RELATION OF EMOTIONS TO INJURY AND DISEASE: A CALL FOR FORENSIC PSYCHOSOMATIC MEDICINE
Authors: Hubert Winston Smith, Stanley Cobb
Journal: Annals of Internal Medicine (1943)

Article1 December 1943RELATION OF EMOTIONS TO INJURY AND DISEASE: A CALL FOR FORENSIC PSYCHOSOMATIC MEDICINEHUBERT WINSTON SMITH, STANLEY COBBHUBERT WINSTON SMITHSearch for more papers by this author, STANLEY COBBSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-19-6-873 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptI. INTRODUCTION AND HISTORICAL REVIEWFew problems of scientific proof have been so perplexing to court and counsel, and to the expert witness, as those which arise in the "nervous shock" cases. A, intentionally or negligently, presents a psychic stimulus to B, with or without impact,§and B alleges that in consequence he suffered "nervous shock" or some disabling injury or disease for which he should be allowed to hold A in damages. How far shall the law go in recompensing B for the alleged effects of fright or other emotions so induced, and how shall the courts deal with...1 A "tort" is a wrongful invasion of some right of personality or of property of another, causing injury in respect to which the law will give redress by money damages without proof of any contractual or consensual relations between the actor and the person acted on. Tort law might be characterized as the sum total of those legal prohibitions whereby the sphere of individual existence is protected from negligent, intended or malicious conduct of strangers. "The law of torts" is thus a generic term covering a wide variety of such wrongs, including "assault," "battery," "trespass," "conversion" (wrongful appropriation of another's personal property), "false imprisonment," "malicious prosecution" for a crime not committed, "slander and libel," "negligence," "fraud or deceit," "breach of trust," a stranger's act in "inducing breach of contract," "malpractice" of a professional man, violation of patents, trade-marks, copyrights or other vested property rights, "unfair competition" in business and other such proscribed conduct. It is through this branch of the law that such individual rights have received greatest legal protection and the citizen has been insured against unnecessary risks of injury in a crowded society. Google Scholar2 The "common law" or judge-made law, consisting of the decisions and supporting opinions of the appeal courts on problems of law brought up from the trial courts, constitutes a precedent for disposing of like cases in the future, if there be no directly controlling provision of a constitution or statute. Google Scholar3 For instance, the intentional conduct may be such as to give the injured person a primary cause of action for assault, battery, trespass, malicious prosecution, defamation, wrongful arrest, seduction or some other tort. In all these cases the courts allow the plaintiff compensation for mental anguish as a parasitic element of damages. Google Scholar4 (Privy Council, Eng.) 13 App. Cas. 222; 57 L. J. P. C. 69 (1888). Google Scholar5 (Queen's Bench and Exchequer Div.) 26 Law Reports (Ireland) 428 (1890). Google Scholar6 Actually, the first case of nervous shock without impact was the unreported Irish case of Byrne v. Great Southern and Western Railway Company (1882) in which plaintiff, a telegraph operator in defendant's station, got a severe fright when a negligently set switch permitted D's locomotive to enter a siding, break down a permanent buffer and destroy one wall of the telegraph office. We have no record of the medical testimony, but plaintiff apparently suffered more than temporary disability from the fright, for he was awarded damages of 325£. On cross-examination, the plaintiff said: "A hair of my head was not touched; I swear I received no physical injury; I got a great fright and shock; I do not mean a physical shake; it was the crash and falling in of the office, and shouts of the clerks saying they were killed; I saw part of the office falling in; I believed it was all falling in." The Court in the Coultas case evidently was unaware of this legal precedent, but Justice Palles, in the Bell case, called attention to it and mentioned the fact that he personally was the trial judge who presided over the Byrne case. Subsequent English authorities have followed the Bell case: Dulieu v. White & Sons, 17 The Times L.R. 555, 2 K.B. 669 (1901); Hambrook v. Stokes Brothers, Ltd., 41 The Times L.R. 125 1 K.B. 141 (1925). The Scottish courts have consistently allowed recovery for disability due to nervous shock, negligently caused, without requiring any impact. Cooper v. Caledonian Ry., (1902) 4 F. 880, Ct. of Sess.; Gilligan v. Robb, (1910) S.C. 856, Ct. of Sess.; Coyle v. Watson, (1915) A.C. 1; Brown v. Glasgow Corp., (1922) S.C. 527, Ct. of Sess.; Currie v. Wardrop, (1927) Scottish Law Times 383. Google Scholar7 Courts of the following American states allow recovery for injury or disability due to psychic stimuli, negligently caused by defendant, without necessity for proving physical impact: Ala. Alabama Fuel & Iron Co. v. Baladoni, 15 Ala. App. 316, 73 So. 205 (1916). Cal. Lindley v. Knowlton, 179 Cal. 298, 176 Pac. 440 (1918). Ga. Goddard v. Watters, 14 Ga. App. 722, 82 S.E. 304 (1914). Ia. Watson v. Dilts, 116 Iowa 249, 89 N.W. 1068 (1902). Kan. Whitsell v. Watts, 98 Kan. 508, 159 Pac. 401 (1916). La. Stewart v. Arkansas Southern R. Co., 112 La. 764, 36 So. 676 (1904). Md. Green v. Shoemaker, 111 Md. 69, 73 Atl. 688 (1909). Minn. Purcell v. St. Paul City R. Co., 48 Minn. 34, 50 N.W. 1034 (1892). Neb. Hanford v. Omaha Street R. Co., 113 Neb. 423, 203 N.W. 643 (1925). N. H. Chinchiolo v. New England Wholesale Tailors, 84 N. H. 329, 150 Atl. 540 (1930). N. C. Kimberly v. Howland, 143 N. C. 398, 55 S.E. 778 (1906). Ore. Salmi v. Columbia, etc. R. Co., 75 Ore. 200, 146 Pac. 819 (1915). R. I. Simone v. Rhode Island Co., 28 R. I. 186, 66 Atl. 202 (1907). S. C. Mack v. South-Bound R. Co., 52 S. C. 323, 29 S.E. 905 (1897). S. D. Sternhagen v. Kozel, 40 S. D. 396, 167 N.W. 398 (1918). Tenn. Memphis St. R. Co. v. Bernstein, 137 Tenn. 627, 194 S.W. 902 (1917). Tex. Gulf, etc. R. Co. v. Hayter, 93 Tex. 239, 54 S.W. 944 (1900). Wash. O'Meara v. Russell, 90 Wash. 557, 156 Pac. 550 (1916). Wis. Pankopf v. Hinkley, 141 Wis. 146, 123 N.W. 625 (1909). Google Scholar8 Courts of the following American states deny recovery for injury due to fright or other psychic stimuli, negligently caused by defendant, if there is no contemporaneous physical impact: U. S. Haile's Curator v. Texas & Pacific R. Co. (U. S. Cir. Ct. of App., Fifth Cir.), 60 Fed. 557 (1894). (Federal courts now must follow the tort law of the state in which they are situated.) Ark. St. Louis, etc. R. Co. v. Bragg, 69 Ark. 402, 64 S.W. 226 (1901). Ill. Braun v. Craven, 175 Ill. 401, 51 N.E. 657 (1898). Ind. Terre Haute Electric R. Co. v. Lauer, 21 Ind. App. 466, 52 N.E. 703 (1899). Ky. McGee v. Vanover, 148 Ky. 737, 147 S.W. 742 (1912). Mass. Spade v. Lynn, etc. R. Co., 168 Mass. 285, 47 N.E. 88 (1897). Mich. Nelson v. Crawford, 122 Mich. 466, 81 N.W. 335 (1899). Mo. McArdle v. Peck Dry Goods Co., 191 Mo. App. 263, 177 S.W. 1095 (1915). N. J. Ward v. West Jersey, etc. R. Co., 65 N. J. L. 383, 47 Atl. 561 (1900). N. Y. Mitchell v. Rochester Ry. Co., 151 N. Y. 107, 45 N.E. 354 (1896). O. Miller v. Baltimore, etc. R. Co., 78 Oh. St. 309, 85 N.E. 499 (1908). Pa. Ewing v. Pittsburgh, etc. R. Co., 147 Pa. St. 40, 23 Atl. 340 (1892). Google Scholar9 Driscoll v. Gaffey, 207 Mass. 102, 92 N.E. 1010 (1910). (Defendant's negligent blasting caused a 20 pound stone to be thrown on P's house with a loud noise; P was frightened and fell to the floor receiving only a superficial bruise. Held: This impact was injurious enough to permit recovery for neurasthenia attributed by doctors to contemporaneous fright.) Google Scholar10 Kisiel v. Holyoke Street Railway Co., 240 Mass. 29, 132 N.E. 622 (1921). (Plaintiff, a pregnant woman, while a passenger on D's street car, was slightly jarred by a negligent rear end collision with another of D's cars, and she alleged that fright caused an abortion. Held, affirming judgment for plaintiff entered on jury verdict: The impact was sufficient; though the bump may have produced no outwardly visible physical injury, it may have produced internal injury.) Note, that in Freedman v. Eastern Mass. Street Ry. Co., 299 Mass. 246, 12 N.E. (2d) 739 (1938), the Supreme Judicial Court of Massachusetts definitely makes the requirement for recovery, "physical injury from without" as contrasted with injury due to "the purely internal operation of fright." Plaintiff, a passenger on D's street car, was so frightened by a negligent side to side collision with a truck that she jumped from her seat and in so doing twisted her shoulder. The trial court directed a verdict for defendant because there was no proof of an impact. Held: Such proof is not necessary where, as here, defendant's negligence causes physical injury from without. Comment: At first this distinction may seem tenuous, but it is substantial in terms of making proof. Most other courts have held that if A creates in B a reasonable apprehension of bodily peril, and B injures himself in trying to escape the danger, he can hold B in damages, even though fear was a link in the chain of causation. The injury is physical (broken leg, etc.) and immediate, and there is no such difficulty with conjectural causation as one finds in the usual nervous shock cases. Google Scholar11 257 N. Y. 231, 177 N.E. 431 (1931). Google Scholar12 HertigSheldon These cases are very numerous and criteria of proof are needed for both traumatic and psychic abortion. Because the subject, in its details, calls for special treatment, we exclude it from the present study. See , Minimum criteria required to prove prima facie case of traumatic abortion or miscarriage, in Smith on Scientific Proof and Relations of Law and Medicine, Albany, N. Y., Matthew Bender & Co., (In press). Google Scholar13 SMITHSOLOMON HWHC See : Traumatic neuroses in court, in Smith on Scientific Proof and Relations of Law and Medicine, id. Google Scholar14 BRIDGES JW: Outline of abnormal psychology, 1931, R. G. Adams & Co., Columbus. Google Scholar15 CANNON WB: Bodily changes in pain, hunger, fear and rage, 1929, Appleton & Co., New York. CrossrefGoogle Scholar16 COBB S: Borderlands of psychiatry, 1943, Harvard University Press, Cambridge, Mass. CrossrefGoogle Scholar17 DUNBAR HF: Emotions and bodily changes, 1935, Columbia University Press, New York. CrossrefGoogle Scholar18 ALKAN L: Anatomische Organkrankheiten aus seelischer Ursache, 1930, Hippokrates, Stuttgart. CrossrefGoogle Scholar19 MOHR F: Psycho-physische Behandlungsmethoden, 1925, Hirzel, Leipzig. Google Scholar20 CANNON WB: Wisdom of the body, 1932, Norton, New York. CrossrefGoogle Scholar21 FRENCHALEXANDER TMF: Psychogenic factors in bronchial asthma, Psychosom. Med. Monogr., 1941, II and IV. Google Scholar22 TALBOTTCOBBCOOMBSCOHENCONSOLAZIO JHSFSMEWW: Acid-base balance of the blood in a patient with hysterical hyperventilation, Arch. Neurol. and Psychiat., 1938, xxxviii, 973. CrossrefGoogle Scholar23 WOOD P: DaCosta's syndrome (or effort syndrome), Brit. Med. Jr., 1941, i, 767, 805, 845. CrossrefGoogle Scholar24 FAHRENKAMP K: Der Herzkranke, 1931, Hippokrates, Stuttgart. 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Google Scholar32 MICHAELSGOODMAN JJSE: Enuresis and other factors in normal and in psychotic persons; comparative study of incidence and intercorrelations, Arch. Neurol. and Psychiat., 1938, xl, 699. CrossrefGoogle Scholar33 NOVAKHARNIK JM: Die psychogene Entstehung der Menstrualkolik und deren Behandlung, Ztschr. f. Geburtsh. u. Gynäk., 1929, xcvi, 239. Google Scholar34 MITTELMANN B: Psychogenic factors and psychotherapy in hyperthyreosis and rapid heart imbalance, Jr. Nerv. and Ment. Dis., 1933, lxxvii, 465. Google Scholar35 LIEBIG H: Trauma und Diabetes mellitus, Med. Klin., 1932, xxviii, 357. Google Scholar36 RAHMANRICHARDSONRIPLEY LHBHS: Anorexia nervosa with psychiatric observations, Psychosomat. Med., 1939, i, 335. CrossrefGoogle Scholar37 GREENHILLFINESINGER MHJE: Neurotic symptoms and emotional factors in atopic dermatitis, Arch. Dermat. and Syph., 1942, xlvi, 187. CrossrefGoogle Scholar38 BUNNEMANN O: Neue Beiträge zur Frage der Psychogenese von Hautsymptomen, Ztschr. f. d. ges. Neurol. u. Psychiat., 1924, lxxxviii, 589. CrossrefGoogle Scholar39 WHITEJONES BVCM: Effect of irritants and drugs affecting the autonomic nervous system upon the mucosa of the normal rectum and rectosigmoid with especial reference to "mucous colitis," New England Jr. Med., 1938, ccxviii, 791. CrossrefGoogle Scholar40 COBB S: Foundations of neuropsychiatry, 1941, Williams and Wilkins, Baltimore. Google Scholar41 SCHINDLER R: Nervensystem und spontane Blutungen, 1927, Karger, Berlin. Google Scholar42 MEANS JH: Thyroid and its diseases, 1937, Lippincott Co., Philadelphia. Google Scholar43 RAHM H: Zur Pathogenese und Therapie des Morbus Basedow, Nervenarzt, 1930, iii, 1. Google Scholar44 ROUSSYCORNIL GL: La maladie de Basedow et la guerre, Presse méd., 1920, xxviii, 753. Google Scholar45 FREMONT-SMITH F: Personal communication. Google Scholar46 DEUTSCH F: Capillary studies in Raynaud's disease, Jr. Lab. and Clin. Med., 1941, xxvi, 1729. Google Scholar47 COBB S: Borderlands of psychiatry, case No. 1, Ch. I, 1943, Harvard Univ. Press, Cambridge, Mass. CrossrefGoogle Scholar48 WHITE PD: Scientific Proof in Respect to Injuries of the Heart, in Smith on Scientific Proof and Relations of Law and Medicine, Matthew Bender & Co., Albany, N. Y., in press. Google Scholar49 SMITHSOLOMON HWHC In connection with this argument for limiting extent of tort liability to idiosyncratic or hypersensitive persons, in respect to mere negligence, see : Traumatic neuroses in Court, op. cit. supra fn. 13. See also POUND, R.: Interests of personality, 28 Harvard Law Rev. (1915) 343, 445. Google Scholar50 As in Victorian Railways v. Coultas, supra, and Bell v. Great Northern Ry. Co., supra. See, also, the many cases against railroads cited in footnotes 7 and 8, supra. Google Scholar51 As in Kisiel v. Holyoke St. Ry. Co., 240 Mass. 29, 132 N.E. 622 (1921); Sundquist v. Madison Rys. Co., 197 Wis. 83, 221 N.W. 392 (1928) etc. Google Scholar52 Inadequacy of stimulus to produce the result in a person of average constitution was regarded as a proper ground for denying liability in the Scottish case of Cooper v. The Caledonian Railway Co., IV Session Cases (1902). Plaintiff alleged she suffered nervous shock from a carriage door swinging open and having its window broken. She was never for a moment in the smallest danger of injury. The trial judge reached this conclusion from the pleadings, without evidence and dismissed the case. The appeal court agreed that the stimulus, to be actionable, would need be one capable of producing an injurious response in an average person, but held evidence should have been received on this issue, and remanded the cause for hearing. In Newton v. New York, N. H. and H. R. Co., 106 App. Div. 415, 94 N. Y. Supp. 825 (1905), X was commuting to New York on defendant's train when it negligently stopped in a tunnel with the result that a train following behind struck it. It was alleged that X suffered nervous shock which four months later caused him to die of acute dilatation of the heart. X's legal representatives, in an action against the RR recovered verdict and judgment for $12,500. Held, on appeal: Judgment reversed because there was no proof that the stimulus caused either physical injury or immediate nervous shock. The evidence showed that when the collision occurred, X was playing cards in a forward coach, and the tremor of impact was so minimal that X was merely moved forward slightly, not thrown against the seat ahead or onto the floor. The players continued at cards without their game board being thrown from their laps. Google Scholar53 The only exceptions seem to be occasional cases where courts have held an intentional wrongdoer liable for injury to one he could hardly have expected to be present. Google Scholar54 D, by negligent operation of his automobile, frightened P's mule so that it ran away. P was not in the buggy, but suffered great shock and consequent physical injury because of fright for her two children who were in the buggy. Held: P could recover damages from D. Spearman v. McCrary, 4 Ala. App. 473, 58 So. 927 (1912). D negligently ran his truck into the basement of P's house. P suffered no impact, but because of fright for safety of his children who were in the basement, he sustained severe shock which led to a hysterical condition. Held: P could recover damages from D. Bowman v. Williams, 164 Md. 397, 165 A. 182 (1933). On similar facts recovery was allowed for parental fright generated by apprehension of immediate bodily harm to children, in Hambrook v. Stokes Bros., 1 King's Bench (Eng.) 141; 94 L. J. K. B. 435 (1925), and in Cohn v. Ansonia Realty Co., 162 App. Div. 791, 148 N. Y. S. 39 (1914). Courts in America have tended to put limits on liability in this series of cases by requiring the parent to be personally present within the circle of risk; if the parent suffers nervous shock as a mere spectator while situated outside the zone of peril, recovery of damages for nervous shock caused by defendant's conduct is denied. Waube v. Warrington, 216 Wis. 603, 258 N.W. 497 (Mother, looking through window, saw daughter crossing street killed by D's negligence.) Accord: Nuckles v. Tennessee Electric Power Co., 155 Tenn. 611, 299 S.W. 775 (1925). In Hambrook v. Stokes, supra, the English courts allowed a parent to recover damages for nervous shock caused by apprehension that a child on the way to school had been injured by a runaway lorry which rolled down a long hill when the driver negligently left it without the brakes set. The parent here was not in peril of personal harm, and the decision has been criticized as extending liability too far. It may be argued on facts of the case that the presence of the parent in the vicinity was known or could be anticipated and that a parental fright reaction was foreseeable. If the parent is entirely absent from the scene of action, and reacts only as the result of an after report, the risk of injury seems too remote to be chargeable against the actor. Google Scholar55 Most courts, to draw limits of liability in the "nervous shock" cases consonant with their views of policy, have made it an arbitrary requirement that the fear be for self or family and not for property. See Waube v. Warrington, 216 Wis. 603, 608, 258 N.W 497, 499 (1935); Dulieu v. White & Sons, (1901) 2 K.B. 669. In a recent Nebraska case, however, the court declined to impose such limitations on liability and permitted recovery of damages where nervous shock was engendered by concern over a dairy herd poisoned by bran negligently sold by D to a dairyman, X. The facts were quite interesting. D, a farmer, having forgotten that he had put arsenic in bran for the purpose of poisoning grasshoppers, sold the bran to X. X fed the bran to his cows and the next morning milked them and made deliveries to customers. Late in the forenoon five cows died and five others were made sick. X allegedly suffered severe nervous shock from injury to his herd and fear that he would lose his dairy business, and from apprehension that customers, whom he promptly notified, might suffer arsenious poisoning. X was unable to work after this episode, due to impaired health, and died nine months later of a decompensated heart. There was medical testimony that this was caused by an excessive emotional disturbance. (Note great danger of imposition: Could death from cardiac decompensation be scientifically attributed to nervous shock as cause, particularly in face of a nine month interval between stimulus and alleged response?!) X's widow sued D for negligently causing death of her husband and injury to the dairy business. The Supreme Court of Nebraska upheld a recovery for both items, by a five to two decision. Rasmussen v. Benson, 133 Neb. 449, 280 N.W. 890 (1938). It is doubtful whether many American courts will permit recovery for injury due to fright or shock engendered by a negligent act which threatens harm only to another's property, unless the conduct also carries a foreseeable risk of personal injury. Serious doubts must also be voiced, from a scientific point of view, about existence of any actual cause-effect relationship in the Rasmussen case between emotional upset and cardiac decompensation nine months later. Google Scholar56 Mitchell v. Rochester Railway Co., 151 N. Y. 107, 45 N.E. 354 (1896). (One ground for denying recovery for abortion allegedly caused by fright without impact, when D's horses were negligently permitted to all but run down plaintiff in the street. Two other grounds were given for refusing a right of action: (1) policy argument: difficulties of proof and likely encouragement of fictitious suits; (2) since there can be no recovery for fright negligently caused, there can be no recovery for physical consequences of fright. This last deduction has been widely attacked as specious.) Miller v. Baltimore and Ohio RR. Co., 78 Ohio St. 309, 85 N.E. 499 (1908). (As in Mitchell case, supra, one ground for denying recovery for injury due to fright, negligently caused, but without contemporaneous impact.) Google Scholar57 Green v. T. A. Shoemaker & Co., 111 Md. 69, 73 Atl. 688 (1909), 23 L. R. A. (N. S.) 667. Google Scholar58 A good example is the New York case of Hack v. Dady, 134 App. Div. 253, 118 N. Y. Supp. 25 (1909). Plaintiff, a pregnant woman, was walking along a city street with her two children when negligence of defendant in laying a main caused an explosion in a pot of molten lead. A few drops of the molten lead were cast upon P's hand and clothes, but she quickly flicked them off and suffered only a small superficial burn. P sued D, claiming that fright and nervous shock caused a miscarriage to occur three and a half weeks after the accident, a second miscarriage six months thereafter terminating a two months' pregnancy, and a third miscarriage three months after the second terminating a three months' pregnancy. On the first trial, Dr. A testified positively that these injuries were due to psychic reactions engendered by fright. P recovered verdict and judgment in the trial court, but this was reversed on appeal on the ground that the New York requirement of impact as a prerequisite to recovery for nervous shock, is not satisfied unless the impact contributes substantially to production of the nervous shock or the final injury (miscarriage). On a second trial, P called Dr. B instead of A. B testified positively that the miscarriages were due to physical injury caused by the spark landing on P's hand. P recovered verdict and judgment for $2000, and on appeal this was affirmed. This case illustrates the imposition which may occur in this species of litigation. It is characteristic of a large group of cases where: (1) The minimal trauma was too slight to produce a miscarriage. (2) The trauma was to a remote part of the body rather than to the abdomen. (3) There was not a sufficient frightening stimulus to prove psychic miscarriage. (4) The long time interval of three and one half weeks without proof of bridging symptoms speaks almost conclusively against causal relationships of either trauma or psychic influences. (5) The history of the case strongly suggests that the repeated miscarriages were due to some independent cause unrelated to D's negligence. Google Scholar59 Swift & Co. v. Ware (Ga. Appeal), 186 S.E. 452 (1936). Phelps Dodge Corporation v. Industrial Commission, 46 Ariz. 162, 49 P. (2d) 391 (1935). X, a miner, ran 500 feet to reach fresh air after blast of a "missed hole" caused shafts and drifts of the sulphide ore mine to become filled up with smoke, gas and dust. He suffered no injury but thereafter developed a neurosis from brooding over what might have happened to him, and in that event what would have been the lot of his family. Held: Since the neurosis was not caused by nervous shock produced by the episode, but by subsequent brooding, the neurosis was not result of an "injury" sustained by accidental means, and was not compensable under terms of the Arizona Compensation Act. In certain interesting cases claim has been made under Workmen's Compensation Acts for suicide due to insanity allegedly caused by an accidental injury received in course of employment. Courts have held it is not enough that insanity was indirectly caused by the injury if the more immediate cause was worrying and fear of losing employment (Grime v. Fletcher [Eng. 1915], 1 King's Bench 734; 8 B. W. C. C. 11, C. A.) or depression and brooding over inability to work. (Withers v. London, Brighton and South Coast Rail Co. [Eng. 1916], 2 King's Bench 772, 9 B. W. C. C. 616, C. A.) There may be actual causation here, but it must be admitted that lapse of time, the entry of independent causes, and difficulties of proof, justify the law in drawing an outer line of liability, though somewhat arbitrarily, in this type of case. Google Scholar60 Klein v. Medical Building Realty Co. (La. App.), 147 So. 122 (1933). Google Scholar61 St. Louis, I. M. & S. R. R. v. Osborne, 95 Ark. 310, 120 S.W. 537 (1910). Google Scholar62 LINDEMANN E: Hysteria as a problem in a general hospital, Med. Clin. North Am., 1938, xxii, 591. CrossrefGoogle Scholar63 Usually it is said the actor must have the apparent means of "then and there" converting threat into injury; hence, it is necessary that the actor be close at hand, and a threat made at a distance, by telephone, would not be sufficient to constitute an "assault." If injurious fright were caused by such a "long distance" threat, the right to hold the speaker in damages might well turn on these questions: (1) Did A, in speaking, maliciously intend to cause B harm through fright? If so, A should be held liable in damages. (2) If the answer to (1) is "no," A's right to recover damages must depend on proof of negligence: a. Did A know that B was idiosyncratic or excessively vulnerable and so apt to be caused injurious fright by the threatening language? If so, A should be held liable in damages. b. If A did not know of any idiosyncrasy, should he have foreseen that his verbal conduct would be likely to cause injurious fright in a listener of average constitution? If so, A should be held liable in damages. Google Scholar64 SMITHSOLOMON HWHC See : Traumatic neuroses in Court, in Smith on Scientific Proof and Relations of Law and Medicine, Matthew Bender & Co., Albany, N. Y. (In press). Google Scholar65 See for instance, Flood v. Smith, 126 Conn. 644, 13 A (2d) 677 (1940). As the result of an automobile collision caused by negligence of D, P1 and P2 sustained injuries in excess of those which an average person would have suffered from a like stimulus. Proof showed that P1, a 28 year old man, two years previously had been injured in another automobile accident, suffering a fracture of his skull and impairment of his nervous system, but with substantial interim recovery. P2, his companion, was a 70 year old library cataloguer, who previous to the accident, had suffered two nervous breakdowns and had undergone surgery for the removal of a cancerous breast. Both P1 and P2 were bruised in the accident and suffered extreme nervous shock, in P2's case aggravated by her morbid fears that a bruise on the site of the amputated breast would reactivate her cancer. The jury awarded P1 $3500 and P2 $4100. The trial court thought these damages excessive and granted D's motion to set aside the verdict and order a new trial unless P1, by remittitur, relinquished $1275 of the verdict, and P2 $2027. P1 and P2 appealed. Held: The damages awarded by the jury were not excessive. Cases remanded with orders for trial court to enter judgment for the full verdicts. The Connecticut Supreme Court said: "The plaintiffs are entitled to recover full compensation for all damage proximately resulting from the defendant's negligence, even though their injuries are more serious than they would otherwise have been because of preëxisting physical or nervous conditions." It is submitted that the result of this case is wrong, for it imposes a liability for a total end result only partly caused by the defendant's stimulus. Google Scholar66 Moore v. Tremelling (U. S. Circuit Court of Appeals, Idaho), 78 F. (2d) 821 (1935); same case, on later appeal, 100 F. (2d) 39 (1938). X fractured his leg and retained surgeon Y to treat it. As a result of negligent failure to take post-reduction roentgenograms at intervals after properly setting the fracture, Y failed to discover that the bones had slipped out of apposition. X developed a bad end result. Held: X could recover compensatory damages from Y for the result of his malpractice but not for such part of the end result