Alienist and neurologist





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Quant am ego quldem video motus morbosi fere omnes a motlbus In systemate nervorum Ita
pendent ut morbl fere omnes quodammodo Nervosi dlci queant."—Cullen's NOSOlOGY: BOOK 11
P. 181-Edinburg ED.. 1780.
Alienist and Neurologist
A JOURNAL OF .:
Scientific, Clinical and Forensic
NEUROLOGY AND PSYCHOLOGY,
PSYCHIATRY AND NEUKIATRY.
Intended Especially to Subserve the Wants of the
General Practitioner of Medicine.
VOLUME XXXIV.
CHARLES H. HUGHES, M. D., Editor and Publisher.
3858 West Pine St., ST. LOUIS, HO.
1913


CONTRIBUTORS AND COLLABORATORS
...?? VOLUME XXXIV.
MARTIN W. BARR,
Elwyn, Pa.
JAMES G. KIERNAN,
Chicago, Ill.
SMITH ELY JELLIFFE,
New York.
C. H. HUGHES,
St. Louis.
ISAAC OTT,
Easton, Pa.
A MOS SAWYER,
Hillsboro, Ills.
E. S. GOODHUE,
The Doctorate, Hawaii.
JAMES C. HASSATT
Washington, D. C.
1913
W. J. HICKSON,
Vineland, N. J.
THEODORE SCHROEDER,
Cos Cob, Conn.
MAX A. BAHR,
Indianapolis, Ind.
HENRI NOUET,
HAVELOCK ELLIS,
London, England.
C. F. NEU,
Indianapolis, Ind.
WILLIAM F. WAUGH,
Chicago, Ill.
WALTER B. SWIFT,
Boston, Mass.


Index 111
INDEX
ORIGINAL CONTRIBUTIONS
Action of Tonsil................................ 117
Anatomical, Physiological and
Philosophical Thoughts on
Evolution.................................... 121
Are Women Polygamists?................ 319
Brain Menace to Man and Nation
of Alcoholic and Other Nar-
cotic Neuropsychopathy.......... 61
Eugenics in the Magazine, Espec-
ially the Medical ..................... 314
Happy Though Insane.................... 175
Hallucinations, Their Study and
Significance in Psychiatry........ 38
Is Genius a Sport, a Neurosis or a
Child Potentiality Developed? 21
Is Genius a Sport, a Neurosis or a
Child Potentiality Developed? 409
Is Genius a Sport, a Neurosis or a
Child Potentiality Developed? 168
Notes on the History of Psychiatry 26
Notes on the History of Psychiatry 235
On the Theory of the Psychopath-
Psychiatry and Psychotherapy in
Surgical Practice...................... 436
“Protecting the Mental Health of
the Growing Child."................ 181
Sexo-Aesthetic Inversion............ ... 156
Sexo-Aesthetic Inversion................ 249
Studies in Neurological Technique,
No. 1; the Points in Jendras-
sik's Method of Eliciting the
Patella Reflex............................ 327
The Traumatic Origin of Nervous
Disturbances in Hysterical
Conditions.................................. 280
The Feeble-Minded a Sociological
Problem...................................... 302
The Adequate Punishment and
Care of Defectives................... 424
The Erotogenesis of Religion ........ 444
The German Method of Treating
the Criminal Insane................ 389
The Imperative Demand for Legis-
lation to Arrest the Rapid In-
crease of Degeneracy ................ 400
ic Constitution..................... ... 379
Presbyophrenia of Wernicke and Where Fancies Fly With Painted
Psychopolyneuritis.................... 141 Wings to Dazzle and Mislead 1
SELECTIONS.
NEUROPATHOLOGY. NEUROther APY.
Abscessed Teeth and Insanity.......... 66 A New Quinine............. … ...... 70
Women and Goiter in Southern A Case of Acute Psychosis After
Norway.......................................... 189 the Chronic Use of Veronal...... 333
EUGENICs. Alcohol Injection Into the Gasser-
Sir Francis Galton.............................. 66 ian Ganglion.................................. 336
NEUROEUGENICs. Dr. J. L. Wolfe. ------ - - - - .
Robbing the Grave.............................. 57 Death Under Stovaine 193
NEURODIAGNoSis Dr. Simon Flexner.............................. 335
- - .*.*.*.*.*.* - Distilled Water in Syphilis................ 492
Diagnosis of Convulsions by Leu- §." i." º 71
cocyte Count.................................. 478 G º Nº." º º º B. ſ
Eosinophiles in Urine in B hial oats Milk Shou e is 01 IC (*-
ºf in vºne in ºnema ºn fore Drinking................................ 494
Osler's Sign................. ...... ......... ......... 341 High Frequency Applications and
Pupils in Acute Alcoholism ... ......... 6s Bºx Tempºrature-Dºrmy tº
The Dowd Phosphatic Index in Re- ndican Superstitions.......................... 334
lation to Disease of the Eye...... 339 Kissing the Shuttle.............................. 7()
N Magnesium Sulphate Cures Tetanus 493
Nºchia 6S Moss Non-Cereal Bread...................... 73
ervousness in Ten.................... Magnesium Sulphate for Tetanus ..., 71
NEUROPATHY. Nomenclature of Tuberculin Doses.... 491
Pancreas in Chronic Alcoholism........ 69 Radium Emanation Therapy ............ 494
302434


iv.
Index.
Spirochaeta Pallida in the Brain 192
Tonicity of Mineral Waters 72
The Urine Neurodiagnosis Just Be
fore Outbreak of a Neurosis...... 72
Tuberculin in Paresis.......................... 193
The Influence of the Chemist on
Modern Therapeutics.......... … 193
Treatment of Insanity...... ..... ... 334
The Oatmeal Cure in Diabetes... ....., 70
The Phylacogen Treatment for
Rheumatic Infections.................. 335
The Relative Value of Turtle Tuber-
culin in the Treatment of Tu-
berculosis................... ... ............. 494
Pasteurized Milk at Low Tempera-
tures................… … … 495
NEUROPHYSIOLOGY.
New Nerve Cell Growth............…. 345
Reproduction of Blood-Constituents 490
The Mechanism of Protein Assimila-
tion.… 343
The Function of the Hypophysis ..., 194
Psycho-EUGENICs.
Editorial on Insane Criminals in
New Albany Medical Journal.... 195
EDUCATIONAL PSYCHIATRY.
Examination for the Diploma in
Psychological Medicine … 197
Medical Greek...................................... 200
The Therapeutic Application of the
Ductless Glands............................ 199
PsychiATRY.
Plato and Freud on the Etiology
and Treatment of Hysteria: a
Comparison and Critical Study 342
The Psychic Effects of Accidents .. 74
CLiNICAL PsychiATRY.
Absence of Proper Provision....…. 4SS
EDITO
Announcement . . . . . . . . . . . .204
Again the Unstable Neurone Ap-
pears....... . . . . . … 76
Alcoholism at the London Interna
tional Eugenic Congress …
A Pyromaniac at Large; Burning
Dairies and Cows His Passion 83
A Good Omen for the Chinese
Republic.......... . . …, 202
A Case for Early Vasectomy … 203
After All These Years of Unselfish
Charitable Ethics.......................... 210
Alcoholism and Psychoneurosis ........ 100
Pertinent Questions Concerning
Prompt Sequestration of Pre-
cursory Insane.............…... 330
Psychiatry and Bacteriology … 190
Psychic Aphasia in Dementia Prae-
COX............................. . . . . . . . . . . . . . . 4S5
Transvestism or Cross-Dressing 4S4
The Popular Idea of an Insane
Individual...............… … 189
NEURotoxicology.
A Peculiar Case of Common Salt
Poisoning ................... … … 101
CLINICAL NEUROLOGY.
New Diagnosis of Paresis ....... … 4S1
Spreading Typhoid After Recovery 483
The Spread of Infection by the
Ascending Lymph Stream of
Nerve..........… ... … …, 3.36
The Pioneer Victor Horsley and
London Temperance Hospital 338
Tumors of the Hypophysis ...... 4S3
The Hypophysis and Polyurea … 191
The Affiliation of Psychology with
Medicine........... ................…. 192
Uncertainty of Diagnosis in General
Paralysis............ ... … … 4S()
NEUROSURGERY.
Purpose of Ancient Trephining ....... 477
NEUROPROGNOSIS.
High Blood Pressure...… - 477
PSYCHOTHERAPY.
Psychotherapy at Battle Creek … 479
NEUROPSYCHOLOGY.
As to Alcohol in the Tissues … 489
Instinct and Intelligence … … 4SS
The Feelings.............. … . 4S9
RIALS. ... •
An Eugenic Bill … . . . . . . . . . . . 21 ()
All Physicians Should Know Some-
thing of Psychiatry . ... 3.50
Another State Recognizes Inebriety 350
A Case the Virile Reflex Would -
Have Decided ...…. 351
A Big Strong Navy........................ 355
A Criminal Insane Hospital for
Missouri ... … … ... … 356
An Element of Psychic Morbidity.... 348
Army Surgeons and Insanity......... ... 349
Acknowledging an Invitation............ 356


Index. v
A Stably Neuroned President… S()
Benjamin Rush on Municipal Sani-
tation … … 354
Berlin's Noise Sanitation.............. ... 78
Chair of Eugenics....................... . 202
Certificate in Psychological Medi-
cine in Great Britain............... 204
Certain Elementary Concepts in
Education Applied to Medicine 353
Dr. P. L. Murphy's Portrait............ 201
Dean Hadley of Yale Dogs Not En-
dorse Carnegie Foundation Re-
Port........…. 81
Dora Doxey and the Court.............. 203 -
Dr. Alvah H. Thompson of Wichita 82
Dr. J. M. Semple.........
Dr. Frank P. Norbury. ---
Dr. Joseph Cooperstein........ .......... 506
Dr. Gorgas Honored º 76
Doctor A. North ........... .................... 507
Dr. Forbes Winslow..... ..... - - - - - - - - - - - - - - 356
Dr. Waugh's Contribution. … … 501
Excessive Penal Infliction Exceeding
Normal System Reactive Power 511
Fifteen Thousand . . . . . . . . . 209
Foreigners in our Colleges... . . . . 209
General Sickles. ........ ... - - - - - - - - - - - - - - - - - - - - - S()
Harvard University and Massachu-
- setts Institute of Technology
, School for Health Officers. ...... 512
Honesty the Best Policy in the Med-
dical Expert … … ..... S2
In Terms Neurological ... . . … 86
Insane in Missouri............ ................. 202
Immigrant Psychiatry and Iatric
Prophylaxis. ... ...… … . . . . 208
Inebriate Hospitals ... ... . . … 208
Invitation Rather Than Coercion . .. 79
Judicial Blunders Concerning In-
sanity S4
Lawyers' and Doctors' Fees.... . . 500
Mr. Carnegie Made a Mistake ... . 352
Medical Napoleon's
Reason for
Sale of Louisiana to the U. S. 211
Medical Provision for and by In-
dustrial Plants . . . . . . . . . . . . . . 211
Many Human Machines...... .......... 7
Miss. Val. Med. A... ............ . . . 207
Mr. Towns Also Calls Attention . . . 87
Mellins Food ............. . . . . . . . . ....... 507
Mellin's Food Received the Gold
Medal ......... . . . 51()
Municipal Care for Sanitary Rest
Rights in Paris.............................. 506
New York Neurological Society........ 79
Notes on the History of Psychiatry 505
Osteopathic Backbone Diagnosis ... 83
Physicians and Drug Addiction........ S7
Panama-Pacific International Expo-
sition, 1915................. ................. 506
Professional Ideals......… 504
Rupert Blue on Health Boards and
Health Education ..... ................. 206
Science and Alcoholics...........…... S5
Sir George H. Savage … 357
Sir William Osler … … 3.54
The Aim of this Magazine.... ........... 75
The Back Wrenching and Spinal
Jolting … … 76
The Oconomowoc Health Resort...... 76
The Physician in Politics............ - - - - - - 77
The Dedication of the Lane Medi-
cal Library..............…........… 78
The Unstable Psychic Neurone........ 79
The Status of Assistant Medical
Officers in Mental Hospitals...... 205
The Wrong Way to Do it.................. 81
“The Continent''.................................. 201
The American Academy of Medi-
cine…º. 202
The Sanitation of the Panama Canal
Zone… … 206
The Psychic Shock That Killed
J. P. Morgan................................ 207
The Menace of the Feeble-Minded. 210
The Unfortunate Victims of the
Opium Habit................................ 210
The Pope is Convalescent…... 211
Too Much for the Medical Student. 510
The Turtle Serum ........ . …....... 212
The Old Thompsonian and His
Alarming Symptoms … … 346
The New Washington University
Medical School Building … 347
The Psychology of the California
Japanese Coloquy ............. . . . .348
The Chicago Medical Society. .......... 349
Insanity in Old Soldiers' Homes. ... 349
The Drama of the Laboratory … 351
The Field Family........…. 352
The Dungeon Punishment… ... . . .354
The Newark Office of the Bancroft
- Sanitarium.......... -
The Many Mistake Poisonings ........ 355
The Stable Psychic Neurone in
Finis Vitae . . . . . … . . .357


vi Index.
The Prospective Release of Haw-
thorne and Morton...................... 357
The Medical Student's Burden.......... 497
The Sanitary Conservation of Hu-
man Labor Power........................ 499
The Unstable Neurone in Barbarous
Hazing Atrocity............................ 500
The Cincinnati Sanitarium 507
The Psychoanalytic Review .............. 50S
The National Catholic Association. 508
The American Society for the Study
it—Two Great Rulers Awakened
to its Peril...................................... 501
The Medical Poet Laureate of Eng-
land.…... 502
The Chicago Medical Society............ 504
The War Department.......................... 503
Visiting Practice for Medical Stu-
dents….
“Where Pennsylvania Excels”
Why Prescriptions Should be Writ-
of Alcohol...................................... 510 ten in Latin, (or Greek).............. 503
The Alcoholic Poison Beverage Hab- Yellowstone Park Dust Clouds ........ SO
CORRESPONDENCE.
A Meeting of Alienists and Neurol- Scientific Lesson from the Attempt.
ogists … 214 ed Assassination of Colonel
A Laboratory for Study of Crimi- Roosevelt....................................... 89
nal Mattoids.................................. 89 The Milwaukee Sanitarium................ 214
A Medical Study of the Alcoholic The Organizing Committee of the
Problems................................. ...... 215 Second International Congress
Barnes Hospital....
of Neurology, Psychiatry and
- Psychology...................................... 216
Dear Doctor.-------- The British Certificate in Psycholog-
Diabetes-Mellitus........". . . . . . . . . . . . -------------- ical Medicine................................ 359
Need of University Students to IIIe Congress International de
Study Man...................................... 213 Neurologie...................................... 359
REVIEWS.
Atypical Multiple Sclerosis................ 376 City…. 101
A Practical Device to Stimulate the Ancient and Tribal Cranial Trepana-
Working of Nervous Discharges 221 tion.… 516
Ancient Greek Medicine.................... 370 A Wave of Degeneracy...................... 519
Announcement of the Program Com- ... A Lively Combination ....... ............... 535
mittee...............… … 373 A Clinical Manual of Mental Diseas.
An Atlas of the Differential Diagno- es............. ........ ... ........ ................. 535
. . Isis of Diseases of the Nervous o A Treatise on Digitalis...................... 536
- - - - - 224 Betterment of Life Insurance Ser.
A Preliminºr.Sºmmºniº Sº. vice.......…........... 218
cerning a "New Diagnostic Ner- - - -
vous Sign.....................… 377 Bºttºn of Life Insurance Ser- 112
A Practical Device to Stimulate - Fiºn ºf tº city ºf
the Working of Nervous Dis- Board of Education of the City of
charges.… 377 St. Louis...... . ............................... 534
American Industries......... - º and the º ------f ------- 52;
Address of the President 8. ". "..." Life ......... §
A Note on the Prognostic Value of entral raine rar Way, ºr 534
Hallucinations in the Manic- Criticism of Stedman's New Medi- .
Depressive Psychoses…. 105 cal Dictionary...................….. 375
A Forceful and Pertinent Plea for Contracture of the Neck of the
the Organization of County Bladder............................................ 216
Commercial Clubs........................ 94 Contribution to the Surgery of Bones,
Among the Several Meritorious Ner- Joints and Tendons ......... . …... 223
vous and Mental Disease Mono- College of Physicians ......................... 218
graphs… º. 97 Criticism of Orthodox Interpreta-
Alcohol and Officials............................ 104 tions...… 113
An Inebriate Hospital for Every Critique of Impure Reason............... 105


Index. vii
Christianity and Sex Problems.......... 518
Dannemora State Hospital................ 523
Department of Commerce......... ... .... 533
Dr. Helen C. Putnam........................ 226
Diseases of the Nervous System........ 366
Das Skaphoide Schulterblatt.............. 228
De L'Intermittence d ns de Begai-
ment ..... ..................…. ... … 536
Exclusion of the Alien Insane Crimi-
nals and Degenerates........…. 372
Experience with Vanadium in Tu-
berculosis........................................ 222
Family Hematoporphyrinuria and its
Association with Chronic Gas-
tro-Duodenal Dilatation.............. 113
Fourth International Congress on
School Hygiene............................ 374
Fulguration and Thermo-Radiother-
a PY.................................................. 375
Facts of Modern Science.................... 105
Fatigue and Association Experiment 94
Fourth Biennal Report of the Super-
intendent of the State Hospitals
for Inebriates ….......... ....... 522
Gallstones..................... ........................ 112
Gonorrhea vs. Tobacco, Alcohol,
and Sexual Intercourse … 104
Genesis..................…... 220
Historie des Origines … … 373
How May We Make Our Scientific
Nomenclature More Accurate?... 377
History of the H. K. Thaw Case...... 513
Half Our Population Living in “Dry"
Territory......... ...................... . . 531
How to Prevent Typhoid Fever ... .. 535
Human Life as a National Asset …, 536
Hoffman, “Die Rassenhygiene in den
Vereinigten Staaten von Nord-
amerika
Influx+Organism-Efflux …............ 373
Intestinal Statis in Relation to Can-
cer Etiology and Prophylaxis...... 112
Judicial History of the States, Terri-
tories and Provinces of North
America........…. 221
Kathareuousa and Scientific Medical
Nomenclature................................ 377
“Lest We Forget"........….... 112
Library Work Among the Insane...... 95
Le Langage et la Verbomanie; Essai
de Psychologie Morbide.............. 104
Luther's Early Development.............. 523
Letters of Julius Commedius Brutus
and the Reply.............................. 524
La Chirurgie des Alienes.................... 111
Le Spleen.......…...... ….......... 533
Mind and its Disorders...................... 107
Medical Greek...................................... 10S
Mortality in Manitou, Colorado........ 231
Modern Treatment of the Insane...... 360
Miss Copeland's School...................... 371
Multiple Sclerosis.....................…. 377
Manuel des Gardes-Malades ... ......... 521
Memorial Relating to the Conserva-
tion of Human Life.... ............... 524
Marriage and Genetics....... … 525
Missouri, the Mother of Empires ..., 535
Milton Fairchild's Story.….. 523
Nervous and Mental Diseases ......... 222
Napoleon's Campaign in Russia… 07
New South Wales....…..... ... 106
Nystagmus … 377
Nervous and Mental Disease Mono-
graph Series No. 14. General
Paresis............…. 217
Outlines of Psychiatry
Organic and Functional Nervous


viii
Index.
On the Psychic Treatment of Some
of the Functional Neuroses Ill
On the Treatment of Some of the
Forms cf Cardiac Failure 111
Practise and the Work-Curve 94
Psychanalysts 98
Proceedings of the Mental Hygiene
Conference and Exhibit 528
Pay of Ancient Greek Physicians .... 533
Ready for Distribution 218
Re-Education of Dementia Praecox
Cases 536
Report of the New Jersey State Vil-
lage for Epileptics 112
Report of the Committee on Pre-
vention of Blindness 21S
Radiurgia and Scyophantia by Maria
Rose 518
Summaries of Laws Relating to the
Commitment and Care of !hc
Insane in the United States 534
St. Louis Public Library 535 |
Su d' un caso di Emiptegia ed
Emianestesia con atrofia Mucol-
arc 536;
Submucous Resection of the Nasal
Septum 112:
Some Experience with the Simpler
Methods of Psychotherapy and
Re-education Ill;
Starr on Organic and Functional
Nervous Diseases 219
School Life and Nervous Diseases
of Children 226'
Saving Time and Killing Men 229
Surgery of the Arteries 110'
Second Annual Report of the Joint
Board of Sanitary Control in
the Cloak, Suit and Skirt In-
dustry of Greater New York. 104!
Some Dont's 951
Spinal Analgesia—Development and
Present Status of the Method 217
Sight Saving as a National Move-
ment 218
Senate Memorial 222
State of New York Special Public
Health Commission 224
Surgery, Gynecology and Obstetrics 225
Summaries of Laws Relating to the
Commitment and Care of the
Insane in the United States . ... 375
Study of Man 375
Schriften des Vercins fur Freie Psy-
choanalytische Forschung 376
Some Psychological Observations in
the Insane 374
Symposium on the Use of Phyla-
cogens 377
Scarlitiniform Erythema 377
The Clinical Congress cf the Sur-
geons of North America ... 217
Twenty-Second Annual Report 218
The Possible Functions of the Life
Insurance Company 218
The Medical Review 222
The Initiative and Referendum 223
The Surgical Treatment of Bright's
Disease 225
The Last Illness of Napoleon 227
The National Committee for Mental
Hygiene 364
The Working Bulletin System and
Board of Control 365
The Luetin Test for Syphilis 112
The De Keating-Hart Method of
Fulguration and Thermo-Radio-
therapy 113
The One Hundreil and Fifteenth
Annual Report 113


Index,
ix
i
The Modern Aspect of the Etiology
and Treatment of Syphilis. … 113
Transactions of the Academy of
Science of St. Louis. . . ......... 113
The Advancement of Psychological
Medicine................ . . . . . . . . . . . 217
The International Congress of Hy-
giene and Demography. … 217
The Action of Animal Extracts
Upon the Bladder… … 376
The Training School..... ….. 221
The Narcotic Drug Diseases and
Allied Ailments............................ 369
The Functional Psycho-Neuroses ... 369
The Second Volume of the Modern
Treatment of Mental and Ner-
vous Diseases by British and
American Authors.................... ... 370
The First Signs of Insanity 367
The Grinnell Review.......... ............... 371
The Activating Motives of Profession-
al Conduct.... ............... …...... 372
The Technical Supplement.... ........... 373
The Slimulation of Organic by
Functional Nervous Diseases...... 374
The Prophylactic Value of Vaccines
in Typhoid Fever........ … 377
The Technical Supplement of the
Urologic and Cutaneous Review 220
The Fifty-Eighth Report of the
Board of Education of the
City of St. Louis...............…. 220
The Task of Social Hygiene ... … 92
The American Journal of Gastro-
Enterology. ........ … 94
The American Book Company...... ... 94
The Psychological Monographs ........ 95
The Clinical Congress of Surgeons
of North America........................ 95
The “Wellcome" Photographic Ex-
posure Record and Diary, 1913 101
The Psychology of Insanity.... ......... 98
Three Months Without and Three
Months With a Social Service
Worker in the Mental Clinic
at the Boston Dispensary ... ... 103
The Conservation of the Child.......... 104
The Question of Association Types ... 105
The Survey...... … 105
The Jukes and Jonathan Edwards ... 108
The Ethics of Our Profession........ .. 111
The Southern Surgical and Gyneco-
logical Association ....................... 111
Traum und Traumdeutung................ 377
The Acid Test in Therapeutics....... 536
The American Labor Legislation........ 5:36
The Strange Case of Dr. Bruno...... 515
The Government Meat Inspection. 517
The Lane Medical Lectures ............. 522
The Letter “Humanum Genus''........ 522
The Establishment of Parks and 524
Parkways.................… 524
Traite Clinique et Medico-Legal........ 525
The Dance Mania...... ........................ 529
The Aftermath of Gettysburg ..... ... 5:30
The Intellectual Standard of Doc-
The Triumph of Inorganic Phos-
phates … 534
The Exercises at the Henry Phipps
Psychiatry Clinic....… . … 534
Unser Verstehen der Seelischen Zu-
sammenhange in der Neurose
und Freud's und Adler's Theo-
Was ist Psychoreflexologie?................ 96
Waukesha Springs Sanitarium Calen-
Westborough State Hospital Papers. 96


X
Index.
Westborough, Mass., State Hospital
Papers.…........... 100
White and Jelliffe on the Modern
Treatment of Nervous and Men-
tal Diseases. ...... .......................... 230
PUBLISHER'S DEPARTMENT.
Legal Language Prolixity and Ob-
fuscation ... … . . . . … 114
The Popular Idea................. - 114
Why the American Medical Associa-
tion is Going Backward.............. 362
What Can be Done to Better the
Race?.............................................. 368
Walt Whitman's Anomaly.................. 371
The Modern Treatment of Infec-
tion.…. … … 115
The Above Homelike Appearance... 116
Winter Colds........................................ 114


A JOURNAL OF
NEMOOGY AND PSYCHIOlſº
Pºlºny AND NEURATRY.
FO D.
THE NEUROLOGIST
GENERAL PPACTITIONER
AND SAVANT
Panopepton
ºf a medicinal food."
ºn toº is ºften described as a medicinal ſood. |
Tº extractives of beef as contained in the juice of a broiled beefsteak or rare
ºf are highly savory and are powerful stimulants of digestion-of the
retions.
ºn cºntains all these extractives. -
Tº º ºs (The ash) are not only nutritive, but are chemical cata-
to the digestion and assimilation of food Panopepton contains all these-
pºet of the wheat and beef, and Tºmºyed
ºn gºes Panopepton to a patient under the very many circumstances
prºves a resource of peculiar service, it is a medicinal food. -
Fairchild Bros. & Foster -
- New Yor. - - - -


X
Index.
Westborough, Mass., State Hospital
White and Jelliffe on the Modern
Treatment of Nervous and Men-
tal Diseases........….....…... 230
Why the American Medical Associa-
PUBLISHER'S DEPARTMENT.
Legal Language Prolixity and Ob-
fuscation … 114
The Popular Idea................................ 114
tion is Going Backward.............. 362
What Can be Done to Better the
Race?....................….................... 36S
Walt Whitman's Anomaly.................. 371
The Modern Treatment of Infec-
tion....... ............… ….... 115
The Above Homelike Appearance. ... 116
Winter Colds........................................ 114



FOR
THE NEUROLOGIST,
GENERAL PRACTITIONER
AND SAVANT.
Panopepton
§^ts a "medicinal food
ANOPEPTON i> often described as n medicinal food.
i The.- extractivesof beef as contained in the juice of a broiled beefsteak or rn
roast beef are highly savors- powerful stimulants of digestion—of tl-
lopepton contains all these extractives.
le inorganic constituents (the ash) are not only nutritive, but are chemical cata-
, essential t lation of foo 1. I'.hx<j't-|i:. m . ontain^ .ill .
um, phosphates, etc., of the wheat and bed . and of the digestive glands employed
When a physician gives Panopepton to a patient under tin .:
in wruch this food proves a resource of peculiar service, it is a medicinal food.
Fairchild Bros. & Foster
New York



THE CINCINNATI SANITARIUM
FOR MENTAL AND NERVOUS DISEASES
INCORPORATED 1873
A Private Hospital of Modern Equipment and Methods
F. W. Langdon, M. D., Medical Director.
B. A. Williams, M. D., Resident Physician
C. B. Rogers, M. D., Resident Physician
For descriptive pamphlet, address
H. P. Collins, Business Manager. College Hill, Cincinnati, Ohio
o.


THE
ALIENIST AND NEUROLOGIST
Vol. XXXIV. St. Louis, February, 1913. No. 1.
WHERE FANCIES FLY WITH PAINTED WINGS TO
DAZZLE AND MISLEAD.*
By
Martin W. Barr, M. D.,
Elwyn, Pa.
Chief Physician to the Pennsylvania Training School for
Feeble Minded Children.
February 16th.
MRS. MacKenzie had an attack of acute mania during
the night. This morning she greeted me with: "Go
home and brush your clothes, you untidy creature, you are
covered with lint." And so I was. "Shut up, you talk too
much with your mouth," was her reply to the nurse's remon-
strance.
Upon Miss Levy wishing she could leap from the window
and break her neck, Miss Ogilvy in her usual practical way,
immediately began to plan how she might accomplish her
object.
At tea Mrs. Tulloch advised Miss Ogilvy to eat some fruit
for the sake of her brain. "Yes," interpolated Mrs. War-
field, "when I don't eat, you may be sure I am very sick men-
tally."
"Continued from November, 1912.
(1)


2
Martin W. Barr.
Why does one always say "Down in Maine?" Miss Leigh
asked. "Because," quickly returned Mr. Archer, "it is down
on the map."
Asking if both Byron and Mrs. Shelley were not "queer,"
he added: "I do not agree with the chief physician's diagnosis
of my case. Why? Because he has known me only a few
years and I have known myself all my life."
February 17th.
Miss Ogilvy is busy arranging a diet for herself. Thus:
"If I eat the legs of a chicken, my legs will be correspondingly
strong; if the wings, my arms will be."
Mrs. Warfield,very talkative to-day, rambled on: "You
know I lived in Colorado nine years ago. I lived there for three
years. I did not like the people. They would not call on
me and I thought them haughty. One night in summer,
in July or August, a storm came up naturally. The clouds
gradually accumulated over Mr. Karkeek's ranch. I was
weeding vegetables in the garden just at sunset. The storm
increased from seven o'clock until eleven; it being terrific at
eleven. For two hours I was as frightened as any woman could
be, and my boy slept through it all. The rain sounded like
pitchers of water being poured on the roof. The lightning
was very intense; no one could see between the flashes. The
thunder was not so loud as I have noticed. It was a grand
storm, but perhaps you might have been disappointed, you
are so fond of grandeur. But to me it was fine. The water
flowed like a river past the house, and left the ranch nothing
but a sand hill.
"It was an arid waste and the cows were starved out; there
was no grass, and the poor things had nothing to eat. I called
up my boy, six and one-half years old, that he might see it.
He was quite a big boy for a little fellow, and I wanted him
to see something for a change. Think of being called from
your slumber, and seeing a river foaming where there was a
garden the day before! It was a cloud-burst. I lost every-
thing. Hard work has killed my intellect." I took aether
at the dentists, and it has never gotten out of me. I took
it to relieve the pain. I thought it wonderful. I did just
as he told me. He said: 'breathe harder.' That music over


Where Fancies Fly With Painted Wings.
3
there is a strange sort of a funeral march. I can read it off, but
have not seen it for three years. My husband became insane,
and died so in an insane hospital.
"I have a haematoma auris—an insane ear. I was a
society woman once. My memory is groping in the disused
garrets of the past.
"I heard Rubenstein, Von Bulow and Ole Bull play; I saw
Dickens when he was here. I met Longfellow one day. His
house is open to the public, but I would advise you not to go.
It is so common to go there. Once when I was in the west a
coyote sat on his haunches quietly looking at me. I wondered
if he would have come in, if the door had been open,"and her
voice trailed off.
February 18th.
Mrs. Warfield had a frightful attack of mania, during
the night. Broke a tumbler and tried to swallow the pieces.
Took a brass screw out of her window frame, and did swallow
it. Then tried to dig her eyes out with her fingers.
This morning Miss Vaizey put her bare arm out through
a crack of the door, and Mr. Cobham covered it with kisses.
Mr. Archer happened along and saw the performance,
and in telling of it, said: "I too had the opportunity but would
not."
Mr. Buckheath went to walk, and met a friend, "D
it," he said, "Now she will write home and say, 'I met poor
Percy Buckheath, and his attendant.' How it galls me. They
ail think I am crazy as a bedbug. I cannot be created again.
The chief is phlegmatic, and wants to make me like he is.
It can't be done. I cannot change my nature. They say
when the chief was at college, he went through the whole course
without ever smiling."
Mrs. Smith and Mr. Archer were in the parlor this after-
noon. "Oh," she exclaimed, "Mr. Archer, I was born with
a wonderful capacity for enjoyment and happiness," and re-
ceiving no reply, she went on in a dreamy tone: "Life is not
worth living—I wish I were dead. I have nothing to live for."
"You have your husband and children," I suggested.
"Yes, but my husband is so common-place. My father was
rich, and I made a mistake to marry a poor man—I see it now.


4
Martin W. Barr.
I should have married an old man and been his darling. I
wanted to be petted. My mind was not strong enough, nor
my nervous system suited to the life of a man of moderate
means. I am too nervous, and my husband never understood
me at all. When I lived in Canada all the swell people with
their prayer books, and flowers and cards and glasses, would
call on me and sit for twenty minutes or half an hour, staring
at me and talking stupidly about the weather or the theatre,
or something. I felt sometimes as if I must strike them or
scream, or run. They were so artificial. When they would
go, I would run to the kitchen and talk to my servants. They
would tell me the truth.
"When we came back to the city, I had trouble with my
servants, and finally lost my mental balance and became insane.
The servants were pert, pretty young things, and my husband
said I was jealous of them and I did not know how to manage
them."
Here Mr. Archer looked up, with: "Mrs. Smith, that is
not right. Your conversation is becoming coarse and immoral.
I do not like the way you speak of your husband. You speak
of him as if he were an insect."
"Well," she replied, "we each ran our own machine."
"Heavens!" he exclaimed, "Why the woman talks as if
they were bicycles or sewing machines. Mrs.Smith.you talk more
silly nonsense in less time than any woman I ever knew. If
you lolled at home as you do here, I don't wonder that your
husband fussed at you. Not a bit. You have your husband
and four children and you should be thankful for them, and say
for these small blessings, Lord make me truly thankful."
"Are you tired of my peculiar style of wit?" he asked,
as I rose to go.
February 19th.
The monthly ball is just over, and surely such a gathering
was unique. Wealth, position, fragments of talent andjwit,
remnants of great beauty—all overshadowed by the cloudjof
mental disease—were there to be seen en masse, presented^as
moving pictures in the hall of phantasy. ffll$
As I entered, Mrs. Smith inviting me to dance, caught and
whirled me until I was dizzy.


Where Fancies Fly With Painted Wings.
5
Mrs. Warfield jumped and pranced. During an inter-
mission, I asked her how she felt and she replied: "It would
be preposterously ridiculous to say one felt anyway but well,
when one takes so much exercise. We breathe oxygen
and hydrogen. The gas is constantly going up and it has a
sleep-giving effect. And when one is not sleepy, one is comfort-
able. No pain nor ache. This is the Gooda—a gas. It has
to be watched that it may be protected and given to the pains.
Therefore it has mind and thought. It wants to protect
people from fright and pain. I have seen the Gooda move
along my finger. It looks like flesh—almost transparent—
melted ice or beautiful saliva. It is viscid. It is so wonderful,
it is best to say little about it. God is good and God is in my
life. I found this out when I was a little girl. I found it in
the Bible. Then mother took me to Boston and the dentist
gave me gas and that entered into me." All this in one breath,
for which when I thanked her, she replied: "you are quite
welcome; and it is very gentlemanly in you to appreciate me.
I am a patient of God. Oh see!" she continued, "Miss
Ogilvy's dress. The combination of pink, green and black
is lovely, but she is rather slouchily arrayed."
"Yes" returned Miss Ogilvy, overhearing her, "I have
on a beautiful dress, but confidentially I do not know to whom
it belongs. I fear I have appropriated some one else's. I
found it in a box directed to me, so I put it on. Wouldn't it
be odd if the person who owned it, came in and ordered me to
take it off? I am not sure of anything in this world, and am
not surprised at anything. And now I find I am covered with
cats. Will you kindly excuse me while I brush them off."
In the lancers, Mrs. Petre pinned a white carnation in
my coat. "See" I said, "I wear your colors." "Yes" she
replied, "I had some, and my nurse insisted in putting them
in a sugar bowl. That was not a proper place for them, and
so to get rid of them, I gave them all away. This one had a
short stem, but I thought it would do for you. Besides you
are the merest acquaintance. I might do better for you,
if you were a friend.
Miss Leigh asked how long it took her to make a friend.
"Ten years," she answered.


6
Martin W. Barr.
Mrs. Frere then observed: "But one becomes better
acquainted in this place in a month, than outside in a year."
"Yes, but Dr. Barr has only been here three weeks," replied
Mrs. Petre.
The Virginia Reel, closing the evening, was bizarre beyond
description.
No one remembered it, but everyone danced it, and like
the race in Alice's Adventures in Wonderland—each got up
and sat down at will.
Mrs. MacKenzie stopped to make faces at Mrs. Tulloch;
Miss Levy stood in the middle of the floor wailing, she was so
stupid, she wanted to die; and Miss Ogilvy continued at in-
tervals to shake off the cats.
Mr. Buckheath and Mrs. Frere would stop to flirt in the
corners, till routed by the vigilant eye of the head nurse. Miss
Gautier, gorgeous in lavender satin, old lace and antique cameos,
in loud tones, compared this with a ball at the Tuileries, and
herself to the Empress Eugenie.
Mr. Ransom, with Mr. Hewett in his arms, galloped round
and round, overturning everyone in their path-way; while
Mrs. Smith discoursed on the vulgarity of it all.
February 20th.
Miss Ogilvy again lost her identity, and could not find
herself.
Told of once going to the wedding of a Miss Ogilvy, who
had married an Englishman of rank; and of later attending
a Miss Ogilvy's funeral; therefore she could not determine
to her satisfaction, whether she had been the bride on one oc-
casion or the corpse on the other.
To-day Mr. Archer repeatedly urged me to tell him of
the pranks of the various insane people I had met.
Miss Maitland was weeping because she wanted to go
to Heaven, but hoped she would not have to wear a crown,
as the nurse's caps here were bad enough; and she hoped she
would not have to play a harp because she detested harp-music.
February 21 st.
Miss Vaisey, while visiting a friend last night, sat next a
strange man at the dinner table, who remarked that he had
never seen an insane person, and would so like to see one.


Where Fancies Fly With Painted Wings.
7
Relating the circumstance, she said: "He did not know I was
insane, and I had a notion to tell him I was. I did tell him
that insane persons were just like anyone else, except that
they were exaggerated in one way or another. The mistake
the insane doctors make, is that they look at everything from
an insane standpoint, and if one is a little eccentric, they think
he is insane."
Mrs. Warfield was sitting in the sun this morning, admiring
her rings: "When I lived in the west, before the cloud-burst,
I used to wash the dishes in my diamond rings. How they
did sparkle. It was a compensation for the dirty work."
Mr. Hood was admitted to-day. All the other patients,
much interested, were eager to know if he was nervous—if
he was in bed—what was the matter with him?
Mrs. Smith was as usual writing the names of her friends
on the margin of a picture, and among others, that of Mr.
Archer. She told him she liked him because, like herself,
he was "the dribbled out remnant of a great family."
In the afternoon going to a matinee, she suddenly without
warning, began to call to the actors on the stage, using the most
vulgar and abusive language.
Mr. Cobham, under the delusion that he was the presi-
dent of all the railway systems in the United States, to-day
distributed "passes for life" freely. Mr. O'Dunne, petition-
ing him, he gave him one for fifty years.
"But this is only for fifty years!"
"Yes," he replied, "but it is for life. You are an old man,
and besides you are such a miserable looking creature, that
you will not live out your fifty years. So be satisfied."
February 22nd.
Mr. Bentley met me with: "Is it not a fine day for the
birthday of Washington? I am glad Mrs. Washington had
a safe delivery. Washington was delivered all right. So was
I. But I brought up at a mad house."
Mrs. MacKenzie showed me some silk lace she was crochet-
ing for a petticoat. "See" she said, "I have done all this
because I have not been excited for seven days."
Mrs. Warfield played "The Virginia Rosebud" and apolo-
gized for her rendition of it. Then after playing "Auld Lang


8
Martin W Barr.
Syne" she said: "I met him going down Washington street
one day. He's crazy, and a Polonaise by Beethoven." I
asked who she meant, and she replied, "You."
February 23rd.
Mrs. Warfield began to ramble on with: "Why did you
pass candy last night to those people? It was too exciting
for their brains and I know a lot of them that did not sleep
for it. Look at Mr. Hewett. He is as thin as a rail. Sometimes
I hate him because he is so hateable. I looked at you this
morning and thought you looked like me. I am so inter-
ested in the wild animals in the west. The coyotes. I saw
a bear and an antelope. I was with a lady and her husband.
The antelope saw us and then darted away. The houses
looked so beautiful against the horizon. The sun was hot,
and the sand was hot too. We had a thunder storm for sixty
afternoons in succession without cessation. The mountains
were beautiful with the tops covered with snow all the year
around."
Upon my asking Mrs. MacKenzie if she knew any Scotch
songs, she became so excited that she insisted upon dancing
the Highland fling. When quieted, she mentioned a number
of songs and dances and talked very lucidly. As I rose, she
said with a laugh: "Ye can't find many old women as well
mannered as me; and me crazy too. Just think on it."
Mr. Archer has slight choreic movements, which attracted
the attention of Mr. Hood, who inquired: "What makes you
blink and wink so?"
Quick as a flash, he replied: "Why the light hurts my
eyes." A few minutes after, upon Mr. Hood's observing:
"I don't like the screens they put around my bed. It reminds
me of a pig in a pen," Mr. Archer retaliated with: "You
are very complimentary to yourself. I had thought of the
comparison, but did not like to speak of it. I am glad you
put my thoughts into words."
February 24th.
Mr. Hewett observed, during my morning visit, that he
was afraid he had melancholia, then began to read his prayer-
book.
Miss Levy sighed: "I was so sorry to awake and find my-


Where Fancies Fly With Painted Wings.
9
self alive."
"Well," retorted Mrs. Frere, "did you expect to awake
and find yourself dead?"
"No, but I am wasting time, money—everything here."
"Not everything, I see that you are not wasting away.
Your cheeks are too red and round for that," returned Mrs.
Frere.
After breakfast Mr. Archer, referring to Mr. Hood, called
him peculiar. "I think that fellow is queer. He has no idea
of the fitness of things at all. Doesn't even know how to eat."
"Doctor, how do that young man's peculiarities mani-
fest themselves? What visible sign does his insanity take?"
inquired Mr. Bentley.
Later he saw him while playing billiards, suddenly cease
to play, put up his hands and toss his hair. Then he refused
to go to walk, or to dress for gymnastics. Claimed that all
the other folks did as they pleased, and he should do the same.
Paced to and fro in his room. Laughed and complained of
feeling "dazed." When told that the gymnastic teacher
was waiting for him, he replied: "Let her wait. If I am not
there, school can begin without me. It always does." No
amount of persuasion could induce him to go. When offered
a sleeping potion, refused it saying: "If I cannot sleep I will
knock this fence (screen) down, pull over the bed, cry fire and
pull the parrot's tail." Becoming more excited, he burst into
tears, sobbing: "But I don't know why I am crazy; I can't
help it." Later when in bed he said: "This is a queer place,
my first meal at table was worth a dollar to hear the funny talk.
I laughed until I was black in the face."
February 25th.
Just before dawn, Mr. Hood called his nurse, asking if
it was cold. Stripped naked, he sprang suddenly upon the
man and began to beat and choke him. When he threw him
off, he splintered the upper panels of the door with fist and feet,
and sprang into the arms of two waiting attendants, declaring
he intended to kill his own attendant. Once overpowered,
he went quietly back to bed, and asked for a drink of water,
saying: "I do not know why I did all this." In the scuffle,
one of his eyes was blackened, and he said: "Some one black


10
Martin W. Ban.
my other eye or I will do it myself. I would have killed some
one, if I had not been stopped. I thought they were going ot
flood my room. I was in the den and heard the lions growling.
I did not mind them, but was afraid of the water. I did not
see any, but I felt it." In the midst of the melee, Mrs. Mac-
Kenzie poked her head out of the door and called: '' The gentle-
men are up, I had better get up too."
"The fools are up,"answered Hood, "at least two of them."
Mr. Ransom upon hearing the noise, said: "He is just
like me when I am wild."
Mrs. Warfield remarked at breakfast: "The fun last night
was due to gas. I think he must have had sufficient to last
him to life everlasting. He must have taken a great deal,
and it is a most horrible thing to take."
"Perhaps they were moving." said Mrs. Frere.
"Well if they were they must have been moving very
rapidly judging from the noise. Why they must have gone
at the very acme of speed."
Miss Vaisey threatened to fine Miss Levy twenty-five
cents for every remark she made about herself.
"Oh don'fshe answered, "my father is not rich enough
for that. He can only pay for things in reason."
February 27th.
"My doctor—my court physician," cried Mr. Koplik,
"I am going to give a grand entertainment—the finest
exhibition of legerdemain that ever was seen; and my dearly
beloved doctor, you will be there. You shall have a front
seat and will be my honored guest. A little licorice please."
Mrs. MacKenzie's greeting was, "Good morning, doctor.
You are like a bad shilling, always turning up. I wish
I could get well and go home to glory and my Heavenly
home. I had a jolly time last night. I laughed and laughed
until I thought I was crazy."
Mr. Ransom, believing he has been appointed in charge
of Mr. Hewett, tells him, to his intense annoyance, when to
sit and when to stand.
Miss Maitland, while driving, passed a store kept by one
Peter Fae, and stopping to ask if he was any relation to Mar-
garet Fae in Mrs. Barr's novel of "Jan Vedder's Wife," was


Where Fancies Fly With Painted Wings.
11
much offended when he laughed and said "No."
Mr. Buckheath, an expert at cards, was teaching me
whist, and notwithstanding his careful instructions, I carelessly
played my ace before my king. Whereupon he leaned over
the table and shook his finger at me with: "Young man, do
you know there are men in Europe going about without dinner
or bed, because they played their ace first?"
The next deal, holding queen, king and ace, again I played
my ace first. Once more he leaned across, to say patiently:
"Young man there are men in Europe going around without
gloves and stockings, because they played their ace first."
The third round, holding the four face cards, I again led
the ace.
"There! Now I will not have to run around Europe
without dinner and bed, gloves and stockings!"
With a profound sigh he leaned back in his chair and replied:
"My dear sir—if you play like that you are never likely to
see Europe."
February 28th.
Mrs. Frere remarked: "I told a white lie to-day. White
lies and conventionalities are the hedges which separate human
beings from savages and keep them from being brutes."
Mrs. MacKenzie after a gentle reproof from the head
nurse, spent the afternoon muttering to herself:
"Ours not to make reply"
"Ours not to reason why."
"Ours but to do and die"
"Nurses to right of us"
"Nurses to left of us"
"Nurses in front of us"
("They are ubiquitous")
"All volley and thunder."
"Stormed at with tongue and mouth."
"Badly we meet defeat."
"I am the poetress laureate of the whole world!"
Mr. Hewett, after reading the Bible all day, towards
evening became restless and uneasy, and suddenly, with a water
pitcher, struck his attendant over the head, exclaiming: "It
serves you right."


12
Martin W. Barr.
Mrs. Tulloch, in a state of depression, first talked to her-
self, asking questions and answering them herself. Next
imagined she could not speak. Thought she was a pony and
then a duck. Next tried to choke herself with a handker-
chief, saying she was going to her own funeral and wanted
to throw herself under the horse's hoofs. Her nurse found
a note on her dresser: "If there is money enough left by selling
my clothing, watch and chain, I would like a little head-stone
with 'Mama' on it. It matters not where I lie. I have no
home, no friends, no husband, no children—save in dreams.
I will write no more letters—it does no good. I am in everyone's
way. I am so homesick, but I don't think I shall ever see
home again. I am insane and never will be well. I have begged
and prayed for death. I do not know how I got the name of
Tulloch. First I got it by falling off the fence. No, I will
explain. I am either sane or insane. If I am sane, I can ex-
plain things—if I am not, I cannot. I dreamed my husband
was crucified. I never will get over the crucifixion, for I
am afraid I have killed him."
Mr. Cobham, greatly excited, boasted he was the greatest
portrait painter in the world; could paint anything. Ordered
that his dinner be sent to his room, or he would tear the house
down.
In the afternoon, came to the parlor clad only in a shirt,
drawers and stockings. Next he appeared'in evening i dress,
talking grandiloquently of his friends as"glorious, magnificent,
sweet and lovely." Expatiating at length upon inventions
he claimed to have made, he gradually grew sentimental,
telling of his "loves" in the past, and how a famous authoress
whom he had jilted, giving her name and history, had in revenge
portrayed him as the villain in one of her most popular novels.
Expressed himself as much interested in the insane people
about him; wanted to get photographs of them, and to write
their peculiarities on the backs of the cards.
Said most men would be disheartened or discouraged by
being insane, but on him it had the opposite effect. It braced
him up.
At supper the conversation turning on platonic friend-
ship, Miss Ogilvy observed: "When I eat off plates, it is


Where Fancies Fly With Painted Wings.
13
platonic, and as Mr. Pate sits opposite, we must be platonic
friends." As she and Miss Levy were returning from a drive,
the latter called to me: "I don't believe I am improving.
I am hopelessly insane."
"Yes, you are improving" I replied,"isn't she Miss Ogilvy?"
"Yes, I suppose she is," was the answer. "She has only
wished she were dead three times during the last half hour
if you call that improving—well—yes." Later upon my
telling Miss Levy that she had a good command of language,
Miss Ogilvy interpolated: "Yes, she has. It is wonderful—
the many different ways she talks of dying and committing
suicide. It is ingenious to say the least, but it does grow mo-
notonous."
"Yes," assented Mrs. Frere: "She has a depressing in-
fluence over one; she has no animation; indeed she reminds
me of a tomb-stone."
Miss Levy appealed to Mr. Archer for sympathy with:
"I wish I was not crazy. I am so tired of it." To which he
promptly replied: "And so is everyone else."
"I am just crazy mad" said Mr. Bentley, "because my
cup is cracked. I am not used to drinking out of such common
china. I found my pitcher set in my basin too, and I am not
accustomed to such vulgarity. It reminds me of a country
hotel." Upon my trying to quiet him, he retorted "I've
been to church conventions, and heard the finest speakers in
congress, but you cap them all."
Miss Vaizey was busy all day with her manuscript, a novel
which has since been published and was a season's success;
no one, except the few initiated, dreaming that it was conceived
and written by one insane. She gave me a volume of her short
stories, in which she wrote the following lines:
"COMMUNION"
I would not in my verses celebrate
The narrow record of one selfish love or hate,
But seek to voice the universal soul
That blends all human life and passion in one whole,
So that in crowds or deepest deserts thrown
The most unfriended heart is never quite alone.


14
Martin W. Barr.
Mr. O'Dunne, in a talkative mood, told of how he never
allowed his four sons and three daughters to receive company
or have friends of the opposite sex; adding that he kept a
small whip, and waiting outside theatres or churches, if he saw
them accompanied by the interdicted friends, he would lash
them all the way home.every stroke drawing blood, so he said.
Blood-thirsty little Irishman, how he did gloat and laugh at
my horror!
March 1st.
Mrs. Petre, labouring under the delusion that some one
enters her room at night and paints her face, is printing the
following notices, which she pins on her door and scatters over
bureau, chairs and bed.
"NOTICE!"
"Fifty dollars fine for ruining me—my eyes, my ears,
my hair and my complexion. Pay me. Mrs. Petre would
like to be paid."
Mr. Cobham sat to-day quietly reading. Spoke only
when spoken to. Toward evening became irritable and excited
and said six bottles of beer would put him right. Told of living
unhappily with wife. Is going to get a divorce and marry Miss
Vaisey.
He expects to make hundreds of thousands of dollars
out of his various inventions: a rubber device to prevent
the rattling of carriages and cars; a table with a stove under
one end, which will keep food warm while people sit at the
other; a breech-loading cannon of peculiar design, which he
claims has already been offered to the British war office.
Mr. Buckheath, wildly insane and entirely nude, crying:
"Doctor, I am filled with remorse at my past life; my cries
are those of a lost soul, who has deliberately broken up families.
When I heard husbands weeping for their lost wives, I laughed
in glee and gloried in my relations with women. Faith is
what I want. Everytime I open the prayer-book I see some-
thing to rebuke me." He opened his book, gave a cry, and
staggered back, pointing to the Collect of Advent. 'Almighty
God give us grace that we may cast away the works of dark-
ness, and put upon us the Armour of Light,**** that in the last
day when He shall come again in His glorious majesty to judge


Where Fancies Fly With Painted Wings.
15
the quick and the dead, we may rise to the life immortal.'
When he finished reading, he broke down and wept like a child.
Mrs. MacKenzie, in a state of wild excitement, and furious
at her nurse, who had done absolutely nothing to offend her,
called out: "I am ashamed to have you speak before this
educated gentleman. The idea of your speaking to me, a
lady of my education and money. I can eat at the first table.
Dr. Barr, order Mrs. MacKenzie's carriage and the Spanish
horses and I will go home. Mrs. Nurse, if you were quiet
and peaceable and gentle, I would like you better."
March 2nd.
Mr. Cobham this morning, quite brilliant, failed for once
to attract the attention of Miss Vaisey, who very sad, was
absorbed in enacting the heroine of her novel, posed in the
attitude of Evangeline.
"Never shake hands with me Doctor," said Miss Ogilvy,
"because if you do I might want to marry you."
Miss Gauticr, much amused, whispered: "I wish you
better luck than to marry a crazy old thing like that."
"Miss Ogilvy!" said Mr. Archer: "you speak in airy per'
sifiage."
Miss Leigh asked: "What great moral lesson does a
weather-cock on a church steeple teach us? Can't you guess?
Why that it is a vain thing to a spire."
March 3rd.
Mrs. Warfield said mysteriously: "Robespierre was here
last night. You know he was the leader of the French Revo-
lution. He did not stay long because he met the head nurse
and she was too much for him. He was so kind and pleasant
to her that she might have been kind to him in return. Maybe
she was, but this morning she is as cross and ugly as ever.
She is part Indian and part Maine, and can you find a more
vulgar combination than that? I should like to murder her,
but she is as quick as a flash. If I took up a dumb-bell in the
gymnasium to throw at her, shewould'nt let me have it. Last
night I thought I died in convulsions. If I had died it would
have been perfect bliss. The Supreme Being—God—is an
odd person. If you don't do as he tells you, you get in a scrape
—and scrapes are so disagreeable. I wish I could endure my-


16
Martin W. Barr.
self and be good."
"You ought to use your prayer rugmore,"I suggested, to which
she replied: "You need not expect any praying from me. I
never pray except when I am frightened or want something.
The head nurse and housekeeper would never get over it if
I did. They would think me horrible."
Mr. Buckheath also has taken a dislike to the head nurse,
Says: "When my friends come, she reminds me of a Greek root,
and flops down on me like a tad-pole. The old harpie. I heard
the old cat tell a patient she would like to spank her and I
was disgusted."
"She certainly has an original way of expressing herself,"
I said.
"Original!" he replied, "I should call it aboriginal, for
the old rip is not yet civilized."
Last night Mr. Bentley announced; "The time has come
for me to die," and began to pinch his throat, but he pinched
too hard and soon desisted with: "No, I guess the time has
not come quite yet."
Miss Levy wailed: "I do so want to die." "Well,"
replied Mrs. Tulloch: "I'll help you. I have a little paint
box that you might like to swallow, and it will do the deed."
Miss Maitland saw some horse-chestnuts and wondered
if they would hatch out little horses and if they would be dead
or alive.
Mrs. MacKenzie met me with: "I am an educated person
and the Queen of Europe." Then pointing to her supper:
"Isn't this a frugal supper for a Queen?"
Miss Amherst was moaning: "Get a coffin and screw me
down. That is the best thing that could happen to me. It
must be so pleasant to lie down in the ground and hear the
rain patter on one."
Mrs. Frere remarked: "It would be rather close breath-
ing though."
Miss Vaizey very wild. Saw (in a vision) the man to
whom she was engaged five years before eloping with another
woman. Says she feels as if the covering of her brain were
torn off.
Mr. Cobham also excited, is making a scrap-book. Wrote


Where Fancies Fly With Painted Wings.
17
poetry in morning, which he tore up in the evening. Said he
and Miss Vaizey would soon be married, and then write and
illustrate a book which would bring them an immense fortune.
March 4th.
"What is the sign when one's nose itches?" asked Mrs.
Smith of Miss Maitland.
"Why you will kiss a fool, meet a stranger, or be in danger."
"I do not like that. Miss Levy kissed me, and Mrs.
Frere called me a fool." Mrs. Frere apologized most humbly
but she refused to be pacified, whereupon Miss Levy put in:
"Well.I don't know that she was far wrong if she referred to me."
March 5th.
Mr. Bentley called Mr. Buckheath a "rastaqouere," and
when asked what it meant, replied: "It is a slang Parisian
word meaning a foreigner who makes a great show of wealth
and about whom no one knows anything."
"Why is a cat better than a swallow?" asked Mrs. Frere:
"Well I'll tell you. Because it takes many swallows to bring
a summer; and only one cat to make a spring."
March 6th.
Asking Mr. Hewett if he was going to church, he blushed
and smiling in a sad way, answered: "No, I shall wait a few
days. It is too soon after my attack of—nervous confusion."
"Ah!" said Miss Ogilvy, "I wish I could go to the childrens'
service. Perhaps my poor deluded brain might be able to
comprehend a simple service."
"What do you want?" was Mr. Sawyer's greeting. "What
do I want?" I replied: "Why I came to bask in the sunshine
of your smiles." "Well bask," he said, pushing me into a chair,
"I am smiling" and he gave a most fiendish grin.
"Why you are the living picture of Benjamin F. Butler—
spoons and all," laughed Mrs. Petre.
March 7th.
The head nurse blowing her nose quite loudly to-day, Miss
Leigh called out: "Don't be alarmed. It is only Gabriel
blowing her horn. I have dubbed her 'Sister Gabriel' because
she is always blowing her own trumpet."
Offering to shake hands with Mr. Hewett, he refused with:
"No I will not—I am tired of it." "You are very peculiar,"


18
Martin W. Barr.
I said. "Certainly I am," he replied. "I would not be here
if I were not peculiar."
Mr. Buckheath in a jolly mood said:"Mr. Archer looks like
Isaac Walton, the father of anglers," and sang to him as the
milk-maid does in the Complete Angler: "Come live with me
and be my love."
Then he quoted from Andrew Lang:
"Old Isaack, in this angry age of ours,
This hungry, angry age, how oft of thee
We dream, and thy divine tranquillity.
* * * *
Ah! happy hours! we cry—Ah! halcyon hours!
Yet thou, like us, hadst trouble for this realm
But naught could thy mild spirit overwhelm.
Oh, Father Isaack, teach us thy content,
When time brings many a sorrow back again!"
Miss Vaizey told me at length of her frequent visits to
the house of a great English poet, and of the practical suggest-
ions he had given her in regard to writing; and also read to me
a number of delightful letters of advice.
Miss Gautier passed a wild night. This morning claimed
her name was not Julia, but Frederick, that they called her
Julia because her sister Julia, an idiot, had been sent to an
institution, where she was trained and became able to marry.
Then she (Miss Gautier) took her sistef's place at home, and
everyone thought she was her sister.
March 8th.
To-day Miss Gautier is better. Gave me many points
on French Court etiquette and showed me with great pride,
a diamond ring, the setting three inches long, made from a
shoe-buckle formerly worn by the "Due de La—" to whom her
father was first gentleman in waiting.
Mr. Cobham, in a state of exaltation, was painting indus-
triously all day, painting out as fast as he painted in, talking
all the time.
At dinner, speaking of alligators, Miss Ogilvy remarked:
"I must be one because my name is 'Allie' and I wear gaiters,
therefore I must be an alligator."


Where Fancies Fly With Painted Wings.
19
Mr. Bentley said he intended giving his attendant a little
money, and when I asked if he would not give me some, he
said: "No, you go work for it. You are a young, strong man.
Shame on you, to beg of a poor, old insane man."
March 9th.
"Good morning, Mrs. Warfield," I said, "What have you
to tell me good this morning?" "God is good," she replied
sweetly, "now, always and forever."
All too soon, came to a close my days of service at the
hospital, and this character study I had found most interesting.
The patients were all drawn up in the hall to wish "farewell
and God-speed," each in characteristic fashion to one they
were never to see again. And so I passed from their midst,
bearing with me a strange memory of these" dead who do not
die, but who may not live;" these victims of the misfortunes
or the failings of themselves or of others. Truly the consequen-
ces of our acts are eternal for as Kipling and Goethe have both
emphasized:
"We are after all but the sum of our ancestors, plus our
own individuality;" and, "Deck yourself in a wig with a
thousand locks; ensconce yourself in buskins an ell high; you
still remain just what you are."
Of some I have since heard:
Mr. Koplik died of cerebral hemorrhage. Miss Levy
finally succeeded in leaping from a high window to find the
rest she longed for. Mrs. Frere recovered and returned to
her home; as did Miss Leigh, now living happily with her
mother.
Mr. Cobham and Miss Vaizey have realized their aspi-
rations, both intellectual and sentimental; he as a fair artist
and she as a writer of fiction. They are happily married, and
prove congenial mates, fortunately without children. Now
and again he seeks a sanitarium, and occasionally his wife
takes her turn at retirement. He still has his amours, but
his wife does not mind, and they are good artistic chums.
Mr. Archer, "Isaac Walton," still lingers fat and content
to live the life of ease.
Mr. Buckheath, now living abroad, is happily married


20
Martin W. Barr.
to an ordinary woman, not of his class, but who succeeds in
making him happy in a quiet home.
For those who remain, the years begin to throw long
shadows eastward, and the time is near at hand when they will
soon push aside the gates of life and enter into the fullness of
joy along the path that leads to happiness for-ever-more.
Heaviness will endure for the night, but with the dawn they
will have crossed the threshold to the joy that comes with the
full morning-tide.


IS GENIUS A SPORT, A NEUROSIS OR A CHILD
POTENTIALITY DEVELOPED?*
By James G. Kiernan,
Chicago, I1l.
Formerly Assistant Physician Manhattan State Hospital
(1874-8) and Superintendent Chicago State Hospital
(1884-9)
Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association; Honorary Member Chicago Neuro-
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professor Neurology Chicago Post-
Graduate School 1903; Professorof Nervousand
Mental Diseases Milwaukee Medical Col-
lege 1894-5; Professor of Nervousand
Mental Diseases Medical Depart-
ment Loyola University 1905;
Professorof Forensic Psychi-
tary Kent-Chicago
College of Law.
Acongenital sexual twist of another type appears in a great
student of Ruskin. Oscar Wilde was born in Dublin
October 16th, 1854. His mother hoped before he was born
that he would be a girl. Her disappointment was great; she
treated him as a girl and kept him in dresses as long as it was
possible. A portrait of Sir William Wilde, Oscar's father,
according to Sherard, reveals "an extraordinary mixture of
intellectuality and animalism, of benevolence and humanity
with bestial instinct." The face is not unlike that of the son
in which the contrasts were equally marked. His "forehead
and eyes were those of a genius or an angel; his mouth was ugly,
almost abnormal." Wilde was brought up in luxury, although
♦Continued from Alienist and Neurologist, Nov. 1912.
(21)


22
Jas G. Kiernan.
his parents did not belong to the wealthy class; still they were
comfortably off and his home in Dublin was attractive, even
luxurious. Oscar took kindly to luxury. In his more opulent
days he spent hundreds of pounds a year in cabs. At one
period he used to take a cab by the day, and the first address
that he gave daily to the driver was a florist in the Burlington
Arcade. Here he bought himself a bouttonniere at half a
guinea, and another at half a crown for his cabman.
According to Sherard.t Wilde escaped that taint of pre-
cocity for which the English dictionary had another and less
euphonious term and, until his inherent perversion broke
out (but probably because of it) he escaped the air of his father's
house. Here high thinking did not go hand in hand with plain
living. The house was a hospitable one; it was a house of
opulence and carouse, of late suppers and deep drinking;
of careless talk and example. His father's gallantries were
the talk of Dublin. His mother, although of spotless life
and honor, had a loose way of talking. One of her sayings
still remembered in Dublin gives an echo of her revolt against
the accepted and the commonplace. "There has never been
a woman yet in this world who would'nt have given the top
off the milkjug to some man if she had met the right one."
The mother's salon, the father's consulting table, were fre-
quented by boozy, boisterous Bohemians, of whom Dublin
furnishes such strange specimens. How free was the conver-
sation may be gathered from a remark which Oscar Wilde
once made to a fellow undergraduate at Trinity college.
'Come home with me,' he said, 'I want to introduce youto my
mother. We have founded a society for the suppression of
virtue.' It is obvious from this phraseology that an atmos-
phere of mixoscopia existed. Had it not, the term conven-
tionalism would have replaced virtue. Here Wilde, as a youth,
differs from Macaulay, in finding the agreeable, unvirtuous;
Ruskin's association with Wilde was a natural result of the
attraction of conventionally unconventionals with a Nar-
cissan sexual trend in each. The mentality which created
Dorian Gray, had much in common with that of the victim
t SherardiLife of Oscar Wilde.


Is Genius a Sport?
23
of the chastity of impotence, the denouncer of vivisection
and of the United States.
At school Wilde was a remarkably brilliant scholar in
everything but mathematics. He was not very popular
with his school fellows, one of whom says that "he used to
flop about ponderously." He never played games and objected
to cricket, "because the attitudes assumed were so indecent."
This remark seems to imply the mentality of the invert. His
manner was reserved and he kept aloof from other boys.
In his school days Wilde showed his fondness for eccentric
attire, and even then wore his hair long. Despite Sherard's
opinion, something was decadent about Wilde when a school-
boy. At Oxford Wilde came under the influence of Ruskin.
He was one of the "ardent young men" who gathered around
Ruskin in his practical demonstrations of the Gospel of Labor.
Though Wilde hated exercise and held games in abomination,
he broke stones on the highway and had the honor of filling
Mr. Ruskin's special wheelbarrow. Being interested in art,
Wilde dabbled a little with the paint brush in his undergraduate
days, but nothing that he did was worth while or has been saved.
Notwithstanding his aversion to games, Wilde was physically
strong. While a young man in London he assisted a man,
a friend, to escape from the police, and in the furtherance of
this object exercised great physical strength, holding a door
against a number of constables, while the fugitive was clamber-
ing out of the window to safety. In Paris he once desired
to learn rapier, so that he might be able to impose silence
at the point of the sword on the slanderers who were attacking
his reputation.
Aesthetism, a naturally fetichic product of Narcissan
homosexuality, Sherard regards as a pose. "There is no
doubt that Oscar Wilde's early eccentricities created an erron-
eous impression concerning his capacities, which for years
militated, and in certain quarters still militates, against the
reputation which his high genius entitled him to enjoy. Fame
is no t to be violated with impunity, and when the claims of the
Pon t d' Arcole were denied, could the peacock's feather and
the sunflower prevail. The pose, such as it was, was eminently
successful. If notoriety were sought after, it was gained to


24
Jas. G. Kiernan.
the fullest extent. Punch celebrates week in and week out,
the eccentricities of the school. The part played by DuMaurier
and Burnand, Mr Hamilton's book, shows :"A11 the time when
Oscar Wilde was thus mumming and masquerading, the bitter-
ness at his heart was great. Knowing what was in him; feeling
the flame of the genius that burned within; conscious of the
part that he might have been playing on the stage of the world,
to none more than himself can his notoriety, acquired as it
was and kept alive by such means, have appeared despica-
ble and a matter for regret."
If Hichen's story, "The Green Carnation" were well based
it was much more and had its foundations deep in homo-
sexuality. Green is said to be peculiarly favored by inverts.
Green however, was the color of the Duke of Artois,
who afterwards became Charles X. It is still worn by the
descendants of Mahomet. While the Koran denounces homo-
sexuality, there are some suggestions of it in the paradise
provided for the true believers. The acceptance of green
by the Irish seems to have been largely an 18th century matter.
It is by no means improbable that the Fians or fairies had a
greater influence over the Gael, who remained in Ireland,
than those who settled in Scotland, since green was tabooed
as the color of the fairies to the latter. For the opinion that
the Fians, Fens, Fenians and Fairies were a mixed Caucasic-
Mongoloid race allied on the one hand with the Ainus and on
the other, with the Laps, Fins, Picts, Quens and Eskimos,
MacRitchie has advanced exceedingly strong evidence.
Green was the favorite color of these races in Ireland and Great
Britain. The Picts were called virides or green men from their
favorite tattoo. The Irish Gael had not the prejudice against
green as a heathen color, which the Scotch retain since the
leprechaun is a fairy dressed in red. St. Patrick was more
tolerant of non-essentials than the later Roman missionaries,
who created that prejudice against hippophagy as a survival
of Odin worship, which still persists among English-speaking
peoples. That homosexuality is frequent among descendants
of the Feno-Gael cannot be said. It was notoriously frequent
among the Normans, who crushed out Celtic civilization and
Celtic Christianity. Their appreciation of green may have


Is Genius a Spurt?
25
dominated the Irish Gael in the same way that their type of
Christianity dominated the Christianity of St. Patrick and
St. Columba. Certainly, green was not the color of the
standard of the last great elected over-lord of Ireland, Brian
Borhoime.
The New York inverts and perverts who go in the under-
world under the title of "fairies," wear an ornate red necktie
to characterize them. Quite a number of these are Germans
and Hebrews however. In Philadelphia perverts are "brownies".
The principles laid down by Oscar Wilde in his highest
contribution to literature, "The Soul of Man Under Socialism,"
significantly demonstrate elements which underlie aesthet-
ism: "A man is called affected nowadays, if he dress as he
likes to dress, but in doing so he is acting in a perfectly natural
manner. Affectation in such matters consists in dressing
according to the views of one's neighbors, whose views as
they are the views of the majority, will probably be stupid."
Practically, this is the sentiment which emerges from the
gnarled cant of "Sartor Resartus."
The individualism, however, of Wilde is infinitely higher
than the authoritarianism of Carlyle. There is a primitive
skatalogic tendency which Zola has depicted in La Terre
which coarsens all its touches and which underlies the so-
called popular influence on Art. This is peculiarly well put
by Wilde in his discussion of English-speaking journalism,
the most emphatic expresson of this element in public opinion.
"Public opinion, according to Wilde, tries to constrain and
impede and warp the man who makes things that are beauti-
ful in effect and compels the journalists to retail things
that are ugly or disgusting or revolting in fact, so that the
English-speaking peoples have the most serious journalists
in the world and the most indecent newspapers."
(To Be Continued.)


NOTES ON THE HISTORY OF PSYCHIATRY. VIII.*
By Smith Ely Jelliffe, M. D., Ph.D.,
Adjunct Professor of Diseases of the Mind and Nervous System,
Post-Graduate Hospital and Medical School.
THIS installment continues the translation of Falk's
Psychiatry of the Ancients. Notwithstanding the re-
cent appearance of Kirchoff's chapter on the History of
Psychiatry inAschaffenberg's new Handbuch der Psychiatrie,
this chapter of Falk still remains unique among historical
contributions. Kirchoff's chapter falls far below it in insight
and value and makes this English translation all the more
desirable.
Our previous installment brought us to the work of Oribasius.
Oribasius—Among the fragments of Oribasius, which
we possess, we find the VHIth book of the Synopsis, which
deals with the head and nerve diseases, also with melancholia.
(We also find a prescription for pediculi. Opt. XXVII.) He
is essentially a compiler and generally quotes his authorities
(as Philumeno on apoplexy,) but in this chapter he gives no
names, although we find the Galenic doctrines concerning
the nature and the treatment of hypochondria.
Again we find the recommendation of the use of helle-
bore. With great circumstantiality he explains in Medin.
collect. lib. VIII, cpt. I the particulars of the hellebore cure.
He recommends its use as the moon is waning. Further he
adds that the treatment of melancholia is the same as that for
insania. Philumeno had praised bryonia root in their treat-
ment. He briefly takes up the subject of lycanthropy, but
in the meantime makes the remarkable insertion of the treat-
ment of those whom love has depraved to grief, insomnia
and refusal of food. He recommends distractions of all kinds,
♦Continued from page 322, Vol. XXXIII, Aug. 1912.
(26)


Notes on the History of Psychiatry.
27
bathing and the like. That he not only has pure and modest
love in mind, I should like to note that he reproaches the way
of living of certain ones and describes as characteristic the
hollow, tearless, but sensual eyes with everlasting tremor
of the lids, which alone are in motion, whereas all remaining
organs grow weak. Otherwise somatic remedies are alone
discussed for the well.
Oribasius is the first who says nothing of phrenitis. How-
ever, he speaks of his "inflammatjo cerebri" ex Philumeno,
in which fever, continuous headache, redness and swelling of
the entire face and head, also of the lids, occurs. If we are
inclined to interpret this as erysipelas it is very striking that
he also speaks of a brain erysipelas by which burning,
headache, a pale, cold face and a hot tongue have been ob-
served.
Finally he describes hydrophobia in which the patients
are quite mute, yet recognize their relatives and refuse nourish-
ment.
Recent authors have written concerning the educational
rules of Oribasius for the strengthening of the body and mind
of the youth.1
Aetius—Another compiler, Aetius of Amida, devotes
likewise in his Tetrabibl. II. Sermo II. a paragraph to the
different head diseases, and no doubt in similar combination
as Oribasius. But he makes a distinction between phrenitis
(Posidonius,) and inflammation and erysipelas cerebri, and
seems to regard delirium as pathognomonic of the former con-
dition. Utilizing Galen's psychology, he distinguishes three
kinds of phrenitis, accordingly as only the imagination, or
only the reason, or the memory—these, however, with the
loss of such faculties—are involved. In the first instance
the anterior part of the brain, in the second the middle, and
in the last the occiput is the site of the lesion.
Loss of memory can also arise apart from phrenitis through
acute disease, old age and excessive study. What he writes
concerning the therapy of phrenitis and imbecility (fatuitas)
is Galenic.
L Frederich, Literar Geschichte, etc. pg. 75. Sprengel, Op. dt.


Smith Ely Jelliffe.
We have already reported concerning the book of Rufus
on melancholia.
"Insania" is described by Archigenes and by Posidonius.
As in all of the hitherto described diseases, here also the brain
is the suffering part, as either too much blood, as in drunken-
ness, or yellow bile flows to the organ. In the first case there
is extravagance as the patient imagines he sees something
funny, and sings. The patients also believe that they hear
music, being misled by the buzzing in the ears. In the latter
case the patients are anxious, sad, irascible and finally break
out in wild delirium, during which they may become very
dangerous, believing, as they do, that those about them are
enemies. Sometimes both forms occur simultaneously. By
a moderate diet the brain is often cleared of its overflow and
amelioration or intermission of the excitement sets in. Some-
times insomnia appears periodically (per cuicuitum quendam
irruit insania coacervato videlicet quod morbosum est. Opt.
VII. "Insania" here is exactly the same as mania of the earlier
authors). It preferably attacks the avaricious, hard tempered
individuals, drunkards and such, in whom the habitual
secretions are suppressed. The treatment is purely somatic.
Both compilations are of value for medicine in that they
make us acquainted with what has been lost in the originals.
The study of these interesting chapters of both authors is not
quite fruitless for us since they contain Galenic as well as
Hippocratic doctrines on the etiology of mental disease.
Alexander of Tralles—A rich personal experience
speaks from the writings of Alexander of Tralles. Alexander
has been considered the greatest of the physicians of the ripest
period of Greek and Latin natural sciences. So far as psy-
chiatry is concerned he has however simply taken over what
his predecessors have given him without increasing it. Yet
it is probable that quite independent of Caelius Aurelianus,
perhaps also unacquainted with the writings of Celsius, he
made several good and striking observations, for which, accord-
ing to his own statement,his wide experience offered abundant
opportunity.
In Chapter XII of his Book I, we learn nothing noteworthy
regarding phrenitis. He also explains an inflammation of


Notes on the History of Psychiatry.
29
the brain and its membranes as induced by yellow bile, whereas
lethargy is due in quite a similar manner to mucus.
We here find the humoral pathology in full bloom, just
as it is in melancholia, which is distinguished from phrenitis
only by means of its chronicity and lack of fever.
Melancholies are sometimes cheerful, others very violent,
others quite idiotic. (Cum torpore moltosesegnitie, quos Graeci
vocant "moroi." Dementia or melancholy with stupor?)
Some are afraid of death, others desire it. Again others believe
they are able to prophesy the future. Some have quite free
intervals in which they can attend to their business, others
are continuously absent-minded. He distinguishes between
forms of melancholia in which there is too much blood, in which
the blood is mixed with yellow bile, and in which the blood
is mixed with black bile. The first form occurs particularly
in people who have led a life of grief and sorrow, also following
severe attacks of hemorrhoids. In the second case the patients
develop raving attacks with great ease. Purgatives and baths
are warmly recommended. Scammony is well adapted as
a laxative, and it is easily given in wine or in raw egg. (Patients
should not be forced to take it against their will.) Stimulating
laxatives, such as hiera, do harm in that they may induce
attacks of great violence.
The humors are harmful because they fill the brain with
bad vapors and spoil the animal spirits. Melancholia due
to black bile in the blood is the worst of all. These patients
are very depressed and finally develop very crazy ideas. They
believe they are other persons, even lifeless objects, as is
seen in many examples To take away such illness psychic
remedies are advised, especially suitable clever deceptions,
such as have been understood by skillful physicians, and were
successfully used by the author. He relates one of his own
experiences in which a wife became melancholy during a long
absence of her husband, but as he unexpectedly entered the
room she fell upon his neck and from that time, without any
other remedy, recovered. Such sudden changes of mind are
proper for those who through grief and sorrow have developed
the disease.


30
Smith Ely Jellifie.
But if the disease has become deeply rooted neither re-
flection nor any other tricks are of value. Very often the disease
is incurable. One may then try hiera, and if the patient
seems to improve after its use (one can determine this by a
lessening of the anxiety or by the patients becoming more
quiet) it may be repeated several times. Lapis Armeniacus
has seemed to be of service and is to be preferred to the old
fashioned veratrum. His method of giving these drugs is ex-
plained in detail.
Alexander naturally maintained the well settled opinion
held by all the great physicians since the days of Galen that
the brain was the seat of the soul and of mental disease. The
lever of all mental activity was the pneuma. Since his etiology
included somatic and psychic causes, his therapy was a mixed
one. However, the choice of psychic remedies, and the pre-
sentation of his entire method, is by no means as clever,
nor as thorough, as are those of Caelius Aurelianus. His
somatic therapy, to which he however ascribes the most im-
portant role, he seems to have elaborated quite indepen-
dently. Numerical increase of remedies is no great progress.
He acknowledges the unfavorable prognosis in some cases.
Superstitious remedies, which he advises for other diseases
(Sprengel, Op. cit. Bd. II) are not found in this paragraph.
Paul of Aegina—A third compiler, Paul of Aegina,
only needs to be mentioned in brief words. He does not give
anything new. He repeats almost word for word the opinions
of his predecessors, especially Oribasius. His therapy is
somatic. In the treatment of love sickness, which, classed
with the brain diseases, he holds is not absurd, (Ad cerebr.
affectiones etiam amores adjungere nihil absurdi est quum
curae quaedam axist nt. lib. II cpt. XVII) he considers mental
entertainment in addition to good nourishment to be suitable.
Actuarius—And now it may be permitted us to close
the chain of the most important medical authors with the
name of a man whose sphere of activity was occupied much
later than that of Paul of Aegina, but one who however is of
great interest for us as he supported with success the doctrines
of the great philosophers and physicians of antiquity, especially
in the field of psychology. It is Johannes, also called Actuarius,


Notes on the History of Psychiatry.
31
who lived in the thirteenth century. Thierfelder (L. c.)
acknowledges in him the greatest psychologist of the middle
age. Although the study of the documents of Actuarius2
make me feel that this praise is somewhat excessive, yet it
cannot be denied that the descriptions and method of writing
in his psychological work is truly attractive and noteworthy.
I do not think it necessary to develop his psychological views
here in extenso, as it does not come quite within the scope of
our inquiry and furthermore Hecker has already given3 in a
clear and precise manner the thought of his psychology. I
will only call attention to the fact that among the activities
of the mind, according to Actuarius, phantasy localized in
the anterior and memory in the posterior part of the brain,
they could be disordered separately, as for instance in people
who have had a great deal of distress. But if reason, which
resides in the mid portions of the brain becomes sick, both
of the other parts of the brain are likewise affected. The mind
now suffers because the xveurja i^uxixov, which is the cause
of the same, has its seat in the brain, and since it is very thin,
it extends its arms like a polyp through the entire brain and
destroys it. This takes place since the juices already mentioned
may bring about excitement or depression according to their
abnormal compositon.
Since the xveu[ia tjwxtxov is thinner and dryer than
the pneumata formed in the liver and heart, and which govern
the vegetating functions, the proper remedy to preserve the
mental health is to carefully regulate the bodily fluids, to live
moderately and to strive to cultivate the intellect by means
of music. Fully developed mental diseases are best combated
by diet and by drugs, especially with purgatives and narcotics,
(lib. II. cpt. XVII.)
In order to properly appreciate Actuarius, it is sufficient
to bear in view that his thorough studies of the old established
doctrines were made at a time when scholasticism had begun
to cloud the comprehension and the doctrines of philosophers
and physicians.
2. (Physici et Medici Graeci minores Alexander Tridentinus. De Spiritu Animali.
1567. Latin Translation.)
8 (Geschichte der Heilkunde, Tb. 11. pg. 355)


32
Smith Ely Jellifie.
Now that we have passed in review the series of authors
and physicians and we have had the opportunity of becoming
acquainted with the transformations in the comprehension
of mental diseases, it seems necessary to recapitulate the most
important points which can be gained from the preceding
considerations.
Mental disease is as old as disease in general. The oldest
sagas, the children of the phantasy of the people, describe
several cases of transitory or fatal mental disturbances. The
history of psychiatry proper, so far as classical antiquity is
concerned, begins with Hippocrates. Most of the later phy-
sicians have more or less taken his teachings as examples,
although modifying the same in many relations as a result
of their experiences. Some have shown a greater variety
of forms of psychic illness, others have developed more minutely
the psychological processes obtaining in mental diseases,
while still others have considered therapy in greater detail.
None of the authors mentioned have adopted the opinion
of his predecessors unconditionally and without criticism.
Even the compilers of later times do not seem to have simply
repeated the ideas of the older physicians and masters, but
have compared them with the results of their own experiences.
Each, with the poet, has sought from the inheritance of nature
to acquire something of his own.
The multifarious correlations of body and mind, in health
and in disease, have naturally not escaped the ancients and
they have quite naturally explained them in such a way that
they located the mind in a special organ of the body, and between
the mind organ and the remaining parts of the body they as-
sumed a more or less close relation.
Which part of the body was to be taken for the organ of
the soul had been already correctly determined by a Pytha-
gorean. Hippocrates has further explained that all the mental
processes took place in the brain and drew therefrom the first
conclusions regarding pathological conditions. His immediate
successors did not follow him unconditionally in all his state-
ments. Plato puts the "divine soul" in the brain only, the
passions and desires were assigned to the heart and abdomen.
Aristotle places all of the intellectual faculties in the heart,


Notes on the History oj Psychiatry.
33
but sees in the brain a sort of control apparatus for immoderate
activities of the heart. Asclepiades differs entirely from Hip-
pocrates, as he apportioned no distinct organ to the soul. Ac-
cording to Celsus, who is a follower of Asclepiades, it is seen,
especially in his therapeutic teachings, that Asclepiades re-
ferred the seat of all abnormal action to the brain. Galen
warmly accepted the old Hippocratic doctrine, and though
he seems to be inclined to the Platonic doctrine that the liver
is the seat of desire, yet nevertheless he develops very clearly
the results of experiments and experience that the brain is
not only the central point for sensation and for involuntary
movement, but it is also the location of the mental processes
of man. It was also he who made the effort to make a psycho-
logical analysis of the mental faculties of man. His ideas
later found an interesting development by Johannes Actuarius.
Galen, but still more Aetius, also tried to locate the different
psychical qualities in different parts of the brain. From the
time of Galen on the brain occupied its important place in
the medicine of the ancients. It was also Galen once more
who showed that these correlations between the brain and
the rest of the body take place through the intervention of
the nerves, and that those organs rich in nerves, such as the
abdomen, were in close physiological and pathological connect-
ion with the brain. It must be noted that the old physicians
never expressed themselves concerning the further relation
of the psychical activities to the brain, and the relation of
mind to matter in an extreme sense. Nowhere do we find
in them such a crass materialism as is seen in the sayings of
Lucretius. It may here be recalled that Lucretius claims the
frequent occurrence of psychic disturbances as evidence for
the mortality of the soul. The soul is, as he says, only a por-
tion of the organism such as the hand or the leg.
Even the later schools, such as the pneumatics and the
methodists, who seemed rather inclined to accept a material
point of view for the psychical processes, do not entirely re-
ject the possibility of a dynamic principle, and Galen, who
however was no enemy of theoretical speculation, never-
theless came out with much emphasis that all such theses
^nd hypotheses were of no value in practice.


34
Smith Ely Jelliffe.
According to their physiological point of view, the old
physicians had a correct insight into the nature of mental
disease. Already Hippocrates opposed the opinions of former
physicians as well as those of his contemporaries, as he does
not admit these affections to have a transcendental origin,
but tries to see in them natural processes, as in all other diseases.
They are diseases of the brain, he states, and all of his suc-
cessors shared his opinion. Even if Celsus does not apportion
these diseases to any definite place, yet nevertheless in his
therapy he uses such remedies as act on the brain, many being
locally applied to the head. Caelius Aurelianus has spoken
most definitely upon this point. Mental diseases, he says,
although not in the same words, are diseases of the brain which
show psychic symptoms in the greater number of cases, but
not always. Like all diseases they come within the domain
of the physician's care. Thus far no philosopher has been
able to bring about a complete cure.
It did not escape any of the students that to the psychical
anomalies in these diseases multifarious somatic symptoms
might be allied, partly as coeffects of the original brain affection,
partly as further consequences of the abnormal mental con-
dition. From the time of Hippocrates on, every one had
called attention to these concomitant bodily symptoms.
That they indeed have always laid the chief importance there-
by upon the psychic manifestations is seen, among other things,
that, as will be shown, they observed in a disease, in which
in addition to the disturbance of consciousness there were
many abnormalities of the vegetative sphere, a mental disease
quite in the sense of to-day.
Of these bodily symptoms the nervous ones were the most
prominent, and the ancients thus recognized also the close
relation between mental and nervous diseases. Hippocrates
had already referred to the close connection between epilepsy
and mental diseases, to which Aristotle called attention.
Later on Aretaeus developed in the most strikingr,way the re-
lation beween these two processes, and all those who devoted
a special chapter to mental diseases have, w"th the exception
of Celsus, followed or preceded it by a chapter on nervous
and brain disease showing principally bodily symptoms, and


Notes on the History of Psychiatry.
35
in a more definite manner, Aretaeus pointed out the compli-
cation of mental disease with spasms as well as paralyses.
Hippocrates especially mentioned the connection of the mental
diseases with spasms and other nervous troubles, which had
their origin in functional disturbance of the female sexual
organs and therefore had been designated by the ancients
as Hysteria.
So far as the mechanism or origin of mental disease is
concerned, they had of course only hypotheses. Hippocrates
upheld the theory of constitution and temperament, which
played a great role in his physiology and pathology, as ap-
plying also to the psychoses, in that he assumed them to arise
from disturbances in his hypothetical juices. All others have
more or less advocated this theory, and especially Galen,
who supported it with great dialectic, and the belief became
so universal as to be taken up by the laity, as can be seen in
the poets and dramatists. It is all the more striking that
we find no trace of this doctrine in the work of Caelius Aurelia-
us, whereas even physicians of later activity, even Johannes
Actuarius, eagerly followed this hypothesis. It is naturally
abandoned at the present time, although certain expressions,
showing their early origin, have been retained, largely for the
sake of convenience. However, with reference to the signi-
ficance of this ancient theory, I would like to refer to the words
of Damerow (in the already mentioned critic of Friedreich's
book, Zeitschr. f. Psychiatrie, XXIII. 5): "The derivation
of most of the forms of mental disease from bile and mucus
is certaily something very poor and tedious, but, not taking
them too literally, it is undeniable that the forms of insanity
originate from their corresponding temperaments as organic
bases."
With respect to the elemental psychical disturbances in
mental disease, Galen sought to develop these anomalies of
thought out of the normal activities described by him, and
later compilers have reproduced his representations, whereas
Johannes Actuarius has modified the opinion of Galen some-
what. To all authors from Hippocrates on it was clear that
insanity consisted very largely in disturbance of feeling, mostly
of a sad nature.


36
Smith Ely Jellifie.
Hippocrates had discussed in a few words—the later au-
thors very completely—that in contrast to depressed and exalted
moods and their resulting judgments and conduct in normal
people, such moods may constitute the foundations of disease
when a slight cause has sufficed to bring about a long continued
action or increased activity, or when without external cause
they originate from within. Also in the anomalies of the will
in the mentally diseased the ancients clearly saw that the weak-
ness of the will, as well as the marked impulse to activity,
even to acts of violence, especially those dangerous to society,
were evidences of disease.
It is of interest to note that Aristotle remarks that not
only the violently maniacal but also the epileptic are dangerous
in this regard.
Suicide and refusal of food in the mentally diseased, and
their origin in most cases from melancholy have been much
discussed by the ancients. Even Hippocrates speaks of
the analgesias and hyperaesthesias of such patients. He
had also recognized the significance of hallucinations. He
himself has only referred shortly to these deceptions of hearing
and sight. Later authors have occupied themselves more in
detail with these manifestations. Nowhere do we find the
expressions "illusion and hallucination" in our authors' works,
the words phantoma and imago are in general use;nevertheless
Asclepiades clearly differentiated both ideas. Hallucinations,
in a narrow sense, alone seemed to him to be of central origin.
Further instruction is obtained neither from him nor from
other authors who have paid but little attention to them.
As to the causes which the ancients suggested for mental
disease and of such effects, which were not transcendental
but originated like any other disease, and as to the classifica-
tion of these afflictions, we shall return later.
So far as the pathological-anatomical knowledge of the
old physicians is concerned it is not surprising that they cannot
enrich our knowledge. It is known that in antiquity hardly
any dissection of human bodies took place (perhaps however
more often than is usually believed.) But how can we expect
any information from the ancients about the anatomical
processes in the normal or morbid activities of the mind, when


Notes on the History of Psychiatry.
37
even our present complete anatomical methods leave us in
doubt? Asclepiades first, and mostly all of those following
him, describe phrenitis as a disease of the membranes of the
brain, whereas in the remaining psychical illnesses the. brain
itself is attacked. How they supported their statement
does not appear in the text, and I have already tried to prove
that we are not permitted to consider phrenitis as a meningitis
alone.
Hippocrates also states that anemia of the brain can cause
mental disturbance. Though this statement concerns chiefly
acute processes, it is evident that it is not based upon obser-
vations made at the dissecting table, and though to him,
as well as to later physicians, the concomitant, sometimes
causative, affections of the abdominal organs were not unknown,
this coexistence must have been comprehended through ob-
servations on the living. And even if they do not mention
many complications seen in the living, we can draw no con-
clusions from that fact.
Regarding the prognosis of mental diseases the ancients
agreed upon the severity of the condition; the acute forms
(one must bear in mind that phrenitis represents the majority
of these) are always critical, though not always fatal, and
the fever and delirium accompanying the acute diseases share
in the prognosis of the fundamental disease. The chronic
psychoses are tedious at best, but even they may have a fatal
termination, as for instance during an attack of frenzy. The
frequent relapses were first pointed out by Celsus; Aretaeus
adds that the prospect of recovery diminishes with the number
of relapses.
64 W. 56th St., New York.
(To Be Continued.)


HALLUCINATIONS, THEIR STUDY AND SIGNIF-
ICANCE IN PSYCHIATRY. AS TAUGHT BY
PROF. TH. ZIEHEN, IN BERLIN*
Max A. Bahr, M. D.,
Clinical Psychiater, Central Indiana Hospital for the Insane.
AN hallucination is a sensory perception without an exter-
nal stimulus—for example, the hallucinant sees forms
in the clear and cloudless sky and hears noises in absolute
quietude.
In the discussion of hallucinations we must take into
consideration the following points:
I. The quality and the intensity of the hallucinations.
II. Feeling tone of the hallucinations.
III. Localization of hallucination.s
IV. Sources of origin.
V. Influence of the hallucinations upon the outflow of the
association of ideas.
VI. Theory of the seat and origin of the hallucinations.
VII. Diagnosis of hallucinations.
VIII. The occurrence of hallucinations.
I.
Quality and Intensity of the Hallucinations.
Hallucinations arise in all sensory areas and show defi-
nite characteristics within each of them.
Visual hallucinations or visions occur in the most
manifold forms. The simplest consist in the seeing of sparks,
lights, the appearance of flames, fogs and shadows. The most
complicated present, with all detail, entire landscapes and per-
sons. Sometimes the patients see themselves in the most
variable situations (so called autoscopic hallucination.)
At times, they are completely colorless, "shadow or silhouette
'Authorized permission for translation and publication.
(38)


Hallttcinations, Their Study and Significance. 39
like"as educated patients express themselves. At times, espec-
ially in alcoholics and epileptics, they show the most vivid
and glaring colors. The definiteness of the outlines also var-
ies much in different cases. At times they appear more flat,
as "paintings" or "pressed into the bed covering;" at
other times as plastic as the actual reality. The number of
objects hallucinatorily seen varies very much. At times the
whole field of vision is filled with a swarm of forms (animals)
especially in the alcoholic psychoses. In other cases, especi-
ally in the hysterical psychoses, a multitude of forms arises
exclusively in one half of the field of vision, usually directly
in that which corresponds to an hemianoptic defect. Still more
frequently the hallucinatory forms appear more isolated.
These individual hallucinatory forms have at times"giant size"
e. g., in the epileptic psychoses. In other cases the visions rep-
resent "miniature pictures." Most frequently they are of
natural size. At times they appear directly before the eyes
of the hallucinant, at times at the farthest distance. When
one of my patients held her hand in front of her eyes, the vis-
ionary forms appeared in the palm of the hand diminished in
size. The actual objects are at times completely concealed
by the visions; at others they appear "through the visionary
formations." "If the visions were false," said one educated
hallucinant to me, "they would have no shadows." In rare
cases one observes that the hallucination presents a redupli-
cation or multiplication of an actual object (hallucinatory or
illusionary diplopia and polyopia).
Auditory hallucinations or akoasms in their most
elementary forms consist of all kinds of rustling, hissing, ring-
ing, thundering, whispering, speaking, etc. The more com-
plicated akoasms consist of words. At times the hallucinant
hears them in their natural tone; at others high-pitched or
low-pitched. Frequently he differentiates, according to the
tone color of the voice, various persons speaking to him. He
also differentiates the voices of men, women and children. At
times he hears individual words—e. g., calls for help, at times
whole sentences, even speeches and conversations. At times,
the akoasms are shrill and loud, more frequently they are faint
and as the patient expresses himself, even '' almost inaudibly


40
Max A. Bahr.
faint." An educated patient told me for example—"The
voices are not even as loud as when a flame crackles, at most
as loud as the moving atmosphere of the room and yet sensor-
ially perceptible." If one requests the patient to imitate the
hallucinatory voices with his own voice, they not infrequently
explain that it is impossible for them,"the voices had an en-
tirely supernatural tone." In other cases the hallucinatory
voices resemble real voices in every detail, and enable the
hallucinant to imitate them with more or less accuracy. Oc-
casionaly, instead of spoken words, melodies without words,
and even whole orchestras are also heard. At times the ako-
asms are located in the far distance, at times the patient states
that the voice screams or whispers directly in the ear. Rare-
ly the patient expressly states that he hears the voices in'one
ear, but usually he hears them symmetrically throughout in
both ears. Frequently it happens that the voices appear
intermingled in striking contradiction; thus for instance, the
patient hears abusive and flattering words mtermingled, etc.
(contrary or antagonistic hallucinations).
Hallucinations of taste in the limited sense of the word
are very seldom isolated. Physiological psychology partic-
ularly teaches that only four qualities of taste exist: viz—bit-
ter, sweet, salty and sour, and that the so-called"taste"of
many eatables is due to the fact that in the posterior part of
the oral cavity, food particles evaporate, and so reach the
nasal cavity, where they induce perception of smell. In
psychopathology it is customary to include these perceptions
of smell which accompany perceptions of taste with the
taste perceptions in a broader sense. The close blending
which takes place between these perceptions of smell and
the special perceptions of taste, justifies the combi-
nation, and also explains that in cases of illness, the
corresponding hallucinations arise joined together. Such
hallucinations of taste in a broader sense are very frequent.
The patients state that they suddenly perceive a taste of
faeces, or blood, etc., in the mouth.
Isolated hallucinations of smell are quite frequent. Odors
of tar, sulphur, smoke, corpses, faeces, perspiration, cholro-


Hallucinations, Their Study and Significance.
41
form, and on the other hand, of roses and other flowers, appear
with more or less intensity.
Hallucinations of touch occur over the entire surface of
the skin (tactile hallucination). Frequently the tactile per-
ceptions are also located within the body (mucous membranes,
etc.). At times the patient receives a sudden blow or stab,
or a kiss or an invisible caress,at times he perceives over the
entire body-surface a net of spider webs, particles of glass in
the bed, or electrical currents, or the running about of invisi-
ble animals or"dwarfs." The multiplicity of these tactile hallu-
cinations is exceedingly great, and in no way exhausted by
this enumeration. A patient with persecutory delusions
perceived while out walking, as if an invisible person
preceded him and continually stepped upon the patient's toes
with his heels. The same patient frequently felt upon his
oral mucous membrane as if a viscid broth was being smeared
upon the same. One hears frequently that "the mouth is
full of hair," "the skin becomes raised in folds." Other
patients feel as if human bodies (especially of children and
persons of the opposite sex, often also animals) are
placed beside them in bed. "I am entirely embed-
ded in warm meat," • one hallucinant related to me.
Generally to the hallucinatory tactile perception an
hallucinatory heat and cold perception is also superadded.
The tactile hallucinations in the sexual field also claim a spec-
ial significance. It reaches here a complete cohabitation
hallucination, i. e.—there arise hallucinatorily all the numer-
ous tactile perceptions accompanying cohabitation, often in-
clusive of the accompanying tones of feeling. The super-
stitious beliefs of middle ages spoke of succubus and incubus in
such patients, in that they underwent an invisible cohab-
itation with the devil. All kinds of abuses of the genitals
are also perceived hallucinatorily.
Hallucinatory organ-perceptions are also closely related
to the tactile hallucinations. Insane patients often complain
of peculiar perceptions in this or that organ of the body, es-
pecially so of peculiar displacements, movements and trans-
formations of the viscera, without it being possible to show


42
Max A. Bohr.
by the most painstaking examination, any form of peripheral
source of irritation.
Kinaesthetic hallucinations are hallucinated perceptions
of movement. The perception of the passive and active
movement of our extremities is very composite, apparently it
originates predominately from the joint-sensibility. Like
every other perception, these perceptions of passive movement
can also arise hallucinatorily, i. e. —without any external
stimulus. Thus many patients declare that they suddenly
have a feeling as if their arms were raised, or their legs
stretched, etc. Farther on it will be mentioned what peculiar
influence these hallucinatory movement-perceptions have upon
the movements of such patients. At times such hallucina-
tions of movement also occur in the field of the muscles of
speech. By the contraction of the muscles of our lips, tongue,
palate and thyroid in speaking, the sensory nerve terminals
likewise are stimulated, and so produce perceptions of move-
ments, as with other movements. These speech-movement
perceptions are also occasionally hallucinated. The patient
then has the perception "as if he were speaking a definite
word."
The vestibular hallucinations are closely related to those just
mentioned. By the vestibular nerve, we perceive the posi-
tion of our head in space. Hallucinations also occur in this field
of perceptions; the patient feels as if he is suddenly lifted in
the air, turned toward the right or left, etc. "My head is
continually distorted, and because of it, I feel distinct diz-
ziness," complained a patient.
Combined Hallucinations.
Sometimes the existing hallucination confines itself to
one sensory area, often however, hallucinations associated
with several sensory areas unite to simulate a real object.
At times it happens that the visionary forms are speechless,
at most the lips move noiselessly, and the voices remain
indistinctly audible. About as often, however, visions and
akoasms combine, i. e.— the visionary form speaks audibly
to the patients, the voice "appears" to him. At times also
a tactile hallucination is superadded thereto; the patient


Hallucinations, Their Study and Significance.
43
feels that the form that is visible to his eye and speaking to
him also touches him. One of my patients said "The milk
tastes of phophorus, it shines extraordinarily." Just such com-
bined hallucinations are scarcely distinguishable by the patient
from the reality. Very frequently also, hallucinations of move-
ment associate themselves with other hallucinations, especially
with tactile; the patient not only feels as if his head is moved
involuntarily, but he also feels the touch of the hand which
carries out this imaginary movement in him. One patient
stated: "First it rings, then I feel as if I were carried upward."
In another, the voices first gave notice by a tickling sensation
in the back, and then the patient feels the tickling, and then
hears the voices whisper, "That is approaching consumption
of the spinal cord." The number of these combined hallucina-
tions is exceedingly great. Frequently in the course of a
psychosis, it can be observed how one sensory area after another
is gradually involved, in order to participate in the building
up of such combined hallucinations. For months the patient
feels, for example, at first only a dagger stab in a definite part
of the body, later he also sees the form bending over him in
a hostile manner and carrying out the dagger stab, and finally
he also hears the threatening words.
Finally it must be expressly emphasized that the specific
quality of the hallucinations, especially so far as they are of
limited sensory activity, at times is not sharply defined for the
patients themselves. Thus are explained the statements
of the patients as "I hear the voices more by the feeling than
by the ear. I feel something red burning about me. I hear
blue clouds trembling about me."
II.
Feeling Tone of the Hallucinations.
Like normal perceptions, hallucinatory perceptions also
have their tones of feeling; generally the tones of feeling of
hallucinations are especially strong. Hallucinations of in-
different content are relatively rare.
III.
Localization of Hallucinations.
In speaking of the quality of hallucinations, it has
already been mentioned that the hallucinatory perception


44
Max A. Bohr.
of the patient is localized at one time in the immediate locality,
and at others, at a greater distance from the patient. This
special projection takes place in general according to the same
rules as those of the normal perceptions. Accompanying
concepts of movement lie at their basis. Generally, when the
hallucinations begin to disappear in the course of an illness,
they not only tend to become less frequent and less in-
tense, but also recede to a further distance. In patients with
strabismus, the hallucinatory objects are sometimes seen
double. At times definite visionary forms appear, always in
a definite location of the field of vision. The same is also
observed at times in akoasms; thus. e. g. —a patient always
hears a friendly voice speaking in his right ear, a hostile one
in his left ear. If the hallucinant moves his eye, or turns his
head, the visionary object frequently follows this glance.
In patients with nystagmus, there occasionally occurs a con-
tinual to and fro swinging of the hallucinatory images. The
localization of auditory hallucinations is usually not influen-
ced by the turning of the head.
In many cases the hallucinations are also located within
the body itself. Thus, I knew a patient who claimed that
he had complicated visions (trees with faces of demons) within
his thoracic cavity, at times within his head. A patient stated
definitely that he also often sees visionary images behind him.
Much more frequently does this occur with auditory hallucina-
tions. The patient often hears the voice speaking in his head,
or in his thoracic cavity, or in his abdomen.at times the patient
even locates his akoasms in individual fingers. A patient of
Siemens heard two men chattering in his left eye. Sometimes
other stimuli, and concepts associated with them, are also
determining for the localization of the hallucinations. Thus,
the auditory hallucinant is readily induced to locate the voices
in the chimney, or ventilation openings, etc. This localiza-
tion is generally a secondary one. In the beginning the
localization of such akoasms has been an entirely different
or indefinite one; but since the hallucinant does not see the
speaker, yet distinctly hears him, he forms the concept that
the same is concealed, for example—within the ventilation
shaft. This concept then determines the localization of all


Hallucinations, Their Study and Significance. 45
succeeding akoasms. Sensorial stimuli occasionally can also
be directly determining for the localization of the akoasms;
thus it happens that the patient heard the voice in that part
of the body which is the seat < of neuralgia or other pains.
IV.
Sources of Origin.
If the visual hallucinant closes his eyes, one frequently
finds that the visions disappear for a shorter or longer period
of time. On the contrary, there are patients in whom the
closure of the eyes is the necessary essential for the appearance
of visions. Likewise, the closure of the ears in one hallucinant
exercises an increasing influence upon the akoasms, in another,
a decreasing one. In many cases the shutting off of external
stimuli is generally without influence. With this is also con-
nected the further observation, that many auditory-hallu-
cinants, in the stillness of the night or in seclusion, hallucinate
particularly actively while others must hear faint actual
noises so that akoasms appear along with these. Likewise
visions arise in one patient predominately in the objectless
field of vision (in the dark or in the empty heaven,) in another
patient predominately amidst numerous actual objects.
The simultaneous influence of actual stimuli in other
sensory areas often weakens the hallucination momentarily.
Thus a sudden noise, a vision, and an interesting picture can
momentarily displace an akoasm. On this account many
patients who wish to listen to their voices, close their eyes,
or hide themselves under covers or in a corner. It is much less
frequent, on the contrary, that an actual stimulus in
another sensory area is necessary in order to call forth the
hallucination. Thus, a patient, when she saw a knife or a
pair of scissors, regularly and exclusively, had the tactile
hallucination that her fingers were being cut. The tactile-
deception was so active in her that she senselessly attacked
the person who held the scissors or knife in his hand. The
consciousness that she was dealing with a delusion was entirely
wanting. Another of my patients, as soon as she saw a brooch
on a waitress, felt "immediately a hook in her mouth." These
hallucinations differ from the secondary sensory-perception in
that another concept e. g., in the cases related, the concept


46
Max A. Bahr.
of the cutting, is inserted between the normal primary-perception
and the hallucination.
Bodily movement, in individual cases, intensifies the
hallucinations. In others they are most prominent in the
morning after awaking. It is also very interesting that the
movements of mastication intensify the akoasms, and that,
on the other hand, by the pressing together of the teeth, the
voices occasionally abate.
The so-called attention in many cases also has great
influence upon the occurrence of the hallucinations. Many
patients hear voices as soon as they listen, either as the physi-
cian requests it, or as they themselves wish to ascertain
something of the voices. Others see forms as soon as they fix
their gaze upon a definite point in space. Here the attention
of the accommodation-apparatus of the ear and eye, and the
constellation of the concepts induce the sensory deception.
It is on this account that many patients can hallucinate
"voluntarily" as one chooses to call it. In many cases the
voices become louder by actual noises. Individual patients
relate that the voices come nearer so soon as they listen.
Finally the question, as to how far the hallucinations
correspond to the momentary concept-content of the patient
is of greater diagnostic and prognostic value. No hallucination
of the patient is a complete new creation. Patients only
hallucinate what they have formerly perceived, and
what already exists in the form of memory-pictures or concepts,
in their brain cortex. Certainly it often enough happens
that the patient sees faces that are entirely unfamiliar to him and
hears combinations of syllables that never before occurred to
him, and whose meaning is puzzling to him but also in
these cases, the hallucination is not a complete new creation,
he has only created new combinations of partial memory-
pictures of former perceptions. The capability of combining,
by which we form new complex concepts out of the remnants
of memory-pictures, we designate in healthy persons as phantasy.
In the healthy, the phantasy is not sensorially active; our
phantasy concepts just remain concepts. In the hallucinant
they attain a sensorial activity, or in other words, they become
perceptions. Just as the phantasy concepts in the healthy


Hallucinations, Their Study and Significance. 47
are not new creations, but only new combinations of old memory-
pictures, so also the hallucinations, in spite of their occasional
strangeness of character in the latter role, are traceable di-
rectly to the memory-pictures of actual perceptions. Upon
this also depends the fact that visions never arise in those
born blind, and akoasms never arise in those born deaf, while
acquired blindness and deafness in no way excludes hallucination.
Our brain contains countless concepts or memory-pictures.
The most of these are latent, i. e., for the time being exist
only as material traces without psychical parallel-processes
in the brain cortex, and only a few are momentarily actually
existing, namely—those of which I directly think at the moment,
as we popularly express it. The hallucinations may therefore
be classified with advantage into those which correspond in
content to the momentary consciousness content at the time
being, that is to actual concepts, and those which have no
relation with the momentary consciousness content but rather
envolve from latent memory-pictures, in part half forgotten,
whether they are in old or new combinations. The former
are designated as immediate or accompanying hallucinations,
the latter as mediate. The immediate hallucinations are
usually less active sensorially, especially less defined in color
and sharpness, in loudness and distinctness than the mediate.
Corresponding to the constant change of the content of
consciouness, they are very changeable, while the mediate
hallucinations are often characterized by great stability.
In immediate visions the patient readily declares "that all
his thoughts are directly arranged into scenes" the immediate
akoasms he often designates directly as a"repetition," a "pro-
nunciation," a "hearing," or "audibility" of his thoughts.
At times, the patients also speak of parallell sounds. If the
patient reads, especially if he reads softly, then a chorus of
voices speaks everything aloud to him. In writing, the words
are "foretold" him. Just these immediate akoasms are es-
pecially frequently located within his own body, especially
within his own head, in the manner above stated. The tone-
color of the akoasms is, in these cases, generally very indistinct,
at times it corresponds to that of the voice of the patient, less
frequently it corresponds to a strange voice.


48
Max A. Bohr.
Often the immediate hallucinations do not represent a
simple repetition of the momentary concepts of the patient,
but they only stand in unmistakable relationship to the latter.
This holds good especially for the akoasms. The voices make
marginal comments to the thoughts of the patient. One
patient compared them directly with the chorus of a Grecian
tragedy. In many cases it comes to a complete play of ques-
tions and answers between the patient and his voices. The
patient is sometimes surprised at the appropriateness
of the hallucinated remarks. Thus I knew a patient who
regularly studied Italian; when he repeated words to him-
self, it sometimes happened that he did not know a word or
pronounced it incorrectly, and then the voices pronounced it
correctly for him.
In patients with immediate hallucinations, new hallu-
cinations can also frequently be called forth by suggestion
(without hypnosis) or influence in content—previous hallucina-
tions. It suffices at times that a definite object is shown or named
to such patients, and so calls forth the concept corresponding
to the object; the concept incited by suggestion immediate-
ly induces hallucinations, which stand in relationship to the
corresponding object. To this belongs also the so-called
"voluntary" production of a definite hallucination by active
thinking of the corresponding concept.
If it deals with patients with delusional-concepts, then
some immediate hallucinations are found with special preference
in the sense of this delusional-concept.
The mediate hallucinations are frequently surprising
to the patient himself. The remotest memory-pictures of
early childhood may suddenly induce an hallucination. The
infrequency of the combination of partial memory-pictures
to apparent new creations surprises the patient, sometimes
directly in regard to his wealth of unthought-of phantasy.
Furthermore, in many patients there occur both mediate
and immediate hallucinations at the same time. There also
exist graded transitions between the two conditions.


Hallucinations, Their Study and Significance. 49
V.
Influence of Hallucinations Upon the Outflow of the
Association of Ideas.
The most important question here is, whether the hallu-
cination is attributed to reality or not, by the hallucinant.
From this standpoint, there are three varieties to differentiate:
1. The hallucinant accepts an external stimulus
for his hallucination just as if it were a normal per-
ception.
2. The hallucinant differentiates his hallucina-
tions indeed from the usual perceptions produced by
external stimuli, but yet attributes to them particular
significance and is influenced by them in his con-
clusions and actions. The hallucinant willingly inter-
prets the hallucination in this case as a divine revela-
tion.
3. The hallucinant is conscious of the subjective
origin of his hallucinations, and indeed then generally
correctly recognizes in them the product of a patho-
logically excited phantasy; sometimes, at any rate, he
traces this excitation to poisonings or other influences
on the part of imaginary enemies.
The conditions presented under subdivisions 1 and 2,
are most frequent in hallucinations which arise simulta-
neously in several sensory areas. If the hallucinations confine
themselves to a single sensory area, then whether the hallu-
cinant succumbs to the delusion or not, depends upon their
intensity, their frequency and their relationship to the actual
concepts, and especially to the mental condition otherwise.
If the hallucinations exist for years, even in the limitation
to one sensory area, then it is the rule that the patient finally
ceases to doubt, and believes in the reality of his hallucinations.
Hallucinations and also illusions, which force themselves
repeatedly upon the patients in a compulsory manner and are
accompanied by consciousness of disease, are designated as
compulsory perceptions. Thus, some patients again and
again see a pointed object approaching them, etc. Thus,
otherwise infrequent compulsory percepts generally originate


50
Max A. Bohr.
from compulsory concepts. Generally their sensory activity
is not marked.
If the hallucinant is convinced of the reality of his hallu-
cinations, then the influence of the latter upon his thinking
and acting is almost an overpowering one. For example the
hallucinant believes and obeys, etc., a voice which forbids him
to eat, if he regards it as real, more than he does the demand
of hunger and of the physician, who requests him to eat. This
has been observed in thousands of cases. The hallucination
shows itself more powerful than all normal perceptions and
reasonable considerations and persuasions. The hallucinations
arise out of the imaginative life, and the association of ideas
does not, as a rule, deny their own offspring. Thus it is also
explained, that the patients often complain directly of a com-
pulsion to yield and ^iswer to the demands of the voices.
The influence of the hallucinations upon the further over-
flow of the concepts in formal relationship is very variable.
At times the hallucinations act inhibitorily, at others, ac-
celeratively upon the same. In the former case we speak
of secondary hallucinatory flight of ideas. In uniform,
frightful, or religious-ecstatic hallucinations, inhibition general
predominates, while numerous exalted hallucinations in general
often lead to flight of ideas. Still it is often difficult in the
individual case, to ascertain why the pre-existing hallucina-
tions just produce inhibition, or in another case, just produce
acceleration of the outflow of concepts. If the hallucinations
become much more increased, and at the same time dispense
with the connections between them, then they also act disturb-
ingly upon the connection of the concept outflow, and produce
a complete confusion of the association of ideas, which es-
pecially manifests itself in confused speech, and is known as
secondary hallucinatory incoherence. The patient is no more
in the condition to join together into an arranged concept-
series, the numerous disconnected concepts which the massive
and scattered hallucinations incite. Combined with this
hallucinatory incoherence, as a rule, there is also a secondary
disorientation, i. e., produced by hallucinations. The hallu-
cinatory appearance of persons living at a distance, and of
distinct landscapes, disturbs the orientation as to time and


Hallucinations, Their Study and Significance. 51
place; the patient believes he lives in another time and at
another locality.
Finally hallucinations frequently cause direct disturbances
in the content of the thoughts, i. e., delusional ideas. A voice,
for example, calls directly to the patient, "You are Christ,"
and immediately the patient is firmly convinced of his becoming
the Messiah; through his hallucinations he has acquired a
grandiose idea. Upon the basis of indefinite foreign hallu-
cinatory perceptions in his arm, the patient asserts that,
"someone has introduced a foreign body into his arm." If
his thoughts become audible then the patient states, for example,
"that they make use of special physical apparatus for the
purpose of ascertaining his thoughts, or that they prompt
him in all his thoughts," etc.
Similarly the actions of the hallucinant will shape them-
selves with endless variations according to the content of
the hallucination. At first the hallucination pictures itself
in the facial expression of the patient. The strained attention
and sudden listening betrays, for example, the presence of
akoasms. The visual hallucinant generally stares into vacancy,
his gaze wanders hither and thither, without any noticeable
object moving. One often also observes characteristic move-
ments of defense by which the hallucinant seeks to avoid
disagreeable hallucinations. The visionary hallucinant closes
or conceals himself under the covering, or sticks cotton into
his ears, and into the key-holes. The taste hallucinant ex-
pectorates, or does not touch the food placed before him.
The olfactory hallucinant holds his nose closed, or suddenly
breaks the window in order to free himself of the hallucinatory
vapor or smoke by fresh air. If the patient refuses information,
then one can frequently learn to intrepret correctly their move-
ments of defense only after the recovery of the patient. Thus,
I knew a patient who continually carried out the most peculiar
rotary movements of his head. During the course of the
disease, any information in regard to the motive of this move-
ment was not obtainable. During recovery the patient said
that he continually saw a gallows before him, and felt a rope
around his neck, and endeavored to draw his head out of
the loop by these movements of the head.


52
Max A. Bohr.
Of special significance is also the influence of the hallucina-
tory perceptions of movement upon the movements of the pa-
tients. A hallucinatory movement-perception may act in a
double manner; either the hallucinant endeavors to counter-act
the supposed hallucinated movement by an antagonistic, or, as
one might say, a compensatory movement, or the hallucinated
perception of movement induces him to actually carry out
the supposed hallucinatory movement. If the patient, for
example, has the hallucination that his head is being suddenly
turned to the right, he will endeavor either to compensate
the supposed turning to the right by an energetic, continuous,
or also frequently repeated spasmodic turning of the head
to the left; or the hallucinated perception of the movement
will, on the contrary, directly cause a turning to the right of
the head. Why, in the one case, this, and in the other case,
that motor re-action takes place can often not be determined.
These peculiar movements are also designated "hallucinatory
re-action movements." "Hallucinatory compulsory speaking"
presents a special instance of this; here the above mentioned
hallucinated perceptions of movements in the field of the speech
musculature, induce the patient to the pronunciation of the
word, whose incident muscular contractions the patient
believes he perceived. In either case, the patient endeavors
by definite positions, to counteract the hallucinated movements.
Such positions are designated as "hallucinatory-compulsory-
positions." Since the hallucinations which induce such com-
pulsory-movements and compulsory positions often recur
for hours and days in a similar manner, such patients
often repeat the same compulsory-movements stereo-typically
for hours and days, and remain continuously in certain stereotyped
compulsory-positions.
It is to be remembered that quite analogous movements
may arise upon the basis of primary excitations of the motor
region even without kinaesthetic hallucinations. The pa-
tients then speak words, or carry out other movements which
they themselves consider as compulsory or inspired. Thus
a paranoiac said to me, "On Ascension Day, God gave me a
wink that he wished me to sit to his right; he did not say
it, but he let it be explained to me and I had the feeling."


Hallucinations, Their Study and Significance 53
Apart from the movements of attention and defense
hitherto considered, the hallucinations also induce numerous
complicated actions. Of most influence from this standpoint
are the so-called "Imperative hallucinations," i. e.—voices
ordering the patients to do this or that action. One person kneels
at the command of the voice, another sets fire to the house,
a third mutilates himself, etc. Some patients themselves
state that they carry out this or that action at the command
of the voices, but only become conscious later that they have
obeyed the voices thereby. In other cases the hallucinations
exercise a motor inhibition. Thus, for example, patients
remain motionless for weeks lying upon the back, because a
voice threatened them with death as soon as they would move.
I knew a patient who stood motionless in one spot during
the whole day for more than a month, the saliva dribbled
from the opened angles of her mouth, the urine and faeces
were voided involuntarily. Later it was ascertained that
she saw abysses, immediately at her feet, and for that reason
did not move from that spot. Besides frightful visions, visions
of splendor, (especially of religious content) may also occasion-
ally lead to motor inhibition. Thus patients are observed,
who see heaven open, God surrounded by his angels, and Christ
on the Cross and, absorbed in this spectacle for days, do not
move a limb. Such hallucinations are designated as "fascinating
hallucinations." If the hallucinations are numerous, very
changeable, and accompanied by strong, especially positive
tones of feeling, then the accelerating influence upon the motor
inervation generally predominates; there arises the so-called
hallucinatory agitation which frequently increases to pronounced
delirium.
VI.
Theory of the Seat and Origin of the Hallucinations.
Physiological psychology teaches that material parallel
processes exist for all perceptions in the brain cortex, for
visual perceptions in the visual area of the occipital lobes,
for auditory-perceptions in the auditory area of the temporal
lobes, etc. We must therefore assume that pathological
perceptions in hallucinations also have their seat there,
the visions in the visual area, the akoasms in the auditory


64
Max A. Bahr.
area, etc. All hallucinations, as regards the localization,
are also cortical. Another question is, where do the hallucina-
tory excitations arise? In former explanations it was indi-
cated, that the hallucinations take their origin, in the first
place, from our memory-pictures or concepts. For the purpose
of illustration, we will make use of the following hypothetical
scheme:
P C
S o o
Normally, a stimulus 'S' produces 'P', an excitation in the
cortical perception-cells-complex, which corresponds to the
perceptions in hallucinations also have their seat there, and
besides this leaves a permanent alteration in the memory-
cells-complex, which under certain conditions corresponds
to the memory-picture of the perception or the concept. Nor-
mally the excitation always takes the course SPC. In
hallucinations this course is reversed. The memory-picture
deposited in 'C, the concept, promotes 'P' in co-excitation,
and produces there the related perception, i. e., an hallu-
cination, because an 'S' is wanting. The memory-
picture in 'C is at times a latent one, at others, an actual one,
i. e., at times the hallucination lies at the base of a concept,
which at the time being does not exist in our consciousness,
content, at times, a concept, of which we are actually think-
ing at the time. We have already differentiated accordingly
immediate and mediate hallucinations. By the observation
of our figure, one can 1 peak directly of the abnormal centrif-
ugal course of the excitation from the memory-cells to the
perception cells. Herein lies the essential pathological course
of every hallucination. In many hallucinations, however,
there yet arises a second factor. It is often possible to show
that 'S', a stimulus acting upon the perception-cells, is not
entirely wanting. Thus it appears, for example, in the visions
of alcoholics, who see bees flying all about them, that the 'S'
is at first entirely wanting. An external stimulus, in the
ordinary sense, as a matter of fact is also wanting, although
more accurate investigation teaches that stimuli are indeed
present in the path from the sensory organ to the brain cortex.
Such stimuli are especially found quite frequently in the sensory


Hallucinations. Their Study and Significance.
55
organ itself; here belong, e. g. the opacities of the vitrious
of the eye, and chronic inflammatory processes in the middle
ear. Such entopic and entotic stimuli are perceived as such
outside of the psychoses, i. e. the opacities of the vitrious
as"muscae vohtantes" the irritative processes in the middle ear,
according to the law of the specific energy, as simple subject-
ive rustling, buzzing, ringing, etc. As soon as a psychosis
breaks out, these "muscae volitantes'' become bees buzzing about,
the simple noises become hallucinatory words. A patient
who for many years previous to the onset of his psychosis
had suffered from a humming in the ears due to a chronic
catarrhal otitis media, related very characteristically, "the
voices repeat every thought with tenfold strength; the ring-
ing in the ears had become impure by the hearing of these voices.''
The proof that in many cases such entopic and entitic stimuli
lie at the basis of the hallucinations is based upon the fact
that in the course of the disease one is able to follow the gradual
transition of the simple subjective noises into voices, etc.;
and later, during the decline of the illness, the retrogression
of the voices into noises. There are also infrequent cases
known in which the removal of catarrhal otitis media (excep-
tionally also a plug of cerumen) had caused the disappear-
ance of the hallucinations. Finally, the unilateral hallucinations
which one occasionally observes, are similarly explained,
in that it deals here with patients who hear their voices only
in one ear and see their visions only in one eye; a close in-
vestigation generally suffices to reveal peripheral diseases
in the ear or eye, which are the seat of the hallucinations.
It has also been possible to demonstrate a similar condition
in all other sensory areas. At times the source of irritation
is not in the sensory-organ, but is to be sought for within
the nerve tract. Thus, atrophy of the optic, auditory and
olfactory nerves, excluding hallucinations distantly located,
directly furnish the necessary stimulus material for the origin
of hallucinations. The same has also been observed in multiple
neuritis. Flechsig found in an auditory hallucinant concre-
tions in the posterior corpora quadrigemina which were infil-
trated into the auditory path, etc.
The more one accustoms himself to examine closely the


66
Max A. Bahr.
peripheral sense organs in every hallucinant, the oftener he
will discover a peripheral source of irritation for the hallu-
cinations. If one strictly adheres to the definition of an hallu-
cination given at the beginning, in which an entire absence
of every stimulus is required, then evidently all the cases
just considered, in as much as a stimulus is demonstrated
in them, would be classed with illusions. For practical
reasons this is not done. If we wish to adhere strictly to the
definition, then on account of the difficulty of demonstrating
a disease of the peripheral sense organs in the insane, one would
be compelled in very many cases to leave in suspense the de-
cision, whether the sympton is an hallucination or an illusion,
and renounce every indication to include all the above cases un-
der hallucinations and accordingly in the definition of hallucin-
ation, only to require the absence of external stimuli. In the
future presentations the word hallucination shall always be used
in this broader sense. It must be borne in mind, however, that
a large part of hallucinations in this broader sense are fed
by stimuli situated within the superficial surface of the body.
By reference to the above given scheme, thismayalso beexpressed
in the following way: In every hallucination, a morbid
excitation-process in the memory cells stimulates the perception
cells and so generates the hallucination; in many cases this
centrifugal excitation of the perception cells is facilitated if the
latter are already found in an abnormal excitable condition,
as by centripetal stimuli (entopic and entotic.)
VII.
Diagnosis of Hallucinations.
The most frequent occasion for the physician to presume
an hallucination in a patient is that a patient reports a sensory
perception for which in all probability every external stimulus
has been wanting. This presumption, however, always requires
a more accurate examination. An hallucination may be erron-
eously presumed, especially in consequence of the following
mistakes:
1. For actual perceptions; the abusive words which
the patient says he has heard, the blow which he says
he has felt, has actually occurred.


Hallucinations, Their Study and Significance.
57
2. For dreams; the patient sometimes mistakes
the experiences of sleep for those of the waking con-
dition.
3. For illusions; it has actually been spoken,
a stimulus was present, but the patient heard the
words differently than they were spoken, he trans-
formed T\
4. For so-called delusional-explanations; the
patient has perceived correctly an actual pre-existing
'S', i. e. without transformation, but has joined entire-
ly false concepts to this normal perception.
5. For active phantasy-concepts; such patho-
logically active phantasy-concepts; and therefore
closely approaching the hallucinations, are designated
as phantasms. They differ from the hallucinations
by their more limited sensory activity, from the de-
lusional concepts in that they deal with an experience
in which the judgment entirely recedes.
Of the dangers of these various mistakes, the following
case offers an illustration: a patient informed the physician
that she heard her children scream the previous night.
It would be entirely wrong to presume directly from this ex-
pression an hallucination. One will first best assure himself
that the children of the woman adjoining did not actually cry.
We take it for granted that this is to be excluded. Then one
will determine if the patient, at the time at which she was
supposed to hear the voices, did not perhaps sleep, and reported
to the physician as a perception while awake what she actually
dreamed. If also this is to be excluded, then one must de-
cide whether at the time in question, there was not perhaps
some other noise present (e. g. an 'S') which the patient had
perceived in an erroneous manner as the cry of her children—
(an illusion.) Finally, the possibility is to be borne in mind
that the actual cries of children had been heard in the night,
that the perception of the patient entirely corresponded to
the external stimulus, and that the patient only interpreted
erroneously the cries as that of her children who were actually
absent (delusional explanation.) Only when all these possi-
bilities have been excluded by examination of the relatives


58
Max A. Bohr.
and attendants, and questioning of the patients themselves,
is one justified in accepting an hallucination. Especially
in the noisy life of an institution one must be cautious in a
hasty acceptance of hallucinations.
Equally as great, if not greater, is the danger, on the other
hand, of overlooking hallucinations. In this respect it is
especially to be considered that many hallucinatory insane
dissimulate, i. e. in the consciousness that the hallucinations
are a diseased condition, or, more frequently, in the conscious-
ness that the hallucinations may be taken for a diseased condi-
tion, deny that they hallucinate. In such cases the physician
is dependent for his conclusion upon the facial expression
and the actions of the patient. These same difficulties exist
in patients who are so confused that they can give no clear
information of their inner processes. In patients suspected
of dissimulation it is often of assistance to request the patient
to write letters and cause inquiry to be made from fellow patients
of casual utterances. Dissimulators often entrust their hallu-
cinations preferably to paper and to other patients rather
than to the physician and to the attendants.
VIII.
The Occurrence of Hallucinations.
In the mentally healthy, i. e., without any other psycho-
pathic symptoms, hallucinations very rarely occur. Generally,
the hallucination is to be looked upon as a partial manifestation
of a psychosis, and even in the rare cases where other psychical
manifestations of disease are wanting, it is always to be looked
upon as pathological. Those instances of men in history
cited as having hallucinations, were mostly cases of illusion.
If we deduct all cases like these as not belonging here, then only
one case remains in which hallucinations occasionally arise as
the only disease symptom; this is the appearance of hallu-
cinations in Individuals psychopathically tainted, but not other-
wise psychopathic, after bodily or mental over-exertion, as well
as in severe emotions. Especially in childhood, unquestionable
hallucinations without any other manifestations of disease can
now and then be observed under such conditions.
These are the so-called hypnagogic hallucinations, which
rather frequently arise even in the healthy by closing theeyes.es-


Hallucinations, Their Study and Significance.
59
pecially before going to sleep, when by a particular position,
they usually deal with vanishing colorless faces, less frequently
entire figures and landscapes. The so-called auto-illumination
of the retina, without doubt, plays a part in the development
of these.
With much greater frequency the hallucinations combine
with other psychopathic manifestations, and indeed they are
quite definite etiological factors, which, independently of the
pronounced psychosis, bring to a focus hallucinations and
other psychopathic symptoms.
The most important of these are the following:
1. The intoxications and indeed especially, but
not exclusively, the acute intoxications. Thus it is
known that opium, belladonna, datura, hyoscyamus,
hashish, and other alkaloids, particularly frequently,
cause hallucinations, especially in psychopathic en-
dowed individuals. In these cases disturbances
of the association of ideas are regularly found.
Alcohol, especially in chronic misuse, leads to hallu-
cinations and indeed, at times, to isolated ones, at
times to massive and persistent ones, e. g. by the
sudden withdrawal of the customary quantity of al-
cohol.
2. Febrile conditions. Even in these a psycho-
pathic endowment generally appears as a predispos-
ing factor. In many cases the factor generating
the hallucinations (the so-called fever delirium) ap-
pears to be less the temperature elevation itself than
the infective poisoning. At least, these fever deliriums
are by far the most frequent in febrile infectious
diseases.
3. Disturbances of nutrition, as they occur in
severe hemorrhage (e. g. childbirth), in inanition, etc.
Such cachectic hallucinations are also observed espec-
ially after febrile diseases as secondary manifestations
of the disturbances of nutrition brought about by long-
continued fever (empyema, tuberculosis, etc.)
4. Caloric injuries (insolation, etc.)
5. Some neuroses; hysteria, chorea and especially


60
Max A. Bahr.
epilepsy. In the latter one often finds hallucinations
as an aura, i. e. an hallucination immediately pre-
ceding a convulsion. The epileptic hallucinations
are generally characterized by frightful or religious
content, and by great activity (variegated forms and
loud voices.) If hallucinations occur in epileptics, and
especially hysterics during a prolonged period of
time, one occasionally observes that the consecutive
hallucinations exhibit a moderately-connected hallu-
cinatory experience after the manner of a dream.
If these etiological factors are excluded, and only patho-
logical pictures of the psychosis is followed, then it is shown
that many psychoses include hallucinations amongst their
principal symptoms, especially so in the so-called halluci-
natory forms or paranoia, while other psychoses, as mania and
melancholia, only exceptionally manifest hallucinations.
Finally, there are psychoses, such as dementia paralytica
and dementia senilis, which very frequently show hallucina-
tions without one being able to designate these as a character-
istic symptom of the psychosis. Acute and chronic psychoses
manifest hallucinations quite uniformly, but visions generally
tend to be more frequent in the acute psychoses than in the
chronic forms.


BRAIN MENACE TO MAN AND NATION OF ALCOHOLIC
AND OTHER NARCOTIC NEUROPSYCHOPATHY.
By Professor Chas. H. Hughes, M. D.
Editor Alienist and Neurologist, Former Supt. Mo. State
Hospital for Insane No. 1. Member American and
Honorary Member British Medico-Psycho-
logical Association, etc., etc.
MAN in his brain and mind is much dependent upon what
he feeds upon, plus inheritance and environment.
An habitually alcoholized blood starves and taints the
brain cells and allied nervous system as do other toxic drugs.
This and the food he eats and drinks and the environing
atmosphere, whether rich or poor in blood purifying and brain
rebuilding and enriching power, combined with congenital
endowment, to resist or yield, make or unmake the brains which
the world needs to use in its service now or which it should,
from an eugenic standpoint eliminate from the field of action.
Our time needs men, rightly endowed, men with stable, non-
poisoned brains.
If we would move the world aright, psychically speaking,
our mental Archimedean levers should be free from alcoholic
deterioration and other drug addiction consequences. Psychic
brain cells, bathed in toxined blood do not give such safety
and logical surety to the movements of the intimately related
mind as the clear and normally nutritiously potent blood stream
does or may and alcoholic drinks, viewed with true chemically
illumined vision, are poisons of the brain and perverters of mental
action. Hence this matter becomes a subject of supreme im-
portance in the study of patriotic eugenics wherein the race, as
well as individuals, rises or falls through right or wrong care
of the brain of man.
Alcoholics should, from the standpoint of the scientific
proof of their nerve center poisoning power, be classed with
(61)


62
C. H. Hughes.
other poisons and their use as beverages should be discoun-
tenanced and discarded.
A neuropath is one whose nervous system has become
shattered and unstable. His nervous system is out of order.
He has become deranged and damaged in power. He is no
longer normal in ordinary action and often markedly abnormal
under stress of unusual demand.
Our honored and esteemed honorary President has justly
eulogized one of the greatest of America's and the world's med-
ical men, who placed alcoholism among the diseases as well as
among the vices of the mind at a time when it was regarded
only as a vice and who plead for its medical recognition and
treatment and hospital care as an insanity of the mind. True,
the gross effects of alcoholics, as in the causing of delirium
tremens and mania a potu, had been recognized before
Benjamin Rush described the insanity of alcoholic drinkers,
terming it oinomania, but the insidious undennining of mental
stability, the neuritides it engenders and other toxic nerve
center and peripheral nervous states have become better known
to the medical world since the immortal Rush made his great
contribution to the cerebro-psychic pathology of insanity,
more than a hundred years ago.
Added to the popularly known and oft proclaimed perils
of the still and the vat in moral, mental and physical wreckages
(but too little considered by the alcoholically bibulous) medi-
cal men have had testimony from laboratory, hospital and fatal
family pathologic lineage and sequence testimony against
alcohol as an unsafe drink forceful for harm beyond former
estimate, as in sudden heart failure, etc., where nature may be
spurred to resistance and the calling forth of her latent organic
powers to collapse against the further tolerance of alcoholics
as a beverage and as a remedy save in exceptional exigencies of
transitory demand. The warnings of the Goughs and Dowsand
their later platform emulators in eloquent warning cry of danger,
are much accentuated in medico-pathological revelation with
potent evidence and conviction, of the insidious undermining of
vitality of this poison of the brain neurones and the viscera.
We pass the epilepsias, idiocies, imbecilities, insanities,
the gross paralyses, apoplexies and sensibly perceptible brain


Brain Menace to Man and Nation.
63
and viscera damaged states, so well known to the profession
as either direct or indirect results of alcoholic toxemia and the
contributory damage of alcohol to the brain as in sunstroke,
to briefly note in passing and in conclusion the insidious
harmful influences of alcoholic intoxication on the central
neurones, none the less hurtful to the human organism, that
further and completely confirm our conviction that alcoholics,
even in their so called mildest forms of dilution, as in wines,
beers and ales or in the seductive julep, diluted cocktail
and other mixed drinks. These are not fit for the family table,
the festal board, the social club, open public bar or in the bottled
bitters or no less perilous highly alcoholized patent medicines
of the sideboard, designed often for clandestine catering to
the alcoholic appetite or to develop the same.
Long before we knew its intimate nature, as chemists
know it to-day the Arabian tongue supplied the world with
the term "al-koh'l" out of which we formed the similarly
sounding word alcohol and subtile was its meaning and Soloman
warned against it and its ultimate effects upon the human organ-
ism as a stinging "mocker" for "in the last it biteth like a
serpent" the wise man said.
Since that wise warning thousands of years have passed,
yet the scars of the chemical bites of alcohol on the human
organism to maim and blast it in mind and body are inflicted
still and in the last worse than the sting of an adder.
If we look at the vaso-motor changes, its poisoned mark
is there in the oppressed and damaged neurone morpholog-
ically altered in tone so that it gives us the damaged sequences
of hyperemia and psychic, aural, visual, tactile, gustatory,
general anesthesia, psycho motor change, asteriognosis, space
and distance hallucinations, which fortunately usually, pass
off with the exit of the poison through nature's kindly acting
vis medicatrix, if the poison be not directly fatal and sub-
sequent adequate aqueous and nutritional replenishing of the
blood and the subsequent prolongued rest, which nature de-
mands for the repair of man's potation mistake or folly here,
provided the ebriation is not prolonged by more alcoholic
drink or too soon or often repeated.


64
C. H. Hughes
What is this vaso-motor system about which we knew so
little before Claude Bernard, Marshall Hall, Brown-Sequard,
Golgi and the European physiologists generally of recent years
and our own Seguin, Sajous, Ott and others let in the light
from the laboratory on the intimate structure and work of
the marvellous nervous system of our bodies and what does
this nervous system do for us, against us and with us, in its
relation to alcoholic toxemia? Why first, it dehydrates
the normal neuron of its sustaining capillary and serum supply
as it does the tissues of the body. As the drunkard must have
immense quantities of water after a debauch to replenish
his serum robbed and parched blood and tissues, so the vaso-
motor nerve center cells feel and display, in impaired function,
the effect of the alcoholic mixture in the blood and serum
whose function is to nourish. An enemy invades the blood
and the confused and startled organism resists in disordered
action. These central neurones of the vaso-motor system feel
and show the alcoholic damage in paresis of function and dam-
age by vaso dilation. Paradoxical as it may appear this
gives us in the brain of the excessively and persistently alcohol-
ized, the dilation of the blood vessels permitting the so-called,
but misnamed, serious alcoholic meningitis.
Just here is the explanation of the drink thirst recurrence,
the drink habit of the inebriate, periodic and habitual, which
is more pathophysiological^ and logically explanable than the
usual and time honored one of hereditary acquisition or trans-
mission and the disposition of the habitual alcoholic inebriate
to be dissatisfied with the substitution of soft drinks for his
craving, when he is without alcohol in his blood to impress
his brain neurones, especially in the gray cortex area, with the
capillary supporting function-en toning distention, to which,
under alcoholic vaso-motor dilation, they have been before
habituated and there may be also something in the mere lack
of alcoholic impression to which the cells of the psychic cortex
have become accustomed. The neurones of the cortex, like the
viscera of a dropsical patient, who must be bandaged under
paracentesis abdominis, miss the supporting pressure of alcohol-
ically distended vessels to which drink has accustomed them


Brain Menace to Man and Nation.
65
through vaso-motor dilation and then feels the craving for his
usual evening night cap and morning eye opener.
But whether my conception of the cause of this recurring
phenomenon in the drunkard or dipsomanic of imperative,
often resistless, craving for alcoholics be correct or not, the
all demanding appetite of the alcoholic drinker, that sooner
or later comes upon him after frequent excessive and often
after rather moderate drinking, is a strong, if not the strongest
indictment against this bane of the human race's welfare,
engendering as it does what De Quincey in his forceful
arraignment of opium, correctly called, an Illiad of woes, as
was demonstrated in De Quincey's own unfortunate and wrecked
life as the victim of the next most potent of habit poisons
to alcohol and cocaine.


SELECTIONS.
NEUROPATHOLOGY.
Abscessed Teeth and Insanity.—Decayed teeth are a
source of pain, producing irritability, loss of sleep, incapacity
for work, mental backwardness and finally, upon the authori-
ty of Dr. Upson, Petin. Med. Jour., Sept., 1912, who cites an
interesting case in substantiating his claim, insanity.
A young man, aged twenty-one, was as a child bright,
honest and truthful. At sixteen he went to work, soon after
began to commit robberies, highway robbery and other crimes,
and was sent to a reformatory. At home his actions were
peculiar; he was irritable at times, flighty and incoherent,
and had periods of automatism. He would take the mattress
off the bed and sleep on the springs. He was strong, well
built and apparently healthy. Family history was good.
Skiagraphic examinations showed badly impacted wisdom
teeth, with abscesses at roots of two molars and one incisor.
Removal of the impacted and abscessed teeth relieved the
symptoms and finally effected a cure.
EUGENICS.
Sir Francis Galton declared Eugenics to be, "The
science which deals with all influences that improve the in-
born qualities of the race, also with those that develop them
to the utmost advantage."
Broadly speaking, Eugenics points out the importance
of paying at least as much attention to the breeding of human
beings as is now devoted to the development of the best strains
in poultry, pigeons, Angora cats or pug dogs.
It is axiomatic that the stream can rise no higher than its
source.—New Hampshire Medical Society, transactions.
(66)


Selections.
67
NEUROEUGENICS.
Robbing the Grave.—It is startling to hear that 1,700
people die unnecessarily in the United States every day of
the year. If such numbers were slain in a single battle a
shocked public would rise up to stop the war that made such
ravages on the race. Professor Irving Fisher, who made the
statement before the National Conservation Congress that
a third of 1,500,000 deaths annually could be prevented, urged,
as the first step in human conservation, the establishment
of an adequate system of collecting and distributing vital
statistics similar to the system in use in Sweden. At present
our vital statistics cover only a little more than half of our
population. But vital statistics are the bookkeeping of health,
and out of Sweden's carefully kept vital statistics for the
last 150 years have grown her wonderful hygienic achieve-
ments.
In the United States we have made reduction in infant
mortality and thus raised the average duration of life; but,
says Professor Fisher, "the mortality after middle age is grow-
ing worse, and the innate vitality of the people is in all probabil-
ity deteriorating." Sweden, on the other hand, has improved
the chances of life for all periods—infancy, middle age and old
age. We in the United States have regarded public health
almost exclusively as a matter of protection against germs
and have practically neglected the chronic maladies of middle
life, such as Bright's disease, heart disease and nervous break-
downs.
It is significant that all three of the political party plat-
forms this year had planks in the interest of the people's health.
The press has done much during the last few years in creating
interest in the matter, but in the work of conservation of human
life the government must officially take a hand. That the
government knows how to tackle such problems is shown
in the transformation wrought in the canal zone and the splen-
did work done for health in Cuba, Porto Rico and the Philip-
pines.—Leslies, 11-21-12.


6S
Selections.
NEURODIAGNOSIS.
Pupils in Acute Alcoholism.—By Dr. F. Stapel' (Mon-
atsschr. f. Psych, u. Neurol., Vol. XXIX, No. 3.)
The material examined for this paper was made up of
thirty-four patients, mostly those with constitutional defect
plus a psychosis and twelve normal persons. The conditions
as to age, time of day, quantity of alcohol administered, etc.,
were made as uniform as possible. The degree of intoxication
and its manifestations varied considerably. The pupils were
tested at intervals and in both daylight and in the dark room.
The following conclusions are reached: Acute alcohol intoxi-
cation causes dilating of the pupils to an equal degree, perhaps
after an initial narrowing; inequality or change in shape were
not observed. The adaptation of the retina to altered light
is interfered with (abolished or delayed.)—The reaction of
the puplis to light, accommodation and convergence is slow.
The extent diminished. The slower reaction may precede
or follow an increased reaction; difference in reaction of the
two eyes was not observed. The reaction to sensory stimuli
and psycho reactions are increased or diminished, but require
further study. All these pupillary alterations are more quickly
produced, more intense, and last longer, in mentally deficient
individuals than in the normal, even with small doses of alcohol.
In pathological intoxication the pupils may even become
absolutely rigid.—Smith Ely Jellifle, excerpt for Post Graduate.
NEUROPEDIATRICS.
Nervousness in Children—its Prevention. (Archives
of Paediatrics, ..'Now.) ."By: Tom A:.: Williams, MB:, CM.,
Edin., Washington; D: C:, - :;:l •.
Aside from physical varieties, there are five well-marked
types of nervous child. The aetiology differs in each, although
all arc psychogenetic from various kinds of faulty manage-
ment by parents' or guardians. Upon the-understanding
of the genesis of these types, must be founded the prophylaxis.
I. The lethargic child: Cause, over attention to vegetative
functions and discouragement of proper activities from the


Selections.
69
false belief that a child's brain is injured by use. Prevention
obvious.
II. The over intense child: Cause, the interference
with due relaxation by artificial stimuli of home and school
and play. Prevented by proper attention to anabolism by
rest and recreation.
III. The psychasthenic child: Cause, hyperconscien-
tiousness and inappropriate self control due to over-repression
by moral means as distinct from coercion. Prevented by under-
standing the limitations of a child's intelligence and its emotional
need for spontaneity.
IV. The hysteric: Cause, insufficient inducement to
self control in efforts to judge before acting; hence easy sug-
gestibility, impulsivity. Prevented by training children in
attention and suspension of action before due thought.
V. The self-willed child: Cause, failure of control, spoil-
ing. Prevented by early mastery of infantile tantrums, and
later providing opportunities for guidance in controlling passion.
Cases are cited.
The conventional cognominal diagnoses of paediatrist,
being without precise significance (neurasthenia, hysteria,
neurotism,) are deplored. Only when the psychological
mechanism has been investigated can be determined the nosol-
ogy of a case.
NEUROPATHY.
Pancreas in Chronic Alcoholism.—Lissauer states
that the pancreas frequently shows organic disease in alco-
holics and that the alterations involve both parenchyma and
connective tissue. We may see an interstitial pancreatitis
due to inflammation of the connective tissue and a fatty de-
generation of the parenchyma, and both these lesions may
be regarded as especially ethylogenic, as the author has not
encountered them save in alcoholics. The two types of lesion
conform to the finds in the livers of alcoholics— fatty liver
and cirrhosis. Friedreich has already described "drunkards'
pancreas," so that the author claims no priority. In theory
alcoholics should be prone to pancreatic diabetes and, as a


70
Selections.
matter of fact, they are known to be subject to the latter.
Deuts. Med. Woch.—Med. Rec.—Exc'p.
NEUROTHERAPY.
A New Quinine.—Samples of a new quinine derivative,
hydroquinine hydrochloride, but prepared from true quinine,
containing two more hydrogen atoms per molecule, is reported
in the Hospital for September 25th. One of its most marked
properties is for water, whereas quinine hydrochloride is solu-
ble only to the extent of 3 per cent in water, hydroquinine
is soluble in half its weight of water. This gives it a great
advantage for hypodermic introduction. It is not yet certain
whether hydroquinine is superior to quinine in the treatment
of malaria, but against trypanosomes the new remedy is stated
to have a greatly augmented effect.
Kissing the Shuttle.—In English cotton manufact-
uring districts it seems customary for the weaver to thread
the shuttle by applying the mouth to it and then drawing the
weft through by a sucking action; this method is known as
"kissing the shuttle." As the same shuttle is used by different
weavers without any attempt at cleansing, this procedure
affords a ready means of conveying pathogenic germs. In
one year, three female weavers who all worked on the same
looms and shuttles, died of tuberculosis. Dr. John Brown,
a Medical Officer of Health, to whom these deaths were report-
ed made inquiries, by which he concluded that the chief factor
in the causation of the disease was this insanitary practice
of "kissing the shuttle." And he strongly recommended
to the authorities that when shuttles are used by more than one
person they should be thoroughly cleansed and disinfected
after each time of using. And in accordance with such recommen-
dation the Borough Council had manufacturers advised
that after use the shuttles should be immersed for about half
an hour in a ten per cent. solution of izal, which in this pro-
portion is non-poisonous and does not injure the material of
which the shuttle is made.—Med. Times.
The Oatmeal Cure in Diabetes.—Dr. S. Strouse,
(Medical Journal, April, 1912) thus sums up on oatmeal


Selections.
71
in diabetes: "Practically all investigators who have tested
the cure in a thorough manner, agree that it is most beneficial,
especially in severe cases where other means have failed to
reduce either sugar output or signs of acidosis. Whether
this action depends on any inherent quality of the oat starch
is still a disputed point. The modus operandi must be con-
sidered as yet unexplained; numerous theories have been ad-
vanced, but none is supported by actual knowledge. Klotz's
researches, if corroborated by other workers, may offer a
scientific explanation of the phenomenon.
Magnesium Sulphate for Tetanus.—Dr. Bryce W.
Fountaine in the Memphis Medical Monthly excerpts and con-
denses the following valuable therapeutic record.
Parker (Journal Amer. Med. Assoc., 1912, lviii. 1746)
reports in detail three cases of severe tetanus successfully
treated by subcutaneous injections of magnesium sulphate.
Parker says that the dosage recommended for intraspinal in-
jection is 1 cc. of a 25 per cent. solution for every twenty pounds
of body weight. The dosage used in the cases treated by Par-
ker was much larger and no ill effects were observed.
Two of these cases were acute and severe, not fulminant,
but belonging to the class from which one would expect a high
mortality. The prompt relaxation resulting after the injec-
tions certainly shows that magnesium is of value in the treat-
ment of tetanus. It has no specific action, but by quieting the
excessive muscular action it permits the patient to obtain more
rest and to take food, and thus tides him over while he is
manufacturing his own antitoxin.
Parker calls attention to the fact that there are some
dangers in the use of magnesium sulphate, as it has been shown
that it often produces toxic effects, chief among which are
depression of respiratory and cardiac centers.
It has recently been proved by Joseph and Meltzer of the
Rockefeller Institute that physostigmin antagonizes the toxic
respiratory depression sometimes caused by magnesium.
Growth in the Use of Bacterins.—Treatment of in-
fectious diseases with preparations derived from correspon-
ding micro-organisms is unquestionably growing in favor.


72
Selections.
Not only do the bacterial vaccines (or bacterins) seem destined
to a permanent place in therapeutics, but their field of appli-
cability is constantly broadening. Proof of this is seen in
the growing list of these products announced by Parke, Davis
& Co., no less than fifteen of the bacterins now being offered
to the profession.
There are a number of reasons for the favor which is being
accorded to the bacterial vaccines. In the first place these
products are in consonance with the scientific trend of present-
day medication. They are being used with a gratifying
measure of success. The method in which they are marketed
(sterile solutions in hermetically sealed bulbs and in graduated
syringes ready for injection) appeals to the modern medical
man, assuring, as it does, both safety and convenience. The
moderate prices at which they may now be purchased will
tend to give them still greater vogue. And these prices are
worthy of note, since they represent a great reduction from
those formerly prevailing, amounting, if we are not mistaken,
to as much as 60 per cent. in many cases. They are announced
elsewhere in this journal over the signature of Parke, Davis
& Co. and will repay a careful scrutiny. ■ .
Tonicity of Mineral Waters.—Menard (Presse Medical,
Paris, July 24, 1912, Abst. J.A.M.A.) calls attention to the
importance of the molecular constitution of mineral waters
which are used for local applications to the mucous membranes.
He has made an examination of a large number of these mineral
waters and among fourteen samples he found two whose freez-
ing point indicated a molecular value hypertonic to that of
the blood. The rest were hypotonic. He suggests that the
hypertonic waters be reduced to the molecular concentration
of the blood by dilution with distilled water. On the other
hand, the molecular concentration of hypotonic waters can
be brought up to that of the blood by the addition of a solution
of sodium chlorid.—Amer. Pract.
The Urine Neurodiagnosis Just Before Outbreak of a
Neurosis. Orlowski (Zeitschrift fur Urologie, Berlin, July, 1912)
calls attention to the changes in the urine he has observed in pa-
tients on the verge of a nervous breakdown. The curve of aci-


Selections.
73
dity of the urine shows a different rise and fall, being lowest
morning and night, contrary to the normal decline in the middle
of the day. The phosphates also behave differently, and the
indican content increases. Orlowski has been studying for
years the behavior of indican in the blood in various conditions,
and is convinced that the proportion of indican in the urine
is an index of low vitality, relaxation of the body, especially
of the nervous system. It is thus a practical index of impend-
ing nervous breakdown. Even healthy persons, when they .
feel languid and without much vitality, have indican in their
urine transiently. Persons with the paradoxic acidity curve
mentioned above often have abnormal proportions of indican
in the urine.—Atner. Pract.
Moss Non-Cereal Bread.—Along the Columbia river, t
says Medical Fortnightly, a kind of bread is made by the In-
dians from a moss that grows on the spruce fir tree. This
moss is prepared by placing it in heaps, sprinkling it with water,
and permitting it to ferment. Then it is rolled into balls
as big as a man's head, and these are baked in pits. This
moss bread ought to be analyzed and tried, if the analysis
justifies it, for a diabetes diet. ,
Dr. J. L. Wolfe, Cedar Rapids, la., in the Medical Sen-
tinel, proposing and answering the question, "What is Disease,"
says that it consists essentially in diminished vital power.
In medicine, error in theory leads to error in practice.
The physician educated to regard fever as constituting disease,
and the increased action of the heart and arteries necessary
to sustain the curative action an evidence of excess of vital power
is led to prescribe antimony, digitalis, and various other poison-
ous agents with a view to moderate or repress those actions,
and notwithstanding the evil consequences of such practice,
the same course of treatment is pursued as long as the theory,
by which the practice is governed, is believed to be true.
In disease whenever the action of the heart is augmented,
there is a cause for it. Thus in fever, inflammation, extreme
debility, etc., its energy is envoked for the accomplishment
of an object or design, ultimately for the preservation of the


74
Selections.
system. Physicians should study the design of nature and
endeavor to assist her efforts more.
Medical treatment, to prove beneficial, must harmonize
with the principles of life.
PSYCHIATRY.
The Psychic Effects of Accidents (Month. Cyclo.
Nov. 1912). By Tom A. Williams, M. B. C. M.Edin., Washing-
ton, D. C.
The actual emotion from an accident may stimulate
internal secretions in an injurious way by a mechanism dis-
cussed in the paper. But the effects are only temporary un-
less maintained by morbid ideas gained from others after
the accident or previously present in the mind of the injured.
Prepossession leads to abstraction with diminished capacity
of thought. This creates a vicious circle. The dissipation
of the false idea of a body disease is interfered with by the
patient's unconsciously exaggerating symptoms in order to
justify what he is beginning to doubt. The passage into
deliberate deception is then easy.
It is, or course, not the trauma which is psychopatho-
genic; the real cause is the ideationally determined complex
in the patient's mind. It is a suggestion, and can be just as
effective apart from an accident at all. Illustrations are given.
Nor is litigation itself the cause of sinistrosis. It is merely
a powerful suggestive determinant. Thus, in a patient in
whom haematomyelia has greatly inspired the efficiency
of the right hand, and who believed himself unable to work
as a mechanic because of somnolence, unsteady gait, partial
urinary incontinence and impotence, the author detected
the psychogenic character of much save the muscular atrophy
and restored the patient without question of indemnity.
Thus, treatment depends upon rational knowledge of
genesis which leads to proper reeducation of the patient's view
point. Mere assurance and encouragement only antagonize
the patient. The main aim is the removal of false notions—
suggestions— and this is most durably done by rational en-
lightenment into a true perspective. It is the treatment of
hysteria. The article is closed by an illustrative case.


THE
Alienist and Neurologist.
Vol. XXXIV.
St. Louis, February, 1913.
No. 1.
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Editorial and Business Offices, 3858 W. Pine Boul.
Huqhes Printing Co., Printers and Binders
EDITORIAL.
\AU Umtgntd Editorials art written or tht Editor.]
The Aim of This Magazine has been from the beginning
when its name and purpose were new and strange to the fold
of journalism, namely, to familiarize the profession and the
philanthropists with the higher phases of eugenics belonging
to the domain of psychiatry and a right understanding of brain
and mind, normal and abnormal, in their medical, medico
legal and social relations for the enlightenment of the medical
and related professions and the welfare of the world.
Though not fully appreciated in some quarters was our
end and aim, so little appreciated in fact that from one re-
markable source we were applied to for a loan, being regarded
from our name as a lienist journal representing a firm having
(75)


76
Editorial.
money to loan. But thirty-three years have flown since then
and as we enter our thirty-fourth our appreciation is complete
and we go on our prosperous career with assurance for our-
selves and from our friends of having done good and useful
work.
? Wijth hearty< thanks for the help given us for' bur labors-
and successes and with good wishes to all for a Happy New Year,
we continue on our hopeful, helpful way with promise of the
best possible service to all concerned, as heretofore.
Dr. Gorgas Honored.—The trustees of the American
Medicine Gold Medal Award respectfully announce that the
medal for nineteen hundred and twelve has been conferred
upon Dr. William G. Gorgas, Ancon, Panama, as the American
physician who in their judgment has performed the most
conspicuous and noteworthy service in the domain of medicine
during the past year.
The Back Wrenching and Spinal Jolting of our street
cars with their constantly changing novice motormen is likely
to put our osteopathic back bone manipulators out of business.
Again the Unstable Neurone Appears, this time in the
recent Washington University boys burning the Faculty in effigy—
for a trivial disagreement as to examinations. If our big
Universities can not train their students to a higher sense of
propriety and respect these big schools had better go out of
business.
More work and less frolic might be more salutary as to
student manners. Not long ago an American reared (not to
say educated) heathen and iconoclast spoiled the morning prayer
service by a brutal interruption. A steady brain with right
moral and intellectual poise is the best part of education.
If the moral inhibitory centers of the brain are neglected and
go wrong under big college training, of what use is the big
college? Better the small one with less vicious mischief
and more personal supervision and propriety of conduct.
The Oconomowoc Health Resort, Oconomowoc, Wis.,
Arthur W. Rogers, physician in charge, advise us of recent
important changes in that institution, of interest to readers


Editorial.
77
of this Journal. During the past few months it has doubled
its capacity, now having accommodations for 50 patients, in-
cluding gymnasium, assembly hall, billiard room, extensive
bath department and large living room, making a very complete
plant. Eight isolated fire-proof rooms are also provided,
modernly equipped for the care of acute mental cases. Ocon-
omowoc is now prepared to care for everything, from the
mildest neurasthenic up to the most disturbed case and with
facilities for their complete classification. ;., . .
... , The Physician in Politics.—One of the most note-
worthy features in the present era of political reconstruction is
the increasing prominence of the physician as a leading figure
in world politics, as exemplified in the recent upheaval in China
and in the present work of reconstruction in Portugal. In
both cases it seems to be recognized that the physician's ex-
perience with the ills of humanity gives him a peculiar fitness
for larger service to the State. In Portugal, not only were
the foremost revolutionary leaders physicians, as were the
principal officers of the provisional government, but the present
leaders of the most influential political parties are medical
men. The former Minister of Justice of the Provisional
Government of Portugal, Dr. Affonso Costa, now heads the
Democratic party which includes the Socialist and laboring
groups. This party includes half of the senators and deputies
in the Portuguese Parliament. Dr. Costa is the author of
the Church and State Separation Law and other measures.
Dr. Antonio Jose d'Almeida, another medical man, is chief
of the Evolutionists, the conservative elementinPortugal. Dr.
Almeida controls the "extreme right," as distinguished from
the extreme left, or ultra-radical Democratic party headed
by Dr. Costa. .:. The Unionist party, a compromise group half-
way between the extreme radicals and the ultra-conservatives,
is headed by Dr. Brito Camacho. These last two parties,
with the Independents, the political organization of the secret
society "Carbonario," comprise the conservative element,
which is at present in control. The Portuguese Cabinet
however, is a coalition, and includes three Democrats, two
Evolutionists, and two Unionists.—Medical Review of Reviews


78
Editorial.
for September. It is time medical men took more interest
in political topics in the U. S. A.
Berlin's Noise Sanitation.—That well governed city
of Germany sanitarily and otherwise sets the world a salutary
example in the suppression of the howling dervishers who
infest and molest the streets of American cities.
A reasonable amount of quiet in the street life of American
people is essential to their best state of health and might, if
enforced, prevent the continuous and everlasting moving to the
suburbs and beyond.
The howling megaphone and falsetto voices of our city
peddlers and corner newsboys are not a necessity of business
nor are certain screeching, brain rattling autos needed, most
of the latter (thanks to our chief of police) having been suppressed.
But the open muffler, and the street auto sprinter yet need police
attention, especially in the night time. Your neighbor's rooster
and a noisy poll-parrot are lawfully suppressible. Why not
the indifferent chauffeur devil and the unlawful open muffler
speeder? "Let us have peace" from these.
The Dedication of the Lane Medical Library which
occurred last November at San Francisco, was a just tribute
and memorial to the philanthropic spirit of a good man whose
memory abides pleasantly and gratefully with the editor of
this magazine.
Many Human Machines are constructed only for use
on the smooth road, while the pathway of life is inevitably rocky
and rough, in places, for most of us. Man does not consist
of "mind" alone, or of a nervous system alone, but of a commun-
ity of cells, tissues and organs, the integrity of all of which
is essential to the efficiency of the whole.
"The physician's work is that of a 'biological engineer,'
whose duty it is to promote orthobiosis; in other words, to
conserve and direct scanty, perverted or unutilized forces,
so as to produce the best possible results in efficiency of output
with a minimum damage to the machine. To accomplish
this end he can never, with wisdom or safety, depart from the
fundamental principles of physiology and hygiene."
—Prof. Langdon in Cincinnati Lancent.


Editorial.
79
New York Neurological Society.—The following
officers were elected for the year 1913. President, Dr. Smith
Ely Jelliffe; First Vice-President, Dr. E. G. Zabrislde; Second
Vice-President, Dr. E. W. Scripture; Corresponding Secretary,
Dr. J. Ramsey Hunt; Recording Secretary, Dr. C. E. Atwood;
Councilors, Drs. Dana, Starr, Sachs, Fraenkel, Kennedy.
Invitation Rather Than Coercion is a better policy
for the American Medical Association in membership.
The plan of requiring first local County or City ^Society
then State Society membership exclusively as essential to mem-
bership in the National body will not, for obvious reasons,
make the solidly organized representative forceful medical
body all loyal well wishers of regular ethical professional advance
would like to see. To accomplish the greatest result the A. M. A.
should embrace all right minded medical men in its fold. This
it can not do by forceful exclusion of all but members of local
County and State Societies. There are often good reasons
why the best medical men in localities prefer to stay out or
may by local interests be kept out of local societies.
Members of the Academy of Medicine and other good so-
cieties should be eligible to membership in the A. M. A. whether
members of local County or State Societies or not.
The Unstable Psychic Neurone displays itself in start-
ling bizarre speech, conduct and tragedy and suggests its own
extinction by methods familiar to the intelligent eugenist, phil-
anthropist and patriot. The wit who suggests that the unfit be
given the glorious privilege of not being born suggests more wisely,
perhaps, than he knows, the world of misery and degenerate
inadequacy to environment and world psychic sanitation and
endurance than he knows.
The boy, for instance, who kills his mother for refusing
him his mandolin, then kills himself, the mother who drowns
her daughter and seeks to kill herself, the child who suicides
because of a parental rebuff or a teacher's reprimand, had better
not been born and such unstables otherwise displaying their
psychic instability in morbid conduct, had better be barred
from the hymeneal altar. Clerical objection to this view


80 Editorial.
for preventing the propagation of the unfit, to the contrary
notwithstanding. But fortunately the church does not, in
our day, stand so much against science as in the past. -
GENERAL Sickles' age, past 90, senile infirmities and eccen-
tricities ought to move his friends to secure a considerate
guardianship in the troubles of his decrepitude. He is as-
suredly, from all accounts of him and his management of
his affairs, not the normal man of his better days.
A StABLY NEURONED PRESIDENT.-The stably neuroned
President humorously singing what he has jocosely termed
his Swan song after a sudden reversal of popular favor, greater
than ever before befell a President, shows an equanimity in
defeat as admirable and unique as the unparalleled stability
and courage which Ex-President Roosevelt displayed at Chicago
after the paranoiac's bullet was , in his breast. But stable
plausible courage has characterized all of our presidents under
stress of assassin's assault, from Andrew Jackson to Lincoln,
Garfield, McKinley and Roosevelt. -
There would be no assaults on American presidents if
all the people were as stably neuroned as our presidents have
proven themselves to be, because there would be no instably
brained cranks. - - - -
YELLOwston E PARK DUST CLOUDs.-Mrs. Isabel C.
Barrows, (In Christian Register) along with an interesting
description of the beauties of this attractive and wonderful
government reservation, justly complains of the clouds of
dust which enveloped their party and “the twenty or thirty
thousand men and women who have passed the portals of the
Yellowstone National Park this summer.” “Why this whole-
sale, annoying, unsanitary “neglect of the comfort of the tens
of thousands who entrust themselves to the care of the United
States Government, only to be choked to death or jolted
out of coaches on roads which are a scandal” she asks. And
so we ask.
The popular welfare has not, of late years, received


Editorial.
81
much congressional or Governmental official attention. Con-
cern for the interests of the politico-monetary influences of
favored trusts and syndicates have too exclusively occupied
Governmental official consideration. The "people be damned,"
has been too much the sentiment of our oligarchic politicians
and political officials in too many instances.
Notwithstanding the long time the subject has been agi-
tated, we have no bureau of public health and no sanitarian
or physician in the President's Cabinet. Yellowstone Park
was set apart as a national health and pleasure garden. The
Government has no right to keep it unsanitary. It is quite
as important to the people as Controller Bay or forest or mineral
conservation.
Some day the people will understand better and demand
of the politicians, concern for their sanitary rights.
Dean Hadley of Yale Does Not Endorse Carnegie
Foundation Report.—In a scholarly and educationally
enlightening address before the Association of American Uni-
versities November 8th, 1912, President Arthur T. Hadley,
the Dean of Yale, took issue with the report of the investi-
gators of the Carnegie foundation, which said that an increase
in general efficiency is the immediate duty of the representative
educational organizations of the country. Dr. Hadley said
he considered the Universities of America efficient.
The spirit and tenor of this report was certainly captious,
unfounded and unfair in regard to more than one medical
college of the country as we can affirm from personal familiari-
ty there-with and falsus in uno falsus in omnibus is liable to be
the general conclusion. There were good schools here before
Carnegie and his foundation report condemning all or most
all but the Carnegie foundation approved and endowed and some
of them continue despite the disparaging efforts of this report
to destroy them.
The Wrong Way to Do it.—"Dr. C. H. Hughes, Dear
Doctor:- I am going to bring you a patient in a few days. I
don't know what is the matter with him but he is terribly down


82
Editorial.
spirited, please examine into his case carefully and do him all
the good you can, and I wish you would add 20 dollars to his
bill for me for R. R. fare.
Yours respectfully,"
A well meaning medical gentleman once brought us a
patient prefacing his visit with the above note. Of course
we could not comply with the request. But when the doctor
and his patient came we asked the doctor why he did not arrange
with his patient for a fee for his visit to the city with the
patient's son and for his counsel as t® the proper consultant
and with the consultation visit, expenses, and time away from
home.
There is no need of secret fee splitting. The home doctor
should put a proper value on his time, knowledge and counsel
services and collect it himself, with a full open understanding
that he would have to be paid for medical advice and time away
from home and valuable information counsel with the distant
medical specialist who is to take charge of or advise concerning
the case. Secret fee splitting is a mistake, undignified, unfair,
harmful to all right interests and morally wrong and degrading.
Honesty the Best Policy in the Medical Expert.—
A medical expert should take pride in the verities of his science
and if he testifies true to them always he will never be con-
founded by references to other cases in which he may be of
record, but the pseudo expert who testifies as a partisan
will often be confused and thrown down by his record of ig-
norance or dishonesty.
It is a perilous thing to be a false expert. It is about as
safe and profitable to be a liar. Besides the honor and principle
of the matter, honesty in expert opinion is the best policy.
Dr. Alvah H. Thompson of Wichita.—Washington,
D. C, Dec. 9. Dr. Alvah H. Thompson of Wichita, Kas.,
has been appointed disbursing clerk of the pension service.
He will pay out annually the $180,000,000 which has been
handled through the eighteen pension agencies which were
abolished January 31. Dr. Thompson is now chief of the


Editorial.
83
finance division of the pension service, having risen from a
clerkship in which he began twenty-three years ago.
It is meet that medical men should fill such positions
and many more in the Government service from which they
are by consensus of partisan political opinion on the specious-
ly fallacious plea that "doctors have not the necessary business
qualifications."
It will be better for Government and people when doctors
come to have more to do with running the Government.
Alcoholism at the London International Eugenic
Congress.—At this Congress in July, the first of its kind
to enquire into alcoholism and other causes of degeneracy,
Dr. Magnan called attention to the fact that alcoholism among
women was increasing yearly. Dr. Mjoen of Norway proposed
labeling all bottles with the percentage of alcohol contained
in them as is now being done in the United States under the
pure food law. So far as practicable the proportion of alcohol
to patent and proprietary medicines should be limited to the
real and only demands of solubility and chemical requirement.
What the American Government has done towards absinthe
might well be done toward the importation of certain dele-
terious alcoholic concoctions under the disguise of medicines.
Osteopathic Backbone Diagnosis.—An Osteopath's
Vertebral Index Key to Diagnosis appears below:
Before the St. Louis Osteopathic Association one of the
members lately said, "The backbone is to human ailments
what the index is to the book. The physician by consulting
this index can immediately discover..what is wrong with the
patient he is treating."
"Diabetes was due," he said, "to lesions in the dorsal
region, bronchitis, pneumonia and liver and kidney diseases
were attributed to injuries and disarrangements between the
shoulder blades and the small of the back."
A Pyromaniac at Large; Burning Dairies and Cows
His Passion.—The mystery surrounding a succession of incen-
diary fires was cleared January 10, at Evansville, Indiana, when


84
Editorial.
Walter Bruner, 46 years old, confessed to the police that he
had burned the dairy barns of four milk companies there.
Suspicion was diverted from Bruner for a long time because
he appeared to be simple-minded and harmless, but an investi-
gation by Policeman Zumstein showed that everywhere Bruner
worked there was a blaze, which came at night, and destroyed
barns and animals.
Questioned to-day for his motive in firing the structures
Bruner said he wanted to hear the cows bellow in fright when
they were in the blazing barns.
"That was music," he said to the chief.
He was bound over to the Grand Jury.
Judicial Blunders Concerning Insanity in its im-
pulsive paroxysmal display with intervals of apparent sanity
under restraint come to light daily through the press reports.
A man, Haas by name, in Vienna, Austria, about the fourth
of last August, shot his consumptive wife, immediately there-
after attempting his own, saying he "could not see her suffer."
He was let off by the judge with a fine of two dollars, not for
the crime, the crime was pardoned, but for unlicensed carrying
of fire arms.
Murderous paroxysms of this kind are liable to recur from
other murderous emotion exciting causes, in such psychic
unstably brained as in this and the case of Harry K. Thaw
now wisely retained in Mattewan Asylum under renewed
judicial order.
A fanatic leader of a religious community not long
ago extinguished the life of a consumptive sister, without
getting the judicial rebuke and punishment it deserved.
Yet we have states that do not even allow capital punish-
ment by judge or jury for any cause.
In another instance, more excusable—in fact commendable
—a physician, Dr. Kennedy, at a fire gave a party pinioned
beyond rescue and burning to death a lethal hypodermic,
which the papers call a fatal euthanasia—but euthanasia
need never be itself fatal.


Editorial.
8
Science and Alcoholics.—The Coming Battle. Dr.
J. Wiglesworth. The New Albany Medical Herald announces
that a great battle is coming. On one side is the "business,"
with the thousands looking to it for support, and the capital
invested in breweries and distilleries, which knows too well
how to place money so as to influence legislation. On the
other side are the mothers and the wives and the daughters
of unfortunate victims of drink.
Dr. J. Wiglesworth, in the Medical Temperence Review
(London), May, 1912, says: "To compare the mental state
of a person who is slightly under the influence of alcohol with
that of one who is suffering from an attack of mania (insanity)
may appear to many persons absurd, but it will appear less
so to those who have had most experience with mental disorders.
As a matter of fact, certain mild forms of simple mania bear a
remarkably close resemblance to slight conditions of alcoholic
intoxication. There is the same loss of the highest conscious-
ness, the same overaction of cerebral centers other than the
highest, the same pleasing condition of exhilaration, the same
incapacity on the part of the individual concerned to realize
that his condition is other than a perfectly normal one.
"But the difference between what is ordinarily considered
to be a state of mild alcoholic intoxication, and the condition of
exhilaration with tendency to loquacity, which is one of the
earliest and most constant results of imbibing small quantities
of alcohol, is a difference of degree only and not of kind. Both
are alike manifestations of a loss of control; both equally imply
the temporary withdrawal of some of the restraining influence
of the highest cerebral centers.
"The subjective sense of increased strength and power
which alcohol confers upon an individual is then, I submit, a
delusion and a snare comparable to the subjective feelings
of happiness and bodily vigor displayed by the general paralytic,
who floats along in a whirlwind of delight, totally unable to
realize his physical weakness, which is so evident to the ob-
jective observer. I submit, then, that the primary and essential
element in the action of alcohol is the paralyzing influence
it exerts upon the highest cerebral centers, those which subserve


86
Editorial.
the delicate adjustments of an individual to his social sur-
roundings, and upon the activity of which the highest processes
of thought and feeling depend.
"These considerations will help us to a clear understanding
as to the part which alcohol plays in the production of mental
disorders. When the action of alcohol is intermittent, the
toxic influence which this drug exerts upon the cerebral centers
is at first speedily recovered from, and it may be said generally
that this agent has usually to be taken into the system for a
long period or in considerable quantities before definite mental
disorder manifests itself. The process can not, however,
go on indefinitely, continuing day by day without some change
of a permanent character becoming developed."
In Terms Neurological.—The secular press is catching
on to neurological nomenclature. A St. Louis city newspaper
of peculiar literary merit laconically designated the P. D.,
is P. D. Q. to catch on to the neurologists manner of speech.
As an illustration note the following from it, Sept. 16th, ult, No-
New Nerves for the Nation.
That Uncle Sam has not even yet reached his full stature
appears from the fact that he is developing a new and wonderful
setofnerves. Speaking impersonally, this is whatthe huge wire-
less plant at Washington, the biggest in the world, practically
means.
It has been the fashion to speak of telegraph and telephone
systems as nerves to the community. And, before the advent
of the wireless, we were satisfied with the thought that civili-
zation was gradually developing a complete system of such
nerves.
But the best possible wire-telegraph system seems infantile
when compared with what this new wireless promises. It
will enable the American Government to communicate in-
stantaneously with many thousands of points on four conti-
nents. It will span the Atlantic and half of the Pacific, as well
as Greenland on the North and Central Brazil on the South.


Editorial.
All wireless stations, and all ships equipped with wireless appa-
ratus within an area of 28,274,400 square miles will be in touch
with this giant nerve center. No less than a hundred million
people living under the Stars and Stripes, will be affected
by the news passing in and out, on instantaneous electric
waves, from this national center.
Physicians and Drug Addiction.—We copy with ap-
proval the following from the Jour. Med. S. Mc. A.
An interesting article by Charles B. Towns, entitled
"The Drug Taker and the Physician," appears in the October
issue of the Century Magazine, in which it is declared that
the number of physicians addicted to the use of drugs is less
than 5 per cent., instead of 15 per cent., as has been generally
asserted. Considering the familiarity that every physician
must have with drugs, and the temptation to their use to which
the physician is exposed because of his irregular hours and the
nervous tension he often suffers in the performance of his
duty, this speaks volumes for the integrity of the profession.
Mr. Towns Also Calls Attention to the fact that
there are no state or city hospitals devoted exclusively to sufferers
from the drug habit, although drug addiction, he shows, has
become one of the problems of our problem-permeated modern
social life. The drug habitue is less responsible and less able
to take care of himself than the alcoholic; he is, furthermore,
a greater menace to society, for there are no lengths to which
the drug fiend will not go to secure his panacea. Despite
this fact, the average drug taker is abandoned to the none
too-tender mercies of the police and the workhouse when he
has reached that stage in disease which renders him wholly
irresponsible and inefficient.
The article notes also with regret, that neglect is the
only attention given the pathology of drug addiction by the
great majority of the medical colleges. The physician is
the person who should deal with the drug slave; is, indeed,
his only salvation; yet the average doctor knows little or noth-
ing about this phase of human affliction.


88
Editorial.
The situation, as outlined by the writer, is startling and
deserves the recognition and the remedial efforts of the pro-
fession, both in private practice and in assembled convention.


CORRESPONDENCE
Diabetes-Mellitus.—I am undertaking an exhaustive
research into the pathology, etiology and dieto-therapy of
Diabetes-Mellitus. I am very anxious to hear from every
physician in the United States who has a case under treatment,
or who has had any experience in the treatment of this malady.
Von Noorden says "the best treatment for the diabetic is
the food containing the greatest amount of starch which the
patient can bear without harm." If any physician who reads
this has similar or contrary experience, and would take the
trouble to write me, I would esteem it a special privilege to
hear from him, if only a postal card. Kindly address, William
E. Fitch, M. D., 355 W. 145th Street, New York City.
Scientific Lesson from the Attempted Assassination
of Colonel Roosevelt.—We take pleasure in placing the follow-
ing before our readers as a matter of importance from the point
of view of patriotic eugenics.
My dear Sir:- I beg leave to call your attention to a plan
to lessen or prevent crime and other abnormalities, especially
such as the attempted assassination of Colonel Roosevelt. I
shall be very grateful for the honor of your editorial aid.
A Laboratory For Study of Criminal Mattoids.—
I have been advocating in Congress, State legislatures, and
with Mayors of large cities, for many years this plan. It
is to establish laboratories or bureaus for the scientific in-
vestigation of criminals and other dangerous abnormals. I
believe that every large city, every State and especially the
Federal Government, should have such a laboratory.
When any one sends to the President, the Gover-
nor, or Mayor, or any prominent citizen threatening
(89)


90
Correspondence.
letters, or repeatedly utters threatening words, or
attempts to injure such officials, or is unreasonably
insistent in demanding to see them personally, such
individual should be detained at least a few hours and
thoroughly studied by scientific experts in criminal
anthropology, psycho-physics and social pathology.
Laboratory Bills have been introduced by Senator South-
erland and by Representative Clayton and are now pending
before the Judiciary Committees of both Houses of Congress.
The members of these Committees are as follows: Committee
on Judiciary of the Senate: Senators: Clark of Wyoming
(Chairman), Nelson, Minn.; Dillingham, Vt.; Southerland,
Utah;Brandegee,Conn.; Borah, Idaho; Brown, Neb.; Cumm-
ings, Iowa; Root, N. Y.; Bacon, Ga; Culberson, Tex.; Overman,
N. C.; Rayner, Md.; Paynter, Ky.; Chilton, W. Va.; and
O'Gorman, N. Y.
Committee on Judiciary of the House: Representatives:
Clayton of Alabama, (Chairman); Henry, Tex.; Webb, N. C.;
Carlin, Va.; Rucker, Mo.; Floyd, Ark.; Thomas, Jr., Ky.;
Graham, Ill.; Dupre, La.; Littleton, N. Y.; McCoy, N. J.;
Davis, W. Va.; McGillicudy, Me.; Sterling, Ill.; Moon, Pa.;
Higgins, Conn.; Howland, Ohio; Nye, Minn.; Norris, Neb.;
and Dodds, Mich.
By patient study of dangerous, unbalanced and often
illusioned persons, who may be called mattoids, their eccentri-
cities and peculiar behavior can be determined to such an ex-
tent that we may detect them in advance. At present it is
almost impossible to do this, because of little or no knowledge
concerning them. This ignorance is due to want of systematic
scientific and sociologic investigation.
Millions of dollars are annually expended by our Govern-
ment for the scientific investigation of the antecedents, pe-
culiarities and behavior of some little bacillus, causing the death
of plants or animals, but little or nothing is given for a similar
study of the larger human bacillus, which has caused this coun-
try to suffer losses beyond human calculation.


Correspondence.
91
Who can estimate the injury and cost to the United States
of the assassination of Garfield and McKinley? Shall we
wait till more Presidents, Governors, Mayors, or other dis-
tinguished citizens lose their lives at the hands of assassins,
before we begin a study of such dangerous individuals? I am
Very sincerely,
Arthur MacDonald.
"The Congressional," Washington, D. C.,—October, 1912.


REVIEWS, BOOK NOTICES, REPRINTS, ETC.
The Task of Social Hygiene by Havelock Ellis. Boston,
Houghton, Mifflin & Co., 1912—This covers a much
wider scope than the ordinary conception of social hy-
giene and logically so. The older sociologists took many
of the problems here discussed into account which the
state socialists, masquerading under the guise of humanitarians
but really trying to make men into their own image by law,
neglected, logically pointing out the complete failure as it was
among the bourgeois Pharisees whom Christ condemned.
In them the same traits were prominent as caused the judi-
cial slaughters of the statutes of George Ill's time. The New
England specimen who cried "have you sanded the sugar,
John? Have you watered the tobacco? Then come to prayers,''
was fertile in law made moral tyranny over others as the Phari-
see who made long prayers and devoured widows' houses.
This type of animal is always prominent in the hysteric re-
formers who seek to make men of the police to create morality
as a means of repressing crime in place of restraining crime
as a means of public protection. Havelock Ellis remarks
that "selfishness is not living as one wishes but asking" (or
as it could be more correctly put, forcing, for this is the sadistic
enjoyment of the Pharisee) "others to live as one wishes."
This spirit of:
Compounding for sins they are inclined,
By damning those they have no mind to,
is as common among bourgeois religiosities of all kinds
to-day, good by law. "There must be a law" is the favorite
sociologic nostrum of these political quacks. This problem of
social hygiene, Dr. Ellis deals with fully and clearly.
(92)


Reviews, Book Notices, Reprints, Etc.
93
Greater stress might be laid on the demoralization of the
police through the increased facilities for blackmail it affords
which, as seen by recent trials in New York, Chicago, San Fran-
cisco and elsewhere, is as frequent as among the British in-
spectors whom Dickens eulogized.
The introduction states the topics to be discussed fully
and freely. The changing status of women discussed in the
second and third chapter lacks to some extent historic per-
spective. The voting power among the six nations of Amerinds
still persists in New York on the Seneca reservation and was
recognized by the Court of Appeals in 1894 by annulling a
Chief's election since the women were interfered with. In New
Jersey ere it became the "state of the Camden and Amboy R.
R." in 1830 women voted, carrying the state for Thomas
Jefferson.
New Jersey had the first Medical Society and imported
Newcomen engines (which preceded Watts) to do its work.
The decadence of the state set in after the American revo-
lution when mean Yankee emigration of the Daniel Drew
type turned the state into a fosterer of monoply and it be-
came indecorous for women to mingle in politics.
Romantic lore and women is discussed in the fourth
chapter but sufficient stress is not laid here as in the Psychol-
ogy on the freedom and equality of women among the Celtics
whose blood and institutions enter so largely into the so-called
Anglo-Saxon. In Ireland, however, this element under the
Norman church became, as George Moore shows, vividly deca-
dent. The falling birth rate chapter does not recognize the
significance as an element of advance pointed out by Herbert
Spencer long ere the present frothy discussion. Eugenics and
love, religion and the child, problem of sexual hygiene, im-
morality and the law are well worth perusal by most of the
blatant sociologic Pharisees. The war against war shows a
little too much of the so-called nonconformist conscience
suggestively deserving Tennyson's satire:
Peace in her vineyard.
Yes, but a company forges the wine.
The international language chapter opposes English but
ignores the evolutionary tendencies fought by the British


94 Reviews, Book Notices, Reprints, Etc.
philistine which in the United States, Australia and South
Africa are leading to, are removing obstacles to its univer-
sality. The chapter on Individualism and Socialism in its
trend rather conflicts with the one on immorality and the law.
The American idea of individualism is that of Jefferson, that
government should be confined to its police power and that
the rights of one individual end only where the rights of an-
other begin; the doctrine of the common law, and that of
Emerson.
Fear, craft and avarice cannot create a state,
When the church is social worth,
When the state house is the hearth;
Then the ideal state is come
The republican at home.
Jas. G. Kiernan
Fatigue and the Association Experiment by Dr. F. L.
Wells, both from the Psychological Bulletin, are essential
reading matter of merit for psychologists and neurologists.
The American Journal of Gastro-Enterology is
devoted to subjects pertaining to digestion with an able and
ample corps of well known editors and collaborators, home and
foreign. It is published quarterly by the Philadelphia Medical
Publishing Company.
Practise and the Work-Curve by Frederick Lyman
Wells, Ph. D., McLean Hospital, Waverly, Mass. From the
American Journal of Psychology. A commendable brochure.
The American Book Company with its School Calendar
for 1913 is a specially valuable artistic production fit to decorate
desk and wall and diagram based on U. S. Census Bureau
Bulletin, 1910, showing a comparison of the values of certain
common necessities and luxuries used in 1909 by the people
of the United States, is especially valuable.
A Forceful and Pertinent Plea for the Organiza-
tion of County Commercial Clubs as an agency for rural
betterment by William H. Bloomer, St. Louis, Missouri,
is before us.


Reviews, Book Notices, Reprints, Etc.
95
We take pleasure in giving publicity to this address for
the betterment of all Missouri and all of our American States
and all the world to which this magazine goes.
The Psychological Monographs, Volume 13, number 5,
edited by James Rowland Angell, Univ. of Chicago, Howard
C. Warren, Princeton Univ., Jno. B. Watson, Johns Hopkins
Univ., and Arthur H. Pierce, Smith College. Association
tests. Being a part of the report of the committee of the Ameri-
can Psychological Ass'n, on the Standardizing of Procedure
in Experimental Tests by R. S. Southworth, Columbia Univ.,
and Frederick Lyman Wells, McLean Hospital. Psycholog-
ical Review Co., Princeton, N. J., Baltimore, Md., and Lan-
caster, Pa.
Outlines of Psychiatry, Nervous and Mental Disease
Monograph Series No. 1. By William A. White, M. D.,
Washington, D. C, fourth edition. We have nothing to add
to or detract from our previous commendation of this work
of merit from a meritorious source. The purchaser will never
regret its possession. Dr. White is a skillful practical clinician
The Clinical Congress of Surgeons of North Ameri-
ca. Third Annual Session, New York City, November 11th
to 16th, 1912. General Secretary, Franklin H. Martin, M. D.
An excellent program well carried out under the Presidency
of President Albert J. Oschner. This was a most elaborate
series of clinics by our greatest surgeons.
Some Don'ts, Medical and Surgical, offered the professon
by the Fellows Hypophosphites Co., is a specially valuable
brochure of therapeutic facts like the hypophosphites them-
selves, worthy of our readers' consideration. We commend
this pamphlet, especially what it says concerning Ehrlich's
Salvarsan. The little book will be sent to any physician
just for the asking.
Library Work Among the Insane by Edith Kathleen
Jones, Librarian at McLean Hospital, Waverly, Mass., from


96
Reviews, Book Notices, Reprints, Etc.
the bulletin of the American Library Association, Vol. 6, No. 4.
An interesting and instructive paper for hospital libraries.
The library for the hospital for the insane is an important
part of its curative equipment if used with psychiatric discern-
ment. Used without such directing judgment it may do harm
likewise.
Was ist Psychoreflexologie? Von Prof. W. V. Becht-
erew in St. Petersburg. Sonderabdruck aus der Deutschen
medizinischen Wochenschrift Redakteur, Geh. San. Rat Prof.
Dr. J. Schwalbe, 1912.
Asking this question which the author places at the be-
ginning of an article which only a Beckterew might write
the author proceeds in his characteristic inimitable way to
the edification of all interested in the subject and more es-
pecially to those who have read the author's work in objective
psychology.
Waukesha Springs Sanitarium Calendar, Waukesha,
Wis., is an attractive illustration of this attractive and well
known establishment with an every day reminder, occupies
little desk space.
It only needs the handsome faces of Dr. Caples and Mrs.
Caples to make the attraction complete. The completed
picture would attract the notice of any healthy individual
and every guest as a patient of this Sanitarium whom we have
known has expressed satisfaction with the hospitality and
treatment of this hospital. But in the matter of treatment
and hospitality the same may truly be said of all of our
sanitarium and hospital advertisers.
Westborough State Hospital Papers, Series 1. 1912.
A testimonial to George Smith Adams, M. D., Edited by
Solomon C. Fuller, M. D. Reprinted from New England
Medical Gazette. These papers, both in their scientific as
well as personal aspects, are too highly instructive to be over-
looked by any American Alienist or Neurologist or admirer
or Dr. Adams and his work. George Smith Adams, M. D.,
is the late superintendent of Westborough State Hospital


Reviews, Book Notices, Reprints, Etc.
97
and lecturer on clinical psychiatry at Boston University of
Medicine. These papers are deservedly and appreciatively
dedicated by his former assistants and pupils as a token of
their regard and in honor of twenty-five years service on the
medical staff of Westborough State Hospital.
Napoleon's Campaign in Russia, Anno 1812, by Dr.
A. Rose, author of many meritorious monographs on the use
and value of Greek in medicine, is the best and only complete
contribution to the medical aspect of the remarkable "little
corporal's" campaign we have seen in any language. It throws
new light on the trials and sufferings of the great retreat from
Moscow and on the fortitude and pluck of Napoleon's army
in that most critical and practically final part of the great
conquering flaming fatal career. Every doctor should read it.
As the author truly says "no campaign in the history of the
world has left such a deep impression upon the hearts of the
people as that of Napoleon in Russia, Anno 1812."
We are accustomed to consider the hardships of this fatal
march as one of the world's greatest horrors, but the typhus
fever of that fatal retreat about equalled the sufferings of that
fatally striken army which but a short time before had dazzled
all Europe by its intrepid heroism and gigantic victories.
Published by the author, 173 Lexington Avenue, New
York, N. Y.
Among the Several Meritorious Nervous and Men-
tal Disease Monographs is series No. 13, being the history
of the Prison Psychoses. Drs. Paul Nietche, Dresden and Karl
Wilmanns, Heidelberg, names well known to the medical
profession. No Alienist nor Neurologist can dispense with
this authorized translation by Francis Glueck, M. D., Senior
Assistant Physician, Government Hospital for the Insane,
Washington, D. C. With an introduction by William A. White,
M. D., New York. The Journal of Nervous and Mental Dis-
ease Publishing Company.
The thanks of an appreciative profession are especially
due the translators for this valuable addition to the literature
of disease and crime. This work, Dr. White in his enlightening


98
Reviews, Book Notices, Reprints, Etc.
introduction says, brings the reader to the present-day view-
points with reference to the prison psychoses through the med-
ium of a historical review of their development in the German
literature. Such a work should be welcomed by all who are
interested in the problems of psychopathology and particularly
those who long for rationalistic methods of dealing with the
criminal and with all of the problems of criminology.
Psychanalysis, its Theories and Practical Application.
By A. A. Brill, Ph. B., M. D., Chief of the Neurological depart-
ment of the Bronx Hospital and Dispensary, Clinical assistant
in psychiatry and neurology at Columbia University Medical
School, formerly assistant physician to Central Islip Hospital
and to the Clinic of Psychiatry, Zurich.
W. B. Sanders Company, Philadelphia and London,
are the well known publishers, 1912. This excellent book by
a brilliant and clinically experienced member of the medical
profession and dedicated to the author's esteemed teacher,
Professor Dr. Sigmund Freud, LL. D., whose ideas are herein
reproduced, is a timely and meritorious companion to the
"trial of Freud's psychology."
The book can not well be omitted from the library of any
psychoanalist, modem alienist or student of psychopathology.
No abstract of its contents can do it justice, though some
will later appear. We commend it to physicians, attorneys,
jurists and philosophers of the human mind.
The Psychology of Insanity. By Bernard Hart,
Cambridge Press.
This little book is an attempt at explanation of the rationale
of irrationality by psychological conception thereof and the
author's conception is that "dissociation of consciousness
plays an important part in abnormal psychology."
The author's presentation of ideational conflict repression
leading to psychic dissociation as well as his discussion of
phantasy projection and the significance of mental ideational
and emotional conflict culminating in insanity make this
an interesting thought stimulating essay for the clinically
experienced alienist who may have practiced the Esquirolian


Reviews, Book Notices, Reprints, Etc.
99
precept of living with the insane to understand them. The
author evidently has not been won over to the surgical mind
conservation methods, as the following excerpt from his con-
cluding chapter shows. "Those enthusiastic reformers who
would initiate drastic legislation to obtain selective breeding
may reasonably be asked to proceed with caution. For it
is at least conceivable that our present complacent assurance
that every individual must live and act within the arbitrary
limits assigned by conventional and purely artificial standards
of conduct, or else be segregated from society, may be falla-
cious and inimical to the best development of the race. It
is possible that insanity, or a part of insanity, will prove to
be less dependent upon intrinsic defects of the individual
than on the condition in which he has to live, and the future
may determine that it is not the individual who must be elimi-
nated, but the conditions which must be modified."
The price of this little book is forty cents. G. P. Put-
nam's Sons, New York, are the publishers.
Organic and Functional Nervous Diseases, a text
book of neurology by M. Allen Starr, M. D., Ph. D., LL. D., Sc.
D. Professor of Neurology, College of Physicians and Surgeons,
The Medical Department of Columbia University in the City
of New York, Consulting Neurologist to the Presbyterian
and St. Vincent's Hospitals, and to St. Mary's Free Hospital'
for Children and author of "Familiar Forms of Nervous Disease"
etc., Third edition, thoroughly revised, Illustrated with 300
engravings in the text and 29 plates in colors and monochrome,
Lea & Febiger, New York and Philadelphia.
This splendid third edition of an acknowledged and proven
superior contribution to the science of neurology with its added
super merits of illustration and text over even its meritorious
predecessors commands our admiration and compels unstin-
ted commendation to the surgeon, the physician, the jurist,
the anatomist, the neurologist and the alienist for its accuracy
and beauty of illustration and verbal description.
The eminent author has always been esteemed by us as
one of the "bright particular stars" of our neurological firmament
especially in the field of diagnosis.


100
Reviews, Book Notices, Reprints, Etc.
He is certainly not a mere satellite but has a distinctive
orbit of his own, notwithstanding the many other stars in the
firmament of neurological science.
His treatment of the neuritides and diseases of the brain
is worth much in merit and in money, in the latter more than
the price of the entire book.
Westborough, Mass., State Hospital Papers, Sept.
15, 1912. A testimonial to Geo. Smith Adams, M. D., edited
by Solomon C. Fuller, M. D. Reprint from N. E. Medical
Gazette.
The papers published in this book have been prepared
by members of the medical staff of Westborough State Hospi-
tal during the past eighteen months. Two of the contribu-
tions, III A study of the Miliary Plaques Found in Brains
of the Aged by Dr. Fuller and XIV Further Observations on
Alzheimer's Disease by Drs. Fuller and Klopp, were first pub-
lished in the American Journal of Insanity for October, 1911,
and July, 1912, respectively. XIII, Alzheimer's Disease
(Seninm Praecox): The Report of a Case and Review of Pub-
lished Cases, first appeared in the Journal of Nervous and
Mental Disease for July and August, 1912. The remaining
papers are here printed for the first time. Two other papers
published during the year have not been included. One of
these by Drs. Fuller and Klopp dealt with data collected
originally for the 1910 Manic-Depressive Symposium of the
New England Society of Psychiatry and concerned one hun-
dred and twenty-nine cases which had been diagnosed as
Melancholia of Involution during a period of six years at this
hospital. This paper was further elaborated and presented
at the 1911 meeting of the Neurological Society, in the pro-
ceedings of which it was published, January, 1912. The other
paper, not here collected, Ein Fall der Alzheimerschen Krank-
heit by Dr. Fuller, was published in The Zeitschr. f. d. gesamte
Neurologie u. Psychiatrie for July 31, 1912.
We are pleased to note that Dr. H. O. Spaulding, Superin-
tendent, intends to publish from time to time, as material
warrants, further series of Westborough State Hospital Papers.
These meritorious and instructive papers are a well merited


Reviews, Book Notices, Reprints, Etc. 101
tribute to a great American psychiater and alienist clinician
of a great State hospital.
The "Wellcome" Photographic Exposure Record
and Diary, 1913.
We have pleasure in acknowledging receipt from Burroughs
Wellcome & Co., New York City, of the "Wellcome" Photo-
graphic Exposure Record and Diary for 1913.
To boil down into one handy pocket volume the accu-
mulated photographic wisdom of the year and of preceding
years is a work of signal utility and one which should win the
gratitude of all photographers. Such a task has been accom-
plished in the 1913 edition of the "Wellcome" Photographic
Exposure Record just published. Within its closely packed
pages this book contains a surprising number of useful and
practical paragraphs for the field, the dark room and the
studio. Among the most novel features are the descriptions
of new methods of toning prints green and blue, by the use
of "Tabloid" toners, etc. Price in the United States 50 cents.
An Inebriate Hospital for Every City.—The Red
Back takes off its hat to this chief of police. He here echoes
what the Red Back has been preaching twenty-five years.
A drunken man is a sick man—he is poisoned—and the hospi-
tal, and not the jail, is the place for him. How much longer
will an enlightened (?) people license men to intoxicate the
laboring men, and then punish them for being intoxicated?
Remove the cause, and the effect will cease.—Ed.
Houston, Texas, December 24.—Chief of Police E. Cullen
Noble announced a few days ago that he wanted to give 100
poor families a sober husband and father for a Christmas present.
He established a "municipal jag school," put Dr. J. J. McKenna
of Oklahoma City at the head of it and invited all wives, sons
and daughters of inebriate husbands and fathers to take them
to the police station for treatment.
"When I aclminister charity, it must be substantial charity,"
said Chief Noble. "Instead of sending turkey and cranberries
to homes that have been reduced to poverty and had the
husband or father stolen away by drink, I want to install in


102
Reviews, Book Notices, Reprints, Etc.
these homes a sober and reliable breadwinner. I don't want
to tease the appetites of the poor unfortunates with delicious
edibles just because it is Christmas, and let them go without
breakfast the following morning.
"More sober and reliable husbands is the crying need
of wrecked families throughout the world."
The "municipal jag school" met with such success that
Chief Noble announced four days later it would become a
permanent branch of the police department, and no more
"drunks" would be fined.
Now, Police Judge John A. Kirlicks neither fines nor sen-
tences inebriates to jail. Instead he says: "I find the defend-
ant guilty and sentence him (or her) to one course of treat-
ment in the 'municipal jag school.'"
Since Chief Noble announced that he would give away
"sober husbands," broken-hearted wives, sons, daughters,
mothers and sweethearts have taken their inebriate loved
ones to the station and enrolled them in "jag classes."
Within three days after the invitation was issued, twenty-
five heavy-eyed and remorseful down-and-outs were taking
the treatment. They stay at the station three days, and
on leaving are given enough medicine to last thirty days.
The first twenty-five men have been pronounced cured
and graduated into the Houston municipal employment bureau,
and from there sent out on jobs. Chief Noble personally
conducts the employment bureau.
None of the twenty-five men had jobs when they entered
the classes. They are required to report to Chief Noble,
and so far none have fallen from the wagon.
"Habitual drinking is not a vice—it is a disease," says
Chief Noble. "To fine a man for his affliction is a crime.
They should never be jailed, except to subdue them when they
are violent. Every city should have an inebriate hospital."
"Every time one of these afflicted men is locked up or
fined, he is struck a discouraging blow, and some wife or child
at home suffers a little more.
"Society has too long and foolishly tried to wipe out
this dread evil with jails and lockups. As long as I am chief
of police, Houston will reclaim her poor alcohol victims."


Reviews, Book Notices, Reprints, Etc.
103
Dr. McKenna says he can convert 100 Houston drinkers
into sober breadwinners. By that time, he thinks, the work
of the school will become lighter, but he says it should never
be abolished.
Three Months Without and Three Months With a
Social Service Worker in the Mental Clinic at the
Boston Dispensary. By L. Vernon Briggs, M. D. Reprinted
from American Journal of Insanity, October, 1912.
Dr. Briggs gives interesting and convincing clinical records
and this concludes this valuable contribution to the eugenics
of clinical psychiatry.
I believe that every hospital for the insane in this country
should have a Field Worker, a Eugenics Worker and a Social
Worker connected with its organization, and each state hos-
pital should have another physician added to their staff who
would be a Field Worker or by this addition there could be
possibly a rotation of field work by different members of the
staff. There should also be added to each hospital organiza-
tion a Eugenics Worker and a Social Worker. Such an arrange-
ment would do much to stem the tide we are all seeking to check
or in other words, to control and lessen the increase of insanity.
The Field Worker would have the advantage of watching
the cases in the hospital and selecting the more hopeful ones
for a trial outside. He could direct the medical life of the pa-
tients after they left the hospital, but would be untrained
to bring about changes in social conditions, environments
or surroundings which would prevent a return to the hospital
of the same patient or the coming to the hospital of other
cases from the same family or locality. The Social Worker
in conjunction with the Field Worker could, I believe, control
conditions to a great extent and prevent much of the increase
of insanity and educate public opinion to a new point of view
concerning the insane, their care and their treatment. The
result of such an organization with trained workers would, I
believe, be
1. To prevent the commitment of the early cases by
directing early medical treatment and improving social con-
ditions.


104 Reviews, Book Notices, Reprints, Etc.
2. To prevent other members of the family or locality
from similar breakdowns.
3. To prevent the return to the hospitals for the insane
of many discharged cases.
Le Langage et la Verbomanie; Essai de Psychologie
Morbide. Ossip-Lourie. Paris: Felix Alcan. 1912. Pp. 275.
This is a discursive treatise on the disease of talking too
much. A review article by Dr. F. L. Wells of McLean Hospital
which will interest any reader of this magazine. It is abstracted
from the Journal of Philosophy, Psychology and Scientific
Methods.
Second Annual Report op the Joint Board of Sani-
tary Control in the Cloak, Suit and Skirt Industry of
Greater New York, December, 1912. Put out by the
Joint Board of Sanitary Control, 31 Union Square, New York
City. Should be read by every citizen.
Gonorrhea vs. Tobacco, Alcohol, and Sexual Inter-
course. By William J. Robinson, M. D., New York City.
Editor of Critic and Guide, American Journal of Neurology,
Sexual Problems of To-day, etc. Reprinted from The Amer-
ican Journal of Clinical Medicine, August, 1912.
Alcohol and Officials. Does the moderate use of
alcohol lower health and efficiency, and should it be prohibited
among officers and officials of the military, naval and civil ser-
vices? By Colonel L. Mervin Maus, U. S. A., Medical Corps.
This is a truthful, forceful and scientifically accurate por-
trayal of the subject and we fully agree with Colonel Maus
on the affirmative position he takes and proves on this vital
subject to our army and navy.
The Conservation of the Child. By Dr. Arthur
Holmes, Assistant Director of the Psychological Clinic of the
University of Pennsylvania.
Dr. Holmes deals in a thorough manner with the problems
of the 6,000,000 retarded and the 150,000 feeble-minded chil-


Reviews, Book Notices, Reprints, Etc. 105
dren now associating in our public schools with normal chil-
dren, to the great danger of the latter. J. P. Lippincott
Company, London, Philadelphia and Montreal, are the pub-
Ushers.
The Question op Association Types. By Frederic
Lyman Wells. From The Psychological Review, July, 1912.
A Note on the Prognostic Value op Hallucinations
in the Manic-Depressive Psychoses. By Edmund M. Pease,
M. D., McLean Hospital, Waverly, Mass. From American
Journal of Insanity, Vol. LXIX, No. 1, July, 1912.
Critique op Impure Reason. By Frederic Lyman
Wells, Ph.D. McLean Hospital, Waverly, Mass. From the
Journal of Abnormal Psychology, substantially as read before
the Boston Society of Psychiatry and Neurology.
This and the two preceding papers are contributions
by one of the McLean Hospital medical staff, a prolific source
of valuable contributions to Clinical and Analytical Psycholo-
gy and Psychiatry, the last one being a rational criticism of
some of Freud's Psychoanalytical methods and deductions,
portions of which may appear in our selection department.
The Survey, Edward T. Devine, Jane Addams and others
the editors, 105 East Twenty-second Street, New York.
Physicians will be interested in the articles on the recent
Congress of Hygiene and Demography published in the Survey
for last November 2nd, and in subsequent issues to present
date.
In these days the physician is becoming more and more
a social worker. His field has broadened from that of merely
curing disease to that of searching out the causes of disease
and preventing it. The Survey should have a special appeal
to physicians. It is a most valuable current guide to advance
in social hygiene.
Facts of Modern Science and their value in the preven-
tion and cure of disease by Hermann Hille, Ph. D., Chicago.


106 Reviews, Book Notices, Reprints, Etc.
Excerpts from Medical Record, June 15, 1912, New York.
Maintaining that ordinary refined foods permit the body
to suffer from mineral starvation which is the primary cause
of disease and that Biosol prevents this starvation by supply-
ing this deficiency. Gives illustration of refined patent flour
as compared with whole wheat flour which has three-fourths
more nutrition than the former, polished rice as compared
with the unhulled grain and raw brown sugar with the refined.
New South Wales, report of Dr. Eric Sinclair, In-
spector-General of the Insane, 1911.
"The outstanding features in the operations of the Depart-
ment during the year were the increased number of patients
admitted for treatment at the different Hospitals, the number
being the largest yet recorded; and also the consequent in-
crease in the Hospital population remaining at the end of the
year. There were 1,247 patients admitted to the several
Hospitals, during the year and the increase in the number
remaining under care at the end of the year was 206, the total
under care being 6,383."
Barnes Hospital, St. Louis, Mo. Laying of the Corner
Stone, October 11, 1912, and other information. We abstract
from an editorial in the St. Louis Christian Advocate, Oct.23,
1912, the following:
"Two events of the present year will serve to make 1912
luminous forever in the history of world-wide Methodism.
One is the opening in October, 1912, of the five million dollar
Wesley House just across the street from Westminster Abbey
in London and the other is the Corner Stone laying exercises
of Barnes Hospital on Kingshighway, the finest boulevard
of the west, in St. Louis.
"The Wesley House in London is the largest and richest
expression the Wesleyan Methodist Chursh has ever made
of itself in England, and Barnes Hospital is the most munificent
expression the Methodist Episcopal Church, South, has ever
made of itself in America. No institution, with which Southern
Methodism is connected, ever started upon its career with


Reviews, Book Notices, Reprints, Etc.
107
as many millions of money to be used in the service of humanity
as Barnes Hospital."
"By the wise and far seeing contract the trustees of
Barnes Hospital have made with the management of Washing-
ton University, the hospital finds available for the afflicted,
are not only the two millions of dollars placed under its care
by Mr. Barnes, but also the more than twice two millions of
dollars under the direction of the University for its Medical
College."
"Mr. Barnes was an Episcopalian and his wife was a Ca-
tholic. It is to the standing in the community, the business
integrity and Christian character of Samuel Cupples, Richard
M. Scruggs and Samuel M. Kennard that we, as a Church,
are indebted for the honor conferred on us by Robert Barnes
in directing that for all time to come our Church shall adminis-
ter his estate for the good of humanity."
Mind and Its Disorders. A text book for Students
and Practitioners by W. H. B. Stoddart, M. D., F. R. C. P.
Resident physician and superintendent of Bethlem Royal
Hospital, Lecturer on Mental Diseases to the Westminster
Hospital, Royal Free Hospital and London School of Clinical
Med., Late Educational Sect'y of Medico-psychological Assn. of
Great Britain and Ireland. Second edition with illustrations.
Philadelphia, Pa., P. Blakiston's Son & Co. Price $4.00 net.
This is a practical book from a practical source of clinical
experience of special value to every .physician connected
with an insane hospital.
The author regards paranoia as a mental disorder which
is to be regarded as a constitutional anomaly rather than a
disease, discusses diabetes and insanity in a most enlightening
way and the handshake and handwriting of many mental
states in a peculiarly original and instructive manner.
He illustrates some congenital structural anomalies not
to be found in other works, gives cerebro-spinal fluid illustra-
tions in general paralysis, the preparation of J. G. Phillip's
test types, test and facial expressions of the melancholies, analy-
ses the psychopathology of the Freudian school, gives a chapter
on the alcoholic psychoses, idiocy, dementia, senility, neuras-


108
Reviews, Book Notices, Reprints, Etc.
thenia, general treatment, methods of commitment and much
more of value pertaining to mind and its disorders, of value
for which we have not space to mention.
The book is appropriately dedicated to the eminent
Hughlings Jackson.
Everybody interested in mind and its disorders should
possess this valuable book. It emanates from a source of
"wisest censure," from one whom the great Esquirol would
have pronounced, because of his clinical experience, compe-
tent to write it.
Medical Greek, Collection of papers on medical onomatol-
ogy by Dr. Achilles Rose, Honorary Member of Med. Soc.
of Athens, etc. G. E. Stechert & Co., 155 West 25th St.,
New York, N. Y. Price $1.00.
"In order to understand the onomatology question in
medicine as it stands to-day one has to read this book."
The only criticism we would offer concerning this excellent
collection is: word and name have different meanings in the
English language. Onomatology applies to names. A name
is a word but a word is not necessarily a name.
Dr. Rose is a real Achilles in assault but Phoustanos'
criticism of Stedman's new Dictionary is fierce but somewhat
captious, though sarcastically, not to say superfluously critical
when we consider the liberty allowed in literature to the coin-
ing of words and we shall doubtlessly be criticised for favoring
hybrid terms if thereby they may be more accurately express-
ive. But though no literateur nor lexicographer is perfect
the philologist will read with profit.
The Jukes and Jonothan Edwards.—A Contrast.
The vicious Juke's family with which we were made familiar
in our youth as a costly and degenerative family illustration
of more or less but not enough custodial psychopathy, comes
fully into the lime light of the field of physiologically demanded
eugenics through Dr. Dugdale's valuable book, not yet forgotten,
with a pleasing and saving contrast in the biography of the
person, Reverend Jonathan Edwards, as will appear below.


Reviews, Book Notices, Reprints, Etc.
109
These family records have been of much value in the prac-
tice and there are yet those in our field of practical and eugenic
endeavor who may profit much by their biographic study.
You will find, says the Albany Medical Herald, in "The
Jukes, a Study in Crime, Pauperism, Disease and Heredity,"
by R. L. Dugdale (Putnams, 1877), that the ancestor of this
famous (or infamous) family was born of Dutch parentage
on the then frontier of New York, somewhere in the neighbor-
hood of 1730. He was a hunter and fisher, a drunkard,
working intermittently, lived to an extreme age and left an
enormous progeny.
Of his direct descendants, 709 have been traced. I quote
from Judge Foster: "The family, while it has included a cer-
tain proportion of honest workers, has been on the whole a family
of criminals, prostitutes, vagrants and paupers. Not twenty
of the men where skilled workers and of these ten learned
their trade in prison, while 180 received out door relief to the
extent of an aggregate of 800 years. Of the 709 there were
76 criminals. Of the females, more than half were pros-
titutes (52.40 per cent. The normal average has been estimated
at 1.66 per cent.)
During this period the "Jukes family cost the State a
million and a quarter dollars, without considering the awful
legacy of crime and criminals which they left behind them."
Turn we now, by way of contrast, to a research made
into the history of the Edwards family, of New England.
(Data to be found in Boie's "Science of Penology.")
Jonathan Edwards, born in East Windsor, Conn., in 1703.
One thousand three hundred and ninety-four of his descendants
were identified in 1900, of whom 295 were college graduates;
13, presidents of our greatest colleges; 65, professors in colleges;
60, physicians, many of whom were eminent; 100 or more,
missionaries, clergymen or theological professors; 60, prominent
authors; 100 or more lawyers, of whom one was our most
eminent professor of law; 80 held public offices; 1 was vice-
president of the United States; 3 United States senators;
several were governors, members of Congress, mayors of cities
and ministers to foreign courts, and almost every department
of social progress and of the public weal has felt the impulse


110
Reviews, Book Notices, Reprints, Etc.
of this healthy, long-lived family. It is not known that any
one of them was ever convicted of a crime.
This is a demonstration beyond cavil of the strength
of heredity in perpetuating ancestral traits, both virtuous and
criminal.
And now, what do we propose to do about it?
There is a remedy, an absolutely feasible, safe and effective
remedy. It consists in asexualization, by an operation known
as vasectomy, first performed (as I said before) by Dr. H. C.
Sharp, of Indianapolis.
This consists in making a resection, cutting out a small
portion of and occluding by ligation, thevas deferens, a minute
duct, through which the spermatozoa pass to the seminal
vesicles.
Dr. Sharp thus describes the procedure:
"The operation is indeed very simple and easy to perform.
I do it without administering anesthetic, either general or local.
It requires about three minutes' time and the subject returns
to work immediately, suffers no inconvenience and is in no
way impaired for his pursuit of life, liberty or happiness, but
is effectually sterilized.
I have been doing these operations for nine full years
(1909.) I have 236 cases that have afforded splendid oppor-
tunity for postoperative observations, and I have never seen
any unfavorable symptoms. There is no atrophy of the parts,
no cystic degenerations, no disturbed nervous or mental con-
ditions, following, but on the contrary, the patient becomes of a
more sunny disposition, brighter of intellect and advises his
fellows to submit to the operation for their own good."
Jonathan had an intellectual overstrain, as Dr. Crothers
has shown, but it was functional exaltation and not vicious
degeneracy and not demanding surgical extinction of progeny
for the welfare of the race.
Surgery of the Arteries. Some personal experiences by
Albert Vander Veer, M. D., Albany, New York. This sub-
ject is treated in so broad and practical a manner that no one
should fail to read it. In fact it is handled in Vander Veer's
always efficient and entertaining manner. This paper is from


Reviews, Book Notices, Reprints, Etc.
Ill
the Transactions of the American Surgical Association, 1912.
The two following papers are by the same potent and efficient
writer and equally well presented. Their subjects—The South-
ern Surgical and Gynecological Association and The Ethics of
the Profession.
Iodin, its sources, preparation, and uses in medicine,
surgery and dentistry, by William A. Boyd, B.S., M.D. As-
sistant superintendent of the Westport Sanitarium, Westport,
Conn. From the Medical Times.
The Ethics of Our Profession by Albert Vander Veer,
M. D., Albany, N. Y. From the New York Medical Journal.
The Southern Surgical and Gynecological Associa-
tion by Albert Vander Veer, M. D., Albany, N. Y. Re-
printed from Albany Medical Annals.
On the Psychic Treatment of Some of the Fncution-
al Neuroses by Lewellys F. Barker, M. D., Professor of Medi-
cine, Johns Hopkins University, and Physician-in-Chief, Johns
Hopkins Hospital, Baltimore, Md.
On the Treatment of Some of the Forms of Cardiac
Failure by Lewellys F. Barker, M. D., Professor of Medicine,
Johns Hopkins University, and Physician-in-Chief, Johns
Hopkins Hospital, Baltimore, Md.
La Chirurgie des Alienes par les professeurs W. Bech-
terew et Poussepe. Extraits des Archives de Neurologic,
numeros de Juillet et Aout, 1912.
Some Experience With the Simpler Methods of
Psychotherapy and Re-education by Lewellys F. Barker,
M. D., Professor of Medicine, Johns Hopkins University,
and Physician-in-Chief, Johns Hopkins Hospital, Baltimore,
Md.


112
Reviews, Book Notices, Reprints, Etc.
The Luetin Test for Syphilis. A preliminary report
of forty-four cases, by R. B. H. Gradwohl, M. D., St. Louis.
From Medical Record.
Gallstones, by Harold DeWolf, M. D., The Glen Springs,
Watkins, N. Y. From Medical Record.
Intestinal Stasis in Relation to Cancer Etiology
and Prophylaxis, by William Seaman Bainbridge, Sc. D.,'
M. D., New York.
"Lest We Forget" read by Comrade William R. Hodges,
before Ransom Post No. 131, department of Missouri—Grand
Army of the Republic, April, 1912.
Submucous Resection of the Nasal Septum, Indica-
tions and Contra-Indications, by Hanau W. Loeb, A. M.,
M. D., St. Louis. From The Journal of the American Medical
Association.
Betterment of Life Insurance Service. Need for
better vital statistics. Report of health committee, Associa-
tion of Life Insurance Presidents. "Public Hygiene is built
upon and directed by, and is everlastingly in debt to vital
statistics. Every wheel that turns in the service of public
health must be belted to this shaft." Dr. John S. Fulton
of Maryland. Secretary General 15th International Congress
of Hygiene and Demography. Submitted at the Sixth Annual
Meeting of Association of Life Insurance Presidents, New
York, December 5, 1912.
Report of the New Jersey State Village for Ep-
ileptics, Skillman, Somerset Co., N. J., for 1912, Opened Nov-
ember 1, 1898. Object: "To secure the humane, curative,
scientific and economic care and treatment of epileptics."
We are pleased to note the curative feature among the
objects, for epilepsy is more curable than has been conceded
by the medical profession.


Reviews, Book Notices, Reprints, Etc.
113
The de Keating-Hart Method of Fulguration and
Thermo-Radiotherapy, by William Seaman Bainbridgc, Sc. D.,
M. D., New York. From Medical Record.
The One Hundred and Fifteenth Annual Report
of the Board of Managers of the Spring Grove State Hospital,
near Catonsville, Baltimore County. To his excellency,
the Governor of Maryland. November, l912.
The Modern Aspect of the Etiology and Treatment
of Syphilis, by Joseph L. Boehm, M. D. Formerly Professor
of Syphilology and Urology, St. Louis College of Physicians
and Surgeons, St. Louis, Mo. Reprinted from the American
Practitioner, June and August, 1912.
Criticism of Orthodox Interpretations of Occupational
Cramp-Neurosis and the Term Neurosis, by Tom A. Williams,
M. B., C. M. (Edin.), Washington, D. C. Formerly Corres-
ponding Member Paris Societies of Neurology and of Psy-
chology, etc.; Neurologist to Epiphany Dispensary. Re-
printed from The Medical Record, October 5, 1912.
Transactions of The Academy of Science of St.
Louis. The annual rainfall and temperature of the United
States. Geo. A. Lindsay, 1912, Vol. XXI, No. 2, and other
numbers.
Family Hematoporphyrinuria and its Association
With Chronic Gastro-Duodenal Dilatation, Peculiar
Fits and Acute Polyneuritis. A preliminary report. Lewellys
F. Barker, M. D., Baltimore, and W. L. Estes, Jr., South
Bethlehem, Pa. Reprinted from The Journal of the American
Medical Association, August 31, 1912.


PUBLISHER'S DEPARTMENT
Legal Language Prolixity and Obfuscation is thus
tersely criticised in the "Censor."
"What would happen if you went into the office of a busi-
ness man and attempted to tell him you just saw a man fall
off a street car, in the same form and manner in which the prose-
cution states its case in an indictment? He would have the
wagon called and would send you to the observation ward."
The Popular Idea.—The Christian Register puts in its
pleasantry page the following from the facetious Philadel-
phia American.
"Well," said Yuss, "I've taken a powder for my head-
ache, a pellet for my liver, and a capsule for my gouty foot.
Now what puzzles me is how do the things know the right
place to go after they get inside."—Philadelphia American.
This seems to be about the average Christian conception
excepting only the Christian Science idea, which is, that medicine
unlike food, does not go at all in the human economy.
Winter Colds.—There is nothing that will remove a
tendency to colds (nasal catarrhs, bronchitis, laryngitis) more
quickly and satisfactorily than a course of treatment with
Gray's Glycerine Tonic Comp. Its effect is not only to promote
reconstructive metabolism and thus enable the whole body to
better withstand disease, but in addition, it imparts a local
effect to the respiratory structures that unquestionably in-
creases the local resistance to bacterial invasion. One thing
is certain, cases of the ordinary respiratory diseases not in-
frequently prove intractable to all treatment until Gray's
Glycerine Tonic Comp. is administered. Experience has
proven this, and there are countless physicians who use this
dependable tonic exclusively for clearing up their cases of
pharyngitis, laryngitis, bronchitis and allied conditions.
(114)


does MELON'S FOOD give
such uniformly good results
in infant feeding?
does MELLIN'S FOOD prove
to be such a satisfactory modi-
fier of milk?
does MELLIN'S FOOD meet
the requirements of infant
feeding when so many other
methods fail?
One interesting and scientific reason which will answer, in part,
the above questions is that during the natural process of digestion a
portion of the Mellin's Food in the prepared diet is occluded in the
casern as it is precipitated by the rennet in the infant's stomach.
The occluded Mellin's Food retains its solubility, leaving the casein
soft, flocculent, sponge-like, easily permeated by the digestive juices
and incapable of existing as a tough, tenacious curd. Thus Mellin's
Food actually modifies the character of the casein.
Another reason for the success of Mellin's Food is that maltose
and dextrin, its carbohydrate content, are the carbohydrates that give
immediate and permanent results, being rapidly and completely utilized
to furnish energy and to increase body weight.
Uniformity of composition and simplicity of preparation are
other reasons why Mellin's Food continues to grow in the favor of
the medical profession.

WHY
Mellin's Food Company
Boston, Mass.


115
Publisher's Department.
The Modern Treatment of Infection.—A new agent
that will yield 90 per cent. of recoveries out of a total of four
thousand cases of infection is worthy of consideration. The
Phylacogens, prepared by Parke, Davis & Co., are credited
with this performance. Reports of the success attending
the administration of these bacterial derivatives have been
appearing with much frequency of late—reports so startling
in their nature that one would hesitate to credit them were
they not known to emanate from competent and conservative
practitioners. These reports compel the belief that in the
Phylacogens we have a group of truly remarkable agents—
products that will be makers of medical history; that are capa-
ble of producing results that may be designated as most unusual.
The Phylacogens are supplied in rubber-stoppered glass
bulbs of 10 Cc. capacity and are administered hypodermically.
Five of them are now supplied and are obtainable from any
druggist. They may be briefly described as follows:
Mixed Infection Phylacogen: Indicated in the treatment
of all infections, acute or chronic, in which it is not known what
particular micro-organism, if any, predominates—notably
in surgical infections, abscesses, puerperal sepsis, eczema,
fistulae, etc.
Rheumatism Pgylacogen: Indicated in the treatment
of any acute or chronic infection caused by the streptococcus
rheumaticus.
Erysipelas Phylacogen: Indicated in the treatment of
erysipelas—i. e., the acute disease caused by infection with the
streptococcus erysipelatis.
Gonorrhea Phylacogen: Indicated in the treatment of
any pathological condition due to infection with the micro-
coccus gonorrhoeae.
Pneumonia Phylacogen: Indicated in the treatment of
pneumonia or any pathological condition caused by the pneu-
mococcus.
Complete literature on the Phylacogens has been issued by
Parke, Davis & Co. and may be obtained from the company's
home offices in Detroit, Michigan.




ST. LOUIS MO.
Vol. XXXIV.
MAY, 1913.
No. 2.
A JOURNAL OF


AND
AND
FOR
THE NEUROLOGIST,
GENERAL PRACTITIONER
AND SAVANT.
Panopepton
§£s a "medicinal food
PANOPEPTON is often described as a medicinal food.
The extractives of beef as contained in the juice of a broiled beefsteak or rare
roast beef are highly savory and are powerful stimulants of digestion—of the
digestive secretions.
Panopepton contains all these extractives.
The inorganic constituents (the ash) are not only/nutritive, but are chemical cata-
lysers essential to the digestion and assimilation of food> Panopepton contains all these—
the potassium, phosphates, etc., of the wheat and beef, and of the digestive glands employed
When a physician gives Panopepton to a patient under the very many circumstances
in which this food proves a resource of peculiar service, it is a medicinal food.
Fairchild Bros. & Foster
New York


THE CINCINNATI SANITARIUM
- FOR MENTAL AND NERVOUS DISEASEs
INCORPORATED 1873
A Private Hospital of Modern Equipment and Methods
F. W. Langdon, M. D., Medical Director.
B. A. Williams, M. D., Resident Physician
- C. B. Rogers, M. D., Resident Physician
-**-
For descriptive pamphlet, address
H. P. Collins, Business Manager, College Hill, Cincinnati, Ohio.


THE
ALIENIST AND NEUROLOGIST
Vol. XXXIV. St. Louis, May, 1913. No. 2.
ACTION OF TONSIL
By
Isaac Ott, M. D.
Professor of Physiology, and John C. Scott, M. D., Lecturer
on Physiology, Medico-Chirurgical College of Philadelphia.
TONSILS are composed of a sponge-like connective tissue
infiltrated with lymphoid cells, accumulated in nodular
shape. These nodules are the germinating centers of the
lymphoid cells. On the surface of the tonsil are tube-like
crypts running inwards and lined with a stratified epithelium
and whose walls are lined with lymphatic nodules. Lymphoid
cells in large numbers are constantly passing through the
stratified epithelium into the crypts to become free and to enter
the mouth as the salivary corpuscles. Into the crpyts mucous
glands open. Delamere states that excluding embryological dif-
ferences there is only one difference between the tonsils and
the lymphatic glands; in the latter the lymphatics traverse
the gland, whilst the lymphatics actually arise in the amygdalae,
which from this point of view are comparable to the spleen.
Functionally the tonsils are a means of defence against
microbian invasion.
In our experiments the powdered dried tonsil of the calf
was used. A few centigrams was rubbed up in a mortar with
distilled water and filtered through paper. We also boiled
the filtrate in some of our tests.
1. The Lymphatics, page 84. 1904
(117)


118
Isaac Ott.
Circulation
In the etherized cat both small and large doses always
produced a fall of pressure (30 millimeters of mercury) and
usually a decrease of heart beats, both lasting a short time,
unless an infusion of 0.1296 grams was given when the depression
of arterial tension may continue for several minutes with a
slow and much stronger heart beat. A dose of infusion of
0.1296 grams can also produce immediately after the injection,
a sudden arrest of the heart. After the temporary fall of
pressure and of rate of pulse both are increased for a short
time, when the effect passes off. This increase in rate of the
beat of the heart may be 30 beats, and of pressure 12 milli-
meters of mercury. In the etherized rabbit the pulse may
not decrease, but increase, after doses of an infusion of 0.0162
grams, but the pressure after a temporary fall becomes greater
than previous to the injection. In larger doses of an infusion
of 0.129 grams the pulse rate may fall, but the pressure aug-
ments considerably. The fall of the rate of the pulse was not
due to any increased inhibitory action of the vagus, as it ensued
after previous atropinization. We also tested the excitabil-
ity of the vagus with Ludwig's shielded electrodes, but no
increase of inhibitory power was noted. Hence we infer
that the temporary decreased activity of the heart is due to
an action of the tonsil on the muscular structure of the organ.
Renal Secretion
The injection of an infusion of 0.1296 grams in divided
doses is followed by a great increase in the secretion of the
kidney for a short time, as the following experiment shows.
Cat, narcotized by 5 c. c. paraldehyde by the stomach,
and afterwards the use of a small quantity of chloroform
by inhalation.
Time P. M. • Drops of urine in 5 minutes.
2.10 2
2.15 6
2.20 2 infusion of 0.012 grams per jugular.
2.25 5
2.30 5 infusion of 0.0324 grams per jugular.
2.35 17
2.40 16
2.45 2 infusion of 0.0648 grams per jugular.
2.50 41
2.55 66
2.60 37


Action of Tonsil.
119
Here there is an increase of over 30 times the original amount.
When an oncometer was used with Albrecht's piston
recorder it was noted that the kidney was considerably en-
larged, so much so in one instance that it loosened the lid of
the oncometer. The increase in volume of the kidney is
considerable and continues for some minutes. As to the cause
of this great activity of the renal organ, it is difficult to be cer-
tain, for the kidney is enlarging when the general pressure
is constant. We have shown that parathyroid, pineal and,
with other observers, that infundibulin acts upon the kidney
cell by a direct action. Now the vaso dilation of the kidney
does not look like increased pressure in it, and the diuretic
action keeps up after the rise in the general pressure has sub-
sided. Hence we infer that the tonsil infusion acts directly
upon the renal cells in promoting diuresis. It seems to be a
stronger diuretic agent than either infundibulin, parathyroid
or the pineal gland.2 In fact, it is the most powerful diuretic
of all the internal secretions.
Intestinal Peristalsis
We made use of the intestine of the etherized rabbit and
the method of Magnus. We found it slightly increased the
intestinal movements.
Uterine Contractions
We used the uterus of the etherized cat in situ, and a
long, light lever was attached to one of the uterine horns.
The abdomen was filled with Ringer's solution heated to the
temperature of the animal. The infusion of the tonsil was
givea per jugular. There was some increase in the activity
of the contractions of the uterus.
Vesical Contraction
In this case we attached the neck of the bladder by a
cannula to a water manometer. The bladder was filled with
normal saline solution of the temperature of the animal's
body. The cat was etherized during the experiment. The
tonsil increased the contractions of the bladder to a small
extent.
2. Internal secretions, page 24.


120
Isaac Oti.
Temperature
The subcutaneous injection of an infuson of 0.1296 grams
of tonsil in rabbit caused the temperature to fall 1.8°F. in an
hour and a half. The animal was permitted to run about
the laboratory.
Internal Secretion
The fall of blood-pressure and the cardiac death after
large doses of the tonsil per jugular are results obtained by other
animal extracts, as pancreas and prostate. But these agents
do not have any diuretic action. Hence we are led to the con-
clusion that the tonsils probably have an internal secretion.


ANATOMICAL, PHYSIOLOGICAL AND PHILOSOPHICAL
THOUGHTS ON EVOLUTION.
By Amos Sawyer, M. D.
. Hillsboro, Ill.
1would not be understood as making the attempt to
demolish the evolution theory in a single essay, as this
would necessitate the dissection of every point, and there-
fore would require quite as much manuscript as the work under
review. I am aware that the opinions herein set forth, lay
me open to the charge of not being "up with the times," but
may it not be that to be "up with the times" is to have gone
in advance of evidence, reason and consciousness? We are
all inclined to accept the assertions of scientific men as true,
assuming that they have been thorough in their research, and
therefore can not be mistaken in their conclusions, and all
this in the face of the fact that a department in science can
not be named, but investigation will prove that at times its
disciples have jumped at conclusions, based upon insufficient
evidence, and stated them as facts, only at a subsequent
period to discover their error and recant. When the House
of Lords in England was investigating Stevenson's project
for a railroad, Sir Ashley Cooper was asked, what would be the
effect on passengers traveling at the rate of 25 miles an hour.
He promptly replied, "It will fill your mad-houses, the human
brain cannot stand the whirl produced by rushing through
the atmosphere at such a rate." Without investigating the
reason for this conclusion, his opinion was accepted as correct
and heralded throughout the land as the principal objection
to the new invention. Yet an illiterate coal miner had the
boldness to declare and demonstrate that the most renowned
surgeon*of his day was wrong in his conclusions.
(121)


122
Amos Sawyer
At the present time it is safe to say that the theory of
evolution has been accepted by nearly every scientific man,
as the most reasonable solution of a question which, with
or without acknowledging the existence of a Creator, would
account for the various forms of life. With the acknowledg-
ment evolution would be unnecessary, unreasonable and com-
plicated. True, Darwin tells us: "A few forms (query: how
many, and how do you know this?) were created capable of
developing into other forms as needed" and this nacessitates
the existence of a creator. Such conception of the Deity,
so contrary to biblical verity can only result as it has in adding
to the atheistical ranks and, therefore unlike the author, a large
proportion of his followers believe that life was induced by
external circumstances.
It is my purpose as succinctly as possible to show wherein
the evolution theory is contrary to the evidence and reason.
I shall attempt to show that everything was created for a pur-
pose, and only ceases to exist when the purpose has been ful-
filled. That it would be unnecessary and therefore unreasonable
to suppose that God would create a spiritual being (soul) in
an ape, for it could never become evolved into man without
this addition, or if so, that he would include them all and ex-
tinguish the species. That the fossil remains of animals
afford no evidence to sustain the theory, they show extinction,
but not merging of the species. After a careful survey of the
subject I will direct your attention to a few philosophical
reasons as well as physiological facts, which to me seena
incompatible with the theories of evolution, descension or select-
ion.
Haeckel says: "There must be a blind belief in the creation,
or a scientific theory of evolution, there is no third course."
Now let us see how much science depends on blind belief.
He says: "After many million of years during the Archilithic
epoch, there came into existence by spontaneous generation,
through a nitrogenous carbon compound in the sea the oldest
and simplest organism—the minera, (query: if this is not
blind belief what is it?1) from these one-cell plants first de-
lWhen this world wu m molten man as it once was, there could not have been life,
and as matter does not contain anything spiritual, spirit can not be evolved from matter,
therefore it must have been created. "For of the soul the body form doth take.
"For soul is form and doth the body make."


Thoughts on Evolution.
123
veloped; then all the invertebrate ancestors of the human race
developed from these one-celled organisms, hence this epoch
is the age of man's invertebrate ancestors. In the Palaeoli-
thic period (of Devonian old red sand stone; Carboniferous;
Petniam or new red sand stone) we have fishes perponderating
or the age of fishes. During this period some fishes began
to accustom themselves to living upon the land and thus gave
rise to the amphilia class, which we find in the carboniferous
period; these were the earliest air-breathing animals. (Query:
How did the fish manage to get on the land, and how could
they sustain life by the gills coming in contact with atmos-
pheric air? They can not do it now.) Toward the close of
the Permian period we find the first amnion or lizard like ani-
mals. In the Mesolethic or secondary epoch (Triassic, Juras-
sic, Cretacious) was the age of reptiles; but the class of birds
also developed during this period, undoubtedly originating
from the flying lizard-like reptiles, from the fact that fossil
birds with toothed jaws and lizard tails belong to this period.
It was in the triassic strata of this period that we find the molar
teeth of a small insectivorous marsupial, and all the mammals
of this period belong to the low pouched animal division.
The fourth division of the history of the organic earth is divi-
ded into three subdivisions: Eocene, Miocene and Pliocene
periods. This, the Lertianz epoch, may be called the age of
mammals. The most perfect section of this class (placental
animals), among which is man, now first appeared. The develop-
ment of man from the most nearly allied ape form dates proba-
bly from the Miocene period, (Vol. II, pp. 11-15.) Now the
strata, he tells us, deposited during this period were about
3000 feet thick. The deposition went on at the probable
(blind belief again) rate of two inches for every 100 years,
or 600 years for every foot. A total of one million, eight
hundred thousand years. Now in this deposit there has been
found about 1000 species of shells, only one fourth of which
are extinct; also the crab, lobster, shark, seal, crocodile, horse,
ox, different species of deer, bear, dog, cat, otter, beaver,
hare and a host of other animals, living specimens of which
exist at the present day, in fact everything but man. Is it
not strange that in whole or part the skeleton man should


1X4
Amos Sawyer
not have been found, or at least that of a monkey in the state
of transition? It seems that all the species of animals which
we find living on the earth existed then, and that the law now
in force, that the offspring is of the same kind with the parent,
at least is not two million years old. Thus we see, to be evo-
lutionists, we must believe, (though belief is no good) in some-
thing which does not exist today and, so far as we have any
proof, never did exist. Spontaneous generation through a
nitrogenous carbon compound, that one-celled plants and
animals developed from these so-called bodies; (i. e., they
bestowed upon another that which they themselves did not
possess) these developed into fish, then some fish crawled on the
land and accustomed themselves to living in an unnatural ele-
ment breathing air through their gills until lungs developed, not
from their gills as they should have done, if they followed
the law of evolution, but from their swimming bladder (Query:
why don't they do this now? Except by a creative act how
could lungs be found within a bladder, and how was the blood
vessel changed so as to bring their contents in contact with
the inspired air?) This gave rise to the amphitra, these
turned into lizards, some of them having wings, these changed
into birds, birds into mammals, including man and the monkey.
That the chief modifications of animals and plants result
in the use or disuse of their organs. (If this is true then lungs
in the fish never developed from the swimming bladder.)
For example: the wood-pecker and humming bird developed
their peculiarly long tongues by the habit of using this organ
to take their food out of the narrow and deep crevices. (Query:
how was this habit established, why at first did they not obtain
their food like other birds?) The frog acquired a web between
its toes from the habit of swimming. (Query: if he was not
created to swim how did he first come to go into the water,
and why was it necessary for their eggs to be deposited there?
Why don't toads have webbed feet? From what were frogs
evolved?) That the mammae were first merely large seba-
ceous skin-glands, and were developed in the marsupialia
by the young sucking a gland. Now what are we to think of
the mental vision of one who would believe that the contents
of a sebaceous gland, one of those that keeps the skin soft


Thoughts on Evolution.
125
by its exudation of the black-heads which girls remove with
a watch key, could sustain a young animal? They would
have to suck on the same gland all the time. How strange
it is that the young animal would develop two nearly opposite
on each side in some animals, and 8 or 10 in each of the two
parallel rows in the belly, like in hogs and dogs. Now I ask
you if this explanation, founded on merely "no good belief,"
as offered by one who stood foremost in the ranks as author-
izing on evolution, does not require a greater stretch of the
imagination and credulity than any before presented by science
or religion? Why, it's the worst kind of blind belief, it's mam-
moth cave piscatorial blindness, for there are no eyes at all.
It is evident that Haeckel recognized this fact, for he says:
"The special proof of all separate parent forms must always
remain more or less incomplete and hypothetical. (Blind belief
again.) For all the records of creation upon which we rely,
are in a great measure incomplete, and will always remain
incomplete for the germ history itself is known only in the case
of very few species." Haeckel's theory makes one feel like
saying with Josh Billings, "I would rather see a man who did
not know anything than one who knew so much there was not
any truth in."2
It has been denied that Darwin claimed that man descend-
ed from the ape, so I will give his exact language in two of
his many declamations on this point. "As man agrees with
the ape in all these characters which he possesses in common,
we may infer that some ancient member of the anthropomor-
phous sub-groups gave birth to man." Again, "The species
have not been separately created." Now let us see what
Huxley's views were on this point. At a meeting of the British
Association in 1879, regarding mans having been once an ape,
he said: "I must confess that my opinion remains exactly
where it was some 18 years ago." sSpeaking of the Neander-
thal skull, he says: "I believe it to belong to the lowest form
of human beings of which we have any knowledge and we know
2. Where did the life of this spontaneously generated miners come from?
3.1 scree with Huxley when he ssys: "An opinion which outstrips evidence, is not
only s blunder but s crime." Remember we can not produce or destrey the smallest
particle of matter. No artificial process has ever made living matter out of dead.


126
Amos Sawyer.
from the remains accompanying that human being, that so
far as all fundamental points of structure were concerned, he was
as much a man, could wear boots as easily as any of us; so that
I think that the question remains much where it was. I don't
know that there is any reason for doubting that the men who
existed at that day were in all essential respects, similar
to the men that exist now."
Virchow said, addressing the savants of Munich: "Not
a single fossil skull of an ape man has yet been found that could
really have belonged to a human being. Every addition to
the objects which we have obtained as materials for discussion
has removed us further from the hypothesis propounded. As
a matter of fact we must positively recognize that there still
exists as yet a line of demarcation between man and the ape.
We can not teach. We can not pronounce it to be a conquest
of science that man descends from the ape or from any other
animal. We can only indicate it as an hypothesis, however
probable it may seem, and however obvious a solution it may
appear. (Freedom of science in the modern state—page 62
and 3.) It is strange that a man possessing the faculty for ob-
servation shown by Darwin, with the evidence at hand, should
have made the attempt to prove that man was evolved from an
ape. Apes are governed in their movements entirely by in-
stinct, no one possessing more intelligence than the rest. It
is a deviation from the procreative without a parallel for the
offspring. Man, although alike in his physical conformation
and nature with his fellow man, differs from his ape progenitor
in osseous and muscular formation in the possession of extra
bones in the spine, an extra muscle in the hand as well as differ-
ent insertions of mutual muscles, not to mention difference
in form and expression, while mentally unlike the ape (one
the equal of all the rest) they range from the mass on the
ground to him who far in advance of all others stands high
upon the mountain of knowledge.
The evolutionists say that man's consciousness has been
gradually progressing from the lowest to a higher sphere of
thought, knowledge and morality. Ethnology proves to the
contrary; it shows a mental ebb and flow. Confucius, who
lived 550 years before Christ, could find no reliable data for


Thoughts on Evolution.
127
the events recorded in Chinese history beyond 200 years prior
to himself. This proves the priority of Egyptian chronology;
for the great pyramid was erected in the fourth dynasty and
has been shown by Mr. Smith of the British Museum, with
other scientific men, to have been designed to perpetuate
certain mathematical and astronomical truths which at the
present day we can do no more than verify. The specific
gravity of solids is determined by the theorem of the renowned
Archimedes, by which he detected the fraud practiced upon
King Hiero of Syracuse, by the goldsmith who furnished
as a crown of pure gold, one of base metal. Compare Homer,
Cicero or Shakespeare with the authors of the present day.
In art Michael Angelo, Raphael and Van Dyke. In science,
Copernicus, Galileo and Newton. In engineering, look at the
Roman aqueducts. In architecture, the Coliseums and Egypt-
ian pyramids. For inventive genius in forging steel, what
will compare with the Damascus blade? Combining the keen
edge of a razor with the elasticity of whale bone, it could be
tied in a knot without breaking. How was steel treated
that no matter what the exposure, it would never rust? How
were images of glass blown into balls of the same material
and remain loose in the cavity by which they were surround-
ed? These are only a few of the lost links of knowledge evol-
ved from the brain of an ancient race of people. If your
son expresses the wish to become a sculptor, painter or musi-
cian, in order that he may excel, he is sent to Europe to study
the works of the old masters. Aristotle is credited with writing
the first history of evolution. Again if this theory is correct,
then the offspring of our learned men or bright minds should
excel their parents; but on the contrary as a rule intellect-
ually they prove to be inferior to their sires, (retrogression
evolution) whilst he who advances to the front ranks of science
and learning usually, like the meteor, flashes his light from
a direction we least expect.
Lamarch says: "The most highly developed apes ac-
customed themselves to walk erect, and gained the ascendant
over other animals. The absolute advantage they enjoyed
and the new acquirement imposed upon them, made them
change their mode of life, which resulted in a modification


128
Amos Sawyer.
of their organization, and their acquiring many new quali-
ties, among them the wonderful power of speech. (Query:
where are some of those speaking monkeys now?) Darwin
accepts this theory, for he says: "As far as we can judge,
the tail has disappeared in man and the anthropomorphous
apes, owing during a long lapse of time to the terminal portion
having been injured by friction (Descent of man, p. 60,1881.)
I presume this will account for the rabbit's short tail, the squirrel
retaining his because of the habit of flopping it over his back
when he sits down. (Query: why didn't the monkey, like the
the ape, wear off his appendage behind? Surely he sits down
quite as frequently as the larger species of his family, and the
friction would be equally as great.) Haeckel says: "Bats
probably (blind belief again) developed their wings in their
flight from tree to tree to escape an enemy, or in search of food.
(Query: As they must, before their wings began to be developed,
have had to jump from tree to tree, would not the legs be the
part developed? Why were not wings developed on our com-
mon squirrel, in their flight from tree to tree?) We see that
friction was an important factor in evolution.
Man is the only being endowed with speech because he
is the only one upon whom God bestowed the scintillation
of His essence— a reasoning soul—which enables him to look
backward over his past life as well as that of the generations
which have preceded him and profit by his and their experience.
Forward, to so guide his craft as to be able to "luff and bear
away" from the obstruction and dangers by which he is ever
surrounded and which by carelessness or over confidence
has wrecked many a staunch craft sailing o'er life's stormy sea,
upward from the boundless depth with which a parent loves;
from the charms of pleasure and the lures of gain to a lovelier
image of the purely beautiful—that of the Creator of the Uni-
verse who has prepared for us in the realms above, a purer,
brighter, happier home where the eternal dialect of love shall
be the free gift of every living soul. Whence sprung such emo-
tions? Can it be from the apes? Never! For they were
not and are not in possession of them. Language results from
thought and knowledge, but as we can not have thought
and knowledge without language, they must have been be-


Thoughts on Evolution.
129
stowed at the same time. The mind of man is an actor, origi-
nating ideas which are absolute. Apes emit sounds like other
anim als induced by external impressions, not produced by the
mind, language like the soul, is indispensable only as far as
human nature is necessary and could not be evolved from an
animal never in possession of it.
Another branch of the evolutionists say that there was
a time when this earth was a fiery globe; when animal and vege-
table life could not exist; but so soon as the temperature per-
mitted, "organic life developed itself from external circum-
stances," or as Haeckel expresses it: "spontaneous generation
through a nitrogenous carbon compound." In other words
something was evolved from nothing and therefore had no
parents. (Query: where did this fiery globe come from, and
how did it originate? We don't want any blind belief, "it's
no good.") Now if this was the case, why does it not happen
today and crowd the earth with organic life, for the nitro-
genous carbon compound is still to be found, at least the
constituents are here in abundance. We are all conscious
that it does not act in that manner now, for even the ciliated
infusiorium, so minute that millions and millions are swallowed
in a draught of water, reproduce their species by means of
eggs formed in special generative organs fecundated by the
union of the sexes and their organization is as definite
as that of the other classes of the animal kingdom. Admitting
the theory of the survival of the best developed of each animal
species and the consequent increased development of the osseous
and muscular tissues in their offspring over the original stock
as between the wild hog and specimens of our improved breeds;
yet in the one case it would be an infusorian, as in the other
it is a hog; for it is the law of nature that animals and plants
are of the same kind as their parents and there is no deviation
from this law. Geology furnishes us proof of the extinction
of certain species of animals, the fossil remains giving evi-
dence of their gigantic size. Why did evolution cease in this
direction if it was not that the object of their creation had
ceased to exist? The wild American bison for this reason
has already been added to the list.
Life is the divided portion of some similar life. The


130
Amos Sawyer.
caterpillar is a young butterfly, though at this stage of its
existence, in appearance, so different from its parents. For
this reason the different species in the animal and vegetable
kingdom have remained without essential change since the
earliest historic record. It is a germination, growth, blos-
soming, fructifying, decay and death, resulting from the opera-
tion of laws in force since the world's creation. The only way
the necessary change in the animal species can be effected,
necessitates the merging of one species into another; but un-
fortunately for the evolutionists, this ends with the first genera-
tion, for hybrids can not procreate. This points, not to chance,
but to a wise provision of the Creator, for it serves not only
to keep every species distinct, but also places a barrier before
the evolutionist which he can not overcome, as it matters not
what a change in size, form, color, may be wrought in an
animal, it will still retain enough of the distinctive features,
which without a moment's hesitation enables us to say, that
is a horse, that is a dog, and so on to the end of the list. For
example; take a group of men, each one in some respect will
differ from the others, yet the vainest fool or ignoramus ana-
tomically, is a man, and he whose learning places him in the
front ranks of science is no more. Evolutionists say that
a change of food and condition produces the wonderful trans-
formation which in the past they claim has taken place. Haeckel
says: "New Zealand possesses two species of bats found no
where else in the world," and many islands possess their pe-
culiar bats that he accounts for by saying that they were
some wandering species modified in their new home by change
of condition. (Blind belief again.) They cite the honey-
bee as an example where a neuter bee can be changed into a
queen bee by changing the food. Grant this: but is it not a
bee and easily recognized as such? Let them change a bumble
bee into a honey-bee, (Query: which was evolved from the
other?) a cow louse into one of the kind infesting a hog,
dog, horse or man and thus get rid of their "blind belief."
If their theory about the change of food is correct, there should
be more points of agreement than difference between a hor-
net and a spider as they both catch flies for their young; and
so on ad infinitum. Cattle lice would only need to be trans-


Thoughts on Evolution.
131
ferred to the horse or man to become changed into the para-
site which naturally infests them; whereas, on the contrary,
they die shortly after the transfer.
Every species of animals has its own epizoa and entozoa
and they die transferred to an animal of another species and
they infest the part where they find the proper pabulum for their
development. To illustrate, one each 5. This shows quite a
numerical difference and often in the wrong direction, we find
that man has one more lumbar vertebrae than either one of the
species that are supposed to approach him more closely, and one
more sacral bone than the apes. Now let us see how the spinal
column of a man could be evolved from the ape. He could
get his 12 dorsal vertebrae from the Orang; the 5 lumbar
vertebrae from the Gibbon; but whence came his fifth sacral
vertebrae? The apes have but four. Coxcyx man has four,
Orang, Chimpanzee and Gorilla each five, Gibbon three.
Now this snarl in the spinal column can't be unraveled by the
evolution theory. They could not straighten it with a plaster
paris jacket. It's a problem in spinal arithmetic that can't
be solved by evolution algebra. The extensor muscle of the
index finger is found alone in man. Now if there was only
a rudiment of the bones or muscles in the ape, there might be
some evolution theory for the conclusion that they had become
developed as the necessity for their use arose; though how
they could be thus developed is a mystery, since we find it
so difficult and ofttimes impossible by the aid of electricity
and massage to restore the atrophied muscle, contracted tendon,
or lost osseous matter, but as there is not, then, admitting
that the evolution theory is true, these extras for man must
have been created, and this would necessitate a Creator, call
it by whatever name you please. In the mammalia, the plane
of the condyles are oblique, showing that the erect posture
is not natural to them. The position of the face immediately
below the brain is characteristic of man alone. Man is the
only one of the mammalia who can stand on one leg.
The skull of man is smooth, in the ape it has ridges for the attach-
ment of muscles which are very strong. The fusion of the
intermaxillary with the superior bone, at an early age of foetal
life, characterizes the human cranium from that of the ape,


132
Amos Sawyer.
which remains separate to a much longer period. The flexor
longus policis muscle is inserted into the great toe of man
on which the weight of the body can be supported, whilst
in the ape it is inserted to the three middle toes. In man
there is an absence of the laryngeal pouches found in apes.
Another remarkable fact, unexplained by the erect
posture of man is his adaptation to the varieties of his sur-
roundings. He can endure the vicissitudes of climate; live
on an exclusive vegetable and almost exclusive animal diet.
The Chimpanzee and Gorilla are restricted to the hottest
parts of Africa; the Orang to the tropical portion of the Indian
Archipelago. They can not live in temperate climates except
by the aid of artifical heat, and even then they do not long
survive. Their diet is exclusively vegetables. Looking at
the subject from this direction, I do not see how the necessary
transformation could have been effected by any known physio-
logical law, or the theories of evolution, descension or selection
sustained. If the evolution theory is true, then man's first
appearance was in a tropical climate.
At a recent congress of German anthropologists at Halle,
Professor Klaatsch, of Heidelberg, read a paper contending
that as the result of several years' investigation the alleged
descent of man from apes was no longer maintained. His
conclusions were based on the construction of the bicepalous
muscle of the upper thigh. He contended that it was a mis-
take to regard man as the most perfectly developed mammal
in all respects. His limbs and teeth do not show any high
degree of development, and he is only superior to other animals
by his extraordinary brain development. To prove our common
origin, mention is frequently made of the fact that the human
embryo in the third and fourth week of its existence exactly
corresponds to the undeveloped embryo form presented by
the ape, ox, horse, dog, rabbit and the other mammals at the
same stage of their ontogeny. But although a close exami-
nation will disclose a marked difference, even in the plates
presented by Haeckel, still admitting his declaration (VI p. 18)
to be true, it adds nothing in support of the theory, for the
germ frame work in all mammals being somewhat similar
in its construction, necessarily there would be in appearance


Thoughts on Evolution.
133
in the inception of its creation, more points of agreement
than difference, yet the fact that in its imago stage, it clearly
shows which was man and which was ape, dog, horse, etc.,
proves beyond cavil that they were not the same form but
distinct patterns of their own species. As well argue that
because the fruit and seed of the mulberry resembles the
blackberry so closely, they must have had a common origin,
and that the tree was evolved from the vine.
The improvements we witness in the different breeds
of domestic animals is accomplished by making ajudieious
selection of those possessing in a greater degree than others,
assimilative powers, which enable them to increase their
muscular and osseous system, or deposit a larger amount of
the carbohydrates with a given quantity of food, and then
propogate the species from them. But this improvement
lasts only as long as the same care and attention is bestowed;
simply this and nothing more can be accomplished by mortal
man. To me, therefore, it seems more in accordance with
common sense, reason and the evidence, to believe that all
the species of animals were created perfect, with mechanism
suited to the sphere and object that they were intended to fill,
than that it was left to nature to evolve as occasion required,
with assistance rendered, as a creative act; as an evolution
starter we can never know that the evolution theory is true,
as the law is not now perceptibly, in force so as to make us
conscious of it; for remember, science deals with facts, and dares
not have anything to do with belief. Confucius said: "To,
know what you do know, and not know what you do not know
is true wisdom;" and this precept seems to have been forgotten
by evolutionists. We find that it is a law of nature that ani-
mals and plants are of the same kind with their parents, and
the fossil remains of extinct animals proves nothing to the
contrary. As well declare that sheep spring from the goat,
the rat from the mouse, the boa-constrictor from the cobra,
or vice versa, as man from the monkey.
If you will stop long enough to consider what a stupendous
undertaking it would be to effect the anatomical and physiolog-
ical changes necessary for the transformation of the ape into
man, we will see the absurdity of such reasoning; as you must


134
Amos Sawyer.
rasp down the ridges and sand paper to produce a smooth cranium
and then enlarge it internally and externally; fill up with
osseous matter the foramen magnum in the middle of the poster-
ior third, and cut a new one just behind the center of the base;
shorten the arms; lengthen the legs; arch the feet; enlarge the
pelvis; add a lumbar and sacral vertebrae; change the angle
of the vertebral column; shorten the jaws; in fact, there is not
a muscle or bone in the whole structure, but that some change
in its form, origin or insertion would be necessary before evo-
lution would be completed, not to mention soul and language
which must have been created. Surely, such wonderful
changes could not have been accomplished in a single leap,
but must have gradually been graded up to man; and if this
was the case where are the intermediate species? Haeckel
answers: "It is evident that no single one of the existing man-
like apes is among the direct ancestors, but they are the scattered
remnant of an old caternine branch once numerous, from which
the human race developed, as special branch in a special direct-
ion—Vol. 11, pp. 181-2-3.) In other words, they are lost.
In this respect they resemble their advocates, for they assert
that the fittest survive, and as each new development, as it
approached man, must, according to their theory, have been
superior to their predecessors, living specimens should be
found, but inasmuch as they have failed to produce the fossil
remains of these pen-pictured, wonderful animals, it is asking
entirely too much, when they demand that we shall admit
their existence from analogy, by observing the laws by which
they profess to be governed, (Science deals with facts), we
consistently can refuse to believe, because they do not know,
and also because the evidence is not sufficiently clear to warrant
their own members uniting upon it; but on the contrary there
are three divisions, each positive they are right. Therefore
the only way left for the evolutionist is to convince us, and
this they must do by reasoning.
The first thing to be done is to show the necessity for
the Creator to adopt this plan; or ignoring such a being, how
external circumstances, or spontaneous generation, by a nitro-
genous carbon compound, acting on an atom of original
slime, could induce the formation of the different genera of


Thoughts on Evolution.
135
animals and plants; as well as why this law does not exist at
the present time? They have not, and can not give satis-
factory answer and it remains as at first, a very pretty theory,
or chain of thought, mended with such ingenuity where the
links are broken, that to the careless observer, the imperfect-
ions would never be discovered. We must estimate the value
of the Darwinian hypothesis by the same rule that we apply
to others, that is, its ability to account for all the facts of which
it pretends to be the solution; for if there is only one fact
which it cannot explain (and there are a host of them), if there
is one fact at variance with the hypothesis (and there is a full
legion) it must give way and the fact stand; for as Professor
Huxley truly said: "One fact is worth 500 hypotheses."
Vegetable life in its various forms, must have been created.
To view it in any other light would be contrary to observation
and reason, as evidenced by the fact that it is possible to kill
out any or all the different varieties of trees and plants by
destroying the growth and seed. If the trichina infusorum,
in fact any species of life from the highest to the lowest, could
all be destroyed there would be no more on this earth. Disease,
like syphilis, chorea, small-pox, etc., once stamped out would
never reappear; that this is universally conceded, legislative
enactments, having in view the extinction of contagious diseases
and obnoxious plants, prove conclusively. It is therefore
logical to conclude that they must have been created, and if
this law applies to a few, why not (in absence of proof to the con-
trary) to life in all its various forms and conditions? In
this wrestle on the "catch as catch can" plan between nature
and organic life, as represented by the evolution theory, it is
strange that we should find, as we do, every part adapted
to the work it has to perform; the elephant's trunk; an ostrich's
stomach, a shark's mouth, the lance of the mosquito, or the
insect that builds its coral house far below the surface of the
deep blue sea. No improvement can be suggested; all is per-
fection . Even when we meet with an exception to one of natures
laws, as in the density of water we see the evidence which points,
not to chance, but to an omniscient and wise Creator, foi
organic life depends on this deviation. The fact that liquid
bismuth also expands in cooling, does not invalidate the fact


Amos Sawyer.
that upon water possessing the same property depends the
existence of organic life. At all events if this deviation is due
to chance, it is a very fortunate thing that it chanced that way.
Finally, if the evidence adduced to sustain the evolution
theory has been demonstrated to be irrefutably true, then all
scientific men should agree upon it; but the fact that there
are many who refuse to believe, a hesitancy on the part of
others, proves to the Christian world that up to the present
time that the evidence brought forward to sustain it is not
sufficient for conviction among their own rank and file, when
therefore the men standing on top of the evolution ladder
cannot agree in the description of the creative changes, which
by their wonderful scientific vision they claim can so plainly
be seen has taken place, how can they expect the mass on the
ground to believe that they see anything? It is like finding
water in the desert; when you reach the spot where under an
optical delusion you could swear that you saw it, it is not there
but the same distance ahead and you follow on until lost.
The truth is, that the greatest observers often form fallacious
generalizations on a few selected facts.
I will now present the premises of both sides, and the
deductions drawn from them. The evolutionist believes
that the organic world sprung from a germ—a one-celled plant—
and from this the various living forms were evolved. Man
is the acme of vegetable life. And this is what Henry Ward
Beecher called "The reigning philosophy for all time." And
right here it would seem proper to ask, why in accounting
for the drift, we find that the "reigning philosophy" of all
the geological world has changed three times? Thirty years ago
geologists thought that they needed not less than a thousand
million years to account for the changes and distribution of
living things on the earth and supposed that they could have
an unlimited duration to draw from, but Lord Kelvin pointed
out that the earth was a cooling body and receives from the
sun a definite amount of heat each year, and the laws of heat
did not allow that the earth could have been a habitable
place for any living thing before 20 million years.
About four years ago Professor Perry investigated the
problem and concluded that a thousand million years was more


Thoughts on Evolution.
137
probable, and so it stands to-day. When examining a number
of deep sea dredgings, Professor Huxley discovered a grey
gelatinous mass resembling protoplasm. This he called
the primeval living slime, the unorganized beginning of life,
that had floated from the beginning: the essence of life from
which the earth had been clothed with green plants and popu-
lated with animal life. Recently, Sir John Murry found that
when it was mixed with strong alcohol it threw down a chemical
gelatinous precipitate. Thus a beautiful theory was demolished.
It proved to have been a jumped at conclusion, stated as a
fact. Now gentlemen of science, how are we to know that
in this case you will not, as in the past, be ready to drop it for
the first new theory advanced by some votary of science whose
aspiration for fame overcomes his normal cerebration. The
Copernicus system of astronomy is only a hypothesis, (blind
belief) yet as there is not any fact which it can not explain,
we accept it as true, but this can not be said of the evolution
theory'. We continuity witness the truth of what Bulwer said:
"The science of to-day may be the ignorance of tomorrow.
Every year some bold guess lights on a truth to which but
the year before the schoolmen of science were as blind moles."
Among other things in proof of this, collegiate science
scorned Galileo and his telescope, as it might be a fraud; ridi-
culed Harvey's circulation of the blood; pronounced the cross-
ing of the Atlantic by steam, impossible, and that electricity
was incapable of competing with steam. It would seem that
they could say with Ruskin: "I have little faith in my opinion
until I have changed it three times." Apart from biblical
history Christian belief in the existence of a Creator of the
Universe is founded upon evidence that up to the present
time has proved incontrovertible; for it is impossible to ex-
plain how, and therefore unreasonable to ask us to believe
that external circumstances from an atom of original slime,
with the assistance of a nitrogenous carbon compound, should
have formed this earth, and male and female of the different
species of animals, the one to contain a receptacle for a mi-
croscopic atom of the other, and from this minute particle
form a little image of itself, with mechanism so complicated
that human intellect up to the present time has been foiled


138
Amos Sawyer.
in it» attempt to fathom it. How, and why evolve a species
of locust that effects its alternation of generation every twelve
months, and another kind require seventeen years? Why two
kinds of wasps, whose chief difference is in color, the one should
construct its nest of mud, and the other of woody fibre? Why
the atoms should have been so grouped that from the same
quantity of the same elements (C 6, H 5, O 5,) there should
be formed such different bodies as sugar, starch and wood?
Or how the rotation of the earth should be just sufficient to
cause the waters of the ocean to remain on that vast slope
that rises from the pole to the equator to a height of 18 miles,
and thus prevent it from seeking its level and making the earth
a perfect sphere? That this same external circumstance
should have so formed the sturdy oak, that rears its broad
head toward heaven's blue dome, that its pollen falling upon
the flowers of the different varieties of the same family, or that
others distinct from it should not fertilize them, until at last
all the genera were evolved into one, or making an exception
to the law of density in water, knowing that a law cannot
change itself, the exception must have been caused by that
upon which it depends, giving evidence of the thought, know-
ledge and wisdom of an intelligent Creator, for without this
provision, this earth would be a globe of ice.
As this peculiar "combination of circumstances" in the
beginning must have been in universal operation, how did
it happen that in the origin of the animal species.that in Ameri-
ca, the rat, house mouse, owlet, moth and a host of other im-
ported pests were not evolved? What did the germ that
evolved the turkey in America make in Europe? The germ of
the horse in Europe make in America? Why did this "uni-
versal one-cell green plant" from which the evolutonists tell
us that all the forms of animal and vegetable life spring, work
its way into a bumble bee in America and miss it in Australia?
Why run into a buffalo here and not in Europe? It must
have been a cross-grained green cell that evolved a grizzly
bear. Again we ask if all animals have an evolutionary ori-
gin, why should they have a scent common to the species?
A hound can be trained to chase deer by day and coons by night.
A bird dog to hunt only quails or grouse. A blood hound


Thoughts on Evolution
139
to keep through a crowd of men the human trail that he was
given to follow by the scent peculiar to the individual. Can
these things be due to chance or creative wisdom? Which
is the more reasonable conclusion? Conforming to the law
of nature we find that the offspring is of the same kind with
the parent, or in other words that animals and plants are pre-
ceded by similar animals and plants and this we find to have
been the case for millions of years; in the absence therefore
of evidence to the contrary, we in accordance with an axiom
in reasoning, conclude that this law must have always been
in force, and as it is incompatible with, we exclude evolution
as a factor in creation.
We also see that force is in the union of opposites; that
everything, whether simple or compound, depends for what
it is upon that which it is not. Water is formed by the union
of oxygen with hydrogen; salts are formed by the combination
of acids with bases, and so on to the end of the list will we
find that the elements of matter depend one upon the other;
they are numbered, each one possessing its own shape, size,
weight and combinations with the other elements; there-
fore its action is limited and determined, and its existence
depends upon the will of its Creator—something not matter.
That the fossil remains of extinct species of animals afford
no evidence to sustain the evolution theory is evidenced by
the fact that an oryetologist at once can determine whether
the osseous specimen belongs to a mastadon or a mammoth
Megatherium or a Milodon. There is no chance to be mis-
taken because there has been no merging of the species, and
there never will be. We argue that if natural selection, or
the law of evolution had effected a continuous transformation
the ratio of progress from one period to another should be
nearly equal—at least there should be no diminution. Professor
Thomas Hughes, S. J. of the St. Louis University, St. Louis,
Mo., in his 9th lecture, post-graduate course, entitled "Arith-
metic and Physiology Among the Fossils," 1884 and 1885,
puts the ratio at the very modest figure of 3 2/5. He says:
"We should then come to only ten species in the Silurian period."
Now, unfortunately, the Silurian period shows 10209 species;
the Devonian, 5169; the Carboniferous, 4901: the Permic,303;


140
Amos Sawyer.
the Triassic, 1310; the Jurassic, 4730; the Cretaceous, 5500;
the Lertiarz, 16970; the present, 150,000. Where is the
arithmetic of evolution? Natural selection is neither supported
by the species claimed for it, not even by some of the choicest
cases of variations referred to it. Thus Hilgendorf's 20 varie-
ties of the multiform planorbis are found to be coeval, there-
fore not progressive by descension. Lo, those immense animals
like the mastadon are not transitional between the adjoining
species, but coeval with them. The theory halts everywhere.
Now I ask, does it seem reasonable, is it in accordance
with the evidence to believe that God created this world and
the laws governing it, as well as the stellar worlds by which
it is surrounded, moving them with that undeviating certainty
that we can foretell for years in advance, the minute where
their shadows will fall, and then only create life in a one-celled
green plant or a few forms of the lowest order capable of devel-
oping into other forms, as needed, culminating in man as the
present perfection of evolution? Such a thing must certainly
detract from God's glory and majesty to a greater degree
than that He spoke creation into birth, organic and inorganic
by a simple command. Therefore just as when we find a
flint arrow-head we, reasoning from a visible effect to an in-
visible cause, recognize the work of man's hands for it gives
evidence of design; so and for the same reason we see, dis-
tinctly and indistinctly, in every animate and inanimate ob-
ject the part that they were designed to fill for they, like the
arrow-head, are fashioned in a manner peculiar to themselves.
Therefore we believe as we exclaim—Behold the works of
the Creator, for all the evidence points to individual creative
design.


PRESBYOPHRENIA OF WERNICKE AND
PSYCHOPOLYNEURITIS*
By Dr. Henri Nouet
Translated by Dr. Mary O'Malley, Senior Assistant Physician
Government Hospital for the Insane, Washington, D. C.
THE presbyophrenia considered by Wernicke, Wallenberg
and Kraepelin as a particular form of senile dementia,
has been studied in France in a very special manner during
the past months. That is to say, there has been published
on this subject most various and diverse opinions. Among
the hypotheses which have been advanced in regard to what
place should be assigned this affection among mental diseases,
that of MM. Dupre and Charpentier1 is perhaps the most
ingenious, and it is also the one which offers most to discussion.
We know that, contrary to the German conception, these au-
thors claim that the presbyophrenia of Wernicke is not a form
of senile dementia but solely a stage of the polyneuritic psychosis
or Korsakoff's disease which, occurring in the already aged
subject, terminates in chronic dementia. This view of the
subject has been accepted by MM. Deny and Camus.2
On the other hand Beaussart,3 Brissot,4 Hamel and
Trenel5 have refused to accept this opinion which does not
seem to agree with the real facts. Since the publication of
the first work6 on this question we have examined several
patients in this category and consider the presbyophrenia
a form of senile dementia deserving a special description by
reason of the particular symptoms which compose it and
give it individual entity.
♦L'Eneephale, Vol. 1, 1911.
Bibliography.
1. Dupre et Charpentier. (Societe de psychiatrie, 17 decembre, 1908.)
2. Deney et Camus. (Societe de psychiatrie, 27 mai 1909.)
3. Beaussart. (Archives de neurologie, fevrier 1910.)
4. Brissot et Hamel. (Societe clinique de medecine mentale, 18 juillet 1910.)
5. Trenel. (Societe clinique. Discussion, 18 juillet 1910.)
6. Nouet et Halberstadt. (Translation from L'Encephale, 1909.)
(141)


142
Henri Nouet.
One knows that for several years Kraepelin has main-
tained the symptomatic analogy existing between presbyo-
phrenia and psychopolyneuritis and the difficulty in making a
differential diagnosis between the two affections.
That is to say, the task of these who liken the presbyo-
phrenia to the psychopolyneuritis is just as difficult as that
of those who defend its anatomy. The mental symptoms common
to the two affections are multiple, the amnesia, the disorienta-
tion, illusions of false recognition, and the confabulations
exist with a remarkably analogous character in the two classes
of patients. The personal history of the patients often reveals
alcoholic excesses, evidence of a toxic origin of the infection.
Finally for M. Dupre the symptoms of polyneuritis are as-
cribed to the level of the lower extremities in the two and show
the bipolar affection of nervous system whether the case be
presbyophrenia or Korsakoff's disease.
The advocates of the presbyophrenia of senile dementia
reply on the other hand by diverse arguments, among which
those of Dissaut and Hamel8 deserve some attention. "If,
say these authors, we admit that presbyophrenia is a chronic
form of the Korsakoff's psychosis having evolved without
motor troubles we must remark that Korsakoff's syndrone
without polyneuritis is the exception, while that of presbyo-
phrenia without motor troubles is the rule." This argument
draws its value from the fact shown by Beaussart9 of the
relatively rare frequency of motor symptoms in the course of
presbyophrenia. This author has examined eleven patients
of this class and he has found in his subjects the integrity
of the functions of the lower extremities without motor or sensory
symptoms is the usual finding.
One can certainly agree with M. Dupre10 that these
motor troubles, which were at first very obvious, have now
disappeared and that the presbyophrenia is only a psycho-
polyneuritis in which the symptoms of polyneuritis, very pro-
7. Kraeplin, Psychiatric, 7th edition, 1904, et introduction (traduction Devaux et
Mercklen.)
8. Brissot et Hamel. Loc. dt.
9. Beaussart. Loc. eit.
10. Dupre. (Societe de psychiatric 27 mai 1909. Discussion sur un cas Deny et
Camus.)


Presbyophrenia of Wernicke.
143
nounced at the onset of the affection, have gradually diminished
and disappeared with time.
But this argument does not stand in the presence of
certain well characterized clinical cases where the symptoms
of the onset of the affection are described with precision in
the case records, and where one is in a position to affirm cate-
gorically the absence of all polyneuritic symptoms in a sub-
ject in the course of the preceding history. In the history
of the presbyophrenics which we have studied and in which
the history has not permitted any doubt in the progress of the
affection, the symptoms of polyneuritis have always been
wanting. Only one patient in which we give further careful
observations, actually presents abolition of the patellar reflexes.
In the absence of all other symptoms and positive history we
are not authorized to consider our subject as a case of chronic
psychopolyneuritis.
To make the differential diagnosis the age must be con-
sidered. Is not the disease of Korsakoff more especially
a disease of the adult? The presbyophrenia is on the contrary
the lot of the aged, but its age of predilection oscillates around
the seventieth year. The idea of sex is not devoid of interest.
In fact, the presbyophrenia we know occurs almost uniquely
as an affection of the female. But the Korsakoff psychosis
is far from being rare in men. Why should a psychosis oc-
curring in its acute form with equal frequency in both sexes
in its chronic form attack almost exclusively the female?
Finally a certain number of differential signs can be
drawn from the mental states to allow us in our opinion to
establish a distinction between the two morbid conditions.
The mood of the presbyophrenic—always gay, euphoric,
self satisfied— is very different from that of the psychopoly-
neuritic, which is usually depressed or apathetic and in which
the facial expression is immobile, while the features of the
presbyophrenic are of extreme mobility, that he laughs, makes
grimaces in which the muscles of mimic participate. The
fades of the psychopolyneuritic is always dull and fixed and
without expression.
The loquacity is a symptom which is rarely absent from
Wernicke's disease. These patients speak without ceasing


144
Henri Nonet.
on all subjects with equal volubility. It is garrulity con-
tinuous and uninterrupted. This symptom is wanting in the
chronic form of Korsakoff's disease. Besides the patients
of the first category have a lively disposition, are attentively
polite and are especially amiable and cordial. These are the
symptoms one seeks for in vain in the psychopolyneuritis,
acute or chronic.
The disorders of consciousness are much more pronounced
in the presbyophrenic. These patients have no appreciation
of their abnormal state, and laugh when answering a question
relative to their physical or moral health. Much to the
contrary, the polyneuritics comprehend to some extent their
condition and are the first to grieve over their state. Their
judgment even in the chronic form is less perceptibly affected
and the degree of intellectual enfeeblement less evident. The
amnesia finally seems more pronounced in the presbyophrenic;
besides in that affection the patient most often does not even
possess a realization of the amnesia, contrary to that observed
in the chronic forms of Korsakoff's disease where the subjects
indicate spontaneously to their questioners the profound
defects of their memory.
The first three cases which follow were cases of psycho-
polyneuritis, two of the acute and one of the chronic form
with dementia. The fourth case is that of a presbyophrenia
of 81 years of age.
Case 1: "(Resume.) Lec. — Armadine, day worker,
aged 40 years, entered the asylum d. Evereux July 25, 1910,
spends all day in a corner of the infirmary without making
a movement, perfectly calm, shows no phenomena of excitation
which call attention to her. She responds with complacency
to questions asked her, submits voluntarily to different tests
of which she is the object.
The gait is hesitating; Lec. — shuffles her feet over the
floor. She complains of violent pain in the calves of the
legs and along the internal surface of the tibia. The patellar
and plantar reflexes are abolished, the sensibility is reserved
but sometimes dulled. No other physical signs are revealed.
11. Kraeplin dans sa 8th edition '1910) estime que la presbyophrenic eomprend 23 p.
100 dee caa. de demence senile.


Presbyophrenia of Wernicke.
145
The pupils are equal, react to light; there is no dysarthria,
tremor of the tongue or hands. The urine is normal; the
cerebro spinal fluid content is normal and there is no lympho-
cytosis.
Lec. — has sometimes involuntary evacuatons.
Mental state is characterized by the following symptoms:
Lec. — is docile, calm and shows some little apathy. The
dominating symptom is the total amnesia, retroanterograde,
of which the patient is perfectly conscious. She does not
know how long she has been here, does not know her age nor
the date. She is disoriented, cannot tell where she is nor
does she know the name of the institution. She sees the
physician each day on his visits. However, she affirms that
she sees him for the first time in this place. She was acquainted
with him formerly, but she does not know under what circum-
stances.
The patient often gives the physician a strange name
and profession. We cannot establish confabulations. Lec. —
is a little loquacious; one is obliged to ask questions many times
to obtain a single response. She has no euphoria and she
scarcely smiles at a pleasantry. She is inactive.
Seated in the same place for hours without making a
movement, she shows no evidence of ennui.
The affectivity is diminished; she is not interested in
her children nor in anything concerning them.
Such is the present state of Lec.
We are not able to obtain any information as to her
heredity. Lec. — has been married, she is divorced. Her
husband was an alcoholic and they drank together, whiskey,
wine and coffee. The patient has three children in good health.
The onset of the actual affection dates back six months
and the use of alcohol is the most evident cause of the illness.
The mental troubles consisted at the beginning of excitement,
nocturnal agitation and insomnia with visual hallucinations
and zoopsia (visions of serpents.) This was accompanied with
marked disturbances of gait, severe pains in the lower ex-
tremities. This is the condition in which Lec. entered the
asylum d. Evereux.


146
Henri Nouet.
After a few days the excitement disappeared and her
condition since then has remained similar to that above de-
scribed. This brief account is a clinical history of the patient.
Case 2: (Resume.) The female Rad. entered the asy-
lum d. Evereux August 31, 1910, at the age of 35 years.
The family history shows that her father died in the
asylum of General Paresis.
Rad. — is married and the mother of five young children
in good health and normal intellectually. It was in 1908
that the patient began to indulge excessively in alcohol. She
drank large quantities of wine and whiskey called calvados
in coffee houses. Under the influence of these libations Rad.
presented visual hallucinations, insomnia and professional
dreams. The mental troubles became exaggerated three weeks
before she entered the asylum in the early part of August, 1910.
The excitement changed considerably and it was accompanied
with loquacity. Rad. constantly accused her husband of
infidelity. The insomnia is absolute, accompanied with agi-
tation, visual hallucinations of a terrifying nature. Rad.
complained of violent pains in her legs, pain on walking and
considerable hyperaesthesia in the region of the knees and
coldness of the lower extremities.
On her admission to the asylum the diagnosis of poly-
neuritic psychosis was made. She was in a constant state
of confusion with accompanying amnesia and confabulations,
illusions of false recognition and the accompanying poly-
neuritis.
These later consisted in great difficulty in walking, abo-
lition of the patellar reflexes, pain over the lower extremities
becoming lacinating on pressure, abolition of the plantar
reflex. The mental examination reveals absolute amnesia,
total retro-anterograde, accompanied by disorientation.
The patient does not know her age, date of birth, current
month or year. She does not know where she is nor how long
she has been here, she believes herself sometimes at home
and again at a neighboring chateau, the confabulations are
very pronounced. Rad. related to us that she was this morning
at her own residence, that she was doing her housekeeping,
that she had dressed her children and prepared breakfast.


Presbyophrenia of Wernicke.
147
Following that she went to work for Countess X where she
worked making hay and taking care cf cattle. She invented
many imaginary stories on most various subjects. It is noted
that she has insomnia and visual hallucinations. Rad. de-
clares that last night serpents had wound around the sheet
of her bed and threatened to bite her.
The condition of Rad. has remained absolutely sta-
tionary during two months. The amnesia lessened but there
still persists a profound dysamnesia. The patient knows
how long she has been in the asylum but she is ignorant of
her age, the date and the season. She is no longer disoriented
and she does not invent imaginary experiences of late.
Rad. — is calm, a little depressed, weeps at times and
is conscious of her morbid state and of her memory defect.
The affectivity is perfectly preserved.
When her children visit her she seems very happy. She
shows to them a loving tenderness and cannot be separated
from them without regret. The symptoms of polyneuritis
are extremely pronounced, spontaneous pain is still evident
and walking impossible. The patellar reflexes are abolished.
Case 3: T. — Woman P. Age 36 years, entered the
asylum at d. Evereux January 12, 1902.
The following certificate accompanied the patient: "This
woman entered the hospital January, 12, 1902 in a state of
general paresis of alcoholic origin, presenting at the time
actual cerebral troubles."
The history furnished by her husband was that "she
had been addicted to the excessive use of alcohol for eight
years. She was continually in a state of drunkenness and im-
perfect elementation. From a mental point of view the ex-
cessive drunkenness had caused insomnia and nightmare, a
state of indifference with diminution of the emotional tone."
"She abandoned her young child; she would not occupy
herself in the care of her household duties, lost interest in her
former occupations. Spent part of the day intoxicated."
In 1901 she showed a progressive emaciation and im-
paired motility of the lower extremities. She first complained
of pain in the legs and thighs, then they became powerless and
would not support the weight of her body, and walking was


148
Henri Nonet.
utterly impossible. It was then P. entered the hospital of B.
in February, 1902.
After a stay of several months in this institution, P.
manifested the idea of suicide and made two unsuccessful
attempts; she tried to hang herself with a handkerchief and
she swallowed pins. It was at this time she entered the hos-
pital at d. Evereux.
P. — is a paraplegic. It is impossible for her to stand
or walk alone. Examination at this time shows abolition
of the patellar and Achilles reflexes. Great spontaneous
pain and tenderness in the legs and thighs increased by pressure.
A notable diminution of sensibility. No Romberg present.
The ocular reflexes are normal. Physical examination
reveals nothing abnormal in the different organs of the body.
Has involuntary evacuations.
Mentally confusion predominates. P. —is inert, apathet-
ic, indifferent to her surroundings, remains the entire day
without speaking if one does not address her. Never asks
for food.
Interrogated she showed some ideas of unworthiness.
Declared she had burned a spinning mill and poisoned her
sister. The most striking symptoms are memory defect and
disorientation. Her replies are irrelevant. She does not
remember her age, that of her child nor the date of her marriage.
Does not know the current year, month or season. Does not
know where she is nor how long she has been here. P. be-
lieved herself at home, later that she was in a hospital.
She was in a hospital at B. and had a mistaken identity
of persons.
June 25, 1902. State of P. shows no change since ad-
mission. Still is apathetic, indifferent; involuntary evacua-
tions.
April, 1903. P. presents no appreciable change in her
condition. She is still paraplegic and there is still loss of
sphincter control.
In 1904 the phenomenon of paraplegia is diminished.
She walks with much difficulty. She is able to advance but
slowly by the aid of a chair. She succeeded in climbing or
dragging herself upstairs and can get in bed without assistance.


Presbyophrenia of Wernicke.
149
Patellar reflexes are abolished. Her feet show very marked
edema. (They are cyanotic and pit on pressure.)
The mental state of P. is characterized by apathy and
emotional indifference, she presents stereotyped attitudes,
remains for hours in the same place, does not take the initia-
tive, is willing to be assisted in the most elementary acts.
As she does not respond to questions it is impossible to deter-
mine the state of her memory. Always has involuntary
evacuations. In Januray, 1905. At this time P. is described
as "demented, apathetic, indifferent to everything, inconti-
nence of feces and urine. Confined to bed on account of
edema of feet and lower extremities."
April, 1905. P. does not recognize her bed, her place
at the table, believes that she has seen the physicians who
interrogated her for the first time this morning, and recognizes
among them a relative and friend. She has forgotten her
age, does not know how long she has been in the hospital.
She thinks the present month is December.
The patient's gait is unchanged.
In 1906, 1907 and 1908 her condition remains exactly
the same, characterized by a state of emotional indifference
with mutism. Memory and orientation are very much impaired.
We have examined the patient in 1909 and 1910 and the
following is her actual state:
Physically there is no lesion of the circulatory or res-
piratory systems. Urine is normal; the only symptom of
interest is the impairment of movement in the lower extremi-
ties. Gait is hesitating; she drags her feet on the ground,
advances slowly step by step, and declares she is fatigued on
the least movement. The pain on pressure is still very dis-
tinct. There is also spontaneous pain in the level of the calves
of the legs.
The patellar reflex is abolished on the right side and is
very feeble on the left, it can scarcely be noted, and sometimes
is totally absent. Plantar reflexes are abolished; sensibilities
are preserved on the surfaces of the legs.
The mental state of P. is one of dementia, total amnesia,
retro-anterograde. Patient is ignorant of her age, the date
of her birth and the current year.


150
Henri Nouei.
She is completely disoriented, does not know where she
is nor in what institution or hospital she has been for eight
years. P. does not know the season, declares it is summer but
that it is ending, when it is actually December.
Disorientation to time is very pronounced. P. is conscious
of her mental condition and knows that her memory is impaired.
She often repeats "I have no longer memory." Patient is
apathetic, indifferent, affect wanting. Never occupied; never
inquires to see her child, never makes a request for her relatives
to visit her. She passes the whole day in a stereotyped atti-
tude and her behavior is analogous to catatonic state. She
does not speak spontaneously, responds to all questions with
words of one syllable. No evidence of loquacity. The emo-
tional tone remains always identical. She is never seen to
smile. The mask of indifference which characterizes her
expression is uniformly the same.
Case 4: Joa, Woman A, age 81 years, entered the
asylum d. Evereux, June 5, 1896, at the age of 66 years.
The records relative to the antecedents or the hereditary
element is unknown.
The woman was married twice. She has a daughter who
is married and the mother of seven children, and shows no
mental trouble. The patient formerly kept a fruit stand in
Paris. Her husband was an inebriate and she herself appears
to have used alcohol, occasionally to excess, although at no
time did she have any mental trouble from the use of it.
The onset of the mental trouble goes back to the time
the patient was 61 years of age. This is five years before her
admission to the asylum. The woman at this time had lost
her husband and had given up her business and had sought
refuge with relatives in the Province. Her memory pro-
gressively failed. About this time she forgot her husband
was deceased and declared he had run away with a woman.
It is chiefly the memory of fixation that is affected. Patient
still retains the principal events of her early life but memory
for recent events is defective.
At this time confabulations were evident. A. related
to her relatives that she had just received a visit from old friends
and she enumerated what she had said during their conversation.


Presbyophrenia of Wernicke.
151
Besides she narrated at length many imaginary voyages and
promenades.
It is noted at this time that there are no physical symp-
toms present; gait is normal; that the patient shows no pain-
ful phenomena in the lower extremities.
On her admission June 5, 1896, the following certificate
accompanied her: "Dementia characterized by intellectual
enfeeblement and enfeebled memory and affect."
She presented further some ideas of persecution. She
believed her husband who had been dead five years had her
locked up so that he could live with a mistress. She pretends
to have seen her husband and to have slept with him the last
few days.
Does not know the day, the month nor the year. Says
she is 50 years old, although she is 66."
On the certificate a fortnight later she pretends she is
here eight days only. She does not know the day, month or
year, believes her husband is living.
In November, 1896, A. declares she has only been at the
asylum eight days because she has gone only once to mass
at the chapel.
During the years that followed she remained in the same
state, calm, docile but demented and amnesic.
In 1899 we find in her record the following note: "She has
totally forgotten her age, date of birth, time of entrance to the
asylum, docs not know the current year, month nor day of
the week. She laughs and weeps without reason. Continues
to believe her husband is not dead, that she has seen him lately."
There is another note in 1901 as follows: "My husband
is in Paris with another lady. I am not unhappy here. My
husband is not dead and there is no danger."
In 1903 observation contained the following phrase pro-
nounced by the patient: "I have been here fifteen days.
I have only gone once to the chapel." In fact, each Sunday
she believes she visits the chapel for the first time and does
not remember to have been there a number of times.
In 1907 she declares she is only eight years old and that
she has been here several days. The disorientation is abso-
lute; she believes she is at the hotel Dieu. She is unoccupied,


152
Henri Nonet.
laughs continually without apparent reason and responds always
when she is questioned "I don't know. That is all I can say."
We have observed A. since July, 1908, and that her state
has remained uniformly the same. The following describes
the actual condition.
"The patient is physically an old woman presenting
the ordinary attributes of senility, arcus senilis of the cornea
and symptoms of arteriosclerosis."
The pulse is heard and often times irregular. Ausculta-
tion of the heart reveals nothing particular. Examination
of the lungs shows a certain degree of emphysema.
The urine contains no sugar or albumin.
Ocular and pupillary reflexes normal. No appreciable
tremor of the extremities.
The patellar reflexes are abolished. The plantar is present
and cutaneous sensibility is normal. The gait is normal,
and is not unlike that of old people. She is not very alert
but goes about without assistance; has no difficulty in moving.
Has usually pain in the region of the legs, either spontaneous
or provoked. Sight and hearing are impaired.
A. is a little old woman, smiling and euphoric, loquacious.
She talks constantly; she questions the physician when
he enters the hall, laughs in a noisy fashion, clapping her
hands, making many gestures. On familiar terms with all
questioners.
Amnesia: Patient does not know how long she has been
in the asylum. "It has been some days. I don't know how
long but I am certain it is not more than a month." Does
not know her age, says, "I am old." Says, "I have lived 40
years, perhaps 50."
"You say that I am 80 years old, no you are laughing."
A. does not know the year nor the month. She retains events
of her early life. Recent events of her life are likewise abolished.
She does not remember having seen the physician before
and each morning on his visit says she has seen him for the
first time in the institution. She has met him formerly but
does not know where.
Disorientation: A. does not know where she is, she
declares that she is at the Hotel Dieu, but she cannot say in


Presbyophrenia of Wernicke.
153
what town. Sometimes she says she is in Paris, sometimes at
Gallin or at Lille. She calls that city "Lille in Flanders," and
speaking of Reims where her daughter lives she always says,
"Reims in Champagne."
Illusions and False Recognition: The illusions are
numerous and all the people who surround her are given a
name and strange profession. This name varies from day to
day and at different times in the day.
Confabulations: This symptom is very pronounced
in A. and its intensity varies from one day to another. Often
times it is wholly absent, but frequently A. holds up and re-
lates the following events: "I saw my husband day before
yesterday. He came to see me in the parlor and I went there.
He has not grown old. I reproached him for having been with
a woman and he has promised to come and see me soon, on
returning we went to the woods up there, but I am very tired
for I am old. This morning I went down there and I have
washed. Yesterday morning I went to church."
This is imaginary for A. never leaves her quarters.
Her knowledge of geography, history and calculations
appears to be lost. A. has little education and is practically
illiterate. She remembers the price of wares and business
of the first interest, of clothing and dress.
If one makes before her an absurd statement as, white
is black, for example, she remarks at the absurdity and ac-
companies her rectification with a loud laugh, facial grimaces
and gesticulation.
A. is always gay, loquacious, docile, obliging and polite.
She strives to render service to the best of her ability. She
lends herself willingly to questioning. She has never given
evidence of irritability. Her mood is always stable. She is
lively, contented and satisfied. A. has no realization of her
mental state. The impairment of her judgment is extreme-
ly pronounced.
Summary: The three observatons of the psychopoly-
neuritis present, it seems to us, without the observation of
our case of presbyophrenia, differences which the reader readily
perceives, are obvious. We will simply call attention to the
fact that in our third observation, which describes a case


154
Henri Nouet.
of chronic psychopolyneuritis with dementia, the patient, far
from resembling a presbyophrenic, presents a symptom complex
very closely allied to that observed in the catatonic form of
dementia precox.
The intellectual enfeeblement is evident but its degree
is not comparable to that of senile dementia. It bears par-
ticularly on the affectivity and the will which, nearly abolished,
leads to a state of apathy with emotional indifference and
suggestibility. The confabulations and illusions of false
recognition are absent. That symptom complex seems to us
very different from that which we meet with in our last observa-
tion, where, to the symptoms of apathy and emotional in-
difference, of mutism in the first case, are opposed in the second
by euphoristic loquacity, expressive and playful mimicry. In
the first case we have a subject conscious of her physical and
intellectual decay. There is a complete disorder of the
consciousness.
To resume, are we to regard the presbyophrenia accor-
ding to Wernicke and Kraepelin as a variety of senile dementia
or do we assent to the opinion of M. Dupre, who considers
it a chronic psychopolyneuritis with dementia? The argu-
ments enumerated above inferred from the ages of the patients,
from their sex, from their disorder of consciousness, which is
a rule nearly absolute, of polyneuritic troubles (observations
of Nouet, Halberstaff and Brissot and Hame, Beaussart, etc.),
a disorder not only present, but even previously mentioned
in the records, and other symptoms of a psychic nature placing
in evidence different disturbances of the mood, of the emotions,
of the activity, of the memory and consciousness, authorize
us, it seems, to adopt the point of view of Wernicke and Krae-
pelin, and to consider presbyophrenia as a special form of
senile dementia. Rare in typical cases, extremely frequent in
atypical cases where the symptoms are only suggested, and
where certain of them may be absent, the presbyophrenia
draws perhaps its distinctive characteristics from the arterio-
sclerosis, which seems more pronounced in these subjects than
in those with simple senile dementia. Death is caused in
nearly all of those cases by cerebral hemorrhage, and the nerve
centers at autopsy show marked atheromatous lesions. The


Presbyophrenia of Wernicke.
155
pathological anatomy of this affection, of which the study, as
begun by Fisher and Redlich, will give us, without doubt,
some day valuable information and perhaps we will definitely
come to classify presbyophrenia among the psychoses of the aged,
a place to which it seems henceforth to have a right by reason
of its very particular clinical symptomatology.


SEXO-AESTHETIC INVERSION.1
By Havelock Ellis,
London, England.
BY "sexual inversion," we mean exclusively such a change
in a person's sexual impulses, the result of inborn constitu-
tion, that the impulse is turned towards individuals of the
same sex, while all the other impulses and tastes may remain
those of the sex to which the person by anatomical configura-
tion belongs. There is, however, a wider kind of inversion,
which not only covers much more than the direction of the
sexual impulses, but may not, and indeed frequently does not,
include the sexual impulse at all. This inversion is that by which
a person's tastes and impulses are so altered that, if a man,
he emphasizes and even exaggerates the feminine character-
istics in his own person, delights in manifesting feminine
aptitudes and very especially, finds peculiar satisfaction in
dressing himself as a woman and adopting a woman's ways.
Yet the subject of this perversion experiences the normal
sexual attraction, though in some cases the general inversion
of tastes may extend, it may be gradually, to the sexual impulses.
The first fully and accurately described case presenting
this condition in a completely developed and typical form
was that of a doctor who sent a detailed account of himself
to Krafft-Ebing in 1890. This doctor was married and not
attracted to his own sex; but his feelings were feminine and he
felt himself like a woman. He was really somewhat feminine
in appearance. There were no actual delusions. Krafft-
Ebing published the case in his Psychopathia Sexualis and de-
scribed it as representing a stage of transition to metamorphosis
sexualis paranoica, that is to say, a stage on the road to insanity.
1. Read before the Chicago Academy of Medicine, April 11, 1913.
(156)


Sexo-Aesthetic Inversion.
157
This manner of regarding the case is not now acceptable.
To describe a mental condition which, though abnormal, is sane,
by its relation to an insane state which it never reaches, al-
though such a method of designation may be the most obvious
to an alienist, is to take up too pathological a standpoint.
The case itself, however, as described by the subject himself,
may still probably be regarded as the most typical and complete
in existence.
I have been acquainted with cases of this psychic anomaly
for many years, but have been in doubt how to classify them.
They seemed to me to represent a combination of feminism
with fetichism. But such a method of classing the anomaly
was unsatisfactory, although it avoided the error of Krafft-
Ebing, for there is no true fetichism in these cases, the garment
possessing no dynamic erotic power in itself, or even when worn
by another person, but only when worn by the subject him-
self; in some cases, moreover, clothing plays little or no part.
In recent years, however, this anomaly has been greatly
elucidated by Hirschfeld in his substantial work, Die Trans-
vestiten. Hirschfeld insists mainly on the tendency to adopt
the garments of the opposite sex, but the class of cases
he deals with is clearly the same that I am here concerned with.
Hirschfeld was able to bring forward a number of detailed ex-
amples, discussing them fully, and making clear that in most
cases there is no sexual inversion.3
Hirschfeld made a highly important step forward in our
knowledge of this anomaly, alike by his elaborate description
of cases, by his conception of the anomaly as a simple rather
than compound perversion, and by his realization that specific
sexual inversion here played an almost negligible part. It
is difficult, however, to accept Hirschfeld's term of Trans-
vestism, (Transvestitismus) or cross-dressing,4 which is not only
2. Magnus Hirschfeld, Die Transvestiten: Eine Untersuchung uber den Erotischen
Verkleidungstrieb, 1910.
3. Stekel in an interesting review of Hirschfeld's book (Zentralblatt fur Psycho-
analyse, Vol. I. Heft 1-2) thinks that Hirschfeld has unduly minimised the tendency to
homosexuality. There is room for some difference of opinion here but it certainly
appears that in this class of case homosexuality is rare and usually secondary.
4. "Cross-dressing," as suggested by Edward Carpenter (American Journal of Re-
ligious Psychology and Education, Vol. IV. 1911) is probably the best English equivalent
of "Transvertism." According to Hirschfeld's terminology, a cross-dressed man is a
transvertit." a cross-dressed woman a "transvertitin."


158
Havelock Ellis.
unsatisfactory in itself (even from a Teutonic point of view)
but by insisting exclusively on inversion of tastes in matters
of dress, unduly narrows the phenomenon with which we
have to deal. Nacke, who equally objects to the term "Trans-
vestism" and prefers Hirschfeld's secondary name, has proposed
to call this condition "the desire for disguise" (Vcrkleidungs-
sitcht.) 6Hirschfeld himself now seems inclined to prefer this
name, for he has adopted it in the title of subsequent publi-
cations in which he has brought together much ethnographic
and historical information bearing on this matter, with many
interesting illustrations and portraits, as well as additional
cases.6 I must confess, however, that this title, in so far as
it implies disguise, seems to me even more unsatisfactory than
the other. There is the capital objection that it is psycho-
logically altogether inaccurate. The subject of the anomaly,
so far from seeking to disguise himself by adopting the garments
of the opposite sex, feels rather that he is thereby revealing
himself. It is only when so clothed that he feels really him-
self; these garments suit him, he is at home in them, he feels
really himself, not so much disguised as emancipated from a
disguise.
I propose, therefore, to adopt a term suggested to me
by a man of intellectual distinction, himself the subject of
this condition in a pronounced form, and to call the condition
at all events provisionally, aesthetic inversion, or more exactly,
sexo-aesthetic inversion.1
5. P. Nacke, "Zum Kapital der Transvestiten," Archiv fur Kriminalanthropologie.
Vol. 47, 1912, p. 237.
6. Hirschfeld und Max Tilke. Der Erotische Verkleidungstrieb (Die Transvestiten,)
1912; Hirschfeld and Bur chard, "Zur Kasstik des Verkleidungstrieb." Aerztliche Sach-
verstandigen-Zeitung, Nos. 23 and 24, 1912. From the first Hirschfeld has felt doubt-
ful regarding the nomenclature of this condition and in Die Transvertiten (p. 300l he pro-
posed and rejected the term "sexual metamorphosis," and stated that "transvertism"
by no means exhausts the contents of the phenomenon.
7. I admit that the names are not completely satisfactory. "Sexo-aesthetic inver-
sion," while a fairly good descriptive term, is open to the objection that it is a hybrid
Graeco-Latin compound. "Aesthetic sexual inversion" would be misleading since it would
apparently be .equivalent to "aesthetic homosexuality." The same subject of the
anomaly who suggested "aesthetic inversion" also preferred "psychical hermaphroditism"
but that is not quite accurate, for these people are not usually conscious of possessing the
psychic disposition of both sexes but only of one, the opposite sex. Hirschfeld regrets that
the difficulty cannot be solved by adopting the name of some well-known subject of the
condition, as in the terms "Sadism" and "Masochism," but thinks none is sulliciently
well-known. It has, however, seemed to me that we might coin the name "D'lonism,'
after the well-known Chevalier D'lone, who exhibited this impulse in a well-marked form.


Sexo-Aesthetic Inversion.
159
Some years ago a man was found drowned off the Cornish
coast dressed in woman's clothes and with his hands fastened
together. Among his effects at the hotel he was staying at
were found numerous refinements of the feminine toilette
and feminine articles of dress. He was a lawyer, practicing
as a solicitor near London, and regarded by his acquaintances
as an ordinary and normal man of quiet habits. There was
no suggestion that his death was due to violence. It was
evident that he had sought what was from the point of view
of an aesthetic invert (apparently with Masochistic tendencies)
the most voluptuous death possible.
Such a case indicates some of the peculiarities of aesthes-
tic inversion. It tends to occur among educated, refined,
sensitive and reserved persons. It is for the most part suc-
cessfully concealed from the subject's friends and acquaintances,
even from the nearest members of his own family. It is some-
times associated with manifestations which recall Masochism
or passive algolagnia. Thus it is a form of erotic symbolism
which, while it must be classified under inversion, in the wider
sense of that term, yet has resemblances to erotic fetichism
and occurs in the kind of people who tend to be subject to
fetichism. It also resembles, in some of its features, the kind
of auto-erotism called Narcissism or erotic self-admiration.
Aesthetic inversion cannot, however, be identified either with
fetichism or with Narcissism; the subject is not really in love
either with a fetich or with himself.
The precise nature of aesthetic inversion can only be
ascertained by presenting illustrative examples. There are
at least two types of such cases; one, the most common kind,
in which the inversion is mainly confined to the sphere of cloth-
ing, and another, less common but more complete, in which
cross-dressing is regarded with comparative indifference
but the subject so identifies himself with those of his physical
and psychic traits which recall the opposite sex that he feels
really to belong to that sex, although he has no delusion regard-
ing his anatomical conformation.
Before bringing forward a fully developed case of each
type, it may conduce to an understanding of the anomaly if we
consider some of the intermediate stages between aesthetic


160
Havelock Ellis.
inversion and the normal sexual attitude.
There are many graduations in the extent to which
aesthetic inversion may occur. It may even be found only
in the dreams of a person who during waking life is absolutely
normal and shows not the faintest tendency to any kind of
inversion. I will first present a well-marked case of such
aesthetic inversion confined to dreams.
The subject is a Welshwoman, twenty-nine years of age,
married two years since. Though not muscularly strong,
she is very healthy, entirely normal, tall and supple, with
good complexion and hair, fond of swimming and of country
life though compelled to live in a city. She is somewhat
emotional in temperament, quick, vivid, high-spirited; it is
a type not so very rare among her country-people. Her
intelligence is of a very high order and she earns her living by
literary work. Her ways and feelings are feminine; she is
attractive to men and attracted to them. She has never at
any time had any homosexual impulses and regards such things
with horror. She has, moreover, never masturbated or played
with herself. Until marriage, at the age of twenty-seven,
she had had indeed, no sexual experiences, auto-erotic or other,—
except in dreams.
From the onset of sexual life at the age of twelve, she
had experienced erotic dreams, coming usually (as shown by
a diary she kept for a long time) two or three nights before the
monthly period, which, as a rule, is fairly easy; sometimes a
period is not preceded by the dream. These dreams have
been accompanied by complete sexual satisfaction, and she
awakens, she states, "all thrilling with the sensations—and
I've tried to prolong them by lying hard on my face; but
in a couple of minutes they've gone."
The dreams have, however, this special peculiarity that,
invariably, the dreamer imagines that she herself is a young
man of about twenty-three years of age, who is making love
to a young girl. She has never had a normal erotic dream
about a man, although she has sometimes dreamed of kisses
that had actually occurred. Indeed, in all her very vivid
dreams, even apart from those of an erotic character she dreams
of herself in this masculine shape. (She makes exception


Sexo-Aesthetic Inversion.
161
of a nightmare, to which she is occasionally liable, in which
she retains her own feminine personality and is pin-sued from
room to room by a loathsome woman.)
"In these dreams," she writes, "I feel myself masculine;
in one or two of these I have touched myself and found it
different from a woman, and once I saw myself in a mirror
and recognized the face as one long forgotten somehow.8 Per-
sonally, I believe I must have been a boy once. My girl is
always the same type, though I've only seen her about five
times, and not clearly. I feel her absolutely distinctly, soft-
skinned and very full-breasted. The only time I saw her
clearly enough to remember, she was dark haired and light-
skinned (as I am), but not of my figure; she was small and
plump and had on a weird costume—sort of Turkish, with a
scarlet jacket and gold jewels and white trousers and a scarlet
close cap on her long, long hair. The costume I must have
got from a picture, though I cannot call it to mind. All this
is absolutely apart from my real life and I seldom give it a
waking thought."
Some extracts from the subject's diary, (after marriage)
may illustrate the occurrence of the dreams and their nature.
21st Sept. (Saturday.) I had that dream last night.
I had intense feeling but could not see my girl.
24th Sept. Monthly period.
20th Oct. (Sunday) My girl came. I saw her lying
in the scarlet and white costume. She was very sweet and I
loved her, besides the feeling, which was strong when I awoke.
I kissed her very much on the breast. I had a feeling that
there was a younger girl somewhere near that I was supposed
to take, but I kept to my own one because she was so pretty.
She was ever so fond of me.
22nd Oct. Monthly period.
12th Nov. That dream with a girl. Couldn't see her.
18th Nov. Monthly period.
13th. Violin dream. (That violin dream found me
so distinctly as a young man that it might be part of the other
dream, though I wasn't having the feeling with a girl at all.
8. This paramnesic feeling (as I have pointed out in The World of Dreams) is very
common in dreams, even in connection with the most insignificant details.


162
Havelock Ellis.
A party of us—tourists, I think—were in a certain Welsh
hotel, in the coffee-room. There is a big mirror over the mantel-
piece. I saw myself in a grey tweed suit with a grey cap.
My hair was as dark as usual and I was about my usual (wom-
man's) height, but it looks less in a man. I saw myself more
clearly than the others—men and girls, I don't know who.
I felt myself fond of one of the girls, though she was only one
of a vague crowd, but I was quite aware of her—and the
young man's love in me was not the same as my woman-feeling
all through my real life. I remembered that vividly after-
wards. I felt I was taking care of that girl, but I didn't
see her. We were waiting for tea. There was a violin case
on a table at the other end of the room. Everybody knew it
was something horrible and the girls were frightened. Then
the violin case lifted itself up without being touched, and
everyone was in a state of horror. I (the young man) had
a feeling that I must stand on the hearthrug with my back
to the mirror. I saw my own shoulder, and the back of my
head in the mirror (I don't see how I did it), I put my left
hand up as if I were playing, (I've never learnt the violin)
and waited. I felt the girl looking at me and I was sorry she
was so frightened. Then the violin suddenly flew through
the air like a bird from the other end of the coffee-room, came
straight at me and nestled under my chin in the right position
for me to play. I held my other arm down at my side, and the
loathsome violin played a tune as if someone else were bowing,
but there was no bow, and no one there. It played the same
little tune twice over, and then dropped out of my hands.
I turned to the girl as I woke. It was an extraordinarily
vivid dream; myself, the room and the violin were as clear
as real life; my feeling for the girl was very strong. Only the
other people were the usual dream crowd:
15th Dec. Monthly period, I had rather a bad time.
23rd Feb. That dream. I saw her shoulders and breast
and her face. She held me tight with her hand down there,
hurting me. I awoke in pain. (This pain was all up me
and in my thighs, like, I imagine, acute cramp. I was not
touching myself, both arms being around my husband, who
was asleep. In about five minutes that pain went, leaving


Sexo-Aesthetic Inversion.
163
me light and easy.) Before breakfast the monthly period
came. Easy time."
These erotic dream experiences had lately acquired a
certain importance in the subject's eyes, owing to circum-
stances following her marriage. Much as she loved her hus-
band the expected emotions of intercourse failed to come
about. The sensations of marriage union, while agreeable
so far as they went, were not to be compared with those of the
dreams. The husband, who had been without experience
before marriage, was ignorant of the sexual life of women
and knew nothing of the art of love. He had not only failed
to arouse the wife's erotic emotions, he had not even been aware
that they needed arousing, or that anything beyond pene-
tration and ejaculation was required of him. Having sought
advice, she speedily realized what was amiss, took the matter
into her own hands, instructed her husband who was quite
willing to learn, and according to the latest report, the sexual
union of marriage speedily became almost, if not quite, as satis-
factory as the dream experiences.
In these dream experiences we see aesthetic inversion
carried to a point which is not possible in real life except during
insanity. We see, that is, an inversion which is not homo-
sexual but heterosexual. The interesting point about these
dreams is the seemingly complete divorce from real life. It
is fairly evident that the subject herself could not explain
the origin of the systematized delusion in her dream-life.
She set forth her history with an evident anxiety to conceal
nothing, however trivial; her motive for keeping a diary of
the dreams at one time was the wish to discover the meaning
of them. It is possible that more minute psychological investi-
gation might have given a clue to the first constitution of
the dream-system, but this was not possible, for the subject,
having received the solution of the special difficulty for which
she sought advice, disappeared from sight. So far as we
can judge of the mechanism of the dream-system from the
available indications, it would appear to be determined by
the impulses of childish sexuality, corresponding to the age
at which the dream system arose. The aggressive tendency,
the homosexual tendency, the tendency to Narcissism are


164
Havelock Ellis.
all youthful tendencies, belonging to the period of puberty
or earlier, and all appear clearly marked in this dream-system.
As regards Narcissism, the subject notes that her dream-girl
when seen, failed to correspond in all respects to her own waking
self, but the most striking features of the dream-girl were
certainly those which the dreamer, when awake, most values
in herself. The transformation of sex still remains to account
for, and it would seem to have been a device of the subcon-
scious mind whereby the tendencies to aggression, to homo-
sexuality and to Narcissism might have free play. It maybe
recalled also that the desire to be a boy is really a very common
wish of young girls, even girls of entirely feminine constitution.9
This aesthetic heterosexual inversion in dream-life is,
in the nature of things, a manifestation which cannot occur
in sane waking life. When we turn to waking life we have
to make a fresh start. The next case to be brought for-
ward seems to me to present a partial approximation to the
attitude of aesthetic inversion.
J. G. aged 35. Married. Father nervous, high strung
individual. Very quick tempered. Storms of rage quickly
and easily produced and as easily subdued. Mother of a
rather phlegmatic type. Two brothers and one sister, who
seem to have been normal. Sister very religious.
As a child he was quick tempered, but his likes and dis-
likes were strongly mastered. It seemed to him that he was
unmercifully plagued for the purpose of exciting a tempest
of rage, when he was punished, usually by whipping. At the
age of seven he became very fond of a little girl, the child of
a neighbour, and enjoyed caressing and kissing her. They
always met secretly and the practice was kept up until dis-
covered by a nuresmaid who informed his mother that he was
very forward. He was punished, he could not understand
for what cause, but decided that kissing and girls were bad.
He was not allowed to play with the children of his own age
for some unknown reason; but he thinks that his mother
9. Maeder (Ueber Zwei Frauentypen," Zentralblatt fur Psychoanalyse, Vol. I,
Heft 12,1911) attributes to what he calls the "clitoris-type" of woman, a tendency at puberty
to want to be a boy and to have dream-phantasies in which she plays the masculine part
especially in sexual matters. Our present subject, however, only corresponds to Macders'
clitoris-type of woman to a very slight extent.


Sexo-Aesthetic Inversion.
165
thought he would be contaminated by even the innocent associa-
tions thus engendered. He was left pretty much to himself
and as he was bright he soon learned to read and his days
when not in the school room were spent in the library where
he pored over many books not written for children. He thus
read translations from Maupassant, Balzac, etc. His partic-
ular favorite was the "Heptameron" of which there was a
finely illustrated and unexpurgated edition. He was taught
French and at the age of eleven could read it well; he was thus
enabled to dabble in other works that had heretofore been
closed to him. He was also fond of working with tools and
constructed several rather ingenious mechanisms. This bent
was discouraged by his parents. He now began to have
hazy notions in regard to sexual matters. Because of a question
of his as to the difference between a boy and a girl he was sent
to school. And evidently his parents chose wisely because
the master was a kind, fatherly middle-aged physician who
seems to have understood the workings of the boyish mind,
and here many matters were explained to him that he had grown
to look upon as nasty. Unfortunately for him the master
died after he had attended the school for just two sessions.
He was now thirteen and puberty was beginning to show
signs of its approach. He was very gloomy and despondent,
had thoughts of suicide. At this time he began to mastur-
bate. The act was not done through the suggestion of any
one, but was spontaneous, and he felt ever so much better for
it. He was very desirous of seeing a girl dress, more especially
as he had been unceremoniously bustled from his sister's room
while she was at her toilet, and when he had asked one or
two of the maids to permit him to see them dressing they
had laughed and called him a bad boy and threatened to in-
form his father.
One night he was left alone in the house, the rest of the
family having gone to the theatre, and happening to want
a needle for some purpose, he went upstairs and entered the
sewing-room in search of one. The room in question was an-
gular and on turning the corner he was astonished at what
he saw. Standing in front of the large mirror there was his
mother's maid busily engaged in lacing her corset. She was


166
Havelock Ellis.
scantily clad and seemed to him a vision of loveliness. As
he was apparently unnoticed he stood still and gazed, fascinated.
Being finally laced to suit, she tied the strings and then with
her hands on her hips, waltzed about the room, finally dis-
covering him with apparently great surprise. "Oh, Monsieur
Jean, you are naughty boy." And then as she regarded him,
"How old are you?" He told her thirteen. "Well, if you are
like ze French boy you are old enough." She then kissed him
passionately and putting an arm about his waist led him to
a lounge in the room upon which she threw herself and then
she initiated him into the mysteries of coitus. He had no
emission nor did he have as much pleasure as when mastur-
bating. Erection still persisting she performed fellatio and
dismissed him. This maid pursued the boy for the next year
and several times dressed him up in female apparel, including
a tightly laced corset, and had coitus with him. He noticed
that plaesure for him was greatly increased at these times.
This liaison was at length discovered and he was sent to a mili-
tary school. He entered a university at nineteen and on
numerous occasions visited prostitutes but never successfully
performed coitus as erection failed to occur. Masturbation
was still kept up. He took his degree with honors and after
graduation went abroad. While on the steamer some amateur
theatricals were got up and he was selected to play a burlesque
old maid. In dressing for the part he noticed a vigorous erect-
ion occurring while lacing himself into a corset. This fact
started a train of thought, and as soon as possible after arriving
in London he purchased a corset, and with it under his arm
sallied forth for a promenade in Piccadilly. He soon made
the acquaintance of an attractive member of the demi-monde
and accompanied her to her lodging where upon disrobing
and having her lace him tightly he was pleased to find that his
surmise was correct and that a vigorous erection ensued.
He had coitus with her several times and he also discovered
that erection was produced by him lacing the woman's corset
for her. As he was very sensual he consorted more and more
with prostitutes. He remained abroad for over a year and on
his return trip met a charming young woman, with whom he
fell in love and whom he finally married.


Sexo-Aesthetic Inversion.
167
He told her nothing of his perversion until after marriage,
when he confessed his inability to consummate the marriage
without the stimulus of a corset. She yielded to his request,
also she herself started lacing tightly, squeezing a twenty-six
inch waist into an eighteen inch corset to please him. He never
had coitus with her except when she wore a corset which he
had laced her into or else when she wore one. In recent years
both have worn them. He was insatiate in his sexual desires;
in three years he performed coitus twice daily except when
his wife was menstruating. In conversation with several mar-
ried women of her acquaintance she gleaned enough to realize
that her husband's sexual life was very [peculiar. She consulted
a physician in regard to him and finally persuaded her hus-
band also to do so. He would not submit to a physical ex-
amination, but was not effeminate in appearance, well-built
and apparently muscular. He had a neuropathic eye and there
was a slight tremor of the hands and fingers. He asked if
anything could be done to make him normal sexually and
hypnotism was suggested, but he refused to allow any ex-
periment. His wife later secured a divorce.
This case may be said, quite truly, to be one of corset
fetichism. But it has the peculiarity, bringing it near to
aesthetic inversion, that the subject not only feels attracted
to the corset on the woman he is attached to, but feels it essen-
tial that he should himself wear a corset. To that extent
cross dressing characterizes his psychic attitude.10 . $fe .
* 10. The fast that fetichism really represents In aome eaaaa a transition to aesthetic
inversion, or constitutes an Initial stage of it. Is well brought out In several eases that
have been published. Thus tola ease'of .developed foot and corset fetichism in a Tstudent
of"twenty-two,'studied by K. Abraham (Jahrbuch fur Psyehoanalytische Forschungen.
1912, pp. SS7 et seq.), the'subject when a boy wanted to be a woman, not in order to
exercise a woman's sexual functions, but in order to dress as a woman. Again in a very
completely", developed ,'caae of cross dressing investigated by Hlrsehfeld and Burehard
(Aerstliehe-Saehverstandigen Zeitung.11912, Nob. 23 and'241 a well marked shoe-fetichism
preceded the development of the aesthetic inversion and seems to have led up to it.


IS GENIUS A SPORT, A NEUROSIS OR A CHILD
POTENTIALITY DEVELOPED?*
By Jas. G. Kibrnan, M. D.,
Chicago, 111.
Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association; Honorary Member Chicago Neuro-
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professer Neurology Chicago Post-
Graduate School 1903, Professor of Nervous
and Mental Diseases Milwaukee Medical
College 1894-5; Professor of Nervous
and Mental Diseases Illinois Med-
ical College 1905; Professor
of Forensic Psychiatry
THE mental attitude of Oscar Wilde in "De Profundus"
seems an egocentric expression of instability rather than
a result of crime, conviction and imprisonment. While the
evidence left little doubt of Wilde's guilt, still a large element
of "chantage" was present. Blackmail is a marked feature
in British crime which, if the presumption of innocence were
properly applied, would be impossible. The usurpation of
jury provinces by the judge's summary of the evidence is often
responsible for conviction of the innocent persons. The
suspicionalism of primitive man often finds expression in the
assumption by the press and the public of a police, crowner's
quest1 and grand jury infallibility. The same omniscient
ignorance appears in one Illinois Supreme Court decision
that chantage didn't occur in sexual pervert accusations.
In the case of the People vs. Kemp, a Chicago jury found
choir boys guilty of it and acquitted the accused despite news-
paper dicta to the contrary. In the Palmer case, tersely
•Continued from Alienist and Neurologist, February, 1918.
1. American Journal of Ins. April, 1896.

(168)


Is Genius a Sportt
169
yet logically analyzed by Allan McLane Hamilton, such chan-
tage was markedly in evidence.
The case involved the issue of spendthriftness in the course
of whose investigation it was discovered that Palmer had
given away to a boy companion $70,000 in 25 years. He was
a highly respected officer of a church. In another case the
victim of sex pervert undue influence, a young woman fell
under the "love spell" of an invert female "physician" who
extorted large sums from her. The egocentric element which
Sherard calls a pose and which Hichens depicts in his Amarinth
of the "Green Carnation" appears prominent in "DeProfundus.'
"I was a man, who stood in symbolic relations to the art
and culture of my age. I had realized this for myself at the
very dawn of my manhood, and had forced my age to realize
it afterward. Few men hold such a position in their lifetime,
and have it so acknowledged. It is usually discerned, if dis-
cerned at all, by the historian or the critic, long after both the
man and his age have passed away. With me it was different.
I felt it myself and made others feel it. Byron was a symbolic
figure, but his relations were to the passion of his age and its
weariness of passion. Mine were to something more noble,
more permanent, of more vital issue, of larger scope.
"The gods had given me almost everything. But I let
myself be lured into long spells of senseless and sensual ease.
I amused myself with being a flaneur, a dandy, a man of fash-
ion. I surrounded myself with the smaller natures and the
meaner minds. I became the spendthrift of my own genius,
and to waste an eternal youth gave me a curious joy. Tired of
being on the heights, I deliberately went to the depths in
the search for new sensations. What the paradox was to me
in the sphere of thought, perversity became to me in the sphere
of passion. Desire, at the end, was a malady or a madness,
or both. I grew careless of the lives of others. I took pleasure
where it pleased me and passed on. I forgot that every little
action of the common day makes or unmakes character, and
that, therefore, what one has done in the secret chamber,
one has some day to cry aloud on the housetop. I ceased to
lord over myself. I was no longer the captain of my soul,
and did not know it. I allowed pleasure to dominate me.


170
Jos. G. Kiernan.
I ended in horrible disgrace. There is only one thing for me
now, absolute humility."
In development of his nature during two years' imprison-
ment, are such stages as "wild despair; an abandonment to
grief that was piteous even to look at; terrible and impotent
rage; bitterness and scorn; anguish that wept aloud; misery
that could find no voice; sorrow that was dumb." He asserts
that he passed through every possible mood of suffering, and
finally reached "an ultimate discovery" which he accepts as
"the starting-point for a fresh development."
"I see quite clearly what I ought to do; in fact must do.
And when I use such a phrase as that, I need not say that I
am not alluding to any external sanction or command. I
admit none. I am far more of an individualist than I ever
was. Nothing seems to me of the smallest value except what
one gets out of oneself. My nature is seeking a fresh mode
of self realization. That is all I am concerned with. And
the first thing that I have got to do is to free myself from any
possible bitterness of feeling against the world.
"Morality does not help me. I am a born antinomian.
I am one of those who are made for exceptions, not for laws.
But while I see that there is nothing wrong in what one does,
I see that there is something wrong in what one becomes.
It is well to have learned that.
"I want to get to the point when I shall be able to say
quite simply, and without affectation, that the two great turning-
points in my life were when my father sent me to Oxford,
and when society sent me to prison. I will not say that prison
is the best thing that could have happened to me; for that
phrase would savor of too great bitterness toward myself.
I would sooner say or hear it said of me that I was so typical
a child of my age that, in my perversity and for that perver-
sity's sake, I turned the good things of my life to evil, and the
evil things of my life to good.
"The fact of my having been the common prisoner of a
common jail I must frankly accept, and, curious as it may seem,
one of the things I shall have to teach myself is not to be asham-
ed of it. I must accept it as a punishment, and if one is ashamed
of having been punished, one might just as well never been


Is Genius a Sport?
171
punished at all. Of course there are many things of which I
was convicted that I had not done, but then there were many
things of which I was convicted that I had done, and a still
greater number of things in my life for which I was never
indicted at all. And as the gods are strange and punish us
for what is good and humane in us as much as for what is evil
and perverse, I must accept the fact that one is punished for
the good as well as for the evil that one does. I have no doubt
that it is quite right one should be. It helps one, or should
help one, to realize both, and not to be too conceited about
either. And if I then am not ashamed of my punishment,
as I hope not to be, I shall be able to think, and walk, and live
with freedom.
"In the very fact that people will recognize me where-
ever I go, and know all about my life, as far as its follies go,
I can discern something good for me. It will force on me the
necessity of again asserting myself as an artist, and as soon
as I possibly can. If I can produce only one beautiful work
of art I shall be able to rob malice of its venom, and coward-
ice of its sneer, and to pluck out the tongue of scorn by the
roots.
"And if life be, as it surely is, a problem to me, lam no
less a problem to life. People must adopt some attitude
toward me, and so pass judgment both on themselves and me.
I need not say I am not talking of particular individuals.
The only people I would care to be with now are artists and
people who have suffered: those who know what beauty is
and those who know what sorrow is; nobody else interests
me. Nor am I making any demands on life. In all that I
have said I am simply concerned with my own mental attitude
toward life as a whole; and I feel that not to be ashamed of
having been punished is one of the first points I must attain
to, for the sake of my own perfection, and because I am so
imperfect."
The philosophy of life which Wilde states, experience
finally revealed to him is that sorrow is the supreme emotion
of which man is capable, and that it is "at once the type and
test of all great art."
"What the artist is always looking for is the mode of


172
J as. G. Kiernan.
existence in which the soul and body are one and indivisible;
in which the outward is expressive of the inward; in which form
reveals. Of such modes of existence there are not a few:
youth and the arts preoccupied with youth may serve as a
model for us at one moment: at another we may like to think
that it is subtlety and sensitiveness of impression, its suggestion
of a spirit dwelling in external things and making its raiment
of earth and air, of mist and city alike, and in its morbid sympa-
thy of its moods and tones, and colors, modern landscape
art is realizing for us pictorially what was realized in such
plastic perfection by the Greeks. Musicj in which all subject
is absorbed in expression and can not be separated from it,
is a complex example, and a flower or a child, a simple ex-
ample, of what I mean; but sorrow is the ultimate type both
in life and art.
"Behind joy and laughter there may be a temperament,
coarse, hard, and callous. But behind sorrow there is always
sorrow. Pain, unlike pleasure, wears no mask. Truth in art
is not any correspondence between the essential idea and the
accidental existence; it is not the resemblance of shape to shadow
or of the form mirrored in the crystal to the form itself; it is
no echo coming from a hollow hill, any more than it is a silver
well of water in the valley that shows the moon to the moon
and Narcissus to Narcissus. Truth in art is the unity of a
thing with itself: the outward rendered expressive of the in-
ward: the soul made incarnate: the body instinct with spirit.
For this reason there is no truth comparable to sorrow. There
are times when sorrow seems to me to be the only truth.
Other things may be the illusions of the eye or the appetite,
made to blind the one and cloy the other, but out of sorrow
have the worlds been built, and at the birth of a child or a star
there is pain."
The impulse of artistic creation strongly reasserted it-
self during the days when prison life was nearing an end.
"If I ever write again, in the sense of producing artistic work,
there are just two subjects on which and through which I
desire to express myself: one is 'Christ as the precursor of the
romantic movement in life;' the other is 'The artistic life


Is Genius a Sport?
173
considered in its relation to conduct.'" He goes on to ex-
press the following hope:
"Perhaps there may come into my art no less than into
my life a still deeper note, one of greater unity of passion
and directness of impulse. Not width but intensity is the true
aim of modern art. We are no longer in art concerned with
the type. It is with the exception that we have to do. I
can not put my sufferings into any form they took, I need
hardly say. Art only begins where imitation ends, but some-
thing must come into my work, of fuller memory of words
perhaps, of richer cadences, of more curious effects, of simpler
architectural order, of some esthetic quality at any rate.
"When Marsyas was'torn from the scabbard of his limbs'
—della vagina della membre sue, to use one of Dante's most
terrible Tacitean phrases—he had no more song, the Greek
said. Apollo had been victor. The lyre had vanquished the
reed. But perhaps the Greeks were mistaken. I hear in
much modern art the cry of Marsyas. It is bitter in Baudelaire,
sweet and plaintive in Lamartine, mystic in Verlaine. It
is in the deferred resolutions of Chopin's music. It is in the
discontent that haunts Burne-Jones's women. Even Matthew
Arnold, whose song of Callicles tells of 'the triumph of the .
sweet persuasive lyre,' and the 'famous final victory,' in such
a clear note of lyrical beauty, has not a little of it; in the troubled
undertone of doubt and distress that haunts his verses, neither
Goethe nor Wordsworth could help him, tho he followed
each in turn, and when he seeks to mourn for 'Thyrsis,' or to
sing of the 'Scholar Gypsy,' it is the reed that he has to take
for the rendering of his strain. But whether or not the Phrygian
Faun was silent, I can not be. Expression is as necessary
to me as leaf and blossoms are to the black branches of the
trees that show themselves above the prison walls and are so
restless in the wind. Between my art and the world there
is now a wide gulf, but between art and myself there is none."
Nordau's2 alleged detection of the sexual in Wilde which
was so widely exploited as a Nordau advertisement failed
entirely to detect homosexuality and certainly ignored religiosity
2. Degeneration.


174 Jas. G. Kierman.
Religiosity was as well marked in Wilde's later career as in
Verlaine's. With a tendency to paedophilia it crops up far
from rarely in clergymen and also, as in Portland, Oregon
in Y. M. C. A. officials and social purity white cross enthusiasts.
(To Be Continued.)


HAPPY THOUGH INSANE
Br C. H. Hughes, II D.,
St. Louis.
THE editor of this magazine, while presiding over an insti-
tution for the care and treatment of the insane, often
noted the surprise of visitors at the apparent happiness of cer-
tain inmates and not all of them being in the grandiose de-
lirium stage of paresis. The asking of the question;
"Are insane people ever happy ?" by an office neurotic patient con-
cerning a mentally maimed friend, suggests this editoria.l
Some people are never so happy as when insane and some
are never happy till they become so. They fret and worry and
strive for so much more of the happiness they consider them-
selves specially entitled to, that the brain breaks under the
strain and under the anxiety, insomnia, depressed nutrition
and lowered assimilation, sequent neuratony and psychatony
a reversion of feeling comes to them in reactionary exaltation.
A delusional alternate happiness comes to them, as may also
be seen in folie circulaire.
Among the author's patients a family of hereditarily
psychopathic variety, contentious at home but happy in the
asylum, who alternated with each other in spending terms
in the hospital, illustrates. Each one appeared happy in the
latter place when their mental malady, folie tirculaire, began
to show signs of returning convalescence. They always,
each one of them, after a period of enforced rest and regulated
habits, recovered within a period of six months usually, and
returned home, when another member of the family would
soon be brought for treatment. This family was a trio of
wife, son and daughter.
The happiest of this lot, when insane, was the son. He
(175)


176
C. H. Hughes.
was exuberant in his delusion of well being and he was almost too
young for paresis, not being over twenty-eight and never
developed typical general paralysis, but appeared to remain
many months free from intellectual disturbance after re-
covery and engaging in business. He was a farmer and cattle
raiser. One of his attacks was precipitated by a trip to St.
Louis, an unprofitable disposition of his cattle and a bout of
dissipation.
Turning the leaves of the Journal of Mental Science
an incidental reference to a recent article by that venerable
Corypheus of pyschiatry, Henry Maudsley on "mental organism'
suggests this clinical note. We extract briefly to comment
in clinical confirmation of Maudsley's statement that the
pictures of torment drawn by Jeremy Taylor and others of
"the torments of hell" they have "depicted in flaming rhetoric"
were in the end "unfelt fantasies of the imagination," many
of the chronic insane giving similar utterance.
Charles Lamb, who had a brief attack of mania, wrote
to Coleridge after his recovery: "While it lasted I had many
hours of pure happiness. Dream not, Coleridge, of having
tasted all the grandeur of and wildness of fancy till you have
gone mad. All now seems to me vapid, comparatively so."
Eloquent writers, like Jeremy Taylor, have used all the re-
sources of language to depict in flaming rhetoric the burning
torments of hell through endless time, but their pictures were
in the end unfelt fantasies of the imagination which did not
seriously horrify those who uttered them, rather perhaps
pungently tickled their fancies, not as in a torturing delirium
unspeakable horrors of feeling from which death would be a
blest deliverance.
In specially pertinent confirmation was a patient of mine
toward the end of the first decade after the American
civil war who, depressed to mental dethronement about the
close of this war, had fall upon him an irreparable calamity
to his family and estate. He was accustomed to pace his
room and the hospital corridors and when out on the grounds
walking, bent over as if carrying a great burden continually
exclaiming "my God, how can I stand it" just as he did
at the onset of his melancholic malady, but merely automati-


Happy Though Insane.
177
cally, without the real feeling, clearly manifest at the beginning
of his mental disease. Acute psychic emotional feeling had
departed, but the painfully sounding utterance yet automati-
cally and subconsciously persisted to the end of a rather
lengthy life of chronic uncured insanity.
The dolorous rhythmic speech had become merely an auto-
matic subconscious utterance without the earlier accompanying
emotion. He would pause in his doleful speech to ask for a chew
of tobacco and refrain from its repetition long enough to thank
you for it and then would start on his pitiably appearing
but not painfully felt utterance and bent-over pace.
Thus certain chronic utterances and appearances
startling and deceptive to the novice, are better comprehended
by the alienist clinically experienced expert.
Arid here obtrudes the potent and true Esquirolian dic-
tum. "We must live with the insane in order to fully under-
stand them" in all phases of their peculiar maladies of mind.
One of my patients, a young man, given to manustupra-
tion and with exalted religious ideas, who looked upon a comely
maiden hotel waitress to lust after her, gouged out his eyes,
saying it was just "if thine eye offended thee to pluck it out"
and he plucked out both of his eyes. Another religious para-
noiac, a masturbater, strangulated his testicles on the misin-
terpreted principle if thine hand offend thee cut it off, only
it was not his hand alone that he thought harmed him but an-
other member. These men did not complain of any pain in
the hurt organs, but seemed quite well satisfied at the time with
what they had done.
A chronic dement, given no special reason and hardly
capable of giving a reason, plunged scissors into her abdomen
and cut away several feet of her upper bowel, resulting soon
after, in peritonits and death, but made no outcry or complaint
of pain at the time of the act. These illustrations are enough.
A word to the clinically wise in psychiatry is sufficient.
A young girl just out of school, brain tired and mentally
overstrained, fell ill with Blandford's acute delirious insanity
after a brief period of mental depression with headache, mental
and intestinal torpidity and scanty menstruation when a re-
actional exaltation of ideation came on, limited in its range


178
C. H. Hughes.
to her farm home. She would skip and waltz up and down
the corridor of the hospital in imagination calling and feeding
the chickens, calling and petting the domestic animals of the
farm and with cheerful voice and manner singing the songs
of her normal childhood days.
With adequately enforced sleep and nutrition, to which
at first she was indifferent, and due attention to bringing about
a normal state of function in liver and bowels, both being
atonic and torpid in action, she recovered, was discharged
from the hospital at the end of three months and has not
relapsed into any form of mental aberration after many years.
This type of insanity, so well described by Blankford but which
some make no note of by its proper name, in these days,
is exceedingly interesting for it is a real delirium without fever
in its later stages especially, a psychosis that typifies Galen's
definition of insanity in general, viz.: Delire sine febre.
All forms of insane exhilaration are neither religious para-
noia nor the secondary stage of paresis. There is a condition
of psychic anaesthesia and analgesia, as well as physical,
among the insane that not infrequently enables them to with-
stand pain without feeling it intensely, which accounts for the
self infliction of painful injury by certain insane, like the glass
eaters and cavity stuffers of pins, needles, plaster, etc., without
greatly disturbing them. They are like men wounded in
passionate combat in battle or duel, or like the exhilarated
anesthetic hysterics in this one aspect of this malady of the
brainand allied nervous system especially.
Spring Grove State Hospital (for insane) near Carons-
ville, Baltimore County, Maryland.
In the February number of this magazine we printed a
domestic picture of women patients weaving and mending
hosiery. Here is a class of patients engaged in making baskets
and below is an outdoor study of a class of chronic patients,
many of them incurable, in the same institution. The most
of these patients are usually classed as incurable, in the dementia
precox class, but they seem not unhappy nor as fit to be killed
as some pseudo and novice psychiatrists would consider some
of them from their histories.


Happy Though Insane.
179
Insanity can not be understood in all of its phases at a
glance as some assume. It is here especially that a little know-
ledge is a dangerous thing, especially in a false medical expert
who testifies as a guess on non-clinically enlightened conclusion
and non-psychopathically informed judgment.
CLASS IN BASKETRY
Spring Grove State Hospital For Insane. Catonsville, Md.


180
C. H. Hughes.

The preceding is a dementia-precox class from same
hospital receiving an outing instruction; and they appear not
unhappy.
Other illustrations will appear in later issues of this
Magazine.


"PROTECTING THE MENTAL HEALTH OF THE
GROWING CHILD."
By Martin W. Barr, M. D.*
Chief Physician, Pennsylvania Training School,
Elwyn, Pa.
THE census records in successive periods at the close of the
last and the opening of the present century while evidenc-
ing the progress of our great nation, give also a bugle note—
a clear warning of an advancing army of Idiots, Imbeciles,
Epileptics and Insane, and the steady growth and persistent
encroachment of that worst enemy of a race—Degeneration.
In this repletion of evidence, we find clear confirmation
of the intimations given by scientists after prolonged research
in the various fields of Physiology, Psychology and Educa-
tion.
Surely we should recognize that the correllated evidence
of two such bodies—Practical and Theoretical—may no longer
be despised as mere fadism, but demands immediate install-
ment of measures of defence, found only in legal protection
from fateful heredity by authorizing sterilization and in safe-
guarding from pernicious influences the mental hygiene of the
growing child.
And yet when we assert the necessity for the unsexing
of the unfit the clamor is at once raised that we are assaulting
the inalienable rights of man.
Rights! What right has any man to wilfully injure
his neighbor, himself and still less his own children? Of which
wrongs that American family through which can be traced
harlots for eleven generations, and the Walker family number-
ing 83 idiots, are striking proofs. The strong arm of law
•Read before the "Mental Hyfiene Coogreai," Baltimore, Maryland, February 26,1918.
(181)


182
Martin W. Barr.
forbids injuries in every other line, and I contend that the
careless or wilful procreation of vicious progeny is a crime
against humanity more far reaching than murder or burglary.
The incompetent is not committing either of these crimes
it is true, but he is using a power conferred, not upon a man
mark you, but upon mankind, for a noble purpose—to manu-
facture criminals and diseased beings by wholesale. Surely
the service of the government of mankind is being prostituted
to evil purposes, and needs protection of law, such at least
as our postal service claims and gets.
Many today re-echo the cry of that poor mother over
her child—"an innocent" convicted of the murder of another
for which he was wholly irresponsible: My poor son! "Oh,
had I but known he would never have been born!"
Far better that children remain unborn than that they
should be introduced into life mental or moral cripples, and
Heaven speed the day when men and women shall realize that
parenthood is not a right but a vocation, to which all are not
called, and the grasping of it by the vicious, the diseased
or the defective is practically the crime of touching the sacred
ark of the Covenant of which the penalty was death.
Quality being the thing sought in the propagation of
species—both vegetable and animal—just so with the human.
It is an axiom long accepted that upon mental potentiality
depends mental efficiency, and, as a specialist years ago replied
to a mother seeking cause for her child's mental condition:
"Ah, for that we must go back fifty years or more!" Just so
it is. A knowledge of antecedents is as absolute a necessity
to the protection of the mental, as to the physical hygiene.
One must know the character and quality of the material
with which one is dealing, before adopting methods towards
the furtherance of healthful growth. For truly, what is meat
for one, is poison for another; thus, where one child needs
encitement, another demands repression, or rather diversion
of aims into quiet channels; and, too often, inertia or highly
nervous conditions are legacies of forebears.
The work of diagnosing such influences has been greatly
facilitated by the formulation of tables of etiology based upon
the study of 6430 mental defectives in England and America.


Mental Health of the Growing Child.
183
Herein, causes are broadly considered in three periods—Before,
—At time of,—and After birth. My personal study of 4050
cases reveals Heredity foremost, and heredity of imbecility
direct, an unfailing cause of mental defect, although it may
sometimes skip a generation.
For instance, one of these shows a father and mother
both mentally defective, aged respectively 38 and 36 years,
with a family of 19 children, all either idiots or imbeciles.
Of the causes acting at birth an example is found in a
case recently brought to me for examination. The child born
in an army post, miles away from a reputable physician,
circumstances enforced the attendance of an unskilled practitioner.
The head appearing to be rather elongated, the doctor, using
much force, pressed and manipulated it into a real ball, with
the result, that today just entering upon young womanhood,
beautiful in form and feature, she has the undeveloped cranium
and mind of a little child.
Of the third period—acting after birth—causes are diverse,
and show some 623 or 20.61 per cent from fevers, insolation,
etc., and 262—8.59 per cent—from traumatism.
Acquaintance with these tables by mothers, present
and prospective, might aid in prevention of mental defect,
as it undoubtedly does aid teachers in the work of protecting
from retrogression, and in insuring healthful growth. Pur-
suing in the nursery this same idea of protection, one must
follow, according to nature's law with the lower animals,
the awakening of the senses through physical activities stimu-
lated by the emotions, alternating regularly with periods
of rest, repose, and silence; this awakening extending through
the third year with normal children, or with backward or
defective children through the seventh, as needs of individual
indicate. Early application to practical work of all, or indeed
any of the senses, might precipitate stultification.
The short kindergarten periods of alternate work and
play are expressly designed to guard against the danger of
over-pressure, while giving stimulation to the child of com-
panionship with his peers in broader avenues of games, and
concerted employment. 4t.V £*..
In the sixth or ninth year, the faculties having gradually


184
Martin W. Barr.
attained healthful growth, now clamor to make practical
exemplification of inherent power, to show "what I can do."
But even here, still must the mental health be guarded, and
watchful care keep the abstract behind the concrete. The
working hand not only makes strong the working brain, but
it will best present to its owner that view of the abstract suited
to his peculiar needs, enabling him to see and grasp for him-
self as no other can for him. Through this period of grasp
and assimilation, he lays up a healthful store of mental power
for the period of education when training in the purely abstract
will, with less danger, begin. Less danger, I say for this period
will include adolescence, when continued study of the indivi-
dual and adaptation of methods is imperative. Weakness
or defect hitherto unsuspected, coming from far back genera-
tions, or superinduced by sudden accident or disease, respond
readily to call when the changing nervous system is under
comparatively slight control. It is at this critical period
when the mental and physical powers are acting and reacting
upon one another, that a healthful envoirnment is imperative.
Simple, nourishing food, and that oversight insuring regularity
in the action of the digestive system, alternate periods of rest
and exercise with free life in the open, if possible, are essentials
in protecting the mental hygiene of the growing child.
To this end the enlargement of play-grounds, and the
providing of school lunches in many places have been great
aids.
That the physical efficiency thus acquired may contrib-
ute, as it should, to mental power it is essential that the
actual area of brain cells be used with such care as not to
encroach too early upon the potential area.
Every sense avenue must be investigated and tested,
and the child not pushed beyond its mental limit, lest there
be an outbreak into insanity, or a sinking into idiocy.
The precocious child is rarely heard of in after years—
the tiny girl who can repeat "Thanotopsis" without a break,
the four year old boy who can memorize "Marco Bozzaris,"
or even the musical phenomenon, except as true idiot savants.
And why? Because they have used both the active and poten-
tial cell areas and there are no more. They have overdrawn


Mental Health of the Growing Child. 185
their account in the bank of life and are mentally penniless—
intellectually bankrupt.
The craze for college courses follows in this same line,
for which many are as totally unfit, as they are for the exami-
nations they feel they must pass by fair means or foul. "Get
there; honestly if you can; anyhow get there," is the motto
of many under excitement conducing largely to mental deterio-
ration.
A practical illustration is found in the experience of
two young fellows, each, with neurotic heredity, feeling un-
equal to purely intellectual labor.
One obedient to his father's behest, passed with difficulty
a university examination, only to return within a week to his
home an insane wreck.
The other, whose mother, also ambitious that he should
undertake a similar course, although he felt himself both
physically and mentally unable to cope with class work, after
consulting some half dozen specialists, came to me, only to
receive the affirmation that if she persisted, the boy's final
graduation would infallibly take place under ground.
Removed from an atmosphere for him absolutely per-
nicious, and given an opportunity to test his powers, he is now
a successful business man, and the father of a family apparently
healthy.
Herein may be seen the necessity for affiliation of teachers
and parents, that the school and the home may work together
for the good of the child.
More important too, than mere scholarship in the teacher,
is that quality of parenthood which insures to both boy and
girl a sympathy and good comradeship in work, together with
firm control—a guiding as well as a compelling hand.
Such qualities in teachers mean more for the mental
hygiene of children than the mere intellectual ability to pass
an examination in subjects often never used, which is practi-
cally the standard too often demanded by many school boards.
My own experience in selecting teachers, recalls and
fully confirms, that of a superintendent of one of your own school
districts which I heard of years ago.
A physician, a man of independent means, engaging in


186
Martin W Barr.
the work as a psychological study, found a teacher in a rural
school doing excellent work in adapting methods to individual
needs.
Recognizing that they could ill afford the loss which
the enforcement of a prescribed examination would doubtless
occasion, he examined her all right, and she remained for years
a power for good in her little community, in entire simplicity
with no idea that she was solving psychological problems,
contributing to the mental hygiene of its children.
That the poor, rather than the rich, may be fortunate
in being reared under conditions suited to needs, is illustrated
in a comparison of two cases coming under my personal ob-
servation.
A young man with exceptional heredity and brilliant
connection—the son of a lawyer of repute, a diplomat par
excellence and ambassador to a foreign court.
The pampered child of wealthy parents, with nurse,
companion, valet and tutor, he did not have what was to him
most important, that comprehension of needs giving incite-
ment, without undue excitation, avoiding under stimulation
and consequent inertia. With mental powers thus enfeebled
in the period of childhood and youth, pushed beyond his
mental strength, on entering college, he, the sad misunder-
stood, broke down completely, and for years has been the in-
mate of an insane hospital.
The contrasting case is that of a waif and stray from the
almshouse, where his mother and her two sisters—feeble-minded,
harlots all—had died; the father an insane suicide; and an
uncle and aunt both confirmed criminals—the one an expert
counterfeiter, and the other a notorious player of the badger
game.
This boy, adjudged an imbecile, was at the age of 10 com-
mitted to a training school. Here he accomplished without
undue effort the lessons adapted to his grade of mentality,
and the exercises in both physical and military drills, while
excelling in athletics. Notwithstanding that physical con-
ditions required frequent attention of both nurse and physician,
he was able to push forward in both musical and manual train-
ing, becoming expert in the building and carving of furniture,


Mental Health of the Growing Child.
187
as well as in the setting of type, and he became easily the chief
of the corps of printers, accomplishing all the work of the place.
In music, equally successful, he was leader in band, orchestra,
special chorus, and the operettas of the various seasons. Prov-
ing entirely dependable, he was frequently placed in charge
of classes in these various departments, in the absence of
teachers during vacation.
Having gained such experience in quiet community life,
it was but natural that in his early twenties there should be a
longing for "beyond the beyond." Desiring to try his theatrical
experience on a broader stage, it was arranged for him to join
a dramatic company then playing in New York. Here the
competition with normal talent and the loneliness of a great
city proved, as had been surmised, his best mentor, and he
gladly returned to former duties amid familiar surround-
ings, as an attendant. After a few years of satisfactory work,
in spite of medical care and treatment, his weak constitu-
tion easily succumbed to a sudden attack.
In reviewing this history, one cannot but recognize that
but few normal people have attained before 30, the preparation
and fulfillment of life's call more fully than did, under common-
sense protection and practical direction, this victim of a fate-
ful heredity, who realized to the full, his peculiar mental
condition, and also his incompetency for parenthood.
That we have, in the new century, entered upon a new
plane of thought regarding mental hygiene, there can be no
doubt. That the mind of the public is awakened to the necessi-
ty for protection from vicious heredity is shown in the action
of legislative and social service bodies, and also of various
churches demanding as a requisite to marriage the certificate
of reputable physicians as to the health of contracting parties.
Likewise as to maintaining healthful mentality, school
boards and medical boards begin to unite in recognizing that
healthful developmental growth must precede education, as we
cannot draw out what is not there, any more than we can
train a plant before it begins to grow; and all horticulturists
know what is the ultimate result of forcing.
It is interesting also to note the suggestion to a New York
educational association by its medical secretary that eventually


188
Martin W. Barr.
grades might express degrees of mentality, not mere book
knowledge.
When children are grouped, classed and distributed
on this basis, and manual training and physical culture are
given wider space in the curriculum; then may we hope to see
a natural drift into the various avenues of industrial, manual
and professional pursuits, each going to his or her own place
and, as contributing to the good of the whole, fulfilling the office
of good citizenship, the end and object of true education.


SELECTIONS.
NEUROPATHOLOGY.
Women and Goiter in Southern Norway—According
to Schiotz's observation on 177 cases, only 10.2 were males.
See Jour. A. M. A., 2-15-13.
CLINICAL PSYCHIATRY.
The Popular Idea of an Insane Individual is that of
a person devoid of all sense and appreciation of environment.
Many think that the afflicted must even howl, froth at the mouth
and seek to commit homicide on all those with whom they
may be thrown in contact; tear their clothing; destroy all
articles that are breakable; fail to recognize their relatives
and friends, before the world at large will admit that the poor
wretch is, in their opinion, insane. They do not seem
able to comprehend that a person may be very sane in some
particulars and very insane in others; in fact that a man may
carry on a very learned discussion on various topics and be
very lucid and far-seeing in his deductions and yet when
about to take his departure refuse to shake hands, with a remark
that "I can not shake hands with you for I am, as you are aware,
a brass kettle." Now a man can hardly have such a delusion
and still be considered sane. So long as the daily affairs
do not entrench upon their peculiar hobbies, or obsessions,
these people may pass muster in any crowd as being perfectly
sane, but, let such an infringement occur and then all of their
acts and talk will show the mental warp.
This misconception, at times, is a stubborn thing to com-
bat and much injustice to families and friends is imposed;
because, those having these erroneous ideas, rapidly imbue
(189)


190
Selections.
others, even juries and judges, with the belief that an in-
justice is contemplated by those directly concerned; especially
should there be a property of any magnitude involved. Fear
of this unkind censure causes many families to desist from
trying to protect the patient, as well as themselves, and they
are compelled to placidly look on while the man wastes his
substance, carrying out vagaries instead of safe investments,
reaping shadows rather than dividends and is often abandoned
by his family and friends, without credit being allowed him
as being fatally ill and irresponsible for what he does.—C. C.
Goddard, M. D. (The Journal of the Kansas Med. Society.)
Alcoholism and Psychoneurosis (L'Encephale, July
10th, 1912.) Mouratoff. In this paper the author discusses
the relation of alcoholism to the several psychoneuroses with
which it is most often and most closely associated, namely,
hysteria, epilepsy, and periodic insanity. Considering dip-
somania from this point of view he expresses the opinion that
in a large number of cases of this condition, especially those
where the alcoholic tendency is clearly intermittent, the real
disorder is periodic insanity. In some instances, the dip-
somaniac impulse may be due to epilepsy, but the rarity of
convulsive attacks in dipsomania and the tolerance of alcohol
which these patients so generally show, go to prove that this
is not a common association. The pseudo-dipsomania of
chronic alcoholism, on the other hand, is an expression of
general psychic degeneration complicated very usually with
hysteria. It is with the latter neurosis also that the author
would connect the numerous cases of alcoholic automatism
with incomplete loss of memory.—W. C. Sullivan.—(Excerpt
by Jour. Ment. Science.)
Psychiatry and Bacteriology. (Psychiatrisch-Neuro-
logische Wochenschrift, No. 28, 1912-13.) Bresler, J—Dr.
Bresler in this paper discusses the relationship of infective
intestinal disease to mental disorders.


Selections.
191
NEUROTOXICOLOGY.
A Peculiar Case of Common Salt Poisoning—0. H.
Campbell, M. D., St. Louis, reports on a healthy boy of 5
years. Parents living and well. Had mumps at 4 years,
measles at 3, no other illness. The mother believed the child
had worms; administered a salt enema. The suggestion had
been to use one tablespoonful in a quart of water, but she
misunderstood and used one pound in a quart of water.
The enema was given at 5 p. m., July 13. In from five
to ten minutes the child cried, with severe pains in head, became
intensely thirsty, vomited violently, and soon began to purge
violently; within thirty minutes he became unconscious
and had one convulsion after another. I saw him at 6:30 p. m.
and found him unconscious and unable to swallow, with one
clonic spasm quickly following another. The temperature
was 99.2, pulse 150, bowels moving often, passing blood and
mucus. At 8 p. m. the temperature was 102.5, pulse 170;
the eyes were crossed, and all the symptoms seemed worse.
At 9 p. m. the temperature was 104.6, pulse about 200. All
of the symptoms seemed worse and continued to increase in
severity until 10 p. m., when the child died. I was unable to
have a post-mortem examination. I have searched the litera-
ture carefully but can find no parallel case. 3542 Washington
Avenue. (Jour. A. M. A., 5-12.)
CLINICAL NEUROLOGY.
The Hypophysis and Polyurea—Simmonds, in Munich
Med. Woch, Jan. 21, ult., relates a case history which shows
beyond a doubt that a lesion of the hypophysis can produce
persistent polyuria. The organ, now known to possess three,
instead of two separate portions, exerts an unusual variety
of functions. Only the anterior portion is concerned with
skeletal growth. The posterior lobe, long believed to be inert,
was eventually brought in relationship with metabolism and
the genital glands. Finally, the third, or middle lobe, or in-
terlobular portion, first isolated by Schafer, stands in definite


192
Selections.
relationship with the renal blood vessels and cells. While
acromegaly and adiposogenital dystrophy have been some-
times accompanied by diabetes insipidus, the present case
seems to be the first isolated example of the latter and was
evidently determined by a cancerous metastasis.—Medical
Record.
The Affiliation of Psychology With Medicine is
of necessity a most intimate one, and this has long been recog-
nized. Lotze's "Medicinische Psychologie" on the one hand
and Tuke's Dictionary of "Psychological Medicine" on the
other, bear testimony to this affiliation. Or we may pair off
in much the same way the various text books of physiological
psychology, written by psychologists, and the books on ab-
normal psychology, written for the most part by medical men.
The Vienna and Zurich schools of psychiatry make much use
of psychanalysis, which, in its various forms, is but an elab-
oration of classical experiments of the psychological labora-
tories. On the other hand men whose chief interests are
psychological are seeking and being appointed to research
positions in connection with many of our leading hospitals.
All of these facts indicate that psychology and medicine are,
in part at least, joint tenants of some common ground of content
or of method. I hope some time to hear a medical man discuss
the contributions of his science to psychology.
The first half of a paper on "Modern Psychology in Medi-
cine and Law," read, by invitation, before the Society of Medi-
cal Jurisprudence, New York City, November 11, 1912 by H. L.
Hollingsworth, Ph. D., N. Y. Dept. of Psychology, Columbia
University.—(Med. Record.)
NEUROTHERAPY.
Spirochaeta Pallida in the Brain Paresis—By Hideyo
Noguchi, and J. W. Moore, is thus discussed editorially in the
Jour. A. M. A., March 29th.
"Noguchi and Moore examined the brains in seventy
cases of typical general paralysis, and in twelve they succeeded
in demonstrating Spirochaeta pallida in all the layers of the


Stltctions. 193
cortex save the outermot one. Both macroscopically and
microscopically the anatomic changes correspond wholly to
those regarded as characteristic of this disease, so that there
is no good ground for the possible assertion that they were
dealing with frank instances of cerebral syphilis in the narrower
sense rather than genuine general paralysis. This demonstra-
tion consequently must tend strongly to support the view that
general paralysis is the result of the direct action of the parasite
of syphilis in the brain; that cerebral syphilis and general
paralysis in reality are, as asserted by Dunlap and others,
part and parcel of the same process.
Death Under Stovaine—A patient, aged 50, died
at the Polyclinic Hospital, November last, just as Dr. William
Seaman Bainbridge was about to operate for strangulated
hernia. Anesthesia had been effected by the spinal injection
of stovaine, but the autopsy showed that the man was in ex-
tremely bad physical condition, and Dr. Bainbridge has ex-
pressed the opinion that the death was not due to this drug.
It may, perhaps, be recalled, however, that when Jonesco
was demonstrating his method of stovaine spinal anesthesia
three years ago, in one or two of the cases it was with difficulty
that the patient was saved from fatal syncope.—Boston Medical
and Surgical Journal.
Tuberculin in Paresis—Within recent years recourse
has been had to the use of tuberculin in the treatment of general
paralysis. This treatment was first carried out by Jauregg
and later by Pilcz. Their aim was to bring about increased
temperature and oxidation. A hyperleucocytosis followed
the injection of tuberculin, and they claim to have produced
prolonged remissions in many of their patients, who were able
to resume their ordinary occupation. Pilcz states that three
out of four patients were cured, but they were in the early
stages of the disease.—Brown & Ross, Jour. Ment. Science on
Leucocytosis in Mental Diseases.
The Influence of the Chemist on Modern Thera-
peutics—One of the advances of modern chemistry has been
to show that cod liver oil possesses more virtue than merely
as a convenient means of administering fat to the patient.


194
Selections.
With a clearer understanding of its chemical construction
has come a more just appreciation of the large therapeutic
value of its essential qualities. Before modern chemistry
had succeeded in isolating the active principles of cod liver
oil, the patient whose stomach was unequal to the difficult
task (a difficult task even to the normal organ) of digesting
a greasy mass, was of necessity denied the advantages of this
valuable agent. Unfortunately this was too often the case
because the very patient who needed cod liver oil was pos-
sessed of a defective gastric organ. It was not until the phar-
maceutical chemist made a practical use of his more theoretical
colleague's investigations that a preparation of cod liver oil
was secured which was freer from fat and which was capable
of being digested by the impaired stomach. The most popular
of such cod liver oil preparations is easily Cord. Ext. 0l. Morr-
huae Comp. (Hagee) which contains in palatable form the
active principles of the oil, and by means of which the patient
may enjoy the therapeutic advantages of the whole oil and
yet be spared the distress inevitable upon taking the whole
oil. Cord. Ext. 01 Morrhuae Comp. (Hagee) has for many
years been put to the severest tests, and no stronger argument
in favor of its clinical value may be advanced than that those
who have used it longest use it the most.—Therapeutic Review.
NEUROPHYSIOLOGY.
The Function op the Hypophysis—Amos W. Peters.
(Reviews of Bio-Chemical Literature)—As an example of the
merit of the training school's meritorious endeavors, we trans-
cribe this from its magazine.
"Aschner shows that the supposed results of previous
experimental work are largely vitiated by the fact that they
were partly due to injury of the adjacent parts of the brain
to which the pituitary gland is attached. It was to these inci-
dental injuries that the large mortality of the operated animals
was due. With his improved technique, Aschner comes to the
conclusion that the removal of the pituitary gland is not fatal,
as has been heretofore held. The damage of this procedure


Selections.
195
to the psychical and growth process of young animals remains,
however, well established.
"The results of extirpation of the pituitary as described
in differ according to the age of the animal (dog.) In adult
animals these effects are not marked beyond a moderate
adiposity, slight depression of character, somewhat subnormal
temperature, decrease of the general power of resistance and
some damage to the sexual glands. Marked and characteristic
trophic disturbances, however, follow the removal of the pituitary
gland from young animals. At the age of four months the
operated dogs showed a great excess of fat, were excessively
quiet and inactive and in their growth had made only half the
development shown by the normal control animals. Infantile
characteristics were prominent in the hair and skin, the denti-
tion showed persistence of the milk teeth, the bony system
showed lack of fusion and calcification and the continuance
of juvenile proportions, the genital organs showed marked
microscopical changes. No positive changes were found
in the central nervous system exclusive of the operative re-
sults. In the other glands of internal secretion the thyroid
frequently showed disturbances of structure, the thymus
persisted abnormally late, which is well in accord with the
general infantile physiological character. Liver and pancreas
showed fatty degeneration."
PSYCHO-EUGENICS
Editorial on Insane Criminals in New Albany Medi-
cal Journal—A new system went into effect in the Tombs
prison, of New York City, on Jan. 1st, which is intended to
show, if possible, how many of the 18,000 prisoners who are
admitted each year, are mental defectives. If the number
is found large enough, it will be advised that a new State Insti-
tution be created, says the Post-Graduate, to which can be
sent those cases which belong neither in the state prisons
nor asylums for the criminal insane, to which latter they are
now committed if their defectiveness happens to be revealed.
Dr. Frank A. McGuire, the Tombs physician, has pointed out


196
Selections.
that too many mental defectives were slipping by either as
normal criminals or as insane criminals; and that probably
the majority of cases are not detected at all and are dealt
with like ordinary criminals. "In European countries, there
are separate institutions for mental defectives convicted of
crime. We have none here. The European statistics show
that about 8 per cent of those in prison awaiting trial are mental
defectives, which would mean about 1,200 cases in a year
out of a total number imprisoned here in the Tombs. We
want to determine just what the figures are." To help decide
this question, as each man reaches his cell, the tier-keeper
is given a card, on which is a column of questions, which must
be answered after careful and extended examination of the
prisoner. Like our present care of the habitual drunkard,
this will be another step in advance, in the treatment of those
who are committed to the State Institutions.
It may be instructive here, says the Post-Graduate,
to recall the history of Ada Jukes. From her were descended
one thousand two hundred persons. Of these, one thousand
were criminals, paupers, inebriates, insane or on the streets.
Unquestionably, if Ada Jukes and her immediate family had
been prevented from perpetuating their kind, the state would
have been spared much expense, and American manhood
would have been considerably better off. Such instances
are not isolated; and their study is the reason for the science
of Eugenics as given us by the late Sir Francis Galton, and
ably continued by Karl Pearson, and other followers. By
means of statistics they show, not only the danger which arises
from the marriage of criminals, lunatics, etc., but the degener-
ating effect upon mankind. It has been shown, e. g. that in
Great Britain, 25 per cent of the population (and that the
undesirable element) is producing 50 per cent of English
children and that, if this is allowed to continue, it must inevitably
lead to national deterioration. Undoubtedly, the proper attitude
towards inferior types is that supposed to be assumed by
Huxley, "We are sorry for you, we will do our best for you,
but we deny you the right to parentage. You may live, but
you must not propagate."


Selections.
197
EDUCATIONAL PSYCHIATRY.
Examination for the Diploma in Psychological
Medicine—By the University of Cambridge, England.
Any person whose name is on the Medical Register is
admissible to Part I of the examination.
Candidates for Part II of the examination must, at the
time of entering for the examination, be registered medical
practitioners of not less than two years' standing, and must
produce evidence of having had twelve months' clinical ex-
perience in any one or more of the following institutions:
(1) Registered mental hospitals in the United Kingdom.
(2) District, county, borough, city or royal asylums
in the United Kingdom.
The first part of the examination will consist of (1) a paper
and (2) a practical and oral examination in the anatomy and
physiology of the nervous system, (3) a paper and (4) a practical
and oral examination in physiology.
The examination in the anatomy and physiology of the
nervous system will include the following subjects:
The structure of nerve-cells and nerve-fibres.
The neuron theory.
The course of the principal nerve-tracts and the connections
of the principal nuclei of the central nervous system.
Reflex action. The spinal cord as a path of conduction.
The decerebrate animal.
The localisation of function in the cerebrum. Association
areas.
The functions of the cerebellum. The co-ordination
of movements.
The development of the brain.
The more usual methods used in examining the structure
of the nervous system.
The examination in psychology will include the following
subjects:
General analysis and classification of modes of conscious-
ness. The relation of mind and body. Methods of psycho-
logical investigation.
Sensation; adaptation, fatigue, contrast, after-effects.


198
Selections.
Specific nervous energy.
Local signature. Localization and reference of sensation,
normal and abnormal.
Perception. Spatial and temporal perception. Illusions.
Agnosia. Orientation and its disorders.
Movement; apraxia. Speech; aphasia.
Imagery; hallucinations.
Memory; recognition and their disorders. Association.
Imagination and its disorders.
Thought. Flight and fixity of ideas.
Volition and its disorders. Attention, normal and ab-
normal. Distraction.
Deliberation. Judgment. Belief. Doubt. Delusions.
Muscular and mental work.
Affective tone. Emotions. Moods. Sentiments.
Personality and its disorders.
Suggestion. Hypnosis. Sleep. Dreams.
The effects of drugs on mental processes.
Individual differences. Temperament. Character.
The second part of the examination will consist of (1)
a paper and (2) a clinical and oral examination in neurology;
(3) a paper in Psychiatry, Lunacy Law and asylum adminis-
tration; (4) a paper containing a choice of subjects for an essay
in psychiatry; (5) a clinical and oral examination in psychiatry.
The examination in neurology will include the following
subjects:
The phenomena resulting from injury and disease of the
peripheral nerves.
The course of the principal nerve-tracts and the connections
and functions of the chief nuclei of the central nervous system,
as revealed by disease.
The methods of examining patients with nervous disease—
(1) for diagnostic, (2) for scientific purposes.
The clinical manifestations of the more frequent nervous
diseases and their pathology.
The elements of neuro-pathology, including the clinical
methods commonly used in examining the nervous system.
The serological and chemical examination of the blood


Selections.
199
and cerebro-spinal fluid (especially in such diseases as syphilis
and parasyphilis.)
Important—The foregoing schedules are not to be under-
stood as limiting the scope of the examination, which is intended
to test the candidate's theoretical and practical knowledge
of every branch of psychological medicine.
The examinations for the Diploma will be held once in
each year. In 1914 and in subsequent years the examination
for Part I will be held in Cambridge during May or June;
that for Part II will be held in London during March or April.
In 1913 there will be an examination for Part I, beginning on
Tuesday, June 3rd, and for Part II, beginning on Tuesday,
July 1st.
Every candidate will be required to pay a fee of six guineas
before admission or re-admission to either part of the examina-
tion.
A candidate who has passed both parts of the examination
to the satisfaction of the examiners will receive a Diploma
testifying to his competent knowledge of psychological medicine.
—From the Journal of Mental Science.
The Therapeutic Application of the Ductless Glands.
—By Hobart Amory Hare, M. D., Philadelphia.
These glands can be used in three ways: viz., to produce
a sudden, positive and positively demonstrable effect, to cause
certain changes in physiological function which can be recog-
nized only after the results of these changes have had time to
develop, and lastly, that a considerable part of drug therapy
depends upon the effect which these glands (in the body)
exercise when under the influence of drugs.
The first glandular product considered is pituitrin, obtained
from the posterior portion of the pituitary body, which,
when injected into a vein or subcutaneously causes a rise of
blood-pressure, similar to that produced by adrenalin but much
more prolonged, due to its action upon the muscular coats of
the blood-vessels. It is therefore useful in cases of shock
where there is a fall of blood-pressure depending upon depression
of the vasomotor center, which, in its depression, might fail
to respond to a drug acting directly upon the center. Pituitrin


200
Selections.
also causes a marked increase in urinary flow, its constricting
action being confined to the peripheral vessels; hence, it is
efficient where partial or complete suppression follows labor
or operative interference with the genito-urinary tract, and
also by its stimulant effect upon the muscular coats of the blad-
der may relieve vesical atony and so render unnecessary the
use of the catheter. Its direct effect upon the uterus is to
constrict the vessels, to produce uterine contractions when
pregnancy has reached its completion, and to diminish the
possibility of or to control actual post-partum hemorrhage.
Most German writers agree that it is the best ecbolic agent,
acting promptly (usually within ten minutes from time of
injection), having a fairly long continued effect, and having
no injurious effect upon the child, its only action being to
increase the strength of the fetal cardiac contractions. * * *—
In Maine Medical Journal.—Abstracts from an article by
Hobart Amory Hare in Amer. Jour, of Obs., the above which
we partly reproduce.
Medical Greek by Achilles Rose is a valuable and in-
structive book for all physicians, philologists and educators.
The author's idea demonstrated in this book is: However
valuable the scientific achievements and literary contributions
of medical authors may be, we are nevertheless, and indeed
all the more, justly entitled to expect from these authors
correctness in language, and the first essential of correctness
is the use of correctly formed technical terms. The moderate
price of this book is one dollar.
The publisher is Peri Hellados, 87 Frankfort Street, New
York.
Greek.that is, philological Greek is so intimately interwoven
with the technical language of medical philology that it would
be of great service to us of that profession and to all of the
learned professions, in fact, if Dr. Rose could find the time to
construct for us a medical lexicon with especial reference to
Greek origins of our professional terms, a Greek medical dic-
tionary in fact.


THE
Alienist and Neurologist.
Vol. XXXIV. St. Louis, May, 1913. No. 2.
Subscription $5.00 per Annum In Advance. $1.25 Single Cop*
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Entered at the Post-office in St. Louis as second-class mall matter.
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CHA8. H. HUGHES, H. D.. Editor and Publisher.
Editorial and Btudnen Offices, 8868 W. Pine Boul.
Hcohbs Pain TIM Co., Printers and Binders
EDITORIAL.
[All Untttntd Edifrith m writtn »* tht tdiltr.)
"The Continent" records that the Canadian govern-
ment, following the lead of the United States, recently prohibi-
ted the sale of intoxicating liquors in the army canteens. The
liquor dealers have been making subtle attempts to restore
the army groggeries, but Colonel Hughes, minister of militia,
has put a quietus on the movement, stating that "the govern-
ment will not act as bartender to serve drinks to fellows who
are foolish enough to be addicted to the habit."
The Prussian minister of the interior has decided to add
to the medical division of the ministry a department which
shall be a central office for warfare against alcohol. The bureau
will be under the direction of the privy medical counselor,
(201)


202
Editorial.
Dr. Abel, and will make use chiefly of literature and operate
through the public schools.
Fifty-six per cent of the Swedish Reichstag are now identi-
fied with the temperance reform. Of the 128 temperance
members, fifty are members of the Good Templar order and
the rest are active temperance workers in other temperance
societies.
Chair of Eugenics—Cambridge University, England,
recently received a gift of $100,000 from an anonymous donor
to be used for the endowment of a professorship of eugenics
in the University, and for supplementary studies of and ex-
periments in heredity. The new chair is to be called the Bal-
four Professorship of Genetics, as the donor received his first
inspiration from Mr. A. J. Balfour. The offer of a further
gift for the equipment of an experimental station at the Univer-
sity for the use of the Balfour professor, if such shall later be
deemed desirable, is also made.
Insane in Missorui (last census). Missouri shows
an increase of more than 1,000 insane. In 1904 there were
5,103 mental weaklings in the hospitals of the State. In 1910
there were 6, 170. In the decade closed in 1910 the population
of Missouri increased, but the increase was far less propor-
tionately than that of insanity.
The American Academy of Medicine meets at Min-
neapolis, Minn., June 13, 14, 15, 1913. An interesting and
instructive program is offered for the instruction of the physi-
cians, eugenists and philanthropists.
A Good Omen for the Chinese Republic is that a
medical man educated in America is China's first president.
Our country might do well to give the medical profession
and its advice concerning a National Board of Health and a
physician in the American President's cabinet, more effective
consideration than it has up to date. Our Government has
had at least one President of late who has approvingly con-
sidered medical men for their merits and ought to have such
a ruler always living in the White House and presiding over
the Nation's welfare.


Editorial.
A Case for Early Vasectomy or castration was reported
in the Associated Press, April third in or near Joliet, Illinois.
A precocious boy thirteen years old asking a girl of seven to
marry him and being refused, stabbed her. Kids of this abnor-
mal "proclivity to sin" should receive with their juvenile court
sentence to corrective treatment, and proper surgical eugenic
procedure enjoined by the court, as preliminary to final release.
The breed of such young unstable erotopaths should be
cut short for the good of posterity. Similar older erotopaths
likewise should receive such sentences, especially in the mur-
derous and erotically degenerate convict class.
Dora Doxey and the Court—The Court is having much
trouble getting this lady into Court on account of her inoppor-
tune relapses into sickness and inability to attend. For the ninth
or tenth time in several years her case has been reset for trial on
charge of bigamy, because of these frequent relapses. A better
understanding of the relapsing power of an opium habitue when
the opium is suddenly withdrawn from the system and the alarm-
ing symptoms which soon follow sudden withdrawal of the
drug and which disappear on restoration of the drug would
explain her condition to lawyers and court. A sentence
of a term under due hospital restraint and treatment and then
immediate trial with merciful consideration of the court, would
be fairer to such unfortunates than forfeiture of bond, as was
done in this case, but considerately renewed.
Visiting Practice for Medical Students, in the homes
of out patients' clinics is a good suggestion coming from the
Medical Era. The practice might be extended into the summer
months and a few of these months added to the curriculum.
This would bring back to the student some of the advantages
he used to have when, under the old system, he spent at least
one year at home with his preceptor, but usually two.
By this means, says the Era, the patients would receive
much of the advice and supervision as to environment, etc.,
the need of which is often so manifest to hospital physicians.
The student, on the other hand, would learn something of the
art of practice, as distinguished from its science, of the diffi-
culties of environment, bad hygiene and sanitary surroundings,


204 Editorial.
and so forth, which he will have to encounter and overcome
when he has patients of his own, etc.
There should also be psychiatry for the too much neglected
out patients.
CERtificate IN Psychological Medicine IN GREAt
BRItAiN.—Candidates for this must produce a certificate of
having resided in an institution for the treatment of insanity
(affording sufficient opportunity for the study of mental dis-
orders) as a clinical clerk or medical officer for at least three
months, or of having attended a course of lectures on insanity
and the practice of an asylum (where there is clinical teaching)
for a like period, or they shall give such proof of experience
in lunacy as shall, in the opinion of the President, be sufficient.
The examinations are held once a year, at such times
as shall be most convenient, in London, Scotland and Ireland,
and are both written and oral, including the actual examina-
tion of insane patients.
ANNOUNCEMENT—The next (Three hundred and twenty-
third ) regular meeting of the New York Neurological Society
will be held in June, 1913. Time and place to be announced
later.
The May meeting will be omitted as the American Neuro-
logical Association meets in Washington, May 5, 6, 7.
American Psychopathological Society, Washington, May 8.
American Psychoanalytic Society, Washington, May 9.
Smith Ely Jelliffe, M. D., President. C. E. Atwood,
M. D., Secretary, 14 East 60th St., New York.
DR. P.L. MURPHY's PortRAIt.—The North Carolina Medical
Society has presented a handsome oil painting of the late
Dr. Patrick Livingston Murphy, many years superintendent
of the State Hospital at Morgantown, to the State Library.
When Dr. Murphy assumed the duties of superintendent
in January, 1883, he found only the administration building
and one wing with capacity for 150 patients finished—the
bare building without furniture or other equipment of any
kind. The outside appurtenances, in the way of garden, farm,
dairy, etc., were entirely lacking and the grounds were native


Editorial. 205
woods and gullied hillsides. When he laid down his work
with his life on September 11, 1907, after nearly twenty-five
years of faithful service, the main building with its base line
of just one mile and various other buildings, modern in structure
and equipment, with a total capacity of eleven hundred patients,
had been completed. The farm, garden, dairy and other out-
side departments were models of their kind and the grounds
with their smooth, sloping lawns, beautiful shade trees, shrubs,
and flowers of many varieties appealed most keenly to the
sense of beauty and taste. No North Carolinian could approach
the pile of massive buildings along the smooth roadway with
its graceful curves winding through this scene of beauty with-
out a feeling of pride in the fact that this splendid institution
was the creation of his State. Dr. Murphy was born Oct. 23rd,
1848 and died Sept. 11th, 1907.
THE STATUs of ASSISTANT MEDICAL OFFICERS IN MENTAL
Hospitals is the subject of an interesting editorial in the London
Hospital, March 8th, from which we abstract some introductory
paragraphs only.
In the interests of the public the question of the status
of the assistant medical officers in our large hospitals for mental
diseases is one which demands immediate attention. Indeed,
any possible doubt of its importance must have been completely
brushed away for all who had the opportunity of reading the
discussion at the quarterly meeting of the Medico-Psycholog-
ical Association of Great Britain. * * * This class plays
a necessary and increasingly important part in a large public
service, while receiving no recognized status in keeping with
its work. The burden of administration which falls upon the
medical superintendent of such an institution leaves little time
for purely medical work. He can in that respect do little
more than act as consultant to his junior colleagues. The
general medical work must fall upon the assistant medical
officer. It is, therefore, essential that the service should attract
and retain the best type of medical man. The work is of a
highly specialized nature. It is a branch of medicine in it-
self, and is more and more calling for peculiar qualifications.
This is now so clearly recognized that, for example, the


206
Editorial.
Universities of Cambridge, Edinburgh, Durham, Leeds, and
Manchester are instituting a diploma in Psychological Medi-
cine.
Rupert Blue on Health Boards and Health Edu-
cation—(From Chairman's Address and Oration on State
Medicine before the Section on Preventive Medicine and Public
Health of the American Medical Association, at the Sixty-
Third Annual Session, held at Atlantic City, June, 1912.)—
Much as a strong federal bureau of health is required and
earnestly as we must strive for its accomplishment, the great
problem lies in the improvement of the state and local health
agencies, in the extension of their powers and the increase
of their appropriations. The key to the solution of the prob-
lem lies in education, the simultaneous education of both the
leaders and the led. The great universities are now providing
for the training of competent health officers, and various public-
spirited medical bodies are acting in cooperation with the
sanitary authorities as teachers of the adult public. This
agitation is largely the result of the continued efforts of the
American Medical Association for the past sixty-five years
and its wisdom is apparent, because no law can be effectively
enforced which is not in accord with public sentiment. This
has been conclusively demonstrated in recent years in the
various campaigns for the suppression of epidemic disease
in this country. Plague was not eradicated from San Francisco,
in 1907, until the public had been educated by lectures and
newspaper articles and their cooperation thus obtained. Simi-
larly the yellow fever suppressive measures during the New
Orleans epidemic of 1905 would have failed of the highest
accomplishment, in the broadest sense, had not the public
conscience been quickened by the thorough inculcation of the
mosquito dogma.
Wisdom in matters medical and sanitary is profitable to
State and people—the best political investment a person or
people can make.
The Sanitation op the Panama Canal Zone having
made possible the prompt completion of that great work of
engineering skill, its presiding genius (whom most people con-


Editorial.
207
sider to be Col. Goethals, but who in reality from our professional
standpoint of merit is Col. Gorgas,) proposed to let the jungle
there grow up from reasons of military strategy. This would
have been a fatal step backward, as Dr. J. Ewing Mears has so
clearly shown in the April 13th, 1912, Medical Record, on the
part of the engineer.
Mears intimates that Goethal's proposition would prove
to be a boomerang in its effect and suggests a Sanitary Park
instead and "so say we all of us."
Sanitation has made the canal's building a possibility;
its neglect would repopulate the cemeteries and mar the merit
and utility of the canal for the world.
Miss. Val. Med. A. will meet at the Gruenwald, New
Orleans, October 23, 24, 25, 1913. The orators are Dr. Henry
B. Favill, of Chicago, Medicine; Dr. Jno. A. Witherspoon,
of Nashville, Memorial oration. Preventive and other medical
problems of the Mississippi Valley and a Consideration of the
Ductless Glands, as Relates to Infantilism, the Nervous System
and its Surgical Aspect and Medical Research. Symposia
also on Pediatrics, Neurologic subjects, including Industrial
and Occupational Diseases, and a discussion of Blood Pressure
in its Relation to Life Expectancy with a clinical discussion
of its Relation to Cardio-Vascular, Cerebral and Renal Con-
ditions, will be considered by eminent men in medicine and will
constitute interesting and instructive features of this great
and growing organization of the profession. A trip to Panama
is contemplated after the close of regular business. Dr.
Albert E. Sterne is the President, Dr. Henry Enos Tuley,
Secretary, 705 South 3rd Street, Louisville, Ky.
The Psychic Shock that Killed J. P. Morgan—"His
day was done—he knew it and he died" is the conclusion of
a Mirror comment on what killed Mr. Morgan after Mr.
Reedy's reference to the work and money trust regulation
recommendation of the Pujo investigation committee. To
this might be added, as additional to Mr. Morgan's paralyzed
resistance to disease engendering environments, the sudden
and startling political reversion to the party whose leaders,
friendly to Mr. Morgan and his related interests, the defeated


208
Editorial.
party he controlled. Mr. Morgan fell as General Grant
fell under the prostrating strain of unexpected shock to life's
ambition, letting in invading disease, always ready as it is
to attack and subjugate unto death the weak. Thus Napoleon,
Europe's conquerer, fell after Moscow's defeat, Waterloo and
St. Helena; as Grant succumbed after Ward's dishonorable
betrayal; as Missouri's statesman, Thomas Hart Benton, fell
after his political failure following his thirty years honorable
career in the United States Senate; as Webster and Clay
soon fell after the blasting of their political hopes and perhaps
Blain later. In all walks of life profound psychic shock has to
be reckoned with as a predetermining cause of destructive
intercurrent disease.
Immigrant Psychiatry and Iatric Prophylaxis—The
paper of Dr. James V. May, of the New York State Hospital
Commission, read before the last meeting of the American
Medico-Psychological Association, suggested and secured the
unanimous passage of the following resolutions urging Congress
to provide a more thorough mental examination of immi-
grants by trained alienists of the United States Public Health
and Marine Hospital Service.
The question as to whether causes of degeneracy in the
recent immigrant existed prior to landing is solved by making
aliens, who become public charges within three years, deportable
unless it is shown that they are public charges from causes
arising in the United States.
Deporting insane and mentally defective aliens without
proper attendants is condemned. It is proposed also to fine
ship companies bringing insane immigrants to this country.
Inebriate Hospitals.—Dr. F. W. Hatch, in report of
the State Lunacy Commission of California, recommends
the repeal of the law regarding the commitment of inebriates
to state hospitals and that a special institution be provided
for the care of liquor and drug addicts, also a new state hospital
be established at some point in Southern California to relieve
the congestion in the other state hospitals. Inebriate hospi-
tals should be established in every state and large city for drug
and liquor habitues, especially in Missouri, since so much


Editorial.
209
effort is being made to foster liquor inebriety, especially in
St. Louis.
New York made a grave mistake against the welfare of
that commonwealth and of thousands of its unfortunate alco-
holic addicts when it converted its inebriate hospital into an
insane hospital and required lunacy proceedings for admission
to its insane hospitals in cases of inebriety, notwithstanding
confirmed inebriety is more or less mental derangement, the
product of alcoholic brain disease, functional or organic.
Fifteen Thousand mentally defective children are among
the pupils in the New York schools, according to the report
of Dr. Henry Goddard to the School Inquiry Committee.
Here is food for reflection and action for the eugenically minded
patriots of the country. What of the conjugal fruitage of this
mental degeneracy and for one state of the American Union
alone?
Figures similar to this elsewhere, the Jukes family record
of psychic decadence and Henry Herbert Goddard's record
of the Kallikak family and study in the heredity of feeble-
mindedness are almost enough to justify the almost hysteric
alarm of the English psychologist, Dr. Hyslop, who gives us his
prophetic conclusion that the ratio of the unfit to the fit to
propagate and live half a century from now will be as one to
one. But fortunately the better minded of the world are getting
their eugenic eyes open and are beginning to "watch out."
Foreigners in Our Colleges—Among the regular
students at American colleges and universities during the year
1911-12 were 4,856 from foreign lands. The constituency
of this group of young men who had come to the United States
to study is interesting. Naturally, we find that the neighboring
countries sent many: Canada, 898; Mexico, 294; the West
Indies, 698. It is gratifying to know that 549 came from
China and 415 from Japan. There were 123 Filipinos, who
ought to take back to their countrymen a better understanding
of the United States, whether or not they acquiesce in its
policies toward their native land.
The twenty-one Koreans who will return to their unfortu-
nate land ought to be equipped to do something for its elevation.


210
Editorial.
These are all understandable. But what are 143 young Ger-
mans doing away from their own universities, popularly reputed
the world's most enlightened centers of science and philos-
ophy?—World's Work.
The Menace of the Feeble-Minded has become so
terrible that the English Parliament, during the last year,
has been making extensive investigations with a view to adopt-
ing comprehensive legislation to stamp it out as a plague
that threatens the existence of the nation. No subject before
that legislative body has received more earnest attention
and consideration that the mental deficiency bill and when it
finally becomes a law it will probably be a fit example for
other countries to follow.—Third An. Rept. State Char.
Commission 11l.
After all These Years of Unselfish Charitable
Ethics on the part of the American Medical Profession, whose
code enjoins everything for the welfare of humanity, including
the inhibition of the use of secret remedies, a German physician
comes into this country with a secret tuberculosis turtle serum
cure and sells it to a commercial stock syndicate—press re-
port says—for an enormous sum. This serum company
is to be organized in thirty-six different states under the name
of the Frederick F. Friedman institutions and the turtle dis-
pensed as a secret consumptive cure.
How about this, gentlemen of the ethical guild of the A. M.
profession?
The Unfortunate Victims of the Opium Habit and
of some other drug addictions deserve our commisseration
and more charitable consideration from courts, juries and police.
The protecting mantle of medical charity should be over
these unfortunates, in the later stages of their psychosis es-
pecially.
An Eugenic Bill, modeled somewhat after New York,
New Jersey and Indiana similar laws, drafted by Dr. D. H.
Calder, Superintendent of State Mental Hospital, Provo, Utah,
was introduced by Mrs. Skoefield in the Utah Legislature
in January. We hope that it is a law by this time. Under


Editorial.
211
right safe guards such a bill should be a statute of every state.
Medical Reason for Napoleon's Sale of Louisiana
to the U. S. Orator William M. Thornton, of the University
of Virginia, referring at the recent Jefferson Memorial dedi-
cation to this great territorial cession to the United States
in 1803, told how Napoleon lost all of the great army sent to
Hayti from yellow fever and thus became convinced it would
be well to sell Louisiana, believing the scourge would be en-
countered there likewise.
Aside from Napoleon's need of funds for military purposes
and his antagonism to Great Britain, this was one of the im-
portant reasons why the great military genius gave his own con-
sent to part with the vast territory the purchase of which
St. Louis commemorates with a monument to the great
Thomas Jefferson.
The Pope is Convalescent.—Dr. Falconia, the Pope's
chief physician, announces nothing remaining but a gradually
improving bronchial irritation which is probably but a mild
tussis senilis peculiar to many of his years.
This is a relief to his solicitous, faithful subjects who
were, a while ago, kept in continual alarm by the startling
and ridiculous press bureau announcements of almost every
possible morbid implication from arterio-sclerosis to impend-
ing fatal pneumonia, persistent insomnia, Bright's disease,
etc., etc. His Eminence has a right to be very ill but should
not be inflicted with all the diseases of the nosological cate-
gory at one and the same time.
Medical Provision for and by Industrial Plants.—
It would be economical to the larger manufacturing as well
as to labor interests if the Kern's Workman's Compensation
Bill provided for medical first and after aid, to the injured on
the factory premises. This would mean a good surgeon, a good
physician and suitable hospital nurses for every large manu-
facturing plant, always on the ground and always at hand
for any accident emergency, with consequent saving of expense
of law suits and health and time of workmen and factory and


212
Editorial.
sometimes saving life. Perilous business, like armies, should
have convenient and efficient medical and surgical help.
The Turtle Serum.—A large illustration is given space
in a Sunday newspaper of a big amphitheater audience watching,
but practically seeing nothing new, while a hypodermic needle
is inserting the turtle tuberculosis serum, Friedman and three
white robed attendants being about the patient, who lies prone
on a surgical table, although the patient might as well be sitting
and the little operation which is no more than the prick of a needle
done by the doctor unaided, as similar serums are injected
in most tuberculosis patients by other doctors of this country.
This picture is called a demonstration of the cure. It
only illustrates the common every day method of inserting
a hypodermic needle (except the audience,) in vogue in every
hospital and with private practitioners. This looks like press
agency publicity for business advertising purposes, the com-
mercial method of a publicity bureau.


CORRESPONDENCE
Need of University Students to Study Man—The
Editor, My dear Sir:- If I were able, I should be glad to write
to every University student, who is interested in the scientific
and sociologic study of man, expecially criminal, pauper and
defective man. I trust therefore, you will publish this letter,
and I request each student to regard it as a personal letter to
himself, whom I shall be pleased to help all I can, should he
desire to devote his life to the fundamental study of social
pathology.
I appeal to the University students to direct their attention
more to the scientific study of humanity. It is a cry to "Come
over into Macedonia and help us." Let the University en-
courage students more to take up these subjects which have
been so long neglected and in which there are great opportuni-
ties to aid humanity, directly, by scientific investigation
of the causes of crime, pauperism and defectiveness, in order
to prevent and lessen them through knowledge gained by
first-hand study of the individuals themselves.
When a student chooses for his life work, a subject in the
older branches of knowledge, as physics, philosophy, philology,
Greek, Latin and natural history, he finds the field somewhat
well developed; but not so in more recent sociological lines of
research, as criminal anthropology (criminology, shorter term),
and other cognate subjects, in which there is full opportunity
for mental acumen and scientific ability of the highest charac-
ter, to carry out most lofty purposes.
The question may arise as to what course of study will
prepare one best for such work. I would suggest the following:
1st. A two years course in psychology, especially labora-
tory work.
2nd. Medical studies to the extent of anatomy, physiology,
(213)


214
Correspondence.
general pathology, nervous disease and insanity (especially
clinical studies.)
3rd. A practical course in craniology in the laboratory.
4th. Facility in reading modern languages, especially
German and French.
Thus social pathology, especially criminal anthropology,
one of its branches, requires more extensive preliminary train-
ing than most subjects, for it involves the investigation of man
both mentally and physically. Such training is synthetic,
which in this age of specialism, is much needed. As such
education is relatively new and experience in it as yet limited,
it is difficult to designate a preparatory course. I have my-
self followed the course of study just indicated, but more
extensively, especially in medical lines, but such additional
preparation might not be practicable for most students.
Leaflets by the undersigned entitled, "Study of Man,"
explain the work more fully. I shall be glad to mail copies
to any student gratis, who will send me his address. As I have
said in this leaflet, "Criminals, paupers, mattoids and other
defectives are social bacilli, which require as thorough scientif-
ic investigation, as the bacilli of physical diseases." I beg leave
to remain, most faithfully, Arthur Mac Donald.—"The
Congressional," Washington, D. C., January 21, 1913.
The Milwaukee Sanitarium, (for nervous and mental
diseases), Wauwatosa, Wisconsin.—Dr. Richard Dewey has
secured the services of Dr. Herbert W. Powers as senior assistant
physician.
Dr. Dewey continues to reside at the Sanitarium and in
active personal charge of the medical service.
Dr. Powers comes from seven years successful service at
the Kenilworth Sanitarium.
A Meeting of Alienists and Neurologists of the
U. S. will be held in Chicago, June 24-27th, 1913, the week
following the meeting of the American Medical Association
at Minneapolis. This meeting is the outcome of a similar
one held in Chicago in 1912. This meeting is to be under the
auspices of the Chicago Medical Societies. Harold N. Moyer,
Chairman; W. F. Mefford, Secretary.


Correspondence.
215
Dear Doctor:- Two years ago, with an incredulity
amounting to suspicion, and with every determination to be
no man's dupe, we began a searching investigation of Doctor
Schafer's claims for his modified bacterial vaccines (Phylaco-
gens). In that interval a vast mass of work has been done—
in the laboratory, on animals, in the hospitals, at the bedside.
Literally hundreds of discriminating physicians have adminis-
tered thousands of doses of the Phylacogens for Rheumatism,
Gonorrhea, Erysipelas, Pneumonia and mixed infections.
A cool, critical survey of the clinical results has convinced us
that the Phylacogens possess great therapeutic power. We
believe in this remarkable group of products as we believe in
Antitoxin, in Adrenalin, in Pituitrin, in mercury, in quinine.
Hence the great satisfaction we take in presenting to the
medical profession this instructive symposium of five papers
by well-known practitioners, with full discussion, reprinted from
the New York Medical Journal.
If you are interested in the subject matter, we shall be
glad to send you further literature and to answer any questions
you may put to us. Very respectfully yours, Parke, Davis &
Co., Detroit, Mich.
A Medical Study of the Alcoholic Problems.—In
1870 a number of prominent physicians and medical experts
formed in New York City, The American Society for the
Study of Alcohol and other Narcotics.
This was the first medical association in the world to take
up the scientific study of alcoholism and inebriety, and determine
from experience, laboratory studies and groupings of facts,
the phenomena and diseases of spirit and drug neuroses.
The special purpose was to examine this subject above
all theories and conclusions, particularly its etiological, physio-
logical, therapeutic and medico-legal relations, also to compile
and make available such studies for home, office and institutional
treatment, and point out the remedies and prophylactic measures
for restoration and cure.
The 42nd. annual meeting of this society was held in Wash-
ington, D. C, Dec. 10th and 11th, 1912. A large and instruct-
ive scientific program by medical men, many of them distinguish-


216
Correspondetice.
ed foreigners, was presented.
This meeting and the subjects discussed attracted much
attention, not only from medical men, but an increasing number
of laymen, who have personal interest in the great questions
of alcohol and drug taking. T. D. Crothers.
The Organizing Committee of the Second Inter-
national Congress of Neurology, Psychiatry and Psy-
chology—Prof. Dr. Dubois, (Berne) President—Prof. Dr. v.
Monakow, (Zurich), Dr. P.-L. Ladame, (Geneva), Vice-Presi-
dents;—P.-D. Dr. R. Bing, (Bale), Substitute—P.-D. Dr. L.
Schnyder, (Berne), P.-D. Dr. O. Veraguth, (Zurich), Secretaries;
to meet in Berne, Switzerland, Sept. prox., first days, sent
out to members of the late Amsterdam Congress the following
questions:
I. Do you acknowledge for the Congress of Amsterdam
of 1907 the title of First International Congress of Neurology,
Psychiatry, Psychology and of Nursing of the Insane, taking
the point of view of the Dutch Society of Psychiatry and Neurol-
ogy, and in consideration that this point of view has been sanct-
ioned by the Congress of 1907?
II. Will you intrust to the Swiss Society of Neurology
the care of organizing the Second Congress of Neurology,
Psychiatry and Psychology which would take place at Berne
in the month of September, 1914?
It seems to them that these two questions might be dis-
cussed in the heart of the Committees without it being necessary
to call together the members of the Society. They ask to
receive a prompt answer to these two questions.


REVIEWS, BOOK NOTICES, REPRINTS, ETC.
Nervous and Mental Disease Monograph Series
No. 14. General Paresis by Professor Emil Kraepelin of
Munich. Nervous and Mental Disease Publishing Co., New
York, 1913.
The name of the distinguished author of this Monograph
is sufficient commendation of its merit. It is well translated
and edited. The illustrations are properly given of the
text and plentiful for the author's purpose of correct elucida-
tion. Price, three dollars.
The Advancement of Psychological Medicine by
Frederic Lyman Wells, Ph.D., from the Popular Science
Monthly, January, 1913.
The International Congress of Hygiene and Demog-
raphy. Mary A. Spink, M. D., Indianapolis. From Indiana
Bulletin of Charities and Corrections, December, 1912.
Spinal Analgesia—Development and Present Status
of the Method with brief summary of personal experience
in 1,065 cases by William Seaman Bainbridge, Sc.D., M.D.,
New York. From the Journal of the American Medical
Association, November 23, 1912, Vol. LIX, pp. 1855-1859.
The Clinical Congress of the Surgeons of North
America.—This is a review of the Third Annual Session,
held in New York, November 11 to 16, 1912. By Samuel
W. Kelley, M. D., LL. D., Cleveland,Ohio;Honorary Professor
Surgical Diseases of Children, Medical Department of the
National University of St. Louis; Pediatrist and Orthopedist,
St. Luke's Hospital, Cleveland; Author, "Surgical Diseases
(217)


218
Reviews, Book Notices, Reprints, Etc.
of Children.'' From the American Journal of Clinical Medicine,
January, 1913.
Twenty-Second Annual Report of the Rochester
State Hospital at Rochester, N. Y. to the State Hospital
Commission for the year ending September 30, 1912.
Report of the Committee on Prevention of Blind-
ness of the Council on Health and Public Instruction of the
American Medical Association made at the Atlantic City
Session, A. M. A., June 4 to 7, 1912.
College of Physicians of Pittsburg, Pennsylvania.
Symposium on the Use of Phylacogens (Modified Bacterial
Derivatives), Session of April 25, 1912. An interesting dis-
cussion for practicing physicians.
Betterment of Life Insurance Service from pro-
ceedings of the sixth annual meeting of the Association of Life
Insurance Presidents, containing many valuable suggestions
for insurance for physicians, policy holders and legislators.
Sight Saving as a National Movement by F. Park
Lewis, M. D., President of the American Society for the Con-
servation of Vision, Buffalo, N. Y. (Read by invitation in
the Section on Eye, Ear, Nose and Throat Diseases of the
Medical Society of the State of Pennsylvania, Scranton Session,
September 24, 1912.) From the Pennsylvania Medical Jour-
nal, January, 1913.
The Possible Functions of the Life Insurance Com-
pany in the Conservation of Health. By Eugene Lyman
Fisk, M. D., Medical Director Postal Life Insurance Company,
New York. Address delivered before the Section on Social
and Economic Science, American Association for the Advance-
ment of Science, Cleveland, O., January, 3.
Ready for Distribution—"Carbohydrates in Infant
Feeding" is now being mailed to every physician in the United


Reviews, Book Notices, Reprints, Etc.
219
States whose address is given in the National Directories.
Physicians who have recently changed their location or whose
address does not appear in the professional directories may secure
a copy of this brochure upon request, as a certain number of
extra copies will be held for a brief period in order that no one
may be disappointed. Please make request promptly. Mellin's
Food Company, Boston, Mass.
Contracture of the Neck of the Bladder, by Charles
H. Chetwood, M. D., Professor of Genito-Urinary Surgery,
New York Polyclinic Medical School and Hospital, etc. From
The Journal of the American Medical Association.
Starr on Organic and Functional Nervous Diseases—
A Text-Book of Neurology. By M. Allen Starr, M. D., Ph. D.,
LL. D., Sc. D., Professor of Neurology, College of Physicians
and Surgeons, New York. Fourth edition, enlarged and thor-
oughly revised. Octavo, 970 pages, with 323 engravings
and 30 plates in colors or monochrome. Cloth, $6.00, net.
Lea & Febinger, Philadelphia and New York, 1913.
In its early editions Professor Starr's work won a leading
place both as a text-book for students and as a guide for practi-
tioners, and the author has spared no effort to keep it in the
forefront by a thorough revision as each new edition was demand-
ed. Its position is so well known that little need be said
beyond mentioning the changes and improvements in this new
issue. It has been rearranged so as to present its subjects
in a still more convenient order and to accommodate the double
space allotted to the functional diseases. Everything new
and approved in neurology has been introduced, several chap-
ters have been wholly rewritten, subjects of recently recog-
nized importance, such as pellagra, have been discussed and
particularly valuable new chapters on headaches and dis-
orders of sleep and other new features have been added. This
single volume is a complete presentation of Neurology, suitable
for readers of all classes, whether undergraduate or practising.
It opens with anatomy and general diagnosis, and then covers
the whole field of organic and functional diseases, and those
of the sympathetic system especially. Prof. Starr's eminent


220
Reviews, Book Notices, Reprints, Etc.
position and extensive clinical experience attest the value of
this excellent book.
The Technical Supplement of the Urologic and
Cutaneous Review publication office, 3700 Morgan Street,
St. Louis, Mo.,U. S. A. Edited by Martin Brothers (S. C. &
C. M.) and filled with indispensable reading matter from home
and foreign sources and unique illustrations of famous
faces and pathologic demonstration in its special field ought
to be in every library and on every practicing physician's
table, especially such as work or study on uro-cutaneous lines.
The Fifty-Eighth Report of the Board of Education
of the City of St. Louis is a document of enlightenment in the
line of unavailed public utility of the public school buildings
which should be read, pondered and utilized in its wise and
intelligent suggestions for the welfare of the child and on-
coming citizen, by everyone having the welfare of our children
and country at heart.
The illutrations and comments therein are especial features
in line with the motto on our state escutchen, "salus populi
suprema lex esto."
Genesis, a manual for the instruction of children in matters
sexual for the use of parents, teachers, physicians and minis-
ters by B. S. Talmy, M. D., former Pathologist to the Mothers'
and Babies' Hospital and Gynecologist to the YorkvilleHospital,
New York, with nineteen cuts, forty-seven drawings in the
text. Price $1.50. The Practioners'Publishing Co., New York,
12 W. 123rd Street.
A valuable, indispensable book as all physicians who read
it (and all should) must recognize. Instructors of the youth of
both sexes should read it and ponder as to how best and when
to impart the knowledge of its pages. There is a stage of young
life where ignorance is bliss and likewise times and places
when and where ignorance is perilous. Pure innocence in
child life, short of peril to the child, is to be fostered. It is
possible to instruct too soon and too much.
There is preferably a time of guardianship. We should,


Reviews, Book Notices, Reprints, Etc.
221
as Foerster of Zurich says, be cautious in this matter. Prema-
ture instruction is dangerous to normal sexual purity.
We must go slow in imparting sex instruction as Waldo
Coe enjoins. Character training is the thing and exclusion
from contamination of our children by lascivious nurses and
the few little lecherous buds of human plants in whom lascivious-
ness and life below the diaphragm is to them about all there is
of living that might come in contact with pure children.
We can instruct our children, even though quite young,
that nude contact with any of the opposite sex is dangerous,
because of the fear of loathesome disease peculiar to many.
The prenuptial certificate of bodily freedom from disease
would also be a wise eugenic foundation for delicately impart-
ing sex protective knowledge and conservative precautionary
thought.
The Training School, at Vineland, New Jersey, should
be read by every eugenist and neurologist. Following is con-
tents of January Number:
Humanity, Sa'di of Shiraz; Medical Research at The Train-
ing School, William J. Hickson; Laboratory Equipment,
E. A. Doll; Bio-Chemical Literature—Review, AmosW. Peters;
Mental Tests at the Mental Hygiene Congress, E. A. Doll;
From the Field; Notes; Review.
A Practical Device to Simulate the Working of
Nervous Discharges by S. Bent Russell, M. Am. Soc. C. E.,
St. Louis, Missouri. From the Journal of Animal Behavior,
January and February.
Judicial History op the States, Territories and
Provinces of North America.—The work will be edited by
Clark Bell, Esq., of the Bar or New York City, and this volume
3, initiated in the closing months of the last four decades of
his work since he assumed the Presidency of the Medico-
Legal Society in the fall of 1872, and the editorship of the
Medico-Legal Journal, June 1, 1883. Address orders and
subscriptions for Vols., Parts or Single States to The Medico-
Legal Journal, Publisher, 39 Broadway, New York City.


222
Reviews, Book Notices, Reprints, Etc.
Senate Memorial relating to the Conservation of Human
Life as contemplated by bill (S. 1) providing for a United States
Public Health Service, prepared by Prof. Irving Fisher of Yale
University, President of the committee of one hundred on
national health, assisted by Miss Emily F. Robbins of New
York City, executive secretary of the committee. Presented
by Mr. Owen.
A department of Public Health with its chief in the Presi-
dent's cabinet is quite as important as any other of the nation's
departments of state. It would be "more than armies for the
public weal."
Experience With Vanadium in Tuberculosis by
William Franklin Harpel, A. M., M. D., Chicago, Ill. Re-
printed from The Journal of the American Institute of Homoe-
opathy.
Recently a metal regarded as having no medicinal proper-
ties has been proving its therapeutic worth. It is vanadium,
discovered by del Rio, re-discovered by Sefstrom, a Swedish
chemist, in 1830 and named by him in honor of Vanadis, the
Icelandic name of the mythological goddess Freyja.
As French, Belgian and German physicians who have
used vanadium noted only good effects, he made a study of
its action and became convinced that a powerful ally in the war
on tuberculosis has been secured and gives his experience,
considering it as a purveyor and imparter of oxygen. This
paper must be read in extenso to be fully appreciated.
The Medical Review and the Medical Era have consoli-
dated to make a better Medical Review, say the publishers,
and while both were good we concur that the two fused
into one are likely to be better.
We are sorry with the editors of the newly blended Review
that the Era ceases to exist, but it has truly not lived in vain,
and in passing out of existence it is useful, for it gives its strength
to the Medical Review.
Nervous and Mental Diseases for students and practi-
tioners by Charles S. Potts, M. D., professor of neurology in


Reviews, Book Notices, Reprints, Etc.
223
the Medico-Chirurgical College of Philadelphia, neurologist
to the Philadelphia Hospital, formerly associate in neurology
in the University of Pennsylvania. Third edition, revised and
enlarged, illustrated with 141 engravings and six plates. Lea
& Febiger, Philadelphia and New York, 1913.
Another revised and up to date volume of this excellent
neurological manual with its fluent text and ample illustrations,
is before us. We can not do more nor justly do less, than heart-
ily commend it, as we have done the preceding volume. Its
possession will well repay the purchaser. We congratulate
the author and publisher upon giving to the medical profession
so valuable a book. A book of enlightenment to all who may
read.
The discussion and illustration of a nerve fourteen days
after injury (osmic acid stained) will especially interest certain
skeptical railway surgeons who too often unjustly contest
conclusions of neurologists as to the gravity of nerve injury
sequences in nerves after accidents, even when external solu-
tions of continuity of texture are not markedly manifest.
See page 32 also page 31.
Contribution to the Surgery op Bones, Joints and
Tendons by John B. Murphy, A. M., M. D., LL. D., Chicago,
President of the American Medical Association from the Journal
of the American Medical Association. Will interest and instruct
all surgeons. Dr. Murphy has unique surgical genius and has
"sought out" and accomplished many valuable inventions
of which the Murphy button is not the least and all are valuable.
This valuable brochure should appear in book form flatly bound
and not sent out in a roll. The illustrations are many and
the text attractive and enlightening.
The Initiative and Referendum, the latest publication
issued by the National Economic League, 6 Beacon Street,
Boston, Mass. Price bound in cloth, fifty cents. Price in paper
cover, twenty-five cents. Contains arguments for and against
the Initiative and Referendum by Robert L. Owen and George
Southerland, both senators, and others. The best argument for


224 Reviews, Book Notices, Reprints, Etc.
both sides of this important question from the best sources
are presented in this interesting treatise on this important
question of our time.
An Atlas of the Differential Diagnosis of Diseases
of the Nervous System, Analytical and Semeiological Neuro-
logical Charts by Henry Hunn, M. D., Professorof the Diseases
of the Nervous System in the Albany Medical College, member
of the Association of American Physicians, The American
Neuroloical Association, etc., author of "Syllabus of a course
of lectures on the diseases of the nervous system", etc. The
Southworth Company, Publishers, Troy, New York, 1913.
"The peculiar characteristic of this book on diagnosis
as the author truly says in this excellent introduction, is that
it gives to the student or physician a key by which, in a com-
paratively easy manner from one or more important symptoms,
he can arrive at a diagnosis. It also has the advantage that
it divides the diseases into groups, the members of which have
a definite relationship with each other, so that in the process
of using the charts the student is constantly catching glimpses
of the natural relationships between the different diseases
of the nervous system. Although the symptoms of different
diseases have often been contrasted in tables of parallel columns,
in no other book, has the subject been presented as it is here,
and this is the author's excuse for publishing it and the excuse
is a good one. There is no model which could be followed
in preparing it. But no apology need be made for any page
in this book. It is painstaking and thorough, evincing know-
ledge and love for the great subject the author here presents.
The author's capacity and knowledge for the task he has
undertaken and performed so well, none dare dispute. Only
a devotee could have performed the great task so thoroughly.
The book is indispensable to the neurologic diagnostician.
The book is lovingly and worthly dedicated to his father,
likewise a physician of merit, wisdom and knowledge. The
illustrations are unique and enlightening, especially as to
focal lesions of the brain and spinal cord.
State of New York Special Public Health Commis-


Reviews, Book Notices, Reprints, Etc. 225
sion.—Before us is a pamphlet containing a message on Public
Health, to the New York Legislature by Governor William
Sulzer. The message also transmits a report by the Governor's
special public health commission, contained in the pamphlet.
This commission was appointed by Governor Sulzer January
10th, 1913, for the purpose of collecting facts, receiving sug-
gestions and making such recommendations as may seem fitting
with regard to what changes, if any, are at this time advisable
in the laws of this state relating to and affecting public health,
and in public health administration.
This is a good and eugenically hopeful awakening of our
day and of this particular State Governor, to the enlightened
health and life saving demand of modern scientifically enlighten-
ed duty to the welfare of the people. "Salus populi suprema
lex esto" is the motto on the shield of one of the best States,
Missouri, which New York, through the present enlightened
Chief Executive well appreciates, through this example for
emulation by all Governors.
The Surgical Treatment of Bright's Disease by
Dr. Geo. M. Edebohls, an eminent surgeon of New York City,
published by Lisieki (Frank F.,)of Murray Street, New York,
is a remarkable book in whose author's conclusion we do not
fully concur, but which is well worth the reading by all sur-
geons, renal surgeons especially. It is suitably illustrated.
The text entertainingly presented. The author plausibly,
but not convincingly, advocates decapsulation for Bright's
disease. In fact, the author offers "the first formal proposi-
tion to treat chronic Bright's disease by decapsulation of the
kidneys."
Surgery, Gynecology and Obstetrics, official Journal
of the Clinical Congress of Surgeons of North America, a maga-
zine of surgery. Franklin H. Martin, M. D., Managing Editor,
Allen B. Kanavel, M. D., Associate Editor.
With the February number of Surgery, Gynecology and
Obstetrics, was issued the first number of the International
Abstract of Surgery. The addition of the new publication


226
Reviews, Book Notices, Reprints, Etc.
doubles the size of the older magazine and likewise the cost
of producing it.
This is the first serious attempt to publish in English a
complete, comprehensive and authoritative review and index
of the surgical literature of the world. We appreciate the magni-
tude of the task undertaken and bespeak due appreciation
and cooperative support of the profession for this great under-
taking.
The publishers have entered into agreements with the
editors and publishers of the three most important abstract
journals of France and Germany, whereby there is to be an
exchange of material, under which arrangement the publishers
are to furnish these journals with abstracts of worthy contri-
butions appearing in American and English journals and are
to receive from them abstracts of articles appearing in foreign
publications.
Dr. Helen C. Putnam has dedicated her forthcoming
book "School Janitors and Health," to the American Associa-
tion for Study and Prevention of Infant Mortality, as follows:
"The surest prevention on the largest scale is to develop through
public schools potential fathers and mothers with wholesome
bodies, minds and ideals."
This book is a popular discussion of standardizing details
by instruments of precision, with training schools and civil
service testing and sanitary care of school premises. It discusses
existing details of school housekeeping of importance to school
physicians and nurses, teachers and parents. Price $1.00
postpaid. For special rates address the publishers. Ameri-
can Academy of Medicine Press, 52 North Fourth Street,
Easton, Pa.
School Life and Nervous Diseases of Children, by
John Punton, A.M., M. D., Kansas City, Mo.
Among the evolutionary changes incident to modern
medical progress none are more conspicuous and striking than
the attitude assumed toward the study of nervous diseases
of children. Formerly when a child was sick the family phy-
sician was called upon to prescribe solely for the disease,


Reviews, Book Notices, Reprints, Etc.
227
but medical advice concerning its prevention, much less the
management and training of the child was neither sought nor
welcomed.
Today, however, this attitude is rapidly changing and
the public are beginning to learn that morality is largely a
question of health, temperament, environment and education
and that vice depends to a large extent upon disease, hereditary
or acquired. Moreover pedagogists are beginning to learn
that education concerns the development of the whole man,
his mental, moral and physical powers and capacities, beside
the recognition and correction of any abnormal or pathological
tendencies which may even seem to lean toward his social
degeneracy. The medical aspect of education and more es-
pecially the medical inspection of our public schools therefore
marks a new era in the progress of civilization, for it has already
emphasized the wisdom of enforcing preventive measures
against the further spread of contagious and infectious diseases,
beside disclosing the marked prevalence of both congenital
and acquired nervous defects among the pupils of our public
schools, which require immediate attention.
Introductory to paper read before the Jackson County
Medical Society at Kansas City, Mo.
This is a good and timely subject for parents, pedagogues
and physicians at this perilous time when brain failure, enfeeble-
ment and degeneracy are becoming so manifest in so many
of our school children and schools for the feeble minded are
multiplying in the land.
The Last Illness of Napoleon.—"The interminable
controversy regarding the nature of the illness to which Napo-
leon Bonaparte succumbed on May 5th, 1821, has been opened
afresh by the publication of Dr. Arnold Chaplin's book. It
must be confessed that the records of the captivity do not form
pleasant reading for British readers, and to us as medical men
the chapters dealing with the illness and treatment of the au-
gust prisoner bring little comfort. Even when we bear in mind
the comparatively limited resources of medicine in Napoleon's
day it is impossible to resist the conviction that the provision
made for his care and treatment was far from adequate. The


228 Reviews, Book Notices, Reprints, Etc.
opinions of the various attendants who were in turn assigned
to Napoleon were throughout influenced more by political
considerations than by such scientific knowledge as they
possessed, and the prospect of their own professional advance-
ment was too often allowed to override the interests of their
patient.
For his facts Dr. Chaplin has relied on the "Lowe Papers"
in the British Museum, which contain the daily reports of the
physicians responsible for the treatment of the patient, and
it appears to us that he has brought forward sufficient evidence
in support of- his thesis that the gastric cancer which eventually
proved fatal was engrafted on a chronic ulcer of the stomach.
Professor Author Keith has investigated afresh the speci-
mens in the Hunterian collection of the Royal College of Sur-
geons, which are alleged to have been surreptitiously removed at
the post-mortem examination at St. Helena, and presented by
O'Meara to Sir Astley Cooper. In spite of professor Keith's
able argument there is still room for doubt as to the authenti-
city of these relics, but if they are genuine the microscopic
evidence which he has produced throws valuable light on the
nature of the early symptoms of Napoleon's last illness and
does something to rehabilitate the sorely battered clinical
reputations of 'OMeara, Stokes and Antommarchi.
The illness and death of Napoleon Bonaparte (London:
Hirschfeld Bros., Ltd., 1913.) Edinburgh Medical Journal,
Editorial Notes.
Das Skaphoidb Sghulterblatt und sein klinische Be-
deutung fur die Prognose der Lebensdaure,
Von Dr. V. Kollert, Aspiranten der Klinik. Wein und
Leipzig. Wilhelm Braumuller, k. u. k., hos und Universitats-
Buchhandler, 1912.
Separat Abdruck aus der Wiener klininischen Wochenschrift,
Organ der k. k. Gesellschaft der Arzte in Wien.XXVJahrgang.
Nr. 51.
Aus dem pathologisch-anatomischen Institute in Wien
(Hofrat A. Weichselbaum) und der II medizinischen Klinik
(Weil. Hofrat E. V. Neusser; der zeitinger Leiter Professor
W. Turk.)


Reviews, Book Notices, Reprints, Etc. 229
All this concerns a discussion of Dr. W. W. Grave's interes-
ting and instructive original contribution on the scaphoid
scapula in diagnosis and prognosis.
It is gratifying to the editor of the Alienist and Neurolo-
gist to note that St. Louis neurological research workers like
Graves and Chaddock are appreciated enough to be discussed
in German neurological literature. Chaddock's external Malleo-
lar sign has already been noticed in this magazine.
Saving Time and Killing Men.—Evey day during the
last quarter century 181 persons have been killed or injured
on the railroads of America—nearly eight every hour or one
every seven minutes. For the twenty-four years covered by
the statistics of the Interstate Commerce Commission, 188,037
persons were killed and 1,395,618 injured. "The ravages
of war pale into insigificance before these silent indications
of the destruction of human life accompanying the peaceful
operation of our railroads" is the comment, not of some care-
less "muckraker," but of the Commerce Commissioner charged
with the enforcement of the Federal Accident Law, Charles
C. McChord.
This needless loss of life is due to several causes, some of
which Congress could eliminate. For instance, the weakness
of the train-order system of operating trains, as disclosed in
official investigations, gave rise to the demand that the block-
signal system be made compulsory. This was in 1903 and
Congress has yet to act. Further to eUrninate the personal
equation, and as a result of an inquiry ordered by Congress,
the Interstate Commerce Commission reported that "the use
of automatic train stops is necessary to the safety of trains."
Congress has merely pigeonholed this report and recommenda-
tion. But the responsibility rests primarily with railroad officials.
Amazing in this regard, is the public statement of Commissioner
McChord, giving this as the underlying cause for railroad
disasters:
"Rules have been violated with impunity, with the full
knowledge of officials whose duty it was to enforce them,
and disciplinary measures have been applied only in cases
where disaster has followed disobedience." Again, "When-


230
Reviews, Book Notices, Reprints, Etc.
ever it becomes the unwritten law on a railroad that schedules
must be maintained and trains moved over the road regardless
of rules that have been enacted to secure safety, the conditions
of disaster on that road are ever present and its managers
are gambling with fate."
The best additional assurance for railway travel safety
is an unvarying eight hour shift,in so far as maybe practicable,
longer retention of good experienced employees in road and
telegraph operator service and pay and rest enough to sustain
the vital energies of all employees and absolutely enforced
sobriety both while on and off duty. Impaired vitality
either through inebriety, loss of sleep or inadequate food, or
normal rest deprivation is bad, cruel and unprofitable manage-
ment.
The human machine and its capacity for best service
should be hygienically considered. The welfare of the men
is as important as the repair of the road bed, rails and machinery.
The best and most profitable service is the best possible
power and experience and judgment; proficiency in service
in good health after they have become efficient is better economy
than discharging them for kids and novices whenever they ask
for better pay.
Superintendents and other managers should think of the
men and their outpaying nerve and body energy as well as of
earnings and dividends. Economy in railway management
should not be considered to be exclusively financial showing
on the bond and stock market but it should also include personal
safety of travellers and employees. Conservation of health
and life is quite as essential as right repair and building in
inanimate machinery.
White & Jelliffe on the Modern Treatment of
Nervous and Mental Diseases, Vol. I.—Published by
Lea & Febiger, Nos. 706, 708 and 710 Sansom St., Philadelphia,
Pa.
The publishers justly call attention to the fact that in-
sanity and idiocy are increasing in some of the States faster
than the population, and that a very large percentage of the
feeble-minded men and women are not properly cared for


Reviews, Book Notices, Reprints, Etc.
231
and procreate mentally deficient children, and to the great
importance and timeliness of a work dealing with the problems
involved in this situation becomes at once apparent. These
volumes go fully into the most modern medical phases of the
issues under discussion, they devote a large amount of space
to the broader question of prophylaxis, which is obviously
the department where the greatest and most far-reaching
results can be attained. This work marks a new departure
in giving full consideration to such subjects as Eugenics and
Heredity in Nervous and Mental Diseases, Education, Sexual
Problems, Educational Treatment of the Fecble-Minded,
Delinquency and Crime, Immigration and the Mixture of Races,
Alcoholism and the Alcoholic Psychoses. It takes up the
treatment of the various forms of nervous and mental diseases,
and discusses them conjointly, for the authors and editors re-
gard the nervous system "as inclusive of the mind." It
exhibits throughout the most modern points of view, and the
most advanced methods for handling these eases. This
valuable book is of prime interest, not only to all medical men,
but to all hygienists, government, State and municipal officials,
legislators, military men, social welfare workers, charity organi-
zations, and all eugenists and philanthropists, and to courts,
juries and attorneys. The authors and editors are both eminent
and capable as well as the American and British authors whom
they have included in this valuable volume.
Mortality in Manitou, Colorado.—Compiled by Dr.
B. B. Creighton, City Physician.
The total number of non-residents at death (55.5 per
cent) were under 60 years of age and average 44 years, 0 months;
7.4 per cent were above 60 and below 70 and averaged 64 years;
22.22 per cent were above 70 and below 80 and averged 73 years,
1 month; 7.4 per cent were above 80 and averaged 83 years.
Among adult residents at death 46 per cent were under
GO years; 54 per cent over 60 years. 17.07 per cent were
between GO and 70; 25.58 per cent between 70 and 80; and ll.25
per cent were over 80. Those between 60 and 70 averaged
65.2 years; those between 70 and 80 averaged 76 years, 2)4
months; those over 80 averaged 82 years 3 and 1:8 months.


in's Food Mellin's Food Mellin's Food Mellin's Food Mellin's Food Mellin's Food Mellin's Food
Something
to think
about
The making of Mellin's
Food is something more
than an ordinary business,
because Mellin's rood
has to do with the feeding
of infants—a most impor-
tant problem where skilful care and accuracy are
paramount.
There is nearly fifty years of consistent and pains-
taking effort behind Mellin's Food
There is nearly a lifetime of experience and exclu-
sive attention to the one subject of infant feeding, for the
makers of Mellin's Food devote their entire time to the
production of the one product.
The continuous success of Mellin's Food as a
modifier of milk for infant feeding is
attained by the superiority of the
product, its uniformity, accuracy and
extreme care in manufacture.
Physicians are in a position to
appreciate all this, and that they do
so is shown by their extensive em-
ployment of Mellin's Food—a pro-
duct of known composition, that can
be used with perfect confidence.

vlellin's Food Mellin's Food Mellin's Fc-! Mellin's Food Mellin's Food Mellin's Food Mellin's Food?



Panopepton
<2£s a "medicinal food"
PANOPEPTON is often described as a medicinal food.
The ■ extractives of beef as contained in the juice of a broiled beefsteak or rare
roast beef are highly savory and are powerful stimulants of digestion—of the
digestive secretions.
Panopepton contains all these extractives.
The inorganic constituents (the ash) are not only nutritive, but are chemical cat
lysers essential to the digestion and assimilation of food. Panopepton contains all these
the potassium, phosphates, etc., of the wheat and beef, and of the digestive glands employ
in the process.
When a physician gives Pauv />epton to a patient underthe very many circumstanc
which this food proves a resource of peculiar service, it is a medicinal food.
Fairchild Bros. & Foster f.
New York



THE CINCINNATI SANITARIUM
FOR MENTAL AND NERVOUS DISEASES
INCORPORATED 1873
A Private Hospital of Modern Equipment and Methods
F. W. Langdon, M. D., Medical Director.
B. A. Williams, M. D., Resident Physician
C. B. Rogers, M. D., Resident Physician
For descriptive pamphlet, address
H. P. Collins, Business Manager. College Hill, Cincinnati, Ohi
io.


THE
ALIENIST AND NEUROLOGIST
Vol. XXXIV. St. Louis, August, 1913. No. 3.
NOTES ON THE HISTORY OF PSYCHIATRY.
IX.*
By Smith Ely Jelliffe, M. D., Ph. D.
New York.
Adjunct Professor of Diseases of the Mind and Nervous
System. Post-Graduate Hospital and
Medical School.
THE present communication contains the final install-
ment of the translation of Falk's Psychiatry of the
Ancients. This brings to a close a rather hastily thrown to-
gether translation, but inasmuch as it was my object to make
the material available to non-German reading students, rather
than to spend time upon literary or philological form, its many
inadequacies may be overlooked.
I purpose a continuation of the translation of Friedreich,
chapters from which have already appeared and also some
notes of the psychiatry of the Middle Ages. This period
has been neglected by nearly all historical students. Snell
and Monkmoller alone have made real contributions.
"Aretaeus was also the first to emphasize that imbecility
may develop after frequent or long persisting attacks of mania
and melancholy, and after many years of epilepsy. It is
surprising that neither Hippocrates, Asclepiades nor Celsus
•Continued from February Number.
(235)


236
Smith Ely JeUifie.
have mentioned this. Only the words of Aristotle can per-
haps be explained in that sense. If we read their statements
about the outcome of those diseases we receive the impression
that, whenever death or suicide did not interrupt their course,
restoration of the mental functions took place, although first
after long continued treatment and without security of relapse.
Aretaeus now called attention to the unfortunate consequences
to the reasoning faculty which may arise out of mania and
melancholy. Hippocrates had also described feeble minded-
ness (perhaps congenital) but without making it clear whether
he classed it with melancholia and mania. The relation of
these processes did not escape Plato. Furthermore, it is not
always possible to know if the successors of Aretaeus, when
•speaking of the stupidity and apathy so common in melancholia,
in reality had in mind apathetic imbecility or only the stupid
melancholic form. I wish to point out once more that Aretaeus
regarded senile delusion, manifesting itself chiefly in stupidity,
as incurable, and that according to the majority of the authors
the cases which occur during adolescence, as melancholy often
does, have a more favorable prognosis. The ancient authors
do not speak of insanity in infancy with exception of con-
genital imbecility.
Regarding the therapy of mental diseases the philoso-
phers of oldest times, and later Plato, held that mental occupa-
tion, namely with music and the noble sciences, particularly
philosophy, in conjunction with bodily exercise is the best
means for protecting body and mind from disease. Later
Oribasius laid down some excellent educational rules. We
do not find any psychic remedies for the treatment of the
developed psychopathies from the beginning of medical his-
tory from Hippocrates up to Asclepiades. He gave the
first right points of view for a psychic treatment. If Damerow
in the previously mentioned review means that the merit of
Asclepiades lies in his saying what common sense ought to
understand, I like to contrast it with the statement that,
in the first place, "common sense was not unknown to his
predecessors," and that in the second place "his so obvious
advice" has long been forgotten.
Celsus employed psychic remedies extensively, though


Notes on the History of Psychiatry.
237
always as adjuvants to the somatic treatment which in his
opinion was the essential. Caelius Aurelianus was the first
to recognize the equal importance of the two methods and the
necessity of skilfull combination; he gives therapeutic instruct-
ions which surprise us greatly through the prudence, experience
and humanity which speak out of them, whereas Aretaeus
and Galen, who did not attribute mental diseases to psychic
causes, used purely somatic measures. Even the later
and latest successors of Caelius could not rise to the
sublimity of his point of view. We find no useful remarks
concerning the criterion of recovery.
Among the somatic cures hellebore plays a great part.
Being a laxative it found frequent application on the assump-
tion that many forms of mental disease, especially hypochon-
dria, had their source in the abdomen, and was moreover
recommended for the derivation of injurious fluids from the
brain, and as an emetic. This remedy has now disappeared,
not only from the domain of psychiatry, but from our materia
medica. However, in the narcotic remedies which later on
have been praised not only as hypnotics, but as direct cures
in mental disturbances, we have a group of substances whose
healing effect in this field is not undervalued up to the present
day. About external remedies we learn that blistering, which
was highly esteemed in antiquity, was also recommended
for mental diseases. Every nerve specialist will approve of
this. Asclepiades tried to induce sleep with cold sponge baths
and friction. Local counter irritation was not as heroic as
at the present time. Vesication, cupping and leeches were
applied directly to the head, because near to the suffering organ.
Asclepiades did not approve of this procedure and he also fought
the extensive use of bleeding advocated by all except by him
and Caelius Aurelianus. Cold applications, bleeding and
sometimes mineral waters were employed out of similar theoret-
ical suppositions as the hellebore cure. Among others
Celsus and Aurelianus believed that they could reach the
brain with smelling remedies and injections into the ear.
If some body disease was recognized as the cause of
insanity its treatment was not omitted. The diet, which
in the entire therapy of the ancients held the first place, was


238
Smith Ely Jellifie.
naturally not neglected in mental diesases. Most of them,
acting on the assumption of an irritable condition of the brain,
advised a restriction of the diet.
Caelius Aurelianus emphasized that moderation was
necessary in restricting the diet as well as in allowing wine
and other stimulants. Regulation of diet, almost without
any use of medicine, was accorded the first place in the treat-
ment of mental conditions by Hippocrates. To mitigate
the irritation which acts upon the brain he advised, especially
at the beginning and height of the disease, rest of body and
mind, whereby the transition to the really psychic treatment
has been made. We have already sufficiently given our opinion
of the psychic remedies advocated by Celsus and Aurelianus
and of the statements of the ancients about coercive mea-
sures. In this relation Caelius has left behind valuable
instructions, remarkable in their freedom from all extremes.
I like to mention again that Celsus attempted to cure
refusal of food by psychic measures as he let the patients enjoy
the sight of feasters. But it is not mentioned whether he and
his followers were successful.
Although in the psychiatry of the ancients, as in all medical
studies, the therapy was considered the ultimate aim, we
nevertheless miss in their writings one indispensable stipulation
which in many cases suffices to bring about a cure, namely
the removal of the patients from their accustomed surround-
ings, as is best done by removal to a sanitarium. From the
information gathered from medical and non-medical writers
of antiquity, as well as other authorities of these times it is
clear that the ancients had no hospitals. Their establish-
ment commences with the beginning of the Christian era.
Thus we find nowhere a hint of the existence of asylums appoint-
ed to the cure or treatment of the mentally diseased. (Compare
Hecker, Geschichte der Heilkunde, II, pg. 285, and Haeser,
Geschichte christlicher Krankenflege u. Pflegeschaften, pg.
1-8.) These authors bring forth that the residence of the
patients near the Aesculapian temple in former times, and the
Valetudinarien of the Romans cannot be compared with the
present sanatoria.


Notes on the History of Psychiatry. 239
We read on one hand in Plato, that one ought not to let
the maniacal into the street alone, and on the other hand,
Caelius explains with great care how necessary it is to isolate
the patient from his troublesome surroundings, and describes
even with exactness the arrangement of the separate infirmary.
But at all events only the wealthy could afford such an arrange-
ment. In view of the lack of proper isolation of the patients
it is remarkable that such good results were obtained, and
I can offer no explanation unless we assume (which the facts
do not warrant) that the ultimate results were poorer than
at the present time. Nor have we any reason to believe that
the mental diseases appeared in a milder form and did not
require such drastic measures as the removal of the patient
from his accustomed surroundings.
The question of the lack of asylums during ancient times
is further of interest as it leaves us in doubt as to the means
by which the ancients gathered their knowledge of the course,
prognosis and treatment of mental diseases. Nobody can
deny that accurate observation of such patients is only possible
in institutions. We can, however, not measure their knowledge
of psychiatry by the incompleteness of their writings. They
have certainly enriched our knowledge of mental diseases,
and, as I have endeavored to bring out, the writers following
Hippocrates have not only comprehended the general charac-
teristics but also special symptoms. That Hippocrates
nowhere enters into detailed descriptions is a peculiarity
of the School of Cos. The adherents of that school have
only endeavored to develop the general characters and to
build up rules on these. This is clearly in contrast to the
present methods of clinical examination. I like to remark
here that Hippocrates and some of his contemporaries opposed
the physicians of the Cnidus School and opened a controversy
with them on the writing, xept 8 tan) o^ewv (Littre's
luminous description, Argument du regime dans les maladies
aigues, Edition des Oeuvres d'Hippocrates.—) If the exper-
ience ofAretaeus, Caelius and Alexander now surprise us,
how much more instructive would their writings be if they
had been able to illustrate their theories and observations
with more detailed case histories. Such histories as we possess,


240
Smith Ely Jelliffe.
and which relate to mental diseases, are too short and in-
complete and can only be regarded as curiosities.
It is perhaps the special merit of the reformers of psychi-
atry (I do not think that Pinel, Langerman and others studied
the ancients) of later times that they have quite independently
freed their specialty from the errors and superstition of the
Middle Ages and have returned to the point of view embraced
by the great physicians of antiquity. Later authors have
continued to build upon this foundation.
It is evident that the ancients did not take up psychiatry as
a specialty, but only gave to it the same consideration which
they gave to other branches of medicine. Their studies in
psychiatry were worthy of those in the other fields of medi-
cine, which we shall however, always consider as the founda-
tion of all medical research. Their views on psychiatry,
and especially their practical rules for treatment, are given
in a pleasing and modest form, perhaps a little too concise.
Galen only is often tiresome and diffuse. The poor Latin of
Caelius does not detract from the value of his writings, while
the classical style of Celsus, Aretaeus and Hippocrates equals
that of the great poets and prose writers of antiquity. A
kind fate has preserved for us the best works, though they
are not quite unimpaired. Other men who devoted their
attention to and revived an interest in psychiatry, as Rufus,
Posidonius, and others, have left such meagre remarks that we
cannot form an opinion of their significance.
To these considerations of the doctrines of the ancients
we may add something concerning the pragmatic history of
mental diseases during antiquity. What do we learn concern-
ing the frequency of mental diseases in antiquity from a study
of these authors? To realize the impossibility of answering
this question for so remote a period one has only to consider
the difficulty, in spite of available asylum statistics, of accurate-
ly determining whether there is a relative increase of mental
diseases in the present century. However, one circumstance
leads us to think that mental diseases were far from infrequent
in former times, namely that every one of the ancients devoted
to them some space in their writings, and, far from treating
the subject casually, have shown, and some have even stated


Notes on the History of Psychiatry.
241
plainly, that they have had a great number of mental patients
under personal observation and treatment. (This does not
apply to Galen, whose exaggeration of his medical experience
equals that of some writers of the present day.) We may fur-
ther ask whether the natural or social conditions of that period
were more conducive to mental health, and are thus brought
to the question of the etiology of mental diseases in antiquity.
Which are the causes according to the opinions of the ancients?
We know that the authors who adopted only the somatic
treatment assumed only somatic causes, or, rather, based their
therapy upon their etiological views. The somatic causes
are especially held forth by Hippocrates. These are:acute
diseases, (apart from the chronic mental disturbances arising
from acute phrenitis and fever delirium) nervous diseases,
as epilepsy and hysteria, tuberculosis, functional disturbances
of the abdominal organs, suppression of habitual secretions,
child birth, intoxication and, as Aetius emphasized, alcohol-
ism. Psychic causes are first mentioned by Plato. He and
others mention grief, fright, worry, love, debauchery, contin-
uous mental exertion, (especially occupation with affairs of
state) and night work. The importance of heredity escaped them.
This fact seems the more remarkable as, according to the
Greek law, marriage among blood relations was not only
allowed, but encouraged, and in the light of recent exper-
ience we would expect that there were frequent illustrations
of heredity as an etiological factor. Nowhere do we find an
adequate representation of the various causes. Only Plato
states clearly how the mental factors act first upon the nutri-
tion and thus become harmful.
The ancients do not always distinguish between the causes
and the symptoms of the incipient stage, but they did realize
that certain temperaments predispose to certain forms of
mental disturbance. It is evident that Lippmann (1. c.) errs
in stating that Plato alone believed in psychic causes. The
passions did not at that time excite the mind to such an extent
as to cause insanity very often. Thierfelder, in his Kritik
der Schlager'schen Abhandlung, Schmidt's Jahrbucher der
gesammten Medezin, 1861, Nr. 12, speaks of several factors
which have a preventive action, as for instance a favorable


242
Smith Ely JeUifie.
climate. The telluric and atmospheric conditions which con-
stitute climate have been regarded by ancient and modern
physicians as indirect factors in the causation of various diseases,
including the psychoses, but have not been discussed with such
clearness and comprehension by any one as by Hippocrates.
His description of these conditions as he had occasion to ob-
serve them in his own sphere of action shows that the climate
was not exactly a mild one.
Hippocrates and others of that period, in agreement with
modern writers, attributed some acute epidemic diseases to
atmospheric conditions. Thierfelder recommends a "public
sphere of action," but I do not see how it can effectively pre-
vent psychoses. On the contrary, the incentive to ambition
and the passions would more likely be harmful. Neither
can one attribute any etiological importance to the position
of women in antiquity and to their influence on the social
order of the times. Although chivalry blossomed at a later
period, love has at all times moved human beings. As
mythology and ancient history prove in many ways that not
only pure, chaste love, but all forms of perversions and sexual
excesses were only too well known to antiquity. Love
also figures in the etiology of the psychopathies. Regarding
the "cultivation of cheerftdness" I wish to point out that
Aretaeus classified religious delusions as a form of mania. Reli-
gious manias were probably not very rare, though they did
not assume such proportions as in later times.
It may be argued that while syphilis and alcohol were
known to antiquity, and the effects of the latter upon the
nervous system and mentality recognized, they were not such
plagues as in our days. Two important causes of mental dis-
orders can thus be eliminated, in spite of the fact that recent
investigations have shown that syphilis was more prevalent
in ancient times than we formerly supposed.
It is doubtful whether certain social and political con-
ditions have any bearing upon this question, as for instance,
slavery. The striking prevalence of syphilis among the slaves
in America is not significant in view of the widely differing
conditions of life. We can also dismiss the notion that the
Greeks and Romans as "Cultur Volker" were exposed to


Notes on the History of Psychiatry.
243
those diseases in the same degree and for the same reasons
as nations of the present civilizations. Recent reports show
that the closely related and severe neuroses are more frequent
among the uncivilized nations of today. (Hirsch, Op. citat.
Bd. II, Art. Hysteric) Similarly, we learn from the ancient
writers that in Arcadia, a country to which civilization had not
yet penetrated, the inhabitants, a rough, nomadic tribe, were
subject to a peculiar psychosis, lycanthropy. This at times
assumed epidemic proportions and was attributed to the
primitive mode of life of the people.
It is quite conceivable that an increase in psychic dis-
turbance is one of the unfortunate consequences of the un-
deniable superiority of modern culture over ancient civilization.
(The moral progress has especially been emphasized by the
authorities on ancient history. See Lippman's quotation
(1. c.) from Boeck's Staatshaushalt der Athener, Zeitschr. f.
Psychiatric XXIII, 55.) However, I do not think that the
Greek and Roman history of psychiatry justify such an opinion,
although certain phases of modern culture cannot be entirely
ignored as contributing factors. For instance, our methods
of bringing up children may in a measure be responsible for
the not infrequent occurrence of mental disease in childhood.
With the exception of congenital imbecility no mental dis-
turbance in childhood seems to have been observed by the
ancients. Puberty with its multitudinous effects upon the
organism apparently marks the onset. Senile dementia
is on the other hand frequently mentioned.
We cannot therefore decide with certainty whether psy-
choses were more frequent in antiquity than at the present
time. (For a short resume see Zeitschr. f. Psychiatric Jahrg.
XIV.)
This brings us to the question of the varieties of mental
disease observed by the ancients. It is not easy to classify
them, as the ancients in general were no friends of differentia-
tion. Probably they were aware, as we are, that in psychiatry
especially are divisions and subdivisions difficult. Hippoc-
rates distinguishes two forms of chronic insanity, mania
and melancholia, the former derived from black, the latter
from yellow bile. He mentions also acute processes and his


244
Smith Ely Jellifie.
division into acute and chronic diseases is apparent through
all subsequent works on pathology. It is strange that all
writers place phrenitis in the former class. We have seen
that this disease is characterized by various forms of delirium
in combination with somatic disturbances. Nevertheless
we cannot form an accurate opinion of its true nature as several
authors describe different processes under the same name.
Fever delirium was regarded as a different form of acute mental
disturbance. Celsus and others mention sudden paralysis
of mental activity and the slow restoration of function after
apoplexy, and Hippocrates and his followers speak of the more
or less transitory disturbances of the intellect after the use
of poisons, as mandragora and veratrum. It is well known
that they regarded alcoholic intoxication as a transitory psy-
chosis. Aristoteles compared it with (lavia. Hippocrates
is the only one who mentions delirium tremens. It is indeed
remarkable that none of the other writers of the antiquity
mention delirium tremens. I have looked in vain for a refer-
ence to it both among the acute mental diseases and among
the complications of traumatism or internal diseases. From
what we know of Greek and Roman wines they do not either
in composition or effects resemble our whiskey, and it is there-
fore not clear how delirium tremens could develop. Excessive
indulgence in wine was recognized as a cause of neurosis and
chronic psychosis.
It is possible that some remarks of Hippocrates and of
Celsus refer to the acute delirium of recent authors. In the
chronic forms all writers distinguish between the depressive
and maniacal. (Even Galen and his followers made this
distinction in phrenitis and lethargy.) Aretaeus pointed out
that a strict line cannot be drawn between these two varieties,
as numerous transition stages existed, which has been further
emphasized by compilers. In fact, in some forms the two
states alternate, but these have not been especially designated.
Caelius, and especially Alexander, merged the two under the
term chronic delusion. It was otherwise recognized by all,
and emphasized by Aretaeus, that there are innumerable
varieties of mental disease, according to the dominant idea,
but that nevertheless the fundamental characteristic in each


Notes on the History of Psychiatry.
is either depression or exaltation.
Aretaeus alone regarded religious insanity as a special
form. The delusions characterizing melancholia are of course
mentioned, as daemonomania, suicidal mania, poisoning
mania and lycanthropy. Celsus brought out that violent
attacks of mania may occur in the course of melancholia.
(lavta, which was the term used by the early authors and also
by Caelius Aurelianus to designate insanity, was applied by
Aretaeus and his successors to mania only, as in the sense of
today. Aristoteles and Aetius emphasized that they could
appear periodically and with quiescent intervals. We have
already stated that Hippocrates mentions what is probably
transitory mania, but gives it no special name.
Hippocrates has also observed that the basic cause of
insanity arose primarily in the brain, or resulted from secondary
irritation of the brain from other organic lesions. Upon
this foundation Galen built up the etiology, and accordingly
classified mental diseases into idiopathic and deuteropathic
with further divisions into acute and chronic, and into depressed
and exalted states. A typical example of deuteropathic
melancholia is hypochondriasis in which the abdominal organs
are the seat of the primary lesion. Hypochondriasis was con-
sidered by all the authors as a characteristic form of melan-
cholia. Caelius differentiates it from other psychoses and
describes it under the name melancholy.
The descriptions of satyriasis can only be interpreted
in the sense of nymphomania. Hysteria is mentioned in the
book xept xap6£vt(!>v of the Hippocratic collections. Hy-
drophobia in man seems to have been much more frequent
in olden times than now. Schramm does not refer to it in
his Geschichtliches uber Hydrophobic, Corres. Blatt f. Psychia-
tric, 1864. Hydrophobia is classified by Themison and Ori-
basius, in opposition to Caelius, among mental diseases because
of the fear, refusal of food and clouded consciousness.
I may further remark that the philosophers of the early
as well as of the late periods of antiquity did not strictly separ-
ate the passions and stupidity from mental diseases. Plato
describes "divine" conditions, some of which we may perhaps
interpret as hysteria, but others, as love and the gift of poetry,


246
Smith Ely Jellijfe.
can hardly be assigned to any group of diseases. Oribasius
also regards lovesickness as a form of insanity.
We have already referred to the opinion of the ancients
concerning feeble-mindedness. I shall only add that Damerow
has justly pointed out how difficult it was for the ancients
(not only for Aretaeus) to apply their own classification to
cases of pure foolishness and madness already recognized
as mentally deranged. The same author remarks that the
delusional ideas of being transformed into leafless objects
and different personalities originated in mythology.
That the ancients do not mention cretinism is not to be
wondered at when we consider that the majority lived in count-
ries in which Cretenism was not endemic. (Hirsch, Op. cit.
Bd. I, p. 395.)
Hippocrates has also mentioned that besides the fully
developed insanities, there are individuals who, though not
quite insane, nevertheless present peculiarities of character
and moderate excitability, and in whom slight somatic dis-
turbances cause delirium.
Many of the ancients may have recognized that psychic
disturbance may exist without delirium, but nowhere do we
find any special name for such morbid conditions.
In reviewing these writings we find almost all the forms
of mental disease known to us and we cannot therefore accept
the supposed infrequency of insanity, which is based on the
less numerous varieties in antiquity. The only form not
mentioned is progressive paralysis of the insane. (It is of
no importance here that in our nosology the term is used
collectively for various anatomical-pathological processes.)
As its symptoms are mentioned in several places it is possible
that the ancients did not regard this disease as an entity,
but classified its somatic symptoms with the other forms
of paralysis and with the convulsions, especially epileptic,
and its psychical disturbances with the depressive stages
of melancholia, the ominous megalomanic delusions in mania
and finally the terminal dementia with the fatuitas moria.
It is surprising that the striking coexistence of characteristic
somatic symptoms and, in most cases, pronounced psychic
anomalies should have escaped the keen observers of antiquity,


Notes on the History of Psychiatry.
247
especially as it is not a disease of short duration, and as its
true nature is unmistakable in at least the last stages. I
have scrutinized every paragraph but find no reference to it
and must conclude with Morel that paralytic insanity was
unknown to the ancients. Syphilis and alcoholism have lately
received much attention as causes of paralysis. Whether
the absence of this disease can be ascribed to the infrequency
of these two factors I can not say. Morel assumes a compen-
satory preponderance of some other form of mental disease.
We only know that with the exception of phrenitis and ly-
canthropy the psychopathies described are those occurring
at the present time, and it cannot be determined from the mater-
ial in hand if melancholia, mania or transition forms have
predominated. Nor is it possible to discover any difference
in this respect between Italy and Greece. Nearly all of the
authors which I have mentioned after Aristotle lived in
Rome, and if they have left more information on this subject
than their predecessors it only proves that the understanding
of this condition improved with the progress of general medicine.
Nor can I make out if the therapy of the ancients in-
fluenced the form of mental disease. We have seen that the
therapy of the later authorities did not differ much from our
own. The opinion which they held of their therapeutic meas-
ures is illustrated by Caelius' statement that the depletion
which melancholies were subjected to often led to disgust
with life and suicide, and that immoderate restraint more-
over sometimes increased insanity or caused it to break out.
But if his results differed I am unable to say.
Hardly any mention is made by any of the ancient authors
of forensic medicine, except by later Roman lawyers, as Ul-
pianus, but we are less interested in the legal than in the psychic
freedom of the individual. I shall only call attention here to the
words of Aristotle, that acts of violence committed by the
feeble-minded, maniacs and epileptics should be judged and
treated differently from those committed by individuals who
from evil habits or bad bringing up have never learnt self-
control.
In expressing our admiration of the knowledge which the
ancients had of psychiatry our praise is the more justified when


248 Smith Ely Jelliffe.
we compare the artful and at the same time careful accounts
of their diagnostic and therapeutic measures with the dim
picture of psychiatry in later times which the modern reformers
had to face.
I like to apply to the psychiatry of the ancients Hippocrates'
words dedicated to his predecessors after he had accentuated
how necessary but also how difficult it is to take the right course:
ou ºnut 3m Sea routo Setu tmy texymy (og oux eoy Say ou 3e xxx(og
$nteoueymy rºy apxamy art 32Xeo'ot, etymäxet rept zavºz axpt-
otmy, a MAz coxy ſizXXou 3:2 to eryu; zuzt, tou a tp.ex xeºutou opiou
Čuvao Cat maśy mortogo rpostão Cat xzi sy. ToMAm; ºxygasetu ta
sºevenueva tug x&Moç xzt optos eşeop m tat, xztoyz aro tuxms.
64 W. 56th St., New York.
*
l


SEXO-AESTHETIC INVERSION.*
By Havelock Ellis,
London, England.
THE next case presents us with a fully developed
example of cross-dressing or transvestism, as
understood by Hirschfeld.1 The subject knew nothing
of Hirschfeld's book, which was not published until
some years later, and like so many persons affected
by psychosexual anomalies, even of the commonest kind,
he imagined that his case was unique. Many very
similar cases will, however, be found in Hirschfeld's
book.2
A. T., aged thirty, artist. He is the last of an
old family. His parents and other relations have been,
so far as he knows, ordinary normal persons. He is
himself regarded by his friends as an ordinary sane
person and none of them have any suspicion that he
is not normal. Yet, he states, "every nerve in my body
seems to cry out that, in spite of my outward masculine
form, I am actually feminine, and I long for female
clothing, female form, female amusements, and female
sexual gratification."
•Continued from the Alienist and Neurologist, May, 1918.
1. D'lonism should read D'Eonism.
2. I may here repeat, what I have often remarked before, that there is no ground
for the notion that sexual perversions are acquired through reading books about them.
It is quite true that reading about them sometimes encourages the subject to acknowledge
them but that is a very different matter. It is only in rare eases of persons who are already
highly abnormal that an acquired perversion can thus be artificially developed. Even
in these cases we may possibly be concerned with a retarded congenital condition.
(249)


250
Havelock Ellis.
"I began to have sexual feelings," he writes, "at
what, I think, must have been an extraordinarily early
age, having discovered, I know not how, at about the
age of four, that the handling of my penis produced a
pleasant sensation and an erection, and that, after a little
manipulation of it, I could bring on a short spasm
of feeling even yet more enjoyable. Thus, long be-
fore I knew anything about sex whatever, I became
enamoured of this kind of pleasure, though, with a sort
of instinctive feeling that it was 'naughty,' I carefully
concealed my indulgence in it. A later discovery was
that it was also very pleasurable to be partly or wholly
naked, and when in that condition to bring my bare
limbs or body in contact with all sorts of inanimate ob-
jects. I can remember when quite a little chap in petti-
coats, which I wore I think until I was about seven or
eight, pulling up my little drawers to walk about with my
thighs naked, and to press between them all sorts of
things such as cushions, bottles, tin cans, or the legs
of tables, which always gave me an erection and some-
thing the same sort of pleasure that I have since heard
a woman confess to having experienced at having simi-
lar things clasped between her legs. Still better it
was to strip quite naked and to roll on the floor or
on the bed tickling my breasts or my thighs and en-
joy the pleasurable stiffening of the penis which always
supervened. As yet I had no consciousness of the
other sex, and, as I have said, I always did these things
when alone, though I generally experienced more pleasure
in doing them in places where, at other times, there
wliere other people, so that I preferred to strip say
in the drawing room to doing it in my own bedroom,
were I knew it were safe to do so, and loved to run all
over the house and up and down stairs quite naked when
I was alone in the house. This passion for nakedness
and exposure has grown upon me, and has driven me
to do all sorts of extraordinary things, and to gratify it
in all sorts of places, both indoors and outdoors, often
with the greatest possible risk of discovery, which,


Sexo-Aesthetic Inversion.
251
however, only seemed to add an additional charm and
piquancy to my actions.
"Growing up to boyhood with this taste for naked-
ness and exposure and constantly indulging in the habit
of self abuse, and being, besides, a very spoilt child, I
became, I am afraid, very much of a molly coddle,
very effeminate and girlish in my tastes and habits.
Against this, however, I developed after a time a great
love and admiration for the other sex, having had many
little sweethearts and juvenile love affairs, though for
a long time I connected the objects of my affections
very little with my curious sexual desires. Although, as
may be seen, I was already in some respects very de-
praved, in others I was very innocent, and I must have
been about fourteen or fifteen before I slowly realized
the relation of the sexes and began to relate my de-
sires to the sex of my charmers. That, however, came
quite strongly in due time, though curiously enough,
the more I began to feel physically amorous towards
the girls, the more bashful I became in their actual
presence. At sixteen, though hardly able to speak
to a girl I admired, I yet, in the exercise of a most
fertile imagination, would in secret imagine myself
engaged with her in all sorts of amorous and volup-
tous adventures, and commit to paper all sorts of stories
in which we indulged in the mutual exposure of our
persons to one another, and in lascivious caressings
of all kinds.
"About this time, too, began to develop the artistic
tastes which have determined my general career and
which have had their strongly sexual influence as well.
I began, for instance, to take the greatest pleasure in
pictures of the female form divine, and would take any
I could get hold of to my bedroom and "worship it,"
as I called it, by stripping myself also naked before it, and
manipulating my erected and excited organ until its
spasm of pleasure culminated in what I termed a li-
bation to my goddess. I also began to take the greatest
pleasure in the sight and details of female clothing, es-


252
Havelock Ellis.
peciallydi'the pretty underthings, an accidental glimpse
of which, given by an extra short-skirted girl or woman,
I got to be always on the lookout for and to keenly enjoy.
So keen did I get on this that I would do almost any-
thing to see a girl or a woman in any condition of ex-
posure V or undress, loving the sight of her clothing, I
think, quite as much as that of her limbs or body.
Many a young girl with particularly short skirts I have
followed for miles enjoying the sight of her shapely
legs and occasional delicious glimpses of her pretty under-
clothing, while one summer at the sea-side almost every
day I used to go up some cliff steps behind a girls' school
in order to enjoy looking up their clothes and feast my
eyes on the details of their pretty drawers and petticoats.
My constant presence and purpose was, I am almost sure,
noticed by one or two little coquettes, for once or twice
I noticed that drawers had been pushed up and that
petticoats were being bunched up with the result of the
display of garters and even of bare thighs above them.
"Then, somewhat later, came, quite naturally, the
next step in my development. While one day enjoying
being naked in my sister's bedroom, where there was a
large mirror in which I delighted to see my naked body
and limbs reflected, I came across a lot of her prettily
trimmed underclothing, and was seized with the desire
to put it on. I did so—and from that moment I date
what I term my change of sex. I cannot describe to
you the pleasure I felt when thus dressing myself for
theT first time in female garments. It was exquisite,
delicious, intoxicating, and far and away transcended
anything I had before experienced, and when, after some
trouble, I was completely attired as a girl, and placed
myself in front of the glass, it was a positive revelation.
I felt that here at last was what I had been longing for.
Now my bashfulness mattered no longer. Here before me
was a pretty girl, whom I could see in any stage of dress
or undress, whom I could pose in any position I liked
that would show off her body or limbs or underclothing.
I could experience all my old pleasures of nakedness


Sexo-Aesthetic Inversion. 253
and exposure and as a girl at the same time in the same
condition. I was both boy and girl at once, and since
that time I have never been a male pure and simple
again, and today I am actually more female than male,
in spite of the actual physical facts to the contrary.
Feeling as I thus did, it is no wonder that the new plea-
sure became a positive passion with me, which I lost no
opportunity of gratifying, surreptitiously borrowing arti-
cles of female attire at every possible occasion in order
to enjoy the exquisite sensations caused by wearing them.
The ladies' newspapers became of the greatest interest
to me and I gloated over their illustrations of sweet
chemises, dainty drawers and charming corsets; and
gradually through their medium, I began to get a collec-
tion of such things for myself. To such a pitch of
refinement have I carried this passion for dressing as
a female that I have now complete costumes of various
kinds, and can appear in full evening dress, with bare
arms and neck, and naked shoulders and bosom; as a
dancing girl with yard and yards of lace petticoats, as a
young girl in short skirts displaying her beautifully frilled
drawers, or even as a child with socks instead of stock-
ings and delightfully naked legs. Each of them gives
me a different variety of pleasure as I wear them under
fresh conditions or in fresh places, or pose and expose
myself in some fresh variety of voluptuous position. For
instance, I have when staying in the country, on going
to bed dressed myself as a short-skirted young girl
and when everyone else had retired, come downstairs
and gone thus attired out into the garden, and walked
about in the moonlight, pulling up my lovely lace petti-
coats to still further expose my shapely legs and frilled
drawers, deriving the most exquisite pleasure from
imagining myself to be a young girl thus behaving her-
self.
"And I have walked down a country lane, in full
evening dress, at night, revelling in the nakedness of my
neck and arms and the complete exposure of my bare
bosom, and enjoying the feel of the billowy laces of my


254
Havelock Ellis.
petticoats foaming round my silk stockinged ankles as
I walked.
"I have also stripped and redressed myself as a girl
in the railway carriage of a long journey non-stop train,
and derived the most exquisite pleasure from the daring
situation.
"Perhaps, however, my most absolutely daring exploit
in this way was when I went into the garden of a London
square late at night, from one of the adjoining houses,
clad in a charming combination of evening and young
girl's dress, with a sleeveless bodice cut low to the last
possible inch, and with the shortest possible skirts and
petticoats, in which the delicious nudity of my bosom,
and the naked exposure of part of my thighs between
the tops of my elaborately gartered openwork silk stock-
ings, was exquisitely exciting and in delightful contrast
to the compression of my body in my tightly laced corsets.
Over this I put on a long overcoat, which on reaching
the square garden I threw off, and stood thus girlishly
dressed and exposed in the open air, feminine, half naked,
and more than half mad with excitement and pleasure.
I walked about, tossed my lace petticoats, sat upon seats
and still further exposed my legs and drawers, pulled even
lower my bodice to still further bare my heaving bosom,
then frantic with the lasciviousness of my feelings,
I took off garment after garment, placing myself in some
fresh extraordinary position in each stage of undress,
and finally throwing all upon the ground and myself
naked upon them I lay madly rubbing my frightfully
erected organ until I spent more copiously than ever
in my life before. Such is the state of things to which
my mad passion for female dressing has at times driven
me.
"What I have already told relates to the earlier
development of my condition, and up to this stage my
aberrations were always solitary. They did not, however,
after a while continue to be so, for I became acquainted
with a widow lady, of handsome face and figure, though
considerably older than myself, and conceived for her a


Sexo-Aesthetic Inversion.
255
great admiration, which she graciously accepted. I
don't know what she can have seen in me, or whether
being herself of a most ardent, not to say lascivious
temperament, she readily guessed mine to be the same,
but anyhow the affair very quickly ripened and under her
encouragement and skillful treatment I quickly became
not only her admirer but also the absolute slave of her
passions as well. When once encouraged I became very
bold, and the first familiarities certainly came from me,
but she soon convinced me that I was a mere tyro in
voluptuousness, and taught me more than I had ever
previously known or suspected. Confession of my half
female condition she soon got out of me, and my state
seemed to amuse her like a new toy, for she gave me
every encouragement and assistance in it, delighting
to dress me in her own clothes and even having some
things especially made for me, such as corsets with special
bust improvers in order that I might have the figure of
a woman, and into these she loved to lace me until I
was almost cut in two in the middle and suffered a
curious blending of pleasure and pain. She, herself,
was a confirmed tight-lacer and experienced much the
same thing when she made me lace her in a similar
manner. She liked the feeling and I the sight of her
full firm breasts being forced upwards and outwards
till they stood with erected nipples well out of her elegant
corsets and courting the kisses and caresses which I
loved to bestow and she to receive on these most sensi-
tive parts of her beautiful form. Apropros of this I
may add that another of my feminine characteristics
is that my own breasts also have this extreme sensi-
tiveness and that I love to have them kissed and caressed
as they rise from my tight laced corsets or low cut
evening dress. Some time ago, on my longing to have
real female attributes I tried to develop them to female
proportions with an advertised preparation for improving
the bust, but failed. When dressed as a woman and with
my bosom bare I want real breasts very badly indeed.
My lady friend was, however, an adept at caressing,


256
Havelock Ellis.
kissing and tickling what I have got, as also in doing
the same to another place where I also have extreme
and quite feminine sensitiveness, namely, the insides
of my thighs. To have between and upon these the feel
of the frillings of very short drawers is just lovely
while to have them touched or tickled by female hands
or lips is exquisite in the extreme.
"In little tricks like these, and in the mutual hand-
ling and excitation of our private parts, we used to
spend most of our time together, she either nude for her
own pleasure or perhaps partly clad for me to enjoy the
sight and feel of her underthings and I usually in some
variety of female attire. At times the pleasure of
the latter, my sense of being actually female, my un-
restrained exposure before my mistress, and her cares-
ses and libidinous actions would almost cause me to
swoon with the exquisiteness of my pleasure. At others
my masculinity would come uppermost and the seance
would end with a connection, but I may frankly confess
that unless the latter were performed in some extraor-
dinary manner or position, I did not enjoy it so much as
when we kept up the illusion of my being female, as we
sometimes even did to the extent of her dressing as a
man and going through a scene of the seduction of my-
self as a woman. I may add that it was curious to note
that just in the same way that I like to be tight-laced in
order to feel thoroughly transformed into a woman and
so enjoy my most delicious sensations, she liked to be
the same during an ordinary connection, saying that it
increased her pleasure to an extraordinary degree.
"This particular amour is of some good time ago, but I
have since had others more or less like it, some with
younger women and girls who were glad to find a male
admirer who could indulge in unlimited lascivious cares-
sing without wanting to go always to the full length of
actual connection, sometimes my masculine and some-
times my feminine desires have been uppermost, but
the latter have always been on the increase, and I have
now I think almost reached the stage described as actual


Sexo-Aesthetic Inversion.
257
sexual inversion. When dressed as a woman, I am a
woman, with all a woman's feelings and longings. The
clothing still gives me all the exquisite pleasure it ever
did, and indeed I sometimes think that to be dressed
in lovely feminine things, down to the last possible
detail, with all of them designed and arranged for vo-
luptuous effect, and when in them to be able to expose
oneself to the lascivious gaze of, or receive the lascivious
caresses of a pretty woman similarly attired, or to pose
for oneself in some extraordinary position in front of a
mirror, or to lie half naked half femininely in a volup-
uous dream, is the absolute height of sexual pleasure;
yet at times when excited to the last pitch of female
desire I sometimes find myself longing for a male instead
of a female lover. Dressed as a girl I seem actually to
become one. With my feet in high heeled shoes, and my
legs looking exactly like those of a girl in black silk
openwork stockings; feeling the clasp of my| elaborate
garters and the tickling of the frills of my drawers; clad
in a delicate delicious chemise; laced to the^ utmost
in shapely corsets; with a foam of lace petticoats round
my ankles; with my neck and arms bare, and my bosom
and shoulders rising nude out of the chiffons of a low
cut evening bodice; I look like a woman, and I feel like
one, and then I seem to want a man to expose the charms
of my person and clothing, to kiss and caress me, while
I give myself up to him in I know not what mad orgie of
lascivious and voluptuous pleasure. I have not yet got
the length of doing any such thing in reality, even if
there exists anyone who would abet me in such a thing,
but when, in my calmer moments, I reflect on the ex-
treme depravity of such desires and realize the depth
to which I have actually fallen by the indulgence instead
of the repression of my extraordinary feelings, I know
that I have gone far enough and that it is quite time
the whole thing was in some way stopped and treated,
I think I know myself well enough to say that if the
right road to a cure is pointed out to me I have strength
enough to follow it. Not that it will probably be easy,


258
Havelock Ellis.
but the same spirit that has hitherto made me seek
gratification at any cost may also serve me to practice
renunciation in the same way.
"I may say that my feminism is almost entirely
mental, for physically in all the matters of conformation,
growth, and distribution of hair, sexual organs, voice,
etc., I am quite an ordinary and normal male. I have,
certainly, rather small and well shaped hands and feet
and my legs, when seen in dainty stockings are surpris-
ingly feminine in shape and appearance, and I hate to
have my hair cut; but apart from these things I have no
marked bodily female characteristics—though I have
often the most intense longing and desire, expecially
when enjoying the nakedness of my bosom in a low cut
evening bodice, to have female breasts, that is in shape
and size, for I already have the feminine quality of ex-
treme sensitiveness in those parts, and keenly enjoy
having them kissed and caressed, in which pleasure my
lady friend used to very often indulge me, getting me,
as I was nothing loth, to kiss and caress her own very
fine, well-developed breasts in return. My other feminine
characteristics are, as I have said, chiefly mental, be-
ginning with the intense longing and desire to be a woman,
and going through the faculty of, under certain condi-
tions, actually being able to imagine myself to be one,
to the love of and exquisite pleasure in the wearing of
female clothing, and to the minor ones of a great love
of perfumes, of jewelry in the way of rings, necklaces
and bracelets, and of pretty things generally. The last
is probably merely a part of the artistic tastes which
make me hate anything that is coarse and ugly and
love the beautiful and elegant. As an artist I get all
my pleasure through the eyes, and suppose I carry the
same thing into my sexuality, and naturally love the
sight of a pretty woman quite nude, or displaying her
charms and her pretty clothing together in some volup-
tuous or suggestive pose.
"That the charms of the underclothing exercise even
a more powerful effect upon me than those of the woman


Sexo-Aesthetic Inversion.
259
herself is probably due to the fact that when I wear
them myself they, to some extent, help to satisfy my
longing to be actually a woman, and so gratify both my
"feminism" and "erotic fetichism" at once.
"Beyond these there, however, still remains my ex-
traordinary delight in nakedness and exposure. This
is a matter of feeling as well as seeing, for when, for
instance, my neck and shoulders, arms and bosom are
bared by a low-necked evening bodice; or a set of girlish-
ly short petticoats and drawers expose above my socks
or stockings a space of naked legs or thighs I enjoy
the feeling of nakedness and exposure, quite as much
as the sight of it in a mirror or on a pretty girl similarly
exposed.
"This exquisitely delicious feeling is tremendously
increased in the case of my bosom when I am extra
tightly laced in a pair of shapely corsets, and in the
case of my legs and thighs when I have on very tight
garters or the bands of my frilled drawers fit tightly
round my thighs. It is also more delightful to be thus
half naked out of doors than in, and most of all to be
in that condition in the presence of and before the eyes
of a woman, who will give the nude parts the caresses
they long for and enjoy. To be dressed like a woman,
exposed before a woman, all at one and the same time,
while she herself in in a similar state of undress and
exposure has been to me the absolute height of erotic
pleasure—until recently I have been assailed with the
further longing to give myself thus to a male instead
of a female lover, and at this point have decided that
things must stop, or they will certainly get to the "dis-
graceful" stage which they have not yet reached. I
think I have the necessary will power to stop this.
"With regard to cultivating the masculine side of
my highly erotic temperament I may be able to do some-
thing, but I fear that any sort of sexual indulgence
with a woman will keep up the present state of things
as my feminism and erotic fetichism are so absolutely
a part of my general sexual feelings. I could not see


260
Havelock Ellis.
a woman undress without at once being mad to put on
her underclothing and experience again all the exquisitely
pleasurable sensations of being myself feminine. So
potent has this erotic fetichism become that I can hardly
tear myself away from the windows of an underclothing
shop, or that of a corsetiere, while the sight of a girl's
or woman's accidentally exposed legs, petticoats or drawers
will sometimes almost madden me with pleasure.
"Dressed in elaborate female underthings; corsetted
and laced to the last gasp; low-bodiced, and short-
skirted; conscious of my exposed legs, my high-heeled
shoes and tight garters; with the froth of billowy lace
petticoats and flounced drawers round my thighs; with my
breasts heaving in exquisite nakedness; and with the long
hair of my wig flowing over my bare neck and shoulders
and in this condition shamelessly displaying myself be-
fore a pretty woman in a similar condition, I become
absolutely intoxicated with the exquisite femininity of my
feelings and I feel that the next development of wanting
a male lover would be actual madness and so must be
resisted with all the means in my power."
This case, it is clear, while it presents a further
stage of the condition revealed in the previous case, is
yet not to be classed in the same group. Both are keenly
interested in feminine dress, both attach importance to
the corset, and both require to wear corsets themselves
to obtain complete sexual satisfaction. But G. W. never
goes beyond this; he wears no other feminine garment, and
he shows no definite sign of any other feminine tastes
or of any conscious identification with the feminine atti-
tude. He may be quite plausibly regarded as a corset
fetichist. But A. T. is both less and more than a fetich-
ist. He is not fascinated by any single feminine garment,
and garments have only their supreme attraction when
worn by himself. They are not really fetiches; they are
simply the outward symbols of the inner spiritual state
and the really essential fact about A. T. is that he him-
self experiences the feminine state, and his tastes have
undergone a feminine inversion and that he feels like a


Sexo-Aesihetic Inversion.
261
woman. A. T.'s attitude towards sexual inversion is
instinctive and probably typical for this anomaly. It has
gradually come about in the course of the full develop-
ment of his sympathetic identification of tastes with
women that he feels that the attentions of a man are
needed to realize fully his feminine attitude. But this is
purely an imaginative feeling, and, further, it is a later
and secondary development. Actually he has not the
slightest sexual attraction to any man. Moreover, he
feels a profound repugnance to homosexual relationships.
It seems highly improbable that he will ever become a
sexual invert.
In the next case, in a man of quite different in-
tellectual, emotional and moral type, we see what may,
I believe, be regarded as the most profound and complete
degree of sexo-aesthetic inversion.
R. M., age 66; man of science and letters.
"My father (a business man) came of a healthy,
prolific and long-lived family of farmers, and was one
of eighteen children. My mother came of a mercantile
family, which suffered from a severe form of hysteria,
showing itself in some members of the family, but not
in others, through at least five or six generations. My
mother was one of eight children, of whom one son and
four daughers lived to be married, and had children.
Of the others, one daughter died unmarried at twenty-
four; and one boy and one girl died in infancy.
My mother and one of her sisters married in the
same year; the former being thirty-one, and the latter
thirty-five. But whereas the sister's husband was only
a year older than herself, my mother (who was my father's
second wife) was sixteen years younger than my father;
and about two years after the marriages, the eldest
children were born.
The sister, who had set her mind on having boys
had six children of which the two eldest and the youngest
were girls, the others, two boys and a girl, died in in-
fancy. My mother, on the other hand, who set her


262
Havelock Ellis.
mind on having girls, had five sons, all still living, of
whom I am the eldest.
At the age of six months, I was frightened by a
railway train, which passed before the window of a
railway carriage at which I was being held up. I became
so ill that my life was despaired of; I suffered much from
convulsions, and could not walk until I was two. Still,
my recollections go back distinctly and continuously to
the age of three and a half, when we were staying at
the seaside; though I have only isolated and disjointed
recollections further back than that.
We were brought up in great seclusion, for my mother
among numerous heresies, has a prejudice against schools;
and we were seldom allowed to speak to other children.
However, older cousins used to come to the house, and
talk and read to me, especially a delicate boy six years
older than myself, whose mother was dead, and who
lived with us during most of my childhood; and who
was like an elder brother to me.
I was subject, till the age of eight or nine at least,
to violent fits of hysterical crying, sometimes brought on
by a mere trifle; I was generally put in a room by myself
till the fit passed off. These fits were called 'freaks.'
The earliest books I remember being read to me
("Sanford and Merton, "etc.) I accepted as real, and at
one time, (when about 5 or 6) kept on running to the
door at every ring, to meet two boys out of one of these
books, whom I expected to come to pay us a visit,
and who specially interested me. At this time I was very
timid, and could not bear to listen to such a story as
"Jack the Giant Killer."
I remember once thinking that I should have to
marry my younger brother, because I did not know any
one else.
When I was able to read, at the age of seven or
eight, I read everything I could get that looked interesting.
There was no supervision, except that a few books
(mostly harmless enough) were tabooed as being 'too old
for me.' But Pope's Homer's 'Iliad' on the other hand,


Sexo-Aesthetic Inversion.
263
and the 'Swiss Family Robinson' on the other were
long my favorite books; and now I began to personally
identify myself with my favorite heroes, and to insist on
being called by their names, changing from one to another,
as the fancy took me. Thus, I was for a long time
Hercules; Fritz of the Swiss Family; or Basil of Mayne
Reid's Boy Hunters, but always the oldest of the boy
characters.
I never thus identified myself with any girl, and
would have been horrified at the idea up to at least
nine or ten; but I believe I was quite as well able to
sympathize with the girls in juvenile tales as with the
boys.
Occasionally I was a little sentimental. I was
greatly impressed by the lines relating to Pasithoe in
Homer, and also by the allusions to the beauty of the
Anglo-Saxon women in Dicken's 'Child's History of
England.' I was always very amenable to suggestion.
I once thought I ought to make a sacrifice in Old Tes-
tament fashion, and was seriously inclined to burn my
crossbow; but not my long bow, which I thought I could
not spare so well.
I remember thinking that 'cutting off the foreskin'
meant something like 'scalping' the forehead; and if I
met a Jew, was surprised not to see the scar.
I was always very anxious to try any new, and
especially physical experience. I was probably not more
than five or six when my mother once told me that she
had used soap-pellets during my illness; and I immediately
insisted on her applying one.
I was also curious to know what it felt like to be
wounded in battle, to be tortured, or to be burned at
the stake. This is a form of masochism not uncommon
with young boys; but in one form or other it was almost
permanent with me. I even felt it when I was about to
have a tooth out. And yet I am very sensitive to pain.
Of sexual matters I have nothing to record, except
that once or twice one of the testes slipped up into the
abdomen, causing me considerable pain and trouble to


264
Havelock Ellis.
get it down again. We were told 'the doctor had brought
us'; I was sorry he had not kept us, for the want of
sufficient companionship and the dullness of our life
made me very unhappy. Like most children, when I
got a vague idea of something further, I thought babies
might come through the navel; or that the navel had
something to do with coition; and if I thought of the
scrotum at all, I supposed it held urine. Among other
things which appear trifles to parents, but often cause
terrible suffering to children, we were kept so long in
children's instead of boy's clothes that we were actually
ashamed to be seen in them.
Fairy tales were tabooed; but I invented the idea
of feather-dresses for myself before I had heard of them.
When I was about ten, I learned to swim, but was
much disgusted at the sight of the men's pubes, which
I had not seen before. I still dislike hair on the face
and body, and even the mention of a beard or moustache
in a book is disagreeable to me, though I wear them
myself, to save the trouble of shaving. A year later,
we were at the seaside, and I saw the whole of my mother's
breast for the first time. It gave me a similar feeling of
repulsion, which lasted some years, if I accidentally
happened to see a woman's breast. (When younger,
I had, of course, seen babies suckled, but had then paid
no attention.) As regards men, the feeling wore off
after I began to bathe regularly; for bathing drawers
for men did not come into general use till about 1860,
or rather later.
When I was about twelve, I found that if I ran
very fast, I was sometimes obliged to stop from a strong
necessity of making water, which feeling went off when
I tried to do so.
I was brougnt up a teetotaller from the age of eight,
and though I abandoned teetotalism after eight or ten
years, I have never been in the habit of taking more
than a glass of wine, or wine and water, in the course
of the day.
\ About the age of twelve I began to feel much in-


Sexo-Aesthetic Inversion.
265
terest in the differences of the sexes, of which, however,
I had no real idea before I married. Then I met with
the Eastern story of the prince who was changed into
a woman by drinking from a magic spring, and whether
it was suggested by the story or whether the idea arose
independently, I am not quite sure; but I began to
think that it would be very nice to be changed into a
girl for a time, to see what it was like. Gradually this
idea became regret that I had not been born a girl,
but unaccompanied at present by any longing to take
the place of any particular woman; and accompanied
for many years, as it had been preceded, by an almost
uncontrollable longing for a life of travel and adventure,
which I never had any opportunity of gratifying except
within very moderate limits, and for which I was wholly
unsuited. Of course the two desires were quite incon-
gruous.
When I was between fourteen and fifteen, I used
occasionally to draw back the prepuce to look at the
glans, and twice had an emission of semen. I had not
the least idea of what it was; and just about my fifteenth
year, I fell into masturbation; but happening at that time
to look into Rees' Cyclopaedia, I stumbled across an
article respecting it, and connecting it with what I was
doing, struggled against the habit as much as possible, and
never yielded to it in excess. As the inversion had then
already commenced, it cannot have been seriously affected
by it, one way or the other.
In the following year I had for the first time a pass-
ing fancy for a girl play-mate; but it never went beyond
that stage.
At this period the desire to be a girl was not very
intense; but it was still present, accompanied as it gener-
ally has been, by the wish to go through the experience
of having a baby. Again, my reflections on sexual sub-
jects were not limited to marriage, but to speculations
on abnormalities, such as hermaphroditism and castration.
The latter never appeared to me as unnatural or revolting,
but only as a curious and perhaps interesting experience,


266
Havelock Ellis.
and I should have subjected myself to it after the death
of my wife, if I could have carried it out without detec-
tion. Hammond mentions a case in which a man wished
to be castrated that he may be more like a woman.
Such a feeling is perfectly intelligible to me. After my
wife's death, I often slept with all the organs tucked
back between my thighs, out of sight and reach from the
front. I have very rarely had erotic dreams, it has
surprised me that I have very seldom dreamed of my-
self as a woman.
When I was about nineteen, I fell seriously in love
for the first time with a very young girl; and enjoyed
two days of delirious happiness, arising simply from the
idea of being really in love; such as I never experienced
before or since. But my mother opposed it, and I found
the girl was much younger than I thought; so the affair
gradually flickered out, without my ever having spoken
a word of love to her.
The "freaks" had ceased when I was about ten or
eleven; but I was liable to violent fits of anger, if greatly
upset, which sometimes left me ill for a day or two.
I succeeded in overcoming this feeling; but at the loss of
the "righteous indignation" and power of taking my own
part which were absolutely necessary to protect my own
comfort and rights in the world. Besides, having suffi-
cient sympathy and insight to see both sides in a dis-
pute, I am equally liable in any doubtful case to be
imposed upon by either cajolery or bullying, and am
often "afraid to strike" when it is my clear duty to do
so, for fear of unfairly "wounding" my adversary. Con-
sequently I am always liable to be grievously imposed
upon, or even talked into doing against my will what I
know to be contrary to my own interests. Nor can I
oftenthink at such times of what I ought to say or do
in the circumstances; and I am quite unable to meet
a sudden and unexpected attack or change of front.
I reproach myself greatly for this afterwards, for when
it is too late, I see clearly what I ought to have said
and done. This weakness is the most painful (and per-


Sexo-Aesthetic Inversion.
267
haps the only really painful) accompaniment of my
inversion; and it may possibly have no necessary con-
nection with it.
When I was about twenty, I met a young foreign
lady at the house of some friends she was visiting.
She was a very bright, lively girl, with a light complex-
ion and dark hair, which I have always preferred; and
we soon became as good friends as if we had known
each other all our lives, instead of meeting as strangers
and foreigners. I believe I attracted her as much as
she attracted me; and there was not an unkind word
between us at any time; and though we married soon
afterwards, we were never happy apart for an hour;
and if we could get away together, it was like a fresh
honeymoon to the last. She departed after we had en-
joyed nearly thirty years of married life; by no means
free from sometimes serious trouble; but as between
ourselves, idyllic. We had one son.
We both thought that the first sight of each other
undressed might be repellent, but we neither of us ex-
perienced any such feeling. Instead of this, much as I
loved her, I also envied her very much, and the innate
and instinctive longing to be a woman myself became
greatly and permanently increased. Nothing would have
pleased me better than for us to have gone to sleep,
and to have waked up in each other's bodies, for a time
at any rate.
Unnatural as it may appear, when our son was born,
the thought that I could not go through the experience
myself, or even be with my wife at the time caused me
the most acute suffering I ever felt in my life, and I
did not get over it for many months. On such occasions
I always sympathise greatly with the mental sufferings
of the husband, not the physical sufferings of the wife.
A year or two later I was affected with hernia on
both sides. That on the right side the doctor called
inguinal, and it has given me more or less trouble ever
since. The left one he called indirect; and I have scarcely
felt anything of it from the beginning. He told me it


268
Havelock Ellis.
was unusual for two forms to exist on opposite sides; but
I may say that I know nothing of the cause, and that
the right side was affected some weeks or months before
the left.
And here I may note that there is a slight tendency
to lateral hermaphroditism, the right side being more
masculine than the left. On the right side the beard is
considerably stronger; and though there is very little
hair on the chest, or indeed on the body generally, what
little there is is mostly on the right side of the median
line; and the right breast is a little smaller and less firm
than the left. The shape of the pelvis seems equally
masculine on both sides.
But on the other hand the right eye is much weaker
than the left; it was never strong enough to read by at
the best of times, and at present hardly reaches no. 2 of
the test types, while the left eye goes up to 5 or 6, and is
still strong enough to read good print with in a good light
without glasses for a short time. But my eyes are quite
too sensitive for me to be able to hold them open for
examination with a light.
I forgot to say that when I was a child I was much
troubled by a sensation as if everything was going into
my eyes (a weakness inherited from my mother); and I
constantly saw films, but had no other hallucinations.
I should add here that I have never been able to whistle;
and though the uvula was operated on when I was about
twenty-six, I don't know that it had any effect beyond
stopping the constant annoyance of tickling in the throat,
from which I had suffered for some years. I have never
had the least inclination to smoke.
After my wife's death, I felt her presence with me
for some years; but it gradually seemed to fade away.
Greatly needing the sympathy of a wife, as well as a con-
genial companion (for I seem to understand and sympa-
thize much better with women than with men) I seri-
ously considered the possibilities of a second marriage, but
several reasons led me finally to abandon the idea. The
young lady who has been most attractive to me since the


Sexo-Aesthetic Inversion.
269
death of my wife married lately. I do not feel jealous
of her or her husband, but feel as if I should like best to
be her daughter. In any case, I hope to have my wife as
my lover or my sister in some other life, according to
whether she is a man or a woman.
When I was about fifty-seven, I was grossly abused
and insulted by some unworthy persons who were under
great obligations to me; and experienced great mental
suffering for a long time afterwards. Whether it had any
connection with what I am going to narrate, I do not
know; but about two years after this, there seemed to be
something like an alteration of sexual polarity. I felt
like a woman born out of her sex, and was affected by
the most passionate longing to be a woman. I could not
look at a pretty girl without envying her, her beauty and
her womanhood, and would gladly have changed places
with almost any woman from fifteen to forty-five who
was in the least attractive to me.
These feelings seem to have stimulated the breasts,
which had previously been almost as flat as a child's,
for they now began to enlarge very slowly, but also very
steadily; and sometimes they seem to alter almost daily.
At first nothing could be felt under the nipples but a
small hard detached nucleus about the size of a pea. This
gradually enlarged, and then seemed to become dispersed
and diffused, and was succeeded by a thickening, at first
under the nipples, and then above; connected with a band
(at first hardly thicker than a thread) a little below the
armpit. Lastly there was a thickening beneath the nip-
ple itself. Then the whole circumference of each breast
became firm and thickened, and it was not till this pro-
cess was completed (after perhaps three or four years)
that the breasts have begun to protrude a little in front.
They continued to enlarge slowly.
The growth of the breasts was occasionally accom-
panied by a titillating sensation in any part which was
about to enlarge; also a throbbing feeling in the whole,
and a feeling of inflammation could often be induced by a
voluntary contraction of the muscles. The development


270
Havelock Ellis.
of the breasts was not accompanied by any atrophy of
the male organs, as sometimes occurs when it is the result
of an injury to the head (I remember once having a bad
fall on the ice on the back of my head when I was a boy
of nine or ten, but don't suppose this had any effect on
my constitution). These remarks chiefly apply to the
left breast, which has always been rather larger; there is
little corresponding sensation in the right, but it enlarges
more slowly, and probably sympathetically—the nipples
have scarcely enlarged at all, and there are no signs of
any fluid secretion.
At present the breasts are beginning to feel increas-
ingly like a woman's, which is accompanied by a strange
feeling of greatly increased physical comfort and well-
being. If I had an opportunity, I should like to try on
a woman's clothes; though I have no very special attrac-
tion for women's dresses or their ordinary occupations—
especially stays; and also put a child to the breast, to see
if it would draw milk. The acme of physical human
happiness often appears to me to be a woman suckling
a healthy child. With the growth of the breasts, the
painfully intense longing for womanhood has somewhat
subsided.
A woman's body appears to me to be far more
beautiful and interesting, and even much more natural
than a man's; and its physical drawbacks would be a cheap
price to pay for the pleasure of living in one. The male
organs appear to me ugly, inconvenient, and almost un-
natural. I am fond of children, and perhaps my feeling
towards them may resemble those of a woman. I should
like to be a woman in order to enter utterly into their
lives as one of themselves.
All of my brothers are more or less bald, but though
I am the eldest, my hair is still very good for my age,
only thinning a little in the front. I may add that I am
not intuitive, and no judge of character, and am clumsy
with my hands.
I am still greatly attracted by beautiful women, but
my instinctive feelings towards them are always more those


Sexo-Aesthetic Inversion.
271
of envy than desire or jealousy; and I always envy a
woman in proportion to my love and admiration for her.
Still, there are many good women, for whom I feel sin-
cere regard, and even affection, who are not in any way
physically attractive to me, and towards whom I feel
neither desire nor envy.
Fortunately I was never thrown among vicious com-
panions, and was too timid and refined to fall into evil
courses, though I might have done so, had bad companions
tempted me. Perhaps, too, my physical passions were
weakened by the tendency to inversion.
My wife and I used sometimes to change clothes,
though her's were much too small for me. But I may
repeat, I do not know that I have any special fondness
for women's clothes or women's occupations.
Intellectual women of some force of character are
most attractive to me, perhaps as a counterpart to my
own weak and easily influenced character. I am not
usually attracted by weak, delicate, fair "feminine
women."
As regards myself, I do not feel the double sex to be
an evil, (except for the weakness of character which may
or may not be connected with it) but rather an advan-
tage, as enlarging my sympathies. I do not suppose it
is possible for one sex to understand the other, without
their being mixed in sufficient proportion to give them a
real fellow-meaning. I consider it most probable that
the sexes are always more or less mixed in varying pro-
portions in every man or woman, one or the other pre-
ponderating.
The peculiar psychical affections which I have de-
scribed might be called aesthetic inversions. It has rarely
been recognized as such, but seems to be alluded to or
experienced by several well-known writers, such as Renan,
William Sharp,3 Moore, and D. G. Rosetti. It is dealt
8. Cf. William Sharp, whose best known books were written under the name of
"Fiona Maclco; we are told in his life by Mrs. Sharp (pp. 52-3) that scarcely a day passed
in which he did not try to imagine himself living the life of a woman, to see through her
eyes, and to feel and view life from her standpoint, and so vividly that "sometimes I
forget I am not that woman I am trying to imagine."


272
Havelock Ellis.
with by several living novelists, especially Frank Richard-
son in 2835 Wayfair.
It differs from ordinary inversions in that those who
are affected by it appear (at least in most cases) never
to be attracted by men, but only by women. There is
no tradition, so far as I know, of anything resembling
inversion in our family.
Those people are generally devotedly attached to
some woman; and love and honour her so much that
they feel as if they themselves were born out of their
sex, and naturally in a kind of uncomfortable exile.
I have written the foregoing account in all sincerity.
The condition is no mere fancy, but has continued and
indeed increased during almost the whole of a fairly
long life.
The foregoing narrative, written by a man of scholarly
habits, and highly trained in scientific accuracy of ob-
servation, was placed in my hands some years before the
writer's death. Not long before this occurred I submitted it
to him for a final revision, which resulted in no essential
changes. During this period I was in frequent corres-
pondence with R. M., both on the subject of his anomaly,
and on other topics. Owing to circumstances I had only
one opportunity of meeting him. The personal impression
he made upon me corresponded with that conveyed by
his letter and his narrative. There was no outward sug-
gestion of femininity, but there were present in an ex-
treme degree the indication of the timid, retiring, sensitive
disposition which is sometimes seen in men devoted to a
scientific career and is apt to be associated with neurotic
tendencies. One could well believe in that absence of
"grit" of which he himself complained. Except for this
and for some slight nervous muscular tics, no abnormality
was suggested. How far more careful explanation would
have revealed more significant changes must remain
doubtful. R. M. had frequently expressed a wish for a
physical examination to be made, and an appointment
for this purpose had been duly arranged. Then occurred
his sudden illness, due to acute nephritis preceded by a


Sexo-Aesthetic Inversion.
273
more chronic form of the disorder, resulting shortly after
in death. It seems improbable that the examination
would have revealed any conditions to which great signifi-
cance could be attached, for some degree of gynecomasty
is far from uncommon. At the same time there was abso-
lutely nothing in R. M's. attitude towards himself and his
anomaly, or in his general mental condition, which reveals
any delusional state. The utmost that can be said is
that he was inclined to suspect that some very minor
physical anomalies might possess a feminine or herma-
phroditic significance which in all probability they fail
to possess. But he was anxious to submit these points
to the judgment of those more competent in such matters
than himself. We see here what the Freudian would
term a "complex," but it is not a paranoic delusional
system.
The condition presented by R. M. seems to me to
be sexo-aesthetic inversion in its most complete form-
In that form it brings home to us the unsatisfactory na-
ture of the term "transvestism." The element of cross-
dressing was, indeed, present, but in slight and unessen-
tial a degree as to be almost negligible. A man of in-
tellectual tastes and of deep feelings, dressing has never
been a matter of great interest to him, and there was
no soil for any pronounced impulse of cross-dressing to
take root in. The inversion here is in the affective and
emotional sphere, and in this large sphere the minor
symptom of cross-dressing is insignificant. The subject
is a man of exceptional intellectual culture and of excep-
tional sympathetic sensitiveness. He possessed marked
feminine affectability. He cannot be regarded as an ex-
ample of aesthetic inversion in its most usual and typical
form. But he seems to me to present it in its most
highly developed form.
When we attempt to classify or to account for the
cases here brought forward the task is scarcely easy.
We may well assert that they illustrate that universal
bisexuality which is now so widely accepted. We see that
R. M. perceived this, and it has recently also been point-


274
Havelock Ellis.
ed out by Nacke. But if we proceed to co-ordinate these
cases of sexo-aesthetic inversion with ordinary sexual in-
version, now commonly regarded as most easily expli-
cable by this same organic bisexuality, we encounter
difficulties. We may be inclined to regard aesthetic
inversion as a slighter degree of the same sexually inter-
mediate state of which we find a more advanced stage
in sexual inversion. But a little consideration shows
that that is scarcely correct. In the narrow sphere of
the sexual impulse itself aesthetic inversion shows indeed
but little if any approximation to the opposite sex.
But in the wider non-sexual psychic sphere, on the other
hand, it goes farther beyond all the most usual manifes-
tations of sexual inversion. The two conditions are not
strictly co-ordinate. They may rather be regarded as,
so to speak, two unlike allotropic modifications of inter-
mediate sexuality. Sexual inversion when it appears in
aesthetic inversion would appear to be merely a secon-
dary result of the aesthetically inverted psychic state.
Aesthetic inversion, when it appears in sexual inversion,
is perhaps merely a secondary result of the sexually in-
verted psychic state.4
Thus, on a common basis, we seem to be presented
with two organic conditions which are distinct, do not
easily merge, and are even mutually repugnant. A large
proportion, perhaps the majority, of sexual inverts have
no strongly pronounced feminine traits, and even so far as
they possess them not infrequently desire to slur over
or disguise them. The majority of sexo-aesthetic inverts
on the other hand, indeed nearly all of them, are not
only without any tendency to sexual inversion, but they
feel a profound repugnance to that anomaly. In the two
transitional cases I have brought forward there could
not be said to be even a question of sexual inversion.
In the two pronounced cases it only comes into question
to be rejected with horror. A. T. had latterly indeed
4. Raffalovich (Uranisms et Unisexualite, p. 93) remarks that one is struck by the
moral inferiority, the superficiality and the immodesty of the effeminate group of sexual
inverts. We generally find the reverse of these characteristics in typical sexo-aesthetic
inverts.


Sexo-Aesthetic Inversion.
275
come to feel that the sexual experiences of a woman were
needed for the complete gratification of his state of feeling.
This is, however, clearly a secondary development of
his aesthetic inversion, and it is a development which the
subject himself views with terror. Moreover he is not
in fact in the slightest degree sexually attracted to any
person of his own sex. The idea is merely an idea, and
though it might possibly become an obsession it seems
highly improbable that it will ever be carried into practice.
In R. M.'s case, although here aesthetic inversion is
carried so far, there has never been, even imaginatively,
the slightest homosexual temptation. After he had de-
vised the term "aesthetic inversion," he was himself rather
inclined to reject it for "psychical hermaphroditism," on
the ground that the use of the word "inversion" might
suggest a connection with homosexuality which he would
regard as highly repugnant.
Psychologically speaking, it seems to me that we
must regard sexo-aesthetic inversion as really a modifi-
cation of normal hetero-sexuality. It is a modification
in which certain of the normal constituents of the sexual
impulse have fallen into the background, while other
equally normal constituents have become unduly exag-
gerated. What are those two sets of constituents?
In normal courtship it is necessary for the male to
experience two impulses which are, on the surface,
antagonistic. On the one hand, he must be forceful and
combative; he must overcome and possess the desired
object. On the other hand, he must be expectant and
sympathetic; he must enter into the feelings of the beloved
and even subject himself to her will. The lover must
be both a resolute conqueror and a submissive slave. He
must both oppose himself to his mistress's reticence, and
identify himself with her desires. This twofold attitude
is based on the biological conditions of courtship.
In civilized human courtship there is a tendency
for the first and aggressive component of the sexual im-
pulse to be subordinated, and for the second and sympa-
thetic component to be emphasized. This tendency was


276
Havelock Ellis.
set forth some years ago by Colin Scott as the "secondary
law of courting" by which the female (who is already
imaginatively attentive to the states of the excited male)
develops a super-added activity, while the male develops
a relatively passive and imaginative attention to the
psychical and bodily states of the female. This "imagi-
native radiation" and "development of the representative
powers," is favored, Colin Scott points out, by the re-
strictions imposed by civilization, and the larger mental
capacity involved.5
This secondary component of the sexual impulse,
the element of sympathy and identification, may be said
to be connected, as Colin Scott seems to have recognized,
with an aesthetic attitude. It is worth while to insist
on the connection for it may furnish a deeper reason than
I have yet suggested for applying the name "aesthetic
inversion" to a condition which, as the reader will by
now have perceived, is to be regarded as an abnormal and
perhaps pathological exaggeration of the secondary com-
ponent of the normal heterosexual impulse.
The philosophic students of aesthetics have frequently
shown a tendency to regard a subjective identification
with the beautiful object as the clue to aesthetic emotion.
They hold that we imaginatively imitate the beauty we
see, and sympathetically place ourselves in it. Our emo-
tions, as it were, beat in time to its rhythm. Lotze
6. Colin Scott, "Sex and Art", American Journal of Psychology, Vol. VII, No. 2.
It may be noted that Dr. Sabrina Spielrein (Jahrbuch fur PsychoanalytUche Forschungen,
Vol. IV. 1912, p. 483) independently confirms Colin Scott's view of the more primary
nature of this imaginative attentiveness in women. There are, she says, two directions
of ideas in the lover: "In the first one is usually the subject and loves the outwardly projected
object; in the second one is changed into the beloved and loves himself as object. In
the men, to whom belongs the active part of capturing a woman, the subjective ideas pre-
vail; in a woman, who has to attract the man, the refluent ideas gain, even normally,
the upper hand. Herewith is connected feminine coquetry; the woman is thinking how
she can please 'him'; herewith is connected also her greater homosexuality and auto-
erotism; changed into her lover, the woman must to a certain degree feel masculine;
as the object of the man she can love herself or another girl who is such as she would wish
herself to be—of course always beautiful. I once found a feminine colleague much
worried over a succession of envelopes she was addressing. She could not repeat the hand-
writing she had achieved in the first. On my asking her why that pleased her so much,
she suddenly realized that that was how her lover wrote. The need for identification
with the beloved was, therefore, bo great that she could only endure herself as being like
him."


Sexo-Aesthetic Inversion.
277
and R. Vischer worked out an aesthetic doctrine of inner
Miterleben on such lines as these. More recently, Karl
Groos has concluded that the play of inner imitation,
inner Miterleben is "the central phenomenon of aesthet-
ic enjoyment."6 Lipps, again, is a distinguished ex-
ponent of imitation and of what he calls Einfuhlung as
the explanation of aesthetic emotion,7 and he has most
elaborately set forth his doctrine. It is very interesting,
from our point of view, to note that, while Lipps on the
whole regards imitation and Einfuhlung as going together
in aesthetic feeling, he stops short at the threshold of
sex and declares that here we must make a distinction.
We cannot, he says, explain the appeal of a woman's
beauty by imitation, for a man does not, for instance,
desire to possess a woman's breasts. Yet all beautiful
forms, he holds, owe their beauth to Einfuhlung, and this
has nothing to do with the sexual instinct for which the
specific form of the opposite sex are objects of a possible
real relationship. The aesthetic enjoyment of a woman's
figure thus shows clearly, Lippo concludes, that the con-
ception of Einfuhlung is different from that of imitation
(or Nachahmung.)8
Here we may perceive a deeper reason than we have
yet reached for describing the psychological anomaly we
are here concerned with as Aesthetic Inversion. The
subject of the anomaly is not merely experiencing an in-
version of general tastes in the sexual sphere; he has
really attained to a specifically aesthetic emotional atti-
tude in that sphere. In his admiration of the beloved
he is not content to confine himself to the normal element
of Einfuhlung; he adopts the whole aesthetic attitude by
experiencing also the impulse of imitation. He achieves
6. K. Groos, Der Aesthetische Genius, 1902, e. g., Ch. V.
7. See T. Lipps, Der.'Aeathetische Genuas in die Bildende Kunat, 1906, Ch. I.
8. T. Lipps, Grundlegung der Aesthetik, 1903, Vol. I. p. 147. It may be remarked
that Lippa entirely dissociated aesthetic emotion from sexual emotion. Groor' t.
248) considers that we cannot escape the conclusion that the artistic enjoyment of marked-
ly sensual situations belongs to the aesthetic sphere. Lipps (op. cit. p. 148) thinks that
it is decadent to envolve the sexual instinct in aesthetics.


278
Havelock Ellis.
a complete emotional identification which is sexually ab-
normal but aesthetically correct.9
Physically, it would appear, this secondary and aesthet-
ic element of the sexual impulse tends to assert itself
abnormally in the form of aesthetic inversion in those men
in whom the primary and more "virile" element of the
sexual impulse is defective. In some, though not in all,
cases there is a lack of physical robustness. Sometimes
early masturbation has been carried to an excess con-
ducive to lowered vitality. In the case of A. T. we find
a precocious auto-erotic sexuality which was probably
a significant factor in the development of the aesthetic
inversion. In the very complete case of R. M., a highly
sensitive temperament was marked by a lack of self-
assertion, an inability to hold his own in conflict with
others, an undue suggestibility, which was to the subject
himself a source of life-long misgiving. In most cases
of aesthetic inversion it would appear probable that the
sexual impulse as a whole is somewhat below the average
in intensity. But in any case, it is certainly inharmonious,
atrophied on one side, hypertrophied on the other.10
It is tempting to suppose that, on the physiological
side, the disharmony is associated with lack of equilibrium
in the internal secretions, and that certain of the hormones
needed to arouse the fully developed normal sexual im-
pulse are defective, if indeed other may not be in excess.
It is the tendency of recent investigation to attach great
importance to the mutual play of the internal secretions,
and we are no longer content to regard the internal se-
cretions of the testes and the ovaries as supplying the
9. Nacke notes that transvestism seems to be specially apt to occur in artists and men
of letters. It is probably significant that of the two completely developed cases I have
been able to bring forward, one is an artist and the other a man of letters.
10. Kiernan has suggested that aesthetic inversion is due to arrest of development.
In this way aesthetic inversion would have some resemblance to the psychic side to what
we find in eunuchoidism on the physical aide. Eunuchoidism is a congenital or pathologi-
cally acquired approximation to the artificially acquired condition of the eunuch; the sexual
impulse usually remains normal in direction, though it is weakened and may be alto-
gether absent. (B. Onuf, "A Study of Eunuchoidism us and its Various Aspects", Ameri-
can Journal of Dermatology, Nov. 1912.) Some of the psychic characteristics of the sexo-
aesthetic invert, it may be noted, resemble those commonly found in the subject of
eunuchoidism.


Sexo-Aesthetic Inversion.
279
only harmones operative in sexual development. Thus
adrenal hyperplasia or neoplasm has been found to in-
crease the female primary and secondary characters not
only in the female but in the male, and adrenal hyper-
plasia has been found associated with some cases of
pseudo-hermaphroditism.11
It is now recognized that the characters of one sex
must be latent in the other sex, and we thus have a
field in which the various internal secretions may display
their stimulating and inhibiting properties. It is possible
that in this way we may be able to account for the varied
and incoordinated shapes in which intermediate sexual
characters are manifested, a feminine strain in the male,
as Hirschfeld remarks, so operating that in one case
hermaphroditism appears, in a second gynecomasty, in a
third sexual inversion, and in a fourth cross-dressing.12
However that may be, it is only possible at present
to hazard a supposition as to the direction in which the
physiological basis of sexo-aesthetic inversion may be
found. It is sufficiently difficult to set this anomaly in
a clear psychological light with relation to other more
or less allied psychic anomalies. I have attempted to do
this, as well as I can, so far as our present knowledge
extends.13
Havelock Ellis.
11. Ernest Glynn, "The Adrenal Cortex," Quarterly Journal of Medicine, Jan. 1912.
12. Swale Vincent, Internal Secretion, 1912, p. 75.
13. Hirschfeld, op. cit. p. 301. There are, it may be added, subdivisions and com-
binations of these intermediate states.


THE TRAUMATIC ORIGIN OF NERVOUS DISTUR-
BANCES IN HYSTERICAL CONDITIONS.
By C. F. Neu.
Indianapolis, Ind.
HYSTERIA and hysterical conditions undoubtedly
belong to the most difficult and perplexing prob-
lems with which the medical profession has to deal.
This is to some extent due to the fact that fundamentally
there is present in the make-up of such individuals cer-
tain peculiar characteristics, partly of hereditary and
partly of acquired origin, which stamp them as victims of
such an abnormal state of health, ready at any time to
manifest itself when the appropriate inciting cause is
encountered. Charcot taught that "it was a diseased
condition which only showed itself in persons whose
nervous system was diseased, degenerate or abused, and
regarded it as a disease of degeneracy." It is generally
admitted to be a disease of unknown pathology affecting
the nervous system, probably localized in the cerebrum,
whether involving local parts or diffusely distributed is
impossible to say. Starr states that "it is not to be
denied that changes in the finer nutrition of the nerve
elements underlie and result from it, but they are not,
even in extreme cases, recognizable by our present methods
of examination." Because of the lack of knowledge of
the underlying anatomical characters of this disorder,
we are in a measure compelled to place it in a group of
so-called functional diseases, which is merely an admission
of our ignorance or limitation of knowledge in regard
thereto. Because of the predominance of the mental
symptoms and because of its responsiveness to such
(280


Nervous Disturbances in Hysterical Conditions. 281
factors as influence the mind, it is regarded by some as
primarily a diseased or defective mental state, with the
physical disturbances as secondary manifestations. An-
other feature which stamps them as predominantly
psychical in origin is the frequency with which the clinical
manifestations are brought to the surface by conditions
which have acted wholly and only upon the mind. These
physical disturbances may very closely imitate those of
organic diseases, and while there is no visible underlying
organic basis for them, they are as real to the patient
as if there were such a basis. This fact is apparently
not given due consideration by many physicians in their
management of such patients.
In those individuals whose constitutional make-up
is of such a nature as predisposes to the development of
this peculiar symptom-complex, the tendency thereto is
further favored by irregular and intemperate habits of
life, as well as by many chronic diseased conditions of
the various organs of the body, particularly of the
nervous system itself.
Of the many inciting causes, there is perhaps not
any found as frequently as trauma, in which there may
or may not be received some physical injury. That
trauma without any apparent organic lesion may be a
cause of nervous disturbances, either general or local,
has been recognized by Charcot, Brodic, Russell, Strum-
pell, etc. According to Berbez, a pupil of Charcot, one-
fifth of all cases of hysteria are of traumatic origin. It
has been found that the hysterical conditions provoked
by injuries do not differ in general from those due to
other causes, yet possess some characteristics peculiar to
themselves. The injury as a rule is not severe, and is
usually associated with more or less fright. In a certain
number of cases the condition of fright or psychical shock
is apparently the only evident inciting factor. It is
generally admitted that the circumstances under which
the trauma occurs and the mental state of the individual
at the time, are of more importance than is the severity
or degree of the actual injury. Influences which cause


282
C. F. Neu.
excitement and fright very much increase the probability
of the development of hysterical conditions.
There is perhaps no better way to point out the
more prominent manifestations than by reporting more
or less briefly the following cases:
Case 1. Mrs. T., age 51; Widow; reports that she
was healthy as a girl. Menstrual function began at
fifteen and was normal in every way. Was married and
gave birth to five children, all of whom are healthy.
Had pneumonia at 37. Passed through the menopause
at 38 without any special disturbance. About 45 the
death of her husband occurred, following which she suf-
fered a breakdown in which she was extremely nervous
and out of strength for a period of about nine months.
The family history so far as could be ascertained was
negative. On January 15, 1911, while entering a street
car from the front end, and when in the act of turning
to take her seat, the car started suddenly, throwing her
to the floor, on her right side. After being assisted to
the seat there was felt pain and numbness in the right
arm and side of the body. Upon getting off the car to
walk home she states that she was unable to place the
foot flatly upon the ground because of the pain produced,
but was compelled to bear what weight of the body was
necessary on the toes. Following the accident she was in
bed about four months, being unable to stand because of
pain in the back, nausea and faintness, loss of feeling
below the elbow and knee, and weakness in the right arm
and leg was present from the first, and for a month there
was also some difficulty in swallowing liquids, in that
after half a glass was taken it would begin to run out of
the mouth. In addition to the loss of use and feeling in
the arm and leg, there was more or less misery and pain
in the back, more marked on the right side through the
chest; and in the back of the head and neck. The
headache has been mostly during the afternoon and
usually occurred when trying to sit up. Eyesight was
impaired so that she was unable to read, and has only
recently been able to read large print. There was no


Nervous Disturbances in Hysterical Conditions. 283
sphincter disturbances. Her condition has very slowly
but gradually undergone improvement up to the present
time and condition. The examination was made February
28, 1912, a little over thirteen months after the accident.
The patient was of slim build and was moderately well
nourished. There was considerable enlargement of the
thyroid gland. The heart action was irregular and inter-
mittent with a peculiar murmur over the mitral orifice,
systolic in time and possibly also during the early part
of the period of diastole. There was also a small femoral
reducible hernia on the right side. Movement of the
facial, ocular and speech musculature was normal. Re-
quested to move right hand and arm volitionally, the
patient at first maintained such was impossible. Urged
to do so, there was manifested distinct voluntary re-
sistance to the passive movements of flexion, extension,
rotation inward and outward of the arm. Later in the
course of the examination she could be persuaded to touch
the thumb and all of the fingers, close the hand, lift the
hand and forearm to the position of flexion and lay it
down again. While examining the lower extremities she
also moved the arm from across the chest down beside
the leg, and with hand adjusted clothing to prevent threat-
ened exposure of the leg. Request to move the right leg
met with the same response as in the arm, not the slight-
est sign of movement. By placing the hand under the
right heel while the left leg was being lifted, there was
distinct downward pressure on the hand, but when placed
under the left heel and requested to lift the right leg, no
such pressure was felt. This phenomenon has been found
to be of considerable assistance in differentiating between
actual and functional paralysis of one or other leg. When
an attempt was made to lift the right leg passively with
the support of the knee, the leg was held out straight, the
foot dropping only when urged to relax it. At first,
passive movements of the foot and leg met with no
voluntary resistance upon request, but later in the exam-
ination did so. The knee jerks were very active and
about equal in both legs. There was no ankle clonus,


284
C. F. Neu.
no Babinski reaction, no plantar reaction on the right
side. There was complete anaesthesia and analgesia
of the right side of the face, neck and trunk definitely
limited at the median line, the mucosa of the nose and
mouth being doubtful, and occasionally the patient re-
ferred to the prick of the pin over the upper part of the
breast as being the pressure of the finger. The epigastric
reflex was difficult to determine on both sides. There
was complete anaesthesia and analgesia of the right hand
and arm to just above the elbow and continuing up the
inner side of the arm to the body. On the outer side up
to the shoulder, sensation was practically normal along
an area about three inches wide. In the right leg there
was complete anaesthesia and analgesia of the foot and
leg extending several inches above the knee on the outer
side, and while not abolished in the inner side was con-
siderably impaired up to the body. Along the outer sur-
face of the thigh over a strip several inches wide and
reaching almost to the level of the Iliac Crest, sensation
was practically normal, but response somewhat delayed.
Placed in the erect position the patient was able to stand
but leaned to the right side. In walking the right leg
was held stiffly and the foot was dragged flatly upon the
floor. The field of vision was apparently not disturbed,
and the special senses practically normal. Several times
during the examination there was manifested some general
tremor, fine and regular, but became excessive, coarse
and irregular in the right arm and leg, more so in the
arm, intensified by being observed, not intensified when
attempting to use the fingers, hand or arm.
After the examination, in company with Dr. J. R.
Eastman, who had also been appointed to examine the
patient, we repaired to an adjoining room to consult, and
upon looking through the door she was seen in the dresser-
mirror to use the right arm quite freely in assisting her
daughter to adjust her clothing while dressing.
The more prominent features of this case are:
1. The history of a so-called nervous breakdown


Nervous Disturbances in Hysterical Conditions. 285
following the death of her husband, and from which re-
covery was very slow and protracted.
2. The absence of any evidence of any local injuries
at the time of the accident.
3. The more or less gradual development of the
condition until reaching the maximum.
4. The unilateral distribution of the disturbances
present and their limitation to the side presumably
injured.
5. The peculiar distribution of the sensory dis-
turbances.
6. The responsiveness of the motor disturbances to
suggestion.
7. The absence of any indications of an organic
lesion.
Case 2. J. D. E.—Male—age 64. Family history
was negative. Patient was the youngest in a family of
ten children. Entered the army at eighteen and while
in it received a blow over the left frontal eminence,
which rendered him unconscious for three hours, following
which he was apparently as well as ever. At 31 had a
right side paralysis coming on gradually and lasting 4-5
months. Was subject to nervous chills following over-
exertion or exposure to the sun for 20 to 25 years, but
none occurred during the last six years.
On July 2, 1908, during a heated controversy received
a blow on the right jaw, and in trying to escape stepped
backward off the sidewalk to the ground, a distance of
1 to 1^ feet, wrenching the small of the back. His op-
ponent struck him again on the cheek, nose and mouth,
causing them to bleed. Following this he sat on the side-
walk for some time, then walked to the house and com-
plained of pain in the back. The following morning he
was unable to place the right foot on the floor owing to
drawing of the muscles of the back and hip. After a
day or two he was able to walk about the house, and
several times walked up town. The night of the 6th he
became paralyzed ? on the right side, involving the face,
tongue, arm and leg, the face and tongue being drawn to


286
C. F. Neu.
the right. He could not speak above a whisper. Sensa-
tion was also lost. The symptoms gradually improved,
the voice returning in a few weeks, and he was able to
walk with the assistance of a crutch. During this time
he complained of some difficulty in swallowing, having
the sensation as if the upper part of the throat were too
small. Vision of the right eye was impaired at times,
as if it were covered with a net-like film. There was
gradual improvement of all symptoms until August 11,
when a second attack of paralysis occurred similar to the
first, except that there was some involvement of the left
side, following a conversation over the telephone, during
which he began to feel sick and weak, when he hobbled
to the couch, fell on his knees, managed to crawl on the
couch, and calling his wife, felt that he was dying. Every-
thing grew black, he folded his hands across his chest,
cried "goodbye" to his wife and became unconscious ?,
body being perfectly stiff while being carried from the
couch to the bed, where he remained three weeks, when
motion began to return, manifesting itself first in the left
arm. Control of sphincters was not lost, but there was
constipation and supposedly retention of urine for some
time. Improvement again took place, the patient being
able to be about the house, but could only speak in
whispers until June 13, 1909, when a third attack occurred
following some physical exertion. While lying on the
couch waiting for dinner, found that the mouth could
only be opened about half an inch. He took some dinner,
returned to the couch and became unconscious, ?remain-
ing so two days. Was able to sit in the chair on the
third day, and since then has gradually improved up to
the present time. He has not spoken above a whisper
since the second attack. Sensation did not return until
eighteen months after the onset of his trouble, and was
first felt on the inner side of the ankle while rubbing the
foot when he noticed a vein "pop up and become black,"
after which he felt pain.
He complains of being paralyzed on the right side,
both of motion and sensation, that he has pains in the


Nervous Disturbances in Hysterical Conditions. 287
back above the right hip bone extending up the back
and neck behind the ear to the temple, stabbing and
shooting in character, that he has a crackling sensation
in the right side of the head as if the bones were rubbing
the brain, that he cannot speak above a whisper and is
constipated. Examination on October 20, 1910, twenty-
eight months after the injury, shows him to be moder-
ately well nourished and fairly good color. Facial and
ocular movements normal. While telling of his condition
would hold right eye widely open, at the same time con-
stantly batting the left eye. Would hold right side of
the face quiet while making contractions of the left, but
when his attention was diverted to other conditions the
movements of the eyes and face were quite symmetrical
and uniform. Pupils and pupillary reflexes normal.
Pharyngeal, palatine and laryngeal reflexes normal. Vocal
cords symmetrical but adducted but very slightly when
trying to whisper. Tongue protrudes in a straight line,
but he reports it as having drawn to the right for a time.
Movements of the hand, arm and shoulder are slowly
and stiffly carried out, tending at times to become almost
tetanoid. There is some movement in all directions, but
is limited in extent, varying at different examinations
and with the amount of persuasion urged. Passive move-
ments met with quite noticeable resistance. Movements
in the right leg were similar in character to those of the
arm, but were more limited in extent. Walking was
carried out with the assistance of a crutch, the right leg
being held stiffly, the foot thrown outward and dragged
more or less flatly on the floor, thus wearing off the inner
side of the sole of the shoe.
All forms of sensation were abolished on the right
side of the body, the line of demarcation being sharply
defined in the median line, the only exception being that
he would occasionally blink his eyes when suddenly and
unexpectedly pricked with the needle. Muscular power
was noticeably less on the right side. The abdominal,
intercostal, and spinal muscles acted symmetrically and
uniformly. The tendon reflexes were normal. There


288
C. F. Neu.
was no Babinski toe reaction, no ankle clonus, no Rhom-
berg phenomenon. The superficial reflexes were absent
on the right side. There was absence of heel pressure
when trying to lift the right leg voluntarily. Eyegrounds
were normal, special senses normal for one of his age.
No trophic or sphincter disturbances. There was some
arterio-sclerosis, pulse full but compressible, heart action
intermittent. Condition of the urine was normal.
In this case the more important features are:
1. The age of the patient—64.
2. The emotional factor in association with the char-
acter of the injury received.
3. The time elapsing between the receipt of the
injury and the culmination of the climax of symptoms.
4. The recurrent so-called apoplectic seizures.
5. The limitation of the disturbances to one side
of the body and that being on the side injured.
6. The prominence and nature of the speech dis-
turbance.
7. The chronicity of all of the symptoms.
8. The absence of any positive indications of an
organic lesion of the nervous system.
Case 3. C. B.—Male—age 31—Married 9 years.
Family and personal history negative. He reports that
on November 11, 1911, at 11 A. M. while assisting to
move a heavy square block of steel he was thrown against
a round iron pillar with his body in a partially stooped
position, hips and small of the back against the pillar.
It did not seem to hurt much at the time and he con-
tinued to work until 3 P. M., when he was taken with
severe pain in the back while lifting a heavy weight. Fol-
lowing this he remained in bed a week complaining of
pain and soreness up and down the spine, intense misery
in the back of the neck and numbness in the left hand
reaching to the shoulder. He went to the hospital for
several days, where the condition was regarded as a
neurosis or malingering, and the patient becoming dis-
satisfied returned home. Examination at the hospital
disclosed an apparent general hyperesthesia, the slightest


Nervous Disturbances in Hysterical Conditions. 289
touch applied to almost every part of the body, but par-
ticularly over the back, being complained of as painful.
Deep pressure at times unnoticed, at others elicited com-
plaint of intense pain. The whole voluntary muscular
was maintained in a state of more or less constant ten-
sion and rigidity. All movements were carried out
slowly, stiffly and limited in extent, but increased by being
urged. The tendon reflexes were overactive, the super-
ficial reflexes apparently normal or decreased. There
were no trophic disturbances. The general attitude
during the examination was one of disproportionate over-
doing or exaggeration.
A few days after the return home he began to com-
plain of a growing-cold sensation in the back at the
junction of the spine and hips which was followed by
numbness, extending in three to four days down into the
flesh of the legs, involving the left leg more than the
right, and later, some time in January, 1912, involving
the arms, more marked in the left. About the time of
the onset of numbness in the hips sexual power also
disappeared. There have been attacks of loss of power
in the left leg lasting from fifteen to thirty minutes. The
general condition has undergone very little change up to
the present.
Examination was made on April 20, 1912, six months
after the accident. He was well developed and nourished,
general condition good. Movements of the facial and
ocular musculature normal, speech and deglutition normal.
Movements of the hands and arms upon request were
carried out slowly, and apparently with great difficulty,
held more or less rigidly and tensely, undergoing con-
siderable irregular tremor and shaking, becoming more
marked the greater the force apparently necessary to
perform the various movements. Passive movements of
the arms met with quite definite resistance and varied
more or less directly with the forcibleness of persuasive
requests to relax. Voluntary muscular power in hand
and arms apparently lessened, more so in the left. In
the performance of grasping, the hand would be felt to


290
C. F. Neu.
tighten and relax intermittently, also varying with the
degree of persuasion urged. Movements in the legs, both
active and passive, were carried out in a manner similar
to that of the arms, but under a much greater degree of
rigidity, tension, tremor and resistance. Prior to the
direct examination of the movements of the arms and
legs, the patient had been noticed to move both volun-
tarily but apparently unconsciously quite laxly. Gait
was carried out stiffly in a more or less pseudo-spastic
character, steps short and jerky, feet spread apart and
apparently sticking to the floor, undergoing constant
clonic, more or less irregular contractions with a tendency
to lean forward and walk on fore part of feet. By re-
peated urging and insisting that longer steps be taken, he
finally succeeded in lengthening them to almost twice the
original length. Requested to lift one foot while sitting
in a chair tends to lift opposite foot also. Requested to
lift either leg while in a recumbent position also tends
to lift the opposite leg, exerting no downward pressure
with the heel of the foot opposite to the one urged to lift.
Sensation on the right dide practically normal. On
the left side touch, temperature and pain apparently
normal over the forehead, and over the anterior and upper
part of the chest between level of the nipple up to the
clavicle. Over the face and abdomen the application of
heat produces sensation only of pressure. While there
appears to be more or less complete anaesthesia and
analgesia over the remainder of the left side of the body,
one frequently observed a momentary contraction of the
eyelids upon sticking the face or abdomen with a pin or
applying the hot test tube, and also often a slight mus-
cular twitch of the leg when applying the same to the
leg. The tendon reflexes were either normal or quite
active. The superficial reflexes were normal except that
the left plantar was visibly less than the right. There
was no Rhomberg or Babinski toe phenomenon, no ankle
clonus, no trophic or sphincter disturbances.
The more important features in this case are:
1. The peculiar character of the injury.


Nervous Disturbances in Hysterical Conditions. 291
2. The gradual and progressive development of the
various disturbances.
3. The apparent pseudo-spasticity of the voluntary
musculature.
4. The prominence and peculiar nature of the tremor
manifested when carrying out voluntary movements of
the limbs, particularly in the legs when walking.
5. The absence of any evidence of an organic
lesion.
These cases in a measure illustrate the more marked
characteristics of the symptom-complex that is usually
manifested, and while these are rather well-pronounced
and more or less typical, one must bear in mind that in
perhaps the majority of cases the hysterical features are
less sharply defined and consequently necessitate close
and accurate observation, combined with careful, pains-
taking examinations, to determine its true character.
For practical purposes it is perhaps most convenient to
consider the disturbances under certain groupings. In
this grouping may be considered the mental, the sensory
and special sense, the motor, the reflex-vaso-motor and
trophic, and the somatic disturbances.
The most prominent feature of the mental state is
that physical symptoms are created which imitate con-
ditions such as may be produced by an organic lesion.
These imitations are frequently of such a nature as to
suggest voluntary attempts at simulation, but differ from
them in that such manifestations reach a higher degree
of perfection than any similator ever attains, and also in
that for the greater part they are unconsciously per-
formed, many of them occurring unintentionally on the
part of the patient and without being recognized by the
patient as being false. Susceptibility to suggestion is also
present to rather a prominent degree in practically all of
these patients, and was well illustrated during the exam-
ination of cases 1 and 3.
Loss of memory is often more apparent than real.
It is rather inconsistent and contradictory, and very
often renders the statements of those patients wholly


292
C. F. Neu.
unreliable. The falsity of their statements is often due to
lack of attention, or arises from dreams during sleep or
states of reverie during so-called day-dreaming, which
they fail to differentiate from actual occurrences. Loss
of memory manifested in this condition differs from
organic amnesia, in the periodical recurrence, and in its
limitation to certain classes of ideas. Aboulia or impair-
ment of will-power is a constant mental symptom. In
its common form it is manifested by a difficulty or
hesitancy, at times amounting to complete loss of will-
power, in performing motor or intellectual acts at will.
Somnambulism, catalepsy and other similar conditions,
so common in the ordinary form of hysteria, are rarely
mentioned in hysterical conditions arising from trauma
or fright. Besides these more or less prominent features
of the mental state in so-called traumatic hysteria, there
are usually found other disturbances more or less char-
acteristic of the hysterical temperament, such as an ab-
normally keen sensibility, marked variations in mood out
of proportion to the apparent cause, impulsiveness,. lack
of control over the emotions, thought and actions, etc.
Sensory Disturbances.
Loss of some form of sensibility is by far the com-
monest symptom of the hysterical condition. The loss
is rarely complained of, cognizance of its existence often
not being present until discovered by the physician in the
course of his examination. The most common form is a
total loss, involving all forms of sensation. There may be
a dissociation, and when such occurs the usual form is
loss of the sense of pain; touch and temperature being
retained. The limits of cutaneous anaesthesia and anal-
gesia are usually sharply defined, and when due to trau-
matism generally coincides with the parts injured or
paralyzed. In some cases, however, the anaesthesia exists
in areas scattered over the whole body. To the eye and
touch, the skin in hysterical anaesthesia is normal, but
shows a diminished tendency to bleed when pricked with
a needle; a phenomenon which as yet has not received
any satisfactory explanation.


Nervous Disturbances in Hysterical Conditions. 293
Other features indicative of a hysterical basis are
that it never follows the distribution of individual nerves
or of spinal cord segments, is more absolute than in most
organic lesions, frequently changes position, ordinarily
disappears during sleep or during the various intoxica-
tions, and can often be influenced by suggestion.
Hyperesthesia and pains are frequently complained
of, as was well illustrated in case 3 in the early stage.
In some cases the slightest contact, when attention is
centered thereon, may incite expression of most ex-
cruciating pain, while deep pressure is well borne. Fre-
quently when the attention is otherwise diverted, manipu-
lation or contact over the same areas are unnoticed.
The situation of the hypersensitive or painful areas is
variable, its general distribution is extremely rare. When
present it is frequently localized either to the point in-
jured or to the so-called hystero-genetic zones. The
hysterical pains differ from actual pains in that they
usually do not interfere with sleep, are not accompanied
by nutritional disturbances, are not responsive to the
ordinary dosage of the remedies given for their relief, are
difficult to explain, but are probably real to the patient.
Of the disturbances of the special senses, vision is
more frequently disturbed than any other form. The
vision may be only impaired or there may be total
blindness, and when so is mostly unilateral, bilateral
blindness being rather rare. Limitation of the field of
vision is common, and in many cases is slight, usually
from ten to fifteen degrees, and follows the outline of the
normal field. When excessive, however, it becomes con-
centric. Both eyes are usually involved, but the dis-
turbance is more marked in the eye on the side of the
unilateral symptoms otherwise manifested. The field of
vision often changes, so varies at different examinations.
The color fields are also often involved. In some cases
there may be a reversal of them. Diplopia is at times
complained of and may be confined to one eye. Uni-
ocular diplopia is said to be absolutely characteristic of
hysteria and to be of purely psychic origin. Like the loss


294
C. F. Neu.
of common sensation, unilateral hysterical blindness may
exist without the patient being conscious of it. Unilateral
partial deafness corresponding to the side of the other
unilateral symptoms is said to be one of the commonest
hysterical affections, although this was not present in
any of the cases reported. Complete deafness is rare,
as is also deaf mutism. Loss of taste and smell is usually
associated with loss of sensation in the mucous membranes
of those parts. Such loss is at times bilateral, but often
is also limited to the side predominantly involved by other
disturbances.
The motor disturbances comprise paralysis, contrac-
tures or tremors. According to Starr "when motor para-
lytic symptoms develop they usually come on suddenly,
are total in that the degree of paralysis is more complete
and greater than that found in central brain disease, the
face is rarely involved, there is no increase of tonus, no
rigidity, no impairment of tendon reflexes, no electrical
changes, no sphincter involvement, with the condition
of astasis abasia often present." In hysterical paralysis
the injury itself plays a very subordinate part in its
production, since the loss of muscular power tends par-
ticularly to follow accidents in which the amount of
trauma is slight, but in which the emotions have been
more or less profoundly disturbed. While the paralysis
may immediately follow the receipt of the injury, as a
rule there is an intervening period between the receipt of
the injury and the onset of the symptoms of paralysis.
Instead of a complete paralysis there may be only a
general muscular weakness, a so-called myasthenic state,
in which the weakness complained of is apparent only,
often showing distinct variations in degree and extent.
The most common forms of paralysis are hemiplegia,
brachial monoplagia or paraplegia, at times paralysis
limited to certain movements.
Hemiplegia is more frequently in the left side, does
not involve the face, involves the leg as a rule more than
the arm, although this often varies with the part injured,
is almost invariably associated withpronounced anaesthesia,


Nervous Disturbances in Hysterical Conditions. 295
the paralyzed limb being moved as though it were an
inert mass and the tendon reflexes are not morbidly
exaggerated.
Monoplegia is said to be the most frequent form of
paralysis seen in traumatic hysteria, mostly occurring in
the left side and usually affecting only certain segments
or muscles. It varies in extent from simple weakness of
the fingers or toes to complete paralysis of the whole
limb.
Paraplegic conditions are usually sudden in onset,
are particularly liable to be accompanied by contractures,
are accompanied by loss of sensation, involvement of the
sphincters has been reported (La Tourette) but is very
unusual, and when occurring takes on the character of
spasm rather than paralysis.
Contractures, when they occur, usually come on
slowly and may occur independent of any paralytic
condition. They frequently follow injuries which on the
surface appear to be too unimportant to produce such
morbid changes. Their hysterical nature is frequently
indicated by their transitory character, by a tendency to
recur, by relaxation under the influence of suggestion, by
their disappearance under narcosis and by their assuming
forms different than those of organic basis. The leg, for
example, being held absolutely rigid and straight, or the
arm in a position of flexion with fingers tightly closed and
drawn across the chest.
Tremor is an almost constant symptom. It varies
in type from a fine rapid tremor of the fingers and hands
to several types which may resemble those of paralysis
agitans, multiple sclerosis or chorea. They usually dis-
appear during sleep and are intensified by excitement or
fatigue. The extreme which it can reach was well shown
in Case 3. The tendon reflexes are frequently overactive
or may be lessened, but are never lost. A peculiar form
of ankle clonus, a so-called pseudo-clonus, may be present
where the foot is held in a position of extension, but it
lacks the rhythm, force and persistence of a true clonus


296
C. F. Neu.
of organic origin. It is said to occur in about 20 per
cent of cases.
The superficial reflexes are either normal, or when its
parts are anaesthetic, are absent.
The pupillary reflexes, as a rule, are normal, but may
be slow or absent when convergence is weak or when there
is spasm of the ciliary muscle. The organic sphincters
are rarely involved. There often is retention of urine
and obstinate constipation, due partly to a spasm of the
sphincters and partly to voluntary opposition to the per-
formance of their normal functioning. The occasional
occurrence of incontinence has already been considered.
The only vaso-motor disturbance of any consequence, and
one which as yet is unexplainable that is sometimes found,
is the slight amount or absence of bleeding when para-
lyzed parts are pricked with a needle. This peculiar
phenomenon is rather characteristic and has been the
subject of considerable controversy amongst neurologists.
Trophic disturbances are rarely present. There may
be some atrophy, and when so is only slight, probably
dependent more upon disuse than any disturbance of
trophic nerve action.
A prominent characteristic, almost pathognomonic,
condition frequently found in these hysterical states is
the so-called hysterical joint in which pain is the most
prominent manifestation, being intensified by movement,
but is apparently due more to the hypersensitive condition
of the skin surrounding the joint than to any alteration
within the joint. Although there is present such an
intense degree of hyperesthesia, the skin is not reddened
and oedema is very rare. The joints are usually more or
less rigidly fixed, due to the contracture of the muscles
about the joints, this contracture and fixation disap-
pearing under narcosis or sometimes spontaneously under
the influence of emotional conditions. The condition in-
volves the knee joint in 50 per cent; the hip, wrist, shoul-
der and ankle joint following in order of frequency.
The onset may appear immediately after an accident,
but usually an interval elapses. The development, when


Nervous Disturbances in Hysterical Conditions. 297
once started, is usually rapid. The joint affected may
remain useless for weeks or months, then suddenly dis-
appear. When of long duration, however, organic changes
are liable to take place, due to pressure or the formations
of adhesions, etc., which may become permanent.
The typical hysterical seizures assuming the features
of an epileptic attack are said to occur in about 10 per
cent of cases where hysterical conditions arise from
traumatic causes. (Krupp). It is sometimes most diffi-
cult to distinguish such outbreaks from the true epileptic
attack. The more important features of such attacks
which are indicative of an hysteric basis are that there is
frequently noticeable a definite inciting cause, usually
insignificant in itself, yet sufficient to arouse the mental
processes leading to their culmination in an orgasm.
The presence of an aura is almost constant, the convulsive
movements are grossly exaggerated, the period of tonic
contracture is prolonged, episthotonous is often marked,
the duration of the convulsive movements prolonged—
often lasting thirty minutes or more; recovery is usually
immediate and not followed by any indications of a con-
fusional state or stupor, although at times they do pass
into a stuporous or semi-comatose state apparently not
responsive to any form of stimulation and incapable of
being aroused, yet with normal vascular and respiratory
functions. The attacks frequently recur, rather regularly
at certain hours of the day, the tendon reflexes are re-
tained, pupils respond normally to light, there is rarely
any loss of control of the sphincters, and rarely any biting
of the tongue or self-inflicted injury.
The general somatic disturbances resemble to some
degree those of the neurasthenic state. Gastro intestinal
disturbances are common—vomiting, impaired appetite,
gaseous fermentation, acid eructations, constipation or
diarrhceal attacks being those usually manifested.
Respiratory disturbances consist mostly of attacks of
rapidity or apparent dyspnoea, and of a peculiar dry,
hacking, irritating cough. This last feature was well
illustrated in a case recently examined, where the in-


298
C. F. Neu.
dividual had been thrown against the side of the seat in
a passenger car, in whom the slightest palpation of the
chest wall and every attempt at percussion would induce
the most violent attacks of coughing, yet neither the
ordinary movements of the body nor the most forcible
movements of respiration produced the slightest dis-
turbance. Attacks of cardiac palpitation or of tachy-
cardia are fairly common and are frequently associated
with attacks of dyspnoea or of gastric eructations. Fre-
quency of micturition at times associated with an ap-
parent dysuria is not uncommon. Disturbances of sleep
with its secondary results also prove a frequent cause of
complaint, yet observation shows that as a rule they
obtain a great deal more sleep than is admitted. Many
other somatic disturbances occur, but as the subject of
this paper deals with the nervous disturbances, the
former will not be considered further.
Diagnosis.
The more prominent characteristics of the hysterical
nature of manifestations referrable to disturbed functions
of the nervous system are pretty clearly illustrated in
the few cases reported, but, as has been stated, not all
cases are so clearly defined. One often meets with a con-
dition where the symptoms manifested have the char-
acter not only of an hysterical nature, but also those of
some other functional or organic disease. One frequently
finds a combination of hysterical neurasthenic symptoms
or hysterical manifestations superimposed upon an organic
basis, so that it requires and demands the exercise of a
great deal of carefulness, close observation and judgment
in the determination of the true status of the manifesta-
tions presented.
We must bear in mind that in children there rarely
is found the variety of symptoms presented in the adult,
and in the former motor paralysis of some form is the
most frequent manifestation. Moreover, in adults there
may be only one symptom manifested, thus rendering
the diagnosis correspondingly difficult. It must also be
kept in mind that when psychic shock alone is the ex-


Nervous Disturbances in Hysterical Conditions. 299
citing cause the symptoms are usually less localized and
more commonly consist of aphonia, convulsive manifesta-
tions, stuporous or comatose states. It is also well to
remember that the greater the number and variety of
symptoms presented, the more probable is it that the
patient was hysterical before the injury. It is also a
significant fact that it is almost unheard of for an anaes-
thetic part to be injured without the knowledge of the
hysterical patient, thus differing definitely from the
anaesthesias of organic basis where such lack of knowledge
of an injury received is invariable. Since there is scarcely
to be found an organic lesion of the nervous system with
its accompanying signs and symptoms which the hysterical
state cannot imitate, one is justified in making the diag-
nosis of an hysterical basis, only after the most rigid and
painstaking examination fails to disclose the presence of
a palpable, structural change as responsible for the
symptoms manifested: that is, one must exclude first
every possibility of an organic lesion of the nervous sys-
tem before falling back upon the diagnosis of the so-
called functional disturbance called hysteria.
Prognosis.
So far as recovery from this condition is concerned,
one is safe in saying that it is difficult to find a more
uncertain proposition in the whole realm of medicine.
The seriousness as regards life depends more upon the
nature of the physical injury received than upon the
hysterical complex manifested. Since there has not been
a case of hysteria reported as fatal in which microscopical
examination has excluded visible pathologic changes in
the nerve tissue, it is rather a safe rule to say that the
hysterical condition does not cause death, and does not
destroy nervous tissue, hence, may be regarded as recov-
erable. To this, however, Starr makes one exception,
when he states that "spinal sclerosis may develop from
contracture, an almost unique example of structural
change resulting from a functional disturbance." It is-
not by any means an easy matter to say positively when
these patients are cured, but in general it may be stated


300
C. F. Neu.
that when objective symptoms have been absent for a
year or longer, a cure can be assumed. Probably the
most prominent factor concerned in rendering the prog-
nosis so uncertain is the question of litigation, and so
long as this is pending no patient with traumatic hysteria
need be expected to get well. But even after this source
of irritation and anxiety is removed most cases still
hang on for a varying period, and in general it may be
said that many of these require a year or so before the
hysterical complex can be suppressed. We are apt to
forget that when the hysterical characteristics have ac-
quired control of the situation they cannot, with few
exceptions, be completely abolished at will. Other factors
which cloud the prognosis are the previous existence of
chronic diseases, alcoholism, arterio-sclerotic conditions,
etc. From a prognostic standpoint one must take into
consideration the patient's purely psychological charac-
teristics of attention, of memory, of mood, emotions and
temperament, of will and of conduct.
Treatment.
The treatment of these cases can only be indicated
in a general way. Every case is a problem of its own.
No two patients can be managed in the same way.
Appropriate medical attention must be given to those
individual symptoms requiring it. On the whole, how-
ever, much more depends upon the regulation and man-
agement of the habits and mode of life. One must as
far as possible guard against injurious social, moral and
mental influences. The essentials of normal living, which
such patients cannot gather for themselves, must as far
as possible be supplied. Frequent and positive assurance,
encouragement, mental and moral support are constantly
necessary. Pleasurable diversion, some form of mental
and physical occupation to divert the attention and
thought from morbid into more healthy channels. An
important point in regard to whatever form of occupation
or diversion is chosen is that it should not be left to the
discretion of the patient, but should be carried out under
the most careful supervision of some one in control to


Nervous Disturbances in Hysterical Conditions. 301
regulate the amount done and insist upon regularity of
performance. Too often this is left entirely in the hands
of the patient, and unfortunately they are the poorest
of all judges as to how and what to do what they are
advised. Failure to attend to this point is almost certain
to result in the failure to attain the desired effects.
The same careful attention to and regulation of all
of the habits of life are absolutely necessary to deal with
such patients adequately. In addition, assistance is gained
by utilizing such factors as hydrotherapy, electro-therapy
and mechano-therapy in various forms, the particular
form used depending upon the objects to be achieved and
the personality of the patient with which one is dealing.
When these ordinary methods fail, it then becomes neces-
sary to resort to more radical measures, such as isolation,
the so-called rest cure, change of scene and associations,
and change of climate.
In spite of all the measures utilized and methods
adopted, these patients are apt to tax to the uttermost
not only all the ingenuity, but also all of the patience
of the physician in charge.


THE FEEBLE-MINDED A SOCIOLOGICAL
PROBLEM.
By Martin W. Barr, M. D.
Chief Physician, Pennsylvania Training School for Feeble-
Minded Children.
Elwyn, Pa.
THE Victim, the Scourge, and the inevitable procreator
of a decadent Humanity is the Imbecile of what-
ever grade. Thus tersely may be described this plague-
spot in the social life of the ages.
Appealing to present as to past centuries, it has yet
met no permanent relief—society no fitting redress.
Ever misunderstood, though rightly adjudging a distinct
race, we trace degenerates as wanderers through many
ages—many lands.
By the ancients regarded as objects of derision,
aversion or persecution, the appellation "imbecile," not
only inspired horror and disgust, but meant for the un-
fortunates a forfeiture of all human rights and privileges;
so in the belief that these hapless ones were accursed
of the gods, or in the effort to preserve, at whatever
cost, the integrity of the race, the practice became com-
mon among some nations of exposing their weaklings to
perish. Of those who escaped these drastic measures,
we find mention now and again, but as set apart, hedged
about by ridicule and scorn and tolerated only for the
sake of diversion and amusement.
The dawn of Christianity was for the mental de-
fective the first gleam of commiseration. Three hundred
years later, when Constantine Magnus was Emperor of
(302)


Feeble-Minded a Sociological Problem. 303
the West, St. Nicholas, the good Bishop of Mira, recog-
nized and tenderly cared for the imbecile. Later again,
in mediaeval times, they posed as fools and jesters or,
regarded as "children of the good God," they wandered
unmolested in Europe and the Orient. Again they were
viewed with superstitious reverence and, it is said, that
Tycho Brache had for his close companion, a fool, to
whose mutterings the great astronomer listened as to a
revelation. Among the Turks and in many parts of Ire-
land and Brittany, this same extravagant idea regarding
these innocents prevails; in Brazil today, an imbecile in
the family is considered more a joy than a sorrow; the
American Indian allows the child of the "Great Spirit"
to go unharmed; and the Koran gives for them a special
charge to the faithful.
The first law regarding mental defectives we find dur-
ing the reign of Edward the 2nd, when it was enacted
that the King should have the custody of the lands and
property of natural fools, as their legal guardian.
The first organized effort for rescue, care and pro-
tection of the feeble-minded is found recorded in the
middle of the 17th century when, obtaining from Ann of
Austria permission to use as an asylum for foundlings the
ancient Chateau of Bicetre, St. Vincent de Paul and his
Confrerie de Charite gathered there the defective children
of France.
In the case of the Wild Boy of Aveyron, esteemed a
savage, we find formulated the first definite scheme for
the awakening of backward intelligence, when Itard—
Physician to the School for Deaf Mutes in Paris—an
enthusiast in the new school of physiologic education
then being carried forward by the Abbes Sicard and de
l'Epee, interested in the boy as a subject for experimenta-
tion, devised for him a program which should lead by
the exercise of the senses to the awakening of the emo-
tions; a program designed to cover all steps from savagery
to civilization, and gradually to the full development of
normal powers.


304
Martin W. Batr.
But Itard failed to recognize that imbecility of which
both Bonaterre and Pinel had warned him might be
there; yet, after five years of unceasing toil and bitter
disappointment in hoped-for results, he might have found
his truest consolation—had he but known it—in the fact
that his intense sympathy and interest in his pupil had
led him, although unwillingly, to modify his methods to
meet the needs more of the defective than of the savage
for, as the endorsement of his work by the French Acad-
emy reads: "It presents a combination of highly in-
structive processes, capable of furnishing science with
new data, the knowledge of which can but be extremely
useful to all persons engaged in the teaching of youth,"
which word of prophecy was more than fulfilled.
Edouard Seguin, the interested pupil and co-worker
of Itard, recognizing the value of his methods for the
development of defective intelligence, opened in 1837,
a private school in Paris for this avowed object. Build-
ing upon Itard's methods for the awakening of the emo-
tions through the exercise of the senses, adding to it
Locke's theory of the connecting link between sensation
and idea, Seguin gradually formulated a program which,
verified in Paris, he later brought to America and lived
to see it the fundamental principle governing the de-
velopment and training of mental defectives throughout
the world. It involves the careful diagnosis of physio-
logic and psychologic conditions, the development and
strengthening of faculties and aptitudes or, as necessity
may indicate, the restraining of certain instinctive and
moral tendencies. These all combine to form a basis
upon which others entering into his labors have builded
and enlarged continuously.
Working upon the theory which Huxley so forcibly
enunciates, that the sense of uselessness is the severest
shock which the human system can sustain, and that if
persistently sustained it results in atrophy of function,
observation and experimentation have revealed manual
training applied in many ways to be a superlative motion
in the development of mental defectives.


Feeble-Minded a Sociological Problem. 305
As schools for the feeble-minded have multiplied and
increased with population varying from one hundred to
the fifteen hundred mark, individuals of similar aptitudes
have been massed, separating the trainable from the un-
trainable, until a clear-cut grouping according to ability
and with corresponding occupation has been formed.
Finally from this experience an Educational Classifica-
tion has been formulated at the Institution of Elwyn, Pa.,
as follows:
EDUCATIONAL CLASSIFICATION
of
MENTAL DEFECTIVES
Asylum Care
Idiot.
Profound—Apathetic; Unimprovable; Excitable. Super-
ficial—Apathetic; Slightly improvable; Excitable; Im-
provable in self-help only.
Idio-Imbecile.
Improvable in self-help and helpfulness. Trainable
in very limited degree to assist others.
Custodial Life and Perpetual Guardianship
Moral-Imbecile.
Mentally and morally deficient. Low-grade—Train-
able in industrial occupations. Temperament bestial.
Middle-grade—Trainable in industrial and manual occu-
pations. A plotter of mischief. High-grade—Trainable
in manual and intellectual arts, with genius for evil.
Long Apprenticeship and Colony Life under Protection
Imbecile.
Mentally deficient. Low-grade—Trainable in indus-
trial and simplest manual occupations. Middle-grade—
Trainable in manual arts and simplest mental acquire-
ments. High-grade—Trainable in manual and intellectual
arts.
Trained for a Place in the World.
Backward or Mentally Feeble.
Mental processes normal, but slow and requiring
special training and environment to prevent deterioration.


306
Martin W. Barr.
Defect imminent under slightest provocation, such as
excitement, overstimulation or illness.
In accordance with this, the untrainable idiot with
no articulate speech and no power of consecutive thought,
is remanded to nursery care in asylum, together with his
brother the idio-imbecile, whose very limited advance in
mentality will admit of his being trained to assist in his
care; and the trainable imbecile is grouped in classes and
work shops.
With methods of training embodying more or less of
this classification the large training schools of today pre-
sent a community of workers; farm, garden, house,
kitchen and laundry having each its corps of busy aids;
as have also the various trades of shoe-making, tailoring,
dressmaking, carpentry and printing. A trained choir
leads in the religious services, while a band, orchestra
and chorus and in many schools a trained company of
actors and athletes, provide amusement and entertain-
ment for all. It is in this quiet routine—this regular
alternation of work, rest and amusement periods—that
the imbecile finds his only safety.
A prolonged observation of the emotional and moral
tendencies, shows a predominance of the former over the
latter, amounting in many cases to an absolute exclusion
of the moral sense necessitating life-long seclusion, sur-
veilance and protection.
The boys who go out into the world, find this routine
and the discipline so necessary to them, only in an army-
post or in the marine corps; and some have been fortunate
in enlisting; the majority of the girls, however, drift
inevitably to ruin.
The homes are unequal to the task of either stimu-
lating or compelling, and more than one poor soul returns
gladly to the institution he was once so eager to leave,
with the exclamation: "I can't get along. Somehow they
don't understand me!" while others soon drop out of the
race and the unequal competition with normal, drifting
into the dependent or the criminal ranks. This is un-


Feeble-Minded a Sociological Problem. 307
failingly the fate of that class of Moral Defectives found
in all grades of imbecility; developing in the lower the
bestial qualities—in the higher that skill and duplicity,
making veritable artists in crime. Thus it will be seen
there must be the ever-compelling hand keeping him
up to the maximum of endeavor, lest through apathy or
indolence he develop insanity or degenerate into idiocy.
Equally, there must be the watchful guarding from excess
of any kind and the safe-guarding from temptation.
In the training schools which are veritable homes for
children, all this and more can be managed for him. Out
in the world, according to opportunity or proclivity, or
too often from inherited propensity, he is sure to be-
come the victim of the vicious into whose toils he will
often fall from sheer loneliness—a feeling he is unaware
of in a community of his fellows where, not only is he
protected from vice, but society from the inevitable
increase of which he will be a certain factor.
It is absurd to speak of cure. Defect is not disease,
and even when brought to its best condition, that ir-
responsibility—the unfailing characteristic of this per-
petual childhood—precludes permanent success in any-
thing. Without the sustaining and protecting hand he
will fall sooner or later, bringing disaster to himself and
others. Protection there must be; for the imbecile from
the world, and for society from him, for this whole matter
of transmission of ill cannot be too carefully guarded
against.
The influences of environment carefully noted have
not only been of inestimable value in training, but have
given in time laws of cause and effect of even greater
value.
Family history, and causes hereditary or accidental
being investigated, and, as upon physical efficiency de-
pends mental potentiality, every sense. avenue interro-
gated and tested, it will readily be seen that in approach-
ing the study of mental defect, a correct diagnosis is of
primary importance. The great difficulty that almost


308
Martin W. Barr.
always confronts one on the very threshhold of diagnosing
is that of distinguishing defect from insanity.
Now Insanity is a diseased condition of the brain
affecting the integrity of the mind, characterized by in-
tellectual or emotional disorders; whereas, imbecility is a
deficiency of brain matter with permanent impairment of
the intellectual faculties; as Esquirol so cleanly puts it:
"An insane man is deprived of advantages which he form-
erly enjoyed. He is a rich man, who has become poor.
The idiot, on the contrary, has always been in a state
of want and misery." Thus you will readily see the dif-
ference is a wide one. Insanity, being a disease of the
brain may prove curable, but imbecility—which is de-
fect—a lesion of the brain—is hopeless so far as cure is
concerned. We cannot supply or cure what isn't there.
This confusion of terms, however, has some reason. Not
infrequently, among the feeble-minded, there is inter-
current insanity—dementia praecox; again among the
insane there are cases that have their origin in mental
defect; thus, the idiot born with limited brain capacity
and the dement whose brain is worn out are very near
akin. It is a distinction in difference, not in kind.
A consensus among students in many lands confirms
conclusively the opinion reached; viz., that any mal-
nutritive condition tending to prevent, arrest or retard
development in the human species, must result in idiocy
or imbecility. As provocative of such condition the hered-
itary causes acting singly or in combination are most
potent. Heredity is here proven law! Heredity—whether
direct or indirect—as inexorable as death itself.
Accumulated data drawn from family histories care-
fully investigated has afforded foundation for authorita-
tive opinion, and upon such basis various studies have
been made from time to time by alienists of repute.
With the aim of reducing these yet more closely to con-
crete form, carefully graduated tables of causation have
been worked out on the Continent, in England and
America; convenience dictating a division into three
periods, causes acting before, at the time of, and after


Feeble-Minded a Sociological Problem. 309
birth. All agree in finding heredity the most fruitful
cause.
Heredity recognized in all ages, among all peoples
as an acting, dominating power in the progression or retro-
gression of races is decried and repudiated by some,
from a simple misunderstanding or misconception. Thus
a disease, or defect, or a weakness need not necessarily
be reproduced in its exact form of, for example, tuber-
culosis, drunkenness, or epilepsy; but during the daily
intercourse and cohabitation of individuals thus affected,
there may be, and often is, a coalition and interfusion
producing an evil far worse than any of these—it may be
idiocy, imbecility or insanity. Or else there may be
a blending of nerve tissue and fibre of such vicious qual-
ity as to produce a "poor make-up," so to speak, in the
off-spring who, with no resisting power, succumbs easily
to sudden attack or to the influences of unhealthful en-
vironment, too often transmitting its burden of accumu-
lated ill. For unfortunately, even among so-called re-
spectable people, the procreation of the human species
does not receive a tithe of the attention given to that of
horses, of flocks or herds. Yet we hear a lot of bombast
against "surgical interference" as a crime against the
inalienable rights of man. Inalienable rights! Exercised
to poison his neighbor's family stock—to flood a com-
munity with paupers for the state to support! Such
would under another guise merit and receive the just
reward of penitentiary or gallows. That a highly emo-
tional race, such as the imbecile, with exaggerated sex-
uality and no power of conscience to restrain him from
being either seducer or victim, must be a highly prolific
one is but a natural law governing all animals. The
Tribe of Ismael is a noted example which the records of
all institutions for the feeble-minded but confirm.
In my own personal investigation of 4050 cases I
find by far the largest per cent—25.43—due to an in-
heritance of idiocy and imbecility direct. In one of these
cases both parents being wholly defective—the father
only 38 years of age—there are no less than 19 defective


310
Martin. W. Barr.
children; another case shows 8 microcephalic idiots; and
yet another from similar stock numbers, in three genera-
tions, 34 imbeciles. In another family, the mother an
idiot, has given birth to 7 idiot children.
Nothing is so readily transmitted as defect and unless
strongly counter-balanced by an infusion of pure blood,
its lack of resisting power and early affiliation with other
neuroses continually intensify it. Often in spite of pre-
potency the taint lingers, and in the fourth or fifth gener-
ation, there will be a physiologic house-cleaning and a
degenerate is bound to appear. Not only unrestrained
cohabitation, but immigration, is responsible for this
swelling of our degenerate population.
New York receives over one-fourth of all immigrants
coming to the United States, and 80 per cent of these are
found on arrival to be either insane or mentally defective.
Census statistics of the feeble-minded show 30 per cent
to be the progeny of aliens or naturalized citizens. The
financial outlay of caring for these is enormous; but yet
more disastrous is the influence of such on the race
question, the feeble-minded being, we have noted, a class
highly prolific.
When we view such an outpouring can we wonder
that the splendid work of scientific investigation, discovery
and reform is overwhelmed? By a flood, too, which needs
only the strong arm of law restraining immigration and
enforcing separation, segregation and asexualization, as-
suring true life and freedom under law alike to society
and to the degenerate.
That the true end of segregation and separation in
asylums is largely frustrated by the sending out of the
imbecile unrecognized or unfit for self-control or self-
protection, there can be no question. Indeed, worse than
frustrated, it is too often perverted into a disguise so com-
plete that the world either refuses to recognize him as
defective, or accepts for his case the fallacy of cure, leav-
ing him free to pursue instinctive tendencies too often on
criminal lines.


Feeble-Minded a Sociological Problem. 311
Such withdrawals, frequently the work of imbecile
parents, are of common occurrence in all our institutions.
Equally true is it that the only solution of the prob-
lem of such dissemination is to be found in asexualiza-
tion. Once adopted as a preventive of Race Suicide, and
a means toward Race Culture, the public mind will
readily adapt itself to it, as merely a new system of
quarantine carrying us forward to yet higher ideals in the
procreation of humanity. In the light of such conditions
may we not with clearer vision find in the custom of the
Greeks allowing their weaklings to perish, but conforma-
tion to Nature's law, which sustains the genus even at the
expense of the individual?
Are we more wise or merciful in first permitting the
procreation of defect and then, failing in recognition, spite
of the warnings and admonitions of science, treat as
criminals these victims of our own ignorance or neglect?
For that is what we are doing today, I venture to assert,
in every State of our Union.
But a few years since, this point was made clear to a
jury in Philadelphia, and the annals of the State pre-
served from the blot of murder which the hanging of
Samuel Henderson would undoubtedly have been.
Only a few weeks since I was again summoned to
examine a boy in a neighboring state who, convicted of
burglary, was saved from the whipping post, the judge
accepting my diagnosis of moral imbecility and utter
irresponsibility.
Such practical exemplifications of theories which
the sciences of physiology and psychology have evolved
should convert the most skeptical and convince the public
that imbecility being defect, not disease, is therefore be-
yond the pale of cure; that psychic defect, either of the
emotional or moral nature, may be as entire as is the
defect of sight or hearing in the physical, demanding care,
protection and always recognition of corresponding ir-
responsibility.
Our institutions are doing much in this line, above all


312
Martin W. Barr.
in providing as means to an end congenial employment
as either incitement or sedative.
The individual thus treated growing content in famil-
iar and attractive environment with no undue respon-
sibility, in regular alternations of work, recreation and
rest arranged for him, lives protected from the world and
the world from him. We have in this combined the wis-
dom of the past, the race is protected from contamina-
tion—the weakling from temptation.
That the public in both church and state is slowly
but surely awakening to the crisis is evidenced in the
recognition of backward children and the special schools
furnished by Boards of Education in most of our large
cities for their benefit. This, as has been clearly demon-
strated, is a class not actually defective, but so handi-
capped by undeveloped conditions, from causes inherited
or accidental, that defect is imminent upon any provoca-
tive incident, upon illness, shock, over-stimulation or
prolonged fatigue. For those, after careful preparation
and given opportunity for quiet selection without excite-
ment, many avenues open, and they may, after passing
the critical stage, enter the arena of life normal men and
women; whereas, without such recognition and provision,
they must, sooner or later, join the ranks of defectives.
The value of such schools, therefore, cannot be
too highly estimated; and as a means of lessening numbers
they must in time aid largely in the work of prevention.
Europe, Austria, Servia and Italy lead in forbid-
ding the marriage of degenerates; as does the Argentine
Republic. England does not forbid marriage, but makes
sexual intercourse with a married degenerate, a penal
offence.
No less than 35 states, including the District of Co-
lumbia, have laws restricting the marriage of those
deemed unfit, for causes specified as follows: insanity,
idiocy, epilepsy, venereal diseases, drunkenness, indigence
and incapacity for consent from lack of understanding.
Dean Sumner, of the Cathedral of St. Peter and St.
Paul in Chicago, is pioneer in the church method of


Feeble-Minded a Sociological Problem. 313
racial betterment by demanding a certificate of good
health, mental, moral and physical, by all seeking mar-
riage; and the federated churches of Cleveland, Ohio,
have recommended that the same be required by all the
ministers of that city, as has also a recent missionary
convention at Reno, Nevada.
The Rev. Charles M. Sheldon, (author and lecturer)
announces that he will never marry another couple unless
a physician's recommendation is produced with the
license, and the Probate Judges' State Association has
prepared a bill for submission to the Legislature of
Kansas, embodying this feature.
What remains to make this wholly effective is to make
it obligatory by the National government. More than
a mere census of numbers is a census of defect. More
than the registration of voters so insisted upon is the
registration of defect in every home and school, and the
relegation of defective members to that care which, first
by surgical procedure, forbids procreation; next by train-
ing in congenial occupations withholds numbers from the
criminal ranks, and provides an efficient corps of laborers
and artisans in the institutions, reducing largely the cost
of maintenance; and by developing what is best in the
individual, latent or self-evident, making him perma-
nently a useful member of his community and, as aiding
in the care of the helpless, a true son of the state.
Thus and thus only may we compass alike the welfare
of society and of its weaklings, and furthermore in the
development of the race, protected by healthful quarantine,
insure the natural decay and final disappearance of
degeneracy.


EUGENICS IN THE MAGAZINE, ESPECIALLY
THE MEDICAL.
An Overflow Editorial.
By C. H. Hughes, M. D.,
Editor Alienist and Neurologist.
AS self-preservation is justly considered the first law
of nature the rule of action of the magazine for
the profession and people should be the welfare of the
individual and the community it serves. The motto of
the writer's native state, for example, "Salus populi
suprema lex esto," might well be selected as the motto of
the medical editor "Pro bono publico et professionis."
In fact such should be our aim in all we do, excerpt
or write. In the direction of eugenics we should seek so
far as we may, to follow out in our pages the suggestion
of Dr. Burrell, late President of the A. M. A. the Harvard
Medical School, the A. M. A., and elsewhere as to lec-
tures for public enlightenment on medico-sanitary matters.
Hygiene, mental, nervous and physical, is sanitary eugenics
and the more the people and the profession learn in this
direction the better for us and our country's welfare and
for our consciences, for the medical editor, as all editors,
should act conscientiously for the good of himself and all
concerned, even in regard to the letting of his advertising
space. The old time doctor's idea of looking wise and
keeping mum before intelligence seeking people on matters
medical and sanitary, is a mistake, from which we, as a
class of truth-seeking and eugenically intentioned practi-
tioners and promoters of the healing art, have greatly
suffered in public esteem, in quarters where ignorance of
our own real medical merit, purpose and performance
(314)


Eugenics in the Magazine.
315
prevails, even though we look less wisely and say more—
though not enough.
The prominence, sometimes dominance and human
life perils of certain erroneous, half and often wholly
false, views of healing power and methods prevailing largely
about us, is greatly due to our own reticence before the
public. We have acted unwisely or rather failed to act
with wisdom in the premises.
We have too long hidden from public view the lights
of scientific revelation which shine for us and for the
welfare of mankind. Let us adopt a wiser and more
eugenically dutiful policy toward all mankind, together
with our brethren of the practicing medical profession in
our enlightening and shine like the sun for all the world.
Let us acknowledge and act openly as the editorial
representatives of the greatest of earth's callings, our
purpose being as it truly is, to heal and help and ad-
vance the welfare of man.
The clergy are taking an interest in medical matri-
monial eugenics. Let us help them and our lawmakers
also to make right laws for mind and body salvation at
the matrimonial altar and save our cradles from con-
tamination of disease and defects of mind and body, to
our honor and glory, and with the approbation of the
God of Nature who signals to us in a thousand ways,
His approbation of every human effort at advance toward
His scientifically revealed design of ultimately evolutioned
perfection of human beings in minds and bodies.
Every vocation in life and every human being should
profit through our eugenic counsels. They are quite as
worthy of being bred and brought up aright sanitarily
as the beasts of the field and pasture, and the dogs and
cats and bird pets of the household. Even as the cattle
on a thousand hills and these domestic animals require
our eugenic concern, so should the children of every house-
hold.
I need not here specify the well known and numerous
far-reaching pathic forces that threaten individual lives
and race extinction, like the venereal and toxic habit


316
C. H. Hughes.
forces, such as the alcoholics and other narcotics, which
we are bound to rightly understand and seek to protect
society against.
All the mind and life threatening diathetic states claim
our special attention and monitory service to the profes-
sion, to all the professions, occupations and all the people.
On certain matters we should write more often for
and to the people far more than we have done heretofore,
as well as the profession.
As a further instance of public awakening the writer
was called upon lately by the specially interested parties
contemplating matrimony for a formal and specially
written opinion concerning the probable safety of probable
offspring of the intended marriage where one of the parties
was descended of a mother who, subsequent to his birth,
had, after another labor, with twins, an irrecoverable
attack of puerperal insanity. [See Alienist and Neurol-
ogist for August, 1912, article, "Apropos of Hymeneal
Eugenics."]
The spreading interest of the laity in Eugenics, both
physical and psychical, will bring to the fore this important
matter, leaving diathetic and infectious states and certain
surgical procedures to us and we shall have new moni-
torial duties to engage our attention.
Some of the surgical procedures of the past, decided
adversely, will come to the front for reconsideration, such
as Batty Tuke's normal oophorectomy, Baker-Browns
cliterodectomy, the asexualizing of men by vasectomy, etc. It
is better that the genital centers should perish in certain
individuals than that morbidity should be propagated.
Better wasted or lost testes or ovaries than saved de-
cadents and we should so advise doctors, divines and the
populace.
Our wise and worthy colleague of the Medical Record
makes a judicious selection germane to our subject, from
that equally wise and judicious brother of the Boston
Medical and Surgical Journal, the same being an excerpt
from the venerable Jacobi anent the general practitioner,
toward whom we have an impelling duty.


Eugenics in the Magazine. 317
I read:
"A. Jacobi states that while one should continue to
admire the specialist, one should learn to revere the gen-
eral practitioner. In twenty-five years the latter will
recover the place of honor which was his fifty years ago.
Alongside of his other work he will help to build char-
acters and souls. He will then be again the general
adviser, having learned from the laboratory men and the
specialists who are the modern handmaids of practical
medicine; knowing the history of his trusting friends and
taking an interest in their wholeness and wholesomeness—
the chum of the old people, the intimate of confiding
girlhood, and the uncle and oracle of the children."
The general practitioner is our working associate,
who will learn of us also and carry out to sanitary and
eugenic fruition the conclusions of our research and moni-
tory labors. We should, therefore, fully and zealously
lay before him the best methods to be gleaned from every
source for saving the people from the pestilences that de-
stroy—the pernicious pestilences and poisons, personally
and atmospherically borne, and germs and other agencies
of disease and decadence markedly manifest or insidious
and above all I place that worse and more threatening
power for race destruction, the too often not duly ap-
preciated psychopathic diathesis which has brought about
the death and destruction of the once flourishing nations
of antiquity, a force more powerful for a people's ex-
tinction, though insidiously silent in their individual and
race-destroying power, than Vesuvius and the destruction
of Pompeii.
As brevity is a virtue in a medical contribution as
it is the soul of wit in flashes of mind, I stop here that
you may further work out, think and write out this sug-
gestive and vital subject. My eugenic sense of propriety
prompts me to refrain from exhausting you and my al-
most boundless subject at one sitting.
P. S.—This note was intended as a hint for action
for the Association of American Medical Editors but was
not presented because of unavoidable circumstances pre-


318
C. H. Hughes.
venting attendance. This also will explain and extenuate
its cursory and non-detail character as to certain essential
facts, "a word to the wise being sufficient."
We have for too long a time let the quacks only, post
the public as to essential matters medical and they have
mislead by commercial perversion of knowledge.


ARE WOMEN POLYGAMISTS?
By William Francis Waugh, A.M., M.D.,
Chicago, Ill.
THE world has definitely condemned polygamy. No
sociologic question is more decidedly settled than this.
Even before the dictum of Saint Paul had become an article
of faith, civilization had adopted monogamy and polygamy
was beccirning unusual. Only in the semi-civilized East does
the latter survive; and in the present downfall of Turkey
we probably have an instance of its degenerative tendency.
The Turkish peasant—who is monogamist—has shown him-
self abundantly possessed of the soldierly qualities that have
made hin proverbial—to fight like a Turk—yet the armies of
the Porte have collapsed through the incapacity of its officers.
A reasonable explanation may be found in the system of so-
ciety where the success that raises one man above his fellows
enables him to acquire a harem, in whose joys his energies are
dissipated.
Monogamy is enjoined by every modern religion and code.
It is supported by the common sense of the day. It goes
without question or argument. It is an ideal established
in the heart of every man. Poesy is the utterance of the soul,
and no poet has so endeared himself to his fellowmen as he
who gives expression in words to the simple emotions, the
heart-throbs of humanity, like Burns. But the soul of poetry
is monogamy—devotion to one and one only.
"Oh, for a lodge in some vast wilderness,
With one fair spirit for my minister;''
is the aspiration to which every manly heart beats in quick
response. Just imagine changing it to read'two fair ministers;'
or a harem of them. Here we draw the line. Men may write
endlessly of their crimes and passions, they may depict the
(319)


320
William Francis Waugh.
lure of the gambling table, the Berserker's rage for slaughter,
or ring the changes of the innumerable Bacchanalian odes
till they reel through the besotted—
'' Drunk again! Drunk again!
Oh how nice to be drunk again!"
Incredible debauchery and obscenity may characterize
the intimate talk of the commoner sort; but even the most
depraved would turn with disgust from him who should pre-
sume to celebrate the joys of multiple cohabitations.
It is therefore with considerable surprise that one who
has studied humanity long and carefully is driven to the con-
clusion that women—many of them—are essentially polyga-
mists. Not purposely or even consciously, but instinctively,
and therein lies its profound significance. Charge any woman
with this and she will deny it vehemently, passionately, pro-
testing with heartfelt sincerity her repudiation of the thought
of sharing her husband with any other woman. But let us
consider:-
The Eastern harem presents the picture of a solitary man
surrounded by a swarm of women, wives, odalisques, slaves
and concubines. Each of these seeks to attract the favor of
the master, and for this employs the arts of her sex, adornment,
accomplishments, seductions, scheming intrigue and crime;
for the war of women is merciless and unscrupulous far be-
yond that of man. No rules are obeyed, no limits observed,
in pursuit of the object; success excusing all means employed
to attain it. Not that sexual ardor rules; far from it; or that
any of these women feels any special 'love' for the man. The
dominating thought is to 'beat the other women to it;' to triumph
over them. Without this incentive the normal woman would
veil her charms except at her mating seasons, to avoid arous-
ing the amorous appetite of her mate.
Glance at the state of social affairs in civilized states,
and note the numerous points of similarity. Women act in
groups, men act individually. Place a proposition before a
single woman and she is bewildered until she has the oppor-
tunity to consult her sisters. She will not wear the most be-
coming garment unless she knows that it is 'the style.' Her
thoughts, beliefs and actions are governed by the fashions.


Are Women Polygamists?
321
The wise man who desires the support of the women lays
his matter before a group of them, not before one alone.
A man's affections settle upon one woman. To him
she presents the sum of all desirables, and to him alone. His
choice is governed by affection. To waken the choice of a mate
is a matter for cool deliberation, weighing of chances and
qualifications. She looks over her field and makes choice
of the most eligible. This is the man most other women want.
As in the harem, the contesting women employ their arts
and artifices to win to themselves the coveted prize. Wealth
and rank are weighed against youth and beauty as always,
health, disposition, liberality, habits, all receive a minute
consideration that would surprise many an unsuspecting suitor.
Any man who shows to the front is tolerably sure to be quickly
surrounded by a swarm of adulating women, each seeking to
attract his especial attention. How many proposals did young
Astor receive since his father's death? Listen to the talk of
the women over the last engagement; it is never how much
she loves him but how did she do! If she has thrown herself
away on a poor man—"the big fool!" Does she marry a
wealthy man?—fine! A Baron—goodness! An Earl—grand!
A Prince—!!!!!
Listen to men in the club talking over the affair; is she
pretty? Is she witty? Is he getting the girl he wants? Never
does one ask how much money she has—and if the man is
marrying money, somebody snorts—"the cad"—and the
men shrug and drop the subject.
Men expect men to marry for love; women expect women
to marry for position.
Don't blame the women, for they must count the cost,
and look out for the welfare of the coming race. Only, appre-
ciate the truth.
Having made her choice, the arts of the toilet are brought
into play to enhance her attractions and conceal her defects.
Her accomplishments are paraded, glances, gestures, allures,
practised for hours until she perfects them; his likes and dis-
likes studied, and the woman's life battle is waged over him.
Meanwhile worth sits neglected in the corner while the women
swarm about Midas.


322
William Francis Waugh.
The pre-mating period is woman's bloom. Her physical
allurements reach their acme, her faculties are stimulated
to their highest point. She is witty, vivacious, playful, keen,
sympathetic, appreciative, chummy, in every way desirable
and adorable. Success in life to her means marriage. Her
lifework begins and ends there. Triumphantly she carries
off the catch of the season, and the campaign ends in the blaze
of glory at the wedding. Then—what?
Too often, disenchantment, and ennui. The excitement
of the chase is past. Possession is the time for examination
of the prize of victory. It does not seem such a prize now,
and comparison with other men, richer, higher, handsomer,
taller, fairer, et cetera, brings the conviction that instead
of winning the most desirable she has thrown herself away on
the least worthy. The incentive is gone, and she misses
the zest of the chase. She sinks into sloth, lolls about all day,
too lazy to keep herself clean or neat, too indifferent to exert
her wits to entertain, and her husband who expected something
different soon finds that to him matrimony has brought only
responsibilities and expenses. Her faculties vegetate, her brain
gets fatty, her figure sprawls, her whole being stagnates.
Now let some predatory widow appear on the scene,
and throw her grapples at the husband. The wife's nature
awakes. She realizes that having caught her man it is up to
her to keep him. Her ownership is challenged, and she trusts
no other to abide by the rules of the game. Back she goes to
her cabinet of feminine weapons and feverishly marshals
her forces for defense. She may decant volubly upon her
shattered confidence and ask sympathy for her broken heart,
but in truth the incursion has done her good and restored a
vital interest to her life.
Men become engrossed in the battle of life, in the struggle
to provide for their families. The wife though ever ready to
avail herself of the fruits of the man's labors, fails to realize
that the winning takes his time and energies, so that he has
little time to spare to her, personally. She likes the luxuries
but she asks for his time also. Lacking his companionship
she tends instinctively to fall in with the groups of feminine


Are Women Polygamists?
323
adorers found around every man who for any reason becomes
prominent. Minister, doctor, actor, author, musician, artist,
bruiser, athlete, burglar, murderer, every man who becomes
distinguished above his fellows is sure to be surrounded by a coterie
of devoted women, who repeat with him the picture of the
harem. Not that they so much as dream of sexual dereliction
—oh, dear, no! They simply seek to win his intimate favor,
and 'beat the other women to it.'
In the days of polygamy among the Mormons, the wealthy
and influential dignitaries of that church were besieged by women
who wished to marry them. While the Mormon women to-
day, when asked if they believe that religion, reply that they
do, but add emphatically, "but not to the extent of sharing
my husband with other women;" this is largely in deference
to the sentiment of the 'Gentile' women, whose contempt no
Mormon woman cares to endure. In truth, every prominent man
among them found plenty of women to whom the allure
of wifehood with a notable, overcame their objection to sharing
the man with other wives. Brigham Young was so pestered
with such proposals that he was accustomed to quote to ap-
plicants for his name that passage from the Prophets which
says that 'in those days seven women shall lay hold of one man,'
and offer to care for their own expenses if he gave them the honor
of wifehood. Many of the 'wives' popularly credited to him
were probably such in this sense alone, enjoying the honors
of union with the head of the church without assuming any
wifely duties.
Few years pass without seeing the rise of some new religio-
social sect, each consisting of a man surrounded by a group
of women. Whether the inter-relations are those of the harem
no outsider may say; but the common belief is that this is the
case. One leader of such a sect has quite recently been con-
victed of contributing to the delinquency of one of his female
satellites. Such men never fail to secure a surrounding of
devoted women, among whom there is an evident rivalry
for the favor of the man.
The strongest evidence of women's tendency to polyg-
amy is their own universal and unquestioning belief in it.


324
William Francis Waugh.
To them every man is a polygamist, and every woman is after
him. Let any man be in privacy with any woman, and all
other women at once assume that the couple are indulging
sexually.
Suggest to many a wife that her husband is unfaithful
to her, and she does not merely believe it—she knows it.
Demonstrate to her mathematically that it is not and can
not be true, and she is not convinced. Prove to her that
at the time of the alleged infidelity her huband was in another
place, surrounded by numberless witnesses, and that the ac-
cused woman was dead and buried, and she merely concludes
that if they had been together at the time they would have
been guilty, and brushes aside the testimony as irrelevant.
To convince her is impossible, for to her all men are polygamists,
all women ever on the lookout to ensnare them. Realizing
this, we may comprehend why in society there is no man
so attractive to the majority of women as the one who has
the reputation of a roue.
With men it is different. The sexual sphere, the re-
productive function, is not so all-important as with women.
When Byron said:-
Man's love is of man's life a thing apart;
'Tis woman's whole existence,
he gave utterance to a fundamental physiologico-psycholog-
ic fact. The duty of providing for the family dominates
man—woman, fed, clothed, sheltered, protected, her wants
and wishes considered and provided for, occupies herself
and satisfies her nature with her children. She remains a
child while the husband assumes the place of the father. The
struggle for social preeminence may use up the children's
place in her affections, and social success depends on the amount
of money that can be extracted from the husband. His rela-
tive value among men is thus fixed. His energies are absorbed
by the effort to meet the demand. He has none left for sex
affairs. He gives no thought to women as such. Seductions
are usually due to the call made—wholly unconsciously—
by the woman for the service of the male; and this is deeper
than sentiment, than instinct even, for its foundation is in
the provisions of nature for the perpetuation of the species,


Are Women Polygamists?
325
the continuance of life. Men may declare truthfully that
they did not so much as think of sex matters, much less design
a seduction, and they cannot account for it. Women will
say the same, no less truthfully, and are amazed to find their
resistance paralyzed. Dame Nature holds the key to the riddle.
As men advance in years the sexual instinct declines,
while that of providing increases. Questioning a man of
fifty as to his sexual capacity, he replied that it had been ten
years since he had given that matter a thought. This is the
rule with men; but no woman may ever realize it. For even
when she does not expect or desire to be loved, she resents
the suggestion that her sex has no longer any attraction for
any man. To her every man must be some woman's lover,
so long as he lives.
Even when polygamous tendencies appear in men, they
are not often due to crass sexuality. Man goes forth in search
of his mate. Many times, perhaps, he thinks he has found
her, but time shows his mistake. When he does, the words
of Holy Writ are fulfilled—he forsakes all others to cleave only
to her. Note that this assumes the fact of previous connections
with women. To what extent this is in accord with fact,
let each individual say for himself; it is one of those personal
secrets no human being shares with any other, nor does he seek
to pry into another's similar case.
The man who has really found his mate knows the truth.
To him there is henceforth but the one woman on earth. All
others are shut out of his life as utterly as if they were non-
existent. The suggestion of commerce with any other is more
repugnant to him than even to his mate; for the intimacy
of their union is such that a secret between them would destroy
their happiness. There is in the union with one's mate that
which he reverences—something too sacred for profanation.
The sense of priesthood inbues him. He has found his mate,
and they twain have become one flesh. They are not merely
husband and wife, but stand as the progenitors of a race, for
whose qualitites, good and bad, they will be responsible. It
is up to them to uproot from their lives and their being every
element that they do not wish to reappear, and to cause to
grow and develop every good quality they may desire to trans-


326
William Francis Waugh.
mit. The peasant of Oberammergau endeavors to live in the
character he represents, and thus becomes imbued with it.
From mated pairs thus imbued with a sense of their responsi-
bility come the world savers.
To say of a right souled man "he loves his mate" is putting
it poorly. In his eyes she is a being more than human, standing
above man and close to the angels. To love her, protect her,
provide for her, study her needs and develop the best that is
in her, is his reason for continued existence. Life with her is
not simply a foretaste of heaven, it is heaven itself so far as
any mortal is capable of a conception of a heaven.
Admit the possibility of attaining such felicity, and we
have an adequate explanation of the way men have of search-
ing among women to find the one. Yet she is not hard to find.
The world is full of sweet, gracious women, who only need the
sun of love to warm them into fragrant life of exquisite beauty.
Dear old John Darby used to say that any man could have
an angel for wife if he willed it. He must tell her at every
opportunity that she was an angel, until she came to believe
it, and to act angelically. Meanwhile he also learned to believe
his oft-reiterated assertion.
Try it—the results are satisfactory.


STUDIES IN NEUROLOGICAL TECHNIQUE, NO. I;
THE POINTS IN JENDRASSIK'S METHOD OF
ELICITING THE PATELLA REFLEX.*
By Walter B. Swift, M. D.,
Assistant to Physicians for Nervous Diseases, Boston City
Hospital. In Charge Voice Clinic, Psychopathic
Hospital. Formerly Assistant to Prof. Oppen-
heim, Berlin.
DURING my sojourn in Europe I had at one time
interest to visit those nerve specialists who had
brought forward some new test, some new symptom, or
some new method of eliciting tests, for the purpose of
studying their technique at first hand. In almost every
case these visits resulted in adding to my former knowl-
edge, points that had not been maintained in trying tests
previously. Since my return I have had a number of
these under investigation for the purpose of trying out
their claims, and improving my own technique in exam-
ination. Several of these investigations have proved of
value and one of them is now worthy of a preliminary
note. This one is Jendrassik's hand grasp. Others will
be reported, when the investigations are completed.
Our method of reinforcement has been to request the
patient to interlock the hands, look up at the ceiling,
grasp tightly when three is said, and at that time tap
the patella tendon. Jendrassik's method differs. He
requires the patient to bend forward and look downward,
whereas the rest of the technique remains as above. He
•Read May 15, 1913, before the Boston Society of Neurology and Psychiatry.
(327)


328
Walter B. Swift
claims that closing the eyes is useless and that looking
upward is useless, while bending forward has a special
value. This method of knee jerk reinforcement I have
tried as far as possible on all the cases where the other
method did not elicit the knee jerk, for the last two years
in the Outpatient Department in the Boston City Hospi-
tal. For the liberty to carry on this investigation my
thanks and appreciation are due to Dr. Knapp, Dr.
Thomas and Dr. Fairbanks, my seniors on the service.
I have found two valuable points result from the use of
Jendrassik's method.
(1) General Increased Ease of the Knee Jerk
Elicitation.
I found that in general by bending the body forward
the knee jerk is much easier elicited. This finding of
course is not of any great value, and yet shows that the
knee jerks already present come out with more ease than
when the other procedure is followed. A large number of
cases show this to be true.
But the bearing of this presence of an easier elicita-
tion has a confirmatory influence upon the other point
which I am about to present. Suffice it, then, so far as
this point is concerned, that evidence is here found to
make the knee jerk elicitation easier—thus facilitating our
neurological examination.
(2) Elicitation of Otherwise Absent Knee Jerks.
I found several cases where the knee jerk was by
several men in the clinic, as well as myself, pronounced
absent with our usual technique, and afterwards with
Jendrassik's method, I found the phenomenon was at
once elicited. It is unnecessary to tax the readers by
presenting the cases in detail. The diagnosis is enough
to illustrate. Let me mention three.
1. Tabes dorsalis.
2. Post-diphtheritic weakness. It may be interesting
here to note that in this case the diagnosis of post-
diptheretic paralysis was made on the basis of the old
method of eliciting the knee jerk, and upon employing


Studies in Neurological Technique
329
Jendrassik's method that diagnosis could no longer be
substantiated.
3. Multiple neuritis.
The second point of value is that Jendrassik's method
elicits the knee jerk when the other method fails. These
three cases may not prove much, but they surely show
when combined with the first point mentioned above,
that his method allows a freer play to the patella tendon
phenomena.
Just the cause of this increase of reaction in one
method over another might take considerable time to de-
termine. We should seek in this test muscle relaxation,
and I think the reason for this finding lies simply in that
direction. If a patient closes the eyes and looks up, or
looks up without closing the eyes, there is more contrac-
tion in leg muscles than there is if the patient bends
forward and looks downward. Then, too, as Jendrassik
told me, when he showed me how he made his test, it
is not a matter of diverting the mental attention, but a
matter of diverting muscular tension.
Summary: Our usual technique proven inferior to
Jendrassik's own method of eliciting the knee jerk.
Conclusions.
(1) About 100 trials show Jendrassik's method elicits
the knee jerk easier than our method in normal cases.
(2) Our usual technique proven inferior in patho-
logical cases to Jendrassik's own method.
The difference in method is a new body position that
secures greater muscle relaxation.
110 Bay State Rd., Boston.


SELECTIONS.
CLINICAL PSYCHIATRY.
Pertinent Questions Concerning Prompt Seques-
tration of Precursory Insane, suggested by Dr. B. D.
Evans.—"It is now in order, says Dr. Evans in his report,
to set forth some of the important reasons why it was
deemed wise to place persons exhibiting evidences of
mental disorder under restraint to await judicial action
when medical authorities recognized by Statute declare
under oath they are persons unfit and unsafe to be at
large because of mental disease; but to make a propo-
sition of this sort clear, it is necessary to take up many
phases which are too easily overlooked and which at the
same time are of vital importance.
For the purpose of this discussion and in order to
set forth these important reasons which seem to me to
be valid and entitled to respect, permit me to assume a
number of every day occurrences, incidents, conditions
and complications such as arise out of persons becoming
mentally deranged and which would seem to call for
prompt action such as is provided for under our present
law governing the commitment of persons to institutions
for the insane in New Jersey:
(1) A man becomes delusional and excited, attacks
his neighbors, members of his family, and shows great
mental confusion and homicidal tendencies; his family
knows it is the result of a toxic condition following
typhoid or some other acute bodily disease; his family
cannot control him, but he needs skillful medical atten-
(330)


Selections.
331
tion. He is dangerous, but it is because of disease.
What shall be done with him—put him in the police
station, or the county jail or a hospital for the insane?
Think it over and determine which is most in accord
with science, humanitarian principles and the welfare of
the man so affected.
(2) A woman, following childbirth, becomes delir-
ious, delusional and maniacal. Her condition is clearly
one for skillful medical attention—a few hours delay
under such conditions may cost her life—her family can-
not control, manage or care for her. What shall be done—
serve a ten days' notice on her and give her a jury trial?
God knows that might meet some technical demands of
a constitutional character, but it would neither be mer-
ciful nor scientific. No one could better give testimony
in such cases than an undertaker, and the Courts would not
know of the constitutional funeral. Think of a police
station or a jail for a case of puerperal insanity! Law
should be, and from a basic standpoint is, pure common
sense. Think of delay under such conditions and ask
yourself and the friends and relatives of the victim the
verdict.
(3) A person is in the early stages of paresis; he
is more or less coherent, but has expansive ideas; talks
of extravagant schemes, is irritable and ugly in his man-
ners to his family; will not tolerate advice; begins enter-
ing into contracts calculated to squander his estate and
leave his family paupers. His family physician recog-
nizes his condition as being one of serious mental disor-
der and incurable. What is the logical process? Start
up a court procedure and give the paretic opportunity
to expend in litigation what his family needs or place
him in a hospital subject to Court inquiry? People
who know these cases and have seen or had them come
home to them can answer this.
(4) A paranoiac with well defined delusions of per-
secution contends that members of his family are trying
to rob him of his social position and his property. He
threatens revenge and prepares himself with weapons.


332
Selections.
His family realize their danger and at the same time
know from a family history and the train of symptoms
he has exhibited that his conduct is the result of disease
and that he needs treatment which he will not submit
to and is not possible at home. The family physician
and other well qualified physicians recognize the mental
condition. What shall be done to protect all concerned?
Shall such a dangerous person be served with a notice
that proceedings will 10 days later be instituted to de-
clare him insane and so give him opportunity to murder
the whole family or those members upon whom his
delusions are especially focused? Is the jail the place
for him pending a Court decision as to the justice of
his being placed in an institution of safety? Shall his
family suffer all that is imposed by criminal charges,
when they know he is sick and the things he does and
threatens to do are but the outcome of disease and not
such as should visit upon them all that is entailed by
arrest and detention in a jail or penitentiary? Would
it seem that our fathers of the constitution contemplated
anything of the kind?
(5) A woman suddenly exhibits a desire to commit
suicide and attempts it. Her family calls in one or two
physicians and after careful investigation into all the
symptoms of the patient and a careful inquiry into her
mental state, as well as the facilities for protecting her
life at home, it is found she must be placed where she
may be restrained of her liberty, carefully watched and
prefessionally treated. Should she be sent to jail, or
served with notice that proceedings will be instituted
to have her declared insane and a fit subject for some
hospital? The fact is that it is extremely difficult to
prevent such persons suiciding even in well equipped
hospitals. Why should hospital treatment be delayed
in such cases? There may be judicial reasons, but it
puzzles a medical man of experience to understand them.
Delay of placing such persons as above described under
institutional treatment furnishes daily newspapers many
columns of what to some readers is looked upon as inter-


Selections.
333
esting though sensational. That sort of law which easily
permits these acts may be constitutional, but it has its
sad phases which by analysis hardly appeal to those
who have already or may hereafter drink of such a bitter
cup of experience, such as no law should provide." These
are pertinent propositions.
NEUROTHERAPY.
A Case of Acute Psychosis After the Chronic Use
of Veronal. [Ein Fall von Akuter Psychose nach chronischem
Veronalgebrauch]. (Allgem. Zeitschr. f. Psych,, vol. Ixix,
No. 4.) Laehr, H.
Hamilton Marr has the following instructive excerpt
among other valuable and suggestive excerpts by other
collaborators in that excellent magazine, The Journal of
Mental Science.
After six and a half years' use of veronal, the resulting
acute insanity had much similarity to alcoholic delirium,
and in its final stages to the hallucinatory insanity of drink-
ers. In literature no similar case is found, probably on
account of the rarity of such a prolonged use of veronal.
Case.—Woman, set 53. Family history unimportant
save that patient's mother in her last years was addicted
to morphia; the cause of her death is unknown. In child-
hood the patient was apparently lively and impressionable.
She took to veronal six months after the menopause, on
account of sleeplessness which supervened on domestic troub-
les. For six and a half years, with the exception of one
month, she took from 0.5 to 1.5 grm. (about 8 to 24 gr.)
every evening (the amount gradually increasing) of veronal
or medinal (veronal circulates in the blood as medinal).
She was admitted to the asylum on April 3rd, 1912. From
that time, or certainly from April 6th, until she was discharged
recovered on June 3rd, she had no veronal. She suffered
from sleeplessness, showed mental confusion, incomplete
disorientation as to time and place, and had hall-


334
Selections.
urinations of sight and hearing. Physically she suffered
from vaso-motor disturbances, as shown in increased rate
of pulse and flushing of the face; muscular tremors and
rheumatic pains in the limbs, twitchings of the face and
variability of reflexes. The physical symptoms undoubtedly
point to veronal as the cause. The effects of veronal
differ from those of alcohol in that, as shown in this case,
there were no disturbances of the digestive system such as
are found in chronic alcoholics. The heart condition was
also good, and only showed the irregularities above-mentioned
after the crisis was passed. The mental state was distin-
guished by systematized dream-like delusions of an appre-
hensive nature, connected with hallucinations of hearing.
In these the patient was the onlooker, and not she, but her
son, was the object of persecution. In this respect the de-
lusions differed from those of alcoholic delirium.
Treatment of Insanity—"Ozofluin" Baths in Ner-
vous Disorders.
Ozofluin is an extract made from pine leaves; it is a
granular substance readily soluble in water. The writer
finds that baths containing this preparation are of con-
siderable benefit is cases of hysteria, depression and neuras-
thenia. The appetite improves, headache is relieved and
sleeplessness overcome; in addition it has no doubt a sugges-
tive influence. Three illustrative cases are briefly described.
[Ozofluinbader bei .Nervenkrankheiten.j (Psychiat-Neurol.
Wochensch., Oct. 5th, 1912.) Dammann.
—Excerpt by H. Devine, in Journal of Mental Science.
Indican SurERSTiTioNS, by A. W. Peters. The Jour-
nal Nervous and Mental Diseases selects the following
from Training School, Feb., 1913.
In an interesting bio-chemical review devoted to
indicanuria, the author shows that most of the present
methods of testing for indican are faulty, and that the
interpretations are fallacious. All urines contain indican.
To interpret an excess of indican as pathological, apart
from a knowledge of the exercise done, physical and


Selections.
335
mental, and particularly of the diet, is an absurdity.
Baa, in his recent important monograph on indicanuria,
has stated that the indican test of intestinal intoxication
is a superstition. The lacto-bacillin, milk cereal diet,
etc., etc., chiefly of Metschkinoff's suggestions have no
effect upon the production or excretion of indican.
Auto intoxication from the intestines is another medical
myth, invented to hide the ignorance of man in the face
of the mysterious.
Dr. Simon Flexner announces from the Rockefeller
Institute for Medical Research, 66th Street and Avenue
A., New York, to Dr. Baines of Toronto and others that the
institute has been engaged for some time in the study of the
treatment of influenzal meningitis with a specific anti-
fluenzal serum. The effects of the serum treatment in
experimental influenzal meningitis are very satisfactory
and the institute is now prepared to supply the serum made
in the horse, in moderate quantities, to a selected number
of physicians for use in human cases. The method of appli-
cation is similar to that which is employed in the treatment
of epidemic meningitis with the antimeningitis serum—
that is, the anti-influenzal serum is injected subdurally in
lumbar puncture.
The Phylacogen Treatment for Rheumatic In-
fections.—Since the announcement, some time ago, of
the large percentage of recoveries following the use of Rheu-
matism Phylacogen in over thirteen hundred cases of rheu-
matism—results reported by clinicians in various sections
of the United States—interest in this new bacterial deriva-
tive has developed to a very marked degree. This agent
appears to produce recoveries in at least 85 per cent. of cases.
Other phases of the Phylacogen therapy—as questions
of dosage, reactions, methods of administration, etc. are
fully treated in the Phylacogen literature, issued by Parke,
Davis & Co. and procurable by any physician upon request
to the home offices at Detroit, Michigan.


336
Selections.
Alcohol Injection Into the Gasserian Ganglion.—
J. Grinker states that the greatest advance in trifacial neu-
ralgia was made when Schlosser, a Munich ophthalmologist,
announced his method of injecting alcohol into the branches
of the trigeminus at their exit from the skull. With the
comparatively easy technique discovered by Levy and
Badouin this has become a distinct addition to the phy-
sician's therapeutic armamentarium. In some cases, how-
ever, this fails and a less peripheral operation is demanded.
Gasserectomy is a serious operation and necessarily one
of last resort. As alcohol had shown its efficacy in the per-
ipheral injection, it has been sought to introduce it into the
ganglion itself to avoid the more dangerous method of ex-
tirpation. To F. Hartel of Biers clinic belongs the credit
of having worked out such a method. The author has had
the opportunity of observing Hartel's technique and has
employed it once in his own practice in a case which he re-
ports. Hugh T. Patrick in 1910 reported a number of
satisfactory results with this therapeutic procedure.—Ed.
CLINICAL NEUROLOGY.
The Spread of Infection by the Ascending Lymph
Stream of Nerve (ascending Neuritis) from the Peri-
pheral Inflammatory Foci to the Central Nervous System,
with Clinical Cases.
In this latest series experimental evidence is adduced as
to the manner of development of acute myelitis, and its
results are calculated to throw light on the pathogenesis
of acute poliomyelitis and analogous conditions. It has
been shown previously that toxins and organisms can travel
by the lymph streams of peripheral nerves into the central
nervous system, utilising for the purpose the method of
placing in contact with the sciatic nerve a celloidin capsule
containing an organism. While we are able to prove that
degeneration of the myelin sheaths of fibres in their intra-
medullary course might thus be produced, we did not find
any unequivocal evidence of actual myelitis. In the pres-


Selections.
337
ent series of experiments the capsule containing the organ-
ism was placed much nearer the spinal cord. The latter
was exposed at the level of the lumbo-sacral enlargement,
and a capsule containing Staphylococcus pyogenes aureus
was sutured against the dura mater; in some other experiment.
it was placed close against an intervertebral foramens
All the experiments gave positive results, although in some
instances the charges were more acute than in others,
owing to the capsule having burst, and the organisms having
actually invaded the nervous system. Speaking gener-
ally, it was found that the nervous and meningeal tissues
nearest to the focus of irritation suffered most, and the
phenomena became less marked from without inwards,
the minimum being found near the central canal of the
cord. In the epidural tissue polymorphonuclear leucocytes
were present in abundance, with plasma-cells, and others
like those which have been designated polyblasts by Wick-
man. In the dura mater and capsule of the posterior root
ganglion, in the substance of the ganglion, especially at
its proximal pole, in the perineurum of the spinal roots,
in the adventitial sheath of the vessels in these roots, in
the pia mater and far along the vessels passing into the
spinal cord, were plasma-cells in quantity; round many
of the vessels neuroglia cells were proliferated. It is impor-
tant to note that the cellular infiltration concerned the veins
only; the arterioles were unaffected, a condition readily
explicable on the view that the lymph regains the general
circulation through the walls of the veins and capillaries,
and as in this instance it contained toxins it produced
irritative effects. Incidentally, it was shown that the dura
mater, with its covering of highly vascular loose areolar
tissue, forms a most efficient protection to the spinal cord,
and to a great extent serves to neutralise infection. Only
rarely were actual organisms found to have passed the
barrier of the dura mater. Notwithstanding the absence
or comparative absence, of organisms, throughout both
the grey and the white matter of the cord the vessels exhib-
ited marked pathological changes, being dilated, infiltrated
with round cells, sometimes thrombosed, sometimes the


338
Selections.
seat of haemorrhages, and not merely the walls of the spinal
vessels, but also the neuroglia of the cord, showed obvious
signs of pathological irritation. Degenerative changes of
an acute type also occurred in the nerve-cells of the grey
matter. It would appear that the evidence adduced by
Wickman and others is incontrovertible, in so far as it
proves that poliomyelitis is essentially a disseminated
meningo-myelitis or rather meningo-myelo-encephalitis.
In that condition the inter-vertebral ganglia are affected
in the same way as the cord, while the peripheral nerves are
normal. This is an important point. It will be remem-
bered that the sympathetic nerves join the mixed nerve
near the distal end of the root ganglion, and the suggestion
is made that the exciting agent of poliomyelitis reaches
the central nervous system from the intestine by the sym-
pathetic nerves entering at that point. In this way the
integrity of the peripheral nerves can be explained. The
resemblance between the experimental phenomena pro-
duced by us and the pathological phenomena found in
acute poliomyelitis is exceedingly close, and there is little
reason to doubt that poliomyelitis is essentially a lympho-
genous infection. The principles enunciated may also be
applied to general paralysis, trypanosomiasis, Landry's paral-
ysis and rabies. In all our experiments, without exception,
we have found a large collection of plasma-cells and poly-
blasts at the proximal end of the posterior root ganglion,
and the appearances are suggestive of a special reaction
at that spot. We are inclined to think that this indicates
some mechanism of defence against the further upward
extension of toxins amd organisms, constituted possibly
by some local anatomical peculiarity.—Abstract of Paper Read
at the May 27th, 1913, Meeting of the Medico-Psychological
Association of Great Britain and Ireland, by Drs. David
Orr and R. G. Rows.
The Pioneer Victor Horsley and London Tem-
perance Hospital—When the London Temperance Hospi-
tal was opened forty years ago it was three days before it
had a single patient, owing to the prevailing prejudice as


Selections.
339
to the risks in a non-alcoholic dietary. Last year it had
27,748 out-patients, representing 214 visits each working
day, and 1,529 in-patients.
Sir T. Vezey Strong, at the annual meeting in the absence
of Lord Averstone, president, said progress had been con-
tinuous and satisfactory. Alluding to the falling off in the
death-rate, from 9.5 to 7.6, he warmly traversed the criti-
cism that they never dealt with really serious cases. "Our
wards are open to all needy cases," he said, "and if we
differentiate at all it is to give preference to the most serious
cases." Alluding to the distinctive characteristic of the
hospital—the treatment of all diseases without recourse to
alcohol either as diet or medicine—he said that of the 1,529
cases alcohol was only administered in three, and he regretted
to add that all those three proved fatal.
In their whole history alcohol had only been used in
95 out of 36,000 cases. A falling off of nearly 3,000 in the
number of outdoor patients was attributed to the effect of
the Insurance Act.
Sir Victor Horsley said the Temperance Hospital had
been a pioneer in medical science. The old routine was
represented by three D's—diet, drugs, and drink, and it
was long before the profession as a whole followed the lead
of that hospital in getting rid of the last item. Sir Vict
corrected the common notion that it was impossible to pre-
pare certain tinctures and medicines without alcohol.—
Abstracted from "Alliance News."
NEURODIAGNOSIS.
The Dowd Phosphatic Index in Relation to Dis-
ease of the Eye.—Clemasha, J. C, Buffalo (New York
Medical Journal), supports the old-fashioned but obviously
true idea that asthenopia, or eye strain, is sometimes due
to a lack of nerve energy, rather than always to an imbal-
ance of the ocular muscles which, by the way, may be
symptomatic at times. His idea is to "consider the meta-
bolism of the nervous system with certain attempts to


340
Selections.
measure and regulate nervous energy produced and exerted
at various times and under varying conditions by the human
organism." His conclusions are: The phosphatic index
measures the amount of nervous energy present in the
organism. A high index will not be a condition of irritation
or a want of adjustment of the nerve cells. A low index
shows a lack of nutrition of the nervous organism, a using
up of the reserve, and a condition below par. A high index calls
for nerve sedatives, valerian or bromide of gold and arsenic.
A low index calls for food, eggs, etc. and the administration
of phosphorus and strychnine.
The urine should be that passed about 10 a. m., the
second in the morning. The crystals should be examined
for size and quality. In any functional disorder or one
accompanied by organic lesions, the phosphatic index is
of the greatest value as a guide to treatment. In all cases
look to assimilation and correct any intestinal putrefac-
tion shown by an excess of indican. Excerpt by Archibald
C. Lewis, Memphis Medical Monthly.
Here is a broad ophthalmologist whose conception of
conditions extends beyond the eyefield of work and vision
in? sight disorders.
EOSINOPHILES IN URINE IN BRONCHIAL ASTHMA
Edelmann and Karpel report their study of the urine of four
patients suffering with bronchial asthma. In all of the
patients there was noticed a slight cloudiness of the urine
following the attacks of asthma, so that a cystitis was
suspected at first, though there were no symptoms to sug-
gest such a condition.
The fresh specimen of sediment showed many leuco-
cytes. Stained preparations revealed an eosinophilia of
as much as 30 per cent. Careful examination showed
that the eosinophles were always abundant in the urine
following the asthmatic paroxysm. In none of the patients
were there symptoms referable to the genito-urinary tract,
and no epithelial cells or bacteria were found in the urine.
There was no gonorrheal infection. The urinary changes
consisted in the appearance of the leucocytes alone;


Selections.
341
no other formed elements, such as casts or red blood-cells
were found. The number of leucocytes resembled that
seen in cystitis.
There was no albuminuria. The cells make their
appearance in the urine, as stated above, just after the
paroxysm; during the dyspneic period the urine is clear or
contains only an occasional leucocyte. The cells persist
in the urine from a few hours to two days. Differential
count of the cells of the urinary sediment showed 30 per
cent. of eosinophiles in a patient whose blood contained
only 8.5 per cent. of these cells. The authors describe
their methods of staining the cells of the sediment. Excerpt
by Bryce W. Fountaine in Memph. Med. Month.
Osler's Sign—The sign under consideration, presented
by Sir William Osier, is described by P. Parks Weber in
The Quarterly Journal of Medicine, April, 1913. It consists
of circumscribed, painful, erythematous swellings appearing
in the skin and subcutaneous tissues, especially of the hands
and feet.
They are tender to pressure and gradually disappear in
a week, more or less. Each spot or lump is ascribed to a
localized inflammatory exudation round a blood capillary
which has become plugged by a minute infective embolus
from a vegetation in the heart. As a rule the infective agent
does not excite suppuration, probably due to the low viru-
lence of the infection or the resistance of the blood and tissues.
These Osier's spots vary in size from a pin's head to a
small pea, with different grades of color depending upon the
intensity of the inflammatory process and depth of focus below
the skin. The smaller spots are generally seen on the fingers
and toes and arise when the inflammation is superficial.
The larger and less highly colored lumps are more deeply
seated, often appearing in the palm of the hand, and last
longer than the smaller ones.
These symptoms are to be distinguished from the ordi-
nary purpuric eruptions often seen in malignant endocarditis,
which also appear in various other diseases. Other symptoms
like albuminuria and hematuria may aid the diagnosis but


342
Selections.
Osier's spots when present are of invaluable diagnostic im-
portance. While they may appear in other diseases, thus far
the writer claims that they have been observed only in
malignant endocarditis, although he mentions its occurrence
likewise in malignant endarteritis of the aorta and pul-
monary artery, which are doubtless of the same infective
nature as the endocarditis.—Abstracted by C. A. S. North-
west Jour. Med.
PSYCHIATRY.
Plato and Freud on the Etiology and Treatment
of Hysteria: a Comparison and Critical Study. J. W.
Courtney.
J. W. Courtney states that the essential features of
Plato's and of Freud's theories are identical. Plato regarded
the uterus as an animal which desires ardently to engender
children. When it remains sterile for a long time after
puberty, it endures this state with difficulty; it grows angry,
rushes here and there through the body, causing either a
globulus hystericus, a syncopal attack, or some other of the
well-known hysterical manifestations. There are mental
and emotional attributes ascribed by Plato to the uterus,
and considered by him as the vis a tergo, which impel it
upon its course. These attributes consist, on the one hand, of
intense strivings, desires, and impulses on the part of the uterus
to get itself fecundated and, on the other hand, of anger and
other violent emotions aroused by delay or failure in the
accomplishment of its designs. Freud simply shifts the
above-mentioned attributes to their real sphere—the mind—
and assumes an unconscious but stormy conflict among
them as the cause of the outbreak of hysterical symptoms.
To paraphrase the language of the Freudian pathology,
there is waged in the mind of the victim of hysteria a con-
flict between two groups of ideas or mental processes which
cannot be brought into harmony with each other. One
complex of mental processes is, for some reason or other,
of such a kind as to be inacceptable to the main body of the


Selections.
343
personality. The personality fails to assimilate it, will
have nothing to do with it, tries to forget it, to submerge
to repress it. The repress complex then takes on an
automatic existence and acts as an irritating foreign body
in the same way as any foreign body that has not been
absorbed. Modern pathology is in itself a sufficient refu-
tation of the etiological portion of Plato's theory. A very
little close reasoning should serve to dispose of Freud's.
The author's first objection to it is that it is absolutely
arbitrary, in that it takes into account one element only
of the many which compose that very complex product
called personality. His second objection is that it is entirely
illogical. It looks upon the symptoms of hysteria as volun-
tary on the part of the sufferer, i. e. a sort of compromise
between unconscious sexual desire, longing and striving,
and the repressive activities of a likewise unconscious
mind. Hence, it asks us to believe that a voluntary act
may at the same time be an unconscious one—in other
words, that the will can operate without the conscious
mind being aware of its operations. There are numerous
other objections to the theory. One of these is to the
effect that it locates the patient's trouble entirely within
the realm of ideation and emotion absolutely without regard
for the fact that the way human beings feel, talk, and act
is but a reflection of organic sensation. In other words, it
deals with the language, actions, and emotions of the psycho-
neurotic quota of humanity as a pure abstraction, without
regard for their organic source.
From Boston Med. and Surg. Jour.
NEUROPHYSIOLOGY.
The Mechanism of Protein Assimilation.—Inas-
much as recent studies by Folin and his associates
and also by Van Slyke and Meyer have made it appear
likely that the problem of protein assimilation is in reality
a question of how the digestion fragments, the amino-acids,
are disposed of in the organism, it becomes of great interest


344
Selections.
to trace them from the alimentary canal through the blood-
stream to the tissues to ascertain their final fate. Van
Slyke and Meyer have found that amino-acids introduced
into the circulation quickly disappear. The suggestion is
obvious that either they are destroyed or removed with
great rapidity by the tissues. The more recent work of
the New York investigators makes it evident that a con-
centration in the tissues occurs. The muscles, liver, kidney,
spleen and pancreas, for example, soon contain about ten
times as much amino-acid nitrogen as is found in the blood
per unit of mass. The amount of amino-acid thus taken
up out of the blood by different tissues varies, that taken
by the brain being especially small. The means by which
these products of digestion are held in the tissues appear to
be physical rather than chemical; indeed, the facts thus
far known are consistent with the assumption that the
amino-acids are taken up from the blood and held in the
tissues by absorption, chemical transformation of the
absorbed compounds following later. The amino-acids
thus retained disappear from the kidneys at a rate incom-
parably greater than that at which they leave the muscles
or other organs. Their disappearance from the liver and
kidneys is accompanied by an increase in the urea content
of the blood. Van Slyke believes that while the muscles
are stored with amino-acids up to their saturation-point
after heavy protein feeding, the liver and kidneys meta-
bolize their portion of the products as rapidly as they receive
them; so that perhaps the entire task of removing the
digestion products from the blood-stream when the other
tissues become saturated devolves on these two sets of
organs. To this may be added the hypothesis that most
of the proteolytic products which the liver and kidneys
take up are normally broken down, the nitrogenous portion
appearing as urea.
Van Slyke, D. D., and Meyer, G. M.: Distribution of
Amino-Acids in the body, Proc. Soc. Exper. Biol, and Med.,
1912, x, 38, Van Slyke, D. D.: Protein Assimilation, ab-
str., The Journal A. M. A., April 12, 1913, p. 1183.


Selections.
345
NEUROPATHOLOGY.
New Nerve Cell Growth—A. Meyer of Baltimore in
April number American Journal of Insanity has found in the
changed state of the hypophysis in acromegaly unmistakably
nerve cells with Nissl bodies.
Dr. John Gray of Utica many years ago in this same
Journal claimed to have found the reproduction of nerve
elements in the brain, but not much notice was taken by the
American Medical press at the time and the possibility of
such formation was denied abroad at the time.


THfc
ALIENIST AND NEUROLOGIST.
Vol. XXXIV. St. Louis, August, 1913. No. 3.
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of the month of issue will please notify us promptly.
Entered at the Boat-office in St. Louis as second-class mail matter.
All remittances should be made to Chab. H. Huohes.
The Alienitt and Neurologist is always glad to receive articles or photographs
from subscribers or friends and material acceptable for publication. Address
manuscripts and photographs to the Alienitt and Neurologist For return of
non-accepted manuscript send addressed envelope and sufficient postage.
Any Comment, favorable or unfavorable, specifically Bet forth, Is always wel-
come from friend or enemy or any "mouth of wisest censure."
CHAS. H. HUGHES, M. D.. Editor and Publisher.
Editorial and Business Offices, 3858 W. Pine Boul.
Hughes Peintino Co., Printers and Binders
EDITORIAL.
\4U Unsigned Editorial! are written by the Editor. ]
The Old Thompsonian and His Alarming Symptoms.
—Old Samuel Thompson, who had a rather exaggerated con-
ception of autotoxicosis in connection with disease before
he or the medical world had described it in terms chemico-
biological, just as our earlier fathers in medicine knew of the
existence of peccant humors in the body in disease, which
had to be eliminated by emetics, purgatives and sudorifics,
etc., patented his system of Thompsonianism which con-
sisted largely of an excessive lobelia vomit, a violent purge
and a long continued exhausting steaming sweat under
blankets in the upright position over a boiling fire-heated pot.
(346)


Editorial.
347
He was called the steam doctor and contended that the
right way to cure disease was to steam or sweat, vomit or
purge it out of the system. He brought on serious de-
pression, sometimes convulsions, by his methods and con-
tended with the confident assurance of that most dangerous
thing, a little knowledge, that if the patient survived the
alarming symptoms following his heroic therapy, he would
get well.
Some medical men with no more regard for the psychia-
try of the situation are too prone to tell patients who mis-
takenly take irritant poisons, for instance, like bichloride
of mercury, that their life duration is limited and proceed
to divert disastrous elimination from the kidneys by means
of excessive and too prolonged and exhausting diaphoresis
with constant hot blanket wrappings, causing both physical
and psychical depression.
The principle of diverting diaphoresis is good, but the
practice of extremely excessive sweating is bad. Intention
may be good in this form of therapeutics but the execution
can be wrong in practice, according to the judgment and
experience, which we call skill, of the practitioner, or lack
thereof.
No one can tell, with certainty, ordinarily, how soon a
poison may kill or if it may certainly kill at all, unless it be
hydrocyanic acid poison, which is about the surest and quick-
est of all poisons, without knowing much more than the
physician generally learns about a case he may be suddenly
called to, as he is often summoned, or reaches the patient
too late and when all of the family or friends are too con-
fused and confounded about the case to give intelligent his-
tory of the tragedy or accident.
The New Washington University Medical School
Building was dedicated at St. Louis, May 17th, last. At
the corner stone laying it was announced a gift of $1,000,000
was made by Robert S. Brookings in addition to his previous
munificent benefaction. The equipment of this school
for teaching medicine in all it phases is equal to the best
in the land.


348
Editorial.
An Element of Psychic Morbidity seems apparent
in these English female suffragists who are and have been
demonstrating their claims to make laws by criminally
breaking them.
We should be obliged if some of our able alienist col-
laborators would look into the ancestral heredity of Mrs.
Pankhurst and her violent fighting followers for the un-
stable ancestral and presently manifest erratic psychic
neurone and see if their own and family brains are neurally
stable.
It might help the cause if it were found that insanity
temperament in these pugnacious ladies and not pure devil-
try, inspired the outrages of the suffragettes of London.
Let us hope in extenuation, that our amiable, but unduly
agitated sisters across the water are only showing an out-
break of the insane diathesis and are not morally as bad as
they appear to be. Otherwise what would become of mere
man here if out amiable sisters should all take to conducting
themselves at the ballot box after the manner of the London
suffragettes? They would nullify the lunatic, idiot and
imbecile voting exclusion at the polls.
The Psychology of the California Japanese
Collocuy is one of mutual compliment. The Californians,
seeing the superior thrift and success of the Nipponese
in their territory, want no more of them and the Japanese,
appreciating California as a land of opportunity and promise
of prosperity, want to be allowed to come into our country
non litnitis because they appreciate us and our country so
well.
Well, let them come, so they do not all come at once
and all into one state. They and their children are quite
as well fitted in morals, intelligence, industry and frugality
to live and vote with us as too many now coming to our
Eastern ports without question. This is a cosmopolitan
-country and its ultimate destiny is to befriend, benefit and
govern the world, not by war but through benevolent
assimilation and unquestioned power. Come in, brother


Editorial.
349
Nipponese and be welcome. Let us sit for a composite
picture, but please do not all come at once and don't bring
your guns with you.
The Chicago Medical Society shows its appreciation
of the medical advance in its promotion of the organization
of the alienists and neurologists of the country into a
society for the discussion of mental diseases in their various
phases.
The meeting of June 23rd, 24th and 25th, 1913,
under the auspices of this advanced scientific medical body
was an eminently successful and auspicious one under the
preliminary management of Harold N. Moyer, M. D.,
Chairman of the Arrangement Committee and W. T. Mefford,
M. D., Secretary.
The splendid program and the brilliant, energetic and
enthusiartic workers in this first meeting will bear rich
fruition for the welfare of medicine.
Insanity in Old Soldier's Homes.—Among the
sequences of battle wounds, army sicknesses and campaign
exposures, forced marches, inadequate sleep, army life
acquired inebriety and other sources of damage to mind
and the human organism generally, is insanity.
Dr. Norbury, State Alienist of Illinois, lately
found among the inmates of the Illinois Soldier's Home,
seven of that institution in condition of mental derange-
ment requiring the special treatment of the Asylum at
Bartonville, to which institution he sent them.
A search of the Old Soldier's Homes and the alms
houses and to some extent in other hospitals and ex-
ceptionally (and unjustly) in the penal institutions by men
of competent expert judgment would discover more
of these unfortunates and a similarly proportionate num-
ber of insanity victims, perhaps, in the National Soldier's
Hospital. The Government Hospital for the Insane at
Washington fortunately cares for a goodly proportion.
Army Surgeons and Insanity.—Apropos of the
preceding there should be a better and more clinical


350
Editorial.
knowledge of insanity among army surgeons, and chairs
of clinical psychiatry should be in every medical course
given in Washington for the benefit of army medical
service aspirants.
All Physicians Should Know Something of
Psychiatry and the psychiatric aspects, tendencies and
phases of disease and wounds and how to conservatively
treat such cases. The phychiatry and neuriety of medical
practice is an overlooked field. How to minimize shock
and fear and dread antecedents and post-operative se-
quences is a legitimate but too much overlooked and
inadequately considered matter in practical medicine and
surgery.
A school of psychiatry and neuriatry for practitioners
of general medicine in Washington City would be of
scientific life-saving value as first aid to operations to be
determined upon when time would permit and to other
treatment. Though it might not prove pecuniarily profitable
at its inception, the Government should inaugurate and
sustain, for a while at least, a free post-graduate school
of psychiatry and neuriatry for reputable graduates in
medicine. Such a school would favorably modifiy mor-
tuary statistics in medicine.
Another State Recogni?es Inebriety as a disease,
requiring hospital and asylum care. Governor Foss of
Mass., in a special message to the legislature has asked
for the appointment of a commission to investigate the
evil and disease of inebriety.
The commission would take charge of every case
of public intoxication and offer to the habitual drunkard
an asylum for an indefinite period where he may be pro-
tected against his own weakness and engaged in whole-
some employment.
He also commends provision for giving the inebriates
enforced work and wage for the benefit of his family
and himself until cured.


Editorial.
351
Commonwealths are gradually coming to consider
the inebriate as they shotdd.
A Case The Virile Reflex Would Have Decided:
Van Buren, Ark., Nov. 30.—Twenty-one years in
the State Penitentiary for attacking 13-year-old Nellie
Nohelty at Mulberry was the sentence Judge Evans
imposed upon J. W. Powell.
Powell, seventy years old, was a former Baptist
minister and extremely infirm.
After being sentenced he addressed the court declar-
ing he was innocent and that his conviction was the result
of a conspiracy.
The absence of virility might have been shown in
loss of this man's penile and virile reflex and the old
man's statement confirmed or vice versa. Epileptic auto-
matism ought also to have been sought for.
The Drama op the Laboratory.—The gift of
$1,000,000 to the University of California for the estab-
lishment of an institute for medical research by a San
Francisco woman, whose husband died of an incurable
disease, emphasizes the day's faith in the laboratory.
There is a healthy resentment against the term "incura-
ble" growing in profession and people.
Since two men, physicians and warriors, pitched their
tent in a swamp to prove their theory that mosquitos
were the media which spread yellow fever, preventive
medicine has made tremendous progress. One of those
men gave his life to the cause of medical research,
but cities freed from the deadly plague justify his sacri-
fice, and the Panama Canal is, in part, his monument.
The battle against the ills of the flesh is being waged
with a courage and devotion as dramatic as in the shock
of arms. Here in St. Louis, Dr. Harris, at the City
Bacteriological Laboratory, has done notable work on the
problem of rabies, while the Barnard Free Skin and Cancer
Hospital is seeking a cure for one of the worst of our


352
Editorial.
scourges. Preventive medicine has fought and conquered
typhoid, the convincing victory of inoculation over that
disease having been won in the German army and in
our own.
The scientist in his laboratory is one of the puissant
figures of our day. He is the Twentieth Century Caesar,
planting his standards ever on new frontiers. His ally
is the layman's generosity, expressing itself in brick and
marble, in popular assessments and, not infrequently,
in million-dollar gifts."
This editorial from a city newspaper, the Republic,
of St. Louis, shows the interest the secular press is taking
in matters medical in the line of human eugenics.
Mr. Carnegie Made a Mistake in proposing to make
mendicants of our Ex-Presidents dependent upon his
bounty, as great a mistake as when his educational
foundation censored and condemned the less liberally
endowed colleges of the country. President Hadley of
Yale has the right and fair view of the efficiency of the
most of our Universities whose teaching is efficient, if
not so richly endowed as Carnegies favorites. His foun-
dation reporters went out of the way with unjust strict-
ures on the less lavishly endowed schools. It is not
always the richly endowed that are the best teaching
plants. Something depends upon men as well as upon
elaborate laboratories.
The Field Family.—"Of the five sons of a New
England Congregational preacher four wrote their names
into the history of their day. The most widely known
of the family was Cyrus W. Field, who laid the first
Atlantic cable. Stephen T. Field was a Justice of the
Supreme Court. Another brother, David Dudley Field,
was a leading authority on international law, and still
another, Henry M. Field, won a place in letters as the
editor of a New York religious weekly and as the author
of several books. The brother who failed of special
distinction was Jonathan Edwards Field, but it was his


Editorial.
353
fortune to be the father of Stephen Dudley Field, inven-
tor of the first electrically driven car, the stock ticker
and quadruplex telegraph system, who has just died at
Stockbridge, Mass. A daughter of that Congregational
minister was the mother of Justice Brewer of the Supreme
Court."—St. Louis Republic.
On a par with the Jonathan Edwards family and in
marked contrast for the bettering of mankind are these
as compared with the Jukes and Kaleikak family. It is
not psychically true that "the only evil men do lives
after them while the good is interred with their bones."
Both the evil and good live in others after us either as
congenital aptitudes or as pattern examples for good
or evil.
Certain Elementary Concepts in Education Ap-
plied to Medicine.—Adami, of Montreal, makes a plea
for the application in America of the educational princi-
ples which guide the General Medical Council for the
United Kingdom. That council registers all duly quali-
fied medical men. And here is the significant fact: that
council conducts no examinations. Education is some-
thing beyond mere instruction, and it is the quality of our
educational methods that should give us most concern.
Adami thinks the time is ripe in the United States, the
way having been prepared by the Carnegie Foundation,
for the appointment of a Federal Medical Council,
subsidized by the government at Washington, and formed
of representatives from all the states, a council which
should appoint well-known leaders of the profession to
act as committees or assessors to visit, report upon and
make recommendations regarding the efficiency and de-
ficiencies of the individual medical schools of this conti-
nent, the expense of such inquisitions to be met by the
schools visited. The private institution which has laid
the foundation should now be supplanted by a national
institution, an institution authorized not by the profession
alone, by the American Medical Association, for example,
but by the nation at large, which shall act authoritatively


354
Editorial.
in these matters. Adami urges that each state continue
to control and direct its own educational methods.
We do not want, we must fight against, any dead level
of sameness in procedure and output. Let the Federal
assessors test the results, making sure that they reach the
desired standard of quality. If this be asking too much
at the present moment, at least the state might take
action, might appoint committees of inquisition to inquire
into and report upon the quality of the instruction af-
forded and the examinations of the schools within its
boundaries, and might accept the graduates of those
schools without the present farce of an examination
which does not educe the capacity of the examinee.—
New York State Journal of Medicine.
The Dungeon Punishment in the St. Louis City Work-
house is to be wiped out and a lesson in up-to-date humanity
and sanitation will be taught autocratic superintendents
devoid of ordinary civilized charity. To shut out light
and air and rob of sleep is to begin the slow infliction of
death and the right to do this should not be allowed to
Martinet Superintendents of penal or correctional insti-
tutions.
Sir William Osler.—Notwithstanding his extremely
advanced age, our old friend and brother in the profession
has been doing some splendid service to his brethren
across the water and to us on this side of the big pond
in the shape of a brilliant and virile address, without a
touch of senility in it.
Sir William is a man of fortytude to do this after
what the newspapers have said of him. "May he live
long and prosper."
Benjamin Rush on Municipal Sanitation.—Now
that an obsession to clean up St. Louis has seized upon
its Mayor and the Board of Health, it is not mal-apro-
pos to quote a little from this most distinguished of
American physicians, now among the immortals, and we


Editorial.
355
might suggest in termino that a beginning be made in
the alley back of our office block.
"To every natural evil the Author of Nature has
kindly prepared an antidote. Pestilential fevers furnish
no exception to this remark. The means of preventing
them are as much under the power of human reason
and industry, as the means of preventing the evils of
lightning and common fire. I am so satisfied of the truth
of this opinion, that I look for a time when our courts
of law shall punish cities and villages for permitting
any of the sources of bilious and malignant fevers to exist
within their jurisdiction."
A Big Strong Navy is as essential to this country's
tranquil, vigorous life and destiny of influence, whether
in peace or war, or both, as great strong hearts and fight-
ing blood with its powerful antibodies are, in the most
healthy, necessary to ward off disease. To be weak
in this world is to be miserable for man or nation. The
sickly sentimentality of our peace friends should put no
obstacle in the way of our developing strength for pos-
sible combat, even though conflict should never come
with any part of the outside world.
To perpetuate peace "in times of peace prepare for
war," as in health one should build in his blood rich
white and red blood corpuscles of resisting fighting
power against disease.
The United States should be like a mastiff in strength
whenever other countries are disposed to cry havoc and
let slip the dogs of war against them.
The Newark Office of the Bancroft Sanitarium,
Dr. G. B. Gale, Med. Director, formerly the Bancroft
Health Resort, has been removed from 409 Fireman's
Ins. Bldg. to 936 Broad St., Newark, N. J.
The Many Mistake Poisonings resulting from the
accidental taking of toxic tablets would suggest that


356
Editorial.
some other form be substituted, differing from ordinary
tablets now in common use, say, for instance, that they
and none other, be moulded and sold only in triangular
shapes with a skull and cross bones impressed on them.
Acknowledging an Invitation to be present at the
commencement exercises of the Training School for Nurses
in the Amusement Hall of the State Hospital at Dan-
ville, Pa., Thursday evening, June 5, 1913, we take
occasion to express with our regrets our approbation of
this good work. Twenty-two graduates go out from this
school of practical psychiatry and they will make the best
or nurses.
A Criminal Insane Hospital for Missouri.—The
Governor of this state wisely advises this provision for
Missouri's criminal insane, and some day this common-
wealth will be in line with the enlightenment and humani-
ty of the age in this important matter.
Many of the criminal insane have latent propensities
that justify their segregation both from non-insane
criminals and from non-criminal insane.
Pennsylvania has just fallen splendidly into the
scientific psychology of penology.
We hope all states yet derelict will soon follow the
Keystone example.
Personal.— Dr. C. L. Woolsey, Braymer, has been
appointed assistant physician at State Hospital No. 2,
St. Joseph.
Dr. E. E. Evans, Columbia, has been appointed
superintendent at State Hospital No. 3, Fulton, vice
Dr. D. E. Singleton, Fulton, who will locate in Keytes-
ville.
Dr. Forbes Winslow, investigator of lunacy cases
in England and America for the last quarter of a century,
died in Chicago, June 8th, 1913, 69 years old. He was
the lineal descendant of Edward Winslow, one of the


Editorial.
357
leaders of the Pilgrim Fathers and the first Governor of
New Plymouth.
Sir George H. Savage has been made an honorary
member of Medico-Legal Society of New York.
The Stable Psychic Neurone in Finis Vitae.—
The New York World, commenting on B. Sanders Walker
and his behavior after his physicians had informed him
that death was certain, after he had mistakenly taken the
poisonous dose of bichloride, thus eulogizes the courageous
brain stability of this expiring Georgian hero of the stable
brain and mind.—Socates died no more nobly.
"The whole country watched him with sympathy
and admiration as he cheerfully faced the inevitable end,
and it will not cease to applaud the fine quality of moral
courage he displayed. He died as 'a gentlemen ought
to die,' as that other 'gentleman unafraid,' Captain
Oates, died in the Antartic, and under conditions calling
for peculiar praise. Certainly a man leaving his counting
room to meet death with all the fortitude of a soldier
and the philosophy of an old Roman has given a new
prestige to civilian courage. Is war needed to keep the
nation's 'fighting spirit' on edge while it produces such
men in the walks of peace? There are monuments to
battlefield heroes with a smaller claim to public remem-
brance."
So much for the stable psychic neurone.
The Prospective Release of Hawthorne and
Morton brings joy to the medical profession and to
lovers of literature. Medical men and literati, absorbed
in other matters than finance, are easily lured into disas-
trous ventures by wily promoters of mining schemes, into
paretic dreams of wealth as these two overcredulous sons
of eminent sires were by the siren song of promoters such
as are constantly singing songs of more than sixpence.
We have a personal sympathy with all victims of
fake mining schemes. If all who joined in the pseudo


358
Editorial.
song of prospective success of the mining promoter were
convicted and sentenced, the jails would not hold them. We
should have been one of the unfortunates ourselves. Even
now a large part of our mail which goes into the waste
basket is mining and other fake schemes. But our
paretic get-rich-quick dreams are over. Get thee behind
me, Satan!



hese pages a homage of respect
f public hygiene in the Western
his incessant activities in behalf
The Late Dr. Walter Wyman, Surgeon General, United States Public
Health and Marine Hospital Service.
"President of the First and Second International Sanitary Conferences of
American Republics, and Chairman of the International Sanitary
Bureau of Washington.
He died suddenly on November 21, 1911.
We fulfill a painful duty upon paying from these ]
to the memory of Dr. Wyman, apostle of \
Hemisphere. His attractive personality, hi
of public health, and, above all, the sincere admiration and sympathy
which he always showed for the countries of Latin America, with whose
hygienists he co-operated efliciently, won for him the respect and affec-
tion of the officials and other distinguished men of those nations, as well
as of all those who had the privilege of coming in contact with him.
Dr. Wyman was born in St. Louis, Mo., in 1848. After graduating from the
School of Medicine of that city, he joined the Public Health and Marine
Hospital Service in 1876. Since then, devoted to the solution of hygiene
problems, he soon attained a prominent position in the medical world.
Once at the head of the Service he reorganized it and broadened the
scope of its activities, to such an extent that it has now achieved a high
degree of efficiency and usefulness.
United States has lost one of its most valuable men; Latin America a sincere
friend, and his colleagues of the Sanitary Conference, the beloved brother,
the respected teacher. But in our hearts his memory shall forever live,
his remembrance shall guide the deliberations of our future conferences
and his spirit, fervently invoked, shall preside over all sessions of these
gatherings initiated by bis far-seeing mind.
May he rest In peace!"
was one
Dr.Wyman was our friend. We knew him well. He
of Nature's noblemen and would have equally well adorned
any calling, as he so well honored his chosen profession.





CORRESPONDENCE.
The British Certificate in Psychological Medi-
cine.—Candidates must be at least twenty-one years
of age.
They must produce a certificate of having resided in
an Institution for the treatment of Insanity (affording
sufficient opportunity for the study of mental disorders)
as a Clinical Clerk or Medical Officer for at least three
months, or of having attended a course of lectures on
insanity and the practice of an asylum (where there is
clinical teaching) for a like period, or they shall give such
proof of experience in lunacy as shall, in the opinion of
the President, be sufficient. They must be registered
under the Medical Act (1858) before the Certificate is
bestowed. The examination to be written and oral,
including the actual examination of insane patients.
The Certificate awarded to be entitled "Certificate in
Psychological Medicine of the Medico-Psychological As-
sociation of Great Britain and Ireland."
Ill* Congress International de Neurologie et de
Pschyatrie, Gand, 20-26 Aout 1913, Monsieur le Redacteur
en chef du Alienist and Neurologist.
J'ai l'honneur de vous communiquer le programme
du IIIme Congress International de Neurologie et de
Psychiatrie, qui se tiendra a Gand du 20 au 26 Aout
1913, et vous prie de bien vouloir l'inserer dans votre
estimable journal.
Avec mes remerciements anticipes, etc.,
Pour le Bureau du Congres:
Le Secretaire general,
Dr. F. D. Hollander.
(359)


REVIEWS, BOOK NOTICES, REPRINTS, ETC.
Modern Treatment of the Insane. By H. G.
Maul, M. D., Pathologist, Nebraska State Hospital,
Ingleside, Nebraska.—In the Nevada Medical Times.
A selected article, with comments by the editor of the
Alienist and Neurologist.
"Psychiatry, today, is receiving more depth of study
than any class of ailments. National committees, state
governments and boards of health are endeavoring to
educate the public and laity in mental hygiene. The
movement is immense, and very creditable work is re-
sulting. The mentally ill can now go to charitable insti-
tutions without legal formality, and receive treatment
as one would with a broken leg.
Insane are looked upon as sick, consequently great
efforts are made to search out the fundamentals of each
patient's trouble by means of our most scientific diagnostic
methods, in connection with the work of field nurses who
conclude a very thorough personal and relative history.
On entrance to the receiving ward, most patients
are put to bed for two weeks or longer, in congenial and
pleasant surroundings, neatly furnished rooms or wards,
decorated with plants, pictures and rugs, as wisdom per-
mits. Great effort is made to have the hospital seem
homelike and quiet. No unkindness is allowed to be
shown. The attending alienist gives him a careful and
detailed examination. He is then placed in that part
of the hospital best adapted to his future developments.
If the case is somewhat obscure, he is placed in a ward
for observation, and a close clinical record taken, and
when classified is treated appropriately.
(360)


Reviews, Book Notices, Reprints, Etc. 361
Elimination for such patients is very essential.
Hygiene is a demand. The hot and cold packs, con-
tinuous baths, sprays, showers, gymnasium work, massage
and electrotherapeutics are very efficient and practical
at institutions.
In seventy-five per cent of the cases the kidney
efficiency by the phenol-sulphonaphthalein test is below
forty per cent. Blood pressure in one thousand cases
shows four hundred and eighty above normal, two hundred
fifty normal, two hundred seventy below normal.
A violent patient is quieted by the above methods,
and if successful, these are continued from two to ten
days. Occasionally it becomes necessary to follow a pack
or bath by a hypodermic sedative, and initiate rest by
small amounts of anesthetic. The treatment means an
effort to establish sufficient rest, nourishment, and quiet-
ude to allow the mentality to recuperate, and the physical
derangements will gradually adjust themselves, as the
former improves. Close watch is kept to detect the patient's
natural fitness for employment, and they are led into this
by skillful nurses and trained attendants, who use nothing
but kind and efficient measures.
An air of quietude is maintained above everything.
Patients are invited to do things, and by kind suggestions
many take part.
Motion picture shows, dances, base ball games, concerts
and the like keep up the social benefits.
When patients are physically ill, the cause, if possible,
is determined, and the case medicated accordingly.
The necessary surgery often aids wonderfully. Rough and
harsh treatment of the insane is today looked upon just
as improper and injudicious as if the same means were
used to obtain successful results in private practice."
As a rule real kindness prevails in our hospitals for
the insane on the part of the nurses, but cruel hearted
"smart Aleck's" often get into service as attendants, who
think they know better that the management how to
treat patients whose malady makes them troublesome
and intractable. These secretly abuse these pitiable


362
Reviews, Book Notices, Reprints, Etc.
creatures of affliction according to the nurses own egotis-
tical and heartless ideas of managing them by various
clandestine devices, such as choking them with twisted
towels, bruising them inwardly by sitting upon or punch-
ing them over the abdomen, squeezing their testicles,
twisting the spermatic cord, smothering them with pil-
lows and holding them overlong under water in the bath,
etc. These brutes make extreme surveillance in asylums
a necessity so that all hospitals for the insane should
have unexpected visits from the medical officers and offi-
cial spotters.
The world has a goodly share of naturally vicious-
minded brutes as it has of thieves, liars and other scoun-
drels, and some of them get positions as attendants on
the unfortunate insane whose complaints are too unvaria-
bly considered illusion or delusion founded and some
of t'hem when injured are so overawed by fear of further
violence as to be afraid to tell how they are treated.
While many complaints by patients of violence from
attendants are delusional, some are real and all should be
investigated.
Every asylum for the troublesome insane should
have its corps of spotters. "He who would lay hands
upon a (lunatic man or) woman save in kindness, is a
wretch whom it were base flattery to call a coward."
Scarce any punishment is too severe for him, even vasec-
tomy or for her oophorectomy, so that no more of their
kind might be produced.
Why the American Medical Association is Going
Backward—(A critique of the Medical Trust.) By G.
Frank Lydston, M. D., Chicago, Illinois. Professor of
Genito-Urinary Surgery and Syphilology, Medical Depart-
ment, State University of Illinois; Delegate from the U.
S. Government to the Congress for the Prevention of
Infectious Diseases, Brussels, Belgium; Member of Authors'
Society, London, England; Professor of Criminal Anthro-
pology, Chicago Kent College of Law; Member of Chicago
Medical Society, Chicago Physicians' Club and of The


Reviews, Book Notices, Reprints, Etc. 363
Illinois State Medical Society; Fellow of the Chicago
Academy of Medicine; Department Surgeon, U. S. W. V.
(Illinois); Member of the American Medical Association.
The Riverton Press, Chicago.
This question should have the considerate attention
of the American Medical Association. The author's arraign-
ment is a serious one and cannot with safety to the
present or future welfare of the A. M. A. be ignored.
The delegates should be instructed by the component
state bodies to take this serious arraignment, coming
as it does from such a worthy source and even if it came
from the most humble and obscure member of the A. M.
A., and sift it to the bottom, and the delegates should
decide with honor and full fairness, that the good name
of the A. M. A. may not suffer and that its prosperity
may grow and its glory brighter shine as a great fair-
minded, purely scientific body, living and doing only for
the good of science, the sake of truth, fair dealing and
humanity.
The author states that he had hoped that it would
not again be necessary to attack the evils which prevail
in the A. M. A., but the course of events has made it
imperative for him to do so. The "Oligarchy" that con-
trols the A. M. A. has grown more and more despotic
and selfish with the passing of the years until it has
assumed—or rapidly is assuming—the proportions of a
trust, and one of the most dangerous trusts which has
ever menaced a profession or class in this country. The
medical profession is asleep, its senses benumbed by the
hypocritical cry of "Organization for the Profession!"
with which the Oligarchy, like the psalm-singing pick-
pocket at the camp meeting, is distracting the attention
of its dupes from its real motives. This only can explain
the apathy and indifference displayed by medical men
toward the operations of the politico-commercial coterie
that owns the A. M. A.—soul and body.
This statement is true or it is not, but true or
otherwise, it should be fully investigated under order of
the entire membership.


364
Reviews, Book Notices, Reprints, Etc.
The National Committee for Mental Hygiene,
50 Union Square, New York City, send out a most
valuable report on the subject of the care 0*f the insane,
which every physician and philanthropist should become
acquainted with; also all legislators and those in authority
over us.
On this important subject Dr. Beers, Secretary, and
Dr. Salmon, director of special studies, inform us and
comment as follows:
The laws in the different states have a very definite
influence upon any measures which may be undertaken
for the betterment of the condition of the insane for,
more than is the case with any other class of the sick,
the kind of care and treatment which the insane receive
depends upon the kind of laws which exist. Many of the
present laws were enacted during a period in which the
insane were closely linked with criminals in the popular
mind. This unfortunate association is reflected in much
legislation and it continues, in some states, to cause many
hardships for this group of sick persons.
In the different states the care of the insane differs
so widely that we can find all kinds—from the crude,
custodial methods of one hundred years ago to the modern
hospital methods—in actual employment at the present
time. Such differences are not the result of varying
standards for the care of the sick. In all these states
we find diphtheria treated by the use of antitoxin, tuber-
culosis treated by serum and rest in the open air etc., and
dependence placed upon the best methods of nursing in
the treatment of typhoid fever serum prophylaxis etc.,
The great differences in the kind of treatment afforded
the insane depend chiefly upon the kind of laws which
each state has enacted and is satisfied with.
"In the period in which much of the present legisla-
tion regarding the insane was enacted, custody rather
than treatment was the object in mind. Newer concep-
tions of the nature of the mental diseases have changed
this attitude and new ideals in care and treatment have
become widely accepted. These ideals have been only


Renews, Book Notices, Reprints, Etc.
365
imperfectly reflected in legislation thus far, however,
and for this reason there must be a concerted effort
on the part of all those interested, to obtain better laws
if standards for care of the insane are to be generally
raised in the United States." Thomas W. Salmon.
The Working Bulletin System and Board of
Control—A plan for collecting evidence concerning the
newer materia medica. F. E. Stewart, Ph. G., M. D.,
Philadelphia.—From the Medical Herald, St. Joseph, Mo.
Following is the author's attitude on this subject:
During the past thirteen years, tens of thousands
of alleged new remedies have been introduced by adver-
tising and not more than one-tenth of one per cent of
them have proved of any therapeutic value.
This introduction represents hundreds of thousands
of useless experiments upon the sick by physicians in
private and hospital practice, and many times that num-
ber by the self-medicating public. No one has profited
by this so-called "new remedy" business, except the manu-
facturers and the press—medical, pharmaceutical, secular
and religious. The public, disgusted by this state of
affairs, has lost faith in doctors and drugs and is turning
to drugless systems of therapy for relief.
The medical and pharmaceutical professions have been
impoverished by it and their prestige seriously injured
in public esteem. The public has suffered by it in health
and finance. There is no use of trying to put the blame
on anybody, for all parties to the transaction are at fault.
The medical profession is at fault because this condition
of affairs could never have occurred if the profession as
custodians of the materia medica had been true to its
obligations toward the public. The pharmaceutical pro-
fession is at fault because instead of making a vigorous
protest against the invasion of the pharmaceutic field
by persons who desired to exploit it dishonestly for
financial gain the profession virtually went into the same
business. The public is at fault because it did not pass


366
Reviews, Book Notices, Reprints, Etc.
and enforce proper laws to make such exploitation of
the sick impossible.
The remedy is not to be found in throwing the mater-
ia medica overboard and resorting to drugless cults.
It is to be found in standardizing the materia medica
and rendering drugs instruments of precision.
How shall this be accomplished? The answer is,
by a co-operative investigation in which the medical
and pharmaceutical press take part.
This paper is well worthy of unbiased medical and
pharmaceutical consideration in its entirety.
Diseases of the Nervous System. By Judson S.
Bury, M. D., London. Manchester at the University
Press. Longman's, Green and Company, 443-449 Fourth
Ave., New York, N. Y. Price, $5.00, net.
This excellent contribution to current neurology is
number XIV of the Medical Series of the Publications
of the University of Manchester, dedicated to the author's
past and present students of that meritorious institution
of medical teaching—the Manchester Medical School.
The author proceeds at once, without undue prelimi-
nary, to the presentation of his interesting theme, as one
entering the amphitheatre and proceeding at once to the
audience and the blackboard.
An instructive schematic presentation, saving of many
words, showing the ascending and descending nerve
tracts and their central connections in the neuraxis pref-
aces the title, though this valuable diagram is made by a
lady proxy, Miss Karlowa, from one of Henry Head and
Gordon Holme's famous lantern slides; this drawing is in
colors.
A description of the chief neuronic system, followed
by cases illustrating the various forms of paralysis and
other symptoms relating to corresponding neurones,
characterizes this practical neurological work.
Among the author's eminent collaborators he records
his sad bereavement in the sudden and unexpected death


Reviews, Book Notices, Reprints, Etc. 367
of Dr. Dixon Mann only four days after Dr. Mann had
finished revising the proof of the book.
The text and the type are clear, the form fully but
briefly descriptive and ample illustrations sustain and
confirm the descriptions of Sherratt and Hughes in Manches-
ter and the foreign publishers. The agents in the Uni-
ted States is the well known house of Longman's Green
and Company, 443 Fourth Ave., New York.
American Industries.—The Manufacturers' Maga-
zine and Manufacturers Association, Colonel George Pope,
President.
The following is part of the first official statement of
Colonel George Pope, the newly elected president of the
National Association of Manufacturers, indicating his
policies and interpreting the principles of the Association.
Colonel Pope says: "In the conservation of the
human and physical resources of the country, this As-
sociation has been a mighty factor. It was among the
first to advance and adopt equitable workmen's compen-
sation laws. In the education of youth it has a profound
interest; to reduce the tremendous waste of the nation's
boys and girls, those who leave school in the earliest
grades, I would earnestly urge a system of compulsory
industrial training for young people at work.
"In all our efforts to promote the industries of this
country; the welfare of our workmen, and our people;
the extension of our commerce beyond the seas; in short,
the nation's prestige and the nation's honor, let us show a
complete sense of our civic responsibilities."
It is gratifying to see business men appreciative of
health, environment and service time, conservative of
men. Men, strong men of mind, muscle and morals,
steady brained men, rightly balanced and turned from
vices of vicious degenerative habits, make for business
welfare and national stability and endurance.
The First Signs of Insanity. By Bernard Hol-
lander, M. D., M.R.C.S. Consulting Physician British


368 Reviews, Book Notices, Reprints, Etc.
Hospital Mental Disorders and Brain Diseases; Founder
and President of Ethological Society; Editor of Ethologi-
cal Journal; Author of "The Mental Functions of the
Brain," "The Mental Symptoms of Brain Diseases," etc.
Cloth, 347 pages and index. 83.25 net, by mail $3.37.
Funk & Wagnalls Company, Publishers, New York.
A copy of this excellent book is before us. It is
designed for the medical practitioner, the psychologist,
the sociologist, the general student, and is, perhaps, the
best work ever written on the subject for layman as
well as physician and would not be amiss in the library
of the alienist, jurist and legal practitioner.
"It is the purpose of this book to show what insanity
really is, how it can be prevented, and how it can be
treated before it reaches the incurable stage. It points
out the fine distinctions between the normal and the
abnormal mind, rational and unsound thought, healthy
and perverted feelings, responsible and irresponsible con-
duct."
A good many might read it with profit not included
in the preceding mention.
What Can be Done to Better the Race? By
George W. Gay, M. D.—Eugenics, the improvement of the
race through judicious mating, is engaging the attention
of thoughtful people everywhere. The quality of human
beings born in civilized communities is finally receiving
some consideration akin to that which for a long time
has been intelligently given to the lower animals with
such satisfactory results. Hitherto most of our attention
has been devoted to results rather than to causes and
prevention.
Among judicious sayings the author notes that:
Procreation is independent of marriage and of state lines.
National legislation on these matters is not in sight.
A physician's certificate as to the health of the parties
contemplating matrimony has a limited field of usefulness.
For obvious reasons its general adoption would fail to
accomplish the desired result. For instance, it would


Reviews, Book Notices, Reprints, Etc.
369
be a bold physician who would certify to the existence
of a contagious disease under these circumstances, as he
would render himself liable to a suit for defamation of
character. A case of this sort occurred in this vicinity
some years ago in which it cost a reputable physician
upwards of a thousand dollars to defend his diagnosis.
—(From the Boston Herald, May 1, 1913.)
The Narcotic Drug Diseases and Allied Ail-
ments. By George E. Pettey, M. D.
In this volume Narcotic Addiction (including Alcohol-
ism) is very properly treated as a disease—a toxemia—
of drug, auto- and intestinal origin, the management and
treatment of which belong to the field of internal medicine.
Long-standing serious errors of far-reaching conse-
quences are corrected, the true pathology and pathogenesis
clearly and fully shown, and as a natural corollary the
most efficient treatment is completely set forth in these
pages.
It is fundamentally different from any other work
published in this heretofore to the general practitioner,
baffling and obscure department of human medicine,
and these diseases should be understood and treated by
the physician in general practice as well as by neurolo-
gists and alienists. In fact the alienist and neurologist
should know these cases all over in order to treat them
aright and do justice to them and secure justice in treat-
ment and care for them. The price of this valuable
book is $5.00 and every physician should have it. F. A.
Davis Company, Publishers.
The Functional Psycho-Neuroses, Langdon, (Re-
printed from The Lancet-Clinic, December 21, 1912),
is a record of some remarks in sketchy facetious scientific
vein by the distinguished author, whose writings always
command attention from his medical colleagues, excite
interest and convey instruction to all who read them.
This paper is too connectedly interesting to be
epitomised. It should be read entire. Freud, hysteria,


370 Reviews, Book Notices, Reprints, Etc.
psychasthenia, neurasthenia are here well and entertainingly
portrayed.
The author's definition of a physician's work con-
cluding this interesting paper is unique and here follows:
"The physician's work is that of a 'biological engi-
neer,' whose duty is to promote orthobiosis; in other
words, to conserve and direct scanty or unutilized forces,
so as to produce the best possible results in efficiency
of output with a minimum damage, to the machine.
To accomplish this end he can never, with wisdom or
safety, depart from the fundamental principles of physiol-
ogy and hygiene."
Ancient Greek Medicine. From the New York
Medical Journal, by A. Rose.
This is a commentary on the article, thus entitled,
by Dr. Charles W. Super, of Athens, Ohio, published
in a back issue of the New York Medical Journal, intend-
ed to do full justice to the Greek physicians of antiquity.
The entire contribution is well worth the reading by all
physicians. It is copyrighted, but may be had probably
by sending to the writer, 126 E. 34th Street, New York
or by consulting the New York Medical Journal of
November 27th, 1908. Dr. Rose is expert on this sub-
ject and knows whereof he writes.
The Second Volume of the Modren Treatment
of Mental and Nervous Diseases by British and
American Authors, edited by Doctors William A. White
and Smith Ely Jelliffe assisted by a corps of able con-
tributors is before us.
A perusal of this volume commands the same meri-
torious commendation given to the preceding volume.
The first chapter, as all that follows, is well written
but this article should be compared with Anstie on "Neuralgia
and; its Counterfeits" before one concludes with the author be-
fore us, that the neuralgias and the neuritides are path-
ologically the same. In' fact both the neuralgias and the
various neuritides have different pathic sources, making


Reviews, Book Notices, Reprints, Etc. 371
them different and sometimes exceedingly difficult clinical
and therapeutic studies, but this does not impair the value
of the well studied contribution.
Miss Copeland's School—We are gratified to learn of
the good work Miss Copeland's school is doing and has done
for children of high grade defective mentality at Saratoga
Springs, N. Y. The object of this school is the proper educa-
tion and training of children who are unable to receive in-
struction in the ordinary schools but require special assistance.
This school gives individual training by the most approved
methods formerly used by Seguin, Wilbur and others.
The children and governesses dine at one time. Some
of the children occupy a room alone and others share
it with a governess. The children are at all times under
competent supervision. The location in the beautiful
and healthful village of Saratoga Springs is unsurpassed.
The water supply and sanitary conditions are perfect.
Board and tuition eight hundred dollars per year, monthly
or quarterly, in advance. (Miss) Susan Eloise Copeland,
26 Madison Avenue, is the principal. The announcement
before us may be had on application.
Walt Whitman's Anomaly by W. C. Rivers. The
sale of this book is restricted to the members of the medi-
cal and legal professions. London, George Allen & Com-
pany, Ltd. Half-a-Crown, net.
This is a well sustained plea for the homo-sexuality
of the author's subject. He shows his subject as an
invert without great lasciviousness or bestiality and with
intellect dominating the erotic emotional life of the nim-
rod poet.
The author of this little book is a man of literary
merit like unto his author subject.
The Grinnell Review is issued ten times a year,
the first week in each month excepting August and Sep-
tember. The subscription price is fifty cents a year.


372
Reviews, Book Notices, Reprints, Etc.
Communications should be addressed to The Grinnell
Review, Grinnell, Iowa.
This review represents one of the best educational
institutions, morally and mentally, West of the Mississippi.
In its earlier day when it was located at Davenport,
Iowa, it did the writer and editor of this magazine
much substantial good in instruction and wise counsel
for his life work. He takes pleasure in here acknow-
ledging its good influence for his welfare.
Exclusion of the Alien Insane Criminals and
Degenerates. By Hon. John J. Kindred of New York,
in the House of Representatives, Wednesday, January 15th,
1913. From the Congressional Record of the Sixty Second
Congress, Third Session.
This is an enlightened and powerful plea for National
Eugenics, for law against the degenerating, debasing and
publicly impoverishing effect of omitted guardianship of
the physical and mental purity of the race, through
neglect of exclusion of foreign defectives and of suitable
sterilization of the unfit to propagate healthy offspring,
by vasectomy, oophorectomy, etc.
It is a forceful showing, with records of the Juke's
and Kalikak families' portrayal of the social and national
peril of unguarded abnormal propagation of those who
are to become a part and possibly an ultimately pre-
dominating part of our social life, unless we be warned
against the multiplication of the unfit in time to save the
future physical and mental normal stamina of the race.
The Activating Motives of Professional Con-
duct. By Henry S. Munro, M. D., Omaha, Nebraska.
From Medical Standard.
The author notes and this pamphlet indicates that:
"Workers in other departments of medicine are waking
up, and that psychotherapy, psychiatry and neurology
are on common ground, and that the advances made in
one of these departments are equally applicable to the


Reviews, Book Notices, Reprints, Etc.
373
problem of the prophylaxis and treatment of all diseases
met within the routine work of the general practitioner."—
Influx-)-Organism = Efflux—The basic law of cure
diagrammed and explained. "A broad-gauge but in-
fallible guide for students and practitioners of all schools
and systems." So the author conjectures. By Edgar G.
Bradford, Physiological Engineer. Price, 10 cents silver.
Interesting if not true. An all round survey of four
pages with many points of view omitted, but if you look
it over you will think some.
Announcement of the Program Committee—
Fourth International Congress on School Hygiene, Buffalo,
New York, U. S. A., August 25-30, 1913.
This worthy Congress under the patronage of our
worthy President Wilson deserves general recognition
and support of all patriotic citizens. This way the con-
servation of our great Republic lies. Through hygiene,
mental and physical, is safety. Chas. W. Eliot, Pres.
Emer., Harvard, is the acting president of this important
Congress.
Historie des Origines et de 1'evolution de l'idee
de degenerescence en Medecine mentale, par le Docteur
Georges Genil-Perrin. 280 pages in-8°. Paris, Alfred
Leclerc, 1913. Prix: 6 francs.
This is an instructive and suggestive record and
discussion from an eminent alienist source that will
especially interest advanced psychiaters familiar with
the French language.
This exhaustive and complete History of the Origin
and Progress of the Conception of Hereditary Degeneracy
in Mental Medicine should be translated into English.
Every alienist and in fact every physician and lawyer
should have it in his library.
The Technical Supplement of Urologic and Cuta-
neous Review comes to us full of exceedingly entertaining and


374 Reviews, Book Notices, Reprints, Etc.
instructive matter and with an eminent advisory and
collaboratory staff.
We do not see how any genito-urinary specialist can
do without it nor how any one but a mere spot specialist
in other departments of medical knowledge and practice
can well dispense with this excellent Medical Magazine.
In all special lines of medical work the whole patient
should be considered in all pathological relations.
Some Psychological Observations in the Insane.
By Max E. Witte, Superintendent, Clarinda State Hos-
pital, Clarinda, Iowa.—From American Journal of In-
sanity, Vol. LXIX, No. 3, January, 1913.
The author is well qualified to speak on this subject
and presents the character change criterion of insanity in a
true and practical manner. The first disorder is manifest in
incipient insanity "in the sphere of feeling." The author
maintains his thesis well, as the true clinical alienist
might, that he is.
The Simulation of Organic by Functional Ner-
vous Diseases.—With a few points of differential diag-
nosis, David S. Booth, M. D., St. Louis, Mo., Neurolo-
gist to the Missouri Pacific-Iron Mountain and St. Louis
Southwestern Ry. Co's., Professor of Clinical Neurology,
Medical Department of the National University of Arts
and Sciences, etc., etc.—From the Railway Surgical
Journal.
Fourth International Congress on School Hy-
giene to be held at Buffalo, New York, August 25-30,
1913. Under the patronage of Mr. Woodrow Wilson,
President of the United States and the presidency of
Charles W. Eliot, President Emeritus, Harvard University.
We fully concur with Dr. Thomas A. Storey, the Secre-
tary, that it is greatly desired to secure large membership
of the Congress. "The man of to-morrow (as he truly
says in his announcement) and the child of today, roughly
speaking, spends half his Waking hours under the in-


Reviews, Bock Notices, Reprints, Etc.
375
fluence of school conditions." We take pleasure in giving
this Congress and its worthy aims publicity.
Summaries of Laws Relating to the Commitment
and Care of the Insane in the United States.—Pre-
pared by John Koren for The National Committee for
Mental Hygiene. Published by The National Committee
for Mental Hygiene, 50 Union Square, New York.
This is a timely and useful publication for reference
by all interested in this subject, emanating from a reliable
and worthy source. We compliment The National Com-
mittee for Mental Hygiene on the accuracy and utility
of this valuable production.
Study of Man in connection with Establishing
Laboratories to Investigate Criminal, Pauper and De-
fective Classes. By Arthur MacDonald, Washington,
D. C., Honorary President of the "Third International
Congress of Criminal Anthropology," of Europe.
A series of valuable papers, suggestions and con-
gressional reports by this author whose address in the
Congressional, Washington, D. C., also a description of
an algometer for registering pain. Write the author
Criticism of Stedman's New Medical Dictionary.
By John A. Phoustanos, M. D. Editor of IATPIKH
IIP00A02 and La Grece M^dicale, New York, 1912. H.
Stamis, Greek Printing Office, 23 Duane Street.
This is a severe literary arraignment beyond our
philologic critical capacity in the premises. We commend
this entire brochure to the learned in the language of
Hellas. But want of space will not allow us to go
further. We may note some features of this interesting
monograph later.
Fulguration and Thermo-Radiotherapy.—By Wil-
liam Seaman Bainbridge, M. D. and Diathermy (Nagel-
schmidt) and Electro-Coagulation (Doyen) by Worthing-


376 Reviews, Book Notices, Reprints, Etc.
ton Seaton Russell, M. D.—From the Journal of Advanced
Therapeutics.
Contains interesting matter for practical electro-
therapeutics.
The Action of Animal Extracts Upon the Blad-
der. By Isaac Ott, M. D., Professor of Physiology,
Medico-Chirurgical College, of Philadelphia, and John C.
Scott, M. D., Demonstrator of Physiology, Philadelphia,
Pa.—Selected from Monthly Cyclopaedia and Medical
Bulletin, July, 1911.
This is a timely paper from a good source and read
before a suitable audience, the Association of Railway
Surgeons.
The average surgeon, railway or other, does not know
so much of neurology as he should and papers like this
one help to enlighten those who need enlightenment.
Atypical Multiple Sclerosis; Atypical Epilepsy;
Cerebral Syphilis with Motor Aphasia and Right-Sided
Hemiplegia; Cerebral Syphilis with Left-Sided Hemiplegia.
By L. Harrison Mettler, A. M., M. D., Professor of Clini-
cal Neurology in the College of Medicine of the University
of Illinois, Chicago.—From International Clinics.
Schriften des Vereins fur Freie Psychoanaly-
tische Forschung. Herausgegeben von Dr. Alfred Adler.
Heft 1. Psychoanalyse und Ethik. Eine vorlaufige Unter-
suchung. Von Dr. Carl Furtmüller.—Verlag von Ernst
Reinhardt in München.
Address of the President—Delivered by Dr.
Charles L. Reeder, Tulsa, before the 1912 meeting of the
Oklahoma State Medical Association at Guthrie.—From
the June Journal of the Oklahoma State Medical As-
sociation.
Unser Verstehen der Seelischen Zusammenhange
in der Neurose und Freud's und Adler's Theorien.—
Von Privatdozent Dt. Otto Hinrichsen, Basel.


Reviews, Book Notices, Reprints, Eu.
377
Zeitschr. f. die ges. Neur. u. Psych. (Originalien,)
Bd. XIV. S. 160. Zentralblatt fur Psychoanalyse.
How May We Make Our Scientific Nomencla-
ture More Accurate. By Dr. A. Rose, New York.
A good paper from the stand-point of a Greek med-
ical scholar.
Symposium on the Use of Phylacogens, (Modified
Bacterial Derivatives.)—Illustrating and showing good re-
sults under skyagraph inspection. College of Physicians,
Pittsburg, Penn., Session, April 25, 1912.
The Prophylactic Value of Vaccines in Typhoid
Fever. By J. Clement Clark, M. D. Superintendent
Springfield State Hospital for the Insane, Sykesville, Md.
A Preliminary Communication Concerning a New
Diagnostic Nervous Sign. By Charles Gilbert Chaddock,
M. D., of St. Louis.
A Practical Device to Stimulate the Working
of Nervous Discharges—S. Bent Russell, St. Louis,
Missouri.
Scarlitiniform Erythema. By William Frick, A.M.
M. D., Kansas City, Mo.—From the Medical Herald,
St. Joseph, Mo.
Multiple Sclerosis—L. Harrison Mettler, A.M.,
M. D., Chicago.—From the Journal of the American
Medical Association.
Nystagmus—L. Harrison Mettler, A.M. M.D., Chica-
go.—From the Illinois Medical Journal.
Traum und Traumdeutung.—Von Dr. Alfred Adler.
Separatabdruck aus Osterreichische Arzte-Zeitung.
Kathareuousa and Scientific Medical Nomen-
clature. By A. Rose, M. D., New York.


Acute Diarrhea
of Infants
MELLIN'S FOOD
4 level tablespoonfuls.
WATER (boiled, then cooled)
! 6 fluidounces.
Give one to three ounces every hour
or two, according to the age of the
baby, continuing until stools lessen in
number and improve in character.
Milk, preferably skimmed, may then
be substituted for water—one ounce
each day—until regular proportions of
milk and water, adapted to the age of
I the baby are reached.
This diet is especially serviceable for the feeding of
infants with diarrhea for the following reasons:—
Readily taken.
Completely utilized.
Protein-sparing, thus preventing tissue waste.
Furnishes sufficient body-heat and energy and
supplies enough nitrogenous food to maintain the
baby's strength during the critical period.
Maltose, the predominating carbohydrate, has the
highest point of assimilation and the lowest degree
of fermentation of all sugars.
MELLIN'S FOOD COMPANY - - BOSTON, MASS ^


A JOURNAL OF
NEUROLOGY ANopsychº Jºy
PºCHAIRY AND NETRATINY
FOR
THE NEUpologist.
GENERAL PRActitioner.
AND SAVANT
Panopepton
º a "medicina/food
Dºº is often described as
The extractives ºf . ed in the juice ºf a broiled beefsteal. ºr rare
ºf ºf are highly sºvory and -
digestive sº retions. - -
Panoº. ontains all these extractives. -
The nº ºnstituent ash) are not ºnly nutritive, but are chemical cº-
sers essentiº ºn. digestion and - -
ºilation ºf food Pano cºntains an
The potassium phosphat ºf the whº and beef, and ºn lºst
tº
in the process.
When º
in whº ºn
ºysician gives panº. patient under the
ºº ºr º
Farehºld Brºs & Foster



THE CINCINNATI SANITARIUM
FOR MENTAL AND NERVOUS DISEASES
INCORPORATED 1873
A Private Hospital of Modern Equipment and Methods
F. W. Langdon, M. D., Medical Director.
B. A. Williams, M. D., Resident Physician
Emerson A. North, M. D., Resident Physician
Georgia E. Finley, M. D., .Medical Matron


THE
ALIENIST AND NEUROLOGIST
Vol. XXXIV. St. Louis, November, 1913. No. 4.
ON THE THEORY OF THE PSYCHOPATHIC
CONSTITUTION.
BODILY SYMPTOMS.
By Geh. Med.-Rath. Prof. Dr. Theodor Ziehen,
Published in Charlte Annalen, 1911.
Translated by James C. Hassall, M. D., Junior Assistant
Physician, Government Hospital for the Insane,
Washington, D. C.
THERE are individual cases of psychopathic consti-
tution in which bodily symptoms are entirely
absent. In most cases, they are found in greater or
fewer numbers. Since they depend for the most part
upon the etiological1 foundation of the psychopathic
constitution, I will discuss them separately under the
individual psychopathic constitutions. As they are in
a great measure already well recognized, I will limit
myself to the discussion of a few more important points.
The Degenerative Psychopathic Constitution.
In this one frequently finds the recognized so-called
stigmata of degeneration. Unfortunately, in spite of the
many separate works, the study of the latter is much
1. I will return to this idea of the etiological foundation in the following section
in discussing the classification of the psychopathic constitutions.
(379)


380
James C. Hassall.
in arrears. There is especially lacking for most of the
stigmata of degeneration, a careful statistical study con-
cerning their occurrence in hereditarily burdened and
hereditarily unburdened mentally normal, with regard to
racial differences. On account of the enormous racial
mixture among the people of Berlin, the clinics here are
particularly unsuitable for such investigation. For this
reason, in the absence of special statistics, I will confine
myself to a few principles which have impressed themselves
upon me as certain and important.
Some of the stigmata of degeneration are more im-
portant than others. In the degenerative psychopathic
constitution, we find especially frequently:
1. Abnormal development of the genitals.
2. Abnormal development of the hair, especially ab-
normal whirl formations (e. g., in the middle of the eye-
brows, on the forehead, etc.) and an abnormal border
of the hair on the forehead and temple.
3. Abnormal proportion of the separate parts of
the body.
I have given a more exact enumeration of these in
Mental Diseases of Childhood, Vol. 3.
The above mentioned stigmata of degeneration are
worthy of notice even if they occur isolated. The others,
as a rule, are of value only when they occur together
in greater numbers in an individual.
The severity of the psychic symptoms of the de-
generative psychopathic constitution and of the stigmata of
degeneration is sometimes the same, though not always.
In no case is it proper to infer the existence of the former
from the presence of the latter; a fact which is unfor-
tunately still often overlooked in forensic practice.
The isolated appearance of a pure epileptic convulsion
in connection with quite definite occurrences, e.g., severe
emotional shock,2 severe alcoholic excess or heat injury,
is especially noteworthy as a bodily symptom of the de-
2. Compare the treatise of Bratz concerning emotional epileptic attacks, Monats-
achrilt f. Psychiatrie and Neurol., Vol. 29, page 45. In other psychopathic consti-
tutions as in the degenerative, these sporadic attacks are rare.


Theory of the Psychopathic Constitution.
381
generative psychopathic constitution. It is not appropriate
to speak of epilepsy in those cases in which the epileptic
attacks occur very rarely and in connection with wholly
peculiar occasional insults to the ecomony. The genuine
epilepsy, for example, is an illness exactly opposite to
hysteria,8 being characterized by the fact that the attacks
sometimes, really very often, appear without apparent
cause. It is true, in individual cases with repeated
epileptic attacks caused by occasional injuries, that a
secondary genuine epilepsy with spontaneous epileptic
attacks can develop. I propose to designate the above de-
scribed sporadic attacks in degenerative constitutions, as
"epilamptic"4 attacks; thus will I express their relation to
the eclamptic attacks of childhood. This relation will be
clear if one remembers that the eclamptic convulsions of
children follow certain exciting causes—usually reflex irri-
tations as dentition, irritation from worms, fever and acute
infections and also stand in an unmistakable relation to
hereditary taint and are likewise able to lead sometimes to
a secondary genuine epilepsy.
The Hysterical Psychopathic Constitution.
As the hysterical psychopathic constitution often
develops upon a degenerative basis, one finds the above
mentioned stigmata of degeneration very frequent. How-
ever, I have a very decided impression that the abnormali-
ties of development, which He outside the nervous system,
are more frequent in the pure degenerative psychopathic
constitution than in the hysterical. In the latter pre-
ponderate the stigmata of degeneration which occur in
the nervous system itself.
Whether there are cases of a decided hysterical
psychopathic constitution entirely without bodily hysterical
symptoms, is still discussed. I have never yet observed a
3. This proves how different is the position of convulsions in the picture of
epilepsy from that in hysteria. In the latter they are only the expression of a special
pathologic reaction on definite psychopathic excitements (emotions), etc, a reaction
which is immediately dependent upon the psycho- and neuropathic constitutions,
in epilepsy, on the contrary, they are the expression of a spontaneous explosion of ex-
citements, whose accumulation in the nervous system is characteristic of epilepsy.
4. Epilamptos (Greek) is an Ionic synonymn for epileptoa—seised.


382
James C. Hassall.
clear case. The bodily symptoms of hysteria are not
only psychogenic, or as I prefer to say "ideoplastic,"
but the psychic symptoms of hysteria also have a decided
tendency to bodily discharge or transference in bodily
symptoms of disease. The latter are often an exact
translation of the psychic symptoms. On the other hand
it is unmistakable that in many cases each parallelism
fails between the severity of the bodily and psychic
symptoms. In many cases of severe hysterical psycho-
pathic constitution, all hysterical convulsive seizures,
for example, are absent. On the other hand, it is true
in rare cases, in spite of the more severe and more
frequent hysterical convulsive seizures, that the psychic
symptoms are inconsiderable. One can scarcely avoid
the impression in a few cases that in the course,—thus
in the same case—a true substitution of the bodily and
psychic symptoms takes place. The affective symptoms
of the hysterical psychopathic constitution particularly
diminish temporarily after they have unloaded themselves
in an attack. On the contrary, delirious symptoms,
especially hallucinations, frequently succeed a convulsive
attack. At times it happens that during a hysterical
contracture, hallucinations disappear, only to reappear
with the diminution of the contracture.
Of the bodily symptoms of hysterical psychopathic
constitution, hemi- and topical disturbances of sensa-
tion and motion are most important. Sometime ago
I designated 6 as topical or regional disturbances those
whose boundaries are determined by the naive ideas
of the individual body part and distinguished topical
pain, topical anesthesia, topical paralyses, etc. In neuras-
thenia such topical limitations are very rare. In the
field of motility belong my so-called functional paral-
yses, as abasia, akathesia, astasia, etc., and analagous
functional convulsive movements, e.g., convulsive rowing
movements after too long rowing (case of Bastian).
6. Realenzyklop d. ges. Heilkd. 3rd and 4th edition. Article Hysteria, Deutsche
KUnlk, Nervenkrankheiten. Page 1319, Special page, 1327, etc. Zeitachr. f. Artal.
FortbUdung, 1911, Vol. 8, No. 1.


Theory of the Psychopathic Constitution. 383
Less important diagnostically are the so-called hysterical
pressure points. Only when they are very decided and
limited to one half of the body or at least predominate
on one half of the body and are combined in their limits
with disturbance of cutaneous sensibility, do they speak
with important probability for hysteria. According to
my experience for the past decade disturbances of the
field of vision are neither so frequent nor characteris-
tic as was formerly thought. The hysterical convul-
sion, and in general, the tendency to increased convul-
sive motor reactions (especially in the field of the ex-
pression movements) is, on the other hand, of great
diagnostic importance. The former are often entirely
absent, the latter, on the contrary, are rarely missed
completely in careful histories. I consider it actually
characteristic for the patho-physiological mechanism,
that in epilepsy the convulsive seizures are independent;
in hysteria, on the contrary, they appear as increases or
distortions of the normal motor reactions, while in neu-
rasthenia, they are absent.
The Neurasthenic Psychopathic Constitution.
Regarding the bodily symptoms of this psychopathic
constitution, I will limit myself to a few general obser-
vations. At all events susceptibility to fatigue and
hyperasthesia stand in the foreground of the bodily
symptoms. The susceptibility to fatigue can best be
measured dynamo-metrically or ergographically. It is
made up of three components: first—of the abnormally
rapid failure of associative energy (associative or psychic
component); second—of the abnormally rapid failure of
the motor innervation act itself (motor component); and
third—of the hyperasthesia of the fatigue sensations6
(sensible component). In individual cases, first one and
then the other component predominates. The suscep-
tibility of fatigue, caused by the preponderance of the
associative component, is shown in the ergographic curve
6. With the unsuitable dynamometer (without leather cover) the hyperasthesia
ii added in the scope of the pressure sensation of the skin.


384
James C. Hassall.
by its great variations. Its conduct contrasts to a cer-
tain degree with the ergographic curve of hysteria in
which there often occurs a sudden, almost complete and
lasting failure of performance.7 The purely motor com-
ponent is shown ergographically by the abnormally rapid
decrease in the height of the curve and the abnormally
few elevations of the curve. In view of the technical
imperfection of our ergographs, the latter is certainly
hard to show. The patients may use auxiliary move-
ments for lifting the weight, and therefore, on account
of the construction of the apparatus, the moment of
total exhaustion (height 0) can be displaced in a manner
which cannot be estimated, making the number of heights
indeterminable and sometimes worthless.8 The decision
whether the number of elevations or the medium height
of elevation9 is characteristic for the pure motor com-
ponent of the neurasthenic susceptibility to fatigue, (prin-
cipally in comparison with the associative component),
must be reserved for further researches.
The hyperasthesias of neurasthenia show a rarer
topical (regional) character in contrast to those of hysteria.
Therefore, they rarely correspond in their extent to the
naive representation of a part of the body, and are also
rarely one sided. They attack, mostly, a function in
toto; here belong the neurasthenic oxyakoia, the neuras-
thenic hyperasthesia retinae (better called optic hyperas-
thesia); the somewhat rarer general cutaneous hyperas-
thesia, the vestibulary hyperasthesia, etc. In this rela-
tive rareness of regionary boundaries, in the slighter
7. Compare Breukink, Monatsschr. f. Paychiatrie u. Neurol. Vol. 15, page 318.
8. I have recently often introduced arbitrarily for the removal of this difficulty
an artificial zero-line which lay from 1 to 4 m.m. higher than the actual one and
which was empirically chosen so that the elevations produced by the auxiliary move-
ments remained below it.
9. Compare Hoch and Kraepelin, Kraepelin's Psychol. Studien, Vol. 1, page 378.
These authors assume that the psychic disposition and exercise change the number of curves
and that the tiring of the muscle and the taking of food change the size of the curves.
According to our ergographic experience in progressive muscular dystrophy, the
second part of this statement is true. I have doubts concerning the first part. The
preponderingly theoretical considerations of the author (page 479, etc.) do not seem
to convey proof. Above all, besides the psychic disposition and exercise and some-
times instead of these two factors, in the sense of the quotations in the text above,
a distinction must be made between the associative factor and the factor of the abil-
ity of performance of the motor apparatus (motor region to the end plate). It ap-
pears very questionable after a preliminary examination in central and peripheral
paralyses, whether in these the elevation height or the number of elevations is changed.


Theory of the Psychopathic Constitution. 385
suggestibility and in the absence of hyperesthesia and
anesthesia are seen the negative diagnostic points between
this and the hysterical neuro and psychopathic constitu-
tion. A positive diagnostic point is shown in the relation
to fatigue. The hyperesthesias and pains of the neuras-
thenic neuro- and psychopathic constitution rarely allow
this relation to be missed. I will give as example here,
only the noteworthy pains, which were observed in neuras-
thenic individuals (girls between 15-25 years of age)
after months of long strained music exercise. These often
have the appearance10 of a regionary boundary, but a
more careful examination shows, at least very often,
that the seat of pain is actually in the nerve and muscle
territories which have been in particular demand in the
piano playing. Just this connection of the local (whether
peripheral or central) fatigue symptoms with the general
susceptibility to fatigue is characteristic for many neuras-
thenic cases; while the ideoplastic character is absent.
So, it is clear that if a neurasthenic patient once shows
one sided hyperesthesias, pains or pressure points, there
is seen etiologically, as a rule, a one sided over-strain.
Finally, in this connection, we find that the pains of
neurasthenia very often have all the characteristics of
fatigue pain. Hence, the intensity of the pain stands
as a rule in a true dependence upon the functional de-
mands; the pain is originated by relative or absolute
too great demands and advances further parallel to the
functional demands.
It must especially be emphasized that these boundary
lines are often indistinct. Within the broad territory
of the so-called hystero-neurasthenia, the above character-
istics blend in most variable relations. In female indi-
viduals, isolated hysterical symptoms are extraordinarily
often mixed with neurasthenia. Accordingly, in the female
sex a pure hysteria is much more frequent than a pure
neurasthenia.
10. In hysteria they usually have regional boundaries and correspond to a true
topalgia.


386
James C. Has sail.
The Toxic Psychopathic Constitution.
The bodily symptoms of chronic alcoholism, saturn-
ism or morphinism have been described often enough.
Therefore, I emphasize that here one cannot speak of an
absolute parallelism of the bodily and psychic symptoms.
Thus, for example, a severe alcoholic polyneuritis may be
combined with the most severe alcoholic psychosis,
alcoholic dementia, acute or chronic paranoia, Korsakoff's
syndrome, etc., as well as with a severe or light psycho-
pathic constitution. On the contrary, in the most severe
alcoholic psychopathic constitution, the bodily symptoms
may be limited to a slight static tremor, a slight advance-
ment of the optic phenomena and a slight pressure
sensibility of the nerves (even without Laseque's symptom.)
It is also observed in the physical examination that the
alcoholic and other toxic psychopathic constitutions
frequently combine with the hysterical and neurasthenic
and then show hysterical and neurasthenic symptoms.
These facts will be easily understood when the classifi-
cation of the psychopathic constitution is discussed in
the following section.
The Traumatic Psychopathic Constitution.
As far as this comes under the picture of hysteria,
neurasthenia, and hystero-neurasthenia, the bodily symp-
toms need no further descriptions. Also the possible com-
plication with trumatic epilepsy which must be kept
in mind in the toxic psychopathic constitution, offers
no new view-point for this treatise. Here only the ques-
tion need be raised, whether the traumatic psychopathic
constitution shows decided bodily symptoms aside from
the specializations and complications. In reality, such
symptoms do occur. In the first place I mention the
cephalaea, which in my opinion must be differentiated11
throughout from the hysterical topalgia of the head as
well as from the neurasthenic head pressure. It is dis-
tinguished by its intensity, its indefinite localization in
11. Of course often in traumatic hysteria and neurasthenia there is topalgic head*
ache or head-pressure.


Theory of the Psychopathic Constitution.
387
the whole head and by its pronounced "pain" character
(in contrast to head pressure). At times it is accompanied
by nausea, more rarely by vomiting. Accompanying
vasomotor phenomena (congestions) are frequent. It is
observed in its clearest and most pronounced form after
the crises in childhood. Here it can appear almost isolated
though it is often combined with the traumatic psychopa-
thic constitution.12 It interferes with the school-work
in an extraordinary measure. Its pathophysiological
foundation is as yet unexplained. It is at least very
doubtful whether these always are vasomotor disturbances
within the skull. Pressure points in the territory of the
trigeminus and the occipital nerves may be absent.
The sutures of the skull are at times abnormally sensitive
to pressure.
A second, not rare, bodily symptom accompanying the
traumatic psychopathic constitution is attacks of true
vertigo. So far as it concerns discoverable lesions of
the labyrinth, vertigo is to be regarded only as a compli-
cation. We exclude, likewise, all those cases in which the
vertigo is to be regarded as equivalent to epilepsy (trau-
matic in origin.) After the exclusion of these there still
remains a considerable number of traumatic cases which
show true vertigo. Hitzig13 was very much inclined to
consider this vertigo as a symptom of neurasthenia and
even cortical. I cannot agree with this assumption.
Hitzig's treatise contains various cases and among them
some which have nothing to do with true vertigo (in-
stead apparent turning movements, feelings of uncertainty,
obscuring of the field of vision, etc.) In uncomplicated
neurasthenia, according to my experience, vertigo is very
rare.14 If true vertigo is more frequent in traumatic
cases, I cannot consider it as a neurasthenic, much less as
12. In isolated cases it is shown after further observation as a premonitory symp-
ton or accompanying phenomenon of a traumatic acquired internal hydrocephalus.
13. Der Schwindel, Wien, 1898, page 46, etc
14. Binswanger, (Pathologie und Therapie der Neurasthenic. 1896, Page 89,)
says that apparent movements of objects are rare as compared with movements of
the person's body. I also believe the latter very rare as far as apparent turning
movements are concerned.


388
James C. Hassall.
a hysterical symptom. I believe that it still concerns
a functional or an organic labyrinth lesion which is so
slight that it cannot be discovered. This is confirmed
by the fact that frequently a caloric or galvanic hyper-
sensitiveness of the vestibular apparatus can be shown.
In any case, a test for this should never be omitted.15
If this understanding of the case is correct, then the verti-
go of the traumatic psychopathic constitution would be
a coordinate phenomenon,16 somewhat analagous to
the alcoholic neuritis in the alcoholic psychopathic consti-
tution. In certain cases, a sudden disturbance of circu-
lation in the labyrinth may be suspected.
I do not consider as cases of true vertigo those in
which there is described only a continuous oscillation
of objects in the field of vision (without movements of
turning.) These exceedingly rare cases of apparent move-
ments occur now and then in neurasthenia but have no
special relation to the traumatic neuro- and psychopathic
constitutions.
Finally, slight coordination disturbances deserve
attention as bodily symptoms of the traumatic constitution.
They are essentially cerebellar or vestibulary in character.
Thus in addition to the more frequent neurasthenic
and hysterical pseudo-Romberg sign, we find now and
then a true Romberg swaying. It is very apparent17
in stooping in the Romberg posture (with closed eyes.)
It seems to me that possibly here also the labyrinth is
involved.18
The remaining bodily symptoms are so well known
and so clear in their significance that they can be omit-
ted.
15. In this relation one should always seek for a diminution of bone conduc-
tion. Compare Baginaky, Berl. Klin. Wochenschr., 1905, No. 87.
16. Oppenheim (Monataschrift f. Psych, u. Neurologie, Vol. 29, page 275) has
communicated cases of prolonged vertigo and has assumed that there is a condition
of excitement in certain regions of the central nervous system. I am, on the con-
trary, still inclined to seek the location of these disturbances, at least for many cases,
in the labyrinth.
17. In many cases much more considerable than it is occasionally found in heal-
thy people.
18. I would not agree with Stenger (Deutsche Med. Wochenschr. 1905, No. 2)
that there is a special "traumatic labyrinth neurosis."


THE GERMAN METHOD OF TREATING THE
CRIMINAL INSANE.*
By W. J. Hickson,
Psychopathologist, Research Dept., Vineland, N. J.
Ishall treat the subject under discussion from two
standpoints, namely—(1). Insanity at the time of
committing a crime-the criminal insane. (2). Insanity
among criminals in penitentiaries-the insane criminals.
There is a saying in Germany that you can tell an
American a long way off but that you can't tell him
much. However true this may be, if we would be a
little more teachable when we go abroad, especially when
we visit some of the more advanced countries, such for
instance, as Germany, there is much that we could bring
home and apply to advantage. Germany itself is not
averse to learning from other peoples. For example
a few years ago when a further reform of the criminal
laws was proposed, Germany investigated those of prac-
tically all other countries and the results appeared in
a set of 16 large volumes. From these findings, new
laws were drawn up and submitted to the people for a
number of years for discussion, consideration and amend-
ment before adoption. The above example also illus-
trates the thoroughness with which the Germans attack
a problem. They make haste slowly but they make
haste, and on account of proceeding so circumspectly,
they seldom, if ever, have to retrace their steps. It
has been said that modern Jurisprudence is emphati-
•Read by invitation before tbe Phil. Psychiatric Society, April, 1913 Meeting.
(389)


390
W. J. Hickson.
cally a German creation. I think therefore that any-
thing that lends itself to adoption that would be an
improvement on what we have, should be applied by
us and we shall seldom, if ever, have cause to regret
having done so. Germany has adopted much from
America. No one country has a monopoly of the world's
wisdom.
My work for the past two and a half years in Europe
has been largely in the field of normal and abnormal
psychology and one does not realize how much there
is for us to learn from the Germans, in the latter sub-
ject especially, until one is confronted with it over there.
The subject of Psychiatry has made wonderful advances
with them in the past two decades, due no doubt to
the excellent psychopathological laboratories they have
developed and without whch their progress would not
have been attainable. Psychiatry at present in Germany
is in the van with the most advanced branches of
medicine.
It is very difficult, however, to approach the ques-
tion at issue without at the same time being drawn
into a discussion of the problem of criminal responsi-
bility as it is affected by the freedom of the will, Deter-
minismus, Indeterminismus, Causality of Psychical events,
etc. To avoid all of these harrassing questions I have
learned for practical purposes to regard the matter from
the same standpoint as that of my much honored former
Chef, Prof. Bleuler, of Zuerich, who leaving out all
consideration of the academic side of these questions takes
the bull by the horns and simply says that an indi-
vidual who is a menace to society should be isolated.
For this reason and also to bring my main points into
as sharp relief as possible, I shall refrain from entering
upon any further discussion of either of the above ques-
tions or the details in the carrying out of the procedure
to be recommended and shall dwell, therefore, only upon
the principles involved themselves, and furthermore since
the various states of Germany have individual modifi-


Method of Treating the Criminal Insane.
391
cations which would take us too far afield to discuss
them all, and since they do not alter the main points
at issue, may very well be left aside.
Legal punishment is inflicted with three objects in
view, namely: 1st, retaliation; 2nd, intimidation; 3rd,
reformation. Now it is quite obvious that none of the
above purposes are effected with the insane, surely
not reformation and if there is any intimidation, it is
only on normal people who see and shudder at the in-
justice of inflicting punishment on the irresponsible.
That leaves only retaliation as having any "standing
in court" and that is the saddest aspect of it all. The
criminal insane who make up a large portion of the
chronic offenders, the mattoids, speak louder than words
of the ineffectuality of our present methods of dealing
with these cases and are to us a living reproach.
In Germany there are from 5 to 7 insane in every
100 of the prison population, and this does not include
all of the lighter forms, such as the defectives, degener-
ates, psychopaths, alcoholics, etc. Insanity is at least
ten times more frequent in the prisons of Germany
than in the outside population.
The eye for an eye, the unrelenting retributive
doctrine is now obsolete or should be at least in its
application to those who are irresponsible. We do not
consider a child under the age of responsibility as guilty
when it has committed an overt act, yet we do the
criminal insane and mental defectives who are in most
cases mentally below the age of responsibility and who
are equally irresponsible and many times the victims,
thru their inability to react properly, of the very social
order that punishes them. The basis of punishment of
a deed presupposes responsibility and the basis of putting
it into effect its efficacy. Yet both of these bases
are lacking in practically all of the insane and feeble-
minded on whom legal punishment is inflicted. These
are only two of the many inconsistencies that exist in
our present methods of treating these cases in America,
and illustrates how far the law lags behind and fails


392
W. J. Hickson.
to take advantage of the advances of the other sciences,
such as Psychology, Sociology, Anthropology, Medi-
cine, etc.
I am afraid that future generations will look back
upon our present methods of treating these cases with
the same abhorrence with which we look back upon
the treatment of the insane not so very long ago when
they were regarded as being beset with devils and were
maltreated and mishandled accordingly. It is only as
late as 1862 that the Supreme Court'of North Carolina,
in pronouncing judgment, said, "To know the right
and still the wrong pursue, proceeds from a perverse
will brought about by the seductions of the evil one."
The eminent Austrian Jurist, Dr. Gross, professor of
Criminal Law at the University of Gratz, in his splendid
two-volume treatise, "Manual for Examining Magis-
trates: a System of Criminology," has well said "It is
only through the greatest care and exceptional conscien-
tiousness that we can repair a part of those shocking
sins of former times in which innumerable unfortunate
lunatics were most cruelly punished for their imagined
wickedness and especial depravity. One comes strongly
by closer study of these difficult and painful relations,
to the conviction that really every accused person and
every important witness should have his mentality ex-
amined and that it is only on account of expediency, to
save time and money, that we do not install such
obligatory examination. On account of this, Science,
Conscience and Humanity demand that we at least do
not proceed narrow-mindedly when there is a doubt,
be it the slightest, arising as to the responsibility of an
accused, that we take every fact into consideration which
arouses a suspicion of the mentality and that we do not
allow ourselves to be deterred from so doing because on
a former occasion we may have raised the question which
was not sustained by the Psychiater. In order to do this
with a good conscience and to spare ourselves in later
years painful reproaches it would be better to have too
many examined rather than too few."


Method of Treating the Criminal Insane. 393
It has been said that all mankind may be divided
into certain well defined groups based on their behavior.
For instance, that men who pursue surgery as a profession
are of a sadistic nature. Should not those members of
the legal profession who (ignoring the question of the
different degrees of responsibility and their treatment
founded on scientific studies) only see the retributive
side in the treatment of these cases, be with more pro-
priety so classified?
The present system in America is unsatisfactory to
all concerned, the bar, the medical profession, and the
laity, expecially in cases where experts figure and there
has long been a demand for a change from the existing
disgraceful and scandalous proceedings which are now in
many instances only travesties on justice. The time is
ripe for this change and I think almost anything would
be welcome that would offer relief from the present
objectionable system. I was told not very long ago by
a clergyman who had been in attendance upon two men
who were executed that they were both undoubtedly
insane, but did not have the money nor the friends to
intercede for them. This could not happen under the
German method, for not only would they be protected
under Paragraph 51, but there is another paragraph
No. 485, Clause 2, which is also intended for those
becoming insane before or after their act when capital
punishment is involved and which reads: "That capital
punishment shall not be inflicted on the insane."
There is at present both here and abroad a cleavage
forming in the ranks of the legal profession dividing them
in two parties, first, those who adhere to a strictly,
severe, retributive form of justice, punishing crime as
an objective offence with a definite sentence, whom I
call the traditional or unscientific class, and second,
those taking advantage of modern research in psychology,
sociology, anthropology, etc., in the legal treatment of
crime, who take account of the psychophysical element
present in both the crime and the criminal, who take a
subjective view and punish the criminal rather than his


394
W. J. Hickson.
specific crime based on a study of his physical condition,
social standing, training, congenital predisposition, etc.
This, I call the humane, realistic or scientific class.
The work of the latter seems to me to be all a prepara-
tion for a still larger field towards which several lines of
human endeavor are converging, namely: Eugenics,
the betterment of the race, all of which means less
crime. We have preventive medicine, why not preventive
law?
Having tried to advance some reason why we should
seek a change, I will now present what I think will be
the remedy for this whole situation, which is practically
an adoption of the German Penal Code and procedure
modified to meet our institutions. The particular part
of this code on which the whole matter rests, is contained
in Paragraph 51, which reads as follows: "There is no
punishable act, if, at the time of doing it, the actor was
in a state of unconsciousness or of morbid disturbance
of the mental faculties which excluded the free determi-
nation of his will."
It is seen here that through the text of this para-
graph, the question of guilt is identical with the question
of mental soundness. This being the case, what is more
natural than when there is a suspicion of mental defect,
that it should be investigated at the very outset. This
presupposes that the crime has been admitted, and that
there is a suspicion of insanity; where this suspicion exists
the examining judge, prosecutin0 attorney or trial judge,
is constrained to take cognizance of it and must have the
mentality of the accused subjected to the examination
of experts. The question of the mental soundness of
the accused can be brought to the attention of any of
the above mentioned officials by the accused himself,
his friends, his lawyer, or any other person or persons.
Most of the cases that I had to do with personally came
either from the examining judge who exercises the same
function as our grand jury, or from the public prosecutor.
Up until the time the charge is publicly announced,
the question of the irresponsibility of the accused is in


Method of Treating the Criminal Insane.
395
the hands of those connected with the public prosecutor's
office. After the charge has been published, the affair
then lies in the hands of the trial judge and he may,
at any stage of the proceedings, when the question of
mental soundness is brought up, stop the trial and order
an examination by experts, sending the case, if need be
to an asylum for observation, but for no longer than six
weeks in order to establish a diagnosis. If the accused
is found at any time under these circumstances to have
been insane at the time of his act, to have been irresponsi-
ble according to Paragraph 51, the trial is immediately
closed and the accused declared 'not guilty,' and sent to
an asylum if his mental unsoundness is still present,
where he is kept until in the judgment of the director
of the institution, he is cured or sufficiently harmless
to be released, only however, with the sanction of the
prosecuting attorney. Different states have different
laws in regard to this point, ranging from immediate
dismissal if mental soundness has returned up to
detention for two years in the asylum from the time of
showing a return to normal mentality. The entire situa-
tion is thoroughly surrounded by safe-guards which
circumvents its abuse from one side or the other.
Let us suppose a case for an illustration. A man
commits a crime, is arrested and taken with the data
in the case before the examining judge, the latter corres-
ponding to our grand jury. If the judge sees in the con-
duct of the prisoner, the nature of the crime, the evidence,
or what not, a suspicion that the accused was not mentally
normal at the time of the crime, or if the prisoner him-
self, his attorney, relation, friends or any one else
should raise this question, the judge is constrained to
instigate an examination into the matter by experts.
If the insanity is very outspoken, the matter is usually
decided by an expert, there is seldom more than one,
making the examination of the accused, wherever he is
confined. In cases, however, where there is any question
about the matter, or simulation suspected, at the request
of the expert or experts, the accused may be sent to an


396
W. J. Hickson.
observation pavillion of an insane asylum for study.
It is not permitted to detain such a person in such an
institution for a longer period than six weeks for such a
purpose. Such clinics with their psychopathological lab-
oratories are to be found in all the larger cities of Ger-
many, sometimes in connection with a general hospital
for the insane, many times as independent institutions
such as, for instance, the clinic of Professor Kraepelin
in Munich. If, in the judgment of the experts, the pris-
oner was insane according to Paragraph 51, at the time
of the deed, the examining judge declares him not guilty
and hence, as far as the courts are concerned, he is en-
tirely free from any further prosecution as far as the act
in question is concerned, with the exception that he cannot
be discharged from the insane asylum at any time without
the sanction of the prosecuting attorney, except where this
discharge is specifically provided for in the statutes.
The above machinery is also brought into use in
deciding the mental status of cases in civil instances,
as well as witnesses.
What then are the advantages of the German system
over our own? In a few words they are these:
First, they have an insanity act based on intelligent
scientific data, adjusted to fit all forms of mental disease.
Ours on the contrary, "the right and wrong test" is
only applicable to one form of mental disturbance, and
yet we try to measure all cases with it, with the unsatis-
factory results which we all know only too well.
Second, the question as to the sanity of the case
is settled at the very outset. This leaves the field clear
for the trial to proceed on the merits of the case and the
judge, prosecuting attorney and jury are free to go ahead
fearlessly, without any qualms in the performance of
their duties. It practically eliminates the misusing of the
insanity plea as a last resort. It prevents the defence
from taking the court by surprise with the plea of in-
sanity and an array of experts to back it up which the
court is not prepared to meet.


Method of Treating the Criminal Insane.
397
Third, the court appoints the experts who, according
to law, are bound to serve and their emoluments are
also regulated. This obviates the present method here
of both sides employing an array of talent to refute each
other regardless of the facts in the case and only tending
to bemuddle the minds of the jury. Apropos of this,
some one has well said "that there is nothing more certain
than the uncertainty of the honest opinions of the in-
dividuals composing the jury. Consequently there need
be no surprise at the very varying verdicts which are
returned as to the sanity or insanity of a criminal."
In Germany, the judge decides on the expert evidence
submitted, as he is both in training and experience,
best qualified for this important duty.
Fourth, it puts the rich and the poor on an equal
footing which is quite in contrast with the present methods
in vogue here.
Fifth, if the case should be really one of insanity,
trials as carried out here are most prejudicial to the men-
tal condition of the accused and if he should be convicted
and sentenced and at its expiration be released, it will
only be a short time when he will probably be again in
the toils of the law, as many of these cases are slaves
to their diseases and their criminal acts are only symptoms
and manifestations of it, and thus, it is that the vicious
circle is established and the dreary repetition of a short
period of freedom and a long period in the penitentiary
is instituted. In the German method, all of this is avoid-
ed. The insane are practically always detected and sent
to an institution where the proper care is administered
both as regards the rights of patients and those of the
public.
Sixth, in borderland cases where there is a question
of lessened responsibility, it leaves the judge the dis-
cretion of administering milder punishments. Under
our present system, the accused must be declared either
guilty or not guilty.
Seventh; to introduce the German procedure will
not necessitate any very radical changes in our present


398
W. J. Hickson.
methods. We have simply placed the cart before the
horse. If we would change the time of making the plea
of insanity to the outset of the proceedings, we would
have at once secured one of the advantages of their
system.
Eighth; our judges and public prosecutors, as they
are in Germany, should be made to feel that they are
just as responsible to see justice done to the innocent
as to the guilty and that their merits should not be based
solely on the number of convictions they secure.
Of course, the treatment of this whole subject pre-
supposes the existence of well equipped psychopathological
laboratories such as they have in all the largest cities
of Germany. Medicine takes advantage of every possible
means to make a correct diagnosis before instituting
treatment in a case. Why should not the law do like-
wise in order to be in a position to treat these cases
legally with proper intelligence? It is the borderland
cases especially where this laboratory will render some
of its greatest service. Well informed judges, as well as
physicians, realize that these cases, as the insane asylums
are now arranged, should not be sent to them, and their
scientific insight into these cases would be done violence
to if they should be sent to prison. Such laboratories
are the antidote to lawless law. What is needed for these
cases is especially constructed institutions similar to those
for the chronic alcoholics. The two might be combined.
The second part of my theme, "insanity among
criminals in penitentiaries," can be disposed of in a few
words, as I only wish to make a plea for these neglected
unfortunates in the hope of directing and perhaps insti-
gating more generally some measures for their relief.
Any expert in psychiatry or feeble-mindedness cannot
visit our prisons and reformatories without being impressed
with. the large percentage of cases who belong to one or
the other of the above classes, if not to both, confined
there and cannot help but realize that prison life and
discipline were never intended for them and only tends


Method of Treating the Criminal Insane.
399
to aggravate their condition. I would therefore suggest
that the German methods here be also adopted, which are:
(1) That all such cases be removed from the prison
to an asylum in order that they may secure proper
treatment for their disease and be removed from the
deteriorating influence of prison life and discipline.
Many of these cases of insanity are not recognized by
the prison officials and they are constantly being punished
for breaches of prison rules which they, on account of
their disease, are incapable of conforming to. Many
times they are suspected of simulation and severely pun-
ished. If the insanity of a person is recognized by the
prison officials and he is accorded a little attention the
cry of favoritism is immediately raised by the other
prisoners. Isolation for these cases is, on the whole,
.very harmful.
(2) There should be special institutions built to
meet the wants and treatment of these special classes.
Special institutions are needed, constructed with this
purpose in view as these cases are not adopted to ordinary
asylum care, requiring much closer watching and super-
vision, and therefore an institution harboring such cases
would have to be much more closed than ordinarily,
which would therefore carry along with it the same
restrictions on the other patients. People on the whole
who have insane relatives or friends do not want them to
be associated with the criminal element.
Many of the foregoing suggestions are not new over
here and many have already been adopted here and there,
but having been impressed with their advantages and
successful operations abroad, gleaned from my personal
experiences and having a conviction that they could and
should be applied more universally over here, has prompted
me to a discussion of them.


THE IMPERATIVE DEMAND FOR LEGISLATION
TO ARREST THE RAPID INCREASE
OF DEGENERACY.
By Martin W. Barr, M. D.,
Chief Physician, Pennsylvania Training School for
Feeble Minded Children,
Elwyn, Pa
IT has been computed that if the standards of a race—
mental, moral and physical—were raised even one degree
thru each successive century the results would be most
amazing: and that all derelicts on the sea of life—idiots,
imbeciles and insane; criminals, drunkards and courte-
sans; invalids, cripples and deformed—would in a com-
paratively short time disappear, being superseded by a
race of strong men and women.
In this we find assurance in the history of the Greeks,
noted for great physical beauty in both sexes or, to come
down to the present day, the Caprians who also show
magnificent physical development, and the Batz, among
whom immorality, mental defect and chronic diseases
are absolutely unknown. And why? Because, sanitary
marriage and sanitary breeding being to them of vital
importance, they have mated properly and live clean,
wholesome lives.
But sanitary marriage is something more than mat-
ing on purely physical and physiologic grounds for the
purpose of producing healthy children. A true mar-
riage must be founded on love. And love is old—many
many centuries older than sanitary science, and can
never be replaced by it.
(400)


The Demand to Decrease Degeneracy. 401
But common sense must also have its place to bal-
ance against mere emotionalism, and just here is where
wise and effective legislation must protect.
So many mistake passion for true sentiment and
say: "I will marry whom and where I please." And
they do! With what results? Alas! Juvenile courts,
divorce courts, reformatories, asylums and over-crowded
institutions give uncontrovertible reply.
"Heredity is that biological law by which all beings
endowed with life, tend to repeat themselves in their
descendents; and it is for the species, what personal
identity is for the individual." (Ribot.)
Shakespeare never uttered a greater truism than:
"Cowards father cowards, and base things sire base."
Heredity plays a most important part in the pro-
duction of degeneracy. It has been estimated that there
is one feeble-minded person to every 500 of the popu-
lation of the United States; and in the state of Penn-
sylvania alone, no less than 15,000. Of these only about
3,000 are being cared for in institutions—public and pri-
vate—leaving 12,000 avowed cases at large to propagate
their kind.
The startling increase among the feeble-minded is
simply because the sexual impulses are, in both sexes,
greatly exaggerated; and with many females, the child-
bearing age is fifteen years or even younger.
The conviction of this certainty of cause and effect came
to me first after less than five years spent in the study of
defectives, and I have since esteemed it the imperative duty
of my profession to affirm it; and thru the press, and
before various associations—medical, educational and phil-
anthropic—to present the urgent necessity for legal
steps toward the arrest of increase rapidly becoming
appalling.
Thus a prognostication made by me in New Haven,
Conn., some eighteen years ago that the day must yet
come when a marriage license should be obtainable only
by those showing a clean bill of health for two genera-
tions, finds an echo within the past few months in Chi-


402
Martin W. Barr.
cago, Ill., when the dean of the Cathedral of St. Peter
and St. Paul, the Rev. Walter T. Sumner, in a sermon
on the "Sacrament of Marriage," taking advanced ground
in regard to the responsibility of marital relations, issued
the following charge:
"Beginning with Easter, no persons will be married
at the Cathedral unless they present a certificate of
health from a reputable physician, to the effect that they
are normal, physically and mentally, and have neither
an incurable or communicable disease.
"This step is taken only after months of study of
the situation and deliberation as to its advisability.
It is believed that this stand will meet with the immediate
sympathy of the clergy in the churches at large, all of
whom have long felt the undesirability of being party
to the marriage of persons who, because of their physical
condition, should never be allowed to enter into the
marriage state and propagate their species."
In Canada in 1897 before an international associa-
tion a plea for the asexualization of the unfit was pre-
sented, the same being aade before the Congress of
Mothers in Washington, D. C. in 1898; these in response
to more than one appeal from charity workers "that the
cry should go up in language that he who runs might
read."
That the experience is wide-spread and the demand
ever increasing is evidenced in the number of families
seeking relief thru the asexualization of their defective
members both in homes and in institutions, Dr. Pilcher
of Winfield, Kansas, reporting in 1898, some fifty-eight
cases with gratifying results. In the legalizing of this
measure, Indiana leads the way in 1907, an honor which
properly should belong to Pennsylvania, since three
times the will of the people voiced in legislation was
thrice defeated; by the veto of two governors—1905
and 1909; and in 1911 by the influence of one legis-
lator.
Meanwhile, public sentiment grows apace, and will
yet achieve the desired end as have already in 1909,


The Demand to Decrease Degeneracy. 403
the states of California, Oregon and Connecticut, and
in 1912, New York.
The opponents of such legislation argue that although
a man may be forced to surrender his life as atonement
for the taking of another's, the constitution forbids
the infliction of any punishment, cruel or unusual. But
what we seek is not punishment for, but protection from
evil—protection alike for the individual and for the
community at large.
Just as many hold annihilation to be preferable to
degeneration, so does the welfare of society demand
safe-guarding from the poisoning of its life-sources as
imperatively as it does security from life-destruction.
Indeed more so, since the former would largely insure
immunity from the latter. Murder is too often the act
of the irresponsible under the strain of hyper-emotional-
ism; consequently to ameliorate neuroses is to lessen
crime. An ounce of prevention here would surely be
worth many pounds of cure! Forbid the procreation
of those whom science has proven are destined inevitably
for the criminal ranks, and the gallows and the electric
chair will soon fall into disuse.
Once establish the theory that parenthood is a vo-
cation to which all are not called, its seizure by the un-
fit a felony, public opinion thus educated would carry
forward true race ideals to emulate the examples above
considered.
There is so much misunderstanding, or rather I
might say misconception, on the part of the general
public in regard to the operations for sterilization, that
just here it might be well for me to say a few words as to
the modus operandi.
It is not always essential that both testicles and ovar-
ies be removed, but I prefer it as absolute removal is a
certainty beyond a peradventure, and when castration
and oophorectomy are performed in the young, desire
almost always ceases entirely or is at least held in abeyance.
The operation is not in the least serious. The usual
cleansing before—a few whiffs of ether—and the operation


404
Martin W. Barr.
is over. There is a slight drop in temperature followed
by little or no fever, and after a couple of days quiet
in bed, the parts well bathed and kept antiseptically
dressed, the patient is physically as well as ever.
If for sentimental reasons the removal of the testes
and ovaries will not be considered, vasectomy—simply
the excising of a section of the vas deferens in the male—
and fallectomy—the cutting of the fallopian tubes per
vaginam in the female, are feasible and so absolutely
harmless that in the male, the operation may be accom-
plished under cocaine or stovaine anesthesia. After vasec-
tomy and fallectomy, the sexual organs do not wither or
atrophy, and there remains sexual desire and sexual power,
but no power to impregnate.
Under either operation the individual otherwise un-
harmed, may likely live out his full period and, with
animal instincts so subdued as to be no longer a menace
to himself or society, may realize and enjoy life as never
before.
There is much talk just now of the Social Evil
and the cry is "educate the youth in sexual matters."
This the charlatan and the sensationalist are doing in
their own way, flooding the country with disgusting
literature embodying often the experiences of various
persons who, "when all others failed were cured by
Dr. Z"
The serious consequences of venereal disorders are too
well known to need elaboration, but they are not suffi-
ciently recognized as potent factors in the production of
blindness, idiocy and imbecility.
Statistics show that at least 20 per cent of all
blindness is due to gonorrheal infection at time of birth;
and a well known ophtholmologist estimates that fully
95 per cent of blindness in the infants brought to his
clinic is a result of gonorrhea.
The Second Annual Report of the Committee on
Prophylaxis of Venereal Diseases of the American Medical
Association, says that 10 per cent of married men enter
wedlock with chronic gonorrhea; and 10 per cent acquire


The Demand to Decrease Degeneracy. 405
it during married life, the source traceable in 70 per cent
directly to prostitutes. And it further claims 80 per cent
of deaths from pelvic diseases are due to gonorrheal
infection; and also affirms that 50 per cent of all involun-
tary childless marriages may be traced to gonorrhea in
the mother.
And in our large gynecological dispensaries 25 per
cent have venereal disease; and 75 per cent of men and
17 per cent of women at large are thus infected.
Syphilis is estimated variously at from 5 to 20 per
cent of the population of America.
Grave facts are these, but facts that can be verified.
A most pitiable case is that of a little imbecile girl
absolutely blind, the result of gonorrheal infection by
parents. When but an infant of nine months one eye
was enucleated, and at seven years the other, leaving in
total darkness this victim of disease and heredity.
But recently I had brought to my notice, an imbe-
cile girl eight years old—the product of a syphilitic father
who two years previous had fallen a victim to the lust
of a grown man, who inoculated her with gonorrhea.
I know a family of nine idiots, eight of whom are
microcephalic. The parents are both imbeciles and both
syphilitic.
And these are only a few of many cases I could cite.
Legislative prohibition of the sale of patent medicines
—the so-called specifics for social diseases, and also the
withholding of marriage license from those afflicted,
would largely stem the tide of ill. Those seeking a mar-
riage license should be required to present a certificate
from a physician in good standing—said certificate to
embody the report of an exhaustive examination, both
microscopic and macroscopic.
Surely as Herder says: "To help where no one
helps, to try to effect improvement where no one attempts
it, to espouse the cause of humanity wherever it lies
imprisoned, languishing in body or in spirit, in things
earthly or of eternal life, this is Christianity."


406
Martin W. Barr.
There is nothing that clings through generations
like insanity, so nearly related as it is to idiocy, and
often the difference is one of degree rather than of kind.
Note the idiot and the dement. Indeed every anomaly
o the emotions is clinically an indication of either mental
enfeeblement or mental disease.
In a careful study of insanity covering a period of
9 years, based on an investigation of 136,478 individuals
20.5 per cent was found due to such heredity.
From my own individual study I quote six examples
thus:
From one insane woman, who had an insane brother
and sister both committing suicide, sprang in two genera-
tions, 13 degenerates—3 insane, 9 feeble-minded and 1
criminal; and three of these were also afflicted with epilepsy.
Another shows the descendants of an insane man
numbering in 8 generations 113 individuals. Of 45 mar-
riages noted in the family history, 29 show an interming-
ling with good stock and 16 with bad.
The prepotency of pure blood is found in 66 normal
children against 47 degenerates—12 insane, 5 imbeciles,
5 epileptics, and 25 whose mental peculiarities and unsta-
ble nerve centres set them apart from normal.
In addition there was noted 5 premature births,
6 infants still born, 4 dying in infancy and 4 illegitimate.
One idiot woman has nine illegitimate idiot children,
the fathers unknown.
In one family connection after over a hundred years
of intermarriage there are found eighty-four mental
defectives—idiots and imbeciles.
In another the father, two daughters and a grand-
child are all imbeciles; and yet another shows thirty-
four imbeciles in two generations.
Surely among the long list of helpless people in the
world, none are more helpless then the insane and the
feeble-minded: the former, sad wanderers in a strange
country, whose boundaries are limitless, have lost their
places in the school of life—are alive and yet dead;
the latter are infants without the promise of life, with no


The Demand to Decrease Degeneracy. 407
future, and so will they ever be. They do not lack
strength, they lack will; and many have not sense enough
to be genuine rogues, nor determination sufficient to be
honest people.
Yet these poor unfortunates are:
“As he who lives through perilous paths must pass,
And life-long trials, striving to keep down
The brute within him born of too much strength.”
(Epic of Hades.)
That the public mind is aroused to a sense of danger
is proven by the fact, that no less than thirty-five states,
including the District of Columbia, have laws restricting
the marriage of those deemed unfit, for causes specified
as follows:
Insanity, 30–California, Delaware, District of Colum-
bia, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Ken-
tucky, Maine, Massachusetts, Michigan, Minnesota, Mon-
tana, Nebraska, New Jersey, North Dakota, Ohio, Okla-
homa, Oregon, Rhode Island, South Carolina, Utah,
Vermont, Virginia, Washington, West Virginia, Wisconsin
and Wyoming.
Idiocy and Imbecility, 22–Connecticut, District of
Columbia, Illinois, Indiana, Iowa, Kansas, Maine, Massa-
chusetts, Michigan, Minnesota, Mississippi, (prescribing
divorce if discovered,) Nebraska, New Jersey, Ohio,
Oklahoma, Rhode Island, South Carolina, Utah, Vermont,
Washington, Wisconsin and Wyoming.
Epilepsy, 9–Connecticut, Indiana, Kansas, Michigan,
Minnesota, New Jersey, Ohio, Utah and Washington.
Venereal Disease, 4–Indiana, Michigan, Utah and
Washington.
Incapable of consent from lack of understanding, 4–
Arkansas, New York, North Carolina and Oregon.
Drunkenness, 2–Ohio and Washington.
Indigence, 1–Indiana.
There is no actual regulation by statute in thirteen
territories and states: Alabama, Arizona, Colorado, Flori-
da, Indian Territory, Louisiana, Maryland, Missouri,


Martin W. Barr.
New Mexico, Pennsylvania, South Dakota, Tennessee
and Texas.
England, while not in sympathy in regard to sterili-
zation, has, this year, adopted the Mental Deficiency
Act which coming into operation on the first day of
January, 1913, reads thus:
If any person intermarries with, or attempts to inter-
marry with any person known to be a defective within
the meaning of this Act, or if any person who solemnizes,
procures or connives at a marriage in which either of
the contracting parties is proven defective, he shall
be guilty of a misdemeanor. And further, if any person
carnally knows or attempts to have carnal knowledge
of any female defective (the consent of the female
being considered no defence) he shall be adjudged guilty,
under penalty of imprisonment for from 6 to 24 months—
with or without hard labor—or a fine of not less than
twenty nor more than fifty pounds.
Such the trend of thought and action in the opening
decade of the twentieth century. Much has been ac-
complished, but the census of increase shows need for
yet greater protection.
In the light that science reveals of the persistent
power of heredity, these restrictions should cover at least
two generations. Thus, and thus only may the desired
end be attained, for truly as Amiel observes: "What is
threatened today is moral liberty, conscience, respect
for the soul, the very nobility of man. To defend the
soul, its interests, its rights, its dignity, is the most
pressing duty for whoever sees the danger. What the
writer, the teacher, the pastor, the philosopher, has to do,
is to defend humanity in man, to war on all that de-
bases, diminishes, hinders and degrades him; and to
protect all that fortifies, ennobles and raises him."


IS GENIUS A SPORT, A NEUROSIS OR A CHILD
POTENTIALITY DEVELOPED?*
By James G. Kibrnan,
Chicago, IU.
Formerly Assistant Physician Manhattan State Hospital
(1874-8) and Superintendent Chicago State Hospital
(1884-9)
Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association; Honorary Member Chicago Neuro-
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professor Neurology Chicago Post-
Graduate School 1903; Professor of Nervous and
Mental Diseases Milwaukee Medical Col-
lege 1894-5; Professor of Nervousand
Mental Diseases Medical Depart-
ment Loyola University 1905;
Professor of Forensic Psychi-
tary Kent-Chicago
College of Law.

HE Freud school, ignoring the essential law of the
etiologic and psychologic moment, assuming that
sex, sex creeds and sex expressions are not evolutions
but the results of innate ideas whereby shock results
in the child to innate modesty, naturally ignore the general-
ized types of emotions, thoughts and feelings just as
the theologic sciolists in evolutionary discussions ignore
generalized types like the ameba where all organs are
responses to needs and irritants and not specially organ-
ized. The underlying phenomena of mental activity,
according to Freud, is the wish to exist from the nutri-
tional and reproductive standpoint. At the outset, as
•Continued Alienist and Neurologist May 1913.
(409)


410
J as. G. Kiernan.
many biologists like Rolph forty years ago, showed the
reproductive is an evolution from the nutritive function,
which implies, moreover, fully developed consciousness.
The older psychologists, who called these instincts,
put them more nearly in their true place. The placing
of a sexual indifference from its possible developments
by environment in the same group as homosexuality
is as illogical as the confusion of the coexistence of sexuality
perfectly developed with the states where it coexists with
other natural functions. Freud claims that the child's
sexuality is polymorphousperverse, that is that it is made
up of four rudimentary instincts: heterosexual, homosexual,
sadistic and masochistic. The child is always autoerotic.
To any student of sex psychology who has followed the
evolution of sex along the lines elsewhere indicated,1
this exhibits a serious miscomprehension of the generalized
type of sex in the child whose sex organ outward ex-
pressions often occur, as Renouf has pointed out, before
birth.
Sex does not exist in the lowest protozoa but the
reproductive state there gradually passes into herma-
phrodism, then into the separate sexes. Psychologically
the same evolution occurs. Masochism is not diverse
from either homosexuality or heterosexuality. It may
occur with either and so may deonism. While Freud
plays here to the amateurish desire for absolute terms
he ignores fundamental laws of evidence. Even in
seeming homosexuality there is a widely different type,
psychologically speaking, as D. Stefanowsky2 points out.
As A. Moll3 had previously shown when the subject
believes himself to be a female, face to face with another man,
when he desires to be caressed, embraced, possessed by the
latter, when he adores in this last, the male in all his
splendor of virility, then the alienist has to do with a per-
version, which belonging to a special category, should receive
a special designation in the interest of scientific precision. It
could appropriately be named uranism, as was suggested by
1.
2.
3.
Alienist and Neurologist April 1891.
Alienist and Neurologist October 1894.
Die Contrare Sexual Emfindung Berlin 1893.


7s Genius a Sportf
411
the famous Hanoverian assessor, Karl Ulrichs, who has
expressed the essence of uranism in the phrase "female
soul in a male body."
The persons afflicted with uranism are called urnings.
They are rarely addicted to passsive paederasty and almost
never to active, as in many instances impotence has been
produced by excessive masturbation. According to their
manifestations of inversion they are divisible into two
types. The platonics or erotomaniacs who are contented
with an ideal, respectful love accompanied with erotic
rumination (Binet.) The second type, the fellators, re-
place the vaginal cavity to them wanting by the buccal.
According to Laurent the title of these last in the prisons
of Paris, is "butter-merchant." Luys has described
several types, above all the case of a young Jew whose
picture is taken from the life. "In the daily satisfaction
of his shameful passion, his lips where hyperaesthetic and
the pleasure, whose extinguishment among his victims he
aided, he asserted, the intensity of the orgasm provoked
far surpassed the intoxication of normal sensuality.
He envied in his sensual desires the low prosti-
tutes, who in blind alleys and retired places throw them-
selves at the feet of debauchees for the same purpose.
These women he supplicated, gold in hand, to allow him
to replace them in their revolting function.
Active paederasts, the only true paederasts, are attracted
by immature youths (gytons) of female feminine aspect.
These paederasts comport themselves as males; their
volupty remains always virile, since relations with females
are frequent with them. Such relations are impossible to
"urnings," as they experience toward women an intense
"trade rivalry," which often attains the extreme degree
of the "woman hater." Preference of paederasts for
anal coitus is easily explained by pathological association,
established between the idea of such a joyance and volupty,
such as occurs in many cases of erotic fetichism, (or
sexual symbolism) as in the adoration of table-cloths,
chemises, drawers, night-caps, etc. A similar association


412
J as. G. Kiernan.
conceived during childhood, re-enforced by masturbation
and erotic rumination, may with time become indissoluble
and indestructible.
Stefanowsky draws the following distinctions between
the two states:
Paederasty.
1. Is more often acquired than innate. Appears
late, sometimes only in senility.
2. The lust manner of acting and feeling is masculine
and often co-exists with normal coitus.
3. The appearance is masculine. The tastes and
habits are virile.
4. The subject is attracted to boys of feminine
aspects (gitons.)
5. The penchant is purely material and gross, and
consists in assuagement of lust by anal coitus.
6. Paederasty is often sadistic, as in the cases of
Nero, Giles de Retz, Marquis de Sade, the German artist
Zastrow, and many others.
Uranism.
1. Is absolutely innate and manifested in youth.
2. The lust manner of acting and feeling is feminine,
and is accompanied with envy and hatred of women.
3. The external aspect is feminine, as are the tastes,
habits and dress tendencies.
4. The subject adores well-built virile men.
5. The penchant is often pure, ideal, disinterested.
Anal coitus is rare; masturbation, especially buccal, occurs.
G. Uranism is almost always accompanied by a more
or less pronounced passivistic state.
The evidence against Wilde leaves little doubt of
the existence of uranism which is peculiarly borne out
by his mental attitude toward games.
Among the evidences of degeneracy in genius often
cited is change in occupation. While, as I pointed out
in a critique on a translation of Lombroso,4 this often
normal as an experience of environment in the U. S.,
4. Alienist and Neurologist, Oct. 1891.


Is Genius a Sportf
413
still even in the British Isles, rigid as conditions used
to be, it may likewise be normal under the pressure of
circumstances and an ideal.
The poet Crabbe was an excellent illustration of
this, as I pointed out eight years ago.6
The celebration of the sesquicentenary of the birth
of Crabbe, the poet, at Aldeburgh, has attracted some
attention to his career as a physician. Crabbe is much
more read even in the United States than one would
infer from the Lancet's insinuation that he has dropped
out of perusal by the multitude. In the cheap edition,
which implies considerable circulation and perusal, Crabbe
still appears and delights a much larger circle than he did
at the height of his boom. Ebenezer Elliott, "the corn-
law rhymer," was of opinion that Crabbe's realism must
be repugnant to the Americans. Crabbe, he remarks,
"takes his hideous mistress in his arms, and she rewards
him with her confidence by telling him all her dreadful
secrets. The severity of his style is an accident belong-
ing not to him but to the majesty of his unparalleled
subject. Hence it is that the unhappy people of the Uni-
ted States of America cannot bear to read Crabbe.
They think him unnatural, for he is so to them, for in
their rigid country cottagers are not paupers—marriage
is not synonymous with misery."
George Crabbe was born in Aldeburgh, Suffolk,
England, December 24, 1754. His family while in com-
petent circumstances, were not as a rule highly educated.
His father could barely read because he indulged in a
preference for the sea. Crabbe was sent to school at
Bungay in order that his literary predispositions, which
had already attracted attention, should be developed.
The enjoyment of physical chastisement by the master
of that school, not uncommon in school masters in a day
when opinion fostered rather than forbade corporal
punishment of soldiers, sailors, scholars, and servants,
came near smothering Crabbe's tendencies to knowledge.
At twelve he was removed to a better institution, where
5. Medicine, 1905.


J as. G. Kiernan.
he achieved considerable attainments. Here he wrote
much doggerel and some creditable verse. The aim of
this second school was to qualify him for the medical
profession, as it had been decided he should be bred as
a surgeon. Accordingly he was, like Lawson Tait,
bound apprentice to a country practitioner. From the
time he left the school until he was apprenticed to a
surgeon near Bury St. Edmunds he had still irregular
warehouse training. The first master employed him as
an errand boy and man of all work after fashion of
Marryat's "Japhet in Search of a Father." Three years
later he was regularly bound to a surgeon at Woodbridge.
During this period he published his first poem, which was
on a quasi-professional topic, "Inebriety." In 1775,
when his apprenticeship and his twentieth year were
completed, he returned to Aldeburgh, hoping his father
would be able to send him to London to complete his
medical education. At this time he obtained the
appointment of parish medical officer, but all his father
could offer him was a place in his warehouse. The poet
was therefore compelled to trust to his own resources.
He succeeded in obtaining funds to study medicine
for eight months in London, when he returned to Alde-
burgh as an assistant to a Mr. Maskill as a surgeon and
apothecary. Maskill left Aldeburgh soon after, and Crabbe
was again consigned to his own resources. Except during
the winter of >1778 and 1779, when the militia were
quartered at the town, he did not have much success in
practice. He later came to London to try his hand at
literature. Here the success of the "Library," the profits
of which were given to the author by the publisher,
brought him fame. He was ordained in the Church of
England in 1781. He was at first assistant curate at
Aldeburgh, and afterward held small clerical places in
different parts of England. Crabbe never lost the high
ethical ideals of the medical profession. Unlike many
clergymen he never tolerated the quack, as witness the
famous chapter on "Physic" in "The Borough:"


Is Genius a Sportf
415
There was a time, when we beheld the Quack,
On public stage, the licensed trade attack;
He made his labor'd speech with poor parade
And then a laughing zany lent him aid;
Smiling we passed him but we felt the while,
Pity so much that soon we ceased to smile:
Assured that fluent speech and flow'ry vest
Disguised the troubles of a man distressed;
But now our quacks are gam'sters and they play
With craft and skill to ruin and betray.
With monstrous promise they delude the mind
And thrive on all that tortures human kind,
Void of all honor, avaricious, rash,
The daring tribe compound their boasting trash—
Tincture or syrup, lotion, drop or pill,
All tempt the sick to trust the lying bill;
And twenty names of cobblers turn'd to squires
Aid the bold language of these blushless liars.
There are among them those who cannot read
And yet they'll buy a patent and succeed;
Will dare to promise dying sufferers aid,
For who when dead can threaten or upbraid.
With cruel avarice they recommend
More draughts, more syrup to the journey's end.
"I feel it not;" "Then take it every hour."
"It makes me worse;" "Why then it shows its power."
"I fear to die;" "Let not your spirits sink,
You're always safe while you believe and drink."
How strange to add, in this nefarious trade
That men of parts are dupes by dunces made,
That creatures Nature meant should clean our streets
Have purchased lands and mansions, parks and seats;
Wretches with conscience so obtuse, they leave
Their untaught sons their parents to deceive;
No thought of murder comes into their head;
Nor one revengeful ghost to them appears
To fill the soul with penitential fears.
Yet not the whole of this imposing train
Their gardens, seats and carnages obtain;
Chiefly indeed, they to the robbers fall
Who are most fitted to disgrace them all:
But there is hazard—patients must be bought,
Venders and puffers for the poison sought;
And then in many a paper through the year,
Must cures and cases, oaths and proofs appear;
Men snatched from graves as they were dropping in,
Their lungs coughed up, their bones pierced through their skin,
Their liver all one scirrhus and the frame
Poisoned with ills which they dare not name.
Men who spent all upon physicians' fees,
Who never slept nor had a moment's ease,
Are now as roaches sound and all as brisk as bees.


416
Jas. G. Kiernan.
Crabbe dealt a severe blow at the soothing-syrup
fads, as prevalent in his day as in ours. The practice
of nurses in this particular was identical with that of
to-day. Too many newspapers at present still urge the
"soothing-syrup," albeit the rise of a non-narcotic, non-
secret nostrum has nearly killed the soothing syrup
in maternal favor:
Who would not lend a sympathizing sigh
To hear yon infant's pity-moving cry,
That feeble sob uniike the new born note
Which came with vigor from the op'ning throat.
When air and light first rushed on lungs and eyes
And there was light and spirit in the cries;
Now an aborted faint attempt to weep
Is all we hear; sensation is asleep.
The boy was healthy and at first expressed
His feelings loudly when he fail'd to rest.
When crammed with food and tighten'd every limb
To cry aloud was what pertain'd to him.
Then the good nurse (who had she borne a brain,
Had sought the cause that made her babe complain)
Has all her effort, loving soul applied
To set the cry, and not the cause, aside;
She gave her powerful sweet without remorse,
The sleeping cordial—she had tried its force.
Repeating oft; the infant freed from pain
Rejected food but took the breast again,
Sinking to sleep, while she her joy express'd
That her dear charge could sweetly take his rest.
Soon she may spare her cordial; not a doubt
Remains, but quickly he will rest without.
When a physician or a lawyer abandons his pro-
fession for that of the clergyman he usually does it in
obedience to an ideal, hence retains the higher ideals
of his previous profession. When a clergyman becomes a
physician or a lawyer he usually does it, not in obedience
to an ideal or revolt against theologic untruth, but for
commercial or social reasons whence the charlatanistic
and special pleading for practice of the clergyman-lawyer
and clergyman-physician. While American environments
are said to differ greatly from European, yet the commer-
cial element often survives to make them akin. This
is peculiarly shown in regard to sanitation as oppossed to
local interests.


Is Genius a Sport?
417
Ere the days of the drainage commission, war was
made upon sanitarians by "business" men and boodling
politicians. Plutocratic demagogues, including the then
city engineer and Mayor6 railed at the water-borne
origin of typhoid and diarrheal disease. In sanitation
more than usual tact is necessary lest the unlucky physi-
cian with stern ideas of public welfare be not only de-
feated in his objects but held up to reprobation as an
enemy of the people, like the hero of Ibsen's famous drama.
The hero of "An Enemy of the People," who is physician
to a mineral spring town, has discovered that the springs
are contaminated with typhoid bacilli, and insists that
the water shall be taken from a place higher up in the
mountains where it will not be polluted by sewage.
Dr. Stockmann has a career essentially that of the
English novelist Dr. Smollett, whose attempt to reform
the abuses at the Bath spa led to an ostracism similar
to that portrayed by Ibsen. The abuses of Bath as
depicted (Humphrey Clinker) by Smollett are singularly
like those often credited to European and American water-
ing-places. Smollett's visitor to Bath remarks: "The
water contains but little salt and calcareous earth mixed
in such in considerable proportion as can have very little
if any effect on the animal economy. This being the case
the man deserves to be fitted with a cap and bells who,
for such a paltry advantage as the spring affords, sacrifi-
ces his precious time, which might be employed in taking
more effectual remedies, and exposes himself to the dirt,
the stench, the chilling blasts, and perpetual rains that
render this place intolerable." Stench was then defended
as health-giving. A most humorous defense of stench
as salutary is given by the fashionable Bath physician.
One of the defects of sanitation in the bathing pool
is thus depicted:
"A child full of scrofulous ulcers was carried in the
arms of one of the guides under the very nose of the
bathers. Suppose the matter of these ulcers, floating on
6. Trans. Illinois Med. Society, 1881.


418
Jas. G. Kiernan.
the water, comes in contact with the skin when the pores
are all open, what must be the consequence? Even con-
sumption itself is highly infectious. When a person dies
of it in Italy the bed and bedding are destroyed. The
other furniture is exposed to the weather and the apart-
ment whitewashed before it is occupied by any other
living soul.
There is some regurgitation from the bath into the
cistern of the pump. 'In that case what a delicate bever-
age is every day quaffed by the drinkers, medicated with
the sweat and dirt, dandruff, and abominable discharges
of various kinds from twenty different diseased bodies
parboiling in the kettle below at the private bath." All
these charges are made against watering-places today.
The infectious theory of phthisis was held not only in
Italy at this time (1750,) but a quarter of a century
earlier by the Irish physicians, who like the Scotch were
more en rapport with continental medicine than their
English confreres.
Ibsen's picture of the Scandinavian watering-place
a century later is a replica of that of Smollett. Sanitary
agitation has diminished these abuses somewhat. The
strained defense of municipal authorities in charge of
water provision by Nordau (Degeneration) against Ibsen
shows, however, that the old commercial speculative
spirit which always defies sanitation is still alert. Nor-
dau's defense of the municipal authorities who ignore
sanitary requirements as laid down by competent medical
men has received a singular blow in East Orange, N. J.
East Orange has water-works. The local authorities
dismissed the medical officer of the town because he was
too suspicious of the quality of the water and of its
bacterial contents. This angered the local reform league.
The councilmen attempted to stifle discussion. Some one
in the league recalled Ibsen's "An Enemy of the People."
There was water pollution to parallel East Orange's water-
works. There was a corrupt, selfish, petty local govern-
ment trying to silence honesty and enlightened public
opinion and its spokesman. In fine, what was true of


Is Genius a Sport?
419
Norway when Ibsen wrote was true of East Orange in
1905. A company was summoned from New York to act
"An Enemy of the People" for the instruction of East
Orange. The hall was filled to the last seat. The owner
of the hall, a member of the ring, did not dare refuse it.
Councilmen and politicians filled the front rows fondly
believing they were seeing a play written by some "Dutch-
man" for the occasion. He was probably from Hoboken.
The reformers and their friends had the rest of the seats.
They saw a local personage in every character, a local
incident in every episode, a local meaning in nearly every
speech. The result of the play was an arousal of public
sentiment. It emphasized the water-borne character of
disease and replaced the "boodling" authorities by an
efficient council. East Orange, however, does not seem
to have an organized mob of Eddyists, otherwise there would
have been a union between them and the "boodling"
politicians for the destruction of sanitation.
One of the great American philistines, James Russell
Lowell, seems to illustrate the criteria Lombroso lays down
as tests of the anomaly he calls genius but which clearly
illustrate effects of adolescent stress. He showed great
vacillation in the choice of an occupation between law,
medicine, business and theology, and finally chose law
(which like Carlyle and for allied Carlylen reasons
he disliked) chiefly to avoid criticism for vacillation.
His father was of English stock and his mother came
from the Scandinavian Orkneys and was full of their
ballad lore.
So badly had the business of living gone with James
Russell Lowell that when he was about 20, he decided
to end it all. He even held a cocked pitol to his fore-
head, but he had not the courage to pull the trigger.
Not long after that he met Miss Maria White, a frail
woman with a fine mind, a poet of delicate power,
of high ideals and splendid courage. Lowell married
her when he was 25, and it was then that he found
himself.


420
Jas. G. Kiernan.
From the time he was 19, when he was graduated
from Harvard, Lowell knew 10 very unhappy years.
He made a percarious living practicing law, which he
hated, and he received very little for his contributions
to the magazines, which took up a large part of his
time, but for all that he decided to devote himself to
literature. He started a magazine called Pioneer which
lasted three numbers. In 1843 he published a collection
of poems, and a year later "Conversations on Some of
the Old Poets," which the critical praised. In 1844
he went to Philadelphia as an editorial writer on the
Pennsylvania Freeman, but he found the publishers
timid, and he did not feel free to express his convictions.
He returned to Cambridge, struggling along as a contrib-
utor of poems and essays to newspapers and magazines
and as a correspondent of the London Daily News.
The invalidism of his wife, the death of his two young
children, his mother's mental illness and his small income
made Lowell almost a recluse. It was under these
conditions that he wrote what is perhaps his finest poem,
"The Vision of Sir Launfal," in which he says:
And what is so rare as a day in June?
Then, if ever, come perfect days;
Then heaven tries the earth if it be in tune
And over it softly her warm ear lays,
Whether we look or whether we listen,
We hear life murmur or see it glisten.
These were followed by the "Bigelow Papers,"
the humorous, satirical verse, which brought him general
fame and a very considerable financial return.
He became the first editor of the Atlantic Monthly,
which was established in 1857. He succeeded Longfellow
as professor of modern languages and literature at Har-
vard, and occupied the chair for twenty years, when he
became minister to Spain under President Hayes. He was
transferred to the court of St. James in 1880 and remained
there five years. He died in 1891.
The "Fable for Critics" was peculiarly strong evi-
dence of the philistinism that marred his work which, not
his genius, was the outcome of the maternal defect


7s Genius a Sport?
421
showing itself in the adolescent vacillation and Welt-
schmertz. His marriage was an illustration of the neurotic
attraction for neurotics. As W. C. Brownell7 points out.
Lowell lacked both philosophic spirit and critical
instinct. In consequence his criticism, which "clearly
grew out of his reading habit, not out of his reflective
tendency," is "largely comment." His critical essays,
says Mr. Brownell, (writing in Scribner's Magazine),
"are distinctly artless in both the literal and the derived
sense of the word"—representing in each case "a cairn
of comment" rather than an organic structure. His
lack of the philosophic spirit is stated in another form
when we read that he had little interest in "ideas as such,
in and of themselves"—an asset "for which there is
absolutely no adequate substitute in criticism." Lowell's
ideas were in general "the conceits, notions, fancies of
the true poet, of the observant rather than the reflective
order." From his essays we learn little concerning
his own general conceptoin of life and art. As Brownell
remarks:
"He had apparently no particular philosophic view
to advocate or express, and his essays have no general
philosophic derivation. His critical work as a whole
lacks the unity of a body of doctrine or even a personal
point of view. It does not discuss principles. Its chief
value is exegetical. This is why he is at his best in his
'Dante,' his 'Chaucer,' his 'Dryden,' his 'Shakespeare,'
and the Eliazbethans generally. For as exegesis is the
strongest part of his criticism, linguistics are the strongest
part of his exegesis, and he is even better in discussing
the language than in explaining the substance of the
poets. For language he had the instinct to be expected
of such a master of expression and of archaic, re-
condite, or foreign language he was an admirable inter-
preter—being both a poet and a precisian. In this field
it would be difficult to over-praise him."
The essay on Dante, the result of twenty years'
study, called Lowell's ablest performance in criticism,
7. Scribnor'j, Feby. 1907.


422
Jos. G. Kiernan.
Mr. Brownell finds, gives the effect of having been
"written at random." In Dante's case, more than in
most others, to admire is to comprehend. Lowell's ad-
miration is limitless, and one feels that he understood his
subject. But his expression of it is only less inartistic
than it is uncritical. His twenty years of study have
resulted in his comprehension oft his theme, but not in
reducing it to any definite proportions or giving it any
sharpness of outline. There is nothing about it he does
not know and, perhaps one may say, nothing in it that he
does not appreciate. But he does not communicate
because he does not express his general conception of
Dante, and he does not because he has not himself,
one feels sure, thought it out into definition. He is
interested in ranking his poet, not describing him. Dante
is next to Shakespeare, next to Homer, above all others,
and so on. Think of him in connection with Byron!
'Our nineteenth century," he says, 'made an idol of
the noble lord who broke his heart in verse once every
six months, but the fourteenth was lucky enough to
produce and not make an idol of that rarest earthly
phenomenon, a man of genius who could hold heart-
break at bay for twenty years, and'—but no one can
care for the conclusion of such a sentence as that. Lowell
himself has been less fortunate than he says fourteenth
century was, but his idolatry merely consecrates the
looseness that mars his admirably sympathetic essay."
It reveals a fine trait in Lowell, says Mr. Brownell,
that his essays should be, in general, so compact of
eulogy. "They constitute a veritable literary monument,
. . . and might be entitled 'The Praise of Great Writers.'"
But alas! "there is no qualification to his praise to give
it persuasiveness, to say nothing of permanence." Thus:
"The Dante essay (to recur to this representative
example) is all patently partisan—patently therefore,
in the sixth century of Dante criticism, either unsound
or superfluous; the day of discrimination is never over,
but wholesale consideration reaches finally its term.
Lowell is, like all the temperamentally energetic but


Is Genius a Sport?
423
reflectively indolent, particularly fond of superlatives.
And though superlatives may be just, they do not de-
fine. Obviously they state the known in terms of the
unknown—A in terms of X, as Lowell might say; clearly
the converse of the critical order. The general atmosphere
of idolatry that they create is unfortunate because it is
plainly 'too good to be true,' and in a world of imper-
fections, the result is bound to lack verisimilitude. Dante
in Lowell's pages ceases to be credible; or, if abstractly
credible, is concretely very difficult to conceive as a
thirteenth-century Florentine, as well as a very different
personage from the Dante of other commentators."
Lowell who had, as have most of the philistines, like
primitive man a repugnance to general principles, had a
peculiar dislike to Poe's attempts to establish at an
unfertile American period the principles of rhythm and
beauty in style, which found vent in the silly.
"Iambics and pentameters which make men of
common sense damn meters" of the "Fable for Critics"
which in the light of modern international reverence
for Poe as a master of style and rhythm damns Lowell
eternally as a genius marred by philistinism.
(To Be Continued.)


THE ADEQUATE PUNISHMENT AND CARE OF
DEFECTIVES.*
By E. S. Goodhue, M. D., LL. D.
Vice-President (for Hawaii) Medico-Legal Society of New
York; American Del. to Medico-Legal Congresses in
Brussels and London, 1909; International Con-
gress on Inebriety, Etc.; The Doctorage—
Hawaii.
IN view of the very general awakening in the United
States at least, regarding the legislative restriction
of venereal diseases, and some provision for the sterili-
zation of habitual criminals, the insane, idiots and other
incurable defectives, I have taken the liberty of empha-
sizing a few points, and of proposing for your considera-
tion some similar action as a remedy for conditions in
Hawaii which call for sane and adequate remedial measures.
There is no need, gentlemen, in your presence, for
me to review at length the history of the evolution of
criminal jurisprudence, to enumerate the forms of cruel
and barbarous punishments inflicted upon the irresponsible
and defective, since the earliest times, both by judicial
and ecclesiastical courts, or to trace the first rift which
let in the light of a better knowledge of the causation
of crime upon the dark and depressing background.
As one of our profession has said:
"Society has been a raging stream, dashing against
rock barriers, which have thrown it back upon itself:
it has been filled with eddies and counter currents. In
the conflict with crime, society may be compared to a
blind giant, dealing furious blows at an unseen but ever-
present and irritating foe, sometimes hitting the mark,
but, alas, too often missing it."
•Read before the Hawaiian Medical Society, March 1913.
(424)


The Punishment and Care of Defectives 425
Throughout all this cpnflict it has been the office
of the scientific physician and humanist to offer an ex-
planation of the persistent appearance of exasperating
offences against innocence and decency, to define crime,
and suggest some remedy therefor; not only to satisfy
an unreasonable and unreasoning rage against the offender
by suggesting wiser measures of repression, but to demon-
strate that the only means of diminishing crime is by
treating the criminal with reason and sympathy.
Biology, ethnology, anthropolgy, sociology and their
various divisions, we have brought to bear upon the in-
vestigation of the diseases of society, and we have shown
by concrete demonstration that the basis of crime and
insanity both are physical, that "its manifestations are
physical, mental and moral."
Our first assaults were made upon the mistreatment
and injustice shown the insane who, from earliest periods,
have been treated with disgraceful ignorance and cruelty,
not only by the populace but by legislators. Until
within comparatively recent times our laws and institu-
tions for the mentally inefficient have been a blot upon
our civilization, and indeed there is still much in need of
modification.
There are yet truisms to impress upon legislators
and judges regarding their attitude towards insanity and
the insane, and we must be prepared to endure the shafts
of ridicule and sarcasm for our plea in protection of the
mentally irresponsible murderer or rapist.
Perhaps no greater or nobler work has developed
upon us than our defence of these poor defectives of the
world who have been hounded by ecclesiastical anathema
and judicial fiat; towards whom though as irresponsible
as babes, has passed the hatred of all classes.
It has become our duty also by virtue of our special
knowledge and the sympathy developed through our
contact with the diseased, to champion the rights of
children, of women, of the insane, of all who in any way
suffer from physical or social errors. Theology has
rendered them no aid, except to offer its universal euthana-


426
E. S. Goodhue
sia; during the life of the culprit it waived the offices
of extenuating limitations and circumstances. "Away
with science," it cried: "Crucify the offender!"
Law and so-called justice were no better. They
merely reflected hierarchical dogmatisms, and so it has
remained for our profession to suffer blame and even
persecution for a position we have established upon the
basis of definite knowledge and humanity, and which,
thank God, we shall never abandon until the class civili-
zation has produced, is given the consideration and treat-
ment it deserves. But our duty as men of science does
not end here. We are as much interested in the good of
the normal as we are that justice shall be rendered the
abnormal. We stand for the interests of society as
well, and for this reason acknowledge that punishments
are necessary; that the perpetrator of crime no matter how
irresponsible he may be, should be restrained.
We have no sympathy for the mere sentimental
consideration of the criminal, for maudlin expression
which lionizes the culprit at the expense of his victim:
not at all. But we demand that he shall be treated
as his condition requires, and that his punishment,
whether it be removal to the hospital, the insane
asylum, or the penitentiary; whether it be police
supervision, or sterilization, shall be administered for his
own best good and the interests of the community against
which he has used his liberty.
Again, having the specific knowledge possessed by
no other class, it is our duty to make such recommenda-
tions for the public good as may seem expedient to us.
Knowing of the extent and frightful havoc wrought
by the spread of venereal diseases everywhere; of the ig-
norance and consequent indifference shown by the in-
nocent and culpable alike, it has become our office to
inform the public of the danger, and to devise means
through the aid of our legislatures, for the protection
of all classes, men, women, boys, and girls, and for the
special protection of women by regulations requiring
a physical examination of all applicants for marriage.


The Punishment and Care of Defectives 427
Moreover, knowing the basis of crime, and especially
of sexual offences; having demonstrable evidence of the
processes of heredity and the transmission of tendencies
and susceptibilities which explain the increasing number
of insane, idiots, habitual criminals, epileptics, incurable
defectives and degenerates, and possessing a humane
remedy in our hands, it is imperative upon us as the
guardians of public health and morality, to make such
recommendations as shall secure for us the necessary
authority to act.
With the object lesson of several recent sexual
crimes in our community, and the consequent recommen-
dation by unqualified persons, of summary and brutal
punishments therefor, let us emphasize the importance of
immediate action on the part of our law makers towards
the authorization of an adequate law which at once
will be a measure of reason and of prevention.
New York, Kansas, Utah, and one or two other
states will soon require official notification of venereal
diseases, which, in view of their prevalence and easy
dissemmination, should have been officially recorded
years ago.
Let us take up the matter of the marriage of those
suffering from venereal disease.
Before this body it is not necessary for me to discuss
the urgent need of some enactment which shall have
for its object the prevention of marriage between parties
either of whom suffers from local or systemic venereal
infection.
It does not matter whether they acquired the disease
innocently or not, we are concerned in protecting one
of the parties who may be clean, and in preventing the
spread of the disease by every possible means. We can
do so, to some extent at least, by making a physical
examination by a reputable physician prerequisite to a
license to marry and to the marriage ceremony.
Clergymen will be glad to assist in this matter,
as we may see from the marriage edict issued by Dean
Sumner of Chicago in a recent sermon on the "Sacrament


428
E. S. Goodhue
of Marriage:" "I will hereafter perform no marriage
without clean bills of health from the contracting parties."
Dr. Tregold of the London National Association for
the Feeble Minded, recommends that "marriage license
be granted only after a medical examination and an in-
quiry into his or her family history."
In England, Sir James Crichton-Browne stands at
the head of a movement to provide a board of physicians
whose duty it shall be to examine all applicants for mar-
riage license, and "rule out all who shall be found physi-
cally or mentally unfit for the relation."
"Society might well demand that before a marriage
license is issued the parties should present a certificate
from a reputable physician of freedom from venereal
disease," says Dr. Davenport, a conservative student
at the Carnegie Institute.
"We ask that the diseased man who would marry
be barred that precious privilege," declares Dr. Bogart
of Indiana.
"Let the ministers refuse to marry unless the parties
show a physician's certificate," says the Journal Record
of Medicine editorially, "while many would avail them-
selves of justices of the peace, the evasion would soon
arouse suspicion and make such marriages unpopular.
The cities and states could well afford to provide means
whereby those unable to pay for an examination could
have it done by the regular city or county physicians."
"The scientific mating of man and woman at the
expense of sentimental tradition would produce superior
children and eliminate disease," voices David Starr
Jordan.
The Indiana law of 1905 states:
"No license to marry shall be issued except upon
written and verified application. Such application shall
contain a statement of the full Christian name and sur-
name, color, occupation, birthplace, residence and ages
of the parties, whether the marriage contemplated is
the first, second or other marriage, together with the full
Christian and surnames of their parents, including the


The Punishment and Care of Defectives 429
maiden name of the mother, together with such other
facts as may be necessary to determine whether any legal
impediment to the proposed marriage exists."
Said Dr. Robert Reid Rentoul of London before the
N. Y. Medico-Legal Society recently: "Marriage is
regarded too much as a mere social function—a fetich
worship for the protection of property. It should be for
the procreation of children. A prenuptial certificate of
good health, and sterilization of certain degenerates
should precede matrimony. Degenerates who desire to
marry should be sterilized after a written direction by
the Commissioner of Lunacy."
California has introduced a bill providing for a
"physical examination as a prerequisite to a marriage
license."
A similar bill will be presented before the Indiana
legislature for action. In Delaware (1893), Minnesota
(1904), New Jersey and Colorado (1904), Ohio (1905),
Michigan, North Dakota and in Argentine, South America,
more or less adequate legislative action has been taken.
A bill is pending in Nevada demanding a "certificate of
health before license to marry," with a clause making
the "wilful communication of venereal disease a felony."
Pennsylvania and Wisconsin are following in line,
urged by their medical societies and the Morals Efficiency
Committee.
In Utah the Woman's Christian Temperance Union
has seconded the work, which shows what concerted and
determined action on the part of the medical profession
can do towards influencing public opinion.
It remains for us as a body to pass resolutions or
formulate a bill in which shall be embodied the necessary
recommendations regarding marriage.
In the second place, but perhaps of primary import-
tance, comes up the matter of the adequate punishment,
care and treatment of the insane, idiots, habitual crimi-
nals, defectives and degenerates, based not only upon the
prevention of the propagation of defective tendencies,


430
E. S. Goodhue
but the amelioration and rehabilitation of the criminal
himself, as well as the protection of society against
his assaults.
To a surprising and gratifying degree this subject
is being discussed in every part of the civilized world,
by all classes of men, and to practical purpose by associa-
tions and congresses of scientific men.
"It is a reproach to our intelligence," says the author
of a recent work on heredity, "that we as a people, proud
in other respects of our control of nature, should have to
support about half a million insane, feeble minded,
epileptic, blind and deaf; 80,000 prisoners, and 100,000
paupers at a cost of 100 million dollars every year."
"Regression to the normal average may be (1st)
by marriage into sound stocks," says Dr. Mott, "or
(2nd) by anticipation or antedating leading to congenital
or adolescent mental disease terminating in the perpetua-
tion of the unsound elements of the stock."
"When both parents are neuropathic, all children
will be neuropathic. One parent being normal, but with
the neuropathic taint from one parent, and the other
parent being neuropathic, half the children will be neuro-
pathic, and half will be normal, but capable of transmit-
ting the neuropathic make-up to their progeny" are the
findings of Cannon and Rosenoff.
"There are degenerates," says Dr. Ball in his presi-
dential address to the Vermont Medical Society, "whose
thought and action (from their hereditary influence and
environment) can be only upon the mean and vulgar.
They are not able to think connectedly, to reason, or to
associate fact and circumstance. They act by impulse,
being governed by those things that please and excite.
It is this class that are especially dangerous to society,
for their tendency to sexual excesses is proverbial. The
number of their legitimate and illegitimate children is
large, and their offspring usually of a lower grade of
degenerates than themselves."
"Criminal tendency," said Dr. Parker before the
Texas State Medical Society recently, "is a species of


The Punishment and Care of Defectives 431
insanity. Hardly anyone will contend that a normal
mind would incite to commit crime. The physician's
records at the New York State Reformatory show that
two-fifths of the inmates are mentally defective."
Recognizing these truths as we all do, the question at
once arises: How shall we prevent this alarming trans-
mission of tendencies which are sure to develop into
crime sooner or later? The answer has been furnished
us by those whose study and findings deserve the gratitude
of every normal man. Sterilization is the remedy. A
simple surgical operation which eliminates the possibility
of procreation, without in any way affecting the subject's
health or happiness. His sexual desires remain undis-
turbed.
Dr. Sharp who has been in charge of the Indiana
Reformatory since 1899, reports over 500 operations.
"It consists of ligating and resecting a small portion
of the vas deferens. This operation is indeed very
simple and easy to perform. I do it without adminis-
tering an anaesthetic, eigher general or local. It requires
about three minutes' time to perform the operation,
and the subject returns to his work immediately, suffers
no inconvenience, and is in no way impaired for his work,
but is effectually sterilized. There is no atrophy of the
testicle. There is no cystic degeneration. There is no
disturbed mental or nervous condition following, but,
on the contrary, the patient becomes of a sunny dispo-
sition, brighter of intellect, ceases excessive masturbation,
and advises his fellows to submit to the operation for
their own good. And here is where this method of pre-
venting procreation is so infinitely superior to all others
proposed—that it is endorsed by the subjected persons.
There is no expense to the state, no sorrow or shame to
the friends or the individual."
Dr. Frank Lydston says: "Coming to vasectomy, a
subject in which an increasing number of legislators are
becoming interested, the physician furnishes a method
of sterilization with no impairment of the sexual function,
merely the blocking of the minute canal (the vas) tra-


432
E. S. Goodhue
versed by the fecundating element, of the male, thus
wholly preventing impregnation."
This author goes on to point out that over 6000 who
have been sterilized for years are in "robust sexual health."
"In the case of mere defectives," says Dr. Rentoul,
"then operation should be voluntary with the sane—here
vasectomy would suffice; with the insane it should be
compulsory spermactomy."
At the recent meeting of a sociological club in London
Sir John McDougall agreed that something must be done
to stop the breeding of defectives. Some "physical means,"
he declared, "should be employed to prevent degenerates
from propagating their like." Earl Russell, who was
present, added: "I think it admits of little doubt that if
the ruling classes in the country, in Parliament, and in
the law, were composed entirely of people of adequate
medical knowledge, some such remedy as this suggested
would soon become a law of the land."
Dr. Barr was quoted: "Let asexualization at once
be legalized, not as a penalty for crime, but as a remedial
measure preventing crime and tendency, and the future
comfort and happiness of the defective."
"Nothing short of such radical measures can stem
the tide of degeneracy," said Dr. Bevan Lewis.
"Some step will have to be taken," declared Dr.
Bernardino, "if we are to protect the nation at large
from a large addition of the most enfeebled, vicious and
degenerate type."
"As a deterrent," writes the President of the N. Y.
Prison Association, "the terrors of punishment do not
exert a great influence on hardened criminals. But I
conceive that the proposed punishment (emasculation)
would have a stronger restraining power than any punish-
ment provided by our penal codes."
Mr. Arnold White, who in England over twenty
years ago, recommended the sterilization of the unfit,
has lately said that he gave Great Britain till 1925
"as the final year of her sovereignty, unless something
practical was done to reduce the number of her inefficients."


The Punishment and Care of Defectives 433
Vice-President Marshall in addressing the Indiana
state health officers, remarked: "I guarantee that you will
cut off fifty per cent of the crime and you will largely
have increased the Christian character of the citizens of
Indiana by your regulations."
The law of New Jersey passed in 1911, permits and
specifies the operation orchidectomy in rapists and vasec-
tomy in all other defectives. This law has been declared
constitutional by the Supreme Court. The Governor of
New York has signed the bill providing for the steriliza-
tion of criminals. By it he is empowered to appoint one
neurologist, one surgeon, and one practitioner of medicine
to be known as a Board of Examiners for Feeble-Minded
and Criminals and Defectives. I give below a section
of the Indiana State law regarding sterilization:
"On and after the passage of this act, it shall be
compulsory for each and every institution in the State
entrusted with the care of confirmed criminals, idiots,
rapists and imbeciles, to appoint upon its staff in addi-
tion to its regular staff, two skilled surgeons of recog-
nized ability, whose duty it shall be to examine the
mental and physical condition of such inmates as are
recommended by the institutional physician and board
of managers. If, in the judgment of this committee of
experts, sterilization is advisable, it shall be lawful for
the surgeons to perform such operation for the preven-
tion of procreation as shall be decided safest and most
effective."
In Oregon the law recently passed providing for
the sterilization of defectives has been declared consti-
tutional by the Supreme Court of that State. The
Nevada State Medical Society has petitioned the legis-
lature to authorize the sterilization of criminals, and so
have California, Iowa, Connecticut, Ohio and Wisconsin en-
acted laws of control, while bills are pending in several
other states, and public opinion has been aroused to
definite action.
In nearly all the states the law properly leaves the
decision of the fit and unfit with a board of physicians.


434
E. S. Goodhue
In Iowa the officers entrusted with the care of the
insane, criminals, idiots, feeble-minded, drunkards, drug-
fiends, epileptics and syphilitics are authorized to con-
sult annually or oftener with the State Board of Paroles
and decide by a majority vote if any such inmates
should be deprived of their power to procreate, and if
so, to sterilize them.
Most of the bills passed cover the ground, but a
few are weak, or indefinite. For instance, sterilization
which is a humane elimination of virility, is not a punish-
ment in any sense, and its purpose is not retribution,
but solely to prevent procreation. Fortunately it does
this without depriving the subject of sexual pleasure
in which he may have a right to indulge.
Sterilization therefore which does not remove sexual
desire or its performance, would not in any way deter
sexual perverts, rapists, sodomists and other degenerates
from exercising their abnormal function, while castra-
tration would.
Castration then in the male, and its equivalent in
the female, is the only effective treatment indicated.
While this operation sterilizes and prevents procreation,
it may be used as a punishment, an object not to be
lost sight of. It is also a prevention and a cure as well.
I would suggest that immediate steps be taken
by the society to formulate a bill, embodying these sev-
eral requirements, for presentation before the Hawaiian
Legislature now in session;! that the president appoint
a committee of members from this Society to draft such
a bill.
With the help of laws already adopted and bills
pending elsewhere, our task is rendered easy and we may
the more surely avoid the errors of some of the provis-
ions so laboriously prepared. I would suggest that one
lawyer be made a member of the Board of Examiners,
recommended for appointment by the governor, he to
assist in the legal aspects of each case.
tSuch a bill was prepared and presented by Representative Irwin (M. D.) before the
House, but failed to pass. The governor was anxious that the bill should pass and wrote
me a cordial letter of approval.


The Punishment and Care of Defectives 435
With such a law upon our statute books, we may
protect society from the assaults of irresponsible men
and women, as well as from the emotional recommen-
dations based upon retribution, which good men are
sometimes apt to make. Such laws also will provide
for the offender the restraint and treatment he deserves.


PSYCHIATRY AND PSYCHOTHERAPY
IN SURGICAL PRACTICE.
An Overflow Review Editorial.
By C. H. Hughes, M. D.,
Retired Dean of Medical Faculties, ex-Prof., Psychiatry, ex-Supt. State
Hospital for Insane, ex-Surgeon of Vols. Civil War, Associate Member
Amer. Association Military Surgeons, Ed. A. and N., etc.
St. Louis.
SO much of man is mind, conscious and subconscious
that surveying this great field of psychic impress
power from the time when the mystical gods of the air
swayed men and women up to our own more rational
day, one is led to marvel that more study and use has
not been and is not now made among us in our teachings and
practice of the healing art and for health conservation.
Our researches into the relations of mind, liminal
and subliminal, to its substratum organism, the brain
and its allied nervous system, together with the marvel-
ous movements of the blood vessels under its influence
and even of the viscera under mental control, through
neurotic inter-relation, bring us close to the conviction
of that far-away philosopher in the passing time of our
earth, that "the mind resides in the whole and the whole
in every part." The wonderful showing of the blood
under mental influence, as of certain of its cells under certain
serums, must give us pause for thought, more than ever
before, as to the value of psychiatry in curative considera-
tion and cooperation in therapeutic endeavor.
The influence of the vaso-motor nervous system, in-
duced by and inducing various brain and mind conditions
through circulatory change, is perhaps the most patent
and most potent of the demonstrable evidences of neuro-
psychic interdependence. But the remarkable power of
(436)


Psychiatry and Psychotherapy in Practice 437
ideation and emotion on physical processes (secretion and
excretion, growth, decay, metabolism etc.) is equally apparent
when we diligently search for it. This, the blood alterations,
the metabolic processes generally and the influences of the
internal secretions which Sajous and his collaborators
(Isaac Ott and others) have done so much to bring into
the physiologic lime light, impress upon us our delin-
quency of psychic vision in the past as to the laws and
potency of nature's power over organic and functional
movement of the vital processes of the machinery of man
entrusted much to our management and repair. We have
done much for him as a physical mechanism, but not
so much as we ought to have done and ought now to do
regarding man as both a psychical and physical machine.
We have left the psychic management much as our ancient
brethren did, to the oracles of the temples, to the sooth-
sayers, necromancers and enchanters, as our forebears did
before the advent of our wise forefather Hippocrates.
But the wise skepticism of the ancient father of
rational medicine as to the deceptive futility of the cura-
tive pretensions of the goddess Hygeia, has led us into
too great indifference of that psychic potency within the
human organism, whose aid may be justly, hopefully and
often extremely fruitionally, evoked in so many cases
and which was included, though apparently unconsciously
so, by the father of rational medicine; as shown in his
potent and true aphorism—concerning the vis medicatrix na-
turae, an agency which always should include in our practical
use thereof, the conjoint influence of a rationally considered
and helpfully employed psychotherapy—the sustaining
and curative influence of right conditions of mind over the
organism in disease, for all concede that states of mind with
reference to disease sustain or depress vital processes.
We have seen the flush of shame or ecstatic joy
mantle the cheek, the pupils change under certain ex-
alting or depressing emotion, dilated or contracted as if
under the tangible impress of atropine or esserine, the
hair blanch in an incredibly short space of time, even
perhaps in a single night, as in the historic case of


438
C. H. Hughes
Marie Antoinette, and in less historic instances, such as have
happened in the observation of most, perhaps all, of us
and yet we have not always taken just account of the
full value of psychic tonus or psychic atony in our prac-
tice, to sustain the physiological processes of resistance
to or advance of the destructive course of disintegrative
disease.
That automatic cerebration known to Socrates as
his familiar spirit and to his Greek countrymen as im-
pressing the mind from without, is familiar to all of us,
but with a more certain and exact conception of its origin
and presiding place in the cerebrum, in certain morbid
states of mind and allied brain, especially as revealed in
hypochondria, hysteria, melancholia and other states of
psychic depression. Ancient physicians with more or less
accurate discernment, placed the blame on morbid states
of the liver and blood (atrabili and peccant humors,)
such as we now with more light than they from our
modern chemico-biologic laboratories and other sources call
ptomains, toxines, microbic empoisonment or other
toxhemias.
The interrelation of the psychic and the chemico-
physical are in our day more definitely understood but
the comprehension as to mutual relations and influences
is similar in conception. We must recognize and employ
both in the rational and most successful practice of
medicine but should beware of skepticism, as is now the
tendency in some quarters as to the value of materia
medica therapy.
The tendency to berate the latter and denounce
defamatorily "drugs," so called, as useless, is as grave a
mistake as to ignore the potent psychical processes in
our therapeutic endeavor, in view of what we know in
positive therapeutic experience. All but a few drugs, say,
certain medical doubters, especially among some surgeons
of limited experience in curative medication and the serum
experimenters who are right enough to show faith of
speech in their sphere of research but wrong to herald
their skepticism concerning therapeutics beyond the zone


440
C. H. Hughes
A woman, unmarried, approaching forty years of age,
came to Dr. Mears from one of the interior cities of the
state Pa. for surgical advice and operative interference.
With the utmost sincerity and candor she informed him
that she had been subjected to several surgical operations
which, as she bluntly stated, had removed all of the organs
of generation, clearing out the cavity in which they were
contained, and leaving nothing behind but the "stumps,"
as she expressed it. With the information she had given
he informed her that nothing more could be done by any
surgical operation, and advised her to return home.
She then stated that she desired him to remove the
"stumps," which gave her pain, and which she was de-
termined to have removed. If he would not perform the
operation, she asserted vehemently, she would consult
an advertising surgeon whom she knew, who would do it.
Feeling that he might help this deluded person, he
sent her to the hospital to be admitted to the surgical
ward under his care, instructing the interne to make a
careful record of her condition from day to day, to keep
her rigidly in bed, and to treat her as a gravely sick
patient. On inspection a cicatrix in the abdominal wall
was found, and digital examination disclosed the fact
that the neck of the uterus had been the sight of operation.
No definite information could be obtained by palpation
as to the condition of other organs belonging to the gener-
ative system. Her mental condition was apparently
normal, and physically she gave evidence of being in
good health. She was resolute in her determination to
have the "stumps" removed. Keeping her under ob-
servation for a week's time, in which he studied the con-
ditions present in her case, he decided to influence her
perturbed mental state if possible, by performing a
quasi operation, very simple in character, but deemed to
be sufficient to accomplish the purpose. To accomplish
this the patient was placed upon the operating table,
an anesthetic administered and a simple scratch was made


Psychiatry and Psychotherapy in Practice 441
with the scalpel over the sight of the cicatrix in the ab-
dominal walls. Dressings of an elaborate character were
applied, the patient returned to bed, and care taken by
the attention given to impress her profoundly with the
important nature of the operation which had been per-
formed, and the necessity of great care in conducting
her recovery. No permission was asked to inspect the
stumps which she had so earnestly desired to have re-
moved. She expressed herself as greatly relieved, and at
the expiration of two weeks returned home to all intents
and purposes cured.
I believe the method of treatment employed in this
case was not only legitimate, but in every respect justi-
fiable. While we cannot sit in judgment on the necessity
for operative interferences in her case to relieve conditions,
the character of which we know not, we can certainly
say that she became the subject of mental perversion
which would have jeopardized her life, possibly, by placing
her in the hands of the advertising surgeon, or sent her
into the field of the faith-healers as an unhelped subject
of scientific medicine, to swell the growing army of be-
lievers enlisted as recruits from those hostile to its progress.
Another, not under Dr. Mears immediate care, but
placed in Dr. Mears' general charge, gave him an op-
portunity to study the case's interesting features. The
patient, a woman, between forty and fifty years of age,
of slight physical development, with evidences of progress-
ive emaciation, gave a history of epileptiform seizures,
the aura initiating the attacks, taking origin in the thumb
of the right hand, and passing up the arm, as she describ-
ed it, until it reached her head, when the seizures would
occur. The convulsive movements, she stated, were limit-
ed to the side of the body on which the aura took
origin and were not accompanied by mouth frothing or
inversion of the thumb so far as she knew. They oc-
curred frequently, and the head, arm, and forearm were
the seats of intense pain. The suffering, unrelieved by


442
C. H. Hughes
grain doses of morphine, was so great as to have become
unendurable, she stated, and she had determined, unless
relieved by surgical operation, to take her life. She
insisted upon the removal of the hand in which the trouble
began, and the surgeon decided to comply with her de-
mand.
In her ordinary garments the patient took a seat in a
straight-backed chair and her body was covered by a
sheet to protect her dress from being soiled by blood.
She refused to be placed under the influence of an anaesthet-
ic agent, asserting that it was her desire to see how the
operation was performed, and presumably, to know that
it was properly done. The forearm being exposed, the
hand was grasped by an assistant, and without any at-
tempts at cleansing the field of operation, amputation
was performed at a point midway between the elbow and
wrist joint. Throughout the entire procedure the patient
did not express any sensation of pain, holding her arm
rigidly firm and watching, with apparent interest, the
steps of the operation. During the period of conval-
escence from the operation, which took place favorably,
no seizures occurred, and the patient returned to her home
in the country, quite well satisfied that the operation
would effect a permanent cure. [A neurectomy might
have sufficed to satisfy here.—Ed.]
With the subsequent history of the case, Dr. Mears
states he is not familiar. A dissection of the part removed
with the exception of a possible swelling of the median
nerve and its digital branches there was no evidence
microscopically of any morbid condition which could
have caused the intense pain complained of by the patient.
These cases take their places in the mind with hysteri-
cal joints (false ankyloses, etc.) and phantom tumors to
which Dr. Mears alludes and about which others have
previously written. A phantom tumor in Ewing's
record disappeared under anaesthesia to which the patient


Illi'strations of "Happy Thoi'gh Insane."—Pub-
lished in May number of this magazine but inadvertently
omitted by the editor.

The Above Homelike Appearance of other days is
now more common in institutions for the insane for the
entertainment of elderly and middle aged ladies from the
farms, of a past generation, than for present day farm
lady denizens.
These and the quiltings and other similar mutual as-
semblages of the housewives tended to interrupt the monot-
ony of the farm life and thus to postpone and drive away
melancholy so common to life on the farm in women.
The picture is from an illustrative report with other
photos of the Spring Grove Hospital for the Insane of
Maryland, by Dr. Percy Wade, Medical Superintendent.
We wish other superintendents and managers would
present more special illustrative features of their institu-
tions. Such pictures of internal hospital life disarm sus-
picion. More or less of it is done by many hospitals
which we purpose showing from time to time, during
the present and coming years.
This and the following illustrations of insane hospital
life should have appeared to illustrate the author's arti-
cle "Happy Though Insane" in the last May number of
this magazine.




Voluntary competitive gardening by male patients of
an insane hospital, intended to have illustrated the paper
in May number, "Happy Though Insane."


Voluntary competitive gardening by female patients.

Regatta of patients manned by attendants.





Psychiatry and Psychotherapy in Practice
443
objected (though her objection was overcome) lest she
might talk in her anesthetic sleep.
Thus autosuggestion may be turned from hypochon-
driacal to salutary self suggestion by psychotherapeutic
environment and salutary surgical impression. Patients of a
certain class may recover at reputed healing springs
whose waters actually possess no marked healing power
beyond their curative repute.*
♦This and mmilar brief articles as they have appeared or may appear from the
pen of the editor, are given space according to the editor's time and chance to partly
cover essential subjects in the psychiatry of medical practice, especially, not com-
passed by other editors in current medical literature and with the view of inciting
others of more leisure perhaps to take up and more thoroughly cover themes of psy-
chiatry in general and special medicine and surgery, a far too much overlooked matter
in medicine.


THE EROTOGENESIS OF RELIGION.
Developing a Working Hyfothesis.
By Theodore Schroeder,
Cos Cob, Conn.
FROM the times of prehistoric sex-worship to this
very hour, sex-mastery, and especially the regula-
tion of other people's sexual affairs, has been probably
the most zealously pursued of all the ambitions of priests
and religious societies. Once convinced of this the
suggestion came to me to inquire as to the how and why
of this relationship. The purpose of this essay is to
develop a working hypothesis for the study of this sub-
ject. Rather than take the readers over all the devious
bypaths which originally took me to my goal, I will
lead them to my working hypothesis by a better route.
Before going far in the consciously planned part of
my investigation, I learned that in so far as my hy-
pothesis involved only the assertion of some connection
between erotism and some religions, it was very far from
being original. The aggregate of the materials considered
by all those whose opinions can be quoted in support
of a connection between religion, and sensualism will
far exceed my own available materials. Often those
opinions are justly entitled to greater weight than my
own inductions, or interpretations, because they come
from persons who were friendly partisans of the religions
of which they wrote, so spontaneously. Furthermore,
most of these persons reached their conclusions without
any design or thought of questioning the objective verity
of their religious beliefs, and without any thought of
discrediting the subjective evidences for the truth of
religious dogmas. In many cases they were free from
suspecting the psychologic import of what they said,
(444)


The Erotogenesis of Religion
445
or the support which their utterances might give to
such a theory as is herein proposed. These opinions,
soon to be quoted, are entitled to great weight, also
for the added reason that they come from many intelli-
gent observers, acting unknown to one another, inspired
by a great variety of motives, considering very different
materials and yet reaching very similar conclusions.
Their empirical inductions should be analyzed in order
to discover the psychic essence, all of their necessary
implications and the elements of their unification. Thus,
by successive inductions and inferences, we may arrive
at a more inclusive generalization and acquire a well
supported working hypothesis. This then will furnish
a condensed recapitulation of practically all of my present
investigation and of much more besides, and will furnish
a working hypothesis better supported than was mine
when originally framed.1
Having now stated why these opinions are being
quoted, it becomes desirable to negative some assumptions
which the reader might otherwise make in explanation
of some omissions. It must be borne in mind that the
following opinions are not offered either as conclusive,
nor even as the final proof of the truth of the theory
which they support. The final proof of the correctness
of this theory must depend, not upon these opinions, but
upon the facts which underlie and justify them and other
facts of the same general character, which will be adduced
at another time. It is also desirable to explain at the
outset why certain contrary opinions are here omitted
from consideration. It is true that eminent men have
insisted that such opinions as are hereinafter quoted
are unwarranted. Their disapproval demands critical
study beyond the space-possibilities of this article.
Those various opinions which attempt to explain the ex-
istence of religion upon a non-erotic physical basis,
need to have their short-comings pointed out. It was
necessary to call attention to these omissions lest some
1. For an outline Method for the Study of the Erotogenesis of Religion, see
American Journal of Religious Psychology, October 1912. This article will five


446
Theodore Schroeder
one might think such matter had been overlooked, or
intentionally suppressed. Since the sole purpose of this
article is to develop a working hypothesis as to the erotic
origin of all religion, it follows that the presumption of
probable correctness of the hypothesis and the desirability
of further pursuit of the study, depends upon the compe-
tence and the number of observers who have noted a
casual relation between sex and religion. This, and the
bibliographical value, are my justification for having made
the quotations so numerous.
Probably the oldest record, showing the recognition
of some relation between lust and religion, is found in
the code of Romulus (about 470 B. C.) wherein it was
provided, "That there should be no night vigils in the
temples and no pretending to sacrifice at such unseason-
able hours." The vicar at St. Mary's in Nottingham also
informs us that: "This was to prevent the meeting to-
gether of men and women, by night, who under the pre-
tense of religion, might gratify their lewdness. The like
order with this, we find recorded of Diagondas, the The-
ban, who forbade all night meetings for religion,"2 but
not other night meetings.
A more specific suggestion that there existed an in-
terdependence between religion and sex, and one almost
as old, is that of Pausanias, (A. D. 174) himself an ini-
tiate into the Eleusinian mysteries of Greece. Although
writing reservedly of the mysteries, he mentions the mix-
ture of the obscene and miraculous, the frequent assig-
nation and "the Pronencss of religious Females to Ven-
ery."3
Centuries ago it was observed that even the normal
sex stimulus of one in love and conscious of its nature,
though without the gratification of sex appetite, would
preclude the greater "spiritual" exaltation which we may
later believe to be due to religious misinterpretation of
sex-feeling. "In the fourteenth century the wise old
Knight of the Tower, Landry, tells his daughters that
2. A View of Ancient Laws against Immorality, p. 4. and citations.
3. Requoted from Bishop Lavington's Enthusiasm of Methodists, etc. Part III,
p. 387, citing Pausanias, Editio Kuhnii, p. 195, et seq.


The Erotogenesis of Religion
447
that unfeignedness which she did aforetime. For I have
heard it argued by many, who, in their young days
have been in love, that, when they are in the church,
the condition and the pleasing melancholy in which they
found themselves would infallibly set them brooding over
all their tender love-sick longings and all their amorous
passages, when they should have been attending to the
service which was going on at the time. And such
is the property of this mystery of love that it is ever
at the moment when the priest is holding our Saviour
upon the altar that the most enticing emotions come' ".
The reason why a young woman in love cannot serve
her God with that unfeignedness she did aforetime is
very easy to uncover. Being in love, she is definitely
conscious that the object of her affection is a man,
and he the objective stimulus of her emotions. In
the presence of this consciousness, the suggestions of the
priest do not as readily create the ordinary illusions of a
"conviction of sin" and "spiritual regeneration," nor in-
duce the maiden to center her erotic longings on a crea-
ture of the imagination.
Cassanova, who was decorated by the Pope, looking
at the matter from a very different standpoint, and
after referring to "that mingling of mysticism and con-
cupiscence which seethes in a Spanish heart," goes on to
say: "I have everywhere observed that devout women
are more sensitive than others to carnal pleasures."5
In the Historical and Critical Dictionary of the learn-
ed Peter Bayle, 6 I find these observations also indicating,
at least, some uniformity of connection between venery
and religious enthusiasm.
"It is a truth, confirmed by the experience of all
ages, that one of the surest means to draw the female
sex, and make them run after men, is to set up fraterni-
ties of an austere reformation, and to make a great
show of strict devotion to certain conventicles. Those,
4. Ellis' Studies on the Psychology of Sex, (Modesty), p. 282.
6. Requoted from Studies in the Psychology of Sex, (Modesty), p. 233.
6. Second edition, London, 1736. Vol. 3, p. 103-280.


Theodore Schroeder
'no young woman in love can ever serve her God with
who trace events to their causes, have not forgot to
meditate on the reason for this. They divide into two
principal classes, those female scholars. Some go to that
school out of a good principle; being led by devotion,
which is innate to the sex: others have heard a thousand
times, that there is a great deal of hypocricy in these
religious founders, and they are men like the rest, and they
play the hypocrites, only to make love without scandal,
and under the cloak of secrecy.
"This is the reason a woman hopes to find a lucky
hour among those pretenders to devotion, and is eager
to put herself under their direction, with whom she may
lose nothing with regard to pleasure, and get a great
deal as to her reputation. Women even hope, that, in
case such men should not be hypocrites, they may have
the address powerfully and victoriously to tempt them;
for, of all vices, none is more untameable and ungovern-
able than concupiscence. As for the scholars of the other
class, they conceive so great a veneration, and even so
great an affection for the pretended man of God, that
they blind themselves in His favour. If he finds it neces-
sary to persuade them that there is no sin in doing some
things, he insensibly turns that way, and at worst,
their tenderness does not suffer them to resist his desires.
However it be, there was never a head of a sect, nor a
founder of a conventicle, let the things practiced there
be never so abominable, but found very tractable disciples
among the other sex; and when we see how solicitous
these men are to draw in women, one must have a great
deal of charity not to believe, that the scope of their
devotion rather centers in the body, which they have
received from nature, than in the salvation of their souls.
"I do not much wonder, that women should have
been prevailed upon to prostitute themselves in the
ancient Paganism; it was accounted a kind of divine
worship; the goddess Venus was honored in that manner:
but it is an amazing thing, that in the midst of Christian-
ity, notwithstanding the wise counsels of mothers, and the


The Erotogenesis of Religion
449
pathetical exhortation of preachers, the first hypocrite
who comes in their way, should be able to persuade
them to a thousand abominations. If he tells one of
his devotees, as Saint Aldhelme did, 'lie by me; I desire to
know whether you will be so powerful an instrument
in the devil's hands, as to make me yield to the tempta-
tion,' she will do it. If he tells her, as some heretics did,
who were punished by the Inquisition of Toulouse,
'let us be stark naked one by another, one upon another;
let us kiss and tickle one another; we shall thereby give
proof of our spiritual strength.' He is obeyed. Can
there be a greater docility? Would she refuse to proceed
farther, if he was willing? Have not many women com-
plied with the order of lying with the first comer, when
candles were put out, in the conventicles of the fraterni-
ty?"7
Another historian, writing upon our theme, uses
these vigorous expressions:
"Moreover, religious and erotic emotions, if not
generally one and the same thing, are at least, two golden
threads spun from the one distaff of the heart's holiest
love, and which, in their spinning, ever and anon touch
and intertwine with each other. I state it as no quip of
levity, but as a simple psychological fact: In the maiden's
heart, when God is near, Man is not far off. Once
interest a lady in Jesus, and it is not difficult to interest
her in Jones. A woman is a woman first, and, if a lady
at all, a lady afterwards. It matters not whether she
be a countess or a cook; with her there is but one step
between Jesus and Jones. I care not whether she be the
stateliest duchess kneeling at the confessional in silk,
stiff enough to stand alone, or the 'Hallelujah lass'
following the tambourine with a devout hop-step-and
jump, the love of God is synonymous with the desire of
Man, and I submit that there is no reason to be ashamed
of the fact; but there is much to be ashamed of the ad-
vantage which the priesthood take of the fact.* *
7. Bayle'a Historical and Critical Dictionary (2nd Ed. 1736) Vol. 3, pp. 103-280
and authorities cited.


The Erotogenesis of Religion
451
and their use of drugs to produce "spiritual" phenomena,
records this:
"They rubbed themselves in various parts of the body,
with the salve, in which narcotics, garlic, etc., were used;
and nymphomania, hysteria, and somnambulic visions
were the consequences. For behind the curtains of magic
and miraculous works lay concealed the unclean spirits
of the Natural flesh, which were not restrained. Accord-
ing to Jung Stilling, in 'Theobold, or the Fanatic,'
Vol. 1, p. 244, the religious excitement often flows from
a very impure source; and he states that a fanatic society
appeared in the thirtieth year of the last century,
(1730) in which such transports followed the rubbing and
kneeding of the body in a magnetic manner, and those
in whom these took place were said to be new-born.
It, therefore, depended entirely upon the explanation
whether in these scenes of excited feelings and of the
life of the imagination, the result should be held to be a
witch-exploit and dealing with the devil, or a vision of
holiness."9
G. B. Vale, the devout author of a little book on
"Fanaticism," written about 1835,. shows by it that he
was in other matters a most exact and conservative on-
looker. Through his intimate knowledge of "Mathias
the Prophet," he had good opportunity for observing
at first hand the phenomena under consideration, and he
wrote:
"We believe there is not a popular clergyman but could
triumph over any number of his devotees, could he be
base enough to apply the arts of seduction. * * We
believe that these feelings, natural in such circumstances,
could be mistaken for divine communications, for even
the scripture will admit of a similar interpretation in
the cases of Sarah, Elizabeth and Mary."10
Sha Rocco, a student of ancient sex-worship, ex-
presses this conclusion: "The primitive religion in
this early day of adolescent manhood was purely passion
9. Enoemoser, History of Magic, Vol. 2, p. 127.
10. Simple Narrative of Isabella in the Case of Mathias, part II, p. 124.


452
Theodore Schroeder
consecrated and sanctified—a religion of feeling. It
was a physical heaven counterpoised by a physical hell.
Promises were sensuous bliss, and punishments were
bodily woe.* * It was based on the dynamics of
nerve."11
Richard Payne Knight, in his "Two Essays on the
Worship of Priapus," shows that cult to have existed
all over the world, and among Christians to have found
widespread devotion as late as the Middle ages.
Hargrave Jennings, another most scholarly student
of Phallic worship, puts the case this wise: "It may be
at once asserted as a truth that there is not a religion
that does not spring from the sexual distinctions."12
Clifford Howard, another student of Phallic worship,
expresses these views: "Love is both the foundation
and the pinnacle of religion; the beginning and the end
of human thought and aspiration. Religious emotion
springs from the animating power of the sexual nature,
and through the emotions' thus aroused we deify and wor-
ship the inspirational source of our spiritual longings.
In every sense both physical and spiritual, both material
and ideal, love is the animating creative force of the
world; the divine immanence of the universe; the actua-
ting source of life, and the indwelling spirit of the soul;
the beginning and end of all that is."13
"But as Cousin observes, 'mysticism is never nearer
the senses than when it supposes itself to be very distant
from them,' an opinion wholly confirmed by the testi-
mony of many writers regarding the sensualities practiced
by monks and nuns in medieval times.* *
"These holy vestals and brides of Christ were doubt-
less devout; but they were frequently sensual by nature,
and their very piety was often a perverted mode of
expressing sex feeling. Ample testimony could be afforded
to prove that the passion of love and the fervour of
religion are closely related. The neurotic nun who be-
11. Ancient Sex-Worship, p. 49-50, by Sha Roeea.
12. Phallicism, page XX of the Introduction, quoted with approval in Phallic
Worship, by Robert Allen Campbell, St. Louis, 1877, p. 7.
18. Howard'! Sex Worship, p. 30.


The Erotogenesis of Religion
453
lieves that she is embraced by one of the saints, imagines
that she has subjugated the instinct of her sex; but in
reality her emotions have a sexual origin. In mania,
old maids in whom no one but the neuropathist would
suspect immodesty, frequently suffer from erotic delusions,
suppressed desires leading them to firmly believe that they
have been ravished. Such subjects also cause surprise
by their evident knowledge of sexual matters, expressed
often in the phrases of the street. Notwithstanding,
this does not impugn the sincerity of the devotee who
vows chastity from a deep sense of the lightness of her
sacrifice. Such minds are self-deceived as to the source
of much of their pietistic emotion, yet they do not always
wilfully deceive others.* * In more than one of these
sects of celibates and spiritual lovers, the flesh has repeat-
edly triumphed and asserted itself. The sect of 'the
Christs' in Russia practice strict continence for prolonged
periods; but at religious festivals, when they are aroused
to an exalted state of hysterical excitement, men and women
tear off their clothes and abandon themselves to
sensuality under the belief that what they do is
sanctified. The 'holy kiss' of religion has been in number-
less instances the prelude to wantonness and license.
Hepworth Dixon's 'Spiritual Wives' reveals the failure
of such spiritualized fellowship between men and women
as commended by the Princeites, and the members of the
Agapemone."14
Alienists and Physicians
If there exists a causal relation between lust and re-
ligion it would naturally exhibit itself most conspicuously
in those mental derangements involving religion and the
sexual apparatus. This is necessarily so because in these
insanities the normal relation would be exhibited in acute
augmentation. We accordingly expect to find alienists
even more uniformly than the historian, expressing an
observed connection between morbid erotism and ecstatic
religious emotion. In the case of the psychologist we
have the added advantage of an observer with special
14. Geoffrey Mortimer, Chapters of Human Love, p. 43-52-259.


454
Theodore Schroeder
qualifications for the selection of materials and for
their interpretation. Our expectation will not be disap-
pointed, and so we come nearer to the statement of
a working hypothesis.
Though others had anticipated him, yet probably
Dr. J. G. Millegan (in 1837) made the first lengthy
statement concerning the sensual origin of religious
ecstatic exaltation.
He says: "No definition of this state can equal that
given by St. Theresa of her own feelings. By prayer
she had attained what she called a celestial quietude,— a
state of union, rapture, and ecstacy.* * 'It was a
voluptuous sensation such as one might experience when
expiring in raptures in the bosom of our God.'* *
Zimmerman (in 'Solitude') relates two cases somewhat
of a similar kind. Madame M. experienced effusions of
divine love of a peculiar nature. She first fell into a
state of ecstacy.* * Suddenly she started up seizing
one of her companions, exclaimed: 'Come, haste with me
to follow and call love, for I cannot sufficiently call upon
his name!'. A French young lady was the second instance
of this affection. She also frequently lost the power of
speech and all external senses, animated with a love
divine, spending whole nights in ecstatic bliss, and rap-
turously embraced by her mystic lover. It is difficult, per-
haps, to separate this amorous feeling from physical tem-
perament; and the following remarks of Virey on the sub-
ject of St. Theresa, are most judicious: 'She possessed
an ardent and sensitive disposition, transported, no doubt,
by terrestrial affection, which she strove to exchange
for a more exalted ardour for the Deity; for devotion and
love are more or less of a similar character. Theresa
was not fired by that adoration which is exclusively
due to the infinite and invisible intelligence which rules
the universe; but she fancied a sensible and anthropo-
morphous divinity; so much so, that she not infrequently
reproached herself with bitterness that these raptures
were not sufficiently unconnected with corporeal pleasures
and voluptuous feelings.'"


The Erotogensis of Religion
455
Continuing, Dr. Millegan asks what other name than
mental aberration "can be given to the ecstatic state of
the Monks of Mount Athos, who pretended or fancied
that they experienced celestial joys when gazing on their
umbilics in converse with the Deity?" Another descrip-
tion of religious enthusiasts, our author concludes with
these words: "The excesses of these maniacs were at last
carried to so fearful an extent, and their religious cere-
monies were so debased by obscenities, that the police
were obliged to interfere."
After more illustrative discussion Dr. Millegan ob-
serves also this: "In Spain and Italy,religious melancholy
and that most vexatious species of insanity called eroto-
mania, are most common.*-——* The ecstatic exaltation
of religion and of love are not dissimilar.* * Extremes
of depravity and contrition do not unfrequently meet.*—*
Emasculation was considered as rendering man totally
unfit for prophetic revelation, indeed any holy inspiration;
and we find in the first Deuteronomy that such subjects
[as eunuchs] were not admissible to the service of the
temple." 15
Henry Maudsley, the celebrated English alienist, has
said much about the "spiritual orgasm," and tempts
one to over-indulgence in quotation. He reminds us
that contemporaries of St. Theresa "did not fail to discern
a marked sensual flavor," in some of her raptures. "Some-
times in a voluptuous ecstacy or orgasm" this saint
"felt herself received like St. Catherine of Sienna 'as a
veritable spouse into the bosom of her Saviour.'" Mauds-
ley expresses the opinion that such experiences were
"little else than vicarious sexual orgasm."16
When St. Theresa became abbess she saw in hysteri-
cal nuns such invasions of sensuality as betray delusion
and the work of Satan. Commenting on her effort at
differentiation between these two, Maudsley says: "It is
a distinction between love and lust which other authorities
on like spiritual seizures were compelled, in face of the
15. Millengen's Curiosities of Medical Experience, Lond. 1837. See Chapter! on
Ecstatic Exaltation, Daemonomania, Enthusiasm, Flagellation, etc.
16. Pathology of Mind, (Appleton Edit. 1890. pp. 143-144.)


456
Theodore Schroeder
gross lubricity sometimes displayed in them, to make,
just as it was necessary to discriminate between the
mania which was the result of inspiration, a divine mad-
ness, and the mania which was madness. In various
parts of the Confessions, St. Augustine's elaborate exposi-
tion of the inexpressible delights of heavenly love betray
plainly their inspirations in the sensual delights of earthly
love."17
With numerous other illustrations Dr. Maudsley con-
cludes a most interesting discussion, which all should read
who are interested in the psychology of religion.
"We find," observed Dr. J. Milner Fothergill, a noted
English medical author, "that all religions have engaged
and concerned themselves with sexual passion. From
the times of Phallic worship, through Romish celibacy
down to Mormonism, certain theologies have linked them-
selves markedly with man's reproductive instincts."18
To this, Dr. Daniel G. Brinton adds: "The remark
is just, and is most conspicuously correct in strongly
emotional temperaments.* * Stimulate the religious
sentiment and you arouse the passion of love, which will
be directed as the temperament and individual culture
prompts. Develop very prominently any one form of love,
and by a native affinity it will seize upon and consecrate
to its own use whatever religious aspirations the indivi-
dual has. This is the general law of their relation."19
The eminent writer on mental disease, Schroeder
von der Kolk, when speaking of the forms of melancholy
arising from physical conditions remarks: "The patient
who is melancholy from disorders of the generative organs,
considers himself sinful. His depressed tone of mind
passes over into religious melancholy; 'he is forsaken by
God, he is lost.' All his afflictions have a religious color."
He adds: "I venture to express my conviction that we
should rarely err, if, in cases of religious melancholy,
we assumed the sexual apparatus to be implicated."20
17. Maudaley's Causes and Supernatural See mi rigs, pp. 249-257.
18. Journal of Mental Science, Oct. 1874, p. 198.
19. Brmton's The Religious Sentiment, pp. 61-73.
20. Hand-book von de Pathologic on Therapie der Krankzinnigheid, (1863, p. 139,
of the Eng. Ed. here requoted from Havelock Ellis' "Studies in Psychology of Sex,"
and from The Religious Sentiment" of Dr. Brinton.


The Erotogenesis of Religion
457
In a similar strain, Dr. Feuchtersleben says: "In
the female sex especially, the erotic delusion, unknown to
the patient herself,, often assumes the color of the reli-
gious."21
"The unaccomplished sexual design of nature," ob-
serves Dr. J. Thomas Dickson, while writing of the effects
of the single life, leads to brooding over supposed miseries,
which suggest devotion and religious exercise as the
nepenthe to soothe the morbid longings."22
Mr. Havelock Ellis has given us a summary of the
conclusions of numerous alienists, from which the following
are quoted: "The relationship of the sexual and religious
emotions, like so many other of the essential characteris-
tics of human nature, is seen in its nakedest shape by the
alienist. Esquirol referred to this relationship, and many
years ago, J. B. Friedrich, a German alienist of wide
outlook and considerable insight, emphasized the connec-
tion between the sexual and the religous emotions,
and brought forward illustrative cases."23
"Regis, in France, lays it down that: 'there exists
a close connection between mystic ideas and erotic ideas,
and most often those two orders of conception are
associated in insanity.' "2*
"Berthier considered that erotic forms of insanity
are those most frequently found in convents. Bevan
Lewis points out how frequently religious exaltation
occurs at puberty in women, and religious depression
at the climacteric, the period of sexual decline.26 'Re-
ligion is very closely allied to love,' remarks Savage,
and the love of woman and the worship of God are
constantly sources of trouble in unstable youth; it is
very interesting to note the frequency with which these
two deep feelings are associated."26
21. Element* of Medical Psychology, p. 218, requoted from Brinton.
22. The Science and Practice of Medicine, in relation to mind, p. 383, (N. T.
1874) requoted from "The Religious Sentiment," p. 73.
23. Ellis, citing.fSystem der Gerichtlichen Psychologic 1842, pp. 266-68. Allgemeine
Diagnostik der psychischen Krankheiten, pp. 247-251, Ed. of 1832.
24. EUis, citing, Manuel Pratique de Medicine Mentale, 1892, p. 31.
25. Ellis, citing. Text Book of Mental Diseases, p. 393.
26. EUis, citing. H. P. Savage, Insanity, 1886.


458
Theodore Schroeder
"'Closely connected with salacity, particularly in
women,' remarks Conolly Norman when discussing mania,
'is religious excitement.'27 Ecstacy as we see in
acute mental disease is probably always connected with
sexual excitement, if not with sexual depravity. The same
association is constantly seen in less extreme cases, and
one of the commonest features in the conversation of an
acutely maniacal woman is the intermingling of erotic
and religious ideas.' Ball, Brouardel, Morselli, C. H.
Hughes,28 to mention but a few names among many,
have emphasized the same point."29
Spitzka, one of the foremost American alienists,
concurred in these words: "All through the history of
insanity the student has occasion to observe the close
alliance of sexual and religious ideas, which may be partly
accounted for because of the prominence which sexual
themes have in most creeds, as illustrated even in ancient
times by the Phallus worship of the Egyptians, the cere-
monies of the Friga cultus of the Saxons, the frequent and
detailed reference to sexual topics in the Koran and sever-
al other books of the kind; and which is further illustra-
ted in the performance which, come down to a modern
period, characterize the religious revivals and camp
meetings, as they tincture 'their medieval model, the
Munster Anabaptist movement."3
Krafft-Ebing, the renowned Austrian specialist on
sexual insanity, deals briefly with the connection be-
tween holiness and the sexual emotion, and the special
liability of the saints to sexual temptations. He thus
states his own conclusions: "Religious and sexual emo-
tional states, at the height of their development, exhibit
a harmony in quantity and quality of excitement, -and can
thus in certain circumstances act vicariously." "Both,"
he adds, ."can be converted into cruelty under pathological
conditions."31
27. Ellis, citing, Tuke's Dictionary of Psychological Medicine.
28. Erotopathia, in Alienist and Neurologist, Oct. 1893.
29. See also Delire Religieuz in Icard's La Femme pendent la periode Menstru-
elle, p. 211-234. All restated from Psychology of Sex, (Modesty) p. 234.
30. Manual of Insanity, p. 39.
31. Psychopathia Sexualis, pp. 8 and 11, also p., 110 Chaddock's translation of
seventh edition.


The Erotogenesis of Religion
459
Dr. James Weir, who so far as I know, has made the
only effort in this country toward gathering and publish-
ing evidences bearing upon our theme, reaches the same
conclusion. He says: "That there exists a relationship
between the cultivated ethical emotions, religious feelings
and the essentially natural physio-psychical function,
sexual desire or libido, is a fact noticed and com-
mented on by many thinkers and writers. The litera-
ture of the subject, is, however, exceedingly fragmentary
and disconnected, no author having devoted as much as
one thousand words to this very interesting psychical
phenomenon. Throughout thousands and thousands of
years religious feeling and sexual desire, the componeat
parts of phallic adoration, were intimately associated;
finally religiosexuality became an instinct."88
"The current opinion that woman is religious is equally
erroneous. Female mysticism, when it is anything more
than mere superstition, is either thinly veiled sexuality
(the identification of the Deity and the lover has been
frequently discussed, as, for instance, in Maupassant's
'Bel-Ami' or in Hauptmann's 'Hannele's Himmelfahrt')
as in numberless spiritualists and theosophists, or it is
a mere passive and unconscious acceptance of man's
religious views which are clung to the more firmly because
of a woman's natural disinclination for them. The lover
is transformed into a Saviour; very readily (as is well
known to be the case with many nuns) the Saviour
becomes the lover. All the great women visionaries
known to history were hysterical; the most famous Santa
Teresa, was not misnamed 'the patron saint of hysteria.'
"All through Hecker's Epidemics of the Middle Ages
one is, by the facts recited, constantly reminded that
religious enthusiasm must a be most powerful aphrodisiac.
He speculates but briefly over the matter, and with these
words: 'An overstrained bigotry' says Hecker, 'is, in it-
self, and considered from a medical point of view, a distinc-
tive irritation of the senses, which draws men away from
the efficiency of mental freedom, and peculiarly favors
32. Religion »nd Lust, pp. 92-110.


4(>0
Theodore Schroeder
the most injurious emotions. Sensual ebullitions, with
strong convulsions of the nerves, appear sooner or later,
and insanity, suicidal disgust of life, and incurable nervous
disorders, are but too frequently the consequence of a
perverse, and indeed, hypocritical zeal, which has ever
prevailed, as well in the assemblies of the Maenades and
Corybantes of antiquity, as under the semblance of re-
ligion among the Christians and Mohammedans.'
"This religious receptivity in early life has been
frequently noted by careful observers. It seems as though
the agitation caused by a mysterious access of vitality,
and the consciousness of physical changes of momentous,
though unknown, import, predisposed the troubled mind
to seek repose within the sheltering guidance of religion.*-*"
"The above instances fairly establish the fact that
widely dissimilar as appear the motives which originate
religious emotion and sexual desire, and divergent as may
be their psychical operations, there subsists between them
an occult yet indissoluble bond. Probably, could we
know the secret history of many a rigid adherent to
church doctrines and observances, we should find that
there is little occasion to scrutinize the records of remote
times and places to discover what, there is every reason
to believe, exists in our midst."88
"Murisier, in an able study of the psychology of re-
ligious ecstacy, justly protests against too crude an ex-
planation of its nature though at the same time he admits
that, 'the passion of the religious ecstatic lacks nothing
of what goes to make up sexual love, not even jealousy.' ',34
Havelock Ellis, the distinguished English author of
"Studies in the Psychology of Sex," whose valuable re-
searches I have made great use of, in a concluding para-
graph, uses these words to express his own opinion:
"There is certainly, as I have tried to indicate, good
reason to think that the action and inter-action between
the spheres of sexual and religious emotion are very in-
timate. The obscure promptings of the organism at
83. Batter*! Love and it* Affinities, p. 74 to 81.
34. La Sentiment Religieni dans L'Extase: I requote from Studies in Psyeholoiy
of Sex, (Modesty) 285.


The Erotogenesis of Religion
461
puberty frequently assume, on the psychic side, a wholly
religious character; the activity of the religious emotions
sometimes tends to pass over into the sexual region;
the suppression of the sexual emotions often furnishes a
powerful reservoir of energy to the religious emotions;
occasionally the suppressed sexual emotions break through
all obstacles."86
In Italy we find Dr. Paul Mantegazza also asserting
the similarity of religious and fleshly love. He says:
"According to the temperament of the particular person,
Mysticism leads either to a contemplative (melancholia)
asceticism, or to a human love. When it teaches that
highest exaltation for religion's sake to do good, the
ecstacy always assumes the character of mysticism,
which it surrounds and guilds with an occult mantle
of beauty.* * Love in its highest degree of intensity
resembles nothing so much as religious ecstacy.* *
To the ecstatic woman, God is always her heavenly
bridegroom. In this earthly life devotion is the highest
form of love. In the religious life devotion is the ordinary
form of love which man feels for his God, or the other
supernatural beings which his fantasy creates.* *
Devotion almost unavoidably results in prostration which
others call the humiliation of the creature before the
Creator. This prostration is not only an expression of
Christian humiliation but is the natural form of all
strong love."86
Tarnowsky, the best known Russian specialistTin
sexual psychology says: "The development of satyriasis
is principally attributed to sexual abstinence, particularly
under the influence of religious conviction."87
No collection of such opinions as this could ap-
proximate completeness without adding the convictions
of the far-famed Dr. Max Nordau. He says: "Now
it is known that certain organic nerve-centers, the sexual
centers, namely, in the spinal cord and the medulla
oblongata, are frequently malformed, or morbidly irri-
36. PsjeBelogy of Sex, p. 244. (Modesty).
36. Die Ekstasen des Menschen, pp. 75-170-172-179.
37. Tht Sexual Instinct and ita Morbid Manifestations, p. 88.


462
Theodore Schroeder
tated among the degenerate. The stimuli proceeding
from them therefore awaken, in the brain of patients
of this sort, presentations which are more or less remotely
connected with the sexual activity. In the consciousness,
therefore, of such a subject there always exist among the
other presentations which are aroused by the varying
stimuli of the external world, presentations of a sexual
character, erotic thoughts being associated with every
impression of beings and things. In this way he attains
to a state of mind in which he divines mysterious relations
among all possible objective phenomena, e. g., a railway
train, the title of his newspaper, a piano on the one hand,
and a woman on the other; and feels emotions of an
erotic nature at sights, words, odours, which would pro-
duce no such impressions on the mind of a sound person,
emotions, which he refers to unknown qualities in those
sights, minds, etc. Hence it comes that in most cases
mysticism distinctly takes on a decidedly erotic coloring,
and the mystic, if he interprets his inchoate liminal
presentations, always tends to ascribe to them an erotic
import. The mixture of super-sensuousness and sen-
suality, of religious and amorous rapture which character-
izes mystic thought, has been noticed even by those
observers who do not understand in what way it is brought
about.* * Mysticism is always accompanied by ero-
ticism, especially in the degenerate, whose emotionalism
has its chief source in morbidly excited states of the
sexual centers."88
Kirsch, the distinguished German alienist who took
up the discussion of Degeneration in reply to Nordau,
while writing of the epidemics of the Middle Ages, says:
"The religious delusion was, as is commonly the case,
connected with states of sexual excitement and of de-
lusion belonging thereto." 89
Dr. Steingiesser of Berlin, the author of "Sexuelle
Irrwege," writes this: "All through the lives of the saints
for the last two thousand years, as a red thread running
88. Degeneration, pp. 61 and 188.
89. Geniua and Degeneration, p. 176.


The Erotogenesis of Religion
463
through all the ascetics, with rare exception, we see
evidences of sexual disorder, and with scarce an omission,
we find every degree of perversion, from the simplest
sexual hyperaestheticism up to sadism, as I have described
them in my book on 'Sexuelle Irrwege,' (Berlin 1901.)
Only through such knowledge, that which heretofore
seemed an insoluble riddle, has now become clear, and only
by assuming a perversion, can we dispel the darkness
which has hitherto obscured the lives of innumerable
ascetics.* * More interesting and plain the female
ascetics and fanatics show all the symptoms which point
to a relationship between religion and sex-feeling, and
from the ecstatic and hysterical Madame Guyon, the
spiritual devotee of Port Royal and contemporary of
Pascal, to the hysterical, epileptic Catherine of Siena,
we have before us all grades of sexual degenerates,
in whose lives we find a more clear and certain verifi-
cation of my above announced thesis."40
Prof. August Forel, a Swiss physician, gives a number
of illustrations not elsewhere found of religio-sexual
abnormities. He records one case of ecstacy which seems
undoubtedly to describe the religious ecstatic without
any religious interpretation or verbiage. "Ein geistes-
Kranker bezeichnete in seiner Druckschrift seine patholo-
gishen sexuellen Gefuhle als psychc-sexuellen Kontakt
per actio in Distanz!'" Forel thus generalized his ob-
servations: "A large number of religious rites and usages
are nothing but the worked-over customs of the sex-
life (in its broadest sense) and many dogmas serve only
to give these sex-customs a religious foundation, to enhance
their authority. Thence they react and work mightily
upon our sex-lives and our whole conception of it."41
Doctors Lauret and Nagour have made an extensive
study of the relation of occultism and love. From a
hundred pages I take space only to translate two para-
graphs. "Without mentioning the cult of the holy pre-
puce (of Jesus) which is the analogue of the heathenish
40. Gaachlechuleben der Heilig-en, (Berlin 1902) pp. 8-9.
41. Prof. A ax. Ford'* Die Sexuelle Fncc. pp. 367-377. (Munehen, 1908 Ed.l


464
Theodore Schroeder
sacrifice to Priapus, it is undoubted, by those who under-
stand the relation between religious and erotic emotions,
that the ethereal passion for the Virgin Mary, as the same
is cherished by young priests and even serious theologians,
portray only a peculiar effusion of erotomania, and show
that a glowing sex passion inspired the writing of these
celibates. Knight von Cadenberg, formerly a pupil at
the polytechnic school, in his book 'Le monde spirituel
et la science chretienne,' informs us of his relations
with an incubus, which assumed the form of the Virgin."42
The Academic Psychologist
Having now reviewed briefly the opinions of historians
and of medical experts, it is fitting to pass on to the opin-
ions of some professional psychologists. Here will be
included the opinions of those who have specialized
broadly on the subject of psychology as distinguished
from those who have specialized upon insanities as an
incident to or specialty within the medical profession.
Now for the first time I find some conflict of opinion,
for such men as the late Prof. James rather flout the idea
of a causal relation between sex psychic sensation and
religion. These adverse opinions will be critically studied
at another time. Here will be presented only the opinions
of those psycologists whose views contribute toward the
development of a working hypothesis concerning the erotic
origin of all religion.
Prof. James H. Leuba, after making a psychological
study of a group of Christian Mystics, reached these
conclusions: "In renouncing the work of the flesh—as
most of the great Christian Mystics have done—they do
not give up the passionate enjoyment which it yields.
They are still ready, nay, eager, to secure carnal delights,
provided it may be obtained otherwise than through
the ordinary channels of sexual gratification. One of the
greatest attractions of Mystical ecstacy is the presence
in it of those voluptuous feelings. Ecstacy is, as we shall
see, a love trance, so far as our Mystics are concerned.
42. Okkultismiu und Liebe. pp. 76-77.


The Erotogenesis of Religion
465
Saint Theresa tells us that she usually enjoyed intoxica-
ting delights in the company of Jesus. Ruysbroek de-
clares that 'the pleasure is greater, more voluptuous,
for the body, and for the soul, than all those the world
may give.' This experience is not peculiar to one or an-
other of the Christian Mystics; it is a trait common to
them all. The voluptuous excitement in which they are
at times plunged may be paralleled only by the most
passionate physical love. Mme. Guyon, frigid towards
her husband, wrote of Jesus Christ, with whom she had
contracted a so-called mystical marriage: 'I love Him
so that I can love no one but Him. I have lost every
other inclination of appetite.' Speaking later on of
that period of her life, she said: 'I was like one of those
drunkards, or one of those lovers who think only of the
object of their passion.'
"For information as to the physical seat of this
pleasure, we may go to Saint Theresa herself. She had
at times angelic visitors. Once the vision of a very small
and very beautiful angel was granted her. He held in
his hand a long shaft tipped with fire. Every once
in a while he would plunge it into her heart and push it
down into the bowels. As he withdrew it, it was, she
says: 'As if my bowels would be torn away and I was
left burning with the love of God.'
"Take in connection with the preceding, the interes-
ting case quoted by Havelock Ellis, in his Psychological
Study in Auto-Erotism. A woman physician, a disciple
of the Brotherhood of the New Life, founded by T. L.
Harris, describes thus one of her religious experiences:
'One morning I awoke with a strange new feeling in the
womb, which lasted for a day or two; I was so very
happy, but the joy was in my womb, not in my heart.'
The difference between these two experiences, so far as
the point at issue is concerned, is that the woman physician
says womb, and the Spanish saint says bowels.
"The sexual origin of at least the most intense and
highest (according to their own valuation) of the divine
raptures cannot be denied. They result from the setting


4Hfi
Theodore Schroeder
into activity of at least some of the organs of the sexual
life, to an extent varying with each person, and always
without his knowledge. It is a distinct form of eroto-
mania."
Dr. Josiah Moses, Ph. D., is the latest psychologist
to bear testimony to the connection between religion and
lust. I will quote him at some length.
"There is a natural dynamic relationship between
religion and sex; the two are inextricably interwoven,
so to speak, and influence each other at every turn.
In the biographies and autobiographies of saints, both
male and female, of monks, nuns and enthusiastic religion-
ists in general we find that sexual disturbances irradiate
and produce marked religious disturbances such as erotic
trances, visions, hallucinations, mystic experiences, etc.
Unable to express itself naturally the sexual impulse
finds an outlet in a more or less sensuous love of God,
Christ or the Virgin Mary."*4
In another place the same author adds this: "Like-
wise the religious impulse, when overwrought, breaks
through its natural bonds and spends itself in sexual
orgies. In the religious ceremonies of the Christs, for
example, a peculiar mystical sect in Russia, after the
performance of a series of hysterical acts, such as rapid
whirling around on their heels, loud singing and stamping,
wild and uncontrolled laughing, yelling, contortioning,
mutual flagellation, tearing off their clothes, running
wildly, throwing themselves on the ground, walking on all
fours, sitting on each others' backs, etc., which continued
late in the night, they threw themselves pell mell, men and
women, on beds, benches, on the ground, and abandoned
themselves to indescribable forms of depravity. 'The
carnal love which we experience for our sisters 'they say,
in justification of their licentiousness,' is sanctified by the
presence of the Holy Spirit among us.' Even more
degrading are the closing scenes of the ceremonies of
another kindred Russian sect, Skoptsy. Similar phenom-
43. Mind (of London) for Jan., 1905 p. 16-17.
U. American Journal of Religious Psychology, Vol. 1, p. 229.


The Erotogenesis of Religion
ena obtained in the festival of Venus, the Bacchanalia,
Floralia, Saturnalia, Liberalia and others, not only of the
early Greeks and Romans, but also of the European
nations until almost recent times.
"Of the influence of sex on religion there are also
very many examples. Mme. Guyon, whose married life was
loveless and most unhappy, cried, 'I wish the Divine
love, the love which puts me in a swoon.' And later,
when she had experienced the mystic union with God,
she wrote: 'O! my God, if you should make the most
sensual persons feel what I feel, they would soon leave
their false pleasures to enjoy one so true.' Another
mystic, Ruysbroeck, sought and found in God an enjoy-
ment, 'more voluptuous for the body and soul than all
other earthly pleasures.' Numerous other erotic mystics,
especially the female ones, such as St. Teresa, Catherine
of Sienna, and St. Gertrude, who experienced mystical
'marriages with God,' express themselves in similar strains.
Of the first, James says, 'In the main, her idea of reli-
gion seems to have been that of an endless amatory
flirtation—if one may say so without irreverence—between
the devotee and the Deity.' And to the last we read,
that one day, 'Suffering from a headache, she sought,
for the glory of God, to relieve herself by holding certain
odoriferous substances in her mouth, when the Lord ap-
peared to her to lean over towards her lovingly, and to
find comfort Himself in these odors. After having gently
breathed them in, He arose, and said with a gratified
air to the saints, as if contented with what he had done:
'See the new present which my betrothed has given me!'
"One day at chapel, she heard supernaturally sung,
the words, 'Sanctus, Sanctus, Sanctus.' The Son of God
leaning towards her like a sweet lover, and giving to her
soul the softest kiss, said to her at the second Sanctus:
'In this sanctity of my divinity and of my humanity,
and let it be to thee a sufficient preparation for the
approaching communion table.' And the next Sunday,
while she was thanking God for this favor, behold the Son
of God, more beauteous than thousands of angels, takes


468
Theodore Sckroeder
her in His arms as if He were proud of her, and presents
her to God, the Father, in that perfection of sanctity with
which He had dowered her. And the Father took
such delight in this soul thus presented by His only Son,
that, as if unable longer to restrain Himself, He gave her,
and the Holy Ghost gave her also, the sanctity attributed
to each by His own Sanctus, and thus remained endowed
with the plenary fullness of the blessing of .Sanctity,
bestowed on her by Omnipotence, by Wisdom, and by
Love.
"Francis Parkman states that the nuns sent over to
America in colonization days were frequently seized with
religio-sexual frenzy. 'She heard,' he writes of Maria
de L'Incarnation, 'in a trance, a miraculous voice.
It was that of Christ, promising to become her spouse.
Months and years passed, full of troubled hopes and
fears, when again the voice sounded in her ear, with
assurance that the promise was fulfilled, and that she was
indeed his bride. Now ensued phenomena which are not
infrequent among Roman Catholic female devotees when
unmarried or married unhappily, and which have their
source in the necessities of a woman's nature. To her
excited thought, her divine spouse became a living presence
and her language to Him, as recorded by herself, is of
intense passion. She went to prayer, agitated and
tremulous, as if to a meeting with an earthly lover.
'Oh my Love!' She exclaimed, 'when shall I embrace
you? Have You no pity on the torments that I suffer?
• Alas! my love! my beauty! my life! Instead of healing
my pain You take pleasure in it. Come let me embrace
You; and die in Your sacred arms!'
"This vital, interdependent relationship between the
two impulses is so marked that, with perhaps only one
exception, Prof. Wm. J. James, all who have given the
matter serious thought have been forcibly impressed bv
it."48
Pres. G. Stanley Hall of Clark University, has more
elaborately studied the parallelisms between religious
45. Pathological Aspect of Religion, pp. 15 to 18.


The Erotogenesis of Religion
469
and sexual love; these are condensed for us by Dr. Moses
and I therefore requote Pres. Hall's sentiments from Dr.
Moses, chiefly in the latter's words: "It is no accidental
synchronism of unrelated events that the age of religion
and that of sexual maturity coincide, any more than
that senescence has its own type of religiosity, nor is
religion degraded by the recognition of this intimate
relationship, save to those who either think vilely of sex
or who lack insight into its real psychic nature and so
fail to realize how indissoluble is the bond that God
and nature have wrought between religion and love. Per-
haps Plato is right, and love of the good, beautiful,
and true is only love of sex transfigured and transcenden-
talized; but the Gospel is better, which makes sex love
at the best the type and symbol of love of God and
man.* *
"The attitude of the lover and religionist towards
death is the same. The fanatic rushes into the very
jaws of death to avenge an insult to his God; the ardent
lover does as much for his offended lady love. The mystic
yearns for death that he may become one with God;
the lover that he may become 'the air that surrounds,
the breeze that fans, or the ornament that adorns his
beloved.'
"The soul in both is highly sensitive to nature.
Both love and religion draw the curtains from the eyes
of their votaries and their beauties in nature to which
they were previously blind. Jonathan Edwards, the God-
intoxicated man of America, tells us that after his conver-
sion, 'the appearance of everything altered; there seemed
to be. as it were, a calm, sweet cast or appearance of
divine glory in almost everything, God's excellency, his
wisdom, His purity, and love seemed to appear in every-
thing—in the sun, moon, stars; in clouds, and blue sky;
in the grass, flowers, trees; in the water and all nature,
which used greatly to fix my mind. I often used to sit
and view the moon from continuance, and in the day
spent much time in viewing the clouds and sky, to behold
the sweet glory of God on these things; in the mean


470
Theodore Sckroeder
time singing forth, wth a low voice, my contemplations
of the Creator and Redeemer.* * Before I used to be
uncommonly terrified with thunder, and to be struck
with terror when I saw a thunderstorm arising; but now,
on the contrary it rejoiced me. I felt God, so to speak,
at the first appearance of a thunderstorm, and used to
take the opportunity at such a time, to fix myself in order
to view the clouds and see the lightenings play, and hear
the majestic and awful voice of God's thunder, which
oftentimes was exceedingly entertaining, leading me to
sweet contemplations of my great and glorious God.
"For the amorist too, do the sun, moon and stars,
the clouds and blue sky, the flowers, grass and trees,
the winds and streams take on a new aspect and meaning,
but to him they suggest not so much the glory of God
as the rare beauty and sweet qualities of his Dulcinea.
"Love builds and decorates its nests and homes;
religion its towers and altars, its shrines, temples and
cathedrals.
"Both love and religion are subject to the laws of
rhythm. Now the lover is elated with joy, now depressed
with sadness; the religionist now despises and scourges
himself, and now is ravished with delight because he has
received some token of divine favor.
"Music and verse, the song and dance are vehicles
of expression for both. 'Music is the language of the
feelings as speech is of the intellect, and the theme of
by far the most music of the world is either love or re-
ligion. The melodies of the one often strangely fit
the words of the other, while songs and hymns have al-
ways been one of the potent aphrodisiacs of religious
affection, and will remain so as long as man is thumic
or pectoral and must have emotion.'
"Both have their fetiches—'rings, tresses, handker-
chiefs, and every article of dress or ornament, any one
of which may and has become the only object capable
of arousing genesic states. The very name assigned them,
amatory fetiches, is significant. So in the history of
religion, men have made idols of almost every object


The Erotogenesis of Religion
471
in nature which has been focused on to arouse crude
and perverse religious feelings and sentiments. There is
almost nothing that has not been worshipped, and there
is a long catalogue of even scatological religious rites.
Nearly every act and attitude have somewhere been re-
garded as worship, and also have elsewhere been used as
passional provocatives.'
"Just as man has been made by woman in manifold
ways and he in turn has made her, so, too, has man been
made by God, and in turn made Him in his own jmage.
"Both hunger for a larger and fuller life, and the best
work of each is to keep the other pure."48
"Love is the greatest thing in the world for both
the religionist and the amourist. Its praise is in superla-
tives, for all else is dross. We must love with all our
might and strength. Both furnish in their sphere
the strongest motive both to assert and to renounce
the will to live. They are exalted and degraded together,
and the best work of each is to keep the other pure.
Religion is at its best when its earthly image is most
spotless and untarnished, and love is at its best where
religion is purest and most undented. Just as this re-
lationship seems to degrade religion only by those whose
ideals or cults of love are lower, undeveloped, so those
who dispraise religion have not realized how indispensable
it is to perfect love. How central this thought was in the
mind of Jesus many parables and sayings attest. True
piety is earthly love transcendentalized, and the saint is
the lover purified, refined and perfected. To have attained
this insight, to have organized it into life, cult, and a
Church, is the supreme claim of Jesus upon the gratitude,
reverence, and awe of the human heart.* *
"Christianity gives a yet higher interpretation of
love—the greatest power of the soul fixed upon the great-
est object, God, and next to him, man. Those both
pray and serve best who love most. To the Christian,
God himself is love, and without the Pauline charity
46. Pathological Aspect of Religion, pp. 20 to 22, restating Hall'* Adolescence,
VoL 2, pp. 296401.


472
Theodore Schroeder
or love, all is sounding brass or tinkling cymbals. The
very end and essence of both moral and religious culture-
is to conceive and cultivate love in the purest, loftiest,
and most all-comprehending way. We saw in Chapter
VI how often in fact the sting of sin lies in the sphere
of sex, and phallic worship shows how religion itself can
grovel. If true love is the religion of the flesh, true
religion is the love of the spirit."*7
In Conclusion.
Here we have the concurring opinion of historians,
devout and non-religious, agreeing substantially that the
world-over, and without distinction as between different
religions, there appears always a concomittance of religious
enthusiasm and sensual enthusiasm. The practical uni-
versality of such synchrones in themselves are very strong
proof of a causal relation between the two.
The alienists and psychologists who have been
quoted, have been a little more specific in pointing
out how, a sexual longing, abnormally intense, creates an
hallucination of the experience longed for, and how a
consciousness that the experience is not of the normal
physical type, but psychic in character, produces in the
attempt at explanation all those mystical verbalisms by
which are described those experiences which are usually
miscalled "spiritual," or "transcendental." Here there
is more or less definitely the recognition that in their
essences religious ecstacy and erotic ecstacy are in-
distinguishable, at least in their respective insanities.
In so far as some of these authors have treated this
as a peculiarity of the abnormal states, and therefore un-
related to the normal functioning, I believe they have
erred. The abnormal manifestations should rather be
utilized to aid us in understanding the normal. Not
one of the authors who has discussed this question of
the interdependence of religion and its sensual co-relate,
has claimed the development of these abnormities to in-
volve even the least change in the nature or relationship
of religion and erotism to one another. This strengthens
47. HaB*a Adolescence, pp. 294-296-314.


The Eroiogenesis of Religion
473
the inference that the relationship is absolutely the same
in the normal condition as these experts found it to be in
the abnormal, although in the latter there is an extrava-
gant augmentation of their importance, relative to other
phases of life. We thus confirm in this particular a
deduction made from the more general truth that insanity
"consists in relative augmentation or diminution of healthy
conditions" without any change in essential causal re-
lations. I therefore conclude that whatever is conspicu-
ously true, of the relation of religion and sex, in patholog-
ic cases and in those great enthusiasms which mark the
borderland between health and disease, must be equally
true, though less conspicuously so, in all cases of perfectly
healthy religionists.
Here we must not overlook those numerous clergy-
men who have assured us of an observed connection
between religion and erotism. Among Christian sects
the most frequent and the most effective reproach,
sought for and always made, against heretical sects or
individuals, is that of unorthodoxy of behavior in relation
to sex. From what has preceded this result must be
expected, not only because a deviation from the normal
in the sexual life is to be expected, on the part of those
whose religious enthusiasm has become abnormally in-
tense, but also because the religious critic, by very
reason of the conditions which make him religious, is
predisposed to search for sexual irregularity, as the most
probable and at the same time, from his viewpoint of
its exaggerated importance, the most damning criticism
that could be made. This results from the predisposition
of all humans to seek and see most easily, in their op-
ponents, all those sins which they themselves are most
tempted to commit, and the repression of which is to
them the most difficult. Because the temptation to
them the most torturing "virtue" it is to that extent
also esteemed to be the one for which they expect most
praise, and for ignoring which others are entitled to
severest condemnation.


474
Theodore Schroeder
It is a psychologic principle that when a person shows
very intense feeling in regard to some one idea, out of
all proportion to the relative importance of that idea
measured by objective standards, the abnormal intensity
is not due to the idea itself but to some unbearable
associated idea which the victim is most anxious to con-
ceal. The method quite unconsciously adopted is the
old, old one of the thief crying "stop thief"—of concealing
an excessive sensualism in one's self by the extravagant
denunciation of sexual irregularities in those whom we
oppose and an equally irrational overvaluation of the
importance of our own sexual orthodoxy and that of our
friends. I believe it is by this psychologic law that
we must explain the fact that all religions, especially
all religious enthusiasts, so extravagantly overestimate
both the sacredness and sinfulness of sex. Thus we
again conclude that there is not only a concurrence
but some causal relation between the sex and religious
conditions.
Now I must say a few words about the nature of
this relationship, and here let me draw chiefly upon the
clergymen.*8 One says this of rapturous enthusiasms:
"It cannot be denied but that the fuel of them is usually
natural." Another writes of divine love as self love
"touched with some fleshly apprehensions of divine things
and excited by them." Another in writing about "a
mixture of natural love to the opposite sex, with Christian
and divine love" explains it by saying that because the
enthusiast finds himself with "more vehement motions
of his animal spirits, thinks himself fuller of the spirit
of God." Rev. Chas. Chauncey says that "some have
been made sensible, their joy was nothing more than a
mere sensitive passion." Baring-Gould testifies that
"Spiritual exaltation runs naturally inevitably into licen-
tiousness." And yet another divine informs us that when
unhallowed men get to expounding scripture there is
something "very delicious to the fleshly appetites of men,"
48. See Religion and Sensualism as connected by Clergymen, Am. Jour, of Re-
ligions Psychology, May, 1908. Vol. 8, p. 16.


The Erotogenesis of Religion
475
and goes on to say that true religion does not consist
in the "glowing heats of passion though these are often
mistaken for it." So it comes that: "'Tis an experi-
mental truth that passion is a great instrument of devo-
tion," and "young converts are apt to ascribe to
the operation of the Holy Ghost what is owing to the
mechanism of the body."
In these clerical admissions there is a very clear
recognition that in the cases observed religious experiences
were only sexual ecstacies, not identified as such, and there-
fore under operation of appropriate suggestion these
would be readily transcendentalized, thus interpreting
them as the operation of the Holy Ghost, the inward
miracle of grace, the testimony of the wee small voice
within, certifying to the truth of any accidentally associa-
ted theology, moral code, or religious ceremonial. The
same isolated facts which these clergymen thus inter-
preted, our historians have found to exist everywhere
as the accompaniment of religion, and some of our alienists
have made the same interpretation in the case of religious
insanities.
I propose now that the interpretation of the theolo-
gian as to the sexual nature of religious enthusiasms; the
historian's findings of the geographical universality of
similar facts; the alienist's interpretation of religious in-
sanities and the deduction which has been made from these;
the facts known about primitive and prehistoric phallic
worship which under the well known formula of the law
of evolution must be reproduced in condensed recapitu-
lation in the religious life of the individual; all this I
propose to combine inductively in one comprehensive
generalization. This generalization shall be my working
hypothesis for further investigation, and it must be
stated somewhat as follows:
All religion, at all times, and everywhere in its
differential essence is only a sex ecstacy, seldom recog-
nized to be that, and therefore, the more easily and
quite uniformly, misinterpreted as a mysterious and
"transcendental," or super-physical, undiscriminating wit-


476
Theodore Schroeder
ness to the inerrancy of all those varying and often
contradictory doctrines and ceremonials of superphysical
value in the promotion of present ecstatic or post mortem
wellbeing and which, in the believing person, happens
to be associated with and conceived as attached to
the feeling-testimony. Thus it is that all variety of
religionists know because they feel and are firmly con-
vinced in proportion as they are strongly agitated. When
we have correctly weighed the probative force of these
"feelings," as evidence for or against any theologic reli-
gious or moral doctrine, and discover their essence,
we will have abolished dualism and spiritism, and finally
establish as irrefutable the essentials of materialist monism.


SELECTIONS.
NEUROSURGERY.
Purpose of Ancient Trephining.—Fractures of
the skull among the Kabyles are practically unknown.
None of the prehistoric trephined skulls show any evi-
dence of a fracture. Unless the entire fractured area
was wholly removed in every instance, which is regarded
as improbable, Lucas-Championniere concludes that the
purpose of neolithic and pre-Columbian trephining was
the same as that of semi-civilized races today, namely,
the relief of headache. In other words, the primitive
surgeon, with his sharpened flint, had practised cerebral
decompression just as it is advocated in modern cranial
surgery.—N. Y. Med. Rec.
NEUROPROGNOSIS.
High Blood Pressure.—W. Edgecombe presents
the following summary of his experiences: The measure-
ment of blood-pressure by the mercurial manometer is,
on the whole, reliable, and furnishes a useful clinical
guide. There is a condition of "functional" or "neurotic"
high blood-pressure not due to arteriosclerosis. In the ma-
jority of cases of "functional" high blood-pressure, direct
treatment is unnecessary and may be harmful. "Functional"
high blood-pressure does not readily lead to arteriosclerosis.
The significance of high blood-pressure as a symptom is
less serious than is usually supposed. The treatment of
early cases of hyperpiesis is imperative and is usually
(477)


478
Selections.
satisfactory. Spa treatment gives the best results. The
treatment of developed arteriosclerosis is unsatisfactory
and should be mainly by general measures and periodic
spa treatment rather than by drugs. Excess of treat-
ment may be harmful as liable to accelerate cardiac
defect. The prognosis in cases of high blood-pressure
is less gloomy than usually considered.—Royal Society
of Medicine. Med. Rec, N. Y., Aug. 2, 1913. Opposite
this excerpt, page 204, may be found apropos good
reading in Beverly Robinson's Obsession.
NEURODIAGNOSIS.
Diagnosis of Convulsions by Leucocyte Count.—
Joedeke (Muench. Med. Wochenschr.) claims that a
trustworthy method of differentiating between hysteria
and epilepsy and one that cannot be imitated, is the
behavior of the white corpuscles.
While these cells show no change whatever after a
hysterical attack, they increase greatly in numbers
after a genuine epileptic seizure. Leucocytoses of more
than 20,000 are not uncommon. They drop rapidly
after the convulsions cease, and soon attain normal again.
—Bryce W. Fontaine's excerpt, in Memph. Med. Month.
Measurements of Pain.—Arthur MacDonald of
Washington, D. C. gives some of his results of pain
measurements on different classes of individuals, in all,
2311, as follows:
1. In general the sensibility to pain decreases as
age increases. The left temple is more sensitive than the
right. This accords with former experiments that the
left hand is more sensitive to pain than the right hand.
2. Girls in private schools, who are generally of
wealthy parents, are much more sensitive to pain than
girls in the public schools. It would appear that re-
finements and luxuries tend to increase sensitiveness


Selections.
479
to pain. The hardihood which the great majority must
experience seems advantageous. This also accords with
our previous measurements, that the non-laboring (professional
and mercantile) classes are more sensitive to pain than
the laboring classes.
• 3. University women are more sensitive than washer-
women, but less sensitive than business women. There
seems, however, to be no necessary relation between
intellectual development and pain sensitiveness. Obtuse-
ness to pain appears to be due more to hardihood in
early life.
4. Self-educated women, who are not trained in
universities, are more sensitive than business women.
The greater sensitiveness of self-educated women as
compared with university women may be due to the over-
taxing of the nervous system of the former in their un-
equal struggle after knowledge.
5. Girls in the public schools are more sensitive at
all ages than boys. This agrees with the results of
our previous measurements that women are more sensitive
to pain than men. But this does not necessarily refer
to endurance of pain.
These measurements of least disagreeableness, or of
threshold of J pain, are approximate measurements of the
combination of nerve, feeling, and idea. Which one
of these elements influences the combined result most
would be difficult to say.
Some of these statements merit further consideration
and more extended confirmation.
PSYCHOTHERAPY
Psychotherapy at Battle Creek.—"The American
Florist" calls attention to the efficacy of flowers in cheering


480
Selections.
the sick and thus aiding in their recovery. It cites
the Battle Creek Sanitarium, at Battle Creek, Mich, as
carrying out this idea most specifically. Here, physicians
actually prescribe flowers for patients, just as they
would order massage or an application of electricity.
After an operation, or if a sick person feels particularly
depressed in spirits, a blooming plant or a vase of flowers
is sent to his or her room, and the effect is often pro-
nounced. Of course, women are more susceptible to
this influence than men, but some of the male invalids
take a surprising lot of comfort from this "medicine."
—Can. Jour. Med. & Surg.
This is often the manner of our best hospitals for
the insane and a good practice for any hospital, medical
or surgical. All cheerful brain and mind entoning instru-
mentalities should be therapeutically employed in our
hospitals.
CLINICAL NEUROLOGY
Uncertainty of Diagnosis In General Paralysis.-
This uncertainty of diagnosis was well illustrated by the
fifty-four cases upon which Wassermann and Plaut first
started their syphilitic investigations, when the one thing
they desired was clinically certain material from the
institutions of Berlin and Munich. They were informed
that "no doubt of the diagnosis of paresis could exist,"
for the cerebro-spinal fluid came from cases almost all
of which were in the "undoubted advanced" stage of
the disease, or were "ordinary straightforward cases"
of "clinically undoubted" general paralysis. In spite
of every precaution three cases of mistaken diagnosis
were found after death in the fifty-four cases, an error
of nearly 6 per cent.
A most instructive investigation into this subject
was made a few years ago in America by Southard.


Selections.
481
He followed to the post-mortem room and the laboratory
forty-one well-marked cases in which the entire medical
staff of an asylum had unanimously agreed on clinical
grounds that the diagnosis of general paralysis was
certain. He found on examination after death that there
were six errors of diagnosis in the forty-one cases, or
15 per cent. From my own experience I am certain that
this is not an over-estimation, and if an attempt were
made to diagnose not merely well-marked but also early
cases, and those showing slight clinical phenomena, the
error would be much greater.
Caution was recommended by the most experienced
physicians of the past, who pointed out that as the diag-
nosis of general paralysis was tantamount to passing
sentence of death on the patient, every other possibility
should be excluded before coming to this conclusion.
Much likewise required to be excluded, for there were at
least ten other conditions from which a differential
diagnosis might have to be made. These included alco-
holic and syphilitic insanity, senile insanity, and organic
brain disease with paralysis, traumatic insanity, certain
toxic conditions and neurasthenic states, epilepsy, mania,
and imbecility. It was often impossible to arrive at a
definite diagnosis, and this was especially the case with
certain forms of alcoholic insanity resembling theconfusion-
al psychoses of Korsakoff. A provisional diagnosis
only could be made, and the course of disease watched,
'for any other policy sooner or later led to most regretabie
mistakes. In cases of organic brain disease with paresis
similar mistakes were also liable to occur. Neurasthenic
states in middle-aged men who had been exposed to
infection from syphilis often gave great anxiety, and in
doubtful senile cases above sixty-four, owing to diffi-
culties and uncertainties, a diagnosis of general paralysis
was seldom made.—Robertson Morrison Lecture in
Jour. Nerv. & Ment. Dis., April, 1913. 1st Art. "Early
Diag. G. P. I."
New Diagnosis of Paresis.—The methods of in-
vestigating general paralysis have now been revolutionized,


482
Selections.
and its diagnosis has been placed on a sure basis by the
six new serum and spinal fluid reactions and tests. The
method of diagnosing it now consists of two processes
which are complementary. There is first the clinical
process in which the patient is examined by the usual
methods employed in psychology and neurology. If,
as a result of this examination, the presence of general
paralysis be suspected, it is then necessary to apply the
second or laboratory process to verify this first impression.
The employment of the latter resembles chemical analysis
in the method of its application and in the certitude
of its results. By obtaining certain definite reactions
in sequence and noting the presence of certain positive signs
in association with the clinical symptoms, an accurate
diagnosis can almost always be made. There are only
two conditions in which there is any uncertainty with
regard to the presence of general paralysis, namely,
when mental symptoms exist in association with its
twin sister, tabes, or its first cousin, cerebro-spinal
syphilis.
It is not the author's intention to give a description
of the classical symptoms of general paralysis, as these
can be found in any text-book. But rather to arouse
suspicion of the presence of the disease at an early stage
by drawing attention to those symptoms, often not serious
in themselves, which appear early. In the past such sus-
picions would have been futile had they arisen, for nothing
further could have been done to complete the diagnosis
but to await developments. Now we can apply the labora-
tory tests referred to, and in almost every case say def-
initely and at once whether general paralysis be present
or not.—Dr. Geo. M. Robertson Morrison Lecture in
Jour. Ment. Sci., April.
The author adds the following mental symptoms
to the above:
"The fundamental symptom of general paralysis
is enfeeblement of function. There is a steady process
of deterioration going on, producing first impairment
and finally destruction or paralysis of the mind, known


Selections.
483
as dementia. Weakness of judgment, loss of memory,
and a blunting of the sensibilities are present in one shape
or another in every case, and these are the characteristic
symptoms. In the early stages the patient is not insane:
he is merely a changed man. There is an alteration
in his intelligence, character, habits, and feelings, and
this change is for the worse. He may continue to do
his work, though in a more mechanical and less efficient
way than before, and it costs him a greater effort. Forget-
fulness is usually a noticeable symptom, and failure
of memory may lead to unexpected mistakes in spelling
and calculation, but there are also more serious lapses
when important matters are forgotten. Lifelong habits
of courtesy, of decent behaviour, and of personal honor
may be departed from, and in their place there may
arise a tendency to alcoholism, immorality, or even
criminal acts, such as absurd theft. Moodiness and ir-
ritability may develop, or else apathy and indifference.
It is said that 12 per cent. of the cases are conscious
of these defects, but it is probable that at this early
stage the percentage is really very much higher."
Tumors of the Hypophysis, according to Bernier,
Presse Medicale, cause adiposoidal degeneration and
acromegaly. The former is shown in complete genital
atrophy, eye derangements and sella turcica hypertrophy.
The acromegaly by hyperfunctioning of the hypophysis
(anterior lobe). The causes are tuberculosis, hereditary
syphilis, alcoholism, plumbism, malaria or other and more
obscure morbid states.
Spreading Typhoid After Recovery.—The Hospital
records the following to be added to the remarkable
case of Typhoid Mary Ann:
In 1895 a woman of sixty had an attack of typhoid
fever and recovered. She got her infection from a son,
whom she nursed: he soon afterwards left the district,
and could not therefore be to blame for any further
cases. She assisted in the management of a small wayside
hotel in a country district, containing a scattered popula-
tion of some 1,500 persons. It was this old lady's duty


Selections.
to attend to the cows, and it is significant that she al-
ways refused to have the milk boiled. In 1898 another
son got typhoid, from which he died. Thirteen more
cases occurred during the next thirteen years. Five of
the patients were boarders in the hotel, and two were
tourists who had stayed there. Three were neighbors
supplied with milk from the hotel cows; two were servants
in the hotel; and the thirteenth was the old lady's niece.
Then in 1911 the "carrier" removed to another hotel
in a different" district: no further cases occurred in the
first district after she left it, but five cases promptly
appeared in the second hotel. Just as preparations for
investigation were being considered, the old lady died.
Her gall bladder was removed two hours after death,
and yielded vast numbers of typhoid bacilli: the intestines
showed bacillus coli communis, but no bacillus typhosus.
The chain of evidence seems strong, and the fact that the
"typhoid carrier" continued to disseminate virulent
germs up to her death at the age of seventy-six is also
remarkable.—Bull and Kidd in the Australian Medical
Journal.
CLINICAL PSYCHIATRY
Transvestism or Cross-Dressing [Zum Kapitel
der Transvestiten.] (Arch. f. Kriminalanth, 1912.) Nacke.
The impulse to adopt the dress and the ways of the
opposite sex without any necessary change in the direction
of the sexual impulse has been vey thoroughly studied
by Hirschfeld, who has termed this condition "trans-
vestism." Nacke here seeks to supplement Hirschfeld's
results.
He would term this condition the desire for disguise
and divides the persons so affected into three classes:
homosexual (including bisexual,) heterosexual and asexual.
The last class is based on the case of a man, thus affected,
who had never had any inclination to either sex and never


Selections. 485
had any sexual dreams. There are further, three types
of cross-dressing: permanent, temporary, and intermittent.
Whether the costume of the opposite sex acts in these
cases as a sexual equivalent for normal gratification
is a question which Nacke answers in the negative,
though he admits that there are exceptions. So far as
his knowledge of them goes, he does not consider that
these people can be termed degenerates; in physical
development and appearance they are normal.
On the whole, the impulse to cross-dressing seems
to be usually inborn and becomes manifest in childhood.
It appears either in heterosexual or homosexual persons,
and may be associated with a sexual impulse of any de-
gree of strength or weakness. It is a congenital perversion
(not perversity), which may occur in the stupid or the
clever (it seems especially liable to occur in the upper
classes, in artists and in men of letters,) in people of
good character or of bad character, in the sane or the
insane. Its medico-legal significance is usually small.
Nacke was at one time inclined to think that cross-
dressing might be regarded as a kind of fetichism, but
gave up the idea since the garment in itself usually
has no sexually stimulant influence. Any definite sexual
aim is generally absent. It is an impulse, Nacke points
out, which decidedly supports the hypothesis of a general
bisexual disposition. It is to be regarded as an anomaly,
a psychic intermediate stage, but certainly not as a
disease.—Abstract by Havelock Ellis in Jour. Ment.
Science.
Psychic Aphasia in Dementia Praecox.—Dr. Wra.
A. White, Washington, D. C. in the Theory of the Com-
plex.
An instructive example in the realm of the abnormal
is that of Miss P., a case of dementia praecox. She
wrote the following letter to her uncle:
Dear Uncle: Washington, D. C.
I am insane as I have been place—in the asylum in
the brain favor as Uncle Bee—was once accused of
being crazy over seeing to much of the Doctor intuition


486
Selections.
of being deying of death over worrying of seeing my
own self Home, where I belong as I am "Eplay, in trouble
all my life & Hope I re gain cinarc tonces of mind in
Body & Kind show me by my own be able in Doctor
Office I hope Mrs. E. & Aunt Ida I join love to all
very own to claim my own Mind bye from
Affection Neice Sarah."
This patient. although noticeably demented, presented
a quite natural appearance to casual observation and
despite the fact that her writing is so incoherent, talked
well about simple things and answered questions with a
fair showing of intelligence. I showed her this letter
and asked her to read it aloud and tell me if she wrote
it. She took the letter and read it with a perfectly
serious manner and said that she had written it. Her
whole attitude when reading the letter and being question-
ed about it gave no indication that it impressed her as
in any way strange. On the contrary it was quite natural
and she appeared while reading the letter to have a full
comprehension of its contents. Here again we are not
justified in coming to hasty conclusions without the
proper mental setting for the mental facts. The mere
fact that this letter is hopelessly incoherent and incom-
prehensible to us does not' necessarily mean that it was
to her, and her attitude while reading it certainly indi-
cates that it was not.
I am tempted at this point to illustrate a conception
of mind, which the consideration of complexes leads to,
by a figure of speech. The mind cannot be conceived
as consisting of or containing ideas which are deposited
here and there, helter skelter, without order as the scraps
of paper that are thrown carelessly into the waste basket.
Quite the contrary. Ideas are grouped about central
experiences, constellated as we say, built up into harmon-
ious structures not unlike the way in which bricks and
stones are brought together to form buildings and these
buildings are again grouped according to the purpose they
fulfill, as government, business, residential, etc. The
city is built according to a general, though often not


Selections.
487
very definite plan, it has its avenues of approach, its
highways and by-ways, its systems of traffic lines com-
municating between the different sections, etc. The
central part of the city is pretty well organized and con-
structed, here little change goes on, but in the outskirts
new ways are being opened up and we see lying all
about building material not yet assembled to form new
structures. Now suppose an earthquake destroys this
city—what happens? All these fine buildings come tumb-
ling down. The walls crack and crumble and the bricks
come falling to the ground. Here and there only a wall,
a tower, perhaps a whole building remains standing.
The foundations of all these buildings, however, remain
fairly well preserved, in outline at least; it is for the most
part the superstructure that has been destroyed. Now
suppose we try to enter the city by the usual way, we
will find ourselves almost immediately arrested by masses
of debris, we will see that the streets that we are familiar
with are blocked at many points, that the whole picture
looks unfamiliar and that landmarks are very difficult
to recognize. Here for example the foundation of a
church which was razed by the shock has been buried
beneath the bricks of an adjoining commercial house.
All of the component parts of the city are still here but
in quite different relations and in this mass of confusion
only the trained eye of the old resident can see the traces
of the old order of things and pick out the old landmarks.
And so it is with many of our patients, particularly
our praecox cases, where the dilapidation of thought
is so pronounced. The fundamental things of mental
life, the foundations, remain until the last but they are
often buried under masses of debris and their location
indicated by ideas with which before they never had any
connection. So, too, if we try to approach these cases
we will find them quite inaccessible by the usual avenues;
we must take our bearings anew, draw up a new ground
plan—the old one will not suffice.
Our patients live a mental life all their own, even
talk their own language which is incomprehensible to us.


488
Selections.
If we are to gain access to them we must learn the ave-
nues of approach.
Absence of Proper Provision for the early treat-
ment of incipient and undeveloped cases of mental dis-
order in Great Britain.
Broadly speaking, General Hospitals do not make any
provision for the treatment of mental diseases. In a few
instances there are out-patient departments, but, although
there are observation wards at Edinburgh, Glasgow and
Dundee, no sufficient provision is made in connection
with any of the General Hospitals for the efficient in-
vestigation and treatment of cases of mental disorder.
Psychiatry is thus divorced from ordinary medical ed-
ucation and practice.
Nowhere in Great Britain can a poor person obtain
treatment voluntarily in a public asylum.
The County and Borough Asylums in England and
the District and Parochial Asylums of Scotland are not
permitted to receive Voluntary Boarders. Expert treat-
ment is therefore unattainable by the poor until the
illness has become so pronounced that the patient can
be certified as insane.—Rept. Med-Psych. Ass'n. on
Status of Psych., Etc.
NEUROPSYCHOLOGY
Instinct and Intelligence.—For many years it
has been the custom to think of instinct and intelli-
gence as set over against each other. The former repre-
sents the inherited reactions of the animal; the latter
signifies those acts which the animal learns in the course
of its individual life and its power to learn in this fashion.
Instinctive acts are "perfect the very first time," while
intelligent acts are slowly acquired. In so far as an animal
is dependent on its instincts it is the victim of its ancestry
and of its immediate environment. In so far as it is in-
telligent it can adapt its environment to itself, can rise


Selections.
489
above its immediate surroundings and act in the light
of a distant end to be accomplished. Instinct is blind
as to the outcome of its action; intelligence foresees and
modifies its behavior in the light of its foresight. The
supreme example of instinct has been the wasp going
through an elaborate course of action to provide food
for its yet unhatched offspring, seeking out a particular
species of caterpillar, stinging every segment just enough
to stun the animal but not kill it, and then depositing
the worm at the bottom of its newly made nest where
it has laid its egg, covering up the cell and then leaving,
never to see the larvae nor to live to do the same act
another season. The supremely intelligent animal is
man possessing the earth by the genius of his intellect.—
Haggerty in Atlantic Magazine.
The Feelings.—Until 1896, the psychologic analysis
of the feelings seemed quite a simple matter; an experience
felt either pleasant or unpleasant, if it were not entirely
indifferent. In that year, however, Professor Wundt,
of Leipzig, published a new theory in which he distinguish-
ed innumerable feeling-qualities. They are classified into
three pairs of opposite qualities—namely, the pleasantness-
unpleasantness group already recognized, a group of
feelings of excitement and depressions, and one of tensions
and relaxations. The first group depends upon the in-
tensity of the stimuli that affect us, a moderate amount
being pleasant, while too much or too little is unpleasant;
the second group depends on the quality of the stimuli,
and the last group on its duration, for as we wait and
expect, we become tense, and after the event we relax.
Many psychologists have accepted this theory, although
others have severely criticized it, especially on the ground
that Wundt has described as feelings what they consider
to be organic sensations, which his system practically
entirely omits. Experimental evidence by the two methods
applicable to feelings has so far been contradictory.—
Dr. Geissler in July Med. World.
As to Alcohol in the Tissues.—Through the activ-
ity of the yeast-cell in the presence of glucose alcohol


490
Selections.
is formed. Is there anything analogous to this in the
case of the animal cells that make up our tissues and
organs? This question has often been debated; and the
suggestion of close chemical relations between the fer-
mentation initiated by yeast and certain aspects of the
metabolism of carbohydrates in the animal body recurs
from time to time. The possibility is further strengthened
by the fact that muscle from freshly killed animals
has more than once been reported on good authority
as yielding traces of ethyl alcohol by distillation. The
immediate explanation ventured has been that alcohol
may be formed by the agency of micro-organisms in the
alimentary tract. It may then be absorbed and distrib-
uted through the organism so that there need be no
surprise if residual traces can be detected in the tissues
at times. A. E. Taylor of the University of Pennsylvania
has approached this phase of the theory advanced by
examining the tissues of an animal in which bacterial
processes within the digestive tube were excluded by
complete removal of the tract. The operation is necessari-
ly a difficult one; the circulation of the pancreas and the
integrity of this gland must be maintained, and the animal
must be kept alive long enough to permit the combustion
of any traces of alcohol that might have been absorbed
from the intestine prior to the operation. Even after
this precaution small amounts of alcohol were still ob-
tainable from the fresh tissues. The implication thus
obtained that alcohol may actually arise in metabolism
offers nothing out of harmony with known biochemical
fact and theory. It merely indicates one of the numerous
possibilities, like lactic acid, formic acid, etc., exempli-
fying intermediary stages in the transformation of glucose
by living organisms.—Jour. A. M. A., Current Comment.
NEUROPHYSIOLOGY
Reproduction of Blood-Constituents.— After tak-
ing 10 liters of blood from an immunized horse, O'Brien


Selections. 491
noted the following: The number of white cells varies
widely and irregularly. Very small differences are found
in the differential count. The hemolytic liter remains
practically constant, showing variations of at most 10
per cent. from the initial figure. The total amount of
salts present does not decrease, but may be increased
10 per cent. The content of all other blood constituents
falls, the hemoglobin and number of red cells falling to-
gether to 50 or 60 per cent. of the initial figure. The
color index of the new red cells remains at the normal
figure. The curve of volume of the red cells does not
correspond very closely with that of the number of
red cells. The curves of total proteins and of diph-
theria antitoxin show a fairly close relationship.—Lancet,
London Jour. A. M. A. abstract.
NEUROTHERAPY
Nomenclature of Tuberculin Doses.—Codd would
select as a final unit the smallest dose likely to be given.
For this unit a name must be found, and it should be an
"unappropriated" Greek letter, with an associated word
with meaning suitable to its minute dimensions. There-
fore he suggests the letter tp and the word psilon, which
may be conveniently translated "shred," "residue" or
"atom." Thus fractions may be obviated, the dose being
given in psilons, until it reaches the cubic millimeter,
and then be given in cubic millimeters until it reaches
the cubic centimeters. Another suggestion is the abolition
of the practice of speaking of the dose of TR in terms of
milligrams of the original bacillary substance, when three-
fifths of that substance is no longer present. It is just
like speaking of a dose of liquor strychninae, not as 5
minims, or as 1-20 grain, but as the original weight of
nux vomica bean from which this quantity of liquid had
been made. If, however, clinicians still wish to prescribe
TR in terms of weight of the original bacillary substance,


492
Selections.
it would still be practicable to use the symbol tj' for
100,000 mg. of original bacillary substance of TR and its
quantity would be the same as if the dose had been ex-
pressed in the Continental fashion—that is, in cubic
centimeters of tuberculin fluid. In the method of pre-
scribing tuberculin adopted at the general hospital, Wol-
verhampton, they use the psilon unit and the cubic
millimeter unit. The cubic centimeter unit is used only
when the dose has attained unity or beyond. If this
method were generally adopted, Codd says, it would
render the use of tuberculin more popular and more
intelligible to busy practitioners who do not give their
whole time to unraveling these ponderously expressed
fractions.—Brit. Med. Jour., Jour. A. M. A. abstract.
Distilled Water in Syphilis.—The British Medical
Journal has the following on this subject and it is es-
pecially interesting:
The treatment for syphilis recommended by Stephens
consists of the hypodermic injection of 6 to 10 c.c. of
distilled water every three days for two to four weeks.
He was induced to give this treatment a trial as the re-
sult of some research work on surface tension. He
claims that the addition of distilled water to blood cor-
puscles so affects the osmotic pressure as to cause a pas-
sage of water into the cell, which gets larger and eventual-
ly scatters its contents. In disease the rapid catalytic
changes and rapid production of antibodies are interde-
pendent, and if one can induce these marked catalytic
changes with or without a vaccine, one stands the chance
of setting free a number of very useful and remedial
antibodies. In such a chronic disease as cancer it seemed
to Stephens that the process was allowed to continue
owing to the absence of sufficient antibodies, or at least
a sufficient number to act together at the same time,
and if one could set free any catalytic antibodies in
sufficient numbers one might get a good result. Knowing
of no vaccine to induce this antibody effect, it occurred
to him that the injection of distilled water might so
affect the surface tension as to bring about the osmotic


Selections.
493
effects. The marked effect produced by the injections
of distilled water made him feel certain that in any similar
disease of less malignancy their effect ought to be still
better, so with that object he undertook the treatment
of syphilitic patients. The Wasserman reaction is,
in his opinion, nothing but a roundabout way of determi-
ning the surface tension at which hemolysis occurs, and
if, he says, this view is correct, the time ought not to
be far distant when a simpler and more scientific method
is introduced, and one that is not open to so many
pitfalls. He cites six cases.
Magnesium Suplhate Cures Tetanus.—A very
valuable instance in which Tetanus was demonstrably
cured by intraspinal injections of magnesium sulphate
has been lately reported in the British Medical. Lumbar
puncture was first performed, and then without with-
drawing the needle 3cc. of a 25% sterilized solution of
the magnesium was introduced. Three similar injections
in the course of nine days were followed by a cure.—
Maine Med. Jour.
High Frequency Applications and Body Tem-
perature—Diathermy.—High frequency currents are
said to increase metabolism; causing more rapid oxidation,
more rapid elimination of watse products, and increased
heat production. They reduce congestion and relieve
pain; give rise to local vaso-dilatation and in some cases
reduce blood-pressure.
It is now recognized that practically all the effects
of high frequency currents proper are due to their thermal
action. These currents, by virtue of their extremely
rapid oscillations, are quite innocuous as far as ordinary
electrical effects are concerned, hence very large doses
can be given. The heat production, however, is directly
proportional to the strength of the current, consequently
we have in high frequency electricity a means of raising
the internal temperature of the body that is only limited
by the power of the apparatus at our disposal. Until
quite recently this limitation was the cause of failure
in many instances, but the introduction of powerful


494
Selections.
apparatus for wireless telegraphy has rendered possible
the medical science of "diathermy," which consists in
raising any part of the body to any desired temperature
by means of modified high frequency currents.—Alfred
C. Norman. "Electricity in Modern Medicine." The
Hospital.
Radium Emanation Therapy.—Engleman, (London
Lancet), says that radium emanations have been found
to increase the activity of certain enzymes in small doses,
decreasing such activity in larger doses. Radium treat-
ment has been observed to first raise, then decrease
the number of leucocytes. Both in gouty and in healthy
subjects uric acid excretion, endogenous and exogenous,
seems to be accelerated. Radium emanantions are ad-
ministered in three ways: by baths; drinking radiated
water; and inhalation of radiated air. Radium inhalations
in any or all of the three ways often cause striking im-
provement in gout. Other conditions sometimes im-
proved are chronic articular rheumatism, sciatica, neuritis
and neuralgia, asthma, arteriosclerosis and some diseases
of women, particularly myoma.—N. C. Med. Jour.
Goat's Milk Should be Boiled Before Drinking
since Malta fever is transmitted by goat's milk and
has affected entire families on goat ranches in Texas and
New Mexico. Comes from the Office of Information,
U. S. Dept of Agriculture.
Scientists of the Bureau of Animal Industry have
compiled a bulletin which is of practical interest to all
who raise goats and to such invalids as have been
prescribed goats' milk as a diet.
Pasteurization of infected milk for twenty minutes
at 145° F. is sufficient to destroy the organism which
transmits the disease. Therefore, milk pasteurized for
the destruction of typhoid and tuberculosis germs will
also be free from the Malta fever germ.
The Relative Value of Turtle Tuberculin in
the Treatment of Tuberculosis.—"The treatment
of individual diseases with medicines or by methods
having a selective curative action has until recent years


Selections
495
been limited. With the establishment of the germ theory,
and vaccine therapy of certain diseases and the develop-
ment of information concerning immunity, new methods
of specific treatment have been made possible, and are
now practiced under the terms of serum and vaccine
therapy." This is part of an introductory paragraph
of a valuable contribution on the above subject, appearing
in the New York Medical Journal for September 13th,
1913, by Doctors J. W. Beattie of New Hampshire and
E. E. Meyers of No. 418 Central Park, West, New York
City.
Drs. Beattie and Meyres quote von Ruck's reference
to the claims of Friedman for the superior value of a
living tubercle baccilli in the treatment of tuberculosis,
and deprecates the Berlin Doctor's spectacular advertising
propaganda in the daily press. Von Ruck said, "inas-
much as living tubercle baccilli of the human type
have been found in vaccinated cattle, both in their
flesh and in their milk, as long as three years after
their intravenous injection, the objection to the use of the
living tubercle bacilli as an antigen, or vaccine for prophy-
lactic purposes in the human subject is well founded.
A more formidable objection is, however, the danger of
virulence."
They aver Prof. Piorkowski, working along the lines
of Prof. Koch's discovery, isolated a living antigen in
the form of tubercle baccilli recovered from a turtle,
as far back as 1903 without in any manner questioning
its non-virulence. Since that time he has continued
his research along this line, and has at last succeeded
in perfecting a tuberculin produced from the tubercle
bacilli of a deep sea turtle which is non-virulent, and with
which, he has successfully experimented with thousands
of cases during the past few years at his laboratory in
Berlin.
Pasteurized Milk at Low Temperatures.—Wash-
ington, D. C.—In order to determine the best way of
pasteurizing milk so as to kill the disease germs and yet
not give the milk a cooked flavor or lessen its nutritive


496
Selections.
value, the Department of Agricultire, through its Dairy
Division, has been conducting a series of experiments,
treating milk at different temperatures and for different
lengths of time. According to the report on these ex-
periments in Bulletin 166 of the Bureau of Animal
Industry, when milk is pasteurized at 145° F. for thirty
minutes the chemical changes are so slight that it is
unlikely that the protein (muscle building element)
or the phosphates of lime and magnesia are rendered
less digestible than they are in raw milk.
Moreover, from a bacteriological standpoint, pasteuri-
zing at low temperatures is found to be more satisfactory
than pasteurizing at high temperatures. According to
Bulletins 126 and 161, where low temperatures are used
the majority of bacteria that survive are lactic acid
organisms which play an important part in the normal
souring of milk. When milk is efficiently pasteurized
at high temperatures, the bacteria which survive are
largely of the putrefactive kinds, and milk so treated
if kept for any length of time has a tendency to rot
instead of sour. From the standpoint of economy, the
technologist of the Dairy Division finds that pasteuri-
zing at low temperatures calls for less heat. It is found
that it takes about 23^ per cent. less heat to raise milk
to the temperature of 145° F. than a temperature of
165° F. A similar gain is a saving of the ice needed,
because it will require 23^ per cent. more refrigeration
to cool milk to the shipping point when it is pasteurized
at the higher temperature. The Department, therefore,
recommends that "When market milk is pasteurized
it should be heated to about 145" Fahr. and held at that
temperature for 30 minutes."—Aug. 1st, 1913 Report—
Dept. Ag.


THE
ALIENIST AND NEUROLOGIST.
Vol. XXXIV. St. Louis, November, 1913. No. 4.
Sesscrlptlon $5.00 per Annum In Advance. $1.25 Single Copy
ThU Journal ia published between tbe first and fifteenth of February. May, August
and November. Subscribers failing to receive the Journal by the 20th
of tbe month of issue will please notify us promptly.
Entered at the Poet-office in St. Louis as second-class mall matter.
All remittances should be made to Chas. H. Huqhss.
The Alitnitl and Nturologitt is alwaya glad to receive articles or photographa
from aubecrlbera or friends and material acceptable tor publication. Addresa
manuscripts and photographs to the Alienitt and Neurologist. For return of
non-accepted manuscript send addressed envelope and sufficient postage.
Any Comment, favorable or unfavorable, apecifically set forth, is always wel-
come from friend or enemy or any "mouth of wisest censure."
CHA8. H. HUGHES. M. D.. Editor and Publisher.
Editorial and Bnsineea Offices, 88S8 W. Pine Boul.
Hnona Printing Co., Printers and Binders
EDITORIAL.
[ 411 Vnngntd Editeriatt are written by Ike Settle*.]
The Medical Student's Burden.—That too much
detail study is being put on the medical student, too lit-
tle condensed'and boiled down to really available essentials
for the practical life before him as a physician and even
for his own sanitary endurance is evident to any ex-
perienced medical educator who will study the number
of teachers and hours assigned to the average American
college.
Some sort of psychic condensing apparatus needs to
be devised for these unfortunates who now aspire to
become doctors of medicine. Some medical Edison
497


498
Editorial.
should come to the aid of the present day medical student.
Perhaps Dr. Achille Rose could suggest a shorter Greek
course for the embryo doctor than is now in vogue in
the literary two-year college course, for philological Greek
the medical student must know if he would rightly under-
stand medical terminology, of which medical terms are so
greatly composed.
By the manner in which we are teaching we are
putting too much and too prolonged work on the medical
student who has ambition to begin his life work along
with others of his fellows before middle age comes upon
him. The present exactions are unfair to him and his
life. He should be prepared for practice by the time he
is twenty-five and we should adapt our teaching methods
by right condensation, illustration and generalization as
well as clinical specialization to his needs and powers of
endurance with justice, fairness and wisdom of instruction.
"The student should possess a good primary and
secondary school education. If the boy enters the pri-
mary school at six, he will graduate from the secondary
school at eighteen or nineteen. He should have in
addition to this, a sufficient knowledge of chemistry,
physics,, biology, to enable him to intelligently begin
his medical studies. In Canada, England and Ger-
many this additional preliminary training can be ob-
tained in one year of work either in the medical school
or in the science department of a university. Then follow
four years of medical studies proper and a year or more
of hospital interneship. According to Dr. Bevan, the
Council on Medical Education believes that one year or
more of hospital service should be required before the
graduate is permitted to engage independently in practice.
To our way of thinking, Dr. Bevan has struck the
happy medium in medical education. If Germany,
the recognized leader in medical thought today, can pro-
duce the men she does without such stringent require-
ments, there is something radically wrong with our methods.
There is no doubt but America is suffering from too much
pedagogical pedantry. Non-medical educators to a large


Editorial.
499
extent have set the standards, and every school not
reaching them is considered behind the times, run for
commercial purposes, and a menace to the country.
Those schools of extremely rigid requirements in many
instances have non-medical men occupying many of their
laboratory chairs, or medical graduates who have never
practiced. What practical knowledge has either of these
classes concerning student needs? As a rule, they teach
pure science, and this applies especially to the non-medi-
cal teacher. The student of medicine is not after pure
science; he is after what is essential and necessary for
him to engage intelligently in the practice of medicine."
What the medical student needs and must have for
the life work before him is all available knowledge for
his future vocation as a physician and that must be im-
parted to him in the most useful form for immediate
bedside and office service in hemo and excretion, inspec-
tion and analysis and in intelligent utilizable therapy.
Teaching methods need revising.
The Sanitary Conservation of Human Labor
Power is the saving of force in length of days and endur-
ance, exceeding in value to the country, the highest
present day ideals of big business. Big business that
overlooks the best sanitation and sustenance by neglect
of adequate and timely nutrition, tranquilizing mental
strain and recuperating sleep makes the gravest of errors
as to the best welfare of big business itself.
Timely hours for rest, recreation and daily repair of
mind and body, used as such and not in depressing dis-
sipation, is economy to both big business and efficient
labor. It bestows to most potent and enduring power
and brings capacity for best results to both labor and
capital.
Ex-President Taft is to be congratulated and thanked
for the signing of the "Phossy Jew" bill of April 9th,
by which American match makers were freed from one of
the most loathsome of occupational diseases. Rejoicing
in the successful outcome of this campaign, the members
of this worthy organization are now planning new meas-


500
Editorial.
ures for the protection of the thousands of men, women
and children who suffer and die from many other oc-
cupational diseases.
They extend to all this worthy organization an op-
portunity to share in this work. The minimum member-
ship fee is only three dollars. Jane Addams, Irving Fisher,
Samuel McCune Lindsay are the Membership Committee,
Metropolitan Tower, New York City; and John B.Andrews,
Secretary, same address.
The country and humanity in general are largely
indebted to the American Association for labor legisla-
tion and the conservation of human resources for this
salutary measure. Some day, but, 0! Lord how long,
the congressmen of the United States will awaken general-
ly to the sanitary needs of the human interests they are
supposed to guard and enact more of this sort of legisla-
tion. And when we get the National Health Board—
But when? Oh, when will the medical, profession cease
to keep out of politics and let the lawyers and the manu-
facturing interests mostly conduct our legislation and lead
our American Congress?
The Unstable Neurone in Barbarous Hazing
Atrocjty was lately again in evidence at one of our
highly endowed home universities. Chief and most
degrading among the revolting immoral semi fous stunts
of the mentally unstable hazing diabolistic students, was
marching their victim freshmen into a liquor saloon
and compelling them to serve liquor and wash the glasses
behind the bar. Of course this was shockingly delightful
news to reach the sober and temperate homes of the
boys' fathers, both of the hazed and of the devilish and
immoral brained unbalanced hazers.
Other students were reprehensible, but not so vicious-
ly violative of the proprieties. Too much mental instabil-
ity is manifest in the non-collegiate world. It ought not
to be countenanced in great university circles and can not
continue without harm to our future national welfare.
The smaller, less numerically matriculated, non-haz-
ing schools, will be and should be preferred from a true


Editorial.
501
psychological point of view. Hazing psychopathy does
not commend a college to intelligent parents or guardians
of youth. A preliminary examination as to mental stabil-
ity must become a prerequisite to matriculation to some
of our big financially endowed universities if this morally
baneful anti-golden-rule business continues in them.
Dr. Waugh's Contribution in the last issue of
this magazine was considered of sufficient interest and
merit to be copied almost entire by the Censor and here
is the apologetic explanation which our censorious and
discriminating contemporary makes for the plagiaristic
faux pas without giving us credit:
"The article in last week's Censor, "Are Women
Polygamists?" by Dr. W. F. Waugh, was taken from that
excellent class publication, The Alienist and Neurologist.
The article was so credited, but the linotype man couldn't
see why it should be, and left the credit off and the proof-
reader did not catch the drift of matters until the paper
was out. Surely, the Alienist and Neurologist is always
worthy of credit. It is one of the few periodicals of
which St. Louisans ought to be proud, as there is no
paper of its kind in the world that achieves a higher
scientific level or which is of greater value to those
physicians who study that delicate and complicated organ-
ism constituted by the brain and nerves."
While our contemporary showed its wise appreciation
of good literature in the reproduction of Dr. Waugh's
paper, it also shows its sense of justice in the preceding
"amende honorable." The Censor is a magazine of judi-
cious selection as well as of "wisest censure."
There is always good material for observation and
consideration in the Alienist and Neurologist. The highest
and best part of man are considered in its pages and by
the best observers and writers. There are no penny-a-
liners or mere space fillers among its contributors.
The Alcoholic Poison Beverage Habit—Two Great
Rulers Awakened to its Peril.—This year's announce-
ment of the defensive attitude of President Wilson,
with his associate Vice-President Marshall, also his great


502
Editorial.
Premier W. J. Bryan, of His Majesty Emperor William of
Germany, and later the Pope, against alcoholic beverage
poisonis commendably significant of the awakening of our wise
men in power to the peril to governments and people
of the alcoholic popular drink habit. The danger of this
blood, brain and general nerve cell poison is no longer
seen afar off, nor as a mirage of5 the mind by "temper-
ance kranks,"but as near andreal. Since the convincing rev-
elations of the biochemical laboratory the perils of alcoholic
beverage poison are no longer seen from a distance or
as through a glass darkly, but with illumined vision
as to the destruction, plain and fatal in the inebriate
cup. The alcoholic canteen—the saloon for intoxicants
will, if Americans are wise, be kept away from
army and navy headquarters even though camp and navy
harbor neighborhoods must be more strictly patrolled. Sol-
diers, seamen and government officials should be always
sober and so should the American people. A sober
Nation, Army and Navy included, is safety for the Nation.
The Medical Poet Laureate of England.—
With Dr. Wood as Military Commander of the American
regular army and Doctor Robert Bridges recently officially
honored as the favorite poet of Great Britain, medical
men of merit in military and literary ranks are justly
coming into their own by way of worthy official recog-
nition. Why not alround and capably educated medical
men as well as not always so well fitted lawyers? Law-
yers have too long taken most of the posts of honor in
government.
The essential anthropological and physical science
studies with the alround relations of the physician of
general practice, reading, travel and study of all that re-
lates to the individual and family in direct physical,
indirect eugenic welfare and direct environment as in
hygiene and sanitation of body and mind peculiarly
adapt the medical mind of philosophical and poetic
inclination and culture for writing a peoples' songs of
feeling, aspiration, mental and physical needs, and life
experience.


504
Editorial.
sequences of the organic strain of army life and exposure
or camp life illnesses, such as typhoid or other fevers
and the wear and tear to the human organism of camp
and field or navy service.
This penurious non-patriotic husbanding of treasury
funds at the expense of veterans' pensions is not com-
mendable but niggardly when compared with other
and more lavish unjustifiable political service appro-
priations.
Professional Ideals.—The rising physician must
be one who can resolutely withstand temptations to wan-
der from the path of rectitude, ethics, altruism, honesty,
morality. The practice of medicine should be conducted
on a high professional plane. As a profession it is
ennobling, inspiring, philanthropic, and has written
brilliant, eloquent pages of heroic deeds in history,
and is still writing them. It is an honor to be a member
of such a profession.
Unfortunately there are some who would relegate
the profession to the merely commercial classification
of a business. The business begins and ends with a
livelihood and has no interest in its patrons other than
dollars and cents. All the halo of altruism and tender
sympathy and care are lacking—those things for which
the profession ever was noted.
But far baser and utterly despicable is the attitude
of those who would make of it merely a game. Shorn
of all attributes of honesty and honor, it becomes ob-
lique, crooked, insidious; undermining the soul; one of
the most disintegrating of all possible inventions of the
mind.—From Dr. Geissler's Psychology of the Adult Mind,
in July Medical World.
The Chicago Medical Society.—At its meeting
held in April, 1912, a resolution was offered dealing
with the prevention of insanity and the various forms of
delinquency with a view to the formulation of a definite
plan to be recommended to the several State Legislatures
and for the purpose of discussing, at a later meeting time,
June the twenty-third to twenty-sixth, mental diseases


Editorial.
505
in their various phases.
Harold N. Moyer, M. D., and W. T. Mefford, M. D.,
were respectively President and Secretary of the arrange-
ments for this commendable movement to which Alienists
and Neurologists were specially invited with the result
of a new society of Alienists and Neurologists being
formed.
Thus do psychiatry and neurology move forward
to their proper place in medical thought and endeavor,
as was predicted by the editor of this magazine at the
time of its foundation, near thirty-four years agone.
Notes on the History of Psychiatry.—Translated
from Falk and other students of the psychiatry of the
ancients and given to the English speaking world for
the first time and through the pages of this magazine
by Smith Ely Jelliffe, M. D., Ph. D., Adjunct Professor
of Diseases of the Mind and Nervous System, Post
Graduate Hospital and Medical School, just concluded
in our pages, is a meritorious and much needed addition
to the study of the record of Psychiatry for English
and American libraries, psychiaters and researchful
practitioners of medicine, law and even for clergymen,
philosophers and literati generally.
This interesting historical production should appear
in permanent book form. The able translator and talented
author has the thanks of the management of this magazine
for this splendidly executed production.
Dr. J. M. Semple, Superintendent of the State In-
sane Asylum at Medical Lake, Oregon, is given complete
vindication in "The Findings of the State Board of
Control."
"After hearing all the evidence, noting the character
of the witnesses and their actions upon the stand, it
was the only course the board could take.
"That the charges were conceived in malice and
brought in revenge was apparent to all who studied
the case," says the Medical Sentinel.
"Dr. Semple's vindication need not be heralded by
his friends as a triumph. Rather it is a matter of course.


506
Editorial.
Those who know Dr. Semple and who know something
of his work at the Medical Lake asylum, know also that
the doctor stands at the top of his profession.
"The Medical Lake asylum is one of the cleanest,
neatest and best managed institutions of the state.
Nor is its standing to be limited by comparison within
state lines."
Municipal Care for Sanitary Rest Rights in
Paris.—"From October 15 the heavy motor-drays,
loaded with stones, pig iron, and similar materials, that
shake the houses to their foundations, must be provided
with rubber tires to reduce the vibration, and their speed
must not exceed seven and one-half miles an hour in
Paris, France.
M. Quentin Bauchard and M. Emile Massard, two
Municipal Councillors, have protested against the use of
motor street-sweepers that wake the citizens at daybreak.
"Juggernaut tramways and rattling motor-omnibuses,
chauffeurs who make an exaggerated din with screeching
sirens, cabmen who are continually cracking their whips,
and engine drivers who make the night hideous with their
whistles—these murderers of sleep," says M. Massard,
"have converted the capital into an inferno."
Dr. Frank P. Norbury, alienist, and member of
the Illinois State Board of Administration, has resigned.
He will practice in Springfield.
Dr. Norbury, who is regarded as an authority on
mental and brain questions, has been identified with the
State Board of Administration since September 1, 1911,
when he succeeded Dr. J. L. Greene, the board's original
alienist. He has been professionally active in Illinois
for twenty-five years, having come here from Pennsyl-
vania.
Dr. Joseph Cooperstein of Chicago has been ap-
pointed to the position of assistant physician of the Ches-
ter, Ill., State Hospital, to succeed Dr. William Hersic.
Panama-Pacific International Exposition, 1915.—
Theodore Hardee has been appointed Chief of Liberal
Arts for this great exposition.


Editorial.
507
"The wonderful developments in medicine and surgery
make certain a display of the highest importance and of
great benefit to the human family. The mechanical
side of surgery will be represented by a complete collection
of instruments and appliances used in this important
field of human endeavor. There will be shown the most
intelligent modern methods employed in the prevention
and mitigation of the ills which beset mankind."
There should also be a department of eugenics
in line with the progress of modern medical thought and
effort.
Mellins Food was awarded a well deserved gold
medal at the late International Medical Congress, London.
The Cincinnati Sanitarium makes a medical lady
its matron, in the person of Doctor, or Doctress as our
predecessors would say, Georgia E. Lindsy.
Doctor A. North becomes resident physician in
place of Dr. C. D. Rogers, resigned.
"Where Pennsylvania Excels" is the caption of an
editorial in the Philadelphia Enquirer complimentary
to the old "Keystone" State on the vital subject of the
care of the inebriate.
It should be recalled that a great Pennsylvania
physician and signer of the Declaration of Independence
was the first American, if not the first world physician,
to declare that inebriety is a disease demanding humane
hospital care.
There should be in Washington and in every State,
institutions for the care and cure of inveterate inebriates.
Vaccinia and Anaesthesia manuscripts, instruments
and data.
In addition to the otherwise and always interesting
displays of the Welcome Exhibits at the International
Congresses was a display of Dr. Edward Jenner's vac-
cination instruments, office furniture, autograph letters,
etc., also some early anaesthetic apparatus of Sir James
Y. Simpson and the autograph diary and manuscript
of Mr. Henry H. Hickman, F. R. C. S., who first experi-
mented successfully with chloroform anaesthetization


508
Editorial.
and proved the possibility of anae: • hesia for surgical
use now so universally practical.
The Psychoanalytic Review comes from 64 W.
56th Street, New York City, laden with much matter
of merit and instructive interest to the new school of
psychoanalysts, now rapidly coming into marked promi-
nence in the growing ranks of psychiatry, psychology
and alienism.
The National Catholic Association condemns
Carnegie Foundation and Council A.M.A. Medical Edu-
cation plan of the A, B and C classification.
New Orleans, La., July 3.—Depreciation of the
classification of colleges by the Federal Bureau of Educa-
tion into groups of A, B, C, condemnation of the action
of the American Medical Association in soliciting aid from
the Carnegie Foundation and protestation against the
education of children in sex hygiene were contained in
resolutions adopted by the National Catholic Educational
Association.
The grouping of colleges as now done by the Federal
Bureau is declared to be unjust and based upon financial
rather than educational standards.
The Carnegie Foundation is arraigned as showing
"a spirit antagonistic to institutions under religious con-
trol."
"The activities of certain individuals and corporations,"
which "threaten to interfere with the just liberties of
private educational institutions," also were condemned.
The above having come to us we take this occasion
to say that while opinions differ as to educational methods,
that the Council on Medical Education, though it may
seek to exercise legislative functions as to chartered
medical schools in behalf of endowed universities, it
ought to be restricted by law to recommendations only
and should reach inferior grade schools only through
legitimate legislation by the state and nation.
To disparage certain schools (as A, B, C, etc.,. in
grade,) chartered to grant diplomas, is to annul lawful
charters. There is a right as well as a wrong way to


Editorial.
509
do almost everything. And grading to degrade or put
out of existence chartered medical colleges and destroy
costly educational plants is a right which should be
exercised only by the charter granting power in the
state legislature, notwithstanding there are and have been
chartered medical teaching schools in the U. S. whose
state right to grant diplomas should be revoked by the
state.
The proper persons to decide on the merits or de-
merits of medical schools should be experienced expert
teachers representing the charter giving power, acting
under and for the investigation and state authority with
power to send for persons, papers, etc., investigate fully
and report.
To charter a college to grant diplomas of proficiency
to practice medicine and then post facto to permit
a politically appointed board, often of non-expert physicians,
regardless of possible personnel inimical, to annul the value
of the grant and plant, is an absurd anomoly in state
law, and one of the many modern tyrannies of our mis-
understood freedom.
The care of the sick and their welfare in college and
hospital should be one of the essential concerns of every
church denomination. Not that any particular religious
conviction should be exacted of patients or students,
but that these health-promoting institutions should be
fostered as a proper part of all church charity.
Lawyers' and Doctors' Fees.—If you consult a
lawyer about a transfer of some lot, or the signing of a
deed or a contract or something of the sort involving,
let us say, only a thousand dollars or so, he will charge
you from $25 to any-old-number of dollars. But the lawyer
will take his pregnant wife to a doctor for an opinion—
which he gets for from $2.50 to $10; or his child, whose
life or death may depend upon the diagnosis and advice
given by the physician, and if the doctor charges more
than ten or twenty dollars the lawyer will be furious.
We forget that it is not our moments of time that we
are selling to our patients—or more often giving to them—


Editorial.
511
pecuniary returns after this long period of apprenticeship
are taken into consideration. Indeed, as Dr. Bevan
states, it is nothing short of a crime committed under
the guise of the interests of higher Education. Then,
too,$from the standpoint of efficiency it is undesirable."
(ft-The Medical Fortnightly also extracts and concurs
in this Bevan statement as much as all of us.
Excessive Penal Infliction Exceeding Normal Sys-
tem J Reactive Power is often too common in our re-
formatories and penitentiaries through the brutal ignorance
in humanity or indifference of jailors, wardens and other
controlling officers.
The "Appeal to Reason" quotes from the Indianapolis
"Sun" the following case:
"John Fritz had served five years in the so-called
reformatory of that state for participation in the theft,
when sixteen years old, of finger rings valued at a few
cents. He was sent to prison for two years, and was
held three years longer without warrant. So morose and
angered did he become over the injustice done him that
he killed a guard. For this he was sentenced to be
hanged. The records show that for 144 consecutive hours,
six days and nights, Fritz stood in a solitary cell with no
chance to sit or lie down, fed only bread and water,
and this more than a year after he had served his sen-
tence."
The governor reprieved the boy's sentence of death.
And well he might for a murder committed after such a
body and brain and other nerve center strain and mind
disordering punishment.
Criminal so-called "cures of crime," inflicted beyond
normal endurance and healthy reaction power, should
be given to the unfeeling brutes that inflict them.
Unhygienic inhumanity to prisoners, "cruel and
unusual" punishment that ought not to be inflicted
is too little considered in this "God given land of the free
and the home of the brave," designed by our father
founders to be a fair play free government, even toward


REVIEWS, BOOK NOTICES, REPRINTS, ETC.
History of the H. K. Thaw Case.—The escape of
Harry K. Thaw from the Matteawan State Hospital for
the Criminal Insane did not come as a surprise in some
quarters. Last March a prominent New York alienist
charged that Thaw was being given every chance to
escape, and that his custodians expected him to do so,
so they could obtain a reward for connivance.
The last few months of Thaw's incarceration in
Matteawan have held much talk of bribery. Last Novem-
ber, Dr. John R. Russell, superintendent of the hospital,
said he had been offered $20,000 to bring about the re-
lease of Thaw by signing a certificate that the prisoner
had recovered his sanity.
Sweeping charges were made involving Dr. Russell
and his subordinates in a business in brokerage pardons
and with planning to release Thaw and others. John
N. Anhut testified that, though he represented Thaw as
a lawyer, he had never offered the superintendent any
money, but, on the contrary, had been asked for money
by Russell. Gov. Sulzer, on February 27, ordered the
removal of Dr. Russell, which Russell anticipated by
telephoning in his resignation.
Thaw was 36 years old when he shot Stanford White.
Up to that time he had been known as one of the wildest
spenders among millionaires' spendthrift sons.
Thaw first discovered Florence Evelyn Nesbit when
she was playing a minor part in The Wild Rose, her
theatrical career having been contrived by Stanford
White. The first rumor of a marriage came October 22,
1904, when the couple registered at Claridge's in London
as "H. K. Thaw and wife." Upon their arrival in New
York they were given the cold shoulder by a number of
513


514 Reviews, Book Notices, Reprints, Etc.
hotels. On April 4, 1905, they were quietly married,
accepted by the family, and opened an elaborate establish-
ment in New York.
The night of June 25, 1906, Thaw, accompanied by
his wife and a friend, entered the Madison Square Roof
Garden, where Stanford White was sitting at a table.
Excusing himself to his party, Thaw strolled down the
crowded aisles of the roof garden and past the table of
White. Suddenly he wheeled and fired three bullets at
point-blank, all of them taking effect.
Thaw was placed on trial for the first time January
23, 1907.
During the trial, Evelyn Nesbit Thaw went upon the
stand and told of how White had become acquainted
with her through seeing photographs for which she had
posed, and of his obtaining for her a place in the chorus
of a Broadway show, of nightly champagne dinners,
and of her ruin by him when she was only 16. This
story, she testified, she had told to Thaw after their
marriage.
The first trial resulted in a disagreement. The second
trial began January 9, the following year. Only married
men were accepted for the jury, and, the prejudice of
Thaw and his family having been overcome, the defense
was straight insanity. Evidence was introduced to show
a hereditary taint.
In the first trial, every other element was subordinated
to the appearance of Evelyn Nesbit Thaw. In the second
trial sympathy was transferred from the wife to the mother.
Weak and faint from a sickbed, she nerved herself to
reveal every detail of abnormal mental development
in the Thaw family on a plea for her son.
The verdict was "not guilty." When Thaw heard
the first words of the foreman, he thought he was to be
freed, but the addition of "on the ground that he was
insane at the time of the commission of the act," plunged
him into despair.
At first, Thaw's commitment to the State Hospital
for the Insane, was not taken seriously. Beginning in


516
Reviews, Book Notices, Reprints, Etc.
of the fiction lover. The case related from the present
reviewer is true to the observed fact.
The scenes and history of this "strange case of
Dr. Bruno" are largely in the southern States of the
American Union and incidentally illustrate the power of
music and especially in this case, the potent psychotherapy
of the violin in recalling to normal consciousness of this
singular amnesic victim medicinally self-induced and time
limited hypnosis.
Dr. Daniels, the talented author of this remarkable
story is the well known editor of the Texas Medical
Journal—generally called the "Red Back" because of
its crimson color and fiery defense of all rightful matters
medical, and of scientific utility and truth in his profession.
The publisher is the Von-Boeckmann Jones Co.,
Austin, Texas.
Ancient and Tribal Cranial Trepanation—The
neolithic skulls unearthed in France and the skulls of
the pre-Columbian period discovered in Peru, bear ample
evidence of the widespread use of this operation. The
perfection with which square and round openings, small
and large, single and multiple, were made by means of
stone or flint implements, the site of election of these
trephine holes upon the parietal region of the skull,
at a safe distance from the venous sinuses—all indicate
that the prehistoric surgeons had considerable knowledge
of cranial anatomy and performed this operation with
definite indications in view. Thirty-five years ago the
distinguished French surgeon Lucas-Championniere pub-
lished an exhaustive historical and clinical study of
trephining, a work which first drew attention to the surgi-
cal possibilities of this operation. Today the same writer
returns to his early theme and shows that many of the
older theories as to the purpose of the prehistoric trephin-
ing are erroneous. Broca was one of those who advanced
the view that the primitive operation was performed
on individuals in order, as the ancients thought, to per-
mit of the escape of demons that were the cause of mental


Reviews, Book Notices, Reprints, Etc.
517
alienation or malefaction. The operation is performed
at the present day among savage and semicivilized races,
notably among the Kabyles of Algeria and the mountain-
eers of Montenegro, just as it. was practised by the ancient
Peruvians. Among the Kabyles the Art is transmitted
from father to son, and one instance is recorded in which
the operation was performed on an individual, himself
an expert operator, a dozen times. The purpose of the
tribal surgeon is to relieve persistent headaches.
"Les Origines de la trepanation decompressive, trepa-
nation neolithique, trepanation pre-Colombienne, trepona-
tion des Kabyles, trepanation traditionelle." Par le Dr.
Lucas-Championniere, is the source of this historic in-
formation.—Abstracted from Med. Rec.
The Government Meat Inspection.—The Govern-
ment Meat Inspection Service shows for the past seven
years (time the law has been in effect,) 377,000,000 animals
inspected at slaughter, of which 1,100,000 carcasses
and 4,750,000 parts of carcasses were condemned. The
reinspection of meat and meat food products in theie
various preparations amounted to 44 billion pounds, or
which there were condemned on reinspection 148.000,000
pounds. There were certified for export 8 billion pounds.
There are 792 slaughtering and packing establish-
ments in 227 towns and cities. The force comprises
2,400 veterinary inspectors and assistants.
Each veterinary inspector is well grounded in the
fundamental knowledge of animal diseases and when
entering the service is taken in hand by an experienced
inspector for careful instruction in his duties.
In the large packing establishments the post-mortem
inspection work is so divided and systematized that each
carcass must pass the scrutiny of several inspectors,
each of whom gives his entire attention to examining
certain particular parts. Under this system the inspector's
vision and sense of touch become so highly trained that
exceedingly slight variations from the normal in organ or


518
Reviews, Book Notices, Reprints, Etc.
tissue are detected instantly, and the government tag is
promptly affixed to all the carcasses which show such
variation and they are set aside for further inspection
by a final inspector.
Radiurgia and Sycophantia by Maria Rose.—This
paper refers to a past controversy with the German Medi-
cal Society of New York concerning "Historical Remarks
on Greek as the Proposed International Language of
Physicians," the title of a paper by Dr. A. Rose read
before the German Medical Society of the City of New
York in 1896. During the session of the society Dr. Rose's
daughter sang and spoke to illustrate the beauty of the
Greek language. The lecture was at the time published
in the official organ of the society, the New York Medi-
zinische Monatsschrift, and forms a chapter in Dr.
Rose's book "Christian Greece and Living Greek." The
controversy is too old to be reviewed but the New York
County Medical Association paid Miss Rose the following
compliment at the time:
"The members of the Executive Committee present
at the meeting of the Association on June 17th, 1895,
desire to express their thanks to Miss Mary Rose for the
charming manner in which she spoke and sang in the
Greek language, in illustration of the subject which formed
a part of her father's address on that evening. Let this
action, with the seal of the Association affixed, express our
pleasure and appreciation of the valuable service rendered
by her."
Signed by S. B. W. McLeod, M. D., Pres. and all
other officers of the Society. Medical Journals copied
this and more at the time 1896.
Christianity and Sex Problems, by Hugh North-
cote, M. A., Philadelphia, Pa., F. A. Davis and
Company.
The popular and political mind of the country is
talking now of forest and mineral deposit preservation
and conservation. Floriculture, horticulture, animal and


Reviews, Book Notices, Reprints, Etc.
519
agriculture betterment have for a long time occupied
the attention of farmers and the raisers of domestic
fowls. Even the better breeding of better dogs has been
considered. Now the light is dimly dawning upon the
mind of some that we might have and should have a
better quality in some of the components of our race of
men and women or at least avert the present threatened
decadence in some of the human family.
Subsidiary to this, the eugenically inclined among
the medical profession and the thoughtful beyond our
ranks, are much concerned in sex problems, especially
in how to impart to the young that delicate knowledge
so necessary for them to timely know, in order to avert
the possible calamity of moral and physical and mental
degeneration that results from premature and perverted
indulgence of sexual powers and propensities.
With the latter worthy end in view, this estimable,
youth saving book, has been so cleverly written, though
its notice has been by inadvertence overlong delayed.
Valuable advice to a boy beginning school, styled
additional note D, appears near the conclusion on pages
239-242, just before the concluding note on nocturnal
pollution, so delicately and forcefully written that any
parent or teacher might use it for juvenile instruction
and counsel.
The well-known F. A. Davis and Co. of Philadelphia
are the publishers of this valuable book for teachers,
parents and all interested in the right moral and medical
guidance of the young in matters sexual and erotic.
A Wave of Degeneracy, by Dr. T. Alexander
Mac Nicholl. In a recent address before a medical
convention, meeting at Atlantic City, N. J., Dr. Mac
Nicholl says:
"A wave of degeneracy is sweeping the land, and its
development threatens the physical vitality of the nation.
Within a period of fifty years the population of the
United States increased 330 per cent., while the number of
insane and feeble-minded increased 950 per cent, according


520
Renews, Book Notices, Reprints, Etc.
to the recent census, practically all of which is due to
the chronic and excessive use of alcohol in one form or
another, and narcotics.
"Degeneracy is shown in the lessened fertility of the
nation. In five years the birth rate in the United States
fell off thirty-three and one-third per cent. Back of all
the causes for this alarming condition, the study of alcohol
and narcotics shows that alcohol is the chief degenerative
factor.
"During the past five years the birth rate in the
United States has fallen off thirty-three and one-third
per cent. This means the loss of a million babies a year.
Let this degeneracy continue at the same rate for one
hundred years and there will not be a native born child
five years old in the United States.
"What is the cause of this degeneracy? A hundred
different intermediate agencies may contribute to the
undoing of the race, but back of them all stands alcohol
as the chief degenerative factor. Statistics compiled
by the leading insurance companies, and presented by
Sir T. P. Whitaker in a report to the British Parliament,
show that out of every 1,000 deaths among the population
at large, 440 are due to alcohol. This would mean a
mortality from alcohol in the United States of 680,000
a year and drinkers' children bear the burden.
"The germ cell that is to be evolved into another being
is the most highly organized of all the cells in the body.
In its protoplasm lies the material and pattern of the
perfected organism.
"Should such poison as alcohol lessen the nutrition
of the cell or impair the quality of the protoplasmic
material and deface the pattern, these shortcomings and
defects would be manifested in the subsequent stages of
development. A defective germ cell cannot evolve a
normal body; this is the reason that we find a large per-
centage of functional and organic diseases among the
children of drinking parents.
In his studies among school children in New York
City he finds that sixty-two per centum are the children


522
Reviews, Book Notices, Reprints, Et-;.
The Lane Medical Lectures given by the medical
department of Leland Stanford University were delivered
by Sir Edward A. Schafer, Professor of Physiology in
the University of Edinburg.
Internal secretion in general, parathyroid, adrenal,
glandular secretion, the pituitary body and other internal
secretions constituted the interesting course; all lectures
being illustrated.
The Lane Medical Lectures were founded in 1896 by
the late Dr. Levi Cooper Lane. They consist of a
"free course of lectures on medical subjects by men dis-
tinguished at home or abroad for their work in either
medicine or surgery, and are intended for medical students
and the medical profession at large."
The highly instructive character of these lectures
continues to be well sustained in the last course of Sir
Edward Schafer.
Fourth Biennial Report of the Superintendent
of the State Hospitals for Inebriates at Knoxville,
Iowa to the Board of Control of State Institutions for
the period ending June 30, 1912. George Donohoe, M. D.,
Superintendent.
Glad to get this report and to note the progress Iowa
is making towards the rational recognition and legal
reformation of diseased inebriates for alcohol is a poison
and those who are deluded into making a beverage of
this poison are not wise, for at the last it enslaves and de-
stroys the higher nerve centers, bringing on paralysis,
blood vessel disease, insanity and death.
The Letter "Humanum Genus" of the Pope,
Leo XIII., against Free-Masonry and the Spirit of the
Age, April 20, 1884. Original and English translation
and the reply for the Ancient and Accepted Scottish Rite
of Free-Masonry. Gr.: Orient of Charleston: 1884.
Masons and Catholics, agnostics and others who would
be guided by the Golden Rule may read this with profit.
How glorious it is that persecution for opinions' sake has


Reviews, Book Notices, Reprints, Etc. 523
passed or mostly gone in Christendom. "The prayer of
Ajax was for light." The light of the twentieth century
is here.
Dannemora State Hospital reports that the most
noticeable difference, when the diagnoses are compared
with those of previous years, is the larger number of cases
of dementia praecox received during the last fiscal year,,
constituting about thirty-six per cent. of the total ad-
missions. This is an increase of about six per cent. over
the previous year and an eleven per cent. increase over
the average for the past five years. As this form of in-
sanity rarely terminates in recovery, it accounts, to some
degree, for the lower discharge rate for the year and the
consequent increased gain in population, though this gain
is, of course, due mainly to the increased admissions.
This applies also to other hospital reports coming to us.
Luther's Early Development in the light of
psycho-analysis by Preserved Smith, Amherst, Mass.
in the July thirteenth issue of the American Journal of
Psychology, is a specially interesting and well treated
article for the edification of Alienists and Neurologists.
Martin Luther's obsessions have always had a
peculiar biologic interest to students of psychiatry
and psychology. From a neuropsychological and neuro-
pathological standpoint this is the best of the several
valuable contributions in this number of this excellent
magazine of mind. This magazine ought to be a companion
magazine to the Alienist and Neurologist in every mind
student's library.
Milton Fairchild's Story.—Some advance mothers
had taught their daughters sex knowledge as to how
children grew inside the mother and how papa was the
stork that started them for this world.
One of the daughters concluded she would rather
have a real baby such as mamma had than a doll. One
of the boys in the school group who knew all about such


524
Reviews, Book Notices, Reprints, Etc.
matters volunteered to show the little girl how it was
accomplished, but she chose another boy for papa and then
there was consternation among the mamma's over the issue
of this advanced sex knowledge.
Letters of Julius Commedius Brutus and the
Reply—By E. S. Goodhue, A. M., M. D., LL. D., Vice-
President (Hawaii) Medico-Legal Society of New York,
etc. from Pacific Commercial Advertiser.
It may interest readers of these letters to know that
the author has written a paper entitled, "The Adequate
Punishment and Care of Defectives," for the Hawaiian
Medical Society, in which a practical and adequate
remedy for sexual crimes in discussed. Acting upon
suggestions in this paper, the Governor has approved of
a bill now before the Hawaiian Legislature, providing
for the examination of applicants for marriage license,
and the sterilization of defectives.
Memorial Relating to the Conservation of
Human Life, as contemplated by bill (S. 1) providing for
a United States IPublic-Health Service. Prepared by
Prof. Irving Fisher of Yale University, President of the
Committee of One Hundred on National Health. Assis-
ted by Miss Emily F. Robbins of New York City,
executive secretary of the committee.
This bill was presented by Mr. Owen April 5th, 1912,
and should have been enacted into law before now.
At least there should be on our Nation Statute Book a
National Bureau of similar purport.
The Establishment of Parks and Parkways.—
Recommended by the City Plan Commission, meets with
the hearty approval of this magazine from the stand-
point of sound eugenics. Parks reduce the need of
hospital space and of cemetery lots required by a city
people and augment the nerve tonic and physical vigor
of those who enjoy them. They are good investments for
any city.


526
Reviews, Book Notices, Reprints, Etc.
so competent a source of informaton and wise counsel
on the subjects treared, justifies our experienced com-
mendation from observation along similar lines as those
of the distinguished author, personally long and favorably
known to the reviewer, a fellow physician. Prof. Reed
is an Ex. Pres. of the American Medical Association, a
surgeon of ecpecial and extensive medical and surgical
experience with women and the family life, and a teacher
of gynecological surgery in a meritorious and prominent
medical school of the United States.
Cant and the Canteen.—By S. B. Dexter, Secre-
tary of the Inter-Denominational Ministerial Commission
on Investigation at Fort Sheridan, Chicago and New York.
The Henneberry Company, publishers.
In addition to the vaso-motor paralyzing power of
alcohol causing the congestions cerebral, hepatic, gastric
and elsewhere as demonstrable in the florid complexions
and blossomed nose, the vertigo and congested head,
cephalagia and Kaczenjammer apparent even to the
non-medical observer, its motor and psycho-motor center
paralysis as shown in the tremors and delirium, maudlin
senseless speech stupor, unsteady gait and other paraly-
zing and toxic effects and other conditions shown after
excessive inhibition in nausea, emesis, diarrhea, coma,
spasms and insanity which ought to alarm the drinker
as to its poisonous power for harm over the vital nerve
centers, its dehydrating effect on the tissue and viscera,
as shown in the parched lips and tongue and intense over
mustering depression the morning after a drinking bout,
there is the great nerve enduring damage center which
develops or awakens into perilous power the neuro-
pathic constitution, entailing upon offspring epilepsy,
insanity, imbecility, idiocy and a great many neuropathic
sequels, more than we have enumerated, causing woes
unnumbered in a sequently suffering world, in its homes
and hearts, and eugenic and euthenic resources damaged
and destroyed by this chemical killer of human vital
power—a poisoning stuff that saves the dead brain from


Reviews, Book Notices, Reprints, Etc.
527
decomposition, but ruins and kills the living brain and
mind—an agent of destruction fit only for the saving of
the dead through its power of taking to itself the life
sustaining serum of the brain and shrivelling this supreme
and all directing organ of the body into slender dimen-
sions and destroying microbic life about it.
It hardens the dead as it tends to harden the living
cells and nerve centers of the brain and mind and does
so indurate when vital resistance is inadequate and over-
come and is the agency of destruction which the author
of this book, "Cant and the Canteen," whose name is
Dexter, but whose work is sinister, would reintroduce
into the army as a daily beverage, to be a part of the
social life of the American soldier. Soldiers of a nation,
one of whose chief virtues is its comparative sobriety—
a nation whose people yet retain a preference for nature's
best beverages—pure water and the less harmful soft
drinks—a nation whose households, hotels and restau-
rants place water first on every table, whose sons win at
foreign marathon and other tests of personal strength
and power, a nation one of whose chief concerns is for
pure water and pure food—a nation awakened as never
before in behalf of the popular welfare.
Here is a book plausible but fallacious in its reason-
ing, pleading for the introduction of a disease producing
beverage into the army home of young soldiers, the only
social place they have—the canteen—pleading for an
opportunity for a certain number of these young defenders
of our country to contract destructive habit—a habit
that often ends in resistless drink crazing and craze in
certain of the many nervously endowed enlisted men of
our over-strenuous nation, developing or bringing from
latency into pathic activity the neuropathic diathesis,
a breeder of convulsive diseases and insanity, both in
the life of the excessive drinker and in his offspring even
unto further succeeding generations.
The author's reasoning is plausible but fallacious.
Because it is hard to eradicate an evil is no reason that
no attempt to do so, especially one so great as alcoholic


528
Reviews, Book Notices, Reprints, Etc.
social beverage indulgence or because one thinks the evil
will endure "till the dawn of the millenial morning."
But all argument aside, habitual alcoholic beverage
drinkers should not be enlisted nor should the means
of making them be provided there. Inebriety is liable
to be as dangerous to our army as dynamite and saloons
in the canteen are liable to develop this danger in some
great crisis when only sober action would save.
Erratum Note.—The following, appearing on page
376, last number, should have appeared on page 374 under
notice of Dr. Booth's paper on "Simulation of Organic
by Functional Nervous Diseases:"
"This is a timely paper from a good source and read
before a suitable audience, the Association of Railway
Surgeons.
"The average surgeon, railway or other, does not know
so much of neurology as he should and papers like this
one help to enlighten those who need enlightenment."
Proceedings of the Mental Hygiene Conference
and Exhibit at College of the City of New York, New
York City, November 8th to 15th, 1912.
The Mental Hygiene Movement, of which this con-
ference formed a part, is a well organized endeavor to
reduce the alarming amount of mental impairment in
the United States by making public careful statements
of the causes of mental diseases, by securing earlier mental
treatment, by promoting special school training and special
classes for the atypical child and the child predisposed
to mental and nervous disorders, and by encouraging the
development of social service for the assistance of individ-
uals in danger of mental breakdown. The movement
also includes a medical survey of institutions caring for
the insane in the United States for the purpose of determin-
ing the best measures to improve standards of care
among the 200,000 suffering from mental disorders.
This is one of the greatest movements of the age
for the conservation of the mental life of the people
and integrity of the nation dependent thereon, for the


Reoitws, Book Noticts, Rtprints, Etc.
529
nation's life is dependent upon the quality and power
of the minds, which aggregated, go into the make-up of
our country for its future weal or woe in guiding "the
ship of state." Sound minds in sound bodies constitute
America's salvation from the shipwreck on which other
nations have stranded.
The illustrated handbook of the Mental Hygiene
Movement and Exhibition we are here noticing is a fit
companion of enlightenment on this important subject
and ought to be read and studied by all physicians,
philanthropists, the judiciary and legislators.
The Dancing Mania is one of the themes editorial
in the Aug. No. of the Medical Times as follows:
In this magazine also appears the handsome face
of our talented author friend Dr. Geo. F. Butler, in con-
nection with his new and interesting book for boys and
girls.
The dancing epidemic which the country is witnessing
recalls in some respects the dancing mania of the Mid-
dle Ages, which has been frequently discussed in the
literature of neurological medicine. The ragtime and
turkey trot manias appear to be contagious in much the
same way that the medieval manias were. They are
alike also in respect to widespread prevalence, the popu-
lations of whole continents being affected. These neu-
rotic phenomena have been ascribed to widespread neu-
rasthenia, due to unrest and other pathological social
conditions. These and the naive determination to be
"amused" that characterizes the masses, together with
the peculiar influence of a type of "music" which seems
to set up characteristic motor reactions, account for the
specially sensitized class which may be observed in ac-
tion day and night almost anywhere in the country.
This class illustrates well the principles laid down by
M. Le Bon, that authority on the psychology of the crowd.
Then it has been pointed out that many ragtime tunes
are versions of negro revival hymns, which perhaps
introduces an element of quasi-religious emotionalism


530 Reviews, Book Notices, Reprints, Etc.
and also recalls the interesting fact that dancing has
always been connected with religion, especially Pagan
religion. The instinct to dance is a very primitive
one, and through the dance certain emotions find out-
let and expression. There is a normal and an abnor-
mal phase to the subject, however, and we are inclined
to think that it is the latter that finds exemplification
in ragtime and trotting.
The Aftermath of Gettysburg.—The Lancet Clinic
has an excellent editorial based on David Star Jordan's
"Blood of the Nation" from which we abstract.
The semi-centennial of the battle of Gettysburg
has brought reflection to the American mind. Think
of the awful sacrifice of young American manhood
upon that awful field. They were mere boys—for four-
fifths of each army were only twenty-two years of age
or younger. The best of both of the warring sections, they
left no descendants behind them, and something is wanting
from our population that time can never replace. The
leaven that should be here will not act upon our civili-
zation, guiding it toward the high ideals that animated
the men who were willing to lay down their lives for
a cause.
Current literature shows that an earnest effort is
being made by many well-intentioned men and women to
improve the breed of men. We hear much of eugenics,
of sterilization laws, of physical examinations before the
granting of marriage licenses, of anti-tuberculosis
leagues, of the "back-to-the-land" movement, and these
are valuable agencies to a country in a state of peace.
But the beneficent work that may be accomplished by
these agencies when they are allowed to work in times
of peace can be ovewhelmed and blotted out by a single
war, even of short duration. Behold what happened to
Spain when she sought to conquer the world—a few years
of ylory, many years of savage but unsuccessful wars,
and then "the mediocrities and clowns were left to be-
come the parents of the succeeding generations, and Spain,
after the Reformation, was rapidly shorn of her power


Reviews, Book Notices, Reprints, Etc.
531
because she could not furnish the men capable of retaining
it."
It is fitting to close with Jordan's keynote, a biologi-
cal fact we must never forget. He says: "A race of
men or a herd of cattle are governed by the same laws
of selection. Those who survive inherit the traits of
their own actual ancestory. In a herd of cattle, to
destroy the strongest bulls, the fairest cows, the most
promising calves, is to allow those not strong nor fair
nor promising to become the parents of the coming herd.
Under this influence the herd will deteriorate, although
the individuals of the inferior herd are no worse than
their own actual parents. Such a process is called race
degeneration, and is the only race degeneration known
in the history of cattle or men. The scrawny, lean,
infertile is the natural offspring of the same type of
parents."
So the medical profession must stand between the
people and those ignorant madmen who would drive
them into war.
Half Our Population Living in "Dry" Territory.
—It is generally thought that Germany drinks more beer
than any other nation in the world. This is a mistake.
Germany comes second. The United States consumes
1,851,000,000 gallons of beer each year, which is a hundred
million gallons more than Germany's consumption. Rus-
sia leads the world in its use of distilled liquors, and the
United States comes second, with its consumption of
133,000,000 gallons. Although the United States is
first as a beer-drinking nation and second as a consumer
of distilled spirits among the nations of the world, the
liquor dealers of America are having a desperate fight
for the life of their traffic.
The saloon has been expelled from one-half of the
population and from two-thirds of the geographical
area of the country. In 1868 there were 3,500,000 people
living in territory where the drink traffic had been out-
lawed; in 1900 the number had increased to 18,000,000;


532
Reviews, Book Notices, Reprints, Etc.
in 1908, or only eight years after, the number had doubled
to 36,000,000, and today there are 46,029,750 persons,
or a fraction over one-half of the population of the
country, living in no-license territory. In the last five
years the no-license population has increased a little over
10,000,000, which is more than 10 per cent. of the total
population of the nation and 30 per cent increase in
the number living in "dry" districts. Since 1868 the
population of the country has doubled, while the number
of inhabitants of "dry" territory has increased over thir-
teen fold.—From "The Campaign Against the Saloon,"
by Ferdinand Cowle Iglehart, in the American Review
of Reviews for July.
The Intellectual Standard of Doctors.—There
is not the slightest reason to believe that physicians
are linguistically inferior to parsons or lawyers. The
assertion that English doctors are inferior in general
culture to their French and German brethren is entirely
unwarranted by facts. It is true that many of the
keenest minds of the nation are attracted to fields of
activity which offer a better financial return. But
fortunately many men of intellect are attracted to the
profession by the interest of the work, and it would be
strange indeed if medical men whose education is more
elaborate and costly than that of any other class of the
community should have a lower intellectual standard
than that of other professional men. It is recorded
by Boswell that Johnson "in general had a peculiar
pleasure in the society of physicians." Sir James Paget,
as is mentioned in his "Memoirs and Letters," sat one
evening at that very select club, Grillion's, between
Gladstone and Matthew Arnold. The talk turned on
professions and Gladstone said that medicine, steadily
developing and improving, was the profession of the future.
Arnold said he had been much impressed in America
by the superiority of the doctors over the clergy and the
lawyers. As regards classical culture in particular,
that is becoming more and more the appanage of a


Review*, Book Notices, Reprints, Etc.
533
highly specialized class. Members of Parliament no
longer quote Latin, and the time is long past when,
as Sydney Smith said, a false quantity in early life is a
stumbling-block in the career of a politician.—British
Medical Journal.
Pay of Ancient Greek Physicians.—The remunera-
tion of physicians originally consisted in presents, but at
the time of Hippocrates payment in money was already
customary. Physicians received also public praise, the
"crown of honor," the freedom of the city, the privilege
of eating at the king's table. Physicians employed by
the state received a yearly salary, as high as $2,000 in
some instances. Rich people would pay enormous sums
for a successful treatment, and a case is recorded in which
$200,000 was paid. The state furnished the means
for elaborate iatreia, with a rich equipment, and levied
a special tax for the physician of the state; it was some-
times the case in rich cities that the citizens were exempt
from all taxes except for physicians.—A Rose, "Ancient
Greek Medicine."
Le Spleen.—Contribution a l'etude des perversions
de 1'instinct de conservation. Par Le Docteur Henry
Le Savoureux. Interne des Asiles de la Seine et de
L'Infirmerie Speciale du Depot Ancien Externe des
Hospitaux de Paris. G. Steinheil, Editeur, 2 Rue Casimir-
Delavigne, 1913.
Hoffman, "Die Rassenhygiene in dbn Vereinigten
Staaten von Nordamerika."—Preis M. 4.—Gebunden
M. 5.—Mitenier Figur im Text. J. F. Lehmann's Verlag.
Muenchen. Paul Heyse Strasse 26.
The Einleitung is written by the author in Chicago.
Department of Commerce, Bureau of the Census,
Wm. J. Harris, Director. Mortality Statistics, 1910.
Annual Report. Prepared under the supervision
of Cressy L. Wilbur, M. D., Chief Statistician of Vital
Statistics. Washington, Government Printing Office, 1913.


Reviews, Book Notices, Reprints, Etc.
535
Conservation of Human Life.—By Robert Lynn
Cox. An outline of the movement among life insurance
companies to prolong lives of policyholders. Distributed
at The Fifteenth International Congress on Hygiene
and Demography, Washington, D. C. From "The
Business of Insurance," New York City.
This brochure proposes the best of all conservation.
How to Prevent Typhoid Fever.—U. S. Depart-
ment of Agriculture, Farmers' Bulletin, 478, by Logan
Waller Page, John R. Mohler, and Edwin F. Smith.
Glad to see such papers sent to farmers. More typhoid
comes from farm milk and negligence, uncleanness and
ignorance than elsewhere. The preventive inoculation
suggestion is timely.
A Lively Combination is the Denver Medical Times,
the Utah Medical Journal and Nevada Medicine.
These three constitute a valuable triune font of
medical knowledge and Dr. Cuneo's foreign translations
are especially cunning and edifying as will appear in our
selection department.
A Clinical Manual [of Mental ^Diseases.—By
Francis X. Dercum, M.D., Ph.D. Professor of Nervous
and Mental Diseases, Jefferson Medical College, Phila-
delphia, Octavo, 425 pages, Philadelphia and London:
W. B. Saunders Company, . 1913.
Cloth, $3.00 net.
Well illustrated and well ^written.
Missouri, the Mother of Empires.—Speech of
Hon. William P. Borland of Missouri in the House of
Representatives, Washington. The speaker stands up
manfully for Missouri and strongly sustains the promise
of his contention.
St. Louis Public Library.—Annual Report, May 1,
1912 to April 30, 1913, &St. * Louis, Mo., June, 1913.


536
Reviews, Book Notices, Reprints, Etc.
A tREATiSE on Digitalis.—Giving its history,
chemistry, pharmaceutical preparations and Therapeutic
uses. Drug treatise number XXVI. This treatise was
mainly in type in 1909, but has been held from distribu-
tion awaiting certain physiological reports not yet com-
pleted. Issued by Lloyd Brothers, Cincinnati.
Human Life as a National Asset.—Address by
E. E. Rittenhouse, Conservation Commissioner of the
Equitable Life Assurance Society, before The National
Conservation Congress, Indianapolis, Indiana, October 2,
1912.
A good and timely address.
The American Labor Legislation.—Quarterly Re-
view. The only scientific labor magazine in America.
Indispensable to writers, lecturers, progressive em-
ployers, students of the Labor Problem, and to all who
take an intelligent interest in improving the conditions
of labor.
Re-Education of Dementia Praecox Cases and
Industrial Training of the Chronic Cases, with report
of Gardner, Mass. State Colony for 1912. By Charles
T. La Moure, M. D., Gardner, Mass. From Proceedings
of the American Medico-Psychological Association.
SU D' UN CASO Dl EMIPLEGIA ED EMIANESTESIA CON
atrofia mucolare.—Per il D.r Eugenio Aguglia Sagini,
Assistente.
A meritorious contribution for the Italian reader.
De LTntermittence DaNS de Begaiment.—Par
Le Docteur Chervin, Directeur de L'Institut des Begues
de Paris. Extrait de la Semaine Medicale.
The Acid Test in Therapeutics.—By John Aulde,
M. D., Philadelphia, Pa. From the Medical Record.


Publisher's Department.
537
For Nearly 20 Years Gray's Glycerine Tonic Comp. has filled
an important place in the armamentarium of the country's leading phy-
sicians. Its therapeutic efficiency in restoring systemic vitality and thus
overcoming functional disorders of the vaso-motor or circulatory system
is not the least of the qualities that account for its widespread use. The
results, however, that can be accomplished in many cases of cardiac
weakness have led many physicians to employ it almost as a routine
remedy at the first sign of an embarrassed or flagging circulation.
Inasmuch as Strumous Skin Disorders occur with great frequency
in children, and children are markedly intolerant of the usual cod liver
oil emulsions, it becomes plain that Cord. Ext. .01 Morrhuae Comp.
(Hagee) has a special field of usefulness in connection with such skin
lesions. This product is palatable and easily digested and serves admira-
bly for administration over long periods.

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c
4
D
TEMPORAl AlGOMETER.
!
It consists of a brass cylinder B F, with a steel rod C running through one of the
ends of the cylinder. This rod Is attached to a spring, with n marker E on the
scale A; this scale Is graded from 0 to 1,000 grammes. The brass disc D Is 15
millimeters In diameter; a piece of flannel Is glued to Its surface, so as to exclude
the feeling of the metal when pressed against the skin, thus giving a pure pressure
sensation. The. whole Instrument Is 30 centimeters In length.
In using this algometer It Is held In the right hand at B, by the experimenter,
who stands back of the subject and presses the disc D against the right temporal
muscle, and then he moves In front of the subject, where he can conveniently press
the disc against the left temporal muscle. These muscles are preferred because no
trade or profession materially affects them. They are also conveniently situated.
As soon as the subject feels the pressure to be In the least disagreeable the amount
of pressure Is read by observing the marker E on the scale A. The subject some-
times hesitates to say just when the pressure becomes in the least disagreeable, but
this Is part of the experiment. The purpose Is to approximate as near as possible
to the threshold of pain.*.
<0


- *******
OCONOMOWOC HEALTH RESORT
OCONOMOWOC, WIS.
Building New—Absolutely Fireproof.
Built and Equipped for treating
Nervous and Mild Mental Diseases
Three Hours from Chicago on C. M. & S. P. Ry.
Location Unsurpassed.
Readily Accessible.
ARTHUR W. ROGERS, B. L.; M. D.
Resident Physician in Charge.
N E U R O N H U R S T
DR. W.M. B. FLEtchER's
- Sanatorium for Mental and Nervous Diseases.
| - A new building newly furnished throughout with accommodations for fifty patients,
| For terms address Dr. M. A. Spink, Superintendent.
Long Dis. Telephone 381 No. 1140 East Market St., Indianapolis, Iºd.
|
..”


DIGESTIVE DISORDERS
r -ci
—characterized by nausea, anorexia, eructations, pain,
fermentation, distress and the usual train of secondary
symptoms—are so promptly relieved and corrected by
Gray's Glycerine
Tonic Comp.
that a great many practitioners have grown to look
upon this remedy as almost a specific in all forms
of atonic indigestion.
Its systematic use rapidly raises muscular tone and the
resulting improvement in the motility of the gastric muscles not
only increases glandular secretion, but usually supplies the
exact impulse needed to assure restoration of the physiologic
activity of the whole organ.
"Gray's" accomplishes these results because it aids and
reinforces natural processes — never supersedes them.
TNE PURDUE FREDERICK CO., 135 CHRISTOPHER ST., HEW YORK.






In this product the virtues of cod-liver oil are left unimpaired, but in the process of
manufacture care is taken to eliminate all of cod-liver oil's disagreeable qualifies.
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^Vs^ (mh fiuio outer or haoii'5 cordiai or im cxiBAcr or cod liver oil compound ripruents tni
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Vol. XXXIV. CONTENTS. No. 4
ORIGINAL CONTRIBUTIONS
ON THE THEORY OF THE PsychopAthic CoNstitution. Bodily Symptoms. By
James C. Hassa!!, M. D., Washington, D. C. .......... ... ............................... ...... 379
THE GERMAN Method of TREATING THE CRIMINAL INSANE. By W. J. Hickson,
Vineland, N. J...........…... . … . . . 389
THE IMPERATIVE DEMAND FOR LEGISLATION to ARREST THE RAPID INCREASE of
DEGENERACY. By Martin W. Barr, M. D., Elwyn, Pa.................. … ... 400
Is GENIUs A SPORT, A NEURosis or A Child PoteNti Ality Developed? By James
J. Kiernan, Chicago, Ill.… … … … …......................... 409
THE ADEQUATE PUNISHMENT AND CARE OF DEFEctives. By E. S. Goodhue, M.D.,
LL. D., Hawaii… -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
Psychiatry AND Psychother APY IN SURGICAL PRACTICE. By C. H. Hughes, M. D.,
St. Louis º 'º. 436
The EROToGENESIS OF RELIGION. By Theodore Schroeder, Cos Cob, Conn............... 444
SELECTIONS
NEUROSURGERY..... … … … ….............…............ -- - - ----------------- - - - - - - - - - - 477
Purpose of Ancient Trephining.
NEUROPROGNOSIs....................…......…...... 477
High Blood Pressure.
NEURODIAGNosis.… … … º...…. 478
Measurements of Pain.
Diagnosis of Convulsions by Leucocyte Count
PSYCHOTHERAPY,. ............................. ....... . . . . . ...... . . . . . . . . . . . . . . . . . . . . - - - - - - - ------------------------- 479
Psychotherapy at Battle Creek.
CLINICAL NEUROLOGY.. ......... ....................................…. … … . . … … 4S()
Uncertainty of Diagnosis in General Paralysis New Diagnosis of Paresis—
Tumors of the Hypophysis Spreading Typhoid After Recovery.


e - - +
Standard Neurotic Prescriptions ſ
HYDROCYANATE IRON AND STRONTIUM HYDROCYANATE IRON AND |
BROMIDE. HORSENETTLE. f
Hydrocyanate Iron.................... | gr. Hydrocyanate Iron.................... l gr.
Strontium Bromide.................... 4 grs. Horsenettle................................ 2 gr.
EPILEPSY HYSTERIA NEURALGIA NEURASTHENIA
Prepared only by THE TILDEN COMPANY
Manufacturing Pharmacists and Chemists
NEW LEBANON, N. Y. ST. LOUIS, MO.
DR. EROUGHTON'S SANITARIUNA
For Opium, Morphine,
Cocaine and Other Drug
Addictions, including Alcohol
and Special Nervous Cases.
Methods easy, regular, humane. §
Good heat, light, water, help, board,
etc. Number limited to 44. A well
kept home. Address
Dr, Broughton's Samitarium -
Phone 536
2007 S. Main St., Rockford, Ill.
MARSHALL SAN | TARIU M.
TROY, N. Y.
A licensed retreat for the care and treatment of mental and nervous disorders and drug
and alcohol addictions. Beautiful location and modern equipment. Terms moderate. For
circular, etc. address
C. J. PATTERSON, M. D., Supt.
THE WESTPORT SANITARIUM.
WESTPORT, CONN.
A Private Institution for the Care and Treatment of Nervous and
Mental Diseases.
Pleasantly situated. Large private grounds. Homelike surroundings. Modern
appointments. Separate building for Patients desiring special attendant. . Single
rooms or suite. Hydrotherapeutic apparatus. Terms reasonable. New York office,
40 East 41st St. First and third Wednesdays of each month, 10:30–12:30.
Tel. 6950 Murray Hill. -
For particulars address Medical Superintendent,
DR. F. D. RULAND.
Telephone, Westport 4. WESTPoRt, CoNN .
|


TYPHOID FEVER.
DIET
Palatable Digestible
2 quarts daily of a diet prepared from
Mellin's Food . . 5 level lablespoonfuls
Milk (average quality J . / 6 fluidounces
affords 1826 calories, or 354 grams of food,
consisting of 72 grams fat, 82 grams protein
and 200 grams carbohydrate.
The carbohydrates in Mellin's Food (maltose
and dextrin) play a most important part in
preventing waste of the body tissues and in
furnishing fuel needed to supply the loss of
energy occasioned by the fever.
As fal tolerance in typhoid varies with
the individual, it is of advantage in some
cases to use skimmed or partially skimmed
milk, instead of whole milk.
MELLIN-S FOOD COMPANY.
BOSTON. MASS.



A Dependable Sedative
is not infrequently the one remedy
indicated in many functional diseases
of women; also in not a few affec-
tions of the nervous and circulatory
systems. Among those usually
employed with greatest satisfaction
PEACOCK'S
BROMIDES
has long stood at the forefront, for it
has proven not only a most efficient
antispasmodic, anodyne, and seda-
tive, but its uniformity of action,
and remarkable freedom from the
unpleasant effects that often attend
the use of other bromide or sedative
preparations, make it the ideal
remedy in its field of activity.
An Effective Cholagogne
is often urgently needed in certain
diseases, but not infrequently its
beneficial effects are jeopardized—or
completely nullified—by the cathar-
sis also produced. In
CHIONIA
fortunately, the practitioner has a
potent hepatic stimulant that can be
relied upon to promote the functional
activity of the liver to a marked
degree without undue stimulation of
the bowels.
Chionia is invaluable, therefore, in
all conditions in which the biliary
function requires augmenting
without purgation.
PEACOCK CHEMICAL CO., St. Louis, Mo.
IS THE STOMACH
* WEAK,
is its muscular power
impaired, and its secre-
tory activity notably
diminished
Seng is Needed
and one to two teaspoonfuls
before meals will not only
stimulate local glandular sec-
retion but will substantially
aid in re-establishing the
physiologic activity of the
whole alimentary canal.
IS THE HEART
FLAGGING,
is it losing its power and
becoming irregular and
weak
?
•
Cactina Pillets
are Indicated
and one every hour or two
will quickly correct arrhyth-
mia, impart tone to the heart
muscle and restore efficiency
to the whole cardiac
mechanism.
ARE THE BOWELS
SLUGGISH
and overloaded and the
whole system depressed
and deranged by the
retention of toxic waste
material
Prunoids are
Required
and one to three at bedtime
will afford prompt relief—
without the usual cathartic
discomfort—and rapidly
restore functional regularity
of the bowels.
THE SULTAN DRUG CO., St. Louis, Mo.


Saint Winifred s Hospital
1065 SUTTER STREET
Between Hyde and Larkin
San Francisco California
The Hospital Building is constructed of "ARMORED
CONCRETE," and is absolutely fireproof and earthquake-
proof.
Each patient has entire privacy in his own cozy quarters.
There are no wards to spread DISEASE and DISSATIS-
FACTION.
Operating rooms, equipment, furnishings and service
are the best procurable.
Every facility is afforded physicians desiring to attend
their own patients.
Contagious and infectious diseases not admitted.
For rates and reservations, apply to
SAINT WINIFRED'S HOSPITAL,
Phone 1065 Sutter Street,
Franklin 136 San Francisco.
I I
a—o
ALIENIST & NEUROLOGIST
SUBSCRIPTION BLANK.
Dr. Chas. H. Hughes, Editor Alienist & Neurologist.
3858 W. Pine Boulevard, St. Louis, Mo.
Enclosed find $5.00 for which please send the Alienist
& Neurologist for one year from date to the following address.
Name
Address
City
Dated State
n.
I


---
ST
WALNUT ~ LODGE - HOSPITAL,
HART FORD, C C N N.
Organized in 1880 for the Special Medical Treatment of
ALCOHOL AND OPIUM INEBRIATES.
Elegantly situated in the suburbs of the city, with every appointment and appliance for
the treatment of this class of cases, including Turkish, Roman, Saline and Medicated Baths.
Each case comes under the direct personal care of the physician. Experience shows that a
large proportion of these cases are curable, and all are benefited from the application of
exact hygienic and scientific measures. This institution is founded on the well-recognized
fact that Inebriety is a disease and curable and all these cases require rest, change of thought
and living, with every means known to science and experience to bring about this result.
Applications and all inquiries should be addressed
T. D. C. ROTHY:3R.S. M. D.. Sup’t Walnut Lodge. HART FORD, CON N.
**-a---------------------~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~<!"
Greenmont-on-the-Hudson
For NERVOUS and MENTAL DISEASES
RALPH LYMAN PARSONS, M. D. RALPH WAIT PARSONS, M. D.
Long Distance Telephone, 365 Ossining. OSSINING, N. Y.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...~.4.
BUTLER, MORRIS COUNTY, NEW JERSEY.
Beautifully located and properly equipped for the care and |
treatment of mental and nervous diseases and drug and liquor l
habituation. Illustrated Booklet Upon Request. l
l
iº
Long Distance Phone, 21 Butler.


REMEMBER
The ALIENIST and
NEUROLOGIST is for
you Mr. Potior. It especi-
ally) serves the general
pratlitioner of medicine in the
line of Neurological Inter-
pretation and treatment of
disease in the true psychiatry
of general pratlice.


Physicians' Patients
may be sent to MUDLAVIA with the full assurance that they will be
as well taken care of as though their physician accompanied them.
We appreciate the cooperation of the physician and are glad to receive
his advice, and report to him the condition of patients that he may
send to us.
The Mudlavia Treatment
is now administered under the direction of Dr. George F. Butler, whos.'
reputation is firmly established with the profession, and he has gathered
about him an able corps of assistants.
The laboratory is complete and the entire Medical department in keep-
ing with the other splendid servicj of this institution.
Physicians are invited to write freely for advic and information.
George F.Butler, A M..M.D.
Medical Director Mudlavia
KRAMER, IND.
I

i
1
•+

Waukesha Springs Sanitarium
For the care and treatment of
THE NERVOUS
BUILDING ABSOLUTELY FIREPROOF
BYRON M. CAPLES, M. D„
Superintendent
WAUKESHA, -:- -:- -:- WIS.
I
•4


SANITARIUM DIRECTORY
The Sanitaria in this Directory are first class, ethical and
directed by men of the highest attainments in their
several fields of endeavor. Consult them.
OCONOMOWOC HEALTH RESORT *
Nervous and Mental Diseases.
A. W. ROGERS, B.L., M.D.
Res. Phy. in charge.
Oconomowoc, Wis.
NEURONHURST SANITARIUM
Nervous and Mental Diseases.
DR. M. I. SPINK, SUPT.
1140 E. Market St. Indianapolis, Ind.
WALNUT LODGE HOSPITAL *
Alcohol and Opium Inebriates.
DR. J. D. CROTHERS, Supt.
Hartford, Conn.
MARSHALL SANITARIUM. "
Nervous and Mental Disorders,
Alcohol and Drug Habitues.
DR. C. J. PATTERSON, SUPT.
Troy, N. Y.
Waukesha Springs Sanitarium *
Nervous and Mental Diseases.
DR. B. M. CAPLES, SUPT.
Waukesha, Wis.
DR. BROUGHTON'S STANITARIUM “
Alcohol and Drug Addictions and
Special Nervous Cases.
R. BROUGHTON, M. D., SUPT.
2007 S. Main St. Rockford, Ills.
DR. BARNES’ SANITARIUM
Mild Mental and Nervous Troubles,
Alcohol and Drug Addictions.
For terms, etc. Address
F. H. BARNES, M. D.
Tel. 1867 Stamford Stamford, Conn.
CINCINNATI SANITARIUM
Nervous and Mental. Diseases.
DR. F. W. LANGDON, Med. Director
College Hill, Cincinnati, Ohio
OAK GROVE HOSPITAL •
Nervous and Mental Diseases.
DR. C. B. BURR, MEd. Director.
Flint, Mich.
MILWAUKEE SANITARIUM
Nervous and Mental Diseases.
DR. RICHARD DEWEY, SUPT.
Wawatosa, Wis.
WESTPORT SANATORIUM =
Nervous and Mental Diseases.
DR. F. D. RULAND, Supt.
Westport, Conn.
PUNTON SANITARIUM
Private Home Sanitarium for Ner-
vous and Mental Diseases.
WILSE ROBINSON, M.D., Supt.
3001 Lydia Ave. Kansas City, Mo.
ST. WINIFRED's Hospital -
1065 Sutter St. San Francisco, Cal.
MUDLAVIA *
Rheumatism, Nervous & Mental Diseases
R. B. KRAMER Pt.
- Kramer, Ind.
BEVERLY FARM
Home and School for Nervous and
Backward Children.
W. H. C. SMITH, Supt.
Godfrey, Madison Co., Ill.
THE BANCROFT SANITARIUM. “
Nervous and Mental Diseases
Drug and Liquor Habituation.
GEO. B. GALE, Butler, N J
* The Advertising Pages Furnish Details


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