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Boston Medical Library
8 THE FENWAY
ur* ^^^^
The
of
Mental Pathology
Subscription Price : — $2.50 per annttm*
fSUL ^^
Smgfle Copies, 50 cents*
Edited by Louise G. Robinovitch, B. ts L., M.D.
]&clitorial Boarcl
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.), Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux), Dr. G. CESARE FERRARI, Editor Rivista Sperim. di Fren. (Italy).
Contributors' Staff
ALBANEL, L., LL. D., President Society Family Patronage (Paris) ; BAILEY, Dr. P. (New York) ; BAJENOW, Dr., (Moscow); BECHTEREVV, Prof. (Russia); BERILLON, Dr. Edgar (Paris); BLEULER, Prof. E. (Zurich); BLIN, Dr.; BOISSIER, Dr. F., BOURNEVILLE, Dr., Chief Physi- cian Bicetre Asylum, Editor Prcgres Medical', BRAESCO, Dr. Al. N. (Roumania) ; BRIAND, Physician to the Asylums of the Seine; BALLET, Prof. G., Faculty of Medicine (Paris); CHATTERJI, Mr. J. C. (Bernares, India); CLAPAREDE, Dr. Ed., Editor Archives de Psychologie (Switzerland); CROCQ, Prof., Editor Journal de Neurolgie (Belgium) ; DRILL, Dimitri, LL. D., Jurist Ministry of Justice (Russia); DEKTEREW, Dr. W. de, Member Municipal and General Council (Russia); DAGONET, Dr.; FAURE, Dr. Maurice; FERRI, E., LL. D., Deputy (Rome, Italy); FAREZ, Dr. Paul; GREIDENBERG, Dr. B. S. (Russia) ; GARNIER, Dr. P., Expert at the Tribunal (Paris) ; JANET, Dr. (Paris) ; KOPOS- SOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr.; LANGELAAN, Dr. J. W. (Holland); LEGRAS, Dr.; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "Annali di Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician Villejuif Asylum; MARINESCO, Prof. G. (Roumania); MARTIN, Dr. E. (France); MEDICI, Dr.; Mac DONALD, Dr. A. E., Superintendent Manhattan State Hospital (New York); NAMMACK, Dr. Ch.; NEISSER, Dr. CLEMENS, Chief Physician of the County Asylum, Leubus (Germany); NICEFORO, Prof. A., Univ. LAUSANNE; OBICI, Dr. (Italy); PETERSON, Dr. F., Commissioner in Lunacy, State of New York; PIERON, Dr. H., Preparateur Laboratory Experim. Psych., School of Higher Studies, (Villejuif); PHILIPPE, Dr. CI.; REGNARD, A., Ministry of the Int., (Paris); REIS, Dr. Mello (Brazil); ROBERTSON, Dr. F. W., General Superintendent Elmira Reformatory; REY, Dr. Philippe, Superintendent Public Asylums (Aix) ; RITTI, Dr. Ant., Chief Physician Charenton Asylum; SEMELAIGNE, Dr. Rene; SEMIDALOW, Dr. B. (Russia); SERIEUX, Dr. P. (France); SERGI, Prof. G. (Italy); SINANI, Dr. B. N. (Russia); SERBSKI, Dr. V. P. (Moscow); SNELL, Dr.; SOUKHANOFF, S., Privat. Docent, Univ. Moscow; SPITZKA, E. A. (New York); STOENESCU, Dr. N. (Roumania); TATY, Dr. (France); TSCHISCH, W., Prof. (Russia); TREVES, Dr. Marco (Italy); TOULOUSE, Dr. E., Chief Physician Villejuif Asylum, Director Laboratory Exper. Psych., School of Higher Studies; TRUELLE, Dr.; VAN DEVEN- TER, Dr., Dir. Meerenberg Asylum, Holland; VAN HAM EL, G. A., Prof. Criminal Law, Univ. Amster- dam; VURPAS, Dr. CI., Asylums of the Seine; VAN GIESON, Dr. Ira T.; VALLON, Dr., Physician to Ste. Anne, Expert at the Supreme Courts (Paris) ; VASCHIDE, Dr. N., Chef des Travaux, Laboratory Exp. Psychol. (Paris); VOISIN, Dr. Jules, Physician to the Salpetriere (Paris); WINKLER, Dr. C., Univ. Amsterdam.
STATE PRESS, PUBLISHERS, 290 Broadway* NEW YORK, N. Y.
INDEX TO VOLUME I.
ORIGINAL CONTRIBUTIONS,
PAGE.
A Contribution to the Fissural Integrality of the Paroccipital ; Observations upon One Hun- dred Brains. Mr. E. A. Spitzka 25
Acute Delirium., Drs. B. Semi- DALOW and V. V. Veidengam-
MER 146
Acute Delirium. Drs. B. Sem- IDALOW and V. V. Veidengam-
MER 210
A Clinical Study of Morbid Ob- sessions and Impulses. Dr. Louise G. Robinovitch 229
Clinical Researches in Circular Insanity. Dr. G. C. Ferrari. . 12
Complicated Respirator-" Tic in a Melancholiac. Drs. V. Sem- idalow and V. Weidenham- mer 78
Communications, J. R 99
Communications. Judge C. H. Hanford 169
Communications. Judge F. S. Landon 167
Editorials. 44, 47» 97, 164 and 232
Idiot and Imbecile Children. Dr. Louise G. Robinovitch. 14 and 86
On the Prophylaxis and Treat- ment of the Recidivist Crim- inal. Dr. Jul. Morel 121
pag£.
On the Duty of the State in the Matter of the Prevention of the Birth of Crime and of its Propagation. Dr. Robino- vitch 152
On the Frequency and Signifi- cance of Transverse Striae of the Finger Nails. Dr. Marco Treves 215
Psycho-motor Hallucinations in General Paralysis. Drs. A. Marie and J. B. Buvat I
Suggestion During Natural
Sleep. Dr. P. Farez 34
The Early Diagnosis of Lues
Cerebri. Prof. W. Tschisch. 65 The Symptomatic Value of
Dreams. N. Vaschide and H.
Pieron 72
The Regicides. Dr. E. Regis.. 135 The Trial, Execution, Autopsy and Mental Status of Leon F. Czolgosz, Alias Fred Nieman, the Assassin of President Mc- Kinley ; With a Report of the Post-Mortem Examination. Dr. Carlos F. MacDonald and Mr. Edward Anthony Spitzka 179
ABSTRACTS OF CURRENT LITERATURE.
page.
Address- to the Section of Psy- chiatry 102
Archives de Psychologie ... 170
American Medico-Psychological Association 175
Blood Pressure in Epilepsy 109
Blood Pressure in the Normal, Cheerful and Melancholic Man, On the 178
Brain Localization, The 238
Brains of Two Distinguished Physicians, Father and Son; A Study of Hereditary Trans- mission Based on Their Com- parison, The 57
Can the Unimpaired Remainder of the Auditory Centre in the Deaf-Mutes be Sufficiently De- veloped to Enable the Subject to Speak Better? no
Cerebral Abscess — ^Trephining — Death in
Cerebral Changes During Nat- ural Sleep, On the 234
PAGE.
Clinical Studies in Pathological Dreaming 174
Colored Individuation 54
Congress of Alienists and Neu- rologists of France and the French-Speaking countries, The Next 177
Congress of Criminal Athropol- ogy. Fifth International 171
Congress of Criminal Anthrop- ology, The Fifth International . 119
Congress of Alienists and Neu- rologists of France and French-Speaking Countries ..119
Contribution to the Study of the Moniliform Condition of the Cortical Dentrites 53
Cortical Hyperesthesia in Acute Alcoholism 117
Encephalitis With Optic Apha- sia, A Case of Acute Hem- orrhagic 237
Erratum 242
Errata in Vol. I, No. i 120
u
INDEX.
PAGE.
Evolution of the Color Sense, The 239
Experimental and Clinical Re- searches on Hedonal 238
Five Years Without Cells 175
Fundamental Psychological For- mula and its Relation to Crim- inality, A 172
Gastric Chemistry in Melan- cholia, Mania and Hysteria, The 113
General Paralysis with Congen- ital Syphilis, Cases of Adult. .174
General Paralysis with Halluci- nations, A Case of I73
Golgi Methods for the Theory of Neuron Retraction, On the Evidence of the 52
Housing of the Criminal Insane, On the ..172
Interna al Fenomeno Delia Stria- tura Ungueale Trasversa ed air Attivita Di Rigenerazione Del Tessuto Corneo Negli Al- lienati. Dr. Marco Treves .... 109
Insanity of Twins, On 236
La Criminalite Juvenile. Etiol- ogie du Meurtre 235
Les Psychoses Post-Operatoires.114
Le Traitement Par Le Repos Au Lit, en Medicine Mentale 174
Matteawar State Hospital .... 64
Modesty. Physico-pathological and Social Study 170
O Letcheni Vnousheniem. Dr. B. N. SiNANi 58
Pathological Anatomy of Idiocy, The 49
Proportions of Sexes in Crime.. 59
Psychoses of Puberty 115
PAGE.
Pseudo-paraplegia of Hysterical Nature in a Child Ten years old 173
Psychoses of Puberty, The 116
Psychoses of Puberty 116
Remote Prognosis of Psychoses
of Puberty, The 114
Revue Generale sur I'Agnosie
(Cecite Psychique) 59
Russian Journal of Psychiatry. A
new .' 233
School for the Insane 233
Significance of the Appearance of Varicose Thickening of the Protoplasmic Branches of the Cortical Motor Cells, On the. 234
Singular Hyperthermia and Oth- er Degenerative Stigmata m a Case of Epilepsy and Moral Insanity 234
Spontaneous Fractures in Gen- eral Paralysis, On 112
State Epileptic Colony, A iig
Studies of the Various Function- al Conditions of the Cortical Nervous Cell by Means of Nissl's Method 176
Suprarenal Extract in the Treat- ment of Mental Diseases, On. .236
Theory of Sleep. The 240
Line Nouvelle Theorie Du Sys- teme Nerveux 175
Thermic Sensibility of the Va- rious Mucous Membranes. ... 174
"Verbal Blindness and Deafness and an Autopsy on the Body, A Case of 40
Verbal Motor Hallucinations in General Paralysis 106
BOOK REVIEWS.
PAGE.
Bed-Treatment for the Violent Insane, A Study of. Dr. Gus-
TAVE POCHON. ThESIS.
Georges Carre and C. Naud, Editeurs, Paris, 1900 60
Contribution to the Study of Stereognostic Perception. Mel- LE. IQ.AVDIA Markova. In- augural Thesis, 1900. Ch. Eggimann and Co., Editors. . 62
Delinquents Intermediary Be- tween the Insane and the Crim- inal (Clinical), Administrative and Medico-Legal, On the Class of. Thesis by Dr. Al- bert Petit 61
Diagnostic des Maladies de L'en- cephale, par le Docteur Gras- set, Professeur de Clinique Medicale a I'Universite de
page. Montpellier. i vol. in — 16 de 96 pages, avec 6 figures, car- tonne, I f r. 50 : /. B. Bailliere et ais, Paris 119
Essai Sur ITmagination Crea- trice. Th. Ribot. Felix Alcan, Editeur, Paris, 1900 61
Nevralgies et Nevrites, Le Trait- ement des. Par A.-F. Plioue, Bailliere et Fils, 190 1 . 178
Philosophie de Tolstoi, La. By OssiP-LouRiE. Felix Alcan, Editeur, 1899, Paris 63
Philosophie Russe Contempor- aine, La. Par Ossip-Lourie, Docteur de I'Universite de Paris, Membre de la Societe de Philosophie re I'Universitie de Saint-Petersbourg. Felix Al- can, Paris, 1902 242
INDEX.
ui
PAGE.
Physician's Visiting List, The, for 1902, 51st year of its publi- cation. P. Blakiston's Sons & Co., Phila 241
Psychologic du Reve, La. Vas- CHiDE and PiERON. /. B. Bail- Here, Paris 242
Psychologic de L'idiot et de U imbecile. Dr. Paul Sollier, 2me. edition. Felix Alcan Paris, 1901 118
Puberte Chez L'Homme et Chez la Femme, La. Antoine Mar- RO. Etudes dans ses rapports avec I'antropologie, la psychi- atric, la pedagogic et la sociol- ogie. Translated by Dr. Med- ici, under the direction of Dr. A. Marie. Preface by Dr. V. Magnan. Four tables and 4 figures in the text. Schleicher Freres, Paris, 1901 240
Serums Artificiels dans les Traitements des Maladies Mentales, Des. Par Docteur
PAGE.
Jean-Baptiste Buvat, L. Boy- er, Paris 241
Suggestibilite, La. Par Alfred Binet, Dr. es Sciences, Laur- eat de I'Institut {Academic des Sciences et Academic des Sceinces morales), Directeur du lahoratoire de psychologic de la Sorbonne (Hautes- Etudes). Avec 32 -figures et 2 planches, hors texte. Schlei- cher Freres. Paris, 1900 178
Trattato di Psichiatri ad Uso dei Medici e Degl Studenti del Prof. Bianchi Leonardo, Diret- tore Delia Clinica Psichiatrica e Neuropatologica della R. Universita e del Manicomio Provinciale di Napoli. Con Numerose Figure Intercalate nel Testo. V. Pasqualle, Na- poli 118
Tristesse et la Joi, La. Dr. Georges Dumas. Felix Al- can, Paris, 1900 119
LIST OF CONTRIBUTORS.
BUVAT, Dr. J. B., France. FAREZ, Dr. P., France. FERRARI, Dr. G. C, Reggio-
Emilia, Italy.
HANFORD, Judge C. H., Washington.
J. R., New York.
LANDON, Judge F. S., New York.
MACDONALD, Dr. C. F.,
New York. MARIE, Dr. A., Paris.
MOREL, Dr. Jul, Belgium.
PIERON, Dr. H., Paris.
REGIS, Dr. E., Bordeaux.
ROBINOVITCH, Dr. Louise G., New York.
SEMIDALOW, Dr. B., Mos- cow.
SPITZKA, Mr. E. A., New
' York.
TREVES, Dr. Marco, Italy.
VASCHIDE, N., Paris.
VEIDENHAMMER, Dr. V. v., Moscow.
LIST OF ILLUSTRATIONS.
page.
Schematic Outline of the intra- parietal-occipital fissural com- plex in the majority of Simia- dae 32
Schematic Outline Showing the Development of the Parocci- pital gyrus 32
Four Plastic Spheres Placed in Apposition and Showing the Zygal or H-shaped arrange- ment of the Partitions 32
Application of Plateau's Ar- rangement to the Gyral Ele- ments in and about the Ex- occipital Fissures 32
PAGE.
Schematic Arrangement of the Fissures as They are Repre- sented in the Adult Human Brain 32
Left Continuity and Rieht Sep- aration of the Parietal and Paroccipital Fissures 33
Continuity of These Fissures on Both Sides 33
Separation on Both Sides 33
Left Separation and Right Con- tinuity 33
Tracings of Chest and Abdom- inal Breathing in Respiratory Tic 84
IV
INDEX.
PAGE.
Luccheni, Luigi, Assassin of Em- press Elizabeth of Austria.. 137
Guiteau, Charles, Assassin of President Garfield 137
Damiens, Robert Francois, At- tempt on Louis XV 137
Ravaillac, Francois, Assassin of Henry IV. 137
Louvel, Louis Pierre, Assassin of the Duke de Berry 138
Alibaud, Louis, Attempt on Louis Philippe 138
Caseiro, Santo Jeronimo 138
PAGE.
Jackes-Clement, Assassin of
Henry HI 138
Bresci, Gaetano, /issassin of
King Humbert 139
Salsou, Francois, Attempt on
Shah Mouzzaffer-ed-Dine 139
Passanante, Jean, Attempt on
King Humbert 139
Leon F. Czolgosz, Full Face and
Profile 202
Schematic Drawings of Skull
and Brain of Czolgosz 203
Finger Nail Striae 216
VOL. L
No. U
TheanJouT
i.iX
I of
Mental Pathology
^s
«<^
JUNE, 1901
Edited by Louise G. Robinovitch, B. es L., M.D.
)E5ttonal JSoar^
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.), Dr. JUL. MOREL (Belgium), Dr. C. H. HUGHES (St. Louis), Dr. E. REGIS (Bordeaux).
Conttibutots' Staf t
ANTHEAUME, Dr. Andre (Paris) ; BAILEY, Dr. P. (New York) ; BAJENOW, Dr., Superintendent
Woroneje Asylum (Russia); BECHTEREW, Prof. (Russia); BERTILLON, Dr. Edgar (Paris); BLEULER, Prof. E. (Zurich); BLIN, Dr.; BOISSIER, Dr. F.; BOURNEVILLE, Dr., Chief Physician Bicetre
Asylum, Editor Progres Medical; BRAESCO, Dr. Al. N. (Roumania) ; BRIAND, Dr. Marcel, Physician
to the asylums of the Seine; fTT " TTF" T" JuiiiirTI ,1 1i 1 CLAPAREDE, Prof. S.; CROCQ, Editor
Journal de Neurolgie (Belgium); DA^I^SSffl^ dM ^^^|&Bs. Dr. Maurice; FAREZ, Dr. Paul; FERRARI,
Dr., Editor Revista Sperim. di FrJC^i^, GREDENB^RGVOr. B. S. (Russia); JANET, Dr. (Paris); DeJONG, Dr. Arie (The Hague) ;^<S^OS?n:Tf^/*BiC^uperifi^n!^ent Simbirsk Asylum; LALANNE, Dr.; LEGRAS, Dr.; LEGRAIN, Dr.;]lbfeRIE, Ossip, Lauttata-pf t^yinstitute (Paris); MARRO, Prof., Din
"Annali di Freniatria" (Italy) ; M^IErigQ%®tel4Mi¥f Phyjician Villejuif Asylum, MARINESCO, Prof. G. (Roumania) ; MEDICI, for. ; INOcDDNALD, Dr. A. ^^ ^perintendent Manhattan State Hospital
(New York); MESCHEDE, ProX Germany) ; NAMMACK, Dr^f^h.; NEISSER, Dr. Clemens, Chief Phy- sician of the Country Asylums, Ledbus (K^eniT3Sf?^°PEfElifea&«f Dr. F. (New York) ; PETTYJOHN, Dr. E. S. (Chicago) ; PHILIPPE, Dr. CTS^tog^D^ ^5**^ ^^' ^^^^° (Brazil) ; REGNARD, Albert, President of Public Charities, M^'"^''-tr]'*'^'f~t?Tr "!TiTPi*'^-'*''t^n^'''> ; REY, Dr. Philippe, Superintendent Public Asylums (Mont-Perrin) ; RITTI, Dr. Ant., Chief Phyrsician Charenton Asylum; ROUBINOVITCH, Dr. J.; SEMELAIGNE, Dr. Rene; SERIEUX, Dr. P.; SERGI, Prof. G. (Italy); SINANI, Dr. B. N.; SERBSKI, Dr. V. P. (Moscow); SIOLI, Dr. E., Superintendent of the Asylum of Frankfort-on-the- Main; SNELL, Dr.; SPITZKA, Mr. E. A. (New York); STAENESCU, Dr. N. (Roumania); TATY, Dr.
(France); TSCHISCH, W., Professor; De TQKARSKI, University of Moscow; TREVES, Dr. Marco (Italy); TOULOUSE, Dr. E., Chief Physician Villejuif Asylum; Director Laboratory Exper. Psych., School of Higher Studies; TRUELLE, Dr.; VAN GIESON, Dr. Ira T., New York Pathol. Instit.; VALLON, Dr., Physician to Ste. Anne, Expert at the Supreme Courts; VASCHIDE, Dr. N., Chef Des Travaux, Laboratory Exp. Psychol. (Paris) ; VOISIN, Dr. Jules, Physician to the Salpetriere.
STATE PUBLISHING COMPANY
290 Broadway, NEW YORK, N. Y.
TABLE OF CONTENTS.
PAGE
Psycho-motor Hallucinations in General Paralysis, Dr. A. Marie... i
Clinical Researches in Circular Insanity, Dr. G. C. Ferrari 12
Idiot and Imbecile Children, Dr. Robinovitch 14
A Contribution to the Fissural Integrality of the Paroccipital;
Observations Upon One Hundred Brains, Mr. Spitzka 25
Suggestion During Natural Sleep, Dr. P. Farez 34
A Case of Verbal Blindness and Deafness and an Autopsy on the
Body, Drs. P. Serieux and F. Farnarier 40
EDITORIALS.
Psychiatry in the Twentieth Century 44
On the Question of Women Attendants in the Men's Wards for the
Insane 47
THIRTEENTH INTERNATIONAL MEDICAL CONGRESS, PARIS, 1900, SECTION OF PSYCHIATRY.
The Pathological Anatomy of Idiocy, G. E. Shuttleworth, M.D.,
and F. Beach, M.B., F.R.C.P 49
Researches in Idiocy, Dr. Bourneville 49
Classification of the Idiocies, Dr. Mierzejewski 50
ABSTRACTS OF CURRENT LITERATURE.
On the Evidence of the Golgi Methods for the Theory of Neuron
Retraction 52
Contribution to the Study of the Moniliform Condition of the Cor- tical Dendrites 53
Colored Individuation .< 54
The Brains of Two Distinguished Physicians (Report made by the
Author) 57
O Letcheni Vnousheniem 58
Revue Generale sur F Agnosie 59
Proportion of Sexes in Crime 59
BOOK REVIEWS.
A Study of Bed Treatment for the Violent Insane, Dr. G. Pochon. . . 60
Essai sur Tlmagination Creatrice, Th. Ribot 61
On the Class of Delinquents Intermediary Between the Insane
and the Criminal, Dr. Albert Petit 61
Contribution to the Study of Stereognostic Perception, Melle. K.
Markova 62
La Philosophie de Tolstoi, Ossip-Lourie 62
NEWS NOTES.
The Hill Insane Hospital, Augusta, Me « 63
Matteawan State Hospital 64
Books and Pamphlets Received 65
The Journal of Mental Pathology.
Vol. I. NEW YORK, JUNE, 1901. No. i.
PSYCHO-MOTOR HALLUCINATIONS IN GENERAL PARALYSIS.
BY DR. A. MARIE, Chief Physician, Asylums of the Seine.
Every psychiater is familiar with the important role played by hallucinations in the semiology of mental ailments. Seglas defines an hallucination as being a perception without the existence of a corresponding object. Hallucinations are at the basis of every delirium ; they are the predominating factors and the capital signs even if not always easy to detect. They may affect all the senses and be auditory, visual, olfactory, gustatory or motor; they may involve the general or special sensibility. The duration and differ- entiation of the hallucination depend on the tendencies of the pa- tient. Nevertheless, alcohol, for instance, produces preferably hallucinations of sight ; cocaine — those of the general sensibility ; it would be difficult to say whether various poisons have a special predilection for given functional centres. The mystic theo-maniacs have characteristic visions which are often combined with verbal or graphic automatism (illuminated, inspired, prophetic, etc.). Dr. Vallon and myself have considered this question in the Arch, de Neurologic, 1896-97 (pp. 12 to 15). The patients subject to sys- tematized persecution delirium have mostly auditory hallucina- tions. Lassegue laid special value on this fact, which is rather underrated to-day. The depressive or expansive religious sys- tematized insanities are often noted by early psycho-motor dis- turbances, particularly in the possessed melancholiac (i) and by tardy psycho-motor troubles in the mystic partial delusional sub- jects; hence there come ideas of double personality: the patient suffers from ideas of diabolical possession, or else from those of direct divine inspiration (2).
I.) Drs. Marie and Vallon, Arch, de Neurol., 1898, 29-30.
2) Dr. Marie — Mysticisme et folie, Arch, de Neurologie, 1899, 40-43.
2 PSYCHO-MOTOR HALLUCINATIONS.— Marie.
Recently Tamburini considered hallucinations in the relative light of cortical aphasia and accepted them as functional disturb- ances of the cortical centres. He says : "Hallucinations are to the alterations of the sensory centres what epileptoid movements are to those of the motor centres/' This opinion is accepted by Seglas, and he applied it in his psychological analysis of the psycho-motor phenomena in the systematized delirii.
Hallucinations combine very frequently, and the analysis of them becomes complex when they embrace functions controlled by different centres. This is particularly the case in hallucinations of speech, the latter being the result of long education and syn- thesis of the functions of superposed centres. The hallucinatory disturbance may affect the motor images of articulation — causing a verbal psycho-motor hallucination, properly speaking; or when the hallucination affects the. graphic images there is a graphic psycho-motor hallucination ; in the systematized delirium the hallu- cinatory trouble begins with the simple and reaches the complex : the oldest acquisitions are affected first and the recent ones later — by extension. I have under observation a patient, at present suf- fering from delirium of persecution, who first showed auditory hallucinations, then reached gradually verbal psycho-motor hallu- cinations : his persecutors could see his thoughts and made use of them to his disadvantage y the same persons made him talk against his will ; recently the enemies make him write, and the manuscripts consist of a mixture of his own ideas and those of the enemies, the handwriting changing in the latter case, resembling that of the "cerebral violators," as he expresses it.
Seglas, who so well described the graphic verbal psycho-motor hallucination, says that the psychic hallucinations may be consid- ered as being psycho-motor disturbances ; he studied particularly the hallucinations of the melancholiacs and of those suffering from delirium of persecution, and does riot mention those of the general paralytic.
I cite here three cases of general paralytics with psycho-motor hallucinations, but let me first call attention to these important points : if an hallucination is to the alteration of the sensory centres what the epileptoid movements are to the motor centres, then, in- deed, should general paralysis, the lesions of which are diffuse, affecting indiscriminately all the nervous territories, be a fertile field of investigation.
Speaking of hallucinations, Girma says in his thesis, which he wrote under the inspiration of the works of Christian, of Lyons, and Ritti, of Paris (1881) : "Hallucinations are very frequent in general paralysis; they may be found during every stage of the
PSYCHO-MOTOR HALLUCINATIONS.— Marie. 3
disease, especially during that of dementia. In the first period, the hallucinations may take on a psychic nature ; later, after the epilep- tiform or apoplectiform cerebral congestions (which seem to have much influence on the production of hallucinations), the hallucina- tions become rather of a psycho-sensory nature, fugacious and varied in the expansive forms ; they are often persistent in the de- pressive forms, during incomplete remissions, and in dementia. They bring about impulsive acts, but it is very rarely that these hallucinations lead the patient to draw from them logical deduc- tions, as do those subject to simple hallucinations."
According to Girma, then, the hallucinations of the general paralytic may be of a psychic nature in the beginning of the malady and become psycho-sensory in the later stages, after the small cerebral hemorrhages have taken place. In his work there are cited three cases which presented psycho-motor hallucinations.
The presence of graphic verbal psycho-motor hallucinations in general paralysis are considered as being of rare occurrence. This may be due to the rapidity of development of the disease which prevents the hallucinations from reaching a distinct degree of differentiation, and, on the other hand, to the demential condition into which the patient soon falls and during which it is most diffi- cult to bring to light the presence of verbal psycho-motor hallucina- tions. Finally, a prolonged period of excitement hinders the inves- tigation; the melancholiacs and the persecuted, however, come of their own accord to recount their trouble to the physician.
The best periods that favor the detection of these psycho-motor hallucinations in general paralysis are: at the culmination of the phase of initial functional dynamia, in the beginning or the end of the period of relative calm of the disease and during the more or less complete remissions.
I wish to remark that in the general paralytic the psycho-motor hallucination does not, generally, reach the stage of double per- sonality; the evolution of the disease is too rapid and the mental faculties are too much affected for that purpose.
I make mention below of the exceptionally rare cases collected by various authors who treat of the subject I am considering in this paper: Baillarger quoted EsquiroFs case and published it in the "Annales Medico-Psychologiques^^ (1881). He treats of a general paralytic who suffered from multiple hallucinations and who was possessed by two demons. Dr. Serieux, in "Archives de Neurologie^^ (1894), says in reference to the same hallucinations: *'Mendel makes mention in his book (1880) of a case of general paralysis, the diagnosis of which was confirmed by an autopsy, who had obsessions during the course of a melancholic and hypo-
4 PSYCHO-MOTOR HALLUCINATIONS.— Marie.
chondriacal spell. The patient was possessed with Latin maxims and complained of the inability to stop pronouncing them; the same plaint was made in reference to some song refrains : 'These voices are as if they came from the tongue/ the patient said. Mendel adds that there was no trace of hallucinations;" Dr. Serieux thinks that the case was one of onomatomania complicated with psycho-motor hallucinations.
Dr. Serieux has published a case from his own wards of a pa- tient who suffered from general paralysis with verbal psycho- motor hallucinations. (3) The resume of the case is: "Somatic and psychic signs of general paralysis ; a spell of transitory melan- cholia ; a spell of mania with expansive ideas and delusions of per- secution; confinement to the asylum; persistent and active ideas of persecution caused by hallucinations of hearing, during three months ; remission of a severe nature ; painful verbal motor hallu- cinations ; absence of other hallucinatory disturbances and particu- larly of auditory hallucinations; permanence and activity of the verbal motor hallucinations during a period of over a year; their intimate association with a condition of erethism of the centres of mastication ; the verbal motor hallucination accompanied by invol- untary movements of mastication or by grinding of the teeth ; these disturbances play an important part in the genesis of the ideas of persecution which have a tendency to systematization ; interpreta- tions and characteristic reactions; secondary episodic spell of a melancholy nature (auto-accusation, ideas of suicide) ; spell of maniacal excitement with ideas of grandeur and of persecution, multiple verbal motor hallucination; kinesthesic, visual, auditory and gustatory ; condition of hallucinatory confusion ; pneumonia — death. Autopsy: Interstitial encephalitis with meningeal adher- ences localized systematically in both hemispheres at the inferior extremity of the Rolandic convolutions, at the third and internal frontal.''
In conclusion Dr. Serieux brings to special notice: "The ex- istence of verbal motor hallucinations in general paralysis; their intimate connection with the convulsions of the muscles of masti- cation; their appearance during the course of a remission as iso- lated symptoms, unassociated with any other hallucinatory dis- turbances; their prolonged duration of sixteen months; their re- peated reappearance ; their role in the genesis of ideas of persecu- tion with a tendency to systematization during the course of a re- mission. Autopsy: Lesions of the meninges, interstitial ence- phalitis at the foot of the third frontal (verbal motor centre) and
3.) Dr. Serieux, Archives de Neurologic, 1894.
PSYCHO-MOTOR HALLUCINATIONS.— Marie. S
the lower extremity of the ascending frontal (centre of mastica- tion)/^
Dr. Maurice Rieu, in a recent thesis, 1900, brings out the fact that verbal motor hallucinations are extremely rare in general paralysis ; that clinically these hallucinations are of the same nature when occurring in any other disease and influence the patient^s delirium and may be accompanied by sensory hallucinations, audi- tory or sensory.
Some authors wish to explain the reason of the psycho-motor hallucinations during the course of parenchymatous encephalitis by the predominance of pathological alterations in the psycho- motor centres : the verbal sensoro-motor and those of mastication (interpretation by Serieux and Marinesco) ; this explanation is based on the usual anatomical lesions present in general paralysis. Unfortunately, this theory stands in contradiction to the facts ob- served in the ordinary insane who also happen to suffer from psycho-motor hallucinations : in these cases there are not found any anatomo-pathological cortical lesions, especially of the centres alluded to above; on the other hand, there is absence of psycho- motor hallucinations in some cases with microscopic lesions of the verbal psycho-motor centres in the majority of cases of general paralytics; in an overwhelming majority of the latter cases, the lesions are v/ell defined and well generalized.
Prof. Joffroy (4) applies a general theory of the phenomena of hallucinations in order to give a plausible explanation of facts. He says : "It is not sufficient to activate a sensory centre by a lesion in order to produce hallucinations; that centre must be specially modified first : it must be originally or by acquired quali- ties predisposed in order to have this abnormal disposition which renders it hallucinogenous ; for this reason there are no specific lesions producive of hallucinations."
The period of evolution of general paralysis during which the motor hallucinations manifest themselves justifies this hypothesis. It seems that the central neurons disintegrate and that the psycho- motor disturbances result from that as expressed by the delirious paraphrase.
We will now proceed to examine the cases which serve as clini- cal demonstrations of the principles above argued.
Case I. — L. H., 35 years old, entered the Villejuif Asylum July 17, 1900, from the St. Antoine Hospital. Dr. Londe, who made out his certificate, mentioned the existence of general paralysis. The patient was then sent to the Admission Bureau at Ste. Anne,
4.) Prof. Joffroy in thesis, Dr. Rieu.
6 PSYCHO-MOTOR HALLUCINATIONS.— Marie.
from where he came into my wards with a certificate which stated that he suffered from general paralysis, ideas of grandeur, inco- herence of ideas, hesitancy of speech and unequal pupils.
The patient^s father is in good health; the mother died at the age of 50; she was an inmate of insane asylums twice and was, perhaps, a general paralytic. She became extravagant in expendi- tures during her illness, and a number of wardrobes were found filled with extravagantly expensive things which were of no prac- tical use; besides, she owed 50,000 francs for dressmaking. She had thus wasted three million francs within a period of three years, during which time she was separated from her husband. An uncle died of general paralysis. A brother, 23 years old, is eccen- tric and a spendthrift; he was confined in prison six months for an attempt to steal from his father.
The patient had syphilis when 16 years of age. He has led an extravagant life. He could speak many languages when quite young and was accepted at the naval school, in 1881, but soon left this school, taking an examination at the polytechnic school, where he failed. He then entered into service of the marine infantry. After having served in Algiers and Tonkin, where he was wounded in the head, he returned to France and passed successfully the examinations in law ; after this he wandered about all over Europe, lived in Sofix three years, and finally married in 1895. Two chil- dren were born, one being now three years and the other fifteen months old. Shortly after marriage he had three epileptiform attacks which followed closely, one after the other. He is an ex- cessive worker, and an excessive tobacco smoker, but does not in- dulge in alcoholic drinks. Since the onset of the attacks he has been subject to tic of the lower jaw. The wandering life which he led exhausted a large fortune he possessed, and as his poverty interfered with his keeping in his own social circle he became de- spondent. In 1899 he was obliged to become a clerk in order to earn a livelihood. He separated from his wife on amicable terms, as he could not support her. At that period his intellectual facul- ties were already weakened and the simple work of a clerk^s duty became a heavy mental strain. Moreover, he felt that his intellect was giving way and in despair, wrote to his wife, saying that he saw before him an abyss into which he was gradually falling. Soon after this the radical change in his faculties came to the sur- face: he began to sell his belongings, indiscriminately — jewels, furniture, etc., and soon became most satisfied with himself and his surroundings. In 1900 a spell of delirium took place : he was excited, had expensive ideas and was very rich; this mental ex- citement was accompanied by insomnia. At that time he showed
PSYCHO-MOTOR HALLUCINATIONS.— Marie. 7
all the signs of general paralysis : the pupils were unequal and did not react to light, there was clipping of words, there was fibrillary tremor of the tongue ; there was marked mimic dissociation with a slight left facial paresis ; tremor of the extremities, exaggeration of the patellar reflexes and instability while trying to stand up- right. His ideas were incoherent and mobile, the memory much diminished ; the memory disturbance was manifest in his writing, as he left out words, and the muscular incoordination was seen in the tracing of the letters. In August the excitement still persisted, although to a lesser degree ; the patient now suffered from nega- tive ideas: he has no brains — they were taken out and not re- placed ; his heart was also taken out, so were the blood, the viscera and the genital organs ; the organs which he had at that moment were not his.
The following is a letter, literally transcribed, which he wrote :
"Mon cher Docteur — Je ne sais pas comment se fait que je sois la langue les dents, les bras, le coeur et Festomac tout mon etre dans toi. Je suis profondement en toi, mon Bob cheri. Je ne comprends ce qui m^arrive, mais je ne sais qui leinte; en somme je ne souffre pas et je sais que nous nous adorons, depuis plus de 4 ans que tu ne m^as jamais trompe, ni moi, non plus, je te jure, tu le sais maintenant, tu reste je ne sais pas pourquoi : je sais que un homme qui s'appelait le Dr. Marie to resoit que ta femma et te retenant toutes les lettres et cependant je f ecrivais presque tous les cinq jours et jamais tu ne me reponds parce que etais dans.
Lors, amene a Thopital, je suis en toi, tu pleures de douleur et je suis teniblement etonne . . . et que tu es desespere d^avoir dans le corps ta Suzanne cherie, ton pigeon rose, ta cherie, tu chantais Suzanne magnificature et jolie en anglais et il parait je pense qu'on fera une consecration et je Fespere; nous serons deux differents et je civis qu^il le pense; tu sais nous pensons parce qu^il chose de magique dans cette affaire. Enfin mon cherie demande la permission de Fhabiller . . . et qui ne te demande rien tu es rhomme. Enfin dis au docteur qu^il y a probablement quelque chose d^olsur et extraordinaire : dans ce qui nous arrive. Au fond tu sais monlobaime que au fond on peut nous faire deux etres de ton corps, nous fuirons Paris et nous irons en Algerie et faire encore de bonnes affaires entends.^^
Regardless of the incoherence in the letter it is evident that the patient speaks of himself in the third person, that there is some person, a woman, inside of him, with whom he holds conversa- tions and who replies to him. On being questioned on this sub- ject he says that there are two women within his chest, staying there continually, talking all the while. He takes part in their
8 PSYCHO-MOTOR HALLUCINATIONS.— Marie.
talks, and they tell him pleasant things which are at times of an erotic nature. Often these women borrow his voice and speak through his mouth — it is not he, then, who speaks.
He wrote two more letters in which his dual personality pre- occupied him; he became excited and violent; this condition con- tinued for some time ; he raved, tearing and breaking things about him; all means used failed to calm him. He passed September, October and November in this condition of mental excitement, the physical condition failing rapidly and progressively; in the be- ginning of December he took to bed, and when his relatives called to see him he said : "L. himself is not in'^ (L. is the patient's initial letter), and he kept on speaking of himself in the third person. He was very feeble then; the mental excitement was intense; he mumbled continually and hung his head over his chest as if listen- ing to the voices there. He died December 25, of broncho-pneu- monia, while he was in a condition of extreme cachexia of general paralysis.
No autopsy was allowed by his relatives.
Case n. — G., 47 years old, entered the Villejuif Asylum August I, accompanied by a certificate which stated that he had general paralysis in its first stage, that he was probably given to alcoholic excesses, that there was clipping of words, and ideas both of per- secution and of grandeur.
His father died of pneumonia at the age of 50, and the mother, who was a highly nervous person and eccentric in conduct, died when 48 years old. Two sisters are very nervous but in fair physical condition.
The patient is given to alcoholic and sexual excesses and has had muco-membranous enteritis since 1895. He married, but never had any children; his wife died in 1895. In May, 1900, he began to show a marked change in behavior : he neglected his busi- ness, lost his memory and wandered about on the streets day and night; he made useless and numerous purchases, imagining that he was rich, that certain financial powers were bent on getting his wealth away from him. In 1895 he had a slight apoplectiform attack which was followed by paralysis of the left eye. On admis- sion he clipped the words while speaking, the tongue tremor was en masse and he also had vermicular movements; there is a left ptosis and a certain degree of facial paralysis which is the cause of marked mimic dissociation. The pupils are slightly unequal, the left being the larger, but both react well to light. The memory is much impaired, the patient being unable to tell how old he is. There is tremor of the extremities, and the handwriting translates the tremor of the hands. The patellar reflexes are exaggerated,
PSYCHO-MOTOR HALLUCINATIONS.— Marie. 9
'especially on the right side ; Romberg's signs are absent, but there is unsteadiness in standing upright. Both the gait and general sen- sibility are normal. The somatic changes are: arterial atheroma shown by the presence of a loud second sound at the base of the /leart and a slight rigidity of the radial arteries. Obesity; no sphincter disturbances. Psychically, besides the diminished memory and attention, he suffers from psycho-motor hallucina- tions. There is a voice in him which he calls "the gift," and the latter speaks for him. When this is the case the patient changes his usual tone of voice and speaks of himself as of a strange per- son. The "gift'' speaks with the patient's tongue, in his teeth, conversing both with the patient himself and those who speak to liim. It says disagreeable things to him at times, and that puts Mm in bad humor, excites him ; he mumbles almost continually — conversing with the "gift ;" he keeps aloof from the other patients, repeating incessantly : "that gift, that ventriloquist compels me to eat enormously, makes a glutton of me because we are two." There is, as seen, a dual personality, although incoherence accom- panies its expression. Some of his letters are written by himself while others he attributes to a strange person who is master of his thoughts. He says: "There is some one who speaks with my mouth," and the letter below was written by that "some one" : "I -am going to take. M. G.'s life in order to obtain those forty million francs. That gentleman is a pig, an assassin, I hold his hands fast." In another letter he says : "M. G. is a nice man ; I always traveled with him — in Bordeaux, Marseilles and Toulon," etc. The double personality as expressed in his letters has persisted since his admission to the asylum.
Case III. — B., 38 years old, entered the Villejuif Asylum March 6, 1900, his Ste. Anne certificate stating that he suffers from gen- eral paralysis. His father is living and 70 years old ; the mother, 65 years old, is in good physical condition. Ten other children in the family are in good health, although some of them are of a strumous constitution ; three other children died in childhood.
The patient had syphilis before his marriage, which took place in 1886; in 1891 he had facial paralysis; from that time he has been subject to frequent spells of vertigo, and has sustained a radical change of nature; he has become sombre and indifferent. In the beginning of 1899 he suffered from marked intercostal pains which were treated with the iodide salts, but he soon interrupted the course of this treatment and manifested strangeness of be- havior; he left his employment, wandered about town, and pre- sented himself for treatment at various hospitals. At the Dubois Hospital he was given calomel injections; he soon left there and
10 PSYCHO-MOTOR HALLUCINATIONS.— Marie.
entered a sanitarium near the Loire-Inf erieure ; he then returned to Paris, March i, in a depressed condition, having ideas of being ruined, refusing to either speak or eat. He did not indulge in alco- hoHc excesses; his wife had four abortions: one, after the sixth year of marriage, at two and one-half months, one at seven months, one at six months and one macerated child.
On admission, the patient^s pulse was rapid, 120 per minute, but the heart was free from any lesion. The general bodily condition was fair, he weighing 85 kilogrammes. There was constipation^ and coated tongue ; the urine was free from both sugar and albu- men. The patellar reflexes were exaggerated, especially on the right side; there was no disturbance in the gait, only a slight in- stability when standing upright with the eyes shut; the dynamo- metric measurement showed 40 on the right side; there was no sensory disturbance. The right pupil was larger than the left one,^ and both reacted defectively to light and accommodation. There was left facial paresis and mimic dissociation. His general aspect was sad, he spoke little, answered in monosyllables, and on read- ing there was clipping of the words, this being due to a vermicular movement of the tongue ; there was also an undulating movement about the peri-bucal muscles. He seemed to be defiant, having hallucinations, and urinated while being examined. March 7 he was submitted to specific treatment and on the 15th a change took place in his condition : he became still more taciturn and apprehen- sive, changed incessantly from place to place and became filthy. It was difficult to keep him in bed, as he made every attempt ta« kill himself; he knocked his head against the walls, and tore out his moustache. He continued restless for some time until finally he became gradually quieter. On April 12 he had an apoplecti- form attack with complete loss of consciousness during half an hour; on recovering consciousness he had difficulty in m.ovement of the whole left side of the body. On the 13th the hemiparesis^ disappeared and the left pupil was markedly contracted. On April 16 he seemed better, but was much annoyed by voices which used bad language. April 19, appearance of right facial paresis with right ptosis and enormous dilatation of the right pupil. On May 24 he became much excited and refused to eat ; there was marked insomnia, and mumbling of continual insults to himself: "You went to Dubois, you are a pig, a low creature; must you be that ., . " When the sound was passed to feed him he struggled against it, saying : "They are poisoning you, they wish to kill you."*' He gnashed his teeth while speaking thus. In June he was im- proved but kept on talking, grinding his teeth: "What are you^ doing in this house, B.? Return to your home!^' When ques-
PSYCHO-MOTOR HALLUCINATIONS.— Marie. II
tioned about these phrases he said that a woman talked to him in- cessantly in his mouth, that she moved his tongue, which spoke against his will and thus made him say insulting words to himself. He clinched his teeth in order to keep from speaking, but he found this struggle useless as he had to speak in spite of all his resist- ance.
On the 25th of July the voice still tormented him and caused him to murmur continually ; there was complete right ptosis with devia- tion of the eye outward ; the deviation he could correct at will, but not so the ptosis. He was subjected to treatment by iodide serum and to hypochloruration. He remained in the same condition in September and October. November 12, 1900, he related, on being questioned, that a woman spoke in him with his own mouth, say- ing: "B., you are a lost man; you were wrong in coming to share the table with these people ; you are done for ; you have committed a crime by coming here ; ask for a pass from the gentleman who comes to see you; you have accomplished your mission in this establishment." When the hypodermatic injections of the serum were made he mumbled, grinding his teeth: "You are being poisoned, old man." When asked to describe the person who thus speaks continually with his mouth he says that she is a woman whom he went to see before entering the asylum, but he cannot give any further description. When direct questions are addressed to him he replies himself, but no sooner is he left to himself than he resumes murmuring — addressing insults to himself.
CLINICAL RESEARCHES IN CIRCULAR
INSANITY.
BY DR. G. C. FERRARI,
Editor Rivista Sperimentale Di Freniatria.
Individual manifestations are far more numerous and multiform in mental than they are in general pathology. For this reason the method of individual observation in the former, while quite op- posed to the old routine school, is yet nearer in its approach to reality than is the old method.
When the material furnished by individual psychology is ap- plied on a larger scale to the researches in psychiatry it will be- come apparent, more than can be supposed at a glance, to what an extent the fundamental nosographical forms of mental disease are based on artifices. Only then will it be understood that the various syndroms are sheer inco-ordinate indices of a marked mental ex- pansion characteristic of the patient's personality.
In 1893 I began a series of studies, in the asylum at Reggio Emilia, relating to periodic insanity, especially the form designated by the term "circular.'^ I began by examining in the patients the sight, the reflexes, and the temperature as well as making the analyses of the urine and the blood. I collected abundant material during a period of two years' research, but found it necessary to eliminate some results which were doubtful as to conclusion. Only data of absolute value were used. Of those I will consider here the temperature and the numerical changes of the blood corpuscles.
After having discontinued the researches for three years I again started in to investigate the question in 1898. This time I limited my work to the examination of the temperature and the numerical variations of the blood corpuscles. The recent results of research were found absolutely analogous to those obtained during the years 1893 and 1894.
THE TEMPERATURE.— The temperature was taken with a finely sensitive thermometer in the external auditory canal ; it was found that a large proportion of patients subject to circular insan- ity have a temperature designated by the term fypus inversus, a type which Tambroni also observed in many cases of periodic in- sanity. This type of temperature exists not throughout the period of the disease, but only during that phase of it which contrasts most with the fundamental psychic state — the period of interval,
CLINICAL RESEARCHES IN CIRCULAR INSANITY.— Ferrari. 13
or, better yet — the period that precedes the onset of the disturb- ance. In cases of periodic insanity of uniform manifestation with no variety of phases — the temperature does not change in type.
THE BLOOD. — The numerical value of the blood varies with the phase of the disease in a manner analogous to that of the tem- perature ; that is to say, there seems to exist an inversion in the nu- merical quantity of the blood corpuscles as follows: a patient ordinarily of a gay disposition, who falls ill with circular insanity, invariably has, during the periods of excitation, a number of blood corpuscles equal to that which exists during the interval between those periods, if such interval exists; whereas that number is markedly decreased during the period of depression. On the other hand, if there are some four million three hundred (4,000,300) blood corpuscles per c. c. during the condition which we call normal (as opposed to gay), that number does not change during the period of depression, but the number will augment more or less during the period of excitation.
The patients who were thus studied, both during 1893-94 and 1898-99, were seven in number, of whom five were women and two men.
These results, which are difficult to interpret, encourage one to theorize with some workers of to-day who have studied the same question and who conclude that many forms of insanity are but clinical varieties or phases of one and the same morbid condition which varies in manifestation according to the individual per- sonality of the patient.
IDIOT AND IMBECILE CHILDREN.
VARIOUS CAUSES OF IDIOCY AND IMBECILITY.
The Relation of Alcoholism in the Parent to Idiocy and Imbecility ' of the Offspring,
A CLINICAL STUDY.
BY LOUISE G. ROBINOVITCH, B. ES L. (PARIS), M.D.
Foreign Associate Member Medico-Psychological Society, Paris. Member N. Y.
Academy of Medicine.
CHAPTER I.
HEREDITARY DEGENERACY.
The causes of idiocy and imbecility are traceable to various fac- tors which always originate in the parent. The most intangible cause is maternal emotion during pregnancy, but a cause underly- ing this one must always be looked for. — Cases. — Mental degen- eracy of the parents is a cause. — Cases. — Psycho-neuroses of the family are marked causes. — Cas-es, — Acute physical ailments dur- ing pregnancy and contagious and infectious diseases are also causeSj but in connection zvith these one must search for underly- ing bases of origin, — Cases. — Myxoedema is also a cause. — Case. — Acute diseases which are followed by psychic defects are only exciting causes.
The study of the causes of idiocy and imbecility is indeed a dif- ficult one and is easiest to be understood through the medium of clinical work. There one finds an inexhaustible source for study of cause and efifect in idiocy and imbecility : of the genesis of the mental anomalies which manifest themselves, now in the total ab- sence of intelligence — the extinction, so to speak, of the psychic being, and the reduction of the subject, as Dr. Magnan has it, to a digestive tube, — which characterizes idiocy, — now in an impaired or undermined intelligence, varying in degree with every subject, according to the extent of freedom of the anterior regions, which characterizes imbecility.
IDIOT AND IMBECILE CHILDREN.— Robinovitch. 15
This clinical study, demonstrating the existence of morbid con- ditions in the parents that favor the birth of degenerate offspring, is so convincing in its data that one feels forced to acknowledge that ^'consequences are cruel."
In some of the cases of the series collected for study, and herein cited, are found apparent difficulties in attempting to discover a tangible source of cause of idiocy and imbecility, as a reading of these cases will show ; but closer application and more minute in- vestigation will uncover these prime causes.
Case I. — Mental Debility with Epilepsy from Childhood. — Alcoholism of Patient Since Adult Age. — Absence of Morbid Heredity. — Psychic Emotion During Pregnancy.
G. A., 23 years old, entered the Admission Bureau, Ste. Anne Asylum, Paris, May 12, 1899. The full history of the patient is not to be had ; it is stated by the mother, however, that there is no morbid heredity known ; the mother sustained a severe shock while pregnant with the patient, by seeing a child killed. The patient was born at full term ; his intelligence was always of a low order. At the age of six he became subject to epileptic attacks. He has always suffered from mental debility ; when he grew up he became addicted to the alcohohc habit, which aggravated the severity and frequency of his convulsive attacks and still further low- ered his mental status.
Case H. — Idiocy from Infancy. — Absence of Hereditary De- generacy.— Maternal Emotion During Pregnancy.
R. L., 3 years old, entered the Admission Bureau July 26, 1898. Her father, a butcher, says that he is temperate and well, but his claim of temperance is subject to question. The mother also is healthy, but while pregnant with the patient she sus- tained a severe burn of the arm which was sore three weeks; at the end of that time the patient was born. L. came into the world at full term, but her intelligence has not developed up to the day of her admission to the asylum. She has always suf- fered from convulsions, is filthy, does not speak, does not un- derstand what is said to her — her whole existence is reduced to feeding herself ; in a word — she is an idiot.
Causes such as those cited in the preceding two cases do not make up the bulk of those to which are ascribable the birth of idiots and imbeciles. Clinical observation refutes the theory that deep-rooted affections of the child's brain can be caused by such subtle factors as a maternal emotion during pregnancy, ex- clusively. A thorough search into histories like the preceding
l6 IDIOT AND IMBECILE CHILDREN.— Robinovitch.
ones must reveal the presence of a more substantial cause of the abnormal condition. In such a search one must look care- fully for the possible existence of physical or psychic stigmata of degeneracy of the parents; in the absence of such stigmata^ a psychopathic taint of the parents may have crystallized itself into idiocy or imbecility of the offspring in conjunction with, such a slight cause as a maternal emotion during pregnancy ; but such an emotion can be admitted only most tentatively as the causative agent of the birth of a profoundly abnormal psychic being.
The mere statement of the parents that there is an absence of either physical or psychic stigmata of degeneracy, or of any psychopathic or neuropathic taint, is not to be accepted unques- tioningly. For the physical stigmata may be deep seated and the psychic stigmata or psycho- or neuro- pathic taint may not have been discovered during the examination. In a hun- dred cases of idiot and imbecile children, to be cited later in tabu- lated form, there are two cases only where maternal impressions- during pregnancy were claimed to have been causes of the affliction of the offspring. On examination, however, it was found that in one of those cases the mother had physical stigmata of degeneracy, and in the other the mother suffered from pulmonary tuberculosis. It is more than probable that a thorough search in this latter case would have revealed the presence of more important pathological factors as responsible elements.
In another case, where the full family history could not be ob- tained, the father drinks alcoholic beverages — as he states it — moderately.
Case III. — Mental Debility with Epilepsy from Infancy. — Absence of Hereditary Degeneracy. — Mother Sustained^ A Severe Fright While Pregnant ; She Died of Pul- monary Tuberculosis.
L. E., 29 years old, entered the Admission Bureau June 19,^ 1898. The full history of the family cannot be obtained. The mother had a severe fright while pregnant with the patient. She died of pulmonary tuberculosis. The patient has always been an imbecile and suffered from epilepsy.
Case IV. — Mental Debility with Epilepsy from Infancy. — Father Indulges in Alcoholic Drinks. — Mother Had a Severe Emotion While Pregnant with the Patient.
G., entered the Admission Bureau May 23, 1899. The father, according to his own statement, drinks moderately. The mother is
IDIOT AND IMBECILE CHILDREN.— Robinovitch. \^
healthy. She had a severe quarrel while pregnant with the pa- tient. The full history of the case cannot be had. The patient was born at full term; he is suffering from mental debility with epilepsy.
As is seen from the history, this case does not properly belong under the heading in question, as the alcoholism of the father can without any hesitation be considered the responsible factor in caus- ing the mental debility with epilepsy of the patient.
As for clinical demonstration of the workings of hereditary de- generacy in the birth of idiocy and imbecility, one has only to direct his attention to the existing facts. In the case below cited this fact is amply illustrated to the satisfaction of the sturdiest dissenter from the theory of hereditary influences. It is a most unusual occurrence for parents who are bearers of stigmata oi degeneracy to give birth to normal children.
Case V. — Mental Debility with Perversion of the In- stincts.— Father Has Physical Stigmata of Degen- eracy And Is a Natural Child; the Patient Also Is a Natural Child.
B. E., age 14, entered the Admission Bureau^ Ste. Anne Asylum, Jan. 17, 1899. The father is a natural child and has physical stigmata of degeneracy. He is a musician by occupation and is temperate. The mother is healthy and has had four children— all natural children : one, a boy, 17 years old, is healthy ; a girl, 8 years old, is cachectic; a girl, 3 years old, has frequent spells of loss of consciousness. The patient is suffering from mental de- bility with perversion of the instincts. He practices onanism and spends most of his time in vagrancy. At times he forsakes the paternal roof for days and refuses to give any account of himself.
Case VI. — Imbecility with Epilepsy.— Convergent Heredity. — Mother Has Physical Stigmata of Degeneracy. — Father Died of Diabetes. — Paternal Uncle Died of "Convulsions/^
P. C, 18 years old, entered the Admission Bureau, Ste. Anne Asylum, March 13, 1899. The father died of diabetes ; the mother has physical stigmata of degeneracy. A paternal uncle died of "convulsions/^ The patient was born at full term ; he had convul- sive attacks during infancy, which appeared again after his eleventh year; he is an imbecile, suffers from epileptic attacks and is un- able to care for himself.
l8 IDIOT AND IMBECILE CHILDREN.— Robinovitch.
NEUROSES AND PSYCHOSES AS CAUSES.
Thus far we have traced the birth of idiocy and imbecility from the subtlest apparent causes, such as maternal impressions, to a more tangible one — as, psychic degeneracy of the parents. The former cause, if it can be accepted as an exclusive one clinically — produces a small percentage of idiot and imbecile children. Even in that small number of cases one must search for more responsible elements. Neuroses and psychoses of the parents, combined, as may be judged, play an important part in the birth of idiot and imbecile children; in the case below given the patient has a con- vergent pathological heredity.
Case VII. — Imbecility with Porencephalus. — Speech Slightly Developed in Infancy, and Progressively and Permanently Lost After the Age of Ten. — Contrac- tures OF the Four Extremities and Curvature of the Spine. — Neuropathic and Psychic Heredity.
H. J., i8 years old, entered the Admission Bureau, Ste. Anne Asylum, March 23, 1894. Her father was a shop clerk and tem- perate. He was highly nervous ; the slightest contradiction made him tremble with anger ; he committed suicide. The grandfather, temperate, was ill during the last six years of his life, and died in 1870 of cerebro-spinal meningitis. The paternal grandmother died of pneumonia. She was nervous, weeping on the slightest provo- cation; she did not have any convulsive attacks; she stuttered. The maternal grandfather died when the patient's mother was a child, and her mother died at the age of 52, from intestinal obstruc- tion. On the father's side, the uncles and aunts died, one of chorea, at 14 years, two in infancy, and one from pleurisy, at 21 years ; on the mother's side there were no uncles or aunts. The mother is not subject to convulsions of any kind, but is very nervous. Often, on seeing her husband enter the room she was in, she would sud- denly scream. When pregnant with the patient she suddenly be- came paralyzed, presenting a left hemiplegia and anesthesia ; this lasted a month, comprising the two weeks preceding and the two weeks following the birth of the patient. The patient's younger sister died of meningitis when 18 months old; one sister, 14 years old, is moderately intelligent; another sister, four years old, has her menstrual flow, and finally, there is a sister three months old.
The patient was born at full term, forty-three hours after the be- ginning of labor. The physician in attendance wished to apply the forceps, but the mother objected, and the child was asphyxiated when born. Restorative means were used, and the child gave the first cry four hours after delivery. The first four days she could not suckle and was fed by having nourishment dropped into her
IDIOT AND IMBECILE CHILDREN.— Robinovitch. 19
mouth by means of a syringe. The child could move its limbs during the first five days after birth, but on the sixth day she had a convulsive attack that lasted nine days. This left her a cripple, as she lost the use of her limbs. She has never walked. At the age of four she began to speak some simple words, such as "mamma^^ and "papa^', but not long after that became entirely unable to articulate. Since the age of ten she has not spoken a word. There is a certain amount of intelligence left: she appar- ently recognizes persons whom she has seen a few times. The legs and arms began to cross when the child was eighteen months old, and she has been unable to sit up, remaining on her back. She has a spinal curvature. She menstruated for the first time when sixteen years old, but the flow is irregular in its periodic appear- ance.
Such are the clinical results in some cases of convergent neu- roses and psychoses. Epilepsy of the parents seems to be a fruit- ful source of idiocy and imbecility of the offspring. As every one knows, epilepsy in the parent is most apt to engender epilepsy in the offspring; in such cases idiocy and imbecility often co-exist with the convulsive malady; again, the latter affections may be the sole manifestations of the morbid heritage. In an unpublished paper on epilepsy soon to appear, these facts are demonstrated in a table comprising 130 cases.
ACUTE PHYSICAL AILMENTS DURING PREGNANCY. — CONTAGIOUS AND INFECTIOUS DISEASES OF THE PARENTS.
Among the causes known to influence the embryonic develop- ment of the cerebrum are also the acute infectious and contagious diseases of the mother during pregnancy or the infectious and con- tagious diseases of the father before conception of the offspring. It is a delicate question to decide whether or not perfectly healthy parents, with no morbid hereditary taint, will give birth to an idiot or imbecile child under the conditions mentioned above. I have not in my possession a sufficiently large number of cases to war- rant a more definite statement than the one that acute diseases dur- ing pregnancy are often a determining cause of the maladies in the offspring, and that contagious and infectious diseases of either parent are also contributive to the same end. The case that came to my notice is one in point.
Case VIII. — Idiocy. — Hydrocephalus with Convulsions and Turbulence. — Paraplegia. — Filthiness. — Premature Birth. — Smallpox of Mother During Pregnancy with Patient. — All the Other Children Healthy.
D. O., 18 years old, entered the Admission Bureau, Ste. Anne Asylum, August 17, 1898. The full history of the family cannot
20 IDIOT AND IMBECILE CHILDREN.— Robinovitch.
be obtained. The mother contracted smallpox in the seventh month of her pregnancy with the patient. Before this child she had a girl who is i6 years old and is healthy, and after the pa- tient's birth she had twins* who are now seven years old; both are healthy. There were no miscarriages. The patient was born before term, at seven months, while the mother was ill with smallpox. At six months it was noticed that the child's head was of unusually large size for her age, and that the enlarging of the head was accompanied by convulsions at frequent intervals. The hydrocephalus was progressive in growth for some time. The child has always been filthy, has never either walked or talked and is turbulent most of the time.
SYPHILIS.
Syphilis of the parent is apt to cause varied ailments of the off- spring. It is astonishing that of the few hundred cases of idiot and imbecile children whose histories I have studied, only a few of the patients are said to have been born of syphilitic parents. In the statistical table of a hundred idiot and imbecile children, which will follow, the number of syphilitic parents is quite small. It must be supposed that, while in a large city like Paris, there is a larger percentage of syphilitic parents than my table indicates, the small percentage of parents described as thus afflicted is due either to reticence in giving the information, or ignorance of the exist- ence of the disease. The case below is an instructive one as to the direct relation of syphilis in the parent to idiocy of the offispring.
Case IX. — Idiocy with Turbulence. — Brother and Sister Healthy. — Mother Nervous. — Father Contracted Syphilis Shortly Before Conception of the Patient.
P. G., 2 years old, entered the Admission Bureau, Ste. Anne Asylum, March i, 1899. The father states that he always enjoyed good health and has been temperate, but that the mother was nervous. They have had three children: a girl who is now 17 years old; a boy, 15 years old, and another boy, ten years old; all three are enjoying perfect health. The father states that he con- tracted syphilis in 1896, and that the patient was conceived shortly after this took place. It is not stated whether the mother con- tracted the malady.
*The birth of more than one child at a time is considered by some authorities in psychiatry as indicative of degeneracy of the parent or parents.
IDIOT AND IMBECILE CHILDREN.— Robinovitch. 21
The patient was born at full term, but he has no development of intelligence and is an idiot. His whole existence consists in ab- sorbing food and being noisy.
The history below given represents a more varied clinical case.
Case X. — Epilepsy with Mental Debility. — Vagrancy. — Lack of Morality Beginning at the Age of Eight. — Syphilis and Hysteria of Mother. i
R. H., i6 years old, entered the Admission Bureau, Ste. Anne Asylum, January, 1897. The father is healthy, temperate, has no convulsions ; he states that there is neither alcoholism nor syphilis on his side of the family. The mother, on the contrary, had syphilis when 23 years old. She has been subject to hysterical spells; though free from them now, she has frequent attacks of what the French call "absence" — a sudden spell of vertigo and amnesia of events transpiring during the spell. She has had eight children, of whom six have died : one at the age of eleven, one at nine, one at two and one at eighteen months, died from meningitis ; one died from an accident, and one at five years — cause not stated. H. had meningitis when four years old, and since that date her intelligence has been impaired; she also became subject to con- vulsive attacks : she screamed and fell in a heap, foaming at the mouth, but did not lose her urine. After the attack, which came two or three times every month, she remained stupefied during a period lasting from one to two hours, not recognizing those about her. The attacks, however, lessened in severity as time went on, and when she was ten years old disappeared completely. Her mental condition has undergone a change. At eight years she be- gan to roam about on the streets, allowing herself to be taken away by young men. Her memory has failed and she has not learned to either read or write. Since the convulsions left her she has been subject to simple spells of sudden vertigo, which unfit her for any steady occupation. Thus, when 14 years old, she was sent out, one day, with her brother, on an errand. She left him on the way and did not return home. When a search was made for her the next day she was found, towards evening, sitting on a bench where, she said, she had spent the night.
Auto-Infection — Myxcedema. Among the auto-infections, myxcedema is pre-eminent as a cause of imbecility. Place cannot be given here to a lengthy dis- cussion of the pathology of the disease and the statement will simply be corroborated by a clinical illustration of this variety of mental infirmity.
22 IDIOT AND IMBECILE CHILDREN.— Robinovitch.
Case XL — Myxcedema. — Absence of the Thyroid Gland. — Arrest of Physical and Mental Development Begin- ning AT the Age of Six. — Mental Debility.
A. S., 17 years old, entered the Admission Bureau, Ste. Anne Asylum, July 30, 1896. The father, 48 years old, is a drunkard ; the mother was born in Calais, and died of chronic bronchitis when 46 years old ; one brother, 14 years old, is of normal growth and features, and is an apprentice in a packing house. At the age of 10 he had typhoid fever which left no sequelae. The second in the family is our patient; the third, a normal girl, who died of an acute infantile disease when five years old.
The patient's history is given by her brother, 14 years old. She was born at full term and nursed by her mother. The child was cachectic and sickly all her life. When two years old she had some convulsive attacks ; it wa^ also noticed that there was curva- ture of the shin bones, and orthopedic apparatuses were used to rectify the defect. The child grew normally, however, until she was six years old ; from that date she made no progress in growth. She has always been good natured, cleanly, coquettish, but the intellect not only remained stationary but is to-day no higher than that of a three-year-old child.
Physically she presents cranial and facial asymmetry, the right side of the cranium being better developed. The face, on the con- trary, is the better developed on the left side. At first sight the most striking feature about her is the smallness of her body, which measures i metre and 9-100 centimetres. The relatively normal size of the head contrasts with the dwarfed appearance of the body.
The cranium is large in the back and disproportionately narrow in the front. From the measurements below it can be classed as a dolicocephalic one.
diameters : Antero-posterior maximum 183 m.
Occipito-frontal
Biparietal
Bizygomatic
Vertical
Metopic
179 m. 142 m. 137 m. 129 m. 182 m.
The ossification of the cranial cap is complete. The hair is abundant, coarse, stiff, and irregularly implanted in tufts.
The face is large and round ; the forehead is narrow and low ; the growth of the hair comes well down the forehead. The skin of the forehead is thick and has many furrows. The eyelids are
IDIOT AND IMBECILE CHILDREN.— Roiinovitch. 23
thick in the upper part' and the palpebral opening seems small. The nose is wide at the root (like a negroes) ; the lower lip and the cheeks are heavy; the color of the face is normal. The teeth present malimplantation, particularly in the upper jaw. The first incisors are very large while the second upper incisors are too small. The lower teeth are regular but have the appearance of the Hutchinson teeth. There is no hypertrophy of the tongue, of the mucous membranes of the mouth or of the pharynx.
Body. — The most marked feature is the absence of hairy growth in the arm pits and on the pubis. The breasts are sufficiently de- veloped but devoid of nipples; the abdomen is large, like that of the batrachian. The limbs are small and undeveloped.
Skin. — On the forearms the skin is thick, purple in hue and markedly cold; this marked cyanosis and low temperature is also found to exist in the hands, which are thick and spade-like in form; the fingers are thick, the finger nails are ribbed vertically, short and atrophied. The tibia and fibula are curved about the point between the lower two-thirds of the bones.
Thyroid Body. — This gland is almost totally absent, with the exception of the right lateral lobe; the trachea and larynx are easily felt, as they are exposed by absence of the gland.
Heart. — No murmurs, the sounds being regular.
Pulse. — 78 to 81, small. Arterial tension 11 centimetres of mercurial pressure; respiration — costal type, 15.
Digestive Organs. — Normal digestion and alimentation; chronic constipation.
Genito-Urinary Apparatus.— Scanty urine; menstruation never took place until she was subjected to thyroid gland treat- ment.
The Special Senses are normal, but the patient is highly sen- sitive to cold.
• Gait. — Slow, but normal.
Mental Condition. — CretinoM immobility of face, slow and monotonous speech, obtuse memory, apathy, emotional; no perver- sion of the instincts. She can count up to one hundred, but the number seems to her an enormous one. Even ten is a large num- ber to her, which she counts on her fingers. She can neither read nor write, but she says she was never taught to do either.
{This case is published by special permission of Prof. Joffroy. The history of the result of the treatment with thyroid glands is omitted here.)
24 IDIOT AND IMBECILE CHILDREN.— Robinovitch.
ACUTE CONTAGIOUS AND INFECTIOUS DISEASES OF INFANCY.
The acute contagious and infectious diseases of infancy, when leaving such psychic sequelae in the patient as either idiocy or imbecility, act only as exciting agents in bringing about these infirmities. A close study of the histories of such patients always reveals the presence of hereditary psychic or neurotic infirmity in the direct or collateral family. In the appended table of one hun- dred idiot and imbecile children only three had sustained mental impairment through acute disease; but an analysis of those three histories shows that the acute diseases were only additional mor- bid exciting factors to a pre-existing pathological heredity. In- deed, case No. 24 in the table had typhoid fever when five years old and his intelligence remained impaired after that malady. The history states, however, that the patient's father was an epileptic. Case No. 40 had typhoid fever when seven years old. The patient suffers from mental debility, perversion of the instincts and impul- sive tendencies. He had convulsions, however, from birth — some eleven attacks daily — until he was 5^ years old. The father of this child was melancholy and violent and the mother had con- vulsions when a baby. Case No. 62, an imbecile with perversion of the instincts, had typhoid fever four years after his recovery from the disease. The mother is insane, the father died of heart disease and one sister is insane.
From what precedes it is evident that a scrupulous search must be made in the family history before incriminating an acute con- tagious or infectious disease as being a causative agent of either idiocy or imbecility of a child.
I have endeavored to adduce the information furnished by clin- ical work, which shows to what an enormous extent morbid heredity is responsible for the birth of idiot and imbecile children. Until now I have considered the manifold and varied causes of idiocy and imbecility of the offspring as revealed by clinical obser- vation. In all cases, with a minimum number of exceptions, there existed a pathological heredity that was radically responsible for the children's psychic ailment. The percentage of the psychic and neurotic heredities is indeed a large one in the families that give birth to idiot and imbecile children ; but there is a special morbid heredity, peculiar to itself, and which towers, in its high per- centage, far above any other in the scale of morbid heredities re- sponsible for the birth of idiot and imbecile children; that heredity is alcoholism of the parent and will be considered in the next chapter.
{To he continued.)
A CONTRIBUTION TO THE FISSURAL IN- TEGRALITY OF THE PAROCCIPITAL; OBSERVATIONS UPON ONE HUNDRED BRAINS.*
BY EDWARD ANTHONY SPITZKA,
NEW YORK;
Student of Medicine, College of Physicians and Surgeons.
I.
Chief among writers upon encephalic anatomy, Turner, Cun- ningham, Parker and Wilder stand as exponents of several hy- potheses concerning the status and origin of the Paroccipital fis- sure. Turner (i) and Cunningham (2) consider it the pars occi- pitalis of an "intraparietal fissural complex'^ composed of four factors. Wilder (3) considers it a zygal fissural integer, his main point being its greatest depth at its middle, with no evidence of a transverse occipital at its caudal end more than at its cephalic, and with no approach to the parietal. Of more recent date is the work of Parker (4). This author, taking into consideration the develop- ment of new conditions and pressure forces as cerebral growth continues, in a skull which assumes a more fixed and rigid shape, concludes that it is not a fisural integer at all, but merely a modi- fication produced in the manner of connection of the originally confluent intraparietal and fissura perpendicularis externa, and that, for reasons pointed out by him, this so-called paroccipital is deepest at its middle point and gradually becomes shallower as it joins the intraparietal and backwardly displaced fissura perpen- dicularis externa.
The scope of this article does not permit the writer to go far into the details of Parker's argument, but I shall endeavor to give a brief account of his idea of the development of the fissure since it serves as the main basis for the present discussion.
In Fig. I is reproduced the condition presented in the majority of the Simidse, in diagrammatic form, and copied from Parker's Fig. 18. A B represents the intercerebral cleft, P O the ''parieto- occipital," i p the "intraparietal," O^ the exoccipital (f. perpendicu- laris externa), P^ and P^ represent the parietal and subparietal gyres respectively, while O is the occipital lobe.
* Read before the Association of American Anatomists, Fourteenth Session, held at Baltimore, December, 1900.
26 THE PAROCCIPITAL.— Spitzka.
Now, as is well known, at some point near P O, but concealed within the depths of the fissure, "there develops in the monkeys, "from its floor, a small bridging convolution,^^* and the external perpendicular fissure, O^, is "pushed backward just in proportion to the development of this gyrus/^ Every one will recognize this as Gratiolet^s premier pli de passage, which in man attains the dignity of a paroccipital gyrus, as it was first called by Wilder. We see, then, that Parker attaches much significance and value to the rela- tive growth of this "pli de passage^^ in the subsequent formation of the paroccipital fissure, and he advances the opinion {loc, cit., p. 336) that all the plis de passage "are nothing but the posterior ex- " tremities of the occipito-frontal and occipito-temporal convolu- " tions, which, checked in their development by the evolution of " the occipital lobe in Primates, lie concealed in the majority of "them by the overhanging operculum,! whilst in the higher forms, " through a renewed growth in this region, as we have seen in the "case of the convolution 2 (i. e., the premier pli de passage) they " finally reach the surface, displacing in their turn the operculum " and pushing it backward/^
The more one studies the morphology of the cerebral fissures and gyres, the more apparent does the value of Gratiolet's plis de passage become, and it is to be regretted that Ecker (5) should have wholly rejected the name because they appeared to him to have no justification in the human brain.
Parker does not proceed further in his very excellent argument, though he might readily have done so and assigned an equally important role to the deuxieme pli de passage. If we take up the discussion at the point where Parker left it, it can be readily un- derstood how a simultaneous upgrowth of the deuxieme pli would serve to limit the ectal extension of such a paroccipital, always bearing in mind that it must be regarded as a segment of the simian exoccipital. The chief difficulty that we encounter then is that we have a zygon of variable length to deal with and one di- rected generally transverse to the course of the exoccipital fissure.
Let us assume that the growth of both the premier and deuxieme plis takes place simultaneously; if we begin with the conditions as they exist in most of the Simiadae, as in Fig. i, such development will result in the isolation of a segment of the exoc- cipital situated between the two plis and forming the proton ("anlage") for a paroccipital zygal fissure.
Parker has shown {loc, cit., p. 335) how a combination of ex-
* Parker, loc. cit., p. 321. t "Poma" of Wilder.
THE PAROCCIPITAL.— Spitzka. 27
pansive forces and resisting forces controls the development of such zygal, as well as of the tri-radiate and quadri-radiate fissures, applying for this purpose the principles deduced by the eminent physicist Plateau (6). In brief, he finds a stable equilibrium in the zygal form due to the apposition of four plastic spheres. (Plateau^s experiments were accomplished by means of soap- bubbles floating on water, or upon a glass plate. ) In the brain the four spheres which are here crowded together in the confines of the cranium are represented in the following four gyral elements : I. Premier pli de passage. II. Deuxieme pli de passage.
III. Parietal lobe.
IV. Occipital lobe.
Development and growth takes place more rapidly and more forcibly on the part of elements I. and II., and hence crowd to- gether before III. and IV. could do likewise, the result being a zygal fissure whose zygon runs in a transverse direction to the course of the interrupted exoccipital. A rapid review of these de- velopments resolves itself into the following synopsis :
First. An unbroken continuity of the mesial occipital with the exoccipital fissure (as in most forms of Simidae).
Second. A simultaneous upgrowth of the premier and deuxieme pli de passage of Gratiolet, bridging the exoccipital and including between them a fissural segment of the exoccipital forming the proton ("anlage^^) for the future paroccipital.
Third. An increased growth of these two plis de passage, crowding upon each other while at the same time pushing apart the occipital and parietal lobar parts, at this site, giving rise to the zygon or stem.
Fourth. The accompanying, though lesser resistance of the parietal and occipital elements, situated cephalad and caudad giv- ing rise to the rami and stipes of Wilder^s description.
The questions involved are, then: is the paroccipital a true fis- sural integer, or not ; if not, of what fissure is it a part ?
Turner and Cunningham evidently consider its main portion a part of the intraparietal, while its caudal rami represent a seg- ment of the "affenspalte,^^ equivalent to Ecker^s "transverse occi- pitaP and Eberstaller^s "anterior occipital.^^ Wilder^s idea has al- ready been referred to. Parker strongly urges that it is a part ot the external perpendicular fissure (exoccipital) with an accom- panying modification of its junction, at that site, with the "intra- parietaP (parietal f.), but he likewise believes the caudal rami to constitute a transverse segment of the fundamental external per- pendicular fissure. With this idea the present writer cannot agree
28 THE PAROCCIPITAL.— Spitzka.
entirely, but Parker's main proposition, that the paroccipital repre- sents a gap in the interrupted exoccipital is doubtless a true one, The comparative frequency of confluence or of separation of the parietal and paroccipital fissures seems to me to involve a question of only secondary importance — that of determining the average standard of fissural and gyral disposition in the human adult brain. These relations are considered at length in the second part of this paper.
In the endeavor to explain the causation of this zygal fissure, the writer may possibly be understood to advocate the old theory advanced by Ecker, that the formation of convolutions is the necessary consequence of mechanical processes. This theory so far as the typical cerebral pattern is concerned, has been abandoned by most morphologists, and rightly so. ''Mechanical packing" as a cause of the cerebral configurations is by far the least important factor, physiologically as well as morphologically. But I do main- tain that so far as zygal fissures are concerned, especially if they represent gaps in what was once a continuous fissure or cleft, that the dynamic factors are of great — if not paramount importance.
Otherwise the cerebral fissures represent lines of retarded growth with respect to the gyres, and thus have some morpho- logical significance with reference to cell-growth, the reaction of fibres and other factors; and that presumably they represent lines of structural demarcation.
The importance of seeking corroborative evidence for these propositions in an extended research upon the appearances and conditions existing in the brains of foetuses, both human and an- thropoid, will be realized by the reader. Prior to the advent of the important discoveries of histological methods which attracted the great majority of original workers, macroscopic and develop- mental encephalic anatomy occupied an important position in the biological sciences; it seems as if this branch will soon regain its former importance and receive the earnest attention and labors of scientific men. The correlation of structure and function is of greatest significance in the study of our organ of the mind.
II.
While engaged in the study of this fissure, I followed out the suggestion of Wilder and tabulated the number of confluences and separations of the parietal and paroccipital fissures in one hundred brains taken from dissecting-room subjects.* In the classification
* The writer is indebted to Professor Huntington and Dr. Gallaudet. of the Columbia College of Physicians and Surgeons, for the privilege of examining these brains.
THE PAROCCIPITAL.— Spitzka. 29
of these results all possible conditions come under four heads, as follows :
Class I. Left continuity, right separation.
Class II. Left and right continuity.
Class III. Left and right separation. ^
Class IV. Left separation, right continuity.
In the present researches the following results were obtained :
Class I 32 per cent.
Class II 45 per cent.
Class III 17 per cent.
Class IV 6 per cent.
There was continuity in 64 per cent, of all hemicerebrums, and separation in 36 per cent., distributed as follows :
Continuity. Separation.
Left hemicerebrum . . - . yy per cent. 23 per cent.
Right hemicerebrum. . . 51 per cent. 49 per cent.
In 62 per cent, the conditions were symmetrical, that is, there was continuity or separation on both halves of the same brain; conversely, asymmetry prevailed in the remaining 38 per cent.
These results are compared with those of Wilder in the follow- ing table. Wilder's figures were taken from his "Lecture Notes for 1900" (Cornell University), which were kindly placed at my disposal. They are also based upon observations on one hundred brains, not exclusively of dissecting-room subjects, but including various grades of social and intellectual walks of life, and of in- fants as well as adults. In general the results are similar ; a notable difference consists in the percentages of Classes I. and II.; there, is therefore a greater frequency of symmetrical conditions in the writer^s observations, perhaps due to the average lower grades of the brains at my disposal.
B. G. Wilder. E. A. Spitzka. Per cent. Per cent.
Class I 44 32
Class II 33 45
Class III 17 17
Class IV 6 6
Continuity (all cases) 58 64
Separation (all cases) 42 36
Left continuity yy yy
Left separation 23 23
Right continuity 39 51
Right separation 61 49
Symmetry 50 62
Asymmetry 50 38
30 THE PAROCCIPITAL.— Spitzka.
As in Wilder^s series, Qass IV. (i. e., left separation and right continuity) is represented in only 6 per cent. For a long time Wilder had found only one such specimen, from an insane Swiss woman. In the spring of 1900 he found five additional cases, two of unknown males, one of an unknown female, one of an insane engineer, and one of an insane negro. One might be tempted to attach some significance to these facts if the writer had not found the same condition in the brain of Dr. Edouard Seguin, the elder of two distinguished physicians.* Curiously enough the son^s brain (that of Dr. Edward C. Seguin) presents the reversed conditions.
REFERENCES.
I.) ^66 — W. Turner, The Convolutions of the Human Cerebrum, Edin- burgh, 1866.
2.) '90 — D. J. Cunningham, "The Intraparietal Sulcus," Journal of Anatomy and Physiology, Vol. XXIV., pp. 135-155.
3.) '86 — B. G. Wilder, "The Paroccipital — a Newly Recognized Fissural Integer," Journal of Nervous and Mental Disease, Vol. XIII., pp. 301-305. Abstract in Neurologisches Centralhlatt, V., p. 501.
— '96 — B. G. Wilder, "The Paroccipital Fissure; Should It be Recog- nized and so Designated;" Proceedings of Assoc, of Amer. Anatomists for 1896, p. 69.
— 1900 — B. G. Wilder, "Further tabulations and interpretations of the paroccipital fissures," Proceedings of Assoc, of Amer. Anatomists for 1900, p. 14.
4.) '96 — A. J. Parker, Morphology of the cerebral convolutions with special reference to the order of Primates. Part 3, Vol. X., Jour, of Academy of Natural Sciences of Philadelphia, 1896.
5-) '83 — Ecker, Hirnwindungen des Menschen, Braunschweig, 1883.
6.) 1900 — E. A. Spitzka, The brains of two distinguished physicians, father and son; a comparative study of their fissures and gyres. Read be- fore the Association of American Anatomists, Baltimore, December, 1900.
EXPLANATION OF THE FIGURES. Fig. I. Schematic outline of the intraparietal-occipital fissural complex in the majority of Simiadae. (After A. J. Parker.) See text.
Fig. 2. Schematic outline showing the development of the paroccipital gyrus. O' O' is regarded by Parker as the backwardly displaced "external perpendicular fissure" (exoccipital).
Figs. 3 and 4 represent four plastic spheres, placed in apposition, and showing the zygal or H-shaped arrangement of the partitions. (Plateau's experiments.)
Fig. 5. Application of Plateau's arrangement to the gyral elements in
* These brains were described by tke writer in a paper (6) read be- fore the Association of American Anatomists in Baltimore, December, 1900, and also before the Section on Anthropology and Psychology, New York Academy of Sciences, February 15, 1901, by invitation.
THE PAROCCIPITAL.— Spitzka. 31
and about the exoccipital fissure. I. is the paroccipital gyrus, or premier pli de passage; II. is the deuxieme pli; III. is the parietal lobe; IV. is the occipital lobe.
Fig. 6. Schematic arrangement of the fissures as they are represented in the adult human brain.
Fig. 7. Class I., left continuity and right separation of the parietal and paroccipital fissures. Present in 2>^ per cent, of the writer's series.
Fig. 8. Qass II., continuity of these fissures on both sides, present in 45 per cent.
Fig. 9. Class III., separation on both sides. Present in 17 per cent, of cases.
Fig. 10. Class IV., left separation and right continuity, the rarest condi- tion. Found in only 6 per cent, of the writer's series.
|
ABBREVIATIONS. |
|||
|
FISSURES. |
GYRES, |
ETC. |
|
|
EOP |
Exoccipital f. |
OCCIP. LOBE |
Occipital lobe. |
|
INTCBL |
Intercerebral cleft. |
PAROC. G |
Paroccipital g. |
|
OC |
Occipital f. |
PAROC. ISM. |
Paroccipital isthmu, |
|
PAROC |
Paroccipital f. |
PTL. G |
Parietal g. |
|
PTL |
Parietal f. |
SBPTL. G |
Subparietal g. |
(Aftir P^rhtrJ
(Aft^ f>*rk^J
0 0
(After P^f/ter.)
5
6
00
5#
EOP
SUGGESTION DURING NATURAL SLEEP.
BY DR. PAUL FAREZ, PARIS.
Psychotherapy has now definitely demonstrated its right to existence in the scientific world by the variety, multiplicity and stability of its curative effects.
The main modes of action in psychotherapy are of varied value : direct suggestion during the waking state, indirect suggestion, by means of medicaments, electricity, etc., have all been used with unquestionable success. Suggestion during induced sleep is, of course, the method most generally accepted — the heroic method; it enables us to act on the patient most efficaciously and to obtain the most permanent cure. According to the expression of Durand de Gros, indeed, the subject hypnotized is plunged into a condition of hypotaxia ; the patient^s mind is free from all distraction, he is offering no mental resistance, being submissive and docile; his psychic being presents a fruitful soil upon which ideoplastia can cause active suggestion to germinate.
The principle of psychotherapists to-day is to succeed in hypnotizing the largest number of patients possible with the greatest ease, and within the shortest period of time. For this reason many practitioners endeavor to perfect their technique and propose new methods of procedure, instruments and apparatuses as ingenious as they are varied.* Regardless of these praise- worthy efforts, however, a great number of patients who can justi- fiably be treated by suggestion fail to be hypnotized ; others refuse to allow themselves to be thrown into a hypnotic state, expressing unjustifiable but none the less irresistible fears and apprehensions. These two classes of patients are not, however, to be definitely given up as persons not subject to treatment by means of psycho- therapy: they can benefit by curative suggestion if the means of suggestion is utilized during normal sleep.
Authentic observations, convincing experiments and proven cures show the efiicacy of suggestion made during natural sleep. One may say that this mode of suggestion is the method suc- ceedant or substitute of the hypnotic suggestion and that the former mode is applicable to all cases amenable to psychotherapy.
*I desire to mention particularly the apparatuses lately presented at the second international congress of hypnotism and at the society of hypnology of Paris by MM. Bellemaniere and Watteau, Berillion, Le- mesle, Paul de Saint Martin and Verdin.
SUGGESTION DURING NATURAL SLEEP.— Faeez. 35
A suggestion made, suddenly, into the ear of a patient who has just fallen into natural sleep has sometimes proven of value. More frequently, however, the contrary is the result. The reason for failure is a double one : either the patient wakes up as the verbal suggestion is enunciated or else he continues in a profound sleep and the suggestion fails to impress him. Before active suggestion can be made use of during natural sleep it therefore becomes necessary to bring the patient into a preparatory condition as fol- lows: the patient must be in a condition such that he may be spoken to without his being awakened and his condition must be such that suggestions made should reach him and nestle in his consciousness. This condition is attained by means of simple but minute, delicate and tedious procedures, requiring of the psycho- therapist much patience and circumspection. We must recall to mind the psychological fact that the condition of hypotaxia is the easiest to be obtained by causing the persistence of a sensation that is simple, homogeneous, continued, uniform and exclusive. In the present case I make use preferably of the auditory sense. I give below, therefore, in general outline, the technique I endorse, with so much more confidence because the psychological laws make it legitimate and because the therapeutic successes justify it.
Several periods are to be distinguished.
FIRST PERIOD.
In the evening, when the patient is asleep, I steal noiselessly into his bed chamber. At first I stand a few metres away from the bed and, in a low tone of voice, scarcely audible, in a long, monotonous rhythm, I begin to articulate the two syllables "dor- mez,^^ "dor mez^^ . . . which I repeat without any impatience whatever as long as is necessary. Little by little I approach the patient until I reach his ear at a distance of from fifteen to twenty centimetres; meanwhile I do not for an instant interrupt the articulation of my two syllables, in the same slow and monotonous rhythm, in a low tone of voice hardly audible.
SECOND PERIOD.
When I am in close proximity to the patienf s ear, I continue articulating my two syllables in uniform measures. I maintain the same rhythm, but after the lapse of some minutes, I heighten the tone, my voice augments in intensity, little by little, without a start, without abruptness, without suddenness.
What takes place psychologically?
The auditory sensation, indistinct at first, hardly existing, settles gradually, becomes more and more distinct, reaches the entrance
;^6 SUGGESTION DURING NATURAL SLEEP.— Farez.
to consciousness, passes from the penumbra to perfect life and soon attains the vivacity of the imaginative representations of a dream, deUrious or otherwise. Then the sensory excitation pro- duced by the repeated monotone does not cease being maintained and becoming progressively augmented; the auditory sensation persists then like an "etat fort f more and more vivid, it becomes preponderant and gradually it reduces the force of the other repre- sentations that previously occupied the area of consciousness. These representations become more and more feeble, they become attenuated and disintegrate until they fall submerged and become altogether remote. At that moment nothing remains of this but the auditory sensation caused by the repeated intonation. All other antagonistic representations have been reduced and have disappeared.
THIRD PERIOD.
It is known that the consciousness cannot long remain identical to itself ; it requires, in a certain sense, the "perception of a differ- ence," else the consciousness, if its contents ceases being dis- tinctively successive and differentiated, soon becomes veiled and dimmed.
Let us then continue repeating the monotone, now not in a pro- gressively increasing tone, but purposely uniform and continuous. From this moment the quantity and quality of the conscious phenomenon does not vary; our simple, homogeneous sensation, fully conscious, will now become less and less conscious, then sub- conscious, that is to say, practically unconscious. At this moment psychic life is void of all contents, so to speak; it has reached a condition of favorable docility, malleability, and receptiveness ; our patient has become subject to suggestion, he can be influenced as if he were plunged into a hypnotic sleep. Thanks to this arti- ficial "anideism," one can by suggestion cause a condition of "monoideism," or, to be more exact, a condition of "oligodeism" in relation to the morbid disturbances.
But is one ever certain of having obtained the necessary condi- tion? At what moment is one informed of its appearance? By what traits is one to recognize it ?
In order to articulate the syllables after an isochronous rhythm, I make them synchronous with the subject^s respiratory move- ments ; in other words, every syllable "dor" is pronounced during every inspiration and every syllable "mez" during every expira- tion. Following this I have noticed that if after a variable length of time I changed somewhat slightly the rhythm of my words the patient^s respiratory rhythm became modified in proportion — that
SUGGESTION DURING NATURAL SLEEP.— Farez. Z7
it accelerated or decreased in ratio with the quickening or slowing of my vocal rhythm.
When I' find that I can thus indirectly act on the respiratory movements of the subject I judge that he is ''ripe" and ready for the suggestion; the period of preparation is ended and the truly passive phase has commenced.
FOURTH PERIOD.
The contents of the curative suggestions vary, of course, with the psychological condition of the patient and the nature of the mental or other troubles. Special suggestions will be used accord- ing to the requirements of the case ; hence they will not be dilated on here, as the consideration is simply of the general technique.
It is well to call to mind, in this connection, the advice given by August Voisin, in reference to the hypnotic sleep, which advice applies as well to suggestion during natural sleep : ''one must pro- ceed slowly — one must not make too many suggestions during one seance, nor run the risk of causing apparent malaise which shows itself by facial contractions." The suggestions must be ex- pressed with distinctness, conviction and authority; in short, they must consist of short, concise, well marked phrases reduced to a strict minimum. Every syllable of every word must be distinct, one from the other, and must be articulated according to the rhythm of the respiratory movement. This rule of synchronism will prevent fast talking and will give the patient a better chance to comprehend all the words spoken and his attention will be fruit- fully occupied.
FIFTH PERIOD
The end of the seance must not be neglected. We must order the patient not to awake before a given hour, to sleep all through the night very calmly and to dream, during his sleep, of nothing but what has been advised. We must suggest to him that on awakening he will not be tired, that he will be full of energy, that his spirit will be alert and active. This done, he must not be left suddenly ; we must retreat gradually, repeating our intonation, this time with a progressively decreasing intensity.
How long should a seance last ?
One cannot formulate any precise rule on that point, for the con- ditions of intervention vary with the subject. The judgment as to the proper duration is left to the discretion of the psychotherapist, who will act according to the requirements of the occasion and as he himself is or is not fatigued or whether the patient remains placid or appears enervated, and whether the preceding sugges-
38 SUGGESTION DURING NATURAL SLEEP.— Farez.
tions have succeeded well or indifferently, etc., etc.* In general 1 may say that a seance, as I understand it, must last not less an one- half hour.
The question of whether seances may be repeated at short or long intervals is a question that again depends on the individual peculiarities of the patient. It is not exaggerated treatment, how- ever, to suggest daily, at least, in the beginning. Later on the in- tervals may be made longer, according to the gravity or com- plexity of the disease and also according to the degree of ameliora- tion obtained.
It is customary to call hypnotic suggestion that caused during artificial or induced sleep. I therefore propose the expression "somnic" suggestion for that caused during normal sleep. I am aware that the term is not irreproachable, but it is short and handy and I use it for the want of a better one. I subdivide the "somnic'* suggestion into two phases: ist The presomnic suggestion, and 26. the intersomnic suggestion. The first is made as soon as the patient gets into bed, and before he has fallen asleep ; the second is made to a patient awakened by the sound of our voice ; the sug- gestion takes place between two conditions of sleep, the one that we interrupt and the one that will follow after we leave the patient. In both cases, the substance of our suggestions will easily become the subject of a dream. In both cases, also, it is well to close the patients eyes and to thus invite his psychic activity to concentrate itself on the auditory sense exclusively, through which avenue our verbal suggestion finds its way.
In conclusion, I wish to say a few words to alienists.
There are certain forms of mental troubles the cause of which is principally psychological, which diseases seem to be susceptible to and which improve or even become cured by suggestive treat- ment. Unfortunately, however, "the insane are not susceptible to hypnotism^^ seems to be a commonly believed fallacy. That this is a fallacy, August Voisinf has demonstrated since 1880. By dint of patient and persevering work and at the cost of much time he finally succeeded in plunging a certain number of insane into hypnotic sleep, and after having hypnotized them he makes sug-
'^For details see Paul Farez, on Suggestion During Natural Sleep, Paris, Maloine, 1898, page 2^.
fFollowing in the steps of Dr. Voisin, numerous physicians have obtained success by the use of suggestive therapeutics in the treatment of the insane, prominently MM, Burkhardt, Buzot, Berillon, Dufour, Von Eden, Farez, Grasset, Von Krafft-Ebing, Ladame, Lombroso. Van Renterghem, Roubinovitch, Repond, Seglas, Von Schranck-Notz- ing, Tokarsky, and Jules Voisin,
SUGGESTION DURING NATURAL SLEEP.— Farez. 39
gestions to them whereby he not only obtains amelioration but actual durable cures, thus saving alleged incurable patients from perpetual sequestration. In a paper written in 1889 he cited cases of patients whose cures dated back three, four and even five years ; out of twenty-two insane treated by hypnotic suggestion four re- mained completely cured. At a congress which took place in Munich in 1896 he made the report of forty-two patients success- fully treated by that method.
Voisin admitted, however, that he could hypnotize only ten out of every 100 patients. This proportion is large, considering that before this the profession deemed all the insane to be refractory to hypnotism.
It is easily apparent that when an insane patient is openly hostile to therapeutic intervention and obstinately refuses to allow himself to be hypnotized when awake, or, on the other hand, when without presenting obstinate opposition his mind if either too beset or dis- tracted, this method of suggestion is the one to be adopted. The patient should be taken in hand while in his normal sleep and the technique, which must be long, minute and delicate, but^ on the whole, simple, must be applied. The suggestion can thus strongly impress the insane patient without having his consent to treatment at a moment when he will attempt to resist : he will be before you calm, tranquil and passive : you will apply to him the moral therapy in security and the application may prove truly curative or simply palliative.
A CASE OF VERBAL BLINDNESS AND DEAF- NESS AND AN AUTOPSY ON THE BODY.
BY DRS. PAUL SERIEUX AND F. FARNARIER.
Mile. Z. L., a domestic, 36 years old, was admitted to the Ville-Evrard Asylum September 21, 1898.
Of the personal history we only know that her intellectual development was of an inferior order; she had no instruction when a child and learned to read and write at the age of 25.
The disease made its appearance in 1895 by an apoplectiform attack with complete loss of consciousness. During the subsequent three years (1895- 1898) the attacks were renewed and were followed, every time, by a certain degree of obnubilation and functional disturbances of speech, predominat- ing in the auditory sphere (verbal blindness) and lasting a few days at a time. The intelligence was progressively decreasing.
The development of the disease was watched by us for fourteen months ; it ended in a series of epileptiform attacks which caused death that was pre- ceded by trophic and generalized paralytic disturbances.
Before touching on the disturbances of the speech we will say a few words about the motor, sensory and mental disturbances.
Motor Disturbances. — The entire evolution of the disease was especially characterized by numerous epileptiform attacks with complete loss of con- sciousness and clonic movements of one side of the body, most frequently of the right side. These attacks were followed by a more marked condition of obnubilation than usually existed, a condition of confused agitation, more accentuated disturbances of speech, and a transformation of verbal blind- ness into total cortical blindness.
Outside of these attacks, there existed a certain degree of spasmodic paresis resembling a hemiplegic form, but the side affected varied with the epileptiform attack; the right side, however, was most frequently affected.
The gait was impeded by this very condition of the spasmodic paresis; the patient was totally incapacitated, however, only during the last weeks of her life.
All the tendon reflexes were much exaggerated; the epileptoid trepida- tion was usual during the days following an attack. Finally, a few weeks before death there was a tendency to generalized contractures, with per- manent trismus, gnashing of the teeth and difficulty in deglutition.
Sensory Disturbances. — The sensibility was always obtuse; pricking, and pinching were felt incompletely, and it was not easy to determine to what degree the intellectual obtusion intervened in the faulty perception or how extensive were the true sensory disturbances. ^
At all events, the acts of auto-mutilation observed during a long period indicated the existence of impairment of the sensibility to pain. As to dis- turbances of subjective sensibility — let us note that from time to time the patient had sensations of being wet.
The special senses were little affected; the sight was intact (verbal blind-
VERBAL BLINDNESS.— Serieux and Farnarier. 4I
ness was nevertheless permanent and almost complete) and the hearing was good, except on the days that followed the attacks. We could not investi- gate the condition of the gustatory sense (much impaired, no doubt, as the patient presented intermittent coprophagia). The sense of smell was little affected, for the patient recognized the smell of eau de cologne.
Disturbances of the Intelligence. — The psychic faculties were much impaired. Nevertheless, this condition of mental enfeeblement, analogous to that of general paralysis or cerebral syphilis, was not so pronounced as to preclude an examination and to render the patient unconscious of her condition. Consequently, the information obtained (which was verified at times) retains its value. She was in a depressed mood and highly sensitive; at times, particularly after the attacks, she manifested highly marked auto- matic agitation. Finally, she seems to have had some elementary melan- choly ideas : she would assert that she was going to die or that she was dead.
The disturbances of speech, the most marked symptoms, consisted essen- tially in sensory aphasia (verbal deafness and blindness with jargono- phasia).
Verbal Deafness. — This dominated the whole pathological scene and, at first sight, the patient could have been taken for a deaf person. Neverthe- less, it was easy to see that she could hear (at least the greater part of the time) the sound of the voice, the noise of a bell, and the tick of a watch. She could not, on the other hand, understand the simplest question ; she could not understand such simple phrases as ''Give me your hand ;" "Show your tongue;" "Stand up;" "You can go." She could not recognize her own name when it was pronounced.
Nevertheless, the verbal deafness was not always quite so marked, and at times the patient seemed to understand certain words. Thus (on De- cember 7, 1898) she was told : "Put your hand on your hair." She recog- nized the word "hair," and answered : "I had much hair, but it has fallen out." And at another time: "Can you sing?" She replied: "Yes, I sang when I was young, but I cannot do so now."
On days following an attack, on the contrary, not only is the verbal deaf- ness complete, but the sounds even are not comprehended. These transi- tory spells of cortical deafness led us to the hypothesis (which was con- firmed by the autopsy) of the existence of a symmetrical lesion of both temporal lobes. This condition of total deafness became permanent towards the end of October, 1899, one month before death.
Verbal Blindness. — Throughout the evolution of the disease the verbal blindness, even that of letters, was absolute. In the very beginning only some ciphers could be recognized ; on November 20, 1898, the patient could recognize "2," and after much hesitation "3." On the other hand, letters were not recognized, and the patient made no remark when a printed page was shown her with the letters upside down.
There was no psychic blindness. She recognized her employer, who visited her, almost to the end; at different times she recognized various
objects shown her: a fork, a bell, biscuits, a doll, etc.
*
The Spoken Language. — The following disturbances were observed — a reduced vocabulary, periphrases paraphasia, jargonophasia, and (rarely) echolalia.
The spontaneous speech was always influenced by the epileptiform at- tacks and reduced, during the hours following, to some unintelligible mono-
42 VERBAL BLINDNESS.— Serieux and Farnarisr.
syllables (be-be-be) ; the words which she was well familiar with, however, she could pronounce correctly: "I am deaf," she often repeated; "No, let me alone, you worry me;" "You hurt me" (while the sensibility was ex- amined) ; "It is a little letter" (when shown cipher figures) ; "It hurts, cold water, it is all wet," etc.
Periphrases and Paraphasia. — She was usually unable to name objects shown her, although she recognized them. Thus, she said: "Camisole" . . . "to amuse one's self," when a cake of soap was shown her; "To cut camises, things," when scissors were shown her : "To brush," when a brush was shown; "It smells good," when asked the name of eau de cologne; "To soap, soap," when shown knitting wool.
At times she used paraphrases: "To sit down," when shown a chair; "To see the time," when shown a watch; "To lie down," when shown her bed; "For the soup," when shown a spoon. On December 12, having been free from epileptiform attacks fourteen days, she correctly named a lead pencil, keys and a fork.
Finally, there was a certain degree of jargonophasia (cormiere, bonoure*), and at times echolalia. Besides, from February, 1899, the vocabulary be- came reduced to some words devoid of any sense which the patient used on all occasions : "Well, well . . . little," and even then the words were pronounced unintelligibly.
Handwriting. — She could write, but it was impossible to obtain a speci- men of her writing either because of the paresis and the spasmodic phe- nomena which predominated on the right side, or because of the verbal blindness (agraphia of sensory origin), which is more probable.
During October, 1899, trophic disturbances made their appearance: a true muscular melting, pemphigus blisters, on the hands at first, then on the heels, and, finally, two extensive ulcers, one on the right nates, the other over the great trochanter of the same side.
Death in November, 1899.
Autopsy. — Very marked atrophy of the brain, particularly of the left hemisphere (left hemisphere, 395 grammes; right hemisphere, 410 grammes). The loss in weight of both hemispheres can be estimated as amounting to about 300 grammes'.
The Atrophy. — In the left hemisphere it is particularly marked in the frontal and the temporal lobes, the convolutions of which are very much wasted, some being reduced almost to mere lines (microgyri) ; re- sistent to touch but without other modification visible to the naked eye. The temporal lobe, much reduced in volume, leaves uncovered the insula, and shows a progressive wasting from behind forward; its anterior ex- tremity is reduced to a sort of a small tongue-shaped form. The first temporal meastires hardly 5 millimetres in thickness. The deep temporal is also much wasted. The supra marginal convolution and those of the gyrus angularis are also touched by the atrophy, though to a lesser degree.
The consistency of the atrophied parts is firmer than in the normal state.
The meninges are somewhat opaque over the paracentral lobules and the upper part of the Rolandic convolutions. The pia mater is easily detached, except at the posterior part of the second and third temporal convolutions, where slight adherences exist.
Right Hemisphere. — The atrophy is similarly distributed, but is less
*These words are untranslatable for obvious reasons. — Translator's note.
VERBAL BLINDNESS.— Serieux and Farnarier. 43
marked, particularlj'- over the temporal lobe; the frontal lobe is more wasted than on the left side.
There are marked granulations in all the ventricles.
The spinal cord seems normal to the naked eye.*
Resume. — From an anatomical point of view : atrophic cerebral sclerosis, probably diffuse (ventricular granulations, loss of weight of 300 grammes), but with predominance in the temporo-f rontal lobes ; the localization cor- responds with the observed symptoms. The temporal lobes, atrophied en masse, are reduced to almost half the normal size.
This case is interesting: (i) From the standpoint of localization of sen- sory aphasia; (2) in the fact that it constitutes an exceptional example of a case of aphasia due to atropic cerebral sclerosis, and (3) as a contribu- tion to the history, scarcely know^n, of symptomatology of cerebral sclerosis in the adult.
Cases of aphasia due to atrophic cerebral sclerosis are exceptional.
Let us call to mind that one of us reported an analogous case the sympto- matology of which was, however, far from being as complex as in this one, for the other was one of pure verbal deafness. The autopsy revealed an atrophic lobar sclerosis strictly limited to the temporal lobes of both hemi- spheres (lesions of chronic polyencephalitis).
remarks by prof, joffroy.
In this case the topography and the great extent of the lesions have some analogy to what is observed in general paralysis.
REMARKS BY M. DEJERINE.
The hypothesis of general paralysis must be eliminated, as there is no trace of meningeal adherence in the brain. — (Bulletin de la Societe de Neurologic de Paris, February i, 1900.)
*Dr. Dejerine will examine the specimens. The case is probably one of diffuse atrophic sclerosis.
TYPOGRAPHICAL ERRORS.
Editorial Articles.
^*^* 6th line from bottom of page : word;; the'; should be stricken out. 3d line from bottom of page : word the should read its.
^^^^ Last line : word '' unreasoned " should read "unreasoning." Page 48.^^ ^^ _ ^^ halucinations" should read " hallucinations."
The Journal of Mental Pathology.
Edited by Louise G. Robinovitch, B es.L., M.D.
Vol. I. JUNE, 1901. No. i.
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PSYCHIATRY IN THE TWENTIETH CENTURY.
To trace the history of psychiatry it is necessary to turn to the other side of the Atlantic. Broadly, the history of psychiatry may be considered as being composed of two parts : the scientific and the practical. So closely are these two interwoven, however, that it would be difficult to treat of the one separately from the other.
Pre-eminent among the alienists, of course, is Philippe Pinel ; a century ago he dared proclaim his belief that chains were not the proper habiliments for the insane, and this belief he carried into practice. His characterization of the manacle stands unrivaled as an epitome of all the arguments on the subject, for he entirely summed up the situation when he described this instrument of the restraint as ''that admirable invention for perpetuating frenzy in the maniac.^'
Modern thought in psychiatry may be said to have had the con- ception at that time; of a sudden the insane became objects of in- terest and of study. Quite naturally the medical literature of this
PSYCHIATRY IN THE TWENTIETH CENTURY. 45
initial period teemed with discoveries of new denominations of dis- eases observed, and even the most scholarly observers were carried away with the congenial task of the fabrication of monomanias; syndroms of diseases were taken for the disease itself. As time wore on, however, the enthusiasm in this direction exhausted itself and closer application to the study of mental science brought the workers in this field to the realization of more exact conclu- sions as to the nature of insanity and the proper method for con- sidering its syndroms. The studies of Morel, Falret andLassegue' in France, and of their contemporaries in other countries marked the period of the wane of the nomenclature of monomania, and to- day, with the admirable work of Magnan in France, Kraft-Ebing in Austria, Kraepelin in Germany and others elsewhere the irre- pressible monomania of old has become not only a relic of an anti- quated nomenclature, but entirely obsolete as a scientific, term among psychiaters.
Clinical research has forced the students in alienism to realize that the major portion of the forms of mental disease go hand in hand with heredity, and so potent did this fact become that the coining of the term "degeneracy^^ became necessary to supply a word that would specifically cover the condition sought to be de- scribed. The study of degeneracy was well covered by Morel, Lassegue and others ; but the honor of having given to the world the keenest insight into the practical working of heredity is due to Magnan. Starting with the lowest denomination in the mental scale, idiocy, and ending with the highest, the superior degenerate, his classification follows, step by step, plainly exposing and analyz- ing the various degrees, the intensity and the complexity of the manifestations of degeneracy.
He has demonstrated that the stigma of psychic weakness marks this great class of insane, a weakness which seldom fails to mani- fest itself by complete abandonment of resistance, either during childhood or adult life, under stress of circumstances of a more or less marked degree. Another part of this system of classification is that based on anatomo-pathology and, finally, come the neuroses. No less valuable is Magnan^s study on alcoholism and its relation to mental diseases, and this line of research must serve as a new source for development of thought and action in the field of psycho- pathology.
The practical application of the theories involved during this purely scientific progress in mental science has kept pace with the new ideas. If the chemical restraint that followed the abandon- ment of the manacle was abused by some, the abuse was due to an erroneous application of unreasoned zeal, and while the majority
46 PSYCHIATRY IN THE TWENTIETH CENTURY.
of alienists were inspired to follow out literally the details and methods of the French school, Guislain made a new departure, and in 1852 was the first one to record the results of what is now known as "bed treatment." It was his contention that the great benefit derived by the melancholiacs from this method of treatment could hardly be appreciated. Hagen seconded this opinion in 1853, adding, however, that the maniac also derived great benefit from this treatment, and Schlager and Griesinger in 1861, and Koeppe, as well as Falret in 1864, bear witness to the efficacy of this sys- tem, the last named asserting that he found the method very bene- ficial in cases of mania with semi-febrile conditions. While the method failed to receive a very enthusiastic welcome at the hands of the profession at large, it was quite extensively employed by physicians in various countries, particularly in Germany. During the last few years this mode of treatment has ceased to be an ex- periment and is now an established part of hospital regime ; it is no longer a means employed in isolated cases, but is an absolute neces- sity in almost all cases. The late Korsakov in Russia, Clemens Neisser in Silesia, and a host of others have established beyond question the adequacy of this means of treatment. Introduced in its present form by Magnan in France, the results were so satis- factory that Professor Joffroy soon adopted the system of bed treatment, and many others have followed. Some American alien- ists have taken this matter up and have demonstrated the efficiency of this mode of treatment, the effects of which have been so long favorably known as applied to the treatment of neurasthenia: as witness Dr. Weir MitchelFs rest-cure as applied to cases other than the insane.
Justly speaking this country has not yet given birth to any "school" of psychiatry. Nevertheless, this science is taking root here; already a few earnest students may be found among the younger men in New York, Philadelphia, Baltimore and Boston, and the prophecy may be ventured that good results are confi- dently to be expected in the near future. From a practical point of view there are, beyond question, many things to which the pro- fession in the United States can point with pride, and it cannot be long before scientific research and experiment will take its proper place in this country. The twentieth century is undoubt- edly fated to produce much in the way of discoveries in the almost untrodden wilderness of psychiatry. The importance of the study of the diseased mind is becoming more and more appreciated here ; and it will not be long before the many obstacles that have been put in the way of psychiatric research will be removed as ignorant opposition on the part of the uninformed disappears.
WOMEN ATTENDANTS IN MEN'S WARDS. 47
ON THE QUESTION OF WOMEN ATTENDANTS IN THE MEN'S WARDS
FOR THE INSANE
The recent alleged scandalous occurrences at Bellevue pavilion for the insane, New York, involve two practical questions, both of which are of living interest. One is of a purely political nature and cannot be discussed here, while the other is of scientific inter- est— touching on the possible means of protecting the insane.
There are few physicians working in the field of insanity who are not alive to the great difficulty encountered in the treatment of the patients : their maltreatment by the attendants. The evil has al- ways existed, but every now and then there is a fresh outbreak of demonstration against it. Investigations follow, then such feasible changes for the improvement of conditions are made as are con- sistent with the policies of the existing administrations and finally the cause falls into its usual state of obnubilation, until a new series of shocking occurrences draws the attention of the public eye. While this evil applies to both the men and women patients, those who have followed out the question for any number of years will recall that the particular sort of abuses in question are brought to notice first from the men^s wards — where there are nien attend- ants. It is this side of the question that appeals most strongly for consideration and solution.
The question of having women nurses to attend to men insane has been brought up at various times within the last few years as a sheer thought: a problem — so to speak — the physician hesitating to take any decided step in the direction, for many reasons that impose themselves on the mind traveling in the deep groove of rou- tine. Conservatism is an excellent thing in many lines of business, but there are conditions in which radical remedies are the only ones feasible. The placing of women nurses in the wards for in- sane is a consummation most devoutly to be hoped for. Indeed, some practical work already done in that line warrants the forma- tion of a most positive conclusion regarding the practicability of this innovation in the treatment of the insane.
A few years ago the administration at the Philadelphia City Hospital tried an experiment in that line that proved most success- ful. The male attendants were displaced by women nurses in the alcoholic wards, with the hope of doing away with just such rough and cruel handling of the helpless patients as is alleged to have taken place in the insane pavilion at Bellevue Hospital. The ex- periment was made with that feeling of fear of failure which at- tends most innovations of this character, but the apprehensions were soon dissipated. Not only was it found that the delirious alcoholic patients could be treated without being beaten, as it was
48 WOMEN ATTENDANTS IN MEN'S WARDS.
claimed the male attendants found it necessary to do in self-defense against the patients' violent behavior, but the patients were found by the women nurses to be very easy to handle. And the writer recalls that while in charge of the medical wards which included the alcoholic, the nurses considered it a desirable assignment to be sent to the alcoholic ward in preference to working in the gen- eral medical wards.
To revert to the general question of the attendance of the insane by women nurses : while no substantial information to uphold this argument may be had at present, there seems to be no lack of rea- soning to warrant a trial of this system.
At the leading European asylums for the insane, in Paris, as is well known, the wards for both sexes are open to women physi- cians and the experience of the writer during some three years of attendance there showed that it was only on two or three occasions during this entire period of every-day visits that a patient became excited or violent because of her presence, and those cases were patients suffering from general paralysis. Incidentally, it may be mentioned that the wards referred to were occupied by violent pa- tients, undergoing the "bed treatment.^' In many instances, indeed, the presence of a woman in the ward had a quieting effect ; often, when one of the patients became excited, another one would call to him, or go to his bed and endeavor to quiet him because of the presence of a woman in the room.
The alcoholic ward was not separate from the others in this insti- tution, and observation in that line leads to the conclusion that there are few delerii so easily soothed by kind words and treatment as are those caused by alcoholism. A woman is never more in her proper sphere as a nurse than when reassuring a delirious alco- holic that the bleeding heads in the air are only halucinations, that the ferocious beasts attacking him in the depth of the lonesome woods are the creations of his own mind and that the axe hang- ing over his head has no existence in fact.
The claim is not made here that men attendants should be done away with entirely; it would seem reasonable, however, to intro- duce vv^omen attendants to as large a degree as possible, retaining the men here and there where they are deemed to be indispensable. If every other consideration be put aside, this one must still pre- vail, that the mere constant presence of women in the wards would act as a deterrent, so that those acts of brutality which necessarily characterize the stern masculine administration to a greater or lesser degree would become things of the past in the history of insane asylums.
INTERNATIONAL CONGRESS, 1900. 49
THIRTEENTH INTERNATIONAL MEDICAL CONGRESS, PARIS, 1900. SECTION OF PSYCHIATRY.
THE PATHOLOGICAL ANATOMY OF IDIOCY. G. E. SHUTTLEWORTH^ M.D., AND F. BEACH^ M.B., F.R.C.P.
The history of the disease is given, beginning with the days of Hippocrates and ending with the most recent times : Modern au- thors are of the opinion that pathology and classification are mutu- ally interdependent. According to this view, the anatomo-path- ology of idiocy is classified under three chief heads, viz. : I. — Congenital formative defects; II. — Developmental cases;
III. — Acquired cases.
Under the first head are placed (i) microcephalus ; (2) hydro- cephalus; (3) scaphocephalus ; (4) Mongol imperfections of the osseous, cutaneous, mucous and, in some cases, cardiac tissues;
(5) neuropathic genetous cases, in which the convolutions are coarse and simple, or are small, slender and curling (microgyri) ;
(6) amaurotic genetous cases; (7) sporadic cretinism, due to de- fective structure or absence of the thyroid gland, and (8) partial local defects, such as defect of the corpus callosum, or porenceph- alus. Under the second head are included (i) eclampsic cases with haemorrhagic or inflammatory lesions; (2) epileptic cases; (3) syphilitic and juvenile general paralysis cases, and (4) par- alytic cases, in which there are degenerative changes in the vessels of the brain, or, in some cases, atrophy of the brain. These cases may be due to birth palsy, to palsy coming on after whooping cough, or to inflammation. Under the third head are comprised
(a) traumatic cases, due to pressure on the head during labor owing to abnormal narrowness of the pelvis, prolonged labor, or less often the use of the forceps, and lesions produced by accidents ;
(b) post-febrile inflammatory cases (under this sub-head is placed hypertrophic idiocy), and (c) sclerotic idiocy, a disease first de- scribed by Bourneville in 1882. The changes in the brain observed in this disease were noted by Dr. Wilmarth in 25 out of 100 cases, and have been noted frequently by Beach, who cited additional changes: hypersemia, softening, tumors and diseases of the mem- branes of the brain ; assymmetry of hemispheres and convulsions ; alterations in relation of gray to white matter of the brain; sim- plicity of convolutions, thickening of the arteries, thrombosis, dis- sease of the cerebellum and spinal cord and anomalies of the con- vex surface and base of the cranium (in Tuke^s Dictionary of Psychological Medicine, 1892). *
Dr. Bourneville. — The researches on idiocy or rather the idio-
50 INTERNATIONAL CONGRESS, 1900.
cies, during the last twenty-five years, both at the Saltpetriere and the Bicetre asylum lead the author to distinguish from an anat- omo-pathological view the following varieties : i. Idiocy symptom- atic of chronic meningitis (meningitic idiocy). 2. Idiocy symp- tomatic of chronic meningo-encephalitis (meningo-encephalitic idiocy). 3. Idiocy symptomatic of an arrest of development of the convolutions without malformation, with cellular nervous lesions (congenital idiopathic idiocy). 4. Idiocy symptomatic of hyper- trophic or tuberous sclerosis. 5. Idiocy symptomatic of atrophic sclerosis: (a) sclerosis of one or both cerebral hemispheres (hemi- spheric or di-hemispheric sclerosis) ; (b) sclerosis of one cerebral lobe (lobar sclerosis) ; (c) sclerosis of isolated convolutions; (d) granulated sclerosis of the brain (?). 6. Hemispheric or para- plegic idiocy symptomatic of focus lesions due to a vascular oblit- eration or a hemorrhage (pseudo-porencephalus, etc.). 7. Idiocy symptomatic of simple ventricular hydrocephalus or complicated with extra-ventricular hemorrhage (hydrocephalis idiocy). 8. Idiocy with pachydermic cachexia or myxoedematous idiocy, in connection with the absence of the thyroid gland. 9. Idiocy symp- tomatic of an arrest of development of the brain with congenital malformations (true porencephalus, absence of the corpus cal- losum, etc.). 10. Idiocy symptomatic of microcephalia due to arrest of development with or without malformations, or having for causes lesions that took place after birth (micro-cephalic idiocy, properly speaking, or symptomatic). The author has not found any case of idiocy that could be ascribed as due to osseous lesions, particularly to a premature synostosis of the cranial bones.
Dr. J. • MiERZEjEWSKi. — Dr. Bourneville^s classification of the forms of idiocy answers the practical side of science ; but the anat- omo-pathological classification based on the study of the delicate structure of the nervous tissue and its elements, and on precise embryonic knowledge, will becom.e necessary with the progress of science. The basis of all anatomical lesions of the brains of idiots consists in a deviation of development of the nervous tissue ; this deviation must be traced to the embryonic life or to the patho- logical lesions which take place during early infancy, and which become the starting points of the deviation of ulterior develop- ment. There is no true arrest of development in the morphological and histological sense of the braiin in its entity, but there is a true arrest of development of certain regions of the cerebral tissue which can be found by the presence of neuroblasts. Among the brains of idiots who belong to this category, whose delicate histo- logical nature is best known, and which may be considered as a special group by virtue of its characteristics, there are brains the
INTERNATIONAL CONGRESS, 1900. 5 1
white cerebral matter of which is very little developed, whereas the gray cortical substance is prodigiously abundant. These brains, which are found in the micro- and semi-microcephalic idiots, gen- erally present a micro-gyric arrangement of the convolutions, but this is not an absolute rule (case of Meine, Matell). The first case described was that of the author, which he presented at the Inter- national Congress at Geneva, in 1877. Other cases were published later. A histological description of the brains of idiots is given and it is concluded that: Richness in gray matter and abundance of nervous cells are compatible with idiocy; but in such cases the system of connecting elements of the convolutions is arrested in development ; this absence of communication, this lack of harmony in the development of the different nervous elements, make impera- fect an organ rich in some respects and so poor in others. But in the central nervous system everything depends, not on the quan- tity, but the quality of the elements and their reciprocal combi- nation. So that the white matter is nothing but the continuation of the processes of the nervous cells. Thus the richness of dendric ramifications and those of the axis-cylinder of these cells favor the abundant development of the white substance, and the paucity of these ramifications makes its development insufficient. In the brains where the white substance is little developed, the nervous cells must be poor in prolongation processes and the functional activity of the cells enfeebled or annulled. The multiplication and large extent of the connections of the pyramidal cells seem to be the principal conditions of intellectual manifestation. But intel- lectual supremacy seems to be not so much the result of the num- ber as of the multiplicity and the extent of the connections (De- jerine). Consequently, richness of nervous cells can coexist with idiocy, if the cells are devoid of their multiple and extended rami- fications. It is thus that there is a lack of the avenues through which take place propagation, accumulation and combination of the nervous forces. The abundance of the larger of neuroblasts in the hemispheres of idiots, which indicates true arrest of devel- opment of certain parts of the cerebral tissue, causes, doubtless, the insufficiency of functions of the nervous system in intellectual manifestation. But, under favorable circumstances, the neuro- blasts can perhaps become transformed into elements of higher order — that is to say, into nervous cells. In the larger of neuro- blasts are sometimes found polymorphous cells. The neuroblasts remaining in their embryonic form, and in a condition of func- tional lethargy, may, under the influence of a propitious impulse, become transformed into nervous cells and thus elevate the cere- bral functions. This explains, perhaps, the cases of profound and
52 INTERNATIONAL CONGRESS, 1900.
hopeless idiocy, in which there is sometimes a notable improve- ment in the intellectual faculties, the idiot seeming to wake up from a prolonged sleep, although he retains for life the stigma of psychic infirmity in a less marked degree.
ON THE EVIDENCE OF THE GOLGI METHODS FOR THE THEORY OF NEURON RETRACTION. Richard Weil and Rorert Frank.
Neuron retractability is regarded by the majority of observers as a function of the protoplasmic processes, and is best manifested by the pyramidal cells of the cerebrum and the Purkinje cells of the cere- bellum. Two changes are said to occur: First, the appearance of local- ized swellings or "varicosities" along the course of the dendrites, and second, the disappearance of the gemmules, or dendritic spines, at the site of these swellings. The two phenomena are supposed, except by LuGARO, to be correlated. The spinous processes withdraw into the body of the dendrites and by so doing produce a localized swelling. Human and experimental material of the greatest diversity has been investigated: of the former, brains of diphtheria, typhoid, insolation, etc.; of the latter, brains of animals poisoned by arsenic, lead, mor- phine, strychnine, chloroform, tuberculosis, hydrophobia, experimental strumapriva, "experimental uraemia," etc. The method employed has always been the rapid Golgi (or Cajal) method, except in the case of certain recent works of Lugaro's, who has employed Cox's modifi- cation of the corrosive method. Criticism of the conclusion above stated has not been lacking. Both gemmules and varicosities are by some authorities considered to be artifacts; others, like Lugaro, while admitting their occasional iauthenticity, attribute a variable proportion of their number to post mortem processes. Lugaro asserts that the only form of the Golgi method which does not exaggerate the true number of varicosities is the Cox modification.
In this investigation four forms of the Golgi method were made use of, the rapid, mixed and slow modifications of the bichromate-silver method, and the Cox modification of the corrosive method. The num- ber of animals used was forty-three. There were five cases of human material, three adults and two foetuses; one dog and thirty-seven rab- bits. Of the rabbits ten were normal; of the remainder, two were poisoned by morphine, one by strychnine, four by chloroform and the rest by the injection of hypertoxic urine or serum. Nine of the rabbits were treated uniformly according to four methods, the three bichro- mate-silver modifications and the Cox; two were treated according to the rapid Golgi method and the Cox; the rest according to the rapid, mixed, or slow procedure alone. In all, 342 pieces were sectioned. The cerebral cortex alone was studied.
The conclusions reached are as follows :
I. The same material, when treated by different methods, yields differ- ent results. The nature of the differences in each kind of material is as follows:
All material treated according to the slow method of Golgi shows, as a rule, an almost absolute freedom from varicosities; varicose cells occasionally occur, but with a relative frequency which is perhaps not greater than a fraction of one per cent, of the total number of pyramid cells impregnated. Exceptionally, a large proportion of varicosities occurs.
NEURON RETRACTION. 53
The mixed method and the rapid method may be considered together. These two methods yield practically similar results as regards the varicosities and the gemmules. The gemmules are almost invariably present and are generally regular, provided the dendrites have taken the impregnation. The varicosities occur in variable proportions. Al- together, their frequency is generally greater and it is almost always very much greater than in the slow method. In some sections almost every dendrite is varicose, in others hardly any.
In the Cox method a fair amount of varicoseness is generally present at any stage of fixation. Gemmules are almost universally present and regular.
2. The above results are independent of the nature of the material, whether normal or toxic. Normal material, as well as the toxic, is, as a rule, free from varicosities when treated by the slow method. Normal material, as well as the toxic, exhibits a variable amount of varicosity when treated by any of the other three methods we have used. We find that it varies within exactly the same limits as the abnormal; that every degree of varicoseness can be illustrated with equal freedom from either, and finally, that it is impossible for an unprejudiced observer to differentiate or distinguish between the two kinds of material.
3. The same material does not yield constantly identical results when treated by one and the same method. Pieces from the same animal, when immersed in the same fluids of the slow, mixed, rapid or Cox method, may illustrate the extremes of varicoseness produced by that method.
The above conclusions seem to demonstrate that the varicosities are to be regarded as artifices of the Golgi method. (Archives of Neurology and Psychopathology, Vol. 2, Nos. 3-4, 1899.)
CONTRIBUTION A L'ETUDE DE L'ETAT MONILIFORME DES DEN- DRITES CORTICALES. (CONTRIBUTION TO THE STUDY OF THE MONILIFORM CONDITION OF THE CORTICAL DENDRITES.)
Dr. T. Geier, Physcian to the Moscow Clinic of Psychiatry.
Authors differ in opinion as to the significance of the varicose condi- tion of the dendrites, as well as to the conditions under which the moniliform changes are produced. Most authors hold that the inhala- tion of narcotics: — chloroform, ether, etc. — have an influence on the cor- tical nervous cells that causes swellings of the dendrites. While De- moor, Melle. Stefanowska, Havet, and others are disciples of the narcotic influence theory," others, like Lugaro, Soukhanoff, etc., af- firm that these inhalations have no influence on the moniliform forma- tions in the dendrites. The author experimented on animals, using ether and chloroform. The brains were examined by means of the rapid Golgi-Ramon y Cajal method; all specimens were treated alike, two days in a mixture of osmic acid and potassium bichromate, and one day in a solution of nitrate of silver (0.75 per cent.). The specimens were examined under a lens enlarging 500 to 900 diameter. Eight experi- ments were made in all and the conclusions were :
(i) In the cerebral cortex there are nervous cells of spherical or oval shape; in the normal state their protoplasmic prolongations have no col- lateral ramifications, the main prolongation presenting in its whole length
54 MONILIFORM CONDITION OF DENDRITES.
small swellings. These cells, it seems, must be either Golgi cells of the second type or cells of Cajal or cells of Martinotti.
(2.) The granular focuses observed by Melle. Stefanowska, identical with our network of fine filaments with small swellings, must not be considered as ordinary moniliform conditions. We think that these granular focuses consist of protoplasmic prolongations of the above- named cells and the normal axis cylinders with the ramifications.
(3.) Even profound etherization and chloroforming do not cause a moniliform condition of the dendrites.
(4). The moniliform condition cannot be considered as an expression of the plasticity of the dendrites.
(5.) The moniliform condition is either an expression of a pathological state of the cells or of its exhaustion.
(6.) In the experiments where chloroform and ether are used for the purpose of determining whether these narcotics are responsible for the moniliform formations in the dendrites, one must choose the animals for experiment carefully, paying particular attention to their physical con- dition. (Nevraxe, February 7, 1901.)
^INDIVIDUATION COLOREE (COLORED INDIVIDUATION).
P. SoKOLOV. Four cases are reported, of which two are types of what the author terms "colored individuation." One patient, 30 years old, with no morbid hereditary taint, but of a nervous temperament, has since early childhood, had a tendency to characterize those whom she knew by cer- tain colors; a given person was gray and green, another blue and lilac, etc. As she grew up this tendency became transformed into a habit, and now her best means of representing to herself the merit or demerit of any one she meets is by colors. Great men deserving much esteem evoke in her a representation in color, which to her corresponds to the mental conception. Thus, instead of representing to herself in her mind the word-picture of a particular great man she expresses that con- ception to herself in the form of a dark blue cloud, bordered with purple and red. .A personality of equal greatness, but lacking in firm- ness, evokes in her the equivalent representation in a cloud — dark red or red tinged with purple (as are the borders of the first cloud), but the centre of the cloud is blue. As the quality of the individual becomes more removed from the ideal of the great man the symbolic color of the cloud (blue) becomes lighter and lighter, until the color itself is changed. That color may have all possible shades of various colors, excepting black and white. Yellow is a color representing the conception of the worst type of personality: absence of brilliancy of mind and of moral principles. She does not know in what color her own personality is represented, but women, with few exceptions, evoke in her the equiva- lent representation of yellow. She explains this harsh judgment of her own sex by the fact that most of the women of her acquaintance are of no importance as a social element in her circle. These chromatic visions are visible to her: Every colored cloud floats before her eyes in the air, assuming the configuration of Africa. The height of this colored Africa is about one and one-half metres and the breadth is one metre. The cloud is so thick that nothing can be seen through it. But, she explains, the cloud does not obscure her vision of anything placed beyond the cloud; she sees psychically only. She expresses in colors
COLORED INDIVIDUATION. 55
only the intellectual and moral qualities of people. Their exterior ap- pearance does not evoke in her an equivalent colored perception. In order to have the color representation she must first have an opinion of the person's qualities, speak to him, or at least hear him. What is curious in this case is the fact that her first colored impression never changes; it may change in shade as she becomes more familiar with the person, but the fundamental color remains unchanged. So soon as the color becomes a sufficiently fixed representation she can never see or think of that person without that cloud of color being evoked in her mind. The only change in the chromatic representation that has been noticed during the last few years is that the colored cloud symbolizing the individual appears larger and at a greater distance than it was formerly. She sees the cloud two metres behind and somewhat to the right of the person whose qualities it represents in color. Besides the chro- matic representation of individualities she also colors, to a certain de- gree, vowels.
The second case is a lady, 45 years old. She was guided in the be- ginning by chromatic representation in reference to the moral character only. Certain actions of persons she called white, black, red, green and VIOLET. Later, however, she began to symbolize chromatically the whole individuality. She must first be familiar with the personality, the individual character of which she formulates chromatically. When the corresponding color symbol is well fixed in her mind it only changes in shade according to the humor in which that person happens to be. She expresses, for instance, two harmonious spouses by the colors rose and greenish; the harmony of these complimentary colors expresses mutual accord. These colors change as soon as she imagines the couple to have quarreled, the rose becoming of a loud hue and the green assuming a metallic tint disagreeable to the eye. In her case, there is a point of interest in this colored individuation. It consists in her ability to mentally translate color into individuality. Thus, when shown Plate XXVII of Lacouture's chromatic repertoire, which shows a com- bination of various shades of violet-blue and black, she said that with the addition of a little red the colors would represent to her two inti- mate persons, such as two spouses, or parents, between whom excellent friendship could exist. She often solves the problem of cause and effect regarding certain acts in persons whom she has symbolized chro- matically. When a certain act on the part of a thus symbolized person- ality is incomprehensible to her, she brings into play the fundamental symbolic color in its various shades and tries to draw conclusions therefrom. This represents, the author says, a true type of concrete thought, in the shape of color-ideas, using chromatic symbols in a man- ner almost identical to that in which ordinary thought makes use of words.
This case, like the first one, symbolizes great men, honest and firm of purpose, by blue. People of moderate intelligence, but kind, honest and of lively temperament, are symbolized by lilac. This color pleases her most, and she appropriates it to her own personality. Energetic people, endowed with logical stnse, active, and at the same time devoid of egotism, she symbolizes by red. The same type of personality, but egotistic, she symbolizes by orange color. Yellow represents, according to the shade, people of tender and sweet disposition or people change- able, effeminate and vapid. People most disagreeable to her are sym-
56 COLORED INDIVIDUATION.
bolized by a metallic grc^n color. Such people are mischievous, vindic- tive and sly. These chromatic qualifications express only an approxi- mate appreciation of leading characteristics. This case, like the other, symbolizes by color psychic characteristics only, leaving out the exterior appearance. She says: "Color resembles a man; it has a soul, and this «oul can be in harmony with that of the man. There is a kind of in- ternal afifinity between them, and in order to find this affinity it is Siecessary not only to represent the color to one's self, but also to FEEL it."
This faculty to symbolize by color has grown weaker in this case within the last four years, for, as she explains it, she has not as much leisure time now as she had formerly. She also symbolizes by color music and general ideas. Strength is red, law is blue.
The sister of the first case, thirty-two years old, symbolizes by color vowels, the human voice, music, etc. Poushkin's poetry she character- izes by pale rose color; Heine's, loud red; Goethe's "Faust," steel blue; Tolstoi's works, orange yellow; Tourgueniev's, pale blue, etc. This patient is the only one of those cited who has been suffering from mental derangement, the last affliction manifesting itself only recently.
A fourth case, a man, 29 years old, colors vowels, the human voice, notes of the scale, the timbre of musical instruments and particular per- sons.
It seems that in cases like those above cited the mind is absolutely concrete, incapable of pure abstract thought, translating thought into intuitive and sensory form. Such a mental state, extremely favorable to the development of idiosyncrasies, analogous to colored hearing, implies, no doubt, some anomalies of a hereditary nature. Nevertheless, the chromatic representations of individualities can be compared to ordinary visual metaphors by means of which we characterize qualities of men's actions; in both cases the representations must be of an emotional na- ture. Thus we say that people and things appear to us under different "colors," in "rose," or "black;" we say, for instance, "a clear" or "scin- tillating" mind, a "sombre" nature, a "dull" thought, a "pale" expres- sion, a "radiant" appearance, a "brilliant" orator, etc.
Psychologically, the phenomenon of such illusions or colored individ- uation is thus explained : The principal cause of that phenomenon must be looked for in the association by resemblance; not by resemblance of qualities, but by resemblance of relations, of ideas, of emotion. Two perceptions or images, having qualities of an entirely different nature, may be brought together in our mind when they are united by a certain general idea to which they have an analogous relation. This is the principle of association by resemblance of idea-relation. In the first case cited heavy colors are associated with the idea of a great man; the sym- bolic color of mind become? lighter as the individual's mind is of less weight. It is evident that she sees an analogy between the condensation of color and concentration of intellectual and moral qualities of a man. Two diametrically different images are here brought together: that of color and that of man.
Association by resemblance of emotional relations is perhaps of still more importance here. Two perceptions or images totally differing in their qualities may be united in our thought, if they call forth analogous sentiments. Thus the second case states that there is a sort of mys- terious affinity between man and color, and that the latter must be
COLORED INDIVIDUATION. ^'^
"felt." Psychologically the simple sensations of the pleasant and un- pleasant play an important role here. This same case associates lilac, her favorite color, with the notion of moral and intellectual people among whom she would count herself. Green, the color of a snake, evokes the idea of an undesirable character.
The colored symbolizing of vowels, etc., is explained in an analogous manner: A vowel ,is represented in the mind by a sound, image, a graphic sign, etc.
All these elements, accompanied by a series of emotions hardly per- ceptible, constitute a whole and characteristic "being" according to the expression of one of Flournoy's cases, or an individual synthesis, as I should prefer to call it. In a child, particularly, the simplest way of symbolizing this is by the use of chromatic association. In all cases, chromatic symbolism persists as long as it fulfills a useful function in thought — the latter being symbolic by its nature; the colored symbolism disappears on becoming superfluous — it then becomes atrophied and ex- ists in a rudimentary state only. (Revue Philosophique,, January, 1901.)
A paper entitled "THE BRAINS OF TWO DISTINGUISHED PHYSI- CIANS, FATHER AND SON; A STUDY OF HEREDITARY TRANSMIS- SION BASED ON THEIR COMPARISON," was read on February 15 before the Section of Anthropology and Psychology of the New York Academy of Sciences, by Mr. E. A. Spitzka.
The brains were those of Dr. Edouard Seguin and his son, Dr. Ed- ward C. Seguin, both of whom were distinguished for high scholarship and brilliant attainments. The elder Seguin is best known for his fruitful experiments in the training of feeble-minded children, and for the methods proposed by him of ameliorating the condition of idiot children by the careful physiological training of all the senses. His contributions to the subject of medical thermometry were equally valu- able, and he was one of the pioneers in advocating the introduction of the metric system into this country. Perhaps the most marked traits in his character were his modesty, his scholarly ways and his great powers as a teacher.
His son, Dr. Edward C. Seguin, departed this life so recently that it and his work are yet a fresh reminiscence. He graduated after a three years' course at the College of Physicians and Surgeons, New York City, at the early age of twenty-one. He was a lecturer on diseases of the nervous system and insanity at that college from 1871 to 1885, founding the clinic for nervous diseases in 1873. His contributions to the pathology and therapeutics of nervous disorders are especially valuable.
Both brains are characterized on the whole by their generally tortuous fissures, which are of considerable depth and are perhaps rather fre- quently interrupted by vadums and interdigitating subgyres. The gyres are bold and massive, so that in spite of the exceedingly intricate fissura- tion, the configurations of the brain are not "overcrowded" or "cramped- looking." The frontal gyres are by far the most complex of the entire brain, though the parietal gyres are almost as rich in their development. The cuneus is relatively small, especially in the left half of both brains. If the expression may be indulged in, one might say that the **phy- siognomy" of each of these brains reproduces that of the other much as the outer physiognomy of their bearers did in life.
58 SEGUIN BRAINS.
Perhaps the most significant feature common to both brains is the slight exposure of the left insula, heretofore observed only in the brains of defectives, deaf-mutes, idiots, negroes, etc. In the Seguin .brains the cause of this exposure is a different one, and is due to the extreme redundancy of the insular pole, a redundancy so pronounced that this region of the insula — in its effort to reach the general cerebral surface — has virtually thrust apart the opercula and made itself visible. The soundings made of the sylvian cleft on both sides and in both brains give good corroborative evidence in favor of this hypertrophic development of the left preinsula.
A large number of unilateral atypies in these brains, after careful comparative tabulation, show^ evidences of direct hereditary transmis- sion. A few features, however, demonstrate "crossed" hereditary trans- mission involving questions of "symmetry in asymmetry" as mysterious as the differences or resemblances are profound.
The elder Seguin's brain weighed 1,257 grammes when fresh, and lost 30 per cent, of its weight during twenty-one years' immersion in alcohol. The son's brain weighed 1,502 grammes — about 53 ounces avoirdupois — standing quite high in the list of brain-weights of eminent men. The low figure for the father's brain seems to be in part due to some wasting of brain-tissue from disease, or age, or both.
0 LETCHENI VNOUSHENIEM, DR. B. N. SINANI.
The application of suggestion as a therapeutic agent is not clearly under- stood by the profession at large. Most psychiaters who are in a habit of using this means in appropriate cases believe, with the originator of the Nancy School, that before suggestion is practiced on the patient the latter must necessarily be put in a condition of so-called "hypnotic" sleep. This is an error easily demonstrable in clinical work : every clinician in this line of work is familiar with the fact that in many cases where the patient fails to yield to the suggestion ordering him to sleep, he will yet be receptive to other suggestions. The treatment in such cases is carried out without the patient being in a condition of hypnotic sleep; and while it may be found difficult or impossible to suggest sleep to such patients in the first instance, the sleep may most easily be suggested after he has shown himself sus- ceptible to other suggestions that bear directly on the conditions for which he comes to be treated. There are many cases v.^here the patient is refractory and refuses obstinately to fall asleep ; the physician persists, but fails to succeed; he then assures the patient that he is susceptible to sug- gestion regardless of his wakeful state; one of the patient's limbs is then lifted, placed horizontally and he is told that he cannot move it; the pa- tient makes an attempt to move it, but fails to do so. This proves not only that suggestion can be successfully carried out without hypnotic sleep being previously induced, but also that successful suggestion and induction of hypnotic sleep may be in contradictory relation to each other; again, the sleep may be easily induced after other suggestions have been made suc- cessfully. In conclusion, it is said that hypnotic sleep, far from being the essential condition before suggestion can be practiced, is only one of the episodes or symptoms, which can be brought out, successfully or not, by an experienced hypnotist. Many suitable cases forego treatment by hypno- tism because of the aversion they have to being thrown into a hypnotic sleep: the feeling of having one's will subservient to another's is objected to and sometimes even feared by many patients. The physician should bear
AGNOSIA. 59
this in mind when appl3ang hypnotic treatment to his patients, and avoid inducing sleep when this is objected to. Twenty interesting cases are cited which the author handled according to the method described. As direct suggestion can be used with such tangible results, it should be utilized in daily life in the relation of parent to child.
REVUE GENERALE SUR L'AGNOSIE (CECITE PSYCHIQUE). Dr. Ed.
Claparede^ Privat-Docent a I'Universite De Geneve.
This is a studied essay and literary review of the most noted cases and theories relating to the psychic disturbances coming under the head of agnosia. The terminology used by various authors is discussed and com- mented on. In view of the great difficulties attending the study and exami- nation of such cases a series of suggestions is given by which the examiner may be guided and guarded against erroneous conclusions. The possible forms of agnosia are tabulated as follows :
AGNOSIA.
DISTURBANCES OF PRIMARY IDENTIFICATION (PRIMARY AGNOSIA) :
Visual agnosia for forms ;
Achromotopsic agnosia;
Stereoscopic agnosia (disturbances of perception of relief and depth) ;
Stereoagnosia (touch) ;
Agnosia for words: pure verbal deafness and blindness.
DISTURBANCES OF SECONDARY IDENTITY — ASYMBOLIA :
With conservation of mental repre- With loss of mental representations :
sentations : .
Optic. Psychic blindness properly speak-
ing. Acoustic. Psychic deafness.
( true (?) ^^^^'^^ \ tactile blindness. ^^""^'^^ ^^"^^^^ ^ ' >
Olfactory. Psychic anosmia.
Gustatory. Psychic absence of taste.
Vaso-motor (apathy).
Apraxia. Kinesthetic and motor. Akinesia.
Disturbances of orientation.
GENERAL, WITH LOSS OF WILL POWER :
For words — Optic aphasia. True sensory.
Acoustic aphasia. Aphasia.
Verbo-optic asymbolia. Motor aphasia.
Verbo-acoustic asymbolia.
{Annee Psychologique, Tome VI., 1900.)
PROPORTIONS OF SEXES IN CRIME.
Dr. Valintin, in a review of Lombroso's work on punishment for women, states that the following is the proportion of criminal women to 100 crim- inal men : In Italy, 19 women ; in France, 16 ; in Austria, 14.8 ; in Hungary, 1 1.6; in England, 20. {Revue de Psychologies December, 1900.)
BOOK REVIEWS
A STUDY OF BED-TREATMENT FOR THE VIOLENT INSANE. Dr.
. GusTAVE PocHON. Thesis. Geoi'ges Carre and C. Naud, Editeurs, Paris., 1900.
The bed-treatment of the violent insane is considered in all its details, clinical as well as historical, and the work is abundantly illustrated with histories of cases. The treatment is followed out in detail from its birth. The conclusions arrived at are as follows : The bed-treatment of the violent insane is possible. To specify, — in cases of simple mania without delirium or hallucination or simply of an episodic nature and secondary, and in cases of agitation by reaction against delirious conceptions, the possibility of the treatment is subordinate to every individual case according to its nature. Possible in all cases, the treatment may become impossible in certain cases of particularly violent reaction ; it is especially useful in all cases of violent alcoholic delirium. In extreme automatic agitation difficulties may be en- countered; under such circumstances hypodermatic injections of hyoscine will be resorted to in doses of from J^ to i milligramme, or else the isolated room will be used. The specified conditions are, of course, subordinate to the extent of the attendants' help. The bed-treatment in all cases of vio- lence is indicated for the physical as well as for the mental condition; while it is an agent of restraint, the advantages derived from the treat- ment otherwise far surpass that inconvenience or any other, such as pos- sible constipation, etc. The anaemia that might result from the treatment is counteracted by taking the patient, out for a walk for two or three hours in the afternoon. It is difficult to say what the influence is on the prog- nosis: this depends mainly on the disease itself; nevertheless, it can be said that the intensity of the maniacal excitement is diminished, as is the anxiety of the melancholiac ; the phenomena of exhaustion consequent on the acute mental conditions are less marked. In the alcoholic the fatal terminations are avoided, unless an organic disease accompanies the trouble. It goes without saying that the bed-treatment is coupled with such special treatment as the case may require: moral treatment, sedatives ( prolonged baths, bromides), hypnotics (chloral, sulfanol, trional) are given in cases of extreme insomnia. The hygiene is also to be observed ; digestive and circulatory disturbances rnust be attended to. Almost always possible, al- ways necessary, the bed-treatment must constitute the basis for treatment of the insane. During the year 1898-99 the number of patients thus treated was 1,180 on the men's side, in the Admission Bureau, at Ste. Anne. Out of those, eight patients had to be given hypodermatic injections, once to every one, and isolation was necessary nine times. On the women's side, out of 570 patients, nine had to be given hypodermatic injections once. These figures prove beyond a doubt the possibility of utilizing the bed- treatment for the violent insane.
BOOK REVIEWS. ^ 6l
ESSAI SUR ^IMAGINATION CREATRICE. Th. Ribot. Felix Alcan,
editeur, Paris, 1900.
Contemporaneous psychologists have studied with much ardor the imagination as a pure reproducer. The works on the various groups of images — visual, acoustic, tactile and motor — are known, and constitute an ensemble of researches solidly based on subjective and objective re- searches, on facts in pathology and on laboratory experiments. The study of the imagination creator, on the contrary, has been almost entirely neglected. Nevertheless, its importance cannot be contested and it does not merit this indifferent disdain.
M. Ribot's work is divided into three parts: The first, analytical, tries to unfold the constructive imagination into its constituent factors and to study every one separately; the second part, genetic, follows out the in- tegral development of the imagination, from the simple to the complex forms. The constructive imagination is reducible to three forms, which are denominated abortive, fixed and objective, according to whether it remains an internal phantom, takes on a material form, but is devoid of strength, or is subjected to conditions of a rigorous internal or external determinism. The abortive form is premordial and original, the simplest of all; it characterizes a moment of the imagination's birth. The fixed form comprises the mythic and esthetic creations, the philosophic and scientific hypotheses. This form is very elastic; language, writing, music, color and lines represent it. The third form constitutes the true imagi- native type.
The psychology of the imaginative is expressed by a progressive and increasing intensity; the images become more and more vivi-d and the perception more and more feeble. In this progress M. Ribot notes four stages: First, the quantity of images; second, the quantity of intensity; third, the quantity, the intensity, and the duration; fourth, complete sys- tematization. The latter is the external form — verging on insanity.
OssiP-LouRiE (Laureate of the Institute).
ON THE CLASS OF DELINQUENTS INTERMEDIARY BETWEEN THE INSANE AND THE CRIMINAL (CLINICAL), ADMINISTRATIVE AND MEDICO-LEGAL). Thesis by Dr. Albert Petit.
The criminals handled by the asylum physician are considered from a clinical, social and medico-legal standpoint. Clinically, these subjects are out of place in the asylum for the insane, and yet such offenders do not belong to the ordinary class of criminals ; the prison is, therefore, not the proper place for the former. Such individuals are born with a deficient moral sense, and although free from mental derangements that would class these subjects among the insane, they are yet morally irresponsible, being of an unbalanced moral equilibrium; therefore, they are irresponsible be- fore the law. Society owes it to its own safety to keep such individuals in homes specially devoted to their use, of the nature of the New York State Reformatory at Elmira. The author enters into detailed consideration of the practical management of such an institution: he is of the opinion that the patient's work should be utilized as an economical element in the sup- port of the institution. Touching on the medico-legal question, he holds, with Professor Brouardel, that it is due to the country to have expert alienists at court who could intelligently separate the ordinary from this
62 BOOK REVIEWS.
class of criminals and isolate these in asylums especially provided for them. Professor Joffroy further urges that it be obligatory for all medical stu- dents to spend not less than three months in the asylums for the insane, to the end that they might become familiarized with the mental forms in ques- tion. The thesis is carefully studied in all its parts and contains much valuable clinical as well as theoretical information on the subject therein treated.
CONTRIBUTION TO THE STUDY OF STEREOGNOSTIC PERCEPTION.
Melle. Klavdia Markova. Inaugural Thesis, 1900. Ch. Eggimann and Co., Editors. ^
The author divides the study of stereognostic perception into two parts. The first part treats of the peripheral conditions that govern that percep- tion and the second of the central ones on which depends the perception of form. A sharp distinction is made between the terms sensation and per- ception, and the division of the research into two parts is based on this interpretation of the two terms. From the etymology of the term "stereog- nostic" it is concluded that a stereognostic perception of objects is tke perception of their forms in space. Though the eye can appreciate the form of objects, the term is used here as applied to the perception of forms by touch. The experiments are illustrated by drawings.
LA PHILOSOPHIE DE TOLSTOI. By Ossip-Lourie. Felix Alcan,
Editeur, 1899, Paris.
This masterly work shows a deep insight into a human life: that of the immortal novelist and philosopher, Tolstoi. Those who are familiar with Tolstoi's powerful photographic narrative style, whether he is dealing with a purely literary subject or a philosopho-psychological, one can estimate to what a degree an analytical work of this nature must interest us. There is exposed here not only the entire life history of the great Russian writer but also the psychology of that life. The longings, desires, aspirations from childhood of this worker and his attainments — all these have been dif- ferent from those which characterize personalities accepting what is for what should be. It has been said that in this work there is exposed not simply one life but that of classes, of a nation and, one might say, of na- tions. To make the wrongs of life understood by all, Tolstoi pours out his soul, his feelings and his reasoning, crushing tradition by the very strength of his convincing softness and gentleness. Living in a country where the Church is intimately interwoven with the fabric of the govern- ment, he attaches much blame to that Church, ascribing to its influence all the sufferings of the people with whose pulse his own beats in unison.
His works touching on the question of woman's influence on life have been considerably misinterpreted: according to him, woman should be the holy spark of life, infusing all that is high and ideal into her family and consequently into society, into government and her country. He attacks marriage as it exists to-day. Commercial conditions are the governing principles between the man and woman destined to play the important role of two intimates who — by virtue of their relations to each other — cannot fulfill the promises mutually made: the soul refuses to invest itself with commercial fetters.
Life is handled in all its phases: individual, collective, social, religious, civil and public, in peace and in war. Tolstoi could depict in an unrivaled
BOOK REVIEWS. 63
Style before he wrote "Vo'ina i Mir" (War and Peace). During the war of 1856, in Crimea, he took an active part in the defence of his country ; and there, on the battle field, he saw the corpse, the half-dead, the wounded and the well, all mixed and writhing in one huge, frightful flood of blood. He ministered to the sick, he smiled consolation to those who were de- parting life and gave manly encouragement to those who could profit by it. When the blood flowed no more and the sighs of the suffering had become hushed, Tolstoi's heart was aching — aching more than it ever had. His fears and doubts, his negations and queries, his why and wherefore as to life, all melted into an imperative fuel of divine order that compelled him to write. To write is hardly the word, for he has carved and chiseled into everlasting figures that which he saw, that which he felt and that which he suffered.
The personality of the author of this volume is so intimately intertwined with what is expressed about Tolstoi that at times one stops to ask: Who is he who states this or that truth? The author of some eight volumes on philosophy, poetic prose and psychology, two of his works having reached their fourth and fifth editions respectively, he seems to have proven himself a fit person to undertake and successfully accomplish the hard task of enabling the world to familiarize itself with the Russian's life and works. This volume has been crowned by the Institute of France.
NEWS NOTES.
THE HILL INSANE HOSPITAL, AUGUSTA, MAINE.
A large amount has been expended in the construction of the new hos- pital for the insane at Bangor, and at the recent opening of the legislature this institution was formally committed by the Governor and Council to the appointed board of trustees as practically completed. Before patients can be received, however, an appropriation must be made by the legislature for furnishing the buildings, so that two or three months may elapse before the hospital will be ready for occupancy. The two wings erected will accommodate two hundred patients, and it is now the plan to trans- fer from the hospital at Augusta one hundred and fifty or one hundred and seventy-five inmates, in order to relieve the crowded condition of this institution. Dr. George W. Foster, of the Government Hospital for the Insane, at Washington, D. C, was appointed superintendent last Novem- ber, and Dr. P. H. S. Vaughan, second assistant at the Augusta hospital, was promoted to the position of assistant superintendent of the Bangor institution. The woman physician, E. Virginia Baker, resigned in No- vember, and Dr. Gertrude E. Heath was appointed to fill the vacancy.
Dr. Hiram L. Horsman, by promotion, becomes second assistant.
B. R. B. Weber, superintendent of the Girls' Industrial School" of Nebraska, writes us that the fundamental practical method of treat- ing the class of girls who land in that school should consist of giving them sufficient employment, as idleness is the main factor in breeding crime. Most of the inmates are brought there because of idleness and consequent misbehavior: Mr. Webber has written an interesting pam- phlet on "Street Companionship."
64 NEWS NOTES.
MATTEAWAN STATE HOSPITAL.
The Matteawan State Hospital has for some time been much over- crowded. The buildings were designed to accommodate five hundred and fifty patients, and before the recent transfers to Dannemora were made had reached a limit of seven hundred and sixty-five persons. The institution at Matteawan receives persons charged with crime who may be found to be insane after arrest or after indictment or during trial. It also receives convicted patients from the various penal institutions of the State in whom insanity is discovered while undergoing sentence. The institution has grown from a population of two hundred and nineteen in 1889 to a total of seven hundred and sixty-five in 1900. A very large per- centage of inmates are "court cases" who have never been convicted but who are held awaiting return to court, which is dependent upon their recovery.
Mingled with such cases are the habitual criminals from the prisons and persons sentenced for minor crimes.
It is proposed by opening the new hospital at Dannemora to separate in a large measure the two classes, and the new asylum will care for persons convicted of a felony who may be found to be insane while under- going imprisonment; while the institution at Matteawan will receive pa- tients from the courts as heretofore and also such persons from the peni- tentiaries who may be charged with simple misdemeanors and petty offenses. In that manner the habitual and hardened criminal will be eliminated.
The purposes to be attained at Matteawan are similar to those at Broad- moor, England, where patients from the courts are detained "during the King's pleasure." The Matteawan State Hospital was originally estab- lished at Auburn in 1855, and was designed to relieve the State hospitals of criminal cases. Its scope has been enlarged from time to time at the request of the various superintendents of such hospitals, so that it has become practically a receptacle for all the insane of the State who are held in custody charged with criminal offenses. Owing to its recent over- crowded condition, it has been able to receive during the past year only a few of the cases which naturally would be committed to its care. With the opening of Dannemora, however, an opportunity of natural growth is given to both institutions, and it is probable that v/hen the buildings are finally completed and in operation, the combined population of the "court" cases and petty offenders at Matteawan, together with the convict insane at Dannemora, will reach a total population of twelve hundred insane crimi- nals in the State of New York. {Correspondence from Dr. H. E. Allison, Medical Superintendent.)
BOOKS AND PAMPHLETS RECEIVED.
TRATTATO DI PSICHIATRIA AD USO DEI MEDICI E DEGLI STUDENTI, CON NUMEROSE FIGURE INTERCALATO NEL TESTO, del. Prof. Bianchi Leonardo. V. Pasquale, Napoli.
L'ANALGESIE CHIRURGICALE. Par Voie Rachidienne (Injections Sous-Arachnoidiennes de Cocaine). Technique, Resultats, Indications. Par Le Dr. TuMer. Nos. 24 and 25. Masson et Co., Paris, 1901.
EMILE ZOLA. A Psycho- Physical Study. By Mr. Arthur MacDon- ald, Washington, D. C
EDUCATION AND PATHO-SOCIAL STUDIES. By Mr. Arthur MacDonald, Washington, D. C.
EXPERIMENTAL STUDY OF CHILDREN, INCLUDING AN- THROPOLOGICAL AND PSYCHO-PHYSICAL MEASUREMENTS OF WASHINGTON SCHOOL CHILDREN, AND A BIBLIOGRA- PHY. By Mr. Arthur MacDonald, Washington, D. C.
SOUDEBNAIA PSYKOLOGIA. W. C. Serhski, Sabashnikowi, Mos- cou, 1900.
BERICPIT UBER DIE STADTISCHE KRANKENANSTALT ZU KONIGSBERG, 1899. Prof. Meschede.
K VOPROSSOU OB OSTRUM BREDIE. V. I. Semidalow and V. V. Veidengammer.
FOURTH BIENNIAL REPORT OF THE SECOND HOSPITAL FOR INSANE. Spencer, W. Va.
TWENTY-THIRD ANNUAL REPORT OF THE COMMIS- SIONERS OF PRISONS ON THE REFORMATORY PRISON FOR WOMEN.
LA PHILOSOPHIE SOCIALE DANS LE THEATRE DTBSEN; LA PHILOSOPHIE DE TOLSTOI. Ossip-Lourie^Fdix Alcan, Paris.
REPORT ON THE FAMILY COLONIZATION OF THE INSANE IN THE DEPARTMENT OF VORONEJ. By Dr. H. H. Bajenow, 1899-1900.
VOL. L
No, 2.
The Journal of Mental Pathology
Subscription Price s — $2.50 per annum*
Single Copies* 50 cents*
Edited by
TCH, B. Es L., M.D.
Dr. V. MAGNAF Dr. A. JOFFROY, Dr. F. EAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.); Dr. JUL. MOREL (Beljrium), Dr. C. H. HUGHES (St. Louis), Dr. E. r:6gIS (Bordeaux).
Contributors' Staff
ANTHEAUME, Dr. Andre (Paris); BAILEY, Dr. P. (New York); BAJENOW, Dr., Superintendent Woroneje Asylum (Russia); BECHTEREW, Prof. (Russia); BERILLON. Dr. Edgar (Paris); BLEULER, Prof. E. (Zurich); BLIN, Dr. ; BOISSIER, Dr. F. ; BOURNEVILLE, Dr., Ctiief Physician Blc§tre Asylum, Editor Progres Medical ; BRAESCO, Dr. Al. N. (Roumania); BRIAND, Dr. Marcel, Physician to the Asylums of the Seine; CHATTERJY, J. 0. (Benares, India); CLAPAREDE, Prof. Ed.; CROCQ, Dr., Editor Journal de Neuralgie (Belgium); DAGONET, Dr.; FAURE, Dr. Maurice; FAREZ, Dr. Paul; FERRARL Dr., Editor Bivista Sperim. di Fren. (Italy); GREDENBERG, Dr. B. S. (Russia); JANET, Dr. (Paris); DeJONG, Dr. Arie (The Hague); KOROSSOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr, ; LEGRAS, Dr. ; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "AnnaU dl Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician ViUejuif Asylum; MARINESCO, Prof. G. (Roumania); MEDICI, Dr.; MacDONALD, Dr. A. E., Superintendent Manhattan State Hospital (New York); MESCHEDE, Prof. (Germany); NAMMACK, Dr. Ch.; NEISSER, Dr. CLEMENS, Chief Physician of the County Asylum, Leubus (Ger- many); OBICI, Dr. (Italy); PETERSON, Dr. F., Commissioner in Lunacy State of New York; PETTYJOHN, Dr. E. S. (Chicago); PHILIPPE, Dr. CI.; POCHON, Dr.; REIS, Dr. MeUo (BrazU); REGNARD, Albert, President of PubUc Charities, Ministry of the Interior (Paris); REY, Dr. Philippe; Superintendent Public Asylums (Mont-Perrin); RITTI, Dr. Ant., Chief Physician Charenton Asylum; ROUBINOVITCH, Dr. J.; SEMELAIGNE, Dr. Rene' s:emidaL0W, Dr. B. (Russia); s:6rIEUX, Dr. P. (France); SERGi, Prof . G. (Italy); SINANI, Dr. B. N. (Russia); SERBSKL Dr. V. P. (Moscow); SIOLI, Dr. E., Superintendent of the Asylum of Frankfort-on-the-Main ; SNELL, Dr. ; SPITZKA, Mr. E. A. (New York); STOENESCU, Dr. N. (Roumahia); TATY, Dr. (France); TSCHISCH, W,, Prof. (Russia); De TOKARSKI, Univ. of Moscow; TREVES, Dr. Marco (Italy); TOULOUSE, Dr. E., Chief Physician Villejuif Asylum ; Director Laboratory Exper. Psych., School of Higher Studies ; TRUELLE, Dr. ; VAN GIESON, Dr. ; Ira T., New York Pathological Institute ; VALLON, Dr., Physician to Ste. Anne, Expert at the Supreme Courts (Paris) ; VASCHIDE, Dr. N., Chef des Travaux, Laboratory Exp. Psychol. (Paris); VOISIN, Dr. Jules, Physician to the Sal- pgtriere (Paris).
STATE PUBLISHING COMPANY
290 Broadway, NEW YORK, N, Y,
TABLE OF CONTENTS.
ORIGINAL COMMUNICATIONS.
Page. The Early Diagnosis of Lues Cerebri, Prof W. Tschisch 65
The Symptomatic Value of Dreams, N. Vaschide and H. Pieron.... 72 Complicated Respiratory Tic in a Melancholiac, Dr. V. Semidalow
and Dr. V. Weidenhammer 78
Idiot and Imbecile Children, Dr. Robinovitch 86
EDITORIALS.
The National Psycho-Physical Laboratory 97
The Abuse of the Imsane 98
The New Commissioner in Lunacy, New York 98
COMMUNICATION : The Insane Criminal and the Criminal Insane. 99
THIRTEENTH INTERNATIONAL MEDICAL CONGRESS,— SEC- TION OF PSYCHIATRY.
Address by Dr. V. Magnan 102
TRANSLATIONS AND ABSTRACTS OF CURRENT LITER- ATURE.
Verbal Motor Hallucinations in General Paralysis, Dr. P. Serieux. .. . 106
Blood Pressure in Epilepsy, Dr. Marro 109
Interna al Fenomena della Striatura Ungueala Trasversa, Dr. M.
Treves 109
The Auditory Centre in the Deaf-Mutes no
CeTebral Abscess,-Trephining,-Deabh in
On Spontaneous Fractures in General Paralysis 112
The Gastric Chemistry in Melancholia, Mania and Hysteria, Dr. P.
Galante 113
Les Psychoses Post-Operatoires, Dr. Regis 114
The Remote Prognosis of Psychoses of Puberty, Dr. A. Cullerre 114
Psychoses of Puberty, Dr. Jules Voisin 114
Psychoses of Puberty, Dr. Ziehen 116
The Psychoses of Puberty, Dr. Marro 116
Cortical Hyperesthesia in Acute Alcoholism, Drs. Collolian and Rodiet 117
BOOK REVIEWS.
Trattato di Psdohiatria, Prof. Bianchi Leonardo 118
Psychologie de ITdiot et de ITmbecile, Dr. P. Sollier 118
La Tristesse et la Joi, Dr. G. Dumas 119
Diagnostic des Maladies de V Encephale, Dr. Grasset 119
MISCELLANY.
A State Epileptic Colony 119
Congress of Alienists and Neurologists 119
The Fifth International Congress of Criminal Anthropology 119
Books and Pamphlets Received 3^ Cover
The Journal of Mental Pathology.
Vol. I. JULY, 1901. No. 2.
THE EARLY DIAGNOSIS OF LUES
CEREBRL
BY Prof. W. TSCHISCH,
University of Dorpat.
An early diagnosis of lues cerebri is as difficult as it is im- portant. Although this form of cerebral affection is far more frequent than any other met with in clinical work, yet is it a de- plorable fact that the physician is more frequently misled than not in determining, at an early stage, — the most important time in this disease, — the existence of cerebral syphilis.
The Practical Value of an Early Diagnosis. — Lues cerebri can be cured only if treatment is instituted at an early date, before damage has been done to the delicate tissues. For want of an early diagnosis many a patient has either died from that cerebral affection through its direct results, or else has fal- len victim to progressive general paralysis.
Lues Cerebri is Curable. — Practical work speedily con- vinces one that the disease is curable if taken in hand early, i. e., — if diagnosed early. If cases are reported of unsuccessful treatment, the failure is always due to the fact that the diagnosis was made too late, that the disease had advanced too far, that irreparable damage had been done before the treatment was insti- tuted. Yet, it would be wrong to censure any physician for a faulty diagnosis during the early stage of the disease; for, no disease is more deceptive in its entity of manifestation. Indeed, so obscure are the first manifestations that one is forced to ad- mit that it is almost impossible to distinguish them by the first symptoms.
The symptoms, or group of symptoms, claimed by some to be characteristic of the disease, are either inconstant in appearance
66 LUES CEREBRI.— Prof. Tschisch.
during the early stages or else, if present, make their appear- ance, in some cases, at too late a date.
The Early Symptoms. — Of the early symptoms, dull, dif- fuse headaches are characteristic, particularly if the ache is worse at bed time. Many diseases, however, are accompanied by head- ache, and the diagnostic value of the symptom is thereby les- sened. The symptom, far from aiding in the diagnosis, often misleads instead, the symptom being taken for an index of the existence of neurasthenia. Such mistakes are more frequent than is supposed, and sad results are their consequences in many cases.
Differential Diagnosis Between Headache in Cerebral Syphilis and That in Neurasthenia. — In neurasthenia the headache generally appears in the morning and the patients feel better towards evening. In cerebral syphilis, on the contrary, the reverse is true; the patient suffers from headaches at night, and feels better in the morning. In addition, the general condi- tion of the patient, his subjective feelings, are all worse at night in incipient cerebral syphilis.
Inconstancy of Headache as a Symptom in Incipient Cerebral Syphilis. — Yet this symptom has no capital value. I have known well educated patients, who could give intelligent accounts of themselves, who assured me, when under treatment for tardy cerebral syphilis, that they had not suffered from head- ache during the early stage of the disease, that in fact, they felt well, as if nothing had happened to them. It must be borne in mind, however, that such cases are exceptions : — the majority of cases do suffer from headache. Yet, this symptom loses there- by its practical significance ; and often our patients astonish us suddenly with an onset of general paralysis when this is least expected, even while under treatment and careful observation.
Obstinate Insomnia. — Obstinate sleeplessness is another early symptom of incipient cerebral syphilis. This symptom, however, is not the rule in all cases. In fact, the minority only suffer from this trouble ; besides, many who do suffer from head- ache state that the trouble was of such short duration in the early stage that it would have escaped their notice had they not been questioned on the subject; that the trouble either disappeared of its own accord, or else yielded to mild soporifics. Such oc- currences are additional misleading factors in the diagnosis. Yet, there are cases with obstinate sleeplessness as an early symptom of incipient cerebral syphilis; in such cases the trouble seldom yields to even heroic doses of potassium bro- mide, even in combination with hydrotherapy and exercise in
LUES CEREBRI.— Prof. Tschisch. 67
the Open air. The insomnia generally grows worse, in such cases, and after consulting many local physicians the patient falls into the hands of a specialist ; a careful inquiry into the pa- tient's history often reveals the fact that syphilis has been rav- aging the brain for from five to twenty years. When specific treatment is applied the patient is generally much relieved, some- times as quickly as within a few days. I have known patients who have suffered from such insomnia and who have become relieved three days after the specific treatment was instituted, potassium iodide being given in large doses, up to 5 grammes. In some cases, where central disturbances have already set in, the question of alleviating insomnia becomes a difficult one. As may be seen, obstinate insomnia, if not a frequent symptom, and when appearing at a late stage of the disease, must be eliminated as a practical guiding index in the diagnosis of incipient cerebral syphilis. But it is the physician's duty to search most carefully into the history of this symptom. There are cases where insom- nia sets in in the early stage, disappears without any treatment, only to re-appear some months later, when the incipient cere- bral syphilis is already well on its way of morbid progress. As applied clinically, these symptomatic irregularities should be carefully scrutinized and not be overlooked. Particularly is such scrutiny of great importance in the case of non-neurasthenic persons, say a man of middle age, who suddenly falls victim to such insomnia. When such cases present themselves, the pos- sible existence of incipient cerebral syphilis must be thought of by the physician and appropriate treatment must speedily be re- sorted to.
Inequality of the Pupils. — Inequality of the pupils has a symptomatic value less than is generally ascribed to it. For, it is not present in all cases; when it is present, its value is only a conditional one. It must first be ascertained whether the pa- tient's pupils were equal before the disease set in. There are many patients whose inequality of the pupils is ascribable to de- fective accommodation, to unequal refraction on both sides, while they are not aware of the fact; and very few among pa- tients are so observant as to be able to give a correct account of the time when the inequality of the pupils set in. Besides, as a cHnical help neither the inequality of the pupils nor the re- flexes are signs of incipient syphilis ; on the contrary, they point to the existence of a grave pathological process in the cerebral tissues, and when these signs are present there is little hope for the cure of the affection.
68 LUES CEREBRI.— Prof. Tschisch.
The Knee and Tendon Reflexes. — Both the knee and neuro- tendon reflexes are of Httle value unless the physician was ac- quainted with their nature before the disease in question set in ; under the latter conditions, and with the knowledge that both were normal prior to the onset of the disease, the exaggerated or diminished reflexes may imply the presence of cerebro-spinal syphilis ; such cases, however, are rare ; it is well to bear in mind also, that in exceptional cases abnormal reflexes may be con- genital and that the intensity of the reflexes varies with every individual. Should it be found that increased or diminished re- flexes exist, which point directly to the presence of cerebro- spinal syphilis as corroborated by the whole history of the dis- ease, treatment stands powerless as a curative measure at that stage.
The Physical Condition During the Course of Cerebral- Syphilis. — The patient may remain in excellent physical condi- tion during the better part of the evolution of the disease. Ex- ceptions may exist and these help make a diagnosis earlier, but when apparently good health prevails, further difficulty is thrown in the way of a correct diagnosis. The general health breaks down, however, when the disease is well advanced and finally, at the end of the course of the affliction, the nourish- ment of the system becomes well undermined. This may aid in making a diagnosis, but no benefit can then be derived from it^ as treatment is of no avail at that stag«.
From what precedes it is apparent that an early diagnosis of cerebral syphilis is a most difficult matter, neither the local nor the general manifestations serving as practical guides to an early diagnosis.
The Arterial Signs as Guides in the Diagnosis of In- cipient Cerebral Syphilis. — As the cerebral tissue is reached by the syphilitic infection through the arterial channels, it is the arterial system that first falls victim to the infection. It is true that not every syphilitic infection ends by working path- ological damage in the brain, but it is the physician's paramount duty to be on the lookout for such a possibility, for, when the disease once reaches the brain no treatment can be of any prac- tical use in restoring the erstwhile intact state of health of the delicate cerebral structures. When the ophthalmoscope shows plainly the presence of morbid changes in the retinal arterial and venous system, the pathological ravages are already too far ad- vanced to be remedied permanently and radically. Besides, I have known many cases vv^here most careful ophthalmoscopic examinations performed by celebrated oculists have failed to
LUES CEREBRI.— Prof. Tschisch. 69
reveal any pathological changes there, while extensive gum- mata invaded the brain tissue. The only positive and least de- ceptive conditions of arterio-sclerosis of syphilitic origin must be searched for in the vessels about the skull, the carotid artery being the seat of predilection for the affection par excellence. The ramifications of this artery make no exception to this rule and the temporal artery is by far the best seat of research for the physician. The intimate anatomical relations of these two ar- teries lead to almost identical lesions of both ; clinical experience warrants my statement that the degree of lesion of the intima exists synchronously, to the same degree, in all — ^the internal, external carotid and the superficial temporal arteries. Phy- sicians have passed in silence the valuable clinical guide found in early detection of sclerosis in the deep arteries around the base of the skull, for the reason that these vessels are not easily accessible to investigation. Even the most superficial arteries in which sclerosis takes place are difficult to study. The poster- ior branch of the temporal artery, and its ramifications, are cov- ered with the hairy parts ; as for the interior branch — it is well covered with thick tissues, rather loosely drawn over it, so that the sclerosis must be well advanced in degree in order to attract the physician's attention. When the cerebral syphilis is well ad- vanced in its progress the sclerosis of these vessels is quite noticeabk, just as it is in the case of chronic alcoholics.
The Site of the Earliest Accessible Arterial Signs. — From my experience and repeated observation I have concluded that the earliest accessible signs of arterial sclerosis are to be found on the temple in the anterior temporal artery ; this runs in a line parallel to the edges of the hair insertions, or perhaps from I to 1.5 centimetres inside of that line. The comparatively superficial situation of the vessel makes a valuable region of research for incipient sclerosis. This becomes easier as the person is older and the skin covering the vessel is looser and more moveable.
The First Signs of the sclerosis that make their appearance in the anterior temporal artery are in the part running through the middle region of the temple ; the affection then spreads back- ward, into the region covered with thick hairy skin. In mild cases this sign niay be lost sight of when the above named part of the artery is examined enface; for, when the sclerosis is mild in nature the thickening of the artery is not marked and does not stand out as it would otherwise. The part must then be examined carefully, from the profile; this position is obtained by placing the patient's face enface; the thickened artery is then
70 LUES CEREBRI.— Prof. Tschisch.
well exposed to view, even when the cfianges are not well marked. It is well, in order to avoid mistaken conclusions, to examine the portion of that artery in its three-quarter position as well as in its profile. Besides the thickening of the artery there is also a zig-zag curving of it; it goes without saying that the degree of sclerosis and the seriousness of the disease are in pro- portion to the marked zig-zag curving. In advanced stages the anterior branch of the temporal artery also becomes involved. When this exists, of course, the disease is too far advanced to be benefited by a diagnosis.
Differentiation From Enlarged Veins of the Temple. — Enlarged veins are often mistaken for sclerosed arteries. My observations warrant the statement that arterial sclerosis in the temporal in question always begins in the middle part of the tem- ple, while the enlarged veins are always more distended in pro- portion and most marked in the region nearer the inside of the face. Besides, physical or mental effort bulges the volume of the veins more than usual, while the sclerosed artery remains unaffected by such causes. The arterial sclerosis that is of ser- vice diagnostically, indicating incipient syphilis, is not marked in degree ; this also may serve as a differential point.
CONCLUSIONS.
The indicated arterio-sclerosis of the branch of the temporal artery described is a most valuable diagnostic guide in discern- ing incipient cerebral syphilis. Since I have begun paying at- tention to this sign I have never found one case of cerebral syphilis that did not present this physical sign. If other ob-. servers find exceptions to this rule, which according to me can not exist, such exceptions are most rare. To eliminate posssible misleading cases, it must be borne in mind that a syphilitic pa- tient may die of a cerebral embolism; the temporal artery sign will be absent here, but so is the cerebral syphilis, the patient dying not from cerebral syphilis, but from embolism.
The Left is the Preferred Side Affected in the Begin- ning of the Disease. — Arterio-sclerosis generally appears on both sides, but the left is the preferred side affected in the begin- ning of the disease, so far as I have observed cases up to this date. Yet, I do not insist on the absoluteness of the fact. In twenty-two cases the sclerosis was marked on the left side only and in two on the right. In all these cases the arterio-sclerosis was my main leading sign in the diagnosis, as all the other symp- toms were scarcely present. The sclerosis becomes marked on both sides when the disease is well advanced and when a diag- nosis of the case is of no special practical value.
LUES CEREBRI.— Prof. Tschisch. 7i
The Indicated Arterio-Sclerosis is an Absolute Sign of Cerebral Syphilis Ex-Jurantibus. — That arterio-sclerosis as described and located is an invariable index to incipient cere- bral syphilis is proven to my satisfaction by the fact that specific treatment in judicious doses dissolves the slight arterio-sclerosis within the course of a few weeks, leaving only the slightest traces of the alteration.
Differential Diagnosis Between Arterial Sclerosis of Lues Cerebri and Chronic Alcoholism. — The differential diagnosis between arterio-sclerosis of lues cerebri and chronic alcoholism may easily be made by aid of the patient's history. Besides, when of alcoholic origin, the arterio-sclerosis is late in appearance, after alcoholic abuse of many years. When the case is a mixed one, the patient suffering from syphilis and indulg- ence in alcoholic excess, the development of arterio-sclerosis is early in its onset. The differential diagnosis between arterio- sclerosis ex-lues and that of other origin can easily be deter- mined by a careful study of the patient's history and a physical examination.
Remarks. — Psycho-pathic and neuro-pathic cases, distinctly stigmatized as degenerates, never suffer from arterio-sclerosis ex-lues cerebri. I have had occasion to speak about this mter- esting fact elsewhere.*
It is in exceptional cases only that those subjects suffer from lues cerebri and progressive general paralysis. This interest- ing fact is of such great importance that in dubious cases, where there is difficulty in determining the existence or non-existence of lues cerebri, one may safely say that it does not exist if the patient is either of neurotic or psychic taint, such as: Strange- ness of character, abnormalities of mental equilibrium, mental diseases, born criminals, puellae publicae, etc. The existence of lues cerebri in such cases is so rare that Professor Joffroy and Dr. Jombault considered it of interest to report a case with the above named taint, the subject being afflicted with cerebral syphilis.**
Dr. Lalanne remarked that he too observed one similar case. Regardless of such rare exceptions, the presence of stigmata of degeneracy is often helpful in the diagnosis, and lues cerebri may, on the strength of that, safely be excluded.
*Die Wahre Ursache der progressiven Paralyse. Psychiatrische Wochenschrift, No. 29, 1900.
**Paralysis Generale Progressive chez un siijet ayant presente dix- htiit ans auparavant du delire de persecution. Congres International de Medecine, Paris, 1900.
THE SYMPTOMATIC VALUE OF DREAMS,
FROM THE STANDPOINT OF THE
MENTAL STATE ON THE EVE
OF ONSET OF CIRCULAR
INSANITY.
BY N. VASCHIDE, and H. PIERON
Chef des travaux, Labora- tory of Experimental Psychol- ogy at the School of Higher Studies, Paris.
Preparateur, Laboratory of Experimental Psychology at The School of Higher Studies , Paris.
During our researches on dreams we were favored with an in- teresting case of circular insanity, the manifestations of which we followed closely, both during the waking period and during dream of the patient. The value of the study lies in the fact that we followed it out during a period of three years, and that we were both enabled to personally collect information from the friends and to observe the case during the period over which this study stretches.
We will omit the clinical history of the case and turn our atten- tion principally to the purely psycho-pathological side of the sub- ject bearing on the relation of the mental conditions on the eve of the onset of the disease and after the manifestation of the same.
Mme. B. is 42 years old. Her physical condition is normal; there is no sensory disturbance, and there was never any serious or infectious disease in the antecedents. There is no morbid heredity. The patient first menstruated when 13 years old. There is nothing of note about her excepting that since the period of puberty she has been particularly susceptible to atmospheric changes. This susceptibility has been increasing in intensity with age. She says in regard to this : "A bright and sunny day intoxi- cates me with happiness, and equally so do gray and rainy days make me weep while they last." She married the second time when 37 years old. She was compelled to renounce many duties and occupations by reason of the periodic outbreaks of circular insanity to which she was subject, and which was increasing in intensity. Ten years ago she had to become an asylum inmate, as the family found it difficult to care for her in her morbid con- dition. She became more and more irritable, the slightest emotion
DREAMS.— Vaschide and Pieron. 73
throwing her into intense agitation of mind, and she then acted without any regard to responsibility. She had remained in the asylum eight years, and was well known as a case of circular in- sanity. During the first four years of her stay in the asylum the duration of the lucid periods covered three-quarters of the time, but the reverse was the case at the end of the eighth year. We have watched the case during the last three years, and have taken particular note of the symptoms manifested during the period that separates the state of lucidity from that of excitation. The period of lucidity was always preceded by one of melancholic depres- sion of a week's duration. During the period of lucidity she was able to occupy herself by reading or working, presenting nothing abnormal that would have led one to suspect her of suffering from the disease in question.
During the alternating periods of depression, calm and exci- tation, the patient always kept a record of her dreams, tried to in- terpret them, and boasted of knowing the interpretation of her dreams. She claims to have noticed that a few days before the on- set of any period of her disease she could foretell the event by her dreams, which were of a different nature, according to whether they preceded a period of calm, of melancholy depres- sion or of mental excitation. As she expresses it, the dreams in- dicated to her her "mental condition." She states that through- out her life, since youth, she has thus been enabled to draw sub- stance from her dreams.
When we knew the patient at large, her friends spoke of her ability to foresee, through her dreams, the onset of her ailment. She often warned her family to take necessary precautions, use- ful during the period of her ailment, asked to be watched care- fully when she knew, through her dreams in the calm state, that she would go through a period of agitation.
We made a study of her ability to predict the nature of the period of her ailment according to the dreams during the period of calm, as she claimed was the case. We observed fifteen periods of melancholy depression, fourteen periods of lucidity and twenty- nine periods of excitation. Three times we were witnesses to the fact that she could foresee a continuation of the period of exci- tation beyond the usual duration.
What we term "normal duration" is not without its variations in length of time ; yet it would be wrong to ascribe the patient's ability to predict with precision the duration of a phase of her ill- ness to cognizance of the period of habitual duration ; the varia- tion of duration of the periods is too irregular to warrant that automatic precision. The list of durations of the phases of her
74 DREAMS.— Vaschide and Pieron.
illness herein given show that she could not have had any precise idea about any given duration.
Table of Durations.
Phase of excitation 8 days.
" " depression 14 "
" " calm 18 "
** " depression 4 "
" " excitation 16 "
" " depression 4 "
" " calm 60 "
" " slight excitation 13 "
" " depression 4 "
" " excitation I "
" " depression 14 ''
" " calm continued two and one-half months. . The above figures show the marked variability of the duration of the periods. We wish to remark that our researches were not confined to the study of the major phases of the disease; the minor ones were analyzed just as zealously, as they are important psychologically, if not pathologically.
Analysis of the Facts. — The nature of her index-dreams varies with the period they announce : that of melancholy depres- sion, of maniacal excitement, or of calm.
Dreams Announcing the Period of Excitation. — We have collected twenty-nine observations relating to the announcement of this period. We were acquainted with the patient's family and studied the case even when at large. The family were most will- ing to aid us in gathering information, and the patient herself made capital of her ability to thus guide herself by her dreams, and spoke about them daily. The periods of excitation set in abruptly, yet the patient could announce them through her dream, thirty-six hours before. She generally went to bed at the usual hour, and arose in the morning at the habitual time also. But on the morning preceding the onset of a period of excitation she would wake up abruptly, suddenly. When we happened to be by her bedside at such a time she would say to us on awaken- ing, "Come to my rescue, I shall again become insane!" This was said as if the patient was in a somnambulistic condition, as if she were awakening from a nightmare, and while she was reach- ing out for her clothes. After a few moments she would come to herself again and speak of her dreams, giving details with precision. It is clear that there was a certain systematization of ideas in the dream — sl difficult thing to observe in the normal person. The nature of the dream was that of a nightmare : she dreamt that people tried to choke or strangle her, to occlude her
DREAMS.— Vaschide and Pieron. 75
nostrils, to burn her eye-lashes, to tear out her finger nails, to pull out her hair, to stun her with a blow on the head, particularly on the forehead; to fetter her head in an iron helmet, to drive gimlets into her tongue, to twist her joints, to inflict slashes on her arms, to eviscerate her, and finally that she was made pregnant by some individual; she had no definite idea as to his appearance. She tried to escape her torturers, but they pursued her, and at this agonizing moment she would feel that she was becoming insane. Then she would wake up and state that she was about to become insane.
In twenty-four of the twenty-nine observations, the period of excitation was thus announced on awakening, the period separat- ing the awakening and the onset of excitation varying from four to twenty-four hours ; in one instance that period lasted twenty- seven hours; in four instances the announcements were false.
Dreams Announcing the Period of Depression. — In eleven out of fifteen observations, the patient's prediction of the time of the onset of depression was true; the prediction took place from eighteen to thirty-two hours preceding the onset ; in one instance the interval was two days, and in four cases the prediction was not verified.
The nature of the dream was quite characteristic, according to the account given by the patient. In her dream she imagined that she did not. exist; she felt herself reduced to the being of a child and was moving in a tub. She saw some "things" pass before her. At times her whole being was transformed into two eyes; these looked at the flow of quiet waves passing an infinite plain.
At times she felt that she was naked and caught in a rain storm, the wind blowing a hurricane while she was being carried off, not knowing where. In another dream the following scene is a fragment told by her: "I imagined that I was about to gather fruit from a tree, but no sooner did I stretch out my hand to reach it than the tree grew to an immense height, seeming to be hundreds of miles above my head ; I remained as if transfixed, still holding up my extended arm in the air, not knowing what I wished to do and feeling puzzled about it all."
In other dreams of this kind she imagined that she was thrown into a sleep by means of drugs and that she slept during an eter- nity; or else people fatigued her by making her take very long walks while she was in a profound sleep. Finally, she often saw herself at the edge of rocks, from which she was about to fall into bottomless precipices ; so frightened did she feel at those moments that she remained as if "photographed" on the rock, as she has it.
The waking from these dreams was, by contrast with the first,
76 DREAMS.— Vaschide and Pieron.
very slow, although she was a light sleeper ; so slow was her waking that at times she had to be shaken. Once awake she re- mained in a condition of marked indecision during the few hours that' preceded the onset of the period of depression. She would say on such occasions : "It is odd, I feel that I am becoming stupid ; my dreams of last night were of the nature that take away my appetite and make me dream during the day."
At the time of these dreams there seems to exist a personal psyphic analysis ; she seems to be conscious of the exterior in- tellectual conditions without being guided by any outside motive. Besides, there is considerable mobility of what passes before her eyes, and there is always a double splitting of her present and on- setting conditions; this is remarkable for its fixity and final im- mobility. All this takes place under the indefiniteness and vague- ness of the chaotic state in which the dream develops.
Dream Announcing the Period of Calm. — The conditions are identical with the preceding ones. We will consider