If you think Chronic Fatigue Syndrome is a new disease, or that it can't start in childhood, read this:

                     VISITING THE EMERSON GIRLS

                                                     by Frank Albrecht

             "The deep human need for a flight into sickness has remained
                                              constant over the years..."
                                    Gerald Weissman, MD

        Alice James died in 1892 at the age of 42, having been an invalid most of her adult life. A year or so later her close friend, Katherine Peabody Loring, published Alice’s secret diary in five copies, keeping one herself and sending the others to members of her family. Henry, one of Alice’s brothers, read this work with deep alarm (because of its candid indiscretions about family and friends) but also with enormous admiration. He wrote another of the James brothers, William, that he now understood what had caused their sister’s debility. The diary, he said, displayed for him Alice’s great "energy and personality of intellectual and moral being," but also,

"puts before me what I was tremendously conscious of in her lifetime -- that the extraordinary intensity of her will and personality really would have made the equal, the reciprocal life of a ’well’ person -- in the usual world -- almost impossible to her -- so that her disastrous, her tragic health was in a manner the only solution for her of the practical problems of life -- as it suppressed the element of equality, reciprocity, etc."
        Alice herself, however, did not see her illness as a product of conflict between her character and her "usual world" surroundings. To her it was instead the outcome of a struggle between her "will" or "moral power" and her "body." "In looking back now," she wrote toward the end of her life,
"I see how it began in my childhood, altho’ I was not conscious of the necessity until ’67 or ’68 [when she was 19 and 20] when I broke down first, acutely, and had violent turns of hysteria. As I lay prostrate after the storm with my mind luminous and active and susceptible of the clearest, strongest impressions, I saw so distinctly that it was a fight simply between my body and my will, a battle in which the former was to be triumphant to the end...."
         She eventually found, she continued, that she had to let loose of her body, giving up "muscular sanity" in order to preserve her mind:

"So, with the rest, you abandon the pit of your stomach, the palms of your hands, the soles of your feet, and refuse to keep them sane when you find in turn one moral impression after another producing despair in the one, terror in the others, anxiety in the third and so on until life becomes one long flight from remote suggestion and complicated eluding of the multifold traps set for your undoing."

        Here we have two opposing views of what causes many ill-defined "psychosomatic" illnesses. In one of these a "flight into illness" relieves the individual of the burden of unbearably conflicted impulses, feelings, or social demands. In the other, the afflicted individual, far from taking refuge in illness, tries vigorously to wrest a remnant of health from the unstable and recalcitrant physical self.

        Do people will themselves sick? Is this the origin of such contemporary conditions as Chronic Fatigue Syndrome, Fibromyalgia, Migraine, or Irritable Bowel Syndrome? Or is this idea only a fantasy, a "just-so" story rooted in the human need to create explanatory myths when no causes are known?

        Let it come down to this: why did Alice James become ill at the prospect of visiting "the Emerson girls?"


        William James was a student at Harvard’s Lawrence Scientific School when, near Christmas in 1861, he wrote his parents to "tell Alice I saw the Emerson girls and they were perfectly wild, crazy, to have her come to Concord." He added that Alice, then 13, could divide her time between the Emersons and himself: "I would take splendid care of her, and would take most lofty pride in promenading the streets of Boston with her..."

        What an attractive offer from a beloved older brother!
        The "Emerson girls" were Ellen and Edith, daughters of Ralph Waldo Emerson, a close friend of Henry James Senior, Alice’s father. Emerson made his living by giving public lectures and for that reason visited New York City several times each year, usually staying at the James residence. Henry James Junior later recalled "the winter firelight of our back-parlour at dusk and the great Emerson... sitting in it between my parents before the lamps had been lighted..." Emerson thus became acquainted with each young James as he or she came into the world, first William, then Henry, next Garth, then Bob, and finally, in 1848, Alice.

        After Henry Senior moved his family to Newport, Rhode Island, Garth and Bob attended boarding school in Emerson’s home village, Concord, where they made almost daily visits to the Emerson residence. Garth became close friends with the philosopher’s son, Edward, who was one of his schoolmates. As a result, Edward spent his 1861 spring vacation in Newport with the Jameses.
        The easy relations between the families were evident the summer following the invitation to Alice, when the Edith and Ellen stayed with the James family for several weeks and, together with the by-then 14 year-old Alice, enjoyed themselves swimming, boating, walking the cliffs, listening to the band in the town square, and watching the parades of fashionable ladies in their carriages along Ocean Drive. On one occasion William sailed Bob’s little boat, the "Alice," with "the real Alice" and the Emerson girls aboard, to Portsmouth, 16 or so miles up Sakonnet Bay. They had a delightful day which included a picnic near a pair of waterfalls and attempts to start conversations with recuperating veterans of the first Battle of Bull Run at the nearby Military Hospital. At least one part of this visit, Ellen Emerson wrote her parents, was "the best time that I almost ever did have."

        There was thus a friendly and familiar family to welcome Alice to Boston, and to help her feel at home visiting the then most vibrant city in America. Surely any adolescent girl would be thrilled at such an opportunity! But Alice’s nerves interfered. Her father explained to Emerson that he had urged "the palpitating Alice" to go to Concord "at any expense of her health." But his daughter had become so excited at the prospect that it was difficult to calm her. Finally her mother had to put her to bed, and the visit had to be canceled.

        Alice was devastated. Her father tried to comfort her, but wrote Emerson that "the tears still trickle in solitude."
        After Christmas William wrote Alice, sourly, that he hoped "your neuralgia, or whatever you may believe the thing was, has gone and that you are back at school instead of languishing and lolling about the house."

        What was this "neuralgia?" We don’t know. Even the symptoms are unclear. Victorians weren’t confessional, didn’t broadcast their aches and pains for the world to see. They hardly confided such delicate matters to their closest friends. But we do know that after her first attack at 12, Alice spent most of the rest of her life, as her mother put it, "busy trying to idle." Any physical or mental exertion, or the slightest excitement, might bring on a faint or put her in bed with tachycardia and stomach or intestinal cramps. Some attacks went on for months. She had many other pains, was never very steady on her feet, and tired easily. In her thirties her legs became so weak that she was unable to walk.

        Over the years, Alice saw a variety of doctors and received such diagnoses as neurasthenia, hysteria, rheumatic gout, suppressed gout, latent gout, gouty diathesis, cardiac complication, spinal neurosis, nervous hyperesthenia and spiritual crisis. In 1886, for instance, an expert in nervous diseases told her that she had "a gouty diathesis" (a hereditary predisposition to inflammation of muscles and joints) complicated by an abnormally sensitive nervous organization. The "neurosis" in her legs, he explained, was due to anxiety and "strain" -- stress, we would call it. All of her symptoms would improve, he told her, after menopause.

        Several years later the British surgeon who diagnosed her fatal breast cancer explained to Alice that she suffered from (as she put it in her Diary) "a delicate embroidery of ’the most distressing case of nervous hyperaesthesia’" plus "a spinal neurosis," "attacks of rheumatic croup" in her stomach, and "cardiac complications."

        Alice had strong words for the role of her stomach in her life. "How strange ’twould be," she wrote in her diary,

"not be under the dominion of that mighty organ, save digestively. No fiat of the fateful three was ever more irresistible than the decrees sent forth by the pivot of my being! Mentally no fate appalls me, but morally no crawling worm was ever so abject as I am before the convolutions of that nest of snakes coiling and uncoiling themselves. What pain remotely approaches the horror of those hours, which may swamp one at any moment, passed, second by second, hanging as it were by a cobweb to Sanity!"
         By whatever name of condition, Alice was ill, and her illness is one still not easy to diagnose, or treat.

        But did she want to be ill? Was there in her a need for a "flight into sickness" -- even when she was 13 and had the Emerson girls so "perfectly wild, crazy, for her to come to Concord"?


         The reader will have understood that this James family was not just any James family. Alice’s father, Henry James Senior, was well known in his own day for his philosophical, religious and mystical writings. Her brother Henry was the most famous American novelist of his time, an international best-seller. Many still feel he is America’s finest writer. Brother William’s massive volume, The Principals of Psychology (1890) was as widely read in scientific and philosophical circles as Henry’s books were among the literary. Later in his career, William founded pragmatism, the most distinctly American school of philosophy.
        Alice’s father and all her siblings were "nervous." Henry Senior had what he called a "vastation" at age 41 -- a sudden, unexpected attack of "doubt, anxiety, and despair," with an "inmost, implacable unrest.... The thing had not lasted ten second before I felt myself a wreck." "This ghastly condition of mind," he recalled years later, "continued with me, with gradually lengthening intervals of relief, for two years..."

        William, the oldest of the five James siblings, had a similar attack at 28. Having been depressed for some months, he wrote, "I went one evening into a dressing-room in the twilight to procure some article that was there; when suddenly there fell upon me without warning, just as if it came out of the darkness, a horrible fear of my own existence... it was as if something hitherto solid within my breast gave way, and I became a mass of quivering fear....The universe was changed for me altogether. I awoke morning after morning with a horrible dread at the pit of my stomach...."

        The next oldest brother, Henry, lived in what seems contented happiness most of his life. His career was successful from the start. He never had financial problems. He did not marry and there is no record of any serious sexual relationship, but he had many friends of both sexes and led an exceptionally active and satisfying social life. Then, suddenly, at 67, in perfect physical health, famous, well-off, still writing productively, he suffered a devastating depression. His friend Edith Wharton visited him during this illness and wrote:

"I sat down beside the sofa and for a terrible hour looked into the black depths over which he is hanging.... I, who have always seen him so serene, so completely the master of his wonderful emotional instrument-- who thought of him when I described the man in "The Legend" as so sensitive to human contacts and yet so secure from them; I could hardly believe it was the same James who cried out to me his fear, his despair, his craving for the ’cessation of consciousness,’ and all his unspeakable loneliness and need for comfort, and inability to be comforted! ’Not to wake--not to wake--’ that was his refrain..."
        Garth, the next oldest James, served as an officer in the famous 54th Massachusetts, the first Negro regiment to fight in the Civil War. Seriously wounded in the assault on South Carolina’s Fort Wagner, he never fully recovered his health. Perhaps as a result, he led an poorly focused life. He also developed a "rheumatic" leg unrelated to his war injuries. Hearing Alice had been diagnosed with "rheumatic gout" he remarked that he, his younger brother Bob, and Alice, "all seemed to be afflicted with the same disease."

        Bob, the bother closest to Alice in age, had "rheumatism" in his hands and was alcoholic. Like Garth, he served ably in the Civil War but was never successful afterward. In 1887, when he went into an asylum for treatment of "progressive nervous degeneracy," Alice wrote William that "Bob has been drinking ever since he was in the Army" and this was the cause of his problems. "The poor creature, " she noted, "seems to have no inner existence of any kind..."

        The afflictions that struck Henry Senior and William sound like what we now call Panic Disorder. William, in addition, was clearly depressed. But to these Victorian men, their crises were spiritual rather than psychological. The father recovered when he became converted to the Swedenborgian religion, the son when an essay by the French philosopher Renouvier convinced him of the freedom of the will.

        Henry Junior’s attack would today be called major depression. He recovered gradually over a few months, as often happens. Garth’s lack of energy and focus may have reflected a chronic depression, now called dysthymia, and his "rheumatism" does resemble some of Alice’s physical complaints. Bob’s rheumatism also recalls Alice. And while Bob’s heavy drinking is unique in the family, panic disorder and major depression are now believed to be linked to one another and to alcoholism by common genetic pathways. It seems likely, then, that the five male James suffered from hereditary tendencies toward emotional disorders; a common illness which found different expressions in Henry Senior, William, Henry Junior, and Bob -- and perhaps also in Garth. In addition (and perhaps connected to depression and anxiety by still unknown genetic linages) the three youngest Jameses all had some form of joint or muscle disease.


        Alice’s problems, however, have not usually been interpreted as having anything in common with those of her male relatives. William noted that her pattern of excitement followed by fatigue was like his own, though more extreme, and Garth, as we have seen, felt his problems in some ways resembled Alice’s. But most others have seen Alice as an example of purely feminine woe. We have seen how Henry began this tradition by fancying that the "extraordinary intensity of her will" was incompatible with the gender role required by Victorian society. Alice’s biographer, Jean Strouse, takes a similar line, writing that,

"...the general outlines of her life parallel those of a great many other women of her period and social class. Mysterious nervous ailments, ranging from occasional ’sick headaches’ and a becoming Victorian delicacy to screaming hysterics and bizarre psychotic episodes dominated the lives of vast numbers of American women. Taken together, these illnesses... can be seen as a collective response to the changing shape of late nineteenth-century American life, in particular to the changing social positions and functions of women....Some women addressed themselves to these changes directly, trying to encourage or thwart them. Others turned inward, making their private lives the battleground for what [Virginia] Woolf called their ’own contrary instincts.’"
         Alice James, Strouse concludes, chose the latter course, "registering social change and personal conflict in the dramatic wars that raged through her body and mind.... The intelligence and energy Alice might have used in some productive way went into the intricate work of being sick... miserable health was her career."

        Or, as Susan Sontag put it, closely echoing Henry’s judgment, Alice embodies the "all too common reality of a woman who does not know what to do with her genius, her originality, her aggressiveness, and therefore becomes a career invalid..."
        Ruth Barnard Yeazill, in her curiously titled
(University of California Press, 1981) avoids such excesses of speculation. Yet she thinks it "likely" that Alice’s problems trace back to "sexual anxiety and repression" and says that her symptoms would have been "familiar currency" to Freud and Breuer and to "the women whose curious histories" filled their pioneering 1895 work, Studies in Hysteria.

        Alice’s doctors also saw her problems as specifically female, but in a different way. To them, it appeared that women were more delicate than men. According to Elaine Showalter, "...the prevailing view among Victorian psychiatrists was that... women were more vulnerable to insanity than men because the instability of their reproductive systems interfered with their sexual, emotional, and rational control." As the British psychiatrist G. Fielding Blanford put it, ’The... connection existing between the brain and the uterus is plainly seen by the most casual observer."

        Even progressive doctors thought that females were particularly liable to hurt themselves through mental exertion. The American neurologist and novelist S. Weir Mitchell, a friend of the James family, wrote that during puberty girls

"are undergoing such organic development as renders them remarkably sensitive. At seventeen I presume that healthy girls are nearly as well able to study, with proper precautions, as men; but before this time over-use, or even a very steady use, of the brain is dangerous to health to every probability of future womanly usefulness."
        Less progressive was the New York physician Charles Fayette Taylor, who treated Alice after her devastating 1867 crisis. In these kinds of attacks, he wrote, the patient’s excitement draws too much energy into the nervous system, leaving other bodily functions "depressed." The typical case, he wrote, was a "bed-ridden woman" who as a girl had been exposed to excessive intellectual and emotional stimulation. Such a woman’s body became "perverted from tissue-making, and absorbed, as it were, in the sensational life. The body is literally starved, while the nervous system is stimulated to the highest degree."

        Taylor thought women were more excitable than men and so more prone to becoming "bundles of nerves". Education, he wrote, calms men but excites women. "For patience, for reliability, for real judgment in carrying out directions, for self-control, give me the little women who has not been ’educated’ too much, and whose only ambition is to be a good wife and mother..."

        That Alice was aware of these kinds of opinions is shown in her occasional comments on the "ignorant asininity of the medical profession in its treatment of nervous disorders." "I suppose," she wrote in her diary, "one has a greater sense of intellectual degradation after an interview with a doctor than from any human experience." After seeing a physician, she told her brother William, it took days of "fierce struggle to recover one’s self-respect." Beyond these scattered reflections, she wrote little in her letters and diary about physicians and their opinions, so we can only imagine what she thought of their theory that her sex, her upbringing, and her continued intellectual interests were the causes of her problems,
        Alice did have definite opinions about males. When William’s wife bore a boy, for instance, she chided her, only partially joking, that she had brought another "oppressor" into the world. She also complained that she and other women were not allowed to use the kinds of strong, expressive language permitted to men. Perhaps she held back her thoughts about medical theories of her illness because they were, in Victorian times, unsayable for females!
Henry, the soul of tact, never wrote a novel in which a character resembled Alice, and he told no one what he thought caused her problems, until after her death.


        My personal interest in Alice is that my teenage daughter Sarah shares with Alice one of these odd, murky, unknown-origin conditions that are so widely suspected to be psychogenic.

        When Sarah was 11 she got a terrible pain in her side. The doctors looked her over and told us firmly that it must be "psychosomatic" (i.e. imaginary). They inquired about stress and asked if there were family problems, or if she might want to avoid her school or her friends. But then, upon reluctant testing, they found she had a kidney stone.
        After months of pain and delay ("drink a lot of water and it will pass") the stone was surgically removed. There were complications from the surgery, more pain, then another stone (again at first dismissed as imaginary) and another operation. Along the way there was a burst ovarian cyst (also at first disbelieved) and, mixed in with the rest, an "opthomalogic migraine" that caused weeks of blurred vision until, after many high-tech tests, it was corrected with a seizure medication.
        Twelve months later we had all this straightened out -- but the pain remained! Sarah’s mother and I were sure she must have another stone. The doctors said there was none -- but after all this, how could we believe them?

        The climax of a long crescendo of frustration and "intellectual degradation" occurred during Sarah’s 10 days at the University of Maryland Hospital, where, after tests and consultations, all negative, the conclusion was reached that her pain was "of psychosocial origin." Her mother and I disagreed vehemently. We protested that such a severe and incapacitating pain, that deprived Sarah of every activity she enjoyed, had to have a physical origin. But the doctors saw our conviction as a neurotic signal that we had been deceived by our daughter’s manipulation. The arrogant and patronizing Chief Resident, Dr. Gladstein, known to us now as "the pediatrician from Hell," simply stopped talking to us. He left his minions to arrange Sarah’s discharge and aftercare plan -- to take a lot of morphine, seek counseling, and lead a normal life no matter what her symptoms.

        We are the doctors, Gladstein’s attitude was. We know!

        A few weeks later I wrote a letter outlining Sarah’s symptoms to Dr. Peter Rowe, a pediatrician at Johns Hopkins whom I had heard was a skilled diagnostician. He phoned us a few days later. "Does your daughter get very tired after she has a hot shower?" he asked. "Well yes," we said, "How did you know that?" "I think I understand the problem," Rowe said cheerfully.

        Dr. Rowe thought Sarah had an odd condition, "neurally mediated hypotension," in which the heart and the brain mis-communicate, producing a fluctuating heart rate, low blood pressure upon standing or sitting for very long (and after a hot shower), reduced blood flow to the brain with consequent problems with memory, concentration, and fatigue -- and mysterious pains. He arranged a tilt table test, an expensive, terrifying and painful diagnostic procedure which confirmed his theory.

        People do sometimes exaggerate or feign illness.  But to imagine that severe pain might be manufactured to serve an inner need, or that anyone not certifiably insane might create painful illness in herself in order to gain respite from stress, is to misunderstand very badly what life is like when you hurt a lot.

        In her 1972 book, ILLNESS AS METAPHOR, Susan Sontag wrote that people tend to believe that poorly understood diseases must be caused by psychological weakness. In the 16th century, for instance, it was said that a happy man would not get the plague. Most who got it died of it -- paying a high price for unhappiness! In the 1800s tuberculosis was thought to be the product of a romantic or sensitive temperament. Keats, Lord Byron, and Robert Louis Stevenson were thus seen as expressing their character in their disease.

        Today we know that plague and TB are caused by microbes. Cancer, however, remains somewhat mysterious, so people still write about a cancer-prone personality. The psychoanalyst Lawrence LeShan, for instance, insists that "The cancer patient almost invariably is contemptuous of himself, and of his abilities and possibilities." Cancer patients in general, LeShan continued, are "empty of feeling and devoid of self."

        What an awful slander this is upon people who are suffering -- calling their disease the price of their cold character!

        A saying of Groddeck sums up this way of thinking. "The sick man himself creates his disease," he wrote. "He is the cause of the disease and we need seek no other."

        Sontag rightly calls this "preposterous and dangerous." When people "are instructed that they have, unwittingly, caused their disease," she observes, they "are also being made to feel that they have deserved it."
        If Henry’s view of Alice is right, she deserved her pain because she had chosen it, consciously or unconsciously, as her only way to cope with "the practical problems of life." In Sontag’s version (which, incidentally, violates her own view that illness should never be taken metaphorically), Alice deserved her suffering because she did not know "what to do with her genius, her originality, her aggressiveness" and so became "a career invalid..." Indeed, biographer Jean Strouse makes that explicit by concluding that "miserable health was her career." Having chosen this course of life, Alice was responsible for the consequences.

        Alice’s "vague nervousness" (brother William’s phrase) corresponds to a spectrum of poorly understood conditions including Irritable Bowel Syndrome, Fibromyalgia, Chronic Fatigue Syndrome -- and Neurally Mediated Hypotension. We have little more idea what causes these conditions than did Alice’s doctors. It may be a virus, a persistent physical stress, an immune system dysfunction, toxins in the environment, persistent but hidden infection, a "chemical imbalance," or... lord help us, maybe the obnoxiously opinionated doctor at the University of Maryland was right after all, maybe it all goes back to the psyche! If this is so, Alice James was a sublimated nut case, and so is my daughter Sarah.

        I believe this is wrong, but to science it remains an open question.


         William James often put his foot in it with sister Alice. In 1886, for instance, he wrote her that she must be "stifling slowly in a quagmire of disgust and pain and impotence..."

        Alice, an avid student of current events, wrote back that William’s "sympathy"

"makes me feel like a horrible humbug. Amidst the horrors of which I hear and read my woes seem of a very pale tint. Kath.[arine] and I roared over the ’stifling in a quagmire of disgust, pain, and impotence,’ for I consider myself one of the most potent creations of my time, & though I may not have a group of Harvard students sitting at my feet drinking in psychic truth, I shall not tremble, I assure you, at the last trump."
        When William found out in 1892 that Alice was dying of breast cancer, he wrote her a long and extraordinary letter in which he remarked that,
 "One must believe (...in these neurotic cases) that some infernality in the body prevents really existing parts of the mind from coming to their effective rights... suppresses them, and blots them out from participation in this world’s experiences, although they are there all the time. When that which is you passes out of the body, I am sure that there will be an explosion of liberated force and life till then eclipsed and kept down."
        The word "neurotic" at that time signified a physical problem of the nervous system, rather than an emotional problem. But Alice was nonetheless annoyed. "When I am gone," she objected,
"pray don’t think of me simply as a creature who might have been something else, had neurotic science been born. Notwithstanding the poverty of my outside experience, I have always had a significance for myself -- every chance to stumble along my straight and narrow little path, and to worship at the feet of my Deity, and what more can a human soul ask for?"
        William’s wife may have grasped Alice’s character better than her husband. "What a big void there’ll be for us when Alice is gone!" she told him. "She stands for the wider sphere of reference!"

        This spirited creature, potent to herself, symbolizing for her physically vigorous sister-in-law "the wider sphere of reference," certainly does not seem the kind of wistful and neurotic lady who might have taken to her bed rather than cope with "the practical problems of life." She was, instead, what William Dean Howells, then the doyen of American novelists, called her in a condolence letter to Henry, "a clear, strong intelligence, housed in pain."
In the same letter in which she objected to being thought of as someone "who might have been something else," the dying Alice told William that the current year "has been one of the happiest I have ever known." Part of her happiness came from the affection she received from Katherine, her constant companion, and from her brother Henry, who visited her daily. The rest came from the fact that she had been successful on her own terms, having found her own area of freedom within the confines of persistent illness. She wrote in her diary,

"If I can get on to my sofa and occupy myself for four hours, at intervals, thro’ the day, scribbling my notes and able to read the books that belong to me, in that they clarify the density and shape of the formless mass within, Life seems inconceivably rich -- full of "l’allegresse de la certitude acquise. La raison a aussi ses emotions..."[the happiness of acquired certainty. Reason too has its emotions...]
        Alice attained this freedom by an effort of will and at the price of abandoning the pit of her stomach to despair, the palms of her hands to terror, the soles of her feet to anxiety. She simply gave up the struggle with her body, refusing "to keep [it] sane," thereby halting the "complicated eluding of the multifold traps set for [her] undoing." Thus freed, she was able to live, as she told William, along her own "straight and narrow little path."

        Perhaps Alice at 13 fled into illness to avoid the potential difficulties of visiting the Emerson girls -- being homesick, becoming ill while away from home, being separated from her mother, facing new experiences. Or perhaps her palpitations and uncontrollable agitation occurred, as one theory of Chronic Fatigue Syndrome suggests, because the pleasurable exhilaration occasioned by William’s invitation provoked her dysregulated pituitary-hypothalamic axis to flood her body with massive excesses of adrenaline.

        We do not know. We do know she wanted to visit her friends, and cried that she could not. Unable to avoid illness, she learned to live well in spite of it-- "and what more can a human soul ask for?"

Copyright 1996 by Frank Albrecht.  Do not reproduce without consent.
Frank Albrecht, Ph.D.
P.O Box 860
Ridgely MD 21660