What was probably a case of incomplete aphasia is mentioned by Pliny, that of Messala Corvinus who was unable to tell his own name; and many instances of persons forgetting their names are really nothing but cases of temporary or incomplete aphasia. In some cases of incomplete and in nearly all cases of complete aphasia, involuntary sentences are ejaculated. According to Seguin a reverend old gentleman affected with amnesia of words was forced to utter after the sentence, "Our Father who art in heaven," the words "let Him stay there." A lady seen by Trousseau would rise on the coming of a visitor to receive him with a pleased and amiable expression of countenance, and show him to a chair, at the same time addressing to him the words, "cochon, animal, fichue bete," French words hardly allowable in drawing-room usage. She was totally aphasic but not paralyzed. Women often use semi-religious expressions like "Oh dear," or "Oh Lord." Men of the lower classes retain their favorite oaths remarkably. Sometimes the phrases ejaculated are meaningless, as in Broca's celebrated case.

Aphasia may be the result of sudden strong emotions, in such cases being usually temporary; it may be traumatic; it may be the result of either primary or secondary malnutrition or degeneration.

There are some cases on record in which the sudden loss and the sudden return of the voice are quite marvelous.

Habershon reports the case of a woman who on seeing one of her children scalded fell unconscious and motionless, and remained without food for three days. It was then found that she suffered from complete aphasia. Five weeks after the incident she could articulate only in a very limited vocabulary.

In the Philosophical Transactions Archdeacon Squire tells of the case of Henry Axford, who lost the power of articulation for four years; after a horrible dream following a debauch he immediately regained his voice, and thereafter he was able to articulate without difficulty.

Ball records a curious case of what he calls hysteric aphonia. The patient was a young lady who for several months could neither sing nor speak, but on hearing her sister sing a favorite song, she began to sing herself; but, although she could sing, speech did not return for several weeks. Ball remarks that during sleep such patients may cry out loudly in the natural voice.

Wadham reports the case of a boy of eighteen who was admitted to his ward suffering with hemiplegia of the left side. Aphasia developed several days after admission and continued complete for three months. The boy gradually but imperfectly recovered his speech. Over six months after the original admission he was readmitted with necrosis of the jaw, for which he underwent operation, and was discharged a month later. From this time on he became progressively emaciated until his death, twelve months after Wadham first saw him. A postmortem examination showed nearly total destruction of the Island of Reil, popularly called the speech-center. Jackson mentions a hemiplegic patient with aphasia who could only utter the words "come on to me," "come on," and "yes" and "no." Bristowe cites the history of a sailor of thirty-six, a patient of St. Thomas Hospital, London, who suffered from aphasia for nine months. His case was carefully explained to him and he nodded assent to all the explanations of the process of speech as though he understood all thoroughly. He was gradually educated to speak again by practicing the various sounds. It may be worth while to state that after restoration of speech he spoke with his original American accent.

Ogle quotes six cases of loss of speech after bites of venomous snakes. Two of the patients recovered. According to Russ this strange symptom is sometimes instantaneous and in other instances it only appears after an interval of several hours. In those who survive the effects of the venom it lasts for an indefinite period. One man seen by Russ had not only lost his speech in consequence of the bite of a fer-de-lance snake, but had become, and still remained, hemiplegic. In the rest of Russ's cases speech alone was abolished. Russ remarks that the intelligence was altogether intact, and sensibility and power of motion were unaffected. One woman who had been thus condemned to silence, suddenly under the influence of a strong excitement recovered her speech, but when the emotion passed away speech again left her. Ogle accounts for this peculiar manifestation of aphasia by supposing that the poison produces spasm of the middle cerebral arteries, and when the symptom remains a permanent defect the continuance of the aphasia is probably due to thrombosis of arteries above the temporary constriction.

Anosmia, or loss of smell, is the most common disorder of olfaction; it may be caused by cortical lesions, olfactory nerve-changes, congenital absence, or over-stimulation of the nerves, or it may be a symptom of hysteria.

Ogle, after mentioning several cases of traumatic anosmia, suggests that a blow on the occiput is generally the cause. Legg reports a confirmatory case, but of six cases mentioned by Notta two were caused by a blow on the crown of the head, and two on the right ear. The prognosis in traumatic anosmia is generally bad, although there is a record of a man who fell while working on a wharf, striking his head and producing anosmia with partial loss of hearing and sight, and who for several weeks neither smelt nor tasted, but gradually recovered.

Mitchell reports a case of a woman of forty who, after an injury to her nose from a fall, suffered persistent headache and loss of smell. Two years later, at bedtime, or on going to sleep, she had a sense of horrible odors, which were fecal or animal, and most intense in nature. The case terminated in melancholia, with delirium of persecution, during which the disturbance of smell passed away.

Anosmia has been noticed in leukoderma and allied disturbances of pigmentation. Ogle mentions a negro boy in Kentucky whose sense of smell decreased as the leukoderma extended. Influenza, causing adhesions of the posterior pillars of the fauces, has given rise to anosmia.

Occasionally overstimulation of the olfactory system may lead to anosmia. Graves mentions a captain of the yeomanry corps who while investigating the report that 500 pikes were concealed at the bottom of a cesspool in one of the city markets superintended the emptying of the cesspool, at the bottom of which the arms were found. He suffered greatly from the abominable effluvia, and for thirty-six years afterward he remained completely deprived of the sense of smell.

In a discussion upon anosmia before the Medico-Chirurgical Association of London, January 25, 1870, there was an anosmic patient mentioned who was very fond of the bouquet of moselle, and Carter mentioned that he knew a man who had lost both the senses of taste and smell, but who claimed that he enjoyed putrescent meat. Leared spoke of a case in an epileptic affected with loss of taste and smell, and whose paroxysms were always preceded by an odor of peach-blossoms.

Hyperosmia is an increase in the perception of smell, which rarely occurs in persons other than the hysteric and insane. It may be cultivated as a compensatory process, as in the blind, or those engaged in particular pursuits, such as tea-tasting. Parosmia is a rare condition, most often a symptom of hysteria or neurasthenia, in which everything smells of a similar, peculiar, offensive odor. Hallucinations of odor are sometimes noticed in the insane. They form most obstinate cases, when the hallucination gives rise to imaginary disagreeable, personal odors.

Perversion of the tactile sense, or wrong reference to the sensation of pain, has occasionally been noticed. The Ephemerides records a case in which there was the sense of two objects from a single touch on the hypochondrium. Weir Mitchell remarks that soldiers often misplace the location of pain after injuries in battle. He also mentions several cases of wrong reference of the sensation of pain. These instances cannot be called reflex disturbances, and are most interesting. In one case the patient felt the pain from a urethral injection in gonorrhea, on the top of the head. In another an individual let an omnibus-window fall on his finger, causing but brief pain in the finger, but violent pains in the face and neck of that side. Mitchell also mentions a naturalist of distinction who had a small mole on one leg which, if roughly rubbed or pinched, invariably seemed to cause a sharp pain in the chin.

Nostalgia is the name generally given to that variety of melancholia in which there is an intense longing for home or country. This subject has apparently been overlooked in recent years, but in the olden times it was extensively discussed. Swinger, Harderus, Tackius, Guerbois, Hueber, Therrin, Castellanau, Pauquet, and others have written extensively upon this theme. It is said that the inhabitants of cold countries, such as the Laplanders and the Danes, are the most susceptible to this malady. For a long time many writers spoke of the frequency and intensity of nostalgia among the Swiss. Numerous cases of suicide from this affliction have been noticed among these hardy mountaineers, particularly on hearing the mountain-song of their homes, "Ranz des vaches." This statement, which is an established fact, is possibly due to the social constitution of the Swiss mountaineers, who are brought up to a solitary home life, and who universally exhibit great attachment to and dependence upon their parents and immediate family. In the European armies nostalgia has always been a factor in mortality. In the Army of the Moselle, and in Napoleon's Alpine Army, the terrible ravages of suicide among the young Bretons affected with nostalgia have been recorded; it is among the French people that most of the investigation on this subject has been done. Moreau speaks of a young soldier in a foreign country and army who fell into a most profound melancholy when, by accident, he heard his native tongue. According to Swinger and Sauvages women are less subject to nostalgia than men. Nostalgia has been frequently recorded in hospital wards. Percy and Laurent have discussed this subject very thoroughly, and cite several interesting cases among emigrants, soldiers, marines, etc. Hamilton speaks of a recruit who became prostrated by longing for his home in Wales. He continually raved, but recovered from his delirium when assured by the hospital authorities of his forthcoming furlough. Taylor records two cases of fatal nostalgia. One of the victims was a Union refugee who went to Kentucky from his home in Tennessee. He died talking about and pining for his home. The second patient was a member of a regiment of colored infantry; he died after repeatedly pining for his old home.

Animals are sometimes subject to nostalgia, and instances are on record in which purchasers have been compelled to return them to the old home on account of their literal home-sickness. Oswald tells of a bear who, in the presence of food, committed suicide by starvation.

Hypochondria consists of a mild form of insanity in which there is a tendency to exaggerate the various sensations of the body and their importance, their exaggeration being at times so great as to amount to actual delusion. All sorts of symptoms are dwelt upon, and the doctor is pestered to the extreme by the morbid fears of the patient.

Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or Zwangshandlungen, and by the French, peurs maladies, have only been quite recently studied, and form most interesting cases of minor insanity. Gelineau has made extensive investigations in this subject, and free reference has been made to his work in the preparation of the following material.

Aichmophobia is a name given by the French to the fear of the sight of any sharp-pointed instrument, such as a pin, needle, fish-spine, or naked sword. An illustrious sufferer of this 'phobia was James I of England, who could never tolerate the appearance of a drawn sword. Gelineau reports an interesting case of a female who contracted this malady after the fatigue of lactation of two children. She could not tolerate knives, forks, or any pointed instruments on the table, and was apparently rendered helpless in needle-work on account of her inability to look at the pointed needle.

Agoraphobia is dread of an open space, and is sometimes called Kenophobia. The celebrated philosopher Pascal was supposed to have been affected with this fear. In agoraphobia the patient dreads to go across a street or into a field, is seized with an intense feeling of fright, and has to run to a wall or fall down, being quite unable to proceed. There is violent palpitation, and a feeling of constriction is experienced. According to Suckling, pallor and profuse perspiration are usually present, but there is no vertigo, confusion of mind, or loss of consciousness. The patient is quite conscious of the foolishness of the fears, but is unable to overcome them. The will is in abeyance and is quite subservient to the violent emotional disturbances. Gray mentions a patient who could not go over the Brooklyn Bridge or indeed over any bridge without terror. Roussel speaks of a married woman who had never had any children, and who was apparently healthy, but who for the past six months had not been able to put her head out of the window or go upon a balcony. When she descended into the street she was unable to traverse the open spaces. Chazarin mentions a case in a woman of fifty, without any other apparent symptom of diathesis. Gelineau quotes a case of agoraphobia, secondary to rheumatism, in a woman of thirty-nine. There is a corresponding fear of high places often noticed, called acrophobia; so that many people dare not trust themselves on high buildings or other eminences.

Thalassophobia is the fear of the view of immense spaces or uninterrupted expanses. The Emperor Heraclius, at the age of fifty-nine, had an insurmountable fear of the view of the sea; and it is said that when he crossed the Bosphorus a bridge of boats was formed, garnished on both sides with plants and trees, obscuring all view of the water over which the Emperor peacefully traversed on horseback. The moralist Nicole, was equally a thalassophobe, and always had to close his eyes at the sight of a large sheet of water, when he was seized with trembling in all his limbs. Occasionally some accident in youth has led to an aversion to traversing large sheets of water, and there have been instances in which persons who have fallen into the water in childhood have all their lives had a terror of crossing bridges.

Claustrophobia is the antithesis of agoraphobia. Raggi describes a case of such a mental condition in a patient who could not endure being within an enclosure or small space. Suckling mentions a patient of fifty-six who suffered from palpitation when shut in a railway carriage or in a small room. She could only travel by rail or go into a small room so long as the doors were not locked, and on the railroad she had to bribe the guard to leave the doors unlocked. The attacks were purely mental, for the woman could be deceived into believing that the door to a railroad carriage was unlocked, and then the attack would immediately subside. Suckling also mentions a young woman brought to him at Queen's Hospital who had a great fear of death on getting into a tram car, and was seized with palpitation and trembling on merely seeing the car. This patient had been in an asylum. The case was possibly due more to fear of an accident than to true claustrophobia. Gorodoichze mentions a case of claustrophobia in a woman of thirty-eight, in whose family there was a history of hereditary insanity. Ball speaks of a case in a woman who was overcome with terror half way in the ascension of the Tour Saint-Jacques, when she believed the door below was closed. Gelineau quotes the case of a brave young soldier who was believed to be afraid of nothing, but who was unable to sleep in a room of which the door was closed.

Astrophobia or astropaphobia is a morbid fear of being struck by lightning. It was first recognized by Bruck of Westphalia, who knew a priest who was always in terror when on a country road with an unobstructed view of the sky, but who was reassured when he was under the shelter of trees. He was advised by an old physician always to use an umbrella to obstruct his view of the heavens, and in this way his journeys were made tranquil. Beard knew an old woman who had suffered all her life from astrophobia. Her grandmother had presented the same susceptibility and the same fears. Sometimes she could tell the approach of a storm by her nervous symptoms. Caligula, Augustus, Henry III, and other celebrated personages, were overcome with fear during a storm.

Mysophobia is a mild form of insanity characterized by a dread of the contact of dirt. It was named by Hammond, whose patient washed her hands innumerable times a day, so great was the fear of contamination. These patients make the closest inspection of their toilet, their eating and drinking utensils, and all their lives are intensely worried by fear of dirt.

Hematophobia is a horror of blood, which seems to be an instinctive sentiment in civilized man, but which is unknown among savages. When the horror is aggravated to such an extent as to cause distressing symptoms or unconsciousness, it takes the name of hematophobia. There are many cases on record and nearly every physician has seen one or more, possibly among his colleagues.

Necrophobia and thanatophobia are allied maladies, one being the fear of dead bodies and the other the fear of death itself.

Anthropophobia is a symptom of mental disease consisting in fear of society. Beard, Mitchell, Baillarger, and others have made observations on this disease. The antithesis of this disease is called monophobia. Patients are not able to remain by themselves for even the shortest length of time. This morbid dread of being alone is sometimes so great that even the presence of an infant is an alleviation. Gelineau cites an instance in a man of forty-five which was complicated with agoraphobia.

Bacillophobia is the result of abnormal pondering over bacteriology. Huchard's case was in a woman of thirty-eight who, out of curiosity, had secretly read the works of Pasteur, and who seemed to take particular pleasure in conning over the causes of death in the health-reports. Goyard mentions an instance in a Swiss veterinary surgeon.

Kleptophobia, examples of which have been cited by Cullere, is the fear of stealing objects in view, and is often the prelude of kleptomania. The latter disease has gained notoriety in this country, and nearly every large store has agents to watch the apparently growing number of kleptomaniacs. These unfortunate persons, not seldom from the highest classes of society, are unable to combat an intense desire to purloin articles. Legal proceedings have been instituted against many, and specialists have been called into court to speak on this question. Relatives and friends have been known to notify the large stores of the thieving propensities of such patients.

Le Grande du Saulle has given to the disease in which there is a morbid doubt about everything done, the name folie de doute. Gray mentions a case in a patient who would go out of a door, close it, and then come back, uncertain as to whether he had closed it, close it again, go off a little way, again feel uncertain as to whether he had closed it properly, go back again, and so on for many times. Hammond relates the history of a case in an intelligent man who in undressing for bed would spend an hour or two determining whether he should first take off his coat or his shoes. In the morning he would sit for an hour with his stockings in his hands, unable to determine which he should put on first.

Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of hydrophobia which sometimes assumes all the symptoms of the major disease, and even produces death. Gelineau, Colin, Berillon, and others have studied cases. In Berillon's case the patient was an artist, a woman of brunet complexion, who for six years had been tormented with the fear of becoming mad, and in whom the symptoms became so intense as to constitute pseudobydrophobia. At their subsidence she was the victim of numerous hallucinations which almost drove her to the point of suicide.

Spermatophobia has been noticed among the ignorant, caused or increased by inspection of sensational literature, treatises on the subject of spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense religious scruples, who was married at eighteen, and lost her husband six years afterward. She had a proposition of marriage which she refused, and was prostrated by the humid touch of the proposer who had kissed her hand, imagining that the humidity was due to semen. She was several times overcome by contact with men in public conveyances, her fear of contamination being so great. Zoophobia, or dread of certain animals, has been mentioned under another chapter under the head of idiosyncrasies. Pantophobia is a general state of fear of everything and everybody. Phobophobia, the fear of being afraid, is another coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or fear of fire; stasophobia, or inability to arise and walk, the victims spending all their time in bed; toxicophobia or fear of poison, etc., will be left to the reader's inspection in special works on this subject.

Demonomania is a form of madness in which a person imagines himself possessed of the devil. Ancient records of this disease are frequent, and in this century Lapointe reports the history of demonomania in father, mother, three sons, and two daughters, the whole family, with the exception of one son, who was a soldier, being attacked. They imagined themselves poisoned by a sorceress, saw devils, and had all sorts of hallucinations, which necessitated the confinement of the whole family in an asylum for over a month. They continued free from the hallucinations for two years, when first the mother, and then gradually all the other members of the family, again became afflicted with demonomania and were again sent to the asylum, when, after a residence therein of five months, they were all sufficiently cured to return home.

Particular aversions may be temporary only, that is, due to an existing condition of the organism, which, though morbid, is of a transitory character. Such, for instance, are those due to dentition, the commencement or cessation of the menstrual function, pregnancy, etc. These cases are frequently of a serious character, and may lead to derangement of the mind. Millington relates the history of a lady who, at the beginning of her first pregnancy, acquired an overpowering aversion to a half-breed Indian woman who was employed in the house as a servant. Whenever this woman came near her she was at once seized with violent trembling; this ended in a few minutes with vomiting and great mental and physical prostration lasting several hours. Her husband would have sent the woman away, but Mrs. X insisted on her remaining, as she was a good servant, in order that she might overcome what she regarded as an unreasonable prejudice. The effort was, however, too great, for upon one occasion when the woman entered Mrs. X's apartment rather unexpectedly, the latter became greatly excited, and, jumping from an open window in her fright, broke her arm, and otherwise injured herself so severely that she was confined to her bed for several weeks. During this period, and for some time afterward, she was almost constantly subject to hallucinations, in which the Indian woman played a prominent part. Even after her recovery the mere thought of the woman would sometimes bring on a paroxysm of trembling, and it was not till after her confinement that the antipathy disappeared.

Circular or periodic insanity is a rare psychosis. According to Drewry reports of very few cases have appeared in the medical journals. "Some systematic writers," says Drewry, "regard it as a mere subdivision of periodic insanity (Spitzka). A distinguished alienist and author of Scotland however has given us an admirable lecture on the subject. He says: 'I have had under my care altogether about 40 cases of typical folie circulaire.' In the asylum at Morningside there were, says Dr. Clouston, in 800 patients 16 cases of this peculiar form of mental disease. Dr. Spitzka, who was the first American to describe it, found in 2300 cases of pauper insane four per cent to be periodic, and its sub-group, circular, insanity. Dr. Stearns states that less than one-fourth of one per cent of cases in the Hartford (Conn.) Retreat classed as mania and melancholia have proved to be folie circulaire. Upon examination of the annual reports of the superintendents of hospitals for the insane in this country, in only a few are references made to this as a distinct form of insanity. In the New York State hospitals there is a regular uniform classification of mental diseases in which 'circular (alternating) insanity' occupies a place. In the report of the Buffalo Hospital for 1892, in statistical table No. 4, 'showing forms of insanity in those admitted, etc., since 1888,' out of 1428 cases, only one was 'alternating (circular) insanity.' In the St. Lawrence Hospital only one case in 992 was credited to this special class. In the institution in Philadelphia, of which Dr. Chapin is the superintendent, 10,379 patients have been treated, only three of whom were diagnosed cases of manie circulaire. Of the 900 cases of insanity in the State Hospital at Danville, Pa., less than four per cent were put in this special class. There are in the Central (Va.) State Hospital (which is exclusively for the colored insane) 775 patients, three of whom are genuine cases of circular insanity, but they are included in 'periodic insanity.' This same custom evidently prevails in many of the other hospitals for the insane."

Drewry reports three cases of circular insanity, one of which was as follows:—

"William F., a negro, thirty-six years old, of fair education, steady, sober habits, was seized with gloomy depression a few weeks prior to his admission to this hospital, in September, 1886. This condition came on after a period of fever. He was a stranger in the vicinity and scarcely any information could be obtained regarding his antecedents. When admitted he was in a state of melancholic hypochondriasis; he was the very picture of abject misery. Many imaginary ills troubled his peace of mind. He spoke of committing suicide, but evidently for the purpose of attracting attention and sympathy. On one occasion he said he intended to kill himself, but when the means to do so were placed at his command, he said he would do the deed at another time. The most trivial physical disturbances were exaggerated into very serious diseases. From this state of morbid depression he slowly emerged, grew brighter, more energetic, neater in personal appearance, etc. During this period of slow transition or partial sanity he was taken out on the farm where he proved to be a careful and industrious laborer. He escaped, and when brought back to the hospital a few weeks subsequently he was in a condition of great excitement and hilarity. His expression was animated, and he was, as it were, overflowing with superabundance of spirit, very loquacious, and incessantly moving. He bore an air of great importance and self-satisfaction; said he felt perfectly well and happy, but abused the officers for keeping him 'confined unjustly in a lunatic asylum.' It was his habit almost daily, if not interfered with, to deliver a long harangue to his fellow-patients, during which he would become very excited and noisy. He showed evidences of having a remarkable memory, particularly regarding names and dates. (Unusual memory is frequently observed in this type of insanity, says Stearns.) He was sometimes disposed to be somewhat destructive to furniture, etc., was neat in person, but would frequently dress rather 'gorgeously,' wearing feathers and the like in his hat, etc. He was not often noisy and sleepless at night, and then only for a short time. His physical health was good. This 'mental intoxication,' as it were, lasted nearly a year. After this long exacerbation of excitement there was a short remission and then depression again set in, which lasted about fifteen months. At this time this patient is in the depressed stage or period of the third circle. So, thus the cycles have continuously repeated their weary rounds, and in all probability they will keep this up 'until the final capitation in the battle of life has taken place.'"

Katatonia, according to Gray, is a cerebral disease of cyclic symptoms, ranging in succession from primary melancholia to mania, confusion, and dementia, one or more of these stages being occasionally absent, while convulsive and epileptoid symptoms accompany the mental changes.

It is manifestly impossible to enter into the manifold forms and instances of insanity in this volume, but there is one case, seldom quoted, which may be of interest. It appeared under the title, "A Modern Pygmalion." It recorded a history of a man named Justin, who died in the Bicetre Insane Asylum. He had been an exhibitor of wax works at Montrouge, and became deeply impressed with the beautiful proportions of the statue of a girl in his collection, and ultimately became intensely enamored with her. He would spend hours in contemplation of the inanimate object of his affections, and finally had the illusion that the figure, by movements of features, actually responded to his devotions. Nemesis as usual at last arrived, and the wife of Justin, irritated by his long neglect, in a fit of jealousy destroyed the wax figure, and this resulted in a murderous attack on his wife by Justin who resented the demolition of his love. He was finally secured and lodged in Bicetre, where he lived for five years under the influence of his lost love.

An interesting condition, which has been studied more in France than elsewhere, is double consciousness, dual personality, or, as it is called by the Germans, Doppelwahrnehmungen. In these peculiar cases an individual at different times seems to lead absolutely different existences. The idea from a moralist's view is inculcated in Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject Weir Mitchell illustrated his paper by examples, two of which will be quoted. The first was the case of Mary Reynolds who, when eighteen years of age, became subject to hysteric attacks, and on one occasion she continued blind and deaf for a period of five or six weeks. Her hearing returned suddenly, and her sight gradually. About three months afterward she was discovered in a profound sleep. Her memory had fled, and she was apparently a new-born individual. When she awoke it became apparent that she had totally forgotten her previous existence, her parents, her country, and the house where she lived. She might be compared to an immature child. It was necessary to recommence her education. She was taught to write, and wrote from right to left, as in the Semitic languages. She had only five or six words at her command—mere reflexes of articulation which were to her devoid of meaning. The labor of re-education, conducted methodically, lasted from seven to eight weeks. Her character had experienced as great a change as her memory; timid to excess in the first state, she became gay, unreserved, boisterous, daring, even to rashness. She strolled through the woods and the mountains, attracted by the dangers of the wild country in which she lived. Then she had a fresh attack of sleep, and returned to her first condition; she recalled all the memories and again assumed a melancholy character, which seemed to be aggravated. No conscious memory of the second state existed. A new attack brought back the second state, with the phenomenon of consciousness which accompanied it the first time. The patient passed successively a great many times from one of these states to the other. These repeated changes stretched over a period of sixteen years. At the end of that time the variations ceased. The patient was then thirty-six years of age; she lived in a mixed state, but more closely resembling the second than the first; her character was neither sad nor boisterous, but more reasonable. She died at the age of sixty-five years.

The second case was that of an itinerant Methodist minister named Bourne, living in Rhode Island, who one day left his home and found himself, or rather his second self, in Norristown, Pennsylvania. Having a little money, he bought a small stock in trade, and instead of being a minister of the gospel under the Methodist persuasion, he kept a candy shop under the name of A. J. Brown, paid his rent regularly, and acted like other people. At last, in the middle of the night, he awoke to his former consciousness, and finding himself in a strange place, supposed he had made a mistake and might be taken for a burglar. He was found in a state of great alarm by his neighbors, to whom he stated that he was a minister, and that his home was in Rhode Island. His friends were sent for and recognized him, and he returned to his home after an absence of two years of absolutely foreign existence. A most careful investigation of the case was made on behalf of the London Society for Psychical Research.

An exhaustive paper on this subject, written by Richard Hodgson in the proceedings of the Society for Psychical Research, states that Mr. Bourne had in early life shown a tendency to abnormal psychic conditions; but he had never before engaged in trade, and nothing could be remembered which would explain why he had assumed the name A. J. Brown, under which he did business. He had, however, been hypnotized when young and made to assume various characters on the stage, and it is possible that the name A. J. Brown was then suggested to him, the name resting in his memory, to be revived and resumed when he again went into a hypnotic trance.

Alfred Binet describes a case somewhat similar to that of Mary Reynolds: "Felida, a seamstress, from 1858 up to the present time (she is still living) has been under the care of a physician named Azam in Bordeaux. Her normal, or at least her usual, disposition when he first met her was one of melancholy and disinclination to talk, conjoined with eagerness for work. Nevertheless her actions and her answers to all questions were found to be perfectly rational. Almost every day she passed into a second state. Suddenly and without the slightest premonition save a violent pain in the temples she would fall into a profound slumber-like languor, from which she would awake in a few moments a totally different being. She was now as gay and cheery as she had formerly been morose. Her imagination was over-excited. Instead of being indifferent to everything, she had become alive to excess. In this state she remembered everything that had happened in the other similar states that had preceded it, and also during her normal life. But when at the end of an hour or two the languor reappeared, and she returned to her normal melancholy state, she could not recall anything that had happened in her second, or joyous, stage. One day, just after passing into the second stage, she attended the funeral of an acquaintance. Returning in a cab she felt the period coming on which she calls her crisis (normal state). She dozed several seconds, without attracting the attention of the ladies who were in the cab, and awoke in the other state, absolutely at a loss to know why she was in a mourning carriage with people who, according to custom, were praising the qualities of a deceased person whose name she did not even know. Accustomed to such positions, she waited; by adroit questions she managed to understand the situation, and no one suspected what had happened. Once when in her abnormal condition she discovered that her husband had a mistress, and was so overcome that she sought to commit suicide. Yet in her normal mind she meets the woman with perfect equilibrium and forgetfulness of any cause for quarrel. It is only in her abnormal state that the jealousy recurs. As the years went on the second state became her usual condition. That which was at first accidental and abnormal now constitutes the regular center of her psychic life. It is rather satisfactory to chronicle that as between the two egos which alternately possess her, the more cheerful has finally reached the ascendant."

Jackson reports the history of the case of a young dry-goods clerk who was seized with convulsions of a violent nature during which he became unconscious. In the course of twenty-four hours his convulsions abated, and about the third day he imagined himself in New York paying court to a lady, and having a rival for her favors; an imaginary quarrel and duel ensued. For a half-hour on each of three days he would start exactly where he had left off on the previous day. His eyes were open and to all appearances he was awake during this peculiar delirium. When asked what he had been doing he would assert that he had been asleep. His language assumed a refinement above his ordinary discourse. In proportion as his nervous system became composed, and his strength improved, this unnatural manifestation of consciousness disappeared, and he ultimately regained his health.

A further example of this psychologic phenomenon was furnished quite meetly at a meeting of the Clinical Society of London, where a well known physician exhibited a girl of twelve, belonging to a family of good standing, who displayed in the most complete and indubitable form this condition of dual existence. A description of the case is as follows:—

"Last year, after a severe illness which was diagnosed to be meningitis, she became subject to temporary attacks of unconsciousness, on awakening from which she appeared in an entirely different character. In her normal condition she could read and write and speak fluently, and with comparative correctness. In the altered mental condition following the attack she loses all memory for ordinary events, though she can recall things that have taken place during previous attacks. So complete is this alteration of memory, that at first she was unable to remember her own name or to identify herself or her parents. By patient training in the abnormal condition she has been enabled to give things their names, though she still preserves a baby-fashion of pronouncing. She sometimes remains in the abnormal condition for days together and the change to her real self takes place suddenly, without exciting surprise or dismay, and she forthwith resumes possession of her memory for events of her ordinary life. During the last month or two she appears to have entered on a new phase, for after a mental blank of a fortnight's duration she awakened completely oblivious of all that had happened since June, 1895, and she alludes to events that took place just anterior to that date as though they were of recent occurrence; in fact she is living mentally in July, 1895. These cases, though rare, are of course not infrequently met with, and they have been carefully studied, especially in France, where women appear more prone to neurotic manifestations. The hypothesis that finds most favor is that the two halves of the brain do not work in unison; in other words, that there has been some interference with the connections which in the ordinary normal being make of a wonderful composite organ like the brain one organic whole."

Proust tells a story of a Parisian barrister of thirty-three. His father was a heavy drinker, his mother subject to nervous attacks, his younger brother mentally deficient, and the patient himself was very impressionable. It was said that a judge in a court, by fixing his gaze on him, could send him into an abnormal state. On one occasion, while looking into a mirror in a cafe, he suddenly fell into a sleep, and was taken to the Charite where he was awakened. He suffered occasional loss of memory for considerable lengths of time, and underwent a change of personality during these times. Though wide awake in such conditions he could remember nothing of his past life, and when returned to his original state he could remember nothing that occurred during his secondary state, having virtually two distinct memories. On September 23, 1888, he quarreled with his stepfather in Paris and became his second self for three weeks. He found himself in a village 100 miles from Paris, remembering nothing about his journey thereto; but on inquiry he found that he had paid a visit to the priest of the village who thought his conduct odd, and he had previously stayed with an uncle, a bishop, in whose house he had broken furniture, torn up letters, and had even had sentence passed upon him by a police court for misdemeanor. During these three weeks he had spent the equivalent of $100, but he could not recall a single item of expenditure. Davies cites a remarkable case of sudden loss of memory in a man who, while on his way to Australia, was found by the police in an exhausted condition and who was confined in the Kent County Insane Asylum. He suffered absolute loss of all memory with the exception of the names of two men not close acquaintances, both of whom failed to recognize him in his changed condition in confinement. Four months later his memory returned and his identity was established.

In the Revue Philosophique for 1885 there are the details of a case of a young man who seemed able to assume six states of what might be fairly called different personalities. The memories attached to each of these states were very different, though only one was completely exclusive of the others. The handwriting varied from complete competence to complete incompetence. His character varied between childish timidity, courteous reserve, and reckless arrogance; and to four of his conditions there was a form of hysteric paralysis attached. Mere suggestion would not only induce any one of these varied forms of paralysis, but also the memories, capacities, and characters habitually accompanying it.

A young man named Spencer, an inmate of the Philadelphia Hospital, was exhibited before the American Neurological Society in June, 1896, as an example of dual personality. At the time of writing he is and has been in apparently perfect health, with no evidence of having been in any other condition. His faculties seem perfect, his education manifests itself in his intelligent performance of the cleric duties assigned to him at the hospital, yet the thread of continuous recollection which connects the present moment with its predecessors—consciousness and memory—has evidently been snapped at some point of time prior to March 3d and after January 19th, the last date at which he wrote to his parents, and as if in a dream, he is now living another life. The hospital staff generally believe that the man is not "shamming," as many circumstances seem to preclude that theory. His memory is perfect as to everything back to March 3d. The theory of hypnotism was advanced in explanation of this case.

The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican Brothers," has been discussed by Sedgwick, Elliotson, Trousseau, Laycock, Cagentre, and others. Marshall Hall relates what would seem to verify the Corsican myth, the history of twin brothers nine months of age, who always became simultaneously affected with restlessness, whooping and crowing in breathing three weeks previous to simultaneous convulsions, etc. Rush describes a case of twin brothers dwelling in entirely different places, who had the same impulse at the same time, and who eventually committed suicide synchronously. Baunir describes a similar development of suicidal tendency in twin brothers. A peculiar case of this kind was that of the twin brothers Laustand who were nurses in a hospital at Bordeaux; they invariably became ill at the same time, and suffered cataract of the lens together.

Automatism has been noticed as a sequel to cranial injuries, and Huxley quotes a remarkable case reported by Mesnet. The patient was a young man whose parietal bone was partially destroyed by a ball. He exhibited signs of hemiplegia on the right side, but these soon disappeared and he became subject to periodic attacks lasting from twenty-four to forty-eight hours, during which he was a mere automaton. In these attacks he walked continually, incessantly moving his jaw, but not uttering a word. He was insensible to pain, electric shock, or pin-prick. If a pen was placed in his hand he would write a good letter, speaking sensibly about current topics. When a cigarette-paper was placed in his hand he sought his tobacco box, and adroitly rolled a cigarette and lighted it. If the light went out he procured another, but would not allow another to substitute a match. He allowed his mustache to be burned without resistance, but would not allow a light to be presented to him. If chopped charpie was put in his pocket instead of tobacco he knew no difference. While in his periods of automatism he was in the habit of stealing everything within his grasp. He had been a concert singer, and a peculiar fact was that if given white gloves he would carefully put them on and commence a pantomime of the actions of a singer, looking over his music, bowing, assuming his position, and then singing.

It is particularly in hypnotic subjects that manifestations of automatism are most marked. At the suggestion of battle an imaginary struggle at once begins, or if some person present is suggested as an enemy the fight is continued, the hypnotic taking care not to strike the person in question. Moll conceded that this looked like simulation, but repetition of such experiments forced him to conclude that these were real, typical hypnoses, in which, in spite of the sense-delusions, there was a dim, dreamy consciousness existing, which influenced the actions of the subject, and which prevented him from striking at a human being, although hitting at an imaginary object. Many may regard this behavior of hypnotics as pure automatism; and Moll adds that, as when walking in the street while reading we automatically avoid knocking passers-by, so the hypnotic avoids hitting another person, although he is dimly or not at all aware of his existence.

Gibbs reports a curious case of lack of integrity of the will in a man of fifty-five. When he had once started on a certain labor he seemed to have no power to stop the muscular exercise that the task called forth. If he went to the barn to throw down a forkful of hay, he would never stop until the hay was exhausted or someone came to his rescue. If sent to the wood-pile for a handful of wood, he would continue to bring in wood until the pile was exhausted or the room was full. On all occasions his automatic movements could only be stopped by force.

At a meeting in Breslau Meschede rendered an account of a man who suffered from simple misdirection of movement without any mental derangement. If from his own desire, or by direction of others, he wanted to attempt any muscular movement, his muscles performed the exact opposite to his inclinations. If he desired to look to the right, his eyes involuntarily moved to the left. In this case the movement was not involuntary, as the muscles were quiet except when called to action by the will, and then they moved to the opposite.

Presentiment, or divination of approaching death, appearing to be a hypothetic allegation, has been established as a strong factor in the production of a fatal issue in many cases in which there was every hope for a recovery. In fact several physicians have mentioned with dread the peculiar obstinacy of such presentiment. Hippocrates, Romanus, Moller, Richter, Jordani, and other older writers speak of it. Montgomery reports a remarkable case of a woman suffering from carcinoma of the uterus. He saw her on October 6, 1847, when she told him she had a strong presentiment of death on October 28th. She stated that she had been born on that day, her first husband had died on October 28th, and she had married her second husband on that day. On October 27th her pulse began to fail, she fell into a state of extreme prostration, and at noon on the 28th she died. In substantiation of the possibility of the influence of presentiment Montgomery cites another case in which he was called at an early hour to visit a lady, the mother of several children. He found her apparently much agitated and distressed, and in great nervous excitement over a dream she had had, in which she saw a handsome monument erected by some children to their mother. She had awakened and became dreadfully apprehensive, she could not tell as to what. The uneasiness and depression continued, her pulse continued to grow weak, and she died at twelve that night without a struggle. Andrews has made several observations on this subject, and concludes that presentiment of death is a dangerous symptom, and one which should never be overlooked. One of his cases was in a man with a fractured leg in the Mercy Hospital at Pittsburg. The patient was in good health, but one day he became possessed of a cool, quiet, and perfectly clear impression that he was about to die. Struck with his conviction, Andrews examined his pulse and general condition minutely, and assured the patient there was not the slightest ground for apprehension. But he persisted, and was attacked by pneumonia three days later which brought him to the verge of the grave, although he ultimately recovered. In another instance a young man of ruddy complexion and apparent good health, after an operation for varicocele, had a very clear impression that he would die. Careful examination showed no reason for apprehension. After five or six days of encouragement and assurance, he appeared to be convinced that his reasoning was foolish, and he gave up the idea of death. About the ninth day the wound presented a healthy, rosy appearance, and as the patient was cheerful he was allowed to leave his bed. After a few hours the nurse heard the noise of labored breathing, and on investigation found the patient apparently in a dying condition. He was given stimulants and regained consciousness, but again relapsed, and died in a few moments. At the necropsy the heart was found healthy, but there were two or three spots of extravasated blood in the brain, and evidences of cerebral congestion. Vos remarks that he remembers a case he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A man who had been intemperate was rolling a sod of grass, and got some grit into his left palm. It inflamed; he put on hot cow-dung poultices by the advice of some country friends. He was admitted with a dreadfully swollen hand. It was opened, but the phlegmonous process spread up to the shoulder, and it was opened in many places, and at last, under chloroform, the limb was amputated below the joint. The stump sloughed, and pus pointing at the back of the neck, an opening was again made. He became in such a weak state that chloroform could not be administered, and one morning he had such a dread of more incisions that, saying to us all standing round his bed, 'I can bear it no more, I must now die,' he actually did die in a few minutes in our presence. His was the last arm that Mr. Holden ever amputated at St. Bartholomew's."



CHAPTER XVIII.

HISTORIC EPIDEMICS.

A short history of the principal epidemics, including as it does the description of anomalous diseases, many of which are now extinct, and the valuable knowledge which finally led to their extinction, the extraordinary mortalities which these epidemics caused, and many other associate points of interest would seem fitting to close the observations gathered in this volume. As the illustrious Hecker says, in the history of every epidemic, from the earliest times, the spirit of inquiry was always aroused to learn the machinery of such stupendous engines of destruction; and even in the earliest times there was neither deficiency in courage nor in zeal for investigation. "When the glandular plague first made its appearance as a universal epidemic, whilst the more pusillanimous, haunted by visionary fears, shut themselves up in their closets, some physicians at Constantinople, astonished at the phenomena opened the boils of the deceased. The like has occurred both in ancient and modern times, not without favorable results for Science; nay, more mature views excited an eager desire to become acquainted with similar or still greater visitations among the ancients, but, as later ages have always been fond of referring to Grecian antiquity, the learned of those times, from a partial and meagre predilection, were contented with the descriptions of Thucydides, even where nature had revealed, in infinite diversity, the workings of her powers."

There cannot but be a natural interest in every medical mind to-day in the few descriptions given of the awful ravages of the epidemics which, fortunately, in our enlightened sanitary era, have entirely disappeared. In the history of such epidemics the name of Hecker stands out so prominently that any remarks on this subject must necessarily, in some measure, find their origin in his writings, which include exhaustive histories of the black death, the dancing mania, and the sweating sickness. Few historians have considered worthy of more than a passing note an event of such magnitude as the black death, which destroyed millions of the human race in the fourteenth century and was particularly dreadful in England. Hume has given but a single paragraph to it and others have been equally brief. Defoe has given us a journal of the plague, but it is not written in a true scientific spirit; and Caius, in 1562, gave us a primitive treatise on the sweating sickness. It is due to the translation of Hecker's "Epidemics of the Middle Ages" by Babbington, made possible through the good offices of the Sydenham Society, that a major part of the knowledge on this subject of the English-reading populace has been derived.

The Black Death, or, as it has been known, the Oriental plague, the bubonic plague, or in England, simply the plague, and in Italy, "la Mortalega" (the great mortality) derived its name from the Orient; its inflammatory boils, tumors of the glands, and black spots, indicative of putrid decomposition, were such as have been seen in no other febrile disease. All the symptoms were not found in every case, and in many cases one symptom alone preceded death. Although afflicted with all the manifestations of the plague, some patients recovered. According to Hecker the symptoms of cephalic affliction were seen; many patients were stupefied and fell into a deep sleep, or became speechless from palsy of the tongue, while others remained sleepless and without rest. The fauces and tongue were black and as if suffused with blood; no beverage could assuage the burning thirst, so that suffering continued without alleviation until death, which many in their despair accelerated with their own hands. Contagion was evident, for attendants caught the disease from their parents and friends, and many houses were emptied of their inhabitants. In the fourteenth century this affection caused still deeper sufferings, such as had not been hitherto experienced. The organs of respiration became the seats of a putrid inflammation, blood was expectorated, and the breath possessed a pestiferous odor. In the West an ardent fever, accompanied by an evacuation of blood, proved fatal in the first three days. It appears that buboes and inflammatory boils did not at first appear, but the disease in the form of carbuncular affection of the lungs (anthrax artigen) caused the fatal issue before the other symptoms developed. Later on in the history of the plague the inflammatory boils and buboes in the groins and axillae were recognized at once as prognosticating a fatal issue.

The history of this plague extends almost to prehistoric times. There was a pest in Athens in the fifth century before Christ. There was another in the second century, A.D., under the reign of Marcus Aurelius, and again in the third century, under the reign of the Gauls; following this was the terrible epidemic of the sixth century, which, after having ravaged the territory of the Gauls, extended westward. In 542 a Greek historian, Procopius, born about the year 500, gives a good description of this plague in a work, "Pestilentia Gravissima," so called in the Latin translation. Dupouy in "Le Moyen Age Medical," says that it commenced in the village of Peleuse, in Egypt, and followed a double course, one branch going to Alexandria and the other to Palestine. It reached Constantinople in the Spring of 543, and produced the greatest devastation wherever it appeared. In the course of the succeeding half century this epidemic became pandemic and spread over all the inhabited earth. The epidemic lasted four months in Constantinople, from 5000 to 10,000 people dying each day. In his "History of France," from 417 to 591, Gregorius speaks of a malady under the name inguinale which depopulated the Province of Arles. In another passage this illustrious historian of Tours says that the town of Narbonne was devastated by a maladie des aines. We have records of epidemics in France from 567 to 590, in which bubonic symptoms were a prominent feature. About the middle of the fourteenth century the bubonic plague made another incursion from the East. In 1333, fifteen years before the plague appeared in Europe, there were terrible droughts in China followed by enormous floods in which thousands of people perished. There are traditions of a plague in Tche in 1334, following a drought, which is said to have carried off about 5,000,000 people. During the fifteen years before the appearance of the plague in Europe there were peculiar atmospheric phenomena all over the world, besides numerous earthquakes. From the description of the stinking atmosphere of Europe itself at this time it is quite possible that part of the disease came, not from China, but originated in Southern Europe itself. From China the route of caravans ran to the north of the Caspian Sea, through Asia, to Tauris. Here ships were ready to take the produce of the East to Constantinople, the capital of commerce, and the medium of communication between Europe, Asia, and Africa. Other caravans went from Europe to Asia Minor and touched at the cities south of the Caspian Sea, and lastly there were others from Bagdad through Arabia to Egypt; the maritime communication on the Red Sea to Arabia and Egypt was also not inconsiderable. In all these directions contagion found its way, though doubtless Constantinople and the harbors of Asia Minor were the chief foci of infection, whence it radiated to the most distant seaports and islands. As early as 1347 the Mediterranean shores were visited by the plague, and in January, 1348, it appeared in the south of France, the north of Italy, and also in Spain. Place after place was attacked throughout the year, and after ravishing the whole of France and Germany, the plague appeared in England, a period of three months elapsing before it reached London. The northern kingdoms were attacked in 1349, but in Russia it did not make its appearance before 1351.

As to the mortality of this fearful epidemic Dupony considers that in the space of four years more than 75,000,000 fell victims, that is, about half of the population of the countries visited. Hecker estimates that from 1347 to 1351, 25,000,000 people died, or one-quarter of the total population of Europe. It was reported to Pope Clement that throughout the East, probably with the exception of China, nearly 24,000,000 people had fallen victims to the plague. Thirteen millions are said to have died in China alone. Constantinople lost two-thirds of its population. When the plague was at its greatest violence Cairo lost daily from 10,000 to 15,000, as many as modern plagues have carried off during their whole course. India was depopulated. Tartary, Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies. In this latter country Arabian historians mention that Maara el nooman, Schisur, and Harem in some unaccountable manner remained free. The shores of the Mediterranean were ravaged and ships were seen on the high seas without sailors. In "The Decameron" Boccaccio gives a most graphic description of the plague and states that in Florence, in four months, 100,000 perished; before the calamity it was hardly supposed to contain so many inhabitants. According to Hecker, Venice lost 100,000; London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000; Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there were 56,000 victims in Marseilles, and at Montpellier three-quarters of the population and all the physicians were stricken with the epidemic.

Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II, Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of Castile, and other notable persons perished. All the cities of England suffered incredible losses. Germany seems to have been particularly spared; according to a probable calculation, only about 1,250,000 dying. Italy was most severely visited, and was said to have lost most of its inhabitants. In the north of Europe two of the brothers of Magnus, King of Sweden, died; and in Westgothland alone 466 priests died. The plague showed no decrease in the northern climates of Iceland and Greenland, and caused great havoc in those countries.

The moral effect of such a great pandemic plague can be readily surmised. The mental shock sustained by all nations during the prevalence of the black plague is beyond parallel and description. An awful sense of contrition and repentance seized Christians of every community. They resolved to forsake their vices, and to make restitution for past offenses; hence extreme religious fanaticism held full sway throughout Europe. The zeal of the penitents stopped at nothing. The so-called Brotherhood of the Cross, otherwise known as the Order of Flagellants, which had arisen in the thirteenth century, but was suppressed by the mandates and strenuous efforts of the Church, was revived during the plague, and numbers of these advocates of self-chastisement roamed through the various countries on their great pilgrimages. Their power increased to such an extent that the Church was in considerable danger, for these religious enthusiasts gained more credit among the people, and operated more strongly on their minds than the priests from whom they so entirely withdrew that they even absolved each other. Their strength grew with such rapidity, and their numbers increased to such an extent daily, that the State and the Church were forced to combine for their suppression. Degeneracy, however, soon crept in, crimes were committed, and they went beyond their strength in attempting the performance of miracles. One of the most fearful consequences of this frenzy was the persecution of the Jews. This alien race was given up to the merciless fury and cruelty of the populace. The persecution of the Jews commenced in September and October, 1348, at Chillon on Lake Geneva, where criminal proceedings were instituted against them on the mythic charge of poisoning the public wells. These persecuted people were summoned before sanguinary tribunals, beheaded and burned in the most fearful manner. At Strasburg 2000 Jews were burned alive in their own burial-ground, where a large scaffold had been erected, their wealth being divided among the people. In Mayence 12,000 Jews were said to have been put to a cruel death. At Eslingen the whole Jewish community burned themselves in their synagogue, and mothers were often seen throwing their children on the pile, to prevent them from being baptized, and then precipitating themselves into the flames. The cruel and avaricious desires of the monarchs against these thrifty and industrious people added fuel to the flames of the popular passion, and even a fanatic zeal arose among the Jews to perish as martyrs to their ancient religion. When we sum up the actual effects as well as the after effects of the black death, we are appalled at the magnitude of such a calamity, the like of which the world had never seen before.

In the fifteenth and sixteenth centuries the plague was generally diffused throughout Europe, and in the latter half of the seventeenth century a final Occidental incursion of the plague took place. From 1603 to 1604 over 30,000 people perished in London from the plague, and in 1625 the mortality in that city amounted to 35,417 persons. But the great plague of London did not begin until 1664. In this plague the patient at first became sensible of great weariness and fatigue, had slight chills, nausea, vomiting, vertigo, and pains in the loins. The mental disturbance rapidly increased, and stupor and delirium ensued. The face was alternately flushed and pallid, and a sense of constriction was experienced in the region of the heart. Darting pains were felt all over the body, soon followed by the enlargement of the lymphatic glands, or by the formation of carbuncles in various parts of the body. About the third day the tongue became dry and brown, and the gums, tongue, and teeth were covered with a dark fur, and the excretions became offensive; paralysis intervened; ecchymosed patches or stripes due to extravasation appeared on the skin; finally the pulse sank, the body grew cold and clammy, delirium or coma seized the victim, and in five or six days, sometimes in two or three, the painful struggle was at an end.

It was supposed that the disease originated in the Orient and was brought to London from Holland. In his "Journal of the Plague in London" Defoe describes its horrors, and tells of the dead-cart which went through the streets gathering the victims. A few extracts from Pepys's "Diary," the evidence of an eye-witness and a contemporary, show the ghastly aspects of this terrible visitation. On August 31st he writes: "In the City, this week, died 7496, and of them 6102 died of the plague. But it is found that the true number of the dead this week is nearer 10,000; partly from the poor who cannot be taken care of through the greatness of the number, and partly from the Quakers and others that will not have any bell rung for them." According to Adams, John Evelyn noted in his "Kalendarium":—"Sept. 7th.—Near 10,000 now died weekly; however, I went all along the City and suburbs from Kent street to St. James's, a dismal passage, and dangerous to see so many coffins exposed in the streets; the streets thin of people, the shops shut up, and all in silence, no one knowing whose turn might be next."

As the cold weather came on the plague diminished in intensity and the people regained their confidence and returned to the city. According to Adams, in the first week of March, 1666, deaths by the plague had decreased to 42; and by the end of the month it was nearly extinct after carrying off about 100,000 victims. In our days we can hardly comprehend the filthy hygienic conditions under which the people in the cities lived, and it was probably to this fact that the growth and perpetuation of this plague was due.

As to the bubonic plague recently raging in Camptown, China, Mary Niles says that it was the same disease as the great London plague, and was characterized mainly by glandular enlargement. It had not appeared in the Canton district for forty years or more, though it was endemic in Yunnan. In some places it began in the winter; and as early as January she herself found the first case in Canton in an infected house. In no case was direct contagiousness found to exist. The glands enlarged twelve hours after the fever began, and sometimes suppurated in nonfatal cases in a short time. Kitasato has recently announced the discovery of the specific cause of the bubonic plague.

Sweating Sickness.—According to Hecker, very shortly after Henry's triumphant march from Bosworth Field, and his entry into the capital on August 8, 1485, the sweating sickness began its ravages among the people of the densely populated city. According to Lord Bacon the disease began about September 21st, and lasted to the end of October, 1485. The physicians could do little or nothing for the people, and seemed to take no account of the clinical history of the disease,—in this respect not unlike the Greek physicians who for four hundred years paid no attention to small-pox because they could find no description of it in the immortal works of Galen. The causes seemed to be uncleanliness, gluttony, immoderate drinking, and also severe inundations leaving decaying vegetation. Richmond's army has been considered a factor in the germination of the seeds of pestilent disorder which broke out soon after in the camps of Litchfield, and on the banks of the Severn.

Sweating sickness was an inflammatory rheumatic fever, with great disorder of the nervous system, and was characterized by a profuse and injurious perspiration. In the English epidemic the brain, meninges, and the nerves were affected in a peculiar manner. The functions of the pneumogastric nerves were violently disordered in this disease, as was shown by the oppressed respiration and extreme anxiety, with nausea and vomiting,—symptoms to which modern physicians attach much importance. The stupor and profound lethargy show that there was an injury to the brain, to which, in all probability, was added a stagnation of black blood in the torpid veins. Probably decomposing blood gave rise to the offensive odor of the person. The function of the lungs was considerably impaired. The petechial fever in Italy in 1505 was a form of the sweating sickness. There were visitations in 1506 and in 1515 in England. In 1517 the disease lasted full six months and reached its greatest height about six weeks after its appearance, but was apparently limited to England. Meningeal symptoms were characteristic of the third visitation of the disease. In 1528 and 1529 there was a fourth visitation which resulted in the destruction of the French Army before Naples. It is said that in 1524 a petechial fever carried off 50,000 people in Milan, and possibly this was the same disease. In 1529 the disease had spread all over Europe, attended with great mortality.

Germany, France, and Italy were visited equally. The famine in Germany, at this time, is described by authorities in a tone of deep sympathy. Swabia, Lorraine, Alsace, and provinces on the border of the lower Rhine, were frightfully affected, so that the disease reached the same heights there as in France. In England Henry VIII endeavored to avoid the epidemic by continual traveling, until at last he grew tired of so unsettled a life and determined to await his destiny at Tytynhangar. It was not the inhabitants of the land alone who were affected, but even fish and the fowls of the air sickened. According to Schiller, in the neighborhood of Freiburg in Breisgau, dead birds were found scattered under the trees with boils as large as peas under their wings,—indicating among them a disease, and this extended far beyond the southern districts of the Rhine. The disease was undoubtedly of a miasmatic infectious nature, as was proved by its rapid spread and the occasional absence of a history of contagion. It was particularly favored in its development by high temperature and humidity.

The moral effect of the sweating sickness, similar to that of the black plague, was again to increase religious fanaticism and recreate the zeal of persecution.

On the 15th of April, 1551, there was an outbreak of the fifth and last epidemic of sweating fever in Shrewsbury, on the Severn. With stinking mists it gradually spread all over England, and on the 9th of July it reached London. The mortality was very considerable. The English residents were particularly susceptible, foreigners being comparatively exempt. The epidemic terminated about the 30th of September. Since that time the sweating sickness has never reappeared in England; but in the beginning of the eighteenth century a disease very similar in symptoms and course broke out in Picardy, in Northern France. Toward the end of the century it spread to the South of France, and since that time has appeared epidemically, 195 distinct outbreaks having been observed in the course of one hundred and sixty-nine years, from 1618 to 1787. The disease has frequently appeared in Italy since 1755, and in various parts of Germany since 1801. In Belgium it has been observed in a few places within the present century (Rohe).

Chronologic Table of the Principal Plagues.—In December, 1880, H. P. Potter, F.R.C.S., published a chronologic table of some of the principal plagues on record. In comments on his table, Potter says that he has doubtless included mention of many plagues which, although described under that name, are probably a dissimilar disease, writers having applied the terms pestilential and pestilent in a generic sense to diseases specifically different. It must also be remembered that, in some cases, death must have been due to famine, want, and privation, which are so frequently coexistent with pestilence. Following the idea of Hecker, the dancing manias have been included in this table.

{table omitted}

Small-pox.—From certain Chinese records it appears that small-pox, or a disease with similar symptoms, was known in China before the Christian era, and it was supposed to have been known at a very early period in India. Most likely it was introduced into Europe in the second century by a Roman army returning from Asia. Before the sixth century, the terrible century of the great plague, there seem to be no records of small-pox or other eruptive fevers. Neither Hippocrates, Galen, nor the Greek physicians who practiced at Rome, mention small-pox, although it is now believed that the Emperor Marcus Aurelius died of this disease. According to Dupony, the first document mentioning variola was in 570 A.D., by Marius, a scholar of Avenches, in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et variola, Italiam Galliamque valde affecit.") Ten years later Gregory of Tours describes an epidemic with all the symptoms of small-pox in the fifth reign of King Childebert (580); it started in the region of Auvergne, which was inundated by a great flood; he also describes a similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him, Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth century wrote a most celebrated work on small-pox and measles, which is the earliest accurate description of these diseases, although Rhazes himself mentions several writers who had previously described them, and who had formulated rules for their cure. He explained these diseases by the theory of fermentation, and recommended the cooling treatment. Adams remarks that although it is probable that small-pox existed for ages in Hindoostan and China, being completely isolated in those countries from the European world, it was not introduced into the West until the close of the seventh century. Imported into Egypt by the Arabians, it followed in the tracks of their conquests, and was in this way propagated over Europe. The foregoing statement disagrees with Dupony and others. It is well known that small-pox was prevalent in Europe before Rhazes's description of it, and after the Crusades it spread over Central and Western Europe, but did not extend to the northern countries until some years later. In 1507 the Spaniards introduced it into San Domingo, and in 1510 into Mexico, where it proved a more fatal scourge than the swords of Cortez and his followers, for according to Robertson it swept away in Mexico three millions and a half of people. In 1707 it appeared in Iceland, and carried off more than one-fourth of its inhabitants; in 1733, according to Collinson, it almost depopulated Greenland. The Samoyeds, Ostiaks, and other natives of Eastern Siberia, have frequently suffered from devastating epidemics. In Kamchatka the disease was introduced in 1767, and many villages were completely depopulated. According to Moore, at the beginning of the eighteenth century nearly one-fourteenth of the population died from small-pox in England, and at the end of the century the number of the victims had increased to one-tenth. In the last century the statement was made in England that one person in every three was badly pock-marked. The mortality of the disease at the latter half of the eighteenth century was about three to every thousand inhabitants annually. India has always been a fertile ground for the development of small-pox, and according to Rohe the mortality from small-pox has been exceedingly great for the past twenty years. From 1866 to 1869, 140,000 persons died in the Presidencies of Bombay and Calcutta, and several years later, from 1873 to 1876, 700,000 died from this disease. China, Japan, and the neighboring countries are frequently visited with small-pox, and nearly all the inhabitants of Corea are said to bear evidences of the disease. In the Marquesas Islands one-fourth of the inhabitants had fallen victims to the disease since 1863. It was first introduced into the Sandwich Islands in 1853, and it then carried off eight per cent of the natives. Australia, Tasmania, New Zealand, and the Fiji Archipelago have to the present day remained exempt from small-pox; although it has been carried to Australia in vessels, rigorous quarantine methods have promptly checked it. On the American continent it was believed that small-pox was unknown until the conquest of Mexico. It has been spread through various channels to nearly all the Indian tribes of both North and South America, and among these primitive people, unprotected by inoculation or vaccination, its ravages have been frightful.

That small-pox a disease so general and so fatal at one time—has, through the ingenuity of man, in civilized communities at least, become almost extinct, is one of the greatest triumphs of medicine.

Inoculation was known in Europe about 1700, and in 1717 the famous letter of Lady Montagu from Adrianople was issued, containing in part the following statements:—

"The small-pox, so fatal and so general amongst us, is here entirely harmless, by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met, the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer her with a large needle, and puts into the vein as much matter as can lie upon the head of her needle, and after that binds up the little wound with a hollow shell, and in this manner opens four or five veins."

Soon after this letter Lady Montagu had her son inoculated in Turkey, and four years later her daughter was to be the first subject inoculated in England. She made rapid progress notwithstanding the opposition of the medical profession, and the ignorance and credulity of the public. The clergy vituperated her for the impiety of seeking to control the designs of Providence. Preaching in 1722, the Rev. Edward Massey, for example, affirmed that Job's distemper was confluent small-pox, and that he had been inoculated by the Devil. Lady Montagu, however, gained many supporters among the higher classes. In 1721 Mead was requested by the Prince of Wales to superintend the inoculation of some condemned criminals, the Prince intending afterward to continue the practice in his own family; the experiment was entirely successful, and the individuals on whom it was made afterward received their liberty (Adams).

According to Rohe, inoculation was introduced into this country in 1721 by Dr. Zabdiel Boylston of Boston, who had his attention directed to the practice by Cotton Mather, the eminent divine. During 1721 and 1722 286 persons were inoculated by Boylston and others in Massachusetts, and six died. These fatal results rendered the practice unpopular, and at one time the inoculation hospital in Boston was closed by order of the Legislature. Toward the end of the century an inoculating hospital was again opened in that city.

Early in the eighteenth century inoculation was extensively practiced by Dr. Adam Thomson of Maryland, who was instrumental in spreading a knowledge of the practice throughout the Middle States.

Despite inoculation, as we have already seen, during the eighteenth century the mortality from small-pox increased. The disadvantage of inoculation was that the person inoculated was affected with a mild form of small-pox, which however, was contagious, and led to a virulent form in uninoculated persons. As universal inoculation was manifestly impracticable, any half-way measure was decidedly disadvantageous, and it was not until vaccination from cow-pox was instituted that the first decided check on the ravages of small-pox was made.

Vaccination was almost solely due to the persistent efforts of Dr. Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.

In his comments on the life of Edward Jenner, Adams, in "The Healing Art," has graphically described his first efforts to institute vaccination, as follows: "To the ravages of small-pox, and the possibility of finding some preventive Jenner had long given his attention. It is likely enough that his thoughts were inclined in this direction by the remembrance of the sufferings inflicted upon himself by the process of inoculation. Through six weeks that process lingered. He was bled, purged, and put on a low diet, until 'this barbarism of human veterinary practice' had reduced him to a skeleton. He was then exposed to the contagion of the small-pox. Happily, he had but a mild attack; yet the disease itself and the inoculating operations, were probably the causes of the excessive sensitiveness which afflicted him through life.

"When Jenner was acting as a surgeon's articled pupil at Sudbury, a young countrywoman applied to him for advice. In her presence some chance allusion was made to the universal disease, on which she remarked: 'I shall never take it, for I have had the cow-pox.' The remark induced him to make inquiries; and he found that a pustular eruption, derived from infection, appeared on the hands of milkers, communicated from the teats of cows similarly disordered; this eruption was regarded as a safeguard against small-pox. The subject occupied his mind so much that he frequently mentioned it to John Hunter and the great surgeon occasionally alluded to it in his lectures, but never seems to have adopted Jenner's idea that it might suggest some efficacious substitute for inoculation. Jenner, however, continued his inquiries, and in 1780 he confided to his friend, Edward Gardner, his hope and prayer that it might be his work in life to extirpate smallpox by the mode of treatment now so familiar under the name of vaccination.

"At the meetings of the Alveston and Radborough Medical Clubs, of both of which Jenner was a member, he so frequently enlarged upon his favorite theme, and so repeatedly insisted upon the value of cow-pox as a prophylactic, that he was denounced as a nuisance, and in a jest it was even proposed that if the orator further sinned, he should then and there be expelled. Nowhere could the prophet find a disciple and enforce the lesson upon the ignorant; like most benefactors of mankind he had to do his work unaided. Patiently and perseveringly he pushed forward his investigations. The aim he had in view was too great for ridicule to daunt, or indifference to discourage him. When he surveyed the mental and physical agony inflicted by the disease, and the thought occurred to him that he was on the point of finding a sure and certain remedy, his benevolent heart overflowed with unselfish gladness. No feeling of personal ambition, no hope or desire of fame, sullied the purity of his noble philanthropy. 'While the vaccine discovery was progressive,' he writes, 'the joy at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities, blended with the fond hope of enjoying independence, and domestic peace and happiness, were often so excessive, that, in pursuing my favorite subject among the meadows, I have sometimes found myself in a kind of reverie. It is pleasant to recollect that those reflections always ended in devout acknowledgments to that Being from whom this and all other blessings flow.' At last an opportunity occurred of putting his theory to the test. On the 14th day of May, 1796,—the day marks an epoch in the Healing Art, and is not less worthy of being kept as a national thanksgiving than the day of Waterloo—the cow-pox matter or pus was taken from the hand of one Sarah Holmes, who had been infected from her master's cows, and was inserted by two superficial incisions into the arms of James Phipps, a healthy boy of about eight years of age. The cow-pox ran its ordinary course without any injurious effect, and the boy was afterward inoculated for the small-pox,—happily in vain. The protection was complete; and Jenner thenceforward pursued his experiments with redoubled ardor. His first summary of them, after having been examined and approved by several friends, appeared under the title of 'An Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June, 1798. In this important work he announced the security against the small-pox afforded by the true cow-pox, and proceeded to trace the origin of that disease in the cow to a similar affection of the horse's heel."

This publication produced a great sensation in the medical world, and vaccination spread so rapidly that in the following summer Jenner had the indorsement of the majority of the leading surgeons of London. Vaccination was soon introduced into France, where Napoleon gave another proof of his far-reaching sagacity by his immediate recognition of the importance of vaccination. It was then spread all over the continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it into America; in 1801, with his sons-in-law, President Jefferson vaccinated in their own families and those of their friends nearly 200 persons. Quinan has shown that vaccination was introduced into Maryland at least simultaneously with its introduction into Massachusetts. De Curco introduced vaccination into Vienna, where its beneficial results were displayed on a striking scale; previously the average annual mortality had been about 835; the number now fell to 164 in 1801, 61 in 1802, and 27 in 1803. After the introduction of vaccination in England the mortality was reduced from nearly 3000 per million inhabitants annually to 310 per million annually. During the small-pox epidemic in London in 1863, Seaton and Buchanan examined over 50,000 school children, and among every thousand without evidences of vaccination they found 360 with the scars of small-pox, while of every thousand presenting some evidence of vaccination, only 1.78 had any such traces of small-pox to exhibit. Where vaccination has been rendered compulsory, the results are surprising. In 1874 a law was established in Prussia that every child that had not already had small-pox must be vaccinated in the first year of its life, and every pupil in a private or public institution must be revaccinated during the year in which his or her twelfth birthday occurs. This law virtually stamped small-pox out of existence; and according to Frolich not a single death from small-pox occurred in the German army between 1874 and 1882. Notwithstanding the arguments advanced in this latter day against vaccination, the remembrance of a few important statistic facts is all that is necessary to fully appreciate the blessing which Jenner conferred upon humanity. In the last century, besides the enormous mortality of small-pox (it was computed that, in the middle of the last century, 2,000,000 victims perished in Russia from small-pox), the marks of affliction, blindness, deafness, etc., were plain in at least one member of every family.

Asiatic cholera probably originated centuries ago in India, where it is now endemic and rages to such an extent as to destroy 750,000 inhabitants in the space of five years. There is questionable evidence of the existence of cholera to be found in the writings of some of the classic Grecian and Indian authors, almost as far back as the beginning of the Christian era. In the sixteenth and seventeenth centuries travelers in the East gave accounts of this disease. Sonnerat, a French traveler, describes a pestilence having all the characteristics of Asiatic cholera which prevailed in the neighborhood of Pondicherry and the Coromandel coast from 1768 to 1769, and which, within a year, carried off 60,000 of those attacked. According to Rohe, Jasper Correa, an officer in Vasco da Gama's expedition to Calicut, states that Zamorin, the chief of Calicut, lost 20,000 troops by the disease. Although cholera has frequently extended to Europe and America, its ravages have never been nearly as extensive as in the Oriental outbreaks. An excellent short historic sketch of the epidemics of the cholera observed beyond the borders of India has been given by Rohe. In 1817 cholera crossed the boundaries of India, advancing southeasterly to Ceylon, and westerly to Mauritius, reaching the African coast in 1820. In the following two years it devastated the Chinese Empire and invaded Japan, appearing at the port of Nagasaki in 1822. It advanced into Asiatic Russia, and appeared as far east as St. Petersburg in 1830, from whence it spread north to Finland. In 1831 it passed through Germany, invading France and the western borders of Europe, entering the British Isles in 1832, and crossing the Atlantic Ocean for the first time, appeared in Canada, having been carried thence by some Irish emigrants.

From Canada it directly made its way to the United States by way of Detroit. In the same year (1832) it appeared in New York and rapidly spread along the Atlantic coast.

"During the winter of 1832 it appeared at New Orleans, and passed thence up the Mississippi Valley. Extending into the Indian country, causing sad havoc among the aborigines, it advanced westward until its further progress was stayed by the shores of the Pacific Ocean. In 1834 it reappeared on the east coast of the United States, but did not gain much headway, and in the following year New Orleans was again invaded by way of Cuba. It was again imported into Mexico in 1833. In 1835 it appeared for the first time in South America, being restricted, however, to a mild epidemic on the Guiana coast.

"In 1846 the disease again advanced beyond its natural confines, reaching Europe by way of Turkey, in 1848. In the autumn of this year it also appeared in Great Britain, Belgium, the Netherlands, Sweden, and the United States, entering by way of New York and New Orleans. In the succeeding two years the entire extent of country east of the Rocky Mountains was invaded. During 1851 and 1852 the disease was frequently imported by emigrants, who were annually arriving in great numbers from the various infected countries of Europe. In 1853 and 1854 cholera again prevailed extensively in this country, being, however, traceable to renewed importation of infected material from abroad. In the following two years it also broke out in numerous South American States, where it prevailed at intervals until 1863. Hardly had this third great pandemic come to an end before the disease again advanced from the Ganges, spreading throughout India, and extending to China, Japan, and the East Indian Archipelago, during the years 1863 to 1865. In the latter year it reached Europe by way of Malta and Marseilles. It rapidly spread over the Continent, and in 1866 was imported into this country by way of Halifax, New York, and New Orleans. This epidemic prevailed extensively in the Western States, but produced only slight ravages on the Atlantic Coast, being kept in check by appropriate sanitary measures. In the same year (1866) the disease was also carried to South America, and invaded for the first time the states bordering on the Rio de la Plata and the Pacific coast of the Continent.

"Cholera never entirely disappeared in Russia during the latter half of the sixth decade, and in 1870 it again broke out with violence, carrying off a quarter of a million of the inhabitants before dying out in 1873. It spread from Russia into Germany and France and was imported, in 1873, into this country, entering by way of New Orleans and extending up the Mississippi Valley. None of the Atlantic coast cities suffered from this epidemic in 1873, and since that year the United States has been entirely free from the disease, with the exception of a few imported cases in New York harbor in 1887" (and in 1893). In 1883 an epidemic of cholera raged in Egypt and spread to many of the Mediterranean ports, and reappeared in 1885 with renewed violence. In Spain alone during this latter epidemic the total number of cases was over one-third of a million, with nearly 120,000 deaths. In 1886 cholera caused at least 100,000 deaths in Japan. In the latter part of 1886 cholera was carried from Genoa to Buenos Ayres, and crossing the Andean range invaded the Pacific coast for a second time. In Chili alone there were over 10,000 deaths from cholera in the first six months of 1887. Since then the entire Western hemisphere has been virtually free from the disease.

In 1889 there was an epidemic of cholera in the Orient; and in 1892 and 1893 it broke out along the shores of the Mediterranean, invading all the lines of commerce of Europe, Hamburg in the North and Marseilles in the South being especially affected. In the summer of 1893 a few cases appeared in New York Bay and several in New York city, but rigorous quarantine methods prevented any further spread.

Typhus fever is now a rare disease, and epidemics are quite infrequent. It has long been known under the names of hospital-fever, spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the regular associate of such social disturbances as overcrowding, excesses, famine, and war. For the past eight centuries epidemics of typhus have from time to time been noticed, but invariably can be traced to some social derangement.

Yellow Fever is a disease prevailing endemically in the West Indies and certain sections of what was formerly known as the Spanish Main. Guiteras recognizes three areas of infection:—

(1) The focal zone from which the disease is never absent, including Havana, Vera Cruz, Rio, and the other various Spanish-American points.

(2) The perifocal zone, or regions of periodic epidemics, including the ports of the tropical Atlantic and Africa.

(3) The zone of accidental epidemics, between the parallels of 45 degrees north and 35 degrees south latitude.

In the seventeenth century Guadaloupe, Dominica, Martinique, and Barbadoes suffered from epidemics of yellow fever. After the first half of the seventeenth century the disease was prevalent all through the West Indies. It first appeared in the United States at the principal ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it reappeared in Philadelphia and Charleston, and since that time many invasions have occurred, chiefly in the Southern States.