Cases of Juvenile Psychasthenia: To 
Illustrate Successful Treatment. 
BY 
TOM A. WILLIAMS, M.B., C.M. Edin., 
CORRESPONDING MEMBER SOCIETIES OF NEUROLOGY AND PSYCHOLOGY OF PARIS, ETC.; 
NEUROLOGIST TO EPIPHANY DISPENSARY, WASHINGTON, D. C. 
FROM THE 
AMERICAN JOURNAL OF THE MEDICAL SCIENCES 
December, 1912, No. 6, vol. cxliv, p. 865 Extracted from the American Journal of the Medical Sciences, 
December, 1912, No. 6, vol. cxliv, p. 865. 
CASES OF JUVENILE PSYCHASTHENIA: TO ILLUSTRATE 
SUCCESSFUL TREATMENT.1 
By Tom A. Williams, M.B., C.M. Edin., 
CORRESPONDING MEMBER SOCIETIES OF NEUROLOGY AND PSYCHOLOGY OF PARIS, ETC.; 
NEUROLOGIST TO EPIPHANY DISPENSARY, WASHINGTON, D. C. 
Definition. The conception which Janet has formed of psychas- 
thenia is described by him in so masterly a manner as “mental 
uneasiness, a state of disquiet, feelings of incompleteness, without 
anatomical lesions.” These are interpreted by him as due to the 
diminution of “psychological tension.” Hence, the superior functions 
of the brain, those of correct associations of ideas and emotions, 
are replaced by such inferior activities as motor impulsions, such 
as tics, dromomania, and other motor agitations; emotionally by 
distress (angoisse) and morbid fears (phobias); and intellectually 
by mental ruminations and manias. It is the interpretation of 
this state by the patient of intellectual type which leads to more 
systematized obsessions, which it is useless to attack directly 
by persuasion, for they represent a much more profound cause of 
which they are only a last expression. Janet recognizes the likeness 
of this condition to that found in cerebral “neurasthenia” of the 
classic type and some kinds of paranoia. There are certain resem- 
blances also to epilepsy and hysteria. He thinks the psychas- 
thenia may be due to an intoxication or congestion, varying with 
the influence of infectious diseases, fatigues, and emotions in 
accordance with a predisposing heredity. 
The syndrome which Janet calls psychasthenia had often been 
noticed previously and described under such names as cerebral 
neurasthenia, phrenasthenia, disequilibrated degeneracy, and mono- 
mania. Janet’s great merit is to have shown the essential identity 
between manifestations which appear so different. For example, 
he has shown that agoraphobia and claustrophobia are really two 
variants of a state of fear which has become morbid by being 
inopportune and out of harmony with reality; furthermore, the 
states of phobia, or angst, are merely two of the manifestations 
which the same patient may show when suffering from psychas- 
1 Read in the Pediatiie Section, Am?r. Med. Assoc , Atlantic City, June, 1912. 2 
williams: treatment of juvenile psychasthenia 
thenia. Motor impulsions, of which the tics are a striking example, 
are merely another way in which is expressed the fundamental 
state of “incompleteness.” 
In some patients neither emotional nor motor symptoms are 
conspicuous; but the asthenia of the psyche reveals itself by a 
state of intellectual doubt, by need for verification of minute 
details, indecision, and a feeling of difficulty in arriving at certitude 
regarding the reality of anything. Janet considers the last the 
cardinal symptom of psychasthenia, and calls it “the loss of the 
function of the real.” Naturally, this leads to a longing for moral 
support, comfort, and affection, and entails a fear of being 
alone, or in extreme cases, sometimes the moral distress leads the 
patient to relieve it by artificial excitants. Work and pleasure 
may be employed; but too often nepenthe is sought in narcotic 
drugs or debauch. 
Psychasthenia in Children. The full syndrome is only 
possible in people of complex intellect with highly developed 
emotions. Hence, children can hardly show it completely. Janet, 
moreover, studied psychasthenia in children only retrospectively 
through the reminiscences of his many patients. Although he 
himself indicates the conditions in childhood which favor the 
psychasthenic state, he has not unravelled its genesis so com- 
pletely as have more recent analysts of psychoneurotic persons. 
All agree that the scrupulosity and over-conscientiousness 
which mark the psychasthenic character are the result of over- 
strict training ill-adapted to the need for untrammeled unfolding 
required for a child’s proper development. The moral and religious 
sanctions which appeal to the adult are injurious to this develop- 
ment, unless they are specially adapted to a child’s intelligence and 
needs. 
This opinion, although well founded, is based upon wide obser- 
vation rather than upon individual analysis of children; for I know 
of no psycho-analyses of young children by trained men, with the 
exception of one made on a five-year-old boy by Freud, which is 
vitiated as an experiment because the boy’s mother had been 
analyzed by Freud and was herself permeated with his ideas, so 
that it is impossible to exclude the influence of these upon her 
child. 
Thus it is particularly gratifying to be able to bring forward some 
observations on psychasthenic children whom I had the opportunity 
of analyzing. More especially is this satisfactory because recovery 
was obtained in each case, and best of all, this occurred without 
the enormous expenditure of time which is believed to be essential 
for reaching the curative point in a psycho-analysis. Working 
against time to catch a train, three-quarters of an hour sufficed in 
the first case, and not more than an hour was consumed in the 
examination of the second case. In both cases, however, the history williams: treatment of juvenile psychasthenia 
3 
had been previously obtained. The third case, in an older child, 
more complex, although not completely analyzed, was cured as a 
result of four interviews which averaged less than an hour each. 
This economy of time is only possible to one who is experienced 
in the technique and psychopathological data, so that he may 
not be led by false scents to explore by-paths without practical 
significance. When this capacity is attained, the method can be 
employed in private practice; and even dispensaries should not 
be deprived of its advantages,2 for there are few procedures of 
practical medicine in which the direct benefits are of greater value 
than in the restoration to economic and social capacity of the 
suffering psychoneurotic, who is not only a sufferer himself, but a 
burden to all his connections.3 
Tics from Monomania. Case I.—A girl, aged eight years, 
an only child, was sent to a Washington sanatorium because of 
numerous grimaces and gestures. These led her attendants to 
believe she suffered from chorea, to give her large doses of arsenic, 
and to isolate her from her friends, while overfeeding her. At the 
end of a month she returned to the country, the morbid movements 
having ceased, but she suffered from insomnia and was unable to go 
to school, in the belief of the parents, because of her “nervousness,” 
which was especially conspicuous when reading and studying was 
required. When she was nine years old I was asked to see her 
by her uncle, Dr. Perry, of Lyons Creek, Maryland, in the hope 
that something further could be done. 
I found a well-nourished, self-contained, sensible child, without 
apparent shyness, overforwardness, or hyperexcitability; but she 
was apt to talk rather fast, and stammered now and then. I soon 
discovered that she was fond of play and the companionship of 
which she had been deprived, to compensate for which she made 
believe that the objects and persons of her play were real. So 
rigorously was she protected that the conceptions of lying and 
stealing were hardly clear to her. She had been strictly managed, 
scolded, and repressed a good deal. She was once whipped for 
persistent dawdling on her way home from school. She did 
not remember other corporal punishments. Her life, however, 
was not felt to be unhappy; for she was very obedient, and was 
not galled by the good manners expected of her. However, she 
wanted to grow up, hated people to call her little, and disliked the 
spoiling which was a tendency of her father before her sickness. 
Although she did not repine at staying from school, she wished to 
learn to read and write; but as lessons agitated and kept her awake, 
she employed herself in play. 
2 See author’s “ Care of the Mentally Disturbed,” New York Med. Jour., September 29, 1912, 
in which is described the organization of such a hospital and dispensary. 
3 The basic principles upon which are founded the methods of management of cases of this 
kind were first set forth in the author’s “Psychotherapeutics: A Symposium,” in 1909, in the 
chapter on ‘‘Psychoprophylaxis in Childhood;” also in Jour. Abnormal Psychol., June, 1909. 4 
williams: treatment of juvenile psyciiastiienia 
The source of the movements she had made was revealed after 
some hesitancy. It seemed that her mother had taught her, when 
aged about five years, that people lived by inspiring the air and 
what they expired was hurtful. This thought led to a distressing 
compunction about the noxiousness of her breath; if it was bad it 
must hurt others. 
Now her training had been such that to hurt others was a great 
offense; but not to breathe was to die. Out of this dilemma she 
found a way. Hurts could be mended; when injured did not some 
one “kiss it better’’? Could not she then kiss better her own 
bad breath so that it would not injure others’ Accordingly she 
made movements of her lips, which represented the healing kiss to 
ward off the danger of the deadly air she expired. 
Later on her discontent was augmented by scruples against the 
injury she did by walking upon creatures with the hard and sharp 
heels of her shoes. Even the planks of the floor were of the ani- 
mated world, which it was wrong to destroy or injure. To assuage 
the distressing thought of this, compensation must be made. She 
found it in another legendary therapeutic procedure, the healing 
touch. So it became her habit, before walking over an object, to 
bend and touch it with her hand. 
These procedures belong to the class of mental manias which 
Janet has called manias of expiation. In their motorial character 
they approach the tics, into which they gradually blend. That they 
had done so to some extent in this case is shown by the fact that 
the kissing nature of the lip movements had not been suspected. 
That the movements had not developed entirely into mere 
symbolic vestiges of their original purpose was due to their arrest 
comparatively early. That they would have developed into 
characteristic tics4 is confirmed by the distress the child suffered 
in overcoming them. She did so after being in the sanatorium a 
few days, and did it deliberately and by a hard struggle, because 
she wished to return home, and they had promised that she could 
do so if the movements ceased. It is possible that the nurse who 
said this had an inkling into the psychological character of the 
child’s disorder. After she succeeded, the desire to repeat the 
movements quickly ceased, although she does not know that she 
was enlightened regarding her notions about the hurtfulness of 
expired air and hard heels. 
Proceeding to the genesis of the insomnia and difficulty in 
reading and study, interrogation showed a simple mechanism. 
Apprehension as to their consequences was raised in the child by 
the attitude of the parents, whose open fear lest they should perturb 
the child reminded me of the procedure of the mother of the boy 
4 The nature and diagnosis of tic is discussed by the author in the Southern Medical 
Journal, August, 1909; Monthly Cyclopedia, January, 1910; International Journal of Surgery, 
August, 1910. williams: treatment of juvenile psyciiastiienia 
5 
whose hysterical hydrophobia was precipitated by her sitting by 
his bed reading about rabies two weeks after he had been bitten 
by a supposedly mad dog.5 So in this case the ostentation of their 
solicitude provoked in the child that which they feared. 
Treatment. The explanation of these mechanisms to both 
parent and child was the first task, and it proved simple, for they 
were intelligent people. The corollary that the child was not 
morbid except by induction was then set forth. The conclusion 
was that the child should resume study and return to school in 
the fall in every respect like an ordinary child, now that the mother 
and father were warned against the evil consequences of unwise 
solicitude, and the induction of hyperconscientiousness in matters 
beyond the intelligence of a young child. The result has justified 
expectations, the child taking part in the school life with enjoyment. 
Some might explain the case as a “fear wish” reaction of the 
sedipus type in relation to father and mother. Indeed, to the 
exponents of the theory upon which it depends the patient’s 
history is not without significance, and in the absence of a dream 
analysis they cannot be satisfied in rebuttal. The fact, however, 
rests that a painful complex originating at least by the fifth year 
had resulted in psychogenetic symptoms, and this complex depended 
upon a moral concept in which the sexual life seemed to play no 
part whatever. 
This plain mechanism of fear of bodily harm from without seems 
to be a much more fundamental feeling, if one is to appeal to phy- 
logeny, than is that concerning the relations with others termed 
sexual. Even hedonic affects occurring autochthonously in child- 
hood, although of the same genus as that which later effloresces into 
sexual emotivity, do not by any means in themselves give origin 
to perturbations of the psyche either in childhood or later. I say 
in themselves, for I believe that the perverted affectivity from which 
arise so many obsessions, phobias, etc., is always the product of 
induction, if not directly and naively from without, at least by 
logical induction from data acquired by observation or didaction 
of the conventions of family and social life. The child’s avidity 
to relate himself correctly to these, to behave as a grown up, that 
being of marvelous privileges, is not sufficiently realized. It makes 
him seize upon the most trifling detail for imitation. One of his 
objects is to transcend the amusement he provokes in trying. 
The shame he feels at the ridicule with which his attempts are so 
often met causes him to keep them to himself in half shame. 
Case II.—Thus in a case of which the analysis occupied over 
a year, and would accordingly take too long to recount, the obses- 
sions, which were mainly sexual scruples fundamentally, had as 
their basis the moral and religious repressions of the patient’s 
5 Miller, Jour. Abnor. Psy., 1910. 6 
williams: treatment of juvenile psyciiastiienia 
childhood. It was the horror and loathing of everything per- 
taining to the corporeal which caused the child, when aged six 
years, to look upon a hedonic state which used then to occur as a 
sinful one, which prevented even speaking of it to the mother, and 
which was the incentive for the repression of indulgences demanded 
by a most affectionate nature, for in the family all display of 
affection was discountenanced. It was the lurking fear of that 
which was awful, because unfaced and vague, but which con- 
tained inexplicable potentialities for evil, which later permeated 
the patient’s relations with fellow-beings to a degree which pro- 
duced utter incapacity for daily life. 
Prepuberal Impulsions. Case III.—Let me ask you to 
contrast on the one hand the loss of a quarter of a century of 
fruitful activity by this patient, the lack of good sense in whose 
upbringing was so late compensated for by what we have learned 
of psychopathology: with the immediate compensation of an 
entirely similar syndrome in a clergyman’s child, aged ten years, 
whom I saw recently. One day she would be well and the next 
crying, feeling miserable, tired, and dizzy, with a dull headache 
as a result of lying in bed thinking. The preceding summer at 
school she had been irritable, cross, impatient, and quarrelsome 
with her sister. She had formerly been easy to manage and full 
of life and joy. Her mother was most anxious, and took pains to 
avoid startling or fatiguing her, and in the belief that it exhausted 
the child, forbade the impulsive squeezing and kissing which the 
child frequently desired. She had noticed that the little girl was 
less impulsive and irritable when having something to do, but she 
had been taken from school, which seemed to aggravate her 
nervousness. 
The physical examination was negative, with the exception of 
a slight hyperopic astiginia and a variable visual acuity without 
apparent cause (Dr. F. N. Chisholm, who referred her). 
Psychically, intelligence was normal. She was timid, hyper- 
conscientious, and much concerned at having been reproved for 
impulsive shouting, for violent hugging of her parents, and because 
of some eau de cologne she took. This had really been taken by 
the little sister, who was punished for it. She was sometimes so 
unhappy and miserable that she did not want other children near 
her, and she was most unhappy because she was not allowed to 
show her affection for her father and mother, of whom she is very 
fond, more especially of the latter. Iler dreams are rare, but she 
recollected one of a white-bearded man who dragged her from the 
bed by her hair and another of a wild animal trying to eat her. I 
could not at the time obtain any associations from either of these, 
and, indeed, I was more concerned relieving without delay the 
intensity of the repressions which made the child’s life a burden. 
A physical factor complicated the case, the child eating excessively williams: treatment of juvenile psychasthenia 
7 
of meats and oatmeal, and making her principal meal at night. 
I believed this was the initial cause6 of the irritability of temper 
and the impulsiveness which led the overconscientious parents to 
repress overmuch. 
Treatment. Mid-day dinner was prescribed, and a supper 
mainly of carbohydrates and fruit, after which she should not go 
to bed for at least an hour. On waking in the morning the child 
was instructed to make a practice of getting up and going outside 
instead of ruminating in bed. The parents were told to avoid 
nagging her about trifles, and her behavior was to be left to take 
care of itself at present. Her affections were to be indulged and 
reciprocated; she was given plenty to do, and was sent back to 
school in a few days. This policy resulted in complete recovery 
within two weeks, the child being as happy and joyous as she 
formerly was. 
Diagnosis. I considered this a prepuberal emotionalism attrib- 
utable to an incorrect dietary and greatly aggravated by parental 
interference, well meant but entirely injudicious. This last, the 
psychogenetic factor of the situation, was the main pathogen of 
a state which might have eventually attained a gravity like that 
of the case with which it contrasts. 
Thus the psychasthenia of this little girl was cut short long 
before its root branched into mental manias or before there was a 
hint of obsessions or phobias. It may astonish one that I include 
this case in the psychasthenia of Janet, as it is without the stigmata 
or cardinal symptoms of that disorder, if we except the impulsive- 
ness and the inadequacy which were hardly even conscious. The 
justification of such a diagnosis need not, however, detain us, for 
it has been set forth in explanation of the case of a child, aged only 
two years, which I reported to the Psychological Society of Paris 
in 1910.7 
Multiple Manias of Expiation. Case IV.—However, in the 
following case the psychasthenic syndrome was in full efflorescence: 
A boy, aged thirteen years, was referred by Dr. Guy Latimer, of 
Ilyattesville, Md., because of extreme timidity, many “nervous” 
tricks, and an inability to concentrate his attention. The most 
conspicuous symptoms were an arithmomania, a mania for veri- 
fication, including a “delire de toucher” and a “manie du sort,” 
one of the forms of which was the imperative need of lying on his 
back on the floor at frequent intervals while dressing in the morning. 
These various mannerisms intermitted and replaced one another. 
Analysis revealed that all were in reality expiatory penances for 
a jealousy of his little brother, which had already begun at the age 
of three years, when he asked that the baby be thrown from the 
8 See author’s “Diet in Nervous Disorders,” New York Med. Jour., April 6, 1912; Canada 
Public Health Journal, June, 1912. 
7 See also Arch, of Pediat., 1910. 8 
williams: treatment of juvenile psychasthenia 
window, and once banged his head on the floor while enraged. lie 
himself had always been much petted, and he craved it. It was 
the reproval of an aunt which first created the shame for his jealousy 
and led him to make penance in these fashions. Latterly, he had 
been urged to cease his peculiarities, and can stop any of them 
when on the alert by a hard struggle. His distress at doing so, 
moreover, soon passes away. But his frequent absence of mind in 
day dreams, which he loves, interferes with his endeavors. This 
tendency was favored by his not having been allowed to play the 
games of which he is fond with the boys in the neighborhood, 
which is a rather rough one. 
This desire for expiation began when he was aged between three 
and four years, by thinking it was mean not to give his toys away 
and so he gave them all to his brother. He was told that it was 
naughty to be jealous, and he felt ashamed, but did not cry, but 
just sank into himself and said nothing. He still reproached 
himself. If his mother did not pet him for a week he thought she 
did not care for him, and so he would be unhappy. 
He does not know the reason wThy he is jealous of his brother, 
for he loves him, and they do not quarrel much, even when the 
other cheats at play. It is in the morning and at night that he is 
most beset by his manias, and he feels things would go wrong 
night or day if he did not perform them. He declares: “I always 
seem to want to do something I do not want to, because I do not 
want to.” He does not know why. He has no shame of body or 
sex, as he has been fully instructed. He is very religious, believing 
in heaven and hell, that he must be good, and feels that he ought 
to make himself sad because he does not like to be sad; but he is 
so prone to sadness that even as a baby music made him cry. So 
conscientious is he that he undertakes every task with too great 
violence, quickly becomes exhausted, and then has to fight against 
the dreamy tendency which supervenes. 
Treatment. Having explained together the genesis of his 
desire for penance, we decided to concentrate attention upon only 
one of his manias at a time, in order to break one by one the habits 
he had formed, and he was to take up carpentry work in order to 
combat the tendency to day-dreaming. Ilis diet was also rectified. 
More and more control was soon obtained. On last hearing 
from him, a year later, he had taken a position, and had overcome 
his disabilities. 
The psychogenetic factor in this case was obviously the unwise 
manner in which an affectionate infant’s natural jealousy was 
reproved by over-religious relatives. The awfulness of the sin 
fostered the poor boy’s shame thereat, and led him to the type 
of expiation which follows from a misapplied asceticism. 
Genetic Types of Psyciiasthenia: Relation to Hysteria, 
etc. Thus in its essence psychasthenia arises as a reaction of williams: treatment of juvenile psyciiasthenia 
9 
discomfort and anguish against unnatural repressions. It is psy- 
chogenic in this form; but there is perhaps another type which 
precedes from a general uneasiness of the body due to a toxic 
factor. 
Case V.—Such was the case of a child, aged two years, whom I sawr 
in the dispensary at the Children’s Hospital, of Washington, with 
Dr. Donally. Distressing howling without relation to extraneous 
stimuli, the eating of sand and clay, the maintaining of a large 
deep sore on the wrist by scratching were among the chief symptoms 
which betrayed her general discomfort, against which these were 
morbid reactions. I interpreted them as due to what would have 
been shown in older people by a sentiment of incompleteness. The 
cause was believed to be a diet almost exclusively of strong coffee 
and milk since the age of three months. The case was reported 
in full to the Society of Psychology of Paris, and was published in 
Pediatrics, 1910. 
A Symptom which is Usually Psychoasthenic is Stammering. 
Case VI.—The ten-year-old son of a Washington attorney was 
referred in November, 1910, by Dr. Spiller, of Philadelphia, for 
advice regarding a stammer of two years’ duration and for “general 
nervousness.” 
A brother who had formerly stammered at the same age had 
recovered after six months spontaneously; but the expectations 
of the parents that this boy’s stammer also would disappear were 
not fulfilled. lie stammered worse when tired or when intent upon 
speaking correctly. In play, he rarely stammered, and a sentence 
was never interrupted by a stammer. The boy was fidgety, espe- 
cially on speaking; but his writing was not jerky. His attention 
was easily tired. He was not overstudious. He did not tremble. 
He was not constipated. He detected differences of pitch. 
Ilis chest was contracted in front, and measured during quiet 
speaking twenty-three and one-half inches, expanding to twenty- 
four and one-half inches. By forced inspiration it could reach 
twenty-nine and one-quarter inches. In singing he expanded to 
twenty-seven and one-quarter inches. The scaphoid scapula was 
not present. 
I omit the detailed psychic examination for the sake of brevity. 
In short, the cause of the stammer was a common one, the dread 
lest he should stammer, added to or supplemented by an insufficient 
preliminary inspiration. The attempt to force the voice to over- 
come these difficulties only added to the glottic spasm, and the con- 
tortion of the muscles of forced expiration due to his apprehension. 
A series of exercises in control led to his recovery in a few months. 
Now the treatment of this boy succeeded only by virtue of taking 
into due account the psychoasthenic factor in the production of 
his stammer; and while that was attended to, the boy remained 
well for several months. When a few months ago this was neglectt d 
a relapse occurred. 10 
williams: treatment of juvenile psychasthenia 
The fact that a disorder may be psychogenic does not identify 
it with hysteria, the psychogenic disorder par excellence. There is 
still much difference of opinion how we shall define hysteria; but 
as I see it, the essential character of the disorder is that it is induced 
by an idea. This may be either revived from the patient’s mind 
by an occurrence which strikes an associating idea or it may be 
direct by what is regarded as suggestion. The mechanism is the 
same in each case, and the term suggestion is appropriate for both.8 
The induction which results in psychasthenia, unlike that in 
hysteria, is indirect. The patients indeed are not suggestible, 
and cannot be hypnotized as can hystericals. What is induced is 
a general state of ashamedness, timidity, and scruple; and it is 
from this morbid root which spring, by psychological processes 
entirely natural, the train of ruminations, anxieties, morbid fears, 
and manias to touch, to count, to search the past or future, to 
explain, to verify, and repeat, to attain perfection, and the mysti- 
cism which springs from this desire. The mania to compensate, 
to expiate, and to make compacts with Fate, too, proceed from a 
feeling of unworthiness which a scrupulous person has. From this 
root spring also the morbid fears of objects, of situations, even of 
one’s own thoughts and bodily functions. The anxiety neurosis is 
simply one of the ways in which is manifested the psychasthenic 
state. A full discussion of the reason for the belief in disagree- 
ment with Freud is given by Janet, but would take too long to 
recapitulate. 
The relation of psychasthenia to tic has been indicated above. 
The impulsion to tic is derived from the general discomfort and 
nervous instability being focussed by peripheral or central irrita- 
tion upon some particular part of the body or upon some action. 
One type of occupational dyskinesis is an interference with the 
action desired through an impulsive tic which takes possession of 
the muscles needed for the desired act. In the author’s9 studies 
of writer’s and telegrapher’s cramps, this is discussed at greater 
length. 
Finally, neurasthenia must be considered. I am of those who 
believe it advisable to cease the use of this term, or at least to 
restrict it entirely to cases of abnormal fatiguability which is not 
induced by an idea nor caused by infections or toxines, disorders 
of metabolism or perturbations of the internal secretions. It is 
certain that psychasthenic symptoms appear quite apart from 
fatigue, which psychasthenics can sometimes support for long 
periods. Hence the treatment of the disease by extranutrition, 
rest, or any physical procedures is in psychogenic cases both 
8 See Nature of Hysteria, Int. Clin., 1908, iii; also Amer. Jour. Med. Sci., August, 1910. 
8 Jour. Psych, u. Neurol., Leipzig, May, 1912; see also Jour. Abnorm. Psych., June-Sep- 
tember, 1912. williams: treatment of juvenile psyciiastiienia 
11 
superfluous and harmful, in that it detracts attention from the 
real source, namely, the psyche of the patient. 
For Correct Treatment. Proper knowledge of the constitu- 
tion of the mind of the child is the only foundation upon which to 
build this successful therapeusis. The diagnosis into categories, 
such as hysteria, neurasthenia, phobia, monomania, followed by 
an empirical treatment, is utterly useless because not accompanied 
by adequate notions of the process occurring in the mind of the 
patient. Doctors who treat neurotic persons with such inadequate 
equipment will meet with even less success than do the followers 
of an unlicensed cult; for these have a conception, however erron- 
eous, of psychological mechanisms, and it is a conception which 
happens to fit a certain proportion of cases, whereas the usual 
physician’s conception fits none at all. And a neurotic who gets 
well under his care does so not because of his medical treatment. 
Now psychological mechanisms are most pure, and hence most 
easily understood in children; and it is in order to appeal to 
pediatrists and physicians for proper study of the nervous chil- 
dren they see that I bring before the profession the foregoing 
considerations. 
I should like to add that one of the reasons why pediatrists do 
not take more interest in neurotic children is because the books 
generally take this subject up in such an unsatisfactory, vague 
manner. Epithets rather than causal mechanisms seem their 
aim. My paper is an attempt to show some mechanisms at work 
in individual children. The analysis and therapy do not require 
any special ability, merely a serious study of the child’s usual and 
unusual modes of thought. Most of us can study this upon our 
own children. Besides, the analysis is easier than in the adult, 
for a child has less complicated motives for concealments. 
Psychic disorders should be observed and analyzed clinically by 
a scientific method essentially similar to that used in all clinical 
and experimental medicine. Loose general terms have no diag- 
nostic value until conceived with definite meaning. Such an 
olla podrida as “neurasthenia” must be either restricted or abolished 
if progress is desired. 
Of the cognomen hysteria the same may be said, unless the 
term is used in a definite sense like that of Babinski, “ any symp- 
tom producible by suggestion.” The lesson of my cases is not 
the cognominal diagnosis, psychasthenia, but the revelation of the 
mechanism of each separately, and its removal by rational measures 
very different from those found in any text-book of pediatrics or 
even neurology. THE AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES 
Edited by George Morris Fiersol, M.I). Monthly. Illustrated. 1920 pages 
yearly. Price, $5.00 per annum. 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, founded in 1820, has 
long been recognized as the leading medical journal of the English-speaking race. From 
the first it sought the epoch-making papers, and becoming recognized as their medium, 
it has, in turn, been sought by those who have had discoveries or real advances in the 
art and science of medicine to announce in its Department of Original Articles. During 
1912 The American Journal will still further develop a feature that has proved most 
useful and popular, namely, a series of Special Articles, written by prearrangement with 
men of the highest authority, and covering present-day topics of the greatest impor- 
tance and interest. These articles are designed to be clinical and practical, and to present 
important advances and the latest knowledge clearly and concisely, with particular reference 
to application in daily work. The Department of Book Reviews will continue to comprise 
critical and discriminating estimates of important new books, as well as briefer notices of books 
of less importance and of new editions. The Department of Progress of Medical Science, 
under the charge of recognized specialists, will continue to summarize the actual advances in 
the art and science of medicine appearing in the leading medical periodicals of the world. 
PROGRESSIVE MEDICINE 
A QUARTERLY DIGEST OF ADVANCES, DISCOVERIES AND IMPROVEMENTS 
IN THE MEDICAL AND SURGICAL SCIENCES, COVERING THE ENTIRE DOMAIN 
OF MEDICINE. Edited by Hobart Amory Hare, M.D., Professor of Therapeutics 
in Jefferson Medical College, Philadelphia; Physician to the Jefferson Medical College 
Hospital, etc. Assisted by Leighton F. Appleman, M.D., Instructor in Therapeutics, 
Jefferson Medical College, Philadelphia. In four octavo volumes, containing 1200 pages, 
amply illustrated. Annual subscription price, in heavy paper covers, $0.00, net; in cloth 
binding, $9.00, net. Carriage paid to any address. 
PROGRESSIVE MEDICINE is the story of the progress, discoveries and improvements 
in the various branches of the medical and surgical sciences, and is published four tiroes 
a year, in March, June, September and December. The matter presented is the digested 
essence of the entire medical literature of the world published during the previous twelve 
months, modified, explained and criticised in the light of the personal experience of the con- 
tributor. By this method useless information is discarded and only that which is valuable and 
really helpful to the practitioner is retained. Practicality and thoroughness are the controlling 
features. The contributors are authorities in their respective lines, and their experience in 
private and hospital practice enables them to choose unerringly that which their brother 
workers require. Every article is original, the veritable product of the author whose name 
it bears. The style is narrative in form, hence easy to read. The interpretation of the facts 
stated is given and their bearing upon the whole subject under consideration is clearly and 
simply indicated. 
COMBINATION RATES 
The American Journal of the Medical Sciences per annum, $5 00 
Progressive Medicine (heavy paper covers) “ 6 00 
Progressive Medicine (cloth binding) “ 9 00 
Progressive Medicine (paper covers) and the American Journal “ 10 00 
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