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International Marketing 3rd Edition
Dana Test Bank

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Chapter 7: International Strategic Planning
TRUE/FALSE
1. An international marketing strategy involves developing and maintaining a strategic fit between the
international company’s objectives, competencies, and resources and the challenges presented by its
international market or markets.
ANS: T
An international marketing strategy involves developing and maintaining a strategic fit between the
international market or markets. This is found in the section entitled “Developing an International
Marketing Strategy”(7-1).
PTS: 1 DIF: Easy
2. At the corporate level, the strategic plan allocates resources and establishes objectives for the whole
enterprise, worldwide.
ANS: T
At the corporate level, the strategic plan allocates resources and establishes objectives for the whole
enterprise, worldwide. The corporate plan has a long-term focus and involves the highest levels of
management. This is found in the section entitled “Developing an International Marketing
Strategy”(7-1).
PTS: 1 DIF: Easy
3. At the corporate level, within each country, decisions are made regarding which consumer segments to
target.
ANS: F
At the business unit level, within each country, decisions are made regarding which consumer
segments to target, using criteria described in this chapter. This is found in the section entitled
“Developing an International Marketing Strategy”(7-1).
PTS: 1 DIF: Medium
4. At the corporate level, the strategic plan allocates funds to each business unit based on division goals
and objectives.
ANS: F
At the division level, the strategic plan allocates funds to each business unit based on division goals
and objectives. This is found in the section entitled “Developing an International Marketing
Strategy”(7-1).
PTS: 1 DIF: Easy
5. At the product level, a marketing plan is developed for achieving objectives.
ANS: T
At the product level (line, brand), a marketing plan is developed for achieving objectives. This is found
in the section entitled “Developing an International Marketing Strategy”(7-1).
PTS: 1 DIF: Easy
6. A product will most likely be first manufactured in a low-cost labor country and exported to the rest of
the world to take advantage of low-cost labor.
ANS: F
A product in the early stages of its life cycle will most likely be sold to consumers in highly
industrialized countries for a high price, accompanied by heavy promotion. A product will most likely
be manufactured in a developed country and exported to the rest of the world. This is found in the
section entitled “Developing an International Marketing Plan”(7-1a).
PTS: 1 DIF: Medium
7. A product in the later stages of its life cycle will be sold to consumers worldwide, regardless of
country development level.
ANS: T
A product in the later stages of its life cycle will be sold to consumers worldwide, regardless of
country development level. This is found in the section entitled “Developing an International
Marketing Plan” (7-1a).
PTS: 1 DIF: Medium
8. The company selling a product in a later stage of the life cycle will most likely manufacture the
product in a developing country, where labor is inexpensive, to sell it all over the world.
ANS: T
The company selling a product in a later stage of the life cycle will heavily compete on price and, thus,
most likely manufacture the product in a developing country, where labor is inexpensive, to sell all
over the world. Most likely, the company will have at least one subsidiary located in the country of
product manufacture. This is found in the section entitled “Developing an International Marketing
Plan” (7-1a).
PTS: 1 DIF: Medium
9. The Wonderbra's failed introduction into the Middle East serves as an example of what not to do in
terms of target marketing.
ANS: F
The Wonderbra is selling very well in Islamic countries. Research determined that women dress
primarily to impress other women in many Islamic countries, in a friendly competitive way. This is
found in the "Requirements for International Segmentation" section (7-3a).
PTS: 1 DIF: Hard
10. Communicating with Indian and Chinese consumers necessitates expensive translation into the local
languages.
ANS: F
Communicating with Indian consumers necessitates expensive translation into the local languages.
Although accessibility issues exist for the Chinese market as well, the costs of translation are not a
primary concern when entering the Chinese market. This is found in the "Requirements for
International Segmentation" section (7-3a).
PTS: 1 DIF: Medium
11. Stability of a segment over times used to be a primary consideration mainly for developing,
low-income, countries.
ANS: F
Stability of a segment over times used to be a primary consideration mainly for developed,
high-income, countries. Today, however, this is an important consideration in a world environment
where products are in different lifecycle stages, and where preferences are continuously changing with
the advent of the Internet and on-line ordering across borders from countries of all development levels.
This is found in the "Requirements for International Segmentation" section (7-3a).
PTS: 1 DIF: Hard
12. Individual market segments should be easy to identify and measure.
ANS: T
The requirements for international segmentation include measurability, substantiality, stability over
time, accessibility, actionability, and differential response. Although it is challenging in international
marketing, a segment should be easy to identify and measure. This is found in the "Requirements for
PTS: 1 DIF: Easy
13. Market segments should be similar to each other to improve marketing efficiency.
ANS: F
Market segments should be easy to distinguish from each other. They should respond differently from
other market segments to marketing strategies. If consumers all over the world are similar then there is
no need for target marketing. This is found in the "Requirements for International Segmentation"
section (7-3a).
PTS: 1 DIF: Medium
14. Market segments should be homogeneous in relation to other segments to improve marketing
efficiency.
ANS: F
Market segments should be easy to distinguish from each other (i.e., they should be heterogeneous
relative to other segments). They should respond differently from other market segments to marketing
strategies. If consumers all over the world are similar then there is no need for target marketing. This is
PTS: 1 DIF: Medium
15. PepsiCo International did not consider profit as the main criterion when they approached the former
Soviet Union to establish a countertrade agreement.
ANS: T
PepsiCo International did not consider profit as the main criterion when they approached the former
Soviet Union to establish a countertrade agreement. Instead, market size and ultimate potential of the
market were the company's primary concerns. This is found in the "Macro-Segmentation: Country
Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Medium
16. The potential of a market can be evaluated based on the rate of economic development, as expressed
through validated, reliable market indicators such as consumer buying power.
ANS: T
The potential of a market can be evaluated based on the rate of economic development, as expressed
through validated, reliable market indicators such as consumer buying power, GDP per capita,
industrial and agricultural sectors statistics, market size and potential, and international investment
figures. Such indicators identify countries and markets where the company should invest important
resources. This is found in the "Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Easy
17. The Baltic Republics, Russia and Belarus are attractive markets that are being actively targeted by
multinationals.
ANS: T
Countries of the former Soviet Union are plagued by inflation and instability, but they also have a
literate, educated work force and an excess of highly qualified labor. They also have a consuming
public that is eager to experience new products. Among attractive markets of the former Soviet Union
are the Baltic Republics, Russian and Belarus. This may be found in the "Macro-Segmentation:
Country Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Easy
18. According to the text, Sri Lanka is an attractive, small country that has a strong export market.
ANS: F
Sri Lanka is described as an attractive, small country located southeast of the Indian subcontinent,
which no longer has a viable export market. Tamil separatists have actively target Sri Lanka's airport.
This has demolished the economy. This may be found in the "Macro-Segmentation: Country
PTS: 1 DIF: Medium
19. The recent discovery of oil reserves in the Sudan has helped to stabilize the economy and make it an
attractive country for foreign direct investment.
ANS: F
The Sudan's oil reserves have further fueled an ethnic civil war that has been raging for over two
decades. Although exporting to the Sudan is still a viable entry-mode alternative, the country
undoubtedly still represents risks for long-term investment and has not attracted foreign direct
investment. This may be found in the "Macro-Segmentation: Country Attractiveness Analysis" section
(7-3b).
PTS: 1 DIF: Hard
20. Ambiguities in a legal system can create an environment that renders the company vulnerable to
competitive theft, to lack of trademark protection, to bribery, and to employee theft.
ANS: T
Ambiguities in a legal system can create an environment that renders the company vulnerable to
competitive theft, to lack of trademark protection, to bribery pressers, and to employee theft. In such
an environment, where everything is perceived as allowed unless expressly forbidden, even exporting
could pose difficulties. This may be found in the "Macro-Segmentation: Country Attractiveness
Analysis" section (7-3b).
PTS: 1 DIF: Easy
21. The lead/lag concept is closely linked to the political structure of a country and is particularly relevant
to firms that sell products of mass consumption.
ANS: F
The lead/lag concept is closely linked to the level of economic development of a country and is
particularly relevant to firms that are at the forefront of technology. These firms usually first introduce
their products in lead countries. This may be found in the Macro-Segmentation: Country
PTS: 1 DIF: Medium
22. Firms that are at the forefront of technology usually first introduce their products in lead countries.
ANS: T
Firms that are at the forefront of technology usually first introduce their products in lead countries.
This may be found in the Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Medium
23. The purpose of macro-segmentation is to identify clusters of consumers that respond in a similar
fashion to a company's marketing strategies.
ANS: F
The purpose of micro-segmentation is to identify clusters of consumers that respond in a similar
fashion to a company's marketing strategies. Macro-segmentation is concerned with looking at markets
at the country level. This is found in the "Micro-Segmentation: Focusing on the Target Consumer"
section (7-3c).
PTS: 1 DIF: Hard
24. Demographics are easy to measure and to compare across countries.
ANS: T
Demographics are easy to measure and to compare across countries. For this reason,they are widely
used by international companies. This is found in the "Micro-Segmentation: Focusing on the Target
Consumer" section (7-3c).
PTS: 1 DIF: Medium
25. The Scandinavian counties have a rapidly aging population and present different challenges to
international firms than countries with half of their population under the age of twenty, like Brazil.
ANS: T
Countries that have a rapidly aging population (the Scandinavian countries for example) present
different challenges and opportunities to international firms than countries with half of their population
under the age of twenty (such as Brazil and most countries in Sub-Saharan Africa). This is due to
different segmentation strategies. Products that work well in one country may not work well in the
other type of country or may need to be positioned quite differently. This is found in the
"Micro-Segmentation: Focusing on the Target Consumer" section (7-3c).
PTS: 1 DIF: Easy
26. While multinationals such as Coca-Cola and Kodak actively target middle class consumers in the
industrialized countries with their global brands, in China, they target their global brands primarily to
the very large lower class.
ANS: F
While multinationals such as Coca-Cola and Kodak actively target middle class consumers in the
industrialized countries with their global brands, in China, they target their global brands primarily to
yuppies. For the remaining 85% of the population, they have developed or acquired local brands in
addition to their premium global brands. This is found in the "Micro-Segmentation: Focusing on the
Target Consumer" section (7-3c).
PTS: 1 DIF: Hard
27. Countries that were formerly communist, and countries that are under communist rule have a high
literacy rate and heavily emphasize education.
ANS: T
Countries that were formerly communist, and countries that are under communist rule have a high
literacy rate and heavily emphasize education. Countries where education is stressed will present
opportunities for education institutions intending to expand globally, to firms selling training
technology, and software. Thus, literacy and education are important bases for segmentation. This is
found in the "Micro-Segmentation: Focusing on the Target Consumer" section (7-3c).
PTS: 1 DIF: Easy
28. The gay and lesbian segment is a market segment characterized by brand switching behavior.
ANS: F
TThe gay and lesbian segment has been identified as a loyal segment, purchasing brands that are
positioned as gayfriendly. It has also been identified as a segment with a high percentage of disposable
income—and with a willingness to spend it for travel, entertainment, and This is found in the
PTS: 1 DIF: Medium
29. The marketing mix typically used to target the "global elite" segment focuses on selective distribution,
value pricing, and status-oriented advertising messages.
ANS: F
The marketing mix typically used to target the "global elite" segment focuses on exclusive distribution,
high price, and status-oriented advertising messages. Examples of brands targeting this segment
include Rolex, Prada, and Mercedes. This is found in the "Micro-Segmentation: Focusing on the
PTS: 1 DIF: Medium

30. In the youth-driven Euroculture, national heritage is becoming increasingly important.
ANS: F
National heritage has become less important for a multi-lingual, educated, and well-traveled
cosmopolitan youth-driven Euroculture. Commonalities are developing based on continental values
and lifestyles. This is found in the "Micro-Segmentation: Focusing on the Target Consumer" section
(7-3c).
PTS: 1 DIF: Medium
31. The majority of consumers in developing countries are very concerned with brand names since they
portray a Western image.
ANS: F
The majority of consumers in developing countries are not as much interested in brand names as they
are in product performance and value. Marketing strategies catering to these preferences have
succeeded in China. For example, Philips Electronics has introduced a very popular combination
video/CD player, which Chinese consumers perceived as good value for the money. This is found in
the "Micro-Segmentation: Focusing on the Target Consumer" section (7-3c).
PTS: 1 DIF: Medium
32. Bounty brand paper towels failed in Europe because consumers prefer to use cloth towels in the
kitchen.
ANS: F
The paper towel offering in Europe had been rather limited before the introduction of the Bounty
brand. European consumers typically used cloth towels in the kitchen, since the brands available
locally did not have sufficient absorption ability for cleaning jobs. Bounty, however was a heavy-duty
paper towel that was accompanied by heavy promotion. The brand quickly took off, and now most
households have a paper towel holder. This is found in the "Micro-Segmentation: Focusing on the
PTS: 1 DIF: Hard
33. Geographic segmentation can be performed at the macro-segmentation level.
ANS: T
Because "macro" segmentation is country-level segmentation, geographic segmentation can be
performed at the macro-segmentation level. In macro-segmentation the marketer typically looks at
indicators such as membership in international trade forums, regional blocks and country analysis.
This is found in the "Micro-Segmentation: Focusing on the Target Consumer" section (7-3c).
PTS: 1 DIF: Medium
34. Companies that have ample resources can, and often do, address the needs of all segments of
consumers.
ANS: T
Companies that have ample resources can, and often do, address the needs of all segments of
consumers. Proctor & Gamble, Henkel, and Kraft all attempt to target all consumers with the products
they sell, filling the supermarket and discount store shelf space with what seemingly are competing
brands and saturating the media with their communication, meeting all related needs of the global
consumer. This is found in the "Target Market Decisions: The Target Market Strategy" section (7-4a).
PTS: 1 DIF: Medium
35. Procter & Gamble pursues a differentiated target strategy.
ANS: T
Procter & Gamble indeed pursues a differentiated target strategy. It offers a variety of laundry
detergents in North America, for example, in an attempt to appeal to almost every conceivable market
segment. This is found in the "Target Market Decisions: The Target Market Strategy" section (7-4b).
PTS: 1 DIF: Medium
36. Mont Blanc pursues a concentrated targeting strategy.
ANS: T
By offering a relatively limited product selection that it markets using the same theme worldwide,
Mont Blanc pursues a concentrated targeting strategy. Throughout the world, Mont Blanc's
high-quality pens are targeted at the professional class. This is found in the "Target Market Decisions:
The Target Market Strategy" section (7-4b).
PTS: 1 DIF: Medium
37. Coke is marketed using a standardized, undifferentiated strategy throughout the world.
ANS: F
Even though Coke is a global brand, it is not marketed using a standardized, undifferentiated strategy.
Coke is sold primarily in recyclable glass and plastic bottles requiring a high deposit in Africa and
Europe, while in the U.S. it is sold in disposable cans and plastic bottles. Even Coke's formula is
different in different markets. This is found in the "Target Market Decisions: The Target Market
Strategy" section (7-4b).
PTS: 1 DIF: Medium
38. Most services do not lend themselves to a standardized strategy.
ANS: T
Certain products, such as food and other culture-bound products, and most services do not lend
themselves to a standardized strategy. They need to be customized to meet the specific needs and
preferences of consumers. This is found in the "Target Market Decisions: The Target Market Strategy"
section (7-4b).
PTS: 1 DIF: Medium
39. Both K-Mart and Mercedes-Benz use a price/quality positioning.
ANS: T
K-mart places emphasis on the value aspect of its offering. Mercedes-Benz, on the other hand,
suggests that its product is the best money can buy. In both instances, the company is using a
price/quality positioning strategy. Thus, both K-Mart and Mercedes-Benz use a price/quality
positioning. This is found in the "Positioning the Brand" section (7-5).
PTS: 1 DIF: Medium
40. When Airbus asks readers of The Financial Times whether they would be more comfortable with two
or four engines when they are up in the air, they engage in product class positioning.
ANS: F
When Airbus asks readers of The Financial Times whether they would be more comfortable with two
or four engines when they are up in the air, it makes implicit reference to Boeing; thus engaging in
competitor positioning. This is found in the "Positioning the Brand" section (7-5).
PTS: 1 DIF: Medium
MULTIPLE CHOICE
1. The international strategic plan creates a link between the company resources and its
a. International goals c. International market
b. International objectives d. All of the above
ANS: D
The international strategic plan forges a link between the company’s resources and its international
goals and objectives in a complex, continuously changing international environment. This is found in
the section entitled “Developing an International Marketing Strategy”(7-1).
PTS: 1 DIF: Medium
international market and all those elements listed below, except
a. Objectives c. Government
b. Competencies d. Resources
ANS: C
Marketing Strategy” (7-1).
PTS: 1 DIF: Medium
3. At which level does the strategic plan allocate resources and establish objectives for the company’s
worldwide operations?
a. Corporate level c. Product level
b. Division level d. Business unit level
ANS: A
management. This is found in the section entitled “Developing an International Marketing Strategy”
(7-1).
PTS: 1 DIF: Easy
4. Decisions on which country or countries to target take place at the ____ level.
ANS: A
management. Planning at this level involves international target market selection decisions: deciding
which country or countries to target based on specific screening criteria and processes. This is found in
the section entitled “Developing an International Marketing Strategy”(7-1).
PTS: 1 DIF: Medium
5. At which level does the strategic plan allocate funds to each business unit level?
ANS: B
At the division level, the strategic plan allocates funds to each business unit based on division goals
and objectives. This is found in the section entitled “Developing an International Marketing
Strategy”(7-1).
PTS: 1 DIF: Easy
6. At which level of the strategic plan is a marketing plan is developed for achieving brand or product
line objectives?
ANS: C
At the product level (line, brand), a marketing plan is developed for achieving objectives. This is found
in the section entitled “Developing an International Marketing Strategy” (7-1).
PTS: 1 DIF: Medium
7. At which level of the strategic plan are decisions made regarding which consumer segments to target,
within each country?
ANS: D
At the business unit level, within each country, decisions are made regarding which consumer
segments to target, using criteria described in this chapter. This is found in the section entitled
“Developing an International Marketing Strategy” (7-1).
PTS: 1 DIF: Medium
international market and the company’s
a. Objectives c. Resources
b. Competencies d. All of the above
ANS: D
Marketing Strategy” (7-1a).
PTS: 1 DIF: Medium
9. A product in the early stages of its life cycle will

a. Be most likely sold to consumers in industrialized countries.
b. Be most likely sold for a high prices.
c. Be most likely accompanied by heavy promotion.
d. All of the above.
ANS: D
A product in the early stages of its life cycle will most likely be sold to consumers in highly
industrialized countries for a high price, accompanied by heavy promotion. A product will most likely
be manufactured in a developed country and exported to the rest of the world. This is found in the
section entitled “Developing an International Marketing Plan” (7-1a).
PTS: 1 DIF: Medium
10. A product in the later stages of its life cycle, such as a videocassette recorder, will be
a. Sold to consumers worldwide, regardless of country development level.
b. Compete on price.
c. Most likely manufactured in a developing country where labor is inexpensive.
d. All of the above.
ANS: D
A product in the later stages of its life cycle, such as a videocassette recorder, will be sold to
consumers worldwide, regardless of country development level. The company selling the product will
heavily compete on price and, thus, most likely manufacture the product in a developing country,
where labor is inexpensive, to sell all over the world. Most likely, the company will have at least one
subsidiary located in the country of product manufacture. This is found in the section entitled
“Developing an International Marketing Plan” (7-1a).
PTS: 1 DIF: Medium
11. When a marketer identifies countries and segments of international consumers that are similar with
regard to key traits, who would respond well to a product and related marketing mix, he or she is
engaging in:
a. international market segmentation. c. market positioning.
b. international market targeting. d. a concentrated targeting strategy.
ANS: A
When a marketer identifies countries and segments of international consumers that are similar with
engaging in international market segmentation. International market targeting involves selecting the
countries and segments that the company can serve most efficiently. Offering the products to the
market, communicating, through the marketing mix, product traits and benefits that differentiate it in
the consumer's mind is market positioning. A concentrated targeting strategy is a form of international
market targeting. This is found in "The Rationale for Target Marketing" section (7-2).
PTS: 1 DIF: Medium

12. When a marketer selects the countries and segments that the company can serve most efficiently he or
she is engaging in:
a. international market segmentation. c. market positioning.
b. international market targeting. d. psychographic segmentation.
ANS: B
When a marketer identifies countries and segments of international consumers that are similar with
engaging in international market segmentation. International market targeting involves selecting the
countries and segments that the company can serve most efficiently. Offering the products to the
market, communicating, through the marketing mix, product traits and benefits that differentiate it in
the consumer's mind is market positioning. Psychographic segmentation is an example of international
market segmentation. This is found in "The Rationale for Target Marketing" section (7-2).
PTS: 1 DIF: Medium
13. Which requirement does not apply to both country and consumer segmentation?
a. Measurability c. Differential response
b. Accessibility d. All of the above apply.
ANS: D
The requirements for international segmentation, which apply equally to country and consumer
segmentation are: measurability, substantiality, stability over time, accessibility, actionability, and
differential response. Thus, all of the above apply to both country and consumer segmentation. This is
PTS: 1 DIF: Medium
14. The level of foreign direct investment in a country is a measure of which segmentation requirement?
a. Measurability c. Accessibility
b. Substantiality d. Actionability
ANS: B
A segment's growth potential is a way of measuring the substantiality of a segment. Growth potential
may be evaluated with surrogate statistics, such as economic development measures (e.g., foreign
direct investment). This is found in the "Requirements for International Segmentation" section (7-3a).
PTS: 1 DIF: Medium
15. Which segmentation requirement may be adversely affected by expensive translation required to
communicate with Indian consumers?
a. Measurability c. Stability over time
b. Substantiality d. Accessibility
ANS: D
Accessibility is the ability to communicate with the target market. Internationally, the differences in
language in individual countries, like India, may pose obstacles, greatly increasing the cost of
advertising and other promotion (i.e., accessibility). This is found in the "Requirements for
PTS: 1 DIF: Medium
16. Which segmentation requirement is most likely to be affected by a country with a large rural
population?
a. Measurability c. Accessibility
b. Substantiality d. Differential response
ANS: C
Accessibility is the ability to communicate with the target market. Rural populations tend to have a
more limited access to technology. This may make it difficult to communicate with the segment. This
is an accessibility problem. This is found in the "Requirements for International Segmentation" section
(7-3a).
PTS: 1 DIF: Medium
17. What is the first step in the segmentation process?

a. Micro-segmentation c. Demographic segmentation
b. Macro-segmentation d. Psychographic segmentation
ANS: B
As a first step in the segmentation process, companies engage in macro-segmentation.
Macro-segmentation is the grouping of countries based on such criteria as economic performance,
evaluating the potential of a particular market, etc. It is important to look at macro-segmentation (i.e.,
country-level segmentation) before considering micro-segmentation (i.e., consumer-level
segmentation). Demographic and psychographic segmentation are both examples of
micro-segmentation. This may be found in the "Macro-Segmentation: Country Attractiveness
Analysis" section (7-3b).
PTS: 1 DIF: Easy
18. Which of the following is not a criteria that a firm should use to group countries to determine which
country held the most opportunity for the firm?
a. Market potential c. Marketing support infrastructure
b. Political environment d. All of the above could be used.
ANS: D
Macro-segmentation should be used to determine which countries hold the most opportunity for a
company. Elements of macro-segmentation consist of market potential, the political, legal, and
financial environment of a country, the marketing support infrastructure in the country, how the
brand/company compares to competing brands/companies (i.e., when the firm already has a presence
in the market), and the degree of market fit with the company policies, goals and resources. Thus, all
of the options listed could be used to determine which country held the most opportunity for the firm.
This may be found in the "Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Easy
19. Which statement regarding the countries of the former Soviet Union is not true?
a. The countries are experiencing high inflation.
b. The countries have a high illiteracy rate.
c. The countries have an excess of highly qualified labor.
d. The countries have a consuming public that is eager to experience new products.
ANS: B
The countries are plagued by a high inflation and instability. However, years of mandatory education
have produced a literate, highly qualified workforce. The opening of borders and trade have caused the
consuming public to desire new products. This may be found in the "Macro-Segmentation: Country
PTS: 1 DIF: Medium

20. Which of the following is not a criterion that should be considered when evaluating a potential country
for entry?
a. Ethnic conflict in a region
b. Recent nationalization activity
c. Legal ambiguity
d. All of the above should be considered.
ANS: D
In macro-segmentation, the political, legal, and financial environment of a country should be
considered. The text indicates that the following criteria should be considered when evaluating a
potential country for entry: ethnic conflict in the region, history of war engagement, anti-foreigner
rhetoric, recent nationalization activity, legal ambiguity - especially in business, trade barriers erected
by government to protect local business, and exchange rate controls. In each case the political risk
increases and the attractiveness of market entry diminishes. This may be found in the
"Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
PTS: 1 DIF: Easy
21. For large multinationals attempting to enter the Turkish market, Sabanci Holdings is in great demand
and already boasts join venture and distribution partners in companies as varied as Carrefour
supermarkets, Dresdner Bank, and DuPont. Which macro-segmentation consideration does this
exemplify?
a. Market potential c. Marketing support infrastructure
b. Financial Environment d. None of the above
ANS: C
The marketing support infrastructure of the target country is an important determinant of country
attractiveness. Important to international firms are the availability and reliability of distribution and
logistics providers in order to ensure that the product is delivered in a timely fashion at locations
convenient to consumers. Thus, Sabanci Holdings controlling the distribution networks in Turkey is an
example of marketing support infrastructure. This may be found in the "Macro-Segmentation: Country
PTS: 1 DIF: Medium
22. Which market segment does Coca-Cola and Kodak target in China with their global brands?
a. "Working Poor" c. "The salaried class"
b. "The Little Rich" d. "Yuppies"
ANS: D
China's working class falls into four segments: "working poor" and "salaried class" - together
accounting for 80% of the urban population; "the little rich," 15% of the urban population, and
"yuppies," representing nearly 5% of the urban household. Coca-Cola and Kodak target their global
brands primarily to "yuppies" in China since they are more likely to desire (and be able to purchase)
Western brands. This may be found in "Micro-Segmentation: Focusing on the Target Consumer"
section (7-3c).
PTS: 1 DIF: Hard
23. Which of the following is not included in a psychographic analysis?

a. Income c. Attitudes
b. Lifestyle d. Opinions
ANS: A
Income is a demographic element. Psychographics include lifestyles, values, attitudes, interests, and
opinions. This may be found in "Micro-Segmentation: Focusing on the Target Consumer" section
(7-3c).
PTS: 1 DIF: Medium
24. According to the text, a recent study classified the Scandinavian countries according to Hofstede's
typology. They rate:
a. low in power/distance. c. low in individualism.
b. high in uncertainty/avoidance. d. high in masculinity.
ANS: A
Hofstede's dimensions can be used to segment countries based on individualism/collectivism,
masculinity/femininity, uncertainty avoidance, and power distance. The Scandinavian countries have a
small power/distance (i.e., are more egalitarian), have a low uncertainty/avoidance (i.e., take more
risks), rate high on individualism, and have a low level of masculinity (i.e., low ambition and
competitiveness). This may be found in "Micro-Segmentation: Focusing on the Target Consumer"
section (7-3c).
PTS: 1 DIF: Hard
25. Which psychographic segmentation system has developed a tool for both the U.S. and Japanese
markets?
a. PRIZM c. ACE
b. VALS d. MicroVision
ANS: B
VALS has developed a survey that is especially designed for the Japanese market as well as the U.S.
market. PRIZM and MicroVision offer psychographic tools for the U.S. market but do not offer
instruments for the Japanese market. ACE is not a psychographic offering. This may be found in
PTS: 1 DIF: Medium
26. Which of the following statements regarding "global teenagers" is accurate?

a. They are described as astute consumers with precise desires.
b. Prada has successfully targeted them through a status-oriented advertising message.
c. They are also called the "global elite."
d. None of the above are true.
ANS: A
Global teenagers are psychographically described as astute consumers with precise desires for
brand-name clothing products and for entertainment. The "global elite" segment is a separate segment.
The global elite have the highest income of all consumers. From a psychographic perspective they
travel the globe, often have homes in more than one country, and spend money on luxury brands, such
as Prada. This may be found in "Micro-Segmentation: Focusing on the Target Consumer" section
(7-3c).
PTS: 1 DIF: Medium
27. Consumers in the U.S. purchase soft drinks such as Coke and Pepsi to quench their thirst, but in
Eastern Europe, these brands are purchase primarily as a special occasion drink. What type of
segmentation does this example illustrate?
a. Psychographic segmentation c. Benefit segmentation
b. Usage segmentation d. Demographic segmentation
ANS: C
Important differences exist between the benefits sought from purchasing a particular product. In the
soft drink example, some consumers seek the benefit of "thirst quencher" while other consumers seek a
status or "special occasion" benefit. Usage segmentation focuses on the rate of use (e.g., heavy users
vs. light users) not the type of use. This may be found in "Micro-Segmentation: Focusing on the Target
Consumer" section (7-3c).
PTS: 1 DIF: Hard
28. Regarding fast food segmentation, the international marketer knows that consumers in emerging
markets are particularly attracted to:
a. speedy service c. clean environment
b. convenience d. all of the above
ANS: C
Consumers in the United States seek speedy service, quality food, and convenience in fast food chains.
However, consumers in emerging markets are particularly attracted to the clean environment, pleasant
ambience, polite staff, and air conditioning. This may be found in "Micro-Segmentation: Focusing on
the Target Consumer" section (7-3c).
PTS: 1 DIF: Hard
29. French women are heavy users of perfume. With this knowledge a marketer may decide to take
advantage of:
a. Psychographic segmentation c. Usage segmentation
b. Benefit segmentation d. None of the above
ANS: C
Usage rate indicates the extent to which individuals are nonusers, occasional users, medium and heavy
users. Therefore, this is an example of usage segmentation. Psychographic segmentation deals with
attitudes, interests, and beliefs and is not directly related to this question. Benefit segmentation deals
with the different benefits sought in a product. For instance, it may be possible that some women
consume perfume to attract the opposite sex while others use the product simply because they like the
smell. However, this was not indicated in the question; thus, benefit segmentation is not an accurate
response. This may be found in "Micro-Segmentation: Focusing on the Target Consumer" section
(7-3c).
PTS: 1 DIF: Easy
30. What is the correct order in country screening and selection?

a. Evaluating country performance on each of the screening criteria, assigning an importance
score to country screening criteria, and calculating a country attractiveness score.
b. Calculating a country attractiveness score, assigning an importance score to country
screening criteria, and evaluating country performance on each of the screening criteria.
c. Assigning an importance score to country screening criteria, calculating a country
attractiveness score, and evaluating country performance on each of the screening criteria.
d. Assigning an importance score to country screening criteria, evaluating country
performance on each of the screening criteria, and calculating the country attractiveness
score.
ANS: D
The first step in a screening process is to aggregate a selection of criteria discussed in the
macro-segmentation section and to assign importance scores to them. In the second stage, potential
target countries are rated on each of the criteria. Finally, the importance score is multiplied by the
performance score for each of the screening variables. The total score for each country is then
calculated. This is found in the “Target Market Decisions: Country Screening and Selection" section
(7-4a).
PTS: 1 DIF: Medium
31. How is the country attractiveness score in a country screening and selection process calculated?
a. An importance score is added to the performance score for each of the screening variables.
b. An importance score is multiplied by the performance score for each of the screening
variables.
c. The Delphi Method is used.
d. A time series analysis is performed on leading economic indicators.
ANS: B
In calculating the country attractiveness score, an importance score must first be developed. Important
segmentation variables are identified. Then the variables are assigned an importance weight that
denotes the extent to which the firm considers a particular trait important in the decision to enter the
market. Potential targets are then rated on each of the criteria. Finally, to calculate the attractiveness
score, the importance score is multiplied by the performance score for each of the screening variables.
The total score for each country is calculated by adding the resulting scores. This is found in the
“Target Market Decisions: Country Screening and Selection" section (7-4a).
PTS: 1 DIF: Medium
32. When a company identifies or creates market segments that want different benefits from a product and
target them with different brands, using different marketing strategies, the company is pursuing a(n):
a. differentiated targeting strategy. c. undifferentiated targeting strategy.
b. concentrated targeting strategy. d. standardized targeting strategy.
ANS: A
Companies that use a differentiated targeting strategy identify, or even create, market segments that
want different benefits from a product and targets them with different brands, using different
marketing strategies. A concentrated strategy is a niche strategy that would pursue a single segment.
Both an undifferentiated and a standardized strategy ignores differences between segments. This is
found in the “Target Market Decisions: The Target Market Strategy " section (7-4b).
PTS: 1 DIF: Easy
33. When The Body Shop caters to consumers who are environmentally concerned and who want to
purchase natural products that have not been tested on animals it is pursuing a(n):
a. differentiated targeting strategy. c. undifferentiated strategy.
b. concentrated targeting strategy. d. None of the above.
ANS: B
When a company selects a single market, it is pursuing a concentrated targeting strategy. The Body
Shop focuses on one segment. Thus, it is pursuing a concentrated targeting strategy. This is found in
the “Target Market Decisions: The Target Market Strategy " section (7-4b).
PTS: 1 DIF: Easy
34. Which category is most likely to pursue an undifferentiated targeting strategy?

a. Food c. Pharmaceuticals
b. Clothing d. Services
ANS: C
Certain products such as food and culture-bound products, and most services no not lend themselves to
a standardized strategy. They need to be customized to meet the specific needs, tastes, and preferences
of consumers. Pharmaceuticals on the other hand, serve a common need across countries. For this
reason, a pharmaceutical firm is more likely to pursue an undifferentiated strategy. This is found in the
“Target Market Decisions: The Target Market Strategy " section (7-4b).
PTS: 1 DIF: Medium
35. ____ entails placing the brand in the consumer's mind in relation to other competing products, based
on product traits and benefits that are relevant to the consumer.
a. Segmenting c. Targeting
b. Positioning d. Actionability
ANS: B
Positioning entails placing the brand in the consumer's mind in relation to other competing products,
based on product traits and benefits that are relevant to the consumer. Actionability is a requirement of
segmentation. Segmentation must occur before positioning. Positioning is a way to target consumers.
This may be found in the "Positioning the Brand" section (7-5).
PTS: 1 DIF: Easy
36. Procter & Gamble positions Dreft as a powder laundry detergent for babies and people with sensitive
skin. This is an example of:
a. attribute/benefit positioning. c. use or applications positioning
b. price/quality positioning d. product class positioning.
ANS: A
"Fabric softening" and "pill/fuzz removal" are benefits that a user receives by using Bold. Thus, this is
an example of attribute/benefit positioning. Most of Procter & Gamble's detergents follow an
attribute/benefit positioning strategy. This is found in the "Attribute/Benefit Positioning" section
(7-5a).
PTS: 1 DIF: Medium
37. Procter & Gamble's Era is positioned as a high-technology detergent that pretreats and washes fabrics
that suspends dirt. This is an example of:
a. attribute/benefit positioning. c. use or applications positioning.
b. price/quality positioning. d. product class positioning.
ANS: C
Procter & Gamble's Era is positioned as a high-technology detergent that pretreats and washes fabrics
that suspends dirt. This is a very precise application that differentiates it in the consumers' minds from
other laundry detergents that have a more general use. Therefore, this is an example of "use or
applications" positioning. This is found in the "Use or Applications Positioning" section.
PTS: 1 DIF: Hard
38. The Mont Blanc pen is usually pictured along with a quality business letterhead, with a passport,
and/or with an attaché case. This is an example of:
a. attribute/benefit positioning c. product user positioning
b. price/quality positioning d. product class positioning
ANS: C
The letterhead, passport, and attaché case are associating the pen with a business executive anywhere
in the world. In this case, the pen is positioned by the product user. This is found in the "Product User
Positioning" section (7-5d).
PTS: 1 DIF: Hard
39. Disney sells magic, not just entertainment. Harley sells excitement not just motorcycles. These are
examples of:
a. price quality positioning. c. product user positioning.
b. use or applications positioning. d. product class positioning.
ANS: D
Products using a product class positioning differentiate themselves as leaders in a product category, as
they define it. Disney selling "magic" is defining the product category. This is found in the "Product
Class Positioning" section (7-5e).
PTS: 1 DIF: Medium
40. When Airbus asks the readers of The Financial Times if they would be more comfortable with two or
with four engines when they are up in the air, it is using which form of positioning?
a. product user positioning c. use or applications positioning
b. competitor positioning d. price/quality positioning
ANS: B
The comparison of two or four engines is an implicit reference to Boeing (i.e., a competitor).
Therefore, this is an example of competitor positioning.This is found in the “Competitor Positioning"
section (7-5a).
PTS: 1 DIF: Medium
COMPLETION
1. At the ____________________ level, the strategic plan allocates resources and establishes objectives
for the whole enterprise worldwide.
ANS: Corporate
PTS: 1 DIF: Medium

NOT: This is found in the "Developing and International Strategy" section (7-1).
2. The ____________________-level plan has a long-term focus and involves the highest levels of
management.
ANS: Corporate
PTS: 1 DIF: Medium

3. At the ____________________ level, the strategic plan allocates funds to each business unit based on
division goals and objectives.
ANS: Division
PTS: 1 DIF: Medium
4. At the _________________________ level, within each country, decisions are made regarding which
consumer segments to target, using criteria described in this chapter.
ANS: Business unit
PTS: 1 DIF: Medium

5. At the ____________________ level, a marketing plan is developed for achieving objectives.
ANS: Product
PTS: 1 DIF: Medium

6. At the country level, ____________________ analysis identifies countries that are similar in aspects
relevant to the company.
ANS: Segmentation
PTS: 1 DIF: Easy

NOT: This is found in the "International Market Segmentation" section (7-3).
7. Individual market segments should be easy to identify and ____________________.
ANS: Measure
PTS: 1 DIF: Medium

NOT: This is found in the "Requirements for International Segmentation" section (7-3a).
8. ____________________ indicates that a segment is large enough to warrant investment.
ANS: Substantiality
PTS: 1 DIF: Medium

9. ____________________ of a segment over time used to be a primary consideration mainly for

developed countries. Today, however, this is an important consideration in a world environment where
products are in different lifecycle stages.
ANS: Stability
PTS: 1 DIF: Medium

10. ____________________ involves having the ability to communicate with the target market.
ANS: Accessibility
PTS: 1 DIF: Medium

11. The market should respond to the market strategies used is another way of saying that the segment
should be ____________________.
ANS: Actionable
PTS: 1 DIF: Easy

12. As a first step in the segmentation process, companies engage in _________________________.
ANS:
Macro-segmentation
Macro segmentation
PTS: 1 DIF: Medium

NOT: This is found in the "Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
13. GDP per capita, industrial sector statistics, and consumer buying behavior are all indicators of
_________________________.
ANS: Market potential
PTS: 1 DIF: Medium

NOT: This is found in the "Macro-Segmentation: Country Attractiveness Analysis" section (7-3b).
14. Companies at the forefront of technology usually first introduce their products in
____________________ countries.
ANS: Lead
PTS: 1 DIF: Medium

NOT: This is found in the "Micro-Segmentation: Focusing on the Target Consumer" section (7-4b).
15. The purpose of _________________________ is to identify clusters of consumers that respond in a

similar fashion to a company's marketing strategies.
ANS:
Micro-segmentation
Micro segmentation
PTS: 1 DIF: Hard

NOT: This is found in the "Micro-Segmentatin: Focusing on the Target Consumer" section (7-3c).
16. ____________________ are statistics that describe the population, such as age, gender, race, income,
education, occupation, social class, lifecycle stage and household size.
ANS: Demographics
PTS: 1 DIF: Easy

17. _________________________ are described as astute consumers with precise desires for brand-name
clothing products and for entertainment.
ANS: Global teenagers
PTS: 1 DIF: Medium

18. _________________________ indicates the extent to which individuals are nonusers, occasional
users, medium and heavy users.
ANS:
Usage
Usage rate
PTS: 1 DIF: Medium

19. Companies that use a(n) ____________________ targeting strategy identify, or even create, market
segments that want different benefits from a product and target them with different brands, using
different marketing strategies.
ANS: Differentiated
PTS: 1 DIF: Medium

NOT: This is found in the "Target Market Decisions: The Target Market Strategy" section (7-4b).
20. When companies select only one market, and segment and target it with one single brand, it is using
a(n) ____________________ targeting strategy.
ANS: Concentrated
PTS: 1 DIF: Medium

21. Pure ____________________ can be described as an undifferentiated marketing strategy.
ANS: Standardization
PTS: 1 DIF: Hard

22. ____________________ entails placing the brand in the consumer's mind in relation to other
competing products, based on product traits and benefits that are relevant to the consumer.
ANS: Positioning
PTS: 1 DIF: Easy

NOT: This is found in the "Positioning the Brand" section (7-5).
23. Dreft is positioned as a detergent that removes tough baby stains and protects garment colors. This is
an example of ____________________ positioning.
ANS:
Attribute
Benefit
PTS: 1 DIF: Hard

NOT: This is found in the "Attribute/Benefit Positioning" section (7-5a).
24. In Asia a bicycle may be positioned as an efficient transportation machine, but in the U.S. it is likely to
be positioned as a high-performance recreation instrument. This is an example of
____________________ positioning.
ANS:
Use
Applications
PTS: 1 DIF: Medium

NOT: This is found in the "Use or Applications Positioning" section (7-5c).
25. Parliament (a cigarette manufacturer) sells glamorous, romantic America all over the world, not just
cigarettes. This is an example of _________________________ positioning.
ANS: Product class
PTS: 1 DIF: Hard

NOT: This is found in the "Product Class Positioning" section (7-5e).
ESSAY
1. Describe the requirement for international segmentation.
ANS:
The requirements for international segmentation include measurability, substantiality, stability over
time, accessibility, actionability, and differential response. Measurability indicates that a segment is
identifiable. Substantiality indicates that the segment is large enough to be profitable. Stability over
time is important for long-term success. Accessibility indicates that the segment is reachable. For
example, rural consumers in China may be measurable and substantial, but they are difficult to reach
and are therefore not very accessible. Actionability indicates that the segment should respond to the
marketing strategies used. Finally differential response indicates that segments should be easy to
distinguish from each other and they should respond differently from other market segments to
marketing strategies. This may be found in the "Requirements for International Segmentation" section
(7-3).
PTS: 1 DIF: Medium
2. Discuss the criteria used in macro-segmentation.
ANS:
Some criteria that firms may use to group countries in order to determine which country to target
include market potential, the political, legal, and financial environment of the country, the marketing
support infrastructure in the country, current brand presence in the country, and the degree of market
fit with the company policies, goals, and resources. Indicators of market potential include, GDP,
consumer behavior, and industry and consumer statistics. All else being equal, a company would
prefer to enter a country with a stable political environment and one in which the legal environment
was not ambiguous. It is important for marketing infrastructure (e.g., distributors) to be developed as
well. This may be found in the "Macro-Segmentation: Country Attractiveness Analysis" section
(7-3b).
PTS: 1 DIF: Medium
3. Discuss the bases for micro-segmentation.
ANS:
In micro-segmentation, clusters of consumers that respond in a similar fashion to a company's
marketing strategies are identified. Bases of micro-segmentation include demographic and
psychographic segmentation, benefit segmentation, usage and user status segmentation, and
geographic segmentation. Demographic variables include age, income, and religion. Psychographic
variables involve attitudes, opinions, and lifestyles. Benefit segmentation demonstrates that different
segments seek different benefits from a product. For example some consumer purchase baking soda to
bake with while other consumers purchase baking soda to remove odors from their refrigerator. Usage
and user status refers to the difference between heavy users and other users of a product/brand.
Geographic segmentation realizes that differences exists between different physical locations. This is
found in the “Target Market Decisions: The Target Market Strategy” section (7-4b).
PTS: 1 DIF: Medium
4. Describe the process of country screening and selection.
ANS:
An international company would typically aggregate a selection of criteria discussed in the
macro-segmentation section that are deemed important by the company (e.g., market potential, degree
of political and financial stability, etc.). The criteria deemed important are selected from brand
managers or other decision makers in different international markets. The criteria are then assigned an
importance weight which denotes the extent to which the company considers a particular trait
important its decision to enter the market. The potential target countries are then rated on each of the
criteria. Finally, an importance score is multiplied by the performance score for each of the screening
variables. The total score for each country is then calculated by adding the resulting scores. This is the
country attractiveness score that can be used to compare between potential target countries. This is
found in the “Target Market Decisions: The Target Market Strategy” section (7-4b).
PTS: 1 DIF: Hard
5. Describe the targeting strategies discussed in the text.
ANS:
The text discusses the following targeting strategies: differentiated targeting, concentrated targeting,
and undifferentiated strategies. Differentiated targeting target segments that want different benefits
from a product and target them with different brands using different marketing strategies. Procter &
Gamble typically uses this strategy with its detergent brands. Companies that can't afford to wage a
differentiated strategy may choose to employ a concentrated strategy. A concentrated strategy targets a
single segment with one brand. Mont Blanc targets the professional class with its pen. In the
undifferentiated targeting strategy, a firm uses a standardized product and campaign. This increases
profitability through economies of scale. This is found in the "Target Market Decisions: The Target
Market Strategy" section (7-4b).
PTS: 1 DIF: Easy

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used in her subsequent treatment. Applications of faradic electricity,
both with the metallic brush and the moist sponges, were made
every other day. She was persistently and strongly encouraged as to
the certainty of her recovery. Her paralysis, anæsthesia, etc.
gradually disappeared, and in little more than two months she was
able to leave home and go to the country. She has since remained
well, but is more easily fatigued than formerly, and does not feel as
strong in the left side of her body as she did when in perfect health.
At her menstrual period she becomes very nervous.
M——, æt. twenty-three, a well-educated young lady,9 in the autumn

of 1880 had nursed her mother faithfully through a serious illness.
She became anæmic and nervous. Choreic twitchings and
occasional slight spasms were the first symptoms that alarmed her
family. The spasms came on apparently from any over-exertion.
Gradually they became a little more severe in character. Under rest-
treatment, with gentle massage, tonics, and steady feeding, in six
weeks she greatly improved. A few weeks later, however, she again
relapsed, and became worse than she had ever been. The spasms
returned with greater force and frequency. She became unable to
walk, or could only walk a few steps with the greatest difficulty,
although she could stand still quite well. On attempting to step either
forward or backward her head, shoulders, hips, and trunk would jerk
spasmodically and she would appear to give way at the knees. No
true paralysis or ataxia seemed to be present, but locomotion was
impossible, apparently because of irregular clonic spasms affecting
various parts of her body. Eventually she became extremely
hypersæsthetic in various regions (hysterogenic zones), along the
spine, beneath the breasts, in the ovarian area, etc. The slightest
pressure or any applications of heat or cold, electricity, etc. would
generally bring on an attack of spasm.
9 This patient was for a long time under the professional care of George McClellan of
Philadelphia, who has kindly furnished me with some notes. I shall simply give an
outline sketch of the case, describing particularly her epileptoid attack. For several
weeks, during the absence of McClellan from the city, she was attended by M.
O'Hara, and with him I saw her frequently in consultation.
While trying to apply galvanism on one occasion she suddenly
complained of nausea, and her expression changed, becoming
somewhat fixed. Her face became flushed, her limbs and body rigid.
The head and body were thrown backward to a moderate extent.
Next, the shoulders were drawn upward, the head appearing to be
sunk between them; the arms were found to be rigidly extended at
her sides, the wrists partly flexed, and the fingers clenched; the legs
also were spasmodically extended, the thighs drawn together, and
the feet in the equino-varus or hysterical club-foot position.
Phenomena like those described above as visceral spasm now were
observed. The chest, and even the abdomen, were lifted up and
down rapidly, and the respiration became quick, irregular, and
apparently very difficult. Consciousness seemed to be impaired, but
not absolutely lost. The symptoms just described took about one
minute for their exhibition. Muscular relaxation now occurred, and an
interval of calm, lasting about two minutes, followed, during which
the patient spoke, answering one or two questions addressed to her.
After the brief period of repose, however, another phase of the attack
came on. In this the heaving movements of the body and what
appeared to be intense respiratory spasms were the chief features.
This portion of the attack endured scarcely a minute; the patient
came to quickly, and was able to converse. In general, her attacks
were of a similar character.
The drugs used included bromides, iodides, strychnia, chloride of

sodium and gold, zinc salts, iron, etc. etc.; her condition vacillating,
sometimes better, sometimes worse. She was finally placed in bed
by McClellan, and an extension apparatus was employed, under
which treatment, in a little more than one year from the time she was
first attacked with spasm, she recovered.
The permanent or intervallary symptoms of hystero-epilepsy are in

the main the phenomena which have been described when speaking
of the prodromes of this affection. They are, indeed, the whole train
of symptoms—the mental or psychical disorders, the motor, sensory,
reflex, vaso-motor, and isolated phenomena—which have been
described under special heads when considering the general
symptomatology of hysteria. The full-fledged case of hystero-
epilepsy is hysteria with a full array of special permanent hysterical
manifestations, and the great paroxysm superadded. Certain
phenomena are, however, more prominent and of much more
frequent occurrence. Among these are paralysis or paresis, either of
the unilateral or paraplegic variety; hemianæsthesia, including
anæsthesia of all the senses; and contractures, particularly in the
lower extremities.
DURATION AND COURSE.—The duration and course of hystero-epilepsy

are very uncertain; most cases last many years. In a few instances
the hystero-epileptic attacks are all from which the patient suffers;
even in the cases of long duration the general health does not
appear to become greatly impaired.
DIAGNOSIS.—To arrive at a correct diagnosis between hystero-

epilepsy and epilepsy is sometimes very difficult. The fact that the
patient is a male does not decide for epilepsy. In making this
diagnosis close attention should be given to—1, The history and the
causes of the disease; 2, the physical and mental condition of the
patient; 3, above all, the phenomena of the spasmodic attacks.
In hystero-epilepsy a careful study of the history of the case will often

elicit a moral cause. The patients rarely injure themselves seriously
by falling, whereas in true epilepsy they often suffer from severe
injuries. The mental and physical health of a person suffering from
hystero-epilepsy differs widely from that of the true epileptic. In
hystero-epilepsy the number of attacks has little or no apparent
influence on the patient's mental or physical condition. Little or no
deterioration of the mind occurs. The memory is not much impaired.
Hystero-epileptics are usually well nourished and frequently of good
physique. This is not the case in true epilepsy; the number of attacks
has a decided effect on the patient's mental condition. The demented
appearance of the old epileptic is well known, whereas in the
hystero-epileptic nothing in physiognomy or carriage indicates that
the patient has been suffering from any disease. It cannot be said
that all epileptics have no mental power, but some deterioration of
the mind usually occurs, and becomes well marked as the case
progresses.
The paroxysms in epilepsy are very well marked, especially if it is

epilepsy of the grave form. They are often ushered in with a scream.
The patient suddenly falls, and at times is severely injured. The
convulsion is generally violent, rapidly alternating from clonic to tonic
spasm, without special phases or periods. Complete and profound
loss of consciousness, with great distortion of face and eyes, is
present. The tongue is frequently bitten. After the attack the patient
passes into a deep stupor. In hystero-epilepsy usually the seizure
does not begin with a scream or sudden fall, the convulsion has
periods and phases, and the tongue is not bitten.
It is said that in hystero-epilepsy there is no loss of consciousness,

but this is not strictly true. This point is the most difficult one for
physicians to clear up in arriving at a diagnosis, as in many
textbooks complete loss of consciousness is laid down as the
strongest evidence of epilepsy. Loss of consciousness does occur in
hystero-epilepsy, particularly in certain varieties. Richer says that the
loss of consciousness is complete during the entire epileptoid period
in a case of the regular type. To decide as to consciousness or
unconsciousness is not as easy as might be supposed. Varying
degrees of consciousness may be present. At times in hystero-
epileptic attacks the patient may respond to some external
influences and not to others. Consciousness is perverted or
obtunded often, and it is hard to decide whether the patient is
positively and entirely unconscious of her surroundings. In epilepsy
the loss of consciousness is profound and easily determined. In
regard to the distortion of the face and eyes, this sign is usually
absent in hystero-epilepsy, as in the German Hospital case, in which
the patient had a series of violent seizures lasting two hours, with
marked opisthotonos, yet the facial expression remained calm and
serene throughout.
In hystero-epilepsy the attacks are rarely single; usually they are
repeated, constituting the hystero-epileptic status. They are more
frequently repeated than in epilepsy, although it is of course well
known that there is an epileptic status terrible in character. In a
series of hystero-epileptic attacks usually the seizures come on in
rapid succession, the interval being brief. These series are apt to last
for hours or days. The attacks that compose a series in hystero-
epilepsy vary in duration and in violence. At first they are of violent
character; toward the end the seizures may gain in extent, but they
are likely to lose in intensity.
Charcot and Bourneville make a strong diagnostic point between

hystero-epilepsy and true epilepsy of the fact that in epilepsy there is
a peculiar rise of temperature during the convulsion, even to 104° F.,
whereas in hystero-epilepsy the temperature is nearly or quite
normal.
Arrest of attacks by ovarian compression in females, and by nerve

compression, nitrite of amyl, and the application of electric currents,
can be brought about in hystero-epilepsy, and not in epilepsy. A
study of the effect of bromides may assist in arriving at a diagnosis.
The action of bromides, drugs which are often used in both
affections, favors the opinion that the two diseases are distinct.
Bromides, according to Charcot and Richer, so effective in epilepsy,
are without effect in hystero-epilepsy. Dujardin-Beaumetz, however,
on the other hand, declares that “who says hysteria says bromides,”
and also that at the present time there is not an hysterical patient but
has taken bromides, the bromide of potassium being most frequently
used. The truth is, that bromides may be useful for temporary
purposes, for certain phases and symptoms of the disease, but
produce no radical permanent improvement in the disease hystero-
epilepsy.
D. Webster Prentiss,10 in reporting a case, gives some good points of

distinction between real and hysterical tetanus, which is practically
hystero-epilepsy. In his case, which was hysterical, the attack was
ushered in by noise in the ears, deafness, and blindness, whereas in
true tetanus and strychnia-poisoning the senses are preternaturally
acute. There was unconsciousness during the paroxysm, which does
not occur except just before death in the other affections. The eyes
were closed during the spasms; they stare wildly open in the other
diseases. The patient had long, uninterrupted sleep at night; in true
tetanus no such relief comes until convalescence.
10 American Journal of the Medical Sciences, 1879.
FIG. 25.
The figure is a representation of the opisthotonos of tetanus.11 It is

the sketch of a soldier, struck with opisthotonos after having been
wounded in the head; and in connection with it I will briefly call
attention to the points of differential diagnosis as given by Richer,
and which have been confirmed by my own observations. In the
opisthotonos of tetanus the contraction of the face and the peculiar
grin are distinguishing points, and are well represented in Bell's
sketch. In the hysterical arched position, while the jaws may be
strongly forced together, the features are most often without
expression. The contracture of the face and the distortion of the
features will be met with more often in the other varieties of
contortion. The curvature of the trunk differs but little in the two
cases, but the abdominal depression observed in the sketch of Bell
is far removed from the tympanitic appearance present in the
majority of hystero-epileptics. In the tetanic cases the patient rests
only on the heels, while in the hysterical cases the knees are slightly
flexed, and the patients are usually supported on the bed by the
soles of the feet.
11 From Sir Charles Bell's Anatomy and Physiology of Expression as connected with
the Fine Arts.
Hystero-epileptics are often suspected of simulation. Richer refers to
many facts which seem to throw out conclusively the idea of
simulation. Among these are the results obtained by æsthesiogenic
agents, the experiments in hypnotism, where many of the results
produced could not be simulated. Some English authors—and
among them notably the physiologist Carpenter—have endeavored
to find the explanation of the results obtained by the æsthesiogenic
agents in a special action of the moral on the physical nature which
they designate expectant attention. While the reality of the action of
expectant attention in certain cases will not be denied, it cannot be
invoked to explain satisfactorily all the phenomena. The patients are
not aware of the results sought; which, indeed, in some cases, are
contrary to the expectations of the observer himself.
PROGNOSIS.—A few cases of hystero-epilepsy get well, either with or

without treatment, in a short time. Some cases, which in addition to
the grave attack have had in the intervals the other striking
symptoms of major hysteria, such as hemianæsthesia and
contractures, get well only after many months or years; some never
recover, although, as a rule, they do not die from anything directly
connected with the disease, but from some accident or more
commonly from some intercurrent disorder. Cases supposed to be
cured often relapse. The patient may be apparently well for months,
or even years, when under some exciting cause the old disorder is
again aroused. On the whole, the prognosis is more serious the
longer the case has endured. Family history and environment have
much to do with determining the prognosis.
TREATMENT.—In considering the treatment of hystero-epilepsy I will,

in the main, confine my attention to a discussion of the methods of
managing and treating the convulsive seizures. With reference to the
numerous special phenomena of this disease, the directions given
and the suggestions made in the general article on Hysteria will be
equally applicable in this connection.
Ruault12 has recently recommended compression of a superficial

nerve-trunk in order to terminate an attack of hysteria or hystero-
epilepsy. The face being always accessible, he prefers making
pressure on the infraorbital nerves as they emerge from their
foramina, but he has also compressed the ulnar nerve behind the
inner condyle of the humerus. In a brief note to the Philadelphia
Neurological Society, made Feb. 23, 1884, I called attention to the
value of strong nerve-pressure for the relief of hysterical contracture,
and can confirm from several successes Ruault's recommendation
for the employment of the same measure to avert convulsive attacks.
12 La France médicale, vol. lxxxvi., p. 885.
Thiery13 of the Saint Pierre Hospital, Brussels, arrests paroxysms by

what he calls torsion of the abdominal walls. He grasps in his hands
the walls of the abdomen and imparts to them a certain kind of
torsion, which he gradually increases. This treatment is practically
the same as the deep ovarian pressure of Charcot. This
compression of the ovary on the side of the seat of the lesion
ordinarily will arrest immediately the convulsions. The patient is
extended horizontally, and the physician plunges the closed fist into
the iliac fossa, often using great force to overcome the muscular
resistance. Poiner has invented an apparatus called a compressor of
the ovaries, which can sometimes be used with advantage.
13 Medical and Surgical Reporter, Oct. 7, 1876.
Nitrate of amyl is undoubtedly of value in averting grave hysterical

attacks—convulsions, trance, ecstasy, pseudo-coma, mania, etc. It is
frequently used with marked success. Its action was studied on a
vast scale at La Salpêtrière. The convulsions usually stop almost
immediately after one, two, or three inhalations. It is to be preferred
to inhalations of chloroform or ether.
Nitro-glycerin can be used in the treatment of the hystero-epileptoid

convulsions. Notes of a very interesting case of hystero-epilepsy in
which this remedy was successfully employed have been furnished
me by David D. Stewart of Philadelphia. The case was one of
hystero-epilepsy with combined crises. Amyl nitrate on several
occasions broke the convulsive attack, but the patient did not
completely regain consciousness. Stewart was called in during an
attack, and found that the patient had been unconscious for an hour
and a quarter. He gave her hypodermically three minims of a 1 per
cent. solution of nitro-glycerin, and another injection after an interval
of about eight minutes. She became conscious within one minute
after the second injection. After this she had two seizures, both of
which occurred on the same day, and yielded with remarkable
promptness to a few minims of nitro-glycerin given by the mouth.
She was put on three minims three times a day of this drug, the dose
being gradually increased. Sufficient time has not elapsed to report
as to the effect of the drug given during the intervals.
Strong faradic currents, applied with metallic electrodes to the soles

of the feet or to the spine, are occasionally efficacious. The galvanic
current to the head has been extensively employed in the service of
Charcot to arrest hysterical and hystero-epileptic attacks of the grave
variety. One electrode is applied to the forehead, the other to any
convenient place upon the body, as the leg, the ovarian region, or
the spine. The current is applied continuously for several minutes, or
voltaic alternations are made. This method has been used with
success in a few instances, but should never be resorted to by a
physician uncertain of his diagnosis or one practically unfamiliar with
the powers and properties of the electrical current.
The question of oöphorectomy for the relief of hystero-epilepsy is

one of increasing importance in these days of major surgery. At the
meeting of the American Neurological Association (June, 1884) G. L.
Walton read a paper14 in which he concludes that hysteria is
sometimes set up by ovarian irritation, and can be relieved by
removing the offending organ. He cited a single case. Carsten15
concludes that it is criminal neglect not to perform Battey's operation
in cases which fail to be benefited by other treatment. In the
discussion which followed the reading of this paper the subject was
well traversed by Spitzka of New York, Putnam of Boston, Putnam-
Jacobi of New York, and others. Spitzka referred to one case of
Israel's of Breslau, in which a patient was cured of hystero-epilepsy
by a sham operation—a superficial incision in the parietes of the
abdomen. Under the title of castration in hysteria the Lancet16 tells of
an hysterical patient who had suffered for years from obstinate
vomiting and severe ovarian pain. She became extremely weak, and
finally consented to spaying as the only hope. The operation—
performed under chloroform with antiseptic precautions—was a
mockery, the skin only being incised; she was, however, perfectly
cured of her hysterical symptoms.
14 “A Contribution to the Study of Hysteria as Bearing on the Question of
Oöphorectomy.”
15 Quoted by Walton from American Journal of Obstetrics, March, 1883.
16 Vol. ii. p. 588.
In two clinical lectures published in the Philadelphia Medical Times17

I have given the histories of two cases of hystero-epilepsy in which
oöphorectomy was resorted to for hystero-epilepsy. In the first of
these cases, in which clitoridectomy was also performed,
nymphomania, which was a distressing symptom, was benefited, but
even this was not completely cured. The following is the patient's
own statement: “Since the removal of the ovaries I have been able to
control the desire when awake, but at times in my sleep I can feel
something like an orgasm taking place. My experience leads me to
say that my cure (?) is not due to the absence of the ovaries; there is
no diminution of the sexual feeling. There would be as much
excitement of the parts if the clitoris were still there. If my will gave
way, I would be as bad as ever.” Her general mental and nervous
condition is much the same as before the operations. She is still
dominated by morbid ideas, still unable to take up any vocation
which demands persistence, and still the frequent subject of hystero-
epileptic seizures.
17 April 18 and May 30, 1885.
The second of these cases was a young girl about seventeen years
old who had never menstruated. She had had epileptic or hystero-
epileptic seizures for several years. An operation was performed in
which the ovaries and Fallopian tubes were removed. Twelve days
after the operation, from which she made a good recovery, she had
four convulsive seizures. She had several attacks subsequently, and
then for a considerable period was exempt. She had, however, acute
inflammatory rheumatism, with endocarditis and valvular trouble.
About seven months after the operation she had several severe
convulsions with loss of consciousness, and died about a year after
the operation, having had many severe seizures during the last few
weeks of her life.
There is no warrant either in experience or in a study of the subject

for spaying hysterical girls who have never menstruated. In a case
diagnosticated as hysterical rhythmical chorea removal of the
ovaries was advised by a distinguished specialist. The girl's trouble
came on at about the age of thirteen years. She had never
menstruated properly, although on one occasion, after several weeks
of electric treatment, she had a slight show for a few days. It was
proposed to remove the ovaries in this case on some general
principle of given hysterical trouble; the ovaries must go. In this case,
as in the last, it would have been far better to have put in a good pair
of ovaries, or to have developed these rudimentary organs into
health and activity.
With reference to oöphorectomy for hystero-epilepsy or any form of

grave hysteria it may be concluded—1, It is only rarely justifiable; 2,
it is not justifiable in the case of girls who have not menstruated; 3,
when disease of the ovaries can be clearly made out by local
objective signs, it is sometimes justifiable; 4, it is justifiable in some
cases with violent nymphomania; 5, the operation is frequently
performed without due consideration, and the statistics of the
operation are peculiarly unreliable.
When we come to consider the treatment of the disease hystero-

epilepsy, the practical importance of the distinction between this
affection and true epilepsy becomes apparent. Cures of hystero-
epilepsy are not rare. The original cases here reported have all
apparently recovered. Grave hysteria is sometimes cured
spontaneously, either by gradual disappearance with the progress of
age, or suddenly because of some violent impression or under the
influence of unknown causes. One of the worst cases in the service
of Charcot has shown a gradual diminution of the hystero-epileptic
manifestations with the advance of age. In another case under the
influence of strong moral impressions the disease disappeared at a
stroke. The affection, however, should not be abandoned to nature,
as treatment is often of value.
The hydrotherapeutic method of treatment has been found of the

greatest service. Hydrotherapy must be methodically employed by
experienced hands. A number of cases cited by Richer were cured
at hydrotherapeutic institutions. Limited success has followed the
use of metallo-therapy. Besides metallic plates, the same results
may be obtained with other physical agents, to which have been
given the name of æsthesiogenic agents. Among these are feeble
electric currents, vibrations of a tuning-fork, static electricity, etc.
Static electricity has a position of undoubted importance in the

treatment of hystero-epilepsy in some of its phases. Those who have
walked in the wards and visited the laboratories of Salpêtrière will
recall the enormous insulated stools to which are brought troops of
hystero-epileptic patients, who, to save time, are given a vigorous
simultaneous charge of electricity. Even this wholesale plan of
treatment is sometimes markedly efficacious. Vigoroux recommends
static electricity as an æsthesiogenic agent, and regards it as the
most valuable of all agents of this character.
Those drugs should be resorted to which have a tonic influence on

the nervous system. Potassium bromide, as has already been
indicated, is not efficacious. More is to be hoped from tonics and
antispasmodics, such as valerian, iron, salts of silver, zinc, copper,
sodium, and gold chlorides, etc. Good hygienic influences, moral,
mental, and physical, are of the utmost importance.
CATALEPSY.
BY CHARLES K. MILLS, M.D.
DEFINITION.—Catalepsy is a functional nervous disease characterized

by conditions of perverted consciousness, diminished sensibility, and
especially by muscular rigidity or immobility, which is independent of
the will, and in consequence of which the whole body, the limbs, or
the parts affected remain in any position or attitude in which they
may be placed.
Catalepsy sometimes, but not frequently, occurs as an independent

disease; that is, the cataleptic seizure is the only abnormal
phenomena exhibited by the patient. It is sometimes present,
although also rarely, in organic disease of the nervous system. It has
been noted, for instance, as occurring in the course of cases of
cerebral hemorrhage, softening of the brain, abscess, tumor, and
tubercular meningitis. One case is referred to by C. Handfield Jones
in which it seemed to be due to intracranial epithelioma. As
commonly seen, it is a complication, or perhaps, more properly
speaking, a form of hysteria—hystero-catalepsy.
SYNONYMS.—Some of the many synonyms which have been used for

catalepsy are Catochus, Morbus attonitus, Stupor vigilans,
Synochus, Eclipsis, and Hysteria cataleptica. Trance and ecstasy are
discussed sometimes as synonymous with catalepsy, but they will be
considered as separate affections, as they have certain distinctive
features. Catalepsy, trance, ecstasy, hystero-epilepsy, and other
severe nervous disturbances may, however, all appear in the same
patient at different times or at different stages of the same seizure.
With reference to the term catochus (κατοχη, from κατεχω, I take

possession of), which has been used as synonymous with catalepsy,
Laycock1 points out what he considers to be the proper use of this
word, differentiating two cataleptic conditions, which he designates
as the tetanic and the paralytic states. Catochus is the tetanic form,
in which the trunk and limbs are rigidly extended and consciousness
is abolished. Catalepsy proper is Laycock's paralytic form, although
the term paralytic, as here applied, is by no means happy. It is the
form characterized by the peculiar and striking symptom known as
waxen flexibility (flexibilitas cerea)—a condition in which the limbs or
parts are passive and are capable of being moulded like wax or lead
pipe. Rosenthal would not consider any case as one of genuine
catalepsy if this waxen flexibility was absent. I do not think that this
rigorous criterion should always be imposed, although it might
perhaps be better to apply the term cataleptoid to all cases which do
not present true wax-like flexibility. The distinction sometimes made
between catalepsia vera, or true catalepsy, and catalepsia spuria, or
false catalepsy, is practically that indicated between Laycock's two
forms. According to Charcot and Richer,2 the flexibilitas cerea is not
present in the cataleptic state of hypnotism.
1 A Treatise on the Nervous Diseases of Women, by Thomas Laycock, M.D., London,
1840.
2 Journal of Mental and Nervous Diseases, Jan., 1883.
HISTORY.—The word catalepsy was used by Greek writers in its

etymological signification of a seizure or surprise. Hippocrates
described catalepsy; Galen, Aëtius, Rondeletius, and Fernelius have
all related cases; Aëtius has left an accurate description of both
catochus and catalepsy. In 1683, Laurence Bellini published a quarto
volume on various subjects, one of which was catalepsy. From time
to time interesting cases of catalepsy have been reported by medical
writers. One of the best is that recorded by John Jebb in 1782, and
quoted by Chambers in Reynolds's System of Medicine. The
researches in hypnotism during the present century, and particularly
those of Heidenhain and of Charcot and Richer, have thrown new
light on many cataleptic phenomena.
ETIOLOGY.—In catalepsy, as in hysteria, insanity, and many neuroses,

inheritance frequently plays a predisposing part. Eulenburg places it
in the large group of diseased conditions designated by Griesinger
constitutional neuropathies. The cataleptic of one generation may be
the descendant of the insane, the epileptic, the syphilitic, or the
alcoholized of a former. Catalepsy is particularly likely to occur in
families which have a history of insanity or drunkenness. Of the
cases detailed or alluded to in this paper, more than a majority had a
clear neurotic history. Catalepsy, like hysteria, occurs with some
frequency among the tuberculous.
Age plays some part in the development of catalepsy. It is of most

frequent occurrence between the ages of fifteen and thirty, but has
been observed at all ages. It is of unusual occurrence in very early
childhood, but A. Jacoby,3 Clinical Professor of the Diseases of
Children in the College of Physicians and Surgeons in New York,
reports a case of well-marked catalepsy in a child three years old.
This patient, a girl, was admitted to the Mt. Sinai Hospital, New York,
in September, 1879. She had whooping cough and some symptoms
of typhoid fever. After she had been in the hospital three weeks
choreic twitchings of the eyes and eyelids, with divergent strabismus,
were observed. Examining her, it was found that she was cataleptic;
her arms and legs would remain in any position in which they were
placed; she would drop the uplifted arms slowly when commanded;
sensibility to contact, pain, and temperature were entirely lost, and
the skin and patellar reflexes were diminished. Her appetite was
ravenous, and urine was passed in large quantities. Other
phenomena and details of cataleptic symptoms, which continued for
about a month, are recorded by Jacoby. The child recovered, but
remained weak and anæmic for a long time.
3 American Journal of Medical Science, N. S. lxxxix., 1885, p. 450.
Monti4 records eleven cases of catalepsy met with in children, male

and female in about equal numbers, of from five to fifteen years, the
average age being nine years. Eulenburg speaks of catalepsy at five
years of age, and quotes Schwartz, who noticed in a boy seven
years old, in consequence of rough treatment, first a choreic
condition, which later passed into catalepsy. Lloyd's case, to be
detailed later, also studied by myself at the University Hospital, was
in a boy eight years old. B. L. Hovey5 of Rochester, New York,
reports an interesting case of catalepsy in a boy eight years old.
4 Gerhardt's Handb. d. Kinderk., vol. v., L. P., 186 et seq., quoted by Jacobi.
5 The Hospital Gazette, 1879, vi. p. 19.
C. E. de Schweinitz of Philadelphia, Ophthalmic Surgeon to the

Children's Hospital and Prosector of Anatomy at the University of
Pennsylvania, has kindly put into my hands the unpublished notes of
a highly interesting case of catalepsy or automatism at command, or
of both, in a child two and a half years old. I will give this case in full,
chiefly in the language of De Schweinitz, because it is, so far as I
know, the youngest case on record. Some of the tests which were
applied in this case are among the most useful which can be
resorted to in determining how far the phenomena presented are
genuine or induced, simulated, or imitated:
The patient was a girl aged two and a half years, who had recently
recovered from an attack of diphtheritic conjunctivitis. During the
period of her convalescence the attending nurse called attention to
the unusual position assumed by the child while sleeping—viz. a
lateral decubitus, the head raised a short distance from the pillow,
and the forearm slightly elevated and stretched out from the body,
the muscles at the same time exhibiting marked tremulousness. A
series of trials readily demonstrated that the child when awake could
be placed in any position compatible with her muscular power, and
that she could thus remain until released. She was placed, for
instance, in the sitting posture, the arm brought at right angles to the
body, the forearm at right angles to the arm, and the hand at right
angles to the forearm, both legs raised from the bed, and the head
bent backward. This position, a most uncomfortable and difficult one
to preserve, would be maintained until the little subject dropped from
sheer exhaustion. Flexion and extension of each separate finger
were easily produced, and the fingers remained until replaced in the
positions in which they had been fixed. At the beginning the child's
mind was sluggish, although she asked for food and made known
her various wants. How far she appreciated surrounding objects
could not be accurately ascertained, inasmuch as the previous
disease of her eyes had left her with a central corneal macula on
each side, rendering her almost sightless in one eye and with but
indifferent object-perception in the other. Voluntary motion was
preserved, and she sat up, turned, and moved whenever she
pleased, but most often when at rest at this stage maintained
somewhat of the position before described which during sleep first
attracted attention to this condition.
In conjunction with Morris Lewis an examination of the cutaneous

sensibility and reflexes was made, which showed diminished
sensibility in the legs and thighs, but not higher up, where the pricks
of the instrument were quickly appreciated. Her knee-jerk was
apparently absent on the right side and present on the left; but this
test, always most unsatisfactory in children, yielded no certain
evidence and constantly gave contradictory results. Scratching the
skin of the soles of the feet, legs, thighs, and abdomen with a
pointed instrument was followed by marked reflex movements.
Electro-muscular contractility was everywhere preserved. The child
at this time was feeble and anæmic, but her appetite was good—not
depraved nor voracious; the tongue was clean, the bowels regular.
The urine was of a light amber color, specific gravity 1020, free from
albumen and sugar.
As the nutrition of the child improved, it was found that the curious
positions could be produced by word of command as well as by
manipulation. In short, within six weeks after the first manifestations
of this disorder, as a usual thing the little patient ate, slept, and
played as a normal child should do, but could at any time be thrown
into this cataleptoid state. Her one dominant idea apparently was to
maintain the position in which she had been placed. She was often
turned into some constrained posture, and all attendants absented
themselves from the room and left her to her own devices; but no
attempt on her part was made to in any way change her attitude. If at
dinner-time a bowl of broth was placed before the patient, she would
begin to eat with great relish, but if the spoon was taken away and
her hands raised over her head, they would so remain, the child
making no effort to return to her meal, although the bowl stood
before her and all watchers again retired from the room. This
experiment was suggested by H. C. Wood, who examined the child
with me. To show how completely her consciousness was occupied
with one idea of maintaining any position in which she had been
placed, the following additional experiments may be quoted: If she
was put into a sitting position, as in the act of supplication, with her
hands folded and arms extended, and then given a sudden push
sufficient to overthrow her equilibrium, the arms would be quickly
and intuitively thrown out to protect her from the impending fall, but,
the fall accomplished, they would as quickly be returned to their
former position. If a heated silver spoon was gradually brought in
contact with her extended hand, an expression of pain would pass
the child's face, perhaps a cry escape her, and the injured member
be rapidly withdrawn, but again almost immediately returned to its
original place. It seemed as if the idea of fixity in a certain position
which occupied the child's mind was suddenly disturbed by another
outside impression, but, being dominant, it quickly drove away the
intruder and the former state was restored. At this time the
phenomena noted were somewhat in accord with those induced by
the mesmeric process, inasmuch as the consciousness seemed
largely given up to the one impression operating at that time—i.e. the
maintenance of certain fixed positions. Unlike this condition,
however, the readiness to receive new impressions, and the
complete abeyance of those senses not operating was wanting, for,
as seen above, the new impression only for a moment disturbed the
child's one idea, to which she quickly returned; nor was there any
true absence of sensibility, as was evidenced by the result from
touching her with a heated spoon.
As time wore on, a new phase of this condition became evident. The
induced manifestations seemed to act the part of some amusement
to the child, and the complete absence of volition which had been an
early characteristic phenomenon was not now so marked a feature.
Thus, if, after the experimenter had for a time moulded and twisted
the child into various shapes, he would suddenly leave the room, the
little subject would cry lustily, as a child does when suddenly
deprived of its playthings, although, curiously enough, no matter how
hard she cried, she would not release herself from the last position in
which she had been left. Often during any series of observations that
were being made it was noted that a faintly-amused look played
about her lips, which speedily gave way to a fit of crying when the
performance stopped. The hand which, when formerly placed in any
position, remained a perfectly motionless and passive object, was
now seen slightly to change its place, move the fingers, or the like—
an observation first made by A. K. Meigs while examining the
patient. The house-physician, Nathan P. Grimm, took great care and
interest in observing the case.
De Schweinitz, in reporting the case, briefly discusses the probable

cause of the phenomena exhibited. He discards the views that either
fear of the experimenter, such as is shown by a trained animal, or
the partial blindness of the child, was responsible for the
manifestations. He believes that a direct relation existed between the
phenomena and the state of the child's nutrition. The more run down
her system was, the more nearly did the nervous phenomena
resemble those of true catalepsy. Evidently, her symptoms were
partly cataleptic and partly phenomena of automatism at command,
similar to those which have been observed in hypnotic experiments,
and which will be alluded to later.
Catalepsy is of more frequency in the female than in the male sex,

but the statistics are not sufficient to give any exact ratio.

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PTS: 1 DIF: Medium

PTS: 1 DIF: Medium

PTS: 1 DIF: Medium

PTS: 1 DIF: Medium

PTS: 1 DIF: Medium

PTS: 1 DIF: Medium