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In this and subsequent periods of depression he furnished very detailed information concerning insistent morbid ideas bothering him since he was a boy. He would be at his work on the farm and suddenly there would come over him a terrible feeling of loneliness, or an uneasy feeling that would impel him to drop his task and go to his mother. He was bothered less in this way as he grew older, but a change came over him about a year before his first commitment; he was run down in health and suffering from stomach trouble at that time. Since that time he has never been entirely well, but has had some trouble "in the back of his mind." He says: "I get two different kinds of feelings. Sometimes I feel well and bright and happy, but even then there is always in my mind the thought that some thing might turn up to make me unhappy again. I get pretty near the top notch, but not quite." Now, every time he visits his home something "strikes his mind” to upset him; he gets a distressed feeling at the pit of his stomach that "gives intensity to his thought," also a slight, uneasy feeling in the forehead, “in the thinking apparatus."

Since his first breakdown his work has bothered him; a reproof from his foreman made him so nervous he could scarcely do anything; a nail or a splinter in the wood he was carving annoyed him; he had trepidation about undertaking each new task, whereas formerly he wanted the most difficult pieces to do. He has been troubled, too, pretty constantly, with vile, dirty thoughts and imaginations obtruding themselves in his mind He scrutinizes his younger children and cannot rid himself of the unworthy suspicion that they are not his; a dimple in the chin of one reminds him of his brother-in-law and leads to the thought that his wife may have had relations with this man. That idea accounts for the fear of him exhibited at the beginning of this attack. The idea of his wife and a dog he traces back to a time when they were children together, and her father had a big dog which in play would jump on the children and knock them down.

The history, from the date of admission to the present time, is a succession of variations as above described. He is robust in appearance, an excellent worker, intelligent, brisk, trustworthy on parole when he is feeling well; and for weeks at a time one would have difficulty in detecting anything wrong with him. But let him be subjected to any possible stress, be thrown on his own resources or called on to make a decision in any matter, and all the symptoms recur. Allow him what he asks for and he is pretty sure to change his mind and decline it, on the ground that on thinking it over he has become nervous and distrustful of his ability to do what he had proposed. So, for example, a trip to the summer cottage had to be given up at the last moment; and innumerable instances, many of them ludicrous, could be given of his vacillation and indecision. This weakness is so well recognized by himself that he has repeatedly advised us not to grant any of his requests, no matter how strongly he may urge them; and so far as possible this is the plan adhered to.

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To conclude this series a case of "compulsive insanity" is reported, in which, owing to the prevalence of epilepsy in the family and the sudden appearance and disappearance of the morbid mental symptoms, the question of its relationship to petit mal has been raised.

S. B., a married woman, age 29, born in England, was admitted January 2, 1904. She had a bad family history, her mother, a maternal aunt and a sister being epileptic, and her father having died of tuberculosis. The patient is somewhat deficient in general intelligence and may be noted as constitutionally inferior."

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Personal History.-She had mumps in childhood and diphtheria and measles since she grew up. She was married eight years ago; her husband is alcoholic. She has borne four children; two were still-born, one died a few hours after birth, the fourth (now 20 months old) is healthy. Nine years ago, when she had diphtheria, her two sisters died of that disease. During her convalescence she was morbidly depressed and wanted to commit suicide; this attack lasted two months. She had a second attack of depression two years later, lasting a few weeks and disappearing suddenly; this time she was not suicidal. Her third attack was 20 months ago, when her third child was born, just previous to which she was severely ill with measles. The mental symptoms came on suddenly, a week after her confinement. She felt sad and worried and had a strong impulse to kill the baby. Again she got well suddenly, after three months, and remained well until the onset of her present, the fourth, attack, eight weeks ago. The trouble came on when she was worried over the child's trifling illness. At first she had a persistent impulse to kill the child, and later to kill anybody. She fought against the feeling, wept much, begged to be watched and prevented from doing it. Upon awaking in the morning the impulse to kill was stronger than at any other time. She threatened to kill herself in order to keep from killing anyone else.

On admission, the patient was in good general health, with the exception of some gastric indigestion and various abnormal head sensations. The physical examination was negative; her height 5 feet 3⁄4 inch; weight 1211⁄2 pounds. She was somewhat undersized, but well developed, and presented no stigmata of defect.

Mental Condition.-She was depressed, with good realization of her trouble. She talked intelligently, had no delusions or hallucinations, was entirely clear as to time and circumstance, and had a good memory. She gave an excellent account of her symptoms, describing the homicidal impulse as overwhelming in intensity, and affecting her like some compelling force external to herself. When the trouble started she felt a heavy weight on the back of the head, then a drawing sensation in the same region, and later a frontal headache. Sometimes the head had seemed to be opening up. She feels nervous and sometimes has twitching of the arms and legs, but has not lost sensation in any part.

There was immediate improvement, owing to a sense of security in the hospital, but she continued depressed-having to worry about her home and anticipating a long absence from it. At times the bad feelings recurred, with pressure in the head, which she once said felt as if "ice water were dripping on the brain."

She was paroled home in April and discharged in June, apparently quite recovered. She was readmitted within a month with the same symptoms as before, and we learned that while at home she continued to have recurrences, but controlled herself until she no longer felt the restraining influence of the parole.

Patient was now very emotional, thoroughly discouraged; she again suffered from indigestion and had vomiting spells. Her head felt like it contained blood or water rushing from behind forward and drifting down; the top of the head seemed to be drawn up into a peak; the brain felt cold. There was dull headache, at times severe; no dizziness. The course was as before, but improvement was more uniform and rapid this time. She seemed much benefited by glasses correcting refractive error. At the end of three months she was again paroled, and four months later was discharged recovered, February, 1905.

Patient was admitted for the third time in December, 1905. Her condition was the same as before. She stated that during the first three months at home she was still annoyed at times by the bad feelings; then they suddenly left her and she was free until their equally sudden return eight weeks ago, caused no doubt by worry over her husband's intemperance and bad conduct.

It will suffice to say that she was again discharged in good health and spirits, April 15, 1907. She has now spent two years away from the hos pital, during which time she has borne another child, and notwithstanding this and other adverse conditions she remains very well.

I had intended to discuss as a part of my topic the differential diagnosis of psychasthenia from dementia præcox, in which traits of this psycho-neurosis are so common; but as I lacked space to include cases illustrating this difficulty I merely refer to it here.

In our series, constituting the small percentage of admissions noted at the beginning of this article, no cases are included which showed progressive deterioration, no matter how marked might be the obsessions or corresponding symptoms. This care I am inclined to think is not universally exercised, and the lack of it engenders confusion.

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SOME ORIGINS IN PSYCHIATRY.'

BY CLARENCE B. FARRAR, M. D.,

Assistant Physician, Sheppard and Enoch Pratt Hospital; Associate in Psychiatry, Johns Hopkins University.

VIII.

It is with relief that we emerge from the Slough of Despond of theopathic mediævalism and approach the threshold of the modern

era.

In the last session we had arrived at the seventeenth century, which represents a transition period from supernatural empiricism to the rational objective study and treatment of disease. As might be expected, we find expressed in the writings of seventeenth and eighteenth century authors, many startlingly inconsistent and incompatible opinions, not only among contemporaries, but even in the works of the same observer, many curious examples of commixture of the old and the new, of inherited superstition and tendencies toward independent investigation which give to the period the character of an age of paradox.

Humanity was still tainted with the belief in devils; that they entered into the bodies of men to produce madness; that insanity was a crime, and the lunatic an enemy to society. Inasmuch, therefore, as alienation was traced to causes outside the laws of nature, it followed that it should be treated by supernatural or extranatural means. These were two-fold. On the one side stood the priest with the authority of Jehovah, who had declared, “Thou shalt not suffer a witch to live." He was, moreover, under the direct admonition of the synoptic gospels and the charge to the apostles that they should go about the country and cast out devils. But prayer and fasting no longer sufficed, and the demons of madness were overcome by scourge and rack, by ordeals of fire and water, by imprisonment, the scaffold and the stake.

On the other side stood the pseudo-scientist, likewise with extranatural methods of treatment, which although no less absurd were

1Continued from Vol. LXV, No. 1, July 1908, page 101.

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far less cruel than those of the church. He dealt out mysterious potions, consulted the stars, observed days and seasons and relied upon magic formulæ and mystic ceremonies. Thus did the astrologer, the alchemist and the necromancer vie with the priest for the control of his victim, and what mad humanity did not suffer at the hands of the one, was visited upon them by the other.

A mingling of old prejudices and beliefs with new and emanci pated trends of thought is conspicuous in the lives of all who were active in the transition period of the Renaissance. Luther was as much a slave of demonology as any of the Roman clergy. PLATER, although recognising the brain as the seat of mental disease, believed at the same time that morbid impulses were the temptings of the devil. A few years later SENNERT (1572-1637) attempted to modernise the ancient humoral theory and suggested the toxic origin of the psychoses. "This malady," said SENNERT, speaking of mania, "must have a specific and obscure cause somewhat resembling poisons, and of such nature that it may be produced by certain venomous substances. Some of these in fact induce delirium, and it is beyond dispute that numbers of persons have become maniacal through drinking certain philtres."' SENNERT was a conscientious observer and his clinical descriptions often emulate those of ARETAEUS and SORANUS; and yet this same man spoke of "demoniac mania." The curious circumstance is that he did not surrender before this demoniac mania as something lying beyond his jurisdiction, and his opinion is peculiarly significant of the transition we have been discussing. "One must not think," he wrote, "that demoniac mania is inaccessible to remedial agents. The treatment should produce such an effect in the patients that the demons finding them no longer suitable for their domination will abandon them of themselves." The question whether the bodies which had thus been rendered unfit for the habitation of devils, would still be suitable for the uses of their natural owners, SENNERT does not discuss. However, the interesting point is that here for the first time was an attempt made to combat supernatural powers by natural means. It was one of the characteristic vagaries of the epoch.

A few years later still in the same century, TH. BONET (16201689) practically freed himself from the chains of superstition and

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