MONOGRAPH NUMBER TWO OF THE PSYCHOPATHIC HOSPITAL BOSTON, MASSACHUSETTS BOSTON W. M. LEONARD, PUBLISHER 1917 _Copyright, 1917. By W. M. Leonard_ =In= MASSACHUSETTS A STATE THAT BOTH TOLERATES AND FOSTERS RESEARCH ------------------------------------------------------------------------ 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.