The Alienist and Neurologist r < 6/0.5- A y e 'Quantam ego quldem video motus morbosi fere oranes a motlhus in systemate nervorum lla pendenl ut morbi fere omnes quodammodo Nervosi did gueant."—Cullen's NOSOLOGY: Book Il P 181 — Edinbuhg. Ed. 1780. ftni%t and I^o-jpologigt A JOURNAL -OF- Scientific, Clinical and Forensic NEUROLOGY AND PSYCHOLOGY, PSYCHIATRY AND NEURIATRY Intended Especially to Subserve the Wants of the General Practitioner of Medicine.' VOLUME XXIII. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGHES, Associate Editor. HENRY L. HUGHES, Manager and Publisher. 3857 Olive Street, ST. LOUIS, MO. CONTRIBUTORS AND COLLABORATORS. TO VOLUME XXIII. F. SAVARY PEARCE, Philadelphia. J. ELVIN COURTNEY, C. G. SELIGMANN, Denver. London. E. S. TALBOT, H. SCHOENFELD, C. H. HUGHES, AUGUST DRAHMS, J. G. KIERNAN, PAUL PAQUIN, Chicago. Munich. St. Louis. St. Quentin. Chicago. Asheville. C. WERNICKE, P. J. MOEBIUS, CESARE LOMBROSO, Breslau. Germany. Turin. E. C. SPITZKA, New York. R. von KRAFFT-EBING, CURKAN POPE, GEORGE ILBERG, Vienna. Louisville. WENDEL REBER, Sonnenstein. Philadelphia. INDEX TO VOLUME XXIII. ORIGINAL CONTRIBUTIONS. A Case of Peripheral Abducens Paisy ...445 A Neuro-Psychologist's Plea for Byron..349 A Question of Figures 183 A Question of Figures 279 Clinical Observations on a New Hypnotic 27 Consciousness and the Neural Struc- ture—A Physio-Psychical Review. .. 58 Dipsomania Ending in Paranoia 325 Eitra-Neural or Adneural Nervous Disease 247 Eitra-Neural or Adneural Nervous Disease 266 Gall's Special Organology 138 Juvenile Female Delinquents 16 Juvenile Female Delinquents 163 Kleptomania and Collectivism 449 Leon F. Czolgosz 53 Manual Stigmata of Degeneration 9 Medical Aspects of the Czolgosz Case ... 40 Outlines of Psychiatry in Clinical Lec- tures 127 Outlines of Psychiatry in Clinical Lec- tures 290 Outlines of Psychiatry in Clinical Lec- tures 399 Pseudospastic Paresis 305 Puberty and Genius ......176 Puberty and Genius 257 Sexual inversion Among Primitive Races 11 Science and "Christian Science" _ 63 The Acquirement of Nervous Health 1 The Prognosis of Mental Diseases 423 The Rational Treatment of Locomotor Ataxia 335 SELECTIONS. CLINICAL NEUROLOGY— A Case of Cervical and Bulbar Tabes With Necropsy 356 A Case of Sudden Blindness Subsequent to Cauterization of the Nose 197 A Case of Temperature Crisis in Tabes Dorsalis - 353 A New Cure for Neuralgia 464 Arachnitis and Spinal Hyperalgesia 352 Arterial Hypertonus 84 Auditory Nerve Deafness 357 Babinski's Sign 356 Chappa 355 Chorea Insaniens 462 Chronic Hemianesthia 466 Cretinism 81 Cyto-Diagnosis 81 Diagnosis of the Backward Child 86 Floating Kidney and Neurosis 467 Glycosuria in Life insurance 195 Gross Leisons of the Basal Ganglia 199 Hysteric Tympanites 462 intestinal Toxhaemia and Paresis 199 instrumental Amusia in Beginning Pro- gressive Paralysis 86 intermittent Bladder and Bowel Paral- ysis From Malaria 85 207077 ii Index. Maine's Jumping Frenchmen 357 Masked Epilepsy 198 Nervous and Mental Diseases .467 Nervous Jaundice 354 Nervous Sialorrhoea 462 Peculiar Nervous and Urinary Mani- festations Following Grip in the Aged 87 Philadelphia Neurological Society 465 Pressure Narcosis 352 Psychical Troubles in Malaria 87 Quinquald's Sign of Alcoholism 197 Rainbow Vision 195 The Neurotic indications of Pre-Senility 196 The Wesphal-Piltz Pupil Reaction 464 Treatment and Prognosis in Neuritis 196 Two Cases of Addison's Disease With a Special Consideration of the Blood 358 CLINICAL PSYCHIATRY— A Deopathic Christopathic Paranoic Prayer 211 A Summary of Work 366 An Anthropoid Degenerate 89 Colitis or Asylum Dysentery 89 Glycosuria in Mental Diseases 88 Hallucination's and Visceral Disease 366 Indican Acetone and Diacetic Acid in the Psychoses 365 Melancholic Blood and Embryo 89 Paretic Dementia in the Last Two Decades 90 Precocious Dementia 209 Sexual Precocity 210 NEURG-SURGERY- Extirpatlon of the Gasserian Ganglion.. 90 NEUROPATHOLOGY— Blood Parasite in Epilepsy 362 Pons Tumor Wiih Degeneration in the Posterior Columns of the Cord 361 The Pathogenesis of Spinal Curvature In Syringomyelia 361 Uric-Acid Fallacies 90 NEUROTHERAPY— A Notable Improvement in the Therapy ot Typhoid Fever 457 Agurin as a Diuretic 362 Antikamnia in Sciatic Pain 200 Ecthol 364 Epidural injections 461 Eucalyptus for Diabetes 365 Hedonal in Insomnia 364 In Gastralgla and Its Treatment 362 Internal Meaiclne 203 Massage in Hemiplegia 200 Music with Anesthetic Procedure.- 460 Subarachnoid Cocainization 200 Suprarenal Extract in Psychiatry 91 The Personal Elements of Error in Therapeutics 201 The Pressor Substance of the Pituitary Body 460 The Treatment of Motor Aphasia After Cerebral Disturbances 92 The Treatment of Neuralgia With Cas- tor Oil 363 The Use of Methylene Blue as a Seda- tive 363 NEUROPHYSIOLOGY— Absence of Superior Longitudinal Fis- sures 207 Cerebral Heat Centers 204 Mechanical influence of the Respira- tion and Circulation Upon the Activity of the Body Organs 360 Muscular Action of Arteries 206 Recent Experimental Neural Studies 360 The Nervous System and the Circula- tion in the Defense of the Organ- Ism 359 NEURO-DIAGNOSIS— Granular Degeneration of the Erjthro-- cyte 457 Taste and the Fifth Nerve 456 The Identification of Criminais Through the Fundus of the Eye 208 THERAPEUTICS— Climatology of Neurasthenia 208 FORENSIC PSYCHIATRY— Propositions Respecting insanity and Crime 369 MEDICO-LEGAL NEUROLOGY— A Contribution to tne Study of Suicide . .468 Index. iii EDITORIALS. A Curious Spanish ''Ad." 374 A Cursory Note on San Francisco Hos- pitais 97 A Day With Dr Marcy 485 A Facetious City Paper Smiles 377 A Facetious Newspaper Neurologist 491 A Judicial Blunder 214 American Medico-Psychological Associ- ation 101 American Medico-Psychological Asso- ciation 10Z Another Tofania 373 An Overcrowded Profession 383 A Singular Legal View 214 A Slaughtered Innocent and Its Psy- chiatric Moral _ 379 A Temple of Hygeia for the Worid's Fair 372 A Vaccinia Fact to Note and Remember 106 Be Sore of Your Horse and of Your Horseman 106 Change of Publication Date 382 Chondrodystrophia Foetalis 220 Christian Scientists .502 Climatology and Climatotherapy 100 Constipation and Civilization 474 Coprolalia 372 Correspondence .' 386 Culbertson of the Lancet-Clinic Hits Pedagogy 384 Czolgosz Again 478 Czolgosz Was Sane 216 Deaths and Obituaries 503 Delayed Manhood and Female Imper- sonation by Males 489 Demonology or Epilepsy 479 Denouncers of Medical Fees, Take Notice 494 Dr. H. B. Carriel Was Elected Central Insane Illinois Hospital Superin- tendent 376 Dr. J. T. Eskridge 217 Dr. J. T. Eskridge's Death 382 Dr. Loeb's Discovery and His Theory of Nerve Impuises 224 Dr. Lorenz Cures Eight for Charity 485 Dr. Oprenheim 373 Dr. Paul F. Munde 229 Dr. James Rodman 223 Dr. Seldon H. Talcott 502 Dr. Silas McDonald 105 Enjoyed Los Angeles Courtesies 93 E. C. Spltzka 217 Filipino Medical Folklore 495 Four Hundred Dollar Prize 107 Hallucinations: Their Pathogenesis, Clinical Import, and Medico-Legal Value 93 Health Census 500 Hedonal 102 Heredity vs. Environment 101 His Majesty the Monarch of Great Britain and Emperor of india 385 Homicide and Suicide in 1901 221 How a St. Louis Doctor Caught on in New York 496 Hypotone ..491 Hydriatic Measures for Neurasthenics.. 96 if Medical Men Paid More Attention to Politics 382 Importing Disease 481 In Memoriam: Dr. John Curwen 104 Inspect the Milk 377 Is the Louisiana Purchase Exposition to be only a Commercial Exhibition..481 Jane Toppan 483 King Alphonso of Spain 502 Laughing Epidemics 492 Marriages Between Women ...497 Mary MacLane Is Neuiopathically Morbid 375 Medical Association Officers 374 Medicine in the East .497 Mental Training of the Child After Birth 475 Musolino vs. Lombroso 501 Necrophilism 215 New Honorary Members of the Medico- Legal Society 218 Neurasthenia and Insincerity 376 New Year Greeting.—The Alienist and Neurologist 107 Obituary.—Death of Dr. Grissom 386 One Cause of It 499 iv Index. Political Paranoiacs 103 President Eliot 500 President Eliot's Christian Psychology..500 Removal Notice 378 Rudolph Virchow's Photo 102 Seldon H. Talcott Dead 383 Somnolentia, Somnambulism and Crime..490 Splanchnoptosis and Its Treatment 378 The American Association of Urologists..229 The Board of Trustees 229 The Boston City Hospital 483 The Committee on Pathologic Exhibit.. 226 The Death of Levi Cooper Lane 227 The Development of Psychiatry 376 The Journal of Mental Pathology 104 The Journalistic Doctor 383 The Louisiana Purchase Exposition 213 The Maryland Hospital News 95 The Medical Director of the Louisiana Purchase Exposition 371 The Medical Press 479 The Mirth Mind Tonic 475 The New Officers 494 The Obstetrical Society of Boston 501 The Peril of Political Paranoia 102 The Popular Power of the Profession ...380 The Power of the Press 224 The Psychically Fit for Freedom 228 The Recent Death of Doctor Charies Henry Brown 107 The Role of theJeJunum _ 96 The Story of Lorenzand Lolita 487 The Surgeon and the World's Fair 219 The Suspected Boston Murderer 501 The Unveiling of the Cell 218 The "Virchow Krankenhaus" 382 There Were Giant Quacks in Those Days of Seventy-six 384 Total Depravity and indigestion 95 Waldeyer of America 104 Was it Morbid Automatism, Delusional Insanity or a Scheme 482 Water for St. Louis 485 William MacCormick 96 The Patrick Case Medico-Legally Con- sidered 473 REVIEWS. A Practical Manual of insanity 233 A Practical Manual of insanity 388 A Start and a Finish 118 A System of Physiologic Therapeutics...114 A Text Book on Practical Obstetrics 234 Church and Peterson's Nervoui and Mental Diseases 112 Clinical Studies 507 Drug Habits and Their Treatment 390 General Paresis 505 Hydrogen Iodide. Syrup Hydriodic Acid 118 Kenkow (The Health) 117 La Migraine et son Traitement 119 Lecons Sur Les Maladies Du Systeme Nerveuz 231 Mariani's Coca Leaf 508 Nervousness 119 Notes of Roman Institutions 509 Peru—History of Coca 115 Progressive Medicine, Vol. II 388 Progressive Medicine, Vol III 113 Psychic Treatment 236 Riley's Toxicology 118 Saunders' American Year-Book 234 Studies in Psychology of Sex; Sexual inversion _ 110 The American Naturalist 507 Text Book of Psychiatry 117 The Criminal ., 116 The Czolgosz Case 230 The Diagnosis of Nervous and Mental Diseases 235 The Force of Mind 506 The Nervous Exhaustion Due to West Point Training 108 The Physician's Pocket Account Book....508 The Physician's Visiting List 508 The Treatment of Tabetic Ataxia 504 Third Series, Vol. XXIII 389 Veint de Paraitre 235 THE EASTON SANITARIUM. EASTON, PENN. Physicians, parents, guardians, or friends who desire to place any mental or nervous patients in a quiet well-furnished home where they can receive good care, and Homeopathic treatment, should visit Easton before making arrangements elsewhere. Over twenty years experience in the Middleton(N.Y.)State Horn. Hospital. Phone 1661. For Circulars, address C. SPENCER KlNNEY, M. D. ECTHOL 1 NEITHER ALTERATIVE NOR ANTISEPTIC IN THE SENSE IN WHICH THOSE WORDS ARE USUALLY UNDER- STOOD. IT IS ANTI-PURULENT, ANTI-MORBIFIC--A CORRECTOR OF THE DEPRAVED CONDITION OF THE FLUIDS AND TISSUES. SAMPLE M9-OZ.) BOTTLE SENT FREE ON RECEIPT OF 25 CTS. FORMULA:--Active principles BROMIDIA of Echinacia and Thuja. PAPINE BATTLE & GO., CORPORATION, St. Louis, Mo.,U.S.A, THE ALIENIST AND NEUROLOGIST. VOL. XXIII. ST. LOUIS, JANUARY, 1902. No. 1. THE ACQUIREMENT OF NERVOUS HEALTH.* By F. SAVARY PEARCE, M.D., PHILADELPH1A, PENNSYLVANIA. Professor of Nervous and Mental Diseases in the Medico-Chirurgical Col- lege of Philadelphia. GENTLEMEN:—A somewhat paradoxical title you may say I have chosen upon which to address you. This is true, but in the chess game of life paradoxes do come and even figurative English at command will not quite per- mit a visitor with you today to use better terms to describe the full meaning of this broad subject under discussion. We should like to contrast the traditional three B's— brains, brawn and belly—against the three W's—wine, women and worry—as complementary trios of the state of nervous health of people, but 'tis too old, yet an unheeded story. I am not desiring to go further today than toward a study therefore in pathogenesis of nervous diseases. That some potent sources of the acquired nervousness so fre- quently seen in American life does exist, all will admit. What a pitiable sight to behold, since too prevention is at hand. The evil predisposing causes can and should be •Read before (he twenty-seventh annual meeting of the Mississippi Valley Medical Association at Put-in-Bay Sept. 13, 1901, and the semi-annual meeting of tbe District Medical Society, Cumberiand County, N. J.. October 8,1901. [1J 2 F. Savary Pearce. largely eradicated. We are to advise then ways to prevent people and individuals from becoming liable to and to actually suffer functional nervous diseases, people on the verge of nervous break-down; or those who. by abusing certain privileges in living, shall surely bring on a collapse in due time. Here alone can we withdraw the moat. It is more frequently in those who are not the subjects of a nervous heredity too that I call your attention toward in advising for wider prophylaxis in medicine, especially in nervous and mental disease. It is this class of business man or woman, for example, who has no warning of his doom; for, as Dr. Weir Mitchell has ably set it down, the nervous system's "wear and tear" is not felt as pain which is the dominating guide to the average man for his assuming self to be ill. The less learned laborer does differently. He seeks rest from the comfortable tire of his muscles and hence seldom collapses. Would it were that we could assign his intellect a place in the apparently more conserv- ative plan of life he pursues; but alas, 'tis but nature's force for the healing balm to assert itself—sleep. Recapit- ulation and assurance of success in bringing about nervous health in persons of nervous temperament impels me to' go on more in detail. I have had no more grateful patients than those who had been guided away from that baneful state of health, "general nervousness." SIGNS OF INSIDIOUS NERVOUS COLLAPSE: Loss of memory and lack of concentration in a banker or professional man is of serious import and should be the sign-board to warn him from the precipice down which he will surely fall with a crash, more or less severe to his nervous health. And, in my experience, let a man past forty years insult his nervous system to such degree as to become a typical neurasthenic and such a one can never quite recover. Health ever after becomes a delusion and a snare. He will work in starts, but continuity of labor I have never found for days at a time in such people, even though no somatic signs present. Depending also upon the The Acquirement of Nervous Health. 3 condition of the gastro- intestinal tract, governed by the sympathetic system, we will have symptoms in warning of a nervous break-down which the patient or every physi- cian perhaps will judge as a transient "wind dyspepsia;" but which to the trained physician will be a signal warning of serious auto-intoxication, for, as a sequella, mal-nutrition of the central nervous system occurs. Indeed the sympa- thetic asthenia thus prevailing means, of course, loss of control of the great involuntary functions of the human body, especially of metabolism so vital to nervous health. Then circulatory disturbances, brought about by overwork of the sympathetic system, add another masked evil by les- sening the proper blood supply to the several cerebro- spinal nervous centres, and at once the pathogenesis of neurasthenia or other serious maladies is surely established. It may be a hysteria, that disorder of the emotion which is recognized so frequently, but the further study of its cause and hence detail treatment of which is so frequently neg- lected; the loss of confidence the patient has in his doctor being in the great majority of such cases undoubtedly due to the lack of fullest understanding of the case, written so forcefully, though subconsciously, upon the physiognomy of the physician. Here it is in place to mention the value of a recent work, "Unconscious Mind," by Dr. Schofield of England, which elucidates the pith of this influence of mind over matter in a practical way. That favorable metabolic changes can accrue from a bright mental state, I have seen in not a few cases of melancholia where persistent efforts, as in conversation and music for the sufferer, was a win- ning card to cure. An intelligent nurse or attendant is a sine qua non for success here. There are two classes of acquired nervousness which should be judged from a civic or social point of view rather than from the medical aspect: A—Cases due to inevitable causes, such as worry over calamities in a family; and B—Cases following absolutely preventable causes, such as worry over occurrences of every day life which the high- strung American takes on almost with a studied effort. 4 F. Savary Pearce. There are distinct cases coming under both of these head- ings which must be carefully selected before the physician can hope for anything like success in the prevention of nervous and mental disease of the insidious types to which we are confining the paper. 1 shall now endeavor to bring out the salient points in cases to be recited where the advice given, being weighed and carried out by the sufferer thus instilled to hopefulness, wherein the suppression of dire results were pretty posi- tively avoided. Case I: Mrs. B., aet 40, always a healthy woman, in the better walks of life, who brought up a family with due indulgence, as a mother, and as a finale, sought the happiness of her daughters, naturally enough, through mar- riage. In this she had been successful, save in the case of the eldest daughter who was married with great ecIat to a man whom the mother, with a sudden shock, discovered was a dipsomaniac and the daughter was doomed to a life of mortification to say the least, in which the mother, our patient, shared ten-fold, and a melancholia followed which medicaments, change of scene, and the whole gamut of desirable methods of treatment, I am sure, will never quite overcome. The above case, which need not be detailed further, is an example of the "inevitable abortion" of endeavor to cure, so well phrased by our obstetrical con- frerres. On the other hand, 1 would feel certain of prompt recovery in this woman if the mental depression could be wiped away by regeneration of the son. Loss of her men- tal health will constantly be the fruit from such seed. The mind alone dominates this case. Case 2: Miss Y., aet 30, a subject of hystero-neuras- thenia of distinctly acquired type, due to the same baneful influence—an alcoholic brother. The patient has been completely restored to health since the abandonment of dissipation by the brother to whom she was entirely devo- ted. My efforts were to create a cheerful frame of mind through rest-cure and fattening. The brother did the real cure. Case 3: Miss R., aet. 34, a woman in perfect physical The Acquirement of Nervous Health. 5 health and without any heredity as to nervous disease whatever, through a life of lack of the initiative, and in which endeavor was never considered essential, at the age mentioned came to a mental status pitiable to observe, in which there was no interest in life and in which she felt there was physical breakdown dominating her state, from the extreme weakness on exertion, and palpitation of the heart, etc. The usual methods of the general practitioner, who did not attend the mental aspect, failed. Finally char- latanism was resorted to, with the result of greater com- plications in the case. With the careful elimination of organic trouble by a thorough examination, the patient was impressed with our statement that no physical disability existed. The plain advice of regulation of life with definite duties of an intellectual and physical nature, such as iight reading, rowing and calisthenics, have acted as sheet anchors for beginning a cure which seems will ultimately come. Case 4: Dr. K. is an example of that general nerv- ousness coming on at the age of 30 years in a man of athletic tendencies and good physique. He was a track runner of distinction in college days. From lack of proper proportion in his mental and physical work after graduation he became the subject of general nervousness—fidgetive- ness well expressing the motor excitability, while persistent disturbances of circulation was manifest by leaky skin and coldness of the extremities, while vertigo of distinct objec- tive type harassed him much in locomotion, but when an attack was forewarned, lying down would give relief by restoring the proper flow of blood to the central nervous system. Here was a case that by exclusion we decided was neurasthenic largely or an active (muscular) type. The man is of extreme intelligence and carried out our detailed advice—the one in a thousand. By cutting down tobacco to almost nil, slowing down his extreme muscular activity by which he was using up his nerve energy too rapidly, horseback riding and simple feeding, with regulation of hours of sleep to eight in twen- 6 F. Savary Pearce. ty-four, the physician is growing back to nervous health as rapidly as common sense methods will allow. The opposite is shown in the following: Case 5: W. B. H., aet 22, a young man of brains, a literary genius, and of but average physique, came to me a year ago suffering from headache, general restlessness of dream states and a lassitude out of proportion to the cause for it. His eyes and all other organs were normal. The patient had no vicious habits. Since elimination proved this acquired irritability of the central nervous system to be due to lack of physical build and exercise largely. Walking a half hour daily in the open air, light calisthenics, a free supply of proteid food stuffs and hot bathing to favor cir- culation in the skin, has wonderfully improved the man. What fully promised to be a nervous wreck twelve months ago, is now, to use his words, "calm and com- posed." It is, with no exaggeration, a very important event that this young person is saved to do a great work in lit- erature. The case has well repaid me in this thought alone; my best fee. The riddles of the nervous system are legion, but many can be solved, and scientifically. Case 6: I shall make a final word in briefly reporting the case of A. B., aet 19 years, seen in the practice of Dr. E. Pearce of Steubenville, Ohio, August 20th, 1901. Miss B. had evidently dreamed of burglars being in the house. She came to her father at night perfectly mute and making signs of her fright by the marauders. She had no convulsion and seemed quite composed in every way the next day when there was found nothing wrong with the vocal or other organs. There was no motor palsy anywhere but there did exist a segmental anaesthesia of both arms to shoulders. At the end of a week the patient suddenly began to talk and in a few days speech became normal and the loss of sensation disappeared entirely. It was proven that no burglars were in the house, but some of the girl's garments were seen out of the window through which she persisted they had descended to the ground. The girl was truthful. The Acquirement of Nervous Health. 7 This case probably represents one of unconscious men- tal impression, as to the fact of a dream auto-suggestion for her throwing the clothing out of the window, and for the suggestion likewise of her aphasia, due, as she persisted, to one of the men having slid a rod down her throat and stating she "could not talk." I have never seen such a case before, but it is valu- able to force the conclusion of conscious and unconscious mind action, a point much disputed in recent years by psy- chologists who could add much to their armamentarium of scientific facts by the advantage of practical studies at the bedside. The point that brings this case into place in this con- tribution is that this woman should be guarded against becoming a confirmed hysterical invalid by proper explana- tion of the case and thus clearing up the psychology of a rare condition spent on our patient. Conclusions: Many nervous and mental diseases have perverted function as a basis for development. The mental aspect must be recognized. Recognizing pathogenesis in this light and seeking eariy signs which are not now given suf- ficient attention by the profession (such as irritability of the motor and sensory nervous system—lassitude, forgetful- ness, etc., in a person of intelligence who tells you in the history that such changes in his life do occur) we can hope by this scientific borderland study to tend for regeneration of many people who will ultimately go into some of the graver organic system diseases, when it can not be truly said, "it is never too late to mend," to use words of the accurate novelist, Charles Reade. Short vacations, a trip on your beautiful lakes, or the quieting ocean voyage, canoeing, horseback riding, over- feeding with milk and plain wholesome foods, good company to aid digestion scientifically, if you please, music, bowling, golf, etc., all selected for the case in hand by careful somatic and mental study, will avail much in preventing general nervousness, the borderland of perhaps irreparable 8 F. Savory Pearce. nervous and mental disease; and that nervous health can be thus acquired in those who do not know (but would wish to if they could learn its value) by carrying out such advise given in the paper. A final word of appeal is made to you, gentlemen, to disseminate these practical facts among the laity. MANUAL STIGMATA OF DEGENERATION. By J. ELVIN COURTNEY, M. D., DENVER, COLORADO. OF the numerous stigmata which strike the eye of the trained observer, few are of more value than the congenital imperfections and malformations of the human hand, so visible and palpable is this member and so nat- urally does it fall under the examination and observation of the expert. These marks are of especial value in the absence of other and grosser signs, such as cleft palate, asymmetry of the cranium, and so forth. While it is not argued that all of the even notable defects of development of the hand portend serious psychical degeneracy, there are several of these defects seen often enough to attract atten- tion and impress the observer that they belong to persons with certain more or less pronounced mental obliquities, or predisposition thereto, and are to be seriously considered in forming opinions of the mental qualities of the individuals. In the prognosis in mental and nervous troubles and in predicting permanency of recovery from such affections the presence of these stigmata are decidedly unfavorable. The same applies to persons of the delinquent and reformatory class. The following are the most frequent and significant manual stigmata: Stub-thumb or abbreviation and clubbing of the last phalanx of the thumb; spur-little finger or marked shortening of the little finger, with or without deflection downward of the lost phalanx (better seen in X-ray photographs) and infantile nails, the nails being small, short, thin and disposed to flare and curl at the edges. Persons presenting these stigmata need not neces- sarily be delinquent nor defective, but are almost certainly [9] I0 J. Elvin Courtney. of neurotic temperament and liable to hypochondria, hys- teria and to become the victims of morphine or alcohol. The evolution to mechanical perfection of the thumb seems especially to have marked the ascent of man to that manual as well as mental supremacy which he holds over other animals. His nearest relative, the anthropoid ape, has a very indifferent thumb. And in man the abbreviation and stubbing of this member implies a stigma at least, of physical and psychical reversion to a lower type. In a number of measurements of the lost phalanx of the thumb when simply flexed at right angles to the joint above, the writer found average measurements 3.5 c.m. or about 1% inches for men and 3 c.m. or about 1¥» inches for women in normal persons. A number of measurements of neurot- ics' showed x/i cm. or about ^ inch of shortening. The little fingers in which pronounced stigmata appeared came only about midway between the last joint of the ring finger and the joint above; whereas normally the tip of the little finger comes about flush with the last joint of the ring finger. The lower hand in Figure 1 illustrates two of the con- ditions mentioned, abbreviation of the thumb and little fin- ger; the hand above is that of a normal person. The subject of this pho t o g r a ph has suffered from attacks of mania for twelve years, enjoying more or less an immoral life. The peculiarity of the thumb had been noted by the patient who said that a sister had the same and evidently the stigma was hereditary; another person with the same mark had a« insane and criminal father, and still another had an insane sister and was herself addicted to drink and perverted sexual feelings. Figure 1. complete re- missions of from four months to nearly two years. One woman with the thumb stigma was an habitue of morphine and liquor and led SEXUAL INVERSION AMONG PRIMITIVE RACES By C. G. SELIGMANN, M. R. C. S. ENG., L. R. C. P. LOND. Superintendent of the Clinical Laboratory, St. Thomas' Hospital, London. BUT few details of sexual inversion and perversion are known among savages, and it is commonly and tac- itly assumed that abnormalities of the sexual instinct are the concomitants of Oriental luxury or advanced civilization. Too often merely the grosser forms of perversion have been looked for or noted, the condition described by Moll as psycho• sexual hermaphroditism, in which, while the psychi- cal resemblance to the opposite sex colours the whole social life of the individual, there are also present traces of normal hetero-sexual instinct, being unrecognized or ignored. Among American Indians, from Alaska to Brazil, homo- sexual practices occur or occurred. Sodomy was prevalent among the Nahua (Aztec) and Maya nations* the latter tolerating if not systematizing its practice. Among savage races Bancroft, speaking of the Isthmian tribes of Cueba and Careba, says: "The caciques and some of the head men kept harems of youths who were dressed as women, did women's work about the house, and were exempt from war and its fatigues."* Again: "In the province of Ta- maulipa there were public brothels where men enacted the part of women,"§ while the modern Omaha have a special name signifying hermaphrodite for the passive agent, whom they regard with contempt.il Among the Aleuts of Alaska •Bancroft, Native Races of the Pacific Coast, vol. II, pp. 467, 677. UoiJ, vol. I. p. 774. ilM, vol. I. p. 635. iThlrd Annual Report of the Bureau of Ethnoiogy, p. 365. Washington. 1S84. [11] 12 C. G. Seligmann. certain boys, whom Holmberg* states were selected for their girlish appearance, are brought up as girls and deco- rated as women. Similar instances might be multiplied, but, apart from the last mentioned, which, according to Havelock Ellis, suggests the possibility of congenital inver- sion, they are all examples of the grossest forms of perversion, and no details suggesting that any of these are cases of congenital inversion are given. Similarly there is reason to believe that the paederasty practiced by certain New Caledonian warriors, which is stated to constitute a relationship more sacred than blood-brotherhood, is resorted to for convenience and perhaps for Malthusian reasons.t as it is among some Papuans of the western district of British New Guinea.! A somewhat different condition of things prevails among the Tupi, a Brazilian tribe in a low stage of civilization to whom Lomonacoll has devoted considerable attention. While noting that sodomy was prevalent in almost every local tribe, and that a class of men were met with whose func- tion it was to lend themselves to the practice, he states that among the Tupi many women took no husbands, devoting themselves for the whole of their lives to perpet- ual chastity, and quotes Gandavo§ to the effect that there are some women among those who decide to be chaste who will not consent to know men even under threats of death. They wear their hair cut in the same fashion as the males, go to war with their bows and arrows, and take part in the chase. They frequent the company of men and each one of them has a woman who waits on her, to whom she says she is married and "with whom she communicates and converses like man and wife." It seems probable that here, among a people addicted to sodomy and in whom here is no strong feeling against homo-sexual relations, •Quoted by Havelock Ellis and J. A. Symonds in Dal ktontrare Geschlechtsgefuhl. Lelpsic. 1896. tFoley: Bulletins de la Societe d'Anthropologle de Paris. 1879. 1Beardmere, Journal of the Anthropoiogical Institute, vol. xlz, 1890. ISulle Razze Indigene del Brasile, Archlvio per I'Antropoiogla e la Etnotogla, 1889 Fiorence. iHistoria da Provincia de Santa Crus, quoted by Lomonaco. lec. cit. Sexual inversion Among Primitive Races. 13 there is an element of true congenital inversion similar to that present in the sporadic cases among Papuans to be immediately described. While with the Cambridge Anthropological Expedition to Torres Straits and New Guinea several instances were met with in the Rigo district of British New Guinea where, unlike the Fly river district, the habitual practice of paed- erasty is unknown.* These cases occurred among a people practically still in their stone age and so uncontaminated by external influences that even white men's diseases had not yet obtained a footing among them. In the following notes the condition of the genitals is given on what is probably good authority, but in no case would it have been politic to have attempted to verify my informants' descriptions by actual examination. Three of the four cases alluded to were inhabitants of Bulaa, a considerable settlement built for the most part on piles in the sea. One of these had been dead for some time. In her, assuming the native diagnosis of sex to have been correct, there was maldevel- opment of the genitalia, while the remaining two Bulaa cases are probably pure instances of psycho-sexual herma- phroditism. Hiro, a female aged about 30 years, is a daughter of one of the most influential men of the tribe. She is rather taller and her figure is less rounded than that of the aver- age Bulaa women. The skin over her breasts is somewhat wrinkled, but apparently the glands themselves are nor- mally developed. Her thighs and buttocks are tattooed in the usual female manner and her genitals are said to be normal and the mons hairy. As to previous history, as a little girl she preferred playing boys' games which by all accounts she played remarkably well; as she got older she still preferred boys as companions and avoided her own sex. For a long time she resolutely refused to adopt the usual girl's petticoat and at puberty was only compelled by threats to»do so. For the next two years her conduct was not remarkable. Menstruation, which was said to be neither *Cf. Beardmore, loc. cil. 14 C. G. Seligmann. irregular nor scanty, occurred and has since been normal in character. At about the age of 16 years she aborted; since then she has lived with her mother and has refused at least three offers of marriage. As far as can be ascertained she has never had a lover of her own sex and since the abortion has lived a solitary life or has at least carried on no intrigue of sufficient duration to arrest public attention. She is said to be more intelligent than the average woman and carries weights man-fashion on her shoulders instead of by a band round her forehead as other women do. In the garden she uses the heavy digging stick (kai) for turn- ing over the soil, which is essentially man's work, women, as a rule, only weeding, planting, and digging yams. An instance of pseudo-hermaphroditism occurring two generations ago was well remembered and appreciated. The subject who, since she had connection in that capacity, was considered a woman, was said to have possessed both penis and vagina; there was some doubt as to whether she had testes. It was stated that she menstruated and passed urine per vaginam and that her breasts were small. She wore a modified petticoat, consisting of a short tuft in front and behind, and spent most of her time among the men of the tribe, with whom she took part in any hunting or fighting that was going on. Gima, aged about 30 years, is a "chief" much trusted by the government and very intelligent. He is thoroughly masculine in appearance and active, plucky, and energetic. Having become a man of importance and a firm supporter of the Government he now wears a jacket and short trous- ers. It is, however, a matter of common tribal knowledge that his thighs and buttocks are tattooed in the elaborate fashion peculiar to women, without which no girl is consid- ered marriageable. His genitals are said to be normal. He is said to have previously taken the passive part in sodomy soon after puberty, later he married, but had no children, and divorced his wife on the score of infidelity. He has since lived as a bachelor, it is stated to avoid women, and to have, at any rate till very recsntly, habitually taken the passive part. Sexual lnversion Among Primitive Races. 15 I am indebted to Mr. A. C. English, Government agent of the Rigo district, for notes of the following case, that of a man belonging to the Garia, an inland tribe which is gradually pressing down towards the coast from the foot- hills of the main range. Unase is aged about 50 years, unmarried, and is some- what doubtfully stated to have abstained from intercourse since soon after puberty. His breasts are normally devel- oped and there is hair on his chest; his genitals are normal and hairy; virile organ perhaps rather small; his voice is shrill. He habitually associates with women and accompa- nies them on their trading expeditions towards the coast, when he carries his "trade" slung by a band round his forehead as women do. He takes a woman's part in domestic and social life as well as in the work he does in the garden. In spite of this he has on one occasion joined a war party and bears on his back the tattoo marks which distinguish the successful homicide. With these cases may be compared the following occurring in Sarawak among a people in the barbarous stage. At Sibu on the Rejang river, Budok, a Mahomedan Milanau,* probably suffering from elephantiasis, asked for medicine for swellings in both groins. He refused examin- ation and it was noticed that he wore a veilt such as Malay women wear. His voice was soft, not shrill or treble; physically he was small-boned and of a somewhat delicate build, but not undersized, and on the whole mascu- line in appearance. He was said to have normal breasts and genitals, but not to care for intercourse, in place of which he took the passive role in sodomy. He sat with the women in the house and like them sewed and made clothes, baked cakes, and weeded the paddy fields. He wore women's clothes habitually and whenever possible. *H, Laing Roth ("'The Natives of Sarawak and British North Borneo." vol. I. p. 12) says: "The Milanaus are a quiet people, not Mahomedan, but dressing like the Malays and cultivating sago." Recently Mahomedanism has made considerable progress among them; there is, however, no reason to believe that It has led to or encouraged sexual perversion. ^Prostitutes at Kuching wore an exactly similar black veil. JUVENILE FEMALE DELINQUENTS.* By E. S. TALBOT, M.D., D. D. S. Chicago. MARION DE LORME lived to be one hundred and thir- ty-five (from 1588 to 1723) so that the Par- isians wishing to instance something which resisted the assaults of time cited her and the tower of Notre Dame. She buried four husbands and was over eighty before los- ing her freshness of mind or body. Ninon de L'enclos at eighty still had as glossy black hair as in youth, white teeth, bright eyes, full form and excited a violent passion in the Abbe de Chateauneuf a youth of twenty. Many Greek courtesans were celebrated even in old age such as Plangone, Pinope, Gnatone, Phryne and Thais. Historians maintain that Thais died at seventy without ever having abandoned her profession. Plutarch relates that she pursued a young Thessalian with whom she was in love into the temple of Venus whereupon the women of the country killed her, angry at her audacity, and jealous of her charms. Phryne when old, had lost nothing of her beauty and she exacted large sums to the day of her death, wittily describing the practice as "selling the dregs of her wine dear." The occasions which present themselves to draw the naturally normal woman into crime are, according to Lombroso, multiplied now by the higher education conceded to females but of which they can make no use by earning their bread in offices or professions. Many women of intel- ligence find themseves with nothing to show in return for •Continued from Alienist and Neurologist, October, 1901. [16J Juvenile Female Delinquents. 17 much expense and labor. They are reduced to want while conscious of not deserving it. Being debarred from the probability of matrimony owing to the ordinary man's dis- like to a well instructed woman they have no resource but in suicide, crime, or prostitution; the more chaste kill them- selves, the others sell themselves or commit thefts. Accord- ing to Mace, governesses are to be found in St. Lazare imprisoned for thefts of gloves, veils, umbrellas, pocket- handkerchiefs and other articles necessary for them to make a good appearance in school for whose purchase they can- not always earn enough. They have been driven to the offense consequently by the exigencies of their profession. The number of governesses who have no pupils is so great that a certificate, whether high or low class, becomes the case of suicide, of theft or prostitution. For centuries, as J. G. Kiernan* remarks, while man was the hunter and warrior, woman was the farmer, tool-maker, carpenter, tailor, tanner, shoemaker and decorative artist. Every art of civilized nations originated with woman. When hunting and war ceased to be the chief male occupations man intruded on arts created by woman. Evolution in biology (an advance from the indefinite homogeneous to the definite heterogeneous with the loss of explosive force,) consists in the creation of checks; these in man result in the creation of a secondary ego, the source of all morality. So far as the race is concerned, the crea- tion of this secondary ego is most important in woman. Checks will not be created when woman is secure in the "home," gynaseum or harem from evil. Society, as Voltaire remarks, is created by women. The nations which seclude women are unsociable. Seclusion hence destroys individ- uality, the source of ethical advance. The question arises whether, as seems indicated, the increase of other criminality at the expense of prostitution be not an expression of advance. In a certain sense, as even Havelock Ellis admits, this is true. Lombroso has crudely recognized the same fact. While in primitive conditions prostitution in the modern sense was exceptional since the •Alienist and Nburologist, 1895. 18 E. S. TaIbot. woman for religious reasons or at the demand of her hus- band and relatives, gave herself for hire, still there was much sexual laxity consistent with tribal ethics which were not of those of civilization. Primitive man became criminal in civilization not from its degrading influence but because he was judged by new standards. Under such conditions crime would take the line of least resistance in the weak. Hence what women had formerly done for religion or at parental or family dictation, they would do for their own advantage. Under Greek civilization, the only career for cultured women was, prior to the time of Pericles, that opened by prostitution, whence came the Hetarai. To a certain extent conditions of primitive life foster the employ- ment of sexual weapons by women as a means of securing power or even life. This condition however, while the germ of civilized prostitution, had not its abject features since the women that adopted it were rather above than below the then existing ethical standards. Under primitive and even under comparatively high Aryan and Semitic standards, woman was the property of man. Prostitution lost its immoral nature when commanded by the husband or father who had the right to dispose of his property as he would. Woman under such conditions, was guilty not of prostitution, when she gave herself either in marriage or without sexually for purposes of gain, but of theft.* In analyzing the inter-relation of prostitution and criminality these facts must be taken into consideration. The view that criminality was an advance on prostitu- tion is borne out by the valuable researches of Pauline Tarnowskyt on the Russian prostitutes and female thieves. After careful analysis of the data obtained she expresses the opinion that: "Professional prostitutes are incomplete be- ings affected by arrest of development generally due to morbid heredity and present mental and physical signs of degeneracy in accord with their imperfect evolution. Female thieves are less tainted with heredity than prostitutes and have fewer signs of degeneracy. The intellectual and moral *Letourneau Evolution oj Marriage. tEtudei Anthropometriqucs sur let Voleuies et Prostitutes. Juvenile Female Delinquents. 19 level of the female thief exceeds that of the prostitute. She has more self-respect, more intelligence, is more ener- getic and struggles better in the contest for existence. She is less lazy and more given to work which she does not fear. However incorrigible be the professional thief and however numerous her crimes,she cannot commit and repeat them every hour of the day, it being assumed that these and prostitution are equally vicious unities. The thief sins but by intervals while the prostitute in a house sells her body without relaxation, accepts her abject trade agreeably and does not want to change it. Laziness and absence of moral sense are the principal traits characteristic of the prostitute. The thief generally gives evidence of a more stable and serious disposition than the prostitute. She is less given to alcoholic abuse and in confinement can be more readily induced to work." The confidence operator type of the prostitute is excel- lently illustrated, as Harriet Alexander* has pointed out, in Alphonsine Plessis idealized by Alexandre Dumas in CamiIle. Her paternal grandmother who was half pros- titute, half beggar, gave birth to a son by a country priest. This son was a kind of country Don Juan, a peddler by trade. The maternal grandmother was a nymphomaniac whose son married a woman of loose morals by whom a daughter was born. This daughter married the peddler and their child was Camille. The idealized Camille declines an opportunity for a higher life offered her by a Duke whose daughter she resembles. She prefers the glitter, glare and boisterousness of her life to the settled conditions of normal civilized existence. The religiosity which she displayed is very frequent among female criminals and prostitutes accord- ing to Lombroso, Marro, Ferrero, and Havelock Ellis. This results from, as Spurgeon points out in one of his sermons, that strange yet natural law by which excessive religion is next door to sensuality. Emotional religious appeals as the Rev. J. M. Wilsont shows, are far from rooting out sensu- ality and even stimulate increased licentiousness. In the *Medical Standard Vol. XIV P. 43. Vournal of Education. 1881. 20 E. S. Talbot. case of Camille, as in others, this religiosity led to the term Lorette being applied to the French demi-monde during the second empire. This title was given because their fav- orite church was that of the Virgin of Loretto. The same phenomena have been noticed among female criminals. The criminal, as Havelock Ellis remarks, when not superstitiously devout is usually stupidly or brutally indifferent. The phenomena of religiosity as might be expected is peculiarly frequent among sexual offenders. Sixty-one per cent of these are frequenters of church. Among 200 Italian mur- derers Ferri did not find one who was irreligious. When a woman who had strangled and dismembered a child in order to spite its relations heard her sentence of death pronounced, she turned to her lawyers and said: "Death is nothing. It is the salvation of the soul that is every- thing. When that is safe, the rest is of no account." The apparent increase of crimes among women is not due solely to the influence of education or of the removal of seclusion but to the fact that criminal woman who, formerly secluded, induced man to commit crime for her, is now, under improved social conditions, compelled to commit her own crimes. This is especially the case, as there is less chance for detection than there was under conditions where as in Spain and elsewhere women are closely watched. Careful study of sex in crime indicates that the crime rate of anti- social criminality falls among men as it rises among women. With the growing enfranchisement of women there is also a greater tendency to hold them to stricter accountability and hence a greater tendency to increase in the registration of criminality. With the growth of sentiment against drunkenness many criminals are now made by law from offenders formerly ignored. Unfortunately also early statis- tics are very defective, since a great many sentences were suspended if criminals, especially women, consented to go beyond the seas. In dealing with the influences of educa- tion it must be remembered that many moral defectives are now able to obtain education which formerly was inaccess- ible to them. Education has not increased crime, but more criminals are educated. Juvenile FemaIe Delinquents. 21 For anthropometric purposes 1 began a series of inves- tigations along the lines already indicated at the State Home for Female Juvenile Offenders at Geneva, Illinois. For the data here employed I am deeply indebted to Mrs. Ophelia Amigh, its efficient matron, and to Drs. H. L. LaBaum, Ava Michener and Mary C. Hollister. The mental side is the first that attracts attention. There was but one demonstrable case of insanity. This was of the periodic type and was not benefited by hospital treatment. The insane source of the alleged criminality was discovered in the State Home, not by the parents or court officials who sent the subject there. No demonstrable motor expressions of epilepsy have been observed, albeit some of the mental phenomena mani- fested, decidedly suggest epilepsy. The craving for excite- ment, for intoxication, for uproar, which is such a charac- teristic of primitive man and of frontiersmen, finds among criminals its chief satisfaction outside the prison, in the love of orgy which, according to Ellis, is confined in its extreme forms to the criminal and his intimate ally, the prostitute. Ellis here puts things too strongly since this condition, an expression of unstable equilibrium, crops up very frequently under conditions of strain among people who certainly do not belong to the criminal class. Indeed in many natures strain from conventionality produces the effect of the prison on criminals. In Germany periodic explosions in prisons are known as Zuchthaus-knaII and have been described by Delbruck and Krafft-Ebing. In the English-speaking countries they are comparatively common and were described by Eliza Farnham* in Sing Sing prison over half a century ago. Sometimes the prisoners know when the fit is coming on and will ask to be locked in refractory wards themselves. The younger they are the worse they behave. Some years ago in the Illinois State Home then under charge of a Christian Scientist, an insur- rection drove nearly all the officers from the place. Nerve storms are still frequent in this institution. In inmates of a low order of intelligence personal violence rather than ^American Journal of lntanity. April, 1846. 22 E. S. Talbot. simple destructiveness often occurs. These outbreaks have a tendency to spread because they are often stirred up for mischievousness. Like Dr. Pauline Tarnowsky, Drs. L. H. LaBaum and Ava Michener have found that the onset of puberty, so far as the menses are concerned, displays many irregular- ities. The usual influence of institutionalism on arrest and irregularity of menstruation has here to be taken into account. Allowing for this, menstruation often ceases for a month or two or a year after it is once established. This was long ago noted by Du Chatelet* among the same class in Paris sent to the reformatory convents. The girls thus affected are in perfect health and show no ill effect from the cessation. The menstrual flow commences again with- out the aid of medicine. Some of the girls who have been in the Home since the age of 10 or 11 years have never menstruated, yet are robust, healthy girls, nearing the time for their final dismissal (the age of 18) from the Home. It is a noteworthy fact that among many primitive races menstruation displays many irregularities.t Cook, the ethnologist of the Peary expedition, found that menstru- ation among the Eskimo women only began after the age of 19 and was usually suppressed during the winter months. Lapland and Greenland women usually menstru- ate every three months or but two or three times a year. On the Faroe Islands menstruation is frequently absent. Among the Samoyds menstruation is so slight that its exist- ence has been denied. Among the Guianas of Paraguay menstruation is not only slight in amount but the periods are separated by long intervals. According to A. B. Holder, the full-blooded Indians of Montana do not menstruate as freely as white women.t Among the naked women of Tierra del Fuego there are no physical signs of the menses. From time to time, cases appear in American medical liter- ature in which healthy women resemble the Eskimo and Fuegians in this particular. •American Journal oj Obstetrics. 1892. fLa Prostitution. XPsycholoty of Sex, vol. II. Ellis. Juvenile Female Delinquents. 23 Of the inmates of the institution examined, one began menstruating at 9, two at 10, two at 11, twelve at 12, thirty at 13, twenty-eight at 14, fifteen at 15, and eight at 16. These figures differ from those given by Pauline Tar- nowsky. Two per cent began at 11, fourteen per cent at 12, fourteen and sixteen hundredths per cent at 13, fifteen and thirty-three hundredths per cent at 14, nineteen and thirty-three hundredths per cent at 15, twenty and sixty- six hundredths per cent at 16, eight and sixty-six hun- dredths per cent at 17, three and thirty-three hundredths per cent at 18, and two per cent at 19. Forty per cent of Tarnowski's prostitutes had begun menstruation between 11 and 15. Ninety per cent of the Geneva juvenile offend- ers had begun menstruation between the same periods. There are therefore striking differences as to the late and early onset of menstruation between the Chicago and the St. Petersburg cases. Neither climate nor early sexual knowledge will account for these differences. It is true that Joubert* of Calcutta claims that early menstruation in the Hindoos is due to precocious sexual knowledge and early exposure to sexual excitement. From the early mar- riages of the Hindoos and the phallic element of their wor- ship these conditions are obviously present. To them many of the Indian tribes which menstruate late ascribe the onset of menstruation. Such conditions are present in all large cities in slum districts where the population is originally of ■ural origin. In all probability atavistic peculiarities when lot due to sexual precocity, the product of arrest at the enile ar simian epoch of intra-uterine existence, are of nfluence here. The influence of irregular sexual life possibly depend-