A. J. (Aaron Joshua) Rosanoff.

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LIBRARY

THE UNIVERSITY
OF CALIFORNIA

SANTA BARBARA

PRESENTED BY

DONALD BEEKS



iCtbrarij of
Viobvrt 3aiihan UaU



MANUAL



L^



OF



PSYCHIATRY



EDITED BY

AAEON J. ROSANOFF, M.D.

Clinical Director, Kings Park State Hospital, N. Y.

Lieutenant Colonel, Officers' Section, Medical Reserve Carps,

U. S. Army



FIFTH EDITION. REVISED AND ENLARGED

TOTAL ISSUE, SIX THOUSAND



NEW YORK
JOHN WILEY & SONS, Inc.
London: CHAPMAN & HALL, Limited
1920



Copyright, 1905, 1908, 1911, 1916, 1920,

BY

A. J. ROSANOFF



PRESS OF

BRAUNWORTH & CO.

BOOK MANUFACTURERe

BROOKLYN. N. .



LIST OF CONTRIBUTORS



J. Rogues de Fursac, M.D., formerly Chief of Clinic at the Medical
Faculty of Paris, Physician in Chief of the Public Insane Asylums of
the Seine Department.

Chapters or sections dealing with symptomatology, general
therapeutic indications, epilepsy, dementia precox, paranoia,
manic-depressive psychoses, involutional melancholia, acute
and chronic alcoholism, drug addictions, genera' paralysis,
deliria of infectious origin, psychoses of exhaustion, ursemic
delirium, myxoedema and cretinism, and senile dementia.

Aaron J. Rosanoff, M.D., Clinical Director, Kings Park State
Hospital, N. Y., Lieutenant Colonel, Medical Section, Offices' Reserve
Corps, U. S. Army.

General editorial responsibility; also chapters, sections, or
appendices dealing with etiology, history taking, methods of
examination, special diagnostic procedures, psychotherapy, psy-
choanalysis, prognosis, prevalence of mental disorders, pro-
phylaxis, medico-legal questions, extramural psychiatry, arrests
of development, constitutional psychopathic states, psychoneu-
roses, Huntington's chorea, cerebro-spinal syphilis, cerebral
arteriosclerosis, traumatic psychoses, hyperthyroidism, organic
cerebral affections, Wassermann reaction, association test.

H. L. HoLLiNGWORTH, Ph.D., Associate Professor of Psychology,
Columbia University.

Chapters or appendices dealing with applications of psychology
in psychiatry, normal course of mental development, and
standard psychological group tests.

Miss Mary C. Jarrett, Associate Director, Smith College Training
School for Social Work; formerly Chief of Social Service, Boston
Psychopathic Hospital.

Chapter dealing with applications of sociology in psychiatry.

Clarence A. Neymann, M.D., Superintendent, Cook County
Psychopathic Hospital, Chicago.

Appendix dealing with lumbar puncture, cell count, and chemical
tests of cerebro-spinal fluid,
iii



PREFACE TO THE FIFTH EDITION



In the course of the World War unprecedented oppor-
tunities enabled psychiatry to make great strides. The
movement for mental hygiene is developing direction,
organization, and force. Psychiatrists no longer confine
their activities within the walls of institutions for the insane,
but are constantly organizing connections with general
hospitals, schools, charitable organizations, courts of law,
penal institutions, etc.

In the endeavor to keep this Manual abreast of progress
and to maintain its usefulness to the student of psychiatry
numerous changes and additions have been made in pre-
paring the present edition.

New chapters, sections, or appendices, dealing with the
following subjects, have been added : applications of psychol-
ogy in psychiatry, psychoanalysis, applications of sociology
in psychiatry, extramural psychiatry, psychoneuroses,
hyperthyroidism, normal course of early mental development,
Stanford revision of the Binet-Simon intelligence scale, Kent-
Rosanoff association test, standard psychological group
tests, and the classification of mental diseases adopted by the
American Medico-Psychological Association.

The chapters, sections, or appendices, dealing with the
following subjects, have been extensively rewritten: arrests
of development, epilepsy, constitutional psychopathic states,
chronic alcoholism, cerebro-spinal syphilis, lumbar puncture,
and tests of the cerebro-spinal fluid.

The remaining chapters have also undergone careful
revision with resulting numerous minor changes and addi-
tions.



Vi PREFACE TO THE FIFTH EDITION

The Index has been greatly ampUfied and, it is believed,
rendered more serviceable.

Some of the alterations have been made as a result of
criticisms and suggestions offered by reviewers, to whom
grateful acknowledgment is hereby made.

In order to introduce all the above mentioned changes
and additions it proved necessary to reset the entire book.
The aim has, however, been adhered to of avoiding its
growth beyond the proportions of a practical manual, con-
venient for frequent reference. By the use of somewhat
smaller type and by making the pages a little larger the
increase in thickness has been kept down as far as possible,
although, of course, it could not be wholly avoided.

This Manual, as many know, first appeared in English in
1905, as a translation of the French Manuel'de Psychiatrie
by J. Rogues de Fursac. The special demands of American
students have, through successive editions, led to changes
and additions eventually affecting even scope and viewpoint.
To-day the original French model still constitutes the
nucleus around which this Manual has grown; yet it is but
the duty of the American editor to acknowledge his full
responsibility for its teachings.

It is the earnest hope of the editor and his collaborators
that this Manual will continue to meet a growing demand,
as, apparently, it has done in the past.

Aaron J. Rosanoff.
Kings Park, Long Island, N. Y.
January, 1920..



CONTENTS



PAGE

List of Contributors iii

Preface to the Fifth Edition v

Introduction xiii

PART I GENERAL PSYCHIATRY

I. Etiology 1

Essential causes: heredity, addiction to alcohol or drugs,
syphilis, head injuries. Incidental or contributing causes.
Other etiological factors: race, age, sex, environment,
occupation, marital condition, education, immigration.

II. Symptomatology 19

Disorders of perception: insufficiency of perception,
illusions, hallucinations; properties common to all hallu-
cinations; the different varieties of hallucinations; theories
of hallucinations.

III. Symptomatology (continued) 40

Consciousness, memory, attention, association of ideas,
judgment: unconsciousness, clouding of consciousness,
disorientation, states of obscuration; different forms of
amnesia, illusions and hallucinations of memory, pseudo-
reminiscences; weakening of attention, flight of ideas,
incoherence, imperative ideas, fixed ideas, autochthonous
ideas; false interpretations, delusions.

IV. Symptomatology (concluded). 61

Affectivity, reactions, personality: morbid indifference,
exaggeration of affectivity, morbid depression, anger, and
joy; aboulia, automatic reactions, suggestibility, impulsive
reactions, stereotypy, negativism, disorders of coenesthe-
sia, alterations of personality,
vii



viii CONTENTS

PAOE

V. The Pkactice of Psychiatry 76

History taking: family history, personal history, history
of psychosis. Methods of examination: physical exami-
nation, mental examination.

VI. The Practice of Psychiatry {continued) 88

Special diagnostic procedures: lumbar puncture, Wasser-
mann reaction, chemical tests, intelligence tests, examina-
tion for aphasia, association tests, other tests, medical
consultations.

VII. The Practice of Psychiatry (continued) 92

Applications of psychology in psychiatry: mental measure-
ments, normal curves of distribution, group tests, associa-
tion tests, experimental psychopathology and pharmaco-
psychology, educational therapeutics, theoretical relations.

VIII. The Practice of Psychiatry {continued) 101

General therapeutic indications: institution, commit-
ment; treatment of excitement, suicidal tendencies, refusal
of food. Psychotherapy. Parole and discharge. After-



IX. The Practice of Psychiatry {continued) 120

Psychoanalysis: realm of the unconscious, sexual theory,
psychopathology of everyday life, interpretation of dreams,
realistic and autistic thinking, technique of psychoanalysis.

X. The Practice of Psychiatry {continued) 146

Applications of sociology in psychiatry: interrelation of
social and mental disorders, the psychiatric social worker,
functions of a sociological department, organization of a
sociological department.

XI. The Practice of Psychiatry {continued) 158

Prognosis. Prevalence of mental disorders: are they on
the increase?

XII. The Practice of Psychiatry {continued) 165

Prophylaxis in psychiatry: relationship between bad
heredity and other causes; prevention of bad heredity;
prevention of alcoholism, drug addictions, and syphilis;
the individual; immigration.



CJONTENTS ix

FAOB

XIII. The Practice op Psychiatry (continued) 181

Medico-legal questions in psychiatry: commitment;
legal competence; testamentary capacity; criminal re-
sponsibility; relationship between vice, crime, and men-
tal disorders.

XIV. The Practice of Psychiatry (concluded) 190

Extramural psychiatry: community surveys, National
Army statistics.

PART II. SPECIAL PSYCHIATRY
Classification 193

I. Arrests of Development 195

Idiocy, imbecility, moronism or feeble-mindedness, bor-
derline conditions. *

II. Mental Disorders Associated with Epilepsy 205

Permanent disorders; paroxysmal disorders.

III. Constitutional Psychopathic States 215

Inadequate personality, paranoid personality, emotional
instability, criminalism, pathological lying, sexual psy-
chopathy, nomadism.

IV. Dementia Praecox 229

Symptoms common to all forms; simple form, catatonia,
delusional forms, delire chronique a evolution systematique;
diagnosis, prognosis, etiology, nature, pathological anatomy,
treatment.

V. Paranoia 262

VI. Manic-Depressive Psychoses 267

Manic types: simple, delusional, confused mania.
Depressed types: simple, delusional, stuporous depres-
sion. Mixed types: mixed type proper, attacks of double
form. Course, prognosis, diagnosis; homogeneity of
manic-depressive psychoses; treatment. Chronic mania.

VII. Involutional Melancholia 292



X CONTENTS

PAGE
VIII. PSTCHONEUROSES 300

Hysteria, neurasthenia, psychasthenia.

IX. Huntington's Chorea 327

X, Acute Alcoholism. Pathological Drunkenness... 331

XI. Chronic Alcoholism 335

Permanent symptoms: psychic, physical. Diagnosis,
prognosis, pathological anatomy, etiology. Episodic acci-
dents: delirium tremens, acute hallucinosis, delusional
states, polyneuritic psychosis.

XII. Drug Addictions 355

Etiology, symptoms, course, treatment; cocaine delirium.

XIII. Syphilitic Disorders 364

Mesoblastic invasion: cerebral syphilis: early involve-
ment, meningitic type, gummatous type, endarteritic type.

XIV. Syphilitic Disorders (continued) 370

Parenchymatous invasion : general paralysis : prodromal
period, essential symptoms, inconstant symptoms, forms,
course, prognosis, diagnosis, pathological anatomy, etiology,
prevention, treatment.

XV. Syphilitic Disorders (concluded) 405

Cerebral arteriosclerosis: arterial supply of the brain;
systemic symptoms, symptoms common to all forms,
symptoms of occlusion of large vessels, disease of the medul-
lary system of terminal arterioles, disease of the cortical
system of terminal arterioles; diagnosis, course, prognosis,
treatment.

XVI. Traumatic Disorders 413

Traumatic delirium, traumatic constitution, traumatic
epilepsy, traumatic dementia.

XVII. Miscellaneous Groups 419

Deliria of infectious origin.

XVIII. Miscellaneous Groups (continued) 422

Psychoses of exhaustion: primary mental confusion;
acute delirium.



CONTENTS XI

PAOE

XIX. Miscellaneous Groups (continued) 429

Psychoses of auto-intoxication : uraemic delirium.

XX. Miscellaneous Groups (continued) 431

Thyrogenic psychoses: hypothyroidism: myxoedema,
cretinism; hyperthyroidism: exophthalmic goiter.

XXI. Miscellaneous Groups (continued) 437

Mental disorders due to organic cerebral affections:
tumors, multiple sclerosis, brain abscess, central neuritis.

XXII. Miscellaneous Groups (concluded) 443

Senile dementia: general symptomatology, delusional
forms, complications, prognosis, diagnosis, treatment.



PART III. APPENDICES DEALING WITH TECHNIQUE OF
SPECIAL DIAGNOSTIC PROCEDURES

I. Lumbar Puncture 449

Cell count. Chemical tests: Lange's colloidal gold test,
Noguchi's butyric acid test, Ross-Jones ammonium sul-
phate test, Pandy's phenol test.

II. Wassermann Reaction 460

Principle of the Wassermann reaction, preparation of
reagents, collection of specimens for examination, technique
of the reaction.

III. Examination for Aphasia 470

IV. Normal Course of Mental Development from Birth

TO Third Year 474

V. Stanford Revision of Binet-Simon Intelligence

Scale 476

Materials and equipment; experimental conditions;
range and order of testing; scoring and recording; alter-
native tests; mental age; intelligence quotient; instruc-
tions for tests for mental ages from Year III to "Superior
Adult."



xli CONTENTS

PAoa
VI. Free Association Test (Kent-Rosanofp) 547

Instructions, classification of reactions, norms, frequency
tables, appendix to frequency tables.

VII. Standard Psychological Group Tests 621

Digit span, logical memory, cancellation, completion,
opposites, part-whole, word building.

VIII. Classification of Mental Diseases Adopted by the

American Medico-Psychological Association .... 625
Main groups and subdivisions; definitions and explana-
tory notes.

Index of Authors 641

Index of Subjects 647



INTRODUCTION



Psychiatry is that branch of neurology which treats
of mental disorders and of the organic changes associated
with them.

Mental disorders arrange themselves in two funda-
mental categories, characterized respectively by insuf-
ficiency and perversion of the psychic faculties.

Insufficiency may be either congenital or acquired. In
the first case it constitutes arrest of development; in the
second, psychic paralysis. When the psychic paralysis
is temporary, causing a suspension, but not a destruction,
of mental activity, it is spoken of as psychic inhibition;
on the other hand, when it is permanently established, it
constitutes mental deterioration or dementia.

Perversion of the psychic faculties may also be con-
genital or acquired. Various terms are applied to its mani-
festations, depending upon the particular function affected:
hallucinations, delusions, morbid impulses, etc.

Mental diseases or psychoses are affections in which
mental symptoms constitute a prominent feature. They
differ from such mental infirmities as idiocy, constitutional
psychopathic states and some states of dementia, in that they
are expressions of active pathological processes and not of
permanent and fixed alterations of the mind.

Psychic infirmity, when not congenital, occurs as the
outcome of mental disease. The relation between the two
conditions is analogous to that which exists between anky-
losis of a joint and the arthritis which produced it; the latter
is a disease, the former an infirmity.



XIV INTRODUCTION

Two general terms still remain to be defined: men-
tal alienation and insanity. Although they are often em-
ployed indiscriminately, their meaning is not quite identical.

Etymologically, an alienated (Lat. alienus) individual
is one who has become " estranged " from himself, who
has loct the control of his mental activity, who, in other
words, is not responsible for his acts. This definition rests
upon the metaphysical conception of a free will and cannot
find a place in medical science, which must be based on
observation and must adhere to demonstrable facts.

It is better to adopt an essentially practical definition,
as has been done by most modern psychiatrists, and to
designate by the term mental alienation the entire class of
pathological states in which the mental disorders, whatever
their nature be otherwise, present an anti-social character.
Not every individual suffering from a psychic affection is
alienated. This term can be applied only to those who,
on account of some mental disease or infirmity, are likely
to enter into conflict with society and to find themselves, in
consequence, unable to be an integral part of it.

Insanity, as a scientific term, has fallen into disuse and
now retains significance mainly as a legal one. Like lunacy,
it seems destined to become obsolete, for even in law it is not
used without stated or implied further specification, such as
incompetence necessitating the appointment of a committee
of person or estate, irresponsibility in a criminal action,
limited testamentary capacity, or irrational conduct necessita-
ting commitment to an institution for treatment and cus-
tody. Thus, according to the law of the state of New York,
an imbecile, epileptic, or senile dement {" dotard ") cannot be
committed to a state hospital unless he is at the same time
insane, i.e., delusional, depressed, excited, or otherwise
irrational in conduct; similarly, some cases of hysteria,
neurasthenia, cerebral arteriosclerosis, or brain tumor may
be declared insane and committed to an institution, and
others not, depending on their manifestations from a sociolo-
logical standpoint.



INTRODUCTION XV

This Manual is divided into three parts. The first
deals with general psychiatry, comprising causes, symptoms,
methods of investigation, treatment, and prevention of
mental disorders considered independently of the affections
in which they are encountered. The second deals with
special psychiatry, that is to say, with the various mental
affections individually. The third consists of appendices
giving technique of special diagnostic procedures.



MANUAL OF PSYCHIATKT



PART I
GENERAL PSYCHIATRY



CHAPTER I
ETIOLOGY

" On studying closely the etiology of mental diseases
one soon recognizes the fact that in the great majority of
cases the disease is produced not by a particular or specific
cause, but by a series of unfavorable conditions which first
prepare the soil and then, by their simultaneous action, deter-
mine the outbreak of insanity." ^

This was written nearly three-quarters of a century ago.
To-day, though this view is still held to a certain extent,
we are nevertheless able to distinguish amongst the many
causes some few that are essential from others that are merely
incidental or contributing. In addition there are other factors
that have to do with the etiology of mental disorders,
especially, race, age, sex, environment, occupation, marital
condition, education, and immigration.

1. Essential Causes

As implied in the term itself, the essential causes are
those in the absence of which mental disorders do not occur.

' Griesinger. Die Pathologic und Therapie der Geisteskrankheiten.

1



2 ETIOLOGY

Of these by far the most important are heredity, addiction
to alcohol or drugs, syphilis, and head injuries.

Each of these alone may suffice to produce a mental
disorder or it may act by rendering the nervous organi-
zation so vulnerable that a breakdown occurs at the occa-
sion of some incidental cause which may be in itself quite
insignificant but which here comes to play the part of " the
last straw that broke the camel's back."

Heredity. ' ' This term is applied to the fact of recurrence
of traits in a number of blood relatives, due to their posses-
sion of a common germ-plasm. Hereditary traits are those
whose development depends chiefly upon germinal factors,
genes, or determiners."^

Heredity of a trait is direct, when the trait is found in
parents and offspring; atavistic, when one or more genera-
tions are skipped; collateral, when the trait is found pre-
vailingly in collateral relatives and not necessarily in the
direct line of ancestry.

It is similar when the condition present in the patient
is the same as that in an ascendant or collateral relative;
in the opposite case it is dissimilar. The latter form is by no
means uncommon: among the ascendants and collateral
relatives of psychotic patients are to be found instances not
only of similar psychoses, but also of dissimilar ones and
of epilepsy, feeble-mindedness, criminality, temperamental
abnormalities, sex immorality, and other neuropathic
manifestations.

The fact that nervous and mental diseases are often
transmitted by heredity was known to Hippocrates and
has since his time been amply attested by psychiatric
hospital statistics, but the exact conditions under which such
transmission occurs have never been fully understood. Espe-
cially perplexing has been the seeming irregularity in the
working of heredity as presented, on the one hand, in the
above-mentioned facts of atavistic and collateral heredity

1 Definition kindly furnished by Dr. C. B. Davenport, in a personal
communication.



HEREDITY 3

and, on the other hand, in the frequent failure of trans-
mission of neuropathic traits. Recent investigations have,
however, revealed some data which seem to indicate that
some mental disorders are transmitted from parent to off-
spring in the manner of a trait which is, in the Mendelian
sense, recessive to the normal condition.^

The bearing of the Mendelian theory seems to be of
such importance in this connection that a brief state-
ment of it may not be considered out of place.

The total inheritance of an individual is divisible into unit char-
acters each of which is inherited more or less independently of all
the rest and may therefore be studied without reference to other
characters.

The inheritance of any such character is believed to be dependent
upon the presence in the germ plasm of a unit of substance called
a determiner.

With reference to any given character the condition in an individual
may be dominant or recessive: the character is dominant when, de-
pending on the presence of its determiner in the germ plasm, it is
plainly manifest; and it is recessive when, owing to the lack of its
determiner in the germ plasm, it is not present in the individual under
consideration.

The dominant and recessive conditions of a character are often
designated by the symbols D and R, respectively.

To make the matter clearer we may take as an example of a
Mendelian character the case of eye color.

The brown color is the dominant condition while the blue color
is the recessive condition, as has been shown by Davenport.^ It
would seem that the inheritance of brown eyes is due to the presence
in the germ plasm of a determiner upon which the formation of
brown pigment is the anterior layers of the irides depends.

On the other hand, the inheritance of blue eyes is believed to be
due to the lack of the determiner for brown eye pigment in the germ
plasm; for the blue color of eyes is due merely to the absence of brown
pigment, the effect of blue being produced by the choroid coat shining

1 H. H. Goddard. Heredity of Feeble-Mindedness. Bulletin No. 1,
Eugenics Record Office, Cold Spring Harbor, N. Y. A. J. Rosanoff
and Florence I. Orr. A Study of Heredity in Insanity in the Light
of the Mendelian Theory, Bulletin Xo. 5. C. B. Davenport and D. F.
Weeks. A First Study of Inheritance in Epilepsy. Bulletin Xo. 4.

2 Science, N. S., Vol. XXVI, Xov. 1, 1907, pp. 589-592.



4 ETIOLOGY

through the opalescent but pigment-free anterior layers of the irides
in such cases.

It must be borne in mind that as regards the condition of any
character every person inherits from two sources, namely, from each
parent. Therefore, with reference to any character he may be pure
bred or hybrid.

A case of inheritance of a character from both parents is spoken
of as one of duplex inheritance and is often designated by the symbol
DD.

A case of inheritance of a character from only one parent is spoken
of as one of simplex inheritance and is designated by the symbol DR.

A case in which a character is not inherited from either parent,
therefore exhibiting the recessive condition, is spoken of as one of
nulliplex inheritance and is designated by the symbol RR.

We are now in a position to estimate the relative number of each
type of offspring according to theoretical expectation in the various
combinations of mates.

There are but six theoretically possible combinations of mates.
Continuing to make use of the case of eye color as an instance of a
Mendelian character, let us consider in turn each theoretical possi-
bility.

1. Both parents blue-eyed (nulliplex): all children will be blue-
eyed, as may be represented by the following biological formula:

RR X RR = RR.

2. One parent brown-eyed and simplex (that is to say, inherit-
ing the determiner for brown eye pigment from one grandparent



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