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 NERVOUS AND MENTAL DISEASE MONOGRAPH SERIES No. 24 
 
 STUDY OF ORGAN INFERIORITY AND 
 ITS PSYCHICAL COMPENSATION 
 
 A CONTRIBUTION TO CLINICAL MEDICINE 
 
 BY 
 
 DR. ALFRED ADLER 
 
 OF VIENNA 
 
 AUTHORIZED TRANSLATION BY 
 
 SMITH ELY JELLIFFE, M.D. 
 
 NEW YORK 
 
 THE NERVOUS AND MENTAL DISEASE 
 
 PUBLISHING COMPANY 
 
 1917
 
 NERVOUS AND MENTAL DISEASE 
 MONOGRAPH SERIES 
 
 Edited by 
 
 Drs. SMITH ELY JELLIFFE and WM. A. WHITE 
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 NERVOUS AND MENTAL DISEASE PUBLISHING COMPANY
 
 no 
 
 wfi 
 
 PREFACE 
 
 The purpose of this book is to add to clinical rppHirin/* a 
 principle of research. From the completeness and the import of 
 these early results I am sure that I have come upon very fruitful 
 territory. 
 
 To me, moreover, it was an attractive task to see our benumbered 
 and thwarted conceptions of disease completely dissolved ; to be able 
 to observe human pathology in its making. 
 
 Many a valuable bit of knowledge has supported my theory of 
 the inferiority of organs. I have been unable to give acknowledg- 
 ment to all at the proper place, as I should have liked. In this paper, 
 in addition to the authors named, the range of thought of Martins, 
 Rosenbach, Exner, Bering, Obersteiner, Haeckel, Schwalbe, and 
 many another has played a large part. 
 
 This work is to count as a beginning. Perhaps, at some future 
 time, I shall be permitted to make the connection with clinical medi- 
 cine, with psychology, and pedagogy still closer by bringing together 
 all previous works on the subject. 1 
 
 1 The author has advanced this purpose in his monograph on the " Nerv- 
 ous Character," a translation of which has been published by Drs. Glueck 
 and Lind.
 
 CONTENTS 
 
 PACK 
 
 INTRODUCTION vii 
 
 CHAP. I. OUTLINE OF THEORY ON ORGANIC INFERIORITY. . . i 
 
 CHAP. II. HEREDITY 12 
 
 CHAP. III. ANAMNESTIC DEMONSTRATION 21 
 
 CHAP. IV. MORPHOLOGIC INDICATIONS 25 
 
 CHAP. V. REFLEX ANOMALIES AS INDICATIONS OF INFERIOR- 
 ITY 38 
 
 CHAP. VI. MANIFOLD ORGANIC INFERIORITIES 50 
 
 CHAP. VII. THE PART PLAYED BY THE CENTRAL NERVOUS SYS- 
 TEM IN THE THEORY OF ORGANIC INFERIORITY 
 PSYCHOGENESIS AND FOUNDATIONS OF NEUROSES, 
 
 AND PSYCHONEUROSES 56 
 
 CHAP. VIII. BIOLOGIC POINT OF VIEW IN THE THEORY OF OR- 
 GANIC INFERIORITY 67 
 
 APPENDIX: THE INFERIORITY OF THE URINARY APPARATUS. 
 FATE OF ENURETICS AND THEIR DESCENDANTS 70 
 
 INDEX 87
 
 INTRODUCTION 
 
 An examination of the diseases of the urinary apparatus can be 
 very extensively carried on so far as their symptomatology is con- 
 cerned. In renal pathology, as in all other diseases, the schema of 
 symptoms is built up empirically, and accordingly rests on a firm basis. 
 It is richly enough equipped to lead the diagnostics of renal dis- 
 eases along safe paths. The compass is at once reduced, however, 
 when the examination is directed towards etiology. The theories of 
 the causes of renal diseases read like a short collection of truisms, 
 in which terms such as predisposition, chill, poisons, infection, dis- 
 turbance of the circulation appear and reappear and play their part, 
 just as they do in other organic diseases. 
 
 The fact that a definition of these causal factors themselves Is 
 notably lacking ought not even to be particularly emphasized. 
 More important is the fact that there is so little positive material 
 available to decide the question concerning the localization of disease 
 in the kidney. What has been emphasized, the sickening of the kidneys 
 through poisoning or infection as well as through the progressive 
 changes in affections of the circulatory system, all this is in line with 
 the basal concepts of pathology, for the urinary organs are affected 
 like all others proportionately to their relation to the disease centres. 
 
 The conditions in those cases which one is forced to designate 
 as "genuine," or "primary" diseases of the kidney are less clear. 
 A long list of diseases falls under these heads. They all have 
 this in common, namely, that the final cause of their pathologic 
 form cannot be traced beyond the kidney, and that a more remote 
 or even an exogenous etiology from the very name seems out 
 of the question. Here may be reckoned, if all other distinguish- 
 ing indications are put aside, true contracted kidney, renal tumors, 
 localized lues and tuberculosis, cystic degeneration, nephrolithiasis, 
 nephralgie hematurique, renal hematuria, floating kidney, imper- 
 fect development and hypoplasia and analogous diseases in the 
 pelvis of the kidney and ureter. I must add also that the genetic 
 course of development in secondary diseases must not under any 
 consideration be deemed exhausted by reference to the causa 
 movens, but, rather, in these cases too, the selection of the kidney 
 is determined in a hitherto unexplained manner. 
 
 If one turns aside from an explanatory attempt which limits
 
 Viii INTRODUCTION 
 
 itself to causes of disease which are purely local and situated in the 
 kidney, one can divide the notions on localization of disease in the 
 kidney synoptically into three groups, of which each one has ref- 
 erence to secondary as well as primary diseases. The one hypoth- 
 esis tries to make the selection of the kidney as center of the disease 
 tenable on the ground of " nephrotoxic " action of a number of 
 poisons. The strength of this hypothesis lies in experimentation, 
 as well as in a number of recorded cases which bring to mind a 
 noxa especially harmful to the kidney, such as is present in scarlet 
 fever, diphtheria and other infections. On the other hand it is in- 
 applicable to a great number of renal affections, does not offer an 
 explanation for the kidney's remaining unaffected upon the appear- 
 ance of renal poisons, and should only be generalized with the utmost 
 caution on the basis of animal experimentation. At any rate we 
 know of no poison at present that invariably harms the kidneys, 
 and at the same time, only the kidneys. A second conception sees 
 the cause of the greater number of renal diseases in the exposed 
 position of the kidney as an organ of excretion through which the 
 waste material of the body is constantly passing. This hypothesis 
 is supposed to serve as a sufficient explanation for most of the renal 
 affections. Its application is surely greater and its bearing unques- 
 tionable, since it has to do, not only with true toxins, but also with 
 the increase of waste products and with heightened external de- 
 mands upon the kidney. But even with this conception we are not 
 in a position to give satisfactory explanations. It also leaves us in 
 the lurch when we ask why, with the admission of the premises, 
 that is, the presence of bacteria in the blood, of toxins and poisons, 
 of chronic metabolic anomalies, of alcoholism, pregnancy or chill, 
 the kidneys are so often found healthy. It also fails us in at- 
 tempting to explain one-sided disease of the kidneys, as in cases of 
 tuberculosis, lues, and tumors. These and other inadequacies force 
 us to a third view, which will be championed, and with good cause, 
 I believe, in this book, a conception according to which most renal 
 diseases are caused by a fundamental inferiority of the urine-ex- 
 creting apparatus. 
 
 That such a condition may be accepted for many cases, and plays 
 its part in renal pathology is probably universally recognized. The 
 appearance of true renal diseases can not be sufficiently explained 
 by the acceptance of hypothetical poisons of metabolism. Above 
 all, the pathological findings, as well as the clinical course, both con- 
 tradict chronic poisoning. This view is refuted almost as strongly 
 by the frequently long duration and by the numerous hereditary ap-
 
 INTRODUCTION ix 
 
 pearances. In the same way, albuminuria of puberty, renal hemo- 
 philia, cystic kidney, the pregnancy kidney, orthostatic albuminuria, 
 and albuminuria connected with constipation are all indications, 
 which one can hardly overlook. But one of the strongest argu- 
 ments for inferiority of the urine-excreting apparatus as the cause 
 of renal diseases, is heredity, which is so often found in renal pathol- 
 ogy. At most it is still questionable whether certain of these cases 
 of albuminuria should be considered diseases. The difficulties in 
 determining this question will not be denied, for the transition 
 from mild anomalies in the condition of the urine, to severe forms 
 of renal diseases, has not yet been sufficiently studied. But even ces- 
 sation for a number of years or improvement of the phenomena, 
 whether under medical treatment or not, has no conclusive force. 
 One can, however, justly emphasize that the acceptance of inferi- 
 ority of the kidney as the cause of renal diseases, regarded from the 
 pathological viewpoint, has many probabilities in its favor, that the 
 transition from abnormal development and functional anomalies to 
 disease can be brought about in the shortest time, and that in many 
 cases it becomes questionable just where the aspect of the disease 
 begins for us. The "physiological" albuminurias play the same 
 part there as, say, the cystic kidney, which can formally appear 
 overnight as a severe illness, after it has existed for some time with- 
 out any symptoms. 
 
 By means of an examination of this sort, from the standpoint 
 of an inferiority theory, these previously mentioned affections of 
 the urinary apparatus attain their proper place in pathology for the 
 first time. Their significance in the field of renal pathology comes 
 out more clearly through the demonstration of a fundamental in- 
 feriority. At the same time it seems necessary to conduct more 
 searchingly the examination of constitutional organic anomalies as 
 the foundation of many, perhaps of most diseases, so that the diag- 
 nostician may draw strong support from the facts of the inferiority 
 theory. The value of this view, however, extends to the study of 
 the symptoms also, and to experimental pathology. In regard to 
 the latter, it determines once for all the differences between inferior 
 and normal organs and thus interferes with the unlimited trans- 
 ference of results of animal experimentation to human beings, and 
 of experiences with well people to sick ones. In regard to the 
 first, it seeks to establish a still closer bond between the empirically 
 determined symptoms, and the diseased organ, and makes related 
 organs responsible for symptoms of a more widespread organic 
 disease. There will be particular stress laid on personal prophy-
 
 X INTRODUCTION 
 
 laxis in all those cases where it is possible to deduce organic in- 
 feriority, where signs of disease have not been already proved. 
 Just as is the case at present, when diseases in the parents arouse 
 suspicions in regard to the children. We must determine first of all 
 for therapy whether the inferior organ should be and can be, by 
 means of any sort of a course of treatment, aroused to sufficient 
 function and eventually to additional development, a question to 
 which one can often answer yes, in the case of young people, but 
 which with older patients must frequently be answered by no. The 
 answering of this question will, however, usually call for a deeper 
 knowledge of the nature of the inferiority in question, and its sig- 
 nificance for the patient concerned. If one is obliged to give up 
 an active cure, or training, then the laws of a protective plan 
 of treatment rest, relief come to the fore. Finally, in making the 
 prognosis, quoad vitam, or sanationem, the inferiority theory, like- 
 wise, guarantees valuable aid. From the point of view now resorted 
 to, not only the sum of the phenomena presenting themselves, the 
 phases, so to speak, of the contest, will have to be taken into con- 
 sideration, but the valuation of the organ has also to be effected, 
 and we must fix our eyes upon the relation of this value to the dis- 
 ease-exciting force. 
 
 These explanations will serve to substantiate the fact that a 
 study of the inferiority of organs is at the foundation of some of 
 the most important problems of pathology. In the following pages 
 I shall try to establish that this theory may claim to be considered 
 as a valuable " heuristic " method on the basis of the characters or 
 conditions that underlie it.
 
 STUDY OF ORGAN INFERIORITY AND ITS 
 PSYCHICAL COMPENSATION 
 
 CHAPTER I 
 OUTLINE OF A THEORY OF ORGAN INFERIORITY 
 
 After having attempted in the previous pages to sketch the 
 great significance of a study of organ inferiority in renal pathology, 
 to which we will add a few special additional illustrations in the 
 supplement, we find ourselves called upon to enlarge the domain of 
 our research and to take into consideration all of the organs. We 
 must do this so much the more, as, on the one hand, the argument 
 which gave us the authority for declaring the inferiority of the 
 urine-secreting apparatus one of the fundamentals of renal pathol- 
 ogy, can be made to apply to all other organic diseases, and on the 
 other hand, the pathological phenomena of the diseased kidney can, 
 in an analogous manner, be demonstrated in the whole field of pathol- 
 ogy. Chronic transformation of the parenchyma, pathological form of 
 the supporting tissue, cystic degeneration, formation of concretions, 
 localization of inflammatory and neoplastic tumors, malformation, 
 imperfect development, diminished development in the whole ap- 
 paratus or in parts of it recur in all or several of the organic 
 diseases, and the theory of inferiority always seems called upon to 
 complete the otherwise insufficient etiology. 
 
 We find analogous transformations in the liver, in the pancreas, 
 in the thyroid gland, in the genital tract, in parts of the digestive 
 tract, the respiratory and circulatory systems, and in the central 
 nervous system. A great number of these diseases are marked by 
 characteristics which are emphasized in renal diseases, such as hered- 
 ity, chronic course of the disease, typical localization within the 
 organ, an insufficient etiology supported neither by poisons nor bac- 
 teria, but they can easily be put into a framework of a theory of 
 inferiority. This is the case in the pathology of the thyroid gland, 
 the etiology of which has proved itself quite insufficient, but which 
 corresponds to all the heretofore mentioned conditions of an in- 
 feriority theory, particularly that of heredity. The macroscopic as 
 well as the microscopic pathological changes of the liver show phe-
 
 2 STUDY OF ORGAN INFERIORITY 
 
 nomena analogous to those seen in almost every case of renal dis- 
 ease, for which reason the primary diseases naturally interest us 
 most. 
 
 It seems superfluous to us, further, to point out in detail how 
 certain transformations may be found in every individual organ, 
 since this is really a problem clearly enough set forth in general 
 pathology. Only the lack of satisfactory etiology will be empha- 
 sized in this connection. On the other hand, the question which is 
 raised in this paper, and which we are trying to solve, asks rather, 
 what reasons there are for the fact that certain diseases attack just 
 a certain organ. The solution accepted by us, which takes a primary 
 inferiority of this organ as a basis of the disease, is at one with the 
 opinions and researches of many authors. In this question we can, 
 perchance, only claim to have undertaken the study of organ inferior- 
 ity more comprehensively, and to have considered its significance of 
 greater import. A greater objection might however be raised against 
 the further declaration that other diseases, too, not considered true 
 diseases, such as infectious diseases, and " adventitious " diseases, 
 often require, or at least are dependent upon the assumption of or- 
 gan inferiority in their course. A still greater number of diseases 
 might be mentioned at this point, as, for instance, tuberculosis, 
 which is probably always localized in the inferior organ, an assump- 
 tion which, if conclusively established would bring many of the 
 doubtful questions relating to heredity, place of entry, and paths of 
 infection, immunity and therapy, nearer to a solution. The colon- 
 ization of Loffler's bacillus and other microorganisms in the pharyn- 
 geal space, of the Frankl-Weichselbaum diplococci in the lungs, the 
 agents of typhoid, cholera and dysentery at definite spots in the 
 intestine, and many other infections, likewise, fall under this head. 
 At the same time the part that bacterial invasion has played should 
 not be denied. But the acceptance of an inferiority of the diseased 
 organs seems particularly assured, since the presence of many patho- 
 genic microorganisms can be demonstrated in well people. To be 
 sure, one can often expect only obscure signs of inferiority, in fact 
 in a number of these diseases the illness itself and its course must 
 be considered, for the time being, as evidence of inferiority. This 
 causes us to drop the conception of " absolute " inferiority for these 
 widely spread diseases, and to introduce the term "relative" in- 
 feriority, which is of value, be it temporarily or only in regard to 
 certain causes of disease. As regards tuberculosis, to be sure, the 
 proofs of primary inferiority of the lung, or of other attacked 
 organs, seem to be abundantly present. The very appearance of
 
 AND ITS PSYCHICAL COMPENSATION - 3 
 
 heredity makes this more easily acceptable. Likewise the frequently 
 typical localization in the lungs, kidneys, joints and brain. As a 
 matter of fact, citations may be quoted which give information in 
 regard to certain arrests of development, as those of Frankl, Schick 
 and Sorgo, statements which we can without further ado classify 
 with the signs of degeneration which are emphasized later on. 
 
 With reference to diabetes, epilepsy, tumors, chronic alcoholism, 
 obesity, cretinism, and a few other diseases, I undertake to deter- 
 mine, after looking through a considerable amount of material, their 
 position with reference to the study of organ inferiority. A little 
 series of observations has suggested to me to consider these diseases, ^ 
 also, as built upon a foundation of organ inferiority. 
 
 The role of chance in diseases of inferior organs is surely not as 
 great as is commonly thought. One comes in contact, at least, with 
 cases that strike one so remarkably that a greater number of them 
 succeed in convincing one that their determination has been differ- 
 erently and more strictly given than by mere chance. One of these 
 cases I will present in the following. Ladislaus F., 8 years old, 
 was injured in August of the year 1905, by a pen which went into 
 the outer upper quadrant of the lejfteyeball, and reached through 
 the conjuctiva bulbi into the sclera. The patient had come too close 
 to a schoolmate who was brandishing a pen, yet neither of the boys 
 could be accused of malevolence or particular inattention. The 
 wound healed with slight reactions. In October of the year 1905, 
 the boy again presented himself with a coal-splinter, which a gust 
 of wind had blown into his eye, imbedded in the cornea of his left 
 eye. After extracting the foreign body the wound soon healed. 
 In January, 1906, the patient again received a prick in the left eye, 
 which was caused, just as on the first occasion, by a schoolmate 
 with a pen he was using, and which was about I cm. below and inside 
 the first punctured wound. This wound also healed like the first, in a 
 short time, leaving an ink-tinged scar. One might think that all this 
 was purely bad luck. I was able to ascertain the following: The 
 maternal grandfather suffered from dia.bp.fir iriHs and was for a 
 long time under the care of an oculist. The mother had convergent 
 strabismus, likewise the patient's younger brother, and both had 
 hypermetropia and diminished acuteness of vision, which could not 
 be accurately demonstrated owing to the inattention and lack of in- 
 telligence of the boy. One of the mother's brothers was troubled 
 by numerous recurrences of conjunctival eczema, and had con- 
 vergent strabismus. Our patient had full acuteness of vision, 
 hypermetropia to a slight degree, but showed a lack of the conjunc- 
 tival reflex in both eyes.
 
 4 STUDY OF ORGAN INFERIORITY 
 
 ^" t 
 
 I do not wish to deduce too much from this case. Neverthe- 
 less it seems certain to me that one must accept an inferiority of 
 the organ of vision in this boy, which is pretty well established by 
 heredity, the different varieties of illness in his relatives, partly of 
 inflammatory, partly of functional nature, and the deficiency of the 
 reflex function of the conjunctiva and the poor protection of the| 
 eyes, a fact which seems to me to be related in some not yet wholly 
 explained way to the deficient reflex action. At this point I must 
 also add that under adequate psychical conditions, by means of 
 greater activity on the part of the psyche, the above mentioned in- 
 feriority of the eyes may be made good. The boy can learn by 
 experience and can hide the partly organic defect by psychical ex- 
 ertion. The transition between nrganir inferiority a'nd osvdalcal 
 compensation becomes^OWiipTylitiiibitJle in such cases. But there 
 can also be no question that from the nature of the psychical com- 
 pensation the traces of the redeemed organic inferiority remain 
 unobliterated, and that, for example, in the above-mentioned case, 
 the protection of the eyes must have moved into the field of con- 
 scious awareness, and in this manner the visual character of the 
 individual experienced a particular strengthening. But more of 
 this later. 
 
 Meanwhile permit me to add, in this connection, the following 
 about the nature of organ inferiority, which seems already to have 
 been elucidated here and there : For the purpose of a simple and dis- 
 tinct arrangement, we shall name only two forms in which the in- 
 feriority of an organ expresses itself, morphologic and functional 
 inferiority. Both are present at the same time in the majority of 
 cases. I should like to designate as "relative" inferiority, a third 
 form, upon which I shall lay little stress. This declares itself only 
 in the case of illness and becomes recognizable only under increased 
 demands or following upon systematic tests. 
 
 i. Morphologic Inferiority: One can point out as deficient the 
 development of the shape of an organ, its size, its individual por- 
 tions of tissue, individual cell complexes, of the whole apparatus 
 or of limited parts of the same. A certain probability, which is in 
 accord with biological conditions, would have it appear that funda- 
 mentally just the most highly developed, differentiated cells and cell- 
 complexes have come out the worst, while the tissues of lesser 
 capacity, which owe their development to an earlier embryologic 
 epoch, may be normally or even super-normally developed. The de- 
 ficiency will concern first of all those portions of tissue which as 
 secretory, nervous elements, protective tissue, excretory ducts or
 
 AND ITS PSYCHICAL COMPENSATION _ 5 
 
 supply channels, guarantee the full development of the function. 
 When life activity begins and with it the innumerable sources of 
 stimulus of energy and metabolism, the remaining fetal or postem- 
 bryonic tissues will experience a great demand and a sufficient sud- 
 den impulse to growth. Their final formation will, to be sure, not 
 be that of normal fetal development, but will be enough to insure 
 the functions necessary to life. In relation to the life and health of 
 the individual, the consideration is, that one of his organs has to 
 perform the functions necessary to the economy of the organism 
 with a lesser stock of tissues or one less capable of resistance. 
 With satisfactory structural material and sufficient provisions it 
 is often possible to master the work. But just as often, perhaps, 
 the hour comes when the insufficiency of the organ is revealed, 
 when the external and internal hindrances can no longer be con- 
 trolled. The normal structure and wear and tear of the organ 
 give place to regressive phenomena, which are just as much deter- 
 mined in their nature by the morphologic inferiority of the organ, 
 as by the special causes setting the disease in action. The moment 
 at which the function necessary to life fails is relative. It is accord- 
 ingly not at all surprising to find that at times inferior organs suffice 
 for a complete lifetime. 
 
 From the conditions of morphologic inferiority of an organ the 
 cause of which is always fetal defect of development, the following 
 conclusions may be positively drawn : 
 
 1. Since the fetal defect in development is brought about by in- 
 herited or acquired properties of the spermatozoon or ovum the 
 hereditary character of organ inferiority must stand out in a par- 
 ticular fashion. The heredity may not always be exhausted in the 
 morphologic inferiority of one and the same organ, it can, as will be 
 later shown, be proved by functional deficiency, by inferiority of a 
 second organ, as was pointed out before, or by cases of illness 
 [" relative " inferiority] among relatives. 
 
 2. Since the greater number of organs are withdrawn from direct 
 observation we are often compelled to infer possible inferiorities 
 from anomalies in their size, form, and position. An extremely im- 
 portant makeshift is presented in the functional anomalies which 
 should be considered in conjunction with other characteristics of 
 organ inferiority as authorized signs of inferiority. Directly per- 
 ceivable to the eye and sense of touch are the organic inferiorities 
 lying close to the outer integument and often standing in relation 
 to it. These have passed up to the present day under the name of 
 external signs of degeneration, or stigmata. They represent for
 
 6 , STUDY OF ORGAN INFERIORITY 
 
 the greater part nothing more than the visible expression of the in- 
 feriority of the related organ, whereupon in the individual cases, at 
 all events, the question always arises as to how far into the deeper 
 part of the organ the inferiority extends. 
 
 3. From the fetal character of the morphologic organ inferi- 
 ority, from the embryonic lack of material which we think causes 
 this, it follows that frequently manifold organ inferiority must occur 
 which can be explained either by local difficulties or by deficiency 
 of material extending through several organs. The relation of 
 different organs to each other has to play a part in this, a part which 
 began likewise in the embryonic stage. In these cases also, a fact 
 which is confirmed by experience, a morphologic anomaly can 
 be replaced by a functional defect. 
 
 2. Functional Inferiority. Perhaps this is the chief group, 
 since through some functional defect the morphologic anomaly be- 
 comes perceived. Its characteristic quality is, briefly stated, a quan- 
 tity or quality of work insufficient to satisfy a standard of required 
 effectiveness. The compensations, which in many cases endure for 
 some time, consist in the vicarious replacement by a symmetrically 
 placed organ, in the compensating aid of a portion of an organ 
 related to it, in the use of another organ, or in the heightened use 
 of the inferior organ itself. The provisional outcome depends on 
 the actual reserve strength. 
 
 The pathology of these conditions exhausts itself in all conceiv- 
 able anomalies of execution, secretion, and growth. The work of 
 the organs or portions of organs on which greater demand is made, 
 is performed under heightened external and internal pressure, so 
 that at a certain point of the organism an increased condition of irri- 
 tation must be relieved in order to guarantee even unstable equi- 
 librium. Shock of any sort, infections, conditions of exhaustion, 
 overwork of a bodily or psychical nature, disturbances in tempera- 
 ture will usually show their effects in this exposed place. It is 
 easy to understand that even the usual demands of life, of civiliza- 
 tion, at this critical point also, the " locus minoris resistentise," may 
 be frequently followed by harm. 
 
 The observations on the vicariousness of symmetrical organs 
 are old and have to do with inherent differences of form and func- 
 tion, as well as with differences acquired during life. Here we can 
 cite: Compensation of one cerebral half for the other, just as with 
 the halves of the thyroid gland, ot the lungs, ^of the kidneys, the 
 ovaries, the testicles. If we put aside the certainly determined 
 cases of inferiority which are but rarely found, we find ourselves
 
 AND ITS PSYCHICAL COMPENSATION - 7 
 
 forced to make a diagnosis of organic inferiority upon the estab- 
 lishment of the phenomena of vicariousness in cases that occur. 
 This condition, and the so often observed increased tendency of in- 
 ferior organs to grow, which I will mention later on, and the con- 
 dition, not at all rare, of equal and uniformly divided anomalies 
 in both sides, as are found one-sidedly in vicarious forms, and anal- 
 ogous conditions in asymmetric organs on the basis of primary in- 
 feriority lead to the assumption that fust the primary inferior organs 
 seem predestined under certain conditions to take upon themselves 
 for a shorter or longer time an increased functional activity. In 
 addition to the well-known types, emphysema in functional inferi- 
 ority of the other lung, struma parenchymatosa lateralis in atrophy 
 of the other side, renal hypertrophy in atrophic processes of the 
 second kidney, etc., may be cited. I should also like to mention here 
 left-handedness, partial situs viscerum inversus, and the vicarious- 
 ness of the halves of the central nervous system. If in all these 
 phenomena there is also no doubt of inferiority, they surely repre- 
 sent merely a lesser degree. There can be no doubt that the primary 
 inferior organ which frequently suffers in its deficient development 
 in size and which is functionally not up to the level of a normally 
 developed organ, if it is not forced to be vicarious, often has only 
 to do a very small amount of work. This is apparently the reason 
 why it is at times found healthy while the vicarious organ is diseased. 
 This condition was found in the following case: 
 
 Miss Fanny H., 23 years of age, comes of a tuberculous fam- 
 ily. Her mother died early of pulmonary phthisis, a sister is also 
 suffering from a pulmonary disease. Except for children's dis- 
 eases, the patient has not had any notable sickness. For some time 
 there has been a strong tendency to constipation ; pallor of the skin 
 and of the mucous membranes ; palatal and pharyngeal reflex lacking. 
 In the spring of the year 1905 the patient began spitting blood. A 
 long sojourn in the South brought a slight improvement. In May, 
 1906, in the region of the apex of the right lung, diminution of 
 sound and a slight rattling during expiration could be heard. The 
 distance from the spinous process of the 7th cervical vertebra 
 to the processus coracoideus was 18 cm. on the right, on the left 16 
 cm. The patient said that since her childhood the right half of the 
 thorax had been noticeably more developed than the left. Even 
 the breathing on the right exceeded that on the left side. We find 
 the focus of disease in this case at a point where the fundamental 
 inferiority of the respiratory organs, which evinced itself clearly 
 enough in the heredity, had made good functionally as well as
 
 8 STUDY OF ORGAN INFERIORITY 
 
 morphologically. But in these and similar cases it seems plausible 
 that the increase in function and of growth in an inferior organ 
 can also give opportunity for increased predisposition to disease, if 
 certain definite relations are disturbed at the same time. Sorgo and 
 Schick recently pointed out that with tuberculosis there is often a 
 smaller nipple or a smaller areola on the side of the disease center, 
 but at times this is true of the other side. We believe that we have 
 indicated the connection and the explanation for this. 
 
 There surely are a number of pure cases of inferiority in which 
 jwe do not find vicariousness, just as an asymmetric organ can re- 
 main without compensation. My impression is that in the asym- 
 metric organs which may be called inferior in the majority of cases, 
 there are also ^partial compensation phenomena. And, for this 
 reason, that general Inferiority of an organ or an apparatus rep- 
 resents a certain degree of inability to live, which gives sufficient 
 cause for early death. One can find support for this conception In 
 families where the infant mortality is high. There need be no 
 doubt at all of the frightful weight of social conditions, but, as in 
 all other attacks of disease, the bulk is concentrated on the inferior 
 organ. Most frequently we find these compensation phenomena in 
 the circulatory system and in the gastro-intestinal tract, where they 
 occur, in accordance with the ruling theory, above all, to act as a 
 temporary balance of mechanical disproportions and conditions. 
 Meanwhile the organ's feebleness alone makes it suspicious. One 
 really ought to accept the fact that a training, more conformable 
 to nature, as on the part of the organ to overcome a usually slowly 
 arising stenosis is scarcely feasible. And yet in many cases we 
 find such a complete lack of compensation in a more or less 
 short time. The notion of an inferiority in the compensating seg- 
 ment also, of which the energy of growth is used up only the more 
 quickly, explains this weakness a great deal. Add to this, that we 
 are forced to see an inferiority of the attacked part of the organ, 
 according to this exposition, in the establishment and the develop- 
 ment of the centers of disease, an inferiority from which we cannot 
 without further question exclude the adjoining portions. We should 
 like to extend similar demonstrations to the urinary strictures and 
 to lithiasis as well as to the compensatory occurrences in the central 
 nervous system. 
 
 I can summarize briefly in regard to compensation of an inferior 
 organ by means of a second organ. In this line we are accustomed 
 to think of cardiac hypertrophy, by which a deficiency in the kidney 
 or the lung is compensated. There is no doubt as to the facts. I
 
 AND ITS PSYCHICAL COMPENSATION - 9 
 
 will only add, as above, that in such cases many things lead one to 
 call the heart an inferior organ too. I should like to say, besides, 
 that this group surely deserves much more attention than it gets at 
 present. The frequent compensatory intervention of the brain in 
 deficient organic functions is undoubted. But the glands with ex- 
 cretory ducts also and the ones with internal secretions can often 
 be made to compensate. The disease phenomena as a whole are 
 often governed by the disease of the compensating organ. The 
 results of the pathologic anatomy do not always cover the disease 
 phenomena that have been found, since they indicate changes, 
 whereas the clinic often has to judge the expression of relationships. 
 Many diagnostic errors, many failures in therapy, are rooted in this 
 not wholly clear connection. To be sure an individual inferiority, 
 as for instance of the kidney, can arise and provide a symptomatol- 
 ogy on the grounds of a mechanical, or some such sort of correla- 
 tion of organs. Above all we must think in this connection of the 
 consecutive disease of the heart, the skin, the eye and the digestive 
 tract, for the relation of which to kidney affections, pathology offers 
 sufficient authority. On the other hand, however, we must empha- 
 size the fact that many of these consecutive seizures are compensa- 
 tion phenomena on inferior ground or " reactionary diseases " in 
 other inferior organs, as in the case of L. Z. in the appendix. From 
 the whole ensemble of inferiority this idea comes strongly to the 
 fore, that normal organs are compensated less by hypertrophy and 
 more by hyperfunction. On the other hand the more inferior the 
 formation of an organ is, the less it has succeeded in functional de- 
 velopment, and the sooner it will react with excessive growth to 
 stimuli of all sorts. 
 
 It is only a step from the fact of excessive growth in inferior 
 organs to the acceptance of the origin of neoplasm in such organs. 
 This seems to us justified if we regard properly the familiar occur- 
 rence, the anamnestic particulars, their appearance in or near pri- 
 mary inferior organs. Whether parasites come into consideration 
 for individual neoplasms, I must leave undecided, but do not con- 
 sider their part very important. The anamnestic data, particularly, 
 speak for the acceptance of the fact that neoplasms originate only in 
 inferior organs. I could always be sure in my cases, and literature 
 offers enough proofs, that the development of the carcinomas are 
 preceded by a number of years of functional disturbances, or fur- 
 ther disease of the organs, frequently of a neurotic nature. The 
 conception of a fundamental connection of lupus, chronic catarrh, 
 inflammation, hemorrhages or microorganisms with the forming of a
 
 IO , STUDY OF ORGAN INFERIORITY 
 
 carcinoma, regularly leaves the causal factor unexplained. Ac- 
 cording to our conception, all these presumed " etiologic " affections 
 are characterized in like manner as the neoplasms, as manifesta- 
 tions of the inferiority of the diseased organ. The same is true for 
 the origin of neoplasms from nevus, in which case the nevus pig- 
 mentosus often betrays in unpleasant fashion inferior and diseased 
 organs. At least, I have learned to watch for it in my cases, and 
 have frequently found it near the diseased organ in pulmonary 
 tuberculosis, renal affections and appendicitis. Since the embryonic 
 origin of nevus pigmentosus and its familiar occurrence has been 
 determined, furthermore, since the facts which lead to Cohnheim's 
 carcinoma theory of the scattered embryonic germ, seem undis- 
 turbed, a confirmation of this theory of mine can also be drawn from 
 his point of view. Only, in place of the scattered embryonic germ, 
 which has not up to the present been established, the fetal character 
 of the inferior organ enters completely or in one of its parts. 
 
 It will not do at all, however, to make the proof of the inferior- 
 ity of an organ depend exclusively on its disease. Only the layman 
 will refuse to admit that a long life is quite compatible with a long 
 illness. Even an inferiority does not of necessity lead to an early 
 death. To be sure, the outcome is determined by the concurrence 
 of deficient fetal development, conditions of irritation, and material 
 reserve under stationary external requirements. One will find 
 changes of atrophic nature, opposed to them those of hypertrophic 
 character, decreased or increased ability, the most varied anomalies 
 of external and internal secretion, deficiency and excess. If in 
 addition we try to take into consideration the external conditions, 
 the demands of exertion, infections, domestication [Hansemann] 
 and surroundings, the diseases of over-pressure and consumption 
 [Edinger] which have just attained importance, localized infec- 
 tious disease, neoplasms, appendicitis, ulcus rotundum, hypertrophy 
 of prostate, etc., neuroses, nervous diseases of peripheral and central 
 type, racial and family diseases, tabes and paresis, all come within 
 the field of our calculations. 
 
 The amount of material to be worked over is accordingly over- 
 whelming. In single cases, the organized points of view suffice 
 to give a survey, and to point out the inferior organ. The deter- 
 mination of the localization of the disease is, and will be, under 
 all conditions, of tremendous importance. The framework of the 
 present clinical medicine is not overstepped. But it is evident at once 
 that our point of view leads further, and puts us into the position 
 to make possible further understanding of the above-mentioned
 
 AND ITS PSYCHICAL COMPENSATION - II 
 
 process, since in connection with the knowledge of sickness in many 
 cases there is established also an organ inferiority, from the nature 
 and intensity of which results are obtained which are of value in 
 the realm of etiology, symptomatology, and therapy. It is more- 
 over clear that new resources are opened up for the individual ob- 
 servation at the sick bed, that is to-day very hazardous, and which 
 are particularly of value in infectious diseases. I can not permit 
 the endemic and epidemic diffusion of infection to count as a serious 
 argument against the theory of organ inferiority. Instead it only 
 shows the relative inferiority of our extant organ cells in the struggle 
 with the microorganisms. On the other hand the prognosis, ther- 
 apy, and above all the theory of complications of disease, secondary 
 diseases and sequelae in these cases also fall into line with the norms 
 of the inferiority theory. The regard for organ inferiority will 
 attain greater surety in all these questions, the better we are able to 
 understand the relations of the inferiority. The course of a case 
 of diphtheria surely depends primarily on the antitoxic power of 
 the organism, on the active or passive immunizing power, but the 
 value of the heart, kidney and respiratory apparatus also comes into 
 consideration for the crisis. 
 
 Besides the inferiority of an organ does not need to reveal itself 
 throughout a whole lifetime, or the expression may remain so insig- 
 nificant that one scarcely thinks that one has an inferior organ before 
 one, or else it expresses itself in morphologic anomaly and even 
 then at times so slightly that the condition of the individual is not 
 affected. Slight deviations also, at times in the most primitive func- 
 tions, may represent the whole of the inferiority, which at other 
 times may lead to disease and death in the victim. A significant 
 light is thrown on the nature of organ inferiority by the frequent 
 phenomenon of manifold inferiority in the organs of a person and 
 the part played by the brain and spinal cord in connection with it, 
 which frequently act compensatingly and cover the existing defect 
 or else shape it to useful ends. In the following pages then we 
 shall discuss: 
 I. Heredity. 
 II. Anamnestic demonstration. 
 
 III. Morphologic characteristics. 
 
 IV. Reflex anomalies as indications of inferiority. 
 V. Manifold organ inferiorities. 
 
 VI. The part played by the central nervous system in the theory of 
 organ inferiority. Psychogenesis and foundations of neu- 
 roses and psychoneuroses.
 
 CHAPTER II 
 I. HEREDITY 
 
 Here we find ourselves on familiar ground. The significance 
 of heredity however is esteemed differently by different investi- 
 gators. Some bring forward the family anamnesis, refer every 
 exact conclusion back to that and want, at best, to deduce from is 
 greater or lesser predisposition to disease. Others, particularly 
 more recent writers find very nearly similar hereditary conditions in 
 healthy as in sick individuals, and they put aside all deeper mean- 
 ings of the problem of heredity. For the most part, the con- 
 ception of the ability to inherit a temperament which under suit- 
 able conditions leads to hereditary disease is prevalent. As far as 
 we can determine French students have always inclined to place 
 sharper emphasis on heredity than German students. 
 
 There have also been contradictions, which we think can, with- 
 out very great difficulty, be put aside. In the foreground of our 
 assertions regarding heredity belongs this sentence: Heredity con- 
 sists in inheriting one or more inferior organs. 
 
 A survey of the diseases regarded as hereditary supports this as- 
 sertion, which contradicts the conception of hereditary degeneration 
 of the whole organism. Even that which is called mixed heredity, 
 as in epilepsy, mental disturbances, hysteria, chronic alcoholism, etc., 
 may be classified according to individual inferior organs, wherein 
 the influence and development of the central nervous system is strik- 
 ingly noticeable. We will have now, at this point, to lay down a 
 fact which is of the greatest importance for the whole conception 
 of our work. The inferiority of an organ may reveal itself in the 
 descendants in the most diverse parts of the organ. With this 
 statement a great number of contradictions to the theory of heredity 
 are removed. Above all "mixed heredity" is reduced to a simple 
 hereditary inferiority of the nervous system. But those investi- 
 gators are in the right too, who attribute, regardless of seeming 
 contradiction, the greatest significance to the heredity problem, 
 despite the fact that sick children may come from healthy parents 
 or individual healthy children from diseased parents. For from 
 the most different sorts of localization of inferiority in the organ 
 and its appertaining parts there naturally arise widely differing 
 
 12
 
 STUDY OF ORGAN INFERIORITY 13 
 
 degrees of vitality and predisposition to disease. We must how- 
 ever consider that there are a great number of forms of inferi- 
 ority which plainly injure neither health nor duration of life, such, 
 particularly, as mild functional or peripherally situated inferiorities. 
 
 In our work we recognize, not the heredity of the disease but 
 the heredity of the inferior organ, a conception which has not yet 
 made a 'way for itself in all pathology, but has probably been ac- 
 cepted for individual pathologic phenomena. We wish to try to de- 
 fend our idea and to introduce further support than that which has 
 hitherto belonged to it in a series of diseases which have usually 
 been considered hereditary. 
 
 The introduction of heredity in cases of genuine epilepsy seems 
 comparatively free from objections. The anomalies of form in the 
 brain emphasized by Meynert and others coincide with our morpho- 
 logic inferiorities. We shall have to lay claim to the epileptic equiva- 
 lent, the imbecility which occurs, as a functional inferiority of the 
 brain. The etiological importance of polioencephalitis discussed by 
 Freud and Rie is found in its appearance as a form of disease of an 
 inferior organ, namely the brain. In our opinion other diseases 
 which have been emphasized are connected with a similar inferi- 
 ority of other organs. This is the case in the frequent anamnestic 
 determination of nocturnal enuresis, a functional inferiority of the 
 urinary appartus, which, in favorable cases, may be counterbalanced 
 by compensation of the central nervous system. The anomalies of 
 the circulatory organs, also, which are on many sides connected with 
 the question of epilepsy, may be thus compensated. Asymmetry of 
 the base of the skull, ocular anomalies, signs of degeneration in the 
 head continually direct our attention to the inferiority of the brain, 
 and are to be counted as peripheral expressions of this inferiority. 
 Changes in the reflexes of the mucous membranes and the skin, as 
 Redlich recently indicated, rest upon similar inferiority of other 
 organs. Moral deterioration, criminality, chronic alcoholism, may 
 arise from this cerebral inferiority, but not epilepsy. Decided 
 mental predisposition, genius which Lombroso has brought to the 
 foreground, may be considered as over-compensation in an inferior 
 brain. It is this inferior brain which may be inherited. In order 
 to lead to epilepsy, there must be further determinations. Crim- 
 inals, drinkers, imbeciles, inventive people, geniuses, apparently 
 healthy people, who however frequently reveal peripheral or partial 
 forms of inferiority, have to alternate in such families till this stock 
 is destroyed by external circumstances or until an equilibrium is 
 reached which guarantees better vitality.
 
 14 STUDY OF ORGAN INFERIORITY 
 
 t 
 
 Take for example the L. family: The father died of carcinoma 
 of the bladder, the mother was mentally inferior. There were two 
 sons, of whom one was feeble-minded with asymmetry of the skull, 
 the other normal. Of five daughters the oldest is afflicted with renal 
 calculus, one of her children wets his bed. The second suffered 
 during her childhood from enuresis and catarrh of the bladder, 
 later in each pregnancy three times from pregnancy pyelitis. 
 The third is an epileptic, the fourth an imbecile, the fifth normal. 
 Of the children of the second daughter, the first shows slight symp- 
 toms of enuresis, the second has deformities of the skull, the third 
 suffered from spasm of the glottis. In this family accordingly, a 
 combination of inferiority of the urinary apparatus and of the brain 
 plays its unfortunate part. 
 
 The analysis of the conditions of heredity in tuberculous cases 
 proves itself equally fruitful. The justification of the problems of 
 heredity in the tuberculosis question is pretty well recognized. It 
 becomes still more clear on accepting our viewpoint, as long as one 
 does not seek in the ascendancy only tuberculosis of the lungs 
 but lays greater stress on the inferiority of the whole respiratory 
 tract, and takes the same attitude toward diseases of this apparatus. 
 Then bronchial asthma, emphysema, diseases of the larynx, of the 
 pharynx, of the nose, also fall into the range of the anamnesis. 
 For just as the inferior brain in epilepsy is transmitted so it is the 
 inferior respiratory organ in tuberculosis, which reveals deficiencies 
 at the most diverse places, and in the most widely different forms. 
 We may not leave the complicating diseases unmentioned either. 
 The connection between gastro-intestinal affections, hysteria, goiter, 
 alcoholism, and albuminuria is sufficiently clear. It would lead us 
 too far afield to give a complete explanation of this connection at 
 this point. 
 
 As a result of my investigations, I can allege, that in all these 
 cases, to which we must also add smallness of the heart and of the 
 arteries, it is not a question of pure connection of a causal nature, 
 but has to do with inferiority in a second organ appearing at the 
 same time. Localization in the apex of the lung is particularly in- 
 teresting. It may be best explained, in our opinion, by accepting a 
 particular inferiority at this point. The Frankel constriction of the 
 upper thoracic opening, the prominent angulus ludovica, the phthisic 
 constitution, the deficient development of the areola of the nipple 
 on the diseased side, emphasized by Sorgo and Schick, are nothing 
 more than peripheral indications of the inferiority of the respira- 
 tory organs, and are surely not to be valued etiologically, any more
 
 AND ITS PSYCHICAL COMPENSATION 15 
 
 than the diminished exchange of air at the apex. All these signs 
 are not found in phthisis subjects only, but are none the less sus- 
 picious factors. The striking size of the lung in phthisis gives em- 
 phasis to that factor of growth tendency in inferior organs of 
 which we have already spoken. One can not avoid a similar im- 
 pression in watching the growth of giant cells. On the other hand 
 the part of the tubercle bacilli as well as the social conditions are 
 assured to be determining factors. 
 
 E. family: The father has emphysema and chronic bronchitis, 
 the mother died of hemorrhage, in a premature birth. Of the sons, 
 the elder is healthy; the younger in his twenty -third year became 
 ill with pleuritis on the left side, affection of the apex on the left side 
 and albuminuria. He suffered from chronic coryza, swelling of the 
 pharyngeal tonsil and of the turbinates. The older sister suffered 
 from spasmodic sneezing (unfortunately we can get no report about 
 it) and in her thirty-fifth year underwent an operation for myoma. 
 The younger sister in her childhood suffered from enuresis and fre- 
 quently had nasal catarrh and recurring laryngitis. The older sister 
 is childless, the younger had three difficult births, in which hydram- 
 nios was present with extraordinarily large children. There were no 
 noteworthy change in the pelvic measurements. In this family may 
 be listed, inferiority of the respiratory organs in different places and 
 in different forms, also inferiority of the sexual organs of the female 
 members. If I add that the father and paternal grandfather suffer 
 from catarrh of the bladder owing to hypertrophy of the prostrate 
 [pr o stats tit erus masculinust}, we will have to grant inferiority of 
 the urinary apparatus also, considering bed-wetting and albuminuria 
 of the younger children at the same time, an inferiority which like 
 the others is of account in heredity. 
 
 There is a whole list of diseases which can be passed down by 
 heredity, which I can either omit or else mention briefly because 
 they have little weight for the material which is to be demonstrated 
 in this chapter, or else can not be verified by me with sufficient 
 material. Such is the case in diabetes, the hereditary significance of 
 which is universally recognized. The assumption of an inferiority 
 of the pancreas, also, regarding its nervous connection with the 
 medulla oblongata would meet with only slight opposition. The 
 principle determination seems more important to me, namely that in 
 diabetic families the alimentary tract is inferior, a fact which may, 
 in the individual family members, not always come to light in the 
 pancreas, but in various parts and with varying strength in this ap- 
 paratus and its appertaining portions, in the mouth, teeth, pharynx,
 
 1 6 STUDY OF ORGAN INFERIORITY 
 
 
 
 stomach, liver, intestine, and rectum. In this connection I consider 
 it necessary to call attention to the numerous gastro-intestinal com- 
 plaints found in diabetic cases, and particularly, to the frequent lack 
 of palatal reflex which indicates a deep-seated change in the whole 
 alimentary tract. The connections between diabetes and obesity, 
 gout and formation of gall-stones, and the alternating appearance of 
 these diseases in individual families can only rest on the common 
 foundation of inferiority of the gastro-intestinal apparatus. Other 
 groupings, such as tuberculosis, disease of the vessels, skin affec- 
 tions, renal changes, Basedow's disease neuroses, which are often 
 found in diabetic subjects, we shall regard as an expression of the 
 simultaneous inferiority of a second organ, which may be more or 
 less burdened by the diabetic disturbance of metabolism. 
 
 For example in his thirteenth year, O. C. became ill with severe 
 diabetes. In his early childhood up until his fifth year he suffered 
 from involuntary defecation, later from constipation and diarrhea. 
 In his twelfth year severe furunculosis set in, which aroused sus- 
 picions of diabetes. The father suffered from gall-stones in his 
 youth, was inclined to obesity, and has for many years been tor- 
 mented by stubborn constipation. The mother shows numerous 
 recurrences of urticaria. A sister has hysteria. The analysis of 
 the case follows from the previous one. The inferiority of the in- 
 testinal apparatus comes from the paternal side, which is distin- 
 guished everywhere by obesity. To this the mother adds the in- 
 ferior skin, which furnishes the ground for furunculosis. Not one 
 of the four members of the family shows a palatal reflex and the 
 pharyngeal reflex can only be obtained with difficulty. 
 
 A theory of diabetes must rest on the acceptance of an inferior 
 pancreas. The deficient pathologic reports in this disease make 
 for a preponderating functional inferiority, which might make itself 
 felt in anomalies of secretion. Yet at times a morphologic inferi- 
 ority (of the parenchyma, abnormal smallness of the islands of 
 Langerhans) can be definitely proved. Thirdly the inferiority may 
 be situated in the nerve connections of the pancreas. 
 
 Case of Dr. G.: The father suffered from exophthalmic goiter. 
 The son has been afflicted since his childhood with severe diabetes. 
 Thyroid gland intact. Here we find inferiority of two organs at 
 the same time, without being able to say anything about their mutual 
 influence. This case requires us not so much to connect exclusively 
 the sugar secretion with the thyroid in the not at all rare glycosuria 
 in cases of exophthalmic goiter, but rather to accept a simultaneous 
 inferiority of the pancreas.
 
 AND ITS PSYCHICAL COMPENSATION 17 
 
 In regard to obesity, I must emphasize at this point that it has 
 been emphatically proved to be hereditary. This, as well as its 
 connection with other diseases, namely with simultaneous inferiority 
 of other organs, is sufficiently well known. 
 
 Diseases of the lymphatic glands are not considered hereditary 
 as far as I know. The reason for this is in the following: As soon 
 as tuberculosis has been determined in an organ, in many cases all 
 further interest seems at once to die out in the investigator or else 
 is directed to the modes and means of spreading the infection. We 
 are however interested above all in the fact that tuberculosis may 
 attack every inferior organ under certain conditions. The inferiority 
 of the lymphatic glands, which is surely of the greatest importance 
 in the further advance of tuberculosis, is inborn and hereditary. 
 Two cases will serve as support for this view. 
 
 I. Alfred B. in his sixteenth year became ill with numerous 
 swellings of lymphatic glands of the neck, all of which showed 
 softened, puslike, disintegrated material and which healed with the 
 well-known scrofulous scars. Neither the patient nor any one else 
 in the family showed signs of tuberculosis. But the mother in her 
 fifteenth year had also had swellings of the lymphatic glands of the 
 neck and showed a few scrofulous scars. 
 
 II. Frieda H., fifteen years old, had always been well up to the 
 winter of 1905. At that time she suffered from countless tumors 
 of the lymphatic glands which particularly filled out and caused the 
 supraclavicular depressions to bulge. To this pleuritis on the left 
 side, and later, swellings of the lymphatic glands under the left 
 axilla were added. Her parents and brothers and sisters are healthy, 
 and have never suffered from swellings of the lymphatic glands. 
 But an uncle on the mother's side did have them. The patient's 
 older sister has a nevus pigmentosus (see previously) in the left 
 supraclavicular hollow. The mother also. 
 
 In such cases we can only speak of inherited inferiority of the 
 lymphatic glands, not of hereditary tuberculosis. 
 
 Following this conception we find ourselves forced to draw the 
 following important conclusions, which have a bearing on tubercu- 
 losis as well as on all other infectious diseases. 
 
 1. All infections which may be overcome by the natural pro- 
 tective power of the organism threaten most of all that organ which 
 has least of this protective power and which in the majority of 
 cases is the inferior organ. 
 
 2. In tuberculosis especially a therapeutic result is only to be 
 hoped for in so far as it is possible to promote the inferior organ
 
 1 8 STUDY OF ORGAN INFERIORITY 
 
 i 
 
 far enough for it by its own strength to overcome the infection. 
 As far as therapy with sera is concerned, the greater chances fall 
 to active immunization. Only in passive immunization can indi- 
 vidual parasites remain viable, and the inferior organ again falls 
 a sacrifice to the next spread of infective material. 
 
 We do not wish to close this chapter without taking into con- 
 sideration the question of carcinoma in so far as it belongs here. 
 In this it is of little importance whether we pursue the question 
 according to the parasitic or non-parasitic etiology. We only re- 
 move the etiologic moment a layer deeper. Carcinoma can only be 
 developed in an inferior organ. Further conditions are unknown 
 so far. A list of facts supports our conception which is most closely 
 allied to Billroth's work on carcinomatous predisposition. There 
 is also the development of carcinoma in the previous history of the 
 diseases of the organ. The present conception regards previous dis- 
 eases as of importance etiologically ; we, however, according to our 
 discussions consider them as of historic importance. All the changes 
 of the organs in the anamnesis of the carcinoma, whether of ca- 
 tarrhal, inflammatory-infectious nature, of hypertrophic or atrophic 
 character, all prove this organ to be primarily inferior. I have 
 spoken of that in this chapter. Furthermore I call attention to the 
 remarkable variability and growth energy of carcinoma cells, which 
 reveal a capacity similar to embryonic growth. Of the same sort is 
 the condition of giant cells and also embryologic tissue. I have 
 already emphasized the significance of nevus. I consider its relation 
 to inferiority to be quite definite. Its relation to carcinoma has 
 long been a well-known one. Besides I can introduce here the 
 whole Cohnheim argument and the collection of illustrative cases 
 connected with it, with the exception, that I have to drop the idea 
 of " scattered embryonic germs " and substitute in its place organ 
 inferiority, with its very nearly embryonic character. The hered- 
 itary significance of carcinoma also I think can be proved, to be 
 sure, in another sense from that which other authors give it. The 
 inferiority of the organ, not the carcinoma, may be inherited. There 
 are other things required for the origin of a carcinoma. The inferi- 
 ority of the organ can however be proved from the genealogy. 
 
 Mrs. A. B. was taken sick in her fifty-eighth year with carcinoma 
 of the left breast. Her daughter, Mrs. L. T., showed deficient de- 
 velopment of the nipples on both sides and was incapable of suck- 
 ling in spite of all efforts. As a striking feature, note that a fairly 
 thick circle of hair surrounds both nipples, a condition which re- 
 minds us of the hairiness in spina bifida, another morphologic in- 
 feriority.
 
 AND ITS PSYCHICAL COMPENSATION , 1 9 
 
 Mrs. Theresa S. died in her forty-sixth year during an operation 
 for carcinoma of the uterus. Her son as well as her daughter's son 
 suffered from enuresis. The daughter has attacks of vomiting 
 and diarrheal stools whenever she is the slightest bit excited. This 
 case offers proof only for those who accept with me the law of 
 manifold inferiority of organs and follow my view still further, ac- 
 cording to which enuresis as well as stomach and intestinal neuroses 
 rest on functional inferiority of the related organs. 
 
 The case of L. (see above) might also be quoted here. 
 
 Case of J. K.: Sensibility to pressure in the gastric region, 
 radiating pains to the left as far as the region of the left shoulder 
 blade, heightened spontaneous pains after taking nourishment, vomit- 
 ing. A pale person, a cook. No palatal reflex, pharyngeal reflex 
 positive. Father died of cancer of the stomach. Here also the 
 inheriting of an inferior organ reveals itself, but also the choice of 
 profession, influenced by the fundamental inferiority of the diges- 
 tive organ, all of which is to be discussed later (V), and the de- 
 ficiency of the palatal reflex, a sign of the inferiority of the ali- 
 mentary tract which we still have to discuss (IV). 
 
 Case of Mrs. Nadja J.: For four years she suffered from hys- 
 terical attacks, which were accompanied by unconsciousness. On 
 her right cheek, at the height of the nostril and about 2 cm. side- 
 ways from the nose, we find a nevus pigmentosus. Her mother had 
 been operated on two months before for carcinoma of the left 
 superior maxilla. Here it is evidently a question of segmentary (of 
 which more later) inferiority in the region of the upper jaw, the 
 presence of which in the family is revealed in the mother and 
 daughter. 
 
 To conclude, I will briefly point out that the great majority of 
 carcinomas are found in such positions as have been specially named 
 by Freud erogenous zones and which he has brought into close con- 
 nection with the neuroses. Such zones are mouth, anus, breast, gen- 
 ital region, etc. The connection between neuroses and inferior or- 
 gans is discussed in another place. 
 
 The other branches of the heredity theory may be classified in 
 a similar manner. I have myself found myomas in mother and 
 daughter, and in sisters. If one holds to the ideas already outlined 
 the inferiority of organs can often be traced in the genealogy. 
 
 I pass over the whole list of diseases conceded to be hereditary, 
 but must point out briefly that in a great number of these, not only 
 just in the center of the disease but in the region of apparently healthy 
 organs, trustworthy observers have indicated changes of atrophic or
 
 2O STUDY OF ORGAN INFERIORITY 
 
 ^ 
 
 hypertrophic nature. One can not challenge such a report uncon- 
 ditionally. But it is in the nature of the thing that in an organ 
 inferiority subject to inheritance, not only to individual portions of 
 the organ predestined as a center of disease show the character of 
 the inferiority, whether it is pure or especially functional or mor- 
 phological, which last phenomenon is to be considered as a reaction 
 of the inferior material under the relatively greater vital irritation, 
 but also adjacent or more remote elements of the inferior organ. 
 Now there would be nothing more out of the way than to insist 
 upon finding again all the anomalies of the ancestors to the same 
 extent in one of the descendants, in an investigation on the nature 
 and compass of heredity. Just as heredity can appear at different 
 parts of the organ, where it is found in the form of functional or 
 morphological inferiority, which gives footing for any sort of dis- 
 ease of a parasitic or non-parasitic nature, so the fact has to be 
 reckoned with that in later life, under the influence of the manner of 
 living, inferiority unconcealed or revealed by illness, will not always 
 be found. Perhaps it happens just as often that in place of the 
 expected inferiority, nothing abnormal or directly an excess, or 
 even an exaggerated peculiarity is found.
 
 CHAPTER III 
 
 ANAMNESTIC DEMONSTRATION 
 
 In the above we have repeatedly thought of the difficulties which 
 at times stand in the way of classifying an organ as inferior. As 
 we use it the idea of full normality on the part of an organ is not 
 at all the same thing as the term health and for the following reasons. 
 There may have been, either by reason of appropriation of reserve 
 growth power at the place of the inferiority itself or more remote 
 from it, in a second organ or in the nerve track, compensation, 
 which has hidden the deficiency, and even conceals it from the medi- 
 cal investigator. Or else the inferiority reveals itself in one member 
 of the family in a place where there is little or no disturbance in 
 the healthy functioning of the organ. In another member the in- 
 feriority may appear as a disturbance of health. Or else the favor- 
 ableness of external conditions, public and private hygiene, enable 
 the individual burdened with an inferiority to escape dangers to 
 health, which present themselves at once when the social position, 
 working time, home or nourishment, become worse. To be sure 
 here it is a question of a lesser degree of inferiority. The higher 
 degrees condition either incapacity for life or else are actually hidden 
 by the so-called " diseased " organ. 
 
 I wonder whether there are any criteria for distinguishing 
 "healthy" organs from inferior ones. We have already shown 
 how the theory of heredity may serve us as a clue. According to 
 our conception an organ may be found to be quite healthy, but in- 
 ferior owing to its heredity. In such cases it is absolutely neces- 
 sary to get the history of youth, or perhaps, better still, the childhood 
 history of the organ, because at times it is possible to determine 
 the inferiority which escapes the perception the moment com- 
 pensation sets in. As soon as the inferiority of an organ comes 
 into account, before compensation in early childhood, it appears 
 preponderatingly as a functional deficiency or as a deficiency in func- 
 tional control on the part of the child. Besides the diseases from 
 which the child has recovered, the anamnestic significance of which 
 is recognized, the same attention is due to the development of the 
 sensory functions and the vegetative organs, to learning to walk and 
 talk, to the control of childish errors. Even with very little ma- 
 
 21
 
 STUDY OF ORGAN INFERIORITY 
 
 terial the significance of this anamnesis in childhood seems deter- 
 mined. And in a special example of childish fault, namely bed-wet- 
 ting, we will furnish at the close, proof of its significance and a 
 few illustrative cases given which show the relation to organ in- 
 feriority. If we add the conception maintained in the discussion 
 of problems of heredity, we have, as further basis of investigation, 
 the principle that a fault of childhood in the inheritance, in parents, 
 children, brothers and sisters of the patient should be regarded as a 
 suspicious sign of the inferiority of the organ relating to the fault. 
 The same is true of compensation or over-compensation which can 
 be proved in heredity. 
 
 Of the anomalies of childhood development which are found in 
 the history constipation, vomiting, blinking, squinting, stuttering, 
 sucking the thumb, and lack of control of the bowels or of the 
 urine should be particularly emphasized. Furthermore it seems of 
 importance to emphasize the fact that the infantile trace of organ 
 inferiority frequently impresses itself as a functional failure of the 
 organ in domestication. This demands the control of organ ac- 
 tivities and at the same time the giving up of the pleasurable sen- 
 sation which unhindered organ activity brings. The limitation of 
 organic sensory pleasure for the benefit of cultural progress becomes 
 the test of organic normality. At other times the domestication 
 [Hansemann] requires functioning under limiting conditions, with 
 insufficient air, unsuitable food, poor light. The harm which this 
 does the child affects primarily the inferior organs, which are not 
 equal to such a strain on their function. Deficient growth of bones, 
 of the organs of respiration and circulation, the digestive apparatus, 
 the central nervous system, of the blood organ, are caused thereby. 
 
 In other, more fortunately situated cases, a functionally superior 
 formation gets the patient out of difficulty. A particular viewpoint 
 has taught me how often a morphologic or functional deficiency of 
 an organ is converted to a higher development of that organ. The 
 stuttering boy Demosthenes becomes the greatest orator of Greece, 
 and up to the present day we seldom find any such heaping up of 
 defects of speech and signs of degeneration of the mouth, as are 
 observed in orators, actors and singers. 
 
 The anamnestic significance of childish faults in neuroses has 
 already been emphasized, and accentuated in its full importance by 
 Freud. It yet remains for us here to refer to the tendency to 
 greater sensory development, found in the peripheral part of the 
 inferior organ especially, portions of which are exposed near the 
 skin surface. In part this increased sensibility, the starting point
 
 AND ITS PSYCHICAL COMPENSATION 23 
 
 of many child- faults, surely comes from the impotence of the in- 
 ferior organ which can not of itself follow the safe pathway of cul- 
 tural functioning ; for it is the cause of every organic activity, while 
 the cultural organic function draws its strength from repressed 
 sensory pleasure. How closely this raising of the sensory com- 
 ponent is related to the embryonic nature of the inferior organ I 
 can not determine definitely. But it is true that the ensemble of 
 phenomena of organ inferiority is reflected on the psyche in such 
 a manner, that its whole structure has a peculiar impression. The 
 psychical steucture^Lhus obtained becomes a foundation for neuroses 
 and psychoses. 
 
 Whereas scarcely a single case of neurosis is without such a 
 history from childhood, to which Freud has already made specific 
 reference, I can only offer scant material, aside from the illustrative 
 cases following in the conclusion. Yet in a number of cases, for 
 instance in diabetic subjects, I could be sure, that since earliest 
 childhood, intestinal function was not what it should have been. I 
 often found constipation present, more rarely involuntary defeca- 
 tion. The frequency of gastro-intestinal disturbances in developed 
 diabetes justifies the theory that this disease depends upon a hered- 
 itary inferiority of the gastro-intestinal apparatus, which appears 
 predominantly in the function of the related gland, the pancreas and 
 at times in the liver also. A few cases to justify this assumption. 
 
 Margit B., 25 years old, complains of headache and chronic con- 
 stipation. Eight days previously, as had often happened before 
 following excitement, she had an attack of diarrhea, which after 
 two days changed to constipation. The constipation has now lasted 
 for six days. The patient feels miserable, suffers from nausea, agi- 
 tation, frequent attacks of fear and violent strangury. The patient 
 declares that she has been in the same condition several times before. 
 The examination gives us a relatively scanty result: the abdomen 
 shows slight meteorism ; no sensitiveness to pressure, no rise of 
 temperature. The analysis of the urine is negative. The patient 
 never had any spontaneous pains, no vomiting. The internal organs 
 are healthy. The lack of palatal reflex and of the abdominal reflex 
 is very striking. The pharyngeal reflex is weak, the conjunctival re- 
 flex normal. The anamnesis gives the solution. As a child the 
 patient was very unruly and had often suffered from headache and 
 constipation. When she was fifteen she had violent attacks of 
 singultus. The patient lisps. The father died of diabetes, one 
 brother was an enuretic and suffered from this as well as inconti- 
 nence of the bowels till his twelfth year. One sister was unfortunate
 
 24 STUDY OF ORGAN INFERIORITY 
 
 in her marriage and at times has attacks of coma. From the anal- 
 ysis of this case we would like to emphasize the hereditary organ 
 inferiority in father, brother and patient and the distinct indication 
 of the early history, constipation in the patient, incontinence of the 
 bowel in the brother as well as lisping in talking, which according 
 to the report of the patient was particularly evident in childhood. 
 The condition of the patient, who accordingly shows a startling in- 
 testinal inferiority, belongs, in the presentday nomenclature in the 
 realm of hysteria, the development of which is however very slight. 
 In the sister this side of the aspect of the disease seems more clearly 
 developed. 
 
 Richard v. R., a healthy man of 30 years of age, suffered in his 
 fifth and sixth years from violent blinking. Later this very preva- 
 lent defect of childhood vanished without leaving any traces. No 
 eye diseases in the family. One brother, Julius v. R. is a well- 
 known, very skilled painter, who told me that he had had excep- 
 tionally sensitive eyes as a child, and especially, he had not been able 
 to stand a bright light. In his seventh year he had a lengthy attack 
 of lymphatic conjunctivitis. This case is interesting in two re- 
 spects. It shows that an organ inferiority may be present in a 
 family without any particular disease. On the other hand we find 
 here the high degree of development of the inferior organ in the eye 
 of the artist. 
 
 Mrs. Elsa S., 24 years old, suffered till late in her childhood 
 from violent blinking. One brother of this woman is myopic to a 
 very high degree, the father towards the end of his life was almost 
 totally blind. Here also we find scattered throughout the family, in 
 different forms, the indications of inferiority. 
 
 Alexandra E., 5 years old, is being treated for recurring catarrhal 
 conjunctivitis and blepharitis squamosa. For two years there has 
 been blepharospasm, lasting for some time and then disappearing 
 for a long time, appearing at intervals which have no time relation 
 to the state of irritation of the eyes. The mother had been operated 
 on as a child for convergent strabismus, and has astigmatism on both 
 sides and a slight degree of myopia.
 
 CHAPTER IV 
 MORPHOLOGIC INDICATIONS 
 
 Our consideration of the inferiority of organs places the begin- 
 nings of the inferiority in the period of embryonic growth. Thus 
 the significance of heredity and " childish faults " is comprehensible 
 in the widest sense of the word and their connection clear. The de- 
 termination of organic disease, heredity and childish anomalies, 
 makes possible a proof of organ inferiority in many cases, and 
 in other cases permits one at least to express a suspicion. A further 
 diagnostic aid, whose significance is connected with that of the other 
 three, lies in the discovery of morphologic arrest of development, 
 malformation, "signs of degeneration" which we have already 
 designated everywhere as morphologic inferiorities. 
 
 The organ inferiority usually enforces itself genetically in the 
 individual and hinders embryonic or functionally related parts from 
 fully developing. Usually one can conclude an insufficiency in a 
 second or third organ at the same time, which seems comprehensible 
 since the cause of organ inferiorities can be referred to an extended 
 deficiency of formative substance. Pathology reckons with degen- 
 eration of the internal organs in certain cases. Outside of these 
 cases of disease we have found a peripheral expression of organ 
 inferiority in childish defects. // now a trace of this embryonic 
 check comes to the outer portions of the body and reveals itself in 
 this manner to the investigator this happens in the form of the uni- 
 versally known signs of degeneration, about which there is to-day 
 a great number of observations and interpretations. Their value is 
 not uniform. As far as I can see, however, the conclusions which 
 follow upon the nature of the signs of degeneration, are entirely 
 too general or else limit themselves to emphasizing the degenerative 
 tendency of the whole person, the inferiority of his total organism, 
 above all his psyche. This precipitancy has brought a great deal 
 of discredit to the theory of degeneration, and recently people have 
 been trying to prove statistically its indefensibility, in this form. 
 To prove less would prove more. What we can affirm with greater 
 surety in regard to signs of degeneration, is, that they represent 
 the external traces of the organ inferiority, which may be found 
 in a similar manner in the whole organ or in single parts of 
 
 25
 
 26' STUDY OF ORGAN INFERIORITY 
 
 it. If we add besides that some of these external traces may 
 fail in spite of organ inferiority, that the degenerative tendency 
 may extend to another organ, that the stigmata of inferiority 
 may belong to the internal organism or may consist of decrease 
 of function, and, as shall be pointed out later, of the related reflexes, 
 we can consider the limits of a " degeneration theory " as known to- 
 day, as sufficiently outlined. 
 
 The significance of the discoverable, external signs of degenera- 
 tion is undeniable in this outline. Their relation to the organ in 
 question and the necessity resulting from this of assuming further 
 signs of inferiority in the whole organ, appears to be sufficiently 
 justified and will be illustrated in the following by individual ex- 
 amples. The probability arises that in such cases there had not 
 been enough formative material to finish the organic development 
 in complete harmony and with sufficient tectonic. And the sus- 
 picion can quite rightly be directed on the central portions of the 
 organ, and one can ask whether the deeper or related parts have 
 remained morphologically or functionally backward, in which case 
 the functional deficiency would be considered in general the low- 
 est grade of primary organic check, the morphologic hypoplasias 
 or aplasias as the highest degree. The injuries growing on this 
 weakened ground cannot, to be sure, be graduated in a like manner, 
 in the first place, because functional and morphological deficiencies 
 may combine in 'different degrees, in the second place, because 
 exogenous disadvantages, such as infection, determine in a marked 
 degree the severity of the disease. To this is added the fact, to 
 which we have already referred several times, that under favorable 
 external circumstances, or as a result of compensation, the inferior- 
 ity of the organ may be hidden or even overcome. As to functional 
 checks we must expect above all, in addition to motor weakness, 
 scanty development and failing of reflex actions, microreflexes, and 
 quantitative as well as qualitative changes in glandular secretions. 
 
 The frequent report of external signs of degeneration in appar- 
 ently normal people shows us then nothing at all surprising from this 
 point of view. The external stigma can, we think by itself 
 signify a unique deficiency in the development of the organ. But 
 even when the related organs participate in the inferiority, the de- 
 ficiency, in so far as it is compensated to a lesser degree or appears 
 compensated by means of other aids, can be endured fairly well. 
 Only one must not conclude from this, as individual authors some- 
 times do, that one should deny a value of orientation to the signs 
 of degeneration. On the contrary! The physician will learn to
 
 AND ITS PSYCHICAL COMPENSATION . 2J 
 
 deduce from them the lesser capability of resisting of the hitherto 
 still functionally capable organs, and to guard against sudden in- 
 juries. And just as in the discussion of functional inferiority we 
 must emphasize here too, how often organs of slight inferiority 
 may develop greater functional capacity than normal organs. The 
 cause lies in the compulsion of a constant training in the capacity 
 for adaptation and variability often adhering to inferior organs and 
 surely also in the development of the related nervous and psychical 
 complexes heightened by inner attention and mental concentration 
 upon the weaker organ. TKe lasFnamed compensatory development 
 of the nerve track comprises also, among other things, the develop- 
 ment of reflexes, of a special protective arrangement and mobiliza- 
 tion of the organ. 
 
 This is not the place to give an extended representation of signs 
 of degeneration as I see them, as peripheral stigmata of organ in- 
 feriority. My own collection of illustrative cases would be too 
 slight. Literature at all events gives us sufficient authority for this 
 conception. I shall only refer to a few of the most important 
 stigmata as they presented themselves to me in connection with 
 organ inferiority. Congenital or hereditary abnormal development 
 of the eyes, the eyelids, pigmentary anomalies of the iris (Fuchs), 
 lamellar cataract, congenital constriction of one palpebral fissure, 
 myopia, hypermetropia, strabismus are often found in people who 
 contract other affections of the eye, retinitis, choroiditis, detachment 
 of the retina. Functional defects are often accompanied by morpho- 
 logic anomalies. An affection in one eye is frequently followed by 
 another in the other eye, the heredity of anomalies of the visual ap- 
 paratus and of affections of the eye is undoubted. The early his- 
 tory is almost always faulty. Very striking is the fact that so many 
 suckling infants show strabismus for a shorter or longer time, and 
 some time after birth. It would not be surprising, in cases of strik- 
 ing functional or artistic capacity of the eyes, to find functional or 
 morphologic anomalies of the outer eye in the individual or in his 
 family. 
 
 A similar thing may be asserted of the affections of the audi- 
 tory apparatus in connection with anomalies of the outer ear. Here 
 also heredity plays a notorious part, and can be considered a cer- 
 tainty, for example in regard to deaf-mutism and otosclerosis. At 
 all events, from my point of view only, it is the inheritance of an 
 organ inferiority which manifests itself in different forms and in 
 different places. This was the case in the S. family, which I have 
 had under observation, in which three of the children suffered from
 
 28 i STUDY OF ORGAN INFERIORITY 
 
 otosclerosis while the other two showed marked musical ability. 
 The last may be explained by the oft-repeated reference to the over- 
 compensation in an inferior organ. One of the brothers had a fre- 
 quently recurring herpes of the auricle, which, as soon as I saw him, 
 took on importance as an indication of organ inferiority (of the 
 mouth, nose, urinary or sexual organs). Musicians frequently 
 suffer from ear affections, or else have suffered from such in their 
 childhood. Beethoven is the classic example. Mozart is supposed 
 to have had a deformed ear. Veterinary surgeons have abundant 
 opportunity to prove affections of the ear in dogs with hanging ears. 
 In a like manner the stigmata of the nose, hypertrophy of the 
 mucous membrane, polypi, adenoid growths and the anomalies of 
 the mouth, tongue, teeth, of the hard and soft palate, of the tonsils, 
 are connected with inferiorities of the respiratory apparatus and 
 the inclination to disease in the same. Individual authors have, 
 without going into the details of the connection, emphasized this 
 relation. Perhaps the opinion most respected is that in which is 
 stressed the connection between the anomalies of the nose and bron- 
 chial asthma, and between adenoid growths or hypertrophy of the 
 tonsils with a lesser degree of development of the thorax and the 
 lungs. I do not need to explain minutely that primarily only the 
 condition of coordination is admitted; but later when the function 
 or the hygiene of deeper lying parts of the breathing organs are 
 encroached upon by certain conditions of growth, the peripheral 
 stigmata also appear to be etiologically conditioned. Deviations of 
 the septum, arrests of development in the formation of the mouth 
 such as cleft palate, long frenulum linguae, poor teeth, anomalies 
 of the teeth, inferior, easily bleeding gums, and a high palate are 
 often the visible expression of an inferiority in the respiratory tract, 
 which does not always of course appear as a special disease form. 
 Heredity and childish anomalies are however often perceivable, 
 among the latter of which are particularly, stuttering, sucking of 
 the thumb, sucking the lips and all sorts of defects of speech. Like- 
 wise with such children catarrh of the air passages, false croup and 
 sore throats are often found as Gutzmann and others have already 
 pointed out. An accumulation of these peripheral stigmata is not 
 rare. In anticipation I must say that the palatal reflex also very 
 often undergoes changes in which it shows itself as lacking, very 
 weak, or increased, whereas the pharyngeal reflex according to my 
 examinations shows this connection more rarely. In a like manner 
 these stigmata are found very noticeably in neuroses, with singers, 
 speakers, and in connection with severe diseases of the respiratory
 
 AND ITS PSYCHICAL COMPENSATION . 2Q 
 
 tract, be it in the patient examined or among his relatives, and along 
 this line I might especially emphasize pulmonary tuberculosis. 
 
 Miss L. shows on her upper lip, in the position of the left em- 
 bryonic palatal cleft, a small ridge-shaped thickening which seems 
 to be colored bluish by dilated blood vessels. The ridge is congen- 
 ital. The anamnesis tells us that the young lady often suffers from 
 laryngeal catarrh and bronchitis, whereas the father, mother, and 
 one brother died of pulmonary tuberculosis. Palatal reflex lacking. 
 The patient shows slight neuropathic characteristics, which have to 
 do with the digestive tract, and often suffers from palpitation of 
 the heart, sleeplessness and lack of appetite. She is an excellent 
 singer (soprano). One sister has attacks of anxiety and at 42 
 years of age still shows a defect in speech in the form of lisping. 
 In regard to this case I should only like to emphasize that to me 
 the impression of the connection between a beautiful singing voice 
 and the organ inferiority which I have outlined is a definite one, and 
 that I have considerable material to support it. 
 
 Marie B., 12 years old, came under medical supervision on ac- 
 count of stuttering and lisping. Her father died of pulmonary 
 tuberculosis. As a child the brother stuttered also, and was at that 
 time being treated for cervical vetebral caries. Mother apparently 
 healthy. The patient shows strikingly poor teeth, hypertrophy of 
 the mucous membrane of the nose and adenoids. Progress at 
 school poor. Palatal reflex deficient in the patient and her brother. 
 
 Josef S., 50 years old, suffers from follicular tonsillitis which 
 frequently recurs. Since his fifth year, the patient has had numerous 
 attacks of bronchial asthma, against which he has hitherto fought 
 in vain. Polypi of the mucous membrane in the nose, adenoids and 
 hypertrophic tonsils had been removed by operation. Of the other 
 stigmata only prognathism was found. In his seventh year the 
 patient had pneumonia and costal pleurisy. The thorax of this 
 strikingly large man is narrow and only slightly arched. At the 
 height of the posterior, left-hand end of the lung there is an angioma 
 as big as a hemp seed. The patient's father had suffered from nasal 
 polypus and once had pneumonia. A brother who also showed 
 prognathism died of pneumonia. The patient's twelve-year-old 
 daughter recently had pneumonia and costal pleurisy, a son had to 
 be tracheotomized in the course of an attack of diphtheria, a second 
 son was operated on a short while ago for hypertrophy of the 
 tonsils. The analysis of this case accordingly shows as a founda- 
 tion for asthma, a very well substantiated hereditary inferiority 
 of the respiratory apparatus, which also expresses itself peripherally
 
 3O STUDY OF ORGAN INFERIORITY 
 
 in individual members of the family in the appearance of congenital 
 stigmata. I should like also to add briefly that just as in the case 
 of nevus a well-deserved place should be accorded to telangiectasis 
 and angiomas in the ensemble of organ inferiority. Years ago some 
 one declared that there was a connection between angiomas of the 
 skin and carcinomas of the internal organs. The connection is this, 
 namely, that an organ inferiority is the basis of them both. The 
 author in question went too far. The complete denial however with 
 which his statements were met seems unjustifiable to us. The posi- 
 tion of the nevi, telangiectasis, angiomas, in short all the congenital 
 skn anomalies in the question of inferiority will be touched upon 
 again at the end of this chapter. 
 
 In the above I have tried to picture the connection between the 
 stigmata of the mouth and the inferiority of the respiratory appara- 
 tus. But there is no doubt that they are in just as close connection 
 with the inferiority of the digestive apparatus ; the common periph- 
 eral orifice of two organs will preserve the power of one of the two, 
 or of both. My experience now leads me to think that all these 
 stigmata of the oral portions may often serve as clues for the dis- 
 covery of inferiorities of individual components of the gastro- 
 intestinal apparatus, just as is frequently found in diseases of re- 
 lated sections of organs. This study of the matter cannot give a 
 complete picture of the relation. It must however be pointed out 
 that diseases such as appendicitis, diabetes, obesity, alcoholism, ulcus 
 rotundum, diseases of the liver, according to my experience belong 
 in this outline, and that the same argument must hold for carclno- 
 mata and tumors of the nutritive tract. A few of these connections 
 have already become truisms in medicine, even if their significance, 
 in my opinion, is incomplete and must first be borrowed from the 
 inferiority theory. The same is true of the connection between 
 bad teeth and gastro-intestinal disturbances, as the relation between 
 angina and appendicitis, recently stressed by Kretz, which we regard 
 as diseases coordinated in one inferior organ. A coated tongue like- 
 wise has significance in gastro-intestinal affections. 
 
 Hernias and stigmata which are grouped about the anus, such 
 as hemorrhoids, fissures, prolapse, have the same significance, the 
 connection of which with organ inferiority may often be proved 
 in oral stigmas, childish defects, reflex anomalies, and neuroses in 
 the family, the connection of which with diseases in the stigmatized 
 organ often may be recognized in the family, at least, in the above 
 mentioned manner. 
 
 Albert F., 32 years old, singer of comic opera songs, acquired
 
 AND ITS PSYCHICAL COMPENSATION m 31 
 
 lues four years ago and since then has been troubled by hypochon- 
 driacal moods. His father suffered for many years from gall- 
 stone colic, his mother died of carcinoma of the stomach. The 
 patient had always been well before and once only was in the care 
 of a specialist on account of a " singer's nodule." At present there 
 is a herpes on the upper lip, which, as the patient says, often recurs. 
 Palatal reflex lacking, pharyngeal reflex diminished. All the pa- 
 tient's incisor teeth are crooked, two upper incisors lacking. These 
 tooth anomalies must be considered as external signs of degenera- 
 tion, corresponding to an inferiority of the digestive tract in the 
 family; father and mother suffered from severe diseases of this 
 apparatus. The significance of the herpes has already been touched 
 upon, the pharyngeal reflex anomalies point to the similar inferi- 
 ority of the respiratory apparatus, to which is added as further evi- 
 dence of inferiority, singer's nodule and deficient palatal reflex. 
 The patient's profession leads us to the same conclusion. We must 
 regard the " singer's nodule " as analogous to many other anomalies 
 in its role as stigma, which betrays to us the inferior organ, the 
 same organ which forces its possessor into the profession of a 
 singer or speaker. 
 
 The following case seems typical to me : Ignas C., a merchant 
 50 years old, has for many years suffered from obstinate constipa- 
 tion. He belongs to a corpulent family in which, as it happens, 
 constipation is not predominant. Ever since his youth the patient 
 has been bothered by anal fissures, which have hitherto defied all 
 conservative treatment. One son showed epignathy and died when 
 he was fifteen in diabetic coma. The childhood anamnesis of the son 
 showed incontinentia alvi up to his fifth year and lisping as a defect 
 in speech. In the father there is deficient palatal reflex, the same 
 in the daughter, who is ill with severe hysteria and who shows a 
 shortening of the upper lip. In this case we find in addition to 
 oral stigmas in the son and daughter, with which this chapter deals, 
 connections, which are mentioned quite often in works on this sub- 
 ject, but which have not been explained. We mean the relation of 
 diabetes to obesity, to neurosis and to dental defects. An inferiority 
 of the nutritive apparatus may lie at the bottom of all three, which 
 I have often proved to my own satisfaction, and which in the first 
 case compensates within itself, and appears to be overcompensated, 
 and in the second case (of which more later) involves the related 
 nerve track and manifests itself undisguised only in the third case. 
 The deficient palatal reflex found with it suggests to us an inexact 
 development of the related reflex apparatus, a check which can be 
 further indicated in diabetes by a deficiency in the patellar reflex.
 
 32 STUDY OF ORGAN INFERIORITY 
 
 The peripheral stigmata do not have to be of a particular sort 
 at all. Any other conclusion but that of inferiority of the nutritive 
 tract is, as has already been emphasized, inadmissible, and complete 
 knowledge can only be won from the great number of symptoms of 
 inferiority, which in general is not so very difficult. The following 
 case is an example. 
 
 Kdthe H. } 24 years old, lost almost all the teeth in her upper jaw 
 five years ago, and now uses a set of false teeth. The patient has 
 come under our care on account of loss of appetite, which has 
 already lasted for 6 months. There are neither spontaneous pains 
 nor sensibility to pressure. During the six month period of want 
 of appetite, vomiting has occurred three times, and this also without 
 pain preceding. The patient says that once, four years ago, she 
 vomited blood. As a child she suffered with frequent vomiting and 
 at times would faint from nausea. The present sickness is supposed 
 to be related to violent excitement. The report on the internal or- 
 gans was negative. From the symptomatology of this want of ap- 
 petite we must still emphasize a particular distaste for meat. The 
 emaciation during the sickness is given as a loss of weight of about 
 6 Ibs. Palatal and pharyngeal reflexes were heightened. The case 
 had the appearance of a gastro-neurosis, and ran along with slight 
 improvement till suddenly, two months later, intestinal colic, violent 
 vomiting, and intense sensibility to pressure in the region of the 
 appendix set in with fever. After the diseased appendix was re- 
 moved by operation, there was complete recovery. Now there is 
 vomiting only at times and in conjunction with migraine. 
 
 The analysis again shows us the peripheral findings, reflex anom- 
 alies of the palate, such as I have occasionally found in ulcus 
 rotundum and appendicitis usually heightening, rarely deficiency, 
 in the palatal reflexes, the anamnesis reaching into early childhood 
 and a fact which explains the relative rarity of the case disease 
 in different parts, in the teeth, the stomach, the appendix. In the 
 literature we find references to gastric hemorrhages in appendicitis, 
 which, as in the above case, in which the periods of sickness were 
 separated, we must lead back to the unity of a gastro-intestinal in- 
 feriority. But the connection of neurosis also with appendicitis 
 makes this case remarkable. The anamnesis at least portrays child- 
 ish hysteria and the loss of appetite preceding the appendicitis looks 
 like a neurosis. The distaste for meat is very striking, a sort of 
 psychical defence of the inferior organ, which we also recognize 
 from the symptomatology of carcinoma of the stomach, another 
 disease on the organ inferiority basis. Here I should like to em-
 
 AND ITS PSYCHICAL COMPENSATION . 33 
 
 phasize the fact that this psychical defence arises from a compensa- 
 tion in the central nervous system, which may be put on a level with 
 the increased palatal reflex. 
 
 In general the dental formation and its deficiency is an im- 
 portant index of the inferiority of the nutritive tract. Even in 
 rachitic children the coincidence of poor or late dentition and gastro- 
 intestinal disturbances is a fact, the pursuit of which promises in- 
 teresting results. In connection with this I shall only mention the 
 frequently occurring obesity, which seems to me to be a result of 
 the over-compensation of the inferior stomach, intestine and its de- 
 pendencies, and not only in rachitic children but in grown-ups as 
 well. I have repeatedly found in higher degrees of adiposity all the 
 indications such as I should expect in intestinal inferiority or at 
 least various signs of it. The same is true in heredity and in the 
 corresponding stigmas in heredity, or diseases, which had occurred 
 in the gastro-intestinal tract. Likewise constipation or involuntary 
 evacuation of the bowels in early childhood. In my small collec- 
 tion of cases illustrative of diabetes there is a great deal of material 
 touching this, for the connection between diabetes and obesity is 
 well known on all sides. Furthermore one can also frequently find 
 palatal reflex anomalies which I shall discuss later. 
 
 The following case shows many of the connections of which I 
 have spoken: 
 
 Friederike U., 6 years old, a child of healthy parents father is 
 obese and belongs to a family inclined to adiposity fell ill while 
 out in the country with often recurring diarrhea, accompanied by 
 violent pain. In her second year the patient had had a long drawn 
 out attack of intestinal catarrh. She was being treated by a dentist 
 for prognathism which only appeared in the family in one other case, 
 in the eldest, her eleven-year-old sister, when again, with colic, the 
 intestinal affection now under discussion revealed itself as appen- 
 dicitis, which the operation proved to exist. Two years ago she 
 had an operation for adenoids and still speaks nasally and with a 
 thick tongue. The palatal reflex in this child as well as in both 
 her sisters was excessively increased. Later on I learned that the 
 father, who had always been a healthy man, had suffered until 
 puberty from nocturnal enuresis and involuntary defecation just as 
 had several of his now very corpulent brothers and sisters. The 
 patient's older sister had suffered from earliest childhood from con- 
 stipation and promptly shows loss of appetite after excitement at 
 home or at school. She is a nervous child and frequently suffers 
 from headache, and at times complains of colic, without causing a
 
 34 STUDY OF ORGAN INFERIORITY 
 
 suspicion of appendicitis to be justified. Anal fissures and sciatic 
 pains often occur and vanish after a short time. The second sister 
 is healthy. 
 
 The analysis of this case is simple after what I have said. I 
 must add though, how closely related appendicitis and the so-called 
 pseudo-appendicitis are, a fact which I can prove from other cases. 
 It is the same relation as that existing between neuroses of the 
 stomach and, say, ulcus ventriculi. Both are at times found in one 
 family, and can even pass into each other in individual cases. The 
 proof of the inferior ground is however always found in the way 
 I have suggested. 
 
 At the close of the chapter I must mention a phenomenon which 
 apparently does not fit into the scheme hitherto outlined. For my 
 assumption is to establish the meaning of external stigmata as 
 signs of the inferiority of the related organ. Now there are a 
 great number of external stigmata in which perhaps the acceptance 
 of an inferiority of the organ to which they belong, the skin, might 
 be proved but which, however, unquestionably show a closer rela- 
 tion to their segmentally related internal organs, so that their pres- 
 ence shows an inferiority of the segment, a " segmental insuffi- 
 ciency." 
 
 I have often referred to them in the previous pages. As far as 
 I can lay stress on their part, it is a question of nevi of all sorts, of 
 angiomas of the skin, of externally visible telangiectasis and of 
 neurofibromas. Their hereditary occurrence can scarcely be doubted. 
 The significance of an occasional transformation of a nevus to a 
 carcinoma has already been emphasized in my remarks on the 
 causation of carcinomata on the basis of the inferiority theory. 1 
 Furthermore I must introduce Virchow's discussions of the fissural 
 angioma as fetal arrest of development and perceive in them a stage 
 in my conception of the indications of segmental inferiority. One 
 can find an abundance of material in the literature which may be in- 
 terpreted according to my views. I must however put off this fasci- 
 nating task for some later time. I can not dwell upon the theories 
 of Head either, the connection of which with the conception under 
 discussion becomes clear at once if one accepts with me segmental 
 disease, for which the ground is prepared by segmental inferiority. 
 
 I shall now introduce a few striking facts which one can very 
 often find in following carefully the ideas which I have sketched 
 here. I must emphasize first of all that nevi in pulmonary tuber- 
 
 1 As I learn from a report at the time of writing my study, it seems that 
 my conception of carcinoma is very like that of Borst ( Wurzburger Abhand- 
 lungen).
 
 AND ITS PSYCHICAL COMPENSATION - 35 
 
 culosis, in the patient or his family, are uncommonly frequent. They 
 are situated in the most varied places on the thorax, on the healthy 
 side, on the diseased side, and are frequently as high up as the zone 
 of the disease or even somewhat higher. One often finds cases like 
 the following: 
 
 Wladimir T., 23 years old, a student, has complained for two 
 months of a cough and pressure in his chest, perspires a great deal 
 at night and declares that he has grown very thin. The thorax is 
 only slightly arched, greatest circumference in this man of medium 
 size is 82 cm. Pulmonary sound RHO somewhat retracted. Aus- 
 cultation shows RHO to RHM soft vesicular rattling in inspiration, 
 and the same, only not as loud, inward from the right shoulder 
 blade. Teeth sound, palate rather highly arched, palatal reflex very 
 much heightened. If the soft palate is touched, the uvula disap- 
 pears without causing any particular inclination to vomit. Over 
 the middle of the right shoulder blade there is a nevus pigmentosus 
 and it is just about in the projection of the lower rim of the per- 
 ceivable center of disease. The patient's mother as a girl of 18 suf- 
 fered from catarrh of the apex of the lung and was finally cured 
 after a long climatic treatment. She is now forty-three years of 
 age and has always been well since then. One of the patient's 
 brothers is now in a hospital at Davos for catarrh of the apex of the 
 lung on the right side. 
 
 Johann K., 25 years old, a student, had spitting of blood 6 years 
 ago. A little while ago he fell ill of dry, left-sided pleuritis. Palatal 
 reflex heightened. In the thorax in back and in front there were 
 scattered naevi. This is a very frequent condition. 
 
 Hans S., 5 years old, is being treated for intestinal auto-intoxi- 
 cation. Close up under Poupart's ligament there is a nevus the size 
 of a grain of hemp. In the same place on the right his father who 
 was once an enuretic has a testicle which did not descend normally. 
 
 I have already referred in the remarks on the carcinoma theory 
 to the case of Nadja J. nevus on the right above the level of the 
 nostril, and whose mother suffered from carcinoma of the upper 
 jaw on the left side. 
 
 David K., 82 years old, before only suffered from constipation 
 (intestinal inferiority) and occasional attacks of colic in the region 
 of the gall-bladder. For a year there has been a high degree of 
 emaciation and loss of appetite. After repeated tests the palatal 
 and pharyngeal reflexes were found to be wanting. In the region 
 of the gall-bladder one can feel a roundish hard tumor about the 
 size of a walnut. The liver is enlarged, a rough structure and pain-
 
 36 STUDY OF ORGAN INFERIORITY 
 
 ful upon pressure. There is 5 per cent, sugar, no acetone, no 
 diacetic acid in the urine, the quantity of which has increased. Som- 
 nolence after a few days, from which the patient again recovered, 
 then increasing jaundice and after a month death. Diagnosis: car- 
 cinoma of the gall-bladder. A little beneath and to the side from 
 the tumor is a nevus pigmentosus as big as a lentil and a small skin 
 hemangioma. Two of the patient's daughters show the above men- 
 tioned stigmata of organ inferiority, epignathism and faulty posi- 
 tion of the upper incisor teeth and are burdened with defects of 
 speech. Similar conditions are not found in the parents. 
 
 It would be easy to prove that the diseases of the thyroid gland 
 also originate in the form of an inferiority. We give the follow- 
 ing case because of its relation to segmental inferiority. 
 
 Mrs. Rosalie G., 46 years old, has had since her youth a cystic 
 struma of the size of a walnut on the right side which has been 
 punctured several times. On the right in the throat and neck there 
 are numerous pigmented nevi, only a few on the left. The patient, 
 who complains of long-standing hoarseness and frequent coughs,- 
 shows greatly heightened palatal reflex. General adiposity. 
 
 Josef Sch., a broker, 55 years old, complains of constipation 
 and bleeding from hemorrhoids. Complete absence of teeth since 
 his twenty-fifth year. At the left above the open inguinal ring 
 there is a pigmented nevus. No hernia. His son, Paul, 19 years 
 old, has a defect in speech, and suffers from left-sided inguinal 
 hernia. 
 
 Albert K., a private, 42 years old, complains of attacks of violent 
 pains in the region of the heart, " as though something were being 
 distended," pains which radiate into the left shoulder joint and into 
 the left arm. The patient had always been healthy. Syphilis is 
 denied, mild drinking admitted. The patient's father was a healthy 
 man till an advanced age, the mother died at thirty-one of pericar- 
 ditis. Diagnosis: angina pectoris as a result of arteriosclerosis. 
 On the level of the apex of the heart there are numerous telangiec- 
 tases, which encircle the front left side of the thorax like a ribbon. 
 On the back, at the height of the angulus scapulae, on the left and 
 the right there are several nevi. 
 
 Anton E., a mechanic, 48 years old, had always been well. His 
 father, a well-known physician, died at 62 of a gastric hemorrhage. 
 In the region of the stomach, about a finger's breadth beneath the 
 edge of the thorax, there is an angioma as big as a grain of hemp, 
 and at the same level to the right there are two smaller angiomata. 
 
 Wolfgang St., manufacturer, 56 years old, is suffering from be-
 
 AND ITS PSYCHICAL COMPENSATION 37 
 
 ginning arteriosclerosis. In the thirties he lost most of the teeth 
 in his upper jaw, and has worn a false set since then. Palatal 
 reflex in the patient as well as in his two sons is greatly heightened. 
 Patient's father died of pneumonia, his mother of carcinoma of the 
 stomach. Just under the edge of the thorax about on a vertical line 
 through the left nipple there is pigmented nevus as big as a pea. 
 On the left half of the back there are two little neurofibromata, 
 the larger about the size of a pea, a finger's breadth under the angle 
 of the scapula, the smaller one under the scapular spine. After 
 our discussion the idea seems justified that of the two neurofibro- 
 mata the lower one is an inheritance from the mother, the upper 
 one from the father. 
 
 Whoever knew the composer Bruckner will remember that he 
 had a nevus under the zygomatic arch at the height of the lobule 
 of the ear. In this case I might also discover an expression of 
 the inferiority of hearing, which has developed in segmental ar- 
 rangement. Bruckner as well as apparently all great composers has 
 attained such a remarkable artistic height in striving to conquer the 
 auditory inferiority and transforming it into inventive, creative 
 hearing. 
 
 Before we close this chapter, we wish in a certain degree to 
 make the connection with the results of pathology already at hand. 
 As I have already pointed out several times Schick and Sorgo have 
 indicated the connection between certain definite modifications of 
 mammary glands and pulmonary tuberculosis. This condition as 
 well as Frankel's emphasis on the narrowness of the chest and 
 Rothschild's on the angle of the sternum in pulmonary tuberculosis 
 seem to me, even if not as distinct as my reports, to be founded 
 on the character of segmental inferiority. Only in these cases 
 a segment, not yet diseased, may declare its inferiority, where- 
 as the disease is localized in an adjoining, or nearby segment. I 
 myself have seen one-sided or two-sided diminution of the areola, 
 but also have seen retraction of the mamillae in women who have 
 had to stop nursing because of lack of milk. I have also seen lack 
 of milk when the areola was hairy (in the case of Mrs. Lina T., 
 whose mother died of carcinoma of the nipple).
 
 CHAPTER V 
 REFLEX ANOMALIES AS INDICATIONS OF INFERIORITY 
 
 We have already often emphasized the fact that inferiority does 
 not make itself felt under all conditions. I should like to add be- 
 sides that the determination of a deficiency becomes possible, and 
 attracts our attention, only when the inferiority conies into promi- 
 nence in some shortcoming of a function, in a failure in execution. 
 For it is at this point first, whether during good health or in 
 the course of disease, that it becomes perceptible and forces us to a 
 consideration of the circumstances. Whatever we can expect from 
 the nature of the matter, from defect phenomena, will appear as 
 motor insufficiency, as deficient production of related glandular 
 secretions and above all, as more inadequate development or lack 
 of reflex actions of all sorts, but also as the opposite of this, such 
 things as motor over-activity, as hypersecretion and as increase 
 in the reflexes. 
 
 Virchow's hypoplasia of the vascular system might be consid- 
 ered as a prize case of motor weakness. We meet with deficient 
 production, for example, in certain diseases of the thyroid gland or 
 in chlorosis (Kahane). We wish to direct our attention at this 
 point particularly to the deficiency and the exaggeration of reflexes, 
 particularly the reflexes of the mucous membranes, because there is 
 a certain amount of material available for this, and its coincidence 
 with other tokens of inferiority seems warranted to me. Thus it 
 happens that the state of these anomalies of reflexes is wonderfully 
 fitted to disclose an organ inferiority. 
 
 The following investigation by no means extends to the great 
 number of well-known skin and mucous membrane reflexes. I had 
 to be satisfied with putting only a minority through a systematic 
 examination, and of these shall emphasize only the palatal and con- 
 junctival reflexes. First however we must touch upon a class of 
 reflexes whose presence escapes immediate recognition but can 
 scarcely be denied. There is no doubt, that in the inner part of 
 the organs, particularly from the tubular formation of the mucous 
 membrane out, reflex actions might perhaps be incited at every 
 point, and by all sorts of stimulation, reflex actions which are of 
 the utmost importance for the continuation of secretion and excre- 
 
 38
 
 STUDY OF ORGAN INFERIORITY 39 
 
 tion. // I may draw conclusions from the analogy with the phe- 
 nomena to be mentioned later, it seems certain to me that certain 
 diseases, such as, for example, cholelithiasis, nephrolithiasis, cylin- 
 druria, Curschmann's spirals, are connected with a decreased reflex 
 capacity in the related part of the organ, without perhaps being ex- 
 clusively determined by it. 
 
 The lack of palatal and conjunctival reflexes is an occurrence well- 
 known to all but which has hitherto played a small role in medicine. 
 Still less frequently observation found increase in these reflexes. 
 The universally conventional view, which is connected with such 
 cases particularly with weakening, consists mostly in the reference 
 to its relation to hysteria, which is in turn questioned on other 
 sides. If, for simplicity's sake, we waive organic nerve affections, 
 / must make the declaration that the lack as well as the striking 
 strengthening of these reflexes should be considered as attributes 
 of organ inferiority. 
 
 I offer the following as proof: (i) These reflex anomalies are 
 found very frequently in heredity, or else occur, where diseases of 
 the related organ can be proved in the heredity; (2) they stand 
 in the same relation to childish defects as stigmata; (3) they are 
 found in connection with stigmata of the oral region or when such 
 stigmata occur in the heredity; (4) they are found in connection 
 with diseases of the related organs or when such diseases exist 
 in the family. 
 
 Before we take into consideration the proofs and references 
 from the list of illustrative cases, we must bring in a few details 
 which deserve attention in later examinations. Thus with regard 
 to the testing of the reflexes. Authors leave no doubt as to the 
 connection between reflex activity and the psyche. A few things 
 should be added here. If. for example, one makes a test of the 
 palatal reflexes one can easily find that the results vary according 
 as the patient is influenced by the test. Thus it can happen that a 
 second examination by means of touching the palate at the height 
 of the insertion of the uvula results in a greater reaction the 
 sense of a choking reflex or a smaller one. In the first case we 
 must suppose that through the initial unsuspected tests which were 
 made a feeling of nausea arose in the patient which on second 
 touching was ready to manifest itself. It is clear that in this 
 case we no longer have to do with the normally present reflex 
 activity in the soft palate, but with a psychically established and 
 deepened radiation, which at times is capable of heightening and is 
 related to an affect phenomenon. In this conclusion I am sup- 
 
 4
 
 4O STUDY OF ORGAN INFERIORITY 
 
 ported by the following results: the test for vomiting reflex by 
 touching the pharynx, or the back pharyngeal wall, is often posi- 
 tive, whereas touching the soft palate gives no result ; in these cases 
 the soft palate seems to be outside the reflex zone. This condition 
 is found quite often in children up to their second or third year. 
 In addition to that, it struck me, that in little children by touching 
 the back pharyngeal wall no vomiting reflex, but frequently cough- 
 ing results, a fact which strengthens my conception that reflex 
 anomalies of the palate and pharynx, as well as stigmata in these 
 parts discussed before may also originate from an inferiority of 
 the respiratory apparatus. The spreading of the vomiting reflex 
 zone to the soft palate may be brought about by repeated tests or 
 sudden contacts expected beforehand by the patient, and the result 
 is then no longer free from objections. My conception derives 
 further proof from the fairly frequent cases which show the 
 vomiting reflex even before touching the soft palate. Thus I 
 could call forth an increased vomiting reflex in a four-year-old girl 
 when I put a thin little rod back of the teeth, without touching the 
 palate or the tongue, which was all the more striking, as the child 
 in consequence of a cleft of the hard palate showed a defect of the 
 central back portion of the soft palate. In three cases it was im- 
 possible for me even to succeed in opening the mouth. The in- 
 spection was always denied with laughing, anxiety and indications 
 of choking movements. Two of the cases had to do with cooks 
 who had been in service in Vienna for some time and who were not 
 at all unintelligent. Injuries of the mouth, of which they might 
 have been somewhat ashamed, were not present. The third case 
 was that of a cultured woman who had been suffering from re- 
 curring abscesses of the tonsils for many years. The incision had 
 to be given up each time on account of the impossibility of getting 
 a probe or a knife into the patient's mouth. I found the same 
 state of affairs at times when no abscesses had formed. Two of 
 the patient's sons acted similarly which gave one the impression that 
 the vomiting reflex zone had extended to the eyes and was irritated 
 by the very expectation of touching the pharynx. The touching of 
 the palate may occur once and without having the person examined 
 expect it, but in contrast to touching the back pharyngeal wall it 
 exhibits the more delicate reagent to the reflex activity of the 
 pharynx. 
 
 Still easier to comprehend is the control of this reflex activity 
 by the will. And yet I think that a certain degree of heightened 
 choking reflex can not be completely checked by the will.
 
 AND ITS PSYCHICAL COMPENSATION 4! 
 
 These reflections and the impression which I obtained from a 
 great number of nursing infants and little children, 2 that the pharyn- 
 geal reflex is a product of the psychomotor sphere in the post- 
 embryonic period, permit me to classify all anomalies of the reflexes 
 of the mucous membranes as defective functioning of an inferior 
 organ. The pure type of this deficient performance which shows a 
 strong relationship to the infantile anomalies, spoken of earlier, is 
 the lack of the reflex, while the increase is to be considered in the 
 light of over-compensation. The occurrences which lead to the 
 heightening of the reflex are openly related to inferior, but func- 
 tionally capable nerve material, increase their energy and influence 
 over the reflex zones and thus attain the higher reflex technic. As 
 we shall show later, the inferior organ with its psychical super- 
 structure almost always is in the focus of its bearer's interest. 
 It is the unsuccessful but indulged organ which keeps the psyche 
 in a state of continual irritation on account of conscious or uncon- 
 scious attention. Newly arriving stimuli for the way to the brain 
 is usually undisturbed in spite of deficient reflex little by little 
 come into a realm of higher psychical tension, which grows greater 
 the less motor reflexes lead from it. This condition may last 
 through the whole lifetime. Very frequently however and evi- 
 dently as a sort of compensation a heightening of reflex capacity 
 appears to take place in childhood, which bears witness in the same 
 manner to the fundamental inferiority of the related organ, and at 
 times of the segment also. 
 
 As to the results of my investigations in regard to the palatal 
 reflex, they fit in very well with my former representations just as 
 did the experiments with the conjunctival reflex. We find a lack 
 or a heightening of the palatal reflex in the most varied diseases of 
 the nutritive and respiratory tracts, above all in angina, pulmonary 
 tuberculosis, diseases of the nose and larynx and in certain pro- 
 fessions, in following which the compliance of an inferior or over- 
 compensated organ is necessary, as in singers, speakers and players 
 of wind instruments. In all these cases, I could be sure of a pre- 
 dominance of reflex deficiency. The objection that there exists no 
 coordination here, but an anomaly conditioned by the disease, or 
 the profession, I can set aside merely with reference to the hered- 
 ity of the reflex anomaly ; the extraordinary or deficient palatal re- 
 flex is almost always met with again in closely related members of 
 the family, and without having any connection between the anom- 
 aly and disease or profession. But on the other hand my concep- 
 
 2 I am indebted to the kindness of Dr. Rie for a portion of this material.
 
 42 STUDY OF ORGAN INFERIORITY 
 
 tion gives an explanation of the fact, that so frequently members 
 of the same family have the same disease or repeatedly follow the 
 same, usually artistic, profession. A third fact can not be over- 
 looked, namely, that the anomaly may be present, without being con- 
 nected with the disease or profession, and reflex capacity may ap- 
 pear normal in spite of disease or profession, for reasons, which 
 we have already introduced several times, particularly that the in- 
 feriority of the organ may manifest itself in other ways or at an- 
 other point. Perhaps still more often is the connection between 
 palatal reflex anomalies and gastro-intestinal diseases established. 
 Above all it seems to me that the lack of the palatal reflex, the 
 rarely important heightening, up to the disappearance of the uvula, 
 is almost regularly connected with hysterical manifestations of the 
 gastro-intestinal apparatus, and at times of the respiratory tract. 
 Hysterical eructation, vomiting, singultus, crying fits, aphonia, the 
 many-sided picture of intestinal and gastric neuroses almost always 
 show palatal reflex anomalies. If the ruling conception regards the 
 lack of palatal reflex as a ground for suspicions of hysteria, those 
 who follow this concept are right to a certain degree, but their op- 
 ponents are just as much in the right because, as we shall see later, 
 the hysterical manifestations may take their starting point from 
 other inferior organs so that the oral zone then appears as normal. 
 As regards organic diseases, I could be sure that between appen- 
 dicitis, pseudo-appendicitis, ulcus rotundum, gall-stone diseases, 
 diabetes, carcinoma of the gall-bladder, chronic constipation, obes- 
 ity, perhaps even chronic alcoholism, and our reflex anomalies, the 
 same connections had weight, as could be proved between disease 
 and childish defects, or between disease and stigma. 
 
 I can not forbear to show at this point how great is the relation- 
 ship between reflex anomalies and childish defects. Both are func- 
 tional anomalies of the inferior organ which may last until an end 
 is made by the compensatory intervention of the central nervous 
 system, the psyche. Furthermore the manner of manifestation of 
 many children's defects is nothing else than an unusually continuing 
 heightened reflex. This is the case in blepharospasm, more rarely 
 nystagmus, thumb sucking and lip sucking (see the sucking re- 
 flex), stuttering, vomiting, enuresis, incontinentia alvi. All these 
 are aroused, not from the outside, but from within and are under 
 the impulse of the central nervous system. They are transformed 
 methods of function of the inferior organ, which come to light in 
 infantile errors as well as in the reflex anomalies and these obey 
 the compensating and over-compensating power of the portion of 
 the psychomotor sphere which has now attained super-value.
 
 AND ITS PSYCHICAL COMPENSATION 43 
 
 In the following I will trace the relationship of childish defects 
 and reflex anomalies to enuresis still further. I can scarcely ex- 
 pect a serious objection if I place this affection among the number 
 of functional inferiorities. The opinions of individual authors who 
 think that organic hypoplasias may be found in the bladder or in 
 the central nervous system, can change nothing in this conception, 
 and moreover, are in harmony with my ideas concerning external 
 and internal stigmata. Now in the symptomatology of enuresis 
 there is a characterizing sign, according to which a direct division 
 into two forms was attempted : namely the behavior of the sphincter 
 in catheterization, which appears now as atony (lack of reflex), 
 again as strengthened tonicity, as a spasm (heightened reflex). In 
 this opposed behavior we can recognize the already familiar reflex 
 anomalies of the inferior organ and we would be in a position from 
 this reflex anomaly alone enuresis, this childish defect, need not 
 always appear in spite of inferiority of the urinary apparatus to 
 infer the state of things, namely to surmise the inferiority of the 
 urinary apparatus or the sexual apparatus in the family. 
 
 If we have to do with reflex paralyses following upon organic 
 nervous diseases, we must not forget at the same time that accord- 
 ing to the established principles the organic disease is localized in 
 the inferior channels. We must think particularly of the phenom- 
 ena of segmental inferiority, which surely plays a part in tabes, in 
 occupation diseases, writer's cramp, etc., in pseudohypertrophy and 
 Erb's disease. 
 
 The brother of a physician fell ill of tabes dorsalis, which for 
 some time manifested itself as atrophy of the optic nerve. The doc- 
 tor himself and several of his brothers and sisters had in their 
 childhood suffered from blepharospasm. The conditions might be 
 similar in tabetic bladder and rectal disturbances, in ataxia, girdle 
 sensation, larynx and gastric crises, whereas in paresis a funda- 
 mentally inferior brain may be surmised. 
 
 I should like to introduce the following case in regard to the 
 significance of the palatal reflex anomalies in connection with dis- 
 eases of the air passages and the nutritive tract. 
 
 Heinrich R., merchant, 52 years old (already mentioned), has 
 for many years suffered from frequent tenesmus with diarrheal 
 evacuation. Ten years previously he had a violent attack of gall- 
 stones which was completely cured at Karlsbad. One of the pa- 
 tient's brothers, a doctor, was operated on by Kehr for the same 
 affection. The mother suffered from enlargement of the liver. 
 Palatal reflex in the patient negative. His son, Herbert, sixteen
 
 44 STUDY OF ORGAN INFERIORITY 
 
 years old had appendicitis four years ago, which was completely 
 cured after internal treatment. At that time there was obstinate 
 constipation. No palatal reflex, slight defect of speech, slight de- 
 gree of epignathia. One the patient's daughters has very stubborn 
 constipation. No palatal reflex. The youngest son, n years old, 
 shows epignathia to a slight degree, has a defect in speech like his 
 brother, no palatal reflex. In this case I wish to emphasize the 
 inheriting of the lack of palatal reflex and the fairly radical intes- 
 tinal inferiority in the family which reveals itself in different dis- 
 eases, as well as in a decided tendency towards obesity. 
 
 Mrs. Amalie B., 61 years old was, as a child, very weak and 
 thin and is supposed at times to have suffered from hemoptysis. 
 Since her twentieth year she has gained a great deal of weight in 
 spite of continually practised self-denial in diet. No palatal reflex. 
 Of her five sons, in three I could find the same lack of palatal reflex, 
 the fourth had died in dabetic coma. I never examined this one 
 or the fifth son. Nevertheless I point to my cases of diabetes in 
 which also the palatal reflex was wanting. The oldest son is ap- 
 parently healthy, the second of the three whom I examined is obese, 
 inclines to constipation and is troubled by recurring anal fissures 
 and by anal eczema. The third was operated on a year ago for 
 appendicitis, after numerous feverish attacks in the region of the 
 cecum had been occurring for four years. With the operation 
 came exudative pleuritis on the right side and double infiltration 
 into the apex of the lung, which turned out favorably. Heredity 
 of reflex anomalies such as in the first case, demonstrable hereditary 
 inferiorities of the nutritive and respiratory tract, and at the same 
 time variations in the diseases of the nutritive tract (appendicitis, 
 diabetes, anal fissures), and at times only adiposity are found in 
 reviewing the family. In addition to this we find at the same time 
 inferiority of the respiratory tract, which reveals itself in disease 
 in the mother and one of the sons. Further on there will be some 
 facts in regard to the connection between palatal reflex anomalies 
 and pulmonary tuberculosis. 
 
 Kdthe H. (see III), governess, 24 years old, was operated on 6 
 months ago for appendicitis. Four years ago there was hemate- 
 mesis. Teeth lacking in the upper jaw, palatal reflex heightened. 
 
 In Friederike U. (see III) and both her sisters we also find 
 heightening of the palatal reflex up to the point of disappearance of 
 the uvula, while in Friederike there was appendicitis, prognathia, 
 adenoid growth, defects of speech, and in her oldest sister, prog- 
 snathia, gastric neuroses and anal fissures.
 
 AND ITS PSYCHICAL COMPENSATION 45 
 
 Hugo R., writer, 34 years old, was stricken at the beginning 
 of his twentieth year, with pulmonary tuberculosis which appeared 
 rather serious and was accompanied by frequent hemoptysis. After 
 spending about two years at the sanatorium at Alland, he took up 
 his profession again three years ago much improved and since then 
 has been uninterruptedly active. He shows complete lack of the 
 palatal reflex. The patient comes from a family which has given 
 us several prominent actors (oral inferiority). His sister also, 
 who died of pulmonary tuberculosis, was active for a time as an 
 actress. 
 
 Maria A., 24 years old, a governess, is being treated for hemop- 
 tysis. Left-sided infiltration into the apex. A sister also has for 
 some time had pulmonary tuberculosis which apparently ran a light 
 course. In both of them conjunctival and palatal reflexes are lack- 
 nig. The patient suffered for some time from frequent loud eruc- 
 tations and singultus and as a child vomited easily and very often. 
 Even at the present time she feels a provocation to vomit when she 
 is brushing her teeth. In spite of deficient palatal reflex sensation 
 of a globus often occurs as well as headaches. Individual members 
 of the family, particularly the father (civil engineer), show ability 
 to draw (lack of conjunctival reflex, inferiority of the organs of 
 vision, psychical over-compensation) . The lack of the palatal reflex 
 here is related not only to an inferiority of the respiratory appara- 
 tus, the missing pharyngeal reflex is evidently connected with the 
 hysterical manifestations of the nutritive apparatus! I often find 
 nausea as an affect and inclination to vomit in children and older 
 people connected with deficient palatal reflex. 
 
 In order not to weary with enumerations and descriptions, I will 
 only present briefly a few more cases and will emphasize their char- 
 acteristic features. The analysis of each case is easy to make after 
 what has gone before. 
 
 Therese M., 27 years old, chambermaid, apex infiltration on the 
 left side, coughs a great deal, and has in the last 3 months become 
 greatly emaciated and suffers from night-sweats. Palatal reflex 
 greatly heightened. 
 
 In this group belong the cases already mentioned in other con- 
 nections : 
 
 Johann K., 25 years old, a student, tuberculosis of the left 
 superior lobe, dry pleurisy on the left side, and hemoptysis 6 years 
 ago, nevi pigmentosi on the thorax. No palatal reflex. 
 
 Fanny H., a teacher, 23 years old, began spitting of blood; 
 apex infiltration on the left side, constipation of long standing.
 
 46 STUDY OF ORGAN INFERIORITY 
 
 The mother died of consumption, the sister has a lung disease. 
 The right half of the thorax is better developed than the left. 
 No palatal reflex, no pharyngeal reflex. The lack of the latter evi- 
 dently has to do with the constipation. 
 
 Wladimir T., 23 years old, a student, has been coughing for two 
 months ; resonance RHO contracted, and gentle rattling in inspira- 
 tion which only disappears at the spina scapulae. Nevus pigmen- 
 tosus over the middle of the right shoulder blade. In her youth, the 
 mother had suffered from catarrh of the apex of the lung, and a 
 brother is being treated at Davos for infiltration into the apex of 
 the right lung. Heightened palatal reflex, and on touching the 
 soft palate the uvula disappears almost entirely. 
 
 Further cases are the following: 
 
 Berta Sp., 23 years old, a cook. Hemoptysis for the last two 
 months; the patient continued with her work. Infiltration of the 
 left upper lobe of the lung. There is a nevus pigmentosus in the 
 region of the spinous process of the seventh cervical vertebra. The 
 teeth of the upper jaw have fallen out, while the lower incisor teeth 
 are horizontally notched. Chronic constipation. The father died 
 young of pulmonary phthisis. No palatal reflex. No pharyngeal 
 reflex. 
 
 Josefine Sch., 21 years old, is suffering from loss of appetite 
 and frequent vomiting. As a child she was chronically constipated 
 and often vomited, particularly when angry. Since puberty vomit- 
 ing occurs regularly during her period. In the last three years she 
 has had, somewhat periodically, violent pains, colic, in the ileocecal 
 region. There is also great sensibility to pressure. The appendix 
 may be felt as a thickened cord. Diarrhea as reported rare, vomit- 
 ing latterly more frequent. Rales in the upper right superior lobe, 
 night-sweats, no palatal reflex, no pharyngeal reflex. 
 
 Siegfried M., 33 years old, a merchant ; apex infiltration on both 
 sides, great emaciation. No palatal reflex. 
 
 Anna R., 28 years old, landlady, every year has several attacks 
 of angina tonsillaris. A brother died of tuberculosis, the father 
 has emphysema. The patient has sound lungs. There is a nevus 
 pigmentosus over the left clavicle. One of the patient's uncles on 
 her father's side is a formidable orator, an obstructionist speaker, 
 who speaks very often in assemblies. The patient shows lack of 
 palatal reflex. Pharyngeal reflex normal. 
 
 I have repeatedly referred to the fact that I have been obliged 
 to consider diabetes mellitus as well as most of the glycosurias as 
 diseases of an inferior nutritive apparatus, particularly of an in-
 
 AND ITS PSYCHICAL COMPENSATION 47 
 
 ferior pancreas and liver. I once more call attention to heredity in 
 these affections, to the connection with intestinal diseases in the 
 patient and his relatives, to the appearance of psychoses and neuroses 
 in diabetic cases and members of their families, to external stig- 
 mata and children's anomalies in the anamnesis. I can add at this 
 point, too, that from a small number of cases I became convinced 
 that the reflex capacity of the palate in glycosuria and diabetes 
 shows the same anomalies as in other diseases of the inferior gastro- 
 intestinal tract; the palatal reflex has usually disappeared and this 
 defect must serve as a token of organ inferiority. The deficiency 
 of the patellar reflex in cases of diabetes has, to be sure, another 
 significance, namely that of an indication of the segmental in- 
 feriority. 
 
 Here are the diabetic cases just as I have met with them re- 
 cently : 
 
 David W ., 25 years old, a student, suffered in his youth from ob- 
 stinate constipation. Four years ago his diabetes was discovered, 
 during the development of which a great deal of sugar was excreted, 
 with periodic acetonuria and excretion of diacetic acid. Tolerance 
 very slight. No further cases of diabetes in the family. The father 
 suffered from attacks which lasted for months when he could not 
 walk nor speak. One sister suffered from a temporary psychosis. 
 The patient lisps very noticeably still. The patellar reflexes are 
 greatly diminished on both sides, and palatal and pharyngeal re- 
 flexes are lacking. 
 
 Mar git B., mentioned in II ; constipation extending to her earliest 
 childhood, defects of speech, attacks of singultus in puberty, hys- 
 terical anxiety. No palatal reflex and a very weak pharyngeal 
 reflex. The father died of diabetes. A brother suffered up to his 
 twelfth year from incontinentia alvi, a sister had hysterical at- 
 tacks of unconsciousness. Here also we find the connection be- 
 tween reflex anomalies and diabetes, neurosis and infantile defects, 
 distributed at any rate among the individual members of the family. 
 
 Otto C., already mentioned. Died in diabetic coma. As a 
 child had suffered greatly from incontinentia alvi. His father has 
 been constipated all his life. His sister also suffered for a long 
 time from constipation and fell ill very early with violent hysteria. 
 Both father and sister show lack of palatal reflex. 
 
 Josef A., 37 years old, a furrier, complains of impotence and 
 ejaculatio precox. Examination shows a great deal of sugar in the 
 urine. No palatal reflex. No patellar reflex. 
 
 Regina D., 38 years old, the wife of a lawyer, complains of
 
 48 STUDY OF ORGAN INFERIORITY 
 
 pruritus vulvse and many nervous troubles. A great deal of sugar 
 and acetone in the urine. Patient's father died in diabetic coma. 
 Two sisters have hysterical affections. In all three sisters there 
 is a lack of palatal and pharyngeal reflexes. Patellar reflex normal. 
 One sister sucked her thumb for a long time. 
 
 Anton M., 40 years old, a caterer, shows a slight defect in 
 speech and lacks palatal reflex. Pharyngeal reflex present. Pa- 
 tient's mother has diabetes. 
 
 David K., whom I mentioned earlier, belongs in this group. 
 Carcinoma of the gall-bladder ,glycosuria. His difficulties began 
 with loss of appetite and emaciation two years before his death. 
 No palatal and no pharyngeal reflex. Patellar reflex not tried. 
 Two daughters show epignathia; one of them suffers from hyster- 
 ical coughing and loss of appetite. 
 
 As I have already stated, we almost always find lack of palatal 
 reflex in people who frequently have sore throats. I also found 
 the same condition in a case of herpes pharyngis in a man who had 
 suffered for some time from flatulence and from an umbilical hernia. 
 
 The case of a hysterical patient, Dr. Heinrich O., in whom there 
 were indications of spina bifida sacralis and adenoid growths, seems 
 worthy of mention. The patient very often made a grunting noise 
 and one day presented himself with aphthae of the palate and 
 pharynx. I also saw reflex anomalies in several cases of ulcus ro- 
 tundum and in relatives of these patients. In chronic alcoholics 
 one usually finds heightening, but also lack of the palatal reflex. 
 These anomalies are surely not to be considered as conditions re- 
 sulting from alcoholism. They show rather that chronic alcoholism 
 is dependent upon an organic cooperation as a foundation of an in- 
 ferior gastro-intestinal tract. I also saw a case of diabetes insipidus 
 with palatal and pharyngeal reflexes lacking. I have already em- 
 phasized the relation of obesity to the inferiority of the nutritive 
 tract. The reflex anomalies which have been discussed are often 
 met with under this condition. 
 
 I introduced a case in regard to lack of conjunctival reflex as 
 evidence of inferiority of the eye in Chapter I. At this point I 
 have a second to offer. 
 
 Elsa R., 22 years old, was treated for a foreign body in the 
 right eye. The blue colored iris of the right eye is colored brownish 
 at a point in the upper outer quadrant. Normal sharpness of vi- 
 sion. No conjunctival reflex. The coincidence of stigmas, reflex 
 anomalies and foreign bodies here also raises a suspicion of in- 
 feriority.
 
 AND ITS PSYCHICAL COMPENSATION 49 
 
 I have already mentioned the painter Karl v. R. photophobia, 
 conjunctivitis lymphatica in youth, thin eyelashes, blinking in the 
 brother. I must add that in this case also the conjunctival reflex 
 is wanting. 
 
 In a similar manner reflex anomalies are found, usually lack of 
 palatal reflex, in people who have attained to higher sorts of work 
 by conquering the fundamental inferiority of their respiratory tract 
 or nutritive apparatus. I have already emphasized three categories 
 of these several times in other connections, singers, speakers, and 
 cooks ; I must still mention gourmands in whom I have almost 
 always found the palatal reflex has become extinct, and in fact in a 
 large number of cases. To these categories I can still add : an oboe 
 player, a trumpeter and a heavy smoker.
 
 CHAPTER VI 
 MANIFOLD ORGAN INFERIORITIES 
 
 Even though the fundamental principles of a theory of inferior- 
 ity, which I have just laid down, are confirmed (of which I have 
 no doubt), nevertheless it is rather striking that their relation to 
 pathology has not hitherto been clearly recognized. The final reason 
 for this seems to me to lie in the fact that the picture of organ 
 inferiority has been only too often obscured by the intrusion of 
 further organ inferiorities and has been made unrecognizable. Dis- 
 cernment is still more difficult in this connection, when one is 
 forced to determine the inferiority in the family from the statements 
 of one patient alone. Usually available reports are of diseases in 
 members of the family, obtained during their lives or about affections 
 which led to their deaths. A test for other organ inferiorities which 
 may have been unnoticed, but which are particularly noticeable 
 in the patient examined, often can not be carried out. On the 
 other hand there is fortunately such a lot of explicable material, 
 particularly in the family physician's practice, that in spite of indi- 
 vidual gaps, owing to the difficulty of producing the material, the 
 foundation of a theory of organ inferiority may be considered as 
 fully established. 
 
 A second phenomenon, which is closely connected with this, Is 
 still more highly adapted to conceal the existing circumstances. For 
 very often organic diseases can be found in almost every individual 
 member of a family, but they concern entirely different organs, and, 
 accordingly, seem to gainsay the claims based on the inheritance of 
 organ inferiority. But in such cases also the connection may often 
 be discovered and the proof of multiple organ inferiority may be 
 secured by information concerning childish defects or reflex anoma- 
 lies. The following is such a case, one which I have already used 
 in the carcinoma theory and which I discuss more at length here : 
 
 Therese S. died at 46 years of age after an operation for carci- 
 noma of the uterus. Her husband, Samuel S., at that time 51 
 years old, has suffered since his 4Oth year from rare attacks which 
 are accompanied by sudden collapse and a short period of uncon- 
 sciousness. Injuries frequently occur in this way. Difficulties in 
 recollecting after the attack, amnesia and stammering afterward, 
 
 50
 
 STUDY OF ORGAN INFERIORITY 5! 
 
 speak for the epileptic nature of the affection. It is impossible to 
 make a psychical analysis of these attacks which occur about twice 
 a year. The patient has chronic constipation. A son, Alexander 
 S., 23 years old, suffered until his sixth year from involuntary mic- 
 turition and defecation, had scarlet fever in his twenty-first year, 
 which was followed by nephritis. Occasionally, a year later, there 
 are still traces of albumin, and quite often excess of phosphates too. 
 Sexual abstinence, even for a short time, calls forth the most vio- 
 lent conditions of excitement, fear of beginning insanity and violent 
 and lasting palpitation of the heart. Ejaculatio precox. The 
 daughter suffers from vomiting on the slightest provocation, ab- 
 dominal colic and diarrheal evacuation. From time to time anal 
 fissures appear. Painful menses, protracted labor. Her six year 
 old son is an enuretic. All four survivors show lack of palatal 
 reflex. The inferiority of the intestinal tract and of the central 
 nervous system inherited from the father reveals itself characteris- 
 tically in the daughter in the same manner: psychical insufficiency 
 toward external impressions and motor defect in the inferior gastro- 
 intestinal tract, which is stigmatized, besides, by the lack of palatal 
 reflex and by the anal fissures. The mother's inheritance, inferior- 
 ity of the sexual apparatus, reappears in dysmenorrhea and the pro- 
 tracted labor. Even the son shows in the accompanying psychical 
 phenomena of his sexual abstinence and in his involuntary defeca- 
 tion the inferiority of the same organs that we have noticed in his 
 father. Enuresis and the same trouble in his nephew, points, how- 
 ever, just as did the nephritis, to an inferiority of the urinary ap- 
 paratus, which, as we shall show later, is, perhaps, regularly con- 
 nected with the inferiority of the sexual apparatus (ejaculatio precox 
 in the son, carcinoma of the uterus in the mother). That fre- 
 quently, adjoining organs, and also those at a greater distance, take 
 part more or less in the inferiority, gives us evidence in the first 
 place, of reciprocal embryonic influence, and also arises from the 
 embryonic connection of many an organ, while more distant organs 
 may be influenced by hereditarily conditioned degeneration of the 
 germ-plasma in numerous places, by early correlation of certain 
 organs, but also by a superimposed inferiority of the circulatory or 
 of the central nervous system. In the last case, particularly, it 
 would not suprise us to see aggregated organ inferiority appear, in 
 case the vital capacity of the embryo seems assured. 
 
 Our assertions have been mightily supported hitherto by the 
 conceptions and reports of clinical medicine which has long been 
 familiar with the connection of many organic diseases. If we com-
 
 52 STUDY OF ORGAN INFERIORITY 
 
 pare our results in regard to manifold inferiority, and if we con- 
 sider them in those cases in which the diseases reveal them most 
 clearly, it becomes evident that we can speak of simultaneous, co- 
 ordinate inferiority, where the former conception had usually de- 
 termined diseases as dependent upon each other. This is the 
 case in regard to two pairs of organs, whose belonging together 
 is also proved by the common terminal issue, in respect to the re- 
 spiratory, digestive and the urino-genital tracts. For each of these 
 pairs we have already found common stigmata and reflex anomalies 
 as indications that inferiority is present. We can draw new evi- 
 dence from clinical medicine. Gastro-intestinal affections in dis- 
 eases of the lungs, in emphysema and particularly in tuberculosis 
 are sufficiently known, and yet their dependence upon a primary 
 lung disease seems to be too strongly stressed. We find that it 
 is oftener the case for them to be entirely lacking, or to precede 
 the lung disease by some time, and that they even extend back to 
 the earliest childhood. We uphold the same conception also in 
 regard to the connection of diseases in the urinary and genital 
 tracts. Aside from the frequency of simultaneous structural anom- 
 alies in both organs, similar reasoning respecting simultaneous in- 
 feriority is entirely in place. Frequent miscarriage in renal affec- 
 tions is universally considered the result of the latter. All 
 justification is lacking for this conviction, since normal parturition 
 occurs in renal diseases and manifold miscarriages without patho- 
 logic conditions are not at all rare. The same thing is true in 
 pyelitis of pregnancy. Nevertheless I wish to stress emphatic- 
 ally, that neither a one-sided nor mutual influence is ruled out 
 through inferior organs. But the simultaneousness of organ inferi- 
 ority deserves special consideration, since through it, it would be 
 possible to obtain greater insight into pathology. The influenc- 
 ing of the circulatory apparatus, particularly of the heart, in a 
 renal disease is certainly plausible according to the material at 
 hand. By accepting a simultaneous inferiority of the vascular 
 system, the hypertrophic heart becomes more comprehensible in 
 such cases, particularly with contracted kidney. To my mind, we 
 shall have to follow the connection of nephritis with diseases of the 
 eye in the same manner. In one of my cases, at any rate, in which 
 the patient acquired inflammation of the choroid and retina in the 
 course of nephritis, the simultaneous inferiority of the visual ap- 
 paratus seems to be determined by congenital lamellar cataract. 
 
 In a like manner I think the acceptance of simultaneous inferior- 
 ity justified, where urinary organs and digestive apparatus side by
 
 AND ITS PSYCHICAL COMPENSATION 53 
 
 side show themselves to be diseased. Here we could mention al- 
 buminuria in intestinal affections, nephritis in diabetes, simultane- 
 ous formation of stones in the bile duct and urinary passage, etc. 
 
 In affections accompanying pulmonary tuberculosis, phenomena 
 of simultaneous inferiority also appear. The same is true in al- 
 buminurias, glycosurias, strumas, the gastrointestinal diseases men- 
 tioned before, affections of the heart, lymphadenitis and certain 
 skin diseases. If we accept with this, primary inferiority of the 
 urinary and intestinal apparatus, of the skin and so forth, it be- 
 comes easily comprehensible that under certain conditions these or- 
 gans also may succumb to tuberculosis, as soon as an opportunity 
 for infection is given. 
 
 This coordination plays a large part in relation to the sexual 
 apparatus and other organs, in which the inferiority of both is often 
 only little apparent but is so often present that I should like to state 
 that, there is no organ inferiority without accompanying inferi- 
 ority of the sexual apparatus. This view is made probable from 
 the outset, by the appearance of heredity in the study of inferior- 
 ity. Since now the hereditary weakness must exist in the sperma- 
 tozoa and ovule, we must understand that the place of development 
 of both, in a wider sense the whole sexual apparatus, participates 
 in the inferiority. This seems to me to be a fundamental law of 
 the theory of organ inferiority, namely, that every organ inferior- 
 ity carries its heredity through, and makes itself felt by reason 
 of an accompanying inferiority in the sexual apparatus. For the 
 present the historic origin of organ inferiority does not concern us, 
 the hereditary significance of which could evidently first appear 
 in connection with the sexual sphere. The acceptance of an inter- 
 nal secretion of the genital glands scarcely touches our argument. 
 If there should be failure of secretion or hyper function, they could 
 only act on other organs, according to the degree of inferiority of 
 these organs, which have shown themselves as inferior. One can 
 only get an unobscured picture of such organs working upon each 
 other by postulating simultaneous inferiority. The investigations 
 in this group will have an enormous field to compass. Previous 
 researches which are not directed toward our point of view of simul- 
 taneous inferiority, exist in numbers and usually only require fur- 
 ther interpretation in our sense. This is the case in the connection 
 of anomalies of position, flexions, infantilism, menstruation, preg- 
 nancy, climacteric with diseases of the digestive apparatus, of the 
 blood, the kidney, the heart and the lungs. This is also the case 
 in the obstinate and severe course of diseases of the sexual or-
 
 54 STUDY OF ORGAN INFERIORITY 
 
 gans, particularly of gonorrhea and its complications, in connection 
 with the inferiority, which can be demonstrated, of the sexual ap- 
 paratus, but also of the urinary organ, the lung and of the blood. 
 Our conception, which essentially declares the frequency of simul- 
 taneous inferiority of the sexual organs, is only reinforced by the 
 frequency of stigmata and of tumor formations in the genitals. 
 And finally the whole outcome of function and growth of the sexual 
 organs, the late, but then too full development, the early promise 
 of growth and function, as is found in no other organ, the colossal 
 growth energy and power of regeneration in the descendants, gives 
 in dazzling light the picture of the phenomena in the inferior organ, 
 just as we have previously shown it. We can state directly that 
 a lesser degree of inferiority adheres to the human sexual organ in 
 all cases, but can easily take on larger dimensions. In such a 
 case those characters also are not lacking which are found in other 
 inferior organs, such as heredity, disease, stigma, childish defects 
 (early masturbation) and reflex anomalies. 
 
 Further inferiorities, which are associated with sexual inferior- 
 ity, have to do with the nose (Fliess), the heart, etc. 
 
 The strongest opposition which our conception can encounter 
 seems to me to be offered by the simultaneous falling ill of two 
 inferior organs. In order to answer this question accurately a 
 vast amount of material and long years of activity in that experi- 
 mental field which nature has formed for itself in the enormous 
 number of inferior organs, are needed. In part of these cases, a 
 disturbance of the inner secretion, presumably, in case of disease of 
 the one organ and corresponding weakening and disease of the other 
 inferior organ, can be accepted. One will quarrel just as little with 
 the reflex influence which the disease of one inferior organ trans- 
 fers to the other, particularly if one remembers that to the inferior 
 apparatus there corresponds a fundamentally inferior portion of the 
 central nervous system, which later becomes greatly over-compen- 
 sated, and thus holds a dominating position both physically as well 
 as psychically. However that may be, I should like to touch very 
 forcibly upon the fact that the simultaneously inferior organs seem 
 to be bound up together in a secret alliance. 
 
 This and that secret bond can be shown nowhere else with such 
 ease, as where an inferiority of the related portion of the cen- 
 tral nervous system is associated with an organ inferiority. This 
 is the case in hypochondria, hysteria, anxiety and compulsion neu- 
 roses, as we shall try to show in the next chapter. It would be 
 more difficult to penetrate into the relation of both inferiorities
 
 AND ITS PSYCHICAL COMPENSATION 55 
 
 when it is a case of epilepsy or psychic disease, paranoia, demen- 
 tia, mania, etc. Psychoses which begin coupled with intoxications, 
 pyretic diseases, diabetes, nephritis, or tuberculosis, surely belong 
 in the framework of this investigation, just as do the often empha- 
 sized relations between epilepsy on the one hand and diseases of the 
 intestinal apparatus, circulatory or urinary organs on the other. 
 
 And finally I should like to say that the discovery of one or- 
 gan inferiority, considering the frequency of numerous insufficien- 
 cies, makes it our duty to seek for further inferior organs.
 
 CHAPTER VII 
 
 THE PART PLAYED BY THE CENTRAL NERVOUS SYSTEM IN THE 
 
 THEORY OF ORGAN INFERIORITY PSYCHOGENESIS AND 
 
 FOUNDATIONS OF NEUROSES AND PSYCHONEUROSES 
 
 Here I wish to add a few considerations which are almost self- 
 evident from our studies. We shall grasp the meaning of our for- 
 mer conception only if we exclude neither the spinal cord nor the 
 brain from the investigations of the inferior organ. Indeed it must 
 be emphasized that the simultaneous, manifold, organ inferiority, 
 already characterized, extends itself to sectors of the nerve tracts 
 of the central nervous system, and that very often there corresponds 
 to the value of each organ a naturally proportionate value of those 
 nerve tracts that conduct to them their stimulation and lead from them 
 their impulses. To be sure, one cannot expect entirely conformable 
 behavior. The inferiority may remain for a long time at unchanged 
 level, and may also be confined only to the organ or parts of it, 
 or else the requirements of life, domestication, culture produce an 
 over-compensation, which if sufficient will make its way particu- 
 larly in the central nervous system. The quantitative differences 
 which show themselves by the degree of inferiority, by the local- 
 ization, by the degree of compensation, can only be perceived 
 as qualitative when looked at from the psychologic standpoint, 
 a fact which becomes comprehensible at once when one com- 
 pares the three most important constellations from the organic 
 and nerve inferiority field with their results : Degeneration, neurosis, 
 genius. The inferior organs incapable of compensation fall victims, 
 under the influence of the outside world, to more rapid or slower 
 destruction. On the other hand nature forms from inferior organs, 
 under the influence of compensation, apparatuses of more variable 
 function and morphology, which show themselves in many cases to 
 be quite capable functionally and even at times somewhat better 
 adapted to external circumstances, since they have derived their 
 increase in strength in overcoming these external obstacles and 
 have consequently stood the test. Between these extremes there 
 are still mixed formations and such as have not been completely 
 compensated, whether because of lack of reserve strength or be- 
 
 56
 
 STUDY OF ORGAN INFERIORITY 57 
 
 cause of premature exhaustion of this strength, disturbance of com- 
 pensation. Under definite conditions the cases of neuroses and psy- 
 choneuroses develop from this group. Some important facts will 
 be touched upon in the following. 
 
 Functional and morphologic formation of the organ and its 
 nerve tracks will make the inferior material functionally capable, 
 as in normal development, partly as a result of stimulus, partly 
 owing to continued effort. Ordinarily the central nervous system v 
 will play the largest part in this compensation. And not only phys- 
 ically, say by particular development of the nerve tracks, associative 
 fibers, by the transformation of a hereditary lack of reflex to an in- 
 crease of reflex capability, but above all in a psychical manner, for 
 the reason that a particular interest seeks to protect the inferior 
 organ and endeavors to ward off the harm by constant attention, 
 and the psyche on a small scale, perhaps, gives the impulse to 
 awaken the attention, to increase it and to connect it with that organ. 
 
 This psychical impulse receives further support as soon as the 
 inferior organ no longer follows its own bent but has to bow be- 
 neath the yoke of civilization. How, in this process, organ* ; in- 
 stincts are changed, ennobled, psychically molded, and often trans- 
 formed to their polar opposites occurrences which are grouped by 
 Freud as " organic repression" shall still be elucidated. 
 
 Now this is undoubtedly overwork as compared with the man- 
 ner of work of a normally valent organ and will clearly appear as 
 such in childhood. We have to do in all these cases with the 
 great number of shy, pale, timid children whose development and 
 future can only be considered assured when they have learned to 
 manage the inferior organ without injury, in other words when 
 they have carried out the compensation and can function without 
 effort. In the other case, if the performances of the organs are 
 not brought about by a surplus from the central nervous system, but 
 at the expense of the latter, the overwork will be lastingly felt and 
 on suitable occasions, chance causes will produce a disturbance of 
 compensation, which will result, according to the degree of dis- 
 turbance and the psychical constellation present at the time in neu- 
 rasthenia, anxiety and compulsion neuroses, and hysteria. 
 
 In the infantile anomalies, which play such a large part in our 
 work, and in their course, inferiority and compensatory efforts must v 
 be clearly estimated. Every free activity of the infant and child 
 is connected with pleasure, or is calculated for obtaining pleasure, 
 as for instance, playing, jumping, running, seeing, hearing, suck- 
 ing, evacuation of feces and emptying the bladder. The pleasur-
 
 58 STUDY OF ORGAN INFERIORITY 
 
 able sensations derived therefrom form properly the bond by means 
 of which the child is connected with his surroundings, socially with 
 the outside world. They are directly perceivable, adhere to the or- 
 ganic activity, and their traces are often readily discoverable in 
 later life. The accentuation of pleasure is also often the cause of 
 the stubborness of children's faults, so that frequently the strength- 
 ening of the child's will, or the suggestive effect of some therapeutic 
 treatment is sufficient to do away with the fault. In the psycho- 
 analysis of the neuroses Freud has demonstrated this primary 
 pleasure principle, and I, too, could always find it in my cases. 
 This fact, moreover, seems convincing to me, namely that I found 
 again in the dreams of healthy grown people, who in their child- 
 hood had suffered from such faults, the remembrance of such pleas- 
 urable sensations in the form of wish-fulfilment by means of a 
 dream. This was the case in dreams of such people who had suf- 
 fered from enuresis in their childhood, and now at intervals dreamed 
 of water, of swimming or of fire. 
 
 Approximately normal organs with a corresponding central nerv- 
 ous system sufficiently capable of assimilation, adjust themselves 
 without delay to the requirements of surrounding culture. No won- 
 der, since they themselves have helped in building up and direct- 
 ing this civilization. On the other hand, changed and increased 
 external requirements, disappointments, cares, traumatic influences, 
 diseases, change of surroundings may show up an organ and at the 
 same time its central superstructure as inferior and may disturb 
 its compensation which is with difficulty maintained for the in- 
 ferior organs meet with difficulties and dangers everywhere, a fact 
 which corresponds to their natural relation to their surroundings, 
 and which shows the real basis of Darwin's theory of natural selec- 
 tion. If it is to be mastered, this must be done with heightened 
 
 j I expenditure of strength. Even the normal organ has the task of 
 subordinating its unrestricted, pleasure-seeking disposition to the 
 compulsion of education. The nutritive apparatus may only find 
 satisfaction in so far as the social organization and the great aver- 
 sions of civilization permit it. Thus the superior psychic realm is 
 forced to do certain tasks, which in the beginning are not easy, but 
 which on the average undoubtedly succeed by reason of the height- 
 ening of the functional capability. In the case of the inferiority of 
 the organ, however, and the corresponding insufficiency of the 
 related portions of the nervous system, the participation of the 
 
 - organ and its activity in the demands of culture remain behind. 
 The function then does not follow the required specified cultural
 
 AND ITS PSYCHICAL COMPENSATION 59 
 
 paths but is predominantly engaged with seeking pleasure. We 
 accordingly find in the development of the normal organ a certain 
 subordination of the pleasure component to the activities called 
 forth by the environment let us call them the " moral " activities 
 the final success of which ensures the child's cultural development. 
 The harmony of physical and psychical functional capability, a 
 psychophysical parallelism in the true sense of the word, charac- 
 terizes the development of the normal child. In the inferior organ 
 it is different. If there is a particular retardation of the develop- 
 ment of the organs, as well as of the related nerve tracks, all at- 
 tempts at culture are unsuccessful and conditions such as idiocy and v 
 imbecility result. But in milder cases also, the inferior organ turns 
 spontaneously to gaining its desire, averse to the psychical inter- 
 ference, and therefore indulges the more, the longer it has to wait 
 for the moral redemption Freud's repression. Since in the mean- v 
 time the organ has become accustomed to the wanton activity, it 
 will now accomplish the later repression against greater organic op- 
 position, and introduce a lasting struggle which will be felt as a 
 torturing compulsion. These conditions may be most clearly seen 
 in the cultural development of emptying the bladder and evacua- 
 tion of the feces. Left entirely alone these functions go on purely 
 wantonly in the infant and are consequently connected with sensory 
 gratification as befits every instinctive organic function. The in- 
 fluence of the surroundings is sufficient to place the function of the 
 bladder and of the rectum on a "moral" basis in normal organs 
 and in normal psychomotor superstructures. But the thing which I 
 must add to these important observations of Freud's is as follows: 
 The childish faults are only the externally perceptible phenomena 
 arising from the disturbed psyche and mark the lack of an adequate 
 compensation in the psychomotor superstructure of the organ. Un- 
 der normal conditions this superstructure is influenced by the 
 peripheral stimulis of the bladder, of the rectum and likewise of the 
 eye, the ear, the skin, the nutritive and respiratory organs, and is im- 
 pelled to continued organic growth, and to this there corresponds 
 in normally developed nerve paths a psychic development suited 
 to the environment. Touching the inferior organ, however, the 
 parallelism in the psychophysical development very often gives 
 way here to a psychophysical contrast. The psychomotor super- 
 structure of the inferior organ carries on a continual battle against 
 the pleasure activity and for the sake of the "moral mission" of 
 the organ. The result depends on the capability of development of 
 the fundamentally inferior superstructure, on the congenital growth
 
 6O STUDY OF ORGAN INFERIORITY 
 
 energy of the related cerebral cells and on the peripheral stimuli 
 reacting on the same. If progress is to result, the fundamental infe- 
 riority of the psychomotor substance must be compensated. In 
 another place we have pointed out that this compensation often 
 leads to over-value of the organ, and finally conclude that this must 
 e by means of over-valuation of the psychomotor superstructure. 
 
 The compensatory, over-valuation may be complete, and then 
 the increased psychic and physical relations and their associations 
 will enrich the psyche as a whole, but at the same time characterize it. 
 From this point of view an understanding of distinguished and genius- 
 like activities is possible, and at the same time a conception of the 
 v prerequisites which very often lay the foundation for a choice of 
 profession or a particular hobby and peculiarity. I have already 
 referred to the degenerative predisposition of Mozart's ears, to 
 Beethoven's otosclerosis, to the stigmatizing of Bruckner's ear by 
 a nevus. I have also spoken of the infantile defect in Demos- 
 thenes's development of speech. It is said of Moses, the orator and 
 leader of the nations, that he had a "heavy tongue." The hal- 
 lucinatory phenomena in Schumann's psychosis show us the increase 
 and overcompensation in the psychic superstructure of the ear, but 
 show us at the same time, even as every hallucination does, the 
 miscarriage of a psychic victory and of psychophysic harmony. 
 Clara Schumann (B. Litzmann, "An Artist's Life from Diaries and 
 Letters"), tells of her childhood; "This woman [the maid in 
 whose care she was] simply wasn't talkative, and it was probably 
 for that reason that I only began to say disconnected words when 
 I was between four and five, and at that time understood just as 
 little." And in another extract : ". . . Since I heard so little talking 
 and showed so little interest in it myself . . . my parents often 
 complained, particularly as I began to speak, that I did not hear 
 well; and I did not get over this difficulty until about my eighth 
 year, although it improved at once, the more I began to talk myself 
 and the more I noticed what was happening around me and to me." 
 Add to this her father's remark : " This is the opening chord of an 
 artist's life, which in its course, by the fullness of pure melody 
 which it bestowed is a bringer of joy of a rare sort to countless 
 people, yes even more than this, it even was to become almost a 
 model of complete and purified harmony of art and life. It begins 
 with a harsh discord." One of our best-known piano virtuosos, 
 R. B., suffered in his childhood from purulent otitis media and 
 perforation of the ear drum in both ears. 
 
 I have already mentioned the tokens of degeneration, childish
 
 AND ITS PSYCHICAL COMPENSATION 6l 
 
 defects, reflex anomalies, in speakers, singers, and actors. These * 
 tokens, as well as the frequent diseases of the respiratory tract of 
 such persons or in their families, lead us to conclude definitely a 
 fundamental inferiority of the respiratory apparatus and consecu- -' 
 tive over-compensation in the related psychic field. The same is 
 true of cooks and gourmands, a fact which I have emphasized in 
 another place. I must, however, call your attention to the fact 
 that in these people the frequent gastro-intestinal diseases as well 
 as the poor teeth, surely do not originate from hot or biting food, 
 but rest upon the inferiority of the nutritive organs. Thus for in- 
 stance the ulcus rotundum, whose tendency to recurring and car- 
 cinomatous transformation can be first understood from this point 
 of view. We find similar conditions in painters as in musicians. 
 I shall not speak of individual cases, such as Lenbach and several 
 artists whom I know. But the optical examinations recently insti- 
 tuted in schools of art show optical anomalies in 70 per cent, of the 
 students. 
 
 These are the results, when considering the successful cases 
 of over-compensation, which are evidently sufficient to explain 
 and correct Lombroso's mistakes. But what happens when the 
 compensation is not successful, when the psychic impulse arising 
 from physical need on the one hand insufficiency of the organ, 
 on the other pressure of life and culture meets with more unser- 
 viceable brain material, when the compensatory activities only get 
 half way? A condition of high psychic tension must naturally 
 arise from these psychophysical relations, which causes those per- 
 sons who undergo such tension to be no longer capable of contend- 
 ing with any sort of heightened requirements. They suffer incon- 
 tinence of urine and involuntary defecation at the slightest difficul- 
 ties in human life, at tests, with fright and excitement, and return 
 to one of those infantile anomalies which they have with difficulty 
 conquered and which, as I have already shown, represent continua- 
 tions and further developments of heightened reflex manifestations. 
 They stammer, vomit, laugh, cry, scratch themselves, tear their 
 hair, start, blink or have violent attacks of spasmodic sneezing upon 
 seeing a bright light, squint when looking at anything close at hand, 
 etc. All these phenomena are too well known individually for me 
 to have to prove them by means of illustrative cases. 
 
 The mastering of children's defects then, and all the difficulties 
 which arise from the inferior organ, point to compensatory activ- 
 ities in the superstructure and if hitherto the childish defects were 
 external tokens of organ inferiority, it now appears that they really
 
 62 STUDY OF ORGAN INFERIORITY 
 
 represent like Chladny's tone figures lines of direction from the 
 life of the psyche, and are signals which indicate the peripheral 
 and central inferiority which has not yet been successfully overcome. 
 
 In regard to reflex anomalies in the inferior organ I can still 
 add that the deficient reflex may get its psychic contrast by reason 
 of the compensatory growth of the related psychomotor zone, so 
 that if, for instance, the palatal reflex is lacking, an excitement will, 
 however, bring retching and vomiting with it. This state of af- 
 fairs is not rare ; I shall cite a few cases, because it seems hitherto 
 to have escaped the notice of neurologists. 
 
 Eugenie /., 46 years old, a teacher, unmarried, was one day 
 addressed in cutting terms by her brother. At night she dreams that 
 her brother is burning out her throat with a candle, awakens in 
 terror, bathed in perspiration, feels violent pressure and burning 
 in the pharynx, in the larynx and in her mouth. She struggles for 
 breath, thinks she has lost her mind, and tries to determine whether 
 gas has been escaping in the room. At the same time she vomits 
 a greenish colored watery fluid several times. Admits that she 
 almost always vomits when excited. The examination shows nor- 
 mal conditions, except for a small umbilical hernia, which has always 
 been the cause of hypochondriacal paroxysms, and complete lack 
 of palatal and pharyngeal reflexes. The tongue is not coated, no 
 nausea in the morning, stomach not sensitive to pressure, appetite 
 normal. From the early history we only find that the patient was 
 a weakly child who did not eat well, who suffered a great deal 
 from heartburn, singultus and vomiting during puberty. Accord- 
 ing to this material we find it to be a case of inferiority of the nutri- 
 tive tract (umbilical hernia, reflex anomalies, anamnesis), which 
 is adjusted by over-compensation in the psychomotor superstruc- 
 ture vomiting only appears now upon a psychic disturbance of 
 equilibrium. The patient has been inclined to corpulence since her 
 twentieth year. 
 
 Julius P., a merchant, 45 years old, vomits if he sees a hair or a 
 fly near any food, and at times even if he thinks of it ; occasionally 
 also in consequence of a vexatious occurrence. In his youth he was 
 almost free from feelings of nausea, and would, without thinking, 
 put the most atrocious things into his mouth. Later he became an 
 epicure and heavy eater and transformed himself from a slender 
 youth into a corpulent man (230 Ibs.). Very characteristic is a 
 dream which keeps recurring in the same form, in which some one 
 keeps constantly stuffing a loathsome mass into his mouth, so that 
 he is in danger of choking and awakens in terror. One of his sons
 
 AND ITS PSYCHICAL COMPENSATION 63 
 
 had enuresis and involuntary defecation until he was 15 years old. 
 Palatal reflex lacking, pharyngeal reflex greatly diminished. Here 
 also we find over-compensated inferiority of the nutritive tract with 
 diminished peripheral and increased central reflex ability. 
 
 Anna W ., 28 years old, married, vomits at the slightest excite- 
 ment. No palatal reflex. One brother was an enuretic until his 
 eighth year and suffered from involuntary evacuation of feces. 
 The patient's father, 54 years old, has, ostensibly, always suffered 
 from constipation. Here also we find the inferiority of the nutritive 
 tract stamped in a different manner upon the family, while in the 
 patient herself there is heightened central reflex as a token of the 
 over-compensation. 
 
 The phenomenology of the successful as well as the unsuccessful 
 over-compensation will show the same fundamental traits, the same 
 internal structure, even though it differs externally from that of the 
 normal cerebral development. We can always find among the 
 achievements of the central superstructure related to the organ the 
 following: Attentiveness, proportionately distributed and in corre- 
 spondence with the organic relation with the outer world directed 
 upon the surroundings on the part of the normal organ, dispropor- 
 tionately distributed and increased according to the organic over- 
 compensation in the inferior organ, more easily aroused, but less < 
 productive by reason of unsuccessful compensation, insufficient or 
 else not present at all in cases of lasting central inferiority. Even 
 in this psychical phenomenon we again find the differences which 
 have for long been considered as determinative in judging the 
 normal brain and the neurosis or psychoneurosis, the establishment 
 of which, however, can only occur with the acceptance of the theory 
 of organ inferiority. In anticipation we will emphasize at this point 
 the fact that this work aims to refer all phenomena of neuroses and 
 psychoneuroses back to organ inferiority, to the degree and nature 
 of the not quite successful central compensation and to compensa- 
 tory disturbances which enter into the matter. 
 
 Organic nerve diseases, however, are according to our premises 
 only special cases in which the localized inferiority is inclined to in- 
 flammatory or degenerative transformations ; the combinations of 
 organic and functional affections, typical of many clinical pictures, 
 appears as a necessary coordination. The influence of psychic and 
 hypnotic therapy can accordingly be easily understood. A few fur- 
 ther citations, relating to the difference between normal psychic 
 development and that resting upon over-compensation, have to do 
 with recollection and memory. One can not however at the same
 
 64 STUDY OF ORGAN INFERIORITY 
 
 time lose sight of the fact that these conceptions characterize for us 
 the symbolic in the web of the psyche and that the occurrences at 
 its basis have a psychic continuity and psychic connection with other 
 occurrences, such as perception, judgment and volitional processes. 
 But their connection is just as certain with the external perceiving 
 and executive organs, the relation of which to the surroundings de- 
 termines the manner and content of all central occurrences. Thus 
 one can declare that every organ has a right to its recollection, its 
 memory in the central psychomotor superstructure, as a function of 
 this psychical field. In regard to the inferior organ, functional in- 
 creases are found upon the entrance of central compensation or over- 
 compensation, one of which may become noticeable as increased 
 recollective ability. Among the number of memory pictures those 
 will predominate in strength and number which belong to the in- 
 ferior organ in respect to its over-compensated psychic field. 
 
 It corresponds only to the special form of our civilization and 
 its reflection in the human psyche, that the eye, ear and organs of 
 speech are held to special activities and according to this acquire 
 very special development of their psychic superstructure even in 
 the normal. Wherever compensation or over-compensation enters, 
 the memory activities belonging to the organic superstructure are 
 heightened, but are also subject to all the dangers which threaten 
 the increased growth of inferior portions of an organ, such as dis- 
 turbances of compensation in the form of weakness of memory, 
 amnesia, an increase in particularly stressed memories, associative 
 strengthening, etc. 
 
 I can not go any further into detail at this point. A similar 
 point of view is at the basis of the development of critical ability 
 in the superstructure of the inferior organ, increased power of in- 
 trospection, inspiration, intuition and the comprehension of the 
 genius, the building up of hallucinatory characters in the psyche, 
 the development of the abnormal idea on the basis of compensatory 
 activity, which also affects the function of the will and the percep- 
 tion of pleasure and displeasure, etc. From the motor portion of 
 the compensating superstructure arise all phenomena of the neu- 
 roses, which are of importance as motor discharges, such as tic, 
 forms of paralysis and hysterical cramps and paralysis, epilepsy, 
 etc., whose whole clinical picture owes its origin to the actual con- 
 stellation in the psychomotor superstructure, and which is less con- 
 nected with the compensatory advancement of the reflex mechanism. 
 The occupation cramps, writer's cramp, etc., may be classed here as 
 compensatory disturbances.
 
 AND ITS PSYCHICAL COMPENSATION 65 
 
 In the infantile anomalies to which are ascribed masturbation 
 characteristics, sucking the thumb, sucking the lips, tickling the 
 skin, touching the anus and actual early masturbation, we can again 
 observe the wanton inclination aimed at the obtaining of pleasure, 
 which is peculiar to the inferior organ, the mouth, intestine, gen- 
 itals. The same thing is true of nocturnal enuresis. If we now 
 remember that all inferior organs are perhaps regularly accom- 
 panied by inferior sexual organs, in which the inclination for 
 pleasure is likewise present in a marked degree, if we admit that 
 almost all the children burdened with childish defects also engage in 
 masturbatory touching of the genitals, we must establish as a result 
 of this consideration the fact that the possession of inferior organs 
 can very easily lead to sexual precocity, to early masturbation. 
 
 If this distinguishing feature has appeared, there are at least two 
 dominating cerebral portions which undergo heightened growth 
 stimulus and heightened psychic impulsion, and one of these builds 
 itself up over the inferior sexual apparatus. It is quite compre- 
 hensible that both the psychic fields should be associatively con- 
 nected, very like the audition coloree which also owes its origin to 
 the compensatory superstructure of two inferior organs. In this 
 manner psychic groupings arise very early, groupings which have 
 been formed fundamentally, of two sorts of impressions: on the 
 one hand from the world of sexual sensibility and ideas, on the 
 other from the psychic superstructure of the eye, ear, mouth, ex- 
 cretory organs, skin, nose. In all these cases the fate of the psyche 
 as a whole depends upon the complete or incomplete mastery and 
 balancing of the two corresponding inferiorities, the central and 
 peripheral inferiorities ; the fate of the patient, then, is at the mercy 
 of the complete or incomplete compensation, of the lasting or inter- 
 rupted compensation. But the prospect becomes much more diffi- 
 cult as soon as the sexual components enter the question and touch 
 upon and influence the other psychic superstructure. The com- 
 pensation may then be a universal one; it may however only have 
 developed in one or in neither of the psychomotor fields. We can 
 not dwell here on how it affects individual cases, in the various 
 psychoneuroses. Only, I must state that the interesting psychic 
 phenomena of repression, substitution, conversion, which Freud 
 demonstrated in his psychoanalyses and which I also found to be 
 the most important constituents of the psychoneuroses, develop 
 upon the above-described formation of the psyche in the case of in- 
 ferior organs. In a like manner the usual statement of " sexual 
 basis " of psychoneuroses is cleared up by the above. Complete
 
 66 STUDY OF ORGAN INFERIORITY 
 
 compensation such as we find in artists, geniuses, a few profes- 
 sional people, has a great many psychic functional characteristics in 
 common with the psychoneuroses, and has with many, especially 
 with hysteria, a common culmination point, the hallucinatory char- 
 acter of the psyche. 
 
 The following quotations from " Grimm's German Mythology " 
 bears witness how closely our conception of the compensation and 
 over-compensation of the inferior organ corresponds to the popu- 
 lar feeling: 
 
 "We find in the heroes as well as in the Gods want of limbs: 
 Orin is one-eyed, Tyr one-handed, Loki [ ? = Haphsestus] lame, 
 Hoeder blind, Vidar dumb, Hagano also one-eyed, Walkeri one- 
 handed, Gunther and Wieland lame; and there are a goodly num- 
 ber of blind and dumb heroes. But it seems heroic that while a de- 
 fect disfigures childhood and early youth suddently from out such 
 gloom appears the radiant presence as well as the power long curbed. 
 To these belong the blind birth of the Guelph and the folk-tradition 
 birth of the Hessian and the Suabian."
 
 CHAPTER VIII 
 BIOLOGICAL VIEWPOINT IN THE ORGAN INFERIORITY THEORY 
 
 The inferior organ gets its most distinct imprint in the phenom- 
 enon of congenital deformity. The nature of the inferiority is 
 shown almost as clearly in the external stigmata. The connections 
 of other tokens of inferiority with both of these have been so clearly 
 pointed out, in this work, that the conclusion is evident: The in- 
 feriority of the organ is embryonic in origin. 
 
 The variability, the growth energy, and compensatory ability 
 have likewise been strongly enough emphasized. These are what 
 guarantee the possibility of an adjustment, provided that the vital 
 capacity and duration of life do not seem to be threatened by the 
 fundamental check in growth, provided, furthermore, that the 
 drawing in of reserve strength does not meet with too great a hin- 
 drance. The final result of the struggle for the existence of the 
 organ arises from the relation between the existing, structurally 
 capable material, and the required work. The efforts at growth 
 which come to light in this process and the results are not to be 
 compared with those of normal organs. They bring before our eyes, 
 rather, a portion of that strength which expresses itself in the live- 
 liness and variability of embryonic growth. A second assumption 
 is justified by this : Namely, that the inferior organ bears with it in 
 morphology and function, its embryonic characteristics. 
 
 By analogy from the causes of deformities, the following out- 
 line of the causes of organ inferiority can be drawn up: 
 
 1. Primary lack of formative material. In this we can observe 
 particularly well the familiar appearance, or can find exhausting 
 diseases, lues, alcoholism, poisoning of the parents at the time of 
 procreation. In the latter case, nevertheless, the selection of the 
 organ will frequently be further determined by its own primary in- 
 feriority. 
 
 2. Inflammatory processes during the embryonic development, 
 by which again the selection of the organ can not occur without 
 determination. 
 
 3. Disturbing influence of a neighboring organ in the foetal 
 period. In this case also a dispositional cause must be sought for 
 the injurious cooperation. 
 
 67
 
 68 STUDY OF ORGAN INFERIORITY 
 
 If we wish, from the point of view now won, to attain a uniform 
 perspective of the inferiority of organs, we must turn our attention 
 to the embryonic formative material and its destiny. The inferi- 
 ority which we are discussing here never occurs as a result, but 
 always as a preliminary condition, and is the one which people 
 have usually tried to class with the confused idea of disposition. 
 The incompleteness in this type of organs, the cessation of develop- 
 ment which can often be found in them, the lack of development in 
 a histologic or functional direction, the functional deficiency in the 
 postfetal stage, and on the other hand the increase in its growth 
 tendency owing to compulsion of compensation, and possibility of 
 compensation, the frequent success in gaining greater functional 
 ability, force us to accept the fact that all inferior organs have a 
 part of the fetal characteristics. With the breaking away from 
 the maternal organism the struggle with the outer world begins for 
 these organs and organic systems, a struggle which must of neces- 
 sity be kindled, and which begins with greater violence than in a 
 normally developed apparatus. Higher rates of disease and mor- 
 tality accompany this struggle. Nevertheless the fetal character 
 supplies at the same time the heightened possibility of compensa- 
 tion and over-compensation, increases the ability of adaptation to 
 usual and unusual resistance and assures the formation of new and 
 higher forms, of new and higher execution. One easily gets the 
 impression that the organism has economized in the fetal develop- 
 ment, that it arrested the embryonic maturity at a certain place, 
 in order to give the organ a means of maintaining itself for life, 
 a heightened formative power. And one can scarcely dispose of the 
 conception that this new formative attempt is undertaken in those 
 organs in which a series of ancestors, owing to external causes, to 
 changed living conditions, have suffered injury during their lives. 
 Thus the inferior organ presents the inexhaustible trial material, 
 by means of the constant working over, repudiation, improvement of 
 which, the organism seeks to come into harmony with the changed 
 conditions of living. 
 
 The struggle with the hostile influences of life very often threaten 
 the possessors of inferior organs with disease and death, even if 
 they can enter the world as viable. Terrible and terrifying as 
 are the demands of this hecatomb, it nevertheless hinders the un- 
 restricted spread of inferior formative material of humanity, if one 
 considers a fairly long stretch of time. If, however, on the one 
 hand inferior organs incapable of compensation meet with more 
 rapid or slower destruction under the pressure of the outside world,
 
 AND ITS PSYCHICAL COMPENSATION 69 
 
 nature, on the other hand, by the creation of a compensation, forms 
 apparatuses of variable function and morphology, which prove them- 
 selves in many cases to be quite functionally capable and somewhat 
 better adapted to external conditions, since they have drawn their 
 additional strength from the overcoming of these external obstacles. 
 The organ's abnormality is deeply rooted in the constraint of a 
 fixed training, in the variability and greater tendency to growth 
 which often adhere to an inferior organ, and in the development 
 of the related nervous and psychic complexes heightened by the 
 inner attention and concentration. The adaptation to altered con- 
 ditions of living takes place preeminently, not in a struggle for 
 existence by the survival of the accidentally stronger, but on the 
 basis of variability and heightened growth tendency of inferior 
 organs. 
 
 We have proposed heredity as one of the most important indica- 
 tions of inferior organs and have tried to make this relation compre- 
 hensible through the phenomenon of simultaneous inferiority of the 
 sexual apparatus. Among the possibilities of explanation of this 
 phenomenon, the foremost place might be given to one which 
 reckons with the additional work to be accomplished by the inferior 
 organ, so that a vigorous demand on the organ would correspond 
 to a check on the embryonic equivalents in the genital glands. Be- 
 sides not everything which is classed as an acquired characteristic is 
 entirely unconnected with the inferior organ. On the contrary we 
 can assume that the most effective changes and injuries take place 
 in the inferior organ, the heredity of which, their embryonic plas- 
 ticity and variable character, is beyond doubt. 
 
 The reference to the whole organic world follows of itself. And 
 in this the theory of organ inferiority seems to broaden and sup- 
 port the theory of heredity in its most important features.
 
 APPENDIX 
 
 THE INFERIORITY OF THE URINARY APPARATUS. FATE OF 
 ENURETICS AND THEIR FAMILIES 
 
 At the beginning of this work there are a few considerations con- 
 cerning diseases of the urinary organs, in the pursuance and expansion 
 of which cases, we were led to establish the organ inferiority theory 
 as the basis of a particular conception of pathology. If at the end 
 an attempt is to be made from the illustrative cases of a single organ, 
 again the urinary apparatus, to make clear the value and extent of 
 the theory of inferiority, to confirm already known connections, to 
 uncover new ones, I believe that I can best overcome the great diffi- 
 culties of such a task if I only choose cases which can be arranged 
 according to a single, and at all events distinct, point of view, those 
 that have one symptom of inferiority in common either themselves 
 or in the family, the symptom of the childish defect, namely, 
 enuresis. 
 
 A vast amount of material, but only partly valuable, may be 
 found in the literature about enuresis, its nature and its pathogenic 
 position. I, myself have emphasized a few of its important facts 
 in this study. 3 At this point I must confine myself to carrying 
 through the centering of the phenomena of inferiority of the urinary 
 apparatus upon enuresis, and to emphasizing the simultaneous in- 
 feriority of the central nervous system and of the sexual apparatus 
 and to illustrate this with cases. In this I shall follow the schematic 
 outline of my study and I hope that the reader will find the general 
 conformity to tradition which was followed there, again in this. 
 
 This will be the case in diseases of the urinary apparatus, whether 
 it is in the enuretic himself or in his family. We may expect all 
 the genuine diseases, in the prostate, the bladder, the ureters, the 
 kidneys and the urethra. We will however also find localization of 
 disease, congenital anomalies, a particular and usually difficult course 
 of infection and functional affections. I should like to stress as 
 particularly interesting facts in my material, carcinoma of the uri- 
 nary apparatus, contracted kidney, scarlet fever nephritis and 
 difficult course of gonorrhea in enuretics or in their families. 
 
 3 I shall give a short exposition on these child errors in the " Illustrierten 
 medizinischen Handlexikon " [edited by Dr. Max Kahane, Urban & Schwar- 
 zenberg, publishers, Vienna-Berlin], which is coming out shortly. 
 
 70
 
 STUDY OF ORGAN INFERIORITY 71 
 
 The second indication of inferiority, heredity, is already strik- 
 ingly noticeable in enuresis itself. No less noticeable however in 
 its appearance in every imaginable affection, anomalies and stigmata 
 in any portion of the urinary apparatus, as has already been empha- 
 sized in the preceding pages. 
 
 We shall frequently meet with signs of the degenerations also 
 quite often falsely called the causes of enuresis, as peripheral 
 phenomena of inferiority of the urinary apparatus. At any rate 
 we find it in the sexual organ, which is almost always found to be 
 included in the inferiority. 
 
 In regard to reflex anomalies we must refer to spasm of the 
 sphincter, which one often meets with in people who have been 
 enuretics. Almost as often do we find, on sounding the urethra, a 
 relaxed, unreacting sphincter externus, both of which are anomalies, 
 as we have emphasized in the discussion of the palatal reflex. 
 Freud's symptom in many cases of enuresis, adductor cramp of the 
 thigh on suddenly pulling the latter out, arises from the extension 
 of the reflex zone of the sphincter and is analogous to the move- 
 ment of choking in cases of increased pharyngeal reflex, which in 
 some cases sometimes even takes place by pushing the spatula back 
 of the teeth. Here we must mention also inability to urinate in the 
 presence of others, shivering and rigor while urinating, functional 
 dysuria, retention of the urine and polyuria, which one often finds 
 in those who have been enuretics, or in their families. 
 
 I must lay very great stress on segmental inferiority in enuretics. 
 Not so much the skin anomalies, which are often found as nevi or 
 neurofibromata at about the height of the kidney, in the region of 
 the bladder or in the groin, but an inferiority which often has to 
 do with the whole rear portion of the body and comes into con- 
 sideration as primary weakness in voiding of the urine, evacuation 
 of the bowels and emission of the semen, which can often be over- 
 come, and even over-compensated and is evidently connected with an 
 inferiority of the spinal cord from the lumbar vertebrae downwards. 
 It is not a rare thing to find the lower extremities also involved in 
 this inferiority. This relation is of importance in regard to the 
 problem of tabes, sciatica, and incontinence of the bowels in the 
 families of enuretics. The spinal column also takes part in it with 
 indications of spina bifida or deformity, and the lower extremities 
 with deformities, disproportionate legs or diseases of the joints. 
 
 As to what concerns the simultaneous inferiority of other 
 organs, particularly of the sexual organs, the material prescribed will 
 evidence. In the literature we find congenital displacement of the
 
 72 STUDY OF ORGAN INFERIORITY 
 
 testicles mentioned most often, which I also often found, and then 
 perhaps, phimosis, hypospadia and adhesion of prepuce and glans 
 penis, if one wishes to consider these as tokens of inferiority of the 
 sexual organs. More significant for my assumptions are the cases 
 of formation of tumors in the sexual organs, such as an enuretic 
 family shows, and the almost invariably demonstrable anomalies in 
 sexual intercourse, above all ejaculatio precox. Strikingly often the 
 mothers in enuretic families die during or after a birth, and one 
 often finds enuretics as step-children. From my material it appears 
 that inferiority diseases of the sexual organs or of the kidneys may 
 occasion such early death, while other such mothers, by reason of 
 a difficult birth (pelvic anomalies, as segmental inferiority), or by 
 reason of injuries during one of the first pregnancies guard them- 
 selves from danger to their lives in case of another pregnancy. In 
 other cases conception does not take place or else repeated mis- 
 carriages prevent maternity. One then usually finds as a cause 
 uterine myoma, renal disease, or infantilism of the uterus (narrow- 
 ness of the orifice). 
 
 The relation of enuresis to the central nervous system and to the 
 psyche is adhered to to a certain degree in the literature, without 
 much weight given to the relations which have here been revealed. 
 Freud, who has advanced the furthest, emphasized the significance 
 of infantile enuresis in dream and neurosis. The Breslau School 
 and many others with it consider, on the contrary, that enuresis is 
 an hysterical symptom. Desire for urination and incontinence from 
 excessive psychic strain, in laughing and crying (Bechterew), in 
 fright, on seeing water and fire and other things have been observed 
 by many authors, but without connecting them as Freud has done 
 to conquered enuresis. H. Ellis emphasizes the fact that music 
 may call forth a desire for urination in children and animals, which 
 was even known to Shakespeare, for he has Shylock say : " And 
 others, when the bagpipe sings i' the nose cannot contain their 
 wine " : In regard to our standpoint, we shall have to indicate that 
 which has been said in the corresponding place and once more 
 emphasize that enuresis, just like every other infantile defect, repre- 
 sents the functional side of organ inferiority. A fundamentally 
 inferior psychomotor superstructure is placed over the organ which 
 responds deficiently to its surroundings, a superstructure which, 
 with every psychical overexertion even as in playing or learning, may 
 fail, and which will only suffice as a cultural control of the organ 
 for a time, if a lasting interest, an inner attention, watches over 
 the ordinarily wanton activity of the organ. Release from the
 
 AND ITS PSYCHICAL COMPENSATION 73 
 
 childish defect may be obtained through compensation in the related 
 psychomotor superstructure and its channels which may lead to 
 considerable strengthening of the psyche as a whole, but may also 
 lead to all sorts of disturbances, which are present in the nature of 
 the compensation. The psyche, however, always carries the traces 
 of the enuretic constitution in itself and in cases, too, where the 
 constitution is not revealed in childish faults, but only in the other 
 tokens of organ inferiority. To the exaggerated increased exten- 
 tion of the reflex channels, the jerking of the feet, inability to urinate 
 in the presence of others, dysuria, retention of the urine, involuntary 
 evacuation of the bowels, in children is due, phenomena which 
 we find again in hysteria, in so far as it owes its origin to in- 
 feriority of the urinary organs, while at' times astasia and abasia 
 in hysterical cases reveal the motor weakness of the segment, which 
 is fundamentally connected with the function of the bladder. The 
 enuresis of idiots shows us the entire incapability of compensation 
 of their inferior central nervous system. 
 
 The one-sided over-compensation in the whole central reflex 
 mechanism, which derives from the impulsion of compensation in 
 consequence of manifold organ inferiority, may be at the bottom 
 of the connection between enuresis and epilepsy. The great need of 
 sleep, the particular soundness of the enuretic's sleep, only corre- 
 spond to the increased consumption of psychic strength, while the 
 normal work of school or of life may often make itself felt as over- 
 pressure. Pavor nocturnus in childhood, which very frequently oc- 
 curs in enuretic constitutions, arises from the over great necessity 
 for tenderness in such children which finds its outlet at night by sleep 
 and in the dark by fright and screaming. The fearfulness which 
 burdens almost every enuretic in childhood is a universal expression 
 of his helplessness in regard to the inferior organ and often burdens 
 even grown people. In later life, in addition to the usual character- 
 istics, fear of water and fire, fear of the night, is frequently added. 
 At times the neurotic is able to conquer the terror in every form and 
 to achieve the contrast, extreme bravery and courage. Many of 
 the things which we are here writing down in dry form, Jean Paul 
 has interestingly revealed in " Schmelzle's Journey," the hero of 
 which, as can readily be seen, shows a compulsion neurosis on the 
 basis of inferiority of the urinary organs. Walking in the sleep, 
 which like talking, involuntary micturition and evacuation of the 
 bowels in the sleep, represents a wanton, pleasurable organic activity, 
 we shall often find in enuretics corresponding to the frequent seg- 
 mental inferiority. The dream of the enuretic, connected during
 
 74 STUDY OF ORGAN INFERIORITY 
 
 childhood with bed- wetting, very often contains the act of urination, 
 and later, after the time of enuresis, the idea of swimming, bathing, 
 boating, and definitely permits the diagnosis of conquered enuresis 
 and appears particularly in childhood as primitive wish- fulfillment 
 after unrestrained organic activity (Freud). Although some retain 
 their fear of water all their lives, others nevertheless attain remark- 
 able proficiency in swimming and boating sports. 
 
 It is, before all, the simultaneous inferiority of the sexual organs 
 and the lasting interest in emptying the bladder which in addition to 
 enuresis almost regularly permit a second childish fault to arise, 
 namely early masturbation, auto-erotic touching of the genitals. 
 With this, new opportunities are given for going astray in the 
 psychical development. The early awakened auto-eroticism makes 
 the child more unfitted for bringing up, the prevention of bad un- 
 civilized impulses becomes difficult from the outside for the same 
 reason, the child does not adapt itself to cultural life and becomes 
 evil and unamenable. At the same time there arise in him further 
 supports for his cowardice, shyness and anxiety and he seeks for 
 comfort and protection from the understanding which he has of the 
 sin, in " childish " superstitions and religious fantasies with un- 
 fortunate results. In the psychoanalysis of neurotic persons we 
 find both in the ideological sexual superstructure. Physiologically 
 viewed, it is compensation of the sexual organs in the psychomotor 
 field, strengthening and check. How often these happenings become 
 the foundations of psychoneuroses, as soon as compensatory inter- 
 ruptions and reciprocal effects of two inferior psychomotor fields 
 occur, Freud has irrefutably shown in his psychoanalytic material. 
 In my list of illustrative cases, also, there are a number of proofs 
 which rest on firm ground by reason of their certain relation to 
 organ inferiority and its consequences. 
 
 The accentuated auto-erotic trait which the enuretic shows and 
 the heightened interest in his own sexual phenomena makes it seem 
 comprehensible that in case there is no other adjustment, above all, 
 the similar sexual organ in other persons attracts him. In a few 
 cases I could determine this connection so that homosexuality and 
 exhibitionism as phenomena in people with inferior sexual organs, 
 often in connection with the enuretic constitution, becomes com- 
 prehensible. 
 
 I must still emphasize in closing that the great frequency of 
 enuresis in the juvenile and habitual criminal is not difficult to 
 understand. Both, function of the bladder as well as impulses, are 
 at times without compensatory limit in extended inferiority of the
 
 AND ITS PSYCHICAL COMPENSATION 75 
 
 central nervous system, and follow their course without any atten- 
 tion to cultural requirements. 
 
 The signs of more intense conscious effort which leads to the 
 compensation of the central nervous system, we will miss completely 
 only in idiots, and partly in juvenile delinquents. They appear in a 
 distinct, though abnormal form in neuresthenia, hypochondria, 
 hysteria, epilepsy, paranoia, compulsion, and anxiety neuroses. 
 Under favorable conditions, however, they may fall to the lot of 
 another category of people, strikingly functionally capable brains, 
 highly gifted and genius-like natures, in the consideration of which 
 we must recognize that the psychic activity has given occasion for 
 restraining enuresis together with powerful training of the psycho- 
 motor sphere to psychical and spiritual superiority. Very often in 
 not wholly successful over-compensation, we find border-line and 
 mixed cases. 
 
 I now briefly present the material to which I owe my report on 
 the inferiority of the urinary organs ; the choice was made according 
 to the occurrence of the childish defect, enuresis, in the family. 
 
 i. Siegfried H.* 34 years old, a merchant, complains of tempor- 
 orily occurring states of excitement, pressure in the region of the 
 heart, feelings of anxiety and impotence. Since his childhood he 
 has suffered from constipation and has several times had violent 
 attacks of abdominal colic. In the course of a severe posterior 
 urethritis there was for a few days retention of urine. Thyroid 
 gland considerably enlarged. General condition as well as analysis 
 of urine normal. Tendency to exhibitionism. The father died of 
 nephritis, three sisters died in confinement. The patient says that 
 he suffered from enuresis until his 9th year. 
 
 2. Oskar C., 23 years old, a student, complains of inability to 
 learn, pressure in the head and nervous irritability. Lately there 
 have been spontaneously occurring pains in the right testicle. 
 Normal condition, except for thickening of the head of the right 
 epididymis. There are two little knot-like thickenings along the 
 spermatic cord, which raise a suspicion of tuberculosis. Two 
 analogous cases, in which the thickening had gone away led us to 
 assume coitus protractus as a cause, while one of the cases had for 
 a time ejaculated bloody semen [rupture of the vessel ?]. In the 
 case under consideration protracted coitus was admitted. Otherwise 
 ejaculatio precox. The patient says that he only wet the bed a few 
 times when he was 9 years old. An older brother suffered till he 
 
 * The names are greatly changed and the bearers of the same are fairly 
 unrecognizable.
 
 76 STUDY OF ORGAN INFERIORITY 
 
 was 16 from enuresis. The analysis of the urine of the father, 
 who is suffering from a mild form of epilepsy, shows for the time 
 being, albumin, hyaline and granular cylinders. The paternal grand- 
 father and grandmother died of cerebral apoplexy (contracted kid- 
 ney?), one of their daughters died of uremia. A second brother 
 of the patient suffered from acute hallucinatory paranoia and showed 
 adhesion of the prepuce to the glans. 
 
 3. Ignaz W. } 52 years old, an official, has been complaining for 
 a year of vague pains in his back and in the region of the kidneys. 
 Condition of the urine: specific gravity 1007, slight traces of albumin, 
 permanently increased quantity, polyuria, tension of pulse raised 
 above normal, second aortic sound accentuated. The heart was 
 hypertrophic. Enuresis denied. One brother of the patient and 
 one child have suffered from it. His mother died at 26 during 
 parturition. 
 
 4. Dolly A., 7 years old, a timid, delicate, pale child who has 
 suffered from enuresis since her birth. Her mother was also an 
 enuretic, and her maternal grandmother died of uremia. 
 
 5. Elisabeth D., 3 years old, nocturnal and diurnal enuresis. A 
 timid child who is afraid to stay alone in the room, does not go out 
 without having some one lead her by the hand, and who shows 
 other great needs for tenderness, and desire for support. Pavor 
 nocturnus. She talks of " making water " almost all day long. In 
 the father's family there is enuresis, the material grandmother is 
 suffering from contracted kidney. When the patient and her sister 
 fell ill of scarlet fever, the sister who was not an enuretic, showed 
 hematuria. (Spieler has published similar cases without establish- 
 ing our relation to enuresis.) 
 
 6. Friedrich V ., 42 years old, a merchant, was a bed-wetter, as 
 were several of his brothers and sisters. At that time showed 
 temporary albuminuria to a slight degree and slight cardiac hyper- 
 trophy. On the occasion of syphilis, violent intolerance of iodine 
 appears. Chronic excess of phosphates in the urine of the mother 
 and one sister, which I have frequently found to be the case in 
 enuretic families. 
 
 7. Alexander S,, 28 years old. Abulia. In response to ques- 
 tions he says that the libido sexualis is lacking. Erection inade- 
 quate. Ejaculatio precox. On the left side severe varicocele, on 
 the right hydrocele. The patient was very fond of rowing and 
 swimming. Frequent swimming dreams. Only a year ago he 
 dreamed that he was attending to the calls of nature and urinated 
 in his bed at the same time. Enuresis up to his tenth year. His 
 father died of a renal affection.
 
 AND ITS PSYCHICAL COMPENSATION 77 
 
 8. Albert K., 45 years old, railroad official. Had had painful 
 retention of the urine for twelve hours. Went through the same 
 thing 20 years ago. Analysis negative. The catheter passed the 
 sphincter without finding any opposition. Ejaculatio precox. 
 Enuresis up to his seventh year. Says he has had no swimming 
 dreams, but he was a swimming teacher in the army. Seven of his 
 nine brothers and sisters died prematurely. He thinks that the re- 
 tention may have arisen through delay in urinating. Normal be- 
 havior after the next day. 
 
 9. Eugen M., 26 years old, a bookkeeper, complains of pressure 
 in the head and weakness. Phosphaturia. Of his 23 brothers and 
 sisters 17 died of unknown diseases, one with the symptom of 
 dropsy. Enuresis up to his twelfth year. Eagerly carries on row- 
 ing sports. 
 
 10. Julius S.j 39 years old, a writer, is suffering from nervous 
 gastric troubles. His mother died at a ripe old age showing uremic 
 phenomena. One brother has chronic nephritis, a second neuras- 
 thenic complaints and excess of phosphates in urine. The patient 
 himself went through a severe gonorrhea and also shows excess of 
 phosphates in urine. Enuresis during childhood, hypospadia and 
 para-urethral opening. 
 
 11. Sophie B. (already cited), went through parturition three 
 times. Pyelitis during the first pregnancy with fever phenomena 
 and pain, likewise during the second and third. Normal condition 
 of urine directly after birth. Four months after the last delivery 
 there were pains in the region of the right kidney. Shortly after 
 this, chill and connected with this intermittent fever, for eight days. 
 Afterwards lytic fall to sub-normal temperature, and convalescence. 
 There have been no further phenomena for almost a year. The 
 analysis of the urine showed, at the time of the fever, pus concretions, 
 red and white blood corpuscles, hyaline and granular cylinders. 
 We must consider the last attack as the last relapse of a pregnancy 
 pyelitis [without pregnancy?]. At the beginning of the sickness I 
 declared that the patient must come from an enuretic family. After 
 denying at first the patient admitted the following : namely that she 
 had suffered up to twelve years of age from bed-wetting, as had 
 several of her brothers and sisters too. The father died of car- 
 cinoma of the bladder, one sister is an idiot, one died in status epi- 
 lepticus. The patient herself had always been very timid. Two of 
 her children showed enuresis up to the third year, later pavor 
 nocturnus. 
 
 12. Fritz C., a merchant, 26 years old, fell ill three years ago
 
 78 STUDY OF ORGAN INFERIORITY 
 
 with pains in the hypochondrium on both sides, which radiated out 
 toward the bladder. At the same time a moderate fever is supposed 
 to have set in. Analysis of the urine then showed : Specific gravity 
 1020, acid, normal quantity, turbid. Albumin 0.08 per cent., and in 
 the sediment there were contained and extracted red blood corpuscles, 
 hyaline, finely and coarsely granular casts, isolated epithelial and 
 red blood corpuscle casts, and a few white blood corpuscles. This 
 state has continued with slight improvement up to the present. The 
 pains also occur still, although not very often. Differential diagnosis 
 took into consideration nephrolithiasis, tuberculosis, neoplasm and 
 nephralgie hematurique, among which the latter diagnosis seems 
 most probable. When one day the patient showed me a burn on 
 his finger, which he had got at night when he got out of bed walking 
 in his sleep as he had already done a number of times and lit a 
 candle in his sleep, I advanced the suggestion that he had been an 
 enuretic, which the patient admitted at once. On further observa- 
 tion the patient showed himself to be homosexual; at times he 
 suffered from retention of the urine for long periods of time which 
 was always connected with a fright. The catheter easily passed 
 the sphincter. His brothers and sisters had also suffered from 
 enuresis, and a grandmother had died of uremia. The patient at the 
 same time since his earliest childhood had suffered from constipa- 
 tion, and had always been accustomed to use the syringe every day. 
 (Second component of homo-sexuality.) 
 
 13. Dr. L. Z., lawyer, 32 years old, neurasthenic. Fell ill eight 
 years ago of inflammation of the choroid and retina on a hereditary 
 syphilitic basis. In the right eye there is a lamellar cataract (in- 
 feriority of the eye of an openly embryonic nature). In the urine 
 there is regularly nucleo-albumin, at times hyaline and granulated 
 casts as well as white blood corpuscles. Complains of sexual weak- 
 ness, which improved after the removal of an exaggerated phimosis. 
 Ejaculatio precox. Enuresis until his fourteenth year, early mastur- 
 bation, inclination to exhibitionism. The father suffered from 
 paresis, the mother died of nephritis in her fiftieth year. One of his 
 brothers showed compulsive ideas after an attack of scarlet fever at 
 the age of twenty-six. The patient is justly considered as a strik- 
 ingly capable, highly gifted individual. 
 
 14. Hugo R., ii years old, a delicate pale boy, suffers, as do all 
 his brothers, from enuresis. According to his relatives he is shy, 
 timid, absent-minded and does not get on very well in school. His 
 mother died in her thirty-eighth year of tabes. 
 
 15. Fritz Sch., 17 years old, shopkeeper's apprentice, had two
 
 AND ITS PSYCHICAL COMPENSATION 79 
 
 attacks of unconsciousness in the course of a month, which are sup- 
 posed to have been connected with anxiety on account of the sick- 
 ness of his mother. Weakness after the attacks, stammering, 
 amnesia, no biting of the tongue. The physician who was called 
 came after the attack which only lasted five minutes and which was 
 without convulsions. Physical condition normal. He is said to 
 have always been an unmanageable child ; admits early masturbation 
 and enuresis up to his tenth year. One of his brothers also had 
 enuresis, another a neurasthenic affection since puberty, a third suf- 
 fered for a long time from gonorrheal arthritis in the knee and 
 ankle joints and has a congenital constriction of the anterior urethra. 
 His mother had an ovarian cyst and had to have an operation. 
 
 1 6. Sophie K., 29 years old, accountant, has suffered since 
 puberty from dysmenorrhea. Half a year ago violent pains in the 
 lumbar and sacral regions began. The examination per rectum 
 showed an intramuscular myoma as big as a fist. Enuresis up to 
 her ninth year. Her mother died during a delivery. 
 
 17. Rosa E., 32 years old, complains of pains which extend from 
 the sacral region on both sides over the back surface of the thigh 
 to the popliteal space. Strong sensibility to pressure of the sciatic. 
 State of abdomen normal. She went through two uncommonly 
 protracted births. Both times hydramnion and retarded first stage 
 of labor. Slight rachitic constriction of pelvis. Frigidity. Strik- 
 ingly short, plump legs with very slight traces of rachitis. Con- 
 trasting with this a slender upper part of the trunk. Enuresis up 
 to 14 years. Urine and later swimming dreams. Was never timid 
 as a child, liked to play with fire, and occasionally "accidentally" 
 (part played by chance!) burned up household utensils. Her 
 mother died at 27 from a hemorrhage during parturition. One sister 
 was operated on for myoma. She had never suffered from enuresis, 
 but was a precocious child and suffered from a washing compulsion 
 neurosis. A younger brother suffered from mild enuresis, which 
 was soon outgrown, from pavor nocturnus, and as a child showed 
 a highly developed condition of anxiety. A medical examination 
 could probably have found in the urine of the now 22-year-old man 
 nucleo-albumin, a condition which like excess of phosphates is very 
 frequent in families of enuretics. 
 
 1 8. Hugo K., 30 years old, a merchant, complains of headache, 
 conditions of excitement and sleeplessness. Querulous behavior, 
 and on the basis of a dream accuses a woman of his acquaintance 
 of criminal intercourse. Corrects himself very soon and sees his 
 mistake. Earlier he had often had violent attacks of rage. Striking
 
 8O STUDY OF ORGAN INFERIORITY 
 
 antipathy for his father. Homosexual inclinations and a morbid 
 fear of dirt. Early masturbation. Ejaculatio precox. The 
 catheter easily passes the sphincter. Nucleo-albumin in the urine. 
 Suffered from enuresis up to his fifteenth year. His father and 
 grandfather had hypertrophy of prostate. 
 
 19. Alois W., 31 years old, engine fitter. For two years he has 
 had posterior urethritis. Indications of hypospadias, operation for 
 phimosis, para-urethral meatus. His father died at 48 with dropsical 
 phenomena. The mother has prolapse of the uterus. The older 
 brother was an enuretic up to his sixteenth year. 
 
 20. Artur S., 28 years old, a merchant. Three months after a 
 severe attack of scarlet fever he still showed distinct traces of 
 albumin. He has the history of a long continued gonorrhea. Since 
 then ejaculatio precox. Intolerance of sexual abstinence, during 
 which he is troubled by sleeplessness, violent excitement, conditions 
 of anxiety and fear of insanity. He admits early masturbation. 
 Enuresis and incontinence of the bowels for some time. He had 
 been an extremely delicate child, who only began to walk at the age 
 of three. Only slight traces of rachitis at that time. His mother 
 died at an operation for carcinoma of the uterus. His father has 
 suffered since his fortieth year from rarely occurring typical epi- 
 leptic attacks and an equivalent in the form of aphasia. 
 
 21. Julius M., a merchant, 38 years old, complains of deficient 
 sexual power. Relaxed sphincter. Enuresis up to his twelfth year. 
 His mother died at an early age. 
 
 22. Georg A., 16 years old, commercial student, has had poste- 
 rior urethritis for half a year. Enuresis up to his eighth year and 
 admits early masturbation. His father has suffered for twenty 
 years from temporarily occurring lancinating pains in his legs, shows 
 lack of PSR, positive Romberg, slight ataxia and Argyll Robertson 
 pupil. No bladder disturbance, no impotence. His mother has had 
 recently to have an operation for myoma, and has for two years 
 suffered from pains in the lumbar and sacral regions. (The parents 
 both show segmental inferiority of the lumbar and sacral regions.) 
 
 23. Dr. M. L., an author, 41 years old, has for years suffered 
 from frequently recurring severe sciatica. Sexual precocity and 
 enuresis in the family is admitted. Syphilophobia. Inability to 
 urinate in the presence of others and dysuric difficulties without 
 analysis. 
 
 24. Josef S., merchant, 42 years old, complains of a state of 
 anxiety, chronic constipation, depression and eructation. He says 
 that in himself as well as in his brothers there was greatly delayed
 
 AND ITS PSYCHICAL COMPENSATION 8l 
 
 ejaculation. Chronic posterior urethritis with complications oc- 
 curring repeatedly. Relaxed sphincter. Between his eighth and 
 ninth year he had a painless paralysis of both legs and was confined 
 to his bed for more than half a year (hysterical astasia-abasia or else 
 cured poliomyelitis?). His gait, reflexes, motor power and develop- 
 ment of the legs since that time have been excellent. On the other 
 hand, in the lumbar portion of the spine there is a lordotic de- 
 formity. The patient suffers with anxiety, hypochondria, inclined 
 to all sorts of complaints about his heart, lungs and digestive appa- 
 ratus, and has lived with a healthy wife in childless wedlock for 7 
 years. Examination of the semen is refused. He admits early 
 masturbation and enuresis into the fourteenth year, and incon- 
 tinence of the bowels for almost as long. (His mother died of 
 diabetes !) Bed-wetting just a short time ago after excessive alco- 
 holic indulgence. 
 
 25. Johann R., 39 years old, an official, complains of feelings of 
 anxiety and swelling of the knee joints occurring almost every two 
 weeks, preceded by pollution and diarrheal evacuation of the bowels. 
 The condition lasts twelve days and began probably in connection 
 with self-reproaches for the death of his father. Ejaculatio precox 
 since then. Excessive masturbation even in early childhood, later 
 increased pollutions. Enuresis and incontinence of the bowels up to 
 the tenth year. At present there is morbid sleepiness and unusually 
 heavy sleep. (Inferiority of the cerebrum.) Complains of con- 
 tinual violent pains in the lumbar portion of the spine and in the 
 sacrum. The lower extremities are remarkably short in comparison 
 to the trunk. The case was under my observation for some time. 
 It had to do with intermittent dropsy of the knee joints. The swell- 
 ing appeared regularly with rare exceptions every fourteen days 
 just above the patella, soon attacked the knee joint and led to intra- 
 articular effusion. In four days every trace of swelling has dis- 
 appeared. It was easy to invoke a suspicion of tabes. Prostate 
 normal. The patient is a passionate tourist. 
 
 26. Maria C., 17 years old, has suffered from her earliest child- 
 hood from enuresis and incontinence of the bowels which still ap- 
 pear quite frequently up to the present, but which can however be 
 checked for a time by psychic influence. Has always been an un- 
 manageable child inclined to outbursts of fury, but is unimpaired 
 in her psychic functional capability. Often has catarrh of the 
 bladder. Defect in speech. In her early childhood she learned to 
 speak very slowly and with great difficulty. At that time she longed 
 to go to the theatre. No palatal reflex. Mild rachitic scoliosis. 
 Constipation, loss of appetite occurs frequently. Has had appendi-
 
 82 STUDY OF ORGAN INFERIORITY 
 
 citis and typhoid fever. She is a courageous girl who knows no 
 timidity. First period at the age of 15, since then they have been 
 regular and painless. A great deal of enuresis in the family. 
 
 27. Wilhelm N., 30 years old, bookkeeper. Has had gonorrhea 
 for eight months. Excess of phosphates in the urine. Complains 
 of chronic constipation, which he has had since his childhood. His 
 father died early of pulmonary tuberculosis. Patient was an 
 enuretic up to his seventh year, his younger brother suffered for 
 some time with enuresis and incontinence of the bowels. (A very 
 frequent condition is to have incontinence of the bowels at first, 
 then in later life, constipation. This often occurs in the domestica- 
 tion of dogs.) 
 
 28. Frits R., 27 years old, a merchant, complains of temporary 
 impotence and regular ejaculatio precox. Adhesion of the inner 
 preputial sac to the glans. In regard to his childhood he tells us : 
 that he was shy, was very much afraid of being alone and in dark 
 rooms, long persistent biting of the nails and tic of the left shoulder, 
 clonic blepharospasm. Early masturbation. Enuresis until his 
 seventh year. Enuresis and ejaculatio precox occur quite fre- 
 quently in the father's family. In addition to these the patient also 
 has slight struma parenchymatosa, at times cramps in his calves 
 and cramps in the toes and fingers, no Trousseau, Chvostek's symp- 
 tom positive. Varicose veins in the lower leg. Constipation and, 
 quite frequently, headache. (Inferiority of the legs? Long lower 
 extremities. Is very fond of touring, skating and skeeing.) 
 
 29. Dr. Robert 6\, lawyer, 32 years old, complains of psychic im- 
 potence and ejaculatio precox. Shows a morbid fear of dirt and 
 suffers from headache and conditions of anxiety. Enuresis up to 
 the twelfth year, a family trait. Nevus pigmentosus over the top 
 of the bladder. 
 
 30. Leopold M., 23 years old, complains of anxiety arising with- 
 out any cause, inability to work and headache. Ejaculatio precox 
 and spermatorrhea. Relaxed sphincter. No gonorrheal infection 
 (just as little in the above cases, if it is not mentioned). Denies 
 early masturbation and enuresis, but says that the latter is a family 
 trait. 
 
 31. Leo T., an official, 34 years old, complains of frequently 
 occurring pains in the region of the left ankle joint (rheumatic in 
 character), of irritability, exhaustion and violent outbreaks of pers- 
 piration. Repeated analysis of the urine shows only an excess of 
 phosphates. The question in regard to ejaculatio precox is an- 
 swered in the affirmative. Likewise the one in regard to enuresis 
 in the past.
 
 AND ITS PSYCHICAL COMPENSATION 83 
 
 32. Martin R. } a merchant, 33 years old, complains of frequent 
 sense of pressure in the stomach, eructation, loss of appetite and 
 heightened irritability. The examination gives no positive results. 
 Sexual intercourse very rarely. Ejaculatio precox at that time. 
 Frequent masturbation (in causal relation to the neurosis of the 
 stomach) and pollutions. Enuresis up to his eighth year. The 
 same childish defect was present in all the brothers and in the only 
 sister. The latter has remained childless after ten years of married 
 life. 
 
 33. Max S., 26 years old, an author, complains of severe states 
 of anxiety and palpitation of the heart as well as of painful sensa- 
 tions in the genital region. Two years ago he had a severe ureth- 
 ritis. Objective condition negative. The patient says that he suf- 
 fers from frequent pollutions and ejaculatio precox. Spasm of the 
 sphincter when the sound is introduced. After long hesitation 
 admits enuresis until his eighth year. His father died of cardiac 
 paralysis, in his forty-eighth year, while in the best of health 
 (nephritis?). 
 
 34. Dr. Rudolf S., 38 years old, refers his cured ejaculatio precox 
 back to gonorrheal infection. Enuresis admitted. Urine games in 
 childhood, extinguishing fire, etc. 
 
 35. Rudolf W ., manufacturer, 26 years old, complains of ex- 
 haustion, dizziness and pressure in the head. Objective state nega- 
 tive. The examination brought an admission of sexual weakness, 
 psychic impotence alternating with ejaculatio precox. Overheated 
 sexual phantasy. Denies enuresis for himself, but admits it for his 
 brother. In the frequent pollution dreams he dreams of urinating. 
 
 36. Max B., an official, 33 years old ; swelling of the lymphatic 
 gland as big as a hen's egg, quite apart from these numerous small 
 swellings in the left groin. Syphilis a year previously. Since then 
 there has been no ulcer, no peripheral lesion. Abdominal organs 
 and vertebral column intact. Catarrh of the apex of each lung, 
 state of urine normal. Neurofibroma in the region of the left 
 kidney. My question about enuresis was answered affirmatively 
 as well as the one in regard to ejaculatio precox. (Inferiority of 
 the lower segment, localization of tubercle bacilli in the inguinal 
 gland?) Extremely long legs, short trunk. Often dreams of fire 
 and water. 
 
 37. Max Sch., official, 38 year old, complains of conditions of 
 fear, anxiety, palpitation of the heart, temporary attacks of uncon- 
 scoiusness. Frequent swimming dreams. Question in regard to 
 enuresis is answered in the affirmative. 
 
 38. Paula D., 37 years old, a merchant's wife, during an attack
 
 84 STUDY OF ORGAN INFERIORITY 
 
 of typhoid had the hallucination that the house was burning and that 
 the children must be saved. Usually she is a courageous woman but 
 always shows tremendous anxiety as soon as she hears the fire- 
 alarm. Enuresis in the family. 
 
 39. Sophie L., 32 years old, office holder, has suffered since her 
 twelfth year from ideas of fear, agoraphobia, terrified screaming at 
 night. She often dreams of fire and rain which soaks her through 
 and through. Enuresis up to her eleventh year. 
 
 40. Alexander H., 22 years old, has suffered since childhood 
 from headache, weariness, dizziness, stuttering and anxiety and com- 
 pulsive ideas. One of his compulsive acts often consists in lying 
 down on the bed with dirty shoes, "in spite of the fact" that he 
 comprehended that he would soil the clean bed upon which his 
 mother laid much stress. This compulsive act occurred when he 
 had conquered the enuresis (around his tenth year) and at a time 
 when he was in strong opposition to his mother. Likes to look into 
 the fire for hours at a time. Swimming dreams. Premature 
 sexuality. 
 
 41. Johanna H., 44 years old, climacteric difficulties. Has for 
 some time suffered from anxiety and compulsive ideas and agora- 
 phobia. In the course of the analysis of a compulsive act the sus- 
 picion of infantile enuresis arose, which the patient denies for her- 
 self, but admits for her brother. 
 
 42. Dr. Max P., 27 years old, complains of anxiety and excite- 
 ment which always attacks him after sexual intercourse. When he 
 tries abstinence it drives him out of the house, through the alleys 
 and streets, until he again flees to prostitutes (migratory neurosis?). 
 Frequent pollutions. Ejaculatio precox. Numerous symptoms of 
 inferiority. Enuresis up to his twelfth year. He is an uncommonly 
 ambitious and talented person. Indications of spina bifida sacralis, 
 nevus pigmentosus in the right groin, several hemangiomas below 
 the region of the right kidney. Segmental inferiority. The patient 
 tried to help his troubles by strenuous " touring." Also note above 
 the instinctive running through the streets. The maternal line shows 
 a number of psychoses. 
 
 43. Alexander E., 33 years old, with hypochondriacal attacks 
 since puberty, complains of suddenly arising attacks of anxiety and 
 fear of a threatening misfortune. Forgetfulness, disinclination and 
 inability for work. Early masturbation which has continued until 
 recently. Bacteriuria. Relaxed sphincter. Enuresis up to his eighth 
 year. 
 
 44. Julius N., brass-founder, 33 years old: Attacks of suicidal
 
 AND ITS PSYCHICAL COMPENSATION 85 
 
 ideas, ideas of injury, inability to work on account of headaches and 
 dizziness, which set in. Sexual impotence for a year. The patient 
 was precocious and suffered from enuresis up to his twelfth year. A 
 strong inclination to religious ideas comes in relation to sexual 
 motives from his childhood. Homosexual inclinations. 
 
 45. Moritz Sch,, 40 years old, a merchant complains of suddenly 
 arising states of anxiety at home, in business, in busy streets. At 
 the same time a feeling of weakness in the legs and pains in the 
 sacral region. Is afraid of an apoplectic seizure and tabes. Admits 
 temporary impotence. Partial adhesion of the glans with the inner 
 preputial membrane. Enuresis up to his twelfth year. Occasional 
 traces of albumin in the urine. His father died at 50 of cardiac 
 paralysis. Neuroses in several of his brothers and sisters. Eagerly 
 pursued rowing and swimming sports. His legs are too short for 
 the tremendously developed body. 
 
 46. Otto St., 13 years old, collegian, had numerous attacks in 
 connection with pertussis in which he sprang about in bed, or in the 
 room, panting, kicking about, and with his features distorted by fear, 
 pulled himself loose if any one tried to hold him, until after about 
 ten minutes he calmed down. His recollection of the attack was 
 not wholly wiped out, he knew that "something had happened to 
 him." Usually a connection could be found between these attacks 
 and unfulfilled wishes. He had always been a wild boy, who lived 
 with his stepmother in a state of continual wrangling. Enuresis up 
 to the present and at times pavor nocturnus. 
 
 47. Lenore B., 20 years old, began to "kick about" at the age 
 of 7, that is she had attacks in which she made motions of the legs 
 such as children make when they have a full bladder. In addition 
 to this she swung her arms and twisted her body. Finally she 
 hurried to the toilet and locked the door. Later there were attacks 
 of unconsciousness, of which there was apparently complete amnesia. 
 Since these attacks also occurred in her sleep, and were at times 
 connected with passing of the urine, and since, moreover, dilation 
 and loss of reaction of the pupils were noticed during an attack, the 
 patient was usually regarded as an epileptic and treated accordingly, 
 and at all events without success, with bromids. It was only by 
 means of psychoanalysis that the psychic conditioning of the attacks 
 could be indicated, which showed a continuity with the occurrences 
 of the day, and revealed particularly a tendency hostile to the mother 
 and in the mental impressions their translation uncovered many 
 references to the toilet. In her earliest mental development the 
 enuresis of her brothers and sisters played a part, which she, in spite
 
 86 STUDY OF ORGAN INFERIORITY 
 
 of a like tendency she also had suffered shipwreck sometimes 
 escaped through the rivalry with her brother and the iron severity 
 of her mother, only that later by reason of the entrance of sexual 
 precocity the fundamental inferiority might be recognized in the 
 neurosis. The father shows inability to urinate in the presence of 
 others and nucleo-albuminuria ; the mother comes from an enuretic 
 family. The patient has distinct homosexual inclinations and shows 
 a slight scoliosis in the lower section of the thoracic portion of 
 the spine. 
 
 48. Johann E., 13 years old, became subject to punishment when 
 he one night, in a somnambulistic condition, took a knife and attacked 
 his sleeping father. Enuresis up to the present. As a child he was 
 very timid and was afraid of being alone, and of the dark. Often 
 cried out in his sleep, often walked in his sleep without remember- 
 ing it after he woke up. Drowsiness on waking, great difficulty in 
 arousing him. He was seduced to masturbation at the age of 6 and 
 to coitus at the age of 10. Strongly religious temperament. Often 
 ran away from home, was very fond of Indian stories and could not 
 adjust himself to the coercion of school. 
 
 49. Jakob K., 1 6 years old, an apprentice, became punishable 
 for stealing from his master. Enuresis up to two years ago. Pre- 
 cocious. Already had to his account a great number of robberies as 
 a servant, and had bolted innumerable times, to wander about the 
 alleys without shelter. 
 
 50. Leopold W ., 14 years old, a musician, was accused of the 
 theft of instruments, the money for which he used in a senseless 
 manner. Enuresis up to the age of 10 and incontinence of the 
 bowels for which reason he was severely beaten. In his eleventh 
 year he was run over by a trolley-car and since then has often 
 suffered from suddenly arising dizziness which usually attacks him 
 in the street. Since that time also he has had occasional attacks of 
 unconsciousness which did not show a psychic origin. No attack 
 was observed by a physician however. During the trial, throughout 
 which he was at liberty, he was tempted to a second theft and was 
 condemned. After he left the prison during his stay there he had 
 had further attacks he soon appropriated others' belongings again. 
 Quite according to the whole scheme of the person lack of suffi- 
 cient compensation in the inferior brain, which can be proved by 
 the apparently epileptic attacks, by the senseless use of the stolen 
 instruments, by the deficient mental development and the ease with 
 which he can be tempted to steal it was all too easy, after the first 
 theft, to recognize in him the future habitual thief into which he 
 soon developed.
 
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