In this article, the author studies the cases of 284 young male patients, between fifteen and thirty years of age on admission to the Philadelphia Hospital, having excluded all those who were plainly imbecile, epileptic, or paretic. After alluding to the histories of these cases, alcoholic in forty-four,—although most of these he believes, were moderate drinkers,—he asks “What relations have the doctrines of degeneration with our present subject?” and points out that Esquirol and Morel have observed the tendency of hereditary insanity to appear at puberty and in adolescence, and that the latter author more definitely states that at this period degeneration reveals itself. A degenerate history was obtained in more than three quarters of the author's cases. The anatomical marks of degeneracy also were common, but unfortunately no systematic study of these was made. Obsessions, the psychic stigmata of degeneration according to Magnan, he believes with Régis are rather actual insanities, disorders of the will on a basis of neurasthenia; coming and going with the state of nervous health they are stigmata only as insanity itself is a stigma: to serve as a real test of degeneration, a stigma must be permanent. Only by close anatomical study on a large scale with classification of stigmata, can degeneration obtain a useful clinical significance. He agrees with Morel that the theory of degeneration should be kept single and thought of mainly as related to heredity. It is important not to confuse the two uses of the word “degeneration,” the one being proper to psychiatry, the other to pathological anatomy. With Jaffray he thinks that “to be insane, the patient must be degenerate.”
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