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Schizophrenia
Treatment Outcomes

An Evidence-Based Approach
to Recovery
Amresh Shrivastava
Avinash De Sousa
Editors

123
Schizophrenia Treatment Outcomes
Amresh Shrivastava • Avinash De Sousa
Editors

Schizophrenia
Treatment Outcomes
An Evidence-Based Approach
to Recovery
Editors
Amresh Shrivastava, MD, DPM Avinash De Sousa, MD, DPM, MS
Lawson Health Research Institute Lokmanya Tilak Municipal
Western University Lawson Health Medical College
Research Institute De Sousa Foundation
London, ON Mumbai
Canada India

ISBN 978-3-030-19846-6    ISBN 978-3-030-19847-3 (eBook)

https://doi.org/10.1007/978-3-030-19847-3

© Springer Nature Switzerland AG 2020

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
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Foreword

 hinking About Therapeutics for Persons

T
with Schizophrenia

This book addresses many aspects of clinical care relevant for persons with a
diagnosis of schizophrenia. Organized around the evidence gathered within
schizophrenia, the various chapters will prove relevant for many psychotic
disorders. It is impossible to be comprehensive since there are so many vari-
ables involved and so much variation between patients. But this is the most
comprehensive effort to date, with presentations in a brief and understandable
framework. This foreword provides a view on concepts related to understand-
ing schizophrenia and the integration of therapeutics at the individual level.
The Biopsychosocial Medical model provides the framework for integrat-
ing patient-centered information. This model calls attention to levels in
human function where therapy can be initiated. More fundamentally, the
model is a general systems concept calling for integration across each level.
For example, if blushing were a disease, a vascular physiologist could explain
the physiology of reddening of the face, but the causative role of shame is
understood at the psychological level, and why the blush occurs in public
requires explanation at the social level. So it is with schizophrenia, where a
cognitive intervention at the psychological level seeks understanding of
effects on brain physiology and simultaneously observes effects on social
cognition and function.
Conceptualizing schizophrenia is important, and for too long the field has
held the view that schizophrenia is a disease or, to be more specific, a brain
disease. A brief history will clarify. Kraepelin initiated this view with demen-
tia praecox and put in place the expectation of a chronic and deteriorating
course. He held that dissociative pathology and weakening of the wellsprings
of volition were the core pathologies that, together with a poor prognosis,
defined a disease entity. Bleuler proposed that the dissociative pathology was
the core pathology in all cases of schizophrenia, hence meeting the concept
of a specific disease entity based on shared pathophysiology. Bleuler, by the
way, viewed hallucinations and delusions as secondary pathologies and not
core manifestations of schizophrenia. This, with the defining of manic-­
depressive psychosis, places conceptual approaches to schizophrenia in the
disease entity category. In the 1960s and 1970s the observations of substan-
tial heterogeneity in development, manifestation, and course challenged the

v
vi Foreword

single disease concept. This heterogeneity may be the result of a broad,

overinclusive diagnostic practice. An alternative view held that nuclear or
true schizophrenia based on specific criteria provided a disease entity consis-
tent with the concept following Kraepelin and Bleuler. But note that the key
diagnostic criteria advocated were symptoms of first rank described by
Schneider as meaning the presence of schizophrenia in the absence of delir-
ium. These special forms of hallucinations and delusions quietly shifted the
concept from dissociative pathology and avolition to reality distortion. This
view was sufficiently influential for DSM-III in 1981 to highlight these first-­
rank symptoms as sufficient to meet the A criteria. Negative symptoms were
omitted altogether.
The International Pilot Study of Schizophrenia was initiated in 1968 to
determine if schizophrenia was similar in different locations. Similar cases
were found in all nine countries, but a broader concept was used in some
centers, including the NIMH center where John Strauss, John Bartko, and I
were working. We found the Schneiderian first-rank symptoms in bipolar and
other psychotic conditions in our center and confirmed in other centers.
Dividing our broad schizophrenia sample into nuclear or true schizophrenia
versus pseudo schizophrenia, we falsified the developmental and course pre-
dictions based on first-rank symptoms. Our conclusion was that schizophre-
nia is a clinical syndrome rather than a specific disease entity and that the
study of schizophrenia required deconstruction and the component parts were
the targets for discovery and for clinical application. These conclusions were
published in 1974 [Strauss JS, Carpenter WT Jr, Bartko JJ. The diagnosis and
understanding of schizophrenia. Part III. Speculations on the processes that
underlie schizophrenic symptoms and signs. Schizophr Bull. 1974 Winter;
(11):61–9] but failed to influence DSM-III, and it was not until DSM-5 that
first-rank symptoms lost their special status and schizophrenia as a clinical
syndrome was made explicit. While schizophrenia as a disease is still in com-
mon use, the twenty-first century has brought a major shift to the clinical
syndrome view, with science moving rapidly to deconstruction, and clinical
application aimed at specific aspects of psychopathology and function, with
diagnosis only as a starting point. There is wide recognition that symptoms
cross diagnostic boundaries. It is within this clinical syndrome concept that
the present book addresses schizophrenia.
The 29 chapters in this book inform the reader on many of the conceptual
issues and therapeutic opportunities in the clinician’s tool box. Individuals
with a schizophrenia diagnosis will vary in which domains of pathology are
present and what functional areas need to be addressed. Chapters range from
pharmacotherapy to pathways and approaches for recovery; from directly
addressing impairments to approaches based on compensatory and resilience
mechanisms; from medical attention to metabolic and comorbid pathology to
peer support and holistic approaches; from individual issues such as suicide
and cannabis use to population issues such as challenges in low-income
countries and therapeutics at different life stages. And much more.
Persons with a diagnosis of schizophrenia face many challenges in life,
and these vary across individuals. Clinical care must identify and address the
full range, and this book provides critical knowledge on many of the issues
Foreword vii

common to this diagnosis. Integration of these many elements is difficult.

Low-income countries lack the professional workforce and financial ability,
but some remarkable programs are developed. High-income countries some-
times provide support for integrated care of the mentally ill. But many patients
are treated in circumstances where the care advocated in this book is simply
not available. The USA is a sad example of not providing a medical system
that integrates the essential clinical care elements.
The busy clinician cannot be knowledgeable in the full range of issues that
require therapeutic attention. Questions about the use of cannabis will arise.
One patient avoids social encounters because of stigma, another has suicidal
thoughts, and others will not understand the role of metabolic effects of life-
style and medications, nor appreciate the role of physical exercise. The clini-
cian needs to address a shortened life expectancy and which therapies and
behavioral changes can reduce risk. How is sleep disturbance to be addressed?
And what special form of CBT is required for each symptom? It is in the
context of so many therapeutic issues that the present book provides critical
information in 29 chapters. Each chapter addresses a specific issue allowing
the reader to focus on specific needs for information. This book provides
much information on what is needed and how to effect clinical application.

William T. Carpenter Jr., MD

Professor of Psychiatry
Maryland Psychiatric Research Center
University of Maryland School of Medicine
Baltimore, MD, USA
Preface

Schizophrenia is a neurobehavioral disorder which affects about 0.7–1% of

people in the world. The plight of patients suffering from schizophrenia has
been due to stigma as well as poor access to care. Both of these factors lead
to treatment resistance. We could never find a convincing and effective treat-
ment for schizophrenia until the last 25 years, when both pharmacotherapy
and psychosocial treatments started showing a remarkable change in the life
of such patients. Though effective treatments have been available, it has been
very difficult to extend the benefit to a large number of people.
On one side we are lacking directions in the search for specific treatments
for schizophrenia, and on the other side we have serious limitations in health
systems management and capacity-building for the disorder. We will be
excited the day we get a treatment which will change the lives of patients with
schizophrenia; however, we will remain worried to take such treatments to
people. More specialized treatments are more complex, and it requires spe-
cially trained therapists. Besides, these psychosocial treatments are no less
expensive than newer medication. More patients live in the less privileged
parts of this world, and thus treatments have to be effective but at the same
time should be within reach of patients.
With more facilities, awareness, and changes in the socioeconomic situa-
tion, there is increased hope and expectation, and thereby newer demands by
the relatives, service users, and caregivers. The scientific community has
responded to such requirements and several social treatments are being tried
in unique settings, which keeps patients close to their families and away from
the hospital while encouraging them to seek employment, develop relation-
ships, have a positive attitude, and becoming economically productive. These
treatments have goals which restore dignity and promote human rights of
these patients while setting a higher benchmark and encouraging clinicians to
achieve the same.
We have compiled this book in order to provide specifics of each of the
psychosocial treatments currently used in schizophrenia, based upon the
recovery model. We are thankful to all our contributors who have taken
extraordinary care to keep the chapters focused and to the point so that clini-
cians as well as students find it easy to read and practice it in their patient
care. The book also deals with the conceptual issue as well as controversies
but not beyond a point.

ix
x Preface

All chapters highlight the opinion, experiences, and evidence for recovery
in schizophrenia. We thank all our authors and coauthors for their valuable
contributions in the making of this handbook. We hope that this book makes
interesting reading for everyone.

London, ON, Canada Amresh Shrivastava, MD, DPM

Mumbai, India Avinash De Sousa, MD, DPM, MS
Contents

Part I Recovery and Return to Wellness

1 Among Patients with Schizophrenia: A Learning Curve

for Psychiatrists��������������������������������������������������������������������������������   3
Avinash De Sousa and Amresh Shrivastava
2 Living Healthy with Schizophrenia: A Consumer’s Approach����   9
Michael Alzamora

Part II Current Status of Outcome, Recovery

3 Gender and Outcome in Schizophrenia ���������������������������������������� 15

Mary V. Seeman
4 Outcome of Schizophrenia in Low- and Middle-Income
Countries������������������������������������������������������������������������������������������ 27
Thara Rangaswamy, Greeshma Mohan, and Vijaya Raghavan
5 Neurocognition and Treatment Outcomes in Schizophrenia ������ 35
Juan Molina and Ming T. Tsuang
6 Cannabis and Recovery in Schizophrenia ������������������������������������ 43
Benjamin McLoughlin

Part III Conceptual Issues in Recovery of Schizophrenia

7 Concept and Model of Recovery���������������������������������������������������� 57

Larry Davidson, David Roe, and Janis Tondora
8 A Model and Evidence Base for Achieving Complete
Recovery in Schizophrenia�������������������������������������������������������������� 71
Ananda K. Pandurangi
9 Biological Markers for Outcome and Recovery
in Schizophrenia������������������������������������������������������������������������������ 85
Damodharan Dinakaran, Vanteemar S. Sreeraj,
and Ganesan Venkatasubramanian
10 Outcome Measurement in Schizophrenia: Challenges
and Barriers�������������������������������������������������������������������������������������� 91
Sandeep Grover and Swapnajeet Sahoo

xi
xii Contents

11 Suicide and Schizophrenia: Factors Affecting Recovery�������������� 125

Avinash De Sousa and Pragya Lodha
12 Resilience as a Measure of Outcome and Recovery
in Schizophrenia������������������������������������������������������������������������������ 133
Reetika Dikshit, Pragya Lodha, Amresh Shrivastava,
and Avinash De Sousa
13 Stigma: A Clinical Risk Factor for Psychopathology
and Recovery������������������������������������������������������������������������������������ 145
Avinash De Sousa, Reetika Dikshit, Pragya Lodha,
Akansha Rathi Maheshwari, and Amresh Shrivastava

Part IV Challenges for Good Outcome and Recovery

14 Attenuated Psychosis Syndrome���������������������������������������������������� 159

Zarina R. Bilgrami, Natasha Kostek, Ian T. Kim,
Rebecca A. Kraut, Jong K. Kim, and Cheryl M. Corcoran
15 Outcome Determinants and Parameters in Late-Life
Schizophrenia ���������������������������������������������������������������������������������� 177
Nitin Gupta and Subhash Das
16 Behavioural and Psychological Symptoms Occurring
in Dementia�������������������������������������������������������������������������������������� 183
Gundugurti Prasad Rao, Chaitanya Deepak Ponangi,
Sanjay Yelamanchali, and Sriramya Vemulakonda
17 Objectives of Recovery from Schizophrenia���������������������������������� 189
Avinash De Sousa, Nilesh Shah, and Pragya Lodha
18 Metabolic Syndrome in Bipolar Disorder�������������������������������������� 197
Renee-Marie Ragguett and Roger S. McIntyre
19 Comorbid Psychiatric and Physical Disorders������������������������������ 205
Suhas Chandran, Shivananda Manohar, Shreemit Maheshwari,
and T. S. S. Rao
20 Recovery in Severe Mental Disorder and Comorbidity �������������� 229
Shailesh V. Pangaonkar

Part V Intervention for Recovery

21 Peer Supports in Recovery�������������������������������������������������������������� 245

Timothy Schmutte, Kimberly Guy, Larry Davidson,
and Chyrell D. Bellamy
22 Early Intervention in Psychosis������������������������������������������������������ 253
Swaran Preet Singh and Benjamin I. Perry
23 Yoga and Outcome of Schizophrenia �������������������������������������������� 269
Naren P. Rao, Venkataram Shivakumar,
and Bangalore N. Gangadhar
Contents xiii

24 Psycho-Education in Schizophrenia���������������������������������������������� 275

Shreemit Maheshwari, Shivananda Manohar, Suhas Chandran,
and T. S. S. Rao

Part VI Clinical Practice

25 Transitioning from Hospital-Based Care

to Community-Based Models of Care�������������������������������������������� 287
Jatinder Takhar and Esther Vander Hyden
26 Cognitive Behavioural Therapy and Its Role
in the Outcome and Recovery from Schizophrenia���������������������� 299
Pragya Lodha and Avinash De Sousa
27 Experience of Psychiatrists Regarding Recovery
of the Mentally Ill in Rural India, with Case Reports������������������ 313
Prakash B. Behere, Anweshak Das, Aniruddh P. Behere,
and Richa Yadav
28 Evidence-Based Outcome for the Interventions
in Childhood-­Onset Schizophrenia������������������������������������������������ 319
Daria Smirnova and Konstantinos Fountoulakis

Index���������������������������������������������������������������������������������������������������������� 339
Contributors

Michael Alzamora, MD Consultant Psychiatrist, Toronto, ON, Canada

Aniruddh P. Behere, MD Helen Devos Children’s Hospital, Department of
Pediatric Behavior Health, Michigan State University College of Human
Medicine, Grand Rapids, MI, USA
Prakash B. Behere, MD(Psy), FNAMS, FIIOPM Director Professor,
Department of Psychiatry, Jawaharlal Nehru Medical College, Wardha,
Maharashtra, India
Chyrell D. Bellamy, MSW, PhD Yale University, Department of Psychiatry,
Program for Recovery and Community Health, New Haven, CT, USA
Zarina R. Bilgrami, BA Icahn School of Medicine at Mount Sinai,
Department of Psychiatry, New York, NY, USA
Suhas Chandran, MBBS, MD St. John’s Medical College Hospital,
Department of Psychiatry, Bangalore, Karnataka, India
Cheryl M. Corcoran, MD Department of Psychiatry, Icahn School of
Medicine at Mount Sinai, James J. Peters VA Medical Center, New York, NY,
USA
Anweshak Das, MBBS, MD Department of Psychiatry, Psychiatric Clinic,
Guwahati, Assam, India
Subhash Das, MD Government Medical College & Hospital, Department of
Psychiatry, Chandigarh, India
Larry Davidson, PhD Yale University, Department of Psychiatry, Program
for Recovery and Community Health, New Haven, CT, USA
Reetika Dikshit, MBBS, MD, DNB Lokmanya Tilak Municipal Medical
College and General Hospital, Psychiatry Department, Mumbai, India
Damodharan Dinakaran, MBBS, MD InSTAR Program, Schizophrenia
Clinic, Department of Psychiatry, National Institute of Mental Health and
Neurosciences, Bengaluru, Karnataka, India
Konstantinos Fountoulakis, MD, PhD 3rd Department of Psychiatry,
School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
Greece

xv
xvi Contributors

Bangalore N. Gangadhar, MD, DSc National Institute of Mental Health

and Neurosciences, Department of Psychiatry, Bengaluru, Karnataka, India
Sandeep Grover, MD Department of Psychiatry, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
Nitin Gupta, MD Government Medical College & Hospital, Department of
Psychiatry, Chandigarh, India
Kimberly Guy, MD Yale University, Department of Psychiatry, Program for
Recovery and Community Health, New Haven, CT, USA
Esther Vander Hyden, BN, RN St. Joseph’s Health Care Parkwood
Institute, Occupational Stress Injury Clinic, London, ON, Canada
Ian T. Kim, MA Rutgers University, Center for Molecular and Behavioral
Neuroscience, Newark, NJ, USA
Jong K. Kim, BA Mount Sinai Hospital, Department of Anesthesiology,
New York, NY, USA
Natasha Kostek, MA St. John’s University, Department of Psychology,
Queens, NY, USA
Rebecca A. Kraut, BA Yeshiva University, Ferkauf Graduate School of
Psychology, Bronx, NY, USA
Pragya Lodha, MA Private Practice, Mumbai, India
Akansha Rathi Maheshwari, MD, DNB Psychiatry, MRCPsych Department
of Psychiatry, East London NHS Foundation Trust, Luton, UK
Shreemit Maheshwari, MBBS, MD (Psychiatry) Department of Psychiatry,
Amaltas Institute of Medical Sciences, Dewas, India
Shivananda Manohar, MBBS, DPM, DNB Department of Psychiatry,
J.S.S. Medical College & Hospital, J.S.S. Academy of Higher Education and
Research, JSS University, Mysore, Karnataka, India
Roger S. McIntyre, MD United Health Network Toronto Western Hospital,
Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
Department of Psychiatry, University of Toronto , Toronto, ON, Canada
Department of Pharmacology, University of Toronto, Toronto, ON, Canada
Benjamin McLoughlin, MD NHS, Nottinghamshire, UK
Greeshma Mohan, MSc Schizophrenia Research Foundation, Department
of Psychiatry, Chennai, Tamil Nadu, India
Juan Molina, MD Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
Ananda K. Pandurangi, MBBS, MD Virginia Commonwealth University,
Department of Psychiatry, Richmond, VA, USA
Contributors xvii

Shailesh V. Pangaonkar, MBBS, DNB, DPM, BA, MSc Central Institute

of Behavioural Sciences, Department of Neuropsychiatry, Nagpur,
Maharashtra, India
Benjamin I. Perry, MRCPsych, MSc, MBBS, BSc University of
Cambridge, Department of Psychiatry, Cambridge, UK
Chaitanya Deepak Ponangi, MD, DPM Department of Psychiatry, Asha
Hospital, Hyderabad, Telangana, India
Renee-Marie Ragguett, BS United Health Network Toronto Western
Hospital, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
Vijaya Raghavan, MD Schizophrenia Research Foundation, Department of
Psychiatry, Chennai, Tamil Nadu, India
Thara Rangaswamy, MD, PhD Schizophrenia Research Foundation,
Department of Psychiatry, Chennai, Tamil Nadu, India
Gundugurti Prasad Rao, MBBS, MD, DPM Asha Hospital, Department
of Schizophrenia and Psychopharmacology, Hyderabad, Telengana, India
Naren P. Rao, MD National Institute of Mental Health and Neurosciences,
Department of Psychiatry, Bengaluru, Karnataka, India
T. S. S. Rao, MD, DPM, PhD Department of Psychiatry, J.S.S. Medical
College & Hospital, J.S.S. Academy of Higher Education and Research, JSS
University, Mysore, Karnataka, India
David Roe, PhD Yale University, Department of Psychiatry, Program for
Recovery and Community Health, New Haven, CT, USA
Swapnajeet Sahoo, MD Department of Psychiatry, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
Timothy Schmutte, PsyD Yale University, Department of Psychiatry,
Program for Recovery and Community Health, New Haven, CT, USA
Mary V. Seeman, MD Institute of Medical Science, Department of
Psychiatry, Toronto, ON, Canada
Nilesh Shah, MD, DPM, DNB Lokmanya Tilak Municipal Medical College,
Department of Psychiatry, Mumbai, India
Venkataram Shivakumar, MBBS, PhD National Institute of Mental Health
and Neurosciences, Department of Psychiatry, Bengaluru, Karnataka, India
Amresh Shrivastava, MD, DPM Department of Psychiatry, Lawson Health
Research Institute Western University, London, ON, Canada
Swaran Preet Singh, FRCPsych, MD, MBBS University of Warwick,
Division of Mental Health and Wellbeing, Coventry, UK
Daria Smirnova, MD, PhD Samara State Medical University, Department
of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara,
Russia
xviii Contributors

Centre for Clinical Research in Neuropsychiatry, University of Western

Australia, Perth, WA, Australia
Avinash De Sousa, MD, DPM, MS Department of Psychiatry, Lokmanya
Tilak Municipal Medical College, Mumbai, Maharashtra, India
Vanteemar S. Sreeraj, MBBS, DPM, DNB, MNAMS, PDF InSTAR
Program, Schizophrenia Clinic, Department of Psychiatry, National Institute
of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Jatinder Takhar, FRCP Parkwood Institute Mental Health Care Building,
Department of Psychiatry, London, ON, Canada
Janis Tondora, PsyD Yale University, Department of Psychiatry, Program
for Recovery and Community Health, New Haven, CT, USA
Ming T. Tsuang, MD, PhD, DSc Department of Psychiatry, University of
California, San Diego, La Jolla, CA, USA
Sriramya Vemulakonda, MD Chicago, IL, USA
Ganesan Venkatasubramanian, MD, PhD InSTAR Program,
Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental
Health and Neurosciences, Bengaluru, Karnataka, India
Richa Yadav, MD Assistant Professor, Department of Psychiatry and
Behavioral Sciences, OU College of Medicine Oklahoma, OH, USA
Sanjay Yelamanchali, MD Guntur, Andhra Pradesh, India
Abbreviations

AACAP American Association of Child and Adolescent Psychiatry

ACh Acetyl choline
ACT Assertive community treatment
AD Alzheimer’s disease
ADHD Attention-deficit hyperactivity disorder
ADLs Activities of daily living
AMHM Avon Mental Health Measure
AMHS Area mental health services
APA American Psychiatric Association
APSS Attenuated Positive Symptom Syndrome
AUDIT Alcohol Use Disorder Identification Test
BACS Brief Assessment of Cognition in Schizophrenia
BD Bipolar disorder
BDNF Brain-derived neurotrophic factor
BIPS Brief Intermittent Psychotic Syndrome
BLT Bright light treatment
BMD Bone mineral density
BMI Body mass index
BPRS Brief Psychiatric Rating Scale
BPSD Behavioral and psychological symptoms of dementia
BS Bariatric surgery
CAARMS Comprehensive Assessment of At-Risk Mental States
CACR Computer-assisted cognitive remediation
CAD Coronary artery disease
CAMHS Child and adolescent mental health services
CAMI Community Attitude toward the Mentally Ill (scale)
CAN Camberwell Assessment of Needs
CAN-R Camberwell Assessment of Need-Research version
CAP Cannabis and psychosis (therapy)
CATIE The Clinical Antipsychotic Trials in Intervention
Effectiveness
CBCL Child Behavior Checklist
CBD Cannabidiol
CBT Cognitive behavioral therapy
CBT-p Cognitive behavioral therapy for psychosis
CBT-R recovery-oriented cognitive behavioral therapy
CCMHI Canadian Collaborative Mental Health Initiative

xix
 Living Healthy with Schizophrenia:
A Consumer’s Approach
Michael Alzamora
Introduction
My name is Michael Alzamora. I am 52 years old
and have been living with schizophrenia for
29 years since 1988. I was born in Bogota,
Colombia, in 1964 and immigrated to Toronto,
Canada, in 1975 at the tender age of 10. My ado-
lescence and early adulthood were very turbulent
times. I remember being extremely depressed
and anxious. I had a difficult time with my stud-
ies and making friends. In elementary school, I
remember excusing myself to go to the bathroom
and find an empty room where I could hide under
a table for long periods of time. My years of sec-
ondary school became more turbulent. I was ter-
rified of public speaking and started to skip class
frequently. Because I was not attending class, I
wasn’t learning the concepts or doing homework.
The end result was failing many courses, and in
turn, I failed grade 11 and again in grade 13 (back
then, it was the senior year).
In 1986, I commenced studies for Electronics
Technology at Seneca College in Toronto. The
stresses of college life got to me. In 1988, I had
my first of a number of breakdowns. They
included hearing voices and thoughts of persecu-
tion. Soon, I was a member of the mental health
community. Finally, I had no more stresses about
M. Alzamora (*)
Consultant Psychiatrist, Toronto, ON, Canada
© Springer Nature Switzerland AG 2020
A. Shrivastava, A. De Sousa (eds.), Schizophrenia Treatment Outcomes,
https://doi.org/10.1007/978-3-030-19847-3_2
2
school commitments and finally started making
friends. This was my first step toward social
integration.
A major component for social integration was
the intervention of antipsychotic medications.
Back in the early 1990s, these medications gave
me some adverse side effects. They included rest-
lessness, impaired vision, and most of all tardive
dyskinesia. On public transportation, teenagers
would mock my involuntary arm movements.
The next step toward social integration was
the introduction of the new type of antipsychot-
ics in the 1990s. My psychiatrist chose for me
clozapine. Although clozapine is not a new anti-
psychotic, it behaves like one. I don’t know if it
is just me, but I think clozapine cured me from
the involuntary movements of my arms.
Clozapine does, however, have its share of side
effects. They include weight gain, especially
around the circumference of the stomach. I
drool a lot, especially at night, and I have high
triglyceride levels, i.e., fat in the bloodstream,
and stuttering when speaking. I also have cogni-
tive impairment in the form of gaps in my speech
because I lose my train of thoughts. My short-
term memory is severely incapacitated. I don’t
know if these are symptoms of mental illness,
clozapine, or both. I also take clonazepam, an
antianxiety pill, for the side effects of clozapine,
as well as for anxiety. I have noticed some cog-
nitive impairment when my dosage of clonaze-
pam is increased.
9
Another random document with
no related content on Scribd:
1899:

"German economists are not exaggerating when they say this

Empire's people and capital are operating in every part of the
world. Not only Hamburg, Bremen, Stettin, Lübeck, and Kiel—i.
e., the seaport cities—but towns far inland, have invested
millions in foreign enterprises. In the Americas, North and
South, in Australia, in Asia, in a large part of Africa,
German settlements, German factories, German merchants, and
German industrial leaders are at work. Nor is it always in
settlements under the Empire's control that this influence is
strongest. In Senegambia, on the Gold Coast, the Slave Coast,
in Zanzibar and Mozambique, in Australia, Samoa, the Marshall
Islands, Tahiti, Sumatra, and South and Central America, there
are powerful commercial organizations aiding the Empire. From
Vladivostock to Singapore, on the mainland of Asia, and in
many of the world's most productive islands, the influence of
German money and thrift is felt. In Central America and the
West Indies, millions of German money are in the plantations;
so, too, in the plantations along the Gold Coast. In
Guatemala, Honduras, Mexico, the Dominican Republic, Cuba,
Puerto Rico, Trinidad, Venezuela, Brazil, etc., German capital
plays a very important part in helping to develop the
agricultural and in some cases the manufacturing and
commercial interests. A consequence of this development is
seen in the numerous banking institutions whose fields of
operation show that German commerce is working more and more
in foreign parts. These banks look after and aid foreign
investment as well as the Empire's other commercial relations.
They help the millions of Germans in all parts of the world to
carry on trade relations, not only with the Fatherland, but
with other countries.

"These are the links in a long and very strong chain of gold
uniting the colonies with the Mother Country. Quite recently,
large quantities of German capital have been invested in
various industries. The Empire's capital in United States
 railroads is put down at $180,000,000. In America, Germans
have undertaken manufacturing. They have used German money to
put up breweries, hat factories, spinning, weaving, and paper
mills, tanneries, soap-boiling establishments, candle mills,
dye houses, mineral-water works, iron foundries, machine
shops, dynamite mills, etc. Many of these mills use German
machinery, and not a few German help. The Liebig Company, the
Chilean saltpeter mines, the Chilean and Peruvian metal mines,
many of the mines of South Africa, etc., are in large part
controlled by German money and German forces. Two hundred
different kinds of foreign bonds or papers are on the Berlin,
Hamburg, and Frankfort exchanges. Germany has rapidly risen to
a very important place in the financial, industrial, and
mercantile world. Will she keep it? Much will depend on her
power to push herself on the sea."

United States Consular Reports,

September, 1899, page 127.

{248}

GERMANY: A. D. 1899.
Military statistics.

A report presented to the Reichstag showed the total number of

men liable for service in 1899, including the surplus from
previous years, was 1,696,760. Of these 716,998 were 20 years
of age, 486,978 of 21 years, 362,568 of 22 years, and 130,216
of more than 22 years. The whereabouts of 94,224 was unknown,
and 97,800 others failed to appear and sent no excuse; 427,586
had already undertaken military duties, 579,429 cases were
either adjourned or the men rejected (for physical reasons),
1,245 were excluded from the service, 43,196 were exempt,
112,839 were incorporated in the naval reserve, 226,957 were
called upon to join the colors, leaving a surplus of 5,187;
there were 23,266 volunteers for the army and 1,222 for the
navy. Of the 226,957 who joined the colors 216,880 joined the
 army as combatants and 4,591 as non-combatants, and 5,486
joined the navy. Of the 5,486 the maritime population
furnished 3,132 and the inland 2,354. There were 21,189 men
who entered the army before attaining the regulation age, and
1,480 under age who entered the navy; 33,652 of the inland
population and only 189 of the maritime were condemned for
emigrating without leave; while 14,150 inland and 150 maritime
cases were still under consideration at the end of the year.

GERMANY: A. D. 1899 (February).

Chinese anti-missionary demonstrations in Shantung.

See (in this volume)

CHINA: A. D. 1899.

GERMANY: A. D. 1899 (February).

Purchase of Caroline, Pelew and Marianne Islands from Spain.

See (in this volume)

CAROLINE AND MARIANNE ISLANDS.

GERMANY: A. D. 1899 (May-July).

Representation in the Peace Conference at The Hague.

See (in this volume)

PEACE CONFERENCE.

GERMANY: A. D. 1899 (May-August).

Advice to the South African Republic.

See (in this volume)

SOUTH AFRICA (THE TRANSVAAL):
A. D. 1899 (MAY-AUGUST).

GERMANY: A. D. 1899 (June).

State of German colonies.
The following report on German colonies for the year ending
June 30, 1899, was made to the British Foreign Office by one
of the secretaries of the Embassy at Berlin:

"The number of Europeans resident in the German African

Protectorates, viz., Togoland, Cameroons, South-West Africa,
and East Africa, at the time of the issue of the latest
colonial reports in the course of 1899 is given as 4,522 men,
women, and children, of whom 3,228 were Germans. The expense
to the home government of the African colonies, together with
Kiao-chao in the Far East, the Caroline and Samoa Islands in
the South Seas, and German New Guinea and its dependencies, is
estimated at close upon £1,500,000 for 1900, the Imperial
Treasury being asked to grant in subsidies a sum nearly double
that required last year. Kiao-chao is included for the first
time in the Colonial Estimates, and Samoa is a new item. The
Imperial subsidy has been increased for each separate
Protectorate, with the single exception of the Caroline
Islands, which are to be granted £5,000 less than last year.
East Africa receives about £33,000 more; the Cameroons,
£10,000; South-West Africa, £14,000; Togoland, £800; New
Guinea, £10,000; and the new items are: £489,000 for Kiao-chao
(formerly included in the Naval Estimates), and £2,500 for
Samoa. A Supplementary Vote of £43,265 for the Protectorate
troops in the Cameroons is also now before the Budget
Committee. …

"Great efforts have been made to encourage German trade with

the African colonies, and it is shown that considerable
success has been attained in South-West Africa, where the
total value of goods imported from Germany amounted to
£244,187, as against £181,961 in the previous year, with an
appreciable falling-off in the value of imports from other
countries. In East Africa the greater part of the import trade
still comes from India and Zanzibar—about £450,000 worth of
goods out of the gross total of £592,630, having been imported
thence. The export trade is also largely carried on through
 Zanzibar."

Great Britain, Parliamentary Publications

(Papers by Command: Miscellaneous Series,
Number 528, 1900, pages 3-5).

GERMANY: A. D. 1899 (August).

Defeat of the Rhine-Elbe Canal Bill.
Resentment of the Emperor.
An extraordinary edict.

Among several new canal projects in Germany, those of "the

Dortmund-Rhine Canal and the Great Midland Canal (joining from
the east to west the rivers Elbe, Weser, and Rhine) are the
most important. The first involves an expenditure of over
£8,000,000 altogether, and the second is variously estimated
at from £10,000,000 to £20,000,000, according to its eventual
scope. The latter is intended to amalgamate the eastern and
western waterways of the nation and to join the Dortmund-Ems
Canal to the Rhine system, in order to give the latter river
an outlet to the sea via a German port, instead of only
through ports in the Netherlands. It will also place the
Rhine-Main-Danube connection in direct communication with all
the streams of North Germany."

United States Bureau of Statistics,

Monthly Summary of Commerce and Finance,
January, 1899.

The Rhine-Elbe canal project is one which the Emperor has

greatly at heart, and when, in August, 1899, a bill to promote
it was defeated in the Prussian Landtag by the Agrarians, who
feared that canal improvements would promote agricultural
competition, his resentment was expressed in an extraordinary
edict, which said: "The royal government, to its keen regret,
has been compelled to notice that a number of officials, whose
duty it is to support the policy of His Majesty the King, and to
 execute and advance the measures of His Majesty's government,
are not sufficiently conscious of this obligation. … Such
conduct is opposed to all the traditions of the Prussian
administration, and cannot be tolerated." This was followed by
an extensive dismissal of officials, and excited strong
feeling against the government in a class which is nothing if
not loyal to the monarchy.

GERMANY: A. D. 1899 (November).

Railway concession in Asia Minor, to the Persian Gulf.

See (in this volume)

TURKEY: A. D. 1899 (NOVEMBER).

GERMANY: A. D. 1899 (November).

Re-arrangement of affairs in the Samoan Islands.
Partition of the islands with the United States.
Withdrawal of England, with compensations in the Tonga
and Solomon Islands and in Africa.

See (in this volume)

SAMOAN ISLANDS.

GERMANY: A. D. 1900.
Military and naval expenditure.

See (in this volume)

WAR BUDGETS.

GERMANY: A. D. 1900.
Naval strength.

See (in this volume)

NAVIES OF THE SEA POWERS.

GERMANY: A. D. 1900 (January).

Introduction of the Civil Code.
 On the first day of the year 1900 a great revolution was
effected in the laws of Germany, by putting into operation the
new German Civil Code. "Since the close of the fifteenth
century Germany has been the land of documentary right. The
Roman judicial code was recognized as common law; while all
legal procedure distinctly native in its origin was confined
to certain districts and municipalities, and was, therefore,
entirely devoid of Imperial signification in the wider sense.
The Civil Code of the land was represented by the Corpus Juris
Civilis, a Latin work entirely incomprehensible to the layman.
{249}
This very remarkable circumstance can be accounted for only by
the weakness of mediæval German Imperialism. In England and
France royalty itself had, since the fourteenth century,
assumed control of the laws in order that a homogeneous
national code might be developed. German Imperialism of the
fourteenth and fifteenth centuries, however, was incapable of
such a task. …

"An incessant conflict has been waging in Germany between the

Roman Law of the Empire and the native law as perpetuated in
the special enactments of the separate provinces and
municipalities. During the sixteenth and seventeenth centuries
the preponderance of power lay with the Roman system, which
was further supported by the German science of jurisprudence—
a science identified exclusively with the common law of Rome.
Science looked upon the native systems of legal procedure as
irrational and barbarous; and as Roman judicature exercised
complete dominion over all legislation, the consequence was
that it steadily advanced, while native and local law was
gradually destroyed. Only within the eighteenth and nineteenth
centuries has the native law of Germany been aroused to the
defence of its interests, … the signal for the attack upon
Roman Law being given by King Frederick William I, of Prussia.
As early as 1713 this monarch decreed that Roman law was to be
abrogated in his dominions, and replaced by the native law of
Prussia. The movement became general; and the era of modern
legal codes was ushered in. The legal code of Bavaria was
established in 1756; Prussia followed in 1794; France, in 1804
(Code Civil); Baden, in 1809; Austria, in 1811 (Das
Oesterreichische Buergerliche Gesetzbuch); and finally Saxony,
in 1863 (the designation here being similar to that adopted by
Austria). Everywhere the motto was the same; viz.,
'Emancipation from the Latin Code of Rome.' The native code
was to supplant the foreign, obscure, and obsolete Corpus
Juris. But the success of these newly established codes was
limited; each being applicable to its own particular province
only. Moreover, many of the German states had retained the
Roman law; confining their reforms to a few modifications. …

"The reestablishment of the German Empire was, therefore,

essential also to the reestablishment of German law. As early
as 1874 the initial steps for the incorporation of a new
German Civil Code had already been taken; and this work has
now at last been completed. On August 18, 1896, the new
system, together with a 'Law of Introduction,' was promulgated
by Emperor William II. It will become effective on January 1,
1900, a day which will ever be memorable as marking the climax
of a development of four centuries. At the close of the
fifteenth century Roman law was accepted in Germany; and now,
at the end of the nineteenth, this entire system is to be
completely abolished throughout the Empire. As a means of
education, and solely for this purpose, the Roman Code will be
retained in the universities. As a work of art it is immortal;
as a system of laws, perishable. The last relic of that grand
fabric of laws, which once dominated the whole world, crumbles
to-day. The national idea is victorious; and German law for
the German Empire is at last secured."

R. Sohm,
The Civil Code of Germany
(Forum, October, 1800).
GERMANY: A. D. 1900 (January-March).
The outbreak of the "Boxers" in northern China.

See (in this volume)

CHINA: A. D. 1900 (JANUARY-MARCH).

GERMANY: A. D. 1900 (February).

Adhesion to the arrangement of an "open door" commercial
policy in China.

See (in this volume)

CHINA: A. D. 1890-1900 (SEPTEMBER-FEBRUARY).

GERMANY: A. D. 1900 (February-June).

Increased naval programme.

With much difficulty, and as the result of strenuous pressure,

the Emperor succeeded in carrying through the Reichstag, in
June, a bill which doubles the programme of naval increase
adopted in 1898.

See (in this volume)

GERMANY: A. D. 1898 (April).

"After the way had been prepared by a speech of the Emperor to

the officers of the Berlin garrison on January 7, 1900, and by
a vigorous Press agitation, this project was brought before
the Reichstag on February 8. In form it was an amendment of
the Sexennate, or Navy Law of 1898, which had laid down a six
years' programme of naval construction. By the new measure
this programme was revised and extended over a period of 20
years. Instead of the double squadron of 10 battleships, with
its complement of cruisers and other craft, it was demanded
that the Government should be authorized to build two double
squadrons, or 38 battleships and the corresponding number of
cruisers. The Bill also provided for a large increase in the
number of ships to be employed in the protection of German
 interests in foreign waters. The Centre party, both through
its speakers in the Reichstag and through its organs in the
Press, at first took up a very critical attitude towards the
Bill. Its spokesmen dwelt especially upon the breach of faith
involved in the extension of the programme of naval
construction so soon after the compromise of 1898 had been
accepted, and upon the difficulty of finding the money to pay
for a fleet of such magnitude. The Clerical leaders, however,
did not persist in their opposition, and finally agreed to
accept the main provisions of the Bill, with the exception of
the proposed increase in the number of ships employed in
foreign waters. They made it a condition that the Government
should incorporate with the Bill two financial projects
designed to provide the money required without burdening the
working classes. Both the Stamp Duties Bill and the Customs
Bill were adopted by the Government, and the Navy Bill was
carried with the aid of the Centre."

Berlin Correspondent, London Times.

GERMANY: A. D. 1900 (May).

The Lex Heinze.

The Socialists won a notable triumph in May, when they forced

the Reichstag to adopt their views in the shaping of a measure
known as the Lex Heinze. This Bill, as introduced by the
Government, gave the police increased powers in dealing with
immorality. The Clericals and the Conservatives sought to
extend its scope by amendments which were denounced by the
Radicals and Socialists as placing restrictions upon the
"liberty of art and literature." After a prolonged struggle,
in which the Socialists resorted to the use of obstruction,
the most obnoxious amendments were withdrawn.

{250}

GERMANY: A. D. 1900 (May).

Passage of the Meat Inspection Bill.

A much discussed and sharply contested bill, providing for a

stringent inspection of imported meats, and aimed especially
at the obstructing of the American meat trade, was passed by
the Reichstag on the 23d of May. It prohibits the importation
of canned or sausage meat entirely, and imposes conditions on
the introduction of other meats which are thought to be, in
some cases, prohibitory. The measure was originally claimed to
be purely one of sanitary precaution. It "had been introduced
in the Reichstag early in 1899, but the sharp conflict of
interests about it kept it for more than a year in committee,
When the bill finally emerged for discussion in the Reichstag,
it was found that the Agrarian majority had distorted it from
a sanitary to a protective measure. Both in the new form they
gave the bill and in their discussions of it in the Reichstag,
the Agrarians showed that it was chiefly the exclusion of
foreign meats, rather than a system of sanitary inspection,
that they wanted. As finally passed in May the bill had lost
some of the harsh prohibitory features given it by the
Agrarians, the latter contenting themselves with the exclusion
of canned meats and sausages. To the foreign student of German
politics, the Meat Inspection Law is chiefly interesting as
illustrating the tendency of the general government to seize
upon functions which have hitherto been in the hands of the
individual states and municipalities, as well as of bringing
the private affairs of the people under the control of
governmental authority. It is another long step of the German
government away from the principle of 'laissez-faire.' The
task undertaken by the government here is itself a stupendous
one. There is certainly no other great government in the world
that would endeavor to organize the administrative machinery
for inspecting every pound of meat that comes upon the markets
of the country."

W. C. Dreher,
A Letter from Germany
 (Atlantic Monthly, March, 1901).

GERMANY: A. D. 1900 (June).

Opening of the Elbe and Trave Canal.

"The new Elbe and Trave Canal, which has been building five
years and has been completed at a cost of 24,500,000 marks
($5,831,000)—of which Prussia contributed 7,500,000 marks
($1,785,000) and the old Hansa town of Lübeck, which is now
reviving, 17,000,000 marks ($4,046,000)—was formally opened by
the German Emperor on the 16th [of June]. The length of the
new canal-which is the second to join the North Sea and the
Baltic, following the Kaiser Wilhelm Ship Canal, or Kiel
Canal, which was finished five years ago at a cost of
156,000,000 marks ($37,128,000)-is about 41 miles. The
available breadth of the new canal is 72 feet; breadth of the
lock gates, 46 feet; length of the locks, 87 yards; depth of
the locks, 8 feet 2 inches. The canal is crossed by
twenty-nine bridges, erected at a cost of $1,000,000. The span
of the bridges is in all cases not less than 30 yards and
their height above water level about 15 feet. There are seven
locks, five being between Lübeck and the Möllner See—the
highest point of the canal—and two between Möllner See and
Lauenburg-on-the-Elbe."

United States, Consular Reports,

September, 1900, page 8.

A memorandum by the British Charge d'Affaires in Berlin on the

Elbe-Trave Canal says that the opening of the Kaiser Wilhelm
Canal injuriously affected the trade of Lübeck. This was
foreseen, and in 1894 a plan was sanctioned for the widening
of the existing canal, which only allowed of the passage of
vessels of about thirty tons. The direction of the old canal
was followed only to some extent, as it had immense curves,
while the new bed was fairly straight from Lübeck to
Lauenburg, on the Elbe above Hamburg. The memorandum states
 that the undertaking is of great importance to the States
along the Elbe, as well as to Sweden, Norway, Denmark, and
Russia. It will to some extent divert traffic from Hamburg,
and possibly reduce somewhat the revenue of the Kaiser Wilhelm
Canal.

GERMANY: A. D. 1900 (June-December).

Co-operation with the Powers in China.

See (in this volume)

CHINA.

GERMANY: A. D. 1900 (September).

Government loan placed in America.

Great excitement and indignation was caused in September by

the action of the imperial government in placing a loan of
80,000,000 marks (about $20,000,000) in the American money
market. On the meeting of the Reichstag, the finance minister,
Dr. von Miquel, replying to attacks upon this measure,
explained that in September the state of the German market was
such that if they had raised the 80,000,000 marks at home the
bank discount rate would have risen above the present rate of
5 per cent. before the end of the year. In the previous winter
the bank rate had been at 6 per cent, for a period of 90 days,
and during three weeks it had stood at 7 per cent. The
government had been strongly urged to do everything in its
power to prevent the recurrence of such high rates of
discount. The London rate was rapidly approaching the German,
and there was reason to fear that there would be a serious
flow of gold from Germany. It was therefore urgently desirable
to attract gold from abroad, and there was no country where money
was so easy at the time as in the United States. This was due
to the extraordinarily favorable balance of American trade and
the remarkable increase in exports out of all proportion to
the development of imports. Another reason was the American
Currency Law, which enabled the national banks to issue as
 much as 100 per cent. of their capital in loans, whereas they
formerly issued only 90 per cent. There was no doubt that the
80,000,000 marks could have been obtained in Germany, but the
public must have been aware that other loans of much greater
extent were impending. There was going to be a loan of about
150,000,000 marks for the expedition to China, and it was
certain that before the end of the year 1901 considerable
demands would be made upon the public.

GERMANY: A. D. 1900 (September).

Proposal to require leaders of the Chinese attack
on foreigners to be given up.

See (in this volume)

CHINA: A. D. 1900 (AUGUST-DECEMBER).

GERMANY: A. D. 1900 (October).

Anglo-German agreement concerning policy in China.

See (in this volume)

CHINA: A. D. 1900 (AUGUST-DECEMBER).

{251}

GERMANY: A. D. 1900 (October 9).

Lèse-majesté in criticism of the Emperor's speech to soldiers
departing for China, enjoining no quarter and commending the
Huns as a military example.
Increasing prosecutions for Lèse-majesté.

On the 9th of October, a newspaper correspondent wrote from

Berlin: "The Berlin newspapers of yesterday and to-day
chronicle no fewer than five trials for 'lèse-majesté.' The
most important case was that of Herr Maximilian Harden, the
editor of the weekly magazine 'Zukunft.' Herr Harden, who
enjoyed the confidence of the late Prince Bismarck, wields a
very satirical pen, and has been designated 'The Junius of
modern Germany.' In 1898 Herr Harden was convicted of
lèse-majesté and was sentenced to six months' incarceration in
a fortress. In the present instance he was accused of having
committed lèse-majesté in an article, 'The Fight with the
Dragon,' published in the 'Zukunft' of August 11. The article
dealt with the speech delivered by the Emperor at Bremerhaven
on July 27, 'the telegraphic transmission of which, as was
asserted at the time, had been forbidden by Count von Bülow.'
The article noted as a fact that the Emperor had commanded the
troops who were leaving for China to give no quarter and to
make no prisoners, but, imitating the example of Attila and
the Huns, to excite a terror in East Asia which would last for
a thousand years. The Emperor had added, 'May the blessing of
God attend your flags and may this war have the blessed
result that Christianity shall make its way into China.' Herr
Harden in his comments on this speech had critically examined
the deeds of the historic Attila and had contrasted him with
the Attila of popular story in order to demonstrate that he
was not a proper model to set up for the imitation of German
soldiers. The article in the 'Zukunft' had also maintained
that it was not the mission of the German Empire to spread
Christianity in China, and, finally, had described a war of
revenge as a mistake." No publicity was allowed to be given to
the proceedings of the trial. "Herr Harden was found guilty
not only of having been wanting in the respect due to the
Emperor but of having actually attacked his Majesty in a way
that constituted lèse-majesté. The Court sentenced him to six
months' incarceration in a fortress and at the same time
directed that the incriminated number of the 'Zukunft' should
be destroyed.

"The 'Vossische Zeitung' remarks:—'We read in the newspapers

to-day that a street porter in Marburg has been sentenced to
six months' imprisonment for insulting the Empress, that in
Hamburg a workman has been sentenced to five months'
imprisonment for lèse-majesté, that in Beuthen a workman has
been sentenced to a year's imprisonment for lèse-majesté, and
 that in Dusseldorf a man who is deaf and dumb has been
sentenced to four months' imprisonment for the same offence.
The prosecutions for lèse-majesté are multiplying at an
alarming rate. We must emphatically repeat that such
proceedings appear to us to be in the last degree unsuited to
promote the principles of Monarchy. … The greater the number
of political prosecutions that are instituted the more
accustomed, under force of circumstances, does the Press
become to the practice of writing so that the reader may read
between the lines. And this attitude is to the advantage
neither of public morals nor of the Throne. … We regret in
particular that the case of yesterday (that of Herr Harden)
was tried 'in camera.' … It has justly been said that
publicity is more indispensable in political trials than in
prosecutions against thieves and murderers. … If there is no
prospect of an improvement in this respect the Reichstag will
have to devote its serious attention to the question how the
present administration of justice is to be dealt with, not
only in the interest of freedom of speech and of the Press,
but also for the good of the Crown and the well-being of the
State.'"

GERMANY: A. D. 1900 (October 18).

Change in the Imperial Chancellorship.

On the 18th of October it was announced in the "Imperial

Gazette" that" His Majesty the Emperor and King has been
graciously pleased to accede to the request of the Imperial
Chancellor, the President of the Ministry and Minister for
Foreign Affairs, Prince Hohenlohe-Schillingsfürst, Prince of
Ratibor and Corvey, to be relieved of his offices, and has at
the same time conferred upon him the high Order of the Black
Eagle with brilliants. His Majesty has further been graciously
pleased to appoint Count von Bülow, Minister of State and
Secretary of State to the Foreign Office, to be Imperial
Chancellor and Minister for Foreign Affairs." Count von Bülow
is the third of the successors of Prince Bismarck in the high
 office of the Imperial Chancellor. The latter was followed by
Count von Caprivi, who gave way to Prince Hohenlohe in 1894.
Prince Hohenlohe had nearly reached the age of 82 when he is
said to have asked leave to retire from public life.

GERMANY: A. D. 1900 (November).

Withdrawal of legal tender silver coins.

"Germany has lately taken a step to clear off the haze from
her financial horizon by calling in the outstanding thalers
which are full legal tender, and turning them into subsidiary
coins of limited legal tender—a process which will extend
over ten years. At the end of that time, if no misfortune
intervenes, she will be on the gold standard as surely and
safely as England is. Her banks can now tender silver to their
customers when they ask for gold, as the Bank of France can
and does occasionally. When this last measure is carried into
effect the only full legal-tender money in Germany will be
gold, or Government notes redeemable in gold."

New York Nation,

November 29, 1900.

GERMANY: A. D. 1900 (November-December).

The Reichstag and the Kaiser.
His speeches and his system of personal government.

In the Reichstag, which reassembled on the 14th of November,

"the speeches of the Kaiser were discussed by men of all
parties, with a freedom that was new and refreshing in German
political debates. Apart from the Kaiser's speeches in
connection with the Chinese troubles, the debates brought out
some frank complaints from the more 'loyal' sections of German
politics, that the Kaiser is surrounded by advisers who
systematically misinform him as to the actual state of public
opinion. It has long been felt, and particularly during the
past few years, that the present system of two cabinets—one of
 which is nominally responsible to the Reichstag and public
opinion, while the other is merely a personal cabinet,
responsible to neither, and yet exercising an enormous
influence in shaping the monarch's policies—has been growing
more and more intolerable. This system of personal government
is becoming the subject of chronic disquietude in Germany, and
even the more loyal section of the press is growing restive
under it. Bismarck's wise maxim, 'A monarch should appear in
public only when attired in the clothing of a responsible
ministry,' is finding more and more supporters among
intelligent Germans."

W. C. Dreher,
A Letter from Germany
(Atlantic Monthly, March, 1901).

{252}

GERMANY: A. D. 1900 (December).

Census of the Empire.
Growth of Berlin and other cities.
Urban population compared with that in the United States.

A despatch from Berlin, February 26, announced the results of

the census of December, 1900, made public that day. The
population of the German Empire is shown to have increased
from 52,279,901 in 1895 to 56,345,014. Of this population
27,731,067 are males and 28,613,947 females. Over 83 per cent.
of the whole population is contained in the four kingdoms; of
these Prussia comes first with (in round figures) 34,500,000
inhabitants, and Bavaria second with 6,200,000. The figures
for Saxony and Würtemberg are 4,200,000 and 2,300,000
respectively. More than 16 per cent. of the population is
resident in the 33 towns of over 100,000 inhabitants. Of these
33 towns the largest is Berlin, while the smallest is Cassel,
of which the inhabitants number 106,001.
The Prussian Statistical Office had already published the
results of the census, so far as they concern Berlin and its
suburbs. It appears that the population of the German capital
now amounts to 1,884,151 souls, as against 1,677,304 in 1895
and 826,3!1 in 1871. The population of the suburbs has
increased from 57,735 in 1871 and 435,236 in 1895, to 639,310
in 1900. The total population of the capital, including the
suburbs, is given as 2,523,461 souls, as against 2,112,540 in
1895, an increase of over 19 per cent. Some figures relating
to other cities had previously appeared, going to show "an
acceleration of the movement of population from the country
toward the great cities. The growth of the urban population in
five years has been astonishing. The population of Berlin, for
example, increased more than twice as much in the last five
years as in the preceding five. The fourteen German cities now
having a population of above 200,000 have increased more than
17 per cent since 1895. … No other European capital is growing
so fast in wealth and numbers as Berlin; and the city is rapidly
assuming a dominant position in all spheres of German life."

W. C. Dreher,
A Letter from Germany
(Atlantic Monthly, March, 1901).

The percentage of growth in Berlin "has been far outstripped

by many other cities, especially by Nuremberg; and so far as
our own census shows, no American city of over 50,000
inhabitants can match its increase. In five years it has grown
from 162,000 to 261,000—60 per cent increase. That would mean
120 per cent in a decade.

"But though Germany has only one city of more than one
million, and one more of more than half a million, and the
United States has three of each class, Germany has, in
proportion to its population rather more cities of from 50,000
to 100,000 inhabitants, and decidedly more of from 100,000 to
500,000, than the United States. In the United States
 8,000,000 people live in cities of over 500,000 inhabitants,
against some 3,000,000 in Germany; yet in the United States a
larger percentage of the population lives in places which have
under 50,000 inhabitants."

The World's Work,

March, 1901.

GERMANY: A. D. 1901 (January).

Celebration of the Prussian Bicentenary.

See (in this volume)

PRUSSIA: A. D. 1901.

GERMANY: A. D. 1901 (January).

Promised increase of protective duties.

In the Reichstag—the Parliament of the Empire—on the 26th of

January, the Agrarians brought in a resolution demanding that
the Prussian Government should "in the most resolute manner"
use its influence to secure a "considerable increase" in the
protective duties on agricultural produce at the approaching
revision of German commercial policy, and should take steps to
get the new Tariff Bill laid before the Reichstag as promptly
as possible. In response, the Imperial Chancellor, Count von
Bülow, made the following declaration of the policy of the
government, for which all parties had been anxiously waiting:
"Fully recognizing the difficult situation in which
agriculture is placed, and inspired by the desire effectively
to improve that situation, the Prussian Government is resolved
to exert its influence in order to obtain adequate protection
for agricultural produce by means of the Customs duties, which
must be raised to an extent calculated to attain that object."

GERMANY: A. D. 1901 (January).

The Prussian Canal scheme enlarged.