1 likes principle of Suprareal PRACTICALLY EVERY FORM OF HEMORRHAGE ENCOUNTERED BY PHYSICIAN AND SURGEON. Its remarkable potency, broad usefulness, prompt action, and freedom from untoward results, stamp ADRENALIN as one of the most notable agents in the materia medica. Supplied in solution (ready for usel, 1 part Adrenalin Chloride, 1000 parts normal salt solution- In ounce glass-stoppered vials. LITERATURE ON REQUEST. Adrenalin chloride, Ipert Bormal sodium chloride solu- tice (with 0.% Chloretone), 1000 parte PARKE, DAVIS & CO. DETROIT, MICH. V. $. A. ACETOZONE 1 OUNCE ACETOZONE POWERFUL GERMICIDE AND INTESTINAL ANTISEPTIC. (CH:CO.O.O.COCH) ANTISEPTIC The contents of this package consist of po ke dilated with an equal weight of the best powder. derlesobe bu proved very satisfactory wim wake, but it serpected that Jus chlet in in the treatmeot of ENTERIO DISTANTA Melu to dom, ele., e enclosed literature. Aortance is very readily decompound, solo patie mest exercised to prevral deler Do place la vicinity of a steam pipe, , der bested object. ff beared to boiling wat we a explosion may result. Avold contact with bure escept when dlapenned. In maklop lelies Khaone, alechol, klycerio kod other puke malasot should not be employed. PARKE, DAVIS & CO. DETROIT, MICH... V. S. A OF MARKED VALUE IN TYPHOID FEVER CHOLERA DIARRHEA TONSILLITIS DYSENTERY GONORRHEA PUERPERAL FEVER MALIGNANT EDEMA and other diseases of like origin in which the source of infection can be reached by the solution. In the opinion of many physicians Acetozone is the most remarkable antiseptic ever brought to the attention of the profession. Sapplied in ounce, half-ounce and quarter-ounce bottles; also In vials of 15 grains each, 6 vials in a box. WRITE FOR BOOKLET WITH CLINICAL REPORTS. The Alienist and neurologist co. þW, ENG EANS, KANSAS FAL, QUE.; PAN. '0 I O) "Quantam ego quldem video motus morbosl fere omnes a motlbus In systemate nervorum ita pendent ut morbl fere omnes quodammodo Nervosl dlci queant."—CULLEN's NOSOLOGY: BOOK II, P, 18X-EDIN8URO ED., 1780. Scientific, Clinical and Forensic NEUROLOGY AND PSYCHOLOGY, PSYCHIATRY AND NEURIATRY. Intended Especially to Subserve the Wants of the General Practitioner of Medicine. THE A JOURNAL OF VOLUME XXVII. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGHES, M. D., Associate Editor. HENRY L. HUGHES, Manager and Publisher. 387a Washington Boul., ST. LOUIS, MO. 10O6. CONTRIBUTORS AND COLLABORATORS. TO VOLUME XXVII. HARRIET C. B. ALEXANDER, Chicago. ALBERT S. ASHMEAD, New York. EDWIN LEWIS, DAVID S. BOOTH, C. WERNICKE, JAS. G. KIERNAN, New York. St. Louis. Breslau. Chicago. HAVELOCK ELLIS, Cornwall, Eng. C. H. HUGHES, MARTIN W. BARR, L. W. WEBER, St. Louis. Elwyn, Pa. Gottingen. MARC RAY HUGHES, E. TROMMER, St. Louis. Hamburg. CHARLES EMERSON 1NGBERT, Independence, Iowa. T. D. CROTHERS, Hartford, Conn. Index. iii INDEX. ORIGINAL CONTRIBUTIONS. A Case of Reflex Epilepsy 301 Adolescent Insanity (Dementia Prae- cox _ 249 A Morphiamaniac on Trial for Mur- der—A Medico-Legal Study of the Matthews Case 328 Coitus Interruptus and Coitus Re- servatus as Causes of Profound Neuroses and Psychoses 397 Erotic Symbolism 47 Erotic Symbolism _ 142 Erotic Symbolism 305 Erotic Symbolism 414 Further Views of the Virile Reflex ... 14 Genius and Degeneration 1 Illinois Legal Procedure in Mar- riage Annulment for Prior In- sanity „ 428 Is Specialism a Psychic Advance or a Retrogression? 438 Legal Aspects of Epilepsy 170 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics 40 123 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics 291 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics 461 Psychoencephalonasthenia or Cere- brasthenia Simplex, and Psy- choencephalonasthenia or Cere- brasthenia Insaniens 156 Psychoencepthalonasthenia or Cere- brasthenia Simplex, and Psy- choencephalonasthenia or Cere- brasthenia Insaniens 282 Psychiatry and Neuriatry in the Medical Press 452 Railway Brain Strain of and Brain Strain Regulation of Railway Employees 189 Relations Between Physical Diseases and Mental Disorders 19 Rodonalgia Phalanx or Phalanges or Finger Erethromelalgia with a Theory of Causation 60 Sadism—Report of a Medico-Legal Case 341 Society and its Degenerates 63 Some Psychological Studies in Man's Moral Evolution 474 238142 iv Index. The Non-Reason Founded Phobias of Neurasthenia 407 A Foolish Clergyman—A Miscon- ception of St. Louis Corrected.... 71 A Notable Honor Merited by a Notable Man 72 A Sadistic Erotopath—The Neglect of Duty by Public Officials 75 A Nightmare Suicide—Railway In- humanity—Pullman Palace Car Crime against Nature 201 An American Institute for Psycho- logical Research is Projected for America—Oklahoma Insane Asylum Burned—The Moro Im- molation Psychologically Con- sidered 362 An Unjust Judgment Against a Physician—A Possibly Justifi- able Error in Diagnosis Pun- ished by Law 206 All Minds Look alike to the St. Louis Police—The Bicycle and Auto-Motor Brain 481 A Sound Patriotic Psychology 480 Automobile Delusion —Lay Evidence as to Insanity 208 British Medical Association—Medal of Honor for L r. Mangan — Trephining in Epilepsy 486 Chicago Beef Packing Rottenness ... 354 Congressman Brownlow's Bill— Characteristic of the Doctor's Charity, and Likewise of the Other Fellow—Terrible Railroad Fatality 359 Collier's Weekly :365 Death in the Palace Car 484 Diseases in the Street Car Strap- Capturing a Murderous Maniac Woman 211 The Training of Mentally Defective Children 274 Dr. George T. Tuttle—Cajal and the Development of the Nervous System 353 Euthanasia 210 Fools Not All Dead Yet 487 Instances of Psychic Cause Blind- ness 363 Le Progres Medical—Proprietaries and the Proprieties 207 Longevity Among Harvardians— Sensible View of a Newspaper on Psychotherapy 4^8 Marriages by the Insane—Two Cases for Euthanasia 209 Military Interference with National Army Sanitation 483 "On to" the Germ Theory 217 Personal Commendation of a Worthy Medical Insane Hospital Super- intendent 204 Pertinent Protest Against Overstudy —If Lower Ceilings and Patent Fixtures 360 President Roosevelt on the Physician 67 Prognosis in Epilepsy 351 Proprietary Medicine Men Against Alcohol and Narcotics in Prepa- rations — The Medical News, New York 77 Proprietary Prescribing 485 Psychopathy in the Sanctuary—Phi- lanthropy and Applied Science ... 205 Railway Validating Tyranny 482 Remarkable Public Press Statement —Hospital Provision for the In- sane and Delirious—Missouri's New Prison Hospital—A Negro Saved from Mob Becomes In- sane 361 EDITORIALS. Index. v Sadism in an Alpine Church Sexton Sanitary Honesty—The Discovery of Ether Anaesthesia Once More —The Other's Fellow's Point of View Seismic and Other Lunatics and Fanatics in Russia—The Persist- ing Peril of the Once Homicidal Insane Street Noises St. Louis Doctors and their Work... The American Journal of Clinical Medicine The Citizens of Memphis—A Fool with a Foolish Dinner—In View of Recent Life Insurance Reve- lations The Crime of Fatal Euthanasia The Errors of Lombroso on Moral Insanity and Crime.—Also a Word on Tattooing and Wrin- kles The Fifteenth International Medical Congress—The Merit of Ameri- can and European Medical Col- IN Dr. Emmet Cooper Dent The Annali Dell Instituto Pasichia- 490 I - leges Contrasted Favorably to American Institutions 73 The Hazing Neuropath and Col- lege Circumspection—The Mc- Naughton Case 215 The Iowa Euthanasia Proposition ... 357 The Japanese Admiral Togo-Just a Sample 213 The Mental Twist in Union Labor Leaders' Heads 212 The Metroneurotherapy or Metro- therapy of Neurasthenia 358 The Morbid Imagination 479 The National Druggist 364 The New Hospital for the Insane— A Typical Apparently Nocturnal Epileptic Automatic Homicide... 491 The Proprieties and the Proprie- taries 356 The Surplus Funds in the Treasury —Congres International Pour L' Assistance Des Alienes 218 The War on Tuberculosis 74 The World's Work 78 MEMORIAM. 79 I trico Dell Universita Du Roma. 80 I Solomon Claiborne Martin, M. D ... 220 355 489 200 219 69 70 216 SELECTIONS. Clinical Neurology— Albumin and Sugar in the Urine 497 A Very Curious Form—Torticollis Hystericus —Eyes and Ears that Might be Saved; An Appeal to the General Practitioner 96 Barometric Neuroses 366 Blood of Epileptics 224 Bright's Disease in High Official Circles at the Nation's Capital —The Neurotic Character of Enuresis 98 Cerebral Paralysis from Embolism, Thrombosis Hemorrhage—Curt Adam, of Berlin 494 Essential and Paroxysmal Tachy- cardia............ 92 Habit Spasm in Children 222 Locomotor Ataxia and Syphilis— Cerebellar Tumor .... - 221 Neuritis Acustica from Influenza 97 Neurasthenia Among the Working - Classes—Acromegaly 95 vi Index. Sudden Starting from Sleep—Cardio- pathy Insomnia—Treatment of Increased Blood Pressure in Arteriosclerosis—The Pancreas and Diabetes 368 The Psychology of the Tuberculous . 493 The Reflex of the Tendo Achillis 93 Two Unusual Epileptic Histories 367 Tic Douloureux 495 We Learn 94 Clinical Psychiatry— Classification of Insanity 499 Luther's Headache and Delusion of the Devil 84 Paretic Dementia and Syphilis— Methods of Caring for Insane.... 227 Progress of Municipal Nursing of the Poor 498 Temple Sleep 85 Tombstone and Candle Powders 86 Vagina Foreign Bodies in the In- sane 226 Neurophysiology— A Review of the End Results in Cases of Exophthalmic Goiter Treated Surgically — Localiza- tion of the Motor Functions in the Spinal Cord 377 Biological Theory of Sleep—Regen- eration of Nerves 83 Do Central Tracts of the Nervous System Regenerate? 376 Neurone Contact, etc 84 Respiratory Movement of the Bron- chial Tubes 232 The Seminal Secretion as a Source of Albuminuria 500 Neuroanatomy— A Brighter Outlook for the Doctor —Less Tippling than Formerly ... 283 The Solar Plexus and Atonic Dys- pepsia 382 Neuropathology— More Autopsies in Epilepsy 225 Neuritis of the Abducens, Accessory and Hypoglossus Consecutive to Influenza 382 "Under the Weather" 86 Neurotherapy— Acetanilid Poisoning from the Use of Proprietary Headache Powders—Acetanilid Poisoning from Bromo-Seltzer—A Fatal Case of Veronal Poisoning 502 Blue Light Anaesthesia — Climate for the Aged 90 Death Following Scopolamine-Mor- phine Anaesthesia—Recreation in its Effects upon the Nervous System 87 Dietary Control of Basedow's Disease 505 Horse Nettle for Epilepsy 372 Lumbar Puncture and Circumscribed Meningitis—In his Address 503 Old Age and Disease, Metchnikoff.. 8s Spinal Anaethesia by Magnesium Sulphate 370 Treatment of Tetany—The Value of Nitroglycerin 228 The Therapeutic Value of Static Electricity —Sensible Ophthal- mologic Advice—Good for Neu- rologists as well—Osmic Acid, Alcohol and Formalin Treat- ment of Trigeminal Neuralgia ... 231 The Amount of Acetanilid in Bromo- Seltzer 232 The Therapeutic Value of Mastica- tion 371 Treatment of Graves' Disease—Un- pleasant Effects of Veronal 375 Index. vii Neuro-Surgery— Surgical Operations Upon the In- sane 226 Neuro-Symptomatology— A New Eye Symptom in Exophthal mic Goiter 500 Neurodiagnosis— Tooth and Nail Corrugations 225 Nasopharyngeal Secretioni 369 Pathology— The First Autopsy in Montreal 91 REVIEWS, BOOK A Compend of Operative Gyneco- logy—The World's Anatomists; Concise Biographies of Ana- tomic Masters—The Transac- tions of the Sixth Annual Meet- ing American Roentgen Ray Society 388 A Primer of Psychology and Mental Disease — Physiology of the Nervous System 234 A Text Book of Sociology—Diseases of the Nervous System Result- ing from Accident and Injury.... 235 Charities and the Commons 113 Checkers—The Proceedings of the American Medico-Psychologi- cal Association lie Christianity and Sex Problems no Criminal Responsibility 105 Handbook for Attendants on the In- sane — 109 Official Manual of the State of Mis- souri—A Medical Pilgrimage to the Republic of Panama 389 Psychiatry— Dr. J. T. Searcy 37g Study of Psychiatry—The Vicious Insane 380 Psychology— Inaccuracy in Observation 501 Preventive Psychiatry— Incipient Insanity 101 Therapy— Intermenstrual Pain —Eumydrin in Alimentary Tract Neuroses 224 NOTICES, ETC. Perjury for Pay 237 Poker Jim, Gentleman 390 Practical Massage in Twenty Les- sons—Taylor's Physicians Ac- count Books in Psychiatry—a Text Book for Physi- cians 107 Rhythmotherapy S°9 Studies in the Psychology of Sex— A Treatise on the Motor Ap- paratus of the Eyes 507 The Nervous System of Vertebrates 508 The Era Key to the U. S. P-VV.B. Saunders & Company—Around the World via India.. 104 The Management of the Nerve Pa- tient 106 The Natural Laws of Sexual Life 385 The Section of Neurology, Psychia- try and Criminal Anthropology.. 387 THE Alienist and Neurologist. VOL. XXVII. ST. LOUIS, FEBRUARY, 1906. No. 1. GENIUS AND DEGENERATION. By H. EDWIN LEWIS, M. D., New York City. THE normal mind of a human being possesses certain attributes which permit the exercise of co-ordinate thought. These attributes or faculties are: 1st. Consciousness, which precedes all thought phe- nomena and renders the individual appreciable of himself and his relation to the external world. 2nd. Attention, which makes the individual cognizant of surrounding objects. 3rd. Observation, which enables the individual to note and discriminate the specific character of different objects. 4th. Conception, which gives the individual the power of recognizing the logical significance of objects. 5th. Memory, which enables the individual to retain (1) 2 H. Edwin Lewis. the impressions derived from stimulation of the foregoing faculties by external objects. And 6th. Judgment, which gives the individual the power of correct deduction and adaptation of the impres- sions resulting from normal observation and conception. Incidentally, it should be understood that all these fac- ulties are materialistic in their impressions, and study of psychic phenomena shows that they can never be anything else. The actual existence of things alone can stimulate them, and as a result the normal mind is always material in its estimation or expression. Complete failure, or perversion of one or more of the essential faculties of the normal mind, presents an ab- normal condition and places the individual so afflicted be- yond the pale of sanity. Such aberration may not be suffi- ciently pronounced or prolonged to constitute the extreme unquestionable condition of insanity. Indeed there are in- dividuals, not ordinarily considered insane, who neverthe- less present deviations of mentality which are only thought to be the result of eccentricity, moral perversion, or errors of judgment. The alienist and student of psychology, however, recognizes such individuals as quite within the borderland of insanity, and it is with one of these phases of what for lack of a better term I have called indefinite alienation that this paper has to deal. I refer to the anomalous faculty of genius. In order to make myself clear and prevent any misunderstanding of what I may say later on, permit me to define what I mean by a true genius. I refer to those individuals who possess unusual development of some special mental faculty which assumes an original and startling method of expression, and which usually exists at the expense of normal cogency of thought and action. Such expression may manifest itself in connection with some extraordinary gift for mathematics, music, paint- ing, sculpture or poetry, or it may assume extreme devel- opment of the memory or will. In whatever form it is ex- pressed, the unique character or originality of the product depicts the genius. It should be remembered, however, Genius and Degeneration. 3 that originality means the first copy, and the thoughts or products of a genius have no prototype. They may be copied, but they are no copy. In other words they are outside the rational circle of cause and effect. Genius and talent are often confounded and used as synonymous terms, but they bear no relation to each other. Genius is the capacity for spontaneous imagination, or imagination de novo, and is therefore unreal. Talent is simply skillful technique applied to material or pre- existing things, and is essentially real. It is proper to speak of the genius of Poe. Whitman, Wagner, Rembrandt, or Beards- ley, or the talent of Shakespeare, Tennyson, Goethe, Holmes, Gounod, Beethoven and Bonheur. Careful study of the prod- ucts of these two classes will demonstrate the grounds on which I make a distinction between talent and typical genius. On the one hand we have originality in the lit- eral sense of the word, the evolution of products which have no prototype, the direct result of a spontaneous ideal- ity. On the other hand we have reproduction of actuali- ties, the demonstration of highly developed perception and observation. The factor of ideality so far as it is original is absent and in its place we find simply skillful expression. In the sense in which 1 consider genius it is an evi- dence of an unhealthy mental state. At any rate, the more we investigate the subject, the more in sympathy we become with Seneca's well known statement that "there is no great genius free from some tincture of madness". The process of normal mentality is such that thoughts are in- variably material in their expression. The very nature of thought itself, owing its inception to the impulses of ma- terial sensations, dictates that normal imagination should always take the guise of remembered things. Spontaneous or original ideation, cannot take place in the normal mind, for all the psychic factors leading up to this function of the mind are so intimately connected with the memory of ma- terial stimuli, that the imagination cannot separate itself from the causes of past sensations. In other words, the simul- taneity of thought with past and present stimuli is such, that its normal expression must always be in terms that 4 H. Edwin Lewis. memory alone can supply. Of still greater significance in the study of individual geniuses and their products is the fact that anomalous ex- pression is not the only manifestation of degeneration or alienation in these unfortunate individuals. Indeed, many anomalous products might be attributed to poetic or artistic license but for the additional evidences of mental alienation shown in the characteristics and lives of those in whom the world recognizes typical genius. The principal symptoms manifested by real genius, in addition to general illogical expressions, are egoism, eroti- cism, incoherence, megalomania, and the senseless repetition of words or sounds in the writings; inversions, distortions and contradictions in the created products; sensualism, hal- lucinations, delusions, and perversions in the mental char- acter; and the physical defects of the individual himself. Not all these symptoms are present at the same time in those afflicted with genius, nor are they equally prominent in all cases, but there is nearly always sufficient variation from normal standards in every true genius to warrant the diagnosis of mental degeneration or perversion in al- most every instance. In order to look at this subject in its more concrete aspects, let us consider some of those individuals to whom the term genius can properly be applied. Edgar Allen Poe can properly be classed as a genius. His poem "The Ra- ven" especially, illustrates the faculty of original ideation to a marked degree. In this particular poem the thought ex- pressed is originally imaginative and as a consequence dis- tinctly unreal. It represents something that does not nor could not exist and herein lies the genius, for the thought describes nothing but a pure creation of Poe's mind with no material basis for its logical conception. The same is true of the thoughts in the "Bells" and many other of his poems. The meaningless repetition of words and sounds in Poe's poems is especially noticeable, and a tendency to play on words, many times at the sacrifice of coherent thought, is a common defect of his work. Thus is shown a signif- icant symptom often observed in certain well defined phases Genius and Degeneration. 5 of mental alienation. If any doubt exists as to Poe's mental degeneration, one has only to consider the man himself; kind and sym- pathetic when himself, but very often the victim of dipso- mania at which time his whole mentality became stultified by his appetite. Devoid of moral principle, and will pow- er, Poe was a creature of impulses, occasionally good, but too often bad, a sad mixture of contrasts. Judged by his genius, the character of much of his work, the frequent in- coherence o his thoughts and his all too evident moral weakness and turpitude, Poe's mental degeneracy cannot be questioned. That his writings are interesting no one can deny, but their chief interest, aside from the in- dividual technique of the writer, comes solely from their strangeness, their outre character and the weird, illogical conception of the impossible. Let me briefly call attention to the following stanzas from The Raven. But the raven still beguiling all my sad soul into smiling, Straight I wheeled a cushioned seat in front of bird and bust and door; Then, upon the velvet sinking, I betook myself to linking Fancy unto fancy, thinking what this ominous bird of yore, What this grim, ungainly, ghastly, gaunt and ominous bird of yore Meant in croaking "Nevermore." Thus I sat engaged in guessing, but no syllable expressing To the fowl, whose fiery eyes now burned into my bosom's core; This and more I sat divining, with my head at ease reclining On the cushion's velvet lining that the lamplight gloated o'er, But whose velvet, violet lining the lamplight gloating o'er, She shall press, ah, nevermore. Then, methought, the air grew denser, perfumed from an unseen censor Swung by Seraphim whose footfalls tinkled on the tufted floor. "Wretch!" I cried, "thy God hath lent thee By these angels he hath sent thee Respite—respite and nepenthe from thy memories of Lenore: Quaff, O, quaff this gentle nepenthe, and forget this lost Lenore," Quote the raven "Nevermore."' 6 H. Edwin Lewis. And the raven never flitting still is sitting, still is sitting On the pallid bust of Pallas just above my chamber door; And his eyes have all the seeming of a demon's that is dreaming; And the lamplight o'er him streaming throws his shadow on the floor; And my soul from out that shadow that lies floating on the floor, Shall be lifted, nevermore; The thoughts expressed are not mere metaphor or in- tentional personifications: they are rather the skillfully ex- pressed aberrations of a perverted mentality almost if not quite hallucinatory in conception. The combination of con- crete, material thought with the symbolic ideas of the writ- er demonstrates his mental weakness. Note especially the material wheeling of a cushioned seat in front of a mythic- al raven, and still further the placing of a symbolic shadow on the floor. I realize that the Raven is considered an ex- pression of a beautiful symbolism, but I maintain that the aberration of Poe is amply shown by his material description and placing of imaginary creations. In the following lines from "The Bells" note the ver- bigeration, and the rhyming of assonances through the use of words which have no logical connection. Unnecessary and senseless repetition is also marked. * Hear the tolling of the bells—iron bells; What a world of solemn thought their monody compels: In the silence of the night. How we shiver with affright, At the melancholy menace of their tone; For every sound that floats From the rust within their throats is a groan: And the people—ah, the people— They that dwell up in the steeple, all alone, And who tolling, tolling, tolling In that muffled monotone, Feel a glory in so rolling On the human heart a stone— They are neither man nor woman— They are neither brute nor human—they are Ghouls: And their king it is who tolls: And he rolls, rolls, rolls, rolls, A peaen from the bells: And he dances and he yells; Keeping time, time, time, Genius and Degeneration. 7 In a sort of Runic rhyme, To the throbbing of the bells: Of the bells, bells, bells; To the sobbing of the bells; Keeping time, time, time, As he knells, knells, knells, In a happy Runic rhyme, To the rolling of the bells— Of the bells, bells, bells, To the tolling of the bells, Of the bells, bells, bells, bells, Bells, bells, bells— To the moaning and the groaning of the bells. Another writer, Walt Whitman, comes under my class- ification of genius. The life, writings, and everything we know about him whom O'Connor with maudlin sentimentality has called "the good, gray poet", shows that he was the victim of meg- olomania, erotomania, hallucinations, delusions and all the other evidences of an unsound mind. He was a vacillator in everything he undertook and was successively typographer, teacher, soldier, carpenter and jointer, and finally a clerk in a government office in Washington. His restlessness, changeability of occupation, and constant desire to be moving on well showed his men- tal instability. In his writings we find the strongest testimony regard- ing his mental degeneration and alienation. His methods of expression are unique and well illustrate the condition of "prose gone mad". They have no coherence, they are bom- bastic to a degree, full of contradiction and absolutely de- void of logic or intelligent conception. Hardly a line of his writings but what shows eroticism, delusions of grandeur, and the disconnected verborrhea of the typically insane. As Nordau still further says, some of his ebullitions are erotic pro- ducts so shameless and perverted that they have no counter- part in literature. Under the veil of mysticism, he has written on many varied topics, but the mysticism is only the result of mental obscuration and indefiniteness. The following selec- tion is typical of Whitman's genius. „ 8 H. Edwin Lewis. "Who has gone farthest? For I swear I wil go farther; And who has been just? For I would be the most just person of earth; And who most cautious? For I would be more cautious. And who has been happiest? O, I think it is I: I think no one was ever happier than I; And who has lavished all? For I lavish constantly the best I have; And who has been firmest? For I would be firmer; And who proudest? For I think I have reasons to be the proud- est son alive—for I am the son of the brawny and tall-top city; And who has been bold and true? For I would be the boldest and truest being of the universe; And who benevolent? For I would show more benevolence than all the rest; And who has projected beautiful words through the longest time? By God! I will outvie him! I will say such words, they shall stretch through longer time; And who has received the love of the most friends? For I know what it is to receive the passionate love of many friends; And who has been given the sweetest from women, and paid them in kind? For I will take the little sweets and pay them in kind; And who possesses a perfect and enamoured body? For I do not believe anyone possesses a more perfect or enamoured than mine; And who thinks the amplest thoughts? For I will surround those thoughts; And who has made hymns fit for the earth? For I am mad with devouring ecstacy to make joyous hymns for the whole earth!"* These senseless jumbles of words would hardly be worthy of consideration but for the fact that so large a num- ber of admirers profess to see in Whitman's work not only the work of a genius, but the dawn of a new philosophy. Many definite examples of Whitman's aberrant and per- verted ideas might be given, but their unhealthy character is so given and so indicative of mental degeneration, that it hardly seems possible that people of normal mental acuity can consider them seriously. In regard to musical geniuses, Richard Wagner is the extreme type. His life and writings show at once that •From Leaves ol Grass. Genius and Degeneration. 9 his mind was aberrant. What we know of his character indicates that he was subject to delusions of grandeur, per- secutions and belief; that he was unstable in his thoughts and deeds; and a creature of contrasts and contra- dictions. In his writings we note incoherence, ran- dom and inverted verbiage, useless repetition of words and sentences, mysticism and specific evidence of sexual per- version. The evidences of mental inversion are especially marked when we stop to analyze the majority of his state- ments and ideas. In Wagner's musical creations, especially those of lat- er life, we find the same incoherence, the same inattention and random expressions. His conception of harmony and melody must have been decidedly vague, and it is generally conceded by students of musical science that his capacity for melodious composition was slight. His inattention has resulted in indiscriminate combinations of musical sounds that cannot fail to offend the normal ear, inasmuch as they express no definite emphasis nor conclusion. Wagner has styled these unfinished products, "unend- ing melody." This illogical conceit perhaps more than any thing else shows Wagner's mental alienation. It is in keep- ing with his other vagaries. Many other reasons for be- lieving him mentally unsound might be brought forward, but it is sufficient to say that study of his life, character and all his productions, literary and musical, in the light of psychopathic knowledge leaves no alternative belief than that Wagner assuredly belonged to the class to which Lom- broso has so aptly applied the term "mad genius." In regard to the genius of Rembrandt and of Beardsley, little need be said except to call attention to their product- ions. The strange outre arrangement of the shadows in Rembrandt's pictures are characteristic of [them all. They nearly all show an aberration of attention and depict a unique illustration of mental inversion. Beardsley's grotesque creations in black and white were for a time admired by faddists, but they have been relegated t" oblivion by a general recognition of their ridiculous, absurd character. They never gave evidence of anything else than a pervert- 10 H. Edwin Lewis. ed conception of form, and an inability to grasp the details of perspective and linear reproduction. All these examples of genius give us definite symptom* of mentality gone astray. The type of aberration has not assumed the complete character of insanity, but is simply demonstrated by disordered conceptions, illogical opinions and varying degrees of oddity. That these conceptions, opinions and oddities are expressed in new and startling terms follows naturally, inasmuch as they have usually no rational con- nection with actualities. Let me attempt to prove my contention a little further by showing the more logical character of products which show talent instead of genius. Poetry or prose the result of normal mentality always shows a clearness of ideas, and a consistency in their ar- rangement. Certain degrees of metaphor, simile and figurative ex- pression are proper, but they must always stand in defi- nite, comprehensive relation to facts and cogent thought. Every word used must fill a definite place in normal thought expression, and repetition of words or ideas, must always serve to emphasize, explain or give force to a main thought, or the repeated portion becomes weak and vapid. It is not necessary to quote from Shakespeare, to show his lucidity of thought or his wonderful capacity for obser- vation and correct deduction. His works are too familiar and the logic of his ideas is too apparent to require any argument in their favor. But to further illustrate my conception of real, normal poetry let me quote the following short poem by Tennyson. Crossing The Bar. Sunset and the evening star, And one clear call for me! And may there be no moaning of the bar, When I put out to sea. But such a tide as moving seems asleep, Too full for sound and foam, When that which drew from out the boundless deep Turns again home. Genius and Degeneration. 11 Twilight and evening bell,' And after that the dark! And may there be no sadness of farewell, When I embark. For tho' from out our bourn of Time and Place The flood may bear me far, I hope to see my Pilot face to face, When I have crossed the bar. Note the metaphors and figurative expression, but ob- serve that they are all material and substantial in their conception. The following lines from Holmes' matchless poem "The Chambered Nautilus" still further illustrate my idea of healthy poetry. "Thanki for the heavenly message brought by thee, Child of the wandering sea, Cast from her lap forlorn: From thy dead lips a clearer note is born Than ever Triton blew from wreathed horn: While on mine ear it rings, Through the deep caves of thought I hear a voice that sings. Build thee more stately mansions, O my soul, As the swift seasons roll! Leave thy low-vaulted past! Let each new temple, nobler than the last, Shut thee from heaven with a dome more vast, Till thou at length art free, Leaving thine outgrown shell by life's unresting sea!'' In considering the art of painting, it is apparent that nearly all the mental faculties are employed in the evolu- tion of normal products. To be logical a picture must have visible or remembered forms and conditions for its basis. It must be a more or less literal reproduction of something that is or was. In other words it must be the specific con- crete result of something seen in its normal relation to nat- ural laws. The pictures of Bonheur, Reynolds, Alma Tad- ema, Sargent and many others amply demonstrate the healthy character of a real intelligent talent for painting. In regard to music the same thought holds true. It too, must have a material basis and represent the evolution of thoughts stimulated by material things. Primarily music is 12 H. Edwin Lewis. recitative, but under the influence of emotional cadences, it becomes euphonious and when the cadences have a rhythmical sequence they assume the character of true har- mony. A comparison of the music of Gounod, Schuman, Chopin, Beethoven and other normal musicians with the music of Wag- ner, Liszt and others of this class, demonstrates far better than any words of mine, the infinite difference between the normal and the abnormal in musical expression. A careful consideration of the foregoing, therefore, just- ifies the belief that a genius is a degenerate, inasmuch as he is abnormal in certain phases of intellection at least, and what he says or does, so often partakes of the same ab- normality. Closer study will demonstrate in almost every instance a pathological basis for the expression of genius as I have considered it. The degree of the organic disease of the brain which precedes and causes the development of genius is indeterminate, but its presence can scarce be doubted in the face of other composite signs of mental alie- nation. Alienists and neurologists recognize the stigma of genius, and understand the influences of heredity, en- vironment and accidental conditions like diseases and injury on the production of those psychopathic vagaries which the true genius invariably shows. In conclusion, let me voice an earnest plea for the cultivation of more healthy tastes in our literature, art and music. The wonderful progress that has been made in all branches of science, should have a developing influence on all mentality, and to quote Nordau, "the course of develop- ment is from instinct to knowledge, from emotion to judg- ment, from rambling to regulated association of ideas. At- tention replaces fugitive ideation: will, guided by reason, replaces caprice. Observation then, triumphs ever more over imagination and artistic symbolism." Let us train our young, then, to prize personal obser- vation far above the ramblings of imagination, the study of objects and actualities far above the distorted figments of dreams and hysteria. For the betterment of us all let us give to the talented every assistance and every approbation, but to the genius nothing but pity and commiseration. His Genius and Degeneration. 13 work is false, illogically conceived and ever harmful in its influence. In Shakespeare's words "Dangerous conceits are in their nature, poisons, Which at the first, are scarce found to distaste; But with a little act upon the blood, Burn like minesof sulphur." As a physician constantly being brought in contact with psychopathic tendencies all too frequent in their occurrence, I wish to emphasize as 1 leave the subject this all important fact, that minds to keep healthy must feed themselves on healthy literature, art or music. Such healthy products must have no hysteria, perversion nor symbolic sensualism in their fabric, but they must instead measure up to nor- mal standards of logic, morality and realism. They must mean for each individual progression and not retrogression. Otherwise they will certainly continue the vicious influences which produced them, and whether these influences lead to the scintillations of genius, or the gibberings of insanity, the significance will be the same—mental degeneration. FURTHER VIEWS OF THE VIRILE REFLEX.* By PROF. CHAS. H. HUGHES, M. D. ST. LOUIS. IF you suddenly stretch the foreskin or grasp and pull the glans penis towards the umbillicus of a virile individ- ual, you will discover a sensible downward jerk of the or- gan and if you place one or two fingers of the other hand on the dorsum of the member you will detect by the sense of touch the downward retraction as plainly as you may see the plantar and toe reflexes after suddenly stroking your finger tips across the sole of the foot or metatarsal region. Both these reflexes are normally downward. Or, if holding the organ slightly tense by grasping the glans penis around the corona and gently pulling toward the umbillicus, you slap the inside of the thigh or sharply stroke upward with the finger tip the inguinal region over Poupart's ligament and the transversalis abdominus muscle or if you forcibly pinch up the perineal integument or the perineal scrotum, you will elicit the same downward re- traction of the virile organ; appreciable to sight, but more so to the sense of touch; or if you suddenly tap the glans with some degree of force, the organ being rendered slight- ly tense, this downward jerk may be felt, even down to the perineal portion of the organ. The compressor urethrae contracts and the bulbous urethra enlarges, the dorsal and muscular branches of the pudic nerve seem to re- ceive and transmit the dorsal impression and return the peripheral impression transmitted into action, in a true re- flex manner, in which the compressor urethrae and the bul- bo cavernous portion of the penis participates when the •Read before the Section of Neuropathies. Mental Maladies and Criminal Anthro- pology, al the Madrid International Medical Congress, In April. 1903. 14 Further Views of the Virile Reflex. 15 organ is erectile. And it may be easily elicited when the organ is not in an erectile condition. Erection is second- ary, resulting from penile excitation and not necessary to the display of this sign of virility. This is a true penile reflex, a true penis jerk, a true sign of virile intactness. The jerk is plainly backward and downward as the knee jerk is upward with a healthy spinal cord. It is not an erection but a retraction, like that of the gullet reflex, a downward and backward jerk. There need be no erection accompanying this phenomenon and usually is none, though erection may come on during its excitation. It is more active in the erectile state of the organ and may be less active after a normal erection has been physiologi- cally exhausted. It is in no sense a penis erection phe- nomenon, though absent, when power of erection is absent or lost from genuine organic impotency and in feeble and in some conditions of psychic impotence. To determine its precise value in psychic impotence and the genital weak- ness of sexual neurasthenia, demands more thorough study before absolutely positive conclusions can be reached there- on. 1 have seen it absent and very feeble in persons who subsequently regained power, especially in sexual neuras- thenia, in the prostration of typhoid convalescence and in two of the spurious forms of tabes dorsalis, i. e., sexual ex- haustion tabes. This sign is of obvious importance in questions of criminality connected with supposed rape. I have also seen the knee jerk absent and recovered from, in post malarial tabes dorsalis and grave forms of malarial toxhaemia. This downward jerk may be elicited by frictioning the glans for awhile by rubbing it with a piece of paper (Onanoff's method) though I have never successfully succeeded in eliciting it in this way until after the organ got into a state of erectile excitement. Bringing it out in this way not only excites erection but it shows more as a twitch modification of true virile reflex. This glans reflex friction method and the resultant twitch is the excitation method and description of M. Onanoff, who made his dis- 16 Charles H. Hughes. covery about the time I made mine, as 1 learned when I communicated my discovery to M. Brown-Sequard, as I have stated in former communications on this subject, but you must note the Onanoff discovery was complicated with erectile co-excitation and is therefore a complex phenomenon and mine is not and is not elicited only in Onanoff's way' of glans excitation, but chiefly and better in a different and less complicated manner. Mine is obtained in various ways and by penis upward traction reinforced by tapping or stroking or pinching in any of the genesiac areas of the body below the umbilli- cus. Onanoff called his discovery a bulbo-cavernous reflex twitch, mine is an upward traction penile reflex, downward jerk elicited when the organ is drawn upward as already indicated. But if any pudic nerve area, of the inguinal, perineal or genital region, is excited, as previously de- scribed, by either upward penis traction or by traction and tap combined or by tickling with a straw, or pinching or pricking certain areas, this phenomenon will appear. This phenomenon has in a manner been known, vaguely and indefinitely, to anatomists and physiologists for several decades before I described it or before Onanoff called attention to his similar phenomenon, but not before separated from other penile phenomena and given the dis- tinctive significance with which we now invest it. Thus Ambrose Ranney, of New York, in 1881, reflecting anatomi- cal observation on this subject up to the time of his writ- ing his treatise of that day on applied anatomy of the ner- vous system, called attention to the fact (Applied Anatomy of the Nervous System 1881 page 469) that in some cases of fracture of the spine, in the dorsal region, where a part of the spinal marrow is left intact below the seat of the fracture, you may be able, by repeatedly pinching the skin of the scrotum and penis, to produce spasmodic contraction of the muscles of the perineum and urethra and often to effect turgidity of the organ to such a degree as to make it resemble an imperfect erection or priapism. It is not uncommon for rectal as well as urethral, orchal and prostatic disease to produce sympathetic manifestations Further Views of the Virile Reflex. 17 in the genito-urinary organs in the form of neuralgic pains involving involuntary emissions, incontinence of urine, etc. Such effects can only be explained by the distribution of the pudic nerve to the integument about the genital anus, and I believe, to the walls of the rectum also, which allows reflex motor impulses to be sent from the spinal cord, (in response to rectal irritation), to the genito-urinary organs and perineal muscles. Now let us run briefly over the anatomy of the pudic nerve and its relations, for explana- tion of the modus operandi of this remarkable reflex and its great value, contributing as it does, to further make the pudic nerve in physiological significance next to that of the . wonderful vagus. Anatomy. The pudic nerve branches from the lower portion of the sacral plexus, coming out of the pelvis through the great sarchoischiatic foramen with the pudic artery, gluteal and sciatic nerves and vessels. It then re-enters the pel- vis and gives off the inferior hemorrhoidal nerve, and passes along the outer aspect of the ischiorectal fossa to divide into the perineal and dorsalis penis nerve. The in- ferior hemorrhoidal nerve sometimes comes directly from the sacral plexus and is not then a branch of the pudic. It is distributed to the rectal sphincter muscles and perineum and integument and it here communicates freely with the superficial perineal and inferior pudendal nerves. The largest branch of the pudic nerve, the perineal, dividing it into superficial cutaneous and deeper muscle branches, sends some filaments to the sphincter and levator ani mus- cles, but it goes chiefly to the perineal integument, the scrotum, penis, labia and anus, communicating with the hemorrhoidal, as already indicated. The muscular branches come usually from the pudic, pass forward and inward beneath the transverse perinei muscle, its terminal filaments going off to the transverse perinei, erector penis, accelerator urinae and sometimes to the bulb of the urethra. The dorsalis penis nerve is a terminal filament of the pudic, going between layers of 18 Charles H. Hughes. perineal fascia, through the suspensory ligament of the penis and along its dorsum to its glans. Its course is sim- ilar in the female. Ranney with Holden, from whom this anatomical description is mainly abbreviated, here intro- duces a note from Hilton to the effect that the integument of the side ol the penis is supplied by the perineal branch of the inferior gluteal nerve and from no other source. This probably explains why the virile reflex is so much more readily obtained by dorsal than from general tapping of the organ. The pudic nerve is a nerve of sensation and motion of the genitals and genital regions of the body, the peri- neum and its integuments, the urethra and clitoris, their mucous walls and linings, the penis and scrotum. It is a sensory-motor nerve of special as well as pain sense, the nerve of the genesiac sense, in main part at least, notwith- standing the probable associated genesiac function of the in- ferior gluteal, inferior pudendal and some cutaneous fila- ments of the small sciatic. I believe the pudic is the nerve sui generis of the vi- rile or genesiac reflex, especially in its infra umbilical and certain of the latter's branches in its distributions and peripheral reflex sensibilities and relations and the dorsalis nerve defines the boundaries of the virile or genesiac reflex areas. The virile or genesiac reflex phenomenon is a mainly, if not entirely pudic nerve area reflex. It is the diagnostic reflex of the sexual spinal cord sphere in the sexually normal . individual, independently of the erectile state of the virile organ of the male or clitoris of the female. The pudic nerve, through its reflex function, of which the virile or genesiac reflex is an important part, makes possible erections, seminal emissions, scrotal retraction, etc. They are brought about through its influence and relations. Anatomists and physiologists have come near to the discovery of the definite virile reflex here described years ago, but have just missed it. RELATIONS BETWEEN PHYSICAL DISEASES AND MENTAL DISORDERS.* By L. W. WEBER, M. D. Superintendent and Privatdocent in GOttingen. IV. DYSCRASIC DISEASES.—A further group of phys- ical diseases, which often result in mental disorders, may be comprised as general exhaustive diseases of gradual onset, as so-called dyscrasias. I might include here the chronic metabolic diseases, like diabetis, albumenuria, anemia, chlorosis, then general carcinoma, general chronic tubercu- losis, and syphilis, finally the metabolic disorders traceable to affections of the thyroid glands. This group, as is seen, is without a uniform pathogenic foundation. A part of the disorders cited here might just as well be called auto- intoxications, and referred to the groups of intoxications; others belong to the infectious diseases, like tuberculosis and syphilis; others again rise from changes in certain organs, like the thyroid glands, kidneys. For the purpose of the present investigation they all have in common—and that justi- fies their being put in one group—that they are not usually of acute onset, like most infectious diseases, that their effect is not confined to a single organ, that we must pathogenetically seek for their pernicious influence in a change in general metabolism, in part in the way of its degeneration, which leads to defective nutrition and thus to exhaustion of the central nervous system, in part in the sense of the pro- duction of pathological, probably poisonous substances. The mental disorders arising on this foundation are extremely manifold in their course as in their symptoms, and little •Concluded from Volume XXVI, No. i. 19 20 L. W. Weber. characteristic of the fundamental disease. Only those of them, which are of acute onset and course, usually present the symptoms shown by Raecke to be characteristic of the "exhaustion psychoses:" blunting of attention, disorienta- tion, incoherence and active, temporary false sensations and delusions. Of pulmonary tuberculosis and general tuberculosis Heinzelmann has shown in a few papers how the progres- sive physical disease may produce a mental weakness and loss of judgment. He especially mentions the unstable mood, the tendency to emotionalism, the false judgment of their own position and of the relation to those about; a lessened volition, a shyness of any occupation, which is in opposition to the increased libido sexualis, often exist. It is not merely the phthisical disease process, which pro- duces these psychical changes, but external factors primar- ily: the influence of relatives, the actually changed mode of life, particularly of those tuberculous patients who for years stay at sanitariums and health resorts, the sympathy of acquaintances, etc. The Euphoria occurring in moribund phthisics is distinguished by H., as a special variety. But besides these psychical changes on the verge of the patho- logical, pronounced mental derangements are found in the tuberculous. Paris has chiefly observed states of anxious hallucinatory excitement and confusion; he ascribes them to a psychical shock, due to the knowledge of the incura- bility of the trouble; when the fundamental trouble im- proves the psychical symptoms abate. That in Korsakow's psychosis so-called, besides alcoholism, tuberculosis also often plays an etiological part, has already been mentioned. I have quite often observed another form of psychical disease in the tuberculous, of which the following case is an instance. P. came of a family with strong tuberculous taint (mother and two great aunts died of tuberculosis), as a child had pneumonia with brain symptoms. At 23 she be- came a nurse, at 26 had a severe typhoid and at 40 was affected with catarrh of the apices of the lungs. Ere the pulmonary disease and its tuberculous nature were estab- Physical Diseases and Mental Disorders. 21 lished, severe hypochondriacal ideas occurred, which were evidently traceable to abnormal organic sensations (especial- ly of the lungs). Then active, agitating false sensations, states of excitement and suicidal attempts rendered admission to an institution imperative. Here with the advancement of the pulmonary tuberculosis pronounced delusions of persecutory and religious content occurred, while the hypochondriacal ideas were no longer manifested. P. succumbed to her lung trouble; during the death struggle the anxious mood heretofore con- stant became quieter, the orientation clearer; the delusions abated. Here then a severe paranoia has been developed of a pro- nounced hypochondriacal character from the first. Still it seems to me as though the insidious tuberculosis, ere it is really known to the patient or physician, is especially suited to develop hypochondriacal ideas; in the organs affected by its numerous abnormal sensations certainly arise, which are then in some way hypochondriacally elaborated. In the tuberculous of little education, who are not, like this nurse, possessed of some medical knowledge, many monstrous hypo- chondriacal delusions, manifested indiscriminately, occur on this basis. It is to be mentioned that tuberculosis represents an essential hereditary predisposing factor for psychoses and in higher degree than other infectious diseases or other chronic diseases of the progenitors (with the exception of the men- tal disorders). English authors particularly mention an alternation of tuberculosis and psychoses in the descendants and trace the disposition to tuberculous diseases of the organs to a defective function of the supposed trophic centers in the brain. That psychical disorders may occasionally be produced by tuberculous diseases of the central nervous sys- tem (meningitis), does not need to be especially mentioned. With respect to the relations of syphilis to mental dis- orders, two forms of psychoses are known, which are close- ly connected with lues and characterized by quite marked changes in the brain: the real brain lues and general [paresis, the first a component symptom of general syphilis, the lat- ter is now generally regarded as a metasyphilitic disease. 22 L. IV. Weber. As the changes in the brain are prominent in both, they do not come under this discussion. With respect to paresis it is only to be said here that the generally accepted opinion is that syphilis is the most important and frequent cause of paresis; if it is wanting, very prolonged and very per- nicious factors may produce a similar picture, but usually defined anatomico-histologically. On the other hand is the fact that not every syphilitic becomes paretic; the assump- tion is evident that other factors are necessary for the occur- rence of paresis. Besides congenitally lessened resistance of the brain (Raecke), individually acquired predispositions, hard mental work, frequent excitement, then chronic external injuries, e. g., in business, further traumatisms, infectious diseases, alcholic excesses are to be considered. In this sense must be understood the diseases frequently designated traumatic, infectious, toxic paresis, that the pernicious agents concerned always represent merely a predisposing factor or exciting cause with an existing syphilitic infection, if the clinical and anatomical picture of genuine paresis shall really occur. Finally it is to be stated that in syphilitics severe neuras- thenia (syphilitic neurasthenia) sometimes occurs, whose clinical picture is like that of a hypochondriacal melancholia or paresis. The most important etiological factor is the in- tense mental depression; but the enfeeblement of the ner- vous system by the infection and the medicinal poisons may have to be considered (Oppenhein). Under certain circum- stances the differentiation from genuine paresis is difficult and the transitions gradual. The mental disorders occurring in carcinomatous disease of some organ of the body may be explained in part of the cases by multiple metastases in the brain and meninges. Siefert has shown that the brain may appear almost un- changed macroscopically, while the microscope demonstrates scattered carcinomatous elements; the clinical picture in Siefert's cases was in a measure characteristic and homo- geneous. In three cases of carcinomatous disease of the organs Elzholz observed mental disorders, which presented a certain uniformity in course and symptoms: active false Physical Diseases and Mental Disorders. 23 sensations, disorientation, intense excitement; in two of these cases a degeneration of the posterior columns of the cord existed, which was found in other carcinomatous patients. E. assumes that these cord degenerations are due to the poisonous products of the carcinoma and explains the men- tal disorders observed by similar toxic effects on the cortex. The necessity of here referring to the theory of autointox- ication for an explanation of the mental disorders seems questionable, atleast in view of Siefert's findings (see above). So it is that similar spinal degenerations as in carcinoma are also found in other exhausting diseases, e. g. anemia and chlorosis; it may then as well be a matter of degenerations in consequence of nutritive disorders of the nervous system, as they occur in all exhausting diseases. The mental dis- orders observed in severe anemia (e. g. in consequence of hemorrhages) chiefly are of the character of exhaustion psychoses (Raecke). Only in rare cases can other gross derangements in the brain be demonstrated. Thus in a young girl with pernicious anemia, who had died in an acute mental disorder with great confusion and excitement, I found a thrombus of the large cerebral sinus, which extended far into the veins of the brain and had caused multiple miliary brain hemorrhages. But when such demonstrable lesions in the brain are absent, the mental disorders occurring in carcinoma and anemia will have to be regarded as exhaustion psychoses due to the deranged nutrition of the nerve tissue. More evident is the assumption of a toxic effect on the central nervous system in the acute mental disorders ac- companying albuminuria. It is unquestioned that the comatose states in nephritis are due to an (uremic) intoxication of the central nervous system, if we do not know the nature of the poison concerned. But mental disorders of all kinds of much longer duration are seen to accompany albuminuria (Hagen Koppen); thiscondition is the most frequent in delirium tremens. Koppen has shown that in part of these cases it is a matter perhaps of an album- inuria of cerebral origin and when no basis for the presence of a real organic kidney change exists. In these cases then the albuminuria, like the mental disorder, would not be 24 L. W. Weber. the cause, but the consequence of a (functional or organic) change in the brain. But in the difficulty in excluding secondary states, this assumption does not exceed the char- acter of a hypothesis; in some cases the physical disorders (convulsions, fever, refusal of food) attending the psychical condition may be the cause of the albuminuria. But it is »ften better to consider a vulnerability of the kidneys, which, favored by external conditions (cold, dietetic errors) cause paroxysmal irritation of the brain by urine products. I am led to this assumption by the observation of a case, in which on the basis of chronic alcoholism a depressive psychosis with agitating false sensations and stupor appeared. At the height of the disease marked albuminuria existed without signs of a severe nephritis. In convalescence the urine was free from albumin; but the patient had two re- lapses of agitated depression with renewed appearance of albumin from dietetic errors (without using alcohol). Patient had had a severe erysipelas shortly before the onset of the psychical disease. If albuminuria many times occurs after the onset of the mental disorder, it only proves that an accumulation of pernicious material in the circulation must occur, ere it is manifested by elimination. With respect to the clinical forms of the uremic psychoses, Hagen states that those of depressive character with agitating false sensations or feel- ings of physical incapacity are more common. The diagnosis of the fundamental trouble might not be possible from the psychical symptoms alone. The relations between diabetis and mental disorders are still less uniform. Bond found glycosuria twelve times in 175 psychoses. In how many cases diabetis is to be con- sidered the etiological factor is not stated. It often seems to be the opposite; in paresis and other severe brain diseases particularly a glycosuria is sometimes found, which is evi- dently of cerebral origin. The psychical disorders excited in the final scene by diabetic coma have another significance, which, similarly to uremic coma, are to be traced to an autointoxication. In two of my cases I have seen a mental disease occur in a diabetis of very long standing at the age Physical Diseases and Mental Disorders. 25 50-60, which had the form of senile dementia with numerous paretic traits. In both patients of good standing by education and social position, an essential weakness, particularly of memory and judgment, especially in the moral sphere (inclin- ation to obscenities and sexual acts) occurred quickly. In one the autopsy shows marked arteriosclerosis of the cere- bral arteries, besides finer changes, which are found in gen- uine paresis. Here the diabetis had evidently favored the premature occurrence of an arteriosclerotic brain atrophy and produced the symptoms of a presenile dementia. Here belong the psychical symptoms of catalepsy in children observed after severe icterus (Damsch) and severe agitated melancholia (Cramer). The brain lesions in the latter case yielded no marked changes. Both authors leave the question open, whether the cholaemia, an unknown toxine, or digestive disorders have led to the condition of the existing severe exhaustion psychoses. Among the diathetic diseases are the mental disorders known as thyreogenic forms of insanity to be spoken of. Although connected with the disease of a certain organ, the thyroid glands, they still evidently depend on general dis- orders of metabolism. As consequences of disordered action of the thyroid glands, we recognize the postoperative and idiopathic myxoedema, morbus Basdow and endemic and sporadic cretinism. Milder or severer mental disorders may be combined with all these conditions, which are manifested particularly in cretins, as marked, congenital imbecility. But besides Herthoge has shown by mkny papers, that these are, particularly in women, depressive conditions in form of melancholia, which showed by simultaneous physical symp- toms especially of the circulatory organs, then by the fre- quence of certain offspring, their connection with metabolic derangement of the thyroid glands. The specific treatment with thyroid preparations effects an essential improvement in the psychical symptoms of these cases. Furthermore, in these most diverse, chronic psychoses a connection with disordered function of the thyroid glands has been sought for without being in general justified by clinical signs or other pathogenetic points of view. The therapeutic efforts, which have been instituted in this direction, have been without a uniform result. The following is to be said of the diseases of this 26 L. IV. Weber. group: The mental disorders occurring in chronic dyscrasic diseases are less uniform and less characteristic of the funda- mental disease. Still other factors than the diathetic condi- tions probably cooperate in their occurrence. But the latter have an essential part in the evolution of these psychoses, in that they produce in part exhaustion of the organism and nu- tritive derangements of the brain by the impairment of metab- olism, in part by autointoxication processes directly producing a damage of the central nervous system. V. DISEASES OF INDIVIDUAL ORGANS.—The physi- cal diseases recently discussed have in common, that they affect less a single organ than the whole body; thus it is explained that they more readily lead by a direct effect on the brain to a damage of its functions. The question still remains whether the mental disorders occasionally occurring in some affections of the organs are only an intermediate connection with the fundamental physical causes. Here is to be mentioned a psychical disease type, which may present relations to all the organs of the body, hypochondria in its various forms. Whether these states belong to a real clinical form of disease will not be dis- cussed here; for the present purpose they have the com- mon, prominent symptom, that the mental depression, like the complaints and actual troubles of the hypochondriac, often refers to a definite organ. It is known that a num- ber of these cases have actual, severe or mild, but usually chronic diseases of the organs as the foundation: they may be termed "hypochondria cum materia." (Alt.) That this is especially frequent in chronic pulmonary tuberculosis, has already been mentioned; quite often at the autopsy of these hypochondriacs tumors, remnants of inflammations of serous membranes, particularly of the pleura and peritoneum, in form of fibrous adhesions and bands, etc., are found. This organic disease does not always need to present clin- ically demonstrable, physical symptoms: it may at least be entirely latent for the examining physician, and result in recovery without causing anatomical changes in the organ, while the patient has various indefinite sensations. Con- PhysicailDiseases and Mental Disorders. 27 nected with it, the content of our consciousness con- sists in great part of perceptions, which are derived from the organs of the body, the so-called organic feelings— somatopsychical consciousness. (Wernicke.*) Perhaps this fact is related, that very often senile melancholiacs are characterized by hypochondriacal traits: the physiological involutional process of all organs incident to the age may most readily be the cause of changed organic feeling. In all these cases then a real functional disorder of the organ may be determined at least in the direction and con- tent of the pathologically changing feelings and ideation. The real and only causes of the psychoses are not these organic changes; that is shown by the fact, that the de- lusions thus arising often far exceed the bounds of the physical troubles possible by the disorder of the organ. The relief of the physical trouble often effects only a tem- porary improvement, rarely a complete recovery from the mental disorder. The hypochondriacal symptoms arise rather on the basis of other psychoses, functional as well as organic, like melancholia, paranoia, paresis and give them their own color above indicated. Of the predisposing fac- tors hereditary taint on the one hand, but then also the condition of exhaustion and overfatigue of the nervous sys- tem, which we meet with in neurasthenia, play an essential role. Besides these hypochondriacal psychoses only loosely connected with physical disorders, we see after diseases of certain organs, other mental diseases occasionally occur, while in individual cases the connection is perhaps some- what closer. Of the diseases of the sense organ ear troubles are found most often in the anamnesis of chronic, especially hallucinatory, psychoses. The subjective troubles due to the ear affection are especially the noises, like ringing and roaring, perhaps the cause of corresponding false sensations, which represent the first symptoms of a later paranoia. The distrust frequent in those hard of hearing, if they are otherwise perfectly normal mentally, and the justified de- *See case of somatopsychosis described by Wernicke In his Outlines. 28 L. W. Weber. pression from this unpleasant defect becoming greater day by day, may cooperate in the origin of the psychoses. Still all these factors will not be able alone to evolve a chronic paranoia, if not by other conditions, to which belongs es- pecially a degenerative constitution, has created a certain predisposition. The connection between ear troubles and mental dis- order in point of time is to be well recognized in the fol- lowing case: A merchant, with no hereditary taint, but with many physical signs of degeneration, became ill about 7 years ago with a catarrh of the middle ear and became deaf; until this time he conducted his business successfully. Five years ago he complained of roaring and ringing in the ear, then he heard several calls and voices, finally whole words; active persecutory ideas (fear of poisoning) now occurred, which still control the disease type. The delirious states occasionally observed after cata- ract opetation occur chiefly in senile individuals or those debilitated by alcohol, poor nutrition, (Lowy) and the eye operation might here play the role of an exciting cause, in which the cooperation of psychical factors (remaining a long time in complete darkness) is not excluded. Among the other organic diseases the connection of diseases of the circulatory system with mental disorders has been referred to. The existing statistical investigations offer no uniform results and no conclusion, whether it is a matter of an accidental coincidence or of an etiological con- nection. At any rate it seems as though in this group of diseases predisposing factors, particularly hereditary taint, is less to be considered; the cardiac or vascular disease is often found to be the only demonstrable pernicious agent in the anamnesis. That in the course of such diseases of the heart and vessels (embolism and thrombosis in valvular in- sufficiency, atheroma of the vessels) focal destructions of the brain and thus mental disorders may occur, needs not to be spoken of further here. In the so-called functional psychoses, states of depression to intense anxiety with and without false sensations, then states of maniacal excite- ment and hallucinatory confusion have been ascribed to Physical Diseases and Mental Disorders. 29 cardiac and vascular diseases. As causes are to be cited the disorders of circulation which may lead to a defective blood supply or congestion of the brain or cyanosis; per- haps other poisons formed in the body cooperate. The va- riation in pressure in the vascular system are of import- ance not to be underestimated. We know that many states of pathological affect are accompanied by changes in the blood pressure, that in melancholia at the climax of anxiety particularly the blood pressure is increased. (Cramer.) The patient's anxiety is often directly located in the cardiac region. Still it cannot be decided in every case whether these variations in pressure are excited cerebrally by an action on the vascular centers, or whether they occur from functional derangements in per- ipheral organs. Here the fact is to be referred to that in middle life or at the onset of senility mild forms of melancholia quite often occur, which show their connection with circulatory disorders by certain symptoms: slight arteriosclerosis, irreg- ular heart action, small, frequent, irregular pulse. That the psychical symptoms are not due to a premature or arterio- sclerotic brain atrophy is proven by the fact, that it is sometimes to effect an improvement in the psychical disease type by regulating the heart's action (administration of strophanthus, digitalis, etc.) 1 have occasionally seen mental disorders occur in young persons with a more direct connection with the prior cardiac disease. Infantile chorea quite often arises on the basis of an endocarditis induced by articular rheumatism. Frequently, at puberty, an epilepsy or hysteria, which may be accompanied by mental derangements, is developed after a chorea, or a severe adolescent psychosis leading to de- mentia (hebephrenia) occurs, in which the symptoms of chorea may still continue. Acute exacerbations of endocar- titis seem to favor the occurrence of hallucinatory or stuporous attacks. In these cases at any rate the ground is generally prepared by hereditary taint or other predis- posing factors; perhaps the infection poison of rheumatism, respectively of endocarditis, plays a part. 30 L. IV. Weber. An instance is the following case: The son of an in- ebriate became ill at 10 with articular rheumatism and en- docarditis and since then had twitchings in the face, arms, legs and spells of crying. The mental development was then retarded; still the patient could help in his father's saloon. Since 17, frequent states of anxiety with running away from home, vagabondage. At 20, admission to a hos- pital. Here no convulsions were observed; but in the otherwise quiet and industrious patient articular pains again occurred frequently, combined with intense anxiety and more marked twitching in the face and choreic move- ments of the fingers. The heart murmur louder, extension of the cardiac dullness and cyanosis were increased. A year after admission the patient died of another severe en- docarditis and pericarditis, which were accompanied by at- tacks of intense anxiety. The autopsy showed no gross brain disease, and only cell degeneration microscopically. Diseases of the gastro-intestinal canal have always played a great role in the pathogenesis of psychical disorders. If the importance, which older psychiatry ascribed to these disorders in the periphery of the vago-sympathetic, seems exaggerated, when it was established that long continued and severe derangements in the digestive tract are not alone sufficient to produce a mental disease, still recent observa- tion has shown that relations between the physical diseases named and neuroses and psychoses of certain kind exist. Alt has first called attention to the connection between stomach troubles and certain nervous or psychical derange- ments. He especially mentions a form of chronic gastric catarrh, which is primarily characterized by changes in the chemical constituents: increase, diminution or absence of hydrochloric acid, occurrence of lactic or butyric acid or other abnormal products of fermentation. The nervous derange- ments then observed may consist of paraesthesias, attacks of vertigo and stupor, irritability and depression, but pri- marily of the occurrence of states of anxiety, which are sometimes accompanied by imperative ideas or actions. The consciousness is not clouded in the intervals; disease insight exists. The more marked the anxiety, the more the picture Physical Diseases and Mental Disorders. 31 of a real psychosis occurs, which Alt has differentiated from true melancholia as "gastric psychosis"; the attacks of anxiety then last longer and are accompanied by illusions and hallucinations and finally by delusions of hypochond- riacal content. In almost all of these cases described by Alt predisposing factors are found, either in hereditary taint or marked neurasthenic exhaustion. The connection between physical and psychical disturbance is afforded according to Alt by an irritation of the terminals of the vago-sympathetic in the gastric mucous membrane, partly in consequence of the abnormal products of secretion and fermentation, in part by mechanical dilatation of the distended stomach wall. These irritations are reflexly conveyed to the central organ, first of all to the medulla oblongata, and on the other hand in- juries to the other distributions of the vago-sympathetic, especially lungs and heart, occur by means of irradiation, so that the derangements accompanying the trouble, e. g. asthmatic attacks, palpitation, etc. are explained. Alt espec- ially emphasizes the importance of this connection, which indicates the treatment: a proper treatment of the stomach long continued, is able to relieve the physical derangements. Further observations by Alt and publications of other authors (Wagner von Jauregg, von Solder, Herzog) indicate, that in the nervous and psychical derangements described diseases of the intestinal canal are often found, chronic con- stipation especially. Von Solder has described a series of cases, which, usually terminating fatally in form of acute delirium, present recent parenchymatous changes in the glandular organs: liver and kidneys, and of the heart; as the cause of this disease he regards the coprostatis found in every case with secondary changes in the mucous mem- brane of the colon. Besides the reflex processes of the vago- sympathetic mentioned, the authors named refer to the damage of the central nervous system by the impairment of nutrition and by the toxic products of the pathologically changed metabolism. Herzog restricts the etiological signif- icance of these physical diseases, of which he especially emphasizes the derangements of the circulatory system, that it is not a matter of a specific disease type—a gastric neu- 32 L. W. Weber. rosis or psychosis. All nervous and psychical disorders ac- cording to him are merely the expression, the component of a neurasthenia existing a priori. The gastric or intestinal derangements are merely the cause of the outbreak or ex- acerbation of the nervous or psychical symptoms. The therapeutic side might be the common and significant of all these observations, which points to a way to relieve severe psychical disorders, may they have developed on the basis of predisposing factors, produced by gastro-intestinal per- nicious agents, or may they be primarily due to the latter. That a nervous symptom reacting by a psychosis to simple gastric derangements is always unstable, deviating from the normal average, is unquestionable. But the recognition and treatment of these physical disorders are of greater import- ance to the practitioner in such cases. We see that in epi- lepsy, where a trifling error in diet often suffices to produce a seizure or a number of them, or a state of marked con- fusion, as the equivalent of the motor attacks. In chronic psychoses also, particularly those occurring in periodical attacks, the occurrence of gastro-intestinal derange- ments, manifested by coated tongue, foul breath, constipa- tion and indicanuria quite often go hand in hand with an aggravation of the psychical condition. If these attacks ap- pear in the hospital, on careful observation the impression is often gained, that the symptoms in the digestive tract precede the aggravation of the psychical condition. Quite often such an attack is induced by demonstrable errors in diet. Doubtless in a number of other cases, in acute psychoses as well as in acute attacks of the chronic, the attendant gastro-intestinal derangement is purely of a secondary nature, produced either by inordinate and deficient food in confused and excited patients or by a cerebral disturbance of met- abolism. This is especially true of many recent cases, who often before admission to the hospital are subjected to the most improper treatment by isolation, etc., by the relatives or in small institutions. Then of course the secondary gastro-intestinal disorder aggravates the psychical condition. Here therefore a therapy directed to the physical derange- Physical Diseases and Mental Disorders. 33 ments is indicated and every psychiater knows that regulation of the diet and intestinal action in these cases often effects a surprisingly quick quieting and improvement in the excited or stupid patients, if the funda- mental psychical trouble is not changed. Examination of the feces, which often present a quantity of indigestible substances (wood fibres, stones, etc.), indicates that an improper nourishment has occurred under the influence of the incipient psychosis. The acetonuria and indicanuria quite often present is merely a sign of the deranged intesti- nal action and cannot be claimed to be a formation of toxines in the sense of autointoxication. But from all observations it seems certainly shown, that primary as well as secondary gastro-intestinal derangements may in part produce, in part intensify reflectly or by changes in metabolism nervous -and psychical derangements, which are capable of improvement by a treatment of the fundamental trouble and thus show their connection with them. It often seems to be a matter of individuals, who are burdened with predisposing factors of all kinds. Long known and numerous relations exist between the processes in the female sexual organs and mental disorders. One has ceased to trace the whole symptom complex, which is termed hysteria to diseases of the genital organs, for neither pathogenetic points of view nor therapeutic results justify this assumption. Whereas the relations between mental disorders and the different stages of development and functions of the female genital organs are important. A large part of these conditions do not belong in the scope of this paper, because they are either within physiological bounds, like the irritability of the normal woman at the periods (Schroter) or are produced by normal, not pathological pro- cesses in the genitals, like the psychical disorders, which occur during menstruation and in the normal process of prop- ogation. A part of the latter which are called puerperal psychoses, are at least related to pathological processes, which may appear during pregnancy, confinement and the puer- peral state in the female genital organs and their adnexa, and not only infectious processes of all kinds are to be con- 34 L. W. Weba. sidered in the gravid or puerperal uterus, but also in the lactation period in the mammae, then exhaustion from hemorr- hage or nursing, finally complications with kidney diseases. Mental disorders occurring here as well as in the normal puerperal state are referred by most authors to the important role, which predisposing factors, particularly hereditary taint, but then also acquired pernicious agents, especially previous diseases, play. According to their clinical symptoms the psychoses originating on these foundations are entirely differ- ent and belong to the most manifold disease types, melan- cholia, mania, hallucinatory confusion, even to imperative insanity (Alt), from which they are not always differentiated in course and prognosis. The puerperal psychoses, as Sommer and E. Meyer have recently shown, cannot be regarded as a uniform disease type of like etiology and symptomatology. The normal puerperal state is merely an exciting cause for the outbreak of a mental disorder prepared for by other factors. The other psychoses occurring after pathological puerperal processes must be called infection, intoxication or exhaustion psychoses, according to the predominance of one or the other pernicious agent. These then present great uniformity in symptoms, course and prognosis, in so far as they often occur in the form of marked confusion, perplexity or excitement with and without false sensations and, in the fundamental puerperal infection or exhaustion, afford a thera- peutic indication, which in many cases renders the recovery from the psychical trouble possible (Alt). The so-called climacteric psychoses belong to those of the age of involution according to their etiological significance; when symptoms of reflex irritation in the genital organs undergoing involution, also hemorrhages in irregular, pro- fuse menstruation and psychical factors may play a part. Other gynecological diseases may afford the causative factor of a psychosis under the same conditions as other organic diseases, which under certain conditions may have the character of hypochondria. We sometimes see the same processes in the male genital organs, in which psychical factors (assumption of an infection, the hypochondriacal worries of masturbators caused by popular books) essentially Physical Diseases and Mental Disorders. 35 cooperate. We see then in the diseases of the individual organs in part merely an exciting cause for the occurrence of other typical mental disorders. Another part of these organic diseases may afford a more profound and important cause for psychoses by reflex irritation, by disorders of circulation, nutrition and intoxications of the brain. But in most cases predisposing tactors are essential; therefore the psychoses thus arising are little characteristic of the fundamental disease; we are not justified in this sense in speaking of cardiac, gastro-intestinal, puerperal psychoses, etc. In many hypochondriacal mental disorders the organic diseases at least furnish the direction and content of the psychical symptoms. VI. CONCLUSIONS. 1. On the basis of physical diseases of the kinds de- scribed in the preceding sections psychical disorders of longer or shorter duration may arise. 2. -Still it is in the rarest cases, that the physical dis- ease is the only or cardinal cause of the psychosis. In these few cases we find that the clinical picture presents certain symptoms, which are characteristic of the origin and that usually on the removal of the external pernicious agent the psychical disorder disappears or improves at least. It is apparently a matter of a direct effect of this agent on the brain, which in some cases is also shown by the patholog- ico-anatomical examination. Instances are particularly several infection and intoxication psychoses. 3. In these the restriction must be made, that the phys- ical injury does not always result in a psychosis of defiinte character, that other causes also cooperate here. 4. In most cases the physical disease is merely an etiological factor together with many other equivalents, yet often only a so-called exciting factor. That is shown espec- ially by those psychoses having nothing characteristic of the cause of origin and not disappearing after relief of the funda- mental trouble. 5. The predisposition cooperating is likewise not a uniform factor and not by any means exhausted by heredi- 36 L. W. Weber. tary taint. Rather ail possible causes injuring the body are to be also understood. LITERATURE. 1. Alt, Uber das Entstehen von Neurosen und Psy- chosen auf dem Boden chronischer Magenkrankheiten. Arch. f. Psych., Bd. 24. 2. Alt, "Puerperalpsychosen." Article from the En- cyklopadie der Geburtshilfe und Gynakologie. 1901. 3. Althaus, Uber Psychosen nach Influenza. Arch. f. Psych., Bd. 25. 4. Aschaffenburg, Uber Initialdelirien bei Typhus. Allg. Zeitschr. f. Psych. Bd. 52. 1896. 5. Azemar, Deux cas de manie, gueris a la suite d'une infection grave. Annales medico-psychologiques. 1901. 6. Behr, Zur Etiologie der Puerperalpsychosen. Vort. auf der 34. Versammlung der Irrenarzte Miedersachsens 1899. Bericht in der Zeitschr. f. Psych., Bd. 56. 7. Bond, Relation of diabetes to insanity. Journ. of Mental Science, 1896. 8. Bruns, L., Die traumatischen Neurosen (aus Noth- nagel, spezielle Pathologie und Therapie.) Vienna, 1901. 9. Ceni, Die Pathogenese der Bleilahmungen. Arch, f. Psych., Bd. 29. 10. Cramer, Gerichtliche Psychiatric 2. Aufl. 1900. 11. Damsch und Cramer, Uber Katalepsie und Psy- chose bei Icterus. Berliner klin. Wochenschr. 1898. 12. Seiters, Beitrag zur Kenntniss der Typhuspsy- chosen. Munchener klin. Wochenschr., 1900. No. 47. 13. Dorner, Glykosurie bei Diabetes. I. D. Freiburg. 1895. 14. Elzholz, Uber Psychosen bei Carcinomkachexie. Jahrb. f. Psych., Bd. XVII. 15. Fischer, Uber Psychosen bei Herzkrankheiten Allg. Zeitschr. f. Psych. Bd. 54. 16. Frankel, Beitrag zur Lehre von den Erkrankungen des Centralnervensystems bei akuten Infektionskrankheiten. Zeitschr. f. Hygiene, Bd. 27. Physical Diseases and Mental Disorders. 37 17. Friedlander, Uber den Einfluss des Typhus ab- dominalis auf das Centralnervensystem. Monatsschr. f. Psych, u. Neur., 1900. 18. Hagen, Uber Nierkrankheiten als Ursache von Geisteskrankheit. Allg. Zeitscher. f. Psych., Bd. 88. 19. Hascovec, Autointoxicationen bei Nerven—und Geisteskranken. Wiener klin. Rundschau, 1898. No. 39-44. 20. The influence of physical upon mental disease. British Med. Journ. 1897. 21. Hensay, Untersuchungen des Centralnervensystems bei Diabetes mellitus. 1. D. Strassburg, 1897. 22. Hertoghe, De l'hypothyroidie benigne chronique eu myxoedeme fruste. Iconographie de la Salpetriere. 1898. 23. Hertoghe, Le myxoedeme franc et le myxoedeme fruste d l'enfance. Iconographie de la Salpetriere. 1900. 24. Herzog, Uber die Abhangigkeit gewisser Neurosen und Psychosen von Erkrankungen des Magendarmkanals. Arch. f. Psych., Bd. 31. 25. Jakobson, Uber autointoxicationspsychosen. Zeit- schr. f. Psych., Bd. 51. 26. Jones, On insanity in lead-workers. British Med. Journ., 1900. p. 350. 27. Kalischer, Influenzapsychose im fruhesten Kindes- alter. Arch. f. Psych. Bd. 29. 28. Katz, Beitrag zur Lehre von der diphtherischen. Lahmung. Arch. f. Kinderheilk., Bd. XXIII. 29. KSppen, Uber Albuminure und Propeptonurie bei Psychosen. Arch. f. Psych., Bd. XX. 30. Koster, Experimenteller und pathologisch-anato- mischer Beitrag zur Lehr von der Schwefelkohlenstoffver- giftung. Neurol. Centralbl., 1898, p. 493. 31. Kuhn, Psychische St5rnngen bei Diphterie im Kindesalter. Neurol. Centralbl., Bd. 16. 32. Laudenheimer, R.; Uber nervose und psychische StSrungen der Gummiarbeiter. Neurol. Centralbl. 1898. p. 681. 33. Id., Die Schwefelkohlenstoffvergiftung der Gummi- arbeiter. Leipzig, Veit & Co. 1901. 38 L. W. Weber. 34. Lowy, Geistesstorung nach Kataraktextraktion. Allg. Zeitschr. f. Psych. Bd. 52. 35. Luhrmann, Uber Krampfe und Amnesie nach Wied- erbelebung Erhangter. Zeitschr. f. Psych., Bd. 52. 36. Murawjeff, Uber den Einfluss des Diphtheriegiftes auf das Nervenststem des Meerschweinchen. Ref. im Neu- rol. Centralbl., 1897, p. 754. 37. Mya, Uber die Pathogenese der diphtherischen SpStparalysen. Wiener med Blatter, 1899. 38. Oxenius, Nervose Nachkrankheiten bei unvollkom- mener Erstickung. 1. D. Kiel. 1897. 39. Prince, Accident neurosis and football playing. Boston Med. Journ., 17. 40. Raecke, Zur Lehre von den Erschoopfungspychosen. Monatsschr, f. Psych, u. Neurol., Heft 1 u. 2. 41. Rothe, Beitrage zur Casuistik der nervosen Stor- gunen bei Diphtheric 1. D. Berlin, 1899. 42. Schroter, Wird bei jungen Unverheirateten zur Zeit der Menstruation starkere sexuelle Erregung beobach- tet? Allg. Zeitschr. f. Psych., Bd. 56. 43. Siefert, Uber das Carcinom der Haute des Central - nervensystems. Vortrag auf der 7. mitteldeutschen Psy- chiaterversammlung in Jena, 1901; referiert in der Mon- atsschr. f. Psych, u. Neur., Jahrg. 1901. 44. v. Sfilder, Uber akute Psychosen bei Koprostase. 45. Sommer, Diagnostik der Geisteskrankheiten. 2. Aufl. 1901. 46. Strohmayer, W., Uber die Bedeutung der Individ- ualstatistik bei der Erblichkeitfrage in der Neuro-und Psychopathologie. Munchener Med. Wochenschr., 1901, No. 45 u. 46. 47. Troiser, Meningotyphus. Sitzung der Societe medi- cate des Hospitaux, 4. v. 1900. ref. im Centralbl. f. Path., 1901, No. 14. 48. Wagner von Jauregg, Uber Psychosen auf Grund- lage gastrointestinaler Autointoxication. Wiener klin. Wochenschr. 1896, No. 10. Physical Diseases and Menial Disorders. 39 49. Wollenberg, Uber gewisse psychische Storungen nach Selbstmordversuchen durch Erhangen. Festschr. f. Nietleben, 1897. 50. Woollacott, Diphtheric paralysis in cases treated with antitoxin. Lancet, 1899, p. 561. MIXOSCOPIC ADOLESCENT SURVIVALS IN ART, LITERATURE AND PSEUDO-ETHICS.* By JAS. G. KIERNAN, M. D., CHICAGO. Fellow of the Chicago Academy of Medicine; Honorary Member of Chicago Neurological Society; Foreign Associate Member of the French Medico-Psychological Association; Professor of Medical Jurisprudence, Dearborn Medical College. TT HE mental attitude of the hysteric towards genital ex- * pressions of affection appears well marked in what de Mauldet calls the platonism of the women of the re- naissance. The newly fledged husband (of the Middle Ages) re- marks de Maulde was under no illusion in the matter; he had married to cure himself of love, or rather to have done with it forever, to turn away from women and toward higher things. He would never have imagined any connec- tion between his marital duties and his soul. First and last wedlock had no romance for him. Marriage was the worn and dusty highway of materialities. Nor did the ex- pectations of the young girl soar any higher. Shown the simple truth by the solemn personages to whom she owed her upbringing she knew all there was to know about her new duties and in regard to these it was thought peculiarly necessary to arm her against errors and enthusiasms that •Continued from November, 1905. t Women of the Renaissance. (40) Mixoscopic Adolescent Survivals in Art. 41 might bring disappointment in their train. Marriage she had always looked upon as a natural function with excel- lent precedents and she had studied its rules in their rudi- ments, at least so as to be able to guide her steps intelli- gently in a career that had necessarily its technical side. This was why Champier, the physician, compiled ex- pressly for Suzanne de Bourbon a little treatise quite for- eign in its nature to what in these days is called "litera- ture for young people". Yet it must be confessed that this treatise, frankly physiological as it is, constituted the best imaginable safeguard against being swept away on a flood- tide of passion and folly. Champier (who was cloister bred) lays down as rigorously as though stating an astro- nomical law, various rules for his lady's guidance in the most intimate relation of married life. Prudence, modera- tion and regularity are his texts and he gives point to his precept by setting against them a menacing array of human ills—gout, anemia, dyspepsia, sight enfeeblement. Montaigne has a good deal of pity for the women sub- jected to the capricious humors of the medieval conception of marriage which survives today; in many cases "they are verily in worse condition than maids or widows. We want them at the same time hot and cold." He does not remark, says de Maulde, for some reason or other that disgust of too pronounced materialism, longing for peace or quiet- ness, coquetry, scorn of sensuality, or what not, the major- ity of women .only accepted wifehood for the sake of motherhood and would be more than satisfied to be virgin mothers or parthenogenetics. Some considered themselves almost as idols, too sacred for human touch. This conception, still a dominant note in the thought of certain social purists, finds to a marked degree vent in current samples of problem fiction. One by Grant Allen* is relatively normal, albeit dominated to an enormous de- gree by this medieval conception of the impurities of even marital sexual relations. A Chicago production by Attor- ney Caroline Huling and Dr. Theresa Schmidt* is perme- ated entirely by the virgin-mother notion. The heroine, a *The Woman Who Did. 42 Jas. Q. Kieman. hysterical degenerate, studies medicine after a trained nurse course. After graduation in medicine she determines to re- vert to primitive mother right and "have a child whose affection she will share with no father." A pruriently prudish medical impossibility furnishes the necessary mate- rial for "scientific artificial fecundation experiments" on an unknown female. A daughter results, which not being a wise child and knowing its own father, worries the mother for information about the male parent. Incidentally during a consultation in a sterility case the physicians learn their relationship to each other and the child. A common law or quaker marriage fortified by a rigid-contract follows. The Courage of Her Convictions was greeted with marked enthusiasm by some notorious Chicago social purists. The preachers who at one time ardently ur^ed the severing of family ties as inexorably demanded by religion, were later seen proclaiming from their pulpits with the same appeal to religion a totally different doctrinet and in- culcating mortification of the flesh of quite a novel kind. Of this the story of the "Excellent Pharmacist at Pant 'who never had anything to do with his wife except in 'Holy Week' by way of penance" is a fair sample. Even in re- mote country places it became the vogue to occupy sepa- rate rooms. There was no attempt at disguising the fact and a great deal of joking on this casuistical refinement went on in polite circles. Another quality which idealists regarded as conducive to charm was a certain stiffness and reserve of manner. Woman, like the Ark of the Covenant, was to be worthy of all respect. She was not thought the worse if like a mimosa, she shrank within herself when the sun's rays were no longer there to warm and if she was afraid of the dark. The woman chary of her smile was considered a beautiful creature. In platonist circles they could scarcely even admire the beauty of the shoulders, indeed there were no longer seen flaunted in street or church under the eyes of the common herd certain liberties in costume from time •The Courage o? Her Conviction?. tDeMauldb, Women of the Renaissance. JHeptameron, Tale 68. Mixoscopic Adolescent Survivals in Art. 43 immemorial, the despair of preachers—low cut dresses like that of Isabel of Bavaria, whom Jacques Legrant admon- ished from the pulpit for showing everything "down to her navel"; robes scalloped at the sides; long pointed shoes so much in the way that a woman had to lift her petticoats very high to be able to walk. Here however was noticeable the influ- ence of an esoteric mental state allied to foot fetechism. The most frequent type of erotic symbolism, remarks Havelock Ellis* is that which idealizes the foot and the shoe! This phe- nomenon is frequently complex. Theologically the lubricious conception of the shoe early appears prominently in church sumptuary laws. At the Rheims synod of 972 Abbot Raoul of St. Remit denounced monks for wearing indecent shoes of large size and tissue so transparent that nothing was hidden. From this time on these "chicken shoes" with a claw or beak, although pursued by anathemas of popes and invectives of preachers, continued in use for more than four centuries. They were considered by middle age casuists as the most abominable evidences of lubricity. It is not evident at first sight, remarks Dufour, what there could be scandalously suggestive in shoes terminating in a lion's claw, an eagle's beak or a ship's prow. The excommuni- cation of this species of shoe preceded the pornographic inventions of libertines who wore shoes with phallic termi- nations. These were often worn by modest women who didn't recognize what fashion placed on the tips of their shoes. Royal and ecclesiastic sumptuary laws alike forbade these shoes. Great lords and ladies, probably wearing modest "chicken shoes", defied these laws. Charles V and the Avignon pope, Urban V, forbade these shoes but they still persisted in use in the reign of Louis XI. The phallic terminations, fashion had meanwhile turned into spirals like those of Chinese and Turkish shoes. Even for the normal lover, the foot is a most attractive part of the body. Stanley Hallt found that among the parts specified as most admired in the other sex by young men and women who answered a questionaire, the feet came -Medicine February, 1906. tHistoire de la Prostitutien, Tome 1. ^Adolescence, Vol. 2, p. 118. 44 Jas. G. Kiernan. fourth (after the eyes, hair, stature and size). Casanova* an acute student and lover of women but not a foot fete- chist, remarks that all men who share his interest in women, are attracted by their feet. These offer the same interest as the particular edition does to the bibliophile. The hand does not appear among the parts of the body normafly of supreme interest. An interest in the hand is by no means uncommon.t The hand does not have the mystery which envelopes the foot and head fetechism of which Bi- nett and Krafft Eben* report instances is rather rare. The normal lover in most civilized countries does not usually attach such importance to the foot as he frequently does to the eyes, although the feet play a very conspicuous part in the work of many novelists. Hardyt shows an unu- sual but by no means predominant interest in the feet and shoes of his heroines. See the observations of his cobbler. Wilkie Collinst makes his shrewd steward Betteredge agree with Cobbett in choosing a wife from the way she sets her foot down. Goethet narrates on episode involving the charm of the foot and the kissing of the beloved's shoe. To a not inconsiderable minority the foot or boot becomes the most attractive part of a woman. In some noted cases the woman seems comparatively an appendage to her feet or shoes. Shoes under civilized conditions much more frequently constitute the sexual symbol than do the feet, which is not surprising since in every day life the feet are not often seen. Only under exceptionally favorable circumstances does foot fetechism occur. Castiglione goes into raptures about the simple velvet boot of a lady who on going to mass one' morning fancied she had to spring lightly across a brook. Aretino, naturally an expert in such matters, declares no one has a greater horror of a gratuitous display of her charms than a courte- san. Refinement and delicacy, according to deMaulde, make women more fastidious and more shy because they realized their value and because they wished to •Memoires Vol. I, Chap. VII. {History XII, Appendix B., Vol III, Psychology of Sex. tBtudes de Psychologic Experimental p. 12. •Psyoopathia Sexuallis. p. 214. tUnder Uie Greenwood Tree. tThe Moonstone. Mixoscopic Adolescent Survivals in Art. 45 be loved, principally at least for their soul. The influence of asceticism in the Middle Ages had generated the absurdly exaggerated desire to put out of sight the existence of the body. Artist's attenuated corporeal forms until on their canvas the body represented merely a thought. The raiment in which the body was delicately and gracefully draped served as vesture to this thought and contributed, so to speak, according to de Maulde, to immaterialize it. This reaction against beauty unadorned naturally affected the most porn- ographic minds. Aretino has naturally indulged in the most virulent invective against the realism of Michael An- gelo. The Council of Trent led a crusade for purging the churches of too life-like anatomies. Pope Paul IV, the "breeches maker", caused some veracious details of Mi- chael Angelo in the Sistine Chapel to be covered with gauze, and generously presented the Virgin with the dress he thought she needed badly. Margaret of France who is de Maulde's ideal platonist, was shocked at the idea that any one could say he adored some Italian princess or duchess lying in voluptuous sim- plicity in the midst of a beautiful landscape. To this fas- cinating, but to her degrading spectacle, she resolved to op- pose another—the spectacle of the soul. This idea occurred at a time when charms other than those of the soul are dead. She had herself painted before a landscape with a setting sun, erect in front of a curtain, clothed in a trans- parent tissue', carefully fastened at the neck, admiring her- self in a little hand glass; an allusion to her book "The Mirror of the Soul." Women genuinely platonic used their physique as a first means of developing their charm. Here they were at odds with the mystics who regarded the body as a negligible encumbrance but they were still more sharply divided from the sensualist. Their idea, de Maulde remarks, was to deify the body, enshrine it, so to speak, and glorify it as the vesture of the soul, the servant of the heart. The art of Albrecht Durer and others of that school, •Elective Affinities. 46 las. G. Kiernan. glorified like some of the art of prehisteric man, pregnancy and maternity as Havelock Ellis* points out. This glorifica- tion by art naturally passed into costume and in times of revolt against race suicide, created simulacra of pregnancy in fashionable female attire. This cropped out toward the close of the Reign of Terror as Carlylet has pointed out. •Psychology of Bex: Sexual Selection, tFrench Revolution. ( To be continued.) EROTIC SYMBOLISM. By HAVELOCK ELLIS, M. D., Carbis Water, Lelant, Cornwall, England. THE erotic symbols hitherto discussed* have in every case been portions of the body, or its physiological pro- cesses or at least the garments which it has endowed with life. The association on which the symbol has arisen has in every case been in large measure, although not entirely, an association of contiguity. It is now necessary to touch on a group of sexual symbols in which the association of contiguity with the human body is absent; the various methods by which animals or animal products or the sight of animal copulation may arouse sexual desire in human passions. Here occurs a symbolism mainly founded on as- sociation by resemblance; the animal copulation recalls the human coitus, the animal becomes the symbol of the human being. The group of phenomena here concerned includes sev- eral sub-divisions. There is first the more or less sexual pleasure sometimes experienced, especially by young per- sons, in the sight of copulating animals. This I would call mixoscopic zoophilia; it falls within the range of normal variations. Then there are cases in which the contact of animals, stroking, etc., produces sexual excitement or grati- fication; this is a sexual fetichism in the narrow sense and is by Krafft-Ebing termed zoophilia erotica. Then occurs the class of cases in which a real or simulated sexual in- tercourse with animals is desired. Such cases are not re- garded as fetichism by Krafft-Ebingt but they come within the phenomena of erotic symbolism, as here under- •Medicine, 1906-6. tFor Krafft-Ebing'B discussion of the subject, see Op. cil. pp. 580-539. (47) 48 Hayelock Ellis. stood. This class falls into two divisions: one in which the individual is fairly normal, but belongs to a low grade of culture; the other in which he may belong to a more re- fined social class, but is affected by a deep degree of de- generation. In the first case we may properly apply the term bestiality; in the second case it may perhaps be bet- ter to use the term zooerastia, proposed by Krafft-Ebing.* Among children, both boys and girls, it is common to find that the copulation of animals is a mysteriously fasci- nating spectacle. It is inevitable that this should be so, for the spectacle is more or less clearly felt to be the rev- elation of a secret which has been concealed from them. It is, moreover, a secret of which they feel intimate reverber- ations within themselves, and even in perfectly innocent and ignorant children, the sight may produce an obscure sexual excitement. It would seem that this occurs more frequent- ly in girls than in boys. Even in adult age, it may be added, women are liable to experience the same kind of emotion in the presence of such spectacles. One lady recalls as a girl, that on several occasions, an element of physical excitement entered into the feelings with which she watched the coquetry of cats. Another lady mentions, that at the age of about 25, and when still quite ignorant of sexual matters, she saw from the window some boys tickling a dog and inducing sexual excitement in the ani- mal; she vaguely divined what they were doing, and though feeling disgusted at their conduct, she at the same time experienced in a strong degree what she now knows was sexual excitement. The coupling of the larger animals is often an impressive and splendid spectacle, which is far indeed from being obscene, and has often commended itself to persons of great intellectual distinction.* But in young or ill-balanced minds, such sights tend to become prurient and morbid. I have already referred to the curious case of a sexually hyperaesthetic nun, who was always painfully *In England it la uncommon to use the term "unnatural offense." This is an awkward and possibly misleading practice which should not be followed. In Ger- many a similar confusion is caused by applying the term "sodomy" to thesu cases aa well as to pederastry. Krafft-Ebing considers that this error is dne to the jur- ists, while the theologians have always distinguished correctly. In this matter, he adds, science must be ancilla thtototiat and return to the correct usage of words. Erotic Symbolism. 49 excited by the sight, or even the recollection of flies in sexual connection, so that she was compelled to mastur- bate; this dated from childhood; after becoming a nun she recorded having had this experience, followed by masturba- tion, more than four hundred times.t In the case of pathological sexuality in a boy of 15, re- ported by J. A. McDonald, and already summarized, the sight of flies is also mentioned among many other causes of sexual excitation. Animal spectacles sometimes produce a sexual effect on children even when not specifically sexual; thus a cor- respondent, a clergyman, informs me that when a young and impressionable boy he was much affected by seeing a veteri- nary surgeon insert his hand and arm into a horse's rectum, and dreamt of this several times afterwards with emissions. While the contemplation of animal coitus is an easily in- telligible and in early life perhaps an almost normal symbol of sexual emotion, there is another sub-division of this group of animal fetichisms which forms a more natural transition from the fetichisms which have their centre in the human body: stuff-fetichism, or the sexual attraction exerted by various tissues, perhaps always of animal origin. Here oc- curs a somewhat complicated phenomenon. In part, there is a considerable number of such cases, the sexual attraction of feminine garments, for all such tissues are liable to enter into the dress. In part, also, there is sexual perversion of tactile sensibility, for in a considerable proportion of these cases it is the touch sensations which are potent in arousing the erotic sensations. But in part, also, it would seem, we have here the conscious or sub-conscious presence of an ani- •The Countess of Pembroke, Sir Philip Sidney's sister, appears to have found sexual enjoyment in the contemplation of the sexual prowess of staUions. Aubrey writes that she "was very salacious and she had a contrivance that in the spring of the year .... the stallions.... were to be brought before such a part of the house where she had a vidette to look on them." (Shart Lives, 1898, Vol. 1., p. 811). Although the modern editor's modesty has caused the disappearance of several lines from this passage the general sense is clear. According to Fuohs, (Dm Erotischc Element inder Karikatur. p. 70),Burckhardt, secretary to Pope Alexander VI, recorded in his diary that it was a favourite amusement of that pope and his daughter Lucrezia Borgia to overlook from the windows of the Vatican a court in which grooms were directed to let loose stallions with mares in heat. \Archivio di psicHiatria, 1902, fasc. 11 - 111, p. 888. 50 Havelock Ellis. mal fetich, :tnd it is notable that perhaps all these stuffs, and especially fur which is by far the commonest of the groups, are distinctively animal products. We may perhaps regard the fetich of feminine hair, a much more important and common fetich, indeed, than any of the stuff fetichisms— as a link of transition. Hair is at once an animal and a human product, while it may be separated from the body and possesses the quality of a stuff. Krafft-Ebing re- marks that the senses of touch, smell and hearing as well as sight seem to enter into the attraction exerted by hair. The natural fascination of hair, on which hair-fetichism is founded, begins at a very early age. "The hair is a special object of interest with infants," Stanley Hall con- cludes, "which begins often in the latter part of the first year. . . The hair, no doubt, gives quite unique tactile sensations, both in its own roots and to hands, and is plas- tic and yielding to the motor sense, so that the earliest in- terest may be akin to that in fur which is a marked object in infant experience. Some children develop an almost fetichistic propensity to pull or later to stroke the hair or beard of everyone with whom they come in contact."* It should be added that the fascination of hair for the infantile and childish mind is not necessarily one of attraction but may be of repulsion. It happens here, as in the case of so many characteristics which are of sexual significance, that we are in the presence of an object which may exert a dynamic emotional force, a force which is capable of repelling with the same energy that it attracts. Fere records the instructive case of a child of i, of psychopathic heredity, who when he could not sleep was sometimes taken by his mother into her bed. One night his hand came in contact with a hairy portion of his mother's body and this, arousing the idea of an animal, caused him to leap out of bed in ter- ror. He became curious as to the cause of his terror and in time was able to observe "the animal" buc the train of feelings which had been set up, led to a life-long indiffer- ence to women and a tendency to homosexuality. It is *G. Stanley Hall, "The Barly Sense of Seir," (Aimrican Journal o/ Psychohcv April, 1888, p. 869.) Erotic Symbolism. 51 noteworthy that he was attracted to men in whom the hair and other secondary sexual characters were well developed.* As a sexual fetich hair strictly belongs to the group of parts of the body; but since it can be removed from the body and is sexually effective as a fetich in the absence of the person to whom it belongs, it is on a level with the garments which may serve in a similar way, with shoes or handkerchiefs or gloves. Psychologically hair fetichism pre- sents no special problem but the wide attraction of hair—it is sexually the most generally noted part of the feminine body after the eyes—and the peculiar facility with which when plaited it may be removed, render hair-fetichism a sexual perversion of specially great medico-legal interest. The frequency of hair fetichism, as well as of the natural admiration on which it rests, is indicated by the case recorded by Laurent.t "A few years ago," he states, "one constantly saw at the Bal Bullier in Paris a tall girl whose face was lean and bony, but whose black hair was of truly remarkable length. She wore it flowing down her shoulders and loins. Men often followed her in the street to touch or kiss the hair. Others would accompany her home and pay her for the mere pleasure of touching and kissing the long black tresses. One, in consideration of a relatively considerable sum, desired to pollute the silky hair. She was obliged to be always on her guard, and to take all sorts of precautions to prevent anyone cutting off this ornament which consti- tuted her only beauty as well as her livelihood. The hair despoiler (Coupeur des Nattes or Zopfabschneider) may be found in any civilized country though the most carefully studied cases have occurred in Parist. Such persons are usually of nervous temperament and bad heredity; the attraction to hair occasionally develops in early life; sometimes the morbid impulse only appears in later life after fever. The fetich may be either flowing hair or braided hair but is usually one or the other and not both. Sexual excitement and ejaculation may be produced in the (•Fere, Ulnstinct Sexuel, 2nd. ed, pp. 282 - 266). tH. Laurent, VAmour MorHdc, 1891, p. 164. tSeveral medico-legal histories of hair-despoilers are summarised by Krafft- Ebing, Opus. cit. pp. 829 . 884. 52 Havelock Ellis. act of touching or cutting off the hair, which is subsequently, in many cases, used for masturbation. As a rule the hair despoiler is a pure fetichist, no element of sadistic pleasure entering into his feelings. In the case of a "capillary klep- tomaniac" in Chicago—a highly intelligent and athletic mar- ried young man of good family—the impulse to cut off girl's braids appeared after recovery from a severe fever. He would gaze admiringly at the long tresses and then clip them off with great rapidity; he did this in some fifty cases before he was caught and imprisoned. He usually threw the braids away before he reached home.* In this case there is no history of sexual excitement, probably because no proper medico-legal examination was made.t The stuff-fetiches are most usually fur and velvet, feathers, silk and leather also sometimes exerting this in- fluence; they are all it will be noted, animal substances.t The most interesting is probably fur, the attraction of which is not uncommon in association with passive algolagnia. As Stanley Hall has shown, the fear of fur, as well as the love of it, is by no means uncommon in childhood; it may appear even in infancy and in children who have never come in contact with animals.II It is noteworthy that in most cases of uncomplicated stuff-fetchism the attraction apparently arises on a congenital basis, as it appears in persons of nervous or sensitive temperament at an early age and without being attached to any definite causative incident. The sexual excitation is nearly always produced . by the touch rather than by the sight. As I found, when dealing with the sense of touch in a previous volume, the specific sexual sensations may be regarded as a spe- cific modification of ticklishness. The erotic symbolism in the case of these stuff-fetichisms would seem to be a more or less congenital perversion of ticklishness in relation to specific animal contacts. *AU**Ut and Neunlatut. April, 1889, p. 826. tit may be added that halr-despoilers have been specially studied by Motet, "Us Ooupearo de Nattes," AnnaUi d'Hyfiau, 1890. tKraff t-Ebisiu presents or quotes typical cases of all these fetiches, Op. olt. pp. 255-266. ||Q. Stanley Hall, "Study of Fears", American Journal of Psychology, 1897, pp. 318-215. Erotic Symbolism. 53 A further degree of perversion in this direction is reached in a case of erotic zoophilia recorded by Krafft- Ebing.* In this case a congenital neuropath of good intel- ligence but delicate and anaemic, with feeble sexual pow- ers, had a great love of domestic animals, especially dogs and cats, from an early age; when petting them he ex- perienced sexual emotions, although he was innocent in sexual matters. At puberty he realized the nature of his feelings and tried to break himself of his habits. He suc- ceeded, but then began erotic dreams accompanied by im- ages of animals, and these led to masturbation with ideas of a similar kind. At the same time he had no wish for any sort of sexual intercourse with animals and was indif- ferent as to the sex of the animals which attracted him; his sexual ideals were normal. Such a case seems to be fundamentally one of fetichism on a tactile basis and thus forms a transition between the stuff-fetichism and the com- plete perversion of sexual attraction towards animals. In some cases sexually hyperaesthetic women have informed me that sexual feeling has been produced by cas- ual contact with pet dogs and cats. In such cases there is usually no real perversion but it seems probable that we may here have an occasional foundation for the somewhat morbid but scarcely vicious excesses of affection which women are apt to display towards their pet dogs or cats. In most cases of this affection there is certainly no sexual element; in the case of childless women it may rather be regarded as a maternal than as an erotic symbolism, t Krafft-Ebing considers that complete perversion of sex- ual attraction towards animals is radically distinct from erotic zoophilia. This view cannot be accepted. Bestiality and zooerastia merely present in a more marked and pro- foundly perverted form a further degree of the same phe- nomenon which we meet with in erotic zoophilia; the dif- ference is that they occur either in more insensitive or in more markedly degenerate persons. •Op. cit. p. 268. 'The excesses of this non-erotic zoophilia have been discussed, Fere, L'ln- stinct Sexoel, 2nd ed. pp. 164-171. 54 Have lock Ellis. A fairly typical case of zooerastia has been recorded in America by W. L. Howard of Baltimore. This was the case of a boy of 16, precociously mature and fairly bright. He was, however, indifferent to the opposite sex, though he had ample opportunity for gratifying normal passions. His parents lived in the city but the youth had an inordi- nate desire for the country and was therefore sent to school in a village. On the second day after his arrival at school a farmer missed a sow which was found secreted in an out- house on the school grounds. This was the first of many similar incidents in which a sow always took part. So strong was his passion that on one occasion force had to be used to take him away from the sow he was caressing. He did not masturbate and even when restrained from ap- proaching sows he had no sexual inclination for other ani- mals. His nocturnal pollutions, which were frequent, were always accompanied by images of wallowing swine. Not- withstanding careful treatment no cure was effected; mental and physical vigor failed and he died at the age of 23.* It is, however, somewhat doubtful whether we can al- ways or even usually distinguish between zooerastia and bestiality. G. F. Lydston of Chicago has communi- cated to me a case (in which he was consulted) which seems fairly typical and is instructive in this respect. The subject was a young man of 21, a farmer's son, not very bright intellectually but very healthy and strong, of great assistance on the farm, very capable and industrious, such a good farm hand that his father was unwilling to send him away and to lose his services. There was no history of in- sanity or neurosis in the family, and no injury or illness in his own history. He had spells of moroseness and irrita- bility, however, and had also been a masturbator. Women *W. L. Howard "Sexual Perversion", Alienist and Neurolotist, Jan. 1896. Kratft- Ebing (op. at- p. 532) quotes from Boeteau the somewhat similar case of a gardner's boy of 16—an illegitimate child of neuropathic heredity and markedly degenerate —who had a passion, of irresistible and impulsive character, for rabbits. Be was declared irresponsible. Moll (Untersucukngen uber die Libido Sexuallis, Bd. 1. pp. 431-438) presents the case of a neurotic man who from the age of 16 had been sexu- ally excited by the sight of animals or by contact with them. He had repeatedly had connection with cows and mares;he was also sexunlly excited by sheep, don- keys, and dogs whether male or female; the normal sexual instinct was weak and he experienced very slight attraction to women. Erotic Symbolism. 55 had no attraction for him but he would copulate with the mares upon his fathers farm, and this without regard to time, place or spectators. Such a case would seem to stand midway between ordinary bestiality and pathological zoo- erastia as defined by Krafft-Ebing, yet it seems probable that in most cases of ordinary bestiality some slight traces of mental anomaly might be found, if such cases always were, as they should be, properly investigated.* Here is reached the grossest and most frequent per- version in this group: bestiality or the impulse to attain sexual gratification by intercourse, or other close contact, with animals. In seeking to comprehend this perversion, it is necessary to divest ourselves of the attitude towards animals which is the inevitable outcome of refined civiliza- tion and urban life. Most sexual perversions, if not in a large measure the actual outcome of civilized life, easily adjust themselves to it. Bestiality (except in one form to be noted later) is, on the other hand, the sexual perversion of dull, insensitive and unfastidious persons. It flourishes among primitive people and among peasants. It is the vice of the clodhopper, unattractive to women or inapt to court them. Three things have favored the extreme prevalence of bestiality: (1) primitive conception of life which built up no greater barrier between man and the other animals; (2) the extreme familiarity which necessarily exists be- tween the peasant and his beasts, often combined with separation from women; (3) various folk-lore beliefs such as the efficacy of intercourse with animals as a cure for venereal disease, etc.t The beliefs and customs of primitive peoples, as well as their mythology and legends, create a community of man and animals altogether unlike anything known in civilisation. *Mollalso remarks ("Pervers Sexual Empfindung" in Senator's and Kaminer's Krankheilen und Ehe) that in thiB matter it is often hardly possible to draw a sharp line between vice and disease. f Instances of this belief—found among the Tamils of Ceylon as well as in Eu- rope—from various authors are quoted by Blocb, Beiirage tur Aetiolitic der Psychopa- tkia Sexuallis. Teil 11, p. 278, and, Moll, Untersuchungen ubcr die Libido Sexuallis, Bd. 1, p. 700. On the frequeney of bestiality, from one cause or another, in the East, see e. f. B. Stern, Median und Ceschlechtsleben in der Turkei, Bd. II, p. 218. 56 Havelock Ellis. Men may become animals and animals may become men; animals and men may communicate with each other and live on terms of equality; animals may be the ancestors of human tribes; the sacred totems of savages are most usually ani- mals; there is no shame or degradation in the notion of a sexual relationship between men and animals because in primitive conceptions animals are not inferior beings sepa- rated from man by a great gulf. They are much more like men in disguise and in some respects possess powers which make them superior to men. This is recognized in those plays, festivals and religious dances so common among primi- tive peoples in which animal disguises are worn.* When men admire and emulate the qualities of animals and are proud to believe that they descend from them it is not sur- prising that they should sometimes see nothing derogatory in sexual intercourse with them.t A significant relic of primitive conceptions in this matter may perhaps be found in the religious rites connected with the sacred goat of Mendes described by Herodotus. After telling how the nedesians reverence the goat, especially the he-goat, out of their veneration for Pan, whom they repre- sent as a goat ("the real motive which they assign for this cumtom I do not choose to relate"), he adds: "it happened in this country, and within my remembrance, and was in- deed universally notorious, that a goat had indecent and public communication with a woman."t The meaning of the passage evidently is that in the ordinary intercourse of women with the sacred goat connection was only simulated or incomplete on account of the natural indifference of the goat to the human female, but that in rare cases the goat proved sexually excitable with the woman and capable of connection.il •Sometimes (as among the Aleuts) the animal pantomime dances of savages may represent the transformation of a captive bird into a lovely woman who falls exhausted into the arms of the hunter. (H. H. Bancroft. Native Races of Pacific, Vol. 1. p. 98.) A system of beliefs which accepts the possibility that a human being may be latent in an animal obviously favours the practice of bestiality. tFor an example of the primitive confusion between the intercourse of women with animals and with men, see, e. g. Bons, "Sagen aus Britlsch-Columbien," Zeilschrift fur Ethnolotic. Heft V. p. 558. tHerodotus, Bit. 11. Oh. 48. IIDulaure (D« Divinites Generatrices. CM. 11.) brings together the evidence showing that in Egypt women had connection with the sacred goat, apparently in order to secure fertility. Erotic Symbolism. 57 The goat has always been a kind of sacred emblem of lust. In the middle ages it became associated with the Devil as one of the favourite forms he assumed. It is significant of a primitively religious sexual association between men and animals that witches constantly confessed, or were made to confess, that they had had intercourse with the Devil in the shape of an animal, very frequently a dog. The figures of human beings and animals in conjunction carved on temples in India also seem to indicate the religious significance which this phenomenon sometimes presents. There is, indeed, no need to go beyond Europe even in her moments of highest culture to find a religious sanction for sexual union between human beings, or gods in human shape, and animals. The legends of Io and the bull, of Leda and the swan, are among the most familiar in Greek mythology, and in a later pic- torial form they constitute some of the most cherished works of the painters of the Renaissance. As regards the prevalence of occasional sexual inter- course between men or women and animals among primi- tive peoples at the present time, it is possible to find many scattered references by travelers in all parts of the world. Such references by no means indicate that such practices are as a rule common, but they usually show that they are accepted with a good-humored indifference.* Bestiality is very rarely found in towns. In the coun- try this vice of the clodhopper is far from infrequent. For the peasant whose sensibilities are uncultivated and who makes but the most elementary demands from a woman, the difference between an animal and a human being in this respect scarcely seems to be very great. "My wife was away too long", a German peasant explained to the magistrate, "and so I went with my sow." It is certainly an explanation that to the uncultivated peasant, ignorant of theological and juridical conceptions must often seem natural and sufficient. Bestiality thus resembles masturbation and other ab- * Various facts and references bearing on this subject are brought together by Bluemenbach, Anthropolotical Memoirs, tr. by Bendyshe, p. SO; Bloch, Beilratt r»r Actiolot't der Psychopathia Sexuallis, Teil 11, pp. 276-288; also Ploss and Bartells, Das Weib, 7th ed., p. 520. 58 Havelock Ellis. normal manifestations of the sexual impulse which may be practiced merely faute de mieux and not as, in the strict sense, perversion of the impulse. Even necrophily may be thus practiced. A young man who was assisting the grave- digger conceived and carried out the idea of digging up the bodies of young girls to satisfy his passions with and whose case has been recorded by Belletrud and Mercier, said: "I could find no young girl who would agree to yield to my desires; that is why I have done this. I should have preferred to have relations with living persons. 1 found it quite natural to do what I did; I saw no harm in it, and I did not think that anyone else could. As living women felt nothing but repulsion for me, it was quite natural I should turn to the dead who have never repulsed me. I used to say tender things to them, like 'my beautiful, my love, 1 love you'."* But when so highly an abnormal an act is felt as natural, we are dealing with a person who is congenitally defective, so far as the finer developments of intelligence are concerned. It was so in this case of necrophily; he was the son of a weak-minded woman of unrestrainable sexual inclinations and was himself somewhat feeble minded; he was also anaemic. But it is by no means their deluded sensibilities, or the absence of women which accounts for the frequency of bestiality among peasants. A highly important factor is their constant familiarity with animals. The peasant lives with animals, tends them, learns to know all their individ- ual characters; he understands them far better than he understands men and women; they are his constant com- panions, his friends. He knows, moreover, the details of their sexual lives, he witnesses the often highly impressive spectacle of their coupling. It is scarcely surprising that peasants should sometimes regard animals as being not only as near to them as their fellow human beings, but even nearer. The significance of the factor of familiarity is indicated 'Belletrud and Mercier, "Perversion de 1'Instiuct Genesique" Annales d'Hv- guiu Publiquc. June, 1908. Erotic Symbolism. 59 by the great frequency of bestiality among shepherds, goat- herds and others whose occupation is exclusively the care of animals. Mirabeau in the eighteenth century stated, on the evidence of Basque priests, that all the shepherds in the Pyrenees practice bestiality. It is apparently much the same in Italy.* In south Italy and Sicily, especially, bes- tiality among goat-herds and peasants is said to be almost a national custom.t In the extreme north of Europe, it is reported the reindeer, in this respect, takes the place of the goat. •Mantcgazza mentions (Gti A mora deeh Uomini, cap. V) that at Rimini a young goat-herd of the Apennines, troubled with dyspepsia and nervous symptoms, told him he had gone to excesses with the goats in his care. A finely executed marble group of a satyr having connection with a goat, found at Herculaneum and now in the Naples Museum (reproduced in Fuchs's Erotische Element in der Karakatur) per- haps indicates a traditional and primitive practice of the goat-herd. tBayle (Dictionary, Art, Bathyllus) quotes various authorities concerning the Italian auxiliaries in the south of France in the sixteenth century and their custom of bringing and using goats for this purpose. Warton in the eighteenth century was informed that in Sicily priests in confession habitually inquired of herdsmen If they had anything to do with their sows. In Norway priests are ad- vised to ask similar questions. (To be continued.) RODONALGIA PHALANX OR PHALANGES OR FINGER ERETHROMELALGIA WITH A THEORY OF CAUSATION. BY CHARLES H. HUGHES, M. D., ST. LOUIS. A CONDITION similar to S. Weir Mitchell's erethro- melalgia has several times, within the past thirty years of neurological observation, come under my notice in the hands only, and not involvingthe feet or lower limbs. The latest case occurring in a maiden lady markedly neuras- thenic and approaching the menopause, having impressed me so forcefully as a vasomotor neurosis secondary to long standing and recurring neurasthenic exacerbations, that I have deemed it a duty to here record it. The lady, tall, slender and light of weight for her height, not exceeding one hundred and twenty pounds, has passed through the dodging period of her menopause with occa- sional general flushings, etc. But the intense pain and rose-: like redness confined to her fingers, with oedema and extreme | sensitiveness to touch of the finger tips was, until recently i persistent and continuous. Her occupation is that of a' writist and copyist in an insurance office. She first came under my observation about twenty years ago with no sign of her recent trouble, but suffering from profound neuras- j thenia and cerebrasthenia, the result of a sedentary life and i copying work in a recording office. Cessation from her accustomed occupation, rest and treatment away from the place of her nervous breakdown then brought about her recovery. Preceding the present local, morbid manifestation, she has several times become mark- edly exhausted and required rest and treatment for neurotic (60) Rodonalgia Phalanx or Phalanges. 61 adynamia and insomnia. A part of her work has been to lift exceedingly heavy books of the weight of which she has often complained. Her fingers, extending to the palm of her hand, would swell and burn and become painfully sen- sitive, remaining so until relieved with copious Goulard's Extract and sulphuric ether bathing, a systematic laxative protoide of mercury and salol course and thirty grain doses of bromide of sodium (ter in die) with constant current galvanism for vaso-contractile effect. The finger pain was excruciating, the tactile sense extremely hyperalgesic, the tips and palmar surfaces of the fingers were roseate in color, including the palms, the dorsal aspect of the hands being also red but not so extremely so. The history of this con- dition and its cause convince me that these rodonalgic phal- anges have been produced by prolonged neurasthenic vaso- | motor strain. There was no rise of temperature but a sensa- tion of heat, of distension and pain with rose red appearance. Galen's definition of inflammation, viz, "calor, dolor, robor, tumor" was all there but the calor. There was no preceding or succeeding angio-spasm in this case. It was somewhat parox- ysmal, that is, subsiding during the latter part of the day, but coming on mornings and persisting for hours, sometimes all day. No secondary oedema showed in this case, no gangrene of the finger tips. There was much accompanying neurotic dyspepsia and the lady has been much and long under neurological treatment at intervals of months and years. The patient was extremely agitated and alarmed over her condition and the neurotic insomnia which formerly troubled her much returned, requiring nightly doses of chlo- ral for a few nights until after she came under full bro- mide control. With the return of sleep and the disappear- ance of the local trouble she regained her mental tranquility. This lady has a narrow shaped, rather masculine pel- vis, small fourchette and cervix and vagina, a densely mem- branous, imperforate hymen, small chest and undeveloped' mammae, scanty genital hair growth, scanty but regular menstrual flow up to the recent final cessation, no appreciable utero-vaginal or ovarian disease. An occasional ovaralgia, 62 Chas. H. Hughes. alternating with transient spinalgias and cardialgias, have ap- peared at intervals, due 1 think, to long standing at a high desk, writing. The case appears to be one of nerve strain from over brain tax and successive bereavements combined, both father and mother being dead. She has had headaches, but no periodically recurring cephalgia or migrain and has no defect of vision. I place the trouble in the vasomotor system, in- fluenced by brain strain, where I place erethromelalgia and think the history of the case warrants the neuro-physiological location. There has been no typical paroxysmal hysteria manifest in this woman's life and less ataxy of the emotions than is common to many neurotic women. Depressive emotions and voluntarily suppressed weepings were sometimes mani- fest, but never without rational apprehensive cause, in view of her self dependent position in life and the fear of becom- ing disabled of her occupation. Most of her neuarasthenic symptoms were cerebropsychic and pointed to descending influence from cerebrum to the vasomotor centers of the medulla. The locus morbi was evidently in the brain. 3872 Washington Boulevard. SOCIETY AND ITS DEGENERATES. By MARC RAY HUGHES, M. D. Professor of Mental and Nervous Diseases, Barnes' University (Med. Dept.) Professor of Criminal Anthropology, Benton College of Law, Associate Editor Alienist and Neurologist, St. Louis, Mo. ■ T is astounding, the rapidity with which crime life is in- ■ creasing in all its branches and departments. Instead of the world growing better, it is steadily becoming a veri- table Sodom and Gomorrah. The blame can be laid at no other door than our own. The terrible rush in which we live, coupled with the use of alcohol, is the foundation and the key-note to the situation, leaving in its terrible wake devastation and ruin, resulting in degenerates in all walks of life. Our whole social system is wrong, and the allure- ments of the so-called high society are as debased and degrading as they were during the degenerate dy- nasty of the soul-eaten, brain-rotted monarch Nero, who lived solely within his animal nature. Instead of our coun- try becoming better in its onward march to the so-called higher civilization, it is receding in that respect, and shame lurks in every corner of our continent. The social evils of "High Society" are enormous and are the producers of crime directly. The way things are going now, and the terrific increase in crime, the next generation will be more completely degenerated, and so on until insanity, crime or de- generacy will be in every family, for insanity, crime, and degeneracy are all of one origin, and belong to the great family of degenerates, whose whole thought in life never passes beyond that of satisfying their animal natures, which dominate their lives. (63) 64 Marc Ray Hughes. Thus the society aspirant lives until this terrible desire for social supremacy has led him from the punch bowl at the fashionable receptions, to the gambling ta- bles of the pseudo ultra set, where nothing less than whiskey is drunk, and the drained glasses filled as soon, or before they are quite empty. A taste and desire for stim- ulation becomes increasing until many, whose naturally weak brains give way to impulse, they find themselves living their unuseful lives in an atmosphere of debauchery, and living for nothing but sensual pleasures. I could enumerate many instances where society, or the aristocracy, if you please, has caused the downfall of many who chose to worship at its infamous shrine, and I offer one of many instances; a clipping from one of our daily papers—verbatim as it appeared in its columns—showing how the extreme desire for social supremacy leads to crime: Says society leads to theft.* Protege of Gen. Grant charged with stealing woman's garments. NO FRIENDS IN COURT. Youth was member of Roosevelt party at Army and Navy game. NEW YORK, Dec. 12.—"Your honor, I did wrong. It is next to impossible to do right here, especially if you have social inclinations." Macon Broome, cousin of Col. Broome, of Governor's Island, protege of Gen. and Mrs. Fred Grant,' and son of former Senator Broome of Florida, made this astonishing confession in Jefferson Market Court. He was charged with larceny in taking $125.00 worth of women's skirts and waists contained in a trunk belonging to the Princess Skirt Co. Broome had obtained employment, and thus received the trunk full of samples. Broome was questioned by Assistant District Attorney Appleton, who conducted the prosecution. "What was the last football game you attended?" asked the prosecutor. *Po$l-Dispatch, Dicembtr 12. 1905. Society and its Degenerates. 65 "The Army and Navy game," replied the prisoner. "You were frequently at social functions at Governor's Island and elsewhere?" "Yes, sir." "You have attended social functions since that date?" HE DfcANK WINE. "I drank wine and liquors on those occasions. It is impossible to do right, especially if you have social incli- nations." "Do you mean to say that these social affairs that you attended led you to this trouble?" "Well, I remained in an intoxicated condition, and failed to fulfill my obligations with the company with which I had negotiated." "You have grossly violated the trust," said Magistrate Wahle, "but so far as I see, you do not come under the jurisdiction of this court." Lawyer Mark Alter, representing Broome, assured the court that the property would be returned to the owner at once. The trunk, containing 49 skirts and 18 waists, was subsequently turned over to the skirt company. Although none of the influential friends of Broome ap- peared in court, it was said that they had retained counsel for him. He said he was a frequent guest on Governor's Island, and was a football enthusiast. At the Army and Navy game, he was a member of the party of which Pres- ident Roosevelt and Gen. Grant and wife were also members. This is only one of the many instances where the weaker or more unstable of the world's human atoms (so far as brains and stability are concerned) had fallen be- cause of thwarted desires to be among the, so to speak ultra class, which in itself simply means to the thinking mind, nothing—intellectually nothing in the majority of cases. They have the self-assertiveness of their class, and are not so free from mental impairment as the next, or middle class. It would be useless for me to go into the details of 66 Marc Ray Hughes. the whys and wherefores which place this class in its present sphere of mental and moral environment; but suf- fice it to say, "The idle brain is the devil's workshop," and there is nothing more true, for it is the producer of immorality and crime among the aristocracy. Their lives are led in such a way as to be an allure- ment to the young and unsophisticated, and lead them blindly into the delusions and snares of Society, as it is termed, until the web of crime has been woven around their supple natures, and they are dragged down to the depths of degradation and ruin. It happens that the ones who fall into the hands of the law are the ones who have not money enough to keep them out. Daily the laws of the country are violated, but it is done so behind the doors of the rich, not the aris- tocracy, but the pseudo-aristocracy, or the plutocracy, if you please, whose money casts a shahow over their crimes, so the "ever-watchful" eye of the law cannot see. 1 men- tion the above and have used the clipping to show that the young man's aspirations were of the highest, and above all, during his rounds of social pleasure he indulged in liquor, which 1 contend is the one evil, and from its use we can count more criminals than from any other source. As a producer of crime, it stands first, unless it be a lack of moral stamina, which is degeneracy itself. THE Alienist and Neurologist. VOL. XXVII. ST. LOUIS, FEBRUARY, 1906. NO. 1. Subscription S5.00 per Annum In Advance. $1.25 Single Com CHAS. H. HUGHES. M. D., Editor. HENRY L. HUGHES. Manager and Publisher. Editorial Rooms. 3872 Washington Boul. Business Office. 3872 Washington Boul. This Journal Is published between the 6rst and fifteenth of February. May, August and November, and subscribers falling to receive the Journal by the 20th of the month of Issue will please notify us promptly. Entered at the Postoffice In St. Louis as second-class mall matter. EDITORIAL. [Alt Unsigned Editorials art written by the Editor.) PRESIDENT ROOSEVELT ON THE PHYSICIAN.—The editor of this journal has before the American Medical Edi- tors Association, and in our editorial columns, commended the fair and complimentary attitude of President Roosevelt toward the physician. We have also insisted on the medi- cal profession coming forward and taking its place among the leaders of the people. It pleases us therefore to see the following editorial in the Canadian Journal of Medicine and Surgery, taken from the editorial pages of the Journal of the American Medical Association. The medical and secular press should copy this. The thoroughly educated medical man stands on the highest plane among men. What President Roosevelt said of the medical profes- sion in his address before the Associated Physicians of Long Island is a decided tribute. He said that "the con- dition precedent on success in digging the Panama canal is having the proper type of medical work as a preliminary." He spoke of the physician's character in a most apprecia- (67) 68 Editorial. tive way. He said, among other things: "The doctor has, on the one hand, to be the most thoroughly educated man in applied science that there is in the country, and on the other hand the doctor gradually becomes the closest friend to more different people than would be possible in any other profession." At considerable length, the President showed that he appreciates the duties, difficulties and op- portunities of the scientific physician. Referring to the task at Panama, he indicated the de- pendence that must be placed on medical science to make the conditions of work such that the engineers can accom- plish their task. We echo his confidence that the condi- tions hostile to health are going to be controlled by the sanitary authorities. The alarmist stories brought by a few panic-stricken individuals must be received at their true value. The fact is that the rainy season is never a favorable one for sanitary work in the tropics, and, further, we are still suffering to some extent, it is probable, from the dilatory and red tape methods which were denounced by Dr. Reed. If Dr. Gorgas could have had full swing from the first we may safely assume that matters would be better now, as we feel sure they will be soon. There will be difficulty, especially on the Atlantic side of the isthmus, in controlling the mosquito pest, but what has been done in other tropical countries, the confederated Ma- lay states, for example, can be accomplished even there. We feel satisfied that the sanitary authorities on the isth- mus will do their full duty if untrammeled, and that the health results will be commensurate. In expressing his confidence in the ultimate results at Panama, the President recalled the splendid example of Cuba, and paid a well-earned tribute to the effective work there of Leonard Wood. In this connection his words of resentment at the criticism to which Wood has been sub- jected were keen. "There has been no meaner and more unpleasant manifestation in all our public history than the feeling of envy and jealousy manifested toward Wood." And then came a sentence pregnant with sad thought for the men of Editorial. 69 medicine—"and the foul assaults and attacks made on him, gentlemen, were largely because they grudged the fact that this admirable military officer should have been a doctor." It is to be feared that there is herein too much truth. Why a physician should be grudged military or civil suc- cess it is not easy to reason out, but the fact seems real. Perhaps it is a popular inheritance from past ages, when medicine was not a science and when physicians were en- meshed in superstition. To what else can such prejudice be laid? Certainly the educated medical man of the pres- ent affords no excuse for such a view of his efforts. How- ever, we need not heed it. Constantly, as we improve ourselves in education and fitness, our position is advanc- ing. The physician of the future again will be in a ra- tional way, the arbiter of men's fortunes. The very words of the President are a step forward, and we should be grateful to him, not for seeing our plight, but for speaking loudly his dissent from the too-prevalent anti-medical prej- udice. Surely, though slowly, we are moving forward, and for every aid are grateful. Not least among our friends and appreciators stands Theodore Roosevelt.—Edit. Jour. A. M. A. The present day physician's advanced research and thought entitle him to a high place in the councils of state and people. With the great forward movement made and making in the sciences that contribute to make his great profession, he can not longer be kept in the back- ground in army, naval, civil or political life. A doctor should have been in the President's cabinet from the time of Benjamin Rush, whose tardily erected monument in Washington is a century late recognition of one of the greatest men and patriot statesmen, and he has not yet found place in Miss Gould's Hall of Fame, where the names of so many less worthy among the conspicuous in other lines of merit, are placed. THE AMERICAN JOURNAL OF CLINICAL MEDICINE is the new title of the Alkaloidal Clinic and indicates a wider development of that very popular publication. Un 70 Editorial. der the energetic management of Drs. Abbott and Waugh and their associates, the changed journal will be sure to increase in influence and value. THE CITIZENS OF MEMPHIS presented ten thousand dollars to Dr. Heber Jones, the health officer, for doing his duty during the yellow fever ;period at New Orleans in keeping the scourge out of his own city. The reward was accompanied with a pretty woman's laudatory presentation speech, concluding with a kiss. The kiss of a sweet, motherly woman was an oppor- tune and appropriate addition to this reward of merit for keeping our domestic yellow peril from our households, sig- nificant as it was, of woman's gratitude for the deliverance. The one reward was substantial, the other aesthetic, and Dr. Jones ought to count himself happy for this pub- lic approval of work for the welfare of his people well done. Medical men are not always thus rewarded. Their le- gitimate fees are too often grudgingly doled to them and their services and sacrifices for the public good, too often unappreciated, while less useful public servants are loudly and fulsomely applauded. Note for example the plaudits of the warrior and oft the politician receives. A FOOL WITH A FOOLISH DINNER and dallying with sin is said to have been the ultimate cause of the greatest investigation and fraud revelations in the history of life in- surance, and yet every state has one or more institutions where idiots may be safely placed beyond harm to them- selves or others, all except the idiot savants of high finance, expert at planning for filling their purses and bank vaults with other people's money, but wickedly foolish in every- thing else. IN VIEW OF RECENT LIFE INSURANCE REVELA- TIONS of enormous profits and official salaries, does not the doctor's little fee seem small and the doctor himself appear smaller still, for accepting so small a stipend. Buncoed out of a worthy recompense through the plea of charity, Editorial. 71 his susceptible heart is won and his pocket is robbed, while robber insurance officials revel in high life, luxury and un- earned wealth. A FOOLISH CLERGYMAN.—Recently in an address to the nurses of the Oakes' Sanitarium, of Denver, an ig- norant, egotistical gentleman of the sacred cloth said: "l am heartily in favor of nurses; they do more good than the physician. But one thing in that connection which has always aroused me, is the fact that the minis- ters are not allowed in the sick room by the physicians. A minister can do a sick person more good than all the pills and medicines any physician ever poured down one's neck, and I want all you nurses to remember this and get us in to see the sick every time we come here." This inelegant, ungrateful, coarse, rude, untruthful, dis- courteous speech ill becomes the follower of the Divine Master, who in sweetness and tenderness said, "they that are sick need a physician." The right sort of ministers are never forbidden the sick, except at times when their silence is golden for the patient's welfare. At such times the wise and considerate follower of the meek and lowly should respect the sanctity of the sick chamber and the counsels of the good physician. Such illy-considered, ig- norant words come with bad grace from such a source. What would St. i Luke, the good physician, as the Saviour called him, say to this false, unclerical, uncharitable in- dictment? A MISCONCEPTION OF ST. LOUIS CORRECTED.— Recently before the Ministerial Alliance, a noted divine, Reverend Dr. Lee, after, reading a very meritorious paper before that ecclesiastical body, received an unanimous vote of thanks. In commenting on it the Reverend Dr. Bitting, who re- cently came from New York, said that when he left the metropolis he was told that St. Louis was centuries behind the times, that the ministers here still adhered to sixteenth* century ideas, and that the city lacked profound scholars. This criticism, he said, he has since learned to know, was 72 Editorial. entirely contrary to facts. Similar impression exists in some benighted Eastern Medical Minds respecting the medical profession of St. Louis, judging from some things said and written and omitted to be said and penned, notwithstanding some of these speakers and writers received instruction and are still so receiving from minds transported from the Missouri, Mississippi, Illinois and Ohio Valley's tributary country, to say nothing of the Rocky Mountain and Atlantic coast re- gion savants in the medical sciences. Eminent names from the west and south and central states will readily oc- cur to one who may seek them in the ranks of medical, scientific and literary achievement. A NOTABLE HONOR MERITED BY A NOTABLE MAN.—George P. Rowell, the pioneer and master in the field of the art and enterprise of advertising, who has retired from the business in which he has won merited distinction, was tendered a complimentary dinner by his friends on the occasion of his active retirement from business, at the Wal- dorf-Astoria, on the evening of October 31, 1905. One hundred and sixty two persons participated. The booklet containing the menu bore on its cover a portrait of Mr. Rowell, and contained the following "appre- ciation" of him: "He has lived three score years, and lived them well. To be conscious of that, one need but know his enemies. Some are in high places. That demonstrates the courage of the man. "Nature has been kind to Rowell. She has endowed him with a prolific mind, a retentive memory and a discreet optimism. They have served him well. His friends they have served better. "Rowell has laid down his work. He is done with the burden of business. Yet his influence will gather strength with the years. Let us be profoundly grateful that he worked with us and for us—that he paved the way. "Then here is to Rowell. If for every man to whom he has extended a helping hand, the Powers will grant Editorial. 73 him a year of life, George Presbury Rowell will live forever." General Stewart L. Woodford, formerly United States Minister to Spain, and a life-long friend of Mr. Rowell, pre- sided, and many kindly and merited words of compliment * were spoken of his long and fruitful career. THE FIFTEENTH INTERNATIONAL MEDICAL CON- GRESS will assemble at Lisbon, Portugal, from the 19th to the 26th of April, prox. The official language of the Con- gress will be French, but in the general sessions, as well as in the meeting of sections, in addition to French, Eng- lish and German will be used. The president is Conz Costa Alemao, and the secre- tary-general is Professor Miguel Bombarda, of Lisbon. The United States committees are Dr. Jno. H. Musser, of Phil- adelphia, president, and Dr. Raymond Guiteras, secretary. The Executive Committee of the Canadian Medical As- sociation has appointed Dr. A. McPhedran as president, and Dr. W. H. B. Aikins as secretary for Canada, to act in conjunction with the International Committees of the Congress. THE MERIT OF AMERICAN AND EUROPEAN MEDI- CAL COLLEGES CONTRASTED FAVORABLY TO AMERI- CAN INSTITUTIONS.—Dr. Nicholas Senn's recent article published in Collier's IVeekly makes the statement that at the present time it in not necessary for the medical stu- dent to go to Europe to complete his medical education, and quotes the following, which we accord with our obser- vation as a travelled teacher: "Our students waste no time in the beer gardens and on the field of honor. They come to our schools with a firm determination to master the principles and practice of their chosen profession as thoroughly as possible during their pupilage, and apply themselves to the task with zeal and devotion. The numerous hospitals that are springing up in all of our large cities secure for a good percentage of our graduates appointments as internes, where they are 74 Editorial. given the best possible advantages for a successful post- graduate practical training. There is no longer any need for our students to cross the Atlantic for the purpose of studying medicine. A comparison between an equal num- ber of recent graduates from our high requirement medical schools and those of Europe would unquestionably result in favor of the former. The American is intensely prac- tical in everything he undertakes, and our methods of teaching medicine constitute no exception. "Present indications in the field of medical education in this country do not only prove that our first-class medical schools have reached a standard of proficiency equal, if not superior, to those of any other country, but that in less than half a century our great cities will become to the med- ical profession what Alexandria, Athens, Bologna, Pisa, Lon- don, Vienna and Berlin have been in the past and present." THE WAR ON TUBERCULOSIS has been revived of late by health boards, state, national and international so- cieties, but the last word has not been said, nor the last effort been made against this life-destroying scourge. Undis- infected tenement houses continue to be occupied by the doomed families of the poor, and even of the rich, without public con- cern, the crowded, closed, undisinfected street car, day and Pullman railway coach, continue to carry their microbic death messengers, and the clothing and utensils of the pawn shops and the second-hand furnishing stores to conceal and sell them to whoever will buy death in apparel or furni- ture of bed or floor. The real estate men, with compunction of conscience equal to the plumbers', sell consumption-infected houses and thoughtless purchasers buy them to die in. Yet it has been suspected for more than a century that tubercular con- sumption was contagious and proven so for more than a third thereof, and so proclaimed to all the people. And this preeminently destructive scourge, more fatal than all the fatal fevers against which the populace quar- antine, continues with but slight public molestation its deadly work, laying low from ten to fifteen per cent of the Editorial. 75 dying of the civilized population each year. Oh! wise and innocent people that the gods thus gather you in so young on bacillian chariots for early immortality! Among the latest and most persuasive literature to right work against the great white plague that menaces the life of civilized humanity, are the forceful addresses of George Brown and his colleagues of the reception com- mittee, Dr. Willis F. Westmoreland and John Colmstead, before the last April meeting at Atlanta of the American Anti-tuberculosis League, and the papers in the transactions which follow these forceful presentations of the professions and the peoples' danger and duty in the premises. Respecting the tuberculosis menace the people act as though they were "but arrows winged with fears and shot from darkness into darkness." The skillful archery of science should shoot them back again into the light where the voice of safety calls to them in accents of sympathetic rescue of the imperilled human family. A SADISTIC EROTOPATH has lately been stabbing many women on the streets of St. Louis and is yet unar- rested. No motive save the morbid one of the gratification of an insane impulse and desire to stab women, i. e., sad- ism has come to light. A lady, the seventh one attacked, who mistook him for a thief, not knowing that she had been cut, but missing her pocketbook, was the means of his escape, saying she would not appear against him when a number of passing young men had seized him and taken his knife, because she had not been robbed. She did not know until later that she had been cut by this sadist. It is not known if any of the ladies attacked, thir- teen in all so far as ascertained, are masochists. This subject and fetchism, especially as elucidated by Krafft- Ebing with Kiernan and Havelock Ellis in the pages of the Alienist and Neurologist, are subjects of much interest in connection with the pathological anomolies of morbid erotism. THE NEGLECT OF DUTY BY PUBLIC OFFICIALS.— "'The Rarity of the Hadleys' and their lack of zeal in the 76 Editorial. public service, especially on the part of prosecuting attor- neys, has been so extensive, except in a few exceptional instances, that the dictum of Ex-president Cleveland that "the public office is a public trust" has fallen forceless and unheeded in many states and become so common that when a Roosevelt, Folk or Jerome or Hadley has come forward and obeyed to the letter their legal duties in the ferreting out and suppression of crime, shouts of public applause arise from the plain-suffering people." A St. Louis city paper, the Star-Chronicle, makes this appropriate and significant comment on this subject, en- titling the plain and legal duty doing devotees to the peo- ples' lawful interests, "The Rarity of Hadleys." High praise is being bestowed upon Atty.-Gen. Hadley of Missouri because of his courage, ability and honesty in sub- mitting the powerful Standard Oil organization to inquiry—and he deserves it all, as does any man who faithfully per- forms his duty. But it is uncomfortable to realize that the sudden fame of Hadley is due to the fact that such honesty and fidelity is exceeding rare in public office. "What Hadley is doing is no more than what every attorney-general in the United States ought to be doing. "This is the purpose for which public prosecutors are created and paid. Their honesty and ability is presupposed, as the vital element of their qualifications. "The extreme rarity of Hadley's and Jerome's startlingly emphasizes the fact that, as the rule, the people are get- ting from their public prosecutors mighty poor service. "The courage called for is, because so rare, apt to be exaggerated. "The attorney-general of the fifth state in the Union, in taking up the law against a trust, is no little David going out to fight a great Goliath. "No; the attorney-general of a state, armed with the law and backed by the public, is himself the powerful fig- ure at the head of an invincible host. "Back of him and back of his state stand 44 other states and the United States government as well. Editorial. 77 "It is not a question of courage so much as it is one of honesty and ability. "And if 99 in every 100 of the public prosecutors of this country, national, state and county, are so deficient in these two qualities as to take no steps to check enormous mo- nopolistic wrongs, what excuse have they for holding office, and what recompense has the public for their betrayal of trust? "Hadley and Jerome loom up so magnificently because they are lone trees in a desert." PROPRIETARY MEDICINE MEN AGAINST ALCOHOL AND NARCOTICS IN PREPARATIONS.—The following res- olutions relative to the sale of proprietary medicines, in- tended to be used as alcoholic beverages, were adopted by the Proprietary Association at its meeting in New York: Resolved, that this Association thoroughly disapproves of any effort on the part of any person or firms, members of this association or not, to market as medicines any articles which are intended to be used as alcoholic beverages, or in which the medication is insufficient to bring the prepara- tion properly within the category of legitimate medicines. Resolved, That the Legislative Committee be and is hereby instructed to earnestly advocate legislation which shall prevent the use of alcohol in proprietary medicines for internal use in excess of the amount necessary as a sol- vent and preservative. Resolved, That the Legislative Committee be also instructed to continue its efforts in behalf of legis- lation for the strictest regulation of the sale of cocaine and other narcotics and poisons, or medicinal preparations con- taining the same. Resolved, That this association urges upon its mem- bers the most careful scrutiny of the character of their ad- vertising and of claims for the efficacy of their various pre- scriptions, avoiding all overstatements. THE MEDICAL NEWS, NEW YORK, and the New York Medical Journal are now merged into one. Lea Bros. & 78 Editorial. Co. will continue the publication. This is an able and powerful merger in the interests of American Medicine. Dr. Frank P. Foster will continue as editor-in-chief of the well- known journals. THE WORLD'S WORK for January, 1906, gives a naive and remarkable personal confession, purporting to come from late senator and political boss, Matt. S. Quay, of Pennsyl- vania, revealing a system of political corruption, which, when fully comprehended by the people, aroused them to re- volt and reform, and the choosing of a state treasurer from a party to which Quay does not belong. This event fol- lowed the indignant awakening of the public conscience and the battle and victory over corruption at Philadelphia. "I don't mind losing a governorship or a Legislature now and then, but 1 always need the State treasuryship," and he always controlled it, and upon it reared the corrupt structure of his political machine. For more than thirty years the little red Colonial Treasury building that stood at the north end of Capitol Hill at Harrisburg was the real source and seat of State>Government. In the stately capi- tol that reared its dome alongside, Governors and legisla- tors came and went. But the power that made them, and the money that often elected them, came from that little red building. When it was torn down, the "system" moved with the Treasurer to the new building; for the system was continuous. The manipulation of State funds for political and private purposes has long been Pennsyl- vania's shame. It has made fortunes and unmade men. Juggling with millions has caused many tragedies, includ- ing a number of suicides. Beyond the occasional disclos- ures that were made when a victim died, the people could only guess at what was going on; for the smug, nicely balanced printed reports covered a multitude of financial sins. IN MEMORIAM. Dr. Emmet Cooper Dent was born in Macon, Missis- sippi, in the year 1857. He was a descendant of the Dents and Witherspoons of Maryland and South Carolina, who were prominent patriotic soldiers and statesmen during the Revolutionary period. His early education was received at the S. W. Presbyterian Theological Seminary, at Clarks- ville, Tenn. Later he began the study of medicine at the University of Virginia, and completed his course at the Bellevue Hospital Medical College in New York City, in 1879. His life work was the study of insanity and the care and treatment of the insane, and for this unfortunate class he sacrificed every personal interest and ambition. On January 29th, 1879, he was appointed assistant physician on the medical staff of the New York City Lunatic Asylum, on Blackwell's Island, by the Commissioners of Public Chari- ties. He was promoted to assistant medical superintendent December 4th, 1882, and was appointed medical superin- tendent December 31st, 1886. On December 8th, 1886, he married Anna Lane Scott, of Mississippi. She, with two daughters, remain to mourn their loss. Dr. Dent was active and prominent in his profession; a member of the New York County Medical Society; Amer- ican Medico-Physiological Association, of which he was also secretary and treasurer; State Medical Society; Phy- sicians' Mutual Aid Association; New York Academy of Medicine; Psychiatrical Societies, and others. He was also a member of the Lotos Club, Southern Society, and the Holland Lodge. F. & A. M. In February, 1896, when the New York City Asylums were reorganized and placed under State care, he, with his hospital, was transferred to Ward's Island, continuing there (79) 80 In Memoriam. as superintendent of the female department of the Manhat- tan State Hospital. On June 1st, 1905, the two depart- ments were consolidated by act of Legislature, and he was made superintendent and treasurer of the entire hospital, as it now exists, it being the largest and most modern of its kind in existence. To Dr. Dent is due the credit of many advances and ideas in the care and treatment of the insane. He was noted at home and abroad as being the first to introduce and develop hydrotherapy as a means of treatment, almost to the entire exclusion of medicine; the introduction of camp life for the acute insane; the use of music, and of special diversions and amusements; advanced surgical care and treatment, and of operative procedure, especially on the female insane. He was the author of numerous articles on the above subjects. His hospital was the first to accept the more modern views in psychiatry, and has made further ad- vance in this feature in the way of systematic investiga- tion in detail, and in the clinical study; he, personally, giv- ing clinical lectures on the various types and manifestations of insanity; also the organization of his staff of thirty phy- sicians into a society for the advanced study of psychiatry. Nothing of promise toward the interest of the hospital es- caped his attention; he was ever keen and alert for the welfare of the five thousand unfortunates under his watch- ful care. It may be truly said "he hath done what he could." Dr. Dent died at 4:15 a. m. January 12th, 1906, from endocarditis. The funeral was held at St. Andrew's Church and was largely attended by prominent physicians from various parts of the state, and by his staff as a body. He was interred in Woodlawn. THE ANNAL1 DELL INSTITUTO PASICHIATRICO DELL UN1VERS1TA DU ROMA comes to us draped in mourning for its distinguished founder, Prof. E. Sciamanna, assistant physician also of this great institution of Italy. With "sentiments of veneration and of affection" his eminent and devoted friend, Prof. A. Tamburini, pays a In Memoriam. 81 heartfelt tribute to the virtues, professional and scientific accomplishments and patriotism of our lost brother in psy- chiatry beyond the seas. Prof. Sante de Sanctis likewise pays a feeling and worthy tribute to the deceased. Sciamannas' work was good and great in psychiatric neurology and his contributions were many. His work lives after him and his name will be revered in medicine above his honored grave, as the name of him who sleeps on Posilipos hill, on the brow of Naples, lives in the history of letters, with whose cherished name every American acade- mician is familiar. More than an hundred meritorious medical monographs embellish the pages of Italian neurology and psychiatry, not the least valuable of which is his last record of experi- ments and conclusions on the psychic functions of the cerebral cortex, which appears in volume 4, 1905, of his own great periodical. He died comparatively young, at the age of fifty-five years, but though his sun has set early, his light yet shines with warmth and brightens the place of his rising and set- ting. Besides the monographs to which we have referred, here is more matter for monumental memorial: Nato in Albano il 4 Settembre 1850 Laureato Nell' Universita di Roma a Pieni Voti Nel 1876 Libero Docente in Neuropathologia Nel 1882 lncaricato di Neuropatologia Nel 1883 Professore Straordinario di Neuropatologia Nel 1892 Professore Straordinario di Psichiatria e Direttore Delia R Clinica Psichiatrica Nel 1895 Professore Ordinario di Psichiatria Nel 1903 Membro Dell Associazione Delia Giovane Famiglia Sani- taria Degli Ospedali di Roma Nel 1881 Membro Delia Societa Lancisiana Degli Ospedali di Roma Nel 1881 Membro Delia R. Accademia Medica di Roma Nel 1882. Membro Delia Societa Freniatrica ltaliana Nel 1891. 82 In Memoriam. Membro Della Società Geogrofica Italiana Nel 1892. Membro Della Società Romana di Antropologia Nel 1893 Membro Della Societè des Medecines Neurologistes et Alienistes de Mouscou Nel 1889 Membro Corrispondente Della (Societè de Medecine de Gand) Nel 1900. Socio Fondatore Dell 'Ordine Dei Medici Della Provincia di Roma Vice Presidente Della Federazione Degli Ordini Sanitari Deputato Sanitario Della Congregazione di Carità di Roma Deputato Sanitario Nella Commissione Dell 'Orfanotrofio di Santa Mario Degli Angeli Membro Della Commissione di Vigilanza Sui Manicomi Pubblici e Privati in Provincia de Caserta SELECTIONS. NEUROPHYSIOLOGY. BIOLOGICAL THEORY OF SLEEP.—Claparede (La Presse Medicale) considers as erroneous the usually ac- cepted conception according to which sleep is thought to be the consequence of an arrest of function, by intoxication and by asphyxia. He believes, on the contrary that sleep is a positive function, an instinct which has for its purpose ar- rest of functioning. It is not because we are intoxicated or exhausted that we sleep, but we sleep in order to avoid these conditions. The fact that sleep is not proportional to exhaustion is an argument in favor of this theory. Sleep may be partial. One sleeps through certain noises but not through others. Finally, the curve of the pro- foundness of sleep, inexplicable by the toxic theory, is in harmony with the theory that regards this phenomenon as a positive nervous function. The instinct, the reflex is provoked by numerous excitants: endogenous (condition of the blood, sensation of fatigue), exogenous (images em- pirically associated with the idea of sleep). The phenom- enon in itself is a reaction produced by these excitants and is an inhibition which manifests itself subjectively by a lack of interest in exterior things.—Medical Progress. REGENERATION OF NERVES.—Perthes describes the particulars of a case of recurring trigeminal neuralgia in which five different operations for its relief had been done. The patient finally succumbed to the progress of a valvular defect, and the autopsy revealed regeneration of the nerves where the Gasserian ganglion had been extirpated, and also after the various resections and other operations on the nerves involved. In a second case the neuralgia recurred (83) 84 Selections. after a Thiersch operation on the nerve, but was abolished again by removal of the regenerated nerve. Experiments on dogs are reported which show that regeneration of a nerve was almost certain to occur after a few months, when it was merely resected, while the mere severing of the nerve, with the interposition of a gold filling between the ends of the stumps in the infraorbital canal, prevented regeneration. The experimental results observed promise good results in man from the use of a dentist's filling to plug the canal in the bone after severing or extracting the inferior infraorbital or alveolar nerve.—herven - Regeneration nach Extraction von Nerven wegen Trigeminus Neuralgia. G. Perthes. Abstract by Jour. A. M. A. NEURONE CONTACT, ETC.—Dr. John Turner con- cludes from personal observations with methylene blue and peroxide that a pericellular beaded network is the great medium for establishing direct connection between the dif- ferent cells of the central nervous system. A successful preparation of the frontal cortex, shows myriads of delicate beaded fibrils coursing in all directions, some of which can be traced for two or three microns as slender as neurofi- brils, but usually these latter appear of a perfectly smooth contour, thus showing a true continuity between the differ- ent cells of the cortex, for not only are the intercalary cells joined together by their processes, but also form the beaded pericellular network to which they give rise, fibres passing directly into the axons of the pyramidal cells. The continuity of the nerve cells of vertebrates by means of neurofibrils appears to exist universally between the nerve cells of the invertebrates and seems to occur in all ani- mals.—The Journal of Mental Science. CLINICAL PSYCHIATRY. LUTHER'S HEADACHE AND DELUSION OF THE DEVIL.—"Martin Luther was a strict believer in the early doctrine which taught men to hold the devil responsible for Selections. 85 the origin of all diseases," says Dr. Hugo Magnus in his new work entitled, Superstition in Medicine." "He thus expressed himself, for instance: 'No disease comes from God, who is good and does good to everybody; but it is brought on by the devil, who causes and performs all mis- chief, who interferes with all play and all arts, who brings into existence pestilence, Frenchmen, fever, etc.' He ac- cordingly believed that he himself was compelled to scuffle with the devil when his physical condition was out of order. Thus, when suffering from violent headache, he wrote to the Elector, John of Saxony: 'My head is still slightly subject to him who is the enemy of health and of all that is good; he sometimes rides through my brain, so that 1 am not able to read and write,' and upon another occasion he said, in regard to his health, 'I believe that my diseases are by no means due to natural causes, but that 'Younker Satan' plays his pranks with me by sorcery.'" —5/. Louis Medical and Surgical Journal. TEMPLE SLEEP.—It was firmly believed by the Greeks so early as the sixth century B. C. that he who slept in a temple would be surely cured of any physical disorder. Dr. Hugo Magnus, in his new book, "Superstition in Med- icine", says that a tablet found in the Temple of Aescula- pius at Epidaurus tells us that a blind man by the name of Hermon, a native of Thases, had recovered his sight by sleeping in the Epidaurean Temple of Aesculapius. How- ever it appears that this man Hermon had been a misera- ble wretch, for he disappeared without having expressed his thanks in hard cash. Naturally such ingratitude pro- voked the God, and summarily he blinded the thankless individual again. It required a second temple sleep before the God condescended to become helpful once more. But our tablet does not mention anything about the amount of the remuneration paid by our friend Hermon who had been twice cured of blindness, neither is this at all necessary. The miraculous tablet, even without stating the price, doubtless made sufficient impression upon the minds even of the most parsimonious of future patients.—St. Louis Medical and Surgical Journal. 86 Selections. TOMBSTONE AND CANDLE POWDERS.—Many strange cures are described by Dr. Hugo Magnus in his new book, "Superstition in Medicine." Two of the most popular remedies of early times were the powders obtained from scraping the tombstones of saints (the powder being placed in wine or water) and the charred wicks of wax candles that had been burned in a church. "Let us listen to what Gregory of Tours has reported concerning the medicinal virtues of tombstone potions. He says, 'Oh, indescribable mixture, incomparable elixir, anti- dote beyond all praise.' Celestial purgative (if I may be permitted to use the expression) which throws into the shade every medical prescription, which surpasses in fra- grance every earthly aroma and is more powerful than all essences; which purges the body like the juice of scammony, clears the lung like hyssop and the head like sneeze-wort; which not only cures the ailing limbs, but also, and this is much more valuable, washes off the stains from the conscience! "This wick was pulverized, and in this manner a very powerful curative powder was obtained, which, when taken acted in a manner similar to that of the watery or vinous tombstone infusion." NEUROPATHOLOGY. "UNDER THE WEATHER."—In a recent book on Weather Influences, Professor Edwin Dexter, of the Univer- sity of Illinois, has proved that a close connection occurs between the weather and conduct. He was led to under- take this investigation by being impressed with the re- markable fluctuations in the conduct of school children, and he seems to have proved that there is a certain rela- tion between the conditions of the weather and the condi- tion of the nervous system. In his opinion the term "under the weather" as ap- plied to a lack of feeling of normal well-being has a real scientific basis. It has long been known that the weather Selections. 87 has a greater or less effect on persons in good health and that in certain diseases it exerts a potent influence, but Professor Dexter generalizes from his experience in this field of investigation to show that children in school and workmen in factories are more or less influenced by the state of the weather and that they both do good or bad work according as the weather is, good or bad. Professor Dexter has also proved that different climate has different effects at different times on the same person, and he hopes by continuing his studies to finally show more intimately than has yet been determined, the relation- ship between nervous diseases and proper climates. NEUROTHERAPY. DEATH FOLLOWING SCOPOLAMINE-MORPHINE AN/ESTHESIA.— J. C. Sexton, of Rushville, Indiana, re- ports in the November ult., Lancet-Clinic a death following the use of the new anaesthetic scopolamine and morphine. The patient, aged forty-seven years, was anaemic and had a weak heart, but otherwise presented no evidence of dis- ease other than that for which she was operated—excessive bleeding from a uterine fibroid. She was given early in the morning a hypodermic of scopolamine hydrobromate, one one-hundredth of a grain, and morphine sulphate, one- sixth of a grain. In fifteen minutes she was asleep, a quarter of an hour later she was unconscious, slightly cya- nosed, pulse 120 and throbbing, with shallow respiration, 20 to the minute; the abdominal muscles and intercostal were so rigid that it was found impossible to compress the lower chest. The eyeballs were turned up, the mouth open, and the j.aw dropped. Efforts at resuscitation, such as stimulation, pain, heat, flagellation, and change of pos- ture failed, and the patient died an hour and a quarter later. No autopsy. RECREATION IN ITS EFFECTS UPON THE NERVOUS SYSTEM.—Dr. Williams James Herdman of Ann Arbor, 88 Selections. Michigan American Academy of Medicine, stated that the practical methods by which suitable recreation was to be selected to meet the requirements of special classes or in- dividuals would vary as taste, occupation, and opportunity varied. From the complexity of occupations in which peo- ple engaged there resulted the greatest variety of channels through which the store of nervous energy was depleted. Outdoor plays and games requiring some skill, such as boating, fishing, swimming, skating, horseback riding, gardening, tool work and the like, were of much more rec- reative value than any of the artificial gymnastics which had no purpose nor incentive beyond the movement itself. For the brain worker the way was open to innumerable recreations, and the opportunity for choice and the possi- bility of varying their character at will, would make the problem of healthful living an easy one if any man would but cultivate a sufficient variety of interests, so that when one channel of activity was for any reason closed to him, as a relief from necessary work, he had but to choose an- other. The practical result in this was seen when the sta- tistics of health and longevity of the brain worker and of the muscle worker were compared. The researches of Dr. Beard and others had shown that brain workers not only lived from fourteen to twenty years longer than muscle workers, but that their health was more uniformly good and their stature of larger average. When mankind was once emancipated from the conception that honest work was contemptible drudgery, and learned to recognize the pleas- ures and recompense it had in store when rightly appre- hended, which meant that the work selected must be suited to individual capacities and tastes, and when greed and selfishness gave place to a spirit of mutual helpfulness, the problem of recreation would be solved. OLD AGE AND DISEASE, METCHNIKOFF.—An impor- tant exposition of this subject is made by L. Lematte (Arch, de Terap., December 15, 1904). Old age is a sort ot disease allied to the changes that accompany atrophy. The same connective tissue scleroses that occur in old pec- Selections. 89 pie are also found in the various chemical intoxicants (e. g., alcohol and lead). The bacilli of tuberculosis and lep- rosy may produce a brittleness of the bones which is similar to that which is the result of senility. Old age is not the result of excessive use, but is an expression of a slow auto-infection. In the intestine is to be found the culture medium for those germs whose toxins are the source of se- nile atrophy. It is well known that birds have a longevity which is greater than that of the majority of mammalia. This is attributed to the fact that birds have no large intes- tine, in which hordes of bacteria may flourish. Even in old age birds preserve their youthful appearance and agility. The intestinal parasites secrete toxins which in some cases cause a destruction of hemoglobin and red blood cells, some- times poison the nervous centers, and sometimes cause an ulceration of the intestinal mucosa. It has been found that the lactic acid bacillus is a redoubtable foe of the putrefact- ive microbes. Moreover, a lactic acid ferment which is found in Bulgaria seems to be more active than those of other countries. Metchnikoff discovered this ferment in a prepa- ration of milk consumed in large quantities by the Bulga- rians, who are reputed for their longevity. It is suggested that this ferment be used in medicine. It precipitates casein, which it also partially digests, which fact explains the ease with which "Bulgarian milk" is digested. The lactic acid ferment found in this preparation of milk continues to live in the intestine, where it destroys unfriendly bacteria. This milk, containing the pure bacillus, has the consist- ency of white cheese. It has an agreeable, acidulous taste and contains neither alcohol nor carbonic acid. It is well tolerated by dyspeptics. It is indicated in fermentative dyspepsia. Inasmuch as Pawlow has shown that the or- ganic acids are the best excitants of the intestinal digestive juices one may regard this form of milk as an excellent intestinal tonic. It may replace ordinary milk in the fetid diarrheas of typhoid fever and entritis. The peculiar fer- ment in the Bulgarian lactic acid bacillus splits up sugar into products which are harmless to the cells. It has been tried in the treatment of diabetes, with the result that the 90 Selections. amount of glucose in the urine was diminished by two- thirds. Possibly this ferment may replace the distastes of yeast cells and of raisins used in the treatment of microbic dermatoses. Bulgarian milk may be a useful adjuvant in the forced alimentation of cases of cancer and tuberculosis, used either alone, or mixed with yolk of egg, beef powder, etc.—La Tribune Medicate, in Journal Med. and Science, Maine. BLUE LIGHT ANAESTHESIA—This subject has again been brought to the fore by some investigations of Dr. Harry Hilliard of the Royal Dental Hospital, London, who finds that a limited anaesthetic effect can be produced by blue rays. It is suggested as a calmative in nervous in- somnia, the restlessness of children, in mania, etc. —Weekly Medical Review. CLIMATE FOR THE AGED.—The early months of the year in the higher latitudes of our country are usually marked by such unfavorable climatic conditions that it is wise to consider what disposition should be made of those who may be fortunate enough to be able to escape from the malign condition which usually prevails. The tuber- cular, the neurasthenic, and the subjects of senility are the classes -hich perhaps are most affected by climatic conditions. The former two classes may, however, be fairly well attended to in any climate, but the death-rate in the aged always appears to bear a direct relation to the vileness of the weather, and it may not be amiss at this time to consider what should be done with elderly people who have the ability, though seldom the inclination, to go where they will. One great difficulty the clinician will encounter will be that of convincing people that they are growing old. A man is as old as he feels and a woman as old as she looks, are convictions which have so deeply impressed themselves in general conception that it takes no little ingenuity to modify such well accepted beliefs. Old age is not a dis- ease, it is a simple atrophy in which the capillaries Selections. 91 wither, so that many of the tissues are ill supplied with blood. We may or may not accept the doctrine of Metchnikoff, but care and age come unawares, and the glands which should manufacture the vital fluids gradually lessen in effi- ciency until decrepitude in mind and body become dull, dead certainties. A recent writer has decided that what he calls a "relaxing" climate is the most favorable to old age and conducive to the amelioration of the peripheral weakening of the capillaries. He compares a climate of warmth and comfort as resembling in its effects a warm but light over- coat. It clothes the shivering body, the warm and moist air bathes and soothes the pulmonary mucous membranes and lessens the tendency to bronchial affections, and these after all, are among the chief causes of the demise of many whose continued presence is still desired on earth. By keeping tne capillaries of the skin in a state of gentle dila- tation the work of the kidneys and of the heart is much di- minished, and the general comfort and well-being of the body is much augmented. Fortunately this country is well supplied with suitable climates for elderly people. Warm, relaxing temperatures pervade a large portion of the South. Cuba and Porto Rico are places in which Americans may feel at home. California with her Mediterranean shores will never fail to give comfort and satisfaction to those whose weakened capillaries need the light top-coat of a mild climate. —Medical Age Editorial. The climate for the aged is not only one that favors open pores but one congenial to the mind in attractive environments. Climate may be substituted for the aged by porous woolen garments covering feet and head during the night time, while in bed, even in the homes of the aged if other artificial heat arrangements are satisfactory. PATHOLOGY. THE FIRST AUTOPSY IN MONTREAL.—In the descrip- tion in "Hakluyt's Voyages" of the travels of Jacques Cartier, is found the following, which describes the earliest reported autopsy performed in this city. It took place in 92 Selections. 153J, when the winter was passed in Hochelaga and many of the crew died of an epidemic disease. "That day Philip Rougement, borne in Ambroise, died, being 22 yeeres olde, and because the sicknesse was to us unknowen, our Captaine caused him to be ripped to see if by any means possible we might know what it was, and so seeke meanes to save and preserve the rest of the company: He was found to have his heart white, but rot- ten, and more than a quart of red water about it; his liver was indifferent faire, but his lungs black and morti- fied; his blood was altogither shrunke about the heart, so that when he was opened great quantitie of rotten blood issued out from about his heart; his milt (spleen, ED.) toward the back was somewhat perished, rough as if it had bene rubbed against a stone. Moreover, because one of his thighs was very blacke withoute, it was opened, but within it was whole and sound, that done, as well as we could, he was buried."—Montreal MedicalJournal. CLINICAL NEUROLOGY. ESSENTIAL AND PAROXYSMAL TACHYCARDIA.—The following sensible view of this subject is presented by J. J. Morrissey in Medical Record, December 2, 1905: Tachycardia may be classed under two heads, namely, essential and paroxysmal, and this classification may be subdivided into true and false. The true tachycardia, ac- cording to the author, finds its best illustration in perma- nent disease of the cardiac musculature; the false may be produced by causes far removed from the heart. There are certain definite peculiarities which distinguish true tachycardia from the evanescent "heart hurry" so fre- quently produced by the most trivial causes. (1) The at- tack is sudden in its onset, reaching its height almost im- mediately; (2) the patient may or may not be entirely unconscious of the great degree of palpitation; (3) there is generally a definite period covered by the attack; (4) the reversion to the normal condition is as sudden as the Selections. 93 onset, the vestiges of the storm through which the patient has passed rapidly disappearing. He then discusses the various forms of these types, and describes several cases which illustrate the difference in origin which may be ex- hibited. For example, one case was produced possibly by myo- cardial degeneration, and another by profound shock to the nervous system. In one case in which digitalis appeared to be of no avail, the fluid extract of convallaria majalis in five-drop doses, four times a day, seemed effective. He concludes by saying that the treatment of tachy- cardia is that of the condition from which it arises, or with which it is associated; but we must remember (1) that es- sential tachycardia is not accompanied with indigestion; (2) that paroxysmal tachycardia and the forms of tachy- cardia accompanied by signs, no matter how slight, of Basedow's disease, are very frequently associated with dyspepsia; (3) that extreme cardiac arhythmia frequently occurs without any indication of stomach disease; and (4) that tachycardia in its various grades is, however, often but a symptom, a prominent expression of a neuropathic state, which requires to be approached for treatment from many sides.—Abstracted by M. A. Brown in Cin. Lancet- Clinic. THE REFLEX OF THE TENDO ACHILL1S.—There are four kinds of foot-clonus: (1) True (pathologic) foot-clonus, occurring as an unequivocal sign of organic nervous disease, and distinguished by the rapidity and regularity of the clonic movements; by its occurrence with the relaxation of the muscles of the leg; by its cessation with the arrest of the exciting upward pressure. Imperfect foot-clonus, simi- larly marked, has the same significance. (2) True (physio- logic) foot-clonus, observed in normal persons, distinguished by the necessary accompaniment of tension of the muscles of the leg. (3) True (reflex) foot-clonus, occurring in association with chronic disease of the ankle joint. (4) False foot- clonus, occurring in functional nervous disorders, distin- guished by irregularity of the movements, or by continu- ance of the vibratory movements after removal of the ex- citing upward pressure, so that the vibration becomes a spontaneous tremor. 94 Selections. If we are able to determine clinically the enfeeblement, absence or exaggeration of one ankle-jerk, or of both, what conclusion can be drawn from our observation? For practical clinical purposes, it may be asserted that functional nervous conditions have no effect upon the re- flexes in themselves, or in any event, no effect that can be utilized for practical medical purposes. Therefore, ac- tual enfeeblement or absence of the ankle jerk tells us that there is an impediment of interruption in the reflex arc concerned, so that nervous energy passes through it feebly or not at all. As far as known, there is but one other cause for diminution or loss of a deep reflex: Complete solution of continuity of the spinal cord above the level of the point where the reflex arc passes through the spinal cord (Bas- tian). If we have found a true ankle-clonus, we know that the reflex is intact. Exaggeration of the deep reflexes is caused only by disease or lesion implicating the motor tracts that lie wholly within the central nervous system. Therefore, pathologic ankle-clonus proves that at some point above the spinal center of the ankle jerk there is an actual organic lesion of some kind, implicating the fibers of the ce- rebro-spinal motor path that are related to the spinal motor centers controlling the muscles upon which the ankle-jerk depends. Since these statements are true of all deep reflexes, we may make the following general rule: Loss of deep reflexes proves the existence of organic disease of the reflex arc: exaggeration of deep reflexes proves organic disease of related cerebro-spinal motor paths. WE LEARN from the Muenchener Meditfnische Wochen- schrift that Kiolemenogion and Von Rube claim that the spirochseta pallida is found in other lesions than those of syphilis and is in fact not a pathognomonic sign of lues. They claim to have seen and observed this bacterium in the discharge in a case of Phimosis. They have also ob- served it in the pus from a gonorrheal abscess. The dis- charge of balanitis has also revealed its presence. It has Selections. 95 been seen in tlie pus from a dermatic abscess in a case of scrofula. Furthermore it has revealed itself in the products of degeneration of suppurating cancer. And finally in the tissue juices from condylomata acuminata. In order that there may not be a suspicion of mistaken observation these authors state that, in all these cases, they have also found the spirillum refringens. So that, taking all the evidence so far furnished we are almost in the condition of status quo ante.—Editorial December, 1905, St. Louis Medical & Sur- gical Journal. NEURASTHENIA AMONG THE WORKING CLASSES.— Leubuscher and Bibrowicz give the results of an interest- ing study of neurasthenia as found among 1,564 patients belonging to the various mechanical trades. Almost one- third of the patients were either compositors, carpenters, locksmiths or mechanics, the others belonging to such a diversity of trades that definite percentages could not be calculated. The typesetters and carpenters together com- prised 25 per cent of the total number, the former workers being apparently the most prone of all to neurasthenic disorders. The authors believe that neurasthenia is rap- idly growing in prevalence among the working classes, and that it is the workmen of the better types who are the most susceptible to it, owing to the spirit of unrest and dissatisfaction that prevails among them. The disease is most serious as an obstacle to work during the ages from twenty-five to forty-five years, that is the period of great- est activity. The prophylaxis of course involves very far reaching questions of sociology and the treatment is best carried out in suitable iustitutions. Sanitorium treatment offers the greatest prospect of a permanent cure as well as of immediate relief to the symptoms, and therefore the erection of such establishments for the masses is strongly to be urged. ACROMEGALY.—D'Orsay Hecht, Chicago (Journal A. M. A., November 4), reports a case of acromegaly in a young woman aged twenty-four, which is of interest in presenting a family history of tendency to malignant dis- 96 Selections. ease. There were persistent headaches since childhood and the appearance of the acromegalic symptoms followed severe mental strain and typhoid fever. The headaches were unrelieved by glasses which had been worn for ten years for myopia, and the pupils presented the anomaly of being small and unaffected by light, accommodation or my- driatics. This prevented the thorough examination of the fundus, which, however, apparently showed no peculiarities unconnected with the existing myopia.—M. A. B. in Lan- cet-Clinic. A VERY CURIOUS FORM of epilepsia occurred among the soldiers returning from South Africa. Over 2,000 were caused by the violent detonations of modern fire arms, par- ticularly cannons and by the explosions of lyddite shells. TORTICOLLIS HYSTERICUS.—J. Kollarits (Deut. Zeit- schr. f. Nervenheilkunde, Bd., xxix, 1905) states that the psychogenic origin of spasmodic "wryneck" has hitherto failed to secure sufficient consideration. Three cases are reported in full and reference is made to three others pre- viously described by Prof. Jendrassik. The author's con- clusions based upon a study of these cases, are: 1. That every spasmodic torticollis consisting in tonic or clonic muscle spasms is a mental torticollis. 2. That mental torticollis is a symptom of hysteria and may occur as monosypmtomatic hysteria without other symptoms. 3. That the therapy of this symptom of hysteria can only be by suggestion and that surgical procedures should never be employed.—Excerpt by Graves Weekly Med. Re- view. EYES AND EARS THAT MIGHT BE SAVED; AN APPEAL TO THE GENERAL PRACTITIONER.—Samuel S. Wallian (Medical Record, January 6, 1906) says that patients suf- fering from atrophy of the optic nerve or loss of the special senses, should be under the care of the general practitioner, because these subjects are with few exceptions, the victims of some form of dyscrasia. This may be from accident, Selections. 97 from constitutional or specific infection, or from one or more bad hygienic habits. Nearly all of them are badly nour- ished, usually in the sense of being injudiciously fed. The general practitioner can temporarily ignore the local trouble and investigate the general and special condition of the patient's entire organism. The author discourages the use of mydriatics or repeated ophthalmoscopic examinations once the diagnosis is made. The proper dietary is described at length. The food should be rich in phosphates and should contain much refuse. The husk of the grains, especially of wheat, fulfills both requirements. Drinking large amounts of distilled water is also recommended. Turkish baths, especially with the electric cabinet instead of the ordinary hot room, are useful, and alcohol and narcotics must be prohibited. Drugs are of little use; the iodides are usually disappointing, but cataphoresis and external applications may be used with more assurance. To arouse the dormant, debilitated nerve the violet ray, high frequency current, and mechanical vibration are of service, but their use re- quires careful analysis of each case. NEURITIS ACUSTICA FROM INFLUENZA.—Alt (AuT- trian Otol. Soc.) describes a neuritis acustica from influenza. In the second day of the disease facial paralysis occurred, and on the third day tinnitus, severe dizziness and deafness on the side of the facial paralysis. Eye-grounds normal. The hearing was that of a labyrinth affection, high notes being better heard than low. (This statement must be a typesetter's error overlooked by the proofreader.—J. E. S.) Sugar (Arch. f. Ohrenh., Bd. 49), describes for the cerebral form of influenza a special ear complication, viz., suddenly occurring deafness, great dizziness, and pain in the tem- poral region. He accepts either hemorrhage into the fourth ventricle, in the sense of a polio-encephalitis hemorrhagica superior acuta, or rather, and to this view he inclines, a hemorrhage into the labyrinth, especially in the prepon- derating, one-sided, ear affections. Influenza otitis has shown various manifestations; Knapp reports a stubborn, repeatedly recurring and very profuse suppuration; Scheibe, a bulb thrombosis, showing that the influenza bacillus is 98 Selections. dangerous, being prone to cause necrosis and to attack blood vessels. Goldstein describes a special symptom— complex, intense, deep-seated pain in the ear, radiating to the temporal region, rapid swelling of the mastoid region, profuse serous secretion from the tympanic cavity, along with dizziness in persisting hemicrania.—Sheppard &- Luti, report on Prog, in Otol., Brooklyn Med. Jour. BRIGHT'S DISEASE IN HIGH OFFICIAL CIRCLES AT THE NATION'S CAPITAL.—Macdonald (Jour. A. M. A.) says that the strenuous life, excessive mental activity and the corresponding degree of physical quiescence and years of overindulgence in rich foods, with the associated high blood pressure, are the essential causes which render Bright's disease frequent in the high official circles at Washington. In conclusion he emphasizes the following facts: Unem- ployed food products become toxic irritants and menace the structural integrity of the kidneys. Man is an organism built round an eliminative system; when that is abnormal he can not be normal. When the balance between inges- tion, metabolism, and elimination is absent, danger is pres- ent. Apparently nutritional excess is the germ of nephritis. Mental activity and physical quiescence aid in its produc- tion. Carking care and the corrosive influence of worry and mental strain render prominent aid in producing it. It is prone to attack the intellectual and the anxious. Alcohol, while offering it encouragement, has been given a too con- spicuous place as a causative agent. It is an extremely insidious disease, and is often well advanced when dis- covered. It is so far-reaching that its first noticeable effects may be visited on organs and tissues remote from the original disease. The conditions which lead to it are quite amenable to correction if efforts are made sufficiently early. It occurs somewhat frequently at the nation's capital be- cause the congregation of eminent public men means a concentration of worries, wealth, and official feasting. THE NEUROTIC CHARACTER OF ENURESIS.—An es- pecially sensible editorial appears in The Medical Era of St. Louis by its able editor, S. C. Martin, M. D., Professor Selections. 99 of Dermatology in the Barnes Medical College, from which we extract in part: 'The neurotic phases of incontinence of urine in children seldom receive the attention their importance deserves. Instead of being regarded as supreme factors, they have been pushed aside to make room for the theory of mus- cular atony of the sphincter vesicae and other organic lesions. This largely accounts for the numerous failures of treatment which daily confront the physician. More atten- tion should be paid to the instability of nerve centers in childhood, to impoverished blood with consequent malnu- trition, and lastly reflex irritations from a great variety of causes. The nervous mechanism of micturition is some- what complex. There is a urination center in the spinal cord which is to a certain extent under the control of higher centers in the brain. From these centers inhibitory control is exercised. Micturition is therefore largely under the con- trol of the will. This will in infants up to the second year is in abeyance, thus incontinence of urine with them is a normal condition, and we can readily understand that many factors may render this normal condition in the very young infant, abnormal, in the child who is just beginning to exer- cise the will. In nocturnal enuresis, which constitutes more than half of the cases, the urine is discharged in a full stream, and is usually passed during the first hours of sleep, when sleep in the child is most profound. Under such conditions, reflex irritation from a distended bladder makes no impression upon the brain, and the unconscious higher brain centers fail to exercise inhibitory control over the urination centers in the spinal cord. If a reflex irritation from the bladder is not perceived by the brain, spasm of the detrusors urinae, which often occurs, will easily overcome the sphincter mus- cles, especially when free from inhibitory control, and the involuntary discharge of urine follows. The reflexes most frequently identified with enuresis originate in genital, ves- ical, or rectal irritations. For example, phimosis, preputial adhesions, vesical lithiasis, an excess of urates or phosphates in the urine and ascarides, are factors that must be duly 100 Selections. considered in the study of this disease. Hereditary influ- ences of a neurotic character must be taken into the account, also habit, sometimes play an important role among the various factors of this troublesome affection. Whilst enu- resis is mainly a neurosis, it is nevertheless in the majority of cases associated with marked nutritive disturbances. Where there is no special evidence of mal-nutrition, the metabolism of the sensitive nerve cells is more or less dis- ordered. It is impossible to recognize all the morbid phenomena connected with this disease, but it is the duty of a physi- cian to investigate carefully the history of each individual case and ascertain as far as possible all of the factors which exert a predominating influence over the course of the disease. We should discover whether the incontinence is nocturnal alone, diurnal alone, or both nocturnal and diurnal, and also whether the intervals between the invol- untary discharges of urine are short or long. Sometimes the little patient will soil the bed every night, but in mild cases, once a week, or even at longer intervals. To treat a case of this kind successfully it must be thoroughly studied before treatment is commenced, otherwise success will be at best, partial and transient. With the discovery of causes and their prompt removal, the difficulties in the way of a cure are gradually lessened until the case is sim- plified to such a degree that spontaneous recovery follows or very little further treatment will be required. Two of the most common factors in this disease are excitability of the nerve centers produced by heredity and age, and ane- mia, with resulting mal-nutrition increasing the excitability of the nerve centers and reflex irritation. In about 80 per cent of the cases, anemia is a marked feature. A diminu- tion of healthy blood in the body always unbalances the functions of the nerve centers. Selections. 101 PREVENTIVE PSYCHIATRY. INCIPIENT INSANITY.—Dr. J. T. W. Rowe, in an ex- tremely important paper (N. Y. Med. Jour., June 3, '05) urges upon the general practitioner the necessity of diag- nosing incipient cases of insanity to the end, in the first place, that many cases may be cured which would other- wise progress to a degree beyond hope of mental restora- tion; and, in the second place, that by this means may be relieved to some extent at least, the congestion which ex- ists in our dreadfully overcrowded public institutions for the insane. It is the general practitioner, not the alienist, with whom lies the remedy, with regard to both these condi- tions; and Dr. Rowe rightly emphasizes that the former has oftentimes been shamefully neglectful of the proper medical treatment for mental sufferers prior to their com- mitment to a hospital for the insane. The physician will find scores of incipient cases in his daily rounds whose progress he can arrest; it is his duty to minister to a mind diseased at least as much as in any other phase of his professional work. He should have a better knowledge of the nature and phenomena of mental disease than generally obtains. There are many cases showing toxemia following abeyance of function, the result of too close application and overwork amid unsanitary surroundings; such cases, taken in time, will unquestionably respond well to treat- ment. There are yearly hundreds of such cases committed to asylums, "a large portion of whom have the conviction that they need never have been certified as lunatics had they received timely medical advice in the stage of incuba- tion, and their functions and physical condition bear them out in their lamentable statement of neglected health." The home and not the asylum is the proper place for neurosis or exhausted states due to neglect or lack of medical care; imagine the effect upon the psychism of such cases when placed among pronounced lunatics of dan- gerous or suicidal or maniacal or like tendencies. The family practitioner sees or should observe departures from 102 Selections. health in a hundred forms; it is his opportunity to check untoward symptoms; to give sound advice; to consult with relatives; to treat declining bodily health. In these days of the strenuous life a large number of both old and young are to be found on the verge of physical and mental break- down. "They dare not give in, for the pace has been set and they strain every nerve to respond to the demands made. The laborer in his ignorance of the laws of nature, sweats in the darkness. The workers in the factory and the slums; the professional man overconfident in his intel- lectual powers and well ordered nervous system; the lad at school weighed down by too close application and not enough open air exercise; the shy, retiring boy just yield- ing t« evil inclinations; the worried business man and father bearing a heavy load and seeing no way of lighten- ing it—all these patients are very near the border line of mental affection and this is the very time when proper medical advice could avert disaster." Many such could be taken from their work and sent to the sea or the moun- tains; they might "do half time;" and the physician could see them every day if need be. The neurasthenic; the alcoholic with his fleeting delusions; the railroad man, fearing that his "nerve" is failing him; the mother at the climacteric; the young girl with ungratified longings and hypochondriasis; those whose sleep is broken and who begin to hear voices at night; such phases typify the pe- riods of initiation and incubation; "they are the varieties of ailments becoming insanity." They generally require but a few days rest in bed with a little medical care; and early diagnosis is manifestly essential. Thirty per cent of admissions to hospitals for the in- sane are due to neuroses, drug and drink habits, toxemias of adolescence and states incident to menopause. The in- Selections. 103 clination to send to the medical certifiers should be re- sisted to the last; an asylum is not by any means the only solution of the problem here indicated. Few among these sufferers require such extreme measures as are im- plied in institutional treatment.—Medical Times. This is in a large measure true, but many patients will not secure timely medical advice for toxemic states and neurasthenia that precedes and are precursory to on- coming insanity.—ED. REVIEWS, BOOK NOTICES, REPRINTS, ETC. THE ERA KEY TO THE U. S. P.—A complete list of the drugs and preparations of the United States Pharma- copeia, eighth Decennial Revision (1905). Vest pocket size, 83 pages, price 25 cents. The Pharmaceutical Era, publishers, New York. A new edition of the well-known "Era Key to the U. S. P." is before us. Its purpose is to introduce and en- courage the employment of official drugs and preparations of the Pharmacopeia. The book gives in vest pocket size all the essential information required by the physician on the subject of officinal remedies, including doses in both metric and English systems. W. B. SAUNDERS & COMPANY, of Philadelphia, the wide- ly known medical publishers, send out an unusually at- tractive illustrated catalogue of their complete list of publications. This catalogue shows a list of authors of leading American and foreign authorities in every branch and specialty of medical science. This firm keeps in close touch with the profession and anticipates its wants well in the books it publishes. AROUND THE WORLD VIA INDIA.—A Medical Tour by Nicholas Senn, M. D., Ph.D., LL. D., C. M., Professor of Surgery, University of Chicago, Professor and head of the surgical department Rush Medical College, Sur- geon in-Chief St. Josephs Hospital, Attending Surgeon Presbyterian Hospital, Surgeon General of Illinois, Lieutenant Colonel and chief of the operating staff with the army in the field during the Spanish-Ameri- can War, etc. (104) Reviews, Book Notices, Reprints, Etc. 105 Dr. Nicholas Senn gives an interesting and highly in- structive account of his travels around the world, and es- pecially of India and Molokai, in this pleasing book. His tribute to the heroism, christian charity, self-sacri- ficing devotion, and courage of Father Domien, who died a leper to be resurrected a saint, is beautiful and well merited. Dr. Senn's incidental descriptions of leprosy are life- like and his plea for a United States Government bacterio- logical laboratory at Hawaii are pertinent and forceful, remind- ing us that "Little Japan" has preceded the United States in this humane and scientific movement. The physician and surgeon will be interested in the great progress shown in this book of the Australian, Cey- lon and Indian Government hospitals, and in the people, plant and tree peculiarities of these interesting countries, as well as his portrayals of the personnel and merits of the members of our profession there, besides the descriptions of Hindu architecture and Hindu institutions, priests, women, dancing girls, snake charmers, etc., and in Calwettes anti-venom and the work of the Parel Labora- tory, as Dr. Senn writes of them. The Singhalese men and women are invested with much interest by the doctor also, and cremation and the Parsee people are likewise viv- idly portrayed. Altogether this interesting book of travel will entertain from title page to finis, not only the emi- nent doctor's friends, for whom it has been especially written, but will benefit and entertain all who may read it.—American Medical Association Press, Chicago, 111. CRIMINAL RESPONSIBILITY, by Charles Mercier, M. B., F. R. C. P., F. R. C. S. Lecturer on Insanity at the Westminster Hospital Medical School and at the Medical School of the Royal Free Hospital: Author of "Ths Nervous System and the Mind," "Sanity and Insanity," "Lunatic Asylums, their construction and management;" "Lunacy Law for Medical Men," "Psy- chology, Normal and Morbid," "A Text-book of Insan- ity," Etc., etc. 106 Reviews, Book Notices, Reprints, Etc. The author being well and favorably known in the do- main of alienism and psychiatry, needs no special intro- duction to the readers of the Alienist and Neurologist. The author's clinical experience conforms to Esquirols' criterion of alienistic competency, viz: he has lived with the insane as an asylum chief physician. After noting the fact that perceptible delusion is no longer the sole criterion of insanity, he notes that delus- ions of exaltation, depression and persecution as most apt to influence conduct and to prompt to criminal acts. The many questions and conditions of irrespon- sibility coming before the mind of men accustomed to discriminating study of mental diseases and mental de- fect, and to draw right lines of demarkation between these states of mind and soundness and insanity for the edifica- tion of courts and juries, are well presented in this valu- able book. These features, together with the records given of his- torical cases and legal procedures, make the book one of inestimable value to the student of criminal responsibility and of irresponsibility by reason of disease misdirecting the movements of the mind.—Oxford, at the Clarendon Press, 1905. THE MANAGEMENT OF THE NERVE PATIENT, by A. T. Schofield, M. D. The book is a sequel to other books by the same author on similar subjects to the present one, viz: The Unconscious Mind, The Force of Mind and Unconscious Therapeutics. It is published by the Blakistons, of Phila- delphia, in their usual attractive style. The aim of the author is to exhault the vis medicatrix naturae in medical practice, which he regards as but a synomym for the un- conscious mind. Besides giving his own emphatic views as to the value and nature of the vis medicatrix naturae—"in other words, the unconscious mind," the author quotes from many eminent authorities, among them Dr. Osterlain's Medical Logic, Fichte, Wilkinson, Churchill's Force of Mind, Sir James Paget, Henry Gawen Sutton, and others high in Reviews, Book Notices, Reprints, Etc. 107 authority in the profession, including Mitchell Bruce, Sir J. C. Brown, Forbes, Morrison and Quain to sustain his con- tention, that disease is largely helped in its cure by men- tal influences acting upon the conscious mind and the sub- limal consciousness, as well as by the more "natural" re- sources of the materia medica. The British Medical Journal is also quoted in support of his contention. He quotes Brudenal Carter approvingly in what he called the treating of the patient and not the cure of the disease. Quoting from the London Lancet, he says: In disease the thera- peutic value of faith and hope, though not in our text- books, is often enough to turn the scale in favor of recov- ery. Thoughts of similar tenor run all through the book, making a volume well worth the consideration of the care- ful clinician. The concluding portion of the book is de- voted to a more material therapy. We would have been pleased to have seen a discus- sion in this book of the relation between unconscious mind and phagocytosis in the case of disease. PSYCHIATRY—A TEXT-BOOK FOR PHYSICIANS, by Stew- art Paton, M. D., Associate in Psychiatry, The Johns Hopkins University, Baltimore, Director of the Labora- tory, The Sheppard and Enoch Pratt Hospital, Towson, Maryland. J. B. Lippincott & Co., Philadelphia and London. The great increase of knowledge concerning those mor- bid conditions of the human body commonly but erroneous- ly described as mental diseases, and the resulting improve- ments made in recent years in the methods employed in the investigation and treatment of them, is in part urged by the author as justifying the publication of this entertain- ingly and instructively written book. The author considers it to be the most imperative duty of the state and institutions of learning to encourage, in every possible manner, the prosecution of studies which promise to result in the determination of the sources of ra- tional thought and action. The author thinks it is evident that the main burden of the work must be borne by the medical profession, from whose ranks must come the 108 Reviews, Book Notices, Reprints, Etc. leaders of any movement which has for its object the pre- vention and cure of the diseases characterized by defective or perverted functioning of the brain. His main object is to call attention to that aspect of psychiatry which is in accord with the results of observa- tions as they are conducted today at the bedside and in the laboratory, and while presenting the different views of leading authorities in a manner readily to be comprehended by students of this important branch of medicine, to stimu- late to greater activity the interest in the investigation of problems, in the solution of which will be found the means of increasing the brain power of the nation. In the first chapter he dwells upon the importance, scope and methods of modern psychiatry, in the second, on the nature of the disease process in alienation and its rela- tion to the pathological changes. Then follows a descrip- tion of the symptoms of alienation, the methods of exami- nation of patients, including examinations of the cerebro- spinal fluid, the treatment of cases of alienation, a descrip- tion of the modern hospital for the insane, a statement of the general causes of insanity, the principles concerned in the provisional clinical grouping of mental diseases, mental anomalies, the result of defective development of the cen- tral nervous system, psychoses which are probably in part the result of autointoxication, psychoses the result of chronic intoxications, psychoses associated with imperfect functioning of the thyroid gland. He describes the maniac depressive group, the dementia praecox group, the dementia paralytic group, the epilepsy group, the hysteria group, neurasthenic and psychasthenic states, psychoses associated with organic disease of the central nervous system, brain tumors, arterio-sclerosis, cerebral hemorrhage, thrombosis, multiple sclerosis, syphillis, the paranoia group, the senile group, psychoses connected with the period of senile invo- lution, states of excitement and depression, paranoid states and senile dementia. The work is clinically instructive physiologically, path- ologically and philosophically analytic, and well and ap- propriately illustrated. It will interest and instruct the Reviews, Book Notices, Reprints, Etc. 109 student, the general practitioner, the lawyer, the divine and priest, as well as the alienist and neurologist and general literateur. The literary writer of the day, especially the newspaper and magazine editor, would find many subjects in this and similar works, which h'e should know in order to speak with the highest general intelligence to the public. The chapter on neurasthenia and psychasthenia is es- pecially commendable. HANDBOOK FOR ATTENDANTS ON THE INSANE—With an appendix giving the regulations for the training and examination of candidates for the certificate of pro- ficiency in nursing, of the Medico-psychological Asso- ciation of Great Britain and Ireland. Fourth edition. Reprinted with revised regulations. Published by the authority of the Medico-psychological Association. W. T. Keener & Co., Chicago. This is a highly instructive book in many ways, care- fully and competently prepared by the authority of the Medico-psychological Association, of Great Britain and Ire- land, and introduces the reader to the kindergarten of psy- chiatry. Besides the very complete instruction it gives as to the proper care and nursing of the insane, the book be- ing designed especially for insane hospital nurses or attend- ants, as we call them in this country, it gives a great deal of valuable preliminary anatomical and diagnostic informa- tion, tersely told, to aid the nurse in understanding the pa- tient, and in intelligently communicating with the doctor and in warding off possible serious homicidal, suicidal or otherwise grave accidents. The book may be read profitably by medical students, especially such as contemplate taking a special interest in psychiatry. In fact it will prove a source of profitable in- struction to the average general practitioner of medicine, who usually knows too little of the insane and how they should be managed. The careful reading of this book by general hospital physicians and nurses would prevent many fatalities, such as occur in general hospitals from neglect of the precautions in it. 110 Reviews, Book Notices, Reprints, Etc. We commend this handbook, not only to all insane hospital nurses, but to all hospital and private nurses and to all physicians who have not had special experience with the insane, and particularly to those political medical ap- pointees who, without special skill and experience in the care and treatment of the insane, and often with a limited knowledge of general medicine, are nevertheless so often assigned, wrongfully, to the superintendency of our Ameri- can Hospitals for the Insane, as well as to those sometimes exceptionally good general medical appointees who, with a wide knowledge of clinical medicine and therapeutics in general, need only the additional information this valuable book conveys, to fit them for psychiatry and its grave re- sponsibilities. CHRISTIANITY AND SEX PROBLEMS. By Hugh North- cote, M. A. Crown Octavo, 257 Pages. Bound in Ex- tra Cloth. Price, $2.00 net. F. A. Davis Company, Publishers, 1914-16 Cherry Street, Philadelphia, Pa. This interesting book discusses many pertinent prob- lems of the human sexual life apropos to our day and gen- eration from the standpoint of the regulation, indulgence, abeyance, perversion and restraint of the dominant human passion. The chief aim of the book seems to reach a correct understanding of the right regulation and proper indulgence with the idea of exalting love with innocent sexual passion degradedly above its baser sexuality, the heavenly axaiTV over the more sensual 9«w which, latter, the author tells us, is not found in the New Testament. The ethics, literature and science of sex, sexual beauty, the Bible and sex and sexual desire, the purity .question, juvenile depravity, base and perverted sexuality, ethics of the sexes, continued incontinence and profligacy, sexual in- version, prostitution, chastity, continence, origin of modesty, these and many other important aspects of the subject for layman, clergyman, lawyer and doctor, are intelligently dis- cussed here by one of ripe research. The author gives some good moral reasons for advo- Reviews, Book Notices, Reprints, Etc. Ill cacy of neo-malthusianism or interference with natural fe- cundity under circumstances of entailable disease, poverty, criminality, etc. He thinks man, within certain limits, may follow by the exercise of a reasoned and conscious control of the birthrate in his own race, the precedent given by blind natural forces. How careful of the type she seems. How careless of the single germ. And this is true. PRACTICAL MASSAGE IN TWENTY LESSONS. By Hartwig Nissen, Instructor and Lecturer in Massage and Gym- nastics at Harvard University Summer School; Director of Physical Training, Brookline Public Schools, Former Acting Director of Physical Training, Boston Public Schools, Former Instructor of Physical Training at Johns Hopkins University and Wellesley College; Former Direct- or of*the Swedish Health Institute, Washington,D. C, etc., etc. Author of "Swedish Movement and Massage Treatment," "A, B, C of Swedish Educational Gym- nastics," "Rational Home Gymnastics," etc. With 46 Original Illustrations. 168 pages. l2mo. Price, Extra Cloth, $1.00, net. F. A. Davis Company, publishers, 1914-16 Cherry Street, Philadelphia. This book is a valuable revision of and improvement upon the author's preceding treatise on Swedish Movement and Massage Treatment, published in May, 1889, and is what its name implies, a practical massage treatise, the re- sult of the author's life work. The best and most useful movements may be found described in this brochure, in- cluding most of the borrowed manipulations of the mis- named and stale fostered osteopathy and fairly discussed without the preposterous and misleading claims of the pseudo art of bone disease, if we may describe this latter so-called system or treatment from its psychologic wrongly- selected derivation. TAYLOR'S PHYSICIAN'S ACCOUNT BOOKS consist of a deskbook and a pocketbook well arranged for quick and brief records of service and convenience as to space of desk or pocket, with valuable business suggestions. 112 Reviews, Book Notices, Reprints, Etc. The whole constitutes a concise and complete finan- cial record embodying the utmost degree of simplicity, plainness and economy of space and time, and available as a legally recognized account book, which may be produced and accepted in court. It deals in dates, service memo- randa and figures under suitable printed headings. CHECKERS.—If there were nothing more in Howard Blos- som's hard-luck story of "Checkers" than the sad, fa- tal, forceful lesson of warning in the pitiful death of Pert, against the "perfectly harmless-guaranteed" head- ache powJers of the day, put up as they usually are by some druggist's derk, with more assurance than medical skill, the mission of the book would well warrant its being. Phenalgin, phenacitin and most of the coal tar derived anodynes are fit only for special' expert medical prescription with systems skillfully fortified and sustained against their depressing influences. Murders by reckless drug adminis- tration, by unskilled drug clerks and boss pharmacists re- quire legal restraint. The career of "Checkers," too, is a lesson against the gambling, betting spirit and habit. The other characters, Barlow, Judge Martin, Sadie, Arthur, Murray, Tobe and Mandy and all are psychologically interesting and true to the nature put upon them by the author. There's great promise in this young writer of fiction. Herbert Stone & Co., Chicago and New York, are the publishers. THE PROCEEDINGS OF THE AMERICAN MEDICO-PSYCHO- LOGICAL ASSOCIATION, at the sixteenth annual meeting held in St. Louis, Mo., May 30-June-3, 1904, is as usual an interesting volume, especially to considering the deviating influences of the great St. Louis Exposition. We re- gret our inability, with the many other engagements of the great World's Fair, with one day imperatively out of the city andiaiday of ill health, to have been daily with the meetings of this always interesting and instructive So- ciety. Reviews, Book Notices, Reprints, Etc. 113 CHARITIES AND' THE COMMONS is a journal of Philan- thropy and Social Advance. Published by the New York Charity Organization Society. Edward T. De- vine, editor; Graham Taylor, associate editor: Aithur P. Kellogg and Graham Romeyn Taylor, assistants. Should be in the hands of all Philanthropists, State and City Health Records. It teems with interesting matter on this important subject. Le Passage a l'Acte dans L'Obsession Impulsive au Suicide. Par le Dr. A. Paris. Medecin de 1' Asile de Mareville. Extrait de la Revue Mldicale de VEst.—1905. Tabes Dorsalis. By L. Harrison Mettler, M. D., Chi- cago. A Case of Spinal Apoplexy with Findings. By Wil- liam Browning, M. D., and Frederick Tilney, M. D., of Brooklyn, N. Y. The Office Treatment of Diseases of the Rectum, with a Description of Some New Methods. By Charles B. Kel- sey, M. D., New York. On the importance of Differentiation in the use of Electric Modalities. By A. D. Rockwell, A. M., M. D., New York. The Education of an Aphasic. Shepherd Ivory Franz. Anomalous Reaction-Times in a Case of Manic-Depres- sive Depression. By Shepherd Ivory Franz, McLean Hos- pital, Waverley, Mass. A Review of Some Recent Papers Upon the Loss of the Feeling of Reality and Kindred Symptoms. By Dr. August Hoch, McLean Hospital, Waverley, Mass. Studies of Feeble-Mindedness. By Shepherd Ivory Franz. 114 Reviews Book Notices, Reprints, Etc. Protein Metabolism in Cystinuria. By Carl Alsberg and Otto Folin. [From the Chemical Laboratories of Har- vard Medical School, Boston, and the McLean Hospital for the Insane, Waverly, Mass.] Brachial Paralysis following Surgical Anaesthesia; Re- port of Two Cases. The Promotion of Early Diagnosis in Malignant Disease of the Uterus. Notes on the Gyneco- logical Examination. Outlines of Treatment for Pelvic In- flammation. By H. S. Crossen, M. D., St. Louis, Mo. to Physicians A. New BooK, Diet after Weaning We have issued this book in response to a constantly in- creasing demand for suggestions on the feeding and care of the child between the ages of one and two years. We believe you will find it a useful book to put in the hands of the young mother. The book is handsomely printed, fully illustrated and is bound in cloth. We shall be glad to furnish you copies for your patients entirely free. For your convenience we print below a coupon. MELLIN'S FOOD COMPANY, BOSTON, MASS. Detach on this line - Melliri$ Food Co., Boston, Mass. Please send me a copy of your illustrated book Diet After Weaning Yours very truly, M. D. WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY GOODS LAST YEAR. WM. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL, SPECIALTIES AT THE; WM. BARR goods COS NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. DF.AUTIFULLY situated on Long ~* Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. DR. D. W. McPARLAND, GREBN'S FARMS. CONN. Telephone 67-5, Westport, Conn. THE NATIONAL MEDICAL EXCHANGE—Physician', Dentists' ■ and Druggists' Locations and Property bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents for Monthly Bulletin containing terms, locations, and list of books. All Inquiries promptly answered. Address, H. A. MUMAW. M. D. Elkhart, lnd. THE NATIONAL Surgical and Dental Chair Exchange. Ail kinds of new and second-hand Chairs, Bought, Sold and Exchanged. JtaTSEND FOR OUR BARGAIN LIST-» Address with stamp. Dr. H. A. MUMAW, Elkhart, lnd. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agent* Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, lnd. PUBLISHER'S DEPARTMENT. THE INSANE OF TEXAS—A NEW HOSPITAL. The Legislature at its last regular session passed a law pro- viding for the erection of an addition to the North Texas Insane Asylum at Terrell. The addition is being constructed. It will give accommodation to 500 insane patients. At the time the appropriation for this addition was made it was stated there were 500 insane people in the county jails of Texas, there being no room for them in the asylums. There are three asylums in Texas maintained by the state government. Each of these institutions is crowded. There are more than 300 applications for admission pending at the Austin asylum and each of the other two institutions has on file several hundred of similar applications. It is conservatively estimated that there are 1,000 in- sane persons in the state who cannot be accommodated at the asylums on account of lack of room. Most of these insane are confined in the county jails. IN CHRONIC BRONCHITIS and "winter cough," Gray's Tonic is a well-nigh indispensable ally to successful treat- ment. Its use palliates the respiratory symptoms and exer- cises a beneficial influence upon nutrition in general—and this latter effect is a matter of no small importance, so authorities state, in overcoming these chronic and recurrent forms of bronchitis. Influenza, pneumonia and typhoid fever are, by means of this practice, rendered less troublesome by the specific action of Gray's Tonic on the respiratory tract—the course of the disease is obviously modified and convalescence more speedily established. Twenty years experience of skilled scientific physicians constitutes the foundation upon which the above statements are based. (115) The Perfect Food Digestor FORBES DIASTASE will digest a far greater quantity of starch food and thus through the formation of dextrines, both albuminoids and fats than any product axtant; acting in acid, alkaline or neutral media. Giving perfect Digestion, Assimilation, Metabolism and Nutrition. DOSE: ONE TEASPOONFUL A Palatable Concentrated Solution of Diastase from Malt without sugar. A large bottle (or several if requested) clinical trial. THE FORBES DIASTASE CO. will be delivered free for Marietta, Ohio. Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Helianthus annuus [sunflower.] Fr. root, bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism, is In- dicated in all cases complicated with Malaria, Scrofula, im- poverished Blood, Anaemia, etc.. etc.,In conjunction with PM Orient- alls (Thompson), will control the most obstinate cases of Impo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for Impotencv, and were poisoned with Phosphorus compounds, readily yield to this treatment. Pil Orientalls (Thompson) contains the Extract Ambrosia Orientalls. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It Is not an Irritant to the organs of generation, but A RECUPERATOR and SUPPORTER, and has been known to the native Priests of India. Burmah and Ceylon for ages, and has been s harem secret In all countries where the Islam has planted the standard of Polygamy. It Is impossible to send free samples to exhibit in Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation (with formulas and medical testimonials) to physicians who are not acquainted with their merits. D,,_„. / Helantha Compound, $1.85 per 02. Powder or Capsules. Knees, j p|1 Orientalis(Thompson)$1.00 1 THE IMMUNE TABLET COMPANY, I per box. WASHINGTON. D. C. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co., Chicago. Evans-Smith Drug Co., Kansas Clt Redlntfton A Co., San Francisco. J. L. Lyons & Co., New Orleans. CLARK ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING- AT 8 4 MASON ST MILWA UKEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING ^IS, (trains of the combined t\ P. Bromides uf Potamdum, Sodium, Calcium, Ammonium and Lith- ium For Physicians' Prescriptions For clinical trial we will send full size bottle of either or both preparations to any physician who will pay exp. charges WITHOUT CATHARSIS CHIONIA DOSE. One to two teasnoontulB three times a day. FORMULA. Prepared from Oilonanttum VirRlnlca, from which the Inert and n>Lu»cating features of the drug have bttn eliminated. Re-establishes portal circulation without producing congestion. Invaluable in all ailments due to hepatic torpor. PEACOCK CHEMICAL CO., ST. LOUIS, MO., U. S. A. Publisher's Department. 117 not available to the apothecary, as well as expert knowl- edge and experience, which he does not possess, are essen- tial to the perfect preparation of this remedy. The process for "Diluted Hydriodic Acid" just published in the Pharmacopoeia of 1900, is identical in every way with that of the Pharmacopoeia of 1890, except that it is more concentrated and the Syrup is omitted.' I HAD TRIED, unsuccessfully, all the known remedies for epilepsy, when 1 heard of a cure effected through the use of the Gelineau Dragees. 1 began this treatment with my patient, since then he has only had two attacks; these 1 am sure he could have avoided had he not, on both occa- sions, had the rashness to discontinue this excellent remedy. —Dr. Randon. BRITISH VISITORS STUDY EPILEPTICS IN LINCOLN, ILL.—The Royal Commission from the House of Parliament of Great Britain, appointed in 1904, to visit the United States to study methods for the care of feeble-minded, arrived in this city Nov. 17th. The party has been in America for the last month and has visited the institutions of the East in that time. The party is headed by William Patrick Byrne, Esq., C. B., principal clerk of the Home Office. Other members of the commission are: Horatio Bryan Donkin, Esq., M. D.; Willoughby Hyett Dickinson, Esq., M. P.; Doctor James Cranford Dunlap and Mrs. Ellen Francis Pinsett, the latter a noted expert on the subject of epilepsy. The Illinois Asylum for the Feeble-Minded Children is considered a model institution, and much time was given to the details of the management under the superintendent, Dr. Charles B. Taylor. Great Britain has no public institution for the care of the feeble-minded or epileptic, and charges are cared for in almshouses. The last meeting of Parliament ordered the appointment of this commission that better provision can be made for dependents. River Crest Sanitarium ' ^t^£L Astoria, L. I., New York City. in Lunacy. FOR NERVOUS AND MENTAL DISEASES. Home-like private retreat. Beautifully located. Easily accessible. 'Detached building for alcoholic and drug habitues- Hydrotherapy, Electricity, Massage. J. JOS. KINDRED, M. D., WM. E. DOLD, M. D., President. Physician in Charge. New York office 616 Madison ave.. cor. 59th st.; hours, 3 to 4 and by appointment. Phone, 1470 Plaza. Sanitarium Phone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore, Md. Dr. Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. THE BLUE HILLS SANITARIUM ""-ton MASSACHUSETTS. A PRIVATE HOSPITAL AND IDEAL RESORT. All classes of patients admitted. Separate department for the victims of ALCOHOL, OPIUM, COCAINE AND OTHER DRUG HABITS. All de»lre for liquors or the baneful drugs overcome within three days after entrance, and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hygienic treatment; also a Ten-plate Static Electrical Machine, with X-Ray. and alt the various attachments. J. FRANK PERRY. M. D., Supt. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIER SUDDUTH, M. P., 1oo State St., CHICAGO. 17 Publisher's Department. 118 J. A. HERRING, M. D., Myrtle Springs, Texas, says in the Alkaloidal Clinic he has used Ecthol, from Battle & Co., containing echinacea and thuja for the last five years and regards it is a specific. It stops boils and carbuncles; and he gives it in all glandular inflammations. Pus and Ecthol cannot stay in the same place. NUTRITION IN HEART LESIONS.—It is conceded that a most essential factor in the handling of cardiac lesions, either functional or organic, is proper nutrition. The chief aim in the treatment should be to maintain this stage of compensation and while the drugs usually employed in these conditions bring about desired results in part, complete results are not obtained unless proper and complete nutrition is supplied. In the handling of all cardiac conditions Dr. T. J. Biggs of Stamford, Conn., comments that Bovinine was the ideal food and tonic. It does not over-stimulate the heart but supplies sufficient stimulation. It gives to the system a proper proportion of every element of nutrition and a normal amount of assimilable iron. A PECULIAR FORM OF TRAUMATIC (CHEMICAL) CONJUNCTIVITIS, by A. M. Hutton, M. D., Navarre, Mich., says some miners employed in sinking a shaft near there encountered sulphur water which gave rise to an acute conjunctivitis. The pain could be relieved only by the use of cocaine, preceded by Adrenalin Chloride, 1-2000 followed by cocaine, 2 per cent solution. His point is that cocaine will not relieve this condition, unless preceded by Adrenalin Chloride. ELONGATION OF THE UVULA.—As a gargle in sore throat or elongation of the uvula, Kennedy's Dark Pinus Canadensis has very general endorsement, the usual pro- portion being teaspoonful to glass of water. WINE VS. COCA—H. W. C, Boston, Mass., writes to the editor of the Coca Leaf: I ask a pertinent question, yet one made in all sincerity, which 1 am sure many of The MILWAUKEE SANITARIUM Wauwatosa, Wis. FOR NERVOUS AND MENTAL DISEASES Wauwatosa is a suburb of Milwaukee on the Chicago, Milwaukee and St. Paul Rail- way, 2% hours from Chicago, S minutes' walk from all cars and trains. Physician in charge: RICHARD DEWEY, A.M., M.D. CHICAGO OFFICE, 34 Washington St., Wednesdays 2 to 4 P. M., (except in July and August). Telephone connections, Chicago and Milwaukee. Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, RID. City Office, 21 East 44th St., SING SING, P. O., N- Y. Mondays and Fridays, 3:30 to 4:30,p.m. Long Distance Tel., Hart, 140A, Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, M. D. EUQENEj G'ven Free FIELD'S POEMS* A $7.00 BOOK t to each person interested In subscribing to the Eugene Field Monument Souvenir Fund. Subscribe an; amount desired. Subscriptions u low as $1.1i0 will entitle donor to his daintily artistic volume "ficlo Flow cub" (cloth bound, 8x11i, as a certificate of subscription to fund. Book coutains a selec- tion of Field's best and most representative works and is re*dv for delivery. But - ,... m Jut for the noble contri- THE Bof,k of the century 2 button of the worid's greatest Handsomely Itlus- t artists this book could not tratcd by thirty* J have been manufactured for two of the Worid's X le%a than $7.00. Greatest ArtiUs. J The Fund created Is di- vided equally between the family of the late Eugene Field and the Fund for the building of a monument to the mem- ory of the beloved poet of childhood. Address EUGENE FIELD MONUMENT SOUVENIR FUND, (Alio at Book Storesi tf yt^u alio wish to nuwLiii suufGninruflL>, 194 Clinton SC., Chicago i »«-nd postage, eneloae 10 cts. PHI UK MEDICAL REGISTER I ULI\ O AND DIRECTORY WAS ESTABLISHED IN Do Not Be Deceived By Imitators. See that the name B. L, POLK A CO. IS ON THE ORDER BEFORE YOU SKIN IT. POLK'S Is the only complete Medical Directory POLK'S is the only Medical Directory having an index to all physicians in the United States. PO LK'S has stood the crucial test of time with increasing popularity. It thoroughly covers the field. R. L. POLK & CO., Publishers, DETROIT, MICHI CA INI. SUBSCRIBE KOW This is the Best Medium for — Sanitaria— Publisher's Department. 119 your readers will be glad to have answered. Is not the influence of the wine in Vin Mariani more important, and really more serviceable, than the Coca it contains? Vin Mariani is primarily a Coca preparation, and its properties are those of true. Coca, the delicate volatile prin- ciples of which are conserved and' rendered more effective by the added influence of the mild Bordeaux wine. The physiological effects (f Coca are enhanced by the initial- stimulation of the wine, which speedily gives place to the prolonged benefits of the drug. On the other hand, the after-effects of even a mild alcoholic, when taken alone, are wholly masked by the influence of the Coca of this unique combination. There are numerous instances when Vin Mariani has been employed to support life during pro- tracted periods to the exclusion of all other forms of nutri- ment. A result which could not be achieved by merely wine alone.—Coca Leaf. MELLINS' FOOD AND TURKEY.—This well-known and prosperous firm so serviceable to the medical profession and people, gave all of its official attaches and employees a turkey on last Thanksgiving Day. Felicitous speeches of congratulation on its continued prosperity were exchanged. HYGIENE OF SPANISH CHURCHES.—The Alcalde of Madrid, who, at least in sanitary matters, is decidedly progressive, has issued an order for the disinfection of churches. This order, which is based on a report from the director of the municipal laboratory, prescribes that all the churches of the Spanish capital are to be swept out daily with sawdust moistened with a solution of copper sulphate. All the fittings and furniture of the churches—chairs, benches, confessional, holy water fonts, etc.—are to be disinfected every day.—British Medical Journal. Here is a good example for American churches, street cars,. railway coaches, school rooms, and all places where people do most congregate, only that the sweeping of street and railway cars should be done with open windows and while passengers are not in them. ADRENALIN V ASTRINGENT AND HEMOSTATIC OF MARVELOUS POTENCY. WIDELY USEFUL IN SURGERY OF THE EYE, EAR, NOSE, THROAT, VAGINA AND URETHRA. AND IN Practically Every Form of Hemorrhage encountered by physician and surgcon. Its remarkable potency, broad usefulness, prompt action, and freedom from untoward results, stamp Adrenalin as one of the most notable agents in the materia medica. SiijijiliwI tn Polulion (radT for Utt, 1 port Adrenslln CMori-ia, 1000 parti normal Hit solution— In ounce 1 i . - - I .[ | _ r. .| i n .. LITERATURE ON REQUEST, ACET0Z0NE POWERFUL GERMICIDE AND INTESTINAL ANTISEPTIC. 01 MARKED VALUE IN TYPHOID FEVER CHOLERA DIARRHEA TONSILLITIS DYSENTERY GONORRHEA PUERPERAL FEVER MALIGNANT EDEMA and other diseases of like origin in which the source of infection can be reached by the solution. In the opinion of many physicians Are/ozone is the most remarkable antiseptic ever brought to the attention oj the profession. Suppllril In ounce, h.lf-ounc .ml i.nart.r-ounc. txittkh; .Is" In vial, of is grata. oaeb, >; .1.1. In . box, Write Ton Booklet with Clinical Reports PARKE, DAVIS & CO. laboratories: Detroit, mich., U.S.A.; walkerville, ont,; hounslow, eng. branches: new york, Chicago, st. louis. boston, Baltimore, new Orleans, kansas city, minneapolis, indianapolis, memphis; london, eng.; montreal, que.; sydney, n.s.w., st. petersburg, russia; simla, india; tokio japan. Publisher's Department. 120 IN BUILDING THE FOUNDATION of a lunatic asylum at Carshalton, the ruins of a fortified British village were discovered. The pottery found in it indicated its existence half a century B. C.—Med. Times. AWAKENING TO THE PUBLIC DANGER Dr. Brown introduces the following kindly tribute to the good physician from Dr. Ralcey H. Bell: "1 like to think in these degen- erate days- there are souls which still possess the freshness of fancy that rrlade the world to blossom as a garden in the dear dim olden time. A Physician who ministers to the stricken and poor without fee or price, a man who with ever open palm is ready to help those less fortunate than he, and a man whose pure heart and high resolve embraces the frailties of the weak—who lovingly forgives and, like nature, forgets—who is ever building where smaller spirits would demolish, is unto the weary world as a loving Prince of Light." AN1 ARCTIC SAILOR'S GRAVE. (Nicholas Senn, M. £>., Chicago, III.) His work is done; he rests Free from hunger, care and pain, Near yonder lofty crests, Without honor, without fame; On the bleak Arctic shore He sleeps forevermore. Far from home on bed of stone, Safe from reefs, storm and gale He dwelleth alone. Wrapp'd in his garb of sail On the bleak Arctic shore He sleeps forevermore. His courage and his deeds, His many hopes, his fears, His sufferings and needs Are forgotten, cause no tears On the bleak Arctic shore He sleeps forevermore. Publisher's Department. All honor to this grave Of stone on granite floor, Where lies a hero brave Forgotten without lore; On the bleak Arctic shore He sleeps to wake no more. —Medical Standard. MARY'S LITTLE CORSET. Mary had a little waist, She laced it smaller still; A stone o'er Mary has been placed Out on the silent hill. And on that stone these words are writ "Oh! let us hope she's gone Where angels never care a bit About what they have on." THE Alienist and Neurologist. VOL. XXVII. ST. LOUIS, MAY, 1906. No. 2. MIXOSCOP1C ADOLESCENT SURVIVALS IN ART, LITERATURE AND PSEUDO-ETHICS.* By JAS. G. KIERNAN, M. D., CHICAGO. Fellow of tbe Chicago Academy of Medicine; Honorary Member of Chicago Neurological Society; Foreign Associate Member of the French Medico-Psychological Association; Professor of Medical Jurisprudence, Dearborn Medical College. ASEXUAL state which appears around the fortieth year wherein the subject, while obtrusively objecting to discussions of sexual physiology, or psychology exhibits at the same time, a decided pornographic tendency. This class of men have themselves photographed in all kinds of pornographic relations and preserve the photographs under circumstances which suggest possible mental aberration. However, in cases, where other evidences of mental dis- turbance are absent, this is clearly a case of exhibitionism. As Havelock Ellist remarks, "by paralysis or inhibition of •Continued from the Alitnist and Neurolotist. February, 1W6. \AUtnist and Neurohttst, Hay, IMS. (123) 124 Jas. G. Kiernan. the finer and higher feelings current in civilization, the exhibitionist is placed on the same mental level as the man of a more primitive age and he thus presents the ba- sis on which the impulses belonging to a higher culture nat- urally take root and develop." Symbolically, this mental attitude appears in the position taken by conventionalists toward literature. Naturally it is frequently associated with religiosity. This last appears very markedly in Pusey, the leader of the theocratic ascetic tendencies in the Church of England, who fiercely denounced Kingsley's Hy- patia as an immoral book. In no small degree was this due to Kingsley's recognition of that poetry of motion, which, like Emerson, he found in dancing. The move- ment which Pusey led resulted in many forms of sexual aberrations, as the insane hospital and clinical records of the time testify. This mental state appears in Carlyle, who passes lightly and humorously over that extremely pornographic production, the "Biblion Erotika" of Mira- beau* to denounce as a "cloaca of a book." Louvet's "Adventures of Faublas" which is an admixture of Joseph Andrews and Clarissa Harlow with an element of dramatic justice, singularly its own. The book would have been re- garded by English 18th century moralists of the Hogarth school, as teaching a valuable lesson. This phase of Car- lyle's impressionism is due to his attempt to make vMira- beau the center of the French Revolution and to minimize his defects. To do this, Carlyle did not hesitate to distort details. Not only did he blacken Marat, but he greatly di- minished the influence of Robespierre. The latter, as Car- lyle admits, had a high conscientiousness, which Carlyle designates in his epithet of the "sea green incorruptible." Against much of the stigma cast upon him by fanatical plutocrats and adherents of autocracy, Robespierre has since been defended even by Macauley. Of his general characteristics Eleanore Duplay, (Robespierre's beloved) draws the following picture in a letter to a female friend, under date of January 8, 1794: "Perhaps you would be surprised if I told you 1 •French Revolution. Mixoscopic Adolescent Survivals in Art. 125 thought him too conscientious—so afraid to do wrong that he sometimes takes too long in making up his mind. Yet so it is. Do not think of him as a hunter of priests, for he is nothing of the sort. He does not like their im- postures, of course. I remember how angry he was last time he went to Arras, when he heard them present to the poor country people that they had wrought miracles on a certain townsman, though they did not dare to mention it to his fellow-townsmen, who knew that no miracle had been wrought at all. And he does not care for the trivial dogmas with which religion has been overladen. You did not care about them either, Jeannette, in the old times; but 1 believe you like anything which is getting beaten, and dogmas have certainly had a bad time of it lately. But if you put aside dogmas and impostures, just, as in politics, you must put aside the personal details which often obscure principles; in the true sense of the word, there is no more religious man than Maximilian. His has always been a religious family. There is a tradition at Arras that they fled from Ireland for religion's sake 200 years ago. Maximilian was always friendly to the Chap- ter of Paris when he was in the Constituent Assembly. He spoke, too, in favor of larger pensions for the humble clergy. He hates the idea of the "feast of reason" (fancy worshiping a woman he would not even speak to) and all the other Herbertist excesses. Oh, if you could hear him. 1 sometimes fancy him a priest himself. He is to me what the priest used to be when I was a little girl. He is always proper when others are wicked^dresses so neatly when others slouch about like slovens—he has his old testament— Racine, Corneille, Voltaire, and his gospel—Rousseau. He reads them to us sometimes, not as the false priests used to drone their gospels, that they were paid to preach, but so beautifully that in the pathetic parts we sometimes all burst into tears. He believes it all so thoroughly; he is so conscious of a mission to teach it. The crowds gather round him in the Jacobins, as round a great preacher, to hear his text and his sermon. He says it so that one cannot disbelieve. Do you know, I sometimes carry the 126 Jas. G. Kiernan. thought further, and ask myself whether one so good and so pure can become a husband to me. 1 think he ought to be celibate as a priest: But if I told him so he would be shocked, poor man: It is contrary to the civil constitution of the clergy. Then you call him cruel. I am sure 1 have never seen him so. When we were walking together in the Champs Elysee with his dear dog Blount following us, we sometimes sit down and the little Savoyards come round, and I never saw him send them away without giv- ing them something. And he is kind to us all, and so thoughtful. 1 can see your look of horror, you little prose- , lyte of La Roche Jacquelin and the Chouans. You point me to the guillotine and ask me, is that not his works. No Jeannette, 1 do not think it is. 1 will allow just this much, that I sometimes wish he had done more to keep back the others. I fancy he does not always realize things that are done under the cover of his reputation. He thinks so much of principles that he sometimes forgets facts. 1 have never told him so, for when we are alone together, it is not often (every morning he is at the Com- mittee of Public Safety, every afternoon at the convention, every evening at the Jacobins,) he always tries to escape from these terrible things and give play to his fancy." Carlyle's portrait is not entirely inconsistent with that of Eleanore Duplay: "But now if Mirabeau is the greatest, who of these Six Hundred may be the meanest? Shall we say, that anxious, slight, ineffectual looking man, under thirty, in spectacles; his eyes (were the glasses off) troubled, careful; with upturned face, snuffing dimly the uncertain future times; complexion of a multiplex atrabiliar color, the fine shade of which may be the pale sea-green. That greenish-colored (verdatre) is an advocate of Arra; his name is Maximilian Robespierre. The son of an advocate; his father founded mason lodges under Charles Edward, the English Prince or Pretender. Maximilian, the first born, was thriftily educated; he had brisk Camille Des- moulins for schoolmate in the College of Louis LeGrand, at Paris. But he begged our famed Necklace Cardinal Rohan, the patron, to let him depart thence, and resign in favor of Mixoscopic Adolescent Survivals in Art. 127 a younger brother. The strict-minded Max departed; home to paternal Arras; and even had a law case there and pleaded not unsuccessfully, in favor of the first Franklin thunder-rod. With a strict, painful mind, and an under- standing small but clear and ready, he grew in favor with official persons, who could foresee in him an excellent man of business, happily quite free from genius. The Bishop, therefore, taking counsel, appoints him Judge of his diocese; and he faithfully does justice to the people; till behold, one day a culprit comes, whose crime merits hanging; and the strict-minded Max must abdicate, for his conscience will not permit the dooming of any son of Adam to die. A strict-minded, straight-laced man. A man unfit for rev- olutions? Whose small soul, transparent, wholesome-looking as small ale, could by no means ferment into virulent ale- gar, the mother of ever new alegar, till all France were grown acetous virulent." That Robespierre was the origin of the referendum, Carlyle demonstrates: There likewise sits sea-green Robes- pierre; throwing in his light weight with decision, not yet with effect. A thin, lean Puritan and Precisian, he would make away with formulas; yet lives, moves and has his being wholly in formulas, of another sort. 'Peuple' such, according to Robespierre, ought to be the royal method of promulgating Laws. 'Peuple' this is the law I have framed for thee; dost thou accept it?—answered, from Right Side, from Center and Left, by inextinguishable laughter. Yet men of insight discern that the Sea-green may by chance go far. "This man," observes Mirabeau, "will do somewhat; he believes every word he says!" Strangely enough, Carlyle portrays the bourgeois limi- tations of Robespierre in his remarks on Robespierre's death; "Unhappiest Advocate of Arms, wert thou worse than other Advocates? Stricter man, according to his Form- ula, to his Credo and his Cant, of probities, benevolences, pleasures of virtue, and such like, lived not in that age. A man fitted, in some luckier settled age, to have become one of those incorruptible barren Pattern-Figures, and have had marble tablets and funeral sermons. His poor land- 128 Jas. G. Kiernan. lord, the cabinet-maker in the Rue Saint Honore, loved him; his brother died for him. May God be merciful to him, and to us." That Robespierre failed to pass through adolescence unharmed, is shown in the cholemic chlorotic complexion universally ascribed to him. This damage appears in Macaulay's* picture of Robespierre, who, according to Ma- caulay, was a vain, envious, suspicious man, with a hard heart, weak nerves and a gloomy temper. He was, in the vulgar sense of the word, disinterested; his private life was correct and he was sincerely zealous for his own sys- tem of politics and morals. The mysticism resultant on adolescent stress, conse- quent on anxious mental states, due to organ instability, ris- ing into consciousness appeared in Robespierre. Concern- ing the most marked expression of this, Macaulay remarks: "An old woman named Catherine Theiot, half maniac, half imposter, was protected by him, and exercised a strange in- fluence over his mind; for he was naturally prone to superstition, and, having abjured the faith in which he had been brought up, was looking about for something to be- lieve." The picture of Carlyle is still more detailed: Catholicism being burned out, and Reason Worship guillo- tined, was there not need of one? Incorruptible Robes- pierre, not unlike the Ancient Legislator of a free people, will now also be Priest and Prophet. He has donned his sky blue coat made for the occasion, white silk waistcoat broidered with silver, black silk breeches, white stockings, shoe buckles of gold. He is president of the Convention; he has made the convention decree, so they name it the 'Existence of the Supreme Being," and likewise le principe consolateur of the 'Immortality of the Soul.' These consola- tory principles, the basis of rational republican religion, are getting decreed; and here, on this Blessed Decadi, by help of heaven and painter David, is to be our first act of wor- ship. See, accordingly after decree passed, and what has been called 'the scraggiest prophetic discourse ever uttered •Bssays: Barere. Mixoscopic Adolescent Survivals in Art. 129 by man,' Mahomet Robespiere, in sky blue coat and black breeches, frizzled and powdered to perfection, bearing in his hand a bouquet of flowers and wheat ears, issues proudly from the Convention hall; Convention following him yet, as is remarked, with an interval. Amphitheatre has been raised, or at least monticule or elevation, hideous statutes of atheism, anarchy and such like, thanks to heaven and painter David, strike abhorrence into the heart. Unluckily, however, our monticule is too small. On the top of it not half of us stand; wherefore there arises indecent shoving, nay treasonous, irreverent growling. Peace, thou Bourdon de l'Oise, peace, or it may be worse for thee. The sea-green Pontiff takes a torch, painter David handing it, mouths some other froth-rant of vocables, which happily one cannot hear; strides resolutely forward, in sight of expectant France; sets his torch to atheism and company, which are but made of pasteboard steeped in turpentine. They burn up rapidly, and from within there rises by 'machinery,' an incombustible statue of Wisdom, which, by ill hap, gets besmoked a little, but does stand there visible in as serene attitude as it can. Catherine Theiot, on the other hand, an ancient, serving maid of seventy-nine years of age, inured by prophecy and the bastile of old, sits in an upper room in the Rue de Contre- scarpe, poring over the book of Revelations, with an eye to Robespierre, finds that this astonishing thrice-potent Maximilian really is the man spoken of by prophets, who is to make the earth young again. With her sit devout old Marchionesses, ci-devant honorable women, among whom Old Constituent Dom Gerle, with his addle head, cannot be wanting. They sit there, in the Rue de Contrescarpe in mysterious adoration: Mumbo is Jumbo and Robespierre is his prophet. A conspicuous man this Robespierre. He has his volunteer bodyguard of Tappe-durs, let us say strike sharps, fierce patriots with feruled sticks; and Jacobins kissing the hem of his garment. He enjoys the admiration of many, the worship of some; and is well worth the won- der of one and all." Robespierre's departure from the referendum principle 130 Jas. G. Kietnan. implying Jeffersonian responsibility to the people marks adolescent decadence. The lynch law legislation which marred the French Revolution, as it has too often marred American progress for the benefit of plutocracy, was the consequence of this, and resulted in Robespierre's down- fall at a time when his usefulness was becoming most apparent. His acquiescence in Danton's execution, though a fatal error, was shared by prevalent Jacobin opinion. Souberbielle,* the lithotomist revolutionist, ("who united two individualities equally interesting for history. The poli- tician taking part in the most serious events of the later 18th century and the surgeon whose skilful hand pre- served the existence of so many sufferers"), coming early one day to the Palace of Justice, found there a good friend of his, a juryman like himself, in tears. "Why are you crying?" asks Souberbielle. "Why" is the reply. "Do you not know that today we judge the patriot Danton, a founder of the Republic, whom we have had at our head on all great days?" "Come, come," answers Souberbeille: "It is a very simple matter; here are two men who can- not exist at the same time, Robespierre and Danton. Which is the most useful to the Republic?" "It's Robes- pierre," hesitatingly responds the juryman. "Very well, then Danton must be guillotined; it's as simple as how d'ye do." The suspicional environment of the time, which was enormous, no doubt had the effect on Robespierre pointed by Carlyle. No people could have resisted the suspicion-producing atmosphere of a treacherous executive (Louis XVI and Marie Antoinette), a civil war (LaVendee) united with foreign invasion (Austria, Great Britain and Prussia.) The invasion by Great Britain was especially treacherous. Support given the autocratic Hapsburgs and HohenzoIIerns by English freedom seemed peculiarly hypo- critical. This war against French freedom originated with the tricky, morally imbecile George HI, who, in the boodle in- terests of himself and the English plutocracy, devised the 18th century crimes against American, English, French, Scottish and Irish freedom. Had England, Austria and •Cabanes: Secret Cabinet of History. Mixoscopic Adolescent Survivals in Art. 131 Prussia kept their hands off, the Reign of Terror would never have come. The Paris mob would never have acquired the habit of dictating to the Legislature. The consequences of this habit led to the creation of Washing- ton as a Capital, dependent entirely on the general gov- ernment and without municipal life of mob-creating type. This mob law element early influenced Marat, who has the sympathies of Carlyle in his opposition to legislative insti- tutions. "Here indeed," remarks Carlyle, "becomes notable one great difference between our two kinds of civil war; between the modern lingual or Parliamentary-logical kind and the ancient or manual kind in the steel battle field— much to the disadvantage of the former. In the manual kind, where you front your foe with drawn weapons, one right stroke is final; for, physically speaking, when the brains are out the man does honestly die, and trouble you no more. But how different when it is with arguments you fight. Here no victory yet definable can be considered as final. Beat him down with Parliamentary invective till sense be fled; cut Tiim in two, hanging one half on this dilemma-horn, the other on that; blow the brains or think- ing-faculty quite out of him for the time; it kills not; he rallies and revives on the morrow; tomorrow he repairs his golden fires. The thing that will logically extinguish him is perhaps still a desideratum in Constitutional civilization. For how, till a man know in some measure, at what point he becomes logically defunct, can Parliamentary business be carried on and talk cease or slacken? Doubtless it was some feeling of this difficulty; and the clear insight how little such knowledge yet existed in the French nation, new in the constitutional career, and how defunct aristocrats would continue to walk for unlimited periods, as Partridge, the almanac-maker did, that had sunk into the deep mind of people's friend, Marat, an eminently practical mind; and had grown there in that richest putrescent soil, into the most original plan of action ever submitted to a people. Not yet has it grown, but it has germinated; it is growing, rooting itself into Tartarus, branching toward heaven; the second season hence we shall see it risen out of the bot- 132 Jas. G. Kiernan. tomless darkness, full-grown, into disastrous twilight—a hemlock tree, great as the world may lodge. "Two hun- dred and sixty thousand aristocrat heads;" that is the pre- cisest calculation, though one would not stand on a few hundred thousand. Shudder at it, O people; but it is as true as that ye yourselves, and your people's friend, are alive. These prating senators of yours hover ineffectual on the barren letter, and will never save the Revolution. A Cassandra-Marat cannot do it with his single shrunken arm; but with a few determined men it were possible. "Give me," said the people's friend, in his cold way, when young Barbaroux, once his pupil in a course of what was called optics, went to see him, "Give me two hun- dred Naples bravoes, armed each with a good dirk and a muff on his left arm by way of shield; with them I will traverse France and accomplish the Revolution." Nay, be grave, young Barbaroux; for thou seest there is no jesting in those rheumy eyes, in that soot-bleared figure, most earnest of created things, neither is there indeed madness of the straitwaistcoat sort. Such prdUuce shall the time ripen in cavernous Marat, the man forbid; living in Paris cellars, lone as fanatic Anchorite in his Thebaid; say as far seen as Simon on his Pillar, taking peculiar views there- from. Patriots may smile; and, using him as a bandog now to be muzzled, now to be let bark, name him, as Des- moulins does, 'Maximum of Patriotism' and 'Cassandra- Marat;' but were it not singular if this dirk and muff plan of his (with superficial modifications) proved to be pre- cisely the plan adopted?" It is obvious from this that Marat never imbibed the English prejudice against assassination. On the continent assassination has always played a part in politics. As Dumas remarks, discussing the subject, "in politics we do not kill a man, we remove an obstacle." In Italy, assassi- nation in the States of the Church played a large part in political changes. Pope Alexander VI, and the other Borgies, converted poisoning into a system whereby wealth was secured and the turbulent baronage of the Romagna was curbed. These procedures were brought into France Mixoscopic Adolescent Survivals in Art. 133 by Catherine di Medici, who united political harlotry, open assassination, (massacre of St. Bartholomew) and secret poisoning, as means of government. The psychology of the poisoner differs so markedly from the popular conception of it, that poisoners are fre- quently regarded as innocent victims of the law, and even from their religious demonstrations as saints. This was no- toriously the case with the Marquise de Brinvilliers, whom the populace of Paris regarded as a saint after her execu- tion. As Arthur Macdonald remarks,* poisoners are gener- ally well educated; they are nurses, physicians, druggists, chemists, etc. They have a sympathetic air, amiable address, persuasive language, which would deceive the very elect; they are often passionate women. Poisoning has been a species of voluptuousness; many have been poisoned some- times with little motive, and as many as fourteen and twenty-one at a time; poisoners are pushed by cupidity, love or unbridled lust; they are hypocritical, calm and de- ceitful, protesting their innocence to the very end; they carry their secret into the grave; they rarely have accom- plices. Sometimes poisoning assumes the form of an epi- demic, especially with women. The mental characteristics of sadist poisoners are illus- trated by Jane Toppan, who was a professional nurse about 45 years of age, single, American. She was arrested October 30th, 1901, for poisoning Mrs. M. G. Four mem- bers of the family had died with similar symptoms. Jane Toppan had been on intimate footing with the family, at- tached to her as one of themselves. Her services were often required for trivial ailments. The short, fatal ill- nesses of these four persons, occurring one after another, finally aroused suspicion, which naturally centered on the nurse who had dosed the victims, and who had only sum- moned the physician when they were at the point of death. She was not only pointedly questioned on the sub- ject by several persons, but was actually told by a rela- tive of the deceased that she was suspected of causing death. Notwithstanding a fortnight later she attended an •Criminology. 134 Jas. G. Kiernan. old lady who was taken ill, and died with the same symp- toms. One person destroyed held Jane Toppan's note for several hundred dollars. Various small amounts belonging to three others were missed after their deaths, but these thefts were not proven against accused. There was no suspicion of theft from the third victim. While B., the latest victim, was ill, a detective called at the house, and in the room below the sick chamber questioned Jane at length about the deaths of her last four patients, ostensibly trying to fasten the guilt upon another person. Throughout the entire interview she was calm and self-possessed, showing no trace of anxiety, and talked freely and pleasantly.. She made no attempt to implicate others.* In September, 1901, she made two attempts to poison herself, probably with morphine, the last an apparently de- termined one. She gave as reason for these that she was jealous because a man whom she wanted to marry paid at- tention to another woman. She subsequently wrote him an absurd, abusive letter. Leaving the hospital she made a visit to some friends in a neighboring state, and later wrote: "I never even thought of the investigation of the murder while at A., until 1 was arrested. I was having a fine time out there. 1 don't think 1 ever enjoyed myself as 1 did that Fall. There was a jolly lot of people there, and I had the kind of a time I like to have. 1 remember perfectly well the detective read- ing the warrant, but it made little impression on me. The funniest thing about it was that 1 was annoyed be- cause the detective insisted on remaining in my room while 1 was getting ready, and I did not think it was very gentlemanly." She took her arrest with perfect compos- ure and without the slightest remonstrance. On the long trip to the jail she was at first thoughtful, but later talka- tive and in good spirits. She talked freely to the officers about herself, and seemed entirely willing then, and at the jail, before seeing her counsel, to admit her guilt and showed little or no realization of her situation. This con- dition of mind remained throughout her imprisonment and *H. K. Stedman: Boston Medical and Surtical Journal. July 21,1904. Mixoscopic Adolescent Survivals. 135 trial. The original name of Jane Toppan was Honora Kelly. When about four years of age she and her sister, were placed in a foundling asylum by her father, an eccen- tric man, who drank hard at the time of his death. She has two living sisters, one a respectable,capable woman some years her senior, the other a chronic dement. A third sister had led a dissolute life. About six years of age Honora was apprenticed and took the name by which she has since been known. She was given a good education, proving intelligent and quick to learn. She was under good moral and religious in- fluences. Her home surroundings were excellent. As she passed into womanhood she became incorrigible. She was deceitful, and gave so much trouble that her adopted mother refused to let her remain longer in the family. Her impossible tales and lies, often senseless and doggedly per- sisted in, despite proof of falsity, are still remembered in the neighborhood. At 28 she began her career as a nurse, after four years of training and service in two general hospitals. There she showed much capability in the technical part of her duties. She knew how to take good care of her patients, but did not like to work. While not of attractive appearance she had a pleasant manner and was wonderfully clever, ingrat- iating herself with such patients and physicians as she wished to please. She was remarkably skillful in escaping consequences of wrong-doing and implicating others. Her hospital life showed her earlier tendencies. Her fellow- workers looked upon her as "queer," because of her un- founded suspicions and tale-bearing, as well as her pleas- ure in inventing fabulous tales. She wrote peculiar letters to the friends of patients, and endeavored to prolong the illness of favorite patients by reporting symptoms that did not exist. In other cases .she reported false temperatures without obvious reason. Suspicion obtained during her hospital service that she stole. During it she was often heard to say that there was no use in keeping old people alive; she liked to discuss poisons and their antidotes dur- ing her hospital service. A nurse who had sorrie slight ill- ness, placed under her care, was taken with an alarming 136 /as. G. Kiernan. collapse but recovered during the night. The following day the collapse was repeated. After this another nurse was put in charge. At that time and since, she was said to be addicted to opium, but careful observation has failed to confirm this. Her conduct in situations where opium taking was impossi- ble, showed that it could not be due to that drug. No tendency to sexuality or alcohol was ever noticed. On leaving the hospital she took up private nursing, in which she was for many years very successful, inspiring certain families, not a few of them of high social position, with confidence in her skill and affection for herself. One family, unsuspecting, employed her after death of one of their members at her hands. Experienced, able physicians recommended her for a time on account of her capability. Her own friends spoke of her jealous and vindictive na- ture. Her conduct was considered strange by not a few, but just why they cannot specify. She had a marked ca- pacity for making trouble for its own sake. She was a clever liar, with a marvelous capacity for inventing and re- membering tales. She borrowed money from patients which was never repaid, although she earned a good liv- ing. Her debts gave her little concern. Occasionally small sums of money and articles of clothing disappeared from places where she was employed, but she was rarely suspected, never detected in theft nor directly accused of it. She undoubtedly prolonged some cases for profit. On the other hand, she cut short many that might have proved equally lucrative by poisoning. She started four fires, but gave the alarm and helped vigorously to put them out. Two were set in the same house to frighten a nervous pa- tient and retard recovery. Her conduct toward the end of her nurse career suggests increasing demoralization. Her stories grew more sensational and preposterous. She ma- ligned physicians, circulated stories of epidemics and criti- cised methods of treatment. In all she committed twenty homicides definitely ascertainable. Twelve she admitted at the examination. While in jail she made a list of thirty- one victims. Possibly four of these should be added to the Mixoscopic Adolescent Survivals in Art. 137 original twenty; of the remainder there is so much uncer- tainty that it cannot be stated that death was caused by poisoning. Most of the patients were killed by opium. One patient was given strychnine. At the first interview after the lunacy commission was appointed, she talked freely and was indifferent to her situation. Her talk was more or less rambling and rather irrelevant. Her utter mendacity and disposition to speak slurringly of even her best friends was a striking characteristic. One minute she would praise and another blame. None of her statements could be re- lied upon unless corroborated by reliable evidence. She was not able to remember details of all cases because poisoning had become a habit. Her favorite method of ad- ministering poison was in Hunyadi water or by enema. Sometimes drugs were so combined as to give unusual or perplexing symptoms. In poisoning she was, she asserted, always calm and clear-headed. After poisoning she experienced great relief, went to bed and slept soundly. In one case she took to bed with her the child of her victim, after administering the fatal dose. In another she lay on the bed with the patient whom she had just poisoned and had a long sleep. When it was too late to save the patient she would, according to her own statement, work hard to do so, but in one instance at least took this opportunity to repeat the dose. During the interviews she showed much levity. She understood clearly that she had done wrong, but did not manifest the slightest remorse. She was totally indifferent as to the outcome of the trial, but said she preferred the prison to the asylum. "When I try," she said, "to picture it I say to myself 1 have poisoned M., my dear friend; I have pois- oned Mrs. G.; I have poisoned Mr. D. and Mrs. D. This does not convey anything to me, and when I try to sense the condition of the children and all the consequences, I cannot realize what an awful thing it is. Why don't I feel sorry and grieve over it! I cannot sense it at all." So far from having delusions of enmity or persecution, she spoke of most of her victims as her friends, and denied any hostility on her side or others. No delusions or hallu- 138 Jas. G. Kiernan. cinations were detectable. She never showed any reticence or distrust common in those with concealed delusions. One fairly typical poisoner was Thomas Wainwrifcht, well known as Havelock Ellis remarks, in his time as as an essayist, much better known as a forger and a murderer. R. Griffiths, L. L. D., Wainwright's maternal grandfather, was an energetic literary man and journalist, whose daugh- ter, Ann, born of a second young wife, when he was well past middle life, "is supposed to have understood the writ- ings of Mr. Locke as well as perhaps any person of either sex now living." She married Thomas Wainwright, and died in childbed at the age of twenty-one, the last survivor, even at that age, of the second family. Thomas Wainwright, the father, himself died very soon afterwards. Of him nothing is known, though there is reason to think that Dr. Griffiths regarded him with dislike or suspicion.* The child was born of a failing, degenerating stock. He was clever, of some means, grew up in a literary and artistic circle; but was vain and unstable, "ever to be wiled away," as he says himself, "by new and flashy gauds." When still a lad, he went into the army for a time. Then, after a while, being idle in town," "my blessed Art touched her renegade; by her pure and high influences the noisome mists were purged," and he wept tears of happiness and gratitude over Wordsworth's poems. But this serene state was broken," he wrote, several years be- fore his career of crime had commenced," like a vessel of clay, by acute disease, succeeded by a relaxation of the muscles and nerves, which depressed me —'low As through the abysses of a joyless heart 'The heaviest plummet of despair could go,'— into hypochondriasis, ever shuddering on the horrible abyss of mere insanity. But two excellent secondary agents—a kind and skilful physician, and a most delicately affection- ate and unwearied (though young and fragile) nurse— brought me at length out of those dead black waters, nearly exhausted with so sore a struggle. Steady pursuits The Criminal. Mixoscopic Adolescent Survivals in Art. 139 were debarred me and varied amusement deemed essential to my complete revivication." Then he began to write his essays and criticisms, dealing chiefly with the later Italian and the French artists, under the name of Janus Weather- cock. He was a man of many sentimentalities and super- refinements. He hated "all vulgarity" and "sordid instincts." His tastes were sensual in every respect. His means were not sufficient to satisfy his desires for luxurious foods and drinks, for fine perfumes, for large jewels to wear. He could not live without luxuries. About the date when his chief literary activities' ceased, about thirty years of age, he forged a power of attorney with the names of his trustees, assigning to himself the principal of five thousand pounds, of which he was enjoying the interest. This offence, then capital, remained undetected for twelve years. He is described at this time as a "smart, lively, clever, heartless, voluptious coxcomb." He was tall, stooping slighty, of dark hair and complexion, deeply set eyes, stealthily but fascinating, a large and massive head. He married a young lady, poor but gay and brilliant. She had a widowed mother and two half sisters. The young couple lived im- providently. An uncle, C. E. Griffiths, who was well off, offered them a home, which offer was accepted. A year after, the uncle, after a short illness, died very unexpectedly, leaving his property to his nephew and niece. This money went rather fast; and there were no longer any expecta- tions from relations. The stepmother and her daughters (the Abercrombies) were poor; their schemes to earn a living were not successful. The Abercrombies were obliged to live with the Wainwrights in the mansion they inheri- ted. A very few months after this Mrs. Abercrombie died, like old Mr. Griffiths, very suddenly, in convulsions. No benefits, however, followed her death. Affairs continued to grow worse. Soon the bailiffs were in the house and there was a bill of sale on the furniture. The Wainwrights and Abercrombies migrated to handsome lodgings in Conduit street, near Regent street. They frequently went to the play. One night, very soon after their arrival, Helen Aber- crombie, who wore the thin shoes then always used by 140 Jas. G. Kiernan. women, got her feet wet and became ill. She was assid- uously attended by Wainwright and his wife, who held frequent consultations as to her treatment by certain powders. In a few days she died with the same symp- toms as her mother.'the same symptoms as Mr. Griffiths, "brain mischief," the doctor called it. She died on the day on which the bill of sale became due. After her death it was found that her life had, during the same year, been insured in various companies for ninety thousand dollars. Helen Abercrombie was a beautiful, very healthy girl; her death created suspicions and gave rise to law suits which, on the slight but definite ground of misrepre- sentation, were decided in favor of the companies. Mean- while Wainwright found it convenient to leave England (he had separated from his wife after the death of Helen Abercrombie), and took refuge with a rather impecunious gentleman, who lived with his daughter at Boulogne. He persuaded this gentleman to obtain money to effect a loan by insuring his life. After the policy had been effected, this gentleman died suddenly. Wainwright next travelled in France, doubtless for excellent reasons, under an assumed name. He fell into the hands of the police, but not being able to give a good account of himself, was im- prisoned for six months. The French police found that he carried about with him strychnine at that time. This was put down to English eccentricity. There was a warrant out againt Wainwright for forgery. He was lured over to England by a detective, with the aid of a woman, and ar- rested. He was tried for forgery and condemned to transportation for life. 'At this time suspicions of the doctor who attended Helen Abercrombie were roused. Wainwright himself, after his condemnation, admitted to visitors with extraordinary vanity and audacity his achieve- ments in poisoning, and elucidated his methods. He kept a diary in which he recorded his operations with much complacency. The one thing that moved Wainwright was being placed in irons in the hold of the ship. "They think me a desperado! Me, the companion of poets, philos- ophers, artists and musicians, a desperado; you will smile Mixoscopic Adolescent Survivals in Art. 141 at this—no, I think you will feel for the man, educated and reared as a gentleman, now the mate of a vulgar ruffian and country bumpkins". At Hobart Town, on two occa- sions, he endeavored to poison persons who had excited his animosity. He is described at the same time by one who knew him well "as a man with a massive head, in which the animal propensities were largely developed." His eyes were deeply set in his head; he had a square, solid jaw and snake like expression, which was at once repulsive and fascinating. He rarely looked you in the face. His con- versation and manner were winning in the extreme; he was never intemperate, but grossly sensual in habits and an opium eater. As to moral character, he was a man of the very lowest stamp. He seemed to be possessed by an ingrained malignity of disposition which kept him constantly on the very confines of murder. He took a perverse pleasure in traducing persons who had befriended him. He was a marked man in Hobart Town—dreaded, disliked and shunned by everybody. His sole living companion was a cat, for which he evinced an extraordinary affection. He died of apoplexy in 1832, at fifty-eight. (To be continued.) EROTIC SYMBOLISM. BY HAVELOCK ELLIS, M. D., Carbis Water, Lelant, Cornwall, England. WHEN among women animal perversions appear, the animal is nearly always a pet dog. Usually it is taught to give gratification by cunnilinctus. In some in- stances coitus between the animal and woman occurs. In a German medico-legal case of cunnilinctus by a dog, cited by Moll,* the issue was raised whether the act should be considered an unnatural crime or simply an offense against decency. The lower court regarded it as the former while the higher took the more merciful view. In a case reported by Pfaff,t a country girl was accused of coitus with a large dog. On examination a loose hair microscopically shown to belong to the dog, was found by Pfaff in the girl's thick pubic hair. While this evidence might indicate contact, it did not prove coitus. This has undoubtedly occurred from time to time more or less openly. Blocht has cited evidence as to the frequency of cunnilinctus, coitus and even paedi- catio between women and dogs. In a Nebraska case, a smart, pretty, well-educated twenty-six-year-old country girl had a profuse, offensive, greenish-yellow discharge glueing the parts together. This which had come on suddenly, had existed for a week. After cleansing the external geni- tals and opening the labia, three rents were found, one through the fourchette and two through the left nympha. The vagina was excessively congested and covered with •Untersuohungen uber die Libido Sexualis, B. I, p. 697, 698. fBeitr. xnr Aetiologie der Psychopathic Sexualis. XWtchly Medical Rnitw. 1893. (142) Erotic Symbolism. 143 points, bleeding on the slightest touch. Coitus was denied. Menstruation was stopped; the girl was terribly worried about pregnancy. Under pressure, she admitted that once while playing with the genitals of a large dog, she became excited and thought she would have slight connection. After the dog had entered she was unable to free herself, as he clasped her so firmly with his fore legs. The penis soon became so swollen that the dog could not free himself. For more than an hour, the most persistent efforts were made, resulting in the ruptures before described, followed immediately by inflammation and the discharge.* An Indiana girl who subsequently became a sadistic invert and was treated by J. G. Kiernan, had her first initiation in sexual matters through a dog licking her clitoris. Subsequently coitus occurred after she had beaten the dog. The initiation here described is according to Gamier,t far from infrequent. He remarks that domestic animals, dogs and cats above all, in licking the sexual parts of young children, little girls in particular, have incited them to mas- turbation, drawing the organ from its torpor. Hufeland reports the case of a little three-year-old girl seated on a tabouret, playing with a dog placed between her thighs which she held clasped against her. Excited doubtless by the contact and heat of her legs the dog's genital instinct was awakened and copulation resulted. Similar effects were produced in the vagina to those just cited. 1. C. Rosset reports the case of a young white single woman surprised copulating with a large mastiff whose endeavors to release himself caused fatal vaginal hemorrhage. The bony struc- ture of the dog's penis and the reversal attempted after completion of the canine sexual act, would be very likely to inflict the wounds described in these cases. Bloch remarks that these acts constitute not infrequent exhibitions given by harlots in brothels. Maschka describes •Schurig brought together a number of facta and fables in the early literature regarding congress of women with dogs, goats and other animals, at the beginning of the 18th century, in his Gynaecologia, Sect. II, Oap. VII. I have not drawn on this collection. fOnanisme. \Va. Med. Monthly, Oct., 1892. 144 Havelock Ellis. such an exhibition between a harlot and a bull dog in Paris. According to Rosse, a similar performance between a harlot and a Newfoundland dog could be witnessed in San Fran- cisco on payment of a small sum. According to the harlot, a woman who had once copulated with a dog would ever afterwards prefer it to a man. Rosse describes similar performance between a harlot and a donkey in Europe. Performances of this kind probably occur in all large cities. In one instance in Chicago, the donkey trampled the harlot causing fatal peritonitis; the case was hushed up by the police. Juvenal* mentioned such relations between donkeys and women. Krausst states, that in Bosnia, women some- times carry on such practices with dogs, and, also, as he observed on one occasion, with cats. Women are known to have had intercourse with other animals, occasionally or habitually in various parts of the world. It seems to Moll, an indication of abnormal interest in monkeys, that women should be such frequent visitors to monkey houses of zoologic gardens. The traveler Castelnau tried to purchase an enormous goat-monkey belonging to an Indian woman, living near the Amazon. Though he offered a large sum, the woman only laughed. "Your efforts are useless" remarked an Indian in the same cabin, "he is her husband." In animals, conditions allied to fetichism occur. In a case reported by L. B. Allen of Humboldt, Neb.,t a donkey was kept for breeding purposes. When first purchased, the donkey was markedly slow in and indifferent to coitus and sometimes absolutely refused it. This continued so long, the donkey was considered worthless for breeding purposes. One day while the donkey and a mare were in the enclo- sure and the donkey could not be induced to perform, a cow stopped on the outside. The donkey saw her through the cracks of the building, began to bray and manifested sexual power to an extreme degree. The previous sluggish- ness and indifference always changed to ardent sexual •VI. 882. tOited by Bloch, op. cit. IMedical Standard. Vol. XII, 1892, p. 21. Erotic Symbolism. 145 feeling when a cow was present. The owner thereafter always led a cow into the enclosure with a mare and no further trouble was experienced. Sometimes, women and men find gratification in sexual manipulation of animals without congress. This is illustrated in the Nebraska case just cited and by an observation communicated to me by a clergyman: "In Ireland, my father's house adjoined the residence of an archdeacon of the established church. Then about 20 I was still kept in religious awe of evil ways. The archdeacon had two daughters, whom he brought up very strictly, resolved that they should grow up examples of virtue and piety. Our stables adjoined, and were separated only by a thin wall in which was a doorway closed up by some boards, as the two stables had formerly been one. One night 1 had occa- sion to go to our stable to search for a garden tool I had missed, and I heard a door open on the other side, and saw a light glimmer through the cracks of the boards. I looked through to ascertain who could be there at that late hour, and soon recognised the stately figure of one of the daughters, who was tall, dark and handsome. She had never made any advances to me, nor had I to her. She was making love to her father's mare after a singular fashion. Stripping her right arm, she formed her fingers into a cone, and pressed on the mare's vulva. I was astonished to see the beast stretching her hind legs as if to accommodate the hand of her mistress which she pushed in gradually and with seeming ease to the elbow. At the same time she seemed to experience the most voluptuous sensation, crisis after crisis arriving.." My correspondent adds that being exceedingly curious in the matter he tried a somewhat similar experiment himself with one of his father's mares and experienced what he describes as "a most powerful sexual battery" which produced very exciting and exhausting effects. Nacke* refers to an idiot who thus manipulated the vulva of mares in his charge. The case has been recorded by Guillereaut of a youth who was accustomed to introduce •Psyclnatrische en Neurologische Bladen, 1899, no. 2. ^Jour. de Medtcine Veterindite et de Zootechnie, Jan. 1899. 146 Havelock Ellis. 0 his hand into the vulva of cows in order to obtain sexual excitement. The possibility of sexual excitement between women and animals involves a certain degree of sexual excitability in animals from contact with women. Darwin stated that there could be no doubt that various quadrumanous animals could distinguish women from men—in the first place prob- ably by smell and secondarily by sight—and be then liable to sexual excitement. He quotes the opinions on this point of Youatt, Brehm, Sir Andrew Smith and Cuvier.* Mollt quotes the opinion of an experienced observer to the same effect. Bloch does not consider that animals will of their own motion sexually cohabit with women, but that they may be easily trained to it. Dogs at all events are some- times sexually excited by the presence of women, perhaps especially during menstruation. Women often bear testimony to embarrassing attentions sometimes received from strange dogs. There can be no difficulty in believing that, so far as cunnilinctus is concerned dogs would require no training. In a case recorded by Mollt a lady states that this was done to her when a child, as also to other children, by dogs who, she said, showed signs of sexual excitement. In this case there was also sexual excitement thus produced in the child, and after puberty mutual cunnilinctus was practised with girl friends. GuttceitH remarks that some Russian officers who were in the Turkish campaign of i828 told him that from fear of venereal infection in Wallachia they refrained from women and often used female asses which appeared to show signs of sexual pleasure. A very large number of animals have been recorded as having been employed in the gratification of sexual desire, at some period or in some country, by men and women. •Descent of Man. tLibido Sexualis Kontrare Sexual Empfindung. JDreissige Jahr Praxis. ||It ia worth noting that in Greek the word Choiros means both a sow aud a woman's pudenda; in the Acharniam Aristophanes plays on this association at some length. The Romans also (as may be gathered Irom Varro's Oe Re Ruslica) called the feminine pudenda porcus- Erotic Symbolism. 147 Domestic animals are naturally those which most frequently come into question and there are few if any of these which can altogether be excepted. The sow is one of the animals most frequently abused in this manner.* Cases in which mares, cows and donkeys figure constantly occur, as wel' as goats and sheep. Dogs, cats and rabbits are heard of from time to time. Hens, ducks, and, especially in China, geese, are not uncommonly employed. The Roman ladies had an abnormal affection for snakes. The bear and the crocodile also have been employed. The social and legal attitude towards bestiality has reflected in part the frequency with which it has been practised and in part the disgust mixed with mystical and sacreligious horror which it has aroused. It has sometimes been met merely by a fine, and sometimes the offender and his innocent partner have been burnt together. In the middle ages and later, its frequency is attested by the fact that it formed a favorite topic with preachers of the fifteenth and sixteenth centuries. It is significant that it was thought necessary to fix the periods of penance which should be undergone respectively by bishops, priests and deacons who should be guilty of bestiality. Egbert's Penitential, a document of the ninth and tenth centuries, states (v. 22) "item Episcopus cum quadrupede fornicans VII annos, consuetudinem X, presbyter V, diaconus III, clerus II." There was a great range in the penances for bestiality, from ten years to (in the case of boys) one hundred days. The mare is specially mentioned.t Theo- dore's Penitential, an Anglo-Saxon document of about the same age, those who habitually fornicate with animals are adjudged ten years of penance. According to Penitentiale Pseudo-Romanum (which is earlier than the eleventh cen- tury) one year's penance was adequate for fornication with a mare when committed by a laymant (exactly the same •Schurigins, Gynatocolotia, pp. 280-387; Bloch, op. cit. 270-277. The Arabs according to Kocher, chiefly practise bestiality with goats, sheep and mores. The Annamites, according to Mondiere, commonly employ sows and (more especially the yonng women) dogs. Among the Tamils of Ceylon bestiality with goats and cows is said to be very prevalent. tStnbbs, Councils and Ecclesiastical Documents, vol. Ill, p. 422. JWasserSchleben, Die Bussordnungen der Abtndlaitdlichcn Kirche. p. 866. 148 Havelock Ellis. as for simple fornication with a widow or virgin) and this was mercifully reduced to half a year if he had not a wife. The Penitentiale Hubertense (emanating from the monastery of St. Hubert in the Ardennes) fixes ten years penance for sodomy, while Fulbert's Penitential (about the eleventh century) fixes seven years for either sodomy or bestiality. Burchard's Penitential, which is always detailed and pre- cise, specially mentions the mare, the cow and the ass and assigns forty days bread and water and seven years pen- ance, raised to ten years in the case of married men. A woman having intercourse with a horse is assigned seven years penance in Burchard's Penitential.* The extreme severity which was frequently exercised towards those guilty of this offence was doubtless in large measure due to the fact that bestiality was regarded as a kind of sodomy, an offence which was frequently viewed with a mystical horror apart altogether from any actual social or personal injury it caused. The Jews seem to have felt this horror; it was ordered that the sinner and his victim should both be killed.t In the middle ages, especially in France the same rule often prevailed. Men and sows, men and cows, men and donkeys were burnt together. At Toulouse a woman was burnt for having intercourse with a dog. Even in the seventeeth century, a learned French lawyer, Claude Lebrun de la Rochette, justified such sentences.t It seems probable that even to-day, in the social and legal attitude towards bestiality, sufficient regard is not paid to the fact that this offence is often committed either by persons who are morbidly abnormal or who are of so low a degree of intelligence that they border on feeble-mindedness. A remarkable form of erotic symbolism—very definite and standing clearly apart from all other forms—is one where sexual gratification is experienced in the simple act of exhibiting the sexual organ to persons of the opposite *Wasserschleben, It. pp. 6S1, 659.) tExodus, Ch. 22, v. 19; Leviticus, Ch. 20, v. 1*. tMantegazza (G/i Amori dctli Uomini, cap. V) brings together some facts bearing on this matter. Erotic Symbolism. 149 sex, usually by preference to young and presumably inno- cent persons, very often children. This is termed exhibi- tionism.* It would appear to be a not very infrequent phenomenon, and most women, once or more in their lives, especially when young, have encountered a man who has thus deliberately exposed himself before them. The exhibitionist, though often a young and apparently vigorous man, is always satisfied with the mere act of self-exhibition and the emotional reaction which that act produces; he makes no demands on the woman to whom he exposes himself; he seldom speaks, he makes no effort to approach her; as a rule he fails even to display the signs of sexual excitation. His desires are completely grati- fied by the act of exhibition and by the emotional reaction it arouses in the woman. He departs satisfied and relieved. A case recorded by Shrenck-Noetzingt very well repre- sents both the nature of the impulse felt by the exhibi- tionist and the way in which it may originate. The case 'was that of a business man of 49, of neurotic heredity, an affectionate husband and father of a family, who to his own grief and shame is compelled from time to time to exhibit his sexual organs to women in the street. As a boy of 10, a girl of 12 tried to induce him to coitus; both had their sexual parts exposed. From that time sexual contacts, as of his own naked nates against those of a girl, became attractive, as well as games in which the boys and girls in turn marched before each other with their sexual parts exposed, and likewise imitation of the copulation of animals. Coitus was first practised about the age of 20, but sight and touch of the woman's sexual parts were always necessary to produce sexual excitement. It was also necessary—and this consideration is highly important as regards the development of the tendency to exhibition— that the woman should be excited by the sight of his organs. Even when he saw or touched a woman's parts *Lasegue first drew attention to this sexual perversion and gave it it generally accepted name, "Les Bxhibitionistes," L'Umian Medicate, May, 1877 Magnan, on various occasions (for example, "lies Exhibitionistes," Archives d I'Anthropolotie Criminelle, Vol. V, 1890, p. 456) has given further development and precision to the clinical picture of the exhibitionist. IKriminal-psrchotorische urtd Psychc-patholotische Studien, 1902, pp. 50-67. 150 Havelock Ellis. orgasm often occurred. It was the naked sexual organs in an otherwise clothed body which chiefly excited him. He was not possessed of a high degree of potency. Girls between the ages of 10 and 17 chiefly excited him, and especially if he felt that they were quite ignorant of sexual matters. His self-exhibition was a sort of psychic deflora- tion, and it was accompanied by the idea that other people felt as he did about the sexual effects of the naked organs, that he was shocking, but at the same time sexually exciting a young girl. He was thus gratifying himself through the belief that he was causing sexual gratification to an inno- cent girl. This man was convicted several times and was finally declared to be suffering from impulsive insanity. Schrenck-Netzing reports also a case of an actor and por- trait painter, aged 31, in youth masturbated and was fond of contemplating the images of the sexual organs of both sexes, finding little pleasure in coitus. At the age of 24 at a bathing establishment he happened to occupy a com- partment next to that occupied by a lady, and when naked he became aware that his neighbour was watching him through a chink in the partition. This caused him powerful excitement and he was obliged to masturbate. Ever since he has had an impulse to exhibit his organs and to mas- turbate in the presence of women. He believes that the sight of his organs excites the woman.* The presence of masturbation in this case renders it untypical as a case of exhibitionism. Mollt goes so far as to assert that when masturbation takes place we are not entitled to admit exhibitionism. The act of exhibition itself gratifies the sexual impulse and usually it suffices to replace both tumes- cence and detumescence. A fairly typical case, recorded by Krafft-Ebing,t is that of a German factory-worker of 37, a good sober and intel- ligent workman. His parents were healthy but one of his mother's and also one of his father's sisters were insane; some of his relatives are eccentric in religion. He has a */*. pp. 57-68. Wntcrtuehungcn uber die I ibido Sexualis, Bd. 1, p. 681. tO<>. cit. pp. 492-484. Erottc Symbolism. 151 languishing expression and a smile of self-complacency. He never had any severe illness but has always been eccentric and imaginative, much absorbed in romances (such as Dumas's novels) and fond of identifying himself with their heroes. No signs of epilepsy. In youth moderate masturbation, later moderate coitus. He lives a retired life but is fond of elegant dress and of ornament. Though not a drinker he sometimes makes himself a kind of punch which has a sexually exciting effect on him. The impulse to exhibitionism has only developed in recent years. When the impulse is upon him he becomes hot, his heart beats violently, the blood rushes to his head, and he is oblivious of everything around him that is not connected with his own act. Afterwards he regards himself as a fool and makes vain resolutions never to repeat the act. In exhibi- tion the penis is only half erect and ejaculation never occurs. (He is only capable of coitus with a woman who shows great attraction to him.J He is satisfied with self- exhibition and believes that he thus gives pleasure to the woman since he himself receives pleasure in contemplating a woman's sexual parts. His erotic dreams are of self- exhibition to young and voluptuous women. He had been previously punished for an offence of this kind; medico- legal opinion now recognised the incriminated man's psycho- pathic condition. Trochon* has reported the case of a married man of 33, a worker in a factory, who for several years had exhibited himself at intervals to shop-girls, etc., in a state of erection but without speaking or making other advances. He was a hard-working, honest, sober man of quiet habits, a good father to his family and happy at home. He showed not the slightest sign of insanity. But he was taciturn, melancholic and nervous; a sister was an idiot. He was arrested but on the report of the experts that he committed these acts from a morbid impulse he could not control, he was released. In a case of Freyert the occasional connection of 'Arch, it VAnthropolotie CriminelU. 1888, p. 256. tZeitschr. b. Medlilne beamte Jahr. Ill, No. 8. - 152 Havelock Ellis. exhibitionism with epilepsy is well illustrated by a barber's assistant, aged 35, whose father suffered from chronic alcoholism and was also said to have committed the same kind of offence as his son. The mother and a sister suf- fered nervously. From ages of 7 to 18 the subject had epileptic convulsions. From 16 to 21 he indulged in normal sexual intercourse. At about that time he had often to pass a playground, and at times would urinate there; it happened that the children watched him with curiosity. He noticed that when thus watched sexual excitement was caused, inducing erection and even ejaculation. He grad- ually found pleasure in this kind of sexual gratification; finally he became indifferent to coitus. His erotic dreams, though still usually about normal coitus, were now some- times concerned with exhibition before little girls. When overcome by the impulse he could see and hear nothing around him, though he did not lose consciousness. After the act is over he was troubled by his deed. In all other respects he is entirely reasonable. He was imprisoned many times for exhibiting himself to young schoolgirls, sometimes vaunting the beauty of his organs and inviting inspection. On one occasion he underwent mental exami- nation but wa6 considered to be mentally sound. He was finally held to be a hereditarily tainted individual with neuropathic constitution. The head was abnormally broad, penis small, patellar reflex absent, and there were many signs of neurasthenia. The prevalence of epilepsy among exhibitionists is shown by the observations of Pelanda in Verona.* He has recorded six cases of this perversion, all of which eventually reached the asylum and were either epileptics or with epileptic relation. One had a brother who was also an exhibitionist. In some cases the penis was abnormally large, in others abnormally small. Several had very weak sexual impulse; one, at the age of 62, had never effected coitus and was proud of the fact that he was still a virgin, considering, he would say, the epoch of demoralization in which we live. In a very typical case of exhibitionism which Garniert •Arch, dl Psichtatria, III-IV, 1889. tlnternational Medical Congress Trana., 1900. Erotic Symbolism. 153 has recorded, a certain X, a gentleman engaged in business in Paris, had a predilection for exhibiting himself in churches, more especially in Saint-Roche. He was arrested several times for exposing his sexual organs here before ladies in prayer. In this way he finally ruined his commercial posi- tion in Paris and was obliged to establish himself in a small provincial town. Here again he soon exposed himself in a church and was again sent to prison, but on his liber- ation immediately performed the same act in the same church, in what was described as a most imperturbable manner. Compelled to leave the town he returned to Paris and in a few weeks' time was again arrested for repeating his old offence in Saint-Roche. When examined by Gamier the information he supplied was vague and incomplete and he was very embarrassed in the attempt to explain him- self. He was unable to say why he chose a church but he felt that it was to a church that he must go. He had, however, no thought of profanation and no wish to give offence. "Quite the contrary!" he declared. He had the sad and tired air of a man who is dominated by a force stronger than his will. "I know," he added, "what repul- sion my conduct must inspire. Why am 1 made thus? Who will cure me?" In some cases, it would appear, the impulse to exhi- bitionism may be overcome or may pass away. This result is the more likely to come about in those cases in which exhibitionism has been largely conditioned by chronic alco- holism, or other influences, tending to destroy the inhibiting and restraining action of the higher centres, which may be overcome by hygiene and treatment. In this connection I may bring forward a case which has been communicated to me by a medical correspondent in London. It is that of an actor, of high standing in his profession and extremely intelligent, 49 years of age, married and father of a large family. He is sexually vigorous and of erotic temperament. His general health has always been good but he is a high- strung, neurotic man, with quick mental reactions. His habits had for a long time been decidedly alcoholic but two years ago, a small quantity of albumen being found in the 154 Havelock Ellis. urine he was persuaded to leave off alcohol and has since been a teetotaller. Though ordinarily very reticent about sexual matters, he began four or five years ago to commit acts of exhibitionism, exposing himself to servants in the house and occasionally to women in the country. This continued after the alcohol had been abandoned and lasted for several years though the attention of the police was never attracted to .the matter and so far as possible he was quietly supervised by his friends. Nine months ago the acts of exhibitionism ceased, apparently in a spontaneous manner, and there has so far been no relapse. Under the title "bustle-rubbers," a certain class of exhibitionists are known to the park police of all large American cities. While by no means a small proportion of these are victims of paretic dementia, epilepsy or mental deterioration, a large proportion of them are perfectly sane. They are quite frequently brought under cognizance of the law, but are usually fined for that omnibus of crime "dis- orderly conduct," which may include anything from simple drunkenness to criminal assaults by boys under fourteen. Exhibitionism is an act which, on the face of it, seems nonsensical and meaningless, and as such, as an inexpli- cable act of madness, it has frequently been treated both by writers on insanity and on sexual perversion. "These acts are so lacking in common sense and intelligent reflec- tion that no other reason than insanity can be offered for the patient," Ball concluded.* Moll, also, who defines exhibitionism somewhat too narrowly as a condition in which "the charm of the exhibition lies for the subject in the display itself," not sufficiently taking into consideration the effect on the spectator, concludes that "the psychological basis of exhibitionism is at present by no means cleared up."t We may probably best approach exhibitionism by regarding it as fundamentally a symbolic act based on a perversion of courtship. The exhibitionist displays the organ of sex to a feminine witness and in the shock of modest sexual shame by which she reacts to that spectacle, *La Folic Erotique, p. 86. \ Unler luchun gen uber die Libido Sexualis, Bd. 1, p. 661. Erotic Symbolism. 155 he finds a gratifying similitude of the normal emotions of coitus.* He feels that he has effected a psychic defloration. Exhibitionism is thus analogous, and indeed related, to the impulse felt by many persons to perform indecorous acts or tell indecent stories, before young and innocent persons of the opposite sex. This is a kind of psychic exhibitionism, the gratification it causes lying, exactly as in physical exhibitionism, in the emotional confusion which it is felt to arouse. The two kinds of exhibitionism may be combined in the same person: thus, in a case recorded by Hoche the exhibitionist, an intellectual and highly educated man with a doctor's degree, also found pleasure in sending indecent poems and pictures to women, whom, however, he made no attempt to seduce; he was content with the thought of the emotions he aroused or believed that he aroused. •-'Exhibitionism in its most typical form is," Gamier truly says, "a systematic act, manifesting itself as the strange equivalent of a sexual connection, or its substitution." The brief account of exhibitionism (pp. 483-487) in Garnier's discussion of "Perver- sions Sexuelles" at the International Medical Congress at Paris in 1900, Section de Psychiatric: Comptes Rendus, is the most satisfactory statement of the psychological aspects of this perversion with which 1 am acquainted. Garnier's unrivalled clinical knowledge of these manifestations due to his position during many years as chief physician at the Depot of the Prefecture of Police in Paris adds great weight to his conclusions. (To be continued.) PSYCHOENCEPHALONASTHENIA OR CERE- BRASTHENIA SIMPLEX, AND PSYCHO- ENCEPHALONASTHENIA OR CERE- BRAS1HENIA INSAN1ENS. BY CHARLES H. HUGHES, M. D. ST. LOUIS, MO., Professor of Psychiatry, Neuriatry, Electrotherapy and Dean of the Medical Faculty, Barnes University.* 1 N number four of volume one, October 1880 of my own * journal The Alienist and Neurologist (that is twenty- six years past,) I published from an alienist's standpoint "Notes on Neurasthenia"t intended mainly at that time to introduce the views of a pioneer American writer on this subject, who antedated Beard in describing this disease. That American writer was Dr. E. H. Van Deusen, to whom I have already referred. At the same time and place 1 also wrote, "To the neurologist neurasthenia is not novel, and alienist physicians have long been familiar with it. Its frequent sequence is insanity, its principal and most characteristic symptoms are psychical, for its presence is often first revealed in Cerebrasthenia as likewise its ap- proach." "The general practitioner as well as the neurologist and alienist, have often encountered it and treated it under the form of general debility, hysteria or chronic malarial poisoning. From time immemorial it has been more or less clearly discerned; even Hypocrates treated it and the other Continental and old English writers saw it, though darkly, as through a glass of the ancient days. •An elaboration of paper prepared for XV Int. Med. Cong, at Lisbon, which author unavoidably failed 10 attend. \Alitnist and Neurolotut. October, 1880, p. 487 et se. (156) Psychoencephalonasthenia. 157 "The term is an older one than the science of neurology. More than a quarter," (now half a) "century ago Dunglisons' dictionary gave its derivation from the Greek for a nerve and debility, with a Latin synonym of debilitus nervosa. This is the true signification—debility of the nervous system, nervous exhaustion, with this qualification that the disease, neuras- thenia, as contra-distinguished from physiological nerve ex- haustion or the coincident nervous debility of other diseases is essentially, a chronic and slowly culminating exhaustion of the nervous system not necessarily or demonstrably, due to recognizable precedent changes in the blood, but inherent in the (cerebro) spinal or sympathetic systems or in both." In a supplement to the biennial report of the Michigan Asylum for the Insane for 1867-8, under the caption of "Observations on a Form of Nervous Exhaustion (Neurasthenia) Culminating in Insanity, Van Deusen said: 'Our observations have lead us to think that there is a dis- order of the nervous system, the essential character of which is well expressed by the term given above, and so uniform in development and progress that it may, with propriety, be regarded as a distinct form of disease.'" Van Deusen discussed its irritability and hyperaesthesia, its cerebral hyperaemias and anemias and the secondary hyperaemias that other observers regarded as the fons malorum itself, and proceeded to mention the headaches, sleepless- ness, mental depression and uterine disturbances, etc. through deficient innervation among women. In noting the psychic symptoms he made much of morbid distrust, because he saw more of the morbid dis- trustful suspicious symptoms as seen in his extreme cases, such as lead physicians to certify to mental aberration, as in the doubts of religious melancholia, business suspicions, distrust of friends, jealousy and features of folie du dout. But he overlooked those forms of morbid fear described so well by Beard as Beard found them and others have since. Beard recognized them before they had culminated in insanity. Neurasthenia or insane psychoasthenia as seen in a hospital for the insane is the culminating and culminated 158 Charles H. Hughes. delusional sequence of the doubting fears of simple neurasthenia. Beard observed, collected, classified and described various morbid or exaggerated and unreasonable fears as symptomatic of neurasthenia, conceding that "the emotion of fear is normal to the human mind," like the instinct and emotion of courage is, as Dowse observes. He made morbid phobias, i. e. fears unnatural to the individual, a symtomatic expression of neurasthenia and fears of course are always of psychic cortex origin, normal or abnormal, "in the pathology of functional nervous dis- eases" he said "the difference between health and disease is of degree rather than of kind, the phenomena that be- long to it we' call disease, passing, by indefinite and not distinctly defined gradations, into the phenomena of what we call disease;" pathology here* is simply a debility, a weakness and incompetency and inadequacy as compared with the normal state of the individual. A healthy man fears, but when he is functionally diseased in his nervous system he is liable to fear all the more and to have the normal necessary fear of his physiological condition descend into a pathological state simply from lack of force in his disordered nervous system. The debility of the brain—the nerve cen- ter impoverishment, renders it impossible to meet respon- sibility, just as paraphlegia makes it difficult or impossible to walk; morbid fear is indeed but a psychical paralysis, but of a functional rather than an organic nature."t While the symptoms of neurasthenia as Beard saw them, are mostly psychical including with its ordinarily characteristic fears,the hopelessness,indecision,excessive blushings,emotion- al erethemas, profuse sweatings and hyperaesthesias, certain cerebro-neurotic caprices and certain accompaniments of its cephalgias and some of the symptoms which have been characterized by the ill-informed as mere imaginations or hysteria. Beard recognized that these did not, per se, con- stitute insanity, because as he said, they were not delusions and he, at that early day, when his first edition appeared controverted the erroneous opinion now repeated by some •The shady side of physiology, morbid fears. (Nervous exhaustion (Neurasthenia) First Edition, 1880, pp. 28-7. Psychoencephalonasthenia. 159 - more lacking in clinical cerebro-psychological power of diagnostic differentiation, that neurasthenia in cerebrosychic form is always insanity. "They are not found in insanity itself save as delusions or hallucinations" he says and 'the habit of calling them forms of mania or delusion is not based on fact or a right study of these cases"* and this is the psychiatric truth as the true alienist sees it. The true criterion of insanity in the cerebropsychic asthenia or the brain and mind form of neurasthenia is delusion, illusion or hallucination one or all combined making the true change of character sign which characterizes acquired insanity as distinguished from its rare idiopathic forms. This includes obsessions. Now let us briefly recall the mental symptoms of simple psychocerebral asthenia and compare them with cerebrasthenia passed into insanity and in doing this we need but recount the fears and apprehensions and dreads and timidities of mental display, with developed illusion, hallucination or delusion, for there is an element of these, if the subject be rightly regarded from the stand- point of correct clinical observation, in all true insanity. Some alienists justly insist that perceptible delusion is not a nec- essary criterion of insanity,but I maintain that a delusional ele- ment tinctures and characterizes all insanity. It is not always a clearly definable delusion formulatable in words but a delusion manifest in the psychical life and conduct, a delusive im- pression or feeling dominating the character. The occupation neuroses are psychomotor neurasthenias or have passed through a stage of neurasthenia to a more advanced neurotic motor degeneracy. These occupation neuroses are often associated with general neurasthenia. Sometimes the occupation neurosis in its early stage is only psychical, one of the neurasthenic fears of inability to do accustomed dextrous work, as that of the typewritists and piano player's neurosis in the early stage, but the phobia sooner or later passes into the real inability of-occupation paralysis or spasm. I have seen the inability fear of the stenographer pass into real pen or pencil paralysis and •Work cited, p. S9. 160 Charles H. Hughes. other fears of neurasthenia follow and pass into the positive delusions of insanity. I have seen true folie du toucher follow mysophobia and haphephobia pass into haphemania, the patient scream and crouch with insane fear at the slightest touch or run at ones approach. The delusions of insanity and the timidities, doubts and fears of neurasthenia appear closely allied, yet are often only apparently connected. There is often an impassable neurotic gulf between them. Some neurasthenics would never become insane. They will have their morbid fears and weari- ness, leading to rest and the dispersion of their fears. The extreme irritability of others will not allow them to rest and they pass on, if not helped out of their dilemma by our art, into grave restless insomnia and delusion. The impassable gulf between the neurasthenic who will recover by nature's aid alone and opportunity for rest is the one with compar- atively little inherent instability of psychic nervous element. The predestined neurasthenic lunatic, unless his insanity be timely arrested by our art, is he who is gravely dowered with the fatal heritage of cerebro-psychopathy. Then his fears, if unarrested by help from without himself, soon become facts and convictions, his doubts delusions. His timid apprehen- sions are transformed by his inherent neuromorbid diathesis into visions of horrible, even demoniac dread. His neuras- thenia culminates into mania or in milder forms of delusional insanity. Maybe in melancholia, only. The non-insane cerebropsychic neurasthenic has phobias but not delusions. He has fears and dreads and timidities and irresolution, but not delusional convictions of suspicions, distrust, antipathies, jealousies, etc. He knows he has fears but they are morbid apprehensions not diseased delu- sions. The non-insane is simply apprehensive of some unpleasant happening or calamity; the insane cerebrasthenic realizes it in delusive verity. The morbid fear has become a delusioned fact to the lunatic, which no reasoning can remove, or if he transiently assents to your reasoning as to its unreality, the delusion immediately returns to him. Besides the myatony of neurasthenia or myoneuras- thenia as it has been termed, or the influences on the nerve Psychoencephalonasthenia. 161 endings of myosinogen transformed through the general neuratony into myosin and its influences on the sensory nerve endings, causing those myoneuralgias which have been termed myalgia and that painful sense of muscular weari- ness that goes up to the neurasthenic brain, to add to its often indescribable misery, that overwhelming feeling of exhaustion harrasses him, to which the brain and other nerve center disintegrations also contribute the materials of neurogenous disintegration. Neuroid or neurogenous excre- tion from excessive aberrant neurone activity in the higher brain centers also plays its oppressive and painful part in the psychalgias of cerebropsychic neurasthenia, as muscle waste does in neurasthenic myalgia. The psychalgias of neurasthenia are revealed in the phobias, in their simpler forms, and in the positive delusions of neurasthenic insanity or graver states of cerbrasthenia. Let us name some of the more or less painful fears and compare them with morbid insane convictions of estab- lished mental aberration, its dreadful apparitions, its painful diseased feeling of the verities of the unreal, its unfounded suspicions and unreal distrusts, its reversions and revulsions of feeling and perception, emotion, thought and action. By this we may clearly see the difference between the mind yet sane in its higher psychic neurone grouping, still maintaining, under fearful stress its integrity and looking on at its abnormal brain changes, while in insanity, broken and vanquished centers of feeling, thought and action have become captive and a prey to forces of abnormal mentality imprisoned and enchained in delusion. Van Deusen, as we have seen, saw neurasthenia under'the influence and dominion of the psychopathic diathesis, awakened from its inherent latency under psychoneuropathic strain, into specific activity, i. e. after it had reached the stage of recognized insanity and asylum incarceration. Beard saw it beyond and before this profounder psychopathic awakening and before it had passed the neuropathic line that demarcates sanity of mind from insanity thereof. The phobias, like the irresolution, instability, timidity and feebleness of mental movement and character, except 162 Charles H. Hughes. under extraordinary goading to action, of neurasthenia, all involve the psychic sphere of the nervous system and demark, according to their various character, the non-insane from the delusion dominated brain of the gravely insane neurasthenic. The added factor of insane psycho- neurasthenia is confirmed delusional, or delusive conviction, as contradistinguished from mere neurasthenic fears, appre- hensions, irresolution, timidity and that peculiar unconscious- ness of being unequal to the demands of one's occupation or duties in life, such as simple neurasthenia of the mental sphere displays. Exaggerated, egoistic or self-feeling of simple neuras- thenia is similar, but differs markedly in degree and in kind from the morbid egoism of the cerebrasthenic insane per- son. The amnesia and perversions of special and general sensation are milder in degree and different often in kind from those of established neurasthenic insanity. Volition is impaired, but not so completely, in simple neurasthenia as in the gravest and and more perverted psychic forms of insanity. Beard's "instinctive consciousness of inadequacy" to life's duty or business demands, is not so apparent in the delusion dominated cerebrasthenic as in its simpler and less grave states. Delusion inspired over-confidence may have taken the place of a previous neuropathic timidity, as in the earlier stages of neurasthenic paresis, the pre-paretic functional stage of the simulated forms of this disease of psychic exaltational delusion which 1 have seen recover under enforced brain rest, renewed neurotic reconstruction and changed environment as 1 have seen functional dementia senilis, (non-terminal,) recover. Neurasthenia and psycho- neurasthenia is common to old people and causes many cases of functional dementia not yet recognized as such in the literature, and here I record my conviction that the recov- eries from dementia recorded by Clouston, seventy-two out of one hundred and two cases were senile neurasthenia' or simple non-organic neurasthenic dementia as dementia precox appears to me to be in so many instances. Insanity is a marked change of character disease. The brain and mind dominate the character and the brain's diseases may Psychoencephalonasthenia. 163 modify mental movement to such a degree as to bring about that insane transformation of individuality which we term insanity. It is thus that cerebropsychasthenia may pass (unawares to the non-alienistic observer) into even marked mental aberration, without his detection, if he looks only for verbal or written expressed delusion. Or it may fall far short of that extreme mental derangement which we characterize as insanity, accordingly, as there underlies the neuropathic diathesis alone, or the simple or insane psychopathic, or all combined. It may be regarded as in- sanity when it is not, or as a pure neuropathy when it is not, by the non-alienist expert physician. It is especially a disease for the consideration of the neuro-alienist, and the altered character criterion is the best of alienism's data for judging whether 'a given case of neurasthenia is one of sanity or insane psychoneurasthenia, by change of charac- ter. I do not mean single or several mere phobias, but a single fear or an assemblage of fears transformed into such degree of delusion of dread, suspicion, apparition, etc., as alters the individuality or mental character compared with what is natural and normal to that individual in his sane state of mind. This is neurasthenia or psychasthenia insaniens. Now, here are some of the phobias of neurasthenia in psychic form briefly mentioned for our study, and Beard's phobias shall come first in our enumeration in honor of his early recognition of them as "symptomatic of functional, never, or rarely, of organic disease," the existence of which, he says, "in a doubtful case of diagnosis would alone almost establish the nature of the disease."* BEARDS' CLASSIFICATION OF THE MORBID FEARS > OF NEURASTHENIA. Astrophobia.—Fear of lightning. Topophobia.—Fear of places. SUBDIVISION. Aggraphobia.—Fear of open places. Claustrophobia.—Fear of narrow places. *Op. Clt., p. 38. 164 Charles H. Hughes. This latter is from Machede, of Germany, amplified by Ball, of Paris, into inability to stay within doors, even when one does not require open air recreation. Anthrophobia.—Fear of men; a generic term including fear of society. Subdivision: Gynephobia.—Fear of woman. Monophobia.—Fear of being alone. Pathophobia.—Fear of disease (hypochondriasis). Pantaphobia.—Fear of everything. Phobophobia.—Fear of being afraid. Mysophobia.—Fear of contamination. (Hammond.) Under pantophobia, Beard included fear of responsibility, and mentions "the wife of one of his patients who has a mobid fear in reference to one of her sons, a lad of fifteen, which took possession of her about the time of the kidnap- ping of Charlie Ross, causing her to keep the boy almost a constant prisoner in her home." Sideromophobia.—Fear of railroad travel. First described by Rigier, of Germany. Attributed to the perpetual jarring, shaking and noise of railroad travel, and most common among railway engineers, Under pantophobia, Beard mentions an astrophobic who regarded it, among other dreads, as an affliction to see her physician. Dowse had a similar patient. This is rare, as neurasthenics try all sorts of doctors and are as fond of thera- peutic novelty as Harrison Ainsworth's Blaise, testing the various patent medicines of his day, in the time of the great London Plague. The osteopath, hydropath, electropath, men- topath and christopath, (Christian Science healer), massage healers and clairvoyants and watering places are the favorite resorts of such as are not troubled with neurotic, water or train travel phobia. Beard mentions, although he does not name or include it in his table, the morbid fear of being at a great height or looking over precipices, acrophobia. A friend of mine couldn't occupy a front balcony seat in opera or theater without pallor, vertigo, perspiration, and an impulse to go over the railing.* Though he manfully tried, he could never overcome the trouble without feeling a morbid impulsion. To these fears, enumerated by Beard from his own and •Obsession of Eigis and others. Psychoencephalonasthenia. 165 others' observation, we might add the following, without by any means completing the polyphobic list of this phase of psychocerebrasthenic neurasthenias. The fear of being touched, as in the case related from our early personal observation,phobopselaphesis,* if our verbal coinage be accept- able, is the opposite contrasting symptom to Hammond's mysophobia. Then there is a fear of being seen and a shame- facedness which one sees in the asylums. One marked case, many years ago, when an asylum superintendent, (the case of L. P.,) forcibly impressed me and led to the seeking and finding of others in other institutions than our own. We called it scopophobia—a morbid dread of being seen. In minor degree it is morbid shamefacedness, and the patient covers the face with her or his hands. In greater degree the patient will shun the visitor and escape from his sight where that is possible. Scopophobia is more often manifest among women than among men. Thanatophobia is morbid fear of death, common to cer- tain psychoneurasthenics, as nosophobiacs or pathophobiacs and hypochodriacs, and mysophobiacs are fearful of contract- ing or of having disease, or that they already have disease. This condition is only in imaginings, and unreal. Thalas- sophobia has been very properly applied to that psychoneu- rasthenic fear which keeps certain neurasthenics from going on water voyages either by lake or river or sea, even though no previous sea sickness has been experienced. It is a mor- bid dread of wide expanse of water, and not from any pre- vious distressing experience with mal de mer, a psychic hy- drophobia not connected with the attempt to taste or swal- low water, or associated with any spasmodic symptoms, as in ordinary clinical hydrophobia of toxic spinal cause. The chief characteristics of a non-insane psychic neuras- thenic are simple self-fears, autopsychic. The character of the fears of the insane neurasthenic are more delusive and pertain to the action of other persons. Our knowledge of this remarkable neuropathy underlying so many and so much of the morbid mental processes that lead to the sequent dissolution of mind and its organ, has greatly advanced of late, and become so much more diffused among •Pselephophobia. 166 Charles H. Hughes. general medical observers that no apology is deemed neces- sary for our intrusion of the cerebro-psychic aspects of the subject. In fact we deem it an imperative duty to our confreres in the profession to present this subject from the standpoint of more than four decades of special and general clinical study of the subject with ample unremitting experience as physician, surgeon, alienist and neurologist. Ailourophobiat, (Katiphobia, or Gatophobia,) is a typical monomania. The fear of cats in certain monopsychoneurotic and psychopathic persons dates back to the beginning of the life of the feline. Its oldest name, according to A. Rose, the precise and classical Greek onomatologist among the breth- ren of the medical profession, and Dr. Kenneth W. Milligan, the classical editor of the 5/. Louis Medical Review, is yaXa>r which nearly answers for that of our great ancient master in medicine, Galen. That American pioneer neurological savant, Dr. S. Weir Mitchell, among the numerous unique neuropathic features enlisting his descriptive pen, has called the condition ailourophobia. The following is in part the classical comment verba- tim of Dr. A. Rose on Dr. Mitchell's term ailourophobia: "In my criticism of Dr. S. Weir Mitchell's ailourophobia I said AL\.ovpo£ is the comical name for cat, composed of aiyXoS and ovpd (ii£ ii«t>pa£ovTOS ti/v l8ui£ovara.v r ij yoAoIS Kivrjeiv njs ovpdsj that is, to indicate the peculiar movements the cats perform with the tail). 1 said further v y°-Ta or yaros of the people's or vulgar language is not permissible in literary, much less in scientific language. Every Greek of learning will assure you that yaros is not Greek at all; at least that was what Dr. B. Leonardos, the Director of the Museum of Inscriptions in Athens, the author of one of the most im- portant Greek works, written in classical style, H OXv>ina told me when we conversed about the word. Besides, my daughter, who has been three years in the national school for girls, the Arsakeion, in Athens, can tell you that y^a is excluded from regular Greek as much as the word "Tabby" for cat is excluded from regular English." But Rose objects to the term ailourophobia as vulgar Psychoencephalonasthenia. 167 because it incorporates with the Greek name alkov/m, the comical name for cat, using this term as indicative of the peculiar movements the cat performs with its tail. Notwithstanding this objection of the scholarly and criti- cal Dr. Rose, 1 am not sure that the peculiar movements of some of those human katiphobiacs (kciti^o/Jos), violative of all decorum and propriety at the sight or in the hearing of the genus felis, the unexpected purring or presence of a cat causing peculiar fright, contortions and exclamations, does not justify the term selected by Mitchell as most appropri- ate to this peculiar morbid fear, one of the most singular in the records of psychopathic mononeuratrophia, for these acroesthetic cat-fear victims who feel and fear catastrophy approaching whenever this harmless animal comes into their presence, are often apparently otherwise sane in their higher mental life, but they are demoralized, without normal will power, hysterical (somnavolistic, as I have heretofore char- acterized the hysteric,) in the presence or within scent or sound of one or more of the feline tribe. Considering the peculiar and ludicrous features of its psychic symptomatology, ailourotophobia, or gatophobia, or katiphobia, though the latter are of vulgar rather than classic Greek usage, is not so mal apropos after all. We are a nation sui generis in word coinages, and are not sensitive for the classical and pedantic, as against the mongrel or even slangy blending, if the words constructed have force and brevity, as many do from the old Saxon. KaTos or yaTos might well stand for the Greek synonym if not the origin of most modern words for cat. Thus It. cat, F, chat, D, kat, Dan., kat, katt, G, katze, P and S, gats, P and C, kat, R, kots, W, cath, Cornish, kath. The Latin gives us Catus. The vulgar Greek is pretty well supported by the flattery of imitation. These are all, according to Webster, the premier and erudite polyglot lexicographer of our country. We are rather inclined to accept the less classic Greek origin for the term to designate the subject under discussion, since it more nearly approximates in sound to the most nearly universal usage. 168 Charles H. Hughes. Galiphobia of katiphobia is a fear of cats variant in dif- ferent neurotic subjects, from wild degrees of neuropathy to extreme states of psychopathic predisposition, wherein the insane diathesis preponderates and gives character to the symptomatic display. The katacroaesthesia in some of these cases amounts to an indescribable terror, while in the milder forms it is only a simple indefinable aversion. Such persons would simply rather not have a cat about them. Some cannot stroke them nor bear the feeling of their furry hide. Some persons cannot bear to handle an unpealed peach. Some mothers with babes have a rational fear of cats about the house because of the reputed disposition of cats, as they have heard, "to suck children's breath," a myth due to the fact that cats have been reported to have smothered infants by lying over their faces while the babes were asleep. I do not include in this description mere aversion to cats without fear from real or imaginary cause, such as Noah Webster expressed in early editions of his great dictionary, viz.: "The domestic cat needs no description. It is a de- ceitful animal, and when enraged, extremely spiteful; it is kept in houses chiefly for the purpose of catching rats and mice." Yet there are those who esteem the cat for the house and the children thereof and for love of the cat itself. There is a cat aversion that is not fear and is not as- sociated with any peculiar sensations of the katophobiac. The true galiphobiac or katiphobiac has acroaesthesia accompanying his fear of this animal. Galeagraphobia (yaXeaypa, a wild cat,) or fear of wild cats, is a natural fear, as the fear of the untamed wolf or other wild animals, as the fear of a particular cat known to be vicious and ill- natured might be, especially in a mother fearing for the wel- fare or safety of a young child. And cat fear as the fear of dogs may result normally from fear of hydrophobia or of scratch poisoning. But the intense fear of domesticated cats without dis- crimination is abnormal, marking a neuropathic peculiarity and marking the individual possessing it as a specially neu- rotic person. Psychoencephalonasthenia. 169 The acroaesthesia of such persons seems sometimes to enable them to discern in some mysterious way the approach of a cat before seeing it. I knew of one such case in the person of a lawyer of no mean ability and otherwise appar- ently healthy who would go into a fit of uncontrollable fear and precipitately flee at the approach of a cat, even before others in the room would know of the cat's coming, and re- gardless of a subject of the most importance engaging his attention at the time and of the astonished importunities of his friends for him to remain with them. His inhibitions in the line of the proprieties were nil on this subject. He was, to all intents and purposes, monopathically insane pro tem- pore on this subject, and on such an occasion a pure example of limited, impulsive monomania, with morbid perception and emotion, and imperative conception and impulse. Yet on all other occasions and at all other times this man appeared to be deliberate and sane. He could counsel clearly in the line of his profession, could present his cause lucidly and plead it with acknowledged legal force and learning before the court, and observed the proprieties in all his ordinary rela- tions of life and environment. According to the change of character criterion of alienism we might class it among the milder forms of transient mental aberration or momentary change of character without adequate external cause, ac- cording to Combe's criterion, if we can bring ourselves to the conviction that the sight or sensation of an appearing or approaching cat mightlalone be a sufficient and exclusive cause for such an anomalous display of emotion, fear and conduct. (To be continued,) LEGAL ASPECTS OF EPILEPSY.* By HARRIET C. B. ALEXANDER, A. B., M. D. Fellow of the Chicago Academy of Medicine; Attending Physician Depart- ment Internal Medicine, Mary Thompson Hospital; Attending Physician Department Nervous and Mental Disease, Woman's Clinical Dispensary; Member Inter- national Medical Congress, 1906. IN FORENSIC medicine definitions are needed for clas- sification or demarcation. Definition is of scientific value only when it permits relative, not absolute applica- tion. A definition of epilepsy meeting these requirements was proposed by E. C. Spitzka,t a quarter of a century ago: "Epilepsy is a morbid state of the encephalon without palpable characteristic lesion, shown in explosive activity of an unduly irritable vaso-motor center, leading to complete or partial loss of consciousness which may be preceded, fol- lowed, or accompanied by various phenomena, expressing the undue preponderance of some cerebral districts and the suspended inhibitory influence of others." The epileptic constitution is characterized by lack of tone, associated with exaggerated reaction and irritability. Thus the pupils are at once widely dilated and unusually mobile. The muscular system, though generally felaxed, manifests exaggerated reflex excitability. The mental state presents at once, great indifference and undue irasci- bility. The vascular system is depressed in tone in the in- terval, but displays rapid decided changes under excitation. The nervous system, generally speaking, resembles an 'Read before the Section on Legal Medicine, International Medical Con- gress, Lisbon, 1906. Abstract. tJVrei England Medical Monthly, 1881. (170) Legal Aspects of Epilepsy. 171 elastic band, which, continually on the stretch, overshoots when one end is let go. Under normal circumstances, be- ing less stretched, the band is not liable to fly afar when the check is removed. An irritation which, in health, pro- duces muscular restlessness, accelerated respiration and pul- sation, and various mental phenomena within normal lim- its, in the epileptic causes similar but more intense phe- nomena. The nervous irritability of the epileptic mani- fests itself in one direction especially. An important ce- rebral vasomotor center is diffused in an area between the thalamus and sub-thalamic region and the pyramidal de- cussation below. Irritability of this produces sudden arter- ial spasm of the carotid distribution so characteristic of the epileptic onset. Simultaneously with artery contraction, the pupil undergoes an initial contraction, and relaxation in- stantly follows in both cases. Sudden interference with cerebral circulation produces unconsciousness and destroys the checking influence of the higher centers on the re- flexes in analagous manner to shock, meanwhile, sudden deprivation of arterial blood and sinking of intra-cranial pressure so far as the great cerebral masses are concerned, has occurred, with a sudden influx of blood to the un- affected vertebral- artery district, whose territory thereby becomes hyperemic. As a result the great convulsive center (the medulla) being over-nourished, functional ex- cess (convulsion) occurs unchecked by the cerebral hemi- spheres disabled by their nutritive shock. Epileptic uncon- sciousness and coma resemble shock more than they do cerebral anemia or syncope. Impeded return circulation of venous blood now comes into play, this, through accumula- tion of proteids, acts as a toxic agent, producing the se- verer symptoms of the post-convulsive periods. The legal relations of epilepsy as determined by this patho-physiology are of three kinds: Those which are brought under cognizance of the law through direct mental results of epilepsy; those which require legal determina- tion because of the consequences of epileptic neuroses; finally those in which legal determination of epileptic eti- ology is required. The first type deals with the civil and 172 Harriet C. B. Alexander. criminal responsibility of the epileptic. The second type involves the responsibility of others for results of epi- lepsy. The third type involves the responsibility of indi- viduals, firms or corporations for the causation of epilepsy. The epileptic constitution from the outset raises doubt as to responsibility, because of the readiness with which in it free determination of the will is impaired. This test of responsibility obtains not only in Roman law countries, but likewise in English speaking countries where the pre- sumption of innocence of the common law is carried to its logical conclusion. The psychic results of epilepsy are usually classified according to their relations to the motor symptoms. This, however, does not include changes pro- duced in mental states, other than dementia. Not infre- quently, after establishment of the epileptic habit, a contin- uous querulent, suspicional state occurs, which resembles that of traumatism, insolation, etc. This mental state at once causes morbid irritability and so weakens the will that the individual develops persecutory delusions and readily yields to them. In this state, the unconsciousness or dazed consciousness considered characteristic of epilepsy, is wanting. In Regina vs. Taylor, the accused barred him- self for hours within his house, held a loaded gun, and filled his pockets with cartridges. After watching his pur- suers for a long time, he deliberately aimed at the police superintendent and fired. The act was not an epileptic im- pulse, but as Bevan Lewis* points out, the well-planned determined act of a delusional lunatic. The accused, under delusion of marital infidelity, killed his infant. When pur- sued by the police, he regarded this as part of the general persecution to which he was subject. There was decided evidence of simulation by the accused, but equal evidence of grand mal, petit mal and epileptic mental states. Coun- sel for the accused claimed that he was a complete mental wreck, evidently thinking the case epileptic dementia. The accused, recognizing his legal status, had told a fellow prisoner, the night before the trial, that he would be com- •Mental Diseases. Legal Aspects of Epilepsy. 173 mitted to a lunatic asylum. He was sent to the Broad- moore lunatic asylum. In certain cases, paranoia is complicated by epilepsy. The general mental state is then affected in two directions. Epileptic suspicional irritability and resultant treachery af- fects the delusional conduct of the paranoiac. On the other hand, the religious delusive conceptions and halluci- nations of epilepsy affect paranoiac delusions, sometimes confirming these and giving the paranoiac a belief in a prophetic message. Such cases, while seeming to indicate consciousness during an epileptic attack, originate from a different source than this, that which gives rise to delusions of memory. These, as Meynert* has shown, have the following pathogeny: An epileptic attack occurs from partial arterial spasm in a hemisphere. When complete occulusion results from this, collateral hyperemia occurs, engendering irritation and pronounced vascular contraction, leading to diminution of pressure in collateral branches. These phe- nomena do not produce hallucination, but the hyperemia causes a delusion of memory at the time the hallucina- tion occurs by so coloring the subjective sensation that the sensorium retains imprint of it. This, while not a true memory, closely simulates it. Mere seeming consciousness is no evidence of a conscious directing will, since many acts apparently conscious, are done by epileptics in uncon- scious states. Epilepsy shocks the mental unity similarly to hypnotism. The epileptic is peculiarly open to sug- gestion along lines that do not antagonize the general mental trend. Shakespeare, who, as Brighamt pointed out six decades ago, prepares his characters for the mental state which they are to develop, prepares Othello for his jealous suspicions, by making him an epileptic. (Act IV, Scene I.) Iago: "My Lord has fallen into an epilepsy. This is his second fit; he had one yesterday. Cassio: Rub him about the temples. Iago: "No, forbear; The lethargy must have its quiet course. If not, he foams at the mouth and by and by Breaks out to savage madness." •Psychiatric 1886. \Amer. Jour, o/ lnsanitj. 1846-7. 174 Harriet C. B. Alexander. While motive may seemingly underlie the criminal act of an epileptic, legal tests of responsibility require analysis of such motives. Morbid jealousy, generally the outcome of chronic alcoholic neuroses, occurs in other erotico-sus- picional states and may tinge an epileptic explosion which would lead to crime, even though the alleged motive were absent. The influence of other psychoses dominating epi- leptic mentality, appears in the somnolentia of epileptics. Somnolentia* is a lapping over of a profound sleep on the domain of seeming wakefulness, producing involuntary in- toxication of the patient, which at the time destroys his moral agency. This state is frequently accompanied by fears and suspicions related to the onslaught of burglars or robbers. In a case reported by Bevan Lewis, a hereditarily defective neurotic imagined, as he slept beside his wife, that he saw two burglars rifling a chest in his room.t He sprang out of bed and, as he rushed for help, saw a bur- glar strike his wife with a hatchet. He remembered noth- ing more, but was found wandering in the streets vacant and confused, holding a hatchet. Immediately subsequent to the idea of the burglar, he had a fit. The idea of the hatchet caused him to rush down stairs, and during the automatic period he had killed his wife. In this case som- nolentia had dominated at the outset. The crime had been committed in an epileptic unconsciousness. The story told was one which a less intelligent, conscientious auditor than the English policeman, who first heard it, would have regarded as a clear proof of guilt. In a case reported by T. M. T. McKennant and W. K. Walker, of Pittsburg, Penn., an 18 year-old boy killed his mother and four sis- ters. An elder brother, awakened in the night by a moan- ing sound in his mother's room, saw his brother coming out of the room with an ax in his hand. The latter, ex- claiming, "burglars, robbers," struck the bed where his brother had been lying and then struck at his brother, who grappled with him and held him; all this time he was 'Wharton and Stille Medical Jurisprudence. fOp. Cit. XMedical Ntws, 1905. Legal Aspects of Epilepsy. 175 calling "burglars, robbers," apparently insensible to his surroundings. He was taken to the police station and left there. In an hour and a half, when the brother returned to the station, the accused asked what was the matter and why he was there. He claimed that in the night he was awakened by a noise of a door being opened. He punched his brother, told him some one was in the house, pulled on his trousers and went into the hall. His mother's door was closed. He went down into the kitchen, but saw nothing out of the way. On his return he noticed his mother's door was open and a lamp was burning in the room. He heard no sound, but saw some blood on the wall or on the bed. He did not go into the room. He saw an ax lying in the doorway, picked it up, went to his own room and called his brother three times, who did not answer. He touched his brother on the thigh with the ax to awaken him. The brother then jumped up, grappled with him and took him to the station house. He was awake, did not commit any crime, and knew nothing of his mother and sisters being killed, until told of it next morn- ing. He had been working on patents and had drawings in a scratch book. A month previous to the homicide, he found leaves torn out and an unsigned note in the book, which read: "If you attempt to find who did this, will kill yourself and family." A detective, when shown the note, told him someone was playing tricks on him. There was hereditary taint and degeneracy stigmata. The education of the accused was limited, but he had shown a tendency for serious reading. He was the bread-winner of the fam- ily, had decided mechanical capacity and, until four months before the crime, he had run a stationary engine. Four months before the tragedy he stopped work and announced he was going to work on a patent for a car brake. While in jail he showed no interest in this. His tongue had been bitten when he was first seen after the homicide. Once he suddenly-fell and remained unconscious for a few seconds, but there were no convulsive movements. He was acquitted on the ground of somnambulistic automatism. 176 Harriet C. B. Alexander. In the Chicago case of the People vs. Mueller,* a de- fense called "epileptic somnambulism" was attempted. None of the characteristic features of either epilepsy, som- nolentia or somnambulism were presented in evidence. There had been frequent quarrels between the man and his wife, and threats of death had been made. The crime was begun with one weapon and finished with another, when the first proved ineffectual. There was some re- membrance of every stage of the homicide. The man was an alcoholist, whom his wife had supported. He alleged before the homicide that the children killed were not his. He was found guilty and executed. Many simulations of consciousness in the epileptic pre- cede, succeed and take the place of the fit, whether this be petit or grand mal. All other things being equal, petit mal is most apt to produce these disturbances, since it tempor- arily breaks up, but does not destroy the mental balance constituting the ego during consciousness. The cases, moreover, where an imperative conception or obsession takes the place of, precedes or succeeds a fit, are cases of true consciousness. In a case reported by Marc, a Saubian,t became epileptic at eight, the convulsions continuing until 25. Then they were replaced by an irresistible homicidal impulse, preceded by an aura. The patient recognized his obsession as illegal but irresistible, so that he demanded re- straint when he felt the aura. In one of my own cases, J the patient had corprolalic tendencies between the attacks during the period of lucidity. The improper nature and abnormal character of these utterances she fully recog- nized. To enable her to control them she tied a cloth around her mouth, which aid to her will was usually effectual. In certain cases from rhythmic neural law, occurrences of the pre-,post, and equivalent epileptic states are remem- bered when the pre-,post, or equivalent state recurs. In a case reported by Clouston, a young epileptic, friendly with •H. N. Moyer evidence: Mueller vs. People, t Maladies Mentales. ^Medical Standard, 188 Legal Aspects of Epilepsy. 177 the doctor when lucid, disliked him very much during post- epileptic excitement. He was once found with another pa? tient, making a weapon to assault Dr. Clouston, out of a stocking into which he had put a stone, tying a string about it and slipping it up his sleeve till he should have a chance to use it. When recovered from the excitement he had no remembrance of this. The seeming conspiracy be- tween the two patients is not so exceptional as to create doubt of the case. In one of J. G. Kiernan's* cases, a victim of epileptoid hallucinatory confusion, preceded by kleptomania, united in a seeming conspiracy to escape with a paranoiac and two epileptics. They were seated on the grounds after their usual walk. The epileptics were in post-epileptic dazed consciousness. The patient first de- scribed suggested they all go home. The third patient rushed on the attendant and threw him down while the others ran off. Later, he had no recollection of his violence nor of the suggestion of escape, albeit, his act was prompted by it. There were several factors which combined to give the appearance of a plot to the result of quickly suggested action on post-epileptic states liable to suggestion. The influence of suggestion on these pre-,post, and equivalent states, naturally creates doubt as to the validity of deeds, wills and contracts executed by epileptics. As the mental state predisposes to undue influence, the burden of proof should be thrown upon the will, deed or contract. The suspicional states are most strongly directed toward those who do not humor them and, hence, are an excellent field for confidence men, parasites, etc., to work. While marriages of epileptics are frequent, attempts to annul them are rare. In two Illinois cases, women who had received large pecuniary damages from corporations for traumatic epilepsy, were married indubitably for these dam- ages. In these cases validity of the marriage was not de- nied by the court when the question was brought before it. The issue, however, was not directly made, but was part of an attempt to place the woman under a guardian. *Alienistand Neurolotist, 1887. 178 Harriet C. B. Alexander. Under Canon law, if the woman had had no clear concept- ion of marriage responsibilities, her marriage would be null and void. Under the contract doctrine of the civil law, such a marriage would also be void, since the contract lacked the elements of mutuality. The epileptic sometimes wanders from home, traversing considerable distance and is guilty of complicated anti-social crimes in the intervallary epilepsy of Falret. The patient seems to have come to himself; he converses with those around him and performs acts seemingly regulated by his will. He is, however, to- tally unconscious of these. In this condition, which is di- vided by Falret into intellectual grand and petit mal, bur- glaries and other seemingly planned thefts have been per- petrated. These states are probably intensified psychic equivalents. They often underlie "double consciousness" and frequently appear in larvated epilepsy. In one of W. A. Hammond's cases,* a manufacturer left his office at 9:00 o'clock in the morning to purchase some bulbs, and remained away eight days. He was tracked all over New York City, but the trackers were always one hour behind him. He went to theaters, to hotels where he slept, to shops where he made purchases, and took a journey of one hundred miles, losing his ticket and being put off at a way station. He returned to New York, passed the night at a hotel and on the eighth day appeared at his office. He had no recollection of anything during the eight days. In one of Legrand du Saulle's cases,t a young man of wealth and good standing, lost himself sometimes for three days. He would find himself far away from home on a railway or in a prison, with clothing in disorder and without recol- lection of what had happened. His pockets would contain pocketbooks, jewelry, cigar cases, knives, laces, bank notes, gold coin, letters and other articles. How he acquired these he would never know. In one of R. Dewey'st cases, a man in the state just described, broke into a store at night in a manner that showed no little skill in bur- •Treatise on Insanity. fEpilepsle. Xlllinois Medical Journal, 190S. Legal Aspects of Epilepsy. 179 glary, stole very useless articles and was tracked by his senseless neglect of the most ordinary precautions. The epileptic equivalent may express itself in moral perversion only. The patient may be a dipsomaniac, nymphomaniac, sexual pervert, kleptomaniac or suffer from homicidal im- pulses during the equivalent, being perfectly moral and up- right in general. In one of J. G. Kiernan's cases, the grandson of a village usurer had true kleptomania as a psychic equivalent. He would steal articles varying in character according to the time of suggestion, and would hide these away, never making any use of them. Owing to the prejudice against his grandfather, he was tried and convicted. The insane origin of his thefts so soon became obvious in the jail that the prosecuting attorneys had him pardoned and transferred to a private sanitarium. Rape and criminal assaults on persons of the same sex, are far from rarely epileptic equivalents. In these cases erotico- religious phenomena often occur. 'The epileptic constitution may develop prolonged acute psychoses. Katatonia, I with Kiernan, Spitzka, Ham- mond, Landon Carter Gray, Conolly Norman, Nolan, Kahl- baum and other English and German speaking alienists re- gard as one. In the case of the People vs. May Buckley, in which 1 was called as expert, the accused had long had pre-epileptic suspicional states prior to entering on a town career. During these she made attacks with scissors or other weapons, while seemingly conscious. Then there was a convulsion followed by post-epileptic stupor, lasting from a few hours to a week. Just after a period seemingly of this type, she called a woman saloon-keeper to the rear entrance of her saloon, and there shot her dead. Although the woman was 65 years old and not especially attractive the State alleged that the accused, who is young and at- tractive, committed the deed from jealousy. Immediately after arrest and confinement, in the central police station, she so displayed the pathetic dramatism of katatonia, that the police matron regarded her as insane. Remains of this dramatism were still present after two months, but stupor and stereotypy were likewise present. Two months later 180 Harriet C. B. Alexander. than this, a cataleptoid state occurred which required feed- ing and attention to the dejecta. There was an expression of terrified stupidity resembling that of the "thunderstruck melancholia" of the Germans, but marked by more intense stupidity. She was found insane under a humanitarian sec- tion of the Illinois criminal code affecting prisoners who become insane before trial. The history of the case left no doubt but that the crime was the product of a pre-epileptic suspicional state, whose stuporous sequence had become katatonia. The epileptic in his relation to society, often involves consequences to others. An epileptic may sustain injuries which aggravate his condition or produce severe bodily hurts. The legal question here, would be as to responsi- bility for results. The epileptic who knows his condition (many epileptics do not) is legally bound to take more than usual precautions. Liability of an individual, a firm or corpora- tion, is determinedby care and prudence exercised by the vic- tim of an accident. Furthermore, no one can be held liable for the consequences of bodily or mental defects. If, however, a negligence which would cause slight injury to an ordi- nary person brings on an epileptic attack through which serious consequences result to the epileptic those responsi- ble for the negligence are liable for the serious conse- quences. Here is involved an interesting question of criminal responsibility. It was claimed in the Illinois case of the People vs. Van Dyne, that epilepsy, prior to the completion of adolescence, which disappeared at adolesc- ence leaving no trace, should excuse a conspiracy to assas- sinate for plunder, whose execution had once been put off, because of change in weather. The accused was convicted. No evidence was offered that the pre-adolescent epi- lepsy had so deteriorated his intellect as to predispose him to undue influence from his companions. Assuming, how- ever, that there had been such a state allied to the post- hypnotic condition, two legal problems would have been then presented. The acts of the epileptic would not then have been the product of his mentality but of other mind?. While he would have been clearly irresponsible, as not hav- Legal Aspects of Epilepsy. 181 ing the free determining power of the will, the other minds would have been responsible for his acts as accessories be- fore the fact. A somewhat similar problem is presented by what are called in English thieves' argot "dummy-chuck- ers"* who feign epilepsy to draw a crowd so that pick- pockets may reap a harvest. Exceptionally close observation has shown that some "dummy-chuckers" are epileptics. Still more rarely, as in the case of Harriet Jaynes, true epilepsy has resulted in a "dummy-chucker." Assuming that an epileptic is induced to become a "dummy-chucker" by criminals, a complicated problem in responsibility results. Simulation of epilepsy for various motives, by epileptics is not unknown in public institutions. This occurs even when there is no hysteric complication. Should the epileptic be free from mental disturbance when he feigns, should he clearly recognize the nature of his act and its consequences, should he have the power to refrain, it is clear that he must be considered an accomplice. All these facts must, however, be determined beyond a reasonable doubt. An- other phase of mental epilepsy, coming under the present category, is where epileptics under suggestion make false accusations. This is not rarely done by the police, even in English speaking countries where inquisitional prac- tices are opposed by the letter and spirit of the law. In the Chicago case of the People vs. Hunkins,t an epileptic wo- man fell in a fit, fracturing her skull against the fender. Her husband finding her bathed in blood, summoned the po- lice to transfer her to an hospital. At the hospital, it was found that her skull was badly fractured over the tempero- parietal region. The police, stung by previous criticism on the non-detection of crime, arrested the husband for as- sault on the wife. On trephining, the middle menin- geal artery was injured, producing considerable hemorrhage. Normal salt transfusion was employed, followed by a severe epileptic status. While the woman was in the stupor, suc- ceeding the status, her vision being affected by the injury, her husband was brought to her with a declaration by the •C. A. Macdonald, Amer. Jour, of Insanity. 1878-80. 'Kitman, Medicine, February, 1906. 182 Harriet C. B. Alexander. police that he was the man who had struck her. Several leading questions were then put to her involving guilt, but ignoring the fact that her husband was the man meant. These she answered in the affirmative. About two weeks after, she completely cleared up mentally, told about her fall as an accidental one and in effect repudiated her declaration. Application for bail resulted in a police statement that she was out of her head when she repudiated her first state- ments. On medical examination it was found that she had no knowledge whatever of the declarations made to the po- lice, of the arrest of her husband or of the accusations against him. His release on bail promptly followed and on her recovery his discharge. This case illustrates the dan- gers of accepting accusations by epileptics, unless exactly corroborated by outside evidence. The Indiana case of the State vs. Beam, reported by W. F. Howat,* of Hammond, lnd., also illustrates false ac- cusation consequent on epilepsy. A woman was found dead in bed, flat on her back, covered up, one of her legs slightly drawn up, with her face turned toward the right. The face was somewhat discolored and swollen. Frothy nv'.cus mixed with blood, came from the nostrils and some blood from the ears. Marks and what were called scratches were on the neck. According to the State physicians, who made the necropsy, there was a blue mark three or four inches long and two inches wide extending from a point about an inch below the right ear lobe. There was a slight abrasion on the left side near "Adam's apple." In two or three places, the skin was removed from pea size spots. The night of her death she slept upstairs alone. The ac- cused and his father slept down stairs. The mother had died some time previously and the deceased was house- keeper. The younger brother was absent that night. Early on the morning of April 24, the accused built the fire as usual. He then called the deceased, hearing no reply, he went to her room and found her dead. He then told his father. The deceased was a robust young single woman about 150 pounds weight. About two years prior to her •Medicine, April, 1906. Legal Aspects of Epilepsy. 183 death, she had borne an illegitimate child. For three or four years prior to her demise, she frequently had "sinking spells or fits." She would fall to the ground and remain un- conscious from a few minutes to hours. At times she would talk incoherently, would be unable to recognize any one, or would become ghastly pale. As a rule, she had the appearance of a corpse, but occasionally she kicked around, attempted to pull her hair and had to be held to prevent her from doing herself injury. At the outset of these "spells" she breathed heavily and could be heard- all over the room, soon the heavy breathing ceased and it be- came difficult to see that she breathed at all. Medical aid had frequently been summoned for her. The attending phy- sician swore that she was an epileptic, albeit he had never seen her in grand mal. The State in its opening alleged that the accused killed the girl in a jealous rage. In its closing arguments, it alleged that the accused, tiring of her wished to be rid of her, insinuating he was the father of her child. At the second trial, (which followed a disagree- ment of the jury) this was shown to be absolutely impos- sible. The State then relied upon an alleged ungovernable temper of the accused. The deceased came to her death according to the State, from strangulation by external vio- lence and pressure on her throat by the defendant. This claim was based wholly upon the marks on the neck and the pulmonary congestion found post mortem. Death from epilepsy was denied because an epileptic, it was claimed, could not inflict the marks or bruises upon his or her person found upon the deceased. Muscular contraction, it was claimed, would prevent her getting her hands to her throat. The healthy condition of the brain and the other organs, disproved epilepsy, according to the State. No examination was made as to persistence of thymus or the unilateral dif- ferences of the blood vessels. No dissection of the neck or any examination of the larynx or trachea or any search for foreign bodies in the air passages was made at the first necropsy. The outer surface of the neck was alone examined. Twenty days after death the body was exhumed and portions of the two sides of the neck re- 184 Harriet C. B. Alexander. moved. These parts, it was claimed, showed bruises, blood clots beneath the skin, extending entirely through the sterno-cleido-mastoid but there was no injury or lesion of the larynx or trachea, and no foreign substances were found in the air passages. The tissues removed were not offered in evidence nor was the defense permitted to exam- ine them. The first necropsy showed that at death gastric digestion was proceeding. She had last taken food about 9 p. m. Dr. Howat was asked whether the "sinking spells or fits" from which the deceased suffered were epileptic. He answered they probably were. He was asked: could an epileptic scratch or otherwise injure him or herself during any portion of the attack. He replied they could do so dur- ing the aura and that various injuries might be sustained during the convulsive and post-convulsive stages. He was asked if the blue mark might not have been post mortem lavidity, and replied that it might, since no evidence had excluded this possibility. He was asked whether this livid- ity might not have been increased in extent and intensity by the fact that the head was drawn to that side and a fold of soft tissue so produced at that point, and answered yes. He was asked if the convulsive movements on that side of the neck might not have been more severe than elsewhere, and replied yes. He was asked if convulsive movements were ever so violent as to cause muscular rupture, and replied yes. In response to the question, whether epileptics ever died sud- denly, he replied that they often did during a seizure. He testified that death might be brought about suddenly in epi- leptic seizures, by exhaustion as in the status epilepticus which exhaustion might be produced by a series of convulsions or by one convulsion, were it sufficiently severe. He likewise testified it might result from paralysis of the respiratory center secondary to severe shock. It might result from tonic spasm of respiratory muscles, in which class he included Hilton Fagge's "spasm of the glottis." It might result from sudden cardiac nerve strain, dilatation or rupture. It might result from asphyxia by foreign bodies (as food) or from suffocation. It might re- sult from accidental violence sustained during the seizure. Legal Aspects of Epilepsy. 185 He testified that patients dying suddenly from tonic spasm of the respiratory muscles would show post mortem signs of asphyxiation. From the evidence in the case, he testified he could not exclude epilepsy as a probable cause of death and that he would not be justified in concluding that death was due to strangulation by external violence. The necropsy had not been sufficiently careful and exact to exclude other causes of death than those alleged by the State. The sec- ond necropsy was valueless. The forensic problem involved in the third type of cases, is rendered difficult of solution, in English speaking coun- tries by judicial rulings which prohibit the expert from tak- ing into account subjective symptoms in civil cases. This difficulty is overcome to some extent by the hypothetical case based on the patient's statement in court and other evidence. In the Illinois case of Sobkowicz vs. The Crane Company, the following hypothetical question was sub- mitted: Assume an unmarried female nineteen years of age, of previous good health, so far as known, save as it may be evidenced by the hypothesis in this question, should be going up in a freight elevator conducted in the manner in which such elevators are usually conducted; that there should have been, according to this person's statements, a jerk of the elevator which was not apparent to other passengers in the elevator; assuming likewise that there was a sec- ond jerk, according to the person assumed in the hypo- thetical case, which was likewise not apparent to the other passengers in the elevator; assuming that the person named in the hypothetical case remembers then of falling back- ward but does not remember anything thereafter; assume likewise that she does not remember of her knees striking the floor of the elevator and does not remember going over the edge of the elevator floor; assume likewise that it seemed to her that she tried to catch hold of something af- ter the elevator jerked, as she says, but that everything then became dark; assuming these facts, can you form an opinion as to the physical condition of the person described in the hypothesis at the time of entering the elevator? 186 Harriet C. B. Alexander. To this question I replied that the person described was suffering from epilepsy or from some condition resem- bling syncope at the time mentioned and that such a con- dition contributed to the fall from the elevator. The following additional hypothesis was then presented: Assume likewise that the person described in the pre- vious hypothetical case received an injury over the right parietal region, that she had a fracture of the clavicle, that she had a dislocation of both wrist joints, that she is picked up unconscious and remained so for about ten days; that a catheter had to be used to relieve the bladder for three days after the accident; that during the unconscious period she tore bandages from her arm and body many times; that she remained one month in the hospital and while there suffered severe pains in the head and various parts of the body; that about two months after the accident she lost consciousness and fell against the stove; that a num- ber of times thereafter she lost consciousness and when she came out of the hospital she was weak; assuming these to be true, can you form and have you an opinion as to the nature of the unconsciousness which occurred in the elevator? To this hypothesis 1 replied that the attacks of uncon- sciousness were probably epileptic, but they occurred too soon after the accident to be due to it. In my judgment, it would take at least six months to develop the epileptic habit in the absence of meningeal irritation or grave corti- cal lesion of which no evidence was presented in the hy- pothesis. The plaintiff presented evidence thereupon tend- ing to show that other persons had been thrown down by the motion of the elevator and also that the attacks of un- consciousness had not occurred until more than six months after the alleged accident. Under the circumstances, the jury naturally found for the defendant since in Illinois they are judges of the evidence. As the whole question turned on the validity of the two hypotheses and as the cardinal facts of the defendant's hypothesis were disputed, the jury logically held that the preponderance of evidence was with the plaintiff. In the Chicago case of Wills, vs. the Chi- Legal Aspects of Epilepsy. 187 cago City Railway Co. the issue turned upon the validity of an hypothesis which assumed that there had been a tonic spasm lasting from 15 minutes to half an hour. The preponderance of evidence being against the epileptic nature of such a spasm and epilepsy having been the specified result of the accident, the jury found naturally for the defendant. The question of diagnosis between epilepsy and hysteria while not demanded by the declaration filed in the case, is often raised. In such cases, attorneys have often wisely abandoned the attempt at demarcation and held that hysteria and epilepsy are equally serious neuroses and if negligence causes either, the person responsible for the negligence is liable to damages for a serious neurosis. This position has been repeatedly sustained by the Illinois courts. The Chicago practice during the 80s and early 90s, had been for the defendant corporation to claim that every- thing was hysteria and that hysteria was a feigned condi- tion. In litigated cases moreover, traumatic hysteria very frequently complicates traumatic epilepsy. In the case of Hogan vs. Chicago,* T. J. Burns saw the patient in an attack of grand hysteria and testified to the existence of that neurosis alone, admitting, however, the possibility of epilepsy as a complication. J. G. Kiernan, who saw the patients in attacks of grand and petit mal and in post-epileptic stupor, testified to the existence of epilepsy, admitting the probability of an hysteria complication. As the patient was a woman, the hysteric diagnosis was the usual omnibus for all symptoms. The jury found for the plaintiff, and their verdict was sustained by the Illinois Appellant and Supreme courts. These cases naturally raise the question whether epilepsy can be diagnosed in the absence of a fit. Spitzka, Kiernan, Landon Carter Gray, Howard of Montreal, Ecche- veria and others, hold with the older clinicians that a di- lated mobile pupil together with petecchiae suffice for diag- nosis of epilepsy in a suspected case. In the criminal case of the People vs. Mooneyt Kiernan diagnosed epilepsy un- suspected in the prisoner from these two facts which diag- 111. Reports, 176. \Alienist and Neurohtitl, 1906. 188 Harriet C. B. Alexander. nosis was subsequently confirmed by the evidence. Epi- leptic pallor is also of value in corroboration, albeit other conditions exhibit a similar pallor. These three conditions are found alike in congenital and acquired epilepsy and hence, when present, are of value in diagnosis. Their ab- sence, however, does not disprove the existence of epilepsy. It has been claimed by certain corporation attorneys that subsequent marriage by epileptics disproves the existence of epilepsy. This contention would hardly merit discussion were it not frequently repeated by judges. It has been decided absurd by the Illinois Supreme Court, which held in the case of Pyott vs. Pyott that even a senile dement might go through a marriage ceremony without understand- ing fully its nature and resultant responsibilities, albeit re- garded as sane by the officiating clergyman chiefly intent upon his fee. At one time marriage was a popular pre- scription for epilepsy. The coprolaliac patient elsewhere mentioned had been married by payment of a fee to her husband. This prescription seems to have been peculiarly prevalent in Germany, where marital affairs are conducted, as in Europe generally, on a much more commercial basis than they are in the English-speaking countries, as Letour- neau points out. RAILWAY BRAIN STRAIN OF AND BRAIN STRAIN REGULATION OF RAILWAY EMPLOYEES. By C. H. HUGHES, M. D., ST. LOUIS. , THE sanitary regulation of the railway service is quite as important as the regulation of its fares, freight rates and rebates, yet the President has not alluded to this important matter, in any of his estimable and salutary public suggestions concerning the regulation of these sordid soulless public servants. The appalling accident records of the railways and their causes in the overworked and wearied brains of railway employees and their parsimonious recom- pense for high class exacting strenuous brain service, needs attention from sources of influence and compulsory authority. The train dispatcher service for instance, should in many stations be reduced to six hours a day, with pay enough to give dispatchers all the brain rebuilding and sustaining influences procurable. The telegraphers, engineers, conductors on great main line crossings, junctions and stations should receive pecuniary consideration something more nearly approximating than now that of the superintendents. Many runs are en- tirely too long for the normal brain endurance and best brain service of one man in these several departments of straining brain work, far too long also for the highest safety of pas- sengers. (189) 190 Chas. H. Hughes. The same precautions as are now given to the inspec- tion and soundness of tracks, the running gear of trains and time schedules, might with equal wisdom be applied to the brain capacity, vigor and recuperative rest opportunity of the brains that dispatch and run trains. Absolute temperance is not more essential in railway employees than ample brain rest. The Pullman car service is also criminally delinquent in regard for the brain rest opportunity of its conductors and porters. A more than twelve hour run without intervening sleep is cruelly inhuman for any railway service, and an eight hour relief all around would be nearer within the daily limit of brain endurance of the strained brain's recuperative capacity. Money and men would be saved by a more moderate and judicious running of the mental machinery that runs our railway trains across and up and down the continent. The railroads are wrecking men in their employ and blasting lives in other ways than by collisions and derailments. A wise and more human regard for the endurance of railroad men, besides saving damage suits for maimed and lost lives, might postpone the dawning day of public owner- ship, and the time when men will demand in the courts, damages for enforced brain service resulting in brain break and its consequences. Over brain strain paralysis, epilepsia and neurasthenia among railway employees will yet seek remedy in the courts as well as the more sensible injuries to body from accidents, unless railway managements become more considerate of the mental recuperation needs of their most faithful and efficient employees. It is the faithful ambitious railway employee, like the willing and mettled horse, that can be and is worked to breakdown and death by inconsiderate railway corporations, as the writer knows from abundant personal observation. Broken brains of railway employees applying to the neurol- ogist for help are far more numerous than the wrecks that strew the tracks. They are brain wrecks caused by untimely psychic neurone service, exhausted to the point Railway Brain Strain. 191 of exhausted mentality resulting in instability ofbrain and mis- takes or failure of duty in this criminally overtaxing service. An exemplary young train dispatcher overworked and suffering also from dental caries and furious odontalgia, asked to be temporarily relieved awhile from service to get the tooth extracted. His brilliant minded superior answered him "if you are able to come down to the office you are able to continue on duty." He continued on duty till a condition of epileptoid developed and now he is out of service and under treatment for this malady developed by unremitting strain of a too exacting service. Another stood up to the rack till he fell in a fit in the office. The wrong attitude of railway management toward the employment of men past the age of thirty-five has grown out of the brain punishment and damage of too severe a service and the premature development of brain wrecks in consequence. The idea that men are too old at thirty-five or forty has grown out of seeing prematurely aged made old before their time by too exacting killing service. Let railway corporations be more sensible and considerate of the brain's endurance and more just in their allotment and demands of brain service of its faithful and most efficient servants and the age limit of capacity.may be extended as far in railway service as in any other ser- vice, with temperate self care-taking of men to the betterment of the railway interests and the better welfare of the employees and the safety and other good interests of the public, whom railroads are bound and chartered to serve in the best attainable manner, as well as to the railway management themselves. The dropping out of used up men at thirty-five and the refusal to employ men over that age, save in exceptional instances, is a condem- nation of the railway service system out of the mouths of the higher management. Men are not born to break in brain, if their brains are rightly considered, at that early age, and not even at the extreme Osier limit if rightly cared for. The service of railway employees from superintendent to brakeman and even of track layers, is one of over stren- uous exacting exactness wherein mistakes are not admis- 192 Chas. H. Hughes. sable. The mistakes from errors of capacity or judgment are here too serious for any other than exact service. The freight transit and travel service, especially, may be likened to the military service and the engineering service. It is much like that of military engineering. The track for the passage of trains is as important as the pontoon bridge for the passage of armies and their supply train and ordnance. Only brainy men and brain cared for men are in place in this service and these need as much care as the horses we groom and care for, for less important work. The wise man "considereth his beast" and the master considereth his ser- vant and the prudent employer has regard to his employees' needs for daily repair of brain through ample opportunity for nightly rebuilding rest. The corporation that neglects these considerations, either from lack of charity or lack of knowledge, neglects its business in this most important regard and damages its interests, and those of the people (if it be a railway corporation), who put their trust in it or confide their lives to its management. Economy of railway service at the expense of brain exhaustion of its servitors is in the end destructive, unwise and criminal extravagance of limb, life and property. Living cerebro-mental machinery driven to premature debility, in- stability, inefficiency and decrepitude, does not argue well for the wisdom of the present railway management systems of the United States. The period of the greatest utility and power in well endowed brains and minds is from thirty-five to fifty-five or sixty and in certain exceptional organisms and in certain advisory directory positions even beyond three score and ten. To ignore this fact or make it impos- sible of practicalization in railway service, is to abridge railway service efficiency and achieve less for the employee, bondholder, stockholder, management and patron, and less than it ought to be for humanity's sake. The mental potency, endurance and capability of long continued efficiency of service counts for supreme suc- cess, as premature mental debility and incapacity from pre- cocious overstrain of brain counts against it. Youths and very young men should be barred from the posts of highest Railway Brain Strain. 193 responsibility in certain places in the service, notably in certain telegraph work and dispatcher work and on trunk lines, from longdistance locomotives, where maturity and vigor of judgment in emergencies may be required. To the criticism that "this is not our business" we reply—we make it our business as it is our duty, from our knowledge of the brain being wrought upon in the over- work or certain railway employees, to sound this too long deferred but yet not untimely warning. The ceaseless, exacting demands of travel service on ourthrough trains,especially the "lightning limiteds" and "fly- ers" between the great cities and transcontinental,requires an unremitting vigilance and mental tension that demands a grea amout of absolutely quiet compensatory sleep after the tension is off the strained brain, not counting in addition, the brain and spinal cord strain of a thousand or more miles of travel, of wobbling trucks and bumping coaches on steel wheels and roughly-jointed roadways, not always so straight or smoothly constructed, as might be possible in some instances. The fatigue to the ordinary traveller of long journeys by railroad is a common experience, requiring several days of subsequent rest with many. To this is added the mental strain of special anxiety and responsibility in the train officer. And what provision is made for the brain and mind rest and repair of these brain tensioned men? None. The Pullman conductor may sleep in his coach or in a neighboring cheap hotel near the noisy station, or in the coach in the noisy yards, for his pay does not justify better accommodations and the demands upon his time often will not permit sleeping at a distance from one of the ends of his run. The time may not yet be ripe for restrictive sanitary legislation of the day time service of railway employees for the conservation of their vitality and mental endurance and power, but it will come and with the approval of the railway management itself, under the diffusion of knowledge the brains' rest needs and normal activity capacity, as neurolo- gists and brainologists see them. The spread of such knowledge among railway directors 194 Chas. H. Hughes. would be a motive of economical management, not in small pay to workmen, but in salvage from disaster. Thus a neurologically and physiologically enlightened and an exalted charity for the good of the railway employees, a wise provision against railway service incompetency, against accidents of incapacity from brain tire and for the best financial results through a vigorous mental service, would go hand in hand. Self interest and charity together joined and both benefitted. Let us now take this record for brief consideration. "During the twelve months ended June 30, 1905, 886 persons were killed and 13,783 injured as the result of accidents on railroad trains in the United States, according to a report of the Interstate Commerce Commission for 1904-5. "Comparison with 1904 shows an increase of 11 killed and 4,123 injured among passengers and employees, the increase in killed being wholly among passengers, while the number of employees killed shows a decrease of 106. "There were 1,231 collisions and 1,535 derailments, of which 163 collisions and 168 derailments affected passenger trains. "The damage to cars, engines and roadway by these accidents amounted to $2,410,671." The utmost care has been and is now being exercised in American railroads to guard against defective wheels, trucks, all running gear, brakes, switches, machinery and signals. Even the inspection of the eyes of the employees as to color blindness and yet the appalling annual record of accidents shows for defect of precaution somewhere. When railway management looks for and remedies the mental blindness in railway traffic and passenger managers and superintendents and the brain defects of forgetfulness, drowsy and brain tired indifference and positive incapacity, sometimes resulting from neglected inspection and timely brain repair and of overworked, sleep-robbed employees, sometimes with the added exhaustion of vicious (and under the circumstances criminal) passion indulgence, sapping vitality in addition to loss of sleep, an explanation of Railway Brain Strain. 195 many railroad accidents may be found, not otherwise ex- plainable. Railway service, railway safety and efficiency and financial interests are best conserved and promoted by strong capacious restful and well rested workable brains, as they are by good tracks, good rolling stock and good men in the directorate and higher managerial departments. This is the testimony of prudent neurological observation. Will the railway interests ever heed it? They will and must, the voices of humanity and self interest unitedly cry for it. Some of the best business men 1 have known were railroad men who died of brain strain disease and some of the living are hovering so closely to the verge of brain break, through ambitious and strenuous life, that the end in brain breakdown is not far off. There is intemperance in brain work as in that vicious intemperate alcoholic indul- gence which the railways now so generally condemn, since fatal expensive experience has shown its harmfulness to the railway service interests and exchequer. The railway service counts a large annual martyr list of overstrained and brain broken unto death among officers and employees. After a time with right enlightenment as to overtaxing of the delicate machinery of the human brain these fatalities will cease, for the brain will and must, in time, receive as much attention as the coarser mechani- cal machinery of man's contrivance which runs on the track. As the proof of this article is being read the brain and heart-shocking record of another horrible railway disaster due to the same cause of brain overstrain, appals the world. Forty crushed or burned to death victims, and others maimed but not killed outright, is the record of two trains coming together "head on" in a blinding snow storm, as the result of the mistake of a train dispatcher's orders, because of his involuntarily falling asleep at his post, after seventy-two hours' work without rest. The horrors of this accident, so-called, but really a predetermined event, for no man can do train dispatcher's work continually for such a length of time and not become unsteady of brain, was preceded by a similar one where 196 Chas. H. Hughes. some one had blundered from overwork and neglect of timely brain rest on the same road, the Denver & Rio Grande, in August, 1904, at Eden, only the present disaster is due to the absolute sleep obliviousness of the operator, and not to an unsteady, inaccurate state of mind preceding the inevitable sleep that the over-tired brain sooner or later secures, if not persistently prevented by ceaseless waking influences from without. In the name of that great professsion, whose duty it is to guard the health and lives of humanity; in the name of the great science of physiology, which reveals and con- siders normal human functions and marks the limit of the brain's endurance and the need of timely sleep for the wearied brain's repair and tells us the limit of human brain capacity; in the name of brain health and strength im- perilled by over brain-strain of overtime work of railway men, and in behalf of the lives imperilled thereby, and of the sorrowing all over the land, bereaved by these numer- ous, oft-recurring railway disasters from over brain-strain of certain railway workers, and the resultant impaired normal, mental, supervisory vigilance needed in such accurate mind-demanding service, we protest and plead for lawful remedy. The overtime system on our railways, especially for train dispatchers, engineers and superintendents of trans- portation, especially in the passenger service, is unsafe to individual workers and to the travelling public, and ought not to be countenanced by railroad companies. The same considerations that inveigh against ordering or permitting overtime service, applies also to the over- strain of the employes themselves when off duty, through alcoholic indulgence or other sources of brain and sleep dep- rivation. The strenuous service of a railway employee demands the man's best powers kept in healthy, vigorous tone at all times by right living while off duty, as well as when on duty. It is the duty of the medical profession in the exer- cise of right sanitary monitorship over the public welfare, as the code of ethics requires, to so admonish all concerned, Railway Brain Strain. 197 and stop if possible the needless and preventable destruct- ion of human life through over brain-strain and deprivation of sleep of railway employees. Public disaster, added to the neurotic disorders engendered through over nerve cen- ter strain in this service, demands sanitary supervision un- der medico-legal guidance. Crimes like this of coerced, mental overtax against normal powers of brain and body endurance, robberies of the physiological need and the moral, which should also be made the legal right of sleep, and consequently of the fu- ture health and livelihood of telegraph and other railway operatives, and against human lives and bodies and the people's right to safety in travel, are repugnant to the heart of natural charity and should be prevented, not by arraigning the minor operative directly responsible, but by arraigning the major directing, criminal official and convict- ing the heartless, overbearing instigator of these railway murders. The railway service is too near the lives and welfare of the people to be conducted solely for pecuniary profit. The brain and body wear and tear of its employees and the safety of travel should be regarded by its management as of equal, if not greater, importance than the wear of rails, rolling stock and running expenses. Hitherto the medical department of its service has been mainly occupied, like that of the military service depart- ment, largely with the care of the dead and wounded after collisions, wrecks and casualties and the legal in minimis- ing accidents and damages. The psychic sanitation of the men who fill the several places of grave responsibility in this important service, as important as the places filled in war by the men behind the guns, has not been duly considered. Their physical health on going into service and freedom from eye and ear defects have been inquired into, but their powers of mental and physical endurance through the overtime system, and habits and opportunities for rest and recuperation when off duty, have not been psychologically duly considered. The psychiatry or mind care of the railway employe, from 198 ttasr-H. Hughes y superintendent down to brakeman and switchm^rn, has been seriously neglected, especially in the train-di«patching, engineer and switch service, and cruel criminal maimings and murders, appalling in number, have followed and be- reavements in thousands of families have resulted from this railway official crime of indifference to the mental en- durance and daily repair needs of certain railway em- ployees, to say nothing ^of'"' the wrong and depressing effect of the comparatively insignificant compensation in certain departments of great responsibility in this service below the higher officials. The railway management is especially particular to secure'perfect watches for all employees. It should be no Ies^ careful about the accurate movement of the minds and thfe physiological integrity of the brains in its service, for neither will run right unless properly and timely wound for cprrect movement. Railway travel will not be freed from its present appalling peril till the exacting and exacted brain strain on its employes is lessened and the employes themselves take better care of their brains by the avoidance of all those influences when off duty that tend to viciate the in- tegrity of the mental powers, and by not seeking to do excessive overtime work. No railway is safe from the possibility, almost certainty, of accident where train- dispatchers, engineers or switchmen serve continuously from forty-eight to seventy-two hours, or even for twenty- four hours continuously, and it is the humane duty of the medical profession, with the present psychological light upon the ordinary brain's endurance capacity, to advise and insist that such over brain strain in all departments of pub- lic service cease, especially where consequences are so serious as in the railway service, y/ This article was intended' for an editorial, but it grew to a length too extended for our editorial space and we place it here. The subject is by no means exhausted. The over brain strain extends far above the employees' chiefly discussed above. The general superintend- ents and chiefs of the several departments are v^^Railway Brain Strain, 199 not sufficiently sparing of themselves in this re- spect. They are as a class strenuous men, working to their utmost and requiring the same sort of service from subordinates. The most reprehensible thing among divis- ion superintendents is the effort at economy at the expense of the brain force and brain rights of subordinates, exact- ing often of one man the legitimate brain work of two at the expense of brain vigor and consequent prolonged en- durance, with resultant collapse of power and final failure and disastrous and expensive mistakes in duty. The writer has seen many instances of strong men at the head of the management bringing on premature neuras- thenia and ultimate fatal brain breakdown, which might have been averted by more judicious regard of the normal and limited brain and mind powers. Brain and mind force has its conditions of development and maintenance and its lim- itations like the conditions of development and display of the mechanical and physical forces. The brain itself is a delicate physical, as well as vital mechanism, and should be treated accordingly. THE ALIENIST AND NEUROLOGIST. VOL. XXVII. ST. LOUIS, MAY, 1906. NO. 2. Subscription $5.00 per Annum In Advance. $1.25 Single Copy CHAS. H. HUGHES. M. D., Editor. HENRY L. HUGHES. Manager and Publisher. Editorial Rooms. 3872 Washington Bout. Business Office, 3872 Washington Boul. This Journal Is published between the first and fifteenth of February. May, August and November, and subscribers falling to receive the Journal by the 20th of the month of Issue will please notify us promptly. Entered at the Postoffice In St. Louis as second-class mall matter. EDITORIAL. [All Vnsigned Editorials art written hy the Editor.] STREET NOISES.—Street noises, against which the professsion in this country has waged a more or less suc- cessful warfare, seem to be at their worst in the large cit- ies of England. The London Lancet recently received a letter from a man who had undergone an abdominal opera- tion in Birmingham. He told in his letter of complaint to the mayor that the quarter-hour clanging of the town bells, especially during the night hours, greatly disturbed his rest. The mayor declined to interfere on "the grounds that the clock is a public one, and its consistent working is of first importance to the inhabitants of the city." The Lan- cet in discussing the letter editorially said that the mayor of Birmingham had made a very poor reply to a sick man, and this journal has in consequence started a crusade against such unnecessary street noises as town bells and chimes.—Med. Age. To this protest might be added the one against tha (200) Editorial. 201 needlessly noisy street car and the unnecessary blowing of whistles and automobile car honks. The noises of the streets are slow destruction to certain neurotics. A NIGHTMARE SUICIDE is reported from New Or- leans March 23, the man, Ralph Vaughn by name, shoot- ing himself by placing a pistol in his mouth, which he had under his pillow, and blowing a hole through his head. He was a merchant of Pinte Coupe Parish, La. His family being away, he was sleeping in a back room of his store at Batchelor, La. RAILWAY INHUMANITY.—PULLMAN PALACE CAR CRIME AGAINST NATURE—Monopoly certainly should re- ceive attention of health boards, humane societies and leg- islators in the matter of its inhuman killing disregard of the physiological needs of sleep for its long run conduct- ors. The nightly allowance of sleep for conductors on long runs, we are informed, is three hours, viz: From three to six a. m. on two nights and one day run, with no sleep during the intervening day. The same rule applies as to sleep time allowance in the longer runs, we are informed. Organized labor is about right, (though it is often wrong and tyrannical in some of its other demands) in ask- ing for an eight hour law. For the best security for health and longevity, the body should have three hours for three leisurely, restful meals, and one for dressing and undressing and toilet, and eight hours for recumbence and sleep; seven for undisturbed, quiet sleep exclusively. It would probably prove salutary for long life and the most perfect health if man were twelve hours at rest and twelve in action out of each twenty-four, as in the days before candles, petroleum, gas and electricity. Railway, and all other strenuously exacting corporate managements, would be recompensed in better and safei service by a more enlightened and humane consideration of the physiological repair needs of the human machines they employ. It is pitiable to see many of the best, most will- ing, courageous and faithful employees of these soulless 202 Editorial. corporations prematurely broken in health, paralyzed, epi- leptic and otherwise stricken in their prime, like soldiers falling on the firing line. And some of the superintendents and general managers we have known have been no kinder nor more considerate of themselves. They never stopped for repairs till outraged nature threw them from the track of ceaseless duty with apoplexy or paralysis or men- tal aberration. They gloried in their strength too long and punished themselves to death, as well as their em- ployes, though they took pains generally to call off their inanimate machinery for timely repairs. Physiologic science, considerate nature and a charitable humanity prompt this protest. The meal rates and day coach sanitation should be regulated, too, in many through trains in the sanitary as well as the pecuniary interests of the poor man. THE ERRORS OF LOMBROSO ON MORAL INSANITY AND CRIME.—ALSO A WORD ON TATTOOING AND WRINKLES.—Among the many great truths told by Caesare Lombroso, here is one error which we deem it important to note with dissent at this time, when the sub- ject of criminology is assuming so much importance, and lest the error take hold upon the young student not clini- cally familiar with the subject of efferent or moral insan- ity, i.e., an insanity of the moral faculties, as Prichard described it. Lombroso here falls into the error, into which some other writers have fallen, of regarding Prich- ard's insanity of the affective life, which he unfortunately termed moral or affective insanity in accordance with the mental philosopher's differentiation of his day of moral and intellectual faculties, from the purely intellectual faculties. He distinguished thus the intellectual from the emotional and impulsive life, from the feelings and propensities which in the state of greater sanity and mental harmony of relation between reason and feeling, the mental faculties embracing the reason and will better restrained. Lombroso has fallen into the not uncommon error of amateur psychiatrists of regarding Prichard's unfortunate Editorial. 203 term of moral insanity as being an immoral form of insan- ity, whereas the learned author and great original observer of insanity of the affective life, under which the French folie tassonante and the German pstmaire l^ernutheit have been included. Moral insanity may show itself in immoral impulses, but it is quite as often, if not more often revealed in a highly moral symptomatology, as in religious emotional moral insanity. Moral or affective mental life insanity, as described by its discoverer, who was himself a practical clinical psychia- trist, is not essentially an immoral form of mental disease and there is no justification in the true history of psychia- tric literature for wrongly applying the term moral insan- ity to immoral displays of conduct, sane or insane, which the intellectual faculties, perverted by normal motive or ab- normal disease impulsions, are essential factors. Lombroso is equally in error in regard to the inherent criminal aspects of tattooing, in which artistic taste and high, even holy motives are sometimes quite manifest, though research among the criminal and homeless classes, as sailors, soldiers and world wanderers reveals more tattoo- ing than among the staid home-staying, conventional class obeying the usual social proprieties. The wise criminal would not tattoo himself with such a mark of identification, except before becoming such, while the innocent nature might wish such a mark of identity, as others like to have an article of personal apparel. This subject may receive further editorial notice. We should be careful in the study of morbid criminology not to attach all peculiarities found upon criminals indicative of mental tastes. Evidences of inborn criminality and tattooing is one of these evidences common to the honest Indian in some localities. Criminal morphography is less misleading than crimi- nal psychography and both should be gauged with the ut- most caution of absolute judicial mindedness, lest adjuncts of organic or psychic form of feature be mistaken for essential 204 Editorial. attributes. PERSONAL COMMENDATION OF A WORTHY MEDI- CAL INSANE HOSPITAL SUPERINTENDENT.—It is gratify- ing to see such just personal recognition as the following, publicly spoken, concerning an insane hospital chief medi- cal officer. The country has many such worthy superin- tendents, but the public does not generally know, hearing only villification from discharged, unworthy employees having a grudge to satisfy, or from a half-recovered, de- lusioned patient full of morbid antipathies and suspicious aversions, removed from the asylum too soon for the good of the asylum and patient. "Having had occasion to visit the insane asylum at Pueblo, Colo., last month, and having visited every room in each ward, and knowing that many who are deeply in- terested in its inmates know nothing whatever of the in- stitute or its management, I feel it a duty to them as well as myself to let them and the world know the truth. It will make them happier and more contented to learn how the afflicted ones are cared for. "I have visited in my time several public institutions of that kind in several of the states, and I am frank to admit that for care, attention, gentleness and cleanliness the in- sane asylum at Pueblo, Colo., has no peer on the Ameri- can continent. I conversed privately with a score or more of its inmates, and each and every one spoke in the high- est terms of their treatment. I examined the tables in the several wards, while the inmates were at their meals, and found that food was of the best, plentiful and properly pre- pared. The sleeeping departments 1 found clean, tasty and homelike, and the sanitary conditions perfect. "Dr. A. P. Bussy, who has charge of the asylum, is a man of sterling worth. He is kind and attentive and will on no account permit any of the attendants or employes to speak harsh or loud to any of the inmates. He is a man with a heart as big as himself, and his whole time, atten- tion and care is devoted to his patients. He sees each and every one in person daily and guards their health, comfort Editorial. 205 and happiness as he would one of his own family. "1 submit this, hoping it will reach many a parent or relative who have dear ones there, but who are unable to visit the asylum in person. Yours truly, MRS. J. J. LEESON, Socorro, N. M." The above appeared in the Denver Post. PSYCHOPATHY IN THE SANCTUARY has some illustra- tions in some of the churches of our colored brethren some- times, as at St. Paul lately, at another place, and a recent convert of color, while being baptized, was taken charge of by nearby police for speech and conduct unbecoming a Christian, including a lot of dashed cuss words, but the worst scene of all was that of a recent riotous demonstra- tion at Chicago against their priest, Reverend Father Ed- ward Steafnowicz. The church is called the Catholic Church of the Providence of God. The Providence of God did not seem to be present on this occasion, for about two thousand persons participated in the riotous affair, one woman slapping the reverend father in the face, another throwing a beer bottle after him as he was going to the pulpit after prayer. The priest fled, but the church was demolished, after a number of the Lithuanian congregation had been hurt or killed. An augmented police force dis- persed the quasi lunatics. These many foreign church riots suggest the propriety of a little more rigid inquiry in- to the mental status of foreign immigrants, as well as into their physical health. They should show sanity enough to observe the proprieties of the sanctuary of God before be- ing permitted into this great sanctuary of Freedom, which we call the land of the free and the home of the brave. Just now this land of ours especially requires level-headed people, that know better and do better than to attack pas- tors in our churches. PHILANTHROPY AND APPLIED SCIENCE.—In a series of free public educational conferences on problems pertain- ing to charitable and philanthropic work, beginning with an address under the auspices of the School of Philanthropy, 206 Editoiial. by Professor Charles A. Ellwood of the department of so- ciology of the University of Missouri, very properly called attention to "The importance of having scientific knowledge in dealing with the problems of charity or philanthropy." Out of thirty-five or forty speakers, not a medical scientist is named, although Gospel ministers appear galore in the list, yet all the true practical philanthropy must be founded on the science of the human organism, psychical and physical, and how by such science to meet man's needs at the hands of his philanthropic fellows. The clergy are important and meritorious workers in philanthropic movements, but the ministers of the sanitary science of mind and body, with their peculiar science and knowledge, are no less essential. Many great philan- thropic movements are blindly managed without right medical counsel, as in the endeavors to suppress prostitution on the clerical idea of ignoring its quarantine and permitting it, unregulated and unsuspected, to scatter vice and disease through an innocent and unsuspecting community, when it might be corralled and circumscribed and smothered out under lawful regulation without restraint, inspection and cordon. AN UNJUST JUDGMENT AGAINST A PHYSICIAN.—A POSSIBLY JUSTIFIABLE ERROR IN DIAGNOSIS PUNISHED BY LAW.—A physician, for having advised surgical relief for appendicitis, when in fact only a pyosalpinx was found and relieved, is reported to have had his bill greatly reduced by the court's instruction and jury's decision because of this mistake in diagnosis. A physician only contracts to furnish his best medical judgment and skill and an error of this kind ought not to be punishable, if due diligence was used in making the diagnosis, since the appendix and the ovary, under certain circumstances of disease displacement, are not so far apart as to make such an error impossible, and the pain pressure and febrile symptoms of either might be misleading. We hope the specialists immediately concerned will take this matter up and diffuse right diagnostic information on the subject. Editorial. 207 This decision looks like professional spite work and jealousy carried into court to the wrong of a well-meaning and perhaps meritorious medical brother. LE PROGRES MEDICAL number for November 14th, 1905, is exceptionally interesting. It is par excellence le numero des etudiants and in it will be found a great fund of medical educational information for our many continental readers, practitioners and students interested in the excel- lent French medical schools. PROPRIETARIES AND THE PROPRIETIES.—While many proprietary medicine promoters exceed the proprieties in an amusing and ludicrous degree, in their methods of en- lightening medical men as to what and how they should prescribe and incline the young medical man to fall away from habits of originality and individuality in his therapeu- tics, many other of these preparations and combinations are valuable, elegant in composition and sensibly and prop- erly prescribed to the profession, giving in practical utilitar- ian and palatable form, medical materials of real value, which physicians in country practice could not prepare and druggists in city or country could not promptly dis- pense, and, in some instances, could not properly dispense at all in palatable form. In the use of the aid to our therapeutics, a wise discrimination in the selection of the proprietaries, rather than an indiscriminate and wholesale condemnation is called for in the present day therapeutic side of the practice of medicine. The essential thing to a wise and proper thera- peutics is to know the exact proportion of and dosage of ingredients. Knowing this, the average physician ought to know when and how to use proprietaries with therapeutic propriety and clinical correctness, without the commercially inspired suggestions and instructions as to therapeutic indications so voluminously, enthusiastically and often incautiously given, in some instances, by proprietary promoter's instructions for 208 Editorial. use that suggest the zeal of the auctioneer, in transcending the professional proprieties between pharmacist and physi- cian. Good, meritorious proprietaries properly presented to the medical profession will, however, stay with us as val- uable adjuncts of our therapeutic resourcefulness in dis- ease. The duty of the day is for the profession to dis- criminate wisely between the therapeutic wheat and the chaff. AUTOMOBILE DELUSION.—In New South Wales, a man has been committed to an insane asylum who thinks he is a runaway automobile. He was black and blue from colliding with trees, fences and walls in his delusive sprinting. This is the first of this kind of delusion reported. This form of delusion may yet become common, as the electric influence and phono-delusions, which came in with electric telegraph, telephone or phonograph. Some of the auto speed maniacs that use the streets as though no one else was on them, are hardly entitled to asylum treatment. The jail or penitentiary would be more curative for some of them. LAY EVIDENCE AS TO INSANITY.—The range and scope of lay evidence as basis for a hypothetical case was in issue in the C. U. T. Co., vs. Lawrence. (211 111. Re- ports 373.) The Supreme Court decided that as tending to show the effect of plaintiff's injury upon his men- tal condition, it is competent to show such con- dition before the injury and also continuously from and after the injury, and any witness having any knowledge upon the subject during any part of the time covered by the injury, is competent to testify, the weight of his testimony being for the jury. The issues in per- sonal injury suits differ from the issues in cases in which testamentary capacity is involved. In such cases, the Su- preme Court points out, the inquiry is principally directed to a particular day and often to the very moment of mak- ing the will, when the result may hinge on a lucid inter- Editorial. 209 I. val. The same rule obtains in the Federal courts. (Ill U. S. Reports 536.) K. MARRIAGES BY THE INSANE.—These are usually annulled at the instance of the relatives of the insane hus- band or wife, practically as the result of undue influence. The fact however, that, in popular opinion, only extreme stupidity, idiocy or furious violence constitutes insanity, often leads to marriages with the insane where the luna- tic has the plausibility of the emotional exaltation stage of paretic dementia, or of allied states like the predelusional stage of mania. The hypomaniac appears usually to the casual observer as a very good humored, brilliant man. Very frequently on escape from insane hospitals, one of this class of the insane marries and is steadily defended by the wife and her relatives against recapture. This condi- tion of things practically occurred in the case of Eckstein vs. Eckstein, tried before Judge Leathers in Indianapolis. The wife sued for annullment of marriage on the ground of insanity, stating that the husband had courted her in 1898, when on a furlough from the Central Hospital for the In- sane. She did not suspect he was mentally unbalanced and no one told her. He had described, after the marriage ceremony was performed, his great wealth and his fine po- sition at Peru, Indiana. The pair went there, but disillus- ion was speedy, for he had neither wealth nor position. He began to treat her cruelly, beating and choking her, till she left him after a brief honeymoon. Two weeks after her departure he was recommitted to the insane hospital, where he still is, in a demented condition. The case was probably one of paretic dementia and, the opinion of ex- Judge Stein (Sunset Club Trans., 1894) to the contrary notwithstanding, is of a type which frequently occurs. The Supreme Courts of Maryland and Illinois have both decided that paretic and senile dements may go through a marriage ceremony, but do not necessarily recognize the signifi- cance of the contract, which is therefore void. TWO CASES FOR EUTHANASIA are humorously and 210 Editorial. sarcastically presented by our friend, Edmund Owen, Con- sulting Surgeon to St. Mary's Hospital, London, one an indent osteo-sarcoma starting from the sacroilliac synchon- drosis sent back to Corwall to die, but not dead yet; the other diagnosticated a cancer of the stomach, for which a gastro-enterostomy was duly performed and the customary sad prognosis was given and who from having been a great sufferer changed gradually into a healthy woman, and in the following year won a tennis tournament. The full details may be read in Sir Edmund Owen's correspondence on the subject to the St Louis Weekly Medi- cal Review, of March 3d, ult. EUTHANASIA, in the sense of precipitating painless death, has again come to the fore through a proposition made by a woman M. D. to secure a law in Ohio author- izing it. This sort of euthanasia involves the question of unerr- ing and absolutely certain prognosis, which is not yet in the power of our science until after Nature herself has brought about her own obtunded sensibility of the mori- bund state. Euthanasia in the scientifically guarded sense of anaes- thesia as apparent dissolution approaches, as often practiced by the conservative and experienced clinician, is a different thing from the easing of what appears to be approaching death with over large, anodyne or anaesthetic doses to hasten and make death certain. Analgesia, when we consider the cure retarding power of pain, is not considered nor practiced enough, especially in post-operative surgery, but favorable prognostic surprises are too frequent in the general diseases to justify anaes- thesia to the point of enforced euthanasia in the sense of making dying easy, even in so-called incurable affec- tions, such as cancer, hydrophobia, consumption in last stages, etc. Forlorn hopes are won in medicine as in war, and the hopeless and unresourceful temperament loses bat- les for life in medicine that might otherwise be won as it loses battles among men of arms. Besides, "Thou shalt not Editorial. 211 kill," is the divine command. Keep the patient free from pain as it may be possible while he fights his disease and continue such relief to the end, but do not hasten his death. It is not our right to lay the hand of death on any man. DISEASES IN THE STREET CAR STRAP.—A street car strap hanger sues for damages resulting in blindness, claiming that his eye itched and that he rubbed it with the fingers that held the strap and a destructive inflamma- tion resulted to his eye. This is a plausible plea. If the public is to continue hanging to the street car strap, companies had better make them of antiseptically washable material—metallic hooks of galvanized iron or aluminum would be better, look cleaner and could be kept cleaner. One could get a specific form of blindness causing ophthalmitis readily enough, under cir- cumstances like the above, from a strap that had been held by a gonorrhreal patients, and could get other diseases too, of both eyes and hands. But this is nothing to the foul microbe-laden atmos- phere of a street car swept out without antiseptic precau- tion and with windows down, at the ends of trips, or even while passengers are in the car—a foul outrage of ignorance or indifference. Tuberculous spitters are in every car, not- withstanding the police occasionally arrest a country boy for spitting on the sidewalk. CAPTURING A MURDEROUS MANIAC WOMAN who had taken possession of a railway car under the delusions of suspicion and pursuit by chloroform injections into the car were rejected by medical expert counsellors as too dangerous and the more caustic and dangerous aqua ammonia was suggested and substituted under medical advice, with the result of capture of the insane woman and a burnt skin and destroyed eyesight of one eye. Chloroform or ether are quite as safe for purpose of producing sleep in the hands of a doctor as in the hands of burglars. Having tried the treatment of such delusion- 212 Editorial. ally destructive patients barring themselves in their rooms and attempting violence to self and others with uniform success, we know it to be a fact that chloroform is the best and always a safe resource in medical hands competent to gauge the quantity to the effect desired, and it does not maim the unfortunate patient. THE MENTAL TWIST IN UNION LABOR LEADERS' HEADS was shown during the late terrible San Francisco catastrophe in the heartless tyrannical protest of certain Min- neapolis labor leaders against the sending of "unfair flour," that is flour on the labor strike boycott list, to the starv- ing sufferers of the earthquake destroyed city of the Pacific Coast. Geo. B. Howley howled that it was an affront to the starving homeless union men of San Francisco to send them flour from mills under the tyrannical ban of the trades union of Minneapolis, though it was not the brand but the flour that was between them and starvation. This labor leader tyrant, with the consent of his co-autocrat Killington, the General Secretary of the International Union of Flour and Cereal Mill employees finally graciously consented that union men could do as they pleased as to what brand they would eat in case they were starving. It may be said that this is none of our business, but such tyranny and its oppression of even labor leaders over union men and their starving families is the business of every patriot in every walk of life in this yet free, fair play government. The psychology .of minds that would withhold succor from starving people, union and non-union alike, in such a calamity as that of San Francisco, unless that relief bore the union brand is hardly comprehensible outside of a lunatic asylum. Union labor leaders must cultivate more sane fairness and less insane tyranny towards its own and those without its enthralled ranks, in harmony with the rights of Americans, else it is doomed to failure in aims that should succeed. Cruel inhumanity and unfair tyrannous injustice will win no cause, good or bad, in this land of law-regulated human rights. The tyrannies of freedom are in the way of circum- Editorial. 213 vention and overthrow in this country and union labor should be careful to avoid the tyrannous ideas of its labor leaders and councils lest freedom-loving people, without whose help the cause of organized labor cannot live, find tongue to curse the slave— Whose treason (to freedom) like a deadly blight, Comes o'er the councils of the brave, And blasts them in their hour of might. THE JAPANESE ADMIRAL TOGO, at the conclusion of the memorable Russo-Japanese war issued an address com- mending the achievements and personal heroism and sacri- fices of his men, which has been commended by President Roosevelt in a letter to the secretary of war, the President insisting upon the necessity for keeping the personnel of the army and navy at the highest pitch in time of peace in order to be prepared for war. This sentiment of personal excellency for the soldier is the sentiment of individual efficiency of the citizen. The improvement of both is the basis of our national perpetuity. JUST A SAMPLE of disease developing brain strain and its sometime medical and non-medical management. She sang in the First Christian Church choir, taught a class in the Sunday-school, was studying to be a missionary, was her father's private secretary, had all sorts of hallucina- tions, especially one that her sister was dead in a distant city to whom she went clothed in the habilaments of mourn- ing and that she was in danger from enemies and as usual with surgeons who know nothing of neurology or psychiatry, she was advised to have, and had had, an operation performed, without benefit. "For seven years she has suffered greatly. At times her suffering was so great," says her father, "that she became irrational and would not know her mother nor me. Then she would faint and remain unconscious for hours, or per- haps days. When this would pass away she would be all right. For the last year her trouble grew worse, and we became greatly alarmed over her condition. She feared 214 Editorial. that she could not pass the physical examination necessary before she could enter the missionary service. We con- sulted a physician, and he advised an operation. This operation was performed last month, and we hoped that it would mean a perfect cure for her." With such incessant overstrain of a weakening brain, is the sequel of grave cerebrasthenia, epileptoid and hystero- epilepsia not at all unnatural, especially with the added nerve strain of a nonbeneficial painful operation and the dread of its repetition before the unfortunate. Has the surgical arm of the profession yet nothing more to offer in neurotherapy and psychiatry than a surgical procedure? While surgical procedures are often necessary even in nervous diseases, they are seldom the sole therapeutic resource and seldom exclusively effect recoveries of grave nervous diseases, though sometimes the long removal from adverse home environments pending a wise preparatory treatment preliminary to operation and judicious after-treat- ment during the convalescence from the operation, combine to maice the recovery from a grave neuropsychic disease effective. Some patients sometimes recover in this way from psychic disease, through reception of right psychic impression and the removal from wrongly impressing environing in- fluences. But the same methods in many instances with- out the too frequent operative procedure of oophorectomy would prove effective in a well conducted psychopathic hospital without the use of the knife. Cases like these are cases especially for psychiatrical and neuriatrical man- agement without, or, if necessary with surgical recourse, but never for attempted surgical remedy alone and exclu- sive surgical diagnosis and treatment. Surgery must come to a realization of its normal limits in neurology and psychiatry or suffer the obloquy of Baker Brown and his clitoridectomies and the normal ovariotomy of Battey, of Rome, Georgia, who operated not wisely but all too well on normal ovaries. Editorial. 215 the Hazing neuropath and college circum- spection.—The neuropaths and psychoneuropaths are not yet all in the insane asylums. Some of them are yet out- side, as auto-speed, football and hazing neurotics, whose easily unbalanced mental machinery tends to go wrong under the stimulus of exciting influences which in more normal psychoneurone centers give simply vigorous, steady and healthy regulated mental action. As a safeguard against the hazing neurotic leader, who is nothing if not bizarre and excessive in suggestions of cruelty and danger, we would recommend a personal family history register for certain of our colleges, to find out where and in whom psychoneurotic instability exists as an ances- tral heritage and the proper regulation and restraint of the unstably endowed within the bounds of propriety and life and limb safety. A chair of decorum and neuron stability with a psychia- tric adjunct to the chair and a psychopathic hospital would be a suitable annex to the hazing department of Yale, Harvard, Cornell, Kenyon and other colleges, and for even some female seminaries, which gallantry forbids us to men- tion, which of late years have become famous for hazing excesses and deaths. The old log school house and the small country college enforced the moral proprieties better and produced a better output of brain stability than some of our modern over- grown, newly rich cursed colleges. The training of the brain in stability and strength and erasing and suppressing wrong and morbid hereditary psychic neurone aptitudes, not the enlarging of wrong inherent proclivities is, or should be, the purpose of right education. A normal practical psychophysiological knowledge and its application to the aims and efforts of pedagogy in school, college, academy and university might receive more attention from the teach- ing profession with benefit to students and the future of this nation. THE MCNAUGHTON CASE.—The usual judicial error in regard to this case, appears in the summing up of Mr. Justice Channel in Rex vs. Key. He remarks: The true 216 Editorial. test of insanity had been thus defined by Justice Stephen in R. vs. Davis. "A person (Medicine, Nov. 1904,) may be both insane and responsible for his actions, and the great test laid down in McNaughton's case was whether he did or did not know at the time that the act he was committing was wrong. If he did, even though he were mad, he must be responsible; but if his madness prevented that, then he was to be excused. As I under- stand the law, any disease which so distorts the mind that you cannot think calmly and rationally of all the different reasons to which we refer in considering the Tightness or wrongness of an action, any disease which so distorts the mind that you cannot perform that duty with some moder- ate degree of calmness and reason, may be fairly said to prevent a man from knowing that what he did was wrong." This rule was not laid down in the McNaughton case. McNaughton was acquitted by the jury making a different test. The mob law outcry led the House of Lords to a very unusual illegal procedure. They summoned the judges, who as Sergeant Ballantyne points out (Memoirs), pro- ceeded to make law under the pretense of saying what the law was. Chief Justice Maule protested however, and claimed that the test should be physiologic, and hence a matter of evidence for the jury (Lawson: Criminal De- fenses) and not a question of law. It singularly illustrates the audacious omniscience of English judges, that the state- ment just quoted about the McNaughton case is repeated when there is a chance to pose for a hanging reputation. K. THE CRIME OF FATAL EUTHANASIA.—The ALIENIST AND NEUROLOGIST joins the home and foreign medical journals in condemnation of medical murder of sick people in extremis by the legislative authority as proposed on weakling medical authority in Iowa and Ohio. It would be an extremely egotistical doctor who could always say when disease must inevitably end in death, and the more egotistic and less clinically competent, the greater the confidence in a certain death result of certain Editorial. 217 painful affections by certain doctors. Euthanasia in its true and better sense of relieving P ii 1 n Jiitli approaches or during the entire stage of a extremely painful illness by therapeutic nontoxic anodyne treatment, including pain obtunding applications is not ob- jectionable and is practiced every day in treatment, but euthanasia as meant by these proposed enactments, (the term euthanasia being simply an euphemism for medical murder) can not be too severely and peremptorily con- demned, as it has ever been, by the medical profession. To destroy life by fatal narcotism or anaesthesia is not the province of a scientific and humane profession. Physicians will not be made executioners; if a patient is to be killed because his disease may be thought to be hopeless and is painful, why not call in the police or ex- ecutioner and shoot him by authority of law as we do mortally maimed lower animals to put them out of their misery. But the medical profession will have "none of it." The medical profession, as the Lancet truly says, has always set its face against a measure that would in- evitably pave the way to the grossest abuse, and would degrade them to the position of executioners. This must be the answer of the whole medical profession to a most mischievous proposal which is the outcome of a degeneracy, mental and physical, that is the by-product of a high civi.lization. Every now and again it is put forward, either by literary dilettanti, who discuss it as an academic subtle- ty, or by neurotic intellects whose high-strung tempera- ment cannot bear the thought of pain. Or, of late, espec- ially as a "little learning is a dangerous thing" proposition from some newly-fledged woman doctor or imperfectly trained and immature nurse or masculine physician just out of college. "ON TO" THE GERM THEORY.—A piano house in St. Louis announces to the public that purchasers are not safe in buying a piano in a private home or from an auction house. There may be a mortgage on the instrument, deadly disease germs may lurk in the felts, etc. This 218 Editorial. matter is worthy of serious thought, it goes on to say, and if you are planning to purchase a used piano, see us. You can get a better bargain and a guarantee that you are safe. . . . We thoroughly renovate all used pianos, clean them by the compressed-air system, positively free- ing them of all extraneous matter, also thoroughly over- hauling them in our workshop, etc. Thus are the profes- sions' labors in diffusing the knowledge that lessens the demands upon it, not in vain. The people are awakening to the dangers and the necessity of killing by sunlight and fresh air the bacillus of tuberculosis and the destruction by violence, petroleum and pennyroyal, of the stegomya faciata, and soon our occupation will be gone, though the quack and the remedial fadist may be expected to abide with us forever. THE SURPLUS FUNDS IN THE TREASURY of the A. / M. A. suggest the feasibility of reducing the annual dues / so as to increase membership among the recent graduates, and the great number of good but pecuniarily impoverished who get more gratitude and experience than money out of their practice. With a two dollar subscription rate, more students could take the Journal A. M. A., and with in- creased circulation it would get more ads. and be able to reduce the ad. rate to doctors. This is only suggestion, not criticism. CONGRES INTERNATIONAL POUR L' ASSISTANCE DES ALIENES. A Milan Septembre 26-30, 1906.—An unique and important International Congress for assisting the in- sane and their families, will assemble at Milan as above in- dicated, under the auspices of many distinguished physi- cians and philanthropists of the world. The president of the committee on organization is the distinguished A. Tam- burini, of Reggio-Emilia. The secretary-general is G. C. Ferrari, of Bologna. "The forthcoming congress is an evolution a trouve sa plus parfaite manifestation dans 1* oeuvre de ces personnes genereuses qui du "Congres international pour 1'assistance Editorial. 219 et pour la bienfaisance privees" de 1900 de Paris, ont su tirer le" "Congres special pour 1* assistance familiale des alienes" de 1901 de Paris, et la "Societe d'etudes pour l'assistance familiale" de M. A. Marie de Villejuif, le plus infatigable defenseur de 1' oeuvre qui, 1' annee d' apres, triomphe completcnt a Anvers. Le Congres d' Anvers de 1902, qui s' intitulait pre- cisement "Congres international pour I'assistance des alienes et specialment de leur assistance familiale." This Congress, it will be noted, takes place during the time of the Milan International Exposition. The English, Irish and American committees on propagand are Professors Wood and Smith of London, Norman Conolly of Dublin and Owen Copp of Boston. ST. LOUIS DOCTORS AND THEIR WORK at Boston at the second session of the American Medical Association, May first, eighteen hundred and forty-nine, is well shown in the following: "Dr. J. B. Johnson introduced a resolu- tion providing for the establishment of schools of pharmacy, in the preamble of which he said: 'Numberless and im- portant evils result . . . from the universal traffic in patent and secret remedies.' Dr. Chas. W. Stevens sub- mitted the following resolution: 'Resolved, That the Ameri- can Medical Association recommend medical men in the Association individually, by public lecture and otherwise, ta enlighten the public in regard to the duties and responsi- bilities of the medical profession and their just claims to- the confidence of the public." On this subject and the subject of a list of physicians and a bureau of American biography, the Jour. A. M. A. says: "It is only this year that these ideas are being put into effect," and yet a certain local medical society of a neigh- boring state has resolved that no member shall talk to the public on any medical subject. This is letting the blind lead the blind and letting the public fall into the ditch of charlatanry, toward which it is rapidly running. IN MEMORIAM. Solomon Claiborne Martin, M. D., was born in Claiborne county, Mississippi, in 1837. He took his academic degree at the University of Michigan and his medical degree at Tulane University. He served as surgeon with the rank of major in the Confederate service under Generals West, Adams and Albert Sidney Johnson. He was a worthy and distinguished member of the medical profession, and at the time of his death held the chair of dermatology with dis- tinction and zeal in the medical department of Barnes Uni- versity. He was the founder and editor-in-chief of the Medical Era. He was a man of industry, ability and en- thusiasm in his profession and his personal character was one of spotless honor and integrity. Fidelity to friends and faithfulness filled out his well-spent life of fruitful worth among his fellows. We tender our sympathy to the stricken family, among them his worthy sons, walking well in his noble foot- steps. His age was 69 years. (220) SELECTIONS. CLINICAL NEUROLOGY. LOCOMOTOR ATAXIA AND SYPHILIS: Tabes, accom- panied with florid manifestations of lues, has a better prognosis than tabes where such manifestations are absent. (Practical Medicine, Series X, 1905). It is probable, how- ever, that this form of tabes is merely one of lues and not a true locomotor ataxia. In such ones the luetic manifes- tations would be more florid than when the lues reached the parasyphilitic stage. The relation of the offspring of tabetics to juvenile tabes is discussed by Milian. The fe- cundity of tabetics is diminished. This diminution is due to syphilis rather than tabes. The small proportion of ju- venile tabetics—the offspring of tabetic parents, as compared with the offspring of syphilitic parents, indicates that he- reditary syphilis is a direct cause of juvenile tabes. CEREBELLAR TUMOR.—Burton Chance reports a case in a man of twenty-six. The symptoms wtre those of in- ter-cranial tumor of the hind-brain, rather than of the more forward portions, and appear to be those produced by irrita- tion rather than by the destruction of the basilar centers. Although an intense papillitis which was present, was con- clusive of the presence of a tumor, the indefiniteness of the other symptoms hindered the assumption that the tumor occupied the cerebellar region. The chief focal symptoms were those of deviation of the optic axes, with disturbances of direct and binocular vision, and facial palsy; yet, after energetic treatment the paresis of the left external rectus muscle, as well as the diplopia and the facial palsy, greatly disappeared, and when the man was placed under strict hospital regimen the general symptoms all but ceased, for there were no headaches, emesis, or muscular spasms, un- (221) 222 Selections. til the last course. The gait, station, and the knee-jerks were not interfered with until very late in the progress of the malady. There was hyperexcitation of the sexual func- tion almost until the end. The general bodily nutrition was maintained up to the last weeks of the man's life. The post mortem examination of the brain was made by Dr. Spiller.—Amer. Med. HABIT SPASM IN CHILDREN.—According to G. F. Still, (Lancet, Dec. 16, 1905) this name has been given to certain oft-repeated seemingly purposeless movements, which most commonly affect the face or head, and which although they may change in character from time to time are for varying periods persistent in kind, whether the movement be a simple twitch of one muscle or more complicated ac- tion of several muscles. The term "tic" lacks the descrip- tive merit of "habit spasm." Simple and easy as the habit spasm seems it is difficult to cure. The most frequent form of spasm is rapid blinking of the eyes, or a more forcible closure of the lids. This was present in 47 out of 100 con- secutive cases. Less common is a movement of the eye itself, which was present in five of the cases. The next most frequent variety of the movements is a twitching of the nose, which may turn to one side, or a sudden draw- ing up of one angle of the mouth, or the twitching may affect the forehead, causing a sudden frown or an elevation of the eyebrows. These facial contortions were present in 48 per cent of the cases. A common spasm is a sudden antero- posterior jerk of the head or a lateral rotation, as in nega- tion. The head may be rotated toward one shoulder only, or it may be drawn upward. Some such head jerk was present in 30 per cent. The limbs are less often affected but the upper limb more frequently than the lower, the former being involved in 22 per cent and the latter in 9. The commonest movement of the upper extremities is a sudden elevation of one or both shoulders. All sorts of curious movements are made, such as snapping the fingers, abduction of the arms, and beating them against the thighs or clawing movements have been noted. The movements of Selections. Ill the lower extremity are equally curious. One boy would at intervals paw the ground like a horse. The trouble had begun with blinking of the eyes two months earlier. When this ceased he acquired a habit of frequent grunting and at times sudden head jerks. A common habit of habit spasm is the frequent repetition of some particular sound, which may be like that made in clearing the throat. Various irregularities are noted in habit spasm, the term spasm being scarcely applicable to some of the quasi-purposive movements, which sometimes alternate with a simple spasm. Frequently one spasm will be replaced by another. Habit spasms tend to diminish when the child is under observation. Habit spasm is but slightly more com- mon in girls than in boys. Children with this disorder are nervously unstable. They are often restless, suffer from sleeplessness and headache. A large proportion are nervous and excitable. In some cases there is irritability and quick temper. Disturbances of sleep were very common. In 20 per cent there were definite disorders of sleep, such as sleep-walking, night terrors, or troublesome insomnia. Headaches were common. Enuresis was noted in 10 per cent of the cases. In 7 per cent of the cases convulsions had oc- curred in infancy, or early childhood. Given the nervous tendency, modern school life or other strain may lead to the development of habit spasm. It is possible that habit spasm may have its origin in a frequently repeated volun - tary movement. Habit spasm is sometimes mistaken for chorea. The dis- tinction is easily made in most cases, though there are a few in which the movements approximate those of a limited and slight chorea. From the standpoint of treatment it is important to differentiate the habit spasm from chorea. The latter requires rest, while the habit spasm is more likely to be benefitted by an open-air life on the seashore or on the farm; a change to the seaside or to the country being by far the most efficient thing in the management of these chil- dren. The strain of school life should be intermitted. In some instances where the family surroundings are unfavorable 224 Selections. school life may be of positive benefit. The parents should be instructed that scolding and punishment is generally useless and may be harmful. All forms of excitement and fatigue should be avoided, late hours having an especially bad influence in such cases. Local irritation is to be removed, the eyes and teeth being the most frequent sources. The most useful drugs are arsenic and bromides. These may be continued for three or four weeks. Ergot has seemed to be of value in some cases, given with 4 or 5 minims tincture nux vomica. In intractable cases, simple change of environment, especially living among strangers for a time, will sometimes do more than any drug treatment. BLOOD OF EPILEPTICS. According to Onuf and Lo- grasso, (Amer. Jour. Med. Sciences, Feb. 1906) a leucocy- tosis may be present, directly before a seizure, but grand- mal seizure need not be preceded or ushered in by a leu- cocytosis. There is no absolute parallelism between seizure and leucocytosis. Where the intervals between the seiz- ures are long, the fluctuations of the leucocyte count are apt to be slight and concentrate around the period of seiz- ures. THERAPY. INTERMENSTRUAL PAIN. According to Rosner, (La Gynecologic, June 1905), systematic tamponade of the va- gina begun two or three days before the pains usually ap- pear, is of value. Ovarian extract likewise, gives good result. EUMYDRIN IN ALIMENTARY TRACT NEUROSES. Eumy- drin or Atropine methylnitrate, a white crystaline powder, easy soluble in water or alcohol, is of value, according to Haas, in functional and secretory neurosis of the alimen- tary tract and in all conditions of the stomach and intestine where belladonna or atropine is indicated. It is given in one sixtieth to one fifteenth grain doses, thrice daily in pill, powder, solution or suppository. The untoward effects Selections. 225 (Therapie Der Gegenwart, No. 3, 1905), are identical with those of belladonna. NEUROPATHOLOGY. MORE AUTOPSIES IN EPILEPSY.—B. Onuf (Journal of the American Medical Association) reports autopsies on six- teen epileptics at the New York State Institution for Epilep- tics; in twelve cases there showed changes of the mitral valve (80 per cent.), less of the aorta, and still less of the tricuspid valves. These he considered due to strain of the major epileptic attacks. Capillary changes, tortuosity and aneurismal dilatations were observed in several cases. In eight of the cases acute pneumonia was a contributory cause of death. In ten cases there was marked thickening of the frontoparietal pia. There was vascular lesions, cir- cumscribed atrophy of one frontal lobe, subdural hemorrhage (one case), internal hydrocephalus (one case), cerebellar cyst (one case) and shrinkage of convolutions of vermis and adjoining cortex (three cases). The most striking changes, .however, were in the thalamic region. In the nature of atrophy, sometimes the pulvinar, sometimes the other portions being most markedly affected. There was also an apparent discrepancy in the proportions of the genic- ulate bodies. Nothing new yet in these post mortems. NEURODIAGNOSIS. TOOTH AND NAIL CORRUGATIONS.—Excepting Hutch- inson's notches, the corrugations of teeth and nails are not much mentioned in medical literature, and G. Lenox Curtis, New York [Journal A. M. A., August 5), remarks that this neglect is a mistake and that they have a decided pathologic significance. From the study of many cases he is satisfied that the transverse lines on nails and teeth are caused by auto-intoxication resulting in rheumatism, and that the severer the attack the more prominent are they. Children whose mothers suffer from rheumatism during 226 Selections. pregnancy and those that have rheumatism themselves during the period in which the enamel of the permanent teeth is developing show these corrugations. The longi- tudinal indentations on teeth and nails, Curtis thinks due to autointoxication from intestinal indigestion, and that white spots on the nails also indicate autointoxications. NEUROSURGERY. SURGICAL OPERATIONS UPON THE INSANE, accord- ing to Broun, are not (Amer. Jour. Med. Science, Feb. 1906) attended by the difficulties usually thought. During the recovery period, it is rarely necessary to employ restraint and then only through the presence of a nurse. The in- sane are curious, at times removing drainage tubes and gauze if they can get at them. For this reason, Broun avoids drainage where possible. CLINICAL PSYCHIATRY. VAGINA FOREIGN BODIES IN THE INSANE.—Dr. W. E. Jinkins, of Jackson, Miss., reports the following case in a patient in the State Insane Hospital. She was a forty- year old woman with a temperature of about 102° and a weight of about 115. She had had persecutory delusional insanity for 16 years. Digital examination of the vaginal revealed foreign body obstruction which required examina- tion under ether. The following articles were then found. (Louisville Journal of Med. and Surgery): Two wire staples; 1 shoe string with tips; 2 4d nails; 3 3d nails; 14 brass buttons; 1 brass screw; 3 shoe buttons; 17 pearl and bone buttons; 1 metal syringe tip; 16 brass washers; 28 rice buttons; 1 safety pin; 111 brass stick pins; 1 dime; 12 tin tobacco tags; 1 piece of broken jewelry; 1 pencil, 1% inches; 1 iron rivet; 1 piece cast iron, weight 60 grs; 5 thimbles; 2 corks; 1 hard rubber syringe coupling; 1 tack; 1 small piece tin. This trash was deftly incorporated with about two ounces of thread raveled from an old stocking Selections. 227 and smoothly wrapped with a piece of unbleached domestic muslin, 3 x 14 inches into an originally cylindrical mass. The force used in passing it into the vagina caused it to assume a globular shape. The body was larger than a large orange. PARETIC DEMENTIA AND SYPHILIS have been co-re- lated as to onset in 112 cases by A. Fournier: The short- est interval (Practical Medicine Series, X, 1905) between the initial lesion and the onset of paretic dementia was three years. In four-fifths of the cases the psychosis de- veloped between the sixth and the fifteenth year. In the majority it made its onset at the tenth. In thirty-seven cases reported by J. G. Kiernan (ALIENIST AND NEUROL- OGIST, 1880), eight had the initial lesion five years before the onset of paretic dementia, eleven had it ten years and eighteen had it twenty years. In these cases the onset of the paretic dementia and the contraction of the initial lesion was exactly settled. METHODS OF CARING FOR INSANE.—There is in the New York State building an exhibit which cannot fail to be of interest to the many physicians at present in town. The exhibit shows the ancient and modern methods of caring for the unfortunate insane in the State of New York, and is a forcible object lesson. There are two rooms side by side, one dingy, unattractive and filled with the instruments of torture, which in olden days were used in caring for those afflicted with insanity. A massive crib with a grated top is exhibited, and the teeth marks of the frenzied patient are plainly visible on many of the slats. Nearby stands a restraining chair in which the patient was bound and placed upon a circular platform and spun round like a top. There are also the shackles and the old-style straight-jacket and the grating which formerly covered the window. One of the old doors from the Utica insane asylum is shown with a little peep-hole through which the keeper could observe the actions of the patient. The other room which adjoins it forcibly tells the story 228 Selections. of the wonderful progress made in the treatment of these poor unfortunates. It is an airy room, attractive paper upon the walls, in fact a model of one of the most modern hos- pital rooms. There is no sign of restraint save that of a- modern canvas straightjacket, which is stowed away in an unconspicuous place beneath a washstand. In wall cabinets surrounding the exhibit are many pictures of New York's model institutions of this kind, and also statistics bearing upon the care of the insane and per capita cost. There is also a large exhibit of photographs, etc., of New York's charitable institutions, than which there are no finer in the world. This is supplemented by an exhibit of the work of the various charitable organizations and societies within the border of the State.—Oregonian. Medical Sentinel, for AugustT referring to exhibit at Portland Exposition, NEUROTHERAPY. TREATMENT OF TETANY: The first indication in tet- any, according to C. P. Howard, is to correct the predis- posing conditions. In the gastric variety, frequent lavage should be practiced with large quantities of warm fluid. Greenfield advises a solution of two drachms of sodium phosphate to a pint of water. Purges and emetics are of value. Active diaphoresis and diuresis should never be omitted. In tetany with gastroctasis, surgery is indicated. Gastrojejunostomy or pyloroplasty relieve stomach stag- nation and prevent further absorption of toxic sub- stances. In the tetany of pregnancy, and where there is thyroid deficiency, thyroid extract is indicated. For the spasms themselves (Amer. Jour. Med. Sciences, Feb. 1906) absolute rest in bed, cold to the spine, tepid baths, hot packs, opium, bromides, chloral, etc. have had little or no result. Primary anesthesia by chloroform lessens the se- verity of the spasm. Kiernan advises conium pushed to its physiological effects as of benefit. THE VALUE OF NITROGLYCERIN—The Therapeutic Gazette, for June 15, 1905, says, regarding nitroglycerin: Selections. 229 It is not many years since we called attention in these columns to the mistaken idea, which seems to be quite general, that nitroglycerin is to be employed in the course of exhausting diseases and in the event of circulatory fail- ure as a stimulant to the heart and blood vessels. We pointed out at that time that there is nothing either in the clinical history or in the experimental records concerning this drug which would justify its use for this purpose, and we endeavor to emphasize the fact that the cases in. which it really does good are those in which the reduction of arterial tension produced by its influence results in reliev- ing the heart of an extra burden which it is finding diffi- cult to carry. Two papers have recently appeared which more or less directly bear upon the use of nitroglycerin for its circulatory effect. One of these is by Dr. Clifford Allbutt, Regius Professor of Physics in Cambridge University, and the other is by Dr. H. P. Loomis, of New York. Dr. Allbutt, in dis- cussing the prevention of apoplectic seizures, urges reliance upon proper rules of diet and modes of life rather than the employment of vascular sedatives, although he recognizes that under certain circumstances the additional use of drugs may be most advantageous. Dr. Loomis, on the other hand, contributes an article which is somewhat iconoclastic in its tendencies. He points out that in the dose of 1/100 of a grain three times a day, nitroglycerin in the majority of instances exercises very little real effect in reducing arterial tension. He also points out that these doses are not only too small to be advantageous, but that the action of the remedy is so fleeting that the effects produced by each individual dose last but a very short time. There can be no doubt that to some extent he is correct in these views, but on the other hand it is certain that many pa- tients are benefited by these small doses given but three times a day, and that any increase in the size of the dose, or in the frequency of administration, produces headache or other evidence of the full physiological action of the drug. 230 Selections. Practical experience has convinced the writer of this editorial note that nitroglycerin is certainly one of the most valuable remedies which we possess, and therefore we are somewhat disappointed that Dr. Loomis should so heartily condemn it. He states in the course of his paper that he has come to rely upon chloral as a very much more efficient and satisfactory vascular sedative than nitroglycerin. No one who has employed chloral largely can have failed to have become impressed with the fact that it is a powerful and constant cardiovascular sedative, but it seems to us that its physiological action differs so materially in some respects from that of nitroglycerin that it cannot be con- sidered, at least in many cases, as a satisfactory substitute. While it is true that it is an active vascular sedative in the sense that it reduces arterial tension, it is also a fact that such doses produce a simultaneous depression of the heart, and in the majority of cases in which nitroglycerin is in- dicated the condition is one of high arterial tension associated with more or less cardiac feebleness or fatigue. In other words, most persons who need nitroglycerin suffer not only from vascular tension, but from myocardial change, and re- quire something which would relieve the heart of the resis- tance which is offered to its action, and avoid any drug which will simultaneously depress this viscus. It is for this reason that physicians almost universally rely upon a com- bination of nitroglycerin and digitalis in treating many per- sons of advanced years when these patients present tense vessels and a tired heart. As we have just said, these conditions certainly contra-indicate the use of chloral, which is well known to possess a distinct depressant influence upon the heart muscle. In those comparatively rare in- stances in which, in association with arterial spasm, there exists excessive cardiac hypertrophy we can readily under- stand that the action of chloral may be advantageous. But we are inclined to believe that such persons will be bene- fitted more by aconite than by chloral, since its effects can be more readily controlled and immediately overcome by the proper use of stimulants, or by the withdrawal of the Selections. 231 drug.—N. Y. Med. Jour., Extracted by Budd Van Sweringen, for Ft. Wayne Jour. - Mag. THE THERAPEUTIC VALUE OF STATIC ELECTRIC- ITY.—Dr. May C. Rice (Medical Record, Dec. 16, 1905) says that static electricity is so valuable an adjunct to other therapeutic measures that it should be better understood by the general practitioner. The positive breeze is useful for relieving congestion, if the positive pole is used; the results are less good if the negative pole is employed. A common mistake in electrotherapeutics is not to allow sufficient time for the treatment. Less than twenty minutes is not enough; usually half an hour is better. Headaches, epilepsy, neurasthenia, hysteria, are benefited by the breeze, which is a sedative; the static spark is a stimulant and pro- duces counterirritation, being useful in breaking up adhe- sions, aborting acute rheumatism, rupturing ganglia, etc. Convalescence after operations or prolonged illnesses, tuber- culosis, neuritis, tic douloureux, and constipation are condi- tions for which the author recommends the use of static electricity.—Excerpt of Med. Rev. SENSIBLE OPHTHALMOLOGIC ADVICE.—GOOD FOR NEUROLOGISTS AS WELL.—General therapeutics in eye diseases is discussed by A. M. Ramsey (Jour. A. M.A.), who points out the danger of a narrow specialism and the neces- sity of paying attention to the broad principles underlying all rational therapeutics, with special regard to the eye. More than its proper value should not be assigned to local treatment. It is necessary to study the general principles of pathology before real progress can be made in ocular therapeutics. Local conditions can often be explained by a study of the general systemic condition. OSMIC ACID, ALCOHOL AND FORMALIN TREAT- MENT OF TRIGEMINAL NEURALGIA.—Dr. Anschutz (Munch. Med. Wochenschrift) suggests one ccm. of a one per cent, solution of osmic acid into the canal of the nerve. In nine cases the attacks disappeared from a few months to two 232 Selections. years. Other substances, e. g., absolute alcohol and forma- lin also were used with similar results. THE AMOUNT OF ACETANILID IN BROMO-SELTZER. —The Journal A. M. A. has had analyses made of Bromo- Seltzer as sold in original bottles to the trade. These analyses show that 100 parts of the effervescing salts con- tain: Potassium 10.53 parts Acetanilid _ _ 4.58 parts Caffein 1.20 parts Assuming an average dose of the article—a teaspoonful —to weigh 76 grains (5.0 gm.) each dose would contain: Potassium bromid 7 grains (0.5 gm.) Its editor also thus comments: "Since a half ounce of this preparation is often taken at a dose, and since many, women especially, are taking it daily, it is anything but 'harmless.'" Rather a dangerous remedy for counter dispensing on the judgment of a soda fountain clerk or a patient. RESPIRATORY MOVEMENTS OF THE BRONCHIAL TUBES.—Dr. E. Fletcher Ingals, in the Journal A. M. A., Oct. 28, 1905, contributes a very interesting article on the above subject in which he sets forth facts not widely known, or, at most, not fully recognized by the medical profession. His attention was called to the subject by do- ing a bronchoscopy on a child two years of age during which he observed the rhythmical dilation and contraction of the main bronchi and their branches during inspiration and expiration. "This movement was so great that in inspira- tion the diameter of the tube was more than twice as great as in expiration." He had failed to observe the same move- ment in the bronchi of adults, but found it well marked in a boy thirteen years of age. Acetanilid Caffein . .3 grains (0.2 gm.j .8 grains (0.05 gm.) NEUROPHYSIOLOGY. Selections. 233 Experiments on two dogs confirmed the clinical observa- tion, and in one of the dogs the ratio of the diameters was as great as one to five between expiration and inspiration. Direct stimulation of the peripheral end of the cut vagus produced marked contraction of the bronchial tubes. He concludes this most interesting contribution with some con- clusions previously published by Dixon and Brodie. 1. The inhalation of ether or chloroform for anesthetic purposes abolishes the effect of the vagus on the brochioles. This is due to the paralysis of the nerve endings by direct absorption through the mucous membranes. 2. Reflex bronchiolar constriction is best obtained by exciting the nasal mucous membrane. Little or no result has been obtained by stimulating the sciatic, central end of the vagus, superior laryngeal or cornea. 3. Gradual constriction of bronchioles followed by dila- tation is usually seen post mortem. 4. Muscarin, pilocarpin and physostigmin excite the vagal endings and induce typical bronchiolar constriction, the effect of which is abolished by atropin. 5. Barium, veratrin, bromin and the salts of many of the heavy metals (e. g., gold) produce constriction, which is not influenced by atropin. These facts are suggestive in the therapeutics of many cases in which expectoration is difficult. 6. Inhalation of CO leads to constriction of the bron- chioles which is not altogether central in origin. 7. Chloroform, ether, urethrane, lobelia and atropin induce dilatation of the bronchioles when constriction is present. The dilatation produced by lobelia is very trans- ient, while that of atropin is permanent. These facts should aid us materially in relieving spas- modic asthma. REVIEWS, BOOK NOTICES, REPRINTS, ETC. A PRIMER OF PSYCHOLOGY AND MENTAL DISEASE.— For use in training schools for attendants and nurses and in medical classes, and as a ready refer- ence for the practitioner. By C. B. Burr, M. D., medical director of Oak Grove Hospital, Flint, Mich., for mental and nervous diseases; formerly medical super- intendent of the Eastern Michigan Asylum; member of the American Medico-Psychological Association; of the Ameri- can Medical Association; Foreign associate member Societie Medico-Psychologic of Paris, etc. Third edition. Thor- oughly revised, with illustrations. Pages viii-183, 12mo. Bound in extra vellum cloth, $1.25 net. F. A. Davis Com- pany, publishers, 1914-16 Cherry Street, Philadelphia. We have nothing further to add to our commendation of the first edition, or of the ability of the author for the good work he has undertaken and done so well, except to mention that in the present edition the section of psychol- ogy has been revised up to the present date and the forms of disease are in accord with the newer classification of the insanities, and the medical treatment is discussed in the hope of increasing the usefulness of the book to the medi- cal student. PHYSIOLOGY OF THE NERVOUS SYSTEM.—By J. P. Morat, of the University of Lyons. Authorized Eng- lish edition, translated and edited by H. W. Syers, M. A., M. D., (Cantab.) Physician to the Great Northern Central Hospital. 263 illustrations (66 in colors.) W. T. Keener & Co., Chicago, 1906. Price, £7.50, net. In completing the English version of Professor Morat's well-known work on the physiology of the nervous system, the translator expresses the hope that he has succeeded in in- (234) Reviews, Book Notices, Reprints, Etc. 235 terpreting the views of the author with fidelity and accu- racy. It has been his aim to adhere as closely as possible to the text throughout the work making use of para- phrase only when this was essential to clearness of expres- sion. This volume, as the translator states in his preface, embodies the Jatest advances in our knowledge of the ner- vous system and portrays the most recent views and ideas on this very intricate branch of physiology. The trans- lator has given to the profession a timely subject, ably treated. The two hundred and sixty-three illustrations, sixty- six of them in colors, many of them entirely original, great- ly help in the comprehension of the text and facilitate its reading. A TEXT BOOK OF SOCIOLOGY.—By James Quale Dealey, Ph. D., Professor of social and political science in Brown university, and. Lester Frank Ward, LL. D., of the Smithsonian Institute, at Washington. A book of much interest to the alienist and neurologist and savant in physiology, as well as to the students of sociology. New York. The Macmillan Company, 1905. DISEASES OF THE NERVOUS SYSTEM RESULTING FROM ACCIDENT AND INJURY.—By Pearce Bailey, A. M., (A. D. Clinical lecturer in neurology, Columbia Uni- versity, New York City; consulting neurologist to the Roosevelt, St. Luke's and Manhattan State Hospitals, etc. This book is appropriately dedicated in grateful remembrance of many kindnesses to Dr. M. Allen Starr, himself a valuable contributor, like the au- thor, to the literature of neurology. Published by D. Appleton & Company. 1906. Whatever Pearce Bailey writes is worthy to be read by advanced neuro and chirurgic clinicians. Our readers know him as the well approved author of "Accidents and Injuries in their relations to the nervous system." The author's introduction, .unlike some other introduct- 236 Reviews, Book Notices, Reprints, Etc. ions to medical books, is entirely germane to his subject and, though extending to the fifty-ninth page, entertains and instructs on every leaf, as reference to the use he makes of the stigmata of degeneration and of the following extract confirm: "In this book the term traumatic is used as indicating quickly acting physical violence or psychic shock which arises outside the body. "The effects of trauma on the nervous system are mani- fold, and in many cases baffle satisfactory analysis. The immediate result of physical injuries can usually be inter- preted at their true value. But the ultimate effects, as well as those of psychic traumata generally, which act through the emotions, are much more difficult of valu- ation. The psychoses, certain neuroses, and hysteria, when they arise from fright and similar causes, open endless questions as to predisposition, to previous attacks, and to auxiliary causes. Physical and psychic injuries, acting either alone or singly, exert potent influences on the organism generally, notably on the circulation and on nu- trition. Causes which disturb metabolism, and which bring about defective or toxic cellular action may some day ex- plain the traumatic genesis of such elective diseases as paralysis agitans and general paresis. Again, injuries may so far change the mode of life of the injured person that he becomes a prey to alcoholism, to nicotinism, to morphin- ism, to introspection, and other disease-inducing influences which are the handmaids of idleness." "Traumata, especially in the aged, make pre-existing dis- ease worse. What can be lightly thrown off by the young is a burden to the aged. Certain diseases, such as ne- phritis, which are the ordinary results of advancing years, occasionally seem to appear first in sequence to injuries, though there is little reason to doubt that they pre-existed, though latent. "The researches of Ehrnzooth have demonstrated that local injuries to the nervous system create a locus minoris resistentice which facilitates the action of toxic principles. Reviews, Book Notices, Reprints, Etc. 237 In his experiments two series of animals were injected with cultures of various pathogenic bacteria. The animals of one series had previously been subjected to slight injuries to the head. The injured animals showed a much lessened degree of resistance, both local and general, to the bacteria, than the uninjured ones. It is possible that certain infectious diseases, such as tuberculosis and cerebro-spinal meningitis, which sometimes appear to be connected with a preceding trauma, without external wound, are explainable on such an hypothesis; it is possible, also, that new growths, appearing after injuries, such as tumors of the nervous system, or multiple sclerosis, may find such ^etiological explanation." PERJURY FOR PAY.—An expose of the-methods and criminal cunning of the modern malingerer. By Willis P. King, M. D., Ex-Assistant Chief Surgeon of the Missouri Pacific Railway System. Author of "Stories of a Country Doctor." The Burton Company, Pub- lishers, Kansas City, Missouri. 1906. Price, $2.CO. This book abounds in sinister sarcasm and betrays a lack of charity and understanding of the subject of psychic traumatism and the sequent brain and nerve center damage from unexpected injury to the cerebro-spinal nervous sys- tems of the weak and miserable victims of grave concus- sional impression. The author's style and knowledge of his subject are defective and in marked contrast with such broad-gauged, well-endowed and well-informed contribu- tions to surgical neurology as Pearce Bailey in "Accidents and injuries of the nerves, and diseases of the nervous system resulting from accident and injury." The apparent aim of this book to place the larger number of railway injury damage claimants on the sus-- pected list of maligners may be in paraphrase of the auth- or's own words on page 149, viz: "there are mean claim- ants of damages for railway injury, of course, so there are mean men in all of the relations and walks of life, but,! believe they are the exception and not the rule." The author makes an exception in which he says "he has been 238 Reviews, Book Notices, Reprints, Etc. compelled to give up his ideas as to men and women, and that is in regard to their false swearing in order to cheat corporations." This has been a most painful experience to him, etc., he is disappointed that virtuous woman should perjure herself for money. There are some matters in the book which would be of scientific value if they had been presented with more thoroughness and less venom. The subject of malingering is always of interest in connection with railway accident and injury. The author pays a well-deserved compliment to his official superior, Dr. W. B. Outten, and at the same time a modest side compliment to himself; in fact the author is quite prolific, as many pages show, in showering bouquets upon 'himself. Pity it is that no word of charity appears in this record of the author's twenty-five years ex- perience for the undoubted nervous and mental wrecks from railway casualties—the neurone stunned and nervous evolution stunted, neurasthenics and psychasthenics, the ob- scessed and brain paralyzed, the traumatic neuritics that make no sign in broken skull or dislocated spinal cord, yet who are nevertheless greatly harmed, and neuropathically maimed and disabled for long periods, sometimes for life, though, perhaps beyond the author's willing or conscious skill of detection. A more appropriate title for this book would have been The maligner of the anti-railroad witness in traumatisms for pay. Acute Anterior Poliomyelitis. With Special Reference to the Stage of Invasion. Sanger Brown, M. D., Chicago. Aetiology, Diagnosis and Treatment of Perinephritic Abscess; with Comments on Cases. By Ramon Guiteras, M. D., New York. The Time of Some Mental Processes in the Retarda- tion and Excitement of Insanity. By Shepherd Ivory Franz. Reviews, Book Notices, Reprints, Etc. 239 Laboratory of the Board of Health, Isthmian Canal Commission. Apparatus and Methods of Testing Disin- fectants. By Arthur I. Kendall, Ph. D., Acting Chief of the Laboratory. The Effects of Exercise Upon the Retardation in Con- ditions of Depression. By Shepherd Ivory Franz, Ph. D., and G. V. Hamilton, M. D. On Sulphate and Sulphur Determinations. By Otto Folin. Aortitis with Illustrative Cases. By Thomas E. Sat- terthwaite, M. D., New York. Thirty-fifth Report of the Inspectors of Prisons and Asylums of the Province of Quebec for the Year 1904. Eighth Annual Report of the Board of Trustees and Medical Superintendent of the Eastern Indiana Hospital for the Insane at Easthaven, near Richmond, for the Period Ending October 31, 1904. Quarterly Bulletin, Medical Department of Washing- ton University. March, 1906. Recentes Publications Medicales. Paris. Masson et Cie, Editeurs. Libraires de L' Academie de Medecine. 120, Boulevard Saint Germain. A good array of authors and monographs. to Physicians A New BooK, Diet after Weaning; We have issued this book in response to a constantly in- creasing demand for suggestions on the feeding and care of the child between the ages of one and two years. We believe you will find it a useful book to put in the hands of the young mother. The book is handsomely printed, fully illustrated and is bound in cloth. We shall be glad to furnish you copies for your patients entirely free. For your convenience we print below a coupon. MELLIN'S FOOD COMPANY, BOSTON, MASS. Detach on this line - Mellin's Food Co., Boston, Mass. Please send me a copy of your illustrated book Diet After Weaning Yours very truly, PUBLISHER'S DEPARTMENT. JUSTICE TO PHYSICIANS.—Since M. Mariani first adapted Coca to the exigencies of daily life, when nearly half a century ago he introduced Vin Mariani to the medi- cal profession, it has been his pride to maintain its high standard as it was then presented and accepted by physi- cians everywhere. M. Mariani has been pained to learn that of all lands wherein Vin Mariani is welcomed, this misrepre- sentation—this attempt to induce prejudice and to intimi- date physicians and users of Vin Mariani—comes only from the United States. He therefore, as a means of tracing this malignity to its source, authorizes the following: Messrs. Mariani & Company offer a reward of one thou- sand dollars for information leading to the arrest and con- viction of any person circulating malicious falsehoods, or libelous and defamatory reports intended to discredit the old established reputation of this house or the integrity of Vin Mariani.— The Coca Leaf, March, 1905. PROPER MEDICATION AND CHEERFUL COM- PANY IN LA GRIPPE.—Lately the number of cases in which the pulmonary and bronchial organs have been very slightly or not at all involved, has been greater than we have noted in former invasions. On the contrary, grippal neuralgia, rheumatism and hepatitis have been of far greater frequency, while the nervous system has also been most seriously depressed. With each succeeding visitation of this trouble we have found it more and more necessary to watch out for this disease in disguise, and to treat these abnormal manifesta- tions; consequently we have relied upon mild nerve seda- tives, anodynes and tonics rather than upon any specific (240) WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR. \V\I. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AT THE WM. BARR ao?ris COS NEW BUILDING, SIXTH, OLIVE AND LOCUST, ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. DKAUTIFULLY situated on Long Island Sound one hour from New York. The Grounds consisting of over 100 acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. DR. D. W. McFARLAND, GREEN'S FARMS. CONN. Telephone 67-5. Wcstport. Conn. THE NATIONAL MEDICAL EXCHANGE—Phrtlclans'. Dentists' 1 jfld Druggists' Locations and Property bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents fur Monthly Bulletin containing terms, locations, and list of books. All Inquiries promptly answered. Address, H. A. MUMAW. M. D. Elkhart, lnd. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. B&-SEND FOR OUR BARGAIN USrw Address with stamp, Dr. H. A. MUMAW, Elkhart, lnd. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, lnd. Publisher's Department. 241 line of treatment. Most cases will improve by being made to rest in bed and encouraging skin and kidney action, with possibly minute doses of blue pill or calomel. We have found much benefit from the use of antikamnia and salol tablets, two every three hours in the stage of pyrexia and muscular painfulness, and later on, when there was fever and bronchial cough and expectoration, from an antikamnia and codeine tablet every three hours. Throughout the at- tack and after its intensity is over, the patient will require nerve and vascular tonics and reconstructives for some time. In addition to these therapeutic agents, the mental condi- tion plays an important part, and the practitioner must not lose sight of its value.—Exchange. A TONIC DURING CONVALESCENCE FROM ACUTE LUNG AND BRONCHIAL DISEASES.—A large number of cases of pneumonia, bronchitis and other acute diseases of the air passages prevalent during the winter and early spring that will confront physicians, put them on the qui vive for agents of a remedial nature. Opinions as to the proper management of a pneumonia differ widely, one man adhering to a certain mode of procedure and another employ- ing another method of treatment. Owing to the very nature of the disease, there could scarcely be any uniformity of treat- ment. The point at issue is to keep the inflammation under subjection as well as possible, guiding the patient with the same cool and steady hand a mariner uses in steering his craft through a treacherous channel. It is at this time when the need for a tonic constructive is clearly shown, such as Hagee's cod liver oil. This is one of the best known of the cod liver oil preparations, and its palatability adds very much to its efficacy as a remedy. Hagee's cordial will prove acceptable to stomachs that are intolerant of ordinary cod liver oil. Its therapeutic value is much enhanced by the addition of the hypophosphites of calcium and sodium.—The Medical Mirror. The Perfect Food Digestor FORBES DIASTASE will digest a far greater quantity of starch food and thus through the formation of dextrines, both albuminoids and fats than any product extant; acting in acid, alkaline or neutral media. Giving perfect Digestion, Assimilation, Metabolism and Nutrition. DOSE: ONE TEASPOONFUL A Palatable Concentrated Solution of Diastase from Malt without sugar. A large bottle (or several if requested) will be delivered free for clinical trial. THE FORBES DIASTASE CO. Marietta, Ohio. Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Hellanthus annuus [sunflower.] Fr. root, bark II. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism, Is in- dicated in all cases complicated with Malaria, Scrofula, Im- poverished Blood, Anaemia, etc.. etc.,In conjunction with Pil Orient- alls (Thompson), will control the most obstinate cases of Impo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotency, and were poisoned with Phosphorus compounds readily yield to this treatment. Pll Orientalis (Thompson) contains the Extract Ambrosia Orientalis. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It Is not an Irritant to the organs of generation, but A RECUPERATOR and SUPPORTER, and has been known to the native Priests of India. Burmah and Ceylon for ages, and has been a harem secret In all countries where the Islam has planted the standard of Polygamy. It Is Impossible to send free samples to exhibit In Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation Cwith formulas and medical testimonials) to physicians who are not acquainted with their merits. p , f Helantha Compound, $1.85 per oz. Powder or Capsules, rnces. ^ p|, Orientalis(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, Washington. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord. Owen ft Co., Chicago. Evans-Smith Drug Co., Kansas City. Redlngton ft Co.. San Francisco. J. L. Lyons A Co., New Orleans. ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST. M I LW A U KEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING ^So^liV-a ORIGINAL DESIGNERS 6 ARTISTS Publisher's Department. 242 DANGERS OF OFFICIAL STATE JOURNALS. — The Virginia Medical Semi-monthly, for July 21st, writes: Noth- ing could more strongly impress the dangers of ownership and publication by a State society of its own journal than a recent occurrence in connection with the California State Journal of Medicine. In its May, 1905, issue, it says of the New York Medical Journal: "Its advertising pages are notoriously an abomination of desolations (sic), and even its editorial columns have been bartered for coin." The attorney for the New York Journal promptly wrote the Medical Society of the State of California, stating that his "client has a cause of action against you by reason of the publication of such false and libelous statements. While the person who wrote that article bears all the ear marks of a malicious and irresponsible individual, he at the same time represented the Medical Society of the State of Cali- fornia. ... On behalf of my client I therefore demand the immediate retraction of the said statement with the same prominence of the said libel, and in the same journal in which the said libel was printed. Before taking any further proceedings in the matter, I shall wait a reasonable length of time to hear from you." 1 The secretary of the California society replied in sub- stance that neither his society nor members of its publica- tion committee had the remotest desire to libel anybody, and asked "which of the expressions objected to, you con- sider libelous and offensive to your client; and also that you give me an idea of the nature of the statement which your client would like to have us publish?" The New York Journal attorney replied, after calling attention to his former letter: "I assume that you have sufficient ability to write that such statement so made by you is false and untrue, without my sending a form of re- traction for you to sign. You know that the statement is false, and that when it was written the writer of the same knew it to be false, and what we demand is that you say so in plain English." Hence in the July, 1905, number of the California State SENG A PALATABLE PREPARATION OF PANAX SCHINSENG IN AN AROMATIC ESSENCE IT PROMOTES NORMAL DIGESTION BY ENCOURAQ- ING THE FLOW OF DIGESTIVE FLUIDS. IT IS THE MODERN AND MOST SUCCESSFUL TREATMENT FOR INDIGESTION A full size bottle, for trial, to physicians who will pay express charges DOSE: One to two teaspoonfuls three times a day CACTINA PILLETS HAS MANY ADVANTAGES OVER OTHER HEART STIMULANTS IT HAS NO CUMULATIVE ACTION, AND , IS ABSOLUTELY SAFE AND RELIABLE Each pillet represents one one-hundredth of a grain CACTINA, the active proximate principle of CEREUS GRANDIFLORA DOSE: One to four pillets three times a day , Samples mailed to physicians only SULTAN DRUG COMPANY, ST. LOUIS, MO. THE BEST RESULTS are assured in Bromide Treatment when you specify PEACOCK'S BROMIDES DOSE One to three teaspoon- fuls, according to the amount of Bromides re- quired Half-pound bottles only AND THE GENUINE IS DISPENSED Neurologists and General Practition- ers prefer it because of Its superior qualities over the commercial salts. HEPATIC STIMULATION FORMULA Each fluid drachm represent* 15 grain, of the combined (.'. P. Bromides of Pota.sium, Sodium, Calcium, Ammonium and Lith- ium For Physicians' Prescriptions For clinical trial we will send full size bottle of either or both preparations to any physician who will pay exp. charges WITHOUT CATHARSIS G H I O N I A DOSE. One to two teaspoontuls three timei a day. FORMULA. Prepared from Chronanthm Vlrfiinlca, from which the Inert and naimeating feature! of the drug have bvi-n eJimhiatcd. Re-establishes portal circulation without producing congestion. Invaluable in all ailments due to hepatic torpor. PEACOCK CHEMICAL CO., ST. LOUIS, MO., U. S. A. I Publisher's Department. 243 Journal of Medicine, the following occurs, after some refer- ence to advertising: "Consequently, we fully, freely, and unqualifiedly retract, and withdraw the statement quoted." —New Eng. Med. Monthly. CRITICISM.—A reader well versed in French, takes exception to my le's and la's, and calls attention to an error which he believes he has caught me making with my genders when saying Vive la Mariani! which, by his inter- pretation, makes Mariani of the feminine gender. But nothing could have been further from my wish, for Mariani is of all men an exceptional type of manhood, and fully entitled to be so engendered. In this expression of long life to Mariani, the individual was not intended, but the subject which he qualifies was in mind, that is, Coca. For all the world knows that Mariani has made Coca synony- mous with his name. Mariani, then, stands for Coca, and Coca means Mariani. The rest is with the French lexico- graphers, who, having made Coca of the feminine gender, enable us to rightly express the heartfelt wish—Vive la Coca! implying also Mariani, or Coca, as you will, and thus affording a pretty play on terms by way of courtesy. So then 1 say, Vive la Coca Mariani! Vive Mariani! — Editor of Coca Leaf. BATTLE & CO., Chemists' Corporation, 2001 Locust Street, St. Louis, have just issued the ninth of the series of. twelve illustrations of the Intestinal Parasites, which they will send free to physicians on application. "OUR OBSERVATION of the medical literature indi- cates that Echinacea is being used far more than formerly." —J. A. M. A. ECTHOL contains in each fluid drachm twenty-eight grains Echinacea and three grains thuja. It is put up in bottles holding 12 ounces and any physician who has not used Ecthol, can get a 12 ounce bottle for experimental purposes by sending 25 cents to Battle & Co., to prepay express charges. River Crest Sanitarium £?2*£L Astoria, L. I., New York City. in Lunacy. FOR NERVOUS AND MENTAL. DISEASES. Home-like private retreat. Beautifully located. Easily accessible. Detached building for alcoholic and drug habitues- Hydrotherapy, Electricity, Massage. J. JOS. KINDRED, M. D., WM. E. DOLD, M. D., President. Physician in Charge- New York office 616 Madison ave.. cor. 59th St.; hours, 3 to 4 and by appointment. Phone, 1470 Plaza. Sanitarium Phone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. . A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore. Md. Dr Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St., Louis. THE BLUE HILLS SANITARIUM MILTON MASSACHUSETTS. A PRIVATE HOSPITAL AND IDEAL RESORT. All classes of patients admitted. Separate department for the victims of ALCOHOL, OPIUM. COCAINE AND OTHER DRUG HABITS. All dealre for liquors or the baneful drugs overcome within three days after entrance. and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hyelenlc treatment; also a Ten-plate Static Electrical Machine, with X-Ray. and all the various attachments. J. FRANK PERRY. M. D., Supt. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIER SUDDVTH, M. D., 100 State St., CHICAGO, Publisher's Department. 244 A SUCCESSFUL HOUSE—The Sultan Drug Co., of St. Louis has been in existence for nearly fifteen years, and its laboratories are under the direct supervision of its president, Mr. F. W. Sultan, a pharmaceutical chemist. Mr. Sultan is a graduate of the Maryland College of Pharmacy, took a special course in quantitative analysis under Professors Simon and Dickery, took the Simon Gold Medal for analytical chemistry in 1884, and has made several achievements in pharmaceutical chemistry, among them Cactina. He was connected with the laboratory of Messrs. Sharp & Dohme, of Baltimore, for nearly ten years, when he organized the Sultan Drug Co. in St. Louis. Mr. Sultan is also Secretary and Treasurer of the Peacock Chemical Co. and is in complete charge of their laboratory. He is justly proud of the critical analysis made of the alkaline bromides found on the English market by Messrs. Helbing and Passmore, the eminent analytical chemists of London, in which it was shown that the salts used in the manufacture of Peacock's Bromides were prac- tically pure and superior to the bromides usually found on the American market. The preparations manufactured by these two houses have always been advertised and offered to the medical profession only in the most ethical manner, and they are indorsed and used by English speaking physi- cians as well as in all of the civilized countries of the world.—Medical Sentinel. WITH THE AVERAGE PHYSICIAN it is a routine prac- tice to administer a cholagogue, and results would seem to justify this procedure. If the liver is not primarily at fault it is affected secondarily, so no exception can be taken to this rule. For this purpose calomel, phosphate of soda and other drugs are in common use, but none has a worthier name as a cholagogue than Chionia. Chionia is the active constituent of chionanthus virginica and in the process of manufacture the inert and objectionable parts of the plant are eliminated. This agent has long been known 'as a valuable addition to modern drug lists and its extensive use among physicians who get results, is evidence that it The MILWAUKEE SANITARIUM Wauwatosa, Wis. FOR NERVOUS AND MENTAL DISEASES WauwatosaSs a suburb of Milwaukee on the Ch'cago, Milwaukee and St. Paul Rail- way, 2% hours from Chicago, 5 minutes' walk from all cars and trains. Physician in charge: RICHARD DEWEY, A.M., M.D. CHICAGO OFFICE, 34 Washington St., Wednesdays 2 to 4 P. M., (except in July and August). Telephone connections, Chicago and Milwaukee. Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, MX). City Office, 21 East 44th St., SING SING, P. O., N. Y. Mondays and Fridays, 3:30 to4:30,p.m. Long Distance Tel., Hart, 140A,Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, in the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, M. D. PHI K'R MEDICAL REGISTER I ULI\ O AND DIRECTORY EUGENE iG^en Free — | to each person interested In FIELD'S POEMS* A $7.00 , Field Flowcrb" (cloth bound, 8x11i, u a i penon Inter iblnf to the .._ Field Monument Souvenir Fund. Subscribe any amount desired. Subscriptions aa low ax $1,00 will entitle donor to his daintily artMlc volume M f .1111 1 certificate of subscription to '■ wb»Wbw X fund. Book contains a telec- ■a fa 4a mm !tion of Field's beat and moat III < representative works and If UUUI* * revlj for delivery. • But for the noble contri- bution of the worid's greatest artists this book could not have been manufactured for leas than $7 00. Tbe Fund created Is dl< Tided equally between the family of the late Euyene Field and tbe Fund for the buildine: of a monument to the mem- ory of the beloved poet of childhood. Address EUGENE FIELD MONUMENT SOUVENIR FUND, UtsoatBcok storesi 194 Clinton St, Chicot* If y. it .ill" wish to lenO pottage, encloae 10 eta. THE Book of the century Handsomely Illus- trated hy thirty- two of the Worid's Greatest Artists. WAS ESTABLISHED IN 1886. Do Not Be Deceived By Imitators. See that the name B. LB POLK «fc GO, IS ON THE ORDER BEFORE YOU SKIN IT. POLK'S la the only complete Medical Directory POLK'S is the only Medical Directory having an Index to all physicians in the United States. POLK'S has stood the crucial test of time with increasing popularity. It thoroughly covers the field. R. L. POLK & CO., Publishers, oetwoit. MICHICAN. SUBSCRIBE NOW. This is the Best Medium for — Sanitaria— Publisher's Department. 245 is a preparation of much merit. The ordinary dose of Chionia is one or two fluid drachms three or four times a day.—The Medical Mirror. SYRUP TRIFOLIUM COMPOUND WITH CASCARA, an -effective combination of an alterative with a laxative. The superiority of Syrup of Trifolium Compound with Cascara must be apparent when its composition is noted. Each fluid -ounce contains the active constituents of red clover blos- soms, 32 grains; lappa, 16 grains; berberis aquifolium, 16 grains; xanthoxyium, 4 grains; stillingia, 16 grains; Phyto- lacca root, 16 grains; cascara amarga, 16 grains; potassium iodide, 8 grains, and cascara sagrada, 40 grains. The dose is from one to two teaspoonfuls three times a day. While it is particularly indicated in the treatment of secondary syphilis, with or without mercury, Syrup Trifo- lium Compound with Cascara commends itself as a general alterative. In skin diseases it evidently stimulates the action of the emunctories, adjusts the balance of waste and repair and produces marked improvement. Many erup- tive diseases are aggravated by constipation, induced by sedentary habits, and in such cases Syrup Trifolium Com- pound with Cascara, P. D. & Co., may be regarded almost as a specific. While regulating the bowels and restoring natural peristalsis, it continues to exercise its alterative effect, which is enhanced by the elimination of waste products. In psoriasis and eczema it may be found effective when other measures produce indifferent results. In strumous cases its favorable effect may be supple- mented by combinations of iodide of arsenic, bichloride of mercury, sulphide of calcium, or iron. As it is easily borne by the stomach and pleasant to the taste, it may be taken by children for a long time without giving rise to derangement of the stomach or producing nausea. It also proves useful as a vehicle for calcium iodide in the acne of adolescents; iodide of mercury in specific ulceration of the fauces; and for the administration of large doses of iodide of potassium in tertiary syphilis. In anemia, ASTRINGENT AND HEMOSTATIC OF MARVELOUS POTENCY. WIDELY USEFUL IN SURGERY OF THE EYE, EAR, NOSE. THROAT, VAGINA AND URETHRA, AND IN Practically Every form of Hemorrhage Encountered by Physician and Surgeon. Its remarkable potency, broad usefulness, prompt action, and freedom from untoward results, stamp ADRENALIN as one of the most notable agents in the materia medica. Supplied [d solution (re&dy for me*, 1 part Adrenalin Chloride, 1000 parts normal sail solution— In ounce glass-stoppered vials. LITERATURE ON REQUEST. 1 OUNCE ACETOZONE (C«h*CO.O.0.C0Ch.i ANTISEPTIC TW taaUat* of ihti ptttiK* r'«iUt rf m ! ■« dilntrd wilts «n *g,u»J wtBbl J U >«MI po>6MT. 'erisuo** bM prOTid s*s7 w*\kt%eV*y u i rni*i Mkaftk, bit II H 'ir-vrud tb.l |ti vtk< tpfVata til m a lb* IrMlmtBt of iiinii. i>iuum N Mb a (a thw, Ma., *m -o. UWrUin. AVarttuiM M wry r«utjllv dwttmpwd, u»t he«J fc wt fin Is ricloilT of ' *t*un ptig.. it-ij 'U» bntad ebhrt. If Uahrd lo brithy P *u uptwiu* ii,»v rwu't. Avi4d ireln dsopfn.nl. la nablkf ■ POWERFUL GERMICIDE AND INTESTINAL ANTISEPTIC. of Marked value in typhoid fever cholera diarrhea tonsillitis dysentery gonorrhea puerperal fever malignant edema and other diseases of like origin in which the source of infection can be reached by the solution. In the opinion of many physicians Ace/ozone is the most remarkable antiseptic ever brought to the attention of the profession. Sappllrd in ounce, half-ounce ami 'iturtrr-ounre botUrs; also hi vials of 1 -i (Tains each, 6 vials in a boa. Write for booklet with Clinical Reports. Publisher's Department. 246 chlorosis, amenorrhea, etc., the most favorable results are produced by alternating it with some iron preparation. DR. W. B. FLETCHER.—"Dr. W. B. Fletcher, the distinguished neurologist, of Indianapolis, who was stricken with apoplexy some time ago is on the fair road to recovery and before this issue reaches our readers he will in all probability be at his sanitarium "Neuronhurst," looking personally after his patients."—Medical Herald. MEDICAL COMPLACENCY.—Eminent Financier: "Doc, I'm going to take out another million-dollar policy. As the company's medical director, you'll -testify, of course, as to my perfect health?" Insurance Physician: "Certainly." Eminent Financier: "And, by the way, Doc, I've been cited to appear before a gimlet-eyed, half-baked investi- gator from the West, a fellow who's totally ignorant of our Eastern financial ethics. As my family physician, just write that I'm threatened with pneumonia, or appendicitis, and can't possibly appear." Doc.—"Appendicitis would be seasonable." This is about what one might expect of a physician who allows himself to be addressed as "doc." Puck is responsible for most of the above. The sort of "doc" referred to is on a par with the sort of financier referred to. DUCHESS AND THE DOCTOR.—The health of her two little boys has been a great source of anxiety to the duchess of Marlborough. They are both afflicted by curvature of the spine, but they have been greatly benefitted by the treatment of a famous Harley street specialist. The duchess herself frequently accompanies the children to the physi- cian's residence and remains while they are put through the species of Swedish movements which constitute an essential part of the treatment. The duchess on one occa- sion thought that the room was not warm enough for the tender little lords, and in a manner that implied a command, intimated that the temperature should be increased. But the physician told her grace that he knew best what he was about, declining to make the room warmer to please her. The duchess humbled her pride for the sake of her children. SCHOOL BOOKS, PENCILS AND DISEASE.—An epidemic of diphtheria prevailed in a small Kansas town. The State Board of Health found it to have been caused by the public ownership of lead-pencils. The pencils used by the schoolchildren were gathered up every night and distributed 247 Publisher's Department. in the morning. One child contracted diphtheria. In a few days the disease was communicated to fifty pupils by . means of the pencils. This is only one instance in which infection may be spread by the use in common of pencils and books. , A French physician who was interested in this subject recently made a series of investigations to establish . the duration of infective power in various bacilli, finding it to range from forty-eight hours for .some, to fifty days for the Eberth and 103 days for the Koch bacillus. It would seem to be pretty thoroughly established that the method of using schoolbooks and pencils in common is too-dangerous to be continued.—Editorial, Medical Age.' NEEDED LEGISLATION.—Increased attention is wisely directed to an alarming extent of sophistication in foods and drugs; the former commonly being contaminated by preservatives which are injurious, and the latter, undtr guise of harmless remedies, often owing efficacy to dangerous narcotics. This deplorable practice has been officially shown to be so widespread and demoralizing as to demand rigid legislation to protect both the consumer and the reputable merchant. Several states have framed laws against the falsity of traffic in commodities essential to life and health, and a bill is now before the congress which, if enacted, will afford Governmental protection against such abuse, and, by guarding against misrepresentation' by misbranding, will extend authoritative assurance to those who place depend- ence upon recognised remedies in time of need. . . The investigations prompted! by state and national measures have necessitated critical examinations of various proprietary preparations as to their purity and fitness. Notable instances of such work were the investigations of the Ohio Pure Food Commission, the State Board of Health of Pennsylvania, and more recently the Illinois Pharmacy Board. In each instance Vin Mariani, analyzed from exam- ples purchased in the open market, was proved to be precisely as represented and in conformity with, the strict Governmental analysis enacted in France, Germany, Russia and elsewhere in Europe. , .. This clearly indicated that the high standard of this preparation, established nearly half a century ago, con- tinues unaltered, and is a justification for the distinctive endorsements which physicians everywhere have voluntarily accorded this unique restorative-tonic. THE Alienist and Neurologist. VOL. XXVII. ST. LOUIS, AUGUST, 1906. No. 3. ADOLESCENT INSANITY (DEMENTIA PRAECOX). BY DR. E. TROMMER, NEUROLOGIST. Hamburg. THE difficulty for the practicing physician to acquire sound psychiatric knowledge consists less in the rarety of the material, less in the time for its study, than in the duration of the psychoses and their mutability. Con- trary to somatic medicine in psychiatry nothing is more momentous than reliance on momentary forms, e. g., the symptom-complex of mania, apparently so readily recog- nizable, may occur in the course of the most diverse diseases. Paresis, hysteria, epilepsy, senile dementia, etc., may all occasionally produce pictures which simulate a genuine mania. This is true of the symptom-complex of a depression, hallucinatory confusion, etc. This phase similarity of different diseases renders possible under cer- tain conditions, after months of observation, complete insight into the fundamental disease process. Mental diseases in (249) 250 Dr. E. Trommer. changing form may take up the whole life. Hence the difficulty of reliable psychiatric diagnoses. The effort to diagnose transitory conditions to advance the knowledge of the fundamental psychical trouble is not very old. Outside of Germany psychiatry still rests largely on symptom- atic diagnoses; but there the concepts melancholia and mania in no way indicate a constant course and termina- tion; many of our text-books still speak of dementia sec- ondary to melancholia and mania. But true mania never passes into profound dementia, just as little does melan- cholia into paresis; for the melancholia was the incipient stage of the paresis and the mania was not a mania, but a phase of a more complicated disease process, whose more careful psychological analysis would have shown certain symptomatic deviations from true mania. In paresis has long been recognized a well characterized psychosis, on whose basis the most diverse conditions may develop. There is no psychosis admissible at this age in whose vesture paresis could not appear and lead to a false diag- nosis: paranoia, amentia or hallucinatory confusion strictly, epilepsy and even delirium tremens may imitate paresis, and still careful observation will make it possible to see the disease in the condition. Even the variedly monotonous epilepsy causes manic, depressive and hallucinatory states, which quite often ap- pear like independent psychoses, until a typical convulsive seizure clears the matter up. The old habit of considering conditions psychoses in themselves of temporary independence and in these the most conspicuous symptoms the essential ones has long delayed advancement from the artificial to the natural system of the psychoses. Who, e. g., makes the diagnosis of stupor from its most conspicuous symptoms, motor inhibition, might experience the following dilemma: it may occur that a stupor follows a mania, which then terminates in recovery; on the other hand, a young person may be attacked with stupor for no cause, which is followed by secondary dementia so-called. The stupor in the one case would then be the consequence, in the other a cause Adolescent Insanity. 251 of psychosis; the same condition first terminates in re- covery, in the latter in dementia; who can tell why? In truth both states of stupor are similar only in external appearance, but of essentially different significance, the one may terminate in recovery, the other in mental en- feeblement; both had prognostically available distinctions. The theory of paranoia, all too symptomatically constructed by some authors, has retarded advancement to the natural system. Particularly students and physicians inexperienced in psychiatry, who have not had an opportunity for careful observation will thus be in the comfortable position of being able to diagnose all psychoses with dominating delusions and hallucinations as paranoia, paranoia simplex if the first control of the field, paranoia hallucinatoria if the latter. But there are no psychoses in which delusions and false sensations are not occasionally prominent symptoms; con- sequently very heterogeneous conditions are actually desig- nated paranoia, conditions which have nothing in common with the primary paranoia simplex, the tolerably typical form, other than these two symptoms, diseases which have in common neither the clinical course nor certain character- istic symptoms. But delusions are not characteristic in them- selves, but how they originate and how they are regarded, not hallucination in themselves, but how the patient reacts toward his hallucinations. The delirious patient, e. g., reacts entirely different toward his false sensations, the imbecile elaborates and asserts his delusions entirely different from the real paranoiac. Establishment of evident symptoms does not suffice: we have first recognized the disease when we are able to causally combine the following states and when we are able to give a prognosis. In every psychical disease the prognosis is of the greatest, not only academic, but practical social importance. It is as in meterology the criterion of the science. The younger the person afflicted, the greater accord- ingly is the number of clinical possibilities, the more diffi- cult and so the more important for the whole life will the prognosis be. 252 Dr. E. Jrommer. This is the cardinal reason for my describing a group of diseases, which, in spite of its frequency, importance and relatively good prognosis, is known to the fewest physicians. They are diseases, which beginning in the years of puberty or after, in adolescence, present poly- morphic, but still characteristic symptoms and usually lead to a definite mental enfeeblement, steadily or paroxysmally. Better known than the name dementia praecox introduced by Kraepelin is Kahlbaum's designation adolescent insanity; better known also the varieties christened hebephrenia and katatonia. States of this disease were of course long known, but the epithets paranoia or mental enfeeblement were satis- factory, or mania and melancholia, which terminated in mental enfeeblement, were spoken of. The honor of having lifted this disease out of the catch-alls of paranoia and mental enfeeblement belongs to Kahlbaum, recently deceased. In 1871 Hecker described in this sense as hebephrenia an adolescent psychosis, which passed through the forms of mania and melancholia and would then terminate in mental enfeeblement; in 1874 Kahlbaum described katatonia, similar to the former, yet characterized by stuporous states and tendency to spastic and stereotyped innervations. Both papers were sign-posts in psychiatry, but met with little consideration and still less recognition, until Kraepelin accepted these diseases, demonstrated their scope and made them capable of diag- nosis and last, not least, popular. He embraced the whole group under the name of dementia praecox, as premature dementia in contradistinction to the dementia of the age of involution, senile dementia. The frequency of this process is much greater than Hecker and Kahlbaum presumed. While Hecker found only 14 hebephrenics among 500 patients, in Heidelberg during my assistantship, a third of the male wards were filled with these patients. Regional differences always seem to exist; e. g., I observed among the numerous admissions of the Adolescent Insanity. 253 Dresden Detention Hospital this disease was much more rare than among those of the Heidelberg Clinic. The possibilities as to course in this disease are great, no less great than in paresis; three subvarieties may be readily instituted for the purpose of orientation, which are united by mixed and transitional forms. The dementia in these cases to be characterized as simple demented forms of dementia praecox is of the most even course. Without conspicuous omens a very gradual decline of the mental faculties begins at 16, 17 or 18, in boys, often during apprenticeship or in the last school years, in girls, at the boarding school; they become inat- tentive, hard to understand, indifferent and obtuse to nobler incentives, lose interest in family and friends, in higher and usually even in lower interests; they become more and more lazy and apathetic or thoughtless, oppositional, un- stable, and, even though cultured persons, vagabonds. Dementia praecox furnishes a large contingent of the insane vagabonds. With the fading of the inner motive force, the spontaneity loses self-confidence and self-consciousness. A patient I knew, and only a little debilitated, whose mental failure had appeared during the last year in gram- mar school, and correctly performed simple clerical duties, always wrote the alphabet for the sequence of the trans- actions. The alienist rarely sees such dementia, because it usually occurs anteportas of the hospital, where it is not regarded by the relatives and usually not by the family physician to be a disease. More often depression, states of anxiety, fear of unknown enemies, hypochondriacal com- plaints, usually of sexual content, or strange remorse re- veals the disease. A patient of the Dresden Hospital was despondent and every evening prayed God for forgiveness, because he had caught a little girl by the abdomen. Soon the mental deterioration followed these preliminaries, which in these cases do not often attain an intense form. In the hospital such dementel patients are the most harmless and stupid of all. Even the most demented paretic utters 254 Dr. E. Trommer. sounds, but the former often do nothing at all, many stand about and do not seem to think, they lead the existence of a lower animal, yet only when left to themselves. For in spite of the destruction of all special impulses the ma- jority noticeably retain such knowledge and ability they have acquired before the beginning of their deterioration. Such a patient, formerly a book-binder, who, if left to himself, stagnated completely, could be readily and skillfully em- ployed in the hospital book bindery, his work was pain- fully neat, if very slow and when he needed new incen- tives in any change in work. Another, who in the first class in school, became ill with apathy and hypochondriacal complaints, was a demented, awkward, lazy, untidy person, who preferably remained on the closet and spontaneously uttered only sneering or bestial sounds; but accosted he was able in a surprising way to give information as to his teachers and even of classics he had read. These terminal states are then easy to recognize after consummated dementia and to be definitely separated par- ticularly from congenital mental weakness by means of its psychological attributes. These are: 1. Loss of the sentient impulses, the lower and higher tones of feeling; 2. Loss of those highly co-ordinated mental faculties, which are manifested in the desire for mental occupation and inter- change of ideas, in objective observation, in criticism and methodical actions; 3. By retention of the lower mental functions, memory, ability to do mechanical work and orientation in time and place. The forms of dementia praecox described as hebephrenai differ from this type of a steadily progressive, quiet mental deterioration, by irregular course, by alternation of the most diverse conditions, by the occurrence of various states of irritation (affects, false sensations, acts of violence, variations in consciousness) and by the early appearance of confusion; they terminate, with rare exceptions, quite rapidly in a mental weakness especially marked by the persistence of delusions, bizarre habits and by the incoher- ence of their assertions. The symptoms considered essen- Adolescent Insanity. 255 tial by Hecker, besides age and termination, namely silli- ness, precocious character and a definite sequence of con- ditions—first melancholia, then mania, then confusion, finally mental deterioration—are no longer to be upheld. The disease usually begins with depressive states, head- ache, disorders of sleep and despondent thoughts, owing to the perception of the loss of ability, but not always; many cases begin with delusions of peculiar, physical influences (probably owing to paraesthesia), the patients believe they are influenced, the blood changed, watched in a mirror, "false ideas put into the head," etc. Other cases begin with hallucinations, quite often of sexual content, virgins believe they are pregnant, others see Christ as bridegroom, etc. I knew of a young man who was arrested because he visited ladies under the pre- text that he had been engaged by voices to serve them sexually. Advanced mental weakness is often expressed by the reaction to such hallucinations. Diverse forms of ex- citement, which usually resembles a frenzy or a so-called hallucinatory confusion, follow the initial symptoms: in women childish, simple excitement seems to prevail; in men, conditions combined with confused delusion formation and sense deceptions. As examples, I will briefly describe two cases observed in Dresden: S., 18, with strong taint, previously good scholar, be- came stupid and languid and began to sleep unusually long. One day she became frantic because she was censured for absent-mindedness in playing the piano; from then on she did not sleep or eat, had dyspepsia, God appeared to her and asked whether she wished to die or be an artist on earth; she became confused and began to use obscene language, talked to angels and devils and jumped out of a window because the world was to be destroyed. In the hospital she was erotic toward the physician, then excited, sang, cried, threw food about, behaved at times like a "spoiled, capricious baby." When quiet she talked silly. Sleep was irregular, at one time she slept without medi- 256 Dr. E. Trommer. cine, again did not in spite of it. She attempted suicide once, because she should take a hypnotic. Many extremely silly suicidal attempts followed this. She was evidently demented, urinated in her clothes and collected a puddle of saliva on the floor. The initial diagnosis of hysteria, based on capricious excitement and analgesia of the tongue must soon be changed to hebephrenia. In the other case, an equally tainted, bright girl of 19 suddenly became depressed, cried, saw figures on the wall, changed her clothes frequently, had a convulsive seizure and afterwards fainted several times. Then rapidly changing conditions, she soiled herself with urine, defecated in the bath, experienced "improper things" in her own body, was electrified by machines, assumed theatrical atti- tudes and temporarily presented cataleptic and analgetic states. When perfectly quiet she talked incoherently and in senseless platitudes. Unmistakable mental weakness. Both cases resembled mania at times of exalted mood, motor impulse and loquacity; but clouded consciousness, excitement rapidly changing, filthy habits and incoherence characterize them as hebephrenic. The states of excite- ment very soon passed into terminal dementia. The other sort of course of hebephrenia, more frequent according to my experience and in men corresponding to their less affective nature is usually spoken of in the older text-books as paranoia; nevertheless it is essentially differ- ent from it. True paranoia usually begins in middle life, is of chronic course without elementary states of irritation, without any primary confusion, without any peculiarities in action and conduct, which for the laity stamp the dement as "crazy," does not result in marked mental enfeeblement and is generally characterized by great constancy. The paranoiac elaborates and egocentralizes his delusions, he watches closely his fancied interests and his hallucinations have a certain sense. Directly evidential of the hetereogeneity of both processes is the primary paranoia described by Sander; it begins in adolescence and bears the traits of Adolescent Insanity. 257 true paranoia and not those of dementia, like the following case of forensic interest: A clerk of 21 emigrated to America for no reason; there he was persecuted and heard his persecutors plotting to drive him out of his boarding place by insults and accu- sations; on his journey home they gave him no peace. As he feared the Free Masons he begged protection of Leo XIII. He also wrote two letters to Bismarck and the King of Sax- ony, in which he offered his services in "political matters," although he had "neither judistic or theological" training; at home he fancied he was surrounded by conspirators, scandalized because his mother gossiped about family secrets and gadded about aimlessly. As vagabond he was punished in different ways, was sent to the almshouse and from there to the work house as insane, but "suspicioned of simulation" where he was punished twenty-one times for laziness, filthy habits and insubordination, until a psychosis was finally admitted. At the hospital he was outwardly co-ordinated, but completely unsettled and pro- duced the most absurd ideas: at seven years of age he had had a knitting business, in Bavaria there are Orinoco men, who are not born in the usual way, the difference in the church relations in Bavaria and Prussia depends on the difference in the postage stamps, etc. His confusion is illustrated by the following letter, in which he asks for new trousers: "Dear Parents: With my Aunt Johanna 1 need my full rig through the elimination of the coal stove. I am at present among strangers and conformable to typhus in the salt damage the powder Hardt at Dresden, lodging in the hospital asylum, where 1 need my camisohl clothing . . . . etc." This hebephrenic incoherence I consider the most impor- tant sign of this dementia, because it may appear in almost all stages, as I will show by a few more examples: A patient, similar to the one spoken of, formerly an in- telligent mechanic, now dissolute and demented, punished sixteen times, "professional vagabond," so-called; but con- 258 Dr. E. Trommer. spicuous by false sensations and confused delusions, wrote the following protest to his confinement: "To the Royal Prefect: My position for the general good is for the purpose of being able to inform against these futile expostulations. The realism and inhabitibility of my country affects me according to martial law. Still, the denunciation of my position proven in nine instances, which will indicate that formality by which I could now be set at liberty, etc." As this letter was of no avail, he wrote to President Thiers: "Honorable Mr. Thiers: The animals cause me to place before you my unsuitable position. I am confined here for a long time, etc." A peculiarly comical confusion is shown in a letter given in Kraepelin's text-book, p. 117, Vol. II, of the sixth edition. The grammatical structure of such exhibits are so plainly different from the form of expression of epileptic, paretic or maniacal patients with confusion, that I am often able to make the diagnosis by it alone. Of its signs four are conspicuous: 1. Maintenance of syntax; 2. The abun- dance of unusual, the most sonorous words possible or foreign words, for which a special tendency exists; 3. Coining words, often of obscure origin; 4. The absurdity which so occurs, that the original sense is replaced by forced, anomalous phrases, by the most sonorous comple- tions possible, by superfluous, aparte words, so disjointed and mutilated, that the original thoughts occur sporadically and fragmentarily; somewhat as Horatio describes Ophelia's incoherence: ". . . . she speaks things in doubt, That carry but half sense; her speech is nothing, Yet the unshaped use of it doth move The hearers to collection; they aim at it, And botch the words up fit to their own thoughts." The incoherence chiefly affects nouns and adjectives and connected with other words neither by inner nor external Adolescent Insanity. 259 associations. Forel has aptly termed incoherent combina- tions of words "word salad." The mutilation of sense increased with the degree of the mental derangement, until only series of "word husks," as Krafft-Ebing expresses it, remain; the critical faculty, which seeks, tests and arranges the words, is wanting; and that is the sign of incoherence. 1 remark, in the interest of clearness, that the symptom incohetence is not to be identified with that of confusion. Confusion may be properly termed the inner connection, which must first be disclosed. Incoherence the derange- ment perceived in speech and demeanor; we therefore speak of hallucinatory confusion, but of incoherent talk. In- coherent talk sometimes occurs in normal persons: 1. Under the influence of toxic factors, e. g., alcohol; 2. In states of trouble and exhaustion. An instance is afforded by Beck- messer's unsuccessful song. Instructive, especially for the estimation of the accom- plishments of certain scholars, is the essay written by a hebephrenic patient in perfect placidity and of which I will give a sample. As a theme she had chosen: "Life a dream, or dream life: "A life is said to begin in general, to be a child in the fullest sense of the word. A child is harmless and innocent. Still all children are not constituted the same. One is sickly, hence needs care, the other is well and only hopes for love, both are children of one God. But which does the mother love the more? According to prosaic conception she loves both. But the poet opposes it, and he alone might. But he has not calculated his word for all persons. But in his garden only roses bloom. He would gladly plant them in every garden, but almost all earthly ground is sterile. Hence he must be careful with the garden. The rose will easily become the bone of contention," etc. Towards the conclusion she becomes still more in- coherent: "All earthly is perishable. Love is deeply implanted 260 Dr. E. Trommer. in a person's breast. George Ohnet says no! no! The people may read so. Imaginary, false and distorted is it still. Nothing new can be found in numbers. Otherwise an Ella would have been recognized in Mary Stuart. Eliza- beth could never have reigned on the English throne right- ly. But Christian orphans sing psalms of children's ven- geance. Oh, that sounds sweet as glance from you is Eve. But in German numbers. The sun of my happi- ness," etc. The tendency to replace sound opinions by phrases and sounding platitudes is peculiar to many young people under the constraint of society, but here far exceeds the limits of anything normal. The normal predeliction of puberty for the labored and affected style, Jor phrases and poses, in a word for the unnatural, we see still increased in the products of its psychoses. Incoherence, analogous to that in the talk, is seen in the behaviour of hebephrenic patients, and this may be especially observed in the gait, manner, gestures and in the way of eating and drinking. While the movements of the maniac are unconstrained and of natural dexterity, those of the hebephrenic, if they are pathologically deranged, are always somewhat constrained, unnatural, forced in a peculiar way. In gait they dance, sway at the hips or strut stiff- legged; their gestures are angular, awkward, often de- ranged by adverse impulses. As the sense of their talk is mutilated by interpolations, motor adverse impulses, seem to constantly distort the line of natural movement. Their talk as well as their movements .gradually lose prime motive, by which normal motor manifestations are always determined. It is true in general of demented hebephrenic patients that differentiated from simple dements, they are harmless, stupid, seclusive, but conspicuous for bizarre practices; they mutter to themselves, grimace, wiggle about and pull at the beard or clothing, etc. I know such a demented referendary, who took food from all parts of his clothing and eat it, as said to kill frogs in his stomach; when the food was gone he eat Adolescent Insanity. 261 slivers from the floor. Another became angry when he saw his own shadow; another became apparently furious when anyone entered, but merely to touch a tip of his clothing; then she sat down apathetically in her corner. The physical signs of hebephrenia are: Exaggeration of the knee jerks, exaggeration of the vasomotor reflexes (dermatographia), exaggeration of the mechanical nervous excitability (facial phenomena), anomalies of secretion, like hyperhydrosis, seborrhoea oleosa and salivation; as more complex phenomena, catalepsy and sporadic convulsive seiz- ures. None of these symptoms are pathognomic, still dermatographia, salivation and catalepsy are to be used as supports of the diagnosis. Sleep is to be considered, if it occurs in spite of daily excitement, for maniacally excited patients do not sleep. Far more conspicuous are the psychical and somatic symptoms of katatonia or tension insanity, the best known and in consequence of its symptomatic peculiarities, the best recognized form of adolescent insanity. We are in- debted to Kahlbaum for the first description of this form; his description might be broadened and completed, but does not need to be essentially corrected. Katatonia is differentiated from hebephrenia by certain motor symptoms, by severe attacks, which may even simu- late organic brain troubles, by remissions, which, as in paresis, may last for years and by sporadic recoveries. In the majority the end is profound dementia. The first symptoms are usually depressive, vague sensa- tions, head pressure, congestion, bad dreams, scotoma, syncopy; the insanity soon becomes evident in confused or terrifying hallucinations, in fantastic fear of death or hell, sporadic delusions, which quite often cause hostility to rela- tives, or precipitate acts of violence, convulsive seizures or peculiar conduct. After these prodromes lasting several weeks or months the specific conditions are developed, katatonic stupot and katatonic excitement. Katatonia stupor resembles ordinary (exhaustion or circular) stupor, but in rapidly attained development pre- 262 Dr. E. Trommer. sents less the picture of motor paralysis than that of fixed motor constraint, often with tonic postures and spasms of the limbs. The patient lies or stands in a petrified atti- tude, often assumes the constrained posture of Apollo, of Tena or Aegina, the limbs stretched out or in peculiar statue-like postures, he does not speak, eat nor react to pain stimuli and often does not wink; every external in- fluence is met with by an elastic resistance; the jaws close before the spoon with food; in attempting to move a limb, it is held with elastic force and on discontinuing the pres- sure quickly returns to its former position. This automatic exaggeration of the katatonic persistence to the elementary resistance is called negativism. A part of the patients present, instead of negativism, the opposite symptom, catalepsy. The limbs do not elastically return to the former position, but retain the one given them, like a lead pipe. Now and then this constraint is interrupted by unex- pected impulses, the patient raises both arms or he suddenly gets out of bed—so-called active katatonic movements—or after days of mutism insults a neighbor or commits a sud- den act of violence. These motor manifestations now and then interrupting long and profound stupor are extremely valuable for the diagnosis. Hallucinations may be the cause of such eruptions, but not necessarily. A patient, who suddenly threw the urinal in another's face, said, after regaining self-possession and begging pardon, he had to do it, it had thus come over him. The excitement is especially distinguished from other sorts, somewhat maniacal, by this tendency to stereotyped innervations in talk and movement. The patients rock back and forth rhythmically as idiots generally do, they pace back and forth like a bear in a cage, or they walk in certain figures (circles, quadrangles, etc.). Stereotyped character of what is said and written is conspicuous. In writing the patients use the same word repeatedly, put a certain sign after each syllable, or they constantly vary the same word, they verbigerate. I heard a patient sing the alphabet Adolescent Insanity. 263 for hours to the melody of "With my Mandolin." It is as though the patients are possessed by some innervation pattern. A frequent peculiarity, occurring in stuporose as well as in excited conditions is a certain suggestibility in manner, word and action, called catalepsy, echopraxia and echolalia, symptoms of unlike significance. While catalepsy is found in imbecility and stuporous states of other origin, the mani- festations of imitated gestures (echopraxia) or of repeating words previously spoken (echolalia) occurs chiefly in katatonia: stupor with echopraxia is almost certainly katatonic. The katatonic betrays himself more than any other patient by his unnatural monstrous behavior, by his predeliction for phrases in speech, poses in movement, but which are still more constrained and deviate still more from everything natural than in hebephrenia. I know a well educated patient, who went about dancing for weeks, gliding with arms and shoulders dangling and sweetly smiling or rolling the eyes; she demented very rapidly. Another patient, a law and corps student, maintained a rigid theatrical pose, threw the head back, rolled the eyes, imitated the vulture, attacked fellow patients with fencing foils and declaimed with pathos: "... I had overcome in battle the sun, the moon and the earth, 1 still believed I am well, for I con- quered the earth, I received a drink of milk and water from Dr. N. 1 bathed in the blood of vengeance, in the blood of the bacillus of vengeance. No, that is not true, who has inspired his death in me, since then 1 always in- spired death. How is it with him?" etc. From such excitement of medium severity or by means of stupor, severe, furibund attacks may occur suddenly, which are best termed katatonic delirium; vague excitement in greatly clouded consciousness, with a motor impulse, usually silent, with whirling, waltzing, snorting and the most dangerous self-inflicted injuries. I have seen a patient jump up in bed and throw himself on the floor head fore- most. All remembrance of it was wanting. Instead of 264 Dr. E. Trommer. delirium convulsive seizure of tetanic or epileptoid character may occur. States of superfaction with intimation of aphasic disorders are rare. Physical symptoms are more frequent in katatonia than in hebephrenia; besides those mentioned, analgesia, mydri- asis and spasms may be observed. All three are of greater diagnostic significance than those mentioned in hebephrenia. In women the menses often disappear or become more rare at the beginning or for the duration of the disease. The laity then naturally make the suppression of the periods responsible for the psychosis. According to Kraepelin the termination of one-fifth of the cases of katatonia is in recovery, but it is always to be taken with reserve, in view of the possible remissions, in one-third of the cases slight dementia, in the rest pro- found. Its final appearance is usually manifested by marked increase in the previously lowered weight in stationary or even increasing mental weakness. In the hospital katatonic dements are noted by the frequent and sodden appearance, by great sluggishness and by stereotyped movements or habits. A pathological anatomy of these severe disease pro- cesses occasionally accompanied by convulsions, delirium and clouding of consciousness and leading: to the most pro- found degree of dementia, is still wholly wanting. Nissl's greater knowledge of detail seems to have disclosed subtle cortical changes to be regarded pathological. At present we must then strive to gain etiological data in the living. We have become acquainted with three allied disease processes with symptoms and termination in common: simple dementia, a simple atrophy of certain mental functions, hebephrenia, a process of mental enfeeblement with states of excitement, and finally katatonia, the disease accom- panied by the most intense and peculiar symptoms. Be- tween all three there are gradual transitions; we recognize as common, prominent symptoms for diagnosis: 1. A pecu- liar incoherence in talk, writing and conduct; 2. The ten- dency to the production of bizarre anomalies of innervation in Adolescent Insanity. 265 gait, gestures, manner and habits, in tendency to gesticula- tion and grimacing; 3. Weakness of judgment; 4. The termination in a peculiar dementia. These common funda- mental attributes and the gradual transitions oblige us to regard the three forms as varieties of the same disease pro- cess. On what factors it depends, whether the disease takes the one or the other form, we do not know. We know little that is certain as to the causes of the whole disease. The most important etiological factors are doubtless heredity and age. Hereditary taint may be estab- lished in seven per cent, of the cases, which is somewhat less than in epilepsy and the curable psychoses of adoles- cence. In regard to age it must be strictly remarked that processes of mental enfeeblement of similar sort may occur in later life; katatonia seems to be developed even at the climacteric. However, the favorite time for dementia praecox is certainly puberty. Other direct causes, like lues, alcohol, infectious diseases or trauma are not proven. In men, mili- tary service and imprisonment have an exciting influence, in women, the puerperium. Quite a contingent of kata- tonias follow confinement or lactation. The majority of the cases of so-called melancholia or puerperal stupor terminat- ing in dementia are certainly to be included in dementia praecox. If psychical trauma, fright, trouble or adverse love affairs, from which fiction derives its psychoses, are only incidental causes, adolescent psychoses often follow adverse passions or broken engagements. Owing to this lack of a certain etiology and pathologi- cal anatomy only presumptions as to the nature of the disease processes can be advanced. The hypothesis, that it is here a matter of a failure of nature in the transition at the time of maturity, suffices at most for the mildest cases usually running their course outside of the hospital. But in the severe cases terminat- ing in dementia, it is a matter not of an arrest, but of a destruction of whole series of functions of the psychical organism by a multitude of pernicious agents; many kata- tonias attended by stupidity, excessive perspiration, my- 266 Dr. E. Trommer. driasis and delirium force the assumption, that it is here a matter of some toxic process in the organism on the basis of a nervous system weakened by taint and the increased stimulation and demands of the years of development. It is not to be forgotten that all that cannot be defined is re- garded as autointoxication; still we must here assume an agent whose point of attack must primarily be the most highly developed layers of the cortex. For we always see the highest psychical functions, and in the simple demented forms alone, fail; while all the somatic and usually the lower psychical functions are often permanently retained. What therapeutic claims can now be advanced from these etiological considerations? The cardinal causes, heredity and puberty, can natur- ally be prophylactically urged in the sense to adapt as much as possible the amount of demands of school and life on the brain to the personal capacity. It is rarely considered what affects, what intellectual stress at this most danger- ous age an inadequate brain is subjected to by numerous requirements of school and society. Protection is to be afforded those brains which appear to fail. By the assumption that it may be a matter of an autointoxication, no reliable therapy has as yet been offered. All the hopes placed on organotherapy have failed. Whereas it seems perfectly natural to increase the elimina- tion of the body in perspiration and urine by a physical means, then hot packs, moist packs and mild cold water procedures. Acute or dangerous excitement, dangerous either to themselves or others, naturally require hospital treat- ment, whose discussion is unnecessary here. Whereas detailed therapeutic considerations are proper, then and in the cases, which after the decline of the storm present the picture of calm and essentially undisturbed dementia. Owing to the formerly acquired knowledge and abilities of being well retained to a considerable degree, they are capable of re-education, if they are kept at a rational occupation. The more severe forms interpose great difficulties through sluggishness and stupidity, while the Adolescent Insanity. 267 milder are readily employed, i. e., trained to mechanical handiwork, copying, etc. The working force of insane colonies are recruited in great part from these patients. For many, especially previously educated patients, the re- turn to family care or to an easy occupation, of course under proper supervision, is not only possible, but even indicated. That proper training is able to resurrect a num- ber of transmitted faculties in seeming dements, is known to every alienist. If the therapy is a matter chiefly in the interest of the patient, the question, which at the outbreak of a psychosis first interests the family, and whose answer they may reasonably desire, is the prognosis, and as this can only be given by the diagnosis, we must now speak of the differ- ential diagnosis, in so far as it has not been mentioned. Of course we can only consider the most important diseases; for strictly not only the possible psychoses would have to be considered, but also neuroses, intoxications and the affects normally peculiar to puberty. In love affairs espe- cially affects of apathetic or excited nature may occur at this time, which are often hard to differentiate from disease. Neurasthenia and hysteria, which quite often begin at puberty, are to be considered with respect to the premoni- tory symptoms of dementia praecox (feeling of depression, attacks of anxiety, insomnia, headache, etc.). Peculiar hypochondriacal complaints are suspicious of dementia praecox. That autointoxications are to be considered, was shown by a hebephrenic, whose initial symptoms were ascribed to and treated as lead poisoning, because he was a compositor. All the psychoses often occurring at puberty may be most clearly classified into so-called organic and functional, the latter in chronic and curable, and again finally into periodical and transitory (that is a typical exogenic psychosis of short duration). Of the organic psychoses in spite of the rarity at adoles- cence, paresis must be considered. I call to mind a woman of 23, who was diagnosed a paretic by speech disorder and 268 Dr. E. Trommer. a form of mild, unreasoning euphoria, rare in hebephrenia, physical symptoms were absent. More often we must make this differential diagnosis in the rare late forms of dementia praecox. The stereotyped form of confusion above described is decisive for dementia praecox, if none of the physical signs of paresis are present. It must always be emphasized against a common opinion, that we are usually able to make the differential diagnosis whether paresis exists or not, without physical signs and solely by psychical symp- toms. The late form of dementia praecox may cause con- fusion even with focal brain diseases, e. g. 1 remember such a patient, whose scanty and slightly incoherent talk with quite well co-ordinated conduct had been regarded as aphasia. Of the function, chronic psychoses remain paranoia and in part epilepsy, both important differential diagnoses, the latter owing to the convulsive seizures occurring in dementia! praecox. Epilepsy may cause a permature mental weakness, but then convulsive seizures in greater number have to be anamnestically proven. Katatonic convulsive seizures are solitary. Epileptic mental enfeeblement is readily recog- nized by its awkward, peculiar, vicious nature. The typical form of manifestation of the epileptic is an awkward, un- wieldy talk, poor in concrete, which always centers about one point. Whereas it is extremely difficult to differentiate katatonic delirium and epileptic dazed conditions, it is im- possible to describe their fine differentiation in concise terms: analgesia, stubborn, visionary character, abrupt im- pulses, terrifying hallucinations may all be alike. The differential diagnosis is important on account of therapy, both are dangerous. It is the factor of dangerousness which renders the differential diagnosis between paranoia and hebephrenia very important under certain conditions. I have already called attention to the differential signs with respect to the occurrence and behavior toward their own delusions. The consistency and energy, with which a paranoiac lieutenant I knew pursued his delusional in- terest—he considered himself an illegitimate son of the Adolescent Insanity. 269 King of Saxony—caused his family most annoying embar- rassments. Whereas a hebephrenic, pseudoparanoiac, who considered himself the Queen's "Greek man," what that is he does not know himself, quietly let his delusions be contradicted and defended them in no way; further, in the paranoiac the feeling of illness, which is quite often present in dements as feeling of emptiness and confusion, is always lacking; in him those confusions and absurdities, which for the laity stamp the hebephrenic as "insane" are wanting. The establishment of dementia does not alone suffice, for congenital imbeciles may also be paranoiacs. The mode of manifestation of the delusions is decisive. Of the greatest significance may be the determination between precocious dementia and curable psychoses—or should be at least—in more extensive family plans (engage- ments, career, etc.). The need of a reliable prognosis, as well for the public as for the family physician is not actually in accord with the present state of our science, neverthe- less in the first beginnings a more certain outlook whether curable or not is often possible. Melancholia, mania and stupor strictly to be considered affective or . emotional troubles, are the most frequent as curable psychoses. All three have essential points in com- mon in spite of apparently great external differences: 1. They usually develop without adequate cause on the basis of hereditary taint; 2. After short duration (one-half to one year) they terminate in recovery; 3. They usually recur many times during life; 4. They alternate in recur- rence or replace each other; indeed, as Kraepelin and his pupils have shown, they even blend, e. g. manic and de- pressive, manic and stuporose traits may mingle. They are then to be regarded psychotic equivalents and consequently to be judged prognosticate alike. The most favorite time for these psychoses, like dementia praecox, is the first half of the third decade. The comparison of two tables taken from Kraepelin's book 270 Dr. E. Trommer. graphically represents the importance of this differential diagnosis. % Relative frequency of dementia praecox of maniac-depressive insanity (mel- cholia, mania, stupor) at different ages. (According to Kraepelin.) If we can diagnose melancholia, mania or pure stupor, so it is that the patient gets well after one-half to one year, but after recovery needs continually the utmost con- sideration to prevent the probable recurrence of the dis- ease. The mild and medium grades of these largely affec- tive conditions are easy to recognize. The feeling of pro- found misery, the desperate anxiety of the melancholic, the natural exuberance, the explosive mood of the mania, the equal retardation of all motor functions in stupor stand out from the first against hebephrenic states, with a cer- tain mental weakness, accompanied by stupidity and a tendency to absurdities. At any rate melancholiacs may make complaints to be called imbecilic or self-accusations, but only in extreme anxiety, maniacs may also be inco- herent in talk and behavior, but only in great motor excite- ment and even then combining in the talk external word associations according to klang or rhyme are to be per- ceived; but the hebephrenic or katatonic is incoherent and disconnected even when quiet. In mania I saw many times the natural dexterity of the movements, the wantonness, clownishness of the whole character decided the otherwise Adolescent Insanity. 271 difficult diagnosis. Profound stupor may greatly simulate the katatonic, but the first lacks the peculiar impulsive movements of the latter; first of all the movements of the stuporose patients are uniformly retarded and consequences of perceptible intention, whereas those of the katatonic after being commenced often meet with a sudden, entirely unintelligible "arrest" or diversion. But genuine stupor may appear catalyptic and insensitive to pain. The diagnosis meets with serious complications, when congenital imbeciles become manic or melancholic, because here the important sign of mental weakness, i. e., the weakness of judgment existing in times of quiet, is wanting. The mental enfeeblement developing in the course of de- mentia praecox is the basis on which the symptoms of a mania or depression arise. Here the mental weakness re- mains the same in all stages, there it originates and in- creases on longer observation. The symptoms of the childish and silly conduct, which was formerly considered especially hebephrenic, here proves untenable; for the manic imbecile as a rule behaves silly and childish; nevertheless on close observation he may not lack the symptoms of genuine mania, then even the expansive mood increased to joy or anger, the flight of ideas, i. e., the tendency to external (rhyme and klang) associations in talk and writing, a cer- tain naturalness in the manifestations of the motor impulse and the insomnia. If an imbecile becomes melancholic, imbecilic self-accu- sations or stereotyped manifestations of affect, which depend on the paucity of ideas of the diseased brain, lead to the wrong diagnosis of dementia praecox; but the melancholic is consistent in his affect, in stereotyped conduct, profound, despondent depression usually exist, partaking of food is lessened and possibly refused corresponding to the degree of depression and the signs of confusion characteristic of dementia praecox wanting. Of the so-called transitory psychoses those states of hallucinatory confusion are most often to be considered, as they affect those with taint after real exhaustion or psychical 272 Dr. E. Trommer. trauma. The true exhaustion psychoses, the puerperal—or lactation stupor or amentia are characterized by the dis- orientation rarely observed in hebephrenia, perplexity and a certain stupor. 1 remind that the katatonia quite often follows confinement. Most of the hallucinatory psychoses originating on the basis of strong taint, to which Magnan's delire d'emblee is to be included, are yet too little known to set forth certain differential signs. A part of these states, particularly fre- quent in large cities, is certainly to be regarded hysterical. I have cases which approximate particularly katatonic states in the manifestation of automatic orders, then catalepsy, echolalia, echopraxia, even in certain incoherent talk. They seem to be differentiated from the latter by the fact that they may be intensely influenced by induced affects or by ob- servation. Also in spite of a theatrical, excessive character , they may be lacking in the signs of mental weakness and primary confusion. The most remarkable of this sort was the psychosis of a lady, who at times presented genuine katatonic stupor and still imitation of an example seen sometimes was not to be proven: she presented mask-like rigidity of the face, mutism, sudden laughing, negativism, refusal of food, she held her breath, collected saliva and let it drool on the floor, etc. The psychosis recovered very quickly; on account of the course and the permanent intact- ness of the intelligence she must be regarded hysterical. Besides severe hysteria with frequent hallucinatory at- tacks at times of quiet may give the impression of being a remittent katatonia: constrained, somewhat inhibited charac- ter with slight mental production, with ability to work re- tained, mydriasis, exaggerated tendon reflex, etc. A case 1 recall was explained after two years by a hysterical, dazed condition. In such difficult cases a continuous observation as unnoticed as possible will always prove the surest way. Time often explains what is concealed from the most careful ex- amination of the present condition. 1 would warn against placing too much value on the so-called hysterical stigmata, then partial analgesias and absence of mucous membrane re- Adolescent Insanity. 273 flexes, in case they are not especially pronounced. They are of little use in the differential diagnosis between hysterical and more serious psychoses. Therapeutically this determination is of course of the greatest importance, for in the first case essential psycho- therapeutic measures are to be considered. THE TRAINING OF MENTALLY DEFECTIVE CHILDREN.* BY MARTIN W. BARR, M. D., Elwyn, Pa., Chief Physician to the Pennsylvania Training School for Feeble-Minded Children. THE successful training of the feeble-minded in various avocations, thereby transforming a dependent class into a community contributing in large degree to self-sup- port, may be accounted as by no means the least of the achievements of the nineteenth century. Not only does it mark a distinct era in education, but it is already influenc- ing a return in the schools to that development through the hand which, in the past, built up communities and asso- ciations of craftsmen, and dignified labor as an honorable calling, and we cannot but feel that this recognition is the best possible endorsement of our work. That our methods demonstrate the true meaning of the word educate, is readily perceived, for we are forced to study the child and develop what we find. We simply cannot pursue the or- •Kead before the Class in Social Work, University of Pennsylvania, May 7th, 1906. (274) Training of Mentally Defective Children. 27S dinary plan of beginning with abstract ideas and second- hand knowledge through the medium of books for many reasons. Take for example, one, the defective memory of the child, which is apt to be either exaggerated or nil. There- fore the presentation of mere facts is to him either harm- ful or useless. Again, inertia or dulled faculties need the constant stimulus of emotions healthfully awakened, in order to be attracted to things or to the occupations that lie nearest. When he begins to do, to accomplish, to him- self create anything, however simple, then, and then only, is the child interested in what others have done and how they do it; and, as step by step he follows this path, does he demonstrate that "the working hand makes strong the working brain," and enables it to grow and develop. In the process of this experimenting with numbers in mass, we have repeatedly found them dropping into three divisions, each evidencing a certain kind of ability within certain limitations, beyond which it is impossible to pass. This has led to a nomenclature of grades, a term some- what confusing to the general public, who naturally asso- ciate it, as used in the schools, with the idea of progres- sion, although they are distinguished, not numerically, but adjectively as low, middle and high. Thus a mother finding her boy year after year in the same room, inquired when he was "going up to the high grade room?" and was quite amazed when the teacher exclaimed: "Madam, your son can no more become a high- grade boy than he can become an elephant. He was born of middle grade and that he will always be, even after he leaves school." However she was afterwards consoled when shown the progression he was making, and the various avocations which would open to him a useful life in some one of which he was capable of being trained. Building upon the experience of half a century, we have gradually evolved the following classification indicat- ing the kind of training suited to capacity of grades and 276 Martin W. Barr. Asylum Care. outlining future possibilities. The value of this we have proven with successive classes for some years: IDIOT. Profound Apathetic Excitable—Unimprovable. Superficial Apathetic—Slightly improvable. Excitable—Improvable in self-help only. IDIO-IMBECILE. Improvable in self-help and helpfulness. Trainable in very limited degree to assist others. MORAL IMBECILE. Mentally and morally deficient. Low-grade. Trainable in industrial occupa- tions. Temperament bestial. Middle-grade. Trainable in industrial and man- ual occupations. A plotter of mischief. High-grade. Trainable in manual and intellec- tual arts, with genius for evil. r IMBECILE. Mentally deficient. Low-grade. Trainable in industrial and sim- plest manual occupations. Middle-grade. Trainable in manual arts and simplest mental acquirements. High-grade. Trainable in manual and intellec- tual arts. BACKWARD OR MENTALLY FEEBLE. Mental processes normal, but slow and requiring special training and environment to prevent deterioration. Defect imminent under slightest provocation, such as excitement, overstimulation, or illness. Custodial Life, and Perpetual Guardianship. Long Apprenticeship, and Colony Life Under Protection. Trained For A Place in the World. Here you find presented in three broad divisions, the perpetually helpless in asylum, the perpetually danger- ous trained in custody, and the tractable class capable of being brought, through training, to various degrees of re- sponsibility, but maintained there only by constant direction Training of Mentally Defective Children. 277 and supervision which should be life long. It must be borne in mind that weak-will, feeble-intellect, and poverty of tissue and fibre, mental and physical, have combined to render them cripples for life and never can they stand alone. And I would say just here that when each and all of those engaged in the work of charities, are able to convince parents and guardians of this fact, and that withdrawal means the inevitable undoing of all that has been achieved for the child, together with almost certain reproduction of his de- fect—a double misfortune—they will have influenced a much needed concensus as to the necessity of the permanent sequestration of defectives and in so doing will have signal- ly aided the work in both the dependent and delinquent classes. In reviewing this outline of training and its confirma- tion and results as found in any large training school for defectives, it will be seen that occupations are provided for grades of capacity in such manner as to stimulate and keep alive the awakened interest. All are busy, each contribut- ing some service to the life and well-being of the whole. Thus the hewers of wood and drawers of water, the laborer in field or garden, the aids in the care of the helpless in nursery or in the simplest or most menial offices in kitchen or asylum, has each gone to his own place after testing and preparation in the school; as have the workers in laundry, bakery, dining-room and dormitories, or ap- prentices in shoe-making, carpentry, tailoring, sewing and printing, drawn chiefly from the middle and high grades. Training has for its object the testing and proving of a diagnosis which rarely errs and, while exercising the men- tal and physical powers so as to achieve all possible de- velopment, to assign each to his own group and there train for that avocation for which the child exhibits a cer- tain proclivity. To this end are arranged schools as distinct in aim and working methods, as is the capacity or ability of the pupils for whom they are designed. For the very young children, Froebel's theory and practice has been so modified as to be adapted in three 278 Martin IV. Barr. kindergartens, to the capacity of those of low, middle and high-grade. From these they pass to their respective grades in the school for which these kindergartens have prepared them. The pupils of the low-grade school are those found in- capable of comprehending abstract signs and who can there- fore never learn to read and write. Their power of grasp goes no further than the clutch of a broom, a rake or hoe; yet some learn readily to knit, to sew and wind carpet strips; others are successful as weavers of mats, of nets and of baskets, and even of carpets and tapestry, where the looms are once set up for them. In addition to this, these children have daily practice in some industry about the house and grounds, giving needed physical exercise and development as well as initiation into what may prove a life service. Children of middle-grade show an intellectual advance beyond these, in ability to recognize and to form letters and figures and, although they glean but little from books —rarely advancing beyond the second or third reader—and that not always intelligently, yet the specific gain for them is in the discipline of class exercise, concentration of at- tention, daily practice in independent working, and neat- ness and accuracy in transcribing. In this latter, the making, lining and decorating of their books forms no unimportant part, as does also the free-hand black- board exercises, the drawing in black and white and in colored crayons, the modelling in clay, the constructive work in card-board and the sewing and knitting. Indeed, the distinctive difference between the two grades of low and middle is this of the muscular sense as evidenced in the clasp of pen and pencil, or grasp of tool, so that a typical child of middle-grade may be counted upon to de- velop into a fairly good artisan. Children of high-grade show an intelligence approximat- ing normal, varying in degree from a slight advance upon middle-grade to that of merely backward children. Capable of receiving and assimilating, of rehearsing and of reproduc- Training of Mentally Defective Children. 279 ing a narration, even of pursuing to a limited extent a sequence of logical thought and deduction, many of these pupils advance as far as the ordinary intermediate or gram- mar school grade, while acquiring at the same time a certain degree of skill in hand crafts, fitting them to enter intelligently upon a trade apprenticeship; and from this class are drawn as we have seen quite capable tailors, shoemakers, seamstresses, carpenters, printers and type- writers. Drawing and modelling in clay, card-board and wood, physical and military exercises; and daily practice in music—both vocal and orchestral—are important adjuncts to training in these higher-grades; and band, orchestra and chorus have each their place, as have athletic sports their season, in contributing to the happiness and well-being of all. That many of this type approach normal, proves often their great misfortune, for out in the world there is more expected of them than they are able to give and over stimulation and over pressure leads to mental deterioration. Even if successful in gaining a position, some eccentricity or else inability to follow business habits, or to sustain any prolonged responsibility, forces them soon to yield and, dis- heartened, they drop out of the race to join either the dependent or the criminal ranks. Experience of this proves the great importance of special methods in the training of merely backward children to enable them to take and hold their place in the world; those whose mental processes are normal but with whom at that critical period mental deterioration is always to be feared. Witness the frequent breakdown of children under the stress of examinations and the nervous collapse of young men and women on the eve of success at college. It has been estimated that an institution colony with a fair acreage and a population of from one thousand to twelve hundred, could, in groups of twenty-five or thirty, under skilled supervisors, train and furnish all its own laborers and mechanics and also supply aids to asylums, thus reducing largely the cost of maintenance. This, how- ever, could be accomplished only under that protection which 280 Martin W. Barr. the legalized sequestration of defectives alone could give. Under present conditions, hardly have pupils entered upon that apprenticeship for which the school has prepared them, when they are withdrawn, and their places too often filled by either helpless idiots, or by imbeciles both mentally and morally defective, whose training, except in close custody, is equally impossible. Now, the idiot, of whatever age, is in a state of perpetual infancy. Devoid of the power of speech, often of locomotion, incapable of self help, many can neither feed nor dress themselves. The incongruity—one might say the absurdity—of ap- plying for admission of such into a training school is self- evident. Yet people will do it, and, after bringing every influence to force in a case, become very indignant at find- ing their children in asylums and not in training. We can do much in the way of developing brains, but we can not do the impossible, nor manufacture brains to order; nor are we surprised that the parents of bright, trainable pupils object, for their children, to such association even in name. An asylum for the hopelessly, helpless class js little more than a well ordered nursery for sick children, under a capable house-mother with efficient nurses; the trained idio-imbecile and those of low and middle-grade making excellent aids to these, more dependable, in fact, than normal labor, because more willing, and content to remain in an atmosphere of constant seclusion. The admission of moral-imbeciles is even more incom- patible with the true interests of the work. Children of this class—a criminal type with moral instincts altogether absent, or so absolutely perverted, that they always choose the bad rather than the good—prove a veritable fire brand among innocent children of weak wills, susceptible to sug- gestion and easily led or dominated by another, especially if that other be possessed of a pleasing personality; and one such case may often demoralize a whole group. Found associated with all grades of mental defect, this moral obliquity varies from bestial brutishness in the lower- Training of Mentally Defective Children. 281 grades, to the skilled cunning and clever adaptations of the merely backward defective, who is but one removed from his brother, the recognized and responsible criminal. Trainable these are, and innocent in the eye of the law they should be regarded, because being defective— morally and mentally askew—they are irresponsible; but both their own safe-guarding and that of society demands, that for them should be provided a LIFE TRAINING SCHOOL, where every advantage and amelioration in the way of comforts of living, amusement and training, might compensate for the loss of that liberty which would be fatal to themselves and to others. Summarizing, therefore, we find the training of mental defectives has resolved itself in the experience of years, and in the development of new phases of defect, into two broad divisions. One for the ordinary imbecile of defective mentality and will-power in community life—the other for the irresponsible, mentally and morally defective in cus- todial life. In each, provision should be made for three distinct and permanent grades of mentality, with complete sex separation. Development through the hand should be the underly- ing principle of each and all. Training should lead directly to some avenue of employment early entered upon, as con- stant occupation is for them the only security from deteriora- tion. This is best accomplished by separation and segrega- tion. Moreover legalized sequestration and sexualization are equally necessary to assure permanency to the work, happiness to the individual, and safety to society. PSYCHOENCEPHALONASTHENIA OR CERE- BRASTHENIA SIMPLEX, AND PSYCHO- ENCEPHALONASTHENIA OR CERE- BRASTHENIA INSANIENS.* BY CHARLES H. HUGHES, M. D. ST. LOUIS, MO., Professor of Psychiatry, Neuriatry, Electrotherapy and Dean of the Medical Faculty, Barnes University.t HEMOPHOBIA under certain conditions or circumstances is a condition peculiar to some healthy but highly nerve tensioned persons, but it comes to neurotics under neuratonic mental stress who never held a special fear of blood before. It is the opposite of hemophilia in its literal, not profes- sionally accepted, sense (hemophilia alpa, blood and