PREFACE
This book is written primarily for the general practitioner and secondarily for the syphilographer, the neurologist, and the psychiatrist. Our material is drawn chiefly from a psychopathic hospital, that modern type of institution in which the mental problems of general medical practice come to a diagnostic head weeks, months, or years before the asylum is thought of.
It is this peculiar nature of psychopathic hospital material—a concentrated essence of the most difficult daily problems of general practice—that brings together such an apparent mélange of cases as are here described, ranging from mild single-symptom diseases like extraocular palsy up to genuine magazines of symptoms as in general paresis; from feeblemindedness, apparently simple, up to apparently simple dotage, both feeblemindedness and dotage really syphilitic; from the mind-clear tabetic to the maniacal or deluded subject who looks physically perfectly fit; from the early secondaries to the late tertiaries or so-called quaternaries; from peracute to the most chronic of known conditions; from the most delicate character changes to the profoundest ruin of the psyche.
Although the bulk of our case-material is drawn from general practice through the thinnest of intermediary membranes, the psychopathic hospital, yet we have tried to depict the whole story by presenting enough autopsied cases from district state hospitals to show exactly what treatment has to face. Nor have we hesitated to insert cases in which treatment has failed.
In addition to (a) the Psychopathic Hospital, Boston, group of incipient, doubtful, obscure, or complicated cases (the early clinical group) and (b) the Danvers State Hospital, Hathorne, group of longer-standing, committed, fatal cases (the finished or autopsied group) we present (c) a miscellaneous group of cases, including many from private neurological or psychiatric practice. No doubt those familiar with Boston medicine will see traces of the teaching of our former chiefs, notably Professors James Jackson Putnam and Edward Wyllys Taylor. We are obliged to them for some well-observed cases.
We have dedicated our work to the Commonwealth, but perhaps we should more specifically ascribe to the Massachusetts Commission on Mental Diseases (formerly the State Board of Insanity) the spirit that permitted our special study of neurosyphilis treatment. To these authorities, who have countenanced and encouraged a somewhat costly piece of special work since 1914, we offer our thanks, hoping that other states will be one by one stimulated to the state-endowment of research. States doing full duty by research can be counted on one hand.
To our Psychopathic Hospital colleagues and the internes, and especially to Drs. Myrtelle M. Canavan and Douglas A. Thom of the Commission’s Pathological Service, we also offer our best thanks.
The Danvers traditions are tangible here: cases of Drs. A. M. Barrett, H. A. Cotton, H. W. Mitchell, H. M. Swift, and others are presented. We have been especially aided by the more recent work of Dr. Lawson G. Lowrey.
Nor should we have been able to present our samples of brain correlation without drawing on the collection arranged and analyzed by Dr. Annie E. Taft, Custodian, Harvard Department of Neuropathology. The photographs, part of a collection of brain photographs now numbering over 10,000 representing 700 brains of all sorts, were made by Mr. Herbert W. Taylor.