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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
 Brief Contents
Preface xxi

PART ONE Elements of Law and the Judicial Process 1

CHAPTER 1 Today’s Business Environment: Law and Ethics 2
CHAPTER 2 The Court Systems 22
CHAPTER 3 Trials and Resolving Disputes 44
CHAPTER 4 The Constitution: Focus on Application to Business 69
CHAPTER 5 Criminal Law and Business 94

PART TWO Elements of Traditional Business Law 119

CHAPTER 6 Elements of Torts 120
CHAPTER 7 Business Torts and Product Liability 143
CHAPTER 8 Real and Personal Property 166
CHAPTER 9 Intellectual Property 191
CHAPTER 10 Contracts 212
CHAPTER 11 Domestic and International Sales 240
CHAPTER 12 Business Organizations 268
CHAPTER 13 Negotiable Instruments, Credit, and Bankruptcy 295

PART THREE The Employment Relationship 327

CHAPTER 14 Agency and the Employment Relationship 328
CHAPTER 15 Employment and Labor Regulations 352
CHAPTER 16 Employment Discrimination 382

PART FOUR The Regulatory Environment of Business 409

CHAPTER 17 The Regulatory Process 410
CHAPTER 18 Securities Regulation 430
CHAPTER 19 Consumer Protection 454
CHAPTER 20 Antitrust Law 481
CHAPTER 21 Environmental Law 504
CHAPTER 22 The International Legal Environment of Business 531
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vii
viii Brief Contents

Appendix A Legal Research and the Internet 557

Appendix B Case Analysis and Legal Sources 560
Appendix C The Constitution of the United States of America 567
Appendix D The Uniform Commercial Code (Excerpts) 580
Appendix E National Labor Relations Act (Excerpts) 598
Appendix F Title VII of Civil Rights Act of 1964 (Excerpts) 603
Appendix G Americans with Disabilities Act (Excerpts) 606
Appendix H The Antitrust Statutes (Excerpts) 609
Appendix I Securities Statutes (Excerpts) 613
Glossary 617
Index 649

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 Contents
Preface xxi

PART ONE Elements of Law and the Judicial Process 1

CHAPTER 1
Today’s Business Environment: Law and Ethics.........................................2
Law and the Key Functions of the Legal System 3
International Perspective: Corrupt Nations and the Law 4
Sources of Law in the United States 5
Lighter? Side of the Law: Creative Claim 8
International Perspective: Civil Law Systems 12
Classifications of Law 12
Business Ethics and Social Responsibility 15
Issue Spotter: OK to Grease Palms? 16
Lighter? Side of the Law: Legal Ethics? 16
International Perspective: Does Regulation Improve Business Ethics? 17
Issue Spotter: Putting Ethics into Practice 18

CHAPTER 2
The Court Systems......................................................................................22
The Court Systems 23
The Federal Courts 25
The State Courts 28
International Perspective: The French Court System 29
Lighter? Side of the Law: In-the-Courtroom Training 30
Jurisdiction 30
Lighter? Side of the Law: Do as I Say, Not as I Do 31
International Perspective: London’s Commercial Court 32
Relations between the Court Systems 35
Issue Spotter: Can Your Firm Be Reached? 36
Venue 40
Lighter? Side of the Law: The Law Applies to Me? 40

CHAPTER 3
Trials and Resolving Disputes ...................................................................44
Basic Trial Procedures 45
Lighter? Side of the Law: Come to the Judge’s Party! 49
International Perspective: British Courtroom Procedure 52
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ix
x Contents

Lighter? Side of the Law: The Dog Ate My Summons 53

Lighter? Side of the Law: You Got Me There, Counselor!55
Lighter? Side of the Law: Wait a Minute—I Thought We Were in This Together! 60
International Perspective: German Trial Procedure 60
Alternate Dispute Resolution 61
Issue Spotter: Are There Limits on the Terms of Arbitration? 62
International Perspective: Arbitration and Cotton Contracts 65

CHAPTER 4
The Constitution: Focus on Application to Business...............................69
The Commerce Clause 70
Lighter? Side of the Law: I Am My Own Sovereign 73
The Taxing Power 75
Issue Spotter: Unconstitutional Business Activity? 77
Business and Free Speech 77
International Perspective: Freedom of Speech 78
Lighter? Side of the Law: Freedom of Bark but Not Burn in Ohio 82
Other Key Parts of the Bill of Rights 82
International Perspective: The (Partially) Unwritten Constitution of the United Kingdom 83
Fourteenth Amendment 87
Lighter? Side of the Law: Drop That Fry! Hands over Your Head! 88

CHAPTER 5
Criminal Law and Business........................................................................94
Crime 95
Crime Categories 95
Lighter? Side of the Law: They Think Big in Chicago 96
Crimes and Elements of Crime 96
Defenses 99
Prosecution Process 99
White-Collar Crime 102
Lighter? Side of the Law: That Wasn’t Me! 103
Lighter? Side of the Law: Who Profits from Crime? 104
International Perspective: Multinational Employers and Criminal Charges Abroad 105
Issue Spotter: Internal Fraud 106
International Perspective: White-Collar Crime in France 111
Sentencing Guidelines and Compliance 112

PART TWO Elements of Traditional Business Law 119

CHAPTER 6
Elements of Torts......................................................................................120
Torts and the Legal System 121
Negligence-Based Torts 121
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 Contents xi

International Perspective: No Tort Litigation Jackpots in New Zealand 122

Lighter? Side of the Law: Extending the Concept of Negligence 124
Issue Spotter: Effective Liability Releases 127
Intentional Torts against Persons 129
Issue Spotter: Dealing with Drunks 133
Lighter? Side of the Law: Battered at the Show 133
Issue Spotter: Dealing with the Elderly and Their Heirs136
Lighter? Side of the Law: How Dare You List My Phone Calls! 138
Issue Spotter: Say Good Things about a Good Employee? 138
International Perspective: Libel in Foreign Courts 139

CHAPTER 7
Business Torts and Product Liability ......................................................143
Tort Law and Business 144
Issue Spotter: Hiring Employees from Competitors 148
Product Liability 148
International Perspective: Is Japan Really Different? 150
Lighter? Side of the Law: You Can’t Be Too Careful 151
Issue Spotter: Understanding Product Problems 151
Lighter? Side of the Law: Hot Stuff 154
Lighter? Side of the Law: Reason #4 Why West Virginia Is Considered a Litigation Hellhole 159
Issue Spotter: Cheaper Can Be More Expensive 160
International Perspective: Asbestos Litigation in the United States and United Kingdom 161
Lighter? Side of the Law: Busted! 162

CHAPTER 8
Real and Personal Property......................................................................166
Real Property 167
Lighter? Side of the Law: Is It Real Property or Personal Property? 168
International Perspective: Insecure Property Rights 171
Lighter? Side of the Law: The Tenants Who Would Not Go Away 175
International Perspective: Americans Crossing into Mexico for Land 176
Public Control of Real Property 178
Issue Spotter: Would Tighter Leases Help? 179
Torts against Property 180
Issue Spotter: Protecting Company Property 184
Lighter? Side of the Law: The FBI Negligent? No, Just Doing Law Enforcement 184
Torts against Property Owners 184
Issue Spotter: Duties to Elderly Customers 185
Lighter? Side of the Law: Pesky Surveillance Cameras 186
Issue Spotter: Protecting Customers’ Kids 188

CHAPTER 9
Intellectual Property .................................................................................191
Trademarks 192
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xii Contents

Issue Spotter: Establishing Your Name 192

Lighter? Side of the Law: Discrimination against Men? 193
International Perspective: Costs of Counterfeiting 198
Issue Spotter: Knock Off the Knock-Offs? 199
Copyright 200
Lighter? Side of the Law: You Owe Us the World and More! 200
Issue Spotter: Fair Sharing of Educational Information? 201
Patents 203
Lighter? Side of the Law: Why Many Patents Are Overturned When Challenged 203
Trade Secrets 205
International Perspective: Patent Differences 205
Lighter? Side of the Law: It’s Secret How We Spend Your Money 206
Issue Spotter: Protecting Valuable Information 208

CHAPTER 10
Contracts ...................................................................................................212
Contract Law 213
Elements of a Contract 213
Lighter? Side of the Law: No Extra Charge for the Smell 215
Lighter? Side of the Law: You Can’t Trust Anyone These Days 221
International Perspective: Problems Enforcing Contracts 223
Issue Spotter: Liars’ Contest? 225
Performance, Discharge, and Breach of Contracts 227
Issue Spotter: Do You Have to Eat the Loss? 230
Remedies 230
International Perspective: Contracting with the Japanese 233
Lighter? Side of the Law: Me, Read the Rules? 234

CHAPTER 11
Domestic and International Sales............................................................240
Introduction to the UCC 241
Forming a Sales Contract 244
Lighter? Side of the Law: Be Honest, Not Necessarily Kind 244
Issue Spotter: Gouge the Wholesaler 250
Performance and Obligations 251
International Perspective: How to Assure Foreign Buyers of Product Quality 251
Sales Warranties 252
Issue Spotter: How Much Advice Should Retailers Give? 254
Remedies and Damages 255
Lighter? Side of the Law: Suckers on a Global Scale 256
International Sales 259
International Perspective: Contracts in China
260
Issue Spotter: What Law Applies, and Where, to Your Contract? 262

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 Contents xiii

CHAPTER 12
Business Organizations ............................................................................268
Sole Proprietorships 269
Partnerships 269
International Perspective: Small Is Not So Beautiful in Japan 272
Limited Partnership 272
Issue Spotter: Sisterly Love? 274
Corporations 275
Lighter? Side of the Law: Your Honor, I’ll Turn Rocks into Gold 277
Limited Liability Companies 280
Lighter? Side of the Law: Mad at Each Other? Sue the Insurance Company 281
International Perspective: Offshore Businesses 282
Key Organizational Features 284
Issue Spotter: Keeping Things in Order 286
Lighter? Side of the Law: I Own the World! 287
Franchises 287
Issue Spotter: The Road to Riches? 290

CHAPTER 13
Negotiable Instruments, Credit, and Bankruptcy ..................................295
Negotiable Instruments 296
International Perspective: Mixing Religion and Finance 297
Lighter? Side of the Law: How to Enforce a Judgment 301
Credit 301
Credit with Security 303
Issue Spotter: Helping a Dream? 304
Lighter? Side of the Law: Don’t You Know Who I Am? 305
Issue Spotter: Lean on a Lien? 310
Bankruptcy 312
Issue Spotter: Credit for the Bankrupt? 315
International Perspective: International Business Bankruptcy Complexities 316
Lighter? Side of the Law: Home Sweet Home 317

PART THREE The Employment Relationship 327

CHAPTER 14
Agency and the Employment Relationship .............................................328
Agency Relationships 329
Lighter? Side of the Law: Is Slavery an Employment Relationship? 331
The Essential Employment Relationship 338
Lighter? Side of the Law: The Ultimate Employment Gig 344
Issue Spotter: Can You Be Too Encouraging to Employees? 345
Lighter? Side of the Law: Who, Him? Must Be an Independent Contractor 346
Tort Liability for Employers and Principals 346
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xiv Contents

International Perspective: Workplace Data Privacy in the European Union 346

Issue Spotter: Use of Company Cars 347

CHAPTER 15
Employment and Labor Regulations .......................................................352
Public Policy Limits to At-Will Employment 353
Lighter? Side of the Law: Grounds for Termination? 355
Substance Abuse 356
Issue Spotter: What Stance Should Be Taken toward Drinking and the Office?
357
Issue Spotter: How Does an Employer Handle an Employee Who Flunks a Drug Test? 358
Worker Health and Safety 359
Lighter? Side of the Law: I Just Wanted My Candy Bar! 361
Workers’ Compensation 362
Lighter? Side of the Law: Rules Are Rules! 362
Issue Spotter: Reducing Risks and Improving Looks 363
Family and Medical Leave 365
General Regulation of Labor Markets 367
Issue Spotter: Adapting to Modern Ways of Working 368
International Perspective: Flexibility in Labor Markets
369
Issue Spotter: Hiring Documentation and Discrimination 370
Major Labor Relations Acts 370
Lighter? Side of the Law: Do What We Say, Not What We Do 371
The National Labor Relations Board 372
Unionization 373
International Perspective: Labor Law in China 375
Issue Spotter: Moves to Help Keep Unions Out 376
Collective Bargaining 376

CHAPTER 16
Employment Discrimination ...................................................................382
Origins of Discrimination Law 383
Title VII of the 1964 Civil Rights Act 383
International Perspective: EEOC Impact on Global Operations 385
Lighter? Side of the Law: A New Protected Class? 386
Bringing a Discrimination Charge 389
Lighter? Side of the Law: Love Only Goes So Far 391
Issue Spotter: Effective Sexual Harassment Policy 394
Issue Spotter: Inadvertent Discrimination? 397
Affirmative Action 398
Disability Discrimination 399
International Perspective: Employment Discrimination in Europe and Japan 400
Lighter? Side of the Law: Wicked Witch of the East? 401
Issue Spotter: Accommodating Disabilities 404
Lighter?
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Right to Harass
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 Contents xv

PART FOUR The Regulatory Environment of Business 409

CHAPTER 17
The Regulatory Process ............................................................................410
Administrative Agencies 411
Lighter? Side of the Law: Keep Pumping Out the Red Tape 412
Administrative Law 412
Enforcing Rules 416
Issue Spotter: Contest a Regulatory Order? 420
Judicial Review 420
International Perspective: Administrative Agencies in Japan 422
Lighter? Side of the Law: Regulators Protecting Consumers? 422
Controls on Agencies 426
Lighter? Side of the Law: We Will Teach You Not to Ask Questions 427

CHAPTER 18
Securities Regulation ................................................................................430
The Elements of Securities 431
What Is a Security? 432
Offering Securities to Investors 433
Issue Spotter: What Are You Selling? 436
Issue Spotter: Can New Start-Up Firms Issue Securities? 438
Regulation of Securities Trading 438
Lighter? Side of the Law: Never Too Old to Withdraw Large Sums 439
Securities Fraud 439
Lighter? Side of the Law: Try, Try Again 443
Insider Trading 443
International Perspective: London, New York, and the Sarbanes-Oxley Act 444
Issue Spotter: Can You Exploit the Gossip? 446
The Investment Company Act 446
International Perspective: European Approaches to Insider Trading 447
The Investment Advisers Act 447
Lighter? Side of the Law: The Fall of a Blood Brother 448
Stock Market Regulation 450

CHAPTER 19
Consumer Protection................................................................................454
The FDA: Food and Drug Regulation 455
Lighter? Side of the Law: Maybe Get a New Laptop 456
International Perspective: Global Drug Controls 457
Issue Spotter: How Much Can You Hype Health Supplements? 459
The FTC and Consumer Protection 460
Lighter? Side of the Law: Protect Me from Myself! 460
Issue All
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xvi Contents

Lighter? Side of the Law: Wild Claims about Water in Europe 467
Consumer Credit Protection 468
International Perspective: Credit around the World473
Issue Spotter: Dealing with Customer Records 474
Lighter? Side of the Law: Watch Who You Nickel and Dime 475
Issue Spotter: How Should You Handle Unpaid Accounts? 477

CHAPTER 20
Antitrust Law ............................................................................................481
Antitrust Statutes 482
Monopolization 486
Lighter? Side of the Law: Milk Monopoly 488
International Perspective: The European Union and Antitrust Law 489
Horizontal Restraints of Trade 489
Lighter? Side of the Law: We’re Lawyers, and We’re Here to Help You 492
Issue Spotter: Share and Share Alike 493
Vertical Restraint of Trade 493
Lighter? Side of the Law: I Am Going to Take My Bull and Go Home! 497
International Perspective: China’s Anti-Monopoly Law 498
The Robinson-Patman Act 498
Issue Spotter: Who Do You Sell What to, and for How Much? 499

CHAPTER 21
Environmental Law...................................................................................504
Environmental Regulation 505
Pollution and the Common Law 505
Clean Air Act 507
Lighter? Side of the Law: Save the Environment: Burn Coal 509
Clean Water Act 512
International Perspective: Industrialization Brings Environmental Problems to China 513
Issue Spotter: Does Obeying EPA Regulations Eliminate Litigation? 516
Land Pollution 518
Lighter? Side of the Law: Thanks for the Housing 520
Species Protection 522
Lighter? Side of the Law: Protect Truly Rare Species 522
Global Environmental Issues 523
Issue Spotter: Picking a Sweet Spot 525
International Perspective: CITES: Global Species Concerns May Conflict with
Local Interests 527

CHAPTER 22
The International Legal Environment of Business.................................531
International Law and Business 532
U.S. Import Policy 534
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 Contents xvii

Issue Spotter: Starting an Import Business 536

Lighter? Side of the Law: I’m a Diplomat, So I Can Do Anything! 537
Issue Spotter: Making the Deal Stick 538
Lighter? Side of the Law I Make Sure Other People Obey the Law 539
Business Structures in Foreign Markets 539
International Perspective: Put the Shoe on the Other Foot 540
Foreign Corrupt Practices Act 541
International Contracts 543
Lighter? Side of the Law: All Corruption Is Not Created Equal 544
Issue Spotter: Where to Produce? 549
International Dispute Resolution 549
International Perspective: Migrating to Australia 552

Appendix A Legal Research and the Internet ............................................................................ 557

Appendix B Case Analysis and Legal Sources........................................................................... 560
Appendix C The Constitution of the United States of America............................................ 567
Appendix D The Uniform Commercial Code (Excerpts) ....................................................... 580
Appendix E National Labor Relations Act (Excerpts)............................................................. 598
Appendix F Title VII of Civil Rights Act of 1964 (Excerpts) ................................................ 603
Appendix G Americans with Disabilities Act (Excerpts) ........................................................ 606
Appendix H The Antitrust Statutes (Excerpts).......................................................................... 609
Appendix I Securities Statutes (Excerpts) ................................................................................. 613

Glossary 617
Index 649

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
 Table of Cases

The principal cases are in bold type. Cases cited or discussed in the text are roman type. References are to
pages. Cases cited in principal cases and within other quoted materials are not included.

A Chambers v. Travelers Companies, INC. 139

ACAP Financial, Inc. v. United States Chevron U.S.A., Inc. v. Natural Resources
Securities and Exchange Commission 449 Defense Council, Inc. 415
Anderson v. Mandalay Corporation 348 Chuway v. National Action
Financial Service 476
Audi AG v. D’Amato 195
City of Livonia Employees Retirement
B System v. Boeing Company 441
Ballalatak v. All Iowa Agriculture Consolidated Edison Company v.
Association 354 Public Service Commission of New York 78

Barabin v. AstenJohnson, Inc. 50 Contractors Source, Inc. v. Amegy

Bank National Association 299
Bearden v. Wardley Corp. 335
Cove Management v. AFLAC, Inc. 332
Black Beauty Coal Company v.
Federal Mine Safety and Health Crest Ridge Construction v. Newcourt 245
Review Commission 418
D
Blimka v. My Web Wholesalers, LLC 34
Davis v. Baugh Industrial Contractors,
Bohnsack v. Varco, L.P. 206 Inc. 10
Bowman v. Monsanto Co. 204 Decker v. Northwest Environmental
Bridge v. Phoenix Bond & Indemnity Co. 107 Defense Center 515
Burlington Industries v. Ellerth 393 DeRosier v. Utility Systems of
America, Inc. 232

C Deschamps v. Treasure State

Trailer Court, Ltd. 226
Caley v. Gulfstream Aerospace Corp 219
Dunkin’ Donuts Franchised
Cash & Henderson Drugs. Inc. v. Restaurants LLC v. Sandip, Inc. 291
Johnson & Johnson 500
Central Hudson Gas and Electric E
Corporation v. Public Service Eagles Landing Development, L.L.C. v.
Commission of New York 80 Eagles Landing Apartments, L.P. 273

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
xviii
 Table of Cases xix

Elonis v. United States 97 In re 1545 Ocean Avenue, LLC 283

Equal Employment Opportunity In the Matter of Kmart Corporation 318
Comm. v. Dial Corporation 395
Erichsen v. No-Frills Supermarkets K
of Omaha 187
Katz v. Google Inc. 202
Erie Railroad Co. v. Tompkins 38
Katzenbach v. McClung 71
F Keith v. County of Oakland 402
Federal Trade Commission v. Wyndham Kim v. Toyota Motor Corporation 158
Worldwide Corp. 462
Fordyce Bank and Trust v. Bean L
Timberland 308
Labrayere v. Bohr Farms, LLC 89
France v. Southern Equipment Co. 339
Lamson v. Crater Lake Motors 18
Fuerschbach v. Southwest Airlines 131
Latta v. Rainey 434

G Lawler v. Montblanc North

America, LLC 135
Geczi v. Lifetime Fitness 128
Lee v. R & K Marine 255
General Electric Business Financial
Services v. Silverman 305 Leegin Creative Leather
Products v. PSKS 495
Greenman v. Yuba Power Products 152
Lewis v. Heartland Inns of
Griffith v. Clear Lakes Trout 249 America, L.L.C. 391
Group Against Smog and Pollution, Lone Mountain Processing, Inc.
Inc. v. Shenango Inc. 511 v. Secretary of Labor 425
Guz v. Bechtel National 342 Long v. Superior Senior Care, Inc. 363

H Lost Tree Village Corporation v.

United States 517
Hamby v. Health Management
Associates, Inc. 147
M
Harder v. Edwards 134
Macpherson v. Buick Motor
Harris v. Forklift Systems 387 Company 149
Hartsoe v. Christopher 24 Massachusetts v. Environmental
Hasenwinkel v. Mosaic 366 Protection Agency 526

Hinson v. N&W Construction Company 220 Moran v. Sims 172

Horne v. Department of Agriculture 86 Morrissey v. Krystopowicz 285

Hughes v. Oklahoma 74
N
I Naples v. Keystone Building and
Development Corp. 57
In Re Polar Bear Endangered Species
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Act Listing 524 Nielsen v. Gold’s Gym 177
xx Table of Cases

O T
OBB Personenverkehr AG v. Sachs 551 Teamsters Local Union No. 523 v.
National Labor Relations Board 377
Orkal Industries, LLC v. Array
Connector Corporation 247 Tetzlaff v. Educational Credit
Management Corp. 314
Thayer v. Hollinger 173
P
Todd v. Exxon Corporation 491
Palsgraf v. Long Island Railroad Com-
pany 125 Troupe v. Burlington Coat Factory
Warehouse Corp. 185
Parish v. Icon 156
Pena v. Fox 217 U
Perez v. Mortgage Bankers Association 413
United States v. Allmendinger 113
POM Wonderful, LLC v. Federal Trade United States v. Apple, Inc. 485
Commission 464
United States v. Jin 207

Q United States v. King 543

QVC, Inc. v. MJC America, Ltd. 258 United States v. Mead Corporation 535
United States v. Salman 444

R
V
RDNT, LLC v. City of Bloomington 180
Venable v. SunTrust Bank 243

S VLM Food Trading International,

Inc. v. Illinois Trading Company 262
SBD Kitchens, LLC v. Jefferson 63
Scheerer v. Fisher 235 W
Schuchmann v. Air Services Heating Whalen v. Union Bag and Paper 506
and Air Conditioning 467
Wyeth v. Levine 458
Seki v. Groupon, Inc. 136
Smith v. Kulig 181
Y
Sowers v. Forest Hills Subdivision 182 Yazdianpour v. Safeblood
Squish La Fish v. Thomco Specialty Technologies, Inc. 145
Products 123 Yim v. J’s Fashion Accessories, Inc. 337
Stark Excavating, Inc. v. Perez 359
Storetrax.com v. Gurland 278 Z
Summers Group, Inc. v. Tempe Zambelli Fireworks Manufacturing
Mechanical, LLC 311 Co. v. Wood 355
Summers v. Earth Island Institute 423 Zhou v. Bickley 270
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 Preface
Knowledge of the legal and regulatory environment of business provides practical background
for students in many careers. There are legal, social, political, and ethical issues in every profes-
sion. Some situations require an understanding of the principles of law to help resolve an issue
or know when legal counsel is needed.
This textbook presents the legal environment as relevant to professionals who are not lawyers.
Only a few students who take this course will become lawyers, although some students will take
additional classes that cover specific legal areas. This course provides the opportunity for people
with various interests to learn key points of the law from the standpoint of a working professional.
Over the years, we have received excellent feedback from professors and students who have
used the 12 previous editions of this book and have pointed out shortcomings and strong
points and given good advice for improvements. We have taken these comments into account
in preparing this edition to make the book even more helpful and practical as we study the
complex legal environment that business professionals face.
Our reviewers agree that this text focuses on practical aspects of the law. As we constantly
update the text, we try to keep to a minimum the legal minutia, such as uncommon exceptions
or rules peculiar to only a few states. We focus on primary rules and issues that arise most of-
ten. We use business situations and examples to highlight legal principles in practice. In select-
ing cases that appear in the text, the focus is on practical situations in business that students
can best relate to and are realistic in a business career. The holdings are straightforward appli-
cations of the law to the facts. However, some major cases are included so students can get a
sense of how courts announce major rules and the evolution of law can be discussed.

Essential Organization
In the legal environment of business course, there is the problem of many possible topics to
cover but not enough time. There is agreement that the key elements of the legal system must
be covered. This is done in Part 1 of the book, Elements of Law and the Judicial Process. Part 2,
Elements of Traditional Business Law, focuses on the major areas of the common law that
apply to business and some statutory law oriented at business functions. Part 3, The Employ-
ment Relationship, addresses a part of the business environment that applies to everyone, the
ever-growing area of employment law, ranging from traditional agency to discrimination and
social media issues. Part 4, The Regulatory Environment of Business, covers the major regula-
tory laws that managers of a variety of firms may face and finishes with key points of interna-
tional business law.

New to This Edition

MindTap
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media, activities, and assessments into a singular Learning Path. Instructors can personalize the
Learning Path by customizing Cengage Learning resources and adding their own content via apps
that integrate into the MindTap framework seamlessly with Learning Management Systems.
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xxii Preface

We have heard that business law instructors want to help students Prepare for class, Engage
with the course concepts to reinforce learning, Apply these concepts in real-world scenarios,
and use legal reasoning and critical thinking to Analyze business law content. Accordingly, our
MindTap product provides a four-step Learning Path designed to meet these critical needs
while also allowing instructors to measure skills and outcomes with ease.
• Prepare: E-book and Worksheets—Help students prepare for class with interactive guided
reading and chapter review questions that can be completed prior to class so that class time
can be spent applying the concepts.
• Engage: Video Activities—Engage students using real-world scenarios that bring business
law to life and help students make connections with real work situations. Includes compre-
hension questions for practice and assignable homework that can be graded.
• Apply: Brief Hypothetical Scenarios—These short fictional scenarios help students spot
the issue and apply the law and concepts that they’ve learned. These are great questions for
exam preparation.
• Analyze: Legal Reasoning—Promote deeper critical thinking and legal reasoning by using
these case problem questions to help improve critical thinking skills.
Every item in the Learning Path is assignable and gradable. This gives instructors the knowl-
edge of class standings and concepts that may be difficult. Additionally, students gain knowledge
about where they stand—both individually and compared to the highest performers in class.
To view a demo video and learn more about MindTap, please visit www.cengage.com/
mindtap.

Case Collection
Now, within MindTap, instructors can search Case Collection—a library of cases from previ-
ous editions of different Cengage textbooks—by relevant criteria and then incorporate those
cases in the Learning Path for students.
This exciting repository allows instructors to personalize their course and truly engage stu-
dents, helping them to reach higher levels of critical thinking.
• Easily search by topic, and then refine the search by subtopic, to find case examples of a
specific legal concept.
• Search by court or state to bring a local flavor or interest to the classroom.
• Enjoy over 1,200 cases at your fingertips. All new edition omitted cases will be added every
year, allowing the archive to continually grow.
Mix and match cases from all textbooks, whether you are currently using it in class or not.
This allows you to provide longer cases with more information from other resources, which is
especially helpful if your text didn’t show the court’s decision.

Key Features

Edited Cases
A primary way to learn law is to read real cases that the courts had to resolve. Each major case
presented in the text has the background facts and legal proceedings summarized by the
authors under the heading Case Background. Then the court’s holding, legal reasoning, and
explanation of the law as it applies to the facts at hand are presented from the published opin-
ion in the words of the judge in the Case Decision. Since most decisions are long, we present
only the key portions of the holding. When there is a long deletion of material from a holding,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
you see asterisks (***). When there is a deletion of a smaller part of the logic in a decision there
 Preface xxiii

are ellipses (. . .). Finally, Questions for Analysis are offered for the reader to consider or for
class discussion. (Answers are provided in the Instructor’s Resource Guide.)

International Perspective
These boxed features discuss how issues similar to those being reviewed in the text are handled
in other countries. As globalization reaches more businesses, managers must know how to deal
with different legal systems and cultures. This feature makes clear that the legal constraints are
different in other nations. Managers must be prepared to resolve problems in different ways in
different locales in today’s complex legal environment.

Issue Spotter
Over 50 Issue Spotter features are scattered throughout the text. Each briefly presents a busi-
ness situation that requires application of legal elements just covered in the text. These chal-
lenges are a way for students to self-test their retention and ability to reason as they apply
newly learned principles to practice. They also remind readers that the material learned in this
course is practical to everyday issues in business. (Discussion points to these features are pro-
vided in the Instructor’s Resource Guide.)

Lighter Side of the Law

These highlights add a light touch to the topic at hand by discussing an unusual legal situation.
While law and business are serious, odd things happen that remind us that trouble can come
from unexpected places, that the results of the legal process can be surprising, that scoundrels
are among us, and that truth can be stranger than fiction.

Summary
The text of each chapter is summarized in bullet format that provides a quick review of the
major points of law and rules covered and serves as a self-test of points that will be covered in
examinations.

Terms to Know
After the Summary, there is a list of key terms from the chapter. The reader should know what
the terms mean because they are an important part of the vocabulary and substance of the con-
cepts covered in the chapter. Besides being explained in the chapter, each term is also defined
in the Glossary in the back of the book.

Discussion Question
Every chapter has a question for general discussion that picks up on major ideas from the chap-
ter. The purpose is to make sure the student understands the concepts of the chapter well
enough to be able to discuss a topic that was covered and should be expanded upon.

Case Questions
Most problems are solved out of court, but some end up in court where judges decide the resolu-
tion based on legal principles. Real case problems are summarized in each case question. Using
the knowledge from the chapter, and perhaps some instinct about how a court is likely to resolve
a dispute, try to decide which party to a dispute is likely to prevail and why.

Ethics Question
Each chapter ends with an ethics question that poses a problem related to the legal area covered
in the chapter. Remember that ethical issues are different than legal issues, so we go beyond
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
legal reasoning in considering the problem.
Another random document with
no related content on Scribd:
40.CHART SHOWING RISE OF TEMPERATURE BEFORE APOPLECTIC
SYMPTOMS IN A CASE OF TUMOR OF RIGHT TEMPORAL LOBE
41.CHART SHOWING THE DIFFERENCE OF TEMPERATURE BETWEEN THE
TWO SIDES IN A CASE OF HEMIPLEGIA
42.CHART SHOWING THE SAME AS FIG. 41 IN ANOTHER CASE OF
HEMIPLEGIA
43.FLAT GLIOMA-CELL WITH ITS FIBRILLAR CONNECTIONS (OSLER)
44.HOMOGENEOUS TRANSLUCENT FIBRE-CELL (OSLER)
45.DIAGRAM OF SPINAL COLUMN, CORD, AND NERVE-EXITS (AFTER
GOWERS)
46.SARCOMA PRESSING CERVICAL CORD (E. LONG FOX)
47.SARCOMA OF LOWER CERVICAL CORD
48.THE SAME AS FIG. 47
49.THE SAME AS FIG. 47
50.THE SAME AS FIG. 47
51.FIBROMA OF LOWER DORSAL CORD
52.TUMOR OF CAUDA EQUINA
53.PSAMMOMA OF DORSAL CORD, JUST ABOVE LUMBAR ENLARGEMENT
54.THE SAME AS FIG. 53
55.DIAGRAM SHOWING THE MENTAL RELATIONS OF MOTOR AND TROPHIC
CELLS WITH CEREBRAL AND SPINAL NERVE-FIBRES (AFTER ERB)
56.VASO-MOTOR NERVES AND GANGLIA ACCOMPANYING THE ARTERIOLES
IN A FROG (GIMBERT)
57.DIAGRAM TO REPRESENT THE MODE OF ACTION OF COUNTER-IRRITANTS
APPLIED TO THE CHEST (LAUDER-BRUNTON)
58.DIAGRAM OF THE ARRANGEMENT AND CONNECTION OF THE MOTOR AND
TROPHIC CENTRES AND FIBRES IN THE SPINAL CORD AND MOTOR
NERVE (AFTER ERB)
 DISEASES OF THE NERVOUS
SYSTEM.

GENERAL SEMEIOLOGY OF DISEASES OF THE

NERVOUS SYSTEM; DATA OF DIAGNOSIS.

BY E. C. SEGUIN, M.D.

I. Psychic Symptoms.

ABNORMAL EMOTIONAL STATES.—Emotional manifestations,

spontaneous or provoked from without, are, in the civilized adult,
held in check directly or indirectly by the will, or by so-called strength
of character. Extreme variations are allowed as being within the
normal, from the stupidity of the peasant and the impassability of the
hero to the sensitiveness and almost unrestrained reactions of the
child or of the artist. Each individual must be judged by his own and
his racial and family standards in this respect. It is more particularly
when the dulness or over-active state observed is in contrast with
the subject's habitual demeanor that the condition is called
pathological.

Emotional dulness, or the complete absence of any emotional

manifestation, may depend upon (1) diminished sensibility to
external influences; (2) sluggishness of cerebral action, more
especially in the range of sensori-ideal processes, or to general want
of intelligence; (3) absorption of the subject's cerebral powers in
some special object, real or delusive. The first form is illustrated in
various grades of idiocy and backwardness; the second, in fatigue,
prostration, and in conditions of dementia; the third is well
exemplified in cases of insanity where the patient is devoted to one
delusion or dominated by hallucinations (melancholia attonita), in
which case the subject may be told the most painful news, insulted
most grievously, or threatened fearfully without manifesting grief,
anger, or fear. In some instances absolutely no emotional life can be
detected.

Emotional exaltation may be due to (1) increased sensibility to

external influences; (2) to deficient self-control. The first condition is
illustrated in neurasthenic and hysterical subjects and in forms of
mania: slight or almost imperceptible provocations call forth reaction,
a noise causes fear, a look anger or tears, etc.; the second
mechanism is apparent in diseases (dementia paralytica) where the
cerebral hemispheres are extensively diseased and the cerebral
power lessened (more especially is this the case where the right
hemisphere is injured), and in cases of simple debility or asthenia, as
when we see a previously mentally strong man shed tears or start
most easily in convalescence from acute disease.

It may also be stated, in general terms, that the emotions are

manifested in inverse ratio to the subject's mental or volitional power.
Psychologically, the emotions are intimately related, on the one
hand, with sensory functions, and on the other with more purely
mental functions. Anatomically, it is probable that emotions are
generated in basal ganglia of the brain (thalami optici and ganglion
pontis), in close association with the sensory areas of the cortex
cerebri, while the volitional, inhibitory power is derived from regions
of the cortex situated frontad. Clinically, we meet with abnormal
emotional states in a great many diseases of the nervous system,
more especially in hysteria, neurasthenia, and insanity.

DEPRESSION in the psychic sphere manifests itself by the presence of

psychic pain (psychalgia), by slowness of emotive reaction and of
intellection, and by the predominance of fear, grief, and other
negative emotional states. This complex mental state is usually
accompanied by corresponding physical symptoms—general
debility, reduced muscular strength, slowness of visceral functions,
and retarded metamorphosis. The features are relaxed and passive;
the posture sluggish, indifferent, or cataleptoid; the animal appetites
are reduced. It is seldom that the entire economy does not
sympathize with the psychic state. In exceptional cases some
emotions are abnormally active, as in hypochondriasis; or there may
be abnormally active muscular movements, as in melancholia
agitata. Usually, depression is a part (a fundamental part, however)
of a more complex symptom group, as in hypochondriasis,
melancholia, hysteria, the prodromal stage of mania or paralytic
dementia, etc.; but sometimes it constitutes a so-called disease—
melancholia sine delirio. Although depressed subjects often appear
indifferent to their surroundings, and react slowly or not at all, it must
not be supposed that their emotions are not subjectively active. They
are often abnormally so, and psychic hyperæsthesia coexists with
psychalgia. No anatomical seat can be assigned to the processes
which constitute this state and the following; their psychic
mechanism is unknown.

EXALTATION, or abnormally great mental activity (including emotions),

so-called psyclampsia, manifests itself by a pleased or happy
subjective state, by increased reaction to external stimuli, by
unusually abundant and rapid ideation, and by a corresponding
increase of somatic activity, as shown by apparent (?) excess of
muscular power, of circulation, of visceral activity, and of the
appetites. The entire being, in certain cases, becomes endowed with
additional capacity and power. In the mental sphere this over-activity
easily passes into incoherence and verbal delirium, while in the
physical sphere it may translate itself into violence. Clinically,
exaltation may show itself as an independent morbid state, known as
mania sine delirio. It more commonly appears, with other symptoms,
in the shape of ordinary mania, of delirium tremens, of dementia
paralytica, etc. Exaltation often follows morbid depression, and these
two states sometimes alternate for years (circular insanity).
Exaltation, even when accompanied by violent muscular action, must
not always be considered an evidence of increased nervous power.
On the contrary, it is often a result of irritable weakness, and as such
indicates a tonic and restorative medication.

ILLUSIONS.—By illusion is meant the result of malinterpretation of an

external impression by disordered sensorial or cerebral apparatuses.
All of the special senses and the common sensory nerves may be
the media of illusions, but they more commonly manifest themselves
in the visual and auditory spheres. A few examples will best illustrate
the exact meaning of the term. An insane person mistakes a casual
visitor for his brother or father: he fancies that a piece of furniture is a
flowering shrub or a threatening animal; another patient will declare
that the food in his mouth tastes of a particular poison; still another,
having pains in the night, solemnly avers that he has been beaten or
cut, etc. A real impression is made upon the centres for vision, taste,
and common sensation, but it is wrongly interpreted or appreciated.
The exact mechanism of illusions escapes our present means of
analysis: the peripheral apparatus or the perceptive centre may be
disordered; probably, in most cases, the latter. This is borne out by
the fact that in many insane the illusions are in harmony with the
delusions present in the mind, and then they are nearly akin to
hallucinations. The word illusion is sometimes employed as
synonymous of delusion, but this is an abuse of terms to be avoided.
Healthy persons are subject to illusions, but the error is quickly
corrected by more careful observation by the same sense, or by the
use of others. The state of intoxication by cannabis indica
(hasheesh) presents numberless illusions of all the senses, together
with hallucinations.

HALLUCINATIONS.—By this term is designated the result of the

projection into the external world, through nerves of common or
special sensations, of formed sensations which arise in a disordered
sense-apparatus or nerve-centre; or, in more popular language, it
may be said to mean the perception of non-existent objects or
impressions, creations of the imagination. Examples: Disease
(sclerosis) of the posterior columns of the spinal cord irritates the
roots of the sensory nerves, the result being pain at the periphery in
the parts connected with the affected segment of the cord. So
objective and real do these peripheral pains seem that if the patient's
mind be weakened he may assert that they are due to his being
beaten, stabbed, or bitten by some one or by an animal. After
amputation, the absent member is long perceived by the subject,
often with startling distinctness, and even after the sensation has
passed away it may be brought back by faradizing the nerve-trunks
above the stump. The patient may hear voices, music, or simple
sounds when in reality there is silence, or he may be surrounded by
imaginary images or plagued by hallucinatory smells and tastes.
Hallucinations may also arise in the distribution of optic nerves.

Besides common hallucinations with their seeming reality and

objectivity, we admit others which are less vivid, which do not startle
or frighten the subject, and which are simply the outward projections
of the patient's own thoughts (delusions). The subject of persecution
by imaginary enemies may see around him the faces of his pursuers
with appropriate expressions, or hears their insulting or threatening
remarks, as outward plastic reproductions of his thoughts; but the
patient himself recognizes the want of actual objectivity and
clearness in these images. These we call, after Baillarger, psychic
hallucinations or pseudo-hallucinations. Similar phenomena are
observed in some sane persons under excitement and betwixt sleep
and waking.
The mechanism of hallucinations is partly understood, and may be
stated as follows: In some few cases a real disorder or defect in the
peripheral sense-organ may give rise to false projections; for
example, a tinnitus may become transformed into a distinct voice, a
scotoma may be the starting-point of false pictures of a man or
animal. The simpler hallucinations of pain, cutaneous, muscular, and
visceral sensations may originate in irritation of the nerve-trunks (as
where the nerves of an arm-stump are faradized and the patient
feels his hand with fingers in motion). But the general or common
genesis of hallucinations is in disordered states of nerve-centres,
those for common sensations and the special centres or cortical
areas in the brain. Thus, a morbid irritation of the cortical visual area
or sphere will give rise to abundant hallucinations of sight; irritation of
the auditory sphere to hallucinations of hearing, as sounds and
voices, etc. It must be borne in mind that, however pathological
hallucinations may be, they arise from the operation of a
fundamental physiological law. In health we constantly refer our
sensations or transfer them into the external world, thus creating for
ourselves the non-Ego. All terminal sensory nerve-endings receive
only elementary impressions or impulses from external agencies,
and these are perceived and conceived as images, formed sounds,
etc. in the appropriate cortical centres; then by the law of reference
of sensations these elaborated, idealized conceptions or pictures are
thrown outward again and contemplated as objective. In this
physiological mechanism lies the kernel of truth which is included in
idealism.

Hallucinations may occur without derangement of mind or

impairment of judgment. Many instances are on record of transient
or permanent hallucinations of various senses in perfectly healthy
persons who were fully aware of the unreal character of what they
saw or heard. Being of sound mind, they were able to make the
necessary correction by reasoning or by the use of other senses. In
very many forms of insanity hallucinations are prominent, though
they also occur in quasi-sane conditions, as in hypochondriasis,
hasheesh, belladonna, and opium intoxication, the stage between
sleeping and waking, etc. As long as the subject is able to correct
the false projections by reason or by the use of other senses he is
considered sane.

Hallucinations are sometimes the cause of acts by the insane, some

of them violent and even murderous actions. Hallucinations of sight
and hearing are especially prone to lead to assaults, murders, etc.
The occurrence for any length of time of acoustic hallucinations in
insanity is accounted of bad prognosis.

DELUSIONS are synonymous, in a popular way, with false beliefs.

Thus, we often speak of eccentric opinions, of fanatical or
extravagant creeds, as delusions. In a certain sense probably all
mankind cherish innumerable delusions. In a strictly medical and
medico-legal sense, however, the term is applied only to false beliefs
in respect to clearly-established, indisputable facts. Thus, a man who
believes in Spiritualism or even in metempsychosis, or in the divinity
of a certain personage, is not medically deluded; whereas, one who
believes that a bare court is a flowering garden or that he himself is
divine is deluded. The essential element in the conception of
delusion is belief or conviction on the patient's part; and that is why
delusions mean that the psychic functions are deeply and seriously
impaired. Delusions may be conveniently divided into ideal and
sensorial.

(a) Ideal delusions are false ideas or concepts arising more or less
spontaneously, or by morbid association in the subject's mind. For
example: he believes that he is a god, that he has millions of money,
that his soul is lost, that he has a thousand children, etc. Many of the
delirious ideas experienced by insane patients are delusions, and so
to a certain extent (subject to temporary corrections by reasoning
and demonstration) are the notions of hypochondriacs about their
health.

(b) Sensorial delusions are such as are founded upon illusions and
hallucinations. The moment a subject is convinced of the reality of an
illusion or hallucination, believes in its actuality, he is said to have a
delusion. The change from illusion and hallucination to the state of
sensorial delusion indicates a deeper psychic alteration—a failure of
critical capacity or judgment. Examples: A man imagines the stump
of a tree in front of him to be a human being, but by reasoning, by
closer visual inspection, or by palpation he concludes that it is a tree,
after all; this is a simple illusion. If he persists, in spite of argument
and demonstration, in his assertion that the stump is a human being,
he is said to have a delusion or to be deluded. If a person sees
wholly imaginary flowers or hears imaginary voices, as long as he is
capable of recognizing the falsity or want of actuality of these images
or sounds he has a simple hallucination; if he ceases to make the
necessary correction, and believes the flowers and voices to really
exist, he has sensorial delusions. It should be borne in mind that
sane persons may have hallucinations, and that some insane have
no sensorial delusions; also, that some insane are capable of
correcting, for a time at least or when closely questioned, their
illusions and hallucinations. Apart from these exceptional conditions,
delusions, sensorial and ideal, are most important symptoms of
insanity. We also meet temporary delusions in toxic conditions (from
Indian hemp, alcohol, etc.) and in the delirium of acute general
disease, of low febrile states, starvation, etc. Delusions are
sometimes named in groups, according to the prevailing type of
mental action; then, we have exalted delusions, in which the false
notions and beliefs are rose-colored or extremely exaggerated (as in
paralytic dementia, etc.). Again, we speak of delusions of
persecutions, where the patient fancies himself pursued, maltreated,
insulted, or where he insanely follows up and persecutes others.
Such classification is useful for purposes of clinical and psychical
study.

Imperative conceptions or controlling morbid ideas and desires are

ideal delusions presenting certain peculiarities; one of which is that
of growth by accretion and assimilation by a sort of false logic and
grotesque analogical reasoning, until from a mere fancy or notion the
growth invades and governs the entire subjective life of the subject.

VIOLENCE is a complex symptom always deserving of study and

psychological analysis. It may present itself as an increase of a
naturally bad disposition or as a wholly new exhibition of irritability
and temper. Beyond these limits it may assume the shape of abusive
and foul language (not before employed by the subject), or of
physical acts of a destructive or dangerous character. Viewing the
condition from a psychological standpoint, we should endeavor to
distinguish between merely impulsive or animal violence due to over-
activity of the emotional state or to a loss of self-control (cortical
inhibition), and quasi-deliberate acts due either to special delusions
or to delirium. Abnormal irritability, or increase in an originally bad
temper, is met with in hysteria, neurasthenia, and partial dementia.
Masturbators and epileptics frequently exhibit this condition. In a
state less pathological, from mere fatigue or overwork, irritability may
temporarily show itself as a result of reduced cortical energy; and in
such cases rest, a cup of tea or coffee, alcohol, or even ordinary
food, restores good-nature and equanimity as by magic. In little
children bad temper is a frequent precursor of illness, more
especially of cerebral disease. Greater degrees of violence in
speech and acts are met with in hysteria, neurasthenia, and in many
forms of insanity, in the guise of exaggerations of animal
propensities, to make a noise, break objects, injure persons in an
aimless general way. Voluntary or quasi-voluntary acts of violence
are those which are done under the influence of hallucinations,
delusions, or of delirious ideas, usually by insane patients. The
delirium of acute or inflammatory disease or of the typhous state is
rarely active, although pericarditis sometimes gives rise to very
violent delirium, and the mild delirium with picking and gesticulating
of pneumonia, typhoid fever, etc. may sometimes simulate mania. In
general terms, the words and acts of patients represent the ideas
passing through their minds in a rapid confused way, much as in
dreams. Violence done under the influence of clearly-defined
hallucinations and delusions is most dangerous, because it is
executed with apparent deliberation and volition. Thus, a man
laboring under hallucinations of hearing, fancying himself insulted,
may turn in the street and strike or shoot some one near him, the
supposed author of the insult. An epileptic falls in a partial attack or
has epileptic vertigo; as a part of the seizure there is a dream-like
scene of assault, actual or threatened, upon him, and on rising from
the ground, or after the momentary vertigo the patient, acting in
accordance with the demands of the dream-like scene, makes an
onslaught upon those near him or smashes furniture, etc. Seeing
such acts, without knowing their genesis, one is liable to consider
them normally deliberate and malicious. On recovering
consciousness (which may not be for several hours or days) the
epileptic patient appears utterly oblivious of his actions, and is much
astonished to learn what he has done. In many cases of insanity
violent acts are done through a similar psychic mechanism—i.e.
through the domination of delusions. Delusions often give rise to
what may be termed negative violence—resistance to personal care,
treatment, giving of food, etc. This is exemplified in acute
melancholia, with overpowering fears of all kinds and terrorizing
hallucinations of sight and hearing. The patients crowd in corners or
sit curled up, and resist with all their might whatever is done for
them, even striking and biting the attendants.

Therapeutically, the question of physical restraint or non-restraint in

the management of violence might be discussed here, but the
question is one which can be much better considered in connection
with the general treatment of insanity, and the reader is consequently
referred for information to the article on that subject.

DELIRIUM is a term which has been so variously applied that a brief

definition of it is wellnigh impossible. Illogical or unreasoning and
incoherent thoughts expressed in words and acts may suffice to give
a general idea of the condition. Extreme applications of the term are,
for example, to say that in a case of extreme dementia the rambling,
disconnected talk is delirium, or that in certain forms of monomania
the expression of the patient's peculiar delusion is delirium. It seems
to us that there should be a certain degree of activity in the
production of morbid ideas, with confusion in their expression, to
justify the use of the term delirium. Again, in some instances the
delirious talking and acting are only the reflex of abundant
hallucinations of various senses which beset the patient. In some
other respects the term delirium is applied in several distinct ways:
first, in a substantive form as a designation for the incoherent words
and acts of a patient. Usually, it is then put in the plural form of
deliria. Thus we have the more or less highly organized, fixed or
changeable deliria of monomania, chronic mania, melancholia,
paretic dementia, etc., and the confused and evanescent deliria of
acute general diseases, intoxications, and many forms of insanity. In
short, we may speak of a sick person's deliria as we would of a
normal person's thoughts; or in still more elementary analysis deliria
are abnormal or insane thoughts and corresponding action. Second,
delirium is used adjectively as designating certain diseases—e.g.
delirium tremens, delirium a potu, acute delirium, delirium of acute
diseases, etc. The seat of the psychic processes which go to make
delirium is undoubtedly the cerebral cortex. This view is supported
partly by the clinical consideration that delirium bears a certain
relation to the psychic development of the subject. Thus, we see in
children and in the higher animals rudimentary or fragmentary deliria;
in advanced age the delirium is feeble and wellnigh absent; while in
ordinary adults with well-developed cerebration deliria are abundant
and varied. From pathological anatomy we learn that deliria become
simplified and subside in proportion as the cerebral cortex becomes
more and more damaged by effusions, by pressure effects, or by
degenerative changes. As to the relation between special
histological pathological changes, our knowledge is small and to a
certain extent paradoxical. Thus, it is universally admitted that
delirium may be due either to hyperæmia or to anæmia of the brain.
The delirium of alcoholic or cannabis intoxication may be fairly
assumed to be of sthenic or hyperæmic origin, either by the nervous
elements themselves being in an exalted state of irritability, or
because an increase in the circulation of arterial blood in the brain
leads to greater activity of the cellular elements. Again, delirium
appears in conditions of general or cerebral anæmia, as in
starvation, after prolonged fever, after the withdrawal of customary
stimuli, etc. These views are confirmed by the fact that some deliria
cease upon the administration of sedatives and narcotics, while
others are relieved and cured by rest, stimulants, and food. On the
other hand, a large class of deliria, as exhibited in the insane,
escape pathological analysis; for example, the delirious conceptions
of monomania occurring in apparent somatic health and without well-
marked symptoms of cerebral disease. We are much in the dark as
to what the processes may be by which delusional notions grow in
the subjective life and manifest themselves outwardly as deliria. It is
probable that in such cases there is no material lesion (appreciable
to our present means of research), but a morbid dynamic condition,
false reactions, abnormal centripetal and centrifugal associations in
the psychic mechanism, with or without inherited bias. The diagnosis
of delirium as a symptom is usually easy, but it is a task of no small
difficulty to determine its pathological associations in a given case,
and to draw from this study correct therapeutic indications. A careful
review of the antecedent circumstances, of the patient's actual
somatic condition, more especially as regards hæmic states and
vaso-motor action, is indispensable.

LOSS OF CONSCIOUSNESS, COMA.—Suspension of all sensibility,

general and special, with loss of all strictly cerebral (cortical)
reflexes, is met with in many pathological states. Its physiology or
mode of production is unknown, but there are good reasons for
believing that the lesion, vascular or organic, affects chiefly the
cortical substance of the hemispheres. Its clearest manifestation,
clinically, is after depressed fracture of the skull or after concussion
of the brain, without or with abundant meningeal hemorrhage. In the
last case unconsciousness or coma appears as an exaggeration of
drowsiness or stupor; after a fall the patient may be able to walk into
the hospital, but soon becomes drowsy, then stupid, and lastly
completely insensible. In the first case, that of depressed fracture of
the skull, the raising of the depressed bone is often followed
immediately by return of consciousness; the patient seems to wake
as from a deep sleep. In medical practice there are many analogous
conditions of abnormal pressure causing coma, as in meningitis,
cerebral abscess, hemorrhage, embolism of cerebral vessels, etc.
Long-continued or fatal coma may be caused by general morbid
states, as uræmia, acetonæmia, surgical hemorrhage, intoxication
by narcotics, alcohol, ether, etc., and by asphyxia. Momentary loss of
consciousness is induced in the various forms of epilepsy, lasting
from a fraction of a second (so short as not to interrupt walking) to
one or two minutes, followed by the more prolonged coma of the
asphyxial stage. Temporary unconsciousness is also caused by
physical or moral shock, but in many such cases the heart is
primarily at fault, and the condition is termed syncope. Although in
practice it is most important to distinguish syncope from more strictly
cerebral coma, yet it must be admitted (and such admission is
important for therapeutics) that in both categories of cases anæmia
of the brain (cerebral cortex) is the essential factor or immediate
cause of suspension of consciousness. This view of the pathology of
coma is borne out by the fact that the condition may be produced at
will, experimentally or therapeutically, by compression of both carotid
arteries. It may be well to mention here the pseudo-coma of hysteria.
In these cases consciousness is really present, as shown by
responses to violent cutaneous irritations (faradic brush), by
quivering of the closed eyelids and resistance to attempts to open
them, by vascular or muscular movements evoked by remarks of a
flattering or abusive nature made in the patient's hearing, and by
cessation of the condition after complete closure of the nose and
mouth for forty-five seconds or one minute (asphyxia). In the typically
unconscious state, as in cases of fracture of the skull or of
intracranial pressure by exudations, clots, tumors, etc., there are
several objective symptoms to be noted. The pupils are usually
dilated and immovable (exceptions chiefly in narcotic poisoning); the
pulse is reduced in frequency and retarded; it is sometimes full and
bounding, or in other cases feeble and irregular. The breathing is
often slow and irregular; the patient fills out his cheeks and puffs
(smokes the pipe); sometimes the Cheyne-Stokes type of respiration
is observed. In hysterical or hypnotic impairment of consciousness
these important symptoms are absent: the patient seems simply
asleep. Although coma is, strictly speaking, a symptom, it so often
appears as the leading one of a group that it deserves study almost
as a disease. Indeed, there are few more difficult problems for the
physician than the case of a comatose subject without a good history
of the preceding condition, causes, etc. It is impossible here to
consider all the possibilities of this problem in diagnosis;1 we can
only state the chief and most probable pathological conditions which
may cause coma.
 1 An able attempt at the differential diagnosis of comatose cases, by J. Hughlings-
Jackson, will be found in Reynolds's System of Medicine, Am. ed., 1879, vol. i. p. 920.

(1) The patient may be epileptic. The following signs of a past

convulsive attack should be sought for: a bitten tongue, fleabite-like
ecchymoses on the face, neck, and chest, saliva about the face and
neck, evidences of micturition or of seminal emission in the clothing,
etc. There is usually a small rise of temperature after a single fit, and
consciousness soon returns without assistance, or a second seizure
appears.

(2) The patient may be suffering from surgical cerebral compression

or concussion. Signs of injury about the head or other parts of the
body, oozing of blood or sero-sanguinolent fluid from the ears and
nose, will sometimes clear up the diagnosis. Especially suggestive of
meningeal hemorrhage is a gradually increasing stupor without
distinct hemiplegia.

(3) The coma may be uræmic. In some cases anasarca and slow
pulse point at once to this pathological condition. In all comatose
cases without history the urine should be drawn with a catheter for
testing, and signs of various forms of Bright's disease may be
detected. The ophthalmoscope (easily used in comatose subjects)
may yield most valuable indications by revealing retinitis
albuminurica or neuro-retinitis.

(4) The patient may be under the effects of a clot in the brain or of
acute softening of a considerable part of the organ. Hemiplegia with
conjugate deviation of the eyes and head is usually present, the
head and eyes turning away from the paralyzed side, the patient
looking, as it were, toward the lesion. A latent hemiplegic state may
sometimes be determined by one-sided redness of the buttock, and
by a slight difference of temperature between the two hands
(paralyzed side warmer). The general temperature of the body
(measured preferably in the vagina or rectum) exhibits a marked
rise. After cerebral hemorrhage there is, according to Charcot and
Bourneville, a fall below the normal during the first hour, followed by
a steady rise to 106° or 108° F. at death in severe cases. After
embolism or thrombosis, causing softening, the rise of temperature
is less in extent and not as regularly progressive.

(5) The subject may be simply drunk or poisoned by alcohol. In such

a case the patient may usually be roused momentarily by loud
speaking, shaking, or by painful impression; the breath is alcoholic;
the cerebral temperature subnormal or normal. The urine must be
tested for alcohol.2 It must not be forgotten that on the one hand
intoxicated persons are most prone to falls causing fracture of the
skull or concussion, and on the other hand that the early stage of
coma from meningeal hemorrhage resembles narcosis.
2 Anstie's Test.—A test solution is made by dissolving one part of bichromate of
potassium in three hundred parts by weight of strong sulphuric acid. The urine is to be
added drop by drop to the solution. If a bright emerald-green color suddenly results
from this manipulation, it signifies that there is a toxic amount of alcohol in the urine.

(6) The coma of congestive or malignant malarial fever is to be

distinguished mainly by the absence of physical or paralytic
symptoms, coinciding with a high rectal temperature. The spleen is
often enlarged. Some would add that Bacillus malariæ and pigment
might be found in the splenic blood, withdrawn by a long, fine
needle.

(7) Toxic narcosis, from opiates, morphia, chloral, etc., are often
difficult of diagnosis, except that from opiates and morphia, in which
extremely slow respiration and contracted pupils, with lowered
temperature, point at once to the cause.

In studying cases of coma all the above-enumerated symptoms

should be considered as of great negative or positive value: often the
diagnosis is only made by exclusion. The Cheyne-Stokes respiration,
pupillary variations, differences in pulse-rate and volume, are
present in such varied conditions, irrespective of the nature of the
lesion, as to render them of minor value in differential diagnosis.

DOUBLE CONSIOUSNESS is a rare condition, in which the subject

appears to have separate forms or phases of consciousness, one
normal, the other morbid. This occurs in hypnotic and somnambulic
states, probably also in certain cases of insanity and epilepsy. The
current of normal consciousness is suddenly broken; the patient
enters into the second or abnormal state, in which he acts, writes,
speaks, moves about with seeming consciousness; but after a
variable time a return to normal consciousness reveals a break in the
continuity of the memory: the patient has no recollection whatever of
what he did or said in the morbid period. In the hypnotic state
subjects may show increased power of perception, and are strangely
susceptible to suggestions or guidance by the experimenter. In a
second attack the patient often refers back to the first, and does
things in continuation or repetition of what he previously did,
apparently taking up the same line of thought and action. The morbid
states, long or short, are joined together by memory, but are wholly
unknown in the normally conscious states. In other words, the
patient leads two (or three, according to a few observations)
separate lives, each one forming a chain of interrupted conscious
states. In epilepsy we observe remarkable breaks in normal
consciousness: the patient goes through certain acts or walks a
distance or commits a crime in a dream-like state, and suddenly,
after the lapse of a few minutes, hours, or days, becomes normally
conscious and has no recollection of what he did with such apparent
system and purpose during the seizure. It might, perhaps, be as well
to classify these phenomena under the head of amnesia. A case is
on record where a man travelled, seeming normal to fellow-
travellers, from Paris to India, and who was immensely astonished
on coming to himself (return to common consciousness) in Calcutta.
Many murders have been committed with apparent design and with
skill by epileptics, who upon awaking from their dream-like state
were inexpressibly horrified to hear of their misdeeds.

AMNESIA, or loss of memory, may vary in degree from the occasional

failure to remember which is allowed as normal, to the absolute
extinction of all mental impressions or pictures. This word and the
expression memory are here used in a restricted sense, reference
being had only to purely intellectual and sensorial acts related to
intellection. If we take the general or biological sense of the term
memory as meaning the retention of all kinds of residua from
centripetal impressions and of motor centrifugal impulses, including
common sensory and visual impressions, special sense impressions,
all unconsciously received impressions, emotional, intellectual, and
motor residua, we should consider amnesia in a correspondingly
general way. This, however proper for a physiological study, would
be far too complex and premature for an introduction to practical
medicine. Recognizing memory, therefore, as a universal organic
attribute—a capacity to retain impressions—we will treat of it only in
the commonly-accepted sense referred to supra.

Failure of memory may be real or apparent. In the latter sense

amnesia is induced by diversion of the attention into a channel
different from that in which the line of inquiry is conducted. A normal
example of this is seen in the state known as preoccupation, where a
person intent upon a certain thought or action forgets who is about
him, where he is, and if asked questions fails to answer or answers
incorrectly. In pathological states, as in acute curable insanity,
apparent loss of memory is often caused by the domination of an
emotion or of delusions. In both cases, if the subject can be roused
or brought to himself, he remembers all that we inquire about and is
amused at his previous false answers or silence. Real amnesia
consists in the actual blotting out of recollections or residua in a
partial or general manner, for a time or permanently. These
differences serve as the basis of a complicated subdivision of
amnesia which it is not necessary to fully reproduce here.

Temporary partial amnesia is a variety which is frequently observed

in normal persons, even the most gifted. A word or fact escapes us,
seems wholly lost for a few minutes, hours, or days; the more we
strive to recall it, the less we succeed; yet later, when not sought for,
the fact or word appears in our consciousness as if spontaneously,
but more probably by some effect of the law of association. Such
partial and momentary forgetfulness may assume proportions which
render it pathological. What is known as transitory aphasia may be
classed in this group. In a few minutes or hours a person without
apoplectic, epileptic, or paralytic phenomena loses all power to
express his thoughts by speaking or writing; there is verbal amnesia
and agraphia. The subject is conscious of his condition and of the
wholly futile or incorrect attempts he makes to communicate with
others.

Temporary complete amnesia is almost equivalent to loss of

consciousness, yet not strictly so. For example, after a sharp blow
upon the head a person may perform complicated acts, reply to
questions, and apparently act normally, yet after a variable time he
will declare that he remembers absolutely nothing of the injury and
what he did or said for hours or days afterward. The same
phenomenon is observed in the course of psychoses, neuroses
(epilepsy), in some acute diseases, and in certain states of
intoxication.

Permanent partial amnesia occurs in states of dementia, such as

senile dementia, paralytic dementia, and in certain cases of aphasia.
Great gaps exist in the patient's memory; some things are well
recalled, others wholly and for ever effaced. The psychological law
governing the failure of memory in these cases is that the earliest
and strongest impressions survive, while recent and less forcible (i.e.
less interesting) ones are lost. Substantives or names are especially
liable to obliteration, as are also many of the delicate residua which
lie at the basis of the subject's ethical conceptions and acts.

Permanent complete amnesia is observed at the end of

degenerative cerebral diseases, as organic dementia, whether of the
form termed secondary or that designated as paralytic. Sometimes
after acute general diseases the memory may be a perfect blank for
a considerable length of time, and education has to be repeated.
Memory may be so completely absent that cases are known in which
the patient gave a fresh greeting to the asylum physician every two
or three minutes indefinitely, as if each were a first meeting.
Momentary perception and automatic (reflex) response are there, but
no impression is made; there is no residuum left in the cortical
centres. In these cases amnesia is accompanied by degeneration of
the visual, auditory, etc. cortical areas or centres.