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psychoses and worthy of more consideration. Third, that it is more apt to be followed by complications and sequelæ and impair the future usefulness of the individual when it occurs during the evolution period; hence a most rigid quarantine should be instituted in each and every case of the disease and prophylaxis should be the "battle-cry."

THE GANSER SYMPTOM AND SYMPTOM-COMPLEX.*

REPORT OF FIVE CASES.

BY THEO. I. TOWNSEND, M. D.,

First Assistant Physician, Dannemora State Hospital, Dannemora, N. Y. Since attention in this country was called to the Ganser symptom by Dr. Adolf Meyer in the Pathological Institute for the New York State hospitals in 1904, Dr. A. H. Ruggles' article in the AMERICAN JOURNAL OF INSANITY of October, 1905,' and the able report of a case by Dr. Henry P. Frost at the 1906 meeting of this Association, published in the AMERICAN JOURNAL OF INSANITY of January, 1907, an interested outlook for this symptom has been kept by the present reporter. It is undoubtedly an hysterical manifestation, and it is with some hesitation that five cases of this admittedly rare disorder are presented occurring in a year's admissions. In none of these, however, was it developed other than spontaneously, nor was there a question of malingering— even in the case of one patient who afterward claimed that he had feigned the symptom.

The typical Ganser symptom-complex is a confusional state, with hallucinations, of rapid onset and short duration; hysterical features are present, and the patient, in addition to silly answers and talk, misnames objects with analogous names, or describes their attributes in a roundabout manner; the replies to questions are often incorrect or absurd, but show a good understanding of the question and a near relation to the correct reply. To this latter symptom the term "Danebenreden" has been given by the Germans. Ganser states that on recovery there is amnesia for the attack.

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The symptom of " Danebenreden," roundabout talk, or symptom of approximate answers," as Dr. Ruggles has aptly termed it, is said to have been observed in dawn states on awakening from hypnosis, hysteria, manic conditions, melancholia, alcoholism, dementia præcox, imbecility, and to be most common in criminals and malingerers.

*Read at the sixty-fifth annual meeting of the American Medico-Psychological Association at Atlantic City, N. J., June 1-4, 1909.

CASE I.-M. N. Admitted March 15, 1907, from New York State Reformatory at Elmira; male; single; 18; nativity, New York State; father, Canadian; mother, New York State.

Family History.-Patient is the ninth of eleven children. A sister had epilepsy in childhood. On paternal side “there has been insanity, but very distant." Mother's family "nearly all have heart trouble."

Personal History.—"Typhoid pneumonia" at the age of seven; addicted to excessive cigarette smoking from an early age; attended school from six or seven to fourteen or fifteen years of age; his mother stated that he was bright in school, but his education was found to be very defective. After finishing school, he ran away from his home (on the St. Lawrence river) to Rochester, working in machine shops, and returned to work in a hotel. He had become addicted to the use of alcohol and had stolen before. One night he robbed a man in the hotel, was caught, convicted of burglary in the second degree and petit larceny, and sentenced to the N. Y. S. R. at Elmira with an indeterminate sentence of ten years maximum.

Psychosis. The medical certificate from the Reformatory states that he had an attack of mania the previous month, and about ten days before admission became excited, screaming, spitting on the floor, making attempts to get out of bed, and was kept in a restraining sheet. He was uncleanly and filthy, attempted to eat his feces, urinated and defecated in bed, masturbated at every opportunity, and yelled and fought the nurses. His conversation was incoherent and he did not reply to questions. He said, "I can hear my mother's voice-I love it-I love it-there she goes— goes-goes-come here."

Physical Status.-A fairly well developed boy of medium height, with stigmata of degeneracy; high V-shaped palate; irregularly implanted teeth; head flat posteriorly; poorly nourished with slender musculature; hæmoglobin, 85 per cent; recent vaccination and circumcision both unhealed, probably accounting for a temperature on admission of 100.6; pulse, 100; respiration, normal; this rise of temperature subsided in four days. The subjective sensations were of depression and confusion, and a feeling of his eyes changing-" they feel queer and I can't see well; it seems as though they were crossing." There was an insufficiency of the right external rectus muscle, causing a frequently recurring strabismus to account for this feeling. Pupils normal, and no limitation of visual fields; twitchings of the left lev. lab. sup. alæquenasi were also observed; patellar reflexes markedly exaggerated-Achilles slightly; fine tremor of tongue, face and hands; slight bronchitis; appetite poor; tongue coated; mouth covered with sordes; breath fetid; constipation with scybalous stools.

Mental Status.-Restlessness; distractibility; suggestibility with a semidelirium and the Ganser symptom-complex were manifested for four days after admission.

He was carried into the hospital, being very weak. His spontaneous production was very rambling, but gave some evidence

of flight of ideas, as follows: "You have started me on the road to hell-You started from a rattler-You started from a snakeYou are a rattlesnake-Go in and get on the glass table" (evidently referring to his circumcision at the Reformatory), and his language became very vile, showing coprolalia without apparent appreciation of its meaning. What is your name? "My name is Carlisle" (more obscenity). "Give me that sewing machine " (no similar object in sight). "My father had a sewing machine at Fishers Landing, and I had a bicycle and fell off and shaved off my fingers in the spokes." Here he leaned forward and touched the attendant's uniform coat button with his tongue. He was not oriented for time, place, or person. His mood was that of anxious depression and he frequently spoke about cutting his head off. The following shows the Ganser symptom of "Danebenreden." Various objects were called to his attention and he was asked to name them. He would reach for everything shown, saying, "Give it to me," before replying. Pen knife? "That's a jack knife; that's a razor, shave my head off" (motioned as if to cut his throat). A pair of spectacles? "That'sA man can see through it with both eyes" (making circles with his fingers and holding them up to his eyes, imitating the appearance of a person with spectacles). Cap? "He pulls it right off his head" (imitating bowing with a cap). Electric light?" That's a curer of blue lights, let me get up and turn it on; give me that razor strops-true." Chair? "Mop-handling Jew, let me get up and I will go over and sit down on it." Cigarette? "A sneakingrette, a smoker of liars, a smokerette." Book? "Dictionary; give it to me and I'll pick 'em all out!" Key chain? "Jail man's chain; chain down my head and give me a hypodermic." Watch? "That's a timepiece; you start from the Grand Central Station and-" Match? "That's a smoker-a piece of―give it to me and I'll light it." Pencil? "That's a stinker of lies; give it to me and I'll show you what to do with it." He took it and made a motion to write, but when given a piece of paper and asked to write, made a vulgar picture of female genitalia, and imitated the motion of masturbation. Bunch of keys (rattled before him)? "That's a rattler of stinking snakes." Dollar bill? "That's one hot ball." The following day called it "one green." Bottle? "That's a killer of lies; that's a kidney cure." Newspaper?

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"That's to read." The word opium was suggested, and he said, "One opium-hop joint-hop box-hop chewer-curer of lies." How many are there in your family? "There are a thousand in our family; you will know me a thousand years from now." How old are you? "I am a thousand years old." (He imitated several somewhat complicated motions of the examiner's hands.) The following day named objects as follows: Empty cartridge? "Shoot me dead; shoot my head off." Pair of shoes? "Shine them everywhere you go." Toothpick (snapped to attract his attention)? “That's a snapper to pick all my teeth with." Knife? "Cut my head off." Why do you want me to cut your head off? "Because I am the dirtiest man in the world." Lead whistle?" Blow it." Fifty-cent piece (with the eagle towards him)? "Eagle." Match? "Smoke it." He continued to talk a great deal about “rattlesnakes” and “a curer of lies." Four days after admission he began to be a little clearer, saying, "Doctor, bring me back to my senses again, I am getting clearer every day." He still continued to talk about rattlesnakes, cutting his head off, etc., and said, spontaneously, "I know you (beginning to cry). "I stole your two dogs; poor boy, chop himself all to pieces." He did not know how long he had been here, and could not recall names, but said that his birthday was on June 6, and that he was 18 years old. He did not show the Ganser symptom at all after this, and the mental status was completed on the fifth day, showing defective orientation, poor memory for the remote and immediate past, and defective retention, with limited grasp on education. Calculation showed mistakes and slowness with fatigue at the end of the examination. He read a short newspaper article fairly well, but elaborated slightly in subsequent rendering. His insight was partial. On admission he once said, in his rambling talk, "I'm crazy over a woman." On the fourth day said that his head was clearer, and asked to be brought back to his senses; on the fifth day said that he was not quite all right and continued, "I never can be all right again.' During the first two days he soiled and wet himself with indifference. Two weeks after admission was in a peculiar dream-like state, in which he kept his eyes closed, made slow gestures with his hands, and muttered almost continuously, but slowly. He held his hands out straight before him and said, "Oh, that gold

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