. Equipment for hydro- therapeutic and electric- al treatment complete and modern—Static, Galvanic and Faradic Apparatus, Electric Bath, Baths and Massage. Noyes Amusement Hall in connection with the Hospital, containing gymnasium, billiard room, bowling alley, hall for assemblies, sitting room, lounging room and library, furnishes ideal facilities for indoor sports and diversion. Carriages for the daily use of patients free. For terms, address DR. C. B, BURR, Medical Director. FLINT, MICH. 437 Publisher's Department. Europe. One^cr more |of these Etchings can be sold in every home. By carrying the book and the engravings your success will be tremendous. Mrs. Waite, of Worcester, Mass., has sold nearly four thousand dollars worth of books there. Mrs. Sackett has sold nearly two thousand dollars worth of books in New York. Both of these ladies answered our advertisement, and had never sold a book before. Took fourteen orders first two days—H. Col well. Took five orders first day; twenty-three orders first week, clearing over #50—Hattie Lemwell. Thousands of others like above. It is printed on velvet-finished paper; bound in Cardinal Red, Green and Gold and adorned with Golden Roses and Lilies. Write quickly for terms as the territory is going rapidly. When you prove your success, we will promote you to the position of Manager and Correspondent under yearly contract. We shall soon move into our new and elegant structure to be occupied solely by us, and to be known as the Light of the World Building. Address, The British-American Co., Cor- coran Building, opposite United States Treasury, Wash- ington, D. C. THE WORK OF PATRIOTIC SOCIETIES.—The Wallace House of Somerville, is made the subject of an illustrated article in the April number of The Delineator. It shows photographs of the interior and exterior as restored. It demonstrates the valuable work done by patriotic societies in saving from further destruction a house and its contents that were memorable in Revolutionary times. NINE HUNDRED DOLLARS yearly to Christian man or woman to look after our growing business in this and ad- joining counties, to act as Manager and Correspondent; work can be done at your home. Enclose self-addressed, stamped envelope for particulars to J. A. Knight, General Manager, Corcoran Building, opposite United States Treasury, Wash- ington, D. C. MADAME GRUND'S APHOISMS.—Madame Sarah Grund lately consented to talk on the Art of Happiness. Some o her aphorisms are worth keeping. The David B. Crockett Company, Manufacturers of FINE VARNISH SPECIALTIES. Leaders in our line daring1 thirty years past. Five Practical Reasons why Architects, Builders. Government and State Institutions should use THE DAVID B. CROCKET CO/S PRESERVATIVE: 1st.—It develops and preserves the different kinds Bath Rooms, Stables. Hospitais, or other public bulld- ot wool In their natural beauty. Ings. 2d.— It is not affected by not or cold water. 6th.—As a finish In Dining; Rooms, Kitchens, Hallways, Sd.— Will not crack, blister or turn white. Bath Rooms and Interiors of Railway Cars.over grained 4th.—Its surface Is not Impaired by contact with work or on hard wood it is superior to any articie in soap, grease, or by the ammonia generated in use. Nothing eise will stand on Refrigerators. "Water Proof Floor Finish For Interior Floors, Oil Cloths. or Linoleums. Can be rubbed and left with an egg shell gloss, wbi h is superior to wax finish- ing and costs less. Bath Room Finish. A new specialty for varnishing Toilet. Bath, fcngine. Refriger- ator, and More Rooms. Boat Houses, Yacht Cablns and Sal- oons, Breweries, Stables, Lab- oratories, Kitchens. Pantries and Water Closets. Not affect- ed by frequent contact with chemical gases. Immersion in salt water, or washing with hot or cold water and soap. Five Practical Reasons Why Architects, Bulldera, Govern. merit and State InstiluTTong should use the David B. Crockett Co/s. Spar Composition: THE DAVID B. CROCKETT COMPANY, The only genuine articie of Its kind in the market. 1st.—As a finish on exterior wookwork on Yachts, Steam- boats and Railway Cars It has no equal. 2d.—On Front or Vestibule Doors, over grained work or on natural woods, it will outwear all other materiais used for such purposes. 3d.—h will not crack, turn white or blister. 4th.—h will stand washing with hot or cold water and soap 5th.—The extreme toughness and durabllity of Spar Compo- sition make It superior to any articie ot the kind ever offered. All our goods can be rubbed and polished or left with an egg shell gloss. If local dealers cannot supply you, send direct to Bridgeport, Conn., U.S.A., SAMUEL SWAN, President. W. B. LENT, Vice-President. CHAS. P. TOWNER, Sec. & Trees. Our "Architectural Hand Book," giving prices and full particulars, sent free on application. Mention this Journal when writing to Advertisers. 438 Publisher's Department. There are minor pleasures whose effect is accumulative, and which make up a happy life. Even in choosing to be miserable we are happy, since there is happiness in every act of choice. Amongst women the desire to work is not so common that it should be discouraged. There is a great deal of difference between a copy and an imitation. The misery children make for their parents is well known; the misery parents make for their children not so well. The two great sources of happiness are health of body and strength of mind. In recipes for happiness goodness must always be the principal ingredient. When people begin to be critical they cease to be pleasant.—The Saturday Evening Post. SUCCESS published by McGraw Marden & Co., New York, $1.00 per annum, contains a sketch of the early life of the present Governor of New York, Mr. Odell, which will be of interest to all classes of readers. AS IN MACHINERY we must first repair the little wheel, out of gear, so in society we must first study the criminals crank, insane, or pauper who can seriously injure both in- dividual and community. Thus a worthless crank by killing a prominent citizen can paralyze the community. The in- jury from such action is often beyond calculation. Our government pays out millions to catch, try, and care for • criminals, but gives very little to study the causes that lead to crime. The study of man, to be of most utility, must be directed first to the causes of crime, pauperism, and other forms of abnormality. To do this the individuals themselves must be studied. As the seeds of evil are usually sown in childhood and youth, it is here that all investigation should commence, for there is little hope of making the world better if we do not seek the causes of social evils at their beginnings.—Dr. MacDonald's Appendix to a Psycho-physical Study of Zola. BARNES flEDICAL COLLEGE, «.S£*. .tefirln *W7m BOARD OF TRUSTEES. JOHN D. VINCIL, D. D., President. Grand Secretary Masonic Grand Lodge of Missouri. JOHN C. WILKINSON. Vice-President, HargadlneMcKlttrick Dry Goods Co. GEO. A. BAKER. President Continental National Bank. A.M. CARPENTER, M. D.. Vice-President ot the Faculty. A. R. KIEFFER. M. D.. Assistant Secretary. WM. T. ANDERSON. Treasurer. President Merchants Exchange and Director St. Louis National Bank. J. B. LEGG President Lest: Architectural Co. C. H. HUGHES. M.D.. Presfdent of the Faculty. JOHN H. MARMADUKE, Cashier Mealco Sav- ings Bank. HON. JNO. M. WOOD. ex-Atty.. Gen'l. Mo. PINCKNEY FRENCH, M. D.. Secretary. [FACULTY. Prof. C. H. Hughes. M. D.. Pres. Prof. A. M. Carpenter, Vice-Pres. Prof. C. M. Riley, M. D. Chas. R. Oatman. M. D. W. C. Day. M. D. Jno. H. Duncan, M. D. Edwin R. Meng, M. D. M. D. Jones. M. D. J. T. Jelks, M. D. S. C. Martin, M. D. W. L. Dlckerson. M. D. G. M. Phillips. M. D. F. L. Henderson. M. D. A. R. Keiffer, M. D. J. H. Tanquary, M. D. Jno. W. Vaughan, M. D. A. W. Fleming. M. D. R. C. Blackmer M. D. C. H. Powell, M. D. M. Dwight Jennings. M. D. J. Leiand Boogher. M. D. Plnckney French, M.D.. Secretary. "•k-A FOUR-YEARS' GRADED COURSE OF INSTRUCTION.-*. Season of 1899-1900 commences September 11th, and continues seven months. Instruction, especially practical: new and spacious building, located In the heart of the city and within five blocks of the new station: modern In all appointments; ample ciinical and laboratory facilities; course of study conforms to the require- toents of all health boards: tuition moderate: ho pltal and dispensary privileges free. Special terms to sons and brothers of physicians, sons of the ciergy and graduates of pharmacy and dentistry. For announcement or information, address BARNES MEDICAL COLLEGE, ST. LOUIS, MO. Mayfield... Sanitarium, ST. LOUIS, MO. Best Under strictly REGULAR management, fession. For further information, address, Diseases of Women a Specialty. Large Surgical Department with Latest Appliances. Nurses Specially Trained In the care of Different Specialties, This Institution has the of modern improvements. Is built of best quality buff Roman Pressed Brick in Italian Renaissance. Large and well lighted rooms, broad verandas, non-absorbent operating rooms, aseptic walls, hydraulic elevators, heated with hot water and lighted with elec- tricity. Complete telephone sys- tem, shower and massage baths, Swedish movements. Electrical treatment of all kinds. CUISINE UNEXCELLED. Staff of Physicians of high standing in the pro- W. H. MAYFIELD, M. D. gia Taylor Avenue, ST. LOUIS, MO. .1 ' -J 439 Publisher's Department. COLLIER'S WEEKLY is an illustrated magazine of ster- ling worth. The illustrations of the current events in the world's history are the best that come to our table and are well worth the small subscription of $5.20 per annum. A NATIONAL PARK at Valley Forge.—Through the efforts of the patriotic societies a bill has been introduced in Congress providing for an appropriation of $200,000 for the purchase and preservation of Valley Forge where Washing- ton and his army encamped in those uncertain and terrible days which preceded the victories that led to American in- dependence. Fortunately this region has not yet been de- spoiled by the changes of modern life. It is a beautiful piece of country with glorious hills, splendid forests and all those variations of topography which will make a perfect pleasuring ground for the people. In addition, the historic points are well preserved, and many of the defenses con- structed by Washington's heroes still remain. Students of history often spend days traversing the country following the footsteps of the patriots. It is held—and rightly so—that winter at Valley Forge was a crucial period of the fight for freedom; that it led to the battles of Trenton and Princeton, which changed the ill fortunes of the war, and that to-day it is one of the sacred spots of American territory. The new park will consist of about a thousand acres, and the ultimate success of the efforts of the patriotic societies seems to be certain.—The Saturday Evening Post. THE SATURDAY EVENING POST founded by Benj. Franklin will be found to contain many items of general interest for old as well as young. THE PAN-AMERICAN EXPOSITION, at Buffalo, N. Y., May 1 to Nov. 1, 1901, will surpass all former enterprises in six important features: (First) In elaborate and beauti- ful electric lighting effects, using over 200,000 lamps: (Second) in the splendor of its hydraulic and fountain WHY NOT, DOCTOR? Why not give your patients the best chance for complete and permanent recovery by referring them to The Alma Sanitarium A Health Home for men and women to live com- fortably in, to get well in, to tell their friends about. Our only "fad" is scientific diagnosis and treatment. Discount to physicians. Write for book- let and full information. The Alma Sanitarium Company, ALMA, MICH. GEORGE F. BUTLER, M. D., Medical Superintendent. 440 Publisher's Department. effects, .a stately canal over a mile long encircling the buildings and all courts having water features of un- paralleled beauty; (third) in exquisite horticultural and floral embellishments, a wall of foliage surrounding the Expionosit, -rare plants and brilliant flowers adorning the grounds; (fourth) in original statuary and plastic ornamentation—more than one hundred and twenty-five large groups of American sculpture; (fifth) in the richness of its color decorations, all buildings to be tinted in beautiful and harmonious shades; (sixth) in the magnificence of its court settings, the court area being much larger than at any former exposition, pro- ducing vistas of exceptional grandeur. Cost of preparing Exposition buildings and grounds, including Midway, about $10,000,000. Proposes, to celebrate achievements of the western hemisphere during one hundred years; to promote trade among Pan-American countries; to present a great object lesson showing progress of the western world to date. All the leading Pan-American countries will participate. Site, three hundred and fifty acres in northern part of Buffalo; twenty minutes' ride from center of city; electric railways on three sides; twenty-six steam railways have access to Exposition station. Architectural features, twenty large buildings, a free adaptation of the Spanish Renaissance, by way of compliment to Latin-America. Albright Gallery ,of Art, costing over $30,000, and New York State Building, costing $150,000, of white marble, fire-proof, in the style of ancient Greek temples. Electricity, grandest electrical exposition ever held. Beautiful electric tower for display, three hundred and seventy-five feet high; five thousand horse-power transmitted from Niagara Falls, four thousand horse-power developed on the grounds. Government Par- ticipation, appropriation $500,000. Exhibits by all depart- ments, including a life-saving station with daily exhibitions; post-office in daily use, light-house in operation, naval and ordnance display, fish in aquariums, weather signal station in operation, displays by the mint; special exhibits from the Hawaiian and Philippine Islands, Tutuila, Guam, Porto Rico and Cuba. Special features, stadium for sports, seat- WE WANT YOU to investigate these machines. We believe it will be to your interest, because a GOOD STATIC MACHINE becomes an investment, yielding a definite and increasing dividend greater, generally, than any other apparatus. Our business is to construct PERFECT MACHINES that produce definite and satisfactory results ALWAYS. WATCH OUT FOR BREAKERS! We are the ONLY house manufacturing the GENUINE IMPROVED ATKINSON T6PLER-HOLTZ MACHINES. There are several imitations, which claim to be just as good, but the manufacturers cannot support their claims. Every machine we have sold is a dividend-producing investment. If you desire to know more about them, let us know and we will correspond with you and send you, WITHOUT charge, our large Illustrated Catalogue. Mcintosh Battery & Optical Co., ggS!g. INTERPINES, GOSHEN, NEW YORK. A beautiful, quiet, restful HOME, for the care and treatment of the Nervous and Mental Invalid. Under State License, voluntary and committed cases received. CITY OFFICE: Mondays and Thursdays. 113 W. 85th St., NEW YORK. 1 to 3 p.m., by appointment. F. W. SEWARD, M.D. ANAnOI ANALGESIC* fViyfVlJUl^ ANTIPYRETIC. Is useful in La Grippe, Sciatica, Rheumatism, Neuralgia, Hemicrania and allied affections. It reduces temperature and relieves pain, without the usual disagree- able after-effects. PRICE Per lb., $330; 1000 Tabs (5 gr.) $4.00. Wheeler Chemical Works, 137 Lake Street, CHICAGO, ILLS. v^anitat'iuin Morphine & Liquor Habits A Specialty. Morphine habit cured without sick- ness or suffering. Liquor habit cured with only one week detention from business; mild cases none. Booklet free, giving particulsri. Citizens Phone Il9i. C. E. PATTERSON, M. D., Mp., Orind Riplds, Mich. 441 Publisher's Department. ing twelve thousand people. Temple of Music, seating two thousand two hundred. Leading bands of the world engaged for free concerts. Grand fashionable horse show. Exhibits of the Indians of Six Nations, Grandest Midway ever pro- duced, over a mile of new amusements, costing, $2,500,000. Buffalo, four hundred thousand population; twenty-six rail- ways, two hundred and fifty passenger trains daily; two hundred and twenty-five miles of asphalt streets; thirty minutes' ride from Niagara Falls; coolest city in summer in the United States. Low rates on all railways during the Exposition. For further information address: Pan-American Bureau of Publicity. MOTHER GOOSE as Modified by Alcohol.—Under the caption of Mother Goose Up to Date, they sing this nurs- ery song: ''Sing a song of penitence, a fellow full of rye; Four and twenty serpents dancing in the eye; When his eye was opened he shouted for his life; Wasn't he a pretty chump to go before his wife? His hat was in the parlor, underneath a chair, His boots were in the hallway, his coat was on the stair; His trousers in the kitchen, his collar on the shelf But he hasn't any notion where he was himself; When the morn was breaking someone heard him call; His head was in the ice-box, which was the best of all." — The Western Druggists' Exchange. Who will say after this that alcohol does not poison and paralyze the psychic centers? MR. ZANGWILL'S MEMORY.—His Vivid Recollection of the Neuralgia of Miss Agnes Repplier.—Miss Agnes Repplier and Mr. 1. Zangwill have met for the second time. Miss Repplier knows very well the conditions under which they first met, but it seems Mr. Zangwill does not. And thereby hangs a story which, told in Miss Repplier's delightful way, is a choice bit of literary gossip. The first meeting was at a small dinner party. The second was at a large reception given in honor of Mr. Zangwill. KENSETT NORWALK, CONN. For the treatment of Insanity and Nervous diseases, Aicoholic and Narcotic Habitues. Vednesdays 2:30 to 4:15 P. M., 12 East 47th Street. NEW YORK CITY. ADDRESS: EDWIN EVERETT SMITH, SOUTH WILTON, CONN. Its place in the talking machine art is at the very "i op. Evtry other machine is successful only to the ex- tent that it imitates or infringes the GRAMOPHONE. The only practical processes for recording and re- producing sound are covered by Oraphophone patents. A comparison shows that no other talking machine approaches the perfection reached by the Orapho- phone in recording and reproducing music, song, speech or any sound. No one should be de- ceived by plausible representations to the con- trary, but decide for himself by making a lair comparison. Is without a rival for home entertainment. For the home la aold from $5.00 up. , fjrjnd The crownlng wonder of the art, reproduces with full . Uldiiu, volume and marvelous perfection of tone. Can be heard as far and farther than the strongest voice will carry sound. SST« Columbia Phonograph Co., 72*"a8M5!sViio. Graphophc Does Your Advertising Pay? IF NOT Consult Us, and We Will Hake It Pay. The information possessed by us covers all mediums, and when an ad- nrci Tl I^O vertisement is placed with us IiCOULf I O are obtained. We write advertisements that attract atten- tion. Terms reasonable. St. Louis Advertising Agency, Mention this Journal when writing to advertisers. ST. LOUIS, MO. 442 Publisher's Department. The author of The Children of the Ghetto was sur- rounded hy a worshipful circle of women. Miss Repplier approached and some one mentioned her name. Mr. Zang- will sprang forward and in his strident voice said how glad he was to see her again. He took her by both hands, shook them warmly, beamed upon her and said he was so glad to have the pleasure of meeting her again; he re- membered so perfectly how ill she was the last time he had met her; she was such a sufferer from neuralgia and the pain was intense that night. Was she better now? She replied that she felt very well indeed, and that she was most happy to see him again. Then the buzz began. "What a genius he is!" they said. "Think of his remembering that she had neuralgia when he last met her! Isn't he truly wonderful?" And so on and so until Miss Repplier was fairly besieged with exclamations about the lion's wonderful memory. "Now, here is where I grow remarkable," says Miss Repplier; "I never breathed it aloud to one person in that worshipful crowd that I never, never had a twinge of neu- ralgia in my life, and that I was buoyantly well on the night on which I met Mr. Zangwill.—Saturday Evening Post. TURKISH CENSORSHIP.—Rules that govern all Publi- cations in the Sultan's Domain.—An official private circular was issued to the Turkish newspapers several years ago as follows: "Article III.—Do not publish scientific or literary arti- cles too long for completion in a single issue. Avoid the notice 'To be continued,' which causes an uncomfortable tension of the mind. , "Article IV.—Avoid blank spaces and suggestive dots in the body of an article. They tend to raise suppositions, and to disturb the tranquility of the reader's mind, as has lately been seen in the case of The Levant Herald. "Article V.—Avoid personalities. If any one comes and tells you that a Governor or a Deputy Governor has been guilty of embezzlement, maladministration or any other blameful conduct, treat the charge as not proved, and say nothing about it. PRIVATE HOME AND SCHOOL FOR Nervous and Backward Children and Adults. Delightfully located in the midst of 130 acres. GODFREY, ILL., One hour's ride on the C. & A. from St. Louis, eight minutes' walk from station. 350 feet above Mississippi river. Individual training and treatment for a limited number. Seventeen years' experience in Lincoln, III. and Elwyn, Penn. State Institu- tions for the Feeble- Minded. Separate cot- tage of 20 rooms for boys' Home training. Owing to recent im- provements, can accept a few more suitable cases. References with terms on application. W. H. C. SMITH, M. D., Consultations held in St. Louis or elsewhere by appointment. Superintendent. The Medico-Legal Journal. This Journal is devoted to the Science of Medical Jurisprudence—is edited by CLARK BELL, ESQ., with a corps of able associates, and published quarterly at $3.00 per annum. Each volume has a full and complete Index, and when bound forms a valuable addition to the Library of any Lawyer or Medical Man. The Journal is illustrated with portraits of eminent men of Bench, Bar, Alienists, Scientists, and Medical Men—A new feature has been the publication of Sketches of the Supreme Court of the States and Provinces of North America.—Embellished with portraits of the Judiciary. The States of Alabama, Kansas, Oregan, New Jersey, the Province of New Brunswick, Pennsylvania, Delaware and Connecticut have already appeared. Those of Rhode Island, Minnesota, Ohio, Massachusetts, Maine, Michigan and North Carolina will shortly follow and be continued until all the States and Provinces are published. The Sketches, when complete, will be collected in a volume which will be of great interest to the Legal Profession. The Portraits of the Chief and Associate Judges of each State will appear and Portraits of early members of the Supreme Court of each State. Each number of the JOURNAL will contain hereafter at least one State and contributeJ sketches of that court and photographs for reproduction. Lawyers and Judges Throughout the Union are Invited to Subscribe. These volumes will contain a historical sketch of the Supreme Court of each State, written by or under the supervision of the Chief Justice of the Court, or some member of the Supreme Bench, or prominent men selected for that purpose. Address, MEDICO-LEGAL JOURNAL, NO. 39 BROADWAY. - NEW YORK CITY. 443 Publisher's Department. "Article VI.—You are forbidden to publish the petitions in which individuals or associates complain of acts of mis- government, and call the Sultan's attention to them. "Article VII.—You are absolutely forbidden to publish a word about attempts on the lives of foreign sovereigns, or acts of sedition in foreign countries, for it is not good that such things should be made known to our loyal and peace- able populations. "Article VIII.—You must not mention these regulations in the columns of your journal, because they might pro- voke criticism or draw unpleasant observations from ill- conditioned minds."—The New Lippincotts. THE SCIENTIFIC HUMORIST—Of The St. Louis Star, that shines so brilliantly for all the people six evenings in the week and every Sunday morning, has judiciously se- lected the following prophylactic warning poem appropriate to the season from another brilliant meteor of the Pan- American Exposition City, The Buffalo Express, which we give to our readers as a suitable spring-time warning ver- sified as well as a bit of wit. This is the time when fool killers abound and Sanitary fools should get out of their way, the pneumococci, the tubercle and la grippe bacilli are looking for them. Oh, think of the microbes, the dear little microbes, Who've slept through the winter, all covered with snow— How glad they must be that the springtime is coming How cheerfully now to their work they will go! The man whose light overcoat's still at his uncle's And who thinks that his winter coat's too hot to wear— How gladly the microbes will rush to infect him As he walks home at night through the chill evening air! The man who wore flannels since early November And casts them off now at the first breath of spring— Ah, he is the fellow the microbes are after And with his constitution they won't do a thing! The man who rides home on the back of a street car While the lake breezes blow down the back of his neck— BURN BRAE THE SANATORIUM A PRIVATE HOSPITAL FOR MENTAL AND NERVOUS DISEASES Pounded by the late Robert A. Given, H. D., in 1859. Extensive and beautiful grounds. Perfect privacy. Located a few miles west of Philadelphia. REFERENCES Doctors H. C. Wood, Pepper, Stille, Penrose, DaCosta, Milis, Tyson. Turnbull, Osier, Wharton Sinkler. Resident Physicians: J. Willoughby Phillips, M.D. S. A. Mercer Given, M. D. Dr. Bar'on Cooke Hurst, Dr. John Ouchtelony. For full Information address BURN BRAE Clifton Heights, Delaware Co., Pa. HUDSON, WIS. ' J EIGHTEEN MILES EAST OF ST PAUL. An Institution fully equipped with every appliance and convenience for the care and treatment of the Invalid and Sick, as Electric Apparatus, every kind of Bath; Massage, Swedish Movement, etc. Contagious diseases and the violent or disagreeable insane not received. Beautiful surroundings and in a healthy locality. For information address THE SANATORIUM. WHEELER'S XISSUI PHOSPHATES. Wheeler's Compound Elixir of Phosphates and Calisnya.—A Nerve Food and Nutritive Tonic for the treatment of Consumption, Bronchitis, Scrofula, and all forms of Nervous Debility. This elegan: preparation combines In an agreeable Aromatic Cordial, acceptable to the most irritable conditions of the stomacbt Bone Calcium Phosphate Ca a 2P0 4. Sodium Phosphate Na » HP0 4, Ferrous Phosphate Fe 2P04, Trl- hydrogen Phosphate H 3 PO 4, and the active principles of Calisaya and Wild Cherry. The special Indication of this combination of Phosphates In Spinal Affections, Carles, Necrosis, Ununited Fractures, Marasmus, Poorly Developed Children, Retarded Dentition, Alcohol, Opium, Tobacco-Habits, Gesta- tion and Lactation to promote Development, etc., and as a physiological restorative En Sexual Debllity, and all used- up conditions of the Nervous System, should receive the careful attention of good therapeutists. NOTABLE PROPERTIES, As reliable In Dyspepsia as Ouinlr.e In Ague. Secures the largest percentage of Benefit In Consumption and all Wasting Diseases, by determining the perfect digestion and assimilation of food When using It, Cod-Liver oil may be taken without repugnance. It renders success possible in treating chronl' diseases of Women and Children, who take It with pleasure for prolonged periods, a factor essential to maintai' the good-will of the patient. Being a Tissue Constructive, It is the best general utility compound for Tonic Res torative purposes we have, no mischlevious effects resulting from exhiblting It In any possible morbid condition of the system. t Phosphates being a Natural Food Product no substitute will do their work. Dose.—For an adult, one tablespoonful three times a day, after eating; from seven to twelve years of age, one dessertspoonful; from two to seven, one teaspoonful. For infants, from five to twenty drops, according to age. Prepared at the Chemical Laboratory of T. B. WHEELER, M. I)., nontreal, P, Q. To prevent substitution, put up In pound bottles only and sold by all Druggists at One Dollar, Read the pamphlet on this subject sent you. - 444 Publisher's Department. Oh, say! but the microbes will greet him with fervor And soon they will leave him'a physical wreck! The fellow who thinks that the walks are so dry now That he can with safety leave overshoes off— How quickly the microbes will seize him and tease him With a cold in his head and a sneeze and a cough! The early porch-lounger, the premature golfer, The man who stands out on the corner to chin— They're all of them meat for the gay little microbes Who will marshal their forces and gather them in!, Then here's to the foolkiller known as the microbe, The friend of the doctor, the druggist's delight— It's no use to dodge him, he's got his eye on you And he'll jump on your neck like a thief in the night! GRAY'S GLYCERINE TONIC COMP.—As a supporting reconstructive agent in convalescence from influenza no remedy acts so effectively as Gray's Glycerine Tonic Comp. It enables the patient to eat, digest and assimilate food, imparts vitality to the nervous system, restores con- stitutional vigor so that the system is fortified against the occurrence of complications and sequela?. The above statements are based upon the recorded experience of thousands of physicians who invariably em- ploy Gray's Glycerine Tonic Comp. as a routine remedy in epidemic influenza or La Grippe. ANNOUNCEMENT.—We wish to announce the purchase of The Stylus the well-known monthly medical journal edited by Dr. William Porter, of St. Louis. The Stylus will be consolidated with the Interstate Medical Journal, and the two publications continued under the latter name. Dr. William Porter, editor of The Stylus, will be associated with Drs. W. B. Outten, R. B. H. Gradwohl and O. F. Ball, in the editorial management of the Interstate Medical Jour- nal. A DOCTOR AS MAJOR-GENERAL.—Among the names of the sixteen army officers, recently sent to the Senate 1 St. Louis Baptist Hospital, patients. It has a well equipped Bacteriolog- ical and Pathological Laboratory under the supervision of a physician well trained In these branches. Surgical cases are given special attention. Address all communications to DR. C. C. MORRIS, Supt. 445 Publisher's Department. by the President for promotion in the U. S. regular army, was that of a doctor of medicine. This is noteworthy be- cause the appointment is in the line, and not in the medi- The officer thus distinguished is Dr. Leonard Wood, the well-known military Governor of Cuba. Doctor, or General Wood, is a graduate in medicine of the Harvard Medical School. His distinguished career in Cuba is too familiar to all readers to need to be recalled here. It is sufficient to say that this career has been in both the mil- itary and civil service, and not in a medical capacity. We understand, however, that General Wood held the regular army rank of assistant surgeon, and that therefore his pro- motion by such a great leap has called forth criticism in army circles, in which it is regarded as practically an ap- pointment from civil life to high rank in the regular army. We are not especially concerned here about these caste distinctions, and we see no reason why a medical man should not be thus advanced in a service in which lawyers and business men are sometimes honored with high mili- tary rank. General Wood has earned his promotion as clearly as any of the other appointees. It is not unusual for physicians in this country to earn high political posi- tions. They have been members of Congress and Gover- nors of States, and perhaps it is reserved yet for one of them some time to be President. It is highly desirable, in fact, that the profession should be better represented in the civil service of the country, especially in the law-mak- ing branches.—Philadelphia Medical Journal. PAN-AMERICAN EMERGENCY HOSPITAL.—For the care of sick at Buffalo. A handsome and well appointed hos- pital building stands near the west end of the Mall, of which the above is an illustration. Floor area rather than elevation is its prominent feature. Utility was first, in the architect's mind but not utility unadorned as the handsome structure shows. The frontage is 90 feet, the main wing has a depth of 38 feet; the height is one story, except in the center, where it assumes the form of a square tower 1 | Typhoid \ La Grippe 1 Tuberculosis and all diseases arising from impoverished blood and a depleted physical condition demand the most efficient NUTRITION The patient JVIU5T have a new and continuous supply of all the vital elements in which the blood is deficient. Introduce in all such cases LIVE BLOOD. All the leading and most successful practitioners to-day are using BO VININE It is LIVE, defibrinated arterial blood. It is preserved by cold process and sterilized. It retains all the vital and nutritive elements. It contains 20 per cent of coagulable albumen. It is a fluid food, pure and simple. It aids digestion, and is promptly assimilated. It is to a large extent directly absorbed. It sustains and stimulates the heart. It renders cardiac stimulants unnecessary. It is a powerful aid to all forms of medication. THE BOVININE CO., 75 West Houston St., New York. LEEMING, MILES & CO., Sole Apents for the Dominion of Canada. 446 Publisher's Department. t with a rounded top. Two electrical ambulances, and a steam and gasoline motor ambulance are provided. The build- ing has natural gas for heating and cooking. Water, gas and electricity are in every part of the hospital. Ster- ilizing apparatus, an apartment for instruments and one for towels and linen are provided. Roswell Park, M. D., Director, Vertner Kenerson, M. D., Deputy Director and Dr. Alexander Allen, resident physician. THE ARMY AND NAVY HOSPITAL AT HOT SPRINGS. —The Government Army and Navy Hospital at the Hot Springs of Arkansas has been greatly enlarged, and its facilities for the accomodation of patients increased in all directions, and yet, from the indications thus far, the sur- geon in charge estimates that the demand for admittance this year will be largely in excess of the possibilities in the accomodation line. And this in despite of the many changes and additions. This has become a most popular place for ailing officers and men of the regular and volunteer armies, as the waters of the Springs seem to be peculiarly well adapted to the relief entirely, or the great alleviation of those ailments which are so likely to seize upon men en- gaged in active service in semi-tropical regions, as has been the case with the United States Army in the last year or two. There is probably no other resort in the country which offers so many inducements in the lines that make life worth living while in the search for health. Judging on Pope's idea that "all looks yellow that the jaundiced spy," it is somewhat difficult to make everything agree- able to a sick man, and have him enjoy life while recov- ering lost or failing health and strength, but if there is any place in this country, or any other for that matter, where this can more certainly be done, than the Hot Springs of Arkansas, it has not been brought to the atten- tion of the recreation and health-seeking public. The causes that conspire to make this place the great- est health resort in the world, and not only that, but the most noted winter resort in this country, for those well as NR.POST *tM - BK i TMI FT.DOP, I SAC j P T A V.F N K ANT - D .HD . . . . D H KET. . . Zf6 . . . . GT.TO.PM.CK N.D 3E F _ .rIP ZD. FT IP F TIP. . t .tir . . .. . EXACT SIZE. Is the only instrument of the kind which FOLDS UP LIKE A KNIFE, HAS REVERSIBLE SHARP AND BLUNT POINTS, THE ENGLISH AND DECIMAL SCALE AND WEBER'S DISTANT POINTS EN- GRAVED ON IT. PRICE, FIVE DOLLARS. Address and remit to 3857 Olive St., St. Louis. Dr. C. H. HUGHES. Why try to stick things with some- thing that doesn't stick? Buy MAJOR'S CEMENT; you know it sticks. Nothing breaks away from it. Stick to MAJOR'S CEMENT. Buy once, you will buy for- ever. There is nothing as good; don't believe the substituter. MAJOR'lTuBBER and MAJOR'S LEATHER. Two uoparatocfmentd—the hest. Insist on having them, ESTABLISHED 187*. 15 and 85 cents per bottle at all druggists, MAJOR CEMENT CO., NEW YORK CITY. Clarence H. Hughes. E. C. Duckworth, HUGHES & COMPANY, Twentieth Century f Printers. £ 418 N. Third St. ST. LOUIS, MO. Catalogues and Annual Reports for Hospi- tals and Colleges a Specialty. 447 Publisher's Department. much as for those ailing, are too numerous to enable an accurate inventory of them to be made. The climate is most delightful, the temperature in the winter agreeable, nor does it rise anywhere near that of the country further North in summer, and the various features of the social life there are such as to attract the best people from every direction. (EDITORIAL.) WILLIAM R. WARNER, widely known as a manufactur- ing chemist and caterer to the medical profession and as the first proprietary medicine man who extensively utilized, if he did not invent, the sugar-coated pill, died at Phila- delphia April 3. He was a distant relative of George Washington, and his art collection includes over one hun- dred portraits of the Father of his Country. (REVIEW.) DISEASES OF THE NERVOUS SYSTEM, a text book for students and practitioners of medicine, by H. Oppen- heim, M. D., professor at the University of Berlin, and translated into English by Edward E. Mayer, A. M., M. D., of Pittsburg, Pa., comes to us through the well-known publishing house of J. B. Lippincott Company, of Phila- delphia. It is the first American edition, enlarged and revised from the second German edition, and contains two hundred and ninety-three excellent illustrations. The translator, Dr. Mayer, has done his work well. It is not necessary to go into a detailed description of this estimable book. It is appropriately dedicated to that distinguished master in neurology, Carl Westphal. The author acknowl- edges his thanks to his able assistants, Cassier and G. Flatau, for the photos and proof-reading. SANITARIA. On this page will be found the largest, most reliable and most com- pletely equipped institutions for the care of the invalid, in all parts of the country, arranged according to States. This Is the Largest List of Private Sanitariums Published. STATE. Arkansas Connecticut Illinois Indiana «« 4 4 Kentucky Maryland Massachusetts Michigan I 4 4 4 Missouri New York Ohio Oregon Pennsylvania Wisconsin CITY. Hot Springs Greenwich Hartford Norwalk Greens Farm Westport Stamford Batavia Godfrey Jacksonville Lake Geneva Lake Forest Attica Indianapolis La Porte Lexington Catonsville Milton Alma Flint Grand Rapids St. Louis « 4 Astoria, L. I. Central Valley Fish-Kill-on-Hudson Goshen Sing Sing P. O. Astoria, L. I. Oxford Portland Clifton Heights Wauwatosa Hudson IN CHARGE. SEE ADV.PAGES J. T. Jelks H. M. Hitchcock T. D. Crothers E. E. Smith D. W. McFarland F. D. Ruland F. H. Barnes F. H. Daniels W. H. C. Smith F. P. Norbury W. E. Dold F. X. Sudduth H. L. Kramer W. B. Fletcher H. Wardner Geo. P. Sprague R. F. Gundry J. S. Perry E. S. Pettyjohn C. B. Burr C. E. Patterson W. H. May field C. C. Morris J. Jos. Kindred J. F. Ferguson W. S. Watson F. W. Seward R. L. Parsons J. J. Kindred G. W. Cook Henry Waldo Coe Richard Dewey S. C. Johnson THE OZARK SANATORIUn, HOT SPRINGS, ARK. The Ozark Sanatorium is located in the centre of Hot Springs, on a wooded eminence, with grounds 300 by 350 feet in extent. It is within three blocks of the railroad depot and the Eastman Hotel, two blocks from the Park Hotel, and contains thirty rooms, especially furnished for a sanatorium with all modern improvements. The building is exceptionally well constructed, finished in natural wood, and is heated by steam. Hydraulic elevator goes to each of the four floors. The water for household purposes is supplied by an artesian well on the premises, 300 feet deep. The broad verandas and large shaded lawns afford ample opportunity for frefch air and exercise. It has a Government hot water privilege, and a bath house constructed after the most modern ideas, with porcelain tubs, vapor, needle, and shower baths. There is also one bath tub on each of the floors of the building, in which the same Hot Springs water baths are given. The sanitary and hygienic arrangements of both the building and premises are perfect. Trained nurses are in constant attendance. Absolute quiet and rest are assured, while suitable diet in every instance will be carefully prescribed by the physicians, and strictly carried out by the matron. All patients are under direct oversight of physicians at all times. The Ozark Sanatorium is designed to accommodate, especially, invalids that are required to remain at the Springs quite a while, and also gynecological and surgical cases. The surgical department is fitted up with the latest appliances, while the operating room has been constructed with great care, and has not a superior in the West. , . The medical supervision of this Sanatorium is in charge of Drs. J. T. Jelks and Thos. E. Holland. Mrs. A. M. Weston, Matron. JAMES G. KIERNAN, M. D. COLLABORATOR OF THE ALIENIST AND NEUROLOGIST. Secretary Chicago Academy of Medicine; Distinguished Editor, and Writer on Psychiatry and Neurology, Active and Honorary Member of Many Learned Societies. DOCTOR JAMES G. KIERNAN Is known to the medico-psychological, and neurological world by his many able and pertinent contributions to the literature of psychiatry and neuriatry through the pages of the ALIENIST AND NEUROLOGIST. Doctor Kiernan graduated in medicine at the New York University, served in a medical capacity in the Ward's Island and Cook County Hospitals for the Insane, and has always favored advance and reform in clinical psychiatry. He is a corresponding member of several foreign medical societies, including the French Societe Medico-Psychologiques. Identified from its foundation with the Chicago Academy of Medicine, that distinguished medical organization owes much to Kiernan's fidelity, enthusiasm and faithfully-be- stowed ability and energy. A clever, jolly, good fellow, well liked by all who have the pleasure of his personal acquaintance, approved and appreciated by the many who know him so well through the literature he has so faithfully enriched, we wish him a long-continued life of usefulness, prosperity and honor. Editorially, Doctor Kiernan first attracted professional attention by his management of, and contributions to, the Medical Review and the Medical Standard of Chicago. The American Medical Journalist lately displayed equal appreciation with ourselves of Doctor Kiernan by presenting his face to its readers. THE ALIENIST AND NEUROLOGIST. VOL. XXII. ST. LOUIS, JULY, 1901. No. 3. THE PHYSICIAN'S DUTIES IN COMMITTING INSANE TO THE HOSPITAL. By PROF. HOCHE,* STRASSBURG. IT is a common fact that physicians in general often regard it a difficult and irksome task when they have to undertake the treatment of the insane, and especially their commitment to an insane hospital. There are many reasons for this. It is in part chargeable to the little personal confidence the physician has in his knowledge of psychiatry, in part aversion for the prescribed legal formalities combined with admission to the hospital and the responsibility entailed upon the maker of the certificate of admission; finally it is due largely to the fact, that the physician, as well as the relatives and the civil officials, have little conception, as a rule, that the hospital shall be primarily for the cure of a patient and not merely for the disposal of an inconvenient and troublesome member of society. The expression "ripe for the insane asylum," which may often be heard from the laity for the designation of a certain grade of mental disease, is very characteristic ■English by Dr. W. Alfred McCorn, Physician In Charire. Grand View Sanitarium. South Windham. Conn. [449] 450 Prof. Iloche. 0 of the perverse conception prevailing among the educated classes, so called, in this respect, and the physician, who would urge the commitment to a hospital before this state of "ripeness" evident to the laity is manifest in the patient generally has to expect that the relatives will dispense with his advice in the future. That the local authorities, mayorality, police and dis- trict officials, bound by the existing regulations, usually recognize only as sufficient reasons for committing pauper insane to the hospital: danger to the commnniiy or dis- turbance of public peace, and the purpose or possibility of a cure does not enter- into the range of their considerations, is not strange so long as the "legislators," the parliamentary representatives and the executive merely deliberate how the public can be protected from the insane asylum, but never as to what has to be done to effect a cure in the largest possible number of the insane by facilitating the conditions of admission to the hospital. It would be vain to hope that in this respect the alienist's plea alone could effect an improvement; it should be the task of the physician, the general practioner in particular, to overcome the current prejudice as to the nature of mental disorders. It would be necessary at least that they equip them- selves with special knowledge and clear views in regard to psychiatry; a physician, who in cases of mental disease is uncertain in his judgment and vacillating in his orders, is unfitted to contest the large sum of biased opinions and deeply rooted prejudices which he will encounter in the relatives. Experience teaches that even those physicians, who possess a good knowledge of psychiatry and are able to make correct diagnoses, often display a remarkable per- plexity and helplessness when the necessity suddenly arises to send or commit a patient to a hospital; if it were different hospital physicians would not have to report such a large number of instances of peculiar, impractical or false measures in the early treatment, transfer and admission of the insane. Committing Insane to the Hospital. 451 It is true that textbooks as a rule confine themselves to discussing the indications for admission to a hospital according to the different forms of disease and the degree and manner of manifestation of the insanity, but the necessary practical directions before and on commitment are not accurately described. I will try to suppy these defects —for such they are.often felt to be—in the following pages; the duties of the physician in the matter of indications, treat- ment of the insane prior to going to the hospital, their trans- fer and especially the wording of the clinical history (list of questions, certificate of admission) destined for the hospital physicians will be briefly gone over.— The indications for commitment of an insane person to a hospital depend in a certain measure on the external, personal and social conditions of the individual case. In extremely favorable financial circumstances, when the obtainment of the nurses and the preparation of suitable rooms can be readily arranged, it is oftimes possible to undertake the treatment of cases at home, which otherwise unconditionally require the hospital; these cases, which are extremely rare, will not be considered, but the average conditions of general practice; the well established diagnosis of a mental disorder does not by any means always necess- itate commitment to a hospital; a large number of cases on the borderland of the neuroses, e. g. mild hysteromel- ancholia, slow chronic mental disorders without marked affects, cases of general paresis with quiet, slowly pro- gressive dementia, but without anomalies of mood, mild forms of periodical insanity, processes of simple dementia on an organic basis, e. g. from vascular changes, etc., may often be just as well treated at home. In these and many other cases the indications are relative, i. e., every case of mental disease should be sent to a hospital whose prospects of recovery seem better there than under home surroundings; the knowledge and tact of the family's medical advisor is decisive in the selection of cases. For the physician, who shares the laity's opinion that the establishment of a mental disease pronounces in a certain measure the individual's civil death sentence, there 452 Prof. Hoche. are no relative indications; whereas the one who knows how high a percentage of recent cases recover in the hospitals for the insane presupposing seasonable admission, finds a gratifying condition; the difference between the prospects of recovery at home and those under hospital treatment are doubtless much greater than for consumptives, on account of which hospital treatment, public or private, is now striven for in large measure. In his deliberations the physician must remember that the insane hospital represents a sum of factors, which as a rule cannot be procured for the patient at home: quiet, cessation of criticism, nagging, moralizing on the part of in- judicious relatives, maintained bed treatment, baths, con- stant surveillance, medical supervision on the necessary employment of large doses of the narcotics, etc., wholly irrespective of the special, expert mental influence of the alienist; he must furthermore bear in mind that the favor- able influence of this advantage of the hospital may be un- able to change the prognosis in cases that have become unfavorable by letting them drag along for months with "diversions," change of air," hydrotherapy and vegetarian treatment, that, in a word, the insane hospital should not be "ultima ratio." The physician is to-day properly cen- sured, if he lets a case run on and become incurable through non-interference when the operative removal of a tumor might have been necessary and possible in a hospital; yet that the same considerations are applicable to mental disease, we are far from, unfortunately to-day. This much is certain, that on the average the physician who better cares for the welfare of his patients in cases of mental disorder the broader he comprehends the relative indications for commit- ment to a hospital. If we find in the relative indications a wide scope for individual variations, which are due to the character of the patient, his greater or less tractability and affability, we have a very definitely prescribed course in the indications, which are termed absolute. These include three of the symptom groups occurring in the insane: danger to the community, suicidal tendency and refusal of food. Committing Insane to the Hospital. 453 The first practically is that which the most readily con- vinces the relatives and officials of the necessity of in- stitutional care, at any rate usually, according to Kind and Brunner, after the patient has given actual evidence of his dangerousness. It generally has a remarkable converting effect on the theoretical views of the people, who are ever crying for further protection against the encroachments of the hospital physicians, when they, perhaps in their own family, have to care for an acutely excited, violent patient for days, whose speedy admission to a hospital is pre- vented by the formalities alluded to as a measure of pro- tection. Under all circumstances the physician has not only to keep in mind the evident, but probable danger to the community from a patient according to the form of the disease, and should not be too reserved in the written attestation of its presence, especially so long as on the evidence of danger to the community depends the technical, financial possibility of letting the pauper in- sane share the benefits of hospital treatment. The "frenzied patient" is not alone "dangerous to the community"; every insane patient with spontaneous sense deceptions, every delirious person, everyone suffering from any form of epileptic mental disorder, every anxiously ex- cited melancholiac, all patients with ideas of persecution, so long as an active affect is present, are dangerous to the com- munity, as well as many cases of general paresis, in whom it consists chiefly in the patient squandering his property and ruining his family's reputation and standing. It is a fundamental error not to regard the suicidal tendency as one of the conditions of "danger to the community"; patients, who will destroy themselves for morbid reasons, are never to be counted on, whether they will not combine assaults against the life of others, either e. g. in the form of in- cendiarism or attempted murder; the reports so common in the newspapers of the mother, who, while insane, throws herself into the water with her children, might properly be recognized as sufficient proof of the danger to others from melancholiacs. 454 Prof. Hoche. Security for those about against the violence of the insane patient at home is often attainable, but only by the employment, of restraint, which is unsuited to the character of the disease, so that "danger to the community" must under all circumstances be regarded an absolute in- dication. 1 mention suicidal tendency as the second absolute in- dication.' Experience teaches that actual security of the patient from his intentions against himself is never attainable at home. The reasons are various. Patients of this sort almost always know how to de- ceive those about as to their intentions; who will believe in the existence of suicidal thoughts only when the patient often speaks of them, will have sad experiences; it may be extremely hard for the physician, e. g. in certain cases of melancholia, to convince the relatives that the smiling, talkative patient harbors the most earnest suicidal thoughts and only waits for a brief unguarded moment to put them into execution. In this respect 1 will never forget one ex- perience; while I tried in vain to make clear to the incredulous and oppositional husband of a melancholic patient the necessity of sending her to the clinic, a terrible outcry suddenly sounded from the adjoining room where the patient was with a nurse, and as we rushed in we found her bleeding profusely from a large gaping wound across the arm she had made with a butcher knife. After such an experience the seriousness of the condition will at least be made clear to the incredulous family, just as after comprehensible evidence of danger to the community. According to general experience the difficulty of a con- stant surveillance of such patients is always underrated by the relatives; under the ordinary household conditions it is almost impossible, technically, to maintain an absolute- ly constant surveillance day and night, in bed and on the closet, while undressing, etc., which would necessarily require two persons to alternate. It is readily comprehen- sible that the relatives caring for the patient, intelligence and best intentions presupposed, gradually lose their Committing Insane to the Hospital. 455 energy in keeping up the supervision; even in hospitals for the insane with trained personal attendants new reminders and medical supervision are constantly required to maintain strict vigilance in these matters. The physician conserves his own interest well in all cases where he presumes a suicidal tendency, and these include all mental disorders attended by depression, particularly melancholia—to decline all responsibility, as soon as his advice to take the patient to an insane hospital is not complied with. As third absolute indication I mention refusal of food, the justly dreaded symptom, which either occurs as a com- ponent of general opposition to every attention or arises from delusions and sense deceptions, but in every case tends to a deterioration of the general condition with de- preciation of the physical strength and also of the mental condition. In the insane still less than in the sane is gastric nu- trition to be replaced by some other method. Nutritive clysters as a rule are rejected with greater energy by those patients who will not take food for some reason; saline infusions subcutaneously or in the veins may somewhat stay the decline and effect a temporary improve- ment, but nothing more, and nourishment by fat by inject- ing oil into the cellular tissue has not as yet passed be- yond the hospital walls. In cases of long refusal of food, particularly when no water is taken and it is a matter of feeble persons, there is nothing else to do but to feed forcibly with the stomach tube, as soon as the decline of the physical strength has reached a threatening degree. Under home surroundings in private practice forcible feeding of resistive patients is not practical. For the danger from the operation with respect to pneumonia, phlegmon, etc., not to counteract its benefit, trained assistants are needed to hold the head and possibly the gag; several assistants are essential to over- come the opposition of strong and in many cases extremely resistive patients, in spite of the preceding period of hun- ger, and the procedure may be such a painful spectacle for 456 Prof. Hoche. the relatives that forced feeding, if undertaken, is not re- peated. Refusal of food by insane patients should then be the physician's unconditional incentive to demand commitment to a hospital and as quickly as possible. If the physician is perfectly clear himself and has ob- tained the necessary consent of the family to commit the patient, the farther question of choice of institution arises. For pauper insane the choice of hospital is usually regulated by certain geographical boundaries; the physician now has to encounter the frequent opposition of the local officials, who desire to send the patient to the cheapest in- stitution; for recent cases, curable, asylums and purely cus- todial institutions are not the proper place; also the wards set apart in the city hospitals of many places, under the patronage of the officials, in which the insane are cared for in unsuitable rooms, without expert management trained in psychiatry, or with the improper employment of restraint, must not be recommended by conscientious physicians. The nearest institution is the best when the transfer of a greatly excited patient in a carriage seems the easiest. However, particularly among people in good circum- stances, the question of the personal confidence of the fam- ily or physician in this or that hospital may be decisive; mere regard for the prejudice of the laity should have no weight in sending patients to an open "sanitorium for nerv- ous diseases," when they require the treatment of a locked institution, a hospital for the insane; usually it only aggra- vates the further course of the disease, because the man- agement of these institutions destined for nervous patients usually consider it necessarry to send away excited insane or those with a suicidal tendency, and then the transfer to a hospital for the insane devolves upon the relatives. What shall be done with the patient until sent to the hospital? Only a few general directions can be given fer the large number of contingencies that may arise. In every case of recent mental disease the effort is to be made of treating the patient in bed at home; surveil- lance is thus facilitated, strength conserved as much as Committing Insane to the Hospital. 457 possible and in many greatly excited cases quiet is secured; it is often easier than the physician and relatives believe to keep the patient in bed without the use of restraint. When circumstances permit warm baths of 26 to 28° R for an hour are to be tried in states of excitement, which are preferable to the administration of narcotics; these, when necessary are the much smaller evil in comparison to mechanical restraint, presuming the physician is in posi- tion to frequently observe their action. The employment of restraint in the form of straight-jackets, straps, etc., is not permissible. The prospect of the existence of a suicidal tendency is to be described in all detail to the relatives by the physi- cian; the removal of the clothing for a bath affords a good opportunity to take all dangerous objects from the patient's pocket. The anxious depression of melancholiacs is properly relieved by opium and small doses of alcohol in the even- ing; it would be wrong to withhold the latter remedy from principles of temperance. In taking the patient to the hospital the attendance of relatives is to be preferred to that of others; uniform at- tendants, as e. g. the municipal officers often sent in rural districts, should be dispensed with under all circumstances, owing to the similarity with a transfer to prison; strange male attendance for female patients is reprehensible; the employment of the straight-jacket is almost always unnec- essary, therefore must never be ordered to dispense with another attendant, and only used with the physician's per- mission. With patients who very strenuously oppose going to the hospital, several attendants, to show them that any resistance is useless, is to be preferred to the employment of mechanical restraint. Any false pretences to induce the patient to go to the hospital, as e. g. to buy something, make a visit, for a consultation, etc., destroy the patient's confidence in the hospital to which he is brought by subterfuge, makes the hospital physician's treatment of the patient more difficult, and as a rule is unnecessary, for many patients submit 458 Prof. Hoche. more quietly than their relatives deem possible to the definite, bare statement of the necessity of hospital treat- ment; many patients go to the hospital more willingly with a physician than with their relatives. When the transfer is made under medical supervision a freer use of narcotics may be permitted. In all these half-technical questions the physician must reserve to himself the power to decide; by his training he alone is capable of harmonizing the demands of the special social position of the case and the purely medical require- ments with the claims of humanity. The physician's duties in sending a patient to the hos- pital are not completed by what has been previously stat- ed; the most responsible duty of drawing up the certificate rests on him. As varied as may be the present legal requirements in the several federal states, which govern the legal conditions for admission to hospitals for the insane, the foundation of the whole proceeding,now and then extremely unwieldy and impractical, is always the medical opinion of the existence of a mental disorder, and such as with respect to the above expounded points of view, renders treatment in a locked institution necessary. It is clear in the question of illegal confinement of sane persons, of late so anxiously discussed by the laity and officials, that impediments to admission, referring the peti- tion and other papers to ever so many officials affords no greater security against errors, if the fundamental medical opinion is false. Experience teaches that in the cases in which erroneously or from carelessness the existence of mental disease in a sane person is certified to by physi- cians, are very rare and will become ever more so as the more general a knowledge of psychiatry becomes. But today the co-operation of the physician does not in any way, on the average, attain the desirable degree is in the manner of writing the certificate of admission. But for the alienist's judgment of the patient, who is often brought to him from a distance, the statements of the at- tending physician are invaluable. Committing Insane to the Hospital. 459 The patient's statements are only rarely reliable; even if we exclude the cases in which obtaining anamnestic facts is impossible owing to. clouding of consciousness or states of excitement, anomalies of mood or lack of intelligence, the patient's judgment of his own previous history, the development of his disease, which he only exceptionally recognizes as such, is only rarely material that can be used in forming an opinion. The statements of the relatives, and when they are the nearest, do not always afford sufficient information for the hospital physicians; indifference, forgetfulness, lack of ability to observe, often also the desire "not to let it get out of the family," to cover up existing domestic greivances—all of which render the anamnesis of insanity a far more difficult task than in physical diseases; it may often enough be experienced that facts, which are acciden- tally learned of in other ways, like suicide of the parents or grandparents, or mental diseases in the nearest relatives, are even denied on direct inquiry. In all these points, as well as regards the existence of syphilis, the presence of intemperance and the like, which are often regarded as dishonorable, the physician alone gives valuable information, particularly when he, as the family physician, is familiar with the development and character of the various members of the family from their childhood. (To be concluded.) HEREDITY AND EPILEPSY.* By SANGER BROWN, M. D., Professor of Nervous and Mental Disease Chicago Post-Graduate Medical School: Fellow of the Chicago Academy of Medicine: Fellow of the N. Y. Academy of Medicine: Member of the London Eng. Neurological Society. AS a working hypothesis, I have elsewhere assumed that an organic substance which I have termed neurener- gen is contained in the body of the neuron and that it is by the destructive metamorphosis of this, that the neuron is able to manifest the energy peculiar to it. During re- pose, this metamorphosis is so slight, there is such a nice automatic adjustment or coordination between the chemi- cal stability of the neurenergen and the forces of the neu- ron which may be supposed to promote the metamorphosis, that practically a state of stable equilibrium results in which only enough energy is made manifest for the main- tenance of a condition of tone. During voluntary activity, however, neurenergenetic metamorphosis and neuronic energy are more or less notably increased,but the coordina- tion between them is preserved; though under these cir- cumstances the equilibrium may by regarded as somewhat unstable. According to this hypothesis, the phenomena of epilep- sy might be accounted for by assuming that this equi- librium is for some reason suddenly lost and fulminoid or explosive discharge of neuronic energy results. This might be explained either by assuming a morbid increase in the quantity or an alteration in the chemical composition of the neuronergen, whereby its stability became greatly reduced; 'Read before the Chicago Medical Society In Outline April 3, 1901. ]460] Heredity and Epilepsy, 461 or a suddenly developed abnormality in the neuron itself, markedly increasing its excitability or magnifying its power of provoking neurenergentic metamorphosis. Thus the etiology of epilepsy should be sought in those influences which might be expected to predispose to or excite the conditions above hypothecated. With present available methods, there is no probability of being able to detect neuronic changes that might throw any light on the subject, and, so far as I am aware, no progress has been made in this direction. The suddenness and violence of phenomena in epilepsy are certainly sug- gestive of chemical reaction, and inasmuch as organic chemistry is a fascinating subject and material is always abundant because the experimentation can be carried on during the lifetime of the patient, careful and extensive research has been made along this line; but so far, no val- uable results hatfe been reached. And indeed therapeutic measures founded upon the theory that the disease was due to an excess or diminution of this or that organic sub- stance in the economy have been utterly disappointing. To just what extent, however, it may be desirable to attempt to separate even hypothetically, weakness of nervous tissue from chemical instability of the neurenergen, I am not pre- pared to say, but the fact that in the large majority of cases repetition appears to favor frequency and that the latter is a potent factor in determining mental deterioration, would seem to magnify the etiological importance of the nerve element. Cases like the following, though somewhat exceptional, so far as the immediate exciting cause of the individual attacks are concerned, seem to support this view. Case I. A girl of eighteen with a bad dissimilar her- edity had severe convulsions while teething and then was free till her twelfth year, when typical major and minor attacks began with the establishment of the menses. She was rather precocious mentally, but enjoyed good health in the meantime. The epileptic seizures became more severe and were accompanied by progressive mental and moral deterioration. They were commonly excited by a compara- tively slight shock of some kind as the unexpected ringing 462 Sanger Brown. of the door bell, dropping of a dinner plate, etc. Inciden- tally, it may be stated, that vigorous enforcement of hy- gienic measures and the bromides brought a prompt trans- formation but of course did not effect a cure. Likewise, those cases developing in early infancy, where many slight seizures—a hundred or more, occur daily, it seems not improbable that the effect is mainly in the tissues themselves, whereas, those cases which develop in adult life and in which attacks occur only once or twice a year or less frequently even, it seems more reasonable to suppose that a sudden chemical change in the neurenergen is the most prominent etiological factor. The frequency and extent of hereditary influences in the etiology of this or any other disease can at best only be reduced to an approximate inference, which must be made by an appeal to statistics. These vary with the education, the mental habits, honesty, accuracy of observa- tion, etc., of each individual who collects or gives the information from which they are compiled. The inaccuracy and insufficiency of this information, together with the imperfect manner with which it is often analyzed and class- ified, affords to some extent a measure of the liability to fallacy. Heredity may be divided conveniently into two classes, similar and dissimilar. Similar heredity implies the exis- tence of epilepsy in ascendants, while dissimilar heredity refers to such ancestral diseases as insanity and imbecility. Authors are far from agreeing as to what diseases should be included in the list of dissimilar heredity influences. Some would include tuberculosis, migraine and hysteria. All agree however, that insanity and imbecility are by far the most important factors. Accepting this latter limitation, Gowers finds either similar or dissimilar heredity in 33% of all cases and of these two-thirds are similar and one-third dissimilar, with a slight preponderence of females. Similar heredity is more often transmitted through the mother and the heritage prefers the sex of the parent from which it was derived. That inherited epilepsy begins in the great majority of cases before twenty is compatible with the Heredity and Epilepsy. 463 view already expressed. That the disease is due largely to an inherited effect of the nerve elements rendering them unduly unstable; and conformably the fact that a majority of all hereditary cases begin during the same period, would be expected, when the eminent instability of the nervous system during childhood, youth and adolescence is remem- bered. The element of heredity is of some moment in prog- nosticating the course and character of the disease, but of decidedly less significance in estimating the probable result of treatment. As might be expected, instances are not wanting where the course and manifestation of the disease throughout presented striking similarity in child and parent, even after making allowance for the great number of feat- ures common to non-heredity cases. There is authority for the assumption of an increased liability to insanity in cases where that disease existed in the ascendants. I have seen an intimation somewhere that cases of heredity epilepsy were more amenable to treatment than those devoid of this feature. My experience does not prompt me, however, either to confirm or contradict this statement. The psychic or mental manifestations may be conven- iently divided into those either momentarily preceding or terminating in other phenomena, or those extending over a period ranging from a few minutes to a few days prior to the seizure or seizures; those which alone comprise the individual attack and those which are a result of the fits either momentarily or remotely; and finally, a class of cases in which the mental disorder is of such a nature that it might be more properly regarded as an association with rather than expression of epilepsy. Indeed, there is a wide border running between these last named cases on one side and the actual insanities on the other. Of the first class, the most common are those which momentarily precede the fit and fairly constitute a mental or psychic aura. To mention these in the order of their frequency, 1 should say that those cases come first in which a familiar environment seems strange, and next those in which the surroundings seem a repetition or at least pecul- 464 Sanger Brown. iarly familiar. There is a vivid mental perception of detail, sometimes, analogous tolthe visual Limpression;[made by a lightning flash in dense darkness. Vague fear, but per- haps intense; a depressing sense of confusion; a conscious- ness of absurd or trivial mental contents; anger; revenge; joy amounting sometimes almost to a mental or psychic orgasm; a vivid recollection, sometimes-] quite ..elaborate—a girl at the Queen's Square Hospital, London, always had a vivid mental picture of a play-ground and play-mates of some years before. Those changes which precede the seizure for a vari- able period, are properly regarded as premonitions. They commonly consist of marked irritability, depression, violent explosions of temper, indecency, untruthfulness, or. a sense of mentar.exhiliration'and joyousness rapidly*progressing to maniacal confusion and frenzy. The following case is illustrative of this latter change: Case II. A gentleman of forty-five, for some years under my care and observation at the Bloomingdale Asylum, developed "epilepsy after a bullet wound ] received in battle which had destroyed the seventh nerve and left [a large hole in the mastoid. His fits usually came in groups of from two to five covering a period varying from two hours to two days. Naturally he was quiet and reserved—indeed saddened somewhat beneath his [infirmity. From a few hours to a day or two before the seizure, the mind would become very active. Various events of his past life would unfold before him in great detail, and his power of pene- tration and analysis seemed to him so magnified that innum- erable grand and varying vistas were rapidly opening up before him, and these he contemplated with something like rapture. He said it seemed all a revelation and that no words of his could even faintly express his happiness. As the excitement progressed, he would sing, shout, and attempt to scuffle with whomsoever happened to be near, unmindful of the proprieties. Finally he became confused, noisy, utterly incoherent, violent and frenzied, failing to recognize or regard his best friends. Some authors might claim that this was transitory mania culminating in epilep- Heredity and Epilepsy. 465 tic convulsions, regarding the maniacal condition as more prominent and essential than the epilepsy. Either the aune or premonitions above mentioned may occur alone in those cases in which they also occur in direct relation to the other epileptic manifestations. In this case it is fair to call them epileptic. They are true epilep- tic seizures confined to the mental or psychic sphere, not properly epileptic equivalents. Though any of the mental changes above alluded to are more or less strongly suggestive of epilepsy, even when they are not known to be associated with the other signs of the disease, they probably do occur to some extent inde- pendently. In estimating their significance,their suddenness, severity, duration, immediate and remote effects would demand careful investigation. This applies mainly to the momentary attacks. The following cases seem to support the view that both transitory frenzy and protracted automa- tism, with complete and amnesic meta-consciousness may happen without epileptic associations. Case 111.. A well raised young gentleman of seventeen, with good heredity, started for home at nine, in the even- ing from the house of a friend a few blocks distant. He was found two or three days later several miles from his home along the railroad tracks in the thinly settled suburbs of the city in which he lived. His normal mental state suddenly returned upon his discovery by his relatives. He had a hazy recollection of some incidents that occurred dur- ing his mental obscuration, and if there might have been an occasional indistinct glimmer of normal consciousness. This occurred fifteen years ago. He made a good recovery and graduated from a university with a good record and has remained well ever since. Case IV. A prosperous contractor, vigorous and past fifty, suddenly became oblivious of his surroundings, scream- ed and shouted meaningless words, sometimes profane, and obscene, and showed violent resistance when interfered with. Was given a strong hypnotic and slept after a few hours. Still a few hours later awoke in his usual mental state without the slightest recollection of what had hap- 466 Sanger Brown. pened. A few weeks later he was brought to the asylum after a rather long attack. He remained there two or three months, during which time he had one seizure at least, lasting nearly two days and nights. His general health was excellent and he finally declined to remain longer, though anxious to please his family. He evidently was far from being able to realize his true condition. In view of the sudden and apparently unprovoked change in the nerve elements, pathology permits a parallel to be drawn between these cases and epilepsy, and the same might be said of migraine; but there is certainly no necessary or even common clinical affinity.' Some degree of mental dullness frequently follows di- rectly upon an attack of grand mal. Occasionally.however, a great exhilaration, amounting to mania, lasting a day or two, occurs, so severe as to require legal restraint. Indeed post-epileptic transitory frenzy has been described as occur- ing unassociated with the fits, but 1 have never seen a case of this kind. In the epileptic wards of the New York city hospitals for the insane, I have seen violent frenzy lasting from a few minutes to an hour or more develop immediately after the fit, both in cases where these mani- festations constituted the sole mental disorder as well as in those where obvious signs of dementia existed. Doubt- less under these circumstances, transitory frenzy might con- stitute a valid defense for homicide. Indeed, a defense of this kind would be very strong if the defendant were known to suffer from epilepsy whether the frenzy had been previ- ously known to be intimately related to the fits in point of time or not. Remotely, moroseness, irascibility, stubbornness, mean- ness, treachery, vindictiveness, different degrees of demen- tia and mental brilliancy are all found variously combined in association with or (excepting the last) as a result of epileptic seizures. Consequent mental deterioration is usually said to vary directly with the number rather than the severity of the fits. Therefore, as the number of the attacks of petit mal is likely to exceed those of grand mal, the influence of the Heredity and Epilepsy. 467 former on the mind is reckoned more deleterious than the latter. I believe this to be erroneous; for, to illustrate, if a patient could live for a given time having, say twenty major attacks daily, his mind would undoubtedly suffer more than if he had a like number of minor seizures for the same period. As a matter of fact, cases with very frequent (say fifteen or twenty daily) haut mal do not as a rule live many months; whereas in petit mal the general health might be little affected by such frequency; hence it would happen that mental defect would be more often observed in the living associated with the latter form. It seems hardly necessary to add that during the period of development the mind is more susceptible to this as well as to other harmful influences; not only is normal develop- ment of the tissues through which the mind operates retarded, but the disease often excludes the child from a fair share of moral, social and intellectual training. It is a matter of common observation that occasional attacks of grand mal in the adult are sometimes altogether without permanent effect upon the mental faculties. I will refrain from repeating the stereotyped historical instances in support of this statement; neither shall I attempt at this time a definition or discussion of the borderland separating epilepsy on the one hand from various forms of alienation on the other. FATIGUE IN ITS RELATION TO CON- SCIOUSNESS. By W. XAVIER SUDDUTH, A. M., M. D. Fellow of the Chicago Academy of Medicine, Professor of Psycho-Pathology in Chicago Post-Graduate School. THE intimate relationship between mental states and bodily conditions is perhaps best studied in abnormal rather than normal types; nevertheless, in certain of the commoner experiences of life which come under the observa- tion of the teacher and parent, it is a subject of general observation and is demonstrable that fatigue of body as well as fatigue of attention have not only a physical but a psychical basis. The limit of resistance of protoplasm which is to be observed in fatigue, in general, but more especially in fatigue of attention, is well known to the nerve special- ist under the terms nervous exhaustion, nervous prostration and neurasthenia. The phenomenon of what is ordinarily known as "second wind" shows very plainly to the most casual observer the influence of the mind over the body in extending the limit of resistance of protoplasm in ordinary physical fatigue. Many times, while tramping in the moun- tains during my summer vacation, I have found myself at close of day several miles from camp and so completely wearied that it seemed as though I could hardly drag one foot after the other; however, by fixing my attention on the camp and picturing the evening meal which I knew was in course of preparation at that hour, and especially calling up the aroma of the coffee, I insensibly found my- *Read before the Chicago Academy of Medicine 1901. [468] Fatigue in its Relation to Consciousness. 469 self walking briskly, head erect and all sense of the pre- vious fatigue gone as by magic. In similar manner, by auto-suggestion, I have dispelled bodily fatigue when walking the streets of the crowded city, by forcing myself to assume an erect position and mentally attributing to myself a sense of lightness and elasticity. The weary limbs soon responded and all sense as well as semblance of fatigue passed away. Even so is the "Pacer to the racer," be it a fresh wheelman at the finish of a bicycle race or a running mate to the trotting horse in a race against time, whereby the contestant is spurred on to his greatest exertion and the limit of resis- tance of the protoplasm extended, and this without subse- quent bodily injury. The superhuman effort of a mother which enables her to save her child from danger, it may be from a burning building, or to snatch it from in front of an approaching cur, also illustrates the possibility of extending this limit of resistance through mental stimulation. Every teacher is familiar with the magical effect of a few minutes exercise in the school room to the music of a stirring march in "waking up" a weary class, when fatigue of the body, the instrument of the mind, induced such a state of fatigue of attention as to prevent good mental work. Several causes lead to early fatigue of attention, among which may be mentioned imperfect structure and over-use of organs of expression, operating separately, it may be, but generally conjointly. A perfect machine, well oiled and run within the limits of its field of adaptability, should never show or feel fatigue. In this electrical age, however, there are. few perfect human machines and consequently few individuals who escape feeling mental and physical ex- haustion at times. Inhibitions of attention due to nervous exhaustion or so- called brain exhaustion are ever present symptoms in neu- rasthenia and many forms of insanity. This failure of the powers of attention may appear at times to be an almost complete atrophy. It may arise from functional and nutri- tive disturbances. The phenomena are manifold. - Seldom described the same by any two persons, one says he feels 470 W. Xavier Sudduth. an "aching void," a painful void, a sense of fatigue (men- tal), an inability to hold or retain the idea as if it was slipping or sliding away. In others it is a condition of mental distraction where many mental images crowd upon each other so rapidly that none are clearly outlined—in- ability to collect his thoughts. The body is the means of expression of the mind and the organ of the soul which eventually comes to self-con- sciousness the development of sense-comparisons. The child-mind may be compared to that of an adult looking out upon the world at twilight, or on a misty morning when "men are seen as trees walking." Contrast of sense-ex- periences, shows a difference between men and trees. Per- ception of difference, however, lies with growing intelli- gence rather than with body or sense-organs. We are made aware of this difference through a dawning conscious- ness which comes through comparison of sense-relationship. Absence of organs for sense-perceptions means lack of means for the development of consciousness. Deficient or imperfect sense-organs, in proportion to the ratio of defi- ciency, cripple and limit the development of objective con- sciousness. And as the power of attention is an attribute of consciousness, or at least, is dependent upon it for its proper manifestations, it may be well to dwell somewhat upon this aspect of the mind in order to throw such light as we may upon fatigue of attention when it exists. It matters not whether we accept the monistic or dual- istic theory of mind, the conclusion is the same in the pres- ent study. If the monistic, then we must admit two planes of consciousness, one of which may be termed objective and which operates above the threshold of consciousness, and the other, the subjective, found below the threshold of con- sciousness and outside the field of attention, which, as we have before indicated, is intimately associated with the ob- jective consciousness, if not entirely dependent upon it for its proper power of manifestation. The process of making comparisons between sense-experiences is by concentration of attention in the field of objective consciousness, which is fatiguing in proportion to the length of time that the idea Fatigue in its Relation to Consciousness. 471 or object is held in the attention and to the intensity of the thought process. The stream of consciousness is con- tinuous, whether the process is maintained in the field of objective consciousness or is allowed to pass without the field of attention into the objective consciousness. Time will not permit the discussion of this phase of the ques- tion. There is, however, a direct ratio between the con- centration of attention in the field of objective conscious- ness and the lucidity with which the thought is presented. Consciousness may be compared to a wave which, while not progressing itself, yet by its alternate rise and fall pro- jects forward toward their destination objects that are cast upon its bosom. Natural attention is spasmodic, rising and falling with the ebb and flow of the wave of conscious- ness; now above, now beneath the threshold. It is thus that nature avoids fatigue, which is pathological whenever it is persistently present. Primitive man followed his in- clinations, now fishing, now hunting, as the spirit moved. Polyideism rather than monideism is the natural state of the mind. The child mind is ever primitive in its action, and the development of the power of attention is commensu- rate with the advance of the individual in the process of en- lightenment. The diagram herewith presented may be said to represent the wave of consciousness in the child-mind in that portion marked I; the adult mind at II and the trained mind at HI. The threshold of consciousness is represented by the straight dotted line running from 1 to 2; the space above this line enclosed in the bracket and marked 2 in- dicates the field of attention in the wave of objective con- sciousness; while that marked 4 represents the field of subjective consciousness. The solid lines marked A, B, C; D, E, F; G, H, I, indicate the wave of consciousness in 472 W. Xavier Sudduth. the field of attention, while the dotted line between C. D. and F. G. lying below the threshold, may be said to rep- resent the idea or thought that has passed out of the field of the objective attention. It is not lost however, as it may be recalled at any time and again placed actively in the field of attention. EXPLANATION OF DIACRAM. I. Field of consciousness in mind of child. II. Field of consciousness in mind of average adult. III. Field of consciousness in mind of educated adult. 1.—2. Plane of threshold of consciousness. 3. Field of objective consciousness, hence field of voluntary attention. 4. Field of subjective consciousness. A. Point where wave of consciousness comes into the field of atten- tion by being lifted above the threshold of consciousness. B. E. H. Crests of wave in field of attention. C. D. and F. G. Troughs of waves below the threshold of consci- ousness. A. B. C. In the diagram may be taken to represent the field of atten- tion in the wave of consciousness in the child-mind. D. E. F. That in the average untrained mind, and G. H. I. the max- imum development of the power of attention in the mind of the educated adult. The height of the wave of consciousness above the threshold of consciousness as represented in the diagram at the points B. E. and H. would also mark the time of great- est intensity in the field of attention. The variations in the power of attention in different individuals I have en- deavored to show in the length of the line of the wave of consciousness from the point of greatest altitude before it is lost by submergence in the field of subjective conscious- ness below the threshold of the latter. In the child- mind the idea drops suddenly from the point of greatest lucidity as indicated in line B. C. In the average adult mind the power of attention is generally greater and the object is held longer in the attention and may be repre- sented by the more gradual descent of the line E. F. into the field of sub-consciousness; while in the trained mind, where the power of attention is at its maximum, the length of the curve is greatly extended, as shown in H. I. in the diagram. This prolongation of the time in which an idea Fatigue in its Relation to Consciousness. 473 or object may be held in the attention varies very greatly in different individuals. Concentration of the attention is generally practiced by an effort of the will. In that degree that the will is called into play to hold or fix the idea or object in the attention does fatigue of attention manifest itself. If the will is exerted to exclude all other objects that might engage the attention, leaving one idea alone uppermost, there is less fatigue present. This is what I have termed development of the attention by exclusion. The process of education should teach the child to vol- untarily extend the length of the wave of objective con- sciousness by holding the idea or object under considera- tion in the field of attention with the least expenditure of vital force. Attention may be defined as a cognitive effort to grasp an idea, and therefore is primarily a mental effort. Yet the power of attention is assisted and accentuated by an attentive attitude of the organism as a whole, and here- in is demonstrated the interrelationship of body and mind before referred to. No better illustration of this dual rela- tion can be had than can be seen in the action of a train- ed fox terrier who attends from the end of his abbreviated tail to the very tips of his ears and the point of his nose. While natural attention is primarily a mental state, yet educated attention is also a physical condition. Without the fullest coordination of two or more of the organs of sense it is never at its best; hence the fatigue of body that fol- lows long periods of study. In this we also find suggestion for prevention of fatigue of attention by change of body position or line of study in order to break up the tense muscular contractions that so often accompany the process of concentration of attention. Ability to attend depends so largely upon motor-activ- ity that to suppress the latter, handicaps, if it does not en- tirely inhibit, its continued application. If you try to watch the movements of even so common an object as a bull in the grass, you will find that you can follow it only so long as it continues to move. Let it remain quiet for a short time and you will find, that while it still remains within the field of vision it has fled the field of attention. Cause it 474 IV. Xavier Sudduth. to move even so little or change your own position and it immediately comes into view again by being restored into the field of objective attention. The same holds true of the attention in microscopic work and all other lines of study or work that require close application. The eye wearies from continuous looking at a quiescent object and the power to attend is lost. Knowl- edge of this fact has led me in years past to constantly admonish my classes in microscopy to "keep the finger on the fine adjustment screw." By changing the focus, the object which was temporarily lost is again restored to sight although it had never left the field of vision. James finds that in the field of consciousness are many objects for attention. These, he says, are more or less submerged in the wave of consciousness to be lifted up from time to time into prominence into the field of attention. It is by careful grouping of these associated ideas that the attention is held by the educated mind. The power to properly group these ideas marks the trained from the untrained mind, or indicates a disordered state of mind. I cannot do better in closing than to call attention to the fact that there is a limit to the power of develop- ment of attention and that in some instances the ability to dismiss ideas from the field of objective attention is more to be desired even than the power to attend. It is dan- gerous to the bodily organism to hold an idea in the field of attention and thus constantly remain in the field of objective consciousness to the exclusion of all other ideas or thoughts. Such a condition is medically known as Fixed Ideas, and when it exists is subversive of reason, leading in many instances to insanity. THE PROPHYLAXIS OF INSANITY. By A. DEBORD YOUNG, M. D., OKLAHOMA CITY, O. T. Formerly with the St. Louis Insane Asylum; Late resident Physician, Illi- nois Insane Hospital, Jacksonville. THERE is vaccination as a prophylactic measure against variola, anti-diphtheritic serum to prevent the spread of that dread disease, and a host of others. Is there no means whereby the number of insanity cases can be reached? Since so large a per cent of mental troubles are essentially of a chronic nature, and since the clouds that obscure the intellectual vision of these unfortunates are so often brush- ed aside, it is obvious that a greater truth was never spoken than the old adage: "An ounce of prevention is worth a pound of cure." It is taken for granted then, that it is the duty of the family physician (for the laity is not educated in these matters) to mould out of the neuropathic individual a use- ful member of society, who, otherwise would perhaps be- come a mental wreck upon the sea of life. It is better to first consider what cannot be done; for, from the time that the insane were supposed to be pos- sessed of devils, to the present day, theoretical and vision- ary ideas have been advanced that are not in the least practical. Witness the suggestion that a law be enacted forbidding the marriage of pathological individuals. This is decidedly impractical. In the first place: Who would have the hardihood to trace a line of demarcation between those who were fit and those who were unfit to marry? Some have proposed that those who have had syph- ilis, be not allowed to enter the matrimonial state. Have L475] 476 A DeBord Young. they forgotten that the grand-children of syphilitics are just as apt to show the stain, as those of the first generation? "And the sins of the father shall be visited upon the chil- dren unto the third and fourth generation." Others have proposed that the mentally unbalanced shall not be permitted to marry. What tribunal in this broad land can be found that will be competent to say where eccentricity ends and insanity begins? And so on, ad infinitum. Suppose such a law were placed upon the statute books, would not such children be born out of wedlock, and would not more criminal abortions occur, and the nervous systems of more women give way on account of these? One of the characteristics of those mentally inferior, is the lowered moral tone, and such happenings would be of more frequent occurrence. Therefore, taken in its broad sense, a law, looking to the control of marriage would be the source of more harm then good. Another means proposed is the unsexing of all persons whose mental infirmity is traceable to, or aggravated by the abuse of the sexual apparatus. Their trouble must have advanced very materially to warrant such radical procedures on the part of the surgeon, and their mind must have been decidedly enfeebled. So, after it is done, what is left? An automatic nonentity, whose physical health may become improved, but whose mental condition remains the same to the end of the chapter, still a care upon his friends and society. So it goes, most of the plans presented have proven impractical. To the mind of the writer there is one way to control insanity, and even after years of earnest efforts upon the part of physicians, it will only partially succeed. 1 refer to education. This education must be commenced with the babe in arms. If there be a nervous or mental hereditary stain in the attendant history of the child, the mother must be coached as to the methods to be used in the rearing of the little one. She must be made to understand that it is no The Prophylaxis of Insanity. 477 disgrace tchave insanity in the family, but that it is a disease the same as is scarlet fever or the measles, and that if she desires to see her child go through life with an unimpaired intellect, she must follow the physician's direc- tions to the letter. The child must live out of doors as much a possible. Its literary education must not be started until seven or eight years of age, though it seems talented and acquires knowledge with little effort. Indeed, beware of the preco- cious child. "Genius to madness is near allied, And thin partitions do their bounds divide." The child must be taught self-restraint, its temper must be controlled, and it must learn to bear small pains and annoyances without complaint. A well ventilated sleeping room, not too warm, must be furnished, regular hours, and a good plain wholesome diet must be insisted upon. In fact, develop the child phys- ically instead of mentally. All nerve stimulants should be avoided, such as tea, coffee, alcohol and tobacco. Finally, let the occupation chosen in later life, be one for the mus- cles rather than'for the mind, an out-door rather than an indoor one, a country rather than a city life. Let these few precepts be religiously followed, and the efforts of the physician will oft-time be crowned with suc- cess. COMBINED MONOBRACHIAL CHOREA AND WRITER'S CRAMP FROM OCCUPA- TION STRAIN. A CASE RECORD IN THE PRACTICE OF DOCTORS C. H. AND MARC RAY HUGHES. AN interesting case of monobrachial chorea, and thumb and finger spasm, came under our observation, and treatment during the past quarter. The patient was a young unmarried American lady of eighteen years of age, intently and enthusiastically engaged in the study and practice of telegraphy and short hand, devot- ing twelve or more hours daily to her practice. Her financial circumstances were good and she was fairly well nourished, but sleeping badly at the time this catastrophe of occupa- tion chorea, finger palsy and spasm came upon her. She was ambitious to excel all others in rapidity of accomplish- ment of this art, and added to her strenuous effort in this direction was her habitual attendance at dancing school, music lessons, and frequently the matinees. She gave out suddenly in accuracy of control over thumb and finger movement. The whole right arm becoming soon after involved in the jerk movement or chorea, exaggerated when she attempted to write with pen or pencil, but the choreic movements were displayed, as in other forms of chorea, independently of any attempt to coordinate the use of thumb and fingers. The case is one of true Scrivener's palsy blended with brachial chorea. There was no history of chorea or other neurosis in the patient or in her imme- diate family. [478] Monobrachial Chorea and Writer's Cramp. 479 Her menses became suppressed just before the onset of this choreospastic condition. Under chemically enforced rest of the affected member and brain, with cephalic, and cephalo-brachial alternate day galvanizations, suppression of all mental strain and sus- pension of all technical efforts being enjoined, the case appeared completely recovered after ten weeks of treatment so that she wrote as follows after recovery: The first specimen of the copy was written with lead pencil, the second with pen and ink. After making a third effort some spasm became apparent in the attempt to form the first two letters of the above copy. The patient show- ing some trepidation at continuing the attempt, she was enjoined to make no further attempt for the present, and to give up all exciting amusements, company or reading, and substitute open air, agreeable walks, rides, and rec- reation. Her electrical seances, nerve and brain tranquilizing medical treatments were resumed. A neuro-hematic reconstructive tonic therapy being prescribed in addition with thirty grains of bromide and two teaspoonfuls of Fair- child's Essence of Pepsin every day after the evening meal. The education of the left hand was advised, and the abandonment of the idea of making a vocation by the use of her pen, for the future, was discountenanced. DEGENERACY STIGMATA AS A BASIS OF MORBID SUSPICION.* A STUDY OF BYRON AND SIR WALTER SCOTT. By JAS. G. KIERNAN, M. D., CHICAGO. Fellow of the Chicago Academy of Medicine; Foreign Associate Member French Medico-Psychological Association, ONE symptom of insanity alleged by Lady Byron was the convulsive attack in the English theater already cited from Madden.t The description of this attack and the conditions under which it occurred, like those of the one at the Bologna theater, would fit both an outbreak of grand • hysteria in an auto-intoxicated, emotionally unstable neuro- path and epilepsy. Giving all due force to Madden's diagnosis, the infrequent recurrence of these attacks and their appearance from fatal malarial toxasmia in Greece, favor the diagnosis of grand hysteria rather than epilepsy. Demarkation in isolated attacks between grand hysteria in an emotionably unstable, badly trained neuropath, and epilepsy by the attack alone is often practically im- possible. That Byron recognized the exciting influence of emotionalism on these attacks attacks at the proper xetiologic moment is shown by the suppressed laughter described by Captain Medwin.t Unrestrained laughter in auto-toxajmic states, not seldom excites a vertigo resembling laryngeal vertigo and the vertigo a stomacho laeso of Trous- •Continued from the April, 1901, Alienist and Neurologist. tlnfirmltles of Genius. Vol. II. P. 92. JJournal of the Conversations. [4S0] Degeneracy Stigmata. 481 seau. This when auto-intoxication is marked may be attended by unconsciousness and convulsive phenomena of isolated occurrence. Byron seemingly had the suspicional nature of epileptics. To this he alludes with exquisite pathos in "Childe Harold": "I have thought Too long and darkly, till my brain became In its own eddy boiling and o'erwrought, A whirling gulph of phantasy and flame, And thus untaught in youth, my heart so tame My springs of life were poisoned." In Byron this suspicional nature was not as in epilepsy, of intrinsic origin but arose from extrinsic fac- tors. From emotional causes, Byron, like most neuropaths, fell readily into auto-toxaemia and during financial and other stress often had jaundice. The irritability from such states so well depicted by clinicians of that day, was doubtless given due importance by the physicians consulted as to Byron's sanity. Mrs. Byron alleged that the keeping of loaded pistols by Byron in his bedroom, imphed insanity. This will strike the average mind in these days of porch-climbing; and burglary (crimes more frequent then than now) as exquisite absurdity. Of necessity Byron's travels in brigand-haunted countries moreover would readily produce such a habit. Lady Byron like other hysterics read her own significance into facts implying more logical explanation. Lady Byron, according to Harness* (Byron's lame friend of Harrow) was self-willed, self-opinionated and the only young pretty well dressed girl he ever saw, who carried no cheerfulness with her^ She moved slowly along her mother's drawing rooms talking to scientific men and literary women without a tone of emotion in her voice or the faintest glimpse of a smile upon her countenance. The impression which she produced on the majority of her acquaintances was unfavorable. They looked upon her as a reserved, frigid being whom one would rather cross the room to avoid than be brought into conversation with un- •Personal Reminiscences, Bric-a-Brac Series, P. 186. 482 J as. G. Kiernan. /: necessarily. Her intriguingly prurient denunciation of the alleged incest of Byron's sister to the latter's hebephreniac daughter, a young, innocent (so far as Lady Byron knew) girl, proved the existence of a remorseless hysteric mind. The attitude of Lady Byron towards servants and de- pendents depicted by William Howitt* is that of a hysterically implacable infallibility. The details of the Beecher-Stowe myth contrasted with the actual factst demonstrate that hysteric wandering from hackneyed limits of the actual which accepts wishes for facts and varies "facts" with the variability of its impressions. The early environment of Lady Byron must have destroyed her power of judicial determination of facts. The environment of Byron at the time of his marriage by itself would suffice to produce his delinquencies even in a poet much more favorably constituted by nature. From king to merchant the time was tainted with coarse narrow plutocratic snobbishness. Its favorite English literati were of caddish type like the Germans whom Goethe and Schiller castigated with the "Xenien." The sensation produced by "English Bards and Scotch Reviewers" was according to Bayard Taylor tmild compared with that pro- duced by these. Byron, like Goethe and Schiller, created bitter enemies among the attacked and their satellites. Thomas Campbell embraced the cause of Lady Byron with enthusiastically unjustifiable bitterness. His attitude was that of an unscrupulous shyster. The fee was the com- pliment of Lady Byron having confided her "grievances" under the flattering pledge of inviolable secrecy. Lady Byron like most frigid hysterics had an ability of assuming "confidential relations with inviolable secrecy" to secure power and adherents. By the flattery implied in such confidential relationships, hysterics captivate self-ad- mirers, especially those who, drenched with philistinism conceive themselves thereby endowed with opinions which must be "common sense." Lady Byron for years thus captivated poseurs of the "social purity" pervert type, of •Homos and Haunts of Some Eminent British Poets, Vol. II. tNoel Op. Cit. P. 116. {Translation of Faust. Degeneracy Stigmata. 483 the "superior" woman type, of the type which canted then about the inherent depravity of American institutions as it now cants about inherent depravity of non- alcoholophobia. No ostentatious charity or pseudo-reform failed of blatant support by Lady Byron as thereby were sycophants secured at slight cost. From her sedulous patronage of that modern notoriety dodge the "Charity" Ball, came Byron's bitter lines: "What matter the pangs of a husband and father, If his sorrows in exile be great or be small, So the Pharisee's glories around her she gather, And the saint patronizes her charity ball. What matters—a heart, which, though, faulty, has feeling, Be driven to excesses which once could appall That the sinner should suffer is only fair dealing As the saint keeps her charity back for the ball." Campbell's emphatic assertion (a la Beecher-Stowe) of alleged enormities in his "friend" Byron, of the justice of Lady Byron's cause, and his plausible reasons for not citing facts to support his assertions, tended to produce an im- pression which, as R. H. Stoddard forcibly remarks,* nothing but facts testified to in plain words by unbiased witnesses, should produce; the production of such an impression even a prosecutor should not attempt in the absence of power to confirm it by facts. Campbell was self-centered, self-dependent, yet social and fond of external excitement. Dashed with philistinism, objective and subjective constantly contended too strongly in him to permit of poetry of the first order. This instability created Campbell's great deficiency as a man and a poet. He had never sufficient control over himself, his intellectual movements. The maternal ancestors of Thomas Campbell had a marked tendency to insanity.t He wrote verses at ten, was imaginative, sensitive, and passionately fond of music. In this was seen the influence of the blood and resultant environment of the Celtic High- lander. At eighteen he had an attack of melancholia. •Personal Recollections of Thomas Campbell. tNisbet Insanity of Genius. 484 las. G. Kiernan. Campbell accompanied Professor Fillians to his father's house so intensely depressed that the father accused the latter of bringing a man bordering on insanity. In a Celtic Highlander however, alternations of depression and exalta- tion are not as significant of mental disturbance as in a Lowlander. Campbell, when at the height of his fame and in most prosperous circumstances, insisted he was ruined. He frequently suffered from uric acid states which to some extent explain the periods.of irritability, capriciousness, de- pression and suspicional exaltation which so often marked him. To these states were also in part due his intolerance of alcohol and resultant seemingly excessive indulgence at irregular intervals. He died demented at sixty-seven. Through suspicionally envious pessimism miscalled "common sense," Campbell ignored in Byron's case the "Golden Rule" and the English common law. Both com- manded him to presume every one innocent until proven guilty beyond a reasonable doubt and to construe anything which could be so construed, favorable to innocence. His puerile jealousy toward potential rivals led him needlessly to exalt himself, as a poet, at the expense of Byron, Sir Walter Scott and greater contemporaries. Campbell, like a hysteric American (who later had reasons to regret popular acceptance of hysteric delusions as to a brother*) accepted without question the hysteric emanations of a mind marred curiously like his own but without the same poetic power. Southey whose narrowness, mental poverty, and apostasy from early republicanism made him Poet Lau- reate, followed likewise the gang which howled after Byron. Southey came of very neuropathic maternal stock. His maternal uncle was an imbecile of the Shakespere "fool" type. He had the inventively stupid shrewdness of that phase of mentality. Southey's brothers and sisters as a rule died early; in one instance of hydrocephalus. Southey, lithaemically neuropathic throughout life, became demented about sixty. Southey and Byron crossed literary swords over •The Tllton-Beecher Scandal. Degeneracy Stigmata. 485 the former's apostasy. Byron's "Vision of Judgment" satirized Southey's preposterous panegyric of George III with the same title. Southey denounced "Don Juan" as a monstrous combination of horror and mockery, lewdness and impiety, regretted that it had not been prosecuted and sainted the writer as the chief of the Satanic school. Byron's parody of the panegyric brought down upon him the vengeance of royalist snobs whereby his publisher was fined. Southey was effectually extinguished by this exquisite burlesque. The hypocrisy of Southey's attitude becomes obvious when his fulsome toadyism to George 111 and IV is remembered. Byron's delinquencies were almost virtues compared to those of George 111 and the Prince Regent afterwards, George IV. George III, one of the most im- becile mentally and morally of English kings, was in- tellectually and ethically akin to the English plutocrats who urged on his war upon English, Scottish, Irish, -American, and French freedom. From avarice he evaded his children's claim on his civil list thus producing that attempt at taxing Americans without representation which formed the United States. His political creed for English men (absurd in one who owed his throne to the 1688 Revolution and a re- sultant parliamentary statute not "divine" right) was: "Fear God and Honor the King." Strong as Byron* puts the case against him: From out the past Of at;es, since mankind have known the rule Of monarchs—from the bloody rolls amass'd, Of sin and slaughter—from the Caesar school, Take the worst pupil, and produce a reign More drenched with gore, more cumber'd with the slain. He ever warr'd with freedom and the free: Nations as men, home subjects, foreign foes, So they that uttered the word "Liberty" Found George the Third their first opponent. Whose History was ever stain'd as his will be With national and individual woes. Yet this censure is mild compared with the sober •Vision of Judgment. 486 Jas. G. Kiernan. . judgment of Green,1 Macaulay,2 and Greville,8 and the caustic invective of Junius4 and Patrick Henry.6 Toward women he was as guilty,6 secretly of base be- trayals as George IV was blatantly. His avarice, his wor- ship of the sacred strong box, his cant, his "law and order" and "farmer" dodges, his deference to the "re- spectable business man" still so sway the British philistine that Thackeray7 and Besant8 dominated thereby have written mawkishly fulsome biographies of him. His aid to the "law and order" dodge (whereby plutocrats defraud work- men by threats of imprisonment) was prompted by more despicable meanness than cant. He and "snuffy" Queen Charlotte not only shared9 in jobs but eternally tried to extend the field of the laws forfeiting a felon's goods to the king. For this purpose more offenses were made capital during the reign of George III alone, than during the reigns of all the Plantagenets, Tudors and Stuarts, put together. The most venial crime was severely punished. The result, as the satirist, sung was that: "Scarce can our fields, such crowds at Tyburn die, With hemp the gallows and the fleet supply." These executions did not reduce crime. Forgery was seldom if ever pardoned, yet, as James Payne10 points out, forgeries increased from fifteen prosecutions in January, 1798, to two hundred and forty-two in January, 1819. For the worst judicial murders, George III and the shop-keep- ing, manufacturing, and merchant classes, were directly responsible. A husband was pressed for a seaman. Left to starve with two* children, one at the breast, the wife stole a bolt of cloth and escaped. Her conscience troubled her, she returned, replaced the cloth and was captured. She was found guilty and sentenced to death. An appeal lHistorv of the Enelisb People. 2Es$ays: The Earl of Chatham. 3Memolrs. 4Letters. SLife and Speeches. 6Banvard: Court and Times of George IV. 7The Four Georges. 8A Fountain Sealed. 9Caricature History of the Georges. lOUIeanlnes of Dark Annais. Degeneracy Stigmata. 487 in her favor to George III was rejected because the cloth merchants demanded an example. The woman was hanged. The child being removed from her breast just ere the black cap was put on. Byron like many English and Scottish Lords was bitterly hostile to such brutal avarice. In Byron's first speech in the House of Lords on the Nottingham frame-breakers bill which met with approval from statesmen he said: "I have traversed the seat of war in the Peninsula, I have been in some of the most oppressed provinces of Turkey; but never under the most despotic of infidel governments, did I behold such squalid wretchedness as 1 have seen since my return, in the heart of a Christian country." Reprobating the severe measures proposed against the poor, starving mechanics, who broke the looms that deprived them of food he asks, "Is there not blood enough upon your penal code that more must be poured forth to ascend to heaven to testify against you?" Byron thus offended two classes still existent which never forgive. The court sycophant now represented by what Macaulay* calls "Boodle's patriot band, Fat from the leanness of the plundered land." And the "respectable business men" who posed then as now, as churchmen, as ostentatious donors of charity, as supporters of canting conventionality of "law and order" while at the same time defrauding the public, the govern- ment and their workmen. This "gigmanity" as Carlyle calls it is responsible for the worst crimes of England from the crushing out of Irish industries to the American tea and stamp tax to the support of slavery in the war between the States, and to the "opium" war. Though Tennyson joined this class during the war between the States still its attempt to aid Napoleon the Little in crushing the second French Republic drove him indignantly to exclaim: Though niggard throats of Manchester may bawl, What England was, shall her true son forget? We are not cotton- spinners all. "Political Georglcs 1828. 488 las. G. Kiernan. This class with the court camarilla stealthily bided its time to crush Byron. Byron's attack on George III and IV and the plutocratic classes finally roused "public" (pluto- cratic mob) indignation against alleged wrongs to his wife. The capricious "public" was, as Noel remarks, now for whipping and breaking its adored idol. People of his own class avoided him. Lady Jersey did not fall away from him, inviting him to her party on the eve of his leaving the country. Yet even that effoit was a failure: the guests cut him, or treated him with marked coldness. Years after he wrote with satirical amusement of the behavior of his quondam friends that evening. The men were wreaking their vengeance on the man whom they disliked: first, be- cause their women liked him; secondly, for not taking more port wine and beefsteak, like his fellow Britons; then for being a great poet, instead of an ordinary partridge-kill- ling seducer who,—commendably free from the eccentricities of that uncanny thing called "genius," veneering his vices with a seemly show of decorum, conformity to established religion and the politics of privilege, throwing his pinch of incense on the altar of the great goddess Grundy, whose image is so well known to have descended from heaven; —might be received with condoning eyes, and deferential smiles into the bosom of the most respectable families, therefrom to carry in triumph the fairest and purest virgin to his den. But this man was also a satirist who had made enemies of the literary set not only by his lashing satire but by the sterling original excellence of his verse. Without one scintilla of proof he was forthwith com- pared to Nero, Heliogabalus, Tiberius and other celebrated criminals while his misconduct at home was mercilessly and monstrously exaggerated by rumor. Far worse men than he, ready to commit any crime in the interest of their own estate or their private property, men of the world as well as intolerable Pharisees made a queer sort of vicarious atonement for their own vices by an immoderate and un- just condemnation of his. George IV had wronged Caroline of Brunswick and scores of women more deeply than Byron had been charged Degeneracy Stigmata. 489 with wronging Lady Byron. Yet this pseudo-religious class and its literary satellites toadied to George IV as king was never toadied1 to before. This plutocratic indignation still re-echoes in the twentieth century partly through the logorrhoea of the hysteric entourage of Lady Byron; partly because of the prejudices raised by Byron's support of principles underlying the American Republic. This support so shocked plutocrats of his time that it still affects the devotees of Mrs. Grundy of to-day. The effect of cant in obscuring truth, is singularly well shown in the fact that while Byron's domestic mis- fortunes are a horror to canting New England Pharisees, Milton's have been passed over without comment. Milton had struck fiercely at the church system of divorce and marriage, and thus had assailed a great source of theologic revenue. With all the oriental views of women of the narrow Pauline Christianity of his day, Milton was so far influenced by the individualism of co-existent thought as to demand freedom of marriage from ecclesiastical tyranny, Milton married the daughter of a royalist who was under financial obligation to his father. Probably pressure was exerted on the girl; if so it was unknown to Milton. After the marriage the family so intrigued with the girl against her husband and his cause that she refused to consummate the marriage. She subsequently admitted Milton was clearly in the right. In consequence of her refusal appeared Milton's "Doctrine and Discipline of Divorce" advocating divorce for incompatibility of temper. This pamphlet probably underlies most divorce legislation in the United States. Early Connecticut divorce legislation is clearly based upon it. The divorce question however disguised by cant has always turned on the question whether church or state should receive fees for granting divorce. Under the Jewish law (still obeyed by Polish and Russian Jews) a divorce (the "get") is arbitrarily given by the husband before the Rabbi. Against this system of divorce Christ protested as it made women the victims of male caprice. The Jewish 490 Jas. G. Kieman. law placed less restriction on polygamy and arbitrary divorce than does the Mohammedan. Early Christian con- tempt for women partly of oriental origin and partly due to the crime ascribed to Eve forced similar tendencies into English divorce law. Adultery sufficed in the case of women but in the case of men to adultery must be added cruelty. The Roman Church (while its canon law does not ostensibly permit divorce) annuls marriage on legal fictions; thus the marriage of Napoleon I and Josephine was annulled by the Pope. For centuries after the Reformation the House of Lords exerted with the agreement of Cranmer, (foun- der of the English Church) the power of divorce. Under what was called dispensation, marriage and divorce were modified to suit the exigencies of those endowed with power or cash. How wide the scope of the dispensation is shown by a question brought before Convocation, the chief ecclesiastic body of the English Church in 1882, when a clergyman applied for recognition of the legality of con- cubinage, in an appeal from the Bishop of London who declined to allow the lawfulness of relations into which the appellant had entered and virtually excommunicated him therefor. The law of England recognized no such tie but this was not regarded by the appellant as an adequate answer since his case was stated with exclusive reference to the canon law. The lower form of marriage, he showed, was expressly permitted in the early church by the canon law and had never been explicitly forbidden by the Church of England. Convocation on the plea of business and similar frivolous pretexts, excused itself from adjudicating this knotty point, left the appellant and his Bishop to fight the question out between themselves. Milton threatened during the Commonwealth that if the law as to divorce were not amended he would not obey it, but would act on that broader spirit of the common law which makes the privileges of one freeman end only where those of another began. The protest of Milton was in essence the same as that of Byron but expressed with far greater dignity. The license of the court of Charles II encouraged and supported Degeneracy Stigmata. 491 as it was by the leaders of the Church of England pre- vented any serious prosecution of Milton for his divorce principles. High churchmen have however, ever aimed to reduce his literary reputation. As Greene* has shown, the state of the English and Irish Church during the reigns of George 111 and George IV was as low as that of the Church during the reign of Charles II and his immediate successors. The subordinate clergy were usually appointed by dissolute squires and nobles to whom they had previously played the part of panders and sycophants. Such men naturally became en- thusiastic supporters of "church and king" and headed the mob which drove Priestely, the chemist, from Birmingham because of his republican opinions. The Tory reaction consequent on the downfall of the French monarchy en- abled the Church of England to denounce liberals for mild lapses while condoning gross violations of decency in the Tories, especially George IV. For these reasons Byron encountered the fierce storm described. Had there not been the slightest difficulty with his wife, he would have encountered it for the reasons given just the same. This storm blew up rapidly after his dazzling rise as a poet. Soon after Byron's speech in the House of Lords "Childe Harold" appeared with electric effect. Lord Byron and it became the universal theme. At his door, most leading men of the day presented themselves; even some whom he had attacked in satire. From morning till night most flattering testimonials to his success crowded his table from grave tributes of statesmen and philosophers down to romantic billets of incognitas or pressing notes of invita- tion from leaders of fashion.t In place of the desert which London had seemed but a few weeks before, Byron saw the whole splendid interior of high life now thrown open to him and found himself its most distinguished object. Moore feared that "Childe Harold" was too good for the age which significantly demonstrates the height of Moore's ideals. "History of the English People. tMoore's Life of Lord Byron 492 Jas. G. Kiernan. Its success, as Nichol observes,* was because it was just on a level with the age. Had it, as Jeaffersont remarks been equal to the poetry Byron wrote later it would have had less immediate success. It had a graceful beauty, was at times novel in subject and manner, faithful in description, the revelation of an interesting personality on the spot to con- firm the impression. It was written by a peer, a "curled darling" of society fascinatingly sad, gently, not too vehemently, skeptic, or defiant. That it is not very in- telligible to the unthinking did not lessen its popularity. It had, Noel remarks, too much melodrama and too great pose as to how interesting the author will appear to women. Walter Scott at once generously acknowledged that Byron had gone beyond him in lyric rush and swing. The critics ("who had failed in literature and art") after passing over with insolent silence or contempt Wordsworth, Shelley, Keats, Chatterton, and Coleridge, needed a new toy. "Public" opinion created by Murray's booming powers swept them from the cold classicism of Rogers and Camp- bell to Byron's fitful splendors. Byron, as Noel remarks, is very much akin to Burns whose supreme song "survives deep in the general heart." Burns has the same wild irregular passion, the same humor and intermingling of grave and gay, the same character full of contradiction. But as Burns had a tinge of coarse commonplace, so had Byron the gaudy pose of life and poetry that imposes on the crowd which acts but does not reflect. Wordsworth, Shelley, Keats, Chatterton and Coleridge waited while Moore, Byron and the lower Montgomery and Southey had their loud day. At the height of his reputation from "Childe Harold," Byron's marriage was brought about. Miss Milbanke, who became Lady Byron, was the daughter of Sir Ralph Mil- banke and Judith Noel. Sir Ralph was a prosy one-ideaed county aristocrat. His wife was a passionate, excitable, in- triguing evil-seeking egotist. Miss Milbanke was a "paragon" of virtue at home; a child who got her own way and was spoiled. She was of that auto-erotic type •English Men of Letters: Byron. tThe Real Lord Byron. Degeneracy Stigmata. 493 which puts meretricious constructions on the most innocent actions of friends, which makes self-indulgence an art, is indolent, selfish and "religious." She was attractive look- ing, ostentatiously philanthropic, clever, stiff, prim, formal, very priggish and pruriently prudish. Naturally therefore she was much influenced by her toady governess, Mrs. Clermont. The latter having been a successful governess in those snobocrat days was a skilled toady. Miss Mil - banke during Byron's courtship had been so jealous of Lady Caroline Lamb as to satirize her in verse. Once she kindly told Lady Caroline that her affectation of a woebe- gone Byronic visage marred the effect of her "fair seeming foolishness." She thus so played the arts of the Minervan "coquette" as to outdo the impulsive Lady Carolina in Byron's esteem. The most skilled matrimonial intriguant could not better have posed at another woman's expense than did this "unsophisticated virgin" of the Beecher- Stowe myth. During the early months of marriage Lady Byron nagged Byron eternally, stimulated by her mother (whose conduct showed there were justifications for the pre-historic taboo* which kept the mother-in-law out of the son-in-law's way on pain of death) and the mischief making Mrs. Clermont. Even on a healthy man such nagging might have the disastrous effects which Shakespere thus paints in the "Comedy of Errors. ADR. "It was the copy of our conference: In bed he slept, not for my urging it; At board he fed, not for my urging it; Alone it was the subject of my theme; In company I often glanced it; Still did I tell him it was vile and bad. ABB. And therefore came it that the man was mad: The venom clamours of a jealous woman Poison more deadly than a mad dog's tooth. It seems his sleep were hindered by thy railing And therefore comes it that his head is light, Thou say'st his meat was sauced with thy upbraidings: Unquiet meals make ill digestions; Thereof the raging fire of fever bred; And what's a fever but a fit of madness *Letourneau: Evolution of Marriage. 494 Jas. G. Kiernan. Thou say'st his sports were hlnder'd by thy brawls: Sweet recreation barr'd, what doth ensue But moody and dull melancholy, Kinsman to grim and comfortless despair And at her heels a huge infectious troop Of pure dlstemperatures and foes to life? In food, in sport and life-preserving rest To be disturb'd would mad, or man or beast The consequence is then thy jealous fits Have scared thy husband from the use of wits. There was therefore good reasons for the depression seemingly amounting to melancholia but due to adequate external causes which even Byron's sister noticed in him at that time. Urged on by the prying curiosity of Lady Milbanke, Mrs. Cleremont did not hesitate to pick locks and search private memoranda in order to pander to Lady Byron's worst qualities. (To be continued.) RACE DEGENERACY AND DENTAL IRREGULARITIES.* By E. S. TALBOT, M. D., D. D. S., Fellow of the Chicago Academy of Medicine, Professor of Oral Surgery Woman's Medical Department Northwestern University. FORCES tending to change, in an existing organism, act in various ways as part of the environment of the individual, and through its influence on him produce changes in the complex union of checks, balances, forces and mate- rial bases which constitute the human organism as inherited. Of necessity any change in this complex unity being un- usual must be abnormal so far as the organism existing prior to the change is concerned. The question whether such abnormality be of benefit or injury is another matter. As Virchow remarked seven years agort Transforma- tion, a metaplasia, a change from one species into another, whether in individual animals or plants or individuals or their tissues, cannot take place without anomaly; for if no anomaly appears this new departure is impossible. The physiologic norm hitherto subsisting is changed, and this change cannot be called anything but an anomaly. In for- mer days an anomaly was called pathos and in this sense every departure from the norm is a pathologic event. If such pathologic event be ascertained, this forces investiga- tion as to what pathos was the special cause of it. This cause may be, for example, an external force or a chemi- cal substance or a physical agent producing in the normal condition of the body, a change, an anomaly (pathos). This •Belne Chapter XVI of Irregularities of the Teeth. VounalAmcT. Mid. Alloc. Vol. XXXII. Page 1311. L495] 496 E. S. Talbot. can become hereditary under some circumstances and then may be a foundation for slight hereditary characteristics propogated in a family. In themselves these belong to pathology, even though they produce no injury. Pathol- ogic does not mean harmful, nor does it indicate disease. Disease in Greek is nosos and it is nosology that is con- cerned with disease. The pathologic under some circum- stances may be of advantage to its inheritor. From this standpoint it is obvious that the fact whether a given change in the organism shall prove a defect or not is determined by the conditions of periods of stress during intra and extra-uterine life. According to general observa- tions made by Weismann and others any condition affect- ing the individual must in some way affect the organism as a whole in order to survive these periods of stress. In dealing with the origin of any defect or gain in the animal organism, several factors must be taken into account, independently of the simple element of heredity. Heredity moreover, is not the uncomplicated agent which is usually regarded as producing certain effects. In dealing with he- redity the influence of inter-uterine stress on the foetus must be determined. Unusual strain of any kind upon the mother during gestation may unfavorably affect the foetus. The healthier the ancestry the less liable the mother would be to ill effect from such strain. On the other hand unusu- ally favorable conditions during gestation may correct de- fects observable at previous pregnancies. Periods of stress are constituted by the different periods of embryonic devel- opment as well as by those extra-uterine. Even sex is determined by conditions of stress after certain periods. Poor maternal nutrition will determine an excess of males, while good will determine an excess of females. Arrest at certain periods of intra-uterine life will produce prematurely senile states; since there is a period in intra-uterine life during which the foetus wavers between the senile appear- ance of adult anthropoid apes and that of mankind in youth. This intra-uterine stress may be an expression of the gen- eral nervous exhaustion of the mother which first affecting checking influences of the central nervous system finally Race Degeneracy and Dental Irregularities. 497 leads to unchecked excessive nervous action of the part of the local nervous systems of the organs, leading secondar- ily to exhaustion of these. In consequence the mother is unable either to manufacture proper elements of nutrition or to excrete waste material. The foetus thereby, starved and poisoned, fails to pass through the periods of stress in a well-balanced manner. The stress in these periods is strongest on those structures which are transitory and var- iable in type. This influence may furthermore be exerted on the foetus through stress, mental or otherwise, of the mother. The human foetus exhibits, as elsewhere shown, very decided reaction to sensory impressions on the mother. At every one of these periods, the forces which deter- mine the variations of the individual from the race and those which tend to preserve the race type are in constant conflict. Conditions affecting nutrition of the ovum prior to fecundation (as derived from the mother) and conditions affecting the fecundation of the ovum (as derived from the father), as well as those derived from both father and mother after fecundation, will determine whether or not the foetus shall pass through the complete embryologic evolu- tion determined by the race type and whether or not indi- vidual variation present in the parents shall be transmitted successfully through these periods of stress. While all of the factors enumerated enter into the cause of jaw degeneration, one of the great factors is the extraction of the temporary and permanent teeth. In no country is this pernicious habit so marked as abroad. Con- stant extraction of the teeth produces variations (arrest of development) which are transmitted from one generation to another. In the evolution of the jaws, nothing could be easier accomplished than this. One period of stress is marked by eruption of the temporary, and the next period of stress by the eruption of the second set. The first per- manent molar is the first tooth to erupt in the permanent set. It is situated in the center of the jaw. Permanent teeth erupt anterior and posterior to the tooth. This tooth because it is larger, requires more room. The first molar is the first tooth to decay. As soon as it aches it is re- 498 E. S. Talbot. moved. When the other permanent teeth erupt they move forward and fill the space made vacant by the lost first molar. Since, therefore, the jaw expands and grows only for the purpose of containing the teeth, if they be not present the jaw ceases to develop. What is true of the first molar is also true of the other teeth. In many coun- tries one tooth after another is sacrificed as soon as it be- gins to ache. Not infrequently whole sets of teeth are re- moved in early life before the jaws have fully developed. The habit of early extraction of the temporary and per- manent teeth from one generation to another causes arrest of development in two ways. First, through the inheritance of acquired defects; second, by natural selection. Since the jaws and teeth are so unstable in their development they are easily affected. The influence of the complex sociologic state on civiliza- tion, while not having the malign influence ascribed to it, has, by its economy as regards food production and prepara- tion, lessened markedly the functions of the jaws and teeth. Food no longer needs the grinding and tearing required from primitive man or even types as high as the "pile dwellers," whose food is still to be found even to coarse breads and cakes. Under the law of economy of growth, lessened muscular action leads to lessened blood supply. Lessened blood supply produces conditions in the offspring tending to under-nutrition of certain parts for the benefit of the body as a whole and to diminish in size unused parts. As the jaws, alveolar process and teeth are com- paratively unstable in all mammals, these of necessity would be peculiarly affected by disuse. A very similar evolution is occurring in the dog in whom domestication plays the part of civilization and who from a carnivore has become an omnivore. In the mongrel dog, race admixture and other factors producing change in man are to be found. In him, peculiarly, domestication would play the part of civilization. In the jaw and tooth irregularities ascribed to other causes occur. Facility for securing food under do- mestication has played a part. Disuse of the jaws as a weapon by man has done its share in the changes com- Race Degeneracy and Dental Irregularities. 499 paratively early in development. To a certain extent this last change is still going on in the dog. In cases predis- posed to advance in evolution, irregularities of beneficial type would occur with great facility. In cases predisposed in the opposite direction changes would result of opposite effect. Irregularities of the jaws and teeth increase proportion- ately westward from Greece to the British Isles, the rate in the British Isles being greatest. Greece, however, no longer contains the race, which so long dominated the world intellectually. The people are a mixed Slavo'-Mon- goloid race who speak Greek. Furthermore as the correc- tional, charitable and hospital arrangements are primitive, the defective classes are not accumulated. Under such conditions a certain seeming decrease in stigmata of degeneracy must result. This, however, would extend more to deeper stig- mata than to those of the jaws and teeth. Degenerate jaws and teeth are commonest next to the English speaking people among the Scandinavian speaking. As both have passed through very similar phases of race evolution and both contain at bottom the same race elements, this was to have been expected. As I have pointed out some years ago, the struggle for existence between the organs, depend- ent on race evolution and race admixture, has resulted in the higher races in the triumph of the brain and skull at the expense of the face, hence, the higher the intellectu- ality the greater the tendency to local degeneracy of the face, jaws and teeth. THE DEVELOPMENT OF THE SEXUAL INSTINCT. By HAVELOCK ELLIS, M. D., LELANT CORNWALL, ENGLAND. Honorary Fellow of the Chicago Academy of Medicine, Etc. IT is a verv remarkable fact that although for many- years past, serious attempts have been made to eluci- date the psychology of sexual perversions, little or no endeavor has been made to study the psychologic develop- ment of the normal sexual emotions. Nearly every writer seems either to take for granted that he and his readers are so familiar with all the facts of normal sex psychology that any 'detailed statement is altogether uncalled for, or else he is content to write a few introductory phrases, mostly made up of extracts from anatomic, philosophic, and historical work. Yet it is unreasonable to take normal phenomena for granted here as in any other region of medicine. A knowl- edge of such phenomena is as necessary here as physiology is to pathology or anatomy to surgery. So far from the facts of normal sex development, sex emotions, and sex needs, being uniform and constant, as is assumed by those who consider their discussion unnecessary, the range of variation within fairly normal limits is immense, and it is impossible to meet with two individuals whose records are nearly identical. There are two fundamental reasons why the endeavor should be made to obtain a broad basis of clear informa- tion on the subject. In the first place the normal phe- [500] Development of the Sexual Instinct. 501 nomena give the key to the abnormal and the majority of sexual perversions, including even those that are most re- pulsive, are but exaggerations of instincts and.emotions that are germinal in normal human beings. In the second place what is normal cannot be determined until the sexual life of a large number of healthy individuals is known, and until the limits of normal sexuality are known, the physician is not in position to lay down any reasonable rules of sexual hygiene. On these grounds I have for some time sought to obtain the sexual histories, and more especially the early histories, of men and women who on prima facie grounds, may fairly be considered, and by themselves and others are so consider- ed, ordinarily healthy and normal. There are many difficul- ties about such a task. Difficulties which are sufficiently obvious. There is, first of all, the natural reticence to reveal facts of so intensely personal a character. There is the prevailing ignorance and unintelligence which leads to the phenomena being obscure to the subject himself. When the first difficulty has been overcome and the second is non- existent, there is still a lack of sufficiently strong motive to undertake the record, as well as a failure to realize the value of such records. 1 have been promised and even offered many histories which have never reached me. Still I have obtained a certain number, some of them exceed- ingly valuable and instructive and I hope to obtain still more. In the present paper 1 bring forward eight such his- tories (four from individuals of each sex) selecting them as fairly varied and typical. Two of the cases, it will be seen, begin narrowly to reach (whether temporarily or per- manently cannot be said) the abnormal (Histories IV and VIII); they represent the transition of pathologic sex phe- nomena. HISTORY I. E. T. T's earliest recollection of ideas of a sexual character are vaguely associated with thoughts upon whipping inflicted on companions by their parents, and sometimes upon his own person. About the age of seven,T. occasionally depicted to himself the appearance of the bare nates and genitalia of boys during flagellation. 502 Havelock Ellis. Reflections upon whipping gave rise to slight curious sen- sations at the base of the abdomen and in the nerves of the sexual system. The sight of a boy being whipped up- on the bare nates caused erection before the age of nine. He cannot account for these excitations, as at the time he had not learned the most rudimentary facts of sex. The spec- tacle of the boy's nudity had no attraction for him while the beating aroused his indignation against the person who administered it. T. knew a boy and girl of about his own age whose imagination dwelt somewhat morbidly upon whipping. The three used to talk together about such chastisement and the little girl liked to read "stories that had whippings in them." None of these children delighted in cruelty; the fascination to them of castigation seemed to be in imagining the spectacle of the exposed nates. Actual witnessing of the whipping made them angry at the time.* Accustomed to watch a young sister being bathed, T. had no distinct curiosity concerning the differences in the sex until the age of nine. About this time he asked his father where babies came from and was told to be quiet. When he persisted in the enquiry his father threatened to box his ears. His mother told him subsequently that doc- tors brought babies to mothers. He credited the story so far as to watch carefully the doctor who came when his mother "was going to have a new baby," in the hope of seeing a. bundle in his arm. T. was nine when he inter- rogated a servant girl of sixteen about babies and their origin. She laughed and said that one day she would tell him how children came. One Sunday this servant took T. for a country walk and initiated him in membrorum con- junctionem telling him he was too young to be a father but that was the way babies were made. The girl took him into the field saying she would show him how to do •J. G. Klernan has described a case In which ("Alienist and NEUROLOGIST 1891) a boy of six found It a peculiar pleasure In throwing- little giris down and spanking their nates. A case described by W. A. Hammond (Impotence) throws some light on the case described above and Klernan's case. A twelve year old boy was severely flogged which flogging pro- duced sexual sensations and prolonged erection. Presuming a sImular condition purely sub- conscious as to Its knowledge of the nature of the sensation to have occured, It will be readily understood how pleasure of sexual sub-conscious origin should associate Itself with the Idea'of whipping. Development of the Sexual Instinct. 503 something which would make him feel as though he were in heaven, informing him that she had often done this with young men. She then provoked genital excitation and instructed him how to proceed. His feeling at the time was one of disgust; the appearance and odor of the female genitalia repelled him. (Afterwards though he wished to repeat the experience with girls of his own age.) Finding the boy unresponsive, the girl embraced him more mascu- linae with great passion. T. can recall the expression of the girl's face, the perspiration on her forehead and the whispered query whether it pleased him. The embrace lasted for ten minutes when the girl said it had done her good. Later the same day they met a girl cousin of this servant about twelve years old. The three went to a lonely part of the seashore. The servant there suggested that T. should repeat the act with the little girl. T. was too shy though the girl was quite willing and experienced. The elder girl told the younger to keep watch a few yards away, while she again brought about membrorum conjunc- tionem with T., more masculinae. The servant told T. not to tell anyone. Intercourse with the servant was never repeated after that day and from shame he kept the promise.* After this episode T. began to speculate about sexual matters and to observe the coupling of dogs with newly acquired interest. At ten years he often lay awake, listen- ing to a woman twenty-five singing to a piano accompan- iment. The woman's voice seemed very beautiful and so strongly impressed him, that he fell in love with her and longed to embrace her sexually. This second attachment was much more romantic than sensual though the idea of embracing the woman seemed to T. a natural part of the *It is evident that servant giris and nurses play a very large part In sexual Initiation of boys. An experience aImost Identical with the above is recorded In History IV. Lawson Tait states ("'Diseases of Women".) that In every case where he has found a number of children to be affected with masturbation, the contagion has been traceable to a servant girl. W. A. Hammond has observed the case of a man whom at the age of seven, a servant girl taught masturbation and with whom she frequently attempted membrorum conjunctioncm Andrleux. Blach, Garnler (Onanism 1890.) and Desiandes (Onanism 183S. ) state that It is not rare for nurses to quiet children under three by sexual manipulation per oj. French of St. Paul Minn.. (Medical Standard Vol. 1U E. C. Spllzka and other American physicians have reported similar instanceslfrom the United States. They have aiso been noted In Germany and Italy. 504 Havelock Ellis. romance. He was beginning to invest the sex with angelic qualities. The thought of his adventure with the servant no longer caused repulsion but rather pleasure. He reflect- ed that if he could meet the girl now, he could be very fond of her and understand things better. At this time he had not masturbated nor even heard of the practice. One day, while playing with a girl of his own age he succeed- ed in overcoming her shyness and induced her to expose her genitals, at the same time uncovering his. On this occasion and once afterward he succeeded in membrorum conjunctionem. Both he and the girl experienced imperfect enjoyment. At boarding school where he was sent at ten T. learned the vulgar phrases for sexual organs and sexual acts, and acquired the habit of moderate masturbation. Coarse talk and indecent jests about the opposite sex were common amusements of the play room and dormitories. At first obscenity was very distasteful; later he became more used to it but thought it strange that sex intimacy should be a subject for ridicule and jest. He began to read love stories and think much about girls. He learned 'the nature of "fornication" and wondered why it should be considered so heinous. Parts of the Bible condemning intercourse between the unmarried alarmed him. Being of a serious as well as emotional and amorous nature, he became converted to evangelic belief. His mother warned him to beware of unclean companions at school. He tried to act as a Christian and think only pure thoughts about women. The talk however was always of girls and of being in love. His mind was often engross- ed with amatory ideas of a poetic, sensuous nature; his sexual experiences having a firm hold on his imagination as they gave him gratifying assurance of actual knowledge concerning things merely imagined by most of his compan- ions. His health was vigorous and he keenly enjoyed all out- door games and excelled in daring and school boy mischief. At twelve he fell deeply in love with a girl of corres- ponding age. He never felt any powerful sexual desire for Development of the Sexual Instinct. 505 his sweetheart and never attempted anything but kissing and decorous caresses. He liked to walk and sit with the girl, to hold her hand and stroke her soft hair. He felt deeply grieved when separated from her. His thoughts of her were seldom sensual. A year or so afterwards he had a temporary passion for a woman of thirty who used to flirt with him and allow kissing. T. thought her queenlike and very lovely and wished to be her knight. One day he saw for a moment in a friend's house, a dark, earnest-looking girl of thirteen who made a very deep impression upon him, and though he did not exchange a word with her, he often thought about her afterwards. Five years later he met the dark girl again and the pair were mutually drawn to one another. He proposed mar- riage and avowed a most desperate passion. A refusal on the plea of youth caused him the deepest misery. About eight years thereafter T. married the girl and the marriage proved a very happy one. When fifteen T. made the acquaintance of a pretty blonde of the same age. She was a high spirited hoiden. They were soon close friends and later lovers. They wrote a number of letters to each other and exchanged locks of hair and presents. Their talk about love was unsensual. One day the blonde told T. that she had been sexually embraced by a former lover; a boy of sixteen, hinting very plainly that she would like T. to embrace her. This amour lasted for about six months. The lovers had many oppor- tunities for clandestine intercourse. They used to consum- mate their passion in a part of a wood they called "the bower." Now and then one or the other would experience a pricking of conscience but they were too passionately attached to each other to sever the intimacy. At length the girl began to dread the risk of conception and the in- tercourse ceased. Looking back upon this episode T. avows that the attachment and its physical expression seemed quite natural, poetic and beautiful, though at times his religious principles condemned his conduct. He now thinks that the experience is by no means to be regretted either by the girl or himself. It was a wholesome youth- 506 Havelock Ellis. ful passion, as innocent as the mating of. birds and the insight which it gave both of the hidden conditions of human nature was morally advantageous in after life. In T's opinion his amative precocity was due to the early awakening of sex feeling by the servant girl. But he also believes that the love passion would have asserted itself early in any event since he inherits a warm tempera- ment, had erectal power long before puberty and has con- siderable seminal capacity. Having closely watched the suppressed normal conditions and desires in youth at the time of pubescence, he maintains that such suppression is disastrous, causing unhealthy thoughts and leading to the formation of a habit of masturbation which may persist throughout life. He believes that temporary sexual intima- cies between boys and girls under twenty from the period of puberty would be far less harmful than separation of the sexes till marriage, with its resultants, masturbation, hys- teria, repressed and disordered functions in young women, seduction, prostitution, venereal affections and many other evils. HISTORY II. I can remember "writes the subject" trotting away as a youngster about five with another to "see a girl's legs;" the idea emanated.from the other boy but I was vaguely interested. How or where we were going to see the object in question I do not remember nor anything further than the intention. When six or seven I remember being put to bed with the nurse girl and feeling her bare arm with undoubted sexual excitement; I remem- ber feeling along the arm very cautiously, fearing the girl would wake and being bitterly disappointed to find it was merely the arm. I had then no idea of sex but the disap- pointment was actual. When about nine I had other experiences of the sort. 1 used to herd cows on the links on the north coast of Eng- land which had then very few visitors and seemed to be very remote. 1 lived in a farm house and used to assist the girls of that farm house and a neighboring one in look- ing after young cattle. These girls certainly instilled sex- ual ideas though I did not realize them with precision. They Development of the Sexual Instinct. 507 used to talk about things a good many of which 1 did not then understand as they did. I liked to. see these girls wading with their dresses tucked up. About this time I . fell passionately in love with a girl cousin, but do not remember having any sensual ideas in regard to her. I can- not say that these early experiences had any influence on my later sexual development; 1 have always remembered ► them vaguely. Sexual dreams took place first at the age of thirteen; there was then an emission and sensation in sleep. These were however not associated with distinctly sexual ideas. All that I recall after them was the sensation which how- ever, 1 did not absolutely localize. Masturbation was un- doubtedly the direct result of these dreams. It was tried at first tentatively out of curiosity to determine if the sensation of the dream could be so reproduced. Sexual dreams occurred frequently although 1 cannot say at what interval. I have never experienced the slightest attraction for the same sex. HISTORY III. "My maternal grandfather (writes the subject of his history)" was a small farmer who kept a few beagles and grey hounds for hare hunting. He had three daughters; one of whom became my mother. One of his drunken sporting companions seduced my mother at the age of twenty. When her condition was discovered she had to flee from the violence of her father and 1 was born some distance from her home. After my grandfather's death I was reared by my grandmother and saw nothing of my mother until I was nearly sixteen. 1 believe that in my heredity the transmission comes Jr /chiefly from my mother, who is now fifty-eight years old. J / Although her life has been blameless in every particular t f / since her youthful indiscretion, she has never gotten over I feel in my character a reflection of her over-strung condition during pregnancy. 1 can distinctly remember from the age of nine years and am sure that I had no sexual feelings before the age of thirteen though always in the company of girls. I had many boyish passions for the girls always older than myself but f/ sin 508 Havelock Ellis. j£ these were never accompanied by sexual desires. I deified all my sweethearts and was satisfied if 1 got a flower, a handkerchief or even a shred of clothing of my inamorata for the time being. These things gave me a strange ideal- istic sensation but caused no sexual desire or erection. At thirteen a twenty-six year old sister of a boy companion so sat down on a sheaf of corn as to expose the mons veneris and enticed me to membrorum conjunctionem. There was slight erection and after the act had been continued some time, a pleasurable sensation of ejaculation but with- out true emission. I had frequent relations with this woman thereafter. About this time the farm servant of a neighbor taught me masturbation. The mistress of this man, a thin, wil- lowy, dark woman, the mother of several children, treated me with such complete indifference as to urinate in my presence so that I once saw her very hirsute mons veneris. From that moment I conceived a great passion for her and used to tremble as soon as I saw her. I had become well developed and virile. While she was a lustful woman I never ventured to touch her. I found an extreme ecstasy in masturbating while gazing upon her clothing. This gave much greater sexual pleasure than membrorum conjunctionem with the ever willing sister of my school fellow. The married woman 1 loved best because the mons veneris was more hirsute. This has always had a peculiar attraction for me. I never would go with puellis publicis unless I was assured the mons veneris was very hirsute. Never much addicted to masturbation, I derived no great enjoyment therefrom unless I had hair or part of the clothing of the woman with whom I was indulging in psychic coitus. At sixteen I left school and went to a large city to learn a business. At this time the sexual appetite was very strong. 1 frequently had membrorum conjunctionem with three women in one evening. I have had but few lascivious dreams. In these the phantom partner was almost invariably a dead woman. (When about eight I had been impressed by the corpse of an aunt who died at twenty-four.) Development of the Sexual Instinct. 509 When twenty 1 went to London and took all the pleas- ure which came my way. I cared only for normal coitus. Offers of another type created disgust. I once allowed a woman to exhaust me sexually per os but felt degraded thereby. Women with whom 1 had become very intimate often urged me to cunnilinguis but I could not do it. I have practiced coitus intermamnce a very few times. At twenty-six 1 married a pure gentle woman after having for ten months before marriage led a life of celibacy. My wife died when I was thirty and for about eight months thereafter 1 lived a celibate life. Lascivious dreams sometimes occurred but I invariably awoke before ejacula- tion. I gave way to cravings of my strong sexual nature but never wished for anything out of the usual except membrorum conjunctionem more canino. A woman with marked development of the nates* had great attraction for me. Masturbation has for some time ceased but a nude woman in cete manustuprone with her back to me gives me great pleasure. 1 am as strong sexually at thirty-eight as I was at twenty. Only I never want women unless I am brought into actual contact with them and they reveal my peculiar capillary fetish of large pelvic development. 1 am in excellent health. Genitals are well developed, and with capillary investment to the pubis. My skull is dolicocephalic. I am violent and tenacious in temper, high strung, rapid in thought and action. My digestion is good, but I have a tendency to constipation. Occasion- ally 1 have a twinge of pain in the occipital region. My early views of women have changed, I no longer deify them. I have known very sensual women living at home in respectable middle class society. One in particular, a girl of eighteen after membrorum conjunctionem used to excite me per os. 1 have had a sweetheart who remained virgo intacla. Had I seduced her as 1 could have done, I should have lost all interest in her. I could never bear the *The part possibly played by such notions In the development of the steatopygla of the Bushwoman and of the woman of the pre-historlc race that left the Ivory carvings of Bassomplerre, through sexual selection of this as a secondary sexual character seems to deserve attention since as Letoumeau (Evolution de la Moralite) points out anything but mart canino is the subject of strict taboo among Melaneslans. 510 Havelock Ellis. presence of naked men and would never go to a public swimming bath for that reason. I regard myself as a man of abnormally strong but on the whole healthy and whole- some sexual feelings. As a rule I have coitus twice or oftener in one week. 1 am a total abstainer and never could embrace a woman who smelled of drink. HISTORY IV. The subject, (a forty-year-old widower) states that when about ten, a boy friend informed him that the latter's sister uncovered his person with which she played and encouraged him to do the like to her. He said it was great fun and suggested they take two of the subject's sisters into an old barn and repeat the experience. This was done. Membrorum conjunctionem was attempted but despite the willing assistance of the girls, no pleasure or unusual sen- sation resulted. Later at school he learned masturbation from a boy. He did not experience any pleasure but liked the boys at- tention and enjoyed manipulatio genitalia pueris. His virile organ was large and was copiously capillary hirsute. He was surprised at the boy's having the emission resulting but more when in himself after repeated attempts by so the boy and himself, no emissio seminis 'though pleasurable sensation resulted. When he went home for the holidays, he took a great interest in and felt the servant girl's legs as she ran up stairs. She kissed and fondled him, calling him sweet- heart. One day she called him into her room where she, being in a half dressed condition, laid herself upon him kissing him passionately on the mouth. She next fondled his genitals per os and directed his manus ad vulva. Much excited, and trembling violently he secured for her an orgasm. Frequently after this followed membrorum conjunc- tionem. On return to school be practiced mutual masturbation with school fellows and at fourteen had his minus enunis virilis and was greatly pleased also with capillous veneris. He loved lying in the arms of another boy, fondling and being fondled. With mutual masturbation there was also coitus interfemora. Development of the Sexual Instinct. 511 After leaving school masculine relationships were neither formed nor desired. He passed much of his time either enjoying or planning to enjoy love passages with women. The sight of a woman's limbs or bust, especially if partly • hidden by pretty underclothing, and the more so if seen by stealth, was sufficient to create a lustful feeling and violent erection, accompanied by palpitation of the heart and throb- bing in the head. He had frequent coitus and regular masturbation at seventeen. He liked manustrupratio puellae even more than membrorum conjunctionem. This was especially the case with girls who had never masturbated. He loved to see the look of surprised pleasure appear on their faces, from the delightfully novel orgasm. Dozens of girls in good social position permitted this liberty. He entered upon an oc- cupation which gave him frequent opportunities for sexual relationships. At twenty-five he married the daughter of an officer with fully developed figure and very amorous. Whilst en- gaged they passed hours practicing mutual masturbation. He would osculate her more colombo, resulting in emissio masculinum and climax feminii. They practiced coitus var- iae bis die, enciente sequella. During this interval he went to stay at the house of an old school fellow who had been one of his lovers. On one occasion he was obliged on account of scanty accomo- dation to share the room with his friend. The sight of his friend nude caused excitatio sexualis and both passed the remainder of the night together in manustrupatio mutualis et coitus inter femora. He was surprised to find how much he preferred this to marital relations. The friends passed a fortnight together. Though he afterwards returned to his wife he never took the same pleasure in her. He devoted himself after she died, to the school friend. His death caused the subject to lose all interest in life. The subject (writes the well known alienist to whom I am indebted for the above history) is fairly healthy in appearance, some- what neurasthenic and with a tendency to melancholia. The genitalia are large. There is wasting of one testicle. 512 Havelock Ellis. Pubic hair is abundant. The body is of distinctly mascu- line type. The patient is neurotic. He improved under treatment and after three professional consultations wrote out the above history and came no more. HISTORY V. The following narrative was written by a married lady. "My mother (herself a very passionate and attractive woman) recognized the difficulty of English girls getting satisfactorily married and determined if possible to shield us from disappointment by turning our thoughts in a different direction. Theoretically the idea was perhaps good, but in practice it proved useless. The natural desires were there. Disappointment and disillusion followed their repression none the less surely for having altered their natural shape. I think the love 1 had for mother was al- most sexual as to be with her was a keen pleasure and to be long away from her an unendurable pain. She used to talk to us a good deal on all sorts of subjects but she never troubled about education in the ordinary sense. When nine years old I had been taught nothing except to read and write. She never forbade us to read anything, but if by accident we got hold of a book of which she did not approve she used to say "1 think that is rather a silly story, don't you?" We were so eager to come up to her standard of taste that we at once imagined we thought it silly too. In the same way she discouraged ideas about love or marriage not by suggesting there was anything wrong or improper about them but by implying great contempt for girls who thought about lovers, etc. Up to the age of about twenty I had a vague general impression that love was very well for ordinary women but far beneath the dig- nity of a somewhat superior person like myself. To show how little it entered my thoughts 1 may add that up to seventeen I fanced a woman got a child by being kissed on the lips by a man. Hence all the fuss in novels about the kiss on the mouth. When I was nine years old 1 began to feel a great craving for scientific knowledge; "A Child's Guide to Science" which I discovered at a second hand book stall Development of the Sexual Instinct. 513 (and which by the way informed me that heat is due to a substance called calor,) became a constant companion. In order to learn about light and gravitation I saved up my money and ordered, (of all books) Newton's "Principia;" shedding bitter tears when 1 found I could not understand a word of it. At the same time I was horribly ashamed of this desire for knowledge. I got such books as I could sur- reptitiously and hid them in odd corners. Why 1 cannot imagine as no one would have objected but on the contrary I should have been helped to suitable books. My sisters and 1 were all violently argumentative but our quarrels were all on abstract subjects. We saw little of other children and made no friendships preferring each other's society to that of outsiders. When I was about ten, a girl of the same age came to stay with us for a few days. When we went to bed the first night, she asked me if 1 ever played with myself whereupon I took a great dislike to her. No sexual ideas or feelings were excited. When still quite a child however, I had feelings of excitement which 1 now recognize as sexual. Such feelings always came to me in bed (at least I cannot remember them at any other time) and were generally accompanied by a grad- ually increasing desire to make water. For a long time I would not dare to get out of bed for fear of being scolded for staying awake and only did so at last when actually compelled. In the meantime the sexual excitement increas- ed also and I believe I thought the latter was the result of the former or perhaps rather that both were the same thing. (This was when I was about seven or eight years old). So far as 1 can recollect the excitement did not recur when the desire to make water had been gratified. 1 seemed to remember wondering why thinking of certain things (1 can't remember what these were) should make one want to urin- ate. In later life I have found that if the bladder be not emptied before coitus, pleasure is often more intense. As a child and girl I had very strong religious feeling (I should have now if I could believe in the reality of religion) which was absent in my sisters. These feelings were much the same as I experienced later sexually, (I feel towards God 514 Havelock Ellis. what I imagined I should like to feel to my husband if I married.) This 1 fancy is what usually occurs. At four- teen 1 went to a boarding school where there were seventy girls between seven and nineteen. I think it goes to show that there is very little sexual precocity among English girls since, during the three years 1 stayed there 1 never heard a word to which the strictest mother would have ob- jected.* One or two of the older girls were occasionally a little sentimental but on no occasion did 1 hear the physi- cal side of things touched upon. 1 think this is partly due to the amount of exercise we took. When picturing my childhood 1 always see myself racing about, jumping walls, climbing trees. In France and Italy I have been struck by the greater sedateness of Continental children. Our idea of naughtiness consisted chiefly in having suppers in our bed- rooms and sliding down the bannisterst after being sent to bed. The first gratified our natural appetite while the sec- ond supplied the necessary thrill in the fear of being caught. 1 made no violent friendships with the other girls but 1 became much attached to the French governess. She was thirty and a born teacher, very strict with all of us, and doubly so with me for fear of showing favoritism. But she was never unjust and I was rather proud of her severity and took certain pleasure in being punished by her; the punishment always taking the form of learning by heart, which I rather liked doing. So 1 had my thrill, excite- ment, 1 don't quite know what to call it, without any very great inconvenience to myself. Just before we left school the sexual instinct began to show itself enthusiasm for art with a capital A, Ouida's novels being mainly responsible. My mother and I agreed that we would spend our lives travel- ing about France, Italy, and the Continent generally a la •According to J. G. Klernan giris with whom the sexual consciousness is dormant dur- ing puberty, sexual topics are instinctively avoided by those women in whom sexual feeling has penetrated consciousness. Giris of the first type draw diametrically opposite pictures of sexual consciousness In boarding schoois and colleges to those drawn by the second. tGrasalng bannisters between the thighs however has often been the first means of bringing about sub-conscious sexual sensations. Stefanowsky reports a case (Alienist and Neurologist 1893) where ciimbing a gymnasium pole had that effect. Beard and Rockwell (Sexual Neurasthenia page 151,) report the case of a seven year old boy who when ciimbing trees had what he afterwards knew to be sexual sensations of pain and pleasure so intermingled as to force him to abandon tree ciimbing. Development of the Sexual Instinct. 515 Tiicotrin with a violin in one pocket and a Stavante Dante in the other. To do this satisfactorily to ourselves, we must be artists and 1 resolved to go in for music and be- come a second Liszt. When my father offered to take us to Italy, the artist's Mecca, for a couple of years we were wild with delight. We went and disillusionment began. It may perhaps seem absurd but we suffered actually that first summer. Our villa was quite on the beach, the lowest of its flight of steps being washed by the Mediterranean. At the back were grounds which seemed a paradise. Long alleys covered over with vines and carpeted with long grass and poppies, grassy slopes, dotted with olives, and ilex, roses everywhere and almost every flower in profusion; with at night, the fire flies and the heavy scents of syringa and orange blossoms. In the midst of every possible excite- ment to the senses, there was one thing wanting and we did not know what that was. We attributed our restlessness and dissatisfaction to the slow progress in our artistic edu- cation and consoled ourselves by thinking when once we had mastered the technical difficulties we should feel al- right. And of course we did derive a very real pleasure from all the beauties of art and nature, with which Italy abounds. It seems to me however that the art craze is one of the modern phases of woman's sexual life. When we were in Italy the great centers of the country were simply over- run with girls studying art, most of whom had very little talent but who had mistaken the restlessness due to the first awakening of the sexual instinct for the divine flame of genius. In our case it did not matter as we were not dependent upon our own exertions. But it must have been terribly hard for girls who had burned their boats and chosen art as a career to have added to the repression of their natural desires, the bitterness of knowing that in their chosen walk of life, they were failures. The results as far as work goes might not be so bad if the passions, as in men, were occasionally gratified. It is the constant drudg- ery combined with the disappointment and finding that art alone does not satisfy which is so paralyzing. Besides 516 Havelock Ellis. gratification is always followed by exaltation of the mental faculties with, in my experience, no depressing reaction such as follows pleasure excited by mental causes alone. At one time when living at the villa 1 met a man about forty-five who took rather a fancy to me but I only saw him once and forgot all about him. Some time later at Florence 1 got a letter saying he was passing through and would call with my permission. Now to be sought out by a man with a string of names ending in io and a was de- lightful not because he was a man—no Englishman or German would have done—but because of his connection in one's mind with the artistic ideal. Well he came and after some (to me) very uninteresting conversation, he began to what we then called "talk nonsense," and things came to a climax by me exclaiming: "If I had expected you to talk like that I would not have received you." "Well what did you expect me to talk about!" "O, vaguely," "about poetry, art or music." I shall never forget his amazed look and the tone of surprise in which he echoed "about music." 1 mention this incident because it woke me up; no emotion was excited but 1 realized for the first time (I must have been nearly twenty) that 1 was no longer a child and that a man could think of me in connection with love. It was only after this and not immediately after either, that men's society began to have an interest for me and that 1 began to think a man's love would be a pleasant thing to pos- sess after all. The sexual instinct at any rate as regards conscious-, ness thus developed slowly and in what I believe to be a very usual sequence. Religion, admiration for an older woman and art. I am not sure that 1 have made quite enough of the first, yet 1 do not know that there is any more to say. There were very strong physical feelings connected with all these which were identical with those now connected with passion but they were completely sat- isfied by the mental idea which excited them. The first time I can remember feeling keen physical pleasure was when 1 was between seven and eight years old. I can't recollect the cause but 1 remember lying quite Development of the Sexual Instinct. 517 still in my little cot clasping the iron rails at the top. It may be said that this is hardly slow development but I mean slow as regards any connection of the idea with a man or any physical means of excitation. I have laid stress on my desire for knowledge as 1 think my sexual feelings were affected by it. A great part of my feeling for my mother was due to the stories of in- formation she appeared to possess. The omniscience of God was to me his most striking attribute. My French teacher's capacity was her chief attraction. When as a girl, I thought of marriage, 1 desired a man who "could explain things to me." One learns later to live one's mental and sexual life separately to a great extent. But at twenty I could not have done so; given the opportunity I should have made the mistake of Dorothea in "Middlemarch." I have spoken of the depressing after-effects of pleas- ure brought about by a purely mental cause but 1 do not think this is the case in childhood and early youth. (Per- haps some women feel no such depression afterwards which may account for their coldness in regard to men.) This may be accounted for by the fact that it occurs much more rarely and also it is perhaps a natural process before the sexual organism fully develops and so not harmful. 1 always find it difficult in expressing the different de- grees of physical excitement even to myself though I know exactly what 1 felt. As a child, from the time of the early experience already mentioned (about the age of seven or eight) and as a young girl, the second stage (secretion of mucus) was always reached. The amount of secretion has always been excessive, but at first secretion only lasted a short time; later it began to last for several hours, or even sometimes the whole night, if the natural gratification has been withheld for a long time(say three months). 1 do not remember ever ieeling the third stage (complete orgasm) until 1 saw the first man I fancied 1 cared for. 1 do not think that mental causes alone have ever produced more than the first two stages (general diffuse excitement and secretion). I have sometimes wondered whether 1 could pro- duce the third mechanically but ) have a curious innate 518 Havelock Ellis. intense repugnance to trying the experiment. It would seem to materialize it too much. As a child and a girl I was con- tented to arrive at the second stage possibly because I did not realize that there was any other and perhaps this is why 1 have experienced no evil results. In dreams the third stage seems to come suddenly without any leading up to it either mental or physical of which I am conscious. I do not however remember having any such dreams before I was engaged. They came at a later period even then. When great pleasure was exper- ienced, it came as a rule suddenly and sharply with no dreams leading up to it. The dreams generally take a sad form (an Evangeline and Gabriel business) where one vainly seeks the person who eludes one. I have however some- times had pleasurable dreams of men who were quite indif- ferent to me and of whom I never thought when awake. The impression on waking is so strong one could almost fancy one's self really in love with them. 1 can quite un- derstand falling in love with a person by dreaming of them in this way. The first time 1 remember experiencing a third stage in waking moments was at a picnic, when the man to whom I have before referred as the first that I fancied I cared for.leaned against me accidentally in passing a plate or dish, but 1 was already in a violent state of excitement at being with him. There was no possibility of anything be- tween us as he was married. If he guessed my feelings they were never admitted as I did my best to hide them. I never experienced this except at the touch of some one I loved. (I think the saying about the woman "desiring the desire of the man," is just about as true as most epigrams. It is the man's personality alone which affects me. His feelings toward me are of, I was going to say indiffer- ence, but at any rate quite secondary importance and the gratification of my own vanity counts as nothing in such relations.) As a rule to reach even the second stage the exciting ideas must be associated with some particular person ex- cept in the case of a story, where one identifies one's self Development of the Sexual Instinct. 519 with one of the characters. In childhood and early youth it was in the case of religion the idea of Cod and the pres- ence and the personality of God which aroused my feelings and always seemed very vivid to us. In the case of my governess, my feelings were aroused in exactly the same way as later they would be by one's lover. In the art craze I am rather vague as to how it came about, but I think as a rule there was rather a c.raving for pleasure than pleasure itself. I do not remember ever thinking much about the physical feeling. It seemed so natural that a pleasant emotion should produce pleasant physical effects as that a painful one should cause tears. As a child one takes so much for granted and later on, my mind was so much occupied with worrying about the truth of religion that I hardly thought enough about anything else to analyze it carefully. I may summarize my own feelings thus: First, excit- ing ideas alone, produce, as a rule, merely the first stage of sexual excitement. Second, the same ideas connected with a particular person will produce the second stage. Third, the same may be said of the presence of the be- loved person. Fourth, actual contact appears necessary for the third stage. If the first stage only be reached the sensation is not pleasurable in reality or would not be but for its associations. If produced, as I have sometimes found it to be, by a man of mental incapacity it is dis- tinctly disagreeable, especially if one feels that the energy which might have been used in coping with the difficulty is being thus dissipated. If it be the result of physical restraint, it is also unpleasant unless the restraint were put upon one by a person one loves. Then however the second stage would probably be reached but this would depend a good deal on one's mood. If the first stage only were reached, I think it would be disagreeable, it would mean a conflict between one's will and sexual feeling. Perhaps women who feel actual repugnance to the sexual act with a man they love, have never gone beyond the first stage when their dislike to it would be quite intelligible to me. 520 Havelock Ellis. Some time after the life in Italy had come to an end I became engaged. There was considerable difficulty in the way of marriage but we saw a good deal of each other. My fiancl often dined with us and we met every day. The result of seeing him so frequently was, that 1 kept in a constant state of strong but suppressed sexual excitement. This was particularly the case when we met in the even- ing and wandered about the moonlit garden together. When this had gone on about three months 1 began to ex- perience a sense of discomfort after each of his visits. The abdomen seemed to swell with a feeling of fullness and con- gestion but though these sensations were closely connected with the physical excitement, they were not sufficiently pain- ful to cause me any alarm or make me endeavor to avoid their pleasurable cause. The symptoms got worse and no longer passed off as quickly as at first. The swelling in- creased, considerable pain and a dragged down sensation resulted, the moment I tried to walk even a short distance. I was troubled with constant indigestion, weight in the chest, pain in the head and eyes, continual slight diar- rhoea. This went on for about nine months and then my fianci was called away from the neighborhood. After his departure 1 got a trifle better but the symptoms remained, but in less acute form. A few months later, the engage- ment was broken off and for some weeks I was severely ill with influenza and was on my back for several weeks. When 1 could get about a little, though very weak, all the swelling was gone but pain returned whenever 1 tried to walk or stand for long. The indigestion and diarrhoea were also very troublesome. I was treated for both by a physi- cian without success. Next year I became engaged to my husband and was shortly after married. The indigestion and diarrhoea disappeared soon after. The pain and drag- ging feeling in the abdomen bothered me much in walking or any kind of exercise. One day I came across a medical work "The Elements of Social Science" in which 1 found descriptions of symptoms (like those I suffered from) ascribed to uterine disease. 1 again applied to a physician telling him I thought there was displacement and possibly Development of the Sexual Instinct. 521 congestion. He confirmed my opinion and told me to wear a pessary. He ascribed the displacement to the relaxing climate and said he did not think I could get well again. After the pessary had been placed in position every trace of pain, etc., left me. A year later 1 thought 1 would try to do without the pessary and to my great satisfaction none of the old trials came back after its removal in spite of much trouble, anxiety, sicknursing and fatigue. 1 attributed the disorder to violent sexual excitement which was not permitted its natural gratification and relief. I have reason to believe that suppression acts very in- juriously on'a woman's mental capacity. When excitement is naturally relieved the mind turns of its own accord to another subject, but when suppressed it is unable to do this. Personally in the latter event, 1 find the greatest difficulty in concentrating my thoughts and mental effort becomes painful. Other women have complained to me of the same difficulty. I have tried mechanical mental work such as solving arithmetic or algebraic problems but it does no good, in fact it seems only to increase the excitement. (I may remark here that my feelings are always very strong not only before and after the monthly period but also during the time itself; very unfortunately as of course they cannot then be gratified). This only applies to desire from within as 1 am strongly susceptible to influ- ences from without at any time. (7b be continued.) THE LEGAL DISABILITIES OF NATURAL CHILDREN JUSTIFIED BIOLOGIC- ALLY AND HISTORICALLY* By E. C. SPITZKA, M. D., NEW YORK. 91 In addition to internecine conflicts, where the assailant was a bas- tard brother of the victim, in some cases like those in the text, also illegiti- mate, there are a number of historical feuds between contestants not related to each other, but both illegitimate in birth. Amorgas a natural son of Pisuthnes, endeavored to revolt a province against Darius nothus; John X. Victor of Lincoln, (A, D. 1139,) Robert Earl of Gloucester, was assassinated by Sergius III and Marozia; the last OrdelafAs—all ille- gitimate—were crowded out of Forli by the greater shark, Girolamo Riario. When the Vicos—also and exclusively represented by bastards—fell out amongst themselves, a bastard seized the opportunity and Viterbo, their patrimony; Archelaus, adulterinus of Mithridates, fell against the Consul Gabinius who battled in behalf of Ptolemy Nothus. The whirligig of politics brought two natural sons of Charles II into the field against each other, as the Phillips Norton skirmish which preceded Sedgemoor's slaughter. A few exceptions are to be noted where a bastard suffered assassination or its essay at the hands of legitimate relatives. The death of Artaxerxes, not to be confounded with the illegitimate Sassanid hereinbefore mentioned (A. Muemon was the son of a nothus, however, of whom the first of the name A. Longimanus was father), was hastened by the death of his favorite Arsames, a popular and beautiful son born in concubinage and slain by a legitimate son, Ochus. So was the assassin of Prefect Sylvestro di Gatti, Fasciolus Vico, slain by a legitimate (?) brother; and the envy of Julius Este's "beautiful eyes" caused an attempt at his life by jealous Cardinal Hippo- ytto, a legitimate Este. The death of the bastard of Polignac at the hands of'Charles VI of France, was in consequence of the latter's first outbreak of insanity, and may hence be regarded as fortuitous. Other innocent victims of assassination or judicial murder were Candidianus (Gibbon op. cit), •Continued from April, 1901. Notes referred to In text of preceding numbers [5