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THE
ALIENIST K^' NEUROLOGISt
A QUARTERLY JOURNAL
SCIENTIFIC, CLINICAL AND FORENSIC
Psychiatry and Neurology.
Intended especially \o subserve the wants of the
General Practitioner of Medicine.
"Qaantam ego qaldem video motus morbosi fere omnes a motibus in systemate nervorum
ita pendent, nt morbi fere onmea quodammodo-.Xervosi dici que»nt."-C«^/fn'. Ecology: Book
n., p. 181— Edinburgh Ed. 1780.
VOLUME IV,
—EDITED BY—
C. H. HUGHES, M. D. ,
And an associate corps of collaborators. / 3 (^-^-^tr
ST. LOUfc, MO.:
EV. E. CARBERAS, STEAM PRINTER, PUBLISHER AXD BINDER.
1883.
PRESS D F
Ev, E, Carreras, Steain PrlntEr, PuhllstiEr and HlndBr,
ST. LDTJIS, MD.
4.
Contributors to Volume IV.
GEORGE M. BEARD, A. M., M. D..
New York.
A. BIANCHI, AL D.,
Italy.
ALBERT N. BLODGETT. M. D.,
Boston, Mass.
D. R, BROWER, M. D.,
Chicaofo, lU.
•I. D. CROTHERS, M. D.,
Hartford, Conn.
S. DANILLO, M. P.,
St. Petersburg, Russia.
CECILIA DEAN, M. D.,
Baltimore, Md.
PLINV EARLE, M. D..
Morthampton, Mass.
J. J. ELWEl.L, M. D..
PROF. GOLGI,
Cleveland, O.
Italy.
WILLIAM A. HAMMOND. M. D.,
Ne«' i'ork City.
C.H. HUGHES, M.D.,
St. Louis. Mo.
J AS. G. KIERNAN, M. D.,
M. J. MA DIG AX, M. D.,
Chicago, III.
Brooklyn, N. Y.
EDWARD C. MANN. M. D.,
New York City.
JAMES H. McBKIDE. M. D.,
Milwaukee, Wisconsin.
ALLAN McLANE HAMILTON. M. D.,
New York City.
WM. JULIUS MICKLE,M. D., M. R. C.P.,
London.
E. M. NELSON, M. D.,
St. Louis, Mo.
A. H.OHMANN-DUMESNIL.A.M.,M.D.
bt. Louis, Mo.
D. V. PARANT, M. D.,
France.
RALPH S. PARSONS, M. D.,
Near Sing Sing, N. Y.
LUIGI M. PETKONE. M. D.,
Italy.
IRA RUSSELL, M.D.,
Winchendon, Mass.
G. SEPPILLl, M. D.,
Italy.
EDWARD C. SPITZKA, M. D..
New York City.
P. R. THOMBS, M. D.,
A. VAN DERVEER, M. D.
I H. WARDNER,M. D.,
I P.M. WISE, M. D.,
Pueblo, Col.
Albany, N. Y .
Anna, III .
WiUard, N. Y'.
JOSEPH WORKMAN, M. D..
Toronto, Canada
IV
INDEX.
Index to Volume IV.
ORIGINAL CONTRIBUTIONS.
I'age.
Bibliocrraphy, report on 655
Bilateral secondary descending scle-
rosis and atrophy, mainly of pons
varolii and medulla oblongata;
sliocht ditFuse myelitis 1
Cerebral syphilis manifested by iso-
lated involvement of ttie triofeminal
nerve; persistent conjunctivitis and
facial ana38thesia 58
Clinical phenomena and therapeutics
of delirium tremens 91
Contribution to the question of the
mental status of Guiteau and the
history of his trial 201
Continuation of the study of the min-
ute anatomy of the central organs of
the nervous system. 383
Concealed insanity. — As illustrated by
the case of Mark Gray ,. 4G1
('urability of insanity; new observa-
tions 01
Experience of an opium eater during
the withdrawal of thech'ug 26
Extract from report on diseases of old
age 97
Female diseases among the insane 113
Folic a deux — its forensic iifipects 285
Guiteau. — A case ot alleged moral
insnnity 193
Guiteau. — A case of alleged moral in-
sanity 621
(juiteaii, mental status of. 543
Guile.iu, in re.— lieply to .1. J. Klwell,
iM. I) 417
Handwriting in relation to patliology,
changes in 566
Pa?e.
Importance of a knowledge of insanity
by general practitioners of medicine. 276
Influence of age upon the mind and
body in relation to mental derange-
ment 220
Insanity from quinine 608
Management of chronic inebriates and
insane drunkards 36
Maniaco-uuemic delirium in renal
alfections 439
Minor treatment of insane patients 675
Myxcedema — pachydermlc cachexia... 14
ISeuratrophia. — The cause of inebriety ;
a clinical study 104
Otha^matoma 687
Pathogeny ol hallucinations in refer-
ence to a case of voluntary psycho-
sensory hallucination 119
Progress of psychiatry and neurology. 270
Keciprocal insanity 591
KetlecLionsonthe development, move-
ments and transmission of mind 291
Jtights of tiie insane 183
Sexual perversion, case of. 87
Siumlation of insanity by the insane... 355
Some new experiments in muscle
reading (thought reading.) 175
Studies on the mmute anatomy of the
central organs of the nervous system. 236
Syphilis in its relations to progressive
paresis 450
Syi)hiliticGummaof the brain, case of. 190
Tlierapeutic value of cephalic and
spinal electrizutions 77
Traumatism in relation to insanity 646
Trifacial neuralgia, report of cases of.. 611
INDEX.
SELECTIONS.
Page.
Anatomy and Physiology. —
Action of the vagus.... 488
Cerebral color center 486
Electro-physiology of human nerves. 489
External acoustic nucleus and resti-
form body 489
Nerve endings in the epidermis 489
Optic nerve 487
Rapidity of nerve force 490
Reflexes in childhood 490
Structure of the spinal cord 487
Terminations of olfactory nerves 707
Cerebro Physiology. —
Posterior lobes of the brain and the
seat of intellectuality 322
Retreating foreheads and intellect ..» 321
Suavitorin modo, etc 322
Clinical Neurology. —
Act of rotation 140
Arsenical paralysis, cases of 315
Arthropathies in progressive paresis. 485
Bulbar lesions in ataxia 701
Functions of the phrenic nerve 140
Hereditary transmission of artificially
produced lesions 320
Localized cortical atrophy, secondary
to an extremity amputation 483
Low temperature in alcoholism 701
Myxoedema, case ot 139
Note on the action of continued cur-
rents, studied from a physiological
stand-point ." 312
Paralytic dysphagia from typhoid 701
Progressive total hemiatrophy 699
Reflex palmar emeses 321
Sexual perversion 485
Transient albuminuria as it occurs par-
ticularly in children, and adolescents
in apparent health 484
Trophoneurosis of the skin in tabetics. 484
Variola and vaccination in insanity.... 482
Clinical Psychiatry. —
Chronic iodoform psychoses 311
Delusions and executive ability 698
Early progressive paresis. 695
Eye lesions of progressive paresis.. 474
Folic avec conscience 137
Gout and insanity 309
Hemiatrophy of the face in a mono-
maniac „ 698
Insanity in a child .'.".'.. 311
Insane from fear 696
Insanity and Addison's disease 475
Locomotor ataxia terminating in pro-
gressive paresis 696
^ ^ Page.
Clinical Psychiatry— Continued.
Meningeal tuberculosis of the cere-
bral convexity, abstract on 135
Mental symptoms and ear disease 697
Moral insanity — What is it? 298
Moral insanity 311
Non-Paretic forms of syphilitic in-
sanity 306
Pathology of athetosis, Schutz on the, 138
" Phobias " and the " Schwindels." 473
Post scarlatinal Insanity 699
Primary monomania 694
Puerperal insanity 311
Pulse among the insane 474
Restraint 311
Senile progressive paresis 138
Stenger on cerebral aflections of sight
in general paralysis 303
Sudden recoveries from amnesia 697
Systematized alcoholic insanity 138
Temperature in insanity 310
Vicaration of nerve function 304
Transitory furor from lead poisoning_ 698
Transitory insanity 699
Forensic Psychiatry.—
II Processo Guiteau 129
Necrotherapy. —
Action of narcotics 706
Actual cautery in neuralgia 481
Administration of choral 475
Alterations of the cord in phosphorus
poisoning 140
Amanila luuscaria in negative lype-
mania ., 481
Amyl nitrite. 702
Capsicum enemata in opium poison-
ing 476
Carbon bi-sulpliide in neuiiilgia 481
Coniin 431
Cure of a case of "rebellious neural-
gia 482
Diabetes insipidus and central nerve
lesion 479
Excitation of vascular nerve-cenlers. 477
Ether douche or lavement lor local
pain : 703
Gold bromide in epilepsy 482
Hydiobromic a*id as a bromide sub-
stitute 705
Hyoscyamia in psycliiatry 478
Indian hemp in epilepsy 482
Nerve stretching .". 707
Nerve stretchinjf and temperature 4S1
Nerve suture and transplantation 704
Nicotine in tetanus 482
Paraldehyde 704
VI
INDEX.
SELECTIONS.
Page.
Neurotherapy — Continued.
Paraldehyde 705
Paraldehyde as an hypnotic 707
Poisoning, case of 479
Silver in locomotor ataxia 480
Spinallesions in ergotism 705
Page.
Neurotherapy — Contmued.
8UCCUS conii in chorea 706
Therapeutic use of the magnet.. 479
Therapeutic value of nitro-glycerine. 480
Tonga, in neuralgia of the face 482
Treatment of Meni6r6'8 disease 706
EDITORIALS.
Alienist and Neurologist 714
Annales Medico-Psycholgiques 500
Announcements 501
Aphasia and insanity 149
As others see us. {Louisville Med.News) 328
Association of American Medical Edi-
tors 329
As others see us 492
Brass poisoning and insanity 152
Center for the salivary serretion 331
Commendable religious journal 325
Cortical sensory discharging lesions. 494
Correction 297
Cotoin 331
Coupling of irresponsibility with in-
sanity 151
Cure of a case of epilepsia 152
Dr. L. S McMuity 715
Gazetteer men 151
General functional neunitropliia 330
Good periodical discontinued 152
Gospel ot fatness. Dr. Clouston's 500
Government's tribute to the medical
profession 147
Guiteau mania 497
Guiteau verdict 713
Hammond prize 331
Higher education of medical men 330
Honor to whom honor is due 147
How the jealous public protect the
insane 329
Hypnotism 496
Insanity in hysterical women 499
Intimidation nnd couip;is8ioii in the
cure of insiiTiity 708
Journalistic 324
Judicial psychology of tlieGuiteautrial 141
Kalaemia va. Uremia 151
Kleptomania 330
Large brain 151
Letters of the insane 327
London Medical Timeaand Gazette 498
Low temperature in insanity 148
Lunatics at large, Dr. Curwen 150
Malaria in skin diseases ; a correction. 150
" Many are called, but few are chosen." 494
Memory of Baron Munchausen re-
vived 326
Medical management of hospitals for
the insane, political changes in 715
Michigan law as to wills 711
Misconceptions of moral insanity 146
Moral character in insanity 714
More light on Gulteau's ancestry 148
Narrow view of insanity 151
New Antipyretic Kairn 501
New England Merficai lUonthly., 501
Other channels of audition 498
Personal liberty and jury trials for
insanity 495
Persistent double consciousness 151
Plea of insanity brought into disrepute 325
Power of vicarious nerve function 145
Premeditation as legal evidence of in-
sanity 712
Psychical effects of nerve stretching... 711
Public prejudice against the plea of
insanity 145
Recent insane asylum investigations... 491
Keign of the " Ines" in therapy 323
Reply to Dr. Elwell 501
Rights of the insane 143
Rights of the insane in Illinois 709
"bane Lunatics." 714
Sensitive cardiac nerves 500
Simulation of insanity 490
Society for the protection of insane... 152
Specialism in medicine 331
Stevens, Dr. Chas. W 742
Style of men who read the Alienist
AND Neurologist 324
Term imperative concejjtion 331
Thirty-seventh annual meeting of the
Association of American Medical
Superintendent? 354
To the friends of tiie Alienist and
Neurologist 715
Tr«'phining in a syphilitic 499
Tri-State Medical" Society 329
YT earning for higher medical education 149
INDEX.
HOSPITAL NOTES.
Page.
A retired American superintendent 343
Central Lunatic Asylum (for colored
insane), at Richmond, Virginia 725
Cincinnati Sanitarium 722
Dakota Hospital for the Insane, at
Yankfon 729
Dixmont, Pa., Hospital for the In-
sane 514
Eastern Lunatic Asylum, at Williams-
hurgh, Virginia 717
Eastern Michigan Asylum 334
Eastern North Carolina Insane Asy-
lum 724
First Minnesota Hospital for Insane,
at St.Peter 722
Government Hospital for the Insane,
Washington, D. C 728
Hospital for the Insane, Topeka. Kas.. 514
Hlinois Eastern Hospital for the In-
sane, at Kankakee 716
Indiana Hospital 514
Missouri State Lunatic Asylum 342
North i-aroiina Insane Asylum 718
State Asylum for the Insane, at Tope-
ka, Kansas 728
Second Minnesota Hospital for In-
sane, atKochester 721
VII
Page.
State Homoeopathic Asylum for the
Insane, Middletown, New York 725
Stat« Hospital for the Insane at Wes-
ton, West Virginia 721
State Hospital for the Insane, Warren,
Pa 515
State Insane Asylum, Agusta, Maine.. 727
State Insane Asylum, at Cleveland. O. 723
State Insane Hospital, at Tuscaloosa,
Alabama .' 724
State Insane Asylum, Jackson, Louisi-
ana 716
State Insane Asylum, Stockton, Cali-
fornia 729
State Insane Asylum, at Athens, Ohio. 719
State Lunati.c Asylum, No. 2, St.
Joseph, Missouri 719
State Lunatic Asylum, Jackson, Mis-
sissippi 720
State Lunatic Asylum. Trenton, New
Jersey 727
State Lunatic Asylum, Columbus, 8. C. 717
State Lunatic Asylum, at Little liock,
"The Retreat," Hartford, Conn......... 514
Western Lunatic Asylum, at Staunton,
Virginia 725
REVIEWS.
American Journal of Neurology and
psychiatiy 351
American nervousness, Herbert Spen-
cer 351
Burr's index to medical subjects 171
Character and hallucinations of Joan
of Arc 351—540
Clinical lectures upon epilepsy 169
Compensazioni Fimzionali Delia Cor-
texcia (erebrale 730
Continental Magazine 739
Crime of suicide, and how to prevent
its increase by legislation and other-
wise 34S
Disease of the Scythians, and certain
analogous conditions 16S
Diseases of the nervous system 539
Dr. Mann's book on insanity 738
Giornal de neuropathologia 166
Greisinger's mental pathology and
therapeutics 170
Hartford Qmrant 170
Hand-book of medical electricity 540
Higher education of medical men, and
its induence on the profession and
the public 347
How to avoid insanity 539
Insanity; its causes and prevention. 736
Insanity, its classitication, diagnosis
and treatment 523
Insanity; its causes and prevention... 538
Introduction a L'Etude De'Electro-
tonus des nerfs moteurs et sensitifs
chez I'homme 539
I-a psychiatric, la neuropatologle e la
scienze affini 540
Lecture on artistic anatomy and the
sciences useful to the ai-tist 351
Luys 627
Medico-Legal Society of New York.. 169
Medico-Legal relations of insanity, etc. 352
Medico-Leofal Journal 540
Medical education and regulation of
practice of medicine in the United
States and Canada 739
Naso-antral catarrh, and its treatment. 351
VIII
INDEX.
REVIEWS— Continued.
Page.
Nervousness 165
Order of disorder in mental diseases... 163
Physician's daily record 740
Proceedino^s of tlie Association of med-
ical officers of American institutions
for idiotic and feeble-minded persons 343
Reports of the insane hospital for the
year 1881 153
Rights of the insane, and their enforce-
ment 349
Scrofula and its jrland diseases 351
Shoemaker's oleates 170
Sympathic diseases of the eye 349
Pago.
Sulla corapensazioni Funzionali del la
corteccia cerebrale 537
Transactions of the Colorado State
Medical Society 345
Truth and removal 350
Treatise on insanity in its medical rela-
tions 531
Ueber die Summirung von Keizen in
densensiblen N«rven des Menschen. 540
Walsh's physicians' combined call-
book and tablet. 171
What shall we do for the drunkard 350
Youth's Companion 171
PROCEEDINGS OF SOCIETIES.
American Neurological Association... 512
Association of Superintendents of
American Institutions for the Insane. 502
British Medical Association 511
Pennsylvania State Medical Society... 508
OBITUARIES.
Clement Adams Wjilker 520
Geo. M. Beard, M.D 332
Hervey Backus Wilbur 516
Prof. Chas. Las^gue. 622
THE
Alienist m Neurologist.
Vol. IV. JANUAKY, 1883. No. 1.
Original Contributions and Preferred Translations.
Bilateral Secondary Descending Sclerosis
and Atrophy, mainly of Pons Varolii
and Medulla Oblongata; Slight Diffuse
Myelitis.
By Wm. Julius Mickle, M. D., M. R. C. P.,
GROVE HALL ASYLUM, LONDON.
T TNILATERAL secondary descending fasciculated
^^ sclerosis of the pyramidal tracts is, not infrequent,
consecutively to certain cerebral lesions. It courses
downwards through the basis of the crus cerebri through
the pons and medulla oblongata, and mainly accompanies
the decussation of the pyramidal columns of the latter
into the post-lateral columns of the opposite side of the
cord, but usually also, to a slight extent, takes on a direct
distribution in the median segment of the anterior column
of the same side. It supervenes in certain cases of
hemiplegia, and its chief clinical manifestations are a
rigid contracture,, distortion and marked paralysis of the
limbs of the affected side, to which also an exaggeration
of the tendon-reflexes may in some cases be added.
This condition is almost invariably unilateral, the
primary' encephalic lesions capable of originating it being
almost always unilateral. Bilateral it may be, if it is
consecutive to certain considerable destructive lesions ot
2 Wm. Julius Mickle.
the pons, or oblong medulla, or spinal cord. Bilateral,
also, the sclerosis usually is in a very different affection
— namely, primary lateral spinal sclerosis.
But even the secondary form of cerebral origin may
also, though rarely, be bilateral; and in what follows
reference is made solely to cases in which bilateral and
similarly situated cerebral lesions have given origin to
double descending atrophy and sclerosis equally developed,
or nearly so, on the two sides, and symmetrically situate
in the crura cerebri, pons Varolii, medulla oblongata and
spinal cord. And of these, attention will be limited to
the examples in which the pons and medulla oblongata
mainly suffer, and in which the spinal changes are com-
paratively moderate and diffuse.
These cases, no doubt, are rare ; for it seldom happens
that bilateral local cerebral lesions are of sufficient extent,
and so situated, as to cause well-marked, symmetrical,
and nearly equal, secondary sclerosis descending on each
aide. Ere this can occur certain strands of fibres passing
from the pyramids of the oblong medulla through
the crura cerebri and internal capsule — or their upward
continuations, apparently must suffer symmetrically from
decisive lesion.
Where this bilateral form of the atrophy and sclerosis
chiefly and severely affects the pons Varolii and medulla
oblongata, but also the cord in some degree (although here
the change is more diffuse), it appears, judging by the case
related below, that a group of symptoms arises which is
distinct from the symptom-group attending primary or
idiopathic lateral sclerosis of the cord, as described by
Dr. W. H. Erb and others, and also from the symptoms
attending ordinary paraplegia, as well as from those found
in locomotor ataxy.
Although, during the earlier periods, at least, the clini-
cal differences between the two affections are marked,
yet in its ultimate course the tendency here perhaps
would be for the locomotor and other symptoms to
become those found in primary lateral spinal sclerosis.
Bilateral Secondary Descending Sclerosis. 3
But this is not certain, inasmuch as symptoms like these
latter may occur without the said sclerosis, and the
sclerosis without some of the symptoms in question.
It is worthy of note, too, that in the case to be
related the lesion itself was rather an atrophy, with
shrinking and disappearance of the affected nerve-elements,
and some induration which tended to diffuse itself, than
an ordinary gray degeneration and strictly systematic
encephalitis or myelitis. Also, that certain cranial nerves
had undergone atrophy and induration, apparently as the
result of a chronic descending neuritis. Also, that the
atrophy and sclerosis descending from the internal capsule
mainly affected the pons VaroHi and medulla oblongata;
the lateral columns of the cord not suffering in any
extreme degree, and the posterior sharing in the undue
firmness ; while the only alteration in color of the cord
was the somewhat increased pallor and whiteness of the
several columns. Clinically, the affection of the lateral
and posterior columns would tend to partially neutralize
each other.
Symptoms. — To describe the symptoms in detail:
Earlier periods. The gait is slow, unsteady, somewhat
shuffling, and has a rather jerking, springy appearance.
The heels are in some measure brought down first,
although not in the highly marked manner usual in
locomotor ataxy. At each step, also, the lower limb is
planted in a heavy and clumsy manner, and with a
quaking and shakiness simultaneously due to quivering,
jerking, flexion and extension movements at the knee-
joint, as if it was loose. There is now no marked tactile
anaesthesia or analgesia of the legs. The reaction to
tickling impressions on the soles of the feet is somewhat
lessened. The patient does not sway or fall on closing
the eyes, and, indeed, he can walk blindfolded. There is
an occasional hesitation in speech, and even quasi-stam-
mering, especially when speech is commenced.
Later on, the gait is shaky and unsafe ; the toes are
somewhat turned out, the heels brought down, and the
4 JVm. Jvlius Mickle.
feet planted jerkily and convulsively. As the patient
walks (but not when he is* at rest), the arms are at times held
stiffly, and a little from the sides of the trunk, and the
fingers rigidly extended, separated and bent back at the
first phalangeal joint. And at this period, on standing
with feet together and closing the eyes, the patient
sways and inclines to fall, and soon violent tremblings
and shakings of the whole frame come on.
And later still, in walking at times the legs are bent
forward, but the trunk bent backward. In its more
marked degrees this produces a strange distortion of the
frame either in standing or in walking ; the legs and
knees being bent forward, and the latter brought nearer
to the ground, the thighs and trunk being bent much
backward, the head a little forward, and the posture
being that of one about to fall backwards upon the
scapulae; as, indeed, the patient would sometimes fall if
not prevented. In walking the heels are still planted
first, and the toes are more or less turned out ; neverthe-
less, the latter at times scrape the floor slightly. The
steps are still shaky, and after taking each one the limb
is convulsively shaken backward and forward at the knee-
joint.
After standing awhile, the body becomes tremulous
and shaky all over.
In the feet, tactile sensibility is now slightly impaired,
but there is great failure in their sensibility to thermic
impressions. Reflex action in them (as to pinching, touch,
tickling,) is also lessened. Patellar tendon-reflex is present,
even well-marked ; no ankle-clonus is found.
In prehensile movement, the fingers are extended and
separated widely and the act is slow, uncertain and accom-
plished after slow approaches.
Speech is now pausing, hesitating and spasmodic ; i. e.
there is an occasional long pause, a slowness to reply
and a spasmodic speech-effort during the pause ; after
which comes a rapid, clear, fluent rush of words until
interrupted by another quasi-stammering.
Bilateral Secondary Descending Sclerosis. 5
The affection of locomotion fluctuates considerably.
Intercurrent attacks occur in which there are increased
motor helplessness, numbness and loss of power in lower
limbs, with momentary loss of consciousness, vertigo and
temporary ocular paralysis causing strabismus.
In the case below, the patient died with cerebral
symptoms which came on at a time when walking was
still accomplished.
Differential Diagnosis.
/. From the gait and other symptoms of locomotor ataxy.
The condition above described must be distinguished
from locomoter ataxy: —
By the presence of well-marked patellar tendon-reflex.
By the failure of thermic sensibility in the legs and
hands.
By the absence until very late, and then the slight-
ness of any ordinary cutaneous anaesthesia of the feet and
of any decided increase of impairment of equilibration,
and of locomotion on closure of the eyes.
By the absence of lightning pains and of engirdling
sensations.
By the differences between the special and more
minute details of the act of walking itself, in the two
affections.
2. From the Spasmodic spinal paralysis and the spas-
tic gait.
The spastic characters were defective and points of
difference, from spasmodic spinal paralysis, obvious. For
there was not marked increase of the so-called tendon-
reflexes ; the toes were turned out, and the heels brought
down in walking (instead of the patient getting on the
toes) ; and in the later periods there was a backward
leaning and tendency to fall backwards (instead of a
forward leaning and a tendency to fall forwards.)
Then, again, on the positive side, the convulsive
shaking and jerking at the knee-joint at each step; and
on the negative, the absence of spontaneous spasms,
6 IVm. Julius Mickle.
ankle-clonus and of any permanent contracture, rigidity
or distortion of the limbs, were all unlike the features of
lateral spinal sclerosis.
Remarks : — The changes in the calvaria and dura
mater in the following case may have been due to a long-
past syphilitic pachymeningitis and those in the basal
ganglia and corpus callosum, to blocking of arteries affec-
ted with syphilitic disease. If so, the prolonged treat-
ment by anti-syphilitic remedies had, for the most part,
cleared up the syphilitic morbid processes, and their
secondary results alone remained, namely, the wasting of
certain nerves, the chronic meningeal changes and the
local destructive lesions in the basal ganglia and other
parts ; while linked thereto, and one remove later, was
a consecutive change, occupying the third place in a
series of lesions successively dependent upon one another
— namely, the descending atrophy and sclerosis of pons
Varolii, medulla oblongata and upper part of cord.
The incipient induration of the cord, however, was
rather diffused, being observed more or less in all its
columns.
Case. — M. M., Private, 79th regiment, single, aet. 35,
service 17 years, partly in India and Ashantee. Admitted
Feb. I, 1876. First attack of mental disease and of
four months duration. There was a history of syphilis
and of some old injury to the head. He fell in a " fit "
on parade, in Nov. 1874; this was followed by hemiplegia
and by some affection of speech From these he recov-
ered to a considerable degree, but complained of severe
frontal pain ; went on furlough, and was found to be insane.
He became incoherent, was sometimes restless, noisy and
violent and suffered from delusions and hallucinations
having reference to personal annoyance, persecution and
danger.
On admission: Height, 5 ft. 9 in.; weight, 137 lbs.;
appearance, cachectic. The pulse was soft and small.
The gait was now heavy and slow ; the feet were
slightly shuffled along the floor; the grasping power of
Bilateral Secondary Descending Sclerosis. 7
the hands was lessened ; the right Umbs were the more
paretic. A sHght scar on the glans marked the site of a
sore incurred in 1 861-2, and one on the prepuce, that
of a sore incurred several years later. In the groin was
a bubo-scar; there had been several attacks of gonor-
rhea. Traces of former tibial periostitis were obvious.
This, he said, had afflicted him about eleven years pre-
viously and also had been associated with sev^ere frontal
pain and cranial tenderness and swellings. For a long
period also, there had been cranial pain and tenderness,
they still existed both by day and night — the pain dull,
heavy, remitting or disappearing for days together; the
the tenderness mainly frontal and more marked on the
right than on the left side of the head. On the lower
face and trunk were cicatrices from acne and brownish
stains on the skin of the back and arms. He said the
forehead had been hurt during childhood, and the right
side of the head in his fall in Nov., 1874, three or four
months after which he had paralysis on the right side of
the body, lasting four or five months and at that time
was unable to speak; "the words were in his head, but
he could not get them to come away, "
To return to the state on admission. The patient
looked dazed and was easily depressed and fatigued,
suffered from extreme impairment of memory and from
auditory hallucinations. He also stated that people who
had followed him from Ashantee, took away his meat
and tobacco, caused the ceilings to flake over him and
put gunpowder in his food.
Iodide of iron was ordered : also ammonia and quassia;
and afterwards full doses of potassium iodide were added.
Subsequently, many of the delusions and hallucina-
tions passed away, but mental impairment was still pro-
nounced. Speech was deliberate, at times slightly
hesitating, with elision or slurring, of syllables and a
somewhat explosive utterance. No decided facial or
lingual tremor or twitching was observed.
In Nov. 1876; vomiting, hepatic pain, tenderness and
8 Wm. Julius Mickle.
increased dullness-area ; pain over coecum, ascending colon
and splenic flexure of colon. The patient also, was now
unusually stupid and dazed, he looked pale, complained
of vertigo, was emotional and wept. Cranial pain had
ceased. These symptoms passed away but the gait
became more impaired than before.
Dec. 1876. Walked in a somewhat jerky, springy man-
ner, the heels also being in some measure brought down
first and the right leg planted the more clumsily and
shakily. About this period, and later, he was paroxysmally
more confused, stupid and helpless and the articulation
worse. At times, also, he appeared to have auditory and
visual hallucinations and his conversation was often incohe-
rent and fragmentary. At each step a quivering, unsteady
flexion and extension movement occurred at the knee-
joint, as if it was loose. The heels were somewhat
brought down. Yet he could still do the "balance step,"
The grasping power of the hands was about equal.
In 1877, the gait became more like that of locomotor
ataxy, but was distinguished therefrom by the facts that
the patient did not sway or fall when the eyes were
closed and the feet planted closely together, that he
could even walk a little when blindfolded, that there was
no apparent anaesthesia and no analgesia of the lower
limbs, though their reflex action to tickling of the soles was
lessened. The body also was bent backward in walking.
The writing was more irregular and erratic than before.
Speech was slow, deliberate and somewhat fragmentary and
at times there was a confused mumbling. Thus he
would begin to speak, would pause, seem about to make
explosive utterance and at last articulate utterance would
come with a sort of quiet rush ; then came a sudden
stoppage and finally a drawling and partially broken
speech. On the hands, pinches and thermic impressions
were appreciated well and thermic and tactile impressions
on the feet ; the reaction of the latter to tickling was only
slight. Incontinence of urine began to be troublesome ;
the pupils still were sluggish and irregular in shape.
Bilateral Secondary Descending Sclerosis. 9
July : Gait, delusions and hallucinations as at end of
1876.
Sept. 1877. A sudden attack of numbness and loss
of power, particularly in the lower limbs, and momentary
loss of consciousness, the speech being worse after it.
Next day he could walk only unsafely, with the legs
much shaken, the toes turned out, the heels brought down
and the feet planted jerkily and convulsively, the right
Hmb being rather the worse. On standing and closing
the eyes, he now swayed and inclined to fall, and soon
violent trembling and shaking of the whole frame came
on. As he walked, the arms were held stiffly and a little
from the sides, and the fingers were rigidly extended,
separated and bent backwards at the first phalangeal
joint. Slight left divergent strabismus was present but
no ptosis, diploplia or mydriasis. Slight tactile anaesthesia
of the feet was evinced and great failure of their sensibility
to thermic impressions ; reflex action to tickling, etc., was
diminished in both, but rather less in the right foot, the
one in which sensory failure was the greater. As regards
impressions of temperature, he felt the same cold gold
pencil case to be "warmer" when applied to the left foot
as compared with the right one ; and on neither could he
distinguish between the same and a warm wooden pencil.
He improved and lost the strabismus. The long occa-
sional pause in speech, the slowness to begin a reply
and the preceding speech-effort remained. In grasping
an object, the fingers were widely separated and extended,
the act was slow, uncertain and accomplished after slow
approaches. At each step after the foot was planted,
were violent, spasmodic to and fro shakings of the limb,
due to flexion and extension movements at the knee-
joint. The patient stood unsteadily, swaying backwards,
and forwards. Vertigo was complained of. In October,
the former quasi-stammering condition of speech was
exaggerated ; also long words were sometimes slurred or
mumbled and with speech were slight tremors of the
upper lip and zygomatici. On December 14th, the manual
10 Wm. Julius Mickle.
grasping dexterity was improved ; left pupil the larger,
both sluggish. On the 27th, patient weaker ; gait worse ;
swayed much when the eyes were closed. Blisters applied
frequently over spine.
1878. At times the legs were bent forward, the trunk
bending backwards as if about to fall supine, and even
to actual falling, if not prevented. The gait varied from
time to time, in degree of defect. Not now wet or dirty.
Rambling incoherent ejaculations. Speech as in October,
1877. The skin became drier, duller, more sallow and
parchment-like. Later on, he staggered, or stood unsafely,
particularly if the eyes were closed. Spasm of muscles
of the face and tongue. Caligraphy worse.
May, 1878. Improved. Gait now but little affected
by eye-closure. (Blister spine).
Sept., 1878. Ejaculatory, irrelevant, incoherent, impru-
dent in his replies and remarks. Still stood and walked
with legs and knees bent forward, and with thighs and
trunk, from the knees upwards, bent backward, as if
about to fall on the back of the head, but the head
itself being bent slightly forwards ; the patient walking
with the heels planted first, and the toes, especially the
right ones, turned out, the right toes at times scraping
the floor. After taking each step the limb still was
convulsively shaken backwards and forwards at the knee-
joint. Tactile sensibility of the feet and hands was now
fair, but their sensibility to thermic impressions was
lessened ; a cold key and a wooden pencil alike seemed
"neither hot nor cold" to him. Patellar tendon-reflex
was present in both legs, especially the right. There
was no ankle-clonus. Grasp of right hand the weaker.
After standing awhile the body became tremulous and
shaky all over. Tongue very slightly tremulous, and
protruded sUghtly to the left. Pupils equal, irregular in
shape, sluggish, of medium size. Omit the iodides of
potassium and iron, and take perchloride of iron and
cod liver oil.
March, 1879. Ecthymatous patches over left first
Bilateral Secondary Descending Sclerosis. 1 1
metacarpo-phalangeal joint; over fronts of thighs, espe-
cially of the left ; and on the back and inner part of the
right calf. Subsequently, boil on lower front part of
left thigh, ulcer on dorsal root of right fourth toe.
13th. — Convulsion; enema chloral hydrate. 20th. —
Convulsion, followed by slight right hemiplegia ; drows
iness. 21st. — Short, shallow respiration, varying much in
frequency, 16 to 48; tongue dry and brown; pulse 58;
•"pain in shoulders;" slight stertor; face flushed; urine
free ; sluggish, contracted pupils. Attempts to swallow
produced violent cough, and he was fed by enemata.
Replied fairly well. 22nd. — Same in day; at night 13
epileptiform convulsions (enemata chloral). 23d. — Modi-
fied Cheyne-Stokes' respiration ; coma ; contracted,
immobile pupils ; imperceptible pulse ; face livid ; skin
rather cold, and of leaden hue generally ; occasional
twitches about face, especially about the left angle of the
mouth. Later, the hands and arms became purplish, and
the pauses in respiration became more marked. Death
took place on March 24th, 1879.
Abstract of Necropsy, 32 hours after death.
Calvaria, of slightly worm-eaten appearance internally,
thin, part removed 12 3-4 ozs.
Dura-tnater, rusty hue, and filmy formation, on its
internal surface in the left temporal region, and slightly,
also, in the right, and on the right orbital surface.
Cranial nerves, atrophy of the sixth pair, especially of
the left ; of the eighth and ninth pairs ; of the second
(optic) pair, which were small and hard ; and doubtful
slight atrophy of the portio-dura of the seventh.
Poyis Varolii and medulla oblongata pale, atrophied,
shrunken, and somewhat indurated on their anterior
aspect. This was found on both sides ; the anterior
surface of the pons Varolii was irregularly sunken longi-
tudinally, being retracted to fill up the place of longitu-
dinal fibres now wasted or destroyed. The anterior
pyramids of the medulla oblongata were shrunken ;
induration of its posterior columns was doubtful.
12 Wm. Julius Mickle.
Meninges, thickened, stripped off from the brain with
undue facility, no adhesions to cortex, pale ; their veins
contained less blood than usual.
Arachnoid, unduly thickened and dense, its patchy
opacity considerable in degree and of customary distri-
bution, on the superior, external, and median aspects of
the cerebral hemispheres.
Pia-mater, slightly oedematous, the cedema being dis-
tributed in its relative degrees in correspondence with
the arachnoidal opacity.
Convolutions, of fair size; cortex of fair depth, rather
soft, turning of a lilac hue on exposure to the air in the
greater part of the extent of its upper aspect, elsewhere
pale, as in the cortex of the base and insula, in both of
which it is alike on the two sides. Yellowish softening,
and brownish-black pigmentation, of gray cortex at left
sulcus interparietalis, one-half inch behind the anterior
limit of the postero-parietal lobule.
White medullary substance of brain, of fair consistence,.
puncta cruenta small.
Corpus callosuni ; yellowish softening of its genu and
adjacent portion.
Lateral and fifth ventricles enlarged, their ependyma
as well as that of the third and particularly of the fourth
ventricles, much granulated and of a sanded appearance
and feel.
Corpora striata. On the ventricular surface of the left
corpus striatum were two patches of softening and atrophy,,
shrunken, yellowish, each of the surface-area of a sixpence
bit; one occupying the anterior tip, the other immediately
external to and behind the first and separated from it by
a narrow ridge of tissue and extending transversely from
the external borders of the candate nucleus to within i-8
of an inch of the internal. In the right corpus striatum
was a softened and atrophied patch, almost symmetrical
with the second of those just described in the left. The
nervous tissue beneath each of them, to the depth of
nearly half an inch, was reduced to turbid, yellowish.
Bilateral Secondary Descending Sclerosis. 13
detritus; and the tissues surrounding the irregular cavities
thus formed were also invaded and modified in texture.
Optic thalami, general shrinking, pallor, and defective
consistence ; but no localized softening except a small
patch in the depth of the right thalamus.
Gray commissure not visible. [Nothing special as to
cerebral arteries at base.]
Cerebellum pale, its arachnoid opaque.
Spinal cord, pale, unduly firm in all its columns, but
perhaps more so in the lateral columns ; a somewhat dif-
fuse leuco-myelitis, more marked laterally.
Weights. Right cerebral hemisphere, 21 1-2 ounces;
left, 22 1-2 ounces ; cerebellum, 5 1-2 ounces ; pons and
med. obi., i ounce ; spinal cord and meninges, i 1-2
ounces; blood and fluid from brain, 7 fl. ounces.
It need only be added that there were congestion and
oedema of lungs and hypostatic pneumonia and at the
right apex, traces of former arrested phthisis. L., 42 1-2
ounces ; R., 22 ounces.
Liver, a capsular cicatricial patch as if from old
gumma, 58 1-2 ounces.
Spleen, 10 1-2 ounces, firm, of flesh color, old peris-
plenitic adhesions and cartilaginoid local thickening of
capsule, which elsewhere was pigmented brown and yel-
low.
Kidneys, healthy. — L., 5 ounces ; R., 5 1-4 ounces.
Myxoedema or Pachydermic Cachexia.*
A Critical Review by Dr. G. Seppilli.
T TNDER the name myxcedenia or cachexia pachydermica,
^^ there has been described a morbid state, which has
long been confounded with other affections of the organ-
ism, and particularly with polysarcia. Although it does
not belong to the domain of the diseases special to the
nervous system, we regard it as not outside our province
to give to the readers of the Rivista some information as
to its nature, as it is characterized, besides the singular
aspect of the external configuration of the body and the
alterations in the skin, by sensory, motor and psychic
disturbances; and furthermore, as several observances of
the disease have been made in individuals received into
asylums for the insane.
The first to draw attention to it was Dr. Wm. Gull,
in a memoir presented in October, 1873, to the Clinical
Society of London, in which he related the observations
made on five women, in whom he had noted, as charac-
teristic, a general oedema, very consistent and extended
in the skin and the subcutaneous connective, which
deformed the whole body, but in an especial manner the
face and the extremities, and was attended by a grade of
intelligence very analagous to that of cretinism ; he there-
fore designated this new morbid state cretinoid cedema.
A few years later, in 1878, Dr. Ord reported some
personal observances, with phenomena perfectly similar to
those stated by Gull in his cases, and he further described
pretty fully the anatoma-pathological results of an autopsy
which he, for the first, had the opportunity of making
in such cases. Ord, having regard to the nature of the
• 1 ranslaied by Joseph Workman, VL. D., Toronto, Canftda, from the i^/J>i»/o
Sperimentale di Freniatria, etc.
Myxedema or Pachydcrmic Cachexia. 15.
oedema, quite special, which, as we shall presently describe
it, is observed in the course of the affection, substituted
for the name given to it by Gull, that of myxedema.
In the meantime Charcot had, in his practice, noted
some singular facts, which he proposed to bring under
attention, under the designation of pachydennic cachexia,
before he became aware of the observations of Ord,
which exactly agreed with his own.
Up to the present time the number of cases found in
medical literature has been more than forty. These cases
are so analagous. in both their symptoms and course, as
to enable us to delineate the general physiognomy and
the principal characteristics of the disease with sufficient
completeness.
In observing the patients we are, first of all, struck
with the general deformity of body, which, at the first
view leads to the belief that they are affected with
Bright's disease. The face is swollen, broad, and of an
ashy pale color, with which the rosy tint of the breasts
is in marked contrast. The eyelids are tumefied and
semi-transparent and are widened with difficulty ; the
distance between the eyes seems to be increased, the
nose is gross, broad and flattened at the base, and the
nostrils are dilated ; the lips are tumid, drooping and
bluish ; the mouth is enlarged transversely, and but little
movable. All these traits give a characteristic imprint
to the physiognomy, deprive it of all expression, and
make it appear as if covered with a mask. The limbs,
too, are notably increased in volume, consistence ^and
weight; they resemble real cylindrical columns, and seem
to be all formed of a piece; the hands and feet become
so tumefied and deformed as to resemble the extremities
of a pachydermous animal ; their movements are accom-
plished with slowness and a certain difficulty. Gull com-
pares the singular form assumed by them to that of a
spade. The abdominal walls are also tumid and resist-
ing. The skin is pale and thick; it presents folds corres-
ponding to the various regions of the body (the forehead,
1 6 G. Seppilli.
neck, etc) ; it is dry to the touch, rough and resisting, as
if it had been bathed with some strong alkaHne solution;
on the palm of the hands and the soles of the feet, it
acquires the consistence of leather, and gross large scales
of epidermis cover it. The secretion of sweat and seba-
cious matter is suppressed, the hairs become scarce and
fragile, sometimes the nails fall off deformed, or break
and become detached.
The oedematous aspect of the whole cutaneous envel-
ope is analagous to that of anasarca, from which, how-
ever, it differs in substance through the anatomical condition
that determines it, and the almost stony hardness which
the skin assumes, in consequence of which it does not pit
under pressure of the finger, nor maintain the imprint, as
observed in true oedema.
Besides the skin, the mucous tissues also participate in
the morbid process. A tumefaction, more or less consid-
erable, of the mucose of the gums, the tongue and the
velum pendulum is met with, which in some cases extends
to the larynx, in consequence of which the voice acquires
a special tone, and becomes hoarse. Sometimes thicken-
ing of the rectal mucose is observed, from which defeca-
tion is obstructed ; the vaginal and uterine mucose also
is thickened. The dyspepsia observed in some cases
renders it probable that the mucose of the stomach also
shares in the general infiltration of the external and
internal investment of the body, as Dr. Ord believed he
had established in an autopsy made by him.
The nervous system is the seat of various disturb-
ances. All the mental processes are usually manifested
with considerable slowness, the association of ideas is
defective and difficult ; memory is imperfect and dimin-
ished, the will is feeble ; in short, a true cerebral torpor
is present. Sometimes, however, psychical activity re-
mains intact. This was observed by Dr. Morvan in
fifteen cases, and he has furnished the richest exemplifi-
cation of the disease.
In some cases, on the other hand, there was observed
Myxoedema or Pachy dermic Cachexia. \J
a state of maniacal excitement with delirious ideas, or of
melancholia with illusions and hallucinations. Hammond
relates the case of a woman affected with myxcedema,
who had frequent hallucinations of sight and hearing, and
insisted that vitriol was put into her milk and food by-
certain Frenchmen, in order to make her suffer. Inglis
reports two cases : one of a man who, three months
before presenting myxoedema, had fallen into a state of
lypemania with suicidal tendency; the other, of a woman
of thirty years, the mother of eight children, who, for
two years past, had given signs of mental enfeeblement,
and was attacked by a true maniacal access.
The case recently published by Blaise is very inter-
esting— that of a woman who, at the age of twenty-seven
years, began to present a progressive thickening of the
skin, which was associated with alterations of the special
senses. She found her food, however well prepared,
tasting and smelling nastily, she accused the persons
about her of speaking evil of her, insulting her and
making obscene proposals to her; it seemed to her that
her body exhaled a repugnant odor, and that her head
was changed into that of a dog. The sensorial alterations
and her ideas of persecution lasted through several months,
and then progressively disappeared. It is noteworthy
that the improvement in the mental state of this patient,
advanced pari passu with the diminution of the infiltration
which had been formed in the skin and the mucose.
The torpor of cerebral activity is exhibited beyond
the psychic domain, also in the functions of motion and
sensation. The movements of the body are tardy, ambu-
lation is unsteady, slow and difficult; the most simple
acts, such as dressing, raising a light weight, or even
raising food to the mouth, are accomplished with effort,
which seems to stand in relation with defect of energy
of cerebral excitement, rather than with muscular enfeeble-
ment. In the first case of Inglis, above cited, there
existed a diminution of the Faradic contractility of the
muscles where oedema was most marked.
1 8 G. Sep pun.
The movements requisite for language take up so
much time in accomplishment, that the words follow each
other with a surprismg tardiness ; the voice is monoton-
ous, hoarse, and, in consequence of the oedema which
infilters the mucose of the larynx and the isthmus fancium,
it takes on a nasal tone. At the moment when the
patient has to speak, says Dr. Ord, he commences to
close the mouth, then he depresses the lower lip, makes
a movement of deglutition, and executes an inspiration,
opening the mouth widely, and at the same time he
drives the air with noise through the nostrils. Accord-
ing to Ord, this movement of deglutition has for its
object the retraction of the velum palatinum.
The general sensibility is usually obtuse ; sensorial
impressions are but little and slowly perceived ; some-
times the special senses are also debilitated.
Among the subjective symptoms most frequent, we
may mention cephalsea, which may be intense, a tendency
to sleep, sometimes irresistible, and a sensation of cold.
The temperature is almost always below the normal, but
sometimes one degree above it. The extremities are
very cold. Haddon examined the mean temperature in
five cases, and in only one did he find it a little above
normal, 37.3 C. (99.14 Fahr). The lowest temperatures
noted by him, oscillated between 35.5 and 25 C. (?) 95-9
and yy Fahr. The last marking was met with a few
minutes before death. In a case of Hammond's a lower-
ing of temperature was noted, which never exceeded
35.5 (95.9). In another, described by Bourneville and
D'Olier, the rectal temperature, taken morning and even-
ing through eight consecutive days, was invariably 37.2
in the evening — (98,96).
As regards the organs of vegetative life, it has been
observed that in the majority of cases the heart pre-
sented no abnormality ; in only a few cases the second
sound was accentuated. Respiration is generally difficult,
and is accompanied with a sense of dyspnoea. The diges-
tive functions are disturbed; dyspepsia and constipation
Myxoedema or Fachydermic Cachexia. 19
are almost always constant ; sometimes sialorrhoea is
observed. Menstruation is difficult and irregular ; usually
amenorrhea is present. The urine does not contain
albumen, unless in the last periods of the disease, in
which there may supervene an alteration in the kidneys
analagous to the vulgar interstitial nephritis. Unless
this complication is realized, the urine does not become
albuminous. Haddon observed in the urine a notable
diminution of urea, and Hammond an excess of urates.
From the preceding description it is seen that the
deformity of the body, and more particularly that of the
face and limbs, consequent on the tumefaction of the
skin, the torpor of cerebral activity, manifested as well
in the psychic functions as in those of motion and sensa-
tion, the diminution of temperature, the absence of albu-
men in the urine, are the morbid phenomena most salient
and characteristic of the special affection which has been
called myxoedeina or pachydermic cachexia.
The causes of this disease are yet unknown to us. It
was, for some time, beheved that women only were subject
to it, but it has since been seen that men also may present
it. Nevertheless, it appears that the disease is most readily
developed in women ; from our collected observations we
conclude that its frequency in the two sexes stands in the
proportion of five women to one man. Some of the women
had been married and had children before the signs of
the disease presented. Adult age is the most predisposed
to this affection; it was observed almost always in persons
between thirty-five and sixty ; very rarely before thirty
years of age. Only two cases have been known in which
the symptoms appeared in infancy. These occurred in two
children of four years, one of whom, reported by Goodhart,
was affected with cretinism, and the other by Charpentier
with idiocy. Some writers adduce as causes, affliction,
emotions, the climactaric period, prolonged fatigues ; but
in our opinion these have little value. It appears that
syphilis, excesses in drinking and eating, climate, have no
influence in the genesis of the disease.
20 G. Seppilli.
Myxoedema has a very slow but progressive course ; it
lasts for many years. It is difficult to fix the time or
manner of its commencement, because the majority of
the patients have come for examination by physicians
when the affection had progressed some time, and they
could not give precise information as to its origin. It
seems that in some cases it had commenced rather sud-
denly, as in the observation of Prof. Charcot, reported
by Thaon, in which the oedema manifested itself cotem-
porarily in all the four extremities. In one patient of
Ord, the first signs of the disease were chills which were
followed by general debility, pains along the back and
tumefaction of the skin. Death occurs after some visceral
complications and especially lesions of the kidneys. It
has been recorded in only two or three of the cases
described.
What is the nature of the phenomena we have detailed?
To what anatomical lesions do they correspond? Dr.
Gull, who was the first to engage in the study, restricted
himself to a very neat description of the morbid phe-
nomena observed by him, leaving to others the task of
determining the nature of the disease. He made choice
of the designation cretinoid oedema, with the sole view of rep-
resenting the exterior aspect of the patients, which much
resembles that of cretins. Ord had opportunity to make
the autopsy of a female patient. By some clinical and
histological researches, he established that the general
cutaneous and sub-cutaneous infiltration, which in a char,
acteristic manner deforms all the body, is not due to a
collection either of fat or of serum, but to a special sub-
stance of gelatinous aspect, which gives to all the tissues
the characters of mucous tissue ; the sudorific glands are
manifestly atrophied ; the nerve extremities in the skin
appear to be enveloped in a transparent substance ; the
adventitious tunic of the arteries is three or four times
thicker than normal. Besides the lesions of the skin,
cedema of the vocal cords and of the gastric mucose
observed, atheroma of the aorta and of the cerebral
Myxoedema or Pa chy dermic Cachexia. 21
arteries, hypertrophy of the muscular interstitial connective,
especially in the heart, from collection of mucine, with
diminution of the muscular elements were also noted.
In the liver also the intercellular substance was increased
in volume, because of which the hepatic cells appeared
very distant from each other and in part atrophied. The
alveoli of the thyroid gland were compressed and in a
large measure destroyed by neoform interstitial substance.
The kidneys were notably thickened, and finely granu-
lous on the surface, with obliteration of the glomerules.
On the basis of these data, Ord sought to explain
all the morbid phenomena of the disease, making them
uniquely to depend on the presence of mucous tissue, and
for this reason he designated the disease myxcedema.
According to him, not only the deformity of the body
and the principal visceral disturbances and especially those
of the digestive functions, but also all the morbid sen-
suous motor and psychic phenomena are due to the infil-
tration of mucine into the connective of the skin, the
muscles and the mucose. He believes that the mucous
substance which is collected in abundant quantity among
the meshes of the subcutaneous connective, finding itself
in contact with the nerve terminations, forms around these
a species of isolating envelope, by reason of which the
nerves respond to the action of peripheral stimuli only
feebly and imperfectly and hence become incapable to
arouse, conveniently, as in normal conditions, the activity
of the nerve centers. These remain in a state of inertia,
which affords us the explanation of the slowness of move-
ments, and of the tardy and monotonous articulation of
speech and the enfeeblement of all the mental processes.
In a word, the brain, coming under want of its habitual
stimuli, falls into a state of stupor and becomes habituated
to tardiness of reply, as happens to a limb whose func-
tion is enfeebled when it remains unexercised.
But this theory of Ord, which subordinates all the
symptoms of the disease to the accumulation of mucous
tissue on the periphery of the body, has appeared to
22 G. Sep pun .
several other observers, and to ourselves also, as not to
be accepted in an absolute manner. The idea of trying
to explain in all cases, the cerebral torpor by diminished
functional activity of the peripheral nerves of sense, and
consequently a less reaction to stimuli, is inexact and
absolutely contrary to what experience teaches. Some
morbid states are known, in which, although general sen-
sibility is notably diminished, cerebral activity is by no
means torpid. Proof of this is given by certain hysterics
who are insensible to any stimulus applied on any part of
the body, in whom the mental processes are yet mani-
fested with uncommon promptitude, activity and energy :
certain insane persons, quite insensible to dolorific and
thermic stimuli, show in the midst of their mental dis-
order, very evident signs that their minds still live and
act. In lepers, despite their general anaesthesia, the cere-
bral faculties remain active through many years.
The interpretation of Ord might have a certain value
had it been first shown that in all cases of myxoedema,
the infiltration of the skin and the cellular tissues had
preceded for a long time the appearance of cerebral
phenomena. But in none of the cases was this chrono-
logical sequence of symptoms verified; in some, indeed,
the inverse order was observed. In the case cited by
Blaise, the cutaneous infiltration and the sensory and
psychic disturbances were presented cotemporarily and
disappeared so, from which we might hold them as the
effect of the same morbid condition.
Goodhart was among the first to combat the inter-
pretation of Ord, noting the fact that no affection of the
skin, such as myoedema, is capable, per se, of disturbing
the mental faculties, when once the brain has acquired
its complete development. This influence, he adds, may
be admitted only in infancy, in which the nervous centers
have not yet been fully developed.
It seems to us much more probable that the cerebral
torpor may be the cause of diminished cutaneous sensi-
bility, rather than the effect of it ; it would then seem to
Myxcedema or Pachydcrtnic Cachexia. 23
be not a subordinate morbid symptom, but would form
rather a cardinal symptom of the disease. Thaon shows
himself inclined to ascribe to the state of the brain the
greater part of the morbid phenomena of myxcedema.
Goodhard thinks that in the nervous centers, modifica-
tions analagous to those observed in the connective of the
other organs take place ; but this opinion is opposed to
the fact, that the researches of Dr. Ord on the central
organs of the nervous system gave negative results.
Dr. Hadden has advanced another hypothesis on the
nature of myxcedema, which is, that it is a primitive
affection of the vaso-motor system, on which depend the
physical and mental torpor, the subnormal temperature,
the diminution of the quantity of urea, &c. But this
hypothesis is untenable, for it is not known that either a
paralysis or a spasm of long duration of the vaso-motor
fibres can give origin to morbid phenomena similar to
those of myxcedema. (Ord)
Thaon makes the observation, that in this affection
all the organism takes part; the decadence is general,
the blood is impoverished, the functions are languid. Such
a state, then, represents a true cachexia.
It is therefore evident, that it is not granted to us to estab-
lish, with precision, anything on the nature of the disease.
In order to arrive at conclusions of some value, further
observations are required, which may serve to exhibit
better, the cHnical course of the disease, and the anatomo-
pathological alterations, about which we know but little.
Almost all the observers are found in accord in holding
that the morbid state described, constitutes a nosological
species quite -distinct. It may be differentiated from the
morbus Brightii by the following characters : absolute
absence of albumen in the urine and of uremic phenomena
in the course of the affection (excepting however
in the last stages), soHd consistent oedema which does
not pit under digital pressure, as in the case of
serous oedema, persistent cerebral torpor. Dr. Mahomed,
however, believes that myxcedema is not an autonomous
24 G. Seppilli.
morbid affection, but a symptom of the chronic disease
of Bright, without albuminuria.
The analogy of morbid phenomena, (tumefaction of
the skin, tardy articulation, cerebral inertia) which is
observed between the myxoedema of adults and cretin-
ism, might lead, according to Ord, to the beHef that
cretinism commences in a simple general myxoedema, in
consequence of which the stimuli of sensation necessary
to favor the development, and to excite the functions of
the nerve centers, are interrupted in their action ; the
absence of external sensations deprives the brain of one
of its principle means of education.
In this hypothesis of Ord, on the genesis of cretinism,
an exaggerated importance is given to the lesions of the
skin. In cretinism we have a slow poisoning of the
blood by a special miasmatic principle, which, associated
with other circumstances, as hereditary defect of race-
crossing, bad hygiene, &c., impresses on the general econ-
omy, modifications more or less profound, impedes the
development of the organs, and above all, of the cerebro-
spinal system.
In a case of myxoedema described by Bourneville
and D'Olier, observed in a certain idiot of nineteen years,
the solid oedema of the skin, the deformity of the limbs
and face appeared tardily. The authors, therefore, in
this case considered the appearance of the myxoedema
as a complication of the pre-existing state — the cretinisms
— which would weaken the hypothesis of Ord.
It may now not be denied that a certain similitude
exists between myxoedema and cretinism, in the external
configuration of the body, the inertia of the cerebro-spinal
centers and the special characters of the skin observed
in the two cases. Dr. Gull, who had already noted it,
defined the special morbid state observed in his cases,
as a cretinoid state developed in adults. It is known,
however, that whilst hypertrophy of the thyroid body is
met with frequently in cretins, it is generally wanting in
persons affected with pachydermic cachexia.
Myxoedema or Pachy dermic Cachexia. 25
Up to the present day but little is known as to the
treatment of this disease ; milk diet, sulphur baths, resi-
dence in a dry temperate climate may promote improve-
ment. It is worthy of note that hygienic means prove
much more efficacious than medicine used internally.
These are, in general, badly tolerated in consequence of
the gastric disturbances so frequently observed, and per-
haps, also, because of the obstacle which the infiltration
of the skin presents to the functions of excretion, through
which the accumulation of medicinal substances within the
organism is favored.
We shall close by calling the attention of our physi-
cians to this as yet little known and little studied disease,
hoping that the description we have given, by profiting
from the observations hitherto published, may serve as
an incitement to the initiation among us also of appro-
priate researches, and to the bringing into notice of those
cases which any may have had opportunity to observe.
ExpeHence of an Opium Eater During
the Withdrawal of the Drug.
BEING THE CONFESSION OF A PATIENT WHILE UNDERGOING
TREATMENT FOR THE CURE OF THE HABIT, AT A
DISTANCE FROM HIS PHYSICIAN.
Recorded by C. H. Hughes, M. D., St. Louis.
^INCE DeQuincy and Coleridge published to the world
^ their experience with the drug that enslaved them,
medical literature has been but little enlightened by the
self-recorded testimony of such as have yielded to the
neuropathic thralldom of opium. Since the highly sensa-
tional records of these literati first appeared in print, an
occasional auto-biography has been printed like those
that may be found written down in " The Opium Habit,"
a book published a few years ago by the Harper Bros. ;
the contributions of Calkins, Kane and others also con-
tain histories of cases. But it is rare to encounter among
one's patients, a person with enough persistent courage
and fidelity and determination of purpose to honestly and
successfully aid in the management of his own case, while
living at a distance from his physician and having to
rely upon his own volition in the trying emergencies
always associated with the perfect emergence, even in
the best managed cases, from the slavery of opium.
The patient whose self-recorded history in great part
appears in the letters that follow, was one of this kind —
a man of rare courage and exceptional fidelity to truth
for an opium eater, respecting his enslaving habit, as he
who pubHshes these records of the true inwardness ot
the feelings and effects of the victim manfully .struggling
and determined to be free, can attest, having had him a
sufficient length of time under his own eye and roof,
after the victory, to know that he was in truth " redeemed,
Experience of an Opium Eater. 27
regenerated and disenthralled." The writer of this record
has had sufficient experience with the victims of chronic
meconism to know how cautiously their words are in
general to be taken, when they pertain to their vice and
its abandonment. The letters are given without the dot-
ting- of an "?" or the crossing of a "//" verbatim et
literatim.
When the patient on one occasion found himself
fearful that no self-resistence aided by what medicines
he had, would alone save him from relapse, he came
speedily by rail, a distance of several hundred miles, to
his physician, remaining until his pangs were relieved by
additional medication. This he did in accordance with
his promise that if he at any time feared he could not
hold out, he was not to resort to morphine, but to come
at once to us for help. This was his last and triumphal
effort. An increase in the amount of his cannabis
indica, quinine and camphor during the day, some timely
galvanism and chloral and the bromides at night, for three
days, turned the scale. The minimum daily quantity of
morphine taken by this patient was ten grains before he
began to break off the habit.
October 20th, 1875.
Dear Doctor. — I have almost begun to think we are
going rather fast. Last night was fearful ; slept consider-
able, but very poor sleep ; and worse dreams ; and this
A. M., feel like I had been stewed. Have not energy
enough to move if I was not compelled to move to rest
my aching bones. Can't keep myself in one position
more than a second; every inch of bone has ached
continually since eleven o'clock yesterday. I think I
turned over 185,000,000,000 times last night; didn't count
'em however, and may have got it two or three too
many ; have tolerable appetite at times ; but when I do
eat, the food stops just as soon as possible and torments
me for two or three hours ; can't get it to go on down ;
sometimes I feel hungry and sit down to eat, but as
soon as I commence the appetite leaves and my stomach
says no more. If I continue to go down as fast as I
have so far, it will be but few days until I can't get out
28 C, H. Hughes.
of bed, I have taken the medicine according to direc-
tion as near as possible, and think I have taken very
httle if any, more or less than one tablespoonful daily.
You did not say at what time of day, or how I should
take the black looking drops from small bottle, those
that I am to increase two drops daily ; thus far I have
taken them in morning, by dropping into the spoon -with
the solution — is this correct ?
Yours truly,
R. S. McM
October 2ist., 1875.
Dear Doctor. — I wrote to you yesterday that 1 was
then feeling rather badly and thought perhaps we were
going a little too fast, but, by ten o'clock yesterday, I
was feeling better and slept better last night than usual,
and to-day do not feel so weak as yesterday, and now
rather hope I am good for it. But, from about three
o'clock A. M., I slept but little on account of soreness in
chest and across kidneys ; suppose it is liver ; have been
subject to spells of same kind for many years ; they
usually hang on two or three weeks at a time unless I
take something; but I have very seldom taken medicine
for it; usually let it wear off. Have been troubled rather
worse than common for two or three days, so much that
I have to breathe very short, as a long full inspiration
seems to tear the lining out of my chest, and at the
above mentioned time, it is impossible to move the body
without pain. But, after I get up and move around
awhile, the soreness leaves me. I concluded I would
adopt a new plan to-day, namely : In morning take only
about half a dose of the solution, and at noon, little or
none, and at night take more so as to get better rest.
Can get along much better in day time than in night,
for during the day, if I conclude I can't sit still any
longer, I can get up, but in night it is not pleasant to
do so. However, if it does not meet with your approval,
of course I will discontinue it and follow directions.
Yours truly,
R. S. McM
October 23d, 1875.
Dear Doctor. — Nothing new. Think I feel fully as
well as when I last wrote, and rather think the idea of
taking light doses of solution, morning and noon and
more at night is a good one, at least it seems to work
Experience of an Opium Eater. 29
well. Yesterday morning I took, as near as I could
guess, about forty drops, and at noon the half of that,
and at night about three-fourths of a tablespoonful, and
rested very well ; however, I got pretty shaky late in
afternoon, but think I can make it go.
Yours truly,
R. S. McM
October 25th, 1875.
Dear Doctor. — Yours of 21st. received. At present,
I have not a shadow of a doubt but I shall get through
in good shape, with considerable of the old frame, which
I can weather-board and fix up so as to look almost as
good as new. I flatter myself that I am getting along
first-rate. I rest better and feel better. For the past
three or four nights have slept pretty well, feeling as well
as one could expect. I understand that unless I can't
get along with the solution [acidulated solution of qui-
nine] and black drops [tincture of cannabis indica], I
am to get the other prescriptions filled. But, if I can
get along without them, I had better do so ; unless I am
mistaken I think I can make it with those alone, at least
for a while.
I emptied the bottle of tonic which I had put up
while in St. Louis, into the bottle of substitute last night,
and as I take from solution, add the substitute. The
pills you mentioned in your last, I will do without as
long as possible, with your permission, for I really don't
believe I could get one down.
Yours truly,
R. S. McM
October 27th, 1875.
Dear Doctor. — Yours of 21st. received. Am still
getting along finely ; have not had the hypnotic prescrip-
tion filled and have some idea that I will not want it, at
least for some time. I understand that I am not to take
any more of either the solution or neurotic than is
necessary to keep me on my pins; thus far I have taken
only two doses daily of latter, twenty to twenty-two
drops each. Am I right to take just as little as I can?
I chew but little tobacco, but smoke a great deal. I
find the more I smoke, the better I . feel. But as tobacco
does not taste right, I chew but little. Would it not
be a good plan to take solution and neurotic both, or
30 C. H. Hughes.
rather either, only when necessary ? I think I take both
sometimes when not really needed. Yours truly,
R. S. McM
October 30th, 1875.
Dear Doctor. — Yours of the 28th, received this a. m.
I am still feeling first-rate ; however, night before last I
had a terrible old head-ache ; I had been at office all
day; head ached a little, but not bad until about 5
o'clock ; went home and by time I got there, was fear-
fully sick ; thought head would burst ; bathed it with
the evaporation lotion [aeth. sulph.] and laid down ; head
eased off in a couple of hours ; felt weak next morning,
but am all O K this a, m. ; have the utmost confidence
in result of your treatment, and am satisfied will take
less than half the drugs and medicines you expected.
Since 3 o'clock, Thursday, to the present, 10 a. m. Satur-
day, I have taken two tablespoonfuls of solution and
sixty drops of neurotic only, [cannabis indica, camphor
and ammonium bromide] and expect to reduce the
neurotic to twenty drops to-day, and if that works all
right will still further reduce amount to-morrow.
Will keep you fully posted and will try no experi-
ments without your knowledge ; but I am just fool enough
to firmly believe that if I was there with you now, I
could drop the entire lot, and by walking around and
having plenty of amusements could get along without
any medicine of any kind ; and I also think by the time
I get the bottle of substitute [quinine solution] all emptied
into solution bottle, that I will be O K, and never loose
a day from office. I have felt better for last two weeks
than I have a long time; but, of course imagination
helps some. I have not the least shadow of a doubt as
to result. The thing is settled ; I will make it O K.
Yours, etc.,
R. S. McM
November 3d, 1875.
Dear Doctor. — Again I write to say, all goes well,
am getting along finely; feel first-rate; sleep very well
and work every day at my desk; think I feel fully as
well if not better than when I wrote last, with the excep-
tion of nausea at meal time. Have good appetite and
go to table hungry, but by time I get one-fourth enough,
begin to feel slight nausea; sometimes it leaves me on
Experience of an Opium Eater. 3 1
quitting table and sometimes have to vomit, especially in
morning — on several occasions within a week have had to
leave breakfast table to vomit; otherwise, I feel as well
as usual; that is, I feel as well as before commencing
the remedy, and am not certain but better. At any rate
I feel five hundred per cent, better than I expected to
at this time.
I think I am too much constipated ; my bowels move
only every other day. Would have written yesterday,
but have been so very busy I could not get time.
Yours truly,
R. S. McM
P. S. — So far have had no occasion to use anything
but the solution and neurotic. Have not had hypnotic
prescription put up, and hope will not need it.
R. S. McM
November 23d, 1875.
Dear Doctor. — I still live ; stomach getting so weak
can hardly eat, especially breakfast. Took a look at
sand box* this morning to see how it was holding out ;
can't find bottom, guess have good supply yet; but if I
get down much lower its going to take a good deal to
run me — bowels pretty loose, back pretty weak and
energy all gone. Have to scribble over four quires fools-
cap before I can get nerves steady enough to write
legibly ; however, I still rest well at night. Last night
slept first-rate, but. when I got up could hardly stand ;
eat no breakfast. Have taken nothing yet but solution
and neurotic ; don't intend to until forced or at least
necessity demands it.
From what I have read and heard of such cases, I
flatter myself that I am getting along better than the
majority of cases, if not better than any heretofore. If
my stomach could stand food so I could get a little
strength, I think I could stand anything else. But it is
this abominable weakness that beats me. Occasionally I
have an appetite and eat a pretty good meal, but it
hurts my stomach so fearfully for hours after, that I don't
dare to eat more than just enough to keep me on my
pins. But still, I am thankful its no worse ; and have
not yet had a doubt as to the result. Yours, etc.,
R. S. McM
•Me'Iicine.
32 C. H. Hughes.
December 2d, 1875.
Dear Doctor. — Yesterday morning I got up with
severe head-ache, which so increased, that by ten o'clock
had to go to bed ; pain appeared seated in back of head
and neck and extended for [from] I [eye] to eye, some-
times left and then right; it was intense; the evapora-
ting lotion had no effect whatever only to apparently
increase the pain ; never suffered such pain before ;
almost wanted to die. About five o'clock p. m., my wife
sent for a physician ; he gave hydrate of chloral, and left
about twenty quinine powders and a box cathartic pills ;
chloral was to be given every fifteen minutes until relief,
but it did no good ; I would take it until I got about so
full and then throw it up ; all the time the pain continu-
ing. About ten o'clock p. m., I decided that something
must be done or I would have spasms ; sent to drug
store and got two grains sulphate morphia; took one-
fourth grain and in twenty minutes, one-eighth grain.
About 10:45 o'clock, pain began to subside; suppose it
was the morphia, but could not feel it in blood. Before
taking the morphia, however, I could hardly feel any
pulse ; it was very low, but sharp and quick ; could feel
it only in temples ; my wife said she could feel it at
wrist, but I could not. You need not be surprised to see
me at St. Louis most any morning, for, unless I feel
better to-morrow, I shall skip out. Yours, etc.,
R. S. McM
December 4th, 1875.
Dear Doctor. — 1 guess I am feeling better this a. m. ;
kept up all day yesterday and day before, and think am
gaining strength since the terrible old spell I had on
Wednesday. Shall postpone visit to St. Louis for present,
unless I get worse again. Have written for passes so if
it becomes necessary to skip out, can do it. Think will
work at office to-day ; did but little yesterday, and
nothing day before. Yours truly,
R. S. McM
December 8th, 1875.
Dear Doctor. — Am still on my pegs and have been
doing very well ; got through with pretty good day's
work yesterday, and will do same to-day. Rest pretty
well at nights, and have given up going down to St.
Louis for the present ; want to put it off as long as
Experience of an Opium Eater. 33
possible. I have a little head-ache to-day, but otherwise
feel pretty well, considering.
Yours truly,
R. S. McM
December 13th, 1875.
Dear Doctor. — Am still on my feet and getting
along as well as could be expected if not better ; have my
ups and downs, more of latter than former; but have plenty
sand [pluck] left ; shall not get discouraged unless I get
down so can't help myself; and I still have faith that I will
yet weather it through without [getting] down. But oh !
Caesar, what work it is to do anything. It takes almost
all the sand I have to stick to desk sometimes, but I
do it ; but if I was to go to bed, I could easily believe
I was sick. Yours truly,
R. S. McM
December 22d, 1875.
Dear Doctor. — Am still able to move around, but
rather slow. Think I will go to St. Louis last of this
week ; probably call on you Saturday morning ; am not
positive, but hope to be able to get away on Friday ;
would have written you oftener lately, but have felt so
little like such work that I have neglected it; in fact
have neglected everything in shape of work that I
possibly could; hoping to see you soon.
I remain, yours, etc.,
R. S. Mc M
[Came to city December 24th, and stayed four days.]
January 24th, 1876.
Dear Doctor. — Must beg your pardon for putting off
writing to you so long; but, for a week after my return
I was feeling so lazy and bad that I never attempted to
write a letter to any one ; and then I took a train and
have been running on road since and have no convenient
place to write, and consequently, have neglected it. I
am now entirely out of woods and can crow ; am feeling
first-rate, only don't like this cough which sticks to me.
I took a severe cold coming home and have been bark-
ing a great deal since. Went to drug store when first
came home and got bottle of cough syrup ; but three
doses were enough ; slept too nice and sound that night ;
34 C. H. Hughes.
spoke to physician next day for prescription for cough
syrup without opium ; he gave it to me and I think am
getting along in pretty good shape. After I run a train
219 miles and take up 150 to 350 tickets, I can go to
bed and sleep sound, five and a-half to six hours.
Your Friend, R. S. McM
Memoranda of directions made at the time this patient
came Jinder treatment. — Mr. R. S. McM is chief clerk
in passenger department of the Iowa R. R. He has
taken as much as two drachms of morphiae sulphas weekly.
He now takes the contents of a one-drachm vial every
week, or eight grains daily in three equal portions. He
began the habit for neuralgia and an obstinate headache.
The medicine was prescribed by a physician. His general
physical health is good. Complexion somewhat sallow ;
but he says this is natural. Began treatment by reducing
amount to four grains, and gradually reducing that at the
rate of y-- of a grain reduction daily. Gave the following
prescription, with accompanying directions :
R Morph. Sulph, - - - 3 ij.
Aq. Month. Pip. - - i xv.
M. Sig. The Solution.
R
Quin. Sulph. _ _ .
3 ij.
Pulv. Ipecac - - -
- gi". V.
Aqua Distill. _ _ _
§ -^•
Elix. Tarax Co.
i V.
Acid. Sulph. dilut. q. s. ft. sol.
The Substitute.
Sig.
R Tr. Cannabis Indica - - § iij*
Sig. The Neurotic.
Directions: — Take from the solution four tablespoon-
fuls daily in three equal doses. Replace each daily
quantity from the solution bottle with a similar quantity
from the substitute bottle. Take of the neurotic two drops
the first day, increasing two drops daily up to 60 drops.
Experience of an Opitan Eater. 35
Prescribed also a tonic of iron, quinine and strychnia
(nux vomica) to be taken as needed, and a solution of
chloral hydrate, as a hypnotic, in fifteen grain doses, at
night time, when needed between sleep and keep nervous
system thereby sufficiently recuperated for each succeeding
day's labor and trial.
We do not now treat the opium habit preciseK* in
this same way, preferring to diminish the number of doses
daily, dropping off one at the beginning and counteract-
ing the depressing effects of withdrawal by galvanism and
tranquilizing neurotics, finally getting the patient to rely
on the one dose and gradually reducing that.
Whatever question there may be as to the propriety
of the withdrawal of the opium in certain of these cases,
especially in old persons long inured to the drug, in whom
marked psychical changes have appeared either before
or since the formation of the habit, when slight reduction
in the daily quantity consumed is attempted, there can
be no question as to the justification of the " weaning
process " in the young or^ middle-aged and vigorous, still
engaged in the active duties of life, and possessing suffi-
cient reserve vitality to justify reasonable recuperation, in
reconstructive response to such therapeutic measures as
we may find it necessary to employ, as we remove from
the system the peculiar influence of this singular drug, which
both weights the nervous energies as an incubus and sup-
ports them like a scaffold.
The Management of Chronic Inebriates
and Insane Drunkards.*
By Albert N. Blodgett, M. D., Boston, Mass.
TN approaching a question of such magnitude as the
■*- present one, certain facts which have been proved
by the experience of the past must be touched upon as
a fundamental necessity to any inteUigent discussion of
the subject. Among these are the following:
It is a recognized fact that the peoples of to-day are
different in many respects from their native ancestors, or
from the peoples of those countries from which they may
have emigrated. These gradual changes have long been
observed, but in later years they have progressed with
accelerated rapidity. This result is not confined to one
language or continent, but is distributed in varying degrees
of development throughout the whole civilized world. The
changed condition is noticeable in many ways, principally,
however, in features relating to the nervous system — that
is, in those departments of the human organization con-
trolled or specially influenced by the great central ganglia,
the brain and spinal cord.
The most prominent evidences of such a change con-
sist in an increased excitability, an abnormal activity of
all the cerebral and nervous functions, a restlessness and
nervousness, a precocity which is not the healthy develop-
ment of normal powers, but is a strained and overwrought
activity resulting from unnatural and disordered excitability.
This condition, if developed suddenly in an individual, is
considered indisputable evidence of disease, and is quite
as properly reckoned a diseased action when its march
is slow and insidious, so that its progress is unnoticed by
the individual affected.
*Read at the Annual Meeting of the Social bcience Association at Saratoga,
Sept. 6th, 188i, by Albert N. Blodgett, M. D.
The Management of Chronic Inebriates. 37
The expression of increased nerv^ous excitability, is
observed in nearly all the ordinary walks of life and in
all conditions of people. Within the memory of most of
us there have been such changes within the limit of
personal observation to verify the truth of this assertion.
The ground was well covered by the remark of a gentle-
man with whom I was recently conversing, who said, " I
would prefer to live seventy years in thirty rather than
to consume seventy years in living thirty."
The causes of the generally elevated tension in which
we live are manifold, and reach into almost every avenue
of life. They invade the most humble home and intrude
into the drawing-rooms of our modern palaces. It is
impossible to enumerate all, or nearly all, the influences
which have united to produce such a baneful effect upon
our population ; but a few of the more potent causes
may be briefly touched upon. Among these may be
mentioned, as one now acting most powerfully in this
country, the modern science of politics, by which I would
not be understood as alluding to the science of true
statesmanship, but the "petty, miserable abortion of
statesmanship — which is now everywhere disseminated
throughout the land — in which personal ambition
usurps the place of principle, and private advantage
controls those acts which should be directed to the
public good.
The abolition of principle, which is to the mind what
the pole-star is to the mariner, is one of the most fatal
accidents which can befall any individual. Its absence
leaves the mind without a proper degree of rectitude,
without that necessary steadfastness of purpose and con-
sistency of method which are essential to healthy and
vigorous mental activity. Weakness and debility of the
mental functions must as surely follow its loss as physical
infirmity succeeds the loss of any material condition of
animal life.
The cumulative result of this defect is continually
augmenting, like that of the opium habit or any other
38 Albert N. Blodgett.
profound and growing influence operating upon the founda-
tions of being in the individual.
The recent great mania for speculation, which has
swept like a cyclone over this country, has been another
powerful agent in disturbing the mental equilibrium of
very many people in the past few years. The insatiable
desire for wealth, the excitement attending the fluctuations
of values, the anxiety regarding the favorite investment,
the giddy exhilaration produced by sudden riches, and
the despair at the shipwreck of the labors of a lifetime,
all exert a most powerful influence in unsettling the mental
balance of many individuals, thus exposing them more
easily to the effects of accidental influences, by which
their debilitated mental and moral natures may now become
more or less profoundly disturbed.
The rapid dissemination of intelligence from one part
of the world to another, thus bringing the events of dis-
tant locations to our earnest attention, with the added
elements of exaggeration and sentiment, with almost the
same force as those affecting our personal relations, must
act as a constant excitant or spur to the emotional and
sympathetic parts of human nature, and operate to strain
these qualities of the mind to an unusual and harmful
degree. In fact, one of the most dangerous forms of men-
tal disease at this time is the so-called " emotional insanity,"
produced, or at least developed and perpetuated, by great
and prolonged excitement of these mental faculties. The
" inspiration theory, " with its frequent deeds of horror,
comes under this class of mental disease, of which we
have had several most piteous examples.
Another potent factor in the increased mental vulner-
ability of our recent population is the changes in the
private and domestic life of the people. There is an
increased tendency towards aggregation in large commu-
nities, and all large cities are overcrowded. The natural
result is that much of the home life, if indeed not all,
with its quiet restraint and peaceful influences, is lost
upon those natures which most need them. The young
The Management of Chronic Inebriates. 39
of both sexes are thus thrown into the whirlpool of
modern town life, and deprived of the most necessary-
means of protection from its contamination.
Is it to be wondered at if irretrievable damage is
done the mental and moral natures of inexperienced or
susceptible individuals, which, like a slight deviation from
a straight line, becomes further and further removed
from its proper course ?
When we add to all these the harmful practices asso-
ciated with club life, now unfortunately becoming so pop-
ular among all classes, which pander to all the foregoing
evils but counteract none of them, and supplement all
these with late hours and their associated dissipations,
the lack of friendly advice, the perils of gaming and the
other social dangers, we surely have ample cause for
the weakened and debilitated moral sense, and the over-
strained and excited emotional nature of a large and
increasing proportion of our young and middle-aged
people.
If, now, these unfortunate individuals become the
slaves to passion or appetite, in any specific form, their
bondage will be more oppressive from the lack of a
powerful will to resist and a firm principle to guide ; and
the danger from encroachments of other vices will be
augmented, owing to diminished power of self-control,
due to degeneration or abolition of standard mental quali-
ities.
At this point, one of the prime evils of our present
system of living becomes evident, in connection with the
facts mentioned a moment ago. Human nature can-
not indefinitely support the increased strain to which a
continually enlarging number of individuals are exposed.
Natural food and natural rest luill not provide for unnat-
ural and superhuman exertion. There is a limit to all
healthy energy. Beyond this limit, labor is accomplished
only at the expense of vitality. In this extremity, which
is exactly the condition in which a large number of our
people find themselves, the use of artificial stimulants is
40 Albert N. Blodgett.
necessar}', in order to follow an irrational and insane am-
bition. The constant mental toil, the unceasing anxiety, the
sleepless nights and overburdened days, gradually produce
a degree of exhaustion, in which the individual is forced
to one of two measures — either to relax the strain under
which the system is laboring or to endeavor to support
the failing energies by the use of some form of artificial
stimulus. There is little need to add that the latter is
the measure usually adopted at the present time. . . . There
is a sensation of exhaustion which imperatively demands
the aid of a stimulant, and is temporarily relieved by its
employment. The individual is led to think that the
remedy has been found, and continues to use an agent
which has afforded such marked benefit.
It is easy to conceive that any article which thus
becomes necessary to the performance of daily labor may
gradually acquire such power over the individual that the
force of habit, combined with the physiological action
of the substance, may at length render all efforts at its
abandonment entirely futile. . . .
The cumulative effect of prolonged over-stimulation is
twofold ; first, the action upon the nervous system, as a
spur, by which an extra amount of energy may be tem-
porarily evolved, with a gradual encroachment on the
normal powers of the organism, until no extra energy
can be azvakened except from the effect of stimulation ;
and, second, a change in the physiological and organic
relations of the structural elements composing the nobler
functional organs, with gradual degeneration of the higher
mental and moral qualities, so that the foundations of
character are undermined and the powers of reason are
perverted, while the emotions and sympathies are excited
to increased activity, and the unfortunate individual be-
comes a slave to sudden and irresistible impulses, the
consequences of which may be disastrous to himself or
others.
Probably, many unsuspected cases which claim our
attention in their care and treatment are the direct results of
The Management of Chronic Inebriates. 41
an attempt to prevent exhaustion of the vital powers by the
use of artificial stimulants. One of the most careful writers
of our day says that " cerebral exhaustion, however caused,
more often leads to irresistible drink-craving than is gen-
erally supposed ;" and Dr. Meyers states that " there is no
form of nervous exhaustion more severe in its character
than that which is induced by the abuse of stimulants."
The organic effect of prolonged over-stimulation upon
the brain may be of two varieties : first, to dry up, so to
speak, and to a certain extent solidify the tissues, with the
symptoms of a greater or lesser deviation from mental
soundness, sometimes amounting to mania ; often followed,
second, by softening of the cerebral structure, accompanied
by a gradual blunting of many, if not all, the mental
faculties, at times resulting in actual imbecility.
Dr. Sankey, in his lectures, traces the close parallel
between the gradual degeneration of brain and degradation
of mind in the drunkard and the insane person, and shows
that these processes exactly correspond in some cases, and
that the cerebral changes are almost identical. . . It is safe
to say that no person can employ alcoholic stimulants for
any length of time continuously without impairing the in-
tegrity of some, or all, the great organs of life, and vitiating
their functions. With this result once induced, the neces-
sity is felt for continued use of the harmful agent ; and the
weakened mental faculties are powerless to oppose the
demands of an abnormal and depraved appetite. Thus, the
bad habit is fostered and perpetuated, and the chronic
inebriate stands before us. The uncontrollable appetite,
diminished mental vigor and complete subjection to the
obnoxious substance, are the essential factors which consti-
tute the chronic toper, whose progress is now invariably
from bad to worse. Dr. Bucknill considers this condition
to be a form of emotional or moral insanity. He says :
"The prominent nature of this propensity is its irresist.
ibilityT
The second class which claims our attention at this time
is that other element of society which is subject to alcoholic
42 Albert N. Blodgett.
influence, and which presents a series of phenomena utterly-
different from those we have previously considered These
unfortunate persons are generally (so far as my observation
has enabled me to judge) those who are originally in some
way constitutionally defective, or are, to a greater or lesser
degree perhaps, congenitally "weak-minded," or, in the words
of Dr. Fisher, "those who inherit an unstable, nervous
constitution from drunken, neurotic or insane ancestors,"
They are oftener found among the more illiterate ranks of
society, or, if they belong to an elevated walk in life, they
are inferior to their position, and are generally regarded
as deficient in some essential qualities. This group of
persons does not generally become addicted to the use of
alcoholic stimulants from an original necessity for them,
but from inherited vicious propensities, pandered morbid
appetites, and depraved mental constitution. In them, the
results which obtain in the chronic inebriate are less fre-
quently observed, organic changes in the various animal
structures are more rare, and the principal deleterious
effect is to be noticed in the department of the higher
cerebral functions.
The nervous system in these unfortunate individuals
seems to be so constituted that the effect of any powerful
stuTiulant is developed at once, and particularly in these
structures. A person who has taken but a very moderate
amount of a common stimulant may present no outward
sign of intoxication ; the step may be firm, the face not
flushed, the pulse but. slightly accelerated ; but the mental
organization of the individual may be completely overturned.
There is often not the violent aspect of mental derange-
ment which accompanies delirium tremens, but a complete
suspension of normal cerebration. The general tendency
of this state is one of personal exaltation, of unlimited
resources, of gigantic enterprise, of assured success in most
extraordinary undertakings. Although not generally in-
clined to be violent, there is complete disregard of the
proprieties of the person or property of others, which, coupled
with the fact that any effort at restraint is at once resented,
The Managetnent of Chronic Inebriates. 43
is often the occasion of the development of a state of fury
in which hfe is often imperilled and sometimes sacrificed.
In this state of maniacal rage there is no consistent
selection of means, nor any consideration of the results
which may ensue, but the unrestrained passion of the
moment leads the individual to the most violent demon-
strations as the result of interference with the delusions
which temporarily possess the mind of the insane drunk-
ard. Dr. Fisher, who has devoted much thought to this
subject, says : " Under the influence partly of an uncon-
trollable impulse and partly of intoxication, they will
perform truly insane acts. Closer investigation of their
mental state will usually disclose the fact that they are
liable to periodical recurrences of causeless exaltation and
bursts of self-confidence on trifling occasions."
A case is now in my mind in which an amount of alcohol,
not usually followed by any appreciable result other than a
slight exhilaration, is in this patient the cause of uncon-
trollable rage, during which his room-mate, who is his dearest
friend, becomes the object of the most malignant iwry, and
is in momentary danger of death from any convenient
means. This impulse to violence towards others alternates
with a powerful inclination to jump from the window, which
is the only expression of any suicidal tendency in this
patient. Some days are required for the re-establishment
of his disturbed mental equilibrium, though the bodily func-
tions are at no time seriously deranged. The effect of
stimulation in this and similar cases seems to be primarily
and chiefly exerted upon the nervous system, and is particu-
larly developed in the cerebral lobes, where its action is
expressed by disordered mental action as the disturbed
function of these organs.
With each repetition of so dangerous an interference with
these important structures, the tendency to diseased action
is increased, so that the aberration of the intellect is each
time more prolonged, and its character perhaps changed.
The diseased condition may be produced by a lesser
amount of the stimulant, and the impression upon the whole
44 Albert N. B lodge tt.
organism may become more pronounced, until at length
reason may be permanently impaired, and the patient
become the object of continuous apprehension or perpetual
restraint, as a protection to himself or his surroundings
or both.
Dr. Blandford regards persons of inherited or acquired
weak mental constitution who are impelled to periodical
drinking, by which indulgence the mental impairment is
increased and perpetuated, as insane, thus expressing exactly
the condition we have endeavored to describe.
From the foregoing, it becomes at once evident that the
victim of drink may become a charge to society in either
of the ways described. As such, he should not be regarded
in the light of a voluntary offender or a hardened criminal,
but as a sick and diseased individual, who is in need of
humane and considerate treatment, and who is perhaps
susceptible to recovery from his disordered condition and
to restoration and cure of his infirmity. The cause of his
present condition, whether intemperate indulgence of vicious
propensities or any other reason, is not now a subject for
consideration. The mental a7td physical requirements of the
patient are to be chiefly regarded. Dr. Bodington, at a
recent meeting of the British Medical Association, says,
" For my part, I look upon all habitual drunkenness as a
disease, and I would boldly call it dipsomania." And the
American Association for the Cure of Inebriates takes the
broad ground that " intemperance is a disease."
Here, our greatest need in the proper care of these
unfortunates becomes strikingly manifest. We have contin-
uously in our midst a class of patients of deficient will-power,
or nervous force, or principle, as we may choose to call it,
who become the subjects of public care, and are daily
becoming such in increasing numbers.
Their existence as a class has been recognized, and
their needs partially expressed. But I believe I am right
when I say that in all our broad land there is not an insti-
tution or an establishment properly adapted to their reception
for remedial or curative treatment, or for their care, if
The Management of Chronic Inebriates. 45
incurable. I have yet to learn of the resort so arranged
as to be applicable to their needs, or so conducted as to
be of practical service to this element in our society, which
the public must care for.
From the nature of things, it is generally among the
poorer people that these patients are met with, and there-
fore among those least able to properly care for them, and
least likely to appreciate the fact that they are really
sick, and deserving treatment rationally addressed to their
condition.
The fact that they are frequently, and indeed generally
brought to our notice through the commission of some act
which calls for the intervention of the civil law, should not
blind our eyes to the equally evident fact that accounta-
bility and moral responsibility may be more or less
deficient or entirely wanting in the subject of the misde-
meanor, and that he is inversely in just this degree incapable
of the commission of a crime or amenable to its penalties.
The only provision which has thus far been made for
the treatment of these unfortunate creatures is of two
varieties : first, those conducted by private enterprise as a
means of accumulating money or from charitable motives,
and those controlled by the municipal or- State govern-
ment.
The first of these is defective in many ways. There is,
as a prime objection, the fact that in these resorts the patient
is a boarder^ and as such is retained only so long as the
means for keeping him there can be provided ; and, upon
the absence of the pecuniary element, he is dismissed with-
out regard to his physical condition. While in these
retreats he is only a voluntary inmate, he is not con-
strained to remain until his condition is relieved, but
often, and perhaps always, the restraint proves so irksome
that the patient leaves the institution before he is in fit
condition to do so, and consequently derives little or no
benefit from his residence in it.
Dr. Fisher says : "If able to pay and willing to go, such
a patient might be kept for a short time in the Washingtonian
46 Albert N. B lodge tt.
Home or some similar establishment on the voluntary plan.
But this kind of temporary detention only restores and
strengthens the confirmed inebriate for renewed indulgence,-
. . . The disease has a deep root in the nervous consti-
tution of the individual, which cannot be eradicated in
this way." These institutions are also often administered
upon certain dogmatic religious or hygienic ideas, which
may essentially impair their usefulness as curative asylums.
The only institutions recognized by the State or
municipal government for the .reception of this class of
patients are of two kinds : first, the various prison institu-
tions for the confinement of felons, thieves, murderers, etc.,
into whose companionship the mentally and physically
weakened victim of alcohol is introduced, and which can
objectively and subjectively act only as an aggravation
to his infirmity, and from whose walls he emerges, cursed
with the moral stigma of its indelible associations.
The second and only other resort to which a patient
may be referred by judicial authority is the mad-house,
with all its horrors, of which words can often convey no
adequate conception. I quote again the words of Dr. T.
W. Fisher, when speaking of Massachusetts : " There is
no provision anywhere for the treatment of delirium
tremens but in the almshouse at Deer Island or Tewks-
bury. Cases of mania from drink, if likely to prove of
short duration, are sent to the former place for observa-
tion, subsequently to be transferred to an asylum, if the
insane condition seems to warrant it. " To the lunatic
asylum, the insane drunkard may be committed with the
same degree of rigor as to the prison ; and too often his
case is fully as much a matter of routine in one place as
in the other. The overcrowded condition of our public
insane asylums, the lack of careful discrimination which
I fear often prevails, with absolutely inadequate facilities
or official - staff for the humane and kindly treatment of
so many sufferers, effectually prevents this resort from
being of service to our subjects.
The confinement with maniacs, the constant association
The Management of Chronic Inebriates. 47
by day and by night with those in whom the power of
reason is perverted, and whose every act and word is
the expression of a diseased mind, is a cruelty and an
inhumanity toward the weak and helpless. We have,
and shall continue to have among us, a certain definite
class of invalids, who are, and will continue to be, a bur-
den to the public, and must be cared for at the public
expense. It is certainly no proper argument that, because
they must be supported at the public charge, they may
as well be maintained in prisons and asylums as anywhere
else. We must not forget that we owe to these unfor-
tunates a degree of humanity in their treatment which
should endeavor not only to relieve their present distress,
but to restore them, if possible, to the full exercise of
their previous faculties. That is to say, the treatment of
these individuals should have for its ultimate object, the
cure of the disease. This beneficent result is surely not
to be attained by incarceration in a prison with the most
hardened and desperate characters of our heterogeneous
communities, nor is it to be hoped for behind the bolts
and bars of our great and crowded insane asylums. Dr.
Fisher expresses the same idea in these words : " Insane
drunkards would be undesirable inmates of our insane
hospitals if there was no difficulty in retaining them.
They need little medical treatment, but require prolonged
restraint, varied employments and moral discipline. The
private retreats for inebriates and insane drunkards are,
so far as my experience goes, quite powerless to accom-
plish any result, further than is in harmony with the will
of the patient, and are, on the whole, of doubtful benefit
for this class of cases. "
As an instance of the working of two of the above-
mentioned institutions, I would cite the following cases,
which occurred within my own personal knowledge. A
gentleman, who had long been a hotel proprietor, met
with sudden reverses and suffered considerable pecuniary
loss. Always of active temperament and usually of sober
habits, his present mental distress was ver>' acute, and
48 Albert N. Blodgett.
he became addicted to drink. I have never seen this
man in the least degree affected in speech, gait, or other
physical manner, nor to a casual observer would 'he
excite attention as being intoxicated. Yet, in this state,
he is a dangerous man, and his family have often suffered
violence at his hands ; and with each succeeding debauch
there is a decided change in his mental condition, which
is gradually approaching a state of homicidal mania.
On more than one occasion, this patient has been
placed in a private institution for inebriates, which has a
very imposing name and a wide-spread fame, in the hope
that he might be reformed, and again become a useful
member of society. Each time, however, after a residence
of a few days in the institution, this patient has called
for his clothes, and has left the retreat to again indulge
in his diseased propensities.
For such subjects as can be influenced by purely
moral persuasions, these institutions may be of service,
as those patients do not require restraint ; but for the
uncontrollable manifestations which accompany the action
of alcohol upon many persons, such resorts are total
failures. They have not the judicial authority to aid
their work, they are powerless to restrain the turbulent
subject, and are quite useless as a means of reformation
or cure in any excepting mild cases.
An example of the opposite form of treatment also
recently occurred within my observation. The patient
was brought before the court and was adjudged an insane
drunkard, and as such was judicially committed to one
of the State Insane Asylums. After a time, he was
released on a motion from the court, and thus describes
his experience while under treatment: "The doors were
barred and kept continually locked. There was no pri-
vacy, hardly the opportunity for the exercise of decency in
personal toilet. Even during the day, the forced restraint
was distressing, but at night it became much more so.
The shouts and yells of excited patients in neighboring
wards were painfully audible and disturbed sleep. The
The Management of Chronic Inebriates. 49
other occupants of this room were one patient who was
constantly endeavoring to take his own life, one who
feared that some one was seeking to kill him, on who
was confined on account of homicidal tendencies, and one
who was constantly striving to kill the others. The ward
went by the cheerful name of the ' suicides' room. ' "
The patient remarked that, " even if a person were sane,
on ^being confined here, he might easily become insane
from such surroundings," — an opinion in which I am
inclined to concur.
Another disadvantage attending the present manage-
ment of insane drunkards is the uncertain length of time
during which the patient is retained for treatment. Upon
this point, I cannot do better than quote from the
valuable monograph of Dr. Fisher, who says : " Great as
is the task of getting an insane drunkard committed to
an insane hospital, the diflficulty of keeping him is still
greater. This arises from the transient character of the
prominent [symptoms, which are only brought out under
the paralyzing influence of alcohol. As one writer has
said, the dipsomaniac is only sane while in the hospital.
Although in his extremity, under arrest for disturbance
of the peace and perhaps suffering mentally and physically
from the immediate effects of drink, he acquiesces in his
commitment, in a surprisingly short time he is on his
feet, under perfect control, looking around for a lawyer
to help him swear that his confused recollection of the
the circumstances of his commitment is the true version.
No hospital can hold him a moment against his legal protest,
and he is discharged as a matter of course. "
In view of the existing facts in relation to the manage-
ment of chronic inebriates and insane drunkards, I think
we are safe in asserting that no wise, humane and practical
plan has yet been inaugurated for this object, which shall
insure the protection of society at large, and work no in-
justice to the individual. It is comparatively easy to see
the defects of existing methods, but it is by no means easy
to suggest a remedy. We may, however, perhaps learn
50 Albert N. B lodge tt.
something concerning the direction in which our effort
may be most profitably exerted, with the hope that in the
fulness of time the desired result may be obtained.
What conditions, then, would be most favorable for
the restoration or cure of an individual wrecked by drink
and a burden to society? This is the question which in
one form or another must really underlie any earnest and
sincere endeavor for the practical relief of this unfortunate
class of people. . . . For its solution upon any plan, one
thing must evidently be premised as an essential condition,
which is, that there shall be a suitable disposition of author-
ity which shall place these people within the control of some
restraining force. Without this indispensable provision, no
effort for their benefit can be successful. With such power
guarded by wise restrictions, it might be possible so to
influence the life of the drunkard that his diseased tenden-
cies and abnormal inclinations might be eradicated, and
mental and physical health be restored to him.
It we consider what elements of treatment would most
conduce to recovery from the state in which we find these
patients, we shall not fail to recognize the great importance
of two conditions, namely : a judicious amount of physical
toil, which will induce a certain degree of bodily fatigue,
with a consequent incHnation to natural repose ; and a life
as much as possible in the open air ; a diet composed of
strong, nutritious food, but of plain, non-stimulating char-
acter, regularity of habits, and provision for abundance of
undisturbed sleep.
By the present methods of dealing with the two classes
of patients of which we are speaking, neither of these
essential conditions are secured. The associations which now
accompany their treatment are of the most unfortunate
character, and cannot but be detrimental to the well-being
of any person exposed to their influence. A mind congen-
itally defective, or unsettled by overwork or over stimula-
tion, or a character depraved by the long continued
indulgence of vicious tendencies and pernicious appetites,
will certainly not be benefited by the companionship of
The Management of Chronic Inebriates. 51
those with whom one is necessarily brought into contact in
a prison or a mad-house. The treatment to which these
patients are at present subjected cannot be properly called
curative. It cannot possibly operate to relieve them to any
such degree as it might do, if these features could be
eliminated.
How this may best be accomplished, and how those
persons addicted to the habitual use of intoxicants, and
those rendered insane by the same means, may be most
advantageously treated both for their own good and for the
good of society, I regard as among the most serious prob-
lems of our day. I doubt if our people are ready at this
time to seriously consider it with that degree of candor
and disinterestedness which the subject demands ; nor will
they do so, until a purer and more healthy spirit pervades
our governing power, and a more rationally humane and
truly charitable disposition is evinced by the people.
The suggestions which I have to make may not be the
wisest or most desirable; but they are the best I can
advance at this time, and are presented not as a basis for
any present action, but for the sake of eliciting discussion
and inviting more practicable suggestions from the members
of this distinguished society.
The fact must be constantly borne in mind that these
individuals, whatever their former condition or ability, gen-
erally degenerate physically, morally and financially, unti
they become dependent upon private charity or require the
official care of the State or municipality. Now, if the public
can assume control of these unprofitable members of its
body and institute a judicious treatment of their infirmities
treatment based upon careful and considerate study of their
diseased condition and needs, these patients will not only
be better cared for than they now are, but they will expe-
rience the added benefit that the result of such treatment
will tend toward their radical cure. Such a plan would
premise that the municipal authority should be in some way
enabled to include within its limits those persons, not yet
criminals perhaps, but intellectually weak and depraved.
52 Albert N. Blodgett.
and possibly unconscious transgressors against laws they
do not comprehend. The protection of society from the
violent acts of drunkards, sane and insane, is a matter of
vast importance, when we consider the frequency of such
occurrences. The public is shocked at each new victim
of insane violence, and shudders at the unending proces-
sion of suicides, but is strangely insensitive to the existence
of potential homicides and suicides, who meet us at every
turn. If these people could be properly cared for, their
indulgence in intoxicants restrained, good and sufficient
food be given them instead, and they may be made to
employ their bodily powers in some muscular activity,
graduated to suit the requirements of each individual
case, with enforced regularity in regard to repose, I am
sure that a short time would be amply sufficient to turn
the tide in many cases from disease to health, and from
the progressive degradation of the insane drunkard to the
light and liberty of a free, sane and competent man.
How this desirable result may be best achieved in
America at this time, under our present system, or rather
lack of system, I am not prepared to say. One thing, I
think, is true beyond question. None of the so-called
" Inebriates' Homes," " retreats," or asylums, as at present
conducted, have proved to be of much service in the real
treatment of habitual drunkards and particularly of insane
drunkards. It is not in their nature to accomplish this
result, as they are entirely without authority to exercise
judicious and needed restraint in those cases in which it
is absolutely required. They are essentially little more
than temperance boarding-houses, where inebriates can
remain by paying a certain sum of money and conforming
to the regulations of the institution. Probably, the ma-
jority of those patients who are benefited by a residence
in these establishments would be quite as well able to
reform under favorable conditions without residence in
any asylum.
But it is not this class of cases alone which we are
called upon to consider. It is also the poor and the
The Management of Chronic Inebriates. 53
helpless whose circumstances do not allow them to enjoy
the luxury of prolonged abode in these retreats, and who
have not the moral strength to forsake their vicious
habits. These also require attention and care. For their
treatment, the exercise of judicial restraint is absolutely
necessary. They must be assisted to overcome a diseased
tendency, for the control of which they do not possess
the necessary strength. Here is where all present insti-
tutions are found wanting. The inmate cannot be legally
detained within their care one hour beyond his own
desire. He can thus at any time defeat all such efforts
for his reformation. Dr. Fisher remarks that "an insane
drunkard with homicidal propensities is more independent
of legal restraint than any other person in the community."
The manner in which a legal supervision is to be
exercised so as to secure the humane and curative treat-
ment of the mental and physical condition in the various
classes of drunkards in our midst, it is not the province
of this paper to discuss. If the views herein advocated
receive the approbation of this society, some plan for
their practical application will not long be lacking. A
few hints from practical experience may, however, not be
without interest in this direction. Some years ago, while
making a foot tour through a portion of Germany, I
passed through a section of country of considerable
extent which had been a barren, cheerless waste, but
which was in some parts at that time occupied by exten-
sive plantations of regularly set and cultivated spruce or
other evergreen trees in varj'ing stages of growth. Upon
making inquiries, I was told that, in several neighboring
municipalities, the penalty for the less serious violations
of law was transportation to this wild region, and a forced
detention there until a certain number of trees had been
properly planted or other forestry labor performed, when
the offender was at liberty to return to his former home.
I was told that drunkenness and its minor accompaniments
were among the more frequent causes of this temporary
banishment and enforced labor.
54 Albert N. Blodgett.
I was forcibly struck at the time by the much better
circumstances for the moral and physical reconstruction of
the subjects of alcohol there than in our own country,
where they are often confined in hot, overcrowded, un-
wholesome rooms, at unhealthy occupations, in company
with those much worse than they are, who must exert a
harmful influence upon them.
In another part of Europe, I was told that the greater
part of the prepared stone for the building and repairing
of the magnificent post-roads in that part of the country
is the result of labor sentences as the penalty for minor
transgressions against the civil law. Certainly no one can
doubt that occupation in the open air, of purely muscular
character, and not so laborious as to occasion too great
a degree of fatigue, with proper restraint and supervision,
would be the very best means for counteracting the
effects of over-stimulation in our inebriate population.
We have, in all large cities, certain commissions or de-
partments of the municipal service which are so limited
and circumscribed as to make it possible to exercise com-
plete supervision. Such is the care of the city stables, in
which one overseer could easily observe the movements of
a number of employes. The paving and sewer depart-
ments U' ually control large enclosed areas, in which con-
siderable numbers of men might be employed. The care
of the pubhc parks, and the labor in landscape gardening,
now so commonly seen in every town of even moderate
pretensions, might be performed by these wards of the
public, who would thus accomplish two important ends :
I. Their own improvement and final recovery in a much
larger proportion of cases than under our present treat-
ment of drunkards. 2. They would, as a class, become
self-supporting, instead of becoming and remaining the
subjects of public maintenance. In many other ways, which
will readily suggest themselves to any thinking per-
son, these individuals might be employed, and carefully
guarded from temptation until nature might effect a cure,
and so reclaim her own.
The Management of Chrofiic Inebriates. 55
Some may consider these suggestions as too visionary
and too ideal ever to become a reality. They may not
be practicable at this time ; but they certainly are possi-
bilities, as has been demonstrated by the experience of
the Lintorf Asylums for Inebriates, near Duesseldorf, in
Prussia. Here, a system similar in its general character to
the one I have outlined has been in operation, if I am not
mistaken, since 185 1, and is productive of very gratifying
results. The life of the inmates is carefully regulated, and
strict compliance with the rules of the establishment is
required. A large majority of the inmates remain for a
period longer than six months, and are treated by means
of good food, medical care, labor, kindness and sympathy,
recognizing in inebriety a disease more than a vice, and
treating it as such.
The reports state the proportion of cures to have
been from twenty-seven per cent, to thirty per cent, of
all cases, a figure far beyond anything yet approached in
our country.
The objection may be raised to the views advance in
this paper, that they are inexpedient, or, in other words,
that the man or woman who is degraded to such a degree as
to indulge in intoxicating drinks has thereby merited the
full measure of disgrace and suffering accompanying the
punishment for their acts while drunk, or their treatment
if sick. In reply to such objection, it can only be said that
in a former age, the same spirit was evinced by the world
toward many other physical and mental disorders with
which frail humanity is afflicted ; but I think the time is
fully come when any such unjust and unsubstantial reason-
ing should be superseded by a mode of treatment more
nearly in accordance with the advanced knowledge of a
more enlightened century. And, in addition to this is the
important fact that, in the majority of cases, the individual
afflicted is really no more reponsible for his condition
than is the victim of syphilis, the slave of opium, the sub-
ject of epilepsy or intermittent fever or many other mis-
fortunes which might be mentioned.
56 Albert N. Blodgett.
It would certainly now be regarded as inhuman to
allow patients with leprosy to die uncared for in the
fields, and it is no longer considered necessary to burn
inoffensive lunatics. It is fully as great a cruelty to con-
fine persons, really the subjects of mental disease, in the
same place with the vile and desperate element which
one finds in our crowded prisons and houses of correc-
tion. It is inhumanity beyond expression to subject the
insane drunkard, perhaps only temporarily diseased and
quite susceptible of cure, to the daily and nightly com-
panionship and uninterrupted association with furious
maniacs, epileptics, suicides, maudlin babblers and imbe-
ciles. Experience demonstrates that the fatal influence of
only occasional exposure to such diseased, surroundings
often shows itself in mental derangement of those who
have been connected with the care of the insane, and I am
informed that a surprising number of the physicians and
nurses connected with our asylums and other institutions
of a similar character, either become subjects for their
protection and care, on account of positive mental de-
rangement, or are maintained by their friends in domestic
seclusion rather than in a public institution. Thus, mental
disorder sometimes seems to be acquired by the healthy
individual from occasional contact with the subjects of
disease ; and, if this be true, how much more liable to the
same danger an individual must be whose nervous sys-
tem is already temporarily shattered by over-stimulation,
whose intellectual powers are already unsteady, if not
positively deranged, and who requires treatment for weeks
or months suited to the necessities of his condition, among
the more essential elements of which are freedom from
excitement, rest and peace of mind. I think the wonder
is, that insane drunkards who are placed in asylums under
the present system, ever escape permanent mental impair-
ment from their unfavorable surroundings.
The practibility of this or any similar plan of treat-
ment will always depend upon two principal factors ; first,
the ability of the public to realize that it is as easy to
The Management of Chronic Inebriates. 57
support an insane drunkard in some asylum arranged for
his particular care, as it is to support him in an institu-
tion designed for the legitimate needs of another and a
different portion of the public burden, in whicK the indis-
pensable conditions for his appropriate treatment and
care do not and cannot exist, and from the restraints of
which he can at present always effect a legal escape at
a time when he is in immediate danger of a relapse upon
any exposure, with a certainty of rendering each subse-
quent period of treatment less hopeful than before. One
such case, the record of which is preserved by a friend and
colleague, has been committed to the house of correction
four times, and has been an inmate of the lunaitc hospital
seventeen separate times, from the recurrence of a diseased
condition, which, by appropriate treatment, might perhaps
have been easily and permanently cured in its earlier
stages, instead of becoming a chronic state, which is truly
a " second nature, " and often justifies the remark that
"the insane drunkard is only sane while in the hospital."
Second. The other factor which must be present to
render this or any similar method of treatment possible,
is that alluded to a moment ago, a dispensation of author-
ity in such a manner that this large and increasing class
of our community may be reached by its provisions, and
benefited by its practical application.
It may be claimed that the views here advanced, are
concerned not with the cause of drunkenness, but only
with its effects, and that any attempt to benefit drunk-
ards should be directed to the prevention of the evil
rather than to its cure, when the evil is already wrought.
This criticism is very true, but it must not be forgotten that
the subject of the prevention of drunkenness is still one of
the purely speculative questions of the day, in the solution
of which, absolutely, no essential advance has been made,
notwithstanding the fact that the ingenuity of a generation
of philanthrophy has been devoted to its study; but the
products of the evil are continually around us, and are
constantly demanding some practical relief at our hands.
Cerebral Syphilis Manifested by Isolated
Involvement of the Trigeminal Nerve;
Persistent Conjunctivitis and Facial
Anaesthesia.
By Allan McLane Hamilton, M. D.
I HE following case presents many interesting features
in relation to diagnosis, in the fact that ocular
symptoms appeared at first which were mistaken and
considered to be only of slight importance. Their persist-
ence and subsequent association with evidences of serious
cerebral disease gave them, however, greater weight. Not
the least suggestive feature of the case was the involvement
of the vasomotor nerves of the skin of the face, and
mucous membrane of the mouth and nose.
C. F., a business man, thirty-seven years old, con-
sulted me in January, 1882. He had suffered for several
weeks from a severe conjunctivitis of the right eye which
defied all ordinary treatment. It was found that there
had been no injury to the eye, that it contained no for-
eign body ; that there was no corneal ulceration or other
trouble visible, and no abnormal appearance was presented
except a lively injection of the conjunctiva, with profuse
lachrymation. The patient complained of pain and photo-
phobia.
I ascertained that he had had a chancre twelve years
ago with bubo, but no history could be obtained of
secondary symptoms that might be made use of. His
hair was luxuriant, and there were no marks of former
eruptions. He had had mucous patches however, and
has recently had nocturnal headaches and shin-pains. His
present trouble began, as he said, like an ordinary influ-
enza ; he had faceache, and his sense of smell was
blunted just as it had been before, whenever he had a
severe cold in the head. His right eye became inflamed
p. 58.
Cerebral Syphilis. 5^
and it " always felt as if there was something in it." As
has been stated, however, nothing was found, except a
small ecchymotic spot near the outer canthus, which was
of spontaneous origin.
The right side of the face was more or less anaesthetic
and analgesic areas supplied by the superior branches
especially, were most so, and sensibility of the lower part
of the face was not so much affected as above the eye.
The right side of the mouth was involved as was the
nasal mucous membrane. Irritation of the right nostril
and removal of hair produced no discomfort. The buccal
mucous membrane was roughened and the gums were
tender and puffed.
There was no notable loss of the sense of taste. He
could always detect acid, sweet, salt and bitter substances,
though in the beginning imperfectly, and always best at
the back of the tongue and on the left side. At one
time the physical character of food was perceived and
little else in the affected side. I applied Neumann's
galvanic test to the tongue, two fine insulated wires with
exposed ends, and connected with fourteen cells, Leclanche
elements being used, and it was found that the electric
taste was most acute at the back of the tongue.
The anaesthesia was preceded by neuralgic pains
which affected the upper branches especially. He has
now atuBsthesia dolorosa occasionally, and when the
Faradic electrode is passed over certain points in the
cheek, it produces deep pain. Hearing is unimpaired.
There appears to be a diminution of reflex excitability'.
The motor branches are seemingly affected but slightly.
The jaw action is good. There is slight elevation of the
arch of the palate upon the affected side. A slight droop-
ing of the lower part of the right side of the face exists,
however, which may depend upon the loss of several
teeth upon this side or perhaps to a weakening of the
masseter.
One of the most interesting changes is witnessed in
the altered vascularity. If the finger is brushed ever so
6o A Haft McLane Hamilton.
lightly over the skin of the right cheek, or when the
points of the aesthesiometer are removed, a bright red
tache is left.
This phenomenon can readily be produced and lasts
for some little time. The left side of the face may be
stroked or rubbed without any such effect. The affection
of the vasomotor fibres in the trigeminus probably accounts
for this, as well as for the condition of the buccal mucous
membrane, and the ophthalmic symptoms.
Since the commencement of treatment his hair has
rapidly changed in color, and there really seems to be a
preponderance of white hair upon the affected side. His
condition during the past nine months has been modified
somewhat by treatment, which is of a specific character
and consists of iodide of potash in large doses and inunc-
tions of oleate of mercury. The effects of taste and
smell have been improved and his eye does not look as
badly as it did, nor is it so hyperaemic as it was several
months ago. The anaesthesia of the maxillary branches
of the nerve is less, but it is evident that the cerebral
lesion is involving other regions, for the tongue points to
the affected side.
The Curability of Insanity ; New Obser-
vations.
By Pliny Earle, M. D,, Northampton, Mass.
SUPERINTENDENT OF THE NORTHAMPTON LUNATIC HOSPITAL.
ONE of the consequences of the publication of the
articles on the Curability of Insanity, in the annual
reports of the Northampton Lunatic Hospital, for the years
1876, 1877 and 1878, was the conviction, in the minds of
of the members of the State Board of Health, Lunacy
and Charity, of Massachusetts, that the long persued
method of reporting the statistics of the hospitals of the
insane was so imperfect, in some respects, as to deceive
rather than to enlighten the mind of the reader.
Desiring to test, so far as possible, by new statistics,
the main question in regard to curability, as well as to
place the institutions of the State upon the right road
toward the attainment of truth, that Board, in 1879, pro-
cured the preparation of an almost entirely new series of
tables, and recommended their adoption in place of those
formerly used. The proposition was immediately acceded
to, not alone at the four State Hospitals, but at the
McLean Asylum and the City Asylum of Boston.
The reports of two official years since that time have
been published, and those of the third, which has just
expired, will doubtless be in print before the 1st of Janu-
ary, 1883. We have already, then, in Massachusetts, the
results of a three years' experience under the new order
of things which was introduced by the adoption of the
tables mentioned. That period is sufficiently long to
furnish material from which, as premises, conclusions
entitled to a very considerable degree of confidence may
62
Pliny Early.
be drawn. Drs. Park, Brown and Goldsmith, of the three
hospitals at Worcester, Taunton and Danvers respect-
ively, have very courteously furnished me, in advance of
publication, with the statistics of those institutions for the
year recently elapsed. I propose to pass in review this
new material from the four State establishments, and
endeavor to ascertain its teachings.
It should be stated that the figures of the statistics
relate to persons and not to cases, the same person not
having been counted twice within either year, whatever
might have been the number of his admissions. It is
possible that, in a few instances, the same person was
admitted in more than one of the years; but, if any such
there were, the number is not sufficient to materially
affect the results. . .
/. Admissions of Persons in Three Official Years.
HOSPITALS.
1879-80.
18^0-81.
1881-82.
Totals.
Worcester, - . . -
Taunton, - - - -
Northampton, . - -
Danvers, - - - -
222
184
115
571
237
267
120
488
304
237
119
5(»7
763
688
354
1.566
Totals, - - - -
1,092
1.112
1,167
3,371
The principal value of this table is in its exhibition of
the progressive increase in the number of persons admitted
to the hospitals. In the two years intervening between
the first and the last report, that increase was seventy-
five (75) — twenty (20) in the first year and fifty-five (55)
in the second. This ratio of increase, if continued, would
double the number of persons admitted as patients in
29.79, or, in round numbers, in thirty years. The popu-
lation of the State is not increasing so rapidly as that,
and consequently, so far as these figures are to be relied
upon, the proportion of the insane committed to hospi-
tals, as compared to the number of inhabitants of the
State, is on the increase.
At Worcester there was a regularly progressive increase
The Curability of Insanity.
63
in the numbers admitted. At Danvers and Taunton, where
fluctuations in this respect were the greyest, the admissions
were largely governed by outside influences, not natural
but arbitrary. The patients from Boston were sent some-
times chiefly to one of them, sometimes to the other, as
circumstances determined.
2. Admissions and Recoveries of Persons in Three Years.
HOSeiTAI^.
D„~.^.,= Persons dis-
Per cent of
Recoveries on
Aitnaission.
Worcester,
Taooton, . . - . .
Morthainpton, - - - - -
763 i 148
688 148
354 76
19.40—
•21. 5H-
■21.47
Total of three Hospitals, -
Danvers, ------
1,805 1 372
1,566 378
•20.61
•24.15
Whole number, - - - -
3,371 750
'2-2. 20
The hospital at Danvers has so recently been opened
that it is exceptional, in some respects, as compared with
the other three. I have consequently so arranged the
table that those three can be considered separately.
The proclamation, — " The best authorities assert that
75 to 90 per cent, of recent cases of insanity are curable,"
with which, or with something equivalent, each half-fledged
tyro in mental diseases formerly soared into the regions
of imaginative psychology', either in his annual report, as
a recently installed superintendent, or in some article upon
the subject, as a pamphleteer or a writer for periodicals,
is familiar to those who have read the Northampton reports,
even though they may not have met it in its original
places. Like the "voice of the turtle," in Palestine, in
the spring-time of seasons long gone by, that proclamation
was, until within the lest three or four years, often " heard
in our land ; " but now, like the song of Childe Harold,
it " hath ceased, " or, at best " has died into an echo,"
like his theme. Yet to him whose faith was chal-
lenged by its reiterated assertion, and whose hope
was stimulated thereby into an expectation that all
cases might soon be treated in their early stages, the
64 Pliny Earle.
table here presented cannot fail to be sadly and sorrow-
fully interesting.
It matters little what is asserted can be done so long
as it is not done. To the philanthropist, the humanitarian,
the political economist, the tax-payer, even the mere cit-
izen, the important question is, not what is the propor-
tion of the insane that has been alleged, on very flimsy
grounds, to be susceptible of recovery, under certain
given but often impossible circumstances, but what pro-
portion do recover and return to their homes as useful
members of society ?
By the table just introduced, it is shown that in the
the course of the three official years ending with Sept. 30,
1882, three thousand, three hundred and seventy-one (3,371)
persons were admitted into the four State hospitals, and
seven hundred and fifty (750) persons were discharged
from them as recovered. The recoveries were 22.25 P^^
cent, of the admissions. Kence, fiat one-half, not even
one quarter, but only a fraction more than one-fifth as
many perso7is recovered as were admitted. In the oldest
three of the hospitals, the most recently erected of which
has been in operation twenty-four years, the proportion
of recoveries was still smaller, being 20.61 per cent., or
almost precisely one-fifth, as compared with the persons
admitted.
It is not a little interesting to observe the very near
approach to equality of these proportions in the oldest
three of the hospitals.
At Danvers, the ratio of recovery was larger. This is
sufficiently explained by the fact that, at the beginning
of the period of three years, that hospital had been in
operation less than eighteen months. It was not full,
and it was the resort for nearly all of the recent cases of
insanity from Boston and the four other cities in its vicinity.
For the purpose of further illustration, I here introduce
a table showing the ratio of persons recovered to persons
admitted, at each institution, in each of the three years
respectively.
The Curability of Insanity. 65
3. Percentage of Persons Recovered in each Year.
HOSPITAL.
1 1879-80.
1880-81.
1881-82.
For Three
Years .
Worcester, - - -
Taunton, . . - .
Northampton,
18 46
j 26.62
24 34
21 94
21. .34
16.66
38.09
17.72
23.83
1 19. 40—
21.51+
! 21.47-
At the three Hospitals,
Dan vers, - - .
2a. 6.1
28.89
20.67
25.41
18.94
17..=«
1 20.61—
1 24.1.5—
1
At the fonr Hospitals
- 1 2.5 95
22 75
18.34
i 22.25-
Perhaps the most noteworthy information derived from
this table is, that at the hospitals, as a whole, there was
a progressive diminution of the annual proportion of
recoveries from the beginning to the end of the period,
as shown by the figures 25.95, 22.75, and 18.34. This
regular but quite sufficiently rapid falling off in the pro-
portion of persons recovered may be merely incidental
and temporary, but nevertheless it is not encouraging.
The graded reduction of recoveries took place at the
oldest three hospitals, but to a less extent. In the hos-
pitals, as a whole, it was equal to 7.61 per cent, of the
persons admitted ; in the three oldest hospitals it was
only 3.71 per cent., or a fraction less than one-half as
much. The greatest diminution, equal to 11.34 per cent,
of the persons admitted, was at the Danvers Hospital.
The cause of this is readily understood. As the institu-
tion became filled to crowding, the current of recent
cases which had been flowing to it was, to a certain
extent, diverted from its course, and directed toward the
other hospitals.
The largest percentage of annual recoveries at any of
the oldest three hospitals, in the course of the period
was 26.62, at Taunton, in 1879-80; and the smallest,
16.66, at Northampton, in 1880-81.
It is a deUcate matter thus to bring the several insti-
tutions into the closest juxtaposition, for the puspose of
a comparison of the results of their work. Were it not
that I have great confidence in all and each of them, it
would not be attempted. I regard these Massachusetts
hospitals as among the best of their kind, not in the
66
Pliny Earle.
United States alone, but in the world ; and I most consci-
entiously believe that they are now under a medical
management so good, and so nearly equal, that any in-
sane person who would recover at any one of them would
likewise recover at either of the other three.
We now approach [a part of the statistics before us,
perhaps the most important as well as the most interest-
ing of all, in consequence of their bearing upon the ques-
tion of the absolute curability of mental disorders. The
extreme liability to relapse of a large proportion of the
cases recovered from insanity, is now very generally
known. In some instances the relapse and the recovery
occur so frequently that some physicians maintain that
there is no recovery ; but that the disease, during the
apparently rational intervals of the patient, is merely in a
state of suspense. But, in these cases, it is the almost
universal practice at the hospitals, if they are discharged
at the subsidence of each returning paroxysm, to dis-
charge them as recovered. As heretofore shown, the
recoveries are thus sometimes largely increased beyond
the number of persons. In view of these cases, I have
often been reminded of the notorious old toper who one
day greatly surprised an acquaintance by telling him that
he had " left off drinking," and when the assertion was
doubted, reaffirmed its truth, declaring, as undeniable proof
of the fact, that he had "left off three times" that morning.
The subjoined table shows the number of persons dis-
charged recovered, and the number of persons readmitted,
who had at some former time been discharged as recovered.
4. Readmission of Persons formerly Discharged Recovered.
HOSPITAL.
Persons Dis-
charged
Recovered.
Readmission
of Persons form-
erlyDIscharged
Recovered.
Proportionof
Readmitted
to Discharged.
Worcester,
Taunton, ...
Ninthampton, . - -
148
148
76
65
70
43
1 in 2.28
1 in 2.11
1 in 1.76
Totals of the three Hospitals,
nanvers, . - -
.•572
378
178
(x;
1 in 2.09
1 in 6.72
Totals of the four Hospitals
7.^
241
I in 3.07
The Curability of Insanity. 67
In the return to their homes of seven hundred and
fifty (750) persons recovered fron their insanity, the hos-
pitals accompUshed a great good. This work of bene-
ficence was, however, as is shown by the table, in one
sense partially counterbalanced by the readmission of two
hundred and forty-four (244) persons who had been pre-
viously discharged as recovered. The percentage of the
readmissions on the discharges is 32.53. In other words,
very nearly one-third as many formerly recovered persons
were taken back from the community, as were given to
it by the hospitals. At the three oldest hospitals the
proportion was still larger, the number of formerly recov-
ered persons readmitted being very nearly one-half as great
as that of recovered persons discharged. At the Worcester
Hospital it was a fraction more than two-fifths ; at the
Taunton Hospital, nearly one-half; and at the Northamp-
ton Hospital, more than one-half, or nearly three-fifths.
At the Dainvers Hospital three hundred and seventy-
eight (378) persons were discharged as recovered, and
only sixty-six (66) formerly recovered persons readmitted.
The proportion of the returned recovered to the discharged
recovered was as i to 5.72, or a little more than one-
sixth. This, like the heretofore mentioned exceptional
results at that institution, is a consequence of its new-
ness. As before mentioned, at the beginning of the three
years it had been in operation less than a year and a
half, and hence there had not been time for a relapse of
any of its recoveries other than in those persons whose
disease recurs at short intervals. As will be seen by the
table next to be introduced, the numbers of the readmit-
ted recovered, in each of the three successive years, was
18, 17, and 31, respectively, nearly one-half of them being
in the last year of the period. As the hospital grows
older, this, as well as the other results in its medical
histor>', will approximate more and more nearly those of
the three other and more early established institutions.
Before leaving this special topic, it should be remarked
that although the Danvers Hospital readmitted but
68
Pliny Earle.
comparatively few of the persons whom it had discharged
as recovered, yet it is highly probable that it admitted a
no inconsiderable number who had previously been dis-
charged as recovered from the other three institutions.
The early reports give no direct information upon the sub-
ject, but within four and a half months from the day
the hospital was opened, no less than forty-three (43)
patients suffering from a second attack were received. It
is probable that the larger part of these had recovered
from the first attack at other institutions. The same may
be said of the seventy-three (73) patients with second
admitted in the official year 1878-9, which began at the
close of that period of four and a half months. Of these
one hundred and sixteen (116) patients, who knows how
many had recovered once each, at either Worcester,
Taunton, or Northampton ? The number can be ascer-
tained only by an examination of records.
In the first two years of the three years' period to
which these statistics refer, the Danvers Hospital admitted
one hundred and one (lOi) patients who had been inmates
of the other three hospitals mentioned, but we are not
informed of the condition, in regard to recover}'-, in which
they had been discharged from those hospitals.
5. Annual Re admissions of Persons formerly Discharged
Recovered.
HOSPITALS.
1879-80.
1880-81.
1881-82.
Totals.
Worcester, - - - - -
Tatinton, ......
Northampton, . - - .
26
19
22
17
29
10
23
22
11
65
70
43
Total of three Hospitals, - - -
Danvers, . . . . -
66
18
56
17
56
31
178
66
Totals of the four Hospitals, -
84
73
87
244
Some of the most important information imparted by
this table has already been mentioned. By an examina-
tion of the figures in detail it would appear that the num-
ber of formerly recovered persons annually readmitted is
accidental, or incidental. It follows no law. There is
The Curability of Insanity. 69
neither a regularly progressive increase nor a regularly
progressive decrease. The whole number is admitted in
the first year is smaller by two than that of the last year ;
but at the oldest three hospitals the number in the first
year exceeded by ten that of either of the other years.
So much in regard to the persons who had previously
been discharged recovered, but who had returned to the
hospitals. It will now be shown that some of those
persons had been discharged recovered more than once.
This will be done by giving the number of times that
all of them (244) had been so discharged.
6. Ratio of Recotieries to Persons Recoi'ered.
HOSPITALS.
Bead mis-
sions of Per-
sons former-
ly discharged
Recovered .
Number ]
of times theyjE sees s o I Average Be-
had been Reco\ eries coveries to
discharged over Persons each Person.
Recovered .
Worcester, . - -
Taunton, -
Northampton,
65
70
43
161)
122
66
95
52
23
1
2.46
1.74
1.53
At the three Hospitals, -
Danvers, - - -
178
66
348
67
170
1
; 1 .9-)
1.01
At the four Hospitals -
•244
415
171
1.70
Hence it will be perceived that the two hundred and
forty-four (244) recovered persons readmitted had been
discharged recovered four hundred and fifteen (415) times.
The excess of recoz'eries over persons is one hundred and
seventy-one (171). At the oldest three hospitals the
proportiojiate excess is much larger. Their one hundred
and seventy-eight (178) formerly recovered persons read-
mitted had been discharged recovered three hundred and
forty-eight (348) times. The excess of recoveries over per-
S071S is one hundred and seventy (170). The number of
recoveries lacks but eight (8) of being twice as great as that
of persons. At the Worcester Hospital, much the oldest of
the four establishments, sixty-five (65) recovered persons
readmitted had been discharged recovered one hundred
and sixty (160) times. The excess of recoveries over
70 Plhiy Earle.
persons was ninety-five (95); and the number of recoveries
nearly twice and a half as great as that of persons. At
the Danvers Hospital the number of recoveties exceeds
that oi persons by only one (i). For reasons already given
this result will be understood.
There is one supposable source of error in these sta-
tistics of repeated recoveries, and that is the possibility
that a person who had been discharged recovered more
than once, may have so been discharged in more than
one of the three official years. If, for example, a person
who had previously recovered three times were discharged
recovered in the first year, making his foiirtli recovery,
and being afterwards again admitted and discharged recov-
ered in either of the other two years, he would be repor-
ted twice in the period, once as having had three former
recoveries, and again as having had four. This would
make the number of his recoveries, as represented in the
table, seven, whereas it had been but four. If the table
contains such errors, they probably do not increase the
totals of repeated recoveries to a greater extent than they
are diminished by the admission of persons at Danvers
who had previously recovered at the other three hospitals.
This rather minute and detailed analysis of the sta-
tistics of recoveries at the Massachusetts State hospitals,
is, from my point of view, more than justified by the
circumstances under which it is made. The truth of the
seven conclusions which were legitimate deductions from
the data which, in 1876, I was able to glean from the
results of observations and experience under an imperfect
method of recording such statistics at the hospitals, was
widely doubted. This doubt was no especial cause for
wonder, since, in some instances, those deductions differ
very greatly from what, even in the minds of well-informed
persons, had hitherto been regarded as the truth. To a
very considerable extent the doubt has been removed by
the articles upon the subject which have appeared in the
reports of the Northampton Hospital since the date just
mentioned, but it may still exist in some places.
The Curability of Insanity. 71
In Massachusetts a method of record and tabulation
expressly designed for the purpose of bringing out, from
the practical experience of its hospitals, the data which
would prove or disprove the truth of those conclusions,
has been in operation for some years. It was clearly
proper that I should avail myself of the fruits of this
crucial test, as I here have done. What are the results?
The answers can best be made to appear by the repro-
duction in brief of several of the conclusions.
Conclusion 1. — The reported recoveries are increased to an important
extent by repeated lecoveries of the same persons.
This is proved by Table 6, where it is shown that at
the three oldest hospitals one hundred and seventy-eight
(178) persons were discharged recovered three hundred
and forty-eight (348) times.
Conclusion 2. — The recoveries of persons are much less numerous
than the recoveries of patients or cases.
This conclusion is, as a proposition, the converse of
the first. Hence, it is proved by the converse of the
same statistics. At the three oldest hospitals the number
of recoveries of persons was one hundred and seventy-
eight (178); but the number of recoveries of patients or
£ases was three hundred and fort>'-eight (348), or very
nearly twice as great as that of persons.
Conclusion S. — From the number of reported recoveries of cases, or
patients, it is generally impossible to ascertain the number of persons
who recovered.
This may also be proved by the same (6) table.
Under the old method of reporting in this state, as well
as elsewhere, the three hundred and forty-eight (348)
recoveries at the three hospitals would have been pub-
lished, without giving any clew to the number of persons
in whom those recoveries took place. By the new method
that number is given, and it is found, in this instance, to
be one hundred and seventy-eight (178).
J 2 Pliny- Earle.
Conclusions 4 and 5 are, by their very nature, not
susceptible of proof or disproof by these statistics.
Conclusion 6. — The (formerly) assumed curability of insanity has
been practically disproved by more extensive experience.
By cumulative evidence in Table 2, that disproof is
corroborated and strongly fortified. At the four hospitals.
3,371 persons were admitted, and only 750, or a trifle
over one-fifth of them, were discharged recovered. This,
proportion — 22.25 P^i" cent. — is much lower than was
even dreamed of in 1876; and he who would then have
ventured to assert that such could be the truth, would
have been considered as either a Munchausen, an ignor-
amus, or a proper candidate for an asylum for imbeciles.
It will be perceived that this reduction of the ratio of
recoveries is in part due to the rejection of the duplicate
and multiple recoveries of the same person, thus giving to
each person but one recovery. For all other than strictly
technical or medical purposes, this is the information
wanted.
Conclusion 7. — The proportion of recoveries at the hospitals has bee»
constantly diminishing, during a period of from twenty to fifty years.
These statistics cannot prove anything anterior to 1876,.
when that conclusion was written. But by Table 3 it is
demonstrated that, in the four Massachusetts hospitals, the
dimunition, since 1879, has continued, the progressive re-
duction being represented by the consecutive annual per-
centages— 25.95, 22.75 ^^^ 18.34. The proportion of
recoveries in the year just elapsed is a little less than three-
fourths as large as it was three years ago, in the ofiicial
year 1879-80.
Very clearly, if insanity is to be diminished, it must be
by prevention and not by cure.
With the forgoing exposition I might, perhaps, very
appropriately close forever these published studies of the
subject of the curability of insanity. If the arguments
which have been used, and the illustrated proofs which
The Curability of Insanity. 75
have been adduced, in the course of a seven-years' dis-
cussion, have been insufficient to procure conviction of
the truth of the conclusions published in 1876, it is not
probable that anything will have power to convince. It
was once intimated that there were minds which would
not " be persuaded though one rose from the dead."^
Others like them there may be at the present time.
There is, however, one hitherto unused illustration fur-
nished by the history of one of the American hospitals,
that I cannot well forbear to present in the present con-
nection. It corroborates the testimony of the experience
at the Massachusetts hospitals during the last three years,
and emphasizes the force of it.
The epidemic fever of opinion in favor of " good " —
thereby meaning, as practically translated — " expensive "
hospitals, which raged throughout the decennium from
1865 to 1875, or thereabouts, will be but too well remem-
bered. It left, for Massachusetts, its own elephantine
monument upon Hathorne Hill, in such fashion that it
is not likely soon to be forgotten by the people of the
Commonwealth, and, at the same time, similarly perpetu-
ated its memory in other States. Of all the excessively
costly curative institutions which were the products or
outgrowths of that temporary craze, the Hudson River
Hospital, at Poughkeepsie, New York, is, if I mistake
not, the most remarkable for its costliness. Danvers is
but a pigmy as compared with it. It was intended to be
the institution of institutions, destined, so long as it might
exist, to stand as a practical and therefore irrefutable
proof that lavish expenditure upon hospital buildings can
cure insanity.
That hospital was opened on the 20th of October,
1871, and its last published report covers the official year
ending with the 30th of September, 1881. At the latter
date it had been in operation ten years, minus twenty
days.
In the course of that decennium it admitted sixteen
hundred and seventy-one (1,671) patients, and discharged
74 Pliny Earle.
as recovered three hundred and fifty-three (353). The per
centage of recoveries, as compared with the admissions, is
21.12, or a fraction more than one-fifth.
In view of this result at the Hudson River Hospital,
one of the most prominent men engaged in the work
connected with the charities of the State of New York,
writes to me as follows : — " If any additional evidence of
the correctness of your conclusions in regard to the cura-
bility of insanity is needed, it is furnished in the ten years'
experience of this most expensive of institutions ' estab-
lished persumably for cure.' "
The very near approach to identity in the results at
Poughkeepsie and at the Massachusetts hospitals, may
arrest the attention of the reader. The proportion of the
recoveries was :
At the Hudson River Hospital, - - 21.12 per cent.
At the four Massachusetts hospitals, - 22.25 "
At the oldest three Massachusetts hospitals, 20.61 "
But there is a difference in the computation of these
ratios which operates pretty largely in favor of the Mas-
sachusetts institutions. The statistics of Massachusetts
relate only to persons ; those of Poughkeepsie to patients,
or cases. The Hudson River Hospital gets the advantage
of all the repeated recoveries of the same person, which,
like all other institutions of the kind, it must have had ;
whereas at the Massachusetts hospitals, these were al
rejected.
Other appropriate topics, furnished by both the United
States and Europe, might here be introduced, but I must
pass them by, with two exceptions upon the other side
of the Atlantic.
In my annual report, one year ago, there was a notice
of the statistics of the Morningside Asylum, at Edinburgh,
Scotland. It appears that, from a misunderstanding in
regard to the patients who had suffered more than one
attack, I was led to erroneous conclusions. It was stated
that of the 347 patients admitted, 108 were readmitted
after recovery from one or more former attacks. This
The Curability of Insanity. 75
was a mistake, of which the acknowledgement and the
correction give me more pleasure than the assertion. The
108 should have been 63. But I will let Dr. Clouston
make the full correction in his own language.
"The asylum discharged [in 1880] 165, but it had
taken back, altogether, of persons who had been dis-
charged, recovered and unrecovered, 80. Of this 80, 63 had
recoved in former years, showing that there is a consider-
able part of the inmates of asylums whose brain condition
being unstable, they come in and go out frequeyitly. But
out of the 267 first admissions there were 97 first recoveries''
My most cordial thanks are due to the doctor. He
acknowledges, in the language which I have italicized,
that his own statistics show precisely what I have been
attempting to prove for the last half-dozen years.
I am now indebted to the doctor for his very interest-
ing report for the year 1881. In this the recoveries for
the year are reported in a manner differing from that of
the next preceding year, and by that difference the report
becomes more lucid. The number of admissions, in the
course of the year, was 339, of which 247 were for the
first time, while 92 were readmissions. I here copy, in
full, the table of recoveries :
Persons Recovered in 1881. *
Males.
Females.
Total.
A. Recovered for the first time,
45
4S
93
(a) Readmitted, and again discharged
recovereii, - - . -
4
4
(6) Readmitted, bnt not again dis-
charged recovered, . . -
6
3
9
8. Had made one or more recoveries in pre-
vious vears, . . -
31
S4
65
(•) Readmitted, and again discharged
recovf-red. - . . .
(6) Re8dmitt<?d, but not again dis-
charged recovered.
'
4
11
Number of persons recovered, ...
76
82
1.5S
Number of cases of recovery , -
76
S6
162
The whole number of persons who recovered within the
year was 158: 93 of these recovered for the first time.
•J 6 Pliny Earle.
But after their discharge as recovered, four of them were
readmitted and again discharged recovered. They made
two recoveries each within the year. Nine more of them
were readmitted, and, at the end of the year, still remained
in the asylum. Although discharged recovered, and coun-
ted among the recoveries, they came back within the year.
The remaining 65 of the persons who were discharged
as recovered, did not recover for the first time ; but each
one of them had recovered once or more in previous
years. Of these 65 who were discharged recovered within
the year, 1 1 came back, and were still in the asylum at
the expiration of the year.
Summing the two classes, it appears that of the 158
persons discharged recovered within the year, 24 relapsed
and were readmitted within the year. Four of them were
discharged recovered a second time within the year, and
and 20 (9 plus 11) were still in the asylum at the close
of the year.
I have thus put the information in the table into the
language of words, for the benefit of those who have na
taste for the language of numerals. It is a lucid showing,
so far as it goes, but it would have been more satisfactory
if we had been told how many recoveries the 65 persons
had»made in previous years.
A series of improved and reformatory tables, by which
the defects in the method of reporting the statistics of the
institutions for the insane would be remedied, was prepared
by a committee and presented for adoption by the British
Medico-Psychological Association in 1881. After due dis-
cussion, it was decided to postpone action upon the sub-
ject for one year. At the meeting of the Association in
August of the current year, there was another discussion,
which ended, at length, in the adoption for one year, of
the new tables. So far so good — and very good. A
prudent caution in driving, even when one knows he is
on the right road, is commendable.
The superintendents of the British asylums will find
that the new tables will increase their labors to a no
The Curability of Insanity. 77
inconsiderable extent; a fact of which no one perhai>s-
is more conscious than they themselves. The work of
preparing the statistics of the Northampton Hospital was
increased, probably threefold, by the tables introduced
three years ago. But the British superintendents have
always put very much more work into their statistics than
have the superintendents of the institutions in this countrj'- ;
and hence their labor will not be proportionately increased.
But, for them and for us, it is the end that crowns the
work, and all upon whom the burden is imposed must
look for tlieir reward in the greater revelation of truth,
and the immensely enhanced value of their statistics.
The Therapeutic Value of Cephalic and
Spinal Electrizations.*
By C. H. Hughes, M. D., St. Louis.
' I "'HE physiological experiments of MM. Latournian and
-*- Laborde {Gazette Hebdotninaire, i8yg,) confirmed
by those of MM. Condorceau and Duval, performed on
inferior animals, have fully demonstrated the power of
electrizations to produce in the brain a state of tempo-
rary anaemia immediately following each application. But
these demonstrations were only confirmations of a fact
previously ascertained by clinical methods. M. Latournian
having, himself, before reported the case of the Abbe C,
whose brain, chronically congested to such a degree as to
produce marked and grave psychical aberrations, yielded
favorably to persistently repeated cephalic electrizations,
and I had, myself, long before this, employed these
applications for this purpose, and became convinced frohi
repeated experience, of their power over the brain to
tranquilize and subdue cerebral excitation, and over the
•This paper was read before the Association of Superintendents of American
Institutions for the Insane, at Toronto, Canada, June Uth, 1881, some of the
clinical records being then briefly detailed Terbally.
78 C. H. Hughes.
vasomotor system to promote through them the contrac-
tion to normal dimensions of the abnormally distended
cerebral arterioles in hyperaemic encephalic conditions.
Though the precise mode of action of the constant
current in destructive brain lesions will probably not be
understood until a number of cases, which have been
treated in a similar manner, have been investigated post-
mortem, as Althaus says, is perhaps true, yet we now
understand its modus operandi in cerebral congestion quite
well, and in this knowledge we have, in part, doubtless, a
comprehension of how it may act in arresting, if not in
diminishing, the growth of morbid products within the
brain. The diminished calibre of the cerebral vessels may
be inimical to their development, and the same influence
that restores normal vasomotor tonicity, may extend itself
to the trophic and absorbent systems.
In the beginning of 1878 it had become quite a rou-
tine practice with me to so employ the constant galvanic
current, and I have the records of a number of cases of
induced cerebral hyperaemia, one of them a case of men-
ingitis verticalliy which occurred in a late general of the
army, as the result of a saber wound received in battle, in
which the effects of repeated applications of this valuable
therapeutic agent were most salutary. Since then I have
extended the employment of the constant current to all
well-marked congestive states of the cerebro-spinal nervous
system, and to parts so involved, and intimately associated
with the sympathetic system.
We may say, before passing to the record of our
cases, that a now somewhat extended observation in
electro- and neuro-therapy seems to confirm what Lowen-
feld deduced from experimental galvanization of rabbits,
viz: that while descending currents contract (the vessels of
the encephalon including its) meninges, ascending cur-
rents, from neck to forehead, dilate them ; and it is well,
also, to bear in mind Lowenfeld's further assertion that
cross currents dilate on the side of the anode and
contract on that of the cathode, while induced currents
Cephalic and Spitial Electrizations. 79
in any direction cause hyperemia cerebri. These facts
may also be satisfactorily proven by personal experi-
mentation, and the failure to appreciate them is at
the foundation of the ill success of so many who have
attempted to employ cephalic electrization for therapeutic
purposes and discarded it. It has not, in these instances,
been the electric current which has been at fault, but
the operator who has misdirected it. It is as valuable a
servant when skillfully used as the surgeon's knife, and
we should not condemn it because, in unskillful hands, it
may prove equally unsafe and unsatisfactory.
In the present note we content ourselves with a few
clinical confirmations of the value of the constant descend-
ing current in conditions of the brain associated, primar-
ily or secondarily, with hyperaemia, reserving for another
time illustrations of its value in other cerebral states and
in certain abnormal conditions of the spinal cord.
Althaus, tnde "Brain" April, 1881, has [employed this
agent successfully in resolving morbid depositions within
the brain, and we have seen hemiplegia, dysphagia and-
aphasia from lesions of the brain and pons, dissappear under
its use, and the conviction has forced itself upon us from
the more satisfactory results since its regular employment
in our treatment of our epilepsias, conjoined with internal
therapy, that it is an auxilliary in this affection which
ought not to be despised. True, these cases recover
under treatment without galvanism, but if the majority
of our cases under the combined treatment stay well,
whereas formerly the most of them, perhaps three-fifths,
relapsed, it is not unreasonable to have acquired a little
faith in its aid.
Althaus {vide snpra) has successfully treated diabetes
insipidus by galvanizing the medulla, and melancholia by
applying the current to the occipital lobes, and has caused
auditor}^ delusion to disappear by applying the current
to Ferrier's auditory centres in the superior tempero-sphe-
noidal convolutions.
We have seen similar results follow the use of the
So C. H. Hughes.
galvanic current applied to the head and spine, though
always from using a descending current except in tinnitus
aurium and other auditory hallucinations. Bright's and
Addison's diseases, which, in all probability, are intimately
associated with renal ganglia disease in their origin, are
greatly benefited by spinal electrizations, and the former
has disappeared under its use, if albumen and tube casts
are to be taken as indubitable evidence of its existence.
Diabetes mellitus, associated with profound melancholia
and sexual apathy (loss of sexual desire without sperma-
torrhoea for six months), we have seen cured by it,
conjoined with codia, cannabis indica and neurotic tonics
and reconstructives. The miracles of medicine already
wrought and still capable of being performed by the aid
of galvanism wisely employed as auxilliary to a judici-
ously prescribed internal therapy, can not yet be
exactly estimated, but if we judge even from the known
<:urative verifications of the medicinal power of this agent,
our prophetic record must be a liberal and exalted one.
It will avoid lengthening this paper, which is intended to
be but a brief note on one part of this interesting subject,
if we refer the reader to Dr. Althaus' two interesting
papers, in Nos. XII. and XIII. of "Brain," "(9« Some
Points in the Diognosis and Treatment of Brain Diseased
The cases of cerebral trouble which we now detail
may serve to illustrate the one aspect of our subject,
which we started out to show :
N. J. W. is a young unmarried man, of dif-
fident mien, florid complexion ; moderately good flesh ;
sleepless ; pulse full and 84 per minute. He is troubled
with morbid fears of various kinds, timid, forgetful and
unable to attend to business. His appetite is ravenous
and he is suspicious of the good intentions of his best
friends, irritable and cross with them. He is of a san-
guine, nervous temperament; some of his family have
died of consumption ; a sister is excessively nervous and
his father died of cancer. Insanity is with him an
impending possibility. Cephalic electrization through
Cephalic and Spinal Electrizations. 8i
February and March (1879) and some general treatment
in April restored him. He now (1882) attends regularly
to business, having only occasional slight recurrences of
the head symptons, which a few days' treatment promptly
dissipates.
A young clerk, F. G. W., aet. twenty-three, of full
habit, red in the face, with bounding accelerated pulse
and constipated ; complains of a severe pressure in the
head. Filling a position beneath his aspirations and es-
teemed by him a menial one, he has become sleepless and
melancholy, brooding over what he considers the tyranny
of his employer, and lamenting his inexorable adverse
fate ; he proposes to end his troubles by jumping off the
river bridge. A consciousness, however, that something
is wrong with his head, leads him to consult his physician,
the distinguished Prof. H., who refers him to me. Coming
directly to our office and receiving a five minutes' elec-
trization, he feels more comfortable, and for the present
gives up his purpose of suicide. Given a drachm dose of
bromide of potassium in a glass of water and retained in
the office half an hour, he is then allowed to go home,
with another drachm dose combined with half as much
chloral, to be taken as he retires. In the morning he
takes a citrate of magnesia and mercurial cathartic, and
comes to the office for another seance, which, repeated
morning and evening for a fortnight, with bromide and
chloral for a few nights, .0 prolong the tranquilizing
effect of the electricity, and later, if he should awaken
between midnight and morning, an uncombined dose of
chloral, to sufficiently prolong his sleep, and this patient's
cure is practically complete. An injunction to take a
dose of the bromide mixture at night when inclined to
be sleepless, or during the day, if head feels full, and a
laxative pill for use when bowels are not free, are all
of the precautionary measures prescribed. The patient
has had no return of former symptoms at this time (Jan-
uary 1st, 1883).
Mrs. G., aet. thirty-three, married, has borne one child ; has
82 C. H. Hughes.
intra-cranial vascular tension, auditory and visual hallucin-
ations, highly vascular sclerotics and protruding eyeballs.
One of the cornae is scarred from former ulceration. Has
had iritis and been under the care of different oculists for
inflammatory and exudative conditions of the cornea and
anterior chambers of the eye, and it has been pronounced
amaurotic and glaucomatous. At the time she came under
my care, March 13, 1881, she could neither see objects in
her room, or discern light from darkness, though the
pupils were dilated with atropine. Her homeopathic oculist
informed her that only Providence could save her. An
ophthalmoscopic examination revealed no retinal trouble,
so that the inference was justifiable that the failure of vision
was due to encephalic trouble beyond the ocular fundus,
(vascular pressure and exudation about the chiasma, the
tubercula quadrigemina and angular gyri probably.) The
latter condition being especially inferrable from the flashes
of light which she has sometimes seen with closed eyes,
and the visions of angels which came to her recently
during a period of cerebral excitation. Her heart's action
was increased in frequency and force, the pulse being 120
when she came under treatment. She had treatment from
an irregular electrician and from most of the pathists of
this city, without avail. The electrician employed the
interrupted current through the head, a prrrcdure not
commendable. The patient had marked insomania, an
impaired appetite and sluggish bowels.
Under Gelsemium and the bromides and proto-iodide
of mercury, with daily cephalic electrization, eight to
twelve elements of a constant current battery — descending
current — she so greatly improved in the course of a fort-
night that she could distinguish all objects in her room
the lineaments of her physician's and husband's laces, the
color of her friends' hair and eyes, etc., in short, to see
anything but fine print. Her appetite and general con-
dition every way improved, the sclerotis became normally
free from blood, and the sanguineous effusion in the
anterior chamber began rapidly to disappear. Our visits
Cephalic and Spinal Electrizations. 83
became less frequent after this — every fourth or fifth day.
A minimum dose of hyoscyamia had a very unsatisfactory
effect, causing much cerebral excitement, and some kalium
iodidum likewise discovered in her an idiosyncrasy, causing,
in ten grain doses, an intense diarrhoea. These abortive
effects greatly prejudiced the patient against our treat-
ment, notwithstanding we had come in as a dernier ressort
and greatly benefited her, and during our absence at
Richmond, she returned to the infinitesimals.
This patient had formerly suffered from malarial con-
gestions, and some years ago fell down unconscious in an
apoplectic fit from which, in a few weeks, she slowly
recovered.
The therapeutic lesson of this case confirms what I
have so often before clinically proven, that it has become
a fixed article of therapeutic faith with me, that for hyper-
aemic cerebral states, passive effusions and intra-cranial exu-
dations, constant galvanism is the remedy par excellence
The current seemingly acts equally well when applied from
above downwards, following the direction of the normal
nerve influence, from one hemisphere of the cortex down
through the basal ganglia and out at the opposite side
of the medulla, as when the electrodes are placed so as
to impress the cervical sympathetic, namely, behind carotid
at the ramus and angle of the jaw, and at the back ot the
neck above the seventh cervical vertebra.
Dr. Edward C. Mann, of New York, in Vol. VII., part
2, of the London Journal of Psychological Medicine and
Mental Pathology, reports an interesting case of blindness
and deafness, resulting from cerebro-spinal meningitis,
successfully treated by him with a constant current, in
which he details an experience with the electricity quite
in accord with our own. We have never, however, cured
a case of post meningitic blindness or deafness from this
agent, though we have employed it with a view (and we
think successfully) of averting this and other horrible
sequelae of this formidable affection.
The following case, however, is much like the preceding.
84 C. H. Hughes.
The details of the case appear more at length in a late
number 'of the Louisville Medical News. The case was
also verbally reported by us along with a number of
others, to the Southern Illinois Medical Society, which
lately met at Anna, Ills. The patient is quite well-known
in that section of the country :
Rev. L. is a Presbyterian divine residing in Illinois,
of intensely studious habits, preparing his weekly sermons
with much research and solicitude. The time habitually
devoted to this labor is from the middle of the week
until the following Sabbath ; his hours of most intense
labor being the night time, rarely terminating before mid-
night on Saturdays, and later, on other nights.
His congregation is influential, critical and appreciative
of his work, which he realizes, and while he has labored
with solicitude to fill their expectations of him, he has had
none of those feehngs of depression which come from a con-
sciousness of unappreciated effort, and is not melancholic.
He has, however, realized of late the failure of his mental
powers for prolonged studious effort, and has become
conscious that he must get relief or abandon his calling.
His symptoms, when he first came under observation,
were protrusion of the right eye and inability to distin-
guish light from darkness with it ; cephalagia with inabil-
ity to labor mentally without intensifying it ; full pulse,
84 per minute, and increased temperature, 99.5 F. on
side of blindness ; sluggish bowels ; an ill-at-ease sort of
feeUng in the day-time, and incapacity for sufficiently pro-
longed, dreamless and refreshing sleep, to daily recuperate
him. He had no catarrh, and there were subjective noises
in his left ear. Otoscopic and ophthalmoscopic examina-
tion gave negative results. ^Esthesiometric examination
gave abnormal and lessened tactile sensibility in the ter-
minal branches of the tri-facial. Giddy sensations were
complained of, and his appetite was somewhat impaired.
The renal, hepatic, enteric and cardiac functions, save the
ganglionic excitation in the latter, were not appreciably
abnormal.
Cephalic and Spinal Electrizations. 85
The condition of this patient was one of partial paral-
ysis of the vaso-constrictor nervous system, due probably
to malarial influences as the pre-determining cause, and
to psychical overstrain as the immediate exciting cause. I
regard the cerebral pathological condition as one of
psychically induced cerebral hyperaemia with meningeal
hyperaesthesia and cortex irritability.
The treatment consisted mainly in cerebral galvaniza-
tion with the constant descending current, daily, of vary-
ing strength, enforced brain rest, and chemical restraint
imposed by the sodium and potassic bromides in after-
part of day and night, together with all rational efforts
to restore trophic and waste cerebral equilibration. The
following further history of this case is given by the
patient himself:
"I came into Southern lUinois in the spring of 1876.
After being here about a month or two, I took chills and
fever. I was troubled with them for about one year.
After getting clear of them I began to be troubled with
what my physician here called nervous headache. As
time passed this grew more troublesome until I had it
half or more, probably of my time. In September, 1881,
I went north to spend a few days, and while there had
severe pains in my head, and was under the necessity of
remaining in a dark room for about forty-eight hours.
During that time I lost the sight of my right eye entirely.
Came back home and staid until last of November, when
my left eye became somewhat affected. When I placed
my case in your hands, or ' under your treatment, my
sight was perfectly restored before I left the city, and
since I have had no irouble whatever, so far as they are
concerned. I have been able to work ever since I returned
home. Have done harder work and more of it than for
three or four years before. My head does not trouble
me much now. I think I have had headache but once
during the last month. I eat well, sleep well, I feel well
generally, but I am exceedingly nervous."
The patient has lost thirty-seven pounds in weight, and
complains that he can hardly hold a paper still enough
to read it. He will require further treatment for the
general nervous symptoms, but the cerebral hyperaemia,
S6 C. H. Hughes,
meningeal hyperaesthesia and cortex irritability were
subdued by the treatment and the concomitant blindness
due to the cerebral condition, disappeared simultaneously.
In our view, while the effect of cephalic electrization
is to produce diminished circulation within the brain, this
effect is often undoubtedly contributed to by a concomi-
tant or precedent tranquilization of the cerebral cells,
whose state of excitation induces hyperaemia. The effect
on the brain and its meninges may be primary, on the
circulation secondary to, and as a consequence of, the
tranquilization of the excited cell movements, in some
cases. An essential property of the constant descending
galvanic curre?it in induced cerebral hypercemia is that of
a tranquilizer of irritable nerve tissue, secondarily contri-
buting to the contraction of over-distended vessels. It
acts on the irritable brain like bromides, hyoscyamin and
chloral, vasomotor results being secondarily induced when
there is over vascular distension as well as primarily
accomplished.
Certain effects of cephalic electrization are too im-
mediate to be the result solely of the circulatory changes
made by it. For example: the prompt relief of migrain
and other hyperaesthetic neuroses of the meninges, as well
as in all forms of anaemic and congestive cephalalgias;
though it is undoubtedly more effective in the latter.
It is a well-known fact, in regard to certain hypnotics,
that they first accelerate and augment in force the ce-
rebral circulation, even while the obtunding of conscious-
ness and the gradual quiescence of the brain is being
accomplished, so that to attribute their sleep-inducing
power to their influence over the vasomotor system is
not logical. They induce sleep under varying states of
the circulation, as in opium, alcohol, chloral and bromide
slumber, the state of the circulation being different in
all. We may fall into error if we attribute the effects
of electricity solely to its vasomotor influence.
Note, — Further detail of cases would be needlessly
cumulative testimony in regard to congestive states of
Cephalic and Spinal Electrization. 87
the head at least, but it will not be amiss to record a
few confirmations of the value of electrization of the spine
in congestive states, of which we have on our case book
the notes of some remarkable illustrations. We promise
them for a subsequent number, contenting ourself now
with th^. assufance, that rightly used, these electrizations
will be found the best of auxiliaries and often our chief
reliance in purely congestive states of the brain and cord.
{To be continued.)
CASE OF SEXUAL PERVERSION.
By P. M. Wise, M. D., Willard, N. Y.,
ASSISTANT PHYSICIAN OF THE WIULARD ASYLUM FOR THE INSANE.
nr^HE case of sexual perversion herewith reported, has
-*- been under the writer's observation for the past two
years and since the development of positive insanity.
The early history of her abnormal sexual tendency is
incomplete, but from a variety of sources, enough infor-
mation has been gleaned to afford a brief history of a
remarkable life and of a rare form of mental disease.
Case. — Lucy Ann Slater, alias, Rev. Joseph Lobdell,
was admitted to the Willard Asylum, October 12th, 1880;
aged 56, widow, without occupation and a declared
vagrant. Her voice was coarse and her features were
masculine. She was dressed in male attire throughout
and declared herself to be a man, giving her name as
Joseph Lobdell, a Methodist minister; said she was
married and had a wife living. She appeared in good
physical health ; when admitted, she was in a state of
turbulent excitement, but was not confused and gave
responsive answers to questions. Her excitement was of
an erotic nature and her sexual inclination was perverted.
In passing to the ward, she embraced the female attend-
ant in a lewd manner and came near overpowering her
before she received assistance. Her conduct on the ward
p. M. Wise.
was characterized by the same lascivious conduct, and
she made efforts at various times to have sexual inter-
course with her associates. Several weeks after her
admission she became quiet and depressed, but would
talk freely about herself and her condition. She gave
her correct name at this time and her own history, which
was sufficiently corroborated by other evidence to prove
that her recollection of early life was not distorted by
her later psychosis.
It appears she was the daughter of a lumberman liv-
ing in the mountainous region of Delaware Co., N. Y.
that she inherited an insane history from her mother's
antecedents. She was peculiar in girlhood, in that she
preferred masculine sports and labor ; had an aversion
to attentions from young men and sought the society of
her own sex. It was after the earnest solicitation of her
parents and friends that she consented to marry, in her
twentieth year, a man for whom, she has repeatedly
stated, she had no affection and from whom she never
derived a moment's pleasure, although she endeavored to
be a dutiful wife. Within two years she was deserted
by her husband and shortly after gave birth to a female
child, now living. Thenceforward, she followed her incli-
nation to indulge in masculine vocations most freely*
donned male attire, spending much of the time in the
woods with the rifle] and became so expert in its use
that she was renowned throughout the county as the
"Female Hunter of Long Eddy." She continued to follow
the life of trapper and hunter and spent several years in
Northern Minnesota among the Indians. Upon her return
to her native county she published a book giving an
account of her life and a narrative of her woods experi-
ence that is said to have been well written, although in
quaint style. Unfortunately the reporter has been unable
to procure a copy of this book as it is now very scarce.
She states, however, that she did not refer to sexual
causes to explain her conduct and mode of life at that
time, although she considered herself a man in all that the
Case of Sexual Petvenion. 89
name implies. During the few years following her return
from the West, she met with many reverses, and in ill
health she received shelter and care in the alms-house.
There she became attached to a young woman of good
education, who had been left by her husband in a desti-
tute condition and was receiving charitable aid. The
attachment appeared to be mutual and, strange as it may
seem, led to their leaving their temporary home to com-
mence life in the woods in the relation of husband and
wife. The unsexed woman assumed the name of Joseph
Lobdell and the pair lived in this relation for the subse-
quent decade ; " Joe," as she was familiarly known, fol-
lowing her masculine vocation of hunting and trapping
and thus supplying themselves with the necessaries of life.
An incident occurred in 1876 to interrupt the quiet
monotony of this Lesbian love. " Joe" and her assumed
wife made a visit to a neighboring village, ten miles dis-
tant, where " he " was recognized, was arrested as a vagrant
and lodged in jail.
On the authority of a local correspondent, I learn that
there is now among the records of the Wayne Co. (Pa.)
Court, a document that was drawn up by the " wife " after
she found " Joe " was in jail. " It is a petition for the
release of her ' husband, Joseph Israel Lobdell ' from
prison, because of ' his ' failing health. The pen used by
the writer was a stick whittled to a point and split ; the
ink was pokeberry juice. The chirography is faultless and
the language used is a model of clear, correct English."
The petition had the desired effect and "Joe " was released
from jail. For the following three years they lived together
quietly and without noticeable incident, when " Joe ' had
a maniacal attack that resulted in her committal to the
asylum before-mentioned.
The statement of the patient in the interval of quiet
that followed soon after her admission to the asylum,
was quite clear and coherent and she evidently had a
vivid recollection of her late " married life. " From this
statement it appears that she made frequent attempts at
90 F M. Wise.
sexual intercourse with her companion and believed them
successful ; that she believed herself to possess virility and
the coaptation of a male ; that she had not experienced
connubial content with her husband, but with her late
companion nuptial satisfaction was complete. In nearly
her own words ; " I may be a woman in one sense, but
I have peculiar organs that make me more a man than
a woman." I have been unable to discover any abnor-
mality of the genitals, except an enlarged clitoris covered
by a large relaxed praeputium. She says she has the power
to erect this organ in the same way a turtle protrudes its
head — her own comparison. She disclaims onanistic prac-
tices. Cessation of menstrual function occurred early in
womanhood, the date having passed from her recollection.
During the two years she has been under observation in
the Willard Asylum she has had repeated paroxysmal
attacks of erotomania and exhilaration, without periodicity,
followed by corresponding periods of mental and physical
depression. Dementia has been progressive and she is
fast losing her memory and capacity for coherent discourse.
Westphal reports the case of a female,* that resem-
bles in its salient features the foregoing ; who, at the age
of twenty, acquired regular desire towards her own sex.
The sexual organs were normal and she practised onan-
ism. Having attempted to violate a female relative for
the purpose of gratifying her desires and being repulsed,
she became depressed with paroxysms of mania. He also
reports the case of a male, and contributes an article
with Dr. Servaesf upon the same subject several years
later. In a contribution! and later, an exhaustive essay,§
Krafft-Ebing gives an analysis of the published observa-
tions of this anomalous and rare disorder to the present
time. With his own additions they number seventeen of
both sexes and represent various degrees of perversion.
In all but one of these cases there was a neurotic dia-
* Archiv fuer Psych., Band IF, Heft 1.
t Archiv luer Pschy . , Band VI, Heft II.
J Zeitschrlft fuer Psych., Baud XXXHI, Heft 2.
§Zeit8chrlftfuer Psych., XXX VHI. Band, Hoft2 und 3.
Case af Sexual Perversion. 91
thesis with positive symptoms of insanity. He discusses
fully the relation of society to these sufferers and sug-
gests they should be excepted from legal enactments for
the punishment of unnatural lewdness ; thus allowing them
to follow their inclinations, so far as they are harmless,
to an extent not reaching public and flagrant offense.
It would be more charitable and just if society would
protect them from the ridicule and aspersion they must
always suffer, if their responsibility is legally admitted, by
recognizing them as the victims of a distressing mono-
delusional form of insanity. It is reasonable to consider
true sexual perversion as always a pathological condition
and a peculiar manifestation of insanity.
The subject possesses little forensic interest, especially
in this country, and the case herewith reported is offered
as a clinical curiosity in psychiatric medicine.
The Clinical Phenomena and Thera-
peutics of Delirium Tremens.
By Edward C. Mann, M. D., New York City.
DELIRIUM tremens is a true alcohol mania which
supervenes after repeated excesses in alcohol, and
generally in those who are habitually intemperate, but
who have been drinking more freely than usual. The
intellectual phenomena consist of hallucinations of sight
and hearing, which excite a profound terror in the patient
from their disagreeable nature, and in actual delusions of
a sad or frightful nature. These cause, oftentimes, exces-
sive mental excitement in the patient. These phenomena
vary verj' much in intensity, from a mild, muttering deli-
rium to such a degree of maniacal excitement as to require
the patient to be placed in a padded room to prevent
him from severely injuring himself. As the patient con-
valesces, these hallucinations and delusions gradually dis-
appear and deep sleep ensues. In a well developed case
92 Edward C. Mann.
of delirium tremens, you will find your patient shivering
violently all over and in a general tremor, a convulsive
trembling of the muscles of the face, hands and legs.
We may also see epileptiform seizures. One patient will
tell us that he sees sparks and phantoms aud indefinite
objects which gradually, to his disturbed and distorted
vision, resolve themselves into animals, devils, snakes, etc.
He will shriek in agony, saying that animals are tearing
his flesh. He will hear voices calling to him or cursing
him or the roaring of cannon and disagreeable, annoying
and horrifying sounds. He may be maniacal, melancholic
or stupid. There is at first simple functional disturbance
and finally, confused hallucinations.
In delirium tremens, Dr. Laycock of England has
shown us that the condition of the brain and its ves-
sels are affected — the condition of the blood circulating
in the vessels and the important viscera in close relation
with morbid conditions of the blood or of the brain.
The most important predisposing causes of the disease
connected with the cerebrum and its circulation are :
1st. Habitual stimulation from any cause, either by
drugs, such as alcohol or opium ; or physically, from over
brain work, anxiety, emotional disturbance or excessive
sexual indulgence.
2nd. A constitutional predisposition to the acquisition
of the neuroses. A neurotic temperament, predisposing
to insanity, epilepsy and dipsomania proper.
3rd. Condition of the brain existing as the result of
previous brain diseases, such as encephalitis ; the sequelae
of mechanical injuries to the head, sunstroke or diseases
affecting the brain.
The most important predisposing causes of the disease
connected with conditions affecting the blood are: 1st., the
presence of alcohol in the blood; defective supply of
nutrient materials in the blood consequent on loss of
appetite or poor digestion, the presence of fever germs
and retained excreta, carbon, carbonic acid, bile and urea.
The most important predisposing causes of the disease
Dehriu7n Tremens. 93
connected with conditions of iynportarit viscera are: 1st.,
inflammatory affections, gastritis, duodenitis with consti-
pation ; haepatitis and chronic nephritis and chronic con-
gestion of the kidneys ; 2nd, structural diseases of the
liver (fatty degeneration and cirrhosis), of the stomach
(chronic thickening and ulceration), Bright's disease and
cirrhosis of the kidneys. In treating delirium tremens, our
patient must have complete muscular repose ; must be
kept in bed or he will exhaust his nervous system. If
he must be restrained, use chemical restraint, chloroform,
not mechanical restraint. In cases where this disease
appears in a daily drinker, we must stimulate by concen-
trated peptonized beef broth upon leaving off stimulants,
and give him healthy food ; but when the disease appears
in a man who is not an habitual drinker, and who has a
good constitution and has been drinking to excess, where
we have not exhaustion but congestion of the brain, the
inhalation of chloroform acts admirably, the patient falling
asleep before the inhalation has been pursued five min-
utes.
We must remove "our patient from all occasion for
emotion or anxiety, must give him food frequently,
encourage diaphoresis as an elimination process. Keep
the surface and feet warm; use an ice cake if the head
be very hot.
If the patient is alcoholized and there are no important
complications, the sleeplessness and delirium are of no
great pathological importance. If the delirium tremens
is not due to the withdrawel of alcoholic stimuli, we
should never administer alcohol as a remedy. I never saw
a case where I could attribute delirium tremens to a
withdrawal of Hquor. The patients are invariably alcohol-
ized when admitted.
The essential nature of deUrium tremens does not
consist, as many physicians think, in the cerebral debility
consequent upon the cessation of an accustomed stimulant.
In most cases the stimulant has been stopped because the
man could drink no more, and the deUrium tremens is due
94 Edward C. Mann.
to too low diet, or abstinence from food and want of sleep,
not want of stimuli. Therefore, I repeat, delirium tremens
does not depend upon inebriates ceasing to drink. It
depends upon the surcharging of the blood with alcohol.
We must have sleep, but we must not give opium; half
ounce doses of digitalis and warm baths are far better.
Delirium tremens is a self-limited disease, if left alone,
and tends to terminate in from 60 to 72 hours. The
expectant method is not the worst method by any means
of treatment. It is neither necessary nor safer to treat
delirium tremens with alcohol. The patient is suffering
from the toxic effect of a poison ; why give him more ?
The treatment by tartar emetic is not necessary ; an
emetic dose of ipecacuhana is much better and not
dangerous. If delirium tremens is associated with organic
affection of the brain, the patient will not recover, while
if not so dependant or not complicated with important
visceral disease, the disease will soon terminate in health.
It takes only a small quantity of chloroform to bring
a patient under its influence and its action can be care-
fully kept up for an hour, after which the patient will
continue in profound sleep. A dose of ipecac is often
very useful in this disease. It stimulates the whole sys-
tem, equalizes the circulation, promotes the secretions
and assists each organ of the body to perform its func-
tions. This action can be assisted by the use of aperients,
diuretics and diaphoretic? to carry the effete matter out
of the system. Light nutritious diet, exercise in the open
air and daily shower baths are important. There is great
danger attendant upon the use of opium in delirium
tremens. Cases will make a quick recovery without
either opium or stimulants. We must enjoin on the nurse
perfect quiet and tranquility in the sick-room with no
noise or light. Under this treatment hallucinations will
disappear, sleep will return and entire restoration super-
vene. We can get real permanent cures, if we adopt the
rational method of treating inebriety, alcoholism and
delirium tremens without alcohol, and in no other way.
Delirium Tremens 95
Quinine and strychnia are the two most valuable tonics
to build up the nervous system during convalescence. In
the treatment of delirium tremens by half ounce doses of
digitalis repeated in four hours, if necessary, the pulse
becomes fuller and stronger and more regular, the cold
clammy perspiration passes off, and the skin becomes
warmer and a sleep of six or seven hours follows as a
rule. Sleep is the guide as to the repetition of the dose.
We do not get an increased secretion of the urine in
these cases. In the most cases of delirium tremens the
pulse is almost inperceptible, the skin is covered with
cold, clammy perspiration, the face is pale, the lips blue,
the hands grasp the air, the face wears the expression of
great fear, the mental faculties are in abeyance and the
patient mutters incoherently and is utterly sleepless and
perhaps has been so for days.
The administration of one-half ounce of the tincture of
digitalis will make such a patient tranquil ; the pulse
grows fuller and stronger ; the patient becomes more
sensible, less tremulous and warmer, and will sleep.
Upon awakening we shall find him sensible ; his fears
will have disappeared ; he will be only slightly tremulous ;
the skin will be warm; the tongue moist and the pulse
full and regular. The heart's sounds and impulse will be
found to be normal. Our patient will now take beef
peptone dissolved in hot water or milk, but must have
no stimuli of any kind. He will sleep at intervals through
the day and the next night will, in all probabihty, be a
good one. If the first dose of digitalis does not effect
this, repeat it in four hours. Smaller doses do no good
at all in delirium tremens. It is useless to try them and
no evil effects ever follow the administration of half ounce
doses of the tincture in this disease. By its use we get
a rapid abatement of the nervous phenomena in greater
quietness of manner and in the disappearance of delusions.
Coincident with this, as we have seen, we shall get
warmth returning to the surface and a healthy perspira-
tion and very soon sleep appears, from which our patient
g6 Edward C. Mann.
awakens, much refreshed. The pulse always increases in
force and fullness. The digitalis seems to act as a true
physiological antagonist to the alcohol in the system.
In chronic alcoholism the nervous symptoms are hallu-
cinations, trembling, loss of sleep etc. If we give the
oxide of zinc, commencing with two grains twice a day,
gradually increasing in the ratio of two grains every
three days, until our patient takes 6 or 8 grains twice a
day, sleep is soon induced, the trembling of the body
and limbs rapidly disappears, the patient no longer suffers
from headache or giddiness, the hallucinations vanish and
in from three to six weeks our patient makes a recovery
from a severe illness. Bronchitis and rheumatism often
complicate chronic alcoholism, requiring special treatment
adapted to these conditions.
Extract from Report on Diseases of
Old Age
*
By H. Wardner, M. D., Anna, Ills.
SUPERINTENDENT SOUTHERN ILLINOIS INSANE HOSPITAL.
A MONG the diseases to which old age is peculiarly
-*■ ^ liable, none are of more importance or graver than
those affections of the brain depending upon pathological
conditions of the blood-vessels.
There may be distention and impeded circulation,
resulting from weakness of the right auricle ; or as in
many cases of aged persons, the pulse may be found
strong and full from increased muscular force of the heart,
which, in such cases, instead of diminishing in size, as
other organs do, undergoes a hypertrophy of its muscular
walls, and is increased in weight, which may exceed that
of the normal adult heart by one twelfth, and still retain
a physiological condition. With the increase of volume
and force of its muscular walls, the size of the cavities
and valvular openings are also increased ; and the ascend-
ing aorta may be considerably dilated. This dilation
being due to loss of contractility resulting from fatty and
calcareous degeneration and an increase of the connec-
tive tissues of the coats of the vessels.
The term, atheroma, is used to designate a patholog-
ical condition consisting of chronic arteritis, accompanied
with fatty and calcareous degeneration.
During the inflammatory process, an infiltration of leu-
cocytes or white blood globules and fluid occurs beneath
the inner coats of the vessel. This deposit forms a soft
tumor projecting into the cavity of the vessel. These
deposited cells may undergo fatty degeneration or the
thin tunic may be ruptured and the contents of the
tumor be carried away in the current of the circulation,
leaving behind a small ulcer.
•Read before the Southern Illinois Medical Association, Noy., 15 1882.
98 H. Wardner.
When this does not occur, and the soft mass is retained
in situ, a retrograde metamorphosis occurs in the deposits,
resulting in fat granules, cholesterine chrystals, the debris
of broken down cells and fibrillated tissues, the latter
being changed into calcareous plates, after the fluid por-
tion of the tumor has been absorbed. Owing to these
calcareous deposits, the coats of the vessels become fri-
able and are easily ruptured. They are then liable to
give way to the pressure of the blood and the resulting
hemorrhage will be more or less serious, according to the
extent and the locality where it occurs.
These changes in the vessels and the liability to hem-
orrhage may be local or general, but in aged persons the
vessels of the brain are the most subject to them, hence
their greater liability to apoplexy and paralysis.
Dr. Hammond, referring to the investigations of Charcot,
Bouchard and others, describes milliary aneurisms as the
result of arteritis, which are not necessarily preceded
or accompanied by atheroma. These French authorities
go so far as to claim that all cases of cerebral hemor-
rhage, except from traumatic causes like fracture with
depression (and in depraved states of the blood), are due
to the rupture of the minute aneurisms.
Dr. Hammond, however, states that he has made ex-
aminations of the brain, after death from hemorrhage in
which not a single aneurism could be found ; he found
the arteries were atheromatous throughout the entire sys-
tem. He had found in other cases the aneurisms in con-
nection with atheroma and in all probability resulting
from it.
These changes in the vessels constitute pathological
conditions predisposing to embolism and cerebral hem-
orrhage— the term apoplexy in its literal sense expresses
the result of the hemorrhage — /. c, falling to the earth.
The matter liberated by the rupture of the tumors
above mentioned being carried into the circulation is
likely to obstruct the smaller arteries or capillary vessels
and embolism results.
Diseases of Old Age. 99
The brain or such parts of it as are deprived of the
normal blood supply from this cause must necessarily
become impaired in its functions and unless the circulation
is re-established at an early date atrophy or softening will
result. For purposes of description, authors recognize
softening under three forms : red, }-ello\v and white. The
first being due to inflammator}- action, which is usually
sudden in its onset; the second resulting from ansemia, the
brain tissues being tinged by the infiltration of serum :
the third may result from an enfeebled circulation. The
amount or quahty of blood in the part determining the
variety.
In producing these inflammatory and anaemic conditions
which result in softening, embolism and thrombosis result-
ting from the atheromatous condition, are perhaps the
most prominent factors, although softening from other
causes, may occur and precede or follow an attack of
apoplexy.
The liability to cerebral hemorrhage in atheromatous
subjects increases with increasing age. The weakened
walls of the vessels may give way without any apparent
exciting cause, before the pressure of the blood. The
hypertrophy of the walls of the heart, before mentioned
predisposes to this accident ; but mere frequently an
increased impulse is given ro the circulation ; by some
muscular action as coughing, running, lifting, a fall, or
violent emotion, or passion which stimulates the heart to
sudden increased action.
Cerebral hemorrhage may be mistaken for congestion,
uremia, alcoholism, or imbolism. In establishing the
diagnosis it is important to bear in mind that in apoplex}-,
coma is persistent and paralysis unilateral, while in con-
gestion the coma is of short duration and the paralysis
is bilateral.
In uremia, hemiplegia is rarely present, but when it
does occur it comes on gradually and is preceded by
convulsions, while in apoplexy there is almost always
paralysis occurring suddenly, and not preceded by con-
lOo //. Wardner.
vulsions ; casts and albumen in the urine will establish a
diagnosis of uremia. Alcoholism may be distinguished
from apoplexy, by the patient being easily aroused from
the coma, the absence of stertorous breathing, a feeble
and frequent pulse, and no paralysis, while apoplexy
presents a deep coma, stertor, full, strong and slow
pulse and paralysis in most all cases.
The difference in symptoms between apoplexy and
embolism may be stated as follows : Embolism rarely occurs
in the more aged, while the liability to apoplexy increases
with increasing age. In apoplexy consciousness is lost;
the is pulse slow and full, face red and turgid, pupils are
unusually abnormal, stertor; paralysis may be on either
side, is persistent and seldom perfectly recovered from.
In embolism consciousness is not entirely lost, pulse is
rapid and feeble, face palid, pupils unaltered, breathing
normal, paralysis usually on the right side, and improve-
ment begins within forty-eight hours. Embolism is attended
with a history of rheumatism and valvular disease of the
heart, while atheroma is generally present in apoplexy.
The following cases of recent occurrence may be con-
sidered as examples of embolism and apoplexy respectively:
Case I. H — M., aged 57, born in Scotland where
he served an apprenticeship in a drug store of seven
years; came to Illinois in 1856; followed his occupation
until the war ; when he served three years in the army ;
after which he practiced medicine in the Mississippi bot-
toms until 1876, when he returned to the drug business.
Is of rheumatic diathesis, and for a number of years
indulged freely in alcoholic stimulants, but for about three
years had abandoned the habit.
His health generally (except the rheumatic troubles)
good as the average, up to March 1882, when he began
to complain of continued headache, occasional vertigo,
impaired appetite and digestion, and an inclination to
sleep more than usual. After a month or so these symp-
toms improved, but the inclination to sleep and occasional
headache continued. He was married a second time in
Diseases of Old Age. lOi
May last. On July 30th, after a week of anxiety over
some pecuniary involvement, while at his desk, suddenly
began sinking down, but was caught by a bystander and
seated in a chair. In a few moments he partly recovered,
walked to a buggy at the door and was driven home.
He was pale, weak and was a good deal of the time in a
comatose-like sleep, from which, however, he could be
aroused without difficulty. There was partial paralysis,
temperature below the normal degree, pupils a little
contracted, otherwise normal and readily responded to
light. Upon being roused he could talk rationally for a
few moments, when mental action would become abnormal
and articulation difficult, was troubled with constipati>jn
for a number of days. Under care and treatment he
began to improve after about three weeks, and b\' the
end of six weeks was able to visit his store daily ; to call
upon his friends about town and converse intelligently ;
appetite and digestion became normal; but he was weak,
walked with an unsteady gait and was easily fatigued.
A report dated November 7th, says : " He only coni-
plains of weakness of the lower extremities ; his mind is
by no means as active as before the attack, forgetful of
names and slow in calculating, in reaching conclusions ;
otherwise his health is good." The report also says he
does not remember the occurrences of the first five weeks
after the attack. [The notes of this case were furnished
me by Dr. F. C. Gay, of Alto Pass. Illinois.]
Case 2. P — W., aged jj years, a man of regular life
and habits, but more or less under a pressure of anxiety,
and for about one year greatly worried by the sudden
and unexpected loss of his property ; was standing holding
a lamp for another person's convenience, when he sud-
denly fell to the floor; was unconscious; and paralized
on the entire right side ; pulse slow and full, and face
congested ; loss of speech. In five or six days speech
began to return a little and slightly improved, but never was
fully restored. Cerebration remained imperfect. Gradual
improvement, however, continued until at the end of about
I02 H, Wardner.
four months he could sit in a chair and by the help of
two persons take a few steps about the house ; at the end
of six months could walk with a cane on a level surface
after being helped out of his chair, could converse, but
soon became mentally weary ; suffered at intervals with
much pain in the paralized limbs, and had an occasional
appearance as of congestion about the face and neck. At
the end of about nineteen months he had a slight attack
and again fell to the floor; partial reaction followed this,
but he was not able to be up. The lower bowel became
enormously distended by impacted feces, which when
discovered could only be removed by mechanical aid. At
the end of twenty months, after several days of suffering
the case terminated fatally.
Atheroma and milliary aneurism of the cerebral arteries>
if they are not the cause of embolism or apoplexy, indi-
cate defective nutrition and real decay of brain tissue,
and are found in most cases of senile insanity. The
symptoms indicating brain decay are generally : first, a
loss of memory of recent events, while the memory will
be tenacous of occurrences that are long past ; second,
impairment of the power of perception ; the patient failing
to comprehend correctly what occurs about him, and to
recognize well-known persons and places, and he mixes
the past and present in a very incongruous manner. The
symptoms become more and more marked as the memory
and perception becomes extinct and he has delusions of
time, places and objects, and exhibits anger at supposed
personal injuries, becomes indifferent to calls of nature
and dies, the wreck of his former self.
The prognosis in these cases is always more or less
unfavorable.
Many cases will partially recover from the effects of
embolism and apoplexy, while in others but little or no
hope can reasonably be given.
The resulting paralysis and impaired mental function
in cases of hemorrhage and embolism generally continue
in a greater or less degree, according to the condition
Diseases of Old Age. 103
and age of the patient with variable symptoms, until
death supervenes.
The treatment on the occurrence of an attack consists :
in raising the patients head, loosening clothing, especially
about the neck, shut out the light and preserve quiet-
Ice bags may be applied to cool the head, and the feet
placed in a hot mustard bath ; bowels should be moved
by active cathartics ; stimulation external and internal
should be used as the case seems to indicate.
The subsequent treatment consists in sustaining the
vital powers by the use of tonics and suitable food and
the use of remedies calculated to favor the removal of
clot by absorption. Nux vomica, phosphorous and iron
with the use of mild stimulants, and attention to the
excretory organs will be useful in the treatment of most
cases, accompanied by the administration of some of the
iodides. Debilitating treatment must not be used.
It is very important that the patient should be freed
from anxiety and worry, and all cares and conditions
that tend to excite.
But where so little can be done to restore such cases
to health, no extended discussion of treatment seems to
be called for.
In cases of senile insanity and dementia, something
may be attempted toward restoring the failing powers,
but it is hopeless to expect a cure.
The prophylactic treatment of cerebral hemorrhage
consists in the avoidance of sudden rfiuscular exertion,
or of strong emotion, a simple nutritious but non- stimu-
lating diet should be the rule, freedom from anxiety,
regular habits, sleep in a well-ventilated apartment, warm
clothing worn loosely, and moderate exercise, and the
avoidance of sudden extremes of heat and cold.
The use of lactic acid has been mentioned as a pre-
ventive of the calcareous formations in the walls of the
arteries, but I am not conversant with any statistics or
tests that sustain the statement.
Neuratrophia.-The Cause of Inebriety;
a Clinical Study.^
By T. D. Crothers, M. D., Hartford, Conn.,
SUPERINTENDENT OF WALNUT LODGE.
"IXT'HATEVER may be the exact pathological state
' ^ called neuratrophia or neurasthenia, the general
accepted explanation is a failure of the nerve centers to
carry on the normal functions of life. This has been
termed functional, but it is by no means clear that it is
not actual structural change, which cannot be determined
by the present imperfect methods of investigation. Dr.
Hughes describes neuratrophia as " a general failure of
the normal nutrition appropriating power in the higher
nerve centers, especially the psychical." Dr. Geo. M. Beard,
the most eminent authority in this field, calls neurasthenia
" an impoverishment of the nerve force, resulting from bad
nutrition of the nerve tissue, on the metamorphosis of
which the evolution of nerve force depends. A deficiency
in quantity, or impairment in quality of the nerve tissue.
The balance between waste and repair is not justly main-
tained in the central nervous system." Dr. Jewell outlines
the subject still more explicitly in the following: "It is
rather a comparatively permanent exhaustion, which is the
result of prolonged overstrain, mental or physical, or both,
too little rest, insufficient or defective nourishment long
continued, until the substance of the nervous system, and
often of the blood which nourishes it, is wasted away far
below healthy limits, entailing, as necessary consequence,
a loss of nerve power, and in most cases, morbid exalta-
tion of nervous sensibility."
Dr. Hughes illustrates the sul-)jcct further, as follows :
"There are symptoms of inadequate nerve nutrition, and
* Read before the American AHBoclation for the Cure (f InebriatcB, at llicir
scjiil-anmial meeting, New York, October, 1882.
Neiiratrophia . 105
in the higher centers of the cerebrum there are instability,
irresolution, timidity, dread and fear, morbid and ground-
less suspicions, hallucinations and delusions, not natural to
the individual in his best estate, positive hallucinations and
delusions appearing generally when greater than mere
neuratrophic changes are affected in the cerebrum, and
the debility has passed into insanity and more or less
organic changes." A glance at the varied and complex
symptoms which mark this condition, brings clear confir-
mation of the truth of these statements. Literally, these
symptoms are often shadows of change and the coming of
grave disease, which may threaten a lifetime or burst into
activity at any moment. Inebriety is always preceded by
these shadowy, vague symptoms, which point to failure
of the nerve centers, to change that is psychical, and
possibly physical.
Of all other drugs, alcohol, in most cases, is a narcotic
of peculiar impressability in these cases of ner\-e failure, but,
while hushing the intensity of the sx-mptoms, it increases
and provokes the very degeneration which it is supposed to
relieve. Alcohol, taken in any form for a length of time,
will be followed by marked symptoms of neurasthenia, or
neuratrophia, and these conditions will demand alcohol or
opium sooner or later, in cases that have been previously
temperate.
A clinical grouping of the early symptoms of cases of
inebriety from the middle and upper classes will show,
before alcohol is used, many of the symptoms mentioned
by Dr. Hughes, as quoted, and other varied hints and
indications of change and departure from the main line
of normal or healthy activity. In the lower classes, these
symptoms are more prominent, and have less of the psy-
chical element. The higher the organization, the more
positive they appear. Theoretically, neuratrophia either
precedes or follows the use of alcohol in toxic doses, or
when taken in moderation for a long time. Clinically, the
proof of this statement is at the command of any observer.
It is proposed to group the history of some cases in
io6 T. D. Crothers.
confirmation, and indicate many of the practical facts
which follow.
In a general study of inebriety, it will be found that
conditions of overwork and exhaustion, both mental and
physical, are traceable long before alcohol is used, in
many cases of inebriety. Some curious symptoms appear
at this point. If the exhaustion is prominent and general,
the preliminary stage of inebriety seen in moderate drink-
ing is very short. If it is less prominent, this may extend
over a long period. As, for instance, an active business
man with insomania, morbid fears, strange hallucinations,
irresolutions and other similar symptoms, will use alcohol
in moderation only a few days or weeks. If he only
suffers from some slight symptoms of this character, he
may use alcohol moderately in some form or other for
months. In the first use, alcohol acts promptly as a nar-
cotic ; in a case of marked neurasthenia, toxic effects, or
intoxication, will follow quickly from a slight overdose.
This is often very profound in both delirium and stupor,
and is always the starting point of grave organic changes
that appear after.
Neurasthenia among muscle workers, followed by ine-
briety, is a very common and grave affection. The following
cases are by no means unusual, and are given to show
how clearly inebriety comes from specific causes :
Case I. — A farmer, temperate, in good health, with no
heredity, was greatly involved in the purchase of a farm,
Overworked for years, night and day, he neglected to sleep
and take proper rest. Became exhausted, complained of
shortness of breath and palpitation of the heart. No dis-
position to work, and fears of ruin ; was neurasthenic.
Was given spirits with marked relief; was intoxicated
within a week from the first use of this drug. From this
time, he drank to intoxication on every occasion, and was
a chronic inebriate. He recovered, in part, from a year's
residence in an asylum, but is now a chronic case, drinking
at irregular intervals.
Case II. — A carpenter, very temperate, in health, and
Neuratfophia. 107
no history of heredity. After his regular day's work,
would spend part of the night working on a house of his
own. This lasted nearly two years. Then he suffered
from nervous tremblings, dizziness, indigestion, and a
feeling of terror at the possibility of sudden death from
accident. Suddenly he drank to intoxication, and gave
no reason or made any effort to stop. He died two years
after from the effects of drink.
Case III. — Was a stevedore, working by the hour
unloading ships. He was temperate and very healthy.
Was offered a partnership in business if he could bring
some capital. For this purpose he worked night and day.
Then he suffered from numbness and loss of control over
his muscles ; had bad dreams at night ; was disinclined to
work. Indigestion and constipation, with severe headaches,
followed. Relief came from spirits, which were taken
moderately for two months, then he became intoxicated
and drank to excess ever after.
These three cases became inebriates from muscular
exhaustion and general neuratrophia. Undoubtedly, there
was present defective nutrition, which, with constant over-
work, precipitated the nerve exhaustion. The use of
alcohol in all these cases, as a rule, is followed by ine-
briety. Neuratrophia or neurasthenia among brain workers
is probably more frequent, and is especially predisposed
to run into inebriety from the slightest causes. Two
classes of these cases will be noted, one in which inebriety
burst out suddenly without apparent exciting cause or
special exposure; the other in which there is exposure
and special causes that encourage this result. The fol-
lowing are clinical histories illustrating these classes :
Case I. — Was a manufacturer, temperate, in good
health up to forty years of age. When, through an
unexpected demand for his goods, an immense business
was created. He gave it close attention and worked very
hard for several years, amassing a large fortune. Then
could not rest at night, or fix his mind long on one sub-
ject ; was weak, restless and filled with fears of death ;
I08 T. D. Crothers.
expected every day his fortune would disappear. Was
hyperaesthetic, and suffered from the weight of his clothes
and the changes of heat and cold. He was treated by
an eminent physician for softening of the brain. Suddenly
without any mention, he purchased a barrel of brandy,
and began to drink to intoxication in his home. In the
intervals between the intoxication he displayed great
mental power and clearness. He went to different asylums,
recovered and relapsed again, and died five years after
of some disease of the kidneys.
Case H. — A clergyman, in good health ; a very active
brain worker, who edited a paper along with his clerical
duties. He suffered from a general neuralgia and local
hyperaesthesias which prevented him from laying long in
bed, or remaining in any position but a short time. He
received treatment with no relief Finally, he began to
use wine in large quantities, and was constantly under its
influence. Retiring from his profession, he became a chronic
inebriate, and died a few years after.
In these two cases, inebriety began at once, without
any exciting cause, as, for instance : the advice or pre-
scription of a medical adviser, or the moderate use of
spirits, or facility and encouragement to procure and use
it. The following cases illustrates the other class :
Case I. — A broker, in active business, previously
healthy and temperate, who, after a season of special
excitement and overwork, suffered from a feeling of
pressure and great weight. Had cold sweats and flashes
of heat all over his body; was unable to move about in
the morning until rubbed by an attendant. When down
in the office, was urged by friends to use brandy, and the
effect was pleasing. He used it at night and morning,
and then four times a day regularly. A year after, he
drank to intoxication every day, gave up business, and is
now an inmate of an asylum.
Case H. — Was an editor doing night work on a large
daily. A temperate, healthy man. Marked neurasthenia
came on, and he began to use spirits with his midnight
Neuratrophia. 109
lunch ; the relief was great. From this time, the use
increased until he became an inebriate and was killed by-
accident.
Case III. — A real estate dealer, temperate, and forty
years of age. Failed under distressing circumstances ;
was greatly troubled and agitated for more than a year ;
then complained of nerve quiverings, hot flashes and
dreams of dying. Was treated medically for it without
relief. A year after he became landlord of a hotel and
sold spirits there, drank himself to intoxication, and was
a chronic inebriate.
In these cases, the exciting causes and exposure to
special temptation were evident. A stage of moderate
drinking preceded the inebriety ; the neurasthenic condi-
tion was clearly present. Another very interesting class
are those with marked heredity to insanity or inebriety,
who, after becoming neurasthenic, are inebriates from the
slightest exposure. One case will make clear the general
history of this class :
Case. — A leading business man, whose father died from
inebriety, and whose uncles, on his mother's side were
drinking men, was temperate from principle and general
horror of falling into this disorder. At forty-five years
of age, he became neurasthenic from overwork, and was
treated by Dr. Hughes. He traveled for a year, getting
no benefit. While visiting his uncle, a farmer, was per-
suaded to try cider brandy, and became intoxicated. He
went home, bought a large supply of this spirit, placing
it in his cellar, and drank to intoxication daily.
These cases have always inherited a special nerve
predisposition which is held in check a lifetime, perhaps ;
then, from some special train of causes, bursts into activity.
Neuratrophia and general failure of both mind and body
are the exciting causes. This latent nerve defect awaits
favorable soil and conditions for full development. Insanity
or inebriety is usually prominent in the history of their
ancestors. A half a life-time passes of clear sanity and
sobriety, then bankruptcy of health, surroundings and
no T. D. Crothers.
hopes end in insanity or inebriety, and these affections
come on without any special exposure or preliminary
symptoms. A noted politition was defeated in securing
a position that he urgently sought. Intense general neural-
gia followed, and marked neuratrophia. Alcohol and
opium were the only remedies which brought relief, and
chronic inebriety followed. The common remark that he
became discouraged and drank in despair, has a physio-
logical basis of truth. It is literally exhaustion of the
nerve centers, and incapacity to sustain the normal activity
of life. He drinks because alcohol brings relief most
quickly, and is always accessible. The failures and dis-
couragements of life produce physiological changes, which
demand alcohol, and not the vague mental state called
despair.
There is a class of brain workers who are markedly
neurasthenic, with groups of symptoms indicating great
nutritive perversion, such as depraved, irregular tastes ;
weak, impulsive judgments about foods and medicines;
great anxiety to know the meaning of every symptom of
disorder, and who try all new remedies and methods of
treatment. Such cases are on the "border land" of both
alcoholic and opium inebriety. They have passed into
the penumbra, and why every case does not move into
the full eclipse of inebriety is a problem for the future.
These cases are numerous, and precede insanity as well
as inebriety. This is the field for therapeutic triumphs,
and here the skill of the physician can discern and avoid
the dangers of the future.
Another form of neuratrophia as a cause of inebriety has
never been mentioned, although it is steadily increasing
in large business centers. The neuratrophia comes from
sudden revolution of all previous habits and activities of
life, and want of healthy action or underwork. There are
two classes quite distinct : One of active business men
who, after many years of stirring hfe, retire from all work
and seek enjoyment through travel and rest in the country,
or farmers and manufacturers who give up work in the
Neuratrophia. 1 1 1
prime of life and come to the city for comfort and enjoy-
ment. The radical change of mental activity and sur-
roundings is speedily followed by nutritiv^e per\'ersions
and congestions. The ordinary emotional frictions of life
are magnified through untrained introspection until they
become sources of nerve exhaustion. The activity of the
mind and body withdrawn from all ambition except its
own personal gratification from day to day, and controlled
by all the lower emotions, becomes neurasthenic as quickly
as from overwork and strain. Inebriety which follows
this condition is unusually profound and attended with
distressing combinations of nerve symptoms. The other
class, among the wealthy, are those who live without
purpose or plan in habitual neglect of all healthy exer-
cise of mind and body. All activity of the mind is
usually on a very unhealthy level. Disturbances of inner-
vation and circulation grow rapidly from stage to stage.
Nutrition is broken up and inebriety and neurasthenia may
either appear first, or be speedily followed by the other.
Inebriety in this class is attended with a short prodromic
stage before chronic conditions appear. Delusions and
hallucinations are more frequently associated, and the
degeneration is always pronounced. The inebriety in
these cases varies in its natural history and progress from
cases that have a different origin. There are marked
differences, physiological and psychical, between the ine-
briate who has became neurasthenic from want of healthy
activity- and from overwork of any kind. Neurasthenia
from shock of any form to the nerve centers, when
followed by inebriety is very profound, and more nearly
resembles insanity than any other form of inebriety.
These cases are generally dipsomaniacs, either continuous
or with free intervals of sobriety.
The clinical study of these varied forms of inebriety,
traceable to neuratrophia, widens in so many directions
that a volume would hardly contain more than an outline
of them. In many cases they stand out distinct and
sharply defined, in others the complications are numerous
112 T. D. Crothers.
and must be studied. As a brief summary of this paper,
the following may be considered as facts which may be
confirmed by any clinical study :
1. Neuratrophia and neurasthenia are conditions of
the brain and nerves which strongly predispose to inebriety
by preparing the soil and germ forces, which, from the
slightest exciting causes, develop inebriety.
2. Alcohol, as a remedy for these conditions of neura-
trophia, is a narcotic of most seductive power, which not
only hushes the pain, but increases the very degenerations
for which it is taken.
3. A recognition of neuratrophia as an active cause
of inebriety will give clear indications of the prognosis and
treatment.
4. Inebriety and its treatment cannot be understood
except from an accurate clinical study of cases, extending
back and covering all the history of the person before
inebriety appeared, including all conditions which have
been formative and entered into his life.
Female Diseases Among the Insane.
By S. Danillo, M. D., St. Petersburg, Russia.
^ I ""HE influence of female sexual diseases on insanity
-■- has been much discussed, but from diverse and, it
may be said, antagonistic standpoints. Some say that the
majority of female neuroses and insanities are due to the
predisposing influence of pathological or anatomical sexual
anomalies; others deny even the existence of such an
influence. The older writers have collected an immense
number of cases which have been well collated by Ber-
thier.' These, however, possess only an historical interest,
and from them no logical conclusions can be deduced on
account of the impurity of the cases. The question is a
decidedly vexed one. The French authorities give certain
indications of value. Esquirol' gives only very general
information. Guislain^ says that in many insane women
the ovaries are the seat of profound suffering. Morel
believes that very many cases of insanity in the female
are caused by female sexual affections.
Farlet* while admitting that female sexual anomalies
were an exciting, a predisposing and an indirect cause of
insanity, called attention to the much overlooked fact
that insanity often produces sexual anomalies. Marc^
expressed very similar opinions ; Ball, Dagonet and Luys
ignore the question altogether. Mairet* and Azam' believe
that insanity can be originated and continued by the action
of uterine disease. Bossi* on the other hand denies that
•Archives de Nenrologie, Sept. 11th, ISS.'. Translattd bv James G. Kiernan,
M. D., Chicago.
1. Menstmal Seurotes 1S71.
•2. Maladies Meutales.
3. Snr les Phreno-pathiea.
4. Lec<5ns Cliniqaes.isur les Maladies Mentales.
5. Insanity in pregiiant women.
6 Maladies Sexnelles et Alienation Mentale.
7. Insanity produced and kept up by uterine disease.
8. Beflex Neuroses and Uterine Disease.
114 *^- Danillo.
sexual disease has any influence in insanity. Boye^ is of
the same opinion as Azam.
Among the Germans, Greisinger/ Leidesdorf/ Schlager*
and Ammon* are of the opinion that functional or anatom-
ical anomalies of the sexual sphere may act in a certain
manner in the female to produce changes in nervous or
mental disease already existing, or spontaneously in certain
cases, an acute attack of insanity. Kraft-Ebing,® Ripping''
and several others are of the same opinion.
Emminghaus** remarks that menstrual anomalies may
exist without any relation to the psychiatrical phenomena
manifested by the patient. Schiile^, on the contrary, says
very decidedly that predisposing and exciting causes are
not less clearly defined than the sexual diseases and the
insanity of the female. The authorities who admit the
relations of female sexual disease and insanity, treat it in
very different ways ; some (Morel, Guislain, Falret, Grei-
singer, Schule) content themselves with stating their
opinion citing no cases in support of the same. Others
deal with the question from the special standpomt of
pregnancy, lactation or gestation (Marce, Ripping, Schmidt^").
Finally, some have dealt with the subject in all its aspects,
citing cases in support of the opinion that anomalies of
the sexual sphere have a positive relation to insanity
(Kraft-Ebing, Boye, Schroeter,'' MuUer,'' L. Mayer," Mairet,
Azam, etc.). Besides there are a number of isolated cases
scattered through the literature. To decide the question
properly, the attempt should be made to determine the
frequency of female sexual anomalies among the insane,
1. uterine Disease and Insanity.
2. Mental Pathology and Therapentics.
3. Pathology and Therapeutics of the Psychoses.
4. Zeltschriftfuer Psychiatrie. Band XV.
'). Neuroses and Genital Aflections.
6. Archiv fuer Psychiatrle. Band XIII.
7. Puerpeial, Lactational and Gestatioual Insanity.
8. General Psycho-pathology,
i). Mental Diseai?es.
10. Archiv fiicr Psychiatric. Band X.
11. Zeitschrift fuer Psychiatric. Band XXXI.
12. " " " i8tie.
13. Female Sexual Disease and Insanity.
Female Diseases Among the Insane. 115
the forms most frequently associated with insanity and by
this means judge of their gravity and probable influence
on mental disease already existent. Here, as elsewhere,
on this subject, exact researches are wanting. Tuke^ says
briefly that sexual anomalies exist in ten out of a hundred
women. Kraft-Ebing found six cases of genital lesions
out of nineteen ; eight being normal, and in five the con-
dition being unknown. Skeene,^ after the examination of
one hundred and ninety-two insane women, found that
but twent>'-seven menstruated regularily and that utero-
ovarian disease was frequent among the insane.
After extended biographical researches, I can find no
other contributions to the frequency of sexual diseases
among the female insane. Autopsy reports are not pre-
cise and differ among themselves. Veiser^ in ten autop-
sies of the female insane (seven melancholiacs and three
maniacs) found uterine and ovarian disease in seven
cases. J. C. Howard* found that out of one hundred and
twenty-seven autopsies, there existed uterine and ovarian
disease in twenty-four cases among which were uterine
fibroids seven cases ; cancer, two cases ; large ligamental
cysts, three cases ; ovarian tumors, four cases ; ovarian
cysts, four cases. Hergt,^ on the other hand, has found
that two-thirds of the cases coming under his observation,
presented sexual anomalies. He has very properly included
retroversions etc., but gives no details as to the type of
mental disease or age of the patient. In the clinic of Mier-
zejewski,* I have examined forty-two insane women and
three hysterics from nineteen to sixty years old with the
following results: six, past the climacteric (aged forcy-four
to sixty-two years) presented no other change than senile
uterine atrophy. Thirty-five of the remainder presented
various types of sexual anomaly. L. Mayer has found
that out of one thousand and twenty-five gynaecological
1. Psychological Medicine.
•2. Archives of Medicine. February, 1S80.
3. Wuertemburger Correspondenzblatt. Ko. XL.,1S^.
4. Journal of Mental Science, 187-2.
5. ZeitBchrift fur Psychiatric. Band XXVII.
6. Biblioteka Medesinokaia. No. V.,1SS1.
Ii6 6". Danillo.
cases, ninety were associated with mental alienation. My
researches are in marked contrast with those of other
authors, particularly Skene and Tuke. As to the result
of the autopsies by Howard, Keiser and Hergt, it must
be remarked that, even without taking into account the
fact of their differing results, these can have but a
very relative value, since the functional and slighter
pathological changes must necessarily escape observation.
Since the deductions from my own observations already
cited must be made with some reserve from the limited
number, I have resolved to augment this in order to make
generalizations which would tend to define the question
more clearly. In each case there was taken, the age of
the patient ; type of mental disease ; physiological state
of the female (virgin or not, births and miscarriages), form
of sexual anomaly. The diagnosis was always made by
touch and the speculum. The patients numbered one
hundred and fifty-five ; my researches in toto would there-
fore cover about two hundred cases. The patients' ages
were between fifteen and seventy-five years. The meno-
pause had occurred in patients aged from forty-two to
seventy-five years ; sixty in all. One hundred and forty
were still menstruating ; of these, thirty-one were virgins,
forty-one non parturient non virgins, sixty-eight mothers,
of whom thirty-eight were primipara and thirtj' multipara.
Of those who had reached the menopause, two were vir-
gins, four non parturient non virgins, forty-four mothers
(nine having had from eight to twelve children.) The
types of mental disease were : idiocy, one case ; epileptic
insanity, fifteen ; hysterical insanity, fifteen ; progressive
paresis, fourteen; chronic mania, thirty-one; chronic alco-
holic insanity, two ; secondary dementia, ten ; melancholia,
twenty-five ; melancholic furor of puerperal origin, five ;
acute mania, eighteen ; acute puerperal mania, eight.
The types of insanity in the patients past the menopause
were : terminal dementia, twenty-eight ; chronic mania,
nine ; progressive paresis, ten ; chronic alcoholic mania,
three ; melancholia, ten.
Female Diseases Aviong the Insane. 117
Of these two hundred cases, one hundred and thirty-
one presented diverse lesions of the sexual apparatus.
In the cases whose physiological functions were in full
activity, the sexual anomalies presented were : Endo-
metritis, with chronic metritis of the fundus, forty cases;
twenty-eight being accompanied with cervical metritis and
endometritis ; twelve with some degree of ulceration.
Chronic metritis diffuse of the fundus and neck existed in
eight cases, and of the body only in four cases. Men-
strual disorders in general (suppression or retardation)
existed in eighty cases. These figures, however, are not
exact, and have but a relative value. Uterine anomalies
of position were found in forty-four cases; associated with
endometritis in thirty-eight cases ; and, still further, com-
plicated with metritis in twenty cases. Six out of eleven
cases of alterations of uterine position were associated
with para, endo, and metritis; the others with chronic
oophoritis. Perineal metritis of puerperal origin was found
in four cases of puerperal insanity ; four cases of vulvitis
and seven of vaginitis were found. One case of puer-
peral insanity was complicated by a large ovarian cyst.
One case of acute mania had a large uterine fibroid. A
urethral caruncle was found in one case of acute mania.
Ovarian hyperaesthesia was found in eight cases (two
of the right, two of the left). There were, beside the
cases of senile uterine atrophy already noted, found in
the menopause patients, six cases of chronic diffuse
metritis ; three cases of long standing perineal rupture
and nine cases of senile endometritis.
Sexual anomalies of the female insane are not much
affected by the type of insanity. Out of forty cases of
melancholia, five of puerperal origin, thirty-two presented
different types of female disease. Out of forty cases of
chronic mania, thirty-four were complicated by sexual
disorders of the same type as those of the melancholiacs.
The maniacs and progressive paretics presented about
the same ratio. Out of thirty-eight cases of dementia on
the other hand, but twelve were complicated by sexual
Ii8 5. Danillo.
disease ; but of these thirty-eight, ten had passed the
menopause. Ten out of eleven hysterical cases presented
diverse sexual anomalies Of the one hundred and forty
menstruating females, one hundred and twenty presented
sexual anomalies. Of the sixty menopause patients,
eighteen only did so. Insanity, before the menopause,
eighty-four per cent, of the women present sexual anom-
alies. While of those who have passed the menopause,
but twenty-eight per cent present these. The menopause
therefore exerts an influence.
The result of my researches may be summed up as
follows : The complication of insanity by sexual anom-
alies is very frequent during the persistance of physio-
logical functions. After the menopause such complica-
tions are rare. Pregnancy and delivery exert an influence
in the production of these anomalies and on their relation
to the menopause.
If the fact be admitted that there is an intimate rela-
tion between the sexual nervous system and the central
nervous system in the female, it will be readily seen
that all irritation which radiates from the sexual organs
may react strongly on an already affected brain. Here is
found a very vivid illustration of the saying of Mauper-
tius that infinitesimal causes frequently repeated, lead to
important results.
On the Pathogeny of Hallucinations in
Reference to a Case of Voluntary
Psycho-Sensory Hallucinations in an
Alienated Person.*
T
By D. V. Parant, M. D.,
PHYSICIAN TO THE ASYLUM OF TOULOUSE.
(Translated by A. H. Ohmaxs-Dcmssnil, A. M., M. D., St. Louis.]
HE question of the nature and origin of hallucinations
is not yet completely solved. After the researches
of Baillarger, of Brierre de Boismont, of Michea, and of
others; after the discussions held in the Medico-Psycho-
logical Society ; after the recent works of Drs. Despinef
and Regis, I who have again called attention to this sub-
ject, it will doubtless not seem out of order to make
known a case which I have observed, and which, on
account of its interesting details, seems to me to have a
real importance in regard to this point. But first of all,
and in order to draw suitable conclusions from the case,
the state of the question must be briefly set before us.
Numerous theories, which it is unnecessary to enumer-
ate, have been given on the origin of hallucinations. It is
sufficient to remember that all have for a common object
to determine the part which is played by the intelligence
and that by sensation, in the production of the morbid
phenomenon. And it is a fact that it is impossible to
search elsewhere than in the abnormal modifications of
the intellectual or sensory functions for the starting point
of hallucinations.
Among all these theories, but two have any great
weight. The most, recent is due to M. Luys and M.
Ritti, who have skillfully maintained it. According to
•From the Annales Medico-Psvchologiques, May, 188.'.
t Or. Despine, Theorie Physiologique de I'Hallucination. (Annales Medico-
PaychologiqueB, Nov., 1881 )
i Dr. Uegls, Des Uallucinatlons Unilaterales. (L'Encephale. ilarch, 1881.)
120 D. V. Parant.
them, hallucination is a purely reflex phenomenon, an act
of cerebral automatism. They start out from the principle
that the ganglia, centers of perception of the sensory-
organs, have certain powers in respect to the function of
different organs. In the normal state, these powers are
only evoked by the influence of external agents ; in the
morbid state, on the contrary, they acquire a complete
spontaneity, and the false sensation is but the result of
the abnormal action of the central ganglia.
This explanation, which excludes all direct interven-
tion of the intellectual element, has certainly the merit
of being simple and easily understood. But it is open to
several objections, and, as we will prove further on by
the case we will cite, it has particularly the fault of not
being applicable to all cases of hallucinations. The other
theory, the oldest and most generally accepted is that of
Baillarger, and maintaining that the point of origin of
hallucination is, and can only be, the intelligence. The
imagination acting upon the brain, its organ, gives to the
centers of perception a mode of acting analogous to that
which they receive in presence of an impression really
perceived by the organs of sense.
But here present themselves, several secondary ques-
tions which demand solution: How is the morbid phen-
omenon produced? Does the intelligence always act
independently of an abnormal modification of the sensory
system ? What is, in all cases, the share of the organs of
sense ?
M. Baillarger has not taken up the study of these
different questions ; he confined himself to establishing a
fact, viz., the certain and primary intervention of the intel-
ligence. The researches of Drs. Despine and Regis, which
confirm the facts acquired by Baillarger, also complete
them by determining the share which appertains to the
senses and the intelligence.
Basing himself upon cases of unilateral hallucinations.
Dr. Regis admits that a hallucination may have for real
origin a pathological modification of the sensory organ in
The Pathogeny of Hallucinatiovs. I2r
which it is localized. " But," says he, " the hallucination
becomes really such only when the intelligence steps in."
And the reason that he gives for this is, that if it was not
thus we could not explain why the same sensory lesions
do not always give rise to hallucinations, still more, to
the same hallucinations. Despite a case he quoted of a
hallucinated person cured of his mental disease, at the
same time as of a disease of the ear, this argument does
not appear decisive to us ; for if the same sensor}' lesions
do not always give rise to hallucinations, it is because
there is not an absolute relation, that of cause and
effect between the one and the other, and it is simply a
coincidence. It is possible (and we believe this is often
the case) that an hallucination may be localized in a
certain organ of sense, on account of a former peripheral
or central lesion of that organ. But it often happens that
the organ in which the hallucination is localized is sound.
The false sensation must arise somewhere else. The
coincidence was none the less important to note, and, in
this respect, the paper of M. Regis is of considerable
interest.
In the memoir of Dr. Despine, we find facts of the
the greatest importance. These are relative to hallucina-
tions of sight, which became double under the influence
of an artificial strabismus, whereas the}^ were single where
the eyes were normal in position.
Analogous to these are the cases communicated to
the Societe de Biologie, at its meeting of Dec, 17, 1881,
by M. Fere, concerning certain hallucination of vision in
hysterical persons. M. Fere has proven that in these
hallucinations, the object is really seen as a real object,
and that it is seen with both eyes according to ordinary
physiological laws. Indeed, if a prism be placed before
the eyes of the patients, these women immediately see
two images, and the false image is placed in accordance
with physical laws.
There is in these facts the evident proof, first, that in
dure hallucination there is a sensor>' and an intellectual
%Z2 D. V. Parant
element ; second, that, to localize itself in a certain
sense, the hallucination employs the aid of the organs of
that sense ; third, that the hallucination localizes itself
when the organ is perfectly normal and consequently that
it is outside of the sense itself that we must look for the
origin of the morbid phenomenon. Another conclusion
to be drawn, is that M. Baillarger has well characterized
hallucinations in denominating them " psycho-sensorial "
It remains to establish that the point of departure of
hallucinations is really in the intelligence. We find irre-
futable truth of this in cases of voluntary hallucinations,
similar to the one we will relate. To impress its full
value to our observation, we must first exclude two species
of voluntary hallucinations which are pretty common but
very different from that which occupies our attention and
which, not being properly hallucinations, cannot be taken
into account.
In the first place, there are persons particularly gifted
(artists, musicians, painters) capable of so concentrating
the faculties of the mind, that they succeed in mentally
representing images, conceiving sounds, as if they saw or
heard them in reality. Brierre de Boismont has studied
cases of this kind in detail, and he makes this the start-
ing-point of his theory of hallucinations, which, according
to him, consist above all of a mental representation more
or less vivid and clear. But the persons of whom he
speaks are not really hallucinated, and only exercise in
an extraordinary manner, their memory and imagina-
tion.
In the second place, there are patients capable of
experiencing, what M. Baillarger has termed psychic hal-
lucinations and that Michea calls false hallucinations.
Although in this latter case, the phenomenon is more
really morbid than the preceding, the manner in which
the individuals explain the impressions they experience,
shows clearly that they are not true hallucinations. They
have, they say, the power of hearing the language of one
50ul to another, the language of thought; they hear
The Pathogeny of Hallucinations. 123
internal voices ; they believe themselves endowed with a
sixth sense.
The majority of the individuals who comprise the
first group, are of sound mind and understand the nature
of their impressions. In the second group can be little
else but alienated persons who beheve in the reality of
what they imagine. The one and the other have in
common the power, and at will, of easily passing into an
imaginary world. The part played by their mental facul-
ties, in this operation, is easily understood and it is
evident that the intelligence only is concerned. But as
these are not true hallucinated persons, they cannot aid
in proving the intellectual origin of hallucinations.
Outside of these two groups of individuals, capable of
having voluntary, false hallucinations, there are also others
who can also voluntarily have real hallucinations, such a?
M. Baillarger calls psycho-sensorial, and in which the
sensitive morbid impression is, without doubt, exteriorized.
Michea has no doubt of this, and others have with him
asserted this. M. Baillarger, on the contrary, seems to
think that in all cases of voluntary hallucinations, there
can only be psychic hallucinations. Our case seems, in
this respect, absolutely convincing ; it is as follows :
Miss X., aged thirty-eight was confided to my care
in 1877 ; she had been ill for several years. She is
attacked by a mental disease characterized chiefly by
delirium of persecutions and by hallucinations. Since I
have observed her, this delirium of persecution with hal-
lucinatious has always been most manifest; it consists in
Miss X. believing herself to be the constant object of
criminal attempts upon her person, from which she seeks
to escape by a thousand different ways; at one time she
remains motionless for hours against a wall, the legs
tightly closed ; at other times she wishes to sew her
skirts and dresses. At night she accumulates bed-cloth-
ing. The women who approach her are men who have
designs upon her virtue. Men are naturally held in
greater suspicion ; a few, whom Miss X. names, have
124 D. V. Parant.
gotten into her bed at night ; she has felt and touched
them, and details their attempts against which she pro-
tests.
Miss X, has, besides, hypochondriacal ideas. She often
believes her intestines to be stopped up, and is ceaseless
in her demands for purgatives. Every moment she com-
plains of ailments which are purely imaginary. The
hallucinations are numerous and almost incessant ; she ex-
periences all those which torment the most ill of alienated
persons ; revelations, menaces, suggestions, future or distant
voices coming either from buildings or caverns which she
believes exist under the house she occupies and in which
she hears the groans of unhappy victims, the members
of her family, etc. What she writes, like what she says,
shows the multiplicity of her delirious ideas. The follow-
ing are two interesting extracts :
October, 1877. Since the ninth of this month, I have
been frequently told, at the extremity of the walk, the
reason of my sojourn here, as well as of my companions.
We are all subjects of the bulls of St. Thomas, according
to which the State affords temporary imprisonment ; my
time, they say, is one hundred and six days. It is added
that it ought not to have been imposed upon me as a
great example, having preceded them ; but the people of
the city had to be satisfied. Consult upon this the code
on the different articles of examples, bulls, police regu-
lations and one hundred days and more.
May, 1879. I certify that a sensible diminution of the
menses having persistently declared itself since Sept 2,
1878, that of this month really makes me fear a great
coagulation in my bowels, and perhaps an accident lead-
ing to pregnancy. To destroy this act of suffering, I
should have remedies reserved by the civil laws, to which
I am entitled. Here I am deprived of the inviolability
of my residence. For the laughter and conversations in
the panels, I am all open.
The short extracts depict well the mental state of
Miss X. But it is not only as a persecuted and halluci-
nated alienated that I wish to show her; in this she
resembles many other persons. What constitutes an
The Pathogeny of Hallucinations. 125
interesting peculiarity of her hallucinations, what distin-
guishes her from the mass of aUenated, is that Miss X.
spontaneously excites some of her morbid sensations, as
we shall see.
She has complaints or requests to make ; she comes
to us to make them known. Generally, the answers she
receives do not satisfy her. Then she goes to a locality
which she prefers, either near the course of a streamlet,
under a wall or near a window with closed blinds, more
rarely behind a door. She strikes several small blows to
attract the attention of invisible interlocutors ; after wait-
ing a few moments, she is informed that they are there,
and the conversation begins. " Major, " says she, (she is
most frequently engaged with majors) , " I have asked
such and such a thing and I have been answered such
and such a thing. What do you think of it?" A pause,
during which she listens ; she speaks again, becomes
silent, recommences ; and after this performance has lasted
several minutes, she comes and tells us that the informa-
tion she has received does not agree with my words and
that we ought to let her free to act otherwise than we
permit. At other times she consults her majors because
she is told to take food which does not suit her; to work
or obtain something which is disagreeable to her.
Sometimes, whilst peacefully sitting among other per-
sons, if anything displeasing to her occurs, she suddenly
rises, goes to the center of the garden or near the wall,
calls in a loud voice, Hstens, speaks and comes back
seating herself, saying that the majors disapprove of what
occurred. No one about her mistakes that which she
experiences, and it is impossible, for the patient, to doubt
of the reality of these pretended conversations which
she has caused. She is undoubtedly in good faith, as her
attitude shows. Here is an extract from one of her let-
ters, proving her sincerity :
" Yesterday, towards ten o'clock in the morning, giving
news of myself in one of the conchas (sea-shells) of the
yard, I heard the major observe that the first substitute
126 D. V. Parant.
is slow or powerless to obtain my release. / sent at the
top of my voice this question to the grating : ' Do the
officers refuse an escort, or the prefect his underlings ?
Then the major answered and informed me that it would
require two sergeants of the sword and not assessments.
At twelve a fife sounded at the gate of the walk, but
did not approach that one which I was knocking to show
my presence. * * * Here is the maul with which I have
struck nine times the neighboring gate of the town-office,
where Majors Pezeux(?) and De Kers(?) are to hear my
demand in order to obtain my release, indefinitely deferred,
as soon as possible ; it is at eight, twelve and two that
I make my demands. "
To establish beyond doubt that it was with true vol-
untary hallucinations that we were concerned, that is,
with psycho-sensory and not with psychic hallucinations,
we observed the patient with the greatest care, and this
is what we found : The voices which she hears in the
conversations which she starts, belong to several different
persons; ordinarily she designates two majors, as we have
seen, under the fantastic names of Pezeux and Kers.
The one has a graver voice than the other. When she
does not interrogate them directly to obtain advice from
them, she leaves them at times; then their voices are
confused, like a murmer, and their speech only becomes
clear when she speaks to them. At times, when interro-
gated, they do not answer immediately ; they commence
to converse in a low voice, as if to prepare a concerted
answer. Then the patient does not hear what they say
to each other. In the beginning, she only heard them
behind a wall, behind the blinds of a room, and she had
had to go and speak to them where they happened to
be. This is yet, ordinarily, the case ; sometimes she can
hear them murmer, speak in a low voice near her where
she may be ; and she need not move in order to question
them. The patient very positively asserts that she hears
with her ears, and not mentally nor by the aid of any
extraordinary sense.
It is very evident that this hallucinated patient presents
very clearly the power of having at her will false auditory
The Pathogeny of Hallucinations. 127
sensations, and of making herself answered by voices she
believes she hears in sentences complete enough to con-
stitute an entire conversation. She believes in the reality
of what she hears, and does not admit that she is hallu-
cinated. She differs a great deal from the other ahenated,
who are only passive in the presence of the morbid
phenomenon, and who do not hold coherent conversations
with their invisible interlocutors, or, at the least, do not
provoke them and do not seek after them. She plays an
active part, and takes the lead, evidently, in the produc-
tion of some of her delirious ideas.
These provoked hallucinations, and willed by her, are
evidently produced under the following conditions: The
patient unconsciously formulates to herself what she
desires or wishes. In this frame of mind, she questions
her majors, who give her answers in accordance with the
preconceived ideas. The answers, previously prepared,
shape themselves as soon as the question has been made,
and, as a consequence of the morbid conditions, become
a true hallucination. In all that has been produced, there
is certainly a primordial intellectual operation, a manifest
influence of the imagination or the placing in activity of
the centers of perception.
If, in spite of the clearness of the fact, it were neces-
sary to demonstrate that the sensory system only acted
after the intelligence, the proof should be found in the
nature and variety of the answers, of the words heard by
the patient. The abnormal vibrations of the sensory
system are of themselves impotent to produce such a
diversity, and can only originate among false sensations,
uniform sounds, or confused sounds, or at most few words,
and indefinitely spoken.
This is generally the case with most hallucinated in
whom a menace, an insult, a short phrase or one or two
words often repeated constitute the hallucination. We
will not disguise the fact that there is here a combination
of operations and modifications difficult to follow. We
could, doubtless, in order to explain them, employ the
128 D. V. Parant.
formulas given by Dr. Despine in the work we have
mentioned. We could say with him that the centrifugal
nervous activity has carried on the cerebral excitation,
creator of the idea, first to the sensitive ganglion, where
this idea has been made sensible, and then to the external
organ of sense, which has been impressed as if by an
extraneous object. But this centrifugal nervous activity
is as yet but a hypothesis. We prefer to limit ourselves
to a recital of the fact, where range is incontestable, that
is, the existence of psycho-sensory hallucinations, volun-
tarily produced by the person hearing them, and in which
the imagination, the thought, has elaborated the elements
of the morbid sensation before it has become real and
sensory, and before it has "exteriorized" itself.
Depending upon this acquired truth, we are led to
recognize that it is not possible to see in voluntary
hallucinations the result of a simple automatism, or the
bringing into play of the reflex properties of the cerebral
cell. From which it follows that the theory of automa-
tism is imperfect, as not being applicable to all cases.
On the other hand, we find there a complete confirmation
of the conclusions of M. Baillarger, that hallucinations
produce themselves from within without ; that is to say,
are conceived by the intelligence before being localized in
this or that organ.
We will make but one reservation to these conclusions,
and it refers really more to a word than to a thing.
M. Baillarger, speaking of the conditions necessary to
produce hallucinations, says that there must be " the
involuntary action of the memory and of the imagination."
Would it not be more exact to say the " unconscious
action ? "
In our case, we see a patient who has hallucinations
excited and willed by herself, but who has no conscious-
ness that she wills them. She spontaneously transforms
into hallucinations that which is but the expression of her
thought and of her will, but who does not account to
herself that she thus has hallucinations. She voluntarily
The Pathogeny of Hallucinations. 129
exercises her mental faculties, but this exercise is entirely
unconscious.
The conclusions to be drawn from this note, and the
case which forms its subject may be summed up in the
following manner : The senses, diseased or sound, have,
each one in its own regard, a certain share of action in
the production of true hallucinations.
There are cases of voluntary psycho-sensor)' hallucin-
ations in the insane, which, in their production, demonstrate
without doubt the primary original influence of the intel-
ligence.
SELECTIONS.
FORENSIC PSYCHIATRY.
Il Processo Guiteau. Notes by Prof. Arrigo Tam-
assia [Revista Sperimentale di Freniatria e di Medicina
Legale, Reggio Emilia, Italy, Anno VIII., Fasciolo III.,
1882). — The Trial of Guiteau, by Professor Tamassia. —
The so-called human justice, but more particularly that
of America, will never more have the opportunity of
becoming overheated by that swaggering vehemence
of a few months back, which it exhibited towards that
most offensive intrusion — the forensic medicine of mental
alienations. The hangman from New York has elegantly
truncated its every apprehension and silenced every clamor.
Over the cadaver of Guiteau, now are silent the ignoble
potentates of the streets, the unblushing presumptions of
American legists, the inhuman fiscalism of certain doctors,
gifted with opportune knowledge and hungry brains, who
have made of this trial one of the most shameful pages
of modern judicial history. These parties and persons of
the same order, who dreaded the flooding of America
with the piteous doctrines of Europe, can now breathe
tranquilly and console themselves with the malign com-
placency of having escaped a grave peril, and now that
there is no further danger, they may boast of having
cordially applauded and assented to the capital punish-
ment of Guiteau, thus displaying a symbol of their
sympathy for his illustrious victim. Silence now reigns.
1 30 Selections.
and, perhaps, those who with so much frenzy called for
the blood of the culprit, have forgotten their heroic efforts
of those days. But that science which, in the name of
right and truth, contended so manfully against the pop-
ular fury for the life of the assassin, does not surrender to
the victory of violence. It calls for new light on that
tragedy, and it appeals no longer to the voluble responses
of citizen magistrates or of the political press, but to the
minds and the hearts of honest men; to the authority of
those enlightened ones, whose solitary judgment is by
far more precious and decisive than the quasi automatic
unanimities of many deliberating assemblies. Behold now \
many of our colleagues who have taken, as experts, a less
part in this memorable trial, are lo the front with
relations and new informations, intent on presenting the
psychological problem to the tribunal of history and of
science. Some pessimists may tell them these posthumous
protests are but the whinings of discomfited personal
ambition ; that they are but bestirring themselves to raise
again a wave now dead by scarifying, after having failed
to demolish, the respectability of a judgment so solemnly
pronounced. Some, too, of those jurists with placid
stom^achs, who made merry over the responses of the
accused, and in their cross-examinations diverted them-
selves by casting nets to entangle the experts with riddles
and charades, may continue still to laugh at every severe
objection which may now be made to the commotions
excited by them in the audience. The whole of this
surpassingly good trial may now dine with comfort;
" write as you will," say they, " but your Guiteau will not
be resusciated, and your ink will certainly not obliterate
the mark of infamy with which we have branded him."
We concede, with all good grace, these consolations to these
gentlemen. But it is not to them that the protests of
science must be directed ; they would believe they perform
a loyal duty by rehearsing with unabated enthusiasm their
great deeds, even though the problem of the mental
state of the accused should, by new studies and new
documents, be established by the very highest grade of
evidence. Our protests are, on the contrary, destined for
that portion of the public who, not sharing in the theatric
emotions of a State trial, and not bending to the tumult-
uous despotism of party politics, are able to distinguish
where science commences, and where sophistry and ignor-
ance obscure. It is from this sane part of public opinion,
Selectio7is. 131
from the response of men of true science, that we are to
expect the service of inducing a salutary reaction in the
pubHc mass by well convincing it that the most arduous
problems of science must not be brutally solved by the
passions of the street, the suggestions of the interests of
the moment, or the instinctive perception of the ordinar}-
sense of the vulgar crowd.
And we of the Revista, who endeavor ever to hold
high the rights of science, cannot remain inert m the
presence of these publications, which review and analyze
all the phases of this strange case. We treasure up all
the materials which our confreres of America are sending
to us, and we have studied to draw from them a faithful
history, which we shall offer to the judgment of our readers.
To us it is not a question bedaubed with politics as it
was in America ; it is a question abstractly scientific. Its
echo and its example will not, we trust, be without effect
on that fraction of our public, and of our magistracy,
who, not being American, will regard with less evil eye
the fact of the gallows and the galley have not been
adopted with any certain liberality as the fittest expedients
for practically defining, in certain intricate cases, the prob-
lem of responsibility. In the meantime, our readers shall
see the biographic records of Guiteau hereafter ; the trial,
the expert researches, the autopsy and our impressions.
Remarks by the Translator. — " To see ourselves as
others see us," the Scottish poet said, " would from many
a blunder free us." But who, at such a cost, would
choose to shun the danger? Were we sure that the view
taken of our words and acts by others would, at all times,
and in all circumstances, be clear and free from prejudice
or misconception, then might we, with better trust, defer
to the opinions of our neighbors or friends. Professor
Tamassia, in the preceding ver}- eloquent preface to his
thesis on the case of Guiteau, has, with more than an
ordinary degree of frankness, indicated to the American
people, but more especially to the members of the legal
and medical professions, his estimation of their moral and
intellectual attributes. Regarding, as we do, everything
coming from the pen of this illustrious Italian, as well
meriting serious consideration and sober criticism, we feel
It to be our duty, alike towards him and our own fellow-
countrymen, to offer a few observations on the more
salient, and, perhaps, we might not unjustifiably say, the
less generous passage of his preface.
132 Selections.
We might, in due order, begin with his first words,
in which he bespeaks the contempt of his readers for
" the so-called human justice, and more particularly the
American," but we deem it better to give antecedence to
a subsequent passage, to which, as a member of the
specialty of alienism, and *' particolarimente r Americana,"
did we not object, we should have good reason to feel
that we have been very indifferent to the good fame and
professional competency of our confreres.
"Sul cadaver di Guiteau," writes Prof. Tamassia, "tacciono
ora quelle ignobili prepotenze della piazza, quelle spudorate
prosunzioni dei legulei Americani, quell inumano fiscalismo
di certi medici a coscienza opportunista ed a cervello
digiuno, etc." Now, as to the ignoble potentates of the
market squares or the public streets, we do not feel
called upon to shed much ink or many tears. We believe
that between our American roughs and the Italian furfanti
there is no very wide intellectual or moral difference.
Indeed, considering the fact that the population of our
American cities so largeh- consists of the outsweepings
of the nations of Europe, it would be more than marvellous
that our " ignoble street potentates " should have left
behind them all their faults and follies, all their ignorance
and long inherited mental inertia ; so let them pass, and
so, too, do we pray let pass the "shameless presumptions
of American lawyers," for, poor things, their morality, as
everybody well knows, is a thing of pure conventionality,
their function is that of reluctant lingual gladiators, and
they are as like their brethren of the old world as two
black sheep are like each other.
But now we come to something that stings more
deeply, something that wounds so lethally that we cannot
avoid crying out in the dying words of the professor'^
illustrious countryman, tii. qjioqiie Brute ! We are not
sufficiently master of idiomatic Italian to have felt justified
in rendering into English vulgate the words " inumano
fiscalismo; we might be unjust to the writer did we
interpret his words by our common phrase, " the reckless
love of gold," and perhaps even more so, should we turn
them into the classic American, " worship of the almighty
dollar." These terms, however, would be more intelligible
to our readers than the two polysyllables of Prof. Tam-
assia, but they would be so repugnant to professional
decorum, and so insulting to the medical profession of
America, that we would rather fail in exact translation
Selections. 133
than believe that they expressed the deliberate conviction
of the author. Again, we must instance the harsh
expression, " coscienza opportiDiista.'" Whether we have
incorrectly softened these words by the English " oppor-
tune hiozvledge'' we do not feel certain; they certainly,
without any detectable perversion, might be rendered
opportune conscience, or in our Anglo-Saxon every-day
tongue, co7wenient conscience, and this commodity would,
we think, better harmonize with the Professor's " cen>ello
digiunoy for a starved or fasting brain would better con-
sort with a convenient conscience than with opportune —
that IS ready to order — knowledge.
But soften it or disguise it as we may, and as the
warmest admirer of the distinguished Italian medico-legal
jurist might feel constrained to do, we find it impossible
to withhold our disapproval of the language of Prof Tam-
assia towards the medical experts who testified to their
belief in the sanity of Guiteau We are all liable to
error; we neither say they were in error, or the contrary;
nor whether their testimony was well founded or ill
founded. We have known several of them for many years,
and have learned from year to year to esteem them more
and more, and we cannot, even from a far off foreign
land, bear to see their well-deserved good fame sarcas-
tically assailed.
Three or four years ago, when the distinguished Tam-
burini closed his introduction to the report of the com-
mission of experts, who were appointed to examine the
would-be assassin of King Humbert, he used the following
language : " Noi per altro albiamo la coscienza di avere
in tutto e per tutto adiempieto al nostro dovere." We
never, for a moment, doubted the sincerity of that highly
accomplished alienist, and even had we believed that the
finding of the commission as to the mental condition of
Passanante was erroneous, we would not have been
tempted to insinuate that their decision was tainted by
the inhuuian fiscalisni of hungered brains, or the plasticity
of accommodating consciences. Prof. Tamassia never, so far
as we are aware, wrote a line in censure or even in mild
criticism of that finding ; and yet we honestly believe that
between the cases of Passanante and Guiteau there
were so many features of resemblance as to constitute a
parallelism which might have prescribed to any prudent
Italian censor the expediency of eschewing, not alone all
verbal severity, but still more, all sarcastic allusions to the
1 34 Selections.
action of his foreign brethren. Indeed, we confess our-
selves unable to evade the conclusion that Tamassia s
rhetorical gun is a double-barreled weapon, or, if single,
it was either double shotted or crooked enough to carry
round a corner. Neither our time nor the space at our
command permits us to enter on the demonstration of the
parallelism between the mental characteristics and the
crimes of Passanante and Guiteau ; nor do we feel at all
disposed to retort on our esteemed confrere by instituting
a comparison between the manifestations of public senti-
ment or popular denunciation, which were alike displayed
in Italy and America, in connection with the two assassins.
Right heartily could we sympathize with the illustrious
Tamburini when he felt himself constrained in alluding to
the difficulties encountered by the Passanante commis-
sioners, to use the following language :
"There certainly was not preserved to the experts, that
calm and serene surrounding which is necessary to those
who should judge impartially, according to science and
conscience(?) ; on the contrary, pressure was brought to
bear on us from all quarters, that we should, with all
speed, complete our task ; the newspapers and the par-
liament, in which the voice of a minister styled us a Psy-
chiatric Acadifny, vied with each other in pressure on the
magistrates and ourselves. Yet surely, if there ever was
to experts a position of the most grave responsibility,
both before the tribunal of justice and in the face of the
entire nation, this was one ; and if ever there was a case
in which it was important to analyze and accurately to
weigh every fact, to sever appearances from realities, exter-
nals from inmost psychological mechanism, this was one."
We content ourselves with the citation of this one
passage from the eloquent preface of Prof. Tamburini,
which is in truth almost throughout a continuous lament
over the flagrant indecency of both the general public and
(which is still worse) of the public officials, in their
relations with the prosecution of Passanante. With all
becoming deference to the eminent Prof. Tamassia, we
now venture to say, that if the trial of Guiteau has been as
he has characterized it : " one of the most shameful pages
in modern judicial history, " it has the honor of not stand-
ing alone ; and if Prof Tamassia has seen, in the exhibi-
tion of popular passion evoked on this side of the Atlan-
tic by the crime of Guiteau, anything more scandalous
than has been (faithfully, we doubt not.) recorded by
Selections. 135
his worthy friend Tamburini, in connection with the case
of Passanante, we can merely say that the atmosphere of
Italy is less clear than we have heretofore believed it to
be. We would now ask, whether, had the Passanante
commission found the offender insane, the Italian street
potentates would have bowed deferentially to their decis-
ion? "Fortunately," wrote Prof. Tamburini, "the judg-
ment (whose ?) was such as to tranquillize completely the
public conscience, and to expose the wrong of the sus-
pectors and distrusters of psychiatry, who suddenly, as
if by magic, ceased to clamor. "
After all, human nature is as like itself in Italy as it
is in America.
CLINICAL PSYCHIATRY.
Abstract os Meningeal Tuberculosis of the Cere-
bral Convexity. By W. JuHus Mickle, M. D. Medical
Times and Gazette, London, April 15, 1882. — The cases are
reported partly for the medico-legal interest. The principal
points in the first case were briefly these :
In a patient with advanced pulmonary phthisis we find
life somewhat abbreviated by the oncoming of cerebral
symptoms due to extensive meningeal tuberculosis of the
convexity of the brain, with incipient inflammation. And
we particularly note the short duration of any cerebral
symptoms, and their slight and ambiguous character,
notwithstanding the considerable lesion of the brain.
There is no reason why death might not have been
brought about in a similar way early in the course of the
case ; and it is evident, therefore, that under certain contin-
gencies, such as may, and will, every now and then occur
in practice, cases of this kind lead to more or less
obscurity as to the manner and cause of death, and to
possible medico-legal enigmas.
The patient, a soldier, aged 41 ; formerly maniacal,
latterly somewhat demented; the subject of chronic pul-
monary phthisis, and of occasional attacks of bronchitis
and of diarrhoea ; became bedridden eleven days before
death. Four days before death he was feeble, emaciated,
and his pulse rather slow. Thus he remained until the
day before death, when cerebral symptoms were first
noticed. For on this day he was mentally dull, apathetic,
drowsy ; paid but little attention to his surroundings, or
1 36 Selections.
to questions put, or to his comforts, wants or inconven-
iences ; when addressed, was slow to understand, and
brief, or even irrelevant, in his replies. Swallowing was
slow and difficult, and some hiccough was noted. Tem-
perature, 98°. No perceptible spasm or paralysis. From
fraction of minute to fraction of minute the pulse rate
varied from 78 to 96 ; and the respiration, 26 per minute,
was of a modified Cheynes-Stokes' character. On some
occasions there was only an ascending and descending
respiratory rhythm ; but at others, a distinct apnoeal period,
though only a brief one, was added. In the latter event,
the respiratory period consisted of five or six respirations
gradually increasing in fullness and loudness, and it alter-
nated with a recurrent pause in breathing, which com-
pleted the respiratory cycle. At first, the pulse was
rather slower during the respiratory period ; subsequently,
not. Later on, the respiration was more regular ; but,
still later, it reassumed the Cheynes-Stokes' form. Left
hand and feet, oedematous. Urine, non-albuminous.
At the necropsy, the meningeal veins were turgid over
the posterior upper aspect of the cerebrum. Numerous
minute whitish tubercular granulations existed in the pia-
mater over the upper and external surfaces, or the con-
vexity, of both cerebral hemispheres. These were more
numerous over the right hemisphere, where also, at points,
the granulations had coalesced into larger nodules, which,
while adherent to the pia-mater, were partly embedded in
the cerebral gray cortex, the surface of which was left
eroded at these points on removal of the meninges. The
right second and third frontal, posterio-parietal and supra-
marginal gyri were those mainly thus affected. Brain
flabby ; slightly wasted. Turbid serosity in lateral ven-
tricles ; and some softening of fornix and corpus callosum,
Phthysis pulmonalis ; bronchial lymphatics tubercular;
slight tuberculosis of kidneys, and tubercular ulceration
of the small intestine; old pleuritic, perisplenitic and peri-
renal adhesions.
The mental symptoms supervening on the meningeal
tuberculosis were not distinctive. The expiratory condi-
tion was an exaggeration of that sometimes occurring in
meningitis of the base. Here the so-called cortical motor
zone was somewhat affected, and yet without decided
motor symptoms being observed. The supposed cortical
visual centers were considerably affected, but without
prominent visual symptoms.
Selections. 137
The second case was that of a soldier, aged 31 ; hallu-
cinations of hearing and of touch ; listlessness, failure of
memory, and of attention, and slight depression existed.
Pulmonary tuberculosis, onyxitis, and finally, slight pleurisy,
preceded death. For two or three days before decease he
had " pain all over," and on the last day of life was slightly
delirious and loquacious.
Necropsy. — Moderately firm, whitish granulations over
the posterior part of right angular gyrus ; yellowish nodules
just above middle of right ascending parietal gyrus, partly
embedded in the gray cortex, some being buried in the
fissure of Rolando, and all appearing together as an irreg-
ular mass formed by the fusion of several nodules, which
were caseous internally, and connected by firm fibroid
tissue. On the under surface of the right occipital lobe
the membranes were the seat of numerous, almost confluent,
dirty-whitish granulations, which were more or less caseous,
and formed an irregular layer, beneath which the convo-
lutions were softened, pulpy, and of dull-red hue. Scat-
tered granulations were seen on the under surface of the
right temporo-sphenoidal lobe ; similar granulations also
existed over the posterior half of the external surface of
this lobe, and a state of gray cortex, such as is just de-
scribed.— Tuberculosis of lungs and pleura ; recent pleurisy
on right side. Old plueritic and perihepatitic adhersions.
on Caseous abdominal glands. Yellow tubercle of spleen,
and of left kidney.
Here the tuberculosis was of the convexity and pos-
terior base of right cerebral hemisphere, limited to the
distribution of certain arteries. Mental symptoms due to
tuberculosis were of short duration, and motor absent.
Here also, with early and long-continued auditory and
tactile hallucinations, tuberculosis finally befell part of the
supposed right cortical auditory center, and parts adjoin-
ing the supposed right tactile center ; while the right
augular gyrus and part of the right (so-called) cortical
motor zone also suffered, but without the production of
obvious visual or motor symptoms.
FoLiE AVEC Conscience. — Under this title Dr. Cotard
{Archives de Neurologie, September, 1882) discusses a form
of insanity which " is characterized by the fact that the
patient reflects on the sensorial and psychical troubles of
which he is the victim, and who, after analyzing them,
recognizes their morbid nature." It is an affection of
slow growth found in hereditary cases, manifesting, as a
138 Selections.
rule, Morel's signs of degeneracy. The cases cited by
Cotard are really cases of persons dominated by imperative
conceptions, the erroneous nature of which they recog-
nize; but mingled with these are cases reported by himself,
in which the patient, already insane, fears to become so,
but does not recognize his already existing insanity.
Two progressive paretics had ideas of suicide and
morbid fears. One case of the same psychosis had a
dim memory of his expansive delirium. During a remis-
sion, his folic avec conscience is, as a rule, simply the
presence of imperative conceptions in persons hereditarily
degenerated. The metaphysical mania, or griibelsacht of
the Germans, would find a place here, and the various
morbid fears mentioned in the July number of the Alienist
AND Neurologist.
Psychologically, Dr. Cotard's view is rather redundant
and tends to complicate psychiatry. Imperative or dom-
inant conceptions, or morbid fears, occurring in the insane
would sufficiently express this condition.
ScHUTZ ON THE PATHOLOGY OF ATHETOSIS {Pfager Med.
Woch., 1882, Nos. 3 and 4) relates a case of athetosis of
the fingers in a man whose right extremities had become
gradually paralyzed. At the necropsy, he found softening
of the left optic thalamus and also of the head of the
caudate nucleus. The internal capsule was involved,
especially at the junction of the middle and anterior
thirds. The posterior part was intact. In a second case
there were general convulsions, followed by feebleness of
the left half of the body. Later on, there were involun-
tary spasmodic movements of the hand and foot. He
ultimately recovered. Schutz thinks that in this case there
was an inflammatory focus in the right hemisphere, which,
perhaps, involved the same parts as in the first case.
Systematized Alcoholic Insanity.— Dr. Parrel [Annales
Medico Fsychologiques, July, 1882) describes a case of
chronic alcoholic insanity, which, like many of such cases,
is accompanied by systematized delusions of marital
infidelity. The patient acting on these delusions attempted
to kill his wife and threatened her supposed paramours.
Like many of tlie cases of secondary monomania, the
case terminated in progressive paresis.
Senile Progressive Paresis. — A form of progressive
paresis occurring in old age has been discussed by Seppilli
,and Riva, and its pathology outlined. To the clinical
Selections. 139
history of the subject, Dr. Rey {Annates Medico Psycho-
logiques) contributes a case : A man seventy years old
was attacked by progressive general mental enfeeblement
which occurred earlier than is usual in progressive paresis.
NEUROLOGY.
A Case of Myxcedema was reported by A. McLane
Hamilton, M. D., at the Dec. 7th Meeting of the New
York Academy of Medicine, of which the following is an
abstract :
The patient was seen by him in September, 1882.
She looked anaemic and badly nourished. The tissues
were swollen and doughy to the touch. The special
senses were impaired and she was morose and inclined to
seek solitude. The swelling was greatest in the face,
though pretty generally diffused. The skin was the color
of white wax, and shiney like the surface of morocco.
Her hair was thin and dark. Her temperature subnormal,
and the thyroid gland had disappeared. Her pulse indi-
cated a condition of increased arterial tension. She had
numbness of the hands and feet, and complained of a
metallic taste in the mouth. Her gait was clumsy like
that of the general paretic, though improving by exercise.
The tendon-reflex was greatly exaggerated. There were
marked indications of mental failure. The urine, on
examination, contained sugar and earthy phosphates, but
no albumen or casts, specific gravity 1022, The oedema
pitted slightly after prolonged pressure, though the tissues
quickly returned to the general elevation.
The author accepts Hadden's theory of the origin of
myxoedema, that the deposit of mucin depends upon lym-
phatic obstruction and that the mental symptoms are due
to the condition of the brain produced by lesions of the
sympathetic system. Dr. Hamilton believes the trophic
changes to be due to disturbance in the lateral and pos-
terior columns of the cord.
It probably depends upon a lesion primarily of the
bulb, with secondary extension to the postero-lateral
columns of the spinal cord and the spinal sympathetic
ganglia. Cases with muscular atrophy and deep tissue-
changes are rare, and when so found probably indicate
degeneration of the multipolar cells in the anterior horns.
Renal disease is not the cause of the malady, but the
result.
140 Selections.
The Act of Rotation, — Dr. Bechterew {St. Petersbur-
ger Med. Wochenschrift) arrives at the conclusion that
not only injury to the middle and posterior cerebellar
crus, and deep injury to the medulla oblongata, produce
rotation, but that lesion of the inner part of the crus
cerebri in its whole course, from the thalamus to the pons
can generate it. When the inner part of the crus cerebri is
injured, the rotation is about the inner side, while a lesion
of the external layer of the crus cerebri causes rotation
about the side of the injury. The rotation about the
long axis is produced through a lesion of those fibres
which go from the cerebellum through the upper part of
the crus cerebri to the corpora quadrigemina. — Chicago
Med. Revieiv, Aug. 18th.
Functions of the Phrenic Nerve. — MM. Henocque
and Eloy's experiments on animals show that afier
removal of the roots of the phrenic nerve, the immediate
consequences were — 1st. Extensive contraction for some
moments of the inspiratory muscles ; 2, the cessation of
diaphragmatic contractions on the side operated upon ;
and 3rd, a very feeble respiratory movement of the
thoracic wall on the same side, caused by the action of
the inferior intercostal and the accessory elevators. Nerv-
ous degeneration has been observed in some cases at
the end of a fortnight or more ; respiration of the side
operated upon recommenced afterwards, but was feeble
in comparison with the healthy side ; in some cases there
resulted difficulty in phonation. — Medical Press. Cin. La7i,
and Clinic.
NKURO-THERAPY.
Alterations of the Cord in Phosphorous Poisoning.
Danillo's researches. — i. In acute poisoning, the central
nervous system contains deposits of pigment of haemic
origin. This has heretofore not been noted.
2. Large doses of phosphorous give rise to a central
myelitis along the whole length of the cord, with the
formation of extravasation and pigment. Smaller and
repeated doses give rise to a diffused myelitis, affecting
the gray and the white matter.
EDITORIAL.
The Judicial Ps^jchology of the Guiteau Trial.
— When a simple-minded colored divine, despite the verifi-
cations of astronomy to the contrary', declares that *' the
sun do move," even though the unscientific assertion
carries conviction to an unlettered congregation of sable
hearers, no great harm is thereby done to science ; or
even when a great church hurls its anathemas against
the heretical teachings of the science of the universe and
compels a Galileo to recant, truth is simph- but moment-
arily "crushed to earth to rise again," for the world does
move despite the opposition of either church or state, and
opposition from both is but little less futile in the long
run than the antipathy of the faithful Jaspers, who read
the scriptures literally, to the disparagement of true
science. And even when the learned judiciary, whose
province it is to interpret rather than to tnake pathological
laws, as it likewise is its province to determine what muni-
cipal laws are, and not to make them, formulates a judicial
psychology not sustained in the laws of morbid mental
movement, sound psychiatrv- may be thereby set back a
quarter of a century or so before the courts ; but the
truths of psychiatry remain the same as though no judicial
fiat had sought to make them what they are not, and
they will ultimately appear uppermost, despite judicial
decision that they are what they are not.
To ignore motives and resistless impulses of mind
deranged, does not and will not obliterate them as facts
from the phenomena of mental disease. To declare that
" the true test of criminal responsibility where insanity is
interposed, is whether the accused had sufficient use of
his reason to understand the nature of the act with which
he is charged, and that it was wrong to commit it,"
unless this phraseology is liberally interpreted to mean
something more than wrong in the abstract, does not
change the fact that many insane persons, while having
sufficien use of their reason to know what is morally and
legally wrong, nevertheless feel by reason of their changed
mental condition, that the particular acts they may be
impelled to do are either impulsions that ought not to
be, or cannot be resisted, or that it is not wrong for them
142 Editorial.
to do them. Acts which to them would appear wrong to
every other person are self-justified. In a lunatic asylum,
" Atlas," groaning under the weight of the world, recog-
nizes the folly of his fellow lunatic, who imagines his
belly full of snakes.
If the insane would only reason like sane people, or
see without distortion the code, moral and civil, such a
test as was laid down by Judge Cox in the Guiteau trial
would be simple enough, but unfortunately for his judicial
psychology, the psychology of clinical psychiatry refutes
the " only safe rule," the one test of criminal responsibility
he has prescribed in that historic trial, namely, "whether
the prisoner possessed the mental capacity at the time the
act was committed to know it was wrong." If only those
lunatics are to be exempt from the consequences of crime,
who are so insane that they do not know what they are
doing, and that the act is wrong in the abstract, then
the number of insane criminals, or who would be criminals,
in our asylums might be greatly diminished by applying
Judge Cox's test to their responsibility.
The judiciary of this country will always be liable to
error so long as it continues to make, instead of trying
simply to interpret, the laws of morbid mental movement,
and to apply the same test of responsibility to the sane
and the insane.
The right and wrong test of responsibility has a more
tenacious hold upon the judiciary of America than upon
that of any other enlightened country, though it has not
always been adhered to, stronger than in France, Germany
or Russia even. The English judiciary has by no means
consistently adhered to this mediaeval test, having succes-
sively adopted and rejected it in different historic trials ;
having relinquished it in the famous trial of Hadfield, in
the year 1800, reaffirmed it in that of BeUingham,
twelve years later ; again abandoned it in the trial of
Martin, in 1831 ; and, three years later, reaffirmed it in
another great state trial, only to be again virtually disre-
garded in the recent trial of Roderick Maclean for
attempting (on March 2d, 1882) the life of her Majesty
the Queen, as the following interrogatories of the Lord
Chief Justice on that trial show:
First question by the Lord Chief Justice. — " Do you
think he knew what he was about?"
Second question by his Lordship. — " Do you think he
knew he was doing wrong?"
Editorial. 145
Third question by his Lordship. — " Do you think that
if he did knoio he could have helped tt f
The right and wrong test was not prominent in this
trial, but if the medical witness had testified that Maclean
knew his act was wrong but resistless, the court, in view
of his history of previous insanity and late incarceration
as a lunatic, would have accepted the morbid irresistibility,
criterion probably, as the third question of the Lord Chief
Justice foreshadowed, and so will the courts generally
when the insanity is undoubted. Why not then make the
test in all cases such as will embrace any form of real
mental disease, and be consistent ? As Chief Justice
Blackburn has said, " we cannot fail to see that there
are cases where the person is clearly not responsible, yet
knows right from wrong."
The only inquiry that would be just to the insane
person would be as to the existence of the disease, and
its influence upon the act of crime, and the possibility of
resisting it. To assume rational criminal intent, if knowl-
edge of wrong exists, is not fair where disease is inter-
posed in extenuation by the defense. The inquiry- should
be, how has disease distorted the normal relationship of
the man to the crime and surroundings, and if courts
persist in defining how alone mental disease can absolve
from responsibility, they should be careful to be compre-
hensive enough to include those forms of insanity which
are characterized by morbid impulsions of the mind, as
well as those in which deranged perceptions are prominent.
When the judiciary shall substitute mental patholog)' for
metaphysical conception of morbid mental action in regard
to questions of insanity, it will only charge that to con-
stitute insane irresponsibility the mind must be so
affected by disease of the brain as to distort its natural
relationship to crime, rendering it truly incapable of
resisting crane, either by overpowering morbid impulse
or delusive conceptions of the legal or moral character of
crime, or of the necessity or duty of committing it.
The Rights of the Insane. — The present age, under
the pressure of sensational journalism, and the misuse of
the habeas corpus, is likely to do as much harm to the
insane as was inflicted upon them in the days of dungeons,
stripes and chains, before Bicetre was reformed, and the
iniquities of old "Bedlam" were exposed and suppressed.
It is no charity to release from asylum custody ever>' harm-
less-appearing lunatic who asserts his sanity, or who may
144 Editorial.
have a friend or two who is unwilling to believe him insane.
Not a day passes in the history of the world without
the public being startled with preventable tragedies, having
for their heroes or heroines some one or more of the
supposed harmless class of insane persons, who have
either been taken out of asylums on habeas corpus, or
have kept themselves out of them by an appearance of
sanity or of harmless insanity. The Hadfields, the Mac-
leans, the Lawrences (not to mention the Passanantes and
Guiteaus), who make kings and queens and presidents
their mark ; as well as the Grays, who walk into theatres
and make targets of its distinguished actors; the Remshaws,
who quit their work to shoot asylum superintendents ; the
Freemans who attend to their business in day time and
sacrifice their children at night ; the moral monstrosities,
sweet-appearing on the witness stand, who break away
from asylum restraint by aid of sympathetic courts only
to make otherwise happy homes hells on earth, the insane
self-destructions innumerable, and the murderers of the
innocent, unsuspecting and helpless which might be averted,
will continue so long as public attention continues to
strain its vision to detect a possibly sane person in our
asylums, and overlooks the great and increasing number
of incipient and harmless (?) lunatics at large. Lunatics
at large are uncertain, however harmless they may appear,
and actually are under the regulated surveillance of a
well-ordered asylum management. Their liberty should
generally be allowed them under judicious surveillance,
even though they appear safe to be at large, and it is
not always a question of safety alone. We owe the
harmless lunatic a duty to save him from perpetual
lunacy if we can. To leave him wholly to himself, even
though he hurts no one, is not always kind. Such a
course endangers incurable chronicity, and this is cruelty to
him. If we were to become insane, and could judge after
insanity as before, we would wish to be speedily cured
whether we might be harmless or not. Recovery would
not be likeh' to be promoted by leaving us wholly to our
insane devices, even though the unrestrained liberty might
be sweet to us, and harmlessly exercised as to others.
What a world of woe to mankind and wrong to these
victims of disease will be averted when the true nature of
insanity and its curative needs shall be publicly under-
stood. The public duty of the hour is to rightly under-
stand and rightly manage the insane.
Editorial. 145
Public Prejudice Against the Plea of Insanity
is daily verified in injustice done to the actually insane.
Cases like the following are quite often seen in the
public prints. We made satisfactory personal examina-
tions of the person referred to below, and testified to her
insanity on the first trial :
Nevada, Mo„ November 17.
In the murder case of the State against .Mrs. Mary Harper, brought to
this County on a change of venue, the prosecution this atternoon entered a
nolle prosequi and the inisouer was discharged. In October, 1881, in
Henry Couuty, Mrs. Harper killed her little step-son. aged about six years,
by cutting his throat with a butcher-knife in a most savage and brutal
manner. The case caused great excitement at the time, and a long and
tedious trial was held in the Henry County Circuit Court. * * * The
result was a hung jury. Another trial was had at the next term of the
Henry County Circuit Court, with the same result, after which the case
was brought here on a change of venue. * * * Over forty witnesses
and medical experts were summoned and in attendance, consequently a
Considerable sensation was created when this afternoon the i^rosecuting
Attorney from Henry County announced that the case would not be pros-
ecuted further.
Mrs. Harper, for several months past, has been confined in the asylum
at Fulton, and was brought from there to the trial at this place. Her hus-
band, the father of the murdered child, believes her insane and has used
his influence to secure her acquittal. She attempted to commit suicide
while in the Henry County Jail about a year ago. * * * Various
opinions prevail iu the community regarding her sanity, and some severe
criticisms are passed on the Henry County Prosecuting Attorney for his
action in dismissing the case.
Dr. Smith, of the Fulton Asylum, and all the medical
experts, testified to her insanity. She was placed into the
asylum at Fulton by order of the Supreme Court.
Thus it is with the inconsistent public. Ever eager to
get them out of, or prevent them from being sent to, the
asylums, but always ready to hang them for the results
of their disease.
This unfortunate woman tried to kill her own suckling
babe, her mother and herself, under the delusive impul-
sion of morbid auditory hallucinations, which commanded
the bloody, unnatural deed. Like most lunatics of her
class.she felt that she "had to do it; they all had to go."
The Power of Vicarious Xerve Function to
which we have before referred in these pages, and which
we have elsewhere maintained {Amer. Jour, of Insaynty,
October, 1875), must be invoked to harmonize the dis-
crepant views of Ferrier, Brown-Sequard and others, with
146 Editorial.
reference to cerebral localization. Goltz has demonstrated^
by carefully conducted experimentation on the inferior
animals, the capability of life for twelve months after
ablation of three-fourths of the cerebral cortex. His con-
clusion was that the doctrine of special motor areas is-
untenable, whereas he should have concluded that the
motor areas of Ferrier are not the only centers of motor
impulse under all circumstances.
Gradual ablation, as well as slow obliteration by dis
ease, permits of active development of motor function in
latent or secondary motor areas.
Dr. J. C. Dalton, referring to these experiments-
of Goltz and others, and observing the impossibility of
permanently paralyzing a single muscle of the body by
the destruction of any part of the cerebral cortex, dis-
credits the idea of exclusive special sense areas. This is
undoubtedly correct, but the special sense areas in the
normal condition of the brain undoubtedly do exist, not-
withstanding their boundaries may be somewhat extended
by the assumption, under certain circumstances of morbid
invasion or physiological experimentation, of vicarious-
function.
Alexandrine La Bross, smis cerebelli, existed and
moved about before Flouren's or Vulpian's slicing experi-
ments on fowls demonstrated that the power of movement
thus abridged was capable of being slowly regained; and
P. P. Gage walked about for years after, though minus
a large part of an anterior lobe of one hemisphere, with
power of speech and thought, verifying the vicarious
function of the hemispheres of the cerebrum.
There are vicarious centers undoubtedly demonstrable,
as the substitute channels of nerve force conduction are
proveable.
Misconceptions of Moral Insanity, Prichard'»
Definition. —
" Moral insanity or mildness consists in a morbid perversion of tbe
natural feelings, attections, inclinations, temper, habits, moral dispositions-
and natural impulses, without any remarkable disorder or defect of the
intellect and knowing and reasoning facidlies, and particularly without any
insane delusion." — [Art. on Moral Insanity, p. 19, BeWs Library.]
"This form of mental derangement has been described as consisting in
a morbid perversion of tlie feelings, atlections and active powers, without
any ilUision or einmcous conviction impressed upon the understanding; ir
aomethnea coexists with an appareiitly unimpaired state of the intellectual
faculties."— [/6ic/., p. 20.],
Editorial. I47
In one sense, indeed, their intellectual faculties may
be termed unsound; they thmk and act under the influence
of strongly excited feeling, and persons accounted sane
are, under such circumstances, proverbially liable to error
both in judgment and conduct.
Conclusions of the reasons alone out of harmony with
the natural character and surroundings of an individual
may have disease for their basis, according to the theo-
retical conceptions of some of our worthy confreres in
psychiatry, while the morbid aversions, antipathies, fears
and feelings are not to be recognized as founded in
disease unless the reason is also deranged.
This is clearly a theoretical objection to moral insanity
in which the reasoners ignore their own reason as the
morally insane do. Moral insanity cannot exist they say
because they will not permit it to be.
Honor to Whom Honor is Due. — At the late
Jubilee Celebration of the Medical Faculty of IMcGill
University there was present one gentleman who graduated
from that institution forty-seven years ago, Dr. Joseph
Workman, for the last generation and up to some four
or five years ago, Medical Superintendent of the Asylum
for the Insane, at Toronto. At the meeting of the Medico-
Chirurgical Society of Montreal, on October 8th, the
following resolution was passed in honor of his presence :
"That the members of the Medico-Chirur^cal Society of Montreal, in
session this evening cannot allow the opportunity to pass of expressing to
you the pleasure your visit to the citj- has been to them. They teel that to
you the Medical i?ocieties of Canada owe much. Your zeal and ability
have always been liberally expended in promoting their welfare, and tliey
desire to express the hope that you may be still spared for many years to
give them the benefit yoiu* wisdom and counsel."'
We are sure that the profession of this city, and
especially the members of the Toronto Medical Society,
at whose deliberations he for two years presided, and the
constant sight of whose venerable form has been an
encouragement to some and a reproach to many, will
eagerly join with us in a heartfelt echo of the sentiments
expressed above by the Medico-Chirbrgical Society of
Montreal.
The Government's Tribute to the Medical
Profession — At last a grateful ( ! ) Congress awards its
honorarium to the consulting surgeons and medical attend-
ants of President Garfield, and thus attests its exalted ( ! )
148 Editorial.
appreciation of the professional fidelity and skill which
sustained and prolonged the life of the late lamented
executive for so many long weeks in comparative comfort
beyond all reasonable expectation, under so mortal a
wound, and the measure of its gratitude is exhibited in
the sum of five thousand dollars awarded to each of the
distinguished consultants for about nine weeks of service
in which their time and talents were at the command of
the nation, and they were debarred from making any
important surgical engagements elsewhere. A grief
stricken nation generously gives the bereaved family a
quarter of a million, to which Congress adds the remain-
ing salary of the President's unexpired term, and gener-
ously donates to Ids chief pliysicians five thousand dollars
apiece, while his medical nurses get nearly an equal
pecuniary recognition, and the regular medical attendant
is awarded sixty-five hundred dollars !
Noble Nation ! Magnanimous Congress ! Generous
Committee !
liow Temperature in Insanity. — We take the
following from the Detroit Lancet for January, being a
part of Dr. Kiernan's address on Insanity :
In the case of a man tried for murder in Canada, Dr. H. Howard cited
low temperature as a corroboratory evidence of insanity. Ulrich has
reported a case of progressive paresis in whicli tliere was a temperature of
91.3 F., and a case of melancholia in which the temperature was 83.4 F.
Tilling reports a case of pi'imary monomania in which there was a temper-
ature of 89.6 F. ; one of melancliolia attonita in which tliere was a
temperature of 82.4 F., and two cases of progressive paresis in which the
temperature was 83.3 F. and 81.5 F., respectively. Bechterew reports one
case of senile dementia in which the temperature was 87.8 F. ; two cases of
progressive paresis in which the temperature was 93.2 F. and 86.9 F.
Ireland reports a case in which the temperature was 82 F. Lowenhardt
reports two cases of insanity in which the temperature was, at various
times, 87.5 F., 89.6 F. and 90.5 F. Mendenhall has reported a case of
dementia in which the temperature was 90.5 F. Zenker has reported nine
cases of insanitj' In which the temperature fell easily; in three cases as
low as 90.6 F. As a corroborative symptom of the existence of nervous
disease, tiiis question of low temperature may be of value. Any sugges-
tion on this topic, however, would be as yet premature.
More Liglit on Guiteau's Ancestry. — We have
good authority for the statement that a large part of the
people of the town of Freeport, 111., where the father of
Chas. J. Guiteau resided, believed his father was insane,
but it was the interest of the officials of the bank with
which Guiteau, Sr., was connected to deny it. The
Editorial. 149
paternal grandmother is said also to have had attacks of
melancholia, and descended from a hypocondriacal father,
and had. an ancestry of peculiar people.
A grave mistake was made in pronouncing Guiteau a
sane man, and the history of his trial only serves to show
how difficult a question to decide that of sanity is, when
only an incomplete life history is studied, and conclusions
are biased by the pressure of popular opinion and the
patriotic feeling. Since the hanging of Mrs. Surratt, the
Government has made no greater blunder than the
execution of Guiteau. If Mrs. Surratt were alive to-day,
no charge of treason would stand against her. When
posterity passes on Guiteau, he will be adjudged insane.
The Yearning: for Higher 3Iedieal Education
has promise of ultimate gratification in the following
aspirations after fame of the Joplin College, though the
beginning is " petit y Behold the announcement :
College of Physicians and Scrgeoxs.")
JoPLix. Mo., 5, 2S. ISS-i. J
OenU : Please send price list of Doctors and Lh-ugglsts Names by states,
&& 1 ^ani to vasAl several thousand Annual Catalogues to the Profession all
over the U. S. A. and canady. I am startino: an embriotic Pioneer- -Medical
College and I must, of necessity, noise it around the world to make it pay
me. An early reply will greatly oblige.
Yours Respectfidly, etc.,
J. C. PETrr. M. D.. :>ran
We take pleasure in helping to noise this ''embriotic
pioneer'' Medical College around the world, knowing the
cosmopolitan a^-pirations of its projectors.
Great enterprises have often very small beginnings.
We feel confident, however, that the Joplin embriotic will
not be easily discouraged, notwithstanding the State
Board of our neighboring State of Illinois cruelly proposes
embryotomy for its aliunni. But such is fate when the
head is larger than the pelvic brim.
Let the Joplin embriotic thrive. Such institutions
make post gradum schools with ante gradinn capacities
in their faculty chairs tolerable. Let the embrj'otics come
forth, there will probably be enough post-gradi to com-
plete their incubation.
Aphasia and Insanity. — Dr. Rousseau {Annales
Medico Psychologiques, November, 1882) comes to the
fohowing conclusions respecting aphasia and insanity : In
general, insanity and aphasia are rarely associated, and
the analysis of them then varies according to which of
150 Editorial.
the affections was primarily developed, for in one case
there may be simple coincidence where in the other it
may be necessary to admit that there is an antagonism.
The lesion that produces aphasia may leave the intelligence
intact, but more frequently it is enfeebled without being
destroyed. Aphasiacs may become insane, but this can
only exceptionally happen since they are somewhat cut
off from relations with the outside word. The insane do
not so frequently give evidence of amnesic aphasia,
although they fall, under the common law, relative to the
ataxic form. Applied to progressive paresis, these opinions
seem somewhat too positive. — K.
Malaria in Skin Diseaes — a Correction. — Dr.
L. P. Yandell refers to a paragraph which has lately
appeared in the Michigan Medical Nezvs and other journals,
as follows :
" What I have contended for, and what I have reiter-
ated, is simply this : Malaria is tJie chief source of acute
skin disease. Scrofula is tJie chief source of chronic skin
disease. The more inveterate cases of skin disease are
often due to the coexistence of these two things. The
specific exanthems, of course, are not included here, but
I contend that their progress and termination are often
largely influenced by the presence of malaria or struma.
/ do not claim that malaria and struma are the sole causes
of the dermatoses. Indeed, many of the dermatoses may
exist independently of malaria or struma, and most fre-
quently some exciting cause is necessary to develop the
cutaneous eruption.
Dr. Curwcin on Lnnatics at liarge. — "A great
deal has been said latterly about the personal liberty of
the insane, but those who are so specially urgent on this
matter, forget that every member of the community has
his personal liberty, and also his life, involved by the fact
of so many irresponsible persons being at large, so that
from the President of the United States down to the
humblest member of the community, no one can tell when
his life may be threatened or his property be destroyed
by some one for whom his family or pretended friends
may interpose this plea of personal liberty. No man has
a right to personal liberty where that liberty may imperil
the life or property of another." — [Address before Alumni
Association, Med. Dept., University of Penn, Jan 19th,
1882.]
Editorial. 1 5 1
Kalsemia vs. Uremia. — Fultz and Ritter {London
Med. Rec, Jan., 1882) have reached the conclusion, after
•numerous experiments and observations, such as the
•injection of solutions of potassium salts, and the examin-
ation of animals that have died from uremic poisoning
-(so-called), and finding an excess of potassa, the injection
-of urea giving negative results, that the so-called
phenomena of urea poisoning are really due to the
acclamation of potassa salts in the blood. They use the
term " potasScTemia," but "kalsemia" is more euphoneous,
if the ureic pathology should be supplanted by subse-
-quent confirmations.
To Gazetteer Men who persistently importune us
to subscribe for directories containing the names of
leading physicians, we have only to say we have no need
of their goods. We can generally find the names of most
•of the eminent men who do not take the Alienist and
Neurologist among the recommendations of the proprie-
tary medicines asking our daily attention.
The Xarrow View of Insanity applied to Guiteau
"has lately been applied very unjustly to some of the patients
in the New York City Lunatic Asylum, and patients with
"hallucinations of hearing and delusions of persecution have
been declared only eccentric and not insane or dangerous.
Yet those who know lunatics well will always give such a
wide birth if they are at large. Mark Gray has also
been set at liberty to shoot at Booth again, may be !
The Coupling of Irrespon.sibility witli Insanity
■causes contests over its recognition in any but its most
marked and undoubted forms in medico-legal cases, and
leads to the non-recognition of its obscurer phases. A
•court-room, wath capital crime or a will in contest is the
last place in the world in which to make a correct and
-satisfactory diagnosis of insanity.
Persistent Double Consciousness. — Fidelia X.,
■of Bordeaux, is probably the most remarkable case of
double consciousness on record. For twenty-five out of
every thirty days, during the past twenty-three years (on
the authority of Dr. Azam), she does not remember what
-she has done during the other five. Her age is thirty-
nine years.
A Large Brain. — Sixty-two and a- half ounces of
brain belonged to a late Leadville, Colorado, gambler, who
152 Editorial.
betrayed no greater excess of greatness than belonged to
the Louisville, Ky., baker, who died some years ago,
with a brain larger than Webster's, Cuvier's or Aber-
crombie's.
The Society for the Protection of the Insane
will meet in Philadelphia on the 25th of this month. That
bod}' has discussed the right of the insane to liberty.
We hope they will consider the paramount right of these
unfortunates to judicious surveillance and restraint in
order that their welfare, as well as that of the community^
may be subserved.
The insane should be protected against themselves-
even though they be not violent, and rescued from
impending chronicity, even though they might harm na
one if unrestrained.
Brass Poisoning and Insanity. — It has been
observed by Binswanger {^Neurologisches Ceiitralblatt^
March 15, 1882) that seventy-five out of one hundred
brass founders suffer from a species of fever. One patient,
aged twenty-seven, while suffering from the initial stages
of this fever, was attacked by a species of melancholia,
with frenzy and hallucinations. — K.
A Good Periodical Discontinued. — We shall
greatly miss from our exchange table the well conducted
and richly instructive Archives of Dermatology, whose ex-
istence has ceased with the completion of the eighth
volume.
Tlie Cure of a Case of Epilepsia in consequence
of excision of a diseased knee (Arthritis and Anchylosis)
is reported in the Jan. 6th number of the PJiil. Med. and
Surg. Reporter.
REVIEWS.
REPORTS OF THE INSANE HOSPITALS FOR
THE YEAR 1881.
1. Report of the Pennsylvania Hospital for the Insane for the Year ISSl^
By Thomas S. Kirkbride, M. D.
2. Twenty-Sixth Annual Report of the Trustees of the State Lunatic
Hospital at Northampton, Mass., for the year ending September 30th,
1881. Pliny Earle, M, D., Superintendent,
3. Forty-Ninth Annual Report of the Trustees of the State Lunatic Hos-
pital at Worcester, for the year ending September 30th, 188!. John G.
Park, M, D., Superintendent.
4. Sixty-Ninth Annual Report of the Trustees of the McLean Asylum,
1881. Edward Cowles, M. D., Superintendent.
5. Forty-Third Annual Report of the Superintendent of the Boston Lunatic
Hospital, for the year ending April 30th, 1882. T. W. Fisher, :M. P.,
Superintendent.
6. Fourth Annual Report of the Trustees of the Danvers Lunatic Hospital,
for the year ending September 30th, 1881. Wm. B. Goldsmith, M. D.,
Superintendent.
7. Forty-Ninth Annual Report of the Managers of the State Lunatic
Asylum, Utica, N, Y., for the year 1881. John P, Gray, Superintendent.
8. Eleventh Annual Report of the State Homeoepathic Asylum for the
Insane, at Middletowu, N, Y, 1881. Selden H. Talcott, A. M., M, D.,
Superintendent.
& Twenty-Seventh Annual Report of the Board of Trustees and Ofhcers
of the (."leveland Asylum for the Insane, for the fiscal year 1881,
James Strong, M. D., Superintendent,
154 Reviews.
10. Forty-Third Anuual Report of the Board of Trustees and Officers of
of the Columbia Asylum for the Insane, for the year 1881, H. C.
Rutter, M. D., Superintendent.
In looking over our file of insane hospital reports, we found so many
had collected, that it would be impossible to any more than mention a
small portion of them. We therefore proceeded to pick out those in the
above, almost at random, promising ourselves that we would, in a later
number, look into as many more as possible.
Wo veiy well remember a time in our early studies of insanity, when
these reports seemed as dry reading as the market quotations in the news-
papers. How our elders could pore and even gloat over them, quite passed
our comprehension. As time went on, however, and our connection with
the topics presented became more near and personal, we too began to take
a lively interest in them, until to-day we look as eagerly for a new report,
as the average of mankind for the last number of Harper's.
The CMSual reader who takes up an insane hospital report, must be struck
witli its curious make-up. Here is a mixture of all kinds of things — pathol-
ogy, piggeries, cow-yards, convolutions, ventilation, ventricles, radisties,
restraint, morals, mowing. We begin with the number of cures and usually
end with the number of night-gowns, wliich the institution Uas recorded,
as its work for the year. \V'e learn how many cabbages have been raised
on one page, and on the next, perhaps, find a table of deaths. VVhy, it might
be asked, do we have this varied bill of tare? To answer this question we
must step Into the superintendent's place and say that we have tried to
write down the doings of a year, as accuratel}', yet as briefly as possible.
This is, we must allow, again assuming our own position, a very proper
answer ; but can the same result be arrived at in any other way? It must
be remembered in tlie first place, that the report must, in most cases, con
form, to a certain extent, to tlie law which requires the enumeration of
these various business details. Then second, that the Trustees are interested
in the business management of the hospital and desire to make a good
showing in this direction, 'i'hen third, there is the public which wants
both a clear business account of details, but desires besides, some popular
instruction on the subject of insanity, as well as medical details concern-
ing the patients. 'J'hese wants are somewhat exacting, yet the conscien-
tious superintendent remembers further the claims of science, and endeavors
more or less briefly, to satisfy them also. It will be seen then, how much
literary labor lie is put to, to compile his report, which may seem little to
the world, but is a mountain to him. We can imagine even Napoleon
himself would have been staggered liad he been obliged to write an annual
report of his campaigns with as much detail as is required of the insane
hospital superintendent.
The report exemplifles what tiie superintendent himself is expected
to be. Popularly he Is supposed to be the physician ministering to his
patients and making studies Into insanity and cerebral patliology. Prac-
tically, lie is doctor, farmer, engineer, cook, steward, carpenter, plumber,
financial comspondent, seamstress and, perhaps, elerk of the Trustees,
chaplain, lecturer and fatlier to patients and employees. When we regard
the very remarkable combination of qualities which go to make up the
Reviews. 1 5 5
ideal superintendent, we see that few men can be equal to the requirements
demanded. What wonder, when we have found the right man, that we
cannot expect much from him in the way of a scientific knowledge of the
morbid anatomy of the brain in insanity I K he does his required work well ,
we can ask no more. Sometimes we get impatient and wonder if a super-
intendent's duties could not be so arranged as to give him more time for
scientific work, but after a careful investigation of every system practiced,
we are reluctantly led to believe, that first and foremost, the superintendent
to do entire justice to his patients, medically, must superintend everything,
for there is no detail, however trivial that does not have a bearing on the
medical management of the hospital. If in an individual case the super-
intendent lias the taste, ability and education to go into pathology, so
much the better. Bye and bye our standard of medical education will be
higher, the superintendent will enter on his duties with the desired knowl-
edge of cerebral pathology which in the past he did not possess, and he will
then be able to superintend this branch also. With a higher standard of
medical education the public will learn to expect more scientific acquire-
ments in the medical ofiicers of insane hospitals, and we doubt not that a
larger staff of assistants and improved methods of management will be
ready at hand when the time is ripe for them.
We see. tlien. that the report presents a very good chronicle or history
of hospital luaiiagement. But cannot some of the details be omitted from
Xhe printed report? Cannot the}- be presented at a trustees' meeting, and
then silently filed away? With the greatest respect for the worthy super-
intendent, we should be so much relieved if he would omit the history of
the old sewer, or the new asparagus bed. or the root cellar. It is such a
disappointment when we see a nicely printed page without the usual tables,
and expect some ripe utterances concerning insanity, to find instead a long
account of draining the meadow down by the old garden gate. Whisper it
gently into the manager's ear. but give us — the public — some glimpses
into your grand experiences. Open a few pages of your clinical observa-
tions and detail to us some of the remarkable psychological phenomena
which daily pass before your eyes. No man has a better chance to study
character than the hospital superintendent, for he sees human nature in all
its nakedness, with the mask of decorum and social respect thrown oS.
He has only to record his observations to give us the most valuable infor-
mation. And it is in this respect that we find him. like other American
medical men, defective. It is an exertion for him to write witii exactness
and precision- He often rattles off many pages of loosely worded English,
but it is difficult for him to sit down and accurately put his observations
into writing.
After all. however, we should be thankful for insane hospital reports,
for they contain very much of value that would otherwise be lost. Only
through their pages many a superintendent makes himself known as a
writer. In times past, our superintendents have rarely published much
in either general or special journals, but every year now witnesses an
improvement in this respect.
1. This report, which is Dr. Kirkbride's forty -first, as usual, contains
much of interest. The kind and worthy doctor is one of the few remaining
156 Reviezi's.
of that generation of superintendents, now neaily passed away, who had
something' to say, and could say it, too. His work stands as a naost fitting
monument to his painstaking efforts to ameliorate the condition of the
insane. Each one of his reports gives us the results of his matured judg-
ment; and. collectively, these reports will be of scientific value for many
years to come.
He has shown us that the two sexes can be satisfactorily treated
entirely separate from each other, but we doubt not that he would have
been equally successful with the two sexes in one building. Another
successful plan of treatment lie has demonstrated is that of daily evening
amusements for patients, and to this he lovingly refers in the report before
us. For thirteen years, every evening during nine months of the year,
gome form of amusement has been provided for the patients, and two years
ago such a system of amusement was made a permanent regulation. The
variety of entertainments offered embraces stereoscopic exhibitions (the
hospital owns an immense collection of photographic pictures), lectures,
concerts, gymnastic exercises, exhibitions of various kinds, social parties,
etc. All these things mnke a very pleasant change for the patients, and
any one who has visited Dr. Kirkbride's must have been struck by the
degree of perfection to which the anmsement system has been brought.
It is to our mind, however, an open question whether so much amusement
is a necessity. A recent writer, in the Journal of Mental Science, has argued
that such a method of hospital life is not well fitted to prepare the patient
for a return to the ordinary duties of life. The whole force of the institu-
tion should be towards work rather than amusements alone. It should
not be forgotten, however, that Dr. Kirkbride has labored to introduce
useful occupation among liis patients.
Out of 3,825 patients admitted since the institution opened, 3,825 have
been restored to their friends, or ujiwards of forty-live per cent., which, to
say the least, is a very good showing. During the last year, 200 patients
have been admitted, and 57 discharged cured, or, we will say, about twenty-
eight per cent. The latter, it will be seen, shows a great falling ofl'from
the total percentage of ciu-es for the forty-one years.
Among the tables, Xo. Vlll., which gives the supposed causes ot
insanity, is of interest. We learn that out of the total number of 8,480
cases, ill health was tlie cause of 1577; intemperance in 828; fright in 73 —
a surprisingly large number, it seems to us ; use of opium in 33 — a very
small number, we should say ; use of tobacco in 17 — a large proportion
relatively to opium. In 3,298, or nearly two-tiftlis. the cause was unascer-
tained, which onlj' shows us how unreliable such tables must of necessity
be with our present imperfect methods of collecting statistics, and how-
impossible it is to make us" of them for the purpose of making deductions
without exercising qreat care,
2. In the footsteps, oi- perhaps more properly, in tlie same rank m iih
Dr. Kirkbride, the nestor of American insane hospital superintendents,
Dr. Earle, must be placed. He, perhaps as much as anyone of our disiin-
guished superintendents, has done his share in endeavoring to infusr into
reports, a spirit of seientilic accuracy. His labors in regard to the curabil-
ity of insanity and hospital statistics iuivc given him a world-wide
Reviews. 157
reputation. He may not be strictly right in all his deductions, but he has
thrown considerable light into obscure noolvs and crannies and knocked
down a good many men of straw. His dignified, accurate, terse, and telling
manner of stating and recording his investigations, has not only stimulated
others to more careful work, but lias also served as a useful corrective
of tiie slouchy, careless, hap-hazard style of writing, so much in vogue in
hospital reports.
Like Dr. Kirkbiide, Dr. Earle is an ardent believer in entertainment.
and we find that during the year, the patients assembled for either worship,
ijistruction, entertainment or amusement, 329 days of the year. About
one-half of the patients attend these meetings and often they do not last
for a longer time than hali an hour, we Lave been told.
Twenty persons were discharged as recovered during the year, 120
persons having been admitted, or nearly 17 per cent.
In the "Studies relative to the Curability of Insanity," which again
from the essay portion of the report. Dr. Earle states that his conclusions
are becoming each year more generally accepieil. both by superintendents,
the medical profession and laymen. At the foui- State hospitals in Massa-
chasetts, diu-ing the year, 1092 persons were admitted and 283 persons dis-
charged recovered, or a percentage of 25 91. The three older hospitals.
Worcester, Taimton and Northampton admitted 521 persons during the
year, and discharged recovered. 118 persons or a percentage of 22.64. Of
the 118 persons discharged. 55 had been previously discharged, thus bring-
ing down the actual gain in the number of recovered persons in the com-
munity to 63, or 12.09 per cent. Of these, 55 persons, readmitted after
previous recovery, had been discharged altogether 115 times. The public
had been told of 115 recoveries of those 55 persons, hence if recoveries and
not persons be enimierated, tfee three hospitals issued 118, but thej' took
back 115, leaving therefore an actual gain of only three persons in the
community. Such figures as these may well startle us, but the question
is, if Dr, Earle draws an entirely correct inference, at how long intervals
were these persons readmitted? Were they able to go out and resume the
ordinary duties of life ? Surely, a person getting apparently well and able
to bear the strain of his usual life must have been well enough to count
as a legitimate cure. As we look at the matter, we should go still further
than Dr. Earle, and ascertain exactly how long it was between discbarge
and readmission and then divide up the persons into real and apparent
cures, according to a standard of length of time of apparent mental health.
Dr. Earle, like other superintendents, must give annual statistics ; now,
supposing one of his tweiity ernes of persons of this year is admitted
immediately at the beginning of next year, how is he going to correct the
false showing that he has just made? He cannot change the statistics of
this year, which counts him as a recovery ; neither if he gets well next
year, can he help putting him down again as a recover}-, and so each year
the same person may make a recovery, and in a few ye«rs make a good
many. We grant that it is a great step forward to make this person recover
less often than formerly, but the principle of allowing him to recover over
and over again, which seems to us after, all the correct one. still remains
true. In the future, we think that the length of time the person remains
158 Reviews.
well, will, as we said before, determine the validity of a recovery, rather
than the number of times.
3. Dr. John G. Park, superintendent of the hospital, states that the re-
coveries have been 21.68 per cent, on the admissions. Fourteen of the 54
recoveries were of persons who had been inmates of the hospital before,
and 12 had been discharged recovered ; one had recovered 9 times ; one 6
times ; one 4 times ; two 3 times ; 1 twice and 6 once each ; one had been
discharged improved and one not improved. Dr. Park says "althougli it
may be a question, upon which there may be an honest difference of opin-
ion, whether each case which recovers may not be fairly called a cure, even
if tlie patient has a second attack within a few months or a year, there can
be no doubt that the public has been hitherto widely misled as to the
meaning of the word "recovery" as used in the hospital reports and as to
the permanency of cures from insanity. Not a small number of patients
who were discharged recovered in the earlier reports of this hospital have
many times since become a burden to the public or private purse by rea-
son of a return of their malady."
Dr. Park finds that of 94 patients discharged previous to 1840, 3 men
and 5 women who remained well after their discharge are still living ; 26
men and 14 women remained well as long as they lived ; 24 men and 21
women became again insane and of this number 7 committed suicide and
10 have been inmates of other hospitals.
The criminal insane in the hospitals are alluded to and the opinion is
expressed that "not a lunatic hospital in the state is a fit place for the safe
custody of the criminal class."
4. Dr. Cowles, acting on a plan the opposite of Dr. Kirkbride's of
separation of the sexes, has introduced into his male wards some female at-
tendants. He has chosen women of matronly, discreet and amiable quali-
fications and placed them (one each) in charge of the ordinaiy housekeep-
ing in two wards. Each one is assisted by one or more ward-maids. She
presides at the table and acts as if she was the mistress of the liouse A
male head attendant has the general care of the wards and direct charge
of the patients. There are now four women thus employed, whose duties
require their presence day and night in the wards, and so far it seems as
if there were no reason why female nurses may not be associated with
insane men with great benefit to them. The results have been better than
expected. The wards are more home-like, and both tiie patients and
attendants are better behaved.
We trust that Dr. Cowler will be successful in his experiment, for
ordinary attendants are quite apt to acquire rough manners and naturally
often lack the refinement that their patients possess and without which
the latter are liable to suffer. It will be no easy matter, however, to find
the right women, for at the best, the nature of the duties is difficult, and
women with the right mental and moral qualities, will often lack the phys-
ical.
5. This old hospital is always interesting to read about, as its reports
show to some extent the progress that has been made in the treatment of
insanity. It is an old, dingy, prison-like building, erected at a time when
the menagerie plan of caring for lunatics was in vogue. While improved
Reviews. 159
plans have been o^duallv introduced, and the lunatic is made very com-
fortable here, the stone floors and thick walls carry us back to the days
of the insane man's Nero. In 1837. patients were taken from the Worces-
ter Hospital and placed at the Boston Almshouse, in cells or in wooden
cages on wheels for convenience in giving them an airing I (We can
imagine Pinel and Connolly writhing in agony in their graves, when they
read these words I) In 1839, however, this asylum was completed and
these patients removed to it, where under the care of Drs. Butler and Sted-
man they were treated like sick persons. Aftirwards extenijious were
made to each wing, containing twenty cells each, but these were abolished
by Dr. Walker, who was the firet superintendent in the State to give up
the cell plan of treatment.
Since 1853, the necessity for more room at the asylum has existed. The
noisy, destructive, violent and filthy patients have been treated in the lower
wards of the main building, much to the disadvantage of the quiet class.
And it seems rather a reflection on the city of Boston that while she has
done so much for many classes of her poor and afflicted, she has neglected
her insane and still continues them in this narrow, contracted old building,
where, Dr. Fisher says, '• a single bad case may disturb the whole wing,
keeping patients awake, whose recovery depends on their ability to sleep."
The herding together of all sorts and kinds of patients gives rise to much
confusion and real injury. Boston may suppose, in her innocence, that
she did her whole duty by her insane, when she helped to build the Dan-
vers palace and squandered hundreds of thousands of dollars on the most
foolishly situated and lavishly finished institution within the borders of
Massachusetts, but let anyone read Dr. Fisher's report and they will be
led to believe that there is still to-day a crying necessity for a new hospital
for her insane. To be sure, $60,000.00 lias been appropriated for new dining-
rooms and indirect steam-heatirfg and ventilation and some minor improve-
ments, but after all, the same radical defects in the building itself must
still continue.
At the end of the report there are some well recorded post-mortem
notes of six cases of general paralysis by Or. W. W. Gannelt, the patholo-
gist.
6. The fortunes of the Dan vers Hospital have been somewhat varied,
we should judge, from what we have read in its annual reports, and the
last year seems to have been no exception to this rule. With its present
able euperintebdent. however, we now look confidently forward to some
permanent progress. As a new institution, much disorder and chaos was
to be expected, and this state of aflTairs was unfortimately heightened by
the bad situation and extravagent and yet faulty constitution of the build-
ing. Built for paupers, it was yet in its finish and general arrangement
quite unfitted for the care of this class. It was badly and inconveniently
arranged and poorly equipped, when opened. It seemed about as well
adapted to its purpose as would be the elegant cabins of a new ocean
steamer for the transportation of emigrants, and it was not much easier
to manage, than would such a steamer be with its helm in the bows and
its wheel-house in the hold. However, after much trial and tribulation,
and a general over-turning, upheaving and May cleaning, a happier future
i6o Reviezvs.
may be looked forward to, and the Danvers Hospital will undoubtedly
take the lead as the great pauper institution of Massachusetts.
The Trustees say that the report again shows that the hospital is not
self-supportino;. We should say not, as it entered on its last year with a
debt of over $23,000.00, which is not likely to be improved as Dr. Gold-
smith says. The only possible way to make this hospital self-supporting,
it would seem, would be to convert several of the wards into large dormi-
tories, thereby crowding together a much larger number of patients and
reducing the per capita cost of maintenance.
A Board of twelve consulting physicians, eminent in their profession
has been appointed, who make monthly visits and favor the management
with much good advice, we doubt not.
The Trustees call attention to the necessity of removing the criminal
insane from the State hospitals and treating them in separate institutions.
Dr. Goldsmith says that a large number of feeble, helpless and demen-
ted old people are sent to the hospital, a part of whom might be treated
at home. The admission of so many of this class accounts in part for the
large number of deaths, 94 or 8 5-10 per cent, of the whole number treated.
There were also 23 deaths from general paresis, or nearly a fourth of the
whole number.
There were 39 autopsies, but we miss the report of the pathologist,
Dr. G. G. Putnam.
.7. There were admitted into this hospital, 212 men and 199 women.
There wei'e discharged, recovered, 128 — 54 improved, 158 unimproved and
51 died. The percentage of recoveries was 31.76. The average of recoveries
since the opening of the hospital in 1843, has been 3G.47 per cent.
The managers report what has been done to insure protection from
fire, and then state that the accounts hare been kept in a satisfactory
manner. They close with a eulogy of the superintendent and his
assistants.
The usual essay of the superintendent is omitted, which makes the
report rather dry reading. The large accumulation of chronic insanity
received during the first year, is due to some specific cause. That cause,
is appai'ently the general distrust in asylums and asylum management
engendered by the sensationalism of the pi-ess and individual notoriety-
seekers and purturbators, in recent years. The committal of tliese cases
to the asylum now indicates, first, an increased confidence in asylums;
and second, that many of this unfortunate class have been retained at home
until their care and custodj' became a burden which could no longer be
borne, and the asylum was sought as a last retreat. This explanation
may be true of New York, but the same preponderance of chronic admis-
sions is found in States where the asylum purturbator is not abroad, and
we should therefore feel obliged to look further for a complete explana-
tion. VVc should say that insanity in its early stages often is not recog-
nized, and even when it is, in many cases the frientls, from ignorance, do
not understand the necessity of early treatment, and keep the patient at
home until he gets completely unmanageable. Then, too, even ,in this
enlightened age, many persons are ashamed to have it known that insanity
exists in their own families. The practical criterion among the laboring
Reviews. i6i
and lower classes for seeking the asylums, is usually, that the insane per-
son cannot be controlled, or supported.
8. The Trustees of this hospital rejoice and are exceedingly glad at
the result obtained, and the Superintendent also joins in hearty congratu-
lations. And well they may rejoice, for they have discharged 50 per cent.
of their patients cured, though we do not understand how they make their
estimate. Apparently, they have beaten Dr. Kirkbride, Dr. Gray and all
the noble army of able superintendents.
Under the heading of ■' The Labor Question" we are treated to a variety
of old fashioned observations, 'couched in the most generous and even
grandiloquent flow of language. We find that '"gentle motion causes the
blood to take on a more active circulation,'" a fact not entirely unheard of
in the annals of physiology. We find further that ''sunlight stimulates a
ruddy glow in the cheek (does it not also gently redden the nose ?) and
plants a healthful brown upon the hands and arms; and the spring-time
breezes, laden with life from the eternal hill-tops bear to the lungs their
inspiring freight of invigorating oxygen and their welcome burden of
disease antagonizing osone." If this is not poetry we should like to know
what it is. Why is it not possible to %\Tite a whole report in song, instead
of occasionally exploding in this unexpected manner? We really hope that
here after the allopathic superintendent, struggling under his heavy load of
pills and boluses, will be stimulated to emulate his homoeopathic brother,
and at least record a few post-mortems in appropriate nursery rhyme.
•'Absolute quiet and freedom from every form of exiting exercise are
Bometimes the most important means with which to tone down to a normal
level a hypersemic and over-stimulated brain I" What ? Is this homoeopathy?
Vs, Xhii, similia similibus curaniur? Should we not treat hyperaemic brains
by violent exercise and powerful exertion? Absolute quiet and freedom
from every form of exercise can only be suited to cases of great depression.
Let us stir up and goad on to furor the violent maniac, and overpower the
unfortunate melancholiac by every means known to homoeopathy, even
starvation being iustifiable in such a case. Than will good, honest old
Hahnemann be forever the savior of all mankind. Om* fiiend will excuse
us if we have caught his poetic style.
We very much regret to see him quoting Di-s. Chapin,Ku-kbride,Gray,
Griesinger. Bucknill and Tuke, and some of the other false advocates of
rational medicine.
In the ''conclusion" we have revealed to us a new fact in physical
science which we venture to assert is not even equalled by the comet. A
last the discovery has been made of the law of crystallization of the "phys-
ical aspects"' of an insane asylum. We find these crystals "are comely and
shapely proportions." We shall now look for a general falling to pieces of
insane asylum^, and as the cold weather appi-oaches shall expect to see
these "comelj" and shapely proportions'" strolling off in vai'ious directions
''Growing experience leads to show more and more conclusively the
wealth of resources that abides in homoeopathy as a piactieal means for
curing the insane." Just what these resources are we do not know, in fact,
not the slightest mention is made of them. We should like to know some-
thing about these "practical means" whereby 50 percent, of the patients
1 62 Reviews.
are cured. And instead of several pages of trite observations about the
"labor question," written to slove music, it would have been much more
serviceable to the ignorant medical public to have had the exact "practical
means" abiding in homoeopathy stated in so many words.
Perhaps the opinion of the homoeopath Worcester* (who by the way
seems to be an admirer of the Middletown H ospital managers) will be en-
dorsed that '-there are two or three agents employed by the old school'
whose use you will do well to bear in mind, both for your patients' sake
and because you will not want to see your patient pass into another vhysudan^s
Aand«."t Charming principles these, if they are homoeopathic, but we hope
the "old school" will avoid them. Chloral hydrate is there recommended
in doses of 20 or 30 grains and bromide of potash in 10 grain doses!
Perhaps also, if they follow the advice of Worcester, if a patient tries
to escape, they use bellod. stramon; or desires to be alone, calc. carb,
cuprum and ignat; or dreads being alone, crimicif, lycop., sulpbur; or
weeps, bellad., ignat., kali brom., nati. vum., pulsat., platina, sefla, sulphur^
At any rate, in the next report we shall regard it as an unpardonable
offence if some demonstration is not made whereby we may at least faintly
discern some difference between "old school" methods of treatment and so-
called homoeopathic '"practical means."
9. The number of patients at this hospital at the end of the year waff-
622. The percentage of recoveries was 33.6 and of deaths 4.28. In both
cases a favorable showing. Among the deaths it is strange not to find one
from general paralysis, especially, when we remember that at the Danvers
Asylum one from sixteen of the deaths last year were from this cause.
The special subject of discussion in this report is on "epilepsy and
some of its varieties." Nothnagle, Echeverria and others are quoted with-
the idea of throwing light on some of the obscure forms of epilepsy.
Several cases are then cited which are illustrative of epilepsy of the non-
convulsive type, which are characterized by mental rather than by bodily
symptoms. These cases are all interesting, and worthy of report, did space
permit. They show how much danger may, in some cases, be associated'
with the concealed or larvated form of epilepsy and semi-popular discus-
sion of the subject will do no harm.
In considering provision for the insane and epileptic in Ohio, it i»
stated that there are about 2,500 incurables and 600 epileptics to be pro-
vided for, and this can best and most economically be done by erecting*
supplementary buildings to the existing hospitals. A large proportion of
epileptics are insane and can be treated in common with the ordinary
insane. It is our opinion too, that supplementary buildings will, in the
future, be the most available means for providing for the constantly
increasing number of the chronic insane.
10. This report is the most bulky one coming to us, for the reason-
that every cent expended at the asylum, during the year, is accounted for
in the financial portion. The publication of so many items seems a little
unnecessary and must add very much to the cost of the report, but perhaps
the good people of Ohio are fond of financial details; we aje not.
•Insttnity and Its Treutriient. p. 274.
titalics are tht- iLvlewcr's.
Reviews. 163
There were 930 patients in the asylum at the date of the report. The
percentage of recoveries was 48.33, and of deaths, 5.31. We find two
deaths, only, from general paralysis, out of a total of 65.
The superintendent of this asylum also considers the subject of more
extended asylum accommodation and argues especially for a separate hos-
pital for insane epileptics, contrary to the opinion of his brother superin-
tendent at the Cleveland Asylum. He gives a rather dramatic picture of
the epileptic, with the '• piercing cry, frothing mouth, clenched teeth,
bleeding tongue, horrible contortions, turgid face,'' etc. when seized with
a convulsion. The effect on the mind of the healthy individual is bad
enough, but still worse, in his opinion, on the insane person.
The advantage of a separate institution for the care of the epileptic
insane he thinks would be: 1. — I'be withdrawel of a turbulant and trou-
blesome class from the general hospitals for the insane. 2. — Cheaper
buildings. 3. — Diminished cost of maintainance. 4. — Better care in s.;cli
an institution.
We are ourselves rather inclined to think that he goes too far on the
side of separation. Dr. Jolly, of Strasburg. comes nearer the mark when
he says* that, on the whole, insane epileptics can best be treated in insane
asylums. Epileptics who demand temporary hospital care, should be pro-
vided for in special divisions of general hospitals. Combined with these,
there should be out-patient's departments. Cases of long duration will
require special buildings or separate divisions in existing institutions. In
Berlin, the Charil^ Hospital has an epileptic department with 30 beds, and
the .Bicetre in Paris has 80 beds for males, and the Salpetriere, 137 beds
for females.
The epileptic insane can here have special wards to themselves
in ordinary hospitals, or a supplementary buUding on the hospital
grounds, as Dr. Strong suggests. It must not be forgotten that many
Insane epileptics have no perceptible convulsion, and many present entirely
different forms of insanity which can be most conveniently classified with
the ordinary insane, presenting similar forms. It must not be forgotten
furthermore, that the epileptic in a convulsion may also affect his brother
or sister epileptic, who may have a very slight degree of epilepsy, or who
is in his or her convalescent stage of the disease.
The Order of Disorder ix Mental Disease, by O. Evarts, Super-
intendent of the Cincinnati Sanitarixmi, is a well-written paper, like all of
the author's contributions to the literature of psychological medicine, in
which the attempt is made, but not successfully, we think, to evolve an
unvarying law for the commencement and progress of cerebral disease
involving the mind.
The author's initial proposition is that "knowledge of disorder presup-
poses linowledge of order in mental as in other diseases," and upon this
the converse proposition, that knowledge of order presupposes knowledge
of the methods of disorder is predicated, but, in our judgment, not
proved. To know the order in which a structure, animal or otherwise,
is built up, by no means assures as how it wiU come to pieces.
•Archlv fur Psychiatrie und Nervenkrankheiten. Vol. XllI, 2. Heft.
164 Reviews.
Construction and disintegration, tliough opposite processes do not proceed
in complementary order, i. e., the one does not alwtiys begin where the
other ends. As in the fall of a building, the destructive disintegration
may begin in the chimney top or gable ends from some adverse winds or
other external force applied to tliem, or in the foundation from inherent
defect existing from the beginning of the structure.
Despite all attempts to define, tlieoreticaily, how mental disorder must
originate and proceed on the basis of how mental order is organized and
progresses, the clinicMlly observable tact is tliat mental aberration begins
sometimes at one and sometimes at another point in the cei-ebrum, some-
times touching first the perceptive, at otlieis first implicating the reflective
faculties, but more often the former than tlie latter if memory be a regis-
tered impression of external or internal occurrences, and be a part of the
perceptive life. The perceptive faculties and the senses, even in the order
of nature, undoubtedly fail before the reflective powers give way. 'J'he old
man ceases 10 see, hear or taste aright before he begins to think, and these
perceptive failures first deceive and mislead hig reflective fuculties.
In the physiological progression of mental life, from infancy through
youth and manhood, to final dotage and senile imbecility, the last change
of all, is just what we so often see in what the author terms the develop-
ment of mental disorder, not an involution beginning with the intellectual
failure, but a progressive degradation, in which, '"sans teeth, sans eyes," the
" last scene of all " is -sans everything."
Dementia is the usual termination of insanity of long standing. It is
most rare for insanity to begin with total loss of mind, so that we cannot
concur with the author, notwithstanding the pleasure his very philos-
ophical treatise has given us, that if his propositions are true (and we are
not disposed to gainsay them) relative to the order of mental evolution, that
mental digorder ends where mental evolution begins. That these aphor-
isms are true, sometimes, may be conceded. Tnat they are the rule cannot
be tienionstrated by observation, however tenaciously they may be held,
as the theoretical base of progressive and retrograde mental movements.
The author thinks that the order of mental disorder should be (and this
is the rock upon which so manj' good men stumble) : '' First, disorder of
imagination or ideation ; second, disorder of feeling ; third, disorder of
memory ; fourth smd last, disorder of consciousness."
But. unfortunately, the order of disorder is more erratic and disorderly
than the Doctor thinks it should be. Consciousness and memory are often
the first to fail, as in epileptoid automatism, apoplexia and aphasia, and
sometimes the feelings give way, as in melancholia and conscious morbid
impulses, in a maimer at variance with the patient's reason.
As miglit be expected, a mental philosopher holding such theoretical
views of how insanity ought to proceed could not acquiesce in the
existence of sucli well known forms of mental aberration embraced under
the generic term "affective insanity," such as moral and emotional insanity
They are contrai-y to liis view of what ought to be "tlie order of nature,"
and, of course, cannot exist (in his mind). He has provided no place for
them. They are not because theoreticdUy they cannot be.
Moral and emotional insanity are in tliis view philosophical
Rti'Uzi's. 165
misconceptions, whereas the believers in these forms of insaniry see them as
clinical facts. -All philosophy." acconiin^ to Dr. Evarts. - which makes a
generic distinctioa between morals and intelligence, imagination and
reason, judgment and wiiU requires revision." The mind L? all and only
reason, according to him. Of coarse, acc-ording to this philosophy, fiicts
most be shaped if received, to m^eet the mental image of what ta»anitT
should be.
We thank Dr. Evartsfor the entertainment the reading of his interesting
paper has given us. and for the strength he has added to our coavictions
that mental disease is a law miro itself, sometimes :ittackin^ the leaves und
bianchee, sometimes the bark and the ro«)t of the tree of mental life, sc-me-
timee destroying by vitiating ct-inditions of s;ip or seed, sometimes destn>y-
in^ by causes touching the top aiid from without.
The paper may be read in the Cincinnati Lancet and Cliiac for October
aist, 1882, and will set the thoughtful to thinking, and will repay perusal.
Skrvocsxess. By Dr. Paul Julias Mobius. Leipzig. ISSi. — In the
I»e£iee to this work the author says : ~ As little as he:dth and disease are
Avided from each other by a charm, just so little can the individual path-
<rio0cal conditions of the nervoa-- system be sharply distinguisheii from
eaeh other (bounded).
He then gives a schematic drawing showing the relation of the most
hnportant general neuroses to each other and to nervousness (vide p. 7).
Then proceeds to define these varioas disorders. Says (p. IS). - It is often
ditScult to discriminate between healthy stupidity and pathological imbe-
cility. In conclusion, he detines neurasthenia as follows : ~ Neurasthenia
is that form of nervousness whose appearances aU possess the character
of irritable weakness without the commingling of the features of other
neoioses.*^
CauMea of Servfntaneas. — Refers to the irfluenoe of heredity. Gives
tables showing inliuence of heredity on the propagation of varioas
nervous diseases (epilepsy, hysteria, etc.). Draws attention to the influence
of age on the development of nervous disease (p. 45). Says puberty is a
dangerous perio<J for those inclined to nervousnes*. Says by far the larger
namber of cases of nervousness take place at the period of perfect physical
ripeness (p. 53, appendix to this chapter).
School. — •* Ot all the detrimental inliuences which react upon hunaanirv
during youth, and which may give rise to or encourage the development
of nervousness, there is none so important as too early or too intense
intellectual work ~ (p. 56).
Six — -The question whether nervousness :ind analogous coaditii>ns
occur with greater or less frequency with men or with women is not to be
answered with certainty" (p. 74).
Baee and Climate. — There are no statistics bearing with certainty on
this subject.
Civilizaiicm. — -The more civilized a people become, the :rreater the
nmnber of "head-workers." and eonsequenily the more asymmetrical the
onployment of the head will become in comparison with the remainder of
file body^ (p. 83).
1 66 Reviews.
Class.— ^- If we except women, we can make two great divisions: Call-
ings necessitating ' head-work,' and such as demands, more particularly,
' muscle-work ' " (p. 91).
The Causes of Disease in a More Narrow Sense. — Menial Causes : "■ Under
this category, mental ' overtaxation' belongs at the head." Games which
A feci the Body: "Overtaxation of bodily function. Under this head
belongs night vigils and intemperate sexual indulgeuce " (p. 96).
The Phenomenon of Nervousness. — "As in all neuroses, weakness of will
is a principal characteristic, and this also holds true in nervousness."
One of the first appearances is the impossibility of directing the atten-
tion for any considerable length of time in one direction. Furthermore,
the absence of individual calculation exhibits itself in this, that these
patients become the playthings of their moods. Now comes weakness of
memory closely related to " rapid fatigue," which takes place on mental
exertion. In many cases, the patient is easily excited, morbid intensity
and auger are frequently observed. Indifference to those things which
were formerly highly esteemed. Over-sensitiveness is the usual cause of
melancholy depression. Rarer is anxiety without cause. Ch;iracteristic of
nervous weakness is helplessness. Very frequent is morbid fear. Fear of
s" thunder-storms " among adults is frequently met with. Another form of
fear is "place fear," characterized by dread of lonely places, etc. (p. 109).
Fear of being alone, "fear of disease" (p. 110), is not hypochondria, which
is a continual consciousness of disease. "Compulsory ideas," those which
appear to one affected by them as alien, and which stand opposed to his
healthy consciousness (p. 113). A particular form of the "compulsory
ideas " is the "grubbing mania'' (p. 114), characterized by a continuous
querry after the how and why of everything.
"Hallucinations of memory." Quite as important as frequent are
hallucinations of the senses; they occur not only with the insane, but also
with the healthy.
It is rare to find the nervous enjoying good sleep; most of them suffer
from pronounced insomnia (p. 119). Again, others suffer from imnatural
somnolence. Here and there nervous persons are to be found who suffer
from somnambulism. An artificial somnambulism or hypnotism is also
spoken of
Dr. Mobius is one of the oldest of German neurologists. The appear-
ance of this work is a sign of the increasing interest in this subject in
scientific Germany, where there is now a larger literature of this nervous-
ness and nerve exliaustion tlian in all the rest of the world put together.
This work of Dr. IMobius is written in a very pleasant and interesting style,
and contains many original and valuable suggestions that thoughtful
persons everywhere should carefully consider. It deals philosophically
and ably with one of the great problems of I he present and future.
GiOHNAi.K DK Nkukoi'atiiologia. — We have received the initial num-
ber of a new publication (8vo.. pp. 64), ])ublished at Naples. Trot". Francesco
Vizioli is the general manager, and Drs. Raflaele and Antonio Vizioli the
editors. In the programme, written by Francesco Vizioli, the necessity
of such a i)uiilicatif-n is insisted upon. He believes in the sentiments
Reviews. 167
«ntinciatcd by Erb in a discourse delivered at the opening of the Polyclinic
at Leipzig, in which he contends that a division into psychopathology and
oeuropathology will nave to be made, which, if it exi^t not in fact, still
shows itselt plainly throughout the domain of nervous and mental
-diseases. Anotlier illustrious Grerman, Benedikt, has pointed out the
progress of the division of labor and liow it is a necessary consequence of
the progress of medical science. It is on these words of Eib and Benedikt
that is based the whole programme of this publicat on. The name Oiomale
di Nniropathologia has bten given to it to indicate its essentially clinical
character, its object being the study of the nervous system from a clinical
point of view.
The question of cerebral localization and cortical excitability are
■reviewed at some length, and a resume of experiments given to determine
the question. The conclusion arrived at is that these experiments are
<;onfii-matory of the idea that electric stlnmli reveal a function of the motor
area and not of the other parts of the nerve centers. To sum up. it is
-asked that clinical phenomena, physiological observMtion and experimental
data be all brought to bear upon this mooted question in order to har-
monize all these various facts in such a manner as to be of real value and
"benefit.
The object of this journal, it is lurther stated, is to pre.=ent papers and
other subject matter on nervous diseases, and intended to subserve the
interests of the general pi-actitioner; for that reason, psyclilatry will not
t)e considered at all. One of the reasons given for this decision is that it is
necessary on account of the large amount of material contributed to each
"branch.
Under the head of "Original Articles," will be embraced all that
concerns neuropathology in its broadest «ense. In this will be included
•clinical observations, experimental researches and experiments in all the
branches of medicine that can serve to illustrate nervous diseases.
Un-ler the head of *' Kesume of Articles ublished in Italy and Abroad,"
wiU be included normal and pathological anatomy, normal and patho-
logical physiology, therapeutics and clinical notes, psychiatry and legal
medicine. Particular attention will be paid to the Italian advances made
in neurology and neuropathology.
The "Analytical Reviews" will make special mention of articles
■which cannot be reproduced, and whose principal poin's, physiologi&il,
histological, pathological, etc., which may have a bearing upon the ^tudy
of nervous diseases, will be given.
The " Synthetical Keviews" will contain short abstracts derived from
"various sources, unaccompanied by any commentaries.
In the ''Review of Scientific Societies" will be included the reports,
facts and conclusions bearing upon the subject, and not included in the two
former sub-divisions.
The "Biography" will deal with reviews of domestic and foreign
■works.
The '• Bibliographical Index " will include not only books and pam-
phlets donated, but articles in journals and i-ecent editions of works, or
«ach as are difHcult to obtain.
1 68 Reviews,
" Varieties and Notices " and "Scientific Correspondence " sufficiently
explain themselves, and form the two last subdivisions.
This journal deserves success, and will undoubtedly achieve it, from
the fact that it will devote itself to a branch of medicine which is of imme-
diate benefit to, and now demanded by, the general practitioner. It has
received high praise from its Italian contemporaries, and deservediy so.
Its editors have been identified with the subject of nervous and mental
diseases for many years, and have had excellent opportunities for observa-
tion, and a long appronticesliip to journalism will fit them for this under-
takiug. — [Ohmaun-Dumesnil.]
The Disease of the Scythians, and Certain Analogous Condi-
tions is the title given by Dr. Hammond to a monograph read before the
American Neurological Association, June 23d, 1882, in which he records
his observations of some " mujerados,^'' or " w^oraaned," impotent men whom
he found among the Pueblo Indians, similar to the unsexed anandrii or
enures described by Hippocrates and referred to by Herodotus as having
existed among the Scythians, and which Nysten has discussed in the
Dictionaire de Medicine under the caption of Maladie de Scythes, as resulting,
as Hippocrates conjectured, 'from inordinate horseback riding, contrary
to the belief of Herodotus and the Scythians themselves that the gods
were at fault.
The difference between the mujerados and the enai-es consists chiefly in
the fact that the deprivation of verility is, in the former, intentionally
produced by enforced masturbation and constant horseback riding " for a
specific purpose in the saturnalia or orgies, in which these Indians
indulge," among which, Dr. H. states, is pederasty.
The genitalia become atrophied, and the instincts and proclivities
undergo a corresponding change, etc The author shows that the ess( ntial
point in the " disease of the Scythians ' is that they act like women in
consequence of impotency, whereas the cases of perverted sexual instinct
described by KrafFt-Ebing and others are not easily embraced within the
scope of his memoir. He classes the mujerados among the mentally
alienated, yet the reasons for tlie classification do not appear quire plain
since " the mi/jerarfo,' as the author states, "is an essential person in the
saternalia or orgies in which these Indians, like theancient Greeks, Egyptians
or other nations indulge ;'' a mere " passive agent in the pederastric cere-
monies which form so important a part iti the peiformances," made a
mujerado by the tribe to which he belongs, "held in some sort of honor
and need not work unless he chooses;" "no disgrace attaching to his
position, the condition being one which is forced upon him by tlie power
of tradition, custom and public opinion, and which, recognizing theimpos-
ibility of escape, he assumes, probably with reluctance in tlie first instance,
but eventually with entire complaisance and assent."
A change of deportment, in a savage. brout;lit about by adequate
external cause, and in conformity to a tribal usage and a changed physical
condition, which render certain physical functions impossible, must be
regarded as rational in character, however uuich that change may be at
variance with the proprieties and customs of civDization.
Reviews. 169
The old chief who, by unmistakable signs and perfect equanimity, ad-
mitted to having committed pederasty on one of these mujerados might uot
have been a reliable "Injun" since the others "avoided all reference to the
subject and confessed the most complete ignorance of the matter when he
questioned them directly thereon."
Insanity may begin in the head or in the testes, i. e„ its exciting cause.
A mujeradj with a neuropathic diathesis might become a lunatic, and a
lunatic might believe himself to be a mujerado.
Clinical Lectures upon Epelepsy.* — This is a collection of lectures
delivered at the St. Anne Asylum, which has already appeared in the
Progres Medical. The first chapter calls attention to the fact that the
crimes committed by epileptics exhibited, as a rule, a remarkably brutal and
purposeless character. Epilepsy is, in Mr. Magnan's opinion, an affection
of markedly hereditary origin. Sometimes not only the tendencies but the
disease itself is directly inherited. Fright and moral causes have been
sometimes seen in the etiology of epilepsy, but in the majority of cases, these
as Mr. Magnan says called into action the disease already in embryo. The
epileptics in the majority of Mr. Magnan's cases exhibit a marked change of
character just prior to the attack. This has been observed as far back as
the time of Paul Zacchius. who from it drew the well-known conclusions
{Quest. Med. Leg., Frankfort, 16SS) that epileptics were irresponsible for
some time before and after an attack.
The usual sensorial and intellectual auras are detailed at length. He
is inclined to believe that an aura starting from a cicatiix affords indications
for surgical interference. He is inclined to believe, like Sommer {Archiv
fuer Psyehiatrie, Band V. and VI.) and Griesinger {Jour. Menial Diseases),
that mental disturbances, consequent upon epilepsy, may manifest them-
selves in four ways: As pre-epileptic phenomena; as equivalent of the
epilepsy; as post epileptic phenomena; or as intenallory phenomena. He
also claims that insanities occur in epileptics without any connection with
the epilepsy. He has never seen progressive paresis result in an epileptic.
The reviewer has seen one ease {Journal of Nervous and Menial Disease,
April, 1878). tie is inclined to believe that transitoiy mania is allied to
epilepsy. The cases reported do not tend to corroborate this view. He is
inclined to believe that epilepsy may be cured. He places great reliance
on the bromides, but says nothing of the peculiar psychical results which
Stork, Bannister, Jewell, Spitzka and the reviewer have observed as the
consequence of their use in insane epileptics. To the use of ergot in this
affection he makes no allusion. Spitzka claims that ergot produces a
number of minor discharges, which take the place of, and thus prevent,
the great epileptic discharge and its consequence. The book is interest-
ingly written, and the cases cited clearly reported.— K.
Medico-Legal Society of New York. — The annual meeting of the
Society was held on the 6th of December, the President, Mr. Clark Bell,
in the Chair.
There was a very large attendance. Dr. O. \V. Mytel of Detroit, Mich.,
had an interesting paper entitled : •• WTuii is experi tesiimony, and who are
•By M. V. Magnau, M. D., Paris, De Paliage ami Lecroisaier, ls8;i.
I/O Reviews.
experts? " Dr. E. Sanders, of New York, had a paper on '' The coroner sys-
tem. Should it be abolished ? "
At the election of officers for the ensuingr year, the following officers
were elected: President, Clark Bell, Esq.; 1st. Vice-President, A. O. Dor-
emus, M. D. ; 2d Vice-President, Hor. D. C. Calvin ; Secretary, Leicester P.
Holme, Esq.; Assistant Secretary, Gilbert R. Hawes, Esq.; Treasurer,
Jacob Shrady, Esq.; Librarian, R, S.Guernsey, Esq.; Curator and Path-
ologist, Andrew H. Smith, M. D. ; Corresponding Secretary, Morris
Ellinger; Chemist, Prof. C. A. Doremus ; Trustees, E. H. M. Sell, M. D.
andB. A. Willis, Esq.; Two members of Pei-manent Commission, Hon.
A. G. Hull and M. H. Henry, M. D.
Large accessions to the Library were announced, and fifteen new
members were elected. After the meeting, a banquet was given at the
Hotel Brunswick, at which over one hundred gentlemen sat down ; Mr,
Clark Bell presided. Speeches were made by Dr. Nitgel, Gov. Stewart,
L. Woodford, Judges Amore Calvin and Church, of Penn. ; Fethian, of
N. Y.; Drs. Layn, Andrew H. Brutle, M. H. Henry and F. R. Stm-gis;
Hon. B. A. Willis, Morris Ellinger and many others.
The Hartford Courant, of Nov. 29th, contains an interesting account
of a meeting for the promotion of practical temperance, held the evening
previous at Allyn Hall in that city, at which three ppecially forcible addresses,
eloquent in facts and figures, which must tell for temperance, were deliv-
ered by Drs. James Campbell, H. P. Stearns and John S. Butler.
If the temperance cause ever wins, it will be through temperate
measures, based on the disclosures of scientil'.c observation, and none
know better than observant and experienced alienists, like Drs. Stearns
and Butler, the fatal potency of alcohol for harm, impossible to the organic
basis of man's moral, mental and physical constitution.
When the invective of the rostrum is substituted by the careful cal-
culations of science, and the destructive ravages of the demon of strong
drink are seen by all, as they arc now revealed to the few in race degen-
eracy irreparable, then will temperance become the voluntary law of man's
being. He will be unto himself a law of prohibition.
Shoemaker's Oleates are not unctions substances designed for lubri-
cating purposes in connection with one of the useful trades, as one of our
friends conjectured, but favorite forms of prescriptions employed by our
dermatological friend. Dr. John V. Shoemaker, whose interesting and
instmctive monograph on the " Oleates and Oleo-Palmiiates in Skin Dis-
eases^'' is before us through coui'tesy of the Doctor.
The monograph is from advance sheets of transiictions of the Pennsyl-
vania State Medical Society, and worthy of ('areful perusal by all interested
in dermatological tlierapeulics.
Greisingkk's Mental Pathology and TiiKRAPEtiTics — Tlie issue of
Wood's Library for 18S2, reproduced from the translation miide by Drs.
Lockhart, Robertson and Hutherford tor the New Sydenham Society, in
18G7. was lirst pnl)liRhed in 1845. Wiien these facts are consWiort'd, it Is
remaikable that our reviewer found so little in it that is objectionable.
Reviews. 171
Burr's Index to Medicax Subjects is an improvement on any index
rerum we have ever seen, and will give satisfaction to any who may wish
a ready index reference to subjects desirable to refer to, in journals, text-
books, etc. Manufactured and sold by the J. B. Burr Publishing Ck)., Hart-
ford, Conn.
The Youths' Companion is the best paper of its kind among onr
exchanges. It is an excellent paper for hospitals and asylums for the non
demented insane, its contents being always entertaining and unobjection-
able
Walsh's Physician's Combined Call-book and Tablet, like his
virus " takes well," and should be in the hands of every practitioner.
Sook^, ]V[or\o^i'k?pl\^, ^td., f^eceived.
Pathological Anatomy, Pathology and Physical Diagnosis. A Scries
of Clinical Keports, Comprising the Principal Diseases of the Human Body,
By J. A. Jeancon, M. D. Progress Publishing Co,, Cincinnati, O. The
price is one dollar per number and those we have seen are well worth the
money.
Burr's Index to Medical Subjects. Adapted to the special use of phy-
sicians and surgeons. An index for future information or future use. All
words and names are indexed by the first two letters, with nearly three
hundred combinations cut in thumb holes in the edges of the leaves. Con-
venient, saves time, labor, money and vexation. So valuable, that we
heartily commend it. Manufactured and sold by the J. B. Burr Publishing
Company, Hartford, Conn.
Die allgemeine Elektrisation des mencbslichen Koerpers. By Sig-
mund Theodor Stein. Verlag von Wilhelm Knapp, Halle am S.
Lecons Cliniques surL' Epilepsie. By M. V. Magnan, of Paris.
Contribuzioni Alio Studio Sperimentale Dell' Ipnotismo. By A. Tam-
burini and G. Seppilli.
Notes on Twelve Cases of Brain Tumor, Chiefly with Reference to
Diagnosis. By Charles K. Mills, M. D., Neurologist to the Philadelphia
Hospital, Lecturer on Medical Diseases, and Electro-Therapeutics in the
University of Pennsylvania. Reprinted from the Ai'chives of Medicine^
Vol. viii.. No. 1, August, 1882.
Comparative Vital Movement of the White and Colored Races in the
United States. By S. S. Herrick, M. D., Secretary of the State Board of
Health, Louisiana. Read before the American Public Health Association,
Savannah, Ga., November 30, 1881.
The Responsibility of Criminal Lunatics. By S. S. Herrick, M. D.,
Secretary Board of Health, State of Louisiana.
Some Points on the Administration of Anaesthetics. By George H.
Robe, M. D., Professor of Hygiene and Clinical Dermatology, College of
Physicians and Surgeons, Baltimore.
Clinical Observations on Inflammation of the Mastoid Cells, By
Edward C. Harwood,M. D., Member New York County Medical Society;
of New Yerk Neurological Society ; of American Medical Association etc.
A paper read before the North- Western Medical and Surgical Society of
New York, with a Report of the Discussion by Members of the Society-
Reprint from the Virginia Medical Monthly, Richmond, 1877.
Some Observations on the Therapeutic use of Alcohol. By Alfred K»
Hills, M. D. Reprinted from the New York Medical Times, for August and
Sepiember, 1882.
Books, Monographs, Etc., Received. 173
Keportofa Case of Pistol-Shot Wound of the Second and Third Cer
vical Vertebrae, Considered in its Medico-Legal Aspects. — Attempted
Suicide — Death. By Edward C. Harwood, M. D, Keprinted from the
Bulletin of the Medico-Legal Society of New York, Vol. iv.. No. 5.
March, 1882.
The Therapeutic Action of Potassium Chlorate. By John V. Scho-
maker, A. M., M. D., Philadelphia, Pa. From advance sheets of Trans-
actions of the American Association.
The Treatment of Syphilis with Subcutaneous Sublimate Injections.
By John V. Schomaker, A. M., M. D., Physician to the American Hospital
for Skin Diseases, etc. From advances heets of Transactions of the Amer-
ican Medical Association. The paper may some day appear in the transac-
Statement of facts in connection with the quarterly Report of the
Treasurer of the Medico-Legal Society of New York. Prepared for presen-
tation at the meeting of Sept. 6tb, 1882. By Ed. C. Harwood, M. D.
Phlegmasia Alba Dolens. By P. V. Schenck, M. D., Resident Sur-
geon of Female Hospital, St. Louis. Read before the State Medical Asso-
ciation. Reprint from the St. Louis Courier of Medicine. August, 1882.
The Use of Hot- Water Injectioas in Uterine Disease. By P. V.
Schenck, M. D., Surgeon to Female Hospital, St. Louis. Reprinted from
the American Journal of Obstetrics and Diseases of Women and Children.
Vol. IV., No.iv., October, 1882.
Use of the Ecraseur for Curing Deep-Seated Fistula in Anno. By J.
M. F. Gaston. M. D., of Campinas, Brazil. Extracted from the American
Journal of the Medical Sciences for July, 1881.
Menstrual Amblyopia. By M. F. Coomes, M. D., Prof, of Physiology,
Ophthalmology and Otology, in Kentucky School of Medicine, Louisville
Reprinted from the Medical Herald, October, 1882.
."iome Thoughts on Phthisis, with Special Reference to the Value of
Laryngeal Symptoms in Diagnosis. By M. F. Cooms, M. D., Louisville
Ky. Reprinted from the Archives of Laryngology, Vol. iii. No 3, July,
1882.
Reflections on Criminal Lunacy, with Remarks on the Case of Guiteau,
By Charles K, Mills, M. D., Lecturer on Mental Disease and Electro-Thera-
peutics in the University of Pennsylvania. Reprinted from the Trans-
actions of the Pennsylvania State .Medical Society for 1882.
Hall's Journal of Health, for November, 1882. E. H. Gibbs, A. M.,
M. D., Editor,
Proceedings of the Seventh Annual Session of the Southern Illinois
Medical Association.
Annual Report of the Barony Parochial Asylum, for the Year 1881.
Annual Report of the Government Hospital for the Insane for 1882.
Biennial Report of the Vermont Asylum for the Insane.
Twenty-second Annual Report of the State Lunatic Hospital at Harris-
burg, Pa., for the Year Ending September 30th, 1882.
Report of the Board of Trustees of the Arkansas State Lunatic Asylum,
little Rock, Ark., January, 1883.
1/4 Books, Monographs, Etc., Received.
The Sanitary News, Vol. ii, No. 6, Hamilton, O.
Twenty-second Annual Announcement of the Bellevue Hospital Med-
ical College, 1882-1883.
Thirty-ninth Annual Keport of the State Lunatic Asylum, Utica, N. Y.
1881.
Eeports of the Lunatic Asylum of Georgia.
Annual Report of the Superintendent of the Cleveland Asylum for the
Insane.
Report of the Vermont Asylum for the Insane, for two years ending
July 8l8t, 1882.
Eeport of the Medical Superintendent of the N ew York City Lunatic
Asylum, Blackwell's Island, New York.
Fifth Annual Report of the Danvers Lunatic Hospital.
Thirty-fourth Annual Report of the Indiana Hospital for the Insane.
Extract from Third Biennial Report of Board o^ Trustees of the State
Charitable Institutions of the State of Kansas. Relating to the Manage*
ment of the State Asylum for the Insane, at Topeka, Kansas, for the
Biennial Period ending June 30, 1882.
The St. Joseph Medical Herald for January, 1388, Vol. i, No. 1.
Edited by J. L. Geiger, M. D. and F. C. Hoyt, M. D., St. Joseph, Mo.
Fifteenth Annual Report of the Inspector of Prisons and Public Char-
ities on the Asylums for the Insane and Idiots of the Province of Ontario,
1882.
Conjoint Session of North Carolina Board of Health and Medical
Society of North Carolina, held in Concord, May 10th, 1882.
Third Biennial Report of the Board of Trustees of State Charitable
Institutions of the State of Kansas, for the Biennial Period ending June
30, 1882.
Biennial Report of the Alabama Insane Hospital, at Tuskaloosa, for
the Years ending 80th September, 1881 and 1882.
Twenty-seventh Annual Report of the State Lunatic Hospital at North-
ampton.
Tw«nty-third Annual Report of the Longview Asylum, Carthage, O,,
to the Governor of the State of Ohio.
v-l"
THE
Alienist ^ Neurologist.
Vol. lY. APRIL, 1883. No. 2.
Original Contributions and Preferred Translations.
Some New Experiments in Muscle-
Reading (thought reading).
By (the late) George M. Beard, A. M., M. D., of New York.
TN The Popular Science Monthly for February- and
■*■ July, 1877, under the title of "Physiology of Mind
Reading, " I gave an account of a series of experiments
begun as far back as the summer of 1874, in the
phenomena of so-called "mind reading" or "thought
reading," to which public attention was first called in the
United States by the performances of the famous Brown,
"the mind reader."
The general conclusion from those experiments, which
were continued through a number of months and with a
large variety of different subjects of both sexes, was that
what was called " mind reading " or " thought reading "
was really muscle reading or body reading, and that in
experiments of this kind an operator, blindfolded and
taking the hand of a subject, found the place to which
the subject's mind was directed, by detecting the mus-
cular or body movements of the subject, muscular tension in
the direction of the locality thought of, and relaxation
when the locality zvas reached. It was further proved by
those experiments, that nothing was found unless there
176 George M. Beard.
was physical connection between the subject and the
operator, at least a part of the time, sufficient to get the
direction, either direct (hand to hand or hand to some
other portion of the body) or indirect, through some solid
body ; and that not the object, but simply the locality of
the object was what was really 'found. It was further
demonstrated that not only large localities but very small
and limited areas could be found in this way when a
skillful and practiced operator had the co-operation of a
good subject. The results obtained in experiments of
this kind were of such a character that they seemed
incredible ; and ten years ago would not have been
beheved to be possible by any scientific man in the
world.
The recent experiments in muscle reading have been
made with the view of determining the precision to which
these experiments can be carried ; to find how small an
area could be found by an expert muscle reader in con-
nection with a good subject. For this purpose I have
devised the following apparatus, which consists of two
annexes to the fingers, so to speak, thimbles with wire
projections, which fit on to the index finger, one of
which is worn by the subject, the other by the operator.
These thimbles are hooked together as shown in the
cut :
New Experiments in Muscle Reading. 177
so that any impulses from the subject are communicated to
the operator the same as though they were really parts
of the fingers — natural instead of artifical fingers. In
the ordinary method of experimenting, where it is desired
to see how small a locality could be found with precision,
the finger of the operator is pressed against the finger of
the subject; but in experiments conducted in this way,
no localities smaller than the breadth of the finger could
be found, as the breadth of the finger would cover several
small localities. With the device here represented, it
,is possible to find the one-sixteenth of an inch on a ruler,
or any one of a row of pins in a paper of pins, or any
one of the smallest letters in a diamond type. This I
have proved with a number of subjects and with different
operators.
I have experimented at different times during the
past eight years with large numbers of muscle readers,
including the founder and father of the art. Brown ; the
mind-reader, W. Irving Bishop, and many persons of both
sexes, whom I have trained or who have trained them-
selves by my suggestions.
These later experiments were made with Mr. Stuart
Cumberland, the English mind-reader (now in this country),
and with Mr. Marshall P. Wilder, of New York. Mr.
Wilder, though known to the public as a reader of humor-
ous and pathetic selections, rather than as a muscle-reader,
is yet a very expert muscle-reading performer indeed.
He goes into a trance state spontaneously (natural trance)
as soon as he begins an experiment. This is not the
case to the same degree with all the performers. Mr.
Cumberland is usually quiet, cool and leisurely in his
movements, though at times he becomes somewhat ex-
cited. Mr. Bishop's pulse would run to 130 a minute and
his movements were at times very rapid, and in some
cases he has physical contact with the subject only part
of the time.
A resume of the history of the whole subject can be
found in Allgemeine Zeitschrlft fucr Psychiatric, Berlin, 1882.
1/8
George M. Beard.
Also the same journal, page 494, contains a thorough
explanation of my paper in the Alienist and Neurologist
of Jan., 1881, on "Current Delusions Relating to Hypnot-
ism (artificial trance)."
MISCLK READING.
Tlie method of '• Brown, the Mind-Reader.'"
My friend, Dr. Kuh, tells me that Prof Strieker of
Vienna, in lecturing on this general subject, remarked
that if we close our eyes and think of a bird flying in
the air, our body moves slightly in the same direction as
the bird, and that if we stand by a rapidly flowing
stream, we tend to go with the stream. The illustrations
of this unconscious action of mind and body are num-
berless.
New Experiments in Muscle Reading. 179
More time is required frequently in these delicate
experiments than in the rougher and more familiar kind ;
but not always necessarily so. I have seen the operator
find the smallest of these localities thought of, in less
than a minute after he began, and out of possible hun-
dreds and thousands from which the subject could choose.
I have also had paper marked off into very small squares
— a miniature checker-board — and have had the subject
concentrate his mind on one of those squares or even on
one of the corners of a square, with the same result. In
some cases considerable time is required for the operator
to be sure that he has found what the subject is think-
ing of
It was some time after I began the investigation of
this subject before I could believe it possible that small
areas could be found by any operator with any subject;
indeed at the outset of my investigations I felt confident
that a small object like a pin would baffle any performer.
This delusion was dispelled by subsequent study.
A second fact, developed year before last, and which
I have recently re-investigated, is that operators who in
the normal state cannot detect this muscular tension and
relaxation sufficiently to find objects thought of, can do
so when in a condition of artificial trance or hypnotism ;
this fact has been proved in a large number of instances.
This experiment is of double interest as one of the
demonstrative phenomena of trance, showing the genuine-
ness of the hypnotic state. It is also another of a large
mass of illustrations of the tenability of the concentration
theory of trance. Persons artificially entranced when they
receive suggestions that they must find the locality thought
of, have their sense of muscular tension exalted, with
corresponding diminution of their senses in some other
directions; this is simply a concentration of force in that
particular line. It is, therefore, an advantage to the
operator to be blindfolded, since the power to detect
slight muscular thrills thereby tends to be exalted. That
there was an important relation between trance and
i8o George M. Beard.
muscle reading was early seen and suggested by me.
This fact was brought out in my original systematic
paper on the subject. The members of the Royal Society
in England who last year experimented carefully in this
same line, Francis Galton, Prof. Ray Lankaster, Mr.
Romanes and Prof. Croom Robertson also went so far as
to observe a reverse like state of the subject on whom
they experimented, as was seen from, their report, which
they published in Nature, June 23rd, 1881.*
The remarkable fact, scientifically, about these muscle
reading experiments is the rapidity, the certainty, the pre-
cision, zvith whicJi oftentimes they are accomplished. A
good operator often knows, as well as if he had been
actually told by the subject, when he is right.
Muscle reading has a dual relation to trance ; the
operator may go into that state through the emotion of
wonder and expectation, through the general excitement
of the occasion, spontaneously, and the subject operated
upon may for the same reason go into the same state ;
this I have seen in a number of instances. That a so-
called spiritual seance is one of the most powerful known
means of hypnotizing a person, I have been able to
demonstrate from many experiments. Muscle reading
experiments to a less degree have the same effect,
especially when done in the presence of large audiences
and under the influence of the delusion that some won-
derful and terribly mysterious thing is to be done, which
science cannot explain, but which is supposed to have
some supernatural explanation.
The lesson impressed by these experiments is that
mind is body, that when we think we move, that the
body thinks with the mind, not to the same degree in all
persons, not as readily perceptible in all persons, but yet
demonstrable in these experiments in the majority of
civilized beings. While the best performers will fail with
many subjects, yet the majority of persons who thoroughly
* I would improve this occasion to thank Prof. G. Croom Robertson for the
hiindsome letter in arkiiowl<'iI>>:nient f)f my iiriority In the scientific Btiidy of muscle
reading, as publiBhed in Naiure, February U, 1881. "
Netv Experiments in Muscle Reading. i8i
concentrate their minds on the locahty thought of, will
find that they are lead to that locality. Here, as in all
things, practice tends to make perfect.
The phenomena of mothers' marks, the causation of
the cure of disease by mind action on the body, the
success of charlatanism in all forms and in all ages, find
their best single explanation in these muscle reading
experiments ; in all their stages they seem to me to
unlock, better than anything I know of, the mysteries of
psychology.
The history of muscle reading is one of the most inter-
esting facts in regard to it, quite as incredible and
important as the phenomena itself. When, in July, 1874,
Brown, the mind -reader, who was to this subject what
Mesmer was to artificial trance or hypnotism, came to
New York, the phenomena of muscle-reading which he
exhibited were as new to the scientific world and to the
popular world as was the telephone or phonograph at
the time they were invented. It is true that, in a rough
way, phenomena of a similar character have been devel-
oped by school girls in their play among themselves, both
in Europe and America, but under the influence of
delusion always and never with sufficient precision and
power to make any impression on the people or on men
of science ; so that, in fact, it may be said that the sub-
ject was absolutely new; and if the scientific world had
been gathered in congress at that time, with representa-
tives from all nations, and the question had been asked
them if it was possible to do what now the whole scien-
tific world knows can be done, if they were asked if the
experiments noted here and in my previous writings on
the subject could be done, the universal and unanimous
answer would have been in the negative, and without any
investigation. The phenomena, when explained, therefore,
become a positive, original, radical contribution to science,
like the phenomena of artificial trance, with which it is
connected, to which, indeed, it is closely related.
A noticeable fact connected with this topic is that
1 82 George M. Beard.
the climate of America is specially favorable for experi-
ments of this kind, as well as for all experiments in
artificial trance and hypnotism. In our dry air — and dry-
ness of the air is a feature of the eastern, western and
northern part of our continent — it is possible for many
persons in many places to light gas by electricity by
simply shuffling across the carpet. European men of
science doubt and deny this fact, but it is a matter of
daily and hourly observation, and it is as easily proved
as any phenomena of electricity. The explanation is sup-
posed to be found in the dryness of our atmosphere,
and this same quality of dryness makes the nervous sys-
tem sensitive, and developes both good subjects and good
operators for muscle reading experiments, as well as for
all trance experiments. It is found that dry, clear, bright
days are better than moist, muggy days for experiments;
and that the northwestern part of our country, as Minne-
sota and Wisconsin, furnish a greater proportion of good
subjects than the eastern and southern portion ; and in
the country over, the proportion of those who would
make good subjects in these and all allied experiments
is probably greater than in Europe.
The Rights of the Insane.
By C. H. Hughes, M. D., of St. Louis.*
Late Superintendent Mlssonri State Lunatic Asylum, Honorary Member British
Wedioo-Psychological Association.
THE age in which we live is pre-eminently regardful
of the rights of man. The corner-stone of our polit-
ical fabric was laid in the professed sanctity of personal
rights. Constitutions were and are framed, and statutes
enacted, for the protection of the weak against the pos-
sible encroachments of the strong. The right to life, lib-
erty and the pursuit of happiness, is the recognized right
of all sane persons, and law cannot take from any citizen
that which is not absolutely essential to his own or the
community's welfare. The citizen's house is his castle 5
the law cannot enter it, " the king cannot enter it, " — and
in this country the voice of the people is king, — unless
it be to protect him in some of those rights of person
or of the community connected with individual affliction.
In an age and country such as ours, the very weak-
ness of mental disease is its safeguard, just as the
weakness of woman secures to her that chivalrous pro-
tection in society which her own frail arms could not
obtain for her, and should be always. And when, men-
tally maimed, a citizen falls in the battle of life, the
government — National or State — cares for the fallen one,
as though he were a soldier, fallen in defence of his
countrj^'s flag. IMoral duty and philantrophic patriotism
combine to lift up the fallen, and " bind up his wounds."
No fault can well be found with the manner in which
municipal government discharges its plain duty of caring
for its insane in hospitals. In fact, so liberally have State
and national governments housed these unfortunates, that
some have regarded the substantial and enduring build-
ings erected for them, as too costly and palatial in
•Read belore the American Medical Association, St. Paul, June, 1882.
1 84 C. II. Hughes.
character. These palaces are the monuments which a
philantrophic age erects commemorative of its charitable
purpose toward those most afflicted of the " children of
affliction ;" serving to show what will further be done
for these helpless ones, when communities are fully-
awakened to all of their needs and rights (and the neces-
sities of their affliction are their rights).
Among the other rights of the insane, not yet fully-
regarded by the State, which are so obvious as to require
only a plain statement of them to carry conviction, are
the following:
First, to such protection against themselves, and the
consequences of their malady, as will secure to them
recovery, where recovery is possible, by care and treat-
ment in the incipiency of their disease.
Under this is the right to have that prompt surveil-
lance and treatment for himself, which, in his best estate,
he would demand for his similarly afflicted friend. The
abstract right to liberty is subsidiary to that of the
insane man's welfare and happiness.
It is the duty of the State to inquire into the existence
of incipient mental disease, and avert its culmination in
consequences disastrous to the afflicted one and others,
because it is a right which the strong owes to the weak,
which a protective government owes to its helpless citizens.
In thus protecting the insane, the State incidentally pro-
tects the community against the consequences of insanity.
The rights of the insane and the duty of the State here go
together ; and the right of every community to be quar-
antined against the often disastrous consequences of
unguarded insanity likewise suggests the obvious duty of
the State.
Out of this right of the insane to have that attention
from the State which their malady requires, grows the
necessity of State inquiry, by competent medical commis-
sions, into the existence of incipient and advanced insanity,
outside of the asylums, and such surveillance as will
secure to the insane of every grade, in every community,
The Rights of the Insayie. 185
their right to proper medical and personal care and
guardianship against self-neglect or possible indifference
of their families or near friends. Every consideration
combines to strengthen the plea for the rights of the
insane to the paternal watchfulness, and, where necessary,
the care of the State, not alone after they have found
lodgement, by judicial process, in the state institutions,
or may have been declared " dangerous to themselves or
others" by a medical inquiry, but in that stage of their
malady when there is hope of averting the culmination
of the ultimate dire consequences of the disease from
themselves and others.
The marital rights of the insane should also be regu-
lated as well as guarded. Insane persons should receive
such protection from the law as they, were they sane
enough to realize consequences, would ask for themselves ;
and posterity should be guarded against the fatal heritage
of unstable organisms, the natural consequence of the
marriage of the insane. No virile lunatic should be per-
mitted to marry. No insane woman should be allowed
by law to bring into the world a mentally maimed or
dwarfed progeny (wherever it can be prevented) to become
an ultimate burden upon the State, and add to the already
large sum of human misery and woe.
Marriage of all insane person? at certain ages should
be interdicted by law, and the victims also of such dis-
eases as entail insanity or epilepsia, should also be forbidden
to enter into matrimony before the sterile time. In behalf
of the rights of the insane, who would not wish to have
a maimed offspring, if, under the dominion of their right
reason, it should be lawful for proper persons to forbid
such disastrous bans, and the duty of the State to pre-
vent them.
It is a terrible thing for the State to tacitly consent
to such deterioration of the race as is caused by such mar-
riages; and duty to humanity, sane and insane, demands
repressive legislation. No "pestilence that ever walked
in darkness, or destruction that has wasted at noon-day "
1 86 C. H. Hughes.
ever called more loudly for State intervention against their
spread, than the destructive heritage of the neuropathic
diathesis calls for the concern of the State. Its evil
influences are all about us, even more disastrous than any
plague or pestilence, afflicting the humblest citizen, as
well as the highest, and their posterity.
Discussion of the marital relations of the insane is not
the purpose of this paper. To exhaust the subject would
require more space and time than this section has at its
disposal.
Under what circumstances the rights of the insane to
retain the marriage relation inviolate should be held
sacred, need not be here discussed in view of what has
been said. Their rights are better secured by interdiction
than by divorce; but the circumstances under which
divorce ought to be granted we prefer to leave to infer-
ence rather than enter on its discussion.
We turn now to briefly notice the rights of the insane
before the law in civil and criminal trials.
Insanity is conceded to be a disease of the brain in
which the mind is morbidly affected in its natural mani-
festation, by which the insane person is made incapable
of conducting his cause as a sane person would, or as he
would in his rational mental estate. It is on the basis of
disease that the insane should have rights before the law
different from those accorded the sane. Their rights are
not all secured to them when they are tried exclu-
sively in the same manner as the sane are. Disease of
the mind, if it exists, must be established in the same
manner as any other fact.
Now, a just regard for the rights of the insane as
mentally diseased persons, and consequently more or less
crippled and perverted in their mental operations, demands
that we should accord to them a medical examination
after medical methods, into the question of the disease;
and that courts should aid in the inquiry by every means
known to them or suggested by medical science, as cal-
culated to elicit the " truth, the whole truth, and nothing
The Rights of the Insane. 187
but the truth, " respecting the existence or non-exist-
ence of disease.
It is obvious, therefore, that the hypothetical case,
without ample personal examination by medical men, is
not full justice to the really insane, while it may, and
often does, answer the purpose of casting doubt on the
jury's mind respecting the sanity of really sane persons,
thus aiding the unworthy to escape the consequences of
crime, while it does not give the best chance to the
innocent, by reason of mental disease, to fully establish
the existence of disease, or, rather, to have their disease
established for them. The really insane should not have
their chances of vindication imperilled by possible medical
deficiencies of counsel. Defending counsel may fail,
through ignorance of essential symptoms, to so present
them, as to convince medical experts, and yet the pris-
oner may be insane, and his insanity may be susceptible
of proof if sought out by medical men by medical methods.
As the determination of the question of disease in
general by an ordinary jury trial must obviously be
very unsatisfactory and unjust to the afflicted, so must
such an inquiry in special cases of mental disease some-
times jeopardize the interests of the really insane, as in
times of great public excitement, and in localities where
prejudice has grown up against the plea by reason of
previous escapes of the guilty upon it, through misuse
and misapplication of the hypothetical case. At such
times and occasions it would seem only just to the insane
for the court to order medical expert commissions, selected
from remote distances, to deliberate upon and deter-
mine the question of the prisoner's mental status from
personal examination and all obtainable evidence.
Finally, a proper regard for the rights of the insane
before the law should secure for them rulings by courts
in accordance with the nature of their malady, as
shown by clinical experience, rather than in accordance
with those theoretical conceptions of courts which are
often judicial misconceptions of insanity. Such judicial
1 88 C. H. Hughes.
rulings as declare that evidence of the existence of
the knowledge of right and wrong in the mind, is
evidence of responsibility, regardless of the overmastering
influences of those resistless morbid impulsions which are
common to and characteristic of certain forms and phases
of mental aberration, do violence to the sacred rights of
the insane, to that just protection due to the helplessness
of disease, from the rational and powerful to protect or
crush them. Insanity is a law unto itself, and is no
respecter of the theoretical boundaries with which jurists
have sought to circumscribe it. We know from observa-
tion of this malady, that an abstract knowledge of right
and wrong may exist in a mind rendered powerless, by
reason of overmastering disease, to resist the wrong and
morbid impulsion, as may be demonstrated, in many cases,
in asylums for the insane. A really insane person is
entitled to judicial rulings in accordance with the facts
and truth of his malady, whether it conflict or conform
with non-medical conceptions of what the nature of insanity
ought to be.
A subsidiary right of the insane is to have the State
provide criminal lunatic asylums, in order that the rights
of the insane may not be put in jeopardy by the just
fear in the public mind of having insane murderers and
others go free. An insane murderer, with certain excep-
tions, notably those of temporary puerperal mania, should
be under the State's surveillance for life, and law should
secure to the lunatic and the community this protection
against the possible consequences of disease. Such security
to society incidently guards the insane man in his rights,
and makes the chances for equal and exact justice, when
insanity is pleaded in excuse for crime, much more secure.
The last right of the insane, but not the least, that I
would here mention, is the right to medical inquiry, in
lieu of the ordinary trial by jury, into the question of
their insanity, before committing them to asylum care
and custody, — such an inquiry and so conducted as might
not aggravate the sick man's malady, by undue causes of
The Rights of the hisane. 189
irritation or needless publicity, or jeopardize his chances
of timely hospital treatment by a verdict of "not insane
enough for hospital treatment, because not yet dangerous
to self or others, or a disturber of the public peace;"
such a thorough, unimpassioned medical inquiry as would
certainly reach the true nature and needs of his malady
— and such an inquiry is best secured by men competent
from experience to investigate the nature of mental disease.
No such construction of the "due process of law "
guaranteed to any one deprived of liberty should be
made, as to deprive a mentally diseased man of a
thorough medical inquiry, conducted in accordance with
the nature and demands of his disease, in preference to
the ordinary "jury of" the insane man's "peers."
A last incidental right of the insane is to have proper
instruction, in regard to insanity, provided for in the
medical schools, and we make this demand for them, that
henceforth no medical college shall be chartered that
does not provide a chair of psychiatry. The true friends
of the insane are in the profession, and its members
should understand them.
Case of Syphilitic Gumma of the Brain.
By E. M. Nelson, M. D., St. Louis.
1\ TRS. M., aged thirty, a native of the United States.first
■^^-^ came under my care Jan, 19, 1882. She com-
plained of intense pain in the right side of the head,
sometimes extending down to the right eye-brow but
always present at the right of the vertex. The pain was
constant and had continued almost without interruption
since the middle of October. There was also complete
ptosis of the right eye-lid, which she said occurred sud-
denly (within one day) about six weeks before her first
visit.
The pupil of the right eye was fully dilated and there
was complete paralysis of all the motor muscles of the
eye, except the external rectus and the inferior oblique
which retained slight power.
She states that in the spring of 1878 she had sores
on her genitalia, which were treated locally, but had no
constitutional treatment. She was then pregnant, carried
child to full term, but it only drew a few breaths and
died. The physician in attendance told her that the
child was terribly diseased.
About a year afterwards, having perceived no symp-
toms of disease of any sort, and having received no
medical treatment, she became pregnant again. During
this pregnancy she was troubled with an eruption on her
chin which persisted for some months and disappeared
just before the time of confinement. There are some scars
now, showing that there must have been deep ulcer-
ation. There were also similar eruptions upon the arms.
She says the spots were dark red, that they ulcerated,
that there was no itching. The arms were free from
eruption much sooner than the face. The child that was
the product of that pregnancy was born at full term,
Case of Syphilitic Gumma of the Brain, 191
has always been a perfectly healthy and robust child and
continues so now at the age of two and one- half years.
About one year before the time of her first visit to
me, she began to suffer with a " sore throat, " which per-
sisted for some three months, causing her intense suffer-
ing. The present condition of the upper part of the
pharynx gives evidence of extensive ulcerative processes
at that time.
About the latter part of the summer she was hang-
ing out clothes in the yard one day, having nothing upon
her head, when she became very dizzy and sick at the
stomach which continued during the remainder of the day.
Next day she felt pretty weak, but no other trouble.
No other symptoms were noticed until her head-ache
commenced, as noted above.
I prescribed for her, ten grains of bromide of potas-
sium and five grains of iodide of potassium, three times
a day.
Two days later she reported little, if any, change. I
then gave her a prescription containing one grain of
bi-chloride of mercury and a half ounce of the iodide of
potassium dissolved in three ounces of water, of which
she was directed to take a teaspoonful four times a day.
One week from that time, the same prescription was
repeated, except that the quantity of the iodide was
doubled. She was feeling a little relief from the severe
pain in her head, at least, enough to encourage her to
continue the treatment. Her general condition was bad,
and beside the pain which still persisted, she was much
troubled with giddiness and, when she walked, staggered
so that she had everj' appearance of one intoxicated. In
walking there was a constant disposition to turn to the
left. She complained of hearing voices talking in the
room when she was really entirely alone. Her condition
seemed very critical, and the more so, as her stomach
then rebelled against so large doses of the iodide, and
we were obliged for a time to reduce them. After about
three weeks' treatment, she reported that the severe pain
192 E. M. Nelson.
in her head had entirely disappeared, and there has been
no recurrence of severe pain since.
The treatment was continued for four months. After
the pain disappeared, there was rapid improvement in
other respects. She gained in strength and flesh and
seemed better in every respect, except that the ptosis per-
sisted without any material change until early in May,
after which there was decided improvement in the power
to raise the lid. The external rectus has nearly or quite its
natural power, while the other muscles are still impaired,
and there is a consequent divergent strabismus with
diplopia which annoys her a good deal, being worse at
some times than at others.
She was delivered about the middle of June of a male
child which lived only a few weeks, dying of inanition
without any pronounced lesions characteristic of syphilis.
The general condition of the patient, now one year
from the time when she first came under observation,
is tolerably satisfactory. She still has a certain degree
of paralysis of the motor muscles of the right eye, and
at times has some pain similar to that which first brought
her to seek rehef, but it is not so definitely localized as
at that time.
The case seems to me an interesting one, as showing,
the characteristic symptoms of brain tumor and the rapid
relief afforded by anti-syphiHtic treatment.
GUITEA.U.— A Case of Alleged Moral
Insanity.
By J. J. Elwell, M. D., Cleveland, O.
MEMBER OF THE CLEVELAND BAR.
/^^ONTINUED discussion of this case is only tolerated
^^ and justified on the ground that its rank is at the
head of the cause celebre of American and English
Medical jurisprudence.
An impartial discussion of the matter is not to be
expected, until a sufficient time has passed to allow the
sediment of popular indignation and professional zeal to
fall to the bottom. Truth will then reveal herself and
not till then, for she shuns excitement and prejudice.
Mind sound and unsound, with many sided and ever
changing phenomena, has escaped the grasp of language
and no satisfactory definition has ever been formulated
of these terms. No standard of measurement or court of
appeals has been erected by which the issue of sanity
or insanity can be measured or decided. Each case is
sui generis, and encompassed by its peculiar difficulties,
and must be judged by its own characteristic phases for
which no precedent can be found. An examination of
mental questions, therefore, is much like a voyage of dis-
covery on an unknown sea, without chart, beacon-lights
or headland.
Aberration of mind or insanity is a symptom of disease
of the higher centers of the brain, or of the rush of
diseased blood through the tender tissues of thought in
a healthy brain — the disease being located elsewhere — in
which the mind loses to a greater or less degree control
of its healthy forces ; presenting a class of phenomenon
NOTE. — For a more full dlscassion of the subject of Moral Insanity, see
Chap XXIX, page 400, 4th edition of the writer's work on Medical Jurisprudence;
also his article in the Xorth American Review, for January, ISS^, on the Moral
Kesponsibility of the Insane .
194 /• /• Elwell.
unlike and antagonistic to its former habit of thinking and
acting; faiUng to adjust its surroundings to its former
normal condition ; interrupting the harmonious relations
of the material and the immaterial which make up a healthy-
mind or soul ; and in extreme cases, destroying a clear
knowledge of right and wrong, and with this last condition,
moral responsibility.
This journal has laid down the following rule, which
is undoubtedly correct : " If no change in the habits of
thought, feeling and action takes place, then it is not
insanity. The true test of insanity, therefore, is this com-
parison of the individual with his former self, taken in
connection with disease of the brain, " By this fair rule
let Guiteau be judged.
The writer proposes as briefly as practicable to group
the salient points of this remarkable case, which, as he
understands them, establishes the proposition of the entire
sanity and consequent responsibility of this homicide on
the 2nd of July, 1881.
First. Insanity, as a disease, is not transmissable from
parent to child, only a tendency or susceptibility thereto.
A person cannot be born insane. Congenital defects are
conditions of idiocy or imbecility, which are not technically
insanity.
There are no positive indications of this hereditary
tendency to insanity being present in the family of Guiteau.
The family physician and John W., his brother, with others
swore to the sanity of the father, and it is not pretended
that the mother was ever insane, or any of the direct
ancestry. Guiteau had apparently as fair a start in life
as men in general ; his career, however, from childhood,
seems to have been that of a wayward and undutiful son,
and as a man, he was erratic, egotistical and immoral.
He was a smooth villian, and his entire life mischievous,
unstable and annoying, as it must have been to his
friends and acquaintances ; no one thought of having
him shut up in a lunatic asylum, though he was more
than once sent to jail as a common felon. His health
Guiteau. 195
was always perfect. According to his policy of life insur-
ance, and his own evidence on the stand and his state-
ments to the physicians who visited him in jail, he had
never needed a physician and had never called one ; a
condition of health absolutely inconsistent with disease of
the brain. This perfect health throughout life, justifies
and sustains the appearance of the brain and membranes
on post-mortem examination, as reported by Drs. Sowers
and Hartigan : " which were such as are often found
without previous history of disease — the consistence of
the brain normal, with no apparent asymmetry of the
hemispheres. " As some controversy has arisen as to the
revelations of the autopsy, among those present, and
from the microscopical examination of the brain, it should
be said that there is not much reliance to be placed on
these post-mortem examinations and microscopical obser-
vations of the brain, as an indication of the standard of
intelligence. Some of the most distinguished and well-
balanced men that ever lived, have been found after
death, to have had extensive chronic disease of the brain,
with structural changes of apparently long standing, while
on the other hand, the brains of the insane, who have
been lunatics for years, show no evidence of disease, or
but little. Extensive lesions of the brain are not incom-
patible with a normal condition of the intellectual facul-
ties, nor is insanity inconsistent with ■ an apparently
healthy brain as developed under the microscope.
Had Guiteau shown signs of a diseased brain, to a
man as sharp as Scoville, he would not have offered him
a business partnership in 1876, which he did do. Dr.
Hamilton pronounces the cranium symmetrical, and that
there were no symptoms of general paralysis. Dr. Spitzka,
the defendant's chief and most important medical witness,
says he found " his skin was in a healthy condition ;
found his appearance perfect; his eyes perfectly healthy.
"No changes of habit, of life or thoughts. "
A life of consistent villiany and brazen impudence ;
a healthy body with] symmetrical cranium ; a normal
196 / /. Elwell.
consistency of the substance of the brain, with well bal-
anced hemispheres ; no need of a physician throughout a
Ufetime ; each and all are evidences, not of insanity, but
of a sound mind.
The long established and well settled rules of evidence
as applied in this case, estabHsh these facts and bring us
to a clear conclusion in which an overwhelming prepon-
derance of medical testimony agrees, to-wit : " No change
in the habits of thought, feeling and action have taken
place ; that a comparison of Guiteau with his former self
shows no material change, and that there was no disease
of the brain." Therefore it is not a case of insanity and
irresponsibility.
Second. It has never yet been held in law, medicine
or morals, that the commission of a great crime — even
when there is apparent, no adequate motive, which was
not the case here, makes a prima facie case of insanity or
in any way lessens the degree of guilt or responsibility
of the criminal, while the sentiment is universal, that the
greater the crime, the greater should be the punishment.
Guiteau's great crime was the logical result of a vile
and vicious life. His father said " in my judgment, his
wickedness has been caused by an unsubdued will, " His
sister : " his childhood was turbulent and flagrantly dis-
obedient to parental authority. "
His estimate of human life is shown, when he says to
Mrs. Garfield : " A human life is of small value. " Dr.
Barker says: "his insanity is wickedness." This wicked-
ness he was conscious of, and attempted to justify it by
an impious allusion to the Saviour of mankind: "Jesus
Christ struck back; and so do I. I do just as Jesus
Christ did." In his rascality he was only following the
example of the Apostle Paul, whom he alleges did not
pay his rent. He was no more a murderer than was
Abraham. His mania was " Abrahamic. " His shocking
godlessness reaches its climax in the declaration that he
was the junior member of tlie firm of "Jesus Christ & Co. "
He was leprous morally as he was physically syphilitic.
Gidteati. 197
Gross wickedness and reckless immorality, however,
ts not insanity. Dr. George M. Beard stands alone when
he says : " the essence of insanity is immorality and the
insane are always immoral. " Neither is immorality
insanity, nor are the insane generally immoral.
Third. The annals of criminal law nowhere show a
more deliberate and cold-blooded murder, than the
one committed by this homicide. In its conception,
pursuit, preparation to extreme details and consumma-
tion ; from beginning to the end, everything w^as com-
plete and there was no miscarriage in his plans till
twelve men pronounced him guilty of murder in the first
degree.
With excellent judgment and care he selected the
bull-dog pistol, as well calculated to do the work in hand.
Without practice, the deadly weapon was useless in his
hands, for he was not even " used to its sound ; " so he
shot at the willows for weeks, until he had mastered its
use. As carefully and with the same coolness he chose
his place and time for the final use of the bull-dog. All
the long wrecks of thoughtful preparation, his will power
seemed to be in good working order and well in hand,
for he made no mistake, nor revealed his deadly purpose
for that would have defeated the result. He could and did
control the impulse to kill the President at the church,
because his own life would be in danger, when there were
so many personal friends of the victim present; he could,
and did control the impulse to kill, when Garfield was
walking with Blaine in the night, as he dogged their foot-
steps, for, as he said afterwards, he '• thought he had
better take him alone." At the time when the fatal shot
was fired, he said he would not have killed the President,
if Mrs. Garfield had been present — he had once before
refrained from shooting, for the reason she was with him.
So the " grinding, grinding pressure," was completely
under the control of his will. He could grind harder,
when he chose to do so, than the " Deity. " He took
especially good care of himself, that an indignant and
198 / /. Elwell.
excited populace might not tear him to pieces or hang
him on the nearest lamp-post, at the depot.
Where there is so much judgment used, so much cool-
ness and deliberation, caution and will-power, insanity-
has no standing ground.
Fourth. Before the smoke of the pistol had cleared
away — before the wounded and dying man had reached
his home to go out no more but to die — in a lawyer-
like manner, as a matter he had well considered, he
announced the legal proposition that malice is an element
in murder, and "I had no malice," therefore, there could
be no murder in his case. The "grinding pressure" and
" inspiration " theory was an after-thought, not having
been heard of, up to the latest stage of the drama. It was
not long, however, before the prisoner himself, as in the
no malice theory, started the insanity idea for a defense.
Guiteauwas the inventor, and Scoville only took it at sec-
ond-hand and used it in the trial. " I was legally insane,
but not in fact insane. I know I could prove this by fifty
physicians, for physicians can easily be bought. " This vile
slander is only another evidence of his inherent meanness.
He also declared that the doctors killed the President.
It was then to Guiteau himself, to whom the defence
was indebted, for the suggestion in the first place, and
it was the only practical line of defense, offering the
least chance of escape. It seems, also, that he furnished
his counsel with the leading authorities ; for before the
day of trial, he had mastered all the leading cases on
the subject of insanity in this country and Europe, not
missing the case of Charlotte Cordoy, who has never
before been classed with the insane. The Freeman,
Coles-Hiscock, McFarlane, Sickles cases, as well as the
celebrated English cases, were as well understood by him
as by any superintendent of an insane asylum or crirsinal
lawyer in the country. He also prompted his attorneys as
to the latest decisions in the courts on the law of insanity.
He said to Judge Porter : " You would have hung Char-
lotte Corday. "
Guiteau. 199
When, since the world began, has a really insane man
suggested his own insanity as a defense, and urged it for
two and a half months, in the presence of court and jury
with such steadiness of purpose and marked ability ? The
writer does not recall such a case.
As the tide was turning strongly against him, his
brother came upon the stand, and swore to his insanity.
The prisoner cried out : " He has not known me for twenty
years ; all that I claim is transitory mania. " While mak-
ing a firm stand and fighting hardest at the insanity
point, he was too shrewd a general to neglect the bal-
ance of his line. Every rod was most stubbornly defended.
" The doctors killed Garfield. "
" Blaine was morally responsible for his death. "
"The President was himself to blame, for he destroyed
the Republican party, and betrayed Guiteau and others
who had voted for him. For this he died."
" Mrs. Garfield was responsible ; I would not have
shot Garfield, had his wife been present on the 2nd of
July. "
The Stalwart newspapers and speeches, he claimed, had
inflamed his mind and impelled him onward to commit
the crime.
Thus he fought ever}' gun, while he had a shot left,
being himself the chief figure upon the field of battle.
If such able leadership and management prove aberra-
tion of mind, who can be pronounced sane ? Then was
Guiteau insane ?
Fifth. It is herewith now in order, to ask those med-
ical gentlemen and journals who still insist on the insanity
and irresponsibility of this homicide : Is there then no
significance and no reliance to be placed in expert tes-
timony when it comes, as in this case, from thirteen or
more of the most eminent and experienced professional
men of the country, all, or nearly all, of them distinguished
superintendents of lunatic asylums, with a reputation in
the Old World as well as in the New ? There is at this
time, a very strong and growing feeling in the courts
200 /. /. Elweli.
and among the unprofessional, that medical expert tes-
timony is of little and doubtful value when insanity is
is set up as a defence for crime. Is this feeling to be
strengthened and intensified by the profession ? It would
seem so.
Admit the scientific evidence in this case, and the
theory of insanity is annihilated beyond dispute.
A full and carefully made analysis of the medical evi-
dence has been proposed as part of this article, but on
second thought, and in view of the exactions and limita-
tions of journalism, it will make the paper too long, if
printed, and is therefore withheld for the present.
These distinguished expert witnesses arguing from an
entirely different standpoint, and taking their stand on
another class of premises from those followed by the writer
in the foregoing argument, and with the strong light of
science fully turned on the case, illuminating its purely
medical features, exhausting all the resourses of their
profession in this examination, spending months in the
presence of the defendant and watching all his actions
and hearing what he has to say, go upon the witness
stand and solemnly declare that, in their mature opinion,
Guiteau was, on the 2nd of July, i88i, perfectly sane and
responsible. These witnesses were not only learned, but
they were honorable and disinterested men, anxious only
for the success of truth and the vindication of their pro-
fession.
Law and medicine never confronted each other in a
court of justice or elsewhere with an issue so momentous,
witnessed by the intelligent people of two continents as
excited spectators ; never did law make greater demands
upon the resources of medicine ; such requisitions were
never more fully and promptly met, by so many and so
able representative men of the profession; never was tes-
timony given under weightier and more solemn circum-
stances ; and finally, never has a great profession been so
triumphantly vindicated from the clamor, general distrust
and odium into which medical expert testimony had
Guiteau. 201
fallen — when insanity was interposed as a defense for
crime — and completely lifted out of that quagmire of sen-
timentality, fatalism, " moral monstrosity, " and wicked-
ness, called moral or emotional insanity, into which it
had fallen.
Contribution to the Question of the
Mental Status of Guiteau and the His-
tory of His Trial.
By Edward C, Spitzka, M. D.,
Professor of Medical Jurisprudence in the New York Post-Gradaate Medical
School; Physician in the Department of Xervous Diseases in the
Metropolitan Throat Hos|)ital ; Member of the American
Neurological Association; President of the
New Tork Neurological Society.
TT WILL probably be many years before a full and
-*- impartial history of the remarkable events which cul-
minated in the conviction and execution of the assassin
of the late President can be written. In view of the
somewhat isolated position which I occupied at the time
of the trial, and the natural bias which might be expected
to exist in my mind on the entire subject, I had at first
intended to refrain from adding to the enormously increas-
ing " Guiteau " literature, which will form the basis of
such a history. As far as my individual position, and the
historical vindication or non-vindication of my positive
opinion that Guiteau was insane was concerned, I believed
that I might leave the matter to fair commentators, and,
therefore, " rested " on the record of the trial.
But, unfortunately. Congress has not ordered the print-
ing of three thousand copies of the trial report, as was
moved by one of the members, and whose general distri-
bution would have facilitated a correct understanding.
The few copies extant are either in the hands of the
counsel or of the medical witnesses. Those who have
written upon the subject, as spectators from a distance,
202 Edzvard C. Spitzka.
have consequently based their opinions largely on the
reports in the daily press, or the scientific communications
made by those who were active participants in the trial.
And it is a fact, that even those who were on the ground,
at Washington, carried away with them quite confused
notions of many of the incidents of the trial. *
With the grave prospect presented to my mind that
the dissemination of erroneous, views, and faulty or improper
records might lead to a flaw in the judgment of a later
generation, it seems to me a duty to correct such errors
as have already been committed, and to do this, even at
the risk of seeming autobiographical. It will probably be
admitted that if it is worth while discussing the mental
state of Guiteau, of balancing the alleged criminal and
insane perversions of his moral state with Folsom ; of
analyzing the faulty state of his logical apparatus with
Godding, Fisher, Hughes and Channing, and of endorsing
the opinion that he was undoubtedly insane, as is now
being so generally done on both sides of the Atlantic, it
is worth while determining whether these or other correct
opinions were announced at the time of the trial. It
strikes me as somewhat pharisaical on the part of several
distinguished gentlemen who took part in the trial of
Guiteau, that they carefully omit any mention of the
opinions actually given at the trial, and shield their own
unwillingness or inability to give a temporarily unpopular
opinion behind a condemnation of, or slur upon Mr. Sco-
ville's notorious hypothetical question. We know from
Dr. Godding,t that the real trouble was " a lack of positive
belief on the part of the experts for the defense in the
prisoner's insanity;" I heard from Mr. Reed that the
same gentlemen were intimidated, and declined, with the
exception of Drs. Godding, McFarland and Kiernan to give
•Thus Dr. Godding, in his excellent and Impartial " Two Hard Cases,"
spealis of my having criticised Mr.Corkhill's conduct of the case in the "publicjour-
nals," when in point of fact I was cross-pxamined on an article written over the
pseudonym "Philalethas" in the Medical Record, and was one of the few witnesse*
in the case who hud neither written for the public Journals, nor permitted them-
selves to be interviewed by tlieir representatives.
t ' 'Two Hard Cases, ' ' page 189.
Mental Status of Guiteau. 203
him their views on the prisoner's mental state. All these
facts will become ingredients in the history of the trial,
and the effort to stifle them by condemning our present
system of calling experts, and examining them in court,
or by raising any other side issue not immediately rele-
vant to the case, cannot alter the fact that there were
opinions given at the trial under every disadvantage
which, if the prevailing view that Guiteau was insane,
passes into history as a correct one, will stand for all
time.
In the first place, Dr. Rice, the family physician of
the Guiteaus, gave an opinion of Guiteau's mental state
in a very few words it is true, but in words which fully
anticipated the opinions published in the essays of Chan-
ning, Fisher, Godding and Kiernan, as well as the opinion
I subsequently gave on the stand. It is to be recollected
that Dr. Rice was called as an ordinary and not as an
expert witness, but I believe that his opinion will be
looked upon in the future as an expert, that is as a
skilled and scientifically true opinion.
The only opinion given by a physician called in as an
expert witness that Guiteau was insane was my own. I
understand from Dr. M. Farland that he was willing to
testify as positively to the same general effect, but he was
excluded from the stand on a technical quibble, and
compelled to Hsten in silence to the unprovoked vitupera-
tion of two of the counsel for the prosecution. I am also
aware that Dr. Kiernan entertained views very much like
my own, but while he gave lengthy descriptions of the
form of insanity under which he believed Guiteau to be
laboring, Mr. Scoville not once asked his opinion regard-
ing the actual prisoner at the bar.
My position in the trial was a very peculiar one. I
doubt whether a medical witness in this country has
ever enjoyed the advantages of a similarly independ-
ent status, and but for the unpopularity of the views
I announced, I think that this would have been
more generally recognized than is the case. I was
204 Edward C. Spitzka.
approached by the prosecution as well as the defense
and declined for partly personal reasons to appear on any
side. I declined to appear for the prosecution because I
was well satisfied that Guiteau was insane, and that sane
or insane, his prosecutors were not proceeding to deter-
mine his mental state in a proper manner. I declined to
appear for the defense because I had no ambition to
become a target for attacks which I foresaw would be
made, nor did I care to interrupt my labors in behalf of
so unpopular and unprofitable a cause. Mr. Scoville,
knowing of my opinion through several private channels
(as I subsequently ascertained), had a compulsory process
issued against me in the shape of an attachment. I dis-
covered that I could not evade it, and to avoid the
semblance of an arrest, went voluntarily to Washington.
I informed Mr. Scoville that I would refuse to testify ;
but he claiming that the court would compel me to do
so, I concluded that it would be of all things desirable
to examine the prisoner beforehand. I may say also that
my sympathies were strongly enlisted for Mr. Scoville
after the interview,* and when I received such positive
and valuable confirmation of my surmise regarding Guiteau
at my personal examination of him, I resolved to make a
less emphatic protest against being compelled to testify
than I had intended when I left New York, and I finally
took an excusable pride in testifying in behalf of what I
thought was a scientific view against an almost unprece-
dented prejudice.
On the nth of December, I testified under the order
of the court, and it is but just to say that while Judge
Cox allowed the prosecuting lawyers to indulge in many
assaults that might have been checked then and there,
he sufficiently appreciated that his order compelling me
to testify after the issue of an attachment, made me a
witness for the court, and not for any party. More than
•When I called ou Mr. Scoville, his wife acted in so strange a manner, among
other things, suggesting conferences with herself relating to the testimony I was
to give, as to strongly Indicate her being herself insane. 1 have since received
evidence of a disordered mind from her, and I imderstand that a jury in Chicago
have pronounced her insane.
Meyital Status of Guiteau. 205
once he rebuked the counsel for the prosecution for some
of their worst attacks, and protected me to the extent of
his abihty under the practice of the district court. When
I resented an examination as to my rehgious belief, as an
impertinence of District Attorney Corkhill, and when I
repudiated having intended to cast any reflection on the
medical witnesses for the prosecution, as the same person
intended I should do — and which some people, not con-
versant with the real facts, believe I did — the Judge gave
me his most emphatic support, and although doubtless
aware that one of the bitterest newspaper attacks made
on him was made in a New York paper whose columns
were controlled by one of the prompters of the prosecu-
tion, because he did his duty to the witness, he protected
me — feebly, it is true — but still he protected me against
the assaults made after I had turned my back on Wash-
ington, and was not on the ground to defend myself.
In submitting from the stenographic report of the trial
the opinion I actually gave, I may say that I had had no
opportunity of preparing my testimony. I omitted detail-
ing many items of my conversation with Guiteau in jail,
and I did not state what form of insanity I believed him
to suffer from. As Dr. Kiernan has been criticised —
inferentially, at least — for pronouncing Guiteau a case of
the "primaere Verruecktheit " of the Germans,* it may be
as well for me to say I thoroughly agree with him, and
that I had, long before testifying, in an anonymous com-
munication,t whose authorship I avowed at the trial,
expressed a similar view based on Guiteau's published
writings and life history.
The substantial portions of the testimony are the fol-
lowing (p. 965 of record) :
" I may say that it would be very difficult for me to
render clear to any jury not composed of experts. I can
•Goddiug's "Two Hard Cases," p. 189. Remarkably enough, Dr. Godding
■abstaniially agrees -with mv estimate of Guiteau, but the facts making up tnat
estimate fit no clinical picture so weU as the "Originaere Verrucktheit" of Sander.
tA^.io iork Medical Record, Oct. 19 h, 1881. This communication was signed
by a pseuclonv m because I did not care to provoke a subpcena, or to add to the grounds
on which I might be compelled t> testify.
2o6 Edward C. Spitzka.
simply say that the marked feature of this man's insanity
is a tendency to delusive or insane opinion, and to the
creation of morbid and fantastical projects, that there is
a marked element of imbecility of judgment, and while I
had no other evidence than the expression of his face,*
I should have no doubt that he was also a moral imbe-
cile, or rather a moral monstrosity."
(p. 966.) — Ques. — Will you state whether you observed
any indication of insanity from his eyes ? I do not mean
from your examination, butf from his general appear-
ance. Ans. — That was to my mind,| the most conclusive
evidence of insanity. I concluded that I had an insane
man to deal with on sight, before I asked him any ques-
tions. He has got the insane manner as well marked as
f have ever seen it in an asylum.
(p. 971.) — Ques. — I am not asking what you are tes
tifying on now, or on what basis ; I want to know on
what basis you rested the opinion that you expressed to
Mr. Porter? Ans. — Upon the man's insane documents,
the insane expression in a good picture which I saw, and
his hereditary history as stated in the papers, and the
almost unanimous interpretation made by the laity at the
time and shortly before and after the crime, of his men-
tal condition. (p. 972.) — Ques. — Can you tell me what
documents you refer to ? Ans. — The one addressed to
General Sherman. Ques. — You think that was an insane
document ? Ans. — That was one. Then there was the
letter about that woman he was going to marry, with a
million . dollars or ;$400,ooo,
(p. 972.) — You have mentioned the Sherman letter.
Give us the rest of the documents? Ans. — The letter in
which he spoke of the Paris consulship in connection
with a rich or wealthy lady he was going to marry.
Ques. — The third (element) was the almost unanimous
opinion of the laity. How did you get that opinion?
* Kel'erB solely to the examination In Jail.
t Relers to ophthalmoscopic examination.
\ This was corrected in the subsequent testimony to "a most conclusive evi-
dence of insanity," whether a stenographer's error or a slip of the tongue.
Mental Status of Guiteau. 207
Did you take a vote of the laity ? A. — No, no ! I refer
here strictly to what was stated in the daily papers at
that time ; the opinion of General Logan for example. I
do not speak of the laity in general, but the laity who
saw this man; the statements of Mr. Reed and others
who have already appeared as witnesses in the case, and
who at that time were interviewed, and their statements
published in the daily papers,
(p. 976.) — Q. — Go on. You say you examined the
shape of his head ? A. — I did. Then I said to him :
"I will have to know a little more about the psychology
of your crime * in the removal of the President." He
then said : " Psychological, doesn't that come from C'-r/r,
tnmd, soul}'' "Yes," I said. Then I said: "What objec-
tion did you have to the President?" "I hadn't any;
he was in the hands of Blaine." I said : "Why didn't
you remove Mr. Blaine, if you had these objections
against him — not the President?" He said: "Because
that would not have done any good ; there would have
been just such another as Blaine to step into his shoes
and Arthur would not have been President, and he has
cemented the Republican party." Then he became
wildly excited about the trial, yelled forth about the way
the prosecution was attacking him, bringing up as he said,
"lying witnesses," and he yelled out loudly, declaiming
and showing the insane manner to perfection.
Q. — (interposing) One moment; you are too fast; he
yelled out what? A. — That they were liars, and intensi-
fied the word louder than I choose to repeat. I told
him to keep cool, as it was difficult to restrain him, and
he wandered off to another subject ; I disremember which.
I said to him: "'Why do you interrupt the Court then,
if you say that God has got this thing in His hands,
and will lead it to a successful conclusion as far as you
are concerned, and that you are resigned to what-
ever fate is administered to you." " Why" said he,
•I examined Guiteau in the character of an aile^ed phrenologist, knowing his
predelection for this and other spurious sciences. I may add this is a characteristic
of many of his class.
2o8 Edward C. Spitzka.
" don't you know that Jesu.s Christ himself, who was sa
lamb-hke, said something." I am not a good Biblical
scholar, but he gave a very good quotation that I rec-
ognized at that time, about somebody being sent down
to utter damnation * for lying. " Can I not do the same
thing? Am I not just in the position of Jesus Christ?
Am I not here a martyr? Have I not sacrificed myself
for the American people?" And so on, through a reg-
ular farrago of the kind that is familiar to those who
visit the wards of a lunatic asylum. That will about
comprise what I found of his mental condition.f I found
his memory good. I found that he had the legal attain-
ments as far as I have a right to pass an opinion, of a
third rate shyster of a criminal court ; he displayed a
certain amount of judgment certainly ; he parried ques-
tions to answer those he preferred to answer, and betrayed
great egotism in everything he said.
(p. 678.) — Q. — You found that he parried questions?
A. — Wherever a question was asked, whose answering
would wound his egotism and vanity, he parried it to
go off to some subject that would develop his greatness
or his high position, or his great services or whatever
else was flattering to his self-love.
(p. 979) — Q. — What do you mean by a tendency to
insane delusion ? A. — I mean a phenomenon frequently
exhibited by those having the insane constitution, a tend-
ency to misinterpret the real affairs of life, especially
those of a complex nature, and to interpret these affairs
in some way as having connection with themselves, the
starting point being the exaggerated self-feeling of the
morbid egotist in this case.
Q. — What made you think he had a tendency to the
formation of morbid projects ? A. — Because he told me.
May I speak of his manner? Mr. Davidgc — O, yes ; speak
of anything you choose. A. (continuing) — He told me,
as positively and sincere as a man could, that when he
• "CoiitUiimiatioii, " In original.
t I hiul tuken lull minutes of the cxiiiuinatidn, but did not altcmpt Id msi' tlicm.
I iiml) rslo d tliat tlicy woidil have been ruled out.
Mental Status of Gidteau. 209
got out of jail, and he felt firmly convinced that the
American people would never allow him to die a disgraceful
death in consideration of what he had done for them,
he would go to Europe for three or four months, and
then he would come back and lecture, and he expected
to make a great success at lecturing. That .was a mor-
bid project in anticipation for the future. I became con-
vinced in my examination of him that the crime for which
this man stands indicted was the result of a morbid
project rather than of a delusion, strictly speaking — delu-
sive opinion entering into the crime.
Q. — I understand you found then that he shot President
Garfield, not in consequence so much of any insane
delusion as on account of this other element ; that is. the
formation of a morbid project? A. — Based on delusive
opinion ; I would wish to be clearly understood there.
If you make a wide construction of the word " delusion,"
of course the murder would have been the result of a
delusion, but in the narrowest sense, not. * * *
Q. — What other instance of the formation of morbid
projects did he afford, except what he said about going
to Europe? A. — Well, I said that was in the future. In
the past, he gave me the history of his removal of the
President, which I interpreted as being another morbid pro-
ject. That is all I obtained from my personal examination.
Q. — Now, that is reasoning in a circle. The thing to
be ascertained by you was tiie condition of his mind when
he removed the President ? A. — I did not so understand it
when I went to the jail. The only thing I expected to
get was his present condition at the time, and what he
said.* In so far as it would tend to elucidate the condi-
tion of his mind at the time of the assassination, I should
require, of course, facts that he could not give, and that
I could obtain in no t examination outside of this, to form
a complete opinion upon the assassination, which have
not been furnished me.
•Erroneous punctiuition in miuutes; here euni-cteil.
t Should lead "an exarcination, etc."
210 Edward C. Spitzka.
Q. — You do not then undertake to give an opinion in
regard to his condition at the time of the assassination,
do you ? A. — Only in so far as I would say that that
man has always been of a morbid character covering the
whole of his life. *******
(p. 983-) — Q' — Moral monstrosity was your last conclu-
sion. What do you mean by that? Will you be kind
enough to define that ? A. — By a moral monstrosity I
mean a person who is born with so defective a nervous
organization, that he is altogether deprived of that moral
sense which is an integral and essential constitution of the
normal human mind, he being analogous in that respect,
to the congenital cripple, who is born speechless, or with
one leg shorter than the other, or with any other mon-
strous development which we now and again see. * * *
A. — Then you mean to say, what enabled me to say this
was the result of a congenital taint, and not the result of
circumstances ? Q. — Yes. A, — The shape of his head and
his face, and certain indications of imperfect brain devel-
opment which I found, those being a defective innerva-
tion * of the facial muscles, asymmetry of the face
and pronounced deviation of the tongue to the left.
These were the evidences that I found that he was born
with a brain whose two sides are unequal, or so much
more unequal than the normal difference as to constitute
a diseased difference. * * * ^_ — ]sjo, not a tendency,
but an actual deviation, which, at the point of the tongue,
would amount to nearly three-quarters of an inch, or
a-half an inch from the median line. Nozv, 1 do not wish
to he understood that on either one of these evidences, singly,
I should call a man insa7ie, I simply speak of the collective
group. * * * And I may say that my opinion was
tinctured by what I heard of his hereditary history. The
fact that a relative died at an asylum, and that another
is at Pontiac, and that they are blood relations, were
among the facts that induced me to believe that his was
a congenital case. Q. — Then you do not base your
•'•Innovation," in original.
Mental Status of Guiteau. 2ii
opinion upon the data you have mentioned to me. A. —
These data, by themselves, would only allow me to form
a very strong suspicion that such was the case. (p. 986.) —
Q. — Now this had some influence upon your mind, as
you say yourself — the idea of heredity — in forming your
judgment in respect to the head, the facial muscles, and
the deviation of the tongue? A. — I have no hesitation
in saying that it certainly had a strong influence on my
mind. Q. — Now, suppose that influence had been removed
altogether, would you still have reached the conclusion
you did in respect to the head, the facial muscles and
deviation of the tongue ? A. — I should only be able to
say what I said before, that it would amount to no more
than a strong suspicion.
(p. 987.) — Q. — Now, let us go back to the first. I want
to know whether the fact of a human head being larger
on one side than the other is indicative of moral mon-
strosity? A. — Not by itself. Q. — To what degree is the
element of increase in one side over the other in the
head of the prisoner greater than that of other people ?
A. — It would be very hard to express that, and I think
you misunderstand me, if you believe that I lay great
stress upon that. Q. — Coming right down to the point,
I want to know, for I am seeking after truth, whether the
inequality of the two sides in the case of the prisoner is
greater than in very many people in the world ? A. —
Yes, sir.
I have been thus lengthy in reporting the portion of
the voluminous testimony, relating to the question of
cranial and facial asymmetry, because I have been made
painfully aware of the fact that it is assumed that I made
more positive assertions about cranial atypy, than are
warrantable. I understand, indeed, that the implied criti-
cism of my character as a witness, in the last number of
the Alienist and Neurologist, was based on such a
belief, as well as on the prevailing erroneous impression
that I acted the part of an aggressive witness.
212 Edward C. Spitzka.
I presume that the writer of the criticism alluded to,
will now, with the true facts reported from the official
testimony, agree with me, that nothing was said in regard
to the physical signs of Guiteau's condition, that has not
been confirmed by the autopsy, by Drs. Folsom and God-
ding, and that is not in accord with men like Krafft-
Ebing, Meynert, Westphal, Muhr, Stahl, Morel, Lombroso
and others. One reason why I introduced the subject of
the physical signs at all was that I knew the " Govern-
ment experts " were about to advance the theory of
simulation, on which they subsequently differed so gravely
amongst themselves. It is a cardinal canon of psychiatry
that the existence of somatic signs of insanity is the best
evidence of the genuineness of the aisorder. And I am
perfectly willing to be placed on record as committed to
the view that where I find the signs of reasoning insanity
(origiuaere Verruecktheit) evidences of heredity, and cra-
nial malformation with defective peripheral innervation, I
do not hesitate to assume an intimate relation to exist
between these factors.*
As the reports in the daily papers read, I can censure
no one for believing that I indulged in — however justifi-
able— repartee to an extent which may have damaged
ae influence of the testimony. It must be recollected
hat the testimony occupied a day and a-half in its
delivery, that this period of time was, with the exception
of in all about twenty minutes, consumed by the cross-
examination, and that everything resembling repartee was
selected for the delectation of a sensation-loving public,
to tlie exclusion of the substantial points of the testimony.
The assaults made on me by counsel were of such a
nature that no meaner a commentator than the Springfield
Republican concluded that they had strengthened my
testimony, a view somewhat in opposition to that of Dr.
Godding. It may be also believed that if the impression
* I have I'l liberated these views, which are so far removed from the absurd that
8chuele w:ih Indiieed to open a question iis to the priority of one oi them, In my essay
on the Somatic Etiology of Insanity, now in course of publication.
Mental Status of Guiteau. 213
left by that testimony had been inconsiderable, that the
three counselors for the prosecution would not have
seized at every opportunity for launching forth into bitter
personal tirades against him who gave it, on almost
every subsequent day of the long trial. If what the
witness said could leave no trace on the minds of the
jury, it is remarkable that the coimsel for the prosecu-
tion should endeavor to fan up religious prejudices against
him, and to falsely assert that he was a "horse doctor,"
an " agnostic," " did not care to acknowledge a deity,"
etc.
I think a perusal of the following extract from the
report in the Ne^v York Herald will show that I was
forced against my inclination to indulge in what was con-
sidered then and there as the hit of the day by not a
few :
" Q. — Have you been a professor in any college ? A. —
Not in any medical * school. Q. — At any college, medi-
cal or not? A. — I was Professor of Comparative Anatom}
at the Columbia Veterinary College. Q. — You were Pro-
fessor of Comparative Anatomy at Columbia Veterinary
College ?t A. — I said so. Q. — What sort of a college
is that. A. — It is a college where physicians are instructed
in the art of treating the lower animals. Q. — Horses,
mainly, I suppose? A. — Yes, sir. The branch I taught
is one taught in medical schools. Q. — Yes? A. — The
branch that is pursued by such ^men as Thomas Huxley,
Baron Cuvier, by Gratiolet, by Haeckel, and other of our
most eminent scientists. I have no reason to be ashamed
of it. Mr. Davidgc — I do not say that you need to be
ashamed of it. Witness — The question has been asked
me before, and suggested from a special quarter,^ I know
that this comes from the same quarter now, and I have
•I was not at that time.
t To have a fall conception of the scene, the reader must imagine the drawn
sneering manner in which the question was— so demonstratively — repeated.
t At the Gosling trial, it was suggested by one of the "Govtrnraent experts,"
Who 80 publicly boasted of the achievement that I need not hesitate to publish the
fact, which is well known in New York medical circles.
214 Edward C. Spitzka.
expected it, it is done with the purpose of casting a
reflection on the witness. Q. — All these celebrated gen-
tlemen, whose names you have mentioned, belong to what
are called horse doctors? A. — I have never treated any-
other animal than the ass, and that animal had two legs,
and therefore I could not consider myself a veterinary
physician, but a human professional. Q. — But you are a
horse doctor, are you not? A. — In the sense that I treat
asses who ask me stupid questions, I am. [Laughter and
applause.]"
Am I asking too much if, in view of the criticism so
freely indulged in by, I am happy to say, but a few of my
colleagues I demand that some of this criticism be directed
to the medical prompter who would prompt such questions,
and the counsel who could lend himself to be the instrument
of an inter-necine warfare ? I know very well that the
counsel for the prosecution were cautioned by their med-
ical adjutants against attempting to cross-examine me on
the literature or the problems of insanity 1 On a former
occasion, although a similar retort was on my lips, I
refrained from giving it, owing to views of professional
decorum and dignity, which I then entertained, which
would have been proper to entertain in a continental
court of law, but which are a little too narrow with such
juries and court-room audiences as we have to contend
with here and in England. I had the choice between
being laughed off the stand, as I was on the former
occasion, or of turning the laugh on the counsel, and
securing what I did secure, a most respectful hearing !
I should question the mental integrity of the individual
who could hesitate which alternative to adopt, with both
alternatives clearly before him, and such an experience
as I had had to reflect on. The end certainly justified
the harmless means employed.
After these digressions, I may state briefly what my
present opinion concerning Guitcau's mental state is.
Early in life, Guiteau showed signs of defective brain
development, learning to speak many years later than
Mental Status of Guiteau. 215
ordinary children, and being unable to pronounce certain
sound combinations, even after he had learned to speak.*
During his youth he showed that vacillating wandering
and fantastic tendency so characteristic of those constitu-
tional lunatics described by Sander under the designation,
"Originaere Verruecktheit." His insanity might have
assumed any of several phases after he reached adult life,
according to the complexion of his surroundings. There
could be no better proof of the claim which has been
repeatedly urged, that the formal contents of delusions or
insane conceptions are merely incidental, the essential
factor being their mechanism, than the fact that at various
periods of his life, Guiteau exhibited indications of so-called
Theomania, " Querulantenwahnsinn " — erotomania or simple
megalomania. All these are simply names indicating the
direction in which one and the same fundamental logical
flaw may carry the subject. His tendency to litigation
displayed toward the Oneida community and the Neiv York
Herald, his keen enjoyment of the controversial episodes
in his own trial, were a faithful reproduction of what
Krafft-Ebing and others have described as " Querulanten-
wahnsinn." His marriage schemes, his platonic distant
admiration of women whom he did not know, and whom
he took no steps to enter into any reasonable correspond-
ence with, savor strongly of the erotic monomania of the
French. His religious reformatory schemes, his exaltation
on the scaffold, and his early display of what Dr. Rice
called a pseudo-religious feeling — though towards the close
of his career, I think it burst out in that full-blown
fixed delusion which it was impossible to determine the
existence of during the time of the trial — correspond to
the symptoms of so-called Theomania, the group in which
Dr. E. C. Mann locates him. Finally, his political and
social aspirations, his financial and business schemes place
him among the sufferers from systemized megalomania.
♦A difficulty in labial sounds was observed at my examination of him. His
niece, Mrs. Scoville's daughter, said "trat" and "trittcn" for cat and kitten,
down to the time of the trial. Guiteau's speech defect was testified to by a Govern-
ment witness, his school-teacher.
2i6 Edward C. Spitzka.
I think that with the extensive record of Guiteau's Hfe,
his documents, his career after his conviction, and the
manner in which he took his departure, as well as his
hereditary antecedents, there can be very little doubt in
any impartial, competent and truth-seeking mind, that these
were evidences of a disordered brain action.
I was much surprised at Folsom'S conclusion that
Guiteau's crime arose from criminal motives. As I under-
stand his view, a lunatic committing a crime from criminla
motives is one whose crime is neither prompted by, nor
directly connected with, his insanity. I can readily con-
ceive of such a thing, I have evidences which satisfy me
that a lunatic might commit a murder or a robbery from
ordinary criminal motives. But, in the instance of Guiteau,
I believe the connection between the insanity and the
crime is clear. In the first place, we have that peculiar
moral color blindness which marked tbis lunatic's career
throughout his life. We then have that tremendous
egotism, which later upheld him under the execrations of
fifty million people, the hatred of the civilized world,
the bullets of three would-be assassins, the bowlings of
the mob, the threats and vituperations of the press, mat-
ters which this remarkable person in great part foresaw,
and, as he thought, provided against. This morbid egotist
is disappointed in his political aspirations ; at this moment
the person whom he holds responsible for the disappoint-
ment is made the subject of a thousand attacks in the
" stalwart papers," one of them actually suggests the
removal of the President as the very best way to break
the power of Blaine. His weak and one-sided mind
ponders over the " situation ; " the outcry of the stalwarts
is an echo of his own little trouble, and he determines to
take the risks of martyrdom in as pseudo-patriotic a char-
acter as he had risked ridicule and the evils of dead-
beatism at an earlier period of his life in a pseudo-religious
spirit. From the time he presented a copy of his speech,
with the word "Paris" written in lead pencil in one
corner, to the President, as <i reminder of his claim to
Mental Status of Gutteau. 217
the consulship, all through that now well worn record :
the threatening letters to persons high in authority ; the
purchase of a silver mounted pistol, that it might make a
better display in the Army Medical Museum ; the visit to
the jail to see whether it would resist mob-violence; the
attack on the President in a crowd, and in open day, when
he could have killed him more safely on an earlier night,
in a comparatively deserted locality ; the letter to General
Sherman; the "Address to the American People"; the
collection of newspaper scraps and other documents in
his pockets, I cannot discover a single unquestionably
sane step in the man's reasoning. Most of these acts,
individually considered, suggest rather unsoundness than
soundness of mind. Some are characteristically insane
acts, considered by themselves ; all, in their aggregate,
are, typically, features of the inception, maturation and
consummation of a morbid or delusional project.
Guiteau, I think, felt confident (almost to the last
moment) that he would never be executed. I feel con-
vinced that his assertion, that he was God's man, was
" dead earnest," to use his own words, just as I feel sure
that his comparison of himself to Jesus Christ was not
blasphemy — as it was characterized in the most non-
sensical effort ever indulged in in any court of law : that
" protest in the name of the American people," made by
the leading counsel for the prosecution — but a delusional
conviction. What else but the faith of a madman sup-
ported this person under the terrific denunciation of the
press, the pulpit, and in sight of the hangman's rope, this
physical coward, who shrank from the report of the first
shot he ever fired in his life ?
It is hardly necessary for me, in the face of my testi-
mony given at the trial, to add that I do not consider
Guiteau as a " homicidal lunatic," whatever that may
mean. The assassination was an episodical development
of an insanity which was not impulsive in its character.
I do not think that Guiteau had any imperative concep-
tions; as to hallucinations, I am not so certain. His
2i8 Edward C. Spitzka.
so called "dream" related to me, and corroborated by
him in court while I was referring to it in my testimony,
if it was not an hallucination, bore the same relation to
the subsequently developing aspirations to the Presidency
in 1884, that the hallucination of delusional insanity
sometimes bear to subsequent delusions. He dreamed, as
he claimed, that he was holding a reception at the Presi-
dential Mansion, that it was an immense affair, and that
the crowd extended miles and miles away. Who will not
recognize in this dream a reflection of the pride Guiteau
took in his jail receptions? If the prosecution had
intended to prevent Guiteau from breaking out in insane
fury, they could have selected no better method than the
permitting him to hold these receptions, which tickled his
vanity and kept him in a complacent mood.*
To the reflecting psychologist, however, the readiness
with which Guiteau accepted bogus checks for fabulous
sums, in sober earnest, while in prison, his childish indig-
nation at the written curses, threats, miniature gallows
and hempen rope sent him by mail ; his belief that
the persons visiting him from motives of curiosity were
his admirers ; his replies to alleged candidates for his
hand in marriage, and so on, are among the strong cumu-
lative evidences of his insanity ; evidences which did
not require the unexpected post-mortem signs of insanity
revealed in Guiteau's brain to elevate them to the dignity
of proofs !
But it was not my purpose to do more than to sketch
hurriedly my own views, as entertained at the present
moment, in order that I may be on record with such
modifications as the reader may detect on comparing
these expressions with those cited from the testimony
given over a year ago. I recognize regretfully that the
personal pronoun and personal matters have been so
prominent in this paper, but how I could otherwise
correct errors for which I am not persomdly responsible,
•Mr. Scovllle iuformed ine that ho tried to have this sciinilal stoiijieii, but in
vain.
Mental Status of Guiteau. 219
but which have formed the basis of invidious personal
criticism, I do not know. I trust that I have at some
risk of inviting further criticism of a different nature,
at least relieved those who hold the view that Guiteau
was insane, of the imputation that the only witness
who had the opportunity of defending the conviction which
they shared, held the ridiculous view that Guiteau was
insane merely because his head was asymmetrical, and
ruined the effect of his testimony by unprovoked sar-
casm and repartee, or believed Guiteau to be a " moral
monstrosity," and nothing else.
I will add, that under the excellent clause on respon-
sibility of the codes of the Central European States,
Guiteau, the free determination of whose will was impaired
by disease or defect, was not a responsible agent when he
killed President Garfield. I have always held the view,
perhaps not emphatically enough expressed at the trial,
that he did not appreciate the ethical aspects, that is the
right and wrong of the act for which he was executed,
although at every time preceding, during and after the
act, he was aware of the ordinary legal results following
the commission of a crime. I am also of the belief that
if Guiteau had been certain, or had even considered it
probable that his shot would earn him an ignominious
death, it would have prevented him from slaying the
President. But it is precisely because such subjects as
Guiteau will rarely, if ever, recognize their own condition
or their relation to their surroundings properly, that they
are not able to adopt the rules of action governing reason-
able persons, as guides. Because Guiteau was insane, he
believed that his foul deed was a meritorious act ; because
he was insane, he believed that he could commit that crime
and not only escape punishment, but earn the gratitude of
a nation ; and because he was insane, when he had no
refuge on earth left, he turned to a future which, if he
had been sane, would have held out little of the con-
solatory to him, and arrogated to himself in the other
world a position side by side with the Almighty — and
220 Edzvard C. Spitzka.
in this a monument erected by a grateful and contrite
nation, after the long and bloody war he predicted would
grow out of his execution. Could sane conceit and sane
egotism ever approach this ? Could the check of the law
ever be applied so as to influence such overwhelming
self-exaitation ?
The Influence of Age upon the Mind
and Body in Relation to Mental
Derangement.
A CHAPTER FROM A FORTHCOMING TREATISE ON INSANITY.
By William A. Hammond, M. D.
Surgeon-General U. 8. Army (Retired List) ; Professor of Diseases of the
Mind and Nervous System, in tiie N^w York Post-Graduate
Medical School, etc.
'' I ''IME, which exercises its influence even upon inor-
-*- ganic bodies, is immeasurably more powerful in its
relations with organized beings. They spring into exist-
ence, increase, decay and die according to the laws of
their being. In some, the cycle is completed in a few
days, or even hours; in others, in a few years; and in
others, again, not until centuries have elapsed.
This is equally true of animals and vegetables. The
moth of the silk worm and certain cryptogamic plants
measure the period of their existence by hours, while the
crocodile, the elephant and the oak count hundreds of
years of life.
King David fixed the length of human life at seventy
years, with eighty as an exceptional limit. Flourens*
believes, with Buffon, the natural life of man to be one
hundred years, and adduces many ingenious arguments
in support of his opinion. Instances arc not wanting in
which even this limit has been greatly exceeded. Thomas
Parr, for instance, is said to have lived to the age of one
•"De liilonK«vitohuraalne ct de la quantitede vie surlii globe," Paris, ISr*.
Age and Mental Derangeme7it. 221
hundred and fifty-two years, and then to have died from
indigestion caused by overeating at a feast given to him
by Charles I. Harvey made a post-morteyn examination
of his body, and found all his viscera in normal condition.
The cartilages of his ribs were not ossified.
Mr. E. Ray Lankester * cites instances in which one
hundred and nine and a hundred and eleven years have
been reached, but doubts if there is any authenticated
instance of more than one hundred and twenty years
having been attained. He cites statistics which go to
show that in civilized communities the average duration
of life is greater in females than in males.
During life, the fluids and tissues of the body are
constantly undergoing change. New matter is deposited,
and the old is renewed with Ceaseless activity. The body
may be regarded as a complex machine, in which the
law that force is only generated by decomposition is fully
carried out. Every motion of the body, every pulsation
of the heart, every thought which emanates from the
brain, is accompanied by the destruction of a certain
amount of tissue. So long as food is supplied in abun-
dance, and the assimilative functions are not disordered,
reparation proceeds as rapidly as decay, and life is the
result ; but should nutrition be arrested by any cause for
any considerable period, new matter ceases to be formed
and the organs, worn out, act no longer, and death
eusues.
The animal body differs from any inorganic machine
in the fact that it possesses the power of self-repair. In
the steam-engine, for instance, the fuel which serves for
the production of steam, and subsequently for the crea-
tion of force, can do nothing toward the repair of the
parts which have become worn out by use. . Day by day
through constant attrition and other causes, the engine
becomes less perfect, and must be put in order by the
workman. In the animal body, however, the material
v/hich ser.-es for the production of force is the body itself,
* ' 'On Comparative Longevity in Man and the lower Atjimals,'' London 1S70.
222 William A. Hammond.
the substances taken as food being first assimilated, and
converted into brain-substance, muscle-substance, heart-
substance, etc.
The body is therefore undergoing continual change.
The hair of to-day is not the hair of yesterday ; the
muscle which extends the arm is not identically the same
muscle after, as before the action ; old material has been
removed and new has been deposited to an equal extent ;
and, though the weight and form, the chemical constitu-
tion, and histological characters are preserved, the iden-
tity has been lost. If, however, a muscle be detached
from the recently dead body of an animal, accurately
weighed, made to contract many times by a current of
electricity, and then weighed again, it will be perceived
to have lost appreciably a portion of its substance.
So long as the processes of waste and repair exactly
counterbalance each other, hfe continues. If it were
possible so to adjust them to each other that neither
would be in excess, there is no physiological reason why
life, if protected against accidents, should not continue
indefinitely. But this is not, with our present knowledge,
possible ; decomposition eventually predominates, and death
from old age results.
The hfe of man has been variously divided by different
authors into artificial stages or periods, the hmits of which
are by no means accurately fixed. A natural division
which is based on the physiological course of life, is not
only more convenient, but is more correct. In accord-
ance with this principle, therefore, I would divide the hfe
of man into three periods: i. — The period of increase, in
which the formation of tissues predominates over decay ;
this stage extends from birth to about the twenty-fifth
year, varying according to individual and sexual peculi-
arities. 2. — The period of maturity, in which the two
processes counterbalance each other, extending from the
twenty-fifth year or thereabouts, to the thirty-fifth year.
3, — The period of decay, in which the tissues are not
regenerated as rapidly and perfectly as they are broken
Age and Mental Derangement. 223
down and excreted from the system, and reaching from
the thirty-fifth year to the extreme Hmit of human Hfe.*
Each of these stages is marked by strong peculiarities,
both of organization and action, and they exhibit immun-
ities to some diseases, and susceptibiHties to others, which
are only to be accounted for by a reference to the phys-
iological condition by which each stage is characterized.
The Period of Increase. — The average height of the
human subject at birth is between eighteen and nineteen
inches, and the weight about seven pounds. The bones
are not yet completely ossified, the muscles are soft, the
skin thin and highly vascular, and the circulatory and
nervous apparatus developed to a much greater extent,
comparatively, than at any other period of life.
A great tendency exists during the first five years of
the period of increase to diseases of the nervous system,
and this is at its maximum during the first dentition.
Convulsions due to irritation, and inflammation of the
brain and its membranes are accordingly of common
occurrence. As we have seen, insanity may exist at this
time, and this either from hereditary transmission, or
arising from some accidental cause. In addition to the
facts cited in the immediately preceding chapter, the
following are worthy of notice :
Guislainf states that he possesses in his notes several
remarkable examples of infants who have become maniacs
before the age of puberty. He has seen subjects only
three or four years old, who, up to that age, had shown
much intelligence, and even a precocious development of
the mental faculties, experience suddenly an entire change
of character, becoming at first morose and then excited,
violent, and exhibiting in their countenances the signs of
intellectual derangement. This condition has lasted several
months, and has then disappeared, to be replaced by an
apparently normal state. Moreover, such instances have
•This flivision, which is as old as Aristotle, is preferable to any which has betn
since devised.
t "Lecons orales snr les phrenopathies, ou traite theorique et pratique des
maladies mentales," Paris, 18S0, t. i, p. 447.
224 William A. Hannnond.
occurred in several infants of the same family, in which,
nevertheless, insanity was not hereditary.
Morel* cites from his own experience the case of a
girl ten and a-half years old who, on being frightened,
fell into convulsions, and immediately lost the faculty of
speech. Her mental state was characterized by exacerba-
tions of such a nature that it was necessary to confine
her in an asylum, in which she was a constant source of
trouble. She seemed never to be happy unless she was
destroying everything which came into her hands, and
tormenting the adult lunatics.
In another case which also came under his notice, the
subject, a boy five years of age, was suddenly frightened,
lost the power of speech, and for three years that he was
in an asylum, exhibited constant turbulence and frequent
maniacal exacerbations.
Dr. Chatelainf reports a remarkable case of acute
mania occurring in an infant four years and nine months
old, who was frightened by a fire-engine. At first she
had hallucinations of heaving and of sight, then, as the
violence of the disease increased, she was constantly in
motion, gesticulated violently, grew angry, struck at per-
sons, wept and wished to kill her relations. Finally, after
several weeks, she became better, and probably entirely
recovered.
Several cases of insanity in youths of either sex have
come under my observation, but only one in which the
subject was of very tender age. This was a boy about
six or seven years old, whom I saw in consultation with
Dr. E. M. Hunt, of Metuchen, New Jersey. Frequently,
during the day, he would experience attacks of acute
maniacal excitement, during which he would bite, kick,
and strike all who come near him, and destroy everything
within his power or reach. While the paroxysm was on
him he was in constant motion, running and dancing
around the room, climbing over the tables and chairs,
*"Trait(i ties maladies mentales," Paris, 18C0, p. 101.
tJournuldc Medicine Menta'e, t. .\, p. 322.
Age and Mental Derangement. 225
gesticulating violently, and shouting or talking incoher-
ently at the top of his voice. There was some evidence
to show that when an infant in arms he had received a
fall, striking his head. The place was pointed out differ-
ently by his mother and grandmother, but, acting upon
what I conceived was the better evidence, I determined
to trephine him. The operation was performed with Dr.
Hunt's assistance, the cranium being perforated at the
right parietal eminence. No injury of the bone was found
but recovery took place immediately, and the patient is
now, as I believe, a healthy and sane young man. It is
a notable fact that insanity in young persons is very apt
to take the form of mania with destructive tendencies.
The patients exhibit strong propensities to kill or torture
animals, and to inflict wanton cruelties on their companions.
Strange as it may seem, suicide is by no means an
unknown act with very young children. With youths, as
we are constantly being informed by the newspapers of
the day, it is more common. M. Durand-Fardel * found
that, of 25,760 suicides occurring in France in the ten
years from 1835 to 1844, one hundred and ninety-two were
in persons under sixteen years of age. Of these latter, one
was under five years, two between eight and nine years,
two between nine and ten years, and six between eleven
and twelve years of age.
Referring to these statistics, Brierre de Boismontf
says :
" We can understand suicide by infants when we read
in the confessions of Saint Augustine that a child at the
breast, when its nurse suckled another baby, went into a
violent fit of anger at the sight, and almost had convul.
sions."
According to the census of 1880, there were in the
United States, during the preceding ten years, two suicides
by children between five and ten years of age, twelve
•"Etndessur le suicide chez les enfants," Aunales Medico-Psycliologiques,
Jiuivler, 1865.
t " Du suicide e,t de la folie suicide," Pans, 1S."6, p. OS.
226 William A. Hammond.
between ten and fifteen years, sixty-six between fifteen
and twenty years, and one hundred and thirty-six between
twenty and twenty-five years.
Montaigne * states that in his time there were many
examples of children committing suicide in order to escape
from some slight inconvenience.
And this is one of the chief characteristics of suicide
when perpetrated by children — that it is generally for
some notion which, to the adult mind appears to be
altogether inadequate, often ridiculously so.
Esquirol f cites the case of a boy thirteen years old
who, for some trifling cause, hanged himself, leaving a
statement in writing that he left his soul to Rousseau
and his body to the earth. And from Falret another,
also a boy, twelve years of age, who hanged himself
because a composition which he hoped would obtain the
first place, was only twelfth. The following cases are
reported by Dr. Forbes Winslow : %
Harriet Cooper, aged ten years and two months, upon
being reproved for a trifling fault, went upstairs and
hanged herself with a pair of cotton braces. Another,
named Green, aged eleven, drowned herself from the fear
of correction for a trifling fault. And he cites from Cas-
per the statement of Dr. Schlegel that in Berlin between
the years 1812 and 1821, no less than thirty-one children
of twelve years of age and under, committed suicide
either because they were tired of existence or had suf-
fered some trifling chastisement.
Collineau § refers to the case of a boy ten or twelve
years of age, who, on being sent back to college before
his holiday was over, hanged himself, as he said in wri-
ting, to make his parents angiy.
Another, ten years old, on being reprimanded by her
mother, answered : " If you torment me in this way, you
• "Easais," llv. i. , chap, -xv., p. 293, edition de Lefevre.
top. cit., t. i, p. 289.
\ " The Anatomy of Suicide," London, 1840, p. 269.
§ "Du suicide Chez lea onfants," Journal de M6dlcin6 Mentale, t. viii, 1868,
p. 417.
Age and Mental Derangemetit. 227
will some day find me hanging to the bed-post;" another
of nine years actually threw herself out of the window,
to avoid a scolding for having broken a goblet; and still
another of only five years hanged himself to escape from
the bad treatment of his mother.
Cases like these might be cited by the dozen. The
daily press makes them familiar to us all ; only to-day
(August loth) the New York morning papers report the
case of a boy aged fourteen, who, having broken a pane
of glass in the shop in which he was employed, was told
that he would have to replace it. Afterward he was sent
out with a clock which had been repaired, and on which
he was to collect a dollar. Then he hired a row-boat,
went out on Jamaica Bay, and anchoring at about three
hundred yards from the shore, shot himself with a toy
pistol. His dead body was found at the bottom of the
boat.
A short time ago, a case went the rounds of the press,
of a boy of ten years who had hanged himself because
as he said he " was tired of so mush dressing and undres-
sing." Surely there must be an innate abnormal brain-
formation in such children, one that if they had lived, to
attain maturity, would have caused infinite trouble to
themselves and those around them.
As the age of the individual advances, the body
becomes more fully developed, and is enabled better to
resist disease. By the time puberty is attained, which
in the United States is about the sixteenth year for boys
and the fifteenth for girls, the tissues have acquired con-
siderable solidity, the bones have become harder, though
the epiphyses are not yet consolidated with the shafts,
and the circulatory, respiratory and digestive organs have
in a measure, lost the excessive sensibility by which they
were characterized in infancy.
The genital organs, which have hitherto exercised but
little influence over the general system, now become
capable of performing their functions. In the male, the
secretion of semen takes place, in the female menstruation
228 Williajn A. Hammond.
begins. The larynx, which, in the infant, is small and
round, now becomes lengthened, and in the male espe-
cially the voice assumes a more grave tone.
The intellectual faculties have not been behindhand.
The brain, though relatively smaller, has undergone con-
solidation and hardening of its substance, and has, in
conjunction with the other organs of the system, lost to a
material extent the peculiar sensibility to external
impressions which belonged to it in early infancy, gaining
in strength, in force, and in capacity for improvement.
The relation between the formative and distinctive
processes is more nearly balanced, and the body has
nearly attained the period when growth ceases. This
point is in males about the twenty-fifth year, and in
females about one year earlier.
Insanity in some one of its several forms, though not
especially common about the age of puberty, is never-
theless not infrequently encountered. Its more usual
variety is mania, but it is sometimes met with as an affec-
tion mainly of the emotions, or as characterized by blind
and unreasoning impulses to acts of deceit or violence.
Fixed delusions are not a prominent feature, but, as
Blandford * states, there are perverted feelings, hatred of
relations, wanton and indecent behavior, cruelty and
destructiveness, and hallucinations of the senses.
Several cases of insanity occurring in young persons
have come under my observation, and all were, with one
exception, of the types eibove described, presenting very
much the general appearance of reasoning mania, to which
attention will subsequently be fully directed. In one of
these instances, the patient, a young lady about fifteen
years of age, had been for some two or more months
affected with an impulse to torture and kill every animal
which came under her notice. How it originated she
could not precisely say, but was disposed to think that
the first time she felt it was when witnessing a cat play-
ing with, and finally killing, a mouse. At once she pro-
* "Insaiiiiy and its Trwitnieiil," Kdinburjrh, 1871, )). J25.
Ao^e and Mental Derangetnent. 229
cured several traps, all so constructed that the animals
were captured alive. Then she would put some into a
wash-basin, and, gradually turning on the hot water,
would watch their struggles with the greatest pleasure
till they were finally scalded to death. Others she placed
in the trap on the top of a hot stove, enjoying their
struggles in their frantic efforts to escape. And others
again were deliberately cut to pieces with scissors. Upon
one occasion, she threw a whole litter of kittens into a
bucket of boiling water. When the larger animals were
not available, she spent her time in catching and killing
flies. She confessed to me that her great desire was to
steal a baby and skin it alive, but that she was afraid to
make the attempt lest she should be arrested and hanged
for it. She was, at the same time, a teacher in a Sunday-
school, and she declared that it was with the utmost diflfi-
culty she could refrain from enticing one of the younger
pupils into a corn field, near which they passed on their
way home from church, and killing her. She had even
gone so far as to put a piece of twine into her pocket,
with which she designed strangling her victim, but the
fear of the law had always prevented her.
There were periods of remission in which she was a
prey to the deepest feelings of remorse, and it was in one
of these that she was brought to me by her father, a
worthy gentleman, who had endeavored to conceal his
daughter's misfortune, and to cure her by moral suasion.
Not finding this successful, he had called together a few
friends, and together they had prayed for her recovery
also without favorable result.
She reasoned with entire calmness about her misfor-
tune, and with tears in her eyes and much lamentation
regretted her inability to control the impulse which moved
her, and which she was sure came from the devil. I
attributed it, however, to another cause, and, by regulating
her menstrual function, succeeded in a short time in
restoring her to health. Such cases, however, more
properly belong to the followmg chapter, on sex. Others
230 William A. Hammond.
of similar character will engage our attention in subse-
quent parts of this treatise.
I am inclined to think that this disturbance of the
moral and emotional faculties without marked aberration
of the intellect, when occurring in young persons, is more
common in girls than in boys.
Later on, during the period from fifteen years of age
to twenty-five, the tendency to insanity is still greater,
the emotional system is more fully developed, and in
both sexes, love begins to play an important part in the
promotion of mental disorders. The struggle for exist-
ence and position has begun, and the individual is some-
times slowly, sometimes rapidly, but always surely, taught
that there are trouble and sorrow and exertion before
him. To some this knowledge is more than the mind
can bear. There are very few at this age and at this
day, according to my experience, who injure themselves
by intellectual exertion. Occasionally, however, the mind
is overtasked, and a quasi insane condition is produced,
which, if not promptly relieved, terminates in mental
alienation. The struggle for position is by no means con-
fined to adults. It exists with the boys and girls in our
schools, counting-houses, and even in our work-shops.
Not long ago a young man, not over sixteen years of
age, was brought to me in a high state of acute mania,
induced by his efforts to excel in the work of copying
letters ; and I was shortly afterward consulted in the case
of another of like age, who had become melancholic and
subject to the delusion that he had committed the "unpar-
donable sin," the consequence of excessive application to
his trade as a violin-maker. This is the exceptional case
to the rule of moral perversion only, to which allusion
has just been made.
The Period of Maturity. — Some authors consider
that physiologically there are but two periods in the life
of man, that of increase and that of decline. Strictly
speaking, this view may be the correct one, but there is
a time when if there is any increase in development it is
Age and Mental Derangement. 231
scarcely perceptible, and if any decline, this is so gradually
effected that it is inappreciable by any means at our
disposal.
This period may very properly therefore be regarded
as that at which the formation and destruction of tissues
are so nearly balanced that the body may be regarded
as fully mature. Tissue is not, as in the preceding stage,
deposited faster than it is removed, but the wants of the
system are exactly compensated by the deposit of new
material to take the place of that removed as effete.
At the beginning of this period, which ordinarily
extends from the twenty-fifth to the thirty-fifth year of
life, the epiphyses of the bones become firmly incorporated
with the shafts, the flesh becomes hard and firm, and the
physical strength is at its maximum.
The mental faculties, though more strongly developed
than in the former period, are not yet in their prime.
This is a curious circumstance, and one which is at
varience with our preconceived opinions. Some faculties
of the intellect and some of the emotions are, perhaps,
equal in force and activity to their development at any
period of life, but, as a whole, the mind is not possessed
of the capacity, the strength, the endurance or the power
of concentration, which it has during the next period,
when the physical powers have begun to decline.
A little reflection reveals to us the reasons for this,
which are two in number:
I. The brain does not attain to its maximum deeree
of development at the same time as do the other viscera
and the osseous and muscular systems. So far as size is
concerned, it probably does not, as the Brothers Wenzel
contended, reach its maximum at the seventh year, but,
as Dr. Boyd* has shown, it is very nearly as large at
this period as it ever will be, and by the twentieth year
it has attained to its full size. But, after this point is
arrived at, it continues to gain in firmness of structure,
owing to the gradual loss of a portion of its water, and
•Qaoted by Thurmaa, op. cit.
232 William A. Hammond.
thus there is a comparative augmentation of brain-tissue,
an increase of weight, going on far into the period of
decHne.
2. As the mind feeds on the impressions which reacli
the brain through the special senses, it has not had time
by the end of the period of maturity, which is at the
thirty-fifth year, to acquire all the information necessarx'
for it to reach its greatest stage of development, which is
during the next period.
It is during the period of maturity that insanity is
most common. Wealth and station have generally not yet
been fully reached even by those most favorably situated
for getting them, while, on the other hand, the contest
has terminated disastrously for many who entered upon
it with high hopes and expectations. These circumstances
cannot fail to increase the wear and tear of brain, and,
consequently, to augment the number of cases of mental
alienation over those of either the preceding or the
following period.
Moreover it is during this period that the cares of life
are greatest in both sexes, through the necessity which
exists for providing for a family not yet able to provide
for itself This, alone, is often a cause of insanity.
The Period of Decline. — The period of decline is
marked by as many striking characteristics as those which
belong to the period of increase. After the body has
remained at nearly a fixed point of development for a
few years, varying from five to ten, a disposition is mani-
lested to degeneration. The process of decay becomes
more powerful than that concerned in the regeneration
of tissues, and, in consequence, the body not only loses
weight from the atrophy of its parts, but the functions
are less perfectly performed. Thus, the action of the
heart becomes weaker and less frequent, the respiration
slower, the digestion feebler, the muscles thinner and
more rigid, the skin shrunken, the joints stiff, the teeth
fall out, the hair becomes gray or the arteries ossified,
and the entire form loses its elasticity and becomes
Age and Mental Deratigevient. 233
less erect than in adult age. The whole tendency of
the body is toward consolidation. The generative func-
tion is greatly weakened or altogether lost in both
sexes, and in the female the menses cease to flow.
The organs of special sense, toward the latter portion
of the period, also become involved in the process of
degeneration. The eyes lose their brightness, and the
sight grows dim and presbyopic. The hearing diminishes
in acuteness, the taste is blunted, and the sense of smell
is almost if not altogether, lost at a comparatively early
period.
In these changes the mind also participates, but not
in an equal ratio to the changes going on in other
parts of the body. Indeed there is during the first ten
or fifteen years of this period, an increase in the strength
and powers of endurance of the mind, and quite often
this process continues for several additional years. The
judgment, owing to the experience which the individual
has obtained in the affairs of life, becomes riper and more
unerring; there is a greater power of determining the
value of facts, and a less disposition to be governed by
the emotions.
But after a time the intellect becomes less absorptive
of perceptions and less creative of ideas. The power of
mental concentration is markedly diminished. The mem-
or}- fails, especially in regard to recent occurrences. The
imagination loses the vividness and extensive range of
youth and maturity, and the judgment becomes feeble
and vacillating. The individual begins to rely on others
for advice as to his affairs, and little by little he parts
with his own will, even in matters of the smallest impor-
tance. The emotions no longer sway the whole being as
they once did, and some of them are utterly extinguished.
Often, however, a maudlin or fretful condition is devel-
oped, which ends with its own expression of tears or
sniffles, never prompting to volitional impulses or pro-
ducing more than a momentary disturbance.
To all this, however, there are sometimes notable ex-
234 William A. Ham^nond.
captions, but yet not enough to invalidate the law that
the period in question, is one of decline in fact as well
as in name.
If the alterations are gradual and uniform throughout
the system, death from old age is the consequence ; but
it rarely happens that derangement of some one impor-
tant function does not produce this result before the gen-
eral breaking-up of the vital principle occurs.
During the first ten or fifteen years, the decay of
the organism is so slowly effected that very little incon-
venience results, and occasionally, as has been intimated,
we meet with individuals who are able to withstand,
to a very advanced period of existence, the tendency
to degeneration. But it is nevertheless advancing, imper-
ceptibly it may be, but surely, to the extinction of the
principle of life.
Such is a brief outline of some of the conditions
which attend the period of decline. The diseases to
which it is especially liable are those which are con-
nected with the most important organs of the body —
apoplexy, paralysis and mental affections being chief
among them.
Owing to the failure of the nutritive processes of
the brain, the power of this organ is so greatly dimin-
ished that what is known as a senile dementia is a
not infrequently engendered pathlogical state during
the latter portion of the period of decline. This con-
dition, which is the result of pathological changes in
the brain, rarely makes its appearance before the sixtieth
year, and generally not till much later. Willie * has
shown that there is a positive shrinking of the brain in
size and weight, to which, doubtless, the failure of men-
tal power is directly due.
General paralysis, though met with in both the other
periods, is far more frequent after the age of thirty-five,
when the system has reached its acme, than at any other
part of life, or, in fact, than both the others combined.
• "Des psychosoB de la senlllte," Allgemelne ZeitBi-.hrilt Juer I'sycliiatrie, 187S.
Age and Mental Derangement. 235
The cessation of the menstrual flow in women, occur-
ring as it does during this period, is a proHfic cause of
mental alienation.
But the individual who has attained to an advanced
age without suffering from any form of insanity is gener-
ally safe for the rest of his existence. Acute mania is
rarely met with in these persons, and melancholia, though
more common, is nevertheless comparatively infrequent.
It is not, indeed, to be expected that, with the exception
of senile dementia, old age, when the intellect is dull and
the passions burned out, can afford many examples of
active mental alienation. I have, however, witnessed a
few cases of what Morel calls senile insanity {folie senile),
occurring in very old men and women. In some of its
features it is not unlike general paralysis, but it has alto-
gether a different course and character of termination.
There are the same mental exaltation and weakness of
the muscular system, conjoined with a peevishness and
disregard for the rights and feelings of others, which tend
to render the subjects a nuisance to those about them, at
the very time that they should be exhibiting the calmness
and dignity of a majestic old age. It generally ends
either in an attack of acute meningitis or of cerebral
hemorrhage, which quickly carries off the patient.
studies on the Minute Anatomy of the
Central Organs of the Nervous Sys-
tem.*
By Prof. Golgi, of Pavia.
"^^EVER so evident in our epoch, in which such notable
-^ ^ progress has been made in the physiology of the
nervous system, has it appeared that, from the point of
view of the relations between anatomy and physiology,
the studies of the central nei^vous system stand in con-
trast with what has been verified in the studies of other
organs and tissues.
Whilst it may, in general, be frankly asserted that the
discoveries relating to the anatomical condition of organs,
tissues and elements, have opened up the path to the dis-
covery of the laws under which these structures function, on
the contrary, in the study of the nervous system, it has been
found that anatomy has been, and still is, at all times, con-
strained to seek for direction for its own researches, and for
the support of its own conclusions, in the data of physi-
ology.
Microscopic anatomy has, it is true, conquered much
territory within the last decades, yet physiology stands
always far ahead of it ; and it is the fact that the former has
not yet attained a position from which to reply to the most
important and most simple questions of the latter. Physi-
ology, for example, is able at last to say, with security, that
to the various parts of the brain diverse functions appertain,
but anatomy is not only unable to give the reason for such
differences, but not at all can it tell whether the different
mode of functioning of the various regions of the brain is
related to difference of form or structure of the constituent
elements of the regions. As to physiology, there can be
no doubt, that, between the different functions of the nervous
•Trunsliited by Josej))! Workman, M. 1)., from thu Ilivlata Siierfmentale, etc.
Minute Anatomy of the Central Nervous System. 237
centers, there exists an intimate relation. Has anatomy, up
to this time, been able to tell through what path, and through
what mechanism the colligation is secured? To this ques-
tion, the response of anatomy has, of necessity, up to the
present, been merely negative.
This insufficiency of our anatomical knowledge of the
central organs of the nervous system certainly cannot be
ascribed to deficiency of studies, for in the last decades this
domain has been well trodden, and not without some result ;
but there is too much ground for the confession that the
final result of the work done has left yet unsolved all the
questions which, as regards the minute anatomy of the
nervous system, have been debated over in the last ten
years.
Impelled by the desire of being able to contrapose to
ascertained physiological laws, some anatomical data, the
special explorers of the central nervous organs were unable
to content themselves with veritably established facts, but
they frequently wished, from a special fact, to deduce
general laws. Thus, it so frequently happens that, in the
anatomy of the nervous system, schemes are substituted for
vigorous description of the forms and relations which they
are brought forward to verify ; these schemes, although,
perchance, wearing the semblance of reality, since they,
under a certain stretch of control, harmonize with physio-
logical doctrines, are nevertheless but so many anatomical
hypotheses. A few examples may suffice :
As regards the structure and elementary morpholog}- of
the central organs, we may to-day see generally accepted
as indisputable the ideas of Gerlach, ScJiidtz, Boll and Mey
tiert ; now, whatever there is in these ideas of essential
character is simply resolved (and it shall be my task in this
work to demonstrate the fact) into a series of ariatomical
hypotheses, which do not cease to be such because they may
give a sufficient explanation of facts ascertained in the field
of physiology.
As to the direction and relation of the nerv^e fasces, the
reciprocal relations between single elements, between diverse
238 Golgi.
provinces, and between various zones of provinces, we see
actually accepted as laws the assertions of Luys, Meynert and
Hugiienin, etc. ; now, whoever sets to work with the object
of special exploration of any of the cerebral provinces, whose
histological structure has been described with the greatest
exactitude, will certainly encounter disappointment in being
constrained to the discovery that the facts do not correspond
to the assertions which, in great part, wall be discovered to
have been so many arbitrary complements of schemes
imagined to meet the requirements of a theory.
The description which I have undertaken to give of the
minute structure of each of the cerebral provinces will afford
me occasion for furnishing proof of my assertion.
It may readily be understood that a system, so con-
structed to complement, theoretically, the results of observa-
tions, must have produced injury, even in this way, that
young observers, in undertaking the study of the nervous
system, finding, as regards the more obscure points, abso-
lute assertions sustained by authoritive names, have become
stultified in their attempts to master the subject by new
researches, or have taken, as proofs of the doctrines submit-
ted to them, certain mere appearances. It is in this way
that inexactitudes, errors, mere hypotheses or schematic
descriptions have been handed down from school to school,
from book into book, as incontestable verities.
It is, how-ever, incumbent on us to recognize the fact that
the paucity of the conquests achieved in the minute anatomy
of the nervous centers must in great part, be attributed to
the extreme difficulty resulting both from the complication
and the extreme delicacy of the texture, and the lack of
means adapted to their search.
The methods by the aid of which, in the modern phase
of anatomical studies, so many conquests have been achieved
in the domain of minute anatomy of organs and tissues
generally, have, in so far as relates to the nervous system,
given, in the hands of patient enquirers, some fruits, which,
though noteworthy, are far from meeting the amplitude of
the wants. Nor could it be otherwise.
Minute Anatomy of the Central Nervous System. 239
Convinced that, in order to pass beyond the Hmits
hitherto reached, it was necessary to tr>' new ways for
opening them by special means corresponding to the special
and complex structure of the organs, I dedicated myself to
the anatomical study of the central ner\'ous system, and it
was almost my first care to put myself in trace of methods
which might, better than those before known, enable me to
enlarge the field of research, and thus to present to me, from
some new points of view, the structure of the organs in
question.
Nor did my endeavors prove fruitless ; for it was granted
to me to find means which, by the fineness and precision of
the results, leave far behind all those which, even in the
most recent epoch, have been employed by anatomists.
Availing myself of these new methods, without at all dis-
regarding those more commonly used, I have been able to
extend considerably our knowledge, to throw light on some
points and to expose some errors, the demonstration of which
I have been prompted by a part of my results to undertake.
Confronting the great extent of the lacunce, it is but too
evident that the contribution which I can offer to the study
of the minute anatomy of the central nervous system is but
a small thing ; it has, however, the value of regarding facts
incontestably ascertained. Not one of the particulars
exposed in the work, not one trace of the illustrating plates,
exists, that has not, on my part, been the subject of the most
scrupulous and patient examination, and which I have not
found myself in a position to demonstrate with the clear
evidence of preparations.
As regards the work, I can further say that it has been
almost my chief preoccupation to see that the illustrations
corresponded to the truth ; and, as relates to the fineness
and clearness of the details, I permitted no liberty to the
artist, so that whilst they serve to prove the goodness of the
methods adopted by me, they may also be used as docu-
ments, or as terms of appeal, by those who, with the view of
extending or of controlling their knowledge, may desire to
undertake similar researches.
240 Golgi.
Among the problems pertaining to the general anatomy
of the nervous system, whose solution is, for physiology, of
essential interest, the following have appeared to me most
deserving of new research :
1st. The general problem of the mode in which the ner-
vous fibres in the brain are put into relation with the gan-
gliar cells.
2nd. That of the exact cellular morphology, studied in
its central relations with the function of the single regions
of the brain ; determining, that is to say, whether the differ-
ence of functions of the single regions of the nervous organs,
stands in relation with differences in the cellular forms, and
in what the eventual differences consist.
3rd. That of the disposition and the mutual relations of
the elements in single parts.
4th. Finally, that of the progression of the nerve fasces,
and of their relations to the diverse groups of gangliar cells.
It is superfluous to say that all these problems may be
posited for every single province, or indeed for every zone
into which the central nervous organs are wont to be divided ;
such exactly would be one of the undertakings which modern
anatomists might propose to themselves, that is, to scrutinize
minutely every zone, point by point, by different methods of
research, whether modern or ancient, in order to be able to
find the response from each of the single regions, to the
problems above stated.
It is understood that we have, from the very outset,
engaged in a simple labor of analysis, the collection and
proper ordering of materials, illustrated by figures which
shall reproduce with scrupulous exactitude, the form, size
and relations of the different constituent parts ; but it is
beyond doubt that it is only from the whole assemblage of
the materials so disposed, that we can be permitted to deduce
well-founded conclusions. And yet, to arrive at this result
would be an undertaking such as to occupy for years, not
one but several investigators, and to require means which
but few could command.
If, however, I could not^ alone, hope to accomplish all
Minute Anatomy of the Central Nervous Systetn. 241
the work, nevertheless by devoting myself to it with patience
and constancy, as I have done, for not a short series of years,
I have, I fondly trust, been able to indicate at least the
principal lines, and to lay down a tracing of one of the paths
which may with certainty be followed with profit. This has
been my aim ; and I shall believe that I have attained it, if it
shall have been granted to me to solve a part, however small,
of the problems enunciated ; but more still, if by diffusing
the knowledge of the methods of study, by making known
especially by means of plates, the notable result obtained by
these methods, ■ and by indicating some of the questions
which may without doubt, by these means, shortly be solved,
I may be able to awaken in others the desire of repeating
and continuing their researches with the same intentions as
I have had.
/. — Preliminary notes on the structure, morphology and
mutual relations of the gangliar cells.
The first question presented, in undertaking, from a gen-
eral point of view, the study of the central nervous cells, is
whether these are furnished with absolute characters, such as
to differentiate them from other elements chancing to have
identical aspect.
The preliminary' treatment of this subject will not appear
superfluous, if we consider that even very recently some
observers have held that there exists no absolute distinction
between the nervous cells and the connective cells, forming
the fundamental stroma of the gray substance, and that they
have even met with some transitional forms between the two.
On the other hand, it is known that the most accredited his-
tologists, including Gerlach, Boll and Deiters, deny to some
categories of gangliar cells the sole character from which a
nervous nature can be attributed to them.
To the enquiry included in the above question, it may be
answered, that in general, by the form, by the special aspect
of the cellular body and of the nucleus, by the manner in
which they originate and are prolonged, as also by their
aspect and mode of ramifying, and finally by a certain par-
ticular aspect as a whole, the nervous cells may, by an expert
242 Golgi.
observer, be differentiated from the other cellular elements ;
yet no one of the above stated characters can be given as
absolute ; so true is this, that, holding as the basis of our
judgment these data alone, not rare is it the case that we
must remain uncertain whether some elements should be
regarded as of connective or of nervous nature ; and it is
known that the elements are not few, relative to which the
judgments of histologists are contradictory ; for example,
the numerous nervous cells of the gelatinous substance of
Rolando, and the so-called granules of the cerebellum, which
have been regarded by many, and are yet regarded as of
connective nature, though they are nervous.
There is, however, yet a datum, which is an absolute
characteristic by which a cell may with certainty be desig-
nated as nervous, and this consists in the presence of a pro-
longation (unique) of special aspect, different from all the
others, by means of which direct connection with the
nerve fibres is established : this characteristic cannot be
clearly shown unless by means of special reactions.
Desiring now to give a concise definition of the nervous
cells, we may say that those alone can be considered as such,
which are furnished with a special prolongation (always
unique) differing from all the others, and destined to con-
tinuation in the nervous fibres.
Description of central nervous cells. — The nervous cells are
presented to us as bodies whose form and size notably vary,
according to the provinces to which they belong. The mod-
ifications of form, and the differences in diameter correspon-
ding to separate parts, will be given in our study of the dif-
ferent regions of the centers with which I intend to occupy
myself
Limiting myself for the present to some general notes, I
shall say, that as regards their forms it is usual to distinguish
these cells as pyramidal, irregularly polygonal, globose,
pyriform, ellipsoid, fusiform and irregular. As to their size,
the nervous cells vary within very large limits ; indeed no
normal texture of our organism presents, relatively to the
size of its cellular elements, gradations so extended. The
Minute Anatomy of the Central Nervous System. 243
largest nervous cells may, in fact, be seen by the naked eye,
under the form of very small points. Taking into account
all the categories of central nervous cells, we may say that
their diameters range from 10, 12, 15, to 100, 150, 200 u.
(micromillimeters). We may find a prevalence of types of
more conspicuous diameter, especially in the anterior cor-
nua of the spinal cord, in the medulla oblongata, and in the
nucleus dentatus of the cerebellum ; examples of nervous
cells of ver>' small diameter are on the contrary furnished by
the so-called granules of the cerebellum (which have been
well characterized as nervous cells) and by the cells which
people the gray stratum forming the fascia dentata of the
foot of the hippocampus major, and by the gelatinous sub-
stance of Rolando in the posterior horns of the medulla
spinalis.
In the elements in question, we should distinguish a cel-
lular body from its prolongations.
The cellular body presents characters somewhat diverse
according as it is studied in the fresh state, or after it has
undergone the influence of the hardening reagents com-
monly employed. In the fresh state it has an aspect per"
fectly clear and transparent, and even with the greatest mag-
nification, we are able to observe in it only very fine gran-
ules. By treating the nervous cells with various reagents
(iodocserum, the weak solution of chromic acid and osmic
acid), it is shown that their bodies present a very fine stria-
tion parallelly disposed on the surface, and concentrically
in the nucleus ; the several stiriae are then seen separated by
a very thin stratum of finely granulated substance.
The nucleus of the nervous cells is, as a rule, pretty
large, its diameter usually being from 2 u. to 8 m. m.
When observed in the fresh state, they appear clear and
transparent, and show a double contour, giving the impres-
sion of an extremely small globose bladder.
The fact that the granulations enclosed in the nucleus
are sometimes seen subject to an oscillatory movement
(molecular) seemsto indicate that the bladder may be occu-
pied by a hquid. Examples of cells with two nuclei are very
244 Golgi.
rare ; the cases observed ought to be considered as mani-
festations of arrest of development of the cells ; the process of
segmentation which always begins at the nucleus, may some-
times have been limited to this part, and not at all have
interested the cellular body, and this state may have become
stationary. According to some writers, the double nucleus
should be a proof that even in adult life there persists in the
nervous cells a formative activity (cellular multiplication).
The first interpretation is the most probable.
The nucleus is usually provided with a relatively large
nucleus, which is' splendent and readily colorable by car-
mine ; within it there is frequently visible a little grain
(nucleololo, anglice, a baby nucleolus). With respect to
acids, the nucleus of the gangliar cells is wont to be much
less resistant than the nuclei of other elements.
In the majority of the nervous cells, at a point near the
nucleus, between this and the cellular periphery, some gran-
ules of brownish-yellow pigment are disposed. This nor-
mal pigmentation is seen more or less marked, according to
the age and to the regions to which the gangliar cells belong.
It is scarcely shown in the young, more pronounced in adults
and still more in the aged. In some regions we meet with
not a few granules in proximity with the nucleus, but with
large accumulations which fill the whole body of the cell,
and in fact hide the nucleus. Such an advance of pigmen-
tation is, for example, observed in the nervous cells of the
strata of gray substance existing in the cerebral peduncles
and in the medulla oblongata, and it is exactly to the yellow-
ish or brown pigment occupying the nervous cells, that we
should attribute the particular color which has caused to be
given to these strata, the name substantia nigra, locus ftiger
of Sommering.
There has been discussion on the nature of the substance
which forms the body of the nervous cells. At first a proto-
plasmic nature was assigned to them, in conformity with the
idea entertained as to cells in general; this idea, as is known,
was combatted by Max Schultze, who held that on the con-
trary, only the soft substance, homogeneous or finely
Minute Anatomy of the Central Neri'ozis System. 245
granulous and contractile, which stands around the embrional
cells existing in the adult organism, should be considered as
protoplasmic.
It is now admitted that the greater part of the cellular
body, like the contractile substance of the muscular fibres,
the substance of the cornea, of the epithelia, &c., is a sec-
ondary formation, or a modification of the primitive proto-
plasm, and that we ought to regard as true protoplasm only
those central parts of the cells surrounding the nuclei, and
which appear clearer and softer and with a more finely gran-
ulous aspect.
With respect to this question it is, however, proper to
state, that several histologists, basing their conclusions on
their own direct observations, have asserted the protoplas-
mic nature of the entire body of the nervous cell. Thus
Waller, as far back as 1868, asserted that the gangliar cells
have the capacity of executing, in a rather limited measure,
some ameboid movements, and this fact, he said, he had
realized in the gangliar cells of the brain of the frog. More
recently, Reklinghausen and Popoff have believed that we
might correlate with this supposed contractility, the fact
that by injecting Indian ink into the meninges, or into the
cerebral substance, of a living animal, the nervous cells after
some time are seen loaded with dark granules. As it has
been demonstrated that penetration of extraneous bodies
into young cells takes place by the action of contractility of
protoplasm, therefore according to Recklinghausen and
Popoff, the supposition that the gangliar cells, completely
developed, conserve a certain degree of contractility, appears
not unfounded.
To the discomfiture of the assertion of Waller and the
argument of Reklinghausen and Popoff, it is now admitted
that the principal constituent substance of the gangliar cells
has a nature different from protoplasm, and correspondingly
a structure essentially different.
Relative to the structure of the substance proper of the
nervous cells, the discussion now circles round the opinion of
Max Schultze, according to whom the structure characteristic
246 Golgi.
of such elements is the fibrillar or granulo-fibrillar ; but
to this opinion is opposed that of other histologists, who
denying the fibrillar structure, consider the cells in question
as simply formed by a homogeneous or granulous substance.
The fibrillar structure of the nervous cells had been men-
tioned by Remak as far back as 1853 ; subsequently numer-
ous other observers alluded to it, among whom were Beale,
Frowiman and KoUiker, but their remarks remained isolated.
The same cannot be said after the publication of the obser-
vations of Schultze, who by studying especially the large
nervous cells of the brain of torpedoes, found reason to be
convinced of the exquisitely fabrillar structure of the elements
in question, not only of the cellular body, but also of its pro-
longations. According to his exposition, the fibrillar struc-
ture may be shown in a most evident manner, by isolation,
in the fresh state, in serum, and it is more conspicuous
towards the cortex of the cell, but it will be evident also in
the internal parts ; it is much more apparent in the young
than in the old. Nevertheless the structure treated of is not
absolutely a pure fabrillar one ; an attentive examination
would show that between the fibres there is a finely gran-
ulous substance which contains a yellow or brownish-yellow
pigment, and that this is often continued in the prolongations.
The nucleus would appear to have become surrounded by a
notable quantity of a substance of purely granular structure
by means of which it will be found perfectly isolated from
the febrilLne, with which it has no connection whatever.
According to Schultze, the course of the fibrillae within
the cells must be very complicate. They would seem to
issue from each prolongation and to be extended into the
substance of the cell, but very soon to pass out of view,
because of the extreme complication of the resulting fabril-
lar entanglement (intreceia, not network) and the intermis-
sion of the interfibrillar granular substance. It would appear
as if each of the numerous prolongations drew the numerous
fibrillae which constitute it, from those of the cellular sub-
stance, thus giving the impression that the entire fibrillar
band does no more than traverse the cell.
Minute Atiatomy of the Central Nervous System. 247
According to the same writer, however, the gangliar cell,
from which the cylinder axis for a nervous fiber departs,
possesses the significance of the organ of origin of this axis,
merely in the sense that the constituent fibrillae are con-
ducted to it by the paths of the so-called protoplasmic pro-
longations.
But the fibrillae which are seen to pass across (traverse)
the substance of the gangliar cells, will not, properly, have
had their origin in the cell, as in it they merely undergo an
evolution intended for the formation of the cylinder-axis
prolongation, and for the passage into other protoplasmic
prolongations ; and further, according to Schultze, it ought
to be admitted, " that in the brain and spinal cord, there
absolutely exist no true terminations (or origin) of the fibril-
lae, and that these all depart from the periphery, and do no
more than traverse the gangliar cells, " which would thus be
mere stations of passage along the nervous paths.
Prolongations of the nervous cells. — The body of a nervous
cell is of no limited contour, but, as has been said, it is con-
tinued into a greater or less number of prolongations or
processes. As regards the number of the prolongations,
there have been distinguished nervous cells, multipolar,
bipolar, tripolar and quadripolar, etc., and even apolar cells,
that is to say, cells without any prolongation have been
described. It is almost superfluous to say that the apolar
variety may, unhesitatingly, be excluded; evidently those
which have been described as unprovided with prolon-
gations have so appeared because of the management
of the preparation. The variety of monopolar cells also
may be excluded, since there always exist more than one
prolongation.
If we exclude the physiological sense, in which all cen-
tral nervous cells would be monopolar, as it is always only
one prolongation that serves for the specific function of cen-
tripetal and centrifugal transmission, it may be said that, in
general the nervous cells are multipolar — that is, provided
with three, four and five prolongations ; but those with ten^
fifteen and twenty and even more are frequent.
248 Golgi.
The bipolar cells also, which are presented in the prepa-
rations made by dilaceration, are pretty numerous ; these
may be considered, in general as cells with elongated fusiform
bodies, whose ramifications are to be seen to a notable dis-
tance from the middle of the cellular body.
Whatever may be the number of the prolongations, one
•of them, always unique, is gifted with special characters
which serve to differentiate it from all the others. This is the
prolongation, which, according to Deiters, is usually desig-
nated by the name cylinder-axis prolongation, or, nervoso-
fibrous prolongation, a term chosen by Deiters, who holds it
as a constant rule that it goes directly to constitute the
cylinder-axis of a meduUate nervous fibre.
For different reasons, which will be seen further on in
this article, and especially for this one, that we hold it as a
thing established, that from no other of the prolongations of
the gangliar cells besides this one, have the nervous fibres
origin, I believe that for designation of the prolongation in
question, the more simple one, nervous prolo7igation should
be preferred.
The other prolongations may continue to have the name
used by Deiters, protoplasmic prolongations, although this
may not be the most exact, since the characters of true pro-
toplasm are wanting in them as they also are in the cellular
body.
It IS proper here to observe that Schultze, signalizing the
inexactness of the qualificative protoplasmic, and observing
that it does not include any differentiation with respect to
the cylinder-axis prolongation, which is a direct emanation
from the cellular bodv, wishes to substitute for protoplasmic
prolongations, ramified prolongations. This denomination,
he says, would have the value of implying a neat separation
from that of cylinder axis prolongation, which he, in com-
mon with the generality of histologists, holds to be always
simple. But as this change, which is the chief one pointed
out by Deiters, has now no value with us, because we know
that, at the least, for the great majority of the gangliar
cells, the nervous prolongation, also is not at all simple, but
Minute Anatomy of the Central Nervous System. 249
complicately ramified ; we do not therefore believe that these
two denominations merit any preference, as titles of
superior axactitude. I add, that the designation Proto-
plasmic, which (besides being now legalized by long use),
serves better to characterize prolongation, as in every way
it implies the most essential datum, which is that of not
giving origin to nervous fibres, whilst on the other hand,
as I shall hereafter show, the protoplasmic prolongations
probably represent the paths for the nutrition of the
ganglier cells.
Protoplasmic Prolongations. — The number of these
prolongations may vary from 3 or 4 up to 1 5 , 20 ; they
have a structure quite identical with that of the cellular
body, that is to say, they are presented as finally striated
in their longitudinal direction.
This striature, as it has been called, for the cellular
body, should, according to Schultze, be the expression of
its fibrillar constitution. He holds the constitutive fibres
to be a continuation of those which form the cellular body,
and they would thus be so many primitive nervous
fibrillae.
The protoplasmic prolongations, even in proximity to
their origin, begin to ramify discotomically and gradually
as the subdivision proceeds, they undergo a progressive
dwindling. The most important question presented in
regard to these prolongations is that which relates to their
final destination.
The opinion which, on this question has had, and still has
greatest credit with many, is that after a more or less short
course, they become interjoined or anastomose, thus giving
place to a complex concatenation. This concatenation
was so much the more willingly admitted, as it permitted
an easy explanation of the functional relations evidently
existing between the diverse systems of nervous fibres.
Above all, for the reflex phenomenon, it appeared to be a
quasi absolute necessity, to admit complicate nervous
anastomose.
Anastomoses, which, indeed, had been already admitted
250 Golgi.
before histologists, by means of particular minute researches,
engaged in the work of verifying their real existence.
Under the influence of this preconception, when some
refinement in the methods of studying the nervous system
were but commencing, it seemed to be an easy matter to
confirm, by observation the presupposed connection ; and
in fact both the histologists and physiologists of that time,
as a general rule, described them. and even gave deline-
ations of them. They evidently believed that an anasto-
mosis came into view every time two prolongations of
nervous cells were seen bearing towards each other, and
afterwards coming into contact.
Among the anatomists and physiologists who pre-
tended to have verified the anatomoses on a large scale,
and who even give figures of them, I record Schroeder
Van der Kolk, Lendhossek, Marithener, Jacubowitz, Funke,
&c.
But to those among the histologists, who, not con-
tenting themselves with appearances, set to work to
verify by means more nice, and above all by patient
dilacerations, the asserted anastomoses, not only did they
become less evident, but by degrees, as in order to
reach their object, they redoubled their accuracy, the
fact appeared less clear, from which they at first began
to doubt it and finally to deny it.
Passing under review so much as has been written on
this subject, we may see that the associated anastomoses
had for a considerable time past, begun to be doubted
and even explicitly denied. The subject is so important
that it seems to me not superfluous to record how, in this
relation, the observers who have the highest credit for
accuracy, expressed themselves. Betters, for example,
declares that despite the many observations made by
him by section and dilaceration, he fails in verifying even
a single case of anastomosis, and he was therefore con-
strained to admit that the data submitted to confirm the
supposed direct connections, the anastomoses, were the pure
result of illusion.
Mhrute Anatomy of the Central Nervous System. 251
M. Schultze also asserts that the numerous anastomoses
of the great cells of the medulla spinalis and the medulla
oblongata, described and figured by S. Van der Kolk and
Lendhossek have long been known to be illusions ; he adds,
also, that the other anastomoses, admitted by Meynert,
between the gangliar cells of the different strata of the
cortex, have yet to be demonstrated ; he gives, in this
relation, the negative results of the accurate trials of iso-
lation made by Deiters, and he adds that, to himself,
analogous trials on the electric lobes of the torpedo organs
exceptionally adapted for the study of the gangliar cells,
proved altogether fruitless.
Koelliker, in his treating of the subject of the probable
connections existing between the elements of the nerv^ous
and central organs, begins by saying that the farther we
advance in the knowledge of the complex structure of the
medulla spinalis in man, so much the more increases the
difficulty of proving how its elements stand in connection
with each other. He afterwards declares that he had
never seen anastomoses, and this, although he had
examined the preparation of Stilling, Gold, Clarke, Lend-
hossek, &c. The very preparations of those histologists
who have described the numerous anastomoses. In conclud-
ing, he says he does not wish withal to exactly deny
them, but under no circumstances is anyone authorized to
declare general laws from isolated observation.
Among modern anatomists, Krause, in like manner,
denies that in the central organs of man and of a
majority of the vertebrates, direct connections exist between
the nervous cells by means of robust branches of prolonga-
tion.
Analogous declarations may be found in the special
works of Gerlach, Boll and others.
Upon the whole, then, the opinion of ancient and
modern anatomists and physiologists, that the proto-
plasmic prolongations directly conjoin, may be declared
an hypothesis ; it is not corroborated by direct observa-
tions, and the figures representing such connections, which
252 Golgi.
we see even in some modern histologists, may be declared
theoretic, or schematic.
Notwithstanding this accord in the denial of anato-
mists, as a general law, it is necessary to take into
account a few cases of direct connection between two
nervous cells, which have been made the subject of
special description, and which, from the authority of the
describers, ought to be regarded as authentic. Such
would be the cases of anastomosis between two cells
described by Wagner, Arnold, Beffer, and some others.
The authenticity of these isolated cases is not at
all contested, but such cases cannot be made the
basis of a general law; rather does the fact that,
despite innumerable researches, there could be collected
the very small number recorded, go to prove that these
represent, rather than a general law, some rare exceptions,
or which should be regarded as occurring under an excep-
tional law. The explanation which seems most reason-
able is, that the very rare known instances of nervous
cells, united by a robust prolongation, or bridge of con-
junction, ought to be considered as instances of arrest of
development.
During the period of embrional development there
certainly takes place an active multiplication of the ele-
ments destined to be transformed into nervous cells, and
the cellular-scission, as is known, takes place first in the
nucleus, and then proceeds to the cellular body, in which,
before all, an elongation happens, and next a dwindling
in the median part, and thus it occurs that the two por-
tions of the cells, to each of which a nucleus corresponds,
appear at a certain period united by the medium of a
bridge of connection. It may then be affirmed that the
scission was arrested at this period, and the cells so con-
tinued into after life.
In conclusion, the cases of anastomosis between nerv-
ous cells, as yet described, rather than proving that
direct connections exist by a general law, ought to be
regarded as exceptional, and precisely as examples of
Minute Anatomy of the Central Nervous System. 253
cells in which the process of scission, having commenced
in the embrional period, did not progress to the complete
formation of two distinct cellular individualities.
On this question of anastomosis I would add another
observation. If there be a method of preparation, as
there now certainly is, which will permit us to see the
anastomosis on a large scale, it certainly would be that
of the black coloration. In fact, by means of this method,
not only the cellular body with its chief prolongations, but
still more, the finest ramifications of these are brought
into view, with a clearness which is beyond comparison
with anything possible of attainment by other methods of
preparation, however accurately applied. By this method
the black coloration may be now limited to a few cellular
groups, or again extended to considerable groups, and
sometimes even a general coloring may be obtained of a
whole province of the central nervous system.
I have obtained preparations thus made, and I have
placed many hundreds of them under minute and patient
examination, but not in one of them has it been granted
to me to establish a case, however unique, of anastomosis
between either the large or the ver>' small prolongations.
It is true that there did not fail cases in which, from the
fact of two prolongations going against each other, the
impression was given of reciprocal fusion, chiefly when
the examination was made with low or medium enlarge-
ments, but an accurate examination made with strong
objectives readily showed that we had been dealing with
an appearance, resulting from reciprocal contact.
The Supposed Indirect Connection of Nervous Cells by
Means of Network. — The idea having been destroyed, that
the protoplasmic prolongations serve to establish functional
relations between cells and cells, by means of direct com-
plicate anastomosis, existing not as exceptional forms, but
by a general law, the problem is de novo presented as to
the mode of behavior of these prolongations at some points
of distance from their origin. This is the problem which
in the last decade has been the principal object of the
254 Golgi.
researches of those observers who, from an anatomical
point of view, have been engaged in the study of the
central nervous system. In saying this I naturally leave
out of the account those who, subordinating the admission
of anatomical data to the functional conception, have
continued, and still continue, to admit, a priori, the exist-
ence of the anastomoses, without at all caring, not only
that direct demonstration is wanting, but even that ana-
tomical researches show the contrary.
Apropos to this new direction of histologic studies of
the central nervous system, I observe that up to the
present some of the opinions expressed in the recent
■epoch, with many persons have had, and now have, the
credit of presenting the definitive solution of the problem
of the final disposal of the protoplasmic prolongations.
This new phase, also, of researches, has in a certain
measure its points of departure from the accurate studies
of Deiters, who may be said to have advanced as far
as was possible with the finest means then at command.
Speaking, in general, of the protoplasmic prolongations,
he says that, having subdivided down to immeasurable
fineness, they are finally lost in the fundamental porose
existing in the gray substance. He asserts afterwctrds that
on attentively examining these prolongations there is seen
to depart from many of them a certain number of very
fine, fragile , fibrillae, which are not simple divisions, but
something of special nature; that is, they may be seen
inserted on the sides of these prolongations, through the
medium of a triangular new sweUing, presenting no marked
difference as compared with the cylinder-axis of the finest
nervous fibres, with which they rather have something in
common — an aspect somewhat irregular, a slight varicosity,
and chromical characters.
In some cases Deiters believed that he succeeded in
seeing those fibrillae invested by a thin medullary sheath.
In fine, resting upon such data, he declared that he had no
hesitation in recognizing in the fibrillai in question a sec-
ond system of cylinder axis, proceeding from the ganglia
Minute Anatomy of the Central Nervous System. 255
cells, a system absolutely distinct from the cylinder axis
prolongation." I note incidentally that Deiters thought
this second category of nervous fibres emanating from the
plotoplasmic prolongation, should be taken into consider-
ation in the explanation of the functional relations between
the diverse cellular groups, and between the nervous
provinces.
As to the final mode of comportment of the ramified
prolongations (protoplasmic), M. Schultze expresses himself
in a rather unprecise manner; he, however, leaves it to
be understood, with sufficient clearness, that his opinion
on the subject is subordinate to the conception which
he has of the exquisitely fibrillar structure of the nerv-
ous cells and their prolongations. After having occupied
himself on the cylinder-axis prolongation, he says, refer-
ring to the protoplasmic prolongation : " Many other
prolongations of the cells place the latter, and with them
the cylinder-axis prolongation, in dependence on the more
distant region of the central organs, and most likely those
on the surface of the body — a dependence which does not
permit us to designate the gangliar cells as the exclusive
orgins of the nervous fibres." And, again, according to my
observation, it should be thought that a real termination
of the fibrillae in the brain and the spinal cord, hardly
at all exists, that is to say, that all the fibrillae have their
origin on the periphery, and hence do no more than
traverse the gangliar cells."
On the subject Koelliker confines himself to the observ-
ation, that the prolongation of the gangliar cells can be
followed much farther, and reduced to much greater
fineness than we might be led to believe, from the observ-
ations of those who have pretended to have verified the anas-
tomoses, and who, wishing in conclusion to express their own
opinion, do so in a rather vague manner, which permits us to
regard it as the announcement of an hypothesis : " Only,"
says he, " by way of supposition, do I note that the term-
inal ramifications of the nervous cells serve at first to con-
join the nervous distant cells of the diverse regions,
256 Golgi.
and that in the second place they may be in connection
by means of some of their terminations, also with the
nervous fibres."
I shall lay aside the opinion of Hadlich and Obersteiner^
who, as regards the nervous cells of the cerebellar cortex,
pretend to have observed that the peripheral ramifications
(protoplasmic prolongation) of the cells of Purkinge,
reduced to extreme fineness in various points of the
cortex and especially in proximity to the surface, bend
upon themselves, forming arches of various sizes in order
then to return, in directions perpendicular to the surface
and parallel to one another, to the stratum of granules,
and concurring in a certain number, to form the cylin-
der-axis of a nervous fibre.
The researches of Riiidflesch and of Gerlach, on the
contrary, call for more particular notice, solely, however,
from the importance which has been ascribed to them,
especially to those of Gerlach,
The study of Rindflesch may be considered as an en-
deavor to return to the ancient conception, favored by
Wagner, Hanley and others, of the existence of a diffused
nervous substance.
According to R., the protoplasmic prolongation of the
nervous cells of the convolutions, after repeatedly ramify-
ing, are brought down to an extreme fineness, and in the
end are seen to be composed of very small points,
in rows, so that the idea of a filament vanishes, and there is
substituted the impression of threads in a direct continu-
ance with the interstitial granulous substance. On the
other part, many fibres would be separated into a pencil
of extremely fine fibres, which, in their turn, would pre-
sent, like the protoplasmic prolongation, the immensely
graduated passage from the fibrous to the granulous.
Rindflesch is therefore of opinion that in the cortex of
the cerebrum there is a double termination of the medul-
late nervous fibres, ist, by direct passage, as described by
Deiters and others, into the cylinder-axis prolongation of
the nervous cells ; 2nd, by dissipation (ravelling out) in
Minute Anatomy of the Central Nervous Syste^n. 257
that granulo-fibrous substance, in which are dissipated
the protoplasmic prolongations of the nerve cells. The
granulo-fibrous interstitial would, then, according to
Rindflesch, be of nervous nature, and the denomination,
anciently used, of diffused central tiervojis substance, would
well befit it ; and among the parts constitutive of the cen-
tral nervous system, the greater consideration should be
awarded to it, whilst to the gangUar cells would pertain
only the significance attributed to them by Schultze, —
that of apparatus destined to transmit nervous excitation.
The notion of a diffused nervous substance was soon
combatted by Gerlach, who, in preparations obtained by
the method of chloride of gold, was enabled to see
that the fine ramifications of the protoplasmic prolongation
pass into a netting of very fine fibrillae, non-medullary,
from which, on the other part, the nervous fibres are
developed.
This very fine netting in the cerebral cortex, would be
found alongside of the gangliar cells, in the interspaces of
a net with large meshes, formed by horizontally running
medullary fibres.
Gerlach, however, remained in doubt, whether all the
gangliar-cells of the cortex are furnished with cylinder-
axis prolongation ; he was able to see only one such pro-
longation in the largest gangliar cells, which sent towards
the surface of the cerebrum a long and large protoplas-
mic prolongation.
To conclude : The opinion which to-day has the chief
credit as to the mode of behavior of the protoplasmic
prolongations is that sustained by Gerlach, according to
whom they, after very complicate subdivisions, pass into
a network of very fine fibrillae, non-medullary, from which
on the other part numerous medullate fibres originate ; or
otherwise these concur in the formation of the diffuse
nervous network, on one part, the protoplasmic prolonga-
tions by means of indefinite subdivisions, and on the
other many nervous fibres, by means of corresponding fine
subdivisions. Granting, however, that this opinion was
258 Golgu
well founded, we might count upon two distinct modes of
connection of the gangliar cells with the nervous cells.
That is, first, by means of the nervous prolongation which
should pass directly, without ramifying, to constitute the
cylinder axis of a nervous fibre ; second, by means of
very fine subdivisions of the protoplasmic prolongations,
which should become constituent parts of the fine net-
work of the gray substance.
That this opinion is attractive, insomuch as it would
furnish the anatomical explanation of the reflex activities,
and of the functional relations between the diverse groups
of elements, is a thing too evident ; but that it has a
right to be collocated among incontrovertible facts cer-
tainly cannot be asserted with any sure foundation. For
my part, I do not hesitate to declare that it cannot resist
the severe pressure of observation. And to express myself
in terms still more concise, I shall say, that the doctrine
of Gerlach is but an arbitrary interpretation, or a com-
pletely ideal one, of those appearances which are obtained
by treating the central gray substance by the chloride of
gold method.
To him who has with accuracy tried the application of
the method of Geiiach, in studying the gray substance of
the nervous centers, it is certain that he will have suc-
ceeded in sometimes obtaining the coloration of an intri-
cate diffuse network, in all the gray substance ; at other
times, on the contrary, of nervous cells, with some pro-
longations, and their first subdivisions, also some secondary
ramifications. In the last case the prolongations naturally
withdraw from examination, from becoming confounded
in the midst of the fundamental entanglement {inireccio)'
But between the fact of gradual disappearance, with the
asserted decomposition into primitive nervous fibrillae, and
the relative formation of the diffuse network, there is a
great chasm [lacuna). Now, Gerlach, who would fill up
this lacuna by introducing into the field the transit of the
protoplasmic prolongations into a nervous netting, advances
nothing more than a supposition, quite unfounded.
Minute Anatomy of the Central Nefvous System. 259
If, then, it has not been demonstrated, nor is sustain-
able, though it is the doctrine of Gerlach, who in every
way, in the modern phase of histology, has had, per se,
the highest honors, it may be now asked, what finally is
to be the behavior and the significance of the protoplasmic
prolongations ?
To the answer which now, at length, I believe I am
able to give to this question, I deem it useful to preface
the following observations :
1st. If there is any process which may enable us
to see the passage of the protoplasmic prolongations
into the fundamental network, it must be that of the
black coloration, which, by the fineness of the results
far exceeds all the methods used by Gerlach and oth-
ers, who have asserted that they have seen the pas-
sage, in question, into the diffuse network. Now this
method actually permits us to follow the protoplasmic
prolongations to a very great distance from their origin,
and to see them ramified dicotomically down to con-
siderable fineness ; yet never does it show anything
which would lead us even to suspect that they pass on to
form the supposed network. Far from assuming an aspect
which would cause them to resemble primitive nervous
fibrillae, or ramifications of nervous prolongment, they
constantly conserve their granulous aspect and their par-
ticular mode of running and ramifying altogether different
from that of nervous fibres.
2d. In the direction of the ramifications of the pro-
toplasmic prolongations, so far from a tendency to be
carried into the localities in which nervous fibres exist
having been verified, it has, on the contrar}', been noted
that, prevalently, they are carried into localities in which
these fibres are absolutely wanting. For example, in the
cerebral cortex it is easy to show that the protoplasmic
prolongations are directed, in greatest part, toward the
free surfaces of the convolutions, where, exactly, as a
rule, nervous fibres do not exist.
3d. There is a cerebral region whose study can offer
26o Golgi.
a decisive answer to the problem of the supposed rela-
tions between the protoplasmic prolongations and the
nervous fibres, and it is the lamina of gray substance
forming the so-called fascia dentata of the great foot of
the Hippocampus. This region, as I shall show in an
apposite study, is no other than a well defined convolu-
tion, continuous with a thin stratum of gray substance (a
rudimental convolution, which, in the form of a streak,
runs along the whole surface of the corpus callosum, by
the side of the linea media (the so-called stricB longitudi-
nales, or nerves of Lancisi). Now, this stratum is occupied
by characteristic small nervous cells, situate with the most
regular and invariable disposition in double or triple series
along the internal margin of the stratum, whose nervous
prolongation having origin from the deep pole of the
small oval cellular bodies, crosses the convolute stratum
in order to unite with the band of fibres which runs along
the internal margin of the same convolute stratum.
The protoplasmic prolongations, on the contrary, by
a law equally invariable, emanating from the opposite
pole, traverse the whole gray stratum, forming the fascia
dentata, in order to terminate on its surface, which,
besides by a blood-vessel, is limited by a thin stratum
of connective cells. On the surface of this stratum there
absolutely exist no nervous fibres, hence, for these typical
cells, the possibility is excluded of any relation of origin be-
tween the protoplasmic prolongations and the nervous fibres.
4th. With regard to the direction of the protoplasmic
prolongations, I have above noted that in these here is
discovered a tendency to be carried into localities where
no nervous fibres exist. I shall add, now, that this fact
might lead us to suspect that they rather tend to be
brought into relation with connective cells; and here we
are reminded that both on the surface of the cortex, and
in other regions, where the ramifications of the prolonga-
tions in question terminate, the tissue is constantly formed
solely by connective cells, which are always found in the
closest relation with vessels.
Minute Aytatomy of the Central Nervous System. 261
The data here set forth may have but an indirect value
unless completed and explained by another, which though
it is in contradiction to whatever has been generally
asserted by histologists respecting the final disposal of
the protoplasmic prolongations, I yet hesitate not to
announce, as I have succeeded by innumerable trials, in
obtaining preparations which furnish evident proof of the
real existence of the fact.
I intend here to allude to the connection existing
between the ultimate offshoots of the protoplasmic pro-
longations and the connective cells. An opportune ground
for the demonstration of this fact is the cortex of the
convolutions, and especially their marginal zone, towards
the free surface. The next part more especially adapted
is the gray stratum before mentioned, which forms part
of the great foot of the hyppocampus, under the name of
fascia dentata.
It is not rare that the impression is given that the
protoplasmic prolongations are inserted directly into the
walls of the vessels by a thin expansion.
It is true that along the whole course of the vessels,
and in direct relation with them, there exists a continuous
and sometimes a complicate series of connective cells, so
that it becomes difficult or impossible to say whether the
thin expansions of the protoplasmic prolongations above
mentioned appertain directly to the walls of the vessels,
or to the connective cells, which are applied to the walls.
In conclusion, I believe I am authorized to hold that
the protoplasmic prolongations take no part in the for-
mation of the nervous fibres ; from the latter they always
maintain themselves independent; they have, on the other
hand, intimate relations with the connective cells, and
with the blood vessels.
Desiring to say a word yet on the functional signifi-
cance of the protoplasmic prolongations, I believe I am
able to assert that their purpose ought to be sought for
from the point of view of the nutrition of the nervous
tissues, and to speak more precisely, I think that they
262 Golgi.
represent the paths through which the diffusion of the
nutritive plasma is brought from the blood vessels and
the connective tissue to the essentially nervous elements ;
to which elements it would otherwise be difficult to say-
by what other path the nutritious material could arrive.
Both a direct and an indirect derivation of the nervous
fibres from the protoplasmic prolongations being excluded,
and it being placed in clear light that these prolongations,
neither directly, by means of anastomosis, nor indirectly,
by means of the supposed diffuse network, can serve as
a functional communication between single cellular indi-
vidualities, and between diverse groups of them, the
question is now presented, whether, notwithstanding this,
a sufficient anatomical explanation of the origin of the
nervous fibres of the gray substance can be given; and
in the second place, whether what has been here exposed
can furnish a probable response to the problem relative
to the functional bond, the existence of which it is a
necessity to admit, between the diverse cellular individ-
ualities, and between the diverse provinces of the gray
substance.
To both these questions I think I shall reply, as far
as I shall go in exposition, in the following paragraph,
relating to the nervous prolongation:
The Nervous Prolo7igation. — The characters by which
the nervous prolongation, from its origin onward may be
distinguished from the others, are paramountly the greater
homogeneity, the hyaline aspect, the more glossy surface ;
these characters contrast with the granulous or striate
aspect, similar to that of the cellubar body and proper
to the protoplasmic prolongation, which last are besides
seen more distinctly in direct continuation with the
cellular body ; these prolongations are, at their origin,
usually more robust, not very regular and early ramifying ;
in fine, the nervous prolongation, as an almost absolute
rule, from the point of their origin from the cellular-body
or from their roots, as far as lo and 15 micromellimeters
distant, proceed gently {dolcemente) and regularly slen-
Minute Anatomy of the Central Nervous System. 263
dering, so that their first part usually has the aspect
of a fine and regular cone. It may be added, that as re-
gards the point of emanation and the successive direction,
there exists for the diverse catagories of cells, laws suffi-
ciently determinate, that is to say, in these cellular groups
the thread in question emanates from corresponding points
on the contour of the cells ; though in this respect there
are sufficiently numerous exceptions. For example, from
the grangliar cells of the cerebral cortex, as a rule, the
nervous prolongation originates from the middle of the
base of the pyramidal forms which constitute the prevail-
ing type of these cells, and from this point it is directed
towards the deep part of the cortical stratum and is car-
ried directly towards the white substance ; yet it may be
said that cells are not very rare, whose nervous prolonga-
tion is carried in the opposite direction, that is, towards
the surface of the cortex.
In the large nervous cells of the cerebellum, on the
contrary, with constant law, the nervous prolongation de-
rives its origin from their diploe, and it is carried,
traversing more or less tortuously to the stratum of granu-
les, towards the region of the respective convolution.
In many ganglia cells of the posterior cornu of the
medulla spinalis, the prolongation in question is carried for
a certain distance in the direction of the anterior cornu
after which its further course is uncertain. The other
more precise particulars respecting the origin and course
of this prolongation will be a subject of study in our de-
scription of the single provinces of the central nervous
organs.
Some observers believe that they have seen an essen-
tial differential datum, between the nervous prolongation
and the protoplasmic, in the different manner of origin, as
respects the diverse parts constitutive of the gangliar
cells. It has been asserted, for instance, that the
nervous prolongation is paramountly characterized by
having its origin from the nucleus, whilst the protoplasmic
is derived from the cellular body.
264 Golgi.
On this question the majority of modern observers
{Deiters, Schultze, Kcelliker, Boll, &c.), concur in asserting
that they have never been able to establish this pretended
connection of the cylinder-axis prolongation with the
nucleus.
The ulterior mode of behavior of the nervous prolong-
ation is of great importance, and is always a subject for
careful study.
Ever since Deiters, on the basis of long and minute re-
searches, furnished the demonstration of the existence of
this special prolongation, which, however, had already
been perceived by Remak, the subject has been the object
of the researches of numerous observers, and as the de-
scription by Deiters related to only the cells of the medulla
oblongata, the new researches have been specially directed
to the cells of diverse other provinces of the central
nervous system.
On this domain the researches of Koscheivnikwo, are
signalized above all, and next those of Gerlach, Handlich,
Obersteiner, Boll, Butzke and some others, who, with one
accord, assert that they have in some cases established
the direct continuation of this special prolongation in the
cylinder axis of a medullate nervous fibre.
Under the influence of these concordant assertions,
the scheme of central nervous cells given by Deiters, has
naturally been generally adopted. And in truth this
scheme represents all of the finest and most accurate ob-
tainable by the means of research, until a few years past,
at the command of histologists, for the study of the ele-
mentary morphology of the central nervous system.
But since the discovery of the most delicate chemical
reaction of the nervous cells of which I have before spoken,
{the black coloration obtained by subjecting the nervous
tissue to the combined action of the bichromate and the
nitrate of silver), by means of which reaction these elements
may be clearly brought out in their most minute details
of configuration, and with all the finest offshoots, whilst
they continue in situ in the tissue, and maintain their re-
Minute Anatomy of the Central Nervous System. 265
lations with the neighboring parts,: — after this discovery, I
say, it has been possible to give new pace to the progress
of our knowledge of the morphologic character and the
relation and laws of ramification of the elements in ques-
tion, thus correcting ideas too absolute, and demonstrating
certain erroneous assertions, which rested more on pre-
conception than on accurate observation.
As I have already had to observe, a particularlised
description of the mode of behavior of the nervous pro-
longation in the diverse categories of the gangliar
cells, cannot conveniently be given unless by study-
ing the single regions of the central nervous system
to which the cells belong ; and as it cannot yet be asserted
that there are absolutely general characters, that is, which
may, without exception, be applied to all the central nerv-
ous cells, I think it useful to take as the basis of my
description the cells of the cerebral cortex, which evidently,
from their quantity and importance, have a great predom-
inance over the others.
In the cerebral cortex, subjected to the reaction above
mentioned, it can be shown that at least in the great
majorit)' of the gangliar cells, the nervous prolongation
has a mode of behavior notably different from that de-
scribed by Deiters and other observers who have asserted
that they have established in their categories of cells the
facts described by Deiters. Severed either directly from
the cellular body, and in general from that surface of it
which is turned toward the white substance (the base of
pyramidal forms), or from the root of one of the large
protoplasmic prolongations which emanate from the now
called surface of the cell, from the point of emersion to
the distance of 20 and 30 m. m. it proceeds gradually dwin-
dling, till at last it becomes a mere threadlet, but always
preserves its simple, usually rectilinear, regular, sleek form.
At the distance above stated it often presents a white tortu-
osity, then it sometimes continues for a short space still
simple ; very frequently closely after the tortuosity, some
lateral filaments begin to emanate, and this process of
266 Golgi.
emanation of lateral branches continues at pretty regular
interspaces, as far as the success of the black reaction per-
mits us to follow the promulgation; it afterwards preserves its
regularity and sienderness, but assumes a slightly tortuous
course (perhaps the result of shrinking of the tissue), and
thus it is not rare to be able to see it traverse the whole
thickness of the cerebral cortex, and even further, to bury
itself in the stratum of nervous fibres (in many instances I
have been able to follow it to a distance of 600 or 80a
{inillimetves) ; even at this distance I could see filaments
given forth. As to thickness, it presents notable differ-
ences ; sometimes in departing from the tortuosity
mentioned it offers distinct variations of diameter,
and arrives in the stratum of nervous fibres in the form of a
manifest filament ; much more frequently, however, as it
proceeds gradually giving out branches, by insensible de-
grees it goes on diminishing till it reaches an unmeasurable
fineness.
I have said, that in all its course, the nervous prolong-
ation from spot to spot, at pretty regular distances, gives
out lateral threads ; in relation to these I shall now add
that with almost constant rule they emanate at right angles,
and by following their course, they, in their turn, like their
parent thread, give out lateral branches, and these in like
manner go subdivising into threads of three, four, five order^
ever finer and finer, passing at last, sometimes far from the
origin, into filaments of extreme fineness. From all these
ramifications of the diverse nervous prolongations, there
naturally results an extremely complex entanglement (in-
terlacement,) which extends into all the gray substance.
That, from the innumerable subdivisions, there may result,
by means of complicate anastomoses, a network in the
strict sense of the word, and not a mere entanglement
interlacement iintreccio), is a thing very probable ; one would
be rather inclined to admit it after examining some of my
preparations ; but whether this is really the same as the
complicate entanglement I cannot assuredly say.
Among the details relating to the behavior of the nerv-
yh
Yui.i.
1
^^ TicA^ir.
Oi^»vv *-v~w.-"Dvwvv^v> wi\., dLii--'
Minnie Anatomy of the Central Nervotis System. 267
ous prolongation, I would finally observe that many of them
in giving off branches, acquire the highest possible fineness,
a good space before arriving among the nervous fibres, and
that, having reached such extreme fineness they yet
divide into threads, three, four, five, which in their turn ramify
and become confounded with the diffuse network of which
I have above spoken.
The fact, then, is well worthy of new, special consider-
ation, that from a not insignificant number of nervous
cells, chiefly of the deep parts of the cortex, the nervous
prolongation neither emanates from that part of the cel-
lular body which is turned towards the white substance,
nor is it directed towards it, but goes in the opposite
direction, presenting changes analogous to those just
stated ; that is, they are decomposed into filaments of the
second, third, fourth orders, which enter to make part of
the general intreccio above described.
Finally, it seems that in the cerebral cortex (and prob-
ably in the gray substance of the nervous centers in
general), there are placed two types of gangliar cells, viz. ;•
1st, gangliar cells (plate ist, fig. i, 3, 4, 6, plate 2d, fig.
3, 4 ; plate 6th, figure unique), whose nervous prolonga-
tion gives out but few lateral elaments, and is directly
transformed into the cylinder axis of a medullary nervous
fibre; 2d, gangliar cells (plate ist, fig. 2, 5, 7, 8, 9, 10,
plate 5, fig. unique), whose nervous prolongation, subdi-
viding complicately, loses its individuality and takes part,
in toto, in the formation of a nervous network, which
extends to all the strata of the gray substance.*
• Of the twenty-six plates furniahed by the author, only two are presented in
the RivUta, and these are of such excelleace and neatness as to create a keen longing
for more. We have the assurance of the author that no liberty for artistic refine-
ment was conceded to the artist, so that the figures may be relied on as genuine
reproductions of the natural forms, and it is deeply to be regretted that the read-
ers of this translation cannot avail themselves of these excelleat representations,
as valuable aids in the study of the text. To the American reader, who has so
often to grieve over the confused daubs which interlard so many of our cheaply
got up medical publications the inspection of these and many other Italian plate?
we have had the pleasure of seeing, would indeed be a rich treat.
Since the preceding note was written, we have received Fascicolo IV. of Anno
VIII. of the Rivista, giving a continuation of Prof. Golgi's splendid article, tc gather
with four exquisitely executed illustrative plbtes. Tl translator will regard his
part of the work as a pure labor love, hoping the readers of the Alienist may be
equally interested in the continuation.
268 Golgi.
At this point I believe I should recall attention to the
manner of comportment of the nervous fibres, or of a
certain number of them, within the gray substance.
In studying the preparations treated in the method
above given, in the same manner as in these, some fasces
of nervous prolongations are often seen which are diverted
towards the white substance, in which other fascicles of
the cylinder axis are frequently seen, colored in like
manner black, and having, from their aspects and their
mode of running and of ramifying identical characters,
as to the nervous prolongations of the cells. In following
the course of these it may be shown that many are
accompanied by fascicles of nervous prolongations, con-
founding themselves with these in such a manner as to
render it impossible to differentiate ; but also, that many
others, on the contrary, continually giving off secondary
threads, which in their turn continue subdividing, are
reduced to fibrils of unmeasurable fineness, and then lose
themselves, in like manner as has been said respecting
the nervous prolongations, in the diffuse network of the
gray substance. Nevertheless, just as, in relation to the
comportment of the nervous prolongation in the gray
substance, we have distinguished two types of gangliar
cells, analogously we may distinguish two categories of
diverse nervous fibres, by the behavior of the respective
cylinder axis, and these correspond to the two described
types of cells, viz. :
1st. Nervous fibres which, although they administer
some secondary fibrillae (that by subdividing are lost in
the diffuse network), yet conserve their own individuality,
and go on to be put into direct relation with the gangliar
cells of the first type, and continue into the related
nervous prolongation.
2d. Nervous fibres which, by subdividing complicately,
lose their own individuality, and pass in wholly to take
part in the formation of the diffuse network before named.
In the formation of the diffuse network there therefore
concur :
Minute Anafomjy of the Central Nervous System. 269
1st. The fibrillae which emanate from the nervous pro-
longations of the cells of the first type.
2d. In totality, the nervous prolongations of the cells
of the second type.
3d. The secondary ramifications of the cylinder axis
appertaining to the nervous fibres of the first category.
4th. Many cylinder axis in totality ; that is, those
which, in like manner decomposing into very slender fila-
ments, unite in the general intreccio, and lose all individ-
uality (nervous fibres of the secondary category).
After this exposition of minute particularities relating
to the structure, and above all to the mode of behavior,
of the diverse prolongations of the gangliar cells, as well
as to the disposition of the nervous fibres entering the
strata of gray substance, it seems to me that I have
gathered in sufficient material to warrant me in claiming
the right of decisively, from a general point of view,
engaging the problem, of the manner in which the nervous
fibres have their origin in the central nervous organs.
\To be continued^
The Progress of Psychiatry and Neu-
rology.
By P. R. Thombs, M. D., Pueblo.*
Superintendent and Physician Colorado St tte Lunatic Asylum.
T>UT little more than a century has passed into the
-■-' history of medicine since Cullen recorded his con-
viction : " That from all that he could discover of the
movements of the system, in disease, they were so de-
pendent upon the nervous system as to entitle them,
in a manner, to be called nervous diseases."
His utterance at the time seems to have made a
very profound impression on the minds of his profes-
sional brethren ; but time in its flight which attests the
truth of scientific and prophetic assertion alike, has veri-
fied the correctness of the great nosologist's observation.
And the intimate relationship which the nervous sys-
tem bears to all morbid processes, is an established fact
in medical science, as firmly enthroned in the professional
mind as Galileo's assertion of the rotation of the earth
on its axis, or Newton's law of gravitation, are fixed in
popular acceptance.
No intelligent physician now doubts the implication of
the nervous system, more or less complete in all morbid
phenomena, from the disturbance paralysis of the sweat
centers in the medulla spinalis in ordinary fever to the
higher involvement of the psychical centers of the cere-
bral cortex when delirium attends upon the same disease.
*Kead belore the Colorado State Medical Society, at Pueblo, June, 1882.
Note.— We give place with pleasure to this address. It likewise gives us
pleasure to see the subject of the Progress of I'syclilatry and Neurology engaging the
attention of an assemblage of general i)ractltioners, and to see the subject Bo
fnlly and fairly jjresented. These subjects are deserving of and must claim no
small share of general medical attention. The real physician must cultivate
these departments more than is now doue. It is surprising that some good
schools have not yet classes devoted to these branches. They can never have
the fullest professional confidence or be what they ought to be, as true foun-
tain-sources of medical knowledge, without them.
The Progress of Psychiatry and Neurology. 2y i
The vaso-motor paralysis, too, which permits of that
dilatation of the cerebral vessels, and the vessels of other
parts, in states called hyperaemic, and in a more extreme
degree, allows of many of the fluxes and effusions, as in
cholera morbus and in certain dropsies, is no longer a
matter of controversy.
Were we to go on noting down these morbid condi-
tions in which the nervous system plays a primary or
secondary part, when not long ago it was not conceded
to play any part at all, we should occupy more of your
time and attention in the detail than you might be ex-
pected to give.
But a very cursory glance will suffice to convince us
that neural-pathology and neuro-therapy are now engaging
a very large share, and justly, of professional thought,
and that they are evidently destined to engage still more
consideration in the not remote future. The humoral pa-
thologists have had their day, the glory has departed
from the solidists, the vascular theories are losing some
of their hold while the neural-pathology asserts its sway
and contests with every other theory, on sound phy-
siological and pathological grounds, the right to reign, if
not supreme, at least jointly, over the vast domain of
pathology.
Psychiatry, which is the keystone of the medical arch,
— the highest department of medicine, and chief branch
of neurology — has made most rapid strides since Chiarugi,
Pinel and Tuke unshackled the insane of their respective
countries. Italy, France and England melted their chains
into deeds of charity. Our profession is justly proud of
its work in this direction. And the beautiful hospitals
with their neatly furnished rooms and pleasant surroundings,
which have taken the place of the old, dingy, prison-like
buildings, and their dark, and damp, and mouldy cells of
confinement, and keepers, and savage turnkeys, stand as
everlasting monuments to the humanity, philanthropy and
advancement of the medical profession.
The Roman Matron pointed with just pride to her
2/2 P. R. Thombs.
children ; and to those comfortably-housed children of
misfortune, many of them restored to the usefulness of
rational life through our care and ministrations, we might,
with pride, point as " our jewels."
It is not my purpose to specially discuss the modern
management of the insane, but we ought not to omit in
passing, to note among the crowning glories of medicine,
this signal evidence of our advancement in keeping with
the rapid progress of the age in which we live, in so many
other directions, what we have done for the insane is not
less than Jenner did to save the race from the ravages
of small-pox. Humanity has no greater foe to the per-
petuity of the species than insanity, and the insane tem-
perament, or neuropathic diathesis.
Neurology, embracing as it does, and should, psychia-
try, to which we have briefly referred, is now the most
generalized specialty in our science, so that in order to
be a skillful physician we must be somewhat of a neurol-
ogist, and the most skillful physicians of the day are
those who least ignore neural-pathology.
With the progress of neurological research, invasion is
being steadily made into the territory of general medicine,
and each year instances the surrender of some of the
battle-ground. The invading horde of neurological ideas
will soon possess the field, and become naturalized in-
vaders, and accepted as good and useful citizens.
It has been but a few years since, to pronounce a
case "nervous" was to dismiss it from our notice. Now
nervous diseases receive from us all no inconsiderable
attention.
Only a few years ago gangliopathic disorders were
unrecognized. Within the last two decades Edward John
Tilt, and hosts of others, have given us floods of light on
this subject.
Certain heart troubles, once sealed as fatal, receive
from us hopeful prognosis, as having their seat, not in
the structure of the organ itself, but in its motor ganglia,
or somewhere along the ganglionic chain of the sympa-
The Progress of Psychiatry and Neurology. 273
thetic nervous system, and reflected to it, as in the ova-
ries, or other parts of the female genitaha, " A wave of
morbid irritation," as Fothergill expresses it, beginning in
a congested ovary, perhaps, [and not ceasing nntil it
reaches the heart, and precipitating an alarming tumult
of movement there, which we may stop at will by firm,
persistent pressure at the distant starting point of the
morbid movement. The irritable heart first described by
Da Costa (FHnt?) during the war, and differentiated by him
from organic disease, as having its foundation in an irri-
table state of the cardiac ganglia principally, that is,
primarily, is an illustration of direct neural trouble. Cer-
tain renal conditions also, associated with changes in
the quantity and quality of the urinary secretions, have
lately been found to be primarily nervous disorders,
notably among them Bright's disease, which Da Costa,
Longstreth, Hughes, and others, place in the renal gang-
lia, and which, in all probability, has its incipient stage
there in states (often remediable) of gangliopathic neuras-
thenia, without marked structural neural change.
Likewise Addison's disease, the starting point of which
Semola, with great plausibility, places in the renal
ganglionic centers, the characteristic alterations of the
supra-renal capsules representing only the last struggle
of trophic disorder caused by the nervous filaments which
preside over the function of nutrition in these organs,
the bronzing of the skin likewise having a nervous ori-
gin, and leading us to address our attention to the
sympathetic nervous system and its ganglia, early, if we
would remedy this terrible trouble.
Diabetes Mellitus has also been assigned a place of
origin in the medulla oblongata, possibly also, in con-
nection with the middle lobe of the cerebellum, by Dr.
Julius Althaus, of London, in " Brain, " and is arrested by
him by occipital galvanism. He considers the final or-
ganic changes in the kidneys as due to the excessive
and long-continued diuresis, causing maceration of the
renal tissue.
274 P' R- Thombs.
Thus we might go over the whole field of neuro-
logical research and discover everywhere, traces of the
rapid progress of the neural pathology.
Even cancer and phthisis, the former by Richardson,
and the latter by Vanderkolk, have been asserted to be
closely allied to neural diseases, being found generally
prevalent in neuropathic families, alternating with the
insane diathesis, and taking the place, in certain branches
of neurotic families, of insanity.
Notwithstanding the undoubted contamination of the
blood in advanced stages, and their probable communi-
cability by contact, syphilis too, in some of its most in-
sidious forms, is an adneural affection that is engrafted
on the nervous system, as Gowers has demonstrated, and
Althaus, Fornier, and others, have shown us, where it dis-
plays itself in paralysis, epilepsia, and insanity.
These familiar illustrations suffice to show the direc-
tion of medical thought and the result of investigation,
within the past few years. These, with the new disease re-
cently described by Gilleneau, as narcolepsia, character-
ized by distinct, persistent, resistless, but intermittant
sleep paroxysms, and the not remotely familiar terms
of pseudo - hypertropic muscular paralysis, progressive
muscular atrophy, " athetosis " (yet struggling for distinc-
tive recognition as different and distinct from chorea),
and exophthalmic goitre, the longest recognized of all ;
sclerosis anterior and posterior, and diffuse, multiple an^
cerebro spinal sclerosis ; the general paralysis of the in-
sane and many other localized diseases of the spinal
cord and brain, which it would be needless to mention.
The distinctive recognition of diseases of the cerebel-
lum are known to be much more frequent as the result
of malaria and other congested states of that organ, than
was, up to quite recently, supposed ; and the study of
the advanced views of cerebral localization, as taught by
Ferrier, Hitzig and Jackson, and the grudging acquies-
cence of Brown Sequard, could not here be touched upon
with sufficient distinctiveness to be profitable, without
The Progress of Psychiatry and Neurology. 275
consuming more time than this body has to give. This
glance serves to reveal to us how much medicine owes
to neurology, and a hint to the wise is sufficient.
We have gone a great way on our journey, and stand
now, as Moses did, on the mountain looking over into
the promised land, longing to go in and possess it. Moses
never reached it, but some of us in the ranks of medi-
cine are yet young enough to hopefully expect to realize
the fruition of our hopes.
We are destined yet to see the many crooked ways
made straight, many dark places made clear, and when
the straightening out takes place, and the grand illumina-
tion comes, it will be through the electric light of scien-
tific truth, largely generated and thrown out through the
progress of neurological research.
Importance of a Knowledge of Insanity
by the General Practitioner of Medi-
cine.^'
By Ira Russell, M. D., Winchendon, Mass.
Member of the Association of American Superintendents of Insane Asylums, New
England Psychological Society, and Massachusetts
Medico-Legal Society.
1\ yf R, PRESIDENT and Fellows of this Society : — You
-*-"-*- are well aware that for several years I have made the
study and treatment of nervous and mental diseases a
specialty, and that I have had a great variety of cases
under my care and treatment in my family-home.
It has occurred to me that some of the results of
my experience and observations may not be uninterest-
ing to the general practitioner of medicine, especially that
which relates to the early and incipient symptoms of in-
sanity and the general treatment of the insane. Until
recently but little attention has been given by our medi-
cal schools to the subject ; when myself and the older
members of this society attended medical lectures, we had
no instruction upon matters relating to insanity.
At the present time many of the medical schools
have taken a new departure, and professorships upon
psychological medicine have been established. Never
before has the general pubUc been so much interested
in the subject of insanity as at the present time.
The trial of Guiteau has awakened an interest in
the public mind, and the symptoms of insanity and the
responsibility of the insane have become matters of gen-
eral fireside and table talk. It was the universal belief
in Guiteau's responsibility that decided his fate and influ-
enced the jury, rather than the medical testimony.
•Read before the Worcester North Medical Society.
Knowledge of Insanity. 277
That the general public should know more about
insanity, its causes, symptoms and treatment, is undoubt-
edly desirable; but much more desirable is it that the
general practitioner of medicine should be well informed
upon the symptoms and treatment of this disease.
Almost every form of insanity in its earlier stages is
amenable to treatment. Take cases of acute mania, the
symptoms of which are so palpably plain that there can
be no mistaking the disease, and when they are at once
put under treatment, the result is that a large per cent,
recover.
But there is a large number of cases that come on
insidiously ; such is the fact with many cases of melan-
cholia. The invasion of this form of insanity is usually
slow — the subject of it gradually and almost impercepti-
bly loses his relish for existence, takes less interest in
his business and his familj , is abstracted in thought,
peevish and fretful in disposition, is easily irritated, has
strange likes and dislikes, is suspicious and distrustful of
those in whom he formerly had the utmost confidence.
He seeks solitude, and in the words of Dryden :
"He makes his heart a prey to black despair;
He eats not, drinks not, sleeps not, has no care
Of anything but thought, or, if he talks
'Tis of himself."
Some are moody, silent and taciturn; every lineament of
their countenance indicates despair. Others will talk con-
tinually about themselves — will blame themselves for hav-
ing done some great wrong for which they are to be
punished.
The particular thing or things upon which the mel-
ancholic dwells are as various as the persons afflicted.
In some, it will be simply an exaggeration of some actual
fact; others will dwell upon things entirely imaginary.
I had a patient with an abundance of means, who
was unwilling to eat because she was unable to compen-
sate for the food, and had it not been for fear of the
stomach pump, she would have died of starvation.
2/8 Ira Russell.
I have a patient, a lady of the highest respectabiHty,
fifty-seven years of age, who, until two years ago, was
most genial and happy in all her relations. She is now ex-
ceedingly miserable, claiming that some time in early life
she did something wrong and for which she can never be
forgiven. She is punishing herself by refusing to eat
certain kinds of food and fruits she was formerly very
fond of.
I had a patient, a young gentleman, a graduate of
college, of refined and cultivated manners, who appeared
all right except in one particular, and that was, that God
had made him without first consulting him, and he was
determined to be even with his Maker by taking his own life.
Nearly all melancholies are suicidal and require the
closest watching.
The general practitioner, when called upon to visit
one of these cases, will very likely be told by the friends
that the patient is bilious; that he has a poor appetite;
that he sleeps badly ; that he has the blues, and worries
about nothing. They will be very careful to conceal his
delusions, his jealousies, his hatreds and his outbursts of
passion without any apparent reason. They conceal these
things for fear of the fancied disgrace publicity would
bring upon the family.
The result is, that a case drifts on from bad to worse
and a patient becomes a confirmed lunatic ; and on some
bright morning the family are thrown into the deepest
distress and the whole community shocked by a case of
cut throat, drowning, pistol shot, poisoning or strangula-
tion. Consult almost any daily paper, and you will find
accounts of from one to five suicides each day.
There are cases of insanity without delusions, illu-
sions or hallucinations, in which the moral or affective
faculties of the mind are alone involved, the intellect
being clear and unaffected. I well know that in such
cases very frequently it is with difficulty that we can
discriminate between viciousness, wickedness, depravity
and actual lunacy. It is by comparing such persons
Knowledge of Insanity. 279
with themselves. A person who has always been amia-
ble, truthful, moral and upright in all his relations in life,
becomes completely changed in his moral sentiments —
such a person, I maintain, is morally insane.
To illustrate : I had a patient, a young lady, mar-
ried, highly educated, a great favorite in the social circles
in which she moved, and was much esteemed by the
church in which she was an active member. Without
any apparent cause she became exceedingly untruthful
and disregarded all moral obligations. Her cunning and
duplicity were remarkable ; still, she had no delusions and
her intellect was clear. After a few months' treatment
she was herself again.
At the present time I have a patient, a married lady,
of cultivated manners, good education and refinement.
Two years ago she was confined and had a poor recov-
ery from her confinement; soon after that she took to
her bed and was confined to it until brought to me.
She was very tenderly nursed, her every wish was grati-
fied, and she became exceedingly exacting, taxing her
ingenuity to make trouble for her attendants and excuses
to have her physician called to relieve some fancied suf-
fering. She would have cataleptic fits, and no one but
her physician could bring her out of them. When
brought to me, for a day or two she continued to have
these fits, but not liking my method of relief, she said
she would not have any more, and has kept her word.
While she appears to be very pleasant, and professes to
be perfectly satisfied with what is done for her, she writes
to her friends the most scandalous and untruthful letters,
claiming that she is abused and cruelly treated. Her
whole purpose seems to be to excite their sympathy and
to make them unhappy.
Notwithstanding these unnatural mental manifestations
which are so common in this class of patients and so for-
eign to their natural disposition and previous history,
their friends are very apt to be unwiUing to admit of
their insanity.
28o Ira Russell.
Here is a middle-aged man ; he has borne an irre-
proachable character, honest and upright in all his deal-
ings. He begins to show some eccentricities, is irritable
and easily excited. He is detected in some immoral
practices — commits forgery, perhaps ; is arrested and
punished as a criminal, to the astonishment and chagrin
of all his friends. A careful examination of this man by
an expert alienist would discover a tremulous tongue,
impaired articulation, contracted pupil, and a hitch in his
gait; the unmistakable incipient signs of general paresis.
I had a patient, a millionaire, suffering from this dis-
ea?e. He would steal and conceal the most trifling
articles, especially if there was something bright and
sparkHng about them. He stole a lady's diamond ring and
concealed it for several months, sometimes about his
•clothing, at other times in his mouth.
The treatment of the insane, all must admit, is of
the gravest importance. The insane have rights, and
first and foremost among these rights is the best and
most effectual modes of treatment for their restoration to
health ; and all obstacles thrown in their way to prevent
them from securing such treatment is an outrage upon
humanity.
A person is found injured and insensible in one of
our large cities ; he is at once taken to the nearest
hospital and given the best surgical care and treatment
possible, and no obstacles are thrown in his way.
A person is -taken insane ; no one doubts the fact,
but, before he can be taken to an asylum, he must be
subjected to some form of trial.
In some States, Illinois for instance, a trial by jury
is required — a trial by a class of men who know no
more about insanity than about the integral calculus or
the inhabitants of the moon.
This difficulty of admission causes delay, and the
excitement caused by the trial (whatever that may be),
aggravates the disease and makes the case less amenable
to treatment.
Knowledge of Insanity. 281
What greater absurdity can there be, than to take
a person afflicted with small-pox before a jury to get a
permit to put him in a pest-house, unless it would be to
take a delicate, nervous, insane lady before a jury to ren-
der a verdict upon her mental condition and the proper
place for her treatment?
In regard to the early treatment of the insane, I quote
the following from Lord Shaftesbury, who is at the head
of the lunacy commission in Great Britain. He says :
^' We must be very careful indeed how we hastily let
loose upon the public persons whom we are not quite
certain have been restored to the power of self-control.
The tendency now is to let out everybody that is shut
up, and henceforward to shut up nobody at all. Though
there were in former times great instances of cruelty and
abuse, my experience of the various asylums (private as
well as public) is not only favorable to the highest order
of intellect, but to the truest and deepest sentiments of hu-
manity towards the poor creatures who are there confined
Therefore, I hope that nothing will be done which will
throw unnecessary impediment in the way of early treat-
ment by a mistaken delicacy in regard to the liberty of
the subject."
There are three methods of treating the insane. First,
home treatment ; second, in private asylums, and third, in
general insane asylums.
There are alienists who advocate home treatment, and
no doubt many can be thus well cared for, especially such
as are harmless or demented. But, as a general rule, the
friends and relatives of the insane are poorly qualified to
take care of them. They do not have the patience and
charity of trained attendants.
As a matter of fact, the abuses perpetrated upon the
insane haye been vastly greater by friends at home than
by those in charge of the insane in asylums.
There are many reasons why the insane should be
removed from home and friends. A wife becomes insane.
The husband says he can never be separated from her.
282 Ira Russell.
She is unable to manage her household affairs ; a house-
keeper is engaged, and the wife at once perceives that
she is supplanted and her authority denied, and the nat-
ural result is hatred towards the husband and house-
keeper, and increased mental excitement.
A few who have the means can be the best cared for
in the family home, or private asylum, provided they are
in charge of competent physicians and well-trained and
intelligent attendants. Such a place should be made as
home-like as possible, with none of the paraphernalia of
restraint or constraint usual in an insane asylum. The
attendants should be the companions of the patients,,
their equals in manners, culture and refinement.
An insane patient from the cultivated, refined and
educated class has the feeling of disgrace and degradation
when subjected to the care and control of uncultivated
and ignorant attendants.
There is a large number of persons suffering from more
or less mental disturbance who would willingly and gladly
go to an institution for the treatment of mental diseases
were it not for the stigma of commitment and deprivation
of personal liberty. Many such are unable to avail them-
selves of the advantages afforded by family homes and
private asylums on account of the great expense. For
such there should be endowed institutions where voluntary
patients could go without any constraint or the feeling of
imprisonment inseparable from confinement in an insane
asylum. In such an institution cases could be treated in
the earlier stages of the disease before the curative period
was passed. I know from personal experience and ob-
servation that many patients have voluntarily gone to
private establishments for treatment who were as insane
as many committed to insane asylums. The feeling of
non-restraint and personal freedom added greatly to the
success of the medical treatment.
The great mass of the insane must be cared for in
the general insane asylums. I have no sympathy for
those who complain of asylum treatment ; as I have before
Knowledge of Insanity. 283
stated, there are greater abuses and greater cruelties in-
flicted upon the insane in private famiHes and poor-houses
than anywhere else.
Instances hke the following, which I clip from the New
York Tribune, are by no means uncommon :
"Troy, New York, Jan. 13.
" Mrs. Abigail Jones, a wealthy widow, age eighty, the
victim of insane delusions, was found frozen to death on
the floor of her room to-day. She was scantily clothed,
and there had been no fire in the stove for several days.
Death is believed to have resulted from exposure."
Or the following from a letter of Dr. J. B. Chapin in
the New York Medical Record :
" On December 20th, inst., a man was admitted into the
Willard Asylum, who had been a patient in the Hudson
River Hospital, and afterwards removed to a county poor-
house, perhaps for the reason that he could be maintained
there cheaper than at the hospital. In the county house
this man wore iron handcuffs, shackles of iron about his
legs, and a chain connecting the shackles with the floor.
All this, too, in the State of New York!"
The cages I have seen in private families and poor-
houses would not be tolerated for a moment in any asylum
for the insane. The improvement in asylum construc-
tion and management during the last fifty years has
been very great.
There are obstacles in asylum management that should
be removed, obstacles for which those in charge are in
no way responsible.
The medical staff is much too small for the number
of patients. They are over-worked and unable to give
the attention to individual cases that is desirable. Super-
intendents are obliged to take all sent to them without
regard to classification. As Governor Butler in his in-
augural message put it: "All classes of the afflicted with
mental disease have been sent to and received in the
same hospital, whether incurable or chronic, the violent
with acute mania, the demented or imbecile. Those
284 Ira Russell.
with a mania for crime, those insane only from relig-
ions fervor, the pauper and degraded, men and women
all herded together, separated only by necessities of re-
straint and safety."
Of course it is not true that "men and women are
herded together, separated only by necessities of re-
straint and safety ;" still proper provision has not been
made for the different social position of the patients.
The educated and refined are associated with the igno-
rant and degraded, classified according to the form of
disease without regard to their former social position in
life. Under no consideration should the criminal class
be associated with the harmless. Separate provision
should be made for them and for those afflicted with
epileptic mania.
Folie a deux— Us Forensic Aspects,
By Jas. G. Kiernan, M, D., Chicago, 111.,
Formerly of the New York City Asylum for the Insane.
FOLIE a deux has received but very little attention
from American alienists. It is of interest from socio-
logical, anthropological and diagnostic standpoints. It cer-
tainly has important forensic relations, although I am
unaware that any case involving these has been the sub-
ject of investigation other than the one cited in my paper
on Katatonia,* the Freeman casef and the Lay case,
which occurred at Sandwich, Illinois. Before proceeding
to pass in review these cases, I propose to examine the
literature relative to the general subject,
Falret, Regis and Lasege,J after an extended study of
the subject, have arrived at the following conclusions :
First, that in ordinary conditions mental contagion does
not proceed from an insane person either to a sane or
another insane individual ; second, that contagion is
only possible in exceptional instances ; third, that these
are divisible into two great classes : (a.) In /oh'e a deux
one of the patients is an active agent, the other a passive
recipient. The active agent creates the delusions and im-
poses them on the other, who receives them and submits
easily to his influence ; but in time the delusions as ac-
cepted by the passive patient react on the other, and are,
in a modified condition, accepted and proclaimed by both
as true. (/^.) For the same intellectual delusions to occur
in two individuals they must have lived a long time to-
gether and have been subject to the same influences.
This condition is more common among women than men.
The patients may be related, but more frequently are
•Aliexist and Neurologist, October, 1S8J.
t Boston Medical and Surgical Journal, March, ]!s*0.
jAnnales Medico- PsychologiqueB, Tome xvii.
286 Jas. G. Kieman.
not. The chief point in treatment is the separation of
the active agent from the other. The passive individual
usually recovers first. Delusions may be communicated
from a second to a third, and so on, but this is some-
what exceptional.
Morandon de Montezel* claims that folie a deux includes
three perfectly distinct orders of cases. First : Folie im-
posee, in which an insane person imposes his insane con-
ceptions upon another intellectually feebler than himself.
Second : Folie simultanee, in which two hereditarily pre-
disposed individuals contract the same form of insanity
under the same circumstances. Third : FoHe comuniquee,
in which an insane person communicates his hallucina-
tions and delusions to another person hereditarily predis-
posed to insanity. This only occurs under the following
circumstances: When the passive recipient is hereditarily
predisposed to insanity; when an intimate association ex-
ists between the two persons who share the insanity and
there is an incessant action of the insane party on the
sane to make the latter accept the former's delusions.
He further says that in a medico-legal point of view the
passive individual in folie unpos'ee is more or less
defective mentally, but even when he cooperates in the
insane acts of the active party need not be considered
necessarily insane. Both victims of folie simultanee and
folie conimuniqu'ee are insane. In folie imposee the ap-
pearance of insanity is a relative matter, Folie simultanee
and folie communiquee are instances of the influence of
surroundings on the forms taken by mental alienation.
These conclusions of De Montezel are much too posi-
tive. There is very little relation between the folie sim-
ultanee and the other two forms. Folie simultanee is well
illustrated by cases reported by Seguin.f Savage^ and Gill.||
Seguin's cases were two sisters attacked by the same
form of insanity, according to him from the same exciting
•Annales Medlco-PsycholOKiques, January, 1881.
tArchives of Medicine, 1879.
^Journal of Mental Science, January, 1881.
Folic a Deux — Its Forensic Aspects. "zZj
cause. There was no inter-communication of insane ideas.
Savage and Gill's cases were twins attacked hy similar
forms of insanity.
Reverchon* and Pages* have reported cases analagous
to this condition occurring at Andouille, France, in which
a father, mother and four grown-up children were seques-
trated in an asylum who became insane in consequence
of a dose of some solanaceous plant administered to them
by a quack. They all had the delusion that they were
bewitched, which delusion had originated in the statements
of this quack. The delusions and hallucinations were of
the same character. This is of course not a perfectly
pure instance. Savagef and Needham| have reported
cases where true inter-communication of delusions have
occurred. In Savage's cases the delusions extended from
a father to his son and latterly to the son's wife, who was
sane but stupid. Needham's cases were two brothers, of
whom the recipient was the weakest mentally.
I have elsewhere reportedjl the majority of the follow-
ing cases: Case I. was a Presbyterian clergyman who
had strong hereditary tendency to insanity. He presented
the episodial variety of primary monomania. He was ad-
mitted to the Asylum and discharged at intervals from 1872
to 1875, during periods of pseudo-lucidity. The contrast
between which and his periods of mental excitement was
extreme. In the pseudo-lucid period he was polite, unas-
suming, unobtrusive, a perfect gentleman, and a pleasant
companion. In the other condition he was egotistically
obtrusive, claimed delusions of inspiration, was given to
very loud talking and had marked insanity of manner.
His letters would then display the unnecessary capitaliza-
tion, italicization, emphasis and punctuation common to
the insane, together with marked superabundance of adject-
ives, and attempts at frequent aliteration. In 1874 he
came to the asylum filled with delusive conceptions of
•Annates Medico-Paychologiques, July, 1882.
tJournal of Mental Science, January, 1681.
t " " " April, 1881.
l|.Journal of Mental and Nervous Disease, 1880.
288 Jas. G. Kiernan.
ameliorating the condition of the insane and improving their
intellectual capacity by a lecture on the " Holy Land."
At this time the evidences of mental excitement were
marked. But the chief interest lay in the insane com-
panions by whom he was surrounded ; all of whom were
permeated with delusive ideas similar to those of the min-
ister based on the improvement of the insane and the con-
version of them into useful members of society. One was
a wandering progressive paretic, one of those cases which
come to the front when any popular uprising happens.
This individual had been in Cuba and claimed to be a
Colonel in the Cuban republican army. Somewhere he
had met the minister, who had obtained a complete
ascendancy over him. He attempted to improve the
condition of the insane by distributing among them five
dollars' worth of red and blue lead pencils. The next
member of the group was a case of chronic mania with
imbecility, markedly religious and full of the delusive ideas
already described. The fourth case was a hebephreniac^
who mingled in his conversation, religion, regrets of his
onanism and the delusive ideas already mentioned. The
fifth and sixth members of the group were a slightly
demented primary monomaniac and an epileptic lunatic-
The minister when a patient displayed great power in
collecting similar groups and imposing his ideas upon
them.
A primary monomaniac succeeded in imposing his
delusion that he was the Deity on a hebephreniac in
the same ward, and created also the delusion that the
latter was an angel, which the hebephreniac accepted.
An imbecile who worked near these two imbibed their
ideas, and, having overcome the primary monomaniac in
a fight, called himself the great god who had over-
come the little god.
The next instance of this condition was found in two
cases of primary monomania, one of whom claimed to
be God the Father and accepted the delusion of the
other that he was the Holy Ghost, the latter accepting
Fohe a Deux — Its Forensic Aspects. 289
his delusion. Another instance of the condition was
to be found in the case of a brother and sister who
interchanged delusions. Finally, a primary monomaniac
possessed of very vivid consecutive hallucinations, suc-
ceeded in imposing these upon a hebephreniac whom he
thereafter brought forward as a witness of the truth of
these. An analogous condition is, as was stated by Dr.
A. E. Macdonald*, who based this opinion upon researches
made by myself, to be found in the tendency of paretics
to accept each other's delusions. This arises, as Spitzkaf
has pointed out, from the paretic's loss of his proper self-
consciousness.
It will be obvious from these cases that insane men
can impose their delusions upon each other or can imbibe
delusions from each other, or can impose delusions even
upon sane people. I have already cited one of these
cases from Savage. According to C. F. Folsom^; the
delusion of Freeman was accepted by his wife, who was
acutely insane, and by several of the sane Second Ad-
ventists. The delusion of the Lay woman was accepted
not only by her son, who is a clear case of primary mon-
mania, but by her sane husband. All three believed that
she was about to give birth to the Saviour and that she
must fast forty days. In consequence of this she was
allowed to starve to death. Another lunatic in Michigan
has succeeded in imposing her delusion that she is the
Saviour born in a female form, upon a large band of de-
voted followers. John of Leyden, Muggleton and numer-
ous other cases of lunatics imposing delusions on sane
people might be cited as instances of this kind.
What is the forensic bearing of all these facts ? It is
often stated that lunatics never fail to recognize each
other's delusions or insanity, which is why combinations
do not occur among them. This is stated with such
positiveness that it might readily be accepted as a rule
to which exceptions do not exist. The cases and
•Medical Record, January, 1879.
tJoumal of Xervous and Mental Disease, April, 1877.
JBoston Medical and Snrgical Journal, March, 1880.
290 Jas. G. Kiernan.
authorities which I have cited show that the insane can im-
bibe delusions from each other and may compel the accept-
ance of their delusions by sane people or by the other
insane. In case of simple reception of a delusion, the
same is not very likely to sway the sane man or lunatic
accepting it. But when the delusion is imposed on the
the sane man or lunatic it becomes a different matter.
John of Leyden controlled large cities and committed
murder by wholesale. Freeman sacrificed his child, as-
sisted by his wife, and his deed was acquiesced in by his
associates. Lay and his son allowed Mrs. Lay to starve
to death. A lunatic in California regarded himself as a
king and was supported by his family in not paying taxes,
they compelling the tax-collector to do homage to him.
Suppose that my minister had deemed it necessary to
purify the United States and prevent imperialism by
killing Grant, he would certainly have been assisted by
his co-lunatics. There would have been marked evi-
dences of design, also evidences of conspiracy. It is very
probable that these lunatics would have been executed.
The minister would certainly made, as he often did, a
claim of being inspired, similar to that of Guiteau, which
would have added to the evidence against him. Sup-
pose that Myers the prophet arrived in Washington for
the purpose of killing Hayes, had encountered a lunatic
whom he could have persuaded into being the Angel
Gabriel. We would have had a trial similar to that of Gui-
teau in its denouement, and the co-delusions of two
lunatics would have been evidence of conspiracy and of
sanity. These are only suppositions, but when lunatics
and sane men support markedly insane delusions to the
violation of the law, as was done in the Freeman, Lay
and California cases, it behooves forensic alienists to take
into account, when called on to judge of the sanity of a
number of seeming conspirators the possibility q{ folie a
deux.
Reflections on the Development, Move-
ments and Transmission of Mind.
By Cecilia Dean, M. D., Baltimore.
NATURE continually presents of every specialized form
of organic life, representations of the highest form
peculiar to that type of development, and is constantly
striving to bring the order up to this expression of excel-
lence. Any considerable variation reverts back to a point
in development, where it joins with, and again follows, the
advance line of progression.
Between these two points oscillate the individuals of
any order. When the oscillations are greater in any
other direction than the forward line, it conflicts with par-
allel or diverging lines, and is absorbed. For, in the
onward sweep of creation a weakly resisting force is neu-
tralized by a superior force in operation.
Mind, an expression of the human organism, as a whole,
depends for the perfectness of its development upon the
complete development of the parts of which it is com-
posed. Mind is made up of the intellectual, the emo-
tional and the physical, including the perceptive powers
and will. That these systems may arrive at the highest
possible degree of excellence peculiar to them, they
must pursue the course established in the evolution of the
organism. The order of progression is, from the physi-
cal to the intellectual, and when fully developed these
systems present in their relation, one to the other, a just
proportion and exquisite balance, in the exercise of their
functions. It is this harmonious unity and co-ordinate
play of functional activity that gives to the function of
the organism, as a whole, that perfect symmetry which
characterizes a superior grade of mental development.
A disproportionate development disturbs or destroys the
292 Cecilia Dean.
nice adjustment between the parts and interferes or inter-
rupts the harmony of co-ordinate action and introduces
an element of antagonism that manifests itself in disor-
dered functional activity. The physical system marks the
differentiation point or inferior boundary-line of the or-
ganism. The emotional system, standing midway between
the perceptive faculties — the lower and more physical
powers — and the reflective or higher mental powers, is the
sensitive machinery of the mental organism, moved by
and moving the intellect. It may be likened to the
digestive system in that it receives, pleasurably or pain-
fully, what is brought to it by the perceptions or reflec-
tions, or to an engine in a vessel, which, nicely ad-
justed, propels the vessel forward without disturbance ;
illy adjusted, it both moves and shatters. It receives
from within and without the stimulus of its movements.
It feeds the intellect and is fed by it, though the latter
manufactures movements at the behest of the former.
Emotional disintegration implicates the intellectual in re-
sultant activity which may go on to destruction or result
in the arrest or balancing of emotional activity, according
to the nicety of adjustment of these essentials of mind.
The intellectual system is the great manufacturing estab-
lishment of the mind ; here disintegration and recombina-
tion occur and appear as emanations of a grand gene-
rating force which converts the two inferior systems into
operative agents, enlarging their capacity for reception of
stimuli and widening the sphere of their activity — multi-
plying, as a whole, the relation of the organism to its
environments in which the ever-increasing breadth' of
mind forms circles that widen and widen into infinity.
But the mightiest revolution of the wheel can not cut a
circle that does not include within the circumference of
the larger, all the smaller ones. The stages that charac-
terize the relative period of development for each part, in
the development of the organism as a whole, are varia-
ble, the superior requiring a longer time than is neces-
sary to complete the period for the inferior one.
Reflections on Mind. 295
The physical and emotional systems are verging into
maturity of power at a time when the intellectual is
passing through the period of pubescence. At this stage
they maintain an existence of functional activity nearly
independent of the intellectual system, the intellectual
not having reached a stage of development that ena-
bles it to accept the combined activity of the inferior
systems as the necessary stimuli to action, which the
full exercise of function continually demands.
The organism may become permanently retarded at
any point of delay in its passage to maturity of devel-
opment, and that which was intended as a means to
increase power in a superior part, is retained and pre-
sented as a local exhibition of strength.
The grade of development, possible to the organism,
is predetermined in quality of structure. The power of
persistence and resistance — a latent force aroused in re-
sponse to stimuli, which, operating within the sphere of
consciousness, is termed will power — is a powerful factor
in development, whether in the direction of progress or
in opposition to it. Physically it may be defined as
molecular movement, actively set in a definite direction.
In the combining power which determines the degree of
intimate association, or ready dissociation, of aggregate
elements, reside the strength or weakness of the will
power of the organic structure of mind, as characteris-
tically apparent in disordered as in regularly performed
functions. The nutritive stimulus, supplied by the physi-
cal and emotional contains many an inflammable product
if retained and disposed of by these systems, but which,
transferred to the refining fire of the intellect, are trans-
formed into divining rods "which serve to reveal Nature
to herself." Absorbing propensities, double-edged weap-
ons of destruction, become the keen instruments of re-
search to open up new fields of beauty that supply
fresh excitation to emotional and physical systems and
furnish an increased stimuli to hasten the wheels of the
intellectual machiner}'. An analogue of the organism is
294 Cecilia Dean.
the fruit-bearing tree, the physical system the roots, the
emotional system the trunk, and the intellectual the spread-
ing branches, and the function of the organism the leaf,,
flower and fruit; by means of which the two become a
sensitized apparatus, reacting to delicately graded influ-
ences wholly inoperative when directed towards one of
its individual parts. The earth-worm, crawling through
the roots, sees no connecting link between these dark
objects clinging to the soil and the fruit suspended from
the overhanging branches. Heredity and an artificial
mode of development interfere with the symmetrical de-
velopment of parts, and when nature's beautiful law of
proportion is divorced from growth, a retrogressive ele-
ment appears which, perpetuated, removes further and
further the artificial from the original type, until at last
it hangs, an excresence, upon the parent tree. Constant
suppression of functional activity during the period of
growth dwarfs organic elements and establishes deformity.
Persistent stimulation not only cripples another part by
withdrawing nutrition from it, but it ultimately results in
the exhaustion of that part. As the regularity of the
function of the organism depends upon the perfect adap-
tations of its units, mitid becomes the mirror that reflects
the want of adjustment between its members, and varies
from the normal just in proportion to inco-ordination of
parts. But, unless there is complete loss of balance,
struggles to conceal that which it is incapable of restor-
ing, the emotional system, occupying a more exposed
position in the organism than the others, in consequence
of the double relation it sustains to the physical and in-
tellectual systems, is more frequently the sufferer in the
variations from normal than either of these systems. Dis-
proportionately developed, it breaks away from the con-
trol of the intellect and interrupts largely the communi-
cation between the intellectual and physical, substituting
its commands for those of the former. It not only de-
prives the intellect of its normal stimulus, but precipitates
into its laboratory a multitude of false impressions. It
Reflections on Mind. 295
drives the physical system along at a furious rate, and
consumes, with reckless extravagance, its own nutritious
material. It becomes the destructive agent to which the
mind more readily yields, than to any other.
It is of grave importance that the organism be devel-
oped in accordance with laws established in evolution, for
mind is conscious of the joys and sorrows of its individ-
ual elements ; conscious of plethora, occasioned from an
over-supply of unappropriated stimuli, to the intellectual
as to the physical system ; as restless, under the cry of
starved emotions, as when besieged by the wants of the
physical, and the tormenting wail of the intellect when
deprived of the nourishment it craves, rings through its
halls of pleasure, and plants thorns in the couch of ease.
Conscious of the suffering of the physical system, when
under the whip and spur of the emotional, or when worn
and drooping, it executes the extortionate demands of an
ambitious intellect. It languishes with the emotions con-
fined within the narrow walls of a prison to which a
tyrannical intellect has condemned it, and utters groans
of agony when the intellect succumbs in a conflict with
the emotions.
A mind warped by inheritance, or suffering from a
neglected or false system of education, is preyed upon by
the alternate sway of regular and irregular activity of its
parts, and at last yields. The function of the organism
is abolished, since it is no longer a whole made up of
parts, but a whole resolved into its parts. Where a sin-
gle system, permanently disordered, has succeeded in
overthrowing the function, as a whole, the other systems
make pitiful attempts to resume their wonted functions.
The efforts growing feebler and feebler, ceases at last.
The king has been dethroned by one subject, but all
are now battling, furiously, for possession of the crown.
In the natural decline of mind the method observed in
its development is preserved ; susceptibility to reception
of impressions is gradually lessened, more impressions are
being constantly received to carry on the machinery of
296 Cecilia Dean.
mere existence. This wave of decline at last involves
the organism, and the mind, receiving no new stimu-
lus, is sustained by the capital stored up during its
period of greatest activity.
Reproduction is the reappearance of absorbed stimuli,
either stored in growth or received as a deposit, is
simple or complex, according to the number and kind
of elements concerned in reproducing. Re-presented
stimuli may change its expression, but the character
always remains the same. Reproduction is therefore an
endowment of every system ; constitutes habit in the
physical, imitation in the emotional, and memory in the
intellectual, and generative reproduction in the organism,
as a whole.
That which the organism transmits is a definite amount
of force, predetermined as to its progressive or retro-
gressive tendency. It is the superior force stored up
either in process of operation or ready to burst forth
and overwhelm the organism. An explosion of force
may suddenly flood the organisin, and go pulsating down
the line for a generation or more. Great functional ac-
tivity is maintained by a corresponding expenditure of
force, and thus an apparently vigorous organism may be
suffering from exhaustion at time of reproduction, thus
giving the ascendancy to latent forces ordinarily held in
abeyance. Nothing can be added to increase the force
originally transmitted. Care may be observed in pre-
serving an economy as to outlay ; this may delay, but
it cannot arrest, the retrogressive movement, which will
be the most actively operating one until a point of inter-
section with the law of progressive action is reached,
when it is again swept into line.
Nature never repaired a structure nor constructed one
by building from the top down. When man makes the
effort, she at once sets the seal of duration upon his
work. She admits of assistance in enriching the soil,
pruning the vine, and preserving the fruit, for the organ-
ism was intended to advance the great progressive
Reflections on Mind. 2gj
movement. Who can say that mind, the highest product
of growth, is not destined to play as important a role in
the evolution of a superior organism, as the physical sys-
tem performs in the construction of the human organism.
For the Idea in process of execution by operation of
natural law, is subtly interwoven into the constitution of
mind, and photographs itself in the formation of laws,
for its improvement and protection. For what end is
it preserved? Mind is an elaborately designed instru-
ment where many converging lines meet. Undulations
from the Great Heart of Creation tremble through the
lines and register upon its surface ; and the more per-
fect the instrument, the truer are the recordings.
CORRECTION.
Editor Alienist and Neurologist:
Dear Sir: In No. 4 (Oct. 1882) of the Alienist and Neu-
rologist is a very interesting article by Dr. H. A. Hutch-
inson, relating his " Personal Experience with Hyoscyamine
as a Hypnotic."
As one of his " medical friends who were present," I
beg to correct a statement of the Doctor's.
Calling upon him by the merest chance, we found him
in the condition described, viz., " in a deep sleep or coma,"
from which we would not arouse him ; but we knew what
was the matter. At least, from the symptoms, we were
quite certain he was under the influence of either bella-
donna, stramonium, hyoscyamus, or duboisia, and aware of
the fact that he had that day been handling a fresh supply
oi Merck's hyoscyamine, we naturally inferred that this drug
was responsible, and did not once think he was in an or-
dinary " apoplectic coma."
We were reasonably alarmed at his condition for a short
time; and were about to resort to a physiological antago-
nist, hypodermically, when some amelioration in the symp-
toms induced us to wait.
Nevertheless, the moral pointed out by the Doctor is a
good one, as his experience forcibly demonstrated to us.
Pittsburgh, Pa., Feb. 6, 1883. Samuel Ayres.
SELECTIONS.
CLINICAL PSYCHIATRY.
Moral Insanity — What Is It ?* — (By J. Workman, M.
D., Toronto, late Superintendent of Toronto Asylum for
Insane, etc.) — The insane do not always rave, nor do
those who rave, always do so ; the insane sometimes rea-
son, occasionally indeed, a little too sharply, as I have
often known, from those who address them as if taking
them for mindless bipeds ; and I apprehend it is within
the knowledge of most of us, that the morality of the
insane is not always of unexceptionable purity.
Every man must, from his own consciousness, feel con-
vinced that the human mind, or if I may without offence
use the term, the human soul, embraces, in its domain,
something more than mere intellect. We all feel as well
as think, and our judgment is often influenced by our
feelings ; in too many instances, indeed, the latter ob-
scure or warp, or even completely subjugate the former.
It is a great error to cut the mind up mto distinct and
independent principalities, any one of which may pass
into a state of rebellion or anarchy, without disturbing
the peace or even endangering the normal integrity of
others. Those who have had sufficient opportunities of
observing the primary manifestations of mental disease,
must be able to testify, that in very many instances, long
before any disorder or impairment of the intellect has
been noticed or detected, some unaccountable change has
been exhibited in the feelings, the moral sentiments, or
the conduct and social demeanor of its destined victims.
•Abstracted IVom a paper read at a meeting of the Toronto Medical So<lety,
Dec. 14th, 1882, and published in the Jan. and Feb. Nos. of the Oanadiam fHACTi-
TIONKK.
We flbould be glad to give the ■whole of this valuable paper, as il is a randid
aTd ronipetent preeenlatlon of the clinical features of the subject from one who^
while controverting the theory of total exemption of the intellect and the propriety
of employing the terra moral iuKanity, especially in court, nevertheless clearly
concedes the clinical leatures of the disease as recognized by i'inel, Esquirol and
Pritchard and confirmed by so many substquent observers. It matters Hitlewhat
becomes < f the name, though >ve think it a good one as descriptive of the characteris-
tic features of some terms of etfective Insanity, bo long as nomencl.atun' is based on
the prominent symptomatology r:ither than upon the distinctive, pathological fea-
ures of insanity.
Selections. 299
The temper which, erewhile, was mild, equable and
cheerful, has become irritable, changeable, morose or per-
haps extravagantly joyous. The loving husband has be-
come harsh and tyrannous, the tender parent has become
capriciously cruel to the children once the objects of his
intense love, the happy home has been transformed into
a den of perpetual misery, strife, recrimination, and, but
too frequently, acts of dangerous violence. It is needless
to amplify the picture. Materials for the filling up may
be found in many an unhappy household. Within the
last two years a case came to my knowledge strikingly
illustrative of the fact which I here desire to accentuate.
The subject of it was, till within a few months past, an
intelligent, industrious, good-living man. In cojisequence
of falling off in business, he became gloomy, taciturn and
utterly despondent. He continued in this state for some
weeks, but under the kind and judicious care of a devoted
and sensible wife, improvement gradually took place, and
his former mental composure returned. Meeting with a
chance of embarking in a line of business suited to his
capacity, and very restorative to his exhausted purse, he
became very energetic, and as fertile in speech as he
before had been reticent. He resided not far from me,
and I watched him with solicitude. I feared that he
would bear his prosperity no better than he had done his
adversity. My fears have been too fully justified. He has
recently embarked in a very problematic business enter-
prise, despite the advice of his wife and all his best
friends ; his temper has become very irritable and at
times ominously violent. His wife and the children have
been forced to leave him. Their religious pastor has ap-
proved of the precaution, and after hearing full details, I
have advised her not to venture back until a promising
change is apparent.
Now, what is the present mental condition of this poor
man ? So far as his intellect is concerned, no outsider
coming to do business, or to converse with him, detects
any flaw or impairment, and I believe it would be impos-
sible for any three medical practitioners undertaking ex-
amination of his mental state to find in his conversation,
or his deportment towards them, adequate facts to enable
them to fill up the first question required to be answered
in the statutory certificate of lunacy, which is indispensable
to the commitment of a person to asylum custody. Should
he commit some capital offence, every judge, jury, or
300 Selections.
crown prosecutor, that I have yet encountered, would
pooh pooh the idea of his insanity. And yet, gentlemen,
this man's case is exactly one of that class which Pritch-
ard, Ray, and other illustrious writers have ventured to
call moral insanity; but woe and abiding ridicule betide
the medical witness who might, when pushed by an ardent
prosecutor, to mention the class of insanity in which he
would place the case, be so indiscreet as to utter this term 1
In a very valuable work on the subject of moral insanity,
published in 1878, by Dr. Bonfigli, of Ferrara, a concise re-
view of the declared opinions of 46 eminent alienistic writer-
on this subject, is presented. These authorities may be di-
vided as follows : —
7, terminating with the epoch of Pritchard, uphold the
doctrine of absolute, or pure and distinct, moral insanity; of
these 3 were Erench, 3 German, and i English.
17 admit the term conditionally; that is to say, they rec-
ognize moral insanity as a conventional or convenient, but
not as a distinct or pure form of mental disease. They hold
that it is always associated with some degree of intellectual
infirmity, or that it is the forerunner of insanity of the intel-
lect. Of these 17, 7 are French, 6 German. ^ Italian, and i
English.
22 absolutely, or impliedly, reject the doctrine in toto.
Of these 9 are German, 7 are French, 5 are Italian, and i is
American.
Had Dr. Bonfigli been more versed in the literature of
English and American alienism, he could have much aug-
mented the numbers assigned to the latter two countries;
and, undoubtedly, the classes of conditional advocates and
of utter repudiators would have had almost exclusive admis-
sion to his catalogue. He, however, introduces into his book
a report of a discussion on moral insanity, which took place
at the Annual Convention of Medical Superintendents of
Asylums in New York, in the year 1863. I had the pleas-
ure of being present and taking part in this discussion, which
was conducted in the most courteous and frrfhk manner.
Dr. McFarland gave it as his conviction that, "in all the
cases of the so-called moral insanity, a real intellectual dis-
order was present." He was followed by the other mem-
bers in rotation, including the distinguished and very long
experienced Dr. Kirkbride, the President of the Association,
and the veritable Nestar of the fraternity, — numbering«n all
present some 40 representatives of the United States and
Canadian Asylums. Of all this assemblage only two or three
Selections. 301
<Ieclared their belief in the actuality of moral insanity, and
even these declined to define it as a distinct and independ-
ent form of the disease. Dr. Gray, Superintendent of the
New York State Asylum at Utica, said that in 5,0CXD cases
of lunacy which had passed under his observance, he had not
met with one of pure and distinct moral insanity. Dr. Chip-
ley said he had not found one in 1,800 watched by him, and
I made a similar statement as to 2,000 observed by myself.
It is not, however, to be overlooked, that asylum physicians
generally become first acquainted with the insane only after
their malady has assumed a fully developed character. Very
probably, had they more frequent opportunities of observing
the disease in its incubative stage, they might feel inclined
to recognize in it a quasi moral (or immoral) monopoly.
Some 16 years ago, I encountered a case of ticketed moral
insanity, sent to the Toronto Asylum by three respectable
and intelligent physicians. The subject was a girl of barely
15 years. She was presented by her mother, who gave me
a terrorizing history' of the daughter's misdeeds, much of
which I thought savoured more of moral delinquency than
of mental infirmity. However, she was sent to me as a lun-
atic, and I determined to treat her accordingly, regardless of
all I had been told of her naughtiness. We began, as we
ended, with uniform kindness. At the end of 4 1-2 months,
I wrote to her mother that she was either completely cured,
or she never had been insane. The mother was rejoiced to
learn of the happy change, and she came promptly and took
her daughter home; but on the second day after, she re-
turned with her, and presented to me a large bag full of var-
ious articles of dress, on which Kate had been practising dis-
sections. I looked over them considerately, and on closing
my inspection. I said to the mother: "There is too much
' method in this madness' to convince me of its genuineness.
We have had the girl here over four months, during which
she has never spoken one word indicative of insanity, nor
has she done one act pointing in that direction. I cannot
re-admit her, for I believe she is not insane." Then I had a
scene, which for long afterwards I did not understand, and,
of course, could not justly appreciate. The distracted woman
exclaimed, "Oh! what will become of her? She will go to
the streets ! " I then said, '• Well, I will do this ; I will give
you the necessary blank forms of certificates of lunacy, and
if yo\i can get three physicians to sign them, I will take your
daughter in again." So, back came my good girl, Kate, and
I gave her the benefit of a thirteen months' further proba-
302 Selections.
tion, during all which she was just as good, as gentle, obedi-
ent and obliging, as she had been throughout her former res-
idence. I now talked to her in a very serious and paternal
manner, showing her the improprieiy and irrationality of her
conduct at home, and pressing on her the consideration of
her own best interests, which must be ruined by her contin-
uance in a lunatic asylum. She listened to all I said with
much deference, but finally told me she would like to leave
the asylum, but not to go home to live with her mother.
Now, her mother was neither harsh nor capricious, but, on
the contrary, she hadbeen both kind and forbearing ; and
her father and brothers had been equally so. I must say
that this ultimate enunciation of my gentle patient let in a
little light; for I well knew that the likings and dislikings of
the insane are almost always unaccountable, and that both
fall upon objects or persons apparently the most foreign to
the rational incidence of either. I wrote to the mother, giv-
ing a faithful detail of the facts, and advising the removal of
her daughter from the asylum, but not her replacement in
the family. She made suitable arrangements for the girl's
residence at a distance in the country, and we had the pleas-
ure of seeing her depart in excellent health, and in perfect
mental composure. Three years afterwards she paid us a
visit, and I learned from her companion that she had shown
no more symptoms of insanity, either moral or intellectual.
Now, suppose I had regarded and treated this young per-
son, not as the subject of mental disease, but as a clear-
minded, moral delinquent ; in other words, that I had, quoad
her exceptio7ial case, converted her asylum residence into
prison correction ; what would have been the probable re-
sult? It is my belief that I should then have transformed
her into a real and a hardened criminal ; or if there was, as I
now verily believe there was, a constitutiooal strain of insan-
ity in her frame, I should have been taking the shortest and
surest course to perpetuate its unmistakable development.
Was it not worth while even to be deceived and imposed
upon for the sake of this girl's rescue from a future of vice
and misery? Hear me further before reading your verdict.
Three or four years after parting with my grateful patient,
a sister was brought to the asylum. There could be no ques-
tion as to the reality of her lunacy. She was a sad wreck,
both mentally and bodily. Some years before, she had left
her home and disappeared. No trace of her was had, until
at last she was accidentally discovered as a demented inmate
of a large pauper asylum in the United States. Her parents
Selections. 3^3
brought her home, and were soon obliged to bring her to
me. When the mother now presented herself, and gave me
the sorrowful history of the daughter's career, the echo of
her distressful exclamation, when I had refused to re-admit
her younger daughter, came back on my ears with thrilling
accusation. But for the happy mental plasticity of the three
medical gentlemen who certified to the moral insanity of my
first patient, and thus secured her re-admission into the
asylum, might not she also haven fallen into a life of aban-
donment ?
It is now my belief that my first patient was truly insane,
call her insanity by what name soever you may choose.
" Not long ago," says Dr. Clouston, " a lady, by a series
of the most extraordinary misrepresentations and cleverly
carried out impostures, raised large sums of money on no
security whatever, and spent them as recklessly ; imposed
on jewellers, so that they trusted her with goods worth hun-
dreds of pounds ; furnished grand houses at the expense of
trusting upholsterers ; introduced herself by sheer impudence
to one great nobleman after another, and then introduced her
dupes, who, on the faith of these distinguished social connec-
tions, at once disgorged more money. To one person she
was a great literary character ; to another, of royal descent ;
to another, she had immense expectations ; to another, she
was a stem religionist."
This lady was, of course, finally brought to book. She
was an impostor, a huge liar, a cheat ; she very well knew
right from wrong, and transacted her business with great
ability and skill. Not one of all these she duped and cheated
— intelligent, prudent, and clear-headed Scotchmen as they
were — ever questioned her mental soundness.
"At last, all this lying, cheating, scheming and impos-
ture, developed into marked insanity and brain disease, of
which she soon died ; and it was seen that all these people
had been the dupes of a lunatic, whose very boldness, cunning
and mendacity, had been the direct result of her insanity."*
•Dr Benj. Rush, in 18U (Obs on Uis. of the Mind) described a form of Insan-
ity as the " lying disease," " which differs from exculpative, fraudulent and mali-
cions lying In being influenced by none of the motives of any of them, " and he
inferred ii to be a corporal disease "from its sometimes appearing in mad people
who are remarkable for veracity in the healthy states of their minds," several
instances of which he knew in the Pennsylvania Hospital. In the course of his lift"
also he had been consulted iu three cases of perversion of the moral faculties. The
wickedness of one had no intervals when she was awake, except when she was kept
buBy in some steady and difficult employment. Bethought that "in all these cases of
umate preternatural moral depravity there is probably an original defective organi-
sation in those parts of the body which are occupied by the moral facu'ties of the
mind " Subsequent observation has only been confirmatory of such facts whatever
theories observers miy hold respecting general mental involvement — Editob.
304 Selections.
Had this poor woman's insanity not culminated speedily,
but progressed slowly and insidiously, as it does in thousands
of cases, she would, beyond all question, have been consigned
to a penal prison ; and had Dr. Clouston, or any other phys-
ician, ventured to express the opinion that she was insane
when she committed the offences charged against her, the
judge would have frowned, the jury would have been as-
tounded, and the press would have applauded their verdict
of guilty.
Her ends were insane ends, and she niiglit, dominated by
a quickly-killing brain disease, have essayed their attainment
by violent insane means. Poor thing ! the only refuge to
her, in escape from the barbarism of law, and the blmdness
of justice, was the madhouse! How many a wretched vic-
tim of legal and judicial ignorance might, in a few years, or
months, have found a similar refuge, had not the gallows an-
ticipated the fiat of Nature ?
Dr. W. now briefly related the interesting details of
two other cases of the so-called moral insanity, which came
under his treatment in later years, both of which he regarded
as genuine, though, as he frankly admitted, he had always
failed to detect in either,whether in language or demeanor,,
anything so clearly indicative of intellectual defect, as might
suffice to enable medical examiners, to sign the certificate of
lunacy requisite for their admission into an asylum. The
statements, however, made by the friends of those patients,,
on which he had every reason implicitly to rely, were of such
a character as to convince him of the presence of actual in-
sanity in both. It is, fortunately for asylum officers, a fact
to them well known, that many of their patients behave,
while residents in asylums, very differently from their con-
duct and language at home, and all that is necessary to de-
velop their mental obliquity is to restore them to their for-
mer surroundings ; many a family has had awful experience
of this fact.
ViCARATiON OF Nerve FUNCTION. — As a Contribution
to the question raised in the January number of the Alien-
ist AND Neurologist (and previously in May, 1875,
by Dr. Hughes), respecting vicaration of nerve func-
tion, Dr. Kiernan communicates the following two cases ,
the autopsies in which were made by Dr. Spitzka.
Somatic Aitiology of Insanity. — The first case was a
negro paretic who had been under observation for about
three weeks, and who to within forty-eight hours of
his death manifested no other trouble with his speech
Selections. 305
than slowness and the usual hesitancy. At the period
mentioned he had forgotten the tools of his trade (car-
penter) and did not know his name, but could signify his
meaning very well by symbols. He was not hemiplegic
and was right-handed. On autopsy there was found gen-
eral bloody suffusion of the pia-mater, most marked over
the convexity of the left hemisphere. There was a sub-
meningeal extravasation of blood which had forced itself
between the gyri, lifting the pia from the cortex and ex-
tending in between the operculum and temporal lobe.
The blood was firmly coagulated, and the maroon-colored
clot covered altogether a circular area involving the first
frontal part of the second frontal (Wernicke-Meynert nom-
enclature), lower third of the prae-central, the whole of
the gyrus angularis and all of the first temporal except its
anterior end. There was a second haemorrhage in the ca-
put of the corpus striatum extending into the internal
articulus of the lenticular nucleus as well as part of the
anterior portion of the internal capsule. This clot was
firm and laminated, some of the lamina being discolored ;
on its outside the blood had the appearance of a more
recent clot, and this portion was continuous with the sub-
meningeal extravasation, through a break in the cortical
substance of the anterior gyrus opertus of the island.
Broca's convolution as well as the contiguous portions of
the island were compressed, and their medullary fasciculi
were destroyed by the extravasation. This case, the aph-
asic symptoms of which were really minimal, shows that
no matter how extensive a unilateral lesion may be, if its
production is gradual (in this case a slow haemorrhage), it
will give the opposite hemisphere time to accommodate
itself to its vicarious duties and the increased requirements
thus thrown upon it.
The second case is somewhat of an antithesis to this.
The patient was a primary monomaniac who had been
for several years an inmate of the New York City Asy-
lum for the Insane. There were no convulsions or paraly-
sis present. The patient about three months before death
manifested symptoms of pachymeningitis. He had sharp
localized cephalalagia, occasionally became stupid and
there were morning rises and evening remissions of tem-
perature. He then exhibited twitching of the facial mus-
cles of both sides, and seven weeks after the initial
symptoms had manifested themselves, he had general
literal convulsions of an epileptiform character without
306 Selections.
complete loss of consciousness. In the last of these
attacks, of which there were seven, he died. From the
time of the first convulsive seizure he became gradually
progressively aphasic ; aphasia being of the ataxic variety.
At first he used wrong words or spoke in broken sen-
tences. Finally he could not speak at all, and remained
speechless till his death. On autopsy the dura-mater,
everywhere else perfectly healthy, was found thickened
and adherent to the skull on the one hand and fused
with the leptomeninges on the other, over the right frontal
lobe. Dense pseudo-membranes were intercolated between
the pia-cortex and the sulci were filled with the same
material. The whole right frontal lobe as far back as the
prae-central gyrus, and down to the lowest frontal gyrus,
was softened and necrotic. There was nearly the same
cerebral area involved on the right side as in the first case
on the left. The lesion was also of slow production, yet
the complete aphasia showed that vicaration did not occur.
The reason was that the left cerebral hemisphere was ter-
atologically atrophic. The optic tracts, pyramids and cere-
bellum shared in this atrophy. The left hemisphere did
not vicarate for the right because of its congenital defi-
ciency.
Non-Paretic Forms of Syphilitic Insanity. — Dr. C. H.
Hughes contributes to the St. Louis Weekly Medical Re-
view the two following cases : Case I. Syphilitic Mania.
From the records of the Missouri State Lunatic Asylum.
Mr. is American born, age 30 years, unmarried, a
lawyer by profession, and possessed of a good English
education and ordinarily endowed intellect.
When rational he was of studious and temperate habits,
and professed the Methodist religion. His natural dispo-
sition was cheerful and social, and he has had no previous
attacks of insanity and no hereditary tendency. His
father's health is good, and mother died at an advanced
age. He came under hospital treatment in the fall of
1869, about ten days after his insane symptoms became
first apparent. His parents were in no way regarded as
eccentric ; they were not blood relatives, and he has no
insane relatives. His general health was impaired and
feeble, with syphilitic periostitis of tibia and nares.
The record of his case attributes to constitutional syph-
ilis the predisposing, and to loss of sleep and excessive
study the exciting causes, but the brain strain was only
ordinary work in the line of his profession. He was con-
Selections. 3^7
stipated, sleepless and turbulent on admission, threatening
God's vengeance on those whom he disliked, proclaimed
himself called upon to preach the gospel, talked religiously
and blasphemously, alternately. His appetite was raven-
ous, and he was filthy and indifferent in regard to his
person, destroying clothing and bedding, soiling the floor,
and walls of his apartment.
At the end of seven months, under specific treatment,
no vestige of his mental disorder remained, and he was
discharged as recovered, with instructions to continue iodide
of potassium for two years. His treatment consisted of a
short mercurial course, followed by drachm doses of kalium
iodidum ter in die, with quinine and iron, opium and hyos-
cyamus.
The true cause of cases like the above is easily recog-
nized. We might also cite a number of them, as well as
the more typical general paralysis. But cases like the fol-
lowing are more difilicult to recognize in their true nature,
and we feel assured that we have ourself often mistaken
their real character. This record will probably, therefore,
prove more instructive to the physician in general practice,
than that of the preceding.
Case H. Mr. S. J. L. came under treatment December
8th, 1879, complaining of " fever, disordered liver, sleep-
lessness, constipation," and various other morbid feelings
too numerous and too unreal to need mention.
The fever, insomnia, hepatic and intestinal torpidity
were real enough to require medical aid, as well as the
constant cephalic pain of which he complained.
He had taken a strong antipathy to an excellent med-
ical gentleman who had previously treated him, and believed
he had poisoned him. His manner was suspicious, and he
was extremely cautious, inquisitive and fearful about all
medication. His eyes were suffused, pulse full, head hot,
and his cerebral circulation over active. The galvanic bat-
tery was his horror, and he withdrew from it as if from a
viper on our first attempting to employ it.
By methods easier to practise than to impart, we gained
his confidence sufficiently to induce him to take the neces-
sary treatment, and to impart to us the information after
inquiry, that he had years ago had a chancre, which
healed spontaneously, giving him no trouble. A course of
rnercury and iodide of potassium, based on this informa-
tion, combined with bromides, chloral and galvanism,
effected such a change for the better that the gentleman
308 Selections.
was enabled to resume his business of traveler for a
mercantile house by the end of January. He has, how-
ever, been kept on kalium iodidum to the present time,
the dose having been diminished from one drachm, ter in
die, to ten grains mane et vesper.
In syphilitic hypochondriasis, if a specific therapeutic
impression can be speedily induced, and in the meantime
the patient can be kept from home and self-harm, he need
not be sent to an asylum. He remarks further that "every
form of mental implication may result from this cause (syphi-
lis), and no part even of the spinal cord is exempt from the
ravages of syphilis. It is as much of a disease of the
cerebro-spinal axis as of the skin or mucous mem-
brane.
Stenger on Cerebral Affections of Sight in General
Paralysis. — Stenger [Archiv. f. Psych.) resports five cases
illustrative of a pecular affection of sight which Furstner,
several years ago, described as occurrng in the course of
general paralysis of the insane. The symptoms are gener-
ally observed after the epileptiform seizures that occur in
this disease. Patient can see objects and follows them with
his eyes, but they do not recall associations. For example,
he shows no fear if a burning stick is thrust before his face.
Though he sees an obstacle in his path, he will continue in
his course till he stumbles over it. If a glass of wine is held
before him, it does not seem to occur to him that it is for
drinking ; it is only after it has been pressed against his lips
that he drinks it. « Patient sees, but does not understand;
just as a man cerebrally deaf hears, but does not understand.
This condition lasts for a variable time. In the first case it
lasted about ten days, and then rapidly disappeared, and
sight was normal for three or four weeks, when another at-
tack came on, which was in turn recovered from. After a
series of such attacks and recoveries, during which the de-
mentia and paralysis gradually increased, the patient died.
In two cases there was absolute blindness for several days,
which was succeeded by the condition of mental blindness
described above. It will thus be seen that there are two
distinct conditions, one of absolute blindness or cerebral am-
aurosis, or, as it is called by Munk, cortical blindness, Rin-
doiblindheit; the other of partial blindness, physical or mental
blindness, the Seelenblindheit of Munk. The cases that Sten-
ger has observed differ in some respects from those described
by Furstner. In Furstner's cases, only one eye was affected ;
in Stcnger's, with one c.xce[)tion, both eyes were involved.
Selections. ' 309
Stenger always found paralysis and dilatation of the pupils ;
while Furstner states that the contractility of the pupils is
retained. Post-mortem showed that the symptoms were due
to disease of the cortex cerebri ; but the lesions were too dif-
fuse to allow of any conclusion as to the localization of the
sense 6f sight. Stenger reports several cases of general par-
alysis in which he has observed hemianopsia, without the
peculiar symptoms of impaired vision just described. A
man had an apoplectic seizure, and lost power over his left
face and extremities. Three days afterwards, by which time
he had regained consciousness and intelligence, there was
found left hemianopsia and hemianesthesia. The hemianop-
sia continued for about a fortnight, and then gradually dis-
appeared, but returned in a few months after a fresh paralytic
attack. In another case, left hemianopsia appeared after a
paralytic attack affecting the left side. Three months after-
wards, right hemianopsia developed, and was followed by
convulsions of the right arm and face. Patient was now
quite blind, and remained so till death, four weeks after-
wards. During the early part of this period he was able to
converse rationally, and the other special senses were normal.
On two occasions he had hallucinations of sight. On post-
mortem, in addition to other lesions, the occipital lobes were
•found to be much atrophied, and the pia-mater injected and
firmly adherent to the softened cortex. — \_Brain, Jan.
Gout and Insanity. — Berthier {Atmales Medico-Psycho-
logiques, 1869,) claimed that: First — If gout has a marked
action on the mind and a special predilection for the
nerves, it may in predisposed cases originate every kind
of neurosis, especially the optic neuroses. (2) The psycho-
neuroses dependent on the gouty diathesis are frequently
metastatic and alternating, but sometimes predispose to a
latent or larval vesania. (3) Gouty insanity is often asso-
ciated with anomalous gout. (4) Sometimes the gouty symp-
toms become lost in the insanity which then become incura-
ble. (5) Gouty insanity has an established place along side of
darirous, syphilitic and rheumatic insanity. Dickson, Buck-
nill and Tuke, and Blandford express similar opinions. At
the January meeting of Chicago }*Iedical Society, Dr. Kier-
nan reported a case which tended to confirm these opinions.
The patient was a descendant of fox-hunting Irish squir-
eens. He was a markedly good humored, as a rule, and
had at irregular inter\'als attacks of gout. The occasion
on which he was first seen by Dr. K., he was wildly ex-
cited and was dashing around the room, smashing articles
3IO Selections.
of furniture and seeking to escape from enemies. He had
been in his usual health up to within three weeks previous
to his visit, when he was attacked by gout. While suffer-
ing from this, and with his foot encased in a shoe open as
far as the toes were concerned, he incautiously went out in
a rain storm. On his return home the swelling of the
joint had disappeared, but he was irritable, peevish and
loudly complained of the noisy streets and his unquiet
children, one of whom he beat severely, contrary to his
usual custom. From the description given by his wife he
soon developed casual hallucinations and then passed into
the condition in which Dr. Kiernan saw him. Under the
application of warm fomentations to the lower extremities
and the internal use of colchicum, conium and potassium
iodide, the excitement disappeared and the patient re-
gained his usual good humor.
Temperature in Insanity. — Extended contributions to
this subject have recently been made by Bechterew [Ar-
chiv fuer Psychiatric, Band xiii.) and Heboid (Ibid.) Bech-
terew has taken the temperature of the rectum with all the
precautions suggested by Liebermeister. He finds that in
the first stage of melancholia the temperature usually re-
mains about normal, or may even rise above it. It has^
been observed as high as 104*^ F. By melancholia Bech-
terew evidently means all cases with delusions of persecu-
tion and with depression. In melancholia with marked de-
pression and with stupor, the temperature may sink far
below normal. In the convalescent period the temperature
is usually normal. Sometimes the temperature is extremely
variable at the onset of this period, and this usually denotes
a sudden improvement in the patient's condition. In the
excited or stuperose period an inverted typhoid fever
curve is often noticeable. The fall of temperature is refer-
rable to the altered metamorphosis in the tissues to cir-
culatory and ha^mic changes. In the first stage of mania
the temperature is lowest. In the period of excitation the
temperature is normal or above normal, and there are fre-
quently marked fluctuations. Low temperature is often
noticeable on the disappearance of the excited period.
An inverted typhoid fever curve is often noticeable here.
The peripheral temperature varies in different places. De-
mentia curves are most irregular, and subnormal tempera-
ture very frequent. Heboid's results, which deal specially
with low temperature, tend in a general way to confirm
these results.
Selections. 311
Restraint.— Dr. R. W. D. Cameron (^Journal of Men-
tal Science, January, 1883), comes to the following con-
clusion on the subject of restraint : First : — Restraint of
some kind will always be necessary while insanity exists,
as it is at present. Second : — It should be limited in its
application so far as is compatible with the welfare of
the patient and the interests of the public. Third : — Direct
control, moral and physical, by good attendants under
the guidance of the higher asylum officials is the best
means of attaining to this end. Fifth : — Restraint other
than this is not necessary. Sixth : — Exceptional restraint is
sometimes, and then seclusion is to be preferred to
mechanical appliances and drugs. Mechanical restraint
is only indicated for surgical reasons or in cases of emer-
gency as a temporary measure until other means of
restraint can be applied.
Moral Insanity. — Dr. Savage {journal of Mental Sci-
ence, 1881-82) said that many so called sound children
are nothing more nor less than children who are morally
of unsound mind. After expressing his concurrence in
this doctrine. Dr. J. Manley {Journal of Mental Science,
January 1883), reports two cases of children, four and a
half and six years old, intellectually bright, yet given to
wild malicious mischief, despite good home surroundings
and careful bringing up.
Chronic Iodoform Psychoses. — Schmidt [Centralblatt
ftier Nervenheilkunde) December, 1882, reports the case of a
women of ^y in whom there was no hereditar>^ taint, in whom
a chronic form of insanity, beginning with (like all toxic psy-
choses) aural, visual, and sensibility hallucinations, passing
later on into a condition of dementia, attended by amnesia
of past events, agitation, loss of personal identity, and per-
sistent hallucinations. The interest of the case lays in its
chronicity.
Insanity in a Child. — A six years, ten months old
child is reported by Berner {Norsk Magazin for Lcege-
vtdenkaben, Bund XII, Hefte 3) to have been attacked by
melancholia. The patient was desirous of solitude, very
restless and unquiet in slumber and had hallucinations of
sight and hearing. There were at times paroxysms of
markedly painful depression. Hereditary history was
uncertain, and the patient recovered in a month.
Puerperal Insanity. — Dr. J. de Burgh GrifTm {Aus-
tralian Medical Journal, June 15, 1882) has had his
312 Selections.
attention called to several cases of puerperal insanity which
usually assumed the acute mania type. He claims that
a premonitory stage exists and that the disease may be
abated. Melancholia may occur, but is most frequent dur-
ing lactation in his experience. He finds tonics and stimu-
lants of great value.
CLINICAL NEUROLOGY.
■ Note on the Action of Continued Currents, Studied
FROM A Physiological and from a Pathological Stand-
point*, by A. Estore, interne at Montpellier. — i. Whilst
studying the physiological action of continued currents, we
were struck with the considerable variations which were pre-
sented in the amount of resistence it encountered whilst
traversing certain tissues. These existed not only in differ-
ent subjects, but in the same one electrized at different times.
This fact, we found, had been already noted by Dr. Vigou-
roux [Gazette Medicale, 1879). Our chief. Prof. Grasset, un-
der whose supeivision we made our researches, requested us
to examine these variations more closely and analyze the re-
sults with care. Through the courtesy of Dr. Regimbeau,
who kindly loaned his apparatus and tendered his advice, it
was an easy task to gather a number of interesting facts.
The following method was pursued : The positive pole
Was placed over the sternum and the negative over some
parts, but always the same, of the forearm. A current suf-
ficiently feeble to be borne for along time (say ten elements)
was then passed through. The precise time of closing the
circuit was noted and the exact number of divisions trav-
ersed by the galvanometer needle, in a minute, was observed,
until it remained permanently at rest; the maximum of in-
tensity had been reached and the examination was concluded.
Numerous experiments were made by this method and it
was observed that in two individuals subjected to the action
of the same current, the resistance may vary in two man-
ners : sometimes, and this is the case ordinarily, the max-
imum of deviation is different; high for one, it is less so for
another, no matter how long the current is applied. At
other times, this being less frequently the case, the needle
arrives at the same maximum, but in different periods of
time ; being rapidly displaced in the one case and less so
in tile other.
•From the Archives de Neurologie, Vol. Iv., No. 11.
Selections. 313
These conditions, the galvanometric deviations on the
one hand and the time on the other, have aided in pro-
ducing curves by means of which the results of different
examinations may be easily compared.
2. This being admitted in physiology, it seemed not
only interesting but imperative to study these variations in
resistance from a pathological stand point. M. Charcot had
just observed [Societe de Biologie, 1882) that Dr. Romain
Vigouroux had proven long since that, in hysterical patients
affected with hemianesthesia, there is less power of conduc-
tion on the affected than on the sound side. We com-
menced our experiments by verifying this. It was at the
Salpetriere, under the very eyes of M. Charcot and of Dr. R.
Vigouroux, that these new researches were conducted.
It was no longer a question of comparing different in-
dividuals : the two sides of a patient were to be the sub-
ject of comparison. The first condition to fill was to isolate
the current, to localize it to that half of the body which was
experimented upon. Its influence was not to be felt on the
opposite side, where the resistence, without this, would have
been diminished before it had been electrized in turn. To
obtain this result we slightly modified our method ; instead
of placing the positive pole over the sternum as before, it
was placed under the axilla; the negative pole was fixed
upon the corresponding forearm by a circular band.
The same electrodes were employed on the right and
on the left, over points exactly symmetrical. They pre-
sented a plane surface of small extent, so that the contact
with the skin might be at its best ; the greatest precau-
tions were taken that the pressure should be equal on both
sides.
Five hysterical or hystero-epileptic subjects, all having
hemianesthesia, were successively examined. The sound
side was first electrized and then the affected one; the first
side was then gone over and then the other and this con-
tinued until the maximum was reached with certainty and
rapidity. The diagrams will aid to a clear understanding
of this and show the results obtained. Subjoined are a
few explanatory notes on the patients examined.
The heavy lines in the figures represent the more sen-
sitive side and the dotted lines the side that is less sensitive.
Kahn (Eva), examined March 6, 1882. — Complete left
hemianesthesia. A current of twelve elements, applied once,
gives on the right side a maximum of 25^ in one minute;
on the left, a maximum of 18® in three minutes. In the
314 Select io)?s.
figure the lines are separated by somewhat of an interval.
A second application brings them together ; the maximum
is the same, but is immediate on the sound side, in four
minutes on the affected side ; in a third trial the lines are
the same, the resistance being equal on both sides.
Georges (Louise), examined the same day, presents anal-
ogus results, but four successive electrizations are necessary
to obtain them. Moreover, the anesthesia being upon the
right side, the resistance here was greater than at the be-
ginning.
The curves of Blanch and of Gall are still
more interesting,
Blanch is examined March i, 1882. — Complete left
hemianesthesia. There is obtained for maximum at first :
50^^ in twelve minutes on the right (sound) side, 40° in
nine minutes on the left (affected) side. A second trial
gives the same maximum of 55"^ on both sides; immedi-
ate on the right, in two minutes on the left. The most per-
fect equality exists in the two curves in the last experiment.
A second examination is made March 7. — A transfer has oc-
curred since the preceding day ; sensibility has completely
returned on the left in the arm and face, slightly in the low-
er limbs; on the opposite side anesthesia or simply dimi-
nution of sensibility at symmetrical points. The results fur-
nished by electricity are inverse to the preceding ones. Max-
imum : 50® in twelve minutes in the left side, 40® in eleven
minutes in the right. The succeeding applications of the
current modify the rapidity of the galvanometric needle, but
not the extreme limits of deviation ; the two lines arrive at
the maximum almost immediately, but never coalesce; the
heavy line is always at 50® and the dotted at 40°.
These two examinations verify each other. They clear-
ly show that, in this case, the resistance is greater on the
side affected with hemianesthesia.
Gall is completel)' insensible on the left side, when
electrized for the first time, March i, 1882. Sixteen ele-
ments produce on each side a deviation of 65 ° in six min-
utes on the right, in eight on the left. This maximum is
immediately attained on both sides, on applying the cur-
rent a second time. Netv examinatio7i, eight days later.
The anesthesia has departed to give place to a marked
hyperesthesia ; the current produces an acute pain on the
left side, and which can hardly be borne ; the right side
has remained normal. Maximum: 70® on both sides; in
four minutes on the left (hyperesthesia), in nine on the right
Selections. 315
(normal) ; the difference in these two lines diminishes not-
ably after the second and completely after the third elec-
trization. In this case the resistance was greater in the left
side with anesthesia ; it becomes less, in the same side when
hyperesthesia is present.
There is nothing contradictory in these two facts, which
are to be considered rather as reciprocal of each other.
Our last patient, Julie de la Mothe, never presented any
appreciable difference in her two sides. Studied on several
occasions, electrical conduction has always shown itself the
same on both sides, although varying in intensity. It is true
that there only existed a slight diminution of sensibility in
the left side, without visual trouble. In fact, we did not
have a true hemianesthesia to deal with.
To recapitulate. — Our two first hysterical patients could
only be examined once ; they confirm fully the opinion of
Dr. Vigouroux. The third one was observed twice from
the fact of the occurrence of a transfer ; the hemianesthesia,
primarily on the left, passed to the right. And the increase
of resistance also changed sides. In the fourth, an active
hyperesthesia having succeeded a complete anesthesia, we
saw, on the same side, the resistance at first greater and
subsequently less than that of the other side. Finally, the
same conductility was observed in both sides of the last
patient, whose sensibility was hardly less on the left
side.
Such are the results of our researches ; although briefly
stated, they seem to us sufficient to demonstrate the im-
portance to be attached to the determination of electric
conductions in all subjects. The element indispensable by
electro-theraphy and electro-diagnosis will take a part in the
future of the semeiology of many diseases and especially
of those of the nervous system.
Cases of Arsenical Paralysis* — By Charles K. Mills,
M. D., Neurologist to the Philadelphia Hospital ; Professor
of Diseases of the Mind and nervous system in the Philadel-
phia Polyclinic and College for Graduates in Medicine. —
On Nov. 2, 1882, at Nornstown, Pa., occurred a series of
cases of arsenical poisoning almost without parallel. The
poisoning was caused by pumpkin-pie, which contained a
large amount of arsenious acid. Dr. Mills saw one of
these cases at Norristown with Dr. E. M. Corson, and sub-
sequently with Dr. S. Weir Mitchell, under whose care the
•Abotract of a paper read before the College of Physlciaus of Philadelphia,
February 7, 1883.
3i6 Selections.
patient was at the Phil. Orth. Hosp. and Infirmary for Ner-
vous Diseases.
The patient, a lawyer, aet. 24, and healthy previously,
was taken sick immediately after having eaten freely
of the poisoned pie, vomiting a few minutes only. Dur-
ing the night and until Saturday morning the vomiting
was almost continuous, ceasing entirely Monday afternoon,
except that at 2 o'clock Tuesday morning he vomited a
dark grumous mass. Just before vomiting this mass he
had constriction in the muscles of the chest and throat,
and the facial muscles were much contorted. His bowels
did not move from November 2d until November 8th. He
had but little pain during the vomiting, scarcely more
than would be accounted for by the retching and vomit-
ing. Prostration was very great from the first. Tuesday
night, November 7th, attempting to get out of bed, he
fainted, and remained for some time in a semi-unconscious
state, and began to have marked fever.
Six days after taking the poison, the patient first felt
aching and numbness chiefly about the knees. The latter
in a few days extended towards his feet. He had fair use
of his legs, although they were extremely weak. Three
days after this appearance of the numbness the same sensa-
tions began in the fingers of both hands, and soon extended
to the wrists, beyond which it never passed.
His legs below the knees were now almost completely
paralyzed, and there was some loss of power below the
elbows.
His face was considerably puffed and swollen.
On December ist, he began to have great pain, begin-
ning in the knees, and speedily invading the legs and the
feet, progressing in the same course as the numbness had
previously taken. Aching was always present, but fre-
quently the pains were boring, tearing, or lancinating. They
were accompanied by a sensation like that produced by a
strong faradic current. Two days after the coming on of
the pain in the legs the fingers and hands also became the
seat of aching. In one week the pains began slowly to
abate ; but throughout December, and, indeed, up to the
present time, he has had more or less pain, varying much in
character. By the middle of December, the numbness and
aching, which had previously b6en below the knees, had ex-
tended above them a distance of several inches. His lower
extremities felt as if encased in a cylinder as high as the
limits of the numbness. The symptoms in his upper extrem-
Selections. 317
ities did not change noticeably. The loss of power in the
thighs increased with the spreading upwards of the sensory-
perversion.
The patient was first examined by Dr. Mills December
24, 1882, but the notes here given are from examinations
made between January loth and January 17th.
He presented no brain symptoms, and no disturbances
of the special senses of sight, hearing, taste, or smell. He
slept fairly well until midnight ; after that time he was usu-
ally restless and uncomfortable.
Wasting of the limbs and emaciation were extreme.
Circumference of the right thigh, 11 inches; of left, 10 3-4
inches; of right calf, 8 1-4 inches; of left, 81-4 inches;
of right arm, 7 inches ; of left, 7 inches ; of right forearm.
6 1-2 inches; of left, 6 1-4 inches.
Paralysis below the elbows was marked, but not com-
plete. The extensors and supinators were most decidedly
affected. The fingers could only be flexed about one-half.
Movements of the thumbs and the small movements of the
fingers were impaired. The loss of power was slightly
greater in the right limb than the left. The dynamometer
registered for right and left hand, 35. mw^
At both elbows were marked contractures at about right
angles. The angles could be reduced to about 160 ^ , but
any attempt to carry the straightening further caused pain
in the flexor tendons.
The legs, toes and feet were paralyzed completely below
the knees.
The legs in their entirety showed a tendency to rotate
outwards, the feet, however, assuming the equino- varus
position. Contractures were not present at the knees, but
at times the limbs would assume a semiflexed position, these
acts of flexure being accompanied by cramp-pains in the
flexor muscles of the thighs, legs and arms not infrequently.
The bowels required cathartics. Some dribbling of the
urine occurred for a few days, also some pain, which he
referred to the lower part of the urethra, just as the dis-
charge of urine was completed. At the time of examina-
tion, January 17th, the urine was passed slowly, but without
pain. The urine showed an excess of phosphates, but nei-
ther albumen nor sugar.
Farado-contractility was abolished in all muscles below
the knees. Above the knees, faradic reaction was found to
be greatly diminished, but not wholly absent.
The muscles below the knees to currents of medium
3i8 Selections.
strength responded, but not normally. The reactions were
those of degeneration. The actions expressed in the Ger-
man formula were : AnSZ" ; KaSZ; AnOZ; KaOz.
In both upper extremities farado-contractility was de-
creased, but not lost; dimunition much greater below than
above elbows. Below the elbows excitability was rapidly
exhausted.
To the galvanic current the reactions of degeneration
were present, but not so decidedly as in the legs. An-
odalclosing gave stronger reaction than cathodal. With
moderately strong currents tetany was produced at the
anode.
Both patellar reflexes were abolished.
The cremaster-reflex presented some interesting points :
Gentle irritation of the skin of the inner aspect of right
thigh and leg, as far down as the malleolus, caused very
vigorous retraction of the right testicle. Sometimes, but not
usually, both testicles were retracted. Similar irritation of
the left thigh and leg led to movement of the left testicle,
which was marked, but not as vigorous as that exhibited by
the right from irritation of the right limb. Now and then, in
making this test, the unilateral movement of the left testicle,
from irritation of the left thigh and leg, was followed a mo-
ment later by an imperfect retraction of the testicle of the
•opposite side.
On admission the surface temperature of each calf was
95 * F. He usually complained of his legs feeling to him
unduly warm.
Late in November transverse white bands were observed
across the finger nails about two lines from their posterior
limits. The nails were not furrowed, but simply showed
white markings. As the nails have slowly grown these lines
have remained.
The fingers and forearms were hyperaesthetic, but at the
same time the patient could not determine with any accuracy
as to one or two points on testing him with the asstheseom-
eter. A similar condition, but more marked, was present in
the feet, legs, and as high as the middle of the thighs. The
muscles were very sensitive.
Applications of hot and cold water were discriminated
readily.
For two weeks from January 9th to 23d, the pulse ranged
between 107 end 148, and was nearly always more rapid in
the morning than in the evening. The respirations ranged
between 20 and 24, standing usually at about 24. The
Selections. 319
temperature ranged between 97.8® F, and 99.8* F., but
commonly was not much either way from the normal.
The following treatment was instituted by Dr. Weir Mit-
chell : Applications of ice and hot water alternately three times
daily for ten minutes at a time to his arms and legs from the
elbows and knees downward. Surface massage with cocoa-
nut oil once daily. Ice-bags to spine for one to two hours
twice daily. One grain of the extract of ergot (new United
States Pharmacopoeia) every two hours, and increased to
thirty grains daily. After a week the ergot disordered the
patient's stomach, and tincture of belladonna in doses
of five drops every three hours was substituted. Fif-
teen grains of chloral were administered occasionally,
and sulphate of morphia, at first i-25th grain, eventually
increased to i-i6th grain, was ordered, to relieve pain when
necessary.
He was placed on full diet, with milk three times, and
beef-tea twice, daily.
He improved steadily, regained almost entirely the use
of the muscles above knees; has also much better use of his
forearms and hands, particularly the latter, being now able
to pick up small objects. The " wrist-drop " has improved
greatly. He has much less pain, aching and numbness be-
low knees ; the legs below the knees, however, still remain
paralyzed, but are not so completely helpless. He has every
appearance of progressing steadily to recovery.
Six others altogether, besides this patient, were poisoned.
One of these was a little boy, 4 years old, I. S., to whom a
piece of the fatal pie was given. He died within ten hours,
and I have no knowledge of observations as to paralysis or
other manifestations of involvement of the nervous system.
Probably his death occurred too soon to allow any such
observation to be made.
M. S., a sister of the little boy, ate a very little of the pie,
and suffered to some extent, but not seriously.
C. H. G., the father of this patient, died November 8th,
six days after the ingestion of the arsenic. Besides severe
gastro-intestinal symptoms, he suffered with pain in his head,
back and limbs, was delirious for some hours, and was almost
completely paralyzed.
Mrs. G., mother of the patient, ate a little of the pie No-
vember 3d, and had an attack of vomiting. On the 4th she
ate a piece of custard, which was also found to contain arse-
nic, and was attacked with vomiting. A few days later
weakness of the legs, with aching and numbness, came on.
320 Selections.
and the right foot and leg became swollen and inflamed.
She gradually recovered.
Mrs. V. ate a mouthful or two of the pie and custard con-
taining the arsenic, and suffered with vomiting, etc., for three
days. She has since had paresis and paraethesia of the legs.
Mrs. F., who ate freely of the poisoned food, suffered se-
verely from gastro intestinal symptoms. She is now under
the professional care of Dr. H. N. Umstead, of Yerkes P.O.,
Montgomery Co., Pa. Dr. Umstead states that Mrs. F. has
been paralyzed from the elbows to the ends of her fingers
and from the knees to the toes. She complained of numb-
ness and coldness in the limbs, and a feeling as if a cord was
tied tightly around the waist. She had extreme pain in the
paralyzed extremities. She had greatly improved, is riding
out daily, can stand without aid, and can even walk a little
with assistance. She still has some pain in the hands and in
the soles of the feet, but they are not tender to the touch.
She has some anaesthesia of the hands and feet, especially of
the latter. She begins to enjoy her food, for which at first
she had great loathing. Her bowels are moved once, and she
urinates twice daily, but has not quite the natural sensation
when the bowels or bladder is evacuated.
Dr. Mills concludes " that in well-marked arsenical par-
alysis we have to deal with a diffused myelitis, decided mo-
tor, trophic and sensory bilateral phenomena being present."
Hereditary Transmission of Artificially Produced
Lesions. — Dr. Brown-Sequard Comptes Rendus, tome xcvi.,
s. 627, many years ago drew attention to the hereditary
transmission of epilepsy in guinea-pigs, rendered epileptic
by section of the sciatic nerve or cord, of alterations in
the eye and ear after section of the cervical s}'mpathetic,
of ecchymosis and dry gangrene after destruction of the
corpus restiforme, of exophthalmos after section of the
spinal cord, and of loss of phalanges or digits after section
of the sciatic nerve. He now adds a fresh series of changes
in the eye, after section of the corpus restiforme, which
causes in the parent, atrophy of the globe, and in the de-
scendants various opacities of the cornea, aqueous, lens or
vitreous humor with atrophy of the globe in one case ;
also muscular atrophy after section of the sciatic. With
the exception of the epileptic attacks, the changes in the
descendants were often bilateral when they were unilateral
in the parent, or vice versa, or the same side was not
affected. P'emalcs transmitted the changes more readily
than males. One generation often escapid. lie has seen
Selections. 321
an abnormality transmitted to the sixth generation. —
Medical Gazette.
Reflex Palmar Emeses. — Dr. W. G. Moore, of St.
Louis, in St. Louis Courier of Medicine for March reports
the unique case of a fourteen months old boy, who would
vomit whenever the rubber nipple of his nursing bottle
came in contact with the palm of his hand. This singular
phenomenon was noticed in the child at the early age of
six months. A maternal aunt of this boy could never
wear velvet goods on account of the disagreeable sensa-
tions from his touching it, and his father was an ex-
tremely nervous person.
CEREBRO PHYSIOLOGY.
Retreating Foreheads and Intellect. — The AthenceiDn
very pertinently says concerning, this, that: "It is usually
supposed that men of great intellectual powers have large
and massive heads ; but this theory, which Dr. Gilbert,
physician to Queen Elizabeth, was the first to suggest, is
not borne out by facts. An examination of busts, pict-
ures, medallions, intaglios, etc., of the world's famous cele-
brities almost tends the other way. In the earlier paintings,
it is true, men are distinguished by their large heads, but
this is attributable to the painters, who agreed with the
general opinion and wished to flatter their sitters. A re-
ceding forehead is mostly condemned. Nevertheless this
feature is found in Alexander the Great, and, to a lesser
degree, in Julius Caesar. The head of Frederick the Great
receded dreadfully. Other great men have positively small
heads. Lord Byron's was ' remarkably small,' as were
those of Lord Bacon and Cosmo di Medici. Men of ere-
nius of ancient times have only what may be called an
ordinary or every-day forehead, and Herodotus, Alcibia-
des, Plato, Aristotle, and Epicurus, among many others,
are mentioned as instances. Some are even lou-browed,
as Burton, the author of ' The Anatomy of Melancholy ; '
Sir Thomas Browne, and Albert Diirer. The average
forehead of the Greek sculptures in the frieze from the
Parthenon is, we are told, ' lower, if anything, than what
is seen in modern foreheads.' The gods themselves are
represented with ' ordinary, if not low, brows.' Thus it
appears that the popular notion on the matter is erro-
neous, and that there may be great men without big
heads. Recent anatomical and physiological researches
322 Selections.
tend to at least lend strength to this view. Spitzka states
{ Journal of Nervous and Mental Disease, p. 483, 1879), that
the development of the intellect in its highest sense de-
pends upon a good projection system. This in turn de-
pends upon a well-developed cranial base. — Gaillard's
Medical Journal.
The Posterior Lobes of the Brain and the Seat
OF Intellectuality. — Dr. Crochley Clapham {^Journal of
Mental Science, 188 1-2,) claims that there is no proof that
the frontal lobes are the seat of intelligence, and gives
the following reasons for rather crediting the occipital
lobes with that function: (i) The occipital lobes occur
only in the primates, being absent in the lowest of mon-
keys. The frontal lobes are present in all the mammalia.
(2) The occipital lobes are the latest developed, whereas
convolutions first make their appearance in the human
brain in the frontal lobes. (3) The occipital lobes are not
occupied, as are the frontal lobes, by extensive motor
areas ; indeed, they have no motor cells whatever in their
cortical substance. (4) The occipital lobes are small and
ill-developed in idiots (a straight back to the head being
a common feature to idiocy), while the frontal lobes are
unusually large, relatively speaking. (5) Wasting of the
occipital lobes is always accompanied by dementia ; not
so wasting of the frontal lobes. Campaigne [Traite de la
Manie Raisonante) and others have shown that in primary
monomania the occipital region not the frontal is deficient.
It may therefore be safely assumed that popular and even
medical notions on this subject are erroneous. — Gaillard's
Medical Journal, Feb. lyth.
[Charlton Bastion in his lectures before the class of
University College Hospital, London, in 1874 strongly in-
sisted that " the posterior lobes of the brain had more to
do with intellection than the anterior," and the fact is in
conformity with the preponderance of clinical and patho-
logical evidence. — Ert]
SuAViTOR IN MoDO, ETC. — "The Merry Mulheron of
the Michigan Marshes" pays his compliments to "the
dauntless dermatologist of the blue-grass region."
When friendly fratcrs editorial fall into frenzied feeling
they furiously fight in finely-formulated phraseology.
EDITORIAL.
The Reign of the **Iiios" in Therapy. — We
have fallen upon strange times. No sooner does a medi-
cinal agent acquire fame than some enterprising druggist
makes a penult or antepenult of the famous name, attach-
it to the terminal iiie which expresses the laboratory hocus
pocus of the combination, and a drug is formed with a
ten-fold virtue over its ingredients, the latter of which
may be obtained on prescription of any reputable phar-
macist. And medical men readily come forward to write
up the new ine as though it were a new discovery in
therupeutics, and the weaklings in the profession straight-
way proceed to take instructions in therapy from mercan-
tile houses in lieu of the authorities in medicine.
We have no objection to the use of these combina-
tions by the profession, but the evil connected with them
is their fulsome laudation beyond their actual merits and
the potency of the drugs they represent, by medical men
whose endorsement is weighty because they are regarded
as honest men in the profession.
We should pause and consider when pressed to com-
mend these enterprising combinations, whether what we
say is the exact truth and nothing but the truth.
No doubt a business house is gratified at the recep-
tion of a testimonial of a thousand bottles of a new com-
bination just on the market, prescribed by one physician in
the small place of one year, but either the statement or
the prescription is reckless.
Horsford's acid phosphate has already passed from the
hand of the profession to the public, and the daily press
heralds its virtues as a cooling drink in summer, an in-
vigorating tonic to fight off cold in winter, a cure for
innumerable nervous conditions which without other aid it
can not reach, and all through the help of medical certifi-
cates thoughtlessly given in the beginning and recklessly
in the end. The big fish take their baits piece-meal, but
finally the little ones gulp them whole, and to the public
one medical certificate is about as weighty as another, if a
few weighty men are in the crowd.
324 Editorial.
The Style of Men who Read the "Alienist and
Neurolog-ist." — First, the medical heads of most of the
hospitals for the insane ; next, a portion of the associate
staff of these hospitals; next, the superintendents" of the
institutions for the feeble-minded and idiotic — not all of
them, but most of them ; next, the chiefs of the medical
staffs of a number of the general hospitals, and the profes-
sors and lecturers on psychological and neurological medi-
cine in some of the best medical schools of the country,
also, some of the professors of surgery and general medi-
cine, etc. ; next, the heads of inebriate homes, and nearly all
the superintendents of the private homes and corporate
hospitals for the insane and nervous.
Last, but not least in number and respectability, that
growing class of advanced and advancing, thoughtful, ob-
servant, investigating general practitioners whose medical
education did not cease when their college curriculm
ended. You will find a few of them in nearly every com-
munity. They are the physicians and surgeons whom their
brethren rely on for wisdon in medical emergencies, whom
the public regard as the capable men in our ranks when
something besides routine fever problems, etc., are to be
solved. They are the men whom the lawyers consult for
valid medico-legal advice, and whom the clergy recognize
as the most enlightened men in the discussions of life prob-
lems intelligently.
We might have named another class, among the most
advanced lawyers and jurists who are regular subscribers
and readers of the Aliknist and Neurologist. The A.
AND N. numbers among its patrons not a few judges who
still think that the true province of the judiciary is
to learn from Medicine what constitutes pathological
law, especially in psychiatry, not to make it themselves
by judicial fiat evolved from the inner consciousness of
the Bench. These jurists read, the Alienist and Neu-
rologist and kindred literature.
Journalistic. — We note the change of the iVi'w York
Medical Journal, to a weekly issue; and that oi X\iQ American
Journal of Obstetrics, witliout supplement, to a monthly.
We note also an increase in size and pages of Gaillard's
American Weekly, the Louisville Medical News (weekly),
and the Neu< York Medical Record. The Michigan Medical
Neii's, and the Detroit Clinic, have consolidated under the
name of the Medical Age, edited by Dr. J. Mulheron. Dr.
IkMiiiss has retired from the New Orleans Medical and
Editorial. 325
Surgical Journal, which is now edited by Drs. H. H.
Watkins, John Godfrey and others. The Annals of Anatomy
and Surger)', of Brooklyn, appears this year on an inde-
pendent footing, under the management of Drs. L. S.
Pilcher and Geo. R. Fowler, of Brooklyn, and others. The
Rocky Mountain Medical Times, ha> become the Denz'er
Medical Temes. The Moiithly Rtvieiv of Materia Medica
and Pharmacy, edited by Dr. Richard V. Mattison, of
Philadelphia, appears this year under the name Quinologist.
The Chicago Medical Reviezv, will henceforth appear as a
weekly simultaneously in Chicago and St Louis, under
the name of Chambers Weekly Medical Review, Messrs.
J. H. Chambers & Co., of St. Louis Mo., being the pub-
lishers and Drs. E. C. Dudley and D. C. Gamble being
the chief editors, with DeWolf, Warrenton, Earle and
Roswell Park (of Chicago), and Geo. Engelmann, H. H.
Mudd and VVm. Porter of St. Louis as associates. The
Kansas Medical Index and the Missouri Valley Medical
Monthly are consolidated, Drs. Diekman and Boteler be-
ing the editors.
A Commendable Religious Journal. — The St.
Louis Evangelist has made its appearance in our sanctum
entirely free from the not unfamiliar attestations, in so
many other journals of the kind, of the miraculous virtues
of certain notorious nostrums. It is so refreshing and ex-
ceptional to see a religious periodical consistent in its
advertising pages with its editorial columns, that we can-
not refrain from commending this consistent conformity
to the decalogue in one, at least, of our religious ex-
changes; accordingly, we cheerfully bear witness to the
fact that the St. Louis Evangelist bears none of the custom-
ary false witness of the ubiquitous " eminent clergvmen," to
the physical salvation properties of certain potent potions
whose impotency is well known to those who are compe-
tent to judge of them. Of all the panaceas certified to
by the divines of a few decades past, not one has stood
the te,-t of time. Even the "sands" of the several consump-
tion cures of a quarter of a century ago have run out and
no more " retired clergymen " are saved by them.
The Plea of Insanity is Brought Into Di.sre-
puce and the insane deserving of clemency are sometimes
hung because of such abuses of the plea as lately occurred
in Milwaukee, Wisconsin, as well as where the insanity
exists only in the hypothetical case. The case in point was
326 Editorial.
that of a bartender who became temporarily insane, largely
from drink, and shot his step-mother because he did not
approve of her marriage with her second husband. The jury
set the murderer free, to commit a similar act probably in
the not remote future, when he gets again unbalanced ;
whereas it should have sent him to a penitentiary and asylum
for life or a long term, not only for the murder, but for getting
murderously insane through vicious indulgence. If a man is
indisputably responsible for his insanity, he should be held
accountable to the extent of prolonged or perpetual restraint,
at least for voluntarily and knowingly developing the dis-
ease and for its criminal consequences. Justice to the deserv-
ing insane demands discrimination in the punishment of con-
scious self-induced and avoidable insanity.
The Meiuory ofBarou Muiicliauseii Revived. —
The " Force Neurique (?) " which Dr. Barity claimed to
have discovered in his choreic patients, seems to have
received some verification in a recent neurique phenomenon
in Michigan. Dr. Barity asserted that :
In man (probably also in animals) there is manifested a peculiar nerve
force (force neurique, neuricite). It radiates outward througli the eyes, fin-
gers and breath, and is distributed in stralglit beams through the atmos-
phere ; it can be reflected and refracted. It can also penetrate lifeless bodies;
certain colors will allow its transmission (dianeuriques) others not (aneu-
riques). The rays of nerve force mny penetrate to a distance of from a few
centimeters to several meters. It travels through tlie air with a velocity
of two meters per second. — {Deutsche Med. Zeit.
This conjecture is by no means new. In a recent
number of the Michigan Medical News, Dr. S. C. Woodman
has made the following singular statement which is worthy
of record along with Barity's. We accordingly give it
space and append thereto Dr. Woodman's letter on the
subject in reply to our inquiries :
" 1 have a singular phenomenon in the shape of a young man living here
that 1 have studied witli much interest, and I am satisfied that his peculiar
power demonstrates that electricity is the nerve force beyond dispute. Hia
name is Wm. Underwood, age 27 years, and iiis gift is that of generating
fire through the medium of his breath, assisted by manipulations with his
bands. He will take anybody's hankerchicf and hold it to his mouth, rub
it vigorously with his hands while breathing on it, and immediately it
bursts into flames and burns until consumed. He will, strip and rinse out
his mouth thoroughly, wash liis liands, and submit to the most rigid ex-
amination to preclude the possibility Of any liumbug, and tlien by his breath
blown upon any paper or cloth envelof) it in flame. He will, when out gun.
ning and without matches, desirous of a flre, lie down after collecting dry
leaves, and by breatliiug on them, start the fire, and then cooly take oflF his
Editorial. 327^
wet stockings and dry them. It is impossible to persuade him to do it
more than twice a day, and the effort is attendant with the most extreme
exhaustion. He will sink into a chair after doing it, and on one occasion
after he had a newspaper on fire as I narrated, I placed my hand on his head
and discovered his scalp to be violently twitching, as if under intense ex-
citement. He will do it at any time, no matter where he is, under any cir-
cumstances, and 1 have repeatedly known of his sitting back from the
dinner table, taking a swallow of water, and by blowing on his napkin at
once set it on fire. He is ignorant, and says that he first discovered his
strange power by inhaling and exhaling on a perfumed handkerchief that
suddenly burned while in his hands. It is certainly no humbug, but what
is it?"
Paw Paw, Mich., Dec. 20. 1882,
Dear Sir : — Yours in regard to Underwood at hand. The article re-
ferred to is no joke but strictly true as can be attested by any resident here
as he has been in the habit and indeed now, will do it any time f<w a small
fee. It is a very singular thing and in the light of it although I might not
be willing to take as a Thesis that electricity is the nerve force. I would be
glad to combat the negative. I am wholly unable to understand it unless
as it now seems to me he generates from his lungs or stomach gas. and
then after filling the handkerchief with it, sets the gas on fire by a spark
of electricity and this burns the paper or tlie cloth. Either of the editors
of our local papers the '• TVue Northerner''^ or " Free Press " wQl substantiate
alL
Very respectfully.
To C. H. Hughes M. D. S. C. Woodman
Lictters of the Insane.— A gentleman discharged from the Barn-
wood Lunatic Asylum.Gloncester. Engl. [British Medical Journal. Marih25,
1882), hMS complained that his letters written in the asylum and while in-
sane were sent to his friends, and he has thus been permitted to make a
fool of himself in public in a way calculated to injure him pecuniarly. The
case illustrates one great difficulty with which insane asylum officials have
to contend. — {CAicogo Medical Review. Apiil 15.
Great injustice and injur}' irreparable may be done the
insane by communicating their utterances, oral or written^
without discrimination to their friends and the public. The
indelicate, profane or vengeful expressions ; the confessions
of marital infidelity, of crime, of folly, the expressions of
suspicion, and dread, unfounded in fact, but often made
while the mind is under the dominion of disease founded
illusion, hallucination or delusion, often make irreparable
breaches in domestic and social relations, marring and
blasting the happiness of once harmonious hearts and
households. To the uninformed, the vulgar and indecorus
utterances, which fall from the lips of the once pure and
refined, suggest the adage "where there is so much smoke
there must be some fire," unaware of the fact that in
328 Editorial.
states of mental disease, expressions which may have fall-
en upon the ear almost unawares, and unconscious or
transient impressions and automatic mental movements, find
expression in states of mental disease, as though they
had been the real habitual voluntary life of the afflicted
person ; as though not only these automatic, semi-con-
scious mental impressions were the real chosen life of the
insane, and the thousand thoughts resisted during sanity,
had been part of the voluntary mental life.
If it be unjust to divulge professional secrets obtained
from the insane, how much greater wrong is it to make
no secret of the distorted communications of the insane,
which, though they have the semblance of voluntary
•statements are often widely varient from the expressions
of their normal mind and volition.
Laws framed to " protect (?)" the insane by transmis-
sion of all they write may thus become grossly violative
of their rights, or those rights which they would main-
tain were they sane, to keep such of their correspondence
as might do them harm, secret. Besides, the Physician's
best clue to the state of his patient's mind is often formed
in the latter's letters. Intelligent answers to friendly in-
quiries and prognosis as to recovery are often based on
them.
As Others See Us—
The January number of the Alienist akd Neurologist, edited by Dr.
C. n. Hajj^hes, of St. Louis, comes to us loaded with fine original papers,
which are indeed contributions of permanent value to our literature. The
contributors to this number are well known to the profession, and liave
long since won an authoritative position in psychological medicine. The
■one hundred and twenty-nine pages of original matter are furnished by
both American and foreign writers. The whole gives evidence of energetic
and tasteful editorial management, and the typography is excellent. This
journal is more properly a special journal for the general practitioner than
a journal for the specialist. Eveiy physician interested in tlie progress of
psychiatry and neurology will tind tliis journal replete with instructive
material. It is higlily creditable to American energy and American
.science — Loulwille Med. News. Feb. 3.
For good opinions from good scources we are grateful,
but when a high estimate of our work comes from so ex-
alted a scource as the Louisville Medical Nezos, we are
greatly encouraged. The Medical Nezvs belongs to that
class of progressive medical journals which duly re-
<;ognizes the work of psychiatry and neurology, and
their important bearing on general medicine. It speaks
Editorial. 329
Avell for itself in all departments of medicine, it has
spoken specially well for ours. We consider ourselves
equally fortunate with the Neivs in having the encourage-
ment of such eminent gentlemen as Yandell and McMurtr}'.
How the Jealous Public Protect the Insane. —
One would judge from the frequent public outcries against
■cruelty to patients in asylums and the jealous watchful-
ness and zealous interest verbally displayed in their behalf
by the dear people in so many other respects, that when
an opportunity is afforded of visiting just punishment upon
the wretch who would needlessly maim an insane man
placed in his care, they would mete out something like
retributive justice and make such deterrents examples
when opportunity is offered, as would teach those who
take service in insane asylums that helpless lunatics are
human and have rights to personal safety which attend-
ants are bound to respect. But fifty-dollar penalties (fine
and costs) for assault and battery on a defenseless lunatic,
such, as was lately adjudged against a brutal attendant of
a State Asylum, will not greatly protect the insane in our
asylums against the base cowards and inhuman fiends
who are sometimes found in them. Such brutes should
be sent to the penitentiar}'.
The Tri-State Medical ^ociety, according to the
St. Louis Medical Jottrnal, will meet this year a long way
from home. September is a good time to go to Mimieapolis
and the right royal reception given the American Medical
Association in that vicinity last year, seems to have left
an indelible impress on Dr. Rumbold, and he probably
thinks all the Medical Societies of the country ought to
meet either in or near St. Paul hereafter.
Or may be he meant Indianapolis, which, though a long
ways in another direction, is likewise a good place for
medical bodies to meet in and is where the next meeting
of the Tri-State will actually take place, and a good time
is promised and expected there.
The Association of American Medical Editors
will be held in the city of Cleveland, Ohio, simultaneously
with that of the American ^ledical Association, on June
5th and 6th, 1883. Addresses will be delivered by the Presi-
dent, Dr. X. S. Davis, of Chicago ; Dr. Hy. O. Marcy, of Bos-
ton, and special papers will de read by Dr. J. A. Octerlony,
■of Louisville, Ky., and Dr. Alexander J. Stone, of St. Paul,
Minn. The subject of the President's address is " The Pres-
330 Editorial.
ent Status and Tendencies of the Medical Profession and
Medical Journalism." Dr. Marcy's address will be upon
the subject of " Journalism devoted to the Protection
and Concentration of Medical and Surgical Science in
Special Departments."
The Higher Education of Medical Men is a sub-
ject in which the medical profession and the public are alike
deeply concerned and in which we should be earnestly inter-
ested. It cannot have escaped the notice of the observant
and thoughtful that no country on the earth has medical men
more superior and capable or a greater proportion of nied-
icores and incapables in the medical profession than ours. A
profusion of greatness, real and assumed, commingled in
true democratic style on the same broad footing " of equality
before the law," and in the estimation of a large number of
the people, characterizes Medicine as a practical science and
art in this great country of common schools, very common
medical colleges in some localities and common privileges.
Kleptomania following suppression of epilepsia by
the bromide treatment has lately presented itself in the
cases of a little girl of a haemiplegic clergyman, both
under our medical care.
The child will take money or any other article she can
get hold of, whether valuable or valueless to her, and give
them away as readily as she takes them, to any one who
will receive them. The stealing propensity is displayed by
spells, mux:h as the epileptic paroxysms were. This case
is interesting to consider, in connection with Bannister's
cases of insanity, recently reported, of a different charac-
ter following epileptic abeyance due to the bromide treat-
ment.
General Functional Neuratrophia. — What we
mean by this term is a condition of mal-nutrition of the
nervous system without appreciable structural lesion ; not '
that there exists no microscopical departure from the nor-
mal condition of the nervous system. There is, however,
no demonstrable complete and enduring solution of con-
tinuity in the nerve substance, and no such structural symp-
tomatology as results from known destructive changes in the
nervous mechanism. We diagnose this condition by exclusion.
It is the foundation of nervousness, so-called non-organic in-
sanity, hysterical paralysis, etc. So that while the symptom-
atic display may be marked enough, the real pathological
fault is rather trophic than more morbidly structural.
EditotiaL 331
Specialism in Medicine. — Dr. Hughlings Jackson's
aphorism that "too much specialism in teaching tends to
produce prigs rather than practitioners," is true enough
when too much speciahsm is taught, but when or where is
that the case? It is never too much of a subject to teach
it thoroughly. As knowledge increases in medicine, the
remedy is to provide ample methods of imparting it.
There is room for vast improvement in the methods of
medical teaching generally adopted. A good deal more
specialism in psychiatry and neurology in our medical
schools would save the profession from many blunders
before the people and the courts.
The Term Imperative Conception expresses
most admirably a state of mind often existing in insanity,
in which the delusional features of the toiit ensemble of
the faculties do not reveal themselves in ordinarily recog-
nized delusion, but in a state akin to it, in which con-'
ceptions, as they arise, are immediately associated with a
morbid feeling of the necessity of immediate action ; what-
ever is thought must be done. The sober second thought
comes with unusual tardiness, if it comes at all, but the
morbid mind generally does not question the propriety of
putting the concept into action. Such are many suicidal
and homicidal imperative conceptions.
The Hanimoiicl Prize of the American Neuro-
logical Association. — The American Neurological Asso-
ciation offers a prize of five hundred dollars, to be known
as the " William A. Hammond Prize," and to be awarded
at the meeting in June, 1884, to the author of the best
essay on the Functions of the Thalamus in Man. The con-
ditions under which this prize is to be awarded have
appeared in most of the monthly and weekly medical
journals, and may be learned on application to F. T.
Miles, ^I. D., Baltimore ; J. S. Jewell, M. D., Chicago ; E.
C. Seguin, M. D., New York.
Cotoin is recommended by Albertoni {Gazette Medica
Italia^ in the exhaustive diarrhoea of the insane, in chronic
uncomplicated diarrhoea, in the diarrhoea of phthisis, meloena,
etc., and in that of sucking and teething children.
The Center for the Salivary Secretion is placed
by Rochefontaine {Le Prog. Med. Nov. 18, 1882) in the sig-
moid g>^rus, electrical excitation of this part of the brain
causing excessive salivation, i. e. the point of origin of the
332 Editorial.
direct downward nerve impulse that induces the salivary
flow in contradistinction from the reflex act which is trans-
mitted aflerently through the gustatory branch of the fifth
crainal to the floor of the fourth ventricle and efferently
along the chorda tympani branch of the facial.
IN MEMORIAM.
Dr. Geo. M. Beard. — In the death of Dr. Geo. M,
Beard medical thought has lost a philosopher and the de-
partment of neurology and psychiatry an enthusiastic
worker. He has died in the midst of his work, at the
early age of forty-four years, having been born on the
1 8th of May, 1839. ^^ ^^^^ i^ ^&\n York, on the 23d of
January, after a brief illness of pleuro-pneumonia. Our
last letter from him was dated January 12th, and related
to the article he had sent us and which appears in the
present number of this journal. He was then in vigorous
health and hopeful of the future fame which awaited him.
Dr. Beard made mistakes (who has not ? ) in his writ-
ings, but no man was more ready to correct his errors,
and no writer bore adverse criticism with more manly
equanimity. This quality ripens the judgment, enriches
experience and makes final success inevitable to the per-
severing author who possesses it.
Dr. Beard's work on neurasthenia, though the symp-
tomatology of his subject was overdrawn, because of a
wider knowledge of neurology than of psychiatry, pos-
sessed by its author, is a valuable contribution to the
symptomatology of certain nervous states, which are too
obscurely recognized by the practitioner of general med-
icine.
Dr. Beard was earnestly seeking to unravel the mystery
of trance and mind reading of late years, and those who
have taken an interest in these phenomena will have cause
to lament his untimely death. His joint work on Medical
and Surgical Electricity (1875) with Dr. A. D. Rockwell,
reveals his skill in Ncuro-therapy by the aid of this agent,
which he early regarded as a nerve tonic as well as nerve
stimulant in 1866. His priority in the solution of many
In Memoriam. 335
phases of mind reading (so-called) based on the phenomena
of muscular tension and relaxation coincident with the
mental movements is conceded.
In 1866, Dr. Beard published "Our Home Physician,"
and in 1871 other popular treatises on "Eating and Drink-
ing " and " Stimulants and Narcotics." He wrote on hay
fever in 1876, and in 1877 a monograph on "The Scien-
tific Basis of Delusions," proposing a new theor}^ of trance
and its bearings on testimony. His book on Nervous Ex-
haustion first appeared in 1880. He subsequently pub-
lished a second edition. He proposed the bromide of
potassium for sea-sickness m 1881, and wrote on the psy-
chology of the Salem witchcraft and its application to
events of our time, referring to and discussing the conduct
of the Guiteau trial, maintaining the insanity of the presi-
dent's assassin and denouncing the injustice of his execu-
tion. He wrote also on sexual neurasthema, writers' cramp,
and many other neurological subjects. His papers may be
found principally in the Medical Record, North American
Rnnew, Fop2ilar Science Montkly, Journal of Neri'ous and
Mental Diseases, and in this Journal. He was an indus-
trious, agreeable and instructive writer, not always pro-
found to the professional reader, but especially popular
with laymen, and in the profession he kept the surface
waters of neurology agitated. While he lived there would
have been no stagnation wherever his thoughts might have
been turned. He was a friend to the insane, a zealous
member of the society for their protection, and we believe
he would willingly have corrected any error he might have
formed to their detriment. He seemed to us to be seek-
ing after truth in regard to them, though he did not always
find it. In a late letter to us he deplored the popular
tendency to liberate the really insane from our asylums.
In his death that society has lost a valuable member. He
was an advocate of higher medical education. At the late
meeting of the American Academy of Medicine he read
an elaborate paper on medical education, comparing the
general proficiency of German and French physicians with
those of England and America, and insisted upon an aca-
demic education as the proper basis for the thoroughly
educated physician. Dr. Beard left much unfinished work.
He died too soon. But he lived and died a philosopher.
Almost his last words expressed his regret, that he could
not record the feelings of a dying man.
HOSPITAL NOTES.
Eastern Michigan Asylum, Dr. Henry M. Hurd Su-
perintendent— The following summary of post-mortem ap-
pearances, furnished by Dr. J. D. Munson, will be found
■of interest:
In fourteen cases the brain was examined ; in one
the entire spinal cord; in fourteen the medulla and upper
-cervical region.
The scalp was found normal in nine cases; in three
extremely thick and vascular; in one very loosely attached
to the cranium, the vessels being congested ; in one very
^rmly adherent to the cranium.
The cranium was found to be extremely thick and
hard in two cases; thicker than usual in two cases; in-
creased in thickness but less dense than normal in one ;
excessively thin in one ; normal in seven cases. In two
•cases where death followed epileptic seizures the diploe
presented bleeding points.
The membranes of the brain were found markedly
changed in many cases. The dura-mater was thickened,
lusterless, and adherent to the skull in two ; in one, loosely
attached to cranium and filled with yellowish points, prob-
ably in consequence of fatty degenerations. The arachnoid
and pia presented deviations from a normal condition al-
inoot universally. These were cloudy, opaque, thickened,
with deposits of whitish material along the vessels, par-
ticularly at their branching. When patients died from
eonstitutional diseases the membranes were frequently
cedematous with effusion beneath the pia. In a case of
profound dementia hemorrhagic spots were found between
the arachnoid and pia on the right side. In a case of
senile insanity where extensive atherometous degeneration
-of the vessels had occurred, several chalky concretions
were found in the membranes of the convexity,' also a
small concretion accompanying a cyst near the lenticular
nucleus of the left side and another attached to the falx
and deeply indenting the internal face of the left hemis-
phere. Deposits of finely granular matter have been more
■common, particularly on the arachnoid at the base of the
Hospital Notes. 335
brain. In paretics the meninges have been found adherent
to the summits of the g^'ri on the anterior lobes, but not
as a rule to the posterior lobes of the brain. In paresis
the pia has been found thickened, opaque, and granular,
and separable with difficulty from the underlying convolu-
tions. Upon its removal the gray substance appeared
worm-eaten. Adhesions between the brain and its cov-
erings were occasionally found in all forms of chronic in-
sanity. They were located near the longitudinal fissure -
and posterior to the fissure of Rolando. They appeared
to be of long standing and were always dense, white,
granular, and fibrous. The adhesions found in chronic in-
sanity were not as extensive as those of general paresis.
In a phthisical case, tubercular deposits were found in the
course of the smaller vessels at the base of the brain. In
a case of general paresis extensive deposits of granular
matter were found on the velum interpositum, also two
small bodies of cartilaginous consistence. In a case of
chorea, thick, granular masses were found in connection
with the pneumogastric on each side of the medulla.
This patient died suddenly in a congestive seizure, but it
is not known what connection these deposits had with
the attack.
The venous sinuses were normal ; clots were sometimes
found in the superior longitudinal and more rarely in the
lateral sinuses, which to all appearance were of post-mor-
tem origin.
The middle cerebral artery was occluded in two cases,
and there was softening of those portions of the brain
supplied by it. The left and right sylvian arteries were
each found plugged once. In these cases extensive de-
generation of the vessels of the brain existed. In one not
a single arter}-, not even the smallest, was in a healthy
condition, and the larger vessels were calcified. Fatty
changes in both cases were v^ery marked. Fatty deposits
in the adventitia of vessels frequently gave them a bulged
or aneurismal appearance. The calibre of the vessels at
these points was generally lessened, and not unfrequently
the vessels were occluded. In some instances the arteries
were inelastic and brittle ; occasionally cloudy and opaque.
When death had occurred during convulsive seizures great
venous engorgement was always found.
The ventricles were normal in most of the cases. In
three instances they were distended with fluid, and in two
paretics the ependyma was roughened and granular. The
33^ Hospital Notes.
aqueduct of Sylvius was occluded in the case of an epil-
eptic imbecile.
The brain varied much in color, size, and consistency.
It was small firm, and with shrunken convolutions in two
cases ; softer than normal and dirty grayish yellow in two
cases of paresis ; extensive softening of the posterior por-
tion of third frontal convolutions, the island of Reil and
lower portions of the ascending frontal and ascending pari-
etal gyri in one case ; minute points of softening in another,
all doubtless from occlusion of the arteries. Sclerotic
masses were found in one case of paralysis agitans with
dementia ; gray degeneration in the white substance of the
brain in two, and complete destruction of the tempero-
sphenoidal g) rus in one case. In those who suffered from,
constitutional disease the brain was unusually pale and
anaemic, with gaping sulci, but no gross lesions were discov-
erable. In a paretic the remains of an old clot partially
organized and firmly united to the vessels was found resting
upon the posterior fibres of the crus cerebri. Owing to the
extensive paralysis which had existed prior to death the
exact significance of this leison could not be ascertained.
Upon section of the brain minute points of extravasation of
blood were frequently found, especially in paresis and other
forms of disease in which degenerations of the arterial coats
existed.
Valvular lesions of the heart, fatty degeneration, hyper-
trophy or dilatation were comparatively common.
Extensive tubercular disease of the -lungs was found in
two cases ; oedema in two ; great hyperaemia in one, and
pneumonia-hydro-thorax in another.
The pancreas was cancerous in one case ; the mesenteric
glands enlarged in two ; the supra-renal capsules were degen-
erated in two.
Peritonitis had existed in two, in one caused by the rup-
ture of a cystic and degenerated kidney, and in the other by
trichinosis.
In two cases the ascending colon was greatly distended ;
in one the transverse colon was of unusual length and
arranged in four parallel rows, each about six inches in
length ; a portion of the descending colon extending from
the splenic to the sigmoid flexure was only one-half inch in
diameter and seemed destitute of muscular fibres. In one
instance the intestines had tubercular deposits. One patient
had but twenty-two ribs. In one patient there was a com-
plete transposition of all the viscera, the cardiac extremity
Hospital Notes. 337
of the stomach being upon the right side, the liver upon the
l^ft, etc.
In one case a granular contracted kidney wa? found ; in
another interstitial nephritis ; in another the right kidney
was enormously enlarged and converted into a large cyst
which was filled with a dirty, grayish fluid containing pus.
The ureter was dilated enormously in consequence of the
occlusion of its lower extremity by a calculus, and was bound
to the ovary by strong adhesions. In another case both
kidneys had undergone cystic degeneration and the right one
had ruptured, producing suppurative peritonitis and death.
Microscopic Appearances. — In the brain of patients who
suffered from chronie insanity the microscope revealed atro-
phy of circumscribed areas of gray matter, and wherever
adhesions had existed between the cortex and the pia. pro-
found pathological changes and even total destruction of the
gray matter. Pigmentation and degeneration of nerve ceils
and their processes, patches of induration involving destruc-
tion of cells and fibres, minute points of softening, lymphoid
infiltration, and amylaceous bodies have been noted. The
arteries were often atheromatous, enlarged, contracted at
one point and bulging in others, their coats thickened and
nuclei increased, with fatty and lymphoid infiltration of the
adventitia, deposits of pigment at their branchings and in
the perivascular spaces. Aneurtismal dilatations of the
capillaries and thromboses of the smallest vessels have been
demonstrated.
In epileptic insanity the cortical cells have usually been
found well preserved. The arteries have generally been
found larger than normal, somewhat tortuous, and their
coats hypertrophied, but without fatty changes or infiltra-
tion of their adventitia. The perivascular spaces have been
been found wide, but rarely containing leucocytes, hematoi-
din crystals or pigment granules. The induration of the
comu Ammonis described by Meynert has not been
observed. In one case characterized by destruction of the
temporo-sphenoidal convolution sections of the neighboring
gyri showed sclerosis. In one specimen the vessels belong-
ing to the olivary bodies and the pneumogastric nuclei were
extremely varicose and twisted. Pigmentation of the cells
of the pneumogastric and hypoglossal centres has been
observed. The pathological changes found in epilepsy are
probably secondary and the results of an intra-molecular
disease which has thus far proven beyond the reach of
microscopic examination.
338 Hospital Notes.
In general paresis more pronounced pathological
changes have been found. The arteries of the brain have
been tortuous, their coats constricted at one paint, dilated,
thickened, and nodular at another, frequently studied with
leucocytes and round bodies which stain deeply and equally
with carmine, logwood or aniline blue-black. The perivas-
cular spaces were large oftentimes, and contained pigment,
hermatoidin crystals, leucocytes, and round bodies. Dilata-
tions in the vessels have been noted, but no capillary aneur-
isms. The coats of the arteries have often been found sep-
arated and the spaces thus formed have been filled with
white corpuscles. Fatt}' changes in the walls of the vessels
were rare, although granular deposits upon them were com-
mon. Minute hemorrhages have often been found, especi-
ally where congestive seizures have been frequent. Patches
of sclerosis, occurring more frequently in the inner layer of
the gray matter, or just beneath it, have been quite com-
mon. They have, however, been met with in almost every
region of the brain. Degenerations of the cortical gray mat-
ter have been most commonly found in the posterior portion
of the frontal convolution, in the lower extremity of the
ascending frontal and ascending parietal gyri, in the convo-
lutions of the island of Reil and in the cornu Ammonia. In
these regions the layers of gray matter have been found
indistinct, and in the outer zone made up of granular matter
and sclerosed tissue. The brain cells have been frequently
found isolated by the increase in the pericellular spaces and
their processes wasted or in an advanced state of pigmentary
degeneration. The cells appeared shrunken, without sharp-
ness of contour, and often deeply pigmented. The nuclei
have often been absent and the cells filled instead with
innumerable pigment granules. The gray matter in the
floor of tlie fourth ventricle has presented a similar appear-
ance, and the cells of the facial and hypoglossal nuclei have
rarely been found normal.
Hyoscyaiuine. — The amorphous preparation of Merck is
still administered with increasing confidence in its range
of therapeutic utility. In addition to what has been written
in a previous report, mention should be made of its bene-
ficial effect when administered in relapsing cases. In one
case of periodic mania characterized by a regular recur-
rence of maniacal excitement, preceded by great irritability
and accompanied by homicidal impulses, a single dose of
hyoscyamine on several different occasions was sufficient to
cut short the attack, in this case it produced a genuine
Hospital Notes. 339
intoxication. The patient sang, shouted, laughed, talked
incoherently, wept, and finally fell into a profound sleep
from which he awoke rational, quiet, appreciative of his
condition, and without a trace of his former mental dis-
turbance. By this means the periodicity of his disease was
so far arrested as to permit of his discharge upon trial
upwards of a year since. The patient himself recognized
that his improvement dated from the administration of the
remedy.
It is also of great service when properly administered in
changing morbid mental action and in destroying delu-
sions. In a case of maniacal excitement accompanied by
extravagant delusions of wealth, one-twentieth of a grain
administered by hypodermic injection was sufficient to de-
stroy the delusions, and they never reappeared. In another
case where there was persistent refusal of food and medi-
cine owing to a delusion that they contained filth, the regular
administration of one-twentieth of a grain hypodermically
for a week was followed by a complete cure of this delusion.
In epilepsy with strong homicidal impulses it has in several
instances completely changed the characteristics of the pa-
tients to whom it was administered, and has transformed
them into quiet, inoffensive men. There are certain patients
with whom it does not agree. In one instance it produced
choreiform movements and its administration required to be
suspended on account of the great discomfort of the patient.
In several instances it has interfered with the action of a
feeble heart and has required to be discontinued. Its action
upon the stomach is also peculiar. During the regular ad-
ministration of the drug there is almost invariably an increase
in appetite, but when it is discontinued nausea, vomiting and
extreme prostration result and continue for twenty-four to
thirty-six hours. It has never been customary to administer
it in large doses or to continue its use in increasing doses.
If a moderate dose is not followed by beneficial results there
is no advantage from a wholesale administration of the rem-
edy. In cases of chronic mania it is often extremely benefi-
cial to administer it continuously in a moderate dose until
the full constitutional effect of the drug is obtained. It is
undoubtedly curative in its action.
Codeia. — Unlike the other alkaloids of opium codeia can
sometimes be administered with benefit to allay maniacal
excitement. It does not increase the cerebral circulation to
the same extent as morphia or crude opium, and often
acts beneficially by allaying irritation. It undoubtedly
340 Hospital Notes.
equalizes the cerebral circulation and produces quiet when
delusions of a painful character exist. It is most service-
able in melancholia, especially when there has been persist-
ent refusal of food in consequence of delusions. Its com-
bination with sulphuric ether is frequently advisable in the
treatment of patients of this class.
Jaborandi. — The fluid extract of jaborandi {^pilocarpus
pennatifolius) has proven serviceable to those patients who
suffer from melancholia and who pick the flesh of their
faces, hands, and other exposed surfaces of the body. In
these cases there exists an actual cutaneous anaesthesia,
giving rise to an alteration of sensation which is described
as " stiffness," or "numbness." Jaborandi administered in
doses of three to five drops of the fluid extract has afforded
marked relief in many of these cases. One patient who
had the delusion that her flesh was filled with worms, and
who was constantly endeavoring to pick them out, under
the use of this remedy relinquished the delusion for several
weeks.
The only disadvantage which has arisen from its pro-
longed administration has been its tendency to produce
eventually a free flow of saliva. This has sometimes been
so excessive as to require a suspension of the remedy.
Chloride of Bariiivi. — This salt has been used with marked
benefit in the secondary stages of general paresis when
marked ataxia exists, and a loss of ability to co-ordinate
muscular movements. Its action seems to be similar to
that of other metallic tonics. It does not arrest the dis-
eased process, but renders the nerve cells which have not
undergone destructive changes more potent. It has been
customary to administer it in doses of a single grain, and
this quantity rarely interferes with the functions of diges-
tion. Under its use marked improvement has been noticed
in the ability to co-ordinate muscular movements. The
general paretic articulates more distinctly and walks with
greater precision. He also executes the more complicated
muscular movements with greater ease. If administered in
combination with hyoscyamine it frequently affords grateful
relief to cases of paralysis agitans, and of senile trembling.
In these cases the patient experiences much discomfort
from the tendency to tremble, even when no muscular move-
ment is attempted, and makes a determined effort of the
will to avoid it, but to no purpose. These remedies produce
quiet and give an opportunity to the affected muscles to
rest.
Hospital NoUs. 341
Convallaria Majalis. — This remedy has been adminis-
tered with marked benefit in cases of cardaic weakness. It
acts as a synergist to the heart's action, and its prolonged
use has not been followed by depression. It has proven
rapidly beneficial in the congestive attacks which are devel-
oped in the course of general paresis.
Monobroviate of Ca7nphor. — This drug promises to be of
lasting value in certain cases of insanity accompanied by
mild excitement and perversions ot the sexual instincts, also
in hysteria and states of mental weakness characterized by
emotional disturbance. Its range of therapeutical useful-
ness is not large. Within its proper sphere, however, it has
frequently proven beneficial in a class of cases where other
remedies failed. It is mildly hypnotic and anaphrodisiac in
its action. In the majority of cases sleep only follows its
use when it is given in full doses. In a single instance
bromism followed its prolonged administration. The symp-
toms were not severe and the eruption of acne was confined
to the cheeks and nose. The drug does not irritate the
stomach nor interfere with nutrition. Its action upon the
heart is sedative and it lessens the frequency of the pulse.
It also lowers the bodily temperature and the number of
respirations. It is free from the depressing and debilitating
effects of bromide of potassium and no disorders of speech
or motility follow its prolonged use.
In an erotic, hysterical patient with strong religious de-
lusions and destructive tennencies, who was frequently noisy,
emotional and sleepless, the continuous employment of the
drug ameliorated her symptoms to a marked degree. In
another case with strong erotic tendencies accompanied by
great irritability and impulsiveness, it proved equally service-
able. She became less violent and improved in bodily health
and mental condition. In still another case, one of demen-
tia characterized by confirmed vicious habits, erotic delu-
sions, loquacity, and general lack of propriety, it was
beneficial. In an imbecile of the first grade who became
excessively excited in consequence of habits of masturba-
tion the severity of the period of excitement was readily
modified by the regular administration of the drug.
It has not been administered in epilepsy. It seems to
control the muscular tremors of degenerative brain diseases
and the involuntary' movements of chorea. Hence by anal-
ogy it would seem to promise some utility in epileps}'.
Ttibercular Insanity. — In view of the statement of Dr.
Clouston, of the Royal Edinburgh Asylum, in reference
342 Hospital Notes.
to tubercular i?isatiity, it may be interesting to know, that
in the experience of this Institution, delusions of the char-
acter which he considers pathognomonic of tubercular in-
sanity, accompany all constitutional diseases, such as
tuberculosis, cancer, Addison's diseast, or organic disease
of the heart. These delusions seem to be due to the de-
pressing effect of the constitutional disorder upon the
general vitality of the individual, and cannot with propriety
be considered pathognomonic of tubercular disease alone.
It is undoubtedly true that cases of tubercular insanity
are much more frequent than cases of insanity from other
constitutional diseases. At the same time there seems no
ground for distinguishing it in any way clinically from
the insanity of cancer or of Addison's disease.
Missouri. — Fourteenth biennial report of the State Lu-
natic Asylum at Fulton ;
Total number treated during the two years ending Nov,
27, 1882 : Males 510, females 361 ; total, 871, of whom 371
were discharged, as follows : Recovered — Males 107, females
68. Much improved — Males 12, females 9. Stationary —
Males 53, females 9. Died — Males 64, females 49.
Though Dr. Smith and his Board of Managers in their
last report appealed most earnestly for relief and made plain
the necessity for better accommodations for the insane of
the Commonwealth, the Legislature evidently failed to pro-
vide the means requisite for the extension of the old. insti-
tutions or the erection of a new one, and now two years
later we have these gentlemen going over the same ground.
Dr. Smith, with evident feeling, refers to his life spent m
efforts to relieve the sufferings of the insane, his frequent
and urgent appeals for assistance without his being able to
rouse the people to a proper sense of their responsibility in
the matter, and concludes as follows: "This, in all proba-
bility, is the last biennial report I shall ever make, and if I
can be at all instrumental in inducing our next General
Assembly to realize this subject in all its magnitude and
act accordingly, I would contemplate the new and brighter
era about to dawn upon the insane with a degree of satis-
faction and pleasure language could not well portray, the
remaining days of my life and in life's closing hours." We
hope that the doctor, if his health permits, will find it best
to reconsider his determination and conclude not to quit the
good work, and we trust that his apparently last appeal
will receive the attention it deserves from the public, the
good men and women too who place the legislators where
Hospital Notes. 345
they are and who have the power to eventually make them
do that which is equitable.
A Retired American Superintendent notes with
approbation the following articles in the (Januar}')
Journal of Mental Science : Ireland on — Joan of Arc.
Cameron on — Philosophy of Restraint, pg. 523, etc.,
with the practical conclusions. Wilks on — Environ-
ment, pg. 549. Colonial Retrospect, pg. 635. Dr.
Manning's Report on Superintendents, etc., pg. 640,
•Reviews, Book Notices, Etc.
Proceedings of the Association' of Medical Ufficebs of Amer-
ican Ikstitutions for Idiotic a>'d Feeble-Minded Persons. Sessions^
Frankfort, Ky., May, ISSl ; Elwyn, Pa., October, 1882; pp. 102. J. B
Lippincott & Co., Philadelphia.
This pamphlet shows a commendable activity among those engaged
in the institutional care and training of the feeble-minded, and a consider-
able growth of a comparatively new work. The reader is struck with the
novelty and variety of thought which this subject commands, and which
may be indicated by the titles of the eight paj^ers of which the body of
the Proceeding-: consists.
Dr. Tarbell, of the Massachusetts Institution presents a paper oa
"Height, Weight and Relative Growth of Normal and Feeble-Minded
Children,''' with the following conclusions:
"First. — That idiotic and feeble-minded children in our schools
throughout their period of growth are about two inches shorter, and nlue
pounds lijihter than normal children of the same ages.
"Second: — That the relative rate of growth of the two sexes of idiotic
children corresponds \ery nearly to that of the two sexes of normal chil-
dren, and is subject to the same variations at the age of puberty ; and
'•Third: — That the period of puberty is about two years later in idiots
than m normal children."
The veteran Dr. H.B. Wilbiu* of the New York Institution, discusses
" Some of the Abnormal Characteristics of Idiocy and the Methods Adop-
ted in Obviating them." This article is thoroughly metaphysical, until
coming to the application of his reasoning in an interesting description of
the initiatoiy means for the education of the feeble-minded child. Dr. I,
X. Kerlin, of Pennsylvania, contributes a paper on, "The Epileptic Change
— its Appearance Among Feeble-Minded Children,"' which appeared in
the Oct. number of the Alienist and Neurologist. His assistant. Dr.
VV. B. Fish, gives a practical article on the "Medical Treatment of Idiots
and Imbeciles."
Mrs. T. W. Brown, of Barre, Mass., presents a pleasing resume of a
344 Reviews, Book Notices, Etc.
visit made in 1881, to the four prominent institutions of England — that at
Darenth, Kent, the great establishment at Earlswood, the Royal Albert at
Lancaster, and the private establishment of Dr. J. I.angdon Down, at
Normanstield.
Dr. J. Q. A. Stewart, of Kentucky, discusses the industrial training of
his wards, while Dr. C. T. Wilbur elaborates very thoroughly the class-
loom ti'jiining of the Illinois children at Lincoln.
Tlie new Institution of Kansas is represented in the Proceedings by
Hon. H. M. Greene, who, in a graceful paper on the relation of the State
to its charities, evolves the doctrine that '' State Charity " is a misnomer,
and that the helpless are just claimants on the lostering care of the Common-
wealth ; one of his illustrations is so striking, that we must repeat it here :
'' Our wards are innocent of crime or fault. In the large majority of
instances they are the feeble and di-formed expressions of parental sins
■or sorrows. And those sad traits, in very many instances, are the'ieflec-
tion of woes wliich the State has directly or indirectly csiised. In my
own State there have been successive eras of Indian and lebel invasion,
to say nothing of the occasional experiences of drouth and insect plague,
which have left other traces than lonely graves and ruined homes, and
memories of eternal sadness. Picture a delicate woman, cultured and
refined, leaving a beautiful Eastern home, loving, life-long known kindred
and friends, and in company ^\ith the man she has chosen, selecting a
dwelling-place far out on the green sea of the plains, where neighbors
were a day's journey aw^ay, and letters from home were weeks old before
aiTival. Lonely enough, when Ae was witli her, but when he was gone,
and she was alone, who can gauge her anxieties? And when, one awful
morning, the troops brought him home, lifeless and mutilated, and she
realized that life for her was done, you need not be told the effects upon
her unborn child. Affrighted at every sound, in a perpetual panic, he
reproduces, happily for him without her mental sensibility, the terrible
ordeal through which his mother passed. This is not a fancy sketch.
The horrors of the formative era of our State can never be told, especially
as they fell upon our brave pioneer women. Tlie duty of the State to iier
heroic dtad, slain in her service and settlement, will l)e but half fulfilled
when the dead are cared for. The unfortunate children, upon whom are
impressed all the terrors of the time, are rightful claimants of her fostering
care." — See p. 257.
Professor H. H. Smith, Emeritus Professor of Surgery of the Univer-
Blty of Pennsylvania, in his reception address atEIwyn, in speaking of the
scientific work expected from this class of institutions, says:
" An important step in elucidating the pathology of idiocy will be the
acquisition of euch anatomical data as can be furnisliod onlj^ by the post-
mor<e»/i examination of idiotic brains; but as few superintendents are ex-
perienced micro^copists, or familiar with brain histology, some one should
be found capable of examining the specimens thus furnished. Let this
general brain pathologist receive with each brain an accurate life history
of the subject. Let each institution remunerate him for his skill and
labor, and there can be no limit to the scientific work that will thus
be done. . . .
Rei'iezvs, Book Notices, Etc. 345
The pamphlet reviewed contains further the Minutes of the Meetings
at Frankfort and Elwyn, from which we are pleased to make the following
extract :
Oct. 5th, 1881, Thursday, 8 P. M.
The Association met in Music Hall, and listened ro highly instructive
and entertaining lectures, by Prof. Hailes, of Albany, on "A Few Points
in Embryology, Derived from the Study of the Development of the Chick."
and by Prof. C. K. Mills, of Philadelphia, on "Cerebral Localization,
Chiefly with Eeference to Idiocy." Both lectures were thoroughly illu;-
trated on the screen by photo-micographs.
After the lectures, Dr. Kerlix called the attention of the Association
to the importance of attaching to our work the services of a pathologist
who should be so amply remunerated that his whole time could be given
to our institution, and that he should be not only subject to call for post-
mortems, but that he should become familiar with the life history and
phenomena of cases in the various institutions of special scientific interest
to the profession.
The subject was very fully discussed by Dr. H. B. Wilbur, Dr. G. A.
DoREN, and Prof. Hailes. and a conclusion reached, that the appointment
of a pathologist was a desirable step for our Association to take, and that
the larger institutions should unite in the expenses such an appointmtnt
wUl entail."
We shall hope that this progressive step vrill at once be taken, from
which most interesting results are so sure to follow.
The Transactions of the Colorado State Medical Society,
(twelfth annual convention held .it Pueblo. June, 1SS2 ) are highly creditable
to the profession of that young state. The address of President H. A.
I.emen is a masterly survey of the field of medical progress, presented
in a scholarly manner, indicative of observant study aud true medical,
rather than mere business interest in the great profession of the present age ;
Dr. Charles Deuison's paper on the Infectiousness of Phthisis, indi-
catfs no less observation and familiarity with its theme than the pre_
ceding address. The Report on Climatology, by Dr. Solly, the paper on
Cerebral Localization by Dr. J. H. Kimball and that on the Fevers of Col-
orado, are worthy of the oldest societies in the country, and Dr. Eisners
Essay on Tracheotomy and Dr. Green's on Sympathetic Ophthalmia are
papei-s of real practi<;al value, in short, nothing in the proceedings appears
worthy of adverse comment, except perhaps the unmerited space devoted
to irregular medicine. The fools of the world must feed on folly and they
are prone, the world over, to reject with scorn all gratuitous enlighten-
ment as prompted by selfish motive. The excellent paper of Dr.
P. K. Thombs, the genial and accomplished superintendent of the Hos-
pital for the Insane at Pueblo, is judiciously and timely presented. He
has done his share, as asylum medical officers ought to do everywhere
when proper opportunity aflbrds. in presenting to the profession of Colo-
rado his conceptions of the relationship of psychiatry and neurology to
general medicine, and in giving an epitomized view of the progress of
these essential departments of medicine. The address of Dr. Thombs
appears in full in our pages. Dr. Geo. M. Cox sliows an intimare familiarity
346 Reviews, Book Notices, Etc.
with the subject of his essay, thouofh with the characteristic modesty
of most authors, he disclaims familiarity with it. We should say, after
carefully reading what the doctor has so well said, that the theme i&
peculiarly adapted to Cox. A singular instance of mental and moral per-
version, worthy of study by alienists is the following .which we tran-
scribe in the language of the essayist:
" It now only remains for me to describe an individual who seems to-
deserve special mention and special study, inasmuch as he not only stands
alone in his peculiarities, but is absolutely unrivaled and unimitated in the
role he assumes in the world of prostitution, and therefore does not belong
to any of the classes already alluded to.
"This man has a wife and several beautiful children, and within the
sanctity of his home, where he is always to be found during the evening
his precept and example are so noble and pure and good tiiat his influence
is felt and praised by all of his many friends and admirers. But at stated
periods away from home, he is a holy terror to the biblical standard of those
who have the promise of seeing God, an angel of mercy to the fast women
whom he patronizes and an insoluble enigma to all mankind.
" He has never been known to coliabit.with a lewd woman, nor to speak
an immodest word; but he is a regUar visitor, and, in his peculiar way, a
liberal customer at certain houses of ill repute. Elis custom is to go early
in the afternoon, select two or three of the largest girls in the house and
repair to a private room and lock the door. Here he divests himself of
every stitch of clothing from the waist upwards, but never removes his
pants or boots. "J hen, lying prostrate upon the floor, with his hands light-
ly crossed over the abdomen and his ej'es tightly closed, he commands his
companions to walk over his naked chest, neck and face, taking care to stop
at each step to grind his flesh with the heels of their boots. After this pro-
cess has continued for some time he begins to buy tlie wine fitr the girls to
drink, but religiously abstains from taking a drop himself.
"About the only noticeable interest he takes in the proceeding is an oc-
casional demand for a heavier girl, or for some means by which they can
increase the severity of the punislimjiit. The tramping process goes on
urinterruptedly for two or three hours, at the end of which time he will
have ordered a dozen or more bottles of wine, besides paying tiie fair tramp-
ers handsomely for their time and trouble.
"One of his diversions is to make one of the girls stand on his chest
with her entire weight on one boot-heel, and have the others spin her
around until hisflesli is torn and bleeding. He will also frequently direct a
girl to place one foot across his eyes with the boot-heel resting in one orbit,
and th«! other foot across his throat. He will keep her in this jmsition for
live or ten minutes— thus sustaining a weight of one hundred ai d fifty
pounds or more. It would be impossible to mention all the means of
torture that this man has invented and submitted to, but 1 merely
mention these few facts as being fair samples of dozens which I have
lieard of.
"At the conclusion of one of these matinees our liero puts himself
through a course of rubbing his injiux'd spots with his naked hands; and a
very strange part of the story is the fact that by this simple process his-
Reviews, Book Notices, Etc. 347
bruises, scars and ecchymosts will almost entirely disappear within a rery
few minutes.
"Having thus rubbed himself back to .the state of presentability. lie re-
sumes his clothing, pays his bill and takes himself off to the marts of trade,
but only to return and repeat the strange entertainment in about a week. ''
The Higher Education op Medical Men and its LxFLtTEXCE ox the
Profkssion axd the Pi.'blic. -Address delivered before the American
Academy of Medicine, at its fifth annual meeting, held at Providence. R.
I., September 2S, 1880. by F. D. Lente. A. M., M. D., President of the
Academy. — The autlior thinks that "it may be justly charged that our
standard of medical education has retrooraded from its earliest founda-
tion in this country, to the present time." Referring to the usages in the
beginning of our history, " a far longer peri<)d of study and a more
mature age were considered necessary to master the science then than
now ; .and, above all, a far|higher grade of preliminary training and acquire-
ment. The remedy in a nutshell is preliminary education. The area of
study has been more than doubled. What additional time has been
added to the regular courses of our colleges to meet this additional
requirement of study ? Within'a very recf^nt period several colleges have
adopted an additional session, and some have added one. two and three
months to The session; but the large majority have made little or no addi-
tion which is obligatory.''
" As our Colleges are mostly private institutions, to keep them going
without too great a pecuniary sacrifice, students must be had at all hazards
and hence follows a rivalry or competition, not for turning out good phy-
sicians, but a good number. The great defect is the admitted antagonism
which ( xists betweeu ihe duty and the interests of the corporations."
The author does not wish to be misunderstood, or quoted as deprecia-
ting the condition of medical science in the United States. This by no
means corresponds with the status of the medical profession, paradoxical as
the statement may appear. In spite of the obstacles just referred to. and
others yc-t to be noticed, we are certainly not behind any country in the
world as regards our achievements in practical m'.'dicine and surgery.
A profession will be judged, not by a few shining lights, but by the
condition of the body. " Everj- ignorant man." says Dr. G*o. E. Paget,
"has an injurious influence on the estimation in which the entire body is
held. His demerits have a tendency to lower us throughout the circle in
which he is known. The want of confidence in him, and the want of
respect for him. beget distrust and disrespect for the profession in general.'*
In answer to the question, how are we to limit the number of physi-
cians, he says, '• to make our system of instruction correspond, in some
manner, to that which prevails in all other parts of the civilized world.
We are all aware that nowhere is the door so widely open to entrance into
the medical profession as here. Xot only are the requirements for entrance
into the medical colleges, and for the diploma, fax hi«;her in the old and
principal governments of Europe, but in such countries as Australia. Chili.
Venezuela and Cuba. By such a course, we would diminish the quantity
and improve the quality."
The true remedy for the great evil in this country of inadequate med-
348 Reviews, Book Notices, Etc.
ical knowledge and training among the majority of medical practitioners, is
neither in state examining boards nor in preliminary literary degrees.
The real remedy lies in an esprit du corps in the profession and in the moral
vis (X iergo of an enlightened people. These are surely coming as we
grow older, and telegraphs and the press and railroads bring the best
work of the best educational centers before the whole people.
We want logically trained and observant medical men as well as thor-
oughly taught students to solve the problems of disease.
Let the profession search for and encourage those schools which
have established liigh standards of proficiency and who exact high quali-
fication and long enough terms of study, to insure trained ^medical minds
and let j^hysicians discourage young men of small calibre and great ex-
pectations from choo^iing medicine as a calling. Medicine, to be mas-
tered, is a calling demanding ample time, some means and a reserve force
of persevering industry, in its proper pursuit.
The necessity of looking out for the loaves and fishes from the start,
aborts many an otherwise honest man in our ranks, turns him into dis-
reputable chaftnels and fates him for failure. It is better to have still
births than living monstrosities. A little less fecundity and fewer prema-
ture births would be more creditable to many medical Alma Maters. Let
us have a little longer gestation for our medical foetuses, a little longer
lactation tor our medical babes and tewer of them, and a little more and
better pap for the growing young doctor.
The Crime of Suicide and flow to Prevent its Increase by Legis-
lation OR Otherwise is the subject of a recent essay read at the last
session of the New Yoi-k Medico-Legal Society, by Clark Bell Esq., Presi-
dent of the Society, in which the statistics of O'Dea, the researches of
Brierfe de Boismont, Foville, Gray and others are discussed, and the con-
clusion is reached, after introducing the propositions which Dr. Jaennell
sought to have incorporated into the penal code of France, that Dr. Jaen-
nel " met the objections " raised to his proposed law '' by powerful argu-
ments," and the conclusion is also arrived at by the author that legisla-
tion is needed to exert : First, a force upon the moral sense of the
community to render the crime of suicide more generally odious and
detestable. Second, to arrest the hand of weak persons who now really
encounter no resistence to their suicidal ideas, by legislation or public
sentiments.
The author notes in brief the views of Blackstone,the maxims of Mon-
tague, the views of the Cynics, Epicureans and the tenets of the old Roman,
French and English laws. The author has drawn very largely on the
work of Dr. 0'')ea, to whom he acknowledges his indebtedness.
The life of a suicidally disposed individual having no legal dependen-
cies is, so far as the State is concerned, his own. He can do what he may
please with it, unless the State can establish a claim on that life.
But the State does not give ii, cannot prevent its coming into being and
cannot prevent its going out of existence except to the extent of its lawfUl
claim.
The State may decree the suicide of a married man or a minor, crim-
inal or one owing service to the State by reason of enlistment or having^
Reviews, Book Notices, Etc. 349
accepted oflBce (but office holders hardly ever feel inclined to suicide) or
punish the unsuccessful attempt by a degree of servitude under surveil-
lance, providing hira labor and placing the products of his labor to the
credit of his dependents, after deducting actual cost of maintenance, if he
De sane ; if insane, then it is the duty of the State to provide asylum
security.
The State might also require a term of military service for all citizens
and make it criminal to attempt suicide while that service is due.
It is the presumption of insanity that justifies interference with the
suicide. Who should take from a sane man, if he should seek to kill but
himself, the liberty of disposing of his life in a summary manner, in such
a way as might please him. If self-destruction be his pursuit of happiness,
the spirit of the law guarantees this, as it permits the citizen to pur>ue a
gradual course that may lead to destruction, if he deems it the best road
for happiness to him.
The Sympathetic Diseases of the Eyb,* always of deep interest to
the ophthalmologist and the ophthalmic surgeon, possess also a special
interest to the neurologist, for the patholoiriftil lessons they teach con-
firmatory of the neural relationship of dlffereut and distant parts of the
organism.
The phenomena detailed in the interesting book before us by Ludwig
Manthner are no less interesting than the anaesthesia transfers and alter-
nate or coincident morbid implications or symmetrical of corresponding
parts of the nervous mechanism elsewhere in the system.
The book before us will be equally interesting to the general practi-
tioner for the real light it will give him on the sympathetic aflFections of
the eye, enabling him to treat or advise concerning them more judiciously
than before its perusal. The anatomy, etiology, pathology, pathogeny
and therapeutics of the subjects which properly come under the titles, are
forcibly and cleverly presented in such a manner as to be readable with-
out weariness.
The book is instructive without verbosity and clear without prolixity;
enabling the general practitioner and the student in ophtlialmology to
gain an insight into what should be the practical treatment of the more
important diseases of the eye, with the least possible amount of that need-
lessly voluminous detail of cases with which some other works abound.
The work of the translators and publishers is well done — Wm. Wood
«fc Co.. of New York, are the latter. Our much esteemed friend. Dr.
Webster, has our thanks for the book and his compliments are cordiidly
recip located.
The Rights of thb Lnsane and theib Esforcemext. By Clark Bell,
Esq., President of the Medico-Legal Society of Xew York.— The tone and
tenor of this address is not such as to win for it the utmost confidence of
the thoughtful and observant. The author betrays a lack of that practical
familiarity with his subject which justifies confident speech, yet he speaks
*By Ludwig Manthner, M. D. Translated from the German by Warren
Webster, M. D., Surgeon U. S. A., and James A. Spalding. M. D., Member of the
Am. Ophtli. Soc. ; Ophth. Sargeon to the Mame General Hospital .
350 Reviezus, Book Notices, Etc.
■with assured confidence and in some places lie is vigorously sensational, as
when he speakes of the " clang of the asylunn door having a sound more
avpful than the dull fall of ihe clods upon the cofBn of the dead " and gives
as the most important of all lensons for a Lunacy Commission, "thenec-
essity of supervision and control over asylum superintendents for the
welfare of the inmates, and the proper administration of remedial agents "
He thiuks the harmless insane stiould be free, whereas it is only the
incurable and harmless who might be thus left to take care of themselves
and not all of them.
There are some good things in this addres*, but its author is appar-
ently better posted in matters legal than medical.
Psychiatry is evidently not his sphere any more than it is Ben Butler's,
whom the author quotes as an authority on insanity. We believe in agita-
ting the rights of the insane, in efficient State surveillance, in freedom
from all needless restraint and In all needful restraint.
Judicious inspection of state, corporate and private and religions
asylums would right many wrongs and reveal many evils toward the
insane, but we should weigh well oiu- words in their behalf, lest we wrong
them with good but unwise intention.
The Truth and Removal, by Charles Guiteau is a fool's unconscious
monument to his and the government's folly.
One cannot read this book through, if he be at all skillful in analyzing
the Inconsistencies of mental imbecility and aberration, without reaching
the conviction that its author was neither sound nor sane-minded, wliat-
ever conviction one might hold as to the public policj" of Guitenu's execu-
tion or of his responsibility, entire or limited, for Garfield's death.
The key to this unfortunately born and surrounded character is shown
in the subjects he preferred to be considered pre-eminent upon, and in the
standaid of comparison they afford with his subsequent erratic and insane
career.
"'the Truth "he says, "is my contribution to tlie civilization of the
race, " and he asks for it " careful attention to the end, that many souls
may find the Saviour. A new line of thought runs tlirough it and if it
does not demonstrate the existence of He.iven or Hell, '' he submits that
" their existence can not be proved." He was '* on theology two or three
years and this book is the result." It was " written as I had light dur-
ing the period," he says, and so he saw that Christ came A. 1). 70 and so
he shot Garfield.
What Shall we do for the Drunkakd? A rational view of the use
of brain stimulants, by Orpheus Everts, M. D.. Supt. Cin. Sanitarium, late
Supt. of the Indiana Hospital for the Insane. This a rational view in fact of
this peqilexing subject. Intemperance is viewed by the author both as a
vice and as a disea8<', and adequate legal restraint and appropriate medica-
tion are conjointly recommended.
The vicious element as well as the morbid element in inebriety are to
be reached. Hospitals for the inebriate, provided or countenanced by the
State, with places of industry attached are recommended, to which every
man and woman, who by the force of morbid habit, is incsipable of refrain-
Reviews, Book Notices, Etc, 351
ing from the causes of drunkenness, should be committed by well guarded
laws, end become for all needful time the wards of the state.
The Amebican Journal of Neukology and Psychiatry, edit( d by
Drs. T. A. McBiide, I.andon Carter Gray and Edward C. Spitzka, all well-
known writers on psychological and neurological subjects, isjust received,
that is, the four numbers for 1882 are. We regret that we had not sooner
seen this very creditably gotten up and aDly conducted quaiterly. The
multiplication of psychiatric and neurological journals is a hopeful sign
of present and coming progress in medical science. The most intert sting
and valuable feature, of this journal is: "The Somatic Etiology of Insan-
ity, " being the VV &. S. Tuke prize essay, which is being published as a
supplement by its author, Dr. Edward C. Spitzka.
Herbert Spencer on American Nervousness. A Scientific Coin,
cidence, by Greo. M. Beard, is a small brochure from the publishing house
of G. P. Putnam's Sons, in which the late Dr. Geo. M. Beard ha^; placed in
juxtaposition with his own views in his work on American Nervousness
and other writings, numerous extracts from the speech Mr. Spencer made
lately while in this country, entitled the Gospel of Relaxation, and which
appeared in the Popular Science Monthly for January. The coincidences of
thought and speech as shown in this little book are interesting reading
and would prove of value to any one wishing to be doubly impressed with
certain observations on this subject.
Lecture on Artistic Anatomy and the Sciences Useful to the Artist.
The first of the regular series of lectures upon these subjects, delivered
Jauuary 30, 1883. By S. V. Clevenger, A. M., M. D. Reprinted from the
Chicago Medical Journal and Examiner, for February, 18S3. The author
handles his theme artistically, while at the same time adhering to truth
with anatomical accuracy, if the simile may be permitted. This is a
chaste, classical and accurately scientific contribution to a theme as yet
not over-wrought. We thank the talented author for the pleasure derived
from its perusal.
Scrofula and its Gland Diseases An introduction to thej general
Pathology of Scrofula, with an account of the histology, diagnosis and
treatment of its glandular afiections. By Frederick Treves, 1^'. R. C. S. Eng..
Assistant Surgeon to and Senior Demonstrator of Anatomy at the London
Hospital ; Late Wilson Professor of Pathology at the Royal College of
Surgeons. This is one ot Henry C.Lea's Son & Co's ten-cent books and
it would be valuable at a much higher price.
Naso-Antral Catarrh and its Treatment. By W. H. Daly, M. D.,
Pittsburgh, Pa., Fellow of the American Laryngological Association;
Physician for Diseases of the Throat and Lungs to the Pittsburgh Free Dis-
pensary, Pittsburgh, Pa., Senior Physician to the Western Pennsylvania
Hospital. Pittsburgh Pa., ex -President of the Alleghany County Medical
Society, etc., etc., etc. Reprinted from the Archives of Laryngology, Vol. iii.
No. 4. Oct, 1882.
The Character and Hallucinations of Joan of Arc. By William W.
352 Reviezvs, Book Notices, Etc.
Ireland, M. D. Read to the branch meeting of the Medico-Psychological
Association of Edinburgh, November 1st, 1882. — Tliis is an interesting
account of the life and history of this remarkable character which is to be
followed by a psychical analysis.
Medico-Legal Relations of Insanity. By Ira Russell, M. D., Win-
chendon, Mass. Reprinted from the Boston Medical and Surgical Journal
of December 14, 1882. — This is an instructive address.
Extract from Third Biennial Report of Board of Trustees of the State
Charitable Institutions of t!ie State of Kansas, relating to the management
of the State Asylum for the Insane, at Oswatomie, Kas., for the Biennial
Period ending June 30, 1882.
Rejiort of the Permanent Commi^Jsion of the Medico-Legal Society, in
answer to the Senate Resolutions of Janu ny 4, 1882. In reply to the let-
ter of the Attorney-General and State Commissioner in Lunacy of the
State of New York.
The Percentage of College-Bred Men in the Medical Profession. A
paper read before the American Academy of Medicine, Oct. 27th, 1882, by
Charles Mclntire, Jr., M. D., of Easton, Pa.
Annual Address delivered before the American Academy of Medicine,
at Pliiladelpbia, October 26th, 1882, by Traill Green, A. M., M. D., President
of the Academy.
Address of President II. A. Lemen, of Denver, delivered before the
State Medical Society at its Twelftli Annual Convention, at Pueblo, June,
1882.
Official Report of the State Hospital for the Insane, for the South-
Eastern District of Pennsylvania, at Norrlstown, Pa., to September 30, 1882.
Biennial Report of tlie Minnesota Hospital for Insane, organized 1866,
located at St. Peter, and Second Minnesota Hospital tor Insane.
Thirtieth Annual Report of the Pennsylvania Training School for
Feeble-Minded Children, Elwyn, Delaware ("ounty. Pa.
Tiie 112th Annual Report of tlie State of tlie New York Hospital and
Bloomingdalt! Asylum, for the year 1882.
Annual Report of tlie Wisconsin State Hospital for the Insane, for the
Year Ending September 30. 1882.
Seventli Annual Report of the President of the John Hopkins Uni-
versity, Baltimore, Md., 1882.
The Management of Clironic Inebrhites and Insane Drunkards. By
Albert N.Blodgett,M. I).
Iteport of the Superintendent of tiie Insane Asylum of the State of
California, 1882.
Reviews, Book Notices, Etc. 353
Report of the Illinois Eastern Hospital for the lasane. at Kankakee,
October 1. 1882.
Annual Report of the State Ajsylum for the Insane, at Morristown. N".
J.. 1882.
Report of the Eastern Michigan Asylum at Pontiac, for the yeftr 1SS2.
Report of State Charitable Institutions of the State of Kausas, for 1882.
Report of the Illinois Southern Hospital for the Insane, at Anna.
Biennial Report of the State Lunatic Asylum at Fulton. Mo.
Annual Report of the vViHard Asylum for the Insane, 1S82.
Report of the State Hospital for the Insane, at Dinville, Pa.
Annual Report of tlie Cleveland Asylum for the Insane.
Reports of the Butler Hospital for the Insane. 1883.
Annual Report of the Cincinnati Sanitarium, 1882.
ADDEN DUM
The Thirty-Seventh Annual Meeting of the
Association of Medical Superintendents of
American Institutions for the Insane will be held at the
" Ocean House," in the City of Newport, R. I., on Tuesday,
June 19, 1883, commencing at 10 A. M.
Resolved, " That the Secretary, when giving notice of
the time and place of the next meeting, be requested to
urge on members the importance of prompt attendance at
the organization, and, of remaining with the Association till
the close of the sessions."
The Trustees of the several Institutions for the insane
are cordially invited to attend the meetings of the Associa-
tion. When an Assistant Physician represents an Institution
that fact should be certified to the Secretary.
The following committees will report on the subjects re-
spectively assigned to them :
On the Annual Necrology of the Association : Drs. Gris-
som, of N. C, Wallace, of Ontario, and Stearns, of Connec-
ticut.
On Cerebro-Spinal Physiology : Drs. Gundry, of Mary-
land, Chapin, of New York, and Kilbourne, of Illinois.
On Cerebro-Spinal Pathology : Drs. Clark, of Ontario,
Kempster, of Wisconsin, and Mitchell, of Mississippi.
On Therapejitics of Insanity and Nezv Remedies : Drs.
Rogers, of Indiana, Strong, of Ohio, and Gale, of Kentucky.
On Bibliography of Insanity : Drs. Hughes, of Missouri,
Godding, of District of Columbia, and Graham, of Texas.
On Relation of Eccentric Diseases to Insanity : Drs. E.
A. Macdonald, of New York, Goldsmith, of Massachu-
setts, and Powell, of Georgia.
On Asylum Location, Co?istruction and Sanitation : Drs.
Reed, of Pennsylvania, Dewey, of Illinois, and Wilkins, of
California.
On Criminal Responsibility of the Insane : Drs. Everts,
of Ohio, Andrews, of New York, and Fisher, of Massachu-
setts.
Dr. Godding will read a paper on " The Rights of the
Insane in Hospitals."
Dr. W. Channing will also read a paper on '* Public Pro-
vision for Epileptics,"
John Curwen, Secretary.
March 28, 1883.
[854]
^^
^
THE
Alienist i Neurologist.
Vol. lY. JULY, 1883. No. 3.
Original Contributions and Preferred Translations.
The Simulation of Insanity by the Insane,
By C. H. Hughes, M. D., St. Louis.
Late SuperinUndeni and Physician of the Miasoun State LunaHc Asylum.
"Notless interesting to the student of morbid psychology than the well-defined,
well-recognized forms of Insanity, are those obscure, anomalous conditions of mind
which occasionally appear, but in regard to which he fails to obtain any light from the
standard books. Though more numerous, probably, than they are generally supposed
to be, yet they are comparatively so rare, and so iinperfectly understood, that, for
the most part, after exciting a little temporary curiosity, they pass from attention,
and are forgotten. And yet they must ever constitute a very important class of men-
tal disorders, lor the reason that their existence, however Infrequent, must neces-
sarily modify the conclusions that might be drawn from the more common forms of
mental disease. In fact, no physician needs to be told that many important steps In
the progress of his science have been made by the careful and persistent observation
of what, at first, seemed to be anomalous and exceptional cases." — I>r.I.Ray,Remarkt
Introductory to Caxe of Bernard Cangly: American Journal of Intanity, July, lS6o.
' I **HE literature of insanity feigned by the sane mind is
-*- extensive, and dates back to the earliest period of
recorded history. The feigning of Ulysses in profane, and
of David in sacred story, are familiar to all, as is likewise
the history of Lucius Junius Brutus, who saved his life by
successfully assuming imbecility, and Shakspeare's two oft-
quoted examples in the characters of Edgar and Hamlet
NoTK BY THE AUTHOR.— EcquBSts for its reproduction and other considera-
tions have prompted the author to reproduce this essay, which was read before the
International Medical Congress, held at Philadelphia, In 1S76.
Xo changes have been made in the context of the original paper, except a slight
rearrangement of the first page, the omission of a clinical record, the inclusion of
Dr Isaac Ray's remarks on this inftresting subject which were called out by the
paper, and an ampler reference to the precedent and subsequent literature. The
«8say may be regarded, however, as a fair resume of the subject, to the present date.
356 C. H. Hughes.
— the latter, I think, blending some actual mental disease
with simulation ; but upon the subject of the present
paper, the simulation of insanity by the insane, not much
has been written, though enough is known to make it a
proper subject of inquiry.
The meagre record of cases of simulation by the in-
sane, to be found in the literature of psychiatry, may be
due partly to the fact that the necessity of searching these
cases out, has not been so imperative as the detection of
feigning by the actually sane, who so often simulate in-
sanity, to defeat the ends of justice, and for other sinister
purposes; partly to the fact that proof of simulation, in
the case of persons already adjudged to be insane, pos-
sesses no real, practical value ; but mainly to the fact,
which I think observation has established and will continue
to prove, that the insane do not, in general, assume either
different degrees or forms of insanity from those with
which they are actually afflicted.
We might here paraphrase a familiar quotation, and say
in mania Veritas, for the lunatic is generally true to the
promptings of, and mainly dominated by, his acquired^
morbid nature. To the practised eye, a tinge of insanity
colors nearly all that a general lunatic says or does, and
it is doubtful if, in the acute stage of profound and con-
stant general mania, the actually insane do ever simulate.
The general insurrection and rebellion of all the ideational
and emotional centers which seem to characterize this
form of mental alienation, the universal tumult into which
all the faculties of the mind are at this time thrown, would
seem to leave no room for the planning and contrivance
essential to simulation, though it be never so imperfectly
done. The assuming of a character different from the
dominant and all absorbing morbid impulses of the indi-
vidual, would be contrary to all observation in acute,
general mania, and is to my mind impossible, notwith-
standing the existence, in this form of mental disease, of
considerable method and shrewdness in planning and ex-
ecuting in the direction of morbid fancies and inclinations.
The Simulation of Insanity by the Insane. 357
To attempt simulation would only seem possible, if possible
at all in this form of mania, after the violence and ex-
citement had passed away and the disturbed faculties had
become comparatively calm, with the return of some de-
gree of rational appreciation of acts committed and of
penalties incurred, and to be avoided, and with an ob-
liviousness, on the part of the individual, of the fact of
his insanity. Here the question would present itself as to
the actual existence of insanity at the time of feigning,
while its pre-existence might be readily conceded.
Feigning has the nature and quality of rationality, and
is rarely, if ever, practised without a motive. It proceeds
prima facie from a rational mind, just as motiveless acts
proceed prima facie from a mind deranged ; yet we know
that all acts without motives are not the offspring of in-
sanity, as we know that acts prompted by rational mo-
tive do not proceed from the sound mind only. We
sometimes see, however, a kind of unconscious imitation,
in some exceptional, morbid, mental states, psychopathic
and neuropathic conditions seen in others, and occasionally
a kind of simulation lacking the conscious element in real
insanity — a mere freak of disease — which, however, is
scarcely worthy to be called true simulation. The insane
appear at times, when they have an object to accomplish,
more crazy than, and different from, what they reallv are ;
this is the sense in which we use the term simulation,
and this condition is akin to that of feigning by the sane.
Of course we do not expect to find feigning in advanced,
general dementia ; but we may not search for it in vain
in the intervals and remissions of recurrent or periodical
mania; after the mania transitoria ; possibly in certain
stages and forms of what is called chronic, general mania ;
in the hysterical and partial forms, the so-called mono-
manias ; and in the moral or afifectional forms of insanity
— the " manie sans d'elire " of Pinel. Let me, however
repeat, to be plain, that in that profound, general involve-
ment of the mind in disordered action, which depends
probably upon more or less implication of the whole brain
358 C. H. Hughes.
and which we term acute, general mania, feigning would
seem an impossibility. The psychical conditions essential
on the one hand to simulation, and on the other to the
truthful acting out of acute, general, mental disease, seem
incompatible ; the real victim of such a malady would not
be sane enough to simulate, except during a so-called lucid
interval, and comparative or entire freedom from disease.
Simulation, while it presupposes a degree of sanity,
does not require that the patient should be wholly sound
in mind, and might be attempted by a convalescent pa-
tient, not thoroughly recovered, for the purpose of re-
maining longer in the hospital or for some other reason.
Supposed feigning, in what appears to be a case of acute,
general mania, should lead us to suspect the correctness
of our diagnosis, and to review the steps by which we
have reached the conclusion that the person is actually
insane. I am not prepared to say this much of other
forms of mental disease, except dementia. We may admit
the possibility of subsequent feigning after the subsidence
of a paroxysm of acute, general mania, and still hold to
its general improbability, simulation being, as has been
said, an attribute of sanity, just as is the existence of a
reasonable motive, though both do often actuate the mind
deranged. We should fall into a grave error, however,
should we deny the possibility of other forms of insanity
than those which I have excepted, being accompanied with
either acts of feigning, or motives ; an error which facts of
daily observation among the insane fully prove.
The government of insane-asylum households, as every
physician knows, is conducted upon the idea that the in-
sane, like the sane though in a degree more or less modified
by disease, are actuated by ordinary motives, and can be
kept within certain rational limits of conduct and expression
by the conditional rewards and inducements to correct
behavior there employed. The rude and indecorous often
act with propriety when such a course is made the condition
upon which they are permitted to take part in the amuse-
ments and religious exercises of the asylum, or to have
TJie Simulation of Insanity by the Insane. 359
other rational indulgences allowed them. Proper letters are
written, and delusions suppressed by the writers thereof,
in some instances, after the patients have learned that very
insane letters are discountenanced by the superintendent,
and returned to the writers for improvement in regard to
their rational tenor. The love of absent wife, husband,
father, son, or daughter, as the case may be, and the na-
tural desire to communicate with them, sometimes leads
to compliance with the superintendent's somewhat com-
pulsory request, and to the expungmg of all evidences of
insanity from their letters, by the patients themselves ; and
at this point the re-establishment of the rational exercise
of volition, in restraining and refraining from the expression
of morbid fancies, sometimes commences, and the patient's
convalescence begins.
The fact, therefore, that the insane are more or less
influences by rational restraints and motives, like the sane,
though in an impaired and lessened degree, would seem
to need no further illustration. All who have much obser\'ed
them, know that they are constantly induced to do the
above and other acts which may result in benefit to them-
selves. They not unfrequently pretend to have abandoned
cherished delusions, and to have entirely recovered their
reason, with the view of securing a premature discharge
from the asylum ; and even good judges of insanity among
medical superintendents have sometimes been deceived by
the plausible pretences of such patients, who, faihng to
convince the asylum medical-officers, have sometimes suc-
ceeded in getting the hearing of courts, and have been
released on writs of habeas corpus, only to convince every
one, after a time, of their perfect fitness for perpetual re-
straint.
The co-existence of insanity with the power of devising
the most plausible explanations of erratic and insane conduct,
is sometimes seen before courts of justice, as in the case
of Col. M., District Attorney in one of the Southwestern
States, under President Jackson, as detailed by Dr. Ray.*
•Medical Jurisprndence of Insanity, 4th ed., p. 196.
36o C. H. Hughes.
Mr. M. entertained the delusion that he was cousin to the
Duke of Wellington, and to Napoleon; he cut off his own
nose, and, after the rhinoplastic operation had been per-
formed, cut out the cicatrix on his forehead whence the
nasal flap had been taken. " He was a passionate, dan-
gerous lunatic," according to Dr. Bell, and yet so plausible
in explanation and extenuation of his conduct, and in de-
fence of his personal and legal rights, that no asylum
could hold, and no tribunal seriously punish him.
The celebrated suit of Wood vs. Dr. Monroe, in England
for false imprisonment, as cited by Bucknill and other
writers, also illustrates how a really insane person may
succeed in concealing his mental weakness for a time from
the most astute observers. The severest examination failed
to detect Wood's mental infirmity until he was asked what
had become of the Princess with whom he corresponded
in cherry-juice, which immediately caused him to reveal
his insanity, and he lost his case. Discovering the cause
of his failure, he renewed the suit in London, and then all
the ingenuity of the bar, and the authority of the court,
could not elicit an exposure of his delusions, though he
still entertained them.
The simulation of insanity would seem no more difficult
than the assumption of sanity by the insane. If they can
conceal, or explain away so as to deceive the best judges,
mental defects which they actually possess, why may they
not assume abnormal traits which they do not possess ?
In the corridors of an insane asylum we sometimes see one
lunatic contemptuously or in sport caricaturing the whims
and vagaries of another, all the while fancying himself the
sanest of men, while he regards his brother lunatic as the
simplest of simpletons, or the most knavish of knaves.
" Amidst our criminal population, too, are hundreds who
can hardly be said to be sane and responsible, but who,
in the lower ranks of life, commit a succession of crimes
of no great magnitude, which render them the almost per-
petual inhabitants of jails. Some of them are so violent,
outrageous, and destructive — so silly in their motiveless fury,
The Simulation of Insayiity by the Insane. 361
and so childish in mind — that we may call them imbecile,
or insane, and have good grounds for our opinion."* These
are the illy fed and clothed, badly raised and housed, in-
habitants of the densely populated portions of our large
cities, or the neglected children of drunken, epileptic, or
otherwise mentally maimed parents, whose blood has been
poisoned with alcohol, opium, nicotine, and the noxious
vapors usually abounding where these cerebro-mental abor-
tions come forth and grow up into dwarfed and diseased
maturity. At the maternal fount they drink in disease, and
are never afterwards entirely well — never perfectly sound
in mind, and never able to act out a natural life. When
these human abnormities grow up to manhood and woman-
hood, having led a life of deceit, we might reasonably ex-
pect to find them simulating insanity, as they sometimes
do, when detected in, and incarcerated for, criminal acts,
being all the while unconscious that they are already really
victims of disease. This class should receive more careful
examination, with a view to the discovery of simulation
among its members. That many cases are not recorded,
may be due to the fact that sufficent search for them has
not been made, simulation by the actually insane not having,
until a comparatively recent period, been conceded by writers.
I can recall the names of no authorities more remote than
Griesinger and Baillarger, who have admitted the possible
co-existence of simulation with real insanity.
Armand Laurent.f as lately as 1866, gave several illus-
trative cases, specially in connection with imbecility. A
case was reported in the American Journal of Insanity for
1863, but the most recent and unequivocal recognition of
the fact of simulation conjoined with actual disease, by high
authority, is to be found in the report of the case of Michael
Trimbur, in the number of the same journal for October,
1874.
It would be interesting to know what might have been
the modification of Dr. Parchappe's view of the mental
•Blandford's Lectures, J871 p. 390.
t Emde Medico-Legale 6ur la Simulation. Par le docteur Armand Lament,
Paris, 1866.
362 C. H. Hughes.
condition of Lambert, whose case is reproduced by Dr. Ray,*
had the physician of the asylum at Rouen had in view the
possibihty of blended simulation with some remaining in-
sanity. It will be remembered that Dr. Parchappe pro-
nounced the case one of simulation of unconsciousness,
after the prisoner had come to himself, in order the better
to escape responsibility for his acts, he having, in a par-
oxysm, induced either by the virus or by the fear of hy-
drophobia, murdered his mistress and another woman
without provocation, and giving as a justification for the
homicidal act, in regard to the former of his victim, the
insane reason that he desired to bestow her money in
charity, which, he said she would never have done had she
lived. On the day of the murder, Lambert admitted killing
his mistress, and repeatedly exclaimed, "Jesus my God,
my fortune is made," and begged his captors to release
him because, he said, he " had eight more murders to
commit." On the following day he denied having killed
his mistress, but said " if I did, I do not remember it."
Four days after the murder he recognized the hatchet with
which he had done the deed, but denied all knowledge of
the murder. I do not offer this as certainly a case of simu-
lation conjoined with insanity. It may or may not have been
such, and, as my purpose is rather to elicit discussion than
to advance positive opinions, I have deemed an illusion to it
not out of place. Dr. Ray, in summing up this case, con-
cludes that it was one of feigned insanity, while Dr. Par-
chappe, as we have seen, thought that it was an example
of simulation after recovery. May not the simulation have
begun before recovery had been completed, after a realiza-
tion, upon the part of Lambert, that he had committed hein-
ous crimes from the penalty of which there appeared to him
no escape, except in assuming unconsciousness of his acts?
Cases like that of the criminal in the prison at St. Ange,
as related by Prof Monteggia and translated by Marc and
Ray, and like that of Samuel S. Rich,t which occurred in
this country, come to mind, in this connection, as having
•Op. clt., p, 415. t American Journal of Insanity, April, 18G0.
The Simulation of Insanity by the Insane. 365,
shown phases of simulation, which might have been revealed
had the possibility of simulation co-existing with insanity-
been entertained by the profession in those times. There
was no history of epilepsy in the case related by Prof.
Monteggia, and though no such rigid search could have then
been made for epileptiform complication as would be made
now, there is not the slightest suggestion of anything of
this character in the history of the case as it has come
down to us.
It may not be transcending the limits of scientific pro-
priety, to suggest simulation in connection with real insanity
as a possible explanation of some of the features of the
famous case of Joseph Waltz,* still fresh in the minds of all.
There was undoubtedly simulation, and it was most bung-
lingly done ; Waltz pretended to be suffering from dementia,
which was certainly not the case. His " don't know "
answers, made so often to interrogatories concerning facts
which he clearly knew (such as the names of his mother
and father, and his own age), and the post-mortem ex-
amination, clearly prove this point.
Just here the thought occurs, that when equally honest
and experienced experts view a case, which they have had
equal opportunities of observing, on the one hand as one-
of insanity, and on the other as wholly one of feigning, it
may be reasonable to look for co-existence simulation and
real disease, to explain the discrepancy of opinion. The
case of Waltz also suggests another possibility, viz., that in
some cases, the eagerness of counsel to make out a case
of insanity from a meagre data, aided unintentionally by
the suggestive questionings of the physicians who visit the
prisoner at the counsel's request, may sometimes lead a
prisoner, not in the beginning so disposed, to attempt
feigning ; and that if the sane may thus obtain an idea that
simulation can be successfully practised, we need not be
surprised to see the same thing undertaken by some real
though not pronounced, lunatics.
In a letter from Dr. Bucknill, referring to the case of
•Ibid., July, 1874.
364 C. H. Hughes.
Jesse Pomeroy, whom Dr. B. had visited with Dr. Edward
Clarke in the jail at Boston, in April, 1875, the writer says :
" Some physicians had suggested concealed epilepsy ....
as the cause of this boy's blood-thirsty propensities, and
had questioned him as to the existence of an aura.
Whether this boy had got the idea into his head or not.
1 know not, but he told Dr. Clarke and myself that he
•often had the feeling that a light feather was drawn across
his forehead from one temple to the other. Now, as Dr,
Clarke remarked to me at the time, this is not the accurate
description of an aura, which follows the course of nerves."
" Generally, after the acute stage has passed off, a ma-
niac has no difficulty in remembering his friends and ac-
quaintances, the places he has been accustomed to frequent,
names, dates, and events, and the occurrences of his life.
The ordinary relations of things are, with some exceptions,
as easily and clearly perceived as ever, and his discrim-
ination of character seems to be marked by his usual
shrewdness."* His replies to questions may or may not
indicate delusions or other extravagances of thought, while
his whole demeanor and conversation may show that he
has some appreciation of his previous mental condition,
and a fair conception of his present surroundings. Under
these circumstances, it is not difficult to suppose that a
really insane person, finding himself arrested, and in the
hands of the law, on the charge of murder or other crime,
which he knows that he has been seen to commit, and
from the penalty of which there seems to him no escape
except through the plea of insanity, might conclude to
simulate such a form of insanity as in his opinion would
secure his exculpation. Such a person might not believe
in the existence of his own real mental disease, and might
fear that those who were to try him would be equally in-
credulous ; the insane are not generally conscious of the
extent and degree of their mental derangement. Admitting,
then, the existence of a sufficient degree of rationality, in
.an insane person, to prompt to an effort at self-preservation
* Uay, op. cit., p. 390.
The Simulation of Insanity by the Insane. 365
through the act of feigning, would he probably assume a
more exaggerated form of mental disorder, just as sane
men usually do with the view of making a favorable im-
pression, and with the customary result of over-acting and
detection ? We cannot reason out an answer to this ques-
tion, and practical illustrations are too few to enable us
to generalize on the subject.
An insane person, having once been an inmate of an
asylum, would there have opportunity to become familiar
with the ordinary characteristics of insanity, and would not,
I think, be so likely to assume the tragic and exaggerated
forms of madness, as one more ignorant. His capacity to
successfully reproduce what he had observed in the asylum,
would depend upon the degree of mental soundness ex-
isting in him at the time at which he had been an inmate,
and remaining with him at the time of attempted feigning.
Insanity is a crippled, rather than a destroyed, or obliter-
ated, mentality.
From the nature of insanity, we see that feigning is
possible oftener than it is shown by experience to occur
in connection with the usual forms of the disease. Insanity
is an impairment of one or more of the mental faculties,
by reason of disease involving the brain ; and as it may
exist in ever}' degree, obser\'ing the same pathological laws
as any other disease, it is evident that acts which in them-
selves are rational in character, may be done by the insane.
A sick man is seldom so sick, unless it be in the last and
hopeless stage of his malady, that he can do none of the
acts which he could perform when well. Among the acts,
therefore, which the insane must be deemed capable of
performing, we must include simulation. It is not uncom-
mon for the healthy human mind to dissemble, especially
in civilized life ; and this natural trait does not always
wholly forsake the mind diseased, though it must be con-
fessed that the insane wear less of a mask than the men-
tally sound, and thus we come again to the general truth
as applied to the insane, in mania voitas. Some excep-
tions to this rule have come to my notice, and further
366 C. H. Hughes.
observation may discover more ; but not enough to invalidate
the rule as applied to insanity in general : Exceptio probat
reguhim. A mental phenomenon worthy of note here, but
not germane to the subject, is the unconscious or semi-
conscious imitation, rather than simulation, of insanity,
which is displayed on certain occasions by those who
largely inherit the insane neurosis. It consists in a sort of
sympathetic taking-on of an evanescent form of insanity
by other members of a family, under great excitement, as
when one of their number has become profoundly afflicted
with some marked form of mental disorder.* A father or
mother, for instance, brings to the asylum a son or daugh-
ter, when, from the exaggerated and unnatural conduct
of the parent, aside from the natural manifestation of grief
to be looked for on such an occasion, but which is some-
times wanting, the superintendent finds it difficult to de-
termine which for the time acts the most insanely, parent
or child. The conduct of the parent appears anything but
rational, yet a return to home, divested, in a measure, of
anxiety and the weariness of watching, with a season of
rest and sleep, and better appetite and digestion, suffice
to restore the disturbed balance of the mental faculties,
and the parent, by reason of regular life and habits, escapes
the affliction of positive insanity, though possessing and
transmitting a neuropathic diathesis but one remove from it.
Insanity, as Prichard observes, sometimes co-exists with
an apparently unimpaired state of the intellectual faculties;
though "the ideational portion of the faculties," as Bland-
ford remarks, "is so intimately joined to the emotional,"
that the two are probably " sound or unsound together."
Admitting the existence of so slight an intellectual aber-
ration, in certain kinds of insanity, that the intellectual
lesion is more theoretical than apparent, it is easy in such
cases to concede the possibility of simulation on the part
of the patient, to extenuate erratic and immoral conduct,
the result of disease. The subjects of moral insanity some-
times simulate inebriety, as well as insanity, to palliate and
•See note at end of this article.
The Simulation of Insanity by the Insane. 2i^j
excuse what appears to them and to others, not expert in
detecting mental aberration, inexcusable conduct. The
case of Col. M., already alluded to, was one of this kind ;
many of his freaks were excused and explained away,
when they could not be denied, upon the plea that he
had drunk a little too much on that particular occasion.
It is not easy to perfectly imitate diseases involving
the mind in disorder, notwithstanding that Zacchias has
said that feigning is easy, and detection difficult. The
unconscious " method that is in madness, the constant and
consistent reference to the predominant idea, which the
practical observer detects amidst the greatest irregularity
of conduct and language,"* requires all the mental faculties
in their fullest vigor, and unimpaired by disease, for suc-
cessful personation, and is then rarely successfully feigned
before the eye of the physician who is experienced in
detecting the true features of morbid mentality. While,
therefore, we may concede the possibility of occasional
successful feigning by the mind in full possession of all its
faculties, we should not expect the crippled mind of an
insane person to deceive us, and the fact of simulation
being detected should not preclude the possibility of co-
existing insanity in any particular case.
Dr. Ray, in his report of the case of Trimbur,t says :
" The criminal classes, to which most of these simulators
belong, know as well as everybody else, that the plea of
insanity is one of the dodges, whereby people now escape
the punishment of their crimes, and they may not forget
to act accordingly when they become insane themselves."
This was the case with Trimbur, who, " being unconscious
of his own real insanity, but with mind enough to under-
stand his situation and to remember what he hacL^ieard
about insanity in connection with crime, concluoed to
make a show of being crazy."
The following case, communicated to the writer by Dr.
Joseph Workman, for many years the distinguished medical
* Ray, op. cit., p. SS8.
t American Journal of Insanity, October, 1874.
368 C. H. Hughes.
superintendent of the Toronto (Canada) Lunatic Asylum,
seems equally illustrative of blended simulation and real
disease, and, as it has never been published, I give it here
in Dr. Workman's words: —
Some ten or twelve years ago, 1 met [says Dr. Workman] with a case
of genuine simulation in a man who had murdered his wife. He had pre-
viously been a patient under my care, for about a year, when he undoubtedly
was insane. Just as 1 was on the poiut of discharging him as recovered,
he eloped. I did not use much exertion to recapture him. He went home
to his farm, and got on well until his insanity returned, taking the form of
jealously of his wife, which, I need not say was utterly causeless. One
day, in the sugaring season, in the bush, he killed her with a billet of fire-
wood. He was apprehended — did not in fact try to escape — admitted his
crime, and was tried at the next assizes. I was summoned as an expert
witness, and had a long intei-view with him in the jail before the trial. I
knew him at first glance, and asked him if he did not remember me ? He
said that he did not; that he did not think that he had ever seen me
" Why, John," I said " you must remember me well ; you lived in the same
house with roe for over a year, and talked with me hundreds of times.
You remember being in the asylum ? " No ! He had no such recollection,
but people had told him that be had been there. " Well, you have not
forgotten your old friend Mr. E., the steward?" He did not know him at
all, and so on throughout all our colloquy. I had the most thorough con-
viction of this man's stupid mendacity and bootless simulation, and at the
same time of his insanity at the time of committing the murder, and I
stated both to the jury. He was acquitted on the ground of insanity, and
was committed to the asylum for criminals, at Kingston, where he is still
detained.
Two or three years after his trial, as I was passing through the asylum
in company with the medical superintendent, a patient stepped up and
held out his hand, addressing me very courteously, and inquiring after all
my family. I did not recognize him until the medical superintendent told
me that he was my old friend J. C. "Oh! John," said I "how is it that
you know me so well to-day, but did not know me at all in Guelph jail ? "
His reply was, " 1 did not want to know you that time." This man had
certainly a very powerful motive for simulation of mental frailty, but he
played his part too unskilfully to impose on my credulity. Jealousy was
not the cause, but the /orm of his insanity, and when he had forever got rid
of the subject of his delusions, a sober after-thought assumed the govern-
ment. He was, as 1 believed, still insane, yet possessing that degree of
stupid cunning which not a few sane people evince. He knew that he
would be hanged unless acquitted on the ground of insanity, for in Canada
murderers generally have but little chance of escaping the death-penalty.
Had he been thoroughly sane, he would have known tliat sufficient proof
of his past insanity, both in the asylum and afterwards, could have been
produced, and he would have abstained from his clumsy simuhition,
or he would have acted his part more cleverly. I could not say
that he committed tlie common error of simulation — overdoing his work.
The Simulation of Insanity by the Insane. ^6()
He did not rave, babble, or declaim, or indulge in foolish antics and
grimac-es.
In criminal cases, when an individual, in whom there
exists undoubted evidence of mental disease, actually pre-
tends to have a form of symptoms of mental disorder not
in harmony with the kind of insanity which actually afflicts
him, or not in the natural course of his disease, the pre-
sumption is reasonable that there also exists in him a
sufficient degree of rational volition and appreciation of
surroundings to modify the degree of his responsibility to
law. The preplexing question then arises as to whether
the individual's state of mind at the time of feigning be
the same that it was at the time of violating the law; the
presumption is in favor of a clearer mind at the time of
the simulation than at the height of the insanity, and this
appears to have been the case with Dr, Workman's patient.
The mind disturbed by disease, varies in the intensity and
degree of its disordered manifestations at different times,
even as the healthy mind is knowa to vary on different
occasions in the display of its natural peculiarities and
powers.
Other questions are here presented, of a medico-legal
character, relative to criminal responsibility and testamen-
tary capacity in certain cases, which, in the present state
of our knowledge of psychology, cannot be satisfactorily
answered in general terms. Eminent alienists all admit, in
the abstract, the existence of different and variable degrees
of rational capacity and responsibility in mental disorder.
There are, as Locke says, "degrees of madness as there
are of folly," but to determine precisely what amount of
impaired mind-power exists in particular cases, may often
puzzle the most learned and experienced psychological
experts. The law has attempted to cut the Gordian knot,
to untie which has so long baffled the most thorough stu-
dents of the mind diseased, by deciding that the capacity
to distinguish right from wrong, should settle the question
of responsibility to law in criminal cases ; but practically
we know that an individual may clearly know right from
370 C. H. Hughes.
wrong, and yet, under the overpowering influence of cere-
bral disease, be irresistibly impelled to do the wrong.
The importunities of the insane to be restrained, when
suggestions of violence, prompted by morbid states of the
brain, arise in the mind, and when the patient's own re-
collection of his past experience teaches him that resistance
to his insane impulses beyond a certain limit is impossible,
are familiar to all accustomed to come much in contact
with the insane in asylums. The physiological fact of
unconscious cerebration is applicable to the mental opera-
tions in disease, as well as in health, and to many acts
of the insane, especially of the epileptic class, but certainly
not to all. The legal test therefore fails, and indeed it
has been much qualified of late in the rulings of the courts.
We must concede, however, that this test can be justly
extended much further than at first blush would appear
to be proper, for unconscious cerebration in a paroxysm
•of insane fury would save many a lunatic who, a short
time before or after, would fully comprehend the nature
and quality of his acts.
The facts admitted in this digression would tend to
prove the possibility of simulation by the insane, even if
it were not established by experience ; knowing as many
insane persons do, that they have unconscious states in
which their irresponsibility is conceded by all, it would not
be strange for an insane man to pretend to have been in
such a state, when he really had not, to escape censure
or punishment for some act which he knows that he ought
not to have done, and the impulse to do which he knows
that he could have resisted, I do not now allude to those
acts of the insane which, from their history, we might
expect them to commit, such for instance as suicide in the
suicidal form of madness, homicide in the homicidal, burn-
ing in the pyromaniacal, steaUng in the kleptomaniacal, etc.
There is one fact which might in some instances deter
insane persons from feigning, even when the disposition
and capacity existed, and that is the knowledge which
they possess of the estimation in which they are held, as
The Simulation of Insanity by the Insane. 371
irresponsible. Who, accustomed to live with the insane
and thus made familiar with their true character, does not
know how keenly conscious they are of the existence of
this erroneous estimate of their real condition as regards
responsibility, removed, as they are in the asylum, from
those sources of irritation which have caused, or which
tend to keep fresh opened, their mental wounds? A patient
once told me that he would have his liberty, or kill me.
I said, " Then you would be hanged." He answered.
"They could not do that, I am insane." "But," said I,
" you would not be insane on that subject. You know it
would be wrong, and your insanity is not homicidal." He
said, and said truly, " No jury would ever hang a lunatic
for anything that he might do in an insane asylum." Not
being able thus to intimidate him, I approached him ever
afterwards with caution, and always dodged, when prac-
ticable, the discussion of the question of his personal liberty.
This patiCnt used the word lunatic sneeringly, for, though
admitting that he was not always right in his mind, he did
not consider himself seriously insane, though, at times, he
was really very much so, his paroxysms of excitement
lasting many days at a time. It is easy to conceive of
circumstances under which such a patient might simulate,
as well as rely upon his reputation for, insanity.
The fact of unconscious cerebration, before alluded to,
as we see it manifested in cases of hysteria, mingled with
conscious and partly volitional, mental activity, explains
the simulation of real insanity which sometimes co-exists
with this singular morbid state. In hysterical insanity,
there seems to be a morbid desire to act out actually
controllable vagaries, as well as those really insane prompt-
ings which are beyond the control of the will. The insane
of hysterical tendencies often act in a seemingly controllable,
but very insane, manner, apparently through a morbid
craving for extraordinary sympathy and attention. Occa-
sionally, however, their actions are apparently wholly
motiveless, as with other and aggravated forms of in-
sanity.
372 C. H. Hughes.
Though simulation is rarely practised without motive^
it is possible for the motive to be sometimes a very fool-
ish one, and, while it may be unaccompanied by delusion,,
yet scarcely explainable upon the hypothesis of perfect
sanity. Such a case would lead to great preplexity in the
mind of the physician.
The egoistic feeling so often uppermost in the mind
diseased, causing the insane to seek in so many ways to
attract attention, or excite wonder and commiseration, is"
only an exaggeration of a not uncommon, natural trait of
rational minds. It may be doubted whether the case re-
ported by Dr. Bell, an abstract of which may be found
in Dr. Ray's* excellent work on the jurisprudence of in-
sanity, was without real disease as well as blended simula-
tion. Dr. Ray, in introducing the case, regards it as-
" somewhat curious, considering the youth of the subject,
the apparent want of motive, and the severity of the
symptoms."
The lad, thirteen years old, had fallen on his head two years previt)us-
to admission, and ever since that period had exhibited some anomalous
symptoms of disease, which had been referred^by his physicians to derange-
ment of the digestive organs. For the last few months, the symptoms had
been more severe and decided. He had refused food for long periods, had
had spasms, had lain with his eyes fixed and his legs drawn up, would hold
his breath and strilve. Ou admission to the asylum, he presented the ap-
pearance of a sickly, emaciated boy, under puberty, unable to stand, ex-
hausted by suffering, breathing quickly, and passing his evacuations in bed.
Every few minutes he had a frightful spasm, commencing witli a convul-
sive shaking of the head, pawing of the hands, and turning up of the eyes.
Soon his hands would vibrate against his sides and chest, his countenance
would be dreadfully distorted, and then would commence a horrid scream
that might be heard over the whole premises. In this condition, with oc-
casional remissions, and the addition, at one time, of diarrhoea, he remained
for about a month. . . . Being watched through a hole in a blanket
hung before his window, he was observed to jump up and stride about his
room as actively as any body, but at the slightest noise resumed his old
position, screaming and groaning.
Dr. Bell broke in upon him before he could regain his
bed, chided him for his deceit, and bade him walk into
the hall. "The spell is broken," says the record, "the
• Op. cit., p. 40.5.
The Simulation of Insanity by the Insane. 373
feeble knees are made strong, the convulsed and distorted
visage is calm and smooth, and the young deceiver goes
forth clothed and in his right mind," Dr. Chipley, com-
menting on this case,* says, " We can scarcely conceive
that one would assume a character so painful to sustain,
without some deliberate purpose, or an end to be accom-
plished ; " and yet no motive such as might be supposed
to actuate the rational mind, is at all apparent in this case.
The fact of the boy's having refrained from his usual
manifestations on the unexpected appearance of Dr. Bell,
whom he doubtless held in no small degree of awe as the
all-powerful head of the establishment, while it proves a
power of control over the actions under great external
influences, and is strongly presumptive of feigning, does
not, to my mind, conclusively establish the fact of entire
sanity. There is nothing absolutely incompatible with
insanity in sudden cessation of its symptomatic manifesta-
tions. If this youth was willing to make such continued,
great, and painful sacrifices of comfort and character for
the ridiculous and unreasonable purpose of exciting wondef
and commiseration, such a motive, coupled with the youth's
history and all the attendant circumstances, is well calcu-
lated to excite our suspicions as to his entire mental
soundness. There were at the time, doubtless, others in
the hospital more insane than this boy, and perhaps others,
regarded as undoubtedly insane, who were fully as rational
as he. A good deal of sanity may still exist among those
who are too insane to mingle with the rational world.
Visitors, passing* through the corridors of a hospital for
the insane, often remark this fact, and the asylum-officers
are often asked why certain patients are restrained of their
liberty, because of their presenting to the casual observer
so little appearance of insanity. So proper are the manners
and conversation of patients, at times, that an unfounded
distrust of public hospitals for the insane has sometimes
been engendered in the public mind from this source —
the insane themselves behaving so well in the presence of
• American Journal of Insanity, July, 1865.
374 C. If. Hughes.
visitors, and at other times, under the present wise and
scientific system of classification, medical and moral man-
agement, and restraint — the latter, in this country as in
England, hardly exceeding non-restraint. (As ought to
be the case in every well regulated hospital.)
It would unduly lengthen this paper to detail the many
instances which might be gathered of insane persons, on
certain great occasions which made profound impressions
upon their minds, having behaved with unaccustomed pro-
priety, and having suspended for the time-being all man-
ifestations of insanity, or to mention instances of great
and unexpected events having been the beginning of re-
covery. Every one accustomed to the care of large bodies
of the insane, knows that grand and unusual occurrences,
which would startle and profoundly impress the rational
mind, sometimes favorably impress the insane, notwith-
standing that, in the main, they are either regarded with
indifference, or cause aggravation of existing excitement.
Some instances in point might be mentioned in connection
with the burning of asylums. No such event has ever
happened in my own experience, but the burning of a
large stable and barn on the asylum premises at Fulton,
early one evening, in full view of a good portion of the
patients, gave opportunity to witness, in some degree, the
different conduct of different lunatics under such circum-
stances. A very few of the patients were more excited
than usual ; the majority were indifferent ; and some gave
us valuable aid in our efforts to suppress the flames and
save the stock.
The coercive methods of treatment, recommended and
practised by Celsus, demonstrated the power of self-re-
straint in some cases, under the influence of overmastering
fear; and in our own day, threats and punishments, though
for obvious reasons neither practised nor advised as cur-
ative agencies, are not without some influence in subduing
some refactory and noisy patients into submissive silence, as
may be learned by visiting some of the almshouses and jails
to which many of these unfortunates are yet consigned
The Simulation of Insanity by the Ifisafie. 375
in the United States. It may be conceded that to be
influenced by fear to such' an extent as to suspend all display
of insanity, is, in some cases, good evidence of feigning; but
it must not be so regarded in all. Fodere has been criticized
by a writer from whom I have already quoted,* for having
relied upon the test of fear in the case of a female, who
acted her part, if she were only acting, so perfectly that the
doctor was on the point of certifying the case. He returned
to her door, however, and said with a stern voice, " To-mor-
row I will visit her again, and if she continue to howl, if she
be not dressed, and her chamber not put in order, you must
apply a red-hot iron between her shoulders." He found
things in order the next morning, and on this proof alone,
with strong evidence to the contrary, immediately decided
that it was a case of simulation. " But was this decision
justified," asks the writer, " by the simple fact that the
patient changed her conduct under the terror by severe
threats? " And he answers the question by referring to the
self-control exercised by patients under the influence of
fear, or the hope of reward. The potency of authority in
suddenly suppressing through fear all appearance of mental
derangement in those who are really insane, is, of course,
exceptional ; I can hardly conceive of such instrumentalities
being successful in aggravated cases of general cerebro-
mental disease, yet their occasional influence in controlling
the less general forms of insanity, especially where sim-
ulation co-exists, is not to be doubted.
In hospitals for the insane, the power of one having
authority is sometimes shown in the restraint which some
patients put upon morbid and quasi-morbid displays, in
the presence of the chief physician, and the arrest of
paroxysms of hysteria by commands and threats, before
the disease has reached the point of recognized insanity
is nothing new to the profession at large. This charac-
teristic of partial control under ordinary circumstances
reaching the point of entire control under extraordinary
circumstances, in cases of hysterical insanity, is too familiar
• Dr. Chipley, American Journal of Insanity, July, 1865.
376 C. H. Hughes.
to the profession to need further notice ; it extends also,
as I endeavored to show, to other cases.
The power of self-restraint implies the power of simu-
lation. Hysterical patients are undoubtedly more prone
than others to " put an antic disposition on," as Hamlet
has it, and are more disposed to act insanely than to ex-
ercise aright what power they really possess of at least
restraining within more rational bounds the ridiculous dis-
plays which they often make.
I turn now briefly to a class of cases regarded by many
as more devilish than lunatic, viz., the morally insane; who
know how they are considered, and why they are in the
asylum, and who take advantage of their reputed insanity
to do many things from which they might perhaps refrain
if they chose, but to which disease really prompts them.
They sometimes pretend to a degree of intellectual im-
pairment not natural to them in their diseased condition.
These patients know where they are and why they are
there, and to a certain extent are able to behave them
selves with propriety when motives are powerful enough
to induce them to do so, particularly under the absolute
authority which they know that they have over them at
the asylum — exercised, it is true, in the mildest and least
irritating way, but usually with firmness and certainty. At
home, with those whom they have been accustomed to
manage, they are uncontrollable, and behave themselves
like very devils, so that they get no sympathy. The world
outside does not understand them, and cannot get along
with them, and indeed those in charge of asylums wish that
these patients could be cared for elsewhere.
With distorted views of men and things about them, just
short of delusion; dissatisfied and suspicious, often without
the shadow of a cause ; sometimes devoid of affection and
gratitude ; sleeping and eatmg poorly ; never in a state of
mental composure, but always quarrelling with the cook, the
laundress, the attendants, or some fellow-patient ; with
bowels often habitually constipated, circulation disturbed, and
general appearance of ill health, if these patients are insane
The Simulation of Insanity by the Insane. 377
— and I think that they are — they can also simulate to an
aggravating degree, when it serves their purpose, abnormal
mental states not actually existing in them.
The possibility of self-control under exceptional ex-
ternal influences coming to the aid of the will of persons
reputed to be insane, does not preclude all possibility of the
existence of real insanity. A more or less modified power
of self-control exists in the incubative stage of most forms
of insanity, even under ordinar}- circumstances, and persists
oftentimes until the case has passed into the form of final
and hopeless dementia. After recover}', our patients some-
times tell us how they resisted morbid promptings to extrava-
gant words and conduct, before these found unwilling and
resistless expression. Suicides and homicides by the insane
are seldom without premonitory^ preparations, threatenings,
and warnings, and much of the freedom of intercourse,
coupled with safety, of asylum-life is due to this fact. Even
in cases of well-advanced insanity, morbid impulses of
various kinds are sometimes long and repeatedly resisted
before their final consummation.
The power to restrain and suppress insane promptings,
so frequently exhibited by the insane, implies the power to
simulate the features of insanity. In all asylums for the in-
sane, there are chronic cases in which the original delusion^
though still persisting, ceases to dominate the patient as in
the beginning — cases in which the aggravated demonstra-
tions and exclamations of the patient are disproportionate
to his delusion. The insane man's oft-repeated actions and
expressions become a sort of second nature, as habit be-
comes with the sane. There is a kind of automatic simula-
tion here ; these patients act out a state of feeling which is
not real to them. If once tormented with a painful delusion,
they cease to suffer as acutely as in the beginning, if they
suffer at all, and their attention is more easily diverted from
self.
Our asylums afford many examples in which the pa-
tients, yielding more or less to their delusions, also more
or less modify or suspend the expression of them. This
378 C. H. Hughes.
fact is illustrated and recognized in the moral treatment
of the insane. Even sane persons are not free from dis-
simulation, and while insanity in the main reverses the
character, it sometimes throws off the natural disguise put
upon the conduct and conversation in health; thus we
may find the natural disposition to dissemble, in not very
profound forms of mental disease, displaying itself less
guardedly than in health. Hysteria is an apt illustration
of this fact, both before and after it becomes actual insanity.
The insane, like the sane, though on the whole more
truthful than the latter, are not always and altogether what
they seem in acting out their real psychic impulses. They
are sometimes more crazy than they appear, and some-
times appear more insane than they really are. We have
generally to scrutinize an insane character closely to fully
comprehend it. Esquirol's estimate of the value of constant
observation, in order to become familiar with the subject,
expressed very nearly the truth : We must live with them
to fully know them. Simulation of insanity may exist in
connection with actual psychical defect, the result of dis-
ease of the brain, just as disease of the stomach, lungs,
or other organ, may be accompanied with a greater or
less degree of healthy function. Only death obliterates
and destroys all function, while disease, short of death,
modifies and perverts organic activity.
Physical disease, involving the so-called physical organs
in contradistinction to the organ of the mind, is not always
or usually entire physical destruction ; and so disease in-
volving the mind and its organ, is not always or usually
entire mental overthrow or obliteration; rather is the latter
the exception, than the rule. Do we not, therefore, err,
if we seek to find in every case of apparent mental aber-
ration all simulation, or all insanity ? Is there anything in
the nature of insanity, as we recognize its different forms^
incompatible with simulation ? I think not, except it be
in profound and advanced general mania and dementia ;
and from this cursory survey of a field which grows wider
as we view it, I conclude that it is not only not impossible
The Simulation of Insanity by the Insane. ^yg-
for the insane to simulate insanity, for a purpose, in any
but its graver forms of profound general mental involve-
ment, but that they do sometimes actually simulate acts
and forms of insanity for which there exists no pathological
warrant that can be discovered in the real disease by
which they are affected.
After the reading of the preceding paper, Dr. Isaac
Ray, of Philadelphia, said : —
Until the present century, insanity was seldom put forth as an excuse
for crime. Its frequent occurrence in our day has made it a duty of phy-
sicians to make themselves acquainted with its phenomena far more accu-
rately than was before required. It often becomes their duty to say, in a
matter of life or death, whether a certain person is sane or apparently in-
sane, and, if the latter, whether the apparent insanity is real or simulated.
Most of the insane know as well as other people that insanity is an excuse
for crime, and there is no reason why they may not strive to use it as such,
when occasion calls, by feigning some manifestations of the disease over
and above tliose belonging to their own particular form of the malady. To
do this requires no more shrewdness and self-command than it does to
concenl their delusions, as they sometimes do. The fact that they are al-
ready insane does not preclude the need of simulation, for the well-known
reason that the insane generally do not recognize their own infirmity. To
them, the need of the excuse seems just as strong and just as apparent as
it would to others.
Dr. Hughes's mention of Dr. Bell's case calls to mind a form of mental
disorder, not unfrequently met with in general practice, in which the real
and the simulated are curiously mingled together. It occurs mostly in
women, beginning usually in a morbid fondness for sympathy, and for the
attentions bestowed on the sick and suffering, and originating either in
some hysterical condition, or in a decidedly insane temperament. There is
nothing which persons thus disposed will not endeavor or endure, and the
aches and ails which they affect, from a simple cough to tits and disloca-
tions, no man can number. We are all familiar with them, no doubt. I
knew of one who, not content with keeping a couple of watchers up all
night for months together, would, when at all displeased, dislocate her
jaw; and another who would, under similar circumstances, dislocate her
hip. In such cases there is, undoubtedly, much mental disease, and also
much downright simulation. And it is not always easy to determine what
is to be attributed to the one, and what to the other, while a mistake may
lead to great wrong and suffering. I call to mind the case of a young girl
of some culture and refinement who kept her bed more than a year, unable
to move without assistance, and regarded by friends and physicians as ex-
tremely ill. At last some one, walking in the garden, observed her, th rough
a window in her room, rise from the bed and jump about as lively as a
cricket. Of course there was an end to this sort of performance, but there-
soon appeared a good deal of mental disorder, which finally made her so
38o C. H. Hughes.
troubleBome that she was placed in our hospital.' Tliere, for weeks to
gether, she behaved with the utmost propriety, evincing neither in conduct
nor in conversation the slightest sign of insanity. This condition would
alternate with periods when she lay in bed, unconscious apparently of
everything around her, her face highly flushed, and her pulse fast and full.
She tooli food only through the tube, and passed her evacuations in bed.
From us she passed into the charge of an Indian doctor, by whom, it was
eaid, she was cured. Some light is thrown on the psychologioal history
of this case by the fact that a brother and sister were spiritualists, and that
her mother presented many indications of the insane temperament. Now,
hiid this young woman committed a criminal act, I fear that the plea of in-
sanity would have availed her little in view of this instance of detected
ei mulation.
At the time this essay was written, the writer was
unaware of some, and had overlooked others, of the few
•confirmatory cases reported by European writers. The
■essay was written also, as most of the author's work is
done, at intervals, under pressure of many other engage-
ments, whenever a little leisure could be obtained. It
was not written in the author's library, nor with such
-deliberation as would have satisfied the author had he
possessed the time for a more deliberate production.
Nevertheless, the observations were deliberately made,
and the convictions expressed are mature.
In the literature may be found, besides those referred
to in this paper and antedating it, cases reported by
Pelman,* Ingels, fStark,! Delasiave,|| Lahr§ and Montezel.^f
" Dr. Nichols** has since reported a case in which a
man committed murder under, as he believed, the com-
mand of the Virgin, who appeared to him in the flame
of a candle. Two young lawyers were assigned as his
counsel, under whose advice he feigned dementia. Drs.
Nichols and Ranney detecting both the real and sham
insanity, had him sent to an asylum where his mental
condition became unmistakable," In marked contrast to
the case of Dr. Nichols, that of Montezel was a chronic
•Irrenfreund, No. x, 1874.
t AUgemelne Zeltschrlft fuer Psychiatric, 1870.
\ Ibid, 1871.
II Journal de M6diclne Mentalo, 18G8.
§ Archiv fuer Fsychlatrie. Baud I.
TTL'Kncephale, January, ]88'2.
••Cited by Kieruan; Alienist and Nkubolooist, April, 1882
The Simulation of Insanity by the Insane. 381
lunatic who feigned an acute form of insanity to escape the
consequences of an assassination. Dr. J. P. Gray* of
Utica had under observation a man who, two or three
days before admission to the Utica Asylum, was met in
the woods saying that he was going to shoot his father.
When admitted to the asylum, he claimed to have been out
of his head. Dr. E. C. Spitzka* has since published the
case of a criminal hereditary lunatic, who feigned a relig-
ious type of insanity. Dr. Kiernanf of Chicago, in the
second systematic American paper on the subject, has
reached conclusions similar to my own, which are
supported by the following cases :
A forty-eight-year old patient had a brother and two
uncles insane; he had been for a long time a pauper and
had, at times, hallucinations of hearing ; he complained con-
tinually about having tar and grease in his head, and said
he was insane in consequence. He said but little on these
subjects except to the doctor, and for a long time refused
to work as being insane and having tar and grease in his
head. He found that his statement drew attention of vis-
itors towards him and led to his receiving tobacco,
and was, therefore, markedly obtrusive with these state-
ments when in the presence of visitors. His hallucinations
could be drawn from him only after prolonged questioning.
The case was one of primary monomania and imbecility,
slightly complicated by dementia.
A "hebephreniac," or primary dement, who displayed
an extremely morbid egoism, found that a monomaniac
attracted more attention than he, because the latter
claimed to have written Shakespeare's tragedies; where-
upon he claimed to have written " all of Byron, all of
Shelley, and all of Milton." Cross-examination showed
this claim to be feigned and was not infrequently so
admitted by the patient to the physician, but he made
this claim to visitors, although he refrained from so doing
to the physicians.
•Utica Aavlam Reports, 1876.
•Journal of Mental and Nervous Disease, Vol. 5.
t Alikkist axd Nkijholoqist, April, 1S82.
382 C. H. Hughes.
A chronic secondary maniac found that by feigning
dementia, he was able to secure tobacco and other httle
comforts, and therefore kept this up on occasion, relapsing
into his usual condition when his end was attained.
Thus the insane as well as the sane may act fraudu-
lently, for while insanity changes the display of character
it does not necessary obliterate all natural characteristics
or reverse them. It changes by intensification as well as
by reversion or perversion and it sometimes also leaves
certain natural traits unaffected.
The cases thus far recorded, and the many more to
come under observation, if we search for them with
unbiased minds, form material enough to constitute a
picture of a feature of mental aberration, at once unique and
significant ; a phenomenon of mental aberration, in one of
its exceptional but none the less interesting forms, which
should neither be ignored nor misconstrued, since from its
comparative infrequency it may become of extreme impor-
tance when mental disorder is considered from a medico-
legal view. The fate of a life — none the less valuable,
because possessed by one mentally maimed — may depend
upon the manner in which we may decide the momentous
question of the possibility of the insane to simulate fea-
tures of insanity different from, or additional to, those
with which they are actually afflicted.
Note referred to on page .'i66. — The subject of folie a deux Is associated
with the study of simulation, folit a deux being in tact a morbid imitation of insanity
by those who possess the insane temperament The readei will find in the April
numberof this Journal, an excellent brief of this subject by Dr. James G. Kiernan,
of Chicago, in which the views of Falret, Kegis, Lasfege, Montezel and Dr. Kiernao's
own conclusions are succinctly presented. The simultation of folie a deum is a more
unconscious, non- voluntary and generally purpo»eZM» imitation of a pattern form of
mental aberration present to the simulator at the initial stage, at least, of his simula-
tion, while the simulation we are now discussirg conforms to some previous con-
cept of mental derangement, based on former observation or exiierience of essential
features of Insanity , and now assumed by the simulator for some more or less rational
purpose.
Continuation of the Study of the Minute
Anatomy of the Central Organs of the
Nervous System.
By Prof. Golgi, of Pavia.
Chapter II.
THE problem as to the mode in which the nerves have
origin from the central nervous organs, is one of
those on which, in modern times, anatomists have been
largely engaged, and it still remains one of the most
controverted.
The gangliar-cells of the cerebrum and of the medulla
spinalis have been, we know, generally regarded as the
central elementary organs of the nervous fibres ; but if,
not contenting ourselves with categoric assertions, which
can be no other than mere hypotheses, we would desire
a more intimate knowledge of the subject, the fact must
become apparent, that not only does the mode in which
the separate nervous fibres are joined with the cells, con-
tinue to be a subject of controversy, but further, that in
our own days it has been questioned, whether any rigor-
ous demonstration has been given of the asserted
continuity between the two forms of the constitutive
elements of the central nervous texture.
Passing unheeded certain skeptical pretentions, such
as that Hystil, who, appropriating an expression of Volk-
mann, recently ventured to say, that "the mode of origin
of the nervous fibres will forever remain unknown, " that I
may take into account, in preference, the results of the
most recent investigations, the truth is that the demon-
stration of the assigned derivation of the fibres, has, up
to the present, been given only for a very circumscribed
category of them, while, for the greatest part, their rela-
tions to the cells are still purely hypothetic. It will suffice
384 Golgi.
in this regard, to record that in one of the most notable
works pubHshed in late years, on the real origin of the
nerves, the author, Laura, after an accurate summation of
the results of other observers, asserts that, " even as to
the facts the most simple, for example, the connection of
the anterior roots and of any cerebral nerve whatever,
with their so-called nuclei of origin, we are very far from
having reached any absolute certainty. "
If we demand from anatomy the solution of some
other interesting ^problems, more neighboring to physio-
logy, as for example, whether in the respective centers
of origin, the two sorts of nervous fibres (of sense and of
motion) present differences in their mode of connection
with the corresponding cellular groups ; whether also there
exist differental characters concerning the origins of the
various categories of sensory fibres ; or whether there are
morphological or other characters, which may enable us
to distinguish the supposed motor-cells from those which
are supposed to be sensory ; if, I say, we demand of
anatomy the answer to these and other questions, we
must confess that we soon fall upon a domain of discus-
sion, where the most absolute obscurity reigns. It is,
indeed, true that some observers have believed they were
able to respond to all the questions mentioned, but it is
evident that not one of the answers offered, resists the
control of severe observation.
As in the preceding part we have had occasion to
mention the principal doctrines which, as regards the
special subject of the mode of connection of the nervous
cells with the fibres, have been contended for, I shall
here limit myself to the mentioning of that opinion which
among modern anatomists, has had the unmerited fortune
of having been almost generally accepted : I mean the
opinion of Gerlach, according to which the gangliar cells
would give origin to the nervous fibres in two assen-
tially different modes, that is to say :
First. In a direct way, by means of a special prolon-
gation differing from all the others in its physical and
Minute Anatomy of the Central Nervous System. 38$:
chemical characters, and which, maintaining its simpUcity,
should pass on directly to form the cylinder-axis of a
medullary nervous fibre.
Second. In an indirect way, by means of numerous pro-
toplasmic prolongations, which, by subdividing indefinitely
should form a fine network, to constitute which, there
should, on the other part, contribute, by an identical
subdivision of the respective cylinder-axis, many of the
nervous fibres, which, originating in the medullary sub-
stance, enter into the strata of the gray substance.
In the first case, therefore, a special prolongation
would be transformed into nervous fibre, simply by becom-
ing covered with a medullary sheath ; in the second case,
on the other hand, the connection of the cells with the
nervous fibres would be the intervention of a network
resulting from the indefinite subdivision of the protoplas-
mic prolongations of the cells and of the cylinder-axis
of the fibres.
As to the doctrine here stated, we have already said
that, far from being based on well demonstrated anato-
mical data, it also, just as the others, which preceded it,
is no more than a simple anatomical hypothesis.
But after having denied the opinion of Gerlach, and
above all having declared unsustained his data relative to
the past, which, in the formation of the nervous fibres,
the protoplasmic prolongations would take, do we find
ourselves in a position to furnish an explanation, free from
hypothesis, of the manner in which, in the different strata
of the gray substance, the nervous fibres are formed and
have origin ? Can we give a well-founded word as
to the question, whether, in relation to the mode of ori-
gin, there exists, between the fibres of sense and those of
motion, some difference corresponding to the functional
difference?
I do not hesitate to assert that the histological particu-
lars shown in the preceding chapter, in their ensemble
represent an array of data, which may enable us to for-
mulate, for the difficult problem confronting us, some laws
386 Golgi.
sufficiently precise and secure. It is certain that if we
•cannot declare, without reserve, the problem already solved,
we can, however, say that for the completing of the work
only a few particulars of secondary importance are
wanted.
The recall of some parts which we have before made
the subject of particular description, will furnish the proof
of our assertion.
I record, first of all, that in the strata of the gray
substance of the various provinces of the central nervous
system, there exist cells whose nervous prolongation pro-
ceeds directly to unite itself with the fasces of nervous
fibres, and becomes transformed into one of these ele-
ments, but not without having first given off a greater or
less number of secondary fibrillae, which, by subdividing
take part in the formation of a diffuse interlacement of
very complex origin.
In relation to this behavior of the nervous prolonga-
tion of some gangliar cells, it should in the second place,
be remembered, that, in following the fasces of nervous
fibres penetrating into the strata of the gray substance,
we not infrequently discover some of them going to place
themselves in relation with gangliar cells, and becoming
transformed into the respective nervous prolongation, but
not without having first, in their turn, given out a greater
or less number of fibrillae, which subdividing in like man-
ner, go to take part in the formation of the diffuse
interlacement.
This manner of behavior of the nervous prolongation
of the ganghar cells, on the one part, and of the nervous
fibres, on the other part, the demonstration of which is
now at length one of the easiest things in histology, I have
established by so extensive a category of elements pertain-
ing to the various provinces of the nervous system (cells
of the cortex of the convolution, cells of the so-called gray
nuclei of the ventricles and the base, cells of Purkinge of
the cerebellum, cells of the medulla oblongata and medulla
spinalis), that I now regard as authorized the assertion, that
Minute Anatomy of the Central Nervous System. 387
it represents one of the general laws which are valid for all
the gray strata of the nervous centers.
Well, then, have I not a right to consider the behavior
here described, as a mode of junction of the cells and
the nervous fibres, and precisely as a mode of direct ori-
gin of the nervous fibres from the gangliar cells of the
centers ?
Evidently the reply can be only affirmative, and we
may add, with security, that it excludes ever>% even most
distant shade of hypothesis.
But there are to be noted other histomorphological
particulars which are presented, of clear significance,
from the point of view of our knowledge as to the
mode of origin of the nervous fibres.
It may be remembered that we drew attention to
the substance of a second type of cells, characterized by
the fact that the respective ner\'Ous prolongation, by
dividing complexly, completely loses its proper individ-
uality, and passes iti toto to take part in the formation
of the diffuse network of nervous fibrillar. It should
likewise be remembered, that we verified the existence
of a second category of nervous fibres, which have an
identical behavior with that of the nervous prolongation
of this second type of cells ; that is to say, fibres whose
cylinder-axis, dividing complexly, pass, in their turn, in
toto into the described diffuse network.
In this other mode of behavior of the nervous pro-
longations of a certain series of cells on the one part,
and of a second category of fibres, on the other part,
ought we not to have the right of recognizing a second
manner of connection between the ner\'ous fibres and
the gangliar cells, or a second mode of origin of the
nerves? Here also, the affirmative reply includes, I
think, absolutely nothing of hypothesis.
And again, as to this mode of origin of the nervous
fibres, we have already been able to verify it, both in
the cortex of the convolutions and the gray substance
of the medulla spinalis. We believe that a fact which
388 Golgi.
seems deserving of particular consideration, in relation to
this matter should be placed in relief : it is, that the
two types of cells, far from being found separately in
this or that other region of the central organs of the
nervous system, are constantly found associated ; at the
most, in some zones there is observed a prevalence of
one or the other type ; this is, for example, observed in
the medulla spinalis, where the cells, whose nervous
prolongation, preserving its proper individuality, passes
directly to form a fibre, prevail in the anterior cornua,
whilst, on the contrary, in the posterior cornua, the
cells whose nervous prolongation, subdividing complexly,
loses its proper individuality, and passes in toto into the
"diffuse network, prevail. It is however known, that in
the same zone of the central organs, some categories
of gangliar cells belong to the first type, whilst others
belong to the second. This is observed in the cerebel-
lar convolutions, where the cells of Purkinge belong to
the type of those whose nervous prolongation, although
it gives off some fibrillae, yet preserves its proper individ-
uahty, and passes on to form the cylinder-axis of a
nervous fibre, whilst all the other cells of the same con-
volutions belong to the second type. The two cellular
types are always, and in every mode, found associated.
Summarising then, we may now say that in the gray
substance of the central nervous organs, we know of.two
different modes of origin of the nervous fibres, correspon-
ding to the two cellular types there recognized by us, —
lypes differentiated, as we have seen, by the different
behavior of the nervous prolongation, viz :
First. An origin which we may call direct from the
nervous cells of the first type, an origin which would be
effected thus : the nervous prolongation of such cells,
though it gives off some secondary threads, yet it pre-
serves its proper individuality and passes directly to form
the cylinder-axis of a medullary fibre.
Second. An origin which may be called indirect, inas-
much as the fibres do not go directly to place themselves
Minute Anatomy of the Central Nervous System. 389
in relation with gangliar cells, but, complexly, subdivid-
ing, they are united in the network, in the formation
of which these take part, in the first line, the gangliar
cells of the second type, and in the second line, the
fibrillae given off by the nervous prolongation of the
cells of the first type. Evidently in this case the nerv-
ous fibres coming from the periphery, do not conjoin, in
a direct way, with either the one or the other type of
gangliar cells ; therefore we think this mode of origin
should not be designated otherwise than as indirect.
With respect to the mode of origin of the nervous
fibres in the gray substance of the nervous centers, we
can also distinguish two types of gangliar cells, noting
that this distinction is mixed with that already given
by us in relation to the mode of behavior of the nerv-
ous prolongation, viz :
{a) gangliar cells which, by means of a nervous
prolongation, that gives off scattering threads, are in
direct relation with the nervous fibres.
[b) gangliar cells which, by means of a nervous pro-
longation that divides complexly, and passes in totality
into the diffuse network, are only indirectly in relation
with the medullate nervous fibres coming from the
periphery.
Do we possess any criterion enabling us to assert
that the two types of cells described by us, and the
two different modes of origin of the nervous fibres, may
be in relation with physiological differences ? and, more
precisely, have we any foundation for admitting that the
two described modes of origin are respectively in corres-
pondence with two functions, sense and motion, to each
of which, according to what physiology teaches, there
should be assigned a special category of nervous
fibres ?
It may be readily comprehended that we are not in a
position to formulate a precise answer to such a question,
yet it cannot be said that we are without some data for
the expression of a founded supposition.
390 Golgi.
In order to throw light on this question, we should
take special account of the results of the researches on
the medulla spinalis, an organ of which we have suffi-
ciently exact knowledge, as well as to its minute
anatomical constitution, as to the functions allied to its
principal constituent parts. And indeed, if we consider:
First, That in the zone of this organ where the nervous
fibres of sense arrive and are distributed, (the posterior
cornua, and especially the gray substance of Rolando^
there are found in prevalence gangliar cells whose nerv-
ous prolongation, complexly dividing, loses its proper
individuality (cells of the second type). Second, That
the fibres of the posterior roots, (of sense,) in the great
majority, perhaps in totality, subdividing finely, form in
the whole zone of their distribution, a complicate inter-
lacement, identical with that we see formed by the
nervous prolongation of the cells of the second type, (the
prevailing interlacement in the galatinous substance of
Rolando and in the posterior cornua, properly called, but
which may be said to be diffused in the whole gray sub-
stance of the medulla, not excluding the anterior
cornua).
On the other hand, if we consider, First, That in the
anterior cornua, (motor zone,) there prevail cells which,
as regards the behavior of the nervous prolongation, cor-
respond to those of the first type. Second, That the
fibres of the anterior roots correspond, in the behavior
of the nervous prolongation, to the cells of the first type,
that is to say, they put themselves in direct relation with
the gangliar cells of the same first type (situated in the
anterior cornua, or also in the other zones of the gray
substance, not excluding the posterior cornua). If, I say,
we consider all the data here set forth, it seems to me
that the supposition may be declared well-founded, that
the gangliar cells, whose nervous prolongation, subdivid-
ing complexly, completely loses its individuality, passing
in toto to form a diffuse network, belong to the sensory
sphere (the psycho-motor, as respects the cerebral cortex),
MttiJite Atiatomy of the Central Nervous System. 391
and that on the contrary, the ganghar cells whose nerv-
ous prolongation, although it gives of some threads, yet
tends to maintain its individuality, and puts itself into
direct relation with the nervous fibres, belong to the
motor sphere (or psycho-motor as regards the cortex of
the convolutions). Correspondently it will appear equally
probable that the first mode of origin of the nervous
fibres, which we have called direct, is proper to the
motor or psycho-motor sphere, and tliat the second mode
of origin, which we have designated indirect is on the
contrary proper to the sensory, or psycho-sensory sphere.
From what precedes, there is presented another ques-
tion, which is connected with the controversy mentioned
by us, as to the supposed direct connection (anastomoses)
between the protoplasmic prolongations of the nervous
cells ; and this is whether the origins of the two systems
of fibres are independent, or is there between them a
union ; and, if so, in what manner is it effected ?
It would truly be difficult to say, whether, and how,
a union could have place, had the common opinion at
any time been shown to be exact, that the nervous pro-
longation of the gangliar cells, after a short traject,
maintaining itself simple, and only acquiring a medullary
envelope, passes, as a general rule, directly to constitute
the cylinder-axis of a medullary fibre. The reply to this
question would be yet more difficult, in face of the de-
monstration given, that the protoplasmic prolongations
neither present a direct anastomoses, nor are conjoined in
a direct way, by means of the supposed minute network
of Gerlach. But from the knowledge of the facts de-
scribed by us, we think we may unhesitatingly specify
in what manner it is effected.
The basis for so decided a reply is furnished by the
assemblage of several of the particulars mentioned.
It is, first of all necessary to remember that the
nervous prolongation of those gangliar cells, regarding
which we admit direct connection with the nervous fibres,
in their course within the gray substance, give out a
392 Golgi.
greater or less number of filaments (primitive nervous
fibrillse) which, subdividing, take part in the formation
of a diffuse nervous network. In the second place, that
the so formed network is of very complex origin, since
in its formation these take part, besides the fibrillae here
mentioned, the nervous prolongations of the cells of the
second type, and the two categories of nervous fibres,
which as regards their manner of behavior, present re-
spectively a perfect correspondence with the nervous
prolongation of the two types of cells. Now, it is evi-
dent that the secondary threads of the nervous prolon-
gations of the cells of the first type, whilst they take part
in the formation of the network, represent the means of
anatomical union between the origins of the two catego-
ries of nervous fibres.
Although we admit that in the central organs of the
nervous system, the nervous fibres have their origin in
two different modes, yet we must at the same time hold,
that within the strata of the gray substance, the parts
which, in a certain manner, represent the roots of the
two categories of fibres, are not independent, but that a
sufficiently intimate band of union exists between them.
Thus, whilst, as regards one category of cells (the motor
or psycho-motor), each element has an individual and
direct origin, (not isolate,) the second category (the sen-
sory or psycho-sensory) has a very complex origin ; that
is, they proceed from a network, in the formation of
which these take part ; in the first line, gangliar cells of
the second type, having their nervous prolongation divid-
ing complexly ; in the second line, filaments emanating
from the nervous prolongation of cells of the first type.
Taking the question from another point of view, it evidently
results from what has preceded, that an extensive cate-
gory of nervous fibres, rather than having individual
relations with corresponding cellular individualities, may
be found related to extensive groups of these, and
perhaps with the gangliar cells of entire zones of the
gray substance.
Minute Anatomy of the Central Nerz'ous System. 393
Some of the facts stated merit being taken into par-
ticular consideration, from the point of view of their
physiological significance.
Under this head, one of the particulars, which claims
our attention, is that of the anatomical bond of union
which, within the strata of the gray substance, exists be-
tween the roots of formation of the two systems of fibres
recognized and described by me. In this connection
stands the explanation of the physiological relations ex-
isting between the fibres of the sensory sphere and those
of the motor sphere. What other significance can be
attributed to the fibres which, emanating from the nervous
prolongation of the cells of the first type, (supposed
motor, or psycho-motor cells,) proceed to be confounded
with a diffuse -network, which, as we have seen, is essen-
tially formed by the nervous prolongations of the cells of
the second type ? (sensor}', or psycho-sensory).
Can, above all, the reflex actions, with the knowledge
of the histologic relations described, find that explanation
which, in the past, has been so earnestly sought after,
either in the never yet demonstrated direct anastomoses
between the protoplasmic prolongations of the gangliar
cells, or in the just as hypothetical diffuse network re-
sulting from the infinite subdivision of these same proto-
plasmic prolongations ?
A subject, which should have special consideration, is
the existence and the complex mode of formation of the
diffuse nervous network, by means of which an extensive,
perhaps, a universal, colligation must be effected among
the elements which represent the roots of origin of the
nerv^ous fibres. This knowledge enables us to understand
how that close bond may be effected which exists betweer
the functions pertaining to the divers provinces of the
central nervous system, and it is specially through the
so-called phenomena of diffusion, that, with the know-
ledge of the mode of formation of the network, we can
be said to have acquired an anatomical basis for a
satisfactory explanation.
394 Golgi.
Taking into account also the particulars described as
to the mode of connection between the gangliar cells of
the nervous centers and the nervous fibres, it seems to
me, it may be held that we continue to speak too arbi-
trarily of isolated transmission between the peripheral
points and the supposed corresponding individualities of
the gangliar cells. Rather do I believe myself authorized
to declare that the so-called law of isolated transmission,
in so far as it would be had to apply to the mode of
functioning of the gangliar cells and the nervous fibres
of the central organs, has been deprived of all anatomical
basis. At least, so far as respects the greater part of the
provinces of the central nervous system, histological facts
constrain us to admit, certainly not an isolated action of
cellular individualities, but a simultaneous action of exten-
sive groups.
The nervous fibre, as an organ of centripetal and centri-
fugal transmission, far from being found in isolated indi-
vidual relations with a corresponding gangliar cell, is, on
the contrary, found connected with extensive groups of
cells ; but the opposite fact is also verified, that is to say,
every gangliar cell of the centers may be in relation with
several nervous fibres which have a different destination,
and probably a different function.
This fact merits better explanation and illustration by
some examples, and it is not to me difficult to find some,
by recalling the results of my recent examinations of the
structure of the olfactory lobe and the medulla spinalis.
According to what I have been enabled to establish in
the olfactory lobes, the gangliar cells are severally in rela-
tion with at least three classes of nervous fibres which have
quite different progress and destination. For example, a
cell of the first type is, by means of its nervous prolonga-
tion, in relation: ist, with nervous fibres of the tractus ;
2nd, with fibres of the anterior commissure; 3rd, with fibres
of the corona radiata ; the relation is, in evA-y instance,
indirect. Thus every cell of the second type would be in
relation with three different classes of fibres, but with this
Minute Atiatomy of the Central Nervous System. 395
difference, that the relation is direct with the fibres of the
tractus, and probably al?o with those of the commissure
(sic). And in the medulla spinalis also I have seen many
instances of gangliar cells, whose nerv'ous prolongation gave
place to various fibres which were carried in opposite
directions.
In conclusion, as regards the greatest part of the nervous
centers, far from the described individual and isolate connec-
tions between cells and nervous fibres there is seen, on the
contrary, an evidently direct disposition, by which is effected
the greatest possible complication in the relations between
the two. And this law exists, not only as regards the
several elements or groups of them, but also as regards
entire provinces.
Another observation occurs to me : The concept of the
so-called locatio?i of the cerebral functions, should it be
insisted on accepting it in a rigorous sense, would not be in
perfect harmony with the anatomical data, or, at the least,
it should now be admitted only in a somewhat limited and
conventional sens^e. It being demonstrated, for example,
that a nervous fibre is in relation with extensive groups of
gangliar cells, and that the gangliar elements of entire
provinces, and also of various neighboring provinces, are
conjoined by means of a diffuse network, to the formation
of which all the various categories of cells and nervous
fibres of these provinces contribute, it is naturally difficult
to understand a rigorous functional localization, as many
would desire to have it. At the most, we might speak of
prevalent or elective paths of transmission, and of provinces,
not rigorously limited, which, as prevalently or electively
excited, so prevalently do they react in a sense correspond-
ing to the excitation effected.
I would lastly allude to another question, already
touched on in the descriptive statement precedently made,
and which should have relation to one of the questions
which we have proposed to solve ; it is, whether in the ner\--
ous centers there exist elementary differences which may
correspond to the different functional task devolved on them.
396 Golgi.
As respects this question we can say that a difference
truly exists, but it exclusively regards the different mode of
deportment of the nervous prolongation. But from the
point of view of the supposable relation existing between
the anatomical differences of the elements, and their func-
tion, we cannot take into account either the form or the size
of the cellular bodies. It is, however, true that there are
prevalently large gangliar cells (of the second type) which,
being provided with a nervous prolongation that puts itself
into direct relation with the nervous fibres, should be desig-
nated as motor, or psycho-motor cells, whilst, conversely,
there are prevalently small cells (gangliar cells of the
second type), provided with a nervous prolongation which
divides complexly to place itself in indirect relation with
the nervous fibres ; these cells probably belong to the
sensory, or psycho-sensory sphere ; but these relations
have so many exceptions that it is not possible to estab-
lish any general law.
That, in correspondence with the functional differ-
ence of the cells, there may at the same time also exist
chemical or other differences, cannot be excluded in any
manner; rather is it probable that they do exist; but
from the anatomical point of view, I think I may assert
that the difference described by me is, at the least, the
most important.
At the end of this study as to the mode of origin of
the nervous fibres of the centers, it appears to me useful
to state, in a series of resumary conclusions, so much as
directly or indirectly regards so important a question.
First. In studying the problem of the origin of the
nerves, in the different provinces of the central nervous
system, it becomes apparent that there exist some second-
ary differences, relative to the morphology, disposition and
distribution of the elementary patts, but that in the essen-
tial parts, as the relations between the cells and nervous
fibres, there exist constant laws, and an absolute corres
pondence between the diverse provinces.
Second. In general, the nervous cells, by their form,
Minute Anatomy of the Central Nervous System. 397"
the special aspect of the cellular body and of the nu-
cleus, the mode in which the prolongations have origin
from them, as also by the aspect, and the mode of rami-
fying of the prolongations, may, by an expert observer-
be differentiated from the other cellular elements ; yet, no
one of the characters assigned can be given as absolute
so true is this that, holding as the basis of our judgment
these data alone, it is not a rare case to find that we-
must remain uncertain whether some cellular elements
should be considered as of connective or of nervous
nature ; and it is known that the elements are not few,
relative to which the judgments of histologists are con-
tradictory. There is, however, an absolute characteristic
datum from which a cell may, with certainty, be desig-
nated as nervous, and this consists in the presence of a
prolongation (always unique) different from all the others,
and destined to be put into relation with the nervous
fibres, or to be transformed into these.
Third. The so-called protoplasmic prolongations in no
way, either directly or indirectly, give origin to nervous
fibres; from these they always maintain themselves inde-
pendent ; they have, on the contrary-, intimate relations
with the connective cells, therefore their functional pur-
pose should be sought for from the point of view of the
nutrition of the nervous texture ; that is to say, they
probably represent the paths through which the diffusion
of the nutritive plasma is brought from the blood vessels
to the gangliar cells.
Fourth. The gangliar cells of all the provinces of the
nervous system, by a law which has no exception, are in
relation with the nervous fibres by means of one only
of their prolongations, that which, in homage to the
author who first made it the subject of a particularized
description, has been designated the prolongation of
Deiters, or the cylinder-axis prolongation, but which we
shall always call the nervous prolongation. Wherefore,
from the point of view of their specific function, all the-
central nerve cells may be considered as monopolar.
398 Golgi.
Fifth. The fact, many times noted, that it is only by
means of the nervous prolongation with which they are
provided, that the gangliar cells are put into relation with
the organs by which they extrinsicate their functional
activities (nervous fibres of sense) is related to another
fact of notable importance, which is that the difference
between the nervous cells of sense and those of motion,
principally, if not exclusively, relates to the mode in
which, by means of this prolongation, their connection
with the corresponding fibres of sense and motion is
effected. The relative differences as to the form, size
and also, with some exceptions, as to the situation of
the gangliar cells, falls into a very secondary rank. As
an evident corollary of this law we ought to hold that,
in performing the anatomical study of the nervous cen-
ters, the function of the gangliar cells can, with secure
foundation, be argued only from the deportment of the
respective nervous prolongations, and from the manner
in which their connection with corresponding fasces of
nervous fibres of known function is effected.
Sixth. All that has been asserted with regard to the
nervous prolongation of the gangliar cells, first by Deiters
and afterwards confirmed by the generality of anatomists
who have occupied themselves with this subject, is erro-
neous, to-wit : that, maintaining constant simpUcity, it
passes directly to constitute the cylinder-axis or a
nervous fibre. Instead of this, the rule is, that this
prolongation gives origin, at greater or less distances
from its departure from the cell, to a more of less large
number of filaments, which are so many nervous fibrillar.
Seventh. The behavior of the nervous prolongation is
not alike in all the gangliar cells ; indeed in this respect
notable differences may be shown ; in many gangliar cells
the nervous prolongation, subdividing complexly, takes
part, in its totality, in the formation of a fine nervous
network, which is found diffused in all the strata of the
gray substance ; in many gangliar cells, instead of this,
the nervous prolongation, although it gives off some
Mimite Anatomy of the Central Nervous System. 399
filaments, in like manner destined to take part in the
formation of the above diffuse network, yet arrives in the
medullary strata maintaining its proper individuality, and
there in fact, it forms the cylinder-axis of a medullary
nervous fibre.
Eighth. In relation to the different mode of behavior
of the nervous prolongation, in the gray substance of the
nervous centers, two types of gangliar cells may be dis-
tinguished, viz :
(rt.) Gangler cells whose nervous prolongation, though
it gives off some lateral threads, maintains its proper
individuality, and passes on to place itself in direct re-
lation with the nervous fibres.
{b^ Gangliar cells whose nervous prolongation, sub-
dividing complexly, loses its proper individuality and
takes part in toto in the formation of a diffuse nervous
network. These cells, therefore, would have only indirect
relations with the nervous fibres.
The arguments resulting from accurate studies of the
two types of cells mentioned, give a sufficiently valid
foundation to the decision, that the cells of the first type
are of motor, or psycho-motor nature, and that those of
the second type are, on the contrary, sensorial or psycho-
sensorial.
Ninth. The two types of gangliar cells recognized by
us, far from being found separately in this or that other
region of the central organs, are constantly found asso-
ciated ; at the most in some zones, as regards their
different function, there is noted a prevalence of one or
of the other type, or it is observed that in the same
zone, a series of cells belongs to the first type, whilst
the others belong to the second.
Tenth. The nervous fibres, also, entering into the
different strata of the gray substance, may, in relation to
the behavior of the respective cylinder-axis, be divided
into two categories, viz :
{a.) Nervous fibres whose cylinder axis, though it
administers some secondary fibrillae (which subdividing are
-400 Golgi.
lost in the diffuse network), yet preserves its proper indi-
A^iduality, and passes on to place itself in direct relations
^th the gangliar cells of the first type, and continues
itself in the related nervous prolongation,
(^.) Nervous fibres whose cylinder-axis, dividing com-
plexly loses its proper individuality, and in totality takes
part in the formation of the diffuse network mentioned.
In the same manner as we judge, the two types of
■gangliar cells described, to belong, the one to the motor,
psycho-motor sphere, and the other to the sensory, or
j)sycho-sensory, so do we hold that the first category
of nervous fibres belongs to the motor, and the second
to the sensory sphere.
Eleventh. In all the strata of the gray substance of
the central nervous organs, there exists a fine and comp-
licate diffuse nervous network, in the formation of which
there concur : —
(«.) The fibrillae emanating from the nervous prolon-
.gation of the cells of the first type (motor, or psycho-
motor).
(<5.) The nervous prolongations of the cells of the
second type, in totality, decomposing complexly (sensory,
or psycho-sensory).
(<:.) The nervous fibrillae emanating from those nervous
.fibres which pass on to put themselves in direct relation
■with the gangliar "cells of the first type (fibres of the
first category).
(^.) Many nervous fibres in totality, that is to say,
those which, identically with the nervous prolongation of
ihe cells of the second type, decomposing into very
slender filaments, and thus losing their proper individ-
uality, pass on to be gradually confounded in the network
in question.
The network here described is evidently destined to
•establish a bond of anatomical and functual union
between the cellular elements of extensive zones of the
gray substance of the centers.
Twelfth. The several nervous fibres, far from being
Minute Anatomy of the Central Nervous System. 401
found in isolate, individual relations with a corresponding
gangliar cell are. on the contrary, in the great majority
of cases, found in connection with extensive groups of
cells; but the opposite fact also is verified — that is to
say — every (?) gangliar cell of the centers may be in
relation with several nervous fibres, which have different
destination and function.
Thirteenth. In the relations between cells and nervous
fibres, rather than the described individual and isolate
connections being verified, there is observed an evidently
direct disposition, by which the greatest possible compli-
cation of relations is effected.
Fourteenth. As a necessary deduction from all that
precedes, we should hold that, up to the present time,
we have continued to speak too arbitrarily of isolated
transmission between peripheral points and the supposed
cellular individualities of centers. Taking account of the
data above described, we may, without reserve, declare
that, from the so-called law of isolated transmission, in
so far as it is wished to apply it to the mode of func-
tioning of the gangliar cells and the nervous fibres of
the central organs, every vestige of anatomical basis is
now taken away.
Fifteenth. Another corollary from what precedes is
that the concept of the so-called localization of the cere-
bral functions, taken in a rigorous sense, — (i. e. — that
certain determinate functions may be referred to one or
another zone, exactly limited,) cannot be said to be in
any manner supported by the results of minute anatomical
researches.
CHAPTER III.
Morphology and Disposition of the nervous cells in the
anterior central and the superior-occipital convolutions.
The study of the form and disposition of the gan-
gliar cells should be entirely re-made in all the provinces
of the central nervous system, in order to enable us to
402 Golgi.
solve the problem, whether the differences of functions
are allied to differences of form, dispositions and relations
of these elements. The solution of this problem has
indeed been attempted by several observers, and some of
them have given a reply, but certainly it cannot be said
that it is tenable.
In order to reach our purpose, no province of the
central nervous system, and no convolution, should be
overlooked in the new survey ; and only after completion
of this long and patient analytic labor, only after having^
put in order, compared, and subjected to control, the
facts gathered in, can there be formulated a well-founded
judgment on the problem.
In the extensive domain opened up in these re-
searches, that of the convolutions, by reason of the
experimental physiological studies executed on these in the
modern epoch, appears to me to have offered an interest
very special in circumstances, and with these parts I have,,
therefore, desired to commence my enquiries with the
object specified.
In face of the extent which these researches ought
to have, in order to enable us to arrive at well-founded
conclusions, it will be readily comprehended that I can
attribute trifling value to the data now presented ; and in
fact I regard them as only two points in the long series
of studies which I think should be gathered in, that we
may reach our object ; at all events I present them, ob-
serving that in selecting these two convolutions, I have
had the intention of establishing a comparison between
those convolutions to which, according to the latest
researches, an opposite physiological significance should
be attributed.
It is known that since the ever celebrated studies of
Fritsch and Hitzig, in almost complete accord, physiolo-
gists have ascribed motor action to the convolutions of the
anterior half of the cerebrum, whilst to the occipital con-
volutions they have, instead, attributed functions more
specially sensory.
Minute Anatomy of the Central Nervous System. 403
As, among the convolutions, which, considered as
centers of diverse functions, might be supposed to be
formed of a different histological constitution, those
regarding which I present this specimen of morpho-
logical study, might properly stand in the first
rank, that is to say, the central anterior and the supe-
rior occipital convolutions. These convolutions, indeed, as
regards structure, should in a certain manner be considered
as two contraposed types.
And since this subject is certainly one of those which
should merit an ample development, so is it my inten-
tion to confine myself, for the present, almost solely to
the presentation of the plates, on which, with scrupulous
exactitude of form, and altogether special typography
and relations, the cells have been depicted as they are
seen in my preparations; in illustration of the plates, I
will merely present a resume of the cellular forms exist-
ing in the various zones, adding, in this relation, only a
few critical observations, on the division into strata,
which, as regards the cortex of the convolutions, are very
generally accepted as the most exact.
Before passing to the description of the two plates (3rd
and 4th) which reproduce the form and disposition of the
cells in the central anterior and the occipital convolu-
tions, I must state, that, within the last years (1S74),
Betz published a work with the same object as that
stated above by me. He would appear to have found
that the cortex of the anterior parts of the cerebrum, in
front of the fissure of Rolando, is characterized by the
presence of special cells of exceptional largeness {Riesen-
pyramiden), in that which he calls the 4th stratum, and
that they would be presented in groups or nests, and
would be furnished with two special prolongations, — one
gross, which, sending out lateral branches, is directed to-
wards the periphery, the other slender, proceeding from
the nucleus, and destined to pass directly into a nervous
fibre. But cells having such characters would be wanting
in the posterior part of the cerebellum.
404 Golgi.
Resting on these data, Betz expressed the opinion,
that in the cerebrum there are two domains which might
be considered as two different centers, one motor, and
one sensory, thus repeating in the structure of the cere-
brum the type of the medulla spinalis.
The part situate anterior to the fissure of Rolando,
would correspond to the anterior cornua, and the part
behind it to the posterior cornua.
That the physiological doctrine which ascribes to
various convolutions different functions, may contain a
portion of truth, after the results of the experimental
and clinical studies for which we are indebted to a select
band of modern physiologists and pathologists, we have
no right to deny ; but that this doctrine has not acquired
any solid foundation from the anatomical data of Betz,
will be apparent after the exposition I now undertake to
make.
Study of the anterior convolution. — {Gyrus centralis ante-
rior) of Ruscke and Ecker.
This belongs to the convolutions in which, according to
Meynert, we should verify the general typical structure of
the cortex, and in which we ought therefore to distin-
guish 5 strata. The same distinction has been made by
Huguenin, who, as to the rest, on this subject, as in all
the others, merely repeats almost always without dissent,
the observations of Meynert.
The Meynert- Huguenin division into strata, having been
commonly judged the most exact, or indeed placed as
the basis of the physiological disquisitions relating to the
cortex, I think it should be selected for the construction
here of a resume to be placed in comparison with the
data resulting from my researches. It is as follows :
First. — A stratum of disseminate small ?iervous
cells. This would have a thickness of 25 centimes
(i-ioo inch) of a millimeter, (1-8 and i-io of the thick-
ness of the whole cortex), and would contain, besides
Minute Ayiatomy of the Central Nervous System. 405
the neuroglia : 1st., Small gangliar cells whose long
axis would measure from 9 to 10 micro-millimeters ; the
form of these cells is pyramidal or polygonal. 2nd., Nervous
fibres which form a thin stratum on the outmost part,
and are directed tangentially to the surface.
Second. — A stratum of small pyramidal crowded cells
This stratum would be 0.25 millem. in thickness ; the
quantity of small pyramidal cells would be so great as to
hide the neurolgia in the interstices.
Third. — A stratum of great pyramidal cells. (Forma-
tion of the cornu Ammonis.) This stratum would be
three times as large as the second, but the gangliar
cells would not be found so crowded as in the second ;
on the contrary their diameter is much larger (25 to
40 micro-millimeters). The name, formatioii of the cornu
Ammonis, used by Meynert, is due to this, that, as he
says, the cornu would contain cells of this nature only.
Relative to the forms of the cells of the second and
third strata, Meynert says that the term pyramidal
given to them, is illusory; the true form (vide fig. 235
of his article. Das Gehirn, in the Handbuch of Strieker),
should be fusate, with the great axis perpendicular to
the external surface of the cortex.
Fourth. — A stratum of irregular small cells. (Granular
formation.) The thickness, 0.20 and 0.25 millim. The
cells rounded, rarely triangular; in diameter 8 to 10
micro-millimeters ; they are much closer to one another
than the great cells of the 3rd stratum. Meynert com-
pares these elements, which he says he has met with
in the cerebral cortex, to the internal granules of the
retina.
A stratum of fusifortn nervous cells. (Formation of
the Claustrum ; Vormauer Formatio7i.) It is the inner-most
of the cortex, the thickness is 0.5 millim.; its cells would be
about 30 micro-millimeters in length. In correspondence
to the summit of the convolutions, these elements would
be disposed parallel to the pyramids ; in correspondence
to the sulcus between the two convolutions, they would,
406 Golgi.
instead, have a horizontal disposition. According to
Meynert, therefore, these cells would send forth prolon-
gations all diverted towards the periphery of the cortex,
and from this circumstance, he, without reserve, draws
the conclusion, that they have nothing to do with the
system of projection (fasces of the corona radiata), and
they ought to be considered as cells belonging to the
system of association. He calls them Vonnauer Formation,
because, as he says, the Claiistrmn consists solely of an
accumulation of cells identical with these.
I note finally, that Meynert attributes a cylinder-axis
prolongation in the same sense as Deiters, only to the
great pyramidal cells of the third stratum, and to these
he consequently attributes the significance of the motor
cells, admitting that they are in direct relation with the
fibres of the corona radiata (system of projection), whilst
to the small elements, in form of nuclei in the 4th stra-
tum, he attributes sensory functions.
How inexact are his anatomical data, and consequently
how trivial is the foundation on which rest his theories
as to the functions of the several categories of elements,
may already have been argued, from what I have before
said respecting the nervous cells in general, and it will
appear yet more clearly further on in this work.
In relation to the stratification above described, I
merely observe, that it corresponds indeed to the illus-
trative plates of Meynert, but if comparison were made,
not with the plates, but with the preparations, whatever
may have been the method of their execution, I believe
that nobody would succeed in making out a correspon-
dence.
Leaving apart, for the moment, the ensemble of the
cortex, before saying whether any division is possible, and
what I believe it may be, I shall make a summary of the
different cellular forms existing in the cortex of the
anterior central convolution, which I have taken as the
type of those which would be designated as psycho-motor
convolutions.
Minute Anatomy of the Central Nervous System. 407
I believe the following types may be distinguished :
First. Pyramidal cells.
Second. Fusiform cells.
Third. Globose or polygonal cells luith angles rounded.
First. — The pyramidal cells. As to their number, these
by far prevail over all the others, and some of them are
ver>' large (their diameter across from 30 to 40 micro-
millimeters, and lengthwise they may correspond to the
thickness of the cortical stratum, hence i 1-2 m, m. and
over); there are also ver>' small ones (diameter across 10
to 15 micro-millimeter, and lengthwise 300 to 500 micro-
millimeter). From the angles of the basal side, and often
also form their lateral surface, there go forth nervous
prolongations (which may be 6, 8, 10 or more, in number),
and these whilst continuing to ramify dicotomically, may
be followed to a very great distance from their origin.
Among the numerous prolongations one alone offers
the characters of an essetitially nervoiis prolongation. All
the others present the characters of protoplasmic prolon-
gations.
In the majority of cases, the nervous prolongation has
its origin at the middle, or a little to one side, of the
basal surface of the pyramidal forms; in some cases, how-
ever, it has its origin from one of the protoplasmic prolon-
gations which proceed from the surface of the pyramids.
As respects the successive behavior of the categories
of prolongation, I refer to the general description which
I have given oi them. They all put themselves into re-
lation with the connective cells which are everywhere
distributed, especially along the vessels in the diverse
strata of the cortex.
Appropriately I nnd it worthy here to note, that in
many cases I have been able to see that the cells situ-
ated in the deepest strata of the cortex are pushed, with
their protoplasmic prolongations, even to the connective
stratum, which in the form of a continuous submeningeai
stratum, in the central anterior convolution, as in all the
others, exists on the surface of the cortex.
408 Golgi.
The nervous prolongations b.ehave in the manner de-
scribed in the first part of this work, that is to say, they
give origin to numerous lateral branches, which, subdivid-
ing, succeed in constituting a diffuse interlacement in all
the cortex.
As regards the distribution of this type of cells, I at
present restrict myself to saying that they pertain, not
exclusively to this or that stratum, but exist in all the
extent of the cortex, not excluding the deepest parts. I
shall resume this subject when I come to treat of a pos-
sible division into strata.
Second. — Fusiform cells. These are in reality almost
exclusively in the deepest stratum of the cortex, where
the nervous fibres proceeding from the corona radiata,
also exist in parallel fasces. It may not therefore be ex-
cluded, that their special form is determined by the
topographic conditions surrounding them, that is to say
their being found in the midst of fasces, which, running
parallel to each other, render it, in a certain manner pos-
sible, that their development shall be only in a longitu-
dinal direction.
As to their essential characters, the fusate cells
conform exactly with the general type ; hence the asser-
tion of Meynert, that they have special relations with
nervous fibres, is totally unfounded. Their protoplasmic
prolongations have the usual relations with the vessels
and the connective elements ; I shall, in this relation,
only now prominently stale, that some of these prolonga-
tions are pushed forward very deeply, reaching the
connective cells situated properly in the medullary
stratum.
The nervous prolongation issues prevalently from one
side of the cellular body, directing itself very soon to-
wards the fibres, and in its traject it always gives out
some very slender fibres; which show a tendency to bend
upwards, in order to reach the diffuse network existing in
the gray substance.
Third. — Globose or polygonal cells zvith rotmded angles.
Minute Anatomy of the Cetitral Nervous System. 409
These exist in but small number, and they cannot be
said to be proper to this, or that zone, as it is possible to
meet with some in the most superficial zones and in the
middle and deep ones. However, they exist in the deep
parts, in correspondence with fusate cells, in notably
greater quantity.
Their diameter across varies from 12 to 20 micro-
millimeters, and lengthwise from 15 to 25 micro-millimeters;
they are in general provided with numerous protoplasmic
prolongations, which emanating from various points on
the surface, are carried verj' far in the most varied
directions, always, however, as to their mode of termina-
tion, according to general laws.
As regards the nervous prolongation, these cells pretty
frequently present a diviation from what may be called a
general law ; though, as a rule, this prolongation issues
from that part of the cell spoken of, it frequently ema-
nates from the opposite part, and takes its course towards
the surface of the cortex. As to its ulterior course, it
presents differences ; in some cases it bends in order to
conform to the course of the others ; much more frequently
decomposing into very slender fibrillae, it passes on to be-
come confounded with the diffuse ner\'ous network.
Therefore, as to the nervous prolongation of these cells,
the fact, that by decomposing into very slender fibrillae, it
in a certain mode loses its proper individuality, through
being confounded with the diffuse network, may be said
to be normal, whilst, as we have seen, for the other cel-
lular types, it is exceptional.
Returning now to the subject of the division into strata,
what I have before said suffices to make it understood
that I absolutely do not believe the division by Meynert
acceptable, for it is utterly arbitrary, and is based on er-
roneous views of the morphological characters of the
elements distributed within the cortical gray substance;
I shall even add, that in all rigor I ought to say, a true
distinction in strata is impossible, since the differences
which are shown in the different zones are so gradually
41 o Golgi.
effected, that it becomes impossible to say where one
stratum ends and another begins.
But as it is useful and convenient, to be able, with a
certain degree of precision, to designate this or that cor-
tical zone, so wishing to adopt a distinction in strata, in
the cortex of the central anterior convolution, I shall
limit myself to the enumeration of these, viz :
First. A superior or superficial stratum (the superior
one-third of the cortex).
Second. A middle stratum (middle third).
Tliird. A deep stratmn (deep third).
It may be noted, that this distinction, which, in fine^
to a certain point, is in relation with the distribution
of the cellular forms described, in some way corresponds
to that distinction which, as is known, is, from its gradua-
tion of color visible to the naked eye.
I next observe, that in making this distinction into three
strata, I do not take account of the pigmy stratum, con-
nective and superficial ; a stratum which, more or less
distinct, exists in all the convolutions and over the entire
free surface. Including, however, this purely connective
part, we would have four strata.
Although it may be admitted that the distinction, so
far as relating to the confines, is always merely arbitrary,
since relatively to the diameter and the form of the cells
the transitions are gradual, yet some differences exist, and
I shall indicate them in the following brief summary :
First. — The first or superficial stratum. (Vide plate
3rd.) It is formed almost exclusively of rather small pyra-
midal cells, which present a slight increase of diameter in
their passage towards the underlying stratum. There are
also here represented, but in rather small quantity, the
cells which I have designated globose or polygonal.
Secofid. — Second or middle stratum. Here we meet
with pyramidal cells which may be designated medium
and great. The latter exist prevalently in proximity to
the inferior stratum.
On account of the great pyramidal cells, I wish to put
Mimite Anatotny of the Central Nerfous System. 41 r
into clear view the fact, that it is not difficult to follow
their prolongation from the apex even to its arrival in the
submeningeal connective stratum. Despite the repeated di-
cotomic divisions which it presents, and the lateral branches
it gives out, we have found that its very last offshoots,
in the connective stratum, have still a notable diameter.
Along with the great and medium cells, there are
others, in like manner of pyramidal form, and belonging
to the smallest existing in the cortex.
Third. — Third or deep stratum. As to its cellular
forms, this stratum presents the greatest variety ; the fusi-
form, however, prevail ; the globose or polygonal and the
atypical are here, more than elsewhere, presented, and the
medium and small pyramidal are not wanting. It is also
in this stratum that the greatest anomalies are met with,
as to the disposition of the cellular bodies, the mode of
origin and the direction of the nervous prolongation.
Concerning the direction, I observe that pretty frequently
the cells are seen disposed obliquely or also horizontally.
Here, with great prevalence I have met with cells whose
nervous prolongation emanates in the direction of the free
surface ; among the diverse other deviations from the
typical disposition, I should mention that of the presence
of cells havmg quite pyramidal form, but presenting a di-
rection opposite to that which may be called normal,
that is to say, presenting the point downward and the
base upward.
In rare types of this sort, met with by me, the nervous
prolongation emanating from the base of the pyramids,
was directed towards the peripher}-.
II.
Study of the superior-occipital convolution. — (Posterior ex-
tremity.)
This belongs to the convolutions which were also
studied by Clarke, who, as is known, distinguished in it
seven strata concentrically arranged. In order to avoid
412 Golgi.
useless repetitions of the description given by him, I
limit myself to recording what he asserted, that in the
cortex of the extremity of the posterior lobe, ''all the
cells are small T
Instead of his division, I shall reproduce that of
Meynert-Hugiienin, which has been the most accredited,
and which, as I wish, at any cost, to make but one work
of both, seems to me the most convenient.
The strata distinguished by Meynert-Hiiguenin are no
less than eight :
First. A stratum which corresponds completely to
that described as the first stratum of general type.
Second. A stratum similar to the second ( ? Clarke's)
of general type. (Small pyramidal cells.)
Third. The stratum of gross pyramidal cells would be
wanting. On the contrary there would be found a stratum
of nuclei, which would offer the same structure as the 4th
stratum of general type.
Fourth. A stratum containing pyramidal cells very
sparse but remarkable for their size. To these cells, by
reason of their small number, Meynert gives the name
solitary cells.
Fifth. A stratum of nuclei similar to that which Mey-
nert admits in the frontal convolution.
Sixth. A stratum similar to that described as the
fourth ; it contains the elements of the neuroglia, among
which are found, disseminate, a few solitary large
cells.
Seventh. A stratum of small cells with rounded nu-
cleus.
Eighth. Lastly, the eighth stratum would be formed
of fusiform cells, which in their form and disposition,
present no difference as to the general type.
According then to Meynert, the convolutions of the
occipital lobe would be distinguished by the prevalence
of the so-called granules of which there would be three
strata.
If I should desire, as to this convolution also, to group
Minute Anatomy of the Central Nervous System. 413
the different cellular forms which are met with in it, I
ought to distinguish, as I have done for the central con-
volution, three principal types, viz : pyramidal cells
fusiform cells, and globose or irregular cells ; as regards
their essential characters, I should be obliged to repeat
exactly what I have said when speaking of the nervous
cells in general, and of those of the central convolution
in particular, which would be superfluous. As relates,
therefore, to the general characters of the cells of the oc-
cipital convolution, I shall only note that we here meet
with, in greater or less number, small and verj"" small
cells, but that these last also always show, quite conspicu-
ously, the cellular character, and are always furnished
with numerous long prolongations, among which the char-
acteristic nervous prolongation may be very clearly dis-
tinguished. I shall add that the medium and large and
very large pyramidal gangliar cells, with characters identi-
cal with those of the cells met with in the central anteror
convolution, are not absent ; nor can it be said that these
cells are found in less quantity in the occipital, than in the
central anterior convolution.
Relative to the subject of the strata, it is superfluous
to state that the division made by Meynert (into eight
strata) is utterly unfounded. In truth, among other puz-
zles, I would not know to what part to refer the three
strata of granules brought into the account by him, pro-
vided that they belong to those elements which merit
being qualified as granules; if, however, we take them in
the sense of small cells unprovided with prolongations,
neither in this convolution, as may be seen on the plate,
nor in any other, have I succeeded in finding a trace of them.
For my own part, as regards the cortical zone, I
must declare that I believe it is not possible to recognize
either a true division into strata, or a regular distribution
of different types of elements; but when, with the view
of rendering the description and the relative position more
easily understood, we would make a conventional division,
I think that here also, leaving always out the superficial
414 Golgi.
connective stratum, three strata might be distinguished, viz :
First. The first or superficial stratum,
Second. The second or middle stratum.
Third. The third or deep stratum.
First. — The first or superficial stratum. As regards the
form, size and disposition of the nervous cells, it would be
difificult to find significant differences in comparing them
with the corresponding stratum of the central anterior
convolution. The cells, here also, of pyramidal or triangu-
lar form, more or less regular, with the apex, as a rule,
turned towards the free surface, are in great prevalence.
As to the size of the cellular bodies, accurate measure-
ments show that there is no peculiar prevalence here of
the small forms, the medium and small cells being found
in nearly equal quantities ; it is, on the whole, noted that
the elements of this stratum offer less proportions than
those of the underlying stratum.
The only difference that can be shown, by continuing
the comparison of the superior occipital convolution with
the central anterior, is that in the former the first order
of cellular bodies is met with at a notably less distance
from the surface, than in the central convolution ; here
(the superior occipital convolution), the nervous cells of
the orders nearest the surface, have a form more stumped
[tozza) than the corresponding cells of the central convo-
lution (because the protoplasmic prolongations of the apex
have come nearer to their termination). This difference is
probably connected only with the greater or less develop-
ment of the connective tissue, as it is known that this is
always most abundant in the parietal and superior frontal
convolution.
Second. — Second or middle stratum. This stratum is
prevalently occupied, like the corresponding stratum of the
central anterior convolution, by pyramidal cells of medium
and large diameter, not however excluding some small
ones. The large prevail towards the deepest parts of the
stratum, where they are seen distributed in rather regular
distances at different levels. Here also I have been able
Minute Anatomy of the Central Nervous System. 415
many times to follow the prolongation, which represents
the continuation of the apex of the pyramids, and likewise
its divisions (which in the traject are pretty numerous,
and in form dicotomic), up to their arrival in the sub-
meningeal connective stratum.
Third. — Third or deep stratum. This stratum presents
the most notable differences, not only as respects the first
and second strata of this convolution, but also as respects
the corresponding stratum of the central convolution.
Here are represented all the described types of cells, and
all the gradations of diameter. Here are met with, in very
large quantity, the fusiform cells, but in a proportion per-
haps rather less than in the central convolution, it is here
in like manner, that the globose or polygonal cells almost
exclusively exist ; and here we find, in notable quantity
the medium and small pyramidal cells, a little more numer-
ous. Finally we should signalize also the presence of rare
pyramidal cells, belonging to the largest which can be met
with in the cerebral cortex. One of these accurately de-
signed, is seen on plate 4, down in the deepest zone, (the
third) where the nervous fasces, (which, in order to avoid
confusion have been omitted in the plate) have hardly
commenced to diverge ; it may be obser\-ed that the con-
tinuation of the apex of the pyramid may be followed up
to its arrival in the superficial connective stratum ; the
length of this cell would therefore correspond to the thick-
ness of the entire cortex ; (the exact length from the base to
the extremity of the prolongations of the apex, I have found
to I 1-2 millimeter, and the breadth 30 micro-millimeter.*
Relative to the general physiognomy of this third
stratum, we may say, that its most conspicuous character
results from the presence of a grand quantity of very
small nervous cells, of globose or pyramidal, or also fusate
form, which are always^provided with several prolongations
(and a nervous prolongation always unique) ; these prolon-
• XoTK BY Tba-Sslator.— Ihis splendid pyra'.iiidHl cell will be found in the third
stratum on the fourth plate, rather more than halt way down. If it existed in nature
just as here shown, it might be regarded as an embryo Jcoraet. (Perhaps its owner
was an astronomer.)
4i6 Golgi.
gations are seen disposed^in the deepest zone of the cor-
tex (but without a marked hmit) ; this zone is situate at
a level, where, with the naked eye, it might, from its
white color, be said that the tissue is formed of nervous
fibres only.
If now, in conclusion bearing in mind the resutm of
the types of gangliar cells belonging to the anterior cen-
tral and the superior occipital convolutions, which we
selected for comparison, we would study to indicate whether
there exist,' between those two convolutions fundamental
differences of anatomical organizations, and to state in what
these may consist, it has appeard to me that, leaving out
of consideration their difference in thickness, the only
other appreciable difference regards the third or deep stra-
tum, and it consists in the fact last stated, of the presence
of numerous small nervous cells, distributed in a rather
limited zone, situate in the deepest part of the same
stratum.
That to this sole difference there may be ascribed
any great weight in explanation of physiological facts,
seems to me difficult to believe ; but keeping in view the
facts exposed, I hold that the contrary decision would be
far more justified, that is to say, that the functional dif-
ferences inherent in the various cerebral convolutions, find
their explanation, not indeed, in the histo-morphological
particularities of these convolutions, but rather in the
mode of progression, and the peripheral relations, of the
nervous fasces, which have their origin in the convolu-
tion. The specificity of functions of the various cerebral
zones (convolutions, &c.) may be in relation, not indeed
with the patticularities of the anatomical organization of
these zones, but rather luitJi specificity of the organs to
ivhich peripherally the fibres ivliicJi have their origin in
these zones, proceed to make their termination.
To be Continued.
Note BY Translator. —In vtry numerous iustanccB the word prolongation may
seem to have been erroneously used In the singular, instead of the plural number.
It is possible that the Italian author has used It in a collective seuse; it has therefore
been judged better to render it literally hi the English version.
A Reply to J. J. Elwell, M. D,, in re
Guiteau.
By E. C. Spitzka, M. D., N. Y.,
Professor of Medical Jurisprudence and of the Anatomy and Physiology of the Nerv-
ous System in the Nevr York Post-Gradnate Medical School; Physician to
the Department of Nervous and Mental Diseases of the Metropoli-
tan Throat Hospital; President of the New York Neurological
Society; Member of the American Neurological Asso-
ciation; W. and S. Tnke Prize Essayist; Wm.
A. Hammond Prize Essayist, etc
MANY years ago the writer read in a book of travels,
of a race of savages in some one of the archipelagos
of the Pacific, whose tribes had a peculiar custom :
Whenever a lesser chief and his people had their posses-
sions raided by a more powerful neighbor, they gathered
together, erected an image of their foe, caricaturing him
as much as possible ; and after taunting the defenseless
object of their v/rath, and offering it every indignity, they
assaulted their handiwork with arrow and spear, hewed
off its head, and dragged the mutilated symbol home — if
their living enemy had left them such — in a triumph,
symbolical of the one they would have very much liked
to achieve in reality, had they felt equal to the task.
While the writer disclaims any intention of even re-
motely attributing a savage nature to any one connected
with the Guiteau case, outside the motley crowd of prog-
nathous Africans, who howled and yelled in ignorant glee
when the drop fell on the 30th of June, 1882, yet it cannot
be denied that there is a great analogy between the con-
duct of the tribe related and the proceedure of Dr. Elwell,
when he entitles his paper *"Guiteau — A Case of Alleged
Moral Insanity." At no time during the trial was Guiteau
asserted to be a case of "Moral Insanity." Dr Elwell may
thumb the long trial record from one end to another or
* Guiteau.— A Case of Moral Alleged Insanity, by J. J. Elwell, M. D.,
Cleveland, Ohio; Member of the Cleveland Bar; Alienist and Seubologist, April
1SS3.
41 8 E. C. Spitzka.
its twenty-seven hundred pages, without finding testimony
given by a single witness, or a clause in the speeches of
the defence, to justify his strange misinterpretation ; and
equally will he search in vain, among the numerous pamph-
lets written by those who maintain that the assassin was
insane, for the statement that Guiteau was a case of
moral insanity and nothing else. But it happens to be
easier for Dr. Elwell to assault a puppet of the prosecu-
tions creation, than to take up the real view of those who
believe Guiteau to have been insane, on the solid basis of
facts, which have been accepted and interpreted in the
same sense by Kelp, Pelman, Lombroso and Tamassia.
Dr. Elwell has chosen to aim at a target which he has
himself put up, and no one — the writer feels certain —
among alienists at least, would occupy a moment of his
time in interfering with the Doctor's idiosyncrasy, if un-
fortunately he had not been guilty of a misrepresentation
of others, of great injustice to scientists who are guilty of
no other crime, then that of valuing their scientific con-
victions above the approbation of newspaper scribblers and
their readers, and if he had not elected to announce views
^misleading to the novice, and dangerously misleading be-
cause they pander a prejudice of the mob which has too
often caused weak and timid men to swerve from the path
of science, into the channel of the evanescent public feel-
ing of the moment.
If Dr. Elwell notwithstanding his very frank and un-
doubtedly subjectively correct admission, *that "an exami-
nation of mental questions, is much like a voyage of
discovery on an unknown sea, without chart, beacon-lights
or headland," could afford to treat the views of those who
hold Guiteau to be insane as absurd and with such
undisguised contempt,** as he does, it is remarkable that
he has had to resort to a misrepresentation of their
• Loc. clt p. lo:^.
•* The tcBtimony convicting Guiteau is landud on imgu 'JOl as tiaving "com-
pU'tely 1 fted medical export testimony out of tliat (luav'inire of seniimfntalily,
fatalism 'moral monstrosity' and wicl<edncs8, called moral or emolli nal insanity,
into which it had fallen."
In re Guiteau. 419
statements, and the facts on which they based them in
order to defend this position. Shall we judge of the jus-
tice of the cause, by the weapons its defender employs?
If so, the following will suffice : Speaking of the medi-
cal testimony for the defence, he says : "Dr. Spitzka, the
defendant's chief and most important medical witness, says
he found 'his skin was in a healthy condition ; found his
appearance perfect; his eyes perfectly healthy. No
changes of habit, of life or thoughts.'" Dr. Elwell actu-
ally uses quotation marks falsely giving the impression
that those words were used by the witness in a certain
order, whereas the fact is, that nothing was actually said
as represented in Dr. Elwell's manufactured quotation.
The misrepresentation of the latter is so vital and palpa-
ble, that at the outset the writer may be permitted to
again cite portions of the testimony from the official trial
record, so that the reader may compare them with the
alleged citations offered by Dr. Elwell :
Page 973. (Mr. Davidge cross-examining.) Q. And
these different elements constituted the groundwork of a
fixed conviction on your part that the man was insane ?
A. Yes, sir. Q. And so strong that you could not ac-
cept employ under the prosecution ? A. Yes, sir. Q.
Now, you saw this man for the first time, yesterday, at
the jail. How did you find him in respect to bodily
health ? A. In very indiffere7it bodily health. Q. What
I mean is did you detect any bodily disease, any physical
disease ? A. I did not examine him for any ordinary-
physical complaint at all, and therefore found no evidence
of it. Q. You examined his skin, did you not ? A. I
did not state so. Q. I ask you if you did? A. As
much of it as I could see on his hands and face that is
all. Q. You do not usually strip a man when you want
to examine his skin do you ? A. Ordinarily, yes, sir.
Q. You strip your patients? A. I strip my patients; yes,
Q. Do you not suppose that if you wanted to find out
how the pores of a man are working his arm is about as
good as his whole body? The Witness: I do not
420 E. C. Spitzka.
catch the word (the question was repeated.) The Wit-
ness : Oh; how his pores are working? Mr. Davidge -
Yes. A. The question of the workings of his pores has
little to do with insanity, so I did not — Q. (Interposing.)
I am not speaking nozo of bodily health, and you know it
perfectly well. The Witness : Yo7i are limiting me strictly
to his physical condition? Mr. Davidge : I am speaking
of his physical condition as you very well know. The
Witness : That is your impression. Mr. Davidge : And
everybody else's, I think. The Witness : Well ? Q,
Now I want to know, whether you had need to strip
this man in order to ascertain what, in respect to the ac-
tion of his pores, his health was. The Witness : Do
you take that in connection with the question of skin
disease? Mr. Davidge : No, I do not. I have never
heardt hat there was any skin disease in the case
Page 974. Q. Did you examine his head? A. I did.
Q. Did you find that in a healthy condition? A. Exter-
nally, I found that in quite a healthy condition ; a little
eruption on the skin, but nothing that you could call
disease.
There is sufficient here to indicate that the witness
repudiated the view subsequently hinted at by the second
medical witness called by the prosecution that psychiatry
is a branch of dermatology, and that Guiteau was not
considered by him to be perfect, but in very indiffereiit bod-
ily health. The questions of Mr. Davidge it is easy to see
were cunningly planned so as to cover the condition of the
skin alone in this part of the examination.
The writer is at an utter loss to find anything in his tes-
timony to compare with the words "no changes of habit
of life or thoughts," which Dr. Elwell pretends to cite
from it, so he may select a few statements made as to
Guiteau's habit, life and thoughts which will indicate to the
readers of the Alienist and Neurologist the extent to
which the manufactured citation of Dr. EhvcU is calcu-
lated to mislead.
Page 9S0. Q. You attributed this crime, assuming it
In re Guitcau. 421
was a crime, to the formation on the part of the prisoner
of a morbid project ? A. A morbid project groiviug out
of a diseased condition of the man. Page 983. Q. I
will not trouble you any further as to your first con-
clusion from your examination of the prisoner ; that is,
a tendency to morbid projects originating in delusive
opinion. Your next conclusion was that his facial ap-
pearance indicated imbeciUty ? A. Insanity. Q. Imbecility
I think you said, sir? A. I beg your pardon. I referred
to the special point of moral imbecility.*
Q. Then as I understand you to correct your tes-
timony ; the appearance of his face indicated moral
insanity as you called it ? A. No ; you have matters
a little tangled up there. I meant f a general proposi-
tion, that this man's facial expression was that which
we would know as the insane one, and I made the
special proposition, that without having any other evi-
dence than the face, I would have concluded that he
suffered fromt imbecility or moral monstrosity. I did not
use the expression moral insanity, but some authors
call that moral insanity, which I term moral imbecility
or moral monstrosity.§
Probably Dr. Elwell may be induced to give the
grounds on which he makes such statements as the
follo\\ing: First. "There are no positive indications of
this hereditary tendency to insanity being present in the
family of the Guiteaus." Second. "Xo one thought of
having him shut up in a lunatic asylum ?" Perhaps, Dr.
Elwell will inform us what he considers evidence of
morbid heredity in a family, if he does not consider in
conjunction with other facts the one that Guiteau's sis-
ter has always been thought insane and has recently been
* This -was aitt-r al out a.i iiMur hu.i ueen eonsmuevl ia attempting lo sliake
the opinion of the witness, uq.I a.ij.juruiug the cjurt for recess, under the pretext
of favoring a sick juror.
t Word "as" omitted.
\ Word "moral" omitted.
§ For contiauatiou of 1 1;- branch of the testimony see Ai^ril number of Alien-
ist AND NECBOLoGtsT page Ji '. It will be noted tluit tile witness there repeatedly
speaks of "disease!" coniitions in the prisoner.
422 E. C. Spitska.
pronounced insane by a jury in the face of public prejudice,
which disapproved of this indirect means of strengthening
the insanity theory in the case of a man, on whom a
judicial murder had been committed, in obedience to its
clamors, — such evidence? How does he manage to elude
the fact, that there is an official record, that one;ofGui-
teau's uncles died at the Bloomingdale Asylum, that another
blood-relative died at the Elgin Asylum, and that still
another is now living at the Pontiac Asylum ? Does he not ,
know that Dr. Rice, the family physician of the Guiteau's,
one of the few men who with Senator Logan dared to tell
the truth, testified that Guiteau escaped from the place
where he was staying at the time he made an attack on his
sister with an ax, while Dr. Rice was taking the steps to
commit him to an asylum ? And to leave for one moment
the record of the trial itself, in which these facts can be
found proven and admitted, does Dr. Elwell not know that
the only expert who ever examined Guiteau's father found
him insane, and was excluded from the stand by a technical
objection of the prosecution ? It strikes the writer, that
Dr. Elwell has approached the question of Guiteau's sanity
about as badly prepared with regard to the necessary
knowledge of the facts of the case, as is possible.
Let us now proceed to examine into the other element
whose analysis will faciliate a proper appreciation of the
bearing of the views and arguments of the gentleman
cited.
Dr. Elwell, who is a practicing lawyer, cites Guiteau's
statements made in an application for a life insurance policy,
that he was of sound bodily health, and had no insane
relatives as a proof of these facts. Is it not a little sur-
prising that a lawyer should be unaware of the notorious
fact, that bodily and family disease are denied even under
oath, in the filling out of such documents time and again ?
And does Dr. Elwell know of a single case where the
statements of a suspected lunatic denying his own insanity,
were ever used as the basis of an opinion by a scientific
alienist ? What conception of a "lawyer-like manner" has
In re Gtdteaii. 423
Dr. Elwell when he speaks of Guiteau, announcing in such
manner, that "malice is an element in murder, and 'I had
no malice,' therefore there could be no murder in his case ?"
Surely a lawyer who would advise his client to put forward
such an imbecile excuse under such circumstances ought to
be disbarred. The cunning evasions, as they have been
called of Guiteau, are on a par with the excuse of the pare-
tic dement mentioned by Simon,* who stole some fish from
the nets of certain fishermen, and when arrested, said that
he had only taken them out with the object of putting them
back again after arranging the nets, which had become en-
tangled by his oars. The writer first suspected Dr. Elwell
of irony when he speakst of Guiteau's conduct during the
trial as being "able leadership and management," and when
in connection with the fact that he attacked his brother
and ruined his testimony by contradicting the latter's state-
ments as to his insanity, he speaks of him as ''too shrewd a
general to neglect the balance of his line." A perusal of
the rest of the article convinced the writer, that Dr. Elwell
had here been as intentionally serious and unconsciously
humorous as where he opened his article by the admis-
sion that his inquiry into Guiteau's mental state was made
"without chart, beacon-light or headland."
It is to be hoped that Dr. Elwell's claim, that Guiteau's
bodily health was good, the chief one he makes in opposi-
tion to Guiteau's insanity, will stimulate some one of the
readers of the Alienist and Neurologist, who defended
the opinion that Guiteau was sane, to explain just what
organ aside from the brain must be palpably diseased to
distinguish real insanity from sham insanity. It so hap-
pens that not only were miliary tubercles found in the
assassin's lungs, but also an abnormal condition of the aorta;
and that his color was sallow; that the had as the writer
stated in evidence an eruption of his skin, and that at
the time of the assassination, he was notoriously in a
wretched physical condition. It is therefore to be hoped
* Die Gehiraerweichung der Irren. Hamburg 1871.
t Loco cit. page 199.
424 E. C. Spitzka.
that when we are favored with the criteria which enabled
the gentleman who defended the opinion endorsed by Dr.
Elwell, to pronounce Guiteau a sham lunatic, they will
consistently commit themselves to the admission that they
never admitted a lunatic into their asylums who had not
at least more physical disease than Guiteau, And for the
sake of the reputation of our specialty, it is to be trusted
that none of them will be betrayed into such self-convic-
ting contradictions as Dr. Elwell is, when he says in one
place* "a healthy body with a symmetrical cranium," and
in another "he was physically syphilitic. "f
It is a notorious fact that Guiteau was regarded as a
lunatic by every one who came in contact with him
before the assassination ; that the very day Mr. Scoville
heard of the assassination, he told a reporter that his
brother-in-law was insane. What foundation Dr. Elwell
had for the statement that Guiteau "started the
insanity idea for a defense, Guiteau was the inventor,
and Scoville only took it at second-hand and used it in
the trial," it is difficult to guess. Whatever its source may
have been it is utterly and demonstrably false.
There is an inside history to the Guiteau trial, which
will undoubtedly see the light some day ; it was not all
enacted in a secret conclave, but it has singularly enough
evaded public attention. Thus Messrs. Blaine and Logan
had both been interviewed in regard to their knowledge of
Guiteau. In the published interview it was stated that
both these gentlemen had given their unqualified opinion
that they considered Guiteau of unsound mind, and
advanced abundant reasons for that belief Mr. Blaine sub-
sequently denied having considered Guiteau insane.
Unfortunately for the credibility of this witness, a telegram
had been sent out to the European capitals and chief cities
of the Union and .'-igned by Mr. Blaine, stating that the
deed was that of an insane man ; a statement of great
weight, as it was made bv one who according to his own
• Loco cit. piige 11(5.
t I>oco clt. |>!ij;e I'.to.
In re Guiteau. 425
testimony had had over twenty inten'iews with Guiteau.
and because it was made before the lingering disease and
death of the President, the hatred of disappointed political
intriguers who saw in Guiteau the cause of their ruin, and the
persistent and shameful misrepresentations of the press had
inflamed public feeling until it burst through the bounds
of reason. We must recollect that there was much of this
sort of testimony; that just as men of science bowed
down before the tempest of public feeling, and the few
that stood up against it, made but a feeble protest, or
sheltered themselves in a neutral or evasive position, but
a half dozen of the hundred politicians who had known
Guiteau and believed him to be insane, could be gotten in
the stand, and when there, to testify to the "whole truth."
It was still worse with the lait}'; it was quite a popular
thing to throw a stone at Guiteau, and the impartial histo-
rian of the future will feel nonplussed when he reflects on
the fact, that one of the chief witnesses, who testified
to Guiteau's bad character, for the prosecution, had pre-
viously escaped conviction for perjury by a very narrow
margin. The behavior of the prosecuting counsellors
■certainly was not of the highest order. The skillful
provocation of the petulancy of Guiteau could not have
been more systematically carried out, if they had been
under the continual prompting of some one who having
had experience with the class of the insane to which
Guiteau belonged, knew that the display of superficial
acuteness of which Guiteau was capable, would convince
many of the laity that he was sane, and if not sane, at
least "responsible. " Then there was the suppression of the
stenographic report of the conversation which Mr. Corkhill
had with the prisoner after the assassination, as well as
the admitting in evidence of a letter of the latter, from
which by a sinister coincidence, the insane portion had
been removed.
Much as the merits of the case have been clouded by
the imperfect elicitation of the testimony, the methods of
the prosecution, and the tone of the trial in general, there
426 E. C. Spitzka.
is one feature of the case, which, while it only served to
fix the halter on Guiteau's neck at that time, will be
welcomed by the alienist studying Guiteau's character in
the future, as having rendered far more efficient service in
showing his mental condition, than the post-mortem
examination, the testimony of the experts, and the pam-
phlets issued by the latter, and of at least equal value with
his family history. The writer refers to the interruptions
of the prisoner, which may be found recorded on almost
every page of the trial report. It is these very interruptions
which Dr. Elwell believes show able management and
generalship on the prisoner's part ; the writer believes that
they are the most convincing proofs of the genuineness of
Guiteau's insanity, and has the firm faith that authorities
every whQ;"e will so regard them. This brings us to the
question of expert authority invoked by Dr. Elwell.
Under ordinary circumstances the writer would hesitate
to approach this question. In the present instance,
however, he feels that he is called upon to do so. Aside
from his citation of the convincing evidence of Guiteau's
weak-mindedness, as evidence of sanity, his misquotation
of the testimony, his suppression of the post-mortem
revelations* and of Guiteau's previous and family history.
Dr. Elwell's paper chiefly consists of a peroration laudatory
of the government experts, and a foot-note referring to his
own work on medical jurisprudence as an authority in
moral insanity.f If Dr. Elwell's position were really a strong
* This will exclude the medico-i)oliiical expressions made on behalf ol those
■who had beeu their hosts on psychiatrical picnic-tours,
t It evidently did not suit Dr. Elwell's purposes to ciuote the ofliciiil report of
themicrcjscopical committee, Drs. Shakespeare, Arnold and McConnell, of the Army
Medical Museum. The writer may be permitted to supply the deiicleucy with a lew
of the most important extracis:
"Chronic disease in numerous diffused areas, accompanied by alteration of the
cellular elements, In the specimnns of bniin submitted for their exiimiuution. While
the lesions found were most marked in the corpus striatum and in the frontal region
of the cerebral cortex, yet they very profusely pervaded all portions of the brain
which the sections represented."
"The llrst (outermost) layer (of the frontal region) seemed to be thinned alnu^st
to nothing.
"The dura-mater was thickened and adherent to the cranlumi the arachnoid
■howcd yellowish aud milky opacities of considerable extent. (All the reports off
he examination of recent brain.)
In re Giiiteaii. 427
one, he would not have needed to fortify it with authori-
ties, and if he had felt that need and had had a half-way
tenable cause, he could have found better authority in its
support than that which he cites, it so happens that
there is not a single writer on insanity, of repute ivhose^
deliberate ivritings, Dr. Elwell could have derived an iota of
support from. He says : "Is there then no significance
and no reliance to be placed on expert testimony, when
it comes, as in this case, from thirteen or more of the
most eminent and experienced professional men of the
country, all, or nearly all distinguished superintendents of
lunatic asylums, with a reputation in the Old World as
well as in the New?" Dr. Elwell is in one sense right*
in assigning a Trans-Atlantic reputation to several of the
gentlemen whose position he defends, or at least to their
views. It is well-known that the peculiar theories on moral
insanity, and transitory frenzy which they have promul-
gated, has had their most prominent exponents in the
persons of two well-known writers on medical jurisprudence,
namely, Dr. Ordronaux and Dr. Elwell himself. Compara-
tively unknown or disposed of, as that portion of the
circle in question which is associated with the name of
Utica, usually has been by the words of Westphal "Nichts
Neues," it is through these two prominent representatives
that the views of the chief of the thirteen gentlemen re-
ferred to by Dr. Elwell have become known abroad. So
let us see what the authorities, whose position as authorities
even Dr. Elwell will not question, have to say about such
views and their upholders !
Utilitarian considerations, growing out of the desirability
of announcing popular views on the witness-stand as a step
"It is sufficient to state that they (the appearances) were usually identical with
those noted in sections from the frontal region, the only difference worth mentioning
being the fact that the areas in which the vessels offered a granular degeneration
were mnch less numtrous and extensive than in the frontal region."
"While the lesions found were most marked in the corpus striatum and frontal
(anterior being synonymous with frontal here) region of the cerebral cortex."
"In conclusion, your committee has no hesitation in aflrmiiig the existence of
unquestionable evidence of decided chronic disease of the minute blood-vessels in
numerous minute diffused areas, accompanied by alterations of the cellular element
in the specimens of brain submitted to their examination."
•Italics ours.
428 E. C. Spitzka.
to further patronage by the legal fraternity, have had
their day in Europe, and the eloquent language of Foville,*
the elder, may be cited as applicable to the rhodomon-
tades indulged in on "unpopular" psychiatrical discoveries.
"Here is a fantastic interpretation which we could scarcely
have expected and which is hardly calculated to rank as
a scientific production.** Other than this, it is not to
scientific procedures that the author has recourse to combat
the existence of moral insanity and mania transitoria ; it
is only by the aid of appeals thoroughly permeated with
religious sentimentality, and drawn from the domain of
literature, that the author declares moral insanity and mania
transitoria false, absurd, ridiculous, and, above all, unworthy
of being received by the courts. To enable the reader to
judge of the extra-scientific method adopted by the author,
we give the conclusion of his article : 'Lastly, we object
to both (mania transitoria and moral insanity) because it
is an attempt to set back the clock of the century, and
to revert to supernaturalism and superstition in medicine.
It is an attempt to curtain the windows {sic)X of that
science whose religious duty it is to cast light and not
mysticism around disease — to treat it not as a personal
devil entirely, to be exercised by philters and mummery,
but rather as the perversion of a natural state struggling
to regain its equilibrium.' Many physicians will be as-
tonished to learn, that according to Dr Ordronaux they are
deceived in believing themselves in the pathway of modern
progress and scientific advance, when in reality they are
returning to the dark ages. But will the rhetoric of their
American colleague induce them to retrace their foot-
steps?"
Kraft-Ebing then, whom (c\w if any alienists stand
higher in forensic psychiatry, has the following* apropos
• Annnles Medico-Psycholojjiiues 1S74.
•» Alluding to this statement that the existence of moral insanity was due to
I'liiel's benevolent attempt to account for the executions of the first French revolu-
ti n, ap]>rovingly rcjjeated by medical witness for the prosecution, A. E. Mac-
Donald.
\ Dr. Foville's interpolation.
• Allg. Zeitschrift f. I'sychlatrie. 39th Vol. 4lh fascicular, 1^<83.
In re Guiteau. 429
of the views announced by Dr. Ehvell as published in
the symposium of the North American Rez'iew. Dr.
Ehvell has strange {sonderbare) views * * * *
with this dictum* the author demonstrates such a
resplendent ignorance {glaenzende Univissenheit) in the
field treated of by him, that the further analysis of the
course of reasoning is not worth while."
Similar opinions of leading representatives of the body
of French and German alienists have been echoed by
Tamassia and Lombroso in Italy ; but even England,
from which land the advocates of Guiteau's sanity may
make the attempt to derive a little consolation,t follows
in the wake of Foville. Bucknill and Tuke in their Treatise
on Psychological Medicine,! say regarding Dr. Ordronaux's
attack on moral insanity, of which Dr. Elwell's is a mere
echo : "See an extraordinary proof of this in an article
in the American Journal of bisanity, January, 1S73, by
Dr. Ordronaux ; while a protest may be entered against
the abuse of the doctrine, the position taken by the
author of this article, in regard to moral insanity seems
to us like 'an attempt to set back the clock of the cen-
tury, and to revert to superstition and supernaturalism in
medicine.' "
It is perhaps scarcely well-timed, since none of the
medical witnesses who testified for the prosecution in the
Guiteau trial have yet raised a voice to defend their
position§ to analyze the record they made on the occasion
of the trial. But if it seems harsh to them, that some of
' Referring to Dr. Elwell's statement that the deterrent effect of punishment is as
great with the ins.ine as with the sane, and that the insane murderer being more
dangerous than the sane murderer, must be executed.
t When the attem])t is made, the writer will ask the indulgence of the editor and
readers of the Alienist akd Neurologist once more. Until it is made the medico-
political articles which have appeareil in the British medical press, may be provision-
ally regarded as having fallen flat.
% rage2.V2, footnote.
§ Except in an article by Dr. Worcester, which smacks much ot qu,i i^ txM*e *' accvtxe
andabitteri)ersoual attack on Guiteau, made after his execution, in an editorial of
the ' 'American Journal of Insanity," whose writer seems to be scarcely able to con-
ceal his mortiiication, that Guiteau was not gagged, rather than that he should be
permitted to demonstrate his insanity and the errors of certain medical witnesses in
io striking a manner as he did.
430 E. C. Spitzka.
their remarkable dicta should be dragged out from the
obscurity of the trial archives, and exposed to the all-
searching light of science, they must hold Dr. Elwell,
who has cited them as authorities and opened the door
to a criticism of the foundations for his claim, responsible
for the result. The writer would rather have left the
illumination of what he considers the darkest pages in the
annals of psychiatry — calling it psychiatry for the sake of
argument — to some one else !
Before proceeding to the discussion of their actual
scientific merits, it may be well to make an introductory
citation, which reveals the conception of the position of an
authority on forensic psychology, which one of Dr. Elwell's
"thirteen" had.
Page 1023. (Dr. Barker on the stand.) Q. Have you
made a personal examination of the accused for the pur-
pose of determining whether he is sane or insane ? A. I
have not. Q. Why did you not ? A. In the first place
because I was not asked to, and in the second place
because I have no desire to do it.
As to the deliberation with which the prominent wit-
nesses for the prosecution formed their opinions in Gui-
teau's mental state, it may suffice to say, that one of them
had his opinion ready five days after the assassination, at
a distance of 400 miles, and published it in the Neiv York
Herald, and another one had secured an interview,
representing his opinion by a reporter of the Evening
Post.
Page 1476. (Dr. Barksdale on the stand.) Q. Have
you ever read Dr. Ray on that subject? A. I thitik 1
have. Q. Have you read all he has said about it in his
published work (referring to moral insanity) ? \. I do
not know as I have. Probably I have not read all of it.
Q. How much of it do you think you have read. A. /
cannot tell.
Page 1543. (Dr. Kempster on the stand.) A. / do
not knoiv zuhat an irresistible inipnlse is. That is some-
thing I do not understand. / cannot conceive of an
bi re Gidteau. 431
irresistible impulse. I suppose, however, that what is
meant by that term, is one of those impulses which are
sometimes observed in the insane, and which are carried
out ver)'- rapidly. The idea comes to the individual and
is rapidly executed, and it may be with reference
(Interrupted.)
Page 1534. There is no such a thing, in fact as
hereditary insanity (adds that susceptible, etc. insanity may
be transmitted). Page 1535. Q. Are people who are
known as eccentric, people or persons possessing marked
traits of character, or illy-balanced, more likely to outbreaks
of insanit}^ than persons of uniform temperament and
steady character? A. No, sir; they are not as liable to
outbreaks of insanity, as those who are more steady and
staid in habits and character, for the reason that an
eccentric person is not so easily affected by the jeers
and taunts of his opponents, and not so easily affected
by the ups and downs of life, as they are called, as those
zi'lio are of more staid habits arid character. They can
bear the jostling and buffeting with much more unconcern
than a person of staid habits and steady character and
disposition, and throw off trouble easier. It does not
weigh them down as it does men of staid habit.
Page 1474. (Dr. Barksdale.) Q. I will ask, you, doc-
tor, whether you are of the opinion that he is acting
naturally in court or feigning? A. Feigning, sir. Q.
What are your reasons for that opinion ? A. Several,
sir. The marked contrast between his behavior in court,
and that on the occasion when I saw him in jail. He
seizes every salient point as it occurs iti the eviderice,
and then becomes excited, but at other times he is quiet
and natural, and behaves as any other man would.
Page 1534. (Dr. Kempster.) Q. What in your opinion
would be the effect upon the question as to whether there
was any hereditary tendency in a family, if it was stated,
that cousins or uncles of a person had been of unsound
mind ? A. In the case of insane cousins, // ivould have
no bearing vjhatever, unless it could be shown that the
432 E. C. Spitzka.
parents of the individual had also been insane. In the
case of uncles or aunts the same answer would apply. It
ivould have no bearing unless it was shown that the imme-
diate ancestry of the individual had been insane, and in
any event it would have no bearing, as I said before, un-
less the parent or parents had been insane previous to the
birth of the child.
Page 1537. Q. Can insanity exist without one of
these characteristics. (Previous question was, "Is there
any difference between a delusion, illusion and hallucina-
tion.") A. No, sir ; I tJiink not. But you may not be
able to determine what the hallucination or illusion is, for
the reasons which I gave in my answer with reference to
delusions, that the mind of the individual may be so active
as to fail to convey .to you the hallucination or illusion
or by reason of the progress of the disease, the operations
of the mind are all in abeyance, so that the individual
expresses no idea on the subject.
Page 1536. Q. Are delusions ordinarily present in
insanity. A. In my experience and observation they are
always present in cases of insanity, zvith perJiaps tivo excep-
tions, acute mania and dementia. * * * * Q. Are
these persons cases of what is known as moral insanity ?
A. No, sir. I do not believe in moral insanity. I think
that is a convenient term, which has been introduced into
certain books, and generally applied to those persons who
have committed an outrageous act of some kind, and for
whose behavior there was no other excuse. These have
been called cases of moral insanity. I have no faith
whatever in moral insanity as expressed by such writers.
Since Dr. Elwell makes it a question of "authority,''
let us cast a brief glance over the galaxy of authorities on
insanity, and see who it is that one of his proteges (see page
1536 of testimony) ventures to sneer at as "such writers."
In America, the great Ray, who, as the writer said on the
stand, would have turned around in his grave, if he had
heard of the steitements of some latter-day would-be alienists
— Rush, Woodward, Workman, Howard, Bannister and
In re Gniteaic. 433
Hughes. In France and Belgium : Pinel, Marce, Foville,
Lentz, Delasiauve, Esquirol, Despine, Morel, Brierre de
Boismont, Falret, names, a single one of which would out-
weigh in the balance tenfold the array of the medical
witnesses for the Guiteau prosecution, with their Trans-
Atlantic sympathizers thrown in. In Germany : Krafft-
Ebing, Griesmger, Stoltz, Schuele, Grohmann, Solbig. In
England: Lockhart Robertson, Crichton Browne, Prich-
ard. West, Maudsley. In Italy, as in fact almost generally
thoughout Europe, the writer is unable to find a single
alienist who opposes the doctrine of moral insanity. Let
it be borne in mind too, that while those mentioned are
prominent defenders of the existence of moral derangement,
as a main and sometimes single feature of insanity, that
the great body of alienists everywhere admit its existence,
and that not thirteen, but one hundred and thirty alienists
could be found in America to subscribe to the same
belief. To say as half a dozen of the prosecuting wit-
nesses did, that there is no such term in science as "moral
insanity" when in the very text-book, which they relied
on for inspiration throughout the trial, as every other,
contains whole chapters devoted to its consideration, is to
call matters by their right names — to tell a falsehood.
Dr. Elwell with all his prejudices devotes twenty-one
pages to "moral insanity" in the treatise to which he refers
as an authritative one ; and if he has preferred to rest his
opinions on the expressions of a distinguished surgeon
(Brodie) who was not an alienist, on the editorial expres-
sions of a medico-political journal and in default of real
scientific authorities in his behalf, on the assertions of
those who since died the death of mediocrity, he will scarce-
ly confess, that he devoted a whole thirtieth of a book
intended to cover the whole field of Medical Jurisprudence
to the consideration of a chimera.
Page 1366. (Dr. Stearns on the stand.) Q. Is it not
the fact that insane people often have very good memories
A. I have answered that question once or twice, O. I
just want it answered yes or no. I will let you explain,.
434 ^- C. Spitzka.
if you desire, after you have answered. A. I do not
think it is often the case, Q. Is not that case laid down
in Ray on Insanity? Mr. Porter. I must object to the
witness being deprived of an opportunity to explain. (To
Mr. Scoville.) You pledged your word as a lawyer and
gentleman* that you would give him that opportunity
if he answered the question. Mr, Scoville. (To the
witness.) Do you desire to explain. The Witness. No,
sir. Mr. Reid. I thought not, judge. Q. Have you
read Ray's work on Insanity ? A. I have never read it
through consecutively ; no, sir. I have read parts of it.
Q. Does he not state that fact? A. / doiit know, sir;
I have not looked.
Page 1363. (Same witness.) Q. What is your theory
of a person becoming insane suddenly through the excite-
ment of fear in its operation on the brain ? A. I suppose
that to be injury of the tissue of the brain from the effect
produced upon it as communicated to it. Q. By the
blood rushing to the brain, or withdrawing from the
brain? A. It is very difficult to say precisely what does
produce the effect. // may be in a change in the elec-
trical currents, that we know pass through the brain.
Page 1398. Q. Is it not true, where persons who are
manifestly insane, kill another, that they sometimes plan
and plot, and deliberate, and practise and get ready for
it ? A. / do not knoiv of my own knoiuledge.
Page 1674. (Dr. John P. Gray.) Q. What is klep-
tomania ? A. It is a word used to express thieving.
There is no such insanity as kleptomania. Q. You do
not believe in it, do you ? A. I do not believe in any
of these so-called moral insanities. I believe that they
are simply crimes. A lunatic may steal, but lie does 7iot
steal because he has only a mayiia for stealing. What do
you understand by Dipsomania ? A. It is what some
.people call insanity ; a strong appetite and habit of
* Loud proteBtatlons of this kind are, it is needless to say, regarded with ])ecu-
liardislavor by lawyers of the better class. This interruption is a sample of the
attempts frequeutiy made by the senior counsel for the prosecution to do a little
"stage" business with the jury.
hi re Giiiteau. 435
drinking, not resisted. / call it drunkenness. I do not
call it insanity at all. What is understood by Pyro-
mania ? A. It is understood by some to be an insanity
for burning houses or buildings. I would call it incendia-
rism— crime. All those tenets are makeshifts to secure fron
punishment for crime.
Page 1662. Q. is that true? A. Certainly a
child a week old might have disease. Q It could not
inherit though, could it? A. No. Q. Are children ever
born with any disease at the time of birth? A. I have
710 personal knou'ledge of that. It is said by some, that
if a motlier has a certain constitutional disease the child
may have it. I do not know whether there is any truth
in that or not. Page 1661. Q. Did you ever know of
a case of hereditary insanity ? I do not mean in the
ordinary sense of the term, but where the disease itself
was transmitted ? A. No ; disease is never transmitted.
Page 1660. O. Do you consider the fact that there is
insanity in a family (among uncles, aunts or cousins of a
person) has any bearing whatever on the question of
the insanity of the individual ? A. No.*
(Dr. A. E. Macdonald.) Q. As a general rule, based
upon your observation and knowledge, do the descend-
ants of insane persons become insane ? A. No, sir ; they
do not. If they did everybody in the world would be
insane by this time. The tendencies in all cases of
constitutional defect is to recover from it. As generation
succeeds generation! there is return toward health. In
the case of hereditary tendency to insanity, the tendency
is more toward health than it is toward disease. t Page
1440. Q. At what age do children usually talk ? A. I
have never had any children, sir, and I have not had
* The end of this matter is not yet; the inherent contradictious of the witnesses
and some related matters are reserved for the future. It may, however, be of sig-
nLdcant interest to the reader to learn at this point, that the witness was immediately
confronted with the tables "showing the statistics of hereditary trantmittiont" in
numerous of his annual reports.
t Shades of Morel !
X To have an innate a fostor, will 'j'T'^afor have to 'e considerrd rather an ad-
vantage than otherwise.
436 E. C. Spitzka.
any opportunity for observing. Q. Did you ever see
any ? A. Yes, sir ; but not so that I could make a
statement about that ; not in such a way as to enable
me to answer your question.
These few from among a hundred similar assertions,
may serv6 to characterize the claims of those making them
to be considered authorities, or even faithful students of
insanity, and with this the writer may be permitted to
close the medical branch of the discussion in its present
phase. He has shown that Dr. Elwell has substituted
issues for the real issue, and the jury of scientists will
undoubtedly judge from the maneuver as to its motive.
He has shown that Dr. Elwell has come prepared to
defend his position so poorly, that he has been compelled
to manufacture, or to retail manufactured quotations from
the witness opposing his view, to deny facts which are
known to every intelligent man and woman in the United
States, to assert things which had no basis, and to con-
fess his inability to do the victim of a most unparalleled
medico-judicial procedure, the paltry justice of citing the
evidence which his dead body yielded to the searching
eye of unimpeached scientists, with even approximate
fairness. He has proven that Dr. Elwell in order to
accomplish his purpose lost sight of his own material
contradictions of self, and made admissions fatal to his
claims as a sound adviser on questions of sanity and
responsibility. Not to say anything about his motives, or
the justice of his cause, it is clear that the effect of his
paper is calculated to pervert opinion. Finally the
gentleman has put into the witness-box thirteen physi-
cians, whom he has endeavored to foist upon a scientific
jury as authorities, and ultimately has taken the stand
himself as an authority on moral insanity. The writer has
shown, not retorting with diatribes and common-places,
such as those Dr. Elwell employs, but by the very words
of the alleged authorities that they are none, and in so
doing he has not been compelled to use a single expression
as harsh as the ones used by one of the very best judges
In re Guiteau. 437
of expert competency in passing on the claims of Dr.
Elwell to being considered an authority on, or to have
mastered the rudiments of legal medicine himself.
Dr. Elwell correctly says, that "an impartial discussion
of the matter is not to be expected, until a sufficient
time has passed to allow the sediment of popular indignation
and professional zeal to fall to the bottom. Truth will
then reveal herself, and not till then, for she shuns excite-
ment and prejudice." Truth shuns prejudice and
particularly when it is as obtrusive as it is in Dr.
Elwell's statement, that "a normal consistency of the
substance of the brain, with well-balanced hemispheres,"
was an evidence of a sound mind in Guiteau's case, he
having on the page preceding, admitted that sanity could
neither be proven nor disproven by an autopsy.
One naturally wonders why Dr. Elwell should take so
much trouble to sustain the justice of Guiteau's sentence,
by endeavoring to prove his sanity, when he already
stands committed to the doctrine, that if Guiteau was insane
there would have been only the greater reason for
punishing him. Evidently Dr. Elwell is by a rapid and'
kaleidoscopic transformation returning to the view of
Heinroth, that insanity originates in sin. The delusive
exaltation of Guiteau who compares himself to Abraham,
Jesus Christ and Company, is for Dr. Elwell merely a
■"moral leprosy" and shocking godlessness.
It is but doing justice to Dr. Elwell to say, that one
of his assertions, although unfortunately one that does not
apply to the case of Guiteau, is correct. He is right in
saying that wickedness and immorality are not insanity,
and that Dr. Beard stands strictly alone, when he says,
"the essence of insanity is immorality, and the insane are
always immoral." This statement is simply a paradox,
and can be paralleled only by the converse statement of
several of the experts called by the prosecution, that
moral insanity is wickedness, and that kleptomania, pyro-
mania and dipsomania are crimes and nothing else. It
is probably to the gentlemen that made these statements
43^ E. C. Spitzka.
and to himself, that Dr. Elwell refers when he says, that
"the Freeman, Coles-Hiscock, McFarlane, Sickles cases,
as well as the celebrated English cases, were as well
understood by him (Guiteau) as by any superintendent of
an insane asylum or criminal lawyer in the country."
With the justice of the comparison, in the sense in which
it is understood by the writer, he has no disposition to
quarrel. Nor will he hesitate to admit his own obtuseness
which interferes with his comprehension of the coherence
of the two ideas involved in the following end of one of
Dr. Elwell's paragraphs. "He also prompted his attorneys
as to the latest decisions in the courts on the law of
insanity. He said to Judge Porter : "You would have
hung Charlotte Corday."
That even to this day there are people who mistake
invective for argument, shallow rhetoric for reasoning and
their prejudices for the truth, is, to use the words of a
distinguished writer, a merciful dispensation of Providence
with which no good man will quarrel. But when misstate-
ments of historical facts and testimony are made with the
view 'of strengthening and confirming a popular misconcep-
tion, it is the duty of those who know the truth, to correct
the errors. If in endeavoring to carry out this duty, the
writer has been compelled, here and there to refer to
individuals, it must be borne in mind as a migitating and
explanatory circumstance, that the issue of personal
authority was first raised by Dr. Elwell, and not by the
writer, and that nowhere has the writer, like Dr. Elwell,
misquoted testimony, omitted essential facts, or resorted
to diatribe. The advocates of Guiteau's insanity feel
that the whole testimony given in the trial should
become more widely known, and all the facts connected
with it should be made public, for the facts point so
strong in one direction and constitute such overwhelming
proof of Guiteau's mental abnormality, that no omission
of facts or sophistry of speech is necessary to strengthen
the position of those who regard the assassin of the
President as a lunatic and not as a criminal.
Maniaco-Urap.mic Delirium in Renal
Affections.*
By LuiGi M. Petrone, M. D.
THE so-called uraemic accidents which arise in the
course of chronic nephrites have been well studied
by clinics ; but though their clinical form has been well
described, the pathogenic interpretation of the phenomena
seems to me to be yet discussible. There is, however, a
certain order of cerebral facts, rather rare, which I think
have need of further study ; they are those relating to
certain maniacal disturbances, and certain deliriums com-
bined with hallucinations of sight and hearing. The
majority of authors have attributed the appearance of these
psychical disorders to ursemic disturbances, or the influence
of an altered crasis of the blood, consequent on renal
disturbance.
The first author, who according to the observations of
Griesinger on the relation between encephalopathia and
renal lesions, met with the manifestation of true parox-
ysms of uraemic-pseudo insanity, was, so far as appears,
Hagan (1869). He published four reports which merit being
here summarized :
First Case. A woman of 46 years, in consequence of
a dispute, followed by a chill, was affected with
albuminuria and violent acute delirium, which lasted six
days. At the autopsy the kidney was found contracted
and atrophied.
Second Case. Melancholy and maniacal agitation in a
man affected with chronic albuminuria. Death took place
on the appearance of pulmonary gangrene. At the autopsy
hydronephrosis on the right, and renal atrophy on the
left from interstitial nephritis were found.
Third Case. Excessive religious practices, followed by
• TrtiDslated by Joseph Woikman, M. D., from tiie Rivitta Sperementale, Italy,
440 Lnigi M. Petrone.
a species of acute melancholy, in a 'man of 25 years, suf-
fering for a long time from chronic albuminuria with a very
extensive necrosis of the tibia. At the autopsy Bright's
kidney.
Fourth Case. Uraemia of mental form, badly charac-
terized, observed in a man of 73 years, an alcoholist.
One kidney only affected with sclerosis.
Hagen attributes the mental state to the insufficiency
of the urinary depuration. More recently this author has
published new observations analogous to the preceding.
Dr. Jolly published (Berlin, 1873) the following case :
A young woman of 19 years, always before sane, ia
consequence of a chill, complained of head pain. She had
ideas of death, fell into a state of stupor, and refused to
eat. In the course of some days there were found, first,
traces of albumen in the urine, and afterwards considerable
quantities of it. The patient lay in the very same state
of stupid indifference ; it became necessary to feed her
with the oesophageal tube. She had retention of urine^
which demanded catheterism. In the course of three
weeks the albumen diminished. The mental disturbances
persisted yet for several other weeks. She left her bed,
in the course of the night, and tried to escape ; she
seemed to be frequently invaded by hallucinations. Finally
the urine being freed from albumen, she went on im-
proving, she consented to take some food, and completely
recovered.
Samuel Wilks published, in the Journal of Moital
Science (July, 1874), three cases of mania Brightia, urce-
mic (?).
First Case. A railway man, manifestly suffering under
chronic interstitial nephritis, was taken with violent mania
which lasted two days.
Second Case. A young woman, long troubled with a
Bright affection, was seized with epileptiform attacks and
acute mania. It was necessary to isolate her. This state
was followed by a species of lethargy, after which recovery
took place.
Maniaco-Urcemic Delirium in Renal Affections. 441
Third Case. A woman of middle age was, for a long
time, affected with albuminuria. All at once she was
seized with fury and hallucination, and remained in this
state over a week. On her death, which occurred some
time after, the kidneys were found atrophied.
Dr. ScJuilz, of Bremen, relates the following case,
(1876): A man of 43 years, without any important ante-
cedents, entered the hospital on account of a Bright
affection. A little anasarca was present, micturition rather
abundant, slight albuminuria. Notable hypertrophy of the
left ventricle, systolic souffle, no disturbance of the lesser
circulation. Pronounced albuminuric retinitis, fascicolate
sclerosis, sinuous, hyperaemic, thickened veins ; papilla of a
turbid grayish ; hemorrhage and discoloration of the
yellow patch. In the course of eight days an attack of
well characterized mania, with brisk e.xaltation and hallu-
cinations supervened. The exaltation was very soon
followed by depression, he became concentrated, then
unquiet and anxious. Later on he showed more tranquility
the hallucinations seemed to weaken, but the delirium
assumed a fixed character; it reproduced the known traits
of delirium of persecution. In the course of 34 days the
patient died, after coma of 36 hours ; he had no uraemic
manifestations whatever. At the autopsy there was found
hypersemia and thickening of the dura-mater ; a recent
gelatinous exudation was spread over the convexity of
the hemispheres. The left ventricle of the heart was
hypertrophied, the mitral valve was insufficient ; the
pericardium was slightly injected, and covered with a thin
stratum of sero-puruleut exudate. The two kidneys, but
especially the left, were granulous and much contracted, and
the cortical substance had almost completely disappeared.
ScJmlz attributes the hallucinations to the maniacal
delirium of Bright's disease ; it is difficult to know what
part, in the pathogenesis, the congestion of the meninges
and the auricular lesion of the heart might lay claim to.
Recently (July 1880, Journal of Mental Science'), an
observation of the same sort was made by Dr. Savage.
442 Luigi M. Petrone.
A woman of 35 years, after having presented a certain
degree of cerebral excitement, appeared dejected, stupid,
negligent and incapable of discharging her duties as a
teacher. After an attack, enfeeblement of the left side
persisted. She had, five years before, received a violent
blow on the head, on the right side, from which she lost
consciousness. In August, 1879, she spoke incoherently ;
she believed herself persecuted, she showed inquietude,
was voracious, sometimes violent and insubordinate ; she
had hallucinations of sight and hearing, and several times
cataleptic crises. She complained of pains in the right
side of the head, and in the ocular globe mostly on the
right side. The pupils were much dilated ; the sight was
weaker on the right than on the left side ; ophthalmoscopic
examination showed optic neuritis on both sides, but more
pronounced on the right. Later on violent vomitings
occurred, the head pain augmented ; the psychical phe-
nomena progressively diminished. The urine became very
abundant and very rich in albumen. In February, 1880,
the optic neuritis showed itself much pronounced, the
papillae were swollen, their borders tumefied, the veins
dilated and sinuous ; in the right eye there were he-
morrhages and white macular. _ The strokes of the heart
were very energetic, the pulsations were very tense. On
lOth February she was semi-comatose; the weakne?s
of the right side was greater, speech difficult, deglutition
of solid aliments impossible. On lOth of April convulsions
came on ; the head deviated to the right. Respiration was
stertorous, pulse very frequent and weak. The patient
died without having regained consciousness.
At the autopsy we found a slight adherence of the
pia-mater, the surface of the brain pale, the convolutions
flattened, the. cerebral substance discolored; the lateral
ventricles were dropsical. In the brain we observed some
sanguineous extravasations, especially on the surface of the
pons Varolii. The arteries of the dura-mater were athero-
matous. The heart was large, the left ventricle much
hypertrophied. The kidneys were small ; their capsule was
Maniaco- Urcsmic Delirium in Renal Affections. 443
adherent, the surface granulous, and the cortex con-
tracted.
Haslund recently (1880) communicated an analogous
case :
A boy of 14 years, affected with Bright's disease ;
albuminuria abundant; oedema, uraemic symptoms — sud-
denly delirium and anguish arose ; the muscles of the face
were convulsively agitated ; then came furious delirium
and hallucinations. This state lasted four months. At
frequent intervals violent paroxysms of mania came on.
The patient was very voracious, and presented all the
aspect of a real maniac. During all this time the
anasarca persisted. At the end of the fourth month
the mania disappeared and with it the oedema. He was
able to re-enter his family and resume his habitual occupa-
tions, yet the albuminuria continued. At this time he
presented no mental phenomena excepting weakness of
memor>^ He died six months afterwards, in collapse,
following an attack of cerebral uraemia, with convulsions
and delirium.
Dr. M. Lecorche, in his medical studies at the
Maison de sante, relates a similar case. Giving a descrip-
tion of interstitial nephritis, he says: "In one case we
observed maniacal disturbances of short duration, it is
true, but such as to render it necessary to place the
patient in a niaiso7i de sant'e. He believed that there
were plots against his life. Through the fear of being
poisoned, he refused every sort of nourishment. The
appearance of these symptoms coincided with the cessa-
tion of the polyuria ; the former disappeared when the
latter appeared."
The author thinks he has the right to ask whether
these accidents may not have been of uraemic nature.
Dr. Raymond (1882), published four observations which
liave much similarity to those we have summarily given.
First Obser. A woman of 69 years, laboring under
chronic Bright's disease. Uraemia, accidents of acute
mania. Coma. Death. At the autopsy both kidneys were
444 Ljiigi M. Fetrone.
seen enlarged, parenchymatous and showed interstitial in-
flammatory lesions (mixed nephritis). The brain was pale
and a little soft. The lateral ventricles had slight dropsy
The convolutions were compressed, and very close to each
other. The cerebral vessels showed the ordinary lesions of
chronic arteritis. The heart presented the alterations de-
scribed by Latulle and Debove, in interstitial nephritis.
Second Obser. A woman of 41 years, ill with oedema
of the face and legs, became, after four days, uraemic ;
presented dyspnceal and intestinal symptoms ; also cerebral,,
consisting principally in phenomena of excitement.
Religious and erotic delirium. The delirium alternated
with the dispnoeal symptoms. Absence of epileptiform
convulsions. Death from syncope. An autopsy could not
be made.
Third Obser. A man of 50 years, ill with chronic
nephritis. Dyspnoeal and intestinal .ursemia. Persistent
cerebral symptoms, delirium, hallucinations, etc. These
symptoms were alternative with those of dyspnoeal uraemia ;.
coma ; death. At the autopsy the kidneys were found to-
be hypertrophic and degenerate in fat. There was vegetant
mitral endocarditis. Cerebral oedema without lesion.
Slight atheroma of the arteries of the base of the brain.
Considerable pulmonary oedema.
Fourth Obser. A man of 55 years, with polyuria, was
seized with paroxysms of dyspnoea. Dyspeptic symptoms,,
cerebral phenomena, delirium, hallucinations, vomitings,
serous diarrhoea. Coma. Death. Autopsy : — Kidneys-
atrophied and granulous. Histological examination showed
an interstitial nephritis arrived at its last period. Cardiac
hypertrophy ; sclerosis of the myocardium. Pulmonary
cedema, and cerebral cedoma. Absence of hemorrhagic
foci and of softening. The arteries of the circle of Willis
were not atheromatose.
Our own observation, which we here report, has some
points of similarity to those we have been reviewing.
Maria R. of 45 years, entered the Hospital for Incura-
Maniaco- Uminic Delirium i?i Renal Affections. 445
bles, in July 1881. She was anxious and externally
dyspnceal. The face pallid and tumid. The palpebrae
puffed ; the lower limbs ver\' cedematous. Pulse frequent
and irregular ; the arteries presented the characters of
atheroma. Heart enlarged. Lungs give signs of diffuse
catarrh. Temperature, axillar}', 99 Fahr. 22nd July. The
patient declares she has never been a drinker of alcohol,
nor has ever suffered from gout, syphilis or saturnism, and
has never used any substances which might irritate the
kidneys. In the month of April these disturbances con-
tinued to appear paroxysmally. In May the palpebrae and
the lower limbs began to swell. In June the swelling in
the legs had so much increased that she was compelled
to have recourse to the hospital. She said she had never
felt any pains in the region of the kidneys, and had never
observed the quantity of urine diminished or altered in
color.
Cardiac examination showed that the left ventricle was
dilated. The point of the heart beat between the 7th and
8th ribs, on the left, and outside the line of the nipple.
The stroke was strong, and the r\'thm irregular. The first
sound at the point, was heard to be weak and murmuring.
The second aortic sound was feebly accentuated. At the
jugular-fossa a very distinct souffle was heard. The pulse
was irregular and hard, 81. There were evident signs of
of bronchial catarrh. The urine was scanty (1200 c. c).
Urea of moderate quantity (15.00). Xo albuminuria. July
29th. The patient has raved many hours. Afterwards she
became tranquil as if weak. Again, towards evening, the
delirium set in with much exaltation. The pulse was
accelerated (98). The tempereture 100 F. The quantity
of urine in 24 ho\irs, 1250 c. c. Urea 16.55. J^b' S^^t,
For the past two days the delirium has continued. It is
paroxysmal and intense. The patient threatens every one
around her bed. Lungs catarrhal. Temperature 102. 7 F.
Pulse 100, weak and irregular. Urine 300 c. c. Urea
8.34. A little albumen.
August 3rd. Somnolence and exultation alternate from
446 Lnigi M. Petronc.
liour to hour. Dyspnoea extreme, Temparature 102.5 F.
Pulse loi. Urine 680 c. c. Urea 12.52. A little albumen.
August 5th. The same state. Persistent coma. Tem-
perature 99 F.
August 6th. Coma continuous. Death.
Autopsy. Heart large and flaccid ; a little degenerate
into fat ; active eccentric dilatation of left ventricle ; its
musculature pale red ; valves sound. Aortic atheroma.
Lungs congested and oedematous ; diffuse catarrh ; mar-
ginal emphysema. Nutmeg liver. Brain pale and rather
soft ; moderate ventricular dropsy ; convolutions flattened;
no macroscopic lesion ; the vessels presented the ordinary
lesions of chronic arteritis. The kidneys much enlarged.
The capsule atrophied, and readily detachable. Their sur-
face knotty, and color pale yellow. Parenchyme congested,
Histological Examination. The vessels of the kidneys,
in every section made by us, presented the lesions of
chronic arteritis. The endothelium was wrinkled in some
of the vessels, and beneath it numerous clear nuclei
appeared. Several vessels showed the middle and outside
coats fused, and thickened by strong proliferations of
interstitial connective. The outermost strata of this fibrous
tissue are infarcted with embrional nuclei, which are further
disseminated in all the renal parenchyma. Almost all the
glomerules contain these nuclei, some, however, present also
the lesions of epithelial ephritis. Glomerules partly atro-
phied, partly reduced into fibrous capsules, which are
attached to the interstitial connective of the parenchyma of
the organ are enlarged, and of an opaque turbid color.
The labyrinth is the seat of sclerosis. The urinary
tubules have an ordinary calibre, and are altered in
various ways. The investing epithelia in some tubules are
intact, in others they are augmented in volume. Cylin-
ders are found here and there, rarely. There are points
in which the the uriniferous tubes (contorted) are atro-
phied.
In this case the delirium assumed the form which is
Maniaco- Urcemic Delirium in Renal Affections. 447
described in the history^ by Raymond, and in many of
those which have been published by Christison and
Gregory, Milks, Lasegue, See, etc. ; the maniacal exal-
tation with general incoherence is the dominant
character of the intellectual perversion. The delirium has
an acute frank course, and it yields the post to mortal
coma. Such a delirium is certainly an accidental per-
version, which is the consequence of the renal disorder.
The patient never before had any form of mental exaltation,
nor was there in her family a hereditary predisposition
to insanity. The character of the delirium, its evolution
in relation to the other accidents, the coincidence with
the symptoms of a chronic nephritis, certainly demon-
strate the symptomatic character and the enduring degree
of intensity of the encephalopathia here treated of.
It remains, however, to determine the relation between
this cerebral symptom and the nephritic affection shown
in the autopsy. In order to search for this relation it
is necessary, first of all, to reflect that the development
of the maniacal delirium, in the observations published
by Haslund, Jolly, Hagen, Wilks, Schulz, Savage and
Raymond, appeared coincidently with the appearance of
albumen in the urine. In the observations of Haslund
and of Jolly, among other facts, there was noted a
certain relation between the albuminuria and the
encephalopathia ; the latter improved as soon as the
albumen in the urine decreased. This coincidence led,
as a consequence, to the attributing to the cardiac
complication, (insufficience, hypertrophy, dilations and so
on) of a certain action on the development of the
delirious accidents, so-called nephritic. It is known that
organic lesions of the heart, because of the circulatory
disturbances which attend them, create a particular
state in the organs of the animal economy, and conse-
quently in the brain. This influence on the brain
is introduced with psychical disturbances. Ball, who
has recently studied the relations between cardiac
affections and insanity, has established that the crises
448 Luigi M. Petrone.
are in strict connection with the asystolic exacer-
bations and the appearance of albuminuria. It is certain
that in cases of nephritis, as in simple cardiopathias, it
is necessary to search for the presence of albumen in
the urine ; but, I add, that the theory of Traiibe, on
■cerebral oedema as a consequence of circulatory disorder
appears to me to explain very badly the appearance
of uraemic encephalopathia, since the cerebral disorders
are rare cases. And it is here to be noted that, in the
■case of Haslund, the intellectual disturbances much im-
proved several times under the influence of a milk
regimen, without, however, the albumen disappearing in
the urine. In my own case also, it might well be said
that between the intellectual disturbances which are
developed in the course of some chronic nephrites, and
albuminuria, there is not a perfect accord.
But to what are we to attribute the genesis of the
encephalopathia Brightia? To uraemic poisoning? Cer-
tainly. The cases in this article call for no other
explanation. The alteration in the urinary secretion
resulting from the permanence of certain products of
retention and decomposition, which circulate in the mass
of the tissues and fluids, induces a species of toxic
influence in the systems, and especially in the nervous
system with all its consequences. The long duration,
also, of the delirious variety of encephalopathia Brightia,
accords very well with the special toxaemia in questionr
The cause of the maniacal delirium will be fruitlessly
sought for in the several known principles of" either healthy
or decomposed urine.
In a memoir on Permanent Hysterical Isciiria (November
and December, 1879) Morgagni has shown by an analysis
of the most noted experiments, instituted by many authors
on the several principles of the urine, (urea, creatina, uric
acid, creatinina, carbonate of ammonia, etc.), injected, in
different ways, into living animals, in order to produce
uraimic encephlopathia, that the mechanism of the form
Brightia, has not, up to the present time, been explained
Maniaco-UrcBmic Delirium in Renal Affections. 449
by any theory, and that we must wait for the explanation
of the uraemic nervous symptoms, in ulterior researches.
These conclusions formulated three years ago are valid
to-day. In this relation I take the opportunity of observ-
ing, that in my patient the appearance of the delirium,
quantitative excretion of urine and urea, did not always
proceed in accord, since there were days in which the
nervous symptoms were intensely developed, though the
quantity of each emitted in 24 hours did not much
exceed the normal proportions.
It must therefore pertain to future observations to
give due import to the reflection oi Lasagne in relation to
uraemic delirium : "We should not be too prompt in
attributing the delirium to uraemic poisoning ; it is neces-
sary that we should search whether another cause exists,
5uch as alcoholism or acute intercurrent affections."
Syphilis in its Relations to Progressive
Paresis,
By J AS. G. KiERNAN, M. D., Chicago, 111.
'T~^HE determination of the etiological value of any
-*- alleged cause of insanity is not by any means a
simple problem. Independently of the personal equation
there is the interaction of numerous influences, and the
reaction of the affection on these influences constituting
the "vicious circle" of the French, to be eliminated from
the influences of any alleged cause. It must be obvious
also that coincidental influences also constitute elements
of error. All of these elements of error are best elimi-
nated by collating the experience of various authorities
with one's own. In endeavoring to determine the etiologi-
cal relations of syphilis to progressive paresis, there are
met with numerous positively opposed opinions. There
are those, who, like ^Esmarch, -Jessen, and "^Kjellberg,
claim, that progressive paresis is always due to syphilis.
On the other hand Lewin and Fournier claim, that
progressive paresis never arises from syphilis. At the
outset of this enquiry there are, therefore, met with
positively contradictory statements. An examination of
the opinions and statements of the various autho-
rities, therefore, becomes necessary to determine which
of these contradictory statements is correct, and
whether they are reconcilable. ^Sternberg, and ^Sand-
berg, found that syphilis causes the majority of cases of
progressive paresis. *^Snell found that seventy-five per cent.
of his paretics had had syphilis, 'Schuele is inclined
1 AllBemelne Zeitachrilt fuer Psychiatrie, 1857.
2 Ibid. B XIV.
S Hospitals TUlendc, 1868.
4 HoBpitalsTldende, 1864.
5 Ibid, 1870.
6 AllKenieine Zeitschrift fuer Psychiatrie. Band xxxviil.
7 Allgemeino Zeitschrift fuer Psychiatrie. Band xxxviil.
Syphilis i?i its Relation to Progressive Paresis. 451
to believe that syphilis is among the most potent and
frequent causes of progressive paresis, and is to be found
in about one-half of the cases. ^Hondoegger, -Schmal-
fuss, ^te Gempt, ^Westphal, 'Leidesdorf and ^Wahrendorf
express almost the same opinions. "Mendel found that
one hundred and seventeen of his two hundred and one
paretics had had syphilis. ®Jespersen found, that out of
123 progressive paretics, 83 had had constitutional syphi-
lis ; in nineteen syphilis was probable, and in fifteen there
was nothing indicative of syphilis. My own experience in
the New York City Asylum for the Insane, is very similar.
Obersteiner^ found that the syphilitic paretics were five
times as numerous as the other syphilitic insane.
Now, although these figures seem to denote a great
frequency of syphilis among paretics, they do not show,
even assuming, that they are correct, and that the rela-
tion between the two affections is an etiological one,
that progressive paresis is always caused by syphilis.
Kjellberg's words, however, are that progressive paresis
never occurs in a subject free from congenital or acquired
syphilis. It therefore becomes necessary to examine as
to the influence of congenital syphilis in the production
of psychoses. Mendel'" has shown that syphilis in the
parent may produce a predisposition to insanity in the
offspring, such insanity occurring long after the usual syphi-
litic congenital manifestations attain their full development.
The question now arises does syphilis occur in progressive
paretics as frequently as is claimed by Jespersen and the
other authorities cited. ^^Ripping and ^-Hugenin find, that
syphilis is only encountered among about twelve per
1. Ibid page 273,
2. " -r.z.
3. " 27-1.
4. " 27.i.
5 Medizinische .Jahrbuecher, ISW.
6. Allgemeine Zeltschrift fuer Psychi.itrie. Band xxx^iii.
7. Die progressive Paralysie der Irren.
8. Hospitals Tideude. Xo. 34. 187*5.
9. ilonatschrift flier praktische Dermatologie, ISSl
10. Arcliiv flier Psychiatrie. Band ii.
11. Ibid. Band x.TXvii.
1-2. Annates Medico-Psychologiques, 1SC9.
452 J as. G. Kiernan.
cent, of the paretics. These results are explained by the ■
fact that, as ^Spitzka has found, the percentage of syphilitic
paretics is greater among public than among private
patients. It becomes also necessary to determine whether
syphilis does stand in any etiological relation to the
paresis with which it co-exists. Whether it is not, as
was sometimes found by Ripping and Snell,- merely an
epiphenomenon of progressive paresis concomitant upon
sexual excitement of the earlier stages, Jespersen's sta-
tistics agree with those of Mendel and ^Erlenmeyer,,
Berthier,* Dreer,'^ and the other authorities cited in the
fact, that the syphilis preceded for a number of years the
earliest development of the psychosis. Such is the affirm-
ative side of the question, and as so far analyzed it leaves
no doubt, that syphilis does produce progressive paresis-
Examination of the negative side becomes now neces-
sary. Lewin's opinion is an opinion merely, and is entirely
too dogmatic, for he denies that any psychosis can be
produced by syphilis. Fournier claims, that syphilid
produces a pseudo-paresis not identical clinically or
pathologically with the real psychosis. The attempts at
demarcation of the two forms must, therefore, be passed
in review. ^Mueller considers, that alterations in the ar-
terial coats with a diminution of their calibre, and
consequent malnutrition and degeneration of cerebral
tissue are common to both affections, and account for
common symptoms. In cerebral syphilis the pathological
changes are not confined to the cerebral arteries or brain
itself, but extend to the meninges and skull. Syphilis
also causes alterations in the sympathetic nerves, hyperplasia,
of the interstitial connective tissue, causing pressure on the
nerve cells and fibres. The diagnosis will rest upon the
existence of aisthesias, epileptoid and paralytic attacks of
1. .Journal of Neurology and Psychiatry. Vol. I.
■2. Op. cit.
;i. Die luetischen Psychosen.
4. Do la folie (liathesique.
5. Archivio Italiano per la Malattie Ncrvoso, 1869.
6. Correspondenzbhitt derdeutfchen Gesellschaft fuer Paychiatrie. Nos. 5—7-.
1873.
Syphilis in its Relation to Progressive Paresis, 453
longer duration, and more gradual origin, than those of pro-
gressive paresis. HVille lays much stress on the existence
of the headache, aesthesias, etc., believes with -Coffin, that
progressive paresis in a man under twenty-one is always
of syphilitic origin. In this case the delusions of grandeur
are wanting. "'Ireland lays stress upon much the same
diagnostic signs as ^lueller and Wille, and believes that
the results of treatment are the great test of the difference
between brain-syphilis and progressive paresis, which forms
he regards as distinct. ^Linstowe and "'Mickle lay great
stress on curability as a decisive test of the two affections
which they regard as distinct. ""Voisin states, that these
two forms are distinct and the diagnosis can readly be
made by means of — First : The presence of other syphi-
litic manifestations. The absence of delusions or speech,
troubles common in progressive paresis or their fleeting exist-
ence. Second: The evolution of the disease; the appear-
ance of the symptoms, indicating a circumscribed lesion.
Third : The happy and rapid results of specific treatment.
Mauriac' states that brain-syphilis and progressive paresis
differ markedly. The diagnosis between the two can be
readily made since — First : In the cerebro-spinal syphiloses
psychic disorders and the motor incoordinations are never
systematized as is the case with progressive paresis. Second :
That this is one o'i the prominent characteristics of the cere-
bro-spinal syphiloses. Fournier claims that brain-syphilis
is distmct from progressive paresis, since it has a different
mode of onset, evolution and duration, since in it there are
frequent partial paralyses and hemiplegia, since it presents
a special cachectic appearance and finally, since it readily
responds to treatment. 'Charcot. ''Hanot, ^"Blandford,
1. Irrenfreund. Xo. 1, 1673.
2. Armales Jfedico-Psychologiques. Tome. Ti. Serle iii,
3. Journal of Mental Science. April, ls74.
4. Archiv fuer Pavchiatrie. Bandit.
5. General Paralysis of the Insaue.
6. Par.ilygie Gt-neraie des Alienes, p. 296.
7. Sur les Ailectians ^yphilitiques des Centres Nervtusts.
S. Gazette des Hospitaux, ISS-).
9. Revue des Sciences Medi-ales. Tome ii.
10. Insanity and its TreatmfiU.
454 J<^s- G' Kienian.
Drysdale,^ -Broadbent, "^Albers, "^Gros, ^Lanceraux, Zam-
baco, "Lagneau fils, ^Concaix, '^Hildenbrand, ^'^Huebner and
^^Baumgarten, express almost the same opinions. Clous-
ton/'- i^Wright, i^Ford, ^^Read, ^^Schuetzenberger, "Bedel,
Williams,^® ^^Brouss, -'^Skae and -^Mansurrow all agree, that
the results of treatment diagnose brain syphilis. For these
reasons Fournier, Voisin and the other authorities cited
make progressive paresis a distinct affection from the
psychosis resulting from syphilis. Against the opinions
last quoted I oppose but a single case, which will serve
as a basis for an argument, showing that syphilis does
produce progressive paresis and that all the alleged criteria
of cerebral syphilis are valueless.
A French laborer was admitted to the New York
City Asylum for the Insane, at the age of twenty-six. He
was luetic and intemperate. On admission he exhibited
grandiose delusions. He maintained that he was in
possession of vast amounts of real estate, and that he
was to grow immensely in stature. His pupils were un-
equal, tongue tremulous and there was a slight difficulty
in articulation. During the first two weeks he was very
excitable. He became progressively more and more
incoherent and irrelevant in conversation. He shouted at
the top of his voice without being moved thereto by
1, British MedicalJourual. August, 1860.
2. Lancet. January.
?i. Syphilitischeu Gehirnkraukheiten.
4. Cited by Fournier op cit.
."j. Ues Affections Nerveuses Syphilitiques.
6. Des Affections Nerveuses Syphilitiques.
7. These (le Paris, 1862.
8. These lie Strasbourg, 1S59.
0. Traite (les Maladies Syphilitiques.
10. Die luetische Erkrankung der Hirn-Arterieu.
11. Archiv der Heilkunde. Band xvi.
12. Journal of Mental Science, lS7">-76.
13. Edinburgh Medical Journal. Volume xvi.
U. Journal of Insanity, 1874-75.
I.'). Syphilitic XervouB Affections.
16. Gazette Medicale de Strasbourg. March 20, 1S.')0.
17. These de Strasbourg, 1861.
IS. Journal of Mental Science, 1869-70.
19. Die lllrn-Syphilis.
20. Journal of Mental Science, 1875-76.
21. Die teriiare Syphilis.
Syphilis in its Relation to Progressive Paresis. 455
any apparent cause. He was at length removed to the
hospital ward in consequence of the motor paresis having
become so extreme as to amount to almost complete
paraplegia, and his labial tremor was marked. He still
retained his delusions more stupidly expressed, and
claimed that he was able to lift the Asylum on the top of his
little finger, but could hardly enunciate one continuous
sentence uninterruptedly. A well-marked convulsive attack
was followed by almost complete aphasia. Death took
place from exhaustion, following upon a maniacal attack.
The most marked mental symptom manifested by this
patient was a complete loss of certain recollections.
The greater part of his existence, while in France, had
become a complete blank to him, he had forgotten al-
together that he had been a laborer, A peculiar motor
symptom was the only variation from the ordinary course
of progressive paresis. It was a passive contracture of
the muscles of the neck and left arm ; the chin being
drawn to the left and backwards, so as to touch the
left clavicle ; the arm being partly flexed and pronated
and carried behind the back. On rousing him he could
abandon this constrained position, but gradually relapsed
into it afterwards.
Dr. *Spitzka, who made the autopsy and histological
examination in the case, made the diagnosis from this
symptom of a left optic thalamus affection locating the
lesion in the posterior part of that ganglion in accordance
with Meynert's diagnosis, from the same symptom, in an
epileptic imbecile in whose case the autopsy confirmed
the diagnosis. The autopsy was made twelve hours after
death. The cerebral dura was adherent to the cranium,
and presented a greenish discoloration over the left
lobules tuberis, otherwise it presented nothing abnormal.
The dura-mater spinalis was extremely thickened from
the point of exit of the first, to that of the fourth cer-
vical pair, exhibiting other evidences of pachymeningitis.
The lepto-meninges of the encephalon were thickened
* Somatic Etiology of Insanity.
456 J as. G. Kiernan.
and infiltrated with young cells but no pus, coagulable
lymph or increase of the arachnoid fluid could be deter-
mined. A more intense similar process had affected
the spinal meninges and a diffuse gummy infiltration,
cheesy in its center, involved the parts around the
anterior fissure of the spinal medulla, opposite the roots
of the third cervical pair and had destroyed the ante-
rior commissure of that district.
The hemispheric cortex was ev^erywhere the seat of
various superficial and nodular infiltrations. The nodules
varied from microscopic sizes up to half an inch or
more ; the smaller were spherical and periadventitial with
respect to some vascular trunk ; the larger were ovoid, their
long axis being represented by the stem of a large vessel,
being vertical to the cortical superficies. The diffuse infil-
tration involved the uppermost la}-er of the cortex, and
was chiefly located at the floor of the sulci and
especially over the island of Reil, as well as the corres-
ponding inner surfaces of the operculum and temporal
lobes.
Where the nodular growths had become larger, they
fused with the superficial infiltration giving to the latter
an appearance as if it had processes dipping down into
the deepest layers. Frequently several nodules, situated
on different branches of the same main vessel,, fused
with each other around the latter, thus resembling a
papilloma. The white substance was also affected. The
nodules, however, were not so well marked and the
transition from the neoplasm to the normal tissue was
gradual. Their color varied as also did their consistency;
while the smallest were undistinguishable by the naked
eye from the surrounding tissue, the medium-sized
nodules were quite firm and exhibited a reddish gray or
yellowish white center, with a markedly red zone at the
peripher}^ Larger ones showed the same peripheral zone,
with a softening of the center, and the last stage of
the breaking down process, which terminated the exist-
ence of these masses, was represented by cavities of
Syphilis in its Relation to Progressive Paresis. 457
varying dimensions, some without any sharp boundary
and softened walls, others provided with a more or less
•firm connective tissue capsule. These masses were
equally distributed in both hemispheres, but softening had
proceeded further on the left side. The right thalamus
was entirely free, while the left, although intact in its
anterior half, was converted into one mass of anasto-
mosing nodular and tubular infiltrations in its posterior
tubercle. The focus of the change was in the lenticular
nucleus and the island of Reil. The central extremities
of the prsecentral gyri, the lobulus tuberis, and the cornu
ammonis were affected in a high degree. The left teg-
mental tract was completely broken down ; one large
cyst occupied the place of the left olivary body ; two
smaller ones were situated in its fellow. There were
besides several small diffuse, and as a rule, softening
nodules in the cerebellar hemispheres, likewise quite
symmetrical.
Microscopical examination showed, that the youngest
tumors consisted of an accumulation of round mononu-
cleated cells, varying in size from that of a red corpuscle
to that of the white. These were seated in the adven-
titial sheaths of the vessels, and gradually encroached on
the perivascular space, obliterated the latter and penetrated
into the neighboring neuroglia. Now the neoplasm began
to assume distinctive characters ; the main body was com-
posed of older elements, which did not imbibe carmine
well and stiff coarse fibres ; pyramidal nerve cells with
intact contours were still to be seen in the very center
of the mass. The peripheral zone was composed of young
elements of the nature described above, as well as free
nuclei, which were rapidly and deeply stained by carmine.
Later on, the center of the nodule underwent a degenera-
tion partly mucoid, partly granular. The neoplasm whose
periphery exhibited a rich vascularity was determined to
be a miliary syphiloma. Had the patient not died from ex-
haustion, his death would unquestionably have been attributed
to the process which destroyed the important centers of
45 8 J as. G. Kiernan.
the medulla and tegmentum. The symptom ascribable to
the thalamus affection could not be so clearly referred to
it after death, for although the part of the thalamus sup-
posed to be affected was involved, there was also a lesion
of the left tegmentum and spinal cord ; either one of
which might have produced the symptom in question.
It will be obvious that in no essential particular did
this case differ from progressive paresis. Anti-luetic treat-
ment was used from the first, but without effect. It may
be said, that the pathological lesions differed from those
of progressive paresis, which is an affection characterized
by early vaso-motor disturbance and subsequent encepha-
litic changes. To this the answer may be made, that
progressive paresis may exist without any discernible
lesion in its early stages. *Rabeman has found many
cases in which this occurred. Spitzka is of like opinion.
It is obvious, therefore, that the encephalitic changes are
the later consequences of the disease, and this is further
shown by the occurrence of remissions in which the
patient's normal condition is seemingly restored. Vaso-
motor changes are at the basis of this encephalitis, and
what could be more potent in the induction of these
changes than the direct or irritative influence of gummata
in certain localities. This is the opinion of Luys,t who'
says, that "if as a rule, syphilis marks its passage through
the organism by sclerotic productions and gummy tumors
it is not impossible that syphilis may reveal itself in certain
cases only by a sclerotic hyperplasia to all seeming a
simple hyperplasia. I say the thing is not impossible for
up to the present the anatomo-diagnostic characters
between non-syphilitic and syphilitic sclerosis are not sa
firmly established as to permit the clinical recognition of
a syphilitic type of progressive paresis." The pathologi-
cal lesions found are no evidence that the case was not
one of progressive paresis. The peculiar motor symptom
was the result of the location of the lesion not of its
• Archiv flier I'bycblalrle. Band iv.
t Maladies Mcntalie.
Syphilis i?i its Relation to Progressive Paresis. 459'
cause. Wille's criterion of the non-existence of grandiose
delusions in brain-syphilis is shown to be of no value.
Similar cases with like delusions have been reported by
Burlureaux.i Rodrigues,- Todd-Thompson,^ Mendel, Zam-
baco* and others. Is curability a valid criterion ? Mueller,
a hostile witness denies that it is. ^Dreschfield remarks
that "In the more chronic syphilo-neuroses where the syphi-
litic deposit has itself undergone degeneration, changes
and established secondary changes in the surrounding
nerve matter, treatment, will of necessity, be of little
avail," and this is the opinion of most syphilographers.
Spitzka® claims that in cases where syphilis can be posi-
tively excluded, mercurial treatment is sometimes of value.
The value of dermatoses, etc., as a diagnostic point, is
totally destroyed by the fact that syphilis may, from causes
already cited, complicate progressive paresis. The other
points of diagnosis cited will, it is obvious, depend upon the
location rather than the nature of the lesion. It must be
obvious, therefore, that, as "Oedmansson, ^Falret, ^Ham-
mond, ^'^Keyes, "Luys, ^-Blanche, '^Magnan, ^*Jung, ^^Rollert,
^^Simon, ^"Meyer, ^^Arndt, ^^Sauvet, Mendel, Ripping,
Jespersen, Spitzka, '^"Jewell and other authorities cited,
have said, a diagnosis between progressive paresis of
syphilitic and non-syphilitic origin is impossible. Taking
all these facts into consideration, I think it may safely be
1. These de Paris, 1874.
2. Cited by Voisin.
'i. Archives de Medecine. Tomexriii.
4. Op. cit.
5. Practitioner, May 1S75.
6. Insanity. Its diagnosis, classification and treatment.
7. AUgemeine Zeitschrilt fuer Psychiatrie. Band xxviii.
8. Maladies Mentales.
9. Treatise on Insanity.
10. Venereal Diseases.
11. Op. cit.
12. Cited by Fournier. Op. cit.
13. Cited by Fournier. Op. cit.
14 Cited by Snell. Op. cit.
15. Cited by Mendel. Op. cit.
16 Gehirnerweichiing derlrren.
17. AUgemeine Zeitschrift fuer Psychiatrie. B.and xxx.
18. Psychiatrie.
19. Cited byFalret. Op. cit.
20. Jonrnal of Nervous and Mental Disease, ISSO.
460 Jas. G. Kiernayi.
concluded that, First: From neither a clinical, nor a
therapeutical, nor a pathological standpoint, can progres-
sive paresis of non-syphilitic origin be demarcated from
that of syphilitic origin. Second : That the etiological
influence of syphilis in the production of paresis has been
over-estimated by some authorities. Third : That the
value of anti-syphilitic treatment in progressive paresis,
will depend upon the stage at which the syphilis is found,
and in no case is it necessarily contra-indicated. Fourth :
That the contradictory statements in regard to syphilis
and progressive paresis are due to doctrinaire and a priori
tendencies altogether too prevalent in medicine.
Concealed Insanity.— As Illustrated by
Case of Mark Gray.*
By D. R. Brower, M. D., Chicago, Ills.
Professor of Nervous and Mental Diseases at the Women's Medical College.
INSANITY is no moral agent — the disordered nutrition of
the brain upon which it depends, does not in any way
improve the ethical tone of the unfortunate victim. II
the patient was inclined to lie or steal or dissimulate
before his insanity, he, is none the less so inclined after.
That insane patients should, therefore, deceive those
around them, by concealing their insanity when occasion
seems to require it, is not inconsistent with such insanity.
That they do it, is within the experience of all, who have had
much personal contact with them. The motives which
prompt the insane to action are not necessarily different
from those which influence the sane. A desire to escape
from the confinement of a hospital for the insane, or to
avoid the ridicule of those around, or to maintain control
of their affairs, is the usual incentive to this concealment.
Those who are successful have delusions that are not
necessarily manifest in their daily life and conduct.
Instances of concealed insanity are numerous. Ingelsf
reports a case in which a systematized delusional lunatic
concealed his delusions so well, that he was about to be
discharged when an accident which excited his emotional
nature caused him to give vent to his delusions. In a
second case a man, who was guilty of very disarre actions,
was twice discharged and twice recommitted in one
asylum. On the third admission Dr. Ingels was able to
determine, but only after a long conversation, that the
patient's actions were from the first based on systematized
delusions. But for an accidental emotional explosion,
• Head before the Chicago Medical Society, December ISth ISSi.
- Annales et Bulletin de la Societe de Medicine de Gaud. August, 1S<X3
462 D. R. Brozver.
these delusions would not have been elicited. In a third
case a systematized delusional lunatic had delusions of
persecution, but for several years had so conducted his
business as to lead every one to regard him as of perfect
mental integrity. To his mother he communicated his
delusive ideas and she accepted them as true, but ascribed
his persecution to sorcery.
Meyer* reports a case in which a man was able to
conceal his insanity from his friends, and this insanity was
only detected on the explosion of a wild business scheme
based on it. Spitzkaf cites a case, in which a systematized
delusional lunatic was so well able to conceal his insanity,
that he was appointed guardian over his insane sister,
Blanche^ reports several cases, in which patients concealed
their insanity to avoid being douched and subjected to
restraint by Leuret, who attempted to treat insanity by
intimidation.
Munro§ had a curious experience of this kind. A
patient brought action against him for false imprisonment
and underwent a severe cross-examination without reveal-
ing any delusion. It was suggested to the Judge (Mansfield)
to ask him what has become of the princess with whom
he corresponded in cherry juice, and immediately a group
of delusions became manifest. The patient indicted Dr.
Munro a second time, but could not be led to say a
single word on the subject which had led to the failure of
his first indictment. Blandford|| says, that patients may
deny their delusions for the purpose of regaining liberty.
Forbes Winslow^ states, that Lord Ellenborough expressed
in the course of a judicial enquiry his opinion, that a
patient had perfectly recovered. The patient was detected
speaking in Latin in order to conceal his delusion. Buck-
nill and Tuke** cite a case in which a patient was able to
• Allgemeine Zeitschrift fuer I'sjchlatrie. Band xxiii.
t American Journal of Neurolojry iiinl Psychiatry. August, 1882.
t Del etat actuel dcs alienos traite jiar Leuret.
§ Cited by Bucknill and Tuke, Psychological Medicine, p. 477.
j Insanity and its Treatment, jiageSCl.
IT Obscure Diseases of the Brain and Mind.
♦♦Opoit.
Concealed Insanity. 463
conceal his delusion in conversation, but revealed it in his
correspondence. Hammond* states, that the insane may
conceal their delusions for a purpose.
fHaslam states concerning the insane that "they have
sometimes such a high degree of control over their minds,
that when they have any particular purpose to carry they
will affect to renounce their opinions which shall have
been judged inconsistent, and it is well known that they
have often dissembled their resentment until a favorable
opportunity has occurred of gratifying their revenge. Of
this restraint, which madmen have sometimes the power
of imposing on their opinions, the remark has been so fre-
quent, that those who are immediately about their persons
have termed it in their rude phrase, stifling their disorder."
Esquirol+ makes very similar statements. On the other
hand. Dr. A. E. Macdonald§ states, that men really insane
do not recognize their insanity, and hence do not con-
ceal it. He is however the only physician who has had
that experience.
Chicago has recently had two striking illustrations of
the same kind in the case of Adelaide Roberts who shot
Theo. Weber ; she was declared to be insane, was sent to
Elgin Hospital, and about two years thereafter released by
Judge Rogers under an habeas corpus proceeding, and in
the case of Mark Gray, the would-be assassin of Edwin
Booth, who was declared to be insane, and about two years
after was released by Judge Williams, of Quincy, under
a similar proceeding.
These learned Judges by a stroke of the pen cured
these two cases of insanity, after the accomplished super-
intendent of the Elgin Hospital for the Insane had
expended his resources in that direction for two years in
vain. Such presumption is marvelous. Had I taken
before either of these Judges a case of phthisis and asked
him to reheve the patient by the same process, it would
• Treatise on Insanity.
t Observation on Madness, p. 53.
: Maladies Mentales.
§ American Journal of Neurology and Psycliiatry. Volume I, p. 120.
464 D. R. Brower.
have created a doubt, as to my mental soundness, yet
insanity is not less a disease than phthisis. The Judges
would soon recognize in a most decided manner the ex-
clusive medical relations of insanity should one of their
own family become insane. The judgment of Dr. Kil-
bourne would then be accepted without question. Neither
of them would under such circumstances think for one
moment, of calling even upon the most exalted jndicial
officer for assistance or relief The case of Adelaide
Roberts may on some future occasion be made the basis
of some reflections on the medico-legal relations of
hysteria and hystero-epilepsy.
At present I ask attention to the case of Mark Gray :
May lOth, 1879. At an inquest and judgment of the
Criminal Court of Cook County, IlUnois, Mark Gray was
adjudged insane, and committed to the Elgin Hospita
for the Insane, into the charge of the superintendent
who was commanded to take the body of the said Mark
Gray, and keep it in safety in said asylum until he
should have fully and permanently recovered from such
insanity. The offense which resulted in this judgment,
was an attempt to shoot Edwin Booth, the distinguished
tragedian, in McVicker's Theater, Chicago. Mark Gray
fired two shots from the dress-circle and was in the act
of firing a third, when he was seized and immediately
placed in the custody of the police.
For a day or two after the event he was morose and
reticent. He would answer questions, if at all, only in
monosyllables. Afterward he became more communicative
and boasted of his wonderful histrionic talent, especially
his proficiency in Hamlet, of which he claimed to know
every line, and of his ability to render it in a manner
much superior to Edwin Booth. His great extravagance
in this direction, his excitability, his reticence about the
tragedy, the seeming lack of motive for the crime, the
fact that Booth had never seen him, led to doubt as to
his mental soundness. After a day or two he manifested
the delusion which impelled him to the crime. This was
Concealed Insanity. 465
the belief that he was the son of Edwin Booth and as
such had by heredity his wonderful histrionic talent.
Edwin Booth had abandoned him in his childhood, had
deprived him of a suitable education for the development
of these talents, had neglected his mother, and in revenge
for this. Gray shot at him twice and would have continued
firing had he not been arrested. It was at first the opinion
of some that there might be a foundation for this belief,
notwithstanding its denial by Edwin Booth. Those who
entertained this opinion abandoned it when Mrs. Gray
made her appearance, a glimpse of her was sufficient to
satisfy the most skeptical, more especially as Gray was
found to be twenty-eight years old, and it was shown that
Mr. Booth had been absent traveling in Australia and
elsewhere abroad for two years prior to Gray's birth.
On examination of Gray, three days after the shoot-
ing, I found him to be tall and slender with small muscular
development. His face was asymmetrical, the muscles of
left side differently inervated from those of the right, so
that a smile caused quite a marked distortion of the face.
There was twitching of the muscles of the right side of
the face. The muscles of the right arm and leg were more
active than those of the left. He dragged his left foot in
walking and kept the right in more or less activity when
talking. His pulse was one hundred and ten and feeble.
He complained of headache which had continued for
months, and of sleeplessness. His tongue was covered
with a heavy white fur and was tremulous.
It was established at the trial in the Criminal Court,
that Mark Gray's father died of ascites, four months after
Marks' conception, which ascites was probably the result
of hepatic cirrhosis seemingly a consequence of spirit
drinking. This is an interesting and important fact in the
record. His father was laboring under an incurable disease
of nutrition at the time of his conception. The other
children of the family have shown none of Marks' peculia-
rities. It illustrates the important bearing of the condition
of the parents at the time of the conception, upon the
466 D. R. Broiver.
health and welfare of the offspring. I recall a case in
which the father had been unfortunate in business, left
the city, drank heavily, returned home after some days,
not yet over his spree, a child was conceived, and it is
to-day the inmate of an hospital for the insane, incurably
insane. There are four other children in the family, three
older and one younger than this patient ; all men and
women of robust, mental and physical health. The spree
above mentioned is the only one in which the father ever
indulged.
The broken down health of Mark Gray's father at the
time of his conception, laid the foundation of a weak
nervous organization which was the first step in the origin
of Mark's insanity. Another interesting feature of the case
is that Mark's age at the time of the full development of
the insanity was about the same as the age of his father,
at the time of his death. The disturbance of nutrition,
which by attacking abdominal organs gave rise to dropsy
in the father, by attacking the brain gave rise to insanity
in the son, and this transfer of morbid action from one
organ in the parent to another in the progeny is a fact
of common observation. Had the same organs been the
seat of disease in the son as in the father, the criminal
trial never would have taken place, and the stupidity of
the Quincy Judge would not have manifested itself in
this direction.
Mark Gray grew up possessed of inordinate conceit
and exalted self-feeling and having ideas of grandeur and
importance. In early life he became intemperate, a part
of the time he drank heavily. In 1876 he stopped drinking
excessively, and began to act strangely about his home.
He would get up at night and declaim Shakespere the
night through. He would keep himself away from the other
members of his family, and would sit for hours with his
head between his hands. At other times he would strike
"stage attitudes" and remain for a long time in these. So
peculiar was his conduct, that his mother and sister were
much alarmed about him. It was at this time that he
Concealed Insanity. 467
conceived the delusion of his relationship to Edwin Booth.
He told me that he heard it frequently whispered as he
passed along the street, "there goes the bastard son of
Booth." His fellow-clerks in the store tormented him by
the same sort of whispering. These were evidently audi-
tory hallucinations.
After a time he determined to have an interview with
!Mr. Booth, and demand a monetary compensation for the
years of imaginar\- neglect which he had sustained. For
this purpose he came to Chicago, April 22, 1879, and went
immediately to the theatre to see Mr. Booth, but did not
find him there. He went to the theatre again that night.
Mr. Booth was playing Richelieu. During this play Gray
imagined that Mr. Booth saw him sitting in the galler}- and
recognized him ; made faces at him, called him by name
several times, " Mark I Mark ! " and made fun of his mother.
Gray left the theatre with the resolution' to kill Booth, for
these insults, the next night. He purchased a pistol the
following day, and afterwards secured the seat which he
thought would serve his purpose best, in the dress-circle
near the stage, and by a study of the play, selected the
prison scene as a favorable time for firing the shots. He
was arrested, tried and found to be insane as already stated.
At the Elgin Hospital for the Insane his delusion of
his relationship to Booth, his delusion of his wonderful
histrionic talent and his constant reading and declaiming
Shakespere were manifest. December 15, 1879, he impor-
tuned Dr. Kilbourne for his discharge as he had often
done before. Dr. Kilbourne told him that he was still
insane and, as a proof of it, stated that his (Gray's)
delusion of being Edwin Booth's son was just as fixed
as the day he entered the hospital. The day after this
the hospital record shows that Gray gave up reading and
declaiming Shakespere, and when spoken to about being
the son of Booth, would say that he had given up all
idea of such a relationship, that it was a crazy notion of
which he had rid himself He continued then to assert
on all occasions, that his delusions had been corrected and
468 D. R. Broiver.
he manifested no interest in Shakespere or theatrical mat-
ters, until December i, 1880.
During this interval of nearly one year, the Board of
Trustees had Mark before them three or four times, care-
fully examined into his mental state, and thought he might
be discharged, but Dr. Kilbourne, not being quite satis-
fied asked them to wait a short time longer. December
1st, 1880, Gray broke out afresh, and the hospital notes
show "that he refused to have his hair cut, likes to wear
it long, as it looks more stage-like, practises elocution
every day in his room, considers himself a great Shakes-
perian scholar, has talent for the stage much superior to
that of his father Booth." He continued thus to manifest
his delusions every day. Thus on October 18, 1881 in
conversation with Dr Crane, assistant physician of the
Hospital, Gray said that Mark Lyon (Gray's father) was
Edwin Booth ; that his father's brother, Pat Lyon, was
Junius Brutus Booth, Jr. ; another brother of his father was-
John Wilkes Booth, and still another, Bryan Lyon, was-
Joseph Murphy the comedian, whom he believes is a
brother of the Booth's. He does not believe that Wilkes
Booth is dead. He beheves his cousin Mary Lyon,
is a daughter of Junius Brutus Booth.
February 5, 1882, he had an interview with the Board
of Trustees seeking a release from the hospital. In that
interview he was again told that so long as he had the
delusions concerning Booth and the stage, he could not
be discharged. During this interview he was much excited
violent at times, and incoherent in language. He left the
room evidently resolved on concealment again, for he
ceased from that time to manifest any interest in
theatrical matters and laughed at his delusion concerning
Booth, $0 that his attendant, who was employed shortly
after this event, and who was quite constantly with him
for about eight months, saw at no time any evidence of
mental disturbances, but noticed Gray avoided with much
effort and with a surprising degree of indifference any re-
ference to theatrical matters.
"V
Concealed Insanity. 469
The habeus corpus trial occurred in Ouincy. Why in
Quincy, two nundred miles from the place of the criminal
trial, is a myster\- 1 The trial was conducted as such trials
usually are. A dozen people were called by Mark's attor-
ney. Some had known him before ; then talked to him
for a few minutes about the weather, business, politics, thea-
tres, etc., etc., and all with one accord testified, that they
had found no evidence of insanity about him. This purely
negative evidence would release from custody nine-tenths oi
the patients of any hospital for the insane. Four persons
who were announced as physicians were called by Gray's
attorney. One, a veterinary surgeon, who felt quite conn-
dent of Gray's complete restoration. One, a retired
clergyman, who had attended one course of lectures in a
medical school, who, to his credit be it said, testified that
if the patient had deceived the hospital authorities as to his
insanity for one year, it is quite probable that he might be
doing it now, and he would hesitate therefore in aiding
Gray's discharge. One was a young M. D., son of the
retired clergyman, before mentioned, fresh from a medical
college, who will probabh- be wiser when he is older, and
the fourth was a physician of fine attainments with that
familiarity of insanity which the countr)- practitioner has.
He testified that while he saw no evidence of insanity in
Gray, yet he would not advise his discharge against the
judgment of Dr. Kilbourne. In addition an attendant
who came to the hospital about one month after Mark
began to conceal his delusions, the last time, testified, that
he had daily intercourse with him and had observed no
evidence of insanity, but was surprised at the pertinacity
with which he avoided all conversation upon theatrical
matters, the attendant being much interested in such
things.
Mark testified in his own behalf and his testimony was
a surprise to the newspaper reporters and the people about
the court room. The average individual looks upon in-
sanity as a complete loss of reasoning powers, as something
which must be violent and strlkincr in its demonstrations-
4/0 D. R. Brower.
I have repeatedly taken visitors through the Insane Hospital
of which I was the superintendent, and when every ward
had been visited have them ask me to show them the
lunatics. To one familiar with insanity, and the history of
this case, Mark's own testimony was sufficient to show that
the disease was not eradicated. He manifested by his
manner and by his talk, the self-adulation which had been
a part of his insanity. He indulged in that denunciation
of the Hospital authorities, which is usual in such cases.
He pronounced judgment on the assistant physician, Dr.
Crane, now in private practice in New York, to the effect
that he was crazy, "crazier than witness was." Dr. Kil-
bourne, one of the most successful superintendents in the
west, a thoroughly scientific physician, was to him vile
and despicable. He accused Dr. Kilbourne of taunting
him with the story of his birth ; of abusing him Sq
maliciously and acting in his visits to him so like a crazy
man, that after he went out the attendant told him he
ought to have knocked Dr. Kilbourne d'own. I have
often, as has every superintendent of an insane hospital,
heard precisely such abuse from this class of patients, It
is a remarkable fact, that patients who leave the hospital
cured, always have pleasant recollections of those who
cared for them in their affliction. This unwarranted abuse
of Drs. Kilbourne and Crane would be sufficient to
establish Gray's insanity were there no other evidences of
it. Gray told the story of his life and of the great trag-
edy he tried to enact, with a smile on his lips and
with many efforts at jocularity ; when these jokes pro-
voked laughter in the hangers-on of the Court, Gray
seemed particularly happy. He told with evident delight
of the way he had fooled all the asylum authorities for one
year ; that Dr. Kilbourne had told him he could not be
discharged until he had given up his delusions; that he
then resolved to conceal them ; that he was successful in
deceiving his ward attendant, Dr. Crane, and the Board
of Trustees, and after plaj-ing the game, as he expressed
it, for a year, he gave it up. The learned judge, at this
Concealed Insanity. 47 1
part of Mark's testimony, asked him : " If you admit that
you did practice this deception for one year, how shaU
I know that you are not doing, it now?" Mark, after a
long hesitation, answered : " I don't know," and in a very
tragic attitude, rising from his chair, appealed to God to
witness that he was not fooling now. On behalf of the
hospital, Mr. J. S. Miller, the attorney, first presented the
record of Mark's hospital life ; an abstract taken from the
daily reports of his various attendants, showing the pres-
ence of his delusions; the concealment of them for one
year; the subsequent reappearance of them in the same
form, and the concealment beginning in Februar}', 1882.
Dr. Kilbourne testifies to the same effect, and stated in
strong and positive language his belief that Mark Gray
was still insane. Dr. W. A. Byrd, one of the leading
surgeons of Quincy, after hearing all the testimony, and
after a careful personal study of Gray, testified that he
was then insane. Dr. Byrd dwelt upon the evidence of
neurosis, as shown in asymmetr}' of the face, in unequal
action of the muscles of the two sides, in the twitching
of the facial muscles, and those of the shoulder and
hand.
My testimony, and that of Mr. Rice, a deputy sher-
iff of Cook Co., who had taken Mark to the hospital,
and had frequently seen him there and knew of his con-
cealed delusion, was to the same effect. Judge Williams
then rendered his opinion, releasing Gray from restraint.
I shall not waste time with a review of this opinion, but
simply state that it shows a profound ignorance of the
law governing the organization of our hospital for the
Insane, of the general medico-legal relations of insanity.
Of course there could be no doubt that the relator
was insane, if there had been any doubt, his subsequent
histor}^ placed it beyond question.. He wrote a letter
four weeks ago to Mr. John W. Norton, of the Grand
Opera House, St Louis, in which he proposed to star
Hamlet in small towns ; still later to the Keokuk corres-
pondent of the Chicago Tribune he said : " It is my
472 D. R. Brozuer.
intention to make arrangements to star with a company
on the road. The notoriety I have achieved during the
last few years, and my great resemblance to Booth would
draw crowded houses. I resemble Mr. Booth in every
particular except the eyes ; his are deeply sympathetic,
mine the most brilliant. Of course my going on the stage
will hurt Booth," and much more talk of the same char-
acter. The resemblance to Mr. Booth is an insane fancy.
This case suggests the necessity of taking this mat-
ter of discharging criminal lunatics out of the power of
the judiciary. It should be placed in the hands of those
who have given some personal attention and study to
insanity. Those who recognize the fact that insanity can
be concealed, and the further important fact that the
homicidal impulse may lie dormant for years, and then
manifest itself in its former fury. Hadfield, whose case
is quoted in every book on medical jurisprudence, who was
released by the eloquence of Erskine, from the responsi-
bility for his act of firing at George III., in- Drury
Lane Theatre, remained in the Bethelem Hospital for the
Insane for years before he showed any other homicidal
impulse, and then he made a murderous assault upon a
keeper for whom he had always manifested the greatest
regard. In Illinois, this important matter could with
safety be confided to the State Board of Public Charities.
[Note. — I am very much indebted to Dr. Jas. G. Kier-
nan for citations of authorities found in this paper.]
SELECTIONS.
CLINICAL PSYCHIATRY.
The " Phobias " and the " Schwixdels." — Erlen-
meyer in reviewing Benedict's article on Agoraphobia
in Erlefuneyers Practical Encyclopedia of the Medical
Sciences thus remarks : "The article by Benedict is
Avritten in 49 lines, in it not a single name of any author
is mentioned. The term Platzangst does not appear. He
gives no resume of literature of the subject Apnan, we
conclude that not a word has been published on this
subject and that there does not exist any other imagi-
nable explanation of this in treating symptoms than that
given by the author. It is not necessarj' that I should
inform the reader of the true state of the case.
"I find only the well known but unique view of
Benedict here reproduced and everything else written on
the subject is ignored.
"Agoraphobia, more properly Platzschzcitidel, is a special
form of Runischzi'indel and in contradistinction to HocJien-
schivindel (giddiness produced by height or depth) is a
feeling of giddiness produced by contemplation of horizontal
expanse. The disease consists in this, that the patients
wherever they go from a narrow space into a larger
one are ov^ercome with a feeling of dread which com-
mences with a disturbance of the general and muscular
sensation, and they have a feeling as if they must fall.
Platzschz^'indel is not a real phobia, /. e. — a dread called
forth by intense exhaustion representative — over-exhaus-
tion— but it belongs to the organic conditions of dread,
that are called forth by insufficient discharge of function
in the organs without consciousness of the fact. An
important etiological point in connection with Platzshn'in-
del is taenia, that ever living opprobrium of exact diagnosis.
The disease is undoubtedly dependent upon function.
The prognosis is generally favorable. The treatment is
to be especially directed to the etiological factor, and
before all things, the reaction and dependence upon taenia
is to be considered. The most important symptomatic
treatment is the galvanic. In a neuropathic patient I
have seen macrocephalus.
474 Selections.
"I do not know what the views of the editor are or
whether he will in a future number publish an article
entitled Platzangst, and I would also prima facie consider
such a division improper. But now, however, I would
recommend that the term Platzangst be used in order
that all the omissions and mistakes of this article on
agoraphobia may be discovered and remedied.
Eye Lesions of Progressive Paresis. — Charles Dutu-
gue [L'Encephale, January, 1883) claims that in the first
stage of general paralysis there is always irregularity of
the pupils, papillary congestion, retinal, arterial and varicose
dilation. In the second stage the lesions are more marked
with the addition of decided papillary and peripapillary
oedema. The disk is often obscured or masked by oedema,,
proportionate in extent to the duration of the disease. In
the last stage, the papilla is small, flat and gray in color ;
the vessels which normally give it a pink tint, having
disappeared from the optic atrophy. Atrophy of the
choroid, retinal hsemorrhages, and granulations of the retina
and choroid also occur. Duterque {Annales Medico Psy-
chologiqiies, September, 1882) makes almost identical claims.
These results are but an extension of those of Clifford
Albutt (^'Ophthalmoscope in Nervous Disease.y C. Albridge
[West Riding Asylum Reports, Volumes I. and II). Monti
{''De L' Ophthalmoscope dans les Maladies Mentales''), and
Spitzka {^Journal of Nervous and Mental Disease, 1877,
page 270) have, however, found cases in which eye lesions
are absent.
The Pulse Among the Insane. — Dr. F. M. Turnbull
{Boston Medical and Surgical fournal, May i8th, 1883)
after extended sphygmographic researches comes to the
following conclusions on this subject: (i.) That no typi-
cal tracing has yet been found in general paralysis, and
that the tracings called "maniacal" are inconstant in acute
mania. (2.) That the tracing of pyrexia, so called, may
be produced by other causes than fever. (3.) That oscil-
lation is at least a very inconstant element in the tracings
of cerebral or cerebro-spinal disorder, and that when
present it is probably due to muscular or tendinous tre-
mor when no cause can be found other than nervous or
mental. (4.) That the sphygmograph is of little or no
use as an aid to the differential diagnosis between the
types of insanity, and that its indications may be the
same in a temporary functional disturbancs of the circula-
Selections. 475
tion as they are in serious organic disease of the brain
and nervous system. Claus' results {Allgemcine Zeitschnff
fuer Psychiatne, Band xxxix., Heft 9) corroborate these
conclusions in a general way.
Insanity and Addison's Disease. — Dr. Jas. D. Munson
{Detroit Lancet, April, 1883) has reported three cases of
insanity co-existing with Addison's disease. In two cases
the relation he claims was etiological ; in the third coin-
cidental. The type presented was that of depression and
suspicion.
XEURO-THERAPY.
The Administration of Chloral. — At a meeting of
the Paris Societe de Chirurgie on October nth [L' Unio?i
Medicalc), M. Xicaise communicated a case of a patient
then under his care, in which chloral administered in
relatively small doses brought on xtry serious symptoms
which obliged him to suspend its use. The case was
that of a man, aged 2>7y the third toe of whose left foot
had been crushed. He continued to work during ten
days. On the tenth day, a surgeon, wishing to put the
wound in order, removed the nail of the crushed toe.
From that day the patient began to suffer ; and on the
14th September, fifteen days after the accident, tetanic
symptoms commenced by dysphagia, and went on to
trismus, stiffness of the muscles of the neck, and opis-
thotonos. On the 2 1st of September the patient came
into M Nicaise's wards. The wound of the toe was then
almost completely cicatrised and entirely free from pain,
which indicated the absence of any foreign body in the
tissues. Tetanus was very slightly marked, although there
was opisthotonos and trismus, allowing slight separation
of the jaws. From time to time, though rarely, general
shocks affected the whole body, accompanied by slight
pain in the region of the injured toe. During five days,
M. Nicaise submitted the patient to the use of vapor-
baths and of opium in large doses ; but seeing that the
tetanic symptoms did not improve, he prescribed four
grammes (a drachm) of chloral to be given in three doses
at intervals of two hours. As this dose produced no effect^
the next day the dose of chloral was raised to six grammes^
Symptoms of extreme excitement appeared, and were fol-
4/6 Selections.
lowed by almost complete resolution of the contracted
muscles. M. Nicaise then thought it right, on the following
days, to reduce the dose of chloral to four grammes. The
condition of the* patient remained the same during some
days ; then, on the 3rd October, there was an aggravation
following a chill, caused by the opening of a window near
the patients bed. The dose of chloral was then raised to
five grammes in a draught, besides two grammes as an
enema ; seven grammes being thus given during the day.
The enema having been expelled almost immediately
after its administration, there was really little or no
chloral absorbed by that method, and the entire amount
of the drug taken during the whole day may be esti-
mated at about five grammes. However, the patient
soon afterwards fell into a peculiar, comatose condition,
not answering to any questions addressed to him, and
having become insensible to any kind of stimulation.
M. Nicaise, attributing this condition to the action of the
chloral, immediately stopped its administration, and by
degrees the coma disappeared and the patient awoke.
The man completely recovered. M. Nicaise thought it
well to call attention to the effects of poisoning by
chloral, which showed themselves when that medicine had
been taken in a dose of only five grammes. He believes
that chloral should be given carefully, beginning by small
doses, and only increasing them progressively. The
action of chloral is of short duration ; but if the dose
be repeated, more than three or four grammes at a time
should not be given. — London Medical Record.
Capsicum Enemata in Opium Poisoning. — By Jas.
G. Kiernan, M. D., Chicago, 111. In the suggestion of
capsicum enemata I can claim originality, but not priority.
"Dr. Charles H. Hughes was the first to use capsi-
cum enemata in a case of opium poisoning. A patient
had taken opium with suicidal intent, and Dr. Hughes
being called in consultation by Drs. Rtiemer, Hypes and
others, after the usual routine remedies had been used,
ordered an enema of one drachm each of aqua ammonia
and tincture of capsicum, using coffee for a vehicle. The
patient rapidly rallied and recovered.
"During the year 1881, I was called to a case which
gave the fcillowing history : A patient suffering from the
insomnia of a prolonged debauch purchased two ounces
of laudanum, one of which he swallowed. Within half an
hour he sunk into a deep slumber. A ph\-sician was
Selections. 477
then called who evacuated the stomach by means of the
stomach-pump, relieving the patient of about half the lau-
danum taken.
This physician found that despite the use of strong
coffee and constant movement the patient did not improve.
Dr. J. S. Jewell was then called in consultation, who
advised the use of atropine. Under all these varied means
of treatment there were temporar}' rallies, but after six
hours of constant treatment the patient seemed to sink
into and remain in a ver\' deep coma. At this stage of
affairs I was called in consultation, and having some faith
in the old idea of a derivative action, ordered three
drachms of tincture of capsicum to be poured directly into
the rectum. The effect was almost magical. The patient
walked around rather briskly, talked freely, and in about
an hour was in his usual condition, other than being
much exhausted and complaining of great dryness of the
throat, obviously the result of the atropine.
In a second case a five year old child obtained
possession of a bottle of laudanum belonging to its
father who was a victim of gastric cancer, and in con-
sequence an op um habitue. From the bottle the child
drank approximatively about a teaspoonful. Atropine,
emetics, the stomach-pump and the galvanic battery
Avere tried with temporary success. But the influence of
the laudanum manifested itself in a gradually increasing
coma. Remembering my former experience I ordered an
equal quantity of tincture of capsicum to be poured into
the rectum. The result was a slower but equally perma-
nent success. The child for some time after suffered from
inflammation of the rectum, from which it made a slow
recover\% From the case narrated by Dr. Hughes, and
the two just cited, it would seem that this measure would
be at least a good addendum to other means of treat-
ment. Dr. Hughes claims to have had equally good
results from capsicum enemata in chloral poisoning.
Hvpodermic injections of str}'chnia being used in addition."'
—Med. Weekly.
Excitation of Vascular Nerve-Cexters by the sum-
mation of electrical stimuli. Kronecker and Xicolaids have
examined the influence of successive stimuli upon the
vaso-motor system, in order to see if the vascular ner\-e-
centers obey the laws which have been established in this
regard for the reflex movements of the limbs. They find
a general agreement. Single induction shocks applied to
47 8 Selections.
vaso-motor centers in the medulla or spinal cord have
no influence upon arterial pressure. Moderately strong:
stimuli first begin to act by summation when they follow
at no greater intervals than half a second. Increasing the
rate of stimulation increases the effect up to a rate of from
twenty to thirty per second ; increase of rate beyond this;
has no effect. Keeping the rate quite slow and constant,
but increasing the intensity of the stimuli, increases the
effect, but never so much as quickening the rate. The
maximum of blood pressure can be obtained either with
powerful shocks at 1-10-1-12" intervals, or moderately
powerful induction shocks at 1-20-1-25 " intervals. It takes,
longer to attain the maximum with slow, powerful stimuli^
than with weaker, but more rapid ; also with slow stimu-
lation the absolute number which must be given before the
maximum result is attained is greater. The conclusion is
therefore reached, that the cells of the vascular nerve -
centers agree essentially with the proper motor cells of the
spinal cord in having an adherent tendency (in the dog) to
vibrate at a rate of about twenty times a second — (/?«■
Bois Archiv. 1883.)
Hyoscyamia in Psychiatry. — Dr. T. Browne {British
]\Icdical Journal, November 25, 1882) finds that his obser-
vations show the uncertainty of hyosciamine when given
b)' the mouth, and the danger of large doses. Also the
marked superiority of the hypodermic method, and the
confidence with which, in some cases, its efforts could be
calculated on, and the dose increased or diminished in
accordance with the violence of the patient. Hyoscya-
mine is a drug which is often capable of controlling the
violence of a furious maniac, and checking the torrent of
rushing ideas on which he is borne along, soothing with-
out putting him to sleep, and differing in these respects
from morphia or chloral. In noisy and destructive paretics^,
the quiet air of comfort and repose following a moderate
dose was such a contrast with the previous condition, as
to strongly impress every one with the feeling that, by
the introduction of hyoscyamine, another valuable aid has-
been secured in the care and treatment of such cases.
No curative action can be claimed for the drug ; it only
moderates or checks for a time the violence, and, perhaps
renders less vivid and overwhelming the delusional whirl-
wind of the frantic patient. Richter [Ncurologische Cen-
tralblatt, July, 1882) in a general way confirms these results
of Browne.
Selections. 479
A Case of Poisoning by citrate of caffeine has just
been reported to the Medical Society of London. The
drug had been prescribed in drachm doses three times
a day for severe headache in a man under treatment for
debility. Bishop's effervescent preparation was intended,
but the pure drug was used. Fifty minutes after taking
one powder he complained of burning in the throat, and
giddiness ; there was vomiting and purging with pain in
the belly. He then became almost paralyzed, and was
affected with tremors, but his intellect was clear. Dr.
Routh found him an hour later collapsed ; pulse about
120. Ipecacuanha was given as an emetic, but failing to
act, some animal charcoal, with nitrite of amyl and
■ether were given. Vomiting subsequently took place, and
ammonia, alcohol and nitro glycerine were given. For
.■some hours he remained much depressed, and did not
rally completely till 1.30 a. m. next day, or nine hours
after taking the caffeine. Xitro-glycerine in one minim
doses was given every two hours, with digitalis, and in
about three days he recovered to his former state. —
Louisville Medical Nez^'s.
Diabetes Insipidus and Central Xerve Lesion. — Flat-
ten [Arc/i. f. Psych.) reports the case of a young man who
sustained a severe injury of the neck and occiput, left side,
causing temporary loss of consciousness, variable diplopia
and impaired hearing at the other side. Almost imme-
diately polydipsia and polyuria set in, and later, boils made
their appearance. When seen by Flatten, the patient had
paralysis of the left sixth and partial paralysis of the right.
Sounds were only conveyed by the solid parts of that
side. There was neither sugar nor albumen in the urine,
of which he passed twelve litres a day. Flatten diagnosed
a lesion directly under the left sixth, extending across and
involving the right. Iodide of potassium and mercurial
ointment relieved the polyuria. The demonstrated seat of
the initial lesion in this and other cases of traumatic dia-
betes, confirm the propriety of Althaus and others, galvan-
izing the occipital region. The successful result of occipital
galvanization too, in non-traumatic diabetes, are confirm-
ator}- of this conjectural pathology of diabetes.
Therapeutic Use of the Magnet. — Dr. D. L. Barra-
quer {Gaceta Medico Catalana, Aug. 15, 1882) reports
two cases in which marked relief followed the application
of the magnet. The first case was cerebral hemorrhacre
480 Selections.
with consecutive hemiplegia. The hemorrhage had
occurred three years previously. One application was
followed by visible improvement, and after four seances
the forearm and finger could be fully extended. The
second case was a boy suffering from deafness, due to
middle-ear disease secondary to measles. Galvanism had
been employed eight times with the effect of increasing
the hearing distance from o to i foot. The magnet was
tried, and, after a half hour's sitting, the hearing distance
was increased to three feet. At the fifth seance the watch
could be distinctly heard at a distance of fifteen feet.
Therapeutic Value of Nitro-Glycerine. — At a recent
seance of the Societe de Therapeutique, this subject came
under discussion. M. Huchard had experimented with a
one per cent, alcoholic solution, in the dose of from one
to six drops. After from four to six minutes there super-
vened cephalalgia, vertigo, a sensation of fullness in the
head, ringing in the ears, and amblyopia. At the same
time there was marked congestion of the face, acceleration
of the cardiac movements, with dicrotism of the pulse,
which became stronger and more rapid. * * * *
M. Huchard uses the following solution :
R. Sol. nitro-glycerine (i %), 30 drops.
Aquas destill. 300 grams.
M. Dose. A dessertspoonful three times a day.
In the discussion which followed M. Huchard's com-
munication, the general opinion of the Society seemed to
be against the medicament, as one of the great and dan-
gerous powers, whose therapeutic effects were not as yet
sufficiently investigated. — Brintoiis, Medical and Surgical
Reporter.
Silver in Lomotor Ataxia. — Dr. H. C. Tweedy,
Dublin, Ireland, {British Medical Jo2irnal, A^n\ 7th, 1883)
reports the case of a pensioner aged 64, who was admit-
ted into Steevens's Hospital in 1871. He was persistently
treated with silver nitrate in one-third-of-a-grain doses
three times daily, the use of the drug at intervals con-
tinued for nearly twelve years, during which time he was
again in hospital during the years 1873, 1876, and 1882.
The ataxic symptoms had completely disappeared, but the
silver having been taken, the patient had become argyrised,
Eulenburg, Mering, Senator and Schultz have also had
seemingly good results from silver nitrate and glycocholate
in locomotor ataxia.
Selections. 48 1
CoNiiN. — Dr. Fliess {Dubois-Reymond' s Archiv., 1882)
claims concerning this drug, that it paralyzes first the
peripheral ends of motor nerves ; later the center. It
excites the inhibitory apparatus. The convulsions seen
in warm-blooded animals do not appear in frogs, on
account of the paralysis of the motor nerves. The fre-
quency of the breathing is first increased and then
diminished- The pulse-rate after small doses is also
diminished. Coniin, conducted through the heart does
not affect the cardiac muscle.
Actual Cautery in Neuralgia. — Dr. A. C. Post
{Medical Record, November 11, 1882) has recently reported
a case of anterior crural neuralgia of three years standing
in a fifty-year-old man, in which the actual cauten,- was
applied along the course of the nerve, from the groin
nearly to the knee, and also upon the leg at a few points
where it was painful. Thorp's multiple cautery, having
six points, was used, and it was applied at eighteen dif-
ferent places, making in all, one hundred and eight minute
punctures. Eight days after the operation, relief was
complete.
Carbon Bisulphide in Neuralgia. — Dr. A. ]\I. Stout,
Sussex,. Wis. [Medical Nez^s, February 17th, 1883) finds
that the external application of carbon bisulphide is of
great value in neuralgia. It, however, fails at times and
stains the flesh more or less permanently. It at first causes
a marked tingling and even severe pain when applied
It is very probable that it acts on the counter-irritant rather
than the anaesthetic principle. Cautiously used it may have
good effect in intractable neuralgia. It causes death by
direct paralysis of the respiratory centers.
Amanila Muscaria in Negative Lypemania. — Dr.
Carlo Bareggi {Archivio per le Malattie Nercoso, F. IV., 1882)
p. 219) has been experimenting with this fungus in the
treatment of forms of insanity attended by negative de-
pression. His results were not at all decisive of anything.
The drug appeared to be allied to belladonna in some
respect, and from his description, might be of value in
acute mania, but was decidedly not indicated in the con-
ditions in which he gave it.
Nerve-stretching and Temperature. — Dr. Redard,
{Progres Medical, February 3rd, 1883) has shown by aid
of the thermo-electric calorimeter that stretching of a
.482 Selections.
sciatic nerve of one side lowers very markedly the temper-
ature of that side, and this usually lasts for months. The
unstretched side has its temperature lowered but very
slightly, and for a brief period, all of which tends to show
that the influence of nerve-stretching extends to the cen-
tral nervous system.
Gold Bromide in Epilepsy. — Gold Bromide has been
used in epilepsy during the past year by Dr. Bourneville
[Progres Medical, February 3d, 1883). He began with a
very feeble dose, one sixty-fourth of a grain, and increased
until the patient was taking one sixth of a grain a day.
The physiological effects of the drug were not observed
and the therapeutical effects were not at all marked, the
drug appearing to exercise a very minimal effect on
epilepsy.
Tonga, in Neuralgia of the Face. — Dr. T. H.
Streets, U. S N., (Proceedings of the Naval Medical
Society, Vol. i. No. 2, 1883) reports sixteen cases in
which tonga given in one drachm doses, at intervals of
two hours, exerted a markedly beneficial influence on
facial neuralgia.
Nicotine in Tetanus. — Erlenmeyer {Progr s M dical,
April 14, 1883) claims to have obtained good results from
the use of nicotine hypodermically in tetanus. The formula
used was: R. Nicotine gr. I-IO, aqua; dist. 3 ii; of
this one-fifth should be used at each injection.
Indian Hemp in Epilepsy. — F. D. Hayman {Lancet,
January 27, 1883) reports that he has had excellent re-
sults from the use of Indian hemp tincture in epilepsy.
The doses given were ten minims, gradually increased to
half a drachm.
The Cure of a case of " Rebellious Neuralgia " of the
median nerve by stretching is reported in the October
number of La Press Medical Beige, by M. Leon Le Fort.
CLINICAL NEUROLOGY.
Variola and Vaccination in Insanity. — Dr. Calastri
[Archivio Italiano per la Malattie Ncrvoso, 1873) reported
sixty-one cases of insanity attacked by variola of which
fourteen recovered from this psychosis ; eight improved ;
Selections. 483
twenty-eight were unaffected and eleven died of variola.
He suggested that in order to discover whether the bene-
ficial effect of variola was due to the disease itself, or to
the prolonged supuration, patients should be vaccinated
and the effect noted. Judging from other cases cited b\-
Sponholz, the febrile disturbance and not the prolonged
suppurations was the chief influence. Dr. Madigan [Gai/-
lard' s Medical Journal, February 24, 1883) has found that
the effects of vaccination on the insane were of four
kinds. In some cases it had a beneficial effect, in some a
disastrous effect ; in some cases serious complications
resulted, and in certain cases dermic phenomena of a
peculiar type occurred. A favorable influence was exerted
on, acute, atonic and agitated melancholia, progressive
paresis, primary monomania, secondary monomania, and
chronic mania with incoherence. In all cases where such
influence was exerted, high temperature and a pretty
general eruption resembling variola occurred. The pro-
gressive paretics were seemingly improved by the boils,
which resulted after vaccination. The primary monomaniacs
and chronic maniacs with incoherence, improved during
the vaccinal fever. Three cases of melancholia recovered
after the vaccination, the recovery commencing during the
vaccinal fever. It would seem, therefore, from ^Nladigan's
results, that both the prolonged suppuration and the febrile
disturbance played a part in the production of improve-
ment.
Localized Cortical Atrophy, Secondary to an Extrem-
ity Amputation. — Bourdon [Progres Medical, May, 19.
1883) reports the case of a seventy -three- year-old man
•who had been subjected, at the age of thirty-three, to a
disarticulation of the left arm. The man died at the age
mentioned, in thirty-six hours, from meningo-encephalitis.
Until then he had not had any cerebral affection, but his
left leg became progressively paretic. There was found
on autopsy in the right cerebral hemisphere, a notable
effacement of the superior part of the ascending frontal
convolution. The same effacement was noticeable on the
paracentral lobule and crest of the hemisphere. The
lateral ventricle of the same side was much increased in
size, above all, about the affected convolution which de-
noted an extended atrophy of the subjacent white sub-
stance. The neighboring corpus striatum presented a de-
pression in the center, and the optic thalamus was slightly
flattened in a vertical direction. Sections of the pons
484 Selections.
and medulla showed a deviation to the right, and that
the nerve substance of this side was much atrophied.
The right hemisphere weighed an ounce more than the
left. This, with six other cases collected by Dr. Bour-
don, seems to show that amputation is followed by func-
tional inactivity and secondary atrophy of the superior part
of the motor zone of the cerebral cortex. The present
case seems to show, in addition, that this atrophy may
extend to the central parts of the brain and to the me-
dulla. The paresis of the leg was a result of the exten-
sion of the atrophy, in Dr. Bourdon's opinion.
Transient Albuminuria as it Occurs, Particularly
IN Children and Adolescents, in Apparent Health —
The occurrence of transient albuminuria is a subject
which has often claimed the attention of observers and
pathologists and is one of much importance. Cases are re-
ported by many observers and different theories have
been advanced to account for this phenomenon.
One considers it due to changes in the walls of the
vessels, another maintains that it is the function of
albumen to nourish the epithelium and when the vessels
are denuded of their epithelial coat, their supply of albumen
appears in the urine. A third theory is that the epithe-
lium when present prevents filtration, when absent the
albumen is allowed to pass through.
Still another theory accounts for it by attributing
it to vaso-motor disturbance of the kidney, producing
slowing of the blood current in the glomeruli. But
what is the cause of the vaso-motor disturbance.
From a careful analysis of my own and other cases,
I am led to believe this cause to consist in the presence
in the blood of unoxidized-nitrogenous matter, in other
words, temporary oxaluria or litha^mia.
A similar albuminuria follows epileptic attacks and
exophthalmic goitre. It is more frequent in children and
adolescents on account of their greater mobility and
susceptibility. It is often observed in active brain
workers — N. V. Acad, of Science, Dec. 15th, 1882.
A New Trophoneurosis of The Skin in Tabetics
— Dr. D. Ballet and T>n^\\ {Frogres Midical, May 19, 1883)
come to the following conclusions respecting trophic der-
mic changes. First : There are to be noticed trophic
dermic changes of a permanent nature among tabetics.
Second : These differ in their appearance and their cvolu-
Selections. 485
tions from an}' hitherto described. The cutaneous erup-
tions (herpes, etc.), the ecchymoses and the pedal perfo-
rating ulcer itself are but expressions of temporary fleet-
ing conditions. The ichthyoid condition of the skin is
on the other hand a dystrophy of slow evolution and of
progressive nature which belongs to the same category as
the osseous changes. Third : This dystrophy finds expres-
sion in a sort of thickening of the skin with more or less
marked discoloration, laxity of the tegumentary portion,
desquamation of the epithelium, the remains of which col-
lect in the form of scales. Fourth : The points of the
body where this trophic change is most noticeable are
those where ana:jsthesias or hypera^sthesias or sensations
of cold, etc., have been noticed. The extremities,
particularly the arms, seem to be most frequently attacked ;
the back of the hand takes on, at times, a pellagroid
appearance. Fifth : The fall of the nails and the other
changes to which attention has been called by Joffroy,
Pitres, Roques, Dorneaux, Turon, seem to be an expres-
sion of this dystrophy.
Sexual Perversion. — Drs. J. C. Shaw and G. X. Ferris
(Journal of Nervous and JMcntal Disease, April, 1883) state
that they have been unable to find any case of this kind
reported in American literature. It is obvious, however,
that their search cannot have been very extensive, for a
correspondent of the Medical Record, March 19, 1S81,
described a typical case of this kind. Dr. E. C. Spitzka,
{^Chicago Medical Reviezv, Volume IV., page 378) also
reported a case, as also did Dr. G. Alder Blumer [Ameri-
can Journal of Insanity, July, 1882) and Dr. P. M. Wise
(Alienist and Neurologist, January, 1S83.) The case
reported by Dr. Shaw is as follows : The patient, a man
aged thirty-five, felt a constant desire to embrace men, and
when in the presence of men is sexually excited. Natural
sexual intercourse is repugnant. No details of family
history or physical appearance of value are given.
Arthrop.athies in Progressive Paresis. — Charcot
{Archives de Physiologic, Tome I) called attention to
the existence of arthropathies of trqphic origin in cerebral
disease. Kiernan [Journal of Nervous and Mental Dis-
ease, April, 187S) reported fifteen cases of progressive
paresis in which arthoropathies of the nature o{ those
observed by Ball and J. K. Mitchell were found. Nine
of these were cases of locomotor ataxia, terminatinsr in
4^6 Selections.
paresis. Dr. J. C. Shaw, {Archives of Medicifie, April,
1883) reports three cases of progressive paresis where
arthropathies were found. One of these was a case of
locomotor ataxia terminating in progressive paresis. The
femur was involved in one case ; the fingers in another, and
the lower jaw in the third.
ANATOMY AND PHYSIOLOGY.
Cerebral Color Center — Samelsohn {Centralblatt fuer
die vied. IViss. p. 581, 1882, says that the existence of a cere-
bral color center turns upon the question whether there are
cases of double-sided hemianopsia, in whom the sense for
space and light is perfectly intact, while on the respective
half-fields of vision the color sense is totally extinguished,
Steffen {Grcefe' s Archiv, Band xxvii.. Heft I, p. 6,) has found
such a case, and says one similar case is a clear proof that
in the brain, the space center and the color center are
divided and there is a special center for each of these senses.
Samelsohn had a case exactly like Steffen's where, in conse-
quence of an apopletic seizure, the sense of space and light
was perfectly intact, but where the color sense was utterly ex-
tinguished. He would have published this case before Stef-
fen's article only he had hoped to supplement it by a post-
mortem. Under treatment absorption was established, all
the symptoms disappeared, and then a second seizure due to
an enormous effusion, rapidly resulted in death ; leaving the
brain in a condition in which finding this center was out of
the question. Bjernum [Hospitals Tidaide, January 18,
1882) reports an additional case in which the patient had
total color-blindness in the left half of the field. The
margin passed precisely through point of fixation, in a ver-
tical direction. There was an acute brain trouble ; at least,
the patient complained of a severe headache, and died sud-
denly. There was no autopsy. Brill [Journal of Neurology
a7id Psychiatry, 1882, p. 366), reports a case, supplemented
by an autopsy, from which he concludes that the apprecia-
tion of color in the intellectual sphere is partly located in
the calcarine fissure and its neighborhood. Brill cites a case
reported hy Boys de Lotay of fracture of the base of the skull
resulting in subsequent hemianopsia and loss of color sense ;
also a case by Cohen in which cerebral concussion resulted
in a loss of color sense and limitation of the visual field and
a case of Forster of a syphilitic patient with hemianopsia
Selections. 487
accompanied by slight cerebral symptoms, from which he
recovered with a limitation of the perception of red in the
previously hemianopic field. S c)\nQ\\e:r {Graefe' s Archiv, Band
xxviii., Heft 8) from a like case to that reported by Brill
which was supplemented by an autopsy, comes to very
similar conclusions.
The Optic Nerve. — Ganser after a series of experiments
on c2X?,{Archiv fuer Fsych.,^di. xiii., p. 341), comes to the
conclusions that the non-decussating fibres of the optic
tract form a distinct bundle, which runs along the lateral
border of the optic chiasma and nen,-e. In confirmation of
this view, he cites the case of an epileptic, in whose bram a
thin band of fibres was seen to separate itself from the
right optic tract a little in front of the corpora geniculata,
pass forward on the ventral surface of the tract to the lateral
border of the chiasma and afterwards become incorpor-
ated with the ner\'e. This is in direct opposition to Kel-
lerman's view which denies that fasciculus lateralis exists,
and asserts that all fibres intermingle in the chiasma.
Ganser analyses Kellerman's case and declares it unsatis-
factory and indecisive. The non-decussating fibres are
distributed to the temporal half of the retina, the decus-
sating to the nasal half and to parts of the. temporal half.
The area centralis seems to be supplied by both kinds of
fibres. After destruction of the decussating fibres of the
optic chiasma, there is atrophy of the nerve-fibre layer, and
of the ganglion-cell layer in the nasal portion of each re-
tina. Removal of the posterior parts of the left cerebral
hemispheres of new-born cats caused homonymous right
hemianopsia. When the animals being killed nine months
afterw^ards, there was atrophy of the left optic tracts
less extensive in the left optic nerve than in the right.
The decussating fibres are evidently developed more largely
than the non-decussating. The nerve-fibre layers were
thinner on the left side of each retina ; there was a homony-
mous left-side atrophy of the layers. Ganser concludes
with some observations on the anatomy of the corpus bige-
minum anterius.
Structure of the Spinal Cord. — Dr. Laura [ArcJiives
Italiettnes de Biologie, tome i, fasc. 2, April, 1882) observes
that the acquisition of the medullar}- sheath is the distinc-
tive character of all processes from nerve-cells that become
nerves. He has endeavored to trace these processes or
nerve-fibres from their cells to their ultimate distribution.
488 Selections.
more particularly with reference to the cells of the anterior
cornua, of the Stilling's nucleus, of Clark's posterior col-
umn, and of the posterior cornua. He concludes that
I. The cells of the anterior cornua send their nerve-pro-
cesses, in the greater number of instances, into the anterior
nerve-roots. 2. Fibres from different points of both of the
anterior and posterior cornua contribute to the formation
of the anterior commissure. 3. The cells of the nucleus
of Stilling (posterior column of Clarke) supply nervous
prologations which pass at first inwards, then after a long
course in the same direction fold backwards, and go to
form a large bundle passing into the lateral column. 4.
The lateral column receives fibres from different points of
both anterior and posterior cornus. 5. The cells of the
posterior cornua furnish processes which pass in various di-
rections : a. into the anterior commissure ; b. directly to
the anterior roots ; c, into the lateral columns ; d, into the
posterior columns ; e, across the middle line behind the
central cana! into the opposite cornu. 6. Cells are found
in the cord which send nerve-processes in opposite direc-
tions, and act intermediately in the change of direction of
the fibres.
Action of the Vagus. — Dr. Rosenthal {^Ccfitralblatt
flier die medizinischen Wissenschafteii, No. 22, 1882)
concludes that, First : There are in the vagus certain
fibres probably pulmonary, the stimulation of which acts
on the respiratory center to cause more frequent and
weaker respirations or, with a stronger stimulation, com-
plete cessation of respiration in moderate inspiration.
These he terms "regulating fibres." Second : The superior
laryngeal nerve contains fibres, the stimulation of which
cause? less frequent and deeper respirations or with a
stronger stimulation entirely checks them. These he calls
"inhibitory nerves" of the respiratory center, analogous to
the inhibitory nerves of the heart. Third: The infe-
rior laryngeal nerve contains fibres, the stimulation of
which also arrests respiration m the stage of expiration ;
but which cannot be the same as the last mentioned,
their action ceases when the stimulation is very strong
when the animal is narcotized, and when the cerebrum is
removed. They probably act like other sensory nerves, only
indirectly on the respiratory centers. Fourth : Chloral
hydrate in large doses completely destroys the action of
the regulatory fibres, but leaves the inhibitory fibres
unaffected.
Selections. 489
External Acoustic Nucleus and Restiform Body. —
Monakow {Neurologisches Centralblatt, No 21, 1S82,)
divided the left half of the spinal cord immediately below
the decussation of the pyramids in a rabbit on the day of
its birth. Six months afterwards the brain was examined,
and the following changes found ; atrophy of left lateral
columns of the medulla ; partial atrophy of the left formatio
reticularis ; atrophy of the lateral cerebellar tract ; atrophy
of left funiculus cuneatus and its nucleus; atrophy of the
external acoustic nucleus ; partial atrophy of the left corpus
restiforme (inner side) ; partial atrophy of cortex of upper
vermiform process. No change in the auditory roots, as-
cending trigeminus root, or inner part of cerebellar peduncle.
Hence the author concludes that the external acoustic
nucleus is in relation with spinal fibres, and not with the
auditory nerve nor the cerebral peduncle : that the funiculus
cuneatus passes partially through the corpus restiforme ;
that the lateral cerebellar columns terminate in the superior
vermiform process.
Nerve-exdixgs in the Epidermis. — That all the cutan-
eous nerves do not stop at the epidermis has long been well
known. It was first demonstrated that in the lower animals
many nervous filaments penetrated the epidermis, where
they terminate in club-shaped extremities. The same was
afterward shown to be the case in man. Pfitzner describes
(" Morphoi, Jahrb.," Bd. vii, p. 726) ner\'es in the epidermis
of the larvae of the frog and salamander, at a certain period
of development, that terminated after penetrating the cell-
wall of each prickle cell, with small bulbous extremities near
the nucleus. Every cell contained two terminal filaments.
He found the same to exist in the epidermis of the human
subject. Unna has recently (" Monatsch, f. prakt. Der-
matol.,"' Oct., 1882) corroborated Pfitzner s results. A
striking feature is the invariable association in every cell of
pairs of the terminal bulbs. They do not appear to be
branches of one twig, but usually approach the cell from
different directions.
Electro-physiology of Human Nerves. — Drs. D. VVatte-
\'<&&2Si6.\^2X\&x {British Medical Journal, August 12, 18S2)
come to the following conclusions on this subject, i.
There is increased excitability in the portion of the ner\-e
submitted to cathodic influence, diminished excitability in
that submitted to anodic influence. 2. With sufficient
strength of polarizing current, the catelectrotonic region
490 Selections.
appears to invade the anelectrotonic region. 3. On
opening the polarizing current the diminished excitabiUty
of the anodic region passes at once into a state of aug-
mented excitabiUty. The augmented excitabiUty in the
cathodic region makes way to a weU-marked diminution,
graduaUy followed by a protracted increase of excitability.
Rapidity of Nerve Force. — Rene [Gazette des Hopitaux
No. 46, 1882) has found the rates of the transmission of
nerve-force, in man, as a mean, to be twenty metres per
second. The rapidity of nerve-force in nerves, either sen-
sory or motor, exhibits considerable difference, according to
the individual, the procedure, the region excited, or even in
the same individual. The rate of transmission increases
with the intensity of the excitation, especially in sensory
nerves. In motor nerves, when the excitation becomes
strong, the rapidity diminishes. In locomotor ataxia there
is a considerable retardation in the transmission of nerve-
force. In the beginning of progressive paresis the rate is
more rapid than normal.
On the Reflexes in Childhood. — Eulenburg [Ne^trolo-
gisches Centralblatt, May, 1882) has been studying the re-
flexes among 124 children. He has found the knee-jerk
wanting, m seven cases on both sides and in three cases on
one side only. Eulenburg claims that the frequent absence
of tendinous opposed to the constancy of mucous and cu-
taneous reflexes is not exactly an argument in favor of the
reflex nature of the former.
EDITORIAL.
Apropos of recent Insane Asylum Investi-
gations, it is strange that more credence should be
attached by courts to the testimony of outsiders respect-
ing the sanity of persons whom the latter have but
casually seen since their commitment to the asylum,
than to the opinions of disinterested asylum physicians,
who are only interested in depleting rather than in over-
filling their already overcrowded wards.
It is strange that the pubHc will insist on cheap
management of these charities with consequent underpaid
and numerically insufficient attendants, and then complain
of the dear bought experience in brutality displayed by
cheap nurses and through inadequate surveillance. The
surest safeguard against brutality to the insane in public
asylums is in the qualities of head and heart possessed by
the attendants ; but educated and refined men and women,
with tender hearts and the power over self that comes of
good training, are not always among those who take service
in asylums at from fourteen to twenty-five dollars per month.
It is strange also that there are any asylum super-
intendents who will entrust to nurses discretion in the
administration of narcotics or baths for therapeutic pur-
poses. Every patient in an asylum for the insane who
receives a bath, hot or cold, electrical or medicated, should
be passed upon by a medical officer on the day the bath
is to be given.
The practice of ducking a patient for purpose of
punishment is never justifiable, and if ever thought proper
as a calmative of excitement, it should never be relegated
to any other person than a medical officer willing to take
responsibility for consequences.
There is a great deal of human nature in attendants
upon the insane and the most successful superintendent in
securing kind treatment of his patients by them, is he who
is most suspicious and vigilant.
The more ignorant an attendant is, the more self-con-
ceited and opinionated he is likely to be, as regards what
is best for controlling the mental excitement and actions
of the insane.
492 Editorial.
There are also paroxysms of insane violence in action
to suppress which, in many cases, were cruelty to the patients
and detrimental. The motor excitation may be only a
normal expression and often is, of morbid intellection, the
indulgence of which to satiety brings a sense of mental
relief and rest along with the normal fatigue of satisfied
physical action, and long needed sleep to the irritated
brain sometimes comes in this way, better than through
narcotics.
It seems also most strange, that Governors or Boards
of Managers will appoint, and statutes make the appoint-
ment valid, of medical men to " skillfully " care for our
wives, parents, children and friends, who have neither
experience nor capacity to properly treat the insane and
then hold them responsible for capacity (not exacted) in
the management of the most exalted and sacred charge
ever entrusted to the care of a physician.
The majority of our asylums for the insane have at the
present time excellent medical heads, but this is owing to
the fact that the institutions have either learned by
experience that every physician without discrimination can
not manage and treat the insane properly, or because in
many localities the members of the profession are too
honest to undertake such a charge without special qualifi-
•cation. Still there yet remain too many asylum manage-
ments that look upon the proper care of the insane as
within the skill of almost any ordinary physician. A
greater mistake could not and can not be made (so long as
reputable medical schools continue to graduate physicians
as all the schools of the past generation did, without
teaching them anything of psychiatry), than to take physi-
cians indiscriminately from the ranks of the profession
and place them in charge of Insane Hospitals.
As Others See Us. — The Alh^inist and Nkurologist for Janu-
ary, 18S3, contains a brief but adequate remme of our knowledge concerning
MyxoKlenia, translated from tlie Italian of Dr. Seppilli by Dr. Workman
of Toronto. This is followed by an interestinj;- record of the cure of a case
of the opium habit, presented in the letters of the patient. The treatment
was carried out by the piitient liimselfat a distance of several hundred
miles from iiis physician ; and with a courageous and manly persistence
wliich are nowhere common, but whicli are very rare indeed among the
devotees of opium and alcohol. Dr. Albert Blodgett has a dolorous article
in wliich he shows that nearly every circumstance of our advancing civili-
zation tendd ever more and more to deteriorate the race of man into a race
of neurotics, lunatics and drunkards. These cheering reasonings are pur-
Bued to their logical result,— the necessity of providing more asylums, and
Editorial. 493
•enacting more riarorous laws in order to fill them. To this desirable
arrangement there is one objection which appears to us fatal, If "every
potential homicide and suicide" is to be locked up, who is to be left outside
to turn the key ? Would not Dr. Blodgett find it rather lonely ? Or does
he mean to come inside with the rest of us, and send for the inhabitant of
some other planet to lock U8 in? Dr. Pliny Earle contributes another of
his dispiriting articles on the curability of insanity, which are all the less
welcome since we can find no flaw in his reasonings, and are compelled
nolens voUns to accept his conclusions. He shows unanswerably that the
percentage of cures of insanity has been factitiously raised by the inclusion
of many cases which have returned again and again to asylums, and on
each fresh discharge have been recorded as cured. When every allowance
and deduction has been made, however, he still admits an average of more
han twenty per cent., which is. after all. not so very discouraging. It
should here be stated that the statistical tables of English asylums will in
future distinguish between the number of recovered eases and the number
of recovered ;3eraorw, and also, as far as possible, between reooverit-s from a
first attack and from a subsequent attack. The recortls of cases by Dr.
Mickle and Dr. Wise are of interest, as are the articles of Dr. Hughes on
Cephalic and Spinal Electrizations, and of Dr. Danillo (St. Petersburg) on
Female Diseases among the Insane.
The Alienist axd Xecrologist. October, 1S82. The number of
this quarterly journal now under notice sustains the high character of the
previous issues. The first article is another of those accounts, of which so
many have been published lately by American physicians, of the nature
and working of the lunacy laws, and the methods of treating the insane,
estiiblished in this country. The second article is an account of a very
interesting case of so-cUled '"moral insanity,'' related by the mother of the
patient. It appears transparently evident from the account given, that the
intellect of this patient was greatly disordered, and the term "moral
insanity," is therefore more thau usually inapplicable. Apart, however,
from hypothesis, the facts of the case are very valuable. Reports of several
other ca*es follow, the editor observing what appears a somewhat incou-
venient practice of interspersing reports of cases among the original
articles. The most important of the cases is that of an experimental trial
by Dr. H. A. Hutchinson of the effect of a quarter of a grain of hyoscya-
mine on himself. Briefly put. the effect was to throw Dr. Hutchinson into
a state of profound coma, lasting eleven hours, to the great danger of his
life. Such an experience is certainly unusual, but it renders necessary the
greatest caution in beginning the administration of this powerful drug,
since it is impossible to tell beforehand liow far a particular individual may
be specially obnoxious to its effects. The preparations of the drug appear
to differ more in strength than, considering its enormous price, might be
reasonably expected. 'I'wo articles upon Guiteau show that that well-
worn subject is not yet exhausted, bat they indicate by their dignified,
calm, and dispassionate tone that the violent and unseemingly feelings that
raged round the miserable being while he lived, are at length giving way
to a more philosophic temper. "Katatonia" — which is the name given by
Kahlbaum to a rather vaguelv cliaracteri/.ed form of insanitv — forms the
494 Editorial.
subject of a long article by Dr. James Kiernaii, and is followed by a very
full and detailed report of the annual meeting of the Association of Medi-
cal Superintendents of American Asylums. The book concludes wilh an
excellent resume of the additions to our knowledge during the preceding
quarter. We beg to aeknowlenge very cordially tlie courteous terms in
which this journal is referred to by the Alienist and Neurologist —
London Medical Times and Gazette. Janua?y, 188S.
Cortical Sensory Discharging Lesions. — Sen-
sory Epilepsy is a term proposed by McLane Hamil-
ton in a late article in the New York Medical Journal, for
those epileptoid displays obviously beginning in the sensory
region of the cortex, as attested by the precursory pheno-
mena, and terminating short of the convulsive movements
of le grande mal.
The term is a good one for differentiation since the
morbid condition described has a real existence and is
undoubtedly a degree or form of epilepsy.
He takes issue with Hammond who holds {Archives of
Medicine. August, 1880, art. "Thalmic Epilepsy") that
the sensory disturbance is due to a lesion ipi the thalamus
opticus, believing that the origin of the disease is in the
cortex cerebri.
The paper will be read by all interested in the protean
phases of epileptic display. The psycho-sensory and the
psycho-motor epilepsia and the pure psychical forms are
no less interesting than those described by the author.
That epilepsia has its starting point in different portions
of the cortex is manifest in the initial aurse which Dr.
Hamilton discusses so well in this interesting brochure.
The precursory shriek so often heard, is doubtless a reflex
response to painful sensory impression, obliterated in the
immediately sequent unconsciousness of the grande mal ;
the automatic act of tasting which often precedes the
immediately following unconsciousness, is likewise, probably
a sensory impression, just as the starting off on a run,
points to the motor regions of the cortex, in certain cases,
and these forms are sometimes observable without uncon-
sciousness, as the visual, aural and tactile hallucinations are.
They are all initial auree and the morbid action sometimes
may and does go no further.
"3Iany are Called but few are Cliosen" grimly
said an eminent Dean of a Medical College as he pro-
ceeded to award, in the name of the faculty, the diplomas
of an old and well-known medical school, to the dimin-
ished number of graduates under the new system of graded-
Editorial. 495
three year-obligatory study in lieu of the usual larger
number which, in former years annually went out from its
halls authorized to practice medicine.
It will be a happy day for legitimate medicine in this
country when fewer are even called as well as chosen, of
the kind that make up the average physician of the day.
To gain that standing to which the science and art of medi-
cine are entitled, there will have to be less of mediocrity
»and more of special fitness for the practice of the profession.
The enormous annual swarm of barely-viable medical
embryos prematurely born, had better be aborted at
matriculation, before the ambitious conception of a future
career in physic has taken definite form, than in the green
room, when hopes are maturing only to be blasted.
The career of a physician is one of great mental labor
requiring strength of mind and talent for high success.
The mediocre thousands who annually recruit our ranks
dilute and lessen the rewards of the meritorious few, and
have a tendency to deter the greatly capacitated, of dis-
criminating judgment, from entering upon a career in which
great fortune and fame so rarely reward the persistent
efforts of the ambitious and deserving, as in the over-
crowded ranks of medicine.
Colleges that nip unfounded medical aspirations in the
bud should be encouraged for the good they are doing
to the profession at large and to the young aspirant who
goes into medicine bUndly.
Personal Liiberty and Jury Trials for Insanity.
As a means of preserving certain supposititious rights of
the insane, the jury trial system of commitments to
asylums has been loudly applauded and has been held up
to reverence as a sure means of preventing infringements on
personal liberty. This at best is but a very weak argument
for a system which makes private misfortune the sport of
a scandal-loving public, but even this justification of a
bad system is wanting, for it furnishes the most potent
means of infringing on personal liberty since it puts practically
unlimited power into the hands of unscrupulous politicians,
as witness a case which recently occurred in Chicago :
The bailiff in charge had been persuading the Judge for
several days to allow him to impanel a jury and take them
to the house of the defendant, and he finally consented,
so when the jury returned all they had to do was to go
through the form of hearing the evidence — there were
only two witnesses — and make up their verdict. In this
49^ Editorial.
there was nothing but a seeming evidence of commend-
able humanity on the part of the baihff but he, instead of
going out and selecting a jury from the body of the people,
as the law requires, simply stepped down to the sheriffs
office and picked up his men, for the jury was composed
of two of the sheriff's custodians, one of his clerks, one
of the janitors of the building, and one county employe,
and the other juror had been summoned at his own solici-
tation. The fanatical reformers of Illinois have, it is
obvious, accomplished their object of preventing the
medical profession from committing lunatics by giving
third rate venal politicians full power to pronounce any
one insane at their own sweet will.
Simulation of Insanity.— The case of Michael
Trimbar. — Trimbar was with two or three other young men
convicted in one of the Philadelphia courts of a heinous
outrage on a young woman, and committed for fifteen
years to a peniteniary which was crowded, rendering it
necessary to put him and one of his associates in crime in
the same cell. Up to the last these two were apparently
on good terms with each other. March 7th, 1872, Trimbar
killed Webb, his room-mate, and assigned as a reason that
he abused his mother, but that they had had no quarrel.
He thereafter pretended ignorance of the sun and was
noisy during the night, which noise ceased on being
deprived of privileges. Dr. Ray detected a wild incoher-
ence of a clearly insane character.
He found that Trimbar's mother had noticed evidences
of insanity long before the murder, and had so stated to
the jail officials. Trimbar became at length so demonstrably
insane, that a trial was an absurdity. Dr. Ray concludes
that Trimbar at the time of the homicide was really insane.
Second : That apprehending the consequences of the act
he concluded to simulate the disease of which he was the
unconscious subject. Third : Finding it produced no
impression, or that his powers of deception were unequal
to the task, he abandoned the attempt after one or two
trials.
Hypnotism. — Dr. D. H. Tuke {Jo7<nial of Me7ital
Science, April, 1883) comes to the following conclusions
respecting hypnotism. First : There may be conscious-
ness during the state of hypnotism and it may pass slowly
or completely into complete unconsciousness ; the mani-
festations not being dependent upon the presence or
Editorial. 497
absence of consciousness which is merely an epiphenome-
non. Second : Voluntary control over the thoughts and
actions is suspended. Third : The reflex action therefore
of the cerebral cortex to suggestions from without, so long
as any channel of communication is open, comes into
play. Foiirth : When consciousness is retained, the pre-
ception of this reflex or automatic cerebral action conveys
the impression that there are two egos. Fiftli : Some of
the mental manifestations as memory, may be exalted,
and there may be very vivid hallucinations and delusions.
Sixth : Unconscious reflex mimicr)- may be the only
mental phenomenon present, the subject copying minutely
everything said or done by the person with whom he is
en rapport. Seventh : Impressions from without may be
blocked at different points of the encephalon according to
the areas affected, and the completeness with which they
are hypnotised ; thus an impression or suggestion whether
by gesture or word or muscular stimules may take the
round of the basal ganglia, or may pass to the cortex,
and having reached the cortex may excite edeation and
reflex muscular action with or without consciousness, and
wholly independent of the will. Eighth : There may be
in different states of hypnotism exaltation or depression
of sensation and the special senses.
Guiteaii Mania.— Some time ago, the British Med-
ical Journal having reached, by some method peculiar to
itself, the conclusion that Guiteau was a sane man, and
expressed itself on the subject to its entire satisfaction,
attempted to forestall further discussion of Guiteau by
applying the term " Guiteau Mania " to the disposition
it had discovered among medical men to be unsatisfied
with its singular psychiatric dicta and to take an opposite
view of the executed lunatic's mental status. Its attempt
at scientific intimidation has not deterred seekers after
truth from analyzing the psychical character of the late
lunatic, and reaching such conclusions as the facts war-
rant, nor has it obscured the editor's lack of real psy-
chiatric experience, so plainly apparent to the discerning,
in the peculiar propositions which the aforesaid journal
propounded at the time, as tests of sanity.
The B. M.J. will doubtless be pained to see this deplor-
able form of mania increasing, since Guiteau paid the forfeit
demanded by the maddened populace, notwithstanding its
lucid criteria of sanity, and timely efforts to restrain the
Guiteau maniacs ( ! ) from displaying their singular mania ( ! )
498 Editorial.
for finding insanity of speech and conduct in a case which
the B. M.J., the courts and the populace have disposed off
in a manner so satisfactory, summary and final.
Other Channels of Audition.— Dr. James C. L.
Carson, in the British Medical Journal for May, referring
to the case of a patient who was so thoroughly deaf that
he could not hear any spoken sound whatever or the
firing of a cannon coming to his ears though the ear
could hear the sound of a mouse running on the floor,
suggests the explanation that the nervous of hearing was
double, being adapted for hearing through the air and
body both, Drs. Abercrombie, Ahson and Bell saw this
case and thought it unique. Dr. Carson found nothing
wrong with the ears. The peculiar impressibilities to con-
tain sounds in deaf persons, deserve further investigation.
Besides, those deaf persons, who can hear conversation
when a great noise is made about them, there are many
who can hear special sounds. A patient was under our
care for incomplete hemiplegia and the phenomena of
Bell's paralysis on the left side, with total deafness to
communicated sounds, can detect the sounds of muscular
contractions made by the muscles of the face and arm
and can hear a sound plainly when an eight cell-current
goes through the ear. A twelve to eighteen cell-current
she describes as awful. Certain deaf persons do actually
" feel sound " (as they express themselves) by vibration,
though other channels of nerve communication than the
auditory nerve mechanism proper. That enterprising med-
ical weekly, the Medical Surgical Reporter, of Philadelphia,
edited by Dr. Brinton, has thought proper to reproduce
in its pages the case of Horshaw, detailed by Dr. Carson,
and this will serve to keep attention to this important subject.
The London Medical Times and Gazette
indicates its appreciation of neurological literature as an
essential part of general medical knowledge and places
us under renewed obligations by the favorable opinion
it continues to hold and express of the contents and
work of this Journal.
Our readers who are not already subscribers to this
live English medical weekly will find it a valuable addi-
tion to their libraries. Dr. Wm. Julius Mickle whose
valuable contributions to cerebro-neural pathology are
familiar to the readers of the Alienist and Neurolo-
gist, is a frequent contributor to the Times and Gazette.
Editorial. 499
The original clinical department is always interesting,
some of the best medical men of "The mother country"
being familiar contributors to the Times and Gazette.
Our English readers in the Canadas and other
provinces as well as in the islands of Great Britain
will find the editorial and news departments of the Times
of special interest to them. But we presume but few Eng-
lishmen in the profession need be reminded of this, for they
probably all take the Times and Gazette.
Trephining in a Syphilitic. — Perrin {Progrks Medi-
cal, June 16, 1883,) reports the case of a syphilitic who had
a syphilitic exostosis, and who in 1878 manifested hesitancy
m speech and right heraiparesis. In 1854 he had been shot
in the head, from which time dated an irregular, but obsti-
nate headache. In 1865 he contracted syphilis, was treated
for this, but the headache persisted. In 1869 Nelaton remov-
ed five sequestra from the center of the frontal bone in which
a fistula had persisted since the wound of 1854 to 1870. Dur-
ing the siege of Paris the headache grew worse, but improved
little by little under antiluetic treatment. In 1878 his char-
acter changed ; he became bad tempered, suspicious and ver}'
excitable. His memory was irregular and the articulation
difficult. At this time he came under Dr. Perrin's observa-
tion, who recognized in the center of the forehead a thick-
ened spot with a minute aperture. Mercurial and potas-
sium iodide frictions were without effect. The patient was
trephined at this point, without affecting the dura-mater, and
a piece of bone, a centimetre in thickness, removed. The
most marked symptoms were relieved at the end of a month,
but returned in three months and then yielded to antiluetic
treatment. The patient at present is in good mental and
physical health. Dr. Perrin believes that the presence of
this exostosis prevented the medicinal treatment from having
its due effect. The discussion of the paper led to the ex-
pression of similar opinions by Despres, Championiere,
Horteloup, See and Trelat, Horteloup held the opinion that
•certain cerebral lesions of syphilis were a secondary result
-of lues, and did not respond to mercurial treatment. The same
opinion was expressed in the last number of the Alienist
and Neurologist. Championiere was of opinion that cere-
bral syphilis was progressive.
Insanity in Hysterical Women.— Dr. J. Marion
Sims [American Psychological Journal, April, 1883) reports
several <:aftes in which g>-necological operations had a
500 Editorial.
seemingly beneficial effect on hysterical women who
were insane. Full histories are not given, but the majority
of the cases seem to be hysterical insane patients whose
insanity depended on teratological defect and on whom
any surgical procedure would have a temporary benefi-
cial effect from its influence on the imagination. Some
of the cases cited were cured by slitting up the cervix,
who will be again cured a few years hence by sewings
it up. In contrast with the wonderful results obtained
by the gynecologists is the experience of Ripping, who-
has never seen a case of insanity of reflex origin from
the sexual organs. A little of the conservatism exhibited
by Ripping and Danillo would be of considerable benefit to-
certain gynecologists.
Sensitive Cardiac Nerves. — Frank {Progres Medical,
June i6, 1883,) recently demonstrated the existence (really
not a new discovery ) of a cardiac sensibility apparatus,
Section of Cyon's nerve dilates, as is well known, the peri-
pheral vessels and relaxes the number and energy of the
cardiac beats. With the aid of this apparatus the heart may
to a certain extent regulate its own work, and not dispense
a greater quantity of force than normal. It can diminish its
activity and its task. The role of Cyon's nerve stops there.
The other apparatus has the opposite powers. It contracts
the vessels of the periphery, and accelerates the contract-
ions of the myocardium. On cutting Cyon's nerve it suf-
fices to touch the ventricular endocardium to produce a
manifest acceleration of the cardiac beat, and contract the
smaller peripheral vessels.
Dr. Cloiiston's Gospel of Fatness. — There is a
therapeutic orthodoxy in Dr. Clouston's late sermon
on fatness which we heartily commend. Though there
is neither piety nor poesy in it, it is very appropriate for
a lunatic asylum : "All acute mental diseases tend to
thinness of body, and, therefore, all foods and all medi-
cines and all treatments that fatten are good." And
this is a good saying worthy of all acceptation by all
doctors for insane, but there are exceptional cases where fat
deposition is at the expense of restoration of nutrition to
the nervous system. Some persons increase in flesh and
in nerve instability at the same time.
The Annates Medico-Psychologiqnes, for March»
1883, contains a synopsis of the original articles which
appeared in The Alienist and Neurologist for the year
Editorial. 501
1880, and speaks in high terms of it. The articles are
not only given in abstract, but short criticisms are
appended and show the estimate which is placed upon
our home productions, which is on the whole very flat-
tering to our contributors.
One of our collaborators was to have furnished our
readers with an epitome of the contents of this valuable
psychological journal, but he failed, much to our regret,
to perform his promise.
The new Antipyretic Kairn or methylhydrate of
oxyquinoline (CnHiaNO, being, like quinine, a derivative
of quinoline.) Prof. Filehne gives from thirty to fifty cen-
tigrammes (in a fever of medium intensity) every hour,
or hour and a half, the temperature, after the third or
fourth dose, descends to the normal or even lower, accom-
panied by profuse sweating, which soon ceases if the
temperature be maintained at the normal, by new doses.
During the apyrexia the patients experience a marked
sense of comfort, the pulse recovering its normal
frequency. To maintain this state, the medicine has to
be continued in one gramme doses every two hours and
a half. Dr. Hallopeau, from the few trials which he has
made of this substance, confirms Prof. Filehne's state-
ment. Its action is certain and powerful.
The Xew England Medical Monthly manifests
signs of increasing prosperity and popular favor with the
profession, in the increasing interest of the matter in its
pages, and in the increased number of contributors,
whose names appear in late issues.
Announcements of new Medical Colleges are com-
ing upon us too fast and too "numerously" for our space.
We have no room except in our obituary pages and we
should be pleased to place some of them there in our
next issue.
The Reply to Dr Elwell by Dr. James H. Mc-
Bride of the Hospital for the Insane at Wauwatosa,
Wisconsin, came too late for this number, but will appear
in October.
The usual number of hospital reports and sonic-
monograph reprints from excellent sources, are unavoid-
edly omitted from this number.
Proceedings of Societies.
The Association of Superintendents of American
Institutions for the Insane held its Thirty-seventh
Annual Meeting at the Ocean House, Newport, R. I.,
June 26, 1883. Dr. J. H. Callender, presiding.
The following gentlemen were present :
Jos. Draper, M. D., Theo. W. Fisher, M. D., VV. B. Goldsmith, M. D.,
J. P. Brown, M. D., John VV. Sawyer, M. D., A. M. Shew, M. D..
C. H. Nichols, M. O., T. M. Franklin, M. D., J. P. Gray, M. D.,
J. B. Chapin, M. D., J. B. Andrews, M. D,, J. Z. Gerhard, M. D.,
S. S. Schultz. M. D., R, H. Chase, M. i).. .John Curwen, M. D..
VV. VV. Godding, M. D., VV. T. Bland, M. D., J. H. Callender, M. D..
R. H. Gale, M. D., G. C. Palmer, M, D., H. M. Hard, M. D..
J. C. Rogers, M. D., G. C. Catlett, M. D., J. T. Sleeves, M. D..
F. E. Roy, M. D., Charles J. Hill, M. D., Ira Russell, M. D.,
D. Clark, M. D., W. E. Metcalf, M, D., G. H. Hill, M. D.,
O. Everts, M. D., E. Cowles, M. D.. VV. B. Hallock, M. D..
A. E. Macdonald, M. D.
Dr. Gray introduced to the Association Dr. H. R.
Storer, President of the Newport Medical Society ; Dr.
Foster Pratt, one of the Trustees of the Asylum for the
Insane at Kalamazoo, Mich., and Mr. D. A. Ogden, Trus-
tee of the Willard Asylum, New York, and also the edit-
ors of the medical press of Newport.
On motion of Dr. Gray it was
liESOLVED, 1'hat the Medical Profession ot Newport and vicinity, and
also the Medical Oliicers of the Army and Navy in this vicinity, be invited
to attend the meetings of the Association.
The Secretary stated that he had been requested by
Dr. Kirkbride to present his kindest regards to the mem-
bers of the Association, and his regret that he was una-
ble to attend the meeting. The Secretary also read a
letter from Dr. Eastman, stating he had resigned his
position as superintendent of the Hospital for the Insane,
at Topeka, Kansas.
Proceedings of Societies. 503
The President then announced the Standing Commit-
tees:
To Nominate Officers: Drs. Hurd, Gale and Andrews.
To Audit the Accounts of the Treasurer : Drs. Steeves,
Bland and Chase.
On the Time and Place of Next Meeting: Drs. Shaw,
Catlett and Roy.
On Resolutions: Drs. Nichols, Everts and Gray.
Dr. Hurd, from the Committee to Nominate Officers,
reported the names of Dr. J. P. Gray, of New York, for
President, and Dr. Pliny Earle, of Massachusetts, for Vice-
President.
The report was unanimously adopted.
Dr. Callender then read his address, as President,
reviewing in a brief, but very able manner, the works of
the Association, during the past forty years. At the con-
clusion of the address he introduced the newly elected
President, Dr. John P. Gray, who after a few fitting
remarks, assumed the chair.
On motion of Drs. Gale and Nichols it was
RESOL\tD, That this Association return its thanks to Dr. Callender
for the able and eloquent composition ot its work, and of its principles
touching the current questions of the rights and treatment of the insane,
and respectfully request ol him permission to publish such a number of
copies of the address, as the members of the Association shall collectively
desire.
Resolved, That the Secretary of the Association be authorized to
have the address published in accordance with the foregoing resolution.
The Secretary presented a large number of invitations
from various societies and individuals, which were accept-
ed and referred to the Business Committee.
Dr. Curwen offered the following resolution, which was,
at his motion, referred to the Committee on Time and
Place of Next Meeting:
Resolved, That the Association hold its next annual meeting in
Philadelphia, on the third Tuesday of October, 1SS4, the fortieth anni-
versary of its organization, and that the Committee on Time and Place of
Xext Meeting be requested to prepare a programme of exercises for that
meeting, with Addresses on the various subjects connected with the
specialty, setting forth the progress which has been made during the last
forty years.
504 Proceedings of Societies.
The Secretary then reported the order of business for
the session of each day.
On motion, adjourned to 4 P. M.
The Association was called to order at 4 P. M. by
Dr. Gray, President.
Dr. Gray introduced to the Association, Rev. Mr, S.
C. Willard, Secretary of the Board of Trustees of the
Hospital at Middletown, Conn.
The President then called for reports from the several
committees appointed last year. No report was made by
the Committee on Necrology, and none by the Com-
mittee on Cerebro-Spinal Physiology, on account of afflic-
tion in the family of the chairman, who had arranged
with the other members to write the report. Dr. Clark
had a very excellent report from the Committee of Cere-
bro-Spinal Pathology. Dr. Gale read a report on the
action of certain medicines in the treatment of different
forms of insanity. The other members of the same Com-
mittee were unable to be present at this session, but will
all present reports.
Dr. Steeves. from the Committee to Audit the Accounts
of the Treasurer, reported that they had found them cor-
rect.
Dr. Callender, after a few appropriate remarks on the
death of Dr. C. A. Walker, moved that Dr. Theo. W.
Fisher be appointed a Committee to prepare a memorial
of Dr. Walker, to be read at this meeting, which was
agreed to.
Wednesday, June 27th, 1883.
The Secretary read a letter from Dr. W. Channing,
expressing his regret that he could not attend this meeting.
On motion of Dr. Curwen it was
Rksolvkd, Tliut a Committee on the Treatment of Insanity be
added to the Standing Committees.
Kksolm:d, That letters testimonial as delegate from this Association
to the Medlco-Psycholoijical Society of Paris and also the British Medico-
Paychologlcal Association be given to Dr. J. E. Roy.
Proceedings of Societies. 505
Dr. Rogers then read a paper on the "Therapeutics
of Insanity."
Dr. Godding read the report from the Committee on
the Bibliography of Insanity.
The Chairman reported that he had not been able to
prepare a report on the relation of eccentric diseases to
insanity, but a paper was read by Dr. W. B. Goldsmith,
entitled : "A case of Moral Insanity, following a Severe
Attack of Scarlatina, accompanied with Convulsions of
some Continuance."
No report was made by the Committee on Asylum
Location, Construction and Sanitation, as neither member
of the Committee was able to be present.
Dr. Gray presented to the Association Dr. A. G. Wat-
son, of Newport, R. I.
The members of the Association spent the afternoon
from 4 P. M. in a yacht-sail on the Harbor by invitation
of the Newport Medical Society, visiting and inspecting
the U. S. training-ship " New Hampshire " and the New-
port Asylum for the Poor.
Thursday, June 28th, 1883,
The Association was called to order at lO A. M. by
the President.
The Secretary read a letter from Dr. R. S. Dewey,
expressing his regret at his inability to attend this meeting.
Dr. Gale related the successful results of a case of
ovariotomy.
Dr. Gray introduced to the Association Mr. George
Gerdon King, of Newport, one of the Trustees of the
Redwood Library.
Dr. Everts then read the report of the Committee on
Criminal Responsibility of the Insane, and Dr. Chapin
then read a paper on " Public Complaints against Asylums
for the Insane, and Commitments to them."
Dr. Curwen introduced to the Association Mr. A. C.
Barstow, President of the Board of Trustees of Butler
Hospital.
5o6 Proceedings of Societies.
On motion it was resolved to hold a session at 8 P,
M., to which hour the Association then adjourned.
At 4 P. M. the members attended a reception at the
Redwood Library and Athenaeum.
The Association was called to order at 8:30 P. M., by
Dr. Callender, in the absence of the President.
Dr. P'isher then read a biographical memoir of Dr,
C. A. Walker, deceased, which was on motion ordered to
be entered on the minutes.
Dr. Draper then read a paper on " The Responsibility
of the Insane Outside of Asylums."
Dr. Andrews then read a paper containing a case
illustrative of the criminal responsibility of the non-insane.
The Committee on Time and Place of Next Meeting
reported in favor of Philadelphia, on the second Tuesday
of May, 1884 (and indicated several subjects for addresses,
with the names of the gentlemen to prepare them.)
On motion of Dr. Hurd, the President was requested
to appoint the usual Standing Committees.
On motion of Dr. Macdonald it was
Resol\':ed, That where the subjects for Addresses selected for next
year are indentical with subjects assigned to the Standing Committees, tiie
President be requested to appoint the gentlemen selected, to deliver such
Addresses, or such Standing Committees.
On motion of Dr. Macdonald it was
Resolved, That the title "Criminal Responsibility of the Insane"
for one of the Committees be changed to "Medico- Legal Relations of the
Insane."
F'riday, June 29th, 1883.
Dr. Godding read a paper on "The Rights of the "In-
sane in Hospitals."
Dr. Hurd read a paper on "The Minor Treatment
of Insane Patients."
The President introduced to the Association Messrs,
Gammell and Brownell, Trustees of the Butler Hospital,
On motion of Dr. Andrews it was
Resolved, That a Committee on the ''Treatment oiIn«anity " be added
to the Standing Committees.
Proceedings of Societies. 507"
The President then announced the Standing Commit-
tees, as follows :
/. — On Annual Necrology of the Association: Drs.
Fisher, of Massachusetts ; Hall, of Pennsylvania, and Forbes,,
of Arkansas.
2. — O71 Cerebrospinal Physiology : Drs. Gundry, of
Maryland ; Rogers, of Indiana, and Dewey, of lUinois.
J. — On Cerebrospinal Pathology : Drs. Goldsmith, of
Massachusetts ; Catlett, of Missouri, and Bucke, of Ontario,
^. — On Therapeutics of Insanity and New Remedies :
Drs. Andrews, of New York; Bartlett, of Minnesota, and
Rodman, .of Kentucky.
5. — On Biography of Insanity : Drs. Hurd, of Michigan ;.
Bryce, of Alabama, and Shaw, of Connecticut.
6. — On the Relation of Eccentric Diseases to Insanity :
Drs. Callender, of Tennessee ; Frankhn, of New York, and
Kilbourne, of Illiiiois.
7. — On Asylum Location, Construction and Sanitation:
Drs. Schultz, of Pennsylvania ; Kempster, of Wisconsin,
and Wilkins, of California.
8. — On Medico-Legal Relations of the Insane : Drs. A.
E. Macdonald, of New York ; Eugene Grissom, of North
Carolina, Strong, of Ohio.
p. — On the Treatment of the Insane : Drs. Everts, of
Ohio ; Steeves, of New Brunswick, and Draper, of Vermont,
Committee of Arrangements for 188^: Drs. Kirkbride^
Reed, Hall, Ward and Curvven.
Prof. Theodore Meynert, of Vienna, was elected an
honorary member of the Association.
The Committee on Resolutions presented their report
which was unanimously adopted.
On motion of Dr. Curvven the Association adjourned tO'
meet in Philadelphia on the second Tuesday of May, 1884.
Addresses announced to be delivered at the meeting
in 1884:
I. "History of the Association and its Necrology," by^
Dr. John Curvven.
5o8 Proceedings of Societies.
2. "Causes of Insanity in America." — Dr. Pliny
Earle,
3. Progress in the Treatment of the Insane." — Dr. H.
P. Stearns.
4. Progress in Provision for the Insane." — Dr. W. W.
Godding.
5. "Progress in the Pathology of Insanity." — Dr.
Daniel Clark.
The Pennsylvania State Medical Society, May 9th
to 1 6th, 1883:
Lunatic Asyltims in their Relations to the Community. —
Dr. R. N. Chase, of the Norristown Asylum, spoke of
the improbability of truth in the sensational charges often
made against asylum officials of retaining sane persons in
custody. Individual cases were referred to in which the
charges had proved utterly unfounded. There was, however,
one great disadvantage consequent upon the cure of the
insane : restored to reason and to marital relations, a per-
son that had been insane was prone to hand the taint
down to offspring that would have had no existence had
the restoration not been effected.
In the discussion on this paper, several gentlemen tes-
tified that the American Association for the Protection of
the Insane had no disposition to attach undue weight to
such charges as Dr. Chase had spoken of, and one gentle-
men spoke from personal knowledge of the groundlessness
of the charges in the Dixmont case.
The Medical Service of Lunatic Hospitals. — Dr. Charles
K. Mills, of Philadelphia, urged the necessity of a more
ample provision of facilities of a purely medical sort in
the management of asylums, such as an increase in the
force of the resident staff, the establishment of boards of
consulting alienists, and the appointment of a pathologist
at each institution.
Writer's Cramp. — Dr. Benjamin Lee insisted that a
distinction should be made between the spastic and the
paretic forms of the disease. He showed certain mechanical
Proceedings of Societies. 509
devices for the relief of the affection, one of which
consisted of a ball to be held in the hand, and another
of the bracelet devised by Von Nussbaum, to either of
which the pen was to be attached. The latter was
especially suited to cases of the cramp-like form of the
affection, since its action was to call the extensor muscles
into play, those being the muscles really at fault, accor-
ding to Von Nussbaum.
The address on " Mental Disorders " was delivered by
John Curwen, M. D., Superintendent of the State Hospital
for the Insane, at Warren, Pa. In the course of his
remarks, he said :
"The hereditary character of mental and nervous dis-
orders, and the necessity of careful regulation of the
health of the mother during pregnancy, and the removal,
as far as possible, of all causes of vexation and annoy-
ance, to prevent as much as may be the influence on the
child, and instances were adduced where the health and
mental integrity of the child were affected by causes acting
on the system of the mother during pregnancy.
" It was urged on the profession to give more strict
attention to the tracing out of the various histories of
different cases so as to reach more certain conclusions as
to the results of certain disorders and influences in the
production of particular forms of disorder.
" The necessity of careful attention to the health of
children, and the impropriety of placing them at an early
age in school, was also insisted on so as to avoid that
taxing of the mind and the interference with the bodily
development so likely to arise from the confinement in
school and inability to fix the mind on what was required
to be learned. The first point to be aimed at was proper
physical development.
"The training of the children should involve a thorough
disipline in the education of the different faculties of the mind
so that one class should not be educated at the expense
of the other, that the states of feeling, including the passions
and emotions, should be kept in subordination to the state
of knowledge and the state of will. The tendency of the
times is to give greater prominence by means of books
and other matters to the development of the passions and
emotions, and on this account so many are unable to
stand the wear and tear of life and fall victims to mental
5IO Proceedings of Societies.
and nervous disorders, which could have been prevented
by that attention to the proper regulation of these in con-
nection with the development of the intellect and the will.
" The necessity of proper nutrition affording these
elements most readily assimilated for the use of the dif-
ferent parts of the system, was also dwelt upon, and also
the prime importance of an abundant sleep, not only in
the early years, but throughout adult life.
" In school life it was insisted that what was taught
should be well drilled in so that what is learned should
be thoroughly learned, as it was better to know a httlc
well, and so as to be of practical advantage in the duties
of life, than to gain a large amount, so that in short it
would only be a confused mixture in the mind and not
of any practical benefit.
" Attention should also be given in education to the
peculiar bent or aptitude of the scholar, so that he shall
not not be compelled to give strict attention to what
is distastful, not within his comprehension or above his
capacity.
" Attention was also directed to the baneful influence
of the use of tobacco on young men in the retardation
of the proper growth and development of the mind, and
its injurious influence on those who had been doing
well, but were thrown back by its use.
" Reference was also made to the practice of
other habits consequent on the character of the books
furnished so generally for the young."
Dr. Benjamin Lee, of Philadelphia, submitted the fol-
lowing, which was directed to be published :
Resolved, That this society, after listening to the num-
erous able papers upon the proper care of the insane,
which have been offered during the present session, in
which this important question has been discussed from
every possible standpoint with the utmost freedom of ex-
pression and in a truly scientific spirit, consider the fol-
lowing conclusions justifiable :
First. That the problems connected with this subject
are of so intricate and delicate a nature, interesting in
themselves on one side with the most sacred social and
domestic interests of life, and on the other calling for
the highest order of scientific attianments that only those
who have made them the subject of careful and conscien-
tious study are competent to attempt their solution or to
criticise those who are endeavoring to work them out.
Proceedings of Societies. 511
Second, That the attempt to create the imputation
that the incarceration of sane persons in institutions for
the insane from improper motives, is one of the dangers
of the day, is an unworthy aspersion upon our profession,
and should be frowned down by all reasonable persons,
whether lay or professional, as utterly unsupported by
evidence.
Third. That in the medical superintendants of our
insane hospitals and their assistant physicians of both sexes,
we recognize a body of workers second to none in our
profession, in unselfish devotion to the interests of humanity,
in elevation of motive and high standard of personal
character and general attainment.
Fourth. That it is evident that, in order to place
such institutions throughout our country in a position to
properly fulfill their functions as hospitals for the treatment
and cure of the diseases of the brain, our State Legis-
lators must be made to feel the necessity for making such
appropriations as shall greatly increase their medical staffs,
and furnish them with all the necessary appliances for the
investigation of disease. [Unanimously adopted.]
British Medical Association. — Fifty-first Annual
Meeting, Liverpool, July 31st, August 1st, 2nd. and 3rd —
Section of Psychology — President, Thomas Lawes Rogers,
M. D., Rainhill. Vice-Presidents, George Henry Savage,
M. D., London, and David Yellowlees, M. D., Glasgow.
Dear Sir : — We beg to remind you that the next Annual
Meeting of the British Medical Association will be held
at Liverpool, on Tuesday, July 31st, and the three fol-
lowing days. In the Section of Psychology, in addition
to the usual papers, the following special subjects have
been selected for discussion : —
I. — The Employment of the Insane. Introduced by
Dr. Yellowlees.
2. — Bone Degeneration in the Insane. Introduced by
Dr. Wiglesworth.
Cerebral Localization in Relation to Psychological
Medicine. Introduced by W. Bevan Lewis, L. R. C. P.
4. — General Paralysis. Introduced (if time permit) by
Dr. W. J. Mickle.
We venture to express a hope that you will be able
to be present at the meeting, and to take part in the
Discussions. Whilst it has been thought desirable to
512 Proceedings of Societies.
introduce special subjects for consideration, it is by no
means intended to exclude other topics, and we shall be
happy to receive any communication which you may
desire to bring before the Section. The titles of all
such papers, and notices of intention to join in the de-
bates on the first three of the special subjects above-
named, should be sent to us not later than the 30th of
June. It is necessary that abstracts of all papers to be
read in the Section should be sent to us before the 15th
of July. We are, dear Sir, yours faithfully,
Geo. E. Shuttleworth, M. D.,
Royal Albert Asylum, Lancaster,
Wm. Julius Mickle, M. D.,
Grove Hall, Bow, London, E.
[We are assured and can confidently assure our con-
freres that " American fellow-workers " will be cordially
welcomed at this meeting. — Ed.]
The American Neurological Association held its
Ninth Annual Meeting, in the Hall of the Academy
of Medicine, No. 12, W. Thirty-first Street, New York, on
June 20th, 21st, and 22nd, Dr. Robert T. Edes, President.
Communications were presented by Dr. W. J. Morton, of
New York, on " Neuritis Following Dislocation ; " Dr. C.
L. Dana, of New York, on " Hydrobromic Acid as a
Substitute for the Bromides ; " Dr. T. A. McBride, of
New York, on "Migraine; its Pathology and Localization;"
Dr. C. K. Mills, of Philadelphia, on " A Case of Locomo-
tor Ataxia Terminating as General Paralysis of the
Insane ; " Dr. E. C. Spitzka, of New York, on " Remarks
on the Alleged Relation of Speech Disturbance and the
Patellar Tendon Reflex in Paretic Dementia;" Dr. Robert
T. Edes, of Boston, on "The Excretion of Phosphites and
Phosphorus as Connected with Mental Labor ; " Dr. R. W-
Amidon, of New York, on "A Case of Tetanoid Pseudo-
Paraplegia, of Interest from an Etiological and Pathological
Point of View ; " Dr. J. W. Morton, of New York, on " An
Apparatus for Treating Scrivener's Palsy ; " Dr. E. C.
Seguin, of New York, on " The Insane of Spain, and their
Asylums," a communication by letter. Dr. R. W. Amidon
Proceedings of Societies. 5 1 3
gave a dinner to the President at Delmonico's. A reception
was given to the members of the Association at the house
of Dr. WiUiam J. Morton, No. 36 West Fifty-sixth street.
On the second day the following papers were read : Dr.
Burt G. Wilder, of Ithaca, New York, on " The Brain of the
Cat, Lacking the Callosum," " On the Alleged Homology
of the Carnivoral Fissura Cruciata with the Primatial Fissura
Centralis ; " Dr. E. C. Spitzka, of New York, " Lesions of
the Stratum Intermedium, with Remarks on the Anatomy
and Physiology of .that Tract — Illustrated by Specimens ; "
Dr. W. J. Morton, of New York, on " The Treatment of
Migraine; " Dr.C. L. Dana, of New York, on ** Note on the
Treatment of Chorea by the Sedative Galvanization of the
Brain ; " Dr. Burt G. Wilder, of Ithaca, on " The Removal
and Preservation of the Human Brain," "On Some Points in
Anatomy of the Human Brain ; " and other papers and
cases.
The Officers of the Society, elected for 1883, are: Dr.
Wm. J. Morton, President; Dr. L. Weber, First Vice-
President ; Dr. Farrington, Second Vice-President ; Dr. M.
J. Roberts, Secretary; Dr. M. Putnam-Jacoby, Correspond-
ing Secretary ; Dr. E. C. Harwood, Treasurer.
HOSPITAL NOTES.
The Hospital for the Insane, at Topeka, Kansas,
ihas lost a good medical head in the resignation of Dr.
B. D. Eastman, whose resignation took effect June 30th.
The Dixmont (Pennsylvania) Hospital for the Insane
has likewise suffered a loss in the recent resignation of
Dr. C. C. Wiley, late Assistant Superintendent at that
institution. We are gratified, also, to learn that the ordeal
of a relentless legislative investigation, at Dixmont, is over,
.and the competent and accomplished superintendent, Dr.
Reed, is unscathed in reputation or character.
The Indiana Hospital has lost an excellent medical
head in the late resignation of Dr. Rogers, and the place
made vacant at Northampton by the resignation of the
-veteran Pliny Earle, can not soon be filled.
Hartford, Conn. — Fifty-ninth Annual Report of " The
Retreat" :
Total number treated during the year, ended March
31, 1883, 200: Males, 93, Females, 107. Of these 74
were discharged ; 35 Males, 39 Females, and 9 died : 4
Males and 5 Females. The admissions during the year
were 78: 35 Males and 43 Females. Number of recov-
eries, 26 — a percentage of 33 on admission. Number
remaining March 31, 1883, 126: 68 Males and 68 Females.
The Retreat is essentially a hospital for the treatment of
acute mental disorders, for, in three-fourths of the cases
.admitted, there had been no previous attacks of insanity.
In twenty cases the disease had existed less than a
,month, and in thirty-six, less than three months, and of
the remainder, none had been insane more than two
years. The movements of patients is reviewed for a num-
ber of years, and it appears that there exists a consider-
Hospital Notes. $1^5
able uniform average as to the ages of persons who
become insane from twenty up to forty or fifty years,
and that a larger number are affected between twenty and
forty, and also during any number of these years, than
there are during any equal number at other periods of
life. We would like to give the views and conclusions
of the caucus, and the curability of insanity, so lucidly
expressed in the report by Dr. Stearns, but want of space
deprives us of the pleasure.
Pennsylvania. — Annual Report State Hospital for the
Insane, Warren, 1882:
Total number under treatment during the year, 433 :
Males, 158, Females, 275. Admitted during the year,
234: Males, 119, Females, 115. Discharged during the
year, jZ: Males, 32, Females, 46, as follows : Restored, 17:
Males, 9, Females, 8; improved, 23: Males, 11, Females,
12; stationary, 15: Males, 4, Females, 11; died, 23:
Males, 8, Females, 15. The report is a detailed account
of the hospital, its accessories and environments, with a
dissertation on hospital management, including proper
mental diversion and judicious employment of the insane ;
the difficult problem of securing the services of individuals
whose duty it is to come in immediate contact with
patients, and the relation of patients to attendants, and
vice versa. Dr. Curwen enlarges upon the subject of
reducing the rate of board from $3.00 to $2.50 per week,
and justifies at length the action of his trustees, who,
judging from their comments upon the subject, are less
sanguine of the success of the movement than the doctor,
who has entertained the idea for years, and believes it is
the best method of inducing towns to elevate the con-
dition of their indigent insane. We truly hope that the
scheme will be successful, and that the doctor will real-
ize all that his earnestness and devotion deserve. With
pleasure we take this opportunity of congratulating the
management at being able to command the competent
and conscientious services of Dr. Morris S. Guth.
IN MEMORIAM.
Hervey Backus Wilbur. — "Died suddenly, May ist,
1883, at his home in Syracuse, N. Y., in the sixty-third
year of his age, Dr. H. B. Wilbur, Superintendent of the
New York Asylum for Idiots."
We jostle one another along the crowded avenues of
this passing life in our eager-pushing for wealth and place
and hardly turn to see who has fallen at our side. The
millionaire dies, there is a momentary ripple in Wall
Street and the seething waters of that life close over
again. But we, as philanthrophists, may well pause a
moment at the open grave of him, beside whose bier men
prominent in church and state stood uncovered to do honor
to a life which had been devoted to the training and devel-
opment of that most pitiable of all God's creatures, the
idiot. Dr. Wilbur was the pioneer of this work in
America. In the article on Idiocy, in Johnson's Cyclopedia,
written by him, he estimates the idiots in the United
States at one for every thousand of the population. To
him as a young man the parable of the ninety-and-nine in
the wilderness found here a new meaning. To our young
men, looking solely for fame and advancement, this devo-
tion of his whole life to a being, who to untutored eyes
appears only as a blot and a mistake in creation, may
seem but ignoble work. Yet if he is rightly styled a bene-
factor of his kind, who makes two blades of grass grow
where only one grew before, what shall we call him who
leads forth the soul that, cramped and entangled in the
swaddling bands of a defective organization, had else
withered undeveloped in the chrysalis?
There is a story told of the princess changed by cruel
enchantment into a repulsive creature, an object of loath-
ing to the passer-by, but those who cared for and cherished
her then, were rewarded by her, when disenchanted, the
transformation came. Who will question that for loving
service to such as these, Dr. Wilbur found his reward when
the change came that fresh spring morning?
The salient points of his life are quickly given. It is
the picture with which American biography has familiar-
ized us; of a New England boy teaching and gaining an
In Menioriani. $17
education; entering Dartmouth at the age of fourteen to
graduate from Amherst at eighteen ; engaged in civil engi-
neenng under the shadow of Bunker Hill monument ;
studying medicine at Pittsfield and graduating at the Berk-
shire school in 1843. Then, passing beyond the New
England hills, there is a visit to Richmond, Virginia, to
Tennesee, and a sojourn of some months in Illinois, probably
hoping to make a home, but his rest is not there. Back
to Massachusetts in the practice of medicine, at Lowell, at
Westford, at Dana, — and still the call to "arise and depart."
At last in 1845 ^^^ finds a home in Barre, Massachusetts.
In 1846 he takes the partner of his life-work, and in July,
1848 he enters upon that work, receiving a few weak-minded
children into his own family, thus opening the first school,
distinctively for idiots, in America; a school which has
since, under the care of Dr. George Brown, become a
model private-home for this class. Three years later he
is called to Syracuse to organize the New York School,
and subsequently is appointed to the charge of the Asylum
for Idiots, and thence forward to the day of his death his
professional life is devoted to this work.
How well that work was done, — how, from schools which
he had helped to found in distant States, at the tidings
of his death, resolutions bemoaning the common loss, came
to strew his hearse; how far his methods in training
these unfortunates have been transmuted into common
knowledge to stand as a memorial of him ; how much of
that personal power which no man can bequeath, is buried
with him; all this, intimate, personal friends, his associ-
ates in this work, can say far better than I, and there
will be no lack of eulogy.
One of these, who knew him intimately for many }'ears,
writes me : "His nature was generous beyond that of
most men-" I can believe it, yet there was another side
to his character, which I think will be found to have had
its origin, though I have not attempted to trace it, in some
Presbyterian ancestor of Cromwell's time, some sturdy old
roundhead, whose blood may have flowed at Marston
Moor, blood which coursing in the veins of his descend-
ant two centuries later, made him a good fighter ; those
of us, who stood in the opposing ranks felt that there was
no mistake about this.
This is a phase of his character which lay wholly
outside of his work among the idiots, and will be differ-
ently estimated according to the standpoint of the one
5 1 8 hi Memoriam.
making the estimate. I refer to his position on questions
of social science, notably to what has been considered
his antagonism in later years to the superintendents of
American Hospitals and their methods. It was my mis-
fortune to know mainly this side of his character and
that almost wholly through his published writings and my
occasional correspondence with him. Antagonists are apt
to measure only swords. He knew how to smite unspar-
ingly, but not always deliberately, hence his blows some-
times missed their aim ; but his pamphlets and articles
flew thick as arrows and they were always aggressive and
vigorous. We felt that his criticisms of our methods were
certainly not generous, hardly just, but the trouble was,
there was too much truth in them. It was good, whole-
some truth for us to hear, at any rate, for the Association
of Medical Superintendents of Institutions for the Insane
had become too much of a mutual admiration society for
healthy growth. More than thirty years ago he had been
introduced to the Association by one of its founders and
welcomed by it, had amicably co-operated with us for
many years, attending most of the meetings ; and then
becoming exclusive, we unwisely and rudely, as it seems
to me, drove the superintendent of idiot asylums out of
our synagogue. Was it to. be expected that he would be
ver}" indulgent to our methods after that ? Unregenerate
human nature respects the man who strikes back, and for
the blows which we bring upon ourselves we can expect
small sympathy. Perhaps after all we were a little sensi-
tive of comparison with the English, fearing that our
methods might not be properly appreciated by an outsider,
and so too easily we took offense where only fair criticism
was meant. I at least am convinced by my correspond-
ence with him, that his convictions were honestly held,
and much as I may regret that he could not see some
things differently, now that I can no longer join issues
with him, — standing uncovered in the presence of that
silence which has fallen over all our strivings — I feel it is
due to him to say that he was more sinned against than sin-
ning. I believe he went abroad to thoroughly inform himself
of the most advanced ideas in the care of the insane in other
countries ; returning, he published his observations and
would have instructed us ; but we were not then asking
advice, and we would none of his reproof, — we were more
sensitive then than now. In 1881 he wrote me, "I am
now contented to republish European opinions, thus
In Memoriatn. 5 1 9
avoiding any personal controversy," but he was only par-
tially successful in this. As he grew older and the gap
between him and his former associates of the hospitals
widened, I think he wearied a little of the fighting, although
the last published article which I recognized as from his
pen, the review of the Fortieth Annual Report of the
Managers of the Utica Asylum, in the Journal of Nervous
and Mental Diseases, for January, 1883, showed that his
eye had not dimmed nor his natural force abated. But
let his last words on the subject of his controversy with
the hospital superintendents speak for him, he could hardly
have covered the whole ground better had he known they
were the last.
In a letter dated one week before his death, in refer-
ring to an invitation to escape the rigors of a northern
spring, and come and see me, he says, "I thank you also
for the kind expressions of the latter part of the letter,
which are very welcome after the experience I have had
the last few years. For years I have had the pleasure
of frequent intercourse with many of the superintendents
of American insane asylums, and with the most of them '
I have been on the most friendly terms. At the request of
Dr. Anderson, of our Board of State Charities, I spent
some time in visiting British and other European asylums,
and made a report to that Board. From thenceforward,
I found myself almost an outlaw — found myself attacked
in various ways that seemed to call for a vigorous defense.
Though I have never had the slightest ill will towards
any of my old associates, I am a zealous advocate of
anything in the line of my convictions, and so the tone
of my papers has perhaps been an unfortunate one."
Can we judge him harshly in the light of this ?
But Dr. Wilbur was seen at his best outside of con-
troversy. And here, too, let his latest words speak for
him, written to me only two days before his death, a val-
edictory- worthy of him. It was a suggestion made in a
direction in which he knew I was writing-, in regard to
expert testimony. It was hardly meant as a criticism,
yet observe how like " the hand which came out and
wrote over against the wall," it records its protest against
much of the medical expertness which has been " weighed
and found wanting " in our time :
" Expert testimony should be the colorless light of
science, brought to bear upon any case where it is sum-
moned. It should be impartial, unprejudiced. There
520 /;/ Meinoriani.
should be no half truths uttered, and suppression of
the whole truth is in the nature of false testimony."
Dispassionately saying this, he went to his rest.
Clement Adams Walker, — " Died at his residence in
Boston, Mass., April 26th, 1883, Dr. C. A. Walker, late
Superintendent of the Boston Lunatic Hospital, aged 63
years."
How the cypress burgeons in these early months,
while already a moaning as of the wind of Autumn is
" calling for vanished faces " through all the empty
pageants of these " lonesome latter years." Hardly has
the grave closed over the fresh manhood of Dr. Beard,
when, unanonunced, the silent messenger enters, and
almost together, Dr. Walker and Dr. Wilbur have gone
away.
Dr. Walker early took high rank in his profession in
the treatment of insanity. A graduate of Dartmouth in
1842, for thirty years Superintendent of the Boston Luna-
tic Hospital, President of the 7\ssociation of American
Superintendents of Institutions for the Insane, since the
death of Dr. John E. Tyler, standing at the head of his
specialty in New England, what was there left for him
to attain ? To what more could he look forward ?
Nothing, save age and its infirmities — ah, yes, the unfad-
ing crown. So death came, and not unwelcomed by that
sad, sick heart, sitting .in shadow.
There are life long friends to write his eulogy, who
will pay him a tenderer tribute than mine. I only wish
to drop one little sprig of green into that open grave,
where, if each loving hand had cast but one, they would
have filled it, so warmly was that man cherished in the
hearts of "troops of friends." Eminent in much, he was
preeminent in this, for the heart is stronger than the
intellect. It was my good fortune for some years to have
charge of a hospital for the insane in the same state with
Dr. Walker, and so often came in contact with those who
had been his patients, and their friends who had gone to
him for counsel, for aid in their extremity. Some of these
were wealthy, for insanity is an affliction which knocks
at all doors alike ; more often they were the humble poor,
the friendless and the outcast of the streets of Boston,
but they all told me the same story of that great, loving
heart, which patiently counselled with them, which took
them into its sheltering sympathy. His very frailties —
In Memoriam. 521
who of us has them not? — grew out of that genial,
social nature. A warm heart makes friends ever\'\vhere,
and friends were his abiding strength in every time of
trouble. Yet he was a proud, and could be a stern man ;
but there was something within which mellowed that
pride and softened the sternness.
He was often called in court, and the poor lunatics
under indictment for crime found in him a powerful
advocate. He was able to discern insanity, if it existed,
even when it was unpopular to see it. In those last days
of June, of a year ago, although confined to his chamber
by sickness, he wrote a strong letter, and in spirit went
shoulder to shoulder with us, as we stood vainly plead-
ing to avert a nation's shame.
Like many men who have been born in Boston, his
heart was bound up in that old town. He planned a
magnificent lunatic hospital "for her (the plan, somewhat
modified but not improved, was afterwards made use of
by the State of Massachusetts, at Danvers). He selected
a site for it which looked out over the city and the
ocean. He gave the best working years of his life to the"
careful elaboration of his plan, and made the mDSt ear-
nest and unselfish efforts to secure its embodiment in
brick and stone. Year after year he saw that plan
deferred, lived to see the one fond dream of his life fail,
to find the whole work had been abandoned. And then
he went back to that miserable, ill-constructed, half
lighted and less than half-ventilated, old rookery at
South Boston, which, even with all the admirable changes
that have lately been made, is a disgrace to that proud
city to-day, and with spirits crushed, and that great heart
bleeding, took up those poor creatures and went sailing
with them down the harbor, into the air and sunshine,
cheered them in their sorrow, and with the warmth of
his heart shining through smiles, lit up the dusky cor-
ridors of that prison pile, till, transformed by his pres-
ence, those low ceilings lifted, and the poor mmates felt
while he was with them that they were dwelling in " kings'
palaces." Said I not well that the heart is stronger than
the intellect ? That heart which at last was broken ?
This was his work. I know nothing of his theology,
but I do know that he kept ever in his life, if not in his
mind, the words of the Master: "When thou makest a
feast call the poor, the maimed, the lame, the blind."
And it is the garlands, which these poor ones bring
522 In Memoriam..
now to lay above his grave, that shall be his monument-
Wilding flowers, withering yet renewed, till taking root
they write an inscription in the dust to outlast the
marble : " These cannot recompense thee, but thou shalt
be paid." W. W. G.
Prof. Charles Lasegue. — Charles Lasegue, the most
brilliant pupil of the number that listened to the immortal
Trousseau, was early marked by his master as his fit suc-
cessor, and he became professor of Pathology in the Fac-
ulty of Paris when his master resigned the position. His
interest in medical literature was manifest and he contri-
buted no small part to it in his capacity as editor of the
medical department of the Archives Geneiale de Medecine^
a position he occupied from 1853 ^P to his death.
He was preeminently a teacher and devoted heart and
soul to medicine. He often contributed to the A7tnales
Medico Psychologiques, and among the principal ones con-
nected with nervous and mental diseases are his notes
and observations on hemicrania, on subacute alcoholism,
on the legal responsibility of lunatics, on the delirium by
acces in a medico-legal point of view, on cerebral diseases,
on alcoholic delirium, on dipsomania and alcoholism, etc.
As a man he was universally respected and liked, his
various attainments were admired, and his teachings were
such as to be of the highest value to his students. As
one of his admirers has said, nature seemed to have in-
tended him for a teacher. His audience listened to him
in rapt attention, and the value as well as the popularity
of his lectures were attested to by the numbers who-
attended them. — Annales Medico-Psychologiques.
Reviews, Book Notices, &c.
Insanity, its Classification. Diagnosis ant) Tkeataient.* — This is
the first systematic treatise on insanity published in the United States
since that of Rush, excepting the less extensive contributions ot Brigham.
Chipley and Fisher, and the cotemporaneous writings of Steams, Ham-
mond and others. The book opeus with a discussion of that much-mooted
question, the definition of insanity, and the following is the definition
given: ''Insanity is either the inability of the individual to correctly
register and reproduce impressions (and conceptions based on them) in
sufficient number and intensity to serve as guides to actions in h.irmony
with the individual's age, circumstances and surroundings, and to limit
himself to the registration as subjective realities of impressi'ni transmitted
by the peripheral organs of sensation ; or the fiiilure to properly co-ordinate
such impressions, and to thereon frame logical conclusions and actions ;
these inabilities and failures being in every instance considered as exclud-
ing the ordinary influence of sleep, trance, somnambulism, tlie common
manifestations of the general neuroses, such as epilepsy, hysteria and
chorea, of febrile delirium, acute intoxication, intense mental pre-oocupation
and the ordinary immediate eonsequence-s of nervous shock and injury."'
The chief criticism which could be parsed on this definition is, that it
is lengthy, and, to some, may seem diffuse. The clauses, excluding certain
states, might be criticised as excluding the mental phenomena resulting
from such states, as they are "common manifestations"' of them. With re-
gard to a definition of legal insanity. Dr. Spitzka very truly and pertinently
says. *'the best legal authorities have decided that what is fact in science
cannot be a fiction in law."' The chapter on delusions takes up the dificr-
ence so Infrequently recognized between the systematized and imsystem-
atized delusions. Spitzka defines delusion as " a faulty belief out of which
the patient cannot be reasoned by adequate methods for the time being.''
Since, as he says. Ray"s definition fails to provide for the lunatics, correct-
ing some of his delusions during his insanity, and all of them as he con-
valesces. The systematized delusion has a complex, logical organization
of which the unsystematized is destitute. This chapter is a decidedly in-
teresting and valuable resume of the mechanism of insane delusions. In
the third chapter he discusses imperative conceptions and morbid propen-
sities, and shows that while both these may exist independently of insanity,
other than, as manifested in them, they are often merely coexist. The
fourth chapter discusses hallucinations and illusions. The first is defined
as -a perception of an object as a real presence without a real presence to
justify the perception." -An illusion is the perception of an object
actually present in characters, which that object does not really possess."
Both, hallucinations and illusions, are shown to depend upon cortical
action. Hallucinations. Spitzka says, may originate from delusions, v^hile
*By E. C. Sidtzka, M. D. N'ew York: BermiDgaam & Co., 18&3.
524 Revieivs, Book Notices, &c.
the contrary is infrequent. In the first case, the occurrence is of grave
prognostic significance. Emotional digturbance is discussed in the fifth
chapter. While the legal misuse f)f the term is pointed out, the value of
emotional insanity, as a useful designation tor certain simple insanities, is
admitted. Spitzka is of the opinion that insanity dors not increase or de-
velop the moral sentiments. The sixth cliapter discusses tlie memory and
consciousness in insanity. He defines healthy consciousness, as '"that con-
dition in which the individual, while registering tlie imi)res8ions of the
outer world to wliich his attention is directed at the time, correlates these
with the summarized observation of the past." The will in insanity is
well analyzed in the seventh chapter. Tlie physical indications of the
acquired insanities are analyzed and described in the eighth chapter, and
the positive statement often made on these points are shown to be partially
erroneous. Othoematoma is regarded as being of central origin.
In the ninth chapter the signs indicating tlie insane constitution are
discussed. The chapter will not bear an;ilysis, it requires perusal to do
justice to it. The tenth chapter is devoted to the morbid anatomy of in-
sanity, and calls attention to the fact that many forms of insanity depend
on impalpable bio-cliemical changes, undemonstrable by microscopic
examination, or otherwise. Tlie necessity of being more than a mere mi-
croscopist is shown by the unfortunate experience of two observers, one of
whom found a flat sciatic nerve in progressive paretics, as he would have
done in the rest of mankind. Another found '-pathologicMlly enlarged"
cells in the parietal regions wliose absence would be abnormal. The " mil-
iary sclerosis," upon whose existence stress is laid by certain pathologists
was shown by Spitzka (1877) to be due to manipulation, and tliis has been
corroborated by Savage and Plaxton. Spitzka agrees with tiie continental
authorities in finding no necessary changes in cases of (acute) mania, or
melancholia, in monomania the changes are teratological in cliaracter,
when they are found at all. In progressive paresis the most marked
chaiiges are found. The elements of error in pathology are analyzed
clearly.
The next chapter is devoted to the classification of insimity. The prin-
ciple adopted is the true one. An attempt is made, as elsewhere in science,
to determine each psychosis before determining the relations of these to
each other. The classification adopted is as follows :
GROUP PIHST — PUKK IXSAXITIES.
Sub-group A. — Simple insanity, not essentially the manifestation of a
constitutional neurotic condition.
Fi7-st Class.
Not associated with demonstrable organic cerebral changes,
Diniaion I. — Attacking the individual, irrespective of the physiological
■period.
Order A. — Of primary origin.
Sab-order A. — Characterized by a fundamental, emotional disturbance.
Genus 1. — Of a pleasurable and explosive character; Simple mani:i.
Genus £ — Of a painful diameter : Simple melancholia.
Genus S. — Of a pathetic character: Katatonia.
RevieiK'Sy Book Notices, &c. 525
Genua 4.— Of an explosive transitory character. Transitory frenzy
(mania transitoria of authors).
Sub-order B.— Not characteilzed by fundamental emotional disturbance.
Genua 5.— With impairment or abolition of mental energy: Stuporous
insanity (acute dementia of authors).
Genua 6.— With confusionil delirium : Primary confusional insanity
(incoherence, etc.. of authors).
Genua 7.— With uncomplicated prooressive mental impairment: Prim-
ary deterioration (primary incurable dementia of some authors).
Order B. — Of secondary origin.
Genua 8. — Secondary confusional insanity.
Genus 9. — Terminal dementia.
Division //.—Attacking the individual in connection with develop-
mental involutional periods.
Genua /£>.— With senile involutions: Senile dementia.
Genus 11. — Hebephrenia (insanity of pubescence).
Second Class.
Associated with demonstrable active organic cerebral change.
Genus 12. — Paretic dementia (progressive paresis).
Genua IS. — Syphilitic dementia.
Genua 14- — Dementia from coarse brain disease.
Genua 15. — Delirium grave (acute delirious mania, typhomania. Bell's
disease.)
Sub-group B. — Constitutional insanity; the expression of a continuous
neurotic condition.
Third Class.
Dependent on the great neuroses.
Diviaion I. — The toxic neuroses, alcoholic, etc.
Division IT. — The natural nem-oses.
Genua 17. — Hysterical insanity.
Genua 18. — Epileptic insanity.
Fuurth Claas.
Independent of the great neuroses
Genua 19. — Periodical insanity (including folie eirculaire).
Genua 20. — Idiocy.
Genua 21. — Imbecility.
Genua 22. — \Ianifesting itself in primary dissociation of mental ele-
ments, or in a failure of logical inhibitory power, or of both: Monomania
(includes manie raisonnant, moral insanity of some types, chronic delu-
sional insanity, etc.)
GROUP SECOND. — COMPLICATING INSANITIES.
Cases, in which certain causes or associated aflfections give peculiar
tinges to the psychoses, as Traumatic. Choreic, etc. This is scarcely an
improvement on the much simpler classification, suggested by him some
years ago. In my opinion, the la.*! group is scarcely justified, nor is hys-
terical insanity ; as he puts some cases of this type very properly under
monomania. Syphilitic dementia and dementia from gross brain disease
526 Revieius, Book Notices, &c.
scarcely differ so much as to require separate geneia to include them.
For clinical purposes the classitication is well adapted, and were it g'en-
erally accepted, would simplify matters markedly.
The second part of the work considers the speciaj forms of insanity.
Mania is defined as a psychosis, characterized by an exalted emotional state
wliich is associated with a corresponding exaltation of other mental and
nervous functions. The typical maniac has the cheeks or inhibitions of or-
ganic and mental life loosened. The varieties of mania are well discussed.
Melancliolia is a form of insanity, whose essential and cliaracteiistic feat-
ure is a depressed (t. e. subj' ctively arising) painful emotional state which
may be associated with a depression of otlier nervous functions. In a sim-
iliar, thorough and exact way the various psychoses are defined. The
pathological details are clear, and, what is rarely the case, conipreliensible
by non-pathologists. In the chapter on uiflerential diagnosis much valu-
able information is given. The question 'of simulation is discussed at
length, and the simulation of insanity by tlie insane is considered in this
connection. Attention is called to the fact that Dr. Hughes was the first
American to direct attention to this important topic.
Under the question of therapeutics, asylum treatment is considered,
and some of the readers of The Auenist and NEUKOLOGisr will be sur-
prised, and, perhaps, not displeased to learn Dr. iSpiizka's sentiments on
the subject, lie says, page 399: "An asylum sojourn has in the vast ma-
jority of cases good effect on the insane. 'Jurable patients are never in-
jured in their prospects of curability in a medically well-managed institution
and incurable patients should be tliere for practical reasons, and are usually
better off in than out of the asylum." Tlie advantages of asylum treatment
are then given at length. He believes in furloughing patients and requir-
ing bonds from relatives for their good behavior. His remarks on restraint
will astonish those who have considered him a doctrinaire. He says, page
401 : "That there are some subjects, who require restraint, who are better
oft with, than without it, there can be no doubt. Tlie demonstrative feat
of tlie novice superintendent, who burnt all restraint apparatus, as soon as
lie took charge of his asylum, was followed by the accumulation of black
eyes, broken noses and other minor surgical accident^ as well as several
suicides. It is with this question, as with many others, lelating to the in-
ternal economy of asylums ; reform cannot be accomplished by watchwords
or catch phrases, nor by arbitrary legislation. Scientific zeal and integrity
within asylums will prove far better guarantees of humanity, than associa-
tions of dilettante and newspaper editorials. Let us liope that the scientific
spirit which was breathed into American psychiatry by Ray and Rush, and
which iias been kept alive by their innnediate followers, will gain that
preponderance, which it merits, over an unwortliy opposition." He has no
sympathy with the " liberation epidemic," as he designates the sporadic
attempts to manufactuic sane men out of lunatics.
In common with the vast majority of Knglisli, French, German,
Italian, Austrian, Dutcli and Danish alienists, and in conur.on with Ray,
Rush, Nichols, Bell, Godding, Hughes, Workman, Howard and others
among Americans, Dr. Si)itzka believes that immoral manifestations may
constitute an evidence of cerebral disease or defect; what is commonly
Reviews, Book Notices, &c. 527
designated moral insanity of imbecility. He believes in the existence of
transitory furor, although he has never seen a case.
He calls attention to the fact that there is much danger in the treat-
ment of certain cases of so-called '• mild melancholia" at home. He
believes that the wonderful results of gynecological treatment in insanity
are due to an imperfect knowledge of psychiatry; the cured lunatics
entering asylums very soon after cure. There is much more quotation of
American authors than is usual in a woric of this kind. To a student
desirous of understanding the present status of psychiatry at home and
abroad.no better bo k can be recommended. There are some faults of
omission and commission. The stjle of Dr. Spitzka is, as a rule, clear and
comprehensible, but in a few instances some awkwardly constructed sen-
tences are here and there to be found. Instances of heterophemy are
sometimes noticeable; "doffed" is used in one place for "donned" and
"subject" for "object"' in another; but these blemishes are few and far
between. The wood cuts are few. but relatively good. The typograph
ical and bibliographical work is as good as cm be expected. It has
one virtue often wanting in English, French and American works, an
excellent index.
K.
An unfiaternal vein of sarcasm towards his confreres in psychiatry
from whom he differs in some chapters, which we should consider as cen-
surable in ourself and requiring emendation, appears in this book, but
tliis critical feature ot the book will probably lend interest to those who
are of the author's way of thinking.
In some places the author is keenly satirical, as in the following cen-
sure of a sometimes reckless therapeutic procedure : " Those pretty
cases in wliich a delusional insanity is instantly cured by restoring a
reirotiected or retroverted uterus to a normal position, do not seem to
•occur nowadays, and the gynecological epoch of psychiatry seems to have
passed by, taking its adieu with the sacritlee at Blackwell's Island Asylum
of Mary Ann Mullen, a sufferer from unrecognized katatonia, on the altar
of Oophorectomy (the ovaries being perfectly healthy). It would have
been as reasonable to extirpate tiie bed-sore of a sufferer from paretic
dementia, and to cut off the ha?matomatous ear of a terminal dement
etc."
Notwithstanding the objectionable personality which in some places
in the book in our view, blemishes the author's style, the book possesses
peculiarly interesting and unique counterbalancing features to commend
it to the attention of the alienist and the general medical reader interested
in psychiatry. — [A'd.
LuYs.— Contribution to the Study of the Statistics on the Weight of
the Cerebral Hemispheres, in the Normal and the Pathological State.
Luys, for the purpose of his researches in the weight of the hemispheres,
availed himself of the brains of individuals between IS and 90 years of
age, who had died from diseases which tlid not involve these organs ; he
always used the same method, that is, making a transverse incision at the
level of the superior border of the protuberance, thus separating the isth-
mus of the encephalon from the cerebrum, and afterwards making an
528 Revieius, Book Notices, &c.
incision which passed between the two mammillary tubercles and was
directed straight for the antero-posterior fissure, thus dividing the corpus
callosum, and with it the two hemispheres, which were weighed, the one
after the other. The following are the results at which he arrived: asym-
metry of the two cerebial hemispheres is the rule in the human species ;
in 32 braius there was inequality 27 times, and only 5 times equality ; excess
of weight of the lelt hemisphere is the rule, and was observed 21 times in
27 cases, that is 78 per cent. ; the excess of the right hemisphere over the
left was therefore 6 times in 27 cases, or 22 jier cent. In the pathological
state in the insane, tlie right hemisphere is ordinarily heavier, and there-
fore more active ; he found that in 55 biains of the insane, 39 showed excess
of weight in the right hemisphere, say 71 per cent., and only 16 showed
excess in the left hemisphere, or 29 per cent. "It remains to be seen," he
adds, "whether this abnormal development of the right iiemisphere, which
should conduce to changes in the harmony of the cerebral functions, is
allied to ^.hereditary influences, or enters into the facts of acquired
order."
So much for and by Luys ; but audi alteram partem, for doctors must
diflfer, and it is wonderful how much men are able to see when they
set out to find anything they earnestly desire to find. We know of but
one exception to this rule, and that was given to us by a shrewd Yan.
kee, whose question was, " did you ever earnestly seek, in the dark, for
something you did not wish to find ? " We failed to reply, and when he
solved the problem, we did not deem it expedient to repeat the question
to others, for the matter was of rather foul odor.
We give now the pars altera, whicii appears in the same number of
the Rivista Sperimentale, under the following lieading : —
'■^ Sulla iji equalianza di soiluppo e di peso degli emisferi cerehrali, peri
Dr.O. Galgio ed E. di Afa^^ei," which is, being interpreted, " On the Ine-
quality of the Development and Weight of the Cerebral Hemispheres, by
Drs. Galgi and E. di Mattel." Here it is : —
"Placing ourselves at an exclusively anatomical point of view, we
have desired to study the relative weights of the right and left cerebral
hemispheres. Normal anatomy, which has diligently weighed, in this
way, all the organs of our body, the ej^es, kidneys, testes, &c., has not
sufficiently illustrated the weight of the two cerebral hemispheres, which
thougli tliey arc fused into one sole organ, by means of the corpus callo-
sum, yet are they, by means of a section carried along the raphe, quite
divisable anatomicjiUy, the one from tlie other.
The deficiency of anatomy, in this respect, is all the more felt, when
we reflect that these researches miglit tlu'ow some light on the questions
as to the independence of the functions of the hemispheres, and the locali-
zation of certain faculties in one or the other of them, and their relative
physiological importance ; recently M. Luys has succeeded in increasing
our interest in this 6ul)ject, by the applications of it nibde by him in the
clinic of mental diseases.
Luys has come to the conclusion that the two cerebral hemisplieres,
though tliey are in unison in many functions, yet enjoy a certain inde-
pendence of action; ttiat tlie left hemisphere is normally more developed
Reviews, Book Notices, &c. 529
and more weighty than the right, by five or six grammes ; and that, on the
contrary, in mental pathology, the right hemisphere is found to exceed in
weight the left,
Crichton-Brown had before arrived at analogous results, respecting
the weight of the cerebral hemispheres in tiie demented. He had observed
the average weight of the right hemisphere, in 40(i insane persons, to be
greater than that of the left, but he adds, '• the greater weight of the right
hemisphere in comparison with the left, is in general still better observed
in the mentally sane, and he infers this from the fact that he had met with
it in 32 cases of insanity starting acutely, and of recent origin, in which
cases it might be presumed that atrophic modifications had hardly yet
commenced, or that they were totally absent.
Alienists have evidently occupied themselves in this weighing of the
hemispheres more than anatomists ; hence the necessity of collecting a
large number of observations on normal brains. Luys. in his last work,
reports only 32 cases of brains of the insane, ip five of which the hem-
ispheres were of equal weight, and 21 showed a preponderance of the left
over the right.
We certainly could liave desired to bring a rich contribution to these
studies, but we have been obliged to content ourselves with 59 cases, the
fruits of two scholastic years (ISSO-'Sl and 1SS1-'S2) which, if they may
not solve the question agitated, may yet throw some light on it. The
brains examined by us all belonged to subjects of sane mind, who had
died from various diseases, chiefly pulmonitis, phthisis, valvular defects of
the heart and cancerous neo-formations.
We proceeded in the division of the cerebral hemispheres by first sepa-
rating the cerebrum, properly called, from the encephalon, by a transverse
secti on made on the level of the upper margin of the pons Varolii, and
then dividing the one hemisphere fro'u the other, along the raphe of the
corpus callosum, so as to carry the cut between the two mammillary
tubercles. We understand but too well the small errors which may be
fallen into in these researches ; and if on the other part, we have scrupu-
lously sought to avoid them, on the one hand we have confidence that a
good number of the cases may compensate the;e errors, and cause them
not to gravitate fatally to either side.
Our results, which are very different from those of Luys, are shown
in the following statistical tables :
[The authors here present two tables, one showing the details of 30
brains of men, and the other, 25 brains of women. In separate columns
are given the age of the subjects, the weights of the hemispheres respect-
ively, and the difierence, plus or minus, between the weights. They then
proceed tlius] :
" It results, then, from our observations, that in 55 brains, we found
the right hemisphere heavier than the left in 39, or in 70.90 per cent., and
in 16. we, on the other hand, found the left heavier than the right, say in
29,09 per cent. On the average of the whole, the right hemisphere was
heavier by 4.01 grammes than the left.
'* For the greater clearness and more easy understanding of the partic-
ulars observed, we present the following statistic summary :
-530
Reviezus, Book Notices, &c.
52 Women.
Total, 55.
Right hemisphere heavier than left
Right hemispheres lighter than left
Mean of excess ol right over left
hemispheres
Mean of excess of left over right
lieniispheres
On Viie general average, the right
exceeded the left
(NO. 20.)
66.66 per cent.
(No. 10.)
33.33 per cent.
gr. 7.16
gr. 3.11
gr. 3.74
(No. 19.)
74.75 per cent.
(No. 6.)
25.25 per cent.
gr. 6.77
gr. 3.30
gr. 4.35
(No. 39 )
70.90 per cent.
(No. 16.)
29.09 per cent.
gr. 6.96
gr. 3.105
gr 4 01
"If we divide all our casej: into two categories, one including the indi-
viduals between 25 and 40 year.*, the other, those between 40 and 70, it
is seen that the young have, in proportion, presented inequality an equal
number of times with the old, between weights of the hemisplieres. But
it is to be observed that the difference in weight ,of the right liemispheres
over the left, is much greater in the old ; and in them also the difference
of the left over the right is the lowest. These relations obtain in both
sexes, as will clearly appear from the following figures :
Men I
Women
From 25 to 40 years , .
" 41 to 70 " . .
S from 25 to 40 vears
) " 41 to 70" "
Aleau of
the
diiference
of
Ditto of left
weigh of riglit
over right.
over left
6. 27
3.44
8. Oti
2.77
5. 27
4.16
8. 10
2.45
" These figures show us, that it i.s especially in the old, that the prepon-
derance of the right hemisphere over the left is most evident ; this cere-
bral asymmetry, as relates to age, permits us to see how interesting
should be a long study of the different ages, more amply carried out than
we have been able to accomplish. For the present it suffices for us to be
able to conclude, that the cerebral hemispheres are rarely of equal weight ;
now one preponderates, then the other; on the average, tlie right is heav-
ier than the left by about four grammes; the predominence, then, of the
right hemisphere, far from being the index of a pathological state of
the brain, is a normal fact.
It remains now to be seen, whether in the progress of these researches
the grand averages will confirm oiu* statements ; whether the difference
in weight of the hemisplieres stands related to embrionic laws, and
whether, concerning a viscus which ought to be modified according to
intellectual exercise, nationality and social surroundings may have some
influence.
[NOTK.— May there not be a radical difference of balancing in French and
Italian brains? We presume the brains examined by Luys were all French, and
those observeil by Gaglio and Mattel, all Italian. The latter would seem to be
all right, and the former all wrong. No doubt this accounts for the passion for
extension of territory in the French, and for the stealings of Louis Napoleon.
If 80, it is certain that the brains of the Italians are not, as to the hemisplieres,
divided, as were those of their Roman forefathers. But time brings about wondrous
clianges.]
We extended the study of these weight relations of the right and left
halves, to the cerebellum also; having, however, obtained but a small
Reviews, Book Notices, &c. 531
number (IS) of these observations, we cannot come to any conclusion;
but up to the present we have observed that the relation of the two
halves of the cerebellum does not in any respect correspond with that of
the cerebral hemispheres, and that the left half is frequently more devel-
oped than the right.
"Confining ourselves to observations on the cerebrum, which were
more amply made by us. we can securely conclude that the greater func-
tional elevation, to which the left hemispheres would generally be
destined, finds an anatomical basis in the greater development of this
part.
"We admit, indeed, with Luyg, as regards a certain independence of
the functions of the cerebral hemispheres, that the difference of weight in
one of these may throw light on the processes of mental pathology, but
we cannot, with him. affirm that the brains of dements are characterized
by a pathological hypertrophy of the right hemispheres.''
A Treatise ox Ixsaxtiy in its Medical Relations. — Dr William A.
Hammond has lately gotten out a new book on this subject (published by
D. Appleton & Co., ot 1, 3 and 5 Bond St., New York), for which he
claims new features.
The author dedicates this book to Dr. J. S. Jewell, of Chicago, "whose
learning has always commanded his heartiest admiration, and whose
friendship is one of the greatest pleasures of his life."
He points out in his preface what he thinks are " the distinctive fea-
tures of the present production." Having been " long convinced that the
term insanity has hitherto been applied in altogether too limited and illog-
ical a manner; he "does not see why all abnormal manifestations of mind
should not be included under the designation of insanity." as much as
normal mental phenomena are embraced under the term sanity. He has
thus marked out or rather taken down the wall of demarkation of, a
broad field, a field which, with such an elastic boundary line, the author
has certainly failed to cover.
Such univei'sal definitions of insanity have been made before, but
mostly by the literati, notably among them Charles Lamb, who " char-
acterized insanity as a straining or excess of one or more of the mental
faculties," and by an obscure alienist we once heard of, who coincided
with Dr. Hammond exactly when he testified in court " that insmity was
just the opposite of sanity, and sanity was just the opposite of insanity,"
and nothing more could be got out of him. Medicid men, before Dr.
Hammond, however, save and except the aforesaid " expert," have never
been so comprehensive. The tendency has been to signify something
definite in all medical definitions hitherto offered, so as to distino-uish
that grave malady which manifests itself mainly through mind de-
ranged from those evanescent psychical changes, which in darker
or lighter shade we see displayed in most diseases. The delirium of a
slight fever for instance, the unnatural petulance or fretfldness of other
physical sickness, and the irritability, changed demeanor and violence
even, associated with certain painful affections, like adontolgia, cephalal-
gia or neuralgia.
It must be remembered, as Forbes Winslow has said, that " there
532 Reviews, Book Notices, &c.
are few minds perfectly developed, balanced, disciplined, without some nat-
ural eccentricty or weakness, or in which some one or more are not prom-
inent enough to exercise an influence incommensurate with their value," or
as Jonson in his '"Rasselas" observes in introducino^ the mad astronomer
"there is no human mind in its right state, whose imagination and fancy
does not sometimes tyrannize over reason.
With most men there are times when
'' The unAvilling brain, feigns often what it would not,
And we trust imagination with such fantasies
As the tongue dare not fashion luto words."
But. if this be insanity, then truly are "All mankind insane, their in-
sanity differing only in degree" — "Such thin partitions do our wit&
divide.-'
It is therefore a restrictive, not an extensive definition of insanity that
is wanted for practical purposes.
Dr. Hammond is a fluent and voluminous writer. His pen is facile
and fertile. It may be said : "No pent up Utica contracts his powers,"
on the contrary Utica seems to have stimulated them. The whole
vast, boundless continent of medical literature is his, under this limit-
less deflnation, and perhaps, he aspires to traverse it and write upon it,,
and has given us this limitless definition of insanity in order that he may
some day indulge an evident penchant, which lie displays for discussing all
pathology. For most diseases have some peculiar psychical display ac-
companying them if we scrutinize them closely. The very sick man sel-
dom acts and speaks with all the sane characteristics of health.
Of course after so expansive a definition, our author must necessarily
reach the conclusion that " legal insanity and medical insanity are very
diflerent things, and the two standards c;m never and ought never to be the
Same." " The law,'' he says : '• establishes an arbitrary and unscientific
line." But sometimes law has been as expansive as Hammond, and as
futile in defining insanity, as witness the Solicitor General's learned dictum
delivered in tiie case of Earl Ferrari, when he declared "all ciiielty
brutality, injustice and violation of duty is insanity." He like Hammond,
would be comprehensive; but to what purpose except to defeat the very
purpose of the definition o! tiie disease, viz.. to make it mean something.
Law aims to be logical, and if the legal line of deinarkation between
2-esponsible sanity and irresponsible insanity is unscientific, the line ought
to be extended so as to include the true scientific view, and sooner or
jater science will triumph on this question of what constitutes irrespon-
sible insanity; just as it has always finally triumphed over all opposition
of Church or State. True science is truth, and the truths of medical science
must ultimately be accepted and conformed to by courts, as they ai'e re-
ceived by physicians. Scientillc dogmas relating to disordered mind, if
not fully accepted now, will j'et prevail because truth will be as mighty in
the future as she has shown herself to be in the past, if not now
triumphant " the eternal years" are hers, and she will ultimately prevail,
despite all forseiisic or other opposition.
The author weakly coniproiiiises with error in conceding the legal,
'' knowledge of right and wrong tests " of insanity to be " about as correct
Reviews, Book Notices, &c. 533
a legal line as a due regard for the safety of society will permit," while
many eminent jurists take a much more just, because more scientific view
of those undoubted forms of morbid aberrant mental impulsions, associa-
ted especially with epileptic and epileptoid conditions, which impel re-
pistlessly to acts of violance at variance with the normal abstract conscious-
ness of right and wrong. As a learned judge lately said : ''what is scien-
tifically true should be legally true,"
The author makes this unscientific and undefenseable surrender to the
policy of the law, kno\ving it to be as he says : " absolutely untenable from
his point of view." ktiowing that it is not a medical line, and that there are
thousands of lunatics insane enough to believe themselves to be veritable
Julius Caesars, that come within it.
"There are few people," the author goes on to state in justification of
his extensive and extensible definition of insanity, " who have not, at some
time or another, perhaps for a moment only been medically insane." We
concede that there should be a diflerancebetween this kind of insanity, and
legal insanity. The history of the human race might be written under
the caption of psychiatry so defined, and our author will have to do it, if
he compasses the subject of insanity as defined in his preface definition.
The author, however, gives another medical definition of insanity.
It is but natural after such a comprehensive view of the subject, that
the author should conclude that there are many varieties of mentat derange-
ment of which asylum physicians never see the beginning." and •• others
not requiring the restraint of an institution of any kind." But he does not
concede that there are any forms of insanity in asylums with which he is
unfamiliar. Under this expansive conception of insanity, it would be per.
haps as well to follow the suggestion of a patient at Fulton, at the be-
ginning of the war who thought in view of the fact.that the whole country
had gone crazy, it would be wisest to send home the comparative few
there restrained.
It is however, undoubtedly true that there yet remain many un-
written phases of prodromal mental aberration, quite unfamiliar to asylum
physicians or to the profession generally. There is still room for many
more books like the excellent treatise of Forbes Winslow on "obscure
diseases of the brain and mind." and he, who. following in Winslow's illus-
trious footsteps, and in those of Mortimer Granville, rightly observes and
faithfully makes further record of tiie precedent symptomatic features of
final mental overthrow, will deserve well of the profession, and of hu-
manity
He who points out the way in which madness lies that we may shun
it, is indeed the greatest of benefactors.
The author finally andoipates the objections that may be made that,
not being the superintendent of a lunatic asylum, he has no business to set
up as an authority on the subject of insanity, and proceeds to state his
claims to be so considered, which are indeed not mean. he. by reason of
the several positions he has held as teacher on the subject of diseases
of the mind and nervous system for tiie last seventeen years, having had
ample opportunity to familiarize himself literally at least on the subject,
and to entitle him to a respectful hearing. But suppose be had seven-
534 Reviezus, Book Notices, &c.
teen years of experience as an asylum physician as well as teacher,
would he have io^nored that experience as valueless? We can not help
thinking that it would have improved the author's qualifications for
writing a book on insanity, if he had resided for a few years ina lunatic
asylum. The logical blade he wields is double-edged, even in the hilt.
Having shown himself entitled to an audience, he concludes his pre-
face with the following parting shot, showing tl^at he holds a not very
exalted estimate of such asylum superidtendents, as do not consider him
clinically qualified to write a treatise on insanity. "Though 1 cannot
claim to have seen so many cases of insanity, as the average superin-
tendent of an asylum with its thousand inmates ( the average hospital
for the insane contains not over half that number of patients), I do
claim tliat a single case thorougldy studied is worth more as' a lesson
than a hundred tliat are simply looked at, and often from a far off,"'
and in comparison he likens himself to the medical student who, de-
secting one human body is likely to learn more of anatomy than the
janitor who sees hundreds of corpses brought to the dissecting room.
This is rather a disparaging, if not modest contrast, between the author
and the superintendents, though it indicates the .author's exalted estimate
of his capacity to write a book upon the subject he has chosen for the
present treatise. The logic of the comparison v.'ill however be diputed,
as notwithstanding the great distance between the author, and tlie asy-
lum physicians, they are physicians, though the latter be ever so insig-
nificant in comparison. lie justly acknowledges his indebtedness to Dr.
Ralph L. Parsons, late medical superinten(!ent of the New York City
lunatic asylum, but now the efiicient snpeiintendent of Greenmont on
the Hudson, for the use of his voluminous case book of patients in
that institution, while it was under Dr. Parson's charge. "The perusal
of those records has been of great assistance to him in his description
of the several forms of insanity."
Some time ago (186S) a prominent asylam superintendent expressed
the hope that " the period might not be far remote when the medical
profession will be as ready to treat insanity, as other nervous and cere-
bral disorders," Tlie book before us is probably written in fulfillment of
that desire and prediction.
Dr. Hammond's capacity to write a book is conceded. He can write
entertainingly on any subject he choses for his theme. He has written well
on syphilis, military hygiene, anthropology, other medical themes and
fiction. This apologetic and denunciatory preface is, thei-efore, while
assertive of self-confidence, suggestive, also, of personal misgivings. It is
a weakness in the bringing forth of a new book, as in the birth of a new
being, to have to establish by argument and appeal to the record, its leg-
itimacy.
In the initial pages of the book the subject of eccentricity, idiosyn-
crasy, genius, habit and temperament are briefly but not profoundly dis-
cussed, the subject of heredity is liere, likewise, too cursorily, but more
satisfactorily, presented. The interesting chapter on age, with which the
readers of this Journal are familiar, which might have been lenghtened
without lessening its interest, comes next. The subjects of race and sex
Reviews, Book Notices, &c. 535
occupy the next twenty pages, and conclude the first section of the book.
Tne second section is devoted to the discussion of instinct, whose chief
seat the author locates in the medulla oblongata and spin:d cord.
The discussion of sleep, its cause and phenomena oc upies the next
section,and carries tlie reader to the two hundred and sixty-first page. The
autlior. following NVinslow and others, refers to the progno-tic value of
dreams, wiih reference to the approach of cerebral disease, and attempts to
give to certain dreams a diagnostic value, but for every dream of definite
character, followed by a lesion of the locality indicated in the dream,
scores of dreams, equally definite, might be cited, followed by no such cir-
cumscribed encephalic affection or, indeed, by no encephalic lesion at all ;
nevertheless, the subject is not without interest an i importance to the
physician, though such a book in the hands of laymen would incline to
develop hypochondiiasis.
The author reiterates the anaemic theory of sleep which is only partly
tenable a=; the favorable and usual condition of sleep, not as the essential
cause always, as the phenomena of artificially induced narcosis, of hypnot-
ism, asphyxiated and hyiterseoiic slumber prove, as well as the arterial
excitation which a companies the falling into sleep from hyosciamin
chloral, etc.
The conditions of somnolency or insomnia are rather in the cerebral
cell than in the calibre of cerebral vessels, whatever adilitional influence
vascular states may exert upon the brain. Nevertheless long age. Macnish
overthrew the cerebral turgescence theory of sleep, and our own Caldwell,
of Kentucky, disproved it in his day. while Play fair, in 1S44. preceeding
Durham, also, demonstrated that ,less blood was in the brain, or needed
there, during sleep than when it is awake.
The author not only adopts the exclusively somatic theory of mind,
but maintains, without reserve or qualification, what might be called the
som itic e:iology of mind, the gene-is of whicli he locates wherever there
is gray matter. That is. "the brain is not the sole organ of the mind.'' but
•'the spinal cord is. likewise, the seat"* (with the brain) "of certain
elements of mind, or rather is capable of evolving them."
Discussing the size of the brain, i-elative to mind, he introduces Thur-
man's tables, but makes no addition to them. In connection with the
statement that the size of the brain is well known to bear a "direct rela-
tion to the intelligence of the individual.'' It would have been interesting to
hear the author's explanation of the relationship of the powerful, but dim-
inutive brain of the great Gambetta, with its deep and complex convolu-
tions, and Whitehead's great sixty-eight-ounce brain and well developed
convolutions without intelligence.
In the subsequent chapters of the book the readers will find the feat-
ures of insanity well porti-ayed, but the discriminating alienist of wide ex-
perience will not discern in what is written therein, the hand of a master
in psychiatry. The book does not compare fivorably with his treatise on
the diseases of the nervous system.
The chapter on the volitional insanities gives just prominence to a
feature of mental alienation, worthy of still more extensive consideration
than has yet been given it. Dr. Hammond gives this mental condition the
536 Reviews, Book Notices, &c.
uneuphoneous name of aboulomania, which sounds, too nearly like a term
which might be framed for a form of insanity displayed in morbid condi-
tion of the appetite. This new term will prove about as unacceptable as
the unpronounceable name the author proposed to give to hypnotism.
Terms, more pleasing to the ear, might be suggested for both. But why
make a new form of mania out of this when the will is just as absent in
hysteria, etc.
In discussing the prognosis of insanity he gives prominence to the
views so well presented in these pages by the distinguished and venerable
medical head of Northampton, Dr. Pliny Earle. Katatonia, so well des-
cribed by Kahlbaum and Kiernan, is given due prominence, and four cases
ai*e recorded by the author.
The interesting case of juvenile pyrophobia reported in these pages
by Dr. Willis P. King, of Sedalia, Mo., has not escaped the author's atten-
tion, while no mention is made of the most youthful case of mysophobia
or toxiphobia on record, reported by the reviewer to the St. Louis Medical
Society, and recorded in its proceedings, probably because it is not desig-
nated as mysophobia but toxiphobia. Mysophobia is not a new form
of insanity, having been long recognized by all alienists as a symptomatic
expression of cerebral disease, mainly under the head of toxiphobia, a
fear of being poisoned being the underlying dread of most of these
cases, and a very common form of dread among the incipient and confirmed
insane.
Reasoning and emotional mania, intellecual monomania, dementia,
acute mania, the epileptic, choreiac and hysterical insanities, and their cau-
ses, treatment, and morbid anatomy are reasonably well presented and some
of the descriptions are classical.
A morbid irritability seems apparent in the author, towards certain
asylum superintendents, to whom some of his chapters seem especially
directed, particularly those on the subjects of resti'aint and recoveries; and
it is painful to see the bias of a personal grievance display itself in state-
ments made under the head of treatment, calculated to intensify tlie
already exaggerated distrust in the popular mind of American asylums
for the insane. It is bad enough for the sensational public press to gloat
over the outrages which are sometimes perpetrated by inhuman attendants
upon the insane in asylums, but which do not compare with the inhuman-
ity towards the insane, outside of the public asylums, but it is not pai don-
able in a medical author to give undeserved prominence to these excep-
tional abuses as it they were general and almost universal occurrences, no
matter how great his personal grievances. Such degressions in a chapter
on treatment will be noted to the author's disparagement, even by those
of his own way of feeling; nevertheless, such attacks will not be without
ultimate good in stimulating to greater vigilance in the protective eare of
the insane, by parsimonious managements of asylums, who, by confiding
to the keeping of too few attendants and political appointments, make
abuses in some State institutions still possible.
The reader will not be disappointed at finding nitro-glycerine among
the author's therapeutics. Indeed with the feelings displayed in the chap-
ter on treatment towards certain American hospitals for the Insane, a
Reviews, Book Notices, &c. 537
prescription of dynamite might be expected. He may be termed the
*• dynamite fiend" of "the asylum circle," for he loses no opportunity
to blow the latter up.
What the author says about special non-asylum treatment, when
means are adequate to provide all essential surroundings and care
for patients under competent alienists, is worthy of consideration, and
has been borne out in our experience, when we have been left untram-
melled by friends and unrestrained in resources; but these are the obsta-
cles. The alienistic physician, whose practice is not limited to a lunatic
asylum, has peculiar facilities for studying insanity in its first and most
curable stjiges, and for arresting its progress, and we hope the day is not
far off, when the profession will recognize the fact generally, not by all
physicians attempting to treat all cases of insanity out of asylums, but by
procuring competent counsel among alienists and securing early judicious
management including prompt removal to asylums of such cases as ought
to be sent there.
The author's strictures on political management of State asylums, and
the appointment of physicians for political reasons, and without knowl-
edge of the human mind and its treatment to take charge of them, a little
more temperately drawn, would be endorsed by the majority of asylum
superintendants in the land, and the reduction of irritating mechanical
restraint is nearer non-restraint in American asylums for the insane than
would be inferred from the reading of Doctor Hammond's chapter on the
subject.
The doctor seems to be not so cool as he might be on the crib, " that
highly moral instrument of persuasion, so much liked by certain of our
American superintendents," an instrument which if dispensed with in cer-
tain asylums, would not probably be objectionable to the doctor if used in
certain others.
Sulla Compensazioni Funzioxali del la Croteccia Cerebrale.
CONTRIBUZIONE SpERIMEN'TALE DEL PrOF. L. BiaXCHI. EsTRATTO DAL
GiORXALE LA PsYCHiATRiA. Napoli, 1883. On the Functions of the Cere-
bral Cortex. An Experimental Contribution. By Professor L. Bianchi.
Reprinted from La Psyehiatria, 800 pp., 73.
This valuable brochure will be noticed in extenso, in our next number-
We extract now, only the distinguished author's conclusions which are
based on a series of seventeen satisfactory experiments :
1. There is a cortical zone on the anterior lobe of the brain, which
has no definite limits, but which does not extend more than one centi-
meter backwards from the posterior limit of the post-crucial convolution
of the dog, and which contains all the motor elements for the whole mus-
cular apparatus of the opposite half of the body.
2. On this large cortical surface some points are alone excitable, and
the remainder, although containing motor elements, are not.
3. Some groups of muscles are certainly represented in distinct areas
within the limits of the zone, but they are also spai-sely so in the whole
remainder of the zone, in such a manner, that after a partial destruction,
what remains of the destroyed zone, will in part act in a compensatory
manner for the functions of the destroyed part.
53^ Reviews, Book Notices, &c.
4. It is only wlien the removal implicates a larg-e part of the motor
zone that the motor disturbance becomes permanent.
5. The motor zone of the normal hemisphere compensates to a cer-
tain degree the function lost by the mutilated hemisphere, not by aseum-
inof a new function, but from the pre-existence of anatomical relations
with the muscles of the same side, and of homologous anatomical elements.
6. Locomotion is not a function of the cortex, like a mechanism or
motor act, although lilce a motor impulse, being generated in the sensory
and intellectual sphere.
7. Disturbances of tactile sensation when but a slight portion of the
motor zone is removed, and not absolutely demonstrable in the dog.
8. On the brain of the dog tlierc is a mixed motor and sensory zone,
and this zone is the anterior branch of the second external convolution,
which is either carried to the signoid gyrus, rendering the hemiplegia
more grave, or is only extirpated, disturbing tlie motility of the dog ;
never the sight.
9. The center of sight is represented bj' a large extension of the cor-
tex, whicli maybe dividi-d in three segments. The isolation of any one
of these is equivalent to the extirpation of the whole, but with a tempo-
rary effect, and whatever remains of the whole center is sufficient to re-
establish vision.
10. The extirpation of the entire cortical center of vision, as I have
considered it, is equal to a section of the posterior segment of the inter-
nal capsule; it produces permanent visual disturbances. The compensa-
tion comes from the hemisphere of the same side if the lesion is circum-
scribed, and not from the opposite hemisphere.
11. The visual disturbances provoked by cortical extirpation are not
ambl\ opia of the opposite eye, but always bilateral hemianopsia. Each
eye is represented in the two hemispheres, more in the opposite, and less
in that of the same side.
12. Vision is a complete function, resulting from more important
elements represented in ditiierent cortical zones, wliich compensate for
each other, when one or more of them are destroj'ed.
13. Tlie conception of localization in general must not be assumed
in the absolute sense of the word, but relatively, from the fact that some
cerebral functions are positively determined and checked by anatomical
limits, and, on the other hand, other functions normally complete in them-
selves, are not so in the presence of all tlie elementary processes, of wliich
they are the ultimate expression as an apparent phenomenon; whilst
similarly the anatomical area, by wh ch it would seem to be explained and
be the Itist station, to which normal functioning is referred and all that
preceded, owes its primal matter or indistinct force, assuming new char-
acters if it determines always more in what form the different gradations
of life follow our senses and our intelligence, which analytic force remains
very much inferior to tiie complexity of the plienomenon.
Insanity; Its Causes and Fkkvkntion. A new book of two himdred
and sixty-eight i)ages, published by the well-known publishing iiouse of
G. I*. I'utnain ifc Sons, wliich, fiom a cursory view of its contents and our
personal familiarity with the qualifications of theautlior, Dr. Harvey Put-
Revieii's, Book Notices, &c. 539
nam Stearns, to write upon the subjects included in the title, favorably
impresses us ; a book suitable to the subject, the times and its author.
Without having yet given it a critical examination, we nevertheless
commend it on the faith we have in the capacity and experience of its
author. It will be reviewed in our next.
Diseases of the Nervous System, is the title of the second edition of
Dr. Samuel Wilk's lectures, delivered at Guy's Hospital, London, and pub-
lished in this country by P. Blaki-ston. Son & Co.. which, like the preced-
ing, has come to us too late for extended critical examination.
We have had time, however, to satisfy ourself that the present volume,
like its j'redecessor, is an excellent practical contribution to the subjects
treated of by the author in his lectures. It has the advantage, also, over
some other similar treatises, of being more decidedly clinical in its features.
We are gratified to find a disposition in this book to give due credit
to American investigators, as witness his just reference to Dr. Caldwell, of
Kentucky, accrediting him with his pan in exploding the hyperamic
theory of sleep. The -matter' evidently got disconnected on the •• form,*'
relating to the subject of chorea.
This book will also probably be reviewed in our next number. In the
meantime we advise those who have not the volume, to possess them-
selves of it.
How TO Avoid Insanity. In the annual report of the Massachusetts
State Board of Healtii is a paper by Dr. Charles W. Page, assistant phy-
sician of the Hartford Retreat, \aluable for its treatment of the import-
ant question how insanity may be avoided. Dr. Page gives a plain, well-
defined and easily compi-ehended description of the most prolific caust-s
of insanity, and of the best methods of applying the laws of prevention,
with striking illustrations of the ease and simplicity of these applications,
and of the absolute necessity of astrict obedience of these laws, as the surest
way to escape from the disease. The prevention of disease is a political
and a social, as well as a medical study.
Taking the report of the Connecticut Hospital as giving a truthful
measure of general lunatic hospital results. Dr. Page finds that in about
half the 2,333 cases admitted, insanity was brought about by causes
largely under the control of man. His oomments upon these causes, and
the best methods of their avoidance are interesting and instructive.
He justly regards hereditary tendencies as the bottom of most cases of
insanity, the bad habits of one generation becoming diseased conditions in
the next.
It is a good thing for state boards of health to put such papers bef Jio
the public; but it would be still better if they would strenuously urge,
until something is accomplished in the direction of the lawful debarring
of matrimonial alliance among those who can only bring forth mentally
defective oflspring to burden human life with misery and woe. and com-
monwealths with demands on charity and reformatory and penal insti-
tutions.
Introduction a L'etude de L'electrotonus des Nerfs Moteurs et
Sensitifs Chez L"hom.me, Par Armand de Watteville —This, as the
540 Reviews, Book Notices, &c.
author states in his preface, is intended to serve as an introduction to tlie
more detailed and extended work, which he has undertalcen with his
friend, August Muller, and which has for its object, to establish an electro-
physiology of human life.
The experiments on the electrotonus of the motor nerres by the
unipolar method have been largely conducted by his confrere ; the experi-
ments by the bipolar method on the sensory nerves have been made by the
author.
These experiments are exceedingly interesting, and will prove a cap-
tivating and instructive study to neurologists, and stimulate an eager
desire to come early in possession of the promised larger work, notwith-
standing the book before is quite complete and valuable. If space permits
in our next issue, we shall favor our readers with some extracts and a
more special reference to the contents of this original contribution to
scientific neurology.
Ueber die Summirung von Reizen in den sensibilen Nerven des
Menschen. Von A. de Watteville, A. M., M. D., B. Sc, in London. Sepa-
rat-Abdruck aL-.s Neurologischea Centralblatt.
An Italian Quarterly, devoted to psychiatry, which is making quite
an enviable name for itself, is : La Psyehiatrie ; La Neurapaiologie e le
Scinze Affini, which is published in Naples under the direction of Prof.
G. Buonomo, and edited by Dr. L. Bianchi. The second number of the
first volume contains the conclusion of a very interesting paper on the
functional compensation of the cerebral cortex, by the editor The brain
in man, considered from an anthropological point of view, by Professor
G. Nicolucci, is begun in this number, and shows great care and research
in its preparation. These original articles are followed by abstracts from
the different foreign and domestic journals, among which the Alienist
AND Neurologist receives prominent mention. The abstracts are all
carefullj^ made by competent men, and the comments are of the highest
value. The journal presents a good appearance and is sure to meet with
success.
Handbook of Medical Elkctricity. By A. M. Rosebrugh, M. D., Sur-
geon to the Toronto Eye and Ear Dispensary ; Member of the Interna-
tional Ophthalmological and Otological Societies. We judge this little
book is intended mainly to introduce a convenient modification of the
Mcintosh Battery, made by the author. As a treatise on Electricty in its
therapeutic applications, it is quite incomplete and in some places mislead-
ing.
On thk Character and Hallucinations of Joan of Arc. By Wm.
>V. Ireland, M. D. Read to the Brancli Meeting of the Medico-Psycholog-
ical Association at Edinburgh, November Ist, 18S2. Reprinted from the
Journal of Medical Science, April, 1883. This is the conclusion of an excel-
lent psychological analysis of tiiis remarkable historical character, wlio,
herself deranged, turned the heads of all France in her day.
The Medico-Lkgal Journal. (Published under the auspices of the
Medico-Legal Society of New York.) This is a new venture in a field
that has not liitiierto proven profitable in this country. This journal
Ret'iews, Book Notices, &c. 541
starts under favorable auspices, and may be more fortunate than some
of its predecessors.
Valedictory Address to Graduating Class, College of Physicians and
Surgeons, Baltimore, March 1, 1883. By Richard Gundry, M. D^ Profes-
sor of Materia Medica, Therapeutics and Mental Diseases, College of
Physicians and Surgeons, Baltimore; Superintendent of Maryland Hos-
pital for the Insane. Reprinted from the Medical Chronicle, April, 1883.
Advanced Sheets from Dr. Ed. C. Mann's new book on Psychological
Medicine are received late. They, however, favorably impress us with the
belief that tht; forthcoming book will be especially valuable to those for
whom it is designed — general practitioners of medicine.
The Opium Habit; its Successful Treatment by the Avena Sativa, A.
paper read before the New York State Medical Society, Febuary 9th, 1882,
with additions, giving a fuller description of its therapeutic action In dif-
ferent diseases, etc. By E. H. M. Sell. A. M., M. D.
The OflScial Correspondence Between Surgeon-General William A
Hammond, U. S. A., and the Adjutant-General of the Army, Relative to
the Founding of the Aimy Medical Museum, and the Inauguration of the
Medical and Surgical History of the war.
Greneral Paralysis of the Insane. An Essay submitted to the consider-
ation of the Medical Society of Morgan county, Illinois, April 13th, 1882.
By T. Fletcher McFarland, M. D., of Oak Lawn Retreat for the Insane,
Jacksonville, Illinois.
Hints on the Treatment of Some Parasitic Skin Diseases. By Greorge
H. Rohe, M. D.. Professor of Hygiene and Clinical Dermatology, College
of Physicians and Surgeons. Baltimore ; Reprinted from The Medical
Record, June 2, 1883.
Homicide and Suicide in the City and County of Phidelphia, Pa.,
during a decade, 1871 to 1881 inclusive. By John G. Lee, M. D., Coro-
ner's Physician. Member of the Academy of Natural Sciences. Phila-
delphia, Pa.
A (^ase of Hemiplegia, with remarks on Secondary Degeneration of the
Pyramidal Tracts. A paper read before the Ohio State Medical Society,
June 14tli, 1882, by Philip Zenner, M. D., Cincinnati, Ohio.
Microscopical Examination of Potable Waters in the State of Connecti-
cut. By William J. Lewis, M. D. (Reprinted from the Proceedings of
the State Board of Health, 1883.)
Experts and Expert Testimony. A paper read before the "Medico-
Legal Society," on Wednesday evening, March 7th, 1883, by Ex-Surrogate
D. C. Calvin.
On the Importance of the Early Recognition and the Repression of
Mental Disease in its incipient stages. By Edward C. Mann, M. D., of
New York.
The Insane Diathesis. By Selden H. Talcott, A. M.. M. D. Medical
542 Reviezvs, Book Notices, &c.
Superintendent, State Homoeopathic Asylum for the Insane, MiddletowD^
N. Y. ,
Medical Notes on the Treatment of Mental and Nervous Diseases
By Selden H. Talcott, A. M., M. D.
Seventh Biennial Report of the Board of State Commissione/'S of Pub-
lic Charities of the State of Illinois.
Aphasia, with Details of Two Interesting (.^ases. By Philip Zenuer, A.
M., M. D., Cincinnati, O.
Pemphigus, and the Diseases Liable to be Mistaken for it. Same
author and source.
Report of the Committee on Ophthalmology, Ontario Medical Asso-
ciation, 1882.
Ocular Symptoms as Localizing Symptoms. By S. G. Webber, M. D.,
Boston.
The Treatment of the Various Forms of Acne. Same author and
source.
General Paralysis. By Philip Zenner, A. M., M. D., of Cincinnati, O.
The Diagnosis of Insanity. By D. A. Morse, M. D., Oxford, O.
Report of the Proceedings of the Illinois State Board of Health.
Jequirity Ophthalmia. By S. Pollak, M. D., of St. Louis.
John Hopkin's University Circulars. Volume II, No. 22.
Weekly Health Bulletins.
THE
Alienist i Neurologist.
Vol. IV. OCTOBER, 18S3. No. 4.
Original Contributions and Preferred Translations.
The Mental Status of Guiteau — A Re-
view.
By James H. McBride, M. D.,
Saperintendent of the Hospital for the Insane, at Milwaukee, Wisconsin.
TN the April ( 1883) issue of this Journal, there appear-
-*- ed an article on the mental status of Guiteau, written
by Dr. J. J. Elwell, a member of the Cleveland Bar. It
will be the aim in the following brief review of the doc-
tor's article, to show wherein it appears to the writer that
he errs, both in his argument and conclusions. The doc-
tor treats of Guiteau's mental status under five separate
paragraph headings, and in this review I shall consider his
propositions in the order in which he has arranged them.
It is of course quite impracticable to quote the doc-
tor fully; and in order that no injustice may be done him,
all who read this review are recommended to first read
carefully the excellently written article by Dr. Elwell.
It is proper that I should preface this article with an
apology for making such frequent references to myself.
Having been one of that army of experts who so long
besieged the court room during the Guiteau trial, it has
been found quite impracticable to write upon the subject
of the prisoner's insanity without making those frequent
references to personal experience, which, if possible, I
would gladly avoid.
544 James H. Mc Bride.
First. " A person cannot be born insane.'' — Dur-
ing the past year this statement has been cried aloud
from the housetops of psychological discussion with
almost wearisome reiteration, and yet it is doubtful if
there is any reason why the air should be so frequently
rent in proclaiming an indisputable fact. It is unques-
tionably true that no person is born insane; and it is also
true, though apparently forgotten, that no person is born
sane. At birth a human being is but a mass of human
possibilities, determined and limited by his inherited or-
ganization. No person can be called sane or insane,
until he has developed mind in some degree, and at
birth a person has no mind, because the organ of it is
quite undeveloped.
" There are no positive indications of the hereditary
tendency to insanity being present in the Guiteau family.''
It is really strange how men differ. If the Guiteau family
did not exhibit a predisposition to insanity — properly
attributable to inheritance — then the meaning of the term
inheritance is narrowed to limits that are quite insignifi-
cant. When we consider the number of cases of insanity
occurring among the uncles, aunts and cousins of Guiteau ;
when further we consider his mother was for eighteen
months previous to his birth sick and helpless from some
form of brain affection ; that of her two subsequent chil-
dren one died of quick consumption in infancy, and the
other was deformed and died soon after birth ; when we
consider the mental weakness of the father, that the
assassin's only sister was insane some years ago, and has
recently been declared insane by an Illinois jury, the
wonder is not why Guiteau became insane, but how by
any possible chance or accident a sound organization
could come of such a union of mental and physical weak-
ness and disease. During the trial of Guiteau, I saw
much of his sister, Mrs. Scoville, and it was my opinion,
as expressed at the time, that she was insane. John W.
Guiteau was barely an improved edition of his brother,
and I certainly never saw so strange a mixture of sanity
The Mental Status of Guiteau. 545
and folly as he exhibited. He was frantic, even unreason-
able, in his efforts to save his brother, yet he retailed to
every chance questioner the plans and secrets of the defense,
and was a continual hindrance to Mr. Scoville. He said to
me on one occasion that if he knew his father was insane,
rather than have the fact proven, he would see his brother
hung. There was a striking similarity of the mental traits of
Guiteau and his father, with an exaggeration in the son
of the eccentricities of the parent. Guiteau was a crooked
limb of a tree that had few straight fibres in it, and
because he was a little more degenerate in organization
than his father, the cycle of his existence was briefer,
and mental disorder came at an earlier period of life.
Considering the eccentricities of the Guiteaus, the numer-
ous cases of insanity occurring in the family, and in par-
ticular the weaknesses of the assassin's parents, we would
naturally expect that mental disease and degeneracy
would occur among their descendants ; to expect sound
organizations to come from such a source would be to
seek for pure water to flow from a poisoned fountain.
That the law of inheritance may help to explain the
mental characteristics and life of Guiteau, it is not neces-
sary that insanity should have been transmitted to him
by a direct and unbroken line of descent. Family
degeneracy may come from many and distant sources,
from states of mal-organization in one generation that
are not easily named, but which when further devel-
oped in succeeding generations exhibit themselves in
various states of disease, and in innumerable forms of
mental and physical deterioration. The offspring of par-
ents who are merely of weak organizations may in one
instance be consumptive ; in another, cancerous ; in another,
epileptic, and in another, perhap?, insane ; all, however,
owing their diseased and degenarate organizations to a
tendency to family deterioration.
When a medical man finds that a number of near
relations are afflicted with insanity or consumption, or
any other disease that is known to be hereditary, he
546 James H. Mc Bride.
is justified by every rule of logic, and all medical
experience, in concluding that a disease affecting so
large a number of persons who are related, must have
had its origin in pecuHarities of constitution of ancestors.
Insanity occurring in three brothers and three sisters and
in certain of their children, and consumption occurring in
other members of the same family, did not, probably, occur
because of the special circumstances of life of each indi-
vidual independent of any form of inheritance. Every med-
ical man who considers such a family history will properly
conclude, that the disease thus occurring has been derived
by descent in some form — the expression in diseased des-
cendants of conditions of degeneracy existing in ancestors.
It is an unquestionable fact, that insanity and other
diseases may have their origin in conditions of ancestral
life, and organizations; although, in those ancestors these
conditions may not develop actual disease, they may be
exhibited in forms of disease and degeneracy only in
descendants. A large proportion of the insanity that
occurs is due to direct and positive transmissal of the
insane temperament, and another proportion is attribu-
table to the inheritance of organizations that are simply
weak and degenerate. This second proportion is as much
due to inheritance as the first, and it is not to be
ignored because disease in the ancestors was not fully
developed and active. If all the insanity existing at
the present day could be swept away, and with it all
the hereditary tendency thereto, insanity would continue
to occur, and a proportion of it would be attributable
to a form of inheritance. That is to say, insanity
so occurring would be attributable to the transmission,
from the previous generation, of conditions of organi-
zations favorable to degeneracy. Guiteau, it is plain to
me, owed his insanity not necessarily to his insane
father, nor to his diseased mother; but to a distinct
and positive and common tendency in the Guiteau
family to mental and physical degeneracy. If evidences
of family degeneracy ever justified the conclusion that
The Mental Status of Guiteau. 547
there is hereditary predisposition, this conclusion is surely-
justified by the history of the Guiteau family, in two
generations of which there were many individuals who
were either defective, consumptive or insane.
That Guiteau's alleged good health was inconsis-
tent with the existence of insanity in his case is a claim
that is not well founded, as every-day experience with
insane persons shows. Insane people are frequently
physically diseased, indepedent of brain disease, but they
may also be physically sound. There is now a man in
this institution who has been insane for about twenty
years, and who has no discoverable disease of any organ,
and who has never been seriously ill in his life, so far
as it is known. In this institution of over three hundred
inmates, there are a number of persons who enjoy
excellent health aside from their mental disease, and it
is not probable that the proportion of those who enjoy
good general health is greater here than in similar insti-
tutions.
In relation to the autopsy, it is not probable that
there will soon, if ever, be a unaminity of opinion regard-
ing the significance of its revelations. Yet it would seem
that those who insist that insanity is always a symptom
of a pathological state, should be slow to cast aside as
worthless the evidences of disease revealed in the exami-
nation of Guiteau's brain. Here was a man who was
believed to be insane by his own relatives ; who years
previously had been declared insane by an intelligent
and experienced physician who had abundant opportunity
for observing his mental condition ; who was also consid-
ered insane by a number of persons who had seen him
at various times ; who was regarded as insane by a num-
ber of medical gentlemen who had made insanity a
special study. This man is executed and his brain is
examined by microscopists, who are disinterested and
scientific gentlemen, and they discover evidences of dif-
fuse chronic disease. All this, and much more, has
appeared to me to be strong evidence of this man's
548 James H. McBride.
insanity, and yet some of those who have written in sup-
port of the idea of Guiteau's sanity have tripped over
these matters with a jaunty air that is quite discourag-
ing to one who is disposed to regard them in soberness.
The careless ease with which such facts have been tossed
aside, in the discussion of this subject, is shown by the
reference in the article of Dr. Elwell, to the evidence of
disease as reported in the examination of Guiteau's brain.
It seems to me, however, there is here a failure
to interpret correctly the meaning of the pathological
appearances in this case. As an architect can with the
same materials construct buildings of various shapes,
according as he fits those materials together, so the con-
clusion at which one may come from a consideration of
certain facts will depend upon the way in which he
regards those facts, upon his manner of fitting them to
each other. If we accept it as a truth needing no quali-
fication, that serious brain disease may exist without
producing insanity, then of course the demonstration of
the existence of disease in the brain of Guiteau is of
little value in determining his mental condition. But to
stop with such a statement is to consider the subject
quite imperfectly. It is not sufficient to say, that because
men have been known to remain in a state of sanity
with serious disease of the brain, that, therefore the
existence of diffuse chronic disease is without special
signification. In our study of this question we should
take into consideration certain distinguishing features of
the morbid conditions, which we attempt to compare.
The trunk of a tree may be struck by lightning, and a
large portion of it be destroyed, and yet, the part
remaining uninjured may take on the function of the
part that has been destroyed, and the tree continue to
grow, and to present the appearance of health. If, how-
ever, the tree is attacked with a form of decay that dif-
fuses itself throughout its structure, its growth may be so
seriously impaired that it will wither and die, and yet,
the most careful examination may be necessary to dis-
The Mental Status of Guiteau. 549
cover the disease that destroyed its life. A man may
have a large abscess of his liver, and yet wholly
recover from it, and the function of the organ after-
wards be properly performed. If, however, his liver be
attacked with cirrhosis, though a microscope be neces-
sary to detect the morbid growth of connective tissue,
yet we know that the disease will slowly but certainly
strangle the little liver cells, and finally destroy the
function of the organ. A bullet, or even a crowbar,
may pass through the brain, and yet, after^ the imme-
diate effects have been recovered from, the mind will
remain in the normal condition ; a large abscess may
form in the brain, destroy tissue, and yet the person
recover without any observable loss of brain function.
Experience teaches us that these things do occur, and
our knowledge of physiology and pathology would lead us
to conclude that they might occur, even without the
lessons of experience. There is, however, a different
and special significance in those forms of cerebral
disease which are diffused and chronic, which are not
localized and isolated in centers of healthy tissue, but
in minute masses and microscopic colonies of degen-
eracy, are found scattered in various regions of the brain.
When we discover evidences of this form of disease, we
are justified in concluding that this wide-spread and
serious impairment of nutrition implies a like serious im-
pairment of function. The function is not only lost in
those parts destroyed by disease, but the undiseased por-
tions of the organ, through contributing to the main-
tenance of a morbid process, lose to some degree in
vigor of function.
In the case of Guiteau's brain, we are informed that
in all parts of the organ examined by the microscope
(more in some parts than in others) the ner\^e tissue was
seriously diseased, the blood-vessels were diffusely and
chronically degenerated, and other evidences of cerebral
degeneration were discovered.
Our knowledge of the pathology of insanity justifies
550 James H. Mc Bride.
the conclusion that the existence of diffuse and long-
standing brain disease, such as was shown to have
existed in this case, has a special significance, and it
seems to me that the reasonable and inevitable conclusion
from the examination of Guiteau's brain must be that the
character and extent of disease shown to exist, was
wholly inconsistent with mental health ; that it compels
us to conclude, that there could not have been in his
case anything short of long-standing and serious mental
derangement. This opinion is not expressed hastily, but
after careful and impartial study of the case during life,
and of the reports of the post-mortem examination ; and
in the Hght, dim though it may be, of nine years of
patient investigation, which I have devoted to the
microscopic pathology of the brain in insanity.
Secojid. No one, perhaps, has claimed that a motive-
less crime is necessarily an evidence of insanity. There
is, however, much evidence of insanity in Guiteau's reason-
ing regarding the consequences to himself of the shooting
of the president.
His whole scheme of taking part in the presidential
campaign, with a view to subsequent political reward, was
conceived in insanity and grew to its absurd and colossal
extravagance tiirough the continual help of progressive
disease. A man without even medium talent who has
attempted to speak in public a hundred times and always
failed, proclaims himself a political orator and asks for
assignments to speak in a presidential campaign ; to the
prospective president from whom he would expect reward,
he hands a copy of a wandering, empty and incoherent
speech, which of itself would destroy all possibility of
political preferment. He attempts to deliver this speech
to a colored audience in the Bowery, but quits before he
has completed it, because, as he said, he " didn't like the
crowd." He subsequently claimed, and doubtless sincerely,
that this speech elected Garfield president. Then he is
seen in Washington seeking an appointment to a foreign
mission as a reward for his imaginary political services-
The Mental Status of Guiteau. 551
He had not even one friend anywhere, was ignorant,
penniless, ragged, bareheaded and without shoes, wander-
ing about the streets of Washington, asking strangers to
recommend him for the position of minister to Austria.
Then his contemplated visit to Europe after the shooting,
his expected triumphant return and welcome by the nation,
a reward for his crime, and an immortality as a nation's de-
liverer. All this, we are told, was seriously entertained by a
sane man, but to me it would seem to be the plans and con-
duct, possible only to a person who was positively insane.
In regard to the question of immorality it would seem
that very much depends upon what men mean by
immorality. When Dr. Beard says that all insane people
are immoral, he doubtless has a different standard of
morality from Dr. Elwell, who says that insane persons
are not generally immoral, for it can hardly be that
phenomena, which are every day being carefully studied
by physicians, would be so differently interpreted. While
it is probably not true that all insane persons are
immoral, yet it is true that conduct which is regarded in
sane persons as immoral, and certainly which is a viola-
tion of that which we regard as the moral law, is not
only observed (as a symptom) in insanity, but it may be
an early symptom of the disorder. A minister of the
gospel stole books and surgical instruments, though he
continued to perform the duties of his profession. Other
evidences of insanity soon appeared, his thefts at the same
time becoming more frequent, with finally no attempt at
concealment. The pilfering was evidently the first symp-
tom of the attack of insanity, which, after having lasted
several months, ended in recover}'. Another minister, as
the earliest observed symptom of insanit}^ becomes intox-
icated and at various times commits gross immoralities.
A gentleman of wealth, during the development of
general paresis, and as the first indication of the disorder,
stole silverware and other articles that attracted his
attention by their brightness.
That the most tender, kind and affectionate persons
552 James H. Mc Bride.
become in consequence of insanity suspicious, unkind,
cruel and even murderous ; that they become untruthful,
treacherous and grossly immoral all this is well known —
and finds illustrations in every insane asylum in the
world.
The moral perversion of general paresis, puerperal
mania and other forms of insanity has been widely
observed, and the literature of the profession abounds
with illustrations. We would, indeed, expect that a loss
of the moral sense would necessarily result from insanity,
because it is one of the latest and highest acquisitions
of the race in the course of its development, and in
accordance with the law of retrograde degeneration it
would be one of the first to fail.
Third. That no amount of deliberation is inconsistent
with insanity is a statement which is supported by an
abundance of testimony. The insane man may be hasty,
rash, impetuous and abandoned to some controlling idea
that hurries him without reflection to the commission of
a crime ; but he may also be calm, shrewd and delib-
erate, and plan with all possible skill and foresight. The
following is a forcible illustration of deliberation in the
commission of a crime by an insane person, and which
was hardly excelled by the much talked of deliberation
of Guiteau :
Mrs. Josephine A. Willner was for a number of years
a resident of Milwaukee, and during that time was a
patient of Dr. G — , a prominent physician of the city.
In 1874, her husband having died, she removed to
Geneva, Ohio, where she continued to reside. For a
year or two previous to her leaving Milwaukee, her
acquaintances observed that she acted very strangely and
by some was regarded as an insane person. After having
lived in Geneva for some months, she wrote to Dr. G — ,
demanding that he quit poisoning the air, as this conduct
on his part was injuring her health, and demanding also
that he quit interfering with her affairs in Geneva, through
atmospheric influences. Finally, to avenge her imaginary
The Me7ital Status of Guiteau. 553-
wrongs, she decided upon a plan of action and proceeded
to carry it into execution with all the care and deliberation
conceivable. With " excellent judgment and care " she
selected a pistol, carried it home and attempted to shoot
with it at a target. It did not act to suit her, however, and
she also states that she did not like the appearance of it, as
" it had a rough, unladylike handle, and that she wanted
a better- looking pistol." She exchanged it for another
pistol, and with this she practised shooting at a target in
her back yard during the period of four weeks. She
then started for Milwaukee, distant seven hundred miles.
She changed cars at Chicago, and during the ride to
Milwaukee, of one hundred miles, was noticed to be
quietly reading a book. At Milwaukee she took a car-
riage, drove to the residence of Dr. G — , called him to
the door and shot him dead. As she had not been satis-
fied with one or two chance shots at a sapling, she did
not need to shoot but once, and sent the bullet to a
vital spot. She says that she purchased the pistol and
practised with it, with the distinct intention of going to
Milwaukee and killing Dr. G— . She was found insane,
and is now held in this institution by order of the court,.
There is not now, nor has there ever been since the time
of the homicide, any reason to doubt her insanity.
Fourth. It is not probable that Guiteau was the
originator of the plea of insanity in his case. Not that
it would be inconsistent with the existence of mental
disorder, but from my acquaintance with him I do not
believe that such a plan of escape would have occurred
to his weak and chaotic mind. That an insane person
may plead insanity as an excuse for crime, finds an
illustration in a case now in this institution. Mrs. Crocker,
a lady who had been well educated and who had studied
law, had resided in ^Milwaukee for many years, but had
latterly been a resident of Washington City. Because of
certain differences between herself and her stepmother,
she came from Washington to Milwaukee, appointed an
interview with that lady at the office of a lawyer, and,.
554 James H. Mc Bride.
without any immediate provocation, shot at her step-
mother. When the case was called for trial, she put in
the plea of insanity, claiming that she did the shooting
in obedience to a command received at night from the
spirit of her dead father. She insisted that at the time
of the shooting she was insane, exhibited much interest
in the trial, and suggested to the attorneys questions to
be put to experts. Being put upon the stand, she
claimed under oath that she was insane at the time of
the shooting, and underwent a long examination without
any apparent inconsistency or contradiction in state-
ment. She was acquitted on the ground of transitory
mania, and was set at liberty. She was soon after
arrested for another offense, and upon trial, being
declared insane, was committed to this institution, where
she now is. She was undoubtedly insane at the time
she attempted to shoot her stepmother, the insanity
having existed for a number of years previous to that
time. She states that the plea of insanity at the time
of the first trial was false, that she did not entertain
the delusion which she claimed to have entertained, and
that she only entered the plea to escape punishment-
There is no doubt in my mind that her statement is true,
and that her claim that she was influenced to commit
the deed through the commands of her father's spirit,
was entirely false. Such a delusion would not be in
keeping with her other mental symptoms ; it is totally
unlike those she is kown to entertain, and a belief in the
communication with spirits is one which she is now, and
always has been, prompt to ridicule. She is shrewd and
intelligent, but entertains many wild and extravagant
ambitions which remind one of Guiteau, though, intellect-
ually, she is far his superior.
On Thanksgiving Day (Nov., 1881), Guiteau said to me
in the presence of another physician, that he had never
read any works on insanity or on tiie jurisprudence of
insanity. When I asked him the general question, if he
had read works on the subject of insanity, he replied
The Mental Status of Guiteau. 555
that he " supposed he had and thought he knew some-
thing about it," and was evidently anxious to impress me
with the idea that he was acquainted with the Hterature
of the subject. When, however, I mentioned the names of
the various prominent authors on insanity, he said that he
was not acquainted with what they have written. He
admitted his ignorance of this subject with evident reluct-
ance, and as I pressed him with questions regarding his
knowledge of works on the subject of insanity, he became
excited and impatient, and dismissed the subject with his
favorite phrase : "I know nothing about it, and I care
nothing about it." That he had a scrappy knowledge of
the cases of Sickles, McFarland, Freeman and Coles-
Hiscock, is probably true, for a person could not read
law, evea in the superficial way in which he read it (and
certainly he could not read the daily papers), without
being informed somewhat regarding these cases. There
is no evidence with which I am acquainted, however, that
he understood their legal and scientific bearings ; he sim-
ply may have known the plea in each case and the
result of the trial, and this is knowledge which many an
insane man might acquire.
Fifth. Notwithstanding the medical talent which
arrayed itself on the side of Guiteau's sanity, it does not
necessarily follow that he was therefore a sane man. In
matters of science neither majorities nor minorities are to
be considered, but opinions are to be valued according as
they harmonize with experience and scientific knowledge.
On the question of Guiteau's sanity we know the doctors
were divided, unequal though it was.
After as careful an examination as I could give to
the mental condition of Guiteau, I believe that he was
an insane man at the time he shot the president, and
that he had been insane for many years. From my
observation of him, it appeared to me, that prominent
mental characteristic of the man was that of congenital
defect of organization, and to this had been added mental
degeneracy.
556 James H. Mc Bride.
I am aware that he was regarded by some as a man
of talent; yet to me his positive and serious lack of sense
and judgment was the first thing that impressed me, and
the more I studied him the more was I impressed with
the belief that, mentally, he was by nature and disease
weak and degraded. He had a certain amount of super-
ficial cunning, as persons of a certain grade of mental
defect have — he would occasionally say a smart thing or
make a witty sally, but the imbecile "court fools" of old
could do this and they were laughed at by royalty.
Guiteau was one of the class of persons whom we meet in
asylums and out of them, who though congenitally men-
tally defective, are cunning, restless and wayward, occupied
for a time with strange and impossible schemes, who are
interested in everything by turns and nothing long, pursue
senseless and impossible ambitions for a time and then
tire of them one by one, like a boy with his tops and
hoops and marbles, and devote their senseless enthusiasm
to some other chimera. The peculiar memory which
Guiteau exhibited, appeared to some to be inconsistent
either with insanity or congenital defect. It may be con-
fidently stated, however, that his memory was one which
persons who are congenitally mentally defective may pos-
sess. There was not an incident of his life which was too
trivial for his microscopic recollection; his memory was
stored with the petty incidents of an existence that was
pitiably dwarfed and inferior in all its possibilities. It was
the memory of a savage of an inferior mind, taking account
of the trifling events of a life that was itself trifling,
because it was that of an inferior organization working
out its own poor and mean salvation. It was a memory
which sensible people do not have, which in fact they
cannot afford to have, for it would be like filling the
valuable space of a warehouse with the garbage and
rubbish of the street.
Superior minds remember prominent incidents or gen-
eral principles, but they do ''not stop to treasure the
trifling and trivial orcurrences of each day. Guiteau, with
The Mental Status of Guiteau. 557
all his Indian-like memory, was doubtless quite incapable of
committing to memory a page of printed matter or of com-
prehending general principles of law, or indeed principles
of anything. He was as superficial as he was quick ; his
mind was wandering, restless, and his ideas on all sub-
jects quite chaotic, and the mind he possessed was but
the miniature of sense and sanity.
During repeated interviews with him, I questioned him
on the subject of the history of this country and of
Europe, the history of political parties, and also regarding
his knowledge of the history and principles of the Chris-
tian religion. When asked the general question he would
assert in his egotistic way his familiarity with a subject,
but upon further questioning it would appear that he
was ignorant of it. He was, in brief, an ignorant man,
because he was incapable of acquiring knowledge, and
because his mind was dwarfed by nature and hopelessly
disordered by disease.
In concluding this paper there are two considerations
suggested by this discussion which may be briefly alluded
to here. Space will not permit of the elaboration of an
argument sustaining these propositions, and I will con-
tent myself with a hasty statement of my conclusions
concerning them.
"The only line that science can draw upon the
definite knowledge as yet acquired of the human con-
stitution, is that which defines insanity to be a positive
pathological state, a physical disease which forms the
underlying basis and caijse of all the complex mental
phenomena by which chiefly its existence as disease is
popularly recognized." — Avi. Jour, of bisatiity, Jan., 1882,
p. 306 and 307.
Our accepted definitions of insanity are based upon
the assumption that the disorder is always the product
of disease ; that however badly organized one's brain
may be, he cannot be technically insane except his brain is
diseased.
It is R. W. Mackey, I believe, who says that
558 James H. Mc Bride.
definitions are less exact as human knowledge progresses.
As man advances in knowledge and in his ability to
comprehend laws that are more and more general, he
learns that nature nowhere in all her infinite varieties
makes sudden leaps nor draws sharp lines of distinction ;
and, therefore, his definitions which artificially separate
and abruptly limit and demarcate, do gradually and in-
evitably lose their value. Mr. Curdle was applauded
for his definition of the dramatic unities as "a sort of a
general oneness," a specimen of word-jugglery equally
applicable to the universe or a housefly. Bichat, was it
not, defined life as the "totality of those processes by
which death is resisted." In this definition, it was thought
he expressed a great truth of nature, yet he taught men
nothing by it ; he simply turned an intellectual hand-
spring and came down in his own tracks.
Let anyone read the thousand definitions of insanity
that have from time to time expressed men's knowledge
of morbid mental states, and he will observe that the
meaning of the term insanity has been continually chang-
ing, and he will observe also that the boundary-lines of
the disorder have, as expressed in definitions, become
more extended and more indistinct. Compare the technical
insanity of the time of Coke or of Hale, with the tech-
nical insanity of the present day, and behold the change!
Definitions are indeed fascinating things, and in a
measure useful, but they are continually misused. They
are but expressions of a temporary phase of knowledge, —
they are at best but rude approximations to the truth,
and are destined to endless change and re-arrangement.
It is doubtful if the present definitions of insanity, which
assumed that the disorder is the expression of disease,
are consistent with medical experience, or with the teach-
ings of modern science. It will doubtless be considered
quite unorthodox to detract from this time-honored dic-
tum of alienists; we all have a fondness for it from long
association, it being the bottle from which the new-
comer in the nursery of psychological science is first fed.
The Mental Status of Gtiiieau. 559
3t should not be forgotten, however, that error is of all
things positive, and contented with herself. Science — that
-embodiment of knowledge — has come, in part at least,
through doubting that which was regarded as unques-
tionable, and through consequent change and reconstitution
-of human knowledge. To question the correctness of
accepted theories may be a means to progress; scepti-
cism, therefore, in matters of science is to a degree desir-
able, and it is this day helping to turn the wheels of
human progress.
It is admitted that the force called mind, if not pro-
duced, is at least made manifest through the agency of
the brain cells, and it is also admitted that through dis-
ease of these cells, or certain clusters of them, mental
disorder may result. Many, however, who accept these
as just conclusions, deny that through an originally faulty
arrangement and association of these same cells, there
could result mental disorder. To the minds of some there
appears to attach to the word " disease," a sort of
magic by which nature accomplishes very strange results,
and results too, which she cannot imitate by any con-
dition or process that is not essentially morbid. It is
true, however, that there are conditions of mental
unsoundness which are not produced by disease, but
which are due to malorganization of brain ; and if we
observe the conduct of those who are unsound from
defect of brain organization and those who are unsound
from brain disease, we find that distinctions which we
attempt to draw are quite unwarranted.
An idiot boy who has seen his father kill a sheep,
•concludes that he will imitate him, and kills his little
brother; but no one would believe it just to punish the
idiot. Please remember that this idiot's brain is not dis-
eased and he reasons too, but because of inborn twists of
organization he reasons badly, and acts badly.
A mother, who when mentally sound is kind, tender
and affectionate, has an attack of melancholia, and during
the continuance of the disorder, kills her three children ;
S6o James H. McBride.
but no one, perhaps, would believe it just to punish her
for conduct which was the result of disease of the brain.
Then disease cannot be the only test in such cases, for
surely the idiot's mind is not less unsound in every sense
of the word, than the mind of the mother.
Keeping this in mind, let us go a few steps further,
and consider a person who is not an idiot, and yet whose
brain is badly and imperfectly organized. This man, in
consequence of his defect, reasons badly about everything,
he is incapable of applying himself except in a profitless
and paroxysmal way which only emphasizes his degenerate
state, and his life is utterly worthless and aimless, though
it is the best that he can make it. Finally, in a time of
political excitement, he conceives the idea that he will
do a patriotic act by killing the ruler of a great nation.
He reasons so badly that he believes that in place of
being shut up as a lunatic, he will be considered the
great man which he conceives himself to be ; that he
will be hailed as a deliverer, and rewarded for his act.
So he kills the president, and he is so unreasonable as
to suppose that if he can only conceal himself for a
few days, the public, which without understanding his
patriotic motives may at first feel disposed to punish
him, will after having had time for reflection, conclude that
his act was a meritorious one. Now all this reasoning,
if such it can be called, is the work of a disordered mind,
and his thoughts run in this channel because the only
existence of which his poor dwarfed nature is capable,
forces his thoughts so to run. Though he be several
grades higher in organization than the idiot who killed
his brother, he certainly is several grades lower in organi-
zation than any man who can properly be called sane ;
and if we fail to recognize this shghter degree of defect,
it is probably the fault of our methods, certainly not
the fault of him who is defective. Therefore, if we have
in our possession a poor old definition, the requirements
of which are that this man shall be hung, the question
is whether we shall execute the man or the definition.
The Mental Status of Gidteaii. 561
Reason would seem to suggest, that we should save the
man from judicial murder and hang our definition, which,
though it may have done well in its time, is old and
useless.
It would seem, therefore, that the distinction which our
definition of insanity attempts to make is one which can-
not properly be made ; it is a definition which does not
define, and no amount of metaphysical gymnastics which
may be performed about it will conceal its conspicuous
imperfections.
The weakness of this definition may be made more
apparent by a further consideration. In studying the
methods by which nature works out the problems of or-
ganic life, we find that without invoking the aid of
disease, she yet departs in many instances from her
general rules of work, and produces every possible degree
of defect and deformity. She gnarls and twists a tree
and causes it to grow crooked, yet the tree is not
diseased ; she bends the bones of a human limb ; she
constructs a defective heart ; she makes defective muscles
for the eye, yet in neither case is there disease. We find,
also, that in the construction of that most complicated of
organs, the brain, that nature's architecture is sometimes
faulty, and that there is every degree of structural defect
in cerebral organization. The most serious defect in brain
organization is called idiocy ; a less serious, imbecility ;
and a less serious still, has not been named or classi-
fied. The subjects of this slighter degree of defect are
left to drift about the world at the mercy of their sense-
less vagaries, to curse society with their useless and
annoying liberty; and when following the evil but resist-
less impulses of a bad organization, they kill some one,
then we rise up in virtuous indignation and choke them
to death.
The question occurs then, does it necessarily follow
that before a person can be considered insane, there
must be a change of mental character produced by disease ;
may not insane beliefs and conduct be the natural product
562 Javies II. Mc Bride.
of a bad mental organization? One man may entertain
a false belief because his brain is in a morbid state ;
he arrives at his conclusions not from choice and correct
reasoning, but because of the action of a diseased brain.
Another may entertain a precisely similar belief, because
there are wanting in his brain certain parts essential to
proper reasoning, or because of a bad arrangement of
existing parts. He, therefore, arrives at his conclusion not
from choice, nor because of a morbid process, but because
of the chance suggestions, the wayward and imperfect logic
of a defective mind. If in the first instance, there is insanity
in consequence of disease, why is there not insanity in the
second case resulting from bad orga7iization ? A human
brain may, in fact, be so badly organized, that in its
evolution there is not only defect of mind but disordered
mental action; so badly organized, indeed, that deranged
action may be its only form of activity.
If nature in a certain case organizes not only a bad
brain, but certain other parts of the system, which
determine the preparation and assimilation of nutritive
material, so that the nutrition of the brain fails to be
what it ought — so that the individual thinks imperfectly
and incoherently — surely the individual cannot be consid-
ered responsible for his conduct which results from his
defective organization. While, therefore, it may be
allowable in the two cases mentioned, to make a distinc-
tion in names and to say that one is insane and the other
is an imbecile or something else, so far as their responsi-
bility is concerned there would surely be no difference.
The true test in each case should be the reasonableness
or the unreasonableness of the belief considered in con-
nection with the condition and life-history of the
individual. One entertains the belief in consequence of
disease, and in the presence of his belief he is helpless;
the other entertains the belief in consequence of
malorganization, and so, in the presence of his belief, he
too is helpless.
In the view here taken, therefore, insanity is not
The Mental Status of Gniteau. 5^3
necessarily and always a symptom of disease ; it may be
so, and it may also be an indication of a badly organized
brain. In the case of Guiteau the difficulty of reconciling
his mental characteristics with that iron-bound require-
ment that one must have changed through disease from
his normal self before he can be considered insane, was
a difficulty that was serious with certain gentlemen. They
could not see that he had "changed," and, therefore, they
could not consider him "technically" an insane man. If
Guiteau, however, with all his wild and strange delusions,
and his utter unreason was not, "technically" insane,
then it is only the worse for the technicality.
Bellingham, an insane man, killed Prime Minister
Percival, but he was hung because he happened to know
enough to be able to distinguish "right from wrong."
He was not, according to the accepted ideas of the time,
" technically," an insane man ; and, therefore, because he
could not be handsomely fitted with a definition, he was
taken out and executed.
" When science cannot speak definitely and with
authority, it is her duty to be silent." — American Journal
of Insanity, January, 1882, page 306.
The scientific man is entitled to give definite and
positive opinions, if he but remembers that his most
cherished laws and highest principles must in the inevita-
ble progression of human thought be subject to cease-
less change and rearrangement. As nature in the pro-
cession of the seasons forever renews, unfolds and
advances in her forms of life, so must the laws and prin-
ciples of science in the evolution of human knowledge be
forever modified and revised. The scientific man, while
he uses every fact for its full worth, knows that the time
will come when it will be laid aside as an outworn gar-
ment of the mind, and its place be taken by those that,
having a higher and a better meaning, answer to new and
advanced conditions of development. Therefore, every
fact or principle is to be used for a time, its enduring
parts assimilated in human knowledge, and then its
564 James H. McBride. ,
identity will be lost in facts and principles that are
higher.
The scientific man, for the sake of being authoritative
and definite, does not cling to the remains of principles
that human thought has outgrown, neither does he des-
pair because in his intellectual advancement the horizon
of human thouglit stretches wider and wider about
him. Being himself in intelligent harmony with nature's
law of progress, he gladly welcomes this rapid growth of
knowledge and this perpetual rearrangement of the forms
of thought as the prophecy and promise of an unlimited
development, and of which the science of the
present time is but the first faint rays of the coming
day. To the man of science human knowledge is
always readjusting itself to the ever-renewing conditions
of mental progress ; to him each principle is but a
temporary formulation of human knowledge, each fact
is but an outpost beyond which there looms a vast
and untrodden region of higher facts which forever
multiply as he advances, and yet forever lure him on.
The medical expert may be positive in his opinions,
in so far as positiveness is warranted by facts, if he
bears in mind the necessity for this occasional revision
of his beliefs and definitions in order that they may
harmonize with the inevitable progress of science.
There is, however, on the part of psychological expert
witnesses, a tendency to an unwarranted positiveness
of statement. The temptation for the psychological
expert to be positive in his statements is great ; for then
he can more easily sustain himself as a witness, and he
is less liable to be entangled by questions that are sug-
gested when doubts are expressed. Hence the expert
witness in cases of insanity is usually positive, and excep-
tionally admits having a doubt.
It is a fact, however, that in quite a proportion
of cases upon whose mental condition experts are
required to give an opinion, the insanity, if it exist,
is not fully developed — it is in the formative stage.
TJie Mental Status of Guiteau. 565
Indeed it is in these obscure cases that the services of
experts are most needed — these cases that occupy the
doubtful region between sanity and insanity. Yet it is,
perhaps, just to say that experts in their testimony
seldom appear to have discovered these cases ; ever}'
case is placed clearly upon one side of the line or
upon the other, and the transition period would appear
to have no existence.
In reading much of expert testimony one would
suppose that in developing insanity nature departed from
her wise rule of passing from one extreme to another
by imperceptible gradations, and that she passed from
sanity to insanity, not over a debatable region, but by
a sudden bound. Definitions are hence unconsciously
framed, so that doubtful cases are excluded and the defini-
tions themselves tend to support the experts in an unwar-
ranted positiveness.
The harm of being uncompromisingly positive is, how-
ever, witnessed by a thousand errors that such positive-
ness has bred in the past, and by a thousand crimes
committed in the name of unquestioned beliefs. The
stake and the thumbscrew were positive, and they were
the natural products of faiths that would not submit to
be questioned, and which silenced the consciences of
those, who working towards mental freedom, were
inclined to listen to the whisperings of doubt. Yet all
experience teaches us that it is right to doubt, and
that an honest doubt has as much right to its existence
as has an honest conviction.
The law tells us that the reasonable doubt of one
man can outweigh the positive convictions of eleven men
and any array of evidence ; nor does the law say that
this doubt should be concealed, but rather that it should
be expressed. If the psychological expert entertains an
honest doubt he will only entertain it as the result of
intelligent reasoning. Pray, why should he not, like a
brave man, give expression to that doubt, and bravely
also give his reasons for entertainingr it?
Changes in Handwriting in Relation to
Pathology.
In review of the tvorJcs of the following mcthors, viz: Marce,-
Poincare, Charcot, Buchwald, Erlenmeyer, Vogt, Swortzoff,
Grasset, Ireland and Durand. 1863 — 1882.
By A. BiANCHi, M. D., Italy.*
'nP^HE study of the alterations observed in the hand-
-■- writing of different individuals, is useful in the
diagnosis of some maladies which have their origin in
alterations in the nervous centres, and may guide us in
their diagnosis and treatment. Varied as the diverse cus-
toms of the peoples, stand the written signs in their form
and their groupings, to denote the different degrees of the
civilization of man, and following them up from the cunei-
form and hieratic characters of the ancient Asiatics and
Africans to the sculptured signs of the Indians and the
Mexicans, from the written words of the Thibetans and
the Chinese, numberless as the ideas and objects, to the
forms of the alphabet of our times, we see that, along
with the development of civilization, there is to be observed
a gradual and progressive perfectionment of the written
speech. This has led to the endowment of man with the
power of presenting, by means of a few letters, so many
combinations as, by their varied groupings, suffice to repre-
sent the names of the various objects he may desire to
indicate, and to evolve his own ideas.
But, if the study of the various and progressive im-
provements of written language is important in ethnology
and anthropology, it may well have some importance for
the physician who must occupy himself solely in the alter-
ations, psychical and mechanical, which may be met with
in the actual mode of writing of different individuals^
•Translated by Joseph Workman, M. D., Toronto, Canada, from II PUani
Gazetia Sicula. Palermo, 1882
Changes in Handivriting. 567"
especially in certain morbid movements. All the obser-
vations hitherto made relate to the common English
characters, and only a few have been accomplished, in
Germanv, in the Dutch characters, which are, however,
pretty near those of the English ; only a few have been
obtained in the Semitic, Arabian and Indian. We are not
at present aware of any study of this sort made by our
physicians in the diseases of China and Japan, though it
would certainly be important to see whether, with these
people, who for ever}' idea have a distinct written sign^
the diseases of the nervous system always effect the same
alterations in their written language, as are observed
among us.
However, limiting ourselves to the simple observation
of facts made by the physicians of those countries in which
written words consist in the union of the letters of the
alphabet, we must make a few distinctions in order to
render the subject more clear.
1st. Physiology of Writing. — When we examine the
method of writing, it is seen that every people traces
the characters with the right hand, whether from pre-
ponderance of structure, result of habit, or education;
it is observed that, whilst the Asiatics write from above
downwards, and from left to right, the Semites and the
Arians trace their writings in lines one below the other;
but the former from right to left, and the latter from left
to right, the one presenting the centripetal and the other
the centrifugal course.
The psychicho-mechanical act of writing is, according
to the majority of physiologists, executed by a retiex
mechanism, similar to that of oral speech, with the sole
difference that the acting muscles are those of the hand,
on which the reflex act, and that the sensation comes,
for the most part, through the organs of sight, although
the auditive sense also takes a notable part. Hence, in
order to learn to write, it is necessary, not only that the
pupil shall see the signs, but also that, being heard, he
should understand what is intended to be expressed.
568 A. Bianchi.
An optic impression is therefore requisite for learning
to write, and for the awakening of the activities of the
motor cells which are in relation with the muscles of the
hand ; and those cells are probably located in a given
centre, which, according to some, is one and the same
with the centre of oral language, but according to others
it is quite different. The former authors base their asser-
tions on numerous pathological cases, in which both the
written and the spoken language were lesioned at the same
time ; the latter, on the other hand, rely upon cases equally
numerous, in which the spoken language was lesioned and
the written not affected, or vice versa, and upon the apti-
tude shown, for example, by deaf mutes (individuals in
whom vocal impressions awaken no reflex action on the
centre of speech), to learn to write and to converse by
different movements of the hands. The opponents of these
authors adduce, as an example, individuals born blind, who,
although they have never received a visive impression, can
yet learn to write, under a patient system of education ;
they are habituated to receive the tactile impression of the
various letters of the alphabet, and to join them in such
a manner as to compose the diverse words expressing the
objects touched by them, the ideas which they adopt, or
the words heard by them.
(A diagram is here presented for the purpose of more
clearly representing the author's "scheme of the probable
mechanism of language," the eye and the ear being the
receivers of impressions. From the eye the impression is
transmitted to the " visive nucleus of the optic thalamus,
thence to the related cortical cells, then down to the
corpus striatum, which acts on the medulla, so as to put
into motion the muscles of the fingers. As to the aural
impressions, they are figured as going into the auditive
nucleus of the optic thalmus, thence to the cortical cells, and
thence down to the bulb, which excites the vocal muscles,
or to the medulla, which puts into motion the muscles of the
hand. Having thus, to his own satisfaction, disposed of the
navigation of sights and sounds, the author proceeds) :
Changes in Handwriting. 569
" Furthermore, instead of auditive and visive sensations,
there may be intellective currents, which, carried to the
medullary centre, may give place to motions of the fingers
for writing. The results of the impressions which may be
transmuted into written language are therefore three, —
the visive, the auditive and the intellective. The tactile
may supply the part of the visive, in exceptional cases,
after long habit ; the intellective are indispensable to good,
regular and sensible writing. The collocation in the cere-
brum of a centre for the co-ordination of the motions
necessary for writing, is a reasonable thing. Woroschiloff
believes that this centre is in the medulla, near its cer-
vical swelling, because he saw that, in a dog, here was
the centre for the associate motions of the fore and
hind limbs. But, in order to explain well the mechan-
ism of writing, we cannot bring to our aid the experi-
ment of comparative physiology, as this is powerless in
presence of this phenomenon, which is the exclusive
faculty of man, and hence man alone can be the special
study relative to the psychical mechanism of writing.
It is not, then, comparative physiology, but truly the
physiology of man, or better, the exact clinical study of
cases of central lesions, with alterations of written language,
which can throw sufficient light on this phenomenon, and
instead of hypotheses, more or less reasonable, may sub-
stitute a theory safely founded on an unassailable basis.
But as yet this is difficult, since the patients met with in
clinics and hospitals are mostly ignorant of writing; and,
therefore, whilst we are able to recognize the varied series
of alterations in spoken language, we cannot, with equal
security and frequency, study those produced in written
language by central lesions.
That the difficulties of observation are great, is a fact
proved by the limited bibliography which, up to the present,
the subject exhibits; and it is exactly for this reason that
we have been induced to press it on the attention of
physicians, in order that, from multiplied observations,
truth may emerge. Attempts have been made, and are
5/0 A. Bianchi.
still made, but hitherto the result has been certainly only-
little encouraging to him who would occupy himself on
the alterations of written language, unless he starts with
the conviction that only by persevering and daily fatigue
he may reach a fortunate result. In this way the legal
expert has so far succeeded, that from macroscopia and
microscopic study of various writings he is enabled to dis-
tinguish alterations introduced into them, artificially, from
those made by the original writer. I need not say how
much psychiatry may be benefited by the study of the
psychical composition of the writings of the insane,
enabling us at such times to judge, from the simple exam-
ination of them, as to the intellective lesion which has
fallen on a given individual, and to form a prognosis
sufficiently secure.
In the meantime, from the divers observations of
physiologists, it may be concluded that writing, a most
complicate muscular art, is a truly marvelous thing.
For the purpose, first of all, the instrument with which,
the written signs are to be made, must be firmly fixed
by the flexors of the first three digits; next, the whole
hand has to join in the action of the flexor and the
interosseous muscles, and finally a regular precise motion
must be required of the hand itself.
This motion, among the Arians, proceeds from left
to right, by means of the extending of the wrist and
forearm, and a rotation and abduction of the arm. By
this mechanism a right line only can be traced, and it
is requisite, in order to effect the writing, that, during
the tracing of this line, the pen shall describe a series
of right and curved lines and points, by alternate con-
tractions of the flexor and extensor muscles.
Buckhardt has, with a miographic apparatus, explored
the three groups of muscles which are in operation in
writing. They are the interosseous and the long exten-
sors and flexors. He saw that the interosseous can hold
the pen and trace the letters ; that the long extensors
aid them in the more extended motions, and maintain
Changes in Handzvrithig. 571
the semiflexions of the hand ; and that finally, the long
flexors, with the muscles of the hypothenar eminence,
are the antagonists of the interosseous, and act only in
the fixing of the hand and the formation of the letters
which are prolonged below the horizontal line on which
the others are traced. But, according to the individuals,
there are modifications of this mode of action, and we
see some using one muscular group in preference to
another. Hence, the act of writing presents a tonic
action (fixation of the hand and the pen), and a clonic
motion (formation of the letters). In order that the
writing shall be normal, there must be regularity in the
transmission of the psychical impressions, a uniform dis-
tribution of the nervous excitations in the muscular groups,
and precision in the relation of these muscles.
In conclusion, the formation of a written letter sup-
poses that the motions of the fingers and of the hand,
together with the psychical excitation, form in the brain
a figurative impression, which, being often received by the
memory, diminishes, each time a little, the time necessary
for the production of an action which finally becomes
unconscious.
But it is certain that the mode of tracing characters,
so varied according to different peoples and different tissues,
must not have as cause any specific conformation of the
brain, but must rather be the result of primitive habits
and external causes observed in every people, and which,
by inheritance and education are transmitted, and after-
wards necessarily retained. It is thence a fact well known,
that all peoples, with the exception of some Orientals
(Mussulmans, Buddhists, Semites), trace their characters
from left to right, and centrifugally as regards the axis of
the body, and all write with the right hand. This fact,
explained by some as depending on hereditary transmission,
education, and also the more precocious development of
the left hemisphere of the brain, is yet involved in
darkness.
2nd. Classification. — Erlenmeyer has recently divided
5/2 A. Bianchi.
alterations in writing into mechanical and psychical. He
distinguishes the former as ataxic and trenmlous ; the second,
as conscious and unconscious ; and the psychical alterations
he designates by the term disgrammatographia.
The ataxic writing, like the ataxic gait, is characterized
by excessive exaggerations of the movements necessary
for the formation of single letters; therefore the ascend-
ing lines are within their limits, whilst the descending
are grosser and longer than necessary, the curves are
angular and large, the form of the letters is irregular, the
words are not in a right line. In short, this is the sort
of writing which is observed in children who are learning
to write, and in which uncertainity and irregularity pre-
dominate. The tremulous writing presents, instead, an
undulating contour of ascending and descending tracts,
so that the vertical lines and the curves are converted
into finely serpiginous or broken lines; this is the writing
we have seen, in the last periods of life, in the phy-
siological state, and in it weariness and tremor predomi-
nate.
To these two varieties of writing should be added the
so-called reverse chirography, which is also called litho-
graphic, spectral and letter-copy. This is the left-hand
writing observed in some patients ; it may be produced
by sound persons ; it consists in tracing the letters
from right towards left, with the upward slope to this
side, so that in order to read it, we have to hold the
sheet before a mirror, whilst looking in, or to turn
the paper over and read by transparency. This sort of
writing, which Erlenmeyer considers as pathological, but
Buchwald and Vogt as the normal writing of the left
hand, has only of late been the object of special obser-
vation. In fact Buchwald described it in 1878, as present
in three right hemiplegics, and he ranked it at first
among the varieties of aphasia, but he was finally led to
the conviction that it obtains also in the healthy, and
especially in children. Erlenmeyer, of Coblentz, in 1879,
as has been said, believed the lithographic form to be
Chayiges in Handwriting. 575
only pathological, but Vogt admits it as a normal fact.
The studies of this sort of writing since 1880 have been
few ; we know of only the memoir of Ireland, who
oscillates as to its pathological importance ; and of that
of Durand, who regards the reverse writing as normal,
and only sometimes to require for its development special
cerebral lesions.
A curious fact has enabled us to learn that the
reversed writing, as a pathological phenomenon, has been
found in some manuscripts. In the Codes Atlanticiis, of
Leonardo da Vinci, preserved in the Ambrosiana di Mil-
ano, all the writmg is of the left hand, reverse sort ; and
though it has been believed that Leonardo adopted this
form, in order to prevent his writings being read by the
importunate, it seems, on the contrary, that it was simply
the consequence of a paralysis in the right hand, which
also impeded him in pamting. This is revealed by a diary
which was found in the national library of Naples, in
which it is recorded that one De Beatis, who, in 15 17,
followed the Cardinal of Aragon in his travels through
Germany, Flanders and France, visited Leonardo in the
vicinity of Ambroise, in a villa given to him by Francis
the First, and he observed that he could no longer
expect valuable paintings from Leonardo, because his
right hand was paralyzed. It was therefore but the
necessary consequence of writing with the left hand that
obliged Leonardo to execute the reversed form of writ-
ing.
We have lastly the agraphia, which consists in the
traces made by the diseased, merely of right, straight,
undulating, or circular lines, instead of the customary
letters. This agraphia may be quite complete, the patient
being unable to trace any letter.
True paragraphia consists in writing ungrammatically,
whilst the patient is aware of his errors. In this it differs
from another sort, that observed in general paralysis, in
which the person is ignorant of his errors. Patients under
this disease always leave out some necessary elements of
574 ■^' Bianchi.
language, and letters, syllables, or whole words may be
passed over unheeded ; the writing may also exhibit the
mechanical alterations above described, especially the
tremulousness.
The alterations in writing may then be physiological
or pathological : we shall speak of the former before call-
ing the attention of the reader to the latter.
'^rd. Physiological alterations in writing. — It is natural
that the handwriting of a child who is commencing to
write, should be different from that of a practiced pen-
man. This diversity is observed, not only in the mode
■of formation of the various letters, but also in the group-
ing of them, and in their disposition. Hence, we see that
the vertical lines are rather prolonged, or they are exag-
gerated ; the curved lines are replaced by pieced ones,
or by acute angles ; the transverse lines are wanting, or
they are too much extended, and finally, all the writing
shows trembling and uncertain turnings. This obtains
as respects the formation of letters and words ; but
when we come to the disposal of them, according to
the rules of syntax, we see numerous errors, whether
proceeding from the suppresion, or the addition, of let-
ters in various words, or from neglected or mistaken
punctuation. Finally, there may be observed in individ-
uals who are beginning to write, errors in the construction
of phrases or propositions, or errors (and not rare) in
the exchange of one word for another. All these
phenomena, which may be called the physiological errors
of writing, go on, more or less slowly vanishing, accord-
ing to the greater or less aptitude of the individual to
learn, and in the well-instructed adult we find they
have totally disappeared ; but in the adult who has not
sufficient capacity, or but little practice in writing,
they remain. — Towards the decline of life, the writing,
for the most part, tends to resume the primitive form,
which was observed in early youth at school ; it becomes
tremul'ous and irregular, with frequent mistakes in syntax,
and the exchanging of one word for another is here
Changes in Handwriti?ig. 575
specially accentuated. Physiologically then, the writing
may present to us alterations in the mechanical execution
alone, or in its psychical elaboration.
In analyzing the different parts of a writing, we see
that it presents vertical lines of various lengths, united
to curved lines variously disposed, and that by the
union of these right and curved lines, all the several
words are formed, composed from the alphabet used
by us. Although it is the habit of the Latin people
to write from left to right, yet there may be cases
(and this is observed, as has before been said, in
children and in inexpert persons), in which, when the
paper has not been ruled, the words are disposed in
a line variously oblique, or from above downwards,
instead of in a right line across. This fact is observed
even in persons who write well, when they are obliged
to write in the dark, and it is more frequent than is
commonly believed.
In our common use, the writing has a leaning from
left to right, from below upwards ; but, this is not
constantly followed, in various individuals, because it
depends on the varying mode of obliquity of the paper
written on, and the different habits of the writers ; so
that we may see some writings quite vertical, and others,
though more rarely, with the slope from right to left.
The lines traced have, for the most part, neat turns,
but frequently they present to the naked eye some
irregularities, depending either on a little cutting off, or
on an irregular distribution of the ink ; hence, we some-
times see that the letters preserve the thick and the
slender lines, according to the established rules, or some-
times they all present, instead, a uniform coloring,
without any increase on one side more than on the
other.
Next, as respects their distribution, it is known that
the letters forming a word should be either united or
collected side by side, and that between word and word
a certain space should be left. This also may be found
57^ ^« Bia7ichi.
physiologically neglected, and there may be seen too,
often extensive areas between words, or even between
letters in the same word, and some words may be united
without any intervening space.
Lastly, the letters, instead of being kept of equal
dimensions and heights, may be seen irregular, — extraord-
inarily elongated, or sweepingly rounded, or one more,
and another less elevated.
These are the mechanical alterations which may be
found in the writing of the sane man, and which it is
important for us to know, for the successive studies
which we shall report on the writing of the diseased
man.
The psychical errors depending, in the sane, for the
most part, on ignorance of the established rules of good
writing, are still more numerous in the insane, and con-
sist in errors of orthography, grammar and syntax. Of
these errors, the appreciation of which is easy of accom-
plishment by the man in a state of sanity, and well
instructed, we shall merely intimate the name.
Summarising, we shall say, that, taking as a type the
writing of the instructed adult man, we see that the
child and the aged man are two physiological termini,
which have, as to the writing, much pathological relation.
In fact we have centres which preside over the psychical
function of writing, but do not yet act in a complete
manner, and therefore, have need of perfectionment;
whilst in old age the centres themselves and their paths
of conduction are lesed and wearied, and are no longer
fitted either to respond with sufficient energy to external
stimuli, or to send back the sensations received, unless
with ever-increasing difficulty.
We have then two different modes of behavior of
the centres presiding over writing ; in the child, an action
of them progressively increasing, but in the aged, their
progressive enfeeblement. We shall see that these two
facts are frequently met with in pathology, in various
central lesions, some of which are capable of altering the
Changes in Handzi'riting. 577
writing, but of having a progressive amelioration, whilst
others bring only successive and continuous diminutions
of the intellectual power that presides over writing.
^th. Pathological alterations of writing. Ataxic writ-
ing.— The ataxic writing, which, as has been said, is
observed in children who are learning to write, is found
in pathology in cases of central or peripheral lesions of.
the nervous system, which impair the coordination of the
motions of the different muscles that accomplish the act
of writing. It is observed also, in cases of convalescence
from grave maladies, as typhus, and especially in cases
of sclerosis of the posterior cervical columns, and diseases
of the cerebellum. Charcot says he could not assign
special characters to the writing of patients under dis-
seminate sclerosis, because he first saw them with the
disease far advanced, and then the writing was reduced
to disconnected marks, without the possibility of nor-
mal arrangement. However, in one case of this scle-
rosis, though the patient presented writing almost
unintelligible and ataxic, after treatment with the nitrate
of silver she was able to write in a much more reg-
ular way.
The ataxic writing is sometimes also observed after
fatigues, and in poisonings by alcohol or chloral. In
these cases, however, it is purely functional, and it ceases
with the cessation of the causes that had provoked it.
In the cramp of writers ataxic writing is very usual,
and it is conjoined with the tremulous and paralytic
types.
Tremtdous writing. — The tremulous handwriting, which
is especially presented in paralysis agitans, may really
be of great aid in the diagnosis of this incipient mal-
ady ; in fact we may, with a lens, see, in the writing
of these patients, parts very accentuated and large and
tremulous, which finally we can observe with the naked
eye, as in the case observed by Charcot in the Sal-
petriere. This writing is further observed in disseminate
sclerosis and general paralysis; and here it may be
57^ A. Bia7ichi.
noted that Erlenmeyer himself is not able to judge of
the difference between the tremulous writing of incipi-
ent paralysis agitans and incipient general paralysis.
This writing is momentarily found also in the sane,
in cases of severe cold or of poisoning by alcohol, mor-
phine, nicotine arid chloral. But it is to be observed, in
this relation, that in alcoholism the patient writes atax-
ically when he is in the period of excitement, through the
influence of ingested alcohol, and on the contrary, he
writes tremulously when this influence has passed off. It is
also seen that in these cases a little alcohol can for some
time give sufficient force to the muscles to write without
tremor or ataxia.
Agraphia. — Writing reduced to mere broken and irreg-
ular lines is observed in the last stages of paralysis agitans
and disseminate sclerosis. There are some cases in which
the handwriting of these patients has been reduced solely
to lines irregularly disposed. The same fact is observed
in cerebral lesions which cause right hemiplegia, and are
capable of bringing alterations of the writing in the most
varied manner, and of thus presenting both the tremulous
and the ataxic writing, and that of difficult execution as
well as complete agraphia, and psychical alterations as
well as material.
Hence agraphia, which is the complete impossibility
(material or psychical) of tracing written signs, may orig-
inate either from paralysis of the muscles which serve in
writing, or from destruction of the cerebral centre or cen-
tres that preside over the execution of writing. Agraphia
and difficultied writing are, for the most part, united ta
aphasia, though there have sometimes been cases in which
the aphasic was able to write, or the agraphic to speak.
In aphasia there may be not only disturbance of the
speech, but also of the other manifestations of thought, as
writing, imitation, drawing, music, etc., and yet the intelli-
gence in some cases remains sound, but in others it is
changed. — In aphasic diseases there is observed not only
the common phenomenology of the patients being inept
Changes in Handwriti?ig, 579
to express in words the image presented by external signs
(logoplegia), but also the other, of integrity of the intel-
ligence, and of the visive and auditive organs, conjoined,
with impossibility of comprehending the written or articu-
late signs, just as if they were those of another language,
unknown to the patient. The conventional written or
articulate signs do not then awake any recollection of the
image, in the mind of the patient, who ignores the relation
that exists between the word spoken or written and the
object it should indicate, and he has thus lost the remem-
brance of the symbol which gives to thought determinate
and precise form, — the internal language, — presenting thus
verbal amnesia.
In these cases there is deafness to words and blindness
to writing, yet the patient hears the noises and has perfect
sight, but the sounds do not awaken any recollection, and
the written signs do not summon any image in his brain.
If, however, we present to the pat-'ent the object named,
or written, he recognizes it, because the notion of it has
not passed away.
Aphasia then comprehends not only alteration of the
passage from the idea to the expression of it, but also the
loss of transmission of conventional sounds from outside to
the brain.
The cerebral lesions that give place to this aphasia are
diverse; thus, while lesion of the centre for the formation
of words (3rd frontal or the insula) maintains in the patient
the motion of the object and of its uses, but not of its
name, lesion of the apparatus of transmission, conjoined
with integrity of the centre for the formation of words
(lesion of the centrum ovale under the 3rd frontal) gives
to the patient the notion and the name of the object, but
does not permit him to give to it the appropriate name ;
hence he often changes it for another, though knowingly.
Further, a partial lesion of the visual centre (piega curva),
or a destruction of the paths of transmission between this
centre and that for the formation of words, will allow, in
the patient, the notion and the visual image of letters, but
580 A. Bianchi.
he will be unable to give the true name to the letter
which he sees. Finally, a partial lesion of the auditive
centre (superior spheno temporal convolution), or a destruc-
tion of the path of transmission between this centre and
that for the formation of words, will carry in the sound
produced by the pronunciation, and he will understand it,
but it will not make him lay hold of the relation between
the sound and the word which it represents. Many cases,
however, favorable, and many adverse, have been marshaled
to uphold or to deny these diverse localizations, and the
cerebral lesions capable of giving origin to such disturb-
ances of written and spoken language.
Lithographic ivriiing. — Among these aphasic disturb-
ances, mutable in diverse diseases, in a curious way, and
strangely conflicting with one another, a special position
ought to be given to the lithographic writing, which, as we
have before said, has been specially studied by Buchwald,
in 1878.
He, we repeat, in 1878, observed in three hemiplegics,
a special lesion in the handwriting, which he called spectral,
or reflex, because the patients, writing with the left hand,
carried the words from right to left, so that it was necessary
to turn the paper over, or hold it before a mirror, or
by means of transparency, to read it. He attributes this
mode of writing to a variety of aphasia, from the perplexity
of written language ; but on the other hand he was aware
that it was not present in all cases of right hemiplegia with
aphasia, but only in grave cases. Further, he observed even
in the sound, and especially in children, some who wrote
better from right to left than from left to right, when they
were caused to write with the left hand. He considered
this writing as a pathological thing corresponding to a
special cerebral disease; but Vogt, in 1880, believed, on
the contrary, that this writing is normal when it is done
with the left hand. Swortzoff" has made merely a short
allusion to this special writing, and has erroneously attrib-
uted its first observance to Erlenmeyer. Finally, if we
except a few other authors who have mentioned this mode
Changes in Handwriting. 5^1
of handwriting, we reach the end of 1881 without seeing
any new work on it. At this time Durand occupied him-
self in an analysis of the works above cited, and he has
made an ample contribution to the cHnical importance of
this writing, which he proposes to call lithographic, or the
letter-copying form, because lithographers write thus on
the lithographing stones, and merchants obtain a similar
form when they take copy of letters written with a particu-
lar sort of ink. The conclusions of this author are in
accord with the opinions expressed by others; and though
he thinks that the ligthographic handwriting is the normal
writing of the left-hand, he does not deny that it may
sometimes be due to lesions of the encephalic central
organ.
The experiments made, in order to be able to see what
muscles were more or less used in writing, were restricted
to those accomplished by a localized interrupted current,
in each of them, on sound persons. It was afterwards
pathologically seen that there is a difference between the
vertical and the lateral tremor, because the former is due
solely to a lesion of the musculo-spiral group of the several
muscles.
It was seen, in analyzing the psychical fact of writing,
that the image of the form of the letters and the words is
received by the brain along with the impression of the
motions necessary for the formation of the letters, and that
by little and little there is established a quasi solidarity
between these two facts ; in fine, by exercise and use we
may virtually see the figure of the word before tracing it
on the paper with the hand, and in the person writing, this
image is united to the remembrance of the muscular
contractions whose co-ordination reproduces the figure
determined at pleasure of the will.
Thus, in the child, we see that he attentively fixes the
model, in order to impress the image on his brain, and to
constrain the muscles of his hand to follow the given direc-
tion ; sometimes, instead, he does no more than pass with
the ink over lines (letters) traced in pale color on the
582 A. Bianchi.
paper, and thus he obtains that the unconscious impres-
sion of the motions executed by the hand, is imprinted on
the brain along with the image given by the sight, and by
many times repeating the same impressions of images and
muscular motions associated with the image, it happens at
length that they obtain such close association that, in the
adult, it is impossible to distinguish the two phases of the
phenomenon. But the same impressions are always pro-
duced, and their imprint is preserved in the memory,
becoming finally so profound that the practiced man
succeeds in writing with the eyes shut, as well as with
them open, presenting at such times, only some disorder in
the distribution of the words, in the horizontal lines, and
the punctuation. Experiment therefore tells us that, for
the act of writing, we require the impression of the image
of the words and the disposition of the words, and further,
the impression of the motions necessary for their forma-
tion. This last fact seems to have its seat in the left
hemisphere prevalently, but a little in the right also, for it
cannot be admitted that the binocular impression transmitted
from the eyes, and producing equal images on the hemi-
spheres, calls forth only on the left the muscular contractions
necessary for the external impression of the image.
In a hemiplegia of the right side it will therefore happen
that the image, not calling forth, on the left hemisphere,
any centrifugal motion in the muscles of the right hand,
will oblige the extensor cellular groups in the sound right
hemisphere to write from the left, because of the preserved
remembrance of the muscular combinations associated with
the image of the word. Hence there will be an identical
centrifugal motion and the reversed lithographic writing.
The same contractions preside over this writing as over
common writing, and it is as symmetrical, as respects the
axis of the body, as the other. In reality, if experiment-
ally, the eyes of an individual be bandaged, and he is
made to write with each hand, we shall see that he
almost always writes reversed with the left hand, and with
a little practice it will succeed that the two writings, being
Changes in Ha7tdiuriting. 583
superimposed, are exactly equal. If, instead, the individual
writes with the left in the common mode, there is a cen-
trifugal form on one side and a centripetal on the other,
but the muscular groups which enter into action are
antagonists, and they give an insupportable contraction.
According to these experiments, repeated by Vogt and
Durand, the centrifugal writing is the normal of both
hands.
Dr. Ireland advances the hypothesis, that the image,
or the impression, or the change in the cerebral texture,
by which the image is produced, is formed in the mind
of the lithographic writer, reversed, like the negative of
a photograph, or if the usual centre forms a double image,
the right and left; they are in opposite directions in the
two hemispheres. We might then believe that the image
of the left, having, from disease, disappeared, the reversed
one of the right remains, and is capable of tracing the
characters from right to left, and in the centrifugal direc-
tion, because it is easier. Further, in those who write
with the left, and not reversed, it may be that there is a
greater facility in copying the image of the right side of
the brain.
The experiment that has most aided this study, has
been that made on children in the German and American
schools, Ireland informs us that in a school of one hun-
dred pupils of both sexes, only five were found, who, in
writing with the left hand, gave the lithographic form,
and these were all who used the left hand instead of the
right. It was observed that they seemed unaware that
they were doing anything abnormal, and they wrote fast
and better than the other pupils. In another school of
one hundred and thirty-four individuals, only three, in
the same condition, wrote reversed.
Vogt, in experimenting on many hundreds of persons,
saw that the ordinary writing was done well with the
right hand and the eyes shut, and almost as well as with
them open, in 98 per cent., if the person wrote often and
at different times, but if performed with the left hand,
584 A. Bianchi.
in the same conditions, it approached to that with the
eyes open in 16 per cent. On the other hand, the
reversed writing, done with the right hand, and the eyes
closed, did not resemble that made with the eyes open,
and frequently it could not be read, whilst if done with
the left hand, it resembled more that done with the
eyes open in 92 per cent. From these experiments it
seems that the reversed writing is the writing of the left
hand, and all the more so since it becomes very difficult
if it is desired to execute it with the right.
Durand observed besides that among intelligent per-
sons, or those who write much, they are seen to do the
writing with the left almost as well as with the right
hand, and they cannot write reversed, " because in them
the image of the word is so fixed in the memory that
they cannot conceive it in another way, and they con-
strain the muscles without knowing it, to trace the
image as they have it in the brain.
But in persons of little intelligence, and who seldom
write, there is an aptitude to write with the left hand
in both ways, and the reversed letters are better
formed than those carried from left to right.
The study of the diseases in which this mode of
writing is observed, is but recent, and the cases are there-
fore few which have been reported by authors. Buchwald
relates, among others, three observations, one of a man
of forty-five years, with hemiplegia on the right side,
combined with aphasia; he wrote with the left hand cen-
trifugally, tracing the letters and numbers well, excepting
the 8. By long education he was enabled to write some
phrases centripetally with the left hand. After six months
the lesions of speech disappeared, but the tendency to
lithographic writing continued. However, the cases may
be divided into two groups; — those with perfect intelli-
gence, right hemiplegia and slight aphasia, and those in
which all the morbid phenomna are very accentuated.
Buchwald observed that, the hemiplegics, or the
slightly aphasic, did not present the lithographic writing;
Cha?iges in Handwriting. 585
Swortzoff observed the same, but Vogt tells us of a
Swiss who, during twenty years, wrote in the non-reversed
way with the left hand, the right being paralyzed.
Among the grave cases Swortzoff places that of a florist
of thirty-three years, who was struck with logoplegia,
from blindness to speech, with right hemiplegia and con-
tracture. Having improved, she re-acquired, in some
degree, the faculty of speaking, and of writing, with the
right hand, her own name reversed ; but her memory of
words had disappeared ; she could not read, but could
write pretty well with her left hand, in the lithrographic
form, though readily mistaking one word for another.
Durand has a case of a man of thirty-five years^
aphasic in a slight degree, from syphilis ; by little and
little he saw his right arm paralyzed ; he wrote with the
left easily, and in the lithographic way, but he wrote
in the normal form, w4th the same hand badly and with
difficulty.
Ireland relates the case of a girl of seven years^
paralytic and imbecile, hemiplegia on the right, from birth,
quasi aphasic, epileptic and active, but timorous. After
eighteen months of education, she learned to write, but
in the lithographic way, as has been seen in the example
reported further back. The same author states the case
of another girl of fourteen years, imbecile, but more
intelligent than the other ; she used the left hand, and
wrote well reversed, better than in the normal way.
Ireland relates the following additional cases : That
of Millard, who, in an imbecile boy of twelve years, who
learned to read, observed that the writing done with the
left hand, required the paper to be reversed, in order to
read it. Next, that of Nibar, who observed a man wha
wrote well with both sides, tracing with the left hand
the letters in the lithographic form. From these few
cases we may conclude, with reason, that the reverse
structure, although it is the physiological of the left
hand, yet it obtains more specially in cases of lesion,
of the left hemisphere, and in aphasia, because then the
586 A. Bianchi.
normal writing of the left is liberated by external cir-
cumstances, by education, by remembrance of the figures
traced from the right, and by the influence, of the sight
and the will, leaving thus only the remembrance of the
impressions of the muscular motions, united to that of
the impression of image. This writing is therefore due,
on the one side, to aphasia, and on the other, it is a
thing purely physiological, and it would be only
accidental to see an organ re-acquire its normal func-
tions under the influence of a pathological part.
Writing of the demented. — Finally, it seems useful to
say, in a little space, how profitable it may be to the
physician to examine the writing, when it is presented in a
case of real or supposed mental alienation. Without in
the least invading the field of the medico-legist, it is
only for the diagnosis of the clinical form of the intellec-
tive lesion that we think these principal points should be
placed in assemblage. Here are observed all the so-called
disgrammato-graphias, conscious and unconscious, in union
with the diverse mechanical alterations of writing corre-
sponding to the various lesions of the peripheral nerves,
and of the encephalic and medullary mass.
Thus, in maniacs, the handwriting runs rapidly and
boldly, but slowly and hesitatingly in melancholies, who
have brief and incomplete thoughts, whilst those of
maniacs are prolix, incoherent and oft-repeated.
Simple dementia presents want of association in the
ideas, repetition of the same words and phrases, omission
of words or of parts of the phrase, and numerous ortho-
graphic errors. In general paralysis, in addition to these
facts of demenitia, there is the true tremulous writing,
and in the last stage of the disease the true handwriting
disappears to give place to marks and lines unintelligible
to us, but with which the patients believe they are able
to communicate and express their ideas.
In monomania there are observed written signs, cor-
responding to the variety of the psychical alterations.
The attentive observation of these signs is of great
Changes itt Handwriting. 587
importance, as a diagnostic and prognostic element, since
from their disappearance we may infer recovery or a
diminution of the intellective lesion.
In mania, the writing is always tremulous and irregular,
with extensive tracts difficult to be read, sometimes quite
illegible, and with oft-repeated lacunae; when this writ-
ing resumes, or tends to resume, its habitual form, we
may with security promise an early recovery.
In maniacal excitation and monomania, the writing is
often full of capital letters, in the beginning, the middle
and the end of words, and the words themselves are
often underscored, in order to draw the attention of the
reader to an idea or a phrase. These two characters of
the handwritinp of these insane persons are useful in
diagnosis and prognosis, because from them a certain
return of the malady may often be predicted.
From the study, then, of the writing of the insane,
not only may we know the exalted or depressed forms
of the malady, but we may also, from them predict its
early arrival, and our prognosis will be easy. Thus, in
patients with general paralysis, when as yet all the
symptoms are silent, and the writing presents neither
tremor nor irregularity, nor forgetting of words or letters,
nor repetition of phrases, or omissions of entire parts of
the discourse, there may be found in the writings of
these persons phrases which- show a weakening of the
reason, a hesitancy, risky projects, and a different form
in the letters.
It is, however, a fact that the intelligence has not
altogether disappeared in cases of abnormal writing in
the insane ; rather, indeed, it may still yet exist, when
speech and writing are abolished.
[Either this looks close akin to mystery, or I have
failed to render correctly the author's language, or the
printer's devil has been indulging in barbarous vivisection.
— Translator.]
Progfiosis. — When we find that we have in hand a
patient who can write, it is highly useful to get him to
588 A. Bianchi.
trace some characters in the commencement of his case,
that we may see whether they are altered ; this may be
of great assistance in the prognosis of a nervous disease.
If, for example, in chronic alcoholism we see that, after
treatment with strychnine, the writing resumes its neat
turns, and is no longer tremulous, we may be quite sure
of a favorable prognosis ; but if we see it remain sta-
tionary, or the tremor in the lines increase, we may
securely anticipate a malady quite incurable. The same
may be said as regards the prognosis of incipient, or
advanced general paralysis, and paralysis which has for its
cause a syphilitic process. In the latter case the prognosis
is more easy when we see, in the progress of the specific
treatment, the writing slowly becoming more regular, and
finally reaching a point of real improvement, characterized
by the return of the handwriting to its normal form.
This fact is realized in cases of amendment in mental
diseases, when we see disappearing the special signs
described by us, which characterize the different forms of
alteration in the writing of dements. It will therefore be
useful to examine the writing of these persons, that we
may be able to judge when a probable recurrence of their
primitive mental malady may happen.
Treatment. — Erlenmeyer speaks of the benefit from gal-
vanization of the brain in general paralysis. He saw that
under the use of the current there was an amendment in
the psychical and mechanical alterations in the writing,
and besides, that it was executed with greater rapidity.
But similar effects were not always obtained in the altera-
tions in the writing resulting from general paralysis. On
the other hand, in cases of paralysis from syphilitic lesion,
successive amelioration and absolute recovery may be
obtained from the specific treatment. And in cases of
acoholic tremitus, under therapeutic measures and appro-
priate diet, the tremulous character of the handwriting
may be made to disappear.
In the forms of dementia the treatment will proceed
with profit to the patient, when we shall see, even before
Changes in Handturituig. 5^9
the disappearance of the phnenomena of the malady, the
writing return to its ordinary forms, and the disgrammato-
graphia altogether, or partly, disappear.
But the therapeutic criterion should be deduced from
the probable seat of the disease. Thus, in cases in which,
whilst the formation of ideas and their perception are yet
unimpaired, the writing is difficult, because of lesion purely
mechanical of the right limb ; galvanization of this mem-
ber, and the employment of those means which may restore
to it force and co-ordination of the motions, will be use-
ful. If the lesion is of the senses only, as for example,
loss of vision, we may by a well-directed method, teach
the patient to write in the dark, and this will be so much
the easier the better the patient has before been instructed,
and if he had before enjoyed the faculty of sight.
On the contrary, in cases of central lesion which has
destroyed in part the cellular mass, or the means of trans-
mission for written language only, treatment will be of
little use ; but if the lesion is on one side alone, we may
hope, by a special education, to be able to make amends
for it. Cerebral galvanization, as Erlenmeyer employed
it, may, according to him, be useful. Every sort of treat-
ment for restoration of the writing will be useless in cases
of complete destruction of the centres assigned for written
language, and of the means of transmission.
5. Conclusions. — We may, from the exposition of facts,
just now completed, draw, with sufficient safety, some
conclusions, provided we content ourselves with the study
of the clinical part only, omitting altogether the physio-
logical investigation :
1st. The study of the mechanical and psychical altera-
tions of writing merits special attention, and may be of
great utility in diagnosis, prognosis and therapeutic direc-
tion.
2nd. The reversed writing, it seems, may in future be
studied with real advantage. Up to the present time it may
be said that it is observed in many cases of right hemi-
plegia and idiocy.
590 A. Bianchi.
3rd. In mental diseases, especially, attentive examina-
tion of the psychical and mechanical alterations of the
writing, may notably clear up the diagnosis of the disease.
4th. In prognosis, whether relative to an improvement
or a relapse, examination of the handwriting may afford
notable aid.
5th. The best treatment in cases of mechanical alter-
ation of the writing is galvanization of the brain, good
intellectual exercise, and a well-directed education of the
hand,
6th. The specific treatment, in cases of altered writing,
from syphilitic cerebral lesions, and that of strychnine in
those from chronic alcoholism, give the most benefit.
Reciprocal Insanity.'
By Ralph S. Parsons, M. D., near Sing Sing, N. Y.
"IT 7"HEN friends of the insane are advised to place the
* ' patient under special care, away from home, the
■question is sometimes asked, whether association with
other insane patients may not be in itself injurious ;
whether insanity may not be in some way a contagious
disease, so that even sane persons who are in constant
association with the insane are on this account liable
themselves to become insane.
The answer is that as a rule, insanity is not contagious ;
that insane patients do not often adopt the delusions of
their insane associates, but on the contrary recognize them
as delusions no less clearly than any other persons
"would ; and further, that attendants in charge of the
insane do not show any greater liability to insanity than
persons who are engaged in ordinary'' occupations. When
insane patients do adopt the delusions of their associates,
as is sometimes the case, they usually accept the false
beliefs on testimony precisely as false beliefs are accepted
by many sane persons. Hence, the adoption of these
delusions in such cases is not a symptom of insanity,
save in so far as it denotes the existence of an already
impaired intellect ; nor do the adopted delusions materi-
ally affect the mental condition of the patient, or the
probabilities of recovery. To a certain extent and in
various ways, an insane patient may sometimes be bene-
fited by being judiciously associated with other insane
patients. On the other hand, annoyances may arise from
such association which are injurious, precisely as any
other annoyance would be injurious, and not at all on
account of the contagiousness of the disease to the
influence of which they are exposed.
•NoTi.— Bead before the American Neurological Association, June 22nd, 1883,
592 Ralph S. Parsons.
In some cases and under certain conditions, however,
two or more persons do sometimes exert an adverse
reciprocal influence upon each other, tending to the pro-
duction of insanity in each, or to its development in
succession from one to another.
Insanities may arise reciprocally in various ways, as :
first. — From identical causes acting at the same time
and under similar circumstances on individuals of like
susceptibilities, who are in close sympathy and intimately
associated. The mental disturbance excited in each im-
mediately reacting upon, and increasing the mental
disturbance of the others.
Secofid. — From insane delusions being entertained by
one of two or more predisposed persons, in intimate
relation with each other; and the deluded person acting
as a cause of the development of similar, or identical
insanity in the others ; and mutual reactions taking place.
Third. — Through emotional influences ; as when one
subject of a convulsive form of nervous disease, or of a
form of insanity characterized by emotional disturbance,
is intimately associated with persons of similar tempera-
ment and susceptibility.
The following cases will serve to illustrate these
insanities :
In the spring of 1865, twin sisters, about nineteen
years of age, were admitted to the New York City Lunatic
Asylum as patients, in a state of acute mania. The
manifestations of insanity were so nearly alike in the two
as to be practically identical. The language, appearance
and actions of the sisters were the same. They were so
similar in person that it was difficult to distinguish the
one from the other. They had always been together,
and had become insane at the same time, under the
influence of the same causes on similar physical and men-
tal organizations. It is quite possible, and even probable,
that either of the young women would have become
insane under the same influences, if she had had no sis-
ter, or if she had been a long time separated from her
Reciprocal Insanity. 593
sister. There can be little doubt, however, that the
beginnings of insanity in each were stimulated by the
disturbed mental state of the other. It was quite evident
that in the result they were mutual causes of mental dis-
turbance.
Only a few weeks ago, all the members of a whole
family, including a father, mother and several children,
residing in the interior of this State, were reported to
have become insane at the same time, through the influ-
ence of fear ; the mental disturbance of each reacting
upon the others as a cause.
The following case is narrated at length, in order to
present a more complete picture of the disease than a
brief abstract would have done :
On the 7th of May, 1870, a woman named Margaret
C , was admitted to the New York City Lunatic
Asylum, as a patient. No positive evidences of insanity,
either in appearance, conduct, or conversation were
observed at the time of her admission. She made the
statement that a certain man wished to marry her younger
sister Julia ; that her sister did not wish to marr^' the
young man, and that he had procured her commitment to
the Asylum, because she had reproached him for pressing
his attentions on Julia. On the 9th of May, Julia visited
her sister at the Asylum, and corroborated her statement
in every particular. Julia was evidently insane ; but it
was then thought that Margaret's notions were founded
entirely on the testimony of Julia regarding her own
troubles ; and hence, that her beliefs could not properly
be considered as insane delusions. She was allowed to
leave the Asylum in company with her sister Julia.
On the 9th day of July following, both Margaret and
Julia were admitted to the Asylum as insane. The
statements made by these sisters were identical in every
particular. The delusive ideas, however, all had regard
to the younger sister. Durmg their examination at the
time of admission, and indeed on all other occasions
when both patients were together, they talked with
594 Ralph S. Parsons.
great volubility and earnestness. One of them would
begin a statement of their troubles ; after a few moments
the other would take up the thread of the narrative,
as though b}' a sort of common consent, and after con-
tinuing a few moments the story would again be taken
up by the first, and so on, until the close of the
interviews. In their ideas and feelings, each seemed to
be the counterpart of the other. They had the idea
that a certain teacher in one of the public schools
was enamored with Julia; that in fact, there was an
understanding between the gentleman and Julia, that
they were to be married, although he had never spoken
to either of the sisters, nor had any communication in
writing ever passed between them. He, on his part, as
they said, looked and acted out that he would marry
Julia ; but in what these looks and actions consisted
they were not able to explain. On their part Julia
had chosefi the gentleman for her future husband, and
this seemed to them a satisfactory and definite settle-
ment of the question. The statement that she had
chosen the gentleman was often repeated in explanation,
or as a proof of the engagement ; and they seemed to
think that Julia's choice having been once made, the
acquiescence of the gentleman would be a matter of
course. Still they repudiated the idea that the engage-
ment was in any sense compulsory on his part. On the
contrary, although Julia was willing and even anxious to
marry the man of her choice, she would scorn to accept
him save as a willing suitor. She would rather remain
unmarried through her whole life.
All the trouble of the sisters [^had arisen from this
engagement. Their father and mother did not understand
them. When on one or two occasions they spoke about
the engagement in the presence of their parents, both the
father and the mother remonstrated with them for enter-
taining such foolish notions. They never afterwards
mentioned the subject in their presence. Still they felt
assured that their parents knew all about the affair, quite
Reciprocal Insanity. 595
as well as they themselves did. Their parents, they said,
had other and more ambitious views. They wished Julia
to marr>" the son of a wealthy builder, who lived in the
neighborhood. They never said anything about their
ambitious wishes, but acted ont what they thought ; they
treated their daughters coldly and sometimes did not
give them enough to eat. So too, the builder's son
pressed his suit, by his looks and by his actions, with
great persistence. This was their greatest annoyance.
Julia, who was the less demonstrative and the less ener-
getic of the two, simply expressed her displeasure to her
sister in mild terms of indignation. Margaret, however,
went to the young man and bitterly reproached him for
his cruel conduct. Not only that, but she attempted to
break the windows of his house with a stick. Through
the connivance of their parents and the builder's son
other people also annoyed the sisters. Tradespeople
would charge them more for articles they wished to buy,
than they charged other people. Such was the history
given of themselves, by these two patients at the time of
their admission on the 9th of July. Although the impres-
sion was at first gained that the delusive ideas originated
with Julia and were simply accepted as true by Marga-
ret, through faith in Julia's statements, a further inquiry
served to remove this impression. On the contrary, it
became a serious question, whether the delusions had
not really originated with Margaret, and afterwards been
adopted by Julia. There was no evidence to show, how-
ever, that the delusions had originated with the one
rather than with the other.
Since it seemed evident that the influence of each
was but to fix the delusions of the other, they were
placed in separate wards at the asylum. JuHa was quiet
and made no especial complaint. She was allowed to
leave the asylum on the the 13th of July, in care of her
father, with the understanding that she was to engage in
some occupation away from home, and that when, after a
little time, Margaret should be allowed to leave they were
$g6 Ralph S. Parsons,
to live apart. Margaret was irritable and abusive in lan-
guage. She was indignant that she should be separated
from her sister, and complained that Julia was abused
and starved, although she had no evidence of any kind
on the subject. When told that Julia had been allowed
to leave the asylum, she would give no credit to the
statement, but expressed the belief that she had been
choked. Margaret was allowed to leave the asylum in
care of her father, on the i8th of July, and was advised
to live apart from her sister.
On the 1 2th of Febuary, 1873, Margaret and Julia
were again admitted to the asylum, as patients. Their
delusions were essentially the same as before. On the
second day after their readmission, the following note was
made at the time of the morning visit, both the sisters
talking alternately, as above mentioned. The notes are
recorded under Julia's history, and as though she only had
made the statement, since each said the same things in
regard to their troubles and used the singular pronoun
in her narration.
The notes are as follows, viz :
Says now, that at the time she was here before, she
was laboring under a misunderstanding in regard to the
young man named Tracy : Says, Tracy did wish to
marry her, but did not- persecute her, as she formerly
supposed. Has since learned that her parents were her
persecutors, in connection with the Devlins. Did not
know of this until two weeks ago. Now knows that
her parents wished her to marry John Devlin. Found
this out by the way in which her parents and other
people acted and treated her, — had herself chosen to marry
first one and then another gentleman ; but obstructions
were placed in the way. Sometimes the priests acted
instead of her parents, and prevented her marriage with
the persons she had chosen. Means were taken to
prevent them from making the acquaintance of Julia.
Has never spoken with any of these men. The men
acted to her that they would not be allowed to speak
Reciprocal l7isanity. 597
with her, until they were allowed by her parents. The
parents acted that they wished her to marry Devlin,
but never spoke on the subject. Devlin was in the
habit of following her about, and she used to do the best
she could to avoid him. Did not think until two weeks
ago that her parents annoyed her on account of Devlin.
Thinks now that if she would return home her parents
might let her marry whomsoever she chose, but is deter-
mined never to return home, on account of the ill-treat-
ment to which she has been subjected. Her parents, she
is persuaded, would be willing to have her marry some
other man than Devlin, if they could make the selection ;
but she objects to any man of their choosing, and now
entertains ver}' strong antipathies against her parents on
account of their persecutions. Her parents interfered with
her by their actions, and without seeing her, or speaking
to her. Found this out entirely by the results, by reason-
ing from what she considered to be the facts. Went in
company with her sister to Devhn's house, and tried to
break the windows with a stick, on account of his actions.
Her parents had chosen Devlin for her, but she does not
want him. Has insulted him publicly and privately, but
he will not notice her insults. Hates him because he is
so little. Does not care for his riches, but wishes to
marry the man of her choice. Wishes to remain here
until Devlin and her parents are willing to let her
alone. Her parents have uijured her for two years, but
she did not know it was they who injured her, until
recently. Went with her sister to Judge Bixby, and
made a complaint against Devlin, when she was arrested
and sent here. Did not live apart from her sister after
leaving the asylum, as she had promised.
The sisters were allowed to leave the asylum in
care of their father, on the 27th of Febuary. On the
27th of March, they were again admitted, having been
arrested and sent to the work-house, and from thence
to the asylum. Their mental condition was the same
in all respects, as before. About one month afterwards.
59^ Ralph S. Parsons.
however, Margaret for a few weeks entertained ideas
in regard to herself, which heretofore, she had enter-
tained only in regard to Julia. She too had chosen a
husband for herself. Said that when she was ready
the man she had chosen would be compelled to marry
her.
Julia was allowed to leave the asylum, in care of
herself, on the 2ist of April. She was so undemonstra-
tive when not in Margaret's company that there seemed
to be little liability of her getting into trouble when apart
from her sister. Margaret, however, was at times exceed-
ingly vehement in her expressions. She at times threat-
ened to take vengeance on her supposed persecutors. At
about this time she began to entertain a strong antipathy
against Dr. H., one of the assistant physicians at the
asylum, saying that he also was one of her persecutors.
She had previously chosen him as her future husband.
She afterwards became quiet and orderly, and was allowed
to leave the asylum. Julia had proposed that she
would go to Philadelphia, where she had formerly re-
sided, while Margaret should remain in New York, and
they were advised to carry this project into effect.
The following letter, postmarked at Philadelphia, was
subsequently received from Julia :
"Dr. Parsons: — I understand that Dr. H. has spied
and watched me to this city, and what a cheek he had
and what mean principles, for he has seen plainly and
publicly in New York City, that I was true to another
gentleman, for when I left the city, how dare he follow
me ? He certainly must have a singular appetite for me
when he watches me, and I false to him and true to
another. Why it was like following me from Egypt's fire
to the north pole. It was ill-bred and impolite in him
to dare it. But I suppose he did not care, through his
impudence. I do not thank any one to spy or watch
me, and I true to another. Therefore, Dr. Parsons, stop
him immediately, because I am not true to him and
never shall be. How dare he watch me coming to this
city? Besides I was always true to this gentleman, even
while I was over there, but I thought it was he who put
Reciprocal Insanity. 599
us there, and persecuted me. I found out since what an
impudent, dirty, ill-bred, know-nothing my wicked parents
had for me. None but an impudent wretch wants me
against my wishes. Stop him quick, for he shall never
come within my door, nor none but whom I am true to
publicly. I never intend to accept of Dr. H., nor do I
ever mean to change to him. I am already pleased
and satisfied, and Dr. K. knows it. Therefore, he had
no business to follow nor spy me, coming here. I
should rather die. I was surprised, for I never thought
about him in the least. I never expected any one to
spy me here, but the gentleman I was true to, and left
the city for. Stop watching me immediately, or I shall
write more scandalous. " Julia C. "
About a month afterwards, another letter written in
the same strain was received. This letter was mailed in
New York City. It was subsequently ascertained, that
the young woman remained only a few weeks in Philadel-
phia. During the latter months of the year, Margaret
wrote several letters to Dr. K., who had been formerly
assistant physician at the asylum on Blackwell's Island.
She complained that Dr. K., Dr. H. and certain other
parties, came to the city, and annoyed them by their inter-
ference and importunities. She threatened to shoot them
unless these indignities were stopped.
On the sixth of January, 1874, the sisters were again
admitted to the asylum. Margaret acknowledged having
written the threatening letter to Dr. K. She averred that
Dr. K., Dr. H., Mr. Tracy and Mr. Devlin had followed
them to Philadelphia; also that Dr. H., had procured her
commitment to the asylum, for the purpose of compelling
her to marry him. Julia made statements that were
nearly identical. They were placed in different wards.
Julia was quiet and agreeable in conversation. She urged
that she was now enlightened, knew that she got into
trouble on account of her notions, and promised in future
to avoid the expression of her peculiar ideas, so as to
prevent further trouble. She very often urged the plea
that she had been enlightened, and hence should be dis-
charged.
6oo Ralph S. Parsons.
Margaret was irritable, and abusive in language. On
seeing the physicians of the asylum, she would often
become greatly excited, upbraiding them on account of
the indignities she had suffered, and on account of her
unjust detention. At times she would expose her person
in the presence of the physicians, in a defiant manner,
intimating that since she was kept here for an improper
object, she might as well show that she knew what the
intentions were regarding her. She did not appear to
expose her person through any impulse to commit an
indecent act, but rather through a sort of bravado, and
to express her defiance. Her animosity was expressed
more especially towards Dr. H.
They left the asylum in care of their father on the
9th of May, 1874.
Nothing further was heard from either Margaret or
Julia, after the date above mentioned until January, 1875,
when, on the i6th, 17th and 20th, of the month, Julia
wrote long letters to the resident physician of the asy-
lum, complaining of her persecutors, and asking him to
stop them. One of the letters reads as follows, viz :
"Saturday, January i6th, 1875.
" Dr. Parsons : — K. is the most treacherous rascal that
ever existed, and hanging is too good for him, through
the wicked advantage he is taking of me through my
parents being wicked. My wicked father has me beat
and starved to death, because I would not destroy my
future happiness by accepting of K., to accommodate him ;
and what a mean brute K. is to accept of me under the
circumstance that I liked another, but accepted of him
because it pleased my wicked parents. K. is a murder-
ous ruffian. Doctor, I have written three or four shocking
letters to the Commissioners, about K., and the murderer
would not stop, through my parents hating me and through
their trying to starve me to death. How dare my wicked
parents be opposing any one I choose, to get me to
marry Dr. K. They know right well that K. dare not
come face to face to me ; that I would have him arrested
instantly and imprisoned for life. Through all the gross,
insulting letters I have written to him, and through the
letters the Commissioners have received from me about
Reciprocal Insanity. 60 1
him, K. should not dare to watch me, after such shock-
ing insults, except to murder me, either this way or that
way. But the ruffian knows that I cannot get work, and
•my wicked father is asking of the parish priests and of
his neighbors for charity, and I am starving with them
during the last four or five weeks. Since I would not
accept him, he wants me starved to death for spite, the
rowdy, for he is a rowdyish professor when he dare take
advantage of me through my parents being my greatest
enemies. What does my father mean by choosing a rake
like K. for me? It is because I hate K., and like another,
and since it is so that he used me cruel all my lifetime
he also wants my future life to be unhappy. I would
rather beg than spend my future life with such an unmerci-
ful infidel as K. is ; even if he would not murder me.
I could not enjoy such an unmerciful, unprincipled slop.
" Doctor, don't you remember what you told Mr. Cole-
man on the 17th of last March, about the terrible letters
I had written to him? How dare he expect me, after all
those fearful letters, as you called them ?
"Doctor, please do go and stop the murderer, immedi-
ately, because my wicked parents are very cross and
stubborn to me through him, and I am living on bread
and tea and cold water, by them, through K. opposing
the gentleman I have chosen and am true to. How dare
K. be trying to pull and drag me to him against my
wishes, from the gentleman I like ? Hanging is too good
for him. It would be a charity for you to stop him
quick.
" Doctor, please excuse this writing, because if my wicked
father saw me writing it, he would kill me, he is so
guilty. Respectfully. "Julia C."
The whole letter (with the exception of the postscript)
is given, for the purpose of showing the general current
of thought, more clearly than extracts would do. The
other letters are similar in character. One of them also
contains a tirade against Sal Devlin, " the low wretch of
a wanton widow, who aided her outlawed robber of a
father in his persecutions."
It is pertinent to mention that Julia had seen neither
Dr. K. nor Dr. H. for a long time previous to the writ-
ing of these letters, the former being in Europe and the
latter in Virginia.
6o2 Ralph S. Parsofis.
At the date of admission in 1870, Julia's age was
stated to be twenty-four years and Margaret's age twenty-
six. When last admitted, Margaret said she was forty
years of age, and that her age as formerly given was
incorrect. She did not appear as old as forty years, but
is probably more than two years older than Julia.
Both Margaret and Julia were in what would gener-
ally be called good health, although each lacked the
bodily vigor and elasticity of mind that result from per-
fect physical health. They were rather thin in flesh, and
had an appearance of physical depression or weariness,
such as might arise from overwork, too great confine-
ment, or trouble.
No very marked hereditary influences could be traced.
A cousin, however, was said to be insane. Their parents
who are well advanced in years, are in a fair state of
health. Their father appeared to be a man of good
judgment and fair intellectual capacity, but the mental
powers of their mother were of a low order, although
she had never manifested any symptom of insanity, or
even of what might properly be called imbecility.
No especial peculiarities in the natural characteristics
of either of the patients were observed, or could be
ascertained. Margaret, however, was rather inclined to
be irritable and aggressive, while JuHa was of a milder
temperament, and more easily influenced and controlled.
No objective cause, or causes of their insanity could
be ascertained, other than their associations, or rather
lack of associations, and their habits of life. Up to the
period of their first admission to the asylum, they
had always lived at home, with their parents. They
were industrious women, and occupied their time in the
munufacture of men's clothing, for wholesale dealers,
one of them operating on the sewing machine and the
other fitting and finishing the work. Through this divi-
sion of labor, each finally came to consider the aid of
the other, in the light of a necessity. Neither of them
thought she could work apart from her sister. They
Reciprocal Insanity. 603
were always together. They never visited, they had no
friendship with other women. Their only acquaintance
with men was in a purely business way. Each was
all-in-all to the other — companion, fellow-worker, friend.
They did not even associate with their parents, but
in all that related to their plans, or to their feelings,
they were strangers to them, as to all the world beside.
Thus in the midst of a great city, they lived a sort
of dual hermitage. They were occupied with the same
work ; they conversed about the same things, for they
conversed only with each other. They finally came to
think and feel almost as though they had been one per-
son, instead of two. And this mutual influence had been
so gradual that it is difficult to judge which was the
leading factor in the development of their beHef, their
feelings and their aspirations. If Margaret was the more
positive and aggressive in temperament, Julia, on the
other hand, had more of imagination and spontaneity.
After a careful study of their history and characteristics,
the conclusion was reached that their delusive ideas had
been of very gradual growth, taking their rise, first in an
undue activity of the imagination, then in the indulgence
of unfounded hopes and aspirations, then in the conviction
that these hopes would one day be realized, and as a
final result the notion that some one had interfered to
prevent the realization of their beliefs. Their delusions
finally became of such a character that there were unmis-
takable indications of the existence of insanity. Through-
out the whole of this process the change in mental state
in each appears to have progressed pari passu with the
change in the mental state of the other ; or, in other
words, under the influence of mutual reactions and of
causes common to both, they became insane at the same
time.
The following points in connection with these cases are
especially noteworthy :
The efficient causes of their insanity seem clearly to
have been moral instead of physical. Neither of the
604 Ralph S. Parsons.
patients had ever complained of serious illness of any
kind. They had sufficient exercise, both at home and
in the open air. They were not overworked, and they
had a sufficient supply of nutritious food, at least until
troubles arose by reason of their insanity. These moral
causes acted at the same time on similar temperaments,
and not unnaturally produced similar results in each case.
In saying that the causes of their insanity were mental, as
contra-distinguished from physical, it is not meant that no
changes had taken place in the brain as the cause of the
insanity ; but simply that the molecular change in cerebral
structure, which was the immediate cause of disordered
mental activity, was itself brought about by moral instead
of physical causes.
None of their relations were known ever to have been
insane, with the exception of one cousin. But still, although
there had been no insanity in the direct line of ascendents,
as far as could be learned, there can be little doubt, that
they were really predisposed to insanity. Indeed, it is
doubtful whether moral causes ever produce insanity
unless a predisposition exists. Their mother was a woman
of limited mental capacity. The mental faculties of the
daughters were of a higher order than those of the
mother, but yet they undoubtedly inherited from her an
instability of cerebral organization that amounted to a
real predisposition to insanity.
The exciting causes of the insanity of the two sisters
would seem to have depended chiefly on their habits, and
on their mutual influence.
Since they associated only with each other, their notions
were not corrected by a comparison with the views of other
people. Hence, the first beginnings of extravagance in
their ideas were unchecked. They continued to indulge in
their unfounded notions, until what was at first a mere wish
or hope, finally became, through force of habit, a firm belief.
Not only did they lose the benefit of a comparison of
their beliefs with those of other people, but each acqui-
esced in, and thus confirmed the beliefs of the other.
Reciprocal Insanity. 605
Hence, hereditary predisposition, lack of occasion for
properly exercising the faculty of comparison, and thus
correcting their false judgment, and a mutual confirmation
of their false beliefs, finally eventuated in delusions, which
are characteristic evidence of insanity.
If the last factor mentioned, that is, their mutual
influence, had been wanting, it is not at all certain that
either of the sisters would have become insane. On the
contrarj', it is not unlikely that both would have escaped
the disease.
Cases not unfrequently happen in which the insanity
of one member of a family becomes an immediate excit-
ing cause of the insanity of another member. The simple
fact that one member has become insane is in itself pre-
sumptive evidence, that other members of the family
inherit the insane diathesis ; and hence, that they are
in danger of becoming deranged, through association with
their insane relative.
The following history', transcribed from the Records
of the New York City Lunatic Asylum, and furnished
through the courtesy of Dr. T. M. Franklin, the Medical
Supermtendent, is similar to the preceding in all essential
respects :
Three sisters, Mary K., Catharine K. and Anna Theresa
K., respectively forty, thirty-seven and thirty-five years
of age, were admitted to the New York City Lunatic
Asylum, as patients, on the 21st of August, 1877. These
three sisters had lived together for many years, support-
ing themselves, principally by sewing. They appear to
have been feeble-minded, credulous, impressionable peo-
ple, over whom their imaginations had more control than
the exercise of their reason. They heard the vague
statement that a relative had died, leaving them a large
amount of wealth, and they conjectured that it was
some one on their mother's side of the family. Talking
this over among themselves, they persuaded each other
that it was actually the case, and that they were in
reality heiresses to a large estate. They then began to
6o6 Ralph S. Parsons.
fear that people were laying obstacles in the way of
their ascertaining the locality of this fortune. Finally,
they feared that every one was trying to cheat them
out of their inheritance. This fear occupied their minds
night and day, and the delusion of immense wealth, of
which they were wrongfully deprived, became the center
about which all their thoughts revolved. The little
intelligence they naturally possessed, became impaired,
their vague suspicions extended to every on? about
them, and a morbid dread took possession of their lives.
The strangeness of their actions excited remark, and they
were several times dispossessed by landlords, without any
given reasons. They were said to have become abusive
on several occasions. The suspicions of their neighbors
were aroused, so that they were arrested, when they were
found to be insane, and sent to the asylum. After
some months they were all discharged, in care of a
relative, as improved.
The following cases are instances of the reciprocal
influence of emotional states in the causation of insanity :
A. B., a subject of chorea, had attended a small
private school, for one or more years, associating freely
with the other pupils. One of her schoolmates, C. D.,
a girl of especially unstable, nervous organization, became
insane, the symptoms partaking of the nature of delirium,
of hysterical insanity, and of epileptic insanity. It was
diagnosed as a case of choreic insanity. E. F,. a cousin
of C. D., attended the same school, having her seat
next to A. B. During the early part of the illness of
her cousin, C. D., she often remained with her as a com-
panion for several hours, or a day. A few weeks after
the commencement of her cousin's illness E. F. suffered
a similar attack, the symptoms being equally severe and
differing mainly in the fact that motor symptoms of
chorea were manifested in the latter case. It was not
ascertained that either of the girls had practiced self-
abuse.
A lady in affluent circumstances, suffered an attack
Reciprocal Insanity. 607
of insanity, with emotional disturbances. After a time
her daughter, who was making a visit to the mother,
was suddenly attacked with a similar form of insanity,
without any other evident exciting cause, than the influ-
ence of the mother's emotional state.
Among the inferences which may be deduced from these
and similar cases, are the following, to wit :
First. — That, although under ordinary circumstances
the contagion of insanity does not extend from one
person to another, the influence of the insane on persons
inheriting similar faults of constitution, or a known pre-
disposition to a similar form of insanity, should be avoided
as dangerous.
Second. — That the conditions favoring contagion are
most likely to occur among blood relations, who are inti-
mately associated.
Third. — That emotional forms of insanity are especially
liable to extend from one child to another; and also in a
lesser degree among women.
Fourth. — That when two or more persons thus become
insane, through similarity of predisposition, sympathy and
intimacy of association, they usually exert an adverse recip-
rocal influence upon each other, both as cause and effect
of their insanity.
Fifth. — That the contagion of insanity under the influ-
ence of sympathy, predisposition and intimate association,
is most likely to occur during the inception and develop-
ing period of the disease ; and that this liability ought to
be taken into consideration, among other reasons, in deter-
mining the question whether it is advisable to treat insane
patients at their own homes, during the early stages of
their insanity.
Insanity from Quinine.
By Jas. G. Kiernan, M. D., Chicago, 111.
TN 1 88 1 I reported* the following cases of insanity re-
-■- suiting from the use of quinine :
Case I. — T. P., American, single ; grandfather, uncle
and brother died insane. Patient had, however, been in
very good health up to about three months before admis-
sion, which occurred during the year 1874, when he was
attacked by headache, for which, on the supposition of
its being malarial, three grains of quinine were prescribed
three times a day. After taking three doses of this, the
patient was seized by a violent attack of lypemaniac
frenzy, with marked hallucinations of hearing of a depress-
ing type, and considerable dimness of vision. These phe-
nomena persisted for three months, as the quinine was
continued, and the patient treated with morphia subcu-
taneously. On admission to the asylum, which was at
length rendered necessary, the patient was in the con-
dition already described, and was placed under chloral
and hyoscyamus as a hypnotic, and conium to quiet motor
excitement. Under this treatment the patient was in fit
condition to be discharged within six weeks after admis-
sion. He manifested, a day previous to discharge, some
slight evidences of malaria, whereupon quinine was admin-
istered, which had the effect of bringing on a fresh attack
of lypemaniac frenzy, with the same symptoms as previ-
ously. The quinine was stopped, and the same treatment
as before resorted to, when the symptoms disappeared.
The patient was discharged, fully recovered, four months
after admission, but returned within a year in the same
mental condition, froiii the same cause, to recover and
relapse under the same circumstances.
• Journal of Nervous and Mental Disease, 1801 .
Insanity from Quinine. 609
Case II. — P. J., Irish, aet. thirty, married, brother in-
sane, sister epileptic, uncle afflicted with shaking palsy, was
admitted to the New York City Asylum in a condition of
extreme dementia, being able to utter but few words, and
being very neglectful about himself and his surroundings.
He had been in relatively good health up to about three
weeks prior to admission, when he was attacked by a slight
chill, for which he was given ten grains of quinine; in
three hours after he sank into the condition in which he
was on admission, but from which he recovered after three
months' treatment in the asylum. In 1875 he was ad-
mitted in precisely the same mental condition from the
same cause ; was treated much the same, and had ap-
parently fully recovered, when, manifesting some evidences
of malarial infection, an assistant physician, who was
ignorant of his history, ordered him five grains of quinine,
which had the effect of producing a relapse, the patient
returning to much the same mental condition as he was
on admission. He, however, at length fully recovered.
To these cases I am now able to add a third case :
Case III. — R. B., aet. thirty-eight, has a sister epileptic ;
a maternal grandmother and a maternal aunt died from
" rush of blood to the head." The patient resembles the
maternal side of the house in appearance and disposition.
He has never been able to take even a small quantity of
beer for fear of it affecting his head. Having recently
come into a malarious district in Chicago, he was attacked
by fever of a quotidian type. Upon the advice of a fel-
low workman, he purchased and took 9i of quinine sul-
phate at a dose. In an hour thereafter he was violent
and destructive, smashing furniture purposelessly. His
friends called me at this stage. There was a wild, purpose-
less violence, but no delusion or hallucination present. He
was very incoherent and hilarious. This condition disap-
peared in two hours, he having meanwhile been given
a hypodermic of conine, which controlled his move-
ments. A second dose of the quinine led to exactly the
same results, and its aetiological influence was therefore
6io Jas. G. Kieman.
clear. Since disuse of the quinine there have been no
further psychical phenomena.
I have been able to find but one case in literature,
that of Dr. Delafield,* who has reported a case of trans-
itory fury due to quinine.
Such cases as these are likely to become of medico-
legal importance. I have heard of three instances in
which the use of quinine has been alleged as an excuse
for certain escapades seemingly the result of intoxication.
In one case, that of a Catholic clergyman, the man had
suffered from vertigo, but was not addicted to the use
of alcoholic beverages. The second case was that of
a Washington lawyer, who, however, had been clearly
insane and an inebriate previous to the use of quinine.
The third case was that of a Presbyterian minister, of
unblemished character and an abstainer on principle,
who suddenly became violent, angry and destructive after
taking five two-grain quinine pills. This violence lasted
less than an hour, and the man was himself again. As
these cases and others are becoming newspaper topics,
it is exceedingly probable that some criminal may, as
was said to have been Sergeant Mason's intention,
plead the use of quinine as an excuse for crime. From
the cases reported, it would seem that the administra-
tion of quinine might test the validity of this claim.
It will, however, be obvious that quinine can act only
as an exciting cause, and that, at the time of the sec-
ond administration, some of the predisposing causes
might have ceased action. A fairer test would be the
character of the insanity alleged to have been produced ;
since, from the nature of the cases cited, it is clear
that a deliberate crime would be inconsistent with any
of them.
•New York Medical Journal, October, 1832, p. 406.
Report of Cases of Trifacial Neuralgia.
TREATED BY REMOVAL OF MECKEL'S GANGLION; ALSO BY
THE SUCCESSFUL INTERNAL ADMINISTRA-
TION OF ACONITIA.
By A. Van Derveer, M. D., Albany, N. Y.,
Professor of Principles and Praclicp of Surgerj and Clinical Surgery, Albany Medical
College; Member British Meilical Association; Attending Surgeon
Albany Hospital; Consulting Surgeon St. Peter's
Hospital, etc., etc.
'np^HE causes that produce such dreadful suffering as
-■- neuralgia are so very different that medical treatment,
or rather, the use of medicine, alone, is not always able to
afford relief; and yet it is well known to all of us that
there are certain conditions, due to the weak and enfeebled
state of the system, that may be reached in this manner.
And then again it may be stated as a positive truth that
in some cases actual surgical interference becomes neces-
sary. The cases I am about to report will, I am sure,
substantiate the statements I have just made. In this I do
not know that 1 present anything especially new or original,
and yet it seems to me the cases are worthy to go on
record as illustrating the good resulting from operative
surgery when medicine has failed to afford that relief
sought by suffering humanity.
Mr. S., aged fifty-eight, came under my observation
May, 1870.' He gave the history of having suffered for
over ten years from severe neuralgic pains about the right
side of face, along the alveolar process, upper jaw and
right side of tongue ; also in the track of the inferior dental
nerve. In the preceding five years Dr. Detmold, of New
York, as well as the late Dr. i\lden March, of this city, had
*«• Portion of this paper was read ut the meeting of the American Snrglcal Asso-
ciation, held at Cincinnati, May and June, ISSo.
6i2 A. Van Derveer.
each operated twice by loosening the attachment of the
cheek from the alveolar processes, affording a few months'
relief each time to the patient. I did the same operation
with equally good effect; but in September, 1870, the pain
returned with as much earnestness as ever. I now made
use of a very thorough treatment of iron, arsenic, Brown-
Sequard neuralgic pills, injections of chloroform, and every
remedy known to me, but with no especial benefit.
March, 1871, I made a section of the infra-orbital nerve,
which resulted in affording great comfort to the patient,
and for two years he remained quite free from pain. It
then returned, more especially along the course of the
inferior dental, and I suggested the removal of Meckel's
ganglion, but his health was such that neither he nor his
friends thought it safe. The old gentleman has lived on
however, and though yet in great pain for months at a time,
he will improve occasionally, and is alive at the present
time.
Between the time of having Mr. S. under treatment and
the care of the following case, I was so impressed with an
operation I saw Dr. Thorndike, of Boston, perform on an
exceedingly feeble gentleman, aged sixty-five, consisting in
the removal of the infra-orbital nerve with Meckel's ganglion,
in a case of long standing trifacial neuralgia, right side of
face, that I determined to try it with my next similar
patient. I would state here that I have since been
informed by Dr. W. G. Wheeler, of Boston, that this patient
remained well for two years ; that the pain then returned
in the left side of the face, and, after suffering a long time,
he entered the Massachusetts General Hospital, had
another operation like the former, and died a few days
afterward from exhaustion.
Miss B., aged forty, first consulted me July, 1875, giving
the following history : For three or four years previous she
had suffered from neuralgic pains in right side of the face,
differing as to length of time and degree of severity. Her
general health up to this time had been good. No serious
sickness, and family history clear. Passed the menopause
Trifacial Neuralgia. 613
about two years before. Since that time she had had Httle
relief from pain unless under the influence of medicine.
All her teeth had been removed (one or two at a time)
from right side upper jaw, and some from the lower jaw
that side, with but little, if any, relief resulting. Had taken
medicines almost constantly. For the previous six months
she had had no remission of pain, though taking large
doses of morphine, chloral and bromides. Was at times
stupid from effect of these drugs, and yet complaining of
pain. Countenance sallow, pale, and features expressive of
great torture. Unable to do any work, or read or become
interested in anything. The pain would start in the upper
jaw, extend over the face, pass down, around and through
the lower, to chin and along right side of tongue, also
penetrating the temporal region, leaving a heat or inflam-
mation in the mouth, verj"- severe.
At times she would be unable to take a drink without
having the pain aggravated for hours. Was thoroughly
miserable, and despaired of ever getting help. An examin-
ation of urine showed kidneys to be in a healthy state.
Was unable to give a satisfactory reason for development
of original trouble, except that she had for the most part of
her life been confined indoors as seamstress or forewoman
in a large store, getting little outdoor exercise or fresh air.
I gave her large doses precip. carb. iron ; also Brown-
Sequard neuralgic pills, but with no apparent benefit.
Gave hypodermic injections chloroform with a few moments'
respite from pain, but the inflammation following was very
severe. Also gave morphine in the same manner, but so
little good followed that she readily consented to an
operation.
On September 5, 1875, assisted by Drs. W. H. Bailey,
N. L. Snow, Lewis Balch and F. C. Curtis, and my two
medical students, ether being given, I proceeded to re-
move the infra-orbital nerve and Meckel's ganglion in the
following manner: Making an incision from the inner
angle of the eye, down to the bone, along the nose, for
a distance of little more than an inch ; then another
6 14 A. Van Derveer.
incision, similar in length, at right angles, under the infra-
orbital ridge, raising the flap and periosteum, I exposed
enough of the anterior wall of the antrum to admit the
application of a good-sized trephine, removing a button of
bone, so that the upper edge, opening, exposed the infra-
orbital nerve and its canal. Lifting the nerve from its
bed by means of a bone chisel, grooved director and
probe-, I followed it until the posterior wall of antrum was
reached, where, by means of a smaller trephine, another
button of bone was removed, and the spheno-palatine
fossa reached. The ganglion was now lifted from its bed,
and, with curved scissors, the nerve and it were severed
and removed. This was followed by a sharp haemorrhage,
at first somewhat alarming, but controlled by portions of
sponge, firmly applied, to which a silk ligature had been
tied. The wound in the face was then closed by inter-
rupted sutures, a drainage tube, with ligature from sponge,
being placed in most dependent point. The patient rallied
nicely from the anaesthetics, and was immediately relieved
from all pain. There was considerable trouble in remov-
ing the sponge, and the parts suppurated quite a good
deal, but ultimately healed kindly. From that time on
she has been in perfect health, increasing in flesh, attend-
ing fully to her work, and a more grateful patient I have
never seen.
Mrs. T., widow, aged thirty-seven, no children. Ex-
cellent family history. When two and a half years old
she suffered from perforating ulcer of the right eye,
resulting in the loss of sight and the partial flattening of
the cornea. At about the age of fourteen she began to
wear a simple cover, she and her people thinking it im-
proved her appearance. This she continued to wear for
seventeen years. During this time she did, in addition
to her ordinary school work, a great deal of fancy needle-
work, such as embroidery. Always felt very proud of the
sight in her left well eye ; could see fine print at a greater
distance than could many of her friends. During the lat-
ter part of the period of wearing the cover, she occasionally
Trifacial Neuralgia. 615
noticed that a strong light would give the eye a tired ,
feeling, followed by a slight pain at times, and then she
would remove the cover for a little while. The ball did
not shrink in any way perceptibly until some time after
marriage.
After the cover had been out for a short time, it would
give, for a few minutes, a slightly increased pain on re-
introducing it. Six years before my seeing her, when in
her usual health, she caught a bad cold by being out in
the chilly night-air, and then the eye began to pain her
severely. The spasms of pain would be only four or five
daily, at first, confined mostly to the eye-ball, and com-
pelling her to leave the cover out most of the time ; but
there was really no rest for any length of time. She now
consulted the late Dr. Robertson, of this city, who adr
vised very positively to let him remove the eye at once,
believing it would stop the spasms of pain, and prevent
any injury occurring to the well eye. This she most de-
cidedly declined to have done, and contented herself by
using a soothing eye-wash.
During the fall of 1877 and winter of 1878 the pain
was yet confined to the eye; but in the spring of 1878
it began to extend out over the cheek, down along the
lower jaw and right side of tongue, and back over the
temporal region. For the next two or three years she
consulted a number of physicians, both at home and in
New York, some of whom advised the removal of the
eye, some an operation on the nerve, and some thought
no operation would do any good. All gave her a thor-
ough course of medicine, which she tried faithfully ; also,
the use of electricity, and many outward applications, no
permanent good resulting. She would be better, but the
pain would always come on, more or less severe, just be-
fore her menstruation. She was referred to me by my
friend, Dr. D. H. Cook, of this city, in the spring of 1881.
I advised her to see Dr. Merrill, of this city, and learn,
as near as possible, how much the eye had to do with
the trifacial neuralgia, and whether its removal was not
6i6 A. Van Derveer.
now the best treatment. She saw Dr. Merrill, who advised
the removal of the stump, as the eye had now shrunken
to quite an extent, but again she positively refused. The
Doctor fitted her with another cover, but no marked ben-
efit resulted. She could wear the cover but very little.
I now gave her a very earnest and careful treatment
with quinine, iron, Brown-Sequard neuralgic pills, arsenic
and aconitia, but with only slight improvement. The acon-
itia was Merck's make, and never given in more than
one-eightieth of a grain doses, three and four times daily,
which would produce marked physiological effects, such
as dryness of the throat and tingling of the fingers.
The spasms of pain were agonizing to witness, re-
turning every one, two or three minutes. At last she
got no rest even with large doses of morphine, by stomach
or hypodermic injection. I also tried chloroform by the
latter method. Her life was becoming a burden to herself,
and one of intense sorrow to her friends. She got no rest
during nearly the whole month of July. August 2, i88l,
I consented to remove Meckel's ganglion, though feeling
firmly convinced that the proper thing to do was the
removal of the eye. The operation was done in the same
manner as described in the previous case, assisted by Drs.
Snow, Merrill and Warden, and my medical students. For
a few days after she suffered occasional spasms of pain, but
on the sixth day she was entirely free from it, and slept for
the first time a quiet, restful sleep. She remained in a com-
fortable condition, improving in general health, not taking
any medicine until the last week in November, 1881, when
the pain returned along the course of the inferior dental
nerve, the spasms being very intense, and coming on so
rapidly as to prevent any rest. I tried faithfully aconitia
(Merck's), but with little, if any, good resulting. Again she
could not bear it in larger than one-eightieth grain doses
three to four times daily. On January 2nd, I trephined the
lower jaw, and removed, as I thought thoroughly, a section
of the inferior dental nerve, giving her almost immediate
relief. From this time on she remained in excellent health,
Trifacial Neuralgia. 617
gaining in flesh and strength, feeling very happy, but grad-
ually losing the sight in her left eye, until the last week
in December, 1882, when she suddenly had a spasm of
pain along the lower jaw and outer portion of the tem-
poral region. This was followed, next day, by two or
three spasms ; then, the next week, she had five or six
daily; then the pain came on as of old, except over the
cheek. She was now very much discouraged, and refused
all medicines. Her sufferings became so great, especially
along the course of the inferior dental nerve, that, at the
urgent request of her family, she finally consented to the
removal of the eye, which was done by Dr. Merrill, April
3, 1883. After this operation the pain lasted for ten days,
then ceased, and since she has been very comfortable.
Occasionally she feels a? weak sensation about the face,
peculiar and difficult to describe, especially just previous
to her menstruation. She says her face feels as if it would
fall to pieces. At the present time it is difficult to believe
so many operations have been performed about her face,
so perfect has been the healing process. In considering
this case, I am strongly impressed that the diseased eye
was the cause of the reflex irritation.
The next case coming under my observation was that
of Mr. H. N. Farmer, aged sixty-eight, married ; referred
to me by Dr. J. J. Buckbee, of Fonda, N. Y. He was
admitted into the Albany Hospital March 20, 1882.
About thirty years before, while working with some
machine, he received a severe blow from a stake, just over
the left Malar bone. This he thought to be simply a
bruise, and it did soon pass away. A few years after he
had a number of ulcerated teeth on the same side. About
fourteen years ago he noticed a dull, heavy sensation in
his forehead, on the left side, and this was followed, in
a short time, by sharp, darting pains, just under the eye,
which could be started by merely touching the part. He
dreaded wiping his face with towel or handkerchief, as
it would result in spasms of pain. The pains would begin
with a jerk, sometimes starting at the angle of the nose,
6i8 A. Van Derveer.
and again near the eye. Later it would come on of itself,
and was more severe in cold weather. About ten years
ago he began to be treated, and received no relief. Five
weeks before he entered the hospital, I saw him first
with Dr. Buckbee, and advised a thorough course of
treatment with aconitia, it never having been used with him;
which was tried, beginning with one-hundredth grain four
times daily, increasing until one-twentieth grain was given
as often, but no benefit whatever resulted, patient noticing
only slightly the physiological effect of the drug. Merck's
make was used. Why the aconitia was tolerated in such
large doses, and producing no more toxic effect, I am
unable to explain. It was prepared by the same druggist
I am in the habit of getting it from, and he cannot offer
any explanation. Mr. N., like Miss B., had had one tooth
after another removed, no relief being afforded by it,
March 21, 1882, assisted by Drs. Snow, Ward, Hailes,
Mosher, Wood, Kennedy and Schofield, I did the same
operation as in the last two cases, and with immediate
relief. After recovering from the anaesthetic, he did not
have a single spasm of pain. It was pleasant to witness
his surprise and comfort. So rapid was his recovery, that
he left the Albany Hospital six days after the operation,
with the parts nearly healed. Dr. Buckbee has since in-
formed me that the wound was entirely healed in a few
days, and that he has been free from all pain since. His
only regret was that he had not had the operation done
many years sooner.
When we contrast the treatment of the cases of Miss-
B. and Mr. F. with that of Mr. S., we can come- to
but one conclusion, — that the removal of the ganglion
and nerve is really the only true operation to do, and
that the manner of making the incision in the natural
curves and folds of the skin, leaves so little cicatrix
as not to deter any patient.
In doing the operation, a good direct or reflected
light is necessary. As regards the danger from haem-
orrhage, I am sure it is possible to avoid it entirely.
Trifacial Neuralgia.
619
\m
By taking out a good-sized button from the posterior
wall of the antrum, and watching carefully, the internal
maxillary artery can be seen pulsating, and
thus avoided, while a most excellent view of
the ganglion can be obtained. As with all
operations upon the nerves, I am convinced
the operation needs to be done very thor-
oughly ; if not, failure is likely to result, as
it will, in cases where the pathological lesion
is still more central and the cause not peri-
pheral. In lifting the infra-orbital nerve from
its bony canal, I found, in my last operation,
the instrument here shown figured of great
service, as by its use the operator is not so
likely to tear or separate the nerve — some-
thing very important to avoid, for, by keep-
ing the nerve in its continuity, he has a sure
and safe guide to and along the ganglion.
That aconitia is of service in treatment I
think the following cases very well illustrate :
Mr. B., aged forty, merchant, good family
history of health, consulted me in June, 1880,
for severe neuralgia in right side of face, hav-
ing come on a year previous, after exposure
in a long ride, to cold. For six months the
pain had been almost constant, much as in the
histor>- given by Mr. N. Had been under med-
ical treatment, with very little benefit. Was
not anaemic, and of good habits. I gave him
in solution one one-hundredth grain of Merck's
aconitia three or four times daily for four
weeks, when he reported himself well. One
year after there was no return of the pain. In
taking the medicine four times daily he felt
only slightly the physical effect.
November 8th, 1880, I was requested by
my friend. Dr. T. D. Case, to see Miss K.,
aged fourteen, excellent family history, who had been
620 A. Van Derveer.
suffering severely for two years from trifacial neuralgia^
right side of face. In that time she had been mostly
under the care of a specialist, who had been trying to
cure her by the use of prisms and the wearing of glasses,
but with little, if any, permanent good. Under the use
of aconitia, as in the former case, she made a most excel-
lent recovery, as I am informed by Dr. C.
Mrs. L., aged thirty-three, married, no children, first con-
sulted me about two years ago. Had suffered for a number
of years from trifacial neuralgia, right side of face, which
was liable to be brought on by over-exertion, or any mental
strain or excitement. The attacks would last from twenty-
four to thirty-six hours, and the suffering be intense. By
use of good tonics and the aconitia in one-eightieth grain
doses, given when the attack was coming on, every three
hours until four doses were taken, she has quite recovered.
Other cases I might mention convince me that in
aconitia (not always relying upon Merck's make) we have a
most excellent remedy for treating this very formidable
disease or train of symptoms.
[SECOND PAPER.]
GUITEAU.— A Case of Alleged Moral
Insanity.
A REJOINDER, BY J. J. ELWELL, TO REPLY OF
E. C. Spitzka, M. D., N. Y.,
Professor of Medical Juiisprudence arid of the Anatomy and Physiology of the
Nervous System in the New Tork Post-Graduate Medical School ;
Physician to the Department of Nervous and Mental Diseases
of the Metropolitan Throat Hospital; President of
New Yorlt Neurological Society; Member of
the American Neurological Associa-
tion: W. and S. Tuke Prize
Essayist; William A.
Hammond Prize
Essayist,
Etc.
Ut Sementem feceris, ita et metes. — A rude ane, a rude ainer.
WHEN my article on Guiteau was printed I had no
thought of appearing again so soon, or at all, on
this or on any other subject. I am compelled to do so by
a bitter and unprovoked personal attack by a writer whose
name I mentioned but once in m\- paper, and then with
perfect respect. When a doctor aciaiin.isiers to you a
good round dose of wormwood, gall and Ijiimstone, in a
mixture of Hammond's nitro-glycerine, \t is about time
for the patient to call his family together, and see to it
that his house is set in order ; tor there is something
serious, real or imaginary, the matter. If the doctor is
particularly smart — knows every thing, as in my case,
and is never for a moment troubled with a doubt on any
subject, however complex or completely hid to others —
then the emergency is the greater. Hashish may also
have been in the dose — for it v.-as fearfi;! — aad should the
622 J. J. Ekvell.
next page or two seem a little wild, it must be attributed
to the medicine.
On opening the last Alienist, I saw, or thought I
saw standing before me, a vast pyramid, with the base
towards the heavens, and the apex lost in the sands of
an all-comprehensive, ^^ etc!' This colossal pile was covered
from top to bottom with eulogistic hieroglyphics, inscrip-
tions, titles, badges, records of the most marvelous exploits
in psychiatry, neurology, and in fact in all departments of
science, outnumbering the deeds of the most noted
Pharaoh, High on the broad base of this lofty monument
stood the figure of what seemed to my heated imagina-
tion, the Prophet of Truth, wrapped in the comfortable
robes of perfect assurance and self-satisfaction, proclaim-
ing in a loud voice, " // is the duty of those who know the
truth to correct error !'^ What I saw, I have since learned
was the apotheosis of a " Scientific Alienist." (This sounds
like "shallow rhetoric without reason," babbling over the
cobble-stones of a disturbed and unsanctified temper. Per-
mit me, however, to try again with my hook baited with
a little fish from the prolific, rhetorical pond of this great
prophet ; and if no better luck attends the effort, I will at
once come down from the dangerous and cloudy region
of metaphor, to the solid terra firnia of facts, figures, and
common sense.) A "scientific" gladiator appears upon
the scene, stripped to the loins, with twisted hair and
painted body, and comes bounding into the arena of dis-
cussion and strife, "like a prognathous African, howling
and yelling in ignorant glee, with arrow an spear, to hew
off" my "head, and drag the mutilated symbol home in
triumph." (This is much better " rhetoric " — nothing
"shallow" here — "symbol" is good, but "hewing off
heads with arrow and spear," is about perfect.) I now
see the folly and shallowness of such sentences in my
poor little article as these :
An impartial discussion of tlie matter is not to be expected, until a
sufficient time has passed to allow the sediment of popular indignation
and professional zeal to fall to tlie bottom. Truth will then reveal herself,
and not till then, for she shuns excitement and prejudice.
Guiteau — A Rejoinder. 623
Mind, sound and unsound, with many-sMed and ever-chano^ino: phenom-
ena has escaped the grasp of language, and no satisfactory definition,
has ever been formulated of these terms. No standard of measurement
or court of appeals has been erected by which the issue of sanity or insan-
ity can be measured or decided. Each case is sui generis^ and encompassed
by its peculiar difficulties, and must be judged by its own characteristic
phases for which no precedent can be found. An examination of mental
questions, therefore, is much like a voyage of discovery on an unknown
sea, without chart, beacon-lights or headland.
I promise, if I get through safely with this job, to
avoid hereafter all vain efforts of the like shallow
rhetoric ; for I will take no more risks of having my
"head hewed off with arrow and spear, and the muti-
lated symbol dragged home in triumph" — or of having
it kicked off by a rhombo-cephalous mule.
All this uproar and fury is over an unpretentious
paper of mine, prepared in response to an invitation of
the editor to write something for his Journal, and almost
forgotten, which has, to my great surprise attracted much
more attention for and against, than its merits deserve.
It pretends to speak for nobody but the writer, and to ^wo.
his views in the briefest possible manner. He makes no
pretention to being "a scientific alienist," or "a practical
neurologist ; " but he does claim to have taken for many
years, a deep interest in all psychological, physiological
and kindred subjects — keeping well abreast, as he thinks,
of the best and latest thought on these important ques-
tions, in his studies and reading — now and then writing
a magazine article, without contributing specially to
the literature of the subjects involved. He holds with
Dr. Dalton, that some things have been settled in the
past.
One would think that a great light had suddenly burst
over the field of psychological and neurological science, and
that the fathers knew and did but little. He is conserv-
ative, and holds to the old landmarks. Dr. Dalton in his
Cartright lectures says :
However much we may pride ourselves on the advance made diulng
our time, we may be sure that hy far the greater part of our actual knowl-
edge is a legacy from the past. It has been winnowed in successive
generations from error and imperfections, which always accompany its
624 /. /. EhvelL
first acquisition; and it is probable tliat many of our own diseoveiies will
require a similar depleting treatment in the future.
This corresponds with what Dr. Hack Tuke said in his
address to the Medico-Psychological Association in Lon-
don, " that progress in this direction had been principally
made by clearijig away former errors, rather than by devel-
oping new treatment."
Confessing, then, our utter ignorance of the mysteries of
brain action and of the brain itself — which Prof. Hamilton,
of Aberdeen, in one of his Morrison lectures on insanity,
says, " is the most complex of all organs " — let us hold
fast to the old creed, that the brain is simply an organ
attuned by immaterial and immortal forces.
Judge then of my astonishment, and indignation as
well, to find myself unmercifully and personally assailed
in a great Journal, and charged with having been " guilty
of manufacturing facts," "misquoting others," "misquot-
ing testimony," " omitting essential facts," " using sophis-
try of speech" and "shallow rhetoric without reason," of
"being a mere echo," who "has not even elementary
knowledge of medicine," and as having " quoted himself
as authority " for what I said, and " ought to be disbarred,"
etc. Having exhausted his own stock of English epithets,
he calls out a German doctor, to denounce me in Dutch ;
which he proceeds to do in the following "scientific" style,
on account of my North American Reviezv paper, which
he says is an illustration of ^^ glcznzende Unwissenheit!*
It is no relief to me that I find Mr. Blain charged with
having denied what he had before stated as a fact ; and
that half a dozen government witnesses — " to call matters
by their right names — told a falsehood^ If this is not
a case where the stern old rule, " an eye for an eye — a
tooth for a tooth " is in order, I see no use for the rule.
The language appHed to Mr. Blain, and to the witnesses
and to myself, is shocking, and such language as one
gentleman never applies to another. He seems to be an
old offender. I find in the New York Record (p. 687,
vol. XX.) this language : " It is difficult to feel great
Guiteau — A Rejoinder. 625
sympathy for a witness who is so inconsiderately aggres-
sive as Dr. Spitzka. He made the surprising statement
that whoever took a different ground from himself was
either incompetent or dishonest."
The defence, with the subpoena of the goverment in its
hands, could find in all this country but one professional
medical witness who would go upon the witness stand, and
under the rules of evidence swear squarely to the insanity
of Guiteau. That solitary witness was Dr. Spitzka. He
even boasts of the fact. " The only opinion given by a
physician called in as an expert witness, that Guiteau was
insane, was my own " ! Four of the distinguished experts
who swore to the contrary " are convicted as liars and
ignorami out of their own mouths," and the balance of the
thirteen able gentlemen who believed Guiteau sane, and said
so, " to call matters by their right names — told a falsehood."
Some lied, the others told a falsehood.
I am wholly unconscious — in the article aforesaid — of
having misstated, misrepresented, manufactured or sup-
pressed any material thing whatever; and have done
nothing of the kind, as I will attempt to show. In my
paper, I took it for granted that so intelligent a constit-
uency as I was addressing through the Alienist, knew al
the elementary facts of the Guiteau case, and that they
were just as familiar with the evidence bearing upon its
main points, as myself; for such evidence has been printed
and published, as the London Lancet says : ad nauseam.
My paper was necessarily very brief, covering only eight
pages. I said, " the writer proposes, as briefly as practic-
able, to group the salient points of this remarkable case,
which, as he understands them, establishes the proposi-
tion of the entire sanity and consequent responsibility of
this homicide, on the 2nd of July, 1881." These propo-
sitions are given as briefly as possible, with my reasons
therefor. I said, "the exigencies and limitations of
journalism demand brevity." I had no desire or right to
occupy valuable pages, to which others had better claim
than I. It would be as impossible to misrepresent or
626 /. / Ehvell.
suppress the main points of testimony in this world-wide
case known and read of all men, as to misrepresent or
suppress the alphabet or the multiplication table. Nor
had I any object to do so. I took no special interest in
it, only as a leading one. Had I been an inconsid-
erate rampant witness somewhere, and then and there
have made a fool of myself, then I might have been glad
to have seen the evidence of my folly suppressed.
It so happened that in the number of the Alienist in
which my little eight-page article appeared, and immedi-
ately following it, there was printed an eighteen-page paper
of a very pretentious and exhaustive character, from the
pen of Dr. E. C. Spitzka, M. D., etc., etc., on the very
question I had discussed, from the opposite stand-point —
that of Guiteau's insanity. On reading that article — though
full of errors of fact, and bad in spirit — it never occurred to
me that I ought to return to the field and abuse him for
differing with me ; yet, I had good grounds for doing so,
for he floundered fearfully through the muck and mire of
his own testimony, when on the stand — exposing himself at
every point to ridicule and criticism. In this article he
says : " Guiteau exhibited indications of theomania, Queru-
lantenwahnsimi — erotomania or simple megalomania." In
this article he says : " I made what was considered then
and there as the hit of the day." "There was laughter and
applause. " He was undoubtedly very smart while on the
witness stand, or we should not have " the hit of the day "
and " laughter and applause." He prints it himself, and it
must have been so. (It is in another paper given hereafter,
that ^he says, " Command me as to any scientific advice
that you may need. I have received more than two hun-
dred letters of commendation," etc. — Letter to Scoville.)
I had presented my reasons for Guiteau's sanity in eight
pages. Dr. Spitzka had given his reasons for believing him
insane in eighteen. There the matter should have rested so
far as we are concerned — at least until others had been
heard.
Now for the main specific charges.
Guiteaii — A Rejoinder. 627
First. — " One naturally wonders why Dr. Elwell should
take so much trouble to sustain the justice of Guiteau's
sentence, by endeavoring to prove his sanity, when he
already stands committed to the doctrine that if Guiteau
was insane, then there would have been the greater rea-
son for punishing him." Let us see if I stand committed
to the doctrine that the really insane should be punished.
I do not. In the North American Revieiv paper, to which
my critic refers as the foundation for this charge, I use
language not easily misunderstood. Here it is :
ThHt no confusion of ideas may arise— no misapprehension of the
points at issue — and that the field of discussion may be properly circum-
scribed and defined, and no words wasted, let it be said at the outset,
and distinctly understood, that there can be no dispute as to the entire irre-
sponsibility of that class of insane criminals coming within the famous
rule of the English judges — those not knowing the difference between
right and wTong. A person utterly unconscious of the distinction
between good and evil, justice and injustice, right and wrong, at the
time of committing the offence, by the comynon consent and judgjyienl of
mankind, is not responsible for his act.^Xot intluenced by fear or Civor.
by punishment in this life or in another, without forethought or calcu-
lation for the future ; he is completely wanting in every element of character
and faculty of mind necessary to Jix responsibility for personal conduct or
accountability to human tribunals.
That is the record where " Dr. Elwell stands com-
mitted to the doctrine that if Guiteau was insane there
would have been the greater reason for punishing him,"
if anywhere. No. To these stricken and desolate lives, and
to their unfortunate families, Dr. Elweli would extend all
the. patience and all the skill of a great profession — the
resources of the nation and the sweet and beautiful char-
ities of a gracious Christianity.
I do stand committed in the North American, as fol-
lows :
On the other hand, to the punishment of that large class of alleged
insane, thrown to the surAice as the emergency requires, for
whom the defense of irresponsibility is so constantly interposed in
courts of justice— composed of the weak-minded, the evil-miuded, those
more or less disordered in mind, but still know right from wrong, the
"odd " and the " singular " people; and, lately have been added to these,
the eccentric ; and still later (see London Lancet). '• those of bad memory,"
have been made to swell the list. This is the class wliose position as to
628 /. /. Ekvell.
responsibility is here under discussion; and thest are the persons who are
spoken of in this article as the, insane, and not those who come under the
rule of the English judges. (See North American Review, for January,
1882.
This language is plain, and correctly defines my posi-
tion on the question of responsibility of the insane; and
there is not the least excuse for the man who has misrepre-
sented me. It is, however, a fair sample of his entire article.
Second. — " Dr. Elwell's paper .chiefly consists of a pero-
ration, laudatory of the government experts, and a foot-
note, referring to his own medical jurisprudence as
authority in moral insanity." That is what the " President
of the New York Neurological Society " says my paper
" chiefly consists of." (By the way. Dr. Seguin, of New
York, who is fesponsible for what he utters, says this
" President " was not fairly elected to the position he
claims to occupy. See report of election in Medical Record.^
Again, " Dr. Elwell. with all his prejudices, devoted twenty-
one pages to moral insanity in the treatise to which he
refers as an 'authoritative' one." In another place, — "he
could have found better authority than that which he cites."
Again: "He has ultimately taken the stand himself as an
authority on moral insanity." Now for the "foot-note "
upon which this slander is based. The " President " did
not print the note, for that would have carried the cure
with the poison. Here it is :
Note. — For a more full discussion of the subject of Moral Ins'inity,
see ciiap. xxix., page 400. 4th tdition of the writer's work on MeiMcal
Jurisprudence; also iiis article in tlie North American iSeview;, for January,
18S2, on the Moral Responsibility of the Insane.
As everybody sees, it is not a reference to what I
have written elsewhere, as aicthority, but "for a more full
discussion of the subject of moral insanity," — because I
could not say all I wanted to, in the little space afforded
me in the Alienist. The note is written in plain language
— there is no room for a mistake. When full discus-
sion means the same as ///// authority, then, and not
till then, will it be true that I ever referred to my
own medical jurisprudence as " authority." The only one
Gttiteau — A Rejoinder. 629
who has egotistically referred to himself is the distinguished
president, on page 432 of his article. Here is the
"peroration," as he calls it, which, with the foot-note,
forms the " chief portion " of my article, to answer
which requires twenty-two pages, and as many notes.
l^aw and medicine never confronted each other in a court of justice or
elsewhere with au issue so momentous, witnessed by the intelligent peo-
ple of two continents as excited spectators ; never did law make gi'eater
demands upon the resources of medicine; such requisitions were never
more fully and promptly met, by so many and so able representative men
of the profession ; never was testimony given under weightier and more
solemn circumstances; and finally, never has a great profession been so
triumphantly vindicated from the clamor, general distrust and odium into
which medical expert testimony had fallen — when insanity was interposed
as a defense for crime— and completely lifted out of that quagmire of sen-
timentality, fatalism. " moral monstrosity," and wickedness, called moral
or emotional insanity, into which it had fallen.
I stand by the " peroration," and the foot-note is
a standing condemnation of Dr. Spitzka's assertion that
" Dr. Elwell quoted himself as authority for what he
said." It is Dr. Spitzka who egotistically quotes himself
as aforesaid, and who says of himself, " It is the duty
of those who know the truth to correct error," and "Com-
mand me as to any scientific advice that you may need.
I have received more than two hundred letters of com-
mendation, and I made what was considered then and
there the hit of the day. Applause and laughter."
Third. — " Dr. Elwell is a mere echo of Dr. Ordro-
noux's attack on moral insanity." That may be. It is
always well to echo truth, whatever may be its source,
and I consider it an honor to follow so safe, wise and
conservative a leader as the gentleman named, and
simply refer to it as another misstatement of fact. It so
happened that my chapter on moral insanity, to which
my critic refers, was written in 1859, and the article
referred to as that of Dr. Ordronoux's in 1873. It is
quite possible that Dr. Ordronoux wrote on the subject
before I did, though I am not aware of the fact. On
the appearance of my book, Dr. Ordronoux wrote in
the New York Journal of Medicine, as follows :
630 /. /. ElwelL
But in justice to a great subject upon which it descants most lumin-
ously, because most briefly — the subject of all subjects in medical juris-
prudence— in justice to the overwhelming importance which must
everywhere, and in all place?, attach to the phenomena of mental disease,
ana the legal conditions flowing out of them, we venture to pause and
utter a few words over the chapter on Insanity. At the outset we may say
that any intelligent man may talk flippantly enough on the above topic,
up to a certain point, because common observation of functional derange-
ments in the brain, as manifested in intoxication and somnambulism, are of
every day occurrence, and to the inexperienced eye simulate forms of
chronic, organic disturbance. Inasmuch also as the causa causana of insan-
ity is in most instances as completely hid fi'om the physician as from the
layman, each meets on equal terms in the deep, dark mine of mental
pathology. Beyond a certain point medical knowledge avails nothing —
up to a certain point it avails much. Wlien the physician has reached his
ultima Thule he can see no better than the layman who has followed him,
and this conviction of the inability of penetrating the mental constitution
beyond its most superficial operations, gives every man the right to have
" his say " up to those pillars of Hercules beyond which lies the psychical
Atlantis. Hence, as Prof. Elwell tells us, " Countless volumes having
been written by the ablest minds of tiie medical profession upon the great
subject; quarterly and monthly periodicals having been established
expressly for its discussion and elucidation ; some of the ablest thinkers
in medicine having made it for a lifetime a speciality, .... the pop-
ular mind and general reader come very naturally to conclude that the
whole subject is well understood." But when either lawyer or physician
comes to investigate and apply rules of law to any individual case he finds,
lamentabiledictu — "That notwithstanding all that has been accomplished by
the accumulation of facts, and the enunciation and discussion of theories
upon the subject of insanity, especially during the last century, tiie wliole
question is still sw^jwrfice,"
With names and classifications the author tells us that courts have
nothing to do, and were courts more prone to remember this they would
most assuredly rejtct the equivocal name of moral insanity from their
adjudications. And in this connection we cannot help saying that if there
be among alHhe chapters in tills truly valuable book, one which we par-
ticularly consider as tiie keystone of all the rest— and whose honest, frank,
and conservative tone will do more to beget a true medico-legal union
before the courts, wliere now we so often have a complete antagonism of
the two professions, it is the cliapter on "The Position of the Courts
upon Insanity."
Who does the President of the New York Neurological
Society echo ? He is a weak echo of a class of modern
crazy German pagans, who are trying, with what help
they can get in America, from such " scientific alienists "
as he, to break down all the safeguards of our Chris-
tian civilization, by destroying if possible all grounds for
Guiteau — A Rejoinder. 631
human responsibility — putting forth the cold vagaries of
agnosticism and nihilistic utilitarianism — accepting nothing
beyond the reach of uncertain human experiment and his
own fallible reason — reconciling the irreconcilable factors
of life and human existence ; while all that he really
does is to start at every turn he makes, or step he takes,
mysteries that are, have been, and always will be, fathom-
less. He solves at once phenomena which, in the present
state of science, are absolutely beyond the realm of legit-
imate inquiry. He sees no difficulty whatever in under-
standing the chemico-molecular action of the brain. He
penetrates boldly into the sacred dark chamber where
thought is born (throws up the curtain), handles it, hands
it over to the nurse, and is then on the lookout for more
" advanced thought." Had Dr. Spitzka been present
when God said "Let us make man," he would have
responded to the " us ; " and, while he would hardly have
undertaken the main work of creation, he would have
made valuable suggestions. Conscience and consciousness,
he would have left out in man, as troublesome factors
in his system and plan of the universe. With him brain
and mind are coexistent and coevil — the death of the
material terminates the mental. Depravity and crime are
synonymous with disease and circumstance. These are
some of the theories dangerous to society, started or
revived mainly in Germany, of which Dr. Spitzka is
" only the echo."
By the side of all this, I wish to place on record the
refreshing and spring-like words of the great physiologist
Dr. Carpenter, of London : " I deem it just as absurd
and illogical to affirm that there is no place for a God
in nature, originating, directing, and controlling its forces
by his will, as it would be to assert there is no place
in man's body for his conscious mind."
The truth is, little as we know of mind or spirit out
of the body and independent of matter, our exact knowl-
edge of the essence of mind, in its connection with the hu-
man brain, is almost as limited, humiliating as the thought
'632 / / Elwell.
may be. Of the existence of mind or pure thought out-
side of matter there can be no doubt, as seen in the
Creator "originating, directing, and controlHng its forces
by his will." We can only know God by his manifes-
tations through mind and matter, and that is about all we
know of mind — its manifestations.
Here is wljat the London Lancet thinks of these mat-
ters: (page 695, vol. i., 1882.)
The plea of insanity ought to be called the plea of irresponaibilUy,
so completely is the idea of disease being subordinated to the hypothesis
of unaccountability. it cannot be doubted that the public safety and— in
a very grave and practical sense — public morals, also, are endangered by
the humanitarian spirit of the times, to which a materialistic philosophy
lends especial force, and which tends to regard man as a mere instrument
in the hands of his physical destiny — a machine wound up and set to work
out a particular class of actions, and obey a certain series of impulses —
and wliich strive to find excuses for his wrong-doing accordingly. It is a
humiliating, and so far as the repute of the profession may be aflected, a
disgusting fact, that in almost every recent case of murder, some medical
person has come forward with the suggestion that the prisoner is insane.
Again, the Lancet says : Lefroy was not insane, and Guiteau is not
insane. The only insanity accruing to the latter case is that which those
who support the plea of insanity may themselves impart to it. The posi-
tion of the matter in regard to this question is becoming one of exceed-
ing gravity, and it will soon need to be very seriously discussed. (Page
1012, vol. ii., 1881.
Fourth. — " Speaking of the medical testimony for the
defence, he says : ' Dr. Spitzka ' — this is the only mention
made of Dr. Spitzka's name in my article — ' the defend-
ant's chief and most important witness says, ' he found
his skin was in a healthy condition ; found his appearance
perfect; his eyes perfectly healthy.'" "No change of
habits or life." " Dr. Elwell actually uses quotation marks
falsely, giving the impression that those words were used
by the witness in a certain order, whereas the fact is, noth-
ing was actually said as represented in Dr. Elwell's
tnanufactured quotation^ He is " at an utter loss to find
anything in his testimony to compare with the words
' no change in the habits or thoughts,' which Dr. Elwell
pretends to cite from it." Dr. Elwell does not pretend to
cite from Dr. Spitzka's testimony, the words " no change in
Guiteau — A Rejoinder. 633
the habits of life or thought," and does not attribute them
to him, as no one knows better than Dr. Spitzka himself.
On the opposite page he had read, not a half-minute
before, precisely the same in substance; the same
words condensed, quoted from Dr. Hughes. Here they
are: .
This Journal has laid down the following rule, which is undoubtedly-
correct : '• If no change in the habits of thought, feeling and action takes
place, then it is not insanity. The true test of insanity, therefore, is this
comparison of the individual with his former self, taken in connection
with disease of the brain." By this fair rule let Guiteau be judged.
The president, essayist, etc., that he might make a
point on me, sees nothing but " quotation marks actually
used," losing sight altogether of the thing quoted. He
can't find the words in all his testimony. Certainly there
were quotation marks, not for him, but for the Alienist,
and they were right before his eyes when he wrote.
There is no chance here for mistake. As for the " manu-
factured quotation;" "he found his skin was in a healthy
condition ; found his appearance perfect ; his head perfectly
healthy ;" they can be found in the Journal of Insanity,
P^g^ 339i January and April, 1881, precisely as I have
used them. Not having the three thousand pages of the
official evidence before me, I relied upon it as I found
it in the Alienist, Journal of bisanity, and other journals.
It is, however, substantially correct, as I find it in the
official record. " I did not examine him for any ordinary
physical complaint at all," says the witness, " and there-
fore found no eindence of it." Again ; " externally I found
the head in quite a healthy co?idition, a little eruption on
the skin, but nothing that you zvould call disease." Did I
try to represent Guiteau any healthier than he was? Did
I not frankly admit the syphilitic "taint"?
I thought and said that Guiteau displayed able gen-
eralship in many respects during the trial. In this I also
" misrepresented and suppressed facts." In reply I will
quote from the Medical Record, the words of its editor.
(Page 65, December 10, 1881) :
634 /• /. Elwell.
Guiteau displayed a wonderful acuteness in appreci'iting the legal
bearing of the questions put to him, and in evading answers that would
criminate him. He clung to liis theory of inspiration with a tenacity
which might raise the suspicion that he appreciated its legal value.
Upon the general public the prisoner's quiclvness of mind and extreme
adroitness made the most impression. Though mercilessly cross-exara-
ine^l, no inconsistency or incoherence was brought out. To the medical
mind the fact tiiat some confession of remorse and regret was made, as
well as the undoubted mental suffering of tlie witness during the cross-
examination, will perhaps have the most weight.
Fifth. — " Probably Dr. Elwell may be induced to give
the grounds on which he makes such statements as the
following : ' First, there is no positive indication of this
hereditary tendency in the family of the Guiteaus; and
no one thought of having him shut up in a lunatic asylum.' "
I have done so once, so far as space would allow, and
can again. What if Dr. Rice did, at one time when
Guiteau had been raising the devil a little more than
usual, advise his commitment to an asylum ? Not one of
his family or friends thought of acting upon the suggestion.
This was in 1875 ; yet in 1876, Scoville tried to have him
go in partnership with him in the practice of law. Does
this look as if so sharp a man as his brother-in-law thought
him a fit subject for the asylum? Why did not Scoville
take the witness stand, as did Reed, his associate counsel,
and try and save Guiteau's life, if he believed he had
ever been insane ? Who more competent to speak on this
question of hereditary insanity than Scoville ? Yet he is
dumb. Guiteau said he had never seen Dr. Rice but
two or three times in his life, which was probably true.
Dr. Rice says, " there was no delusion, no hallucination, no
illusion." It seems from the evidence, that Dr. Rice did
not think best to make out a certificate of lunacy. Dr.
Rice swore positively that Guiteau's father zvas not insane.
So did his brother and sister. No effort, I repeat, was
ever made by anybody to confine him except for fraud.
Nobody pretends the mother was insane. No ancestor
was insane. Insanity does not often descend from uncles,
aunts and cousins. The Medical Record says : " It is
worthy of note that despite his eccentricities, the uniform
Guiteau — A Rejoinder. 635
story of his life is that nobody thought hi^n insane." (Page
65, October 22, 1881.) Guiteau had, without doubt, an
ancestral " taint " of Spitzka insanity, but this kind of
insanity Dr. Barker calls " wickedness," and the " taint "
is from his father the devil. Again the Record says :
" But neither morbid egotism nor consequent delusions,
necessarily stamp the individual as a lunatic. The degree
of the one, the irrationality of the other, as well as
accompanying facts, must be considered. Guiteau's
egotism was great but not phenomenal ; his delusions were
contemptible, but not entirely without data. Add to this
that his feelings, though brutal, were not uncontrollable ;
that he was more vicious than passionate ; more coherent
than'incoherent'in his language or writing, and we get the
fiction of a man who is vain, brutish, weak-minded and
offensive, eccentric — but 7iot itisane. The testimony of those
who have known him most in mature years, viz., his
wife, his brother, Noyes and others, shows that they saw
in him something disagreeable and eccentric. He was
indeed suspected of insanity by Mr. Scoville, but it may
be that this was largely because he was such a nuisance."
— Medical Record, page 630, December 3, 1881.
Sixth. — " If Dr. Elwell, notwithstanding his very frank
and undoubtedly subjectively correct admission, that an
examination of mental questions is much like a voyage of
discovery on an unknown sea, without chart beacon-lights
or headland," etc. Let me remind the reader that when
I wrote this, nautical psychology was not so well under-
stood and defined as now, and consequently more unsafe
and uncertain. Capt. Spitzka's great and complete chart
was not yet on the market, and I had to do the best I
could without it. On his new map I find every crooked
channel made straight, every rock, sunken danger and reef
marked with buoys of empty barrels, — every creek, bay and
inlet, flagged. All is now clear, safe sailing, day and night.
The chart is dotted all over with beacon-lights. In fact
there is no darkness on what before was a foggy and
dangerous coast. This chart is called " Insanity, its
636 / / Elwell.
Classification, Diagnosis and Treatment, by E. C. Spitzka,
M. D,, New York." I can only, I am sorry to say, for want
of space, make room for part of his " classification ;"
to wit :
Group 1.— Sub-group A. of group 1; 1st class of sub-group A. of
group 1 ; division 1 of class I of sub-group A. of group I. — Order A. of
division 1 of 1st class, of sub-group A. of group I. — Sub-order A. of
order A. of division 1 of 1st class of sub-group A. of group I. — Genus 1 of
sub-order A. of order A. of division 1 of class lof sub-group A., of group
I. — Genus 2 of sub-order A. of division 1 of class 1, of sub-group A. of
group [. — Genus 3 of sub-order A. of division 1, of 1st class of sub-group
A. of group I. — Genus 4 of sub-order A. of division 1 of class 1 of sub-
group A. of g!oup I — Sub -order B. of order A. of division 1 of class 1
of sub-group A. of group I. — Genus 5 of sub-order B. of order A. of
division 1 of class 1 of sub-group A. of group L— Genus 6 of sub-order
B. of order A. of division 1 of sub-group A. of group I. — Genus 7 of
sub-order B. of order A. of division 1 of class 1 of sub-group A. of group
I. — Order B. of division 1 of sub-group A. of group I, — Genus 8 of
order B. of division 1 of sub-group A. of group I. — Genus 9 of order
B. of division 1 of class 1 of sub-group A. of group I. — Division 2 of
class 1 of sub-group A. of group I.— Genus 10 of division 2 of class 1
of sub-group A. of gi'oup I, — Genus 11 (Hebephmania) of division 2 of
class 1 of sub-group A. of group I. — Second class of sub-group A. of
group I. — Genus 12 of second class of sub-group A. of group I. —
Genus 13 of second class of division 2, of class 1 of sub-group A. of
group I. — Genus 14 of class 2 of division 2 of class 1 of sub-group A.
of group I. — Genus 15 of class 2, of division 2 of class 1 of sub-group
A. of group I. — Sub-group B. of group I. — Class 3 of sub-group B. of
group I. — Division 1 of class 3 of sub-group B. of group I. — Division 2
of elass 3 of sub-group B. of group I. — Genus 17 of division 2 of
class 3 of sub-group B. of group 1. — Genus 18 of division 2 of class 3
of sub-group B. of group I. — Class 4 of sub-group B. of group I. —
Genus 19 of class 4 of sub-group B. of group I. — Genus 20 of class 4
of sub-group B. of group I. — Genus 21 of class 4 of sub-group B. of
group I. — Genus 22 of class 4 of sub-group B. of group I. contains
all other insanities of gi-oups not enumerated in tlie foregoing sub-groups,
divisions, sub-divisions, orders, sub-orders, classes and sub-classes, and
21 Genera. It contains ^'failure of logical inhibitory power^m&ma. raisonant,
moral insanity of some types," not all.
I would humbly suggest that a 23 Genus might be
added to class 4 of sub-group B. of group I., to include
the few left of the human family not covered by the 22
Genera of group I., and those corralled in group II. ; who
are supposed to have still left, a little common sense. It
would be much the smallest list in the catalogue.
Guiteau — A Rejoinder. 6yi
Then comes group 11., with a shot-gun full of insani-
ties, in which he puts hysterical itisatiity under monotnania.
This group IL, if possible is more complex and endless
in its nomenclature than group I. I have given group
I. complete, for the benefit of the psychological mariner;
and if in trying to follow it he finds himself in a fog so
dense, that that off Newfoundland is bright daylight by
the side of it, it is not my fault. After his great feat
at classification, diagnosis and treatment of the insane,
and success as a witness, essayist, professor, president,
critic, etc., Dr. Spitzka should have another title, that of
professor of universal knowledge. He is the psychological
clearing-house of America. Ke is fully competent to fill
the chair which Haller, in Gottingen, occupied a hundred
years ago, as professor of anatomy, history', physiology,
surgery, obstetrics and medical jurisprudence, combined
with the duty of writing at the same time one review a
week, and summing up at the same time all medical
knowledge in his Bibliotheca. These duties would not
apparently, from the amount he seems to know, interfere
with his other professorships, presidencies, essays, etc.
Dedicate this crazy nomenclature and this insane book
to the Moon, and the effort is complete.
Forsart said, "Good heavens, young gentlemen, let
us have less science, and more art ! "
Seventh. — " Dr. Elwell may thumb the jury trial records
from one end to another of the twenty-seven hundred
pages, without finding testimony given by a single wit-
ness, or a clause in the speeches of the defense, to justify
his strange misrepresentation, and equally will he search
in vain among the numerous pamphlets written by those
who maintain that the assassin was insane, for the statement
that Guiteau was a case of moral insanity arid nothing
else.'' This raises the whole issue as to the existence of
moral insanity, and nothing else. Dr. Spitzka dare not
stake his case on pure moral insanity. Why not stand
squarely up to the doctrine as held by Prichard and Ray,,
and not leave its defense to a few sincere and honorable
638 /. / Ehvell.
believers in it like Dr. Hughes and others, who stand
up manfully and ably to the defense of what they believe
to be true ? Dr. Spitzka seeks to take all the advantage
of the principle of moral insanity without having to use
the term by which this condition of mania is best known.
I use the ■ expression " moral insanity " in its general
sense, just as he used it in his testimony when he said,
" I would have concluded that he suffered from moral
imbecility, or moral monstrosity. I did not use the
expression moral insanity ; but what others call moral
insanity, I call moral monstrosity ; " and what Dr.
Spitzka calls moral imbecility and moral monstrosity,
others call moral insanity. What then is the difference, if
any, between what I call, in the case, alleged moral
insanity, and what he calls moral monstrosity? He says
the terms are used thus interchangeably. Dr. Spitzka calls
Guiteau's case a pure case of moral imbecility or moral
monstrosity, and it is what others call moral insanity.
He does not say what he means by the terms "moral
imbecility" and "moral monstrosity," only that what he
so calls, others call moral insanity. He does not say in
his testimony that Guiteau had what he called moral im-
becility or moral monstrosity, "and nothing else." But
he does say that where he uses those terms others use
moral insanity. I have used the term "alleged moral
insanity," and it was used correctly, according to his own
definition of moral imbecility or moral monstrosity, which
he says means moral insanity as others use it. Dr.
Spitzka, and his class of alienists, believe as one of them
testified, that one-fifth of the human family are insane in
a greater or less degree, and that in one group alone, to
say nothing about the other groups, there are twenty-two
genera. In one of these genera he places some kinds of
moral insanity, the other kinds he scatters elsewhere ; but
nowhere in his book is he as liberal as when on the
stand, for then what others called moral insanity he
called moral imbecility and moral monstrosity. There is
no getting away from this position.
Guiteaii — A Rejoinder. 639
Moral insanity, as defined and understood by the best
class of alienists who use the term, at whose head stands
the editor of the Alienist, there is nothing particularly
objectionable. Dr. Hughes, instead of making ever}^ fifth
person insane, thinks that about one in a thousand is
found in that category ; and when on the stand he is
always conservative. Dr. Hughes says:
It 18 not contended that a person affected with derangement in his
affective life, in order to be designated as morally insane, should be more
free from errors of judgment and of the understanding, than an average
number of sane people are liable to be under excitement. Understan' lings
are not all alike. Errors of judgment are common to the rational mind.
To err is a human attribute of mentality, and it is obviously illogical and
irrational to expect that before we should permit or acquiesce in the use
of the term ''moral insanity" or "affective insanity," describin? that
form of mental aberration, with which we are all familiar, that we should
demand of the individual so affected, that he should be sounder in his
reasoning powers than the average rational mind. Misconception- of
judgment, and mision<*eptions of fact are common to sane people. Mis-
taken conceptions are not uncommon to rational minds, and it is not to be
expected that there sliould be nothing of that kind before we should recog-
nize the existence of a state, of disease — call it •• moral insanity '' or
"affective insanity," '' reasoning mania" or whatever term we may choose
to invent — it is not to be expected that with such a form of aberration we
should gauge the mind of the affected individual by a more rigid standard
than that by which we would measure the average rational mind. That
is what I should argue in a case of that kind. Of course I know that
there are gentlemen who would differ as to the propriety of the term,
and knowing the theoretical basis upon which those differences are made,
I should make no quarrel with them or enter any objection to their
designating it by some other appeUation. Nevertheless, the fact of mental
disease still remains, in my humble opinion.
Again he says :
In the vast majority of changes in the moral character, the intellect
either becomes abeyant — and in such a sense may be considered to have
undergone a change — to have become subservient and acquiescent, and
evidences a predominance of the aberrant moral over the intellectual
character; or the intellect btcomes also specially implicated and delu-
sions accompany the effective change which we call moral insanity.
There is no obscurity here. Again, he says :
We recognize the fact that there is a form of insanity, which displays
itself especially in disordered impulse, feeling propensity or passion with
whatever of intellectual implication may be apparent. I call it moral
insanity as the most descriptive term.
640 /. / Elwell.
And again :
It matters little what becomes of the name, though we think it a
200(1 one as descriptive of the characteristic features of some forms of
eifective insanity, so lon^ as nomenclature is based on the prominent
symptomatology rather tlian upon the distinctive pathological features of
insanity.
This is clear enough. We can understand just what he
means by the term moral insanity ; and as he teaches
and testifies on the subject, no danger can arise to
the community. So of J. Workman, M. D., of Toronto,
and others. Such writers I place on my list of the
noted " thirteen," who are trying to lift the profession
out of the disgrace brought upon it by just such wit-
nesses and writers as Dr. Spitzka.
Dr. J. S, Jewell, a noted alienist, says:
Whether all insane are morally irresponsible, lias been and ought to
be questioned, especially when opinions vary so widelj^ as to what are the
phenomena to be included under the term sanity. There is. however, a
general criterion for determining the fact of moral insanity, and it Is that a
person to be considered irresponsible for his actions, must be unable to
distinguish the difference between the right and wrong of an act. That
insanity often involves practically complete irresponsibility there can be
no real question. That on the other hand, the plea of insanity is often
falsely made and successfully urged as a defense against the extreme
penalties of the law for sgme flagrant crime, when there is no real ground
for such a plea is notorious. That the public sentiment has become
justly inflamed against the insanity dodge is plain to all.
I suppose those witnesses in the Guiteau case, who
said that science knew no such insanity as moral insanity,
simply mean that science only recognized insanity based
upon disease of the substance of the brain and tangible
symptomatology, and not as Dr. Hammond says in his
new book, " on an emotion." I do not see how human
tribunals are to fix responsibility to law, if they cannot
cast an anchor on something more substantial than an
emotion or an indefinite term like moral insanity, when
used to cover wickedness. There must be disease, or real
imbecility — not "moral" imbeciUty — just simple imbecility,
or disease, if there is irresponsibility. This the courts
can lay hold of, and always do, gladly.
Guiteaii — A Rejoinder. 641
Dr. Spitzka claims also that all the alienists of Europe
agree with him on the question of moral imbecility or
moral monstrosity. He says : " in Italy, as in fact almost
generally throughout Europe, the writer is unable to find
a single alienist who opposes this doctrine of moral
insantt}'." Here he uses the term, but don't tell us what
he means by it, so he must mean moral imbecility or moral
monstrosity. What is European and Italian opinion on
the question of moral insanity ?
Dr. Bonfigli, of Ferrara, who is good authority, talks
very differently. He has written a book on moral insan-
ity, and in it is found a review of the declared opinions
of forty-six eminent alienistic writers on the subject of
moral insanity. He says, seven of these forty-six hold
to the doctrine of absolute, pure and distinct, moral
insanity. Of these, three are French, three German and
one English. Seventeen of these forty-six hold to moral
insanity conditionally — not as a distinct, pure mental
disease. They connect it with more or less intellectual
insanity. Of these seventeen, seven are French, six Ger-
man, three Italian and one English. Twenty-two, he says,
de?iy the doctrine of moral insanity in toto. Dr. J. Work-
man, of Toronto, late Superintendent of Toronto Asylum
for the Insane, etc., in commenting on this statement of
Dr. Bonfigli, says : " Had Dr. Bonfigli been more versed
in the literature of English and American alienism, he
could have much augmented the numbers assigned to the
latter two countries ; and, undoubtedly, the classes of
conditional advocates and of utter repudiators would have
had almost exclusive admission to his catalogue. He,
however, introduces into his book a report of a discussion
on moral insanity which took place at the annual conven-
tion of Medical Superintendents of Asylums, in New York,
in the year 1863. I had the pleasure of being present
and taking part in the discussion, which was conducted
in the most courteous manner. Dr. McFarland gave it
as his conviction, that " in all the cases of so-called
moral insanity, a real intellectual disorder was present."
642 /. /. Elwell.
He was followed by the other members in rotation,
including the distinguished and very long experienced Dr.
Kirkbride, the- President of the association and the veri-
table Nestor of the fraternity, numbering in all present,
some forty representatives of the United States and Cana-
dian asylums. Of all this assemblage, only two or three
declared their belief in the actuality of moral insanity,
and even these declined to define it as a distinct and
independent form of disease."
This seems to be about the position of the question
in Europe and America; and yet Dr. Spitzka "is unable
to find a single alienist who opposes this doctrine of
moral insanity in Italy or in fact generally ! "
Eighth. — Dr. Spitzka says : " To have an insane ances-
tor will hereafter have to be considered rather an advan-
tage than otherwise." No, not an advantage — yet the
physiological and pathological fact remains true and is
not to be laughed down, that the wonderful living forces of
nature, which push the infant to adolescence and holds
the man perpendicular on his feet for threescore years
and ten, against the constant powers of gravity, is the
ever-watchful enemy of disease, and the constant conser-
vator of health and life. So imperative are nature's
demands in this regard, and her efforts in the direction of
health, if she fails, she often proclaims sterility. If she can
encyst a ragged bullet, and thus save life, who dare limit
her power? It does not follow that because the vis coft-
servatnx natures, and the vis inedicatrix natures at once
summon their occult but myriad forces to encyst a bullet,
or repair a fractured femur; that it "will hereafter have to
be considered rather an advantage" to be shot or to have
a broken leg. It is high time that the foolish and danger-
ous doctrine of once insane always insane — that because
insanity has once been developed in a family a cloud ever
after rests on that family from generation to generation ;
that that family and all its collateral branches in every
direction are " tainted," and that this taint is liable to
break out at the most unexpected times, in the most
Guiteau — A Rejoinder. 643
unlooked-for quarter — be discarded and denounced. The
theory is false, and the doctrine is dangerous to society.
Ninth. — " It evidently did not suit Dr. Elwell's purpose
to quote the official report of the Microscopical Com-
mittee," etc.
I did not refer to the microscopical test, because the
best medical authorities place no reliance thereon as
a test of insanity. Even Dr. Ray says: "It will scarcely
be claimed, at the present day at least, that structural
changes found after death from any disease, are the prim-
ary cause of the disturbance manifested during life."
Who knows what structural change takes place under the
strange alchemy of death in the microscopical tissues of
thought? Take the report of Dr. Shakespeare, et. al. —
what does it amount to ? There is not even a hint in it,
much less an assertion, that Guiteau was insane, as the
result of their microscopical investigations.
Dr. Savage, editor of the Journal of Menial Science^
says of the microscopical appearances of a section from
the frontal convex of Guiteau's brain :
I should 6ay there is nothing' that I have seen which is not com-
patible with mental healtli. It is true there are changes about the vessels
and their walls, but these and similar changes are commonly found in
bodies of persons dying or being l<illed wlien past middle age. There are
no marked general changes in the nerve-cells, and I can only repeat that
the specimen examined would not have any weight with me in causing me
to reconsider my judgment on the sanity of the assassin.
That is what one conipetent to speak on the question
of the microscopical appearance of Guiteau's brain thinks.
The editor of the Medical Record, says :
The facts seem to be. that while there was some chronic disease in
and about the blood-vessels, there was nothing indicative of any form of
insanity; while on the other band, much more serious changes are
not infrequently found ia the brains of persons who had been perfectly
sane. Account must be made also of the fact that Guiteau had been suf-
fering from malarial poisoning, and that he suffered death from stransula-
tion Guiteau's insanity, if it existed, was confessedly chronic ; therefore
all acute changes found would have no weight in estimating their aetiolog-
ical bearings on the alleged mental disease. The severest form of vascular
disease was apparently the cbrpora striata, a place where physical troubles
would not be excited, while it is well known that the disease did not dis-
turb any function known to pertain to those ganglia. The view that the
644 /• /• Elwell.
changes found were all significant or characteristic of coramencing general
paresis, is unfounded, and quite unwortliy of serious discussion. The
same remarli must be made regarding Dr. Godding's surprising statement,
tliat the arachnoid opacity was indicative of mental disease. There have
been some rathei- labored attempts to prove the brain atypical. The con-
volutional development, however, as we are told, though deficient in some
parts, was compensated for by fuller adjacent gyri. So far as the eye and
some rough measurement could tell, the two hemispheres showed no
asymmetry. The fundamental fact in the present case for the determination
of atypy, viz., the comparative weight of the two hemispheres being
absent, it would not be allowable, nor in accordance with scientific honesty
to make positive statements regarding the matter. The futile and decidedly
ex-parte attempt to show pathological cranial asymmetry hardly needs com-
ment. In fact, Gulteau's mental condition must be decided by a study of
his words and actions when alive. If these did not prove him a lunatic
and irresponsible, the post-mortem findings will not help the case.
Tenth. — Not wishing to be again charged with " sup-
pressing," I ought to include "a gem of purest ray serene,"
brought to Hght by my muck-rake. It was written nine
days after his brilHant appearance on the stand. Here it is :
130 E. 50th St., December 22, 1S81.
My dear Sir: I have written Keed some important points on
Hamilton, whom you may also ask if he wrote or inspired an editorial in
the Philadelphia Evq. Bulletin. I feel morally sure he did.
Introduce that cast by all means. I suppose the sculptor will have to
swear to its identity & give his experience. Leave out phrenology. The
skull shape of the cast is reliable; the face part " was smoothed out because
G. smiled," & is not as reliable.
It is possible that I had the right & left sides mixed up on the stand.
It is the left side which shows defective innervation (tongue & face), while
the rioht lialf of skull is smaller, but the chief anomaly is the posterior
face & crest.
Ask Hamilton whetlier Broca does not call such skulls abnormal,
whether Meynert in his last article on the subject does not do so, and
attach the greatest weight to skull anomalies. I sent Reed a paper of
mine ; marked the authorities cited in the foot-note ; you need only read
over to see their importance on cross-ex.
I trust you recoo;nize the importance of the points Dr. Kiernan gave
you. «& the further necessity of asking questions exactly in such an order
that the "'bad" four are convicted as liai-s and ignorami out of thtir own
mouths.
Command me as to any scientific advice that you may need, not
involving a trip to Washington.
1 have received more than two hundred letters of congratulation and
commendation, three anonymous threats, and two letters from lunatics.
bend copy of my evidence if you can. With regards,
Geo. Scovili-e, Esq. SPITZKA.
Guiteaii — A Rejoinder. 645
There are other things in this menagerie, called a reply,
which I would like to exhibit, had I not already exceeded
my limits. For instance :
Dr. Spitzka is extravagantly laudatory of the " Con-
tinental Courts," as contrasted with those of England and
America. The rule of responsibility, as found in the
criminal code of Germany, is substantially the same as
the knowledge of right and wrong in England and
America. Here it is :
There is no criminal act when the actor, at the time of the oftVn?p. is
in a state of unconsciousness or morbid disturbance of the mind, through
wliich the free determination of his will is excluded.
„@» gi6t lein 33erbre(^en, loenn jur 3eitbe§ 2?ergc^en», bie ^'cr=
fon in einem befinnungslofen ober fonftigen Ironl^aften geifligcn
3u[tanbc ift, toobiird^ bet fteie SBille beeintrQd)tigt ift."
Dr. Spitzka ought to learn from all this, that reckless
and headlong abuse of one who has never intentionally
laid a straw in his way, or said an unkind word of him,
is not prudent. The saying of Napoleon, " Laudace,
raiidace, toiijours Vaudace^' may do for a warrior, but is
not a safe maxim for a president, censor, essayist, etc.,
and that blows can be given as well as taken.
And now I take my leave of him forever, with the
benediction of my Uncle Toby, when he held the fly
between his fingers, before letting it go.
[This and the former article are from a strictly medical
stand-point. Possibly I may sometime speak to the intel-
hgent readers of the Alienist, from the legal stand-point,
that they may see how lawyers, judges and law journals
look at the case.]
Cleveland, Sept. i, 1883.
Traumatism in Relation to Insanity.
By D. R, Bkower, M. D.,
Professor of Jlental and Nervous Disease, Women's Medical College, Chicago, 111.
TTXURET,* in his discussion of cerebral traumatisms,
-*— ^ comes to the following conclusions, which have an
intimate relation to the subject of this paper :
First. — When a localized lesion is produced by the
traumatic action of the cephalo-rachidian fluid, in any
region whatever of the myelencephalon, it is revealed by
certain signs in relation to the part's function.
Second. — In the first period of the phenomena of
shock, the signs differ according to the intensity of the
lesion produced. If the destruction of the wounded part
(center or conductor) is complete, there is a loss of func-
tion— a paralysis. If the lesion is light and non-destruc-
tive, and consists in a light shock, there is, or will be, by
mechanical irritation, exaltation of function.
Third. — In the second or period of congestive and in-
flammatory reaction, if the destruction of the part is com-
plete, exaltation of function, followed by paralysis, may
be observed, finally succeeded by paralysis.
Fourth. — In all periods, phenomena of diffusion of symp-
toms (epileptiform attacks, psychic phenomena, etc.) may
be observed.
From these conclusions it will be obvious that the
immediate effects of traumatism are not the only ones to
be dreaded, and that slight traumatisms may produce very
serious results. Fiirstnert and Azam's| results, in a gen-
eral way, corroborate Duret. The literature of trauma-
tism in relation to insanity is by no means meager.
The earliest American ahenist, Benjamin Rush,§ reports
• itudes Experiinentttles et Cliniiiues 6ur les Traumiitismes Cerebraux, p. 137.
t AUgemeine Zeltschrift fuer Psycliintrie, Band xxxviii.
\ Archives Gcnorales de Mi-deciue, February and Match, 1881.
§ Medical Inquiries and Observations, p. -iS.
Traumatism iti Relation to Insanity. 647
the case of a young man, who died in the Pennsylva-
nia Hospital in 1809, who became deranged in conse-
quence of a contusion on his head, by a fall from a
horse, in his fifteenth year. A Mr. died insane, in
the same place, from a brain injury, caused by his be-
ing thrown out of his chair some years before insanity
became manifest. He says that cerebral injuries are
slower in showing themselves than are the results of
traumatism elsewhere. Esquirol* says that falls on the
head, even during infancy, predispose to insanity, and
'sometimes excite it. A three-year old fell on its head,"
and from that time suffered from cephalalgia, which be-
came more marked at puberty, resulting in insanity at
seventeen. Crichton Brownef has reported psychic
phenomena, varying from idiocy to senile demen-
tia, which resulted from traumatism. Griesinger^ says
that traumatism may set up insanity immediately ; but
in other cases it does not appear for, sometimes, years
after the original injur)\ The traumatism sets up an
acquired predisposition, without detectable cerebral lesion,
Schlager,§ after a study of forty-nine cases, found that,.
in twenty-one of these, the injur}^ was followed by an.
immediate loss of consciousness, in sixteen by simple
mental confusion and wandering of the thoughts ; in
sixteen by dull pain in the head. In nineteen cases,,
insanity commenced within a year after the accident ;
the other cases in from four to ten years. The patients,
as a rule, manifested, from the time of the injury, a
tendency to cerebral congestion, after the ingestion of
a small amount of alcohol or mental excitement. In
several, cases ocular hyperaesthesia and amblyopia made
its appearance. There appeared, in fifteen cases, sco-
tomic dots, which exercised an influence on the psychi-
cal phenomena. The patient often experienced tinnitus
aurium. In eighteen cases dullness of hearing resulted.
♦ Maladies Mentales.
t West Riding Asylum Reports, Volume II.
t Mental Pathology and Therapeutics.
§ Zeifschrift der k. k. Gesellschaft der Aerzte zu Wien, XIII, lSa7.
648 D. R. Brower.
In three, hallucinations of smell and pupillary changes.
The character and disposition changed. In twenty cases
great irascibility and angry, passionate manner, even to
violent, passionate outbursts, was remarked. Sometimes
there occurred over-estimation of self, prodigality, rest-
lessness and disquietude. In fourteen cases, loss of
memory, and mental confusion was present. Fourteen
attempted suicide. The prognosis in all cases was bad.
Seven became paretic dements. Marce* says that, in the
greater number of cases of cerebral traumatism, the
psychosis assumes an illy defined form, offering irregular
alternations of stupor, agitation and imperfect lucidity,
without systematized delusions; but recovery is never
complete, and the patient becomes progressively de-
mented.
Skaef says that: First, — Traumatic insanity is gen-
erally characterized, at the commencement, by maniacal
excitement, varying in intensity and character. Second,
— The excitement is succeeded by a chronic condition,
often lasting several years, when the patient is suspicious,
irritable and dangerous to others. Tliird, — In many such
cases distinct homicidal impulses exist. Foiirtli, — The
characteristic delusions of this type of insanity are
those of pride, self-esteem and suspicion, true melan-
cholia being but rarely present. FiftJi, — This form of
insanity is rarely recovered from, and has a tendency
to pass into dementia, and terminate fatally, by brain
disease.
Luys| agrees with Schlager. Dickson§ believes, like
Schliiger and Luys, that traumatism may cause both a
predisposition to and insanity itself. Krafft-Ebing|| classi-
fies insanity from traumatism as it is : First, — The direct
consequence of the accident. Second, — Manifested later,
the prodromus of disordered motor and sensory phenom-
• Maladies Mcntales.
t Cltofl by Tuke, Psycholojjical Medicine.
t Malailles Menlales.
§ Medicine in Kelation to Mind.
II Leliibucli der Psychiatrie.
Traumatism in Relation to Insanity. 649
ena, and change of character. Third, — Preceded by a
latent susceptibility, the result of the accident, which may
be called an acquired predisposition, which requires but a
slight exciting cause to develop into insanity.
Calmeil,* Voisinf and Lasegue;}; report cases in which
traumatism in infancy produced epilepsy at puberty, fol-
lowed by paretic dementia in middle life. Blandford§
agrees with Krafft-Ebing and Skae that insanity may be
due to traumatism, and that this may cause a predisposi-
tion to insanity. HammondU is of like opinion, and
reports several corroborative cases.
Furstner** and Veritytf entertain similar views.
Kiernan,;{;t after analyzing forty-five cases, comes to the
following conclusions: First, — That traumatism produces
certain psychoses. Second, — That the majority of these are
unaccompanied by epilepsy. Third, — That a large pro-
portion are accompanied by depressing delusions. Fourth,
— That the majority of the latter are unattended by any
hereditary taint. Fifth, — That, with certain modifications,
Krafft-Ebing's views are correct. Sixth, — That injuries re-
ceived before the age of forty are more potential in the
production of insanity than those received subsequently.
Sez'enth, — That slight injuries are as much to be dreaded
as grave injuries. Eiglith, — He finds that the percentage
of insanity, due to traumatism (ten per cent.) given by
Schlager, was greater than that found by himself (two per
cent). Ninth, — That certain cases of insanity, due to
traumatism, have well-marked, systematized delusions.
Tenth, — That in all cases of insanity due to traumatism,
a guarded prognosis should be given. Spitzka§§ expresses
his concurrence with these views of Kiernan.
* La Paralysie Chez les Alienes.
t Paralysie (Jenerale lies Alieues.
\ Cited by Voistn.
§ 103311117 and Its Treatment.
li Treatise on Insanity
*• Allgemeine Zeiischrift fuer Psychiatrle, Band xxxvili.
tt American Journal of Neurology and Psychiatry, May, 13S2.
\\ Journal of Xervons and Mentsl Disease, Jnly, 1831.
§5 Insanity: Its DiaKuosis, Classitication and Treatment.
650 D. R. Brower.
Bucknill and Tuke* believe that, while there is some
truth in Skae's views, exceptions are very numerous.
Macleodf reports a case in which the physical symptoms
resembled paretic dementia, but, in its initial symptoms,
corroborated Skae's views. McGee| has reported a case
of periodical insanity due to traumatism, Molliere§ reports
a very similar case.
Cases are reported by Mickle,]] Schiile,** Austinff and
Emminghaus|| which corroborate Kiernan's views. It may
be accepted, in a general way, that traumatism produces
a predisposition to insanity ; and that the psychoses caused
by traumatism are, as a rule, of a chronic type.
The following three cases recently came under my own
observation :
Case I. — Capt. , set. twenty-three, was wounded in
the right parietal region, in one of the early campaigns
in Virginia; he was rendered insensible for a short time,
but speedily recovered after being carried to the hospital.
Examination showed a contused wound of the scalp,
without any involvement of the bone. In a few days he
returned to his command, apparently well. Prior to the
beginning of the war, he was the junior partner of a
prominent law firm in New York, remarkable for his
steady and regular habits, his industry and mental bril-
liancy. Impelled by patriotism, he gave up his chances
for preferment there, and entered the army as a private.
The qualities which so distinguished him in New York,
rapidly advanced him to a captaincy.
Shortly after the injury he began to have headache
and to pass sleepless nights. About four years afterwards
a change was manifest in his emotions, in that he became
irritable, resentful, quarrelsome and dissolute. The attacks
• Psychological Medicine.
t Psychological Medicine.
\ Mississippi Medical Monthly, April, 1883.
§ Lyon Medicali', April 3, IdSl.
il General Paralysis.
•• Ilandbuch der Geisteskrankheiten.
tt General Paralysis.
\\ AUgemeine Psychopath ologie.
Traumatism in Relation to Insanity. 65 1
of cephalalgia became more severe, and were accompanied
by dipsomania.
He had a wife and two children. Prior to this condi-
tion, he always manifested for them the warmest attach-
ment ; but now, during the paroxysmal attacks, he treated
them brutally, and yet, during the interval, his old love
continuously showed itself. These abnormal states became
more frequent and violent, and finally his wife, not under-
standing their pathology, lost her patience, and became
divorced, thus cutting him loose from his only balance-
wheel.
He then left this country and went to France, where
he became an active member of the Commune. Here, as
elsewhere, he was a leader. His outrages were conspicu-
ous, and furnished abundant occupation for his irregular
explosions of nerve force. At the close of the Commune,
he escaped from France, and was last heard of in the
South African diamond fields, having escaped from jail
after conviction of attempted murder and mail robberj'.
This case has in it the evidences of logical perversion,
.which form the basis of systematized delusions; and, in
all probability, the disorder in vaso-motor action will result
in paretic dementia. The immorality displayed by the
patient was, it is obvious, of pathological origin. His
affinity for the Commune was of the same nature as that
which led so many of the insane to join that movement
(which decreased the number of hereditary lunatics by
killing off so many of them).
Case H. — J. K., ast. thirty-nine, Irish father of unsta-
ble mental equilibrium. Paternal uncle, three paternal
cousins and a brother insane. He was a quiet, orderly
youth. Entered the army early in the civil war, and was
struck on the head several times, resulting in a cicatrix
over the junction of the right coronal and sagittal suture.
He remained unconscious for twenty-four hours. On his
return home, he was found to have undergone a change
of character ; was quarrelsome and subject to fits of un-
governable fury. His family manifested fear of him, and
52 D. R. Broiver.
he conceived the delusion that they wished to poison him.
About this time he had one attack of grand mal. He
beHeved that other people wished to poison him, and car-
ried about him various roots and camphor as antidotes ;
and frequently took doses of sweet oil. These delusions
of conspiracy and suspicion increased, and he carried a
knife and pistol for self-defence. The Catholic Church and
its priesthood, of which he had been a devout member,
were regarded by him as active agents in persecuting him.
In 1870 he left home, and traveled to and fro to avoid
persecution, but found this impossible. He had frequent
attacks of petit mal and epileptiform neuralgia. He had
attacks of transitory furor, which led him to attack his
wife, who regarded him as insane, but was deterred from
action by the publicity attendant on the disgraceful trial
by jury system, of the lunacy laws of Illinois. He finally
shot and killed his wife, under the delusion that one of
his persecutors had attempted to enter his room. He was
suddenly awakened by his wife arising, supposed her one
of his enemies, and killed her. On finding that he had
killed his wife, he attempted to commit suicide. A small
bottle of whiskey, smelling strongly of camphor, was found
in the room. His wife and himself had been on very good
terms.
Dr. H. M. Lyman and myself were called as experts,
and testified to the man's insanity. The prosecution en-
deavored to account for all his irregularities by attributing
them to the effects of whiskey; and in corroboration of
this view, the small bottle of whiskey, half empty, played
an important part. The judge instructed that, if the in-
sanity was the result of inebriety, it was no defence, —
which resulted in the following verdict: "We, the jury,
find the defendant guilty in the manner and form charged
in the indictment, and fix his punishment at death by
hanging. We, the jury, also find the defendant insane at
the present time." The judge granted a motion for a new
trial, but K. relieved the case of any further legal relations
by committing suicide the day after. There was found
Traumatism in Relation to Insanity. 653
among his effects a note, written the first day of the trial,
which showed that his failure to sooner commit suicide
was altogether due to a want of opportunity.
It will be obvious that, in this case, there were sys-
tematized delusions of persecution. The epilepsy was an
epiphenomenon. The suicide was an expression of the
man's love for his wife, and not in itself necessarily an in-
sane act, although an evidence of insanity. A sane man,
killing his wife under a mistake, might have committed
suicide in like manner.
Case III. — J. V., aet. fifty, had a paternal grandmother,
two of his paternal uncles and two paternal cousins died
insane. He manifested such mental impairment at the
age of puberty as to earn for himself the sobriquet of
"silly" and "crazy" among his companions. He grew
up, however, to be a man of seeming ordinary mental
capacity, with industrious and frugal habits, raising a large
family and accumulating considerable property for one in
his station.
When forty-two years old, while at work on the rail-
road track, he was struck by a passing locomotive ; his
left arm fractured, and his head injured sufficiently to pro-
duce cerebral concussion, followed by loss of conscious-
ness, which continued for several days. After recovery he
complained of severe and frequent cephalalgia, had restless
nights, and gave evidence of a change in emotional con-
dition, by irritability, fits of crying and dislike for soci-
ety. One year after this injury he sustained another. A
staircase he was assisting in erecting fell, and, striking him
on the head, knocked him senseless.
After this second accident his mental perturbation
was more manifest ; he neglected his work, squandered
his property till he became penniless, and manifested de-
lusions. He thought himself possessed of great wealth,
boasted of being the third son of God, wandered about
his neighborhood hatless, coatless and barefooted in mid-
winter. He was ardently devoted to his wife ; he told
sev^al persons that she was too good for this world;
654 -^- ^- Broiver.
that he was the third son of God, and must send her
to heaven; accordingly, in June, 1878, in a public place,
in the presence of several persons, without warning or
evidence of passion or excitement, he shot her. She
died immediately.
The plea in defense was insanity. Dr. H. M. Lyman
and myself served as experts. With this history before
us, and with the evidence of neurotic disturbance shown
by pupillary inequality, well-marked nystagmus, fibrillary
twitchings of the muscles of the face, back, thorax and
lower extremities, the evidence of the jail attendants
that he slept scarcely at all, ate but little, and only
such things as were brought from without, believing the
jail food to be poisoned, we had no hesitation in say-
ing that he was insane at the time of the homicide,
and at the time of the trial. After this opinion was
rendered, E. P. Weber, Esq., the prosecuting attorney,
abandoned the case, and the jury returned a verdict of
insanity without leaving their seats.
This case was an impure one. The man was, at
starting, a primary monomaniac ; but that the traumatism
exercised a decided influence in changing somewhat the
type of the psychosis is sufficiently evident from the
history. The termination of the case was paretic de-
mentia, but the intervening phenomena were such as
have been already ascribed to traumatism. The ques-
tion of treatment naturally occurs. Would trephining be
of service ? It is doubtful. As has been shown, trauma-
tism produces deep-seated, impalpable change, and on
this the trephine could exert no influence. Trephining in
cases of depressed fracture would relieve one source of
irritation, and would therefore be justifiable. Mickle* has
proposed, in cases of traumatism, to use kalium iodide,
rest and local cephalic applications of cold water. From
an a priori stand-point, these would seem likely to be
of value during the period between the receipt of the
injury and the inception of the psychical symptoms.
• American Psychological Journal, April, 18S'}.
Report on Bibliography.
PRESENTED TO THE THIRTY-NINTH ANNUAL MEETING OF
SUPERINTENDENTS OF AMERICAN HOSPITALS FOR
THE INSANE, AT NEWPORT, RHODE
ISLAND, JUNE, 1883.
^ I ""HE present year has seen many works on psychiatry
-■- issued into existence. In England, Tuke has con-
tributed a valuable historical work, to the literature
of this subject. In France, Luys, Bra, Ball, Bonnet and
Voisin have written systematic works on insanity. Billod
has collected his scattered contributions into two large
volumes; Magnan has produced an interesting volume
on Epilepsy ; Mairet, one on Melancholic Dementia ;
Castaing, a small work on Chronic Mania ; Mobit and
Durantel, small works on Recurrent Mania; Le Grand
du SauUe, an extended and valuable treatise on Hysteria ;
Rougier, a small essay on Melancholia, from locomotor
ataxia ; Regis, a small work on Progressive Paresis in the
Female ; Bourneville, one on Idiocy, Hysteria and Epi-
lepsy; Descourtis, one on the Divisibility of Mental
Operations ; Ribot, a work on Psychical Heredity, and
one on Diseases of the Memor\' ; Paris, an essay on
Ambitious Delusions ; Lelorrain, one on The Insane from
a Penal Point of View ; Broquere, one on Apoplecti-
form and Epileptiform Attacks in Progressive Paresis ;
Roux, one on Ethyl Bromide in Epilepsy and Mania.
In Germany a new edition of Krafft-Ebing' s Lehrbuch, has
appeared, and a work by Arndt. Mendel's work on
Mania, is a contribution of decided value. In Italy, Ver-
ga's work on the Classification of Insanity, looms up
prominently. In the United States and Canada, alienists
have been very active in the production of works.
Griesinger has been reproduced, unaltered from the Syd-
enham Society translation in an American edition. Drs.
656 Report on Bibliography.
W, A. Hammond, E. C. Spitzka and E, C. Mann have
published systematic works on Insanity; while Drs. H. P.
Stearns and E. C. Spitzka have discussed the Etiology
of Insanity, The first deals with the general aetiology ;
the second with the somatic only. In Canada, Dr. Howard
has published a small work on the *' Philosophy of Insan-
ity, Crime and Responsibility." Dr. Worcester (a homoe-
opathist) has also written on Insanity in general. No less
than five new journals devoted to Psychiatry, have appeared.
Of these, two are American, one is German, one Italian
and one Russian. It will be obvious from these that the
tide of periodical psychiatrical literature is growing in vol-
ume, and to chronicle even the titles of the same is no
mean task. A bibliography is always a matter of perhaps
equal fatigue to the reader and writer.
SPECIAL PSYCHOSES.
The contributions to the special psychoses are by no
means few. Drs. G. Alder Blumer,' P. M. Wise ' J. C.
Shaw,' Charcot,* Raggi* and Sterz,* have reported cases
of sexual perversion, corroborating the views expressed
by Westphal, Krafft-Ebing and others, that this type of
mental alienation occurs in hereditarily defective indi-
viduals, and is characterized by the fact that the male is
attracted by the male, and vice versa. Transitory insanity
has been analyzed by Brush,' Lowenfeld,^ Lombroso,*
Burns," Kiernan," Engelhorn,'' Spitzka" and Delafield,"
whose reported cases confirm the views of Krafft-Ebing
and Schwartzer. Epileptic Insanity, in its varied phases,
1. American Jourual ot Insanity, July, 1882.
2. Alienist and Neurologist, January, 1883.
3. Archives de Neurologie, Tome IV., 1882.
4. Jourual of Nervous and Mental Disease, April, 1883.
5. Annall Universali di Medlcina y Chirurgia, 1882.
6. Jahrbuecher fuer Psychiatrle, Band III.
7. American Jourual of Insanity, July, 1882.
8. Neurologisciies Centralblatt. ^
9. ArchlviadiPsichlatrla, Fascl., 1883.
10. Rooky Moiintain Medical Itevlew. March, 1882.
11. Detroit Lancet, March, 188.i.
12. Centralblatt fuer Nervenheilkunde, 1882.
13. American Journal of Neurology and Psychiatry, 1882.
U. New York Medical Journal, October, 1882.
Report on Bibliography. 657
has been discussed by Kiernan/ Kerlin,* Respaut/ Bourne-
ville,* Jehn/ Spitzka/ Hughes/ Russell/ Kuhn/ Lent,'"
Fiirstner ," Vallee," Pelman and Moli," Botkin" whose cases
support the views of Falret and Samt. Progressive
Paresis has been the subject of papers by Hughes/' Ken-
ner/' Zacher," Magnan/' Obersteiner,'" Snell,*° Fabre de
Parel/^ I^maestre," Baillarger " Frigerio,** Regis,*^ Lange,**
Rey/' :^Iickle,'« Foville,^ Taguet,^ Mendel/' Cullere/' La-
ftte,"" Stenger,=" Tuttle/' Goldsmith^ Broqu^re,'' Schiile,*^
Howard,=^ Camuset," Berger/' Seppilli/' Wigglesworth,"
1. Chicago Medical Keview, February, 18S2.
2. Alienist and Neurologist, July, 18S2.
3. Alienist and Senrologist, January, 1SS2.
*. Archives de Xeorologie, Tome IV. , liSS2.
6. Xeurologisches Ceatralblatt, No. 3, 188i.
6. American Journal of Neurology and Psychiatry, 1SS2.
7. Alienist and Neurologist, July, 13S2.
8. Medical Times and Gazette, January, 7—21, 1882.
9. Berliner klinische Wochenschrift, Xo. 17, 1SS2.
10. American Journal of Neurology and Psychiatry, 1SS2.
11. Berliner klinische Wochenschrift, July 10, 1SS2.
12. L'Union Medicale du Canada, January, 1882.
13. AUgemeine Zeitschrift fuer Psychiatrie, Band XXXLX.
14. Medleinkoje Obosrenje, July, 1&*2.
15. Chicago Medical Review, April 16, l5S.i.
16. Cincinnati Lancet and Clinic, March 5, 1883.
17. Archiv fuer Psychiatrie, Band XIII.
18. Journal de Medecine et de Chirnrgie, January, lsS2.
19. Monatshefte fuer praktische Dermatologie, No. 11, 1882.
20. Zeitschrift fuer P--ychiatrie. Band XXXVIII.
21. Annales Medico-Psychologiques, July, 1SS3.
22. Ibid.
23. Ibid, January, March, 1883.
^4. Archivio per la Malattie Nervoso, F.I. to II. , 1883.
25. L'Encephale, No. 1, 1883.
26. Hospitals Tidende, May 19, 1883.
27. Annales Medico-Psychologiques, Nol, 1SS3.
28 Journal of Mental Science, July, 1SS3.
29. Annales Medico-Psychologiques, Tome VIII, 1882.
30. Ibid.
SI. Neurologisches Centralblatt, Febmary, 18S2.
32. Annales Medico-Psychologiques, March 1SS2.
33. Ibid.
34. Archiv fuer Psychiatrie, Band XIII.
3.1. Boston Medical and Surgical Journal, December 2S, 1882.
36. Archives of Medicine, August, 1S83.
SI. These de Paris, 1S83.
38. Berliner klinische Wochenschrift, July 10, 1882.
39. Journal of Neurology and Psychiatry, February, 1883.
40. Annates Medico-Psychologiques, January, 1883.
41. Neurologisches C«ntralblatt, October. 1882.
42. Kevista Sperimentale di Freniatria, Anno IX. , Fasc I.
-43. Journal of Mental Science, January, 1^3.
658 Report on Bibliography .
Oebeke/ Spitzka/ C. K. Mills,' McFarland and Kiernan. *
Baillarger and Frigerio discuss the question whether there
be not paralytic insanities of different aetiology, prognosis,
and clinical course. Seppilli discusses at length the ques-
tion of progressive paresis in the female, and disproves
Neumann's assertion that this psychosis does not occur
among females. He is of opinion that the climacteric is
not without influence in the production of this psychosis
in the female.
Mendel has recently discussed at length melancholia,
in the same clear analytical way which gave his study
of mania so much interest. He defines melancholia as a
functional cerebral disease, attended by morbid psychical
phenomena, which has for its basis a morbid excitability
of the sensitive side of the mind. In the typical melan-
cholia, there are three stages, — a stage of depression, in
which the patient although depressed, has not lost the
power of appreciating his relations to his surroundings ;
a stage of melancholia, in which this power is lost, and
the patient has delusions or hallucinations of a moral or
physical nature ; a stage of decline. Besides this typical
form there is: First, The so-called "mild melancholia"
of the Americans ; the " reasoning melancholia " of the
French, which lacks the melancholic stage. Second, The
melancholia attonita. Third, The melancholia periodica.
Morse has also discussed the same subject, and Kier-
nanz has briefly confirmed Mendel. Moral Insanity, — that
morbid entity which has been claimed to be unknown to
science, seems to have had much attention directed to it dur-
ing the past year. It has been discussed by Hughes," Gas-
quet,* Manley,' Andrusski,^ Magnan,® Hollander,^" Work-
1. Allgemeine ZeltBohrift fiier Psychlatrie, Band XXXIX. , 18S2.
2. American Journal of Neurology and Psychiatry, August, 1883.
3. Journal of Nervous and Mental Disease, July, 1883.
4. Alienist and NeurologiBt, July, 1883.
f). Alienist and Neurologist, January, 1882.
(i. Journal of Mental Science, April, 1882.
7. Ibid, January, 1883.
8. Wratschebnija WedomoatI, No. 27, 1882.
9. Journal de MMecine et de Chirurgle, April, 1882.
10. Jahrbueclier fuer Psychiatrie, Band III.
Report on Bibliography. 659
man/ Lombroso' and N. Folsom ;' and the weight of
authority during the year is in favor of the existence of
the psychosis denominated by Morel, Ray, ConoUy, Kraflft-
Ebing, Schiile, Tuke and Crichton-Browne, moral insanity.
On the other hand the New York Medical Society, at
its 1882 meeting, passed a resolution that the alienist
was not justified in drawing conclusions as to sanity from
moral manifestations of conduct, that department pertain-
ing exclusively to law. Primary Moxomaxia has been
discussed by Pasternazki,* Burr,' Andrusski,® Buccola '
and Spitzka,^ who confirm the conclusion of Sander that
there is a congenital type of insanity dependent on cor-
tical malformation rather than disease. Katatoxia first
described by Kahlbaum, in 1874, whose existence was sub-
sequently confirmed by the researches of Kiernan, Brosius
and Hecker, has been discussed by Lafenauer,' Kiernan^**
and Hammond ;^^ and their researches are fully confirm-
atory of those already cited.
Reasonixg Maxia has been discussed by Hammond^
and Chase," and its relations to primary monomania seem
clearly demonstrated.
Hebephrexia, or insanity of pubescence, has been dis-
cussed by Burr,'* who confirms pre-existing researches on
the subject. He alludes to the fact that religiosity and
sexual ideas are often concomitant or alternate, as noted
by Workman and others. In a general way his results
corroborate those of Hecker and Kahlbaum.
FoLiE DU DOUTE has been discussed by BalP' and
1. Canadian Practitioner, February. lSi3.
2. Archivia di Psichlatria, No. 1, 1SS2.
3. Xew York Medical Journal, February, 1S82.
4. Wratsch, Xo. 31, ISSJ.
5. American Journal of Medical Science, July, 1SS3.
6. Loc cit, Xo. 27, 18S2.
7. Kevista Sperimentale, Anno VIIl.
8. Somatic Etiology of Inaanity.
9. Orvosi Hetilap, Xos. 5 and 6, 1S3-2.
10. Alienist and Xenrologist, October, 18S-2.
11. Xew York Medical Journal, April 1.5, 1SS3.
12. Journal of Xerrous and Mental Disease, January, 1SS2.
13. Chicago Medical Review. May 1, 1S82.
14. Physician and Surgeon, March, 1SS2.
15. Eulenburg's Real Encyclopsedie.
66o Report on Bibliography.
Tamburini.^ Under this title are included mysophobia,
toxophobia and allied conditions. Tamburini divides it
into the metaphysical type, whose intellect is affected by
endless imperative metaphysical conceptions ; the realistic
type, in whom trivial realistic imperative conceptions affect
the patient; the scrupulous type, whose morbid impulses
relate to the question of conscience ; the timorous type,
who fear to compromise themselves by any act, however
simple ; the calculating type, who find themselves forced
to calculate ; and finally, a type in which the contact of
external objects is feared.
Megalomania is discussed by Foville. The types of
insanity occurring at certain periods, in childhood, old age,
in pregnancy, during lactation, etc., have been discussed
by Hughes,'^ Leidesdorf,* Gauthier,* Savage,* Guermon-
prez," Mackintosh,' MoUer,* Kiernan,' Cohn,'" Magnan,"
Griffin," Berner" and Hammond.^*
Acute Delirious Mania, the typhomania of Bell, has
been discussed by Gene^* and Kiernan.^®
Periodical and Circular Insanity has attracted the
attention of Koster,'' Foville,^' Haase,'» Ritti,'° Hurd,"
Taguet," and Schafer,*^ who confirm previous researches.
1. Ohio Medical Journal, April, 1883.
2. Alienist and Neurologist, 1882.
8. Jahrbuecher fuer Psycliiatrie, 1883.
4. These de Paris, 1S83.
6. Journal of Itfental Science, July, 1883.
6. Archives G6n^rales de Mfedecine, August, 18t2.
7. Edinburgh Medical Journal, April, 1883.
8. Archiv fuer Psychiatric, Band XIII.
9. Detroit Lancet, 1882.
10. Archiv fuer Kinderheilkunde, Band IV.
11. Journal de M6dicine et de Chirnrgie, April, 1882.
12. Australian Medical Journal, June, 15, 1882.
13. Norsk Magazine of Liegevldenskabens, 3 B. Xll.
14. Alienist and Neurologist, July, 1883.
15. RevistaFrenopatica Barcelonesa, November, 1882.
16. Detroit Lancet, September, ]88.t.
17. Allgemeine Zeltschrlft fuer Psychiatrie, Band XXXIX.
18. Brain, July, 1882.
19. Allgemeine ZeitschrUt fuer Psychiatrie, Band XXXIX.
20. Annales Medico- Psychologiques, July, 188i.
21. Journal ol In«anlty, 1882—3.
22. Annales Medico-Pfychologiqiieo, July, 1882.
23. Neurologlsches Centralblatt, May, 1882.
Report on Bibliography. 66 1
Koster attempts to show that periodical insanity has some
relations to lunar periods.
Communicated Insanity, or folie a deux, has been
discussed by Morandan de Montezel,^ Kiernan,"- Hughes,^
Lehman,* Bouteille, Savage and Gill.^ In general these
researches tend to show that several varieties of dis-
tinct insanity are collected together under the term folie
a deux. Some of the cases originate from the intercom-
munication of delusions ; and others, as has been pointed
out by Hughes and de Montezel, arise from one insane
patient imitating another's delusion.
MECONISM.
On dipsomania, opiophagism, etc., there have appeared
valuable papers from Drs. Evarts, Crothers, Mattison, Kane,
Mann, Blodgett, Wright and others. There is to be noticed
an increasing number of articles on inebriety and its kindred
states of alienation, and of perversity associated with the
abuse of drugs or stimulants. It is becoming an important
problem for the student of psychiatry to determine what
is the real mental condition in these cases, and what dis-
posal should be made of these victims of constitutional
disease, vice and s^n ; for, since psychiatry is so simplified
that half what the fathers of psychiatry held to be taint
of blood or moral cretinism is relegated to the turnkey and
headsman, and it is authoritatively declared that dipso-
mania is drunkenness — another name for crime, we shall,
in the near future, have to meet this question, " What
punishment shall be meted out to this crime, since the
thirty and ninety days' sentences of the police courts are
confessedly powerless for reform ?" In other words, since
we close our doors against them as not insane, what must
society do with them as criminals ? It is a question which
must be met, for this sphinx of the unguessed riddle is
devouring her victims at a fearful rate.
1. L'Encephale, No. 3, 188J. "^
2. Alienist and Neurologist, April, 18S3.
3. Alienist and Neurologist, July, 1883.
4. Archiv fner Psychiatrie, Band XIV.
5. Journal of Mental Science, July, 1S82.
662 Report on Bibliography .
[Note. — To these are to be added six papers on different aspects of
opium addiction, by Dr. J. B. Mattison, published in the N, Y. Medical
Record, Medical Oazeite. Cincinnati Lancet and Clinic, N. E. Medical Monthly,
St. Lo2iis Courier and the Journal of Inebriety, "]
COMPLICATIONS.
M. J. Madigan^ discusses the relations of insanity
to diabetes, and finds that these two diseases alter-
nate at times. Gundry' discusses the interrelations of
abdominal disease and insanity. Munson^ reports cases of
insanity complicated by Addison's disease. Fritsch* reports
cases of insanity cured by erysipelas. CampbelF and de
Montezel*' report cases where typhoid fever exerted both a
favorable and unfavorable influence on insanity. Madi-
gan' and Kiernan*^ discuss the influence exerted on insanity
by small-pox and vaccination, which they find to be some-
times favorable and sometimes the reverse, Kiernan^ also
discusses the relation of gout to insanity. Howden^°
reports a case of insanity associated with osteo malaria.
Ball'^ and Ringrose Atkins^- discuss insanity in its rela-
tions to paralysis agitans. Wigglesworth^^ discusses the
relations of insanity to chorea. Brueger^^ and Raymond'^
analyze the relations of kidney disease to insanity. Shaw,^^
Sioli^" and Kiernan^^ find that progressive paresis produces
arthropathies similar to those of locomotor ataxia; and
Christian'^ has found perforating ulcer of the foot to exist
in progressive paresis.
1. Journal of Nervous and Mental Disease, April, 1883.
2. Detroit Lancet, May, 1883.
3. Ibid, April, 1883.
4. Jahrbuecher fuer Payfchiatrie, Baud 111.
5. Journal of Mental Science, July, 1882.
6. Annales Medico- Psychologiqiies, Scrie VI., Tome IX
7. Chicago Medical Review, July 15, 1882.
8. American Journal of Neurology and Psychiatry, August, 1883.
9. Alienist and Neurologist, April, 1883 ;
10. Journal of Mental Science, April, 18—.
11. L'Encephale, 1882.
12. Journal of Mental Science, January, 1882.
13. Ibid, April, 1882.
14 CharlK^ Annalen, VII., 240.
15. Archives Gt-nerales de Medecine, March, 1882.
10. Archives of Medicine, April, 1883.
17. Neurologisches Cenlralblalt, No. 2, 1882.
18. Detroit Lancet, July, 1883.
19. Annales M«dlco-Psychologi(jues, September, 1882.
Report on Bibliography. 66^
Othaematoma, or as it is more commonly called, haema-
toma auris, or the insane ear, has been discussed by Biaute, ^
who claims that it is of trophic, not traumatic, origin ; by
Kiernan,- who is of the same opinion ; by Hammond"' and
Spitzka,* who both agree as to the possibility of traumatism
acting as an exciting cause, but that insanity is a predispos-
ing cause of a very powerful nature. Hallock^ has proposed
blisters behmd the ears as a means of treating this com-
plication. An explanation of the origin of this complication
is to be found in Dastre and Morat's** discoveries respect-
ing the vasomotor nerves of the ear and the vessels of the
same.
ETIOLOGY.
The psychoses produced by toxic agencies have been
much discussed. Hassler,^ Konig,'- Smidt^ and Schede *
report acute and chronic psychoses due to iodoform.
Depression was the prevailing type. Barbowes,^ Bog-
donow,*^ Diesterweg," Charkey* and Strieker^ report
psychoses due to the use of salicylic acid, depression being
the type. Bannister,^** Jewell,^* Hughes^- and Kiernan^^ find
that two types of insanity result from the use of the
bromides in epilepsy ; one due to the suppression of the
convulsions ; the other directly due to the drug, Dr. T.
L. Wright" and Frigerio^'^ have discussed the aetiological
1. Annales Medico-Psychologiques, July, 1S5-2.
2. Detroit Lancet, July, 1883.
3. Treatise on Insanity.
4. Insanity, itsClassiflcation, Diagnosis and Treatment.
5. American Journal of XeuroJogy and Psychiatry, 1882.
6. Archiyes de Physiologle, October, 1&S-2.
1. Gazette Hebdom., No. 30, 1882.
2. Centralblatt fner Chinirgle, No. 10, H82
3. Centralblatt fuer Nerven, December 1, 1883.
4. Centralblatt fner Chirargie, Xo. 3, 1882.
5. Medical Record, April 29, 1882.
6. "Wratsch, Ko. 12, 1882.
7. Centralblatt fuer Chirurgie, No. 3, J8S2.
8. Lancet, 1882.
9. Berliner klinische WochenEchrift, 1882.
10. American Journal of Neurology and Psychiatry, 1882.
11. Detroit Lancet, June, 1S&3.
12. Alienist and Neurologist, January. 1883.
13. Detroit Lancet, June, 1S83.
U. Detroit Lancet, November, 1885: June, 1883.
15. Archiv. Ital. per la Malatt. Nerv. , from I. to II. , 18*3.
664 Report on Bibliography.
relations of alcohol. The latter agrees with Regis'^ in
believing that alcohol produces a pseudo-paretic dementia.
Fabre de Parrel^ has found that systematized insanity-
results from alcohol. Moreau de Tours^ and Gnauck *
find that carbonic oxide poisoning sometimes produces
insanity of a depressing type. Binswanger^ reports a case
of insanity due to brass poisoning, and very similar cases
due to lead are reported by Moli,'^ Ulrich/ Kiernan *
and Goodheart,^ who also report chronic psychoses due to
the same cause. Rennert^° finds that chronic lead poisoning
in the ancestor gives rise to macrocephalic idiotic chil-
dren. DelafieW reports cases of transitory furor due to
quinine, and a like case is reported by Kiernan," who
also reports" other types of insanity, due to the same
cause. Kiernan reports cases of insanity due to second-
ary syphilis. Otis" and Hughes^* have reported cases of
acute insanity due to syphilis. Obersteiner,'® Snell," Kier-
nan,'® Lange" and J. Oebeke,'*' claim that the type of
progressive paresis produced by syphilis cannot be dis-
tinguished from the ordinary types. Berry'^' has discussed
dementia from syphilis. Krapelin," in an extended mono-
graph running through several volumes of the Archiv fur
Psychiatrie, discusses the etiological relations of acute
1. L'Encephale, January, 1883.
2. AnnaleB Medico-PBychologiques, July, 1882.
3. Detroit Lancet, June, 1883.
4. Charlte Annalen, 402, 1883.
5. Neurologlsches Centralblatt, March 15, 1883.
6. Cbarlt6 Annalen, JahrganK VIII.
7. Allgemeine Zeitschrift fuer Psychiatrie, Band XXXIV.
8. Detroit Lancet, June, 1883.
9. British Medical Journal, April 11, 1882.
10. ArchivfuerGynaliologle, Band XIV.
11. New York Medical Journal, October, 1883.
12. Alienist and Neurologist, October, 1883.
13. Detroit Lancet, June, 1883.
U. New York Medical Journal, Vol. XXXVII., 1883.
15. Alienist and Neurologist, April, 1883.
16. Monatsheit fuer praktische Dermatologie, No. 11, 1882.
17. Allgemeine Zeitschrift fuer Psychiatrie, Band XXXIX.
18. Alienist and Neurologist, July, 1883.
19. Hospitals Tldende, May 19, 1883.
20. Op. cit.
21. British Medical Journal, April 8, 1882.
22. Op. cit. , Band XI to XIII.
Report on Bibliography. 66$
diseases to the psychoses. Spitzka^ reports a case of
moral insanity due to scarlet fever, and psychoses of
like origin are reported by Ayer,* Wicks' and Kier-
nan.* Madigan,* Wicks^ and Kiernan,'^ report cases of
insanity due to measles. W. H. Daly® reports a case of
insanity due to typhoid fever. Wicks/ a case of insanity
due to vaccination. Traumatism in relation to the pro-
duction of insanity, has been discussed by Verity,^" who
gives a good resume of the literature of the subject,
Mickle," Spitzka," Lombroso" and McGee." The last was the
case of a man who became morally insane after an injury,
and had a morally imbecile son born after the receipt of the
injury. Guermonprez" finds that depression of the skull
in children gives rise to psychical symptoms. Leides-
dorf* discusses the effects produced by synostosis of
the skull sutures. It should be remembered, that, Vir-
chow's hypothesis to the contrary notwithstanding, this is
an expression of a congenital deficiency, not the cause
of microcephalus, and that, acting on an already defective
brain, it might produce pathological changes. Fiirst-
ner,^^ discusses the influence of aural affections on the
psychoses, and shows that such influence has been much
over-estimated. Ripping.^^ Danillo,^^ Mairet and Cleaves,-^
show that female diseases are not as potent in the pro-
duction of insanity as has been supposed, although
1. American Journal of Neurology and Psychiatry, 18S3.
2. Boston Medical and Surgical Journal, January 26, 1882.
3. Cincinnati Lancet and Clinic, March 10, 1833
i. Detroit Lancet, June. 1883.
5. American Journal of Neurology and Psychiatry, May, 1883.
6. Cincinnati Lancet and Clinic, March 10, 18S4.
7. Detroit Lancet, June, 1883.
8. Medical News, January, 1882.
9. Cincinnati Lancet and Clinic, March 10, 1883.
10. American Journal of Neurology and Psychiatry, May, 1882.
11. Journal of Mental Science, January, 1883.
12. Somatic etiology of Insanity.
13. Archivia di Psychiatria, 1882.
14. Mississippi f alley Medical Monthly, April, 1883.
15. Archives Generales de Medecine, August, 1832.
16. Jahrbuecher fuer Psychiatrie, Band III.
17. Berliner klinische Wochenschrift, No. 18, 1883.
18. Allgemelne Zeitachrift fuer Psychiatrie, Band XXXIX.
19. Archives de Neurologic, Tome III.
20. Western Lancet, March, 1883.
666 Report on Bibliography.
H. Marion-Sims^ and H. T. Byford,^ still hold to the con-
trary. The influence of heat in the production of
insanity has been discussed by Brush^ and Kiernan. *
Mendel,^ discusses the psychical results of cerebral
haemorrhage. The moral causes of insanity are discussed
by Chapman^ and Kiernan.''' The works on aetiology,
specially deserving attention are Krapelin's Monograph,
Spitzka's Monograph, and the Monograph of Stearns.
SYMPTOMATOLOGY.
Low temperature as a symptom of insanity, is discussed
by Howard,^ Haase,'-^ Bechterew and Heboid,^ and Kier-
nan.'^ Ball,^ discusses hallucinations in their relation to-
otitis, and the same are discussed by Fiirstner.*^ Bail-
larger,'^ discusses hallucinations in progressive paresis, and
agrees with Mickle, that these are unsystematized.
Oeffinger,^ discusses the sense of smell in lunatics.
Chadzinski,^ Frigerio'*^ and Kiernan,^i discuss self-mutilation
in the insane, and its probable psychic basis. MoH,^^ dis-
cusses the optic conditions of the insane, and Buccola^^
the pupillary conditions of paresis. Mickle,^* discusses
kneejerk in paretics, Seppilli,'^ discusses the blood of the in-
sane ; Albertotti,^'' discusses the tactile sense in lunatics ;
1. American PsychologicalJournal, No. 1, 1883.
2. Weekly Medical Review, Vol. VIII.
3. American Journal of Insanity, 1882—8.3.
4. Detroit Lancet, June, 1883.
6. Deutsche medizinische Wochenschrift. Jahrgang VIII.
6. Journal of Mental Science, July, 1882.
7. Detroit Lancet, June, 1883.
1. Pliilosophy of Insanity, Crime and Responsibility.
2. Allgemeine Zeltschrift fuer I'syohiatrie, Band 3CXXIX.
3. Archiv fuer Ppjchiatrie, Band XIII.
4. Detroit Lancet, Vol. VII.
5. Journal de M6decine et de Chirurgie Pratiques, August, 1882
6. Op. Cit.
7. Annales Medico-Psychologlques, January to Ajjril, 1883.
8. Irrenfreund, XXIV, No. 6.
9. Anuales Medico-Psychologiques, May, 1882.
iO. Journal of Nervous and Mental Disease, 1882.
11. Gazetta degli Ospitali, September 13, 18S2.
12. Journal of Nervous and Mental Diseiv8e,1882.
13. Revlsta Sperimoniale di Freniat, Anno IX.
14. Journal of Mental .Science, October, 1882.
l.T. Revlsta Sperimentale dl Freniat. Anno IX.
16. Archiv Ital. per la Mai. Nerv., 18a3.
Report on Bibliography. 66j
Kuhn^ discusses epileptiform hallucinations ; Ritti- dis-
cusses deficient capillary circulation ; Claus,^ Ragosin and
Turnbull* discuss the pulse of the insane ; Hirschberg ^
discusses the optic symptoms of progressive paresis ;
Rey^ reports hysterical symptoms in the same psychosis ;
Verriest'^ and Everts^ discuss the general symptomatology
of insanity; Clouston discusses alternation and periodicity
in insanity; Leidesdorf,^ the relations of the time of
causation to the form of insanity ; MitchelP" discusses
athetosis in the insane.
PROGNOSIS.
Pliny Earle^ adds new statistics to those he has
previously adduced, showing that certain elements of
error exist in the asylum statistics of recovery. Thom-
son,- Wigglesworth,^ Chapman* and Gene,^ also discuss
the question of prognosis ; and contributions to this
subject are made by Giraud,® Guillemin" and Sizaret. ^
Asylum statistics in general are discussed by Wil-
bur,^ Allen^° and Chapman.^^
TREATMENT.
The use of hyoscyamine in insanity is discussed by
J. Berliner klinische Wochenschrlft, No. 17, 18S3.
2. Annales Medico-Psychologiques, Serle VI. to IX.
3. AUgemeine ZeiUchrift fuer Psychiatric, Band XXXIX.
4. Boston Medical and Surgical Journal, May 11, 18S2.
5. Neurologisches Centralblatt, 1882.
6. Annales Medico-Psychologiques, S. 6, Tome IX.
7. EeTue Medicale, 1882.
8. CincinnatiLancet and Clinic, October 21, 1882.
9. Wiener medizinische Wochenschrlft, 18S2.
10. Edinburgh Medical Journal, May, 1S82.
1. Alienist and Neurologist, October, 18S2.
2. Journal of Mental Science, July, 1S82.
3. Ibid, April, 1883.
4. Ibid., April, 1883.
5. Revista Frenopatica Barcelonesa, May, 1882.
6. Annales Medico-Psychologiques, January, 1883.
7. These de Paris, 1883.
8. Annales Medico-Psychologiques, January, 1883.
9. Boston Medical and Surgical Journal, April 5, 1882.
10. Journal of Psychologcal Med . , 1882.
11. Journal of Mental Science, April, 1883.
668 Report on Bibliography.
Hughes,! Shaw,- Browne,^ Richter* and Kretz,^ whose ,
researches tend to confirm the opinion, that while hyoscy-
amine is of value, its use is not unattended by danger.
Cervello,^ Morselli,'^ Berger^ and Bergesio,^ claim that
paraldehyde is a valuable hypnotic substitute for chloral
hydrate; the dangers of which last hypnotic have been
pointed out by Kiernan^*^ and Gene.^^ Conium has been
discussed by Kronecker^^ and Kiernan.^^ Agaric has been
experimented with by Bareggi.^* Arsenic has been used
by Gene^^ in cases of congestive mania. Acetal has been
found of no value by Berger.^^ Apomorphia has been
used in agitated insanity, by Marshe.^'^ Krapelin^^ has
experimented with amyl nitrite. Ralfe,!^ has discussed the
use of sodium nitrite in epilepsy. Quinine has been
used in intermittent melancholia, by Baillarger.-" Surgery .
among the insane, is discussed by Schiile.'-^ Venesection
Tias been resorted to in a case of melancholia, by For-
dyce Barker.^2 Restraint is discussed, from a stand-point
favoring its use, by Kiernan,-^ Nichols,^^ Spitzka,-^ Cameron-^
and Becoulet;^^ from an opposite stand-point by Shaw^^
1 . Alienist and Neurologist, 1882.
2. Journal of Nervous and Mental DiseaBe, 1882.
3. British Medical Journal, November 25, 1882.
4. Neurologisches Centralblatt, July 15, 1882.
5. AUgemeine Zeitschrift fuer Psychiatrie, Band XXXIX.
6. Archivio Italiano per la Malattie Nervoso, F. I, 1883.
7. Journal of Nervous and Mental Disease, April, 1883.
8. Breslauer aerztllche Zeitschrift, March 24, 1883.
9. Archivio lialiano per la Malattie Nervoso, F. I., 1883.
10. Journal of Nervous and Mental Disease, April, 1883.
11. Revista Frenopatiea Barcelonesa, November, 1882.
12. Du Bois Keymond's Archives.
13. Journal of Nervous and Mental Disease, April, 1883.
14. Archivio per la Malattie Nervoso, 1883.
15. Revista Frenopatiea Barcelonesa, November, 1882.
16. Breslauer aerztliche Zeitschrift, March 24, 1883.
17. Revue Medicale Suisse Romande, May, 1882.
18. Wundt, Phil. Studien, I.
19. Lancet, December 9, 1882.
20. Revue Medicale Suisse Romande, May, 1882.
21. AUgemeine Zeitschrift fuer Psychiatrie, Band XXXIX.
22. New Yorli Medical Journal, Vol. XXXVII., 1883.
23. Journal of Nervous and Mental Disease, January, 1883.
24. New York Medical Journal, Vol. XXXVU. , 1883.
25. American Journal of Neurology and Psychiatry, 1882.
26. Journal of Mental Science, 1882—8.
27. Annales Medico-Psychologiques, Serle 6, Tome IX.
26. Archlvesof Medicine, 1882.
Report on Bibliography. 669
and Woodside ;^ and from a purely critical standpoint
by Bannister and Moyer.'*' Alimentation of the patient
refusing food, has been discussed by Riva.^^ Employ-
ment of the upper-class patients has been discussed by
Bower.*^ Education .in treatment of the insane, has been
discussed by Lalor,^ Fox,^'* Kiernaa^ and Turnbull.^
Treatment of bed-sores has been discussed by Rein-
hardt.^"^ The use of electricity has been discussed by
Tigges."^ Under the allied topic of administrative detail,
may be mentioned the discussion of the furnishing of
asylums, by Urquhart.'^ The subject of insane colonies
is discussed by Morton" and the Jahrbucher fur Psychiatrie.
PATHOLOGY.
The blood of the insane has been examined by Sep-
pilli.^ The skull of the insane has been discussed by
Amadeo.- The weight of the brain, by Morselli.^ The
diagnosis of insanity post-mortem, by Spitzka.* The
pathology of chronic insanity has been discussed by
Munson.^ The pathology of progressive paresis has been
discussed by Wigglesworth,^ Mendel,' CuUere,* Zacher, ^
Seppilli,^o Baillarger,!! Wesphal,!^ Schulz/-^ Rey.i^ Zen-
29. Medical Record, Vol. I, 18*2.
30. Journal of Nervous and Mental Disease, ISSi.
31. Bevista Sperlmentale di Freniat, Anno IX.
32. Journal of Meutal Science, 1882-83.
33. American Psychological Journal, April, 1?S2.
34. Journal of Mental Science, 1S82 — 83.
35. Jcurnal of Nervous and Mental Disease, January, 1883.
36. Journal of Nervous and Mental Disease, 1SS2.
37. AUgemeine Zeitschrift fuer Psychiatrie, Band XXXIX.
38. Ibid.
39. Journal of Mental Science, 1882—3.
40. Journal of Nervous and Mental Disease, 1882.
1 Kevista Sperlmentale di Freniatria, Anno VIII.
2. Annales Medico- Psychologiqnes, January, 1S82.
3. Bevista Sperimentaledi Freniatria, Anao VIII.
4. American Journal of Neurology and Psychiatry, 1883.
6 Alienist and Neurologist , April, 1883.
6. Journal of Mental Science, January, 1883.
7. Nenrologisches Centralblatt, No. 3, 1882.
8. Annales Medico-Psychologiqnes, May, 18S2.
9. Archlv fuer Psychiatrie, Band XIII.
10. Bevista Sperlmentale di Freniatria, Anno VIII.
11. Annales Medico-Psychologiques, January, 1882.
12. Archiv fuer Psychiatrie, Band XIII.
13. Keurologisches Centralblatt, No. 4, 1883.
14. Annales Medico-Psychologiques, May, 1882.
6/0 Report on Bibliography.
ner.^5 The pathology of typhomania has been discussed
by Clevenger^^ and of katatonia by Kiernan.^^ The gen-
eral subject of pathology has been discussed by Deecke^*
and Hoffmann. ^^
FORENSIC PS YCHIA TR V.
The mental status of Guiteau has been discussed by
Drs. J. P. Gray,^ Elwell,^ A. McL. Hamilton,^ H. P.
Stearns/ Worcester/'' Bucknill,^ Orange/ and E. Hart, *
who maintain that Guiteau is sane and responsible. Drs.
G. M. Beard/ Channing/o Fisher/^ N. Folsom/^ Godding/^
L. C. Gray," Chase,^'^ Denny.i^ C. F. Folsom," H. How-
ard,i8 Kiernan,i9 Mann,^" W. J. Morton.'-^i C. K. Mills,^*
R. L. Parsons,23 C. H. Hughes,^* A. McFarland,^^ Lom-
broso,26 Kelp,27 Pelman,^^ Pick,29 Tamassia,"'" C. A. Walker,"^*
15. Cincinnati Lancet and Clinic, October, 188-2.
16. American Journal of Neurology and Psychiatry, August, 18S3.
17. Alienist and Neurology, October, 1882.
18. American Journal of Insanity, January, 1883.
19. American Journal of Neurology and Psychiatry, August, 1883.
1. American Journal of Insanity, October, 1882.
2. Alienist and Neurologist, April, 1883.
8. Boston Medical and Surgical Journal, April 6, 1882.
4. Archives of M6dicine, June, 1882.
5. New England Medical Gazette, April, 1882.
6. Brain, April, 1882.
7. Journal of Mental Science, 1882 — 83.
8. British Medical Journal, 1882.
9. Journal of Nervous and Mental Disease, 1832.
10. Boston Medical and Surgical Journal, March 30, 1882.
11. Ibid, July 15, 1882.
12. New York Medical Journal, June, 1882.
13. Two Hard Cases.
U. American Journal of Neurology and Psychiatry, 1382.
15. Chicago Medical Review, Vol. V.
16. Boston Medical and Surgical Journal, December 14, 1882.
17. American Law Review, February, 1882.
18. Philoeophy of Insanity, Crime and Responsibility.
19. Alienist and Neurologist, April, 1882.
20. Journal of Psychological Medicine, 1882.
21. Journal c.f NeiTous and Mental Disease, January, 1883.
22. Transactions of Pennsylvania State Society, 1882.
23. American Journal of Neurology and Psychiatry, April, 1^82.
24. Alierist and Neurologist, 1882.
25. American Journal of Neurology and Psychiatry, 1882.
26. Archlvia di Psichiatria, 1882.
27. Deutsche medizinische Wochenshrift, No. 87, 1882.
28. Berliner kllnische Wochenschrift, November 25, 1882.
29. Berliner klinische Wochenschrift, Decembi-r 25, 1882.
30. Revlsta Sperimentale di Freniatria, Anno IX.
31. American Journal of Neurology and Psychiatry, 1882.
Report on Bibliography. 6yi
W. A. F. Browne,^ Riva,- Russell^ and Spitzka,^ regard
Guiteau as insane and irresponsible ; while Karrer* leaves
the question an open one, and Drs. W. A. Hammond, ''
Herrick," Henry,^ Bigelow,^ Reynolds,''^ regard Guiteau
as insane, but responsible. The editors of the Annales
Medico-Psychologiqiies cite Dr. Folsom's'^ paper as ex-
pressive of their views. The question of responsibility
has been discussed by Drs. Hammond,^- Reynolds, ^-^
Palmer^* and Bigelow,^-' who take very Spartan views of
the subject ; while the more humane view is taken by Dr.
Ira Russell,i6 Kane,'^ Ball,i^ Fritsch,^"^ L. C. Gray,-^ Krafift-
Ebing,'-' Seppilli," Tamburini,--^ Freyer,-* Schwartzer,-°
Cylits,-*' Tuke,-'^ Liman,-* Manouvrier,-^ Neumann,*^ Spitzka^^
and Howard.*-
The Medico-Legal Relations of Cranial Asymmetry
have been discussed by Dr. H. C. Wyman,^"^ who regards
1. Journal of Psychological Medicine, 1SS2.
2. Archivia di Psichiatria, Fasc. IK.
3. Hoston Medical and SurgicalJoumal, December 15, ISSi.
4. Alienist and Neurologist, July, 1S83.
5. Centralblatt fuer Neryenh., 1882.
6. Journal of Nervous and Mental Disease, .January, ISSi.
7. New Orleans Medical .Journal, December, 1&*2. '
8. American Journal of Neurology and Psychiatry, 1S82.
9. Medical Record, January, 1, 1SS2.
10. Chicajro Medical Review, Vol. V.
11. Boston Medical and Surgical Journal, February 16, 1882.
12. Journal of Nervous and Mental Disease, January, \iS&,
13. Iowa State Medical Society Transactions, 1882.
U. Medical New?, May 1, 1882.
15. Medical Record, January 21, 1882.
16. Boston Medical and Surgical Journal, December 28, 1882.
17. Alierdst and Neurologist, 1882.
18. L'Encephale, 1882.
19. Wiener medlzinischePresse, No. S8, 1882.
20. American Journal of Neurology and Psyeliiatry, February, 1882.
21. Friedreich's Blaetter 87—100, 18S3.
22. Revista Sperimei tale di Freniatria, Fate. 1 to IV, 1882.
•23. Ibid.
24. Vierteljahrechrift fuerGericht. Medicin. Band XXXVIII.
25. Jahrbuecher fuer Psychiatrie, Band III.
26. Bull, de la Societe Metl. Mcnt. Fasc. I, 1882.
27. Joarnalof Mental Seience, April, 1882.
28. Vierteljahrschrlft luer Gericht. Medicine, Band XXXVIII.
29. Annales d'Hygiene Publiques, 188-3.
.30. Allgemeine Zeitschrift fuer Psychiatrie, Band XXXIX.
31. American Journal of Neurology and Psychiatry, April, S?2.
32. Op. Cit.
33. Detroit Lancet, 1882—83.
6/2 Report on Bibliography .
artificially produced cranial asymmetry as of no forensic
value ; by Spitzka/ Kirn,^ Brower,^ Sterz* and Meragliano, ^
who agree with Krafft-Ebing in believing that these
hereditary stigmata are of value in diagnosis.
The Concealment of Insanity by the Insane has
been discussed by Dr. Brower.''
The Forensic Relations of Attacks on Asylum
Officials have been analyzed by Kiernan/ who cites
cases to show that the insane may give sane reasons for
an attack undertaken from insane motives. Similar cases
to those cited by Kiernan are reported by Giraud.^
The Forensic Aspects of Sexual Perversion have
been discussed by Kirn^ and Krafft-Ebing. '^
The Forensic Aspects of Incendiarism have been
analyzed by Giraud.^^
The Burden of Proof in Insanity has been recently
decided in Indiana'- to rest upon the State. This decision,
which is in accord with an Illinois and Washington decision,
is opposed to the decision of Judge Cox, in the Guiteau
case, but is in support of the views of Judge Sedgewick,^^
who says that " in such cases it would seem as if the
presumption of innocence, if it is to be of any value,
must belong to whatever facts are involved in the idea of
innocence."
The Question of Lucid Intervals has been dis-
cussed by Drs. Hammond'^ and Clymer,''* who claim that
except in the periodical insanities, true lucid intervals in
a legal sense do not exist.
1. Allgemeine Zeitschrift fuer Psychiatric, Band XXXIX.
2. Ibid.
3. Alienist and Neurologist, April, lirSS.
4. Jahrbuecher fuer rsj'chiatrie, Band IIL
5. Giornale interuaz. delle Scien. Medic, 1882.
6. Alienist and Neurologist, April, 1883.
7. American Journal of Neurology and Psychiatry, February, 1885.
8. Annales Medico-Psychologiqnes, November, 18S2.
9. Allgemeine Zeitschrift fuer Psychiatric, Band XXXVIII.
10. Ibid, Band XXXVII.
11. Annales Medico-Psychologiques, January, 1882.
12. Anieiican Law Review, April, I88ri.
13. American Journiil of Neiirolowy and Psyoliialiy, 1882
14. Journal of Nervi us and Mental Disuuse, l8;<-2.
l.'). Ibid.
Report on Bibliography. 673
Insanity in its Relations to Divorce has been dis-
cussed by BalP and Savage,- who cite the case of a
melancholiac who refused to allow marital consummation,
and whose insanity was shown to have existed before
marriage. It appears that the English common law
regards insanity existing before marriage as a cause for
divorce. Luys^ and Blanche* agree that the English
common law view of the subject is just.
The subject of Feigned Insanity has been discussed
by Krafft-Ebing,-^ who reports the case of a criminal who
feigned dementia, and was detected by his acting in
obedience to suggested symptoms ; Spitzka^ reports a
similar case. Dr. Robertson" reports the case of a
thief who feigned insanity ; but Dr. Robertson's reasons
for regarding this insanity as a feint are insufficient, since
the co-existence of depressing and exalted delusions
occur in many types of insanity, and deficient memory of
recent events, with good memory of past, is a very com-
mon phenomenon of insanity.
S1MUL.A.T10N of Insanity by the Insane has been dis-
cussed by Morandon de Montezel,^ Kiernan,^ Nichols,^^
Spitzka,^' Hammond,^- Hughes^"^ and Bluthardt,^* who cor-
roborate the views first advanced in a systematic article
by Hughes.^^ In dealing with the subject of simulation,
this fact should always be taken into consideration.
The Self-Recognition of Insanity is another factor
which must be taken into account in dealing with the .
1. L'tncephale, IS^J.
2. Journal of Mental Science, April, 1SS2.
3. L'Encephale, 1882.
4. Annates Medico-Psychologiques, July, 18S2.
5. Freidreich's Blcetter, S. 103 to 113, 1S8S.
6. Insanity, its Classification, Diagnosis and Treatment.
7. Journal of Mental Science, April, 1883.
8. L'Encephale, No 1, 1882.
9. Alienist and Neurologist, April, 1882.
10. Ibid.
11. American Journal of Neurology and Paycliiatry, 1882.
12. Ibid.
13. Alienist and Neurologist, July, 1883.
14. American Journal of Neurology and Psychiatry, August, 188S.
15. Transactions of the International Congress of 1S76.
6/4 Report on Bibliography.
feigning of insanity. This has been discussed by de Mon-
tezel,^ Hostermann,^ Pick^ and Spitzka.^
The Relation of the Lnsane to Society has been
discussed by Hughes,'"' J. P. Gray,*^ Kiernan,'^ Spitzka, ^
Stephen Smith,^ M. F. Eller/o Clark Bell^^. Channing/^
Ball^^ a;id Brower.i*
The Foren'sic Relations of Aphasia have been dis-
cussed by Rosseau''' and Jolly, ^^ who agree that aphasiacs
are not necessarily destitute of testamentary capacity.
Criminal Lunatics are discussed by Voisin,^^ Pon-
toppidan,'^ Channing^^ and Howard.^''
It is hoped that no one will take offense at this
imperfect sketch of the bibliography of insanity, during
the past year, if he has been unintentionally omitted. Since
the hour is coming when it will be a proud distinction
to a man, that, living in the last quarter of the nine-
teenth century, he simply did his duty, neither speculated
nor peculated ; and, dying universally respected, they wrote
above him, as the best evidence of his philanthropy, this
inscription : " For he had compassion on the multitude,
and published nothing — not even his memoir."
C. H. HUGHES, M. D.. \
W. VY. GODDING, M. D., V Committee.
W. B. GOLDSMITH, M. D., )
Postscript. — The coramlttee acknowledo^e their indebtedness to
Jas. G. Kiernan and others, for additions and amplified references,
and would be pleased to malie this bibliographical report more complete,
appending, in tlie January number, references to such additional papers
germane to the subject as have been omitted from the present imperfect
psychiatric record of the year.
1. Archives de Neurologie, Tome IV.
2. Jahrbuecher fuer Psychiatrie, liand IV.
3. Archiv ftier Psychiatrie, BandXIlI.
4. Op. Clt.
.''). Alienist and NcuroIoKist, 1882.
fi. American Journal of Insanity, January, 1882.
7. American Journal of Neurology and Psychiatry, 1882.
8. Ibid, 188-.'.
9. Ibid, 1883.
10. Ibid.
U. American PayohologicalJournal, April, 1883.
12. Ibid.
J3. L'Enc^phale. No. 1, 1883.
14. Alien stand Neurologist, April, 188.3.
1.5. Annak'B .Medlco-Psychologiques, s. <>, Tome IX.
IC. Jahrbuecher I'uer Psychiatrie, Hand IV.
17. Hritish Medical Journal, March 4, 18f<2.
18. Norditkt Medicinslit Arkiv, Band XIV.
lit. Boston Medical and Surgical Journal, April, 188S.
20. Op. cit.
The Minor Treatment of Insane Pa-
tients.
IT is my desire at this time to present a few sugges-
tions relative to the care of patients, in certain minor
details, with the hope of eliciting discussion, and securing
a comparison of views. In this manner I think the
practical experience of the different members of the
Association may be called forth, to the mutual advantage
of all. It is my purpose to speak of the every-day
management of certain classes of patients, and of methods
of treatment, which have proven best adapted in my own
experience to meet the emergencies and difficulties which
constantly arise in the care of the insane.
I. The management of certain cases of Epilepsy. — There
are many epileptics who are for the most part orderly,
quiet patients, and whose periods of disturbance come
on at regular intervals in consequence of the disturbances
of circulation, which accompany convulsive seizures.
Many 'A these persons become extremely violent at such
times, and their periods of disturbance, although brief, are
full of danger to themselves, their associates and personal
attendants. Such patients, after an initial stage of men-
tal disturbance, which finally culminates in acts of
violence or outrageous outbreaks, dangerous to themselves
or others, are apt to be placed in restraint, and there
remain until the period of fury is past. The attack is
usually self-limited, and restraint is only required for a
few days. These patients, if « restrained, become more
furious and destructive, and after the storm of excite-
ment is past, usually recall the events which accompany
it only imperfectly. They generally remember the fact
of restraint, but never appreciate its necessity, and are
sullen and irritable in consequence for a long time
after the actual excitement is over. During the past
6/6 The Minor Treatment of
year I have pursued a different course with this class
of cases, with decided benefit. As soon as an epileptic
is noticed to be disturbed, he is undressed and placed
in bed, and secluded in his room. By keeping him
away from his associates, the opportunity for collisions
is removed, and personal assaults are thereby prevented.
In some instances, such patients are more quiet in the
covered or crib bed. In the majority of cases, how-
ever, lying in bed solely in seclusion, is sufficient to
prevent an outbreak of excitement. The patient generally
behaves like a semi-intoxicated man, who has some
appreciation that he is not making a creditable exhibi-
tion of himself, but is powerless to act otherwise. In
one case where the patient, at intervals of about six
weeks, was destructive and violent for nearly a week at
a time, by pursuing the method above outlined, a period
of severe excitement has been avoided for upwards of
fifteen months, and a dangerous man has been trans-
formed mto a comparatively harmless patient. It is true,
he still retires from the world about as frequently as
before ; but his periods of disturbance are shorter, and
his bodily health does not suffer as it formerly did in
consequence of his severe and exhausting excitement.
He usually emerges from his " retreat " in better flesh
than when he took to his bed, and there is no trace of
irritability as before. In these patients there exists a
pathological state of the brain and its vessels which finds
expression in acts of violence, convulsive seizures, etc.
There is also a marked tendency to physical exhaustion.
I believe the method of treatment which I have out-
lined to be sound, and calculated to fulfill a physiological
indication. Rest and isolation act with these patients as
directly curative measures. They prevent excitement and
exhaustion, and break up the habit of outbreaks of
excitement. In this connection I desire to speak of the
great value of the administration of hyoscyamine in cases
of epilepsy accompanied by a high grade of excitement.
It is my custom to administer this remedy, just as atropia
Insane Patients. 6j/
or belladonna are administered in the ordinary treatment
of epilepsy, that is continuously, until a constitutional
effect is produced. It is customary to commence with
one-twenty-fourth or one-twentieth of a grain of the
amorphous preparation of Merck, and to continue the use
of the drug for weeks and months. As might be antici-
pated from the analogy of the physiological action of the
drug with that of atropia, it seems equally serviceable in
controlling the convulsive seizure, and has the added advan-
tage of preventing outbreaks of excitement or irritability.
If the constitutional effect of the drug is produced, it is
usually advisable to withdraw it temporarily, taking pains,
however, to administer it agam when the system seems
passing from under its control.
In the status epilepticiis great advantage is frequently
derived from the use of the hot bath, at a temperature
of from lOo" to 105. ^^ It is my custom to place the
patient in a bath at 98" and to gradually increase the
temperature of the water until 105" is reached, continu-
ing the bath frequently from ten minutes to half an
hour. Used in this manner, I believe the bath to act
as a powerful sedative to the nervous system, lessening
its hyper-excitability, and giving the vital powers an
opportunity to rally. If the patient in the status epilepti-
cus has a lax, moist, clammy skin, and fatal exhaustion
seems impending, great benefit frequently is derived from
hypodermic injections of ergotme. I have never derived
the prompt relief in the status epilepticus which Dr.'
Major, of the West Riding Asylum, has derived from the
use of enemata of chloral. The same is true of the
inhalation of nitrite of amyl. In some instances the
violence of the epileptic seizure is so great that life seems
imperiled by interference with respiration. The patient
becomes blue, respiration ceases and the pulse flags. In
several cases which have come under my observation I
am positive that a prompt resort to artificial respiration
has saved the patient's life.
2. The care of untidy patients. — The problems which
6/8 The Minor Ireatment of
arise in the care of untidy patients are among the most
difficult in the minor management of patients, and yet
upon their successful solution the comfort of the patient
largely depends.
To break up habits of untidiness at night, I know of
no method so good as the systematic visitation of a night
nurse to rouse sluggish and indifferent patients, and to
get them out of bed at regular intervals during the night.
For those who are extremely . feeble and who require
attention by day as well as by night, I know of no
arrangement equal to an infirmary ward where such
patients can have constant attention during the twenty-
four hours. In one instance the bad habits of such a
patient were corrected by getting him out of bed once
every hour during the night. (He was in good bodily
health). After a few nights of such painstaking atten-
tion, the habit of wetting his bed, which had been an
annoyance for years, was broken up. The systematic
administration of belladonna or atropia will often assist
materially in accomplishing the same object. If there is
atony of the bladder, or a constant dribbling in conse-
quence of the retention of Urine in a partially distended
bladder, I have found regular catheterization of the ut-
most service. One patient at present under my care,
who required and received half-hourly changes of clothing,
and who was constantly wet from a dribbling of the
urine, has been made very comfortable by the intro-
duction of a catheter twice a day. No large amount of
urine is ever drawn at any one time, but the regular in-
troduction of a soft rubber catheter seems to relieve the
unpleasant condition almost completely. The nurse has
been instructed in the use of the instrument and takes
great pride in its successful introduction. In another
persistently untidy patient, where an elongated and nar-
row prepuce was present a complete relief of the infirmity
followed circumcision. It was evident that the irritation
of the contracted prepuce was sufficient to produce in-
continence of urine. For such as soil their beds with
hisane Patients. 679
feces at night, I know of no remedy so good as the
regular nightly administration of an abundant enema of
water just before retiring. If the lower bowel is un-
loaded at bed-time, the possibility of soiling the bed at
night is much decreased. In my own experience this is
much preferable to the use of opiates or astringents by
the mouth, or the use of astringent suppositories and in-
jections. After a few nights the habit of an evacuation
at this time is established and the enema can then be
dispensed with, the patient simply being taken to the
water closet before retiring.
If the untidiness of the patient at night is due to at-
tacks of diarrhoea, incident to imperfect digestion of food,
much benefit is derived from the administration of acid
phosphate. In many of these cases the digestive powers
'are so much impaired through defective innervation of
the digestive tract that the food undergoes a fermentation
and becomes irritating. Hence the necessity of remedies
to assist in its more speedy and perfect digestion. With
many also it is advisable to withdraw liquid food at
supper-time. In some instances the simple regulation of
the diet in this respect suffices to correct the tendency
to diarrhtea or incontinence of urine.
If the urinary incontinence depends upon polyuria, as
frequently happens with the insane, great benefit is de-
rived from the use of nux vomica or ergot. The latter
remedy is extremely efificient. I have learned never to
cease efforts to correct the habits of even the most untidy
patient. Care, attention to details and persevering, per-
sistent personal attention frequently accomplish wonders.
3. Position in the tyeatmcnt of insanity. — After much
trial of methods, I have reluctantly come to the con-
clusion that cases of acute mania as a general rule do
not do well if placed in bed. In many instances where
exhaustion seems impending or where the patient is ex-
tremely emaciated, the physician instinctively places the
patient in a recumbent position, but m my experience, to
the very serious danger of the life of the patient. I have
68o The Minor TreaUnejit of
never been able to fully satisfy myself as to the cause of
the sudden and rapid exhaustion which is almost sure to
follow such a proceeding. At first I thought it to be due
to the fact that the real debility of the patient, which had
existed from the start, had been masked by his constant
excitement, and that with rest and quiet in a recumbent
position it only became apparent. Subsequent experience,
where patients suffering from acute mania were placed in
bed before symptoms of exhaustion had occurred, demon-
strated to me that this was an error, and that the rapid
exhaustion was promoted by the position in bed. Con-
finement to bed and cutting off the physical activity
evidently increased the molecular activity of the diseased
brain cells and hastened destructive changes. The mus-
cular activity of the patient seemed to indicate nature's
method of relieving cerebral hyperaemia whether general
or in circumscribed areas. I have accordingly made it
a rule never to put a patient' suffering from acute mania
in bed if I can possibly avoid the step. Even if the
grade of excitement is intense and restraint to a seat
becomes necessary, I much prefer to have the patient sit
up. Since this mode of procedure has been adopted, I
believe that I lose fewer cases from exhaustion.
In melancholia, on the other hand, I am equally
certain that many lives are saved by adopting the op-
posite practice. Feeble, depressed patients, with delusions
of fear and distrust are vastly more comfortable in bed.
The position seems to favor the nutrition of their starving
nerve centers, and their mental action becomes more
natural. A word in justice to the much-maligned covered
bed or crib seems appropriate. No device of which I
have any knowledge seems to meet the requirements of
this class of patients as well. They frequently have a
sense of quiet and security in a bed of this sort which
can be obtained in no other manner. They instinctively
recognize the fact that they cannot assume an upright
position, and with a better nutrition of the brain cells
comes healthier mental action. In this connection I
Insane Patients. 68 1
would express the conviction that feeble, anaemic patients,
suffering from chronic insanity, are frequently noisy and
wakeful at night because they become too much wearied
before they retire. In some instances patients sleep more
quietly at night who also take a brief nap during the day.
4. The treatment of masturbation. — This is an unsa-
vory topic, but unfortunately one which obtrudes itself
upon our attention constantly. The practical failure of
any attempt to prevent this vicious habit which does not
have the co-operation of the patient, leads many physi-
cians to relinquish all effort. In my own experience I
have found benefit from a variety of methods, and use
them to meet emergencies which arise in the treat-
ment of those who are addicted to this practice. For
chronic cases, where self-control and sense of shame
are lost, and where excessive mental irritability is
developed by the exhaustion which follows an indul-
gence of the propensity, I know of nothing which acts
so promptly as the local use of cantharidal collodion.
This should not be applied in a wholesale, barbarous
manner, but merely in sufficient quantity to keep the
parts moderately sore until the habit is arrested. A
persistent effort should then be made to give such
patients abundant open air exercise and labor. They
are usually in good bodily health, and can do the
simpler forms of labor, like digging and wheeling earth,
running lawn-mowers, etc. By following up the local
treatment, with such physical and moral measures, the
condition of patients suffering from chronic forms of
disease can often be much improved. In cases of
recent disease, where it is desirable to give the weak
will assistance in overcoming tendencies to vicious
indulgence, great benefit frequently is derived from the
use of silver wire. This, however, is but a temporary
measure, and cannot be depended upon for many days.
In many of these cases, however, if the indulgence can
be prevented for even a single week, marked improve-
ment is perceived in the mental condition. In cases
682 The Minor Treatment of
of acute mania accompanied by intense sexual excite-
ment, mechanical restraints "at night, and constant per-
sonal attention by day, seems all important. In the
vast majority of cases, and especially with female patients,
the mono-bromate of camphor, in liberal doses, is after
all the most serviceable, It should be given in doses of
from two to fifteen grains, and its administration should
be persevered in for months if necessary.
5. Mechanical feeding and forced alimentation . — For
mechanical feeding the best device in my experience is
a Nelaton catheter attached to a Hall's Health Syringe,
of the largest size. The Nelaton catheter is passed through
the nostrils, and the fluid is injected by pressure upon a
bulb at the top, which is provided with a valve. This
furnishes a steady, continuous stream through the catheter,
and no air passes in with the injection. After the food
is fairly started, it frequently continues to flow from
syphoning, or through the force of gravity, and no con-
tinuous pressure upon the bulb is required. The appara-
tus is also well adapted to the administration of emulsions
or other medicines, and the bulb is never contaminated
by them.
The best aliment for forced feeding is unquestionably
milk. In many instances it is ample to preserve the bal-
ance between repair and waste, and the patients fed with
it gain in flesh. In one case under my care, which was
fed mechanically for upwards of four years, milk only
was used for upwards of three years, and she did not
lose flesh. If the condition of the patient is very feeble
milk and beef essence combined are frequently very ser-
viceable, or milk with brandy or whisky, or milk and
egg beaten together. Whenever the powers of digestion
are feeble, it always seems important that the food
injected be warmed at least to the temperature of the
body.
In these cases, I have never found any advantage
from the administration of solid food. It is well nigh
impossible to secure its preparation so that the stomach
Insane Patients. 685
may act upon it efficiently in the absence of proper
insalivation, and I long since "relinquished any attempt to
administer it. In cases where there is organic disease of
the stomach or persistent vomiting, or a prolonged refusal
of food in consequence of anorexia, great benefit fre-
quently results from enemata of bullock's blood. When
patients refuse food in consequence of delusions of
poison, the use of bullock's blood is especially indicated.
The dyspeptic symptoms upon which the delusions fre-
quently depend are generally speedily relieved by giving
the stomach an opportunity to rest, and the delusion
promptly disappears. The constitutional aversion which
most patients feel towards nutritive enemata also seems
to contribute materially to the same result. Of all sub-
stances adapted to rectal alimentation I believe the
" bullock's blood " so called, prepared by Parke, Davis &
Co., of Detroit to be the best. It is always ready for
use; its bulk is small; it is free from irritating qualities,
and it is readily taken up by the bowel. I can recom-
mend it as a valuable adjuvant when patients require
artificial alimentation.
6. The forced administration of medicine. — When medi-
cine is refused by a patient in consequence of a delusion,
and its administration seems imperative, I regard any
attempt to give it by the mouth unwise and even
dangerous. I very much prefer to administer it hypo-
dermically, or through the nose or by the rectum.
Fortunately the number of remedies adapted to hypoder-
mic use with the insane is constantly increasing. Ergotine,
hyoscyamine, conia, morphia, picrotoxine, aloin and many
others, can be used in this manner. Results are more
prompt and less digestive derangement follows. The dose
can also be reduced to the minimum. If for any reason
it is not advisable to use the hypodermic needle (and
with many sensitive patients it is not) excellent results
can frequently be attained by rectal suppositories or
enemata. Chloral hydrate, sulphate of quinine and the
preparations of opium can be given in this manner with
684 The Minor Treatment of
the same efficiency as by the mouth. The potash salts,
cathartics, preparations of iron, etc., can be fully diluted
with water whenever required and given through the
nose by means of a feeding apparatus such as has been
described above. The wedge, the stomach-pump, the
oesophageal tube and the heavy spoon can generally be
dispensed with, and should be whenever practicable.
7. Liberty of patients in and about the asylums. — I have
never yet been able to see the way clear to an asylum
with open doors, or even to single wards with, open
doors. It has always seemed that when proper atten-
tion is given to the curative treatment of patients, every
ward ought to have some person in it who should not be
allowed to go out and in without supervision. If the
open door is to be anything but a name, I do not well
see how mildly excited, or depressed, or suicidal or per-
verted patients can have the benefit of it. For my own
part, I feel much more comfortable in the thought that I
can, if need be, use every hall in the asylum for recent
cases than if I were precluded from using one or more
of them in each department for patients whose con-
dition will not justify such privileges. A convalescent
hall, so called, needs the stimulus constantly of recent
cases both for the good of attendants and patients ;
otherwise it becomes the abode of selfishness and in-
efficiency. The prime object of the asylum, the curative
treatment of patients, should never be lost sight of for a
single moment by any person connected with it. The
recovery of a patient does more to elevate the standard
of the care bestowed upon all patients than any other
single agency. Even if open doors are not advisable, it
by no means follows that individual patients cannot in
many instances enjoy a large degree of liberty. It is
always possible to arrange walking parties who can go
out unattended. Among female patients I think it is
preferable to allow three persons to go out in a com-
pany, taking pains to fix certain limits to their walks and
to prescribe certain hours. The necessity of having three
Insane Patients. 685
go out together frequently induces an indolent person to
go out who otherwise might remain in. In persons of
middle age two patients can frequently be permitted to
go out together. I rarely deem it wise to permit patients
to go out wholly unaccompanied. It is of little service
to a man whose mind is under the influence of delusions,
painful or otherwise, to permit him to wander aimlessly
about. Unless something fresh and stirring is brought
into his daily life by greater liberty in the open air, the
good he may derive from exercise is more than counter-
balanced by the harm which follows a greater liberty to
indulge in delusions. There are, however, individuals
who are much benefited by going out alone. I have at
present under treatment two cases of chronic insanity
who are permitted to spend the greater portion of each
day in the open air. One, a male, suffering from chronic
mania, previous to receiving this privilege was untidy
both by night and by day, restless, destructive to clothing,
irritable, profane and quarrelsome. One year ago he was
permitted to go into the open air unattended, care being
taken to restrict his walks to a plat of ground adjacent to
the building. Occasionally he broke over the limits as-
signed and the privilege was withdrawn for a half-day at
a time in consequence, but always restored upon a re-
newal of his promise to avoid further transgressions. The
effect upon his whole conduct has been remarkable.
Although incapable of any effective labor, he is bus\-
after a fashion, collecting stones, driving nails, searching
after useless rubbish, sometimes committing acts of wanton
mischief. He has ceased to be untidy, and his relations
to the asylum have wholly changed. He is amenable to
discipline, and has lost many of his former unpleasant
characteristics. The other patient is a female, nearly
sixty years of age, who has been insane for many
years, and is irritable, perverted, and the victim of many
hypochondriacal fancies. She has periods of mental dis-
turbance characterized by extreme violence and destruc-
tiveness. These formerly recurred each year, and were
686 The Minor Treatment of Insane Patients.
exceedingly trying to all who came in contact with her.
Three 'years ago the privilege of going out unattended
was granted as a matter of experiment, and she has
since been permitted to come and go within certain pre-
scribed limits. The effect has been to avert several
threatening periods of excitement/ and the house has
been relieved of her presence, at all times a source of
annoyance and a discordant element. Her own comfort
has also been greatly enhanced by the arrangement.
In one instance I allowed a patient who suffered from
periodic insanity to have the liberty of the grounds un-
attended during a period of considerable mental dis-
turbance. The effect was to cut short the period of
disturbance and to deprive it of characteristics which
had formerly been extremely trying to both attendants
and fellow-patients.
It is my custom to place cases of acute mania, during
the earlier stages of convalescence, as far as possible
under the care of special attendants, with instructions to
keep the patient almost constantly in the open air. This
permits the greatest liberty of action and ensures a more
speedy convalescence.
Each year's experience in the management of pat'ents
in the minor details of treatment serves to emphasize the
necessity of an individual study of every case which
comes under our observation. If the right method to
meet the varied conditions could always be discovered,
I am positive that more speedy and perfect cures would
be effected.
OTHEMATOMA.
By M. J. Madigan, M. D.^ Brooklyn, N. Y.,
Formerly Assistant Physician New York City Aeylum for the Insane.
"r\ESPITE the advances which have been made in
-■-^ neuropathology, respecting trophic and vasomotor
affections, the exact nature of this complication of insan-
ity is still in dispute. Griesinger* for example says : "A
purely accidental and traumatic origin, which has been
lately advocated by Gudden f is the most probable. The
affection is almost entirely confined to male patients (by
male attendants) and to asylums. It occurs more fre-
quently in the left ear (suits right hand of attendant).
It is rapid in its origin, the print of finger nails is some-
times noticeable, and the affection can by care on the
part of the attendant be made to disappear entirely from
well regulated asylums." Bonnett^ and Bouteille,!] say
haematoma of the ear in boxers and the insane, presents
the same clinical history, deformity and therapeutic indi-
cations. The alleged predisposing causes have, not the
value ascribed to them.
Is there anything^ in the system of aural nerves to make
spontaneous othaematoma a possibility ? If there is not,
then a double responsibility rests upon him who denies
the traumatic origin of the affection. Baratoux§ after a
very careful experimentation concludes : First, That divi-
sion of the sympathetic, causes at the end of a certain
time, middle and external ear hypersemia, sometimes lead-
ing to suppuration of the latter. Second, That division of
the trifacial causes greater disorder in a shorter time,
which shows that this nerve contains more vasomotor
•Mental Pathology and Therapeutics.
t Gunzberger Zeitschrift, Band VI.
t Annsles Medico-Psychologiques, July, 1878.
II Annales Medlco-Psychologiques, May, 1877. .
§ Tribune Medical, August 7 to Sept 25, 18S1.
688 M. J. Madigan.
fibers, than the sympathetic branch supplying the ear.
Third, That irritation of the vasomotor center formed
between the descending trifacial root nucleus and first
dorsal nerve, causes an immediate aural alteration, char-
acterized by haemorrhage into the labyrinth and vestibular
ecchymosis. Fourth, All diseases causing increased cir-
culatory activity, produce congestion, suppuration and
haemorrhage into the ear. Fifth, Every lesion of the
trifacial before its exit from the skull, may cause disturb-
ance in aural nutrition similar to that consequent on its
division. Sixth, Disorders of the. vasomotor center
cause lesions of the organ of audition, like Meniere's dis-
ease, and spontaneous haemorrhage. These results have
recently been corroborated by Berthold.f
Dastre and Morat have found that the local varia-
tions in the caliber of the vessels of the external ear
are dependent upon the contractile power of the ves-
sels themselves. They do not depend directly upon a
temporary, rhythmic augmentation of the force of the
heart's contraction. They are simultaneous in symmetrical
regions. The vascular muscle is antagonistic to the car-
diac muscle. The dilator nerves of the vessels may be
found in all nerves, except the sympathetic. Constrictors
and dilators arise very near each other. They make their
exit by the same roots, or by roots very near each other,
and run usually in the same trunks.' Irritation of one
set is scarcely possible, without irritation of the other
set, and the effect observed is the resultant of two antag-
onistic actions. The vaso-dilator nerves of the external
ear arise from the spinal cord in the upper part of the
thoracic region, which is very near the origin of the vaso-
constrictor nerves. These vasomotor nerves together form
a very circumscribed, centralized system. There is an
absolute difference in result, between irritation of the
thoracic sympathetic, and irritation of the cervical sympa-
thetic. Irritation of the cervical sympathetic contracts
the vessels of the ear, while irritation of the thoracic part
t ZuitechrlU fuur Uhrenhellkunde, Baud XII.
Othcematovia. 689
in its upper part dilates them. The point where the
effects of irritation are reversed, is marked by the pres-
ence of a large ganglion, the first thoracic or inferior
cervical ganglion. This phenomenon is due to the fact
that the dilator fibers terminate in the ganglion itself;
and they end in ganglionic cells, situated in the course
of constrictor fibers, the tonic action of which they are
thus able to suspend. In the reflex dilatation of the ves-
sels of the ear, the nerve which determines the dilatation
is the auriculo-cervical, a branch of the cervical plexus.
the principal sensitive nerve of the tympanum. This
nerve contains elements from the second cervical, and a
small number of elements from the third. The study of
reflex dilatation of the external ear vessels, fully confirms
the results obtained in investigating directly the vaso-dil-
ator nerves of this organ. A notable proportion of the
vaso-dilator nerves of the ear is contained in the sympa-
thetic nerve trunk, and arises in the cilio-spinal center of
Budge and Waller.. From this region arise the dilator
nerves of the iris, and the secretory and constrict©
nerves of the vessels of the face. These vaso-dilator
fibers of the ear, have two origins; one in the spina^
cord, and another in the medulla. After division of the
cervical or thoracic sympathetic, reflex irritation of the
centers provokes a still greater degree of vaso-dilatation^
which is due to the action of the nerves of the medulla.
Brown-Sequard* has shown that section of the resti-
form body of the medulla oblongata m guinea pigs, will
cause aural haemorrhage followed by gangrene, which lat-
ter would not occur in the human ear, because of its
greater resisting power. It is therefore clear that from
the a priori stand-point of neurophysiology, a belief in the
spontaneous non-traumatic origin of othaematoma is justi-
fied.
The investigator is now prepared to discuss the
clinical evidence, pro and con the traumatic origin of
othaematoma. Gudden has stated, that the statues of
• Archives de fhysiolo^ie, uoioo<r. i;*-.
690 M. J. Madigan.
ancient boxers are ornamented with remains of othaema-
tomata. Roosa,* however, points out that othsematomata
are not mentioned, as resulting from the practice of
pugilism in England. Gudden's statement would therefore
appear to be based on error, and this error is that of
mistaking deformed ears, the congenital stigmata of con-
stitutional defect, for remains of othsematomata. Gmesinger's
statements are scarcely ingenuous, and based on a most
peculiar experience, for in other countries othsematomata
are to be found in female asylums. Bouteille's objection
meets with the same difficulty as that of Gudden.
According to Virchow, the essential morbid process of
othsematoma is a softening induced by the general dis-
turbance of nutrition, or by logal injuries to the cartilage.
It was supposed that in the hyperaemia and general
change in the system there ensued a subperichondrial
haemorrhage. As a rule, however, the haemorrhage is
intercartilaginous. Hoffmanf considers it a haemorrhagic
inflammation of the aural cartilage, connected with cere-
bral change. Ferrus,| who first described othaematoma,
offered a very similar explanation. Mabille,|| Hearder,§
Hallock^ and Lennox Browne,** entertain similar opinions.
Vallon tt and Biaute %% claim that this affection does
not result from traumatism in the majority of cases, but
from trophic changes, the result of the patient's mental
condition. Biaute has noted ten cases in which traumatism
produced aural ecchymosis, but not haematoma. Christian||l|
reports a case in which purpura haemorrhagica and
othaematoma appeared after an epileptiform convulsion-
in a paretic. Bucknill and Tuke,§§ say that " othae-
matoma indicates that the nutrition is below par."
* Diseases oX the Ear.
t Gunzberger Zeitschrift, Band I., p. 250.
t Gazette Ues Hopitaux, 1838.
II These de Paris, 1878.
§Zelt8chrlft fuer Psychlatrie, Band XVIII.
IT American Journal of Neurology and Psychiatry, Vol. I.
•• Went Riding Asyliin) Keports, Vol. \. •
ttT/Encephale, July. 1881.
tt Annales Medico-P^ychoiogiques, July, 188*2.
nil Innales Medico-Psychologiques, 1882.
§§ Psychologcal Medicine, p. 126.
OthcBtnatonia. 691
Van der Kolk* does not believe that othaematoma results
from traumatism. Blandfordf says, that it is not always
or even generally the result of violence, but is probably
the result of great vascular excitement and of a weakness
of the vessels of these parts. Hammond;}; believes that
the changes produced by insanity, act as a strong predis-
posing cause, while traumatism serves to excite the
affection. Spitzkaij says: "Whatever the fact may be, it
is generally admitted, that if violence is a factor in pro-
ducing othaematoma, it is a subsidiary one due to
structural predisposition of the patient's tissues. Injuries
which would fail to produce any noticeable reaction in
the sane, produce othaematoma in certain lunatics. If it
should be shown that othaematoma, when found in term-
inal or paretic dementics, imbeciles epileptics, are as
constantly associated with blood cysts of the arachnoid
as I have found to be the case in the limited number of
examinations, this sign may attain a relative value of a
kind which cannot now be assigned to it. Although
occasionally, perhaps frequently, the result of a blow or
fall, there can be no doubt that othaematoma may occur
independently of either."
Sankey§ believes, othaematoma is often of spontaneous
origin, and in explanation of its occurrence says : " There
are several veins which pass through the mastoid portion
of the temporal bone in an oblique direction, and so join
the veins of the inner table or empty there contents
directly into the lateral sinus at the base of the skull. It
is also well known that the bony case of the skull in
lunatics becomes more dense and compact, and thus arises
a constriction or obliteration of the veins passing through
the bone and oedema of the parts whence the veins come.
When this swelling occurs it therefore indicates that
• densification ' of the skull bone has taken place." It will
be obvious that this is the explanation of a man not too
• I'athology aud Therapeniics of Mental Disease.
t Insanity and its Treatment.
X Treatise on Insadity.
II Insanity. Its Classification, Diagnosis and Treatment.
§ Lectures on Insanity.
692 M. J. Madigan.
well acquainted with recent researches in vaso-motor
physiology, and driven into a corner to account for what
he knew to be a fact. Roosa* says that there are two
forms : one due to traumatism and the other of nervous
origin. Hunf says, that the person who presents othae-
matoma is either insane or neurotic. He is strongly of the
opinion, that othaematoma is of vaso-motor origin. Kier-
nan| expresses the same opinion. Sockeeljl says, that
othaematoma is not peculiar to the insane. It may be the
direct consequence of traumatism, but as a rule it is pre-
ceded by an inflammatory degeneration or hypertrophy
of the fibro-cartilage. These anatomical alterations are
the predisposing cause ; all aural congestion is an excit-
ing cause. The sanguineous exudation occurs between the
perichondrium and fibro-cartilage; sometimes it occurs in
the thickness of the latter. From all these opinions it is
obvious that othaematoma is of neurotic origin.
In what types of insanity is it most frequent? Hun
reported twenty-four cases ; of these eight were paretic
dements; six melancholiacs ; four acute maniacs; four
chronic maniacs and two dements. Biaute found it most
frequent among epileptics, paretic dements and recurrent
maniacs. Blandford's experience is similar. In my own
experience and that of Kiernan it is most frequent among
the forms of insanity dependent on marked vaso-motor
changes. Nine of Hun's twenty-four cases were bilateral.
Seven of the forty-eight cases coming under my observa-
tion were bilateral.
Has this tumor any relation to prognosis ? Hun is of
that opinion. Bucknill and Tuke say that othaematoma,
when not traumatic, is of serious significance. Kiernan
leans to the same opinion. He once reported three recov-
eries ;§ but all these patients died insane. Spitzkal,
• Diseases of the ear.
t American Journal of Insanity, 1809—70.
X Lectures on Insanity.
II Archives Gtn^rales de Medicine, November and Drcembor, 1881.
§ Journal of Nervous and Mental lOieeafe, April, 1877; The Detroit Lancet,
July, 3883.
ir Op. cit.
OthcBtnatoma. 693
while leaving the question sub j'udice, inclines to Kiernan's
opinion. Hammond* is of the opinion that it has no
bearing on the question of prognosis. Sockeelf says, this
condition is without significance, as regards recovery.
BiauteJ is of much the same opinion as Hun. BouteillelJ
states, that othematoma has no prognostic significance.
D. G. Thompson! says, " that it is a very bad sign show-
ing evidence of grave cerebral disorders, there can be no
doubt ; but that it is a sign of absolute incurability, even
when not due to a blow, is certainly not correct." Dr.
Schofield^ reported three recoveries; one of which re-
lapsed, ^nd died insane; the other two were still in good
mental health five years after. As to treatment, Dr. Hal-
lock** has proposed blisters behind the ears and has found
this procedure of benefit in diminishing the amount of
deformity. Sockeel says that by incising the sac, good
results are obtained. Spitzka states that the deformity
may be to a great extend avoided by making numerous
small punctures over the most prominent part of the
tumor and cleaning out the half-clotted and half-fluid
dark blood and tissue debris constituting its contents.
Hearder advises that the inner surface of the pinna be
painted with a blistering fluid. In six consecutive cases so
treated, he found that the morbid process was arrested.
From my own experience and that of the others cited, I
can safely conclude, that : First, othaematoma is of central
origin, and that it is ever produced by traumatism alone,
has not yet been demonstrated. Second, That it is most
frequent in types of insanity in which marked vaso-motor
changes occur. Third, That while not denoting a hopeless
prognosis, its appearance is of serious significance as
regards permanent recover^'.
• Op. cit.
+ Loc. cit.
X Loc. cit.
li Loc. cit.
§ Journal of Mental Scipncp, July, 1883.
^ Report of Canaberwell House Asylum, ISTT.
•• American Journal ol" Neurology and Psychiatry, 1882.
SELECTIONS.
CLINICAL PSYCHIATRY.
Primary Monomania. — Dr. C. B. Burr, of the Pontiac
Asylum, Michigan {American Journal of the Medical
Sciences, July, 1883), reports a case of this psychosis, of
which he says': It requires but a cursory review to devel-
op resemblance to the case of Guiteau. Disregarding the
moral traits of these two individuals, their cases were
strikingly similar. Each possessed a neurotic organiza-
tion. Each committed a sudden and premeditated homi-
cidal act with an ostensible motive. Each was deterred on
two occasions from carrying a pre-formed plan for killing
into execution. Each took measures for personal safety
after the commission of the crime. Each laid claim to
inspiration. Each pleaded insanity, the one to escape
punishment, the other to obtain a pension. Both were
intensely egotistic, had an exaggerated sense of their own
importance, wrote profusely, and had followed unsuccess-
fully the profession of lecturing. Both were visionary and
expansive, and showed a lack of good business judgment.
Each became erratic and perverted at an early age. In
neither case were the higher mental faculties much below
the normal standard for the individual ; each reasoned
logically though from false and inadequate premises.
The points of dissimilarity arise almost wholly from
the separate degrees of mental development which the
individuals enjoyed, and the circumstances attending their
education and training. In contradiction of the oft-
repeated assertion that the execution of an insane criminal
now and then has a deterrent effect upon others of like
propensities. Dr. Burr's case may well be cited, inasmuch
as his homicidal assault was made less than five months
after the hanging of the murderer of the President, and in
face of the strong popular sentiment against the so-cal'ed
"cranks" and lawless fanatics. There are few more strik-
ing illustrations of the impotency of moral and legal
measures to restrain or control a morbid impulse. It seems
that, becoming restive under detention. Dr. Burr's case
contemplated effecting his release by taking the life of the
asylum superintendent. He concealed in his stocking a
Selections. 69$
sharp-pointed steel husking-pin and laid a plan for the
murder. Unless he was previously discharged this was
to take place on or after the first day of April, at which
time his conscience, to use his own expression, " would
be clear." The coincidence of this conduct with that of
Guiteau in certain particulars, is, allowing for superficial
circumstances, sufficiently significant.
Early Progressive Paresis. — Cases of progressive par-
esis under the age of twenty-five, have been but ex-
ceptionally observed. Spitzka {^Journal of Nervous and
Mental Disease, April 1877) reports one such case at the
age of twenty-three ; the patient having been two years
an inmate of the asylum, and the psychosis therefore
beginning at the age of twenty-one. Meyer {Arc/iiv fur
Psychiatrie Band I. ) reports one case at the age of
twenty. Krafift-Ebing [Archiv fur Psych. , Band VII.), one
at the age of twenty-four. Mendel [Die progressive Par-
alyse der Irren), one below the age of twenty-five. Turn-
bull [Journal of Mental Science, October, 1881), one at the
age of eighteen, and one at twelve. Wille [Irrenfreund^
No. I, 1873) and Coffin {Annales Medico-Psychologiques,
Tome VI. , S'erie III), after citing several cases under twenty-
one, claims' that the psychosis is then always of syphilitic
origin and never presents grandiose delusions. Kiernan
{Lectures 07i Insanity) cites two cases under twenty-five.
To these cases an interesting addition is made by the
cases of Dr. Regis [Lenc'epliale, No. 4, 1883). These were
patients of nineteen, twenty-four and twenty-five ; in one
the psychosis was complicated by syphilis ; in the other
there was evidence of heredity. Regis claims : First, That
progressive paresis is essentially a climacteric affection,
occurring in middle age. Second, The real cause im-
mediately giving rise to the psychosis is a perversion of
the normal anatomical changes of the cerebral frame-
work. Third, There are beside the true progressive
paresis an early and a late type ; one before twenty-five,
the other after sixty. Fifth, Cases of progressive paresis
before twenty-five years of age are rare. Sixth, While no
cause is to be found as a rule for the true progressive
paresis, the early type is readily traceable to the influence
of such agencies as syphilis, heredity, saturnism, trauma-
tism, etc. These in Regis' opinion, early lead to the cere-
bro anatomical status usually arising from middle age.
Seventh, This " early " type is of slow progress and sub-
ject to remissions.
696 Selections.
These generalizations of M. Regis, though based on
data as yet inadequate for indubitable conclusions, are
nevertheless instructive.
Locomotor Ataxia Terminating in Progressive Par-
esis.—Dr. C. K. Mills, Philadelphia (New York Medical
Journal, June 23, 1883), reports a case of a forty-year-old
man, who was of strong constitution, until about eight
years ago, when he began to suffer from "rheumatism,"
for which he was treated for three years. There had
been chancre, but no secondary or tertiary symptoms.
The patient was addicted to venereal excess and to
alcohol. Locomotor ataxia developed gradually and
became typical, and then passed on, after about four
years, to present typical symptoms of general paralysis
of the insane. The patient died eight years after the
commemcement of so-called rheumatic symptoms. A min-
ute microscopical examination was made. Throughout the
spinal cord there was marked sclerosis, more marked in
the lumbar region; also inflammation of the pia mater
throughout. There was sclerosis of the pons, of the optic
thalami and of the cerebral convolutions examined. Dr.
Mills staled that while at first he was inclined to the view
that there had been a direct extension of the sclerosis
from the lower portion of the spinal column upward,
until it had reached the cerebral convolutions, he was at
present rather of the opinion that the condition involved
the various portions of the cerebro-spinal system sepa-
rately, and not necessarily by direct extension from the
starting point. He believed that some cases began as a
low grade of chronic meningeal trouble, or peripheral
perineuritis. It should, however, be recollected that the
changes going on in the cord might produce sufficient trans-
mitted irritation to the medullary vasomotor centers to
result in the initial stages of progressive paresis, which
would not of course result from an extension of the
morbid process.
Insane from Fear. — There has just died at the Cha-
renton Asylum, near Paris, a man who had a very curious
history. Thirty years ago this person was condemned to
death at the Seine assizes for the murder of an old gen-
tleman. The court was crowded with spectators. Standing
immediately behind the criminal, who was flanked by
gendarmes, was an employe of the Presse newspaper,
who had contrived to wriggle himself into that position
Selections. 697
without attracting notice. Scarcely had sentence been
pronounced when this Presse employe, moved by an
uncontrollable impulse, passed the side of his hand over
the prisoner's neck in imitation of the keen blade of the
guillotine, at the same time emitting a whirring sound.
The criminal instantly fell forward with a shriek of terror,
and the indignant bystanders rushed upon the Presse em-
ploye and roundly abused him. He was subsequently con-
demned to two years' imprisonment. His victim remained
insane until death. He was pardoned by the Emperor,
and confined, first at Bicetre, and afterward at Charenton.
The unfortunate man had the delusion that he had been
beheaded in the Palais de Justice, and when relating the
story was in the habit of imitating the sound that haunted
him for thirty years.
Sudden Recoveries from Amnesia. — Dr. Forbes Wins-
low {Obscure Disorders of the Brain atid Mind) reports
the case of a well-educated gentleman who, at the age of
thirty, was, at the termination of a severe illness, found
to have lost recollection of even the most common objects.
On his general health being restored, he began to learn
to read, then to learn Latin. On day, while reading with
his brother, he suddenly stopped and put his hand to
his head, and on being asked why, he said, " I feel a
peculiar sensation in my head, and it seems to me I
knew all of this before," from which time he rapidly
recovered his faculties. Gaillard's Medical Journal reports
a similar case from New Haven, Conn. : A young woman
of that city recovered from a neurosis some time ago,
unable to recall the names of familiar objects, or to play
the simplest music, though she had been a skillful organ-
ist. Having still her love for music, she has been
relearning the notes and practising the scales. While,
one afternoon, drumming clumsily at the piano, like any
beginner, her memory of music suddenly returned. She
astonished and delighted her family by playing her most
difficult pieces.
Mental Symptoms and Ear Disease. — Fiirstner
{Berliner klinische Wochenschrift, No. 18, 1883) briefly
describes twenty-six cases of insanity, in which ear dis-
eases first appeared. Two cases closely allied have been
already described by Fiirstner in the same Journal for
1 88 1. Two hereditarily defective females, with normal
hearing, had, after painful entonic sounds had a sharp
698 Selections.
attack of lypemania (melancholia). An aural examina-
tion was negative. These were evidently the result of
chlorosis, causing venous hums and anaemic sounds. The
patients recovered on the removal of the sounds, by con-
stitutional treatment. Of the twenty-six cases, nineteen
are cases in which ear disease, furnished supports for
insane delusions. In another class of cases, acute periods
of excitement were in relation to suppuration in the
middle ear. In one case a profuse discharge of pus
brought a case of melancholia to an end. In some cases
the slight suspiciousness not uncommon in normal parti-
ally deaf people, was exaggerated into a depressed
condition tending to sucide.
Delusions and Executive Ability. — The Birming-
ham Medical Review reports that one of the members
of the Executive Council of the Bank of Brussels was
many years ago attacked by the delusion that his
legs were glass, and positively refused to move. A
financial crisis came, involving the bank to some extent.
Mr. B. got up and went to Brussels, where by his
energy and skill he largely assisted in getting matters
straight. At the end of the month he returned home
remarked how marvelous it was that he had not
smashed even one of his legs, and taking to bed, never
again left it. In all lunatic asylums patients combining
business ability with the most remarkedly fixed insane
delusions are to be found.
Hemiatrophy of the Face in a Monomaniac. — Men-
del, [Nenrologisches Centralblatt, June 15, 1883) places on
record the fifty-eighth case of facial hemiatrophy. The
patient was a twenty-three-ye^r-old woman, who presented
symptoms of monomania. There was no ascertainable
heredity. The patient had been well, up to her seventh
year. From this time there could be obscurely traced a
" disfigurement " of the face, but for eight years no very
perceptible change was noticeable. The left side was the
one affected. There was a difference in the two sides of
the body, but this was evidently congenital. The facial
changes were clearly hemiatrophic in character and not
simply somatic stigmata of degeneration.
Transitory Furor from Lead Poisoning. — {Gaillard's
Medical Journal). A well authenticated case is reported
Trom Nevada. A miner who became so stimulated from
inhaling lead fumes, while repairing one of the tunnel fume
Selections. 699
escapes, that had he not been immediately secured he
would have killed three men standing near him with a
sledge-hammer. The patient having been removed to the
open air the attack disappeared. The patient had unfavor-
able neurotic ancestral history.
Post Scarlatinal Insanity. — A case of insanity re-
sulting from optic nerve changes, primarily the result of
scarlatina, is reported by Dr. Martin (Gaillard's Medical
Journal, July 7, 1883). The type presented was depression,
and although the patient was blind, there were very
vivid visual hallucinations.
Transitory Insanity. — Lowenfeld [Neurologisches Cen-
iralblatt,']\xnQ 15, 1882), attempts to determine a relation
between the mania transitoria of English authors, the
transitorische Tobsucht of Schwartzer, and migraine. In
his opinion it is in many cases only a migraine replacing
psychosis.
CLINICAL NEUROLOGY.
Progressive Total Hemiatrophy. — Heuschea {Nord-
iskt Mediciniskt Arkiv, Band No. XIV., Haftel 7, 1883)
reports the following unique case : A man, forty-six years
old. One cousin has had melancholia, no other nervous
disease in family ; had been of good health up to four-
teen years, when he slightly twisted the left foot, and
soon after erysipelas attacked the left leg, requiring him
to remain in bed. After this he was for some time in
and out of bed, owing to the existence of leg ulcers,
which were recovered from at intervals. During this
time he suffered from prickings and stingings in the left half
of the body. At the end of six months, he noticed atrophic
changes in the trunk, extremities, and six months later,
in the face. At this time he had marked, and painful
migraine. Since then, these modifications are progressing
more or less slowly. In his nineteenth year, the patient was
attacked by melancholia, and recovered. Two years and
a half ago he had a fresh attack of this psychosis. He
married at forty, and is the father of a healthy well
formed child. The patient is well built, but the left side
of his face his markedly sunken and atrophied, as also
700 Selections,
are his left arm and leg. The skull above the eyebrows
seems symmetrical, but the left temporal fossa is the
deepest. The face is markedly asymmetrical, the left
side being sensibly smaller than the right. The nose is,
as it were crowded to the left. The left cheek is mark-
edly thinned, deprived of its fat, and surrounded by
radient striae. The left eye is thinned, but otherwise
normal. The eyelids are deprived of fat. The zygomatic
bone, the soft parts covering it, and in the temporal
fossa and parotido-masseterine region, are sensibly atro-
phied. The skin of the left side of the face is thin. The
skin around the left edge of the mouth is slightly pig- •
mented. The left superior maxillary and inferior maxillary
segment are markedly atrophied, and the teeth have
fallen out. The palatal raphe is drawn to the left. The
left soft palate is partially atrophied. The left half of the
nose is atrophied. The right face is in marked contrast
every way with the left. The neck is symmetrical. The
left half of the trunk is slightly less than the right,
except in certain places where the atrophy is marked.
One of these places is between the fifth and seventh
intercostal space ; a second stretches from the umbilicus
between the tenth and eleventh ribs, about twenty-three
centimeters ; a third stretches from the crest of the left
illiac bone, below the groin, in a line uniting the anterior
superior spine of the ilium with the trochanter. Over all
these parts the skin is thinned and more or less strongly
pigmented. Fat is almost everywhere wanting, so that
the muscular fibers are traceable in the skin. The
muscles are atrophied, as also is the inter-muscular tissue.
The left arm is atrophied as a whole, and shorter than
the right. The muscles are markedly atrophied, especially
along head of the triceps, which is almost altogether
wanting, and replaced by tendon to the thickness of some
millimeters. The skin is contracted, thinned and pig-
mented. The arm muscles are atrophied. In consequence
of affections of the articulations, the arm and fingers
cannot be extended. The right leg is strong, muscular
and well provided with fat. The left, is thin, weak and
its subcutaneous adipose tissue has almost entirely dis-
appeared. The skin covering the femur is thin, with well
defined pigment. The muscles are atrophied, especially
the quadriceps, in which there are two ossifications. The
leg cannot be extended, because of alteration of the
knee-joint. The left leg is about one half the thickness
Selections. 701
of the right. The muscles have almost entirely dis-
appeared, leaving the tibia and fibula covered by parch-
ment-like skin, somewhat pigmented, and lacking hair
and sweat-glands. There is an anchyiosis of the tibio-
tansal articulation. The skin of the foot is parchment-
like, shiny and fixed immovably over the bones. The
tactile sensibility of the affected parts seems unchanged.
In the affected parts fibrillary twitchings are frequent, as
also are chillings and drawings. The internal organs
present nothing remarkable. The case is unique, as
combining hemiatrophia facialis, localized atrophies,
orthropathies, and from the history evidently is of an
ascending nature.
Bulbar Lesions in Ataxia. — Laudouzy and Dejerine-
{Gazette Hebdom., May 25, 1883) in ataxias presenting
laryngeal crises, found posterior sclerosis extending to
the beak of the calamus scriptorius ; the bulbar roots of
the spinal and pneumogastric nerves, presenting gross
lesions precisely similar to those of the posterior roots of
the cords. In the medJKa, the decussating fibres, and
the origins of the pneumogastric and spinal nerves were
profoundly altered on both sides. These lesions explain
the laryngeal crises, but the intermittence of the crises is
still unexplained in their opinion. A very slight analysis
of the lesions found, would, however, have led them to
the conclusion that these were the result of oft-repeated
and recovered-from fluxions, the result of irritation of the
vasomotor centers, a condition sufficiently explicatory
of intermittence.
Paralytic 'Dysphagia from Typhoid. — Dr. C. Lellman
[Medical Record, March 17, 1883) reports the following
case : A twenty-year-old tailor, had the initial chill,
September i8th. A few days after admission, several pro-
fuse intestinal haemorrhages occurred, which jeopardized
life, and served to increase an already existing anaemia.
Six weeks later, after the subsidence of the typhoid symp-
toms proper, a paralytic dysphagia manifested itself. The
patient spoke in a thick unintelligible, nasal voice. He
could not swallow unless lying down, and ingested fluids
occasionally passed out through the nostrils, or into the
larynx. At the same time he suffered from severe epis-
taxis. By Febuary, 1883, he had completely recovered.
Low Temperature in Alcoholism. — Dr. E. Bull
(Norsk Magazin for L<zgevidenskaben, Band XII.) reports
yo2 Selections.
a case of acute alcoholism, which entered the depart-
ment of the hospital under his charge. On the patient's
entrance the rectal temperature was found to be 87" F.
Under treatment it rose rapidly to 98° F. The treat-
ment consisted in cutaneous excitants. Temperature as
low as this is also reported in other neuroses.
NEUROTHERAPY.
Amyl Nitrite. — Dr. D'Ancona says {Gazz. Med. Ital.
Prov. Venete, Febuary 3, 1883) that amyl nitrite acts on
the vasomotor centers, causing relaxation of the vessels,
diminishes the peripheral pressure and with it increase of
force. Its effects pass off rapidly with the suspension of
the inhalation. Dr. D'Ancona has obtained very striking
results from continued methodical adminstration in acute
febrile respiratory diseases, complicated with, or due to,
organic cardiac disease. He has used it in these cases
for the last five years, always with good effect. With
repeated inhalations the fever was never increased, rather
the reverse. Cynosis of the hands and lips disappeared.
There was never any cumulative symptoms. He concludes
that amyl nitrite can be used in all cases of acute respir-
atory disease, when defect of cardiac activity and great
dyspnoea place life in jeopardy, with certain benefit and
possibly saving of life. Dr. S. C. Smith {British Medical
Journal, June 9, 1883) says that amyl nitrite most distinctly
shows its power in cases of cardiac dyspnoea, due to
cardiac failure, a sign that degeneration of the cardiac
muscle is taking place, and that hypertrophy is no longer
truly compensatory. The attack generally occurs in the
night. There is orthopnoea, a sense of suffocation, and a
feeling of danger of death, unless something be removed
from the chest; the hands are cold and clammy; the
face bathed in perspiration ; the heart's action is labored
and irregular, but the arteries are almost pulseless ; the
muscles of deep respiration act forcibly, and air freely
enters the lungs ; but this gives no relief to the
miserable sense of apncea, which goes on sometimes for
several hours, until, towards morning, a little frothy
expectoration occurs, often tinged with blood, and the
breathing gradually becomes less difficult. During the
inhalation of the amyl nitrite, the pulse fills out ; the
limbs become warm, the breathing is relieved, and the
Selections. 703
misery passes away ; but it is most important that the
rapidity with which ease is obtained, should not be
taken as proving the really neurotic origin of the attack.
The drug must, however, be used with both caution and
intelligence ; otherwise, instead of giving an opportunity
for useful treatment of the disease, and, while easing
painful symptoms, merely lead the patient on to eutha-
nasia.
The Ether Douche or Lavement for Local Pain.
—Dr. C. H. Hughes {Phil. Med. Times, Sept. 8, 1883)
calls attention to the fact that ether lavements have been
employed by him in all painful surface affections for
many years, whether with or without inflammation, but
mainly in neuralgic affections. In facial, sciatic and cer-
vical neuralgias, no remedy except galvanism has given
him such signal satisfaction during the past ten years
of his practice in neurology. These lavements will cure
some cases of recent origin ; they will relieve all. He
uses the ether douche, not the spray; and Dr. McLane
Hamilton is in error in his reference to his treatment of
the intense pain of cerebellar abscess by ether spray. In
the case referred to, which he reported in 1877 {Journal
of Mental and Nervous Diseases, October), Dr. Hughes
simply poured the ether on the head so copiously as to
benumb all sensibility and restore a state of ease and
mental tranquillity to a patient absolutely maddened with
pain. The ether douche or lavement in trigeminal neu-
ralgia is quite uncomfortable to many persons, on account
of the unpleasant impression of the ether on the nose
and eyes ; and when applied to the supra-orbital region
great care should be taken to keep the ether out of the
eyes, by laying the head back and covering the eyes
with a handkerchief. If the ether should get in the eyes,
the patient should be cautioned not to rub them, but
simply to sponge the eyes with cold water and wait
patiently till the ether evaporates. It should be poured
on the part till relief is obtained. He applies it in this
way to the motor regions of the head and down the
spine in general or unilateral chorea likewise. Of late
years he has heard of the ether spray, but the ether
douche or lavement has been with him a most common
and efficient agent in the local therapy of pain, espe-
cially superficial pain, for more than a decade, ranking
with electricity, and better than mechanical vibration for
temporary effect.
704 Selections.
Nerve Suture and Transplantation. — Dr. E. G. John-
son [Nordiskt Mediciniskt Arkiv, Band XIV., No 31), cites
fifty-two cases of nerve suture from the literature, to which
he adds some cases communicated to him personally.
He has performed sixteen experiments in nerve suture ;
uniting in these cases the totally dissevered end of a sciatic
nerve with a catgut suture. The suture in nine cases was
direct, in seven indirect. Union by first intention did not
take place. The passage of nerve impressions was estab-
lished, after the fortieth day in rabbits, after the thirty -first
in dogs, and after the twenty-fifth in hens. In twenty
experiments upon rabbits the cut ends of the sciatic were
not united ; nervous conduction was not established till
after the sixtieth day. Microscopical examination showed
that nerve structure was re-established about sixty days
after operation in case of nerve suture, and about seventy
in simple section. The difference in nervous conduction
was marked in the two cases. Nerve section without
suture resulted in frequent trophic changes, with suture
they were absent. Nerve suture is therefore destitute of
all danger. In fifty-two cases of the operation in man
there was no bad result, and nervous conduction was
established with comparative rapidity. Indirect suture is
preferable to direct. Kaufmann, in 1880, successfully
transplanted a dog's sciatic nerve to man. From experi-
mental results Dr. Johnson believes that this example
should be followed in cases where indicated. It is for
future experimenters to determine whether nervous con-
duction is established most promptly and thoroughly by
suture or, as was proposed by Vanlair, by placing between
the severed ends a tube of calcined bone.
Paraldehyde. — Dr. John Brown {British Medical Jour-
nal, June 2, 1883), who has been studying the action of this
hypnotic, says, that he has found the hypnotic dose to be
from thirty to fifty minims. It produces, sleep in most
cases in a few minutes after taking it, the effect lasting
from three to seven hours. He maintains that it produces
no headache, no constipation, nor stomach derangement.
In one case it caused a slightly depressant effect on the
heart. In a patient who had been accustomed to take
chloral hydrate, the sleep was refreshing, but, if disturbed
during the sleep, the tendency to sleep left, which was
not the case with chloral hydrate. Paraldehyde some
times causes a peculiar burning taste in the mouth the
following morning. The breath smells of the drug for
Selections. 705
several hours after waking. It is probable that nearly all
the drug disappears by the lungs in the same state as it
is taken. Paraldehyde is not superior to chloral. There-
fore it is not likely to come into general use. Being so
insoluble in water, it makes rather a large draught, which
is objectionable.
Paraldehyde. — Drs. Cervello and Morselli {Archhio
Italiano per la Malattie Netvoso, Fasc. 1., 1883) and Dr.
Bergesis have experimented largely with this drug. It
has the chemical composition, C,; Hio O.j ; and is a poly-
meric form of aldehyde. In physiological action it strongly
resembles chloral. A dose of three grammes procures
quiet and refreshing sleep for from four to seven hours. It
differs from chloral in its action on the circulatory^ system,
strengthening the heart's action, while diminishing its
frequency, and has also a well-marked action on the
kidneys ; greatly increasing the flow of urine. The skin
is not at all affected. The drug does not give rise to diges-
tive disturbances, to headache, or to other unpleasant symp-
toms. Up to the present time MorselH has used paraldehyde
about three hundred and fifty times, and has found it of
value in mania, melancholia, and other nervous affections,
as well as in the insomnia of acute bronchial catarrh, lobar
pneumonia, and cardiac disease. He believes that it will
largely take the place of chloral.
Spinal Lesions in Ergotism. — li\JLCZQk{Archiv f. Psych.,
Bd. x.iii., p. 99) reports fifteen cases of spasmodic ergotism
which presented symptoms of spinal disease. The patel-
lar tendon-reflex was absent in every case. Other symp-
toms were paresthesiae, ataxia, diminished sensibility to
pain. These showed themselves months after the acute
intoxicant stage, when the patient had become markedly
cachectic. In four cases (one was nine years old, another
sixteen) an autopsy was made. In all there were sclerosis
of the external division of the posterior columns. The
cases differed pathologically from locomotor ataxia in the
rapidity of the development of the morbid process.
Tuczek finds an analogy to the appearance of tabes in
ergotism in the occurrence of an acute primary disease
of the posterior columns in exceptional cases of pellagra,
lepra, absinthe-poisoning, scarlet fever and diphtheria.
Hydrobromic Acid as a Bromide Substitute. — Dr.
C. L. Dana {N'ew York Medical Journal, June 23, 1883)
states that the dose of the pure acid is from ten to
7o6 Selections.
twenty drops ; of the officinal, or the ten per cent, sol-
ution, one drachm to two drachms and a half. It was
usually given in two small doses. During the past two years
he had employed hydrobromic acid in epilepsy, alcohol-
isrri, various cephalagias, vertigo, general nervous
depression, neurasthenia, chorea, insomnia, hysteria,
post-hemiplegic disturbances, etc. He had had the
greatest benefit from the drug in epilepsy, in post-hemi-
plegias, and in other lighter general nervous troubles.
It did not prevent cinchonism, in the small doses in
which it was usually prescribed. Hydrobromic acid was
recommended in preference to the alkaloids, because it
was agreeable to take, non-irritating, and did not pro-
duce an eruption or bromism.
Succus CoNii IN Chorea. — Mr. J. F. W. Siek reports
[Lancet, May 26, 1883) cases of chorea relieved by suc-
cus conii, which seemed to show: i. That the drug, to
be of any service, must be given in large doses. 2. That
its action must be sustained by frequent repetitions of
the dose at short intervals. The uncertainty of the
action of given specimens of succus conii necessitates
great care in its administration, and militates against its
general adoption. But cases in which neither chloral nor
morphia have any affect may arise, and in which, as in
the above, succus conii may prove efficacious. A fluid
extract made by Squibb is much more certain than the
succus.
Treatment of Menieres Disease, — Grazzi [Progrls
Medical, July 21, 1883) divides the cases of this affection
into primary or secondary types, the secondary types
being due to lesion of the external or middle ear, or to
traumatism. He has had good results from the following
formula R quinine valerianate 3i; solid extract of aconit.
napel. grs. xii. ; solid extract cinchona, q. s. Make
twenty-four pills. Give one pill every six hours, decreasing
the time between the dose, and increasing the dose till
the patient is taking five pills in eight hours ; then
decrease till recovery.
Action of Narcotics. — Dr. Brown-Sequard [Progrks
Medical, March 24, 1883) believes that these substances
cause sedative effects only by cerebral inhibition. Opium
does not produce slumber because of its hypnotic effects,
but because it is an energetic anresthetic of the sensory
nerves, from which would result a clinical indication that
Selections. joy
the place of administration, as well as dose, is an im-
portant matter. A small quantity of morphine injected
below the superior laryngeal nerves, would lead to a
more profound general anaesthesia than if the injection
was made elsewhere.
Paraldehyde as an Hypnotic. — Berger {Breslauer
(Brzt. Zeitschrift, March 24, 1883) has been experimenting
with this new hypnotic, and finds it of value in cases
where chloral is contra-indicated, or fails to produce its
effects. He gives it in the following mixture : ft Paral-
dehyde 3 ss — 3 i ; Mist. Gummos § ii ; Syr. Cort. aurant 3 i
M. S. at a dose. Its chief disadvantage is its unpleasant
taste, and the large quantity of menstruum required to
disguise this.
Nerve Stretching. — Westphal, {Chariie Attnalcn, Jahr-
gang Vni.) concludes that stretching of the crural nerve
may cause temporary disappearance of the kneejerk and
musclespasm, but that it should not be forgotten that
crural nerve stretching may result in a lesion of the spinal
cord in cases where the same is affected prior to the
ooeration.
ANATOMY AND PHYSIOLOGY.
Terminations of the Olfactory Nerves. — Holmfeld
{Nordiskt Mediciniskt Arkiv, Bandet XIV., Haftel 7, 1883)
concludes, that the olfactory cells are the true terminal
organs of the olfactory nerves, and that the epithelial
cells are not in direct relation with these nerves. In his
opinion the description given by Max Schultze, of the
organization of the olfactory mucous membrane, is the
true one, and Exner's observations are not correct.
EDITORIAL.
Intimidation and Compassion in tlie Cure of
Insanity.— Intimidation was first proposed by Leuret {Des
hidications a Suivre dans le Traitement Moral), as an illus-
tration that this system, when practised, so to speak,
accidentally, has had decided beneficial results. Dr.
Kiernan cites the following case, reported by Singowitz
[Die Geistesstorungen): A young man in the Charite luna-
tic wards at Berlin, who had been there for eight years,
had an enormously exaggerated opinion of himself. He
was extremely haughty and dignified, and was a good
case of primary monomania. Another man, subsequent
to excessive indulgence in alcoholic and sexual pleasures, '
was attacked by hypomania. To every question asked
him, he replied that he was a colonel and adjutant-gen-
eral, a capital player at billiards, an extraordinarily expert
horseman. He had lately got on horseback at the circus,
and astonished everybody by the unique skill with which he
managed the most restive horses. He was very rich ;
invited every one to his house, and in his attendant saw
only a pleasant companion and a witness of his circus
exploits. Singowitz proposed to introduce the latter
individual to the former. The introduction took place.
The two were at first interested in each other. The
second patient claimed to be a colonel in the Russian
army, whereupon the first proposed to make use of his
military talents. The second patient then made more
extravagant claims, but he was called a lunatic, and
told that he ought to be in an asylum. From this time
the second patient improved, and rapidly recovered ; the
first symptoms of recovery dating from the time when
he was so rudely and sharply contradicted. Dr. Kier-
nan also reports the following case, coming under his
own observation [JottrnaL of Nervous and Moital Disease,
January, 1883) : A hypomaniac had, among other unsystem-
atized delusions, one that he was the " Supreme Being."
In the same ward was a primary monomaniac, who
claimed to be the " Holy Ghost." Coming up to the
latter individual the first made his favorite assertion that
he was the "Supreme Being," whereupon the "Holy
Editorial. 709
Ghost " knocked him down, and insisted on a retraction
of this blasphemy. The " Supreme Being," much aston-
ished, did not make any reply, and was much battered
when rescued by another patient, who suggested to the
" Holy Ghost " that the " Supreme Being " was a lunatic.
The latter from this time never mentioned his delusion,
which finally disappeared. He became industrious, and
was soon discharged recovered. Guislain {Le<;ons Oralles
sur les Phrenopaihies) has reported a case in which the
intimidation was not so purely physical, and in which
recovery occurred. Y^xdi^t-Khing [Lehrbuch der Psychiatrie),
from similar clinical experiences is of opinion that cer-
tain cases are benefited by treatment on Leuret's prin-
ciple. It is obvious that the beneficial action of
intimidation depends upon its suddenly changing the
current of the patient's ideas, and from it being at
times per se sufficient to introduce new ideas. In cer-
tain depressing delusions the effect would be to increase
the depression ; and in certain cases of primary mono-
mania, such treatment would add supports for the patient's
insane ideas. It has occasionally been observed that
compassion for other people is a means of initiating
recovery. Dr. Barstow [American Journal of bisanity,
1874-75) has reported a case in which compassion for
a little child led to a patient's recovery. In a case
observed by Dr. Kiernan {^Journal of Nerz'ous and Men-
tal Disease, April, 1883), a patient recovered by the
feeling of indignation excited by an attack made by a
strong man on a little boy. Previous to this attack the
patient was wrapped in his own lugubrious ideas, and up
to the very minute of the attack was complaining of
his bitter fate. After the attack he spoke of nothing
but it ; he was much excited, and when calmed, was
found to be more cheerful than he had been in weeks.
Rights of the Insane in Illinois.— The Board
of State Charities thus pertinently remarks on the unjust
law of that State respecting commitment of insane per-
sons to its asylums :
Does not the uncertain condition in Illinois, under our law, demand
a return to the common sense law. with modifications, once exist! 0* in
Illinois, wiiich virtually treated an insane person as mentally siclc. and
did not require him to be treated as a criminal and be trietl by a jury?
What orood has bt^en etlected by the change in the law? We mainrain
that no good has been done, and that serious questions arisp, clogsfing
the individual's future, and also attacliing more of a stigma, if such it be.
yio Editorial.
of insanity by the finding of a jury. Why not leave the matter, as in
many of our States in the United States and as in England, to be dealt
with as a scientific, professional question for the medical man and pathol-
ogist, and not for the finding, by a verdict of jurors, bised on slight
evidence? Is it essential to liberty and to the maintaining of personal
freedom from undue restraint, that the law should exist in its pn sent
form ? A writ of habeas eorpxis will always lie, as a writ of right, to
inquire into the cause of the detention of any party in an hospital for
sane or insane. It is believed by many that our present jury law was
superinduced by undue excitement, growing out of one case, which was
by no means a clear case of misapplication of the rigor of the law. Is it
essential or at all consistent that trial by jury be given or maintained,
when the near relations, and, when none exist, then a respectable person
of tlie county, must petition for the trial of the person's sanity or insanity,
and it is obvious from the law that the proceeding is for the welfare of
the individiial supposed to be insane? It is not a criminal charge, and
yet you treat the matter with the formality of a charge or trial for crime.
In place of having a commission or board of physicians, you try the
per- on and render a verdict, from which you provide no escape by his
individual act that would be legal.
Illinois is too enlightened a State to permit so onerous
and unjust a statute towards the most to be commisser-
ated and helpless of her children of misfortune, to long
remain in* force. Insanity is no civil offense. Why should
the disease of its afflicted victim be a subject of inquiry
by a jury ? The purpose of law is protection, but jury
trials of questions of mental disease are more likely to be
oppressive in erroneous conclusions as to mental condi-
tion or disposition of the patient.
The board pertinently asks what cause is to be tried in
a question of alleged mental disease ? Certainly no
cause in law, and no case whatever for other than men
expert in solving problems of mental disease, to decide.
A non-expert jury is more likely to rob a shrewd lunatic,
who may be apt at concealing his mental derangement, of
that right to prompt treatment and recovery which he
may be too insane to appreciate, but which ought to be
secured to him by a rational legal friendship toward him
in his sad affliction, despite his insane objection to treat-
ment, than it is to save a sane person from wrongful
imprisonment, with the safeguard of habeas corpus to pro-
tect him.
Let law pile high the penalties for false certificates of
insanity, and searchingly inquire as to the qualifications
and responsibility of those who may sign them, but save
the poor lunatic from the uncertain chances of speedy
treatment, through a petit jury trial.
Editorial. 711
The Psychical Effects of !?ferve Stretching.—
Dr. Westphal believes the so-called results of nerve
stretching are the effect, psychologically, upon the patient
undergoing a great operation, which he is assured mast
prove successful in his case; and from the sanguine
view, which ataxic patients take of their condition, they
are only too ready to believe themselves better if
required. A very apt illustration of the truth of this
is to be found in the case reported by Dr. Kiernan
i^Jotirtial of Neurology and Psychiatry, February', 1883),
The patient had been with him some months. He was
a man of twenty-one, well-built and well nourished, and
gave the following history : He had, at the age of six-
teen, been attacked by typhus fever. During the
delirium of this disease he was seized by an apoplectiform
convulsion. On recovery from this his right hand became,
as he expressed, "somewhat shaky," especially when he
tried to use it for any purpose. This " shakiness " had
at first occurred only in "spells," but became permanent,
and gradually extended, until it involved the whole arm,
and finally the lower extremity on the same side, also
the facial muscles. The patient was irritable, depressed,
complained much of cephalalgia, and was addicted to
the use of paregoric. The hereditar^'^ history was unattain-
able. Dr. K. had placed him under barium chloride,
hyoscyamus and conium, but without apparent effect.
Dr. K. was obliged to be absent from the city, and
for two months lost sight of the patient. He called on
Dr. K. upon his return, and was markedly improved ;
so markedly that Dr. K. was at a loss to account for
it. He informed him that he had gone to an irregular
practitioner, who had given a certificate that the " poster-
ior cord of the brachial plexus " had been stretched.
On examining the wound it was found that a very
superficial incision had been made over and parallel
with the center of the clavicle. The man had been pre-
viously etherized. The tremor hitherto existing had disap-
peared ; the patient was able to write, which he had not
been able to do since his illness. He was able to walk
without being started, as had been done when Dr. K.
last saw him. These effects remained for six months, at
the end of which time the arm tremor returned, and,
to a slight extent, the impaired gait also.
The Michigan Law as to Wills. — The Solons of
the Michigan Legislature have passed an exceedingly
712 Editorial.
absurd law on this subject. The testator makes his will,
and then during his lifetime petitions the probate court
for citations to all his heirs, and such other persons as he
deems necessary to attend an examination into his sanity
and testamentary capacity. If it shall appear that the
person was fully competent to make a will, a decree to
that effect shall be made, and the question of incapacity
cannot be raised again, except upon appeal from the
decree. If the testator subsequently becomes insane, and dies
in that condition, his ivill nevertheless, can^iot be questioned
on this ground. The contents of the will are not to be
made known until the death of the testator. The absur-
dity of this procedure must be self-evident to anyone who
has ever studied the subject from an impartial stand-
point. The law is inconsistent with certain every-day
legal decisions, that a transaction can best be judged by
its nature. That such a law might sometimes work in-
finite hardships there can be no doubt. Under such a
law the prima facie fact might be established as to the
existence of testamentary capacity, but there would still
remain the contents of the will, a part of the competent
evidence necessarily excluded at the inquiry, the nature
of which might be undoubted evidence of the testator's
mental unsoundness. Under such a law some lunatics now
justly retained in asylums might establish their compe-
tency, barring the fact against them of being in an asylum.
How is the question of the sanity or insanity of an
individual to be promptly determined, while the particular
act concerning the sanity of which question is raised, i. e.,
the will, is excluded from consideration? Some lunatics
speak sanely enough and act so in general intercourse
with people, whose writings proclaim their mental aber-
ration beyond doubt.
Premeditation ns Legal Evidence of Insanity.
— [Nortlnvestern Reporter, March 3, 1883.) Judge Taylor,
of the Wisconsin Supreme Court, recently decided in a
case appealed to that court, that " the judge erred
in giving the following instructions, unexplained, to the
jury, upon the trial of the issue of insanity, viz: 'If
the defendant, at the time of the killing, was sufficiently
sane to deliberate and premeditate a design to effect
death, then he was sane within the spirit and meaning
of the laws applicable to this case, although he may
have been, in truth, subject at the time to insane delu-
sions on other subjects. * * * jf he had sufficient
Editorial. 713
power of mind and will to deliberate and premeditate a
design to effect the death, then you should find that he
was sane.' These instructions, set up as an absolute
test of sanity, the power to deliberate, premeditate and
design. They make the presence of sufficient intelligence
in the party accused, to form a design to do a crimi-
nal act conclusive evidence that he is sane, and subject
to punishment if he executes such design. As was said
by Justice Stowe, of Pennsylvannia, in quoting from an
opinion of Chief Justice Agnew, of that State : ' Intelli-
gence is not the only criterion, for it often exists in the
madman in a higher degree, making him shrewd, watch-
ful, and capable of determining his purposes and selecting
the means of accomplishment. Want of intelligence,
therefore, is not the only defect to moderate the degree
of offense ; but with intelligence there may be an
absence of power to determine properly the true nature
and the action, — a power necessary to control the im-
pulse of the mind, and prevent the execution of the
thought that possesses it.' "
The Guiteau Verdict.— (77/^ Lo7ido7i Medical Times
and Gazette) thus refers to this subject in the September
7th number:
The indefatigable Dr.' Spitzka has a long critical digest of the evi-
dence given by the medical witnesses for the prosecution in the case
of the wretched Guiteau. If this report is an accurate one, the answers
of these witnesses, upon whose evidence the man was liai.ged, are simply
amazing ; and one can only wonder where and how the prosecuting
counsel contrived to find a group of persons pretending to a knowledge of
insanity who could make such statements as the following : " I do not know
what an irresistible impulse is. That is something I do not understand.
I cannot conceive of an irresistible impulse." " People who are known
as eccentric ... or illy-balanced (^sic) are not as liable to outbreaks
of insanity as those who are more steady and staid in habits and char-
acter." "The existence of insane cousins, uncles or aunts, would have
no bearing whatever on the question as to whether there was any hered-
itary tendency in a family." "There is, I think, no difference between
an illusion, a delusion, and an hallucination." "I never knew a case of
hereditary insanity where the disease itself was transmitted. Disease is
never transmitted." It is difficult to believe that this report is correct,
but if it be correct, and if the criminal was convicted on this evidence, it
would be as erroneous to speak of his being executed as to speak of his
victim in the same terms. We repeat, that if he was convicted on such
evidence as this, bis death was not an execution, but a murder.
Our pages are freely open for a full, fair and dispas-
sionate examination of this question. We believe the
714 Editorial.
government experts erred in their judgment concerning;
Guiteau's mental status.
"Sane IiUnatics."~A New York Daily paper com-
ments on murders by lunatics in the following fashion :
Another crazy man has been arrested in New York for dauK* roiisly
stabbinor a citizen, if >few Yorli Bhould libeiate the sane per8< ns now
confined in her lunatic asylums, she mi^ht, perhaps, find room for the
incarceration of the numerous maniacs who are making life unsafe.
If lunatics were not so often miraculously transformed.
into sane men by jury verdicts, and unreasonable and unjust
obstacles were not every day thrown in the way of com-
mitting the insane to the asylums whose care and treatment
is their due, and whose restraint is their right and the
community's protection, murder by sane lunatics would be
less frequent. Suppress the liberation epidemics which
have recently broken out in some of the States, and
guarantee communities against the roaming at large of the
many murderous cranks who are only considered sane
when they are brought to trial, and murders by the
insane would diminish.
Harper' s Weekly makes an apt suggestion when it asks
that the attention of judges should be called to the propri-
ety of disbarring lawyers who ransack the insane asylums
in search of rich lunatic clients to release.
Moral Character in Insanity. — Resolutions declar-
ing that the moral character should not be considered in
estimating questions of insanity by State Medical Societies
are not only unscientific but exceedingly out of place, and
have the semblance, whether so intended or not, of attempts
at bulldozing for bolstering purposes. The moral perver-
sions of certain forms of mental disease are stumbling-blocks
in the way of certain theorists on mental alienation, but they
cannot be gotten out of the way in this manner. Such
resolutions are prima facie confessions of weakness on the
part of the movers of them, but they will not bias the
really scientific investigator. Whatever constitutes mind
in its sane estate and thus contributes to make the rec-
ognized character, will be taken account of by the true
alienist in estimating morbid and irrational change, whether
it be in thought, feeling or action.
The Alienist and Neurologist enters, with the
coming January number, on its fifth year. Please call the
attention of your friends to the fact and induce them to
become subscribers. Please also remit your subscription for
Editorial. 715
1884. A liberal support from its friends will greatly enlarge
its usefulness and the value of its contents for 1884, Every
£ood Journal can be made better by zealous co-operation a?id
increased subscriptiotis.
Political Changes in the Medical Manage-
ment of Hospitals for the Insane are more to be
deprecated than similar changes in the management of
any other State charity, not excepting even the schools
for the feeble-minded, the blind and the deaf and dumb.
No physician of ordinary skill, ability and experi-
ence in his profession, be he ever so diligent, can acquire
5uch a familiarity with the special features of insanity and
the management of the insane, as to honestly justify assum-
ing control of a State Lunatic Asylum, as its chief
medical head, in less than a year's residence among the
. insane ; and an equal length of time is requisite to famil-
iarize a new physician, unless he knows well by previous
experience, how to go about acquiring this knowledge,
with the personnel and previous history of the usual num-
ber of insane patients in a State asylum.
Few physicians can properly qualify themselves for
their duties in this time. Only here and there a first-
class medical man of exceptional experience and ability
in general practice, or who has gained a special reputa-
tion in neurology and psychiatr\' by zealous labor and a
peculiar love for this work, constitutes an exception.
We must therefore protest against changes in the man-
agement of these institutions for anything but just cause.
In the coming political contests we hope all parties will fly
the neutral flag over their State charities.
Purely political changes wrong the friends of the
insane, who have the right to expect the greatest possi-
ble skill in the management of their insane friends, and
they seal unfavorably the fate of many an otherwise cura-
ble insane person.
To ihe Friends of the Alienist and Neurolo-
gist.— In the interim between now and January proximo we
hould like to add at least five hundred more subscribers
to our subscription list. We hope all who are interested
in the diffusion of sound practical psychiatrical and neuro-
logical knowledge will display their interest in this journal
by practical endeavors to thus promote its prosperity.
Dr. L. S. 3Ic">Iurtry has retired from the Louisville
Medical Nen's, and is succeeded by Dr. H. A. Cottell,
formerly an editor of the News.
HOSPITAL NOTES.
Dr. B. F. Sanborn succeeds Dr. H. M. Harlow resigned,
to the superintendency of the Maine Insane Hospital, at
Augusta. Dr. Harlow filled his post there long and well.
Dr. Pliny Earle, of Northampton, has not resigned as
stated in our last number, but is still faithfully and zealously
on duty.
Illinois Eastern Hospital for the Insane, at
Kankakee. — The Biennial Report shows the total num-
ber treated during the two years, 520; males, 352;
females, 168. Admitted during same period, 295 ; males,
I 2; females, 123. Discharged and died, 194; males,
132; females, 62, as follows: Recovered, 44; males, 29;
females, 15. Much improved, i female. Improved, 50;
males, 38; females, 12. Stationary, 78; males, 46; females,
32. Deteriorated, i male. Died, 19; males, 17; females,
2. Not insane, i male. Remaining under treatment Octo-
ber I, 1882, 326; males, 220; females, 106. Dr. R. S.
Dewey has the happy faculty of investing with interest
the usually dry details of a hospital report. His statistics
as to restraint are valuable, and his common-sense views (not
always found among alienists — may it be in the Associa-
tion ?) are worthy of deep consideration. The "doctor is an
earnest advocate of detached buildings, and gives the cost
of such at Kankakee at ;^3i8 per capita, while the cost of
main building is placed at ;^895. His experience is that
they are better adapted and far more beneficial to a large
class of patients than the " close " hospitals ; and we have
no doubt that taxpayers will not hesitate to avail themselves
of this economical manner of providing for the bulk of the
insane. Employment figures largely as a remedial agent in
this institution.
State Insane Asylum, Jackson, Louisiana. — This
report, from changes in the State laws, embraces a period
of twenty-eight months, from December i, 1879, to March
31, 1882. Total number under treatment during entire
period, 337; males, 171; females, 166. Admitted, 127;
males, 71; females, 56. Discharged and died, 93; males,
Hospital Notes. 717
52; females, 41, as follows: Recovered, 39; males, 29;
females, 10. Improved, 6; males, 4; females, 2. Unim-
proved, I male. Died, 47 ; males, 18 ; females, 29.
Remaining April i, 18^2, 244; males, 119; females, 125.
The superintendent, Dr. John W. Jones, certainly merits our
deepest sympathy. Estimating the entire cost of mainten-
ance of his patients at the small sum of ^150 per capita,
he is compelled to accept State warrants on that basis at
a discount on their face value of over 25 per centum. He
shows the general average cost, as taken from twenty-five
of our principal asylums, to be $225.44 per capita; and
earnestly protests that the State of Louisiana shall not per-
mit her insane asylum to be catalogued as an almshouse
or a prison, when elsewhere they are referred to and pre-
sented as objects of State pride. It is to be hoped that
the pelican State has not forgotten her traditions, and that
the worthy doctor may not be compelled to fashion his
dietary table after the old plantation style.
Eastern Lunatic Asylum, at Williamsburgh, Vir-
ginia.— Remaining September 30, 1881, 354; males, 193;
females, 164. Admitted during year, 115; males, 64;
females, 51. Total number under treatment, 469; males,
257; females, 212. Discharged during year, 92; males, 57;
females, 35, as follows: Recovered, 45 ; males, 27; females,
18. Improved, 7; males, 5; females, 2. Unimproved, i
male. Died, 39; males, 27; females, 12. Remaining Sep-
tember 30, 1882, 377; males, 197; females, 180. It is
gratifying to find that Dr. Richard A. Wise so well appreci-
ates the proper system of combining treatment of the recent
and chronic insane under one management. We are also
glad to see that the accommodations of this asylum are not
near so inadequate to the demand as at Staunton, and it is
to be hoped that the bright anticipations of Dr. Wise of a
more liberal provision for the insane of Virginia will be ful-
filled. With no bias or disposition to reflect upon parties
or persons, one cannot peruse the asylum reports of the
State of Virginia (for the past few years) without being
struck by the baneful effects of partisan management, and
the hesitating uncertainty incident to a political tenure,
which characterizes them. May we not hope, in this era of
civil service reform, that the helpless insane will receive
some protection.
State Lunatic Asylum, Columbus, South Carolina. —
In asylum October 31, 1881, 490; males, 231; females, 259.
Admitted during year, 265; males, 135; females, 130.
71 8 Hospital Notes.
Whole number under treatment, 755; males, 366; females,
389. Discharged during year, 205; males, 114; females,
91, as follows: Recovered, 62; males, 43; females, 19.
Improved, 29; males, 12; females, 17. Unimproved, 14;
males, 8 ; females, 6, Escaped, 3 males. Not insane, I
male. On trial, 18; males, 7; females, 11. Died, 78;
males, 40; females, 38. Remaining October 31, 1882, 550;
males, 252 ; females, 298. Dr. P. E. Griffin gives a most
flattering resume of his year's work, and the statistics fully
justify him. The system of sending convalescent and other
suitable patients " out on trial " is largely adopted at this
institution, and from the data furnished, has worked with
gratifying success. The State seems to deal liberally, and,
as a result, the efforts of the officials are bestowed con
amove. A fitting tribute is paid to the memory of the
late lamented Dr. John W. Parker, formerly superintendent,
and at the time of his death assistant physician ; his associ-
ation with the hospital having extended over forty-five
years.
North Carolina Insane Asylum. — The number under
treatment during the year, 33^^ ; males, 173 ; females, 161.
Admitted during the year, 50; males, 24; females, 26.
Discharged during the year, 56; males, 28; females, 28,
as follows : Recovered, 16 ; males, 10 ; females, 6.
Improved, 5; male, i; females, 4. Unimproved, 18; males,
II; females, 7, Died, 17; males, 6 ; females, 11. Remain-
ing December 31, 1882, 278; males, 145; females, 133.
Dr. Eugene Grissom enters a vigorous protest against any
plan looking to the separate treatment of the chronic and
acute insane. While admitting the force of some of his
arguments, especially that the establishment of chronic
asylums may lead to a too economical care of such unfortu-
nates, still we cannot see why the close hospital for maniacs
and more cheaply-constructed, detached buildings, for the
imbeciles and demented, under one general management,
may not be not only advisable but beneficial to both
classes.
State Lunatic Asylum, at Little Rock, Arkansas. —
We are in receipt of the first report of the Board of
Trustees of above asylum, and congratulate the State of
Arkansas upon having at last realized its duty towards its
indigent insane, as well as upon the rare judgment dis-
played in the selection of the able gentlemen who are to
initiate the asylum. The greatest care has apparently
been exercised in the selection of a proper site, and the
Hospital Notes. 719
buildings erected in accordance with the most modern
requirements of asylum construction. Dr. C. C. Forbes,
of Louisville, Kentucky, has been, without solicitation on
his part, selected as the first superintendent, and we have
no doubt will fulfill the flattering commendations received
of him.
State Insane Asylum, at Athens, Ohio. — The
report of this Institution gives the total number under
treatment during the year, 832; males, 391; females, 441.
Admitted during the year, 216; males, no; females, 106.
Discharged and died, 207; males, 94; females, 113, as
follows : Recovered, 93 ; males, 5 1 ; females, 42. Re-
lieved, 14; males, 8; females, 5. Unimproved, 65 ; males,
18; females, 47. Died, 36; males, 17; females, 19.
Remaining on November 15th, 1882, 625; males, 297;
females, 328. Dr. Richardson furnishes additional proofs
of the value of out-door employment and exercise, not
only as adding to the comfort and enjoyment of patients,
but in lessening violence and attempts to escape, while
the curative influences are marked, as compared with the
too frequent dependence on the use of medicinal agents,
to the neglect or oversight of the more important prin-
ciples of careful nursing, and a proper regulation of
surroundings. In the appointment during the year, of a
female physician, Agnes M. Johnson, M. D., while the
matter of qualification (not of sex) seems to have been
the guiding motive, still Dr. R. expresses the opinion
"that for some reasons I believe the treatment of the
female insane can be more successfully accomplished by
female physicians than by males with the same qualifi-
cations and adaptation for the work."
State Lunatic Asylum, No. 2, St. Joseph, Missourl
— The Biennial Report shows the total number
under treatment during the two years, 511; males, 284;
females, 227. Admitted during the same period, 316;
males, 182; females, 134. Discharged and died, 251;
males, 149; females, 102, as follows: Recovered, no;
males, ^j \ females, 43. Improved, 46; males, 22;
females, 24. Unimproved, 37 ; males, 27 ; females, 10.
Not insane, 3 ; males, 2 ; female, i. Escaped, 6 males.
Died, 49 ; males, 25 ; females, 24. Under the most
unfavorable conditions. Dr. Catlett bears out his well-
earned reputation as a scientific alienist. A deficient
water supply, with its .legion of concurrent evils, is
one of the most disgraceful and pernicious errors of
720 Hospital ISfotes.
hospital construction, and this the doctor has had to
contend with in a most, virulent form. No matter how
desirable in other respects, the least doubt as to a
bountiful water flow, should condemn any site suggested
for a hospital, and more particularly one for the insane,
the major portion of whom, while in the most favorable
condition to imbibe disease, are necessarily for a greater
portion of each twenty-four hours, so exposed. Notwith-
standing this mahgn influence, the report presents a grati-
fying result of what may be attained by indefatigable
and intelligent labor. Dr. C, in most pertinent and
convincing language, urges increased accommodation, by
the erection of supplementary and detached buildings
for the chronic and epileptic insane. The doctor feels
constrained to attach to his report an emphatic denial
as to the practice of " ducking " in his institution. To
the profession such disclaimer is entirely unnecessary,
for to them, and the general public who may be
acquainted with him, not a thought of ill-treatment could
possibly be associated with his care of the insane.
State Lunatic Asylum, Jackson, Mississippi. — Bien-
nial Report. Conformably to new legislation the report
embraces only twenty-tRree months. Remaining, Jan.
I, 1881, 401; males, 193; females, 208. Admitted to
Dec. I, 1882, 239; males, 112; females, 127. Whole num-
ber under treatment, 640 ; males, 305 ; females, 335. Dis-
charged, 224; males, 121; females, 103, as follows: Re-
covered, 98 ; males, 48 ; females, 50. Improved, 8 ;
males, 4 ; females, 4. Unimproved, 7 ; males, 4 ;
females, 3. Not insane, 3; males, 2; female, i.
Eloped, I male. Died, 107; males, 62; females, 45.
Remaining under treatment November 30, 1882, 416;
males, I84 ; females, 232. The report of Dr. T. J, Mitchell
for 1880-81 evidences a conscientious discharge of duties
amidst depressing surroundings. An overcrowded hos-
pital with deficient water supply may well account for
the heavy mortality, and in his plea for increased hos-
pital facilities. Dr. M., in the true spirit of a philanthro-
pist, advises no additions to . his own charge, but the
selection of a more salubrious and better adapted site
than one so near a city peculiarly adapted to epidemic
visitations. The want of a proper flow of water would,
in our mind, condemn, the use of the present buildings
altogether. The lighting of so large a mass of buildings
by means of coal oil can eventuate in only one direc-
Hospital Notes. 721
tion, a destructive conflagration, and attendant loss of
life. The experientia docet of advanced thought, seems
to be merged into the fatalism of what is to be, will be,
of the Turk.
State Hospital for the Insane, at Weston, West
Virginia. — Remaining under treatment September 30,
1881, 589; males, 317; females, 272. Admitted during
year, 199; males, 93; females, 106. Whole number
under treatment, 788; males, 410; females, 378. Dis-
charged during year, 153; males, 84; females, 69, as
follows: Recovered, 56; males, 30; females, 26. Im-
proved, 35 ; males, 20; females, 15. Eloped, 2 males.
Died, 60; males, 32; females, 28. Remaining Sept. 30,
1882, 635; males, 326; females, 309. The problem of
providing for the chronic insane is becoming the fore-
most and apparently the most difficult of solution in the
minds of our alienists. Dr. W. J. Blond is not the
only superintendent who finds it difficult to impress the
laity with the importance of early hospital treatment ;
and later, that even economy, which with many appears
to be the prime consideration, is best attained in properly
graded hospitals. How long are we to continue the
crowding of our asylums with the hopeless insane, made
so by incarceration in jails and poor-houses, when the
remedy is so plain. We may be a hobbyist on this
subject, but no matter casts such deserved claims upon
the American system as this, and our efforts shall be
continued until the foul blot is removed, and we confi-
dently challenge the criticism of the world, not so much
by displaying palatial buildings at $1,200 per capita, as
by exhibiting the " greatest good for the greatest
number," detached buildings and homes clustering around
a central or "mother" home. This is not Utopian for
already do we see the realization in more than one en-
lightened community.
Second Minnesota Hospital for Insane, at Roches-
ter.— The Biennial Report shows the number remaining
in hospital December i, 1880, 113; all males. Admit-
ted durmg biennial period, 215; males, 69; females
146. Whole number under treatment, 328; males, 182
females, 146. Discharged, loi ; males, 69; females, 32
as follows: Recovered, 32; males, 20; females, 12
Improved, 26; males, 17; females, 9. Unimproved, 9
males, 8; females, i. Died, 25; males, 15; females, 10
Remaining under treatment, November 30, 1882, 236
722 Hospital Notes.
males, 122; females, 114. Dr. Bowers has been fortunate,
considering the crowded condition of his hospital, in clos-
ing his biennial record without accident or disaster of
any kind. In view of recent additions it is to be hoped
that no such overcrowding may again exist.
First Minnesota Hospital for Insane, at St. Peter.
— Biennial Report. Number of patients December i, 1880,
612; males, 271; females, 341. Admitted during bien-
nial period, 439; males, 249; females, 190. Total num-
ber under treatment, 1,051; males, 520; females, 531.
Discharged, 415; males, 167; females, 248, as follows:
Recovered, 106; males, 60; females, 46. Improved, 96;
males, 36; females, 60. Stationary, 115; males, 29;
females, 86. Died, 98 ; males, 42 ; females, 56. Re-
maining under" treatment November 30, 1882,636; males,
353; females, 283. Dr. Bartlett has had need of all his
skill to properly conduct the affairs of his large institution
during the last biennial period. That he has succeeded
so well is highly commendable, and with the restored
buildings in better form than before the disastrous fire,
we shall look forward to an administration of his hospital
alike creditable to himself and the State he serves.
Cincinnati Sanitarium. — The total number under treat-
ment during the year, 164; males, ill; females, 53.
Admitted during the year, 117; males, 86; females, 31.
Discharged and died during the year, 108; males, 79;
females, 29, as follows : Recovered, 49 ; males, 38 ; females,
II. Improved, 41; males, 28; females, 13. Unimproved,
14; males, 10; females, 4. Died, 4; males, 3 ; females, i.
Remaining November 30, 1882, 56; males, 32; females,
24. Dr. Everts gives to the profession refreshing evidence
of what may be accomplished in the cure of insanity, and
did space permit, we should be glad to lay before our
readers the full text of his classical report. His ideas on
the ratio of insanity in the United States are highly flat-
tering to our native population, he claiming with great
plausibility, croakers to the contrary notwithstanding, that
lunacy is not on the increase in our day amongst Ameri-
cans; the causes of our greater immunity being that the
organic heritage of native Americans is superior to that
of any other civilized people, that they are the most gen-
erously fed, and freer from the disease of drunkenness
than were their immediate or remote ancestors; and that
our reputation of fast living and overwork is erroneous
it being only the natural unrest of a free populace, who
Hospital Notes. 723
may spring or climb from the lowest to the highest stratum
. solely by their own activities. To those who had the
pleasure of visiting the Sanitarium during the session of
the Association of Superintendents at Cincinnati, the mod-
esty of the doctor's reference to that visit will be appar-
ent ; for an asylum more nearly approaching the ideal it
would be difficult to find. One point in this report must
strike the most superficial reader. It is the fact that the
necessities of the hospital seem to be anticipated by the
directors in a spirit of true economy, and we do not find
the begging and imploring for essential improvements, as
in hospitals under pubHc control. The pleasing and ele-
gant appearance which the report presents might be copied
to advantage by some of our larger and more pretentious
institutions.
State Insane Asylum, at Cleveland, Ohio. — Total
number under treatment during the year, 848 ; males, 429 ;
females, 419. Admitted during the year, 226; males, 115;
females, in. Discharged and died, 226; males, 124;
females, 102, as follows : Recovered, 91 ; males, 48 ; females,
43. Improved, 44; males, 25; females, 19. Unimproved,
61; males, 35 ; females, 26. Died, 28 ; males, 15; females,
13. Not insane, 2; male, i; female, i. Remaining under
treatment November 15, 1882, 622; males, 305; females,
317. Dr. Strong certainly has reason for gratulation in
the special prosperity of his charge during the year; a
death percentage of only 4.43 on average population, and
a recovery percentage of 40.26 on admissions would indi-
cate the most favorable surroundings. Dr. S. discusses
quite fully two subjects of great importance to the public
at large as well as the profession, to wit, the alleged con-
finement of sane persons in asylums, and objections to inebri-
ates in asylums. In view of recent terrible occurrences
how prophetic sounds the warning, " The nonsense, twad-
dle and falsehood about the confinement of sane people
in asylums should cease, and a portion of the energy, at
least, which is directed to such a mischievous work, should
be turned into the wiser and better channel of urging the
prompt and early admission of the insane to asylums.
The trouble does not lie in the number of sane people
who are in asylums, but the number of insane people who
are outside of asylums. It is due to this fact that homi-
cides by the insane horrify, from time to time, every
community, and that suicides, possibly suicides and homi-
cides combined, embracing the slaughter of whole families.
724 Hospital Notes.
so unexpectedly and too frequently shock society." We
regret that want of space precludes further extracts, but
we most earnestly beg our confreres of the daily press to
a perusal of the entire articles, to the end that our people
may be so instructed on this vital question as to avoid
the terrible evils, to the unfortunate lunatic as well as the
sane, of false teaching and cruel apprehension. In dis-
cussing the bearings of inebriety and insanity, the doctor
takes the most radical stand ; regards all attempts to
sugar-coat drunkenness as an error, contending that it is
simply and plainly a crime, to be treated solely and dis-
tinctly as such, without regard to color, sex or previous
condition.
State Insane Hospital, at Tuscaloosa, Alabama. —
Biennial Report, Number under treatment September 30,
1880, 402; males, 213; females, 189. Admitted, 260;
males, 130; females, 130, Whole number under treatment,
662; males, 343; females, 319. Discharged during the two
years, 245; males, 134; females, iii, as follows: Recov-
ered, 126; males, 64; females, 62. Improved, 49; males,
24; females, 25. Unimproved, 13; males, 9; females, 4.
Died, 57; males, 37; females, 20. Remaining under treat-
ment September 30, 1882, 417; males, 209; females, 208.
A peculiar feature of the discipline of Dr. Brice's estab-
lishment is the imposition of a small fine in money for
every careless or willful neglect of duty. The doctor
thinks it " secures a more efficient corps of nurses and em-
ployees, since the insubordinate and worthless characters
who are always on the look-out for easy places, seldom
apply to us for employment." The open door system is
discussed with practical intelligence, as also the necessity
of occupation and amusements for the insane ; in fact the
whole report evidences the skill which has been rewarded
with such successful results during the past two years.
Eastern North Carolina Insane Asylum. — Remaining
January i, 1882, 89; males, 34; females, 55. Admitted
during the year 45 ; males, 15 ; females, 30. Whole number
under treatment, 134; males, 49; females, 85. Discharged
during the year, 89; males, 37; females, 52, as follows:
Recovered 17; males, 8; females, 9. Improved, 6; males,
i; females, 5. Much improved, 2; male, i; female, i.
Unimproved, 5; males, 2; females, 3. Died, 21; males,
4; females, 17. Dr. J. D. Roberts repeats the more room
more cures. It is a crying shame, with the light before us
in this nineteenth century, to stint the lunatic in room,
Hospital Notes. 725
either inside or outside the hospital walls. We would far
rather see the Gheel system, with all its disadvantages, than
the jail system.
Western Lunatic Asylum, at Staunton, Virginia. —
Remaining at beginning of year, 492; males, 217; females,
275. Admitted during year, 131; males, 87; females,
44. Total number under treatment. 623 ; males, 304 ;
females, 319. Discharged during the year, 115; males,
53; females, 62, as follows: Recovered, 66; males, 26;
females, 40. Improved, 7 ; males, 3 ; females, 4. Un-
improved, 7 ; males, 3 ; females, 4. On furlough, 2
males. Died, 33; males, 19; females, 14. The report
of Dr. R. S. Hamilton, while reflecting great credit upon
his management, shows a sad condition of affairs in the
" Old Dominion." For want of space two out of every
three applicants for treatment, had to be rejected. This
should not be, for even admitting the chronic character
of this large proportion of rejections (and they could not
all have been incurable), the economical care of this
class has been so clearly demonstrated of late years, that
the community which thrusts them into county jails and
poor-houses, is lacking equally in humanity as well as
economy.
Central Lunatic Asylum (for Colored Insane), at
Richmond, Virginia. — Number at beginning of year, 351 ;
males, 159; females, 192. Admitted during year, 165;
males, 83 ; females, 82. Whole number under treatment,
516; males, 242; females, 274. Discharged during the
year, 135 ; males, 73; females, 62, as follows: Recovered,
85; males, 51; females, 34. -Improved, 5; males, 3;
females, 2. Died, 45 ; males, 19 ; females, 26. Remain-
ing under treatment September 30, 1882, 381 ; males,
169; females, 212. The colored population of Virginia,
seem to be looked after better in the matter (if not the
manner) of provision for their insane, than the white;
for we are told by Dr. David F. May, that all patients
making application, and found to be meritorious, are
received, while, as we have seen at Staunton, two out of
three are rejected. The report is in every way creditable
to the asylum.
State Homceopathic Asylum for the Insane, Middle-
town, New York. — Number present at beginning of
year, 216; males, 108; females, 108. Admitted during
the year, 175 ; males, 82 ; females, 93. Whole number
726 Hospital Notes.
under treatment, 391; males, 190; females, 20. Dis-
charged during the year, 151; males, Jj; females, 74,
as follows : Recovered 69 ; males, 36 ; females, 33.
Improved, 13; males, 6; females, 7. Unimproved, 48;
males, 22 ; females, 26. Not Insane, i female. Died,
20; males, 13; females, 7. Our orthodox friends need
not be horrified, for with the exception of the title page,
not a line appears in the whole report that does not
command the respect and commendation of the most
sectarian advocate. Dr. Talcott must be exceedingly
fortunate, or else (and this the worthy doctor would most
strenuously resent) the name of his institution deters the
masses, for every page breathes a satisfaction with his
accommodations which few superintendents feel. The
articles on " The commitment and discharge of patients,"
and the habeas corpus, are well worthy the perusal of all
interested. He says very pertinently, "That a sane man
may be imprisoned in an asylum, by prejudiced friends,
is, perhaps, a barely possible event. That sane men are
frequently committed to asylums as insane we have no
reason whatever, after careful observation and consider-
able experience, for believing." The doctor gives the
experience of releasing three patients under his care by
means of the " great bulwark and second Magna Charta
of British liberty." In case No. i (in 1878), the patient
was produced before " twelve good men and true," who,
with that knowledge of insanity which belongs intuitively
to the average layman, declared him sane and fit to be
at large. In a few days, mark you, this very jury peti-
tioned to have this "sane" man recommitted, as he was
threatening the lives of' the jurymen. Before, he had
only threatened to kill his wife, which he did absolutely
attempt, between the day of his release on habeas c 'rpics
and his recommitment. This man is now an inmai j of
the Willard Asylum for Chronic Insane. Last year two
patients were discharged by virtue of the great writ. In
a very short time one of these patients was locke<l up
in jail for threatening to kill his mother; a little later
the other was returned to the asylum as being unman-
ageable and desperate, having amused himself during his
few days of "sanity" in beating the heads of his helpless
little children against the walls of the house where he
resided. The doctor indulges in some very forcible and
truthful comments as to the responsibility of judges and
juries, for evil consequences to the community, and also
Hospital Notes. 727
for the frequently irreparable injury to the patient, who,
dragged from an asylum just as his mind is resuming its
normal condition, forced by excitement again into a
state of maniacal excitement, is recommitted, and drifts
into the wards of a chronic asylum, a burden to the
community for life, through the criminal interference of
busy-bodies, and the more criminal ignorance of a part-
isan judiciary. We regret that want of space precludes
further notice, but earnestly implore all who really have
the good of the insane at heart to peruse the whole of
Dr. Talcott's report, and learn from the lessons taught
therein, that such meddlesome interference is not philan-
thropy.
State Insane Asylum, Augusta, Maine. — Remaining
December i, 1881, 450; males, 240; females, 210. Ad-
mitted during year, 198; males, 116; females, 82.
Whole number under treatment, 648 ; males, 356 ; females,
292. Discharged during the year, 183 ; males, 103 ;
females, 80, as follows: Recovered, 71; males, 38;
females, 33, Improved, 35 ; males, 21 ; females, 14.
Unimproved, 34; males, 17; females, 17. Died, 43;
males, 27; females, 16. Remaining November 30, 1882,
461 ; males, 252 ; females, 209. In this report Dr.
Henry M. Harlow, makes his adieu to the public after
thirty-seven years of continuous service in this hospital,
thirty-one of which have been as superintendent. That
the Board of Trustees, in their flattering notice of the
doctor, only echo the feelings of the people of Maine —
professional as well as lay — is well known, and we can
only join in their wishes for long years of that otiinn cum
dignitate which properly follows so long a career of use-
fulness and mercy.
State Lunatic Asylum, Trenton, New Jersey. —
Remaining October 31, 1881, 577; males, 307; females,
270. Admitted during year, 186; males, 96; females,
90. Whole number under treatment, 763 ; males, 403 ;
females, 360. Discharged during year, 134; males, 74;
females, 60, as follows : Recovered, 48 ; males, 27 ;
females, 21. Improved, 24; males, 10; females, 14.
Unimproved, 5; males, 3; females, 2. Died, 57; males,
34; females, 23. Remaining October 31, 1882, 629;
males, 329; females, 3CX). Dr. Ward enjoys the felicity
of reporting a prosperous year, as an uneventful one in
an insane asylum must always be. No accidents, no
epidemics, a gratifying restoration to the duties of life of
728 . Hospital Notes.
many who had come to him under a darkness deeper
than death, are all subjects of gratulation.
State Asylum for the Insane, at Topeka, Kansas. —
The Second Biennial Report shows: Remaining June 30,
1880, 121; males, 69; females, 52. Admitted, 116; males,
58; females, 58. Whole number under treatment, 237;
males, 127; females, no. Discharged during biennial
period, 92 ; males, 46 ; females, 46, as follows : Recovered,
54; males, 34; females, 20. Improved, 15; males, 5;
females, 10. Not improved, i female. Eloped, 2 males.
On visit, I female. Died, 19 ; males, 5 ; females, 14.
Remaining June 30, 1882, 145; males, 81; females, 64.
Despite the not-to-be-foreseen difficulties of the first few
years of an asylum for the insane (and not the least is the
want of trained subordinates), Dr. Eastman has left the
Topeka hospital in a condition alike creditable to the State
and himself. His recommendations for increased space will,
it is hoped, be adopted ; and with these and the new
asylum at Osawatomie, the State of Kansas will, in its care
of this unfortunate class, as in every other philanthropic
cause, stand as the very foremost of our Western States.
We shall greatly miss Dr. Eastman from the ranks of psy-
chiatry, and trust that his rare abilities and well-matured
experience may soon again be devoted to his noble
specialty.
Government Hospital for the Insane, Washing-
ton, D. C. — Remaining June 30, 1881, 925; males, 700;
females, 225. Admitted during year, 247; males, 178;
females, 69. Whole number under treatment, 1,172; males,
878; females, 294. Discharged during year, 230; males,
169; females, 61, as follows: Recovered, 81; males, 60 ;
females, 21. Improved, 39; males, 31 ; females, 8. Unim-
proved, 7; males, 2; females, 5. Not insane, 2 males.
Died, loi ; males, 74; females, 27. Remaining June 30,
1882,942; males, 709; females, 233. The Twenty-seventh
Annual Report of this magnificent institution presents to
the alienist exceptionally full and accurate statistics. The
sHght increase in death rate is accounted for by the termi-
nation of a number of chronic cases from organic disease of
brain, more than one-third of the deaths being from that
cause alone. In these days, when the subject of providing
for the chronic insane is occupying the deepest thoughts
of our philanthropists, a visit to " St. Elizabeth " might
be productive of good results. For several years a sys-
tem of "relief" to the "close" hospital has been here in
Hospital Notes. • 729
practical operation, and so favorable have been the results
that each year witnesses its extension. Dr. Godding, the
distinguished superintendent, with the modesty and pru-
dence of a scientific alienist, has not launched himself into
the arena as an exponent of any particular system of
buildings or treatment ; yet the every-day workings of his
asylum are an exemplification of what may be done with
" open doors " and home-like edifices, and astonishes the
visitor by the very silence in which such a great measure
of success has been attained.
Dakota Hospital for the Insane, at Yankton. —
Biennial Report. Number remaining December i, 1880,
36; males, 24; females, 12. Admitted during the two
years, 74; males, 50; females, 24. Whole number under
treatment, no; males, 74; females, 36. Discharged, 46;
males, 39; females, 7, as follows: Recovered, 23 ; males,
21 ; females, 2. Improved, 5; males, 4; female, i. Died,
18; males, 14; females, 4, Remaining November 30, 1882,
64; males, 35; females, 29. The disastrous destruction of
the temporary hospital buildings April 2, 1882, and sad loss
of life incurred (5 patients directly and a valued assistant
indirectly), would, coupled with the singular fatality of such-
institutions to fire, seem warning sufficient tg guard against
all preventative causes, yet we find Dr. McGlumpty com-
pelled to heat his new buildings by means of a stove, and
light his wards with coal oil.
State Insane Asvlum, Stockton, California. —
Number of patients July i, 1881, 1,102; males, 782;
females, 320. Admitted during year, 179; males, 144;
females, 35. Whole number under treatment, 1,281 ; males,
926; females, 355. Discharged during year, 186; males,
153; females, 33, as follows: Recovered, 71; males, 62 ;
females, 9; Improved, 1 1 ; males, 8 ; females, 3. Escaped,
II males. Died, 93 ; males, 72; females, 31. Remaining
July I, 1882, 1,095 ! males, 773 ; females, 322. Dr. Shurtleff
chronicles a year's work creditable alike to his manage-
ment and the munificence of the State of Cahfornia. He
is of the opinion, after an experience of twenty years,
that "intemperance in the indulgence in alcoholic bever-
ages and the general dissipation to which it leads, has
been the most prolific factor in the production of mental
diseases."
Reviews, Book Notices, &c.
CoMPENSAzioNi FuNziONALi DFXLA CoRTEXCiA Cerebrale (Functional
Oompensations of the Cerebral Cortex). By' Professor L. Bianchi,
Naples. .
The translator is indebted to the ijolitoness of the distinguished
author, for a copy of the above interesting and very instructive
work, wliich, within the compass of scventj'-three octavo pages, con-
veys an amount of valuable piactical matter, seldom presented in
productions of much greater bulk and far loftier pretensions. It is,
however, but fair to the ifader, who may have entertained the idea
of a cerebral duality in unity, by virtue of which the two symmetrical
hemispheres are endowed with a capacity of reciprocal functional
supplementation, so that when one of the two, from traumatic or
other morbific lesion, ceases to peiform its duty, the function is
assumed by its associate, to intimate to him that the views of the
autl or, ill this relation, are decidedly negative to this belief; and that
the conclusions drawn by him from the series of viviseetional experi-
ments made by him, are quite antagonistic to the theory of the
souppleance cerebrate of a ceitain class of French modern authorities
on cerebral physiology. Not only does Bianchi hold that the lost
function of a hemisphere is never taken up as an act of reciprocity
by its fellow, but that it is not resumed even on its own side, when
the lesion has been of such extent as to involve the whole, or the
greater part, of the motor centers which governed the previouj^ly
normal function. He does not, however, deny that a certain degree
of apparent motor compensation may be often observed, but he
ascribes this fact to the action of the medullary fibers whicli pass the
bulb without crossing to the opposite side. In every muscular move-
ment th(re is a eonsenaua of activity between the two hemispheres,
one indeed being the chief factor, but the otlier not nn inert looker
on. Jn persons laboring under incomplete h« miplegia, it. is ol}8 rved
that when they are requested to move the fnfetbled member, a
responding action will be observed on the part of the sound one.
When the limbs of dogs paralyzed on one side were stimulated by
pinching, etc., they remained motionless, whilst those of the other
side were excited into motion. Sensation continued, but not its
motor response, on tiie paralyzed side.
The animals experimented on by Bianelii were all of the canine
species, and were of both sexes, and various ages, and though it is
certain that the dog stands far below either the monkey or man in
cerebral organization and intellective capacity, yet, for the purpose
of Bianchi's thtorem, the n suits obtained were quite snllleient
To follow the Proftssor through the ample details of his expi-ri-
m<nts, or even to reproduce well chosen extracts from these and from
Reviews, Book Notices, &c. 731
Lis luminous observationp on their physiological significance, would
demand more space than the pages of the Aliexist could award to
them. As, however, the author has preAiced each geries of his
experiment* with a proposition exhibiting the conclusions which have
appeared Ui him to be dedueible from the facts observed, the reader
must, for the present, be content with the careful perusal of these,
until he possesses himself of the whole worii. the merits of which
should certainly justify some of our enterprising American publishers
in bringing out an early translation. It is very certain that they
award this grace to not a few far less deserving productions, and
were they better acquainted with the indomitable energy and scien-
tific exactitude displayed in the present day by emancipated Italy.
our American medical profession would soon become indebted to
them for a very acceptable and instructive supply of modern Italian
works.
The propositions of Bianchi, above alluded to. are as follow:
First. — Recovery from a paralysis consequent on a large destruc-
tion of the c0rtic.1l motor zone in dogs, is only apparent and partial ;
locomotion and its correlative acts are, alone, reintegrated : every
other movement in difierent conditions continues permanently {for
months) abolished, and strength remains permanently defective.
Second. — The parts (of the cortex) surrounding the excitable
points of the motor zone of the limbs left unhurt afrer a limited
destruction, may in some manner compensate for the functionality of
the destroyed part; but they do not acquire that electric excitation
power which was before displayed on the members whose cortical
center has been destroyed.
Third. — Locomotion is not represented in the cortex of the brain
of dogs by centers of its own {proprii). In these animals the corti-
cal motor zone may be destroyed without any durable disturbance
in their locomotion succeeding.
Fourth. — In dogs in which the motor zone of one side has been
largely destroyed, the opposite hemisphere, and especially its motor
zone, influences the movements of the limbs on both sides.
Fifth. — In the period of development the cortical motor zone in
dogs may assume the functions of the cerebellum, which has been
in great part destroyed.
From the preceding propositions it will be seen that the views of
Prof. Bianchi do not differ much from those of Ferrier, to whom.
Indeed, he seems to be pleased to avail of every opportunity of
awarding approval and support.
The reader will, perliaps, not accuse us of unwarrantable prolixity,
if we here introduce SDme extracts from the notes of Bianchi's two
experiments made on the cerebellum of a young dog, in demonstra-
tion of his fifth proposition. He does not say whether he first chloro-
formed the dog. in the first experiment; but he di^ so in the second,
and more than once, to his great grief, for, as he naively tells us.
he '-had the misfortune of the irreparable loss of this important
animal after a few inspirati ms of the chloroform." He must then have
732 Reviews, Book Notices, &c.
found himself in much the same quandary as the man whose horse
died just when he had educated him to live on one straw per dtiy.
Whether an American coroner's jurj^ instructed by Mr. Birch, would
have ascribed the poor dog's demise to the vivisectional injuries in-
flicted on his cerebellum, or to the lethal force ot the humane
anaesthetic, may be left as a moot question, for solution by the
humanitarian sisterhood. Here are the details:
Experiment IS. — (February 27, 1881.) On a male pup, eighteen days
old, which for several preceding days was observed to walk well, I
uncovered the cranium far back, below the occipital ridge. I made
an opening on the occipital bone, where it covers the superior vermis,
and through this opening I made three injections of chromic acid, of
two per cent, strength, into the cerebellar pasenchyma of the superior
vermis and two lateral lobes, most on the right side. I sewed up
the wound, and set the animal on the floor. He presented no unu-
sual phenomenon, — ^just as if nothing had happened to him, he walked
and went round the laboratory as perfectly as before.
Experiment 14- — (June 3, 1881.) The preceding young dog, fed from
the first quite well, as long as he sucked his mother. He never
showed disturbance of any sort in any of the senses, as far as it
was possible to judge, by our usual means of research, exhibiting no
difference in all the manifestations of life, when compared with the
others of his own age; but in his ulterior development he appeared
very different from them. He was more torpid in his movements, less
speedy, less playful than the others, and certainly less intelligent.
He seemed to become tired after a few paces, and as if worn out ;
he recognized his mother, and always kept close to her; he knew
those who had care of him, and he played with us, but not so lively
as the others; he knew where his kennel was, and fan to it; but
how much did he diffier from his brother, the co-survivior of the
same litter! He was tardy and slow in every action; he had been
the largest of the six, and now he was about half as big as the
other; his hair was not glossy — it was bristly; the skin was ill-con-
ditioned and wrinkled; he looked old.
More than three months after the first experiment (13th), being
politely assisted by Dr. Adriani, I laid bare, with a large trephine,
the whole of the sigmoid gyrus on the left, and the anterior branch '
of the second external convolution. I chloroformed the animal, but
after a few inspirations, breathing was suddenly arrested ; I patiently
practiced artificial respiration, and the animal revived ; I cut the
dura mater, and produced a haemorrhage, which I waa able speedily
to stop. In his state of hemi-anaesthetia, I proceeded to electrization,
with the Farradic current, so very weak that I hardly perceived it on
tiie inner surface of my lips.
The foreleg was represented by almost the whole of the sigmoid
gyrus; there was an area, by which the shoulder was carried forward
and outward; another by which the shoulder and the foot were car-
ried inward and a little forward ; another whose excitation provoked
associate movements of the two foreleg«; the foreleg of the side
* Reviews, Book Notices, &c. 733
opposite to the wounded side of the brain, was carried forward,
upward aud outward ; the foreleg on the same side with the lesion,
was carried backward and a little outward and downward, slightly
tiexed. With my friend Dr, Adfiani, I established these movements
many tunes, and always alike, by exciting in every instance the same
zone, with the feeblest current, and keeping clear of all contact with
the dura mater and every other source of error. Prolonged excitation
of any one of the before mentioned zones provoked epileptic seizures,
which were especially, and with the greatest readiness, determined
by stimulating, with even the feeblest current, the cortical zone of
the orbicularis palpebrae, the zygomaticus, and the muscles of marti-
cation. JJy repeating the experiments I obtained, on the same zones,
always the same effects. I wished to destroy all of this zone, but first
I would assure myself whether the same movements might be obtained
in a more profound and complete chloroformization; but after a few
inspirations of the chloroform, I had the misfortune of losing irrep-
arably this important animal! {Heu me miserum, non canem!)
Autopsy. — This was made shortly after, the death of the animal,
very accurately, by Dr. Adriani, who made the following notes: The
motor zone, specially represented by the sigmoid gyrus, was more
developed than ordinary ; the sigmoid gyrus on the left, sensibly larger
than that on the right; the rest of the cerebrum throughout normal
in form. The cerebellum almost completely destroyed. Viewed from
above it was but a formless pultace, broken down, as if it had gone
into total softening and ulceration; the borders of the lateral lobes
were softened and broken down, so that what remained of them was
externally wasted, as was also the vermes, or rather the part which
occupied the seat of the superior vermes, so that for a great extent
the medulla oblongata was left uncovered. There was hardly any
difference between the right lobe and the left. Viewed on the under
surface, only the anterior and more curved portion of the inferior
vermes was observed; of the two lateral lobes the lower stratum,
towards the interior on each side, was merely in part preserved.
Perhaps the experiments above detailed are, as throwing additional
light on the function of the cerebellum, the most important of the
whole series practiced by Bianchi. He, however, very truthfully says,
that the grave diflaculties connected with cerebellar experimenta-
tion, and especially that of preserving the animals in life, after the
complete destruction of the cerebellum, must render such explorations
very embarrassing, and debar the possibility of numerous observations.
The adult dogs thus operated on by him, "all, or almost all, died in
a short time, in consequence of the grave operation ; " and he adds
" partial extirpations or destructions are inconclusive for our object."
Bianchi's obsei-vations on the cortical area of vision, which he
says is very extensive in the dog, are worthy of particular notice.
He summarizes these under the following heads:
(o) The fibers of the retina of each eye go in great part to
the cortical center of the opposite hemisphere, and in less num-
ber to that of the hemisphere of the same side.
734 Reviews, Book Notices, &c.
[h) The visive cortical center of the dog is very extensive, com-
prehending the whole of the second external convolution, from its
anterior extremity to the occipital lobe, including this and part of
the first and third external convolution (the middle and the posterior
parts).
(c) The compensation (for visive function) is made by the part
remaining sound, of the cortical center, which has been partially de-
stroyed in the same hemisphere. Very doubtfully, or not at all, does
the opposite hemisphere contribute to the compensation.
Bianchi reduces his conclusions into the following thirteen corol-
laries :
" Firti * — There is a cortical zone on the anterior- lobe of the
cerebrum, which has not determinate limits, but which does not reach
farther than one centimeter behind the posterior limits of the post-
crucial convolution in the dog, and which contains motor elements
for all the musculature of the opposite half of the body.
^'^ Second. — On this large cortical surface only some points are excit-
able; the rest, though containing motor elements, are inexcitable.
^^ Third. — Some muscular groups are certainly represented on distinct
areas within the limits of this zone, but they are also represented,
though more sparsely, in all the rest of t!ie zone, so that in partial
destruetions, that which remains uninjured in the zone compensates
in part for the function of the destroyed part.
^^ Fourth. — Only extirpations over a great part of tlie motor zone
give place to perraament motor disturbances.
'■'Fifth. — The motor zone of the sound hemisphere, up to a certain
point, compensates the lost function of the mutilated hemisphere, not
by its assumption of a new function, but from the pre-existence of
anatomical relations with the muscles of the same side, and of homol-
ogous anatomical elements.
'• Sixth. — Locomotion is not a function of the cortex, as a mechan-
ism or motor-act, but only as a motor impulse, generated in the
sensorial and intellective spheres.
*NoTtt — Tlie present translator desire^ to intinate to ih(» readers of the
Alienist and Neurologist, that ilic rendering of Binnchi'g " conclutiont,'
which api)eari'd in the July i^8ue, on |)ases 537, 538, was not Inrnished by him.
Ciiveful comparison of the two versions will show, that in a few important in-
stances llie real meaning of the aiulior his been misunderstood. It niijfht have
been as well to have cut dowu No. 13 as l;irj;ely as was done with No. 12; or
still better, to have exterminated both. It is, however, but an act of justice on
the part of the present writer, Xn confess that h'* had himself much diilicnlly In
reaching a satisfactory translation. iCver)' reader of Italian well knows that
the (inding of exactly equivalent English w.)rds, thouih sonnetinies a quasi impos-
sibility, is by no means his crrea'est einbarrassnaent. It is far rather, the taking
asunder of long sentences, and i)!:icing their pans in that order of succession
whicti best comports wdh our own graniinatli-al reqiili-einents, and at the same
tirae does no violence to the sense of the anther. the Italian, like itA parent
tongue, tlri I/itin, owing to its c ompar iilve riohness in grammatical inflections,
permits a wide liberty of arr.ingeraenl of the members and words in any sen-
tence—a liberty totally foreign to our emasculated and mutilated would-be
Anglo-Saxon.
Reviews, Book Notices, &c. 735
" Seventh, — Disturbances of the tactile sense from limited abstraction
of the motor zones, are absolutely undemonstrable in dogs.
^'■Eighth. — On the cerebrum of dogs there is a zone which is pro-
miscuously motor and sensory ; it is the anterior branch of the second
external convolution, which is either carried off along with the
sigmoid gyrus, thus rendering the hemiplegia more grave, or it is
extirpated by itself, and disturbs the motility of the dog, and his
eight also.
" Ninth. — The center of sight is represented by a large extent of the
cortex, which may be divided into three segments; the isolate extir-
pation of any one of these segments is equivalent to that of the
whole, but with only temporary effect, and what is spared of the
center suffices to re-establish sight,
" Tenth. — Extirpation of the whole cortical center of sight, as it has
been considered by me, is equivalent to the cutting of the posterior
segment of the internal capsule; it produces permanent visive disturb-
ances. The compensation, then, is made when the lesion is circum-
scribed by the same hemisphere, and not by the opposite one.
" Eleventh.— The visual disturbances provoked by cortical extirpations
are not an amblyopia in the opposite eye, but always a bilateral
hemianopsia. Each eye is represented on both the hemispheres ; but
more on the opposite than on the same side with the lesion.
" Twelfth.— isight is a complex function, resulting from numerous
elementary momenta, represented in different cortical zones, which
are compensatory in the re-establishing of vision, when one or more
of them has been destroyed. Volitive movement is also a complex
fact, of which all the psychical momenta remain unaltered after the
destruction of the known motor zone, by which destruction are
abolished the motor elements that represent the ultimate station, in
which sense and all the other psychical acts proceeding from it are
transformed into excito-motor force, finding here the anatomical and
functional dispositions adapted to the differentiation and co-ordina-
tion of movements.
" Thirteenth. — The concept of localizations in general should not be
assumed in the absolute sense of the word, but rather in a relative
sense, considering that on the one part the anatomical limits of any
cerebral function have not been determined; and on the other part,
no function is normally accomplished without the concurrence of all
those elementary processes of which it is the ultimate expression ;
whUst, parallelly, the anatomical area on which it appears to be con-
summated, is the last station in whose normal functioning all those
preceding it concur, and in which the materia prima, or indistinct
force, assuming new characters, is always determined in that form,
which, in the diverse gradations of life, reaches our senses, and our
intelligence, whose analytic power has hitherto remained much inferior
to the complexity of the problem."
The foregoing extracts, though fraught with instnictive matter, we
are forced to admit present but a fragmental outline of the facts
detailed by Professor Bianctil, and the important inferences drawn by
73^ • Reviews, Book Notices, &c.
him from them. The minute details of his various experiments could
not fail to he practically instructive to all those engaged, or interested,
in physiological research, the number of whom on this side of the
Atlantic, is indeed lamentably small, and it is to be feared, is likely
to continue so. We patronize and protect dog catchers, and dog kil-
lers, who do their work in the way most comfortable to themselves
—whether by carbonic acid fumes, pistol bullets, hanging, strychnine
or any other most handy means; and we daily eat the flesh of many
sorts; of animals, without ever enquiring as to the humanitarian pro-
cess by which the butcher has deprived them of life; for any such
fastidious questioning might blunt our appetite and seriously aflFect
our digestion. Indeed, indeed, we are tender-hearted, animal {id est
beef) loving, and patronizingly pious people, and in everything
relating to rational, useful and beneficial physiological research, we
are just about as stupid, proud and pig-headed as too much beef can
make us.
But, as Sterne said, " They manage these things better in France."
better too in Germany, and far better in Italy. The glorious old
Peninsula, once the cradle of anatomical and physiological science,
and the fostering nurse of the art of surgery, now actually teems
witl) ardent, keen-sighted and tireless searchers after truth; and who
is the pretender to the love of science and the best interests of
humanity, who will hesitate to wish them success?
In the very first lines of his present work, Bianchi writes thus:
"In our science it happens almost always, that every new discovery
which seems destined to the solution of a great problem, carries in
itself the germs of new and ever-for\\ard-pressing unknown mysteries,
towards which our incited minds run, gleaning, as they can, straying
rays of light, which may guide us in thai ever profound obscurity in
which life and all nature lie concealed." So has it ever been, and ever
must be, and happy for us that it is so, for what would human life
be, unstimulated by the craving for further knowledge of the works
of the Infinite?
Insanity; Its Causes and Frkvention. Henry Putnam Stearns, M. D.,
Sup't Retreat for the Insane, Hartford, Conn. Lecturer on Insanity
in the Medical Department of Yale College, etc., etc. G. P. Putnam
& Sons, New York, 1883.
There is no law in this country against book making. Every-
body is at liberty to write and print if they can find publishers— or
can pay for printing, themselves. The multiplication of medical books,
and medical journals, in the United States, of late years, is some-
thing phenomenal. Every artifice of tlie publishing craft is resorted
to, to ornament tlie shelves of tlie doctors' libraries, throughout the
land. Every possible pretext for representing all works, and creating
new ones on the same subject, is urged upon the credulous. Happy
is he, who if he reads much, has a mind sutticiently tenacious to
resist the otherwise consequent dilution. Happy are the credulous
wiio believe in the authenticity of books. Happy are the skeptical
who do not have to add to their natural suspicion of the fallibility o*
'Reviews, Book Notices, &c. 737
books in general, personal knowledge of the incompetency and vain
pretensions of facUe authors. A mere literary faculty is one thing;
knowledge, sincerity, integrity of purpose, and fidelity of statement,
which should characterize medical literature, are quite another thing.
At whose behest is this flood of medical literature being poured
out? It is not in the interest of science, surely! An annual volume
of a hundred pages would meet all the demands of science — would
record everything new in physiology, pathology, chemistry, and
physics. As for practice — all progress might well be announced in a
paragraph. For example, "Great improvement in the treatment of
diseases has resulted from an increasing confidence in the operations
of nature, and a material reduction in quantity of drugs adminis-
tered."
What occasion has there been for a new edition of Watson's
Pratice of Physic, beyond the insertion of such a paragraph under
the head of ireaitnent? What occasion— so far as science is interested,
for any other book of practice, since Sir Thomas wrote? What
excuse, except, there is no law against it.
Who ever reads this little book of Dr. Steam's on Insanity; Its
Causes and Prevention, may fail to see the relation of the foregoing
criticism of medical book making in general, as a preface to a notice
of this excellent production of a most worthy author, in particular.
There can be no other relevancy than that of contrast. This book is
not a digest of European bibliography on the subject treated, mixed
with a modicun of American egotism and personal advertising. It is
a modest, conservative, candid, clearly-expressed summary of what
may be regarded as knowledge, at the present time, on the subjects
treated. It is written for intelligent readers of all classes or profes-
sions; for the benefit of all classes, rather than for personal aggran-
dizement, or the gratification of an over-weening vanity. It has neither
the monotonous twang of the pedagogue — the over-awing tone of Sir
Oracle, nor the metallic blaze of the self-trumpeting egotist it is
indeed, in manner, matter, and purpose, "eminently respectable," and
(which can not be said of most other medical books of the season)
it is timely.
The subjects treated of in the various ciiapters of Dr. Steam's
little book (248 pages) are: '"Increase of Insanity," ''Insanity and
Curlesa'ion,'' ''The Insane Diathesis." "The Influence of Education,"
'•Industrial Education," "Moral Education," "Heredity," "Alcohol,"
" Tobacco," " Sex in relation to Insanity,'' '• Poverty."' " Religion,"
'• InsuflScient Sleep," etc. From which it wiU be seen, by the profes-
sional reader, that the book is not designed to present the whole
subject of insanity in a systematic treatise, but is limited to a pre-
sentation of certain correlatable subjects of great importance to the
public as well as to practitioners of medicine and psychiatry. To
present the author's views on these various topics would be to
republish his book— which is not only protected by copyright, as the
property of U. P. Putnam & Sons, but by a proper sense of the
authors right to be read in his own language. So, with the full
73^ Reviews, Book Notices, &c.
assurance that no intelli|:ent man or woman can read this book without
being profited thereby, and that no one can be misled, to his or
her own detriment, by any proposition affirmed, or suggested as
probably true, by the author — the book is cordially commended to
the reading public. E.
Dr. Mann's Book on Insanity. — It has been a legitimate criticism
upon the labors of those in this country engaged in treating the insane
in our many large and well-ordered establishments both public and
private, that from the time of Rush until the present year, no American
book on insanity at all commensurate with the dignity and importance
of the subject had been written.
The present year is distinguished by the almost simultaneous publi-
cation of three treatises in which it is considered from different stand-
points. The work before us aims to be a practical reference book for the
general practitioner. As such it embodies the consideration of the most
frequently occurring pathological brain and nerve manifestations without
entering too deeply into the philosophy of mind or mystifying the reader
by words and phrases which are out of the ordinary range of the physi-
cian.
The first thing that strikes us in the perusal of Dr. Mann's book is the
free use which he has made of the experience of other alienists, and what
especially marks a difference between it and the other works published by
American authors is the fact that the ripe experiences of our own special-
ists are freely quoted. The names of Ray, Kirkbride, Gray, Earle and
others, appear as frequently as those of English and German authorities,
who have too long been regarded as the exclusive exponents of doctrine
and practice.
The results worked out by American alienists in hospitals for the in-
sane have been to a large extent incorporated in the able reports which
they have presented yearly, or have appeared as occasional contributions
to the various medical journals. These embrace the opinions and practice
of men of large experience. No candid seeker after truth would ignore
their just claims as authority, and we are glad to see that Dr. Mann has so
far enlarged the scope of his work as to include these results with his
own.
The book is naturally divided into two parts, the first treating upon
the general subject of insanity with its classifications, diagnosis, pathol-
ogy, medico-legal aspects, treatment, etc. The second, upon the various
allied diseases of epilepsy, hysteria, hyperaemia and anaemia of the brain,
etc.
The subject of hereditary transmission of insanity and the repression of
mental disease in its incipient stages is well considered. The practical
recommendations In regard to education and the social evils of modern
life should be read by every physician. As Dr. Mann truly says, " We
must look to the general practitioners for practical aid in stemming the
great and growing tide of insanity."
Upon the Important topics that have occupied the attention of those
interested in the welfare of the insane. Dr. Mann has taken an advanced
position. The subject of non-restraint receives a careful consideration
Reviews, Book Notices, &c. 739
and the system of complete non-restraint he regards as one of the possibili-
ties of the future. " The necessary conditions for this are, that our asylums
must not be overcrowded as they are to-day, and that the patients must be
under constant medical supervision."
Clinical lectures and instruction upon the subject of insanity — early
removal of patients to an asylum — small hospitals and more of them, are
made the basis of very sound suggestions. The legal aspects of insanity
and mental responsibility are fully treated. Great prominence is given to
hereditary influences and deficient cerebral organization in considering the
test wtiich the law should recognize as a valid defence in criminal cases.
To the general practitioner the remarks upon the examination of medico-
legal cases and the functions of experts will be especially valuable, while
the practical suggestions and typical cases Ulustrating the various phases
of mental action in inebriety, trance state, epilepsy, etc, cannot fail to be of
great importance to the legal profession.
The pathology of insanity is considered in relation to abnormal cere-
bration. The various changes are well described and illustrated by typical
cases. According to Dr. Mann, " the theory of localization of brain func-
tion does not throw as much light as we could wish, or lead to much
practical benefit in the treatment of cerebral diseases." The allied affections
of epilepsy, hystero-epilepsy, chorea, locomotor ataxia, spinal concussion,
etc, etc., are treated very fully. The author, while giving in detail the
results of treatment which he has pursued, has drawn largely from the ex-
perience and practice of other physicians.
It will in no way detract from the merits of other cotemporary works
to say that Dr. Mann's book will supply a want which no other has yet
filled, viz., a manual of plain rules for guidance in the practical con-
sideration of insanity and the treatment of the various allied nervous
affections. — Dr. Hesae^ of Philadelphia.
The time is fast approaching when the many diploma mills that dis-
grace the profession with inferior grists, will be forced to manufacture
better grade doctors, or stop running. We recommend the new roUer
process schools like the St. Louis Medical College, Havard and Penn-
sylvania Universities, which make only good brands, and take more
time to make them. Good grade doctors are like good brands of flour,
they are appreciated when they become known.
Medical Education and the Regulation of the Pkactick op
Medicine in the United States and Canada. Keport of the Illinois
State Board of Health, 1883. This report is fuli of useful information
on these subjects, and reveals the shallo>v merits of many as well as
the excellent endeavors of some of our medical schools to exalt medical
education on this continent
The Continental Magazine is an excellent literary magazine for
the home and the hospital, its contents being entertaining and instructive.
Its low price, six cents per month, or fifty cents per year, commends it as
one of the cheapest of the meritorious periodicals. To every subscriber
who sends us a new subscriber to the Alienist and Neubologist for
1884, we will send this publication one year as a premium.
740 Reviews, Book Notices, &c.
The Physician's Daily Kecord, published by the D. G. Brinton
Medical Publishing House, No. 115 South Seventh Street, Philadelphia,
Pa., is an indispensable pocket companion for the busy practitioner of
medicine.
Adherent and Contracted Prepuce, commonly called Congenital
Phimosis. By De Forest Willard, M. D., Lecturer on Orthopaedic Sur-
gery in the University of Pennsylvania, and Surgeon to the Presby-
terian Hospital. Read before the Philadelphia County Medical Society,
April 11, 1883. (Reprinted from the Philadelphia Medical Times for
June 30, 1883.)
Anatomy, Surgery, and Hygiene of the Rectum. By Joseph East-
man, M. D., Professor Diseases of Women and Clinical Surgery,
College of Physicians and Surgeons, Indianapolis, Ind. Read before
the Indiana State Medical Society, May, 1883. (Reprint from the
American Practitioner, July, 1883.)
Des Effets Compares de Divers Traitements de la Fievre Typhoide
et de Ceux Produits en Particulier, par L'Ergot de Seigle de Bonne
Qualite. Par Le Dr. Duboue (de Pau), Membre Correspondant de
L' Academic de M6decine de Paris. Labor improbua omnia vindt.
1882.
Club-Foot; Simple Measures for its Early Relief. By De Forest
Willard, M. D., Lecturer on Orthopaedic Surgery in the University of
Pennsylvania, Surgeon to the Presbyterian Hospital, etc. Extracted
from the Transactions of the Medical Society of the State of Penn-
slyvania, for 1883.
Kecherches Cliniques et Therapeutiques sur L'Epilepsie, L'Hyst6rie,
et L'Idiotie, Compte Rendu du Service des Epileptiques et des
Enfants Idiots et Arrieres de Bicetre Pendant 'L'Ann^e, 1881. Par
Bourneville, Medecin de Bicetre. Bonnaiie (E.) & Wuillaml6, Internes
du Service, Paris, 1882.
The Opium Habit; Its Successful Treatment by the Avena Satlva,
A paper read before tlie Mew York State Medical Society, February
9, 1882, with additions, giving a fuller description of its therapeutic
action in different diseases, etc. By E. H. M. Sell, A. M., M. D.
SuU' Alimentazione Forzata, Dei FoUi Sitofobi. Pel Socio Onorario
Prof. Vincenzo Leonardo Cera, Vice-Direttore del Manicomio Provinciale
di Napoli. Memoria estratta dal Kesoconto della R. Accademia Medico-
Chirurgica, Anno 37" Tomo 37° Gennaio a Giugno, 1883.
Myelitis following Acute Arsenical Poisoning (by Paris or Schwein-
furth Green). By E. C. Seguin, M. D., Corresponding Member of
the Verein fUr innere Medlcui, of Berlin, etc. (Reprinted from the
Journal of Nervous and Mental Diseases, Vol. IX., No. 4, October, 1882.)
A Report on Laceration of the Cervix Uteri. By T. B. Harvey,
M. D., Professor Surgical and (yllnical Diseases of Women in the
Medical College of Indiana. Stenograpliically reported for the Indiana
State Medieal Society, at Indianapolis, May, 1883.
Reviews, Book Notices, &c. 741
Contribuzione Alia Casuistica della Inversione Dell' Istinto Sessuale.
Pel Dott. Gugllelmo Cantarano. Medico ordinario del Manicomio pro-
vinciale e del R. Albergo" del Poveri. Estratto dal Giornale La
Paiehiatria.
A Case of Primary Monomania (Primare Verriicktheit). By C. B.
Burr, M. D., Assistant Physician to the Eastern Michigan Asylum,
Pontiac From the American Journal of the Medical Seiencea, July,
1883.
A Contribution to the Study of Neglected Lacerations of the
Cervix Uteri and Perineum. By Thomas A. Ashby, M. D., Professor
of Obstetrics, Woman's Medical College of Baltimore, etc., etc. Read
before the Clinical Society of Maryland, May 4, 1883.
Ambulance Service in Philadelphia. By De Forest Willard, M. D.,
Surgeon to the Presbyterian Hospital, Lecturer on Orthopaedic Sur-
gery, University of Pennsylvania. Read at the Academy of Music,
April 30, 1883.
A Tracheotomy Tube for Gradual Withdrawal, and Report of a
Case in which it was used. By H. F. Hendrix, M. D., of St. Louis.
(Reprinted from the St. Louis Medical and Surgical Journal, August,
1883.)
Professional Jealousy— Its Causes, Consequences, and Cures. By
R. Harvey Reed, M. D. A paper read before the North Central Ohio
Medical Society, at Mansfield, Ohio, June 27, 1883. (Reprinted from
Columbus Medical Journal for August, 1883.)
On a Peculiar Cutaneous Lesion (Ulcus Elevatum), occurring dur-
ing the use of Bromide of Potassium. By E. C. Seguin, M. D.
(Reprinted from the Archives of Medicine, October, 1882.)
Paralysis in Children, and Paralytic Contractions. A clinical lec-
ture, delivered by Edw. Borck, A. M., M. D., Professor of Surgery in
the College for MedicaJ Practitioners, St. Louis, Mo.
A Case Illustrating the Coincidence of Diseases ; Cervico -Brachial
Neuralgia and Aneurism of the Innominate Artery. By E. C.
Seguin, M. D.
Report of the Pauper Insane Commission, appointed to examine
into the condition of the Insane in the County Almsiiousea in New
Hampshire.
Diagnosis of Ovarian Tumore. Lectures delivered by Edw. Borck,
A. M., M. D., Professor of Surgery, etc., etc.
Medical Supervision of the Public Schools. By L. W. Baker, M. D.,
Baldwinville, Mass.
Cottage Hospitals. By L. W. Baker, M. D , Baldwinville, Mass.
742 Addendum.
ADDENDUM.
Dr. Charles W. Stevens has finally been confirmed
Superintendent and Physician of the St. Louis Asylum
for the Insane. He was the first Superintendent of this
institution. He is eminently fitted, by quahties of head
and heart and previous experience in the treatment of
the insane, to fill this position with credit to the city and
advantage to its insane wards.
0
P Alienist and neurologist
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