191 1 ] A. J. ROSANOFF AND FLORENCE I. ORR 233 



notorious fact that most of the so-called clinical entities are 

 remarkable for the variety of their manifestations. This fact has 

 necessitated the introduction in clinical practice of the conception 

 of neuropathic equivalents. Thus notably in epilepsy it has long 

 been found necessary to bring- together such manifestations as 

 fainting spells, convulsive seizures, psychical attacks, brief ab- 

 sences, spells of automatism, periodic dipsomania, etc. 



More recently Kraepelin has shown that certain depressions, 

 manias, circular and mixed states are but various phases of the 

 same underlying constitutional disorder analogous to the various 

 equivalents of epilepsy."* And Dreyfus has been able to establish 

 the fact that the anxious depressions of the involutional period 

 are but a special variety of manic-depressive insanity ."^ 



Similarly, in one immense group, under the general heading of 

 dementia prsecox we now, following Kraepelin, include such 

 widely contrasted conditions as simple hebephrenia, catatonia, 

 and delire chroniqiie a evolution systematiqne — conditions which 

 were long regarded as independent clinical entities. 



Thus in clinical psychiatry progress has been marked by a 

 simplification of classification through a far-reaching extension 

 of the conception of clinical equivalents. 



Some of the data furnished by our material seem to indicate 

 the necessity for a still further extension of this conception. It is 

 interesting to note that what we learn in institutional experience 

 to recognize as insanity is a comparatively uncommon group of 

 manifestations of the neuropathic constitution, for of our total 

 of 437 neuropathic subjects (not counting the 21 who died in 

 convulsions in early childhood) only 115, or 26.3 per cent, pre- 

 sented at any time in their lives indications for commitment to 

 sanitariums or hospitals for the insane; moreover, it is obvious, 

 where the facts are known in detail, that in most cases in which 

 such indications have occurred they were in the shape of special 

 reactions to special environmental conditions ; and it seems equally 

 obvious that our definition of the various types of neuropathic 

 constitution must be in terms not of such special reactions, but 

 rather of the more stable and more general underlying psychical 

 traits and tendencies. 



" Kraepelin, Psychiatrie, 7th ed., Vol. II, p. 558. 



"^ Dreyfus, Die Melancholic, ein Zustandsbild des ntanisch-depressiven 

 Irreseins, Jena, 1907. 



