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 Contents vii

Essay (Identity): Gender in Classic Country 262

Essay (Songwriting): Story Songs 264
Essay (Culture): The Opry Moves 265
Listen Side by Side: “Muleskinner Blues” 267
Chapter 9: Outlaw Country and Southern
Rock Rebellion................................................................................................... 271
The Emergence of Outlaw Country 272
Artist Profile: Willie Nelson 276
Outlaw Country Runs Its Course 278
Listening Guide: “Luckenback, Texas (Back to the Basics of Love)” 280
Southern Rock and the Country Audience 282
Listening Guide: “Sweet Home Alabama” 286
Listening Guide: “The South’s Gonna Do It” 288
Artist Profile: Charlie Daniels 290
Essay (Musical Style): Outlaw Country 292
Essay (Musical Style): Southern Rock 293
Essay (Music Business): Behaving Like Outlaws 294
Essay (Culture): Long-Haired Rednecks, Hippies, and Cosmic Cowboys 295
Listen Side by Side: “Can I Sleep in Your Arms” 297
Listen Side by Side: Red Headed Stranger 298

Part IV: Expansion: Country Makes

It Big-Time (1980s and 1990s)
Overview......................................................................................................................... 301
Chapter 10: Urban Cowboys, Countrypolitan,
and the Reagan Era......................................................................................... 303
History and Rise of Crossover Country 303
Pop Culture, the Cowboy, and the Country Boy 305
Politics, Economics, and the Appeal of the Urban Cowboy 308
New Media and Breaking Down Genre Borders 308
Listening Guide: “Islands in the Stream” 310
Listening Guide: “I Was Country (When Country Wasn’t Cool)” 312
Artist Profile: Ronnie Milsap 314
The Stars and Songs of Urban Cowboy 315
Artist Profile: Barbara Mandrell 316
Listening Guide: “Love in the First Degree” 320
The End of Urban Cowboy 322
Essay (Musical Style): Countrypolitan 323
Essay (Culture): Country Music on the Silver Screen 324
Essay (Music Business): International Country 327
Listen Side by Side: Country/Pop Comparisons 331
viii Contents

Chapter 11: Neotraditionalists

and Remaking the Past......................................... 333
Countrypolitan Fades 333
Neotraditionalist Philosophy 335
Listening Guide: “All My Ex’s Live in Texas” 336
Early Practitioners 337
Artist Profile: George Strait 340
Listening Guide: “Grandpa (Tell Me ’Bout the Good Old Days)” 342
Neotraditionalism Takes Root 344
Artist Profile: Reba McEntire 346
Listening Guide: “How Blue” 348
Co-opted, Conservative, and Commercial 350
Essay (Musical Style): Neotraditionalist Recordings 352
Essay (Culture): Branson, Missouri, and Country Music Tourism 354
Essay (Songwriting): Cover Songs Revisited 356
Listen Side by Side: “Deep Water” 358

Chapter 12: The Commercial Country Explosion....... 361

The Class of 1989 and “New Country” 361
Artist Profile: Garth Brooks 364
Listening Guide: “Friends in Low Places” 368
Themes in New Country 370
Listening Guide: “Gone Country” 372
Stylistic Pendulums and Country-Pop 375
Artist Profile: Shania Twain 376
Listening Guide: “Any Man of Mine” 378
The End of the 1990s 383
Essay (Musical Style): New Country and Country-Pop 384
Essay (Culture): Line Dancing 385
Essay (Songwriting): Songwriting and Sophistication 388
Essay (History): Southernization and Soccer moms 389
Listen Side by Side: Cowboy Songs 391

Part V: Country Music Navigates Genre

(1990s and 2000s)
Overview......................................................................................................................... 395
Chapter 13: Alternative Country and Beyond.......................... 399
Defining Alternative Country 399
Alternative Country Origins 400
Alternative Country Coalesces 401
Listening Guide: “No Depression” 402
Artist Profile: Ryan Adams 404
A Broader Definition: Alternative Country as Musical Space 406
 Contents ix

Listening Guide: “Suppose Tonight Would Be Our Last” 408

Americana 413
Another Alternative: Bluegrass 413
The Impact on Mainstream Country 414
Artist Profile: Alison Krauss 416
Changes in Commercial Country 416
“Murder on Music Row”: The Turning Tide 419
Listening Guide: “Man of Constant Sorrow” 422
Essay (Culture): The O Brother Phenomenon 424
Essay (Musical Style): What Alt-Country Doesn’t Sound Like 426
Essay (Technology): The Internet Age 427
Essay (Culture): Gay Line Dancing 429
Listen Side by Side: “Waltz Across Texas” 430
Chapter 14: Redefining Country in
a New Millennium......................................................................................... 433
Country Music in the Spotlight 433
Artist Profile: Brad Paisley 434
Listening Guide: “Whiskey Lullaby” 436
Return of Roots and Rednecks 440
Listening Guide: “Redneck Woman” 442
Listening Guide: “Long Time Gone” 446
Americana and Alternative? 448
Artist Profile: Carrie Underwood 452
Pop Culture Lays Claim to Country Music 452
Reflecting and Projecting Meaning 457
Essay (Culture): Dixie Chicks and Politics 458
Essay (Identity): Race in Contemporary Country 462
Essay (Technology): MP3s Please 464
Listen Side by Side: A Woman’s Voice 466
Chapter 15: Breaking Borders............................................................. 469
The Past Is Alive and Well 469
New Directions 470
Nashville On Screen 471
The Rise of Bro-Country 471
Artist Profile: Blake Shelton 472
Listening Guide: “Cruise” 474
Promises Unfulfilled 477
Listening Guide: “Girl Crush” 478
Artist Profile: Miranda Lambert 480
Listening Guide: “Tin Man” 482
Crossover and Hip-Hop-ification 484
Dark Horse Surprises 489
Through the Lenses 492
x Contents

Essay (Identity): Tomato-Gate and the Women of Country 493

Essay (Musical Style): The Splintering of Country 495
Essay (Identity): Who Listens to Country? 497
Listen Side by Side: “Tennessee Whiskey” 499
Appendix A: Song Form................................................................................................ 503
Appendix B: Country Instruments.............................................................................. 517
Appendix C: Glossary.................................................................................................... 527
Selected Bibliography..................................................................................................... 531
Index................................................................................................................................ 535
Preface

T
his book has grown from two seeds: one is a deep passion for country music
of all stripes, styles, eras, and varieties; the other is an insatiable curiosity
to understand the music, from the notes, rhythms, and words of the songs
to the very human performances, the music’s endlessly varied meanings, and what
it can teach about history, about culture, and about the essence of human relation-
ships. The book offers a journey through a century of country music, presenting
information about the music, musicians, fans, and historical contexts, along with
explorations of several important themes and issues that arise from that study. It is
designed either for a one-semester, college-level course on country music or for use
with country-music units and topics within the framework of a course on American
music or popular music. Individual chapters within the book can also be used in
many other contexts to investigate specific time periods, artists, and topics.

Coverage
The book presents a chronological history of the development of country music. It
begins with the source materials from which country music emerged, then traces
the music from its earliest recordings in the 1920s through the present. The book
covers the developments of different musical styles, the evolution of the music in-
dustry, and the changing ways that the music relates to popular culture and differ-
ent historical contexts. It includes information on an extensive number of country
stars, songwriters, and industry personnel. It does not, however, attempt to be com-
prehensive on that front. It will instead give the curious reader the tools, informa-
tion, and big-picture understanding to figure out how other bands and artists fit
into the history of country music, while country music encyclopedias and websites
can readily provide basic biographical information about bands and artists not cov-
ered in this book.
The main focus of this book is American commercial country music. There are
thriving country music scenes in other areas of the world, and some coverage of
them is provided here. The main narrative, however, explores the music in its native
home. The attention to American commercial country music is an inclusive one: the
book covers bluegrass, alternative country, western swing, and many other styles at
length, and examines geographic centers far beyond the main production sites.
In the intervening years since the first edition appeared, the field of country
music scholarship has expanded, with significant new research by Diane Pecknold,
Dene Hubbs, Jeremy Hill, Travis Stimeling, Charles Hughes, Murphy Henry, Lee Bid-
good, and many others. I have attempted to weave that new scholarship into the text
throughout the book so that students will have access to the most contemporary
ideas possible. This expansion of scholarship on country music is exciting, and stu-
dents at all levels should be encouraged to reach beyond this textbook.

xi
xii Preface

Approach
As explained in the Introduction, the book focuses on three interpretive themes
that run throughout the history of country music: cultural identity; authenticity;
and otherness, specifically the ways in which country music remains distinct from
mainstream popular culture.
The book carefully and consistently avoids making any arguments about what
music is or is not “real” country, and instead takes the stance that the student of
country music should ask questions about “how” and “why” rather than merely
assign categories. The fastest way to stall one’s learning is to declare a song “country”
or “not,” or a performance “authentic” or “not.” Asking students to think beyond such
binary judgements will lead to far more insight and understanding. Individual in-
structors and students will have varying personal tastes for country music, and their
interpretations of these issues will encompass many different perspectives. These are
to be encouraged and can lead to very insightful class discussions and supplemental
research projects.
This course of study can be undertaken from a variety of disciplines, including
but not limited to music, history, cultural studies, American studies, English, soci-
ology, and communications. The book assumes no formal musical training on the
part of either the student or the instructor. Supplemental materials are included for
students in a music discipline or those seeking more technical study of the music
itself. These include an appendix on song form and a few musical examples that are
not essential to the main body of the book.

Layout
The structure of the book will readily align with a typical one-semester or one-
quarter course syllabus. The book is laid out in five parts, each of which covers ap-
proximately two decades and features three chapters. Each part begins with a brief
overview that presents the major developments covered in the unit and situates
them in a broader historical context. Each chapter contains the following:
1. A main narrative that covers the musical and cultural history of one era.
2. Two artist profiles that explore the biographies of key figures.
3. Three detailed listening guides that connect specific recordings to the ideas
presented in the chapter. These listening guides form a core component of the
book and should be a major part of the student’s experience, because they link
the ideas and main narratives to the sound of the music.
4. Comparative listening, identified as a “Listen Side by Side” exercise. These ex-
ercises guide close readings of two or more songs in relation to each other,
where comparisons yield better understanding of the main themes of this
book. These also serve as useful stimuli for in-class discussions.
5. Several essays that offer in-depth exploration of a single topic. These essays
fall in one of seven categories: history, musical style, the music business, cul-
ture, technology, songwriting, and issues of identity (such as race, class, and
 Preface xiii

gender). For instance, the musical style essays provide definitions and dis-
cussions of different musical styles such as western swing or countrypolitan,
and the technology essays provide concise discussions of key developments
in music technology that have had a major impact on country music. These
essays will help students and instructors explore threads in these categories
across the whole span of country music and tailor their courses to their spe-
cific disciplinary interests.
6. A playlist that suggests additional listening beyond the three songs covered in
the listening guides. Together, the listening guides plus these additional playl-
ists offer approximately eight songs associated with the main topics, issues,
and ideas covered in that chapter.
7. Suggested sources for additional reading.
8. Review materials, including questions that are suitable for class discussion or
writing assignments.
Four appendices are also provided. Appendix A is an introduction to song form
that covers technical vocabulary and ways to analyze a song’s form. These skills are
essential to any close reading or analysis of individual songs. Appendix B offers a
basic introduction to the instruments commonly heard in country music. Each
entry describes the instrument’s role in the history of country music and suggests
songs where the instrument can be readily heard. Appendix C provides a glossary of
key terms. And Appendix D presents a timeline of events in country music history
along with touchstone events in American history.
The listening guides that appear throughout this book require some techni-
cal explanation. The timings shown for the start of each section align with the
first structural downbeat of that section. This approach is consistent throughout
the book and matches the accepted methodology for formal analysis of popular
music. Students without a formal musical background may think more casually of
sections starting with the singer’s lyrics, which in many instances may be either
pickup notes or after-beat patterns and may therefore occur a few seconds before
or after the timing listed in the book. Therefore, students who are not focusing as
much on the music-analytic aspects of this subject matter may treat those timings
as general guidelines, while students taking a more rigorous approach to the musi-
cal analysis and music theory will be able to use them to identify specific structural
features of the songs.

Source Materials
Along with this textbook, students will need access to recordings. Students and in-
structors have a variety of resources at their disposal to help in this task. Listening
to the recordings is essential, and students should rely on those recordings as a
primary source throughout their study. Students should also consult song lyrics;
these are readily available on many internet sites, in liner notes to recordings, and
of course through firsthand transcription of the recordings.
xiv Preface

Outcomes
The student outcomes for any course in the history of country music are determined
by the specific disciplinary approach and course design that the instructor chooses.
This book will support a wide variety of learning outcomes, including but by no
means limited to the student’s ability (a) to recognize by ear many different styles,
eras, trends, individual artists, and major themes in country music; (b) to interpret
the varied meanings of country music within different historical and cultural con-
texts; (c) to use country music as the creative lens through which to study different
people, cultures, places, and times; and (d) to explain country music’s role and iden-
tity as a genre within popular culture.
Most of all, I invite instructors and students alike to incorporate this book into
their personal explorations of country music. I hope that, in the course of their
studies, students will encounter country music they love, country music they hate,
­country music that confuses them, and country music that inspires them. I encour-
age them to engage all of that music with a heightened sense of curiosity and critical
inquiry. The music has much teach us all about human relationships, history, and
culture. Enjoy the journey!

Acknowledgments
I am deeply grateful to the many people who have helped me write this book.
­Richard Carlin guided its creation with his extensive expertise and his own passion
for the subject matter. Hannah Whitcher and the publication team of editors were
invaluable throughout the publication process.
Thank you to the many reviewers for Oxford University Press who have pro-
vided productive suggestions and insights throughout the book’s existence.
Colleagues who share my deep interest in country music have offered their own
expertise, including Nate Gibson, Joti Rockwell, and Travis Stimeling. Fellow speak-
ers at conferences, including Jewly Hight, Barry Mazor, Jon Weisberger, Fred Bartens-
tein, James Akenson, Don Cusic, Erika Brady, Diane Pecknold, Russell ­Johnson, and
so many more have stimulated my thinking. The many students who have enrolled
in my country music classes over the past decade, served as teaching assistants, and
undertaken country music research projects with me have all helped me shape this
book, including Christa Bentley, Gina Bombola, Meg Orita, and more. And I am
grateful to the professors who inspired me to pursue this path of scholarship in the
first place and made such study possible, including Betsy Marvin, Dave Headlam,
and John Covach,
I owe the greatest debt to my family for their support of this project. My parents
instilled in me a love both of music and of teaching. My children, Caelen, Rhiannon,
and Liadan, are the center of my world. They have grown up surrounded by both
this music and the research that led to this book. May they follow a pathway in life
enriched both by music and by an endless desire to understand both the people and
the culture of all the music they encounter. It is to them I dedicate this work.
Introduction:
Heading into
the Country

W
hat is country music? It is an indelible part of American popular cul-
ture, interwoven with our sense of identity and our retelling of history.
It is nostalgic, yet focused on the present. Some of it has been called
hillbilly music, but at times the music has purged itself of all hillbilly associations. It
is rural in origin, yet has always been reliant on an urbanized commercial industry.
It is primarily white in terms of its racial and ethnic associations, but inextricably
dependent on a range of musical styles with strong racial and ethnic pasts, including
black, Cajun, and Latin, and home to diverse artists and audiences. It is extremely
popular, yet one of its main concerns is to differentiate itself from what we call pop
music. It offers both a window on working- and middle-class life and a punch line
for tasteless jokes as old as some of the tunes themselves. Ask five different fans to
define it, and you will likely get five contradictory yet equally passionate answers.
None of these characteristics produces a clear definition, yet the music’s complexity
is what makes studying it so rewarding.

Country as Genre
Country music is a genre of popular music whose boundaries are determined by
the interactions of fans, the commercial music industry, and musicians. “Genre”
means category, and this book—along with most studies of popular music—­
includes the opinions of the music’s fans as an important way in which a genre
is defined. P
­ opular music is the term by which we identify mostly commercially
produced and disseminated music that is a common part of its audience’s daily
lives. Popular music is generally popular (meaning lots of people like it), although
some genres within popular music have much smaller fan bases. In the past, music
that has not been considered part of popular music has included art music, which
is sometimes called classical music, and folk music. Some scholars in previous de-
cades considered art music to be music that was neither a product of nor intended
for mass culture, and folk music to be that which was entirely outside commercial
enterprise. Art music was described as intellectually cultivated and an expression of
high culture, such as a Beethoven symphony. This music was taught in formal music
appreciation courses and supported by grants and institutions of higher learning,
with the assumption that it was good for people to study it and hear it. Folk music,
by contrast, was considered the anonymous music-making that was simply part of
oral traditions in local communities and families. It was valued by collectors in the

xv
xvi Introduction

early twentieth century precisely because it appeared to represent a grassroots, raw

expression of regular people’s culture.
These distinctions, however, do not hold up to critical examination. In recent
years, scholars have explored how some art music is both extremely popular and
highly commercial, and how folk music was never really isolated from the forces of
commerce, meaning that the songs that people sang in their homes, churches, and
gathering places often came from identifiable songwriters, published songbooks,
and traceable commercial sources. Thus, any apparent distinctions between popu-
lar, art, and folk music, which were never clear-cut in the first place, are even more
suspect in the twenty-first century’s musical landscape. To further complicate
these terms, so-called folk singers such as Peter, Paul, and Mary or the Weavers
were very much a part of popular music in the mid-twentieth century, when “folk”
became a genre within popular music. For our purposes, we mainly need to un-
derstand popular music as that which is created for mass consumption within the
commercial marketplace. Popular music includes some art music and is continu-
ally interdependent with folk traditions. Finally, the definition of popular music is
always closely tied to the cultural identity of its fans: the people who listen to it,
the circumstances in which they listen to it, the reasons why they listen to it, and
the meanings they find in it.
Different genres of popular music include rock, pop, jazz, blues, hip-hop, rhythm
and blues (R&B), gospel, Latin, folk, and country; think of these as the different bins
one might have seen in a conventional record store. Thus, we will consider country
as one genre within the broad category of popular music. Most music fans listen to
and like many different genres. Similarly, individual artists might perform music
that belongs to more than one genre. Songs, and even performers, often cross over
from one genre to another. These categories we call “genres” are constantly shifting
and changing, but there are some characteristics that remain consistent in how we
understand them.
One point of potential confusion is that one genre of popular music is com-
monly called pop music. Historically, pop music emerged as the genre most widely
accepted by mass culture as represented by a generally (although not exclusively)
white middle class. Bing Crosby, Kay Starr, Frank Sinatra, and Rosemary Clooney
were all routinely described as pop singers in their day. In later decades, pop music
describes a musical genre and performers that have achieved mass acceptance by a
young mainstream audience without being subsumed into racially and stylistically
differentiated genres such as hip-hop. Lady Gaga, Katy Perry, and Justin Bieber are
examples of pop stars.
The relationship between pop and country is particularly complex. For instance,
country fans and performers often complain that country music is crossing over
into pop, or that a pop star is trying to make country records; at other times, they
celebrate the fact that country music is being accepted by a pop audience. The ever-
evolving tension between pop and country will form an important part of our study.
Some writers have proposed that musical genres are merely labels that the music
industry applies to recordings in order to market them. That perspective, however,
relegates fans to a passive role and discounts their power in defining musical genres.
 Introduction xvii

Our approach will instead acknowledge the fans’ role in this process. In recent years,
record labels have on several occasions packaged a CD as “country” and offered it to
the fans, who have resoundingly rejected it on the basis of genre. Conversely, some
recordings that sound radically different from most country music have been em-
braced by fans and accepted as country music, a process that can radically change
the genre. And finally, some music that sounds like country is made by musicians
and listened to by fans who reject that label entirely. Fans are active participants in
how genres are formed and defined, primarily through the ways that they identify
and express themselves in relation to their musical preferences.

Definition of Country
Country music, as we will define it in this book, is a commercial genre that claims a
lineage from early twentieth-century, rural, white, mostly Southern, working-class
popular music. It is symbolically related to the cowboy, and it draws on a largely
Protestant, evangelical theology for its underlying philosophy. Its songwriting relies
on storytelling; sympathetic, working-class characters; clear narratives; and relat-
able experiences from everyday life. Stock references such as trucks, cowboy hats,
family, small towns, church, “y’all,” and countless others often signal a song’s affin-
ity with country music. Although its musical sound has changed radically over the
past century, it retains associations with certain iconic instruments such as fiddles,
steel guitars, banjos, mandolins, and acoustic six-string guitars, although not all
of these instruments are present in all styles of country music, nor does their in-
corporation automatically mean that a recording is country. Country singers and
musicians often use Southern vocal accents, verbal interjections, and particular
techniques of playing their instruments to differentiate country from other genres.
Artists’ biographies come into play at various times in the music’s history, when a
singer’s hometown, family, or occupation may be invoked to help define the genre.
Country music often situates itself in particular geographic locations: small-town or
rural America, the South, Texas, the West Coast. One additional determining factor
is whether the people who think of themselves as country fans accept a particular
performer or performance music as country.
Our text will address many different musical styles within country music.
Musical style is difficult to define but refers to those characteristics that can be
identified by listening to the music. It describes the particular approach to a per-
formance, the use of instruments, and the musical arrangement, based on what
one can actually hear in the performance or recording. It tells us what tradition
that performance came from and provides clues as to when, where, and why the
recording was made. Think of the country genre as a large umbrella that covers
many different styles of music. Over the decades, the styles gathered under that
umbrella have changed and evolved so that what we hear today (instruments, type
of singing, musical arrangements, etc.) may not sound at all like what we might
have heard on a country radio broadcast in the 1920s. Nevertheless, all of those
styles come together in the idea of country as a genre, which is a larger category
defined by fan identity, traditions, and lineage.
xviii Introduction

MAIN COUNTRY STYLES WE WILL STUDY

The main styles of country music that we will study include the following. Dates
indicate when the style was most prominent; keep in mind, however, that many
styles were present for several years before they became widely known, and many
styles remained part of country music long after they faded from prominence. The
chapters indicate where the main discussion of the style is found.
Hillbilly music 1920s–1930s chapters 1 & 2
Western swing 1930s–1950s chapter 3
Singing cowboy 1930s–1940s chapter 3
Brother acts 1930s–1940s chapter 3
Honky-­tonk 1940s–1950s chapter 4
Rockabilly 1950s chapter 4
Bluegrass 1940s–1950s chapter 5
Country teen crooners 1950s chapter 6
Nashville sound late 1950s–1960s chapter 6
Bakersfield sound 1960s chapter 7
Country rock 1960s–1970s chapter 7
Progressive Bluegrass 1960s–1970s chapter 7
Classic country 1960s–1970s chapter 8
Outlaw 1970s chapter 9
Southern rock 1970s chapter 9
Countrypolitan 1970s–1980s chapter 10
Neotraditional 1980s chapter 11
New country 1990s–2000s chapter 12
Country pop 1990s–2000s chapter 12
Alt-­country (postpunk) 1990s–2000s chapter 13
Alt-­country (retro) 1990s–2000s chapter 13
Commercial country (roots revival) 2000s chapter 14
Commercial country (honky-­tonk themes) 2000s chapter 14
Commercial country (Latin influence) 2000s chapter 14
Commercial country (Southern rock influence) 2000s chapter 14
Bro country 2010s chapter 15
Country/hip-hop 2010s chapter 15
 Introduction xix

Imagine for a moment that you are flipping through various radio stations. What
clues do you hear that help you quickly identify the country station? Your responses
might include the lyrics (the words of the songs), the instruments, or the overall
timbre (the general description of the sound), which is often described as having a
“twang.” Imagine that you are shopping in a record store. What visual clues tell you
which CDs are country? Your responses might include the types of clothing and ac-
cessories worn by the stars, the way that the stars are presented in the photography,
or the props seen in the photographs and cover art. Imagine that you are attending a
concert or a club with live music. What clues identify the genre of the performance?
Your responses might include the wardrobe or modes of transportation favored by
the audience members, the types of graphics used in advertising posters, or even the
name of the venue. In other words, country music has many signifiers in its sounds,
visual presentations, and fan identities. As part of our studies, we will examine where
these signifiers come from, how they became part of country music, and what they
mean, both to country fans and to others.

Is it Real? Issues of Authenticity in

Country Music
The biggest issue in scholarship on country music is the idea of authenticity. Schol-
ars have written extensively about the topic; many agree that authenticity is a qual-
ity or value that fans ascribe to music based on two general considerations. The first
is listeners’ perception that the music is traditional, “like it used to be,” or from a
source that is an accepted part of country’s roots. In this sense, listeners might de-
scribe a performance as authentic if it sounds like country music from some earlier
era, or if the fans believe the artists belong to the country music tradition (perhaps
through their family’s history or biography). The second consideration is listeners’
perception of the music as original (as opposed to a copy or facsimile), genuine (as
opposed to artificial), and honest. In this sense, listeners might describe a perfor-
mance as authentic if they feel like the singer is telling a story based on his or her
own experience and attempting to connect directly and honestly with the listener
without any calculated or constructed mediation. These very complicated and nu-
anced ideas of authenticity sometimes conflict with each other. Yet together, they
help explain how fans continuously make judgments about what is or is not “real”
country music.
What passes that test of authenticity will vary from one fan to the next, and from
one era to the next, as we will see. Many fans of alternative styles of country claim
that the Top 40 country music on contemporary radio is not what they consider
“real.” Conversely, lots of fans of Top 40 country music are not fond of and do not
value alternative styles of country music. In every period in country music’s his-
tory, contrasting musical styles have existed, and fans have debated their perceived
authenticity. Think again about the signifiers we just listed that help define country
music. For each of those, there are contradictions, exceptions, and controversies: fans
sometimes reject as inauthentic a performance or recording that has many of those
xx Introduction

signifiers; in other instances, fans embrace a performance, singer, or recording as

country even if it lacks any of those common signifiers. For our purposes, we are not
going to concern ourselves with what is or is not “real” country music, even though
that is a debate into which music fans often enter. Frankly, asking whether or not a
particular artist or song is “real country” is a question that leaves us dead in the water
and teaches us nothing. Our task, as students and historians, is instead to study how
and why these differences of opinion occur, what they mean in the larger history of
the music, and how they help us interpret culture and meaning.

Goals and Themes

Our study of country music focuses on two main goals:
1. to understand the music’s history.
2. to identify country’s major musical styles and trace their development by ear.
The history of country music includes its important singers, songwriters, busi-
ness practices, cultural institutions, and songs, all within social and cultural contexts.
Most of our study will focus on those contexts as they occur in American history,
although we will also examine the export, import, and influence of country music
in foreign locations. Country music is a useful window through which to revisit the
cultural history of the past century. The Great Depression, World War II, the Korean
and Vietnam wars, the Cold War, conflicts in Afghanistan and Iraq, periods of eco-
nomic upheaval, the changing face of American life, technological advances, new
media, new forms of entertainment and communications, the civil rights movement,
the women’s liberation movement, and countless other global events and cultural
milestones are reflected through the lens of country music. Similarly, country music
has acted as a voice for different marginalized populations throughout the past cen-
tury, offering those groups a chance to be heard. To that end, this study of country
music is really a study of history viewed through country music.
Our second goal, which is to be able to identify country’s major musical styles by
ear and trace their development, requires that you immerse yourself in the sounds
of country music rather than merely reading about it. Each concept and idea in this
book should be reinforced by constant and careful listening to relevant recordings.
At the end of this study, you should be able to listen to just about any country music
recording and identify the general musical style, the time period, and the historical
or social context in which it was made.
This book is constructed around three primary themes:
1. Cultural identity
2. Authenticity
3. The “otherness” of country
These themes provide a framework through which to interpret the information
we have about country music. Think of them as a lens that you can use to exam-
ine the music and its cultural context. The question is never whether these themes
can be applied to country music of a particular style, era, or artist (they are always
 Introduction xxi

applicable), but rather how you can use these lenses to make sense of the details and
musical specifics of that style, era, or artist.

Cultural Identity
Both performers and fans have used country music to express who they are and
to give a voice to their frustrations, goals, passions, concerns, and fears. Country
music’s content and meaning are often linked to its performers’ and listeners’ eco-
nomic and social status, class, race, ethnicity, gender, political beliefs, religious be-
liefs, fields of employment, and family status. The fans and performers represent the
full range and diversity of identities within any of these categories. That explains,
for instance, how one performance can take on very different and even contradic-
tory meanings for different listeners. Identity, namely who is making and listening
to the music, the circumstances and major concerns in their lives, and the social,
economic, political, religious, and historical contexts through which they are con-
necting to country music, will be a major focus of our investigation.

Authenticity
Scholars, fans, and performers alike have focused on authenticity as the most im-
portant value that listeners ascribe to country music. What it means, however, varies
from one listener to the next, and from one moment or song to the next. We will see
how the genre depends on fans and performers at any given time agreeing on what
seems “authentic,” whether it is a revival of an old style or—totally different—an
emphasis on new songs written by the singer, or something else altogether. Com-
peting definitions of authenticity also explain different scenes, movements, or styles
within country music, why one group of fans heads to a bluegrass festival and claim
that is authentic, while another group of fans heads to a stadium to hear a concert
headliner sing songs that they feel they “relate to.” Sometimes authenticity means
abandoning or at least hiding any desire to achieve commercial success. Consider
that in the minds of some fans, being an authentic artist and wanting to sell records
are incompatible ideas. At the heart of this paradox, country music came into ex-
istence as a commercial music, but has always cultivated the notion that it eschews
commercial success.
The best way to study how authenticity functions within country music is to
discard entirely any urge you have to label some music as authentic and some other
music as inauthentic. Rather than declaring what you think is or is not authentic, ask
yourself how and why a group of fans relate in a particular way to an artist or song.

The “Otherness” of Country

Through a variety of ways, country music continuously differentiates itself from
other genres, most significantly pop music. In order to maintain its distinction
from pop, country music has to be noticeably different from the mainstream. At
the same time, many forces within the country music industry push the genre
toward mainstream acceptability and larger audiences, which simultaneously in-
crease country’s popularity and decrease its distinctive identity. Therein lies the
problem: if country music gets too popular and acceptable to the mainstream
xxii Introduction

audience, it literally becomes pop music. But if country becomes pop music, it
no longer enjoys a unique identity as something different than mass, mainstream
culture, and its very existence as a genre is threatened. Its “otherness,” therefore,
is the ways in which it remains culturally marginalized and noticeably differ-
ent from mainstream pop. Being different can be both an asset and a liability.
Throughout this book, we will trace the way the music has sometimes blended
into the cultural mainstream, thereby diluting its distinctive identity, and at other
times amplified its differences. We will also consider why fans and musicians con-
sider this issue vitally important to country music.

Situating a Performer
This book does not offer a comprehensive catalog of all significant country musi-
cians. Such a collection might well be impossible, although there are some ency-
clopedias, websites, and books about the history of country music that come close.
Instead, this book provides a framework for understanding the major trends, devel-
opments, and issues within the genre. Bands and artists generally appear in this text
when they are either innovators in an area or style that had lasting impact or rep-
resentatives of a larger development. The literal constraints on the size of this book
mean that many interesting, influential, and important musicians are not covered
directly. It is possible—or even likely—that your favorite artist might not appear.
Rather than be disappointed if your favorite band or artist is not featured in the
book, consider instead that by the end of your studies, you will have the tools and
knowledge to do further research on those bands or artists and to make sense of
how, where, and why they fit into the larger history of the genre.

How to Listen
Listening to music is easy to do. Most of us listen casually almost all the time for
pleasure, to accompany to other tasks, or as a means of socializing. But listening to
music as part of a serious study requires a different approach. Recordings will be our
main source materials, and we have to treat the listening experience as a focused task
that deserves our full attention and significant time. Each chapter includes listen-
ing guides and a playlist, which should be studied as carefully as the text itself. And
each chapter includes a “Listen Side by Side,” which guides you through a detailed
comparison of two or more recordings. Let these recordings be your primary texts;
study and “read” them as closely as possible, as they are the focal point of this history.
Every country recording invites three layers of listening:
1. The first addresses the song as a text consisting of both music and, in most
instances, lyrics. Hank Williams’s “Your Cheatin’ Heart,” for instance, has some
words, a tune, and some chords that together comprise that particular song.
2. The second layer addresses the recording as a particular performance from
a specific time, place, and set of circumstances. The singer’s voice (if there is
a singer) is unique; the choice of instruments (including additional voices)
 Introduction xxiii

is part of that performance. Those instrumentalists are using different tech-

niques, improvising (creating on the spot) particular harmonies or short
musical enhancements for that one performance, and blending in ways that
create an identifiable musical style. Each performance uses a specific arrange-
ment of the song, meaning which verses or sections are included, omitted, or
repeated, and with what chords and musical parts, harmonies, and enhance-
ments. No two performances, even with the same musicians and the same
song, are identical. All of these aspects of the performance are important in
our listening comprehension.
3. The third layer addresses the mediation of the recording itself—in other
words, the technology involved in capturing, manipulating, reproducing, and
delivering the sound to our ears. When we listen to early-1920s recordings
made on wax-coated discs without the benefit of electric microphones, for in-
stance, we hear vestiges of that recording process. The same song recorded in
a modern, digital studio with sound-processing software such as Auto-Tune
will sound very different. Again, these aspects of the recording itself are es-
sential to our understanding of the music and its context and meaning.
In order to get the full benefit from listening, make sure you are hearing the
specific performance or version of the song described in this book. In other words,
we are not listening just to the words and melody of a song, but rather to the whole
performance, with all three layers, to find out what it can tell us about the people,
place, time, and traditions in which that performance took place.
The Listening Methodology Chart suggests a strategy for approaching a record-
ing in all three layers. When you listen to music, make sure you have the best pos-
sible speakers or headphones, a quiet space, time to play the music several times,
and a way to take notes on what you hear. You may not be able to write down some
features of the recording such as the melody and chord progression (the actual notes
being played and sung), because these skills require advanced, specialized training.
However, you will still be able to describe some features of those musical elements.
As you listen, think about comparisons between the recording and the other music
you know. If you hear two versions of the same song, what has changed, and what is
the same? If you hear two different songs in the same general musical style, what do
they have in common? By the end of the semester, you will have a large catalog of
country music recordings in your head that you can use to understand large trends,
developments, and significant changes over the entire history of the genre.
The recordings that we have represent only a tiny fraction of the country music
that has been performed over the past century. For every record that we can hear,
a performer may have played dozens of concerts live, sung privately with friends,
and rehearsed hundreds of other songs for which there is no extant record. While
it is essential to acknowledge this, we should also be grateful that we get to hear as
much music from the past century as is now possible, particularly with the increas-
ing access to reissues of older recordings and the easy accessibility through the inter-
net to current artists’ music. Thus, our study pays tribute to the technology of sound
recording and how it contributes to our access to the past.
xxiv Introduction

Listening Methodology
The Song The Words What do they mean?

How do they sound?

How are they organized?

The Melody What does it sound like?

How is it organized?

The Chords What is the chord progression?

The Performance Musical Style What is the sound of the ensemble?

What is the arrangement of the song?

The Singer What does the voice sound like?

What performance techniques are used?

The Recording How was the What were the conditions where the
sound captured? recording was made?
What technologies were used in the
recording process?

How is the sound What technologies were used in creating the

delivered? final product?
Another random document with
no related content on Scribd:
make a mistake on this basis, he will have the recompense of
knowing that he has assisted in a very rare case, in which it was next
to impossible for him to be right. This condition is said to be found
more frequently when the brain lesion and paralysis are on the right
side.

Severe pain in the head, followed by gradually but rapidly deepening

coma and paralysis of one side, becoming more and more complete,
probably means a hemorrhage into or just outside of the great
ganglia and involving a large extent of one of the hemispheres.

If there have been moderate loss of power or complete paralysis

lasting some hours, with, afterward, sudden loss of consciousness
and general muscular relaxation, with sudden fall, soon followed by
rapid rise, of temperature, it is very probable that a hemorrhage has
broken through into the ventricles or beneath the membranes, and is
still going on.

Rapidly-deepening unconsciousness, with general muscular

relaxation and gradual manifestations of more paralysis on one side
than the other, may come from meningeal hemorrhage.

Very sudden and complete hemiplegia without prodromata, with

deep unconsciousness coming on rapidly or suddenly, but a little
after the paralysis, is likely to denote the occlusion of the middle (and
perhaps anterior cerebral) artery of the opposite side at a point
sufficiently low down to produce extensive anæmia of the motor
centres along the fissure of Rolando as well as the underlying great
ganglia.

Aphasia with hemiplegia, often without the slightest disturbance of

consciousness, is in a considerable proportion of cases connected
with a lesion of the third left frontal convolution, and in a somewhat
larger proportion with the frontal lobes in general and the island of
Reil. This lesion is in a great majority of cases occlusion of the
artery. Difficulty of speech, connected with difficulty of swallowing
and associated with a certain amount of amnesic aphasia, has been
found with lesions of the pons. As aphasia, however, may occur
without any fatal lesions at all, it is not certain in all these cases that
the obvious lesion of the pons is a direct cause of all the symptoms.

Word-blindness is associated, according to a case reported by

Skworzoff and a few others,49 with a lesion of the angular gyrus, pli
courbe (P2 of Ecker), and word-deafness with a lesion of the first
temporal (T1). These localizations agree with those experimentally
determined.
49 West, Brit. Med. Journ., June 20, 1885.

Conjugate deviation is of importance as a localizing symptom, chiefly

because it may be manifest when other signs of hemiplegia are
difficult to elicit. I do not find it mentioned in twenty-seven cases of
cerebellar hemorrhage not included in the table of Hillairet, but it is
not infrequent with lesions of the pons; and when the lesion is in the
lower third, it is in the opposite direction to that described as usual
with lesions of the hemispheres.

Hemianæsthesia involving the organs of special sense, unilateral

amblyopia, and color-blindness is supposed to be connected with a
lesion of the posterior third of the internal capsule, or the thalamus in
its immediate vicinity, sometimes also with a lesion of the pons.
Bilateral hemiopia—blindness of the corresponding sides of both
eyes—is apt to be connected with a lesion of the occipital lobe of the
opposite side. Rendu and Gombault remark that hemianæsthesia of
the limbs and face may be met with in certain lesions of the cerebral
peduncles, but in this case the higher special senses (sight, smell)
remain unaltered. Hemichorea points to the same localization as the
more complete hemianæsthesia.

Alternate hemiplegia is due to a lesion of the pons upon the side of

the facial paralysis, and opposed to the paralysis of the limbs and in
the posterior or lower half. Care should be taken not to confound this
with the accidental addition of a facial paralysis to a hemiplegia of
the other side.
Irregular ocular paralyses are very likely to be due to lesion of the
same region. In some of these forms an investigation of the electrical
condition with reference to the presence of the degeneration reaction
may be of great assistance.

With extensive lesions profound coma and relaxation without distinct

hemiplegia are likely to be due to injury of the pons. A thrombus of
the basilar artery may lead not only to rapid, but even to sudden,
death. A phthisical patient died suddenly while eating his supper, and
a thrombosis of the basilar artery, with softening of the pons, was
found. Of course the lesion must have been of older date.50 Bright51
thought that when symptoms pointing to disease of the intracranial
vessels were present the diagnosis was confirmed, and the location
of the lesion in the vertebral arteries rendered highly probable, by a
persistent occipital pain. In the upper part of one side of the pons the
hemiplegia is not alternate, but of the ordinary form.
50 Bull. de Société anatomique, 1875.

51 Guy's Hospital Reports, 1836.

Any extensive lesion of the medulla must cause death so rapidly as

almost to defy diagnosis, but such rarely occurs. The very rapid
termination of certain cases of hemorrhage into the pons and
cerebellum is due to the escape of blood into the fourth ventricle and
consequent compression of the medulla.

Lesions of the lower and inner part of the crus are indicated by
paralysis of the third nerve of the same, and hemiplegia of the
opposite side of the body.

Obstinate vomiting, severe occipital headache, and vertigo, with or

without a distinct paralysis, render a cerebellar hemorrhage
probable, though no one of these symptoms is necessarily present
or pathognomonic. Vomiting is very much more common with
cerebellar hemorrhage than with cerebral. Ocular symptoms, like
nystagmus and strabismus, accompany cerebellar lesions.
A difference in the temperature of the paralyzed and non-paralyzed
sides, when amounting to one and a half to two degrees and lasting
for a long time, is thought by Bastian to indicate a lesion of the optic
thalamus.

The severe and rapid sloughing of the nates sometimes seen in

rapidly-fatal cases is stated by Joffroy to be most frequently
connected with a lesion of the occipital lobes.52
52 Arch. gén., Jan., 1876.

It is plain, from what has been said about the symptoms of the
different kinds of lesion, that a distinction may be often very difficult,
and at times impossible; and in this connection all observers are
agreed, the apoplectiform shock, the hemiplegia, and the slighter
attacks being common to two or three lesions. The diagnosis can be
made, if at all, only by the consideration of more or less secondary
symptoms and the careful weighing of the various probabilities
against each other. Most of the statements of differences of
symptoms are only relatively true.

A glance at the nature of the pathological processes involved may

serve to systematize our observations.

Hemorrhage is a sudden accident, with a severity increasing as the

amount of effusion increases. It has been prepared for by arterial
disease, but this disease is one which may have no previous
symptoms. It is at first an irritative lesion.

Embolism is a sudden attack which may be as severe at first as even

a few minutes afterward. It is also prepared for by disease of other
organs, which may or may not have symptoms according to the
origin of the embolus. As embolism affects especially those regions
where the motor centres are spread out, while hemorrhage attacks
more frequently the conductors in their locality of concentration, the
paralyses arising from the former affection may be more narrowly
limited.
Thrombosis is a gradual affection, which may, however, manifest
itself suddenly, from the obstruction reaching a certain point and
suddenly cutting off the supply of blood. This also depends on
previous disease which has more or less definite symptoms.

The severity of the attack is not conclusive, though the completely

developed apoplectic attack is more frequent with hemorrhage.
Rapidly increasing severity, especially if there have been
prodromata, is in favor of hemorrhage. Convulsions, early rigidity,
and conjugate deviation of the eyes of the spastic form, especially if
afterward becoming paralytic, are strongly in favor of hemorrhage,
and the latter possibly conclusive. Hughlings-Jackson states that he
cannot call to mind a single case of hemiplegia from clot in a young
person in which there were not convulsions.

Sudden paralysis without cerebral prodromata, unconsciousness, or

pain can hardly be anything else than embolism; but, unfortunately
for diagnosis, the initial paralysis from the embolus may be slight,
and afterward added to by the secondary thrombus, so as to put on
the appearance of more gradual approach.

Aphasia, and especially aphasia associated with but little or no

paralysis, is very much more frequent with embolism than with
hemorrhage.

The temperature, if we could always have it recorded from the very

beginning, might be of value, as the initial depression is said to be
less with embolism than with hemorrhage, but Bourneville,53 who
lays down this rule, gives so many cases where no great depression
occurred with hemorrhage that it cannot be considered decisive.
Besides this, we are not likely to get the information at the time it is
of the most value.
53 Op. cit.

Etiological information may have a very practical bearing on this part

of the diagnosis. Age gives a slight amount of predominance to the
chances of hemorrhage, and youth a considerably greater one to the
chances of embolism. Interstitial nephritis with hypertrophy of the
heart, after the exclusion of uræmia, gives a strong probability in
favor of hemorrhage. Valvular disease of the heart, especially a more
or less recent endocarditis, is strongly in favor of embolism. A feeble
action of the heart, slow and irregular pulse, are more likely to be
connected with thrombosis.

Atheroma and calcification, as detected by examination of the visible

and tangible arteries like the radial and temporal, is a condition either
connected with the periarteritis aneurysmatica which gives rise to
hemorrhage, or one which furnishes a suitable spot for the
deposition of a thrombus; hence it can be considered conclusive in
neither direction.

Arcus senilis, even of the fatty variety, can only show some
probability of arterial degeneration.

Retinal hemorrhage, if present, favors the presence of a similar

cerebral lesion, but nothing can be argued from its absence.
Landesberg54 has reported a case in which embolism of the central
artery of the retina, easily diagnosticated by the ophthalmoscope,
preceded by a few days a similar accident in the middle cerebral;
and Gowers55 another in which the two arteries were occluded
simultaneously.
54 Archiv für Ophthalmologie, xv. p. 214.

55 Lancet, Dec. 4, 1875.

If a sudden paralysis arises in connection with a septic process, we

may diagnosticate an embolus with a good deal of confidence; but it
is not unusual to meet with small abscesses of septic origin which
have given rise to no special symptoms whatever, or only to such as
are covered up by the more general constitutional ones.

PROGNOSIS.—The prognosis quoad vitam of cases of apoplexy still in

the unconscious state is based upon the general severity of the
symptoms as indicated by general muscular relaxation, or, at a later
period, the extent of the paralysis, the amount of affection of the
heart and respiration, and especially the progress during the first few
hours. Too much weight should not be placed upon a very slight
improvement at first, since this often takes place in cases soon to
prove fatal.

Stertorous respiration with perfect tolerance of mucus in the throat,

absolute loss of the reflexes, and immobility of the pupils signifies
profound depression of the organic nervous centres, and is
consequently of unfavorable augury.

The temperature is a valuable guide. In proportion as it moves

steadily and rapidly upward is the prospect of an early fatal result. A
person may die during the initial fall of temperature, but in such a
case there would hardly be need of a prognosis.

In general, the prognosis from hemorrhage, supposing the

symptoms to increase in severity for an hour or two, is worse than
that from occlusion.

Age, aside from the fact that it makes hemorrhage more probable
than occlusion, is not of great importance in prognosis, certainly not
out of proportion to the general impairment of vigor in advanced
years.

A renewal of the hemorrhage within a few hours cannot be predicted.

It may be indicated by another fall of the temperature, which, if it
have been previously on the rise, renders, of course, the prognosis
more unfavorable.

After recovery, more or less complete, from the apoplectic condition

the prognosis is favorable, for a time at least, except so far as one
attack may be looked upon as the forerunner of another. After the
temperature has reached a sort of standstill in the neighborhood of
normal, its subsequent rise will furnish among the earliest indications
of an approaching fatal termination.
Urinary trouble, retention, incontinence, or, much more, cystitis, is to
be looked upon as a complication which materially increases the
gravity of the situation. Bed-sores or abrasions may be placed in the
same class, except that the early and extensive sloughing of the
nates described by Charcot is of almost absolutely fatal significance.

After some days or weeks the progress of the paralysis either toward
better or worse may be exceedingly slow, and as time goes on the
danger to be apprehended from the latter becomes less and less.

When paralysis takes place in young persons and the primary attack
is recovered from, it is doubtful if the chances of a long life are
materially diminished. A case has already been referred to in this
article where the consequences of a cerebral hemorrhage occurring
in infancy were found in a woman of eighty-three in the form of
atrophied limbs and an old pigmentary deposit in the brain.

Hemorrhage into the cerebellum would appear, from statistics, to be

exceedingly fatal, but it is certain from old lesions occasionally found
that it is not absolutely so, and its apparent severity is partly caused
by the fact that it is very seldom diagnosticated except at the
autopsy.

The prognosis quoad restitutionem ad integrum cannot be made to

advantage at an early period. After the immediate danger to life has
passed it is safe to say, if pressed for an answer, that it is highly
probable that some recovery from paralysis may take place, but that
it is highly improbable that it will be absolutely complete, and just
how far improvement may go it is impossible to predict with accuracy
at first. Time must be given, in the first place, for pressure to subside,
compressed nerve-fibres to be restored, and for such collateral
circulation as is possible to be established. How recovery takes
place beyond this it is not easy to say. It is hardly supposable that
any considerable portion of nerve-structure is renewed. A certain
amount of substitution, by which one part of the brain takes up the
functions of another part, is among the most plausible suppositions;
but how this is accomplished it is hardly worth while in the present
condition of cerebral physiology to speculate.
Practically, it may be said that physicians are apt to consider a
paralysis absolute at too early a period, while the patient and his
friends continue to hope for a complete restoration after it is evident
that no really useful increase of power is to be looked for. Weeks,
and even months, may elapse before any return of motion can be
perceived in cases which are really susceptible of considerable
improvement, and a year most certainly does not cover the limit of
the time during which it may go on.

The most unfavorable symptom, one which probably precludes all

hope of useful recovery in the limbs affected, is contracture,
heralded for a time by increase of the deep reflexes, indicating
degeneration of the motor tract in the white substance of the cord.
Until this begins, certainly for many weeks, the patient may be fairly
encouraged that some improvement is possible, though after a few
weeks the chances diminish as time goes on. In the rare cases
where the muscles undergo rapid wasting the prognosis is, if
possible, worse still. The localization of the lesion after the early
symptoms are passed does not greatly influence the prognosis.

A rapid recovery taking place in either hand or foot, and especially of

the hand first, without corresponding improvement in the other limb,
is of unfavorable import for the latter, and, in general, the prognosis
is not exactly the same for both limbs involved. In the rare cases of
hemiplegia from acute brain disease occurring in children the
nutritive disturbances in the form of arrest of growth should be taken
into the account in prognosis, since the result may be nearly or quite
the same as is found after infantile paralysis from disease of the
cord.

In regard to the slighter forms of paralysis, it may be said that the

less extensive the original paralysis is, and the sooner improvement
begins, the better is the chance of complete recovery.

TREATMENT, INCLUDING PROPHYLAXIS.—Cerebral Hemorrhage.—As the

condition upon which the usual form of cerebral hemorrhage
depends is so frequently aneurism, and probably nearly always
some arterial disease, the prophylaxis must evidently consist in such
a mode of life as will least tend to this degeneration, or at least put it
off as long as possible. This, of course, means the avoidance of all
the special causes described under the head of Etiology. It is a
disease of old age, but in a pathological sense old age begins in
different persons after a different number of years. Fortunately for
rules of hygiene, there is little that is contradictory in those to be
given for most chronic and degenerative diseases. Abstinence from
alcohol, as an agent tending at once to paralysis and dilatation of the
vessels, is one of the most important rules and insisted upon by
nearly all writers. The avoidance of over-eating, and especially of
nitrogenous food as tending to lithæmia—a generally recognized
cause of arterial degeneration—is perhaps the next. Over-eating is
of course to be understood as a relative term, and to be estimated
with reference to the habits of exercise of each person. Practically, it
will be decided by its effects; that is, if careful thought be given to the
matter and the statements of the gourmand as to his immunity from
all risk of trouble are not accepted as of scientific value. On the other
hand, insufficient food, producing anæmia, may be a factor in arterial
degeneration. Keeping one's self free from anxiety, and getting
through the world with as little experience of its roughnesses as
possible, might be, properly enough, added in a purely theoretical
point of view if any one ever asked a physician's advice in youth as
to avoidance of the diseases of age, or if any one could or would
profit by this advice if it were given.

Intellectual pursuits have been credited with a special tendency to

apoplexy, but there is no good reason to suppose that healthy
exercise of the mind is otherwise than beneficial to its organ. Hurry,
over-anxiety, and mental tension are undoubtedly potent factors in
general breakdown, but do not necessarily lead to this form. They
are certainly not to be found by preference in those persons who
lead an intellectual life.

Syphilis, one of the most important of the causes of organic cerebral

disease, and that too in the form of thrombosis, is not specially
concerned in the etiology of the forms here under consideration.
If symptoms have occurred that justify the apprehension of apoplexy
or paralysis, such as frequent headaches in an elderly person,
hemiopia, temporary aphasia, or slight and temporary paralyses, or if
one have reached a time of life at which the risk of cerebral
hemorrhage becomes considerable, a stricter attention to the rules
laid down above, and even to some to which but little heed would be
given in health, is not out of place. A certain amount of limitation of
diet, moderate and regular but not violent exercise, clothing suitable
to the season, and especially warm enough in winter, and, most of
all, rest if the patient be doing wearing and anxious work, should be
enjoined. Finally, it should be said that the real prophylaxis of
cerebral hemorrhage is to be begun in early life.

Among the exciting causes to be avoided are those which obstruct

the flow of blood from the head, like tight clothing around the neck.
Increase of the arterial pressure by severe or prolonged muscular
effort, as in lifting or straining at stool, is to be avoided, as well as
violent fits of passion. The condition of the bowels should be
regulated by mild laxatives.

When the apoplectic attack has actually occurred, treatment, though

apparently urgently demanded, is really of little avail. If a patient is
about to die in an hour or two from rapidly increasing pressure,
nothing within the reach of medical science can stop him.

There is one danger, however, easily avoided, but probably often

overlooked. A patient may die from suffocation. The stertor is often a
result of the paralysis of the tongue and palate and of the amount of
fluids collecting in the pharynx from the almost invariable position of
the patient on his back; that is, if he have been seen by some one
who wished to do something for him, but did not know what.
Insensibility and paralysis combine to favor this accumulation, which
obstructs the respiration, and which may find its way to the lungs,
together with brandy and milk, and set up an inhalation-pneumonia.
The simple and obvious thing to do is to place the patient sufficiently
on his side, with the face somewhat downward, for the tongue and
palate and secretions to fall forward, instead of backward into the
pharynx. Swabbing out the pharynx may be of some use, but cannot
be so thorough. An easy position and proper ventilation should be
secured in all cases of unconsciousness, even at the risk of treating
a drunkard with undue consideration. Police-stations should be
provided with rooms where these conditions can be secured, and the
necessity avoided of placing persons picked up in the streets in the
narrow, close, and perhaps distant cells provided for malefactors.
The writer recalls the cases of two young men—one who had been
drinking some time before, and the second roaring drunk—who were
locked up in a suburban station-house in the evening, and found the
next morning—one dying and the other dead.

Artificial respiration may be used to prolong life in some cases until

the nervous centres have sufficiently recovered their functions to
carry on the process without assistance. The condition of the bladder
should be ascertained, and the urine drawn if necessary, though it is
more frequently passed involuntarily.

Although it is manifestly impossible to remove the clot from the

interior of the brain, it may appear that the further flow of blood may
be stopped and the amount of damage done limited. For this
purpose two remedies are proposed—namely, bleeding and
purgatives. Both of these act to diminish arterial pressure, which is
forcing the blood out of the rupture. Though the treatment seems
reasonable, it would not be difficult to imagine a condition where
sudden and premature diminution of pressure in the brain, which of
course exists outside of the arteries as well as inside, would tend to
set going again the flow which has ceased from the very force of the
pressure it itself exerts, very much as if a tampon were prematurely
removed from a bleeding cavity elsewhere. As the conditions are
somewhat complicated, and at the same time only remotely to be
estimated, it is safer to be guided by experience in the use of these
remedies than by abstract reasoning. In some of the cases of
temporary aphasia, as notably that of Rostan narrated by Trousseau,
bleeding seems to have given immediate relief. Trousseau, however,
is no advocate of that method of treatment. Most modern authors
speak of venesection as to be used in cases where the pulse is
strong and full and the face red, but not to be thought of in the
opposite class. When a case presents the appearances of plethora
and an attack has come on suddenly, the loss of a few ounces of
blood can certainly do no harm. Other forms of bleeding, such as
cups and leeches, are not rapid enough to be of great value, though
a large number of leeches about the head might be useful. Some
French writers recommend leeches to the anus as revulsives.
Cathartics may be more freely used, although they should be given
cautiously when there is any tendency to cardiac depression. It can
be clearly shown that a brisk purgative lowers the arterial tension
decidedly. In case of cerebral tumor or injury with occasional so-
called congestive attacks, the relief afforded by cathartics is very
great, and, although the conditions are not exactly parallel, it is fair to
assume a similar action in the congestion accompanying cerebral
hemorrhage. From one to three drops of croton oil may be placed far
back on the tongue or it may be diluted with a neutral oil. Ail enema
may be desirable for the unloading of the bowels, but has a much
less marked effect on the tension of the cerebral circulation.

In most cases of apoplectiform cerebral hemorrhage, and probably in

all of simple paralysis, no very active treatment is called for.
Measures directed to the prevention of another hemorrhage, and to
allay any irritation that may supervene during the changes taking
place about the clot and the formation of its capsule, are of the
simplest, and consist in keeping the head high and cool, the clothing
sufficient for warmth, and offering no obstruction to respiration or
circulation, laxatives sufficient to keep the bowels in good order, and
a diet not highly nitrogenous, but sufficient and digestible.

That which will tax most severely, however, the care and patience of
attendants is the scrupulous and minute attention to cleanliness and
pressure over the bony prominences which is necessary when a
patient is helpless and unable to control the discharges from the
rectum and bladder. Frequent change of clothing, bathing, change of
position, and avoidance of wrinkles and roughnesses in the bed may
be successful in keeping the patient free from bed-sores. Bathing
with alcohol hardens the skin and makes it less susceptible to
pressure.

Surgical interference may perhaps be of value in cases where the

portion of the clot outside the brain can be clearly demonstrated; and
this would apply with special force where the hemorrhage arises
from injury.

Trephining and removal of the clot has been done in a few cases of
meningeal hemorrhage, though with indifferent success (3 cases—2
deaths, 1 unknown.)56 An intracerebral clot is obviously a step
beyond, though possibly in some cases not absolutely without, the
reach of the surgeon.
56 Med. Press and Circular, Oct. 14, 1885.

Treatment of Cerebral Embolism.—The prophylaxis is in the

avoidance of such conditions as give rise to the formation of
detachable vegetations or clots. Unfortunately, these are numerous,
not completely known, and not always avoidable. Arterial disease is
to be looked upon as of some importance, but cardiac valvular
lesions of much greater, and the causes of these, like rheumatism,
scarlet fever, and the puerperal condition, are not always to be
escaped. The presence of a detachable piece of fibrin in the
pulmonary veins, heart, or aorta being granted, nobody can possibly
say what will prevent its being loosened and lodging in one of the
cerebral arteries; so that, practically, the prophylaxis of embolism
consists in the judicious treatment of acute rheumatism and the other
conditions just mentioned. The treatment of the first attack must
consist solely in the relief of respiration, bladder, and bowels, if they
have not taken care of themselves. Stimulants may be of use for a
short time, but there cannot be any call for even the slight amount of
depletion suggested for some cases of hemorrhage. Bed-sores are
to be looked out for, just as in hemorrhage, and the subsequent
treatment conducted on the same principles. As regards the primary
lesion, we can do nothing about it either in the way of removal of the
embolus or restoration of the necrosed brain-tissue.
Treatment of Cerebral Thrombosis.—There being two factors in this
affection, both of which are to a certain extent under control,
something may be done toward diminishing the risk of its
occurrence. Arterial disease and its prophylaxis have already been
spoken of. The other condition which is necessary to the production
of thrombosis—namely, an enfeebled circulation—is to some extent
under the control of general hygienic rules: a nutritious, not too
highly nitrogenous, diet, and especially sufficient exercise and the
avoidance of completely sedentary habits. If there is a crasis which
predisposes to the formation of coagula in the vessels, it is not
known that there is any special treatment, medical or otherwise,
which can prevent it. The attack is to be treated exactly on the
principles already laid down. Bleeding is about the last thing to be
thought of. Stimulants, though they cannot dislodge the clot, may be
of use for a time to sustain the heart under the shock. The secretions
and the condition of the skin are to be looked out for.

After a few weeks of waiting the patient and his friends not
unnaturally feel as if something ought to be done to hasten recovery,
and certain measures may be taken, in addition to careful hygiene,
which have this object in view. It is very doubtful, however, whether
anything really shortens the time necessary for such repair as is
possible or diminishes the amount of damage which is to be
permanent. As has already been said, improvement may go on
slowly for months. In the first place, it is sometimes considered
desirable to practise shampooing and massage of the affected
muscles in order to keep them in as good a condition of nutrition as
possible. This, as well as the regular use of the faradic battery if it be
not begun too early, will prevent a certain moderate amount of
atrophy, but could not have any influence in those rare cases where
rapid wasting depends upon secondary degeneration of the anterior
gray columns. It may be doubted, however, whether it is necessary
to pay much attention to the condition of the muscles, as they do not
ordinarily atrophy to the extent of becoming unsusceptible to the
nervous stimulus from the brain so soon as it shall be transmitted to
them. Faradism, like many other agencies, such as magnets, metals,
pieces of wood, and so forth, is said to produce a transfer of
sensibility in cases of hemianæsthesia.

There is no sufficient reason to suppose that any drug is of any value

in the restoration of the nervous structure. Iodide of potassium may
possibly prove to have some effect as a sorbefacient. Very favorable
results have been claimed for ammonia salts in the restoration of
aged persons to a nearly complete use of paralyzed limbs.
Phosphorus has been spoken of as assisting in repair, but the writer
is not aware upon how wide a basis of facts. Silver and gold have
been said to counteract the sclerosing myelitis. Strychnia is certainly
useless, and probably worse. It may make the paralyzed limbs
twitch, but this does just as little good as the involuntary spasmodic
movements, which have never been considered desirable, except as
awakening in the patient false notions of immediate recovery, and
which are frequently a very annoying symptom. The galvanic current
has been applied with a view to a sorbefacient or restorative action
directly to the brain, or rather to the pericranium.

Something can be done for the comfort of such patients: the rubbing
and kneading of the paralyzed limbs, if they do not hasten the
recovery of motion, relieve many of the painful and unpleasant
feelings. Since we do not know how far one part of the brain may
supplement another, attempts at motion after it has once appeared
to ever so slight a degree should not be abandoned by the patient.
He should walk with crutches frequently as soon as he can, though
not to the point of fatigue.

There is one faculty which seems capable of re-education to some

extent: that is of speech in cases of ataxic aphasia, and even in
others the attempt should be made to teach the patient the names of
things. A very interesting case has been reported by Bristowe57 of a
man who came under his observation after an attack which may
have been anterior poliomyelitis with extensive paralysis, able to
write well and intelligently, but unable to say anything. By gradual
education, first in the sound and formation of letters and afterward of
words, he reacquired the use of language. It is obvious that in this
case there could have been no loss of memory for the words
themselves, but simply the loss of the knowledge of how to produce
them. When his speech returned he spoke with his original American
accent.
57 Clin. Soc. Trans., iii. p. 92.

In short, the therapeutics of hemiplegia from arterial disease in the

brain is good nursing and attention to symptoms, with a moderate
amount of care of the paralyzed muscles.

Capillary Embolism.

It may be remarked, in the first place, that the lesions known by this
name are not necessarily strictly capillary, but are situated in the very
small arteries. The microscope marks the transition from the larger to
these smaller embolisms.

More is known about very small embolisms experimentally than

clinically, since they have been produced by the injection of small
seeds and insoluble particles of various kinds. Embolisms arising
from natural causes and deposited in the minutest arteries may have
very similar origin to the larger ones already described, but there are
also other conditions which give rise to particles which pass through
larger arteries without any disturbance, and are arrested in smaller
ones. The softening of thrombi is undoubtedly one source. The same
thrombus which, if detached en masse, would block the carotid
artery, may, if broken up into a number of minute fragments of fibrin
and fat, pass into the ultimate distribution of the cerebrals. The same
thing may of course happen if the thrombus have already undergone
one transportation.

Cases of localized softening are seen where no cause has been

found, except perhaps a thrombus in the heart, which has
discharged its softened and puriform contents; and it is probable that
the connecting links exist in the form of embolisms so minute as to
escape ordinary observation.

The consequences of capillary emboli if they block every minute

ramification of an arterial branch must be essentially the same as if
the branch itself were stopped; but if only a part are thus affected,
the resulting anæmia is not so complete, since the zones of capillary
congestion surrounding the part the supply of which is cut off may be
sufficient entirely to cover it and make more or less complete
compensation. The experimental emboli, in the form of tobacco-seed
and other insoluble substances, which have been traced into the
brain in considerable numbers, often give rise to no distinct lesions in
the cases where the immediate effects are recovered from.

Among the other sources, ulcerative endocarditis may be mentioned

as of special importance, not from the size but the character of
detached emboli, which will give rise, not to simple anæmia, nor, on
the other hand, to merely negative results, but to septic changes at
the place of lodgment.

Aside from these conditions, which are almost the same on a small
scale as we find with the large emboli, we have several peculiar
substances formed in the body and floating in the blood which lodge
in the capillaries of the brain. These are pigment, fat, lime salts, and
white corpuscles. Every one of these, however, is much better
known anatomically than clinically.

Pigment scales, flakes, granules, or cells containing them, are

formed in the course of severe malarial fever, and deposits
consisting of this pigment are found in the spleen, liver, kidneys,
heart, lungs, and lymphatic glands, as well as the brain and spinal
cord. The brain, when a deposit of pigment has taken place, is of a
slaty-grayish or chocolate color, which is marked only in the cortical
substance, the white being unaffected. The pigment is found in the
capillaries, and, according to Frerichs, fibrinous coagula are often
associated. Punctiform hemorrhages in the brain have been seen, as
well as meningeal hemorrhages, in connection with this
degeneration.
The point at which these masses are formed is still a matter of
theory. If the liver, as has been supposed, is one of the places of
formation, or if they originate in the blood, it is of course easy to see
how they reach the brain. If in the spleen, they must pass through
the wide portal capillaries before they are arrested in the narrower
ones of the brain.

It is by no means certain, however, that pigment reaches the brain in

the form of emboli. It is quite as probable that it is found in many
organs which undergo repeated congestions from the local
destruction of blood-corpuscles and changes in their pigment. The
very general deposition seems to point to a process of this kind
rather than to a local origin and a distribution through the blood. The
punctiform extravasations which may be found with deposits of
pigment are also found without it.

Minute particles of fat have been found in cerebral capillaries, but

are much less common here than in the lungs. They may be derived
from the decomposition of a thrombus, as described above, or they
may come from a fractured bone, when, of course, only particles fine
enough to pass through the pulmonary capillaries can reach the
brain. This form of embolism has an interest in connection with
diabetic coma.

Collections of white corpuscles in considerable number have been

observed to form an embolus. These cannot be considered to differ
very widely in character from the ordinary fibrinous embolus, which
contains white corpuscles. It is, however, not certain that such
emboli are deposited during life.

Calcareous masses formed from the decomposition of bone have

been seen in cerebral arteries.

About the symptomatology of such emboli little is known. An array of

minute emboli from the breaking up of a thrombus in the left auricle,
carotid, or even aorta, might possibly so block up large numbers of
arterial twigs as to give rise to the ordinary symptoms of embolism;
but considering the possibility of the re-establishment of circulation,
provided a certain proportion of the minutest vessels escape,
complete anæmia of a large tract produced in this way must be rare.
It is possible that some of the slighter and more transitory attacks of
hemiplegia or of more or less vague cerebral symptoms may be
referred to a lesion of this kind, the first action of a large number of
emboli being to cause an anæmia, which is compensated for much
more rapidly and thoroughly than would be the case if a single
considerable vessel were obliterated.

Various attempts have been made to connect definite and peculiar

diseases with capillary embolisms. Chorea in particular has been
said to depend upon a lesion of this kind, but, although cases have
been observed where the symptoms and lesion coexisted, yet they
are very far from being the rule, or even from constituting a
respectable minority of cases. The lesion of chorea in the great
majority of cases is not known, although attention has been directed
to this theory long enough to have established its truth.

The same may be said of the relationship between pernicious

attacks of intermittent and pigment embolism. There is occasional
coexistence, but far from invariable. Cerebral symptoms of the same
kind and severity occur without as with the pigment deposit. If
pigment embolism is the cause of coma, delirium, etc. in pernicious
fever, it is difficult to see why such cases can recover so rapidly, and
why no symptoms referable to a localized cerebral lesion are
observed after the primary unconsciousness.

Even less proof can be adduced as to any connection between

leukæmic embolisms and the cerebral symptoms occurring toward
the end of severe acute disease.

Calcareous embolism is a pathological curiosity.

DIAGNOSIS.—In the case of multiple capillary embolism it would be

impossible, if it were complete, to distinguish it from a blocking of the
main branch.