3 9015 00222 197 9 University of Michigan - BUHR º: Hºlº º - (, | O, 6. "Quantam ego quidem video motus morbosi fere omnes a motibus in systemate nervorum ita pendent ut morbi fere omnes quodammodo Nervosi dici queant.”—CULLEN's NosoloGY: Book II P. 181—EDINBURG ED., 1780. THE * . . r * Alienist and Neurologist - a - - - - • * A JOURNAL OF Scientific, Clinical and Forensic NEUROLOGY AND PSYCHOLOGY, PSYCHIA TRY AND NEURIA TRY. Intended Especially to Subserve the Wants of the General Practitioner of Medicine. VOLUME XXXV. CHARLES H. HUGHES, M. D., Editor and Publisher. 3858 West Pine St., ST. LOUIS, MO. 1914 - ***. CONTRIE ORS AND COLLABORATORS :::::io volume xxxv. - - - - - MAX A. BAHR, Indianapolis, Ind. MARTIN w. BARR, Elwyn, Pa. C. G. CHADDOCK, St. Louis, Mo. T. D. CROTHERS, Hartford, Conn. E. S. GOODHUE, The Doctorate, Hawaii. JAMES C. HASSALL, Washington, D. C. C. H. HUGHES, St. Louis, Mo. H. C. KEHOE, Frankfort, Ky. 1914 JAMES G. KIERNAN, Chicago, Ill. JOHN E. LIND, Washington, D. C. P. H. MURPHY, Washington, D. C. D. G. O'NEIL, Washington, D. C. HEBER ROBARTS, Belleville, Ills. DAVINA WATERSON, TOM A. WILLIAMS, Washington, D. C. B. F. WILLIAMS, Lincoln, Neb. Index iii INDEX ORIGINAL CONTRIBUTIONS Devotional and Agnostic Paranoia.... 36 Incidental Deliria Occurring in the Insane, Including a Citation of Cases ---------------------------------------------- 173 Infection and Intoxication Psychoses 345 Insanity of Adolescence...................... 414 Is Genius a Sport, a Neurosis or a Child Potentiality Developed?.... 249 On the Propositions of the Associa- tion of Superintendents of Amer- ican Hospitals for the Insane.... 397 Paretic Dementia and Bank Fail- uſes.--------------................................... 159 lishment, Development, and Partial Analysis of an Ether Anes- Maintenance of Racial Charac- thesia Dream.................................. 310 teristics............................................ 290 Prevention of Growth and Extension The Physician's Duty in Forming of Care of our Feeble-Minded Public Opinion.............................. 184 Population...................................... 365 The Pioneer Founder of America's Remarks on Intrathecal Injections Inebriate State Hospital ............ 40 as a Factor in the Improvement The Signs of the Hand in Diseases of Tabetics After Salvarsan........ 372 of the Nervous System................ 146 Rescue: The Story of Albertus.......... 17 Wassermann Reaction in Dementia Praecox........................….. 1. SELECTIONS NEURosurgery. Prolonged Administration of Extracts 427 An Instructive Vagus Resection Error 436 Quinin for Rabies.................................. 201 Nerve Grafting in Poliomyelitis........ 206 Radium.................................................. 201 Surgery of the Nervous System........ 61 Radium Emanation in Medicine........ 63 N Radium as a Therapeutic Agent........ 64 Neurotherary. Salutary Results of Typhoid Vacci- Adrenalin Glycosuria............................ 199 nation at Springfield, Maryland, Chemical and Physiological Inves- tigation on the Harmful Constit- uents of Roasted Coffee............ 62 Epinephrin According to Causes........ 199 Fifty Dollars.......................................... 62 Infundibulum........................................ 203 Intravenous Mercury Ministration.... 61 Magnesium Sulphate in the Treat- ment of Tetanus............................ 426 Neurotic Anorexia................................ 199 New York Neurological Society........ 427 Organotherapy in Acromegaly. With Psychic Disturbances.................. 200 Peril of Twilight Anesthesia.............. 427 Some Observations on the Symptom- atic Psychoses of the Nephritic Group..... ... . - -------------------- 351 “Surgery as a Cure for Insanity”.... 192 The Causa". Force of Mental Deficiency ----- - - --------------------------- 274 The Diathesis Ebrietatis at the Communion Table and Else- where..............…. 183 The Feeble-Minded—Their Environ- ment and Social Relation............ 281 The Influence of Subtle and Unde- termined Forces in the Estab- lishment, the Development and Maintenance of Racial Charac- teristics..........................….. 123 The Influence of Subtle and Unde- termined Forces in the Estab- Hospital for the Insane.............. 202 Sodium Bicarbonate and Other Allied Salts in Shock. Ex- perimental Study.......................... 64 The Chaulmoagra Oil Cure for Leprosy....................…. 62 The Comatose State The Phylacogen Treatment of Hay Fever.............................. 320 Treatment of Hiccough 321 Venesection in Cerebral Hemorrhage 204 NEURotoxicology. Use of Heroin Spreading Rapidly Among Drug Addicts.................. 302485 iv. Index. NEURodiAGNosis. Serotherapy of Epilepsy...................... Diabetes, E. Frank ............................. 425 Spirochaeta Pallida in Paresis.... Dr. Ira Russell's Views of the Drink Sugar in the Blood..................... -- Habit......................................…. 423 The Ductless Glands in Dementia Lombardi's Varicose Zone of Warn- Praecox............................................ 319 ing.… 66 The Metabolism in Epilepsy.............. 204 Robert's Test for Albumen.............. 206 Clinical Psychiatry. Spinal Fluid Cell Count, in Syphilis Alcohol and Delirium Tremens.......... 438 of the tºº. 68 Compulsory Ideas and Manic-De- The Four Reactions in 3%agnosis pressive Psychoses.................. ... .. 204 of Lues.......................... ...... ... , 66 Dr. Gay of Boston............................... 76 “The Passing of Paresis" 68 Psychologic Conception of Disease.... 77 The Eyeball-Heart Reflex. 206 The Fixation of Poisons by the The Traumatic Neurosis.... 424 Central Nervous System ......... 433 “Weeds" to Eat................. ... ... 69 The Prevention of Insanity ... ... ....... 429 NEUROHEMAtology. The Relation of Wasserman Re- - - action to Neuriatry...................... 204 Hemotologic Researches in Alcohol- 70 CerebroPsychiatry. 1Sſm........................ - --------------- The Denver Medical Times................ 79 NeuropAthology. Psychiatry. A Human Being Without Cerebra What Each Person Can do in the Hemispheres...................... ........... 71 Mental Hygiene Movement........ 81 Degeneration of the Neurone............ 73 Clinical NEURology. Myxidiocy. in the Presence of the The Virus of Rabies and the Negri Thyroid Gland........................ ... 193 Bodies.................................... ........ 78 Napoleon's Death.................................. 3.18 NEUROANATOMY. Phagocytic Power of Eosinophile A Newly Discovered Nerve................ 198 Leucocytes........ ............................. 3.18 Endogenous Fibres of Spinal Cord.... 437 EDITORIALS A Chiropractic's Ethics ... .. 329 An Inebriate Hospital and Reforma- A Compliment to the Editor.......... 92 tory for St. Louis................. 225 A Diploma of Honorary Membership 99 An 9d Poctor ------ 324 A Facsimile of a Fake Price List. 326 Annals of Surgery… ... 323 A Good College Movement........ ... 93 A Medical University - 209 A Monthly Course in Psychiatry 226 A Municipal Drug Fiend Hospital.... 328 A New Vocation for Medical Men.... 327 A Panama Canal Enginner Becomes Insane. -- ------------- 93 A Physician in General Practice .. 83 A Problem for Gyneco-psychologists 89 A State Epileptic Colony................ 87 A Widowed Victim of Meconism . . 96 Alcoholic Pseudopsia........................ ... 330 American College of Surgeons........ ... 97 American Medical Editors' Associa- tion… 227 Ample Rest and Moderate Congen- ial Work............ ........... --- - - - - ------ 449 An Anesthesia Supplement........ ... 449 An Eugenic Convocation............ . ... 221 Annual Meeting: Medical Society of the Missouri Valley............ 323 Another Honor to Gorgas...... . . ..... 220 Any Definition of Insanity Not Conceived on the Basis of Dis- ease is a Misconception of the Subject...................... - - ---------------- 226 Bailing Homocidal Lunatics a Judi- cial Blunder ........ … ... ... 212 Battlefield Medical Amenities............ 450 Bequest to the St. Louis Medical Society.................. . . . ... ....... Case and Comment. ..... ....... .........., 227 Clinically Expert and Non-Expert Alienist Opinion........................ ... 447 Court Penal Commitments for Inebriety.............................. ........ 329 Diploma in Psychiatry........................ 21S Doctor.............................. ... .............. 451 Dr. Edward Charles Spitzka ........... 85 Dr. Langdon ............................. ... ..., 88 Index. V Dr. John Green....................... . . . 90 Dr. T. D. Crothers, of Hartford.... ... 92 Dr. W. B. Kern.................................... 219 Dr. Isaac Ray, Pioneer on Non- Mechanical Restraint.................. 325 Dr. Hugh T. Patrick.......................... 451 Drs. Pettey and Wallace's Sanitar- itim...... ... .. ------------------------------- - - - 448 Drunkenness in Massachusetts. ...... 329 During Our Vacation—Boston......... 441 Erratum...... .............................. 443 Errors of Judgment Concerning Insanity - - - - - ------------ - - - - - - - - Eugenics Poetically Considered.... . . 215 Ex-President Taft..... . ....................... 90 Fatal Thanatophobia............................ 210 For an American Physician............... 88 George W. Crile, of Cleveland, Ohio 333 German Army Medical Staff Losses. 450 Hans Schmidt...................... ........... 440 Harm to the Homosexual. ... ......... ... 220 Harry Thaw ......... .............................. 89 Healthy Conservation from Noises.... 87 Holmes on the Eclecticism of Regu- lar Medicine.... ..... . . . . . ... 223 If This Magazine Pleases You ..... ... 219 Imbeciles in Massachusetts and the United States ..... ............. . ... 325 In Memoriam of Dr. James P. Tuttle 98 It is Obvious.......... . . . . ... ................ 99 Lectures on Inebriety. ...... . . ..... 89 Liquor Drinking Condemned and Hospitals for Inebriates Approv- Lust and Religion Not Necessarily Related......... ....................... ...... 441 Medical Blunders in Newspapers. 331 Militant Insanity.......................... ....... 328 Modern Day Administration of Cod Liver Oil. ........................ ... ......... 335 More Progress in Clinical Psychia- Needless Noise and Neurasthenia. 443 Now is the Time............................... . 450 On Washington Street .......... 442 Opium is a Disease Developing Drug 215 Our Tardy Appearance ........ 214 Political Psychiatry............ ... … . . 217 Physicians Unappreciated................... 214 Psychiatry and Eugenics in Relation to Military Service Fitness........ 225 Psychiatry in Pedagogy . ... . 95 Psychiatry in Surgery....................... 223 Psychic Error of the Cold Air Tu- berculosis Treatment........ .. ... 327 Psychology and Medicine Basis of Children's Bureau.................. . . 228 Psychological Philology in Finance Literature ............................... ... 322 Public Protest Against Noise.... . . . 94 Purity Hetc. ...,ng Cºntagious...... . . 213 Recover rom Insanity ... ......…. 10’) Recreation for Insane Hospital Pa- tients… 441 Reports of Hospitals for the Insane 446 “Salus Populi Suprema Lex Esto".... 331 Sanitary Life Above the Denser Dust Line . ......... ... ......... 323 Seguin-Montessori Method With Im- beciles and Others........................ 100 Sir Batty Tuke.................................... 211 Sixty Thousand Insane........................ 321 State and Private Hospitals, Asy- lums, Sanitoria, Psychiathrons. 83 Surgeon General-Major General W. C. Gorgas..................................... 86 Surgeon-General U. C. Vets..... ......... 451 Tardy Acknowledgment of an In- vitation .......................... . … ... 97 Thaw Has Threatened to Kill Dr. The Acquittal of Mendel Beiliss........ 83 The A. M. A. Journal's Incomplete Index… 82 The Cost and Care of Insanity and iocy.… . | 85 The Editor Acknowledges With Thanks...................................... ... 99 The “Friends.” Asylum for the In- Saſle.................................. ... 90 The Government of the A. M. A.... 81 The London Hospital.................... 91 The National Committee for Mental Hygiene........................................ 88 The New Narcotic Law of Pennsyl- vania.…. … ... 88 The Prevalence of Insanity........ . . SS The Re-appointment of Surgeon- General Stokes......... 86 The Rest Cure in Popular Literature 84 The Simulation of Organic by Func- tional Nervous Diseases............ 87 The Time Factor in Medical Edu- cation.… 208 The Unstable Neurone.................... .. 83 The Unstable Psychic Neurone........ 01 The Washington Society of Nervous and Mental Diseases.......... ------ 90 vi Index. The Alcoholic Pyschosis ---------------------- 215 The American Medical Association. 218 The National Medical Association.... 446 The Neurone Wastage of Perverted The American Medical Association.... 451 and Diseased Sexuality.............. 219 The Brain of Dr. Alphonse Bertillon The Next Meeting of the American Pledge of the Surgeons................ 218 Academy of Medicine.................. 449 The College of Medicine of the The Siamese Twins ..... 445 University of Illinois. .....…... 330 The Undersigned -- 226 The Degenerative Efatic D º 324 The Unsanitary Tactics of Con- The European War................ }… 4:43 tinuous Trench Fighting............ 451 The First Two Articles in North- The William H. Welch Endowment western Medicine.......................... 225 for Clinical Education and Re- The Fº". Annual Meeting of search............…. 228 the American Society for the Twilight Anesthesia.............................. 449 The Study of Alcohol............. ... 213 Tw..". b. - 322 The Greatest Asset.............................. 219 ----------- ~~~~º The Henry Phipps Psychiatric Two º: * Oldest Physicians of * als Clinic at Johns Hopkins Hospi- uls................................................ tal...........…. 448 Urban Quietude.................................... 94 The Highest and Broadest Educa- Weir Mitchell Dead................ 98 tion… 222 - ºr “The Modern Treatment of Inebrie- Wells Hawke's Brain Break................ 91 ty'"… 226 Wisconsin “Eugenic” Marriage Law 215 CORRESPONDENCE Course of Perfectionment at the Psychiatric Clinic of Munich.... 454 Reputable Manufacturing Pharma- cists do Not Furnish Emmena- My Dear Doctor Hughes.................... 229 gogues for Immoral Purposes.... 102 President Lowell on High Standards - - in Medical Education.................. 452 The American Roentgen Ray Society 337 REVIEWS A Course of Lectures on Mental Pathology and Mental and Nervous Diseases.......................... 106 A Fatal Case of Coccidioidal Granu- loma.…. 236 A Method of Operating on Fistula Without Cutting Muscular Tis- Sue.................................................... 110 A New Method for Estimating the Functional Capacity of the Kid- neys by Forced Elimination of Performed Urea............................ 340 A Notable Work on Biological Therapeutics.................................. 458 Actes du Congres Penitentiare In- ternational...................................... 232 Affezione del Cono Midollare in Seguito a Rachiostovainizzaz- ione … 120 Alcoholic Insanity and the Stigmata of Degeneracy................................ 237 American Association for Labor Legislation Program...................... 118 American Civic Association Paper on National Parks........................ 108 Arterial Ligation, With Lymphatic Block, in the Treatment of Ad- vanced Cancer of the Pelvic Organs… 234 Atypical Multiple Sclerosis................ 466 Bill to Repeal the Hetch Hetchy Grant...........…. 231 Burkholder on the Anatomy of the Brain.…. 241 Chronic Intestinal Stasis With Ref- erence to Conditions Found at Operation and the Mortality.... 234 Chronic Intestinal Stasis.................... 116 Circular of the School for Health Officers............................................ 119 Concerning Labor Shifts................. ... 104 Congrès des Medecins Alienistes et Neurologistes de France........... . 242 Conservation of the Nation's Brain Danvers State Hospital Laboratory Papers, 1910.................................. 103 Power................. … ….. 105 Department of the Interior................ 464 Diagnostic Symptoms in Nervou Diagnostic Symptoms in Nervous. 1SeaSeS.......................................... Dietetic Studies -------~ . Diseases of the Nervous System........ 106 Dynamic Psychology............................ 119 Economic Influence on the Medical Profession of the Periodic Ex- amination of Insured Lives........ 119 Enteroptosia (“Enteroptosis") and 68 Its Treatment............................ 468 Epidemic Poliomyelitis........................ 242 “Exceeding Fine".................................. 461 Experimental Pathology of the Higher Mental Processes............ 118 Forty Years' Evolution in Construc- tion and Administration of State Hospitals in the Middle West.... 231 General Information Regarding the Hot Springs of Arkansas............ 112 Gonococci as They Appear Under the Microscope.............................. 467 Gonorrheal Prophylaxis........................ 341 Governor Sulzer's Message on Public ealth.…........…. 236 Gray's Glycerine Tonic Compound. 341 Handbook of the Mental Hygiene Movement and Exhibit................ 457 Health Circular...................................... a Case...............…. How to Prevent Typhoid......... Humanizing Criminal Law Insanity Occurring in Latent Brights Disease............................................ 466 Intraperitoneal Injections of Ozone in Animals Following Injections with Virulent Bacteria ................ 233 Intravenous Anaesthesia...................... 235 La Cyclophrenie.................................... 116 La Paralysie Generale.......................... 238 La Physicotherapie du Cancer........ 342 La Spleene, Contribution a l’Etude des Perversions de l'Instinct de Conservation par le Docteur Henry le Savoureux.................... 111 Le Alterazioni Nucleari delle Cellule Radicolari in Seguito a Rese- zione dello Sciatico...................... 115 Le Syndrome Atavisme..................... 120 Linking Life Insurance Companies to Public Health Movement.... 118 List of Members of the American Medico-Psychological Associa- tion..................... 235 Mental Mechanisms 108 Navy League of the United States.... 118 On Formulation in Psychoanalysis.... 118 One ºf Lea and Febiger's Medical Epitºm: Series.*... .................... 461 Opium N- a Habit-Forming Drug. 114 Origin, Objects and Plans.................... 117 Origin, Objects and Plans of the National Committee for Mental Hygiene............….. 119 Phases of the Mental Hygiene Move- ment............….. 11 Pneumonic Hemiplegias...................... 467 Possible Errors in the Diagnosis of - Adbominal Cancer........................ 234 Practical Points on Syphilis................ 339 Preventive Medicine, U.M.................. 464 Primary Infection with Tubercle Baccilli, With Special Reference to Thoracic Glands.................... . 242 Principles of Mental Hygiene Ap- plied to the Management of Children Predisposed to Ner- VOuSIless.......................................... 117 Proceedings of the American Medico- Psychological Association............ 340 Proceedings of the Mental Hygiene Conference...................................... 111 Professor Cattell's Relation to the Association Method...................... 468 Psychanalysis: Its Theories and Practical Application.................... Psychology and the Medical School. 119 Psychology in Daily Life.................... 338 Psychology and Mental Disease........ 338 Publications of the National Com- mittee for Mental Hygiene........ 117 Publicity Concerning the Insanities. 236 Rapport sur le Traitment des Mala- dies des Pays Chauds dans les Stations Thermales et Clima- tiques.......................…. 120 Report of the Committee on Ap- plied Eugenics................................ 235 Results of Early Marriage................ 341 Review of Sigmond Freud's “The Interpretation of Dreams''........ 118 Rheumatism Phylacogen...................... 234 Statistical Studies of the Insane .... 116 Some Problems of the Institution Library Organizer in the State Hospitals ........................................ 119 Some Remarks on Bronchial of True Asthma........…. 119 viii Index. - . - School for Health Officers..... … . . 232 Serology of Nervous and Mental Seven Ambitious Brothers and How They Bred a Race of Kings........ 341 Solving the Mystery of Bright's Disease, a Preliminary Paper... 236 Some of the Incorrect º Terms in the Manual ºf the . International List of Causes of Death.............................................. 242 “Spondulix" Therapy.......................... 342 Stammering and Cognate Defects of Speech........................................ 339 Straws from the Fields of Leprosy.... 234 Summaries of Laws Relating to the Commitment and Care of the Insane in the United States...... 120 Teaching Sex Hygiene in the Public Schools.......................................... Technic of the Intra-Abdominal Administration of Oxygen.......... 234 The Action of Oxygen, Hydrogen Dioxide and Ozone Gas Upon the Growth of Certain Bacteria 234 The Adequate Punishment and Care of Defectives and the Insane.... 118 The American Labor Legislation Review............................................ 340 The Bulletin of the American Acad- emy of Medicine.......................... 242 The Care of Milk and Its Use in the Home...................................... 113 The Chemic Problem in Nutrition.... 456 The Conflict of Conscience................ 340 “The Culture of Joy".......................... 110 The Effect of a Momentary Contact with an 18,000 Volt Current.... 235 The Forty-Third Annual Meeting. 247 The Illustrated Handbook.................. 108 The Injustice of History... ... 242 The Institution Quarterly....... ...... 110 The Intervertebral Foramen.......... ... 121 The Intervertebral Foramen............ . 233 The Journal of Experimental Medi- cine… 246 The Journal of Inebriety and Its Possibilities.................................... 343 The June 30th Report of the Insti- tution Quarterly............................ 463 The Layman Revato........ ... 339 “The Modern Hospital".................... 109 The Monthly Cyclopedia and Medi- cal Bulletin.................................... 233 The Most Recent Report. ................. 465 The Myth of the Birth of the Hero. 339 * The National Committee for Mental - Hygiene.......................................... 109 The Personal Factor.... .............. ... 466 The Principle of Mental Tests........ 118 The Psychoanalytic Delusion............ 460 The Psycho-analytic Review .............. 235 The Recent Conferences on Medical Education..................................... 23.) The Rectal Plug.................................. 110 The Registration of Vital Statistics and Good Business........................ The Relation of the Medical Pro- fession to Accident Insurance.... 467 The Relation of Sight and Hearing to Early School Life.................... 464 The Science of Human Behavior ..... 118 The Sei-i-kwai Medical Journal.......... 341 The Significance of Intra-Abdominal “Bands,” “Folds” and “Veils”. 467 The Smaller Colleges............................ 245 The Surgical Treatment of Cancer.... 234 The Surgical Treatment of Chronic Intestinal Stasis. ................... ... 119 The Training School Bulletin........... 111 The Training School Bulletin........ 464 The Treatment of Rheumatic In- fections............................................ 238 The Truth About Wood Alcohol...... 109 The United States Public Health Service as a Career..................... 340 The Value of the Library.................... 466 The Wassermann Reaction in Can- Cer.….............… 244 The “Wellcome” Photographic Ex- posure Record and Diary, 1914 107 The World's Leading Books on Sex Knowledge.............................. ... .. 459 To the Front in Europe's War..... . 462 Training for Citizenship............ … 112 Traite Clinique et Medico-Legal des Troubles..... .......… ----------------------- 455 Treatment of Neurasthenia by Teaching Brain Control............. 231 Uniformity in Dosage of Radium Emanation. ....... . . . ........ ............. 4 United States Brewers' Association. 341 Voice and Manners in Medical Practice .................... . ....... - ------ 467 What is Paranoia?..... . . . ................ 465 “Whom the Gods Wish to Destroy They First Make Mad".......... 244 A JOURNAL OF ºf TRY AND NEURATRY. FOR THE NEUROLOGIST. GENERAL PRACTITIONER AND SAVANT | Panopepton– first of all and always a Cherapeutic Food ºts at moments of urgent need emergising and sustaining effects often conside rºle - so described by the physician; peculiarly useful as an “accessory coºlescent and the invalid; having many special uses—in the “rest feed- for instance. In fact, Panopepton, the perfectly soluble, highly diffusi- proves a peculiar “ability for good service" to the physician and in de range of conditions. 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 Emerson A. North, M. D., Resident Physician Georgia E. Finley, M. D., Medical Matron --- For descriptive yearly report address H. P. Collins, Business Manager. College Hill, Cincinnati, Ohio. THE ALIENIST AND NEUROLOGIST "Vol. XXXV. St. Louis, Febbuary, 1914. No. 1. WASSERMANN REACTION IN DEMENTIA PRAECOX* By Max A. Bahr, M. D. Clinical Psychiater Central Indiana Hospital for Insane. Indianapolis, Ind. SINCE the establishment of complement fixation in the diagnosis of syphilis, a new avenue of re- search has been opened in psychiatry and there have been wide-spread and awakening revelations made, as to the part that syphilis plays in this particular field of medicine. Especially has this been true of one type of psychosis, namely: general paralysis of the insane. The intricacy of the structure of the brain, the organ of the mind, has always tended to retard definite conclu- sions in the field of psychiatric research, but in view of the facts revealed by modern medical science, we are better able to understand the close alliance of syphilis with many heretofore obscure psychical and neurological conditions. Research along this line has recently led to the finding of the treponema pallidum in the paretic brain by Noguchi.1 Although there was much cumula- tive evidence that some sort of causative relation existed 'Read at the annual meeting of the Alienist* and Neurologists of the U. S. A., Chicago, Jane 23rd, 24th and 26th, 1913. (1) 2 Max A. Bahr between paresis and lues, we were still in darkness un- til this fact had been more definitely established. Only by work along this line in other psychoses will we be able to fathom the true nature of psychic diseases and not alone by clinical investigation. Dementia praecox is not merely a condition as was thought by Pick, who first used the term in 1891, and whose ideas were later developed and expanded by Kraep- lin, but is a morbid entity, and as distinct a form of dementia as is paresis. Although dementia praecox has many of the features of a purely developmental anomaly, on the other hand, pathologically and clinically it has many of the features of a true disease. The pathology has as yet shown nothing pathognomonic, for in fact there is but little pathology of mental diseases aside from dementia paraly- tica, in which condition certain histological changes have been observed. Changes have been found by many investigators, but so far nothing distinctly characteristic, and it has not as yet been possible to make a positive diagnosis from the pathological findings alone. Chiefly from the work of Alzheimer there is much evidence pathologically of an active process as well as clinically from the fact that the onset of the disease is at times rather sudden. It progresses and has remissions. It may be checked and recoveries may even take place. Often we find physical disturbances, such as cyanosis, edema, increased reflexes, muscular irritability, disturbances of nutrition, menstrual disorders, abolition of cutaneous reflexes, and great variations in the reaction of the pupils to light and accommodation. It also presents true psychical disturbances and may terminate in a complete destruction of intelligence, which has a resemblance to, and really is, the epilogue of a true disease. Studies in metabolism in this disease have been many. The blood has received attention. Every constituent of the urine has been estimated, and wide-reaching con- clusions drawn. The various glands with internal secre- tions, especially the thyroid and suprarenal glands, - Wassermann Reaction in Dementia Praecox 3 have furnished ready material for hypothesis. Most noteworthy has been the chemical analysis of brains as studied by Koch,2 in which he revealed a variation in the neutral sulphur fraction; in other words, a difference in chemical composition of a nature not so far observed in other forms of insanity, or in cases free from mental disease. Research however, along all these lines has as yet not come any nearer the solution of this problem. The causes usually assigned as productive of demen- tia praecox are very numerous, as, psychogenic, heredi- tary, toxins, exhaustion, puberty, auto-intoxication, etc. It matters not how we consider this disease, be its pathology acquired or be it developmental, the various pathogeneses have up to the present time been nothing more than hypothetical conjectures. Meyer,3 in his masterful studies of the psychogenic theories of dementia praecox, admits that they do not explain the basic factors of the disease, for, back of all as to the question of ultimate cause, we are left in a purely speculative position. He believes, as you know, that dementia praecox is a disorder in which there are certain types of reaction which are almost pathognomonic, and that these types are an inevitable and natural development from the de- terioration of certain habits; and this deterioration is due, partly to developmental defects of the mental endowment; and in part at least, to a clashing of instincts and to progressively faulty modes of meeting difficulties. There is no question that the dynamic value of psychic factors in the reactions of these patients is of the greatest importance, but they are not the fundamental factors which explain the changes of reaction type which are noted in dementia praecox. Kraeplin's hypothesis that dementia praecox is due to an auto-intoxication produced by poisons which are elaborated in the sexual organs, has had many advocates, because of the frequent appearance of the disease during puberty, the disturbance and variations that it determines in the generative functions, and on account of the in- 4 Max A. Bahr frequent occurrence of the specific syndrome in aged persons. That dementia praecox is not a reaction entirely to external etiological factors, but is rather, at least in part, an endogenous degeneration which represents the loss of adaptability to environment, has most ably been brought out in the work of Hoch.4 The work of Jung is admirable. His conception of this disease is that it is largely of a psychological nature. He has shown that the symptoms consist in the out- cropping, in a peculiar, distorted and frequently symbolic form, of the thoughts, ruminations and longings of the individual, and on analysis of the individual's life, we find that these elements have been a disturbing factor throughout, and this disorder appears to arise in individ- uals of certain temperamental peculiarities. Recognition of the defective constitutional make- ups in these cases has not as yet thrown any light on the etiological factors in the production of this so-called dementia praecox soil. Endogenous causes which are connected with the individual constitution, are operative in any environment, and if they are traced back to their origin in the ancestry, it is seen that they also come from without, and that they are ultimately not essentially different from exogen- ous causes. It appears to me that in the consideration of the etiology of any mental disease, we are dealing largely with the etiology of the predisposition, and direct causes, no matter how far reaching they may be, are not able to call forth a mental disorder without this predisposition. Under the same conditions of environment there are those who become insane and those who do not. The delirium of typhoid fever and of other infectious processes is not merely an expression of the severity of the in- fection or of the degree of the fever; it is also in part dependent upon the manner in which the brain reacts, or the physical or psychical personality of the patient. These diathetic predispositions have their origin J Wassermann Reaction in Dementia Praecox 5 somewhere and behind all this there lies a hidden cause which is producing these conditions. The chemistry of the brain is as yet too little known to materially aid us in explaining certain organic patholog- ical changes noted in this disease, and it appears to me that the destructive brain changes noted, are the cause of the manifestations observed in dementia praecox rather than the result, as is believed by some, for we know that clinically such manifestations are not present in normal individuals. As I have already stated, this psychosis is considered by some a purely developmental anomaly, and although it may be considered as such in its incipiency, during the course of the acute phase of the disease, there is in a sense an active process going on, which is directly responsible for the neurotic decay which has been found in its pathology. The pathological anatomy, although as already stated, not pathognomonic, reveals three different types of lesions, namely, those of congenital abnormalities, those connected with the onset and course of the disease and consisting of a granulo-pigmentary atrophy of growth of neurones, and those changes ob- served in other parts of the organism. The localization of these lesions being more pronounced in the association paths, as first noted by Alzheimer, explains in a manner the chief symptom of the disease, namely, the dementia, which in all probability is due to a loss or degeneration of paths of connection between the cells of the cortex of the brain which interferes with a free communication of these cells with each other. We know from our observation of syphilitic changes in other conditions, that hereditary syphilis acts in a three-fold manner. At times it calls forth specific changes in the brain, as gummatous processes in the cerebrum and meninges, hydrocephalus, etc; at times it brings about diffuse so-called non-specific alterations, which resemble the acquired parasyphilitic conditions, and then finally a general retarded developmental condition which funda- mentally in many ways resembles just what we have been 6 Max A. Bahr able to note in the pathology of dementia praecox. In the first two conditions the Wassermann reaction has been found positive quite regularly in the serum and fluid by Lippman,6 and Ziehen,6 and it was also observed by the former author that in long existing hereditary syphilis the Wassermann test finally gave negative re- action. I contend that it is just these long existing heredi- tary cases, and especially where syphilis is or has existed in an attenuated form, that is the basic factor in the pro- duction of the dementia praecox soil, in quite a large per cent. of these cases. With the finding of the positive Wassermann reaction in a certain percentage of cases of dementia praecox, I believe we have the clue to a nearer solution of the question as to the etiology and nature of this disease than we have ever had before, notwithstanding, the most extensive and exhaustive research into its etiopathology along other lines. Although the specificity of the Wassermann reaction is at the present time quite well established, it must be taken into consideration that this reaction has been noted in other conditions than syphilis, and also that different investigators differ widely, and in fact report almost contradictory results. Thus, Plaut,7 in examination of the blood serum in one hundred and fifty-nine cases of paresis, found a positive reaction in 100 per cent, while other equally competent investigators as, Nonne, Marie,8 and Levaditi,9 obtained positive findings in from 59 to 90 per cent. As yet the efficiency of the Wassermann test has not been improved so that in every case of syphilis, be it acquired or congenital, active or latent, a positive re- action is obtained; so that as a diagnostic means a negative reaction offers no guarantee of the absence of luetic infection. Since Noguchi and others have been able to obtain the spirochaeta pallida in pure culture, it is to be hoped that an antigen prepared from such culture will be efficient i Wassermann Reaction in Dementia Praecox 7 in complement fixation in syphilis, and will make it pos- sible to consider the test as a true antigen-antibody reaction. Although this as yet has not been practicable, it is not absolutely essential as other spirachaetal diseases as framboesia, sleeping-sickness, etc., in which also positive reaction has been noted, are not contenders in this country in the diagnosis of syphilis. The other diseases in which the reaction occurs can as a rule be easily differentiated, and the numerous discrepancies that have been noted at times, may generally be attributed to numerous possibilities of error due to the complexity of the technique of the reaction. It must also be borne in mind that by varying the propor- tions of complement or of the haemolytic amboceptor, it is possible to make the reaction more or less sensitive, although its reliability is not altered. The following are some of the diseases in which a positive Wassermann has been noted by various workers: Marchildon10 has observed it in malaria, recurrent fever, appendicitis, cancer and typhoid. Welchelmann and Meier,11 have reported positive results in leprosy. Halberstaedter, Mueller and Reiche12 have reported re- action in measles, varicella and pertusis. Semon18 has found it present in eclampsia and Boas and Peter- son14 have noted it in patients following chloroform narcosis. Boehm15 and Reinhart,16 in cases of malaria and beriberi; Newmark,17 in gliosarcoma of the brain; and Kaplan,1 in cases of jaundice. Citron,19 Collins and Sachs,20 have noted positive findings in aortic insufficiency, and Major,21 observed it in twenty-one out of twenty-two cases of aneurism, mostly of the aortic arch. Simon,22 also has observed in a not in- considerable number of cases a positive reaction in cancer. We must also take into consideration that the finding of the Wassermann reaction in certain conditions and diseases, does not necessarily exclude syphilis, as many cases cited above, especially those of aortic insufficiency, aneurism and jaundice, are of probable syphilitic origin, 8 Max A. Bohr although the patient may not necessarily give a luetic history. With the exception of the conditions noted, the consensus of opinion is, that when the positive Wassermann is found on repeated examinations by competent trained laboratory serologists, the individual has been infected at one time or other by the spirochaeta pallida, and still either harbors the active foci of the syphilitic agent or syphilitic products, irrespective as to whether the clinical symptoms are only very slight or are not present at all. In formulating the following statistics, the blood was examined by the Wassermann test in two hundred and fifty two cases of dementia praecox, and simulta- neously with this, the test was also applied to the cerebro- spinal fluid in ninety-five of these cases. In the latter the fluids were examined by lumbar puncture, from five to ten c.c. being removed and the patient confined to bed for twenty-four hours after the operation. In two of the cases we noted quite serious collapse and the patients were not able to be out of bed for ten days or more, but in the remaining cases, aside from a slight head- ache, dizziness and occasional vomiting, there were no ill results. The butyric acid and ammonium sulphate tests of the fluid were also made, as was likewise a cytological count for the estimation of lymphocytosis. The cases to which these tests were applied were all well recognized types of this psychosis and repre- sented cases which had been received in the Central Indiana Hospital for the Insane within the past six years. None of the older cases of the so-called secondary dementia, which could possibly be considered as cases of dementia praecox, were included in this series of investigations. Furthermore, all specimens that pre- sented a reaction merely faintly positive were counted negative in order that our estimates might be as nearly accurate as possible. Specimens of some cases that were questionable were Wassermann Reaction in Dementia Praecox 9 repeatedly examined, and also new specimens obtained until an accurate and definite conclusion could be reached. Also parallel with these experiments, we tested out for control some normal sera and fluids, as likewise the sera and fluids of from ten to twelve cases of syphilis or paresis which we knew to give a positive reaction. The principle of complement fixation in the diagnosis of syphilis as taught by Wassermann, is so familiar and the technique so well known that it is unnecessary for me to enter into the details, either of its original form or its later modification. The Noguchi modification of the Wassermann was used in making these tests as we consider it one of the most accurate complement fixation tests for syphilis, as well as one of the most convenient. We used antigen prepared from non-syphilitic tissue, beef heart being em- ployed. The Noguchi butyric acid test was also applied, in which one part of spinal fluid is mixed with five parts of a ten per cent. butyric acid in physiological salt solu- tion. This mixture is heated to boiling and immediately one part of four per cent. sodium hydrate solution is added and the mixture again boiled for a few seconds. We used from one-half to one c. c. of the spinal fluid in a large test tube. In this test the presence of an in- creased content of protein in the fluid is indicated by the appearance of a granular or flocculent precipitate, which gradually settles under a clear supernatant liquid. This precipitate appears within a few minutes in a speci- men containing considerable increase in protein, while two hours may be required to obtain a distinct reaction in specimens weaker in protein. Normal fluid may give a turbidity, but the granular precipitate does not occur at all or only after many hours. This protein, called by Noguchi euglobulin, was not observed in a single case. In several cases the Robert's nitro-magnesia test for albumen was made and an increase of albumen was noted in some cases. This finding was estimated by the appear- ance of the ring. Normally the fluid contains a very 10 Max A. Bahr small amount of albumen, so small that the reaction by this test is always very faint. The Ross-Jones test we found very satisfactory. In this test clear cerebro-spinal fluid is cautiously added to a saturated solution of ammonium sulphate in such a manner, that the fluid lies on the reagent without blending with it. If the reaction is positive, at the junction of the two fluids, a definite, sharply defined, thin, white film forms immediately, or almost immediately, which, when looked at against a dark back-ground has very much the appearance of a cobweb. This test was found positive in two cases and one of these also presented a positive Wassermann in the blood and fluid. The cell count was made by the French method in which three cells or fewer in an oil immersion field (l/12th oil immersion objective, 1 inch eye piece B.L.) was considered normal; four to six cells slightly positive; seven to twenty moderate increase; and twenty to one hundred and fifty decidedly pathological. The fluid was centrifuged in a pointed tube for about one hour, and the supernatant fluid removed. The sediment from the lower end of the tube was then obtained by a pipette and dis- tributed in drops on slides. It was dried and fixed for ten minutes in absolute alcohol, when the specimen was stained and washed thoroughly in distilled water. As some of our specimens became unavoidably mixed with blood, the count could only be satisfactorily made in sixty-seven of the ninety-five cases, of which number only three cases, or 4.4 per cent., showed a count over six cells per immersion field. The estimation of the pres- sure of the fluid was only approximate, as it was merely made by the number of drops per minute, a water or mercury manometer not being at hand. An increase was noted in seven cases, or 7.3 per cent. The following are the results of the Wassermann test applied to the sera and fluids: Wassermann Reaction in Dementia Praecox 11 TABLE I WAssERMANN Test APPLIED to the Blood DEMENTIA PRAEcox Positive 81 cases Negative 171 cases Total 252 cases Total per cent. positive 32.1 TABLE II WAsserMANN Test APPLIED to THE CEREBRO-SPINAL FLUID DEMENTIA PRAEcox Positive 10 cases Negative 85 cases Total 95 cases Total per cent. positive 10.5 TABLE III WASSERMANN TEST POSITIVE IN BOTH SERUM AND BLOOD DEMENTIA PRAEcox Positive 3 cases Negative 92 cases Total 95 cases Total per cent. positive 3.1 Out of 252 sera examined, the Wassermann was found positive in 81 cases and negative in 171, represent- ing 32.1 per cent. positive. 12 Max A. Bahr Of the 95 cerebrospinal fluids examined, the Wasser- mann was found positive in 10 cases and negative in 85 cases, thus representing 10.5 per cent. positive. In 3 cases, or 3.1 per cent., the reaction was found positive in both blood and cerebro-spinal fluid. In 2 cases of this series, we were able to obtain a positive history of acquired infection after the psychoses had already been initiated. One was a female, 19 years of age, who had come to this country at the age of 15 and was employed as a domestic. She was brought over by some tourists and after she had been here a short time, there was noticed quite a change in the patient which was attributed to home-sickness but which in reality was the beginning of her psychosis. She manifested numerous hallucinations, was apathetic and indifferentandat times catatonic and would frequently break out in childish laughter and become impulsive. The infection took place about two years after the onset of the psychosis and the patient was admitted to the Central Indiana Hospital, December 21st, 1911. Traces of occult blood were noted in the feces. The other case was one of a young man 25 years of age who developed the psychosis while serving in the U. S. army, and who after its onset became infected with syphilis. One patient who presented a pronounced positive reaction in both serum and fluid was one whose father was syphilitic and who later developed tabes. He committed suicide when the patient was but five years of age. The mother died of heart trouble and was known to have had several miscarriages. Two brothers are reported living and in good health; one sister is of decided neurotic temperament, nervous, introspective and depressed. Another patient of this series is one whose father is a paretic in our institution at the present time. Only one patient of this series presented a positive Wassermann reaction in both serum and fluid, a positive Wassermann Reaction in Dementia Praecox 13 ammonium-sulphate test, heightened pressure and an increase cell count. This patient, a painter, was admitted to the Central Hospital, September 12th, 1912, with a picture of a well advanced catatonic type of dementia praecox. Little of his early life could be learned, ex- cepting that he had always been very irregular in his habits, and that he at one time had had lead poisoning with wrist drop. He had also been addicted somewhat to alcohol. Incidentally we also noted that since in the institution the patient has had bile pigment and indican in his urine repeatedly. I believe that the most hopeful lines of investigation are to be found when we consider dementia praecox as essentially similar to paresis, where nerve tissue is de- stroyed by the presence of poisons, be they exogenous or endogenous in character, and where in the slow deter- ioration of the nervous system, many mental pictures may crop out, and that it is in the pathological labora- tories where further light on the pathogenesis of dementia praecox will be thrown, rather than in the clinical obser- vation of the often vague influence of psychogenic factors. The manner in which syphilis acts as an etiological factor in these conditions I am not prepared to say, whether we are dealing with the active spirocheates, a syphilitic antibody, or with old healed syphilitic lesions, in which the active process has long ceased and only the disturbance of function remains, an attenuated virus, or some antitoxin produced in the body in its effort to destroy the spirocheates. The finding of the positive Wassermann in dementia praecox in a certain per cent. of these cases does not as yet establish as an absolute fact that syphilis is the etiological factor in the production of this disease. It merely substantiates that the patient is a syphilitic and not necessarily that this syphilis, be it congenital or acquired, is the cause of the psychosis, for there is no law in medicine that a patient may not have two diseases irrespective of each other. However, the finding of the positive Wassermann reaction in a considerable 14 Max A. Bahr number of these cases, especially in the cerebrospinal fluid, signifies at least that the central nervous system is involved. Clinical evidence is not necessary to estab- lish syphilis in these cases. Its presence may be made clear by the reaction as has been the case in the recent investigation of Profeta's law, that a non-syphilitic child of a syphilitic mother does not acquire syphilis from this mother who suckles it; and Colles' law, that a non- syphilitic mother does not contract syphilis when suckling her syphilitic child, whereas a wet nurse does. This shows that the child in the first case and the mother in the second case do not clinically give the slightest evi- dence of syphilis, yet in both cases give a positive Wasser- mann reaction and in fact are syphilitic. May we not view dementia praecox in a similar way? Furthermore, the frequency of dementia praecox in patients of tabetic and paretic parentage, as was specially noted in the study of two thousand cases by Pilcz,23 is well known, also the history of frequent mis- carriages in the mother, children born dead, and also children dying in infancy, and children apparently healthy, but who later present this characteristic deteriorating psychosis, and finally healthy children, suggesting either that in the course of time, the virus becomes attenuated, or that the resistance of the offspring increases in strength, or that both of these processes are in operation together. If the work of antecedent syphilis were given a most careful investigation in dementia praecox, as for instance, subjecting the parents of these patients to the Wassermann test (a work which we hope to carry out as far as possible), I believe an astonishing amount of evidence will be accumulated which will, in part, at least, clear up the etiological mysticism which heretofore has always shrouded this disease. We will then recog- nize its true nature and its cause, for not until then will we be able to pave the way to its rational thera- peusis and the scientific problems of preventive psychia- try, in a type of psychosis which represents nearly 20 per cent. of the admissions to our institutions. Wassermann Reaction in Dementia Praecox 15 Conclusions 1. A positive Wassermann reaction of the blood in 32.1 per cent. of cases. 2. A positive Wassermann reaction of the cerebro- spinal fluid in 10.5 per cent of cases. 3. Butyric acid reaction negative in all cases. 4. Increase of globulin content in 2.1 per cent. of cases by the ammonium-sulphate test. 5. A positive Wassermann reaction in both serum and fluid in 3.1 per cent. of cases. 6. Increased pressure of the cerebro-spinal fluid in 7.3 per cent. of cases. 7. Pleocytosis noted in 4.4 per cent. of cases. 8. Parallelism between the Wassermann reaction in both serum and fluid, globulin content by the ammon- ium-sulphate test, lymphocytosis and increased pressure in one case. 9. Positive history of acquired syphilis in only two cases and both these contracted the disease after the onset of the psychosis. 10. Ancestral syphilis in the production of the syphilitic soil is to be considered as one of the etiological factors in the production of dementia praecox. 11. Clinical evidence of luetic infection is not necessarily present in dementia praecox, for we are proba- bly dealing with syphilis in an attenuated form. I desire to express my indebtedness to Dr. George F. Edenharter, Superintendent of the Central Indiana Hospital for the Insane, for his unceasing encouragement of medical research; to the members of the medical staff of our institution for their hearty co-operation; also to Drs. Truman C. Terrell and Ernest D. Martin, pathologist and assistant pathologist, who conducted these serological tests. BIBLIOGRAPHY 1. Journal of Experimental Medicine, Feb. 1913. 2. Koch, W. Chemical Study of Brain in Dementia J Praecox. Journal Experimental Med., 1911. 3. Psychological Clinic, Vol. 2. 4. Rev. Neurol. and Psychiat. Vol. 8. Max A. Bahr 5. Lippman: Munch. Med. Wchnsch., 1909. Nr. 47. 6. Ziehen. Psychietrie. 4. Auflage. 1911. 7. Plaut. AUg. Zeitsch. f. Psychiatric 1909. 8. Nonne: Quoted by Plaut in Sere-Diagnosis of Syphilis, 1911. 9. Marie, Levaditi: Compt. rend. de la Soc. de Biol., Vol. LXIV. 10. Marchildon: Wassermann Reaction in Diseases other than Syphilis. Interstate Medical Journal, Sept. 1912. 11. Welchelmann and Meier: Deutch. med. Wchnschr. 1908. 12. Halberstaedter, Mueller and Reiche: Berlin. Wchnschr. 1908. 13. Semon: Ztsch. f. Geburtsh. u. Gynak. 1910. 14. Boas and Peterson: Folia Serologica. 1911. 15. Boehm: Folia Seriologica. 1909. 16. Reinhard: Munchen. med. Wchnschr. 1909. 17. Newmark: J. Am. M. Ass. 1911. 18. Kaplan: Am. J. M. Sc. 1910. 19. Citron: Bert. klin. Wchnschr. 1908. 20. Collins and Sachs: Am. J. M. Sc. 1909. 21. Major: Johns Hopkins Hospital Bulletin. June, 1913. 22. Chas. Simon: Clinical Diagnosis. 7th Edition. 1911. 23. Obersteiner's Arbeiten. 1907. RESCUE: THE STORY OF ALBURTUS. By Martin W. Barr, M. D., Chief Physician, Pennsylvania Training School for Feeble-Minded Children. Elwyn, Pa. THE following life-history, unique in its way, records the partial triumph of healthful environment over baneful heredity where, on the one hand, through careful training the best impulses were aroused and constantly fostered by stimulation; while on the other hand, the inherent tendencies, kept in abeyance and guarded from temptation, became in great measure nullified. Any believer in heredity will recognize that however exceptional this single case of mental defect may appear, yet in event of marriage, the frightful neuroses inherited although dormant in him, would undoubtedly have de- veloped either in modified or exaggerated form in after generations. The early history shows the father an Englishman, much older than his wife, by trade a house painter, a drunkard, who finally committed suicide, presumably, from family troubles. The mother, with but little mind, the daughter of a most immoral man, also a drunkard, had a brother who was an expert counterfeiter, two idiot sisters, and another sister—a moral imbecile—well known in the under- world as "The Infamous J. E. of Philadelphia." Alburtus, the fourth born, had two brothers and one sister, all though physically strong, morally weak. During infancy and early childhood, suppressed and kept down, starved and neglected, with poor food and (17) 18 Martin W. Ban. poorer hygienic surroundings, he yet had vivid recollections of his mother frequently giving him beer to keep him quiet. Why, when, or by whom he was named Alburtus, is not known, but so he was entered on the books of the "Children's Home," when my attention was first called to him. Coming under my care in his ninth year, a tall, pale, dark haired, dark-eyed, delicate lad, with a record of frequent attacks of catarrhal jaundice, weak lungs, weak morals, and defective nervous system, we classed him a high-grade mental defective with many contradic- tions. Superficially affectionate with but slight apprecia- tion of values, he would soon forget a kindness conferred; at the same time he would render willing and ready ser- vice if called upon. Given to introspection, moody or full of life, he had periods of dreaminess, enveloped in thoughts which he refused to divulge. Bright in many ways, notwith- standing the history of neglect, he was both indolent and erratic: persistently head-strong and disobedient, particularly in trifling with fire, yet appreciative of a trust committed to him, he could be depended upon in an emergency. His teacher found him upon entering school, slow and behind others of his class; a backwardness easily traceable, however, to the influences of heredity and early environment. Responding to the stimulation of compan- ionship in congenial occupations, he soon completed very satisfactorily the primary work, making a good record in the 3 R's. Orderly and attentive to rule in school, outside he exhibited a propensity for mischief amounting almost to vandalism. Within the year she reported development in many lines—eagerness in the study of geography, history, and music, showing also considerable facility in sight reading. Often naughty, his wild escapades continuing—but withal, very interesting and lovable—he got on well with the other boys, and was a leader, although given to per- petual teasing. The Story of Alburtus. 19 Every once in a while sick for a day or two, was given to calling himself "A Delicate Duck," which indeed he proved to be, to such an extent, that he was finally remanded to the hospital for several months treatment. Here a growing appreciation of values is evidenced, as standing one day at a window with a far-away look in his eyes, he said: "What a beautiful place this is, and how lucky I am to be here." Improving and returning to school, after two years, he is reputed as: "Always quiet, industrious and re- sponsive to training; an earnest reader of good literature, remembering, absorbing and discussing intelligently. Neat in person and clothing, teeth and nails well kept, under military training he has become erect, active, and alert, with firm step, graceful figure and carriage." Full of fun, he delighted in playing jokes, especially on his teachers. A leader in mischief, responsible for many pranks of others, he required constant supervision. When fourteen years old—five years after entering the institution—he became a leader in athletic sports, especially baseball, began to play a cornet in the band, reading music with facility and rendering it with unusual precision and feeling, and developed also a fair- singing voice of tenor quality. Growing gentlemanly and well-mannered, his former indolence was replaced by ambition, and he began work in the printing office, and setting type rapidly and accurately, he soon became a careful proof-reader. As he awakened sexually, he became curious regarding the origin of life, and asked many embarrassing questions; and others, showing a philosophic trend of thought, such as: "If God made the world, who made God? Why do we not build boats shaped like fish? If they can swim, why can't a boat?" Out of school hours, or when unemployed, he was a regular "dare-devil." There was no prank too wild; absolutely nothing he would not attempt. Always polite when rebuked and reasoned with, he would listen atten- tively, simply smile, and go away to perpetrate some act 20 Martin W. Barr. of lawlessness hitherto undreamed of. Nothing seemed to make any impression, except constant congenial employment and perpetual safe-guard- ing—exercise, amusement and companionship being equally essential. In matters of discipline, therefore, our hands were tired. His food could not be cut down since rapid growth, (leading ultimately to the attainment of over six feet in height) had already diminished, both flesh and appe- tite, so that very slender, and a dainty eater, he re- quired special diet. This state of things continued until the close of his fifteenth year, after he had worn everyone out trying to help him, it now became evident that he must help himself and control his propensity for vandalism; and thus he was told: "We have tried everything for you and failed. Now it remains only to put you some place where you can give no more trouble." At once he became serious and replied: "Just wait, I'll tell you! I think I have musical talent, and if you will get me a violin and a teacher, I will be good, and you will have no reason to complain of me again." And I never did! Ready to grasp at anything and to try any experiment, I secured a young man, who, meeting the occasion exactly, proved just what was wanted as a teacher, companion and guide. As soon as he was installed the regeneration began, and progress was assured and upward. With thoughts and energies once directed into the new and healthful channel, that he himself was clever enough to recognize, Alburtus practised faithfully, devoting every spare moment to his instrument, so perseveringly and enthusiastically, that within a year his teacher told me frankly that he had accomplished all he could for him in preparation for the advanced training, which his really exceptional talent demanded and suggested that I give him the advantage of study with a violinist just coming into notice. At the end of two years this teacher gave the same report as had his predecessor; that his pupil had gone The Story of Alburius. 21 as far as he could take him, and urged that he might enter the class of one of the truly great violinists of the country. At first this artist refused, feeling that the training of an abnormal of whatever degree of talent, was more than he cared to undertake. But after hearing Alburtus play, he not only reversed his decision, but be- came eager for the experiment, and, taking him at a very great reduction, worked with him for three years, at the end of which time he returned to me a young man, well equipped to teach my violin class, and lead my orchestra, both of which he did exceedingly well. His repertoire, popular and classical inclusive, ranged from dance and rag-time up to Lange, Rubenstein, and Mendels- sohn, but he was fondest of Greig and Chopin; and never content to rest on his laurels, was always looking higher. In connection with other work he took up the clarionet, on which, his early training proving invaluable, he made wonderfully rapid progress. And so he grew in knowledge and in favor with all, his whole nature softened and attuned to the harmony of life. During vacation periods he rendered efficient service as director of the printing staff, and also of the band practice. A sudden and severe attack of neurasthenia— characterized by irritability and depression, alternating with short periods of brightness and nervous excitement— caused him, just at this time, to lose interest in every- thing—work, athletics and even music. Disturbance of emotional equiUbrium was evidenced in loss of power of concentration and appreciation, so that the gentle nature became apparently cold, inert and irresponsive. Responding, however, to treatment, he gradually built up, and again became interested in work—printing, carpentry, photography and music practice. The addi- tional stimulant of athletic exercises, and long walks with prolonged periods of rest—retiring early and rising late—at last enabled him to approximate normal conditions. In his twenty-second year, he was advanced to the position of attendant in charge of a club of small boys, 22 Martin W. Barr. discharging his duties most satisfactorily, both as a leader and companion to the boys devoted to him. Careful of his earnings, while enjoying excursions from time to time, and presenting always a good appear- ance, he was at this period in no sense wasteful or ex- travagant, until he had accumulated quite a little, his bank account amounting to some five hundred dollars. Then, suddenly showing the instability and contra- dictory nature of his class, he began to spend without limit or reason, and whether for the mere excitement of money-spending or the novelty of it, he became a veritable spend-thrift, until fifty dollars was all that remained of his savings. With the single exception of his beloved violin, for which he gladly paid a high price, he bought without aim or object—cheap watches, silver match-boxes, patent medicines, for which he had no use, books, some relating to sexology, others to fishing and gunning in neither of which latter had he any experience. His varied musical ability had become an important factor in our regular entertainments—dances, concerts and theatrical performances; and in the latter always taking leading parts: Indeed with such marked success that with a natural longing for "beyond the beyond" he now conceived an unquenchable desire to become a professional actor. 'Willing to allow the trial (although disapproving and warning him at the same time of inevitable disap- pointment) I made arrangements for an interview with Mrs. B a favorite actress noted for her careful discrimination of character, her excellent companies, and the high standard maintained in her plays. Advised of his pathetic history, she recognized in him a psychologic study and, pleased with his attractive personality, became so interested that she promised him the first vacancy in her company, for which he might be adapted. Some months later, upon reviving one of her most popular plays, she sent for him. He responded and, in a very small part, gave entire satisfaction. When at The Story of Alburtus. 23 the close of the season, he thanked her for her kindness, she replied: "Try hard Alburtus; work hard; and you will get on." And he did strive to follow her advice, but the loneliness of a great city made him homesick for Elwyn and familiar environment, and returning, he was glad to fall into old traces amid the comforts and protection of community life. At the end of two years, however, again came the lure of the foot-lights, and he secured a position in the company of a mediocre star touring the smaller towns of the west. Unfortunately, however, lacking both the education and discernment of the other lady, as well as discrimination, she gave him a leading part, to which he was not equal, and here he met the disappointment of which he had been warned. Failure in one way, however, proved a success in another by revealing to him his limitations, and he was glad to return to live on in his own environment, fully assured that for him, there was no place like home. And well it was for him, for to one of his naturally delicate constitution any sudden strain, or prolonged depression, might have resulted in entire collapse, the condition of throat and lungs, liver and nerves, all presaging possibilities of a general collapse. Safe-guarded from this in a home atmosphere where any indisposition met prompt attention, his life prolonged found content- ment in work and in music, a happiness he ever loved to share. Indeed with him, this giving pleasure to others, being a veritable religion, love was truly the fulfilling of law. And so he lived on for five years beloved by all his associates, when in his twenty-ninth year, at the close of the preparations for Christmas—the rehearsals for choral services and the operetta in which as usual he was a leader—he suddenly succumbed to an attack of pneumonia. All watched anxiously for his recovery, but the collapse at last had come; there was no possibility for recovery; the springs were dry. And as the evening shadows gathered, the light of 24 Martin W. Barr. life flickered, and the wearied heart beat more slowly, until as night fell, he passed down the dim path, and through the portals, to the endless glow of the Eternal City to obtain the Crown of Everlasting Life. In this review of rescue from the evil consequences of filthy heredfty and environment, one cannot fail to recognize that few normal lives in the brief period of their twenties, discover and fulfill more completely life's vocation, accepting without dispute its closed gates, and seeking to develop the best in its open paths, as did this brave son of misfortune. The query has often been made of him as of others of his class: "Is he feeble-minded? Wherein does his deficiency lie?" The answer for him as for them is: "He lived in the land of innocent and perpetual childhood, the borders of which he never passed." Clever in many things, his musical talent placing him very near if not altogether in the idiot savant class, upright and manly in the pathway in which he had been trained and upheld, yet absolutely immature, he often thought as a child and spoke as a child. Feeble-minded he was beyond a peradventure, and no one recognized it more clearly than did he; especially after his efforts in competition with normal people, and life on the broad highway. That his deficiency in judgment required ever the protection of rule and regulation he also recognized, and came to rely upon. Had any mischance thrown him out of this atmosphere, as a tool of the vicious, what might not have been his fate, enfeebled as he was, weak of will, and easily influenced? Thus while we cannot but realize that for such a life, early consummation and passing was a merciful dispensation, it lingers with us ever a delightful memory, a memory which has been crystalized in verse by a friend in an apostrophe to "His Violin." Thou sad and silent thing! Where sleep the strains that gladdened all who heard? The joy that poured from every wakened string Like song of morning bird? The Story of Alburtus. The muffled pulse of pain— The peace, like that of prayer which has prevailed— Voices that rang through heart and soul and brain— Why has that music failed? The empty cells and strings Give back no answer; but beyond our ken, Somewhere in being's range, on unspent wings, That music lives again! (Mary Hilton.) CONSTITUTIONAL PSYCHOPATHY IN CHILDREN. With a Report of Four Cases. By James C. Hassall, M. D., Junior Assistant Physician, Government Hospital for the Insane. Washington, D. C. SPARE the rod and spoil the child" is sufficient proof that the problem of the care of the child is not new. It is ever before us and constantly demands our attention. Of all individuals born, a certain number, great enough to cause apprehension, are found to differ from the average mentally. In describing their departure from the normal, one has the choice of several terms. In describing their defects in the intellectual fields, we prefer to speak of idiots, imbeciles and morons. This division, one of degree and not of kind, has been made arbitrarily by the use of the Binet-Simon tests to determine the psychological age of children. Due to their inability to acquire knowledge beyond that possessed by the normal child of two years of age, we classify certain individuals as idiots. These, even with the greatest care, cannot be educated. Those of the next division, the imbeciles, are able to acquire knowledge possessed by the normal child of from three to eight years of age. These individuals are capable of being taught to care for themselves to a certain extent, but they are incapable of leading a separate existence. The morons psychologically are between the ages of eight and twelve; they can be taught to read and write and in some cases to be quite efficient in manual work requiring no initiative. Under the guiding hand of relatives or under the protection of an institution they do admirably (26) Constitutional Psychopathy in Children 27 well and are able to earn a livelihood. Left to them- selves they cannot cope with the social requirements and are soon a burden on the community. The above mentioned individuals often show marked defects in their emotional spheres, in addition to their intellectual defect. The former are often shown in periods of excitement with more or less vicious tendencies. There is yet to be considered another small group of children who are not feeble minded, whose psychological age, by the Binet-Simon tests corresponds to their chronological age, in whom mental symptoms are present, especially in the emotional fields. These are the boys and girls who seem to be normal so far as intelligence is concerned, who seem to have plenty of ability and shrewdness and even cunning, but who lack moral sense, moral judgment, moral stamina, who lack the ability to adapt themselves to their environment, and live a decent life in the society in which they are placed. This group comprises the wayward girl, the incorrigible boy, the ne'er-do-wells, for whom as yet we have found no satisfactory treatment.1 They are persons who from an early age display some mental defect coupled with strong vicious or criminal propensities on which punishment has little or no deterrent effect.2 They show weakness of will, violent changes in temper and strong ungoverned feelings, which if allowed to proceed in their growth will undoubtedly develop anti-social instincts and the children possessed of such tend to become criminals, vagabonds, prostitutes, or even insane.3 According to Ziehen these conditions are spoken of as the Psychopathic Constitution. Many of these children show what apparently is an intellectual deficiency, but an examination of them proves this to be due to their improper training rather than to an intellectual defect. As a rule they are mischievous, unruly and hard to manage and do not get on well in an ordinary school. Truancy, among them, is very com- mon. Soon they fall behind their class and are a hindrance to the education of others. It is not uncommon to find that they are children 28 James C. Hassall of parents who are themselves slightly abnormal, or who are unable to care properly for their offspring. The result is that the children do not receive the care and training necessary to save them from their fate. Ill treatment and lack of supervision are often the cause of the child's running away from home. These 'fugues' are a common manifestation of the psychopathic constitu- tion. On account of their thieving, their tendency to viciousness and to running away, they frequently come under the hand of the law, or are brought to the physician by parents for advice as to their care. The following cases, which it is hoped, will be of value as examples of the psychopathic constitution, are taken from several which came under the hand of the law and which were committed to the Government Hospital for the Insane for examination, observation and subsequent recommendation to the Juvenile Court. Case I. P. M. White, male, age 14. Family history was negative regarding alcoholism, nervous diseases or insanity. He is the oldest of seven children. Birth was difficult and delivery was instrumental. There was slight injury at that time to the left side of the skull. He was bottle fed, his mother being unable to care for him on account of illness. As a young child, he was extremely nervous; sleep was induced with difficulty and the slightest sound would startle him so that he would jump out of bed. Since infancy, he has been of a highly nervous temperament. He suffered the usual childhood diseases and made good recoveries. He never played much with other boys, being fearful of getting hurt. He began school at six; never applied himself diligent- ly to the usual studies but was fond of music and draw- ing. During his stay in the fifth grade, he did not like his teacher, who stated that he was backward in his work solely because he would not apply himself. Fre- quently he played truant and on account of this he was away from school about one month during the year. While in the sixth grade he left school to go to work. Constitutional Psychopathy in Children 29 He first came in conflict with the law by assaulting a smaller boy for which he appears to have had more or less provocation. Later he was arrested for knocking down a girl six years old. One evening he attended a performance at a low grade theatre and with several other boys he awaited the troupe at the stage entrance. He accosted one of the women and accompanied her home, where he was seduced. Following this experience, he twice visited houses of prostitution. His mother once found in his pocket a very obscene note from a girl at school, inviting a visit from the boy. Intercourse with this girl was denied by the patient. On one occasion he left home and spent the night in a hotel in the city. For this he would give no reason. The patient appeared before the Juvenile Court for the third time by having been arrested while trying to sell a suit of clothing belonging to his father, in order to obtain enough money to run away from home to go to a distant city to work. Mental examination of the boy showed him to be bright and alert, and well oriented. No hallucinations or delusions were present. The result of the Binet- Simon tests showed his age to be 12 plus years. He read and understood difficult passages and impressed one as being of normal intellect. He denied the sexual irregu- larities as given in the history obtained from his mother. Physical examination was negative. He was well develop- ed and showed no abnormalities or stigmata of degenera- tion. Wassermann reaction with the blood serum was negative. During his stay in the hospital he was con- tinually in trouble with other patients and bullied the younger juvenile cases on the ward. At times he was impudent and refused to do as he was told. He diso- beyed rules by smoking cigarettes and by cursing the other patients and frequently it was necessary to censure him. Case II. A. S. White, male, age 14. History of grandparents negative concerning alcoholism, mental or nervous diseases. Father is an inmate of the Government Hospital for the Insane, suffering from a deteriorating 30 James C. Hassail psychosis. Mother is of a nervous temperament and appears to be hysterical at times. He is the third child of his parents. Birth was normal, and as a child he was very healthy. He made good recoveries from the diseases from which he suffered in childhood. He was always obstinate and "hardheaded" and never cared for the association of his mother and sisters. He began school at the age of six, attending parochial schools until the present time. He has always learned rapidly and has been a favorite among his teachers. At the age of five he began stealing money from home. This has continued and every year amounted to the sum of several dollars. He always spent the money, sharing it usually with other boys. His mother's first knowledge of his thieving was when he was twelve years old. He stole a large sum of money from her and gave it to another boy. The same year he stole money from her again and went to a distant city, returning willingly with his mother when she went for him. At thirteen he again left home and spent three weeks at a seaside resort. He would not state where he obtained the money for this trip. He returned willingly when funds were sent by his mother. During the present year he entered a home and stole several rings. These were returned to their owner by his mother. Ten days later in company with another boy he was arrested while stealing a slot machine from a store. This led to his appearance before the court. During his life he has always been easily excited and at such times he has bitten his finger nails until his fingers bled. He denied all sexual habits, although he gave the impression of not being sincere in his answers to question- ing along this line. He has had many fantastic dreams during his waking hours. He would imagine himself a millionaire, and has pictured himself the owner of auto- mobiles, houses, etc. He denied the association with a female in any of his phantasies. Mental examination showed him to be accurately oriented and emotionally indifferent. No psychotic symp- toms were present The Binet-Simon tests showed him Constitutional Psychopathy in Children 31 to be of normal mental capacity for his age. Physical examination revealed no abnormality. Wassermann reaction with the blood serum negative. During his stay in the hospital this patient conducted himself fairly well though occasionally he annoyed the other patients and violated the rules in various ways. At times he appeared emotional, especially when questioned regarding his misconduct and on two occasions he became lacrimose. Case III. S. M. White, male, age 14. History of grandparents negative. Father has used alcoholic liquors to excess for many years. On this account he was unable to hold any position for a great length of time. He was once arrested for disorderly conduct. When sober he was capable of earning a very good salary. He finally left his family on account of drunkenness. His mother is fairly well educated, gentle and refined. The patient is the sixth child. One brother was reckless and diso- bedient until be became of age. One sister left home following her mother's objection to her accepting the attentions of several men. She is now believed by the family to be living an immoral life. One son left home and has not been heard from for several years. Patient was healthy until two when he had a bad attack of measles. At three he suffered "brain fever (?). As he grew he became peevish, hard to please and irritable. On this account he was humored by his mother. He began school at seven, at nine he was away from school for sometime with pneumonia. He did not attend regularly and made poor progress. He would magnify slight ail- ments so that he could remain at home. While in school he was mischievous and disobedient and was often punish- ed. He was finally expelled from school, his teacher having said that he was so bad she could do nothing with him. He stole children's lunches, books, pencils, etc., and teased them in every way he could. He was very rude and impolite to his teacher. His mother tried keeping him at home for a time. He would not obey her and when corrected would run away from home, remaining 32 James C. Hassall away for several days, his mother having no knowledge of his whereabouts. Often he would return home with small amounts of money, saying that he had earned it selling papers, though in reality it was obtained by selling articles which he had stolen. After a time at home, he was sent to another school which he attended for five months, receiving good reports daily. One day he was taken home by an officer who accused the patient of having stolen some fruit from a stand. In April, 1913, he was arrested for beating and dragging a smaller boy across the street. He was placed on probation by the court to which he reported each week. During this time he continued to do bad things; he stole and smoked cigarettes. Several times he was found stealing and committing offenses but for these he was never arrested. His next appearance before the court was caused by his being found in a store stealing candy. He was later arrested for having stolen a purse and two small articles from an office and was committed to the Government Hospital for the Insane for examination. He would frequently lie, especially when questioned about his thieving. Mental examination elicited no psychotic symptoms. The Binet-Simon tests showed him to have a mental age of 12 plus years. Except for outstanding ears, prominent abdomen and a marked flat foot, patient's physical examination was negative. Wassermann reaction with the blood serum was negative. During his short stay in the hospital, his conduct was not good. He was very nervous and active and always inclined to annoy other patients. At times he was stubborn, cross, noisy and disagreeable, and it was necessary to censure him. Case IV. B. R. White, female, age 16. Patient's paternal grandfather goes on regular sprees every two or three weeks. One paternal uncle was insane, and was confined in an institution. One maternal uncle was considered erratic. Father uses alcohol to excess and is possessed of a violent temper. Mother is well and her habits are good. Patient was the only child. Birth was uneventful; she was backward in learning to walk. Made Constitutional Psychopathy in Children 33 good recoveries from the childhood diseases, from which she suffered. Began school at ten, made rapid progress until she reached the eighth grade, in 1911, when she eloped with a young man whom she married. To do this she misstated her age. She lived with her husband for two weeks. She then visited an aunt for several days. When she returned to her apartments, her husband had left. Returning to her parents she lived with them for a few months. She then entered a school for girls some distance from her home. After a few months here, during which she applied herself very well, she eloped and returned home and obtained employment in a store where she remained two weeks. She then met a young man and was away from home with him for nineteen days. When met accidentally on the street by her parents, she willingly returned home but continued to elope whenever the opportunity presented itself. The last time she eloped was with two young men who took her to a house of prostitution where she remained for two days. When found there by her parents she showed no evidence of shame, seemed unconcerned and returned willingly with them. The next day she was taken before the court and subsequently admitted to this hospital. Physical examination was negative. Wassermann reaction with the blood serum was negative. Mental examination revealed no hallucinations or delusions. Her responses to the usual intelligence tests were good and there was no mental impairment. Throughout the ex- amination she did not appear particularly interested; frequently she spoke of things of greater importance to her, drummed on the table and hummed tunes. She told of her past experiences willingly and showed no shame or remorse for her actions. During her stay in the hospi- tal she conducted herself well, except on the occasion of a visit from her mother, when she became much excited, abused her mother and called her various improper names. It is seen that these children are not intellectually defective and have shown no psychotic symptoms. Yet they are abnormal and because of their abnormality 34 James C. Hassall they have come into conflict with their environment. The important question in connection with such children is that of their recognition and their training. Parents should be taught to seek the physician for advice regarding their children who show an early tenden- cy to incorrigibility, theft, truancy, or to running away from home. Teachers should be on their guard and should report to proper authorities for medical examination, chil- dren who show the above tendencies and all juvenile delin- quents seen by the court should have their mental status determined. The early recognition of such types in the school should lead, as with the intellectually defective, to the separation of them from the great mass and to the placing of them in the best institution available. It is an interesting and withal a difficult problem to care for such children and with our present knowledge we cannot offer a full and complete solution of it. In the past, it has been the custom to send these children, when detected in misdemeanors, to penitentiaries or reform schools with the hope of making useful citizens of them. This form of treatment has largely failed. There is no doubt but that the majority of these people in reforma- tories and penitentiaries could have been spared their crimes against society and their sad fate if proper treat- ment had been instituted early enough. As no public provision is made for the care of such children they are most frequently left to their fate. They cannot be cared for in an institution for the insane for they show no frank psychosis. They are mischievous and hard to manage and annoy the other patients. Here, too, they would rapidly deteriorate. An institution for feeble-minded is also not to be considered. These children are not weak minded for examination shows them to be of average intelligence. Their emotion, not their intellect. is defective. With their superior intellect they would instigate all sorts of mischief among their weaker associates. Many of these children have not proper parental care, so there remains the possibility of placing the child in Constitutional Psychopathy in Children 35 another family. The difficulty met with here is to find a home for such a child for most people would not undertake the responsibility of caring for an abnormal individual. At present we are met with the bare fact—these children must remain uninstructed. They cannot get along in the ordinary schools and special instruction is necessary. They soon fall behind their class and are a hindrance to the education of others. Because of their tendency to disobedience, theft, and truancy, it is fre- quently necessary that they be expelled from school. The boarding school where children receive more individual instruction may be of help to some of these cases, but they are in need of training entirely different from that of the normal child with whom they are thrown in contact. The discipline which is proper for the normal child is not proper for the psychopath and he reacts to it with great obstinacy and frequently with an increase of the psychopathic symptoms. There is need of a special school or institution where such children could be given the proper care and super- vision. When the presence of the psychopathic constitu- tion has been determined, the child should be committed to the institution where he should receive a special medical examination. Then considering his individuality, a special plan of treatment should be devised. Each child should be given individual training and uninterrupt- ed oversight until all symptoms of the psychopathic constitution have disappeared. The length of residence in such a school should be determined by the severity of the psychopathic symptoms. Such problems as are herein presented are pressing for an answer in the general effort to build up the race. Many earnest workers are busying themselves with them and it is hoped that a continued interest will lead to a clearer understanding of the psychopathic constitution and a minimization of the number of failures traceable to it. DEVOTIONAL AND AGNOSTIC PARANOIA. Paranoiac Egoistic Psychic Erethism with Reference to the Canadian Dukhobortsi. Dukhobortsic and Scorn Insanities. By C. H. Hughes, M. D., Retired Dean of Medical Faculties, ex-Prof. Psychiatry, ex-Supt. State Hospital for Insane, Ed. A. and N., etc., etc., etc. St. Louis. AMONG the unstably neuroned, even outside of the asylums, this phase of morbid mental display is common, especially in insanity of the religious emotional type, both in its really devotional and perverse and antagonistic or agnostic forms. The following illustration and text immediately be- low, of him that "sitteth in the seat of the scorner" and likewise "writeth," may serve to show two contrasting forms of the unstable psychic neurone as they manifest themselves to the discerning alienist in two unique forms of mental aberration. Neither of these illustrations show mentally whole and normal character, although the world may consider them sane, because they seem to know what they are about and perhaps to recognize right from wrong in a legal sense. Both illustrations need the care of the alienist physician, at least for the probably plainly paranoiac leaders, for paranoiac leaders may have sane but illogically reasoning adherents as dupes or rather idiotic followers who (36) Devotional and Agnostic Paranoia. 37 can not draw the true lines between sophistic representa- tion and true logical showing. To be acquiescent and imitate others' folly is not necessarily to be insane. "The Dukhobortsi are a fanatical Russian sect founded in the early part of the eighteenth century by a soldier named Procope Loupkin, who pretended to make known the true spirit of Christianity, then long lost. "They have no stated places of worship, observe no holy days, reject the use of images and all rites and cere- monies, have no ordained clergy, and do not acknowledge the divinity of Christ or the authority of the Scriptures, to which they give, in so far as they accept them, a mystical interpretation. Owing to their murders and cruelties, they were removed to the Caucasus in 1841 and subsequent years; they now form a community there of seven villages."—(Century Dictionary.) Further light may be found on the origin of this word by referring to the word in this and other sources. This illustration of this peculiar paranoiac religious sect represents a number thereof, nude, in cold weather, marching together in Northern Canada, before the Cana- dian police interfered in behalf of civilization, normal modesty and their sanitary welfare. It is probable that if Procope Lupkin, the founder of the Dukhobortsi, had been timely subjected to suitable sanitary treatment, including proper and timely emesis and catharsis, right food and sleep and he had come of a stable neurotic heritage, his delusion would not have developed and he would not have misled others. Disease, like toxemia, may develop an insane sophistry; sophistry is morbid delusion when induced by brain disease and delusion, as well as truth, leads people, the former misleading them. Ptomains may breed insanity. They make toxemia. This illustration had been printed on the reverse side of the card, and sent out with it as an advertisement was the following egoistic, perverse, impious and bizarre epistle of a Canadian photographer in business in a Christian and ordinarily reverent community. 38 C. H. Hughes. Muskeg Philosophy (The Lord's Prayer as Paraphrased by Our Father who art everywhere, hallowed be thy maint': thy kingdom, come, thy will in joue on earth as it is in other places. Give us this day our daily 1,1-ead and pray see that we do not have to work too d——d hard for it. Forgive us our tiespasses as we forgive the son of a biscuit who inter- feres with our hobbies or treads upon our corus. Reulove out of the world, we praw thee, temptation and evil, th’ī; we can not get into theni. 1;ºr will thºu be put to the great trouble of delivering us from then, and in other ways keep us from butting against anything hard so we can go through this world a pack of weaklings and cowards: for thºu unt the greatest thing on earth or elsewhere for nught we know. Do all this iſ it pieuseth thee and it will please at least ONE of your own making.—Auley, and again A intº. “Photo by seen everywhere Sunil. iii:ies he's kei e and sometime. tº: in the ºth ye ºr of his age. Both the pictured and the portrayer are sailing in the same unstable neurotic boat and are liable to fall overboard at any time further on into the sea of surely and generally recognized insanity, though neither would consider himself insane. I once asked a manic depressive at the Fulton, Mo. Insane Asylum what he thought of a certain paranoiac with high ideal delusions of his own religious perfection and the answer was, “O! He is a d- fool” and the paranoiac opinion of the first one interrogated was that “the other had no sense.” Morbid egoism caused the variant answers respecting each, of the other. In asylums for the insane it is not uncommon for certain inmates to thus concede the manifest insanity of the others while vehemently denying their own mental affliction and they may even believe the entire world is insane concerning themselves. This record illustrates the fact that insane persons, oblivious to their own insanity, often readily recognize the insanity of others. In fact the insane often regard everybody about them as insane but themselves. Dukhobors LookING For CHRIST IN CANADA IN WINTER. “Photo by the undersigned, author of Muskeg Philosophy, whose philosophy here follows in parenthesis." Devotional and Agnostic Paranoia. 39 The picture in the context above, was mailed to the present writer by the author of the above recorded paranoiacally paraphrased Lord's prayer. Interrogating patients at a hospital for the insane, one may hear a paranoiac, securely credible, but uncon- scious of his own undoubted dominating delusion, say the other inmates are fools, sometimes with profane emphasis. The author has often noted this, as likewise have most clinical psychiaters. Such insane persons, especially of the paranoiac, paranoid and melancholic type, often make an impression of sanity and unjust restraint upon visitors and before juries and courts and may even sometimes deceive the elect expert in psychiatry, especially if he has not sufficient clinical experience in psychiatry to cause him to watch and wait before deciding, that is, if he has not lived with the insane, visited them sufficiently often to fully understand them in their various moods and actions. THE PIONEER FOUNDER OF AMERICA'S INEBRIATE STATE HOSPITAL. Memorial Address on Dr. Turner's Life and Work. By T. D. Crothers, M. D., Supt. Walnut Lodge Hospital, Hartford, Connecticut. Amemorial study of the life and work of Dr. Turner may be compared literally, to that of a picket far out beyond the great army of science, marking out paths, and clearing the way for the advancing hosts to follow. These pioneer pickets are not recognized in their day and generation. Their work is criticised, condemned and misrepresented. Later when the army of advance moves up and on, they are recognized as the great bene- factors and leaders. My purpose in this address is to briefly summarize the main facts of his history, and follow it with some detailed studies of his particular work and its results. Joseph Edward Turner was born in Bath, Maine, Oct. 5th, 1822. His ancestors came to this country in 1641. His father was one of the first settlers in that town and was a shipbuilder and farmer. His mother was born in Ipswich, Mass. He began life as a clerk, studied medicine, was licensed to practice, opened an office in Trenton, New Jersey, about 1841. Soon after he became possessed with the idea of found- ing an inebriate asylum, and gave up his work for that purpose. He made three visits to Europe during the next eight years in the interest of this cause. In 1852 he presented a large petition for a charter to build an inebri- ate asylum in the New York Legislature. Two years later this charter was granted, and a (40) Dr. Turner's Life and Work. 41 stock company organized, called the United States Inebriate Asylum Company, of which he was general manager and treasurer. In 1856 and 57 he secured large petitions to the Legislature of New York for the appropriation for 10% of the excise money to the institution. In 1858 the city of Binghamton, New York, donated 250 acres of land for this purpose, and the same year the corner stone of the asylum was laid. In 1862 Dr. Turner married Miss Gertrude, the daughter of Col. Middlebrook, one of the oldest and most respected citizens of Wilton, Conn. In 1864 the institution was opened for the reception of patients and Dr. Turner was made Superintendent. In 1867 he resigned and spent several years securing new subscriptions for the completion of the building, and assignment of the original stock. In 1874 he pro- jected the Woman's National Hospital at Wilton, Conn., and in 1881 a charter was granted by the state of Conn., and the same year the ground was broken for the erection of a building. Three years later the charter was repealed, and in 1888 he issued a volume called "The History of the First Inebriate Asylum in the World." The next year in 1889 he died at his home in Wilton, Conn. During this period of 47 years his entire time was occupied in the promotion and development of institu- tions for the medical care of inebriates. He traveled continuously, calling on prominent men, securing their names to petitions, begging material for the building, and planning to perfect the asylum at Binghamton and build one at Wilton, Conn. It was an incessant preaching and teaching the doctrine that inebriety was a disease and curable in organized institutions, built for that specific purpose. This most remarkable man and his work can be better understood by dividing our historic study under various topics. First: The Man and His Personality. Dr. Turner was a man of medium height, compactly 42 T. D. Crothers. built, with a well formed head, clear cut features and a sharp kindly eye. His manner was intense, sympathetic and attractive. His language was clear, decisive and the words used were accurate and suggestive. His illustrations were apt and graphic, and his opinions and observations on matters outside of the great theme of his life showed wide reasoning, excellent judgment, and clear recogni- tion of men and events. He dressed neatly and had a decided business and professional air, and showed an interest in every subject and person he came in contact with. In the early part of his career he was critical and sharp in his judgment of men and events, but never severe or harsh. Later he became broader and more charitable in his views and opinions. There was a certain self-confidence and poise in his manner and calm reserve that was not disturbed by outer conditions, and gave the impression of a man of power and force. He would have succeeded in any position in life, or in any business, and his intense earnestness and ability to adapt himself to all the conditions around him would have brought him into prominence as a leader. His manner was dignified, sympathetic and intense. He could reach the level of any person into whose com- pany he was thrown. In the presentation of the great purposes of his life he was simply overwhelming, not only in suggestion, but with a flood of arguments, facts and illustrations which were convincing. There was a certain magnetism about the way in which he presented the facts which grew with every experience, and very few persons could listen to him without being impressed with their reality. As a preacher this personality would have attracted crowded audiences. As an advocate in courts of law and before a jury he would have forced conviction with every statement of facts, and as a doctor he would have been an ideal man and the center of a large admiring circle. Dr. Turner's Life and Work. 43 Unreasoning men judged that this impulsive im- petuosity was mercenary, but a closer acquaintance showed the delicate generosity and kindly spirit of a great mind, trying to overcome the confusion and doubts, and make the facts clear for their sake, and not for any ulterior purpose. The great central thought of his life was to teach the world that the inebriate was diseased and could be cured. He did not repel the moralist who thought the malady was moral, and could be cured by conversion and pledges, but he urged a higher view, and a recognition that the physical conditions and surroundings of the inebriate should be changed and improved, and the poisons from which he was suffering should be removed, and then the moral and spiritual remedies could be applied together with physical agents that would bring about restoration. He was repeatedly asked to take part in reform work, and his answer was restore the body, correct the surround- ings, and then reform work will be natural and real, because the soil on which it must grow has been cultivated. This idea of physical care and treatment filled his entire waking thoughts, and the dream of his life was an institution where this work could be carried out. The obstacles which he encountered only intensified his ambitions and gave him greater energy and determina- tion. Having built the asylum at Bingham ton and failed to retain control he saw the possibility of building another on a grander scale, and this idea possessed him almost to the verge of infatuation. The Origin and Growth of the Purposes of his Life is of great interest and is a repetition of what has been the history of the great pioneers in every advance of science. Whenever a great truth comes up on the horizon of the world's progress someone appears to teach its practical relation and incorporate it with the evolutionary march of the race. Someone is always raised up to be a leader and 44 T. D. Crothers. teacher when the hour comes, and the facts dawn on the advanced movement of civilization. Over 2000 years ago Ulpian, the great Roman Jurist, urged that inebriety was a disease and should be treated in hospitals, the same as insanity or other illness. From that time down to 1790 the idea was repeated at long intervals, but made no impression. At this time Cabannis a French philosopher, elaborated this subject at some length, and published it widely. In 1798 and 1809 Dr. Benj. Rush of Philadelphia, repeated this idea in several articles and books, urging that it was the only solution of the great drink problem. In 1830 when Dr. Turner was only 8 years old, Dr. Eli Todd of the Hartford Insane Asylum read a paper before the State Medical Society, urging the State to recognize the disease of inebriety and provide special institution for its care. This paper was widely scattered. Ten years later a student of Dr. Todd's, Dr. Woodard of Worcester, wrote a paper on the same subject, which was very widely circulated. These papers were condemned as impractical, chimerical and attracted little or no attention. In all probability Dr. Turner in his early student life came across copies of these papers, and any previous convictions he had were stimulated and intensified by them. In later life he said that as a boy he was called to take care of his uncle suffering from an attack of delirium tremens, and the impression he received at that time was that inebriety was a disease and must be treated in hospitals the same as other diseases. He referred to another incident in which a warm personal friend under the influence of spirits attempted to do violence to him, and a few hours afterwards re- covered, and had no recollection of his conduct or words. This experience no doubt deepened his previous impressions and convinced him that a new field for the medical treatment of these maladies must be revealed to the world and brought into practical service. In 1840 the Washingtonian Movement began and Dr. Turner's Life and Work. 45 was a great pledge signing crusade which swept over the country. It was estimated that over 5,000,000 persons signed the total abstinence pledge in the course of a few years. Practical men realized that something more than pledges were needed, and so lodging houses were opened by the Washingtonian Clubs to take care of the poor victims and protect them until they could secure a degree of restoration. There can be no doubt that this movement was watched with great intensity by Dr. Turner, who saw its significance and realized that it indicated the recognition of the physical nature of the disorder and the coming of inebriate asylums and hospitals where they could be housed and cured. This thought found abundant confirmation in the penal treatment by the courts, and in the hospital treat- ment of the more chronic cases, and grew to be a positive conviction, sustained by evidence from every side. The Work and its Results showed that Dr. Turner realized that the idea of an institution must be based on data secured by circulars and was not a matter of opinions, also that the public must be impressed by figures and statistics that would admit of no other interpretation. Evidently the first work he did was to send out circular letters to physicians, superintendents of insane asylums, prison authorities and others, asking for statistics and opinions concerning the causes and conditions of inebriety, and asking suggestions of what could be used most practically in the matter of cure. He followed these by personal visits and interviews. In all probability the answers were unsatisfactory, and the cold contempt which greeted him, and indifference showed that the world was not prepared to take up this subject. He probably realized that American medical men were dominated by teachings and opinions of physicians of Great Britain and on the Continent, and anything 46 T. D. Crothers. endorsed by foreign authorities would receive the greatest of respect and attention here. Curiously enough this idea prevailed for more than half a century, but laterly within the last 20 years the reverse is coming into prominence. This was the purpose of his early visit to London and the Continent sometime about 1841 or 42. He spent his time in visiting hospitals, calling on leading men, securing statistics and soliciting their interest and sympathy to have inebriety called a disease and to urge its treatment in hospitals. He brought back with him a large number of letters, all expressing an interest in the subject, but in so con- servative a tone as to be of little or no value. No doubt these letters aided him in influencing the leaders in the profession of this country. At least they secured respect- ful attention, but beyond this little of anything was secured. In 1848 he went abroad again. His visits were practically for the same purpose and extended to many of the large hospitals of the Continent. In 1850 he made another visit to the Continent, bringing back about the same kind of personal endorsement and letters of sympa- thy. In the meantime he had kept up circular inquiries, writing and calling on different persons, soliciting their opinions and names on statements as to what was con- sidered the best plans to promote this work. About 1849 he began a petition for the organization of an institution which was circulated among business and professional men for signatures, and this grew rapidly. The next year it was merged into a stock company, and in the course of a year 140 persons agreed to form a stock company paying $10.00 a share for the purpose of organizing and building an institution. Later another petition was signed by several thousand persons and was presented to the New York Legislature asking for a charter for a company called the United States Inebriate Asylum Company. Dr. Turner's Life and Work. 47 This petition was opposed and put over. Two years later, in 1852, a charter was granted and the company formed and Dr. Turner was made Treasurer and Manag- ing Director. In the name of this company Dr. Turner solicited do- nations of land for the building and by incessant personal effort succeeded in having the city of Binghamton give 250 acres of land for a hospital in the neighborhood bf that city. The ground was broken for the building in the year 1858. In the meantime the board of directors who were very eminent men, and actively engaged in their private duties, were unable to do much more than give their names and influence to help on the work, hence the burden fell on Dr. Turner, who traveled continuously soliciting sub- scriptions of money and material for the building, securing names to petitions, and influencing the legislatures, and in every way promoting the cause generally. It was thought best to change the name to The New York State Inebriate Asylum and have laws passed regu- lating the commitment of cases and placing it on a par with other institutions. This was secured by Dr. Turner ably, assisted by Dr. Valentine Mott, one of the greatest surgeons in America, who was President of the board of directors. A monster petition was secured asking the legislature to give 1/10 of the excise money for the purpose of build- ing and maintaining the asylum. This petition received only one vote in the first session when presented. The next year it passed by an overwhelming majority. This was due to Dr. Turner's personal efforts, visiting every prominent politician and securing the influence of their constituents and endorsement. It was a work that required nearly two years of tremendous effort. In the meantime Dr. Turner drew the plans for the building at Binghamton and began its erection under his personal care and supervision. He hired the contractors and workmen and secured donations of building material and money, and carried on the work with an energy and enthusiasm that was contagious. 48 T. D. Crothers. During all this time he secured a petition, signed by over 1500 physicians, 60 leading judges, 600 prominent lawyers and over 5000 business men, asserting the need of such a hospital, and begging the legislature and private individuals and the public generally, to sustain it in every possible way. This attracted a great deal of attention, and was published in the large dailies. Many of the religious papers opposed it very bitterly, and considered the entire effort an infidel one, to dignify vice and excuse the drunkard, and give sympathy where it did not belong. The more conservative men agreed that it was wise to make the experiment, and withhold judgment until it had been tested. The facts were new and the opposition to their acceptance was intense, and the board of directors as well as Dr. Turner himself received large numbers of letters protesting against the effort. The struggle was to overcome this opposition by letters, personal appeals, visits, statistical evidence, and wherever Dr. Turner went his earnest and enthusiastic presentation of the facts made converts and friends. The building was projected on a palace-like scale and built in the most substantial artistic way, and there were no debts, the activity of the building depending on the contribution, and finally in 1864, it was so far completed as to be open for the reception of patients. It was intended to accommodate 300 persons, and was to be equipped with elaborate Turkish and Roman baths, together with a chapel for religious services, and a stage for dramatic and literary entertainments. Workshops, hot houses, gardens and large fields for the cultivation of plants and raising of produce required for the needs of the institution, made it one of the most complete asylums erected at that time. No patient could be received for less than six months, and military discipline and medical care was to be kept up constantly, and each patient was to be treated as sick, Dr. Turner's Life and Work. 49 diseased and requiring the best methods and means of physical restoration. The opening of the institution brought a large number of incurable inebriates from the wealthy and influential families of the country, and after the first glamor was over, and they had become somewhat restored, they began to rebel against restraint, the methods of management. Then they appealed to their friends to help them, giving most exaggerated accounts of the superintendent and management. Intrigues of all kinds and efforts to embarrass and to complicate the work was poured in upon the management and board of directors. It was the experimental stage of a new work, and the public thought that the opinions of patients were entitled to consideration and should be consulted. Dr. Turner was emphatic in his convictions of what should be done, and the board of management were weak and vacillating. Several of them were intensely selfish and grasping, and tried to make the institution serve their own mercenary ends. For the next three years a series of the most bitter recriminations between the board of managers and Dr. Turner and the friends of patients who sided with both parties in the controversy continued, to the injury of the institution and its work. Finally these differences became irreconcilable and Dr. Turner resigned to save the work, and give his opponents an opportunity to carry on the work according to their plans. There was a marvelous generosity in this, that after having planned and built the institution and marked out its future, and then because the managers failed to sustain his plans, and interposed all sorts of obstacles he gave it up, rather than have the work destroyed. On withdrawing from the active work in the institu- tion, he began to secure subscriptions to enlarge and perfect it, and receive assignments of the original stock- holders, so as to have the building reinstated and placed under his direct care again. 50 T. D. Crothers. During the next six years he visited every prominent man in the country, many of them over and over again, soliciting stock and subscriptions and explaining the plans and methods of the hospital at Binghamton. Over 95% of the original stock of the company was transferred to him, making him the legal owner of the institution, and the lists of subscribers had increased until it embraced many of the most intellectual men in the country. The managers had turned the institution over to the State of New York without the assignment of the original stockholders and when Dr. Turner had secured these assignments to him, he began a suit against the State of New York, for the restoration of the institution to its legal owners. The management realizing that if this suit was pressed they would be turned out, and their methods of control would be the subject of scrutiny, and very likely destruc- tive to their reputations, hence to prevent this they kept up a persistent persecution of slanders against Dr. Turner and his work, using the press wherever they could, to destroy his influence. Realizing that his claim would be opposed, and that years would pass before a final settlement could be accomplished, he projected a Woman's National Hospital to be built at Wilton, Conn., along the same lines as Binghamton. With a subscription book he started out as before, personally visiting prominent men in all parts of the country, soliciting subscriptions and material and money and exhibiting plans for the new building. Notwithstanding the bitter criticism that followed him wherever he went he secured the largest personal endorsement, and subscription list of names of leading men that had ever been given to any institution, except that of Binghamton. In 1881 a charter was secured from the Legislature of Connecticut. The citizens of Wilton and neighboring towns promised liberal contributions, and a board of personal Dr. Turner's Life and Work. 51 friends was gathered to second his efforts. The ground was broken for the new building in October in 1881, with appropriate services. The plan of the asylum was spacious and artistic, and was drawn up under the direction of a famous architect, and in all probability was superior to that of any other institution. The following four years were occupied in the same intense work which had characterized his earlier efforts, namely, soliciting money and material, and perfecting the plans for the endowment of a new building. Suddenly the Legislature of Connecticut repealed the charter for the institution, and the same old persecution which had followed him from Binghamton was apparent in the wide-spread efforts to advertise the fact that the charter had been repealed, and bring out the doubtful character of the founder. After the first shock of disappointment new plans were formed, and arrangements for a stock company, and a continuation of the building was perfected. Like the elder Napoleon he never recognized defeat, and while driven back and forced to take a new course, his interest and determination were increased. It was then that he determined to write the History of the First Inebriate Asylum in the World, giving an account of the difficulties and trials, and including in it the opposition to the Wilton hospital. This book was published in a volume of 500 pages and is most pathetic in its account of the battles and struggles which he passed through. With this book as evidence he started out with more enthusiasm and energy than ever, soliciting donations and rousing interest everywhere. His plans matured; capitalists rallied about him and material aid was offered, and he was on the merge of putting it into practical materialization, when suddenly the grim archer appeared and he was called away. The week before his death several important inter- views had been arranged, and as he said, he was nearer' 52 T. D. Crothers. the consummation of his life purpose than ever before. Some of the Difficulties Which He Encountered. The idea that an inebriate was diseased and cou d be cured by physical means in an institution was startling to the world fifty years ago. It appeared to be contra- dicted by personal experience, and the various assertions of the victims themselves. To the religious world it was rank heresy and infi- delity. To the medical world it was quackish, and to the business world it was absurd. Although the idea had been mentioned long before, it had been repelled as un- worthy of the slightest consideration. Dr. Turner, as its advocate, was unknown, a young man, with nothing but enthusiasm to support his claims. Huxley said that every advance in scientific truth is rejected by authorities, because it envolves change and putting aside previous conceptions. It was a most startling presumption from a practical point of view for a young, unknown man to throw his whole life into a tremendous effort to make the idea of disease and curability in asylums practical, and have it accepted by the world, but he was a hero in the largest sense of the word, and after years of most incessant effort his teaching took form and shape in a palace-like building at Binghamton, and was opened for a practical demonstration of the truth of his ideal. Then another great obstacle concentrated in the institution. The work was new, and there was no ex- perience or prestige to follow. Dr. Turner laid down a system of management, which 50 years later has been proven to be correct and thoroughly scientific, but at that time was denied and contradicted. The genius of Dr. Turner in outlining and attempting to carry out at that early day a plan of treatment so complete in all its details is simply astonishing to us at this time. The board of managers and the patients became the great obstacle to the growth of the institution. They assumed that Dr. Turner's medical knowledge was Dr. Turner's Life and Work. 63 incompetent to personally care for such patients. While granting that he had great genius in the organization and building of the institution, they demanded that the institution should be conducted along lines of their own judgment. Dr. Turner was neither a politician nor diplomat, but he saw clearly that they were incompetent and with- out knowledge and refused to yield. Then the storm broke. Dishonest intriguers, wilful blunderers, personal selfish- ness gathered and drifted over the work of the institution, and Dr. Turner was practically driven out. The difficulties were greater than ever he had en- countered before. Public sentiment could not be con- trolled. Political methods and schemes covered up all his advanced views, and a great Bull Run defeat took place when he left the institution. Had the board united with him in his far-seeing plans the great obstacles would have been overcome, and a great ideal establishment would have grown up. Curiously enough the opposition and persecution kept public attention drawn to the work, and the fight over Binghamton asylum stimulated an army of observers everywhere, to put into practice, and test the correctness of the theories that were denied and advocated. The result was that fully 50 institutions were estab- lished in this country and Europe, all based on the ideals urged by Dr. Turner at Binghamton. This opposition turned into persecution which at the time seemed fierce and cruel, but later it was found to be the most significant endorsement of the man and his work. When Talyrand was asked how a new religion could be introduced into the world he said: "Have the promoter of it crucified and hanged as an impostor." The asylum at Binghamton went down thirteen years after Dr. Turner left it, in a fogbank of political dishonesty and incompetent management, but it proved to the world the great fact, that inebriety was a disease and curable, 54 T. D. Crothers. although its demonstration was along entirely different lines, unknown by the management. Institutions for the care of inebriates are still beset with difficulties. The armies of incurables bring problems that tax the greatest skill and energy to solve. The quacks with their miraculous means and measures complicate the conditions, but each year brings into greater prominence the almost prophetic judgment of Dr. Turner. The intensity of the personal persecution which follow- ed him from Binghamton asylum and sought in every way to cripple and destroy his efforts is difficult to understand. While it repeats much of the history of the advances in the past, it is startling to think that men of intelli- gence should lend themselves to destroy and break down what they cannot understand. Dr. Turner saw that notwithstanding the obstacles and the apparent failure of the institution at Binghamton, the great ideals of his life had materialized and been incorporated into the great working truths of the world. Then came the ambition to build up another institution on a broader basis with more certainty. His effort to get control of the stock of the institu- tion kept alive most vindictive slandering. Hence Dr. Turner preferred to work alone and to go on quietly with his plans and efforts. Influential friends offered from time to time to assist him, but this would bring promi- nence to his work which he wished to avoid, until his work was matured, beyond the power of misrepresentation. Curiously enough a representative of the town of Wilton and another man in a neighboring town were found to lend their influence and become active agents to continue this persecution. When these facts were brought to the Governor of the State, he offered personally to lead in a stock company and have the charter renewed, and give of his time and substance to correct this mistake. Had Dr. Turner lived, the State of Connecticut would have renewed the charter and given substantial aid to a most magnificent hospital here in Wilton. There Dr. Turner's Life and Work. 55 is something very heroic in the endurance displayed in overcoming these obstacles, and the marvelous faith that went on undaunted no matter what the difficulties were. It was the spirit of the old martyrs who felt the breath of the upper air of progress, upholding them through all the difficulties from trials that compassed them. The Genius of Dr. Turner This was very evident in the bare fact of a young man, unknown with limited training and acquaintance with the world, becoming possessed with the idea of introducing a great new truth, and developing it. Those who knew him personally realized the inspiration and genius of his entire life. There was a superior outlook and daring energy which pressed the thought with a positiveness that could not be mistaken. To strangers there was something mysterious in the loftiness of his mental ambition and purposes, which was interpreted in various ways according to the discernment of the person. His genius was evident early in the monster petitions for the building of the institution, signed by eminent men, including two Presidents of the United States. The hearty endorsement of his plans and appeals . to the legislatures creating public sympathy and educating public sentiment despite the most adverse opinions was genius of the highest grade. Obstacles made no impression, except to rather in- crease his energy, and his whole life was one continuous journey without halting, changing or retrograde movements. When he became Superintendent of the Inebriate Asylum and his personal views of management and treat- ment were opposed by the board of trustees there was no variation or turning. He was right, and he knew it, and the same masterly conception of what should be done, and unflinching determination to carry out his ideals marked every step of the journey. His genius was not confined to vitalizing the idea of disease of inebriety, and enlisting others to believe it, and securing their personal influence, but it showed it- 56 T. D. Croihers. self in the magnificent structure at Binghamton, which artistically and in many other ways was far ahead of the public buildings of that day. The plans for the buildings at Wilton were equally comprehensive in beauty and adaptability. He knew what an institution should be, externally and internally, and he knew how it should be conducted, and the great princi- ples of treatment that should be applied. We turn now to a phase of his character which was human in a startling degree. After the great shock in the loss of confidence and failure of the board of trustees at Binghamton to sustain him, and their efforts to crush him out, there grew up in his mind doubts and fears which destroyed his confidence in other persons and then- offers to join him and take part in his work. He probably realized that anyone who united their fortunes or interests with him would have to encounter great difficulties and in all probability failed in the time of strain and stress. Hence the idea grew that all future plans and materializations must come under his particular care and direction, and be accomplished by him alone. A great law firm in New York offered to conduct the suit against the State to recover the asylum at Binghamton, and receive a certain per cent of the value as their fees. Other men made similar offers, but they were all put off as matters to be considered in the future. Two prominent men of wealth on several occasions offered to contribute the money necessary, to build the asylum at Wilton, but the conditions repelled him. The executor of a large estate offered to build the institution and when I personally chided him for not ac- cepting the offer, he replied, "To do so, would be to lose control of the institution, and this would be a source of future danger." His dread of partnerships, associations, contracts and agreements in which others would have a part or equal share, seemed to grow with the years. He said that he would accomplish more personally, and with full control Dr. Turner's Life and Work. 57 of the destinies and future of the institution than with the help and assistance of others. Many times during the last few years of his life, large sums of money were offered to him, and while he probably would have availed himself of it in some way, when the work had gone on, he hesitated at the time. The bitter experience at Binghamton impressed him with a lurid fear of its repetition, and while he planned a board for the asylum at Wilton and arranged all the details, he was to have central authority and control. The repeal of the charter of the asylum at Wilton raised a number of very influential friends, who would have given substantial aid in the erection of the building. One man promised $50,000 for a wing of the building if it would be named after his wife. Another proposed to conduct the building personally and advance the money, and trust to Dr. Turner's efforts to have it paid back. The last year of his life he realized that something of this nature must be done, and he had in his mind, no doubt, several plans, in which his friends would have aided him. In this brief memorial study it will be interesting to trace Some Results and Conclusions which have followed from Dr. Turner's work. It may be stated that his real work began sometime about 1845 in the circulars addressed to the profession, to secure their interest in the work. Sixty-four years have now passed and Dr. Turner's work practically covered over fifty years. At the beginning he was unknown, without friends, influence or acquaintance. At his death he was widely known, not only in this country but Europe, and now 10 years later his name and reputation are growing steadily everywhere. Wherever institutions are opened for the care of inebriates, and wherever the study of inebriety as a disease is mentioned the name of Dr. Turner marks the beginning. In 1870 a society of medical men was formed in this 58 T. D. Crothers. country to study this subject purely from its scientific side, and this society exists today and we as its representa- tives come here to pay tribute to the memory of our pioneer leader—Dr. J. Edward Turner. In 1876 the first medical journal was published, devoted to this particular subject, called "The Journal of Inebriety," and continues to the present day. In 1880 an English society composed entirely of physicians was organized on the same basis for the same purpose, and in 1881 this society began the publication of a journal along the same lines, which continues to the present. In 1870 two societies of physicians and laymen were formed on the Continent, for the same study, and each of them have published papers giving their transactions and studies. The first inebriate asylum at Binghamton was followed by a large number of institutions, many of them chari- table, and all founded on the same principle of disease and its curability. In 1886 the number of institutions had increased in Great Britain to such an extent that a Government Inspector was appointed to grant licenses and superintend their management, and prevent abuses that might grow up from them. In 1889 an International Congress was held in London in which the disease of inebriety and institutions for its cure were discussed in many papers, and lasted over two days. About this time a great wave of quack curers swept over this country, and at one time more than 100 homes and asylums were opened for the cure of the inebriate. These have nearly all disappeared, because of their empiric claims and conduct. Every insane asylum in the country has special wards set apart for the care and treatment of inebriates, and every private sanitorium receives such patients. The literature growing out of these two journals has expanded Dr. Turner's Life and Work. 59 into many volumes, and is growing more and more voluminous every day. All this is the direct result of Dr. Turner's life work. Literally a new land for medical practice has been opened, and the inebriate is now recognized as sick and diseased, and his treatment is a matter of physical means in the proper surroundings. Dr. Turner's oft-repeated statement, that he would rather have built the asylum at Binghamton than been President of the United States is verified, and the critics of his early day, who thought he was only an enthusiast, have disappeared. The men who maliciously persecuted him literally contributed to his fame and reputation. They brought into prominence the great ideals of his life, and kept them before the public, until they were recognized as great working truths of the world. This brief sketch of his life only brings an outline of some of the stirring events that followed his life and work which will appear in a volume at some future time. Looking back from this point of view we can say with great certainty that this one man's life has changed and widened the great race march, from the lower to the higher, that it has opened a new path of preventive medicine, and pointed out a new method of escape, and made life brighter and clearer. I conclude by quoting a paragraph from Dr. Turner's "History of the First Inebriate Asylum in the World," which no doubt contains a sort of an instinctive con- ception of the reality of his work, which dawned upon him at that time. "It has been discussed and decided by many of the friends of the founder that a man would exhaust his estate, mortgage his property, live in hotels and railroad cars for over a quarter of a century of his life, and permit himself to enjoy his home less than four weeks each year, giving his entire time for a great public cause, without any moneyed consideration, is either an idiot or a lunatic. Yet there are others who would make the same sacrifice, 60 T. D. Crothers. if called on to accomplish a similar great work. The real labor of the founder has gone over a period of nearly fifty years, in which he has fought a campaign of battles and skirmishes with all sorts of success and failure. All the good men associated with him in this work have passed away, and not one is left in this dark day to speak of the asylum history and its behalf. "Although their labors in the material asylum have perished, yet the idea which built it is immortal." SELECTIONS NEUROSURGERY Surgery of the Nervous System—Loewy notes the most recent advances in this field. Among these are the cure of hydrocephalus by ventricular puncture. In tumors of the brain we see daring interventions along with a tendency toward conservatism, the former being indicated of course when life is menaced. When delay is obtainable von Eiselsberg, a leading cranial surgeon, pushes Hg and I for months. A few intraspinal tumors are amenable to operation. Hypophysis operations are of course on the increase and the author speaks of von Eiselsberg's 18 cases as if it were a record. Cashing is ignored. Forster's operation for spastic palsy continues to be a subject for endless discussion.—Med. Rec. Abs. NEUROTHERAPY Intravenous Mercury Ministration—Kalledey con- cludes from his work (Centralbl. f. Bakt., Vol. lxviii, p. 358) that the intravenous administration of small amounts of mercury bichloride results in an increased antibody and complement formation in both sick and healthy animals. He studied the quantitative changes in the complement, and the normal agglutinin and lysin of pregnant women, and the specific agglutinin and lysin in rabbits immunized against sheep's red cells or the ty phoid bacillus. All of these bodies reacted similarly, and it seemed to make no difference whether the dose was (61) 62 Selections. three or five milligrams. Following the injection there was a rather rapid fall, corresponding to a "negative phase," which reached its maximum in two days. Then began a gradual rise so that the number became normal about the fifth day and reached its height about the tenth day. The number gradually declined again until at the end of fifteen days the value of the serum was again normal. The author is naturally reluctant to offer any ex- planation as to the manner in which this change is ac- complished, but is inclined to believe that, as mercury is a protoplasmic poison, the negative phase represents a primary destruction of the cells. After this the cells are stimulated to increased production of protective substances. He believes that arsenic, and therefore salvarsan, acts in the same way, and that it is the quanti- ty rather than the quality of the antibodies which de- termines the cure. It would be contrary to the rule for the body to react in this way to an inorganic poison, but his experiments seem conclusive and are certainly worthy of attempts at confirmation. Other recent work would tend to indicate that the quality of the antibody is of the highest importance.—Abst. Stedman, Editorial, Med. Rec. Fifty Dollars was the fine imposed on the shippers of a so-called headache remedy labeled "Jaquequina," according to judgment by the Department of Agriculture. Misbranding was alleged because the label failed to state the quantity or proportion of acetanilid contained therein. Analysis showed about 230 grains per ounce. The Chaulmoagra Oil Cure for Leprosy is re- ported to have been effective in the St. Lazarus Hospital by the Philippine Board of Health, two patients showing on final examination, no signs of the disease persisting, microscopic or otherwise. Chemical and Physiological Investigation on the Harmful Constituents of Roasted Coffee.—The disturbances of the digestion which follow excessive coffee drinking are considered by the author, in a communica- Selections. 63 tion to the Societe de Therapeutiquc, not to be due in any degree to the caffeine, but solely to certain volatile constituents formed, and only partly volatilised, during roasting. These are named cafeotoxin, and may be elimi- nated by submitting the roasted coffee to successive treat- ment with steam under pressure of several atmospheres, followed by exposure under a vacuum. The coffee thus treated is called "atoxicafe." It retains its caffeine unaltered. It differs from ordinary coffee only in con- taining less cafeotoxin. Cafeotoxin has a marked reducing action on haemoglobin, a hypotensive action on the cir- culation, a depressant action on the central nervous system, occasioning cardiac arhythmia, and on the respira- tory centres, causing dyspnoea.—J. Burmann (J. Pharm. Chim., 1913, 8, 281.)—Pacif.-Phar. Radium Emanation in Medicine.—-The distinguished English surgeon, Sir Frederick Treves, recently stated that radium emanation is just as effective for curative purposes as radium itself. Assuming that radium is really the valuable therapeutic agent which it appears to be, the announcement is of great importance. Radium is extremely precious, for a small quantity of radium can produce practically an unlimited quantity of very cheap emanation. Radium emanations contained in sealed metal applicators are being sent off daily to all parts of England for medical men to use on their patients who cannot attend the Radium Institute. In a space of ten days emanations equal in curative value to $86,000 worth of radium have been sent out. Radium emits three sets of rays, designated respectively by the Greek letters, "alpha," "beta" and "gamma." The first two destroy the healthy tissues of the body when directed at close range, and at greater distance stimulate the abnormal tissues of tumors to renewed growth. The "gamma" rays are those which are desired. The more or less undesirable "alpha" and "beta" rays are filtered out by lead screens, through which the hard "gamma" radiations pass easily.— Scientific American. Pac.-Phar. 64 Selections. Radium as a Therapeutic Agent.—In the October 18th issue of the Journal of the American Medical As- sociation appears an article by Drs. L. G. Bowntree and W. A. Baetjer on the action of radium in internal medicine. The paper is largely a summary of results observed by foreign investigators. According to these reports radium is apparently of great therapeutic value in various disorders such as gout, lumbago, neuralgia, neuritis, rheumatism, arthritis, etc., etc. Apparently the best results are ob- tained from inhalations of the radium emanations and internally, as in the form of waters charged with radium. The authors conclude that the results so far obtained warrant more exhaustive tests with this agent. Radium was discovered by Mme. Curie. It occurs in pitchblende and it has been noted that carrying the ore in the pocket causes destruction of cells and tissues in close proximity. Those interested should read the article referred to or a fuller report thereon in the Bulletins of Johns Hopkins Hospital, Baltimore, Md.—A. S. in Pacific-Pharmacist. Sodium Bicarbonate and Other Allied Salts in Shock. Experimental Study.—Henderson suggested the prevention of the loss of carbon dioxide as a rational therapy for shock. Howell in 1903 found that sodium carbonate was an excellent cardiac stimulant in shock. On the assumption that Henderson's theory was the correct one an effort was made to supply the blood stream, di- rectly with carbon dioxide gas. (Seelig, Tierney and Rodenbaugh, Amer. Jour. Med. Sciences, Aug., 1913.) A molecular solution of sodium bicarbonate was used for this purpose, as carbon dioxide is set free from this solu- tion by the action of the (1) hemoglobin, (2) serum albumin, (3) the primary (acid) sodium phosphate in the blood. The results of experiments upon dogs seem to justify the statement that the intravenous introduction of sodium bicarbonate is the most efficacious remedy in the treatment of shock. There was always a rise in blood presurre in those dogs subjected to shock, the rise Selections. 65 persisting for some time. In unshocked dogs no such results were obtained. In addition to the rise in blood pressure, there was an increase in the amplitude of the heart beat. As opposed to the action of adrenalin, the phenomena ob- served were lasting in character. Sodium bicarbonate had no effect upon the rate of the heart beat. In addi- tion to the action upon the circulation, there was a marked increase in the depth of respiration following almost immediately the injection of the bicarbonate solution, and persisting for some time. The action on the rate of respiration varied. Sometimes there was no change, at other times a slowing or an increase. The results of the experiments, however, seem to indicate that the action of sodium bicarbonate is due to something more than the intravascular liberation of carbon dioxide. To substantiate this, carbon dioxide gas was introduced directly into the blood-stream and although the respiratory function was stimulated, there was no effect on the rate of heart beat, amplitude of pulse pres- sure or height of blood pressure. The problem then presented itself: was the action of the sodium bicarbonate solution due to (1) the bulk of fluid injected, (2) the hypertonicity of the fluid injected, or, (3) the alkalinity of the fluid injected. Each of these hypotheses was experimentally disproven, leaving naught but the con- clusion that the sodium bicarbonate acted specifically upon the heart muscle. Corroboration is afforded by the fact that a rise in blood pressure follows an injection of sodium bicarbonate even after both vagi have been cut, and even after all the higher cerebral centers have been destroyed.—Med. Rev. of Rev.'s. NEUROTOXICOLOGY Use of Heroin Spreading Rapidly Among Drug Addicts.—Laws against the promiscuous sale of morphine and cocaine leading those with drug habits to take up even more dangerous substances. 66 Selections. According to the U. S. Department of Agriculture, there has been a sudden and very significant increase in the use, by persons with a drug habit, of "heroin." The sales of this drug have recently increased greatly, particularly in those States which have rigid laws pre- venting the indiscriminate sale of morphine and cocaine. It occasionally kills the victim outright. The De- partment warns to avoid all preparations containing the substance and to take it only on the prescription of reputable physicians. NEURODIAGNOSIS Lombardi's Varicose Zone of Warning to the incipiently tuberculous. This "xona varicosa d' allarme," is described in the Giornale Internazionale della Scienzi Mediciniae as consisting of small varicosities about the seventh cervical and three upper dorsal vertebrae, one to one and one-half centimeters brought out plainly by gentle cross stroking of these parts of the nucha and back. Professor Antonio Lombardi is known to our readers as a close and reliable observer. The Four Reactions in Diagnosis of Lues.—The Laboratory News for September last has the following editorial by Dr. Gradwohl: Clinicians should avail themselves of the four re- actions in syphilis if they wish to get a full substantiation of their clinical diagnosis. It has been repeatedly proven that syphilis of the nervous system requires much serologi- cal study for accurate diagnostic purposes. There are many cases of cerebro-spinal syphilis which show a negative Wassermann in the blood and a positive Wassermann in the spinal fluid. Syphilis affecting more especially the blood vessels of the cerebro-spinal system always causes a single Wassermann test in spinal fluid. Besides the Wasser°man test we have recourse to the Selections. 67 Nonne-Appelt globulin test of spinal fluid, and lastly the lymphocyte count. The four reactions, therefore, of syphilis which are to be looked for in substantiation of syphilitic diagnosis are (1) Wassermann of the blood; (2) Wassermann of the spinal fluid; (3) Nonne-Appelt test of the spinal fluid; (4) lymphocyte count of the spinal fluid. In making the Wassermann of the spinal fluid it is very important to follow the Hauptmann technique, which employs the use of large quantities of fluid. This technique is carried out as follows: Make five Wassermann tests of this fluid using 1.0, 0.8, 0.6, 0.4, and 0.2 c. c. of fluid to each test with proportionate increase in physiological sodium chloride solution; in this way we can accurately determine the degree of positiveness of the fluid. If these four reactions are consistently looked for in all cases of suspected syphilis, especially syphilis of the nervous system, which includes, of course, paresis and tabes, a great many cases will be easily diagnosticated and perhaps remedial measures can be applied which will lead to better results in the treatment of cerebro- spinal syphilis. Prognosis above all can be materially improved by this method because we can confirm a clinical diagnosis of paresis by the presence of all four reactions, enabling us to stamp an incipient paretic with an absolute diagnosis and thereby letting his family know definitely the present incurability of his condition. It is found that some cases of cerebro-spinal syphilis show a positive Wassermann of the spinal fluid, a positive Nonne-Appelt and an increased lymphocyte count, but no Wassermann in the blood serum. Others will show positive Nonne-Appelt and an increased lymphocyte count but no Wassermann. Again, some will show a positive Wassermann, a lymphocytosis, but no Nonne-Appelt. In other words it is the presence of one or more of these reactions coupled with clinical findings which will enable us to accurately diagnose syphilis. 68 Selections. Spinal Fluid Cell Count in Syphilis of the Central Nervous System.—The central nervous system is so delicately constructed and so thoroughly protected that a direct examination for diagnostic purposes is very seldom to be thought of. But we have, in lumbar puncture, a means of determining with considerable accuracy the condition of these structures. We are able to withdraw and examine a portion of the fluid which bathes them; and it has been found that this fluid under- goes various changes following an inflammatory or irrita- tive process of the covering membranes. The change most frequently encountered is an in- crease in the number of cells floating in the fluid, due to actual pus formation in some cases and, apparently, to a desquamation of cells from the diseased surface in others. This paper will be limited to a discussion of this one abnormality, an increased cell count, with special reference to its peculiarities in cerebrospinal lues, paresis and tabes. A pleocylosis is very constantly present in these diseases, even more so than is the Wassermann reaction; and it has the added value, as compared with that re- action of localizing the disease definitely in the central nervous system. The author's results are 98.2 per cent positive for paresis, 100 per cent positive for tabes, and 86.3 per cent for c. sp. lues.—O. P. Bigelow, A. B., M. D.' Cleveland. In Cleveland Medical Journal. "The Passing of Paresis."—The October Medical Review of Reviews has an interesting record and comment on this subject from which we abstract a few pertinent paragraphs. "The history of the development of our knowledge of syphilis is interwoven with many names that give lustre to medical literature. Schaudinn, Ehrlich, Wasser- mann, Fournier, Charcot form a galaxy of eminence to which must be added Noguchi. Important as were his investigations into the serological diagnosis of syphilis through the test known by his name and valuable as have been his experiments with luetin, his recent finding Selections. 69 of the Treponema pallidum in the brains of paretics will have a more significant influence upon our theories as to the etiology of the late conditions following in the course of syphilis. Noguchi's positive findings were in patients who had rapidly succumbed to paresis. It is possible that in- vestigations of the nervous system of tabetics will dis- close similar findings in the cases where death occurs in the early stages from some intercurrent disease. The great importance of this discovery by Noguchi lies not in the clearing up of medical nomenclature but in the positive indication for prompt treatment of syphilis. For many years there has been a tendency to await the development of secondary symptoms before beginning the active administration of salvarsan or mercurials. If the so-called parasyphilitic diseases are due to spirilosis of the brain itself, it is important to lessen the number of infecting spirochetes at the earliest possible stage. The exhibition of the initial lesion affords the best op- portunity for limiting the infection. Prompt therapeutic attention to primary syphilis will result in destroying the infecting organisms before they disperse to become disseminated throughout the system." Etc. "Weeds" to Eat.—In the Gardener's Chronicle of America, March, 1913, Mary Tabott calls attention to the value of many of our common weeds as vegetables and salads. The common dandelion, the milk-weed, yellow dock, red clover, poke shoot, sour grass and golden thistle. The value of the mineral elements contained in these common plants differs but little from that obtainable from most of the vegetables cultivated at present. As sources of nitrogen, some are of greater service than the salads now in common use. The medicinal qualities of the dandelion, yarrow, marsh marigold and similar wild plants is well established in folklore. It required twenty-five years to establish a good dietetic reputation for the "love apple," as the 70 Selections. tomato was termed. Mushrooms were long forsworn as inedible and poisonous. The cultivation of foodstuffs of high caloric value and with low cost deserves encouragement. In the struggle for life and sustenance, we must not under- estimate the life-preserving qualities and the dietetic value of the common "weeds." Nourishment is not to be refused, though it comes from the roots of the thistle, the shoots of hops, the purslane or the tuberous roots of broad leaved arrow. The soy bean is barely known, save as a forage crop or as an anti-diabetic food. Alfalfa promises to assume a place of importance.—Abstract from "Weeds to Eat" in Medical Review of Reviews. Editorial. NEUROHEMATOLOGY Hemotologic Researches in Alcoholism.—By Ar- turo Garrieri in Revista Sperimentale di Freniatria and Revue de Psychiatria. 1. The proportion of haemoglobin has been proved by this author to be below the normal in alcoholics. 2. The number of red globules is diminished. 3. The leucocytes vary in number, yet, during the acute stage, there is a constant polyneucleosis, which disappears gradually as the general state of the disease is improved. With this polyneucleosis is associated a reduction of mononucleus and lymphocytes. 4. The blood pressure is above normal in alcoholics. 5. There was not a constant relation in these patients between the blood pressure, the pulse and the respiration. 6. The globular resistance is much diminished during the acute stage. It increases progressively with the return to the normal state of the subject—psychical and physical. 7. The osmotic tension of blood serum is greatly increased in alcoholism. Selections. 71 NEUROPATHOLOGY A Human Being Without Cerebral Hemispheres. —The classic experiment of Goltz in which he removed both cerebral hemispheres from a full-grown dog which was subsequently kept alive for some years has since been duplicated by others and has furnished the basis for important deductions regarding the functions of the portions of the brain involved. In a decerebrate dog it is evident that all those reactions in which the associative memory plays a part are permanently lacking, while the simple reactions that depend on inherited conditions only, may remain. In accordance with this the dog without cerebral hemispheres sleeps and wakes; it moves spon- taneously; there is an extreme restlessness doubtless connected with the removal of cerebral inhibitions. ^ Dis- crimination is shown by such animals with respect to food of varying taste. Goltz's dog could still bark and howl. It could be awakened by noise and it responded to bright light. On the other hand, it could not seek its food and recognized neither master nor companions. The general impression which one gathers from the investigations of cerebral functions in animals is that their subcerebral centers are complete enough to be able to carry out many motor reactions independently of the higher hemispheres of the brain. It is, of course, desirable to ascertain to what extent the facts of animal experimentation find their analogy in the workings of the human brain. Accidents have furnished numerous instances of partial loss of cerebral substance; but such cases are far from comparable with those in which there is extensive or complete removal of the hemispheres. There are instances on record ti human beings born without a cerebrum, but they have been anencephalous fetuses which have survived for only a few days. Even the scanty observations made in such cases have demon- strated that in the absence of a cerebrum movements of the limbs and eyelids, sucking movements and the act of crying can be carried on successfully. It has remained 72 Selections. for Edinger and Fisher to furnish the first description of a human being devoid of cerebral hemispheres who has remained alive for any considerable period. Their subject was under observation until its fourth year, when death, due to pulmonary tuberculosis, occurred. We are told that, although the symptoms exhibited by the child gave occasion to assume the existence of some severe brain involvement, prior to the necropsy, no one would have suspected the complete absence of the cerebrum. Entirely occupying the place of this portion of the brain was found a membranous bag filled with fluid, while the lower portions of the central nervous system exhibited a fairly complete and normal structure. The very satisfactory account of this child's experi- ences during the three and three-quarter years of its life which Edinger and Hirsch have fortunately suc- ceeded in obtaining impresses one with the decided inferi- ority of the decerebrate human subject as contrasted with comparable dogs. The child showed scarcely any change of behavior from its birth to its death. This is not true with regard to decerebrated dogs for which suit- able records have been obtained. These learned to walk, to assume characteristic postures in the acts of defeca- tion and urination, to alternate sleep and waking. The child never acquired such capabilities. It lay motionless in sleep unless awakened, and unlike the dogs, failed to learn to take food otherwise than by the primitive act of sucking. Like the dogs, it was apparently blind. It seemed impossible to discover a reaction whereby any relation which was semipsychic or conscious on the part of the child could be entered into. To quote the German observers: The child without cerebrum was less capable than a decerebrate fish or frog. The difference in the reactions of various animals to lesions of the motor cortex is now explained by physi- ologists as being connected with the gradual shifting of functions from the sphere of necessary reactions to the sphere of educatable adaptations, that is, from the lower centers to the cerebral cortex. This is characteristic Selections. 73 of the evolution of the higher type of nervous system and is a concomitant of the increased adaptability which dis- tinguishes man from all the lower animals. In the animal without hemispheres the motor mechanisms for all the movements of the body are present and can be set into action from any point on the sensory surface of the body. The first effect of adding the cerebral hemi- spheres to this mechanism is to increase the range of reactions, to modify or inhibit them, by diverting the stream of nervous impulses into channels which have to a large extent been laid down in the cortex by the past experience of the individual. In the dog, although a portion of the brain is in direct connection with the spinal motor centers, and can therefore initiate move- ments without making use of the midbrain motor machine- ry, these movements play only a small part in the motor life of the animal, and the removal of the corresponding centers takes away little of the conscious functions of the animal. In man the enormous power of acquisition of new movements is, as Starling emphasizes further, rendered possible by the shifting of one motor function after another to the sphere of influence of the cerebral hemispheres. Almost every act of human life has come to involve the cooperation of the cerebral cortex. The motor defects and the lack of adaptations exemplified in the child we have described would seem to show that the subcerebral centers in man are not complete and that this lack is permanent.—Nov. 22, 1913. Jour. A. M. A., Ed. Degeneration of the Neuron.—F. W. Mott, in November Lancet, points out that degeneration of the neu- ron may occur from an inherent lack of durability of certain correlated functional systems, as occurs in certain diseases which affect members of families at the same age in life and often generation after generation—e.g. Huntingtons' chorea, hereditary ataxia. Degeneration of the neuron may result from direct injury or local extension of in- flammation or by ischemic softening due to obstruction of the blood supply by vascular occlusion; the degeneration 74 Selections. that results therefrom is secondary. But when for what- ever cause nervous tissue disappears the neuroglia always reacts by a nuclear and fibrillar proliferation—a law for- mulated by Weigert in 1890. The replacement of the nervous tissue by the neuroglia tissue causes a "sclerosis." But the term "sclerosis" in the sense of a neuroglia proliferation being the primary cause is incorrect; the sclerosis is the effect, not the cause. A pure primary decay of the neuron has been termed by Sir William Gowers "Abiotrophy." Many of these conditions of abiotrophy are associated with chronic inflammatory changes, and it is very difficult to say how far these cause the decay of the neuron or are the result of it; certainly a proliferation of neuroglia tissue may result from simple atrophy and decay of the neuron, but a perivascular lymphatic infiltration with lymphocytes and plasma cells is evidence of a reaction to the poison. There are two diseases in which this perivascular cell infil- tration, together with neuroglia proliferation, is particu- larly marked and more or less universal in the central nervous system. They are the diseases caused by two specific protozoal organisms—the Trypanosoma gambiense and the Treponema pallidum.—Medical Record Excerpt. Sugar in the Blood.—Bing and Jakobsen report the results of estimation of the sugar content of the blood in sixteen normal persons, in thirteen with kidney disease, in seven with stomach or pancreas disease, in five with merely nervous disturbances, in seven with diabetes, and in six suspected of diabetes. The estimation was made by means of Bang's technic which they regard as an improved method for the purpose on account of its simplicity, rapidity and the fact that only a drop or two of blood is required for the test. Normal range was from 0.06 to 0.12 per cent., the average 0.1. The test was applied always at the same hour, 8 a. m. fasting. In a series of tests on a similar group of ten healthy persons given 100 gm. sugar in a cup of tea, the sugar content of the blood was found materially increased one hour afterward, but by the second hour the proportion had dropped back Selections. 75 to the previous figure. This shows the importance of making the test always under the same conditions and of being on the lookout for the briefly transient alimentary hyperglycemia. In two other cases, men of 65 and 60 had been taking very large amounts of sugar systematically on account of a chronic heart disease, hoping thus to improve the nourishment of the heart. Even with these doses of 250 gm. of sugar and above, the sugar content of the blood kept within normal range. In kidney disease the sugar content was a little above normal in a few of the thirteen patients tested, but it generally dropped to normal during the stay in the hospi- tal and there was no abnormal alimentary hyperglycemia. The finding showed further that there is no constant relation between the sugar content and the blood-pressure; each may run an independent course. No excess of sugar in the blood was found in the cases of stomach or thyroid affections or neurasthenia, but there was a slight tendency to hyperglycemia in a case of acute pancreatitis and of cancer involving the pancreas. With polycythemia there was hyperglycemia, on account evidently of the large proportion of reducing substance in the blood corpuscles. With diabetes, the sugar content was abnor- mally high both fasting and after meals, but the hyper- glycemia and the glycosuria did not run parallel; the latter may exist with normal sugar content in the blood. This emphasizes the kidney element in diabetes. In seven typical cases of diabetes, the sugar content ranged from 0.071 to 0.146 per cent. in one patient aged 44 in the course of a month. The range in the total seven was from 0.071 to 0.265 per cent. The great practical importance of the research reported lies in the fact that by examining the blood for sugar in dubious cases of diabetes or when the condition has improved under treatment, we are able by estimation of the sugar content to determine whether the diabetes has actually been conquered or whether it is liable to flare up again on any indiscretion. In such cases the casual and occasional appearance of glycosuria with normal sugar content in 76 Selections. the blood may be accepted as a comparatively trivial phenomenon, not fraught with serious consequences.— Jour. A. M. A., excerpt from Ugeskrift for Laeger, Copen- hagen. Serotherapy of Epilepsy.—Gasper gives no details but speaks in general terms of the conception of epilepsy as a toxemia, evidenced by the toxicity of the cerebro- spinal fluid for animals, and by the efficacy of reinjection of the patient's own cerebrospinal fluid or fluid from other epileptics. The fluid is injected subcutaneously or into a muscle once a week, the amount not over 10 c.c. He queries whether the undeniable unmistakable improve- ment and even cures realized by this serotherapy can be explained by assuming the existence of antibodies in the fluid—Ibid. CLINICAL PSYCHIATRY Dr. Gay of Boston in a recent letter to the daily press makes the following startling statement: "Hitherto, physicians have considered the results more than the causes and means of prevention. It is high time now for the tax payers of Massachusetts to recognize the defects in her people, as seen in the fact that it requires seven million annually to care for her defective, delinquent and criminal classes. These include the insane, feeble-minded, epileptic, inebriate, paupers and criminals. Thousands of these unfortunate people have become public charges. Many are of no use to themselves or any one, but are simply burdens of an overtaxed common- wealth. Among the chief causes of these deplorable affairs are alcohol, the social diseases, and heredity. The abuse of alcohol directly or indirectly does more to fill our prisons, insane hospitals, alms houses, and other institutions, than all other causes combined." This opinion is stated as a fact by a commission appointed by the legislature to consider and report on Selections. 77 this subject. Upon the best of authority it is clear that a large proportion of chronic alcoholics are the victims of one or both of the social diseases. This fact is rec- ognized by the medical profession with greater frequency. So far the only effective method is by segregation in asylums, schools, prisons, colonies and homes. There is a great, unknown field, stretching out from this point, yet to be occupied.—The Journal of Inebriety. Psychologic Conception op Disease.—Brock main- tains that health consists in an effective, disease in an ineffective, reaction of the organism to its environment. Organisms moving in highly complex environments have developed a unique instrument of adjustment—namely, intelligence—to help them to deal adequately with such environments. Much of what, by a confusion of thought, is called "mental disease" is simply an abnormal reaction of such an organism to its environment—a misuse by it of this intellectual instrument of adjustment. Natura non facit sal turn. Life proceeds cautiously, repeating again and again the reactions she has found serviceable, before proceeding to experiment further. The repetition, however, is for the sake of the advance; an organism which contents itself with marking time is doomed. Brock aims to demonstrate that certain diseases are best understood from a geneticopsychologic point of view, and that, accordingly, it is first and foremost by the employment of educational methods that we can best ensure the prevention of these diseases in the future. Some of the accompaniments of disease are not themselves, strictly speaking, pathologic. Thus inflammation may be looked on as a perfectly healthy and "normal" reaction to an extraneous stimulus of relatively infrequent occur- rence. Or again, in the "mental" field, certain conduct on the part of highly gifted and far-seeing persons is often branded as "cranky" or even insane, when, as a matter of fact, it may have been necessitated by, or at least may form a quite healthy and useful protest against certain pathologic manifestations in the social environ- ment.—Edin. Med. Jour. 78 Selections. CLINICAL NEUROLOGY The Virus of Rabies and the Negri Bodies.—A distinct advance in the diagnosing of rabies followed the discovery, by Adelchi Negri in 1903, of certain cellular in- clusions constantly present in the nervous system of animals affected with this disease. In the past ten years many of our health boards have used means for the recognition of these bodies which have come to be regarded of prime importance in the diagnosis of rabies. Negri himself worked for nearly ten years in studying these bodies and successively demonstrated their presence in various ani- mals suffering from rabies. His work has been confirmed by many observers the world over. The findings have been so generally uniform that it has come to be recog- nized that when Negri bodies are found in the ganglion cells of the hippocampus major it is a positive sign of rabies. These bodies have been further studied by re- searchers with a view to proving their parasitic nature but without advancing our knowledge of them any more than in the case of the Guarnieri bodies caused by vaccine virus. The smallest of these bodies are almost ultramicroscopic and react to stains like nuclear particles, but the largest—the typical Negri bodies—are readily differentiated from nuclear particles by appropriate staining methods. Any further light upon the significance of these bodies is to be welcomed, especially since, every now and then, some false prophet preaches that there is no such disease as rabies. Pasteur's work alone in 1884 should refute this. Recently Acton and Harvey of the Pasteur Institute in India have published a report of their studies on the fixation of rabies virus in the monkey (Macacus rhesus) with a study of the appearance of Negri bodies in the different passages (Parasitology, Vol. 5, No. 4, February, 1913.) These authors found that the street virus of the dog becomes exalted and fixed by successive passage through the monkey, just as in the rabbit and other animals; the type of rabies being at first furious, Selections. 79 but after the seventh passage, paralytic. With each successive passage the Negri bodies were found to be smaller in size until ultramicroscopic. After the seventh passage, when the paralytic form of rabies was fully developed, very few Negri bodies were found. This diminution of the number of Negri bodies seems to bear a definite relation to the fixity of the virus as shown by another experiment. The authors inoculated two bullocks, one with street virus and the other with fixed virus. The street virus caused large Negri bodies, whereas the fixed virus caused none at all—and this in an animal showing the largest Negri body known.—Editorial N. Y. Med. Rec. CEREBROPSYCHIATRY The Denver Medical Times thus discourses—The Chemistry of Thought—The substratum of all animal functions is the energy liberated by chemic change, such reactions being more or less limited to the organ chiefly concerned. Thus, in muscular exercise and grandular activity much heat is produced through the oxidation of carbohydrates, so that the blood in the hepatic vein is the warmest in the body. The amount of chemic ac- tion taking place may be estimated approximately by the quantity of end products (water, carbon dioxid, ammonia, etc.) manufactured and excreted within a given time. Accumulation of metabolic products leads to fatigue and an instinctive desire for rest or recreation. That the brain while actively functionating requires more blood within the period than when at rest, has been proved beyond a doubt; one method of proof being that when the body is evenly balanced upon a delicate appara- tus and then the subject of the experiment concentrates his thought upon anything, the upper pole of the body becomes heavier and the head sinks. It is evident, therefore, that in the process of thought the common 80 Selections. nutrients in the circulating blood are needed, as well as the more specialized lipoids of nerve tissue. Psychic influences occasionally cause a rise in temperature above the normal, and are very important factors in leading to vascular hypertension. The chemic composition of brain substance is dis- tinguished by its peculiar richness in phosphorized lipoids, particularly lecithins. These are much diminished in degenerations of the cerebro-spinal system, with a cor- responding increase of extractives (neurin, cholin, fatty acids and purin bodies.) "According to Sajous, the entire nervous system is built upon the plan of fibrils containing blood plasma surrounded by a layer of myelin. The main constituents of these bodies, the oxygen of the plasma and the phosphorus of the myelin, are thus brought into contact, and nervous energy is liberated." This concep- tion, while necessarily somewhat figurative, expresses the essentials of the chemic nature of nerve and brain function- ing in the simplest possible manner. Myelins and kepha- lins (Thudichum) are related to the lecithins, being distinguished mainly by differences in solubility. Considering the mind as the function of the brain, there naturally arises the question, to what extent may diet influence the faculty of thought? We believe that the nature of their food has a great deal to do with the ideals and mental status of individuals and nations. Compare the zoolatrous East Indians with the handful of their beef-eating British conquerors. If proper feeding affects the temper and spirit of a dog, how much more it will do to a man! Among the foods particularly rich in the elements needed for brain work are eggs (7 per cent lecithin in yolk,) fresh meats and fish, milk and cheese, whole wheat bread, beans, cocoa, butter, olive oil and other neutral fats. It goes without saying that excess in any of these articles of diet may defeat the desired end, by causing indigestion and autotoxemia. Of medicines to build up the brain and nerves, the most reliable is phosphorus itself, perhaps accompanied with thyroid extract, to enhance its assimilation. Selections. 81 The study of the body fluids may in certain cases of cerebrospinal affections render diagnostic aid of at least confirmatory value. Thus, indicanuria is marked in most melancholic conditions. Oxaluria ("false Bright's disease") attends nervous depression and irritability. "Phosphaturia" is likewise noted in hypochondriacs, and the earthly phosphates are greatly in excess in the urine in meningitis. An attack of migraine often ends with a urinary uric acid cloudburst. Halliburton has demonstra- ted an excess of cholin in the blood and the cerebrospinal fluid in degenerative diseases of the nervous system. The cerebrospinal fluid is chemically altered (acid reaction; presence of neutral fat and butyric acid; reaction for globulin, absence of normal copper-reducing power) in the meningitides, and to a less degree in parasyphlitic maladies. PSYCHIATRY What Each Person Can Do in the Mental Hy- giene Movement. From Origin, Objects and Plans of National Committee on Mental Hygiene. 1. Inform yourself thoroughly regarding the causes of mental diseases. 2. Help to make the facts you now possess generally known. 3. Refrain from those acts and habits which are liable to result in mental disorder. 4. Speak and think of insanity as a disease and not as a crime. 5. If relative, friend, or acquaintance seems to be suffering from bad physical or mental habits, take steps to see that he is given the information you possess and receives proper medical care without delay. 6. Inform yourself of the modern methods of caring for the insane, and lend your voice and influence to all projects which make for. better or earlier care of those suffering from mental diseases. THE ALIENIST AND NEUROLOGIST. Vol. XXXV. St. Louis, February, 1914. No. 1. Subscription $5.00 per Annum In Advance. $1.25 Single Cop? This Journal is published between the first and fifteenth of February, May, August and November. Subscribers failing to receive the Journal by the 20th of the month of issue will please notify us promptly. Entered at the Post-office in St. Louis as second-class mall matter. All remittances should be made to Chas. H. Hcohss. The Alienist 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 Alienist and Neurologist. For return of non-accepted manuscript send addressed envelope and sufficient postage. Any Comment, favorable or unfavorable, specifically set forth, is always wel- come from friend or enemy or any "mouth of wisest censure." CH AS. H. HUGHES, M. D.. Editor and Publisher. Editorial and Business Offices, 8858 W. Pine Boul. Hughes Pbtnting Co., Printers and Binders * EDITORIAL. "Quantam ego quidem video motus morbosi fere omnes a motibus in systemate nervorum ita pendent ut morbi fere omnes quodammodo Nervosi dici queant. — Cullen's Nosology: Book II, p. 181—Edinbubg Ed., 1780. The A. M. A. Journal's Incomplete Index.—An ex- tremely crippled, incomplete and misleading index of current medical literature is published by the Journal of the American Medical Association, making the same worthless for reference since too large a number of the Journals of the American Medical Editors' Association publications are omitted. As a member of the American Medical Association we regret to see the Journal of the American Medical Association thus impairing its usefulness and discriminating in its selections against the Journals of the A. M. E. A. * l 411 Umitntd Editorials art writtsn hr tkt EdiUr.] 82 Editorial. 83 The Acquittal of Mendel Beiliss, the innocent brick yard work-man of Kiev, of the Bandt propagated, but unfounded and impossible charge of ritual murder, which deceived the Russian government into the poor man's prosecution and the court and police protection given the unfortunate prisoner in the face of this super- stitious anachronism reminds us, to the credit of that great autocratic country, that there are yet existent some psycho-neuronic stability, even though prej- udice against the Jew there ordinarily exceeds normal bounds among race prejudiced people. That long suffer- ing Semitic tribe whose ancestral faux pas in regard to Christ in that distant century when our era began has, up to a comparatively recent period, brought social ostracism into their life and "all their woe." State and Private Hospitals, Asylums, Sanitoria, Psychiathrons and sanitary institutions of all kinds for the mentally and neurotically maimed or congenitally marred in mind, exceptional homes and schools, etc., will do this magazine a favor by mailing us photographic illustrations of their family life, similar to some already published in our pages. We desire these worthy establish- ments to appear in their best and true light. They are not everywhere fully understood in their home-like cura- tive aspects. From time to time, in subsequent issues we would present them. The Unstable Neurone appears to have been in evidence throughout the career of Hans Schmidt, the confessed murderer of Ann Aumuller and others, through- out his startling career of priest and thief and multi- form murderer and criminal. While race suicide is censurable among the better hereditarily endowed, asexualization and race famine were better for cases like this criminal, with his many aliases. The breed of such unstables, whether technically insane or not, should be put out of the way of further harm. A Physician in General Practice in a distant State, Dr. R. E. King, thus expresses this true psycho- therapeutic idea in practice. 84 Editorial. "Any means that will direct the mind of a patient into a channel of hope, expectancy, faith and belief, and establish a suggestion opposite to that usually found in the mind of the sick, will constitute an important factor in that patient's ultimate recovery."—(President's Address, before the Oregon State Medical Association.) The Rest Cure in Popular Literature.—Wm. Mathews in Success Magazine some time back remarked as follows: "Men who fill unaccustomed positions, exacting severe mental toil, are almost sure to be short-lived. Persons whose callings subject them to a heavy nervous strain ought occasionally to spend a day or two in bed. Even an afternoon nap is a tonic, and may do much to lessen the wear and tear of nervous, anxious days. One of the ablest statesmen of modern times, when once reproached in early life for indolence, retorted, 'I am restoring energy.' "When will we learn," comments the writer, "that it is not the number of hours we work but the efficiency of the work done that counts? Many of us would accomplish much more in two or three hours of vigorous, effective work than we could accomplish in an entire day with the whole system out of tune." The Government of the A. M. A. is too much oligarchical and too little democratic for this day and generation. If the association's delegated form of government is to continue there'should be more managerial interest taken by the members at large in instruction of the delegates, and the recall would not be amiss. As in the government of our country, so with our association, rotation in representative delegates in office would prove salutary and promote accessions to the mem- bership. The American Medical Association should be so governed that it would draw into its fold all of the regular ethical medical profession and take care of all real medical interests promotive of the welfare of the entire profession and the highest welfare of all the people. Editorial. 85 A recent court decision has hit the A. M. A. a serious blow in declaring the association methods illegal and especially in deciding that every member should have a vote. The Cost and Care of Insanity and Idiocy, these numbering in the United States about a quarter of a million and the expense amounting to about sixty millions annually, suggests a rational government effort at pre- vention, beginning at our ports of immigrant entry and continuing with marital prenatal eugenics. The child has a right to be born free of these psychic hardships and the nation in self-defense of its future existence must prevent by suitable hygienic and other legal measures the propagation of mental defectives too many of whom even now exercise the election franchise. Surgery has remedies of prevention and the law can apply them and others to prevent the menacing annual crop of imbeciles and mentally unstables who escape asylum commitment, from propagating their unstable and perilous kind. Thaw has Threatened to Kill Dr. Flint because the doctor testified and has subsequently maintained that Thaw was insane. If Thaw and White had been vasectomized in early life the Stanford White murder would have never happened and Thaw would have been more stably brained. Timely oophorectomy in many women of our time would also prevent much crime and divorce. Dr. Edward Charles Spitzka, personally well- known to the editor of this magazine, died at his home in New York, January thirteenth. He was a distinguished cerebro-anatomist, pathologist, diagnostician, practitioner and author. His brain is bequeathed to the famous Baugh Institute collection for scientific study. His eminent cerebro- anatomist son, Dr. Edward A. Spitzka, will make the examination of his famous father's brain. The deceased Dr. Spitzka achieved special notoriety and eminent consideration in the famous Guiteau trial 86 Editorial. for the murder of President (General) Garfield. But he was renowned for his researches on the brain and as an eminent alienist before this event. He first described the interoptic lobes in the reptile's brain, showed that there were no pyramidal tracts in the cetacea and added many other facts to cerebro- anatomy and physiology. In earlier days he was an important contributor to this magazine of the brain and mind. The Re-appointment of Surgeon-General Stokes of the U. S. Navy is advised by the Medical Record on the ground of his proved ability in his post, his able conduct of the navy hospital ship. We heartily join the Record, one of the very best of our national medical weeklies, in this very proper sugges- tion. Dr. Stokes is the right man for the place. Surgeon General-Major General W. C. Gorgas.— We congratulate the President, Senate and the people and the Colonel on his promotion to a post he so well deserves. Having been over the ground ourselves and seen the great sanitary salvation work done at Ancon, Panama and Colon and having learned from personal army ex- perience in camp and field, we know the value of the right sort of medical work and men in the service. The ri- diculously and ignorantly absurd estimate of certain field officers concerning the value and rank for service of the medical staff to the contrary notwithstanding. The Simulation op Organic by Functional Ner- vous Diseases by David S. Booth, M. D. 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 surgeons who need more neurological enlightenment than they generally display in post and pre-operative practice. Editorial. 87 The above comments were inadvertently omitted at - the time this valuable paper was noticed in the review department of the August number of last year. Harry Thaw.—While it may be conceded that Harry Thaw, in the sense in which some alienists use the term, was a paranoiac at the time he killed Stanford White and much of his time while under the influence of excessive champagne to which he was much addicted and as he was at the time of the tragedy which ultimated in his conviction regarded as a paranoiac and committed to Matteawan (noepa beside, near, vou? mind—beside or off in mind), it is not wise for such a person to be at large without the asylum restraint which has kept him steady and apparently normal in mental action. We should rather consider Thaw as a paranoid, viz: one liable to go beside himself with passion under drink and from slighter cause than is common to the average human mind. Such a perilous uncertain person should be under constant personal and legal surveillance for the remainder of his life after such dangerous demonstration of mental instability and he should not be allowed to indulge in champagne suppers and other brain disordering condi- tions and appetites such as disturbed his mental equanim- ity to the extent of a murderous brain storm. Evelyn, his wife, seems to understand him as the paranoiacally inclined victim of the morbidly unstable neurone and dangerous under the mind perverting sway of drink. A State Epileptic Colony for Illinois is to be established, $300,000 appropriated. Bequest to the St. Louis Medical Society.—The Medical Fortnightly informs us that the St. Louis Medical Society is the fortunate recipient of a bequest from Mrs. Francesca Bartscher as a memorial to her son, Dr. Hugh Bartscher, who died several years ago. Healthy Conservation from Noises that rob weary brains of sleep is as essential a matter of public official concern as forest or water conservation or saving 88 Editorial. cotton and grain from the weavel or hogs and chickens from cholera. Brain saving sleep is worth much to this rushing wearing world of workers with brain and brawn. Re- cuperative sleep is as imperative as toxine generating out- wearing action. Dr. Langdon announces to the profession the opening of his new consulting rooms at Number 4003 Rose Hill Avenue, Cincinnati. For those who prefer a down-town appointment, he retains his present city office in The Groton. Practice limited, as heretofore, to consultations with physicians, and with patients referred by physicians. Patients are not accepted for continuous personal treat- ment, excepting those who enter by advice of their attending physicians, some one of the various hospitals with which Dr. Langdon is connected. The New Narcotic Law of Pennsylvania pro- hibits the indiscriminate sale of habit-forming drugs, except upon the prescription of a physician, dentist or veterinary, but does not prohibit the public from getting those legitimate preparations containing certain specified minimum quantities of these drugs. For an American Physician it is an unpardonable sin of omission not to be familiar with the writings of that womderful medical pioneer, Benjamin Rush, and not to have perused the most monumental work ever penned in the West, the "Diseases of the Interior Valley of North America," by that consummate master, Daniel Drake.—From Mental Hygiene for Doctors. The National Committee for Mental Hygiene is studying conditions among the insane in the United States, under the terms of a special gift of $50,000 for the purpose of helping to ameliorate their condition and sending out much valuable literature on the subject. The Prevalence of Insanity.—"While it is generally known that insanity is a very prevalent affliction, it is doubtful whether many people realize that on January 1st, 1910, there were 187,454 insane persons in institutions Editorial. 89 in the United States. This number exceeds the combined enlisted strength of the United States Army, Navy and . Marine Corps; it exceeds the population of Columbus, Ohio; and it exceeds the number of students who were enrolled in all colleges and universities in this country upon that date."—Rep. Nat. Com. for Ment. Hygiene. A Problem for Gyneco-psychologists.—Five male children, all perfectly formed, were born at Abbeyville, La., Jan. 2, to Mrs. Audrey Lassen, wife of a carpenter. Two of the children were dead at birth, but the others lived. The babies were born at intervals of from five minutes to more than an hour. The smallest of the chil- dren weighed 22 ounces, and the largest tipped the scales at slightly over 5 pounds. Physicians in attendance say that other than the unusual number of the children there were no abnormal circumstances attending the birth. Mrs. Lassen had three other children, two of them twins and born two years ago. All three of these are boys. She is 28 years of age, and her husband is about four years her senior. Mrs. Lassen weighs nearly 200 pounds, while her husband weighs 140. Lectures on Inebriety.—The University of Califor- nia has announced a course of ten lectures on the various aspects of alcohol. In the reminiscences of a doctor who died long ago, was found this very significant sentence: "When a medical student in 1806, I was very much impressed with Dr. Rush's lecture on Alcohol, in which he described its pernicious effects and special dangers to medical men. This has kept me a temperance man all my life." In 1890 Dr. Crothers gave a course of four lectures in the Vermont Medical University at Burlington, Vt. The next year he repeated this course in the Albany Medical College. In 1900 the New York School of Clini- cal Medicine created a chair of spirit and drug neuroses and appointed Dr. Crothers as teacher. For four years he gave courses of four or five lectures each year to small classes of medical men. < 90 Editorial. In 1912 The Boston College of Physicians and Sur- geons created a distinct chair for the study of drink and drug neuroses and Dr. Crothers was appointed the profes- sor. From that time to the present he has made inebriety and alcoholism the subject of eight or ten lectures each year. The "Friends'" Asylum for the Insane, Frankford, Philadelphia, in 1913 completed the one hundredth anniversary of its existence. It was founded by the Society of Friends in Phila- delphia for "Friends" but its scope in 1834 was enlarged to include all who might seek its beneficent aid as is done without discrimination today. Its management wisely and intelligently propose to change its designation from asylum to that of hospital or some other name less suggestive of a mere place of confinement and restraint for the insane. It is a beautiful and attractive and restful home and hospital combined-—a really beautiful and well adapted place of treatment and rest for the mentally maimed—a true psychiatrone where the brain weary and perturbed in mind may find hope and rest and recovery. The Washington Society of Nervous and Mental Diseases has inaugurated its seventh session by re- electing last year's officers as follows: president, Dr. Tom A. Williams; vice-president, Dr. W. M. Barton; secretary, Dr. W. M. Hough. The society has a limited membership but welcomes physicians and surgeons interested in neurology and psychiatry. Ex-President Taft, finding it necessary to reduce his superabundant adipose, consults a regular licensed physician for treatment, not an advertising quack or faddist. All presidents have not been so considerate of medical regularity. Dr. John Green, an eminent oculist of St. Louis of distinguished success in practice, who died December seventh, 1913, bequeathed his medical library, which in- cluded also the library of his uncle, Dr. John Green of Editorial. 91 Worcester, Mass., to the Worcester District Medical Society. Dr. John Green having been a practitioner of over half a century and his uncle having practiced medicine near that length of time many rare out of print medical books were in the collection. The London Hospital condemns very justly the spectacle of British prudery, which is afraid to let scholars read Havelock Ellis' "Psychology of Sex" at the author's expense (for he offered, it seems, to present that perforce foreign published work on condition it were catalogued, only to be refused), as lowering the national prestige more than a good many foot-races lost at Olympic Games. Indeed, the London Library stocks standard books like that just mentioned, and is not afraid to say so. "As a result," it says, "the Royal College of Surgeons library cannot make up to medical men for the depriva- tion they suffer because of the old-maidishness in vogue at the British Museum, etc." Wells Hawke's Brain Break last December, was displayed by the throwing of his clothes out of his window at the Marlborough-Blenheim Hotel, New York. This peculiar symptom of insanity displays itself in certain insane persons not only in divesting their bodies of personal clothing but in clearing their rooms of every- thing in them, as though they realized that they wanted an open field and fair play. It suggests a sense of psychic apprehension though it is not displayed in this manner by all insane persons nor by even the majority. So far as we know psycho-diagnosticians have not discussed or explained this peculiar symptomatic display in psychopaths, yet it is common, (and in weather when the narrow windows of the asylums are open) for the ground under certain patient's rooms to be strewn with sheets and other bedding, etc., just as a sane man about to engage in a fight proceeds to strip himself of cumber- some garments. The Unstable Psychic Neurone is much in evi- dence in this non-restraint country of ours where too 92 Editorial. many of its ignorant erratic people do too much as they please regardless of the welfare of others. These im- pulsions rather than regulating reasons govern conduct. With less neuropathy and more neurotone and conse- quently more stable brains and steadier mind the auto- mobile speed fiend and other accident engenderers. Accidents generally (not all of course) result from some unforeseen, uncalculated, but not always uncalculable, circumstance or omission of essential precaution resulting from brain tire, brain fag and mind omission. The misplaced switch, the disremembered time, the forgotten order, etc., are often due to under tone of brain duty enforced or dissipation caused engendered loss of sleep or voluntarily by over-work or by dissipated rest time, by care, worry, alcoholism or other exhaustion in the worker or by epileptoid transient lapses of consciousness which overstrain of brain brings on in some. Dr. T. D. Crothers, of Hartford, has been re- elected president of the New York Medico-Legal Society for the third time. This is a great compliment and evi- dence of the esteem in which he is held in medico-legal circles in New York and the East. Probably no man in this country has done more to develop the scientific study of the drink and drug neuroses in his work as Supt. of Walnut Lodge Hospital, and editor of the Journal of Inebriety. Through his books and writings he has roused new interest in the subject and attracted attention among the leaders here and abroad. —Hartford Evening Post. A Compliment to the Editor and his work. A friend sends us the following for which we return thanks and acknowledge appreciation: "In presenting a paper contributed by Dr. C. H. Hughes of St. Louis, Mo., at the recent meeting of the American Society for the Study of Alcohol and Other Narcotics, the president said, 'we feel highly honored in presenting a paper from one of the great neurological pioneers in the Southwest. Long ago Dr. Hughes called attention to the disease of inebriety and defended it in Editorial. 93 papers before societies, before this association was organized. He saw with a marvelous instinct the facts that we have been urging through the long years, since 1870, and he has been a student and teacher of these truths in his college lectures and in the journal of the Alienist and Neurologist, of which he is editor. Beyond this topic Dr. Hughes has made a reputation both here and abroad for exhaustive studies along these and other lines of neurological studies." A Good College Movement.—"Detroit College of Medicine and Surgery request the pleasure of your presence to inspect the College building and newly equipped laboratories January 1st, nineteen hundred and fourteen." (Letter to the editor.) While regretting our inability to be present we cordial- ly commend this effort of this excellent college to familiar- ize the profession with its equipment and efforts in the line of right scientific medical advancement. The profession should take pains to familiarize itself with what the colleges are doing and not rely on the grading of politically appointed boards, some of which are liable to be non-expert and not above mediocracy judges. We want good colleges and to know the real value of the A. B. C. gradings of state politically appointed Boards of Health. A Panama Canal Engineer Becomes Insane.— Lieut. Col. David Dubois Gaillard, of the United States Corps of Engineers, returned last August from Panama, suffering from nervous breakdown and mental trouble. He was taken to Phipps Psychiatric Clinic for the Insane of Johns Hopkins Hospital. The breakdown is attributed to the trying climate and anxiety caused by slides in the Culebra cut. Lieut. Col. Gaillard has been in charge of the central division of the work. With right living, a largely vegetable and fruit diet, without alcoholics, reasonable rest and hours of work, the climate, since Col. Gorgas' great sanitary achieve- ment in abolishing malaria and the yellow fever mos- 94 Editorial. quito, living ought to be as safe as anywhere at Panama. We found the climate delightful during a recent winter visit. Urban Quietude lately engaged the attention of a legislature and a court in this country relative to the early cock crowing. A Chicago court decided that chanticleer must not crow before six a. m. to the annoyance of a complaining neighbor, notwithstanding the annoyed neighbor himself opened the muffler of his auto car at midnight to the discomfort of the rooster's owner. It is good to see the people of this restless, rushing country awakening to the need of needless noise suppress- ion and recuperating quiet and rest betimes before neurosis and neurasthenia, which Europeans call the American disease, become universal among us. When will the railways and factories moderate their whistles and the street cars abate their screeching steel wheels and jungling trucks on steel rails and the factories be brought to sanitary reason as to smoke and steam whistle noises? Public Protest Against Noise.—Apropos we note the Sunday Post-Dispatch quotes a three column con- tribution from Frank Putnam's City Government in Europe including also germane views of the alert and able health commissioners of St. Louis. If we aspire to have the possible most healthful as well as beautiful cities in this land we must suppress the needless noises, for though the past anti-noise campaigns in American cities have not been wholly fruitless, yet they must be more fruitful. Needless -noise must be minimized if not abolished altogether. "City noise," Dr. M. C. Starkloff, city of St. Louis, as Health Commissioner, says, "is undoubtedly one of the problems to be solved in working out the whole question of the public health. Unnecessary noise has long been regarded as a nuisance, and has sometimes been legis- lated against on that ground. Now we come to the point where we recognize that it is a question of health. Editorial. 95 "The needless blowing of factory and steamboat whistles, the rattle of trolley cars at crossings, the rumble of trucks on pavements, all mean wear and tear on the nerves of the more nervous sort of persons. Some persons seem to have no nerves, so far as noise is concerned. They could live in a boiler shop and never be disturbed. But others do mind the noise, and never get wholly used to it. So that the noise is a tax on vitality, and in so far as the noise may be unnecessary, it is an unnecess- ary tax. "The Board of Health has considered this problem, and there are things which could be done, if the proper authority were given, toward abating noise as a measure of health. But at a time when people resist such necessary ordinances as those for the screening of fruit and vegetables and the muzzling of dogs, and when the city's lawmakers receive sanitary measures like the bread-wrapping ordinance with indifference, it is questionable how much the health authorities could accomplish with a matter whose import- ance is generally so little realized as the noise question." To this arrangement might be added others, viz: the procession over granite block paved streets such as Vandeventer Avenue, of the city garbage carts with their loud talking negro drivers, when they might parade over more than one street of the city's west end, the long string of heavy meat wagons and the howling news- boys on the street corners for which Putnam over kindly apologizes. The London plan of displaying the paper in front of their chests is better and more sanitarily sensible. Psychiatry in Pedagogy.—Right pedagogics for this country from the standpoint of practical psychiatry, that is: the eugenic care of the American mind of this conglomerate people, with a view to the rearing to maturi- ty and of the duties of strong brained rightly trained citizens for the right comprehension and support of true liberty and fair free government is a matter to be con- sidered deeply and promptly and promoted. 96 Editorial. The Republic needs strong developed minds with bodies to sustain mental action, trained as thoroughly and as early as practical in the right use and understand- ing of the mind's powers with reference to personal and political welfare. And the holding back of the minds, especially of those who have not the means to pursue a long and expensive curriculun of preliminary detail study, cuts out too many meritorious and inherently powerful minds from fair chances to make themselves great. Mind merit of capable brains should have no needless barriers in its way to powerful and reasonably early development. To this end and aim the view of Albert in the Selections Department of this journal appears to be special- ly valuable reading. A Widowed Victim of Meconism of a Southern born and white anti-miscegenation family and mind, lately married her negro nurse. A negro clergyman tied the knot and a court awarded her property to her black husband. Prima facie this lady, judging from her antecedents and normal character was not in her right mind at the time she gave matrimonial consent. It is not impossible for such matters to be preceded by a ravishment and to make partial amends it would not be impossible for a person in a state of opium psychopathy to imagine that a marriage might make amends for her faux pas. Cases like this should have medical inquiry by a competent medical psychopathically expert commission before final judicial decision. This lady was probably non compos mentis. Errors of Judgment Concerning Insanity by pseudo-alienistic experts are often like those the negro made concerning Chief Justice Marshall, one of the ablest jurists on the U. S. Supreme Bench. According to the Christian Register "the Chief Justice was driving over a wretched road, and his horse turned aside so that a sapling prevented him from turning either to the right or left. The judge, engrossed in thought Editorial. 97 knew not how to get out, until an old negro came along, and said 'Marster, what fer you don't back your horse?' 'That's true,' said the judge; and, after taking his ad- vice, he felt in his pockets for change, but no change was there. 'Never mind, old man,' he said to the negro, 'I'll leave some money for you at the tavern.' When the negro called and received his present, he commented on the judge thus: 'He was a gem'man for sho'; but,' he added, patting his forehead, 'he didn't have much in here.*" American College of Surgeons.—The object of the college is most worthily to elevate the standard of surgery by establishing a standard of competency and character for practitioners of surgery, to provide a method of grant- ing fellowships in the organization, to educate the public and profession to understand that the practice of surgery calls for special training, and that the surgeon elected to fellowship in this college has had such training and is properly qualified to practice surgery. It is high time such an organization existed. The character and well-known qualifications of the leading surgeons connected with the worthy organization gives promise of great good and the assurance of greater safety to a bleeding public than it now enjoys from the too promiscuous and unwisely directed use of the knife. Tardy Acknowledgment of an Invitation to be present at the opening exercises of the Henry Phipps Psy- chiatric Clinic, established and erected by Henry Phipps, Esq. of New York, as a department of Johns Hopkins Hospital and of the university to promote the study of mental disease and their early treatment, is made. While unable to be present on the important occasion, we take pleasure in noting this great salutary movement in medical teaching and rescue work in behalf of humanity. The study of the human mind is not only the noblest branch of medicine, as de Groot wrote years agone, but the salvation of minds is the saving of nations. Psychia- try has been too long, too lightly considered in the practice 98 Editorial. of medicine. This medical oversight inspired the found- ing of this magazine, four and thirty years ago. In Memoriam of Dr. James P. Tuttle.—Dr. Joseph M. Matthews pays a just and well-merited tribute to our good friend whose initial studentship days were spent in our office, and at my house in St. Louis. He and my wife were first cousins and we knew him well. Dr. Tuttle was of the stuff that worthy and capable physicians are made. He was the soul of honor and diligent, almost to a fault, for he spared not himself in endeavor for proficiency and faithful service such as our day demands of the true physician. He labored to his own hurt. But he accomplished. He was modest and unpretentious in demeanor but great in achievement. His great work "Diseases of the Anus, Rectum and Pelvic Colon" is an imperishable memorial to his industry, enthusiasm and skill in his special line of work but no more enduring than his good name and Golden Rule observing character and fame. Weir Mitchell Dead.—The death of our eminent colleague and collaborator in neurology at the ripe age of 83 years at his home in Philadelphia is a loss to the profession and to science and literature which will be seriously felt. He was noted for his knowledge and skill in neurology and for fluency of speech of tongue and pen in the higher walks of medicine and literature. The rest cure for the brain fagged was a special feature of treatment in his practice and fat and blood and how to make them attracted much attention among his profession- al brethren as well as his literary novels "Hugh Wynn," etc. A bit of humor at the expense of Dr. Wm. A. Hammond when Hammond was at the zenith of his literary renown after Hammond had written his well- known treatise on diseases of the nervous system was the remark Mitchell made that Hammond was excellent with fiction. It was then being said by some rivals that Hammond made up some of his clinical records. These slanders may have inspired Hammond's "Robert Editorial. 99 Severne, his Friends and his Enemies," written about that time. A Diploma of Honorary Membership in the Academia Physico-Chemica Italiana of Palermo with medal of the first-class is hereby acknowledged with grateful appreciation. This distinguished society has done and is doing great work for science and human welfare thereby promo- ted. The distinguished and most worthy names of Marlotti and Bandero, known and appreciated world wide for their work and zeal in this branch of science tributary to medicine appear on the parchment to our great grati- fication. They are worthy and honored names in an honored and worthy place. The Editor Acknowledges with Thanks the receipt of the Diploma of Honorary Membership and a previous one of active membership in that most worthy, eminent and humane organization, The International Medical Association for Aiding in the Suppression of War, now so worthily presided over by our eminent colleague in the profession, Dr. T. A. Riviere. To this diploma the name of the distinguished Dr. Mazevy is also attached as secretary. We wish the great and good cause for which this worthy association stands and labors the early fruition of perpetual world peace. It is Obvious that money spent for the prevention of insanity will be a saving of intelligence as well as money to the state, but is spite of this fact thousands of dollars are spent in housing terminal cases and in laboratories for the study of pathology, and, with two or three exceptions, there is not a state in our union that is spending any money in organized prevention. In closing my paper I quote the following from the 6th Annual Report of the Trustees of the State Lunatic Hospital at Worcester, Mass., for 1838, of which Horace Mann was chairman. They say: "The great object at the hospital is the cure of insanity or the mitigation 100 Editorial. of its sufferings. The great object of the state and of individuals should be its prevention. The hospital is succeeding preeminently well in accomplishing the former; what can be done by the state and by individuals to effect the latter purpose?"—Dr. L. Vernon Briggs' con- cluding note to article in Oct. Jour. Insan. on Problems with the Insane. Recoveries from Insanity.—"Recovery, when applied to insanity, is somewhat a relative term. Each individual possesses his own standard of intelligence. What would be considered recovery in one case would not be in another. In short, insanity is a departure from one's normal mentality; consequently, we consider a case as having re- covered when he is restored to his own peculiar normal mental condition. Insanity is a very curable disease when treated early and properly. "Of cases given proper institutional care and treatment within the first month of the first manifestation of mental aberration, from seventy-five to eighty per cent will recover, but unfortunately it is rare for cases to be sent to a hospital in the earliest stages of the disease. "The foolish odium attaching to being sent to a hospi- tal for the insane is responsible for more chronic and in- curable cases of insanity than any other one cause. In this day of enlightenment it is strange that people still cling to the idea that insanity is some kind of a mysterious disgrace, instead of accepting the scientific conclusion that it is only the result of disease."—South- western Texas Insane Asylum Report. Eccentric people after insanity, if fully recovered, are apt to return to their normal eccentricity of character. Chronic incurable insanity usually comes about through neglect of right treatment away from home and in the hospital in its early stage. Seguin-Montessori Method with Imbeciles and Others.—"The recent publication in this country of an English translation of 'The Montessori Method' has spread far and wide a great curiosity to learn about, and Editorial. 101 a consequent knowledge of, this system of training and instruction. "In the introduction, by Professor Holmes of Harvard University, credit is given for the fact that 'much of the material used by Dr. Fernald at Waverley is almost identi- cal with the Montessori material,' and then, parentheti- cally, 'it may interest American readers to know that Seguin, on whose work that of Dr. Montessori is based, was once head of the school at Waverley.' In other words, the 'method' which is now in the minds and on the hps of every progressive educator is one which for sixty years has been quietly used in your school for the feeble-minded at South Boston and at Waverley, and prac- tically every one of our children has been taught by the Seguin method. The impress of Dr. Seguin has never left the school. His influence as an educator was lasting and far-reaching. "Further than this, from the elementary system has been developed the varied training, instruction and occupa- tion practiced in the manual training rooms at Waverley and in the open air on the farms at Templeton."—65th Annual Report, Waltham, Mass. Sch. for Feeble-Minded. CORRESPONDENCE Reputable Manufacturing Pharmacists do not Furnish Emmenagogues for Immoral Purposes.— Recently one of the leading manufacturing pharmaceutical houses received a letter upon the letterhead of a retail druggist, but signed by another name followed by the word "druggist." The person signing the letter may have been a clerk or successor of the druggist. The letter was as follows: "There is practically no sale for your Emmenagogue Improved Pills, as few ladies know anything about them, and we can give no advice, as we know nothing about them ourselves as to dose, etc. Please let us know by return mail and tell us how to use, dose, etc." Reply was made to the pharmacist whose name was on the letterhead, and was as follows: "We have our doubts about Mr being a druggist, for we cannot imagine any druggist not knowing that it is not only immoral, but criminal, to sell an emmenagogue except upon a physician's pre- scription. We believe that every druggist who sells an emmenagogue direct to the consumer is put upon his notice that it will be used for an immoral and criminal purpose. Emmenagogues on our list are intended ex- clusively for the prescription trade and we never know- ingly sell them for popular use or to be recommended and resold as remedies for female complaints, etc." 102 REVIEWS, BOOK NOTICES, REPRINTS, ETC. Danvers State Hospital Laboratory Papers, 1910, Charles Whitney Page series, reprinted from the Boston Medical and Surgical Journal and now offered in book form, is a collection of valuable contributions to the literature of clinical psychiatry of such merit that it should grace the library table and shelves of every physi- cian. The handsome, searchful, intellectual, psychiatric face of the editor, Dr. Charles W. Page, appears on the first page. Dr. Page contributes the first article. The other contributors are E. E. Southard, L. B. Alford, A. S. Hamilton, Anna H. Peabody, Albert A. Horner, Myrtelle M. Canavan, E. T. F. Richards, F. Robertson Sims, Gordon T. Brown, Newell B. Burns and Herman M. Adler. The subjects are: Laboratory Work of the Danvers State Hospital, Margin of Error in the Diagnosis of Mental Disease, A Study of the Dementia Praecox Group, in the light of certain cases showing anomalies or scleroses in particular brain regions; Ten Obscure Cases of Mental Disease, An Histological Study of the Thyroid Gland in Mental Disease, Incidence of Heart Disease in Acute Psychoses, Bacterial Invasion of the Blood and the Cerebrospinal Fluid by Way of Mesenteric Lymph Nodes, Bacillary Dysentery at the Danvers State Hospital, Massachusetts. Organisms Recovered from Dysentery Cases Studied Bacteriologically, The Persistence of Agglu- tinins for B. Dysentery in Danvers Hospital Cases, together with a series of Conglutination Tests, Mannite and Non-mannite Fermenting Organism in a Case of Dys- entery, complicated by hemorrhagic endometritis probably due to a third organism, Primary Adrenal Tuberculosis in a Case of Juvenal General Paresis, Case of Autoch- thonous Sinus Thrombosis, Diagnosis of Fractured Skull 103 104 Reviews, Book Notices, Reprints, Etc. as aided by the finding of brain tissue in the vomitus; Note concerning brain and other visceral weights in sixty-six subjects showing carcinoma or sarcoma; Some Effects of Overfeeding with Fats in Certain Cases of In- sanity. Concerning Labor Shifts.—"The combined effect of the twelve-hour day and the day-and-night alternation of shifts in the continuous industries is to produce a class of men who can be regarded as but little better than slaves to the machines which they operate. They are worn out more rapidly than were the slaves on the Southern plantations, and more effectually debarred from the common pleasures of life than many of the prisoners in our penal institutions," said Basil M. Manly, special agent of the federal bureau of labor in the recent in- vestigation of the iron and steel industry. "The twelve- hour worker," continued Dr. Manly, "has no time for recreation, no time for friends, no time for his wife, no time for his children to whom he is a dull stranger who comes and goes and whom they see less frequently and know less intimately than their school teacher." That the shorter work day is more economical as well as humane was the declaration of S. Thurston Ballard, flour manufacturer of Louisville, Kentucky, and member of the Federal Industrial Commission, who has had the eight hour shift system in operation since July 1, 1907, while all other flour manufacturers work their employees two shifts of twelve hours each. "While on two shifts we had 22 men on each watch, making 44 men to pack our output in twenty-four hours," said Mr. Ballard, "but when we changed to the eight hour basis we re- quired only 15 men to a crew, or 45 men in all, so that practically the same number of men were able to do the work. A man doing active or laborious work can do as much in 8 hours as he can in 12. We pay our men the same wage for eight hours of work that we formerly paid for twelve. In quality of output, in steadiness of Reviews, Book Notices, Reprints, Etc. 105 running, in loyal workmen contented and pleased with their condition, it has been a profitable investment." Ample rest and nutrition without alcoholics between shifts conserve energy and increase output capacity and prevent mistakes and consequent accidents in railway service. Neither brain nor brawn are perpetual motion machines in human or inferior animal organisms. Conservation of the Nation's Brain Power.—"If a training in pedagogics gave teachers a clearer and more practical insight into actual life as well as some apprecia- tion of the beginning pathological tendencies of humanity, many failures would be avoided and many difficulties would be overcome."—Krafft-Ebing. Our conduct and thoughts depend upon the capacity of our nervous system. The Brain is the individual— by it man lives, moves, and has his being. Education is the process of training the Brain and Nervous System by study and discipline. The aim of an education should be to develop the capacity of these organs to the utmost. Personal achievement measures the efficiency of any individual's brain. National greatness is an index of the citizen's brain-power. Social reforms have for their object the improve- ment of human conduct. In order to understand conduct we must have some idea of the mechanism which de- termines its character. A few years ago physicians were chiefly occupied in the attempt to cure diseases. Today one of their duties is to educate the public to realize the importance to the individual and the nation of preventive medicine. This remarkable change has been brought about by the study and avoidance of conditions which are the sources of disease. The advances made during the XlXth Century in the study of the brain and nervous system have been among the greatest achievements of the human race. The application of these discoveries to the study of educational and social problems has only just begun. Already the public is awakened to an appreciation of 106 Reviews, Book Notices, Reprints, Etc. the fact that men who are ignorant in regard to all questions connected with the structure and function of the brain are not the men best qualified to speak with authority upon the methods for training these organs. —Drs. Warren, Paton, Dalgren, Cotton, in the Training School. The preceding extract is a sample from this repre- sentative magazine of the Vineland, New Jersey, Training School for the Feeble-Minded. A Course of Lectures on Mental Pathology and Mental and Nervous Diseases has been inaugurated at the Central Indiana Hospital for the Insane at In- dianapolis, Indiana, under the supervision of the board of trustees of which Dr. D. H. Davis is president and of which Dr. George F. Edenharter is superintendent, assisted by his official hospital staff and others. Dr. Max A. Bahr being the clinical psychiater of the hospital, Dr. Frederick C. Potter, M. D., pathologist, E. D. Mar- tin, M. D., assistant pathologist. Dr. Bahr, Dr. Potter, Dr. Martin, Profs. Lindley, Sterne, Hutchins of Indiana University are the principal lecturers. The medical profession and students of medi- cine generally are invited to attend these valuable lectures so timely and so much needed. We suggest that lawyers be included in this invita- tion for many of the latter are an ignorant lot on these matters. Diseases of the Nervous System for the General Practitioner and Student by Alfred Gordon, A. M., M. D., (Paris.) Late Associate in Nervous and Mental Diseases, Jefferson Medical College, late examiner of the insane, Philadelphia General Hospital, Neurologist to Mount Sinai and other hospitals, etc., etc., etc. Second edition, revised and enlarged with one hundred and sixty-nine illustrations. P. Blakiston's Son & Co., 1012 Walnut St., Philadelphia, 1913. This is an interesting and well written book. The text embraces every legitimate subject in neurology up Reviews, Book Notices, Reprints, Etc. 107 to date and abounds in familiar and many new pictorial illustrations, not the least interesting being the author's original microscopic portrayals of a spinal ganglion in rabies, also one of the author's, showing involvement of the posterior columns of the cord in lead multiple neuritis. A case of left facial palsy caused by alcohol injected into the left facial nerve is interesting in descrip- tion and illustration as is also both text and picture of birth palsy. The many contracture and anaesthesia features of hysteria are especially well shown as well as the author's original drawing and description of multiple neuritis. Lumbar puncture and cerebro-spinal fluid are well and timely discussed as well as paresis and all of the classic nervous diseases. The neurone doctrine and secondary degeneration are well presented, likewise the author's original illustra- tions of hemorrhages and descriptions of apoplexias, embolisms and thrombosis. Though, for want of space, we have not half described in this valuable book the omitted subjects, viz: cerebral localization, inflammation of the brain and its sequences, the colored illustrations, the author's original showing of diplomyelia, porencephaly, amyotrophic lateral sclerosis, his presentation of syphilis of the nervous system, claudi- cation of the spinal cord, tuberculoma of the cord, written and originally illustrated which alone commend the book as meritorious above its price, ($4.00) for the practitioner and student and even for the neurologist in practice. The author's treatment of epilepsia, diseases of the cerebellum and brain concussion will interest any physi- cian. But there are other and more good things in this good book than we have space for mention. The "Wellcome" Photographic Exposure Record and Diary, 1914—If brevity be the soul of wit, condensa- tion is the essence of literature. Expecially is it so in these hustling days, when leisure is with many people 108 Reviews, Book Notices, Reprints, Ets. reduced to a minimum quantity. It is for this reason amongst others that the pocket guide to photography issued under the above title obtains so wide a circle of readers. It condenses into one small volume, clear, definite and precise instructions on a very wide range of subjects. All that long experience has taught the success- ful worker are here set forth in simple formulae and exact directions. Development, toning, fixing, printing, the various processes of production in warm tones, and colors, and the methods of dealing with errors of technique are explained, particular attention being directed to green and blue toning. Three editions of the Exposure Record and Diary are published, one for the Southern Hemisphere, one for the Northern, and the third, a special edition, for the United States of America, Obtainable from all photo- graphic dealers. Price 50 cents. American Civic Association Paper on National Parks.—Ex-President Taft's, Ambassador Bryce's, Hon. Walter L. Fisher's and Mr. J. Horace McFarland's views. This magazine is in accord with the President of the American Civic Association, the Secretary of the Interior and the other eminent gentlemen above named and we would like to see Hahatonka Park in Missouri made a national one. The conservation of our parks is a national need from a public happiness as well as sanitary point of view. Happiness contributes to health and good health in return promotes happiness. The Illustrated Handbook of the Mental Hygiene Movement and Exhibit we are here noticing is a fit companion of enlightenment on this important subject and ought to be studied and read by all physicians, philanthropists, the judiciary and legislators. Mental Mechanisms by William A. White, M. D., Washington, is number eight Nervous and Mental Disease Monograph Series and one of the best of that interesting Reviews, Book Notices, Reprints, Etc. 109 series for the neurologist and general practitioner. Dr. White's well-known ability as a medical writer has been noted heretofore and the book before us detracts nothing from his well-known capability for instruction in psychia- try. The National Committee for Mental Hygiene has published a document, entitled, "Summaries of the Laws Relating to the Commitment and Care of the In- sane in the United States," compiled by Mr. John Koren, who has made a special study of the subject. This has been issued with a view to securing uniformly good laws in all States, and as a means of raising the standards of care for the insane throughout the country, it being an accepted fact that States with highly developed systems of care and treatment of the insane also have the best and most complete laws on the subject. (Copies of this report will be mailed upon receipt of $1.00, sent to the Secretary of The National Committee for Mental Hygiene.) "The Modern Hospital."—A monthly international journal devoted to the building, equipment and ad- ministration of hospitals, sanatoria and allied institutions and to their medical, surgical and nursing services. Similar in purpose to the "Hospital," London, only less local in its aims. A long list of papers from competent sources of experience accompanies the preliminary announcement and augurs for the prospective usefulness of this new magazine. There is a place for such a magazine and we wish it success. The Truth about Wood Alcohol.—Wood alcohol has been the object of sensational attack by apparently well-meaning, but certainly misinformed persons, who have made the impression in quarters where ignorance prevails that its use even for ordinary industrial purposes is dangerous to health. This conclusion is unfair. It is a chemical solvent, used in the arts and manu- factures and harmless when not evaporated in close places 110 Reviews, Book Notices, Reprints, Etc. and extensively inhaled. It is poisonous as a drink and not intended nor adapted for drinking or cooking usage, only fools or crazy inebriates or intended suicides or the ignorant or with intent, drink it. This pamphlet is a very proper defense of its manu- facture. "The Culture of Joy."—Jennings and Graham, Publishers, of Cincinnati, Ohio, issue a series of excellent books for the Christian reader and aspirant after the Christian life whose author is Reverend Ora Lee Pride, M.A..B.D. Their respective titles are: "Culture of Joy," "Nature of the Child," "The Master Passion." These books are suitable for hospital and school libraries and not objectionable reading for most insane asylum patients and especially valuable for certain melancholiacs as well as the general reader. The wounded in spirit and the broken hearted will find the comfort in them that holy scripture imparts. The Rectal Plug by Rollin H. Barnes, M. D., St. Louis, is commended to professional consideration from what we know of the author's repute and ability in this line of observation and practice. A Method of Operating on Fistula Without Cutting Muscular Tissue by Rollin H. Barnes, M. D., St. Louis. This method being by a thoroughly capable practologist, editor of that well-known and worthy magazine, "The Proctologist," ought to receive, as it merits the considerate appreciation of the entire medical profession and especially of all operators in this line of work. The Institution Quarterly.—An official organ of the Public Charity Service of Illinois. The volume before us contains, as have its prede- cessors a mine of valuable information for all interested in psychopathy, psychiatry and eugenics. The editorial staff is composed of A. L. Bowen, Dr. Frank P. Norbury and Dr. H. Douglas Singer. Reviews, Book Notices, Reprints, Etc. Ill Earnest, intellectual and enthusiastic faces adorn the pages of this book and themes vital to human welfare therein discussed will entertain. and profit the many institution heads of other States among our many readers. Proceedings of the Mental Hygiene Conference and Exhibit at the College of the City of New York, New York City, November 8th to 15th, 1912. "A Sound Mind in a Sound Body." Phases of the Mental Hygiene Movement, etc., by Lewellys F. Barker, M. D., President of the National Committee for Mental Hygiene. A good and forceful presentation of a most important subject. La Spleene. Contribution a l'Etude des Per- versions DE L'lNSTINCT DE CONSERVATION PAR LE Docteur Henry le Savoureux, Interne des Asiles de la Seine et de l'lnfirmerie Speciale du Depot ancien Externe des Hopitaux de Paris, Paris G. Steinheil, Edi- teur, 2 Rue Casimir-Delavigne, 8, 1913. This is a much , dedicated book evidencing the author's appreciation of the high sources of his great neurologic acquirement, including the author's mother and many masters psychiat- ric. The chapters on "l'Ennui Normal" and "l'Ennui morbid" are especially instructive and interestingly por- trayed. They will well repay for the reading of the history and clinical records. We commend this valuable treatise to the alienist, the neurologist and the philosophic student of the human mind in its normal and morbid aspects. An apt quotation from Seneca (letter XXIV) to Lucullus, "De la tranquillite de l'aime" adorns the title page of this remarkable book. It is altogether a valuable contribution to the subject of melancholia and allied states and should have a place in every physician's library. The Training School Bulletin.—Devoted to the interests of those whose minds have not developed nor- mally. Is worthy of a place on the reading table of every physician and all others who would intelligently 112 Reviews, Book Notices, Reprints, Etc. manage or rightly advise or treat the rising generation. Following is a leading sentiment of its pages drawn from ancient history. "Once upon a time the citizens of a certain city in Greece were greatly interested in the nurture and training of children. When the question arose as to whether they should build a great public school or open a play- ground, it was decided to open a playground. Now, in the course of years, it came to pass that the citizens of that city advanced so far beyond the rest of the human race, that in all the centuries since, even to this day, the nations that have gone on building public schools and neglecting to open playgrounds have not been able to catch up with them."—Geo. E. Johnson, in the "Survey." The "Training School" is edited by the author of The Kallikak Family, Herbert Henry Goddard. Its motto is "We Believe in Happiness First, All Else Follows." Eugenics is its worthy aim. Its contents are always instructive in the line of human welfare. General Information Regarding the Hot Springs of Arkansas.—Legends and history and details concern- ing baths, physicians, etc. Issued free by the Department of the Interior at Washington. Physicians having occasion to send patients here for treatment and patients wishing to visit and use the baths should possess this document. Training for Citizenship.—An article on the Winston-Salem plan of Training for Citizenship. By Leroy Hodges, Petersburg, Va. is a Senate document of patriotic good citizenship purpose, showing the Winston- Salem, N. C., plan of training boys while in business for the obligations and responsibilities of citizenship and to despise the wretched rascally graft methods all too prevalent in our greater cities, for their welfare. This document was presented by Mr. Swanson, September 18, 1913. It ought to have a wide circulation over our crime and graft imperilled country. Honest and true patriotism must be revived for the country's salvation, especially in New York. Reviews, Book Notices, Reprints, Etc. 113 The Care of Milk and its Use in the Home.— From U. S. Department of Agriculture, Farmers' Bulletin 413. By George M. Whitaker, in charge of Market Milk Investigations, Dairy Division, Bureau of Animal Industry; L. A. Rogers, Bacteriologist in Charge of Research Laboratories, Dairy Division, Bureau of Animal Industry, and Caroline L. Hunt, Expert in Nutrition, Office of Experiment Stations. How to Prevent Typhoid.—Showing the importance of vaccination against typhoid and other important sanitary measures and dangers of typhoid. By Logan Waller Page, John R. Mohler and Erwin F. Smith. These are valuable documents for the people but they should come with more force from a medical re- search department of Health and Sanitation. From the latter report the following is of special interest: "This method of vaccination against typhoid fever has now been practiced on a large scale, chiefly in the armies of various nations, with striking results. It failed in the English Army during the Boer war, when there occurred 57,684 cases of typhoid fever and 8,020 deaths. But the cause of this failure is now well-known. It was supposed at that time that the inoculated men were protected by the inoculation, but it is now known that the temperature at which the typhoid cultures were killed for these inoculations was too high (60 to 65° C). It has been demonstrated repeatedly since that date that cultures killed at this high temperature lose almost all their protective power and the bacterial cultures now used are sterilized at a temperature 10° lower (53° C. for 1 hour). "But in other places, for instance in the Japanese army at the time of the Japanese-Russian war, the results were very striking. The Russian army was largely incapacitated by fever, while the Japanese army had practically no cases of fever. 114 Reviews, Book Notices, Reprints, Etc. "Recently in the British army in India typhoid inoculation has been practiced on a large scale, and very careful records have been kept of all the cases occurring among about equal numbers of non-inoculated and in- oculated soldiers in the same regiments and subject to the same conditions. We now have records for 20 such regiments, and they show that even including one regi- ment which was inoculated with cultures heated too high the troops which had been inoculated have suffered very little from typhoid in comparison with the uninocu- lated. "If we exclude this one regiment and consider the regiments inoculated with cultures subjected to a mini- mum quantity of heat, there have been about ten times as many cases among the uninoculated." Valuable sanitary prophylactic measures are recom- mended in this interesting and important report. Opium Not a Habit-Forming Drug.—Morphinism, the Disease, its Aetiology, Pathology, Rational Treatment and Cure. By Dr. C. H. Bartlett, St. Louis, Mo., U.S.A., 1913. This is a scientific showing of the basis of the so- called opium addiction habit and is, in the sense meant by the author, correct. Regular taking of opium or its derivative salts for a considerable length of time is a disease engendered imperative habit calling for the anodyne and nerve center and peripheral nerve tran- quilization which it both relieves and disturbs. Opium is a therapeutic paradox. The author presents his case in its true light, thus: "The impression prevails, among the medical pro- fession, as well as the laity, that opium, its principal derivative, morphine, and the various other derivatives obtained from the drug, are habit-forming. I fully realize that any statement contrary to the fixed, though faulty, opinion of the medical profession will meet with severe criticism, yet the knowledge gained from long study, and association with those afflicted with that diseased condi- Reviews, Book Naticts, Reprints, Etc. 115 tion of the nervous system caused by the use of the drug, warrants me in making the statement that opium, its alkaloids and derivatives, are not habit-forming drugs. "The use of morphine or opium in its various forms, excepting in a measure, opium smoking, does not produce a habit. It is not a habit-forming drug, but is decidedly a disease-producing drug. The exception in opium smoking is made to cover what opium smokers term the 'bunk habit,' the social feature which leads the unfortu- nate victim to the use of the drug, and smoking the drug produces the diseased condition. The use of morphine or opium in any form, including opium smoking, produces effects terminating in immediate and pronounced patholog- ical changes in the human system, causing a specific disease requiring specific treatment." The author concludes this valuable brochure with the following human and true professional advice as to treatment: "When the drug diseased victim appeals to the physician for relief, no matter how hopeless his case may appear, do not turn him aside with the advice, 'quit using the drug, it's only a habit,' but give him the same consideration, kindly treatment and relief that would be given if he were afflicted with any other disease. The physician must be ever mindful that he has a disease to treat and not a mere so-called addiction to palliate." The author very properly enjoins secrecy in prescrib- ing opiates. A similar principle as to therapy might wisely be followed for the welfare of the subject as to prescribing alcoholics and a similar view also might well obtain among physicians as. to the nerve center diseases of habitual and periodic alcoholic inebriety. Lb Alterazioni Nucleari delle Cellule Radico- lari in Seguito a Resezione dello Sciatico.—Dr. Eugenio Aguglia, Assistente. Estratto dalla Rivista Ital. di Neuropathologia, Psichiatria ed Elettroterapia. Diretta dal Prof. G. D'Abundo. 116 Reviews, Book Notices, Reprints, Etc. The nuclear changes in the cell are well described with accompanying illustrations. This brochure is of especial interest to the clinical neurologist. Statistical Studies of the Insane.—By J. V. May, M. D., Albany, N. Y. Member New York Hospital Commission.—From Amer. Jour. Insanity. This is a valuable subject ably treated by the author, especially for the alienist and sanitary statistician. The author's observation gives a remarkable showing of re- coveries of the psychoses when timely treated after their onset and admission. Of 627 cases of manic depressive insanity, 235 entered hospitals within 15 days after the onset of the psychoses, 54 from 15 to 30 days, 100 from 30 days to two months. Three and three-tenths per cent re- covered within one month, 38.8 per cent after one to three month's residence, 15.6 per cent 4 to 6 month's residence, 12.6 per cent 6 to 7 months, 8.6 per cent 8 to 9 months, 7 per cent 10 to 13 months, 4.5 per cent 14 to 17 months, 4.8 per cent 18 to 24 months, 4.8 per cent were in the hospital more than 24 months; 57.7 per cent of the whole number of cases recovered after a hospital residence of less than 6 months. Chronic Intestinal Stasis.—By William Seaman Bainbridge, A. M., Sc. D., M. D., New York City—In Maine Med. Journal. An instructive contribution for the abdominal surgeon and a suggestive one for the neurologist who considers brain and nerve tone in relation to enteroptosis, intestinal stasis. La Cyclophrenie.—(Psychose circulaire) par Theo- dore Rybakow. Professeur de psychiatrie a l'Universite de Moscou. Directeur de la Clinique Psychiatrique. This valuable contribution to the literature of psychia- try comes from Moscow in the distinguished professor's tongue. A resume in French also comes with this book so that the French as well as the Russian reader may Reviews, Book Notices, Reprints, Etc. 117 - enjoy it. The author makes cosmopolitan quotations among which he includes Alienist and Neurologist collab- orators. This book is worthy of further notice and may later receive the same from us. Publications of The National Committee for Mental Hygiene.—Sent upon application, free, or for the price indicated below. No. 1. Origin, Objects and Plans of the National Committee for Mental Hygiene; the mental hygiene move- ment; State Societies for Mental Hygiene; information regarding the problem of mental health and the care of the insane. No. 2. Principles of Mental Hygiene applied to the Management of Children predisposed to Nervousness.— By Dr. Lewellys F. Barker, Professor of Medicine, Johns Hopkins University. (Issued March, 1912.) No. 3. Summaries of the Laws relating to the Com- mitment and Care of the Insane in the United States. Compiled by Mr. John Koren. Price, One Dollar, post- paid. (Issued September, 1912.) No. 4. Some phases of the Mental Hygiene Move- ment and the Scope of the Work of the National Com- mittee for Mental Hygiene. An address by the President, Dr. Lewellys F. Barker, at the 15th International Congress on Hygiene and Demography, Washington, D. C, Septem- ber, 1912. Requests and orders for pamphlets and reports should be addressed to Clifford W. Beers, Secretary, No. 50 Union Square, New York City. Principles of Mental Hygiene Applied to the Management of Children Predisposed to Nervous- ness.—By Lewellys F. Barker, M. D., Professor of Medicine, Johns Hopkins University Publication of The National Committee for Mental Hygiene. Origin, Objects and Plans of The National Com- mitteee for Mental Hygiene. 118 Reviews, Book Notices, Reprints, Etc. The Science of Human Behavior; Biological and Psychological Foundations. Maurice Parmelee, New York: Macmillan, 1913. From the Psychological Bulletin. Re- view by F. L. Wells. The Principle of Mental Tests.—Dr. Frederic Lyman Wells.—From Science. On Formulation in Psychoanalysis.—By Frederic Lyman Wells, McLean Hospital, Waverly, Mass.—From The Journal of Abnormal Psychology, Boston. Oct., Nov. Experimental Pathology of the Higher Mental Processes.—By F. L. Wells. From The Psychological Bulletin. Hereditary Chorea With Report of a Case.—By William A. Boyd, B. Sc., M. D., Westport, Conn. From the Boston Medical and Surgical Journal, November 6, 1913. Review of Sigmond Freud's "The Interpretation of Dreams."—F. L. Wells. From The Journal of Philoso- phy, Psychology and Scientific Methods. Navy League of the United States, Washington, D. C. The purpose of the Council of National Defense. American Association for Labor Legislation Program. Linking Life Insurance Companies to Public Health Movement.—By Engene Lyman Fisk, M. D., Medical Director Postal Life Insurance Company, New York. Read before the Reed College Conference on Conservation of Human Life, Portland, Oregon, May 9, 1913. The Adequate Punishment and Care of De- fectives and the Insane.—Being a reply to the letters of Julius Commedius Brutus. By E. S. Goodhue, A. M., M. D., LL. D., The Doctorage, Hawaii. From The Pacific Commercial Advertiser, Honolulu, Hawaii. Reviews, Book Notices, Reprints, Etc. 119 Economic Influence on the Medical Profession of the Periodic Examination of Insured Lives.—By Eugene Lyman Fisk, M. D., Medical Director Postal Life Insurance Company, New York. Address before the American Association of Life Insurance Examiners at Minneapolis, June 16, 1913. Reprinted from the Cin- cinnati Lancet-Clinic. Some Remarks on Bronchial or True Asthma.— By Harold DeWolf, M. D., The Glen Springs, Watkins, N. Y. From the Medical Record. A practical instructive paper read before the Schuyler County, New York, Medical Society. Health Circular.—Health Department of St. Louis. A good advice concerning eyesight. Circular of the School for Health Officers, September, 1913. Harvard University and Massachusetts Institute of Technology catalogue and announcement. Dynamic Psychology.—By Dr. F. L. Wells, McLean Hospital. Psychology and the Medical School.—By E. Stanley Abbot, M. D., Pathologist and Assistant Physician McLean Hospital, Waverley, Mass. Some Problems of the Institution Library Organ- izer in the State Hospitals.—By Edith Kathleen Jones, Librarian at McLean Hospital, Waverley, Mass. The Surgical Treatment of Chronic Intestinal Stasis.—By William Seaman Bainbridge, A. M., Sc.D., M. D., New York. Professor of Surgery, New York Polyclinic Medical School and Hospital, New York City. From The American Journal of Gastro-Enterology. Origin, Obiects and Plans of The National Committee for Mental Hygiene.—The Mental Hygiene Movement, State Societies for Mental Hygiene, Descrip- tion of Mental Hygiene Exhibit, List of Publications. 120 Reviews, Book Notices, Reprints, Etc. Published by The National Committee for Mental Hy- giene, 50 Union Square, New York. 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. Price: One dollar, postpaid. Contains valuable information for all interested in the removal to or from hospital or sanitaria and the care thereof, medical and legal. Le Syndrome Atavisme ou Zoanthropoidisme Mental, par le Dr. Paul Courbon, Medecin de l'Asile d'Alienes d'Amiens. XXIIe Congres des Alienistes and Neurolo- gistes, Tenu a Tunis. Paris, Plon-Nourrit et Cie, 8, rue Garanciere—6e, 1913. Rapport sue le Traitement des Maladies des Pays Chauds dans les Stations Thermales et Clima- tiques.—Par le Dr. Edmond Vidal, Medecin Consultant a Vichy. IXe Congres International d'Hydrologie, de Climatologie et de Geologie, Madrid, Octobre, 1913. Humanizing Criminal Law.—By Arthur MacDonald, Washington, D. C. Author of Juvenile Crime and Ref- ormations. Affezione del Cono Midollare in Seguito a Rachiostovainizzazione.—Pel Dott. Eugenio Aguglia, Assistente. Estratto dalla Rivista Ital. di Neuropatholo- gia, Psichiatria ed Elettroterapia. Dirretta dal Prof. G. D'Abundo, Fasc. 9, 1913. Istituto di Clinica delle Malattie Nervose e Mentali e di Antropologia Criminale delle R. Universita di Catania diretto dal Prof. G. D'Abundo. Prof. Abundo needs no further commendation other than his name as our Italian readers will appreciate who have read other contributions from his experience and his facile and instructive pen. Reviews, Book Notices, Reprints, Etc. 121 The Intervertebral Foramen.—An Atlas and Histological Description of the Intervertebral Foramen and its adjacent parts; by Harold Swanberg, Member of the Am. Assn. for Advancement of Science, with introductory note by H. A. Santec, A. M., M. D. Illustrated by sixteen pages of plates from the best halftones printed on engraver's proving paper. None of these plates have appeared before, being especially en- graved for this work. Text is on best book paper and covers over 100 pages 0" by 9". Elegantly bound in silk. ^3.00 postpaid. Chicago Scientific Publishing Co. This is the only book on this subject extant. The intro- duction by Professor Santce is a special commendation for this book. Professor Santee's introductory note and the author's preface shows this book to be unique and largely original. Though the field of this book is restricted, it is sufficiently broad to form the anatomic basis for several schools of practice. Mr. Swanberg shows by actual sections the exact relations of the first dorsal nerve at the intervertebral foramen. A study of his work will help to determine whether compression of the nerves at this point is likely to occur: and whether, therefore, there is substantial ground for the doctrine that such compression is the immediate cause of all or of a consid- erable number of pathologic conditions, claimed to exist by schools of chiropractice and osteopathy so-called. Here are 2 pages of the new edition of "Formulas for Infant Feeding. There are 60 more pages just as inter- esting and helpful ~ and a copy can be had without Melin's Food Co. Boston, Mass. Panopepton first of all and always a therapeutic Food Exhibits at moments of urgent need energising and sustaining effeets often i - "remarkable"—so described by the physician; peculiarly useful as an "acCer I" far the convalescent and the invalid; having many special uses—in the "r ing" of infants, for instance. In fact, Panopepton, the perfectly soluble- hi;; ble food for the sick, proves a peculiar "ability tor good service" his patient in a wide range of conditions. ?-; ;' 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 Emerson A. North, M. D., Resident Physician Georgia E. Finley, M. D., Medical Matron For descriptive yearly report address H. P. Collins, Business Manager. College Hill, Cincinnati, Ohio. THE ALIENIST AND NEUROLOGIST Vol. XXXV. St. Louis, May, 1914. No. 2. THE INFLUENCE OF SUBTLE AND UNDETER- MINED FORCES IN THE ESTABLISHMENT, DE- VELOPMENT AND MAINTENANCE OF RACIAL CHARACTERISTICS. By E. S. Goodhue, M. D., L L. D. "There is no chance in results."—Emerson. MANY of the ethnological distinctions and differences which have arisen in the gradual evolutionary pro- cesses affecting mankind, are easily traced to their causes by scientists and historians, but there are other important ethnic variations and modifications which do not so readily yield the secret of their action even to the most careful and assiduous student of the subject. Like all unrevealed and unexplained manifestations of cause and effect, to the untrained mind they have become mysteries; to the scientist, problems. We are fairly agreed upon the fact that, notwithstanding our inability to determine the cause of a particular mani- festation, the cause still lies anteriorly to the effect, and has acted or is acting in a purely natural way. We eliminate all occult or supernatural factors as having (123) 124 E. S. Goodhue no part in the origination or furtherance of material results, offering what proofs we are able to furnish, and acknowl- edging that what we are unable to explain may be entirely demonstrable at the right time and by the right person. In the study of racial differentiation out of a homo- geneous, primitive ancestry, it is as if one tossed a ball across the yard over considerable inequalities of surface and with an unmeasured force. The ball will go somewhere, at a given speed, over a given course, to a particular point, where it will stop. Roll the ball a second time with the same approximate impetus, and it will pursue a different course and reach a dif- ferent destination, and so on for an indefinite number of times the ball varies in its response to impulse. The end of each career was the physical destiny of the ball and, so far, what shall be always shall be; but the speed, the direction, the distance traversed, and the end of the whole movement, were an inevitable result of certain, unmeasured and unrecorded forces set in motion, and certain unascertained helps and hindrances to these forces occurring along the ball's journey; slight variations in direction and propulsion, irregu- larities of surface covered, and other unseen and perhaps avoidable conditions affecting the transmission of the ball. Could the forces have been accurately measured, and the helps and hindrances made exactly alike each time the ball crossed the yard, we should have known each time how and where the ball would go. We should have known to a mathe- matical degree. Chance could have no part in the transaction. But as the forces concerned vary with each propulsion, and we be- come conscious of dissimilar results, we lose sight of the cause in the effect, and say that the ball "happened" to go thus and so. Without dwelling upon technical nomenclature or fine distinctions in ethnic classification, we may well look upon the apparent and external characters of racial modification as we do upon the progress of our ball; purely the result of forces The Influence of Subtle and Undetermined Forces 125 which, if they have not been, might be determined and classi- fied. In dealing with the large question of anthropology and ethnology, a conscientious student feels obliged to accept the conclusions of Darwin and later investigators, who have modi- fied his theories upon the basis of new discovery and collabo- rative research. If we cannot accept the whole theory of any one evolutionist regarding the differentiation of species, we recognize that in the more distinct modifications of race, se- lection and variation have been determinative. Also, we must believe that the action of environment in its influence upon racial variation is less direct and potent than that exercised by ancestral characters in the germ-cell.* That physical surroundings have an effect upon not only plant but animal life is obvious to the most casual observer. This effect may show a clear relation to its cause, or such re- lation may be obscure, yet, as a rule, it is more readily traced to antecedents than is the action of heredity or other physio- logical influences. The phenomena furnished by the latter are difficult of interpretation, in the individual as well as in the race. As Quatrefages says: "Every movement which takes place in plants appears to be produced solely by inanimate forces. The transfer of mat- ter in particular, which is necessary for the development and sustenance of every vegetable, belongs to actions of this kind. "Can we believe that these forces, as they are known to us from innumerable experiments, could, if left to them- selves, have formed an oak, or even raised a mushroom? Can we believe that they could have organized the acorn or the spore, and hidden in those minute bodies the power of repro- ducing the parent? *Weissman makes a biological classification. His outline is as follows: 1. Blastogenesis (a) Amphimixis. 11. Somatogenesis (a) Kinetogenesis, (b) PhyBiogenesis. 126 E. S. Goodhue "And yet without them the vegetable cannot exist. But, in my opinion, nothing makes their real subordination more apparent than the importance of their part in the process of execution. * * * "Are we to conclude then that life is an intelligent force, conscious of the part it plays, and enjoying the dominion it exercises over the subordinate inanimate forces? Not at all. "Like these forces it is ruled by general and fixed laws. Nevertheless, we do not find in the application of these laws, and in the results to which they lead, the mathematical pre- cision of the laws and phenomena of gravitation and ethero- dynamy. "Their mode of action merely seems to oscillate between limits which remain impassable. "This kind of liberty, and the bounds imposed upon it, are conspicuous in the constant diversity of the products of life, a diversity which contrasts in so striking a manner with the uniformity of the products of etherodynamy. Crystals, when similar in composition, and when formed under similar circumstances, resemble each other perfectly; but we never find two leaves exactly alike upon the same tree." Let us examine briefly a few of the most important physical forces generally regarded as effective in inducing change in the individual. Perhaps of chief importance is geographical position, the place a man occupies as regards altitude, and isothermic influences. It is well known that altitude, or relative elevation above sea-level, is productive of temporary and permanent perturba- tions in the human body. Viault has shown that a residence for two weeks at an elevation of 4,392 meters caused an increase in the red blood corpuscles from 5,000,000 to 7,000,000 per cubic millimeter; in the third week this reached 8,000,000. A diminished pressure in the atmosphere stimulates the haematopoietic organs. We have, as a result, increased respi- ration, rapid heart action and, in the unaccustomed, various disagreeable sensations and symptoms, subjective and objec- tive. The Influence of Subtle and Undetermined Forces 127 Those who reside permanently in elevated regions, be- come used to the effects of diminished barometric pressure, but give evidence in many ways of physical, physiological and psychic changes brought about by the continued influence of their altered environment. These changes are generally perceptible and comparative- ly rapid, giving rise to what are called acquired characters which, in turn, act upon the reproductive cells modifying them more or less, they themselves becoming congenital. At all the points between sea-level and an elevation com- patible with permanent residence, the extent of bodily pertur- bation is ascertainable, and the various phenomena of heat, moisture, atmospheric pressure, wind velocity, and electrifica- tion, may be accurately measured. Light is a very important influence which is being more and more studied in its relation to animal life, particularly man. We are learning with an expanding knowledge of its chemical properties that its effect upon the individual is prob- ably greater than that of heat or humidity. The latest experiments with the various divisions of the spectrum, have shown that excessive oxidation of light pro- duces a metabolism which in some conditions of the body is beneficial, but in others, may easily lead to nerve exhaustion. Actinism being a chemical effect, its constant action pro- duces upon the body a condition of nervous stimulation which cannot persist without becoming irritative and subsequently destructive to living tissue: "It is well known," says Professor Mathews of Chicago University, "that all the vibrations of the ether will produce those changes in protoplasm which the ions produce, and further, the character of the change in protoplasm produced by light varies with the wave length or the number of im- pacts per second. Violet light or the ultra violet rays stimu- late protoplasm, while the red rays, as a rule, do so very feebly or inhibit movement. By the electro-theory of light the other disturbances which we call light must be due to the movements of electrons or 128 E. S. Goodhue changes in the sun, either constituting a part of the sun's atoms, or associated with those atoms. * * * Chemical stimulation and light stimulation are identical." It has been demonstrated that certain rays of light are stimulating while others are depressing; that constant ex- posure to these rays induces a condition called neurasthenia, to which may be referred many of the deviations from a normal physical state. These alterations easily traceable to their cause, give rise to other modifications obscure and erratic in their develop- ment. They are probably biologic becoming congenital: they are probably the result of protoplasmic impressions of chem- ical origin, transmitted from one individual to another, and accentuated by compatible, physiological reactions the nature of which we have not determined. Doctor Woodruff, in his work on "The Effects of Trop- ical Light on White Men," says: "The latest work of our aathropologists is a careful study of each of the characters of each type of man with the pur- pose of discovering why that character is beneficial in that zone, and why a different character arose in a different zone. It is of vital interest to us now, for it explains why races al- ways fail to colonize in a zone markedly different from the home-land, and it teaches us how we can avoid these causes of death if we are compelled by business to reside temporarily in a climate to which we are physically unfitted. For instance, the shape and size of the nose and position of the nostrils are now fairly well proved to be a matter of selection of fittest variations. In the tropics where the air is hot and therefore rarified, more of it is necessary, and it is essential that there should be no impediment to the air currents, so that the nos- trils are open and wide, and the nose very flat. Such a nose is unsuited to cold countries as it permits masses of cold air to flood the air passages, and irritates the lining membrane, so that the nose must be large and have much warming sur- face, and the nostrils therefore are slender slits to admit the air in thin ribbons easily warmed. The air being cold is con- The Influence of Sttbtle and Undetermined Forces 129 centrated, and less of it is needed than in the tropics, and the slender nostril is no disadvantage. "The nasal index, or extreme width of nose divided by the extreme length, gradually increases as we go from colder to hotter countries, where we find some races with nose index much greater than one thousand, i. e., width greater than length. "It is now many years since it was first pointed out that the open tropical nostril was one reason for so much pul- monary trouble of negroes out of the tropics. Hence there must have been a natural selection in cold countries of one kind of variations—large contracted noses, and a selection in hot countries of the other extreme, so that the various types gradually arose." Food, upon which so largely depend repair and waste of tissue, the nutritional adequacy of the various structures and organs of the body, the response in a normal way of nerve cells to stimuli, and the maintenance of organic equilibrium throughout, is a constant and never diminishing necessity. It must be provided if life would be sustained, and its quality and quantity are regulated to a great extent by geographical loca- tion. Where people live determines to a considerable degree at least, what they shall eat, and what they eat affects not only their physical but their ethical, social and moral development. Another factor in the trend of variation is physical iso- lation, which exists when a number of individuals of a tribe or group, become separated from their fellows, and remain sepa- rated by some permanent barrier. This isolation may be vol- untary or involuntary, and is generally due to migration to some remote and inaccessible land, in pursuit of food or ad- venture. We have an example of this in the migrations of Poly- nesians from their distant home-land to the widely scattered islands of the Pacific ocean. Racial modifications have been great owing to this iso- lation and changed environment, but it is easy to connect the 130 E. S. Goodhue various Polynesian peoples through their common language root. They lived on islands small enough to make each settle- ment compact, while each archipelago was separate enough to render communication difficult, thus ensuring the preserva- tion of traditions and the emphasis of inherited habit. In this people particularly may be traced the effect of physiological isolation, producing still greater variation and modification; changes quite obscure and, in their action, too subtle for satisfactory analysis. Among important forces in the origination, development and persistent of racial variation, is that of climate. We have lost the pleasant etymological meaning of the word climate (aspect), which may be denned now as the to- tality of weather in a given geographical area; the condition of a place in relation to the various phenomena such as tem- perature, moisture, and so on, particularly as they concern animal and vegetable life. As will readily be acknoweledged, the individual is greatly affected by the atmospheric conditions which surround him, and some of the most serious and far-reaching perturbations to which the body is liable are due to climatic mutations. The pathogenic impressions of a climate possessing a humid day of heat following by a cold night with sensible moisture, are cumulative in their action, demonstrable, and easily recorded, but the ultimate effects, the insiduous disturb- ances of the thermo-taxic function, while appreciable in their totality, are as to action, confusing. In a paper which should have a larger reading, sent me by Doctor Ferguson of British Guiana, the author, says: "Nerve centers possess what may be called a memory of their own. The thermo-taxic center possesses also this quali- ty. The sudden exposure of the body to cold results in a reflex action which is not purposeless, but calculated to pre- vent the loss of heat. This highly complex action is the result of the accumulated experiences of the heat-regulating center, which has been subjected to the same kind of stimulus so The Influence of Subtle and Undetermined Forces 131 often that it reacts immediately and accurately against it. Here, then, we have three notable properties of this heat-regu- lating center; namely, its power of inhibiting its own im- pulses, its liability to be driven into a state of exaggerated ir- ritability, and its capability of retaining something of the impressions it has previously experienced in a manner which amounts to a sort of memory. From the birth to the death of a man, his thermo-taxic mechanism may be said to undergo a kind of progressive training. "In the foetus this mechanism develops, indeed, but its function is never called upon to exercise its full powers. It remains in abeyance, in a primitive stage comparable to that of the cold-blooded animals; so much so that at the. moment of birth it behaves in a way similar to what is observed in the latter. "Without experience of danger from outside, it does not know how to meet in a homoiothermic manner the variations of external heat. The temperature of the new-born child falls and rises directly with that of the atmosphere. But the heat- regulating center learns marvellously soon to bring into ac- tion its latent higher powers. "From that moment it is engaged in a ceaseless struggle with the variations of external temperature; and its increas- ing experience renders it ever more and more ready to meet all ordinary emergencies. But when it has to deal with at- tacks which are unusual either in kind or degree, it must nec- essarily find itself in situations to which it can adjust itself only with difficulty. It even happens, as has been pointed out, that the center may fail in its efforts at adjustment; and its function may be so deranged as to be thrown into a state of disorder. Even death may be the consequence. "We have already seen that each individual or race has a certain co-efficient of heat production, the result of accom- modation of his system to the climatic conditions in which he normally lives. We may also speak of a co-efficient of heat dispersion, of a capacity for actively throwing off heat under circumstances which threaten to induce its internal accumula- tion to a dangerous extent. The thermotaxic function of the 132 E. S. Goodhue northern European is concerned chiefly with the internal pro- duction of large quantities of heat and with its preservation from loss, on account of the coldness of his surroundings. That of the dweller of the torrid zone is trained to secure a minimum of production and a maximum of dispersion of heat, because of the hot climate in which he lives. It cannot be supposed that these two could suddenly exchange climates without perplexing, at least temporarily, their respective thermotaxic activities. We are justified in assuming that, when this nervous function by inherited tendency and ac- quired habit, manages to adjust itself with exquisite delicacy to certain meteorological conditions, it must needs be in dan- ger of a serious disturbance if suddenly exposed to an oppo- site set of atmospheric states. "The northern European who comes in robust health to the steamy heat of an equatorial swamp must abstain from hard muscular work, at least for a considerable period of time, if he hopes to find his thermotaxic function accommodating it- self gradually to the unaccustomed exigencies of the climate. "Were he to attempt at once to perform hard agricultural labor under the terrific heat of the sun and in an atmosphere almost saturated with steam, he would expose himeslf to con- ditions calculated to upset the physiological working of his thermotaxic mechanism. "Even the Negro, whose heat-regulating function is fitted both by heredity and acquired habit to withstand high degrees of external heat, gasps when doing hard muscular work at certain hours of the day in an atmosphere the temperature and saturation of which renders the throwing off of blood heat al- most impossible. "But the climate of an equatorial swamp is characterized not only by stifling heat plus steam during the day, but also by atmospheric changes at night which form a violent contrast therewith. "This nightly fall of temperature is accompanied by a precipitation of the steam of the day into sensible particles of moisture. The humidity of the night, especially from mid- night to sunrise, is intense; and the full exposure of the sleep- The Influence of Subtle and Undetermined Forces 133 ing body to it puts the thermotaxic function to a severe strain in order to preserve from loss the modicum of heat produced internally during the period of organic and systemic rest. * * * "The normal temperature of man's body shows a diurnal undulatory movement coinciding with the diurnal variation of cosmic heat. Whatever be the details of the process by which this diurnal curve of our temperature is brought about, it cannot be questioned that it bears some relationship to those meteorological undulations. "Those variations of atmospheric heat whose regularity is unchangeable, associated as they are with corresponding periods of systemic activity and rest, have so affected our thermotaxic function as to prevent it from ever attaining to the ideal of an absolutely uniform level of bodily temperature. * * * The more closely and intimately is man's thermo- taxic function brought into contact with these powerful pulsa- tions of nature around him, the more strongly is their impress stamped upon it. "On the contrary, the more effectively man's ingenuity enables him to shield himself against their influence, the less marked is the diurnal range of his normal temperature curve. "The force of these diurnal meteorological phenomena increases as the equator is approached; and they attain their maximum of regularity and intensity in the torrid zone. "For there the duration of the day is ever equal to that of the night, and the corrective influence of the seasonal lengthening's and shortenings of these two periods found in regions more distant from the equator, is practically absent. "And there more than anywhere else on earth, man's thermotaxic mechanism is incessantly brought under the spell of those diurnal atmospheric variations, * * * "In the daytime the nervous center has to deal with the period of maximum systemic activity and heat production. The muscles are toned and worked; the cardiac contractions are accelerated; metabolism is rapid in the liver and other internal organs; the brain is active. All this results in the production of a great amount of heat, especially when hard 134 E. S. Goodhue muscular labor is undergone, which cannot be allowed to ac- cumulate, but must be thrown off. "It is precisely during this period that the air becomes heated to a temperature not much below that of the blood itself, and saturated with watery vapor by the action of the vertical sun on the marshy surface. "How is the heat-regulating center to deal with such a situation? As we have seen, the difficulties presented to the thermotaxic function by a hot atmosphere is immensely in- creased by its saturation with steam. "In an atmosphere at 90° F. or higher which is dry, the throwing off of excessive blood heat is facilitated by the evap- oration of the sweat, although the loss by radiation is reduced to a minimum. But when that hot atmosphere is almost sat- urated with watery vapor, even sweating ceases to afford much help to the heat-regulating mechanism; the sweat can- not be sufficiently evaporated. "In such conditions the temperature of the blood can be kept normal only by a minimum of internal heat production, and hard muscular labor tends to produce a rise of tempera- ture and thermotaxic disorder. Obviously the thermotaxic center will be put to a great effort by this ordeal of heat, especially in individuals and races having a high co-efficient of heat production. "When these thermal conditions, internal and atmos- pheric, are extreme, the strain on the center may be so severe as to produce on it a pathogenic impression. And this will not immediately be effaced; for, as has been pointed out, this nerve center possesses a sort of memory, and retains not only impressions which produce a tonic effect, but also such as are pathogenic in force. "I do not say that this nerve center may not undergo these trials once, twice, or a number of times without becom- ing deranged. But it seems undeniable that the repetition of these pathological impressions, of opposite kinds by day and night, are calculated to produce cumulative effects on the thermotaxic center the tendency of which is to goad it into a state of exaggerated excitability, into a condition analogous The Influence of Subtle and Undetermined Forces 135 to that of the motor nerve centers under the action of strych- nia. "In that state a comparatively slight excitation is capable of throwing it into a disturbance of more or less violent and explosive character." These observations, founded upon a careful analysis of the facts, indicate how large may be the field for the action of impressions, pathogenic and benign, resulting from one ex- trinsic force only. What "acquired characters" and congenital prepossessions may not result from the combined influences of all the various external phenomena which act upon the in- dividual in his course through life: helps to the advantageous development in the establishment and adequate equipment for vital persistence and transmission, or hindrances to the normal action upon important centers, of stimulating or inhibitive forces as yet subtle and undetermined? Before going any further, let me quote a few brief ex- tracts from scientific evolutionists regarding the more obscure causes of racial modification; the unmeasured impulse, and the helps and hindrances of which we have spoken in our refer- ence to the toss of a ball. Huxley says: "It is a truth of very wide, if not universal application, that every living creature commences its existence under a form different from, and simpler than, that which it eventu- ally attains." F. W. Hutton: "The chief difficulty in investigating the problem of the transmission of acquired characters, is the difficulty of deter- mining what are acquired characters. "The evolution of the species of Deilephila shows that the evolution of the marking follows throughout a certain law; that it proceeds in all species in the same manner, all the species seem to steer towards the same point; and this gives the impression that there is an external law of evolution, which, like an impelling force, determines the future phyletic modifi- cation of the species." Ouatrefages: 136 E. S. Goodhue ,'I believe with the majority of those that respect modern science, that organized beings owe their distinctive character- istics to a special Force, to a special Cause, to Life, which in them is associated with the organic forces." In view of all the facts and the conclusions of able stu- dents of the subject, it seems reasonable to assume that the Special Cause, Force, or Life, mentioned is no more than an ancestral force of the germ-cell; an inherent Tendency to im- pulsion in a particular direction, modified by all the various influences which we have been considering, and possibly by others which we have not taken into account. This Tendency is direct, potent, and determinative, subject to compensatory displacement, yet persisting in spite of all obstacles in its path, bearing towards beneficent development always, and at the end of the series reaching a perfected type. Speaking only of the physical development of the individ- ual, what we have termed the subtle, undetermined forces, act continually in vitalizing the Tendency which, in itself per- sists towards an outward, definite form. This perpetual progression, the life of evolutionary proc- esses, is modified while inducing changes in the organism it dominates. In the individual there is a form termed characteristic be- cause racially indicative of long-continued biologic bias, with outlines general enough to include a whole race, but influ- enced by controllable as well as uncontrollable factors, and, in the end, made subservient to particular necessities. Although the individual receives much from his ancestry besides the biologic bias, the complete ancestral correlation is not enough, fortunately, in the race to neutralize later influ- ences into whose power the individual has been driven by the vicissitudes of life. While a degree of physical and mental personality comes by accretion, and individuality reaches its full development something after the manner of the crystal, after all, there is still the directing and determining Force which never ceases to act, though often under the stress of de- structive modification. For the seed of this tree continues to produce fruit after The Influence of Subtle and Undetermined Forces 137 its kind, perpetuating characteristics of the genus while main- taining the individuality of the species. Nor can we force this tree which exactly resembles a progenitor, immediately to give us fruit characteristic of an alien race, or of a species unclassified; not indeed until there has elapsed a period of time sufficiently long to establish the impression of a definite variation—until the evolution has completed its cycle. Even the inherent Tendency will persist in the eliminating process of growth, and a silent war go on, as pathetic in many ways, as the wars of more perfected forms of nature. We must stand in awe of this conflict which is taking place in all nature, destroying the connecting links between what we have been and what we are. The original pervading and pervasive Force continues to sway the expansive move- ment, at the same time yielding to the action of apparently ac- cidental influences. We may compare the one to the irrepressible, impulsive assertion of enthusiasm in the young; the other to the experi- enced, immovable and apparently unsympathetic yet really helpful attitude of the old. Whatever happens, the exuberant manifestation will continue to be modified. While we may never be wise enough to determine what is the exact nature of the Force which urges the cell on to a definite, ultimate form, and cannot name the agencies which are jealous of their own through the most complex processes of evolution, we know that the destiny of this or that indi- vidual is outlined in his atomic organization, and guarded by a latent but unerring vitality; that both of these guardians of individual autonomy will be influenced by unforeseen, extrinsic forces and continue to be so modified. As the change is gradual and continuous, the more dif- ferential series there are, the greater will be the modification in each. It becomes a matter of compound interest. The form of this child born to day is the result of certain, special forces set in motion in a certain, special way—a long- drawn synthesis. In other words, a composite. 138 E. S. Goodhue It is the product of an accumulation of psychic and phys- ical events which cannot again be assembled for the same spe- cific result. Never again shall another individual be estab- lished in life under identical conditions, for the forces and entities concerned are intangible. The psychic impression has passed, and so has the period of time in the history of men and things. Hence our different faces and characters. There is no duplicate mould for us; our own nearest of kin mus* assume his unchallenged individuality. A patent of physical preroga- tive is given to each new-born child. A cast of our physical aggregate may be taken, but never of all that goes to make us what we are. Who can tell even of himself what forces helped to dif- ferentiate him from all his fellows? What particular mental states impressed most the sub- jective cell? More than this, the individual is surrounded by what will never surround another individual in quite the same way— quantity, quality, time, place, potentiality. It is to be inferred that these conditions will sometimes resemble each other in some respects, and such being the case, that the resulting products will in some respects be alike. This may be seek in children of the same parents, the is created at a different period of time, at a different epoch product of an identical ancestry, but that is all. Each child of parental life, by a different psychic and physical impres- sion. While these differences do not apply to twins, there is the inevitable difference in the primitive cell elements, the dif- ference in the subsequent nutrition when pre-natal advantages are given to the fittest, and possibly a dissimilar sex develop- ment. Upon these differences may be based more appreciable ones which persist throughout childhood, and even to the end of life. But we always secure what we call a Family Resem- The Influence of Subtle and Undetermined Forces 139 blance. This, like murder, will out. It betrays itself some- how. It may be a form of face or body, an eye glance, a mo- tion, a gait, an oddity of speech, a dimple, a mole, a wart, an intonation, a nod of the head, a laugh, a handwriting, a vicious curve, a mode of dying. We may have a "close" resemblance between strangers, because the forces concerned were in one or more respects similar, producing a so-called "double." When two persons bear a strong resemblance to each other, we may reasonably infer that they are somewhat alike in char- acter. Expert penmen take this into consideration, and so should teachers who have qualified themselves by a study of psychology. In explaining such resemblance we may profita- bly enquire not only into the early environment of the per- sons concerned, but who their far-back ancestors were; what were the ascertainable influences which helped to make them what they are. In this connection recorded genealogies would be useful, as a sort of index to guide us in our study. The child of a rich and cultured family may be found to be the product of centuries of family ignorance and stupidity, while the street arab may prove to have descended from gen- erations of culture and intelligence; the accidental offspring of a drunken, poverty-stricken father and mother. All that goes to make a race bears upon the physical as well as the mental part of the individual, and vice versa. How else can we explain the racial character? A day existed when the typical Jew was not a type of his race, when he gave no evidence of his limited inheritance. He showed traces of two or three other races, butj no well- defined racial characteristic. While we find today in each new-born child of . pure Jewish ancestry, a characteristic in- dividual of a specified race, we have nothing more than the union of certain primitive elements acted upon by certain spe- cific forces; and the conditions involved remain peculiar. The vital, racial Tendency may persist in the descendants of the Jew, but a change in the product will ultimately result, 140 E. S. Goodhue owing to the entrance of certain subtle and undetermined forces which cannot remain identical through indefinite pe- riods of time. The mere fact that this child is born in an age of tele- graphs, railroads, telephones, steamboats, automobiles and aero- planes, provides modifying forces which will have their in- fluence in determining a changed cell and an altered individ- ual. It is utterly imposible to "duplicate" a man. The result will be an a-typical Jew according to the old standards; a modern Jew instead of the Jew of yesterday. In the typical composite face you may trace the history of a people, although the form belongs to an individual alone. The facial value becomes established through the patency and persistence of recorded factors, and receives a name from its time and generation, but it is not permanent, and when some centuries hence, our descendants look upon a Jew, they will know him for what he is, and not for qualities they find attributed to him in ancient books. This has been the history of races. We cannot change the particular or general indi- viduality by any hasty process of causation or elimination. It has grown slowly and must be modified in the same gradual way. It is a law of physics that the larger the body and the longer it remains in motion, the greater will be its momentum, and the slower the stopping will be. If we transplant Irish stock to French soil, for instance, it will still produce Irish fruit, until, once more, the force of new influences has modified the type. The Irish will be- come French in name and to the eye, but the individual will insist upon retaining something racial which, in time, will be regarded as a French characteristic. Red hair in the Norman French is a sort of ethnic defiance. The French people have made the best of it by calling it French. We cannot have a race with peculiar and definable characteristics until its gen- erations have been placed under the influence of forces which produce such characteristics. With all the individuality ex- pressed by the face and form of the new-born child of a par- The Influence of Subtle and Undetermined Forces 141 ticular race, we have still only the establishment of an outline; development will bring into play passive muscles as yet un- affected by an unasserted will. The essentially French bias (cell) will develop its body and mark its material emphasis in a distinctly French way, securing certain characteristics by use and eliminating others by disuse. The pretty baby i= only a temporary expediency, and awaits more definite and char- acteristic sculpturing, while the intrinsic forces which are vi- talizing and propelling, the environment which is persistent and inductive, are still factors. What pushes the leaf out of the seed, continues to make its presence felt, and while we have in the young plant a dif- ferent thing from the perfected tree, there are marks of iden- tity which the busy forces are urging to a typical expression Df individualty. When, at last, the order has been established, and the child is born, a different set of conditions begins to modify a more yielding Tendency. And these new conditions are ruder and less considerate of ancestral preferences. An unused mechanism is started by the influence of the air, by the stimulation of food which is no longer supplied unconsciously; by the action of light, until adaptation ensues. Then in the space which time allows for growth, we see mar- vellous changes. We may see the movement of expansion al- most as we see the night-blooming sereus open. Grandmoth- ers will tell you that pretty babies make ugly grown-ups, and vice versa. The change is recognized but not accounted for, and like other acts of nature, little understood. We do not take into account the forces within and without, aiding each other in the work of growth; we are ignorant of the artist's design, and cannot tell where the lines of shading shall be placed, but they are the finishing touches, and without them the design cannot be comprehended as a work of art. Slowly but painstakingly nature has carried on the work laid out, and given at last the face which belongs to no other person in the world but one. 142 E. S. Goodhue Besides subtle forces it is most true that appreciable, ex- trinsic influences, intellectual, moral, social and religious, are most potent, and all have their part to do in moulding char- acter, and so altering physical expression; in establishing eth- nological if not anthropological features. Norman Bridge has said that "learning is the establish- ment of cerebral automatisms. A given process of mind is re- peated over and over and over again, becoming automatic. The life of the student is devoted to establishing this condi- tion." So with the attainment of a physical shape. Nature, through hidden forces acting upon the cell, establishes bio- logic automatisms subject to extrinsic inhibitions. While a large amount of this work is done for us, we are required to contribute incessantly towards the development of our own individualities, in the direction of physical, moral and intellectual betterment—in all ways leading upward and on- ward. We are permitted, yes, required to assist a very present and abiding outgrowth and upgrowth; in the elimination of our grosser nature, in the curtailment of inherent propensities, in the final adjustment of our bodies with all that contributes to their maintenance and perfecting. Herein lies one of the advantages of recognizing the ex- istence, if not the character of undetermined forces, and in placing ourselves in the way of helping instead of hindering a beneficient evolution. As Huxley says: "It seems impossible that any variation which may arise in a species of nature should not tend in some way or other, either to be a little better or a little worse than the previous stock; if it is a little better it will have an advantage over and tend to extirpate the latter in this crush and struggle." The person who assures us that he can tell by a man's appearance what vocation or avocation that man follows, may be over positive, but it is certain that he has some basis for his confidence. An individual's constant thought passes into facial ex- The Influence of Subtle and Undetermined Forces 143 pression as definitely as a painter's colors are placed upon the canvas. How are the emotions of the mind traced upon the mo- bile face, certain significant shadings, mysterious lines drawn here and there, giving to each person his characteristic ex- pression! How inadequately the words, "She is sorrowful," con- vey the picture of a grief-bound face. Love, hate; content, agitation; joy, sorrow; sympathy, coldness; pity, indiffer- ence—all expressed by the action of certain facial muscles which, like faithful servants, do as they are bidden by a Mas- ter will. The subtle evidence of mentality is so suggestive in the face of every man, that intuitively we have come to judge of a person's character by his face. The outward mark of a gentle, refined mind is unmis- takable, and as plainly do we recognize the effects of a brutal- ized life. As a rule, large, heavy-faced, coarse forms belong to a like natures. There are exceptions, of course. The ignorant, heavy-browed Australian with his inartistic features, his high- cheek bones and sinister expression, is a very low order of man. His mind deals with the simplest of concrete things. For some reason, his evolution has been checked, or pos- sibly the forces at work in other races—the inherent, intrinsic tendency which compels the developing individual gradually to part company with the grosser elements of his nature, and mould him into something better than he was—are in the "un- developed" latent or perhaps dead, although I believe that the tendencies towards a better type neevr cease to be available for the uses of evolution. This stranded relic of a primitive age appears to be af- fected only by extrinsic forces. There is a psychic inco-ordi- nation, and while impressions upon the periphery continue to be made, the internal response is small, and the man lives in the fulfilment of insignificant automatisms. He may well be called biologic flotsam—an ethnic anom- aly. 144 E. S. Goodhue In this light, it is interesting and instructive to study the different races of mankind, and to enquire into their varying susceptibilities to educational and physical improvement, their response to all the ethical and social influences which so affect special sections of the human family. More than this, in those whom educational forces have not reached, we may be astonished to discover the almost magic touch of contact with more advanced peoples, and the quick response which even backward races make to unaccustomed stimuli. Here are pencil touches indeed, though our advantage over the set picture which remains unresponsive to the artist's de- sign, is truly great. We have merely to set factors at work. In the beginnings of development there is an excess of manifestation; repair exceeds waste, and we have rapid growth; here is our opportunity to be helpful in the training of children or the direction of the immature or undeveloped man. Then follows the adult product, waste and repair being equalized. By and by waste is ascendant, and the familiar face ages. Death, which comes when the extent of the loss is incon- sistent with the discharge of normal functions, is at this pe- riod not a calamity but a sequence; a perfecting and comple- tion of progressive modifications. It has been said that there is often a growing resemblance between those who are closely associated in intimate relation- ships, as between husband and wife. If there be such a re- semblance and it is not due to causes already discussed, I should attribute it to the fact that these two persons are sub- jected to like influences at the same time, in the same place, and under similar circumstances, which influences acting upon masses of men help to induce the racial face and form. But in such cases there is, of course, only the action of extrinsic forces; two individuals cannot share or mutually exchange an identical biologic prepossession. Place two pieces of clay under the same pressure, and The Influence of Subtle and Undetermined Forces 145 you shall have lumps somewhat the same in f roce, modified only by the size and consistency of each piece. If all the forces, social, religious, climatic and so on, have contributed towards the production of the typical Irishman, why should not closer-drawn influences, though extrinsic and exerted over a comparatively short period of time, give the two affected by them a family face, modified, of course, by sex and vital forces which do not grow less in the individual? Husband and wife, more than others, are affected by the same vexations and fears, depressed by the same anxieties, and gladdened by the same blessings. If the psychic influence is to be considered, it may well be here. While evolutionists have readily acknowledged the ex- istence of undetermined factors concerned in anthropological modifications, physicians have been slow to grant that such forces are at all involved in the production of disease, even when the causation and mode of transmission of such diseases baffle investigation; even when the ordinary therapeutic meas- ures do not put a stop to the morbid process. (To be Continued.) THE SIGNS OF THE HAND IN DISEASES OP THE NERVOUS SYSTEM. By M. Hounze. Regimental Surgeon of the Second Class in the Belgian Army. (Translated by C. G. Chaddock, M. D., of St. Louis, at the Editor's request, from the Gazette Medicale de Paris, ler. Mai, 1912.) THE nervous system is the directing system of the whole human machine, the regulator in chief of its organic life. By means of its ramifications it reaches all parts of tihe body; thus it is easily seen that all organs may suffer as a result of its lesions. So of all the diseases to which humanity is subject, nervous maladies are, without contradiction, those which give rise to the most numerous and divers disorders— disturbances of motility, sensibility, reflectivity; trophic, vaso- motor, secretory, electrical abnormalities. Nervous affections are often at once manifest in modifi- cations of external appearance. Thus, scoliosis is met in (146) Diseases of the Nervous System 147 syringomyelia, in Friedreich's disease; the thorax is deformed in acromegaly (boat-shaped) ; in primitive progressive myop- athy (dystrophy) the wasp-waist has been described by P. Marie; paddle hands form a part of the picture of the disease of Marie; in the myopathies, the face is inert and without ex- pression; in Fredreich's disease the foot is arched and there is extension of the toes, especially the great toe. Sometimes the nervous affection attracts attention by symptoms predominant in one or another organ—now in the face (convulsive tic); now in the eyes (nystagmus, ex- ophthalmos) ; now in the lower extremities (ataxia, cerebellar gait) ; now in the upper extremities (tremors, contractions). Thus certain nervous affections cause in the hands ana- tomical changes and functional troubles which induce special characteristic attitudes almost sufficient in themselves to make diagnosis of the disease. The particular symptoms and special attitudes which the hand may present in divers nervous diseases, have seemed to me to be worthy of description in a single chapter entitled: Signs of the Hand. Owing to its remarkable development, the extreme mobility with which it is endowed, and owing to the exquisite sensibility of its skin, in man the hand is a mar- velous instrument, principally as an organ of prehension and tactile sensibility. In no animal does the superior member pre- sent an equal degree of morphological perfection. This makes sufficiently clear why the functional and anatomical troubles in the hand become at once striking and are specially described in studies of nervous affections. The external form, the anatomy and the physiology of the hand I deem well enough known to allow me to omit them here. I shall limit myself to a description of the different symptoms which the hand may present in the few nervous maladies we have to consider. Progressive Spinal Muscular Atrophy.—The affection begins almost always in the upper extremities. Usually the atrophy begins in the right hand. It first attacks the small muscles of the thenar and hypothenar eminence and is ac- 148 M. Hounze companied by related functional disturbances. No matter what the other symptoms, disturbances of sensibility, pares- thesias, pains, are usually absent. The atrophy commonly first shows itself in the short abductor of the thumb, then in the opponens, the short flexor, and the adductor. From the first, the thenar eminence becomes hollowed and flattened in a char- acteristic way, and the thumb remains abnormally close to the second metacarpal. The long extensor of the thumb, predomi- nating, draws the first metacarpal backward and outward. The hand assumes the appearance of the simian hand (ape hand). Opposition of the thumb with the other fingers (short flexor for second and third; short abductor and opponens for third and fourth) becomes more and more difficult and finally impossible. At the same time atrophy begins in the interossei, seen in the deepening of the interosseus spaces and the abnormal prominence of the metacarpals, which seem on the back of the hand deprived of flesh; the terminal phalanges are less and less readily extended. Atrophy of the lumbricales pro- duces a hollowing of the palm, and abduction and adduction of the fingers becomes impossible. If the play of the interossei and lumbricales is abolished, since they are the flexors of the first and extensors of the sec- ond and third phalanges, the common extensors and flexors of the fingers are deprived of antagonists. Then the first phal- anges become extended to the metacarpal plane, even making in hypertextension an obtuse angle posteriorly; the second phalanges flex on the first and the first on the second, thus constituting the claw-hand {main en griffe). At a later period the hand becomes so lean that it re- sembles the skeleton.hand: and then, all muscles being com- pletely paralyzed and atrophied, the fingers are inert and flaccid. 2. Amyotrophic Lateral Sclerosis.—During the first period of the disease, that is to say, some months after the beginning of the symptoms, the upper extremities present a combined picture of spreading atrophy and permanent con- Diseases of the Nervous System 149 tracture. The affection commences oftenest in the small mus- cles of the hand. The patient experiences twitchings and feel- ings of fullness in the hand, which becomes stiff, weak, and finally awkward. At the same time the patient notices that the hand grows lean; the thenar eminence disappears, and from the beginning are established the true principal phenomena of the disease—muscular atrophy and spastic paralysis. The muscular atrophy takes place progressively, but rath- er rapidly and quickly attracts the patient's attention. It be- gins in the small muscles of the hands and fingers. The short abductor of the thumb first disappears, leaving a trough; the first metacarpal becomes very prominent. Progressively the atrophy invades the muscles of the thenar eminence, those of the hypothenar eminence, and the interossei, while the flexors of the hand and fingers long remain untouched. The first metacarpal falls back to the plane of the other metacarpals. The prominences and pknes of the hand be- come level and then disappear; the first phalanges extend on the metacarpal while the second and third flex toward the palm (claw hand). These symptoms of contraction are in- creased, of course, as the muscular atrophy makes progress. The muscles undergoing atrophy are the seat of very pro- nounced fibrillary contractions. When the atrophy progresses very rapidly and simul- taneously invades the flexors and extensors, the hand presents the appearance of the skeletal hand. 3. Syringomyelia.—In this affection the muscular atro- phy from the beginning is localized exclusively in the upper extremities, and especially in the small muscles of the hand. It begins in the first interosseus and the invades succes- sively the thenar and hypothenar muscles, the interossei and lumbricales. However, this order is not absolutely constant; the interossei may sometimes be involved before the thenar and hypothenar eminences, and the latter before the thenar. The resulting deformities are like those observed in pro- gressive spinal muscular atrophy. Still, the paralysis is ordinarily less pronounced in the 150 M. Hounze muscles innervated by the radial nerve; and thus it happens that while the last two phalanges remain flexed in the palm, the others are in extension on the metacarpals with the hand in forced extension, an attitude spoken of as the preaching hand (main de predicateur). When the atrophy attacks both upper extremities, often, but not always, corresponding muscles disappear; thus the two hands may present similar or dissimilar attitudes. Besides the attitude described, we observe in syringomye- lia dissociation of touch, pain, and heat as modes of sensibility, i. e., persistence of sense of touch with anesthesia to painful and caloric stimuli, as well as trophic disturbances (felon, vesicles, bullae, gangrene of the skin, ulcers, arthropathies, exostoses, etc.). 4. Hypertrophic Cervical Pachymeningitis.—After a painful initial period which may continue several months without the appearance of other phenomena than severe pains starting from the nape of the neck and radiating towards the occiput and the upper extremities, the paralytic symptoms of the second period supervene. This period is marked first by weakness of the muscles of the hands and their progressive atrophy. This atrophic paralysis attacks especially the territories of the ulnar and median nerves, sparing the domain of the radial, consequently, the movements flexion and adduction of the hand and forearm are especially implicated. Owing to the contrac- tion of antagonists (extensors) the hand assumes a special attitude, known as the preaching hand (main dc predicateur). It is overextended on the forearm and the fingers are flexed. , The palm is flattened as a result of atrophy of the muscles of the thenar and hypothenar eminences. In these, as well as in those of the forearm, the reaction of degeneration is observed. I recall here in a few words that the reaction of degen- eration consists of three elements: (1) Loss of faradic ex- citability in nerves and muscles; (2) loss of galvanic excita- bility in nerves with its preservation in muscles, inversion of the formula of the reactions (NCC = or < PCC) ; diffusion of Diseases of the Nervous System 151 the motor points with reaction from a distance; (3) slowness of the contractions and their more rapid fusion into tetanic contraction. 5. Paralysis of the Ulnar Nerve.—The ulnar nerve innervates the anterior ulnar muscle, the internal of the deep flexors of the fingers, the interossei and a part of the lum- bricales, the adductor of the thumb, and all the muscles of the hypothenar region. When these muscles are paralyzed, ulnar flexion and ad- duction of the hand are limited as a result of paralysis of the anterior ulnar muscle; flexion of the last three fingers is in- complete (in part owing to paresis of the deep flexor) ; the third phalange can no longer be flexed; movement of the little finger is completely abolished owing to paralysis of the mus- cular mass of the hypothenar eminence. But the most striking peculiarity, due to paralysis of the interossei and the last two lumbricales, is that flexion of the first phalanges and extension of the terminal phalanges are no longer possible. The movements of separation and its oppo- site of the fingers (interossei and lumbricales) are much hin- dered. It is impossible to bring the thumb inward and to place the first metacarpal in opposition with the index finger, owing to paralysis of the adductor of the thumb. In all the varieties of paralysis of the ulnar nerve, be- sides the muscular atrophy which causes especially marked hollowing of the interosseal spaces of the dorsum of the hand, there is produced an attitude of the hand that is very characteristic, as a result of contracture of the antagonists of the paralyzed interossei (common extensor and flexor), when an attempt is made to place the hand flat on its palm—) the first phalanges go into forced extension, while the second and third flex (claw-hand). This position is even maintained in the state of muscular repose. Sensory disturbances, if present, are confined to the palmar surface of the last two fin- gers, to the dorsal surface of the last three and to a part of the dorsum of the hand. Trophic lesions of the skin of the fingers are sometimes seen. 152 M. Hounze 6. Paralysis of the Median Nerve.—The median nerve controls all the muscles of the anterior region of the fore- arm except the anterior ulnar and the two internal fasiculi of the deep flexor of the fingers, all the muscles of the thumb (except the adductor), and the first two lumbricales. Paralysis of these muscles suppresses almost entirely pro- nation of the forearm (pronator quadraters tires). Flexion of the terminal phalanges is no longer possible (superficial and a part of deep flexor), while flexion of the first phalanges is still possible by the interossei. The patient can no longer seize objects save with the last three fingers, flexion of which is still possible in part by action of the deep flexor (ulnar nerve). The terminal pha- lanx of the thumb cannot be flexed (long flexor of thumb), and its first phalanx can only be flexed by the simultaneous adduction of the adductor and internal portion of the short flexor (ulnar nerve) ; movements of opposition of the thumb with the other fingers, which for the second and third are made by the action of the short flexor, and for the fourth and fifth by that of the short adductor, are completely abolished. The first metacarpal is drawn backward by the long extensor of the thumb. The ensemble of these deformities constitutes the ape-hand {main de singe). Disturbances of sensibility are not uniform; they may be wanting entirely, or they may involve the area of terminal distribution of the median (external [radial] half of the palm, the palmar surface of the three first fingers and the radial half of the ring finger, dorsal surface of the second and third phalanges of the index and middle finger, and the radial half of the ring finger). In severe cases quite often trophic disorders are observed (bullae, atrophic skin, alterations of the nails). 7. Radial Paralysis.—The radial (musculo-spiral) nerve innervates the extensor muscles of the forearm, or of the posterior region of the forearm (common extensor of the fingers, extensor of the little finger, proper posterior ulnar, anconeus, long abductor of the thumb, long extensor of the Diseases of the Nervous System 153 thumb, short extensor of the thumb, extensor of the index proper), the triceps (brachial), and the muscles forming the fullness of the antero-external aspect of the forearm (long supinator, first and second external radials, short supi- nator). Therefore the radial nerve presides over the move- ments of extension of the hand and fingers and of supination. In paralysis of this nerve, if the patient raise the arm, the hand, in pronation, hangs m limp flexion on the forearm, and he cannot raise it up (posterior ulnar and two radials). The dorsal surface of the hand is slightly convex, while the palmar surface is excavated as a result of the predominance of the thenar and hypothenar eminences, the action of which is no longer balanced by that of the paralyzed extensors. The patient is unable to execute any lateral movement of the hand, because the radial muscles (abductors) and the posterior ulnar (adductor) are paralyzed. The fingers are flexed, the first phalanges can no longer be extended on the metacarpus (common extensor of the fingers, proper extensors of little and index fingers). But if one extend and sustain passively the first phalanges, active extension of the terminal phalanges is possible, as in the normal state (action of the interossei innervated by the ulnar nerve). The thumb is flexed and adducted; at the same time no active movement of abduc- tion (long abductor) or of extension (long and short exten- sors of the thumb) is possible. The action of the flexors themselves is weakened because their points of insertion are brought nearer together than is normal, because of the perma- nent flaccidity of the hand. Besides the motor disturbance, sometimes, in the zone of distribution of the radial nerve, there is an alteration of sen- sibility which rarely attains a notable degree. 8. Lead Paralysis.—It is usually bilateral, and in the great majority of cases is localized in a very typical manner in a part of the radial nerve, which it attacks with marked preference. It invades most rapidly the common extensors of the fingers. Extension of the first phalanges of the third and fourth fingers and later of the second and fifth fingers 154 M. Hounze is impossible. On the contrary, extension of the terminal phalanges takes place as in the normal state (interossei). Later the paralysis extends to the long and short extensors of the thumb, to the long abductor of the thumb, to the extensors of the carpus, in grave cases to the interossei, and the mus- cles of the thenar eminence, while the long and short supina- tors are never paralyzed, in contrast with what is observed in radial paralysis. Very often there is observed a chronic thickening and swelling of a special nature affecting particularly the tendons of the back of the hand. Almost invariably, sensibility remains normal or is but lit- tle altered. In serious cases, pronounced atrophy develops in the paralyzed muscles, and they then present the reaction of degeneration. 9. Tetany.—This affection is characterized by painful cramps occurring intermittently and by preference in the dis- tal portions of the members, with integrity of the general health and the cerebral functions. A person in perfect health is suddenly seized with vague malaise and feels painful for- mication in the extremities, with some trouble in moving them. The attack is usually preceded by prodomes consisting espe- cially of subjective disturbances of sensibility, sense of fullness, formication, painful pricking in the tips of the fingers. The contracture shows itself first in the upper extremities, where it ordinarily predominates. In one variety the resulting atti- tude is typical and permits a diagnosis at sight; the thumb is in adduction and flexed toward the palm of the hand; the fin- gers are straightened and in adduction with relation to the axis of the hand, and they are brought into the form of a cone, with the borders of the hand approximated, and the palm excavated. This is the attitude which Trousseau com- pared to the obstetrician's hand ready to enter the vagina. In another variety, the hand is quite closed and clenched into a fist, the fingers flexed, with the thumb within or with- out the fingers. This flexion is sometimes so forced that the nails may pierce the flesh, and it becomes necessary to protect the palm with a cotton pad to prevent this accident. Diseases of the Nervous System 155 10. Acromegaly.—Marie's disease usually begins in the hands and fingers, which present a remarkable hypertrophy. This is a massive hypertrophy, which affects equally all the tissues, but the general form is preserved. The hand retains its normal length, while its breadth and thickness are greatly increased, whence the names paddle hand, upholsterer's hand. The fingers are larger, without being longer; sausage- fingers, filled out between, but not at the joints. The skin is darker than normal, firm, hard, but not edematous. The creases of the skin are more marked than usual and render more pronounced the rounding out of the palmar eminences of the fingers and the thenar and hypothenar eminences. 11. Osteo-arthropathy.—Here the whole hand is aug- mented in size; it is enormous; but the hypertrophy affects especially the fingers, which are elongated, flattened and thick. The nails are broadened and curved laterally and lengthwise, ending like a parrot's beak, presenting numerous cracks. The terminal phalanges enlarge and take the form of a club, drum-stick or a bell-clapper—an exaggeration of what is called the tuberculous hand. The metacarpus is but slightly altered, presenting neither the prominences nor the fleshy cushions of acromegaly. 12. Hemiplegia.—Sometimes in this condition we meet rare disturbances of a trophic nature, consisting of vasomotor disorders in the paralyzed members, especially in the upper extremity. It may happen that the hemiplegic's hand shows an increase of volume, with quite marked thickening which wipes out the usual markings of bones and tendons on the back of the hand and in the fingers. The fingers are more regularly cylindrical and often show unusual tapering at the ends. But this increase of volume is not due to ordinary edema, and pressure does not cause pitting. Gilbert and Godet have called this condition the juicy hand. The skin of the hand and fingers is thinned and shiny, and presents a red or violet color. 13. Paralysis Agitans.—Two symptoms characterize Parkinson's disease: tremor and muscular rigidity. Tremor 156 M. Hounze is usually the first symptoms the patients notice. Beginning in the hands, and especially in the right one, this tremor pre- sents a special character which differentiates it from other forms of trembling. The hand assumes a peculiar attitude; it seems to be holding a pen as if to write. The last four fingers, extended and united, tremble as if made of one piece, while the thumb moves in contact with them synchronously. This attitude has given rise to numerous comparisons, all more or less exact. The patient seems to be crumbling bread, to be making pills, to roll a cigarette or a paper wad, to be counting money or to be spinning wool. The handwriting shows the effect of the tremor; usually the letters are formed of lines which are made up of a Vie, irregular, sinuous zigzag, and if the tremor is very pronounced, of little broken lines, the ap- pearance of which is quite characteristic. These movements occur when the muscles are in repose; they cease during sleep; they diminish or may even cease when the muscles are acti- vated by a strong vouluntary contraction, as when the patient shakes hands energetically. The rigidity of the muscles may in time cause true de- formities of the hands, analogous to those of chronic pro- gressive rheumatism, always, however, with the exception of the tumefactions of the bony structures, and the deformity of the thumb, which, in paralysis agitans, presents a flatten- ing from before backward, due to the constant pressure against the index finger. 14. Athetosis.—Athetosic movements are sometimes very complicated and extremely remarkable, keeping the part of the body affected in constant agitation. The athetosic movements are best characterized in the hands and fingers. The movements are involuntary and slow, taking place notably around the metacarpophalangeal articulations, in such a way as to cause the fingers to pass from flexion to extension, from abduction to adduction, with a remarkably exaggerated slow- ness and excursion. Successively, the fingers spread like a fan's ribs, are approximated, bend, extend, curve on themselves, turn backwards, are placed one on another, are crossed, and assume the most curious attitudes. Diseases of the Nervous System 157 The nature of the movements show that the interossei are the muscles most affected. As a result of the tension to which the articular ligaments of the phalanges are subjected, there is finally produced a state of such relaxation and flaccid- ity that the fingers move to degrees of hyperextension much beyond that which is normally possible and which a normal person cannot imitate. These movements of athetosis have been compared to the movements of the tentacles of the devil- fish (marine polypus). Voluntary movements are not abolished, but they are dis- orderly and cog-wheel like. The patient succeeds in seizing objects by making a movement out of proportion with the movement normally necessary to attain the desired end, but they quickly allow it to fall from the grasp, since extension of the fingers follows flexion of them, no matter what effort is made to prevent it. 15. Arthritis Deformans.—Since some writers consider arthritis deformans to be a neurotrophic affection, the pri- mary lesion of which has its seat in the spinal cord or its mem- branes, it seems to me justifiable to describe here the deform- ities of the upper extremities met in this disease. Charcot divides them into two types. The first, or flexor, type is the more frequent. It is characterized by: (1) Flexion at an obtuse, right, or an acute angle of the third upon the second phalanges; (2) extension of the second phalanges on the first phalanges; (3) flexion of the first phalanges on the head of the metacarpals; (4) flexion, at an obtuse angle, of the metacarpals and the carpals on the bones of the forearm. Be- sides, there is a deviation of the phalanges en block toward the ulnar side of the hand, with an inverse deviation of the third phalanges on the other phalanges. The second type, or that of extension, consists of: (1) extension of the third phalanges on the second; (2) flexion of the second phalanges on the first; (3) extension of the first phalanges on the head of the metacarpals; (4) flexion of the carpus on the bones of the forearm. There is likewise deviation of all the phalanges toward the ulnar border of the hand. 158 M. Hounze Such are the principal symptoms of nervous diseases man- ifested in the hands. These diseases, as shown by the signs described, may be divided into three groups. In the first group belong those affections in which occur the simian hand or the claw-hand; progressive spinal muscular atrophy, type Duchenne-Aran; amyotrophic lateral sclerosis; syringomyelia; paralysis of the median nerve; hypertrophic cervical pachy- meningitis. To the second group belong those nervous diseases which present attitudes of the hand different from those of the first group: tetany, radial paralysis (musculo-spiral), lead palsy, acromegaly, osteo-arthropathy, hemiplegia, arthritis defor- mans. Finally, the third group is made up of affections in which the hands and fingers exhibit movements of a special char- acter. PARETIC DEMENTIA AND BANK FAILURES. A Study of the Kirby Case. By James G. Kiernan, M. D., Chicago. PARETIC dementia, as LeGrande du Saulle1 points out, has a medico-legal period. This is the first or mental alteration stage of Mickle.* Of the ordinary moral defects I have already3 given many cases. Of cases bearing on the present topic the following were the most striking then noted: A Poughkeepsie bank cashier was suddenly noticed to be extravagant. This led to investigation, and a seeming de- falcation was found (on examination of the cashier's house drafts, cheques, money orders were found in all sorts of places, placed there for some years). The psychosis of the cashier was then clearly evident. As a paretic dement he died in an insane asylum. The teller of a Troy bank was insane from paretic de- mentia for some years before it was discovered. Meanwhile the cashier was able to wreck the bank nearly, because of the teller's mental disorder. These were national banks. In a case reported by Le Grande du Saulle4 a similar fate threatened a French bank because of the paretic dementia of a cashier. Most of these seeming embezzlements are due, as Spitzka5 has pointed out, to forgetfulness rather than mis- appropriation. In some cases delusions of memory occur and play the same role. A patient of mine who had marked de- generacy stigmata was attacked by a paretic dementia. His periods of exaltation and depression alternated twice or thrice and disappeared, leaving a paralucid, querulent, pes- (159) 160 James G. Kiernan simistic state. He had an inward conviction, from what were evidently memory delusions based on his former depression, that everything was going to go wrong with his business. Under the influence of this state he sold out some stock, which, by a "bear" movement induced by a lawsuit, had been forced down in value. This lawsuit and the resultant "bear" move- ment had been foreseen by him when he purchased the stock. The stock rose above par within a week after he sold it. The remission gave place to a period of depression followed by one of emotional exaltation, during which he was committed to an insane hospital. Suit was brought by his conservator to amend the sale of the stock. The jury under the instruc- tons of the court decided that the sale should stand. This decision was in full accord with repeated decisions of the Illinois and Iowa Supreme Courts, which hold persons of un- sound mind by an executed contract or conveyance where the transaction is fair and reasonable, and in the ordinary course of business, and where the mental condition of the party is unknown to the second part, and the parties cannot be placed in status quo ante. In another case with hereditary taint complicated with lues there occurred periods of paralucid querulence, emotional de- pression, and exaltation. The patient previous to the demon- strable onset of the paretic dementia had contracted to have two houses built. The contractor after making several sub- contracts failed. The subcontractors demanded payment of the patient for work for which the contractor had been pre- viously paid. This was refused. The patient was sent to an insane hospital, whence he was discharged in a paralucid querulent interval. Despite my advice to the contrary, he was placed in charge of his property. In a short time he verbally agreed to pay the subcontractors their bills. Owing to a new period of exaltation requiring hospital treatment, these prom- ises were not fulfilled, whereupon suit was brought. The jury decided for the plaintiffs for the same reason as in the pre- vious case. The civil and criminal responsibility of the insane differs Paretic Dementia and Bank Failures 161 according to the common law, and very justly so. The estate of the insane patient is justly liable for his torts while he is not criminally responsible for these.9 The assumption of the trial judge in the case under dis- cussion that an insanity dodge would exempt from civil re- sponsibility was a piece of judicial legislation without war- rant in either Federal or State supreme court decisions. Federal courts, as President Roosevelt pointed out in 1904, have a tendency ot ignore the common law, although the constitution says no case tried before a jury shall be other- wise reviewed than according to the common law. It was judicial legislation of this kind that led to Lincoln's denun- ciation of the Federal courts for their extreme subserviency to local interests, a denunciation embodied in the Republican platform of 1860. As Macaulay points out, there is a too common tendency on the part of judges to legislate in place of interpreting. In the case under discussion the judge had at one time been attorney for railroad of which the banker-physician had been surgeon. On this personal association he based his opinion as to the insanity dodge. The physician had given up practice and become a banker, for the rather peculiar reason that he forgot appointments, forgot ingredients and their quantity in prescriptions and had periods of absent-minded- ness. His bank ran along in a happy-go-lucky way for some time. He at the end succeeded in getting $20,000 from an- other and rival bank by a check-kiting scheme. This he in- vested (with alleged wire tappers) in a horse race (the horse, bet on at 40 to 1, actually won). The alleged bookmakers were simply swindlers, who were later sent to the penitentiary for this transaction. The bank induced some of the depositors to throw the bank into bankruptcy. The doctor's mother-in-law offered to guarantee the depositors, provided the doctor was placed under a conservator and the costly receivership pro- ceedings avoided. After an examination, I advised calling business asso- ciates to witness to the banker's mental state. The county physician, Dr. Davis, and Dr. R. C. Hamill heard the evidence, 162 J as. G. Kiernan. but the business associates were not called. They found the banker insane, and a conservator was appointed. When the plea was made in the Federal court in the bankruptcy pro- ceedings Judge Landis declared it a fraud on the court. He declared the lawyers guilty of a conspiracy in contempt of court. Later he had them and other lawyers subsequently engaged, indicted for conspiracy on his evidence, by the Fed- eral Grand Jury. For some reason, I was left out of the indictment, although mentioned as one of the conspirators. Court Judge Owens set aside insanity findings, without re- hearing, at Judge Landis' instance. Judge Prendergast and Judge McConnell had previously held this could only be done on a rehearing of the case. The contempt of court conspiracy charge was tried by Judge Sanborn, who rendered the follow- ing verdict: United States District Court. Northern District of Illi- nois. Eastern Division. The United States vs. Thomas B. Lantry, James B. Rosenthal, Francis J. Houlihan, Patrick H. O'Donnell, William T. Kirby and Margaret L. Kirby, Re- spondents. THIS is an order to show cause why respondents should not be punished for contempt of this court, committed in an involuntary bankruptcy proceeding pending therein against the respondent, Dr. William T. Kirby. The alleged acts were committed at various times during the month of November, 1912, and consisted in the alleged fraudulent use of an insanity adjudication against Dr. Kirby in the state court made prior to filing the bankruptcy petition against him, as a plea in abatement of the bankruptcy case. After the bank- ruptcy proceedings had gone on for some time, the matter of the alleged contempt was investigated by a grand jury, re- sulting in a report or presentment to the effect that the respondent Lantry, for the purpose of preventing this court from assuming jurisdiction over, and administering upon, the estate of William T. Kirby, in bankruptcy proceedings which might be thereafter commenced, caused the said William T. Kirby to be adjudged an insane person by the County Court Paretic Dementia and Bank Failures 163 of Cook County, through a concealment from that court of material facts of which he had knowledge, with respect to the conduct and the mental condition of said Kirby, and which concealment of facts and misrepresentation of facts to the County Court were fraudulently made; and further, that with such fraudulently procured adjudication as a basis for the appointment of a conservator, in the probate court, the said Lantry caused such appointment to be made. The use of this fraudulently procured adjudication of the County Court, and the letters of conservatorship which had been issued to Roger S. Gorman, a brother-in-law of the said Kirby, as the result thereof, in an endeavor to prevent the District Court of the United States from administering upon the assets of the estate of William T. Kirby, bankrupt, through its duly ap- pointed officers and agents, is the ac.t complained of as an attempt to obstruct the administration of justice. The contempt charge against Rosenthal, Houlihan and O'Donnell, who are attorneys at law and members of the bar of this court, as well as against Dr. Kirby and Mrs. Kirby, is that with knowledge of the fraudulent procuring of the insan- ity adjudication, they used such adjudication before this court sitting in bankruptcy in an attempt to oust its jurisdiction, and the same charge was made against Lantry. In other words, all the respondents were charged with bringing into the bankruptcy court a fraudulent, fictitious and collusive judgment, in an attempt to defeat its jurisdiction. After the hearing on the order to show cause had pro- ceeded for some days, and at the close of the testimony offered by the government, the court on its own motion discharged all the respondents except Lantry, on the ground that there was no evidence showing any knowledge of the respondents Rosenthal and Houlihan and O'Donnell of the circumstances under which the insanity adjudication was procured, or any knowledge that Dr. Kirby was not actually insane. It was not claimed by the district attorney or his assistants that there was any direct evidence on either of these points, but it was suggested that these respondents were put upon inquiry by 164 Jos. G. Kiernan. what occurred in the bankruptcy court. On this point Mr. Godman made the following argument: "On November 8th all of these gentlemen, with the ex- ception of Mr. Rosenthal, were before Judge Landis at the time when Mr. Kirby was brought in court. The court by announcement from the bench indicated that in his opinion at least, Dr. Kirby was shamming insanity. He characterized the whole proceeding, as I remember it, as a farce, and indi- cated that the adjudication in insanity had been procured fraudulently and for the purpose of defeating that court of jurisdiction. "Now, I suggest to your honor, that while the announce- ments from the bench in that case are not of a conclusive character or binding on anyone, particularly as to what the true facts are, nevertheless, when such announcements were made and repeatedly made from that time on throughout the hearing, I suggest that it became the duty of counsel then to inquire as to whether or not the adjudication in insanity hac'. been in fact procured in good faith, and for the purpose of determining whether or not any imposition was being at- tempted to be practiced on the court. "It is inferable, certainly, from the facts that any attor- ney engaged in the matter, in view of what was said by the court there of the atmosphere surrounding the case and of the facts which from time to time appeared as the hearing pro- gressed, it was the duty of the counsel to at least inspect the files; it was their duty to inquire and determine and find out upon what evidence this adjudication in insanity had been had I am sure that probably your Honor has never had called to your attention in any record of any happenings in any court, any remarks by the presiding judge of a more pointed and direct character concerning his views as to what was transpir- ing before him, than in the case in which counsel in this case were engaged." In view of the fact, found on a subsequent page, that there was at least probable cause for the adjudication of in- sanity, it is unnecessary to give further attention to this aspect of the case. It appears that Judge Lantry, while the bank- Paretic Dementia and Bank Failures 165 ruptcy administration was proceeding, was engaged in an apparently earnest effort to determine whether Dr. Kirby was really insane. If the three attorneys had made all the inquiry suggested they must still have been in doubt, at least, whether Dr. Kirby's adjudication was not entirely proper, both for mental and physical disability. Dr. Kirby and his wife were at the same time discharged, for the reason that the evidence did not in any way connect them with the technical use of the adjudication by their coun- sel as a plea in abatement to the jurisdiction, or as a plea in bar of the power of Dr. Kirby to commit the alleged act of bankruptcy. The proceedings in the County Court resulting in the adjudication in insanity of Dr. Kirby, were brought under the provisions of section 1 of chapter 85, Hurd's Revised Statutes of Illinois, p. 1499, which reads as follows: "That the word insane in this act shall be construed to mean any person who, by reason of unsoundness of mind, is incapable of managing and caring for his own estate, or is dan- gerous to himself or others, if permitted to go at large, or is in such condition of mind or body as to be a fit subject for care and treatment in a hospital or asylum for the insane: "Provided, that no person, idiot from birth, or whose mental development was arrested by disease or physical injury occurring prior to the age of puberty, and no person who is afflicted with simple epilepsy shall be regarded as insane, un- less the manifestations of abnormal excitability, violence or homicidal or suicidal impulses are such as to render his con- finement in a hospital or asylum for the insane a proper pre- caution to prevent him from injuring himself or others." As the district attorney argues, it seems clearly to appear that, despite the fact that the chapter of which the section above quoted is part, is entitled "Lunatics," the section is sus- ceptible of a construction that an adjudication of insanity might be had in two distinct kinds of cases, namely: (1) where the subject was actually mentally unbalanced and deranged, and on that account unable to manage and care for his own 166 J as. G. Kiernan. estate, or dangerous to himself or others if permitted to go at large, or (2) where the subject was in such condition of mind or body as to be fit for care and treatment in a hospital for the insane. In other words, the county judge had jurisdiction to find Dr. Kirby insane for bodily infirmity alone. He was clearly in a most serious and pitiable condition of health, as admitted by all the witnesses on both sides. It was, therefore, of little technical consequence whether his mind was sound; by the terms of the Illinois statute he was "insane," and a proper subject for commitment. Nor was it important to inquire whether or not all the facts as to his mental condition were disclosed to County Judge Owens, since the latter was fully justified, if not morally compelled, to commit him for bodily infirmity alone, without exhaustive investigation of his mental condition. In the bankruptcy court, however, this double aspect of the lunacy statute was overlooked. Dr. Kirby came into court and shammed insanity, that is, he pretended to be in a much more serious mental condition than he actually was, thus strongly tending to show his sanity. It further appeared that Mrs. Kirby and Dr. Kirby, within a few hours before bank- ruptcy, had secretly made with way $20,000 in money, with a strong presumption that this large sum was still in Mrs. Kir- by's possession. These facts justly excited the strongest sus- picion, and that court would have been derelict in its duty had it not taken the promptest and most vigorous measures. In so doing it was possibly unmindful of the full extent of all the constitutional rights of the attorneys and parties concerned. When a court is shocked almost beyond precedent it is the time for action; and there was certainly an abundance of it, and that without delay. That the subsequent proceedings bore hardly upon all who were concerned was to have been expected, although it turns out, on a careful and extended hearing before another judge, that they were at no time guilty of the serious offense of contempt of court. As has been said of certain political events, "To comprehend all is to justify all." Paretic Dementia and Bank Failures 167 All other respondents having been discharged, it remains to consider the case of Judge Lantry, who is charged with having committed acts in an endeavor to obstruct the due ad- ministration of justice in the Bankruptcy Court; and, as coun- sel on both sides agree, the sole question is whether he acted in good faith in securing the adjudication in insanity in the County Court, and in using the same as a basis for objecting to the jurisdiction of the bankruptcy court. The use made of the adjudication was to plead it in abatement to the jurisdic- tion on the theory that another court, through the appoint- ment of a conservator after bankruptcy in a proceeding com- menced theretofore, had obtained exclusive jurisdiction, and as a defense in bar on the theory that Dr. Kirby, having been adjudged insane for a year before bankruptcy, could not have committed the alleged act of bankruptcy. As to Judge Lan- try, therefore, the main question is whether, in good faith, he thought Dr. Kirby was of unsound mind. Without dispute the testimony shows that up to about two years before the events in question, Dr. Kirby was a ro- bust, healthy and vivacious man, having a very large practice as a physician and surgeon. His health suddenly began fail- ing, and early in 1911 he was obliged to give up his practice because of failing memory and physical strength. He was afraid to write prescriptions, and sometimes entirely forgot appointments he has made. His weight rapidly fell off, and his appearance was so much changed that, during 1912, his acquaintances sometimes failed to recognize him. Judge Lan- try did not see him from January to October, 1912, during which period he had failed in a marked degree. Obliged to give up his profession, he took advantage of the lax laws of Illinois to start a private bank, of which he became president, and his cousin, a boy of sixteen, was cashier. Neither had had any banking experience. While he was man- aging the bank he conceived the idea of getting a motor car, painting it red to attract attention, putting a safe in it, and running it around the south side of Chicago, taking deposits and cashing checks. The banking business ran eighteen 168 J as. G. Kiernan. months, closing October 31, 1912. On the previous day Dr. Kirby and his wife, by a series of kiting checks, drew $20,000 from two other banks and lost the same in some manner not clearly disclosed by the evidence, but supposed to have been the old wire-tapping horse-race scheme. During the banking period Dr. Kirby's health steadily declined. His trouble was diagnosed a brain syphilis by Dr. A. Davis, and a course of treatment commenced under Dr. Belsan. It appears that in many cases this disease is innocently contracted; and it is a fruitful cause of insanity. Judge Lantry had been for some months the attorney for Dr. Kirby, who was owing him $300 on account. He was called on October 20. He found Dr. Kirby greatly changed in appearance, walking with a shuffle and a stoop, and appear- ing to be partly paralyzed on the left side. He gave contra- dictory accounts as to what had become of the $20,000, and appeared somewhat incoherent. He would not give the name of the person to whom he had given the money, fearing he would be shot. Presently it was suggested by Mrs. Durkin, Mrs. Kirby's mother, that Dr. Kirby was mentally unbalanced. On October 31 Mrs. Kirby for the first time began to doubt her husband's sanity, by reason of some apparently strange actions on his part, and her suspicion was communicated to Judge Lantry. It is, however, apparent from the testimony that Judge Lantry did not regard Dr. Kirby insane prior to the first day of October, when the adjudication of insanity was made. On the previous day he received from him $500 on account and for future services, and on both days he con- sulted with him frequently about turning over the business to another bank. After these suggestions had been made to Judge Lantry he was further informed by Mrs. Kirby that Dr. Kirby had a brain tumor, and by Thomas Durkin, her brother, that he had thought he was insane, giving a number of incidents show- ing mental weakness. Judge Lantry then consulted Dr. A. Davis and Dr. Belsan. Dr. A. Davis said he had organic brain disease, but thought it was under control, and suggested con- Paretic Dementia and Bank Failures 169 suiting an alienist. Accordingly Dr. Kiernan, an experienced alienist, was consulted, who pronounced Dr. Kirby to be suffering from paretic dementia. Dr. Belsan also thought he was mentally affected. In addition to such information Judge Lantry was told by Mrs. Kirby that her husband had not been taking the medicine prescribed by Dr. Davis for brain syphilis. In this situation Judge Lantry conceived the idea of having Dr. Kirby adjudged insane under the statute quoted, of hav- ing a conservator apointed, and thus administering his prop- erty for the benefit of his creditors. Mrs. Durkin had con- siderable property, and had agreed to pay Lantry's fee, and help out the financial situation. His idea was to have a con- servator apointed who would act without a fee, and for that reason induced a brother-in-law of Dr. Kirby to act, who gave a surety company bond for $30,000. Lantry thought that bankruptcy proceedings might follow, but would be expensive, and that if the Probate Court of Cook County should appoint a conservator his possession of the property would oust of jurisdiction later proceedings in the Federal court. At this stage it does not appear that he thought of using the alleged insanity to defeat possible bankruptcy by pleading that Dr. Kirby could not, two days before the lunacy judgment, have committed an act of bankruptcy. This theory was conceived at a later time. The bankruptcy court was strongly impressed by the fact that Lantry took $500 from the bankrupt October 30, and could not, therefore, have thought him insane two days later; but when he took the money the situation had only be- gun to develop. No one had suggested insanity, nor had any doctor been consulted. So far there is nothing in the evidence to impeach the alleged good faith of Judge Lantry. It is entirely justifiable to attempt to select the forum, and this is done every day in reputable law offices. The Federal jurisdiction is constantly defeated by alleging damages at $3,000 or less in cases where the proof will show more, or by joining as defendant a person wholly unable to pay a farthing. These acts are common practice, and not even subject to fair criticism. No court, 170 J as. G. Kiernan. by process of contempt, can indirectly add to its jurisdiction. It is charged in the presentment of the grand jury that the County Court proceedings were designed to obstruct the ad- ministration of justice in the bankruptcy court. Even if so, no criticism of the act can properly be made, if such proceed- ings were valid on collateral attack. It is further charged that important evidence before the County Court was suppressed, that Judge Owens was de- ceived, and would not have made the adjudication if his attention had been called to the fact that Dr. Kirby, up to the previous day, had been managing a private bank. But it ap- pears in the proofs, without any contradiction whatever, that Dr. Kirby was in such a condition of health as to require care and treatment in a hospital or asylum for the insane. He was, in other words, even if not mentally unsound, at least "insane" within the statute. It is further shown that two doc- tors, one a noted alienist, and three members of the family had pronounced him insane in the mental sense. Judge Lan- try also knew, from what Dr. Kirby told him and what he observed, that the doctor had been acting in a strange manner. Under these circumstances he was warranted in seeking a court where the property could be administered with small expense. He says he had no doubt of actual insanity, that Judge Owens knew Dr. Kirby as well as he did, and he sup- posed the Judge knew that the doctor was running a bank. He procured several witnesses, two of whom knew all about the banking business. One of these was Ryan, a real estate agent having an office in the bank, and who, if Judge Owens had called him, would certainly have disclosed the fact that Dr. Kirby was in the banking business. Following his usual practice, Judge Owens briefly examined the witnesses himself. He hears a large amount of lunacy cases, and expedition is necessary. Ryan's name appeared on the petition, but Judge Owens did not think necessary to call him. Dr. Belsan's name was also on the petition. He had a considerable deposit in the bank, and this fact was uppermost in his mind. Had he been questioned by the court it is likely this fact would have come out. The names of all who had told Lantry of Paretic Dementia and Bank Failures 171 Dr. Kirby's mental condition were placed on the petition. All this is inconsistent with any intent to deceive the court on the part of Judge Lantry. It also appears that Mrs. Kirby tes- tified before Judge Owens that the doctor had no real estate except what was in his business, which seems to have been understood by the court to refer to his business as a physician. Judge Lantry testified that he stated to Judge Owens at the hearing that a "property verdict" was desired because Dr. Kirby had a bank; but he is not sure that the judge heard the statement about the bank, and the latter testifies that he did not. Judge Owens thought he had been misled, and set aside his adjudication on his own motion, after the state's attorney had moved to vacate it, and Judge Lantry had moved for an early hearing of that motion. Events occurring after the adjudication of insanity tend to corroborate Judge Lantry's claim of good faith, even though it was apparent that Dr. Kirby, when he first appeared in the bankruptcy court on the 9th of November, pretended insanity. In connection with the other attorneys in the case Judge Lantry procured a conference of five or six doctors to be held in Mr. O'Donnell's office. All these doctors thought Dr. Kirby insane. A number of other persons told Judge Lantry of queer conduct of the doctor, extending back eighteen months. Another circumstance tending to show good faith was Lantry's action, taken on the 11th of November, in serv- ing notice on the state's attorney of a motion before Judge Owens to have an early hearing of the motion to vacate the insanity adjudication. Instead of opposing that motion he urged a speedy hearing. While these motions were pending, and on November 26, Judge Owens vacated the adjudication on his own motion. It does not appear in the evidence that any person ever expressed the opinion to Judge Lantry that Dr. Kirby was not insane. On the whole, it appears by the great weight of evidence that Judge Lantry acted in good faith. It is difficult for me to see how any adjudication of insanity under the Illinois statute could be supposed to be an estoppel on the question of 172 J as. G. Kiernan. Dr. Kirby's capacity to commit an act of bankruptcy, since the statute defines insanity to include physical disability; but Judge Lantry consulted attorneys on this point and was advised that this was a matter of doubt. Of course such an adjudication might be used as the foundation of a plea in abatement to the jurisdiction, as it was, on the ground that the county court had obtained prior cognizance of the case. It is not necessary to pass upon the question whether such a plea was good. In view of Farmer's Loan & Trust Co. v. Lake St. El. R. Co., 177 U. S. 51, 20 Sup. Ct. 564, 44 L. Ed. 667, such a plea was at least debatable. In that case it is held that prior actual pos- session of the property by the court first taking jurisdiction is not necessary to give priority of jurisdiction. Another point of some importance is that, even assuming fraud in the insanity proceedings, they were good on collateral attack. This question is fully considered by Judge Van Fleet in his work on collateral attack, sections 558, 559, and is dis- cussed in United States v. Throckmorton, 96 U. S. 61, 25 L. Ed. 93. While not necessary to be decided here, it will be seen that if the lunacy judgment was a valid one it would not be a contempt to assert it in another court. Without the necessity of applying the rule as to reason- able doubt, as held in Gompers v. Buck Stove Range Co., 221 U. S. 418, 444, 31 Sup. Ct. 492, the respondent Lantry should be discharged for the reason that he acted in good faith, and that he had probable cause for believing that Dr. Kirby was mentally unsound. Necropsy showed diffuse meningo-encephalitis. BIBLIOGRAPHY 1. Gaz. des Hop., Sept. 11, 1883. 2. General Paralysis. 3. Alienist and Neurologist, Oct., 1884. 4. Gaz. des Hop., Sept. 11, 1883. 5. Insanity. 6. See authorities cited, Alienist and Neurologist, Feb., 1905. INCIDENTAL DELIRIA OCCURRING IN THE IN- SANE, INCLUDING A CITATION OF CASES. By John P. H. Murphy, M. D., Jr. Asst. Phy. Govt. Hosp. Insane. Washington, D. C. Delirium, as defined by one of the modern authors, is conceived to be a state of confusion or disorientation in all the spheres, and by this I mean temporal, spatial and personal, together with clouding of consciousness. The condition is transitory in character; and although it usually occurs during the course of some febrile infection, it is very often observed, not only in the drug habituae, and in those patients who have been given certain drugs indiscriminately, and who in some cases exhibit marked idiosyncrasies to minor amounts, but in many other instances, such as asphyxia, trauma, anemia and inanition. The term has often been used in an extremely broad sense, sometimes applying to conditions entirely foreign to the ordi- nary conception of the word, even entering into the realm of psychology. The fact that the condition is of transitory nature is im- portant to bear in mind, for in this we distinguish the point of differentiation between delirium and permanent mental impairment—dementia. In both cases the lack of judgment is a prominent feature, while the critical faculty is practically in abeyance; but while in the former the symptoms diminish with the subsidence of the intercurrent malady, in the latter the course is steadily downward; the manifestation of perma- nent organic changes. (173) 174 John P. H. Murphy It is extremely difficult in some cases, however, to draw a sharp line of distinction, for not only may an acute delirious state appear in an individual who is already in an advanced stage of mental deterioration, but it may for a certain period, by its multiform psychosensory and psychomotor manifesta- tions, successfully disguise the initial signs and symptoms of some underlying malady, whose course tends to bring about progressive mental enfeeblement. If one would understand the subject of delirium, he must needs make an analysis of the various motor and sensory phe- nomena occurring throughout its course; for although the numerous drugs and infecting agents may each give a distinct and characteristic coloring to the picture, nevertheless the background of confusion with clouding of consciousness stands out prominently under the varied, and often fantastic, hallu- cinations and delusions. Turning then to the sensory field, we first consider the hallucinations and illusions so characteristically present in these forms of mental aberration. These false sense percep- tions are frequently multiform in type, and are often a source of abject terror to the patient; while on the other hand, they may be of considerable interest or fascination, sometimes forming the basis of an occupation delirium, which is so often seen in delirium tremens, and at times in certain cases of Catatonic Dementia Prsecox. It goes without saying, that upon the character and varia- bility of the hallucinations, which in themselves may be inti- mately associated with the subconscious stream, the under- current, so to speak, containing practically all the events of the psychic life, are built a loose and unstable system of idea- tions, the delusional character of which varies with the type of the hallucination, and the intensity and apparent reality with which it becomes manifest. A few abstracts from selected cases in the clinical records at the Government Hospiatl for the Insane, may serve to illus- trate that these hallucinations and accompanying ideations are not only based upon a false conception of the mind and its Incidental Deliria Occurring in the Insane 175 relation to the environment, but that they are often dependent upon, and intimately related to, the everyday life of the indi- vidual. Case A.—Toxic delirium due to chloroform. The patient, a Government employee, had been an habitual user of the drug for many years. He began by inhaling a few drops from a handkerchief each evening in order to secure relief from pain in the stump of a limb which had been ampu- tated. When he first began using chloroform in sufficient quan- tities to produce an effect, he experienced the most delightful and wierd sensations; he imagined himself in the company of gaily dressed people, all of whom he knew; everything was beautiful; he had a sensation of peace and rest. This of course was followed by the usual disagreeable after-effects, such as nausea and headache, when the drug wore off. As time went on, and he began using the drug in increasing amounts, which he found necessary to relieve the pain, he would feel very languid in the mornings, and was finally obliged to give up work. A little later he took to his bed. On admission to the hospital he was in a wretched physi- cal condition; being a man of 5 feet 9 inches in height, his weight was 101 pounds. Shortly after his arrival he devel- oped extravagant optical and auditory hallucinations, saw members of his family fighting with the patients and attend- ants; heard voices saying they were going to kill him, and held frequent conversations with President Taft in one of the adjoining rooms, also with a woman who wore a hat he had seen in a shop window. He believed that the paraffine used on the floor had the odor of chloroform and was used to anaesthetize visitors. He was wildly excited at times, throw- ing his arms about and shouting at the top of his voice. He made a good recovery, however, after a five months' stay at the institution, and when he left he had gained thirty pounds. There was, however, some impairment of memory, especially for recent events, which might in part be due to the chloro- form, and also to the fact that the patient was well advanced in life. 176 John P. H. Murphy Case B.—Exhaustion Psychosis, following Parturition. The patient, a nurse by occupation, had always been con- sidered peculiar. She was of an irritable and precocious tem- perament; intimate friends said that on several occasions she had done peculiar things, and at one time she ran out into the street in her night clothing. After her marriage she was very irritable, especially during the menstrual period. Her first confinement was extremely difficult, instruments being used, and the child was born dead; she was very weak after labor, and for a long time her life was despaired of. Her psychosis began at that time. On admission to the hospital she was restless and excited, at times abusive and showed incoherence with flight of ideas, having little or no grasp on her surroundings. She would remove and destroy her clothing, and was very untidy in her habits. Physical examination showed her to be fairly well nour- ished, but examination of the heart revealed a loud systolic murmur at the apex, transmitted to the axilla. She soon de- veloped visual and auditory hallucinations, heard her husband talking in the ward, and saw him flirting with the nurses. There had always been a strong sexual trend in her make-up, as was evidenced by various remarks noted in her history. She was, shortly after admission, placed in a warm continuous bath, and while there the following stenogram was taken, which brought out a broken chain of ideas that nevertheless had a distinct bearing upon some of the events of her pro- fessional life. A sample of the remarks noted is as follows: "Litmus paper, M. D., making prescriptions, writing prescrip- tions, put down dust, locomotor ataxia, cow, sugar, dairy products, weighing ounces a week, 98% cream, 4% fat, sul- phuric acid, sordes on the teeth, stenographic, stenogram, Rock Park," etc. The case, when taken as a whole, presents not only some of the features characteristic of the degenerate, together with some maniac features, but to my mind, in considerifng the life history as a whole, it has the appearance of an exhaustion Incidental Deliria Occurring in the Insane 177 delirium occurring in a dementia praecox. The patient left the hospital after nine months in a fairly normal condition, having gained in weight. Case C.—Intoxication Psychosis due to Carbon Monoxid. The patient, a woman of about 45 years, was employed as a domestic. She had always been of a cheerful disposition, and of a religious turn of mind. One night she went to bed in her usual good health, but in the morning, she not having arisen at the usual hour, the other servant found her in an un- conscious condition. The odor of escaping illuminating gas attracted attention to the stop-cock, which was found broken, but the fact that the window was open to its full height showed that no suicidal tendencies existed. She was taken to a local hospital where she remained four days in a stuporous condition, during which time she showed some rise of temperature with rapid pulse and respiration. She gradually aroused, but was restless, dull and apathetic. At the end of ten days she left the hospital, and after spend- ing a week with a relative she returned to her former employ- ment. Here, however, she showed mental torpor, would per- form erratic acts, memory was very poor, and she could not perform her usual duties. She was obliged to give up work, and came to her aunt. The latter noticed that she laughed without cause, was unable to find her way about, and talked incoherently. She grew rapidly worse, was unable to care for herself, was confused, and untidy in her habits. On arrival at the hospital she showed clouding of con- sciousness, and was disoriented in all spheres; could give little account of herself; was untidy and soiled the bedding. At times she was unable to identify familiar objects, and made frequent mistakes in persons and names. Physical examination showed her to be fairly well devel- oped: slight scoliosis of the spine. The heart showed slight enlargement with a presystolic murmur at the apex; second pulmonic accentuated. Lungs showed few crackling rales at the apices. Olfactory sense showed impairment, a number of different odors not being differentiated. The knee jerks were 178 John P. H. Murphy all exaggerated. Babinski was marked on both sides and the tongue and fingers showed a fine tremor. The gait was ataxic. The patient made a good recovery after a four months' sojourn at the hospital, and when she left, her memory for both recent and remote events was excellent. Case D.—Acute Delirium associated with oedema and hyperemia of the brain. The patient, a colored man of 58, had used alcohol for years, and at times to excess. On arrival at the hospital he was confused and greatly excited, showing great psychomotor activity, constantly moving about, shouting, singing and talk- ing incessantly. He showed marked visual and auditory hallucinations and was disoriented in all spheres. Said he was a white man and was wiser and better than Solomon; that he was God the Father wrapped in human nature. Said he had been given gall and bitters as Jesus received on the cross; someone came in his room and gave him chloroform. The Book of Revelations was opened, and he heard Christ com- ing as the old world passed; he saw George Washington, he saw a horse's paw, and it said "bar-bar." He saw snakes, angels, animals and hideous faces. The patient grew steadily weaker and died after a month's stay in the hospital. Autopsy revealed hyperemia of the brain, and catarrhal pneumonia of the upper lobe of the right lung with pulmonary oedema. Case E.—Post Traumatic Delirium. Patient, a man of 62, had been drinking heavily during the latter part of his life. About two years prior to his en- trance to the hospital he had struck on his head in falling from a wagon. For months afterwards he had been unable to walk and had been acting in a peculiar manner. On admission to the hospital he was confused and dis- oriented in all spheres, in fact seemed entirely oblivious to his surroundings; was extremely restless and imagined his daughter was in the next room. Physical examination showed a slender, weak old man, Incidental Deliria Occurring in the Insane 179 skin dry and wrinkled, showing all the evidences of senility. Heart showed a mitral systolic murmur transmitted to the axilla. At times a marked twitching of the hands would be observed. He gradually grew weaker and died after being in the hospital about four months. There are many other cases of delirium which have come under observation at the hospital from time to time, but they are too numerous to mention here; and although each indi- vidual case may present an unique and at times fantastic and bizarre set of hallucinations, and the accompanying delusions, loosely organized because of the unstable foundation upon which they are erected, nevertheless the fundamental charac- teristics, viz., confusion with clouding of consciousness, are the dominant feautres. Another prominent factor in all these cases is the state of exhaustion, and, to bear out this statement, I quote from an article by "Hirsch" in the Reference Hand Book of Med- ical Science, in which he makes the following statements: "A genuine delirium indicates often a state of inanition de- manding energetic stimulation. It may appear during the course of various mental diseases, and in such cases always indicates general exhaustion. It is of bad prognostic signifi- cance when it develops gradually under these circumstances, and is not infrequently the first sign of approaching death." Again he states that the hallucinations are produced by psychosensory irritation, and that the psychomotor irritation is responsible for the impulsive movements. This being the case, they must both be more or less dependent upon some toxic product, either as the direct result of infection, or to the catabolic changes in connection with excessive tissue waste. At this point it might be well to consider for a few mo- ments Case D. Here we have a middle-aged negro, who, nat- urally endowed with all the superstitions and imaginative powers characteristic of his race, and who, at the same time undoubtedly appreciates his relation to society, finds conso- lation in wish-fulfilling dreams. He is a white man, even wiser than Solomon; wishing to be great, he is great, and as 180 John P. H. Murphy stated by Dr. White in his treatise on dreams in Mental Mechanism, man will have his way, if not in the realm of facts, then in the realm of fancy, and in this case of acute delirium, where the controlling power of judgment or critique has been removed under the influence of disease, we see the subconscious coming to the surface and finding expression in the wanderings of a psychosis. Not every excited mental case with hallucinations and de- lusions can be classified as a delirium, but the fact that the condition may occur at any time during the course of almost any psychosis, due either to some indiscretion, as in the alco- holic, or to some cerebral irritation, as in the epileptic, is important to bear in mind, for although it is of transitory nature, it may exert a decidedly evil influence upon some well established degenerative change, or be the forerunner, so to speak, of progressive mental deterioration. THE RIGHTS OF PATIENTS. A selected editorial article from Medical Review of Reviews for commendatory comment. By the Editor. "Institutions, even hospitals, despite their humanitarian work, frequently become callous to the feelings of sufferers. The social worth of an institution is frequently indicated by its conception of duty towards the community it serves. Some hospitals, at times, act as if the unhappy sick belong to them. As a matter of act, hospitals and all institutions working in behalf of the public health belong to the people, save the few institutions that are organized and managed by self-constituted bodies for their own commercial benefit. The rights of a hospital to transfer patients without con- sent is frequently assumed. No institutions should transport patients from one place to another, as if they were cattle, be- cause it does not wish to have its mortality rate increased or because it does not care to house a patient of a particular color, creed, or denomination. The dictates of humanity and conscience should give rise to common sense in hospital ad- ministration. Patients, the poor, foreign, and ignorant, have hospital rights which should be recognized even by the super- intelligent interne who, perchance, may be the arbiter of their fates. Recently a child who contracted measles while a patient in a children's hospital was transferred, without the knowl- edge or consent of the parents, to a hospital for contagious diseases, where it soon after died. A city hospital to which had been sent a patient ill with tuberculosis, transported the almost moribund girl to a hospital far removed which could not receive her, then delivered the patient as so much baggage to a second institution for which she was not fitted, and finally had to drive her back to the original hospital until she could (181) 182 C. H. Hughes be placed in an institution, where Death found her about a week later. In the meantime a distracted colored mother was trying to find her child, and learn why such treatment had been accorded her inasmuch as no consent to transfer had been asked or given. If the parents of either of these children had had wealth or influence these incidents probably would not have occurred, or if such inhuman practices ahd been suffered lawsuits and untold publicity would have followed. Internes, head nurses, even hospital superintendents occa- sionally arrogate to themselves superior manners and author- ity as if they had just descended from Olympus and were giv- ing the common people the privilege of sitting at their feet. Such self-constituted, imaginatively developed, and self- asserted superiority of public servants is to be deprecated. To serve humanity is noble work, but it should be accompanied with both dignity and humility and not with arrogance and cold indifference. Patients and the relatives of patients are entitled to cour- tesy and humane treatment, even if by virtue of unfortunate circumstances they are obliged to be charges in the public wards. Institutionalism is not a term which at present con- jures up pleasant memories. It is time that the hospitals and the dispensaries become socialized. A splendid start could be made in the admitting rooms. The more ignorant, stupid, nervous and poor the patients are, the greater is the necessity of a humane and understanding admitting physician." This is timely and pertinent. It hits the nail squarely on the head or rather some of our interne medicos, "clothed with a little brief authority," in hospital or dispensary who, forget- ful of the fact that the humblest and most indigent of patients have hearts and feelings and rights, do "bestride the earth" of the dispensary or wards of a hospital or before helpless down and out indigent sick, "like a colossus," without thought of the claims of the humblest who are ill, to kind, considerate treatment in manner, prescription and speech. We plead for consideration of the disabled under dogs of our human but not always humane species, in their feeble and handicapped fight for themselves in the unequal battle of life. THE DIATHESIS EBRIETATIS AT THE COMMUNION TABLE AND ELSEWHERE. By the Editor. If there is one place more than another where the peril of alcoholic inhibition is gravest, it is here. Any observant clergyman may note this peril among reformed inebriates. The experience of Mr. Denyer, recorded in the Alliance News, of "a number of cases in which communicants have lapsed into drunkenness through the use of fermented wine at the Table of the Lord is not common," says this gentleman. The julep and the cocktail before meals and the daintily handled glass proffered in my lady's parlor are serpents of the still that "sting in the last like an adder." Bishop Thornton's experiences in East London, which we take from the same literary source, led him to study the question, and he found it necessary, in the case of "reclaimed" communicants, to "retain control of the cup, lest to some of them the temptation to 'gulp' might be too strong." Some years' experience as a chaplain to a large Female Inebriate Asylum proved to him the impossibility of administering the communion with the fermented cup." (The individual glass now becoming common, of course mitigates this danger somewhat.) The strong drink craving constitution entailed or bibu- lously acquired, must be reckoned with by church and state and people and even by physicians in their prescribing. There are those to whom the putting of the cup to the inebriate's lips is perditionally perilous, and woe unto him that doeth it. Safety with such lies especially in the patriarchal injunction, "touch not, taste not, handle not." This is the testimony of neuropathic science concerning oinopathy. Here is where psychiatry as well as eugenics, which is a part of psychiatry, should have due consideration in medical as well as popular thought and action. (183) THE PHYSICIAN'S DUTY IN FORMING PUBLIC OPINION. An Abstracted Article, With Editorial Comment. About a year ago La Tribune Medicale contained a thoughtful, forceful and timely editorial on the above sub- ject, which, not having received from our American contem- poraries the attention it deserves, is here given place, because not only it merits the attention of medical men everywhere, but because it is likewise in harmony with our own opinion on the subject. Men of medicine with their superior knowledge of man psychical and physical, as compared with most of their fellows, are peculiarly fitted to enlighten the less informed and guide and lead the civilized world in the way of its highest mental and physical welfare, and this includes his political improve- ment in the direction of his highest and best state of being and away from the perils of degeneracy and retrogression to the semi-barbaric life. For without advance in scientific, moral and mental enlightenment it would not be difficult for calamity to come in that universal democracy towards which the world is rapidly tending through the threatening "cult of incompetence" and the numerical preponderance of mediocracy as we see these coming to the fore in certain half-enlightened and only partly true politico-social propositions and organized movements. There is a place, and a much-needed one, for the enlight- ened physician and scientist in social and political life, and he ought to be worthily filling it. He should help with his knowledge and to avoid a possible calamity of national de- (184) The Physician's Duty in Forming Public Opinion 185 cadence and reversion to conditions that may lead to racial extinction. We are unconsciously making profound social and po- litical changes arising from a mental fermentation which appears to be affecting not only the highly civilized races, but also the semi-civilized and backward nations, as evidenced by the revolution in China. In India, where custom has always been considered immovable, a very interesting contribution of Dr. Hari Mohun Sen, of Dinapur, on the "Health of India, Its Past, Present, and Future" (Tribune Medicale, Feb.-Mar.- April, 1912), shows that even the sleepy East is waking up to the necessity of modifying ancient caste and social preju- dices. However repugnant a rearrangement of society may be to the conservatively minded, there is too much impetus behind the movement to hope for any permanent arrest in its progress. As an indication as to the way things are trend- ing, we have only to reflect on the long series of concessions wrung from the capitalist in recent years by the laboring and agricultural classes, who, through their unions, now practi- cally control production and all sources of wealth, so that we are actually witnessing the beginning of a gradual confisca- tion of private wealth and the extinction of individual and corporate profits which must curtail if not arrest in the creat- ing of new industrial activities. Whatever our private views may be on socialistic ques- tions, the sooner we become accustomed to its possibilities, the better can we use our influence to intelligently direct the movement in regard to questions for which our training and experience especially fit us. It is useless to analyze the alleged causes of these so- called socialistic tendencies (e. g., the sentiment of revenge by the unsuccessful; the Utopian ideals held up to the mediocre); for the movement is too powerful to be ignored. Whether the reorganizations of society will be universal or localized in one country; whether it will be permanent, successful or a failure; whether it will increase the general well being, or give rise to confusion and misery, there can be no doubt that the ex- periment will be attempted sooner or later on a vast scale. 186 C. H. Hughes As men we must therefore face the future with courage and add our quota in guiding public opinion on essentially medical aspects of the subject, which must of necessity be taken se- riously into consideration, and, above all, we should use our influence to prevent the fundamental mistake of empowering primitive types of humanity in a transitional stage of mental development, from dictating, at the bidding of demagogues, how the world's work should be done. It is unfortunate, but undoubtedly true, that the prevail- ing socialistic theories encourage continual concessions to inferior grades of society, so that with the control of many natural laws which heretofore diminished the production of defective offspring, stagnation must result by the crushing out of the superior elements from the sheer mass of undesirables. As Emile Faguet, of the French Academy, says in his recent work, "The Cult of Incompetence," "I have often won- dered what principle democrats have adopted for the form of government which they favor, and it has not required any great effort on my part to arrive at the conclusion that the principle in question is the worship and cultivation, of, briefly, the cult of incompetence and inefficiency." "Democracy is thus led quite naturally, irresistibly, one may say, to exclude the competent precisely because they are competent." This it is that made Aristotle say that where merit is despised. there is democracy. "Democracy in its modern form encroaches first upon the executive and then upon the administrative authorities, and -reduces them to subjection by means of its delegates, the leg- islators whom it chooses in its own image, that is to say, be- cause they are incompetent and governed by passion." Dr. Allan McLane Hamilton in the N. A. Review for March, 1908, pointed out the danger of the high executive offices being held by men with psychopathic tendencies, and again in the N. Y. Times for May 12, 1912, the eminent pro- fessor of mental diseases at Cornell University Medical Col- lege says: "Their shortcomings are due to defects in early education or to later ignorance; some are by nature vain and vulgar and abusive, or swollen with conceit, and in every way The Physician's Duty in Forming Public Opinion 187 lack stability, dignity and judicial capacity. "Others have espoused the anarchist doctrines of equally crazy agitators and revolutionists. "Still others belong to the well-known psychopathic class who are able to gather about them a following of unthinking adherents who, as a rule, are discontented, and whose pabulum is the sensational newspaper or the muckraking magazine." "Most of the projects and loudly advertised plans of re- form are not carried out, but dropped when the first effect is produced and the vanity temporarily gratified. The delusive hatred of others is hardly distinguished from the effeminate spite of hysteria or temperamental defect.'* "It therefore becomes the great American public to exer- cise the greatest care in the selection of a President, for if men are accepted at their own estimation or hysterical sugges- tion takes the place of good sense, there is nothing but ruin and dissension ahead. "Unlike the sane, well-balanced man, the self-interested and shrewd paranoic, especially if with a following of unbal- anced persons more ignorant than himself, may skillfully play upon all the passions implanting dissension and dissatisfaction, and possibly overthrow the long established laws made by other minds." We must hope, therefore, that great medical minds may be allowed to direct popular theories of government in all that appertains to eugenics. It is well to bear in mind that man progressed not only in spite of, but because of, what we now consider vices and animal passions. Intense selfishness, brutality and utter dis- regard for the injury resulting to his fellows, were cardinal virtues in the savage, necessary for his very existence in his struggles with the elements, wild animals and his own kind, and even with the dawn of intelligence, a low cunning, which we now consider ignoble, prevailed, and morality only slowly gained ground. As he began to make provision for the mor- row and replaced the chase by agriculture, he relied more upon forethought and experience than on residual brute instincts for maintenance, until, in the course of time, a glim- 188 C. H. Hughes mering sense of tolerance and justice developed which ren- dered social relations outside his immediate family impossi- ble. This, finally, culminated in those nobler humanitarian sentiments of love and sympathy which now sway the best of mankind. Yet, strange as it may seem, forbearance and non-resistance are responsible for our present social and polit- ical unrest, because the unscrupulousness, immorality and bru- tality, proper to the prehistoric cave man, are unequally trans- mitted in his descendants of to-day. Civilization unfortunately has not established a uniform type of man, for development has not proceeded in the same uniform ratio as has obtained in wild animals under the rigor- ous laws of the survival of those individuals best suited to their environment. In the dim vista of the remote past, in- tense selfishness and the ability to plunder or defend, were the salvation of the family; to be timid or considerate of oth- ers, meant extinction. It was scorned and unappreciated then, as it is to-day, by individuals with a preponderating prim- itive ativism which has outlived its usefulness in promoting human progress. This opinion may be challenged by those who have not had the opportunity of coming in contact with the primitive peoples of Africa, Australia, Malay, Asia, India and the South Seas. Such races as are in a low state of mental development do not, in our experience, appreciate consideration, but mistake it for fear. In their heart of hearts they despise and lose respect for those who treat them with kindness, and even such as have had the advantage of some educa- tion and training by missionaries, are only modified on the surface, and relapse when circumstances make them forget the restraint imposed on them. So-called crimes, therefore, in our opinion, should be considered as due to an abnormal anatomical relapse to ancestral defects which, according to Mendel's law, occa- sionally crop out, and are only restrained by a thin veneer of social polish enforced by contact with the truly civilized. Education, example and restraint may do something The Physician's Duty in Forming Public Opinion 189 with retrograde individuals, but after all, the individual lives and dies much in the state he is born in, and any- apparent improvement in the so-called criminal, simply means the unfolding of some few latent and desirable in- herited qualities. Evolution and selection antedating birth alone make for real progress, and laws which will tend to encourage healthy progenitors with desirable characteristics ap- proaching as nearly as possible a normal mental and phy- sical type, are the true solution of the social problem. Crude processes of natural selection are now so modi- fied by increased brain development in man, that the unfit together with the best types are preserved; this selection of progenitors, however, should be confined to the better elements of society and the privilege should not of neces- sity be extended to all. Unfortunately, the inferior are more prolific than the intelligent, so that the majority con- tains a higher percentage of inferior over superior types. The prospect is not encouraging, because it necessi- tates a government with the moral courage to enforce restraint and practical eugenics in order to counteract the tendency to degeneracy which unwise socialistic theories are liable to accentuate as they gain more and more as- cendency in the dictation of social and public affairs. In order that the medical profession may obtain the necessary influence Tn guiding public opinion, we should be represented in the Cabinet, and this is now a vital question which has reasonable prospects of success. In order to command respect, we as physicians should strive to raise our standard of professional ethics, dignity and knowledge, for we cannot disguise the fact that we do not hold the same exalted position in this country as in Europe, owing in a measure perhaps, to the overcrowding. of our ranks and the only recent enforcement of thorough medical education at our schools. Among other things, our legislators should be made to understand that the good accomplished by hygiene, asep- sis, sanitation, preventive medicine, better food and in- 190 C. H. Hughes creased material comforts in the last few decades, has not been unmixed with e,ril results, for it has brought about the preservation of physically inferior children and adults who would have inevitably perished even fifty years ago. We are in this way diluting our desirable stock with strains of civilization's submerged strata which do not make for material or moral progress. This necessitates the humani- tarian creeds of labor union demagogues, who advocate the accommodation of conditions to meet the mean average intelligence, which tends to a leveling down rather than an upward process. Humanity has reached a stage in mental advancement where it has a right to determine who shall and who shall not procreate, and the initial steps in correct- ing some of the ills we now suffer from has been the work of physicians as exemplified in the Indiana law and some other states with regard to the sterilization of the criminally insane. The Louisiana State Medical Association is now urging the passage of a law which will deprive habitual criminals and drunkards of both sexes, of the power of reproduction, and we may hope that this will become univer- sal on the North American Continent within a few years. In July next, the first International Eugenic Congress will be held at the University of London and will be attended by from five to six hundred scientists, including distinguished biologists and physicians. Unless something is done to prevent a decadent posterity, we must continue to revolve in a vicious circle; periods of great brilliancy, vigor and prosperity, alterating with long periods of dark- ness. Since the entire world is now linked up by commerce and easy communication, a retrograde movement involving the most civilized and temperate zone parts of the world, would be more serious than the temporary setbacks which occurred to ancient nations who fell by the wayside after periods of great virility and prosperity, for they were iso- lated oases among barbarians. It is true that the uncivilized in turn improved either from within, or by contact with more advanced peoples without, but a renaissance is less The Physician's Duty in Forming Public Opinion 191 likely to occur in the future than in the days when hu- manity was young and unjaded by generations of stren- uous nervous tension. As physicians, our duty to the public should not only be confined to councils of hygiene, sanitation and pre- ventive medicine, but must also include the sexual relations, the care of children, the vexed subject of animal experiment- ation, eugenics, physical and mental improvement, questions in fact which are now boldly treated in our newspapers and magazines by laymen who do not grasp the physiologic and psychologic aspect of these questions from the same practical standpoint as the medical profession. The question is by np means hopeless; our medical journals are taking up the question of eugenics energet- ically. SURGERY AS A CURE FOR INSANITY; An Erroneous View of Insane Hospital Treatment—Se- lected for Comment by the Editor of This Magazine. "Probably no one subject pertaining to the practice of medicine has been so neglected and treated with such scorn and indifference by the profession as insanity, and surely no class of patients ought to appeal to us more than these unfortunates, because of their utter helplessness. The profession at large looks upon these people in the beginning usually as nervous breakdowns and advises them to go to sr.nitariums and rest cures, etc., and when they become too bad or unmanageable they advise their commit- ment to asylums. "The family physician may have had the care of the patient for months, prescribing the usual nerve remedies to quiet them, and when they are removed to the asylum, little else is done beyond confinement and restraint." "The treatment of the insane patient has scarcely ad- vanced beyond the dark ages. Institutions are endowed by private and public charities for the purpose of taking care of the insane, and the patient is placed therein under restraint, but little or no effort is made to seek out the cause of his affliction." (Egregious error.) "Many of these people could be turned loose if it were possible for them to make known their wants, and if the same amount of care and skill were bestowed upon them that is lavished upon the sane, but the very nature of their troubles puts them in the light of the shunned and neg- lected. Of course, their words and complaints are treated (192) %Surgery as a Cure for Insanity 193 as of the irresponsible, hence of little or no weight." (Mistake.) "Knowing all these things, we owe to these patients a manifold duty; one of sympathy and surely a professional obligation to see into their physical wants. The latter we have shamefully neglected." "Knowing as we do the many mental symptoms that arise from physical ills, it is incumbent upon us not to look lightly upon the symptoms manifested by the insane. The vast majority of postmortems made upon those who have died while insane has not proven cerebral degeneracy, but has shown the cause to be foreign to the brain. I doubt not if the same advancement that has been made in treating diseases of the internal organs would be applicable to those mentally affected, 50% of the inmates of the asylum would be at large and become useful citizens." Dr. M. J. Buck, of Pittsburgh, Pa., writes the above for the Medical World, August, 1913—and cites four cases of operative success with consequent recovery in his own experience. There is some exceptional truth in the above state- ments excluding Doctor Buck's medical experience, but an extreme amount of error, of which the better informed editor of the Medical World knows as he shows in the fol- lowing correct comment: "Much is being done nowadays in insane asylums to cure, by medical, surgical and other therapeutic means, the insane committed thereto. Great progress has been made in these matters ever since the days of Pinel.—Ed. Med. World." The general estimate and treatment and care of the insane has advanced to an amazingly enlightened plane since the dark ages, Doctor Buck to the contrary notwith- standing. The modern hospital with its homelike sanitary and delusion-diverting features, conveniences, personal com- fort, change of environment from the place where insanity usually has its inception, and the change of name from asylum to hospital or sanitarium is evidence of the present 194 C. H. Hughes day advance in view of the psychic and medical therapy of insanity, or rather of the insanities is evidence of medical progress for the welfare of the insane alone, to say nothing of the special teaching of psychiatry in medical schools, the organization of psychiatric associations, the provision for diplomas in alienism as in Great Britain. The general medical conception of insanity as a psychic somatic affection and the approved therapeutic efforts in vogue in the profession concerning insanity refutes the view of Dr. Buck. Fewer operations are performed on the insane in hos- pitals for them than outside because of the delusional aver- sion against the knife and other difficulties and embarrass- ments better known to insane hospital medical officers than known to surgeons outside. When the writer was in supreme charge of such an institution he did his own surgery and treated the medical ailments of his hospitad patients all over to the best of his ability, remedying whatever he discovered was wrong in their organisms. Medical superintendents, so far as he knows as a member of the American Medico Psychological Association (and of Great Britain as honorary member) treat their insane in the same or a similar manner. His observations of other insane hospital superintendents are all similar. In fact, the average so-called insane asylum medi:aL officer is a superior diagnostician and therapeutist consid- ering always the psychic as well as the physical needs of his patients. That many cases of insanity are due largely to extrane- ous causes indirectly involving the brain may be conceded from clinical experience, but seldom exclusively, for there is the psychopathic diathesis to be considered, which deter- mines psychic overthrow under distant traumatism. In fact, insanity is usually the product of two or more generations of thsi psycho-somatic disease or proclivity to insanity, as most alienists of large clinical experience affirm, with predisposing factors, as well as exciting or final determining factors. Surgery as a Cure for Insanity 195 In conclusion, Dr. Buck, to elucidate his view that many cases of insanity are due to extraneous causes and "not to be attributed to the brain," cites the four cases that came under his care during the last ten years. But insanity did not supervene till the nerve center strain of the diseases demanding operative relief, involved the brain also in dis- ease disordered action, for insanity is always a disease primarily or secondarily involving the brain, and is usually the product of hereditary or predisposing aptitude in the brain to take an insane departure from the brain's natural and normal function direct or indirect disease—though direct traumatism or extreme toxemia may cause this calamity to brain and mind. But it is a clinical and therapeutic fact for surgical or medical psychiatry that every source of peripheral or extraneous irritation to the brain and mind should, when practicable, be removed from the body and environment of the insane with a view to recovery or prevention of insanity. Appropos and in refutation of the misconception on the subject of treatment of the insane in our hospitals, espe- cially surgical, we make the following abstract, the first one and nearest to hand of our insane hospital reports. This is from the Utica State Hospital, and is headed "Surgery," report, 1913: "During the past year, attention was directed to a num- ber of pathological conditions for which surgical interfer- ence was deemed necessary. The operations performed include two laparotomies, one herniotomy, one cauteriza- tion for prolapsed rectum, one mastoid resection and one tonsillectomy. The laparotomies include one complete hysterectomy for fibroid uterus and cystic degeneration of the ovaries, by Dr. F. J. Douglas, acting consulting surgeon of the staff, and one oophorectomy and trachelorraphy by Dr. Hicks of Amsterdam. Great relief was afforded a male patient suffering from direct inguinal hernia when Dr. Glass, of the consulting staff, performed a Bassini operation. The mastoid resection and tonsillectomy were performed by Dr. 196 C. H. Hughes Gage of the consulting staff. The results in all these cases were uniformly good. Many cases requiring minor surgery were cared for during the year as occasion demanded, etc. The next heading is Gynecological Work. In getting the history of the female patients, the nurse sent for the case pays special attention to the history of any disease in the reproductive organs and makes a definite report on each case. Before leaving the reception building, all female pa- tients are interviewed by the woman physician. A pelvic examination is made and when indicated appropriate treat- ment is instituted. From time to time, pelvic symptoms arise in the women * * * and the attention of the woman physician is called to these cases. The senior nurses receive a course of lec- tures in gynecology and obstetrics and are instructed in the special care of the women patients." In reach of our table as we write is another, that of the Butler Hospital of Providence, R. I., whose first superin- tendent was the eminent alienist author, Dr. Isaac Ray, to whom the writer owes much for valuable counsel and clini- cal instruction, both by word of mouth during visits to this same institution and through the great alienist's writings. This report advises us that: "In 1870 the State Hospital for the Insane was opened at Howard and seventy pauper inmates of the Butler Hos- pital were transferred to it, and this action was the leading cause of a far-reaching change in the policy of this institu- tion. Up to 1870 it had been the only place in the State where the insane could be kept and made comfortable, and far the larger part of its inmates had been incurably insane and it had been forced to become an asylum rather than a hospital—a refuge and home for the insane of the State where they were carefully looked out for and fed and kept alive, rather than an institution where those in the incipient stages of mental disorder could be treated by skillful phy- sicians and watched over by trained nurses in the effort to Surgery as a Cure for Insanity 197 alleviate and cure the disease they were suffering from. After 1870 it was decided to make the hospital a cura- tive institution, and ever since its best efforts and its increasing expenditure of money have been directed to try- ing to cure its patients. It was also decided to transfer to the State institution patients who were found to be incurable, and to decline to receive applicants for admis- sion whose cases seemed to be hopeless and who would not be benefited by treatment, in the expectation that thus more room would be made for the reception of patients who might be benefited by treatment," etc., etc. The transition in name from lunatic asylum to insane hospital, and now to simply hospital, which designates most of these institutions, indicates the curative features of these institutions. The words "for the Insane" in this title of Butler Hos- pital were rarely used in common speech. In 1906 they were formally dropped by act of the General Assembly. These and the words lunatic asylum are now rarely used anywhere in connection with places where insane are treated. Nor are there any bedlam or mad houses now. They are simply hospitals where the mentally ill are treated humanly scientifically. The motto on the seal of this great hospital indicates its hospital feature, as it does the curative medical treat- ment purpose of other like institutions. "Miseris succur- rere disce," and "Learn to help the afflicted." And they are doing it at Butler. While endorsing the propriety of properly timed and executed surgical procedures for the insane, gravely dis- eased external to the brain, and for certain cases of brain disease or injury implication, we could not, in the interest of sound psychiatry, medical as well as surgical, permit the erroneous opinions respecting modern hospital treat- ment of the insane of this paper to go unchallenged. The author is more familiar with practical surgery than with psychiatry as practiced in our non-politically managed hos- pitals for the insane. SELECTIONS NEUROANATOMY. A Newly Discovered Nerve.—Before the last Decem- ber meeting of the Minnesota Neurological Society (St. Paul Medical Journal report): "Dr. J. B. Johnston demonstrated the nervus terminalis, a nerve not hitherto known in connection with the human brain: this being the first instance in which this nerve has ever been shown in the brain of man in a formal society meet- ing. The nerve is non-medullated, having one or more root- lets attached to the brain in the medial part of the anterior perforated space. The rootlets run forward beneath the pia between the olfactory peduncle and the median fissure, unite into a common trunk and pass through the anterior part of the cribriform plate to the nasal septum. The nerve is pres- ent in all embryonic, fetal and adult brains examined. In some individuals ganglion cells have been found singly and in groups in the course of the nerve. The nerve is supposed to contain both sensory and motor sympathetic fiber." NEUROPATHOLOGY. Myxidiocy in the Presence of the Thyroid Gland.— The rare occurrence of myxidiocy in spite of the presence of the thyroid gland is explained by the author in the following manner: As the result of a developmental disturbance there has ensued a deficient growth of the brain and of the system of endocrine glands, especially the testicles, thyroid. and hypo- (198) Selections. 199 physis. The idiocy is the result of the underdevelopment of the brain. The disturbance of correlation of the entire glandular apparatus thus produced gives rise to the myxede- matous condition. Goldstein (Deutsche Zeitschrift fur Ner- venheilkunde), Archives of Diagnosis. Sajon's and Taylor's Cyclopedia. NEUROTHERAPY. Epinephrin According to Causes.—Decrease of albu- minuria and an increase of urinary output, but parenchyma- tous degeneration of the kidneys is in no way influenced by epinephrin. Hess and Wiesel (Wiener klinische Wochen- schrift, February 27, 1913). Neurotic Anorexia.—While loss of appetite and nau- sea are usually symptoms of a host of diverse pathological con- ditions, they sometimes constitute a disease in themselves—a kind of neurosis. In these cases the physician will find Gray's Glycerine Tonic Comp. of almost specific value for restoring the impaired appetite. It is not only agreeable to take, but produces its benefits at once in such a natural way that before the patient realizes it, the normal amount of food is being taken. It is also exceedingly useful in relieving nausea in early pregnancy. Adrenalin Glycosuria.—A number of important re- sults have been obtained in the investigations carried on by Anastazy Landau and reported in the Zeitschrift fur klinische Medizin, Vol. 79, Nos. 3 and 4. He found that whereas 150 grams of grape sugar increase the sugar content of the blood, this increase is as a rule insufficient to evoke glycosuria. If adrenalin is injected subcutaneously it gives rise to glyco- suria provided that immediately before the injection the or- ganism receives a considerable amount of grape sugar or of foods containing it. In this case the glycosuria is accom- panied by a marked hyperglycemia. If, instead of grape sugar, levulose is administered, no glycosuria results. 200 Selections. Another important observation made is that the glyco- suria-producing and the diuretic powers of adrenalin are quite independent of each other. Moreover small doses of cocaine sensitize the action of adrenalin, increasing both the hyperglycemia and the glycosuria. On the other hand a preparation containing the total alkaloids of opium, if injected with adrenalin, inhibits the glycosuria-producing powers of the latter. The mechanism of this inhibition is twofold. On the one hand the opiate delays the mobilization of the glyco- gen in the liver and reduces the hyperglycemia; on the other hand it diminishes the glycosuria by impairing the secretory activity of the kidneys. - The above facts are pregnant with significance from th viewpoint of the mechanism of diabetes and its treatment. There can be little doubt that a derangement of the internal secretions is at any rate in part responsible for this condi- tion, and that possibly an excess of the internal secretion of the suprarenal capsules or of some allied gland is an impor- tant factor in the production of diabetes. There is another necessary component in the nexus of adrenalin-glycosuria, namely, the intake of a sufficiently large quantity of grape sugar. In other words the dietetic factor in diabetes is an important one. Another fact brought out by the experiments of Landau is that the therapeutic value of opium in diabetes may in part be due to a harmful effect of this substance upon the renal epithelium.—Medical Record. ORGANOTHERAPY IN ACROMEGALY WITH Psychic Dis- TURBANCEs.-Patient admitted three times for melancholic depression. Unmistakable signs of acromegaly present. Neither radiography nor examination of ocular fundus showed a tumor of the hypophysis. Symptoms considerably under pituitary extract. A thyroid preparation instead coincided with disappearance of the headache, dizziness, vomiting, and improvement in the mental state. Renewed pituitary treat- ment caused all these symptoms to reappear, after which they yielded again to thyroid treatment. Salomon (Société cilinique de Médecine mentale, Paris; Presse médicale, De- cember 13, 1913). Monthly Cyclopedia and Medical Bulletin. Selections. 201 RADIUM.–At a meeting of the Radium Institute of America, at Columbia University, Feb. 17, papers were read by Prof. George B. Pegram, Prof. William Duane of Har- vard, Francis C. Wood, director of cancer research, Colum- bia University, and others. The principal address was made by Dr. Robert Abbe, of New York, who was among the first investigators to make practical use of radium. He announced a report from Dr. Alexis Carrel, who, at his request, had been making researches at the Rockefeller Institute, which had convinced him that the manner in which he had been applying radium in the treatment of malignant and other growths was wrong. The experiments of Carrel had demonstrated that the gamma rays, which had been depended upon for stopping cellular growth, were almost entirely inert, while the beta rays, which had been considered of little or no value, were extremely active. “Carrel's experiments,” said Dr. Abbe, “are only just beginning. . . This new method of studying the isolated rays emitted by radium will end our period of confusion as to the qualities of each ray.” Dr. Carrel says he “knows that the action of each ray is different from the others.” Under Dr. Carrel's cautious hands and others more work will be needed before we can assign to each division of the isolated rays its exact rôle.”—Abstract from Boston Medical and Surgical Journal. QUININ FoR RABIES.—Moon tried quinin on dogs that were inoculated with rabid brain material, and rabies devel- oped. Quinin was then administered internally in doses equiv- alent to from twelve to eighteen grammes daily for an aver- age man. The medication was pushed to bordering on the toxic. Three untreated animals died. The three treated ones recovered. This method has been employed successfully in one case of a human being.—Abstracted and abbreviated from New York Medical Journal. The Dominion Medical Monthly has an excellent method of brevity in making abstracts, of which the following is a sample appropriate to our pages: THE CoMAtose STATE.—Grober (Deut. Med. Wochen.) 202 Selections. states the first step should be to avert immediate danger from the heart or respiration. Then seek to discover the cause of the coma. If due to a poison, an antidote, venesection, stom- ach pump, vomiting, stimulating kidneys and purging as indi- cated. These failing, then the treatment can only be expect- ant and symptomatic. Close supervision must be kept upon circulation and repiration. Where there is paralysis from a poison atropine sometimes restores the muscular tone. SALUTARY RESULTs of TYPHOID VAccINATION AT SPRING- FIELD, MARYLAND, Hospital. For THE INSANE.-Major Rus- sell's conclusions in his article published in the Journal of the American Medical Association are all borne out by the results of our experience at Springfield. The conclusions are: (1) “That the inoculations are harmless in healthy per- sons is now well established.” In our own cases not a single ill effect has been discovered among the 1,316 inoculated, 890 of whom have been under daily observation by our assistant physicians for eighteen months. (2) “That it confers almost absolute immunity against infection.” Our typhoid rate has been reduced from 1 to 2 per cent. to nothing. (3) “That it was the cause of immunity of our troops against typhoid fever in the recent Texas maneuvers.” (4) “That the duration of immunity is not yet deter- mined, but it is assuredly two and one-half years, and prob- ably longer.” Immunity has lasted among the 890 vaccinated in 1911 for 18 months. (5) “That only in exceptional instances does its admin- istration cause any appreciable degree of personal discom- fort.” All our patients were up and ready for breakfast the morning after the inoculations with eight exceptions. (6) “That it apparently protects against the chronic bacillus carrier and is at present the only known means by which a person can be protected against typhoid under all conditions.” All known precautions, as boiling water and milk, disinfecting stools, sterilizing clothing, screening the windows, etc., had been tried, but still a few cases developed each fall. Selections. 203 (7) “That all persons whose professions or duties in- volve contact with the sick should be immunized.” It is a well-established fact that attendants and nurses are more lia- ble to typhoid infection than those engaged in other occupa- tions—eight times as liable, according to the statistics of the Massachusetts General Hospital. (8) “That the general vaccination of the entire com- munity is feasible and could be done without interfering with the general sanitary improvements, and should be done where the typhoid rate is high.” This is a safe and sane proposition. Considering the harmlessness and safety of the use of typhoid vaccines, there is no reason why typhoid vaccination should not be compulsory, just as smallpox vaccination. Certainly every case of typhoid that is prevents lessens the liability of the infection of others, both by the possible contact and the various channels of transmission while sick, as well as the possibility of his becoming a typhoid carrier after conva- lescence. (I am indebted to my assistants for carrying out the technique and recording the results from various cases.) It has now been one year since the above report was written, during which time 572 additional cases have been inoculated, making a total of 1,888 since the early part of 1911. During the past season we have had three cases of typhoid fever developed in the institution; two of these cases having had typhoid fever before were not inoculated, and the other one had received an inoculation in 1911, but at that time only small doses of typhoid virus were being used. To summarize, we have had six cases of typhoid fever in the institution during the past three years, two having had typhoid fever before, two had been inoculated in 1911 with the high dilution in use at that time, one case was overlooked while the inoculations were being given and the other, an attendant, refused to be vaccinated. INFUNDIBULUM is a rapid and powerful galactagogue.— Ott. 204 Selections. Venesection in Cerebral Hemorrhage.—Medical Rec- ord. A. MacFarlane extols the value of venesection in cases of apoplexy. If the blood pressure is above 200 mm., he says, this procedure is urgently indicated. It lessens the hemor- rhagic effusion and allows coagulation. Prompt blood-letting may save a patient from a permanent hemiplegia, which is worse than death. [L. D. C] Abstract in Boston Medical and Surgical Journal. CLINICAL PSYCHIATRY. The Relation of WassErman Reaction to Neuriatry is intelligently and instructively discussed in "Brain," Novem- ber ultimo, showing mostly negative reactions in syphilitic and parasyphilitic sequences on the basis of ninety-one cases examined by Drs. Flider and Mcintosh. Compulsory Ideas and Manic-Depressive Psychoses. —K. Bonhoeffer (Monatschrift f. Psychiatrie und Neurolo- gie, Vol. 33, No. 4.) Jelliffe in Post-Grad. With a brief case history to illustrate his contention, the writer points to the approximation of compulsory ideas to manic-depressive psychosis. Other observers have noted the frequent periodicity of the first of these two affections, and this writer shows that there is no casual relationship between them, but that many things point to a close nosological kin- ship, chief among them being the occurrence of definite manic manifestations during the course of the condition. Of impor- tance also is the frequency of manic-depressive in the ante- cedents. NEUROPATHOLOGY. The Metabolism in Epilepsy.—The discovery of oxy- protein acids in the normal urine by Bondzynsky and his col- laborators and pupils, and the inference that these acids are found in an increased amount in the urine of persons who Selections 205 have marked disturbances of metabolism, stimulated inquiry along this line by S. Kozlowski, with special reference to epi- deptics. His results are reported in the Zeitschrift fur klinische Medizin, Vol. 79, Nos. 3 and 4. He found that oxy- protein acids are in some cases of epilepsy excreted in enor- mous amounts. At the same time, there is an accompanying increase in the formation of ammonia in the organism. Pos- sibly these chemical changes are more or less directly related to the epileptic attacks. This supposition is strengthened by the fact that epileptic attacks are diminished if meat is with- drawn from the diet and replaced by milk, for this diet dimin- ishes the formation of oxyprotein acids not only in epileptics but also in healthy people. In agreement with these facts one may cite the observation made by Krainski that lithium carbonate as well as borax diminishes the frequency of epi- leptic seizures. These salts lead to the formation of fixed bases, which combine with the oxyprotein acids. The ques- tion now arises whether the periodicity of epileptic attacks can be explained on the supposition of a chemical intoxica- tion of the body. According to the author, it appears that the periodic onset in these attacks can be easily explained on this basis, for it must be considered that in the body of the epileptic the toxic substances in unfolding their activity find a suitable soil in the periodically increased irritability of the nerve centers.—Ed. New York Med. Rec, April 4, 1914. Spirochaeta Pallida in Paresis.—(Jour. A. M. A.) U. J. Wile, Ann Arbor, Mich., describes the results obtained by Forster and Tomasczewski in using their method of brain puncture to demonstrate the presence of the spirochete in the brains of living paretics. Drilling through the skull under antiseptic conditions, and drawing out with a syringe a small cylinder of brain substance, gray and white matter and more or less fluid from the ventricle. ... In twenty cases ex- amined the spirochetes were found in the gray matter in eight. This confirms the discovery of Noguchi, so far as the central nervous system is concerned. 206 Selections. NEUROSURGERY. Xekve Grafting in Poliomyelitis.—The success which has been obtained in a few instances of nerve grafting has been such as to encourage the belief that great relief could be furnished in confined paralysis from anterior poliomyelitis by this surgical procedure, but clinical evidence so far collected does not substantiate such an opinion. The method may be regarded as still in the experimental stage, and at present it does not offer much hope of relief, and the number of cases to which it is applicable is small.—Bulletin Man. Bd. Hlth., 1912. NEURODIAGXOSIS. Robert's Test for Albumen.—Dr. John W. Boyce, Pittsburgh, Pa., in Urologic and Cutaneous Review, believes: 1st. Robert's test is more convenient, more definite, and more delicate than the more popular tests. 2nd. The cases in which its extreme delicacy will prove a disadvantage do not amount to more than one in 40. 3. Every urine which reacts with Robert's test is worthy of careful microscopical study. It consists of one part of nitric acid, and from five to eight parts of a saturated solution of magnesium sulphate in distilled water. Such a solution is not corrosive, and a bottle of it with an ordinary stopper may safely be carried in a med- icine case. It is of higher specific gravity than nitric acid, and is employed by the contact method even more conven- iently. When so employed, the line of contact between urine and reagent is sharp, and no color bands whatever are formed. The presence of the merest trace of albumen shows a sharp white line, such as renders the test an exceedingly definite one.—Medical Council. The Eyeball-Heart Reflex.—Loeper and Mougeot reported research last year confirming the instructive import of Aschner's reflex, the slowing of the heart-beat when pres- Selections. 207 sure is applied to the eyeballs. In two or three seconds at most, the heart slows up by about 8 beats to the minute, but the former rate returns as soon as the pressure is released. In tabes this reflex seems to be abolished. In some cases the absence of the oculocardiac reflex, as they call it, was the first sign to attract attention to the tabes. The apparently para- doxic tachycardia with abnormally high blood-pressure does does not affect this reflex, but this tachycardia warns of im- pending breakdown of the left heart and calls for digitalis unless it yields to other measures. They explain the mecha- nism of this tachycardia, saying that the eyeball-heart reflex first threw light on it. They published several communica- tions on the reflex in the Progres Medical, 1913, xli, 211, 663 and 675. With a gastric neurosis this reflex is an indication whether the pneumogastric or the vagus is predominantly involved, and this may prove a guide to treatment. In one of the cases reported the patient had an ulcer on the lesser curvature, and the pulse slowed up by 14 beats on pressure of the eyeballs. Three months after resection of the stomach the pressure cause the pulse to drop from 88 to 62, a loss of 26 beats. The pressure on the eyeballs never seemed to do any harm. It exaggerates bradycardia when it is of nervous origin, and may exaggerate arhythmia. With rudimentary exophthalmic goiter and very emotional subjects, with a ten- dency to "hot flashes" and profuse sweating, pressure on the eyeballs is liable to accelerate the pulse.—Jour. A. M. A., Feb. 14, 1914. THE ALIENIST AND NEUROLOGIST. Vol. XXXV. St. Louis, May, 1914. No. 2. Subscription $5.00 per Annum in Advance. $1.25 Single Cost This Journal is published between the first and fifteenth of February, May, August and November. Subscribers failing to receive the Journal by the 20th of the month of issue will please notify us promptly. Entered at the Post-office in St. Louis as second-class mail matter. All remittances should be made to Cms. H. Huohks. The Alienist 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 Alienist and Newologiet. .For return of non-accepted manuscript send addressed envelope and sufficient postage. Any Comment, favorable or unfavorable, specifically set 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. Huohis Printing Co., Printers and Binders EDITORIAL. The Time Factor in Medical Education.—The com- plexity of studies and the vast amount of increasing knowl- edge (almost paralyzing to contemplate) necessary for the medical student to acquire and the limited time he can give to study, if he would begin medical practice as his liveli- hood occupation, make it necessary that we should con- sider the time factor at the average student's command in providing for his education in medical essentials. In order to meet his training needs and the time he can give in preparation for practice before getting into practice, it looks as though we should have a different arrangement from the proposed high school graduation and two-year literary and scientific university course added to the four-year medical term and one additional clinical 208 Editorial. 209 year in hospital experience, before sending him out to practice. A Medical University.—The substitution under the cir- cumstances of an exclusive medical university, where all the essential knowledge would be condensed and boiled down, by expert teaching, and adapted to the needs of the doctor in embryo were demanded, such as physics, physiology, biochem- istry, philological Greek and Latin, pathology (alcoloidal, galenical) serotherapy could be taught in more condensed form and shorter time than are now taught. The essentials of the specialties should be practically con- densed and imparted in a briefer and less paralyzing way than they are now, with so many score professors, for the student who contemplates a general practice only. For the stu- dent who expects to devote his life time to laboratory work—to become an expert chemist, biologist, pathologist or a medico-legal court advisor or a teacher of a department, or course in the great and greatly endowed universities would be advisable, but not necessarily for all medical stu- dents. The subject demands considerate thought. But for the student intending to become a family advisor and general physician and not expecting to make specializing his life work or to be supremely thorough beyond diagnosis and treatment and having of necessity to to get at his life work by the time he has reached early manhood—say at twenty-one or twenty-three years of age, his instruction should be concentrated into an earlier and shorter time limit than many of the advocates of the so- called higher education demand for all. The doctor's education should of course be thorough, both preliminary and special. It should be boiled down to the practical and essential. The knowledge of the lan- guages should be taught with his special needs in view (as a doctor only, not as a literateur), mostly philological and by the natural method, to aid in the full, complete and clarified comprehension of technical terms. He should be taught Greek and Latin, for instance, mostly in their 210 Editorial. medical aspects—Hippocrates and Galen as text books. Xenophon's Anabasis or Caesar's Commentaries, etc., might be set aside like Ovid's metamophosis, etc., for a convenient season, when the leisure for them shall come to the student later, while he sits in his office waiting for practice to come to him. He will generally get the time while he waits. Let us in our teaching consider the student, his time, his pecuniary means, his health and his life expectation. But at the same time inspire him with a love of general and classic culture as well as life saving, disease relieving, facts from every source of knowledge. Fatal Thanatophobia.—Last year a record of a case of this kind came over the wires of the "Associated Press" from Wabash, Indiana, Dec. 18th. As the result of fear occasioned by the death of two men at the County Infirm- ary, where he is an inmate, Bert Jackson, 87 years old, dropped dead. Jackson has long had a mortal fear of the dead, and following the demise of any person at the place, went in hiding, where he remained until after the funeral, doing without food. Within two hours of each other on the above date, two deaths occurred at the institution, and the shock was so great that Jackson soon afterward expired. Psychic phobia brain-heart shock paralysis is more common than gets of record. It is too often designated as simply heart disease. Much of the popularly so-called sudden heart disease is brain-shock paralysis—the pre mortem improvement of which is the therapeutically induced cerebro-neural im- paired brain vagus nerve tone in which the brain and heart are chiefly at fault. The stable neurone is the thing here, as elsewhere, in too many cases of so-called heart disease as the post mortem normal heart too frequently shows— simply heart disease, is misleading. Editorial. 211 Sir Batty Tuke.—This eminent psychiater, who died last October in Edinburgh, was renowned at his English home and abroad, as well as among us here in North America and Canada. He lived to the age of eighty-three years. T. S. C, which letters stand for our eminent college of the medi-psychological association, gives the distin- guished deceased a well-merited eulogy in the Journal of Mental Science, including also an excellent estimate of the dead doctor's charm of character and wealth of ability in his profession. Dr. Clouston tells us "Dr. Tuke was the first to describe the course of pigmentary deposits in the vessels and cells of the cerebral cortex. He was the first to describe the great importance of the intra-cranial lymph- atic system as an element in the pathological process in some forms of insanity. He described a new appearance which called 'miliary sclerosis,' which is now known by the name of 'senile plaques,' and certain other degenerations of the cerebral cells. He was one of the early observers of the clinical symptoms and pathological appearances in syphilitic arteries, as also of the increased blood pressure in general paralysis. In his Morrison lectures he described 'The Insanity of Over Exertion of the Brain.' He wrote the articles 'Insanity' and 'Hysteria' in the last edition of the Encyclopaedia Britannica. He advocated strongly an extension of the open door methods of treating patients in asylums, extending the ideas of the amount of freedom that might be given to certain patients. He believed strongly in a scientific study of insanity. He read at the Royal Society of Edinburgh a paper on the 'Constitution of the Pia-mater,' maintaining that the pia-arachnoid was one membrane, the arachnoid being simply the outer layer of the pia. This view has since been generally adopted. He contended that the vessels course between the two layers, instead of the older view that they ran in its inner layer. "He was in short a faithful and efficient wheel-horse in the advancing chariot of modern clinical and research psychiatry. 212 Editorial. "In his long and useful life he taught medicine in the Royal College's School of Medicine and was for a period of three years its President, resigning then because of failing health. He was a member of Parliament for ten years, and knighted because of his many gifts of mind and service in his profession and for the advancement of science in connection therewith. He was a member of the British Medico Psychological Association and honorary member of other similar foreign societies. He did much to elucidate the subject of puerperal insanity." Bailing Homicidal Lunatics a Judicial Blunder.—An insane person who has committed murder under delusion of Deity inspired impulse, or such delusion possessed indi- vidual as the religious paranoiac, George Bernhardt, of West Orange, New Jersey, who threatened the life of Pres- ident Wilson and the destruction of Washington if the President did not bring about better times, signing his letter as God's Son, is a case in point. This man had a murderous record. He had been in the restaurant business and killed his partner in an altercation about a woman. On the insanity plea he was committed to the Philadelphia Hospital. There he had several violent attacks and gave the physicians and attendants much trouble. On Sept. 8, 1910, Bernhardt and another inmate attacked and killed a fellow patient. They were tried and acquitted on the ground of insanity, and were returned to the crim- inal ward in the hospital by Judge Ferguson. At his second trial, Bernhardt rehearsed the shooting of his business partner in 1900, and told the jury that "it was the spirit of God that was upon him and caused him to commit the murder." In addressing the jury, Bernhardt said he had been visited by the spirit of God, and anything he did or might do was under the direction of God, is right. He said he killed this man by divine direction and could not be pun- ished for it. Editorial. 213 Bernhardt escaped from the hospital in February, 1911, and was caught in the home of relatives in West Orange three weeks later, but was not returned to the hospital. This was a grave error on the part of the authorities or guardian, and always will be in like cases. This sort of murderously delusioned man is dangerous. It is a wrong and risk to the President for him to be at large and to the com- munity, even though he is ridiculously bonded in the paltry sum of one thousand dollars, or in any sum against yielding to a brain disease impaired delusion. A bonded lunatic, dom- inated under such a delusion, will break any bond whenever the overpowering delusion of God's inspiration may come uppermost in his mind, and he might become again delusion- ally crime impelled from his Heaven inspired delusion. Bonding deluded lunatics to keep the peace and refrain from diseased brain impulses is not judicial. As well bond an epileptic against having a convulsion, and many insane murderers are in fact epileptic homicides. Purity Becoming Contagious.—After the pure food law, comes now the Laundry Men's Association demanding of Congress a pure fabric law, and in their resolution which re- sulted in the Linquist Pure Fabric Bill, H. R. 10080, which we cordially endorse, this association might have incorporated a law for pure antiseptic laundries. Now if we can only get a pure and clean congressman law that would accomplish the moral and financial puri- fication of the members of that distinguished body of too many misrepresentatives, patriotic citizens might feel that the country's future would be safe. Oh, that some sanitary genius would devise an effec- tive moral antiseptic that would cleanse and keep clean official Washington. The Forty-Third Annual Meeting of the American Society for the Study of Alcohol and Other Narcotics, held 214 Editorial. at Philadelphhia in the early days of last December, was an exceedingly interesting and enlightening one. The de- structive and fatal effects of this baneful destroying bever- age were shown as well as its possible good in medicinally measured dosage in emergencies of medical practice. The best and the predominating worst of this toxic destroying foe of our race were shown from sources of wise research. Resources and methods for the salvation of its victims by men of experience and acknowledged good medi- cal observation and judgment in that line of research phi- lanthropy were well portrayed. Almost every aspect of this subject known to scien- tific medicine was presented at this meeting, except the moral exhortation phase of the old platform lecturer of the past, before the light of science fell so convincingly upon the health and life-damaging power of this baneful bev- erage of so-called enlightened humanity. The interesting papers presented will appear during the year in that valuable magazine—the Journal of Inebriety, published at Hartford, Conn., by Dr. T. D. Crothers. Our Tardy Appearance this issue is due to a fire which almost totally destroyed the printing establishment of Hughes & Company on February 21st, putting them almost out of business temporarily and as this concern has published the Alienist and Neurologist for the past twenty years, the editor was disposed to await their re-establish- ment for the issuing of the present number, rather than to seek new publishers temporarily. Their service in the past has been so satisfactory that we cordially recommend them to our readers who may be contemplating the issue of books, hospital reports, etc., assuring them the same careful attention that has been given to this Journal. Physicians Unappreciated.—The distinguished physi- cians and surgeons, who by their discoveries and their self- sacrifice, have done more than all others to mitigate the physical miseries of humanity, are less recognized and remem- Editorial. 215 bered, I have often thought, than any other benefactors of the race. Their names may have an unpleasant association with a disease or an operation, but they themselves pass out of sight, although the lives they led and the work they did, and their observation of human nature, are more interesting than those of many of the men about whom volumes have been written.—From Henry Cabot Lodge, A. M. A. Journal. This is largely due to the out of sight and not to be heard policy of the profession. The medical profession is too mod- est and retiring before the world as to its meritorious deeds, and Professor Lodge deserves its thanks for this appreciation. Opium Is a Disease Developing Drug.—Only incident- ally habit forming through the disease it causes. Opium fiend is a cruel misnomer. The term opium habit is a mistake. Morphine taking develops relaxed and painful states of the nervous enterical and visceral systems when the opiate is long withdrawn, that are hard to endure, and can only be ap- peased by repetition of the drug or by other treatment. Dr. C. H. Bartlett in Vol. xxxv. No. 1, is right in saying the so- pital No. 1 at Fulton, Mo. Eugenics Poetically Considered.—Our humorous and called habit is not a habit. The so-called habit consists in tak- ing opium or its salts again and again to cover up and relieve the distress sequent to previously repeated doses and the harm it has done to the organism. It is cruel to call these unfortu- nate slaves of this pernicious drug fiends, because once enslaved, they can not do without being medically treated and cared for. The Alcoholic Psychosis.—That an individual with an alcoholic psychosis is not fitted for a soldier's life, at any rate, in war time, is self-evident, is the opinion of one of our ex- changes, and Secretary of the Navy Daniels is right, for Navy officers and men all the time. Sobriety only should guide our ship of state at all times, and under all circumstances, and 216 Editorial especially now. If the United States had now to deal with a clear, level-headed, humane-natured man acting as Mexican dictator, we might have an honorable peace with Mexico. After Huerta, who and what in Mexico? Dr. M. O. Biggs is the new Superintendent of State Hos- talented friend, Dr. Richard Dewey, has blossomed out in Jan- uary as an eugenic poet, as shown by the Milwaukee Sentinel of February 8th, thus: THE WISCONSIN "EUGENIC" MARRIAGE LAW. The following is a production read at a complimentary dinner recently given to Dr. H. M. Brown of Milwaukee: A POEM BY "EUGENE." Can be sung (perhaps) to the air, "A grasshopper sat upon a sweet potato vine; Along come a turkey gobbler creepin' up behind." A bridegroom was a sittin' on the curb before a church, He'd been left there in the lurch, He had fallen from his "perch." His promised bride had left him, she had "shook" him cruellee He was shy of a "certificate eugenic," don't you see? With his marriage proposition she would not at all agree, Tho' he went down on his knee, Tho' he sang "Oh, promise me," Tho' he'd spent of hard earned dollars something more than three times three, A "certificate eugenic" neither love nor "mon" would get. Heart and purse were "broke," "you bet." The doctors were most kind, But they wouldn't change their mind. They wouldn't take a chance of a suit for perjuree, Tho' they seemed unto that bridegroom "D. blank D," "per- nickitee." This bridegroom "non-eugenic," he was "up against it" hard. He might as well hang up his lute, he could get no lady "pard." Editorial. 217 This tragidee is "something fierce," All tender hearts 'twill sharply pierce. For all luckless "Wisconsinners" we may feel much sym- \ pathee. But it's right, we all agree, To protect the familiee And safeguard posteritee. The thing about this law that fails most dismalee— It demands of the m. d. an impossibilitee! If he "try for to" comply and his honest efforts fail, First thing he knows, a "copper" may be "campin' on his trail" And "pinch" him in his grief, Like any common thief, And lug him off to jail. Another funny thing is the clause about your age. If you're 20, you will not do. It takes "30" for a sage. Finalee, the poor male biped gets "his'n," "come" or "go." He has to do just so, And he has to be just so, But a flirty little female can do just as she's a mind, There'll be no bloomin' "copper" creepin' up on her behind, Creepin' up on her behind. And now to brother Horace Brown, you may remove your hat. Irreverently but honestly he remarked "requie" scat! Now let us all go straight to work for right eugenic laws. The "idee," it is a good one; let's eliminate the flaws! —R. D. Political Psychiatry.—Were De Groot, who pro- nounced the care of the human mind the "noblest branch of medicine," with us today, and could be among our adopted patriot citizens as most of their kind have proved to be in our country he would probably be saying the same of psychi- atry in our politics. Right quality tone of minds is what this country needs. We need eugenic politics and politicians. 218 Editorial. Two of the Oldest Physicians of St. Louis, Dr. Geo. F. Dudley, aged seventy-nine, and Dr. Wm. Webb, eighty, have died this year. The former was the first Health Com- missioner of St. Louis. Dr. Webb served as Confederate Surgeon in the Civil War. Both were members of the St. Louis Medical Society, the last having been made an hon- orary member. The American Medical Association for 1914 will meet at Atlantic City June 22, 23, et seq. Diploma in Psychiatry.—"The necessity of keeping abreast of modern discoveries in psychiatry has now become so important that it will certainly soon be indispensable that assistant medical officers entering and rising in the service should take out special courses in the scientific branches of their work at one or other university, and it is suggested that study leave should be granted to assistant medical officers to enable them to do this, and to obtain one of the diplomas in psychiatry now granted by several universities."—The Hos- pital, London. A good plan for America. The Brain of Dr. Alphonse Bertillon, recently de- ceased, weighed 1,525 grams, or 165 grams above the aver- age, notwithstanding the doctor had suffered from anemia for some time before death, and brain shrinkage was found at post mortem. The Pledge of the Surgeons.—The American College of Surgeons signalizes the beginning of its worthy existence by the following propriety resolutions.—Long may this worthy body live to practice them. To cut out psychic cruelty is quite as worthy of this worthy craft and as appropriate as to excise physical mor- bidity: "To avoid the sins of selfishness. To shun unwarranted publicity, dishonest money seeking and commercialism as dis- Editorial. 219 graceful to our profession. To refuse all secret money trades with consultants and practitioners. To teach the patient his financial duty to the physician and to urge the practitioner to obtain his reward from the patient openly." The greatest asset of any nation is the health and efficiency of its people.—The Training School Bulletin. True! and this useful bulletin and this magazine and eugenics generally will show the way to increase the value of this great national human asset. More Progress in Clinical Psychiatry.—The Psycho- pathic Hospital at the University of Michigan conducts a course of special instruction for physicians engaged in psy- chiatric work. This and Brill's new book are interesting evi- dences. If This Magazine Pleases you and has helped you in the practice of medicine or surgery, tell your friends about it. If it has displeased you or disappointed you at any time dur- ing its long life, tell us about it. Its aim has been and is always to help the physician and surgeon in the psychiatry and neuriatry or the psycho-neurotherapy of all disease in its practical aspects. All disease has psychic and nervous fea- tures to be considered in medical practice. Dr. W. B. Kern, of Hastings, Nebraska, for twelve years past superintendent of the Nebraska State Hospital for In- sane, Ingleside, Hastings, and closely identified with the growth and development of this important and modern insti- tution almost from its incipiency, has retired from hospital service and located in Exchange Bldg., Los Angeles, limiting his practice and work to nervous and mental disease. The Neurone Wastage of Perverted and Diseased Sexuality.—Its effect on personal and national sthenosity is thus suggestively broached in Hearst's Magazine, under the 220 Editorial. caption of the social measure of Japan, discussing Marian Cox's man-made women of Japan and the Yoshiwara of that country, "not tolerable among us," and this is its wise and portentious warning conclusion of this matter: "The ultimate conquering power of any race is in pro- portion to the normal physical relations of men to women, and to the idealization and self-restraint displayed relative to the sex question." And this nation, unlike the unfortunate nations that have gone before us and are mostly off the stage of mortal action, had better watch out. Harm to the Homosexual.—Medical and Judicial— to these unfortunately endowed and perverted in sexual love and impulse, "The social and legal penalties attached to this reversal of the normal sexual life are very severe and unjust in a large proportion of cases," as Havelock Ellis has lately stated, in a communication to the Medical Review of Reviews concerning an article of the same tenor by Mr. Russell Hertz. Dr. Hughes quite agrees from personal observation with both of these gentlemen as to the "extreme ignorance of homo- sexuality which prevails even among the medical profession" and as to the too often unjust estimate and treatment of these unfortunates by people, physicians and judges and juries. Some of these perverts have otherwise displayed gentle traits and ability, lamenting their "contrary sexual" instinct. And this considerate view was that also of this distin- guished author, who so early and so correctly described and considered it. Another Honor to Gorgas.—The medical profession of London gave a dinner last March to Brigadier General William C. Gorgas, Surgeon General of the United States Army, as a tribute to his splendid work as chief of the sanitary department at Panama. General Gorgas also received the Oxford degree of Doctor of Science. At last the medical profession is coming to be appre- Editorial. 221 ciated. We have seen the time when the rank and service of a surgeon were estimated, not so much above the rank of a sergeant, and even when the second mess was proposed for Navy surgeons. The honor and glory of De Lesseps and France might have been the same as that of Goethals and the United States had the value of medical service in the Canal Zone been ap- preciated and emulated. The more sanitary science and the medical corps are appreciated in the service, the better for both army and navy. , "Wise physicians skilled our wounds to prevent and heal Are more than armies to the public weal," Even in the army and navy themselves for the army's and navy's weal. We have seen little martinet captains and lieutenants in transient command of posts, commanding as to purely med- ical matters connected with post hospitals. That time now has passed with us, for it was in civil war days, and gone for the good of the service. An Eugenic Convocation.—Several hundred prominent scientific and philanthropic eugenists assembled at Battle Creek, January 8th, 1912, to consider race deterioration and methods of remedy of the same. Some views of the movement are here abridged: "It will be no easy task to improve the race to the point where there will be no dependent children, but the elimina- tion of the dependent child will be one of the best indices of the superiority of our national stock."—Dr. Gertrude E. Hall, New York State Board of Charities. "I believe that a great deal can be done by publication of facts as to the physiological effects of alcohol, in the way of inducing educated and intelligent people to conserve their health by limiting the use of alcohol or giving it up alto- gether."—Henry Smith Williams, Author. "Eugenics does not eliminate romance. We eugenists be- lieve romance should be retained. Through the past it has 222 Editorial. proved a good thing.—Prof. Roswell H. Johnson, Univer- sity of Pittsburgh. "In order that the race may survive it will apparently be necessary to make a eugenic selection of healthy mothers and to provide that the cost of bearing and rearing children shall be equally shared by all."—Prof. J. McKeen Cattell, editor Popular Science Monthly. "The boys are learning that they have a calling just as sacred as the call to motherhood and that is the call to father- hood."—The Very Reverend (Dean) Walter Taylor Sumner of Chicago. "The negro in the south, with all his weaknesses and handicaps, is not yet in any large measure, in the ditch."— Booker T. Washington, principal of Tuskegee Institute. "We must cultivate pure blood, instead of blue blood if we would develop a race of human thoroughbreds."—Dr. J. H. Kellogg, Superintendent Battle Creek Sanitarium. The Highest and Broadest Education possible and practicable to attain is not too great an achievement for physicians. Whosoever enters the medical profession should enter therein with ambition, determination and hope to attain this desirable end, sooner or later in his career, for his own happy success and the welfare of mankind. Fortunately through beneficent endowment by certain of our great philan- thropists of our great universities, aspiring students of the sciences collateral to medical teaching, the utmost limit of achievement is now a possibility for the training of great medical experts, and even the smaller and less favored med- ical schools no longer assume to teach medicine without ade- quate laboratory, anatomical, chemical and clinical instruc- tion. Great praise is due to our predecessors in medicine for their efforts and devotion, not only for the honest but mis- named commercial schools which they founded and main- tained from their personal purses often, while neither the public nor legislatures took a sustaining interest in them, but Editorial. 223 for impressing the extremely wealthy with the importance of high-grade medical instruction to the extent that the fruition of their labor has become manifest in our great million and multimillion endowed universities, giving to medical science and art all of nature's present-day laboratory research, resource and hospital and clinical help. Holmes on the Eclecticism of Regular Medicine.— The Critic and Guide thus quotes the eminent discoverer of the communicability of puerperal fever, anatomist and lit- erary writer, whose name should never perish from the annals of literature and medical science of America: "Medicine, sometimes impertinently, often ignorantly, often carelessly, called 'allopathy,' appropriates everything from every source that can be of the slightest use to anybody who is ailing in any way, or likely to be ailing from any cause. It learned from a monk how to use antimony, from a jesuit how to cure agues, from a friar how to cut for stone, from a soldier how to treat gout, from a sailor how to keep off scurvy, from a postmaster how to sound the Eustachian tube, from a dairy maid how to prevent smallpox, and from an old market-woman how to catch the itch insect. It bor- rowed acupuncture from the Japanese, and was taught the use of lobelia by the American savage. It stands ready to- day to accept anything from any theorist, from any empiric who can make out a good case for his discovery or his remedy." Psychiatry in Surgery.—When this Magazine started in 1880 on its successful career, it announced its purpose to disseminate psychiatry and neuriatry in the profession gen- erally. Since then remarkable progress in appreciation of states of the mind and allied nervous system in disease have become manifest, a late and forceful illustration appearing in such communications as the following, which that excellent periodical, the American Journal of Surgery, abstracts from an equally meritorious source in surgery, as follows: 224 Editorial. The Psychic State of the Surgical Patient. There is an interesting fact concerning the psychic state of the patient at the time of the operation. If the patient is in grave doubt as to whether or not he can survive the oper- ation; if he lacks confidence in the hospital or in the surgeon, the patient has what in psychology is known as a low threshold, and if he goes under the anesthetic in this state, the effect of any physical injury will be augmented and throughout the entire anesthesia there is manifested the evi- dence of fear in the respiration and the pulse, and in the way in which he reacts to the anesthetic and the trauma of oper- ation. These patients take the operation poorly. It is as though the patient went under the operation with his motor set at high speed, so that the energy of the body is consumed more rapidly, and hence the exhaustion or shock is increased. Anoci Association in Operations. The brain being a tissue of surpassing delicacy, is dam- aged with wonderful facility by injury and by fear and worry. The good risk patient when operated by almost any method, by almost any surgeon of experience, will recover from his operation, but the delicate nervous organization is only too frequently shattered by the experience. We now understand why. Though the principle is clear, the technique demands to a certain extent a re-education of the surgeon; it demands a certain amount of detail and precision; it demands for more consideration for the patient; but through anoci the destiny of a patient is to a greater degree placed under the control of the surgeon, who through it is enabled to reduce both the morbidity and the mortality.—George W. Crile in The South- ern Medical Journal. This evidence of progress in appreciation of psychiatry in surgical practice is gratifying. Operative surgery is com- ing to a right consideration of the entire patient, including mind and nervous system as well as the part operable, both pre and post operative. Editorial. 225 Psychiatry and Eugenics in Relation to Military Service Fitness.—A nation's endurance and greatness de- pends upon the psychial and sanitary fitness of its managers and men. Apropos to this proportion the New York Med- ical Record editorially discusses the proposition presented by Dr. W. A. White before the United States Naval War Col- lege that psychiatry and military service were intimately re- lated and contends against the enlistment of defectives and the average "ne'er do well," contending also against heredi- tary defectives prone to break down under the stress of war and other brain strain, including the alcoholic and syphilitic psychoses, etc. "Persons with these tendencies," says Edi- tor Stedman, "are prone to break down in war time than in the time of peace, and therefore are not fitted to be sol- diers." Dr. Stedman continues: "A knowledge of psychiat- ry would come in good stead to eliminate these unfit from the military standpoint, but White shows from the experience gained in the Russo-Japanese war that the syphilitic psychosis is likewise of the first importance. At the Russian Psychiat- ric Hospital at Harbin, during the war, the percentage of paresis among those brought back from the front was 5.6." All of which is true and not malapropos to the Secre- tary of the Navy's interdict abolishing the wine mess from the Navy. Uncle Sam should take no part in the making of dipsomaniac officers or men and then in disgrace dismissing the pitiable creatures of his own making. Let not the Gov- ernment manufacture its unwary officers who fear not se- ductive drink, or men, into final inebriates. An Inebriate Hospital and Reformatory for St. Louis is proposed in the new City Charter now being pre- pared for popular adoption. It is certainly a necessity for this time and place. It is as badly needed as an Insane Asylum, Free Bridge and City Legislature annex. An amnesic dementia as to the public welfare appears to have seized upon our city government. 226 Editorial. A Monthly Course in Psychiatry.—Physicians' work will be given at the Psychopathic Hospital of the University of Michigan, Ann Arbor, from March 30 to April 25, 1914, including clinical lectures, conferences, laboratory studies and demonstrations, for a fee of twenty-five dollars. The number of students will be limited to fifteen. Address Dr. Alfred M. Barrett, Director of the Psychopathic Hospital, Ann Arbor, Mich. Any Definition of Insanity Not Conceived on the Basis of Disease Is a Misconception of the Subject.—The fact that insanity is mental disease, makes it a subject for med- ical observation, judgment and treatment. Only a disease perverted mind in which a primarily or secondarly disease involved brain perverts the mental ex- pression or personal conduct or distorts action, speech or thought as compared with the natural character, presents the picture of true insanity. Absurd beliefs or bizarre conduct not caused by functional or organic brain and mind disturbing disease, by change in the brain's blood or its blood movement or in the brain structure or by reflex brain impression, must be otherwise explained than through insanity. Mere peculiar conduct by imitation or example, illogical persuasion, wrong leadership, erroneous beliefs are not insanity. Blood poisons or changes in blood volume or composition changed in the blood, such as hyperemia, anemia, alcoholism, etc., may pro- duce insane brain action in any of its varied forms. The Firet Two Articles in Northwestern Medicine for May are on two of the most up-to-date subjects in medical advance, viz., "Recoveries of the Insane" and the "Psychic Mind in Medicine." The best and most advanced minds in medicine are bringing psychiatry to the front. "The Modern Treatment of Inebriety" is the subject of a paper by Irwin H. Neff, M. D., Foxborough, Mass., to be read before the Medicopsychological Association May 28th, of which the following is an abstract: The modern conception of habitual drunkenness demands Editorial. 227 that there be developed a practical method of handling such cases. Any system proposed which is put into practice must be sufficiently elastic so as to permit of its universal adoption. State care is preferable, and a centralization of authority is essential. The carrying out of the purposes of any plan should be authorized and controlled by the medical profession. All the details of such a plan, both preventive and curative, should be censored by medical experts before submission to the pub- lic for approval and adoption. Any institution built for the care and treatment of drunkenness should be constructed so as to meet the selective requirements of these people; it should also allow for regional departments directed by the parent in- stitution, which should be considered the administrative head. A description of the Massachusetts plan for the care, treat- ment and study of drunkenness, its scope, control or adminis- tration and co-operation with allied interests. This is especially appropriate for St. Louis readers, since such a much-needed institution is contemplated for this city, too long neglected in this regard. American Medical Editors' Association.—On June 22nd, 9 a. m., the above-mentioned Association will meet at the Marlborough-Blenheim Hotel, Atlantic City, N. J., under the presidency of Dr. E. A. VanderVeer, of Albany, N. Y. An unusually attractive programme is being prepared. Case and Comment.—The Lawyers' Magazine, conducted by The Lawyers' Co-operative Publishing Company, Roches- ter, New York, is a Magazine of merit and special value for attorneys, jurists and physicians, a good supplement in its medico-legal aspects for the physician who may be called into court as a medical expert, and this may happen any time in the doctor's career. We acknowledge a cordial invitation to contribute to this much-needed Magazine, to which we have thus far been unable to accede, because of pressing demands connected with our own Magazine and the unexpected reduc- tion of our working staff. 228 Editorial. Psychology and Medicine Basis of Children's Bureau. —Suggested amendment to the "Legislative Bill" (H. R. 15,279), as reported to the Senate May 15, 1914. On page 147, under "Children's Bureau," in line 3, after the figures, "$25,640," insert the following words: provided that the chief and assistant chief shall be ex- perts in child study, and provided further, that the super- visory officers and all other persons now or hereafter em- ployed, in the bureau, in investigations of infant mortality, diseases of children and similar subjects of a medical nature, shall have had a medical training. The undersigned announce that they have formed a partnership for the general practice of law, under the firm name of Gubernator, Connell & Jones, with offices at 902 Pierce Building, St. Louis, Mo. Phone, Olive 622. E. S. Gubernator Jamies J. Connell Douglas H. Jones May 1, 1914. CORRESPONDENCE Wauwatosa, Wis., April 23, 1914. My Dear Doctor Hughes: Believing that an amende is due Dr. Adolph Meyer, Director of the Henry Phipps Psychiatric Clinic of John- Hopkins Hospital, Baltimore, on account of failure on my part to mention his services in a recent paper,1 I take this occasion to state the circumstances to the confreres to whom the reprint of the paper was sent, members of the American Medico-Psychological and American Neurological Associa- tions. In the paper referred to I spoke of the "Ward for Ner- vous and Insane Patients," "Pavilion F," at the Albany Hos- pital, established in 1902, as one of the first steps toward a "Psychiatric Clinic" later to be evolved. I should have added that it was in the same year that Dr. Adolf Meyer, having been appointed Director of the Pathological Institute for the New York State Hospitals, inaugurated an advance of the greatest importance in the same direction. A friend who noticed the omission in my paper and kindly mentioned it to me, states that in his opinion Dr. Meyer's signal accomplishments at the hospitals on Wards Island led to Mr. Phipps' munificent gift to Johns-Hopkins University and Hospital and to Dr. Meyer's own promotion to a field of higher activity. My inadvertence resulted from the fact that my paper had reference mainly to the Middle West and was prepared under great pressure for time. I make the above statement more on my own account than that of Dr. Meyer. The matter can be of little con- sequence to him, but I am unwilling to rest a moment even under the appearance of injustice to another. 229 230 Correspondence I remarked in closing my paper that it was "cursory and imperfect." It was delivered at a semi-popular meet- ing attended by many of the laity where much technical statement would not be appreciated. While making the above correction, I wish to supply one other omission in my paper. I did not include in my sketch an additional fact worthy of mention in connection with "Evolution in State Hospitals;" that is the develop- ment of the "Colony" as an outgrowth of public hospitals for the insane. This addition to such hospitals was first adequately described by Dr. Henry M. Hurd in 1887* and carried out with decided success at Kalamazoo, Michigan, and later at various other institutions. Yours truly, RICHARD DEWEY. 1. Forty Tears' Evolution in Construction and Administration of State Hospitals in, the Middle West. Reprinted from Illinois Medi- cal Journal, issue of March, 1914. 2. The Colony System as Proposed in Michigan. By Henry M. Hurd, Pontlac, Michigan, Proceedings Conference of Charities, Omaha, 1887. REVIEWS, BOOK NOTICES, REPRINTS, ETC. Forty Years' Evolution in Construction and Admin- istration of State Hospitals in the Middle West.—Rich- ard Dewey, M. D., Wauwatosa, Wis. Reprinted from the Illi- nois Medical Journal, issue of March, 1914. Dr. Dewey's extensive clinical and long literary famil- iarity with this subject justifies the enlightening brochure be- fore us. It should be in the hands of all alienists in and practical study. The Registration of Vital Statistics and Good Busi- ness.—Address delivered before the Annual Conference of Health Officers of the State of Indiana, Indianapolis, May 13, 1913, by Louis I. Dublin, Ph. D., Statistician, Metropoli- tan Life Ins. Co., New York. The most important thing insurance companies can do in regard to death certificates and vital statistics generally is to provide a fee to medical men for the time spent by them in writing and attesting death certificates, now gratuitously. Parsimony in this regard too often gets but half-hearted, inadequate service. Bill to Repeal the Hetch Hetchy Grant, and re- marks of the Honorable John D. Works of California in the Senate of the United States. From the Senator's speech it appears reasonable that this bill should be considered. Yosemite ought not to be so marred except under imperative necessity, nor the riparian rights of that valley's population taken away without just cause. Treatment of Neurasthenia by Teaching Brain Control. By Dr. Roger Vittoz. Translated by H. B. Brooke. 231 232 Reviews, Book Notices, Reprints, Etc. Longmans, Green & Co., 39 Paternoster Row. London, New York, Bombay and Calcutta. 1911. All rights reserved. Physicians, especially alienists and neurologists, will read this book with interest, surprise and profit. But the neuras- thenic brain, i. e., the cerebro-psychasthenic brain needs nu- tritional and chemical as well as volitional control, but self- volitional control by a crippled will power due to brain debil- ity and impairment in its volitional inhibitory centers is one of chemic restraint and repair largely, but a normal, healthy brain may help some, as the surgeon may aid in moving a sprained joint which the patient cannot himself unaided move. But not much. The author offers a series of exercises for teaching brain control, interesting and valuable, especially for the convales- cent condition of neurasthenia, but the best of all treatments is rest of the exhausted organism through sleep, mild, untax- ing diversion and easily appropriated and adequate nutrition. The book is well worth the consideration of the thought- ful therapeutist of neurasthenia. School for Health Officers.—Harvard University and Massachusetts Institute of Technology. Catalogue and An- nouncement. A good move with a good object, from a good source of capability for right instruction. As philanthropic sanitary science promotion advances, the welfare of society is en- hanced. ACTES DU CONGRES PENITENTIAIRE INTERNATIONAL de Washington, October, 1910. Publies a la demande de la Commission Penitentiaire Internationale par le Dr. Louis C. Guillaume et le Dr. Eugene Borel. Proces-Verbaux des Seances et Voyage d'Etudes, etc. Groningen. Bureau de la Commission Penitentiaire Internationale. 1913. En commis- This interesting and important Congress held at the American national capital is the eighth, though such a Con- gress was first proposed for the civilized nations by the United Reviews, Book Notices, Reprints, Etc. 233 States Government, and this is the first of these important Con- gresses held in in the United States. Attorney General Wick- ersham welcomed the delegates in a most felicitious speech, in the name of the American Government. Attorney General Wickersham was proclaimed an honorary president, and Dr. Chas. Richmond, president of the International Penitentiary Commission, was proclaimed president, succeeding his hon- ored and regretted predecessor at the Budapest Congress, Dr. Barrows. Many interesting subjects germane to such a convoca- tion were profitably discussed, the tenor of which was to advance humanity and right methods of humane penology. But for report of which we regret that we have not space in extenso. The disposition of the death penalty was promi- nent in the discussions. The Monthly Cyclopedia and Medical Bulletin makes a special feature of the Internal Secretiona, giving orig- inal articles entire and summaries of others on these subjects, under the editorial management of Doctor Charles E. de M. Sajons. Readers of this Magazine should read this depart- ment. We greatly regret that we have to limit our selections therefrom for want of space, as this department should con- stitute companion reading to the Alienist and Neurologist. The F. A. Davis Co. are the publishers, 1914 Cherry Str., Philadelphia. The Intervertebral Foramen.—An Atlas and Histo- logic Description of the Intervertebral Foramen and Its Adja- cent Parts. By Harold Swanberg, member of the American Association for the Advancement of Science. With an Intro- ductory Note by Harris E. Santee, A. M., Ph. D., M. D. Intraperitoneal Injections of Ozone in Animals Following Injections With Virulent Bacteria. By S. E. Finch, M. D. From the New York Medical Journal. 234 Reviews, Book Notices, Reprints, Etc. The Action of Oxygen, Hydrogen Dioxide, and Ozone Gas Upon the Growth of Certain Bacteria. By S. E. Finch, M. D. From New York Medical Journal. Chronic Intestinal Stasis With Reference to Con- ditions Found at Operation and the Mortality. Deliv- ered at the North-East London Post-Graduate College. By Wm. Seaman Bainbridge, A. M., Sc. D., M. D., Professor of Surgery, New York Polyclinic Medical School and Hospital; Surgeon, New York Skin and Cancer Hospital. From the British Medical Journal, November 1st, 1913. This is an interesting and instructive story of kinks and bonds sequent to neurasthenic intestinatory and operable enteroptosis. Artekial Ligation, With Lymphatic Block, in the Treatment of Advanced Cancer of the Pelvic Organs— With a Report of Fifty-six Cases. By William Seaman Bainbridge, A. M., ScD., M. D., New York City. Straws From the Fields of Leprosy. By E. S. Good- hue, A. M., M. D., LL.D., The Doctorage, Hawaii. Rheumatism Phylacogen (Modified Rheumatism Vac- cine) . Prepared according to the method of Dr. A. F. Schafer, by Parke, Davis & Co., Detroit, Mich., U. S. A. A convincing brochure. Technic of the Intr\-Abdominal Administration of Oxygen. By William Seaman Bainbridge. Sc. D., M. D. New York. The Surgical Treatment of Cancer. By William Seaman Bainbridge, A. M., Sc. D., M. D. New York. Possible Errors in the Diagnosis of Abdominal Can- cer—A Plea for Exploratory Laparotomy—Illustrative Reviews, Book Notices, Reprints, Etc. 235 Cases. By William Seaman Bainbridge, M. D. New York City. Report of the Committee on Applied Eugenics. To American MedicoTPsychological Association, at its Sixty- ninth Annual Meeting. From American Journal of Insanity. List of Members of the American Medico-Psycho- logical Association. Officers of the American Medico-Psy- chological Association, 1912-1913. The Psycho-analytic Review, Vol. 1, No. 1, Quarterly, for November, 1913, is "a journal devoted to an understand- ing conduct," edited and published by Wm. A. White, M. D., and Smith Ely Jelliffe, M. D., two medical writers of merit appreciated by the profession, and already well known to our many readers. The theory of psychoanalysis is well set forth in the pres- ent volume by C. G. Young. Self Mutilation, by L. E. Emer- son. Blindness as a Wish, by Ames, Technique of Psycho- analysis by Jelliffe, A Critical Digest of the Paranoia Prob- lem, by C. R. Payne, and a translation of wish fulfillment and fairy tales by Franz Riklin, with abstracts, correspondence and book reviews concludes the first number. All of the above, with what we know of the merit and ability of the able editors and demonstrated by former work, some of it through our own pages, give promise of a valua- ble addition in the literary medical world of the psycho- analytic side of psychiatry. The Effect of a Momentary Contact With an 18,000 Volt Current. By Philip King Brown, M. D., San Fran- cisco. Intravenous Anaesthesia. By William Francis Ho- nan, M. D., of New York, Surgeon to the Metropolitan Hos- pital, and J. Wyllis Hassler, Assistant Surgeon, Metropolitan Hospital. From Annals of Surgery for December, 1913. 236 Reviews, Book Notices, Reprints, Etc. Solving the Mystery of Bright's Disease, A Prelim- inary Paper. By John Aulde, M. D., Philadelphia, Pa. From the Medical Record. The author maintains and gives experimental data to prove that neutralization of acid excess in Bright's disease nephritis suffices to arrest its progress, maintaining that mag- nesium infiltration is the chief cause and magnesium dissocia- tion is the principal remedy. A Fatal Case of Coccidioidal Granuloma. By Philip King Brown, M. D. San Francisco. Dietetic Studies.—An Experience With Casein-Sodium- Glycero-Phosphate in Twelve Cases in Private Practice. By R. J. E. Scott, M. D. (New York), M. A. and B. C. L. (Dur- ham), Gynecologist to the Demilt Dispensary; Assistant Gynecologist and Chief of the Gynecological Clinic at the West Side German Dispensary; etc. Governor Sulzer's Message on Public Health, With Report of Special Public Health Commission of the State of New York. This report on the part of the Governor and of the Pub- lic Health Commission is broad, comprehensive and thoroughly considerate of the sanitary interests and welfare of the people of that great Commonwealth and worthy of emulation by every state chief executive of the American Union. Publicity Concerning the Insanities.—Medical Rec- ord and Medical Era. Publicity in the sense of enlightening the public as to what insanity really is and our present-day method of treat- ment as well as to the prevention is not amiss. A sentiment exists even now among the laity that to be insane is a dis- grace; that a patient suffering from insanity is a howling maniac to be guarded and watched as though he were a crim- inal. They are not familiar with the disease and its present- Reviews, Book Notices, Reprints, Etc. 237 day treatment and they do not know that many forms of the disease are not hereditary in the truest sense. Our present knowledge of the etiology of the disease is that alcohol, syphilis and heredity are the potent factors. The public should be judiciously instructed relative to alcoholism and syphilis; the question of heredity, however, is a subject which should be handled guardedly. Segregation and sterili- zation of the feeble-minded and the prevention of marrying of chronic alcoholics and epileptics should be pushed to the utmost. The Cleveland Medical Journal contains the following: "I plead for the abolition of the practice of brushing pas- sengers in the body of a Pullman coach. The traveling pub- lic seems to be totally unaware of the effect of this practice on fellow passengers, and its danger to their health. I have seen the health officer of a big city and the head nurse of a medical dispensary stand up while the porter transferred the dust from their garments upon their fellowpassengers. The Pullman Company claim to have some rules requiring the brushing to be done in the little narrow hall. This works a hardship to passengers in either end of the coach. What is needed is total prohibition of the practice in the coach, and the archaic whisk broom replaced by a modern process for the accommodation of those who wish the service. "(Mrs.) S. Louise Patterson." This is in line with our editorial plea, oft repeated, for a chance to escape the diseases while traveling. All the risk in traveling is not in derailing, collisions, etc. The whisk broom in action and the culinary department of the diner are perils to be considered. Alcoholic Insanity and the Stigmata of Degener- acy (illustrated) is the caption and theme of an interesting and timely medical paper of decided merit, by Dr. Marc Ray Hughes, formerly a Professor of Psychiatry and Neurology, which appears in the February 25th number of that excellent exchange, the Medical Fortnightly, of St. Louis, Mo. 238 Reviews, Book Notices, Reprints, Etc. It is significant at this time of anti-alcoholic agitation in the public mind to see medical men turning their investiga- tion toward a right understanding of this pernicious, all too popular alcoholic drink in the form of its potable compound used so generally as though it were a harmless beverage. The author presents for the reader's consideration the faces of five boys and men, ranging in age from sixteen to thirty-two years. Each one has or had, at the time of their birth, parents who were habitual drunkards or inebriates, and each one of the six shows stigma of degeneracy, and each one serving a sentence for some crime. The author concludes: "It is impossible to get away from the fact that like begets like, and alcoholic parents beget children with criminal or other degenerate tendencies." In this he is in harmony with Morel, Crothers and other eminent investigators who have wrought before him. La Paralysis Generals. Par le docteur Henri Damaye, Medecin de l'Asile d'alienees de Bailleul. Extrait de l'Echo Medical du Nord. 8 Fevrier, 1914. Lille. Plateau & Cie., Imprimeurs-Editeurs. This is a clear presentation of this always interesting sub- ject to the alienist clinician. The Treatment of Rheumatic Infections is an inter- esting brochure emanating from the press of Parke, Davis and Company, and setting forth the views of Dr. Schafer and showing the clinical and therapeutic value of Schafer's Phyla- cogens in rheumatism and other affections. The theory of Dr. Schafer is that rheumatism and many other diseases are due to mixed infection, that is, "the great variety of micro-organisms harbored by the human organism without harm to itself during periods of physiological resist- ance falls below par, and microbic forms of toxicity join in the morbific assault and should be antagonized by a combined assault, hence the combination named phylacogens, a mixture of bacterial derivatives as devised by Dr. Schafer." Reviews, Book Notices, Reprints, Etc. 239 Much clinical and therapeutic experience and laboratory experience is detailed in this book. Many brief articles from many medical sources, physicians and medical magazines commendatory of phylacogens treatment showing good re- sults are presented. The author has drawn upon and records an extensive bibliography for so new a subject, and the little book has a remarkable amount of information for its size. It is exceedingly well indexed and can be read piecemeal in the physician's leisure moments. Phylacogens embody a new idea in medical thought and not alone in regard to rheu- matism. The Recent Conferences on Medical Education.— The Bulletin of the Chicago Medical Society is before us con- taining among other interesting matter the two especially important subjects which here follow: In the Bulletin of recent date was published the program of the A. M. A. conference on medical legislation and medi- cal education, and also the meeting of the Association of American Medical Colleges. Both of these conventions were well attended and exceedingly profitable to those who followed the papers and discussions. J. W. Pettit, of Ottawa, 111., read a paper on "Public Edu- cation Through the Daily Press," and boldly expressed the belief that the public is entitled to knowledge of advances in medicine, not in the form of special cures by particular men, but well chosen reliable news given officially to the press by organized medicine. We have had considerable experience with the press dur- ing the last year and are glad to endorse what Dr. Pettit said on this subject. Our observation proves his contention that the press gladly accepts news of interest to its readers when it is real news. The subject of most vital importance considered during both conventions was preliminary education. Much was said 240 Reviews, Book Notices, Reprints, Etc. on the subject by a few, and we gained the impression that each was vieing with the other to add just a little more to the preliminary requirements. However, one point of criticism seems pertinent In most of the sessions it was noticeable that little or no pro- vision had been made for general discussion by the delegates. In most instances a paper was read, and as soon as the official discussors had made their comment, lack of time was pleaded, and the program crowded at once to the next paper. This plan we think a great mistake. Better one-half the number of papers and free discussion, or better yet, perhaps, the same number of papers extended to evening sessions or to an added day. The effect of this excessive economy and limitation of time is to rob the proceedings of the ripe experience and virile thought of many men who come from widely different loca- tions and conditions and view things from different angles. The way to get effective service from the membership of such organizations and a wise public opinion based upon the initial co-operation of many, is to give encouragement to free expres- sion of ideas. This appertains especially to subjects of such vital importance as that of "preliminary medical education." Whatever the authority and actual powers of the above organizations, it is after all a fact that the settlement of this question rests with two forcse: the United States Government (a faint possibility) and the individual State Legislature. The latter is the present factor and not easily reached. It is true that a few state legislatures have been broad and intelli- gent enough to recognize the needs in this matter, but only a few. Our suggestions to the delegates for future conferences is to forget the learned discourses about units, credits, con- ditions, etc Put all of the energy into efforts to agree upon a standard which will meet with the approval of all. Make the standard a little lower than seems now proper, but higher than it is at present as an average in all of the states, and then educate the public to their own need. Get together first. Follow the advice of Dr. Pettit in his paper and give the news officially to the press for the educa- Reviews, Book NoHcM% Rtprints, Etc. 241 tion of the public, leaving it to the public to force tbeir rep- resentatives in the legislature to keep away from the pathists, cultists and such ilk who are now the obstructionists in the matter. We also suggest to the delegates not to overlook the fact that the press always sends reporters to attend the meetings, and, judiciously handled, first-hand information may be fur- nished where it will do the most good. At the conference of American Colleges the press representatives were so vitally interested in the great question of whether physics should be made a one-half unit condition or no condition at all, that two reporters, after a heated discussion, nearly settled the future of the Federal Base Ball League. Editorial Comment.—Concerning the making of doctors of medicine the essential thing now is to circumvent the pres- ent fearful multiplication of fake and faddist practitioners by giving young men inclined to rational ethical medicine, a chance in regular schools within reasonable time of their ma- ture opportunity for earning a livelihood. If the medical education term is too long the medically inclined will take up with chiropractics. osteopathy and other prevailing limited or spurious medical cults. Four years is long enough study time for the average medical practice aspirant and the general welfare of the regu- lar medical profession and the people's interests generally, and this is saying nothing to the disparagement of more prolonged school education for the exceptional few, who may have the time, means, inclination and opportunity to make exceptionally well informed laboratory and other specialists of themselves. BurkholdSr on the Anatomy of thb Brain, a manual for students of medicine and practitioners, has made his sub- ject so plain that no student or physician in practice discon- nected from medical college dissection opportunity can well dispense with this worthy book. It is full of splendid illus- trations celarly confirming the lucid text. The most unique and practical thing about this book for the ordinary doctor without special human dissection facili- 242 Reviews, Book Notices, Reprints, Etc. ties is the fact that the author has dissected the brain of the sheep because of its availability and practical identity with the human brain for illustration. Dr. Burkholder is professor of ophthalmology in the School of Medicine of Loyola University. The introduction is by Prof. Henry H. Donaldson. Forty full-page plates illustrate the book, and G. F. Engelhard & Co., Chicago, are the publishers. Congres des Medecins Alienistes et Neurologistes de France, et des Pays de Langue Francaise. XXI Ic. session. Tunis, ler-7 Avril, 1912. Le Syndrome Atavisme ou Zoan- thropoidisme Mental. Par le Dr. Paul Courbon, Medecin de l'asile d'alienes d'Amiens. Paris. Typographic Plon-Nourrit et Cie. Some of the Incorrect and Hybrid Terms in thb Manual of the International List of Causes of Death. —Published by the Bureau of the Census, E. Dana Durand, Director, Washington Printing Office, 1911. By A. Rose, M. D., New York City. The Injustice of History.—A Neglected Patriot. By Companion Captain William R. Hodges. Commandery of the State of Missouri. Military Order of the Loyal Legion of the United States. Read October 4, 1913. Primary Infection With Tubercle Bacilli, With Special Reference to Thoracic Glands. By Philip King Brown, M. D., San Francisco. Epidemic Poliomyelitis. By Philip King Brown, M. D., San Francisco. The Bulletin of the American Academy of Medi- cine, specializing, as it does so well, in medical sociology, should be an essential part of every physician's collection of medical magazines. In line with an editorial in our present Reviews, Book Notices, Reprints, Etc. 243 issue on the physician's duty in forming public opinion, it will keep his mind alive to the meritorious work of the physi- cian members of that eminent society's efforts during the past fifteen years for the sanitary welfare, mental and physical, of our race. This Bulletin and Society were, in fact, among the earliest uplifts in the direction of our social and profes- sional welfare. Our exalted aim as a profession for higher medical edu- cation and the present diffusion of extensive sanitary knowl- edge had its organized beginning in the organization of this valuable Society and Bulletin of higher medical aim and ef- fort. Long may this worthy body and its worthy Bulletin live and prosper. Only three dollars a year is the subscrip- tion price, or fifty cents a copy. Draw checks to the Amer- ican Academy of Medicine, 52 N. Fourth street, Easton, Pa. PSYCUANALYSIS: ITS THEORIES AND PRACTICAL APPLI- CATION. By A. A. Brill, Ph. B., M. D., Chief of Clinic of Psy- chiatry and Clinical Assistant in Neurology, Columbia Uni- versity Medical School; Chief of the Neurological Depart- ment of the Bronx Hospital and Dispensary. Second edi- tion, thoroughly revised. Octavo of 393 pages. Philadel- phia and London: W. B. Saunders Company, 1914. Second Edition. Cloth, $3.00 net. W. B. Saunders Company, Phil- adelphia, London. This interesting book by an always interesting writer is dedicated to the author's esteemed teacher, Professor Doctor Sigmund Freud, the renowned author and developer of Psych- analysis "whose ideas are herein reproduced" and extended. The author's "main object in this book is to present the practical application of Freud's theories in one volume, hop- ing thereby not only to remove many false conceptions enter- tained concerning psychanalysis, but to stimulate further interest in Freud's original works," and he has succeeded in his object. The author has done much in bringing psychanalysis within the field of psychotherapy. 244 Reviews, Book Notices, Reprints, Etc. The author very correctly notes that Medical Schools are now paying more, though not enough attention to mental dis- eases, especially in the "border line cases," and considers psychanalysis the "most rational and effective method of psychotherapy." Diagnostic Symptoms in Nervous Diseases. By Ed- ward L. Hunt, M. D., Instructor in Neurology and Assistant Chief of Clinic, College of Physicians and Surgeons, New York City. 12mo. of 229 pages. illustrated. Philadelphia anil London: VV. B. Saunders Company. 1914. Cloth, $1.50 net. This is a tersely written and well illustrated book of brief enough dimensions for the overcoat pocket and withal thoroughly comprehensive and clear in its text, the author being clinical instructor in the clinic of the College of Physi- cians of the Medical Department of Columbia University, etc., as above noted. is particularly well qualified for the task he has imposed upon himself and done so well as to merit the expert commendation of experienced criticism. One of the special features of this valuable book of diagnostic instruc- tion is the prominence given to the handwriting and gait of patients. The stepping gaits, foot prints, hernia cerebri and the peculiar wearing sequences on the soles of patient's shoes are especially included in the author's illustrations of neuropathic symptoms. The Wassermann Reaction in Cancer. By Frederick J. Fox, M. D., New York. Medical Record. "Whom the Gods Wish to Destroy, They First Make Mad." The Coterie of Politicians Who Run the A. M. A. Finally Shows Its Hand. G. Frank Lydston. M. D. The author presents this paper to the profession merely as one standing on the side lines watching the passing show, enter- taining no hope, he says ironically, of awakening the physi- cians of the country to a sense of their danger from medical despotism and trust-monopoly. Many years of hard and ex- Reviews. Book Notices, Reprints, Etc. 245 pensive endeavor have shown him that the average member of the profession is indifferent to everything save his own individual interests. Five years ago the political Powers That Be sent from the throne on Dearborn avenue this message to the profession in answer to his expose of the putrid conditions that prevailed in medical Denmark: "There's simply nothing to it. Everybody except Lyd- ston is satisfied with conditions in the A. M. A." Experience has proved that the oracle of Dearborn ave- nue was right. Certain persons were, of course, not satisfied to have certain other persons hold all the offices, otherwise there apparently was no complaint. The author further says he is not foolish enough to be- lieve that the perusal of it will let the smallest ray of light into the thought chambers of those "insurgents" for place and power only, who consider that the end and aim of reform agitation are only to capture offices for themselves and their satellites. And so these gentlemen go empty-handed to state and national association meetings and empty-handed they return. They simply march up the hill and down again. We think the author is mistaken. A storm is brewing. The A. M. A., like the country, will become again a democratically governed society, for right and truth and justice will prevail. There are too many just men in the A. M. A., even among whom the author considers the oligarchic gang, for this to not come about in a little while. The A. M. A. have not all gone mad. Some symptoms of insanity are still discernible. Wait, Lydston, wait. The vis medicatrix in A. M. A. medical heads works slowly. The Smauer Cou.F.f.ES. From the Indianapolis Star. Speakers at the Founder's day celebration of I hitler College emphasized what they believe to be some of the questionable tendencies of higher education, particularly in this country. "The greatest danger to American colleges today is the in- 246 Reviews, Book Notices, Reprints, Etc. clination to build great laboratories and buildings and buy large tracts of picturesque campus space while the scholarship standards are allowed to decline." said Abram E. Cory of Cincinnati, head of the "men and millions" movement in the Christian Church. Dean Percy H. Boynton of the Univer- sity of Chicago added his opinion that "the tradition of work- has declined steadily in our colleges." Dean Roynton spoke an encouraging word for the small colleges. where, he said, men usually are more sincere in their efforts to succeed, and become stronger than those that are graduated from the lar- ger institutions. The power of the small colleges to build sturdy, self- reliant manhood and womanhood may be attributed now, as in the days when there were no large colleges to speak of in the United States, to the greater attention to the personal side of life that prevails there. Men attached to the faculties of the great universities have been led to question whether there ought not to be a limit on their number of students. And if this doubt exists, one of the causes for it may lie in the fact that in vast congregations of young people there is bound to grow up the impersonal atmosphere between teachers and stu- dents, and among students themselves, that is destructive of a normal and vigorous unfolding of human character.—Edi- torial. The Journal of Experimental Medicine is one of the magazines of American medical research that if space allowed we would copy entire into our pages. It should he a com- panion magazine to the Alienist and Neurologist in every wise physician's file of instructive magazines. Teaching Sex Hygiene in the Public Schools. By Dr. E. B. Lowry, author of "False Modesty." "Herself." etc. This book is timely and prudently written. The instruction of children in personal purity is treated sensibly and thoroughly. The relation of the home and the school to the subject is dis- cussed and proper methods. h will prove a help to parents. Reviews, Book Notices, Reprints, Etc. 247 teachers and all interested in child welfare and a right knowl- edge of sex and its impulse perils, the government of the dom- inating passions as esesntial to racial safety from degradation and degeneracy. The Forty-third Annual Meeting of the American Society for the Study of Alcohol and ( Hher Narcotics made at Philadelphia, last December 3 and 4. A splendid showing of scientific and convincing progress as to the toxic and de- generating nature of alcoholic toxicity and was a great warn- ing to the thoughtful as to the personal peril of the alcoholic social drink habit all too popular yet in our alcoholically imperilled country. A Temporary Diet for Infants in Summer Diarrhea Mellin's Food 4 level tablespoonfuls Water (boiled, then cooled) 16 fluidounces Each ounce of this mixture has a food value of 6.2 calories—affording sufficient nourishment and in a form readily assimilable. Panopepton— The "Energy Sparer" Panopepton makes no demand on energy other than that concerned in metabolism. r4'he energy required! for the conversion of the food itself has already been applied in the laboratory. in the "silent transmutations" (Sir Wm. Roberts) of the basic foods, beef and vheat, into perfectly assimilable and diffusible substance. Sus, without taxing energy for digestion, Panopepton contributes to the m . both digestion and energy arc recruited. And it leaves no indigestible, inassuni- In practice Panopepton is constantly demonstrating its "ability for good servici 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 Emerson A. North, M. D., Resident Physician Georgia E. Finley, M. D., Medical Matron For descriptive yearly report address H. P. Collins, Business Manager. College Hill, Cincinnati, Ohio. THE ALIENIST AND NEUROLOGIST Vol. XXXV. St. Louis, August, 1914. No. 3. IS GENIUS A SPORT, A NEUROSIS, OR A CHILD POTENTIALITY DEVELOPED?* By James G. Kibrnan, Chicago, 111. 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 Nervous and Mental Diseases Medical Depart- ment Loyola University 1905; Professor of Forensic Psychi- atry Kent-Chicago College of Law. Lowell in the forties became the pessimistic philistine which his adolescent stress and environment prophesied. Howells' sketches this vividly in his picture of Lowell, who, as Howells says, "came into his life when it had spent its impulse to positive reform, and I was to be a witness of its increasing tendency towards the negative sort. He was quite past the storm and stress of his antislavery age. With the ♦Continued from Alienist and Neurologist, Feb, 1914. 1. Literary Friends and Acquaintances. (249) 250 James G. Kiernan close of the war, which had broken for him all his idols of inviolable peace, he had reached the age of misgiving. * * * I never heard him express doubts of what he had helped to do or regrets for what he had done, but I know he viewed with critical anxiety what other men were doing with accom- plished facts. His anxiety gave a cast of what one may call reluctance from the political situation and turned him back towards those civic and social defences which he had once seemed willing to abandon. * * * He had quite a Socratic reverence for law as (used in the sense of statutes) law and equity. This was not the logic that would have justified the attitude of the antislavery men to the fugitive slave law. Writing at the distance of Europe and with America in per- spective, which the alien environment clouded, he spoke of her as 'the Land of Broken Promises.' * * * He was rather severe in his notions of the subordination his domestics owed him. In short, with the climacteric, New England anglo- maniac contempt for other Americans and the common people cropped out. The contempt that showed itself in the sweat- ing at Lawrence and the earlier sweating Butler checked by his famous milestone levy for petty wages cut down by early discharge. Refusal of which no suit could check ere that levy. The attitude of Lowell after the pharisaic pose of the abolition era (chiefly an expression of New England's con- tempt for the South and West) was that of the British squire- archy. The spirit that in the war of 1812 led Nantucket to secede from the United States and annex itself to Great Britain. When urged as a Hayes elector, by certain of his own Brahmin cult, who favored justice to the popular majority, to vote for Tilden and thereby lesson the Supreme Court Judge Bradley as to equity, Lowell on the narrowest poli- tician grounds refused. The appeal was made to him on moral grounds he had urged against the slave oligarchy. Had this oligarchy been a Massachusetts one like the "protected" wage slave oligarchy so much in evidence in Lawrence, Lowell would never have fought it. Is Genius a Sportf 251 While he eulogizes Lincoln as our great American, he had no sympathy with Lincoln's Jeffersonian love for a gov- ernment of the people by the people and for the people. Albeit like Cromwell, Lincoln converted the republic into an abso- lutism for this purpose, still, like Cromwell, he was prepared when the emergency passed, to restore all powers. The youth of de Musset has much of the storm and stress which Goethe felt and which appears in Carlyle, Ruskin, Lowell and many others. The adolescent pessimism there- from resulting appears in full egocentric vigor and bitterness in "The Child of the Century." Lewis Pruget Shanks2 goes far in the optimistic direction when he remarks that "all the dreams of French romanticism are recalled by the centenary of Alfred de Musset (born Dec. 11, 1810), for the life of this poet might be said to typify the romantic school. "Never did the genius of 'Young- France' come to such , a sudden flowering as in 1830; and this spirit of youth Musset personifies in all its vivid brevity. A nervous, precociously brilliant boy, he recited his first verses, at seventeen, in the salon of Charles Nodier; and the long-haired Romanticists petted and spoiled the youth, unconscious that he was to be- come their enfant terrible. Famous at twenty, Musset lived the life of a dandy, dividing his time between society, his cafe, and the writing of Byronic verse. A gay young Epicurean, he remained heart-whole and fancy-free until he met George Sand, in his twenty-second year. How he fell in love with that passionate Egeria, eight years his senior, and how his fickle muse betrayed and abandoned him within the year, every one knows in this age of literary gossip; and every one knows how this catastrophe gave us Musset's greatest poems, written in anguish and blotted with his tears. The permanent effects of this experience upon the poet's character have been various- ly estimated, some critics entirely absolving George Sand from blame; but however that may be, it is true that Musset never outgrew his disillusionment. A victim of Romantic ideals, 2. Chicago Dial. 1910. 252 James G. Kiernan we find him, at thirty, exhausted in mind and shipwrecked in morals, yet destined none the less to drag his genius for sixteen years through Paris gutters, until the curtain fell upon the sordid tragedy. “It is not an edifying story, especially in its pitiful ending. A veritable spoiled child, as M. Faguet calls him, Alfred de Musset remained a spoiled child to the end of his days. To a nature such as his, life itself could teach little or nothing. A voluptuary as well as a dreamer, all that he got out of his search after happiness was a philosophy of disillusion; and his was a despair which lacked the force to take refuge in the ob- jective world. He could not cry with Candide, “Il faut cultiver notre jardin' [We must cultivate our garden]. And so we feel that one thing was lacking to his destiny—the early death which consecrates a poet as dear to the gods. Why was he not taken away at thirty, to join the immortal company of Chatter- ton, Keats, and Shelley? Alas for Musset, in his later years his poetic muse had all but left him, and the muse of debauch rarely beguiled his pen.” Middle age was reached before death claimed him, yet for all this, for all that he died at forty-six, even de Musset's later verses stamp him in literature as the poet of youth. It wells up, in his early plays and verses, “like the sap of April—youth in all its exuberance, effervescent with energy, overflowing with the restless fancies of an awakened imagination and a quenchless curiosity.” All of youth's thirst for experience burns in the early work of Alfred de Musset. All of youth's changing moods are there —sentiment, passion, and revolt; and, playing over all, the prankish humor of a young faun. Even opposites find place in its variety of moods, for in that first volume are revealed a lighter-hearted Don Juan and a lesser Lamartine. “En litté- rature on est toujours fils de quelqu'un' [In literature one is always the son of some one]; and Byron, we must remember, lay beside Shakespeare and Schiller on the table de nuit of the French Romanticists. Musset, however, never consciously imitated any one; indeed, he did not need to. There were so many themes to weave into plays or poems: love and life, and * Is Genius a Sportf 253 all the emotions of youth. There were so many moods, so many measures; and his lute knew them all in turn. All the wit and mischief of the Paris gamin bubble up in the 'Ballade a la Lune'; all the fervor of a boy's revolt against conventions overflows in 'Mardoche' and 'Les Marrons du feu.' There is melancholy, too, in some of his verses; but we need not take it very seriously. 'It is so pleasant to think oneself unhappy,' says Musset in his autobiographical novel, 'when one is only empty and bored.' Lamartine, of course, had made pessimism fashionable, and no one could escape it in 1830; but if our young poet yielded a moment to its spell, his real attitude may be seen in his hero Rafael, who has rejected melancholy and 'given his life to the lazy god of Fancy.' In fact, Don Rafael is no other than his creator Musset, in all the pride and spirit of his twentieth year. "Of course, all of these early poems deal with love. In- experienced as yet, Musset already reveals his temperament; through all the objectless passion of these verses we see the disillusionment that must come. At twenty-two, his knowl- edge of love is mainly literary and if we turn for its sources to his favorite books, we shall find that they were the Decam- eron and 'Manon Lescaut,' the novels of Crebillon and Louvet de Couvray. Such, alas, was Musset's early reading; and this is why our poet's ideal of love, as it appears throughout his plays and poems, reveals itself as a curious mixture of Ro- mantic aspiration and the pagan spirit of the Regency or of the Renaissance. "Such is the Musset 'before George Sand.' The Musset that came after is a more tragic figure, and the love he sings, in the splendid 'Nuits,' that voice his passion and his despair, is now a terrible reality. No willful fancy of a sensuous imagination is this, but love in the presence, burning with all the passionate regret of a wrecked hope and a shattered ideal. In 'Souvenir' we have a calmer mood, love in its regret for a past idealized by time; and in the matchless stanzas to la Malibran, love thrilled with the tragedy of death and the long- 254 James G. Kiernan ing for an immortal life. We can see now why Musset was the idol of his contemporaries. We can understand why his admirers once outnumbered Victor Hugo's. "We realize why his comedies and dramatic proverbs, in which he catches a breath of the true Shakespearian fancy, still hold their own upon the boards of the Comedie Fran- caise. 'It is not enough to be admired,' he says in one of his poems, 'one must be loved too.' Alfred de Musset was both admired and loved. 'The favorite poet of France,' as Taine called him years ago, his popularity, temporarily obscured by the symbolists and the Banville school, lies safe in the hearts of the older generation. "No permanent eclipse can fall upon this singer of youth. No change of literary fashion can overthrow a poet who, dandy of letters as he was, never wrote a line save in absolute sincerity to his mood. We wonder so often, when reading Victor Hugo, whether his finest flights are not merely feats of rhetorical maestria. Not so with Musset. When death overtook him, in May, 1857, Alfred de Musset was ready. Tired and disillusioned, worn out with life as he had conceived it, he closed his eyes at last with the words: 'En/in je vats dormir.'" This analysis disregards not only the known psychology of de Musset, but its literary expressions, the "Child of the Century," which is decidedly decadent rather than romantic. "Gamiana,"de Musset's pornographic story, is a decided expres- sion not merely of the sexual psychopathy of his pre George Sand period, but of his sadism. This was confined in actual expression to soiling of dresses, but, like all such early ex- pressions of sadism, contained potentialities of graver and darker types. Daudet's picture of him in "Sappho" as the poet of Love is truer than that just cited from Shanks. Even Shanks' picture has much of the morbid adolescent. A simi- lar mental state appears in Charles Eliot Norton's edition of Ruskin's letters.4 They reveal, says Norton, a nature that was "in the high- 4. Literary Digest, December 17th, 1904. Is Genius a Sport? 255 est degree complex; it was full of contrary elements which he never succeeded in reconciling so as to obtain steady equilibrium and tranquillity of soul, or persistent fixity of aim." "Taken altogether," Norton says, "they form a tragic record of the perplexities of a great and generous soul, the troubles of a tender heart, the spendthrift use and at last the failure of exceptional powers. Such genius, such high aims, such ardent yet often ill-directed effort, and such great yet broken achievement, such splendors sinking into such glooms —it is a sorrowful story." Ruskin's ungoverned extravagance of expression is found in the very early part of the intercourse, before broken health and disappointed hopes can be urged in explanation. He writes to Norton, then at Rome, and gives what seem to him "incontrivertible and accurate conclusions" as to the general character of that city: "* * * t^at struts are damp and moldy where they are not burning; that the modern architecture is fit only to put on a Twelfth-cake in sugar (e. g., the churches at the Quattro Fontano); that the old architecture consists chiefly of heaps of tufa and bricks; that the Tiber is muddy; that the Fountains are fantastic; that the Castle of St. Angelo is too round; that the Capitol is too square; that St. Peter's is too big; that all other churches are too little; that the Jews' quar- ter is uncomfortable; that the English quarter is unpictur- esque; that Michaelangelo's Moses is a monster; that his Last Judgment is a mistake; that Raphael's Transfiguration is a failure; that Apollo Belvidere is a public nuisance; that the bills are high; the malaria strong; the dissipation shameful; the bad company numerous; the Sirocco depressing; the Tramon- tana chilling; the Levante parching; the Ponente pelting; the ground unsafe; the politics perilous, and the religion pernic- ious. I do think that in all candor and reflective charity I may assert this much." In the latter years of 1850-60 Ruskin's convictions in re- spect to matters of deepest concern "underwent a vital change, which disturbed the currents of his life, turning them into 256 James G. Kit new and troubled channels. Youth came to its close; the props which had supported it and the defenses which had guarded it fell away one after the other. and were leaving him solitary and exposed." The following shows the effect of this unsettlement: "TquN-, 15th August "* * * It's very odd I don't keep writing to you con- tinually, for you are almost the only friend I have left. I mean the only friend who understands or feels with rne. I've a good many radical half friends, but I'm not a radical and they quarrel with me—by the way, so do you a little—about my governing- schemes. Then all mv Tory friends think me worse than Robespierre. Rossetti and the P. R. B. are all gone crazy about the Morte d'Arthur. I don't believe in Evangelicalism, and my Evangelical 'once) friends now look upon me with as much horror as on one of the possessed Gen- nesaret pigs. Xor do I believe in the Pope—and some Roman Catholic friends, who had great hopes of me. think I ought to be burned. Domestically I am supposed worse than Blue Beard; artistically I am considered a mere packet of squibs and crackers. I rather count upon Lowell as a friend. though I've never seen him. He and the Brownings and you. Four —well—it's a good deal to have—of such, and I won't grum- ble—but then you're in America, and no good to me—except that I'm in a perfect state of gnawing remorse about not writ- ing to you; and the Brownings are in Italy and I'm alone as a stone on a high glacier, dropped the wrong way instead of among the moraine. Some day, when I've quite made up my mind what to fight for, or whom to fight, I shall do well enough, if I live; but I haven't made up my mind what to fight for—whether, for instance, people ought to live in Swiss cot- tages and sit on three-legged or one-legged stools: whether people ought to dress well or ill; whether ladies ought to tie their hair in beautiful knots, whether Commerce or Business of any kind be an invention of the Devil or not; whether Art is a Crime or only an Absurdity; whether Clergymen ought to be multiplied, or exterminated by arsenic, like rats; whether Is Genius a Sportf 257 in general we are getting on, and if so where we are going to; whether it is worth while to ascertain any of these things; whether one's tongue was ever made to talk with or only to taste with." In 1861 the following pathetic outcry: "As for things that have influenced me, I believe hard work, love of justice and of beauty, good nature and great vanity have done all of me that was worth doing. I've had my heart broken, ages ago, when I was a boy—then mended, cracked, beaten in, kicked about old corridors, and finally, I think, flattened fairly out. I've picked up what education I've got in an irregular way—and it's very little. I suppose that on the whole as little has been got into me and out of me as under any circumstances was probable; it is true, had my father made me his clerk, I might have been in a fair way of becoming a respectable Political Economist in the man- ner of Ricardo or Mill—but granting liberty and power of traveling, and working as I chose, I suppose everything I've chosen to have been about as wrong as wrong could be. I ought not to have written a word; but should have merely waited on Turner as much as he would have let me, putting in writing every word that fell from him, and drawing hard. By this time I might have been an accomplished draftsman, a fair musician, and a thoroughly good scholar in art literature, and in good health besides." Ibsen sprang from a mixture of Scotch, German and the dark Gael who, according to Mantegazza, had a colony near Bergen, Norway. His adolescence was spent in decidedly conventional surroundings, the mental reaction against which would naturally create the drama of protest. This influence of environment is regarded usually as temperamental and ex- pressive of individualism purely. According to George Brandes:5 "After his confirmation Ibsen's school days were over as far as his parents were concerned. They could not afford to let him study art as he wished to, and he began to work as a clerk in a drug store at Grimstad. Grimstad was a little village of 800 inhabitants, and they were not broad- 5. Literary Digest, March 19. 1910. 258 James G. Kiernan minded or interested in anything lofty or ideal. Everybody knew every body else, not only by sight but through and through; people were ranked according to their fortune and social influence: they worshiped the usual, the customary, and considered any individuality as impertinence or madness.'- Christian Due6 says: "When passing the pharmacy one day with a friend he asked me whether I had seen the new clerk, as there was some- thing peculiar about him. People who had no errands at the drug store had no occasion to see him, for Ibsen was never seen outside, at least not during the day. I soon found a pretext for entering the store. This was a low room, so low that i could almost touch the ceiling with my hands, and it was very dingy and dark and musty. It was primitively fur- nished in every way. There was no sign of life. I rapped on the counter and there very hastily appeared a young man with a lively and engaging face. Ibsen grew a beard at an unusually early age, and it gave his face an energetic and at the same time harmonious expression. My general impression was that of a handsome young man with a good and well-formed figure. At this occasion his face expressed an unmistakable and im- patient question, which clearly proved that the customer was far from welcome. I asked him for a few pennies' worth of court-plaster, which he gave me without wasting time or words. But when I handed him the money our eyes met, arH I was struck by the wonderful gleam in his eyes. That gleam was the spark of genius. I speak of this apparently unimpor- tant meeting because it made so strong an impression on me." Soon afterward Due became better acquainted with Ibsen whose "intelligence and bubbling wit was extraordinary." "I soon became a daily guest in the drug store, especially in the evening, when Ibsen had some time to himself. I used to look forward to these evenings all day long." The Ibsen Due knew was totally different from the Ibsen the world knew, the man he grew to be. "And when I have seen my childhood's friend live like a lonely man I have often thought of his youth. 8. New York Son, 1906. Is Genius a Sport? 259 when he loved so much to have friends around him. Had life and people brought him to much disappointment that he had been forced to isolate himself and to speak only through his works?" In the Grimstad days Ibsen was very frank, open and fond of friends, even if he never was part of the social life in the little town. His little room behind the drug store soon be came the center of attraction, "for the lively, witty young man began to attract attention." His friends used to drop in after the day's work, and— "There was always fun and Ibsen was the center of it, with an admiring circle around him, bubbling with wit, slightly tinged with sarcasm, and always, in spite of oppressive sur- roundings, in the best of humor. No one who did not know him would have thought that anything weighed on him. Epi- grams rolled lightly from his lips as verses flowed with incred- ible facility from his pen. He was a wonderful caricaturist and his sketches were passed around with glee. . . . His sense of humor was unusually keen, and kept us all bubbling over with laughter. "Around midnight some of the more sensible would sug- gest that Ibsen needed rest, for we all knew that he spent pari of the night in studying, but he would always remark calmly that there was plenty of time both for reading and sleeping. "Ibsen's capacity for work and his bodily strength were phenomenal. It was almost inconceivable what he found time to do in a day. Besides the work of the store, which took up practically the whole day, he studied for college, and most of the subjects he had to master alone. Then his natural bent drove him to spend hours in writing, and this absorbed his attention more and more." "Ibsen could do everything he put his hand to," says Mr. Due. "His caricatures were extraordinary, while as a land- scape painter he showed undoubted talent. But he could not sing. He had a great sense of rhythm, but no ear." The little room behind the drug store is today often a social and political centre. In the edition of Ibsen's letters 260 James G. Kiernan recently translated, as the Literary Digest points out, we find at times "that unreserved expression of his personal feelings which has hitherto been, to a great extent, withheld from the public," and we discover, moreover, that "his proverbial re- serve is not in reality an essential element of his character." It appears, rather, that his has been a struggle against an atmosphere of restraint. He speaks of himself as a fighter in the intellectual vanguard, and feels that the world has not moved rapidly enough in its toleration to catch up with him. Writing to George Brandes about "The Enemy of the People," he says: "You are, of course, right when you say that we must all work for the spread of our opinions. 3ut I maintain that a fighter in the intellectual vanguard can never collect a ma- jority round him. In ten years the majority will, possibly, occupy the standpoint which Dr. Stockmann held at the public meeting. Rut during these ten years the Doctor will not have been standing still; he will still be at least ten years ahead of the majority. He can never have the majority with him. As regards myself, at least. I am conscious of incessant pro- gression. At the point where I stood when I wrote each of my books, there now stands a tolerably compact crowd; but I myself am no longer there; I am elsewhere; farther ahead, I hope." "Dear Bjornson," he once exclaimed, "it seems to me as if I were separated from both God and men by a great, an infinite void." And in an appeal to his king for a pension in 1866 to enable him to continue his work, he said: "It is not for a care-free existence I am fighting, but for the possibility of devoting myself to the task which I believe and know has been laid upon me by God—the work which seems to me more important ad needful in Norway than any other, that of arousing the nation and leading it to think great thoughts." From the very earliest period, the spirit of restlessness was dominant in Ibsen's character; an ethical dissatisfaction that drove him out of his country the better to view it. He Is Genius a Sport? 261 must have no relatives around him who intellectually are his enemies; he must keep no friends who would prove "an expen- sive luxury." He wrote: "The costliness of keeping friends does not lie in what one does for them, but in what one, out of consideration for them, refrains from doing. This means the crushing of many an intellectual germ. I have had personal experience of it; and there are, consequently, many years behind me during which it was not possible for me to be myself. . . . "I myself am responsible for what I write, I and no one else. I cannot possibly bring trouble on any party; for I do not belong to any. I stand like a solitary franctireur at the outposts and act on my own responsibility." Regarding "Ghosts," he says: "It may well be that the play is in several respects rather daring. But it seemed to me that the time had come when some boundary-posts required to be moved. And this was an undertaking for which an older writer like myself was more fitted than the many younger authors who might desire to do something of the kind. "I was prepared for a storm; for such storms a man can- not alter his course; that would be cowardice." Late, Ibsen wrote: "So to conduct one's life as to realize one's self—this seems to me the highest attainment posible to a human being. It is the task of one and all of us, but most of us bungle it." Once out of his own country, he began to write freely, expressing himself unreservedly in his plays, and breathing the greater atmosphere of intellectual activity. Removal from Scandinavia resulted in an interesting change in himself, thus indicated: "It would be quite impossible for me to settle for good in Norway. Nowhere should I feel less at home than there. A man of reasonably well-developed intellect is no longer satis- fied with the old conception of nationality. We can no longer be content with the political community to which we belong. I beli eve that national consciousness is on the point of dying 202 James G. Kiernan out, and that it will be replaced by racial consciousness; I myself, at least, have passed through this evolution. I began by feeling myself a Norwegian; 1 developed into a Scandi- navian ; and now I have arrived at Teutonism." Whenever a return to home is mentioned, Ibsen expresses with fear of the banal influence: "What I feel is that I should not be able to write freely and frankly and unreservedly there. And this simply means that I shall not write at all. When, ten years ago, after an absence of ten years, I sailed up the Fjord, I felt a weight settling down on my breast. a feeling of actual physical op- pression. And this feeling lasted all the time I was at home; I was not myself under the gaze of all those cold, uncompre- hending Norwegian eyes at the windows and in the streets." When he had realized his spiritual home in Munice, and lived for years in Rome and Dresden, and returned to Nor- way, he writes thus: "Oh, dear Brandes, it is not without its consequences that a man lives for twenty-seven years in the wider, emancipated and emancipating spiritual conditions of the great world. Up here, by the fjords, is my native land. But—but—but! Where am I to find my home-land?" As regards his own work, while there is much which he indicates as personal opinion in his many plays, his chief desire always was to make his ideas consistent with the characters he had in mind. On the publication of "Hedda Gabler," the critics imme- diately began their consideration of the problem underlying the dialogue. Ibsen commented as follows: "The title of the play is Hedda Gabler. My intention in giving it this name was to indicate that Hedda as a personality is to be regarded rather as her father's daughter than as her husband's wife. "It was not really my desire to deal in this play with so- called problems. What I principally wanted to do was to depict human beings, human emotions, and human destinies, 7s Genius a Sport? 263 upon a ground—aimed at my own spiritual emancipation and purification—for a man shares the responsibility and the guilt of the society to which he belongs.'' Outside of his own country, Ibsen's influence has taken effective hold. He writes: "The introduction of my dramatic works into France has long been my dream. Rut I dared not think seriously of it, as it seemed to me to be something quite unattainable. I had no connections in that country to speak of. And I was already so fully engaged, attending to my literary business in Scan- dinavia, Germany, Austria, England, America, and elsewhere, that it was quite out of my power to make any attempt to extend my field of operations to that great and very inaccessi- ble city, Paris, or what in matters literary is the same thing— to France." When William Archer was doing pioneer work for him, he wrote: "I regret ever more and more that I neglected at the proper time to learn to speak English. Now it is too late. Were I conversant with the language, I should go to London at once, or, to be more correct, I should have been there long ago. I have been revolving many things in my mind lately, and one of the conclusions to which I have come is that there are very strong traces in me of my Scotch descent. But this is only a feeling—perhaps only a wish that it were so. I lack the experience and knowledge necessary to judge." Another curious illustration of a natural psychic reaction against an environment similar to that which marred Villon is John Masefield who. evidently imbued with the spirit of Shakespeare's "Home-keeping youth Have ever homely wits," ran away from school to which he had often played truant thus beginning a long series of wander years and at last found him- self stranded in New York at the beginning of a sultry summer. Two friends, in the same desperate straits, were at that time sharing a garret in Greenwich Village, where he joined them. 264 James G. Kiernan For several days they lived on doughnuts and on the sand- wiches of the free-lunch counters, while they tramped about the city looking for work. Masefield used to call at livery stables, little eating-houses, bucket-shops, factories, bakeries, and general stores, offering his services at rates which none might call exorbitant. Perhaps he seemed top boyish for employment, for he always looked very young, and perhaps people shunned him for the uncouthness of his appearance. He was burned to a dull brick-color by the sun, for he had passed two months as a common laborer on a farm. He wore the red shirt and the dungarees of the sailor, and an old slouch hat with a broken brim. Those to whom he applied for work were sometimes kind, sometimes rude. But whether they were rude or kind, they refused, one and all, to have any- thing to do with him. "His friend fared as he fared, so that in ten days' time their condition was almost desperate. 'We reduced our ex- penses to tenpence a day among the three of us,' he wrote to a friend in London. 'We did our own washing and dried it out of the window. One of us slept each night on the floor upon a pile of newspapers, with a coat for a pillow. Once or twice a week we went to the Eighth avenue pawnshops, or to a clothes store in lileecker street, where we raised money on our gear, to enable us to buy tobacco or an occasional egg. Once we sallied out and sang song's in the street, but it came on to rain, and we were all soaked through before the citizens had had time to get out an injunction.' "They were living in this way when Masefield's good star sent him to the Colonial Hotel on Sixth avenue, which has since been torn down. He was in the habit of sToin? there at lunch-time, for those who bought a class of beer at the bar were entitled to a free lunch and a sight of the papers." In one of Masefield's sketches, he writes: "The proprietor, a small, pale man in a tweed suit, Pan- ama hat. and tan boots. came over to me and began a conver- sation. 'Say.' he said, speaking slowly, 'do you want a good job?' I said I did. 'Well,' he said, 'I want you to help be- Is Genius a Sport? 265 hind the bar here. Here's a dollar bill; go over to Lee's there an' have a hair-cut. I'll fix you up with aprons. I'll give you $10 a month and your board and room, and you kin start in right away.' "When my hair had been dipt I returned to Luke O'Don- nell, the hotel proprietor. He brought out a white jacket and an apron, bade me put them on, and then sent me behind the bar to clean glasses. There were two other bartenders, one named Johnny, a little merry man with a dark complexion; the other named John, an elderly stout man with a fat red head and a continual smile. My duties were to clean the glasses which these two artists filled for the thirsty. I, who was not an artist, and could not mix the subtle drinks in vogue, might only serve beer and cigars. If necessary, I had to take a tray laden with curious drinks to men living in the hotel or loafing at the bar-tables reading the papers. "I had to see that the piping through which the beer ran to the taps was kept packed in ice. I had to keep the bar ice- box filled from the cold-storage cellar. I had to keep the free-lunch counter supplied with food, such as pretzels, sliced Bologna sausage, sardines, salt beef, rye bread, and potato salad. Twice a week I had to take down the electric-light shades, which were of a pinky-blue porcelain, to wash them carefully with soap and water. My meals I ate with the pro- prietor's family at his flat some half mile away. I slept in. a garret in the hotel, right at the top, a queer little room with an ant's nest in the wainscot." After several months of this life with us, "which, from a financial point of view, were not very profitable, but which enlarged greatly his store of experience and broadened his views on life and the human animal," Masefield returned to England. One of his earlier friends, Mr. Jack B. Keats, an artist and brother of the poet, "prevailed upon him to pause a iittle and to describe for the benefit of the public his adven- tures on sea and land." 266 James G. Kiernan "This led to some more or less regular hack work, which led to marriage, which led to more regular work, and the tramp settled down. "Thirty-eight years old and the father of two children, he has probably recovered from his acute and seemingly chronic attacks of wanderlust. And strangely enough London is lionizing him. I say strangely, not because I disapprove of this sudden Masefield craze, but because he seems to be writ- ing the very stuff which in the parlance of editorial chambers 'the public does not want.'" The influence of environment at the periods of stress has lately been demonstrated vividly by studies of hostile apostles of eugenics like Karl Pearson. In 1911 C. B. Davenport7 pointed this influence out. For the sciences dealing with environment Dr. Havelock Ellis coined the term euthenics. Previously to either, Harriet Alexander8 had termed the united factors of birth and environment orthogenics. She discussed its influences before the Chicago Academy of Medi- cine nearly two decades ago. Davenport remarks: "The two schools of euthenics and eugenics stand op- posed, each viewing the other unkindly. Against eugenics it is urged that it is a fatalistic doctrine and deprives life of the stimulus toward effort. Against euthenics the other side urges that it demands an endless amount of money to patch up conditions in the vain effort to get greater efficiency. Which of the two doctrines is true? The thoughtful mind must concede that, as is so often the case where doctrines are op- posed, each view is partial, incomplete, and really false. The truth does not exactly lie between the doctrines; it compre- hends them both. What a child becomes is always the re- sultant of two sets of forces." Harriet Alexander states that "the tendency is to view degeneracy not from the biologic but from the pathologic standpoint. Teratologic defect, though it may produce not 7. Popular Science Monthly, 1911. 8. Medicine, 1896. Is Genius a Sport? 267 only secondary biochemic and even organic patho-anatomic changes, is not identical with these, but often expresses merely a functional disorder correctable by environment and train- ing. The forces summed up in natural selection so act, as Ray Lankester9 remarks, on the structure of an organism as to keep it in statu quo to elaborate it or to diminish the complexity of its structure. As Roux10has shown, there is not merely a struggle for existence between organisms, but likewise a struggle for existence between the organs of the metazoa themselves. Degeneracy is a gradual change of struc- ture whereby an animal becomes adapted to less varied and less complex conditions. In degeneration there is suppres- sion of form corresponding to cessation of work; elaboration of one organ usually accompanies degeneracy in all the oth- ers. Hence, contrary to the usual opinion, race of a degen- erate does not necessarily tend to die out, but it so departs from the type that this dies out. Degenerates as a rule tend to be parasitic or semi-parasitic; indeed the parasitic state is necessary for their survival as the fittest. The degenerate spider of the human skin (demode malliculorum) excellently illustrates this. Should man become extinct, this spider would die out. Sexual selection appears here as elsewhere in development. The female as a rule is true to the type; the male (as in the barnacle) often becomes a mere parasite on the female. Sometimes the reverse occurs. What is true of the lower animals is peculiarly true of man. In the infant, a being wrapped up in the instinct of self-preservation, the primary ego is predominant and the child is an egocentric parasite. As development proceeds, this standpoint is passed conscience assumes its priority, the fore brain acts as check on the purely vegetable functions and the secondary ego be- comes predominant over the primary. Civilization follows this evolution. If this inhibition be weakened or disordered, predominance of the natural instincts occurs, and when totally lost the indi- 9. Degeneracy. 10. Der Kampf der Thelle lm Organisms. 268 James G. Kiernan vidual opposes the ethical order of the race—he is a parasite of the worst kind who lives on his host and destroys him in so doing. Egotism may vary from this extreme to that of the genius who pleads the baby act of eccentricity as an excuse for excess.11 The last, from a biological standpoint, according to Huxley's logical opinion, stands in the same position as a "sport" among animals and plants, and is a product of that variability which is the postulate of selection both natural and artificial. On the general ground that a strong and therefore markedly abnormal variety is ipso facto not likely to be so well in harmony with existing conditions as the normal stand- ard (which has been brought to what it is largely by the oper- ation of those conditions), a large proportion of genius "sports" are likely to come to grief physically and socially. Intensity of feeling, a condition of genius, is especially liable to run into insanity. Hypertrophy in one place is equivalent to atrophy elsewhere. Removal of inhibitions does not always account for the appearance of art, literature and mechanical powers in the in- sane hitherto destitute of them. Emotional exaltation is in excess in hypomania and acute stages of mania or allied states of other psychoses. Many an artist, litterateur or mechanical genius finds that an increased cerebral supply of oxygen increases his invention; such increased supply underlies the psychoses mentioned. Insane conceptions rapidly arise under such conditions, and from their very rapidity of origin weaken and even annihilate each other, but as the fittest of them under certain circumstances survive and are as truly creative as the allied creations of artistic literati and mechanicians. The ego- tistic mental background generally checks development of these creations, which, however, occasionally survive under proper insane-hospital discipline that tends to crush delu- sional factors. That aid can thus be given these tendencies is a fact that demonstrates their kinship to the normal rather than to that predominant primary ego constituting the ab- normal. ;1 11. Spencer: Principles of Sociology. Is Genius a Sport? 269 Since, even on the Lombroson view, the genius is nearer to the normal than the lunatic, the effect of environment is demonstrably greater. The genius, along with the whole gen- eration of which he forms a part, along with its institutions, language, manners, and its multitudinous arts and appliances, is a resultant. The genius depends upon the long series of complex influences which have produced the race in which he appears and the social state into which the race has grown. All these changes, of which he is the proximate initiator, have their chief causes in the generation he is descended from. With all Ruskin's teleologic bias he is forced to admit that much artistic intellect is daily lost in other avocations.12 (Gen- erally the temper which would make an admirable artist is humble and observant, capable of interest in little things, and of entertaining itself pleasantly in the dullest circumstances. Suppose, added to these characters, a steady conscientiousness which seeks to do its duty wherever it may be placed, and the power denied to few artistic minds of ingenious invention in almost any practical department of human skill, and it can hardly be doubted that the very humility and consciousness which would have perfected the painter have in many in- stances prevented their possessor from becoming one. In the quiet life of steady craftsmen, sagacious manufacturers and uncomplaining clerks may frequently be concealed more genius than ever is raised to the direction of public work or to be the mark of public praise.) The principle thus enunciated lights up the gloom of the ordinary pessimistic view of degeneracy with the hope that the neurons of the degenerate may be trained Till within The twilight mazes of his brain (Like embryos within the womb) Thought pushes feelers through the gloom. As degeneracy is a process of evolution leading to altera- tion of form because of cessation of inhibitions in certain directions resultant on diminished work, it logically follows that since diminished functionating precedes change of struc- 12. Ruskin: Modem Painters. 270 James G. Kiernan ture, increased functionating must check the change of struc- ture in its biochemical stage. Nay, more; it is evident that the structural elaboration due to degeneracy may be retained while the degenerate structures resume their functions and the degen- erate race rank higher in evolution because of the utilization of the beneficial variation due to degeneracy. The influence of this principle is increased by the fact that the vast majority of the children of degenerates exhibit a tendency to degen- eracy rather than degeneracy itself." There is a too general tendency to regard the old, much- exploited results of superficial experiments like Mendel as to minor character as evidence that offsets the law of the trans- formation of heredity, which Moreau de Tours pointed out nearly six decades ago.18 Moreau found that degeneracy in a family may result in absence of conception from too excessive cell multiplication in the ovum; retardation of conception; un- expected conception; incomplete products, weak products with predispositions, Some seventeen years ago I reported14 the following family, which originated in the Eastern States, but has branches south and westward. A farmer lived twenty miles distant from his nearest neighbor, whose only child he married. The daughter had led a lonely life till her courtship at the age of 28 by the farmer, then three years younger. The fanner married her for $200 after having impregnated her. He then found lead on his farm, and went to a city. A stock company bought his farm and launched him into the stock market, where he made money, more as cunning tool than adventurer. He became a high-liver, gouty and dyspeptic, and died from gouty kidney at 70. The couple had five chil- dren. The eldest, a son, became a "Napoleon of Finance," inherited his father's cunning, and died wealthy within the pale of the law. He married a society woman, the last scion of an old family. The second child, a daughter, was club- footed and early suffered from gouty tophi. She married a 13. La Psychologle Morblde. 14. Medicine. 1897 Is Genius a Sport? 271 society man of old family who had cleft palate. The third child, a daughter, had congenital strabismus. She married a man who was suffering from irregular migraine. The fourth child, a daughter, was normal. She married a 30-year-old active business man in whom ataxia developed a year after marriage. The fifth child, a son, was ataxic at eighteen. The scions of the "Napoleon of Finance" and the society woman were an imbecile son, a hysteriac, a female epileptic who had a double uterus, a nymphomaniac, and a society man who wrote verses. The cleft-palated society man and club-footed woman had triplets born dead, and a strabismic migrainous son who. left penniless by his father, married his cousin, the nymphomaniac daughter of the "Napoleon of Finance," after being detected in an intrigue with her. The migrainous man and strabismic daughter of the farmer stock-broker had a sexual invert masculine daughter, a daughter subject to periodical epistaxis irrespective of menstruation, as well as chorea during childhood, a normal daughter, a deaf-mute phthisical son, a cloacal daughter, an ameliac son, a cyclopic daughter born dead, and a normal son. The sexual invert married the versifier son of the "Napoleon of Finance." The progeny of the normal daughter of the farmer stock-broker and the ataxic man were a dead-born sarcomatous son, a gouty son with early tophi, twin boys paralyzed in infancy, twin girls (normal), a normal son, and a son ataxic at fourteen. The progeny of the nymphomaniac and her strabismic migrain- ous cousin were a ne'er-do-well, a periodical lunatic, a dipso- maniac daughter (who died of gastric cancer), deformed trip- lets who died at birth, an epileptic imbecile son, a hermaphro- dite, a prostitute, a double monster born dead, a normal daugh- ter, and a paranoiac son. The ne'er-do-well married his epis- taxic cousin. The gouty son of the farmer's normal daughter married the hysteric daughter of the "Napoleon of Finance." They had a son born with unilateral asymmetry, a prostitute, dead triplets, a male sexual invert, a color-blind daughter, and a normal son. The color-blind daughter married a para- noiac grandson of the "Napoleon of Finance." The progeny 272 James G. Kiernan of the sexual invert and the versifier (who were soon di- vorced) were a periodical nymphomaniac who had some artis- tic and literary talent, and a son who died of gastric cancer. The scions of the ne'er-do-well and the epistaxic woman were a moral imbecile, a "bleeder," a stammering daughter who had uvula deformity, a deaf-mute cryptorchid, dead-born triplets, an infantile paralytic son, and dead-born quadruplets. The progeny of the paranoiac and his color-blind cousin were an exophthalmic daughter, an epileptic cryptorchid, a cleft- palated imbecile with a cloaca, dead-born quadruplets, an idiot boy, and a "bleeder." Strong as seems the influence of heredity here, the envi- ronment produced has emphatically to.be taken account. How far the influence of environment may entend has been shown by the experiments of Dareste16 and E. C. Spitzka, embryolo- gists, as they pointed out, "may imitate natural nerve terato- logic by artificial procedures. By wounding the embryonic and vascular areas of the chick's germ with a cataract needle, malformations are in- duced varying in intensity and character with the earliness of the injury and its precise extent. More delicate injuries pro- duce less monstrous development. Partial varnishing or irregular heating of the egg-shell in particular results in anomalies comparable to microcephaly 2nd cerebral asym- metry. This latter fact (showing the constancy of the injuri- ous effect of so apparently slight an impression as the partial varnishing of a structure not connected with the embryo at all directly) suggests the line of research to be followed in determining the source of the maternal and other impressions acting on the germ. What delicate problems are to be solved in this connection may be inferred from the fact that eggs transported in railroad cars, and subjected to the vibration and repeated shocks of a railroad journey, are checked in develop- ment for several days. A more delicate molecular transmis- sion during the maturation of the ovum, during its fertiliza- 15. Amer. Jour. of Psych. and Neuro., 1882-5. Is Genius a Sportf 273 tion, or finally during embryonic stages of the more complex and therefore more readily disturbed and distorted human germ, accounts for the disastrous effect of insanity, emotion, or other mental or physical shock of the parent on the off- spring. The cause of many cerebral deformities exists in the germ prior to the appearance of the separate organs of the body. Artificial deformities produce analogous results because they imitate original germ defects, either by mechanical removal or by some other interference with a special part of the germ. Early involvement of the germ is shown by the fact that somatic malformations in the hereditary psychoses often involve the body elsewhere than in the nervous axis. The stigmata of heredity—defective development of the uro- genital system, deformities in the face, skull, irregular growth of the teeth, misshapen ears and limbs—owe their grave significance to this fact. Like deformities of the brain, these anomalies are also more marked and constant with the lower forms of the systematized perversions of the mind than the higher. It is easy from these results to understand how far and how the nervous system has its part in the disorders of general development. It can easily be understood how the individuals who present most deformities are equally those who suffer from most decided disorders of the nervous sys- tem." As already indicated, these disorders may be trans- formed into each other and coexist as well. (To be continued.) THE CAUSATIVE FORCES OF MENTAL DEFICIENCY. By H. C. Kehob, M. D., Superintendent Kentucky Institution for Feeble-Minded Children.* Frankfort, Ky. |N the discussion of this subject we enter an endless ■ avenue to a shoreless ocean. It has so many angles and intricate detail that we are es- topped from lack of time and fear of verbosity to do justice to the subject. Beginning with the curse of alcohol we are at the very threshold of shackled and abnormal brain development. In the immediate family we see in the offspring the idiot and the feeble-minded, especially if the parents are mentally and physically weak. If strong and vigorous mentally and physically we see insanity in all its various manifesta- tions cropping out in the second generation, and so on down the line in each succeeding generation ad infinitum. Tea and coffee drinkers become neurasthenics and often die of arterio-sclerosis and paralysis. The children of such parents fill the hospitals for the insane with hys- terical subjects in all its various manifestations. Those addicted to the drug habit destroy themselves and go to our insane hospitals a pitiable and deplorable army of incurables. *Bead before meeting of AHenlite and Neurologist*, July 18th to 17th, Chicago. (274) The Causative Forces of Mental Deficiency 275 Those who have traveled the primrose path and wound up with syphilis, and then marry a trusting and innocent maiden, reck not of the consequences to human life and our social fabric. Infantile paralysis, insanity, idiocy and feeble-minded are the legacy they leave to posterity, and in addition locomotor ataxia. The disciples of chronic gonorrhea are more numerous and even more to be dreaded than the syphilitic. The young and innocent wives of these ghoulish triflers with human life soon give evidence of salpingitis, ovaritis and a long train of ills connected with the female generative organs that have caused more deaths than all the wars in Christendom and from the loins of these master pillagers of human life come the sycotic children destined to reach an early grave through the feeble-minded institutions of the various states. Those of strong parentage live on infested with all the ills that human flesh is heir to, such as con- tagious diseases, catarrh, goitre, tumors, caries, lucorrhoea, tabes dorsalis, throat and lung troubles and cancer. The religio-fanatic is another source of plebian de- serving no little mention in the category of causative in- sanity and feeble-mindedness. We mean nothing deroga- tory to the followers of the meek and lowly Nazarene in these remarks. Far be it from us to insult the intelligence of those who worship God according to the dictates of their own conscience, but we refer to the ranters and vacilla- ting pulpiteers of small caliber and little gumption. From these pious and regenerated and benighted ilk come mis- fortune in breeding resulting in the insane and feeble- minded. Our state institutions attest the truth of these statements. Heredity is the hand-maid in all cases tending toward abnormality, and trickling down through the ages it has intermingled and added to all the vicious habits of the individual its quota of strange phenomena. Succinctly stated these are some of the causative forces of mental deficiency and to suggest a plan to lessen these evils by an act of the Legislature is fraught with great opposition beeause of the make-up of the average 276 H. C. Kehoe solons, together with the added expense in providing means in the different states to adequately care for the army of the now unrestrained who would come within the per- view of such newly enacted laws. However, a few suggestions: First. Establishment of inebriate asylums connect- ed with all state hospitals, trial by jury and forced con- finement of all drunkards till such time as they are cured and safe subjects to mingle with the social world. Second. The prohibiting of marriage among syphi- litics and those with chronic gonorrhea under heavy penalty. Third. Laws requiring custodial care, segregation and sterilization of all the feeble-minded before turning them back to society. I believe most states now have laws governing marriage among the feeble-minded and mentally deranged. The enforcement of these laws should curtail the growing evils now resulting in the filling of our institu- tions with the abnormal, including the criminal, the insane and feeble-minded. AN EMASCULATED HOMO-SEXUAL. His Antecedent and Post-Operative Lira. By Chas. H. Hughes, M. D., St. Louis. FOUR years ago, a gentleman of ordinary moral, in- tellectual and physical parts and psychic impulsions, save for the. affliction which distinguished him, vol- untarily came into our professional care. He was, by occupation, a professional bookkeeper of ability and recognized as an expert in his line in the adjusting of accounts of business firms and estates. He had ordinarily a fair degree of control of his ab- normal passionate propensity, especially under judicious and extremely heroic bromide management, fruit and vege- table, (meat prohibited diet, oysters and fish excluded), predigested food, malted cereals, etc., and ptomaine elimi- oation, i.e., two complete evacuations under salol, protoiodid nf mercury or podophyllin and other laxatives, substituting or alternating. His bowels were kept free of ptomains and flatus so that the least possible amount of irritation might proceed from them to genitals or brain. Tonic electrizations from spine to genitalia and tranquilizing brain electro seances were likewise employed. But the patient got tired of being under treatment, he being an intelligent reading man, and solicited a radical operation of which he had learned and solicited the more certainly effective surgical operation. He had been much mortified in his relation with certain employers to whom, through his morbidly erotic inclinations and perverse (277) 278 C. H. Hughes unguarded displays, the higher inhibitions of his cere- brum having inopportunely failed him at times, to his great chagrin and mortification and with loss of several valuable positions. It was pitiful to see and hear this unfortunately and un- happily dowered gentleman of otherwise good and proper instincts confess his painful, and to the world in general abhorrent, unnatural propensity to erotopathic evil. The clergy and the courts have classed this lapsus libido perversus as sin against "Nature," as Alexander Smith has put into the mouth of the fallen virgin—"Oh! if she had proclivity to sin—Nature may leer behind a gracious mask," etc. Hoping to stop erections and thereby to proba- bly make a salutary psychic impression without positive asexualization, for he was (except for his sexual perversion) a splendid man who might become, if normal, the father of splendid children, this unfortunate man was operated on. The first operation, taken with the consent, but not with the counsel of a neurologist, was an excision of the dorsales penis nerve. This procedure did not arrest the pervert erotism nor obliterate it. Vasectomy would have done better. The obliteration of other branches of the internal pubic nerve would have done better. But the second operation a year or so after excised the testes entire. The sequellae of this last surgical procedure were pecu- liar. It gave the gentleman tranquility and satisfaction. After the operation he lost his erotic inclinations towards his own sex but showed a social inclination towards asexualized ladies, one of his imperative and special requests of me, being that I might find and introduce to him a lady who had been oophorectomised for a similar contraire sexuel etnp- findung. It is a most singular contrary sexual instinct, as Krafft-Ebing and others have further detailed. Dr. Riddle* at the last meeting, in a most interesting paper before the American Academy of Medicine, detail- *"The Biological Basis and Experimental Control of Sex." Oscar Riddle, Ph. D., The Carnegie Institution, Station for Experimental Evolution. Cold Spring Harbor, L. I., N. Y. The Annual Address before the American Academy of Medicine at Atlantic, Jane 11th, 1914. An Emasculated Homo-Sexual et Sequallae. 279 ing his laboratory experiment on birds, showed it to exist also in pigeons. This gentleman was about 28 or 30 years old. In bis youth he had reciprocal homo-sexual associates but he as- sured me that their mutual affection was mostly platonic. He was not given to lascivious bestiality. His peculiar sexual perversion distressed him much because of the damage it did to his business interests and the consciousness that he was abnormal and unnatural and so regarded by some of his associates, who knew him well. He detailed more instances of his sexual perversion than it would be worth while to enumerate. He displayed his failing by following those about, whom he loved and seek- ing to be much and too continuously in their company and in inopportune, erotic handpressing, kissing and em- bracing, when not strongly and overmasteringly self- guarded. He, on one occasion, lost a very valuable posi- tion by a sudden, inopportune and ecstatic embrace of his superior at a most improper and inopportune time, even if the party had been a female and he a normal and accepted lover. He was erotically pure in heart and by nature abhorred all lasciviousness. He was inclined to be exceedingly affec- tionate in his demeanor toward me so that I had to be particularly matter of fact and brief in my interviews with him when he would come for prescriptions, treatment or counsel, especially for the constant current galvanism of head to the lumbo-genital area, which I soon discovered it was wise therapeutics to discontinue. The specially notable feature in the character of this case and the one which particularly justifies its addition to the considerably large number of similar cases now on record in the literature of psychic per- version, is the display of pronounced normal Platonic regard for the sex to whom he was rather averse than otherwise, while under the dominion of his perverted 280 C. H. Hughes homo-sexual passion, before the surgical] (procedure had accomplished asexualization. ;Vj There is no other case precisely like this to my knowl- edge in the records of sexual psychopathy. THE FEEBLE-MINDED—THEIR ENVIRONMENT AND SOCIAL RELATION.* By H. C. Kehoe, M. D., Frankfort, Ky. Superintendent Kentucky Institution for Feeble-Minded Children. STATISTICS show that 50% of children attending school are retardates, and evidently 25% of these are really feeble-minded. How many feeble-minded there are who never reach the school room will never be known, but they certainly add their quota to the sum total of social derelicts who tend to leave their blight and contami- nate the stream of human endeavor toward a higher civi- lization. We are making very little progress toward relieving this condition. Our eelymosinary institutions, kept up by state aid, are but the dumping ground for children of genteel poverty and the substrata of the nether world of hopeless degenerates. My experience as Superintendent of a great state institution has taught me to only look in the faces of these unfortunates to determine whether they are the offspring of the Alcoholics, Syphilitics, Sycotics, or Feeble-Minded. From no matter which of these parents the child comes into the world his or her tendencies without restraint tend (281) 282 H. C. Kehoe toward a retrograde metamorphosis. No greater calamity could happen than to let the children of such parents go haphazard through life without custodial care, and yet if they were all provided for it would impoverish the American Nation. Through eugenics we are beginning to see the light, and if taken hold of at once by the medical profession and all of those interested in stemming the tide of moral degener- acy yet four hundred years will be consumed before statistics will show much progress. This is lamentable but true. We are now so busy contaminating the stream of human life that we will soon exist in a world en masse with feeble- minded, lunatics, cranks, neurasthenics, idiots, alcoholics, syphilitics, nerve-ends, and depraved and hopeless de- generates. To see an individual of natural poise, normal mind, and healthy body will be the exception and not the rule. Yet we boast of our great educational institutions and take cognizance of a world dotted with churches whose very steeples pierce the heavens, and we hear men prate about the world growing better. Ish ka bibble! As Americans we boast of our patriotism and the wealth of a sun-kissed nation, while our markets groan beneath the burden of products sufficient to supply the nations of the world—yet as specimens of the genus homo we are becoming driveling idiots and a nation of nincompoops. If half as much attention was given to the procreation of the human family as is now given to the raising of stock, we would soon electrify the world. As it is the wires are crossed in the human dynamo and we are daily being shocked by short-circuits in the human laboratory. No more delicate piece of mechanism ever existed than the human brain. Its ability to appropriate materials from the human reservoir that makes the mind the most complex unit in all the world, comparable only to the superhuman and intangible ergo God. Society in reality is carrying a purposeless equation, the state a hopeless burden, and posterity an ever present menace so long as segregation and sterilization are not The Feeble-Minded 283 permitted as a means of mitigating the evil consequen- ces of the feeble-minded. Science is doing wonders for the mentally diseased as well as the psychoepileptic and the psychoneurasthenic, but the deficiency of the feeble-minded is irreparable, and but little aided by the Binet-Simon system or any other known method. When the feeble-minded are allowed to follow unhinder- ed the trend of their minds, moral training becomes a play- thing, turpitude reigns supreme, the passions are allowed to run riot and the body politic is made the scape-goat in every community of an army of shiftless, senseless, soulless barnicles of human misfits, destined in the end to become the submerged majority. Should we not take a new sounding of human life and plant buoys along life's highway? As it is we are only marking time while the procession of derelicts are sowing seeds of degradation and shame that are filling our prisons with the abnormal and our state institutions with the insane . and hopeless defective. It is a known fact that cancerous children are the off- spring of tubercular parents and vice-versa; that slobbering children—i. e., those with active salivary glands and de- fective minds are traceable to parents addicted to alcohol; that the defective with partial paralysis point unerringly to syphilitic progenitors; that the feeble-minded with the stooped shoulders and inherited dyscrasia are the children of like parents; while the blue eyed, delicate, pale children with glandular enlargements and lymphatic conditions are from sycotic parents. And no matter what group they all tend toward an early demise, and 75% die of tuber- culosis in some form. It is appalling and the end is not yet. Epileptics should have a special colony and not be associated with those of feeble mind, as the latter are great imitators and become affected by contagion or psychoepi- lepsy, while the former need special diet and entirely different treatment. All feeble-minded are creatures of habit, and epetition fixes the habit, and punishment will not correct the con- 284 H. C. Kehoe ditions once established in their minds. They have no pride of character and no sense of shame. To do evil is paramount by inheritance and increased by environment. They follow the path of least resistance, and are powerless to prevent the things upon which their mind is bent. It seems characteristic for the mind to grow weaker and passions stronger, and thus they become a prey to all the unmention- able evils of lust that can be enumerated. This is an aw- ful indictment, but it is the plain and unvarnished truth. As Shakespeare says: "I could a tale unfold," if permitted, that would blanche the cheek and paralyze the unsophisti- cated. This paper might be regarded as pessimistic by many of my hearers, but understand I am a Democrat, and there- fore optimistic most of my time. There is another side to this subject and those who are "talking to the galleries" are often in the foot-lights—telling fairy-stories of wonderful accomplishments. The truth is a few sparodic cases are helped and a little progress made from individual effort, but all too costly for verification. To educate the feeble-minded is a dreary waste of time and a woeful waste of money, as they will forget as much in recess as they are taught during class hours. They learn to read and write a little and then forget it all unless kept constantly repeating. Those who have mechanism can do better in manual training or basket making. Sus- tained effort is impossible and they fall 50% below normal in all work. They are all gormandizers and can eat a yard of microbes a minute and live in an atmosphere surcharged with foul odors and carbon-dioxide. They are not susceptible to contagion and can swallow most poisons with impunity. They are forced into a bath and unalterably opposed to cleanliness, and nine-tenths of them are natural liars and born thieves. They are simply pawns in human form and subject always to a higher power of intellect. 'Tis said a fool and a cipher are never in danger, and these unfortunate creatures are certainly of the tribe of Ishmael, and, in an immaterial way, will be cared for as The Feeble-Minded 285 was the Scion of Hager and Abraham of old, and this part we can well leave to Him "Who doeth all things well." But just so long as they infest the earth and are wont to multiply and replenish they should, in a material sense, be subject to custodial care, segregation and sterilization lest we be lost as a nation both mentally, physically, socially and financially. "Out of the soil—the lily; Out of the ooze—the pearl." Back to the vomit—the dog— Back to the wallow—the hog. So with the feeble-minded. DEAD MEN DO TELL TALES. By Davina Waterson. ONCE upon a time, many a murderer was acquitted and many an innocent man hanged, because, to all appearances, they had or had not, been guilty of the crime. But today an assassin has to reckon with the physi- cist, the chemist and the Rontgenologist, who start off on his track and force him to face damning, dispassionate scientif- ic facts, but, with equal zeal bring these facts to clear a miserable man protesting his innocence, yet condemned beforehand by circumstantial evidence. Now, if a man is found walking quickly away from the place where a body has been found, and if the man has blood stains on him and on his pocket knife, naturally he is the murderer, so why spend a fee on an expert to prove the contrary? Just such a case occurred in France. It was no use the man saying he had poached a rabbit, made a stew and burnt the skin and bones to avoid possible detection. He was condemned because the bloodstains and a known hatred for the victim shouted guilty! Then came along a physicist and showed the blood to be that of a rabbit, for, by the unique methods of two professors, E. T. Reichert and A. P. Brown, it can be determined to what species of animal, bird or reptile the blood belongs, since every species has distinct crystallization. Experts claim to distinguish differences of nationality and it is no illogical optimism to state that their claim to prove consanguinity may prove to be correct. If Jacob had been able to set a scientist to work on Joseph's coat the brethren would have (286) Dead Men Do Tell Tales. 287 been confounded and Reuben, the connivor at deliverance, extra triumphant. Ever since those days the malignant have tried to fix guilt on innocency by spattering the blood of animals on clothes or weapons, but it never can happen again in civilized countries. A little while ago a mother murdered her little girl in a lonely spot and "murder by person or persons un- known" was the verdict. A suspicious neighbor, who dis- liked the woman, took up the search privately and one day found a blood-stained knife near the house. "Why, that's the knife I used to kill a rabbit last week. I put it there in the wall meaning to clean it," cried the mother. Submitted to an expert, the knife told of human blood, blood shed a year ago, and the terrified mother confessed her guilt. It is now over seven years since an Italian physi- cist, A. Lechanarzo, perfected the method of determining the age of a bloodspot. Would Rizzio's blood, said to be renewed every year on the floor of Holyrood Palace, stand an investigation? I think the tourist, enjoying the induced thrill of horror, would rather the scientist kept out of the way! Mutilation of a body is not always effectual, and has occasionally, by its very dexterity, convicted the real offender. A murderous butcher will, naturally, cut up his victim with precision, and a medical student or surgeon would do it in a skillful fashion. The mutilations by Jack the Ripper showed him to have considerable anatomical knowledge. A physical defect, engendered by disease or habit, often guides an expert in detection, but when a man cuts his old father into 130 pieces and buries these separately in garden and field he naturally expects to lull suspicion, especially when he daily expresses surprise that the aged parent does not return from Paris. Six months after the deed a farm hand dug up a hand, no clue apparently, except that a friend, a medico-legal expert, took note of certain callosities in the palm, rather peculiar ones, and soon after begged of the son his father's stick as a memento. The curiously carved knob exactly 288 Davina Waterson fitted the skeleton hand and the son was convicted of the mur- der. In the same way the body of a mutilated nun was identified by the callosities on the knees produced by con- stant kneeling; and Sir William Fergusson proved the identi- ty of Livingstone (though it was hardly doubted) by show- ing an old ununited fracture in the left humerus. The struc- tural deformations induced by occupation, often lead to the identification of a murdered man when he has been, say, a tailor, a barber or a shoemaker, while the condition of the teeth may show the victim to have been a printer or a potter, owing to the plumbism engendered. Now, if a man is found shot through the head and with a pistol in his hand, what more rational than a verdict of suicide? But in real suicide the weapon is held so firmly that force is required to dislodge it. It seems as if the muscular spasm persists until rigor mortis occurs and sets it. Several experts have tried to make the hand of a corpse grip a weapon, but have never succeeded and their knowledge of this fact has often opened the avenue to detection of murder. Again, if you found your grandfather on the floor with a rope round his neck and the other end dangling from a nail in the wall, certainly you would say that he had hanged himself and his weight had broken the rope. But the medico-legalist is as well up in knots as a sailor and knows a suicide will tie them one way, a murderer another. There was a case in Paris of a grandfather who had, apparently, hung himself in the manner described. But he had not tied the rope, declared the expert, and, in face of such uncanny knowledge, two neighbors con- fessed they had from their window seen the son-in-law strangle his father and arrange the other piece of rope. A would-be murderer might advantageously study physiology, i.e. the physiological action of certain substances on the human body and might also, if he intends hiding the corpse, read concerning flora and fauna in the dead. The advice of Moquin-Tandon, sometime professor of Natural History in Paris University, was often asked by legal doctors because he had made a special study of the latter. The body of a little girl was found tightly packed up in a soap box, Dead Men Do Tell Tales. 289 and the mother, when found in another city, tried to fix the crime on a friend and as happening two months ago. It was then the end of July. By a careful study of the flies and larvae found in the remains, the expert proved the body to have been in the box since the preceding February and the mother confessed to having killed the child on February 27th. In the same way the examination of the larvae on the body of a child hidden up a chimney proved death to have taken place fully two years previously, and this verdict led to the acquittal of a suspected person. There are certain fauna which begin their work soon after death, then disappear to give place to others, but the suc- cession is invariable and marks time for the scientist. The different physiologic action of fire on a dead body and a living one was not known by the man who rushed frantically to his neighbors, saying he had found his wife lying across a chair by the fire badly burned from waist to knees and also on the neck. Unfortunately for him the doctor pointed out that burns made before death contained serum and there was no vesication (thin serous fluid under the skin), moreover, the fire could not have passed from waist to throat. The man then confessed to strangling his wife and afterwards setting fire to her. The student who murdered his aged uncle by drowning had clearly not taken chemistry in his studies or he would not have been so confounded when brought to justice. He had wound nine yards of thick lead tubing round the body to sink it. Surely enough? But a little knowledge of chemistry would have made him make a few incisions for the escape of natural gases, as these brought up the corpse in spite of the heavy weight. Lynx-eyed Science is rendering it ever more difficult to dispose of a body or hide the crime of murder. Human blood and hair and bones have characteristics distinctly their own. The "gory knife" of melodrama is no longer sufficient to fix a crime, and even if, as seems possible, the penny novelettist should kill his hero with radium, why, the physicist would come along with the electroscope and with it absolutely refute or confirm the accusation. THE INFLUENCE OF SUBTLE AND UNDETER- MINED FORCES IN THE ESTABLISHMENT, DEVELOPMENT AND MAINTENANCE OF RACIAL CHARACTERISTICS.* By E. S. Goodhue, M. D., L L. D. "There is no chance in results."—Emerson. WHY are children extremely susceptible to many diseases which an adult will hardly acquire on full exposure? So true is this that we have books treat- ing of children's diseases. Nature immunizes or renders susceptible, as the case may be. 12:- And the healthiest subject may contract small-pox, yellow fever, dengue or many of the other diseases which require a prepared soil; a specific soil not necessarily the result of deterioration, temporary or permanent. In a rare little monograph bound in boards, and published in China several years ago, James Cantlie makes some observations and suggestions of great value to students not only of leprosy but of evolution. He recognizes the anomalous diffusion of leprosy, its so-called freaks; its innocuous simulation, but he con- tinues to believe in its contagious nature. He is convinced of this by what he has actually seen in his large ex- perience with leper patients, and as it is with all of us who have seen much of the disease, nothing theoretical can displace the abiding conviction based upon clinical observation. *Continued Irom M»y number, 1914, Alienist and Neurologist. (290) The Influence of Subtle and Undetermined Forces 291 "This tendency to leprosy," says Mr. Cantlie, "can only mean that the children of leper parents have a diathesis; some peculiarity in tissue development, some apparent anatomic structures of the nature of sufferers from congenital syphilis. "All that can be said of this, is, that the development- al lesion has never been noticed or made out. A very important point this would be, and worth investigating. Had the leper a birth-stamp upon him, persons pre- senting it could be guarded against, could be segregated, and there would be hope of arresting the spread of the disease. Is there a leprous diathesis, showing irregulari- ties in anatomic structure, occurring with sufficient fre- quency whereby a person of leprous diathesis can be known?" There is certainly if not a "diathesis" (which after all is a much abused word,) a dyscrasia; a biologic or peripheral susceptibility to inoculation by the germ of leprosy. And this condition supplies the media in which the germs of leprosy will thrive; media we have become acquainted with in the recent investigations of Clegg and Currie of Hawaii. But the results of such investigations only confirm the theory that immunity is due to some subtle and un- determined influences inherent and intrinsic in the in- dividual, for with all the success which is met with in cultures of the leper germ outside of the body of man, and despite the fact that a successful inoculation has probably been made upon a monkey, the human organism remains resistant to successful artificial inoculation. This still leaves the mode of transmission largely in the dark with a wide field for speculation.1 Cases are found in which exposure in the most adequate way has not infected the person concerned, who, a few years later, falls a victim to a slight contact. It has been our error, I think, to suppose these cases to be incubatory. There is no chance for freakish 1. This was written previously to the appearance of Or. W. J. Goodhue's report to the Hawaiian Board of Health, on the surgical cure of leprosy, June IS, 1913. 292 E. S. Goodhue happening in the natural world; all is the result of cause and effect. What seems mysterious is only not understood, and we shall find, no doubt, that when the germ of leprosy is properly introduced into suitable soil, it will grow according to specific laws. It is not according to the working of other laws regulating exposure to disease, to suppose for a moment that the bacillus leprae will remain quiescent in the tissues for ten, twenty and even sixty years, as some authors state. We are led to this conclusion by the difficulty, per- haps impossibility, although that is a large word—of implanting leprosy artificially in the human body. We infer from this that what destroys the leper germ (and some other micro-organisms as well,) in the human body is a biologic force or influence rather than a chemical agent, since successful cultures are now made outside of the human organism. This opinion is strengthened by the fact that bodily resistance is variable, that it is present at one stage and not at another. The failure to recognize this probability gave rise to unreasonable hypotheses regarding the periods of incubation. When a certain person, grossly exposed to disease, failed to acquire it, then at a subsequent period became a victim upon the slightest contact with the same disease, we said that he was infected at the first exposure and has had the disease, lol these sixty years without giving any evidence thereof! But it seems necessary that we should reach truth in a round-about way. We say that this acts so and so, drawing our inconclusive inference. It is only a short time since we found out that yellow fever is spread by the mosquito. Before that we de- clared that its propagation was induced by fomites, yet thought some things very strange: for instance, that the disease did not spread in some directions, to The Influence of Subtle and Undetermined Forces 293 some countries, that it did not travel very far in lines of ordinary exposure. But we were very sure that old clothes and personal contact infected us, and today some of us are just as sure that immunity is merely a matter of chemical action. So long as undetermined forces are not taken into account in the investigation of this obscure matter, so long will men like Jonathan Hutchinson claim that leprosy is due to fish diet, or to some other factor linked by chance or necessity with the disease. A narrow view will yield its distorted perspective; leprosy will be a form of syphilis, a manifestation of tuberculosis, a disease of cold countries, a disease of warm countries, a disease of the sea coasts, and in our effort to demonstrate every detail of the causation and transmission of leprosy and other diseases which are ob- scure, we shall find ourselves farther from solution than when we began. Unless, like philosophers and scientific evolutionists, we acknowledge that there is an undeter- mined force working through all benign and morbid processes, we shall never, I believe, advance very far in our researches regarding the nature of certain diseases or prove very successful in removing them. That the immunity of disease is due to some un- determined and antagonistic factor in the individual, is plain; that this force is due to biologic prepossession is probable; that it may be actinic and chemical is possi- ble. At any rate, it is beneficent and resistive, and in some respects at least, it is analogous to the external reactions which have heretofore prevented the artificial culture of certain mocro-organisms outside of the body, and caused inoculations in the body to be abortive. So far as leprosy is concerned, the recent investiga- tions of Clegg and Currie have determined the con- ditions under which the leprosy bacillus thrives, and the media in which cultures may be made, but have added nothing to our knowledge regarding the immunity of particular individuals to the contagion of the disease. 294 E. S. Goodhue The same rule applies to immunity in connection with other diseases which are extremely contagious for the majority of individuals, and it is quite a question whether immunity in the individual is not a condition of normal health in which resistive and beneficent forces of the economy are not in any way thwarted in their legitimate functioning. At any rate, there is a growing inclination on the part of scientists as well as clinicians, to recognize that psychic impressions, however obscure, and so far as we are able to demonstrate, unprovoked by ordinary stimuli, are yet potent factors in biologic deviations; that such deviations may result in acquired characters and these in turn become congenital. The whole result becomes an imperative Tendency, a determining and constructive as well as obstructive force, equal to almost any morbid invasion, provided it is assisted in its work by the proper influences outside of the body. Any dwarfing or thwarting of such forces, intrinsic or extrinsic, any neutralization of the co-efficient, opens the door to morbid processes, gives the key to disease, and allows of degenerative changes which may ruin the individual as well as the race. It is my opinion that the resistive forces and the co-ordination of intrinsic and extrinsic influences are impaired by the exposure of the body to disease. I believe that there are no grounds to assume that the im- pairment occurs first and that the invasion of disease follows. The deterioration of nations and races of men has been laid to the prevalence among them of some diseases like malaria or hookworm. It may be granted that in the individual the existence of particular diseases like malaria and ankylostomiasis, is productive of destruct- ive physical and biologic changes, but a compensatory process soon arises, and the autonomy of the race is saved by this provisional reaction. The Influence of Subtle and Undetermined Forces 295 It is claimed that Greece went down because of the prevalence of malaria within her borders. But we find that malaria had always existed in many sections of Greece; that it was not more extended or prevalent during her misfortunes than it had been while she was at the height of her glory. In fact, the disease bears no relation whatever to the historical events of the country. After the decadence of the Greeks, due to various causes, there remained no individuals to redeem the race, even in districts where malaria did not prevail, and which malaria had not previously affected. The decline of the Roman Empire has been attributed by several writers to the decadence of morals, to luxury, idleness, effeminacy among the people, but there seems to be no reasonable groun