to him of it.

two or three days he felt quite prostrated, and In the youthful recollections of Sonia Kowalewvery melancholy. He was possessed by a cer- sky she says that she and her sister knew of tain anguish and irritability which could hardly Dostojewsky's disease, but never dared to speak be mastered. He felt himself a criminal guilty He himself once introduced the of some offense unknown to him. One of his subject and told how the first attack came about. characters in "The Karamasoff Brothers" suf- It was something as follows: While in exile he fers in the same way and for the same reason. had been punished in the house of correction. Milukoff, another who knew him, speaks of cer- He was isolated from his fellow beings and could tain alleged peculiarities of Dostojewsky, such exchange ideas with no rational person. Sudas avoiding acquaintances on the street, refusing denly an old friend visited him, on an Easter to acknowledge greetings in society (he even night. Forgetting the sacredness of the occaswould ask, "who is that man," when greeted by ion, both began to converse on literature, art, some friend). Milukoff admits that such things philosophy and religion, during which hours may have occurred, but is certain that if Dosto- passed. The friend was an atheist while Dosjewsky behaved in that manner it was after an tojewsky was a believer in Christ and immortalattack. Dostojewsky had once taken tea at ity, and an argument started. Dostojewsky beMilukoff's house, and just as a glass was handed came greatly excited. It was now early mornto him he turned pale, began to totter and as ing and the bells began to call the faithful to soon as he was led to a sofa he had a fit. Fifteen minutes later he asked what had befallen him. When told he should stay all night he refused decidedly, saying he must go home, but couldn't or wouldn't give a reason for going. He even refused a carriage to the station, saying he needed the walk. His host nevertheless went along. As they were passing through a park Dostojewsky came to a halt and whispered that he felt an attack coming on. He was led to a bench but no attack appeared. There were two similar false alarms before Dostojewsky reached the station where a relative was found who took the train with him. Next day Milukoff visited Dostojewsky at his home. The latter was very weak and did not at first recognize Milukoff.

It appears from Solowjew that Dostojewsky had his first attack while in exile and was never afterwards free. He remembered down to the finest details everything which happened to him before the disease appeared,-every event in his life, every face, everything which he had ever read or heard. But of that which happened after the first attack, much has been forgotten. He often completely forgot those who had been well known to him. He even forgot much that he himself wrote. In writing his romance, "The Devil," the contents of the book were forgotten and he often had to reread the preceding chapters before he could go ahead with the story.

arise. Dostojewsky felt a sense of ecstasy, thought he was in Paradise (as was also Mohammed, another epileptic). During this ecstasy the first attack appeared.

While he spoke thus to the sisters, his mouth failed to articulate, his facial muscles twitched, he evidently saw the fear and anxiety in the girls' faces, they feared that an attack was due. He smiled and told them not to be afraid as he always knew when an attack was pending. However, he told them later that he had had an attack at the time.

From the preceding testimony there can be no doubt that Dostojewsky had epileptic attacks. In the first attack the sound of church bells was an auditory aura. Dostojewsky admitted afterward that no bells really rang. The unspeakably ecstatic feeling was associated with nearness to Heaven or Paradise.

For two or three days after the attack Dostojewsky was in the twilight state. The morose nature and great irritability showed the extraordinary action of the disease upon him. wrote "The Devil" when his disease was beginning to tell on him, as was plainly evident in the character of the book. The circumstantial, detailed treatment is characteristic of the epileptic activity, and as a result the work lacks in cohesiveness. Malice and intolerance are also shown to a remarkable degree. Solowjew states that after a crisis Dostojew- The preceding covers the period of 1860 to sky was often insufferable. His nervous state 1880. It should be added that Dostojewsky had was so marked that he was quite irresponsible. a mania for roulette. In 1863 he started on a He often came in the room like a black cloud, tcur but lost all his money in this way, and this forgot to greet people and sought opportunities happened more than once. During this period to quarrel. It appeared to Dostojewsky that the attacks were unusually frequent, and he was everything which was said to him was vexing, doubtless insane as a result. He had a fixed insulting, or it was done to excite him. The belief that he would win and once was 4,000 conversation had to be brought to his pet franes ahead and not playing. His wife begsubjects about which Dostojewsky would then ged him to be satisfied, but as he had sometimes been 30,000 francs ahead while playing, this become enthused. After an hour of such gentle treatment Dostojewsky would be in the best was impossible. He lost everything, even his own and his wife's personal belongings. How humor. Only his pallor, brilliant eyes and infantile, foolish or defective this may have heavy breathing showed that he was mentally been I shall leave others to judge. The indictdisturbed. Such changes of mood are often ment is only so strong as one is inclined to perfound in Dostojewsky's books sonally make it.

As far as known Dostojewsky was very tem-talent, is a character named Murin, an old man, perate in both eating and drinking. He was in whom we see the "epileptic character" withfond of sweets, was a heavy smoker and con- out any effort. He has the moods of Dostojewsumed much tea and coffee. But little is known sky when the latter was young. The attacks of any affairs with women. As already stated, described, however, are crude, as any layman he was married. He was born in Moscow in might view them. The influence of alcohol on 1823 and was the son of a physician. Their epilepsy is shown, Murin has a seizure after circumstances in life were moderate and Dosto- drinking a glass of wine. jewsky led a life confined in small compass. Not much is known of his childhood. The mother was sickly and died of consumption in 1836, so young that Dostojewsky was raised partly by nurses who told him gruesome stories. He was very impressionable and imitative, and was on the lookout for the novel. The father under took the boy's education. He was a stern man, a military physician, and was a stickler for discipline.

The second type is represented by "Nelly" in a work written in 1861 after Dostojewsky had been banished and had had time to study his own case. The influence of heredity is shown in this work. The grandfather (maternal?) was "odd." The mother was exalted, readily excited and inclined to reveries. Her stubbornness in holding certain ethical views was readily mistaken for a strong will. The child's life was miserable and became worse In 1831 the boy moved to the country and after the mother's death. She was of prothere plunged into rural life, developing a love nounced epileptic character. Her attacks are for nature, and became absorbed in folklore described as follows: "After a prolonged stare from peasants. He was much given to revery. (at some person) she gave a fearful cry, her As a reader he was precocious and he limited face was distorted, and she fell to the floor. himself to literature proper. He was a great After the convulsions she looked fixedly at the admirer of Pushkin, whose death in a duel oc- same person as if trying to collect her thoughts. curred near that of his mother's. These deaths At last her face lighted up as she began to comgave him a great shock. It is authentically re- prehend. For a long time she could not collect ported that he lost his voice, probably a psy- her thoughts and murmured meaningless words. chogenic episode. For a long time she did not fully regain her In 1837, when Dostojewsky was nearly fifteen, senses. Reality was much mixed with fancies, he entered the School of Engineering at Peters- and it seemed that something fearful excited burg and remained four years there, but found her soul. Finally she fell into a deep sleep. the discipline very severe. He developed tuber- She was pale and her lips were still bleeding. culous symptoms which would seem to have Her face, despite the sleep, showed great fear been little more than scrofulous glands. His and a painful longing. Once when Nelly was cough may have been due to excessive smoking. requested by the physician to take medicine, He remained an engineer only until 1844, when she spat it out three times in succession in his he at once devoted himself to his first novel, face. Astonished at his good nature she began "Poor Folks." Soon afterwards he became a to sob in despair." In this work we see exmember of a literaray coterie to which belonged citability, moodiness, sensitiveness, suspicion, Tolstoi and other to-be-famous men. His novels want of psychic balance and endless oscillation were very successful and he was a prolific between exaltation and apathy.

writer.

The third type is seen in "The Idiot" (1868). Long before his first epileptic attack he was The boy had had attacks since earliest childhood the victim of so-called neurasthenia or some Sent to Switzerland for treatment he improved hypochondria. An alarming symptom was a so much under expert care that he figures in lethargic sleep. A state of depression coupled the story as a well developed human being. His with anxiety about the future troubled him. At appearance betrayed nothing. His eyes were times he lived in a dream for long periods. Yet large and blue with a leaden color of the iris in 1849, when he had trouble with the Govern- and a fixed look which to some suggested epiment, all his mental symptoms left him and he lepsy. There was in him something silent and began to show admirable qualities; he exhibited melancholy. Describing his attacks in childpatience, tranquillity, etc. He believed that his hood he said that after a series of violent seizarrest saved his reason. Evidently his numer- ures he was left apathetic, without recollection. ous nervous and mental symptoms were all psy- His brain worked, but not logically. He could chogenic. His lethargic sleeps, however suggest not connect more than two or three ideas. that he was already on the way to an epileptic the attacks became weaker, his condition imcareer. One medical man who treated him proved correspondingly. An inexpressible longbefore his exile pronounced him of the epileptic ing possessed him. Often he wished to weep. temperament, and said that some of his disturbed He marvelled at everything, was excited over episodes were so severe that his mental integrity everything. It depressed him very much bewas threatened.

In Dostojewsky's works we find no less than five types of epileptics. In "The Landlady," written in 1874, before he had developed his full

As

cause all about him was strange. This epileptic, the Count Mischkin, is a good man, and has fine feelings. Abnormal only is his naiveté, which often borders on stupidity. His will is

weak, so that it lends him something boyish and immature. Like Dostojewsky himself, he writes a beautiful hand.

seated himself and began to look about, regardless, with flaming eyes. His word storm, in which one thought followed so quickly upon anAssociated with Mischkin are accounts of the other, forboded some danger, and in fact he twilight state which are of great value to the shattered a vase. When this was past he felt psychiatrist; also the feelings and thoughts of himself struck to the heart, filled with mystic an epileptic in his "sound" movements; thus, horror. Another instant and this gave way to a to quote Dostojewsky's text, "At times he looked feeling of light, joy and inspiration. Then he about him with great curiosity, but most fre- began to breathe again, taking deep breaths. The quently was quite indifferent, not even knowing expected severe attack had not taken place. For where he himself was going. He lived in pain- a long time he remained confused. He beheld ful excitement and restlessness, wishing to be and understood what was going on but seemed. alone, yet finding solitude unbearable. Present- to himself to be only an unseen onlooker, taking ly he finds himself occupied with something, a no part in anything. Then once more he began former employment. He has been so occupied to declaim. He spoke with increasing inspirafor a long time but has not known it. He be- tion, saying things he did not intend. Another gins to seek something but at once forgets it. period of full ecstasy followed and then the atAfter half an hour he resumes the search rest-tack came. After a series of strong psychic dislessly. He knew that before his attacks he is turbances, minor attacks and psychic episodes distracted, often confusing objects and faces and his reason began to darken." At the end of the requiring all his efforts to prevent blunders. It story we find him in a Swiss institute hopelessly was necessary to give his full attention for a demented. long time to everything he saw. In his epilep- The fourth type of epileptic is Kiriloff in tic states there would suddenly be a clearing up "The Devil" (1871-2). To quote text from of consciousness, when his mind would glow and Dostojewsky's novel, "Externally he presented all his old powers return. The sensation of liv- nothing singular but his speech is striking. He ing, of self consciousness, would be accentuated speaks in monosyllables or broken sentences and tenfold. These periods, however, lasted but an one notices at once that his thinking is difficult. instant. During their existence all excitement, His ideas are associated in the strangest fashion. doubt, restlessness vanished suddenly, replaced His contemplations are religious-mystic, which by full harmony, joy and hope. These bright are rooted in his illusions and hallucinations. moments, however, really presaged convulsive He has no convulsions but psychic equivalents. attacks and therefore were unendurable. He He says of these, 'For seconds, not over five or looked back on them, however, as glimpses of a six in all, in which there is a sudden feeling of higher existence but nevertheless pathological. infinite harmony which fills the whole of exisThis was the paradox of his disease. There tence.' This feeling is not earthly nor is it could be no doubt of the beauty of these mo- necessarily heavenly. But an earthly being canments. They were not like the sensations due to not tolerate it, and must be physically transalcohol or opium. One such experience com- formed or perish. It is as if one suddenly felt pensated for all the evil of the disease and was within him the whole of Nature and said, 'Yes, worth a whole lifetime. In such moments he this is Truth.' So the Creator might have felt that some day time would cease to exist. spoken as he finished the world. Here is no Thus one catches a flavor also of Dostojewsky's commotion, only simple joy. The feeling is style of treatment of his characters. Continuing not only that, but something higher. Terrible one reads, "No doubt Mohammed's religious it is that these feelings are so clear, this joy so faith was based on these experiences, thought powerful. If this mood should last over five Mischkin. He had similar moments. The soul seconds the soul could not endure it and must was flooded with a wonderful inner light. Yet perish. During these few seconds one lives the time required was but half a second! This through an entire life. Of what need is posmoment passed at once into the cry of an epileptic seizure. Everything human has vanished for the time. The voice which is heard is not human. In one attack Mischkin falls down a stone stairway. Once when in company Mischkin was excitedly discussing a subject. Gradually a feeling of infinite happiness came over him. He ceased speaking save to answer questions and at last became completely silent. He sat quietly and listened, and seemed to sink in happiness. A sublime inspiration filled him more and more, and he was ready at any moment to 'burst into flame.' Then he began to declaim with passion, strove for breath, was as if suffocated with the excess of goodness in his heart. He ceased to breathe, became pale,

terity, when the entire goal of life has been attained." We find that Kiriloff has one or two of these experiences weekly, and they never usher in severe attacks. He was told that they would do so eventually. Mohammed flew through the entire heavens before the water could flow from a can. It required five seconds to empty the can, and for Mohammed to have an epileptic fit.

His

In "The Karamasoff Brothers" (1879-80) we find Smerdjakoff, a classical epileptic. mother, an idiot, wandered about clad only in a chemise. His father was a debauche. The boy was born in a truck garden and he was raised by the brothers. At 21 he was shy and silent. He was, however, high spirited and apparently despised all mankind. In his childhood he killed

once lost

cats and buried them with pomp. Once when against the government, which is unconsciously whipped he crawled into a corner where for a the adult father, Dostojewsky at week he looked vexedly at all people. Once he the neurasthenic and hypochondriacal symptook a box on the ear calmly but afterwards toms and became patient, tranquil, etc. went into a corner as before. After a similar Dostojewsky himself believes his mental inexperience he had his first convulsion and they tegrity was saved by this action on his part. continued throughout his life, both mild and To an intense egoistic nature who suffers insevere in type. In time he came to despise food. tensely under the chafing restrictions of the paHe would toy with a mouthful for a long time, ternal rule the revolt against such authority finally deciding to eat it. After several years often permits a freer range of the libido and the of instruction he changed greatly, aged rapidly, repressive symptoms before such an act of rewas pale and wrinkled and had the look of a volt often disappear completely. One cannot. eunuch. Visiting Moscow he took but little however, be quite clear how much of the supinterest in it but learned to appreciate good pression of the libido was relieved, as it seems clothes and clean linen. He became an excel- Dostojewsky's epilepsy also showed about this lent cook and his other interests were clothing, time, although in a somewhat masked form. He pomades, perfumery, etc. Men and women he was definitely epileptic soon after he took up despised alike. his life in exile, perhaps the attacks carried off much of the pent up repression of the libido as has been noted in many another epileptic. Often migraine attacks, lethargies and abstractions are to be found in the preconvulsive stage of an after frankly diagnosable epileptic.

Finally Smerdjakoff had a trick of gazing on the ground for some minutes. Walking along he would suddenly stop, lower his head and stare downward for ten minutes. Whether he simply stared or was fixed by something in his own mind puzzled those who saw him. Dostojew- The account of the first genuine attack, much sky says in the text, "These people are not uncommon. It is probable that he was collecting certain impressions. As a result at some remote period an epileptic might begin a voyage, burn a house, etc." However, one of the brothers upon questioning him found always a deep pathological self love.

of which was to recur in subsequent seizures, is characteristic. One should note especially, after long confinement, the expansion of the ego, possibly the inflation of the infantile unconscious in the term of Hoch; the meeting with an old friend; the religious controversy; the insistence of Dostojewsky in establishing the orthodox What are the special points brought out in tenets of a paradise in the hereafter; the aura, this cursory study of Dostojewsky, especially in and the inflation of the unconscious at the bethe light of our present day knowledge of epi- ginning of an attack. Again the feeling of onelepsy? First, that he had the infantile type ness with truth and the eternal verities of the of mentality. He reckoned or dated all things universe in the attack, and then Dostojewsky from his own inner consciousness. He was in- was in ecstasy of in ecstasy of a minor attack. The tensely egoistic, most of his reported conversa- expansion of his ego at the beginning tions were but monologues on his part. Still of earlier he was intensively devoted to his mother; had a psychogenic or hysteric episode after her death; had an intense antagonism to his father who was a stern disciplinarian and from whom he revolted to his tutors who fed him upon the gruesome tales his fancy craved. He could not take on or submit to the onerous discipline in the engineering school and left it with a thorough distaste for it owing to the strictness of the discipline. He continued to develop his self-centered characteristics, failed to observe the conventions of society, did not recognize friends in these fits of abstraction. He inconvenienced his friends by requiring the household arrangements to be changed to suit his own convenience. He had childish tantrums and odd ways of defy- All of the outcroppings of Dostojewsky's egoing the physician's prescriptions of foods. Quite istic and infantile feelings and ideas in the some time before his epilepsy developed his per- minor attacks and in the beginnings of the major sonality underwent further changes, he had fits attacks are over and over again elaborated in of depression and anxiety, lethargic sleep after Dostojewsky's novels as we have seen. Lest too which he seemed to strive to continue his life much stress be placed upon the epileptic's own in a dream. He also had periods of extreme responsibility and his shortcomings for his disirritability, embittered himself with governmen- ease Dostojewsky now and then accounts for the tal authority and suffered in lonely exile. Here epilepsy in many of his novel characters by famin the light of recent psychoanalytic research, ily heredity from which his creations sprang. one notes with interest that after a revolt

an attack (the sense of allmacht) the oneness with the peace, security and safety of paradise itself, strongly suggest the unconscious strivings to revive the infantile memories of the mother life and its paradoxal qualities. Regarding the latter, I hope at another time soon to dilate with greater emphasis in a comparative study of the epilepsies of St. Paul, Plutarch, Mother Ann Lee, Mohammed and even Joseph Smith, the latter of whom, as is not frequently known, died epileptic. In time it will probably seem less strange that much of our religious conception of Heaven which has been fashioned by epileptics out of their unconscious conceptions of the mother life should be so satisfying to the entire human family.

We see in Dostojewsky's personality the dis

his own character as well.

organization of the mind, the replacement of statistics, a factor which may have been somebad judgment, faulty memory and childish re- what modified by the new State Labor Laws of versions in character as the result of indulgences 1912-13,-and that is the unusually large numin his disease. The same is also portrayed in all ber of the especially susceptible women and chilhis novel characters. Dostojewsky also mentions dren that is employed in the industries of Rhode how his characters all mend when the individu- Island. Of the total industrial population over als grow better of their disease. Yet the per- 16 years of age, 36,000, or 32%, were womensistence of the naiveté, the weak and vacillating the highest percentage in the United States. will, the boyishness and immaturity of Count There were in that year 5,000 children under 16 Mischkin's mind under a partial restoration years of age working in Rhode Island, 4% of from his disease shows Dostojewsky's unconsci- the total industrial army, the largest percenous but deep appreciation of the infantile make- tage in the United States with the exception of up of the epileptic constitution and probably of the child-labor cursed Southern states of North and South Carolina and Georgia. Unable to Finally, it is interesting to note the probable protect themselves, especially susceptible to unconscious workings in Dostojewsky's mind many forms of industrial disease, this portion when he wrote "The Devil;" no psychoanalyst of the industrial workers makes a specially urneeds to be told that the devil is the father sym- gent appeal for protection to the conscience of bol in a derogatory sense. Dostojewsky often the community. forgot the thread of the narrative in this story It is not the purpose of this paper to discuss and had to reread much of the manuscript to in particular Rhode Island conditions nor indeed finish the succeeding chapters. In it all lies a to present in any detail the special features of virile hate which Dostojewsky cannot repress or occupational disease control. This is not an seems to make little effort to do so. It even goes industrial hygiene conference and consequently far to mar an otherwise admirable piece of writ- for the most part the remarks shall be restricted ing. The malice, hatred and intolerance shown to the more general features of the problem. It in this novel is much more than the situation might be well, however, in so far as it is reasonwould ordinarily seem to demand. Dostojewsky able, to select our illustrations from the local told one friend that he so hated the book and its field. Certain features of Rhode Island industry subject he could never reread it once it had been lend themselves most admirably to this treatwritten. ment, as would be the case in any community.

OCCUPATIONAL DISEASE AND THE
PUBLIC HEALTH.*

BY DONALD B. ARMSTRONG, M.D., NEW YORK,
Director of the Department of Social Welfare, New
York Association for Improving the Condition
of the Poor.

As is universally known, the state (quoting again the 1910 census figures) was second to one other only in the manufacture of woolen and worsted goods and fifth in cotton textile manufacture. It is widely recognized that these industries offer especially difficult problems from the points of view of ventilation, dust control, etc., and in industrial hygiene are classified as dangerous trades, particularly because of the exposure to vegetable fibre and animal fibre dust. As might be expected, there results from this RHODE ISLAND in population and area is a dust exposure an increased susceptibility of the small state, but the things she does are done in a pulmonary tissue to infection with a consequent big way. According to the 1910 census the state increase in the morbidity and mortality rates ranked fourteenth in the amount of its products from tuberculosis. It was found, for instance, turned out, this value totaling $280,344,000. In in England and Wales in 1902, as reported by the 1951 manufacturing establishments in the the Registrar General, that among males emstate there were in 1910, 114,000 wage earners, ployed in cotton manufacture between the ages 46,000 of which were centered in Providence. of 15 and 19, the death rate per hundred thouFrom these figures one conclusion certainly is sand from tuberculosis was 82 as compared with inevitable, and that is, that there is here a very a rate of 54 for all occupied males of that same evident necessity for control over the industrial welfare of the workers of the state. Nothing is more important to the public health than the conditions under which the average man earns his daily bread. It is in this field that conditions of good or evil have the most far-reaching influence upon the morbidity and mortality rates of the state and upon the health and welfare of the state's citizens.

From the point of view of responsibility another important factor is disclosed by the 1910

* Delivered at the Rhode Island Conference of Charities and Correction, Westerly, Rhode Island.

age period. The tuberculosis death rates for the woolen and worsted workers bore much the same relationship to the average, the rate per hundred thousand for woolen workers being 69 as compared with 54, the figures for all the workers in all industries. Undoubtedly the statistics for textile workers in this country, did we but have them, would illustrate fully as ef fectively the relation of this dusty trade to tuberculosis. It must be obvious that these conditions both at home and abroad cannot be remedied until certain specific preventive methods are universally applied. It is impossible to dis