Addresses, Papers and DiscDssiflns 
 
 IN T:^E SBCTION OF. 
 
 AND NEUROLOGY, 
 
 AT THE 
 
 PORT Y-SECGMnNBUAL MEETING 
 
 OF THE 
 
 AMERICAN MEDICAL ASSOGUTION; 
 
 At Washington', D.,C., IVTay5-fi, 1 89 1 . 
 
 CHICAGO: 
 Printed at the OPpic'E of the Association 
 1891. • ■ 
 
THE GIFT OF 
 
 J^. ^Jj£u^^ 
 
 ..^$Jjlf...i... 
 
INDEX. 
 
 Karly Physical Symptoms of Traumatic Brain Injuries. 
 
 Crothers ... ... i 
 
 The Neuroses from a Demographic Point of View. Rosse. . 13 
 
 Status Epilepticus. Trowbridge and Mayberry 25 
 
 Functional Brain Degeneracy. Searcy 51 
 
 The Virile and other Nervous Reflexes. Hughes. 79 
 
 A. Case of Idiopathic Spinal Hsemorrhage. Diller 91 
 
 The Diagnosis of Traumatic lycsions in the Cerebro-Spinal 
 Axis and the Detection of Malingering Referred to this 
 
 Centre. Watson. 95 
 
 A Consideration of Traumatic Lesions of the Spine Resulting 
 from Railroad and other Injuries; their Etiology, Pathol- 
 ogy and Diagnosis. Manley ^ 119 
 
 Electro-diagnosis in Brain and Nerve Injuries. Methods Used 
 
 and the Apparatus Required. Walling . '. ... 173 
 Ligation Disease a Form of Neurosis. Judd . • • ■ 195 
 Paretic Dementia and Life Insurance. Kiernan . . ... 211 
 Medico-Legal Investigation of Deaths by Violence in Massa- 
 chusetts. Presbery . 219 
 
 Ether Inebriety. Kerr. . . 229 
 
 Synopsis of Opium Inebriety; Effect, Needed Legislation, Dis- 
 tinctive Plans of Treatment Necessary for the Successful 
 
 Cure. Watson. . . . . r. 243 
 
 The Absence of Reasonable Motive in the So-called "Criminal 
 
 Acts" of the Confirmed Inebriate. Mason. 259 
 
 Personality as it Affects the Course of Drunkenness. Wiight. 277 
 
 Treatment of the Opium Neurosis. Lett . . 299 
 
 Does Science Justify the Use of Alcohol in Therapeutics. If so, 
 
 when? vrhere? Chenery. . . . . 317 
 
 Insanity as Related to Civilization. Everts. 333 
 
 Studies of Criminals. Degeneracy of Cranial and Maxillary 
 Development in the Criminal Cl-ass, with a Series of Illus- 
 trations of Criminal Skulls, and Histories Typical of the 
 Physical Degeneracy of the Criminal. Lydston and Talbot. 353 
 
The original of tliis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924031303567 
 
EARIvY PSYCHICAI, SYMPTOMS OF 
 TRAUMATIC BRAIN INJURIES.' 
 
 BYT. D. CROTHERS, M.D., 
 
 OF HARTFORD, CONN. 
 
 The department of neurology in the practice 
 of medicine has attained such proportions that 
 it would be almost impossible in the limits of a 
 single paper to give any complete history of the 
 advances of even one year. 
 
 In this country there are six large journals 
 devoted exclusively to this branch. Five quar- 
 terlies and one monthly, viz: The Journal of In- 
 sanity; The Alienist and Neurologist; The Jour- 
 nal of Psychology; The Journal of Mental and 
 Nervous Dise,ases; The Journal of Inebriety; and 
 The Review of Insanity and Nervous Diseases. 
 
 Abroad, the periodical literature is more vol- 
 uminous, and books and pamphlets follow each 
 other rapidly. A neurological library of to- day, 
 to be complete, would number thousands of vol- 
 umes and pamphlets. 
 
 This would be exclusive of the literature which 
 
 I Address by the Chairman of the Section. 
 
appears in the general journals, comprising rec- 
 ords of cases, theories, and discussions of diseases 
 of the brain and nervous system. 
 
 The different fields of neurology have been 
 studied until the specialists find it almost impos- 
 sible to master more than a single phase of the 
 subject. The lunacy specialists, the specialists 
 of nervous diseases, the specialists of alcohol and 
 drug diseases, the specialists of idiocy and con- 
 genital diseases, the experimenter and teacher 
 of psychology, and the electrician are all ex- 
 amples. 
 
 The unknown regions of the physiology and 
 pathology of the brain and nervous system are 
 attracting an increasing number of most ardent 
 students, and already the discoveries are very 
 numerous and startling, and the process of learn- 
 ing and unlearning is more and more difficult. 
 In the department of Medical Jurisprudence prog- 
 ress and change is less rapid. Seven medico- 
 legal societies and one large quarterly present 
 the many practical topics which are constantly 
 appearing. 
 
 The confusion of theory and practice in both 
 law and medicine, relating to questions of crime 
 and responsibility, has given rise to many strange 
 conceptions of the teachings of science. Thus, 
 from the text books and legal rulings of judges, 
 the lines of sanity and insanity are laid down as 
 absolute facts. Free will, and accountability, 
 judgment, punishment, equity, with brain con- 
 trol and capacity, are regarded as settled facts, 
 
based altogether on theory. All these questions 
 comprise a realm of the densest superstition and 
 error that will continue until studied scientifi- 
 cally. To- day the student of medical j urisprudence 
 must pursue his studies above all present theo- 
 ries, text books and rulings of law. The ques- 
 tions of motive and human conduct must be de- 
 cided from a knowledge of natural laws of physi- 
 ological and psychological growth. 
 
 Science calls for a great revolution and evolu- 
 tion in the medico-legal solution of many of the 
 disputed questions of to-day. The insane, the 
 inebriate, the defectives of all grades and condi- 
 tions, and the tramp and criminal, can never be 
 restrained or prevented from being sources of 
 peril to all law and order, on theory, or meta- 
 physical abstractions of mind, or legal rulings. 
 
 Medical jurisprudence of the future must de- 
 pend on the progress of scientific medicine. 
 
 Both neurology and j urisprudence are largely 
 influenced by the neurotic element of American 
 civilization. This is a tremendous factor in de- 
 generation and disease, and enters into all de- 
 grees of life and living. 
 
 The family physician and general practitioner 
 are most favorably situated to become the earliest 
 and most accurate students of most of those con- 
 fusing problems in neurology and jurisprudence. 
 
 Every year it is more and more apparent that 
 the failure to recognize the early symptoms of 
 brain degeneration and disease, constantly in- 
 creases the army of incurables. The crowded 
 
insane asylums, alms-houses, jails and hospitals, 
 all refer back to early neglect, and failure to rec- 
 ognize and apply the means of prevention and 
 cure. 
 
 A clearer knowledge of neurology would point 
 to conditions and methods of treatment that 
 could be successfully applied at that time only. 
 An outline view of some of those early stages is 
 the central topic of this paper. 
 
 There is probably no one disease more often 
 mistaken in its early stages than general paraly- 
 sis. Even after the symptoms have become ap- 
 parent, there are confusing halts, and a delusive 
 masking of symptoms that often puzzles even 
 experts. A long formative stage precedes the 
 well-defined symptoms, beginning in slight 
 changes of conduct and character, elation of 
 spirits, increased activity of the intellect; the 
 disposition, the manner, the temper, the habits, 
 and general character all become altered. Then 
 come acts and words which are unusual, the 
 friends and associates are conscious of some 
 change which they seek to remedy by moral ad- 
 vice. Finally, when some reckless conduct or 
 strange disposition is manifest, the physician is 
 called and the disease is clearly made out. To 
 the patient this has no foundation in fact, and 
 sometimes the physician joins in this belief, and 
 explains these changes of mind and conduct from 
 some moral basis. Symptoms of alcoholic and 
 sexual excesses are explained in the same way. 
 After a period extending over months and years 
 
in many cases, the disease is above all question, 
 and beyond all medical skill. This formative 
 stage has been attended by distress, loss, sorrow 
 and most serious blunders. In some cases, crim- 
 inal acts and sad domestic and pecuniary afflic- 
 tions have marked this period. If the family 
 physician had made an early diagnosis, and the 
 treatment been based on this, a different history 
 and result would have followed. 
 
 Some of the ataxies have a similar obscure, 
 early stage, marked by psychical disturbances 
 which are regarded as moral lapses. Nearly all 
 forms of insanity begin with this obscure failure 
 of the high brain centers. Early changes of 
 temper, conduct and character, defects of emo- 
 tional control, defects of reason, slight and ob- 
 scure at first, and yet clearly the oncoming shad- 
 ows of diseases that should be anticipated and 
 pointed out. 
 
 These changes and early symptoms are not new 
 to science, but in most cases, they are overlooked 
 and seldom receive the attention they deserve. 
 
 There is a class of symptoms that are already 
 becoming the center of serious controversy. They 
 are not only not recognized in the early stages, 
 but are sharply disputed by both laymen and 
 physicians. I refer to the alcoholic, opium and 
 other drug symptoms, which are affirmed to be 
 purely vicious acts and the voluntary giving way 
 to the lower animal impulses. Public opinion 
 has sought to control them by fine and impris- 
 onment. The medical profession accepts this the- 
 
ory of treatment, only asserting after a time, the 
 use of these drugs brings on diseased states. The 
 impulse for alcohol and other narcotic drugs is al- 
 ways a symptom of some form of brain palsy. 
 There are two classes of these cases in which this 
 fact seems very clear. The first class are those 
 with a history of some distinct traumatism — no- 
 ticeably, sunstroke, blows on the head, profound 
 wasting illness and severe injury of any kind. 
 
 Recovery follows, but with it appear changes 
 of temper, character and emotions, then comes 
 the drink impulse or the use of some form of 
 opium. These drugs cover up other changes 
 and are interpreted to be the cause of all subse- 
 quent degeneration and disease. 
 
 Many of these cases die of pneumonia or some 
 other acute disease, others go on to insanity and 
 become inmates of asylums, while the majority 
 remain as common drunkards or inebriates 
 slowly growing worse year after year. They are 
 treated as low, voluntary inebriates, despised, 
 persecuted and punished, and die the centers of 
 wretchedness and misery, and frequently leave 
 defective families that are always burdens to the 
 world. 
 
 The second class of inebriates or drug takers 
 have a distinct history of psychical traumatism. 
 A man previously temperate and well, will have 
 a history of profound mental shock, such as sud- 
 den overwhelming grief at the loss of wife, or 
 children, or property, or the failure to realize 
 some absorbing ambition, or some calamity that 
 
will distress him acutely. His entire character 
 and disposition will change, and the drink im- 
 pulse will appear suddenly, without any cause, 
 and continue persistently. 
 
 Several instances have been noted in which 
 the effect of a railroad accident, where no exter- 
 nal injury was produced, was the beginning of 
 the drink impulse. The shock of sudden fear 
 seemed to so paralyze the brain as to demand 
 alcohol or opium ever after. In these cases, 
 alcohol may be taken at first as a medicine and in 
 moderation, but the degeneration which calls 
 for it is apparent when efforts are made to dis- 
 continue its use. Another class of cases show 
 these symptoms equally marked; thus persons 
 who occupy centers of great care and business 
 or professional responsibility; persons who are 
 most active in business in the prime of life, pre- 
 viously temperate, who suddenly begin to take 
 spirits and rapidly become excessive drinkers, 
 and defenders of its value as a medicine. Such 
 cases are soon incapacitated and die. The drink 
 symptom is always treated as a moral condition 
 in these cases. 
 
 In the first class of physical traumatisms some 
 form of brain degeneration is apparent in this 
 morbid impulse for alcohol and opium. The be- 
 ginning and progress of the case confirms this. 
 
 In the second class of psychical traumatism, a 
 brain palsy and siidden perversion of brain func- 
 tion and activity takes place, and the demand 
 
8 
 
 for alcohol and opium is the expression of this 
 state. 
 
 In the third class, the use of spirits is a symp- 
 tom of exhaustion and general brain failure. 
 
 All these forms of palsy and degeneration are 
 rapidly intensified by the chemical action of the 
 spirit or drug used. 
 
 The pathological condition which calls for re- 
 lief by these drugs has a uniform order of events, 
 beginning at a certain point and passing down, 
 marked by a regular succession of symptoms, 
 reaching a certain termination that rarely varies. 
 
 The drink craze is a symptom which should 
 never be misinterpreted or overlooked. Any 
 one who persists in using alcohol or opium to ex- 
 cess is suffering from some brain degeneration and 
 ■ disease, which requires medical study and care. 
 
 The use of alcohol or other drugs is, in a cer- 
 tain number of cases, a marked symptom of in- 
 sanity. This fact has been noted for many years, 
 and generally occurs in neurotics who, after some 
 great strain or mental perturbation, become ex- 
 cessive users of spirits, and continuously or at 
 intervals, stupify themselves with such drugs. 
 When arrested and deprived of spirits in jails, 
 acute mania or melancholy follows; then it ap- 
 pears that the spiiit and drug craze were only 
 symptoms of insanity concealed and masked by 
 the spirits. 
 
 The facts in this direction are numerous and 
 startling, and unknown except to the few stu- 
 dents who are at work in this field. 
 
Scientific study has established this fact, viz. : 
 that the "drink craze" ("meaning the impulsive, 
 unreasoning desire for spirits or narcotics) is a 
 symptom of disease. Whether this is so in all 
 cases at the beginning is not yet established; yet 
 nothing can be more certain than this, that the 
 use of spirits will cause disease and diseased con- 
 ditions in all cases. 
 
 Another fact is becoming more prominent, that, 
 .the number of inebriates of all forms is increas- 
 ing; and with them the army of neurotics and 
 defectives is likewise rapidly growing larger. 
 
 The problems of causation, prevention and cure 
 are still involved in the realms of obscurity and 
 quackery. Great parties and numerous societies 
 are attempting its solution frorn the moral side 
 alone. 
 
 As a scientific problem, it is practically un- 
 known, and yet, no question of modern times is 
 so eminently one of causes and conditions that 
 are tangible and within the range of science to 
 understand. 
 
 The neurologist must point out the road and 
 stimulate the family physician to study these 
 early psychical symptoms, which, like signal 
 flags of distress, are becoming more apparent. 
 
 Scientifically the abnormality of an increasing 
 army of neurotics and suicidal drug takers, who 
 receive no care or medical attention until they are 
 chronic, is a reflection on modern medicine. 
 
 Over five million of laymen in this country 
 are agitating the question of means and remedies 
 
lO 
 
 to check this disease. Of the sixty thousand 
 physicians, less than a hundred have given any 
 special attention to the cure and prevention of 
 this wide reaching malady. 
 
 The specialists can study these cases in asy- 
 lums, but the family physician must be the scien- 
 tific student to point out the early causes and 
 remedies. The drink problem can never be 
 solved except from physiological and psycholog- 
 ical study. This must begin with heredity, 
 growth, nutrition, culture, surroundings and all 
 the phenomena of life. 
 
 The early psychical symptoms must be studied 
 also, the traumatisms, the beginnings of patho- 
 logical changes that manifest themselves in the 
 drink impulse. 
 
 This is the path along which science must 
 seek the solution of this problem. The temper- 
 ance agitator and reformer must give way to the 
 physician. The roar and conflict of parties and 
 societies will die away, and only the voice of 
 science will be heard. Then the armies of ine- 
 briates, criminals, and insane will be halted, dis- 
 banded and forced back to health and rational 
 living. The inebriates will be protected and 
 housed. The saloon will disappear, and alcohol 
 will be unknown. This will be a reality when 
 medical men take up this study from a purely 
 scientific point of view. 
 
 In discussion Dr. Kiernan said: 
 
 He thought that Dr. Crothers did not fully 
 
appreciate the legal difficulties in caring for the 
 inebriate. It is only when he has reached crim- 
 inality that the law becomes efficient in restrain- 
 ing his morbid appetite. Additional difficulty 
 ■was added to these cases by the confused rulings 
 ■of courts regarding tests of criminal responsibil- 
 ity. There were, however, signs of advancement^ 
 and a disposition to yield time honored but 
 «rroneous precedents. Inebriates should have 
 the same legal status as lunatics. 
 
THE NEUROSES FROM A DEMOGRAPHIC 
 POINT OF VIEW. 
 
 BY IRVING C. ROSSE, M.D., 
 
 OF "WASHINGTON, D. 0. 
 
 The title of this paper may seem rather an 
 ambitious one, since the study of vital and social 
 statistics, and their application to the compara- 
 tive study of races and nations, is almost too new 
 to furnish many principles that may serve as 
 bases of induction. However, I purpose to state 
 in a fragmentary way a few notes and observa- 
 tions bearing on the subject. 
 
 More than usual experience as a traveller has 
 brought me in contact with various races of men 
 under different mesological conditions. Experi- 
 ence and observation in this line show that, in 
 spite of physical and moral varieties, there exists 
 practically, for the physician, but one people, 
 since there are no wide differences, biologically 
 or medically speaking, in the human species; 
 and the infirmities of men, notwithstanding their 
 physical inequalities and the extensive range of 
 the nosological table, are much the same the 
 
14 
 
 world over, no matter whether they be classified 
 among the white, the yellow, or the black races^ 
 
 I confine myself advisedly to the simple classi- 
 fication of white, yellow and black, as it seems- 
 to be the best for descriptive anthropological pur- 
 poses, and is, moreover, that adopted by Aris- 
 totle, Cuvier, and by a recent contemporarj- au- 
 thority, Dr. Latham. 
 
 In the consideration of ethnological subjects 
 there seems to be an inability, on the p&rt of 
 some people, to rid the mind of such abstractions. 
 as geographical lines and political distinctions, 
 though it is well known that they will not keep- 
 away disease or noxious products. Indeed, the 
 prejudice is carried so far that one might infer 
 the notion that being born in a stable makes one 
 a horse. We should not lose sight of the fact 
 that the offspring of an English man and woman. 
 in Africa will partake of the ethnological chara€>- 
 teristics of the Anglo-Saxon race for all time to- 
 come, so far as we know, and that the descend- 
 ants of a black African man and woman in 
 America will perpetuate the negro type witb 
 marked persistency. The latter fact is so well 
 established that in studying cases of the crossing. 
 of the colored races, families have been observed 
 in which, at the end of several generations, there 
 were a series of children having much more thaik 
 their father and mother the signs of an Africaa 
 mixture, going back at least to a fifth anterior 
 generation. A woman whose father was a quad- 
 roon and whose mother showed traces of Africais 
 
15 
 
 blood, having married an Englishman of pure 
 race, had nineteen children, all of whom showed 
 unequivocal traces of this sixteenth of African 
 blood (Bulletin de la Soc. d' Anthropologic, 1865, 
 p. 288). Among the motley population of the 
 West Indies, it is noticeable that the African 
 negro, transplanted to a sky but a little differ- 
 ent from his own, has scarcely undergone any 
 physical or moral modification ; in fact, he flour- 
 ishes in the Antilles like the green bay tree, na- 
 ture there being so much in his favor that after 
 successive generations of mulattoes, the children 
 revert to the negro type. Of course I do not pre- 
 tend to deny the influence of meteorological con- 
 ditions. Food and drink, and social and political 
 surroundings; the conception of the remotest past 
 and a forecast of the remotest future circumstan- 
 ces ; everything in space, from a man's shirt to 
 the farthest nebulae and deepest stratum of earth 
 that he can infer, are but parts of the tremendous 
 whole that acts upon man, or that he can act 
 upon. 
 
 In the climate of the West Indies, for instance, 
 which Darwin speaks of as a great wild, untidy, 
 luxuriant hothouse, the combined efiect of hu- 
 midity with extreme heat softens, relaxes and 
 impairs the fibres in men and animals, renders 
 them lazy, inert, phlegmatic, and reduces them 
 promptly to a state of complete atony. In these 
 islands of indolence, even mosquitoes are lazy, 
 and appear supremely indifferent when compared 
 with the ones that I have seen inside the Arctic 
 
i6 
 
 circle in Northern Alaska. Fish are not game. 
 It is related with some show of authenticity, as 
 evidence of climatic result, that the tarpon has 
 allowed itself to be caught by fishermen who 
 dived to the bottom and placed a hook in its 
 mouth. Mice are also wanting in the alacrity 
 that characterizes the northern species. Imported 
 quadrupeds weaken and degenerate rapidly. The 
 hog alone flourishes. Frenchmen do not accli- 
 mate and flourish in the Caribbean climate as 
 they do, for instance, in Canada, under the same 
 isotherm as Denmark, and Dr. Rochoux declares 
 that families who are not from time to time re- 
 cruited become extinguished in the third and 
 fourth generation. 
 
 It is true that atmospheric vicissitudes have 
 much to do with the sicknesses of all latitudes, 
 and may impart a different shade of color to a 
 malady, that is produced by a sort of anatomical 
 determinism. Meteorological influences of the 
 climate modify the telluric conditions, alimenta- 
 tion, habits, etc., yet as regards climate, obser- 
 vation and experience seem to be our only guides. 
 Up to the present time, climatology has given us 
 many figures with but few results, and topogra- 
 phy teaches nothing upon the salubrity of a coun- 
 try. It does not explain why cholera is in India, 
 plague in Egypt, and yellow fever on the shores 
 of the Gulf of Mexico. Nor does it tell why 
 malarial fevers spare New Caledonia, in spite of 
 the existence of numerous marshes, and why 
 
17 
 
 they ravage Madagascar in spite of its grand 
 chain of mountains. 
 
 We, of course, do not look for sunstroke and 
 malarial fevers among Eskimo, nor for frost bites 
 and snow blindness among the natives of tropical 
 Africa, yet I have found locomotor ataxia equal- 
 ly in Hayti and New York, and have seen the 
 prevailing geophagism of the Antilles and South 
 America among negroes of the Southern States. 
 
 This neurosis of the function of digestion is 
 not the exclusive infirmity of degraded and prim- 
 itive negro tribes. Pathological geophagy is 
 found among the yellow races' in Java, China and 
 Siberia. It has been observed in the white race 
 in some of the provinces of Spain, and among 
 the poorer classes of whites inhabiting the pine 
 barrens and thinly settled portions of several 
 Southern States. 
 
 Gastric depravity is not confined to human 
 Ijeings. Collective investigation on this subject 
 enables me to mention numerous instances. 
 
 I have known a sow to eat her whole litter of 
 pigs, and I have seen coprophagy in one of the 
 elephants confined in the I/ondon Zoological Gar- 
 den, On observing the habits of the fur seal 
 during four visits to the Prybolof Islands, I have 
 learned that these animals are in the habit of 
 swallowing stones. The lithoborous habits were 
 confirmed by finding in many stomachs stones 
 weighing J^ lb. apiece. One paunch contained 
 in the aggregate over 5 lbs. of large pebbles, and 
 in the stomach of one sea lion there were found 
 
i8 
 
 more than lo lbs. of stones, some of them of 
 great size. 
 
 If such facts as the foregoing convince the bi- 
 ologist of the identity of pathological phenomena 
 occurring in the animal series with those ob- 
 served in man, it is more striking from an anthro- 
 popathological point of view that there is strong- 
 er relation among diseases of men of all races,, 
 in all climates. Nervous diseases form no excep- 
 tion to this principle ; for in a general way it is. 
 true that all species suffer nearly in the same 
 manner when exposed to the action of the same 
 morbid causes. 
 
 In a retrospective way it is quite possible for 
 a neurologist to study at the present time some 
 of the convulsive manifestations of the Middle 
 Ages ; and if we have the snake worship, magi- 
 cal associations and nocturnal mysteries of voo- 
 douism in Africa and Hayti, is not our own 
 country preeminently the land of spiritualists, 
 mesmerism, soothsaying, and mystical congrega- 
 tions ? 
 
 Much of my practice having been among Jews, 
 I have had occasion to notice the calm, sober, 
 and sedentary manners of that cosmopolitan race, 
 in whom the prolonged influence of climate has 
 certainly caused no material transformation of 
 type. The world over, they preserve the Semitic 
 stamp, and observe the excellent hygienic code 
 that secures them such pathological immunity- 
 that it is said they are less often struck by light- 
 ning than other people. On the other hand, the 
 
19 
 
 phenomena of nervous and mental disease are 
 more frequent in them than in other races. 
 
 We find familiar examples of strange nervous 
 manifestations in such circumstances as a dance 
 among the Sioux Indians, or a revival among 
 the Anglo-Saxons at a camp-meeting. At both 
 many of the participants will sing, laugh, weep, 
 foam at the mouth, and fall exhausted in a faint 
 or swoon. 
 
 Analogous conditions of nerve disturbance may 
 be found equally among the black inhabitants of 
 equatorial latitudes and the Hyperborean Mon- 
 goligse who live under the midnight sun. Be- 
 sides gross anatomical differences in the negro 
 and a difference of personal essence, so to speak, 
 we find an obtusion of peripheral sensibility, said 
 to be owing to flattening of the tactile corpuscle. 
 There is a want of fineness in the reflexes, les- 
 sened sensibility to alcohol, small intensity of 
 nerve action, and, according to some observers, 
 difference in the electrical state. I have noted 
 similar things among the Eskimo of Bering 
 Strait, the Tchutchkis of Arctic Siberia, and 
 among the Innuit population generally. The 
 nervous derangements of the Northern tribes, 
 who, by the way, believe in and practice Sha- 
 manism, go to show that nervous diseases are 
 not, as many people believe, confined to civiliza- 
 tion. Among these people I have seen insomnia, 
 epilepsy, chorea, cerebral haemorrhage, paraple- 
 gia and hemiplegia, and suicidal mania. 
 
 A nervous affection known in the State of 
 
20 
 
 Maine as the jumping disease, has its analogue 
 in the Siberian emeryaki, so prevalent in the vi- 
 cinity of Jakutsk. I may remark incidentally 
 that, in the original account of this affection 
 given to the public, the word was incorrectly 
 spelled. Dr. Bunge, of St. Petersburg, writes 
 me that it should be written emeryaki in order to 
 approximate its Russian pronunciation. There 
 is, besides, emeryak, the male patient; emeryaki, 
 emyraka, the female patient ; and finally a verb, 
 emery atschitz, to be affected with this disease. 
 My friend, Lieut. Schutze, of the Navy, who has 
 seen much of this disease, thinks it is owing to 
 excessive consumption of tea and tobacco, and 
 psychic depression of isolated communities and 
 long polar nights. 
 
 The ancient habit of tattooing is still common 
 among school-boys, sailors, soldiers, criminals, 
 and prostitutes living in so-called civilized com- 
 munities. The practice, generally confined to a 
 low grade of development and originating in 
 perversion of the sexual instinct, is found pretty 
 much over the world, notably in the Polynesian 
 Islands and some parts of Japan, and I have been 
 struck with the similarity of design on the chins 
 of women when visiting two places so far apart 
 as Morocco and Saint Lawrence Island. To 
 anticipate criticism for mentioning what may 
 seem a very trivial subject, I would say that tat- 
 tooing is significant from a medico-legal point of 
 view, no less a person than the Lord Chief Jus- 
 
21 
 
 tice of England, having characterized it as a 
 matter of vital importance. 
 
 As regards perversions of the sexual instinct 
 and outrages on morals, our common humanity 
 seems to have much the same aptitudes and in- 
 stincts, regardless of the points of the compass. 
 
 Even a superficial observance of the sexual 
 morals of the Eskimo causes one to smile at 
 I<ord Kame's "Frigidity of the North Ameri- 
 cans," and at the fallacy of Herder, who says: 
 ' ' The blood of man near the pole circulates but 
 slowly, the heart beats but languidly; conse- 
 quently the married live chastely, the women al- 
 most requiring compulsion to take upon them the 
 troubles of married life," etc. Nearly the same 
 idea, expressed by Montesquieu and repeated by 
 Byron in ' ' Happy the Nations of the Moral 
 North," are statements so at variance with my 
 experience, that this fact must alone excuse a 
 reference to the subject. So far are they from 
 applying to the people in question that it is only 
 necessary to mention, without going into details, 
 that the women are freely offered to strangers by 
 way of hospitality, showing a decided preference 
 for white men, whom they think beget better off- 
 spring than their own men. In this regard one 
 is soon convinced that salacious and prurient 
 tastes are not the exclusive privilege of people 
 living outside of the Arctic circle ; and observa- 
 tion favors the belief in the existence of pederas- 
 try among Eskimo, if one may be allowed to 
 judge from circumstances not necessary to par- 
 
22 
 
 ticularize, and from a word in their language 
 signifying the act. 
 
 Coming nearer to home, we find that paranoia 
 and general paresis are more common in the 
 white race as they come under the civilizing in- 
 fluences of town life, the bad features of which 
 are increased consumption of tea, alcohol and 
 tobacco, exposure to venereal disease, and the 
 unequal distribution of wealth. The same causes 
 seem to have produced an anotomical determin- 
 ism in the black race, among whom suicide and 
 insanity were rare before the civil war, which 
 goes to show that such affections are modified by 
 mesological causes rather than by race. 
 
 I trust that the foregoing experiences, incom- 
 plete as they are, may call the attention of others 
 to the study of pathological anthropology in its 
 bearing upon nervous diseases; and if any obser- 
 vation of mine shall prove, genetic enough to 
 broaden the enthusiasm of the medical man, and 
 enable him to show less hesitancy in the treat- 
 ment of disease, then I shall not regret having 
 claimed your attention. 
 
 In discussion of Dr. Rosse's paper. Dr. Osier 
 referred to the remarkable fact that chorea was 
 rare in the Indian and negro, also that locomotor 
 ataxia was rare in the colored race, while syphi- 
 lis was common. On the contrary, hysteria was 
 a frequent disease among negroes. 
 
 Dr. Hughes said that Dr. Beard had made the 
 observation that nervous diseases were relatively 
 less frequent in the South than in the North. 
 
23 
 
 Dr. Kiernan recalled that Dr. Spitzka, Dr. 
 Eannister and himself had made a study of eth- 
 nological psychiatry. Paretic dementia, for ex- 
 ample, was present in the negroes of New York 
 and Chicago, but absent from those in the South. 
 The reason for this was found in that in the cit- 
 ies named they were exposed to the same condi- 
 tions that produced the disease in the white race. 
 
 Dr. Rosse, in closing, said that he had recently 
 seen a case of locomotor ataxia in a full-blooded 
 negro. 
 
STATUS EPII.EPTICUS. 
 
 BY G. R. TROWBRIDGE, A. M., M.D., AND C. B. 
 MAYBERRY, A.M., M.D., 
 
 Fellows of the American Academy of Medicine; Assistant Physi- 
 cians State Hospital for the Insane, Danville, Pa.; Members of 
 the American Medical A-ssociation, and Pennsylvania 
 Medical Society, 
 
 It should be a source of regret that a promi- 
 nent writer and authority in medicine, in the de- 
 scription of epilepsy, in his work on practical 
 medicine, makes this statement; "As regards 
 the immediate danger from the paroxysms, the 
 prognosis is always favorable;"^ and, moreover, 
 he makes but bare mention of the condition 
 status epilepticus, when in reality it is the most 
 serious phase epilepsy assumes. It is for the 
 very reason that but comparatively little consid- 
 eration has been given to this condition by the 
 profession, excepting the medical men connected 
 with institutions for the insane, that it has been 
 chosen the subject of a paper, with the hope 
 that, without being obtrusive, a somewhat sys- 
 tematic description and a few suggestions in re- 
 
 I Flint : Principles and Practice of Medicine. 
 
26 
 
 gard to the treatment of such cases may be given, 
 which may be of some interest and value. 
 
 The alarming mortality among epileptics, 
 shown by the reports of our asylums and hos- 
 pitals for the insane, and due in a great measure 
 to status epilepticus, makes constant demands 
 for new suggestions and ideas in the treatment 
 of these cases; and "when, moreover, it is taken 
 into consideration that every individual, whether 
 in an insane asylum or not, who has fallen prey 
 to the as yet unexplained disease, idiopathic epi- 
 lepsy, either in a mild or severe form, may at any 
 time be attacked with this almost surely fatal 
 phase of the disease, it would seem that any 
 point, either in clinical history, pathology or 
 treatment, must be of interest to the profession, 
 and certainly to the neurologist and alienist. 
 
 This paper has been prepared in the hope that 
 it may possibly advance some new ideas, and at 
 least be a reminder of this extremely serious 
 phase of epilepsy. 
 
 As to the cause or causes productive of idio- 
 pathic epilepsy, we must, as yet, say we do not 
 know, and consequently the same statement must 
 be made in regard to status epilepticus; so the 
 treatment of these cases will of necessity be de- 
 pendent upon theory and symptoms. 
 
 Whether or not epilepsy is an entity and has 
 but one cause in its production, or is a disease re- 
 sulting from a number of factors, it is well known 
 that it varies in intensity from a form which but 
 slightly interrupts the daily routine of life to one 
 
27 
 
 which utterly destroys the individual physically, 
 mentally, morally and socially, and no matter 
 how mildly the neurosis may exhibit itself in a 
 special case, the individual has the taint of lesion, 
 which at any time may be productive of violent 
 convulsions, atld in a few hours carry its victim 
 into eternity. 
 
 It is as if one were standing near a compara- 
 tively innocent and' harmless stream; but the 
 bursting of a dam sets in motion the pent-up 
 flood, and in an instant he is swept into oblivion. 
 
 If we accept the theory of J. Hughlings Jack- 
 son regarding the cause of epilepsy, viz. , an over- 
 discharge of nerve force, or energy, from the brain 
 cortex, we might define status epilepticus as a 
 continuous, rkpid and violent discharge of this 
 nerve force, followed by a condition of extreme 
 stupor verging upon coma, or, in place of the 
 stupor, a period of maniacal excitement, though 
 this latter is extremely rare. 
 
 Status epilepticus can scarcely be considered a 
 special form of epilepsy, nor is it all correct to 
 make it a distinct disease, but, on the contrary, 
 it should be regarded as a climax of epilepsy. 
 
 A condition resembling status epilepticus may 
 result in epileptics in whom the disease is caused 
 by gross lesions, as tumors, cysts, etc., and to a 
 considerable extent it is analogous to the epilep- 
 tiform seizures, and consequent condition of pa- 
 retic dementia; but it is not the purpose of this 
 paper to treat of such cases. 
 
 In order to preserve as far as possible a syste- 
 
28 
 
 matic order in the consideration of the subject, 
 the following headings are given : 
 
 1. The clinical history. 
 
 2. Resume of cases treated. 
 
 3. Notes of autopsies. 
 
 4. Prognosis. 
 
 5. Treatment. 
 
 The clinical history of status epilepticus, 
 "etat de mal," or "les series," of the French, 
 or, as Charcot calls it, "the epileptic acme," 
 from observations made by the writers upon the 
 cases to be cited hereafter, is as follows.: 
 
 A rapid succession of convulsions, usually ot 
 " grand mal" type, with intermissions varying 
 from a few seconds to a few minutes, and often 
 following one another so closely that they re- 
 semble one continuous convulsion, the patient 
 being in a stuporous or even comatose condition 
 in the intervals. 
 
 The pulse and breathing are greatly accele- 
 rated, the former being weak and irregular; there 
 is deep congestion of the face and neck and in- 
 tense throbbing of the carotids. 
 
 The temperature rises rapidly, until it has 
 reached io4°-io7° F., and there is often a differ- 
 ence in the temperature of the two sides, the 
 greatest heat being on the side which is most 
 convulsed. 
 
 As the convulsions increase in frequency and 
 violence, there is a corresponding rise in the tem- 
 perature and a deepening stupor or coma in the 
 intervals. The conjunctivae are insensitive; the 
 
29 
 
 pupils are widely and (as a rule) evenly dilated, 
 though occasionally there is a difference in size, 
 and are not affected by light; patient is bathed 
 in a cold sweat, though the skin feels intensely 
 hot; sordes appear on the gums and teeth, and 
 the bladder and bowels are involuntarily evacu- 
 ated. .This condition may last from one to sev- 
 eral hours; but, as a rule, the convulsive stage is 
 of comparatively short duration, though occa- 
 sionally it is prolonged.^ 
 
 Death may occur in this stage from exhaustion, 
 or the convulsions may cease and the patient 
 pass into the second or stuporous stage. 
 
 This stage is characterized by an intense stu- 
 por, total abolition of sensation and motion, ex- 
 ceedingly depressed heart's action, and a conse- 
 quent dyspncEic condition. The temperature re- 
 mains above normal, though not as high as in the 
 convulsive stage. 
 
 There is paralysis of the muscles of degluti- 
 tion, very often irritability of the stomach, and 
 sometimes profuse diarrhoea; bed sores appear; 
 the tongue is dry and coated; increasing sordes 
 on the teeth and gums, and, in short, everything 
 points to a rapid dissolution. The second stage 
 lasts from one to several days. 
 
 Charcot^ makes two classes of status epilepti- 
 cus, viz., " the minor acme (' les petites series'), 
 constituted by from two to six fits, and the major 
 
 2 One patient in the West Riding Asylum had 1,849 convulsions, 
 covering a period of fifteen days. Delasuiave reports a case where 
 the first stage lasted a month, the patient having 2,500 fits. A pa- 
 tient in the Northern Michigan Asylum had 3,000 in three weeks. 
 
 3 Charcot : Diseases of the Nervous System. 
 
3° 
 
 acme ('les grandes series'), in which from twenty 
 to thirty fits have been reckoned in the twenty- 
 four hours." It would hardly seem that this di- 
 vision is necessary, for the very reason that it is 
 an extremely rare occurrence for from two to six 
 fits to produce the stuporous stage of the status 
 proper. Evidently Charcot regards the convul- 
 sive stage as constituting status epilepticus with- 
 out including the comatose stage. Hence his 
 two classes. 
 
 Rosenthal* gives the following description : 
 "Another severe form of epilepsy is described 
 under the name of status epilepticus. It presents 
 the following characteristics : Rapid succession 
 of attacks, presenting slight remissions and with- 
 out return to consciousness (convulsive stage) ; 
 a comatose condition secondary to these attacks, 
 with abolition of reflex power, except during 
 short periods of temporary increase (meningeal 
 stage) ; more or less complete and permanent 
 hemiplegia ; acceleration of the pulse and respira- 
 tion ; and especially a marked elevation in tem- 
 perature (40°-43° C), which persists even in the 
 intervals of the paroxysms, and may increase af- 
 ter their disappearance. The duration of these 
 attacks may vary from three to nine days ; more 
 than one half the cases terminate in death." 
 
 PutzeP gives the clinical history in the follow- 
 ing words: "The prodromata do not differ in 
 any respect from those which are usually expe- 
 
 4 Rosenthal : Diseases of the Nervous System. 
 
 5 Putzel: Functional Nervous Diseases. 
 
31 
 
 rienced by the patient prior to the ordinary at- 
 tack of convulsions; but the fits, instead of ceas- 
 ing, follow one another rapidly, and before the 
 epileptic coma has entirely disappeared, another 
 convulsion makes its appearance. The intervals 
 between the fits become shorter and shorter, un- 
 til they run into one another and finally the pa- 
 tient appears to be in one long continued con- 
 vulsion. 
 
 ' 'The pulse is regular, but usually small, the 
 respirations become frequent and labored. The 
 temperature begins to rise from the very begin- 
 ning, and may rapidly reach a height of 104°, 
 105° or 107° F., and upward. The skin is hot 
 and scorching, the face is covered with an abun- 
 dant, viscid sweat. Marked nystagmus is present, 
 and the face and neck may be drawn to one side. 
 The pupils are dilated, either equally or une- 
 qually, and do not react normally to light. 
 
 "After the convulsions have lasted some time, 
 hemiplegia develops in a large number of cases, 
 the face and limbs being affected as in ordinary 
 hemiplegia. . . . The sensorial and intellectual 
 functions are totally abolished, and the patient 
 lies in a profound stupor, which often deepens 
 into coma." . . . 
 
 Secondary or Meningitic Stage. — "At the close 
 of the first stage the convulsions become more 
 infrequent, and finally cease, but another series 
 of symptoms develop. The intelligence is more 
 or less affected, and the patient is in a condition 
 of hebetude or coma," The author goes on to 
 
32 
 
 say that in this stage the coma may be replaced 
 by maniacal excitement, general disturbance of 
 nutrition, emaciation, bed-sores, and a gradual 
 dissolution or an extremely slow recovery. 
 
 Bevan I,ewis» describes it as follows: "If the 
 attacks succeed each other rapidly and conscious- 
 ness is not restored between the convulsive seiz- 
 ures, if fit succeed fit at, intervals of a few mo- 
 ments only, the patient remaining comatose, we 
 have developed what is termed the status epilep- 
 ticus, a condition of most serious import. 
 
 "The pulse and breathing become quickened; 
 . . . the temperature rises to 105° or 107° F., 
 with deepening coma or stupor. ... As the fa- 
 tal termination approaches, the convulsions be- 
 come more frequent, a few seconds only inter- 
 vening between each discharge, so at times they 
 appear almost continuous, a fresh discharge being 
 only recognized as a slight increase in the inten- 
 sity of the convulsions. 
 
 "When this period arrives, however, the epi- 
 leptic discharge becomes progressively feeble, 
 and the fit may be characterized by a slight 
 turning of the head and eyes to one side, with 
 slight clonic movements of the limbs or merely 
 convulsive twitchirigs of the mouth, with conju- 
 gate deviation. The conjunctivae are, of course, 
 quite insensitive, the pupils being widely dilated 
 and fixed to the strongest glare of light, while 
 the face and body are bedewed with a cold sweat. 
 Often the temperature exhibits unilateral devi- 
 
 ti Bevan l«ewis: Text Book of Mental Diseases. 
 
33 
 
 ations, being highest by a degree or more on the 
 side first (or most) convulsed. If the patient re- 
 cover, the fall of temperature is most rapid on 
 this side until a balance is established, and sub- 
 sequently an equal and continuous decline of 
 temperature proceeds on both sides. . . . The 
 mortality from status epilepticus is said to be 
 due to (a) collapse and {b) to meningitis." . . 
 
 Bourneville' in his treatise characterizes status 
 epilepticus: i. By the frequent repetitions of 
 the convulsions, which may even become almost 
 continuous with one another; 2, by a variable 
 ■degree of collapse, which may deepen into a most 
 profound coma, unattended by any return to con- 
 sciousness; 3, by a more or less complete hemi- 
 plegia, developing after a variable duration of 
 the symptoms; 4 by increase in frequency of 
 pulse and respiration; 5, by considerable eleva- 
 tion of temperature, which persists in the brief 
 interval between the convulsions. He, with 
 others, divides it into two periods — a convulsive 
 and meningitic. 
 
 Calmeil, Trousseau, Delasuiave, Gowers, Web- 
 ber and Blandford give more or less on the sub- 
 ject; but as their statements are covered by the au- 
 thors already quoted, it is useless to give them here. 
 
 Twenty cases of status epilepticus have come 
 under the observation of the writers; but only 
 twelve are cited, as the remaining eight would 
 only be repetitions of the others. 
 
 7 Bourneville: Etudes Cliniques et 1 hermom^triques sur les 
 Maladies du Syst&me Nerveux, 1873. 
 
34 
 
 Case I. — Male, aged 25; congenital imbecile; 
 family history shows marked neurotic taint; had 
 scarlet fever when 15 years of age, and soon after 
 recovery epilepsy appeared; has had an average 
 of ten fits a month since development of the 
 neurosis; physical condition mudh impaired. 
 During November, 1888, had three fits; Decem- 
 ber, eleven, and January, twenty- four. 
 
 All of this time he was taking a mixed tonic 
 and biromide treatment. On February 24, at 2 
 P.M., after an interval of several days without 
 fits, he had a severe convulsion, followed by 
 others in rapid succession, averaging one every 
 two minutes for the first hour. At three o'clock 
 his temperature was 102° F., respiration 30, 
 pulse 106, skin hot and covered with perspira- 
 tion, pupils dilated equally and not reacting to 
 light, face much congested; unconscious, though 
 not having a convulsion at that time. Bther 
 was given and carried to surgical anaesthesia, 
 with a cessation of the convulsions. Given 
 chloral hydrate, grs. xxx, by rectum. Slept 
 well until 9 p.m., but on awakening he immedi- 
 ately went into a series of convulsions, having 
 thirteen in twenty minutes. At 9:30 p.m., tem- 
 perature was 104° F., respiration 35, pulse 130. 
 Ether was ag§in administered, and morphiae 
 sulph., grain %, hypodermically. February 25: 
 Slept well during the night. This morning he 
 lies in a stupid condition; temperature 105.6° F.; 
 respiration 41, pulse 129, cold sweat over entire 
 body, pupils dilated and insensible to light. 
 
35 
 
 Given nourishment and stimulants by stomach- 
 tube. Remained in this condition until death, 
 at 5 P.M. Duration of attack, fifty-seven hours; 
 number of convulsions, forty -three. 
 
 Case 2. — Male, aged 28; congenital imbecile; 
 had scarlet fever when ten years old, and imme- 
 diately after developed epilepsy; no known hered- 
 ity. During February, March and April, 1889, 
 he had one fit while under tonic treatment. On 
 May 2, between i and 5 a.m., he had one hundred 
 and six convulsions; at 5 a.m., temperature was 
 104.5° ^-t respiration 32, pulse 130. The fits- 
 followed each other with very short intervals, the 
 patient being unconscious. Chloroform was ad- 
 ministered, and continued for a half hour; ol. 
 tiglii. gtts. iii, followed by profuse evacuations. 
 In this case the convulsions were general, but 
 stronger on the right side; right hemiplegia fol- 
 lowed the attack. Patient sank into a stupid 
 condition which lasted five days. During this 
 time the temperature and pulse were constantly 
 above normal, the gradual return to conscious- 
 ness being preceded by an even fall of tempera- 
 ture. Sordes collected on the teeth; tongue 
 brown and dry. The reflex action of the eyes 
 was lost, and death seemed imminent. Stimu- 
 lants and nourishment were given constantly by 
 the nasal tube. On the fifth day he recovered 
 consciousness; the temperature slowly fell to 
 normal. Rapid improvement followed, and in 
 ten days he was able to be about the ward. The 
 total duration of the convulsive and comatose 
 
36 
 
 periods was about ten days; number of convul- 
 sions, one hundred and six. 
 
 Case 3. — Same patient as Case 2. On October 
 27, 1889, was found in the morning in a coma- 
 tose condition, which, without doubt, resulted 
 from his having passed through the convulsive 
 stage of status epilepticus during the night. 
 Temperature 105° F.; impossible to arouse him 
 from the deep coma; pulse weak and intermit- 
 tent. Stimulants and nourishment given per 
 nasal tube. The physical exhaustion was so 
 great that the man sank rapidly, and died eight 
 hours after first being seen. 
 
 Case 4.. — Male, aged. 30; neurotic family; epi- 
 leptic from childhood; no specific history; in 
 good physical condition. Has had several at- 
 tacks of status epilepticus, of which no record 
 has been kept. These attacks were all marked 
 by the large number of convulsions, their sever- 
 ity, the rapidity of their occurrence, and the 
 short intervals between them. On February 21, 
 at 3 P.M., the convulsions began while the pa- 
 tient was outdoors. When first seen he had had 
 fifteen convulsions within a half hour and was 
 in an extremely exhausted condition. Temper- 
 ature 102° F., pulse small, body covered with 
 cold perspiration. The convulsions were gen- 
 eral and of uniform severity on the two sides. 
 Coninse hydrobrom., gr. -^^ was given hypoder- 
 tnically. One convulsion followed the injection, 
 after which the patient sank into a quiet sleep, 
 lasting six hours. On awakening his condition 
 
37 
 
 seemed much improved; temperature 99.8° F., 
 pulse 106; conina, grs. j-J j, with digitalin, gr, 
 TBT^, given hypodermically. Slept during the 
 night Without convulsions. Next morning he 
 was much better, though very weak. Stimulants 
 and nourishment. Two days after was about 
 the ward as well as before the attack. 
 
 Case 5. — Same patient as Case 4. On April 
 15 had twenty convulsions, followed by great 
 exhaustion. Given ether to anaesthesia, chloral, 
 grs. XXX, by rectum. At intervals for twenty - 
 four hours he had convulsions of a more or less 
 severe character, followed by stupor, from which 
 he could not be aroused. Stimulants, nourish- 
 ments, injections of ether, digitalin and atrophise 
 sulph. were given without effect. Patient grad- 
 ually failed and died ten days after. The highest 
 temperature in this case was 105.2 F. , which oc- 
 curred just before death. For some weeks before 
 each of these attacks the patient had been taking 
 bromide treatment.' 
 
 Case 6. — Male, aged 45; no known heredity; 
 cause of epilepsy unknown; bodily in good 
 health; weight 170 pounds; has very few epilep-; 
 tic convulsions, usually not more than six in a 
 year; during the four months before the attack 
 had three convulsions; several previous attacks 
 of status epilepticus. This attack began May 4, 
 1889, at 7 A.M., and in one hour he had thirty- 
 two convulsions, which were continuous, the in- 
 
 8 Bromide of ammonia, bromide of sodium, aa gr. xv., suspend- 
 ed in a tonic mixture, t. i. d., and a pill of oxide o. zinc, extract of 
 delladonna, aa. gr. 1^, at night. 
 
38 
 
 tervals between the fits being marked only by a 
 slight diminution in the severity of the convul- 
 sions. At 8 A.M., there were no signs of ex- 
 haustion; temperature ioo°F., pulse 90. Given 
 ether to anaesthesia and morph. sulph. gr. ji, hy- 
 podermically. No diminution in convulsions 
 except while under ether. At 9:30, chloral, grs. 
 XXX, by rectum, after bowels had been moved 
 by enema. At 1 1 ether was given and carried 
 to surgical anaesthesia, without effect. At 12 
 coninae hydrob., gr. -Yh'u> hypodermically; a few 
 minutes after he had a single fit, and this was 
 followed by sleep. This same dose was repeated 
 at 6 and 9 p.m. Slept all night. No convul- 
 sions in the morning, no excitement. An inter- 
 esting feature of this attack is the absence of 
 excitement, which has always before followed 
 status epilepticus in this patient. 
 
 Casey. — Admitted July 8, 1889. Male, aged 
 38; family history of insanity and epilepsy. On 
 January 4, 1890, was attacked with status epilep- 
 ticus, though since admission has only had five 
 convulsions; fits followed each other so closely 
 that attendants were unable to count them. 
 When first seen, the convulsive stage had nearly 
 ceased. Ether was administered, and morphine 
 hypodermically. The convulsions were stopped 
 entirely, but the man died in the second stage 
 f^om exhaustion forty-eight hours after the com- 
 mencement of the attack. 
 
 Case 8. — Male, aged 26^ no known heredity; 
 a deaf-mute; febrile disease in early childhood 
 
39 
 
 is the supposed cause of epilepsy; has had an 
 average of -five epileptic fits a month while under 
 a mixed tonic and bromide treatment; physical 
 condition is usually good, but at present some- 
 what impaired from constant use of bromides. 
 May 25 had a series of convulsions in the night, 
 number unknown, but when first seen he was 
 passing from one fit to another without any 
 marked interval. Given hyoscine hydrobrom, , 
 gr. tItj, hypodermically, at 4 a.m. Slept until 
 7 A.M., and was then awakened by a convulsion, 
 which was immediately followed by others; giv- 
 en amyl nitrite by inhalation, without effect; 
 ether administered, and chloral, grs. xxx, per 
 rectum, with but a temporary cessation of con- 
 vulsions; 12 M., coninae hydrobrom., grs. yus, 
 hypodermically, after which the fits ceased and 
 sleep ensued. At this time his physical condi- 
 tion was bad; temperature 104° F., pulse 142, 
 body covered with cold perspiration, face cyan- 
 otic, hands and feet cold. At 9 p.m. he was 
 somewhat restless, although there had been no 
 recurrence of the convulsions; slight muscular 
 movements in different parts of the body. Given 
 nourishment and whisky per nasal tube, an 
 enema, digitalin and coninae hydrobrom. , aa, gr. 
 ■jl„, and atropise sulph., gr. -g\, hypodermically. 
 Slept during the night without a convulsion, and 
 is less stupid this morning; takes nourishment 
 and stimulants. From this time he improved grad- 
 ually, and in five days was about the ward again. 
 Case p. — Same patient as Case 8. For past 
 
40 
 
 two months has had no convulsions under a 
 mixed tonic and bromide treatment. August 
 20, at 2:30 P.M., an attack began similar to the 
 last; physical condition much better than at 
 time of last attack. When first seen had had 
 thirteen convulsions; temperature 100° F., pulse 
 no. Given coninae hydrobrom., gr. y^; slept 
 until evening without convulsions and was in 
 good physical condition; takes nourishment this 
 morning, and was able to be about the ward on 
 the following day. 
 
 Case 10. — Male, aged 46; family history shows 
 a predisposition to nervous disease; duration of 
 epilepsy unknown; has a history of syphilis 
 twenty years ago, but there is no indication of 
 cerebral disease or that his convulsions are not 
 true epilepsy. At the time of his attack he had 
 had no convulsions for several months. On De- 
 cember 16,1890, had three fits in the afternoon,, 
 followed by seven in the evening without physi- 
 cal failure. At 9 p.m. given coninse hydrobrom., 
 gr. jf^j,; slept during the night without recur- 
 rence of the fits. At 8 A.M. convulsions again 
 occurred the same in character as before. Given 
 chloral, grs. xxx, and potass, bromide, grs. 60, 
 by stomach, without effect, also morph. sulph.,. 
 gr. y^, and atropias sulph., gr. -^-^, with the same 
 negative effect; at 11 p.m., coninas hydrobrom., 
 gr. ^'d, with an immediate cessation of the con- 
 vulsions. Patient rapidly improved, and in two> 
 days was in his usual health. 
 
 Case II. — Male, aged 45; 'family and previous 
 
41 
 
 history unknown; has had previous attacks of 
 status epilepticus, all having two points in com- 
 mon, viz.: I. The large number of fits and their 
 rapid occurrence, and 2, a state of secondary 
 consciousness following such attacks in which 
 the patient was greatly excited and very brutal; 
 violent to any one who came near him. Physi- 
 cal condition good; has had three fits in the last 
 three months. On May 10, at 4 p.m., he had a 
 severe convulsion, followed by others with inter- 
 vals of about two minutes between them. At 
 4:20 he was etherized, after taking chloral hyd., 
 grs. XXX, and potass, bromide, 3 i. On coming 
 out of the anaesthetic, no convulsions occurred 
 until 5:30 P.M. At 6 he was given coninae hy- 
 drobrom., gr. y-J^. Slept during the night with- 
 out convulsions. No attack followed this, and 
 the man rapidly returned to his usual condition. 
 The highest temperature during this attack was 
 104° F., pulse no. 
 
 Case 12. — Same patient as Case 11. Physical 
 condition impaired; no convulsions for several 
 weeks. September 30: had twenty-three fits be- 
 tween II A.M. and 12:30 P.M. Given coninse 
 hydrobrom., gr. j-^-j. Convulsions ceased. Slept 
 until 7 p» M., when the convulsions again com- 
 menced; coninae repeated with same good result. 
 October i, had several severe convulsions, fol- 
 lowed by unconsciousness, stertorous breathing 
 and right-sided hemiplegia. After being in this 
 condition for about fifteen hours, death occurred. 
 Temperature in this case ranged between 103° on 
 
42 
 
 the first day of the attack and 107" at time of 
 death. 
 
 Such are the histories of twelve attacks of 
 status epilepticus. 
 
 Of the twenty cases which have come under 
 our care, four were examined post-mortem. 
 
 These examinations showed certain points 
 common to all: i. A lack of symmetry in the 
 two hemispheres, which is so often found in epi- 
 leptics; 2, an inequality in the weight of the 
 two hemispheres, also quite common in epilep- 
 tics; 3, more or less extensive decortication; 4, 
 intense engorgement of the brain and its mem- 
 branes — the sinuses were filled with blood, the 
 vessels of both the dura and pia were distended, 
 the brain on section showed the puncta vasculosa 
 to a marked degree; 5, in all four cases, and es- 
 pecially marked in two, serous efiusion into the 
 ventricles and arachnoid space. 
 
 In one of the cases there was softening of the 
 first and second temporo-sphenoidal convolutions 
 on the right side. In another, which showed all 
 the symptoms of apoplexy toward the end of the 
 attack, a large haemorrhage from the middle cere- 
 bral artery on the left side was found. 
 
 In a third case, in which death occurred in- 
 stantly and during a convulsion, a small haemor- 
 rhage was found in the medulla. 
 
 In none of these four cases was the cause of 
 the status epilepticus found, and in only two was 
 there evidence of the immediate cause of death. 
 
43 
 
 The others, in all probability, died from the ex- 
 haustion consequent upon the convulsions. 
 
 The prognosis of status epilepticus is very un- 
 favorable, the mortality being estimated at fifty 
 per cent. The violence and frequency of the 
 convulsions; the high temperature; the rapid, 
 weak and irregular pulse; the consequent coma- 
 tose condition, with its accompanying extreme 
 depression, are all factors of such grave import 
 that the outlook in most cases is very serious. 
 Besides this, we must take into consideration the 
 mechanical action brought into play, viz., the 
 intense and powerful contractions of the muscles 
 during a convulsion, which by exerting an irre- 
 sistible pressure on the vessels, force the blood 
 into the cerebral vessels, thus producing the 
 great engorgement, with imminent liability to 
 cerebral haemorrhage. 
 
 Even though the individual passes safely 
 through the status, hemiplegia often results, 
 leaving him in a weak and helpless condition, 
 and totally unable to withstand a second attack. 
 
 The three most probable modes of death are: 
 I, exhaustion; 2, from cerebral haemorrhage; 
 3, from serous effusion. 
 
 Tredtment. — In a condition like status epilep- 
 ticus, where the life of the individual may be de- 
 stroyed in a few hours, any measure which will 
 abort the attack is of the greatest importance. 
 Our treatment must be chiefly symptomatic, at 
 least until more is known of the pathological 
 condition than we know at present. There are 
 
44 
 
 two important indications for treatment which 
 must be met in each case: i. To bring the con- 
 vulsive period to an end as quickly as possible, 
 and 2, to sustain the life of the individual 
 through the stupid or excited period which may 
 follow the attack. 
 
 I. In order to meet the first indication for 
 treatment, a large number of drugs have been 
 tried, with a view of depressing the motor cen- 
 tres of the cerebrum or cord, or of paralyzing 
 the efierent nerves, or all of these, and thus pre- 
 venting a fatal termination, either by diminish- 
 ing the number of convulsions, making them 
 less severe, or preventing them altogether. 
 Among the therapeutic measures suggested to 
 fulfill this indication, we shall consider only 
 those with which we have had personal experi- 
 ence in our own cases. These include the fol- 
 lowing: Ether, chloroform, chloral hydrate, bro- 
 mide of potassium, nitrite of amyl, sulphate of 
 morphine, sulphate of atropine, hydrobromate of 
 hyoscine, salicylate of physostigmine, and hy- 
 drobromate of Conine. 
 
 Ether and chloroform are given with the pur- 
 pose of itr mediately stopping the convulsions by 
 paralysis of the motor centres of the cerebrum 
 and complete muscular relaxation. 
 
 However successful these may be in the con- 
 vulsions of Jacksonian epilepsy, in our experi- 
 ence in rases of idiopathic status epilepticus they 
 are but temporary measures, the convulsions 
 ceasing only when the point of surgical anaes- 
 
45 
 
 thesia has been reached, and coming on again 
 before the patient has regained consciousness. 
 They are of great use, however, in preventing 
 the convulsions when exhaustion is imminent, 
 while waiting for some other agent to act. Either 
 may be used; but ip a case where the heart and 
 respiration are already in a weakened condition, 
 ether would be the safer. 
 
 Chloral hydrate by the rectum has succeeded in 
 some cases, but has more often failed. In giving 
 this drug, it has been the custom to keep the 
 patient under an anaesthetic during its absorp- 
 tion, giving grs. xxx, and repeating it in an 
 hour if necessary. Although acting as a de- 
 pressant of the spinal cord and brain, yet the 
 amounts which can be given with safety are 
 usually too small to produce the desired effect. 
 We have not used it hypodermically, but it 
 seems probable that used in this manner the re- 
 sults would be much better. 
 
 Bromide of potassium has been given in sev- 
 eral cases in combination with chloral hydrate, 
 but without any good results. If, as in several 
 of our cases, status epilepticus follows a course 
 of bromide treatment, very little could be ex- 
 pected from it, and indeed in any case, its action 
 is so slow that but little could be hoped for from 
 its use. In the few cases in which we have tried 
 it, it has been given in doses of 3i-.^ii. 
 
 Nitrite of amyl is highly recommended by 
 some authors; but repeated trials have failed to 
 establish its value. It has been given by inha- 
 
46 
 
 lation, "L x, repeated at intervals; Although 
 undoubtedly useful in preventing an impending 
 convulsion of ordinary epilepsy, it has proved of 
 but little value in the cases of status epilepticus 
 in this hospital. 
 
 Sulphate of morphine has succeeded in one case 
 in which gr.^ was given hypodermically during 
 ether anaesthesia; but in several other cases in 
 which it was used it failed to change the course 
 of the attack in any appreciable way, although 
 given in doses of gr. }i—%, hypodermically. 
 
 Sulphate of atropine, in any safe dose, acts 
 strongly upon the cardiac and respiratory centres 
 and upon the pneumogastric nerve, but very 
 slightly upon the motor nerves of voluntary mus- 
 cles. Carried further than this, it stimulates 
 the cardiac sympathetic and paralyzes the pneu- 
 mogastric, and in consequence there results a 
 rapid heart failure. For this reason it is impos- 
 sible to stop the convulsions without cardiac 
 failure. Its immediate effect has been good by 
 its stimulating action on the vagus and the re- 
 sultant improvement in the character of the res- 
 piration and circulation. Although it has been 
 used with a view to stopping the convulsions, it 
 is of more value in the second stage of neurosis. 
 
 Hydrobromateof hyoscine, if given in sufficient 
 amount hypodermically, produces almost imme- 
 diate sleep, affects the motor tract of the spinal 
 cord and cerebral cortex, and in a case in which 
 its use is not contraindicated by weakness of the 
 heart or respiration, its employment promises 
 
47 
 
 good results. In the cases in which it has been 
 used, the convulsions have quickly ceased, the 
 heart's action has been slightly depressed after a 
 short time, the respirations have been more fre- 
 quent and less full, and sleep has followed, last- 
 ing from two to eight hours, with a recurrence of 
 the convulsions on awakening, and an improve- 
 ment has occurred in the patient's condition. 
 Although hyoscine has failed to bring the at- 
 tack to an end in any of these cases, yet the rest 
 and freedom from convulsions for several hours, 
 with the resulting improvement in the bodily 
 condition, would indicate its use as a temporary 
 measure. It has been given in doses of gr. -j\j- 
 ttssj hypodermically, its success in acute mania 
 when given by this method, and its almost com- 
 plete failure when given by the stomach, suggest- 
 ing a similar result in status epilepticus. 
 
 Salicylate of physostigmine, gr. -ji^, was given 
 in one case with a view of depressing the cord 
 sufficiently to stop the convulsions, but without 
 success. 
 
 Hydrobromate of conine was first used in a 
 case in which most of the other measures in this 
 list had failed, and its use was followed by an 
 almost immediate cessation of the convulsions. 
 Its action is from the periphery, extending to- 
 ward the centre, the motor nerves being chiefly 
 affected, the sensory nerves remaining almost un- 
 changed. When a case in which it has been 
 given is carefully watched, the following results 
 are noticed: i. Weakening of the convulsive 
 
48 
 
 movements, beginning at the lower extremities, 
 and extending upward over the trunk and upper 
 extremities, and last the head and face, with 
 finally a complete cessation of the movements if 
 a sufficient amount has been given; 2, slight di- 
 lation of the pupils and ptosis; 3, some impair- 
 ment of general sensibility; 4, heart slow and 
 full, respiration slow and labored; 5, combined 
 with sulphate of morphia, sleep follows, lasting 
 several hours; 6, if the convulsions are to return, 
 as the influence of the drug is lost, fibrillary con- 
 tractions, beginning above and passing dowuT 
 ward — that is, in the opposite direction from 
 what they ceased — and finally the general con- 
 vulsions are reestablished. This drug has been 
 given in small doses, gr. -rffT-^V. hypodermically, 
 and. repeated as often as indicated, the adminis- 
 tration being guided by the character of the res- 
 piration. It has usually been combined with 
 sulphate of morphine to produce sleep, and sul- 
 phate of atropine to act as a stimulant to the 
 respiratory and circulatory organs, and also at 
 times with digitalin and hyoscine. Only two of 
 the cases in which it has been used have termin- 
 ated unfavorably. In the first it stopped the 
 convulsions; but they recurred, and cerebral 
 haemorrhage complicated the case. In the second 
 case it was given, as were all the drugs mentioned, 
 the only measures attended with any success be- 
 ing the administration of ether and chloroform, 
 until there was complete muscular relaxation; 
 and in this case the patient died suddenly, while 
 
49 
 
 in a fit, from haemorrhage into the medulla. In 
 several of the cases, conine and a small amount 
 of morphine have been the only drugs used. 
 Although it failed to control the convulsions in 
 one case, yet it has been the most successful 
 method of treatment tried, and its results encour- 
 age us to believe that it will succeed in the ma- 
 jority of cases of status epilepticus. 
 
 2. The exhaustion of the patient gives the 
 second indication for treatment. In almost every 
 case of status epilepticus, before the convulsions 
 can be controlled there are evidences of physical 
 failure; the pulse is rapid and weak, the respira- 
 tion shallow and increased in rapidity, the tem- 
 perature raised several degrees above normal, 
 and a profuse perspiration covers the body, all of 
 which call for immediate treatment in order to 
 carry the patient through the dangerous period. 
 The condition of the patient usually prevents the 
 administration of food or medicine by the mouth, 
 although if introduced into the stomach they will 
 be retained. To fulfill this indication, we have 
 introduced two methods: i. The hypodermic use 
 of such agents as atropine, digitalin, spt.frumenti 
 and quinine sulph. ; and 2, the introduction of 
 milk, eggs and stimulants into the stomach by 
 means of the nasal and stomach tubes, on account 
 of the inability to swallow; artificial introduction 
 of food into the stomach being especially called 
 for in cases in which the stupid or excited periods 
 are of several days' duration. 
 
50 
 
 The conclusions drawn from this paper are as 
 follows: 
 
 1. On account of its association with epikpsy, 
 status epilepticus should not be considered a dis- 
 tinct disease, but merely a climax of the neurosis, 
 
 2. It consists of two stages: i. A convulsive, 
 and 2, a comatose, though the latter is some- 
 times replaced by a period of maniacal excite- 
 ment. 
 
 3. That there is no demonstrable lesion causa- 
 tive of the status. 
 
 4. That the prognosis is unfavorable. 
 
 5. That the treatment is in a measure symp- 
 tomatic, but considerable reliance can be placed 
 upon the hypodermic use of the hydrobromates- 
 of hyoscine or conine combined with the sulphate 
 of morphine. 
 
FUNCTIONAL BRAIN DEGENERACY. 
 
 BY J. T. SEARCY, M.D., 
 
 OF TDSCALOOSij ALA. 
 
 It is interesting to notice how much we are 
 given to the habit of grading and estimating oth- 
 ers in society. We are continually engaged in 
 this kind of work, and we consider the opinions 
 we have of our acquaintances and associates as 
 very valuable items of information. So intuitive 
 and instinctive is this kind of work that we do 
 it unconsciously, as it were ; and as soon as we 
 make an acquaintance, we find ourselves silently 
 estimating and classifying him. 
 
 The two particulars in which we generally con- 
 sider it very important to estimate others are, 
 first, their intellectual ability ; and secondly, 
 their ethical sense. We call these ' ' mental and 
 moral qualities," and recognize that they are 
 more or less distinct and separate. 
 
 In common with all other living beings, man 
 lives in competitive life ; and so fundamental and 
 continuous, from the earliest existence of life in 
 the world, has been the necessity of alertness 
 
52 
 
 and observation in order to survival and continu- 
 ance, that man, in common with all other sen- 
 tient beings, has acquired a constant sense of in- 
 security on account of rivalry. We are all born 
 with an instinctive knowledge of this fact. It 
 haunts us from our earliest consciousness, and it 
 follows us all through life. By highly advanced 
 and improved brain capacity, and by suppression 
 of rival species, man has so widened the distance 
 between himself and lower grades that, compar- 
 atively, he recognizes little danger from that di- 
 rection. His principal rival is his fellow-man. 
 
 It is this instinctive sense of insecurity on ac- 
 count of rivalry, that begets the instinctive habit 
 in us of grading and estimating our fellows. 
 
 We wish to know at once how formidable a 
 competitor our new acquaintance will prove, 
 hence we promptly grade him in intellectual 
 ability ; and we wish to know whether he will 
 conduct his competitions or associations with us 
 in accordance with established and advanced 
 rules of decorum and propriety — hence, with 
 equal promptness, we grade him in ethical sense. 
 
 By the long progress of practice, we have be- 
 come exceedingly expert in this kind of work. 
 Some boast they can frame an opinion from as 
 slender a foundation as expression of face, the 
 cut of the eye, the step on the pavement, the 
 iandwriting, the tone of voice, or style of dress. 
 Of course such expressions are exaggerations, 
 still they show how adept we have become, and 
 how much we value such information. 
 
53 
 
 As we estimate men in these particulars, we 
 grade them into types, from the lowest savage, 
 who is both very ignorant and very immoral, to 
 the highest civilized, who is both highly intelli- 
 gent and highly moral. Between these extremes 
 there is every conceivable grade, variety and 
 type. 
 
 In the gradual rise of man from the state of 
 savagery to that of civilization, his steady prog- 
 ress is occasioned by and marked by gradual im- 
 provement in both these particulars. There is a 
 steady improvement in him of intelligence, and 
 a steady improvement in him of ethical sense. 
 
 We readily recognize that the person who suc- 
 ceeds and excels is the intelligent one. He sur- 
 passes others in the competitions of active soci- 
 ety. Intelligence is very plainly a double quali- 
 fication. I would divide it into two parts : the 
 inherent brain- ability of the person to think — 
 intell igoncc , and the acquisitions he has made by 
 thinking — knowledge. . Ability to think is by far 
 the most important, and whatever tends to im- 
 prove or lower this qualification of the person 
 tends to raise or lower his amount of knowledge, 
 and his chances for success in the world. The 
 person with a high order of brain capacity can 
 and does acquire knowledge as the occasion re- 
 quires. By intelligence, therefore, I mean ca- 
 pacity to think and knowledge combined. 
 
 In the slow and gradual advance of man, 
 through generations, from a savage condition to 
 a highly civilized one, it is the gradually increas- 
 
54 
 
 ing necessities occasioned by the competitions of 
 a more and more complex society, that force him, 
 in order to avoid suppression and elimination, to 
 steadily improve his brain ability to think. The 
 elimination of those least fit in brain capacity, 
 and the survival of the more fit, is the natural 
 method of gradual improvement in humanity. 
 The original source of improved capacity and of 
 accumulated knowledge, that is, of intelligence 
 in the world, is therefore competitive life, and it 
 is very easy to trace back all varieties of intel- 
 lectual ability to the gradually acquired brain 
 capacity that has been the result of the struggles 
 for existence and for ascendency, carried into the 
 more and more complex and refined methods and 
 habits of advanced society. 
 
 As society advances, we notice that not only 
 is there an advance in intellectual qualifications 
 — in ability to think — but almost pari passu with 
 this line of capacity, there also is acquired an- 
 other habit of thought, namely, an ethical sense. 
 
 As soon as human society begins to grow com- 
 plex, then arises the public necessity that the 
 competitions of its membership shall be regulated. 
 Families, communities and races soon become 
 themselves aggregated into wholes, individual- 
 ized, because they become competitors with other 
 families, communities and races, and public good 
 demands that the internal rivalries of their mem- 
 bers shall be so harmonized and so adjusted to 
 each other as to subserve general welfare. Pub- 
 lic safety demands ethical observances, and a 
 
55 
 
 large proportion of the efforts and powers of so- 
 ciety are spent in the inculcation of rules of con- 
 ■duct that relate to public good ; in this the rules, 
 laws and government of society, with the moral 
 sentiment and public opinion that back them, as 
 men become intelligent, become of a higher and 
 higher grade, until those that harmonize and 
 adjust the associations and competitions of the 
 most advanced society are reached. 
 
 For these reasons the individual member of 
 advancing society, besides becoming by compet- 
 itive practice more and more capable intellectu- 
 ally, at the same time, becomes more and more 
 habituated in the performance of ethical obser- 
 -vances. The habit of adjusting conduct ethi- 
 ■cally, that is, according to established rules of 
 society and the rights and wishes of others, be- 
 comes more and more fixed as a trait of character. 
 
 My object in this sort of observation is to draw 
 attention to the fact that the tests by which we 
 grade and classify our fellows — their intellectual 
 and ethical abilities — are the results of the grad- 
 ^lal practice and exercise to which men have been 
 submitted through generations on generations of 
 advancing, developing existence. 
 
 A most advanced man, therefore, is he who 
 las such intellectual ability to think, that he can 
 so understand the complexities of advanced soci- 
 ety as to be able to formulate arid promulgate the 
 highest and best rules of conduct, and has such 
 an ethical habit inherent in him that he holds 
 
56 
 
 true by an educated conscience in the observance 
 of tbem. 
 
 The highest type of man, in short, is he who 
 has the highest intellectual sense, coupled with 
 the highest ethical sense. 
 
 Brain strength, like muscle strength, is the 
 result of previous practice and exercise. All- 
 round ability is the result of all-round work, and 
 specialized accomplishments are the results of 
 special kinds of practice. In brain-work, as in 
 muscle-work, the exercise, in order to be im- 
 proving, must reach the degree of being effort. 
 Unless there is a constant sense of effort in mus- 
 cle-work, muscle strength does not improve ; the 
 same is the case in brain- work. Brain work is 
 therefore necessary in order to continue brain ca- 
 pacity; and in order to raise the level of capacity, 
 increased effort is necessary. Previous activity 
 alone produces capacity; continued activity alone 
 continues capacity ; and increased activity alone 
 increases capacity. 
 
 The previous activity that produces capacity 
 is either ancestral or individual. In biological 
 descent the individual only represents one link 
 in a chain of activity. ^The person gets his abil- 
 ity from the line of his ancestry — receives it at a 
 certain level, and maintains or raises it solely by 
 his own activity. Heredity means no more than 
 the continuance in the line of the habits of ac- 
 tion established in the ancest«» Of the two 
 elements of intelligence which I have mentioned, 
 viz.: capacity to think and knowledge, capacity 
 
57 
 
 is inherited, knowledge is not. Knowledge has 
 to be acquired, but by far the greater part and 
 the best part of the capacity is inherited from 
 ancestry, and is the result of previous ancestral 
 brain exercise. 
 
 Brain abilities are not constant qualities; they 
 vary in the life of the person and in the line of 
 descent according to habits of thought. Prac- 
 tice alone produces ; practice alone continues ; 
 and increased practice alone increases brain abil- 
 ities. 
 
 According to these rules, our high-grade intel- 
 lectual person is the result of previous ancestral 
 and individual intellectual practice, and is, at 
 the same time, ethical to a high degree, because 
 of high-grade ancestral and individual ethical 
 practice. The highest type of man, the one 
 highly intelligent and highly ethical, is solely 
 the result of the practice of both these kinds of 
 brain work, and can occur only in that sort of 
 advanced society which has been active and in- 
 dustrious, so as to have necessitated brain activ- 
 ity on the part of its members, and in that sort 
 of society where the study and observance of 
 high ethical rules are a constant practice. 
 
 No community, no matter how civilized, is 
 uniform in its membership ; we can find low 
 types of men everywhere. In the most advanced 
 society its membership will grade from the high- 
 est type — highly intelligent and highly ethical, 
 to the lowest — very ignorant and very immoral. 
 Brain abilities are not constant qualities. There 
 
58 
 
 is no constant level of capacity; it rises and falls 
 according as the brain is practiced or not prac- 
 ticed. 
 
 While, therefore, we may state that activity 
 improves capacity, we can with equal accuracy 
 assert that inactivity lowers capacity. Much — 
 probably most — of tbe impaired or lowered brain 
 capacity in society comes from brain idleness. 
 Functional capacity begins at once to lapse if 
 functional brain activity is abated. We witness 
 this on all sides : whatever conditions, due to 
 wealth or poverty, conduce to lessen functional 
 brain work, tend to impair intellectual capacity 
 to think, and the ethical sense to do right. In 
 the idle wealthy ranks and in the idle poor ranks 
 we find most degeneracy. The active, indus- 
 trious middle class carry the main current of 
 improvement. Improvement is only found where 
 there is activity, and degeneracy is always an 
 accompaniment to idleness. Society sloughs off 
 at its two inactive idle extremes. , If you study 
 the conditions that lead to brain work on the 
 one hand, and those that lead to a cessation 
 from brain work on the other, you have much of 
 the secret of improvement and of degeneracy, in 
 the individual, in the family, in the community, 
 and in the nation. There is in this way a very 
 ready, because a very physiological, explanation 
 of much that otherwise is strange and diflBcnlt to 
 understand. Families lapse from wealthy posi- 
 tions into poverty in the course of one or two 
 generations, because the necessities for brain 
 
59 
 
 ■work having been removed, degeneracy comes 
 ■with the condition of inactivity. Races and 
 nations readily follo^w the same course. A very 
 large proportion of the incompetent and the 
 ■vicious elements of society is made up of the 
 lapsed members — of those whose lines of capacity 
 point downward. Almost every family can be 
 said to be tending towards survival or towards 
 elimination, and the cause of their tendency can 
 be readily learned by observing whether their 
 brain habits are active or inactive. 
 
 The competitions of active, industrious society 
 determine the levels of its members. The incom- 
 petent poor classes become poorer, occupy unfa- 
 ■vorable and unhealthy positions, and eliminate 
 rapidly; while wealth induces idleness and de- 
 generacy, and consequent inability to add to, or 
 to even hold to the property that parental or 
 "ancestral capacity may have provided ; in time 
 the rich disappear, or ' ' the top rail goes to the 
 bottom, " to be eliminated in the poor ranks. In 
 •our rapidly changing American society, it is 
 ■very common to find in the second or third gen- 
 eration the relics of once wealthy families, unable 
 now to compete successfully for a living because 
 of degeneracy in intellectual ability, and with 
 ethical habits alongside the very lowest. 
 
 I have probably said enough to warrant the 
 statement that brain activity alone induces brain 
 capacity, and that brain inactivity induces brain 
 incapacity. 
 
 In this observation, we notice that there is 
 
6o 
 
 only one way of improving capacity, namely, by 
 activity; but when we turn to the converse prop- 
 osition, we recognize there are several ways of 
 lowering it. Inactivity, I have said, induces 
 most of the incompetency, but it does not pro- 
 duce all. It does it by impairing the brain's 
 ability; but the brain's ability is also lowered by 
 whatever else, in any other way, impairs or in- 
 jures its structure. Functional capacity depends 
 upon structural integrity. Any defect, injury or 
 disease of the brain lowers its capacity ; and we 
 judge the pathological disability by the same 
 tests that we use in grading physiological disa- 
 bility; that is, we witness there is always more 
 or less impairment in intellectual and ethical 
 capacities in brains pathologically impaired. In 
 all our insane asylums we find persons who once 
 were graded high in intellectual and ethical 
 abilities, now sadly lowered in both these quali- 
 fications. We estimate the insane by the same 
 tests we estimate the sane. In a large majority 
 of cases the decision is easily made. It is only 
 in those cases when the insane degree of disabil- 
 ity is not yet quite reached, but is approaching, 
 and it is necessary to anticipate it, and in those 
 cases when the disability is transient and ques- 
 tionable, that the expert is required. 
 
 The methods of brain degeneracy I have thus 
 far mentioned are, foremost and principally, brain 
 idleness, and next, those pathological conditions 
 which are the results of disease, injury or defect; 
 but there are other causes at work in society, by 
 
6i 
 
 some not recognized or classed as pathological, 
 which question I won't stop to discuss ; and 
 these causes, in my opinion, are very potent — 
 probably, next to brain idleness, the most potent 
 in modern brain degeneracy. I allude to the 
 widespread and abundant use of brain drugs, the 
 principal one of which is alcohol. Next to 
 brain inactivity, I believe brain injury with 
 drugs, especially alcohol, produces most modern 
 brain degeneracy. In proportion as the amount 
 of alcohol in the circulation is increased, in addi- 
 tion to a lessening of sensibility, we witness a 
 gradual lessening of intellectual ability. This 
 declines through descending stages from the 
 condition in which we describe the person as a 
 "little off," intellectual capacity slightly low- 
 ered, judgment and accuracy of thought slightly 
 defective, to that condition where there is entire 
 loss, and the man is a temporary dement. 
 
 In proportion, too, to the amount of alcohol 
 taken, we witness ethical ability to be lowered, 
 and the cerebral disability in this particular will 
 be exhibited in descending stages, reaching from 
 slight loss of the sense of propriety and decorum 
 to that condition in which the person is such a 
 nuisance, or is so degenerous to his associates, 
 that he reaches the degree of temporary mania, 
 and has to be restrained. 
 
 These effects of alcohol upon the brain will 
 vary in different persons. Callous brains exhibit 
 impairment to a degree than more sensitive ones; 
 low grade brains reach the savage level sooner 
 
62 
 
 than highly advanced ones, and defective, injured 
 or diseased brains exhibit their failures in the 
 lines of their deficiences. 
 
 The length of time, also, that the alcohol use 
 is continued increases the degree of disability. 
 A single debauch can be readily recovered from, 
 but long-continued use leaves such impairment 
 that only in rare cases does complete recovery- 
 ensue. 
 
 Sometimes we have these conditions all super- 
 vene in the same person; that is, we have a con- 
 siderable quantity taken by a brain already weak 
 or defective, and the drinking is continued a long- 
 time. This is the case with the majority of those 
 whom we call inebriates. In a majority of cases 
 the brain of the inebriate is originally low- grade, 
 and nothing could be done to more effectually 
 lower its capacity still further. But it matters 
 not whether there is original weakness or not, a 
 sufficient quantity, long continued, will bring^ 
 down, in intellectual and ethical capacity, the 
 most advanced brain to the level of the lowest. 
 Whenever an idle, incompetent brain is rendered 
 still more incompetent by the chemical effect of 
 a drug, degeneracy and the consequent elimina- 
 tion of the person and his lines of descent is 
 rapid indeed ; and this happens not nearly so 
 much by the injury to other structures and 
 organs of the body, so as to induce death direct- 
 ly, but, because the injury to the brain places 
 the person, by his loss of intellectual and ethical 
 capacity, in unfavorable, poor and vicious sur- 
 
63 
 
 roundings and indirectly causes the elimination 
 of himself and his line. 
 
 Brain injury with drugs produces a great deal 
 of modern brain degeneracy, and, in connection 
 with brain idleness, is an exceedingly rapid elim- 
 inator in society. The popular and indiscreet 
 use of alcohol, nicotine, opium, and similar 
 drugs, is a very potent factor in modern degen- 
 eracy. 
 
 The application of the above principles to the 
 explanation, on the one hand, of success and sur- 
 vival, and on the other, of failure and elimina- 
 tion, is very interesting. 
 
 We are very apt to lose sight of the rapid rate 
 of human elimination. What is a possible or 
 normal rate of increase is never reached by any 
 people; causes of elimination are constantly at 
 work to keep the increase below the normal rate. 
 If every human female who is born reached adult 
 life, and bore a reasonable number of children, 
 directly, there would not be standing-room in the 
 world. The grade of brain ability, as I have 
 said, is the factor that, more than anything else, 
 determines a person's position in the world ; and 
 a physiological consideration of the causes that 
 lead to increase or decrease of these faculties is 
 seldom heard ; yet it is a most rational way of 
 dealing with the subject. 
 
 Before I close, I think it will prove interesting 
 if I apply some of the physiological principles I 
 have been enumerating to a broader field, and as 
 briefly as possible show how the rise and fall of 
 
64 
 
 races run on the same principles that individu- 
 als rise and fall in society. 
 
 A race is an aggregate of similar individuals 
 — or, more properly, of similar lines of descent. 
 What determines the grade of a race is the level 
 of the aggregate capacity of these lines. The 
 centre of the aggregate potentiality of the race, 
 in the progress of its social dynamics upwards or 
 downwards, varies as an individual's ; with, of 
 course, less sudden variations, because of the 
 overlapping of generations — still it never, or sel- 
 dom long, remains at the same level. Just as 
 much as with the individual, it takes continuous 
 activity to keep up capacity in the race, and in- 
 activity lowers capacity. 
 
 We often hear it stated that a race or nation 
 degenerated because they forgot the instructions 
 or accumulated experiences of their forefathers. 
 The forgetting or the not heeding had very little 
 to do with it. The records of the accumulated 
 experiences of a race's previous history are al- 
 ways abundant, and the alarmed, but gradually 
 thinning ranks of their leaders are continually pro- 
 claiming and preaching and teaching them; but 
 the secret of their gradual decline in prestige and 
 power, and comparative influence among other 
 races, lies, as is often the case with the individual 
 in society, in gradual abatement and stopping of 
 previous brain industry and activity. An active 
 race soon reaches a stage of comparative excel- 
 lence and wealth and power, so as to be relieved 
 of the immediate competitive necessity for con- 
 
65 
 
 tinued exertion. When this is the case, it is just 
 as much " human nature " in the aggregate of 
 individuals, as in the single individual, to stop 
 further exertion and exercise. 
 
 The ancient Semitic races, who once inhabited 
 western Asia and ancient Egypt, and who long 
 antedated the Aryans of Europe in civilization, 
 grew powerful first and then rich, stopped activity 
 and declined in excellence. 
 
 It matters not whether you locate the origin of 
 the Aryan races in the centre of Asia or in cen- 
 tral Europe, as is more recently advocated ; when 
 first known, they were an active, combative, com- 
 petitive people in Europe, considered by the an- 
 cient Assyrians, Phonicians and Egyptians as 
 barbarous and semi-civilized. Those Aryans who 
 occupied the peninsulas of ancient Greece and 
 Italy, caught up first the civilizations of Asia and 
 Egypt, because they were nearest to them. An 
 active, progressive, advancing race, like the in- 
 dividual, is acquisitive of knowledge as well as 
 wealth, They learned from their advanced neigh- 
 bors, and by activity themselves became powerful 
 in knowledge and resources ; then conquered and 
 plundered the old Semitics, and rose to be the 
 excellent and leading races of Greece and Rome. 
 Greece, the one nearest to the Semitics, improved 
 first and declined first. 
 
 In time, the same physiological processes took 
 place with the people of Greece and Rome. They 
 waxed "comparatively excellent, the necessity for 
 further exertion was relieved, and they turned 
 
66 
 
 the pinnacle of excellence and began the decline 
 of the other side because of brain degeneracy— 
 not because they had not the accumulated wisdom 
 and wealth of the world, but because the aggre- 
 gate of their brain capacity lowered in level for 
 the want of the continued brain practice and ex- 
 ercise necessary to keep them up. The aggregate 
 capacity of the nation to think and to act 
 ethically declined. 
 
 Defended by the mountains to the north of 
 them from their kindred Aryan races of central 
 Europe, and having thoroughly demolished the 
 races south of them, the Empire of Greece, and 
 of Rome particularly, had abundant time of idle- 
 ness and inaction to become thoroughly degener- 
 ate ; so, when the hordes from the north poured 
 over the mountains, these empires sank easily. 
 The darkness that followed the submergence of 
 these ancient civilizations, was for a time so com- 
 plete and dense, because the Goths and Vandals 
 were themselves not able to appreciate and appro- 
 priate the civilizations that they destroyed. They 
 conquered Rome too soon, before they were them- 
 selves ready for it. "The dark ages " were the 
 result ; and if it had not been for the Arabs in 
 Alexandria, who worked round the coast of 
 North Africa, and into Spain, keeping up the 
 lamp of civilization, with the help of the Jews 
 and Greeks they imported to teach them, the 
 light of civilization would have been almost to- 
 tally submerged. The Moors of Spain took event- 
 ually the same old routine course, before the 
 
67 
 
 gradually improving Aryans of central Europe ; 
 in their turn became rich, inactive, and disap- 
 peared. 
 
 Those Aryan nations of Europe who to- day 
 hold their positions of highest excellence in the 
 world, have solely reached their eminence by 
 their improved brain abilities — the result of gen- 
 erations on generations of advancing brain prac- 
 tice. 
 
 A semi-civilized king of Asia or North Africa 
 may think in his visit to London, if he had all 
 the wealth and vast material resources of Eng- 
 land transported to his country, his would be a 
 nation equally as great. Nothing is more mis- 
 taken. The only way for his people to reach the 
 proud eminence of excellence of the British Is- 
 landers, is for them to have gone through the 
 same long processes of industrious, persevering, 
 high- ordered brain practice, similar to that 
 through which these people have passed. It is 
 the work of generations, and cannot be donated 
 in a day. 
 
 In this connection, it is interesting to notice 
 to what degrees and at what levels the different 
 savage, barbarous, semi-civilized races of the 
 world have appropriated the civilization of Eu- 
 rope, as it has, in the intercommunication of 
 modern commerce and travel, and by teachers, 
 been conveyed to them. There are hundreds of 
 illustrations in the world of the fact, that a low 
 grade race accepts and runs advanced civilization 
 just at the level of their inherent ability. A 
 
68 
 
 singular observation, connected with this fact — 
 often some test of competitive ability, in war for 
 instance — is necessary to show the superiority of 
 the advanced race to the inferior one, so as to 
 make it ready to appreciate and learn. 
 
 The inhabitants of the Pacific and Indian 
 Ocean Islands are good illustrations of these 
 principles. Those inhabitants, who by ethno- 
 logical tests show themselves to be descendants 
 of the more advanced races of Eastern Asia, have 
 appropriated civilization at more rapid rates than 
 those types similar to the races of Southern 
 Asia and Africa. At one extreme, we may men- 
 tian the notable examples of the Sandwich Is- 
 landers and the Hoovas of Madagascar, both of 
 Eastern Asia types ; and at the other extreme, 
 the Andaman Islanders and the inhabitants of 
 Tasmania and New Zealand, of African type. 
 Of the Eastern Asiatics, the Japanese exhibit, 
 in all particulars, more activity, and consequent- 
 ly more progressiveness, than tne Chinese, the 
 Malays or Burmah races. The ancient civiliza- 
 tions of these races were among the first in 
 the world, but, in the case of the Chinese par- 
 ticularly, the rigidity of too crowded a popula- 
 lation suppresses improving activity. 
 
 I could take the range of the world to illus- 
 trate these principles, but have not the time. It 
 may prove more instructive to come closer home. 
 
 In America we have three very distinct types 
 ■of men^the Indians, the Africans and the Euro- 
 pean whites. 
 
69 
 
 It is a remarkable fact, low-grade races melt 
 away and disappear in the presence of the more 
 advanced ones. In modem times they are not 
 exterminated by war; very few are killed out ; 
 still, they rapidly disappear. Whole tribes con- 
 tiguous to the English and European colonies 
 in Africa have disappeared, and in Australia 
 they are melting away like our Indians. The 
 last Tasmanian has been said recently to have 
 died, and- the English government, out of sym- 
 pathy, has recently been gathering together the 
 few natives of New Zealand as ethnological curi- 
 osities. 
 
 When an advanced race, as the Europeans in 
 America, for instance, occupy the country of a 
 low-grade race, and attempted to force them to 
 assume the methods of civilization, the change 
 of the brain habits of thought is too sudden for 
 the inferior race to assume. In civilized society, 
 as I have shown, persons of low intellectual and 
 ethical abilities occupy the eliminating grades. 
 To force an inferior people, never practiced or 
 trained in the habits of industrial competitive 
 thought, into the ranks of a civilized race, is 
 equivalent to forcing them into the eliminating 
 grade of that society. The Indians have no- 
 where been able to enter into industrial competi- 
 tive life with the Europeans and survive, but, 
 wherever it is attempted, they simply asstmie the 
 position they are capable of taking ; in common 
 language, they become poor and vicious, and 
 are eliminated along with the eliminating whites. 
 
70 
 
 The vice of civilized society, to which they take 
 with avidity, is alcohol drinking ; and nothing 
 contributes more rapidly to increase their incom- 
 petency and viciousness. As with low- grade 
 individuals in advanced society, alcohol is a 
 most rapid eliminator of low-grade races. The 
 general government, in its management of the 
 Indians, finds it has to prevent their access to 
 alcohol, and the missionary among them, in his 
 endeavors to arrest the current of their downward 
 degeneracy, finds his efforts futile, if drink is 
 allowed. The elimination of the Indian races is 
 due principally to these causes; first, it is impos- 
 sible for the Indian to assume so suddenly the 
 habits of civilized thought which are necessary 
 in order to prevent elimination. For the same 
 reasons the hyena and eagle in confinement be- 
 come unprolific and defective in descent, so does 
 the Indian ; and he often adds rapidly to his 
 degeneracy by drink habits. 
 
 When the Spaniards discovered America, they 
 set out at once to enslaving the Indians. They 
 did this first on a large scale in the West Indies, 
 by the hundreds of thousands. The sudden 
 change of brain habits was so severe and extreme 
 that these races exterminated excessively. To- 
 day there is hardly a relic to be found. They 
 proved so unsuitable for slaves, the Spaniards 
 had soon to import Africans. 
 
 The Africans, from the remotest antiquity, 
 have been preyed upon by other races for slaves. 
 From the eastern side of the continent, next to 
 
71 
 
 Asia, they have been raided most, and are still 
 so to-day, On the west coast, whence America 
 received her slaves, they had been before that 
 for thousands of years unmolested and least 
 mixed with Asiatics. They had, among them- 
 selves, varied to some extent into grades, accord- 
 ing; to activity, climate and surroundings. The 
 lowest types of men in the world were found 
 among them, while some were somewhat ad- 
 vanced. The characteristic that rendered them 
 suitable for slaves was, they were passive in dis- 
 position, and would bear pressure and moulding. 
 After African slavery had begun in the West 
 Indies, it was soon extended to the continent. 
 
 The two hundred years that slavery continued 
 in the United States under its extreme artificial 
 conditions, it exerted powerful modifying influ- 
 ences upon both the Africans and their European 
 masters. 
 
 The Africans, for four or five generations, un- 
 derwent forcible practice in very much more 
 advanced brain activity than they ever performed 
 before. The African, originally, with very mod- 
 erate exceptions an abject savage, was rapidly 
 made to assume the language, dress, customs and 
 conventionalities of the whites, and practice 
 their habits of thought as far as he was able to 
 understand and imitate them. Each one may be 
 said to have had a private tutor of his own. It 
 is true, the master's interests directed and largely 
 controlled their brain practice; selfishly, in many 
 cases, he directed his slave's habits and labors ; 
 
72 
 
 still, involved in all such work, was brain exer- 
 cise of a higher order than the African ever prac- 
 ticed before. His muscles were exercised, hi& 
 food directed, and his improved sanitary condi- 
 tion brought his average general health to a. 
 higher level. At the time of their emancipation 
 there could not, in my opinion, have been found 
 in the world six millions of people, in a body, to- 
 excel the American slaves in three essential par- 
 ticulars — general healthfulness, prolificness, and 
 sobriety. These excellences were the results of 
 two or three hundred years of artificial selection 
 and improvement. In brain work, higher intel- 
 lectual and ethical practice and instruction was- 
 the result of simple association with the whites, 
 as well as the result of direct efibrts on the part 
 of the whites to improve them. The. selfish in- 
 terests of the whites dictated, probably, most of 
 their efforts ; still, some were incited by the 
 highest altruistic motives. Upon the whole, the 
 American negro emerged from slavery improved 
 above his original grade in intellectual and eth- 
 ical capacities; and his was an example of more 
 rapid advancement than has ever been witnessed 
 before in such a type of people in such numbers. 
 The national processes of improvement by- 
 activity, and of deterioration by inactivity, had 
 obtained to some extent among the tribes of 
 Africa, which made slight variations in the types- 
 imported as slaves, and probably still hold in 
 the grades among them; but the artificial and 
 forcible influences which obtained all during 
 
73 
 
 slavery, by training, association and education, 
 and are still continuing, in the efforts made to 
 improve and govern them, together with mis- 
 cegenation, have tended to advance some few 
 lines toward comparative ability to compete, and 
 toward continuance and survival; but the large 
 majority are taking their natural level in the 
 eliminating grades of society, and prove an incu- 
 bus upon the country's progress. The race is 
 certainly letting down in the three particulars in 
 which they excelled — of healthfulness of sys- 
 tem, of prolificness, and of sobriety. Among 
 those, braced up by, and floating along with, the 
 currents of activity established and maintained 
 by the whites, most examples of improvement 
 are found. But in these sections, where they 
 are in large majorities, and left to their own ex- 
 ertions, intellectual and ethical deterioration is 
 very apparent. Statistics show very rapid elim- 
 ination of them in the towns and cities, where 
 competitions with the whites force them into 
 most unfavorable surroundings. 
 
 That the negro, in the South, is seen to fill 
 the prisons, the police courts and the peniten- 
 tiaries is an exhibition of a natural condition ; 
 he is living under a civilization and a code of 
 laws that he is not able himself to formulate or 
 maintain. He fails ethically, as well as intel- 
 lectually, in larger proportions than the whites, 
 because he is not as capable in maintenance of 
 the kind of activity his surroundings demand. 
 
74 
 
 But I have not the time to pursue this question 
 further. 
 
 It- is only necessary, generally, in the case of 
 the European whites in this country, to apply 
 these pri&ciples, to have ready solutions of the 
 changes going on in our diflFerent communities 
 and in our national society. The wholesale im- 
 portation of the degenerating classes of the old 
 world is having a most deteriorating influence 
 tipon our national, intellectual and ethical level. 
 As the good of society feels the fluctuations in 
 the ethical currents first and most, we can see 
 the deterioration, even in high places, due to 
 this influence. Brains degenerated in capabili- 
 ties, by the rigidity of the strata in European 
 society, which prevents all kinds of activity, 
 •except muscle drudgery, are filling our land 
 faster than the three or four generations neces- 
 sary to elevate them can counteract. We have 
 not yet invented a cerebral dynamometer by 
 -which we can quickly test a man's intellectual 
 ability and his ethical strength. Such a test, 
 "however, is sadly needed. Persons who fall below 
 A certain level in these two essential qualifica- 
 tions ought not to be allowed to enter the coun- 
 try, no matter whether they haU from Europe, 
 Asia or Africa. 
 
 In conclusion, I insist I have been on purely 
 physiological and professional ground all the 
 ^way in this discussion. The corrollaries I would 
 4iraw from it are: 
 
75 
 
 1. Brain capacity is solely the result of ances- 
 tral and individual brain practice. 
 
 2. The test of these qualifications are the 
 grades of intellectual and ethical abilities, usu- 
 ally determined by the level the individual, the 
 family or the race occupies in competitive life. 
 
 3. Degeneracies of brain ability are occasioned 
 by brain inactivity, which is the principal meth- 
 od of deterioration ; but whatever injures the 
 brain structure impairs intellectual and ethical 
 ability, whether it be traumatism, disease or 
 defect, or abuse with drugs. 
 
 4. A great field for the highest order of public 
 sanitation is open in this direction, heretofore 
 almost wholly unoccupied by our profession. 
 
 In discussion Dr. Herdman, of Michigan, said: 
 I, for one, feel like congratulating the -mem- 
 bers of the Section upon the privilege of listen- 
 ing to such a philosophical paper as has just 
 been read. It seems to me to have presented 
 topics eminently appropriate for consideration ' 
 by this Section. It is a deplorable fact, disheart- 
 ening oftentimes to the neurologist and alienist, 
 that many of the diseases with which he has to 
 deal in his daily practice are, in the individual, 
 incurable ; but little can be done for them in one 
 generation. The causes and influences that have 
 been at work in bringing about the pathological 
 change are inherited from the ancestor ; are the 
 fruit of bad social customs, of imperfect methods 
 of education. 
 
76 
 
 The work of the neurologist, therefore, as a 
 student of brain deterioration, carries him beyond 
 the immediate to a study of remote causes, which 
 are the chief factors oftentimes in producing the 
 result in the individual he is called upon to treat. 
 Upon us rests the responsibility of pointing out 
 these far-reaching influences, and herein is the 
 most encouraging field for the exercise of our 
 talents as promoters of the welfare of humanity. 
 
 It is true, as has been clearly set forth in the 
 paper, that man, in his evolution to the point of 
 greatest efl&ciency, can only attain that end by 
 healthful exercise of every faculty. Man's con- 
 stitution is a trinity composed oi physical, mental' 
 and moral faculties. • The perfect man is the 
 product of these three acting harmoniously and 
 carried to the degree of their highest possible 
 devslopment. They constitute a tripod on which 
 the superstructure, when symmetrically built, 
 rests securely. And in the process of develop- 
 ment toward the perfect man no one of the three 
 pillars, upon which the final result depends, can 
 be ignored. To neglect the physical, the mental 
 or the moral faculties of his nature ; to cultivate 
 one at the expense of the other; to fail to observe 
 the interdependence of the one upon the other, 
 will produce a greater or less degree of deformity, 
 and not the perfect man. The central nervous 
 system is the organism upon which the develop- 
 ment of these faculties depends, and by means 
 of which they find expression. The growth of 
 the normal structure and function go hand in 
 
77 
 
 hand. What then, we should ask ourselves, are 
 the causes, the influences at work in the race and 
 in society; what are the conditions necessary for 
 obtaining perfection in the harmonious develop- 
 ment of man's threefold nature? 
 
 These are legitimate subjects for the thought- 
 ful consideration and research of every physician 
 who attempts to enlighten his fellow- man as to 
 the laws to which his nature is subjected, and 
 the forces that afiect his well-being in its entire- 
 ty. And such responsibility rests upon the neu- 
 rologist and alienist, perhaps to a greater degree 
 than upon any other class of practitioners of the 
 healing art. In him do we expect to find a store- 
 house of all truth, so far as discovered, which 
 has a bearing upon the evolution or dissolution 
 of man's brain. What then is the value of the 
 discussion of this or that agent in the pharma- 
 copoeia in some particular disease, as compared 
 with a study of these principles, which underlie 
 an entire class of pathological conditions ? 
 
 There is at the present time a strong convic- 
 tion among neurologists, which is shared by oth- 
 ers in the medical profession and by thoughtful 
 men and women among the laity as well, that the 
 man addicted to the use of alcohol in excess is a 
 sufierer from disease ; that his brain has under- 
 gone functional, if not structural, change, which 
 renders him as incapable of self-control as the 
 idiotic or the insane, and that this condition of 
 irresponsibility is not confined alone to those 
 times when his blood is saturated with alcohol 
 
78 
 
 from recent indulgence or debauch — but that 
 during the intervals of drunkenness he is inca- 
 pable of acting as a sane man, and should there- 
 fore be dealt with, not as a criminal to be turned 
 over to the police only in some fit of bacchana- 
 lian excess, but is at all times, until pronounced 
 cured by competent judges, a fit subject for the 
 hospital or the asylum. 
 
 This and other social problems of no less im- 
 port and wide-reaching applications, come within 
 the legitimate range of our purpose ; are rather 
 the most vital questions for discussion by the 
 members of this Section, and the paper which 
 has just been read points out the road along 
 which, as a company of specialists, we can do 
 the greatest good to our fellow-men. 
 
 Dr. Hughes said he desired to express his ap- 
 preciation of the worth and excellence of the 
 paper. He was glad to see papers of this kind 
 brought before the Section. Formerly physio- 
 logical psychology was a subject that emptied 
 the room, but this to a great extent had been 
 changed by Maudsley and Spencer. These wr ^' 
 ers had attracted general medical attention. Pa- 
 pers of this kind will do much to settle' psychical 
 hygiene for both the individual and society. 
 
THE VIRILE AND OTHER NERVOUS 
 REFLEXES. 
 
 BY C; H. HUGHES, M.D., 
 
 OF ST. LOUIS, 
 PROFESSOR OF NEUROLOGY IN MARION-SIMS COLLEGE OF MEDI- 
 CINE, HONORARY MEMBER OF THE BRITISH MEDICO- 
 PSYCHOLOGICAL ASSOCIATION, ETC. 
 
 In a previous communication on this subject 
 {vide Alienist and Neurologist ior 'i&nn.airy, 1891), 
 I have called attention to the fact that in a per- 
 fectly healthy individual, whose spinal cord is 
 entirely normal, especially in its genito- spinal 
 center, placed supine on a couch without head- 
 rest, nude about the loins, the sheath of the 
 penis made tense by clasping the foreskin with 
 the left index finger and thumb at about the 
 place of the fraenum, and pulling it firmly toward 
 the umbilicus, placing the middle, ring and little 
 finger low down upon the dorsum of the virile 
 organ, the dorsum or sides of the penis, near the 
 perineal extremity, then sharply precussed, a 
 quick and very sensible reflex motor response or 
 retraction of the bulbo-cavernous portion will be 
 felt to result from this sudden percussional im- 
 
8o 
 
 pressioD, like that which follows, though less 
 pronounced, in the testicles, after sensory irrita- 
 tion of the inner aspect of the thighs, and known 
 as the cremasteric reflex, with this difference 
 only, the cremasteric reflex is a sudden upward 
 moyement of the testicle of the side irritated, 
 while the virile reflex is a sudden downward jerk. 
 While this reflex, like all reflexes with which I 
 am familiar, is away from the irritating afferent 
 impression, it is in marked contrast with the 
 patellar tendon phenomenon in being away from 
 the heart instead of toward it, as so many reflex 
 movements are. It differs from the ordinary 
 penile erection, and must not be mistaken for it 
 (for it cannot properly be called an erection) in 
 this respect, too, viz., that it is downward, and 
 not upward, and proceeds always from a periph- 
 eral and external irritation; whereas, erections 
 more often proceed from direct central (cerebral) 
 impression proceeding downward and outward. 
 
 Its action corresponds to the oesophageal re- 
 flex, or reflex for swallowing. 
 
 This reflex symptom is of important clinical 
 and physiological significance, as will later on 
 be shown. 
 
 I have called it the virile reflex, because I 
 think, if properly sought for, it will be actively 
 ■present in all healthy adult males with normal 
 spinal cords ; at least, I have so found it in all. 
 It is absent in infants, and feeble or absent in 
 male children who have not attained the age of 
 puberty. 
 
8i 
 
 A number of years ago I ventured the asser- 
 tion that the absence of the cremasteric xeflex 
 would be found of significance in the determiaa- 
 tion of impaired virility from sexual excess or 
 masturbation. This, subsequent experience has 
 only confirmed. Now this new sign— the virile, 
 the penis percussion reflex, or, as M. Ounanoff 
 calls it, the bulbo cavernous reflex — present, im- 
 paired or absent, gives us another valuable evi- 
 dence of the vigor, impairment, loss or abeyance 
 of the sexual powers in man. 
 
 After prolonged excessive venery it becomes 
 impaired or disappears, to return again with 
 sexual recuperation. 
 
 After excessive masturbation, long continued, 
 with accompanying neurasthenia, I have found 
 it impaired, but seldom entirely absent in young 
 subjects. It is not impaired in masturbation 
 when the habit has destroyed the sexual power. 
 It disappears in some cases of chronic meconism, 
 and becomes abeyant in long and beastly intoxi- 
 cation, though often excitable in acute alcohol- 
 ism. This subject needs further investigation. 
 
 It is lowered and abeyant in the later stages 
 of typhoid fever, and I have found it also in the 
 moribund state. I have found it absent in old 
 men who have acknowledged and sought treat- 
 ment for entire virile incapacity. 
 
 It is often, but by no means uniformly, found 
 in sympathy with the other reflexes in spinal 
 cord disease of the lumbo-dorsal spine, as the 
 quadriceps extensor femoris tendon reflex, the 
 
82 
 
 anal, vesical and cremasteric reflex, the Achilles 
 reflex; ankle clonus, etc. 
 
 This phenomenon may also be elicited by sud- 
 denly jerking the foreskin after it has been made 
 tense, or by pinching the theca of the penis when 
 it is in this stretched condition. This reflex 
 may be reinforced like the knee phenomenon, but 
 by a difierent process, viz., the frictional excita- 
 tion of the glans and body of the organ by means 
 of a brush, or brushing it briskly with a piece 
 of paper. It may also be evoked by electrical 
 excitation, a kind of clonus sometimes appearing 
 after this form of irritation. As I said in my 
 first communication, some skill in palpation — a 
 sort of tactus eruditus — is necessary in examin- 
 ing for this sign, the characteristic jerking back 
 of the bulbous urethra within the sheath of the 
 penis being felt only when carefully sought for. 
 It is not ordinarily to be seen. 
 
 I have found the sign absent in cases like the 
 following : Pupils unequal, patellar reflex exag- 
 gerated, and other evidences of sclerose in 
 plaques, with history of syphilis, and acknowl- 
 edged feeble virility, and diagnosis by a compe- 
 tent ophthalmologist of optic- atrophy. I believe 
 it will be found to be quite generally absent when 
 there is optic atrophy, unequal pupils, and other 
 evidences of cerebral sclerosis, or multiple cere- 
 bro-spinal disease of this nature. I have found 
 this sign absent in the status epilepticus, but not 
 necessarily modified in hemiplegia, and exag- 
 gerated in cerebral paraplegia. 
 
83 
 
 The following clinical records, made since my 
 first report on this subject, add additional confir- 
 mation to the significance of this sign : 
 
 Case I. — Mr. J. B., aged 23, single, locomotive 
 fireman, first presented himself for treatment at 
 my office July 11, 1891, when I obtained the fol- 
 lowing history : Some three years ago, in alight- 
 ing from his locomotive running at the rate of 
 15 miles an hour, he sprained his back, but it 
 did not give him much trouble at that time. 
 About three weeks ago, while perspiring freely, 
 he ' ' caught cold ' ' and the perspiration suddenly 
 stopped — from this patient refers present trouble, 
 though he had an attack of la grippe in Febru- 
 ary, and about latter part of April, he noticed 
 impairment of motion of right leg. Some four 
 years ago he indulged in sexual intercourse to 
 excess — ^upon one occasion, had connection seven 
 times in twenty-four hours. He has had no in- 
 clination for sexual intercourse lately, thinks he 
 has had sexual desire but about a half dozen 
 times during the past two years. 
 
 Bowels constipated, for which he resorts fre- 
 quently to purgatives. Had an attack of vertigo 
 to day, and fell to the floor while in the act of 
 yawning. Pulse (sitting) 66 ; upon slight exer- 
 tion (walking about the room), pulse increases 
 to 78. Right knee-jerk abnormal; R. quadriceps 
 clonus marked up to origin of muscles — a slight 
 tap below right patella (not suflBcient to produce 
 patellar reflex), will cause quadriceps muscle to 
 vibrate, R. knee response below normal, left 
 
84 
 
 knee-jerk impaired, no quadriceps clonus. R. 
 gastrocnemius reflex normal ; R. plantar and 
 solar reflexes exaggerated, and clonus follows 
 reflex excitation; plantar surface of right foot 
 hypersesthetic. Flexion of right foot incomplete 
 one- half, rotation impaired one-half, flexion and 
 extension impaired about one-half. While sit- 
 ting, he can only lift right leg and thigh about 
 three-fourths as compared to left. Has head 
 and«back ache. No spinal tenderness, tender 
 over crest of right ilium and beneath ribs of 
 right side. 
 
 ^sthesiometric tests of finger tips give nor- 
 mal results. Numbness of left great toe, but no 
 abnormal sesthesiometric sign. Has slight right 
 scrotal hernia ; has phimosis. 
 
 Virile reflex impaired, extremely feeble, and 
 elicited with difliculty. Patient put upon the 
 following treatment : 
 
 R. Quiniabisulphatis, drachm ij. 
 
 Ext. nucis vomicae, gr. xij. 
 
 Ergotine, scrup., ij. 
 
 Ext. belladonnEe, 
 
 Aloiu (Merck), aa gr. iij. 
 
 Liq. potass, arseuitis, gtt. xv. 
 Misce, et fiat cap.. No. xxxvj. 
 Sig. One three times a day. 
 R. Sodii bromidi, oz. iss. 
 
 Aq. menth. pip., q. s. ad. oz. vj. 
 Misce, solve, et Sig. Tablespoonful at night. 
 
 Patient reported some three times at intervals 
 of a week, and a marked improvement was ob- 
 served. He then left on a trip, to return unless 
 the improvement continued uninterruptedly, and 
 1 have not heard from him since. 
 
85 
 
 Case 2. — Mr. Chas. B. H., 21, occupation far- 
 mer, single, applied at my office for treatment 
 August 15, 1891, and gave the following history: 
 About a year ago, he slept on the damp ground 
 for five successive nights, each morning he felt 
 stiff, and head was very sore. As the effect of 
 this, he was sick in bed with fever for a week or 
 more, legs were paralyzed, bowels constipated, 
 and urine retained — was catheterized several 
 times. He was attended by two local physicians. 
 Says he suifered severe pain during first three 
 weeks of illness, and was troubled with erections. 
 Patient's present condition is as follows : Pulse 
 90 (patient sitting) and full, temp. iod° Fah., 
 appetite and digestion good, and sleeps well ; no 
 erections at present. Some pain in lumbar and 
 sacral region. Crosses right leg over the left 
 with difficulty, cannot lift the left leg without the 
 assistance of hands, cannot stand alone. Patellar 
 tendon reflex is absent, virile reflex present, but 
 impaired, cremasteric reflex normal, and has ab- 
 dominal reflex. Has never had syphilis, or any 
 zymotic disease. 
 
 Patient placed upon the following treatment : 
 
 R. Quiniae bisulphatis, drachm ij. 
 Ext. nucis vomicae, gr. vj. 
 Ext. ergotae, gr xxiv. 
 Fowler's sol., gtt. xl. 
 
 Misce. Tiat. cap. No. xxiv. Sig. Take 2 capsules 
 three times a day — in the morning, after dinner, and at 
 bedtime. 
 
86 
 
 R. Sodii bromidi, oz. iss. 
 
 Kalii iodidi, oz. ss. 
 
 Syr. Hypophos. comp. (Fellows'), oz. iv. 
 
 lyiq. pot. arsen., dr. j. 
 
 Aq. merith. pip., ad., oz. vj. 
 Misce. Solve, et Sig. Teaspoonful in the morning and 
 2 teaspoonfuls in the evening. 
 
 I select and epitomize a few cases from my 
 earlier records as follows: 
 
 The first three were middle aged, of these, the 
 first was married, and gave a history of syphilis, 
 brewer by occupation, erections feeble, white 
 atrophy of retina, unequal pupils — left larger 
 than right, vision obscure in both eyes, cerebro- 
 spinal sclerosis (multiple and lateral). 
 
 The second gave a history of former syphilis, 
 though at time of observation he was in good 
 flesh and general health excellent, miller and 
 merchant, lives in country; impotent — seldom 
 has erections, but at times has good erections 
 and completes the sexual act. 
 
 The third is impotent, fails to have erections. 
 
 The next two are children under twelve years 
 of age; of these, the first is a country boy and 
 has epilepsia mitior, the second, also a country 
 boy, has epilepsia gravior. 
 
 Another case was that of a civil engineer, sin- 
 gle, aged about 28, with nocturnal epilepsia from 
 excessive masturbation. 
 
 Additional experience since the discovery of 
 this important diagnostic sign only confirms the 
 conviction uttered in my first paper, viz.: It 
 should receive further consideration at the hands 
 of neurological clinicians, for it appears worthy 
 
87 
 
 a place in clinical neurology with Westphal's 
 paradoxical contraction, Erb's reaction of degen- 
 eration, or any of the hitherto recognized diag- 
 nostic reflexes, or clonuses. 
 
 I have found an analogous reflex to this phe- 
 nomenon in healthy females. 
 
 It may be elicited in normally vigorous per- 
 sons when that condition of the organ is present 
 that we find coexistant with a desire for coitus, 
 when the sexual act is about to commence, and 
 shortly after coitus, if the sexual desire has not 
 been gratified to satiety. It can be evoked dur- 
 ing priaprism, and during penile relaxation, if 
 power for a second coitus remains in the organ. 
 
 In conclusion, I think we are on the verge of 
 further most important discovery in the direction 
 of physiological and pathological reflex phenom- 
 ena, and on the verge of an enlarged comprehen- 
 sion of their value in diagnosis and prognosis. I 
 believe that every part of the body supplied by 
 an afierent (sensory) nerve communicating with 
 a center, whether cerebral, spinal or ganglionic, 
 capable of an efferent or motor response, will be 
 found susceptible under appropriate stimuli (elec- 
 trical, mechanical, or special) in normal or path- 
 ological state, responsive in some way, and that 
 this plus or minus responsiveness is yet to have 
 far more remarkable value in clinical estimation 
 than is now accorded it or dreamed of in medic-al 
 minds. For instance, in our clinical investiga- 
 tions, we take into consideration such purely 
 physical reflexes (in addition to the cardiac and 
 
88 
 
 visceral movements) as the palpebral, pupillary, 
 naso-pliaryngeal, gastro- cardiac, diaphragmatic, 
 vesical, cremasteric, anal, and the tendon re- 
 flexes of the lower and upper extremities, nor- 
 mal and abnormal, and the clonuses which 
 are of the nature of reflex phenomena prolonged 
 into rhythmical movements. 
 
 Many of these are more or less influenced by 
 conditions of psychical inhibition like singultus. 
 
 Then we have in disease often to consider the 
 state of the psycho- physical reflexes, as the in- 
 voluntary sobbing or sighing, unintentional, or 
 causeless weeping, involuntary and unsuppressa- 
 ble laughter, shouting, involuntary exclamations 
 of various kinds, as of fear, disgust, joy, the 
 many, emotional reflexes of hysteria, etc., and 
 sudden involuntary and unrestrainable psycho- 
 motor responses of various kinds, virile erections 
 under erotic psychical impressions. These latter 
 are downward influences, reflex responses from 
 psychical excitation through peripheral impres- 
 sions transmitted through sight or other senses, 
 or originating altogether in ideational center. 
 Then we have the psychical responses to periph- 
 eral impressions, such as the sudden mental 
 states and expressions following physical im- 
 pressions, like the immediate outcry of periphe- 
 ral pain — the true nature of a reflex phenomenon 
 wherever we find it being a peripheral impres- 
 sion transformed into an immediate, or almost 
 immediate, motor response or expression. 
 
 If we take into consideration how much of our 
 
89 
 
 power for regional diagnosis has been aided with- 
 in the past few years by what we already know 
 of these reflexes, especially of the knee jerk, 
 Achilles reflex, the foot clonus, the anal, vesical, 
 cremasteric, and virile, and the numberless 
 and as yet unnamed reflex responses to elec- 
 trical stimulation, how much more may we hot 
 hope for with confidence, if we but persevere 
 in our search for yet unknown manifestations of 
 these phenomena? I have already elicited in 
 certain moribund states, an oral reflex, as here- 
 tofore announced, and a physiological anal re- 
 flex; and have confidence even before its an- 
 nouncement, not knowing it was new, much that 
 Rosolimo asserts concerning the reflex of the an- 
 al sphincters, this latter reflex serving as an es- 
 pecially valuable difitrentiating test where sex- 
 ual failure is to be early distinguished from com- 
 mencing vesical or rectal paralysis. 
 
A CASE OF IDIOPATHIC SPINAL 
 HEMORRHAGE. 
 
 BY THEODORE DILLER, M.D., 
 
 FELLOW OF THE PITTSBURGH ACADEMY OF MEDICINE. 
 
 Haemorrhage into the spinal cord of traiimatic 
 origin, while not of very frequent occurrence, 
 has been noted often enough to establish the 
 fact of its occurrence beyond a doubt. But as to 
 whether haemorrhage into or about the cord may 
 take place without an antecedent traumatism 
 some writers are in doubt. However, the major- 
 ity of writers do admit that idiopathic spinal 
 apoplexy may occur, but they are all in accord 
 in stating that the affection occurs only very 
 rarely. 
 
 In view of these facts I trust the case I am 
 about to relate will prove to be of some value as 
 tending to place the existence of the disease 
 beyond the perad venture of a doubt. 
 
 Although the case is incomplete insomuch as 
 no post-mortem record is included, yet I believe 
 the clinical history alone will be sufficient to 
 establish the diagnosis. 
 
92 
 
 T. K., a laborer aged 51 years, had been in 
 robust health and worked steadily up to the 
 date of present illness He is a tall man of 
 rugged frame; habits of life good; never had 
 syphilis nor any prolonged illness; heart normal. 
 
 March 12, 1891, after performing his ordinary 
 day's work he went to bed feeling as well as 
 usual. But instead of going to sleep in a few 
 minutes as had been his habit, he remained 
 awake, turning about the bed uneasily until 1 1 
 o'clock, when he was suddenly seized with an 
 excruciating pain at about the first lumbar verte- 
 bra, which radiated from thence around the 
 abdomen and down the thighs. He at once 
 arose from bed in the intensity of his agony and 
 rapidly walked up and down the room. After a 
 few minutes he sat down upon the edge of the 
 bed and bathed his feet in hot water which his 
 wife had brought for him. While thus engaged, 
 became nauseated and attempted to vomit several 
 times but did not succeed. The gastric distress 
 lasted only a few minutes. While his feet were 
 yet in the water he noticed that they were becom- 
 ing "numb," and told his wife about it. Upon 
 attempting to stand up, soon afterwards, he be- 
 came conscious of a diminution of power in his 
 legs. He became greatly alarmed at this discov- 
 ery and at once got into bed, and became aware, 
 a few moments later, of the entire loss of motion 
 and sensation in both legs. The pain rapidly 
 lessened in intensity so that he was entirely free 
 from it twenty- five minutes after the initial 
 
93 
 
 attack. The patient feels sure that his conscious- 
 ness, his memory for words and ability to utter 
 them, was never lost or even impaired during 
 the attack. Members of his family bear him out 
 in this statement. They are further in accord in 
 stating that at no time was the motion or sensa- 
 tion in any of the organs above the umbilicus 
 impaired. The loss of voluntary control of the 
 bladder and bowels was noticed the next day and 
 must have occurred coincidently with the pari- 
 plegia. 
 
 A critical examination the next day revealed 
 the following conditions: Paralysis of motion 
 complete in both legs ; power in the abdominal 
 muscles greatly impaired ; anaesthesia of all kinds 
 completely lost in both legs, impaired over lower 
 half of abdomen. Patient is unable to expel 
 urine or faeces; was not aware that both bladder 
 and bowels needed emptying. No impairment of 
 mental functions; no pain; motion and sensation 
 in muscles of upper half of body unimpaired. 
 
 Subsequent history. — Pain never returned, save 
 for an occasional twinge. Urine and faeces taken 
 away regularly by mechanical means. The par- 
 alysis as described continued unchanged until 
 about April 4 (three weeks after initial symptom) 
 when the first signs of the return of muscular 
 ppwer were noted. Patient could at that time 
 move toes of left foot. From this time up to the 
 present date (May i) there has been steady pro- 
 gress towards recovery. He can now move both 
 legs about the bed, flex knees and thighs. Sensa- 
 
94 
 
 tion has largely returned. He is not yet able to 
 expel his urine and faeces, although the desire to 
 micturate and defecate now comes to him. 
 
 Remarks. — The very sudden onset of the symp- 
 toms would preclude the possibility of the trou- 
 ble being due to tumor, aneurism, bone disease 
 or myelitis. An embolus would produce sudden 
 symptoms, but it would be highly improbable 
 that trouble of this kind could cause such a com- 
 plete condition of paraplegia in less than half an 
 hour. So I am forced to conclude that the le- 
 sion was a haemorrhage — and a large one — either 
 in the cord itself or in the structure immediately 
 surrounding it. I am inclined to think the haem- 
 orrhage occurred in the cord itself. As .to the 
 part of the cord involved, the symptoms would 
 indicate the lower part of the dorsal region. 
 
THE DIAGNOSIS OF TRAUMATIC I,E- 
 SIONS IN THE CEREBRO SPINAI, 
 AXIS AND THE DETECTION 
 OF MAI^INGERING RE- 
 FERRED TO THIS 
 CENTRE. 
 
 BY B. A. WATSON, A.M.,M.D., 
 
 CONSULTING SURGEON TO THE BAYONNE HOSPITAL, SURGEON TO 
 THE JERSEY CITY HOSPITAL, ETC., JERSEY CITY, N, J. 
 
 The counterfeit can not be detected without 
 an accurate knowledge of the genuine, and in ad- 
 dition to this an exact knowledge of the counter- 
 feit, and likewise a definite knowledge of the 
 difference between the genuine and counterfeit, 
 is still imperatively required. 
 
 It therefore follows that he who would attempt 
 to detect malingering should always be able to 
 diagnose concussion of the brain and spinal cord. 
 The proper performance of this task requires a 
 full knowledge of the etiology, semeiology and 
 pathology of the morbid condition under consid- 
 eration. Let us, therefore, direct our attention 
 to these essential factors of diagnosis — carefully 
 analyzing each — in order that we may more 
 
96 
 
 thoroughly comprehend their relation and bear- 
 ing on each other. It is universally admitted 
 that concussion of the spinal cord most common- 
 ly follows falls upon the feet, buttocks, less fre- 
 quently on the hands when both arms are out- 
 stretched, gun-shot wounds involving portions 
 of the spinal column, a stroke of lightning, 
 heavy blows delivered over the bones of the pel- 
 vis or in the line of the spinal column, etc. The 
 direct effect of these falls and blows is the pro- 
 duction of contusions of the soft parts, etc., which 
 are more or less disorganized by these traumatic 
 agents. The force of these agents is not by any 
 means entirely expended in the production of 
 these contusions, but there will be carried along 
 the bony structure a vibratory motion which will 
 also be imparted in varying degrees to the adja- 
 cent soft parts. A very fair idea may be gained 
 of these vibratory movements by placing the hand 
 on the apex of a bell, suspended in the air, while 
 its base is struck with a metallic hammer; or by 
 the touch of a properly keyed string of a musical 
 instrument when it has been put in motion. 
 The same vibratory motion may be likewise very 
 well illustrated by tapping gently with the finger 
 on a glass jar or other vessel which is partially 
 filled with jelly, and then watching the tremulous 
 movements imparted to the contents by the 
 slight blows delivered on the vessel. The at- 
 tention of the medical profession has been very 
 frequently called to the peculiarities of con- 
 cussive or vibratorj- force by French authors, 
 
97 
 
 but its physiological and pathological action 
 has never received that careful study to which 
 it is entitled. A very important factor, which 
 presents itself for our consideration in connec- 
 tion with study of this force is, the fact that it 
 is not transmitted equally well by the various 
 organs and tissues of animal bodies; and, 
 consequently, a direct blow delivered on one part 
 of the body may be entirely negative or result in 
 the production of very little vibratory action, 
 while on another part of the organism the results 
 will be very marked. Thus a blow delivered 
 directly on the nates will give rise to the con- 
 cussive force and be transmitted along the spinal 
 column to the bony walls of the skull, and from 
 this structure to the brain itself, which is in such 
 close contact with these bones. A portion of the . 
 same force will likewise be expended in varying 
 degrees on those organs which are in intimate 
 contact with this line traversed by the traumatic 
 agent. The functional disturbances and the 
 pathological changes in the various organs will 
 depend on the physiological functions, weight, 
 texture, etc., of the parts involved, which need 
 not be enumerated here. A blow delivered on 
 the feet, while the lower extremities are extended^ 
 will be transmitted to the bones of the pelvis^ 
 and then along the spinal column. A somewhat 
 similar result may possibly be produced by a fall 
 on the hands when the arms are extended; how- 
 ever, the force of this blow will be much dimin- 
 ished by reason of the anatomical differences in 
 
98 
 
 the parts, particularly the less intimate connec- 
 tion between the bones of the arms and the 
 spinal column, than that which exists between 
 the bones of the lower extremitif s and this im- 
 portant highway for the transmission of concus- 
 sive force. It should likewise be remembered 
 that the more concentrated the direct traumatic 
 force, i. e. , the smaller the area to which it is 
 applied, the greater will be the amount of con- 
 cussive force generated while the other factors 
 remain unchanged. Thus a blow covering an 
 area of four square inches delivered directly over 
 any part of the spinal column will generate far 
 more concussive force than it would if spread 
 over the whole posterior region of the body. In 
 fact, in the former case, if the blow was a severe 
 one, functional derangements and pathological 
 lesions might be rationally expected to follow 
 from the concentrated nature of the concussive 
 force, but in the latter they will be looked for in 
 vain. There is a very marked difference between 
 the concussion in the case of gunshot wounds 
 produced by musket or rifle balls, and that which 
 follows heavy blows or falls — in the former the 
 pathological changes are more circumscribed, 
 while in the latter they may be considered gen- 
 eral. Thus a musket ball having found lodge- 
 ment in the vertebral column, which has in some 
 degree impaired its outer surface without pro- 
 ducing any lesion of the osseous tissues within 
 the canal, the spinal cord will be frequently 
 found in an ecchymotic state at a point approx- 
 
99 
 
 imating to the lesion in the spinal column. In 
 connection with this subject, it may be further 
 stated that no single blow, — however great its 
 momentum — delivered on the anterior surface of 
 the thorax or abdomen, could be rationally ex- 
 pected to produce concussion of the spinal cord, 
 since its force would be almost entirely expended 
 on the visceral organs within these cavities. The 
 study of the effects of lightning, and likewise 
 those of electrical currents of both a high and 
 low degree of potency — possess for the surgeon, in 
 connection with the consideration of concussive 
 force, very great interest. The vibratory charac- 
 ter of electrical currents is apparently identical 
 with the other forms of concussive force; and, 
 furthermore, it is readily demonstrable that the 
 physiological action, functional disturbances and 
 pathological changes likewise possess essentially 
 the same characteristics. The fact has long 
 been recognized by the ablest authorities that 
 concussion is physiologically indicated by,a nerv- 
 ous and circulatory excitation or depression. In 
 accordance with this opinion Verneuil has given 
 the following definition of concussion: "A series 
 of phenomena more or less sudden followed by a 
 mechanical disturbance of the anatomical ele- 
 ments, tissues and organs, characterized by a 
 temporary excitation or a depression of the func- 
 tions of the parts disturbed, and likewise pro- 
 ducing anatomical changes which are generally 
 observed in cases of functional activity or re- 
 pose." Mschaaical concussive force, like light- 
 
lOO 
 
 ning strokes and electrical currents, may produce 
 every possible degree of concussion, varying from 
 the slightest functional disturbances, which pass 
 off within a few seconds, to instantaneous death. 
 Further similarity on the effects of these agents 
 is shown by the fact that concussion and even 
 death may be produced by rapidly repeated me- 
 chanical blows or a rapid succession of electrical 
 strokes, while a single impulse would be scarcely 
 sufiBcient to cause even temporary functional 
 disturbance. The pugilist knows that the blows 
 which will promptly render his antagonist un- 
 conscious should be delivered on his head. He 
 therefore seizes the head of his enemy and deliv- 
 ers on it in rapid succession blow after blow until 
 his object is accomplished. Experimentation on 
 animals has shown that concussion of the brain 
 may be caused by slight taps delivered on the 
 head in rapid succession with a hammer, etc. 
 
 In our consideration of the etiology of concus- 
 sion of the cerebro- spinal axis we have said little 
 in regard to its causation in the brain. It is 
 probably understood, however, that those agen- 
 cies which have already been mentioned are the 
 important factors in its production in this organ 
 as well as the other organs of the body. The 
 same general laws pertaining to the etiology of 
 this morbid condition are as applicable here, as 
 elsewhere; consequently a blow delivered on the 
 head will be more efficacious in the production 
 of concussion of the brain than would be the con- 
 cussive force had it been transmitted to this or- 
 
lOI 
 
 gan from some other part of the body. Further- 
 more, the weight of this organ and other anat- 
 omical peculiarities of the same, must receive due 
 consideration. In this attempt to describe the 
 symptoms of concussion in the cerebro spinal 
 axis, we immediately encounter a difficulty aris- 
 ing from the fact that the functions of the organs 
 are materially difiFerent; and, consequently, the 
 symptoms observed in connection with a trauma- 
 tism in the spinal cord, will produce entirely 
 different symptoms from those found when a 
 similar lesion exists in the brain. The remedy 
 for this difficulty is very simple, and only requires 
 that the symptoms be separately noted as they 
 pertain to lesions in the different organs. A 
 much more serious obstacle is found in the com- 
 bination of all sorts of injuries with those oi pure 
 concussion, especially those having their origin 
 in fractures, dislocations, sprains, rupture and 
 stretching of ligaments, particularly in the spi- 
 nal column, and likewise with the concussion 
 in one organ, the symptoms of which are erron- 
 eously attributed to this morbid condition in an- 
 other. In illustration of the above mentioned 
 error, I desire here to call attention to the fact, 
 that haematuria is frequently mentioned as a symp- 
 tom of concussion of the spine, while I have con ■ 
 clusively shown by my experiments on animals, that 
 it bears no constant relation to lesion of the cord, 
 but on the contrary, following concussive acci- 
 dents, indicates a concussion of the kidney. Fur- 
 thermore, visual changes are frequently attrib- 
 
I02 
 
 uted to concussion of the spine, while as a matter 
 of fact, the lesions on which these changes de- 
 pend are situated either in the brain or the eye, 
 I am now prepared to assert that the greater part 
 of the organs within the thorax and abdomen 
 are equally as liable to suffer from concussive 
 force as the brain itself; and likewise that con- 
 cussive accidents are much more frequent in 
 these visceral organs than in the spinal cord. 
 This assertion is based on the fact, that these 
 lesions are entirely analagous to those observed 
 in the brain, merely requiring that the proper 
 allowance be made in these organs for difiFerences 
 in weight, texture, etc., factors which must be 
 taken into consideration in connection with the 
 study of the lesions of concussion in the brain 
 and spinal cord. Furthermore, every true con- 
 cussion takes its origin in the same peculiar 
 force. Therefore, if it is desirable to speak of 
 concussion of the brain, spinal cord, etc., why 
 should it not be applied to the lungs, liver, kid- 
 neys, etc.? Would it not be absurd to speak of 
 gunshot wounds of the brain and spinal cord, 
 while the term is withheld from analagous lesions 
 caused by the same peculiar force in other parts 
 of the body? There has recently been made an 
 attempt to employ the term ^''jiervous shock" in- 
 stead of concussion; but this departure' possesses 
 no advantage and has already caused much confu- 
 sion. No attempt is here made to deny that cer- 
 tain portions of the nervous system participate 
 in the concussion; although it is self-evident that 
 
I03 
 
 the functional disturbance and pathological 
 lesions are primarily developed in connection 
 with the circulatory system. These preliminary 
 comments are made in preference to any attempt 
 at the mere enumeration of symptoms, which, in 
 order to possess real value, must be fully stated 
 and explained. It should likewise be remem- 
 bered that there are different degrees of concus- 
 sions, and these differences are indicated by a 
 corresponding difference in symptoms. 
 
 It -must now be apparent that the limits of this 
 article compel me to economize space, so far as it 
 can be done without defeating the object for 
 which it was written. Permit me, therefore, once 
 more to call attention to the fact, that concussion 
 always produces either excitation or depression, 
 i. e. , functional activity or repose. The former 
 condition possesses practically little interest, if 
 observed immediately after the application of the 
 concussive force, since it is commonly of short 
 duration, and does not require any attempt at 
 treatment. However, there is another form of 
 excitation occasionally observed in severe cases 
 of concussion of the brain, which commonly 
 makes its appearance from twelve to forty- eight 
 hours after the receipt of the injury." This con- 
 dition is indicated by a full pulse, flushed face, 
 throbbing of the carotids, headache, dry and hot 
 skin, photophobia, noises in the ears, and some- 
 times m arked drowsiness. These symptoms point 
 to the existence of cerebral hypersemia, which is 
 commonly of short duration ; but in some cases 
 
I04 
 
 it is the prelude to inflammation of the brain. 
 In the severe cases of concussion of the brain or 
 spinal cord, \h& prompt appearance of symptoms 
 indicative of depression, commonly suggests the 
 existence of organic lesion, rather than mere 
 functional disturbances; while, as a general rule, 
 the degree of danger is fairly expressed by the 
 depression. It should, however, be remembered 
 that the symptoms of depression, in order to pos- 
 sess any special value, must pertain especially to 
 the functions which are known to be performed 
 by these organs. Therefore diminished con- 
 sciousness, although the patient may be aroused 
 sufficiently to answer questions, the pupils con- 
 tracted or dilated, relaxation of the sphincters, 
 a feeble and irregular pulse, shallow and sighing 
 respirations, a cold, pale and clammy skin — point 
 very clearly to the brain as the seat of the injury, 
 when the symptoms have followed promptly after 
 the application of concussive force. The symp- 
 toms following those recorded in the above belong 
 to the reactionary period ; the object of this paper 
 does not require that they should be mentioned 
 here. Concussion of the spinal cord is most com- 
 monly indicated by the appearance of paralytic 
 symptoms, which frequently involve the lower 
 extremities — -especially the motor power, and 
 likewise, in many cases, also the sensory. There- 
 fore, in our experiments made on dogs, our at- 
 tention was promptly directed to the movements 
 of these animals immediately after the applica- 
 tion of the concussive force. 
 
I05 
 
 The following facts possess an important bear- 
 ing on the subject now under our consideration. 
 In a recent summary made from my "Experi- 
 mental Study of Lesions arising from Severe 
 Concussion," I shall here venture to cite the 
 following : ' ' Paraplegia is a very important in- 
 dication of a lesion of the spinal cord, and may 
 have its origin either in a disease or traumatism. 
 This morbid condition may be either complete or 
 incomplete, and when due to disease, it is com- 
 monly slowly progressive ; but if due to a trau- 
 matism, it is rapidly manifested, and soon reach- 
 es its fullest development. In support of this 
 statement, examine the following facts: The 
 whole number of cases in which pathological 
 changes were found in the cerebro-spinal axis 
 were fifty ; the whole number of cases in which 
 any indications of these lesions were observed 
 during the life of these animals were thirty- three, 
 while our record shows that in the last mention- 
 ed class there were twenty- three cases of para- 
 plegia." 
 
 It will here be observed that there were ten 
 cases in which there had been noted during the 
 lifetime of these animals some indications of a 
 traumatism, but which did not exhibit during 
 that period paraplegic symptoms. It is also wor- 
 thy of notice that in every instance these para- 
 plegic symptoms were observed immediately after 
 the application of the concussive force, and 
 furthermore, that in all cases of complete para- 
 plegia there was not a single case which subse- 
 
io6 
 
 quently improved. In the large majority of cases 
 of incomplete paraplegia there was commonly 
 some improvement observed during the first three 
 days, but in a few instances the paraplegic symp- 
 toms became more marked during the first twen- 
 ty-four hours; however, even these cases soon 
 showed signs of improvement. It is not claimed 
 that even the immediate appearance of paralytic 
 symptoms after the application of concussive 
 for-ce, in all cases establishes the existence of pa- 
 thological lesions in the spinal cord. I am 
 strongly impressed with the idea that an injury 
 of the peripheral nerves may be followed by tem- 
 porary and commonly local paralysis. A certain 
 degree of importance should be attached to the 
 existence of either anaesthesia or hyperaesthesia 
 in all cases where lesions of the spinal cord are 
 suspected. The existence or absence of pain in 
 these cases — especially true concussion of the 
 spinal cord — possesses very little interest for the 
 diagnostician. In fact, the existence of pain 
 and soreness ought probably to be looked on as 
 having their origin in a contusion, sprain or 
 wrench, involving the vertebral ligaments, mus- 
 cles, etc. , rather than indicating lesions of the 
 cord. Having now presented a few of the char- 
 acteristic symptoms of true concussion of the 
 brain, and likewise of the spinal cord, I desire 
 to add in this connection, that it is certainly' very 
 unfortunate for the science of surgery, that hith- 
 erto it has been the custom of nearly all authors, 
 writing on what they have unfortunately desig- 
 
I07 
 
 nated as "concussion," to group togetter "half 
 a dozen or more traumatic conditions, difiFering 
 radically from each other in their etiology, semeiol- 
 ogy and pathology. It requires no prophet to 
 assert positively that so long as this grouping is 
 continued there will be a want of clearness in 
 all these articles^that theory will be frequently 
 introduced in the place of scientific facts, that 
 clinical observation will continue to mislead the 
 profession, that good-natured authors, believing 
 that all their predecessors in writing on this sub- 
 ject have told a little truth, will still further add 
 to the existing confusion in their attempts at 
 compounding these incompatible ideas. Let me 
 ask what would be the inevitable result, if med- 
 ical authors should group together under the 
 unfortunate cognomen of "Smith's disease" 
 scarlatina, diphtheria, rubeola, roseola, variola, 
 typhus fever, etc.? However, this combination 
 is no more objectionable than that grouped under 
 the name of " railway spine, " which is so fre- 
 quently employed by many of our surgical au- 
 thors even at the present time. However, the 
 dawn of a new light may be approaching, since 
 Dr. John A. lyidell, in writing on "Injuries of 
 the Back, Including those of the Spinal Column, 
 Spinal Membrane, and the Spinal Cord," states 
 that " the traumatic lesions of the back naturally 
 arrange themselves in three groups, as follows : 
 
 1. Injuries of the integuments and muscles, or 
 soft parts generally. 
 
 2. Injuries of the vertebral column. 
 
io8 
 
 3. Injuries of the spinal membranes, spinal 
 cord and spinal nerves.' 
 
 It must be apparent to any one that this classi- 
 fication presents many important advantages 
 over that which is so commonly employed. An- 
 other serious source of confusion has arisen from 
 the fact, that the term concussion, in former 
 times, was restricted in its application to the 
 brain — although analagous pathological lesions 
 were produced by the same force in nearly all 
 the organs of the body. 
 
 Furthermore, concussion was badly defined by 
 the old authors; since the term was used to indi- 
 cate a condition induced by a more or less vio- 
 lent shaking of. the brain, whereby serious symp- 
 toms were produced without lesions of the struc- 
 tures. 
 
 Recent experiments on animals and a careful 
 study of this subject have entirely failed to sup- 
 port their statements in regard to the non-exist- 
 ence of lesions after concussive accidents in the 
 brain and spinal cord. The results of my exper- 
 iments were very conclusive in regard to the ex- 
 istence of these lesions. There were fifty cases 
 in which pathological changes were observed in 
 the cerebro-spinal axis, but only thirty-three of 
 these cases showed any symptoms during life of 
 injury of this centre; it will therefore be readily 
 seen that in seventeen cases, although patholog- 
 ical lesions existed, they were not made apparent 
 
 I The International Bncyclopsedia of Surgery, Vol. iv, p. 668. 
 Edited by John Ashhurst, Jr., M.D. New York: Wm. Wood & Co. 
 
I09 
 
 by symptoms whicli could be recognized on the 
 animals. It is likewise important to state in this 
 connection, that there was not a single case ob- 
 served during all of our experiments in which 
 ■we even suspected the existence of concussion of 
 the cerebro spinal axis where we failed to discov- 
 er pathological lesions by our subsequent exam- 
 ination— /(Ji/worfew or microscopual. These pa- 
 thological lesions, in true concussions, are cer- 
 tainly unique in character and nearly or quite 
 pathognomonic in their signification. The only 
 lesions which bear semblance to the pathological 
 changes of concussion, are those arising from 
 contusions, and these are localized, and not dis- 
 tributed generally throughout the organ, which 
 is commonly the case in the former morbid con- 
 dition. However, there is found an exception 
 to these rules in the case of concussion following 
 gunshot wounds, in which the injury is common- 
 ly localized and resembles more or less closely 
 the ecchymotic appearance arising from contu- 
 sions. The functional disturbances and the pa- 
 thological lesions are clearly shown in my exper- 
 iments, to have had their origin in the vaso mo- 
 tor system. In order to illustrate the pathologi- 
 cal changes in the spinal cord which have been 
 observed to follow in a mixed or complicated case 
 of concussion of this organ, I will here cite the 
 report of an autopsy, etc.,'' made on the body of 
 
 2 International Kncyclopsedia of Surgery, Vol. iv, p. 790 et seq. 
 Edited by John Ashhurst, Jr., M.D.. New York. Wm. Wood & Co. 
 
no 
 
 a coal- porter who died thirty-four hours after the 
 accident. 
 
 Autopsy. — There was no external trace of in- 
 jury. The membranes of the cord were healthy. 
 The substance of the cord was contused opposite 
 the fourth and fifth cervical vertebrae. On sec- 
 tion, there was found ecchymosis of the posterior 
 horns of gray matter on the left side, and of the 
 adjacent part of the lateral and posterior columns. 
 There were also limited spots of ecchymoses on 
 the right side, one in the right posterior column, 
 and one in the right anterior horn of gray mat- 
 ter. The gray substance generally was hyper- 
 aemic. On removing the spinal cord and mem- 
 branes, nothing abnormal was discovered in the 
 vertebrae until the posterior ligament had been 
 dissected off, when it was seen that the body of 
 the fourth was separated from that of the fifth, 
 and the left articular process of the fourth had 
 been chipped off. Dr. John A. I^idell, who re- 
 ports this autopsy, comments on it as follows: 
 "The essential features of this instructive case 
 areas follows: i. The cord substance was injur- 
 ed by concussion, and not by any displacement 
 of the parts; 2. the injury was attended by a 
 number of minute extravasations of blood (ecchy- 
 moses) in the gray substance; 3. there were an- 
 aesthesia and loss of motion in both lower ex- 
 tremities and in the left arm; 4. there was paral- 
 ysis of the sphincter ani and sphincter vesicse, 
 which denoted that the reflex motor apparatus was 
 also paralyzed; 5. the anaesthesia passed away 
 
in the course of some hours, the return of sensi- 
 bility being noted first in the parts most distant 
 from the injury; 6. hyperaesthesia appeared syn- 
 chronously with the reaction from "shock," and 
 steadily increased in severity; 7. hypersemia of 
 the gray substance was found as well as ecchy- 
 mosis. It should be remarked that the hyper- 
 aesthesia was more severe in the right arm than 
 elsewhere, and this part had not at any time been 
 paralyzed." This case was reported by Dr. Li- 
 dell as a pure or unco>mplicated one of spinal 
 concussion, but I am compelled to question the 
 correctness of the report in this particular, and 
 direct attention to the ruptured ligament, which 
 it seems to me may have permitted a partial dis- 
 location to have taken place — with contusion of 
 the cord — the vertebrae afterwards having been 
 restored to their proper position by the natural 
 resiliency of the parts. The symptoms of paral- 
 ysis were certainly more marked than they are 
 usually in cases of pure, uncomplicated concus- 
 sion of the spinal cord. The following micro- 
 scopical report conveys a very clear idea of the 
 pathological lesions observed in our experiments 
 on animals in the cerebro-spinal axis when there 
 were no complications in this centre.^ "Brain in- 
 tensely hypersemic otherwise normal. Every por.- 
 tion of the cord intensely hyperaemic. There were 
 punctate haemorrhages in the dorsal and cervical 
 regions of the spinal cord, in both the anterior and 
 
 3 An Experimental Study of Lesions arising from Severe Con- 
 cussion, p. 22 et seq. by B. A. "Watson, M.D., Philadelphia, Pa. P. 
 Blalciston, Son & Co. 1890. 
 
posterior horns, also in the middle commissure." 
 The striking analogy existing between the path- 
 ological lesions in cases of death caused by elec- 
 tricity and the other cases of concussion, may be 
 probably better illustrated by giving a condensa- 
 tion of the report of the autopsy made by Dr. 
 Carlos F. McDonald on the body of William 
 Kemmler, after execution by electricity, since 
 this examination has been more carefully detail- 
 ed than any of the others. The others, however, 
 entirely agree with McDonald's so far as given. 
 McDonald's report is as follows: "Rigor mortis 
 marked. On incising the skin over the sternum, 
 the blood which escaped was unusually dark and 
 fluid, remained so on exposure. Lungs: tardieu 
 spots were noticed on the posterior border of the 
 lower lobe of the left lung, so also in the middle 
 lobe of the right lung. Heart: valves and sub- 
 stance normal, ventricles empty. Liver: blood 
 from cut surface of dark crimson hue. Gall 
 bladder: distended with bile. Spleen: normal. 
 Kidneys: both markedly congested. Brain: 
 capillary hemorrhages were noted in the floor of 
 the fourth ventricle, also in the third ventricle 
 and the anterior portion of the lateral ventricle. 
 The perivascular spaces seemed to be distended 
 with serum and blood." Dr. Spizka's report of 
 the preliminary microscopical examination is as 
 follows: "The brain, spinal cord and peripheral 
 nerves appeared strictly healthy in every part ex- 
 amined, except in the area corresponding to the 
 discolored (anaemic through the contraction of 
 
"3 
 
 the vascular channels) area of the Rolandic and 
 pre-Rolandic regions, the ventricular surfaces, 
 the pons and the medulla oblongata. The latter, 
 which had been the seat of post-mortem preser- 
 vation of temperature approaching that of the 
 normal human body, were distinctly softer than 
 the observer has ever been accustomed to find 
 these parts in autopsies on persons of Kemmler's 
 age and performed so soon after death. The 
 hsemorrhagic spots in the fourth ventricle, which 
 were strongly marked, were not accompanied by 
 signs of parenchymatous rupture of large blood 
 vessels. Hence they may be regarded as having 
 the same significance as the "taches de tardieu" 
 found on the surfaces of the organs, notably the 
 heart and lungs. The peculiar softened vesicu- 
 lar zone of tissue underlying the outermost lay- 
 er of the cerebral cortex is noteworthy, as "the 
 destruction line" runs parallel to the free surface 
 of the brain and does not dip with the sulci. Ex- 
 amination of the fresh specimen revealed the ex- 
 istence of vacuoles (probably gas bubbles) in the 
 ganglion cells and in the parenchyma of the "de- 
 struction line." From the fact that no haemor- 
 rhages had occurred in this softened area it is a 
 just inference that it was produced after life had 
 become entirely extinct, for the continuance of a 
 blood circulation in a softened brain area is in- 
 compatible with the bloodless appearance, al- 
 ready noted, and the absence of capillary haem- 
 orrhages in this very district while they were 
 
114 
 
 present in those remote from the site of the elec- 
 trode." 
 
 In order to approach the consideration of ma- 
 lingering, it is necessary to devote some attention 
 to the traumatic conditions which frequently com- 
 plicate concussion in the cerebro-spinal axis, since 
 the majority of authors still include these morbid 
 conditions under the head of ' 'spinal concussion, ' ' 
 ' ' railway spine, ' ' etc. Fractures and disloca- 
 tions of the vertebrae require little attention, at 
 the present time, since they are easily diagnosed. 
 The only exception to this rule will be found in 
 those cases where there is a complete absence of 
 deformity, which may be the case where the frac- 
 ture consists in chipping off a portion of the ar- 
 ticular vertebral surface, etc. , or in an incomplete 
 dislocation of a vertebra, in which the natural 
 resiliency of the ligaments and muscles has re- 
 stored the symmetry of the parts. In these cases, 
 it is thought that the careful and observing sur- 
 geon will not be compelled to remain long in 
 doubt as to whether the patient before him is a 
 malingerer, or suffering from a real traumatic in- 
 jury ; since the prompt appearance of objective 
 symptoms will certainly be largely dependent on 
 the locality of the injury, while their degree of 
 severity will depend very much upon the extent 
 and character of the traumatism. There now re- 
 mains for our consideration in connection with 
 this subject, contusions, sprains, twists and 
 wrenches of the back, which are entitled to a 
 more thorough analysis than can be given 
 
115 
 
 them in this article, on account of their medico- 
 legal bearings, in litigated cases. The study of 
 these morbid conditions, it should be remem- 
 bered, will be greatly simplified by bearing in 
 mind the fact that their symptoms, the primary 
 and secondary effects, are entirely analogous to 
 injuries of the same character in other parts of 
 the body. It is claimed that the spinal col- 
 umn and the bones which connect directly 
 with it, are provided with ninety-nine articula- 
 tions. The symptoms which characterize the 
 morbid conditions now under consideration are 
 pain, swelling, tenderness under pressure and 
 occasional ecchymoses. The existence of the 
 symptoms will be limited to the area involved in 
 the traumatism, while the degree of severity will 
 depend on the intensity of the injuries. There 
 may be likewise, in some cases, constitutional 
 disturbances which will aid in establishing the 
 existence of a morbid condition. The ecchy- 
 moses and swelling are objective symptoms, and 
 consequently entitled to due consideration, while 
 the pain, stiffness and tenderness under pressure 
 may require confirmation. The verification of 
 the patient's statements on these points, and 
 frequently on others — especially questions in- 
 volving the existence of paralysis — might be defi- 
 nitely put at rest by the proper use of an anaes- 
 thetic, which ought to be frequently employed 
 in medico-legal cases. The general surgeon no. 
 longer hesitates to employ this agent in his pri- 
 vate and public practice for diagnostic purposes, 
 
ii6 
 
 and why should it not be thus employed for the 
 purpose of securing justice in our courts? 
 
 Drunkenness and syncope may make the diag- 
 nosis more difficult in certain cases of concussive 
 accidents, whether it be pure or complicated con- 
 cussion ; but these factors are of short duration, 
 and therefore cannot continue long to embarrass 
 the surgeon. Having presented our views on the 
 chief factors involved in the diagnosis of the so- 
 called "railway spine," therefore we are prepared 
 to devote a few minutes to the malingerer. It is 
 unfortunately too frequently the case that a sur- 
 geon commences his examination, in medico- legal 
 contests, after having fully formed an opinion, or 
 at least a bias or prejudice. This, in many cases 
 — in fact, almost universally — arises from the 
 want of an analytical mind, and likewise the 
 want of any carefully arranged system of exam- 
 ination. These are very serious defects in the 
 expert witness and, when fully demonstrated, 
 should disqualify him to give testimony. There 
 is another serious defect, frequently observed in 
 the members of our profession, which sometimes 
 has its origin in laziness, although occasionally 
 in an inordinate greed — where the physician has 
 been accustomed all his life to give an opinion to 
 a patient without either an examination or 
 thought. It will be perceived that I have not 
 yet reached the case of the malingerer ; but I 
 have thus far merely paid my respects to those 
 Nwho aid and assist the malingerer. The malin- 
 igerer is certainly entitled to a careful and thor- 
 
117 
 
 ough examination, and each surgeon employed 
 in the case ought to proceed in his examination 
 with the same degree of care and caution that 
 the most conscientious chemist would exercise, 
 when required to make a chemical analysis in 
 the interest of justice. It therefore becomes 
 highly important to learn the true history of the 
 litigant, and likewise that of his father, mother, 
 brothers and sisters. All these matters have a 
 special bearing on the case. It will be readily 
 admitted that any person who has established a 
 good character for truthfulness and honesty ought 
 not to be classed with a mere adventurer. In 
 the examination of all the factors involved in 
 these cases of so-called "railway spines," the 
 fact should never be lost sight of that correct sci- 
 entific opinions can only be reached by a systematic, 
 methodical and painstakijig investigation. 
 
 Let us here present a brief risume of some of 
 the points which have been more or less consid- 
 ered in this paper. 
 
 1. The term concussion, as used by those who 
 first employed it, was erroneously defined, and 
 unfortunately restricted in its application to the 
 brain. These errors had their origin in a defi- 
 cient knowledge of the pathological lesions en- 
 gendered by concussive force. 
 
 2. Concussion is a more or less violent shaking 
 or agitation of various organs in the body, pro- 
 ducing functional derangements dependent on 
 vaso motor changes and well-defined pathologi- 
 cal lesions. 
 
ii8 
 
 3. Concussion may be either general or special, 
 general when several organs are involved at the 
 same time, or special when the entire concussive 
 force is expended on a single organ. 
 
 4. The symptoms arising from concussion will 
 chiefly depend on the extent of the pathological 
 lesions and the functions of the organs. 
 
 5. The frequency with which concussion will 
 occur in any particular organ will depend on the 
 point to which the concussive force is applied, 
 the relative weight of the organ, the character 
 of its texture, and the protection afforded by its 
 anatomical surroundings. 
 
 6. The fifth statement supplies the explanation 
 of the comparatively frequent occurrence of con- 
 cussion of the brain, lungs, liver and kidneys to 
 that of the spinal cord. 
 
 7. Concussion of the brain and spinal cord iS' 
 always attended with immediate symptoms. 
 
 8. Concussion of the brain or spinal cord with- 
 out immediate symptoms is a mere hypothesis — 
 a myth — and has no real existence. 
 
 9. There is no pathognomonic symptom of 
 concussion in any organ of the body ; but a thor- 
 ough, systematic, methodical examination by a 
 skilled surgeon will secure a correct diagnosis. 
 
 Finally, I desire to reiterate the fifth conclusion 
 expressed by Dr. Henry Hollingsworth Smith, in 
 a paper which he read before the Surgical Section 
 of the American Medical Association in 1889, 
 which is as follows : ' ' No physician should go 
 into court and swear that a plaintiff has had a 
 concussion of the spinal cord, or of its nerves, 
 unless he has proved the disturbance of the nor- 
 mal functions of the cord, as shown in sensation 
 or motion, or both, and that the symptoms ap- 
 peared soon after the injury," 
 
A CONSIDERATION OF TRAUMATIC LE- 
 SIONS OF THE SPINE RESULTING 
 FROM RAILROAD AND OTHER 
 INJURIES— THEIR ETIOL- 
 OGY, PATHOLOGY AND 
 DIAGNOSIS. 
 
 BY THOMAS H. MANI/EY, A.M. M.D., 
 
 VISITING SURGEON TO HARLEM HOSPITAL, NEW TORK. 
 
 Since the enormous extension of the railroad 
 system — surface, submarine and elevated — where- 
 in steam is utilized as a motor, the attention of 
 surgeons and the profession has been attracted to 
 certain special features, which commonly at- 
 tend or subsequently follow accidents, sustained 
 by individuals on cars in motion, on iron rails. 
 
 Many have maintained that injuries resulting 
 from railway disasters, possess characteristic and 
 positive lesions, which are peculiar to themselves, 
 in symptomatology, pathology and termination. 
 While, on the contrary, there are not a few, who 
 take an opposite view and claim identity of an- 
 alogy, between them and other disorganizations 
 of tissue, in which the collision of heavy, mov- 
 ing bodies has been the direct cause, or in which 
 
I20 
 
 similar physical agencies, but devoid of steam 
 propulsion, have come into action. 
 
 In the meantime, as if to give stability and 
 warrant to the former allegation, certain practi- 
 tioners in different sections of the country have 
 organized, and now the profession is threatened 
 with another specialty; we have the Society of 
 Railway Surgeons. We have in several of our 
 large cities and railroad centers, hospitals owned 
 and controlled by railway corporations, or the 
 medical officers in the immediate employ of 
 roads. These are maintained by the companies 
 for the purpose of treating those of their em- 
 ployes injured while in their service. With those 
 hospitals owned and controlled by individual 
 surgeons or colleges, services are usually render- 
 ed by contract with the railroad corporations, 
 much to their advantage; for while professional 
 aid is procured at a minimum rate, the compa- 
 nies are also protected, in having their maimed or 
 injured under such supervision, as will effectual- 
 ly guard against malingering; and, besides, 
 should a civil suit arise, the surgeon is drafted 
 into their service. 
 
 So far we have no special section at the meet- 
 ings of the American Medical Association, for 
 railway surgeons. Is it necessary to further sub- 
 divide the field of surgery? While all general 
 surgeons are presumed to possess ample qualifi- 
 cations to serve their country in the field, in 
 times of war, yet France, Germany and Eng- 
 land have each, supplementary medical institu- 
 
tions to equip medical graduates for military duty. 
 With our rapidly extending lines of railroads, 
 which radiate and ramify in every direction, on 
 which more than one hundred thousand men are 
 employed and millions of travelers ride, we can 
 easily apprehend that the number injured annu- 
 ally must be very large. Do their injuries or 
 lesions differ in their dynamic essentials, their 
 anatomical characters or pathological phenomena, 
 from those sustained by other causes in civil life? 
 Do those injuries occasioned by collisions on 
 railroads or otherwise in connection with travel 
 or employment on them, constitute a certain and 
 separate category of features, which are charac- 
 teristic and peculiar, with regard to their local 
 destruction and ultimate termination, and de- 
 mand for their successful treatment the superin- 
 tendence of one of special skill and extended ex- 
 perience? I think the majority will answer in 
 the negative. 
 
 ETIOLOGY OF SPINAI, INJURIES ARISING FROM 
 RAILWAY ACCIDENT AND OTHER CAUSES. 
 
 Conditions of the spine arising from trauma in 
 a general way, may be resolved into two divisions, 
 viz., those in which there are' distinct and defi- 
 nite lesions, and those in which there are func- 
 tional disturbances, without any visible alteration 
 of structure. With the former chiefly are we con- 
 cerned, on the present occasion. 
 
 It has been seen that many regard railroad in- 
 juries of every description as possessing charac- 
 teristic features. Everyone, who has had any 
 
122 
 
 hospital service, into which are entered casualty 
 cases from railroads, has noticed that the destruc- 
 tion of the soft parts is very much more than is 
 seen from other injuries, so that when amputa- 
 tion becomes necessary, and we trim sparingly, 
 in a few days after, the flaps are gangrenous and 
 we must go further up; or if we secure primary 
 union not infrequently we will see an insidious 
 osteo-myelitis arising; requiring a later and more 
 extensive section of bone. It is this class of 
 cases, too, in which we all must often notice that 
 fearful phenomenon, of which so much is seen 
 and dreaded by military surgeons — secondary 
 shock. 
 
 It is important, therefore, before we can make 
 a rational study of this question, that we ask 
 ourselves, what a serious railway accident really 
 is, which should give it those fearful attributes 
 of destruction, or why they should be more com- 
 mon now, than formerly. 
 
 In considering the physics of the study, we 
 must have a correct notion of inertia, momen- 
 tum, velocity, power, resistance, motion and di- 
 rection. A body at rest, is struck by a flying 
 missile, the penetrating power of which is in di- 
 rect proportion to its initial velocity. In study- 
 ing railway injuries, or rather those occasioned 
 by collisions on railways, we will discover the 
 same identical laws in effect, as in the case of a 
 flying missile, but the picture is reversed; the 
 human being is then in a passive, inert state, 
 
123 
 
 wholly beyond his own control at the moment of 
 collision. 
 
 In the practical flight of an express train down 
 an inclined plane, that ponderous mass of metal, 
 the engine, and the passenger coaches are literal- 
 ly shot through space. In this state of motion, 
 in making a sharp curve, or otherwise, the wheels 
 leaving the rails, this train and its human freight, 
 are sent onward, until the initial motion impart- 
 ed by the locomotive and by increased gravity, 
 has spent itself on the parts, in a state of inertia 
 at the instant of collision. What gives to rail- 
 way rolling stock its great destructive properties 
 are its weight and speed. The car trucks to sup- 
 port their burdens, with safety, must be heavily 
 constructed; besides, the more weighty their 
 wheels, the more regular and easy their motion. 
 To supply the demands of travel for fast mail and 
 freight transportation the moving rate of speed 
 has been very greatly augmented, hence danger, 
 in the event of an accident, is proportionally in- 
 creased. 
 
 We have then, in the modern moving train, pro- 
 pelled by steam, two factors indispensable for force, 
 viz., weight and speed, which are always brought 
 to bear on the body, in cases of sudden and violent 
 concussions, when it in whole or part, is crush- 
 ed, stretched or twisted. In many respects there 
 is no little analogy between the spine and a train 
 of cars. We may suppose each vertebra a car; 
 the interlying cartilage a buffer; the ligaments 
 connecting links and the head, the massive ma- 
 
124 
 
 chine. In the center of all the medulla cerebralis 
 et spinalis, the precious freight, the passengers. 
 
 Of all the traumatic lesions which have defi- 
 nite and presumptive pathological lesions, aris- 
 ing in consequence of railway accident, or other 
 mishaps, there are none, which have given rise 
 to so much investigation, study, experimenta- 
 tion and vehement controversy, as those arising 
 from railway accident, and which occupy the 
 cerebro- spinal axis. 
 
 Eric Erichsen was among the first who contrib- 
 uted anything in a methodical way on the subject 
 of spinal lesions attributable to railway casualties. 
 In America Dr. B. A. Watson, of New Jersey, 
 conducted a very extended series of experiments 
 on the lower animal (the dog) with a view of 
 further clearing up mooted pathological ques- 
 tions and endeavoring to connect symptoms with 
 pathological changes. 
 
 Since the appearance of Erichsen's lectures we 
 have had such a pathological entity as the ' 'rail- 
 road spine." For he taught that the clinical 
 features, morbid anatomy and history of certain 
 forms of spinal injury, caused by railway acci- 
 dent, were unique, definite and characteristic' 
 Watson, on the other hand, after his painstaking, 
 laborious and exhaustive investigation, conclud- 
 ed, to quote his own language, that "concussive 
 accidents never produce pathological changes in 
 the spinal cord, except when g^eat force has been 
 
 I Watson, An Kxperimental Study of Traumatic LesiGn of the 
 Spine 
 
125 
 
 applied to the spinal column, and these cases 
 generally, if not always, are complicated with a 
 fracture, rupture and stretching of the ligaments, 
 or severe lesions in other parts of the body, 
 which terminate quickly in death." 
 
 Erichsen ventured to aflSrm that neuroses of 
 every phase and degree, from profound melan- 
 cholia, dementia or paralysis, might arise, either 
 immediately after the railway collision, or at a 
 remote date. His observations are mainly limit- 
 ed to the elements of the cord and brain with the 
 meninges, and he takes but little notice of the 
 part which the enveloping tissue play, either in 
 association or as independent factors. The mus- 
 cles, tendons, ligaments, extravascular supply 
 and peripheral nerves are wholly ignored, and he 
 looks solely for pathological changes to support 
 his theory in the medulla and meninges. Wat- 
 son's experiments having been conducted on 
 the dog dropped through a chute, we must com- 
 pare the striking difference between them and 
 man, with respect to their physical conformation 
 and mental attitude, before we can properly esti- 
 mate the clinical application of these experi- 
 ments. In one the spine is nearly perpendicular, 
 and we must not overlook the element of fear. 
 In the otber, the spine is horizontal and has four 
 supports instead of two, besides psychological 
 influence is wanting. Man's head is very heavy 
 in proportion to his size. The quality and di- 
 rection of concussive force possessing but little 
 analogy with such as is inflicted in railway acci- 
 
126 
 
 dents, we cannot unqualifiedly apply those ex- 
 periments in the lesions under consi'deration. 
 
 Although the views of both distinguished 
 authorities here cited are widely divergent and 
 antagonistic in many respects, though, strange as 
 it may appear, in one direction, at least, they 
 evidently agree, for neither appears to attach 
 much, if any, importance to the direful conse- 
 quences to the integrity of the spine, which may 
 follow injury of the soft parts independent of 
 implication of the cord itself. Neither author 
 has been able to supply anything but very scant 
 pathological data from post-mortem examination 
 on the human body, where death has been di- 
 rectly or indirectly caused by spinal injury. 
 
 In this connection an effort will be made to 
 demonstrate by anatomical analysis and patho- 
 logical observation that, quite independent of 
 alleged morbid states which are manifested by 
 clinical symptoms, we may and frequently do find 
 the motor functions of the spine temporarily im- 
 paired orjlost by lesions which in no way direct- 
 ly implicate^the cord itself. 
 
 To proceed intelligently with the separative 
 causative factors, we must have a clear compre- 
 hension of the varied structures which we have 
 to deal with, their relations and functions. 
 Among^the laity, and even medical circles, some- 
 times a most confused notion would seem to pre- 
 vail with regard to injuries in the rachidian re- 
 gion. 
 
 What is the spine? We will be told that so and 
 
127 
 
 so met with an accident and has seriously injured 
 his "spine." Lay people have a vague but sin- 
 gularly correct impression, nevertheless, that 
 when paralysis immediately follows injury, the 
 "back is broken." With our profession, the 
 general opinion of a serious injury of the spine 
 always implies that the cord has participated in 
 the lesion. Neither view is correct, for we may 
 have complete paraplegia without a broken back, 
 and vice versa. And we may too see individuals 
 invalided for life when the great nerve cylinder 
 and bony arches have entirely escaped. 
 
 The spinal column in man is maintained in the 
 upright position by a powerful set of muscles, 
 with an accessory set of stays, the numerous lig- 
 aments which, though permitting varied move- 
 ments, firmly retain the vertebrae in position. 
 Besides those osseous spurs given off by each 
 vertebrae, serve as levers and are so intimately 
 interlocked that even in the dead body they are 
 detached from each other with diflSculty. 
 
 If the vertebral column be denuded of its mus- 
 cles and traction force is applied in opposite di- 
 rections, the arches or transverse processes will 
 give way often before the ligaments. As the 
 dorsal vertebrae are firmly braced on either side 
 by the ribs, the spine, in the event of a trauma- 
 tism, will yield less in this situation, but as the 
 lumbar region is reached lateral support is want- 
 ing, and on this the whole weight of the head and 
 trunk is borne. 
 
 Speaking in a general way, we may say that 
 
128 
 
 among the manifold and varied purposes which 
 the rachidian column serves, the most obvious 
 and important are: i. To form the posterior 
 boundaries of four cavities, if we include the 
 sacrum. 2. To support the head. 3. To carry 
 all viscera and structures lying beneath the un- 
 der surface of the cranium. 4. To provide lodge- 
 ment and protection to the spinal cord. 
 
 Its weakest and most superficial segment is its 
 most mobile; its middle the most fixed, and yet — 
 to employ a paradox — is in constant motion, 
 through costal action on either side. The lum- 
 bar region is the most powerful and is the center 
 of flexion between the trunk and pelvis. 
 
 It may be well in this connection, while cou- 
 sidering the powerful and complicated structure 
 of the spine, to remember that that organ within 
 the tubular canal, the cords, is but fifteen inches 
 long and weighs but an ounce and a half; that it 
 floats in a water bed that protects it from pres- 
 sure and ordinary jars. The cervical or lumbar 
 segments, in the event of great and concentrated 
 violence, permits of a distinct, lateral swayingmo- 
 tion, so that the momentum of force may be spent 
 rather on the ligamentous, osseous or muscular - 
 parts, than be transmitted to the cord or brain. 
 
 Besides either extremities of the spinal column 
 where force may be applied, either in the way of 
 traction or compression, it may be also brought 
 to bear from behind, or latterally. Violence, to 
 reach the cord interiorly, must first encounter 
 the viscera, or disorganize the spinous bodies, 
 
129 
 
 which would be impossible without immediate 
 destruction to life. 
 
 Of the different regions, probably none can sus- 
 tain a crush or fall with as much impunity as the 
 dorsal. The osseous structures of the spine, here 
 lie below the posterior costal curves and force is 
 diffused through the elastic contents of the thor- 
 ax, or one or more ribs are fractured. The same 
 degree of violence inflicted on the cervical re- 
 gion, suddenly and unexpectedly, would have 
 mortal consequences. But, when one has even 
 a second's notice, he instinctively shortens his 
 neck, obliterates it, as it were, by crowding it 
 into the thorax, by raising his shoulders up to 
 the ears, depressing the chin to the sternum and 
 the occiput to the vertebree prominens. 
 
 Accordingly we find the lumbar region the 
 most vulnerable; for we may regard this segment 
 as the centre of a hinge joint, and, as might be 
 expected, is oftenest found the part which suffers 
 in these spinal injuries, from which a patient 
 may, for a time, survive. But the lumbar seg- 
 ment has a powerful and compact development ; 
 hence, simple violence, to compromise its deli- 
 cate contents, must be direct and great, so that, 
 as Watson discovered in his unique experiments 
 on the dog, the lesion of the cord often, in itself, 
 is of but minor importance, in comparison to the 
 rupture or laceration of an organ vital to life. 
 
 It would be rational to assume that, in the vast 
 majority of cases in which force operated in the 
 cervical or dorsal regions with sufiBcient concus- 
 
I30 
 
 sion to fracture bone, death would seem an al- 
 most inevitable consequence. In eight cases 
 which have come under my observation, in which 
 the brunt was borne by the lumbar spine, six 
 died, one in six hours, two in a week, and one 
 lived three weeks. One recovered completely, 
 and the other left the hospital, paraplegic. There 
 was paralysis in all these cases in the beginning. 
 Three of them were the result of railroad acci- 
 dent. In all the cases, the kidney sustained as- 
 sociate lesions. 
 
 As far as the etiology of traumatic spinal mal- 
 adies goes, my experience is mainly in harmony 
 with the views promulgated by Dr. B. A. Wat- 
 son, of New Jersey, in his experimental Work on 
 the spine, viz. : that in traumatisms of the spine, 
 attended with paralysis, we will always find path- 
 ological lesions involving it, of a definite and 
 positive description. 
 
 Prof. Erichsen, in his lecture on spinal concus- 
 sion, details at considerable length a large num- 
 ber of cases, in which symptoms of paralysis at 
 varying intervals after railroad accidents appear- 
 ed. In some of these cases, there were compli- 
 cations of brain symptoms, with affections of the 
 nerves of special sense. In many there were dis- 
 orders of vision or hearing, melancholia, halluci- 
 nations, neuralgias, loss of memory, unsteady 
 j^ait in walking, numbness and hyperaesthesia, 
 and other ailments aflecting the nutrition of the 
 body. 
 
 In none of those cases were pathological 
 
131 
 
 changes present which could be proven, but it was 
 assumed that ansemia of the cord existed, or that 
 there were either chronic meningitis or myelitis. 
 
 Having seen myself a considerable number of 
 cases of injury to the back, arising from railroad 
 injuries, in none have I ever encountered these 
 sequelae. And, with proper deference to the dis- 
 tinguished author, yet I am convinced that his 
 premises are unsound and untenable. And I am 
 satisfied that his conclusions, though ingeniously 
 constructed, will not meet with favor among those 
 of extensive experience in the treatment of rail- 
 road injuries, or serious traumatisms of the spine. 
 
 There are, however, other serious lesions which 
 may attend injury of the spine, which have been 
 described by no writer in modern times, except 
 Olliver.^ I refer to those which are limited to 
 the peripheral nerves, muscles, tendons, liga- 
 ments, vessels or bone ; which are attributable 
 to strain, twist, pressure, laceration or contusion, 
 and give rise to extravasation of blood, to in- 
 flammatory exudates, synovitis, periostitis, ab- 
 scess, amyotrophic changes, myopathies, throm- 
 bosis, embolism, phlebitis, cellulitis or anchylosis, 
 and which may and often do, in early childhood, 
 or even in middle life, be the starting-point of 
 various organic maladies. 
 
 Extrinsic spinal injuries are very common. 
 The vascular system supplying and maintaining 
 the nutrition of the cord ; its coverings, the 
 meninges; the rachidean structures, osseous, lig- 
 
 * Traits Maladies de I'Epine, ed. i, p. 207. 
 
132 
 
 amentous and muscular, is peculiar in its arrange- 
 ment, although in many respects it is similar to 
 the cranio cephalic, in that there is a free inter-, 
 communication between the peripheral and the 
 deep vessels. Hence, the explanation how in- 
 flammatory conditions are propagated from the 
 superincumbent cellular tissues to the synovial 
 investment of the vertebral joints, or to the ele- 
 ments of the cord, when the process is in relation 
 to the cervical region. 
 
 I have on three occasions met with cases of 
 spinal meningitis, in which the primary injury 
 was first borne on the nates, or over the shoulders. 
 A case of this description I saw with Dr. W. B. 
 Fisher two years ago, in the town of Yonkers, 
 N. Y. The patient was a young lady who, while 
 on roller skates, fell on her left nates and side. 
 She was very sore, over the seat of injury, for two 
 or three days, the parts being swollen and tender. 
 Soothing applications were applied, and she was 
 confined to bed. 
 
 As the fulness and pain commenced to subside 
 over the gluteal region, she began to complain 
 of "pins and needles" (formication) in the soles 
 of her feet. This was followed by numbness, 
 and on the seventh day after injury she was com- 
 pletely paraplegic. On the tenth day she died, 
 of typical meningitis of the spinal cord. 
 
 My two other cases were seen in hospitals. In 
 one, spinal meningitis developed six days after 
 the patient was violently clubbed by a police offi- 
 cer. On the second day after his castigation, his 
 
133 
 
 mid-dorsal region was one mass of welts and 
 bruises. The skin over the injured area was mot- 
 tled, hard and lumpy. With him, paralysis was 
 confined to the lower extremities, but there was 
 much more convulsive spasm of the ■•xtremities 
 than in the preceding. His case was remarkable 
 with respect to its termination, as he recovered 
 from the meningitis, so that he was able to leave 
 -the Workhouse Hospital, on crutches, i/iree months 
 after injury,, the paralysis not having wholly disap- 
 peared. No doubt a thickening sclerosed condi- 
 tion of the neurilemma of the nerve roots lingered, 
 which might account for the nerve symptoms. 
 
 In my third case, the patient was injured by 
 being knocked down by a passing team. Two 
 ribs were fractured, but she was able to get on 
 her feet, and walk home without assistance. 
 
 She was brought to the hospital on the fourth 
 day, with symptoms of incipient spinal menin- 
 gitis. The disease made rapid progress, quickly 
 extending into the cervical section. She died on 
 the fourth day after admission into hospital. 
 
 On post-mortem examination we found, on the 
 left side, the sixth and seventh ribs fractured, 
 close to the transverse processes. A large, "dif- 
 fuse extravasate of blood was discovered under 
 the long, broad bands of the serratus magnus 
 muscle, and the connective tissue on the right 
 side. In places, it was liquid, in others partly 
 organized, but for a very considerable radius 
 about, the tissues were deeply red- stained by the 
 escaping hsematin. 
 
134 
 
 The tendinous and ligamentous structures in 
 the vicinity of the sixth and seventh cervical 
 vertebrae were softened and thickened. On en- 
 tering the spinal canal, no haemorrhage was met 
 with. The dura mater was greatly distended 
 with a turbid, flocculent serum. Between the 
 arachnoid and pia mater, throughout the cervical 
 area, as far as the atlas, a fibro-plastic exudate 
 was seen, which insinuated itself along the hori- 
 zontal septa into the lateral sulci of columns. The 
 medullary substance of the cor^ was softened in 
 the centre, and was everywhere dotted with mi- 
 nute ecchymoses. 
 
 Besides those lesions which involve the cord 
 secondarily, and have reference to propagation 
 of irritation or infection, through the nerves, 
 vascular channels or lymphatics, we have anoth- 
 er important group arising from muscle or liga- 
 ment strain, from contusion of the peripheral 
 nerves, which regulate movement and nutrition 
 of all the overlying structures, from the integu- 
 ments inwards, from haemorrhage, cellulitis, peri- 
 ostitis, synovitis, arthritis, fatty degeneration of 
 muscle, limitation of muscular action or anchy- 
 losis. The etiological factors in all the above 
 were primarily concussive force, and conditions 
 dependent on vital phenomena. 
 
 Sprains are commonly understood as trivial 
 wrenches or twists of an articulation, attended 
 with pain, swelling, and ecchymosis of the in- 
 teguments. Authors give them little noticed 
 But over strain or violent sprain of a joint, or 
 
. 135 
 
 series of joints, attended with extravasation of 
 blood into the articulation, with laceration of 
 muscle or ligament, may be the starting-point of 
 very grave organic changes, particularly in the 
 young, or those inheriting a feeble constitution. 
 In spinal injuries, chronic, multiple synovitis, 
 periostitis, softening, wasting and atrophy of the 
 muscles, with weakening, stretching or displace- 
 ment of the ligaments, are a few of the sequelae, 
 in aggravated cases. I have met with a case, in 
 which a violent twist at the ankle-joint origi- 
 nated a diffusive osteo-myelitis which ultimately 
 necessitated amputation above the joint. 
 
 We may have, in one or more joints of the 
 spinal column, the same precise pathological con- 
 ditions as obtain in the extremity ; but as the 
 spinal articulations are all deeply lodged, they 
 more often escape. And, if they should be the 
 seat of sprain, it must, during life, be rather in- 
 ferred than proven. 
 
 Nevertheless, when a person comesunder our ob- 
 servation, who is injured in the back, who has a 
 febrile pulse and a high temperature, with a local 
 fulness and hardness over a localized area of the 
 spine, but in whom sensation and motion are 
 perfect, there can be no doubt as to superficial 
 or extrinsic nature of the lesions. 
 
 The most frequent source of injury to the lig- 
 amentous and muscular structures, is by indirect 
 force at either terminus of the column. The 
 dorsal and lumbar regions suffer most from this 
 form of violence. One falls from a considerable 
 
136 
 
 height, or is hurled a short distance, striking on 
 his nates or hip. The spine is bent backwards, 
 forwards, or laterally, the inertia of the head, 
 shoulders and trunk is mostly spent on the lum- 
 bar vertebrae. 
 
 Not infrequently, however, serious strains are 
 induced by concussive force coming from an op- 
 posite direction ; as when one is precipitated in 
 such a direction that the point of impact is on 
 the shoulder and side of the head, when the whole 
 weight of the lower trunk and extremities im- 
 pinges, with great momentum, on the upper mo- 
 bile, lumbar segment. These accidents, involv- 
 ing only the extrinsic structures of the spine, 
 then, well deserve a careful study, for it cannot 
 be denied that, when of a severe nature, the 
 original pristine strength of the spine is forever 
 lost, and locomotion will be always thereafter 
 diflBcult and painful. If they occur in a maiden, 
 she can never properly fulfil the duties of matri- 
 mony with safety ; nor, in fact, perform any sort 
 of labor requiripg considerable effort. 
 
 A consideration of those infirmities of the 
 spine, exclusive of the neuroses of the cord, fol- 
 lowing spinal injuries, opens the way for a new 
 line of study, which may be cultivated with great 
 interest to the surgeon and practitioner, and ad- 
 vantage to the crippled. 
 
 I have met with a few cases of spinal injuries 
 in adults in which there followed absolute and 
 permanent impairment of power, while the cord 
 remained free. 
 
137 
 
 The first case I saw with Dr. Sheahan, of this 
 city, in which the patient, a young woman, was 
 suffering from the effects of a fall into a deep 
 trench on a dark night. She thought she struck 
 on her shoulder but was not positive. She was 
 confined to bed for more than six months and 
 was unable to sit in the upright position for 
 more than a year. The lumbo-dorsal muscles 
 were markedly atrophied on both sides and the 
 spinous processes of the lumbar vertebrae pro- 
 jected out so that the tips could be easily counted. 
 There was no neurotic condition of any descrip- 
 tion. Her infirmity was local and was confined 
 to the muscular and ligamentous structures 
 alone. She was, when I saw her, wearing a very 
 heavy gypsum jacket. Without it she was al- 
 most powerless to move. Her general condition 
 was good, with a fair muscular development. 
 There had never been any question in this case, 
 or the two others which will be recorded, as to suits 
 for damages. It is now two years since I saw 
 her, and her physician writes me that though 
 she makes a living with the needle, yet she is 
 as weak and helpless in the back as ever. 
 
 The second case was also in a woman. She 
 was nineteen years old, and was injured while 
 descending the steps from an elevated railroad 
 station. She was near the surface when she 
 slipped and fell with great violence on her back. 
 Being unable to stand or walk, she was conveyed 
 home in an ambulance, where she lay in bed four 
 months. She was now examined by the railroad 
 
138 
 
 surgeon, who was inclined to regard her troubles 
 as trivial, inasmuch as there was no central im- 
 plication of the cord. At this time she was ad- 
 mitted in the hospital. On examination in the 
 lower lumbar region it was evident that an ab • 
 scess was forming close to the inner border of 
 the quadratus lumborem muscle. On freely 
 incising it a fistulous tract was discovered ex- 
 tending down to the transverse processes of the 
 second and fourth lumbar vertebras. By enlarg- 
 ing the wound, we came down on those proces.ses 
 of bone which were necrosed, and with the ron- 
 geuer cut them away. There was a considerable 
 area of diseased tissues along the line of the in- 
 cision, which was scooped away. The incision 
 healed by granulation, beginning at the bottom, 
 but it was more than three months before it 
 closed in entirely. She now occupies a position 
 in a dry goods store, but there remains a rigidity 
 of the muscles of the back, which greatly limits 
 the normal stooping movement and prevents her 
 from occupying her former position. 
 
 My third case of permanent impairment of func- 
 tion following severe injury of the back, was a 
 carpenter, who while in a stooping position was 
 struck over the lumbar region by a falling piece 
 of timber. I saw him shortly after he was in- 
 jured. There was no palsy, but his spine was 
 rigidly fixed and over the seat of injury there 
 was great pain. He passed blood in his urine, 
 both as coagula and in the fluid state, in such 
 quantities as to threaten fatal anaemia. By the 
 
139 
 
 aid of refrigerant drinks and cold applications 
 on the nephritic regions it gradually lessened 
 and in a few days completely ceased. This man 
 had a slow and painful convalescence. For 
 many months he could not maintain the trunk 
 on the femora in sitting or walking, without 
 making a lumbar support, and for three years he 
 was an invalid. For a long time there was a 
 marked and considerable fullness over the left 
 kidney, whether attributable to haemorrhage be- 
 neath the capsule into the parenchyma or steno- 
 sis of the ureter with hydronephrosis, we are 
 unable to say. It, however, gradually diminished 
 in size and ultimately disappeared. 
 
 These three cases constitute all the lesions of 
 an extrinsic character clearly attributable to over- 
 strain or contusion of the spine, in which perma- 
 nent disability in varying degrees have followed 
 injury, that I have seen. 
 
 In the treatises and brochures of Abercrombie, 
 Guthrie, Brodie, Cooper, Ollivier, Chappioneare, 
 Duplay and Richet many cases of this character 
 are mentioned but not fully described. 
 
 In analyzing the phenomena of those painful 
 neuroses over the long axis of the rachidian 
 plane, we cannot forego at least a cursory exam- 
 ination of the nerve supply, of the meninges, the 
 bony framework of support, the soft parts and 
 integuments. 
 
 The dura-mater is supplied mainly b}' extreme- 
 ly delicate prolongations inward of the sympa- 
 thetic through the intervertebral foramina, and 
 
140 
 
 by ganglionic fibres from the nerve roots which 
 pierce the neuralemma, and are reflected inward 
 and upward in opposite directions. 
 
 The deep osseous tissues, ligaments and cellu- 
 lar elements in the dorsal region, are provided 
 by the posterior ramifications of primary divi- 
 sion of the twelve dorsal nerves. The anterior 
 branches of the six lower dorsal nerves supply 
 the three sets .of muscles which laterally wall in 
 the abdomen. 
 
 The arrangement of the lumbar nerves is simi- 
 lar to the dorsal, but it may be noted, in all the 
 regions of the vertebrae, that, beginning in the 
 superior segment, the cervical nerves send pro- 
 longations into the thoracic region and freely 
 inoculate or are blended with its nerve-trunk, 
 the dorsal with the abdominal, and the lumbar 
 with the pelvic or sacral nerves. 
 
 As a result of violence to the spine we may 
 have haemorrhage, laceration of substance, in- 
 flammation, peripheral paralysis or neuritis. The 
 consequences arising from these various condi- 
 tions are important or serious in proportion to 
 their extent, the age of the patient, sex, and the 
 condition of health. One of those pathological 
 conditions may be dependent on the other. For 
 instance, sanguineous extravasation into or-along 
 the muscle sheaths, if properly treated and of 
 moderate extent, will rapidly disappear. But 
 under varying circumstances it may give rise to 
 irritation, inflammation or suppuration. I^ocal 
 
141 
 
 inflammation may he confined and its spread 
 prevented. 
 
 As a rule, however, unless very great injury 
 has been inflicted, the processes of repair in the 
 spinal coverings are rapid and complete. This 
 may be explained partly, perhaps, by their greater 
 vascularity and elasticity. 
 
 There are, nevertheless, occasions when a 
 muscle is subjected to sudden and considerable 
 strain; the result may be very serious. Such we 
 sometimes meet with, in those cases of irreduci- 
 ble luxations at the shoulder joint, in which the 
 muscle has lost its elasticity with contractility, 
 and we fail to retain the head of the humerus 
 in position after replacement. Dire results may 
 follow rupture of the meningo-rachidian veins. 
 Their walls are very thin, hence, when ruptured, 
 fail to close in the rent. Bleeding from these 
 vessels is a most prolific source of secondary in- 
 flammation, of the meninges and pyelitis, by 
 pyogenic processes, propagated either through 
 the lymph channels or the blood vessels, which, 
 in this situation, communicate very intimately. 
 
 Primary and direct disorganization of the os- 
 seous structures of the spine, without mortal 
 implication of the medulla-spin alls, or such a 
 lesion as will at once and permanently destroy 
 the conducting power of the spine below the 
 area of contact, is very rare. 
 
 Pathological changes involving the bones of 
 the spine, after injury, are mostly secondary, and 
 are not often seen, except in early life. Even 
 
142 
 
 then, when met with, after an alleged injury, it 
 might become an important question to decide 
 just what part the traumatism exercised as an 
 etiological factor in the initial changes, or wheth- 
 er or not the necrosis or caries was rather attrib- 
 utable to influences originating within the or- 
 ganism itself, the development of which, imme- 
 diately following the accident, being rather an 
 adventitious circumstance. 
 
 The same observation might apply to synovial 
 implication of the manifold articulations of the 
 spine. 
 
 In all grave spinal traumatisms, provided the 
 patient survive immediate shock, spinal- meningi- 
 tis arises, and, in time, the brain shares in the 
 changes which commenced in the cord. Hence, 
 when the basilar membranes are reached, and 
 those of the meduUa-oblongata, the respiratory 
 centers become the theater of inhibitory action, 
 and life is quickly terminated. 
 
 The subarachnoid cavities of the brain and 
 spinal cord freely communicate. In serious in- 
 juries of the cord we often have premonitions of 
 approaching dissolution, accentuated through 
 the nerves coming from the cord, within the 
 skull, while all the mental faculties are yet un- 
 dimmed, and the patient himself is warned of the 
 terrible change which awaits him only by indi- 
 cations made manifest through those nerves which 
 preside over respiration and phonation. 
 
 Very much has recently been written concern- 
 ing what is designated "concussion of the spine" 
 
143 
 
 —a condition which has no definite pathology, 
 and the existence of which is mostly based on a 
 series of vague and ambiguous symptoms. In 
 other words, it is revealed mainly by clinical 
 phenomena. 
 
 It is alleged that its striking characteristic is 
 the fact that it manifests its effects only after the 
 lapse of considerable interval from the time of 
 injury; is exceedingly insidious in its onset, but 
 withal, may have a speedy and favorable termi- 
 nation; that it is always followed by psychical 
 disturbances of an emotional character, impair- 
 ment of vision, ataxic symptoms, unsteady gait, 
 pain in the back, headache, and a general break- 
 ing down of health. 
 
 Many distinguished authorities agree that as a 
 result of violent physical shock, we may have a 
 condition of the brain or cord in which there are 
 well-marked evidences of serious pathological 
 disturbance, and yet, after death, no gross lesions 
 of structure are found to account for them. 
 
 No one who has examined many bodies of men 
 or women who have come to their end by a ca- 
 tastrophe but must admit that not infrequently 
 practically nothing can be found which unequiv- 
 ocally accounts for death. Yet, from my own 
 experience, I feel confidant that in many of those 
 cases set down as spinal concussion, wherein 
 there is no shamming, pathological changes may 
 be discovered which will account for symptoms. 
 
 It is preposterous to assume, then, whgn vio- 
 lent and concussive force is appligd to the body, 
 
144 
 
 that that slight, delicate cord, firmly enclosed 
 by the dura- mater, and protected within a pow- 
 erful, bony wall, will suffer detriment, while the 
 exposed, friable viscera escape. 
 
 Dr. B. A. Watson's experiments on animals 
 have definitely decided this question. 
 
 The spinal cord, we are told, may become 
 anaemic. The patient, they say, has "anaemia 
 of the cord." It is said to be a morbid condition 
 which arises solely as a result of railroad acci- 
 dent. 
 
 A most ingenious theory has been devised to 
 connect cause and effect in this new addition to 
 our nomenclature of disease. 
 
 The imagination and credulity of the observ- 
 ing and thinking student are strained to the 
 utaiost to reconcile many of the unsupported 
 theories and allegations of its discoverers and 
 votaries. 
 
 In order to maintain the theory, and give force 
 to reasoning, something more is demanded than 
 hypothetical assumption and illogical conclu- 
 sions. 
 
 It is imperative and proper that the profession 
 be enlightened on some of those moot points, 
 which have been ignored or warily evaded by 
 those who have written most on this mysterious 
 disease. In the beginning, we must be con- 
 vinced that the emotional state of terrible alarm, 
 trepidation and suspense attendant on a railway 
 collision are different in quality and magnitude 
 from those which must be of frequent occurrence 
 
145 
 
 in the carnage of battle, during the firing of 
 heavy guns, explosions of shells, and springing 
 of mines, from that borne by the wounded when 
 a whole limb is torn away, or when the maimed 
 and crippled, unable to withdraw their mangled, 
 bleeding bodies, are ridden over, or trampled on, 
 by the columns of advancing cavalry or artil- 
 lery. 
 
 Can the horrors of railroad calamity exceed 
 those which accompany the crashing destruction 
 of a thunderbolt, when it falls with destructive 
 energy on a dwelling, lifting it off its foundation, 
 cleaving it in two, killing outright, in an instant, 
 one or more individuals, yet, with the survivors, 
 how many of them suffer from spinal anaemia ? 
 
 In our large cities, with their numerous, enor- 
 mous n^odern apartment houses of great height, 
 from which occupants or mechanics often fall in 
 every attitude of the body, here, accordingly, the 
 bospital surgeon will meet with every variety of 
 spinal injury. In no case which I have ever 
 seen of spinal injury was there ever observed by 
 me that mental aberration which is said to con- 
 stitute that condition which they allege to be an 
 integral part of spinal anaemia. 
 
 Next in importance to those symptoms reflect- 
 ed through the, organ of the mind in spinal 
 anaemia is that condition in which the spinal 
 cord is the seat of pathological changes; or in its 
 molecular, or vascular elements. 
 
 It is not clear whether we are to understand 
 by this, that the quantity of the blood present is di- 
 
146 
 
 minished, or whether its nutritive, reconstructive 
 elements are deficient, for the demands of the 
 cord. Presuming that the pathological condi- 
 tion can exist, as a sequelae of a violent shake of 
 the body, there is no difiSculty in the way of ar- 
 raying symptoms almost indefinitely, as arising 
 from or dependent upon it. 
 
 But, what proof is there from an anatomical, 
 physiological or pathological standpoint, that 
 such a condition is probable; that such a phase 
 of spinal disease is possible; that the vascular 
 supply to the spinal cord is obstructed, dimin- 
 ished or altered, so that its nutrition is disturbed, 
 or that its cellular elements are impoverished, 
 while all the other organs of the body are func- 
 tionally active? Organs stimulated by the same 
 nervous systems, the same blood current; under 
 the same physical laws and influenced by the 
 physical and chemical changes. 
 
 All such proof is totally wanting; nay, on the 
 contrary, in mechanical anaemia of the organ or 
 limb induced by the surgeon, there is no analogy 
 whatever, into the symptoms resulting and those 
 said to be associated with "spinal-anaemia." On 
 ligation of the femoral arterj', as it emerges from 
 under Poupart's ligament, we will notice a cool- 
 ing of the limb arising from the emptying and 
 collapse of the peripheral capillaries and loss of 
 heat. Owing to veinous stasis and temporary 
 diapaedesis, there is a sense of fullness in the 
 iconnective tissues; but usually no pain, except 
 
147 
 
 wfiere the ligature was applied and perhaps a 
 nerve branch was injured. 
 
 With the brain itself, although one or both of 
 the carotid currents is dammed back, we may im- 
 mediately notice the physical effect resulting; yet 
 nothing will present itself, having the slightest 
 analogy to this new disease. "We have other in- 
 stances of mechanical, accidental, or pathological 
 exsanguination in which every organ must con- 
 tribute its share in the general loss, the spinal 
 cord as well as others, but the local impoverish- 
 ment of the spine, here, is not demonstrable by 
 any special symptoms. 
 
 From the foregoing, it is evident that there 
 is absolutely nothing whatever, which should 
 permit the continuance of a supposed pathologi- 
 cal entity which has no substantial existence. 
 We have no right, in these days, when instru- 
 ments of percision are at hand, to assume the 
 existence of a malady demonstrable, if at all, 
 rather by therapeutic than pathological proof. It 
 being supposed that certain functional disorders 
 are present, which indicate impoverishment of 
 the cord, medicines are given, which supply tone 
 to the muscles, enrich the blood and act as a spur 
 to the nervous system. But it is inconceivable 
 how one can infer from therapeutic induction 
 alone, that the spinal-marrow is the center of a 
 morbid change, when the system responds to 
 constitutional tonics or alteratives that act on 
 every fibre in the organism. It would be just as 
 illogical to argue that there was a localized anse- 
 
148 
 
 mia in the sciatic nerve, when, through some 
 acute malady, the bodily strength is at a low ebb. 
 
 The actual pathological condition which the 
 patient suffers from, in so-called spinal-anaemia, 
 is unquestionably a peripheral neuroses, of a neu- 
 ralgic character. As a matter of observation, it 
 is well known that along the central and lateral 
 planes of the spine there are local diseased areas, 
 whose principal manifestations are pain and hy- 
 peraesthesia. This pain may be localized or dif- 
 fused; constant or intermittent. It is usually 
 regional. It is a condition of aduk life, and is 
 much more common in women than men. 
 
 There is always a well-marked derangement of 
 the general health. The hepatic functions are 
 languidly performed. The patient has loss of 
 appetite and is constipated. He is pale, leuco- 
 cythenic and weak. If a woman, there will be 
 menstrual disturbances. What constitutes its 
 essential clinical differences in the sexes, ' is its 
 local, neuralgic manifestations, its seat of selec- 
 tion. 
 
 With the male sex it is very uncommon, 
 though when it does arise, its location will be in 
 the lower lumbar and gluteal regions; or those 
 parts supplied by the peripheral, or muscular 
 ramifications of the posterior division of the lum- 
 bar and sacral nerves. Then we will have what 
 is designated lumbago or sciatica. 
 
 With woman, these neuralgias generally radi- 
 ate through the nerve- filaments from the anterior 
 branches of the six upper dorsal nerves, on the 
 
149 
 
 left side, and also, along the pelvic fibres of the 
 anterior crural, which penetrate the ovary. 
 Here, too, singularly, pain is most frequent in 
 the left side. 
 
 These neuralgias, intercostal and ovarian, then, 
 are a consequence of a general debility, malaria, 
 and functional disturbances, and are not depend- 
 ent on traumatism of the spinal cord. 
 
 These neuroses belong to that class in which 
 the faith-healer and charletan reap a rich har- 
 vest; or in which anyone, who can make a sud- 
 den and positive mental impression on the mind, 
 will meet with marked success, when internal 
 medication fails. 
 
 Many phases of this, so-called, anaemic spine, 
 will yield to internal, reconstructive remedies, as 
 quinine, iron, arsenic or mercury; good dieting, 
 sea-bathing, change of air, travel, faradization, 
 shampooing, massage, dry cupping, plasters, etc. 
 
 The above may seem rather a digression from 
 the strict text; but under the circumstances, it 
 forms an important constituent of our theme, as 
 it is, in reality and fact, no fanciful or imaginary 
 picture; but is a truthful resume of what has 
 evidently been erroneously designated "anaemia 
 of the spine." 
 
 I have endeavored to completely demolish the 
 artificial and unstable foundation on which it 
 rests, and tried to demonstrate that this 'Watl- 
 roarf spinal anaemia" is a myth; but is, unhappi- 
 ly, often a source of distress among many who 
 have never seen a railroad. 
 
I50 
 
 Having so far considered the etiology and 
 clinical history of those lesions and derangements 
 attended with definite and precise pathological 
 changes, and other maladies assumed to succeed 
 concussive force applied to the back, it is now 
 necessary to extend our field of inquiry from 
 the parts which directly enter into the composi- 
 tion of the spine, to the cavities which it poste- 
 riorly walls in, the abdominal, thoracic and buc- 
 cal. 
 
 The abdominal cavity contains four fixed, solid 
 organs, dependent and suspended, having . no 
 bony encasement, and lying immediately anterior 
 to the flexible lumbar-curve, which are frequently 
 exposed to injury from indirect violence. 
 
 It is in this situation, that is most frequently 
 seen, destruction, limited or extensive, from trans- 
 mitted force; as when the liver, kidney, a dis- 
 tended stomach, bladder or gravid uterus, sufi"ers 
 laceration or rupture. 
 
 The renal organs suffer most frequently. Their 
 juxtaposition to the spine, behind the perito- 
 neum, when their meso-nephron, or the envelop- 
 ing layers of fibro-cellular tissue, is dense and 
 firmly fixes the organ in position. 
 
 With the exception of grave injury of the 
 cord, as a complication, I had never seen but 
 two cases of injuries of the back in which there 
 were evidences of kidney complications in ex- 
 trinsic lesions. One of those cases, a physician, 
 who, while aboard what is known as a cable-car, 
 was inj ured. These cars stop and start suddenly ; 
 
151 
 
 so that, unless managed by a competent grip- 
 man, there are almost constant jars and starts, in 
 their working. He had but entered the car and 
 was advancing towards the front, when it gave 
 a lurch forward, throwing him violently back- 
 wards against the iron-arm of a seat. The doc- 
 tor was unable to rise unassisted, and suffered 
 from shock for several hours. The day follow- 
 ing injury, he had haemoptyses and bloody urine. 
 By proper remedial measures combined with rest, 
 after ten days the haematuria ceased, and he was 
 able to sit up. His recovery to health was slow, 
 though in time he quite regained his former 
 vigor. 
 
 I have never seen hepatic disorganization, as a 
 sequence of spinal injury, unless mortal force had 
 been sustained. 
 
 This leads me to infer either one or two things 
 in this connection. The liver may suffer periph- 
 eral or central disintegration, when this does 
 not involve the large bload-vessels, with quite 
 unique impunity, as it undoubtedly possesses 
 within itself the property of complete and rapid 
 repair. It may, perhaps, be partly attributable 
 to its situation which, when attentively studied, 
 will be found to have a configuration and posi- 
 tion which effectually provide against extensive 
 damage by violence, and guards it against sud- 
 den concussive force. It has long been a matter 
 of observation by physiologists engaged in ex- 
 perimental work on the liver, of lower animals, 
 and by surgeons operating on hepatic structure, 
 
152 
 
 that if the primary gush of blood could be con- 
 trolled, little diflBculty would be experienced; as 
 the triple compound, circulating through the 
 hepatic lobules, possess marvellous haemostatic 
 properties, and plastic inflammation with rapid 
 coaptation, was the rule. 
 
 Only the free, thin-edged borders of the liver 
 are exposed. The solid, compact mass of this 
 organ, has a broad and intimate attachment to 
 the inferior surface of the diaphragm. It rises 
 high up under the shelving margins of the ribs 
 and rests on a surface well calculated to receive 
 and scatter concussive force, as it lies at its ante- 
 rior, superior, and greater part of its posterior 
 border on an air-cushion — the highly elastic and 
 expanding lung. 
 
 I know of no recorded case, wherein the spleen 
 suffered laceration in connexion with spinal in- 
 jury. 
 
 The stomach in a distended state, lying on its 
 posterior surface, in immediate contact with the 
 vertebral bodies, one might expect, would easily 
 rupture. It, however, is singularly invulnerable 
 to physical shock. 
 
 Certainly, it goes without saying, that violent 
 concussion, sustained, through transmission, by 
 the uterus, when impregnated more than three 
 months, almost inevitably leads to abortion or 
 premature delivery. 
 
 The contents of the thorax, the circulatory and 
 pulmonary organs, are seldom involved in severe 
 injuries to the back. Very often, force brought 
 
153 
 
 to bear will so compress the chest antero- poste- 
 riorly as to induce multiple, costal fracture. The 
 pulmonary parenchyma is very tough and will 
 resist great pressure. I have never seen rupture 
 of the heart from concussive force, through the 
 dorsal region; although Watson has observed 
 such a complication in his experiments. 
 
 An injury of the cervical vertebrae sufiici«nt to 
 compromise the integrity of the buccal cavity, 
 alimentary or air-passages, must be almost in- 
 evitably fatal. 
 
 MORBID ANATOMY AND PATHOLOGY OF TRAU- 
 MATIC SPINAL LESIONS. 
 
 Morbid changes of structure, resulting from 
 injuries born of the spine, vary according to 
 manifold circumstances, to the quality and force 
 applied; the time intervening from the accident; 
 the age and condition of the patient; the extent 
 of parenchymatous changes and degree of repara- 
 tive effort. 
 
 If the violence have been shortly followed by 
 death, little will be noted, except extensive lacer- 
 ation of the parts, with disorganization, partial 
 or complete, at the seat of injury. There may be 
 ecchymosis of the integuments and evidence of 
 some bleeding in the underlying tissues, its 
 quantity and quality being dependent on the de- 
 gree of shock, heart depression, chemical and 
 vital changes. 
 
 I ha-ve frequently noted that when the bleed- 
 ing is eccentric to the spinal- canal, the blood is 
 commonly more or less coagulated; but when 
 
154 
 
 within the bony rings of the vertebrae, whether 
 intra- or extra-meningeal, is always ©f a dark 
 liquid consistence. 
 
 In those who have succumbed from lesions 
 entailing much loss of blood, with compression 
 of the cord resulting therefrom, I have invaria- 
 bly found the haemorrhage located external to 
 the meninges spinalis, and coming from the lacer- 
 ation of the meningo-rachidian or the longitudi- 
 nal spinal sinuses. 
 
 /ntra-meniageal haemorrhage, either from the 
 fine capillaries on the serous surface of the dura- 
 mater or the medulla- spinal viens of the columns, 
 horns, sulci and substance of the cord itself, I 
 have never seen. Possibly it may occur as a 
 pathological process in certain constitutional 
 maladies, but as a result of an injury is not pos- 
 sible, except in connection with mortal destruc- 
 tion. It is well to remember that the cord, weigh- 
 ing but an ounce and a half, has but from sixty 
 to eighty drops of blood ever circulating in it, that 
 it is swung in a chamber holding' nearly three 
 ounces of fluid, by which it is surrounded on ev- 
 ery side, and nowhere comes in contact with the 
 bony walls which enclose it. 
 
 Haemorrhage within the theca seldom is seen, 
 post-mortem, to rise above the mid-dorsal region. 
 The adjacent fibrous tissues are always deeply 
 stained and occasionally the haemorrhage will 
 find its way outward through the inter -vertebral 
 foramina in the direction of the nerve -trunks. 
 
 I have not yet seen any cases in which ad- 
 
155 
 
 vanced changes in the direction of disintegration 
 tion were noted after spinal bleeding. 
 
 When haemorrhage has been considerable, not 
 disappearing by absorption, we will find associ- 
 ated with it changes attributable to congestion 
 and inflammation. The vessels on the thecal 
 and serous surfaces of the dura- mater are greatly 
 distended, the subarachnoid fluid is turbid, and 
 small flakes of lymph may be seen floating in it. 
 In places the piamater and arachnoid are glued 
 together, by adhesive inflammation. The cord 
 itself is softened, and under the microscope are 
 seen along the periphery of the white matter 
 round cell infiltrate with leucocytes and granu- 
 lar matter intermixed. 
 
 All the membranes are markedly thickened 
 and have a deep congested hue. 
 
 The soft tissues overlying the spinal cord in 
 spinal-meningitis, as with all other tissues which 
 overlie inflamed serous membranes, as those 
 of the abdomen, thorax and skull, are always 
 considerably thickened and distended by an in- 
 flammatory exudate. 
 
 There will be found at times, evidences of bone 
 implication, synovial destruction within the cap- 
 sular ligaments, and sero- purulent formations. 
 
 The pathological changes observed during life 
 after spinal injuries, are important to correctly 
 comprehend. They may, for purposes of descrip- 
 tion, be divided into four classes: i. Eccentric 
 lesions; 2, centric lesions; 3, organic lesions; 4, 
 functional disturbances. 
 
156 
 
 Eccentric lesions are those of the structure 
 which are situated external to the spinal canal 
 and involve the bony architecture, the motor 
 leverage, circulatory system, mainly; and the 
 peripheral nerves. They are dependent on pressure, 
 tension or laceration. In the vast majority of 
 cases, being of a trivial nature, they give little 
 inconvenience; but when the back has borne 
 great and considerable force, we may witness 
 such lesion of muscle or other structure as will 
 cause temporary or permanent loss of function. 
 If inflammation supervene, the residuum of its 
 deposit may undergo fibrous changes and so bind 
 the sinewy structure together, as to occasion 
 muscular anchylosis, pressure on the nerves or 
 blood-vessels and amytrophic changes, in all the 
 tissues. If the integuments and the subjacent 
 tissues are lacerated we can readily comprehend 
 how, through the intimate connection between 
 the dorso- spinal and meningo-rachidian vessels, 
 septic processes may be transported to the envel- 
 oping membranes of the cord . 
 
 Primary congestion or inflammation in the in- 
 ter-muscular connective tissues seldom give rise 
 to organic changes, and readily subside. But 
 a severe injury, the widespread effects of which 
 involve en masse all the tissues, may be followed 
 by a low grade of inflammation, implicating the 
 vascular supply, giving rise to a phlebitis or 
 thrombosis of the superficial or deep veins, in 
 this manner seriously interfering with nutrition 
 and inducing a softening or wasting of the mus- 
 
157 
 
 cles. The bony structure of the spine usually 
 escapes an injury unless great violence is borne. 
 In children, however, this immunity does not 
 obtain, especially when tubercle is inherited. 
 
 In fractures of the spine, so called, everything 
 will depend on the direction which the fragments 
 have taken. If the broken bone be crushed in, 
 on the cord, we will have haemorrhage, inflam- 
 mation and softening, while if there be slight 
 displacements, the cord may escape. We have 
 no proof that the bones of the spine will regen- 
 erate; certainly if they are allied anatomically 
 and physiologically with those of the cranium, 
 which is claimed by some anatomists, then they 
 are destitute of osteogenetic power. 
 
 Simultaneous or consecutive osseo-arthritic 
 changes of an inflammatory nature in the verte- 
 bral joints seldom extend to the cartilagenous 
 pulp between the bodies in the absence of consti- 
 tutional cachexia. The pain along the spine in 
 various regions according to where concussive 
 force is applied, is dependent, I am convinced, 
 rather on a low grade of cellulitis, involving the 
 muscles and tendons, than a peripheral neuritis. 
 
 Centric lesions of the cord, accentuated by 
 clearly defined symptoms and resulting from 
 trauma, are very seldom met with. Although 
 I have seen and treated now more than one hun- 
 dred, and fifty cases of fracture of the vault of the 
 skull, up to the time I reported them in Oct. , 
 1890 (Trans. New York Medical Ass'n., 1890), 
 and saw more than fifty fractures at the base, 
 
158 
 
 besides very many cases of cranial injury in 
 which spasm or paralysis followed and the pa- 
 tients recovered; in that seventeen years experi- 
 ence I had under my care but ten spinal injuries 
 of an intrinsic character, so that on a reasonable 
 calculation, in falls, blows, or collisions, it may 
 be said that the proportional injuries of the cord 
 with that of the brain under those circumstances, 
 was rather less than one to twenty. 
 
 As the spinal cord cannot be stretched nor 
 sundered by concussion, we must direct attention 
 mainly to the effects of pressure; pressure by bone, 
 luxated or fractured, or pressure by blood; by an 
 excess of serum, lymph, a plastic exudate or pus. 
 
 Should a large spicula of bone be driven in or 
 through the meninges, the cord is irreparably 
 disorganized beneath it. Fractures of the lateral 
 arches, involving the transverse processes, imply 
 great violence, and I believe are always fatal, 
 either immediately or remotely. The spinous 
 processes in slim subjects being very superficial, 
 give way to force most frequently; but owing to 
 their inclined, overlapping adjustment and nu- 
 merous ligamentous supports, are dislodged with 
 difficulty. When bone pressure is moderate but 
 constant, along with producing paralysis, involv- 
 ing the motor or sensory nerves, or both, it gives 
 rise to meningitis and myelitis. Before necrotic 
 processes of the osseous structures is complete, 
 the patient has usually succumbed. 
 
 Intra-spinal haemorrhage, after severe injuries 
 of the back, by pressure, may induce temporary 
 
159 
 
 paralysis, meningitis or molecular degeneration 
 of the medullary substance. The pathological 
 changes which it induces are those characteristic 
 of pressure exercised by a solid substance. The 
 effused blood being confined within an air-tight 
 chamber, in which the circulation is necessarily 
 languid, absorption is slow and imperfect. 
 
 Spinal meningitis, resulting from trauma as a 
 primary affection, is very rare, except in the 
 presence of fracture. . Commencing as a local and 
 well-defined affection,' its tendency is to spread 
 upward into the basic meninges of the brain. 
 
 The peripheral sensory nerves in spinal men- 
 ingitis are always morbidly susceptible to im- 
 pressions, and the reflexes in the early stages of 
 the malady give rise to intermittent or constant 
 spasm of the muscles. 
 
 Authors have in turn framed different theories 
 to explain the predominance of one phenomenon 
 over the other in those meningeal inflammations, 
 when at one time we will have anaesthesia or 
 hyperaesthesia in a limb which is motionless. 
 
 They have sought to justify and prove their 
 conclusions by experimental physiology, ascrib- 
 ing one set of symptoms as attributable to path- 
 ogenic changes in the an tero- lateral columns of 
 the cord ; another, to the posterior columns ; to 
 the grey matter and white substance, alternate- 
 ly. These views are, however, merely specula- 
 tive, and are lacking the confirmation of post- 
 mortem examination. Admitting, nevertheless, 
 their scientific accuracy, it would, as far as we 
 
i6o 
 
 know, in no way aid their surgical management. 
 Meningeal inflammation, although, as its stages 
 merge one into the other, thus inducing pain, 
 spasm and paralysis of the lower regions of the 
 body, is compatible with consciousness and life, 
 until the upper cervical segment of the spine and 
 base of the brain are involved. 
 
 Irregularity of cardiac and respiratory action, 
 with twitching of the facial muscles, loss of 
 speech and the power to swallow, slowly devel- 
 oping deafness and dimness of vision, announce 
 that the roots of the cranial nerves are involved 
 and that the end is near. As we invariably wit- 
 ness spinal manifestations in cerebral meningitis, 
 so in grave spinal meningitis the vital and psy- 
 chological functions of the brain never escape parti- 
 cipation. Organic lesions of the cord, arising inde- 
 pendently of constitutional causes, are infrequent. 
 
 The medulla-spinalis is seldom involved in 
 inflammatory processes without the participation 
 of the meninges, the latter being the primary 
 structure to take on inflammation. 
 
 When the spinal marrow undergoes intersti- 
 tial or molecular disintegration, as a result of 
 trauma, along with constant pain over the integ- 
 uments of the back, which often, too, is reflected 
 along the sensory nerves into the extremities, we 
 will see paralysis, spasm or hypersesthesia, which 
 will correspond with that area of the cord sup- 
 plying the affected group of muscles. 
 
 As I have never seen the seat of traumatic 
 pyelitis or pathological changes limited to the 
 
i6i 
 
 cords alone, post mortem, I cannot speak from 
 personal observation ; nor can. I find such a con- 
 dition even mentioned by such world-renowned 
 pathologists as Virchow, Paget, or Billroth. 
 
 We must turn to medical pathology for infor- 
 mation relative to those fine structural changes 
 which occur in the pulpy matter, for, no doubt, 
 like pulmonary tuberculosis and Bright's disease 
 of the kidneys, those microscopical changes in 
 the nerve-cylinders invariably depend on sys- 
 temic influences solely, and not on violence of 
 any description; hence what has been written so 
 fully relative to pathological changes in the spi- 
 nal marrow has but little application to surgical 
 or traumatical lesions of it. 
 
 Of the functional neuroses of the spine, their 
 name is legion. In a surgical essay on spinal 
 diseases, their consideration from a pathological 
 stand would seem a work of superrerogation, if it 
 were not claimed that many of them had their 
 starting point in an injury. They have been 
 designated spinal anaemia and spinal congestion, 
 spinal concussion, etc., and one author CHam- 
 mond on the Nervous System, page 217) has 
 even gone so far as to further subdivide them on 
 a physiological basis into anaemia or congestion 
 of the antero-lateral and posterior columns. An 
 imaginary pathology has been elaborated, with 
 considerable detail and circumspection, to corre- 
 spond with the views and notions of the authors, 
 and we are told now that precise localization of 
 spinal lesions is a matter of great simplicity. We 
 
1 62 
 
 are informed that certain cells within the grey mat- 
 ter and white substance degenerate and regenerate 
 under the influence of the circulation, which, at 
 one time, is excessive and another diminished ; 
 that one train of symptoms is dependent on one 
 phase of the blood supply, another on a contrary. 
 Now, as no one has yet been able to demonstrate 
 by an autopsy the pathological changes, if any 
 in those functional maladies are present, the 
 necessary proof is wanting to support these 
 assertions. 
 
 These allegations are dependent then wholly on 
 empiricism. When subjected to the rigorous 
 test of scientific analysis, they fade away into 
 nothing. 
 
 Very many of these spinal neuroses of a func- 
 tional nature are chiefly hysterical, epileptic, or 
 choreaic, probably dependent on hereditary in- 
 fluences, sex or habit, which act through the 
 blood. Their pathology cannot be definitely 
 written yet, for it is not understood. Without 
 question, however, we may rather look to the 
 cerebral organs for the central trouble than the 
 medulla-spinalis. 
 
 THE DIAGNOSIS OF INJURIES OF THE SPINE. 
 
 Before the days of I,aennec, every species of 
 acute inflammatory afiection involving the lung, 
 its parenchyma, its tubular structure, and serous 
 investment, was designated "a pleurisy," and 
 all were treated on the same general principles, 
 by essentially the same remedial agents. But 
 
1 63 
 
 there came forth a genius, who applied the reve- 
 lations of physics to vital phenomena within the 
 human body, and he taught how, by the aid of 
 the eye, the ear and the tactile sense, we might 
 not only recognize the different structures in- 
 volved, but that we could, with certainty and 
 precision, estimate the progress or retrogression 
 of the pathological changes within them. Now, 
 though of great value, this application of physical 
 laws to the elucidation of pulmonary diseases, 
 for diagnosis and prognosis, yet the late famous 
 clinical teacher, Thomas Watson, said, in speak- 
 ing of pulmonary disease : "It may seem para- 
 doxical, but the very perfection of the physical 
 diagnosis of pulmonary diseases, has often con- 
 stituted an impediment to their treatment." 
 
 Spinal diseases taken collectively, as a whole, 
 were in the same chaotic state, at the beginning 
 of the present century, as were maladies of the 
 lungs before the days of I^asunec. But through 
 the discoveries and experiments of Magendie and 
 Bell, the functions of the nerve roots are now 
 known, and by the aid of Brown Sequard and 
 other experimental pathologists, we have been 
 made aware of the special properties resident in 
 the columns and matter of the cord, itself. 
 
 Surgical pathologists have made it possible for 
 us to differentiate the inflammations or patholog- 
 ical changes in the various structures which en- 
 velop the medullary cylinder, from within out- 
 ward. And hence, to-day, not as formerly, we 
 are enabled to speak definitely of the idiopathic 
 
164 
 
 or traumatic affections which may occupy any 
 area of the spine, or its organic components. 
 
 It may not be always possible to effect a defi- 
 nite diagnosis immediately after an injury of the 
 spine has been sustained, unless very great vio- 
 lence was applied, and the cord itself suffered 
 direct and positive pressure from displaced bone, 
 or fracture, as under which circumstances, complete 
 and instantaneous paraplegia is invariably a 
 symptom of mortal omen. 
 
 At the first visit to our patient, we may find 
 him suffering severe pain in all the joints below 
 the sacro-lumbar articulation and upward along 
 the lateral planes of the spine. He is unable to 
 raise the body or elevate the lower limbs without 
 very great difficulty, even if it is possible at all. 
 He has perfect control of his sphincters, and sen- 
 sation is nowhere impaired. 
 
 The family, friends, or patient himself may 
 now demand of the medical attendant informa- 
 tion as to the nature and extent of the injury. 
 This cannot be stated at this visit, but I feel as- 
 sured, from my own experience in a large num- 
 ber of spinal injuries, that, however, it will sel- 
 dom require but a very few days before we can, 
 with certainty, say whether the spinal marrow is 
 involved or not. Haemorrhage, inflammation, se- 
 rous or purulent effusion, will present symptoms 
 of such a clear and unmistakable type, that one 
 cannot be deceived or incapable of interpreting 
 their clinical significance who has had experience. 
 
 The most serious, but infrequent, lesions at- 
 
i65 
 
 tending violent injuries to the back, are those 
 which have reference to the cord and its mem- 
 branes. 
 
 These are of a primary and secondary charac- 
 ter. With the former, we are promptly apprised 
 of direct medullary implication, by the presence 
 of paralysis in the lower members, complete or 
 incomplete. Primary paraplegia after the inju- 
 ry is usually induced by pressure, which effects 
 the disorganization of the cord, destroying its 
 conducting power. We are not always able to 
 precisely define the exact situation or extent of 
 pressure, for an arch or lateral plate of vertebra 
 may have been fractured and forced into the spi- 
 nal canal at the time of accident, but, owing to 
 the elasticity and strength of its connecting liga- 
 ments, with the rebound, it is retracted away 
 from the indented cord. And, on examination, 
 although there may seem some slight increased 
 mobility of a projecting vertebral spur, we can- 
 not always assume that there is displacement. 
 
 As a diagnostic aid, we might have recourse to 
 an exploratory incision, so as to effect a more ac- 
 curate estimate of the effect of the injury, and to 
 guide us in the way of treatment. 
 
 But, although this might be a theoretical ad- 
 vantage in serving a dual purpose, yet practically 
 it cannot, only in very exceptional circumstances, 
 be regarded as a permissible procedure. Possi- 
 bly, under extreme circumstances, might a free 
 incision into the tissue be allowed as a therapeu- 
 tic measure — as a diagnostic, never. 
 
1 66 
 
 In the presence of total inhibition of the 
 spinal or neural functions in the lower extrem- 
 ities, we may pronounce the lesion in the 
 spinal cord one of an irreparable character, re- 
 sulting from direct and permanent disorganiza- 
 tion of such a description that, even though the 
 cord were stripped of its investments and com- 
 pletely accessible, we are powerless in the way of 
 instituting remedial measures. 
 
 Traumatic compression, laceration, or disinte- 
 gration of the spinal cord, accordingly, may be 
 said to be a condition of easy diagnosis, when 
 complete paraplegia is present. Certainly, when 
 bone is fractured, but is not displaced, and no 
 symptoms are present indicative of paralysis, we 
 cannot, in the deeply buried lines of the back, 
 always make an immediate diagnosis. It is ol 
 little consequence under these circumstances, how- 
 ever, that we fail to correctly ascertain the extent 
 of lesion, for it will in no way influence remedial 
 measures, or affect prognosis. 
 
 Unfortunately, when the cord and its mem- 
 branes become secondarily involved, some days 
 or weeks after injury, diagnosis is attended with 
 many perplexities. 
 
 Next to osseous pressure, in producing organic 
 changes in the spinal cord, will come haemorrhage. 
 
 Paresis following hypersesthesia within twenty- 
 four or forty-eight hours of the injury, will be 
 suggestive of intra-spinal haemorrhage. Its vol- 
 ume may be estimated by the extent of paralysis 
 and the areas affected. When the viscera sup- 
 
1 67 
 
 plied by tHe lumbar plexus show evidences of 
 paralysis, and the sphincters of the bladder and 
 rectum fail to act, we may assume that the efiu- 
 sion has mounted up to the dorso- lumbar junc- 
 tion. 
 
 It may require a very nice discrimination in 
 diagnostic tact to differentiate, at the outset, in- 
 tra-spinal haemorrhage from meningeal inflam- 
 mation. But the patient's exsanguinated condi- 
 tion, the deep-seated pain from pressure, the 
 absence of chills, acceleration of the pulse and 
 of rising temperature, all point to the exclusion 
 of inflammatory changes having yet occupied 
 the rueninges. 
 
 Our diagnosis of intra- spinal haemorrhage will 
 be corroborated if, within a week's time, amelio- 
 ration of the symptoms is present, and restora- 
 tion of function is being gradually reestablished. 
 
 Extensive haemorrhage from the dorso-rachid- 
 ian vessels, when profuse and localized as in an 
 intra-muscular haematoma, may be recognized as 
 a sanguineous effusion which, in the healthy in- 
 dividual, rapidly vanishes by absorption. 
 
 Changes of an inflammatory character in the 
 spinal cord are rnanifested by a diversity of symp- 
 toms. First, by constitutional phenomena, which 
 profoundly impress the nutritive processes and 
 local conditions. The patient has fever, quick 
 pulse, rising temperature, is thirsty, has neither 
 sleep nor appetite. 
 
 There is always pain in the back in traumatic 
 spinal meningitis, associated with extreme pe- 
 
i68 
 
 ripheral tenderness, localized or extensive anass- 
 thesia along tlie extensor or flexor surfaces of 
 one or both limbs. Thus a clonic spasm, unilat- 
 eral or symmetrical, is always present, provided 
 there has been no implication of the medulla. 
 When there is this association, the cord having 
 lost its connective power below the seat of lesion, 
 spasm will be noticed only above this limit. 
 
 We are perhaps justified, in the presence of a 
 certain set of symptoms, in assuming that we 
 may, at the outset, be able to localize the limit 
 of meningeal inflammation. This would seem 
 all the more positive when, in the presence of 
 every symptom of incipient meningitis, we suc- 
 ceed, by the active interposition of therapeutic 
 resource, in arresting its progress. Accordingly, 
 we may assume that the lumbar segment, the 
 Cauda equina, is the primary and only region af- 
 fected when paralysis, paresis, hypersesthesia, 
 spasm or muscular twitching, is confined to the 
 parts supplied by the nerves whose roots are lo- 
 cated in this district. Stifihess, pain or spasm 
 in the muscles supplied by the lower dorsal seg- 
 ment, those muscles animated by the lower six 
 dorsal nerves, viz.: the deep spinal muscles of 
 that region and the three sets of muscles which 
 anteriorly and laterally wall in the abdomen, the 
 external and internal, oblique and transversalis. 
 Hence, the muscles of the back are hard, stifi" 
 and unyielding, and it is noteworthy at this junc- 
 ture, that the patient begins to complain of a 
 most oppressive sense of weight and constriction 
 
169 
 
 over the abdomen, which he compares to being 
 drawn tightly by an encircling cord, the abdom- 
 inal muscles pulling in an opposite direction ; or 
 having a heavy weight resting on the prsecordia. 
 The movable wings of the thorax are locked 
 and fixed by an intermittent spasm of the lower 
 intercostal muscles, and respiration is maintain- 
 ed principally, now, by its auxiliary muscles, 
 the cervical and scapular, with the aid of the 
 diaphragm. 
 
 Meningeal inflammation having compromised 
 the entire dorsal district, we have anticipated it, 
 as it were, i. e., knowing, when this area of the 
 arch is invaded, our patient — whose mental fac- 
 ulties remain as yet unclouded — is warned of his 
 impending danger, and given time to prepare 
 himself and arrange his affairs — as, with but an- 
 other slight advance into the cervical region, the 
 implication of post- thoracic and the phrenic 
 nerves, when asphyxia will terminate the strug- 
 gle. 
 
 The diagnosis of cervical meningitis is unim- 
 portant, as the general meningeal disease is 
 wholly beyond our control, and swiftly fatal, 
 when this area is occupied. 
 
 I have seen in several fatal cases, a rather sin- 
 gular clinical phenomenon, in the upward march 
 of inflammatory changes. It was this: that 
 whereas the extension of the disease, from the 
 lumbar to the lower dorsal district, may occupy 
 several days and be extremely insidious in its 
 advance, but, when it was finally manifest in the 
 
dorsal segrnent, it often, within the lapse of a 
 few hours, spread into the cervical region and 
 quickly terminated life. 
 
 CONCLUSIONS. 
 
 In dealing with the foregoing subject, my aim 
 has been to compress within a small compass as 
 much as possible, without omitting any impor- 
 tant detail ; but I fear, with the space at my 
 command, in this I have but partly succeeded. 
 Quotations and the historical part of the subject 
 have been largely omitted. 
 
 In presenting the study of spinal lesions my 
 object has been, rather, to make it clear and 
 comprehensive than to confine myself rigidly to 
 any arbitrary arrangement of matter; for, re- 
 gardless of what pains may be taken in con- 
 structing an article, under various headings, the 
 divisions and subdivisions are often more rela- 
 tive than absolute. 
 
 Very little or no notice at all is given to the 
 subject of traumatic lesions of the spine, in text . 
 books, or even encyclopaedic works on surgery ; 
 hence, we are justified in assuming that serious 
 injuries of this structure are rare, or else, that 
 surgeons have given them very little attention. 
 
 An attempt has been made here to isolate the 
 complexity of lesions following severe injuries of 
 the back, and not confound the consequences of 
 one with the other, and to demonstrate that grave 
 injury may be sustained in the rachidian region 
 without any implication of the cord. 
 
Accordingly, in the light of our present knowl- 
 edge, and after a careful study of normal struct- 
 ure and function; the physics of force which give 
 rise to spinal injury; experimental investigation, 
 clinical phenomena, pathological changes and 
 morbid anatomy, it may be definitely stated : 
 
 1. That in the vast majority of cases in which 
 complete paraplegia immediately sets in, after 
 spinal injury, it may be assumed, with almost 
 positive certainty, that the medulla-spinalis has 
 sustained a palpable lesion of its integrity, which 
 usually ends mortally. 
 
 2. That there is no proof that mere concussive 
 force will either simultaneously or consecutively 
 ever lead to paralysis, without inducing well- 
 marked and positive pathological changes in the 
 anatomical elements of the cord. 
 
 3. Physical force and the psychological effects 
 of fright being the same in railroad as other in- 
 juries, there is nothing to justify the claim that 
 there are grave lesions of the spine resulting 
 from railroad collisions which are characteristic 
 and peculiar. 
 
 4. There being no proof of the existence of 
 such diseases as anaemia or hypersemia of the 
 cord, as pathological entities, they are entitled 
 to no place in the nomenclature of traumatic spi- 
 nal diseases. 
 
 5. Eccentric lesionsof the back, without anyim- 
 plication of the cord, may, nevertheless, by pres- 
 sure on the meninges secondarily give rise to 
 meningitis, local or general; also by infection, 
 
172 
 
 propagated inward, ultimately effect tlie meduUa- 
 spinalis. Those extrinsic injuries may, too, of 
 themselves, by inducing pathological changes in 
 the bones, cartilages, joints or muscles, occasion 
 a permanent weakening or loss of power in the 
 back. 
 
 6. It should be constantly borne in mind that 
 there are always essentially two different and 
 distinct sets of pathological lesions which result 
 from spinal injury, viz., those involving the cord, 
 of rare occurrence and generally fatal, and those 
 exterior to the spinal canal, very common, but 
 seldom giving rise to serious impediment of 
 function. 
 
EI.ECTRO-DIAGNOSIS IN BRAIN AND 
 NERVE INJURIES — METHODS USED 
 AND THE APPARATUS RE- 
 QUIRED. 
 
 BY W. H. WAI/LING, M.D., 
 
 OF PHILADELPHIA, PA. 
 
 There are two very important propositions to 
 be considered in connection with electro-diagno- 
 sis, the first of which is, an adequate knowledge 
 of electro-physics and electro-physiology, and 
 the second, the need of the proper apparatus 
 with which to conduct such investigation. 
 
 The first proposition, or a proper understand- 
 ing of the subjects named, is so obviously essen- 
 tial that it is scarcely necessary to discuss it. 
 
 The apparatus required for accurate electro- 
 diagnosis merits our careful consideration. While 
 with an ordinary faradic battery and common 
 electrodes the approximate condition of a nerve 
 may be arrived at, our tests will be of only a 
 proportionate value. 
 
 The batteries, meter and controller that I use 
 here to- day were made by Mr. Otto Fleming, of 
 Philadelphia. 
 
174 
 
 Unfortunately, we have no definite standard 
 in this country for our faradic coils, or for the 
 size of our electrodes, hence the resulting confu- 
 sion in comparative tests by different operators. 
 It is to be hoped that the American Electro- 
 Therapeutic Association will, at its next meet- 
 ing, appoint a committee to consider this very 
 important question of the standardization of our 
 apparatus and electrodes. This is secondary in 
 importance only to the proper standardization of 
 the fluid extracts and tinctures of the U. S. P., 
 which I so strenuously advocate. 
 
 For electro-diagnosis three different currents 
 are used, the faradic, the galvanic, and the 
 franklinic. The faradic coil, which I use in 
 diagnosis, which I here show you, is constructed 
 upon the DuBois- Reymond principle, and grad- 
 uated, by means of a scale, into centimeters and 
 millimeters. The cell used to operate this coil 
 is a modification of a grenet cell, and has an 
 electro- motive force of one and a half volts. For 
 my stationary coil I use two modified I,aw cells, 
 as they are less troublesome, and are quite con- 
 stant in action. The dry cells have not, as yet, 
 met our expectations, when used upon the fara- 
 dic coil. It must be remembered that the cell, 
 in all faradic machines, is on what is termed 
 short circuit when in use, hence the dry cell, 
 having a tendency to rapidly polarize, soon runs 
 down, and the battery will not work until the 
 cell has time to recover. 
 
 This apparatus is supplied with a slow, as well 
 
175 
 
 as a rapid interrupter, and the movements of the 
 former may be regulated to suit the operator. 
 With a machine constructed upon this plan, the 
 exact coil distance required to produce a con- 
 traction, if one be obtainable, may be observed 
 and recorded, andaccuratecomparisons made from 
 time to time. 
 
 It has been repeatedly stated that it makes no 
 difference which of the two poles of the faradic 
 battery are used, as the reaction of nerve and 
 muscle is the same for both poles. I dissent 
 from this statement. In testing a nerve with my 
 ofiSce coil, for instance, I find that I can get a 
 contraction with the cathode from six and a half 
 centimeters coil distance, while seven and a half 
 centimeters are required with the anode to get 
 the same contraction. This from the primary 
 coil. With the secondary coil the same contrac- 
 tion was produced by two centimeters c.d., cath- 
 odal closure, and two and eight-tenths of c.d. 
 were required with the anode. 
 
 The electrodes selected to make the first ex- 
 amination should be used throughout the case. 
 Erb recommends that the active electrode should 
 be ten square centimeters surface measure; Stintz- 
 ing one of three centimeters surface. Erb's in- 
 strument is the one most generally used. Both 
 electrodes should be covered in the same manner, 
 preferably with absorbent cotton, wetted to the 
 same degree, in the same solution, and be placed 
 upon the same spots on the body at each exam- 
 
176 
 
 ination, and the pressure should also be the same 
 as near as possible. 
 
 The size of the electrodes used make a vast 
 difference in the amount of current required in 
 order to produce a contraction. 
 
 For the purpose of general diagnosis, the pa- 
 tient is prepared by removing as much of the 
 clothing as may be necessary, and, if a female, 
 protected by a sheet or loose wrapper, and seated 
 upon a suitable stool, upon which a wet sponge , 
 electrode is placed, attached to the positive pole 
 of the secondary coil of a faradic machine. The 
 operator then takes a small, well-wetted sponge 
 or cotton-covered electrode, attached to the neg- 
 ative pole, and, commencing at the nape of the 
 neck,' with a current plainly perceptible to the 
 patient, passes down the back upon both sides of 
 the spinal column, noting the effect produced. If 
 there are tender spots, they will be quickly ap- 
 parent by the patient wincing, or saying that it 
 is painful. Note the coil distance required to 
 locate these spots. Anaesthesia may be present 
 in some areas, and more current be necessary to 
 produce an impression. 
 
 The tender spots indicate points of greater or 
 less inflammation. Blood being the best conductor 
 of all the tissues of the body, all such foci of 
 congestion or inflammation offer less resistance 
 to the current, consequently the greater amount 
 will seek to pass in that direction, and cause the 
 pain by reason of such density. Test both sides 
 of the spinal column, and note all the reactions. 
 
177 
 
 Pain is ijot always an indication of an inflam- 
 matory condition, or of a lesion, as when the 
 sponge is passed around the sides of the patient, 
 and over the ribs, more or less pain will be ex- 
 perienced, due to the effect of the vibrations upon 
 the periosteum. This effect is always seen when 
 the faradic current is used over bones which are 
 superficial, such as the scapula, etc. As the 
 electrode passes over the motor points of some of 
 the abdominal muscles, they will be strongly 
 contracted, but this is, as a rule, of no particular 
 significance. For testing for anaesthesia, this 
 small electrode will be found useful ; also for 
 testing the electro- cutaneous sensibility of va- 
 rious parts of the skin. It is made of a large 
 number of copper wires, closely approximated, 
 but insulated from each other, and placed in this 
 hard- rubber case. The coil distance necessary 
 to produce a sensation upon different parts may 
 be compared. This electrode is to be attached 
 to one pole of the secondary coil, and the other 
 placed upon the sternum, and the coil distance 
 required to produce a sensation noted. A pain- 
 ful impression is then given, and noted, when 
 the active electrode is removed to the opposite 
 side of the body, and the same test made, when 
 the two may be compared. 
 
 Diminution of sensibility, or sensory irritabil- 
 ity, is present in nearly all lesions of the spinal 
 cord and peripheral nerves, which are serious in 
 character, and is also present in many cerebral 
 affections. 
 
178 
 
 Stintzing has tabulated the normal reactions 
 of nerves to the faradic current, a few examples 
 of which I present. The numbers are the milli- 
 meters on scale: 
 
 Musculo cutaneous, contraction at 15 m.m. 
 
 Frontal branch of facial, 25 m.m. 
 
 Ulnar, at olecranon, 31.5 m.m. 
 
 Crural, 38.5 m.m. 
 
 Radial, 45 m.m. 
 
 As no two machines are alike, the value of 
 these tables are only approximate. 
 
 THE GALVANIC BATTERY. 
 
 As the galvanic battery is our sheet anchor in 
 definite electro- diagnosis, it is essential that 
 everything be as perfect and complete as possi- 
 ble. The battery must be able to maintain a 
 fairly constant potential, and for this purpose, 
 especially for an ofiEice, or stationary battery, the 
 I^aw or lycclanche cells are the best. The cells 
 should be coupled in series; that is, the zinc of 
 the first cell is attached to the carbon of the sec- 
 ond, the zinc of the second to the carbon of the 
 third, and so on until all are connected, the bat- 
 tery consisting of from forty to eighty or more 
 cells. The two terminal wires from the end cells 
 are run to the controller and meter, thus com- 
 pleting the circuit. This is the common arrange- 
 ment, but I prefer to have each cell connected 
 with my switch-board, so that I may select any 
 number, from one up to the whole number. My 
 reasons for such arrangement are, that where you 
 
179 
 
 are using the whole battery, and attempt to con- 
 trol the current by means of the rheostat, the 
 amperage is alone controlled, and not the volt- 
 age. In this connection, I desire to enter my 
 protest against the use of the Edison electric- 
 light current for medical purposes. It will charge 
 your secondary -batteries, light your houses, your 
 streets, and some of the cavities of the body, but 
 I consider it unsafe and unreliable when used in 
 place of a chemical galvanic battery. There is 
 too much voltage, or electro motive force, which 
 cannot be properly controlled. But there is the 
 greater danger of a short circuit somewhere, and 
 of the whole current being thrown in upon an 
 unsuspecting patient, with damage to health, 
 and possible loss of life. Such accidents have 
 happened, and are liable at any moment to be 
 repeated. 
 
 It is also on account of the high voltage from 
 the primary battery, when all the cells are con- 
 stantly in circuit, that I object to the series 
 arrangement. Suppose, for instance, that you 
 wish to use one half of a milliampere of current 
 upon the eye; of what possible use have you for 
 eighty to a hundred volts of pressure? Not 
 only is such pressure useless, but it is hurtful, if 
 not positively damaging. This I have demon- 
 strated again and again, to my entire satisfac- 
 tion. For instance, one of a series of patients 
 referred to me by Prof. Kej'ser for treatment for 
 facial paralysis, and now under my care, com- 
 plains of intense pain in the supra-orbital nerve. 
 
i8o 
 
 with only one-half of a ma. of current, when I 
 have fifty cells in circuit, the current- controller 
 •being also used, but bears one ma. from twenty 
 cells, not onl}^ without pain, but with positive 
 comfort. A painful and sensitive nerve quickly 
 differentiates against voltage. It seems evident 
 that as we throw in resistance, by means of a 
 rheostat, we increase the pressure, and my rule 
 is to use only just a sufiBcient number of cells to 
 give the current strength I want, and no more. 
 All above that number is a waste of force, and a 
 positive disadvantage. 
 
 When making a diagnosis, the meter, but not 
 the controller, should be in the circuit. DeWatte- 
 ville's method is to place the electrodes in posi- 
 tion, and commence with ten cells, adding cell 
 by cell as needed, to get the reaction desired. I 
 have tried various methods, but have gone back 
 to DeWatteville's plan, as being the most satisfac- 
 tory. For brain testing I have a separate series 
 of ten cells, arranged according to my plan, and 
 kept almost exclusively for the purpose named. 
 
 Attention to polarity was seen to be of advan- 
 tage, when using the faradic battery. With the 
 galvanic, polarity becomes of prime importance, 
 for the reaction of nerves is distinctive for each 
 pole, and gives definite and unvarying results, 
 when intelligently applied. Suppose that we 
 wish to test the median nerves, in its most super- 
 ficial portion, about two inches above the annu- 
 lar ligament. With the anode, or positive pole, 
 placed on some convenient point, place this small 
 
i8i 
 
 electrode, attached .to the cathode, or negative 
 pole, upon the nerve, and turn on the current. 
 So long as there is no break in the current, there 
 is no movement of the muscle, differing in this 
 respect from the faradic current. Having say- 
 two or three ma. the current is broken, and again 
 suddenly closed. A quick, sharp, lightning- 
 like contraction of a healthy muscle takes place, 
 quickly subsiding. Upon reversing the polarity 
 of the battery, we will find that it requires more 
 current to get the same contraction with the 
 anode, than it did with the cathode. Upon this 
 has been based the following formula of normal 
 reactions of nerve and muscles. 
 
 First we have cathodal closing contraction , c . c. c . 
 
 Followed by anodal closing contraction, a. c. c. 
 and this 
 
 Followed by anodal opening contraction, a. o.c. 
 
 The two latter may change places and still be 
 classed as normal, but if the anodal closing con- 
 traction appears first, we then have what is 
 termed the reaction of degeneration, generally 
 expressed by the letters, R. D. 
 
 There is a fourth reaction, the cathodal open- 
 ing contraction, but it requires too strong a cur- 
 rent to produce it, and being painful, I do not 
 attempt it in health. Ordinarily, we will get the 
 three contractions above noted with about the 
 following current strength, that is in healthy 
 subjects: 
 
 Cathodal closing contraction, with 2 to 5 mil- 
 liamp^res. 
 
I82 
 
 Anodal closing contraction, with 5 to 8 mil- 
 liamperes. 
 
 Anodal opening contrsction, with 5 to 8 mil- 
 liamperes. 
 
 These numbers are only approximate, as much 
 depends upon the condition of the subject, 
 whether there be much or little adipose tissue to 
 deal with. 
 
 To illustrate the reactions, we will take a case 
 of injury to the arm, the result, we will say, of a 
 railway accident. The patient states that the 
 arm has been rendered useless. Having bared 
 both arms, and the chest of the patient, place a 
 large,' well wetted sponge, or other electrode, upon 
 the sternum, connected with the positive pole of 
 the faradic battery, and with the small negative 
 electrode, test the well arm first, noting the coil 
 distance necessary to produce a contraction. 
 Use the secondary coil in such testing. Next 
 test the diseased arm, noting, as Bramwell tersely 
 puts it: 
 
 "i. Whether a muscular contraction is pro- 
 duced or not. 
 
 2. If a contraction is produced, what is the 
 minimum strength of current required to produce 
 it, and whether the character of the contraction 
 is in any way altered from the normal. 
 
 3. The strength of current and the rapidity 
 (whether slow or quick) of the interruptions re- 
 quired to produce the maximum amount of mus- 
 cular contraction." It is better, in all such 
 
i83 
 
 cases, to test corresponding groups of muscles, as 
 above stated, so as to compare results. 
 
 Next test with galvanic current and note 
 
 "i. Whether a muscular contraction is pro- 
 duced or not, 
 
 2. If a contraction is produced [a] what is the 
 minimum strength of current required to pro- 
 duce it; \_l>] the order of the polar reactions; [c] 
 the character of the contractions, whether 
 healthy or not; [rf] the strength of current re- 
 quired to produce tetanus; [e] whether the con- 
 tractions are more easily excited by slow or quick 
 interruptions of the current." 
 
 In order to get the most satisfactory reactions, 
 the muscles must be relaxed. If you get con- 
 flicting or confusing reactions, and the patient is 
 resisting the current, he must be placed under 
 ether, or some other anaesthetic, when the prop- 
 er reactions will readily appear. 
 
 If, however, you find the normal formula re- 
 versed, that is, if anodal closing contraction 
 comes before cathodal closing contraction, you 
 may be assured that there is degeneration, as the 
 reactions of degeneration cannot be simulated. 
 
 We are here dealing with a peripheral paraly- 
 sis, and the reaction of degeneration appears, 
 because the nerve has been separated from its 
 trophic center in the cord. I herewith present a 
 graphic representation of the normal reaction of 
 a nerve under galvanic stimulation. 
 
i84 
 
 
 
 4 
 
 s<a 
 
 
 
 
i85 
 
 The first shows the normal reaction, with a 
 quick sharp contraction of the cathodal closing, 
 while the second shows the reversal of the for- 
 mula, with the anodal closing contraction ap- 
 pearingfirst, which is thereaction of degeneration. 
 
 The following table, taken from Dr. Adams' 
 little work, and compiled from Erb, shows the 
 relationship between thereaction of degeneration, 
 and the histological changes accompanying it, 
 this ' 'reaction of degeneration depending upon a 
 specific histological modification of the irritable 
 tissues, called 'degenerative atrophy,' and this 
 degeneration itself is due to an interference with, 
 or a stoppage of, the peculiar influence of the 
 gray matter upon the nerves and muscles, known 
 as 'trophic' influence." 
 
 There is another and important factor to be 
 considered in all these cases, and that is the re- 
 sistance of the patient. When a galvanic cur- 
 rent is passed through the tissues of the body, it 
 meets with resistance, dififering with the portion 
 traversed. The dry epidermis offers the greatest 
 resistance, presenting, according to some obser- 
 vers, as high as three hundred times as great a 
 resistance as that of all the intervening tissues, 
 when a current is passed by percutaneous appli- 
 cation, with two layers of the epidermis inter- 
 vening. 
 
 This resistance may so vary upon different sides 
 of the body, as to be very misleading, unless 
 carefully considered. For instance, if, in testing 
 an arm for a supposed lesion, you found that it 
 
i86 
 
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 Muscular wasting in phthi- 
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 Idiopathic myositis. 
 
 
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i87 
 
 required a much stronger current to produce a 
 contraction upon one side than upon the other, 
 before diagnosing the injury, test the resistance 
 of the two sides, and you may find the difiiculty 
 there. This testing is done by means of resist- 
 ance coils, which should be attached to every 
 oflSce battery, and range in power up to at least 
 20,000 ohms. 
 
 Still another point in this connection is, that 
 as the current passes through the body, the re- 
 sistance more or less rapidly declines, due to two 
 causes : the moistening of the dry epidermis, and, 
 according to Prof. Rhoe, the electrolytic arrange- 
 ment of the molecules in the track of the current. 
 Both have their influence. 
 
 In some conditions, I have found cocaine cata- 
 phoresis to be of great value in determining 
 whether a lesion was superficial or not. For in- 
 stance, in a case of severe tic, if cocaine be used 
 upon the anode, and applied to the nerve, and 
 relief be not obtained, the lesion is deeply seated. 
 If, on the contrary, the pain is controlled, the 
 lesion is superficial, and an operation is not, as 
 a rule, indicated. 
 
 [Dr. Starr, an^ Dr. Peterson, of New York, 
 have done much in this direction, especially the 
 latter.] 
 
 In testing nerve and muscle, also during treat- 
 ment, I have noticed some curious phenomena. 
 A case under my care, in which the hand had 
 been amputated, gave, upon tests, and frequently 
 during treatment, sensations of contraction of 
 
i88 
 
 the muscles of the amputated hand, and the pa- 
 tient complained that the hand pained him, at 
 such times. 
 
 BRAIN AND SPINAL CORD LESIONS. 
 
 In brain testing, the phenomena are mostly 
 subjective, and yet, as the patient, unless familiar 
 with the reactions, not knowing what to expect, 
 will genera.lly give correct descriptions of what 
 is taking place. 
 
 We will take a normal brain, and note some of 
 the reactions produced by the galvanic current, 
 first noting that there are the following methods 
 of brain galvanization : longitudinal, transverse 
 and oblique. The transverse is subdivided into 
 bitemporal, from the parietal prominences, the 
 mastoid processes, and suboccipital. In a nor- 
 mal, healthy brain, no unpleasant sensations are 
 felt, more than a possible slight dizziness, when a 
 current of from 3, or even 5, and in some instances 
 more, ma. are passed through it, in any direction. 
 By reversing the current, without shock (which 
 should always be avoided), the molecular ar- 
 rangement having been disturbed, the sensation 
 of dizziness will most likely be-produced. 
 
 In anaemia, the tissues being but poorly sup- 
 plied with blood, the reactions might not appear, 
 but pain would follow. In hypersemia, however, 
 the effect is very marked, and I have had pa- 
 tients almost fall from the chair, when only a 
 very mild current was applied. In cases of brain 
 tumors, the patients complained of great pain in 
 
i89 
 
 the region of the tumors, when the electrodes 
 rested over it. 
 
 The optic nerve is stimulated by both the gal- 
 vanic .and faradic current. The former, however, 
 is the one to use in such testing. When a feeble 
 current is broken or made, with the electrodes 
 placed transversely upon the temples and in 
 other directions, the optic nerve will be stimu- 
 lated, and a flash of light be noticed. In some 
 cases of paralysis of the orbicularis palpebrarum, 
 I have noticed that this stimulation was very 
 marked in the affected eye in cases of central 
 lesion. Where the cause was peripheral, the le- 
 sion was not particularly marked. In a case of 
 almost complete loss of vision in one eye, the 
 result of a syphilitic iritis, the optic nerve on 
 that side will not respond to any current which 
 I would use upon the head. In the case of a 
 gentleman now under my care, I find thgt at 
 times, especially after prolonged mental exer- 
 tion, he can bear but a very mild current 
 throuhg the mastoid region, say i)^ ma., or 
 longitudinally, without considerable pain being 
 experienced. He is subject to sudden attacks 
 of epistaxis, which afford more or less relief 
 from the pressure. Now while this patient can- 
 not bear the moderate currents alluded to, when 
 comparatively small electrodes are used, yet with 
 a positive helmet covering the entire head, 20 
 ma. may be given with comfort and benefit, the 
 negative being at the feet. 
 
 The reactions of the auditory nerve to the 
 
igo 
 
 galvanic current, as formulated by Brenner, are 
 painful to produce, and few patients will be 
 found, who are willing to submit to them. I sel- 
 dom attempt them. In some cases of tinnitus 
 aurium, the tinnitus will subside entirely during 
 the passage of a mild current through the audi- 
 tory nerve, and in such patients I give a very 
 favorable prognosis. 
 
 The effect of the electric current upon sensory 
 nerves differs from that upon motor nerves, in 
 that the sensory nerves are stimulated by a con- 
 tinuous flow of either current. With the gal- 
 vanic, a sensation is felt with a weaker current 
 with ca. cl., an. cl., and an. o., than with a con- 
 tinuous flow, in this respect behaving precisely 
 as do the motor nerves. 
 
 The use of the static spark in diagnosis, is at 
 times essential. When a nerve will not respond 
 to either the galvanic or faradic current, it will 
 sometimes do so to the static spark, thus show- 
 ing a continuity, not otherwise demonstrated. 
 The reason for this is, that the franklinic current 
 possesses such an enormous voltage, which 
 penetrates deeply, affecting areas that the other 
 currents fail to suificiently stimulate. Obviously 
 this current is not available for use about the 
 head, in diagnosis, but must be confined to the 
 trunk or limbs. 
 
 RECAPITULATION. 
 
 When a lesion is in the cord, above the dorso- 
 enlargement, as in sonje forms of transverse mye- 
 
igi 
 
 litis, all the nerve and muscle reactions will be 
 normal, for the parts below the trophic centre, 
 except that possibly there may be some increase 
 in readiness of response to electro-stimulation. If 
 the lesion involves the dorso- enlargement, of 
 course there would be the reactions of degenera- 
 tion. 
 
 If the lesion be in the basal ganglia, or in the 
 hemispheres above, there will be no change in 
 the normal formula, unless the disease, in its 
 progress, produces changes in the cord, thus af- 
 fecting peripheral nerves. 
 
 In a hemiplegia, the result of a clot in the cor- 
 pus striatum, there will be no change in the re- 
 actions, except that in some cases, the muscles 
 respond more readily than the normal muscles, 
 to both currents. In other cases, tjie reactions 
 are simply normal, but in still other cases, there 
 may be a quantitative decline, due merely to the 
 degenerative changes in nerve and muscle. 
 
 In uncomplicated lateral sclerosis, the reactions 
 are all normal. I have a case of lateral sclerosis 
 under my care, of eight years standing, and spe- 
 cific in origin, which, when first tested, some six 
 months ago, showed partial reaction of degener- 
 ation, but now the normal formula has been re- 
 established. 
 
 In amytrophic lateral sclerosis, there will be 
 both qualitative and quantitative changes in the 
 muscles, or partial reaction of degeneration. 
 
 In anteriorpoliomyelitis,infantile paralysis, and 
 
192 
 
 in lead palsy, we have the reaction of degenera- 
 tion. 
 
 It will also be found in peripheral paralysis of 
 traumatic, rheumatic, neuritic or diphtheritic or- 
 igin. It is absent in all cerebral, hysterical, mye- 
 litic and purely myopathic paralyses. 
 
 In cases where the reaction of degeneration is 
 limited to a definite peripheral neuro-muscular 
 area, the probabilities are in favor of the diagno- 
 sis of a peripheral lesion. When the phenomena 
 of R. D. are observed over a larger area, a cen- 
 tral (spinal) origin of the paralysis is rendered 
 probable. 
 
 In light forms of rheumatic, traumatic, or 
 pressure paralysis, the reactions will all be nor- 
 mal. In the middle form of these affections, 
 qualitative and quantitative changes appear, and 
 there is partial reaction of degeneration. When 
 the severe form appears, we then have complete 
 reaction of degeneration, or the normal formula - 
 completely reversed. 
 
 In muscular wasting, or simple atrophy, such 
 as in phthisis, etc.; in diseases of the joints, and 
 in idopathic myositis, the reactions are normal, 
 or the diminution is to the maximum of excita- 
 tion. 
 
 By quantitative changes, is meant an increase, 
 a diminution, or a total disappearance of electri- 
 cal irritability to one or both currents. 
 
 By qualitative changes, are meant a modifica- 
 tion in kind, of the normal reactions of nerve and 
 
193 
 
 muscle, to electric currents. This is the so called 
 "reaction of degeneration." 
 
 There is a third, or a mixed change, or a com- 
 bination of quantitative and qualitative variations 
 of irritability.* 
 
 The histological changes shown in the preced- 
 ing table, explains the phenomena of the reac- 
 tion of degeneration. There is a solution of con- 
 tinuity, and a consequent inability to transmit 
 impressions. Gessler, in his researches upon 
 cold-blooded animals, seemed to prove that true 
 R. D. was entirely due to muscular degenera- 
 tion, as, while in these animals complete nerve 
 degeneration occurred, muscular degeneration as 
 well as R. D. were absent. 
 
 There is much yet to be learned regarding 
 brain diagnosis, and I hope at some future time 
 to present the result of some investigations that 
 I am making in this direction. 
 
 2009 Arch St., Philadelphia. 
 
 I Bibliography: Liebig and Roh^, Ranney, Adams, Cleavinger, 
 Erb, De Waiteville, Bartholow. 
 
LITIGATION DISEASE A FORM OF 
 NEUROSIS. 
 
 BY HERBERT JUDD, M.D., 
 
 OF GALESBURG, ILL. 
 
 During the fall of 1881, E. S., aged 60 years, 
 in form tall and slim, temperate habits, previons 
 health always good, a noble specimen of average 
 humanity, occupation farmer and dealer in stock, 
 an expert in this line of business, was on his 
 way to Chicago from W., Iowa. While at a 
 feeding station he was standing in the rear door 
 of the way car looking out, the train was backed 
 to way car with such force as to loosen the up- 
 per bunk next the door at his right side; as the 
 bunk fell into its place it struck S. on the right 
 shoulder and arm, and also caught the right 
 hand, crushing one of the fingers; the finger was 
 at this time dressed with a rag at hand by the 
 other stockmen. S. completed his trip to Chi- 
 cago, nearly two hundred miles, made a satisfac- 
 tory disposal of his cattle and returned home. 
 The accident and injury being noised about, 
 a lawyer called himself into the case, a doctor 
 
196 
 
 was employed, and after a short time suit was 
 brought against the railroad company. 
 
 On the morning of March 14, 1882, I was called 
 from breakfast at my home in Galesburg, to the 
 door, to find E. S., who, in the way of introduc- 
 tion, handed me the card of a prominent railroad 
 attorney in Chicago, Inviting S. to breakfast, 
 the above history of his case was learned. The 
 man's appearance was favorable. He seemed to 
 be unable to use his right arm and hand, the 
 arm being carefully carried, in a sling, with the 
 hand between a button space in his outer coat. 
 He fed himself with his left hand. Having been 
 injured some six months previous, he had ac- 
 quired this habit, and had become an adept at 
 feeding himself with his left hand. There was 
 not a line of pain about this man, and his every 
 appearance would indicate to a close observer a 
 strictly honest, conscientious person. He appre- 
 ciated every courtesy shown him, and after 
 reaching my office, myself and assistant, having 
 ascertained that the finger had never been 
 dressed or redressed since the time of the acci- 
 dent, some six months previous, we suggested 
 to him that it was time to remove the filthy 
 crust about the finger. He acquiesced in this. 
 After getting the finger bare, it was found to 
 have been thoroughly and properly healed for 
 months; thereupon we suggested, as nicely as 
 possible, the shoulder and arm had also recov- 
 ered. To this suggestion a prompt denial was 
 made, although accompanied with a candid dec- 
 
197 
 
 laration that aside from extreme care used when 
 a change of clothing was necessitated, no at- 
 tempt was made to use the shoulder or arm since 
 it was first examined and put in a sling some six 
 months previous. S. was afraid of being hurt; 
 he said he was willing for us to examine him; 
 that he wanted to do what was right and fair; 
 that he knew he was injured, permanently in- 
 jured, hut other persons, whom he had no rea- 
 son to suspect or distrust, had plainly told him 
 there was nothing the matter with him; that he 
 had been sent to me for examination, and was 
 willing to submit to what was right, but he did not 
 propose to be hurt. "I want to be fair and hon- 
 est with everybody as far as I know," was what 
 he said. We proposed to administer chloroform 
 to him in order to make an examination and to 
 do the necessary manipulation without causing 
 him pain. He sternly refused, and as a reason 
 stated that he had been instructed by his lawyer 
 and by his doctor not to take chloroform for an 
 examination. We spent one hour patiently in 
 getting this man stripped. In the meantime a 
 Drescher faradic battery had been placed on a 
 table conveniently near, and after much persist- 
 ent childish persuasion we did get him to clasp 
 in each hand an electrode, with the primary cur- 
 rent mildlj'^ established, then by suddenly turn- 
 ing the switch the secondarj' current was estab- 
 lished, and the withered shoulder and arm 
 responded naturally in a lively manner, and 
 without pain. He was sitting before a large 
 
1 98 
 
 mirror, and as he witnessed himself in his curi- 
 ous gymnastics, he became first frightened, then 
 angered. Matters being brought to a close, time 
 was given him to realize his condition and think 
 about his situation, which resulted in this state- 
 ment from him: That until then no one could 
 have made him believe there was nothing the 
 matter with himself. He could easily and nat- 
 urally move his shoulder, arm and hand, and 
 aside from the wasted condition of the muscles, 
 and the palsied appearance, everything was right 
 and had been for months and months. He cried 
 with joy, then he scolded himself in disgust. He 
 said he was willing to do anything to keep from 
 further disgrace. The railroad company had 
 months previously made this man a liberal offer 
 in money for his injury, but suit had been 
 brought in his behalf against the company for a 
 large sum based upon permanent injury. He 
 quietly took the money that had been offered 
 him, and a speculation lawyer was out of a job. 
 We believed from the first that this man was 
 honest. We afterwards ascertained that he bore 
 a good name, but that he was ignorant outside of 
 his own business, and that he was easily influenced. 
 He was told by interested persons that he was 
 injured, permanently injured, and his cupidity 
 overpowered his judgment. No practical at- 
 tempt had been made to convince him that he 
 was recovered, and that he was not still suffering 
 from his injury, before I saw him. The demon- 
 stration that there was no paralysis in the shoul- 
 
199 
 
 der or arm was so simple and clear that he was 
 overpowered with joyful emotion, simple and 
 natural in its character. The experience and 
 knowledge gained in this case have caused me 
 to follow up and watch other cases of a similar 
 character, cases in which suits have been brought 
 and judgments of large amounts have been paid, 
 and which were, after settlement, followed by a 
 speedy convalescence and total recovery, — cases 
 which previous to settlement had been bed-rid- 
 den for a term of years, and during the trial were 
 pronounced by high medical and legal authority 
 in court as being permanently injured, hopelessly 
 so — two cases in which death was predicated with- 
 in the space of .three or four years in the pres- 
 ence of the court, and within the hearing of the 
 condemned plaintiff. 
 
 I have cited the case of E. S, , for the reason 
 that it is typical of this class of cases. It is 
 clean cut and can be identified. The injury was 
 slight and simple, but nevertheless was made the 
 basis of an important suit at law to recover 
 heavy damages for an alleged permanent injury. 
 It is the small and simple things, neglected in 
 this world, that cause most of our trouble. I 
 believe that such persons can be said to be suf- 
 fering from "litigation disease;" that this condi- 
 tion can be truthfully stated as a form of neurosis 
 in which fright, or shock, temporary disturbance 
 from business, and many other trivial things, 
 naturally figures, which under other circum- 
 stances would be unaccountable, and that in all 
 
of these cases the proper course to pursue must 
 be kind attention properly administered, and in 
 all cases where the question of liability for dam- 
 ages is conceded, a prompt and liberal payment 
 of money on the part of the corporation or rail- 
 road company should be made — a functional 
 nervous disease will then be rapidly and perma- 
 nently cured; that it is safe and humane to look 
 upon these cases as a form of functional nervous 
 disease, meaning of course the class of cases as 
 illustrated by E. S. I never had the heart to 
 style S. as a malingerer. I do not believe he 
 knew any better. He was told by interested -^^x- 
 sons that he was injured, permanently injured, 
 and that the railroad company was liable, and 
 could be made to pay a large sum' of money — all 
 of which he believed; and the part he most be- 
 lieved and knew to be true was that he was in- 
 jured, permanently injured; and here is where I 
 think I am warranted in bringing this paper be- 
 fore you. It is to call your attention to the pe- 
 culiar condition of a person who has been in an 
 accident and who was at that time injured, and 
 wherein is conceded the payment of money to 
 him for the damage done him. We all know 
 that a functional nervous disease can be made 
 organic, lasting, permanent, and it is certainly 
 hard, impossible sometimes to demonstrate that 
 such a person has not received a permanent in- 
 jury; that he is not suffering from an organic 
 disease caused by his injury, incurable in its 
 character, and possibly progressive as regards 
 
bad results or death. Particularly is this the 
 case in neglected cases that are solicited by inter- 
 ested persons, and placed in litigation; cases in 
 which it is certainly easier and more natural to 
 exaggerate than it is to simplify or improve. I 
 never knew but one man to get better, to im- 
 prove on a line of recovery while his case was 
 being litigated, and I expect to have to look a 
 long time before I find another It is out of the 
 line of ordinary humanity. It is a fact that such 
 cases are knowingly or unknowingly terribly 
 abused; that justice relative to them is travestied. 
 These cases are put in court, and verdicts for 
 enormous sums are obtained and paid. Perma- 
 nent injury is alleged and proven to the satisfac- 
 tion of the court and jury; death is even pred- 
 icated openly in court, and with no respect paid 
 to ordinary rules of medical practice, and after 
 all this has been so skillfully done such cases 
 have been known to recover, rapidly recover. It 
 is a fact that this is the rule, and not the excep- 
 tion in this class of cases. 
 
 Railroad companies, corporations and cities in 
 this country are paying millions of dollars to 
 such persons. The Government is doing the 
 same. The advantage and the gain is with all 
 such. They have nothing to lose. If the ma- 
 chinery to run such a case in one city is not com- 
 plete, the patient is packed off to another city. 
 Some noted specialist in nervous diseases is 
 reached through his cupidity. No dishonesty 
 can be attached to him. The electric battery is 
 
called into use. The reaction of degeneration is 
 found. Organic disease is supposed, and claimed 
 to be proven; actual cautery even, is applied 
 along and over the spine, and this, too, in a case 
 that bears every aspect that the patient may suc- 
 cumb under this terrible treatment, and the won- 
 der is that he did not. I am no expert lawyer. 
 I am no expert doctor, not even a medical pro- 
 fessor, but fortunately or unfortunately it has 
 been my lot to witness just such cases and to see 
 just such procedures as herein detailed, and I 
 am here to cry hai,t. I never have seen nor do 
 I expect to see a case of pronounced legitimate 
 injury in court and under trial for money to be 
 paid, wherein the question of liability has been 
 concerned. This is a hard statement, but the facts 
 are prolific, extremely abundant, existing all 
 through this country, that bear me out in the 
 statement. I find my sympathy with this non- 
 malingering class of cases. They are certainly 
 injured persons in more ways than one. They 
 are practically suffering from functional neivous 
 disease; I have styled it "litigation disease," a 
 form of neurosis, same as we call certain neivous 
 conditions hysteria, and other functional nervous 
 conditions neurasthenia. These persons are so 
 conditioned as to be beyond self control. They 
 have, in a hasty and unpremeditated manner, signed 
 away their liberty, and this in a free country. 
 They are being fitted for a legal race, in which 
 they are bound to win, regardless of all profes- 
 sional honor and integrity. Whether as yet this 
 
203 
 
 practice can strictly be called fraudulent, remains 
 in some cases to be seen, to be found out. The 
 results certainly bear out the conviction that 
 somebody was terribly mistaken. 
 
 In discussion, Dr. Clevenger said : 
 
 Mr. Chairman and Gentlemen : The scientific 
 aspects of Erichson's disease are obscured, and 
 all that concerns the matter of spinal concussion 
 is wrangled over for the very simple reason that 
 there is money involved. I may say it concerns 
 contention over millions of dollars. Were ty- 
 phoid fever, or any similar complaint, dragged 
 into court and made the basis of a money issue, 
 there would instantly arise a host of interested 
 parties claiming that there was no such disease. 
 Where the carrion is, the buzzards will gather, 
 and lawyers seek out witnesses who best serve 
 their particular side. They do not want the 
 judicial- minded physician (unless they have a 
 very strong case), and both for plaintiff and de- 
 fendant we too often see {not always, but too often) 
 the buzzard doctor swearing sturdily to any thing, 
 almost, that his attorney requires. By a process 
 of elimination, the unpurchaseable physician 
 (and there is plenty of him) is less often seen in 
 court, and the buzzardy swarms are contemptu- 
 ously regarded by juries, judges and lawyers as 
 constituting "experts." 
 
 But the expert standard is gradually being 
 raised, and it suffices no longer that the witness 
 
204 
 
 may ventilate himself of an opinion; he must 
 now give reasons for his belief. 
 
 The bombastic surgical bluffer who pooh 
 poohs at the lost leg, and congratulates the vic- 
 tim upon his freedom from corns and bunions, 
 has had his day, as well as the calamity doctor, 
 who rears mountains out of molehills. 
 
 There is a golden mean in this matter that can 
 be arrived at by a little study. Dr. Rohr recently 
 called me to the case of Fred Schultz, who two 
 years previously had fallen from a stool back- 
 ward upon a pile of bricks, and suffered all the 
 characteristics of Erichson's disease, finally dying 
 therefrom, notwithstanding that there was no 
 damage claim, and his ignorant neighbors had 
 declared that he was only lazy, and wanted to 
 escape work by pretending to be sick. On the 
 other hand, at Frankfort, Indiana, the case of 
 George E. Miller against the Monon road ended 
 in establishing the fact that he had filed a pen- 
 sion claim just one month before the wreck, and 
 his pension application contained the sworn 
 statement of a spinal injury sustained in 1864, 
 disabling him from earning a living, while his 
 declaration against the railroad alleged the same 
 thing as resulting from the railway accident, and 
 that previous thereto he had been strong and 
 healthy. As both these statements were judicial 
 affidavits, there would be considerable difficulty 
 in determining which should be believed. 
 
 Dr. Watson's experiments, as stated by him- 
 self in his recent publication, do not justify the 
 
205 
 
 deductions he makes from them; in fact, there is 
 little connection between his facts and inferences, 
 and, jfurther, the experiments themselves bear 
 very little upon the subject. 
 
 In last year's Surgical Section, Dr. Watson 
 took occasion to speak of the alienist as cultivat- 
 ing a "pseudo science." So ill-advised an asser- 
 tion convicts him of not possessing the " mental 
 breadth" he has just mentioned as necessary in 
 the investigation of spinal concussion. 
 
 Dr. Spitzka recently called my attention to an 
 article by Hans Ichmans in Virchow' s Archiv, 
 p. 326, vol. 122, strongly sustaining my claim of 
 tangible results in Erichson's disease, and time 
 does not permit me to more than allude to Op- 
 penheim's statement (^Neurolog: Centralblatt, 
 Aug. 15, 1889): "In the majority of cases the 
 symptoms unite to form a type of disease which 
 cannot, in the present state of our knowledge, be 
 mistaken, frorti its significance, its clearness, its 
 objective character, and the sharpness with which 
 it is defined. In the policlinic where I examine 
 such cases before a large audience of students 
 and physicians, in almost three-quarters of the 
 cases I develop the diagnosis in a convincing 
 manner on the first examination, so that I often 
 hear the question, 'How is it possible that such 
 diseases should be regarded as simulated ? ' " 
 
 Dr. King said that he would like to know what 
 constituted spinal concussion. 
 
 Dr. Hughes requested Dr. King to tell us what 
 was the lesion in cerebral concussion, and we 
 
206 
 
 might be able to answer his question as to spinal 
 concussion. 
 
 Dr. I^ydston asked Dr. King if he believed in 
 surgical shock. 
 
 Dr. King said that he did. 
 
 Dr. I^ydstori then asked for its pathology. 
 
 Dr. King: Haemorrhage. 
 
 Dr. Clevenger: What organs are affected ? 
 
 Dr. King: The whole man. 
 
 Dr. Clevenger: So is the entire man affected 
 in spinal concussion. 
 
 Dr. G. Frank Lydston said: 
 
 Too much stress has been laid upon the no- 
 menclature of spinal, and especially railroad spinal 
 injuries. As the term spinal concussion is gen- 
 erally applied it is not remarkable that there 
 should exist so many conflicting opinions. Con- 
 cussion of the spine as an entity does not exist, 
 neither in my opinion does concussion of the 
 brain. But that certain varying symptoms de- 
 pendent on widely different pathological condi- 
 tions may result from a jarring of the cerebro- 
 spinal axis, must, I think, be admitted. 
 
 I have this to say of the theory of molecular 
 vibration as a cause of the symptoms following 
 spinal injuries. The most rational theory of 
 nervous conduction yet advanced is that of molec- 
 ular motion now if we may except this view we 
 must believe that disturbances of the normal 
 molecular arrangement of the nervous structures 
 will almost necessarily produce aberration of nerv- 
 ous function and, if these disturbances be severe, 
 
207 
 
 it is rational to expect permanent morbid effects 
 in a certain number of cases. 
 
 The argument has been advanced here to day, 
 that "spinal concussion" has not occurred unless 
 there be anatomical changes in the cord. This 
 is begging the question. Must we hit our patients 
 in the head with an ax so that we may examine 
 the cord for anatomical lesions? Is it necessary 
 to see the ileum in typhoid in order to believe in 
 the existence of such a fever? Is tetanus none 
 the less real because of its obscure and scant mor- 
 bid anatomy? Must we throw every functional 
 , disease out of court because there is no morbid 
 anatomy? No, and yet that is what the railway 
 surgeon proposes to do with spinal concussion. 
 Accept the view that concussion is a physical in- 
 fluence upon the spinal cord, which may produce 
 a varying degree of morbid phenomena according 
 to the severity of the jarring, and the subject 
 will be divested of much of its confusion. It is 
 to be remembered that the tissue protaplasm of 
 the cerebro- spinal axis may be acted, upon by 
 jars in very much the same manner as the amoeba 
 by an electrical discharge. It is probable that 
 the cause of death by lightning or electric cur- 
 rent is a severe concussion of the nerve tissue, 
 inhibiting the energy of the protoplasm of the 
 nerve cells. 
 
 Dr. Manley speaks of the manner in which the 
 spinal fluid acts as a water bed in the protection 
 of the spine. I fancy this water bed does not 
 stand the criminal who is hung in good stead, it 
 
208 
 
 certainly does not completely defend the spine 
 from jars. Indeed I fancy there is more of com- 
 pensation than design in its presence in the spi- 
 nal canal — its presence is due to the necessity for 
 filling the vacuum incidental to the loose and 
 mobile texture of the envelopments of the cord. 
 It is possible that it favors rather than otherwise 
 the transmission of jars to the cord. 
 
 There is one question that I should like to ask 
 of those who do not believe in the theory of spi- 
 nal concussion. Can you tell me the precise con- 
 dition in surgical shock ? Can you determine in 
 fatal cases that the patient died of shock, by the 
 morbid anatomy present? I fancy yoii cannot, 
 yet fatal cases do occur, and short of a fatal re- 
 sult we meet with not a few cases of chronicjn- 
 validism. The assertion that a person who has 
 suffered from a railroad injury is ' 'never the same 
 man again" is not without foundation. We can- 
 not throw all the neuroses in which there are no 
 anatomical lesions, out of court, and yet, that is 
 what we are asked to do in the case of railway 
 spine, or Erichson's disease. 
 
 Laying all theory aside, the practitioner is con- 
 fronted with many cases in which the settlement 
 of damages does not cure the case, and many in 
 which they even get worse after settlement. There 
 are many frauds perpetrated against railroads it 
 is true, but in the aggregate I think the roads 
 get the best of the bargain. 
 
 Both sides must be fair and charitable. A few 
 isolated instances of surgeons who sell their souls 
 
209 
 
 to railroad corporations do not prove all rail- 
 road surgeons to be knaves; a few mistakes 
 should not stamp all of them as ignoramuses. On 
 the other hand, an occasional fraud does not dis- 
 prove the honesty of a large class of railway liti- 
 gants. I,et us lay personalities and recrimina- 
 tions aside and seek for the truth in these cases. 
 In my own experience I have seen a case of 
 lateral curvature which I believe to have been 
 due to a concussion of the spine from a fall upon 
 the buttocks. This developed within a few weeks 
 after the injury and was attended by spinal ten- 
 derness, neuralgia, etc. In another case paraly- 
 sis of the serratus magnus seemed unquestiona- 
 bly to be due to spinal concussion. Dr. Moyer 
 is now treating one of my cases in which most 
 profound nervous symptoms have developed — 
 without paralysis — chiefly since her case was sat- 
 isfactorily settled by the railroad. 
 
PARETIC DEMENTIA AND UFE 
 INSURANCE. 
 
 BY JAS. G. KIERNAN, M.D., 
 
 OF CHICAGO. 
 FELLOW OF THE CHICAGO ACADEMY OF MEDICINE. 
 
 The increase of paretic dementia among civil- 
 ized nations has created many important legal 
 problems for solution. The present question has 
 puzzled the solicitors of more than one insurance 
 company. In a case which came under my own 
 observation, a paretic dement insured his life. 
 A month later he was adjudged insane and sent 
 to the Cook County insane hospital, of which I 
 was then Superintendent. Eight months later 
 he died in an apoplectiform attack. 
 
 Dr. S. V. Clevenger has had under care a com- 
 mercial traveler addicted to sexual excess and 
 luetic, who, precedent to May 6, 1889, had spi- 
 nal symptoms of paretic dementia, following 
 which came a condition of emotional exaltation. 
 His life was insured precedent to the spinal symp- 
 toms for $5,000. In a period of emotional ex- 
 altation he desired to increase this to $20,000, 
 
212 
 
 which was done in January, 1890. June 4, 1890, 
 he died in an apoplectiform attack. The solici- 
 tors of the company wrote to Dr. Clevenger to 
 know if the patient knew he was suffering from 
 insanity when he consulted the doctor. After 
 such a bright attempt to manufacture evidence 
 of fraud, it is not surprising that the company 
 had to pay the full amount. 
 
 lyegrand du Saulle' reports the following case: 
 Dr. Blank, a physician well known in science, 
 had had for more than nine years an insurance 
 of $20,000 on his life. He suddenly gave une- 
 quivocal evidence of mental impairment, went 
 and came rapidly, wrote and spoke a great deal. 
 He had an exaggerated opinion of his labors, 
 vaunted his success in practice, and boasted of 
 his professional ability. In one of his walks he 
 accidentally met the President of the company 
 in which his life was insured. After a long con- 
 versation, Dr. Blank said that his life was insured 
 for an insignificant sum, and that he had resolved 
 to increase the amount to $100,000. He was re- 
 ferred to the proper authorities, who consented. 
 The policy was prepared, and all that was needed 
 to complete the assurance was a receipt for the 
 same. The agent, who was ready to deliver the pol- 
 icy on the signature of the receipt, suddenly no- 
 ticed, just as the doctor was about to sign this, that 
 the latter talked rather freely and loudly. Sus- 
 pecting intoxication, he put off delivery of the 
 
 I Gaz. des Hdpitaux, 1884. 
 
213 
 
 policy until Dr. Blank should become sober, claim- 
 ing to have forgotten some important formality. 
 The following day the physician was sent to an 
 hospital for the insane, where he died in six 
 months from paretic dementia. The company 
 paid the $20,000 to his widow, and esteemed it- 
 self happy that it did not have to pay the $100,- 
 000 for which the husband had desired, in a fit 
 of pathological temerity, to assure his life. 
 
 The intellectual powers of a paretic dement 
 are such as make him an easy prey to the bland- 
 ishments of any ' ' sharp ' ' insurance agent who 
 would believe him, from his apparently excellent 
 health, to be a good risk. Once started in the 
 life insurance direction, the paretic dement might 
 keep on, like I,egrand du Saulle's patient, in- 
 creasing the insurance on the life of the valuable 
 citizen he believes himself to be, since paretics 
 have a tendency to adopt and extend ideas de- 
 rived from others, as shown by the case of the 
 paretic dement cited by Spitzka, who, saved by 
 his wife from a paretic suicide, proposed to erect 
 a monument to her for saving the life of so valu- 
 able a citizen. It is curious how often this psy- 
 chosis escapes observation by the non- alienist 
 physician and laymen, when compared with the 
 ease with which it is diagnosed by even asylum 
 attendants familiar with it. In two cases which 
 occurred in New York State, two cashiers of 
 banks who had been paretic dements for at least 
 two years, nearly brought the bank to a condi- 
 tion of insolvency by simple lack of attention to 
 
214 
 
 business, but their mental condition had not 
 been at all suspected by their business associates. 
 A Chicago saloon keeper with a paretic delusion 
 of having inherited $2,000,000, was interviewed 
 by the reporters of every paper in the city, by 
 none of whom was his mental condition suspect- 
 ed until his friends took measures to have him 
 placed under treatment in the county hospital 
 for the insane. There is, therefore, nothing an- 
 tagonistic to the existence of paretic dementia 
 in the fact that a man insures his life for a large 
 amount, and his mental condition escapes obser- 
 vation from the business men of the company. 
 It may, however, be urged that the medical offi- 
 cers of the companies would detect the psychosis. 
 He who knows how these medical officers are 
 chosen, either from relatives or connections of 
 the officials of the companies, or by agents who 
 tell the physician that "he must not be too 
 strict," or for political reasons to influence State 
 Legislatures, from medical politicians (who in- 
 dulge in ' ' graveyard ' ' insurance dodges in which 
 they get caught sometimes, but not as a rule), 
 will scoff at the idea that men like these, who 
 neither know nor care to learn anything of psy- 
 chiatry, could be of value in the detection of in- 
 sanity. 
 
 The same point is still more strongly illustra- 
 ted by another case cited by I^egrand du Saulle: 
 Two brothers presented themselves at the office 
 of a French alienist. The elder brother entered 
 the office first, and asked the alienist to examine 
 
215 
 
 with care the patient brought him. "There 
 seems to be nothing the matter with my broth- 
 er," said he, " but he is no longer the same." 
 The physician, after a long examination, said : 
 " Your brother is in the initial stages of paretic 
 dementia." Explanations were then given, and 
 the prophecy made that the patient would die in 
 three or four years. The following day an in- 
 surance of $20,000 was placed on the life of the 
 patient. Three years after, the brother pocketed 
 the amount. In Germany, a medical officer of 
 a railway corporation claimed that symptoms of 
 paretic dementia presented by a 43-year old man 
 were only changes due to old age. 
 
 Hanot'' calls attention to the dangers to which 
 life insurance companies are exposed from this 
 class of patients, who, as already stated, escape 
 the diagnostic ability of the average insurance 
 company's physician, who is worthless in the 
 detection of this psychosis. 
 
 Is the insurance effected on the life of a paretic 
 dement, by himself or his relatives, in good faith, 
 binding on the company making such assurance? 
 The Supreme Court of Iowa has decided that 
 persons of unsound mind are to be held bound 
 by an executed contract or conveyance where the 
 transaction is fair and reasonable, and in the or- 
 dinary course of business, and where the mental 
 condition of the party is unknown to the second 
 part, and the parties cannot be placed in status 
 quo ante. The converse of this necessarily fol- 
 
 2 Annates d'Hygiene, 1S84. 
 
2l6 
 
 lows. A paretic dement cannot be guilty of 
 fraud, for fraud implies a knowledge of the true 
 state of things, and of such knowledge the pare- 
 tic dement is destitute. A paretic dement effects 
 an assurance on his life because of his psychosis. 
 If contracts with the insane, under the circum- 
 stances mentioned by the Iowa decision, are bind- 
 ing, then his policies are binding on the company. 
 If the policies were binding on the companies, 
 no suicide by him could vitiate them. It may 
 be admitted that, even assuming the truth of all 
 the circumstances, it was an injustice to burden 
 the companies with the results of the actions of 
 an insane man. With the consequences of a law 
 a judge has nothing to do; his duty is to declare 
 what that law is, and the same holds good of a 
 scientist and scientific truth. The companies 
 were themselves to blame for accepting such a 
 risk — a risk offered by the would-be policy holder 
 in good faith. It may seem hard on the compa- 
 nies, but it would also be hard on th€ family of 
 paretic dements if they should be deprived of the 
 provision made for them. The life insurance 
 companies use all means to detect fraud and to 
 ascertain the value of risks. If such means 
 prove insuflScient, not through fraud of the pol- 
 icy holder, but through the incapacity of the 
 company's agents, the company should be held 
 responsible. 
 
 Another aspect of the case presents itself. If 
 a paretic dement insured his life, and then, with 
 a paretic idea of smartness, committed suicide to 
 
217 
 
 compel the company to suffer for some imagined 
 affront, or with the vague idea of making money 
 for his friends, would this act vitiate his policy ? 
 Under the Iowa decision, I believe not. I/egally, 
 I believe the policy could not be declared void, 
 however seemingly unjust its non-voidance, or 
 rather the full requirement of all its provisions, 
 under the circumstances, would be. The ques- 
 tion simply resolves itself into this : Can a con- 
 tract which per se involves an element of risk, all 
 means of diminishing which risk are supposed to 
 be taken by one of the persons making the con- 
 tract, be regarded as void because, without fraud 
 on the part of the other party to the contract, the 
 risk proves greater than was anticipated ? I,ife 
 insurance contracts are based on the theory that 
 the company ascertain the exact condition as re- 
 gards disease. If the insured have an ordinary 
 physical disease unknown to himself and the 
 examiner, and die from such disease, the com- 
 pany is held bound to pay the amount of the 
 policy. It would seem that the same rule should 
 hold good in the case of a paretic dement. Though 
 stockholders suffer unjustly in case of paretic de- 
 ments from the inventive stupidity of agents and 
 medical oiEcers, yet their own negligence has 
 been the cause of this loss. In the esse of the 
 two brothers cited by Legrande du Saulle, fraud- 
 ulent intent was clearly evident, and probably 
 that policy could have been set aside. 
 
MEDICO- I.EGAI, INVESTIGATION OF 
 
 DEATHS BY VIOI.ENCE IN 
 
 MASSACHUSETTS. 
 
 BY SILAS D. PRESBERY, M.D., 
 
 OF TAUNTON, MASS. 
 
 In 1877 the I^egislature of Massachusetts 
 passed "An Act to abolish the office of coroner 
 and to provide for medical examinations and in- 
 quests in cases of death by violence." By the 
 terms of this act the county commissioners in 
 each county, except that of Suffolk, were called 
 upon to "divide their several counties into suita- 
 ble districts for the appointment of one medical 
 examiner in each district;" and such examiner, 
 while appointed from a district, has the power 
 to exercise his function in any part of the coun- 
 ty of which his^ district is a portion. In prac- 
 tice, however, an examiner does not act in the 
 district of another except in case of absence or 
 disability of the latter. Examiners hold office 
 for seven years and are appointed by the gover- 
 nor by and with the advice of the council. 
 
 The thirteen counties were divided into 68 
 
2 20 
 
 districts, according to the distribution of centres 
 of population in each county. The usual num- 
 ber of districts is four, but some counties have 
 more and some less than that number. Each 
 examiner is sworn and gives bonds with sureties 
 in the sum of $5,000 to the treasurer of the coun- 
 ty conditioned for the faithful performance of 
 the duties of his office. Every medical examin- 
 er is required annually, on or before the first day 
 of March, to transmit to the secretary of the com- 
 monwealth certified copies of the records of all 
 deaths which have occurred during the previous 
 year, the cause and manner of which he has offi- 
 cially investigated. For this purpose blank 
 books for records and blank forms for returns are 
 supplied to each examiner. A small fee is al- 
 lowed and paid by the commonwealth for these 
 returns as is done for the returns of births. These 
 returns are bound and indexed, and preserved 
 for reference, and from them are prepared and 
 published by the secretary of the commonwealth 
 such tabular results as will render them of prac- 
 tical utility. 
 
 The work of the examiner may be best studied 
 under the following heads: i. Notification; 2. 
 View; 3. Autopsy; 4. Records; 5. Fees. 
 
 I. Notification. Examinations under this law 
 are made ' 'upon the view of the dead bodies of 
 such persons only as are supposed to have come 
 to their death by violence," and "whenever a 
 medical examiner has notice that there has been 
 found or is lying in his county, the dead body of 
 
221 
 
 a person who is supposed to have come to his 
 death by violence, he shall forthwith repair to 
 the place where such body lies and take charge 
 of the same." 
 
 There is nothing in the law to indicate what 
 shall constitute oflScial notice, nor to show who 
 has authority to give such notice. According to 
 the theory and practice, any responsible person 
 has such authority, and the intent of the law, it 
 is to be presumed, was to allow the broadest lib- 
 erty in the notification. A.s a matter of fact the 
 calls usually come through the police in cities, 
 the selectmen or their representatives in towns, 
 the officers of corporations, the undertakers, 
 some member of the family of the deceased, the 
 person finding a body, or possibly, though not 
 frequently, notice may be given by some neigh- 
 bor or enemy even of the deceased, who is in- 
 clined to be suspicious or desirous of settling 
 some old score by instituting investigation. The 
 last motive is rarely successful, since almost 
 without exception the services of the examiner 
 are welcomed by the unfortunate family. 
 
 The question, shall an examiner ever refuse to 
 make a view, has been discussed by the examin- 
 ers, and the general opinion is that he should 
 not refuse, unless there has been a misapprehen- 
 sion of the condition under which he is required 
 to exercise his functions. It is not sufficient to 
 say that one died without medical attendance, but 
 the idea of suspected violence must enter into 
 the case. The boards of health of cities and towns 
 
are authorized to give certificates of the cause 
 of death in cases of uncertified deaths, not sus- 
 pected of violence. Not infrequently the exam- 
 iner is consulted by undertakers, sometimes by 
 town officers, to learn whether a certain dead 
 body should be the subject of official view, and 
 the answer turns entirely upon the question of 
 the possibility of any one supposing that the 
 death may have been caused by violence. If 
 there be such a reasonable possibility, it is un- 
 doubtedly a case for view. 
 
 2. View. Having been notified, the examiner 
 is required by law forthwith to repair to the place 
 where the body lies and to take charge of the 
 same. He now makes a careful view of the body, 
 with such accuracy as to enable him to say 
 whether or not the body shows any marks of vio- 
 lence, and especially any marks sufficient to in- 
 dicate the cause of death. For this purpose the- 
 usual custom is to have the body entirely naked 
 and to make careful inspection of every part, He 
 also makes personal inquiry into the cause and 
 manner of the death, if any one can be found 
 who can give information. Under some circum- 
 stances a careful investigation of the surround- 
 ings of the body becomes important evidence in 
 the investigation. All the facts learned in this 
 search are to be accurately recorded. 
 
 If upon this view and inquiry the examiner is 
 convinced that the death was not caused by vio- 
 lence, he will deliver the custody of the body to 
 the friends of the deceased, if there be such. In 
 
223 
 
 case the body is not claimed, or is unidentified, 
 it is to be kept in his custody for forty-eight 
 hours and then delivered to the overseers of the 
 poor of the city or town wherein it is found 
 lying. In case the body is not identified, a care- 
 ful description of the deceased is to be made. 
 The examiner next is to certify to the clerk or 
 registrar of deaths the name or description of the 
 deceased, together with cause and manner by and 
 in which he came to his death. And here the 
 investigation may end. 
 
 If,on the other hand,the examiner is convinced 
 that the death was caused by violence, and he is 
 able to determine without further examination, 
 the cause and manner of death, he will certify as 
 before to the registrar, and also notify the dis- 
 trict attorney and a justice of the district, police 
 or municipal court for the district or city in 
 which the body lies, that there has been within 
 the district a death by violence in the meaning 
 of the law. 
 
 3. Autopsy. If the examiner is unable to de- 
 termine satisfactorily the cause of death without 
 autopsy, and he deems a further examination 
 necessary, he shall so report to the district at- 
 torney or to the mayor or to the selectmen of the 
 district, city or town where such body lies. Any 
 of these officers may authorize him in writing to 
 make an autopsy, but he can make no autopsy 
 officially without such authority. Before pro- 
 ceeding to make an autopsy he shall employ two 
 or more discreet persons, one or more of whom 
 
224 
 
 may be physicians, and he shall first call their 
 attention to the position and appearance of the 
 body, and in their presence he shall make an 
 autopsy of suflScient thoroughness to fully estab- 
 lish the cause of death, or to establish the fact 
 that the cause can not be learned by autopsy. 
 The examiner, if he deems it necessary, may 
 employ a chemist to aid in the examination 
 of the body, or of substances supposed to have 
 caused or contributed to the death. The ex- 
 aminer, or a clerk whom he may employ, 
 shall reduce to writing at the time of the autopsy 
 any fact or circumstance tending to show the 
 condition of the body and the cause and manner 
 of death, together with the names and addresses 
 of the witnesses, which record the examiner 
 shall subscribe, and which is known as the record 
 of the autopsy. A duly attested copy of the 
 record is filed with the district attorney, and an- 
 other with the justice of the district court, to- 
 gether with a certificate of a death by violence 
 above described. 
 
 If, however, an examiner is of the opinion that 
 a death was not caused by violence, and the dis- 
 trict attorney or attorney general is of a contrary 
 opinion, either the district attorney or the at- 
 torney general may, notwithstanding such an 
 opinion, direct an inquest to be held in accord- 
 ance with the provisions of the law, at which 
 inquest he or some person designated by him 
 shall be present and examine all the witnesses. 
 
 Since the action and opinion of the medical 
 
225 
 
 examiner turns wholly iipon the question of vio- 
 lence, it becomes very desirable that the term 
 violence be exactly defined, and yet, as in the 
 case of notification, the law not only does not 
 define it, but seems to use it in its broadest sense, 
 if not indeed in difiering senses. But since it 
 is the object of the investigation to learn if any 
 other person than the deceased has been either 
 directly or indirectly causative of the death, 
 it is fair to consider that the violence, which 
 is to be officially reported, is ar violence that 
 may have been contributed to by the act or by 
 the neglect of another. All cases of death by ac- 
 cident upon a railroad are, by special provision, to 
 be reported for inquest, and the district attorney 
 or attorney general may, if he deem it necessary 
 or expedient, direct an inquest to be held in the 
 case of any other casualty from which the death 
 of a person results. 
 
 5. Fees. In the county of Suffolk, the exam- 
 iners are paid annual salaries for all services per- 
 formed. In all other parts of the State the ex- 
 aminers are paid fees as follows: For a view 
 without autopsy, five dollars; for a view and 
 autopsy, thirty dollars; and for travel, at the rate 
 of ten cents a mile to and from the place of view. 
 The bills for the services are rendered quarterly 
 to the county commissioners, who certify their 
 correctness, when the fees are paid by the coun- 
 ty treasurer. In case of autopsy, however, there 
 must accompany the bill the certificate of thfe 
 mayor or selectmen who authorized the autopsy, 
 
226 
 
 and a statement from the district attorney certi- 
 fying that the autopsy was in his opinion neces- 
 sary. In order to enable the district attorney to 
 make this certificate, the examiner is required in 
 every such case to file with the attorney together 
 with his report of the autopsy an account of his 
 view and personal inquiry in the case, and shall 
 certify that in his opinion, the cause and manner 
 of death could not be ascertained by view and 
 inquiry, and that an autopsy was necessary for 
 that purpose. ■ 
 
 At this point the official relation of the exam- 
 iner as such ceases, though he may or may not 
 be employed as a witness at the inquest, or at 
 the subsequent trial, if one follows. 
 
 Inquest. In case the examiner has notified, as 
 above described, the justice of the district court 
 that there has been a death by violence, the jus- 
 tice is required to hold an inquest, and is allowed 
 no discretion in the matter except as to time and 
 place of such inquest. At this hearing such 
 witnesses as have been found to have any knowl- 
 edge of the facts are summoned to testify, and 
 the district attorney or some person designated 
 by him may attend the inquest and examine all 
 witnesses. In practice, the judge himself usually 
 examines the witnesses. 
 
 After hearing the testimony the justice is re- 
 quired to draw up and sign a report in which he 
 shall certify when, where, and by what means 
 the person deceased came to his death; and if it 
 appears that his death resulted wholly or in part 
 
227 
 
 from the unlawful act of any other person or 
 persons, he shall further state the name or names 
 of such person or persons, if known to him, and 
 he shall file such report with the records of the 
 superior court in the county wherein the inquest 
 is held. The law further allows the justice to 
 bind over such witnesses as he may think best, 
 and requires him to take the necessary steps for 
 the apprehension of any person or persons 
 charged in his report with the commission of an 
 offense. 
 
 Thus I have endeavored to describe to you the 
 method of a medicolegal investigation of deaths 
 by violence that has been practiced in Massachu- 
 setts since the abolition of the office of coroner, 
 and naturally the question may arise, what has 
 been gained by this change? In answer I will 
 call your attention to a few of the points of gain. 
 First, the expense, which to many minds is of first 
 importance in matters of public concern, has been 
 diminished about one-third. Second, promptness 
 in action and exactness in investigation have 
 been accomplished. Third, all the facts of the 
 case from the first discovery of the body to the 
 finding of the justice are matters of accurate 
 record and are material as evidence in the higher 
 courts in case a trial follows the inquest. Fourth, 
 the duties are now so divided that the man of 
 medical training investigates so much of the 
 case and only so much as has to do with the med- 
 ical question of the cause and manner of the 
 death, while the man of legal training settles the 
 
228 
 
 question of responsibility and determines wheth- 
 er or not a crime has been committed, what the 
 nature of that crime, and, if possible, who is the 
 suspected criminal. Fifth, the records in the 
 hands of the secretary of the commonwealth con- 
 stitute a valuable body of observed facts that 
 may become of great value to the student of 
 legal medicine. Last, the association of Medical 
 Examiners, constituting the Massachusetts Med- 
 ico-Legal Society, has stimulated each examiner 
 to keep himself well-informed and as far as pos- 
 sible prepared for any case that may fall to his 
 lot. And in general, the diffusion through the 
 State of a number of physicians specially inter- 
 ested in medico legal research has tended to call 
 the attention of physicians to that branch of 
 medical study, and has had an influence to im- 
 prove the grade of medical testimony in the 
 courts of the commonwealth. 
 
ETHER INEBRIETY. 
 
 BY NORMAN KERR, M.D., F.L.S., 
 
 OF LONDON, ENG. 
 
 PRESIDENT SOCIETY FOR THE STUDY OF INEBRIETY; CHAIRMAN 
 
 BRITISH MEDICAL ASSOCIATION, INEBRIATES' LEGISLATION 
 
 committee; consulting physician, DALRYMPLE HOME. 
 
 Ireland has in the nineteenth century present- 
 ed to the- world two interesting and remarkable 
 series of inebrio-psychological phenomena. In 
 1838, a simple-minded Roman Catholic priest, 
 Father Mathew, adopted and began to advocate 
 the practice of abstinence from all intoxicating 
 drinks. So amazing was the impression made 
 by him that, in three years, the roll of the tee- 
 total pledges which he had administered exceed- 
 ed 5,000,000, in Ireland, in addition to large 
 numbers in England, Scotland and America. 
 The reality of this epidemic of temperance was 
 attested by the statement of the Chief Secretary, 
 in 1840, that "the duties of the military and 
 police in Ireland are now almost entirely con- 
 fined to keeping the ground clear for the opera- 
 tion of Father Mathew." Though this great 
 wave of sobriety has gradually receded, till now 
 
230 
 
 the extent of drinking in Erin is simply terrible, 
 I am every now and again meeting professionally 
 with sons and daughters of Hibernia, who glory 
 in their steadfastness to the pledge which they 
 so long ago took at the hands of the Irish apos- 
 tle of temperance. An accurate study of this 
 unique crusade would, in psychological results, 
 amply repay the laborg of any earnest student of 
 mental science. 
 
 Curious to relate, the other series of inebrio- 
 psychological phenomena is an experience in an 
 opposite direction — an experiment, so to speak, 
 not, as in the former case, in temperance, but in 
 intemperance. 
 
 ETHER INEBRIETY. 
 
 The disease of inebriety or narcomania (a ma- 
 nia for intoxication by any kind of narcotic or 
 anaesthetic), may, besides other phases, assume 
 a form correspondent to theparticular inebriating 
 substance. It may, therefore, be interesting to 
 glance at the origin and growth of this new mode 
 of inebriate indulgence, as this is the first oppor- 
 tunity afforded to us of observing the rise and 
 progress of such a process in a community. 
 
 RISE AND PROGRESS IN IRELAND. 
 
 The centre from which ether drinking spread 
 was the town of Draperstown (with a population 
 of some 300), in the southern part of the County 
 of Londonderry. Before Father Mathew's absti- 
 nence propaganda, ether drinking was there un- 
 
231 
 
 known. Between 1842 and 1845 a local medical 
 practitioner, in response to a request from a few 
 newly- pledged abstaining converts for something 
 the taking of which would not violate their vow, 
 gave them a drachm of ether in water. So far 
 as I can ascertain, this was the/ons et origo mali. 
 A desire for more frequent doses grew upon the 
 ether drinkers, and the practice spread in and 
 around Draperstown till there was a shop for the 
 sale of ether, in one town, to every twenty^three 
 of the population. In the session of 1855-6, an 
 Act was passed by the British Legislature allow- 
 ing spirits of wine to be used duty-free in arts and 
 manufactures, provided it was made nasty as a 
 drink (which the Government, in their innocence, 
 supposed would prevent people from drinking it) 
 by the addition of a minimum \ of methylated 
 spirit. As ether prepared in this way is much 
 cheaper than ordinary sulphuric ether, this cheap 
 production of ' ' methylated ether ' ' caused the 
 consumption to increase ' ' by leaps and bounds. ' ' 
 The present ether area was, from its mountain- 
 ous features, a central locality for the illicit dis- 
 tillation of whisky. Owing to the activity of 
 the police and the making of roads, this illicit 
 traflBc was effectually stamped out. The disap- 
 pointed cheap whisky drinkers found a cheap 
 unintoxicant in ether. Mr. H. N. Draper first 
 called attention to Irish ether drinking in 1877 
 {Medical Press and Circular, May 30), followed 
 by Dr. B. W. Richardson about 1879, and by Mr. 
 Ernest Hart in 1890. 
 
232 
 
 AREA OP DISTRIBUTION. 
 
 Ether drinking was in a year or so gradually 
 introduced from Draperstown into the neighbor- 
 ing town of Maghera, and soon extended its sway 
 till it occupied an area of somewhere about 295 
 square miles, with a population of nearly 79,000 
 souls. This area may, in general terms, be said 
 to comprise the mountainous districts, especially 
 of Derr-y and Tyrone, and to some extent, of 
 Armagh and Antrim. Cases of ether intoxica- 
 tion have occurred in Dublin and other parts of 
 Ireland, in Glasgow (Scotland), in Lincolnshire 
 in England, and I have seen several in London. 
 
 THE ETHER DRINKERS. 
 
 All the cases which I have seen in England 
 have been persons of education and refinement, 
 who had first been alcoholic inebriates and grad- 
 ually developed into devotees of these twin poi- 
 sons. Nearly all of these English cases have 
 been females, the only males having been mem- 
 bers of the medical profession. In Ireland, wo- 
 men assert the equality of the sexes by taking 
 their fair share of this form of intemperance. 
 Small farmers and agricultural laborers make up 
 the bulk of the Irish ether tipplers. Workmen, 
 too, are well to the front. But the practice is by 
 no means confined to these classes. Members of 
 the learned professions have their representatives. 
 Etherists are to be found at almost all ages from 
 puberty onwards. Sturdy Irish lads and beau- 
 tiful Irish lasses, brimful of Hibernian wit, as 
 
233 
 
 well as " 6o-year olds " of both sexes, are slaves 
 to ether drunkenness. The mother may be seen 
 with'her daughters, and maybe a neighboring 
 Irishwoman or two, at a friendly ether "bee." 
 The habit has become so general that small shop- 
 keepers treat the children who have been sent to 
 purchase some article, with a small dose of ether, 
 and schoolmasters have detected ether on the 
 breaths of children from lo to 14 (or even young- 
 er), on their arrival at school. Some critics have 
 endeavored to lay the blame of this new devel- 
 opment of inebriety on the Roman Catholic re- 
 ligion. Nothing could be more unwarrantable 
 and unfair. The disease has spread principally 
 among Roman Catholics, simply because this is 
 the creed of the greater part of the population. 
 One Protestant village, Tobermore, is as bad as 
 any other place. All my cases have been Prot- 
 estants. 
 
 QUANTITY TAKEN. 
 
 The amount swallowed at a draught varies 
 mainly with the stage of education in ether con- 
 sumption. A novice will find a drachm (a tea- 
 spoonful) sufficient. GraduUy the wished for 
 effect demands an increased dose, till }( of an 
 oz. may in time become the ordinary " peg" of 
 an accomplished drinker, to use the phraseology 
 of Anglo Indians. These are average quantities 
 of a so called "moderate" drinker. More "sea- 
 soned casks " have a higher capacity, many top- 
 ing off half a wineglassful as unconcernedly as 
 
234 
 
 an average Englishman would drink a glass of 
 claret, or an average American a glass of cham- 
 pagne. 
 
 The amount of ether consumed in a day is 
 often remarkable. A confirmed ether inebriate 
 will take a much larger dose than any I have 
 just enumerated, and repeat the dose three, four, 
 five, or even six times in the twenty- four hours, 
 when " on the spree." Indeed, in some cases, 
 half a pint has been the regular daily allowance 
 of constant (or habitual) inebriates. In England 
 I have known an ether inebriate use a pint of 
 ether by inhalation every day. In Ireland, many 
 persons keep themselves intoxicated pretty well 
 during the day for the sum of sixpence — taking 
 two pennyworth at lo o'clock, i o'clock and 4 
 o'clock. What a paradise for drunkards ! Drunk 
 three times a day for 13 cents ! 
 
 HOW TAKEN. 
 
 In England, in my own practice, the majority 
 of ether drinkers have inhaled the poison. In 
 Ireland the universal method is drinking. By the 
 latter mode the ether is taken "neat." Owing 
 to an idea that ether, like whisky or brandy, 
 should be drunk diluted with water to sheathe 
 the virulence of the poison, the uninitiated and 
 ignorant Englishman, when in Ireland, some- 
 times mixes his ether "peg " with water, "just 
 to try the stuff, you know." I^udicrous failure 
 awaits him, for, unlike ardent spirits, ether is 
 but sparingly soluble in water. The pungency 
 
235 
 
 of ether, except to those who have "finished 
 their education," generally calls for an "over- 
 ture ' ' to the ' ' act ' ' of ether swallowing. Scene 
 I. — The mouth is washed out with cold water. 
 Scene II.— A draught of cold water is drunk. 
 Scene III. — The ether is swallowed "neat." 
 Scene IV. — The performance closes with a second 
 and final drink of cold water. The preliminary 
 draughts of water are to cool the mouth and 
 throat, and the post- ether draught is "to keep 
 the ether from rising." The washing of the 
 mouth is soon omitted, By and by the prelimi- 
 nary draught of water follows the same fate, the 
 ether dose and the succeeding draught of water 
 being the commonest method. As his education 
 advances, the etherist dispenses with water alto- 
 gether. He may for a while, especially when 
 drinking an unusually large dose, hold his nose 
 with one hand, but probably ends by despising 
 all precautionary safeguards, and by simply 
 drinking his mouthful of ether at a gulp. 
 
 WHAT IS TAKEN. 
 
 Ether purus of the British Pharmacopoeia was 
 at one time affected by my inebriate patients. 
 This pure ether {Q.^^fi, which is free from al- 
 cohol and water, has been in my hands the only 
 ether preparation which has proved to be with- 
 out complicatory drawbacks when used as an an- 
 aesthetic (Brit. Pharmacopoeia, 720; U. S., 725). 
 Ether of the B. P. (sulphuric ether) was, how- 
 ever, the article generally used for purposes of 
 
236 
 
 intoxication. It contains 8 per cent, of alcohol 
 and water with 92 per cent, of ether purus, and 
 is soluble in all proportions with rectified spirit, 
 but in only i in 10 with water. The specific 
 gravity should be (B. P.) .735; (U. S.) .750. 
 It is a swift, potent, difi'usible stimulant, nar- 
 cotic, anaesthetic and antispasmodic, of great 
 value in medicine. It has a strong, penetrating 
 odor, is sweetish, hot, burning and pungent to 
 the palate. 
 
 To America the whole world owes a deep debt 
 of gratitude for the introduction of ether as an 
 anaesthetic by Dr, Morton, in Boston, in 1846, and 
 any saddening misuse of this grand mode of al- 
 leviating human suffering ought not to lessen our 
 appreciation of this splendid boon to humanity. 
 
 By the Act 18 and 19 Vict, c. 37 (1855-6) the 
 use of spirit of wine, free of duty, was permitted 
 in the arts and manufactures, on the addition of 
 a minimum of ^ of wood naphtha (methylic al- 
 cohol or spirit from the destructive distillation 
 of wood, after rectification; specific gravity .803 
 B. P.), with a view to prevent this fouled liquid 
 from being drunk as a beverage. Ether prepared 
 from this fouled duty-free spirit is, of course, 
 much cheaper than ether prepared from spirit of 
 wine on which duty has to be paid. The inten- 
 tion, however, was defeated, inasmuch as in the 
 process of manufacture of ether from the fouled 
 spirit, the fouling ingredients (i. e., the methyl 
 products) are destroyed. Thus, contrary to the 
 general belief in what is commonly called " meth- 
 
237 
 
 ylated ether " being as nasty as the methylated 
 spirit which is used for lamps and for polishing 
 purposes, "methylated ether" is to the taste 
 hardly discernible from pure sulphuric ether. 
 This so-called "methylated ether" is practically 
 undistinguishable from ether (B. P.) at the spe- 
 cific gravity of .717, i.e., when purified. At 
 any other specific gravity, an odor is given off 
 after evaporation. Practically, one cannot dis- 
 criminate between the ethylic and methylic pro- 
 ductions. 
 
 Price. — The ether thus prepared from the duty- 
 free spirit (sp. vin. rect. cum methylic alcohol), 
 can be produced at as low as one seventh of the 
 cost of ether prepared from the duty paid spirit, 
 the latter being bought wholesale at $1 25 per 
 lb. , and the former at as low as 16 cents. 
 
 HOW PROCURED. 
 
 Ether is imported mostly from England, partly 
 from Scotland, by larger chemists and druggists 
 in the principal towns of Cookstown, Maghera- 
 felt, and Maghera. The large dealers supply small 
 shopkeepers, and also cottagers, who sell in 
 "draughts " (rather less than 2 teaspoonfuls) for 
 one penny. The small shopkeepers also supply 
 the hawkers (who are very often women), who 
 attend fairs and other festive gatherings to dis- 
 pense the "draughts" of the liquid poison. 
 These ' ' draughts ' ' are also to be had from the 
 surgeries of some medical practitioners, and in 
 cottages or ether shebeen, where the cottager 
 
238 
 
 keeps a pig or two, and sells ether, the country- 
 people frequently giving potatoes, meal, or other 
 produce in exchange. The hawkers carry about 
 a bottle of ether, and do not scruple at selling to 
 any one, however young, bartering a little for 
 one or two eggs. In this way the children may 
 procure the ether on their way to school. 
 
 ETHER PHENOMENA. 
 
 Intoxication by ether presents one distinguish- 
 ing feature as compared with alcoholic intoxica- 
 tion. The phenomena are practically alike, but 
 in rapidity of manifestation, alcohol is "no- 
 where." Indeed, in this respect, ether beats the 
 record. There is the exhilarative stage of mor- 
 bid exaltation, when the fun and exuberant mer- 
 riment, the latent and ineradicable impulse of 
 one ' ' spoiling for a fight ' ' of the genuine Irish- 
 man stands revealed in the twinkle of the eye, 
 and the flourish of the shillelagh. The pleasing 
 but quickly vanishing whirl of enjoyment is fol- 
 lowed by an evanescent episode of brain disturb- 
 ance and mental riot, with muscular paralysis 
 and incoordination. To these succeeds the con- 
 cluding comatose stage, when the patient is said 
 to be "dead drunk." The shortest period in 
 which I have seen this inebriate panorama move 
 on till it swung round to recovered sobriety has, 
 with alcohol, been six hours. With ether, I 
 have witnessed the entire revolution in less than 
 two hours. 
 
 In my observation an alcoholic inebriate career, 
 
239 
 
 from start to a fatal finish, has in America been, 
 on an average, one- third of the duration of a 
 corresponding career in Britain. So, curious to 
 say, has the length of an ether intoxicative par- 
 oxysm been one-third the length of an alcoholic 
 intoxicative paroxysm. Thus the etherist can 
 have three thorough "drunks" for one of the 
 alcoholist. Herein, in addition to the greater 
 cheapness, lies the superior claim of ether to the 
 "greedy for intoxication," the true "narcoma- 
 niac." 
 
 Intoxication by ether may be described as 
 "hysterical," and intoxication by ether cum al- 
 cohol as " maniacal." A man arrested while 
 drunk on ether alone, would probably be quite 
 sober by the time the constable had him at the 
 police station, which might be very awkward for 
 the constable, though the arrest had been made 
 when the man was in a frenzy of boisterous ex- 
 citement. Several deaths from ether, and ether 
 cum alcohol, have occurred. 
 
 PATHOLOGY. 
 
 Wttle is known of the pathology of ether. 
 The habit has been too young to afford opportu- 
 nities of much post-mortem examination of ether 
 inebriates. Premature old age, an antedated 
 shriveling up of the living frame, attests the 
 poisonous influence of the destroying agent. 
 Gastritis (acute and chronic), debility, dyspep- 
 tic distress, epigastric pain, pallor, tremors, tim- 
 idity, moroseness, suspicion, nervous prostra- 
 
240 
 
 tion, chilliness, a cyanosed or lemon skin, and 
 an intermitting heart- beat, with exaggerated re- 
 flexes, are prominent symptoms. I have one 
 such victim in my mind's eye now. Fawning, 
 cunning, terror-stricken, this wretched medical 
 colleague is the incarnation of utter misery. Not 
 yet 40 years of age, he shuffles about like a worn- 
 out old man of 90 after a wasted and mis-spent 
 life. It has been urged by some medical author- 
 ities that ether is guiltless of producing any 
 pathological lesion, from the almost lightning 
 rapidity with which its inebriating manifestations 
 appear and fade away, and from no serious mor- 
 bid after- death appearances having been observed. 
 This conclusion is, in my judgment, premature. 
 Judging from the symptoms from which I have 
 seen ether inebriates suffer, I have not the slight- 
 est doubt that ether has a pathological influence 
 on various organs and tissues, and that, if ether 
 drinking could boast of as venerable an antiquity 
 as alcohol drinking, unmistakable lesions would 
 have been but too manifest. What are the forty 
 years of ether consumption by a hundred thousand 
 persons, to the thousands of years of alcohol con- 
 sumption by at least as many millions of human 
 beings? 
 
 REMEDIES. 
 
 Happily, this new form of inebriation is but 
 in its infancy, so there is some hope that its 
 growth may be "nipped in the bud." As, in 
 the conversion of methylated spirit into ether, 
 
241 
 
 the nauseous methyl products are destroyed, 
 something might be done towards making the 
 liquor loathsome to the palate by the compulsory 
 addition of the wood spirit after the completion 
 of the etherification, before the sale of the liquid. 
 This, however, would be but a palliative, for I 
 have had patients under my care who drank 
 methylated spirit (some even from jars with 
 anatomical preparations), and, in Edinburgh and 
 Glasgow, Sunday drinking of this nasty bever- 
 age recently flourished apace. In a certain lo- 
 cality in the north of Ireland, the drinking of 
 methylated spirit was introduced seven or eight 
 years ago. At first confined to the very poor in 
 a hilly district, it has spread rapidly, till now 
 farm laborers and farmers are daily indulging 
 in it. 
 
 There are many inebriates who hate and abhor 
 the taste of the intoxicant which, in their narco- 
 maniac madness, they would barter their salva- 
 tion to procure. 
 
 Another remedy would be the abolition of the 
 retail sale. This would help by putting difBcul- 
 ties in the way of the drinker, but would only 
 mitigate the mischief. Still more efiectual would 
 be the scheduling of ether as a poison, the sale 
 of which is restricted to druggists under certain 
 safeguards. This course was so readily adopted 
 for Ireland by the British Government in Janu- 
 ary last, that I have yet hope the day will come 
 when the more deadly allied poison — alcohol — 
 will be placed in the same category, and so dan- 
 
242 
 
 gerous a drug will be relegated to the shelf of 
 the apothecary, its sale hedged in with as strin- 
 gent precautions as is now the sale of arsenic or 
 prussic acid. But this halcyon era of prohibi- 
 tion will only be attained after a prolonged strug- 
 gle, amid the howls and groans of an enraged 
 liquordom, whose indignation is concentrated on 
 all who attempt to " rob a poor man of his beer." 
 
 It is too soon yet to foretell the ultimate result 
 of the bold step taken by our Government in 
 scheduling ether as a poison, but it has made the 
 procuring of ether for drinking purposes so diffi- 
 cult that for the present the sale has diminished 
 by at least 75 per cent. I fear, however, that the 
 cupidity of some wholesale dealers will incite 
 them to risk the penalties of the law by surrep- 
 titious sales, which will speedily be ferreted out 
 by the marvelous cunning of the diseased and 
 demoralized inebriate. 
 
 The lines of sound treatment of ether inebri- 
 ety, and of its prevention by law, must alike be 
 based on an intelligent appreciation of the true 
 character and etiology of ether drunkenness. 
 This is, in reality, but a new manifestation of an 
 underlying morbid condition which renders cer- 
 tain of the sons and daughters of men peculiarly 
 liable to plunge into intoxication. We can never 
 hope to succeed in the cure and prevention of 
 any disease, until we first recognize the presence 
 of the disease itself. The malady of narcoma- 
 nia, as subtle as it is far-reaching in its influence 
 on body, brain and mind, and morals, is a legiti- 
 mate outcome of natural law, and we will not be 
 adequately equipped for the fight till we are 
 thoroughly conversant with the laws under which 
 every form of the disease of inebriety is developed 
 and propagated. 
 
SYNOPSIS OF OPIUM INEBRIETY; EF- 
 FECT, NEEDED-LEGISLATION, DIS- 
 TINCTIVE PLANS OF TREAT- 
 MENT NECESSARY FOR THE 
 SUCCESSFUL CURE. 
 
 BY W. S. WATSON, M.D., 
 
 OF MATTEAWAN, NEW YORK. 
 
 Member of the American Association for the Study and Cure 
 
 of Inebriety, of the Ninth International Medical Congress, 
 
 of the American Medical Association, Dutchess 
 
 County Medical Association. 
 
 He who has proven himself an attentive ob- 
 server of the transactions of man for the past 
 twenty- five years, does not hesitate to pronounce 
 the last quarter of the transpired portion of the 
 nineteenth century the most remarkable in the 
 history of man. The philosopher, the scholar 
 and the philanthropist, will be ready to declare 
 that at no period, in all former times, have the 
 intellectual energies of our race made so momen- 
 tous discoveries, or put forth such exalted plans 
 of benevolence for the benefit of mankind. The 
 mighty achievements in the mechanical world 
 have given new impetus to old powers and crea- 
 ted new ones of vast results, profitable to us as a 
 
244 
 
 nation and as individuals. Revelations in lan- 
 guage, in inscriptions, in customs and laws of 
 nations have unfolded treasures of undoubtable 
 excellence and worth, important in history, and 
 eminently subservient to profound and philo- 
 sophical investigation of man ; while the knowl- 
 edge now possessed of Nature and her laws, has 
 enlarged the domain of humanity with results of 
 vital importance. lYearning is necessarily no 
 longer confined to the favored few, nor is wisdom 
 locked up from those earnestly seeking. L,ike 
 the rays of the noon-day sun, intellectual light 
 beams forth from almost every countenance; in- 
 struction is easily acquired by almost every in- 
 dividual; knowledge unfolds herself to every in- 
 quirer. Man is more and more aware of his capa- 
 bilities. Onward, is the watchword. Progress, 
 the spirit of the times. This is an age of inves- 
 tigation; the relation of cause and effect is 
 sought; mind penetrates everything, theories of 
 the past are being submitted to a more searching 
 inquiry in the crucible of the present, new truths 
 are evolved, old ones confirmed; error and preju- 
 dice vanish before the judgment of this enlight- 
 ened age; we live in an epoch full of change, 
 alive with conflicting opinions. Nted we won- 
 der at an obtuseness in the public mind in 
 regard to the legitimate claims of the medical 
 profession, a want of discrimination in recogniz- 
 ing the genuine, or an absence of veneration for 
 the dictates of experience? It has been hinted al- 
 ready that the spirit of the age is one of reform. 
 
245 
 
 In social institutions, in jurisprudence, in our 
 criminal legislation, and political economy, 
 leading minds are ardently at work advancing 
 new theories; should not the same principle be 
 made evident in our profession? Should so vital a 
 thing as that of the public health be neglected, is 
 it well that we look on with unconscious indiffer- 
 ence at the warfare that is being waged on the 
 life and health of untold thousands by charlatans 
 and imposters, who vaunt their so called cures 
 broadcast through the medium of the press? The 
 newspapers and periodicals are filled with adver- 
 tisements skillfully designed to extort money 
 from victims of the opium, morphia and chloral 
 habit; you cannot pick up a paper, be it a religious 
 or not, that does not contain their advertisements. 
 How a Christian paper or journal can be a party 
 to such a crime as that of helping these unscru- 
 pulous fiends to make capital out of the unfortu- 
 nates that are addicted to the use of such drugs, 
 is more than we are able to comprehend; the 
 money to be realized from advertising for such 
 imposters seems to crowd out all sense of right, 
 hence the only way to overcome this evil is to 
 enact such laws as will make it a criminal offense, 
 punishable by imprisonment, to offer for sale any 
 mixture or compound for the cure of inebriety, 
 opium or alcoholic, into which composition 
 opium or alcohol enter, or for being a party to the 
 sale of such drug or compound, by advertising it 
 or otherwise. Until such a law is in effect through 
 the United States, opium, alcohol, and inebriety 
 
246 
 
 will hardly have a cure; there is no question but 
 thousands are made mad by the vile stuff that is 
 offered as cures for the opium and alcohol habit; 
 if the compound of itself does no actual harm by 
 reason of any powerful constituent, the disap- 
 pointment, the blasted hopes that were so ele- 
 gantly colored up by the advocates of the so- 
 called cures is enough to set one crazy when he 
 learns that his habit has only been fed. Il,egisla- 
 tion, and legislation alone can reach this specie 
 of fraud, once it is made a felonous act to sell or 
 offer for sale, or advertise for sale any nostrum or 
 compound until an analysis has been made by 
 the State Analyst, and his certificate is attached 
 thereto certifying that said compound does not 
 contain any drug or combination of drugs that 
 are known to enslave. Opium addiction : Is it 
 on the increase? It may be said that opium in- 
 ebriety is a disease of modern life, or recent ori- 
 gin. Opium eating, as it is called, has been 
 practiced for centuries in the East; in China al- 
 most one-fifth of the entire population are ad- 
 dicted. Opium eating and smoking, strictly 
 speaking, never prevailed to any great extent 
 among "Western nations until after the discovery 
 of morphine in 1817. Since morphine has come 
 to light it has made thousands of victims; espe- 
 cially has the habit increased with alarming ra- 
 pidity since the hypodermic syringe came into 
 use. To day, opium, in some of its forms, holds 
 in bonds hundreds of thousands, yes millions of 
 the human race. We believe that there is no 
 
247 
 
 habit that is more pernicious to us, as a people or 
 nation, than that of opium inebriety, for it takes 
 possession more insidiously and holds on more 
 tenaciously than any other known drug. The 
 amount of opium coming through our United 
 States Custom Houses, as reported, does not 
 show an increase in the consumption of opium, 
 during the past eight or ten years. There being 
 no increase of imports does not conclusively show 
 that no more opium is being consumed; legisla- 
 tion, increase of duty, has not shut out the sup- 
 ply. Some years ago Congress imposed a duty 
 of ten dollars a pound on opium, with the hope 
 that such' duty would cause a decrease in the 
 consumption of the drug; the effect has been an 
 opposite one. The increase in price has been the 
 means of a large amount of smuggling through 
 various channels, the profits being enormous. 
 Some statistician has calculated that the gains of 
 English opium merchants in the last half cen- 
 tury, exceeds two thousand million dollars. 
 Large financial interests are concerned in foster- 
 ing the opium vice in the United States, and here 
 as well as in England fortunes are being made, 
 by evading the tax imposed. We imported, and 
 there was passed through the custom house, ac- 
 cording to statistics of the Treasury Department, 
 as follows: 
 
 In 1884, crude opium, 9 per cent, morphia, 
 264,746.15 lbs., for smoking 1,66,600 lbs., mor- 
 phine 27,850.18 ounces. 
 
 In 1885, 351,609.15 lbs. crude opium contain- 
 
248 
 
 ing 9 per cent, morphia, morphine 20,709.50 
 ounces. 
 
 In 1886, 351,193.11 lbs. crude opium contain- 
 ing 9 per cent, morphia, morphine 17,731.47 
 ounces. 
 
 In 1887, 468,153.13 lbs. crude opium contain- 
 ing 9 per cent, morphia, morphine, 14,431.00 
 ounces. 
 
 In 1890, 380,621.42 lbs. crude opium contain- 
 ing 9 per cent, morphia, morphine, 19,953.60 
 ounces. 
 
 It is estimated that during the year 1889 alone, 
 there was something over 800,000 pounds of 
 smoking opium alone smuggled into the United 
 States, and there is every reason to believe that 
 the amount smuggled in is perhaps double, when 
 we consider the fact that every month three or 
 more steamers arrive from China, at the western 
 terminus of the Canadian Pacific Railway, at 
 Vancouvers, most of them having opium on 
 board. An average cargo, it is said, is about 25,- 
 000 pounds; a small amount may be retained for 
 consumption in Canada, the remainder, it is said, 
 is smuggled into the United States. 
 
 EFFECTS OF OPIUM. 
 
 There is a vast difference between individuals, 
 not only as regards tolerance of such a poison, 
 but aLso as regards the forming of the habit; 
 some temperaments fall almost immediately in- 
 to the habit, others can use opiates for years and 
 seem as free as though habit was an impossibilit}'; 
 
249 
 
 we will, however, find victims among all classes. 
 Morpho-maniacs include many of our literary 
 men, mathematicians and scientists; medical men 
 are more exposed to the formation of the habit 
 than any other class. There is in his case what 
 might almost be called a reasonable excuse for 
 something which will quickly give relief from 
 pain, if attacked, knowing as he does the un- 
 doubted effect of morphia to relieve pain; in his 
 hurry, while others are calling upon him to help 
 them, he may and often does insert or take a dose 
 of an opiate. Business and urgent calls give him 
 no time to consider his own case, or how often 
 he has resorted to the remedy, and presently he 
 finds he cannot throw off the craving, a need is 
 implanted almost without his suspecting it. 
 Thus thousands of physicians are made slaves to 
 the opium habit, from which they cannot free 
 themselves unaided, for he ig himself no more, 
 all is abnormal. The normal state with an opi- 
 maniac is given in a few words: the *ill is 
 paralyzed, his personality is destroyed. The 
 opium habit is one difficult of eradication, the 
 percentage of reformed drunkards is greater than 
 that of opium inebriety; the drug opium long 
 used becomes a necessity, and if withheld the 
 whole system, every cell, cries out in agony, har- 
 mony of function can no longer be maintained 
 without opium, the whole organism has been ad- 
 justed to the new or artificial condition in which 
 the elements of equilibrium are in the poisonous 
 drug. A sudden failure to supply the stimuli 
 
250 
 
 gives rise to an overwlielming craving, and 
 plunges the individual into a trying ordeal from 
 which there is no relief unaided, except it be by- 
 repetition of the poison and in increased doses. 
 It has often been said by those having passed the 
 trial of abstinence, that no one else but such can 
 tell or give the faintest idea of the suffering one 
 experiences when trying to abstain, without 
 having been prepared for such withdrawal; 
 against their better judgment they are driven to 
 madness, and as a rule they seek relief by return- 
 ing to the accustomed drug. It matters not who 
 he may be, whether of the high or low, or of 
 what caste, he finds he is indeed a slave to a hab- 
 it over which he has no longer control; self con- 
 trol is a lost factor with him. Opiurn inebriates 
 tell us but one story, that they are no longer 
 free. Opium inebriety is truly a disease; there is 
 brought about certain molecular changes, and a 
 neurosis is produced amounting to a necessity for 
 the continuance of the drug, until a preparatory 
 stage is passed, during which sedative drugs are 
 used and the system thoroughly aroused, reflex 
 sensibility, or disturbances anticipated by such 
 medication as will displace and tone up the par- 
 alyzed functions. The mental faculties are 
 among the first that suffer from the use of opium, 
 as melancholia, hallucinations, especially of 
 sight and of dread; sometimes the opposite is the 
 case, instead of sadness or depression, there is 
 excitement or mania, vertigo is common; with 
 some insomnia is of frequent occurrence, perhaps 
 
251 
 
 wakeful all night and sleepy during the day. 
 Sensation is generally impaired ^or perverted, in 
 most cases there is a state of anaesthesia which 
 largely accounts for the painless punctures with 
 the syringe; upon the digestive organs morphia 
 exercises, sometimes, a peculiar influence, if ad- 
 ministered hypodermically it sometimes devel- 
 opes an appetite for a time, when if taken by the 
 stomach, it destroys all desire for food, and not 
 infrequently brings about nausea and vomiting; 
 upon the bowels, the paralyzing effect is marked, 
 a large proportion of persons are obstinately con- 
 stipated while they continue its use, abstinence 
 brings about diarrhoea; many patients are also 
 troubled with dysurea, and only pass a few drops 
 at a time, the kidneys seem to be paralyzed and 
 do not perform their functions well; general nu- 
 trition suffers from the paralyzing influence. 
 Those addicted to opium grow old fast, their 
 eyes grow dull, face is without expression, skin 
 becomes yellow and generally greasy. 
 
 Abstinence, there is a state of disquiet, an un- 
 easiness, a state of agitation comes over the in- 
 dividual if his dose is long deferred and the sys- 
 tem is long deprived of the stimulent, a sense of 
 discomfort takes hold and he is restless and irri- 
 table. The highest effects of the abuse of opium 
 are developed in the abstainer; among the mark- 
 ed symptoms are diarrhoea which can always be 
 expected if the opiate is suddenly withdrawn, 
 and if it does not come on, the patient should be 
 
252 
 
 watched, for he is probably deceiving you, 
 shamming. 
 
 DIAGNOSIS. 
 
 You are generally struck by the strange ap- 
 pearance and expression of this class of people, 
 the wan complexion, the vacant look together 
 with a duluess, listlessness, with marked lower- 
 ing of the physical as well as moral status, 
 functions of nutrition are profoundly affected, 
 with generally a loss of appetite and obstinate 
 constipation; the most reliable method of diag- 
 nosis, and one that does not require acknowl- 
 edgment on the part of the patient, is the exam- 
 ination of the urine; morphine is eliminated by 
 the kidneys and can be found in the urine, and 
 when found you are absolutely certain that the 
 habit exists. Examination from day to day is a 
 part of my method for the detection of deceit on 
 the part of the patient; of course it must be taken 
 into account that the alkaloids of opium are not 
 all eliminated for some eight, or possibly ten 
 days after commencing to abstain; by analysis of 
 the urine we have a certain means of knowing 
 the condition of our patient. 
 
 TREATMENT, DISTINCTIVE PLANS. 
 
 There are some three or more plans or meth 
 ods. First is the abrupt withdrawal or suppres- 
 sion, practiced by the somewhat noted German, 
 Dr. Ivivinstine, and by man}"^ others after him. 
 The plan is simply to take away the drug at 
 once, without any preparation whatever. In re- 
 
253 
 
 gard as to dose; experience has taught thousands 
 that the use of morphia or opium can not be sud- 
 denly stopped without serious results following. 
 The abrupt withdrawal entails much suffering of 
 mind and body and a risk of suicidal ending. 
 Collapse is threatened on every hand; such a 
 method is barbarous, uncalled for and inhuman; 
 any one subjecting a person to such cruelties 
 should be held for malpractice. Dr. J. B. Mat- 
 tison, of Brooklyn, one of our ablest American 
 writers, a man of considerable experience in this 
 line has, upon several occasions, expressed him- 
 self as bitterly opposed to the abrupt withdrawal, 
 and holds that no man is warranted in subject- 
 ing his patient to such torturing ordeals. We 
 are awafe that the I,ivinstine method has' its ad- 
 vocates even to day, and some are high in the 
 profession; we are of the opinion of Professor 
 Bartholow, when he says one such an experience 
 and he could not be induced to repeat it, if for no 
 other reason than strictly humanitarian reasons, 
 since the mental and physical sufferings are 
 truly horrible. The dread of untold sufferings 
 that one has to undergo keeps hundreds under 
 the yoke of habit; the impression is broadcast 
 over the land that to quit it is to entail upon 
 themselves tortures beyond the endurance of al- 
 most any ordinary person. A second method is 
 the rapid withdrawal, but not abrupt. Dr. Mat- 
 tison advocates this method and it is generally a 
 safe one to pursue. The plan consists of first 
 producing a certain amount of sedation or con- 
 
254 
 
 trol of the reflex irritation present. Dr. Matti- 
 son, in his monograph on the treatment of opium 
 addiction, bays the use of sodii bromide is, so far 
 as he is aware, original with him in connection 
 with the treatment of the opium reflex irritabili- 
 ty; we have found in it the safest and most valu- 
 able sedative in such cases, for many years, our 
 attention being first called to the effect of bro- 
 mide of sodii and its probable action in the reflex 
 disturbances following the withdrawal of -opium 
 from the human system by the late Dr. Beard. 
 In using bromides to counteract, and to get de- 
 sirable results, it requires large doses and for 
 some days, from four to six days. The system 
 needs to be constantly under the influence for 
 such a length of time as named before an attempt 
 is made to withdraw, in other words, the maxi- 
 mum sedative effect of the bromide should be se- 
 cured by the time the maximum nervous dis- 
 turbance is expected or brought about by with- 
 drawal of the opium. The rapid withdrawal is, 
 in some respects, the most desirable of either 
 the three plans. Sudden, rapid or gradual, bet- 
 ter than the first from the fact that the system is 
 saved the severe shock of the first and the neces- 
 sarily longer time of the latter, and were it not a 
 fact that many cannot even endure without se- 
 vere trial and suffering under the rapid method, 
 I certainly would rigidly adopt such a plan, but 
 the gradual, with me, seems to meet more con- 
 stitutional conditions than either. Gradual 
 withdrawal is the easiest plan and the one most 
 
255 
 
 likely to succeed in the largest percentage of 
 cases; it is to us the most logical from the very 
 fact the habit is gradually formed, certain condi- 
 tions and changes were produced gradually, 
 therefore, it is rational to gradually withdraw or 
 undo. 
 
 NECESSARY MEANS TO SUCCESS. 
 
 It is indispensable that the patient place him- 
 self under care of one familiar with the work, 
 one that has studied the conditions that are like- 
 ly to arise during the period of abstinence. Opi- 
 um addiction, it matters not how used, pro- 
 duces radical changes in the system, a neurosis 
 is produced amounting to necessity for the con- 
 tinued use of the drug, the demand for opium is 
 so imperative as to place the consumer wholly 
 beyond the power of resistance unaided. The 
 principal difficulty we encounter in treating 
 those addicted to the use of opium, is that they 
 have lost about all their will-power, or self-con- 
 trol, in fact, confidence in themselves; they have 
 a disease that impels an increase rather than 
 power to diminish the doses, repeated attempts 
 to abandon the use of opium has proved their 
 utter inability to even diminish the dose; there- 
 fore there is but one road leading to a cure, and 
 the only remedy or reasonable chance or plan 
 that offers any assurance of a cure, is to place 
 themselves under the care of a specialist in the 
 work; in the hands of a conscientious practitioner 
 who from contact, study and close attention to 
 
256 
 
 each patient's peculiar needs can best provide for 
 every emergency, opium inebriety or eating, as it 
 is called, is a vincible disease and curable, the 
 person being otherwise constitutionally strong 
 and free from organic disease, having an earnest 
 desire to be cured; it matters little as to the ex- 
 tent or time used, nor need there be any dread of 
 the hard ordeal to be passed through that has 
 been pictured as worse than death; there are days 
 of rational medicine, of humane and scientific 
 methods. A special institution designed for such 
 cases is the proper place, where appropriate ar- 
 rangements are made for the care of each person, 
 with provision for carrying out the best method 
 for each particular case; certain symptoms and 
 conditions have to be met promptly when they 
 do arise; in some instances a collapse condition 
 threatens, which is best met by stimulants of 
 ammonia or alcohol; in extreme cases a hypoder- 
 mic dose of morphia may be a necessity for the 
 time; delirium can be warded off by coca, chloral 
 and bromides; if there is vomiting, omit food of 
 solid character and give hot beef extract, hot 
 milk, beef peptonoids (liquid form), medicine, 
 ammonia ar. spr., bismuth sub. nit. Diarrhoea: 
 clear out the prima- viea first by an emulsion of 
 ol recine with spr. galci, then give bismuth sub. 
 nit. and zinc sulph. carbolate. Pains in the legs 
 treat by hot foot bath, massage and friction. 
 Sleeplessness, restlesness: be sure first that your 
 patient is not shamming, then give full doses of 
 bromide, and sometimes ammonii valennate in 
 
257 
 
 the elixir form. Where sleeplessness comes 
 without pain, I believe we have in the new drug, 
 sulfonal, a most excellent sleep producing agent; 
 being tasteless, is easy to administer. Sulfonal- 
 bayer, is truly a hypnotic, in doses of from' lo to 
 20 grs. it does not derange the appetite or diges- 
 tion, and does not seem to have any effect on the 
 renal secretions, acts in from i to 3 hours and the 
 the effect lasts from 5 to 7 hours. In insommia 
 from pain it is of no value. From our present ther- 
 apeutic knowledge of sulfonal we think it not ad- 
 visable to give it in increased doses, from day to 
 day, rather, if necessary, to give it nightly, in 
 diminishing the doses. Codea is a preparation 
 of opium that can be given to allay pain as safe- 
 ly as any of the opiates and without any great 
 liability to formation of habit; in cases present- 
 ing an anaemic condition, iron and strychnia 
 are proper. If any notable depression or pros- 
 tration of any considerable duration, alcoholic 
 stimulants are demanded. Restlessness and in- 
 somnia are frequently warded off by the hot bath 
 before the hour of retiring. Electricity is use- 
 ful in lamost all cases and many times will tran- 
 quilize the system, especially the electric bath. 
 Among the essentials that are positively needed, 
 if you would succeed, is mental quietude. Opium 
 and chloral cases need be in an atmosphere of 
 tranquillity, away from all exciting causes; lively 
 diversions, pleasant company are desirable; the 
 patient should first of all select a heathful place 
 with cheerful surroundings as practicable, and 
 
258 
 
 above all, place him or herself in the care of one 
 in whom they have confidence; once in the insti- 
 tution no more information should be imparted 
 as to when or how they get rid of the opiate; if 
 the patient is one that uses the hypodermic 
 syringe, a change must be made at once, the syr- 
 inge must be discarded and all opium should be 
 taken by the mouth. 
 
THE ABSENCE OF REASONABIvE MO- 
 TIVE IN THE SO-CALLED "CRIM- 
 INAL ACTS" OF THE CON- 
 FIRMED INEBRIATE. 
 
 BY L. D. MASON, M.D., 
 
 CONSCLTING PHYSICIAN INEBRIATES HOME, FORT HAMILTON, L. I. 
 
 "Motive" may be defined as that which actu- 
 ates or influences, that which determines choice. 
 It implies the presence of an unimpaired will 
 power, at least one that is not so seriously im- 
 paired as to be incapable of volition, and actua- 
 ted either by right or wrong desires. 
 
 Impulse is the sudden application of some 
 powerful motive, that causes the will to act has- 
 tily without usual deliberation, or that exercise 
 of the reasoning faculties that occurs when a pur- 
 pose is deliberately formed. The genesis of im- 
 pulse may be a good or evil motive. 
 
 In both instances either when the apt results 
 from the motive operating upon the mind through 
 a deliberate and logical course of reasoning, or 
 impulsively, as when the motive acts independ- 
 ently of, or supercedes and dethrones reason, if it 
 
26o 
 
 attempts to assert itself in either instance, 
 there is one condition that is corhmon to both, 
 and that always is present, namely, consciousness 
 of the act. The person invariably knows he has 
 performed the act whether the "motive" were 
 good- or evil, the result of deliberation or of im- 
 pulse. 
 
 How often do we hear the expression, "what 
 motive urged him to do such an act?" and if the 
 person be in a normal mental condition the law, 
 if the act involves a legal infringement, arrests 
 and punishes the transgressor. But are these 
 words applied to the acts of an insane person ? 
 Certainly not. All acknowledge that the will 
 power in this case is held in abeyance in some 
 instances, or permanently annulled in others in 
 which the insanity is incurable. The actions of 
 the acute or chronic insane are "senseless" and 
 utterly devoid of reason; if a"quasi" motive is 
 asserted it is insufficient, and as a rule ridiculous, 
 incompetent to explain an act often involving 
 matters of the greatest moment, even life itself. 
 This is seen in certain forms of monomania. 
 Thus the pyro-maniac sets fire to a crowded 
 tenement. Gives as a reason for his motive in so 
 doing that he likes the excitement and confusion 
 incident to such a scene; all other motives based 
 on rational explanation being excluded, such an 
 one would be regarded and dealt with simply as a 
 person possessing a dangerous monomania, and 
 demanding close confinement in an insane asy- 
 lum. No one is held responsible for his acts, if 
 
26l 
 
 he is incapable of exercising his will power, the 
 ability to reason from cause to effect or discrimi- 
 nate between good and evil courses, and the con- 
 sequences resulting from these. 
 
 Even in some forms of insanity where the will 
 power and reason are not totally annihilated, the 
 insane person capable of exercising a discrimina- 
 ting power to a certain extent, having at least a 
 partial knowledge of right and wrong. Even in 
 these cases the insane person is never legally 
 punished although he may be disciplined by "in- 
 stitutional forms of correction;" this treatment is 
 much the same as a child, who has not yet ar- 
 rived at the years of discretion, and is still sub- 
 ject to his parents; the parent may correct the 
 evil doer of tender years, yet the law will not 
 punish such an one. 
 
 The law recognizes this fact, the absence of 
 full responsibility among the more youthful class 
 of criminals, and among the "criminal insane," 
 so-called. In the former instances the State es- 
 tablishes "Reformatories," in the latter, an asy- 
 lum for the "Criminal Insane." But while the 
 insane, the imbecile, the idiots, and those of ten- 
 der years, have thus been leniently dealt with, 
 by some strange, illogical process of reasoning, 
 or by actual indifference to the facts of the case, 
 the confirmed inebriate has been excluded from all 
 these benefits, and moreover, his inebriety has 
 been regarded not as an extenuating circum- 
 stance, but rather as an aggravation of his so- 
 called criminal act. 
 
262 
 
 Are his acts rational? Are they based on a 
 reasonable motive? are they the result of a well- 
 balanced mind? is he always even conscious of 
 the acts he performs? Analyze the acts of the 
 confirmed inebriate and you will find that they 
 are the acts of an insane person. Insane from 
 the temporary or habitual use of alcohol. 
 
 If we can show that in the majority of cases, 
 in the acts of the confirmed inebriate there is ab- 
 sence of proper motive, absence of intelligent 
 impulse, absence even of consciousness of the 
 act in some instances, otight he not to come un- 
 der the benefits of that unwritten or recorded law 
 which excludes from penalty the insane or those 
 of an irresponsible age, and does not hold them 
 responsible for their acts? 
 
 It has been abundantly shown, particularly by 
 the researches of Dr. T. D. Crothers, that am- 
 nesia, partial or complete, is the mental condition 
 of the average confirmed inebriate. If the loss 
 of memory is complete, he becomes a veritable 
 automaton; his movements are mechanical, de- 
 void of thought or reason, and he is therefore 
 unconscious of his acts; under this condition 
 what he does may be ridiculous or even danger- 
 ous. His actions are similar to those of a som- 
 nambulist who, walking in his sleep, performs 
 deeds of which he is totally unconscious when 
 awakened. The acts of the confirmed inebriate 
 are thus often performed unconsciously, and 
 when he comes out of this "trance state," so- 
 called, or condition of cerebral automatism, he has 
 
263 
 
 not any knowledge of what he has done, and yet 
 oftentimes there is a seemingly rational action on 
 his part, and his condition may not be detected, 
 because not suspected, by those with' whom he is 
 brought in contact; while in this condition the 
 inebriate may. commit acts that are criminal: 
 
 Mendacity has been set down as one of the 
 prominent characteristics of the inebriate, but I 
 am convinced that the denial of the inebriate of 
 the statements he has previously made or the 
 acts he has done, when confronted with them, is 
 often due to his utter unconsciousness of ever 
 having made such statements or performed such 
 acts. 
 
 The "testamentary capacity" of a confirmed 
 inebriate should be excluded on this ground, and 
 no "confirmed inebriate" should be empanelled 
 in any jury, nor should his testimony as a wit- 
 ness be received in any court. 
 
 The validity of the signatures of confirmed in- 
 ebriates, to wills, contracts, or atSdavits should 
 always be questioned if allowed, and "marriage" 
 contracted under these conditions should be an- 
 nulled. I am acquainted with an instance in 
 which the confirmed inebriate was a young man 
 of wealth, who contracted such a misalliance. 
 The validity of the marriage was not questioned 
 on the ground of the avoidance of publicity, and 
 the woman, whose sole object was money, finally 
 consented to relinquish her claim for the sum of 
 twenty thousand dollars. Now I maintain that 
 
264 
 
 such a marriage was not valid, and would not 
 have been recognized in legal courts. 
 
 Not only in the trance state, where conscious- 
 ness seems to be annulled, and the memory tem- 
 porarily abolished, may the inebriate perform acts 
 that he is totally unconscious of as a somnambu- 
 list or automaton, and thus render himself liable 
 to criminal procedure, or the subject of fraud on 
 the part of others. 
 
 But there is under this condition a tendency to 
 repeat the crime or act he may have been previ- 
 ously guilty of, a monomania, so to speak, for a 
 special act. 
 
 Dr. Alex. Pudden of Edinburgh, reports the 
 following cases: 
 
 At the prison of Perth, one woman was com- 
 mitted 137 times for being drnnk, her invariable 
 practice was to smash windows. A man when 
 drunk stole nothing but bibles. Another stole 
 nothing but shawls; another shoes. A man was 
 transported for stealing tubs on seven different 
 occasions; with one exception he was always 
 guilty of tub stealing. Others have been repeat- 
 edly convicted of horse stealing. 
 
 In others the destructive tendency is marked; 
 to pull down and destroy, unusual prodigality and 
 waste, such as scattering money in the street, or 
 throwing it in the fire. Such persons are notori- 
 ous for "cleaning out" a saloon, smashing, break- 
 ing and throwing out on the street articles of furni- 
 ture, etc. There is not any "reason in the mad- 
 ness" of these temporarily insane inebriates. 
 
265 
 
 Their actions are "motiveless." The whole ma- 
 chinery of the will is out of order, the power of 
 coordination of the faculties is lost, hence all acts 
 are erratic. 
 
 In addition to the "trance state" and "mono- 
 manical acts" of the confirmed inebriate, there is 
 another condition under which the inebriate may- 
 perpetrate higher grades of crime. We refer to 
 that condition where the prominent characteris- 
 tic of the insanity of the inebriate, is the mono- 
 mania of suspicion or persecution, a condition not 
 uncommon in the confirmed inebriate. Under 
 this condition the inebriate is morose, taciturn, 
 secretive; if he communicates his suspicions to 
 any one, it is only occasionally and with great res- 
 ervation. He imagines that enemies are try- 
 ing to poison him; he hears voices in the air; he 
 is followed, and in danger of being waylaid, or 
 his wife is unfaithful to him; suspicion of "mar- 
 ital infidelity" is very common in these cases. 
 Robbery, mutilation, murder, every possible con- 
 tingency that may happen to a person, are im- 
 agined by these insane inebriates, as being ap- 
 plied to their case. 
 
 Acting under erroneous suppositions, they 
 prepare themselves for the imaginary danger, or 
 assault those whom they believe would injure 
 them; or take vengeance on the innocent wife 
 whom they judge guilty of marital infidelity. 
 Oftentimes their mental condition is not suspect- 
 ed, and oftentimes only after they have wreaked 
 their insane fury on those about them. 
 
266 
 
 And just here in parenthesis we would remark 
 that though the acts of the confirmed inebriate 
 may fill every grade of crime, from petty theft to 
 homicide, yet those criminal acts which call for 
 shrewdness, mechanical skill, involving as they 
 do the maturing of long continued plans, well 
 laid, and aptly executed.as professional burglary, 
 systematic forgery, etc., the confirmed inebriate 
 is incapable of. 
 
 The burglar and the systematic forger may 
 drink liquor, but they have the fullest exercise 
 of their mental faculties, and the ability to use 
 liquor moderately, so that their hand is steady, 
 their nerves unflinching, and their reason un- 
 clouded. This is the universal testimony of the 
 governors or wardens of .penitentiaries and pris- 
 ons in America and Great Britain, and hence is 
 the great distinction between the so called ' crim- 
 inal inebriate" over the professional criminal. 
 The confirmed inebriate acts without motive, 
 without the deliberation, without that usual 
 caution and concealment that characterizes the 
 criminal who is in a normal mental and physical 
 condition. 
 
 Hence the insane inebriate, the subject of the 
 monomania of suspicion or persecution, is easily 
 traced to the act committed by him, and his at- 
 tempts at concealment, if made at all, are illy 
 disguised. He is not an assassin, striking from 
 the shadow and then disappearing. His acts are 
 often in the open day and the most conspicuous 
 public places. 
 
207 
 
 I,et me cite a prominent example or so that 
 may more forcibly illustrate this class of insane 
 inebriates. -And these cases will also partially 
 illustrate the acts of the inebriate epileptic — dif- 
 ferent only in this, that the prodromata or period 
 of incubation is longer in the inebriate having 
 the monomania of suspicion or persecution, than 
 in the epileptic inebriate. In the latter, the act 
 occurs as the coma following the convulsion had 
 passed off. The latter class are the most dan- 
 gerous of all insane inebriates,, for they add to 
 the insanity of epilepsy, that also which alcohol 
 begets. The following cases are instances where 
 the characteristic type of the insanity of the in- 
 ebriate was the " monomania of persecution " or 
 of suspicion. 
 
 Case I. — " The patient is 43 years of age, has 
 been drinking to excess for several years past, is 
 insane. The insanity is the direct result of his 
 excessive use of alcohol — there is not any hered- 
 itary taint. His insanity lasted about a year ; 
 he recovered and resumed his business, only to 
 relapse, and is now drinking harder than ever. 
 The immediate cause of his relapse was a sprain- 
 ed ankle, from which he suffered very much. 
 His insanity at all times is that of the ' mono- 
 mania of suspicion ' or 'persecution.' His sus- 
 picions are mainly directed towards his wife and 
 child. He walks about the house, and if he had 
 his full liberty, would no doubt assault them, for 
 it was found before his condition was fully ascer- 
 tained, that he had concealed, under the station- 
 
268 
 
 ary washstand of the bedroom occupied by him- 
 •self and his wife, a dirk knife, which was covered 
 with some old clothes." (Reported* by Dr. I. E. 
 h^st&r, Journal of Inebriety, Vol. vi, p. 32.) 
 
 The following case was reported by Dr. Drake, 
 of Cincinnati, O., and was published in the re- 
 port of the New York State Inebriate Asylum for 
 1866, the late Dr. I. E. Turner, Superintendent. 
 At the time of the occurrence, it attracted the 
 attention of the medical public in its bearing on 
 the legal responsibility of the insane. 
 
 "John Birdsall, of Harrison, in that State, 
 was indicted in 1829 for the murder of his wife 
 with an ax, by dividing the spinal column in the 
 neck. He was about 50 years of age, had been 
 married to this his second wife nineteen or twenty 
 years, and had children by her. For some years 
 previous he had been subject to fits of intoxica- 
 tion. These, of late, were followed by delirium 
 tremens, which generally lasted several days. 
 In these paroxysms, he entertained great fears 
 for his safety — ran about the village as if attempt- 
 ing to escape pursuit. At another time he con- 
 cealed himself between a straw bed and a feather 
 bed in his own house. He would point his gun from 
 a window, as if for defense against ima.gma.Ty per- 
 sons. He was also very watchful. 
 
 "The prevailing maniacal delusion was that his 
 wife was in combination with his neighbors, and 
 his son by his first wife, against his life. He had 
 charged her, during his paroxysms, with crimi- 
 nal intimacy with these, and had threatened to 
 
269 
 
 kill b,er on Sunday. He was intoxicated Monday, 
 Tuesday and Wednesday. On Wednesday even- 
 ing, he complained of being unwell, but seemed 
 to be rational. He slept none that night, and 
 next day the family thought him crazy, but were 
 not alarmed. In the course of the day he took 
 an ax and went to a neighbor, whom he desired 
 to return with him, as he stated they wanted to 
 kill him (monomania of persecution). He spent 
 the remainder of the day at home, apparently in 
 terror and agitation, manifested jealousy of his 
 wife, barred the doors, and fancied that the per- 
 son of whom he was jealous was manufacturing 
 ropes up stairs to hang him. In the course of 
 the afternoon he suddenly committed murder. 
 His wife was sitting by the fire, and he walked 
 into the room. After the fatal blow on the neck, 
 he followed it by two or three on the face. His 
 eldest daughter seized the ax, which he yielded, 
 but took a scythe and attempted to strike her. 
 She defended herself until the door was opened. 
 When arrested, he acknowledged the homicide, 
 and knew, he said, that he would be hung, and 
 regretted that he had not done it sooner. After 
 being committed, he became regular, and ex- 
 pressed sorrow for what he had done. On trial, 
 three medical witnesses agreed that he labored 
 under mania cL potu when he committed the hom- 
 icide. 
 
 "For the defense it was urged, that when 
 drunkenness gives rise to insanity, it should cause 
 immunity, and hence form a legal excuse. On 
 
270 
 
 the other hand, the counsel for the people re- 
 marked ' that Birdsall k?iew that his delirium fol- 
 lowed his intoxication, and hence U was voluntary. 
 The law therefore held him accountable for ac- 
 tions during such a state. ' The • verdict was 
 murder in the first degree, and he was sentenced 
 to death." It is needless to add that there was 
 not the slightest foundation for the insane vaga- 
 ries of Birdsall, and no " reasonable motive'''' for 
 his act. 
 
 Let me cite still another case, reported as a 
 newspaper item. "Alexander C. Wingate, a 
 wealthy resident of Woodford Co., Ky., was shot 
 dead at about 4 o'clock this morning (March 29, 
 1882), on an Ohio and Mississippi train,"near 
 Mitchell, Ind,, by a man named Haynes, who 
 was crazed by drink, and had no provocation for 
 the shooting. 
 
 "Mr. Wingate was returning home from a 
 business trip from the West, and was in a sleep- 
 ing-car. Haynes entered the car, laboring under 
 great excitement, and said to the porter and sev- 
 eral passengers that he had been followed by 
 thieves from San Francisco, who were bent on 
 robbing him (mania of suspicion). He begged 
 the passengers to keep his money — which amount- 
 ed to only $90. The porter tried to pacify him, 
 but he grew more desperate, and flourished his 
 revolver around wildly. The train men were 
 either too cowardly, or did not have sense enough, 
 to wrest the revolver from him, and eject him 
 from the train. 
 
271 
 
 " At this time, Mt. Wingate stepped from his 
 berth. Haynes immediately confronted him with 
 therevolver, andexclaimed, 'Givememymoney,' 
 and fired. Wingate threw up both hacds, cried 
 ' I am shot,' and sank down dead. The maniac 
 (from alcohol) turned, and fired two random 
 shots, then darted past the passengers and out of 
 the car door, and jumped ofi'the train, which was 
 running at the rate of 45 miles an hour. He 
 landed safely, walked half a mile to a creek, 
 stripped himself naked and jumped into the 
 stream. His dead body was found there this 
 morning. His clothes were found hanging to a 
 tree 100 yards distant, and they contained $90 in 
 gold, a gold watch, an express receipt for $400 
 sent from El Paso, Tex., to New Salem, O., and 
 a quart bottle of brandy, half full. In his valise 
 was found a gambler's ' lay-out.' Haynes is from 
 Yuma, Ariz. He was evidently laboring from 
 delirium tremens (?) at the time of the deed, or 
 rather ' mania ^ potu.' " 
 
 Although homicide was the prominent feature 
 ofthecase, " homicidal mania " was not. Haynes 
 did not kill Wingate because a predisposition to 
 kill some one predominated,* but as an act of sup- 
 posed self defense, and to resent the injustice that 
 he supposed Wingate had inflicted on him. In 
 other words, the "mania of persecution" was 
 the leading form of insanity — a form very com- 
 mon in cases of insanity arising from alcohol. 
 
 There is no crime in the calendar that these 
 alcoholic maniacs may not commit. Their reason 
 
272 
 
 is temporarily dethroned, they are unconscious of 
 not only the character of the act, but of the acts 
 themselves, and are therefore irresponsible. The 
 following case shows the complete annihilation 
 of all mental and moral responsibility. 
 
 " A young man in Madison Co., in this State, 
 in the year 1859, was attacked with alcoholic de- 
 lirium for the third time. While under the at- 
 tack, he killed his father and mother, cut out 
 their hearts, which he roasted and ate. He was 
 arrested, thrown into prison and indicted for mur- 
 der. He was brought into court for trial, when 
 Judge Gray, of the Supreme Court, stated that 
 the case could not be tried, ' as there was no mo- 
 tive to prompt a man to commit such a crime.' This 
 man was sent to an insane asylum." 
 
 I,et me cite a case taken from the records of 
 Broome County Circuit Court: "On Decoration 
 Day, 18-85, George Axtell, a young farmer of 
 the town of Middletown, New York, visited De- 
 posit village, and became intoxicated. While 
 in this condition, and without provocation, he 
 ran amuck (a mok) with a pistol and killed 
 three men. Axtell was condemned to be hanged, 
 but died in jail of heart disease, prior to the 
 date fixed for his execution, or we would have 
 had to record another case of judicial murder." 
 
 Axtell was undoubtedly affected by "mania a 
 potu," or "alcoholic frenzy " or mania, when he 
 committed the homicides, and was entirely irre- 
 sponsible. These cases of ' 'alcoholic homicidal 
 
273 
 
 mania" are not uncommon, and the daily prints 
 often furnish us with similar examples. 
 
 I might cite many cases in point showing the 
 various kinds of alcoholic insanity, and the 
 crimes committed, as well as the judicial opin- 
 ions expressed, but let these suffice. 
 
 The question whether ' ' premeditation ' ' could 
 be proven in the case of the criminal inebriate 
 could not, we think, weaken the position taken 
 of the irresponsibility of the inebriate. In some 
 instances apparent premeditation may exist; but 
 the absence of a " reasonable motive ' ' should 
 certainly give force to the plea of irresponsibility. 
 
 The popular impression seems to be, testifies 
 Mr. John C. Salter, the warden of the State pen- 
 itentiary at Chester, Illinois, that a criminal is 
 necessarily a drunkard. 
 
 The large proportion of criminals, such as 
 burglars, forgers and counterfeiters, need clear 
 brains, steady nerves, quick perceptions, to carry 
 out their plans, which would be impossible under 
 the influence of intoxicating drink. 
 
 The assassin may drink to nerve himself to 
 the deed, but only to that extent, and no more. 
 This form of crime, where the alcoholic stimu- 
 lant is taken deliberately, with the intention of 
 nerving the criminal to the act, is most aptly 
 shown in the great Shakespearean tragedy. 
 I,ady Macbeth, so stimulated and nerved as an 
 accomplice to Macbeth in his bloody deed, thus 
 soliloquizes: 
 
274 
 
 That which hath made them drunk hath made me bold ; 
 What hath quenched them hath given me fever. 
 
 Here the antecedents, the motive and the subse- 
 quent events of the plot take precedence, and the 
 alcohol taken within to produce drunkenness — 
 not lethargy — plays but a secondary and inferior 
 part in the whole tragedy. The " deep damna- 
 tion of the taking oflF of Duncan ' ' is not lessened 
 one whit by the fact that alcohol was used by 
 the -conspirators and murderers to nerve them- 
 selves for the tragedy. The alcohol did not 
 prompt the deed; it was deliberately taken to 
 enable theni to perform it — a condition quite the 
 reverse of the insane inebriate or the person suf- 
 fering from "chronic alcoholic mania," in which 
 the "mania of suspicion," or an acute alcoholic 
 mania is developed. Here the maniac, in his 
 sudden fury, cyclonic in its violence and rapid- 
 ity, kills those nearest to him without premedi- 
 tation or motive. 
 
 To sum up the logical conclusions resulting 
 from the study of criminal inebriates in a single 
 paragraph, we would state: 
 
 "An act, to be criminal, and to be enrolled 
 under the code as a crime, must show such pre- 
 conception, or preparation, or motive, as to make 
 it an act of deliberation, and the intent must be 
 proven by the relation of the accused party to 
 the deed, before, during and after its commis- 
 sion. 
 
 "If fromsimple impulse,without premeditation, 
 the act must be shown to have been uninfluenced 
 
275 
 
 by any drug capable of affecting the intellect and 
 developing maniacal impulses; and further, that 
 the person committing the act was in full posses- 
 sion of his mental faculties, and was uninfluenced 
 except by a reasonable motive that prompted the 
 deed. In special cases, as in murder, the ground 
 of self-defense may satisfactorily be excluded. 
 Under these circumstances, the person has com- 
 mitted a crime, and the evidence must acquit or 
 condemn him." 
 
 In all cases, a history of previous confirmed 
 inebriety, coupled with an entire absence of rea- 
 sonable motive or antecedents, should give the 
 person committing the act the full benefit of the 
 plea of irresponsibility, and the same ' ' legal ex- 
 cuse " that is applied to the acts of "insane 
 criminals." 
 
 And in conclusion, I have only to add that the 
 "criminal inebriate" should be dealt with in the 
 same manner as the "criminal insane." 
 
PERSONALITY AS IT AFFECTS THE 
 COURSE OF DRUNKENNESS. 
 
 BY T. Iv. WRIGHT, M.D., 
 
 OF BELLEFONTAINB, OHIO. 
 
 When the elements of the human character are 
 observed in any individual, there will be per- 
 ceived a number — sometimes more and some- 
 times less — of intervening, interrupting, inter- 
 polating, constitutional characteristics that, 
 abstractly, are not really necessary to the com- 
 pleteness of human nature. And these charac- 
 teristics, while non-essential, may nevertheless 
 be, so far as the individual is concerned, domi- 
 nant and decisive in the aggregate and sum total 
 of life's history. 
 
 Such peculiarities in the elements of person- 
 ality indicate imperfections in the constitutional 
 stamina of separate and distinct persons. In 
 some cases they have been impressed upon the 
 individual by ancestry — pointing to a history of 
 disease, or of profound physical injury, or of 
 mental and moral suffering, or inquietude, or 
 disaster. But whatever these lines in men's 
 
278 
 
 characters may be, or whence they come, or 
 what they signify and portend — they are present 
 in a state, to some degree obvious to the expert 
 eye, in every human being now, inhabiting the 
 earth. 
 
 Of the modifying qualities which may thus im- 
 press the nature of man, of course only the more 
 obtrusive receive special notice; and of these, the 
 members of the so-called neurotic family more 
 particularly demand our present attention. For 
 the alcoholic constitution rightfully belongs toi 
 this singular group of incapables; and it is inter- 
 changeable with all the other distinctive neurotic 
 traits affecting mankind. The simplification of 
 the elements of matter, through its allotropic 
 capabilities, has its parallel in the great family of 
 the ?ieuroses. Carbon, we are told, may exist in 
 separate material forms — as in the diamond, in 
 charcoal, in soot, in the carbonates and in other 
 material substances. In a like manner, one neu- 
 rotic form may be found masquerading in the 
 features of some other member of the same fam- 
 ily — dipsomania being interchangeable with 
 amnesia or epilepsy, or some appearance of in- 
 sanity; and conversely, these and other neuroses 
 may become — either in the same person, or by 
 heredity, transmuted into dipsomania. 
 
 This is not the place to speak of heredity at 
 large. But to deny heredity is to deny parent- 
 age. He who cannot perceive both likenesses 
 and contrasts in ancestry and posterity which 
 denote unequivocally lineal descent, is, it seems 
 
279 
 
 to me, either blind or of dull apprehension, (a). 
 The cast of the eye, the pose of the head, the set 
 of the ears, the shape of the nose, the arch of the 
 brow, the color and texture of the skin, the "cow- 
 lick" of the hair — all these and innumerable 
 other special marks, indicate the power of hered- 
 ity in \h& perceptible construction of the physical 
 organism., {b). The mental and moral nature, the 
 general disposition and tastes, the family likes and 
 dislikes, the development of particular inclina- 
 tions and propensities as life progresses, still 
 more strongly if possible, testify to the reality of 
 heredity, (c). Again, diseases tell the unfalter- 
 ing tale of heredity through the transmission of 
 epilepsy, insanity, heart imperfections, hysteria, 
 dipsomania, somnambulism and a multitude of 
 other undoubted pathological states. They 
 point, not to perceptible and notorious physical 
 conditions of the bodily organism; but they rather 
 denote imperceptible changes in the ultimate 
 structure of the brain and nervous system. 
 
 The evidence of heredity derived from physi- 
 cal conformation, and also deformation, is direct, 
 and comes at once from observations conducted 
 through the perceptive faculties; while the evi- 
 dence derived through mental and moral proper- 
 ties, and from the transmission and transforma- 
 tion of diseases, is circumstantial. It consists of 
 symptoms and indications, and phenomena. It 
 is, therefore, most commonly unimpeachable; for 
 it is composed of coincidences that mutually 
 sustain and illustrate each other. 
 
28o 
 
 Heredity, especially the heredity of disease 
 and criminality, is a doctrine as old as humanity 
 — or at least as old as human suffering and guilt. 
 It has been the theme of philosophers and sages 
 through all the world's history; and it enters 
 largely into the elements of the Christian's hope, 
 as well as the sinner's despair; for, in the dis- 
 obedience of the progenitor of the hjiman race 
 itself, all mankind were smirched. 
 
 The effects of alcohol upon the human consti- 
 tution may be divided into two classes or groups — 
 those which are obvious to the senses of every- 
 body — and those which are more remote, con- 
 cealed, and unexpected. Both groups, however, 
 have to do with the whole man — mental, moral, 
 and physical. 
 
 Alcohol, for instance, acts openly and within 
 the view of all in exaggerating the egotistic 
 feelings. There is in drunkenness, not only un- 
 seemly boasting, and a claim to the possession 
 of qualities in every department of life, superior 
 to others, but there is a tendency to embark in 
 enterprises far beyond the capacity of the person 
 concerned. An habitual indulgence in the use 
 of alcohol, produces a custom or habit of asserting 
 pretentious and preposterous claims to excellence 
 and prowess, so that the drinker is eventually 
 degraded into a bragging and besotted imposter 
 and nuisance. 
 
 The changes induced in the physiognomy, the 
 speech, and the physical movements of the ine- 
 briate are universally recognized. Besides these 
 
28l 
 
 perceptible bodily disabilities due to alcoholic 
 impressions, there are a number of other notable 
 mishaps that speedily occupy the field of ob- 
 servation. The liver, kidneys, stomach, brain, 
 heart and lungs, show indications of functional 
 — and finally of structural impairment and de- 
 gfeneracy. The interstitial substance throughout 
 the entire organism exhibits a tendency to hy- 
 perplasia, although the features of this patho- 
 logical condition are more pronounced in some 
 localities than in others. Subsequently shrink- 
 age is apt to occur. The consequence is, that a 
 number of organic degenerations are likely to 
 ensue. Nerve fibres in the brain may be impli- 
 cated and torn in sunder; while the capillaries of 
 the encephalon are, possibly, strangled and oblit- 
 erated. These, and numberless other physical 
 disasters are amongst the common effects of al- 
 cohol. They, and their symptoms, are open to 
 daily inspection and inquiry; and they are liable 
 as a matter of fact, to appear in all constitutions 
 and persons impartially. There are, however, 
 many exceptions of course. 
 
 But the usual and open efiiects of alcohol upon 
 its victims do not stop with the acute or initial 
 stage of inebriety. After a lapse of considerable 
 time, possibly of j^ears, the boasting of the early 
 drinker, so absurd, so empty and frivolous, ceases 
 to merit the name of mere boasting. It descends 
 to the level of habitual and malignant lying. 
 The lofty and assertive egotism, loving and seek- 
 ing notoriety, is transformed at last, into a sullen 
 
282 
 
 and mean selfishness. Stiffened and bent over, 
 his muscles clamped by the shrinkage and indu- 
 rations induced by alcohol affecting their sheaths, 
 the chronic inebriate drags himself away with a 
 diflBcult and crawling movement, shunning the 
 sight and society of men. And the great high- 
 way he has traveled between the noisy and bois- 
 terous beginning of his career, and its woful con- 
 clusion, is the broad road of habitual drunken- 
 ness; wherein the daily sot staggers along, lonely 
 and despised. 
 
 These are the obvious, the common character- 
 istics of alcoholic drunkenness. They are often 
 viewed, superficially, of course, as illustrating all 
 the essential traits of alcoholism, physical traits, 
 representing incapacity of action, moral traits, 
 representing incapacity of responsibility, mental 
 traits, representing incapacity of discrimination, 
 reflection, choice. 
 
 But in real truth, hidden beneath these direct 
 and sensible displays of the alcoholic power, 
 comprehensive and distinctive as they are, there 
 may be discerned other traits of alcoholism, less 
 obtrusive certainly, but probably not less impor- 
 tant and far-reaching. Careful attention will 
 reveal the fact that there are many profound and 
 subtile influences exerted by alcohol upon the 
 nature and welfare of man, that are quite imper- 
 ceptible to the casual observer. 
 
 A good deal has been written, an^ justly too, 
 upon the effects of the difierent kinds of 'alcohol 
 on the human constitution. The constitution 
 
283 
 
 here meant is that of the average man; the sev- 
 eral effects being due to differences in the article 
 applied, and not to personal idiosyncrasies. 
 
 For example, it is known that ethylic alcohol 
 (CffO) produces the agreeable and alluring 
 movements of mind and body, that are so seduc- 
 tive to the inebriate. Amylic alcohol however, 
 called also fusel oil and potato spirit (C'H^'^O), 
 produces very peculiar and serious consequences 
 when mixed (in impure spirits) with the ethylic 
 or common alcohol. It is to this substance that 
 must be chiefly attributed the muscular instabil- 
 ity and trembling, together with the profound 
 poisoning of the brain that characterize delirium 
 tremens. 
 
 But the purpose now is, not to apply different 
 alcohols to similar constitutions, but to apply 
 the common alcohol, that is, a similar- (and least 
 poisonous) alcohol, to different constitutions. 
 The desire is to view the effects thence flowing 
 upon mind and morals — upon life and responsi- 
 bility — rather than upon the grosser physical 
 organism. 
 
 It has already been noted that through force 
 of the inevitable accidents of time, and the opera- 
 tions of inimical and destructive agencies, the 
 constitutions of men often represent elements 
 that are not essential to the completeness of 
 human nature. These imperfections and ob- 
 liquities are frequently present in such force and 
 number, that they greatly influence, and may 
 even chiefly direct the course of human life. The 
 
284 
 
 nature of some of these disturbing constitutional 
 attributes may be seen in the several members of 
 the neurotic family of diseases. It is not neces- 
 sary to enumerate the individuals composing it. 
 But it maybe said that besides the characteristic 
 members, there is a great multitude of persons 
 in whom the neurotic features are imperceptibly 
 shaded off into more or less indefinite degrees of 
 completeness, until in fact, they are obvious only 
 to the eye of the skilful and practiced observer. 
 
 In every community the neurotic family has 
 maoy representatives bearing many names ; and 
 there are also relatives of that family that are 
 as yet unnamed. Take for example the man 
 wholly intent on piling up a mountain of wealth; 
 riches that he neither can use, feel, taste, or in any 
 conceivable manner enjoy in this life, nor take 
 with him when he dies. 
 
 In such a life there is absolutely no rational 
 object at stake. The man is a "crank." He is 
 possessed of an undoubted neurotic constitution. 
 He is closely connected with the insane family — 
 perhaps a member of it. Not infrequently, 
 amongst his offspring there will appear an idiot, 
 or imbecile, or scrofula, or deformity. Quite 
 commonly there are drunkards — one or more — 
 true dipsomaniacs: and possibly a suicide. It is 
 not exclusively the allurements and opportuni- 
 ties of wealth that so frequently wreck the fam- 
 ilies of rich men. It is owing, possibly to the 
 inherited neurotic constitution, transmuted in 
 posterity, from the craze of money getting, into 
 
285 
 
 the repulsive forms of epilepsy, dipsomania, and 
 the moral insanity of useless and unsatisfying, 
 but universal profligacy. True, sometimes the 
 ofifspring continues in the paternal groove — and 
 the neurosis of colossal fortune building goes on. 
 But such is not the rule. The neurotic bent takes 
 the form of unbalanced nerve equilibrium — moral 
 insensibility being connected with physical hyper- 
 esthesia. Here is, indeed, sensuality unre- 
 strained. 
 
 All this is simply in illustration of the fact, 
 that the neurotic constitution abounds in society- 
 more plentifully than generally has been sup- 
 posed. 
 
 The effects of alcohol upon the mind and con- 
 duct, no doubt vary in some particulars, in each 
 individual from its effects elsewhere. 
 
 But the gross and disgusting qualities of 
 drunkenness that are common to all intoxicated, 
 persons, are apt to absorb the attention, to the 
 exclusion of nice.but obscure idiosyncrasies. 
 
 There are, however, several specific qualities 
 that alcohol impresses upon certain constitutions, 
 that are not peculiar to drunkenness in general. 
 These in fact are of frequent occurrence — and 
 are of very great significance. 
 
 I. Some inebriates invariably exhibit signs of 
 irrepressible mania when under the influence of 
 alcohol. Here is the true mania a potu — a des- 
 ignation often misapplied to delirium tremens. 
 This is a condition readily developed in certain 
 persons. The speech is loud and incessant; 
 
286 
 
 nothing can stop it. If admonition or even force 
 is employed, the ceaseless chattering continues 
 unabated. The topic may change, but not the 
 talk. Frequently this state of alcoholic mania 
 displays itself by producing an inclination, al- 
 most uncontrollable, to scream at the top of the 
 voice and "make the welkin ring." The ine- 
 briate may not be entirely lost to the impropriety 
 of this proceeding, and may pause a brief moment 
 or two, and wonder in his silly mind what peo- 
 ple will think of it — whether they will not think 
 he is drunk. But all such sage reflections are 
 speedily lost and swallowed up in the burning 
 desire to "give them one yell anyhow." And so 
 drunkards go up and down the streets, singly o>r 
 together, shouting, singing and yelling to the 
 utmost limits of their vocal capacity. 
 
 But these persons do not always confine their 
 pranks to noisy demonstrations. Very often 
 there appears a strong desire to "smash things." 
 
 Windows are broken, doors kicked down, fur- 
 niture ruined, walls defaced, crockery thrown 
 into the streets, and the spirit of utter destruc- 
 tion reigns supreme. All these things may take 
 place without the slightest incentive of anger or 
 malice. It is an instinctive mania of demolition; 
 and it seems to be simply a process of occupying 
 the attention, and relieving or staying morbid 
 cerebral exaltation, by the act of doing something. 
 It is scarcely necessary to say that positive and 
 abrupt interference with the movements of an 
 individual who is in such a condition of mania, 
 
287 
 
 might prove to be dangerous. It would be lia- 
 ble to arouse a feeling of ungovernable and in- 
 sane rage. 
 
 2. There are many persons in whom alcohol 
 develops a peculiar disposition that is dangerous 
 to any community in which they' live. These 
 individuals, when under the influence of alcohol 
 are morose, revengeful, homicidal. Such a spirit 
 may exist in so great a degree of intensity as to 
 amount to actual mania. It is by no means un- 
 common to read of murders committed in sheer 
 wantonness by persons laboring under intoxica- 
 tion. Such individuals, without ofiense being 
 given, without a personal acquaintanceship even, 
 or a word being passed either way, will perhaps 
 shoot down some one who, bj- chance, happens 
 to be in their presence. But the homicidal ten- 
 dencies of inebriety do not display themselves 
 usually in quite so unexpected and truculent a 
 manner. There are persons in every community 
 who are known to be dangerous characters when 
 drunk; and when they are perceived to be in- 
 dulging in drink, the public invariably feels that 
 serious trouble is liable to ensue. 
 
 These folks may be quiet and pleasant enough 
 when sober, but as drink mounts to their brains, 
 they become implacable and defiant. The mem- 
 ory of old slights and feuds, perhaps latent and 
 for a long time forgotten, suddenly revives. The 
 inebriate asserts that he neither fears nor regards 
 consequences. He would "as soon die as livj 
 anyhow. ' ' An intoxicated individual possessed 
 
288 
 
 of such a disposition, is in a state of mind that is 
 a menace to the public safety. He is really in a 
 condition of insane rage — without limit or abate- 
 ment — and thinks of nothing but killing and 
 murder as remedies for all his fancied ills. 
 
 3. Other men again, possessed of constitutions 
 peculiarly modified by extraneous circumstances, 
 become affected, when under the influence of 
 alcohol, with a nervous condition called by some 
 alcoholic trance. Events that take place during 
 the continuance of this remarkable state of the 
 brain and mind, are afterwards but dimly remem- 
 bered. Sometimes no recollection whatever of 
 them is retained. This mental situation is 
 brought on largely by the anaesthetic property 
 of alcohol. The anaesthesia of alcohol so be- 
 numbs the sensibilities of the life of external re- 
 lation that the inward movements of the organ- 
 ism, to some degree, come into consciousness; at 
 the same time, common sensation and the percep- 
 tive faculties remain in abeyance. Ordinarily, in 
 health, the reverse of this is true. Sensations 
 and the perceptive functions engross the atten- 
 tion, and become the subjects of thought, while 
 the inward movements of the organism are un- 
 perceived. This peculiar modification of the 
 senses through the influence of alcohol may re- 
 sult in serious consequences. The objective and 
 subjective sensibilities appear sometimes so in- 
 definite, so mixed and intermingled, that one 
 may be mistaken for the other, and the judgment 
 be thereby misled. It is not difficult to see how 
 
289 
 
 motive and conduct may be influenced by the 
 misinformation of the mind derived from organic 
 sources. 
 
 No sensation or perception is absolutely trust- 
 worthy in itself It must be attested by other 
 senses ; and the several comparisons must be 
 weighed and accepted by the judgment before it 
 is received in the mind as undoubted knowledge. 
 But it is obvious that the dim and incomplete 
 suggestions of automatic or subjective life cannot 
 afford these necessary testimonies and proofs of 
 their own accuracy. The mind, therefore, rea- 
 soning from the flata of a false and impaired 
 consciousness, is dragged from its moorings, and 
 it accepts as facts the unsubstantial phantoms of 
 a wayward and uncurbed imagination. 
 
 4. Leaving now the consideration of the pecu- 
 liarities of individual constitutions which modify 
 the phenomena and responsibility of the drunken 
 state, attention is called to some fundamental 
 traits which characterize races, tribes and fami- 
 lies, and which impress distinctive features upon 
 inebriety. 
 
 The Celt possesses a physical organization in 
 the highest degree sensitive. His appetites are 
 strong, his aspirations are unbounded, his ideals 
 are the exaggerations of fancy, and much beyond 
 the reach of the actual. The Celt is frequently 
 seen either in a state of radiant hope or gloomy 
 despair. If he is an inebriate at all, he is an 
 excessive drunkard. There is no moderation in 
 his cups. His time is passed in getting drunk 
 
290 
 
 or becoming sober. His is a character of contra- 
 dictions and extremes. In the Celt, the pleas- 
 ures of sense are not always satisfied by their 
 reasonable gratification. Sensuality in him often, 
 is bounded only by the limits of physical en- 
 durance. 
 
 When such a nature is addicted to the alco- 
 holic habit, the indulgence is likely to be intem- 
 perate and destructive. The craving for intoxi- 
 cation is like that of dipsomania — almost irresist- 
 ible. The Celt drinks the strongest liquors, and 
 in great quantities. His will is feeble in the 
 presence of temptation, for his passions are vio- 
 lent and unruly; and this is especially true with, 
 respect to intoxicating liquors. In a manner 
 parallel with the dipsomaniac (whose will is- 
 weak from disease), the will of the Celt is weak 
 through the constitutional organization of the 
 race. The Celt, when an inebriate, may abstain. 
 altogether by a strenuous effort ; but commonly,, 
 he cannot "drink in moderation." 
 
 It is a widely spread notion that, if the dipso- 
 maniac would partake of small quantities of 
 alcoholic liquor daily, his craving would be sat- 
 isfied, and he would thus avoid his periodical 
 spasms of intemperance. The fact is, that alco- 
 hol directly weakens his power of resistance by 
 overcoming the inhibitory functions of the ner- 
 vous system, and hypnotizing the moral nature. 
 It therefore happens that the will, already feeble 
 from disease with respect to the alcoholic temp- 
 tation, is, in him, completely overcome, destroyed,. 
 
291 
 
 when his brain is even partially affected by the 
 alcoholic poison. The dipsomaniac may possi- 
 bly, under the pressure of uncommon and super- 
 lative motives, abstain for a short time altogeth- 
 er ; but he can never drink in moderation. The 
 moderate drinker has moral inhibition to contend 
 with; the total abstainer has not. Ordinarily, a 
 single dram completely annihilates what little 
 will or self control the dipsomaniac may have by 
 nature, and a spell of drunkenness goes right on, 
 till the physical organism is poisoned and ex- 
 hausted. Indeed, the interference of the super- 
 lative motive, with the course of the dipsoma- 
 niac, is more of the nature of a brief substitution 
 of some antagonistic emotion, stronger than the 
 alcoholic crave, than it is an assertion of true 
 will power. The intervening emotion may arise 
 from grief, or overwhelming disaster. But, in 
 the nature of things, it must be temporary; and 
 when it passes away, the neurotic tendency is 
 resumed. 
 
 It may, likewise, be possible for the Celtic in- 
 ebriate to abstain totally from alcoholic indul- 
 gence; but it is usually impossible to partially 
 abstain. To him, temperance in the sense of 
 limited drinking is quite out of the question. 
 
 These facts and considerations warrant the in- 
 ference that the constitution of the Celtic race 
 contains in its elements peculiarities that are not 
 common to human nature in general, and that 
 do materially modify the character of inebriety, 
 lyiquor drinking among the Celts is impulsive 
 
292 
 
 and extravagant, and drunkenness is likely to 
 exhibit its worst and most furious aspects. In 
 this race, especially, may be engendered homici- 
 dal inebriety, maniacal inebriety, trance inebriety, 
 to say nothing of the unbidden impulses to all 
 manner of inebriate vice and crime; and all this, 
 not from the stress of actual disease, either per- 
 sonal or through heredity, but from the natural 
 and necessary influence which the peculiar con- 
 stitution of the race exerts upon the phenomena 
 of alcoholic drunkenness. 
 
 • 5. There is considerable difference, not to say 
 contrast, between the constitutional peculiarities 
 of the German and the Celtic races ; and the 
 modifications impressed upon the phenomena of 
 inebriety by the distinctive traits of the German 
 character are as singular and interesting as are 
 those associated with the Celtic constitution. 
 
 Phlegmatic is the usual term employed to des- 
 ignate the German temperament. The German 
 of to day is essentially the same as the German 
 described by Tacitus. He is the unswerving 
 and unchangeable democrat of history. He will 
 possibly agree to surrender a part of his individ- 
 uality into the keeping of society at large, in 
 order to secure certain social and civil advan- 
 tages — notably, protection and security ; yet, 
 should he be exposed to inconvenience on that 
 account, he is ready to repudiate at once the 
 compact. Touch him on what he deems to be 
 his individual privileges — as, for instance, in the 
 matter of temperance legislation — and he will 
 
293 
 
 deny the right of society to control him. He 
 loudly inveighs against the curtailment of his 
 " personal liberty, " and he.will claim for him- 
 self the utmost individual license, rather than 
 willingly submit to what he regards as slavery. 
 
 The Celt apologizes when he gets drunk. He 
 explains that he has trouble to contend with, or 
 disappointment, or sickness, or death ; and he 
 professes that he drinks to soothe an insupporta- 
 ble anguish of spirit. But the German never 
 deigns to give a reason for intemperance. He 
 declares that he has a right to get drunk, and, 
 indeed, that drinking, so far from being harmful, 
 is positively beneficial, and he verifies his opin- 
 ions on the subject by bringing beer into his 
 family to be used by all its members. The Ger- 
 man does not crave the strong and overmastering 
 liquors that are so alluring to the Celtic nature. 
 He seldom becomes helplessly intoxicated ; but, 
 unlike the Celt, he drinks with steadiness and 
 regularity, and is not liable to be disabled with 
 the deep prostration of inebriate excess. 
 
 Unquestionably, the beer of the modern Ger- 
 man is the drink described by historians as the 
 national beverage of the wandering tribes of that 
 people in the days of Julius Csesar. It is a drink 
 containing considerable alcohol, yet so tempered 
 with other ingredients that it sustains its inebri- 
 ating influence steadily, and with little liability 
 to sudden abatement. When the German arrives 
 at the point of inebriation where the song and 
 the muddy witticism break forth, he has little 
 
294 
 
 difficulty in maintainitig his condition for a con- 
 siderable length of time. Not so the Celt, who 
 prefers the stronger drinks of whisky or brandy. 
 His nervous exaltation is so glorious, so ecstatic, 
 that he becomes intent on elevating his feelings 
 and fancies, if possible, still higher, and the po- 
 tations are redoubled, soon ending in mental 
 disintegration, stupor and oblivion. 
 
 The desire for alcoholic indulgence in the 
 German race is, therefore, influenced by the 
 physical constitution of that race. The German 
 calls for a peculiar and modified inebriety, and 
 the ingenuity of his mind has discovered and 
 prepared a material which exactly fulfills his 
 wishes in the matter of inebriating drinks. 
 
 There is, perhaps, small encouragement in 
 attempting to influence the German inebriate in 
 the direction of abstinence. His inebriety be- 
 longs to his constitutional nature; it is sui gene- 
 ris. It is, in fact, a leading characteristic of his 
 race, and has been recognized as such from the 
 time of his first appearance in history. No 
 amount of evidence seems to be competent to 
 shake the faith of the German in the harmless 
 properties and useful virtues of his national bev- 
 erage. Beer is German, naturally and constitu- 
 tionally, just as the instinct of personal liberty 
 is German. 
 
 In an ancient period of time, the German peo- 
 ple inhabited wild and inhospitable woods and 
 morasses. Their houses were poor and open 
 huts, set up without labor, and abandoned with- 
 
295 
 
 out regret. They were ever ready to shift their 
 habitations and country for others that were 
 more inviting. But, above all, for our present 
 purpose, they drank habitually and copiously a 
 kind of intoxicating liquor, "corrupted," as Tac- 
 itus has it, into a "semblance of wine." An im- 
 portant point is, these people have' amended their 
 houses, but not their drinking peculiarities. 
 
 The Scandinavians, a neighboring people, not 
 only partook of this same alcoholic drink as long 
 as they lived, but they believed that they would 
 be "served with horns of mead and ale" after 
 death, in Valkalla, the hall of Odin — th6 para- 
 dise of heroes. 
 
 In Saxon England, the characteristic national 
 revels were embalmed in song, for 
 
 " 'Tis merry in hall 
 When beards wag all " — 
 
 a description totally inapplicable to the frantic 
 and insane fury of Celtic intoxication. 
 
 The application of some of the principles ad- 
 vanced in this paper is of much wider extent 
 than a superficial consideration of them would 
 indicate. I will confine myself, however, to a 
 single point. 
 
 Prof. Wiesmann, of Frieburg, has recently 
 claimed that ' ' characters acquired by the parent 
 are not transmitted to the offspring."^ There is 
 nothing to show that the national habit of beer- 
 drinking might not have been in entire accord 
 
 I Journal of Am, Me4. Ass'n, 1890, Dec. 27, page 924. 
 
296 
 
 with the barbarous customs and surroundings of 
 the ancient German people. It is not impossi- 
 ble, indeed, but the habit may have been, under 
 the circumstances, conservative and beneficial. 
 But as the manners of the ruder times became 
 softened, and good houses and pleasant homes 
 arose on all sides, while the lights of civilization 
 began also to glow and brighten, the ancient 
 custom of drinking was not correspondingly- 
 affected. It was not abated, apparently, in the 
 smallest degree. What was at first, probably, a. 
 habit merely circumstantial, became, by long^ 
 continuance through ages, a habit personal, cen- 
 tral, constitutional ; and, when the ancient cir- 
 cumstances had disappeared, the hereditary 
 mark, affixed to the constitution of the race, re- 
 mained unmoved and unchanged. So deeply 
 implanted is the proclivity for malt liquors ira 
 the German people, that it is questionable if a 
 portion of the advantages and pleasures of civili- 
 zation itself would not be surrendered, rather 
 than the national and traditional habit of beer- 
 drinking should be abandoned. 
 
 Illustrations of {he influence of race on the 
 characteristics of inebriety might be multiplied. 
 The American race, the African race, and many 
 distinctive tribes and families, furnish examples 
 of the fact that the phenomena and responsibili- 
 ties of drunkenness are modified by constitu- 
 tional peculiarities. And this truth shows that 
 in estimating the motive and guilt of imputed 
 crime, the utmost circumspection, discrimination 
 
297 
 
 and industry should be brought to bear on the 
 investigation. For it shows a weakness in the 
 legal assumption that the criminal inebriate 
 knows, before he drinks, what will be the effect 
 of drunkenness upon the powers of his mind and 
 will. 
 
TREATMENT OP THE OPIUM NEUROSIS. 
 
 BY STEPHEN I,ETT, M.D., 
 
 MEDICAL SUPERINTENDENT OF THE HOMEWOOD RETREAT, GUELPH, 
 ONT., CANADA. 
 
 It is not my intention to enter into elaborate 
 statistics to prove the prevalence of the opium 
 disease, or to discuss the causes which operate 
 in its production ; sufiSce it to say, that the 
 habitual consumption of opium and its products 
 does exist to a very alarming extent in this 
 country, and that some of the causes which give 
 rise to this malady are under qur control; others 
 are beyond our power. Nor do I purpose por- 
 traying the dire physical and mental manifesta- 
 tions resulting from the daily and prolonged use 
 of the drug, interesting and instructive as the 
 subject might prove to be, but rather do I wish 
 to confine myself to a consideration of the treat- 
 ment of this disease as it is presented to us, and 
 indicate those methods which, in my hands, 
 have proved most practicable, and, in my opin- 
 ion, calculated to produce the best results. 
 
 In that plan of treatment which I am about to 
 
300 
 
 advocate, I cannot lay claim to originality, hav- 
 ing closely followed the lines marked out by 
 others. Experience, however, has caused me 
 to make some modification in detail. But the 
 general course adopted essentially consists in 
 that plan of treatment known as "gradual reduc- 
 tion. 
 
 In attempting to treat the opium disease, it is 
 all important the physician should eliminate 
 from the mind the vice theory, and consider the 
 case in the light of a neurosis, which presents cer- 
 tain pathological conditions requiring skill, pa- 
 tience and sympathy to successfully combat, fully 
 as much as when he is treating other forms of 
 disease. 
 
 What the special pathology of this disease is 
 has not been clearly demonstrated; but that such 
 a condition exists can hardly be questioned, and 
 has been strongly insisted upon by eminent au- 
 thority. 
 
 When we find a patient able to take repeated 
 poisonous doses of such a drug as opium, with 
 perfect impunity, and when it is demonstrated 
 that such doses are essential to his bodily com- 
 fort, or even necessary to sustain life itself, cer- 
 tainly there is the justifiable inference that some 
 change in the animal economy has taken place, 
 that a departure from normal action is set up, and 
 that a pathological condition is established. Dr. 
 Clouston, in the July, 1890, number of the Quar- 
 terly Journal of Inebriety , clearly recognizes this 
 diseased condition, while Dr. Charles I,. Hughes, 
 
30I 
 
 of St. I/Ouis, in the Alienist and Neurologist for 
 July, 1886, makes mention of it in the following 
 language: "The long continued use of opium or 
 of its salts engenders a disorder of the nervous 
 system which is entitled to distinct recognition. 
 Its sequence is as much a pathological entity as 
 alcoholism, saturnism, hysteria or chorea.'" 
 
 " Meconeuro-pathy," he says, "is as much 
 entitled to recognition as that well-known dis- 
 ease, epilepsia." 
 
 This assertion he fortifies by many interesting 
 and undisputable facts, and in this connection, 
 draws particular attention to, and points a viv- 
 idly realistic picture of, the dire results conse- 
 quent upon the sudden deprivation of the accus- 
 tomed drug in an opium habituate. Many other 
 eminent men hold the same opinion, and I look 
 forward to no distant date when we shall see 
 these assertions verified by microscopic demon- 
 stration. 
 
 These pathological changes appear to be situ- 
 ated, chiefly, in the nervous system, more par- 
 ticularly in the great nerve centers, and thus 
 false impressions are conveyed to all organs of 
 the body, thereby interfering with the due per- 
 formance of their several physiological functions, 
 producing disturbance and discord where har- 
 mony and normal action should exist. 
 
 Without enquiring further into the pathology 
 of chronic opium poisoning, and accepting as 
 fact that disease does exist, it remains for me to 
 
302 
 
 give a r&ume of the methods of treatment ad- 
 vocated and adopted. 
 
 In the first place, we must bear in mind that 
 there is no drug known to the medical profession 
 which will cure this disease. We have no speci- 
 fic for it. Substitutes there may be, but substi- 
 tution is not curing the neurosis, and the risk 
 of producing a worse disease thereby requires 
 extreme caution as to the selection of such a 
 remedy. 
 
 Three separate and distinct modes of treating 
 the opium habit are advocated and practiced : i . 
 That of abrupt and total withdrawal of the drug; 
 2, its rapid reduction; 3, that of gradual reduc- 
 tion. 
 
 ABRUPT WITHDRAWAL. 
 
 As regards the abrupt withdrawal of the drug, 
 I cannot for a moment countenance such a bar- 
 barous,'*inhuman and dangerous procedure, in- 
 volving, as it does, the most exquisite torture, 
 which no being on earth can fully realize save 
 the opium habituate deprived of his opium. The 
 shock to the nervous system is so intense as to 
 make a lasting impression, which is manifested 
 in the higher brain functions, and the risk of 
 fatal collapse is unjustifiable. Words fail me to 
 adequately express the reprehension I would cast 
 upon those who set out on this despotic course, 
 or to convey to you an appreciable idea of the 
 misery and suffering it entails upon a most pitia- 
 ble and helpless creature. I am astonished be- 
 
303 
 
 yond measure to find so eminent an authority as 
 Dr. Clouston, of the Royal Edinburgh Asylum, 
 advocating and carrying this treatment into prac- 
 tice. The deservedly recognized marked attain- 
 ments he possesses, the careful and sound obser- 
 vations he has made and recorded in other 
 neuropathic disorders, the valuable work on in- 
 sanity he has published — a book which should 
 adorn the library of every asylum physician — 
 and the distinguished position he occupies among 
 his confreres, gives weight as coming ex cathedra 
 to anything •emanating from his pen. I would 
 not dare to thus criticise his treatment of the 
 morphinqmaniac were it not that I feel it a duty 
 to humanity to protest against such cruelties 
 being practiced upon a most unfortunate class of 
 suflFerers who are powerless to defend themselves. 
 How a man endowed with the keen accurate 
 perception and high educational attainments of 
 Dr. Clouston, whose long and varied experience 
 among the mentally afflicted must have devel- 
 oped in a marked degree that sympathy for suf- 
 fering humanity which is so essential to the 
 successful treatment of the insane, could ever 
 advocate, much less carry into practice, such 
 "heroic" treatment, is to me, at least, a problem' 
 incapable of solution. 
 
 In his article published in the Quarterly Jour- 
 nal of Inebriety, vol. xii, No. iv, page 311, he 
 clearly recognizes the diseased condition we are 
 now considering, and truly describes in terse 
 language the subject thereof in the following- 
 
304 
 
 words: "A morphinomaniac, in the advanced 
 stage of his complaint, is a most miserable object 
 in mind and body. He is manifestly diseased in 
 all his nerves and most of his other functions. 
 There is jiist one other being on earth who is 
 more miserable- looking and more miserable, and 
 that is the morphinomaniac who is being cured 
 by enforced abstinence. The one is alive ; the 
 other is more than half dead. As we shall see, 
 the fight is not altogether for the cure of the 
 deadly habit, but in the first instance, to enable 
 the patient to live through the cure." 
 
 Such are Dr. Clouston's accurate observations; 
 nevertheless, in the very next paragraph he gives 
 us a sample of his mode of curing this disease by 
 enforced abstinence, which he justly admits causes 
 a fight to keep the patient alive. I^ook at the 
 pitiable subject he practices this on. A man, in 
 the first instance, weighted down with a "distinct 
 nervous diathesis, ' ' who at an early age suffered 
 under a severe illness, which left him weak and 
 sleepless. He "crams" beyond his strength to 
 pass examination at college ; buoys himself up 
 on opium; he becomes the subject of rheumatic 
 arthritis; at the end of twenty-five years of mor- 
 phia disease under compulsion, he places him- 
 self as a voluntary patient in an asylum. He 
 now presents the appearance of a "broken-down 
 looking man," a physical and mental wreck. He 
 was treated with beef-tea and brandy. We are 
 told "the beef- tea caused diarrhoea, and had to 
 be stopped. He could retain milk, liquid cus- 
 
305 
 
 tards and brandy better than anything else. The 
 heart's action got very weak, and digitalis 
 seemed to strengthen it. No morphia was given. 
 For a week he was horribly depressed and debil- 
 itated, and his life was certainly in danger." 
 Under chloral and bromides, "he slept restlessly 
 and awoke with a feeling of horrors." Contrary 
 to what I would have expected, he weathered 
 the storm and reached anchorage, but what a 
 wreck ! to use Dr. Clouston's own words. "His 
 brain is irretrievably damaged in all its higher 
 functions by his twenty-five years' continuous 
 intoxication by opium." 
 
 How sublimely does the doctor take shelter 
 behind this twenty- five years of so-called "in- 
 toxication by opium," and ascribe to this cause 
 all the permanent damage done to the ' ' higher 
 brain functions." Granted that the opium was 
 an important factor in the production of this dire 
 result, did not the fearful ordeal the unfortunate 
 victim went through tend to still further disor- 
 ganize and produce a marked untoward impression 
 upon an already mentally depressed and physi- 
 cally diseased condition; could the same man, 
 crippled as he was with an originally unstable 
 nervous organization, even though he had never 
 ta:sted an opiate, have gone through a similar or- 
 deal and retained a " mens sana in cupore sano;" 
 would not a milder form of treatment have at 
 least prevented so terribl' i shock and given na- 
 ture a far better chance to repair the inroads 
 made upon the patient's health by the long con- 
 
3o6 
 
 tinued morpliia habit? What was there in the 
 result that in the smallest measure compensated 
 for the terrible suffering sustained in effecting a 
 so-called cute. What advantage accrued either 
 to the patient, society or science, by this barba- 
 rous treatment ? Would it not have been better to- 
 have permitted the poor creature to continue his- 
 morphia, and in his own way enjoyed what few- 
 years were left to him to live, and when death 
 was inevitable have quietly, gently and tenderly 
 lowered him to his grave with as little pain as 
 possible? 
 
 Two other cases are recorded by Dr. Clouston 
 in the same article; the same line of treatment 
 was adopted, the same ordeal passed through, 
 similar results obtained. If this is success, if 
 this is a' cure, " I will none of it." I have said 
 enough about the abrupt withdrawal plan of 
 treatment. Let us draw a curtain over this hor- 
 rible picture, hide it from view, and pass from sa 
 revolting a topic to the second plan of treatment, 
 that of 
 
 RAPID REDUCTION, 
 
 I regret being unable to speak from experi- 
 ence as to the merits or demerits of the rapid 
 withdrawal plan of treating the opium habituate. 
 Such has not been my practice, therefore what I 
 may say regarding it is gleaned from the litera- 
 ture pertaining thereto, more especially the pub- 
 lications of my friend Dr. Mattison, of Brooklyn, 
 and those of Professor Ball, of the Paris Faculty 
 
307 
 
 of Medicine. Both these gentlemen, as well as 
 many others, appear to have met with marked 
 success and satisfactory results. Certainly this 
 .method of treatment seems to carry with it many 
 advantages, The time occupied in removing the 
 drug from the circulation is comparatively short, 
 from eight days or less to two or three weeks, 
 yet it is withdrawn by such gradations that the 
 shock to the nervous system is not so great or 
 the danger of collapse so imminent as when the 
 patient is at once deprived of all opiates; at the 
 same time other remedies are employed which 
 appear to have the desirable effect of quieting the 
 nervous system and sustaining the patient whilst 
 the final withdrawal is being accomplished, there- 
 by safely carrying him through a crisis other- 
 wise critical; when this object is attained the 
 special remedies employed are apparently discon- 
 tinued without inconvenience. Amongst such 
 agents so employed may be enumerated, general 
 and special stimulants, cardiac tonics and nerve 
 sedatives, such as ether, alcohol, nitro- glycerine, 
 sulphate of spartein, the various preparations of 
 valerian, Jamaica dogwood, cannabis indica, 
 belladonna, hyoscine, electricity, hydrocyanic 
 acid, phosphoric acid, paraldehyde, chloral and 
 the bromides, especially the bromides of soda in 
 large doses mounting up to ii per day. This 
 latter has been especially brought to the notice 
 of the profession by Dr. Mattison, in whose 
 hands it appears to have proved a valuable reme- 
 dy, fulfilling a most important oflSce and safely 
 
3o8 
 
 meeting all required indications. As accessories, 
 hot mustard, salt or electric baths, sustaining 
 nourishment, careful nursing, and the best of hy- 
 gienic surroundings. 
 
 As already stated, I have not followed out the 
 treatment by rapid reduction, chiefly because I 
 have found the more gradual method, though in- 
 volving more time, eminently satisfactory and 
 have thereby safely and successfully cured many 
 patients whose enfeebled condition appeared to 
 me to prohibit the more rapid method. I must 
 also confess being somewhat skeptical as to the 
 ease and freedom from pain with which an opium 
 habituate can be cured by rapid reduction, and 
 before abandoning that mode which I have found 
 satisfactory, I would like more information than 
 I possess as to pain, discomfiture, restlessness 
 and general relaxation of the mucous membranes. 
 Whether in the rapid reduction plan such phe- 
 nomena are severe or merely trivial in character. 
 Again, it appears to me that the time required to 
 restore the general health and overcome the in- 
 roads made upon it by years of opium addiction, 
 is quite equal to the extra time involved by the 
 gradual reduction method. Many writers state 
 that fully six months should be occupied in such 
 restoration, but I know in practice, the rule is a 
 much shorter period spent under special medical 
 supervision. 
 
 GRADUAL REDUCTION. 
 
 It now remains for me to consider the third 
 
309 
 
 mode of treatment, viz. : that of gradual reduc- 
 tion, which has been so ably described and advo- 
 cated by Dr. Hughes, of St. I/Ouis, and prac- 
 ticed by myself and many others. It is claimed 
 to be rational, humane and a safe line of treat- 
 ment, reassuring to the patient, and what is all- 
 important, presents to their minds a feasible and 
 comparatively easy mode of casting off these 
 shackles which have so unrelentingly bound them 
 for so many years, constituting them veritable 
 slaves to an overpowering drug which is gradu- 
 ally but surely pressing them onward to meet a 
 miserable and appalling death, which comes at 
 last as a relief to a more pitiful and painful exist- 
 ence. 
 
 This treatment essentially consists in a slow, 
 even and methodical withdrawal of the drug, 
 without substitution; at the same time using all 
 the means known to medical science to restore, 
 as far as possible, the shattered nervous system, 
 which is the universal condition of all these 
 cases. The gradual withdrawal of the opiate is 
 effected by decreasing the amount in fractions of 
 a grain at each dose, and the following is a gen- 
 eral outline of my mode of procedure. 
 
 Having by a categorical enquiry ascertained 
 as nearly as possible, the amount of opiate the 
 patient is in the habit of taking during twenty- 
 four hours, I calculate its equivalent of morphia, 
 then dividing this amount by the number of 
 times it is necessary for him to resort to it during 
 the day, a fair approximate of a single dose is 
 
3IO 
 
 arrived at. This dose is carefully weighed, ad- 
 ministered, and its effects noted; especially as to 
 the following points: Does it suflBciently sustain 
 the patient and keep him comfortable? How 
 long does its effect last? When will a repeti- 
 tion of it be necessary to prevent depression, and 
 would a smaller dose suffice. In a few days by 
 careful observations of this nature, accuracy is 
 obtained, a basis of treatment instituted, and 
 reduction commenced. The rate at which re- 
 duction progresses must be governed entirely by 
 the nature of the case in hand. Some patients 
 will bear to be reduced faster thaa others; much 
 depends upon the physical condition and the 
 quantity of opiate consumed, those taking large 
 quantities can, at the commencement, be reduced 
 faster than where a less amount is the starting 
 point. The guiding rule is, to remember there 
 is a point at which the patient remains comfort- 
 able for a certain number of hours. That point 
 can be noted between the extremes of stimula- 
 tion by excessive opiate and depression conse- 
 quent upon too small a dose. Upon the accuracy 
 of adjustment of the dose to this point, depends 
 the ease or the discomfiture of the patient, and 
 success in treatment. The rate of reduction also 
 varies with the progress of the case. As a rule, 
 when treatment is commenced with a patient 
 taking, say 20 grains of morphia a day, reduc- 
 tion can be effected at the rate of about one 
 grain every three days. As the quantity taken 
 in twenty -four hours gets less, so also must re- 
 
311 
 
 duction be more gradual, so that it will require 
 four, five, six or even ten days to withdraw a 
 single grain. When a point is reached at which 
 only one grain is consumed in twenty-four hours 
 the greatest skill, care, and caution is necessary, 
 and to remove this single grain I usually employ 
 from three to four weeks.gradually paring a frac- 
 tion of a grain from each dose, and when you re- 
 member that that last grain is divided into per- 
 haps three or four doses in the day, the final dose 
 being brought down' to so fine a point as j-oVb of 
 a grain, you can appreciate the delicate and gen- 
 tle manner in which it is withdrawn. No appre- 
 ciable difference in the dose is noticed by the 
 patient, no shock is produced on the nervous 
 system, the dreaded upsetting of the stomach is 
 avoided; there is little or no relaxation of the 
 mucous membranes, diarrhcea is almost absent, or 
 if present is so mild that the patient will not 
 •complain of it. There is no restiveness or ina- 
 bility to continue at a fixed occupation ; sleep is 
 usually good, natural and refreshing, and the 
 patient finally slips from under the yoke of the 
 -demon opium without being able to note when 
 he took the last dose. Emerging from his years 
 of tyrannical bondage with a new lease of life, 
 buoyant in spirits, physically improved and men- 
 tally bright. 
 
 Such a course of treatment necessarily in- 
 volves constant and ever watchful care on the 
 part of the medical attendant, and such physi- 
 cians who are not prepared to devote time and 
 
312 
 
 patience to it had better not set out in the task. 
 To those who follow it out faithfully, the result 
 will amply reward them for all the trouble in- 
 volved. Each dose should be put up by the 
 physician himself. Accuracy in measurement is 
 essential, none the less so, is punctuality in the 
 time of administration; this cannot be accom- 
 plished without some fixed method to work upon. 
 With such method the task is not so insuperable 
 as might at first appear, though I doubt if the 
 general practitioner could carry it out; the un- 
 certainty of his movements would seriously con- 
 flict. 
 
 Thus I have given you a general detail of the 
 method I adopt. Certain modifications are 
 necessary to meet special exigencies. Should 
 reduction be going on too rapidly and signs of 
 depression set up, the patient is easily righted 
 by halting for a few days and holding him at the 
 point reached. It is sometimes astonishing to 
 see how rapidly the system will respond to this; 
 rest; in a short time the patient will be bright and 
 buoyant, when reduction may again be safely re- 
 sumed though perhaps at a slackened pace. In 
 some cases many such rests are required. In 
 others reduction may proceed steadily from, com- 
 mencement to finish without inconvenience. 
 
 Concurrent with this reducing process our skill 
 must be directed to restoring the physical health 
 and bringing it as nearly as may be to a natural 
 standard. Sustaining nourishment, if necessary 
 repeated at short intervals, frequently a light 
 
313 
 
 meal at bed time, is of great advantage. But 
 usually the appetite soon improves and regular 
 meals are enjoyed. Pleasant recreations of a 
 light nature short of fatigue, and out of door ex- 
 ercise should be encouraged. Tonics, chiefly iron 
 and quinine in tonic doses; the syrups of the hy- 
 pophosphites is an admirable form. Some cases, 
 however, do not bear the strychnine well; when 
 it is tolerated it proves useful. In emaciated 
 cases cod- liver oil emulsion will be found of ser- 
 vice. 
 
 If from causes you cannot control, time is an 
 important consideration and you are obliged to 
 push the reduction more rapidly than sound judg- 
 ment would dictate, restlessness and loss of sleep 
 coming on, gr. yi doses cannabis indica ext., will 
 prove a valuable aid. Hot salt baths with fric- 
 tion to the skin is of much value; iss. doses fluid 
 ext. humuli often produces refreshing sleep, or 
 occasional doses of chloral, paraldehyde or anti- 
 pyrine at bed time, will be followed by good re- 
 sults. Electricity and stimulating liniments 
 will allay the pains sure to arise if too rapid re- 
 duction is practiced. Gelsiminum will relieve 
 old neuralgias now likely to give trouble. 
 
 All opium patients are more or less troubled 
 with constipation, oftentimes very obstinate. 
 Keep the bowels regulated but do not make a 
 " Balaklava charge" on the alimentary canal by 
 giving drastic purgatives; paralyzed nerves resent 
 such treatment. "Milder measures best prevail." 
 A copious enema will relieve the lower bowel, 
 
314 
 
 and lubricate the passage for the discharge of 
 hardened accumulations. A mild mercurial is 
 often of much service. When it is desirable sim- 
 ply to clear the intestinal tract my sheet anchor 
 is fl. ext. cascara sagrada and glycerine rn equal 
 parts. 
 
 Alcohol in any form I disapprove of, it invari- 
 ably causes a demand for more morphia. Bro- 
 mide of potash in suflBcient doses to be of any use 
 causes too much after-depression. Cocaine in 
 the treatment of the opium habit I have tried and 
 discarded as dangerous in the extreme. 
 
 In cases of double addiction of morphia and 
 alcohol, or morphia and cocaine, I invariably at 
 once withdraw the alcohol or cocaine and con- 
 tinue the morphia, giving sufficiently large doses 
 to keep the patient comfortable. I can fight and 
 conquer one devil but not two. 
 
 Whatever form of opiate is used, I discard it at 
 once and give its equivalent of morphia. So also 
 with the use of the hypodermic syringe; I abandon 
 that and administer morphia by the mouth. Pa- 
 tients are apt to object to this at first, but they 
 soon realize the many advantages gained by the 
 change. The same dose administered by the 
 mouth will sustain the patient fully as well as 
 when given hypodermically; it is however, less 
 prompt in its action, but more lasting. 
 
 With very much broken down and highly nerv- 
 ous patients, I permit them to retain their syringe 
 and morphia until they become accustomed to 
 their surroundings and the new order of affairs; 
 
315 
 
 it is a source of much comfort to them, dispels 
 their fears and in my experience will not be used 
 unless necessity requires it. In a few days, when 
 confidence is established, the syringe together 
 with all morphia, will be voluntarily handed to 
 me, ^nd the patient will place himself entirely 
 and unreservedly under my care, willing to as- 
 sist in the treatment of his case to the utmost of 
 his ability, 
 
 I^astly, I would enjoin you to pour out your 
 full sympathy towards the unfortunate opium 
 habituate who has had a hard battle to sum up 
 enough courage to present himself to you for 
 treatment. He needs help. He needs care. He 
 needs kindness. He has suffered long years of 
 torture and deprivation; been tossed hither and 
 thither, like a rudderless vessel, upon the turbu- 
 lent waves of a cold and austere world; looked 
 upon as a vicious outcast whose every action is 
 treated with suspicion, his statements doubted, 
 his case mismanaged. Give credence to what he 
 • tells you. Extend a rescuing hand to the drown- 
 ing man. Pour oil and wine on his smarting 
 wounds, let your full sympathy and aid go out 
 towards him; you will then brighten a dark spot 
 in the deepest of despair, and have the heartfelt 
 thankfulness of an ever grateful fellow being. 
 
DOES SCIENCE JUSTIFY THE USE OF 
 
 ALCOHOIv IN THERAPEUTICS ? IF 
 
 SO, WHERE? WHEN? 
 
 BY EIvISHA CHENERY, M.D., 
 
 OF BOSTON, MASS. . 
 
 The time is upon the profession to review and 
 recast its notions concerning the use of the alco- 
 holic compounds in the treatment of disease, 
 grounded upon what they are, what they do, and 
 what they do not do; for Argus-eyed science of 
 our day shows alcohol to be widely different from 
 what was supposed of it, in the years that are 
 past. If our fathers drove their cows around a 
 stump to make them give down the milk, we are 
 not bound to do the same. Moreover, the liquor 
 treatment has come to have a moral bearing, 
 which both the human and the divine of our pro- 
 fession requires that we respect. And let me 
 here add what the learned President of this Sec- 
 tion has said: "The influence and teaching of 
 the medical profession ' the great drink ques- 
 tion, is most imperatively demanded." Yet I 
 radically differ from him in another statement : 
 
3i8 
 
 " Medically and scientifically, the whole subject 
 is the polair region of mystery." 
 
 Certainly this speaks poorly of the candor of 
 those who still prescribe it. If so, then why not 
 leave it alone? 
 
 Bunyan got his hero into the Slough of Des- 
 pond ; but does any one in his senses believe that 
 the Slough of Despond is a necessary part of the 
 pilgrim's pathway? 
 
 My subject compares to my time, to-day, like a 
 man's hat to a boy's head. Hence I can touch only 
 a few points, and that in the most unsatisfactory 
 way — of leaving out most of the proofs of my 
 positions. 
 
 ALCOHOL AS A RKSTORATIVE. 
 
 This term includes the tonics — agents which 
 increase strength and overcome languor — the pro- 
 moters of the constructive metamorphoses, and 
 the force producers. It excludes that which 
 adds nothing, only whips out the strength the 
 body already has. Restoratives are in great de- 
 mand. The physician to day prescribes them 
 more frequently than any, if not all, others. 
 He feels, when doing so, he is adding to the sum 
 total of vitality. 
 
 Considering alcohol in this relation, we meet 
 the fact that its chemistry is squarely against it. 
 Not a particle is incorporated into tte bodily tis- 
 sues ; so, to say the least, he is visionary in the 
 extreme who prescribes it with the idea that it is 
 
319 
 
 incorporated, or that it incorporates anything 
 else. 
 
 It contains carbon, as all carbo-hydrate food 
 substances do; but that carbon cannot be ex- 
 tracted from it as from them. They all undergo- 
 certain changes, as chemistry shows ; while it 
 enters, pervades, and escapes from the body as 
 alcohol, no proof of its transformation, either in 
 the digestive tract, the blood or the tissues, ever 
 having been found. This one fact of its indi- 
 gestibility nullifies all arguments in its behalf as 
 a force producer. If any contend that it does 
 change, let them give the evidence. 
 
 The various symptoms, commonly attributed 
 to this supposed change, are very satisfactorily ac- 
 counted for from its known irritating and anaes- 
 thetic actions. Yet if we admit all that has 
 been claimed for it in this respect, we concede 
 very little, for Voit and Subbotin say : "In the- 
 amount we can take without injury, its impor- 
 tance as a nutriment is too small to be consid- 
 ered." But we have no warrant for the conces- 
 sion. 
 
 That all the liquor taken cannot be recovered,, 
 we allow. It is the same when alcohol is min- 
 gled directly with freshly drawn blood: But the 
 mere loss of a portion is not a proof that that 
 portion changes and becomes useful . Such con- 
 clusion is not scientific nor rational. The loss- 
 of my knife is not proof that Jones has it, or 
 that he stole it. As well contend that Stanley's 
 ' ' rear eolumn ' ' found Emin Bey. Better do as- 
 
320 
 
 Hahnemann did — jump from the tangible of 
 medicines into their spirituality. Right reason 
 requires that we withhold our conclusions till we 
 establish the premises. In the light of the fore- 
 going, how unreasonable were the assumptions 
 of Dr Todd : ' ' Alcohol is the most easily diges- 
 tible and assimilable of substances. ... It oxi- 
 dizes in place of the tissues." Equally absurd 
 is the theory that alcohol conserves tissue, as we 
 showed in our essay last year.^ 
 
 That it is sustaining because some persons 
 have lived a long time while taking it, is not 
 conclusive. There is every reason to believe 
 they would have done better without it. Had 
 Dr. Tanner and the others who fasted longer than 
 he, depended on alcohol rather than on the store 
 of nourishment in their bodies with water to dis- 
 solve it, it is unquestionable that the undertaker 
 would have had them long ere the forty or forty- 
 five days expired. But, so far from acting as a 
 restorative, abundant, careful observation shows 
 that liquor actually depreciates the strength one 
 has. It is the strong, not the weak, who bear it 
 — not the young, the feeble, and those addicted 
 to it. In other words, the strong can resist it, 
 while the weak cannot. 
 
 Thus speaks Dr. Chambers : ' ' Above all, I 
 would caution against employing wine as a sub- 
 stitute for the true restorative treatment." "To 
 
 I "Does AlcohoJ Conserve Tissue? " in pamphlet. jE?ree to phy- 
 sicians' wlio send to the author for it. See this much more fully 
 shown in the author's " Alcohol Inside Out," i2mo, 35op^es, mail- 
 ed for $r. 
 
321 
 
 call alcohol food," writes the Editor of the Brit- 
 ish Medical Journal, ' ' in the present state of our 
 knowledge, is an abuse of language." "The 
 popular belief," says Dr. A. MuUan, " that beer 
 and. other alcoholic drinks are strengthening, is 
 a mistake, a delusion, a mere superstition, which 
 receives no support from science." 
 
 ALCOHOL AS A STIMULANT. 
 
 This class adds little or nothing to the bodily 
 forces. They call out what was in store, using 
 it up before its time. They act promptly, and for 
 the time only. Their repetition is a matter of 
 much discretion. They take from the sum total 
 of vitality, and lead to exhaustion unless wisely 
 guarded. Alcohol has so monopolized this term, 
 that alcoholics and stimulants are at present quite 
 synonymous. But is not the term mostly misap- 
 plied when applied to alcohol ? When and where 
 does it summon out the forces of the body the 
 better to resist opposing forces ? Never, except 
 in very small doses, much smaller than we should 
 be likely to give, if we give it with the idea that 
 it is stimulating. 
 
 If we, for a moment, lay aside our pack of 
 vague notions, and sit down at the deliverance 
 of instruments of precision, we shall learn for 
 certainty that any considerable doses do not stim- 
 ulate, but dep- ess and weaken. ' ' Careful obser- 
 vations," B .ton states, " leave little doubt that 
 a moderate dose of beer or wine will, in most 
 cases, diminish the maximum weight a person 
 
322 
 
 can lift." So Liebig : "The circulation will 
 appear accelerated at the expense of the force 
 available for voluntary motion, but without the 
 production of a greater amount of mechanical 
 force. It is attended with an inward loss of 
 power. ' ' Prof. Marvaud of France, Zimmerberg 
 of Germany, Richardson of England, and Mar- 
 tin of Baltimore, have wrought at this and find 
 alike. According to Prof. Martin, as much as 
 an ounce of whisky or brandy always lessens the 
 force of the heart, though generally increasing: 
 its frequency. Prof. W. E. Ground, of Toledo^ 
 asserts " that it acts as a paralyzer from the first, 
 through paralytic effect on the nerve centres, as 
 in experiments where the inhibitory nerve is cut."' 
 Alcohol adds no heat. It strengthens neither 
 body nor mind ; and this is not only science, but 
 the common sense view of common experience. 
 Alcohol agitates the system, while nutritive 
 agents perform their work silently within, leav- 
 ing other functions undisturbed. Moreover, it 
 has certain drawbacks which stand in the way of 
 its repetition, which proper stimulants do not 
 have. Cold, or mechanical irritation to the stom- 
 ach, increases heart frequency, and heart and 
 vascular force. For the instant, small doses of 
 spirits will do this, but, directly after, the ab- 
 sorbed portion begins to paralyze the nerves and. 
 capillaries. Hence heat, hot drinks, the aro- 
 matics, etc., are the proper means to warm a. 
 chilled person. They do not tumble the blood, 
 into the external capillaries as alcohol does, to- 
 
323 
 
 the neglect of the more important internal parts. 
 Whales are made to resist cold and not heat. 
 Their exterior is in contact with the waters of 
 the polar seas, while under their skins is a thick 
 layer of non-conducting blubber, beneath which 
 their warm blood circulates. Our bodies are 
 made to resist both heat and cold. Exposed to 
 the latter, perspiration stops, the skin contracts, 
 forcing most of the blood beneath the subcutane- 
 ous layer of fat, where its heat is protected. A 
 drink of grog unlocks the skin and drives the 
 blood to the surface, dissipating its heat, just as 
 would happen to the whale if his blood were 
 brought to the outside of his blubber, when it 
 would lose temperature and his heart chill. Not 
 only is alcohol bad in this way, but it does more; 
 it puts a wet blanket over the internal fires, by 
 shrinking and depressing the functions of the 
 blood cells. So, so far from its being a stimu- 
 lant to bring out the forces of the system to re- 
 sist cold, it is a traitor, and appears doubly arm- 
 ed on the side of the enemy. Arnold had his 
 good qualities ; so has this. If a person has 
 been exposed to severe cold, and is sufiFering in- 
 ternal pains and cramps from the vascular en- 
 gorgement, no doubt alcohol has temporary help- 
 ful relations to the case, bringing the blood away 
 to the surface. So has it useful relations to syn- 
 cope, to shock, and to other cases of deiicieht 
 brain circulation, where its irritation to the stom- 
 ach, and not its absorption, may serve. Hence, 
 what is used for the purpose should be strong. 
 
324 
 
 There are many other things as good,' if not bet- 
 ter. Thus the horizontal position, splashing the 
 face and neck with cold water, cold or hot drinks, 
 aromatic teas, camphor, ammonia, are appropri- 
 ate, and are the people's remedies ; while physi- 
 cians may add amy 1- nitrite, nitro- glycerine, and 
 other things too numerous to mention. For years, 
 nitro- glycerine has been the chief remedy of the ■ 
 writer. It is good to administer in anticipation 
 of faintness from operations. So iron, and not 
 alcohol, for anaemia and anaemic neuralgia ; bis- 
 muth for gastralgia and pyrosis; not whisky, but 
 the bromides, capsicum, digitalis, feeding, nutri- 
 tious enemata, for delirium tremens ; heat to the 
 chest, camphor, ammonia, strophanthus, digi- 
 talis for the flagging heart ; not alcohol, but 
 digitalis, strychnia for dropsy ; camphor, chloro- 
 form, turpentine, not liquor, for malarial chills ; 
 not liquor, but turpentine, ergot, salt, milk, for 
 haemorrhages; not alcohol in congestive dysmen- 
 orrhcea, inflammatory colic, dysentery, and a 
 thousand other conditions in which stimulation 
 is required. In all cases of nervous exhaustion, 
 or where the stomach is at fault, Dr. Archibald 
 Billings says ' ' restoration will not be expedited 
 by stimulants, ' ' meaning alcoholics. Being, then, 
 rather a hindrance than a help, good sense is on 
 the side of the surgeons of certain corporations 
 where accidents are common, in recommending 
 that the employes be prohibited from resorting 
 to liquor in cases of injury. It would be well 
 
325 
 
 if this term, as applied to alcohol, were ex- 
 cluded from medicine. 
 
 AI^COHOI, AS AN AN^^THETIC. 
 
 That alcohol by the skin, stomach, lungs, ob- 
 tunds the nerves, paralyzes the muscles, stupefies 
 the brain, needs no confirmation here. As persons 
 see these effects, they name it according to their 
 conceptions — intoxicant, narcotic, paralyzant, 
 etc. I use the word anaesthetic, for, like 
 Aaron's rod, it swallows up all the rest. 
 
 Anaesthesia is the most conspicuous of its ef- 
 fects. It is this which balms the feelings and 
 brings the cheer ; that smothers the aches and 
 the pains ; that exhilarates the mind, beguiles 
 to repetition, to increasing doses, to habit, to in- 
 ebriety, upsetting the mind, and raising the 
 devil. 
 
 Alcohol is thus the very mad dog of materia 
 medica. Nevertheless, it was the best anaesthet- 
 ic known to our fathers. They also wore wood- 
 en shoes, things we need not wear. Ether, gas, 
 chloroform, and many other agents have come to 
 the fore, pushing it to the rear. They are not 
 so deceptive, so seductive, so habit-producing, 
 and those who handle them are not so likely to 
 catch the Tartar — inebriety. 
 
 Having so numerous and efiScient agents as 
 substitutes, agents which have not its peculiar 
 back-cut upon the blood cells, I need not waste 
 time in pointing out when and where it can be 
 used in this direction; for it was the new cane 
 
326 
 
 the old man used while all the former ones were 
 put in a brace in the wood- shed. Neither need 
 I stop to indicate the purposes its varied proper- 
 ties fit it to serve as an external remedy. I 
 therefore pass at once to my last point. 
 
 ALCOHOL AS A PERTURBATOR OF THE ORGANISM. 
 
 The effects of alcohol on structure, and so, on 
 functions, marks it as the most remarkable dis- 
 turber of the animal body with which we are ac- 
 quainted. Whatever else it may do, here it 
 takes preeminence. Its etherial influence, to be 
 sure, are the lulling wings of the vampire ; in 
 this is its mouth applied to the vital fluids. Its 
 anaesthesia is the dummy hand of the thief ; here 
 are the concealed fingers which filch the purse. 
 The mental exhilaration it produces is the smiling 
 face of Brutus; this, his bloody hand which 
 plunges the poniard. 
 
 With all that is known of the morbid changes 
 produced by alcohol, how little is systematically 
 considered and applied in practice? I,ast year 
 I called attention to its power over the blood cor- 
 puscles, and showed a photograph of the extreme 
 changes it produces in their phj'sical character, 
 in a portion of blood taken directly from a drunk- 
 en man. This was right to the point. It gave 
 ground for explanations and deductions other- 
 wise impossible. Knowing the physiology of 
 these corpuscles, as the gas carriers of the body, 
 we do not require to be beaten with a club to com- 
 prehend that such alteration in their character 
 
327 
 
 must amazingly effect their important functions. 
 But this is not all. The alcohol which gets into 
 the interior of the corpuscles, acts the part of the 
 dog in the crib and refuses the oxygen and the 
 carbonic acid. Thus in a double sense their 
 functions are depressed. In the paper referred 
 to, I explained how it was that alcohol so affected 
 their physical character, by showing that the spirit, 
 having a great attraction for water and little or 
 none for the substance of animal membrane as 
 such, by the laws governing osmotic action, com- 
 pels the water to come out of the cells and min- 
 gle, with it on the outside. Not only does it 
 thus collapse the cells, but it also similarly af- 
 fects all other moist structure throughout the 
 body. "Who has not seen this in mucus, in al- 
 bumen, in the protoplasm of rapidly healing 
 w.ounds? 
 
 What it does under the eyes on the outside of 
 the body, it does on the inside, and the more so 
 in proportion as they are watery and the cell 
 walls delicate. In this way are the tendons, the 
 muscles, the nerves, the connective tissue and the 
 organs affected. Is there, therefore, difficulty in 
 comprehending why the bodies of drinking young 
 men grow old apace? An agent that will steril- 
 ize the cells of a pup and prevent their evolution, 
 thus holding his body throughout in the condi- 
 tion of a Chinese woman's foot, must and does 
 pervert the structures of those who drink it. 
 Here, then, we have the key to the alcoholic 
 pathology — the changes so conspicuous in the 
 
328 
 
 bodies of old topers, and so surprisingly numer- 
 ous in the bodies of moderate drinkers suddenly 
 cut off by otter causes. This shows why we 
 cannot cure persons made sick by alcohol while 
 the habit is continued; why surgical cases act 
 badly in alcoholized patients; why the healing 
 of wounds is not expedited but hindered when 
 liquor is given ; why the white blood-cells are 
 crippled and protoplasmic movements arrested 
 by this agent. 
 
 Here is the key that unlocks the mystery of 
 fatty degeneration, fatty bloating. -Is it strange 
 that such organs as the kidneys, the liver, the 
 stomach, the brain and spinal cord, the vascular 
 system, should undergo fibroid and cirrhotic 
 changes by so active an agent and acting in the 
 way that alcohol does? 
 
 Here is the explanation why the bodily tem- 
 perature can never be raised by alcohol, but al- 
 ways lowered ; and why this antipyritic action 
 cannot be rendered serviceable in practice. Here 
 is its philosophy in weakening brawn and brain. 
 Every other function must be depressed when 
 the blood-cells are strangled. 
 
 Now, I ask, what reason have we to expect 
 good from it in the treatment of any or all dis- 
 eases of the respiratory system ? They obstruct 
 oxigenation and the elimination of carbonic acid. 
 Does not alcohol do the same? They weaken; 
 this, more. If pneumonia blocks pulmonary cir- 
 culation and aeration, and by heaping excessive 
 labor on the heart, tends to overwork it and ex- 
 
329 
 
 haust it, determining heart failure; this, more. 
 Strange that we should lose our heads as philos- 
 ophers in the face of alcohol. Would that we 
 return to the lancet for this grave disease, reliev- 
 ing the volume of blood upon which the embar- 
 rassed heart has to act, and be done with this most 
 irrational and fatal treatment of it, ever employed. 
 If the structural changes in the lungs of consump- 
 tives hinders oxidation and weakens the body , does 
 not liquor do the same, albeit it diminishes the 
 cough by times? Is our philosophy correct when 
 we give alcohol in disintegration with defective 
 depuration, as in fevers and the like? Does it 
 not itself increase depuration by hindering the 
 absorption of oxygen and the expulsion of the 
 waste, represented by carbonic acid and urea? 
 
 Certainly if it can obstruct the waste in a well 
 man till he stinks from head to foot, it can never 
 purify the blood of one already foul. These 
 questions, with scores more that might be asked, 
 being based on solid grounds, leave me little room 
 to answer. Where? When? give alcohol. There 
 is nothing in physiology more certainly scientifi- 
 cally demonstrable than that alcohol changes 
 the structure of the blood-cells, and, through 
 these, the functions dependent upon them, and 
 as their functions are vital and no hindrances to 
 them can conduce to the restoration of the sick, 
 the reasons for alcoholic medication are driven 
 to the polar region of barrenness. They cut the 
 tap- root of the popular liquor therapeutics, and 
 no human invention can make it again bear 
 
330 
 
 green leaves. Alcohol, when in any degree of 
 concentration, is opposed to ptyaline, to pepsine, 
 to pancreatine. It is contra -indicated in bilious 
 cases, cirrhosis of the liver, gout, Bright's dis- 
 ease and diabetes; the last of which it can di- 
 rectly produce. 
 
 But this paper is not written in ignorance of 
 the fact that many good physicians use it. Were 
 it not that many do, the statements herein would 
 not be worth the making. I may be wrong; we 
 all err. In a neighboring city an astute physi- 
 cian stood up in a medical meeting and deposed 
 in favor of a certain pill, relating numerous cases 
 where he had given it with good results. An- 
 other physician followed, showing the same pills 
 which had been gathered from the former's pa- 
 tients, they passing whole, only losing their sugar 
 coats. A prominent member of this Association 
 had a fever case which got into the typhoid state; 
 his kidneys being obstructed, I counselled efforts 
 to open up the kidneys and skin and so relieve 
 the nervous condition. The doctor was obsti- 
 nate, believing in "bridging the chasm" with "the 
 bridge that brandy makes," and gave it. His 
 bridge was rotten. I now have a patient under 
 my care who told me he had taken quite half a 
 barrel of different liquors on the prescriptions of 
 this same physician, and began to improve the 
 moment he left the liquors off. A clergyman 
 called on me, relating that his child had been 
 sick with the typhoid and got to that condition 
 where the doctor said nothing but brandy would 
 
331 
 
 save him, and accordingly brought a bottle of it 
 to the house. The clergyman took it, threw it 
 into the back yard, made a liberal portion of beef 
 tea and gave it. Soon the sweat started, and the 
 child fell into a sweet sleep and was better the 
 next morning. The doctor spoke of the change 
 and attributed it to the wonderful power of the 
 spirit. I warmed that clergyman for not unde- 
 ceiving his doctor, and allowing him to go away, 
 strengthened by the success of the brandy in 
 this case, to give it with increased confidence. 
 
 It may have been good in cases of fever, diph- 
 theria, etc., where large doses have been given 
 and which appeared to be beneficial. If so, I 
 am very positive that it was owing to its power 
 over the peculiar microbes in these diseases,ster- 
 ilizing and rendering them inert; for we know 
 that alcohol, at fifteen or twenty per cent, 
 strength, overcomes and practically destroys 
 most of the germs about us, eveu the bl'ood- cells 
 themselves, as I have witnessed, producing death. 
 And it is a most wonderful provision of nature 
 against fatality from the drink habit, that the 
 medulla oblongata is so much more resisting to 
 the power of alcohol than the rest of the body, 
 continuing its functions when all else is practi- 
 cally dead, keeping the heart beating and the 
 lungs moving, fanning out the poison from the 
 prostrated blood -cells. Were it not so, how of- 
 ten would the undertaker's service be required 
 to what it now is! 
 
 I know I cannot answer all your questions. 
 
332 
 
 yet I trust I have said enough to show you that 
 this subject is not all a mystery, but full of in- 
 terest and instruction, if we but come out of the 
 clouds and study it from ground principles. I 
 came up the historic Potomac, and, though the 
 oar, the sail, the smoking steamer, seemed to in- 
 dicate that the current was devious, I am sure 
 its steady flow is to the ocean beyond. Though 
 I note some drift-wood held in sluggish side cur- 
 rents, some cross currents, whirlpools and waves, 
 I am as satisfied that the stream of alcohol, 
 whether taken foolishly, from habit, or on the 
 advice of physicians, in large or in small doses, 
 has but one general course, one end — the fathom- 
 less deep. 
 
 Comparing the results of my practice with the 
 practice of those who use it, until so'mething 
 more scientific in its favor comes up, some new 
 revelation is made, the day is far distant when I 
 shall send another Brutus after my Caesars. 
 
INSANITY AS REI.ATKD TO CIVILIZA- 
 TION. 
 
 BY ORPHKUS nVERTS, M.D., 
 
 SUPERINTENDENT OF THE CINCINNATI SANITARIUM, ETC., COL- 
 LEGE HILL, OHIO. 
 
 Insanity may not be, as is so commonly and 
 confidently asserted, '"a disease of civilization" 
 — but conditions essential to the phenomenal 
 manifestations of insanity obtain so rarely among 
 savages and lower animals, and so frequently 
 among civilized people, that, in the absence of 
 contradictory testimony, the assumption that it 
 is so, would seem to be justified. The question 
 then becomes pertinent and interesting: What 
 constitutional modifications are efiected by, or 
 with, the process of civilization, whereby human 
 beings are rendered more liable to become insane? 
 Who shall answer ? 
 
 By common consent the medical profession is 
 looked to for intelligent answers to all questions 
 pertaining t insanity, and the insane. Is the 
 profession qualified to so answer ? 
 
 Qualified or not, there are members of the pro- 
 
334 
 
 fession ever ready to respond; the least qualified, 
 often, being the readiest. Capability to talk 
 volubly, or write voluminously, about insanity 
 — or any other subject, for that matter — with an 
 affectation of learning, is a " gift" not unknown 
 to the profession, however reputable it may be, 
 as a body, for its thoughtfulness and reticence. 
 Sucli 'gifted' members are, as a rule, however, 
 not the most trustworthy, as expounders of prin- 
 ciples, or historians of facts. 
 
 By interrogating less pretentious, but ordinar- 
 ily intelligent members of the profession, respect- 
 ing the relation of insanity to civilization, it will 
 be found that various opinions are entertained by 
 them on the subject; each having some value 
 when properly estimated; but based upon foun- 
 dations of facts too narrow and incongruous to 
 stand the test of rational criticism. 
 
 Nor should it be anticipated of such men, 
 whose preliminary studies, and subsequent hab- 
 its of thought and observation have been in the 
 way of specializations, rather than generaliza- 
 tions, should grasp the question as propounded, 
 comprehensively; or respond to it otherwise than 
 by some more or less dogmatic assertion of per- 
 sonal opinion; citing this, that or the other dis- 
 ease, habit, accident, or incident, of civilization, 
 as the true cause of insanity: overlooking the 
 fact that certain physical conditions, not com- 
 mon to the race, but essential to the manifesta- 
 tion of the phenomena of insanity, must have ob - 
 tained, individually, before such "causes" could 
 
335 
 
 become operative; regardless of all other circum- 
 stances. 
 
 The first man, for example, will assert, as an 
 indisputable proposition, that alcoholic intemper- 
 ance is the cause, direct or indirect, of all mani- 
 festations of insanity ! 
 
 "The demon alcohol" as this man sees it, has 
 superseded all old fashioned "demons" of what- 
 ever ^^«m5, or species, to whose machinations all 
 diseases, and death itself (when not inflicted by 
 a supremely good spirit), were attributed by our, 
 not very remote, ancestors; and should now be 
 held responsible, in their stead, for all the mis- 
 ery of mankind. 
 
 Nor is this man alone in his belief A good 
 man, and true, within his own bounds — devoting 
 all the energies of being to an ameliorating of the 
 more painful conditions of his fellow- men — his 
 notions are not singular; nor is his conduct pecu- 
 liar to himself 
 
 I/imited and fanatical by nature; cramped by 
 long service in a narrow field of labor; feeling^ 
 voluminously, but thinking neither comprehen- 
 .sively nor rationally; toiling ever in the penum- 
 bra, if not the shadow, of superstition; habitu- 
 ally personifying phenomena, and ascribing gen- 
 eral conditions to special antecedents as causes; 
 having witnessed with increasing dismay, from 
 year to year — in his professional as well as his 
 civil capacity — ^^the unstayed ravages of this ap- 
 parently pitiless and unsparing monster — invad- 
 ing every land and every household — insidious 
 
336 
 
 as pestilence; greedy and insatiable; feeding like 
 a fabled dragon, witli ever increasing appetite, 
 upon all that is estimable in human nature; im- 
 perishable, and many-headed_ as a hydra; from 
 whose many mouths proceed, incessantly, false- 
 hood, delusion, violence, and crime; each giving 
 instant birth, in turn, to all manner of kindred 
 but ever- varying vices; it is not to be wondered 
 .at that he should so believe; nor that, being so 
 filled, he should go his way vituperating alcohol, 
 and all persons not already enlisted in a crusade 
 of extermination against it — however hopeless of 
 success the fanatical adventure. The measure of 
 his understanding is full. It were folly to over- 
 flow it. 
 
 The next man, closely related to the first by 
 capabilities, education, and experience; difiering, 
 temperamentally, only so far as to be able to ac- 
 cept the inevitable with less friction, or emotion, 
 will insist that the insanity of civilization is a re- 
 sult of overwork, and mental strain, and other 
 incidents of modern life, characteristic of a ' fast 
 age and greedy people !' 
 
 In addition to an exhaustive arrangement of 
 our most active and enterprising business men, 
 because of their habits, and methods, of accom- 
 plishing ends without regard to means, or con- 
 sequences — straining every fibre of being in pur- 
 suit of unworthy objects, success outweighing 
 every other consideration, he may be expected 
 to impeach everything modern without discrimi- 
 nation or reason. Under present circumstances, 
 
337 
 
 as the world seems to him to be wagging, women 
 are everywhere disquallifying themselves for 
 healthful maternity, (the chief end of female ex- 
 istence) by unreasoning devotion, in their social 
 relations, to absurd fashions; and criminal viola- 
 tion of natural and statutory laws in their rela- 
 tions of wives and mothers. Men are as unmis- 
 takably deteriorating, physically and mentally, 
 because of such "maternal delinquencies," and 
 their own acquired habits of life. And children 
 are being dwarfed, or destroyed, by thousands, 
 through the instrumentality of modern schools, 
 and newfangled notions respecting the education 
 of youth — both methodical and institutional. 
 
 "Doctor of Medicine" though this man be — 
 and presumably familiar with the fact, if not its 
 significance — that an evolution of science has 
 been taking place within his time, by which old 
 opinions and beliefs have been, and are being, 
 revolutionized; his own profession, even, meta- 
 morphosed, dignified, and advanced — he is one 
 of those, nevertheless, who are being carried for- 
 ward by the stream of human progress somewhat 
 reluctantly; lagging in the rear of the advancing 
 column of humanity — marching like a discon- 
 tented soldier in retreat, with vizor reversed, 
 looking ever rearward. Intellectually myopic, 
 he ;ees neither before nor after, to any consider- 
 &.jie distance. He is not without his uses. 
 
 The burden of the third man's response will 
 be an ascription of insanity to the general disor- 
 der of society incidental to existing forms of gov- 
 
338 
 
 ernment and social customs; it being one of the- 
 penalties inflicted by nature upon mankind for 
 violations of natural laws of justice and equality 
 —effected more immediately by the excesses of 
 the stronger, indulged while rapaciously feeding 
 upon and devouring the weaker; and the priva- 
 tions that the weaker (and worthier) are com- 
 pelled to sujBFer that the strong may luxuriate^ 
 All characteristic, he will say, of civilization. 
 
 Intellectually a hybrid — a mixture of philoso- 
 phy and lunacy— this man sees no prospect — no- 
 possibility — of anything but disorder, under ex- 
 isting circumstances — and wonders, only, that 
 more persons do not "go mad." As he sees- 
 things now, all governments are despotic, cruel, 
 and unjust; established byusurpations of power, 
 and maintained by violence and fraud. 
 
 The cornerstone of each is a denial of the nat- 
 ural, inherent "rights of man," individual and 
 social; upon which rests a superstructure of fic- 
 titious distinctions, and class privileges, abhor- 
 rent to justice, and obnoxious to the welfare of 
 the race. All institutionalized religions as he 
 sees them, are alike dogmatic and intolerant; af- 
 fecting recognitions of the ' 'fatherhood of God,, 
 and the brotherhood of man," — but practically,, 
 historically, denying such recognitions; and 
 representing God as an immensely magnified hu- 
 man despot, and but a few select people as worthy 
 of divine favor. So, too, all social organizations- 
 are outgrowths of erroneous ideas respecting the 
 natural equality of human beings, and their 
 
339 
 
 rights and duties under all circumstances, in 
 every relation of life. 
 
 Our fourth respondent — a modern specialist by 
 chance — may be expected to assert, with charac- 
 teristic energy, and apparent sincerity, that one 
 half of the insanity to be met with now-a-days, 
 is attributable to untreated surgical diseases of 
 the reproductive organs of women; amenable to 
 treatment, generally overlooked by ordinary 
 practitioners, and wholly neglected by the medi- 
 cal officers of our hospitals and asylums for the 
 insane. 
 
 Congratulating this man, and his confreres in 
 opinion, upon so great a medical discovery, in- 
 cluding the localization of mental function in the 
 female organism, presuming, analogically con- 
 sidered, thai the other half of insanity, not ac- 
 counted for gynaecologically, is ascribable to dis- 
 eases of the male organs of reproduction, we may 
 profitably pass to an examination of the next 
 "expert," however superfluous further inquiry 
 may appear to be. 
 
 The fifth interlocutor — he may as well appear 
 now — to whom the problem under consideration 
 appears to be exceedingly simple — will maintain, 
 with- an air of conscious superiority, the asser- 
 tion that insanity, in all of its phases, is but an 
 upsetting of feeble-minded persons by trivial cir- 
 cumstances; such as disappointment in love, loss 
 of property, or friends; grief, jealousy, or relig- 
 ious fervor; fear of hell, and the like; because of 
 their ignorance, and lack of common sense. He 
 
340 
 
 thinks that people "go crazy" on certain sub- 
 jects, such as religion, spiritism, christian 
 science, or some other form of fanaticism; leav- 
 ing out of consideration any possible morbid ma- 
 terial element, however important such consid- 
 eration, may be to a scientific solution of the 
 problem. 
 
 Superficial, vain, voluble, vulgar, probably 
 profane; it may be anticipated of this man, who 
 has never really thought of insanity as having 
 any definite relation to civilization, that while 
 casting about for material wherewith to am- 
 plify his discourse, he will bethink himself of 
 sexual excesses and abuses as causes of insanity, 
 and haying struck the dead-level of his intellect- 
 ual tastes, that he will descant indefinitely upon 
 the familiar topic of sexual appetites and indul- 
 gencies; relating many anecdotes, and bringing 
 into bold relief the fact that he looks upon all 
 emotionally pious, as well as hysterical women, as 
 erotic; all spiritualists as "freelovers;" and all 
 ministers of religion as lascivious, if not licentious. 
 
 Fortunately, we do not have to, listen to all 
 that such men have to say, and may so leave him 
 to indulge his own egotism and vulgarity, while 
 we interrogate a worthier, if not a wiser man. 
 
 And here he is — slow and irresolute of speech 
 at first, gaining time, as it were, for reflection, 
 we need not be surprised by a final announce- 
 ment of the conclusion, that civilization has 
 nothing to do with insanity, generally or spe- 
 cially considered. Nor by the assertion that, ac- 
 
341 
 
 cording to his personal observation, nearly, if not 
 all insanity, is of syphilitic origin. Candid, consci- 
 entious, resisting plausible testimony, fearing to 
 be misled, he will attempt to fortify his position 
 by facts ; stating that he now recalls a great 
 number of cases of insanity caused by syphilis 
 — many — several — two or three — (?«f well- marked 
 case ; that of a man, about 45 years of age, who 
 had, etc., etc. When a worthy brother begins 
 to recite clinical history, from memory, in support 
 of an absurd proposition in medicine, he is liable 
 to become tedious. 
 
 Should we meet a seventh witness in this line 
 of investigation, let us hope that he may be a 
 man who has had suflScient mental training to 
 comprehend the full purport of a question when 
 plainly stated; as well as one who has dug through 
 all merely superficial indications of valuable mat- 
 ter, and struck his intellectual pick into a matrix 
 of pure ore. Not that surface indications are of 
 no value. To an experienced miner they may 
 be of great significance. But incompetent obser- 
 ■ vers are liable to overestimate their intrinsic 
 worth, or to mistake them for wholes of which 
 they are but fragments. The uninstructed, in- 
 deed, often deceive themselves by holding frag- 
 ments of truth in such relation to the eye as to 
 permit them to occupy the entire field of vision.- 
 It is thus that the massive sun is sometimes to- 
 tally eclipsed by the tiny fragment of a world, 
 called the moon. 
 
 But what need of further illustration? No 
 
342 
 
 well-informed man, capable of weighing testi- 
 mony, and applying general principles to special 
 subjects, can fail t« recognize the lack of breadth 
 and comprehensiveness of commonly entertained 
 views of the subject before us. Nor will it es- 
 cape his observation that, vary as they may, they 
 are all of the same general type, or purport; each 
 consisting of certain limited speculations respect- 
 ing the relation of insanity to certain ' ' exciting 
 causes," without an allusion to any inferentially 
 essential precedent, constitutional preparation 
 for the efficient action of such "causes," or the 
 part played by civilization in effecting such con- 
 ditions. While the fact is, not one alone of all 
 the many exciting causes of insanity — not all of 
 them combined — can produce the phenomena of 
 insanity by their influence upon other than ex- 
 ceptional persons. Nor can all of the facts per- 
 taining to the subject be taken into consideration 
 and harmonized, by such limited speculations, 
 however satisfactory they may be to those who 
 entertain them. 
 
 It is a fact, for example, that neither alcohol, 
 nor alcoholic intemperance, is peculiar to civiliza- 
 tion. It is a fact, also, that alcoholic intemper- 
 ance has been steadily decreasing among the more 
 highly civilized peoples, for half a century or 
 'more, while insanity has been as steadily in- 
 creasing. 
 
 It is a fact that our hospitals and asylums for 
 the insane are populated, almost exclusively, by 
 very ordinary people ; men and women who have 
 
343 
 
 never suffered great vicissitudes of any kind, un- 
 distinguished persons, who have neither aspired 
 nor endeavored, struggled nor attained, to any 
 considerable extent, in any direction. 
 
 It is a fact that while men may, and do some- 
 times, destroy themselves by overwork and men- 
 tal strain, in their pursuit of wealth, or fame, or 
 tneans of personal distinction or enjoyment, not 
 many ambitious, capable, successful men of af- 
 fairs become insane, however effected, or prema- 
 ture, their dissolution. Rare exceptions to this 
 rule attract attention because of their rarity. 
 
 It is a fact that the opulent and luxurious, who 
 have become such by personal enterprise, sagacity 
 and acquisition of means, however destructive of 
 morals, or of health, their habits may become, 
 <do not, many of them, become lunatics. 
 
 It is a fact that, while pelvic and abdominal 
 •diseases of women are more frequently and intel- 
 ligently recognized by the profession now than 
 formerly, and, because of modern modes of dress- 
 ing, and pernicious habits of preventing concep- 
 tion, or arresting gestation, on the part of many 
 women, they may be more numerous and preva- 
 lent, it may also be affirmed that more women, 
 ten to one, have been consigned to hospitals for 
 the insane — victims of needless or unskilful 
 surgical operations, performed by ambitious and 
 pretentious gynecologists, than have ever been 
 restored to reason by the most commendable and 
 skilful abdominal surgery. 
 
 It is a fact that no people have ever achieved 
 
344 
 
 greatness, or accomplished anything worthy of 
 existence as men, without government — the worst 
 being better than none — and it is likewise true 
 that all civilized governments have been growing 
 more and more beneficent, more and more consid- 
 erate of the welfare of the governed, of all classes, 
 for the past hundred years or more ; growing in 
 grace with the evolution of rationalism and mor- 
 als that has characterized the present century ; 
 extending their blessings, more especially, to the 
 weaker and more dependent classes. 
 
 It is a fact that " our time " is notable for its 
 freedom from fanaticism, and the grosser features 
 of superstition ; there never ha^dng been a time 
 before — strange as it may sound to the worship- 
 pers of antiquity — when the world was so nearly 
 rational as it is now. 
 
 It is a fact that, historically considered and 
 contrasted,, this is not a licentious age, nor are 
 we a lascivious people. Nor is syphilitic con- 
 tamination, thanks to science and a more general 
 diffusion of useful knowledge, nearly as exten- 
 sive or destructive now, as it was formerly, among 
 civilized peoples. 
 
 It is a fact that savage peoples have been, and 
 are now being, decimated, if not annihilated, by 
 the ravages of syphilis — notably the native Ha- 
 waians, and Alaskans — conveyed to them from 
 civilization, without any history of concomitant 
 insanity whatever. 
 
 It is a fact that while the longevity of indivi- 
 duals has not increased by, or with, the progress 
 
345 
 
 of civilization, the longevity of the race, so far 
 as afifected by civilization, has increased, owing 
 to modern triumphs of peace over war-, of sci- 
 ence over pestilence, of reason over superstition, 
 and a constant increase of food- supplies, and bet- 
 terment of habiliments, including all manner of 
 habitations, and the consequent survival of large 
 numbers of persons otherwise destined to inevi- 
 table extinction. 
 
 How, then, does civilization affect the condi- 
 tions of manljind — what does it do to men, physi- 
 ologically or historically considered, whereby 
 they are rendered more liable to become insane, 
 than are savages or barbarians? 
 
 The answer, so far as present knowledge ena- 
 bles us to answer intelligently, is neither difficult 
 nor complex. It is this : 
 
 Civilization, by its extensive and intricate co- 
 operative combinations and activities — its arts, sci- 
 ences, inventions, ethical perceptions, apd consequent 
 benefactions, not only rescues from otherwise inevi- 
 table dissolution, but nurtures, matures, arid enables 
 them to multiply by reproduction, multitudes of or- 
 ganically defective individuals, of the human spe- 
 cies, in whose structure inhere certain potentialities, 
 not common to the race, but essential to the mani- 
 festation of the phenomena of insanity, under any 
 given combination of circumstances. 
 
 This answer is both explicit and comprehen- 
 sive, and harmonizes, not only the facts already 
 recited, but all facts pertaining to the subject. 
 
346 
 
 among which the following are offered as authen- 
 ticated and suggestive, viz.: 
 
 The -fact that all peoples now classified as 
 "civilized," have become such by transitions 
 from barbaric and primitive conditions; there 
 being no evidence acceptable by science, that 
 any originally civilized people ever existed, or 
 that any people having become civilized sponta- 
 neously, ever relapsed to primitive, or intermedi- 
 ate barbaric conditions. 
 
 The fact that man, as related to^he universe, 
 is not an exceptional being, but subject to the 
 same general conditions and contingencies that 
 determine the becoming, continuance and disap- 
 pearance, of all other specializations of living 
 matter. 
 
 The fact that the same germinal and seminal 
 prodigality that characterizes nature everywhere, 
 forcing into being multitudes of superfluous in- 
 dividuals of varied capabilities, for whose subse- 
 quent development adequate provision has no- 
 where been made, necessitating an inevitable and 
 _ immediate conflict and "struggle for existence," 
 in which the weaker, or otherwise defective, must 
 necessarily perish, is characteristic of mankind, 
 as well as of other animals of the same order. 
 
 The fact that the first intelligent effort of man- 
 kind (called "instinctive" when exhibited by 
 lower animals), to mitigate the severities, and 
 supplement the deficiencies, of nature respecting 
 the welfare of the race, consists of cooperative 
 combinations of individuals for the accomplish- 
 
347 
 
 ment of ends otherwise unattainable ; such as 
 the capture and appropriation of food-animals, 
 too strong or ferocious for individual prowess, or 
 defense against enemies of like character seeking 
 to make food of them ; combinations by which 
 two or more individuals are enabled to live where 
 but one could have existed under other circum- 
 stances — the weaker ever being, if existence is 
 to them a benefaction, the real beneficiaries. 
 
 The fact that all subsequent, successive, efforts 
 of mankind, having in view the conservation of 
 individual existence, instigated by organic senti- 
 ments, or love of life, of self, of offspring, and 
 finally of the race, resulting in the various phases 
 of civilization, are but extensions of, or evolu- 
 tions from, primary, simple, cooperative combi- 
 nations of individuals, whereby the disastrous 
 indifference and negligence of nature have been 
 supplemented, and -counteracted, in an ever-in- 
 creasing ratio. 
 
 The fact that in the transitions from primitive 
 conditions to civilized states, common to all civ- 
 ilized peoples, a constitutional diversification of 
 individuals, as in the domestication of lower ani- 
 mals (a similar process), always takes place, cor- 
 responding in variations from original types to 
 the degree of cultivation reached at any given 
 time, finally necessitating recognitions of classes, 
 or breeds, consisting of individuals presenting 
 certain peculiarities, suflSciently similar to relate 
 them as a group, while, at the same time, distin- 
 guishing them from the common stock. Classes 
 
348 
 
 among civilized peoples whose characteristics 
 elevate them above the common level of human- 
 ity, and classes correspondingly depressed. 
 
 That the insane constitute a " class " of soci- 
 ety cannot be rationally denied ; inasmuch as the 
 constitutional conditions essential to the manifes- 
 tation of the phenomena of insanity do not ob- 
 tain uniformly in the development of mankind — 
 but few only of a given number of persons being 
 capable of manifesting them. 
 
 That the insane, as a class, are defective, is 
 also self-evident ; defective manifestations of phe- 
 nomena always implying defect of mechanisms, 
 the activities and conditions of which are there- 
 by reflected, the mechanisms of mind not ex- 
 cepted. 
 
 The constitutional peculiarities of the insane 
 are, likewise, correlatable with the peculiarities 
 of other defective classes of .society, such as the 
 anatomically asymmetrical, the physiologically 
 unstable, the intellectually incompetent or eccen- 
 tric, and others whose abnormal co*;ditions find 
 expression, phenomenally, otherwise than by man- 
 ifestations of mania, melancholia or dementia; 
 responding to excitation, sometimes, by exhibi- 
 tions of hysteria, epilepsy, neuralgia, or uncon- 
 trolled impulses to irrational violence, unresisted 
 propensities toward sensuality or intemperance, 
 and not infrequently, a general perversity of feel- 
 ing and perception, constituting the diathesis of 
 crime. 
 
 The inference is therefore forced upon us, and 
 
349 
 
 may not longer be resented, that with every in- 
 crease of cooperative complexity and activity — 
 embracing larger and ever larger aggregations of 
 individuals, with increasing comprehensiveness 
 of purpose, and efficiency of action — attended by 
 continuous growth of capability and accumula- 
 tion of knowledge, from which evolutions of hu- 
 mane sentiments and ethical perceptions are in- 
 separable, the number of individuals rescued from 
 premature dissolution will increase, and the lower 
 will be the stratum of " unfitness" from which 
 such rescuing will take place. 
 
 What ! Insanity, and other blemishes of civ- 
 ilization, attributable to the apparent benefac- 
 tions, instead of the evident malefactions, of civil 
 life? Impossible! Good and evil are not so 
 closely and inextricably related. 
 
 So it may seem to the multitudes whose no- 
 tions of good and evil are as incoherent as their 
 knowledges of the universe are limited and su- 
 perficial. But no well informed, thinking man 
 will shrink from the conclusion. The law of 
 compensation is never suspended. Mankind can 
 afford to accept the facts, or conditions of civili- 
 zation, even as thus depicted. Reciprocity is the 
 highest practical ethic of which mankind is capa- 
 ble. Public as well as private charity is quite as 
 beneficent in its influence upon the doers, as 
 upon the intended receivers of benefactions. He 
 who neither apprehends the past nor trusts the 
 future, is liable to suffer irrational doubts, and 
 groundless apprehensions. 
 
350 
 
 Civilization as a whole, or general condition of 
 human affairs, is harmonious, however discord- 
 ant its component features may appear to be 
 when considered separately, or unrelated. 
 
 The higher and lower degrees of civilization 
 are as continuous, yet discreet, in their relations, 
 as are the upper and lower surfaces of any object 
 geometrically considered. Whatever is higher, 
 ideally or materially, grows out of, rests upon, 
 and is inseparable from, that which was before, 
 and is lower, or beneath. 
 
 He who should anticipate ripened fruit, with- 
 out the necessary antecedents — blossoms, leaves, 
 twigs, branches, stems and roots of a perfect tree, 
 would be scheming both ignorantly and idly. 
 He schemes as ignorantly and idly who hopes or 
 expects to attain and maintain a high degree of 
 civilization without a long series of antecedent 
 lower degrees, with which the higher must re- 
 main forever continuous. Disrupt civilization as 
 it now exists, and separate the highest attain- 
 ment from its antecedents, as we pluck fruit from 
 trees, and it would as inevitably, if not as speed- 
 ily, begin to perish. We cannot think of civili- 
 zation as thus dismembered, if we try, without 
 confusion of thought. 
 
 As an illustration of civilization as it now is, 
 take for example any great city of the world. 
 It is a perfect illustration. Barbarism never built 
 a great city. I<ook at its population! The rich- 
 est and the poorest, the noblest and the vilest, 
 the strongest and the weakest of mankind are 
 
351 
 
 here inextricably, yet discreetly and harmoni- 
 ously, associated. Look at its streets and build- 
 ings ! Temples, palaces, and magnificent man- 
 sions, with all of their" accessories, many and 
 ^beautiful, are here ! But miles on miles of nar- 
 row, filthy streets, flanked by common dwellings, 
 cottages and hovels, constitute an inseparable 
 corollary. Imagine now, if possible, a transfor- 
 mation ! Wave the magic wand of ideality, and 
 behold! these buildings all converted into palaces 
 of equal beauty, sumptuousness, and magnifi- 
 cence ! And these inhabitants — all transfigured [ 
 all strong, noble, intelligent, learned, rich, lux- 
 urious, free, and secure in every right or privi- 
 lege acquirable by man! Alas! such a condition 
 is not maintainable! Humanity may be crushed, 
 but cannot be elevated, to a common level. Crush 
 society to a common level, and the result will be 
 a common condition of barbarism or brutality. 
 Utopian philosophers and pious dreamers, of all 
 ages and nationalities, have imagined and pre- 
 dicted the coming of all manner of impossible 
 conditions of society, equally chimerical, because 
 implying unification of human qualities, capabil- 
 ities and necessities, and a final solidarity of 
 good, and disappearance of evil. But whether 
 pietistic or political, such prophetic dreams have 
 ever been discredited by disappointment, as they 
 ever will be, so long as the conditions of man- 
 kind are determined by growth and environment, 
 and not by miraculous interpositions of hypo- 
 thetical influences, which cannot be rationally- 
 
352 
 
 contemplated, because of implied disturbances of 
 the relations of sequences to antecedents, which 
 it is impossible to regard as otherwise than in- 
 evitable. 
 
STUDIES OF CRIMINALS. 
 
 DEGENERACY OF CRANIAL AND MAXILLARY DE- 
 VELOPMENT IN THE CRIMINAL CLASS, WITH 
 A SERIES OF ILLUSTRATIONS OF CRIMI- 
 NAL SKULLS, AND HISTORIES TYPI- 
 CAL OF THE PHYSICAL DEGEN- 
 ERACY OF THE CRIMINAL. 
 
 BY G. FRANK LYDSTON, M.D., 
 
 Professor of Genito-Urinary and Venereal Diseases in the Chicago 
 
 College of Physicians and Surgeons ; Fellow of the Chicago 
 
 Academy of Medicine, and of the Southern Surgical and 
 
 Gynecological Association, etc., 
 
 AND E. S. TALBOT, M.D., D.D.S., 
 
 I,ecturer on Dental Pathology and Surgery, Rush Medical College; 
 
 Fellow of the Chicago Academy of Medicine; Member of the 
 
 Odontological Association of Berlin, etc. 
 
 The mutuality of interest involved in their 
 studies of the degenerate classes, has led the 
 authors of this paper to combine their observa- 
 tions in a joint paper. This paper, however, is 
 too lengthy for presentation to this Section. We 
 have, therefore, abridged the subject-matter as 
 far as possible, with the view of presenting only 
 the most important features of the essay,. reserv- 
 ing its complete publication until some future 
 time. 
 
354 
 
 The present paper comprises a portion of an 
 address upon "The Skulls of Criminals," with 
 cuts of the more important specimens, delivered 
 by Dr. I^ydston, at the meeting of the Mississippi 
 Valley Medical Association, September ii, 1890, 
 together with some of Dr. Talbot's studies of the 
 jaws of the degenerate classes, and deductions 
 drawn from, an extensive series of cooperative 
 studies of criminals. No attempt has been made 
 to formulate an arbitrary theory regarding the 
 crime class. Indeed, it is the opinion of the au- 
 thors that even the extensive researches of Lom- 
 broso, Ferri and others, have been insufficient in 
 this respect. We advance the proposition — 
 which is itself not a new one — that the crime 
 class is simply a part and parcel of that human 
 flotsam and jetsam which can be so aptly termed 
 the world of degeneracy. 
 
 We give due credit to Lombroso, Fefri, Bene- 
 dikt. Osier, Mills, Roussel, Badik, and numerous 
 other workers in this field, and are free to ac- 
 knowledge that we do not hope to add much to 
 what these eminent men have contributed upon 
 this subject. 
 
 Very little has been done in America in the 
 study of criminal anthropology. Nothing what- 
 ever has been done in the study of the degener- 
 ate development of the jaws as exemplified by 
 the criminal class, hence our contribution to the 
 subject may be of interest. 
 
 C. I/ombroso, of Italy, has done most wonder- 
 ful work in the study of the criminal classes. 
 
355 
 
 His "L'Homme Criminel" is justly regarded 
 as a classic upon this subject. There is one 
 point, however, in regard to his observations, 
 that is worthy of serious consideration, viz. : it 
 is to be remembered that he has collated his ma- 
 terial in an environment entirely different from 
 that in which the American criminal is found. 
 This fact will explain the diversity of opinions 
 regarding the crime class as observed here and 
 in Europe. As Dr. I^ydston pointed out in a 
 paper on "The Pathogeny of Vice," published 
 some years ago, the results of evolution and ata- 
 vistic tendencies are necessarily more pronounced 
 in the offscourings of the older social systems as 
 met with in Europe. Our observations tend to 
 show that the more pronounced criminal types, 
 as seen in this country, are among the imported 
 criminals. 
 
 The aberrant brain types as seen among the 
 degenerate classes, and so excellently described 
 by Benedikt, C. K. Mills and others, do not con- 
 cern us in the present paper, save in a general 
 way. As far as the-specimens which we present 
 are concerned, it is rational to suppose that an 
 aberrant brain was present in each of the deform- 
 ed skulls of our series. While external confor- 
 mation is not an accurate criterion of brain de- 
 velopment, it is still logical to suppose that when 
 a skull is malformed through degeneracy, its con- 
 tents are also involved in the maldevelopment, 
 and from similar causes. There is often, how- 
 ever — and, according to Biliakow — especially 
 
356 
 
 among Griminals, an entire lack of harmony be- 
 tween the external and internal measurements. 
 Oftentimes the external circumference — especial- 
 ly in the frontal and occipital regions — is greater 
 than the normal average, while the internal cirr 
 cumference is notably diminished. In case the 
 relative deformity of the skull is due in a measure 
 to an increased thickness of bone, much depends 
 on the disposition of the increase, i. e., on wheth- 
 er it is uniform, involving both tables of the 
 bone, several bones, or is due to excessive devel- 
 opment of external bosses. lyombroso advances 
 sclerosis as an explanation of diminished cranial 
 capacity when associated with large external 
 measurements. The relation of syphilis to a 
 disparity of the internal and external measure- 
 ments and conformations is at once called to 
 mind. 
 
 Other things being equal, the internal confor- 
 mation is certainly a fair criterion of cerebral de- 
 velopment ; it is most positively an accurate cri- 
 terion of cerebral conformation. 
 
 We wish to be clearly understood as recogniz- 
 ing perfectly the fallacy of arbitrary conclusions 
 regarding cerebral development founded upon 
 osseous conformation. As is well known, even 
 the relative size of the cerebral mass itself has 
 no definite and arbitrary relation to intellectu- 
 ality. The old familiar illustration of the com- 
 parative measurements and. weights of the brain 
 of Daniel Webster and that of an idiot immedi- 
 ately suggests itself at this point. Spitzka has 
 
357 
 
 recently exhibited the brain of an idiot which 
 weighed 68 ozs. , but in which the ependyma was 
 five times its normal thickness. 
 
 In the collection in the Army Medical Museum 
 is a specimen which aptly illustrates the inaccu- 
 racy of the size of the brain as a criterion of in- 
 tellectual capacity, This is the skull of a Chip- 
 pewa squaw, of dwarfed and degenerate physique, 
 who died at the age of 85. The stature of this 
 subject was but 3 ft. 7 in. The skull measured 
 633 mm. in circumference, and presented a ca- 
 pacity of 2,760 en. cent. The facial angle is 
 105". The brain weighed 73.5 ozs. 
 
 The vertical index in this specimen is platy- 
 cephalic, the horizontal brachy-cephalic. The 
 occipital plane is almost horizontal, the parietal 
 eminences extraordinarily developed. The facial 
 bones present an arrest of development ; the in- 
 ferior maxilla is square, excessively developed 
 and prognathous, the teeth are degenerate. These 
 points are interesting as showing excessive max- 
 illary, arrested facial and excessive cranial devel- 
 opment in the same subject. The association of 
 the defective structure in this specimen with dis- 
 ease is suggested by the fact that the subject had 
 suffered with caries of the spine. 
 
 The variations of type of the degenerate brains 
 of criminals and the insane, as shown by Bene- 
 dikt, Osier, Roussel, Lombroso, Parker and C. 
 K. Mills, embrace briefly : variations in number, 
 length and development of convolutions, the ques- 
 tion of length of gyres being of special impor- 
 
358 
 
 tance. Simplicity of type of gyres seems to be 
 indicative of degeneracy. Dr. C. K. Mills has 
 presented this subject in a very plain and com- 
 prehensive manner.^ The researches of this au- 
 thor will be quoted in detail when the present 
 paper is published in its entirety. 
 
 In one of Dr. I^ydston's specimens (Fig. 24), 
 the_ degeneracy of brain type is shown by the 
 shallowness of the. cranial fossse and feeble de-. 
 velopment of the ridges, lines and prominences 
 of the interior surfaces of the skull. In a gen- 
 eral way the same may be said of all the other 
 specimens of the series, those which are not im- 
 perfectly developed being excessively developed 
 in varying localities. 
 
 Criminal anthropologists lay great stress upon 
 the capacity of criminal crania. Tabular com- 
 parisons of large numbers have shown some very 
 interesting points. According to I,ombroso, the 
 maximum of cranial capacity is met with in 
 counterfeiters, the capacity in this class varying 
 in different localities, but with two exceptions 
 being greater in each locality than that of other 
 criminals. Murderers and brigands are next in 
 the scale. Thieves of the petty sort follow with 
 a mediocre capacity, while the lowest is found 
 among violators and incendiaries.- These esti- 
 mates are about what might naturally be expect- 
 ed in the various grades of criminality. The 
 type of criminality varies with the degree of in- 
 tellectual development, and the latter depends to 
 
 ■ Transactions of the American Neurological Association, 1886 
 
359 
 
 a certain degree upon physical cpnformation. 
 The tables of E. Ferri confirm I,ombroso's de- 
 ductions. He finds the greatest capacity among 
 those convicted of assault, the smallest among 
 pickpockets and professional assassins. Crimi- 
 nals who have been repeatedly convicted {reci- 
 divistes) present, according to Ferri, a smaller 
 cranial capacity and frontal diameter, with a 
 larger development of the jaws than the average 
 normal subject. ' The researches of Baroffio, Ri- 
 va, Troyski, Roussel, Corre, Biliakow, Manouv- 
 rier and others, are practically in accord with 
 Lombroso and Ferri. 
 
 As compared with the researches of such in- 
 vestigators as those mentioned, our observations 
 have been of a very general character, and we 
 have as yet been unable to obtain a sufiSciently 
 large series of measurements to permit of a tab- 
 ulated comparison of normal and criminal crania. 
 We have observed, however, many facts which 
 appear to us of great interest, drawn from the 
 study of criminals confined in a number of our 
 penitentiaries. 
 
 The most striking features of the criminal 
 skull as seen in American prisons, are the ten- 
 dency to brachy-cephalism and sub- microcephaly, 
 and the great frequency of cranial asymmetry. 
 As far as our observations go, they tend to show 
 that a degenerate type of skull is common among 
 criminals, and that the assertion of Lombroso that 
 the deviation of type, as far as the index is con- 
 cerned, is toward brachy-cephaly, is correct. The 
 
36o 
 
 broad head is usually associated with a relatively 
 low vertical inA&yL, plafy cephalie; the long head 
 with a high vertical index, oxi-cephalie, vilaich, 
 however, is more than compensated for by the 
 long transverse diameter in the one and the nar- 
 row transverse diameter in the other (Figs. 24 
 and 33), 
 
 The direction of degeneracy is modified by 
 racial characteristics. Thus in the case of the 
 Chinese, characterized by a relatively high in- 
 dex, the tendency of degeneracy seems to be in 
 the direction of a more pronounced brachy-ceph- 
 aly, although an occasional example of the op- 
 posite index is seen. The dolicho- cephalic type, 
 when degenerated, becomes in general more dol- 
 icho-cephalic, etc. 
 
 In considering the degree of degeneracy the 
 question of compensating increase or decrease of 
 diameter must be considered as affecting capaci- 
 ty. A glance at the original of Fig. 33 while 
 living would doubtless have suggested a capa- 
 cious cranium, but a measurement of the vertical 
 and frontal diameters puts an entirely different 
 complexion upon the status of the subject as in- 
 dicated by cranial capacity. A glance, at Fig. 
 24 shows a cranium which to a superficial ob- 
 server might appear to have considerable capa- 
 city. Yet it is ultra-brachy cephalic, and even a 
 proportionally exaggerated vertical diameter does 
 not redeem it from sub-micro cephaly. 
 
 A striking feature of the degenerate skull as 
 illustrated by many skulls in the habitual crimi- 
 
36 1 
 
 nal class is its peculiarly twisted confortnation. 
 The foftn suggests what might result if the skull 
 were taken while soft between the hands and_ 
 twisted in snch a manner that all points of ana- 
 tomical correspondence are thrown out of their 
 normal relations. The result would naturally 
 be an asymmetry in all diameters. Figs. 34 and 
 35 show this most admirably. 
 
 The researches of Dr. Talbot in the jaws of 
 the degenerate classes have been of extraordi- 
 nary interest, and are rendered even more inter- 
 esting by our joint observations of the jaws 
 of a large number of criminals. The types 
 of degenerate maxillary development are well 
 shown by the appended drawings ^prepared by 
 Dr. Talbot, and will be expatiated upon later on. 
 ■ t,ombroso, Ferri and Manouvrier claim cer- 
 tain peculiarities of development in the criminal 
 jaw. Exaggerated development, preeminently 
 among homicides, is the especial feature com- 
 mented upon by l,ombroso. .Ferri has found 
 the greatest diameter of the jaws among homi- 
 cides and petty criminals, the smallest among 
 professional murderers and pickpockets. The 
 jaws according to Ferri are not well developed 
 among the insane, s^ve those who are the sub- 
 jects of impulsive monomania. This does not 
 agree with Dr. Talbot's observations. 
 
 In our studies of criminals we have found that 
 the most marked variations from the average 
 normal type of cranial development occur among 
 the habituals. We have made no attempt to se- 
 
362 
 
 lect special cases bearing out this assertion, but 
 have studied each case as it has been taken at 
 random. We append a series of observations 
 upon criminals, selected by a convict orderly 
 from among the habituals and murderers in the 
 Joliet penitentiary. In reply to his inquiry as to 
 what kind of cases we wished to study, we re- 
 marked that we wished to see old-timers or ha- 
 bituals. He therefore selected the prisoners ac- 
 cording to their criminal, with an entire disre- 
 gard of their physical status, with the possible 
 exception of several who happened to be on sick 
 call. All complaints of subjective ailments were 
 verified by the resident medical officers. 
 
 We present the history and description of 
 eighteen of these, taken in regular order: 
 
 Obs. I. — White, male, American, aged 30 
 years. Has been committed twice for burglary. 
 Was first committed at the age of twenty-two, 
 since which time has been a confirmed criminal. 
 Hereditary influences as a possible cause of de- 
 linquency not probable. Intemperance is admit- 
 ted and is claimed to have had much" to do with 
 his moral degradation, and as he is markedly neu- 
 rotic, this is highly probable. Syphilis is denied. 
 Never experienced an injury until two years 
 ago, when he received a severe fall with contu- 
 sion of the head. This was followed by epilepsy, 
 severe headaches, insomnia, deafness, defective 
 vision in the right eye and pronounced right 
 hemiplegia. Hearing normal. Mentahty im- 
 paired. He is thin, anaemic and badly nourished. 
 
363 
 
 Was formerly right-handed but has acquired left- 
 handedness since the accident. 
 
 The jaws, especially the inferior, are quite 
 asymmetrical and the nose deflected, not from 
 traumatism. Features very asymmetrical. Ears 
 small, protuberant, pointed and asymmetrical, 
 the left being the larger and more prominent. 
 The septum nasi is thickened and greatly deflec- 
 ted. Cranium of medium development, of sub- 
 brachy- cephalic type and rafter shaped calvar 
 rium. Jaw, orthognathous. Occipital region 
 very prominent and asymmetrical, the protuber- 
 ance being markedly deviated to the left of the 
 median line. Pronounced asymmetry of parietal 
 development, the left eminence being very prom- 
 inent and the right perceptibly flattened. Palate 
 imperfectly developed with a V-shaped arch. 
 
 Obs. 2. — White, male, Irish, aged 27 years. 
 Sentenced for arson. Committed for the second 
 time, the first ofiense being robbery. Has led a 
 criminal life since childhood, being addicted to 
 petty and minor delinquencies for which he es- 
 caped punishment. Knows nothing of his pa- 
 rentage or family. Has never been addicted to 
 drink. Admits syphilis. Is thin, anaemic and 
 poorly nourished, says that he was never very 
 strong. Right-handed. No lameness or deform- 
 ity. Slightly deaf. Vision normal. Perceptive 
 faculties somewhat blunted and mental processes 
 sluggish. Is a melancholiac and sufiers from se- 
 vere headaches. Features noticeably asymmet- 
 rical. Nose perceptibly deflected and flattened. 
 
364 
 
 not ttaumaticaHy. Septum thick, crulnjpled and 
 on the right side enchondrQipatous, the right nos- 
 tril being occluded. The ears are peculiiarly de- 
 formed, the right being small, thick and crum- 
 pledj the left of medium size and very protuber- 
 ant, handle shaped. Cranium large, ultra- 
 brachy-cephalic, with platy- cephalic vertical in- 
 dex and resembling in its general outline the 
 skull shown in Fig. 33. To the left of the ver- 
 tex the calvarium is flattened, but the left parie- 
 tal protuberance is very prominent, the entire 
 left side bulging in outline. The right side is 
 flattened and the parietal prominence slightly 
 marked. The body of the occipatal bone is very 
 straight and flat, but the protuberance is dispro- 
 portionally prominent. The facial outline is or- 
 thognathous, the jaw being of a pronounced re- 
 treating type and very asymmetrical. Palatal 
 arch V-shaped. 
 
 Obs. 3 — White, male, American, aged 40 
 years. Serving second sentence for burglary. 
 Prior to first commitment had been sentenced for 
 numerous petty delinquencies and had been tried 
 on charges of burglary and acquitted on several 
 occasions. History shows a bad heredity. 
 Mother healthy, but father died of consumption 
 and a sister is subject to fits. Has been addicted 
 to liquor. Says that liquor is responsible for his 
 life of criminality (?). Contracted syphilis eigh- 
 teen years ago, which has troubled him off and 
 on ever since. General appearance Very fair, is 
 well nourished and of good color. Right-handed. 
 
365 
 
 No lameness or deformity, but plentifully sup- 
 plied with syphilitic scars. Is quite deaf and 
 vision is so defective that he reads with diflBculty. 
 Suffers from tinnitus aurium. The facial contour 
 of this man is very striking. There is such a 
 marked disparity and asymmetry of the two 
 sides of the face that it has the appearance of two 
 halves of faces of different sizes joined together, 
 and by a bad artisan. Nose deflected markedly 
 and septum twisted and mal-formed so that the 
 left nostril is completely blocked. The ears are 
 very asymmetrical and situated on different 
 planes, the right ear being much the smaller and 
 situated several lines higher than the left. 
 
 Cranium sub-micro cephalic and very asym- 
 metrical. The right side of the cranium is very 
 perceptibly flattened and the parietal prominence 
 feebly marked. The left prominence is very 
 marked. The forehead is low and retreating. 
 The narrow and contracted skull in this case is 
 directly noticeable, but the index is sub brachy- 
 celphalic on account of the markedly sloping 
 frontal region, which compensates in a measure 
 for the narrow transverse diameter. The facial 
 type is orthognathous. On examining the 
 mouth, a high palatal vault of partial V- shape, 
 with pronounced saddle contour on the right and 
 full curve on the left, are noted. There is marked 
 faucial and pharyngeal asjmmetry. There is a 
 lateral curvature, which accounts, in a measure, 
 for the pharyngeal and faucial deformity. 
 
 An interesting feature of this case is that the 
 
366 
 
 subject suffered from constant and severe head- 
 aches until fifteen years of age. They then 
 stopped, but were developed later in life by 
 liquor. Has had them steadily for the last fif- 
 teen months and is suffering from insomnia — 
 possible pachymeningitis syphilitica or alcohol- 
 ica suggests itself in this connection. 
 
 Obs. 4.. —White, male, German extraction, age 
 41. Serving time for murder. This case is 
 most interesting as an example of illogical dis- 
 pensation of law and of the physical basis of 
 crime. The subject is typically neurotic; hered- 
 ity bad, mother having died of cancer, and her 
 branch of the family being subject to various 
 forms of nervous disease. Cause of father's 
 death unknown, but he was known to have been 
 a dissolute character. The subject under consid- 
 eration was struck in the head with a hatchet 
 when a child. Since the age of eight he has had 
 epilepsy, the filts occurring sometimes every 
 three or four days and at others at very long in- 
 tervals. Has at times escaped them almost en- 
 tirely for a year or two and has then brought 
 them on by indulgences in liquor, to which he 
 was addicted; subject to violent paroxysms of 
 fury at all times under slight provocation; has 
 been committed to the asylum several times; his- 
 tory would seem to point to the furor epilepticus 
 as a cause for the murder which this man com- 
 mitted. A noteworthy fact is that this man is 
 very artistic and spends much of his time in mak- 
 ing artificial flowers. Syphilis is denied and no 
 
36? 
 
 evidences of the disease are perceptible; subject 
 is pale and anaemic; is right-handed; vision nor- 
 mal, but is quite deaf in left ear; no deformity or 
 lameness. 
 
 Features very asymmetrical, the right side of 
 the face being much larger than the left. The 
 nose is markedly deflected to the left, the septum 
 being thickened, crumpled and deviated in the 
 same direction. Ears very asymmetrical, the 
 left being the larger, higher situated and badly 
 formed. The right ear is very protuberant^ im- 
 perfectly developed and crumpled. 
 
 Cranium of medium size, quite round and 
 dome-shaped. Vertical index oxy-cephalic. In- 
 dex markedly brachy-cephaliq. The skull 
 shows the same asymmetry as the face, the right 
 side being disproportionally developed and the 
 right parietal eminence very large. The left side 
 is flattened and the parietal prominence barely 
 distinguishable. The arch of the jaw in this 
 case is normal, but the development of the palate 
 is defective and the rami defective in develop- 
 ment. 
 
 Obs. 5. — White, male, American, aged 37. 
 Committed for the third time for burglary. Fam- 
 ily history unknown save as regards mother, 
 who died of cancer. Has had syphilis and has 
 been intemperate since youth. Was hurt in a 
 railroad accident in 1881. Prior to this time he 
 had worked tolerably steadily, but since the ac- 
 cident he had drank harder than ever and had 
 developed an uneasy, restless disposition, which 
 
368 
 
 made honest labor irksome and criminality at- 
 tractive. General appearance fair, is well nour- 
 ished. 
 
 Right-handed and has no lameness or deform- 
 ity. Complains of tinnitus in the right ear, re- 
 ferable he thinks to the railroad accident. Vision 
 and hearing normal. Pace very asymmetrical, 
 the right side being much the larger. Right 
 
 Fig. I. 
 
 malar prominence exceptionally marked. Left 
 eye so disproportionally small as to attract the 
 attention of the casual observer. Nose deformed 
 and septum deviated to the left, but as the organ 
 has been broken this point is not of great impor- 
 tance. Ears very small, crumpled and closely 
 
369 
 
 set, the left being much the larger and lower. 
 
 The skull is sub- micro cephalic in capacity, 
 oxy- cephalic in its vertical and brachy- cephalic 
 in its cranial index. The right half of the cra- 
 nium is the smaller, with the exception of the 
 right occipital and mastoid regions, which are 
 excessively developed. The left parietal emi- 
 nence is very prominent. None of the aberra- 
 tions noted were referable to the injury, except 
 possibly the nasal deformity. Tte superior max- 
 illa is V-shaped. 
 
 Obs. 6. — White,- male, Irish, aged 50. Serv- 
 ing a five-year sentence for horse stealing. Served 
 a six-year sentence twenty years ago for the same 
 offense. Acknowledges repeated offenses for 
 which he has never been punished. 
 
 Family history not clear, but says that father 
 died of old age and mother of "fever sore" on 
 her leg; has been intemperate since youth and 
 has bad severe syphilis; has had severe small- 
 pox, with resulting great disfigurement, not 
 shown in the cut; general appearance fairly 
 healthy; is very awkwardly built, "slab-sided," 
 as the orderly expressed it; his gait is of the 
 shuffling or shambling variety; is right-handed ; 
 is lame as a consequence of syphilis; hearing 
 normal; vision has been impaired for many years; 
 features very asymmetrical; the face is long and 
 narrow and the chin pointed, but not progna- 
 thoiis; the left eye much smaller than the right, 
 not properly shown in cut and the entire left side 
 of the face imperfectly developed; the nose is 
 
37° 
 
 slightly flattened and the septum deviated to the 
 left, the nostril being nearly occluded; the ears 
 are asymmetrically developed, the left being the 
 larger, most thickened, irregular and deformed; 
 cranial index brachy-cephalic; vertical index 
 platy-cephalic; the large size and disproportion- 
 ate breadth of the cranium are very noticeable. 
 
 Fig. 2. 
 
 The cranium is asymmetrically developed. 
 The. right frontal eminence is very prominent. 
 The left parietal prominence is very large. The 
 calvarium is depressed at the right of the vertex. 
 There is also a well-defined depression at. the 
 bregma. The right occipi to- mastoid region is 
 excessively developed. The generally twisted 
 appearance of cranium already alluded to is well 
 
371 
 
 shown in this subject. The jaws are saddle- 
 shaped and the palate irregular and unevenly 
 developed. 
 
 The actions and garrulous conversation of this 
 subject showed him to be a paranoiac of a pro - 
 nounced type. • A glance at the physiognomy of 
 this man, as shown in Fig. 2, is suggestive to the 
 neurologist in this connection. 
 
 Fig- 3- 
 
 Obs. 7. — White, male, American, age 53. 
 Sentenced for horse stealing. Had several sen- 
 tences elsewhere and is serving a second term in 
 Joliet. Family history not obtainable; had been 
 occupied in farming and horse dealing, alternat- 
 ing with horse stealing most of his life; no his- 
 tory of syphilis or alcoholism; general appear- 
 
372 
 
 ance bad, pallor and cachexia being pronounced; 
 is right-handed; presents no lameness or deform- 
 ity; vision and hearing normal; the features are 
 very asymmetrical; the nose is quite straight, 
 but the septum is deviated to the left, producing 
 partial occlusion; the eyes are small, deep-set and 
 somewhat of the slanting type peculiar to the , 
 Mongolian. This peculiar slant is most evident 
 upon the right side; the right eye is also smaller 
 and on a higher plane than the left. The differ- 
 ence in development of the two sides of the face 
 is very marked, the right being the smaller. The 
 left half of the inferior maxilla is much longer 
 and straighter than the right. Hair has been 
 very gray since quite a young man. The 
 right ear is of moderate size, of fair form and 
 very closely set — the left is flattened, flabby and 
 protuberant, "handle- shaped" and lower than 
 the right. 
 
 Cranial capacity is raeso-cephalic and cranial 
 index subb-rachy-ceph^ic. The vertex is point- 
 ed, oxy -cephalic with marked depression upon 
 each side of the median line. The left occipito- 
 mastoid region is exceedingly prominent, the 
 right being deficiently developed. The left pa- 
 rietal eminence is very prominent and the right 
 poorly marked. Semi- V-shaped superior maxil- 
 la, lower maxilla well developed. The subject 
 is an apt illustration of the irony of fate and the 
 unintelligent administration of law. He is a par- 
 anoiac and affected with monomania of the re- 
 ligious delusional type. At times imagines him- 
 
373 
 
 self Jesus Christ. He preaches in his cell to 
 imaginary spirits, over which he imagines that 
 he has control, and regales his fellow-convicts 
 with an occasional sermon on their wicked ways. 
 His conversation is characterized by egotistical 
 garrulity; is particularly desirous of impressing 
 us with the idea that his magnificent head was 
 designed for some great purpose which "died 
 a-bornin'." I^ike the preceding case, the physi- 
 ogonomy of this subject is to the alienist con- 
 firmatory of the foregoing remarks. Fig. 3. 
 
 Obs. 8. — White, male, Swede, aged 30; up for 
 larceny, second conviction and acknowledges 
 offenses for which he was never punished; has 
 worked at different trades and occupations, but 
 labored steadily until he received the injury here- 
 with described. Family history obscure; mother 
 had some skin disease of a severe type; has been 
 a moderate drinker; syphilis is denied; general 
 condition fair; is somewhat anaemic; is right- 
 handed; some years ago was caught in a railroad 
 smash- up and sustained a fracture of the skull; 
 several years ago had his arm caught in machin- 
 ery and received a compound fracture of the fore- 
 arm; was in hospital seven months. 
 
 Hearing greatly impaired; vision normal. The 
 face is very asymmetrical, the right side being 
 the better developed, and the right half of the 
 jaw especially prominent; nose of normal type; 
 no deflection of septum; ears very asymmetrical, 
 the left being larger and more closely set and de- 
 cidedly pointed; the right is of medium size and 
 
374 
 
 normal outline, but situated lower than tte left; 
 jaws square and well formed, but the hard palate 
 is very asymmetrical; left palatal process much 
 broader than the right. 
 
 The cranium is large, horizontal index brachy- 
 cephalic; vertical index pi a tj cephalic; the 
 frontal region is asymmetrical, the right promi- 
 nence bulging decidedly; the parietal prominen- 
 ces are exceptionally well marked, the left being 
 much the larger; the entire right half of the 
 cranium is disproportionately well developed, 
 with the exception of the parietal eminence; de- 
 pression at site of old injury in parietal region. 
 This subject, like the foregoing, should not be in 
 prison. He is a paranoiac — has delusions of per- 
 secutions, quarrels with imaginary enemies in his 
 cell and has on one occasion attempted suicide 
 by cutting his throat. 
 
 Obs. g. — White, male, American, aged 59. 
 Fourth commitment; offense, horsestealing; com- 
 mitted three times before on ' 'general principles;" 
 does not deny that said commitments were for 
 the public good; heredity bad; father died of 
 cancer of the stomach, mother was insane and 
 died of consumption; says he does not give a 
 ' 'fake' ' history for the purpose of exciting sym- 
 pathy — says his motto is: "Sympathy be d — d!" 
 Has never been intemperate — :says that he feared 
 to drink on account of the insanity in his blood; 
 syphilis is denied; had his head cut by a rock in 
 Chester penitentiary years ago. 
 
 General appearance quite bad; is anaemic and 
 
375 
 
 poorly nourished; was originally right-handed, 
 but on account of lameness in joints of right 
 hand, has acquired the use of left; left arm is 
 also lame from injury; joints are generally crip- 
 pled by arthritis deformans; vision presbyopic; 
 hearing normal. 
 
 The face is very asymrhetrical, the right side 
 being the larger; nose malformed and deflected 
 to the right; septum deflected and presents a 
 large perforation; ears of average development 
 and symmetry; right ear a little lower than left; 
 dental arches normal but inferior maxilla greatly 
 flattened at angles and quite asymmetrical; cra- 
 nium of average development; sub -br achy -cephal- 
 ic index. Since the injury to his head this man 
 states that he has "wild spells" when his mind 
 is aberrated. These "spells" follow severe head- 
 aches. 
 
 This man, although uneducated, is quite tal- 
 ented, very bright and logically argumentative. 
 His moral obliquity is evidently due to a bad 
 heredity and lack of mental discipline; Under 
 more favorable auspices he would have made a 
 valuable member of society. 
 
 Obs. 10. — White, male, German, age 31. 
 Serving sentence for grand larceny. Has been 
 in prison five times, this being his third term in 
 Joliet. Heredity bad; father healthy but intem- 
 perate, quarrelsome and subject to violent fits of 
 passion, which made him a "dangerous custom- 
 er' ' at times. An only brother, though honest, 
 is intemperate and a ne'er-do-well. Paternal 
 
376 
 
 grandfather said to have been a martyr to scrof- 
 ula; has not been intemperate; syphilis denied, 
 but states that he was very scrofulous as a child; 
 extensive scrofulitic scars visible on neck and 
 face; is still quite sickly, looks cachectic and 
 badly nourished; is right-handed; no lameness 
 or deformity; vision and hearing normal; facial 
 asymmetry quite marked, the right side being 
 much the larger. The nose is markedly deviat- 
 ed to the left and the septum much deformed 
 and deviated to the right, producing almost com- 
 plete occlusion. The left palpebral fissure much 
 smaller than right; left eye perceptibly smaller 
 than right; ears fairly symmetrical and well 
 formed; cranium very large, index ultra-brachy- 
 cephalic, vertical index platy-cephalic; fair de- 
 gree of symmetry; left parietal eminence very 
 prominent. 
 
 This subject has been affected with severe 
 stammering since childhood; is frequently under 
 treatment for severe cephalalgia and has had 
 since childhood what he terms "dumb spells," 
 which we interpret as mental depression, proba- 
 bly associated with disturbed circulation. 
 
 The inferior maxilla in this case was poorly 
 developed, orthognathous and very pointed; up- 
 per jaw presents a marked saddle-shaped arch. 
 
 Obs. II. — White, male, Swede, age 27. Ac- 
 knowledges habitual criminality, though serving 
 first sentence; is in for highway robbery; hered- 
 ity not shown; mother died of dropsy, and father 
 of pneumonia; intemperance and syphilis both 
 
377 
 
 admitted; no history of injury; general appear- 
 ance fair; right-handed; somewhat lame in left 
 leg — thinks that always was weak in this limb; 
 vision and hearing normal; face asymmetrical, 
 left side much the larger — left side of the lower 
 jaw being extraordinarily prominent; left palpe- 
 bral fissure and eyeball much larger than the 
 right; nose deflected to right, with marked cor- 
 responding deviation of septum; ears very large, 
 long, pointed and closely set; cranium sub-micro- 
 cephalic with sub-brachy-cephalic index; oxy- 
 cephalic vertical index. 
 
 Development of average symmetry. In his 
 general characteristics this subject is a weakling 
 and the crime for which he is doing time is in- 
 consistent with his physique. 
 
 The jaws in this case are markedly deformed, 
 the upper presenting a semi-V and the lower a 
 marked saddle. 
 
 Obs. 12. — White, male, half-breed Egyptian, 
 ^gs 35- Serving sentence for horse stealing. 
 Says that it is his first commitment, but his 
 statements are contradictory and he has either 
 been committed before or has led a criminal life 
 without punishment; the family history is im- 
 perfect, as he was born in Egypt of a native 
 mother and an American father. One brother is 
 known to be insane but not criminal; has drank 
 periodically after he has had one of the "fits, "to 
 be described; syphilis denied; when quite a 
 young man he enlisted in the American navy 
 and served for some years; was finally dis- 
 
378 
 
 charged for disability, having been sunstruck 
 while in the foretop, falling to. the deck and sus- 
 taining severe head injuries, the scars of which 
 still remain. After his discharge he suffered 
 from epileptic fits at intervals of from a few days 
 to a few weeks; is still suffering from these at- 
 tacks and from severe headaches; criminal ca- 
 reer began since injury (?). 
 
 General appearance excellent; right-handed; 
 no lameness or deformity; head badly scarred 
 from old wounds; vision and hearing normal; 
 face fairly symmetrical; eyes equally developed; 
 right side of face slightly the larger; nose not 
 deformed, but septum deviated to the right with 
 partial occlusion of nostril; ears very small, close- 
 ly set and crumpled. 
 
 Cranium large and index sub-brachy-cephalic; 
 development asymmetrical; right side much the 
 larger; occiput unequally developed, right half 
 being very prominent, left parietal eminence 
 very large as compared with the right ; j aws normal . 
 
 Degeneracy of physical type is not very pro- 
 nounced in this subject. We consider the histo- 
 ry of injury a very important point. 
 
 Obs. 13. — White, male, American, aged 26. 
 Committed for the first time for forgery; ac- 
 knowledges petty delinquencies before sentence 
 for forgery; family history bad; father delicate, 
 scrofulous and affected all his life with sore eyes; 
 mother died of consumption; has been a steady 
 but moderate drinker; syphilis denied; general 
 appearance good; right-handed; vision and hear- 
 
379 
 
 ing normal; face quite asymmetrical, left half 
 much the larger; left eye much smaller than the 
 right; nose straight and symmetrical, but sep- 
 tum markedly deformed; ears symmetrical, but 
 very small and closely set; cranium of medium 
 size and asymmetrical; index meso -cephalic; 
 left occipito parietal region disproportionately de- 
 veloped; right half of occiput flattened; protu- 
 berance situated seven mm. to the left of the 
 median line; left parietal eminence very prom- 
 inent. 
 
 Facial development marked ; pronounced prog- 
 nathism of inferior maxilla. 
 
 Obs. i^. — White, male, Irish (typical imported 
 criminal), aged 54; in for bank robbery on long 
 sentence. This is one of the toughest specimens 
 that ever broke into jail; he has done time in a 
 number of prisons in America and served sever- 
 al sentences in Kngland before being exported 
 to this country by the generous British authori- 
 ties; family history bad; father intemperate; 
 both parents died of consumption while subject 
 was very young; one brother died of consump- 
 tion; has always been a hard drinker; has had 
 syphilis; general appearance very bad, is thin, 
 sallow and badly nourished; has a chronic cough; 
 is somewhat crippled by rheumatism, otherwise 
 no lameness or deformity; hearing normal; vision 
 impaired by age; face very asymmetrical, left side 
 being disproportionately developed; left eye per- 
 ceptibly the larger; right frontal prominence, 
 however, is bulging and prominent; nose badly 
 
38o 
 
 deformed, septum enchondromatous and deflect- 
 ed and so badly deformed that it is visible ex- 
 ternally; ears very prominent and pointed, the 
 left is badly crumpled. 
 
 Cranium sub micro-cephalic; index sub-doli- 
 cho cephalic; fairly uniform development on 
 each side, but right side much the larger. 
 
 Lower jaw small, prognathous and left half 
 much the larger; upper jaw large with low arch. 
 
 Obs. ij. — White, male, Dane, aged 42; serv- 
 ing life sentence for murder; family history good; 
 has never been intemperate and until the com- 
 mission of the crime for which he is under sen- 
 tence he was an honest hard-working farmer, 
 distinguished only by a violent temper; the 
 murder for which he is doing ' time was the re- 
 sult of a quarrel; has never had syphilis; gener- 
 al appearance excellent; right-handed; vision 
 and hearing normal; no lameness or deformity; 
 features asymmetrical, the preponderence of de- 
 velopment being on the left side; nose deformed 
 and deflected to the right; septum shows a cor- 
 sponding deflection; ears asymmetrical, the right 
 being pointed, closely set and of medium size, 
 the left large, protuberant and lower set than 
 the right. 
 
 Cranial capacity meso cephalic; index sub- 
 brachy- cephalic; pronounced asymmetry, the 
 left side being the larger, the development of the 
 left occipitoparietal region being especially dis- 
 proportionate; the right parietal eminence is 
 much larger than the left; the forehead is low 
 
38 1 
 
 and retreating; frontal prominence slightly 
 marked on left side and absent on right; upper 
 jaw excessively developed and prominent; arch 
 semi-V shaped; lower jaw prognathous and 
 heavy and disproportionately developed on the 
 left side. . 
 
 Obs. i6. — White, male, American, age 42. 
 Serving a life sentence for a murder which had 
 been committed in a quarrel. Prior to this crime 
 had been an industrious farmer. Family history 
 unknown; alcoholism and syphilis denied; gen- 
 eral appearance fair; right-handed; no lameness 
 or deformity; is lame at times from rheumatism; 
 vision impaired; hearing normal; nose well 
 shaped; no deflection of septum; ears small, thin, 
 and closely set; cranium above the average ca- 
 pacity and fairly symmetrical; index brachy -ce- 
 phalic; some flattening at the bregma and in the 
 occipital region; upper jaw excessively devel- 
 oped and partial V-shape; lower jaw massive 
 and prognathous. 
 
 Obs. 17. — White, male, age 17. This is one 
 of the most melancholy cases which have come 
 under our observation. The prisoner, a bright, 
 handsome boy, having been sentenced for life 
 for a murder committed while under the influ- 
 ence of liquor. The lad was raised on a farm 
 and his family history is unexceptionable. Ha- 
 bitual intemperance denied; no history of syph- 
 ilis; general appearance excellent, but subject is 
 plainly neurotic; is right-handed; no lameness 
 or deformity; vision and hearing normal; facial 
 
382 
 
 development quite symmetrical save a little ex- 
 cess of development of the right half of the infe- 
 rior maxilla; nose slightly deviated, with some 
 deflection of septum; ears large and protuberant 
 (oreilles d anse); capacity of cranium meso- 
 cephalic. Practically no asymmetry, the form 
 of the cranium being better than^the average 
 normal type. The lower jaw is asymmetrical as 
 above noted and the upper jaw presents a partial 
 V. 
 
 Obs. i8. — White, male, American, age 6i, do- 
 ing time on fourth commitment. Last offense 
 burglary and arson. Family history unknown. 
 Was evidently a vagabond in early life but was 
 never convicted of crime and he states was never 
 delinquent until 1871, since which time he has 
 been in jail off and on — in fact for the greater 
 part of the time. Intemperance and syphilis is 
 denied. Drifted into the army in his early man- 
 hood and was several times wounded. Is lame 
 from a saber cut in the left leg and head shows 
 a large scar from a saber cut received in '63. 
 
 General appearance excellent; vision and hear- 
 ing normal; right handed; has been gray for 
 many years; face fairly symmetrical; nose slight- 
 ly deflected, but septum well formed; ears well 
 formed; cranial capacity meso-cephalic; index 
 brachy-cephalic; asymmetry not very pro- 
 nounced; left parietal , eminence disproportion- 
 ately prominent; occipital region exceptionally 
 flat; mastoid prominences excessively developed; 
 
383 
 
 normal arch in upper jaw; lower jaw very prom- 
 iment, heavy and prognathous. 
 
 The foregoing cases might be multiplied from 
 the material at our command, but they are amply 
 sufficient as indicative of what may be found 
 among the degenerate classes met with in our 
 American prisons. A glance at these cases plain- 
 ly shows the physical degeneracy, and often the 
 bad heredity of the subjects. A noteworthy fact 
 is that the cases which most nearly approximat- 
 ed the normal type of development were in 
 sporadic criminals, of which the young lad (Obs. 
 17) is an example. It will be noted that a num- 
 ber of the series were of foreign birth. As be- 
 fore remarked, it will be found that the most 
 markedly aberrant types are seen in the imported 
 criminal. This is instructive as explanatory of 
 some of the apparently dogmatic claims of Eu- 
 ropean criminal anthropologists. We have 
 found that left-handedness is not so common 
 among American and foreign American crimin- 
 als as has been claimed by these authorities. 
 Among 400 criminals in the Joliet penitentiary 
 but one per cent, were found to be left-handed. 
 Dr. Lydston found but about two per cent, among 
 the criminals in the New York City prison. Ob- 
 viously a much larger number of observations 
 would be necessary to determine this point. 
 
 Regarding deviations of the form of the nose, 
 ears, etc., we are well aware that these aberra- 
 tions of development are frequent among normal 
 individuals, or at least those reputed normal. 
 
384 
 
 We do not believe, however, that so large a pro- 
 portion is observable in normal as in criminal 
 subjects. It is to be remembered, moreover, 
 that degeneracies of development are present in 
 many otherwise normal subjects, whose morale 
 is such that no delinquencies have occurred. We 
 have nothing to do with the co-relation of crim- 
 inal tendencies with osseous aberrations save in 
 a general way, i. e. , we advance only the prop- 
 osition that cceteris paribus, cerebral degeneracy 
 is to be expected in cases where the osseous 
 framework is markedly aberrant. The same in- 
 fluences govern the development of both nerve 
 and bone tissue, hence like results are to be 
 looked for. 
 
 The history of alcoholism in criminals is to be 
 studied very carefully. " I was drunk when I 
 did it," is the old familiar plea, and to be taken 
 cum grano salts. Alcohol often develops inherited 
 or innate acquired tendencies; seldom, in our 
 opinion, is it a cause of critmnaXiiy, per se. It 
 is the touchstone — the crucial lymph — that brings 
 out the inherent infection of madness, crime or 
 bestiality. Heredity is the latent power, and 
 alcohol the potential energy that drives the ar- 
 row to the mark. 
 
 Very little has been written upon the subject 
 of aberrant development and asymmetry of the 
 skeleton. In looking up this subject a few years 
 ago in the medical library at Washington, only 
 twenty-four cases could be found in foreign and 
 American literature. The only work treating 
 
385 
 
 upon this subject has lately been issued by Dr. 
 Sutton, of England, and this but elementary in 
 character. It is a singular fact that, in the study 
 of the defective classes, the attention of scientists 
 has been almost wholly confined to the study of 
 the brain. The most interesting portion of the 
 subject, asymmetry of development of the osse- 
 ous framework, has been almost entirely neglect- 
 ed. The study of the development of the bony 
 structure through the medium of the defective 
 classes, opens up a field for investigation which 
 is decidedly interesting. That the brain is de- 
 fective in the flotsam and jetsam of humanity, 
 has come to be generally accepted. The question 
 now is, "Does a defective brain influence the 
 development of the tissues of the body, or is it 
 coincidental with defective development in gen- 
 eral, and if so, to what extent? " We must as- 
 sume that if the tissues in one part of the body 
 are affected by faulty nervous structure, the tis- 
 sues in other parts may also be affected. We 
 must also a.ssume that if the tissues on. one side 
 of the body are arrested in their development, as 
 a consequence of trophic derangement, the tis- 
 sues of the opposite side may also be arrested or 
 excessively developed from the same cause. It 
 is more difiBcult to observe this asymmetry of de- 
 velopment of the body in general, because of the 
 distance of the parts from each other, than to ob- 
 serve the inequalities of the cranium and maxil- 
 lae. Here we have the lateral halves in such 
 close proximity that even a casual glance by an 
 
386 
 
 accustomed eye will recognize tte smallest devi- 
 ation in the bones of the head, face and jaws. 
 We would naturally, therefore, select the crani- 
 um and maxillse for an accurate examination. 
 
 In the degenerate classes in general, there is a 
 certain degree of similarity of aberrations of type 
 of cranial development. In idiots and the insane, 
 as well as in the habitual criminal, we observe 
 micro cephalic as well as macro-cephalic crania. 
 In such cases the jaws may become well devel- 
 oped or arrested, according to the degree of the 
 development of the skull, although sometimes 
 independent of it. Asymmetry is very marked 
 -in these individuals, especially in the hereditary 
 and habitual criminal. 
 
 Although prepared to find a goodly proportion 
 of atypical conformations of the jaws and teeth 
 among criminals, our observations gave results 
 which were a little surprising. 
 
 There were 477 criminal subjects examined, of 
 whom 468 were males and 9 females. Of the 
 whole number 3 were Chinese, 18 were negroes, 
 and the remainder were whites, the latter repre- 
 senting many nationalities. 
 
 The accompanying table shows the diflFerent de- 
 formities of the jaws and teeth that were found. 
 
 In the majority of the cases the jaws of the 
 negroes were well developed. One had a partial 
 V-shaped arch, one a saddle, one a V, and in 
 one the left body of the lower jaw was found to 
 be much smaller than the right. The bones of 
 the head and face were also well developed. The 
 
387 
 
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 IBijjBd: 
 
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 padBqs-A 
 
 2" " & ' 
 
 ■UnBA 
 
 
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 VO 
 
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388 
 
 three Chinese were all sub-microcephalic, with 
 very small jaws, and two of the three had saddle- 
 shaped arches. It is worthy of note that the nine 
 females examined had large and well- developed 
 jaws, with normal arches. 
 
 In no part of the osseous system is arrested 
 and excessive development so conspicuous as in 
 the superior and inferior maxillae. In this re- 
 gion, therefore, we would naturally expect to 
 meet with the aberrations of degeneracy. The 
 reason for this lies in the fact that, while the in- 
 ferior maxilla is developed independently of the 
 other bones of the skeleton, and attains its nor- 
 mal size by exercise, the superior maxilla, being 
 a fixed bone, is dependent upon the various in- 
 fluences which govern ossification of the bones 
 at the base of the skull, and determine whether 
 such ossification shall be defective, excessive or 
 normal. Some of the causes of aberrant devel- 
 opment are inflammation of the parts in utero, 
 hereditary taints, eruptive fevers and other con- 
 stitutional diseases. 
 
 It is a singular fact that most of the deformi- 
 ties of the jaws and teeth are confined to the su- 
 perior maxilla. When deformities of the inferior 
 maxilla occur, they consist in either excessive or 
 arrested development of the bone, while irregu- 
 larities of the lower teeth are always due to,local 
 causes, such as the influence exerted by the ir- 
 regular teeth on the upper jaw when coming in 
 contact with them in the act of mastication. De- 
 formities of the jaws, as already obser\'ed, are 
 
389 
 
 more noticeable to the casual observer than de- 
 formities of other osseous structures, because 
 they are in closer proximity to each other than 
 the outlines of the lateral halves of the rest of 
 the body, and because any deviation from the 
 normal occlusion of the teeth can be detected at 
 a glance. 
 
 The deformities of the jaw proper which we 
 have observed in the criminal classes are fixed 
 and definite in character and few in number, 
 while those of the alveolar processes and teeth 
 are numerous and variable. 
 
 The deformities of the jaw proper consist of 
 excessive or arrested development of one jaw, 
 while the other may be normal, or, one may be 
 over-developed and the other stunted. Some- 
 times the right side of one jaw will be normal, 
 while the left side will be either excessive or ar- 
 rested in developinent. In other cases the two 
 sides will present different forms of development. 
 Again, one may frequently observe a lower jaw 
 with a normal body, while the rami are arrested 
 or excessively developed, or the reverse may be 
 found, z. e., normal rami, with an arrested or ex- 
 cessive development of the body. 
 
 Fig. 4 illustrates the condition of excessive de- 
 velopment of the upper jaw, as seen in Obs. 14. 
 The jaw, alveolar process and teeth protrude to 
 such an extent that when the jaws are closed, 
 the individual is unable to close the lips. 
 
 Pig, 5 illustrates excessive development of the 
 body of the lower jaw, as seen in Obs. 13-18, 
 
39° 
 
 and in one of the negroes. This deformity is 
 called an ' ' over-bite. ' ' The lower teeth protrude 
 and shut outside the upper, which is the reverse 
 of normal occlusion. 
 
 Fig. 6 illustrates arrest of development of the 
 rami of the jaw, as seen in Obs. 4. The borders 
 of the alveolar processes, which contain the teeth, 
 are not parallel, and as a result, when the molaris 
 make their appearance at the twelfth year, the 
 anterior part of the jaw is forced open. 
 
 Fig, 4. 
 
 Fig. 7 illustrates arrested development of the 
 superior maxilla, producing a deformity similar 
 to that seen in Obs. 13 and 18. There is no 
 protrusion of the anterior superior alveolar pro- 
 cess and teeth, owing to the absence of the germs 
 of the lateral incisors and bicuspids, hence these 
 teeth are wanting. The result is that all the su- 
 perior teeth that are in place, shut inside the lower 
 teeth. When arrest of development of the supe- 
 
391 
 
 rior maxilla takes place, and all the teeth are 
 present, two forms of deformity of the jaws and 
 teeth are always observed. The V-shaped arch 
 (Fig. 9), as seen in Obs. 5 and 18, and one of 
 the negroes; and the saddle-shaped arch (Fig. 
 8), as seen in Obs. 6, 10 and 18, and also in 
 one of the negroes. The V-shaped arch is al- 
 ways contracted anterior to the cuspid teeth, 
 while in the saddle-shaped arch the arch is con- 
 tracted posterior to them. 
 
 Fig- 5- 
 
 These peculiar deformities commence to form 
 at about the eighth year, i. e., these deformities 
 are produced while the permanent teeth are erupt- 
 ing. The reason for this formation is that the 
 long diameter of the jaw is not large enough to 
 contain the long diameter of the teeth. The pe- 
 culiar variety formed depends upon the time and 
 order of the eruptions. It frequently happens 
 that the teeth upon one side will erupt in their 
 natural manner and at the proper time, in which 
 
392 
 
 case the jaw and teetli upon that side will be nor- 
 mal. The other side, owing to premature extrac- 
 tion on the one hand, or on the other" to delay in 
 removing the temporary teeth, will form either a 
 semi-V-shaped arch (Fig. lo), as seen in Obs. 
 I, 2, 3, 7, II, 15 and 16, or a semi- saddle- shaped 
 arch (Fig. 1 1), as seen in Obs. 3, which had a 
 semi-V on one side and a semi- saddle on the 
 other. 
 The foregoing illustrations represent the types 
 
 •^j-v- 
 
 
 ^ 
 
 Fig. 6. 
 
 of aberrant development of the jaws and teeth, 
 as met with in the degenerate classes, and can 
 be readily verified by even a superficial examina- 
 tion of the criminal classes. As far as their ac- 
 curacy as illustrative types is concerned, they 
 are fairly representative of the various tj'pes of 
 deformities as outlined by Dr. Talbot, from a 
 careful study of nearly 4,000 irregularities of the 
 teeth. 
 
 It is our fortune to be able to present in this 
 
393 
 
 paper a series of illustrations of specimens show- 
 ing tlie aberrant types and asymmetry found in 
 degenerate skulls, and especially those of crim- 
 inals. These specimens are exceptionally inter- 
 esting from the fact that they have not been se- 
 lected from among a large number, but have been 
 picked up here and there by non- scientists solely 
 for their morbid and historic interest, having sub- 
 
 Fig. 7. 
 
 sequently fallen into Dr. I,ydston's hands quite 
 by accident. It is worthy of comment that even 
 the remarkable series depicted in I^ombroso's 
 " Atlas " does not present such markedly aber- 
 rant types as this comparatively small series of 
 studies; indeed, a search among several thousand 
 skulls would not be apt to bring to light such 
 peculiar types of conformation as the crania 
 which we present. The illustrations are from 
 photographs, and are exceptionally accurate. 
 
 The specimen first to be described is one of the 
 most interesting crania which we have had the 
 
394 
 
 privilege of studying. The subject was a negro 
 criminal of the petty class, who spent most of his 
 time in correctionary institutions. As might be 
 inferred from the extremely degenerate type of 
 cranial development which is here exhibited, he 
 was of a very low grade of intelligence. After 
 a very precarious existence, this negro committed 
 suicide. 
 
 Fiff. 8. 
 
 In viewing this skull from the front, one is at 
 once struck by the immensely powerful maxillary 
 and malar development, as contrasted with the 
 remainder of the cranium. The orbits are rela- 
 tively very capacious. The superior maxilla is 
 relatively poorly developed, at least as compared 
 with the lower jaw. Rarely, indeed, is such an 
 inferior frontal development found associated 
 with such a pronounced facial development. 
 
395 
 
 As will be seen in connection with the speci- 
 men of brachy- cephalic degeneracy shown in 
 
 
 \# 
 
 b' 
 
 ■ 1 t 
 
 Fig. 10. 
 
 FigS- 33i 34' 35> ^^^ frontal development in this 
 
396 
 
 narrow type of a skull may be vastly better than 
 some specimens with a decided tendency to the 
 brachy- cephalic type. The skull at present un- 
 der consideration is the most marked specimen 
 of the dolicho- cephalic cranium which we have 
 seen. As the horizontal index in this case is 
 59.9, the extreme variation, according to Isaac 
 Taylor and others, being from 58 to 98, the ex- 
 treme type of this skull is at once obvious. 
 
 Fig: II. 
 
 On viewing this skull laterally^ its strong sim- 
 ilarity to the anthropoids is very striking. This 
 is especially marked with respect to the develop- 
 ment of the mastoids and the occipital protuber- 
 ance ; the position of the latter is quite an an- 
 omalous ^one, and the occipital bone is almost 
 horizontal. Despite its extraordinary develop- 
 
397 
 
 ment, the occipital is relatively small, both trans- 
 versely and in its vertical measurement. The 
 distance from the posterior border of the foramen 
 magnum to the superior occipital angle is only 
 103 mm. 
 
 On contrasting with any of the other crania of 
 the series, the relative shortness of the occiput 
 is very noticeable. For example. Fig. 22, which 
 is a rather small specimen, distinguished rather 
 
 Fig. 12. — Front view of extreme dolicho-cephalic cranium. 
 
 by the symmetry than by the extent of its devel- 
 opment, shows an occiput measuring 130 mm. 
 from the foramen magnum to the superior angle 
 of the occipital bone. 
 
 Fig. 14 shows the inferior surface of this doli- 
 cho-cephalic specimen, and brings out the mas- 
 sive development of the processes and muscular 
 attachments at the base of the skull. It is evi- 
 dent that the muscles of the neck in this case 
 
398 
 
 were immensely powerful, af sine qua non where 
 the leverage for muscular action is so short as in 
 this particular occiput. The facial type in this 
 specimen is markedly prognathous, as regards 
 both upper and lower jaws. 
 
 Fig. 13.— I,ateral vie.w of extreme dolicho-cephalic skull. 
 
 The tout ensemble in this case is strongly sug- 
 gestive of a reversion to the anthropoid type, 
 which is often the distinguishing characteristic 
 of the degenerate Ethiopian type, criminal or 
 otherwise. " The following are the measurements 
 of this exceedingly interesting cranium : 
 
 2 Dr. Ivydston has found in comparative studies of crania that 
 the plane of the occipital bone is of some importance as bearing 
 upon differentiation. In the anthropoids, the relative shortness 
 and horizontal direction of the occipital bone is very striking — es- 
 pecially is this true of the basilar process. In the degenerate typps 
 of human crania, or, at least, in the atavistic types, there seems to 
 be a direct relation between the length" and angle of the basilar 
 process and intelligence. Dr. Clevenger called attention to the 
 angle of the medulla as bearing upon intelligence, years ago, but 
 Dr. Lydston's observations, ^though confirmatory of those of 
 Clevenger, were made independently, as he had not had access to 
 thework of the latter. 
 
399 
 
 Horizontal index ... 59.9 
 
 Circumference. 48.4 c. 
 
 Anterior demi-circumference 21.3 c. 
 
 posterior demi- circumference . ... . 26.9 c. 
 
 Bizygomatic diam 13,3 c. 
 
 Longitudinal diam ' 196.5 mm. 
 
 Transverse diam 122 mm. 
 
 Vertical diam. (vertex to foramen maguum).. 132 mm. 
 
 Occipito-mental diam 241.5 mm. 
 
 Bifrontal diam • • • 95 vita. 
 
 Bimastoid diam. 114 mm. 
 
 Over vertex, from ear to ear 317 mm. 
 
 Ant. bord. foramen mag. to sup. occip. angle. 103 mm. 
 
 Kg. 14. 
 
 The excessive development of the iaws and 
 alveolar processes in this specimen is such as is 
 generally observed in the negro races, in whom 
 the jaws are generally well developed and rarely 
 deformed. The only noticeable feature of this 
 particular specimen is a high palatal vault. 
 
 The next specimen is not especially notewor- 
 thy from the standpoint of degeneracy, being 
 interesting chiefiy on account of its peculiar his- 
 tory, and its exceedingly fine development. It 
 
400 
 
 is, however, an excellent illustration of the bra- 
 chy- cephalic cranial type. 
 
 The subject was a Chinese cigar- maker, of 
 Chicago, who is remembered to have been thor- 
 oughly civilized and quite prosperous. Physi- 
 cally he was a fine, well developed and handsome 
 fellow. He became engaged to a white girl, 
 whose Mongolian aflBnity weakened at the last 
 
 Fig. 15. — Skull of Mongolion suicide (Brachy-cephalic). 
 
 moment, and this preying upon his mind, im- 
 pelled our Mongolian friend to shoot himself. 
 This was noteworthy, as he was the first China- 
 man in America to commit suicide, and there 
 has been but one since, as far as we can learn. 
 The peculiar religious belief of the Chinese ex- 
 plains the rarity of suicide among those in 
 America. 
 The contrast between the negro skull. Fig. 12 
 
40I 
 
 and Fig. i6, is very striking and obvious to the 
 most careless observer. A front view of this 
 specimen shows a splendid development of the 
 jaws and teeth. We have never seen a finer or 
 more regular set of teeth than this. Like the 
 negro race, the Chinese is characterized, on the 
 average, by well formed and strong jaws and 
 teeth. 
 
 Fig. i6. — Skull of Mongolian suicide (Brachy-cephalic), 
 
 The characteristically excessive development 
 of the facial and jaw bones among the Chinese is 
 well shown by a lateral view of this skull. The 
 disproportionate development of the face and 
 jaws in this instance is, however, much above 
 the average Mongolian skull. By comparing 
 the two views, the brachy- cephalic type of the 
 cranium is readily observed. By comparing the 
 views of this cranium with those of the negro 
 shown in Figs. 12 and 13, one may observe the 
 
402 
 
 wide difference between the extreme types of high 
 and low cranial indices. This is nowhere better 
 shown than by a comparison, of marked Ethio- 
 pian and Mongolian types. 
 
 On examination of the crania of more degen- 
 erate types among the Chinese, it will be found 
 that the tendency is towards a high cranial index. 
 The tendency of the degenerate type of a brachy- 
 cephalic race to become more brachy- cephalic, 
 and that of a dolicho cephalic race to become 
 
 Figure 17.— Negro panel-worker (Dolicho-ceplialic). 
 
 more dolico-cephalic, is peculiar, but is borne 
 out^as far as our opportunities for study have 
 permitted us to observe. 
 
 Aside from a change in the cranial index there 
 are seen, among negroes particularly, many pe- 
 culiar aberrations of form, one of which is shown 
 in Fig. 28. The palatal arch in this Mongolian 
 specimen is high, and the alveolar processes ex- 
 
403 
 
 cessively developed. The measurements of this 
 
 skull are : 
 
 Horizontal index 83.9 
 
 Circumference : 50.6 c. 
 
 Anterior demi-circumfereace 29.4 c. 
 
 Posterior demi circumference 21.2 c. 
 
 I/Ongitudinal diam.' 174 mm. 
 
 Transverse diam 146 mm. 
 
 Vertical diam 145 mm. 
 
 Bimastoid diam . . . . 127 mm. 
 
 Bifrontal diam 96 mm. 
 
 Foramen magnum to superior occipital angle. 139 m. 
 
 Fig. 18. — Negro panel-worker (Doliclio-cephalic). 
 
 The next specimen presents some extraordi- 
 nary features. It is the skull of a celebrated 
 negro panel worker, confidence operator and des- 
 perado who, at the time of his death, was the 
 consort of a notorious courtesan who flourished 
 in Chicago some years ago. This individual, 
 after some years' dalliance with the law without 
 especial harm to himself, was finally knifed in a 
 
404 
 
 brawl. A front view of the cranium shows the 
 ordinary and characteristic negro facial type, with 
 the exception, perhaps, that the bones are excep- 
 tionally massive and well developed. Unfortu- 
 nately, the inferior maxilla is absent, a fact which 
 we greatly deplore, as the general cranial devel- 
 opment suggests to us the probability that the 
 missing part presented some very interesting 
 features for consideration. A lateral view of 
 this cranium shows the ordinary dolicho-cephalic 
 negro type. The cranial index is low, being 72.1. 
 
 Fig. 19.— Skull of prostitute (Dolicho-cephalic). 
 
 A comparison with Fig. 12, however, shows the 
 extreme degeneracy of type in the latter to great 
 advantage. 
 
 A view of this skull (Fig. 18), after a section 
 of the calvarium has been removed, shows its 
 most interesting feature. Skulls of such extreme 
 thickness, even among negroes, are rarely met 
 with. The consistency of the bone in this cra- 
 nium is very dense and hard, and traditionally 
 
405 
 
 this negro, when he was alive, was noted for his 
 butting propensities. Violent contact with such 
 a skull would be apt to damage the fist of a Sul- 
 livan. Indeed, it is said that this fellow rather 
 enjoyed the impact of a policeman's club. 
 
 We will state at this point, that we are of the 
 opi;iion that the massiveness of bony develop- 
 ment in this case is not due to disease. The 
 
 Mg. 20.— Skull of prostitute (Doliclio-ceplialic). 
 
 general character of the overgrowth and the con- 
 sistency of the bone would seem to support this 
 view. Syphilis may produce thickening of the 
 cranial bones, as some of Virchow's specimens 
 show, but syphilitic bone does not present the 
 characters and uniformity present in this case. 
 
 At the densest part of the calvarium this spec- 
 imen measured 13 mm. in thickness, its average 
 thickness being 1 1 mm. A comparison with Fig. 
 21 readily shows how phenomenal the osseous 
 
4o6 
 
 development in this case is. The cranial meas- 
 urements are : 
 
 Horizontal index 71.1 
 
 Circumference 47.8 c. 
 
 Anterior demi-circumference 25.4 c. 
 
 Posterior demi-circumference 22.4 c. 
 
 Longitudinal diam 181. g mm. 
 
 Transverse diam 131 mm. 
 
 Vertical diam. (vertex to foramen magnum). 128 mm. 
 
 Bifrontal diam 95 mm. 
 
 Bimastoid diam 113 mm. 
 
 Bizygpmatic diam 126 mm. 
 
 Anterior border of foramen magnum to sup. 
 
 occipital angle 117 mm. 
 
 Fig. 21. — Skull of prostitute (Dolicho-cephalic) Calvarium 
 partially removed. 
 
 The Upper jaw and alveolar process in this 
 skull is well developed, the only peculiarity be- 
 ing a low palatal vault. 
 
 Figs. 19 and 20 show the skull of a once no- 
 torious member of the Chicago demi-monde. She 
 was a very tall woman of mixed Indian and white 
 blood. The cephalic index shows what might 
 
407 
 
 be inferred from the appearance of the cuts — a 
 decidedly dolicho-cephalic type and a peculiar 
 outline. This -specimen is the most symmetri- 
 cally developed of the series, with the exception 
 of the Sioux squaw, next to be described, and 
 whether co-incidental or not, the fact remains 
 that this subject presented a higher type of in- 
 tellectuality while living than any of the other 
 subjects embraced in this essay. The skull is, 
 nevertheless, of a degenerate type, as shown by 
 
 Fig. 22.— Skull of Sioux squaw (Dolicho-cephalic). 
 
 its extreme tenuity and its markedly dolicho- 
 cephalic index. 
 
 Fig. 21 shows the extreme thinness of the cal- 
 varium, which was at the point of section only 3 
 mm. in thickness. A striking feature of this skull 
 is its freedom from prominences, its surface be- 
 ing uniformly smooth and rounded. In this re- 
 spect the specimen differs greatly from another 
 cranium of a prostitute in the same series which 
 
4o8 
 
 we have examined, but of which, unfortunately, 
 we have no illustrations. In this case there was 
 an excessive development of the occipital bone, 
 the enlargement being symmetrical and most 
 marked upon the left of the median line. The 
 right parietal eminence was excessively and dis- 
 proportionately developed. The cranial index 
 was markedly dolicho cephalic. 
 
 The principal measurements of the skull at 
 present under cousider'ation are: 
 
 Fig. 23. — Skull of Sioux Squaw (Dolicho-cephalic). 
 
 Horizontal index , . . . 67.09 
 
 Circumference 51.2 c. 
 
 Anterior demi-circumference, . . . 22.9 c. 
 
 Posterior demi-circumference ... . . 27.3 c. 
 
 Longitudinal diam igo mm. 
 
 Transverse diam i30-5 mm. 
 
 Vertical diam ... ... 128 mm. 
 
 Bifrontal diam. . .... 88.5 mm. 
 
 Bimastoid diam. . . 71 mm. 
 
 Bizygomatic diam.~ , - . - 130 mm. 
 
 Anterior border foramen magnum to ant. sup. 
 
 occipital angle 116 mm. 
 
 The jaw in the case is poorly developed but 
 fairly well formed. In regard to the extreme 
 
409 
 
 tenuity of the skull, we do not believe that it is 
 the result of pathological change. The general 
 lightness of the bones and the symmetry of the 
 skull are not consistent with the existence of 
 such bone changes as might produce absorption 
 and thinning. The markedly dolicho- cephalic 
 type of this skull is interesting in view of the 
 strain of Indian blood in the subject. As has 
 already been observed, the degenerate type in 
 
 Fig. 24. —Half-breed Mexican and Negro (Ultra-bracliyK:ephalic). 
 
 dolicho-cephalic crania is in the direction of a 
 still lower index and in this instance the admix- 
 ture of Indian blood evidently determined the 
 degenerative type. This observation would ap- 
 pear to be contradicted by the case outlined in 
 Figs. 12, 13, 14. In this case, however, there 
 was an admixture of negro and Mexican blood. 
 
4IO 
 
 with a resultant degeneracy of form in general 
 as well as in the cephalic index. This case, in 
 fact, partakes in some respects of the character 
 of a teratological rather than an atavistic type, 
 per se — at least as far as the facial development 
 is concerned. 
 
 A comparison of the prostitute's -skull with 
 the female Indian type next presented shows a 
 marked difference in the cranial index, the dis- 
 
 Fig. 25.— Half-breed Mexican and Negro (TJltra-brachy-cephalic). 
 
 parity being 7.07. Even the negro in Fig. 17 is 
 less dolicho- cephalic than this specimen. The 
 n^xt specimen, the cranium of a full-blood squaw 
 of the Uncapapa Sioux, who was the wife of one 
 of the leading malcontents in the recent Indian 
 outbreak, and consequently of the better type of 
 Indian development. 
 
411 
 
 This specimen is exceptionally symmetrical 
 and moderately dolicho-cephalic. Aside from 
 the purposes of contrast, there is little of interest 
 to be said of it in connection with the present 
 series. The subject was as intelligent as the 
 better class of her people average and there is 
 nothing to be said regarding her from the moral 
 standpoint. Indeed, as the saying goes, the 
 shoe might be on the other foot, as the Indian 
 estimate of the Caucasian grave-robber is not a 
 high one, as evidenced by his treatment of the 
 desecrator of the Indian burial-places when the 
 latter happens to be caught. However, as our 
 connection with the aforesaid desecration is very 
 remote, we trust that our red brother will extend 
 his forgiveness. 
 
 Fig. 23 shows the same skull in lateral view. 
 
 Its symmetrical outline is quite evident. The 
 
 measurements are as follows: 
 
 Horizontal index 74.16. 
 
 Circumferential . 51.2 c. 
 
 Anterior demi-circumference . . . . 26.6 c. 
 
 Posterior demi circumference 23.8 c. 
 
 Longitudinal diam. . . 161 mm. 
 
 Transverse diam . 152 mm. 
 
 Vertical diam . . 140 mm. 
 
 Over vertex from ear to ear 318 mm. 
 
 Occipital protub. to root of nose. . . ■ ■ . . 293 mm. 
 
 Bimastoid diam .... 121. 5 mm 
 
 Bifrontal diam 96 mm. 
 
 Anterior border foramen magnum to superior 
 
 occipital angle 130 mm. 
 
 The superior maxilla presents arrested de- 
 velopment. The vault is of medium height and 
 the alveolar processes well developed. It will 
 be found that in the Indian, as in all primitive 
 
412 
 
 races, a well-formed palate and regular teeth are 
 the rule. It would be interestrng, at some future 
 time, to study the effects of civilization of the 
 Indian in this regard. 
 
 The rule regarding the development of the 
 jaws in the primitive races, has had especial 
 stress laid upon it by Dr. Talbot in his work on 
 irregularities of the teeth and jaws.^ 
 
 Fig. 26.— Outlines of ancient Peruvian skull mechanically 
 deformed. 
 
 The next cranium which we describe is the 
 most remarkable of the series and in many re- 
 spects presents phenomenal characters. 
 
 The subject was a half-breed Mexican and ne- 
 
 3 I am of the opinion that the exceptions to this rule are much 
 more numerous than Dr. Talbot would have us believe. Com- 
 parative studies of primitive crania and jaws show some very inter- 
 esting facts. Among the older Egyptians, relatively small, oblique, 
 narrow and pointed jaws, associated with relatively large and 
 symmetrical cranial development were not infrequent. Arrested 
 ,or excessive development of the facial bones was not rare. Among 
 the skulls of the older Romans, skulls with peculiar obliquity of the 
 occipital plane and angular outline of the occipital parietal regions 
 are to be found. It is also highly probable that maxillary aberra- 
 tions were not infrequent. 
 
 Specimens of Polynesian skulls show numerous examples of ex- 
 cessive and defective maxillary development. In as primitive a 
 
413 
 
 gro, who had left Mexico — his native country — 
 for the good of his compatriots. While he had 
 never distingushed himself by any startling act 
 of criminality and had managed to keep himself 
 out of the clutches of the law, he was identified 
 with the petty criminal class -which forms a 
 prominent portion of all social systems, and with 
 which Mexico is especially infested. He finally 
 died in a public hospital, as a result of some 
 
 type as the Malay, excessive development of the inferior maxilla, 
 with resulting extreme prog;nathism, arrested development of the 
 superior maxilla and excessively high vault may be met with. 
 
 Among the mound-builders aberrations of cranial and maxillary 
 development were frequent. Posterior flattening is frequent but 
 not typical. Kxtreme oxy-cephaly and platy-cephaly are to be 
 found in certain of these skulls. Arrested and excessive develop- 
 ment of thejaws is often met with. 
 
 The iEsquimau type of jaw is varied by excessive breadth, great 
 narrowing and marked obliciuity on the one hand, or angularity on 
 the other. A peculiar aberration occasionally seen is a flaring out 
 of the lower border of the rami. This is usually associated either 
 with the broad and angular type. The result is a most striking 
 "jowl." 
 
 Specimens of Aleut and Alaskan skulls also present aberrations 
 of maxillary type. 
 
 Among the American Indians similar aberrations are to be seen. 
 The Modocs, now almost extinct, showed pronounced variations ot 
 cranial and maxillary development; the teeth, however, were usu- 
 ally strong and well formed, as is typical of our native races. The 
 crania of the native Californians of the lower types, the probable 
 progenitors of the Piutes, Shoshones and Diggers, present marked 
 and frequent cranial aberrations, associated often with excessive 
 or defective maxillary development. Prognathism is frequent. 
 The almost typical maxillary characters of this degraded race are 
 extreme obliquity and slightly marked angles of the inferior max- 
 illa; so pronounced is this feature that the jaw is almost symmet- 
 rically curved. This type of jaw is interesting as bearing upon the 
 theory of the relation of jaw conformation to character; the Cali- 
 fornia Indians of the lower grades are the most degraded specimens 
 of humanity imaginable. Ethnologists give the bushman a Iotv 
 mark enough in this respect, but he must yield the palm to the 
 American Digger, 
 
 The Sioux present great variation of type of cranial and maxil- 
 lary development. The great variation of orbital indices is strik- 
 ing and lends color to the suspicion that the importance of the or- 
 bital index as a criterion of race is a bit overdrawn. 
 
 Independently of mechanical causes there appears to have been 
 great variation of type among the older Peruvians. Superior and 
 posterior flattening and enormous development of the parietal em- 
 inences were frequent. 
 
 These aberrations tend to limit the application of the rule 
 which Dr. Talbot has advanced regarding the pure races.— G. F, 
 Lydston. 
 
414 
 
 acute disease with cerebral complications. The 
 general physique of this man was very fair, al- 
 though he presented a generally overgrown and 
 loose-jointed appearance. When alive he was a 
 very peculiar looking specimen indeed, the 
 dome-shaped appearance of his cranium being 
 exaggerated by a luxuriant crop of kinky wool, 
 several inches in length, that stood straight out 
 from his head. From a mental standpoint he 
 was up to the average of the negro race, but mor- 
 
 Fig. 27.— Inferior surface of half-breed cranium. 
 
 ally speaking he was decidedly degenerate. One 
 of his prominent characteristics was a very irri- 
 table and irascible temper. 
 
 This cranium, as is well shown in the append- 
 ed illustrations, is most markedly brachy-ce- 
 phalic; indeed, its circumferential outline is almost 
 perfectly round, its longitudinal and transverse 
 diameters being nearly equal. The term dome- 
 shaped is as nearly accurate as possible from a 
 
415 
 
 descriptive standpoint. It is a singular fact that 
 the degenerate t3-pe of the African skull often 
 presents the oxy- cephalic or rafter- headed type, 
 even when the dolicho- cephalous index is pro- 
 nounced. These rafter heads are often seen. 
 
 The skull at present under consideration is, as 
 already remarked, a distinctive dome shape, 
 
 Fig. 28.- 
 
 -Dome-sliaped cramuu 
 (Brachy-cephalic). 
 
 which corresponds not at all with the rafter 
 head. 
 
 The peculiar conformation in this case is evi- 
 dently not the result of pathological conditions 
 or mechanical pressure. The vault of the cra- 
 nium is quite symmetrically developed, although 
 
4i6 
 
 the base of the skull is decidedly asymmetrical, 
 as will shortly be showb. We know of no me- 
 chanical means which might have caused the pe- 
 culiar dome-like form of this specimen, and we 
 have been unable to find mechanically deformed 
 crania of a similar type. Such deformities as 
 those presented by the Chinook or Flat- head In- 
 dians are quite familiar types of skulls mechani- 
 
 Fig. 29. — Dome-shaped cranium ; Mulatto {Brachy .cephalic). 
 
 cally deformed. Certain specimens found in an- 
 cient Peruvian graves are almost precisely iden- 
 tical with the characteristic Chinook type and 
 show a probably common origin of the two 
 races. This type is fairly well shown by the 
 conventional outline of Fig. 26. 
 
417 
 
 There are several interesting features in con- 
 nection with the skull under consideration: One 
 of the most striking is the extreme shallowness 
 of the orbits. This is well shown by comparison 
 with some of the other types already described, 
 the measurements being one and three quarters 
 inches from the upper margin of the orbit to the 
 optic foramen, while in the Indian and negro 
 skulls in this series the orbits measure two 
 inches in depth. The outer walls of the orbits 
 encroach upon the cavities, giving a still more 
 marked appearance of shallowness. The form 
 and index of the orbit is- given considerable 
 weight by anthropologists as a criterion of racial 
 type.' 
 
 The inferior maxilla also presents some pecu- 
 liarities: The coronoid processes are very small 
 and short, the body long and the angles very 
 oblique. The anterior alveolar process is exces- 
 sively developed. The same is true of the alveo- 
 lar process of the superior maxilla, it being so 
 situated on the outer surface of the jaw that the 
 teeth were necessarily tipped in to facilitate oc- 
 clusion with the lower teeth. The central incisors 
 were evidently lost in early life, the alveolus be- 
 
 4 I claiiu, and have verified by comparative studies of orbital 
 development, that the form of the orbit is of even greater import- 
 ance as bearing upon the question of degeneracy of type. That 
 marked variation of the form and measurements of the orbit is in- 
 cidental to differentiation , is seen by observation of the anthro- 
 poids. There is a .striking difference between the members of the 
 Simian group in this respect, and a still greater difference is notice- 
 able between the simiidcs and lemuridtz. The shallowness and ob- 
 liquity of the orbits in Fig. 24 is strikingly similar to the charac- 
 ters observed in the gorilla and chimpanzee, which are quite differ- 
 ent from those noted in the orangrs. The general outline of the 
 orbits and their proportionate relation to the facial development in 
 Fig. 12 are also decidedly Simian in character.— G. F. Lydstow. 
 
4i8 
 
 ing absorbed and the border of the jaw only one- 
 eighth of an inch in thickness at this point. The 
 palatal vault is very low and the general devel- 
 opment of the jaws imperfect. 
 
 There is a marked deflection of the vomer and 
 ossae nasi, evidently of non- traumatic origin and 
 due to excessive development of the osseous and 
 cartilaginous structures of the septum nasi. The 
 nasal spine is enormously developed. The era- 
 
 Fig. 30.— Skull of Westeru desperado (Brachy cephalic). 
 
 nial index in this case is extraordinarily high, 
 being slightly above the maximum given by most 
 anthropologists. The type is as marked in the 
 direction of a brachy cephalic index as is Fig. 
 13 in the direction of a low or dolicho cephalous 
 index. 
 
 Fig. 27 shows the inferior surface of the skull 
 under consideration. A glance suffices to show 
 its remarkable asymmetry. The foramen mag- 
 num is almost entirely to the left of the median 
 
41$ 
 
 line. A line drawn through the center of the 
 foramen traverses the median line of this surface ' 
 at an angle of about forty-five degrees. The 
 center of the anterior border of the foramen is 
 situated at 76.5 mm. from the left and 58 mm. 
 from the right mastoid. The center of the pos- 
 terior border of the foramen is 64 mm. and 61 
 mm. from the left and right mastoids respective- 
 
 Fig. 31.— Skull of Western desperado (Brachy-cephalic). 
 
 ly. The margin of the foramen is extremely 
 thin and the occipital ridges very prominent. 
 The measurements are: 
 
 Horizontal index . 
 
 Circumference 
 
 Anterior demi-circumference . 
 Posterior demi-circumference . . 
 Longitudinal diam . 
 
 Transverse diam 
 
 Vertical diam 
 
 Root of nose to occipital protuberance . 
 Anterior border foramen mag. to sup.occ. angle 
 
 Bimastoid diam . ... 
 
 Occipitomental diam 
 
 Bifrontal diam. . . . . 
 
 Bizygomatic diam 
 
 Over vertex from ear to ear 
 
 98.1 
 
 46.5 c. 
 
 22.6 c. 
 
 23.9 c. 
 146 mm. 
 143 mm. 
 148.5 mm. 
 313 mm. 
 , 91 mm. 
 115 mm. 
 248.5 mm. 
 
 95 mm. 
 133.5 mm. 
 350 mm. 
 
420 
 
 On comparing the longitudinal, vertical and 
 transverse diameters of this remarkable skull 
 with those of some of the others of the series, the 
 relatively great height of this dome- like cranium 
 is made very apparent. Thus the diameters are: 
 
 
 Trans. 
 
 ho 
 
 ag. 
 
 Vert. 
 
 Fig. 12 . . . 
 
 . . . 122 mm. 
 
 196. 
 
 5 mm. 
 
 132 mm. 
 
 Pig- 15 ■ • 
 
 . . 146 mm. 
 
 174 
 
 mm. 
 
 145 mm. 
 
 Fig. 17 . . . 
 
 . . . 131 mm. 
 
 181 
 
 mm. 
 
 128 mm. 
 
 Fig. 19 - • 
 
 . . . . 130.5 mm. 
 
 190 
 
 mm. 
 
 128 mm. 
 
 Fig. 21 . . 
 
 . . . 152 mm. 
 
 i6i 
 
 mm. 
 
 140 mm. 
 
 Fig- 31 • • ■ 
 
 . . . . 140.5 mm. 
 
 180 
 
 mm. 
 
 136.5 mm. 
 
 J^ig- 33 • 
 
 . . . . 149 mm. 
 
 168 
 
 mm. 
 
 u8 mm. 
 
 Fig. 32.— Skull of Western desperado (Biachy-cephalic). 
 
 Those of the specimens under consideration 
 being trans., 143 mm., long., 146 mm., and ver- 
 tical 148.5 mm., a comparison with Fig. 33 is 
 especially interesting. 
 
 While making some observations at the Joliet 
 penitentiary we discovered an example of the 
 dome-shaped brachy-cephalic cranium, which 
 
421 
 
 strongly resembles the extraordinary specimen 
 just described.- 
 
 This subject is a mulatto about twenty-three 
 years of age, who is doing time for attempted 
 murder. He is a surly, truculent fellow, of a 
 low grade of intelligence and inclined to be un- 
 ruly. He is at present suffering from a mild 
 type of syphilis. The form of the cranium is 
 well worthy of remark, the more especially as it 
 so nearly approximates the types shown in Figs. 
 24 and 25. 
 
 Fig- 33.— Desperado and train-wrecker (extreme Brachy-cephalic). 
 
 The facial bones, jaws and teeth in this case 
 were extremely well developed and the palatal 
 vault normal. There was no history of mechan- 
 ical compression, and as the subject was born in 
 Tennessee such a cause is improbable, if not im- 
 possible. 
 
422 
 
 'The measurements were not complete. As 
 
 far as taken they were: 
 
 Horizontal index 76.7 
 
 Root of nose toocc. protuberance over vertex. 39.5 c. 
 
 Circumference ... 50.8 c. 
 
 Transverse diam i45 ™™- 
 
 Lon^tudinal diam 191 ^'^■ 
 
 Occipito-frontal diam ... 59 m'D. 
 
 Occipito-mental diam . 28.5 mm. 
 
 The dome-like form of this cranium will be 
 
 more evident on comparison of the two principal 
 
 Fig. 34.— Desperado nd train-wrecker (Brachy•^:ephalic). 
 
 measurements with those of a skull of average 
 development. A comparison was made with 
 that of one of the white orderlies in the prison 
 hospital, a man of fine physique and good crani- 
 al development. It was found that while the 
 measurement over the vertex was the same as 
 that of the negro, 39.5 c, the circumferential 
 measurement was 58.5 c. 
 
 The next specimen (Fig. 30), is the skull of a 
 noted Western criminal and desperado, who was 
 lynched for train wrecking in Wyoming a num- 
 
423 
 
 ber of years ago. The conduct of this man dur - 
 ing the progress of the lynching stamped him as 
 a bravo of the most hardened type. An attempt 
 was made to induce him to relate the particulars 
 of a murder »in which he had participated, the 
 wife of the murdered man being present at the 
 hanging and anxious to learn the details of her 
 husband's death. To the persuasive efforts of 
 the "regulators" and the tears and entreaties of 
 
 Fig. 35. — skull of Western Desperado (Brachy-cephalic). 
 
 the widow of his victim, he replied: "D — n it, 
 you'll hang me if I tell, and you'll hang me if I 
 don't. So here goes," saying which he deliber- 
 ately kicked the barrel upon which he was stand- 
 ing out from under himself, and thus saved his 
 self-appointed executioners all further trouble. 
 
 This specimen is brachy-cephalic and chiefly 
 characterized by its marked asymmetry. 
 
424 
 
 The occipital region in this cranium is exces- 
 sively developed, prominent and bulging, being 
 especially prominent on the left of the median 
 line; the occipital protuberance is situated about 
 8 mm. to the left; the parietal eminences are 
 very asymmetrical, the right being very promi- 
 nent and of irregular contour; the palatal vault 
 is of medium height, the teeth regular and the 
 maxilla well developed; the measurements are: 
 
 Horizontalindex 77.8 
 
 Circumference 50.3 c. 
 
 Posterior demi- circumference ... ... 28.6 c. 
 
 Transverse diam ... 140.5 mm. 
 
 Anterior demi-circumference 21.9 c. 
 
 Longitudinal diam 180 mm. 
 
 Bifrontal diam ... 105 mm. 
 
 Bimastoid diam . ... 126 mm. 
 
 Bizygomatic diam 134 mm. 
 
 Root of nose to occipital protuberance . . 312 mm. 
 Over vertex between auditory meati .... 327.5 mm. 
 Foramen magnum to sup. occipital angle . . 128 mm. 
 
 Viewed from above (Fig. 32), this cranium 
 shows a fairly symmetrical outline. The above 
 illustration is used for the purpose of comparison 
 with Fig. 35. 
 
 The next specimen is by far the most interest- 
 ing of the series from the standard of degeneracy, 
 and is certainly the most markedly asymmetri- 
 cal. If it were possible to conceive of a special 
 criminal type of cranium, this would, in many 
 respects, be an ideal illustration. The subject 
 was a noted Western desperado and train-wreck- 
 er, who was lynched at Carbon, Wyoming, back 
 in the seventies, for an attempt to wreck a train 
 at Medicine Bow. In this attempt he was assisted 
 
425 
 
 by the individual represented in Figs. 30, 31, 32. 
 
 The extremely disproportionate breadth of this 
 cranium is well shown by the above illustration. 
 The meagre development of the frontal region is 
 very noticeable. On viewing this skull from 
 above, the peculiar twisted appearance which 
 may be observed in connection with .the cranial 
 type of the criminal in general will be observed. 
 The orbits are relatively large, and the face, as a 
 whole, of a decidedly "squatty" appearance. 
 The absence of the inferior maxilla is to be re- 
 gretted, although, considering the vicissitudes 
 which the skull has experienced, its otherwise 
 perfect state of preservation is rather remarkable. 
 After the lynching of this gentleman, the body 
 was buried in a hastily improvised and shallow 
 grave, from which it was very promptly resur- 
 rected by those scavengers of the prairie, the 
 coyotes. The skull was finally found by a rail* 
 road employe, and subsequently used as a paper^ 
 weight for some years. 
 
 Judging from the conformation of the cranial 
 and facial bones, the lower maxilla, while prob- 
 ably well, or perhaps excessively developed, was 
 without doubt asymmetrical. The relatively 
 defective frontal development of this skull is its 
 most striking. feature when viewed in its anterior 
 outline, and is best shown by comparison with 
 Figs. 12, 13 and 17. In the former the extreme 
 breadth is 122 mm, and the extreme length 196.5 
 mm., while the frontal breadth is 95 mm. In 
 the skull under consideration, however, although 
 
426 
 
 the extreme breadth is 149 mm. and the extreme 
 length but 171 mm., the frontal breadth is only 
 90 mm. The great disproportion in the meas- 
 urements is at once obvious. In Fig. 17 the 
 greatest breadth is 131 mm. and the greatest 
 length 1 8 1. 5 mm., yet the transverse frontal di- 
 ameter is 95 mm. 
 
 The disproportion is not compensated for in 
 Fig. 33 by an increased longitudinal develop- 
 ment of the frontal bone. 
 
 The twisted appearance of this skull is most 
 evident on comparison of the parietal eminences. 
 These are very prominent on both sides, the left 
 being much the larger of the two; the occipital 
 region is greatly deformed and exceptionally 
 prominent, the bulging being most marked upon 
 the left of the median line. The asymmetry of 
 development is shown by a comparative meas- 
 urement of the distance of each parietal eminence 
 from the occipital protuberance; this measures 
 on the right side 132 mm. and on the left only 
 119 mm. The squatty, animal-like type of this 
 cranium is shown by a comparison of its vertical 
 measurement with some of the others of the 
 series; from the highest point at the vertex to 
 the anterior border of the foramen magnum the 
 measurement is 118 mm.; that of Fig. 13, which 
 is so distinctively anthropoid in its development 
 and outline, the vertical measurement is 132 mm.; 
 of Fig. 16, a symmetrical brachy-cephalic type, 
 is 145 mm.; of Fig. 17, 128 mm.; of Fig. 21, 140 
 mm.; of Fig. 25, 148.5 mm., and of Fig. 31, 
 
427 
 
 136.5 mm. A little study of these measurements 
 will show the extreme animality of type in this 
 cranium, even as compared with others of a pro- 
 nounced degeneracy of type. 
 
 A view from above (Fig. 35) shows the cir- 
 cumferential outline of this specimen. By com- 
 paring the quadrants of this illustration, the 
 pronounced asymmetry of development is easily 
 seen. 
 
 The superior maxilla in this skull is well de- 
 veloped, although the alveolar process shows an 
 inferior development; the palatal arch is exceed- 
 ingly low ; the left superior maxilla is much 
 smaller than the right ; the palatal processes 
 show great asymmetry, the right being 61 mm. 
 and the left but 5 mm. in breadth. The meas- 
 urements of this cranium are: 
 
 Horizontal index . . . . ... 87.13 
 
 Circumference .... . . 49 c. 
 
 Anterior demicircumference ... . 20.35 c. 
 
 Posterior demi-circumference 28.65 c. 
 
 Longitudinal diam. . . .... 171 mm. 
 
 Transverse diam . 149 mm. 
 
 Vertical diam . . 118 mm. 
 
 Bifrontal diam 90 mm. 
 
 Bimastoid diam 108.5 i^m. 
 
 Bizygomatic diam 132 mm. 
 
 Vertical circumference from ear to ear . . . 279 mm. 
 
 Center of left parietal prominence to occipi- 
 tal protuberance 119 mm. 
 
 Center of right parietal prominence to occi- 
 pital protuberance 132 mm. 
 
 Anterior border foramen magnum to superior 
 
 occipital angle 128 mm.