“This fear has been spreading and has become quite extensive, involving my family, my children, my friends, my acquaintances, and my patients. Usually I ignore these fears, or get control over them by an effort of will. When, however, I happen to be fatigued, or worried over small things in the course of my work, or happen to be in low spirits by petty reversals of life, these fears may become aroused. Under such conditions I may become afraid, for instance, of drinking milk, because it may be tuberculous. “This fear may spread and involve fear for my children and my patients; or again I may be afraid of eating oysters and other shell fish, because they may be infected with typhoid fever germs. I may refuse to eat mushrooms, because they may be poisonous. The other day I was actually taken sick with nausea and with disposition to vomiting after eating of otherwise good mushrooms. The fear seized on me that they all might be poisonous ‘toadstools.’ Such fears may extend to ever new reactions and to ever new associations, and are possibly the worst feature of the trouble. “I have a fear of coming in contact with strangers, lest I get infected by them, giving me tuberculosis, influenza, scarlet fever, and so on. This mysophobia involves my children and my friends, inasmuch that I am afraid that strangers may communicate some contagious diseases. A similar fear I have in regard to animals, that they may possibly be infected with rabies, or with glanders, or with some other deadly, pathogenic micro-organism. I am afraid of mosquito bites, lest they give me malaria, or yellow fever. The fears, in the course of their extension, may become ever more intense and more insidious than the original states. “As a child I had some bad experiences with dogs; I was attacked by dogs and badly bitten. Although this fear is no longer so intense as it was in my childhood, still I know it is present. My heart sometimes comes to a sudden standstill, when I happen to come on a strange dog. When the strange dog growls and barks, all my courage is lost, and I beat an inglorious retreat. It is only in the presence of other people that I can rise to the effort of walking along and apparently paying no attention to the dog. This is because I fear the opinion of others more even than I fear the growls of dogs. My social and moral fears are far greater than my purely physical fears.