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 Contributors

Stergiani Agorastos BS Viren Amin MD

Research Assistant Attending, Department of Medicine
Laboratory for Behavioral and North Shore-LIJ Health System
Molecular Neuroimaging Hempstead, New York, USA
Feinstein Institute for Medical Research
North Shore-LIJ Health System Leo I Amodu MD MPH
Hempstead, New York, USA Resident, Department of Surgery
North Shore-LIJ Health System
Rajesh K Ahlawat MBBS MS MCh MNAMS Hofstra North Shore-LIJ School of Medicine
Chairman Hempstead, New York, USA
Division of Urology and Renal Transplantation
Medanta Kidney and Urology Institute Mashael Anizi MD
Medanta the Medicity Foundation Doctor
Gurgaon, Haryana, India Bart’s and the Royal London
North East Thames Foundation School
Khalid Al Meshari MD FACP London, England
Consultant
Richard Barnett MD
Renal Transplant Nephrologist
Attending Physician in Nephrology
Director, International Affairs Office Corporate Level
North Shore-LIJ Health System
King Faisal Specialist Hospital
Associate Professor of Medicine
Kingdom of Saudi Arabia
Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA
Asha Alex MD
Division of Transplant Surgery Pablo César Bassan MD
Department of Surgery General and Thoracic Surgeon
North Shore-LIJ Health System Military Central Hospital
Hempstead, New York, USA Medical Chief, Health Department
National Military School
Mohini Alexander MD Assistant Professor of Surgery
Consulting Nephrologist University of Buenos Aires and University of Salvador
Valley Nephrology Associates Buenos Aires, Argentina
Manteca, California, USA
Amit Basu MD
Nicole M Ali MD Attending
Attending, Division of Nephrology Division of Transplant Surgery
Department of Medicine Department of Surgery
North Shore-LIJ Health System North Shore-LIJ Health System
Hempstead, New York, USA Hempstead, New York, USA
viii Kidney and Pancreas Transplantation

David Bernstein MD Nirupama Chandel PhD

Chief, Division of Hepatology and Department of Medicine
Center for Liver Diseases Feinstein Institute for Medical Research
North Shore-LIJ Health System North Shore-LIJ Health System
Professor of Medicine Hempstead, New York, USA
Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Nataliya Chorny MD
Attending, Division of Pediatric Kidney Center
Mahendra Bhandari MS MCh FAMS FNASc DSc MBA Department of Pediatrics
Director, Robotic Surgery Education and Research North Shore-LIJ Health System
Vattikuti Urology Institute, Henry Ford Hospital Assistant Professor of Pediatrics
Detroit, Michigan, USA Hofstra North Shore-LIJ School of Medicine
CEO, Vattikuti Foundation Hempstead, New York, USA
Honorary Professor
Centre Biomedical Research Gene F Coppa MD
Sanjay Gandhi Postgraduate Institute Campus, India
Chairman, Department of Surgery
North Shore University Hospital and
Madhu Bhaskaran MD
Long Island Jewish Medical Center
Medical Director, Transplant Program
Senior Vice President, Surgical Services
North Shore-LIJ Health System
North Shore-Long Island Jewish Health System
Associate Professor of Medicine and Surgery
Executive Director
Hofstra North Shore-LIJ School of Medicine
Surgical Service Line
Hempstead, New York, USA
John D Mountain MD
Professor of Surgery
Louise Bongiorno MS RD CSR CDE
North Shore-LIJ Health System
Dietician, Division of Transplant Surgery
Hempstead, New York, USA
North Shore-LIJ Health System
Hempstead, New York, USA
Catherine D’Agostino MD
Joaquin A Cagliani MD Attending
Department of Surgery Department of Radiology
North Shore-LIJ Health System North Shore-LIJ Health System
Hofstra North Shore-LIJ School of Medicine Associate Director
Hempstead, New York, USA Body Imaging Fellowship Program
Assistant Professor of Radiology
Kellie Calderon MD Hofstra North Shore-LIJ Health System
Transplant Nephrologist Hempstead, New York, USA
Department of Medicine
North Shore-LIJ Health System Maximiliano de Rodrigo MD
Assistant Professor of Medicine Instructor in Surgery
Hofstra North Shore-LIJ School of Medicine Hospital Interzonal General de Agudos
Hempstead, New York, USA “Dr. Oscar Alende” (HIGA)
Esophageal and Gastric Surgery
Renee Cercone Mar del Plata, Argentina
 Contributors ix

Craig Devoe MD Timothee Freisen MD

Associate Attending Attending, Finney Trimble
Division of Hematology and Oncology Surgical Associates
Monter Cancer Center Greater Baltimore Medical Center
Department of Medicine Baltimore, Maryland, USA
North Shore-LIJ Health System
Assistant Professor of Medicine Dominick Gadaleta MD
Hofstra North Shore-LIJ School of Medicine Associate Chairman
Hempstead, New York, USA Department of Surgery
Chief, General Surgery
Yosef D Dlugacz PhD Director, Bariatric Surgery
Senior Vice President/Chief Department of Surgery
Clinical Quality North Shore-LIJ Health System
Education and Research Assistant Professor of Surgery
North Shore-LIJ Health System Hofstra North Shore-LIJ School of Medicine
Assistant Professor of Science Education Hempstead, New York, USA
Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Larry Gellman MD
General, Laparoscopic and Bariatric Surgery
Cinthia B Drachenberg MD Chief, Division of Minimally Invasive Surgery
Director, Electron Microscopy Laboratory Co-Director, Bariatric Surgery
Department of Pathology North Shore-LIJ Health System
Professor of Pathology Hempstead, New York, USA
University of Maryland School of Medicine
Baltimore, Maryland, USA Charmaine Gentles NP
Bariatric Clinical Liaison
Regina S Druz MD FACC FASNC Department of Surgery
Clinical Associate Professor of Cardiology North Shore-LIJ Health System
Hofstra North Shore-LIJ School of Medicine Hempstead, New York, USA
Hempstead, New York, USA
George Georgiev BS
Alicia Eubanks Clinical Research Associate, Sr.
Masters Program Institute for Cellular Transplantation
University of Southern Florida Department of Surgery
Tampa, Florida, USA University of Arizona
Tucson, Arizona, USA
Antonette S Flecha PharmD
Clinical Pharmacist, Division of Transplant Surgery Matthew Giangola MD
North Shore-LIJ Health System Resident, Surgical Residency Program
Assistant Professor of Surgery Department of Surgery
Hofstra North Shore-LIJ School of Medicine Postdoctoral Research Fellow
Adjunct Professor of Clinical Pharmacy Feinstein Institute for Medical Research
St. John’s University-College of Pharmacy North Shore-LIJ Health System
Hempstead, New York, USA Hempstead, New York, USA
x Kidney and Pancreas Transplantation

Veronica Claudia Gigena MD Richard J Grieco MD

General Surgeon, Military Central Hospital Clinical Vice Chairman
Medical Associate Professor Department of Anesthesia
Buenos Aires University North Shore-LIJ Health System
2nd Chief of General Ultrasound and Doppler Assistant Professor of Radiology
Military Central Hospital Hofstra North Shore-LIJ School of Medicine
Buenos Aires, Argentina Hempstead, New York, USA

Michael J Goldstein MD FACS Angelika Gruessner MS PhD

Chief, Kidney Transplantation Professor of Public Health
Miami Transplant Institute Division of Epidemiology and Biostatistics
Jackson Memorial Hospital Mel and Enid Zuckerman College of Public Health
Executive Director University of Arizona
Life Alliance Organ Recovery Agency Tucson, Arizona, USA
University of Miami
Associate Clinical Professor of Surgery Christine E Gruessner BA
University of Miami Miller School of Medicine Medical Student
Miami, Florida, USA University of Arizona
Tucson, Arizona, USA
Evelina Grayver MD FACC
Attending, Department of Cardiology Rainer Gruessner MD PhD
North Shore-LIJ Health System Professor and Chairman
Assistant Professor of Medicine Department of Surgery
Hofstra North Shore-LIJ School of Medicine University of Arizona
Hempstead, New York, USA Tucson, Arizona, USA

Stuart Greenstein MD Stefan A Gruessner BA BS

Attending, Division of Transplant Surgery Medical Student
Department of Surgery, Montefiore Medical Center University of Arizona
Director, Outreach and Program Development Tucson, Arizona, USA
Professor of Surgery, Albert Einstein College of
Medicine of Yeshiva University W Mark Hamilton MD
New York, New York, USA Attending Staff Radiologist
Baylor University Medical Center
Blaine Greenwald MD Dallas, Texas, USA
Vice Chairman, Combined Department of Psychiatry
Long Island Jewish Medical Center and David A Hirschwerk MD
North Shore University Hospital Attending
Medical Director, The Zucker Hillside Hospital (ZHH) Division of Infectious Disease
Director, Geriatric Psychiatry Division, ZHH Department of Medicine
North Shore-LIJ Health System North Shore-LIJ Health System
Associate Professor of Psychiatry Assistant Professor of Medicine
Hofstra North Shore-LIJ School of Medicine Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Hempstead, New York, USA
 Contributors xi

Ezra Israel MD Edward Kraus MD

CEO, American Medical Diagnostics Attending
Mount Sinai Health System Division of Nephrology/Transplant
New York, New York, USA Department of Medicine
Johns Hopkins Medicine
Wooju Jeong MD Associate Professor of Medicine
Senior Urologist, Vattikuti Urology Institute Johns Hopkins School of Medicine
Henry Ford Health System Baltimore, Maryland, USA
Detroit, Michigan, USA
Prathik Krishnan MD
Kenar D Jhaveri MD Division of Transplant Surgery
Attending, Division of Nephrology Department of Surgery
Department of Medicine North Shore-LIJ Health System
North Shore-LIJ Health System Hempstead, New York, USA
Associate Professor of Medicine
Hofstra North Shore-LIJ School of Medicine Ramesh Kumar MD
Hempstead, New York, USA Clinical Fellow
Vattikuti Urology Institute
Louis R Kavoussi MD Henry Ford Health System
Chairman, Department of Urology Detroit, Michigan, USA
North Shore-LIJ Health System
Medical School Chairman Michael Kuncewitch MD
Department of Urology Resident
Waldbaum Gardiner Professor of Urology Surgical Residency Program
Hofstra North Shore-LIJ School of Medicine Department of Surgery
Hempstead, New York, USA Postdoctoral Research Fellow
Feinstein Institute for Medical Research
Liise Kayler MD MS North Shore-LIJ Health System
Attending, Division of Transplant Surgery Hempstead, New York, USA
Department of Surgery
Montefiore Medical Center Alexander Lee MD
Associate Professor of Clinical Surgery Program Director
Albert Einstein College of Interventional Cardiology Fellowship
Medicine of Yeshiva University Department of Cardiology
New York, New York, USA North Shore-LIJ Health System
Assistant Professor of Medicine
Adam Khader MD Hofstra North Shore-LIJ School of Medicine
Resident Hempstead, New York, USA
Surgical Residency Program
Department of Surgery Jessica Lee MD
Postdoctoral Research Fellow Resident
Feinstein Institute for Medical Research Department of Obstetrics-Gynecology
North Shore-LIJ Health System North Shore-LIJ Health System
Hempstead, New York, USA Hempstead, New York, USA
xii Kidney and Pancreas Transplantation

Ashwani Malhotra PhD Pranjal Modi MS MCh

Senior Research Scientist, Division of Nephrology Professor of Urology
Department of Medicine Head of Transplantation Surgery
Associate Investigator H.L. Trivedi Institute of Transplantation Sciences
Feinstein Institute for Medical Research Ahmedabad, Gujarat, India
North Shore-LIJ Health System
Hempstead, New York, USA Christine Sardo Molmenti MPH PhD
Postdoctoral Research Fellow and
Prashant Malhotra MD Postdoctoral Research Scientist
Attending, Division of Infectious Disease Department of Epidemiology
Department of Medicine, North Shore-LIJ Health System Mailman School of Public Health
Hempstead, New York, USA Herbert Irving Comprehensive Cancer Center
New York-Presbyterian
Carlos E Marroquin MD FACS
Columbia University Medical Center
Chief, Division of Transplant Surgery and Immunology New York, New York, USA
Department of Surgery, Fletcher Allen Health Care
Associate Professor of Surgery Divya Monga MD
University of Vermont College of Medicine
Assistant Professor
Burlington, Vermont, USA
Division of Nephrology, Department of Medicine
University of Mississippi Medical Center
Sabeen F Mekan MD
Jackson, Mississippi, USA
Attending, Division of Hematology-Oncology
Department of Medicine, North Shore-LIJ Health System Robert A Montgomery MD DPhil
Assistant Professor of Medicine
Chief, Division of Transplantation
Hofstra North Shore-LIJ School of Medicine
Director
Hempstead, New York, USA
Johns Hopkins Comprehensive Transplant Center
Marcelo Mendez Jr MD Johns Hopkins Medicine
Resident, Department of Internal Medicine Professor of Surgery
Mount Sinai Beth Israel Hospital Johns Hopkins School of Medicine
New York, New York, USA Baltimore, Maryland, USA

Mani Menon MD Raghava B Munivenkatappa MBBS

Professor of Urology Attending Surgeon
The Raj and Padma Vattikuti Distinguished Chair Division of Transplantation
Director, Vattikuti Urology Institute Department of Surgery
Detroit, Michigan, USA Johns Hopkins Medicine
Baltimore, Maryland, USA
Andrew W Menzin MD
Vice Chairman for Academic Affairs Thangamani Muthukumar MD
Department of Obstetrics and Gynecology Division of Nephrology and Hypertension
North Shore University Hospital and Department of Medicine
Long Island Jewish Medical Center Department of Translational Medicine
North Shore-LIJ Health System New York Presbyterian Hospital
Professor of Obstetrics and Gynecology Assistant Professor of Medicine
Hofstra North Shore-LIJ School of Medicine Weill Medical College of Cornell University
Hempstead, New York, USA New York, New York, USA
 Contributors xiii

David Nagata MD John C Papadimitriou MD PhD

Internal Medicine Director, Anatomic Pathology
St. Luke’s Fruitland Clinic Department of Pathology
Fruitland, Indiana, USA University of Maryland Medical Center
Professor of Pathology
Jeffrey M Nicastro MD University of Maryland School of Medicine
Vice President Baltimore, Maryland, USA
Clinical Services, Surgery Service Line
Vice Chairman, Department of Surgery RoseMarie Pasmantier MD
Chief Attending Endocrinologist
Division of Acute Care Surgery Department of Medicine
Program Director, General Surgery Veterans Affairs New Jersey Healthcare System
Residency, Department of Surgery East Orange, New Jersey, USA
North Shore-LIJ Health System
Assistant Professor of Surgery Pallavi Patri MD
Hofstra North Shore-LIJ School of Medicine Instructor
Hempstead, New York, USA Division of Hypertension and Nephrology
Department of Medicine
Julia Nunley MD FAAD FACP NewYork-Presbyterian/Weill Cornell Medical Center
Professor and Program Director New York, New York, USA
Department of Dermatology
Medical College of Virginia Hospital Andreas Paul MD
Virginia Commonwealth University Chairman
Richmond, Virginia, USA Department of General, Visceral and
Transplantation Surgery
Christopher Palestro MD University of Duisburg-Essen
Chief Essen, Germany
Division of Nuclear Medicine and
Molecular Imaging John Pellerito MD
Department of Radiology Vice Chairman, Clinical Affairs
North Shore-LIJ Health System Director
Professor of Radiology Peripheral Vascular Laboratory
Hofstra North Shore-LIJ School of Medicine Department of Radiology
Hempstead, New York, USA North Shore-LIJ Health System
Associate Professor of Radiology
Abeed Pall MD FRCP Hofstra North Shore-LIJ School of Medicine
Consultant, Renal Transplant Physician Hempstead, New York, USA
Section Head, Adult Transplant Nephrology
Department of Kidney and Pancreas Transplantation Benjamin Philosophe MD PhD
King Faisal Specialist Hospital & Research Centre Clinical Chief
Ridayh, Saudi Arabia Division of Transplantation
Department of Surgery
Gabriel Pantol MD Johns Hopkins Medicine
Chairman, Neurology Section Professor of Surgery
Cape Fear Valley Health System Johns Hopkins School of Medicine
Fayetteville, North Carolina, USA Baltimore, Maryland, USA
xiv Kidney and Pancreas Transplantation

Barbara Ponieman MD Andrea Restifo RN MPA

Attending Associate Executive Director, Administration
Department of Psychiatry North Shore University Hospital
North Shore-LIJ Health System North Shore-LIJ Health System
Assistant Professor of Psychiatry Hempstead, New York, USA
Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Lee Richstone MD
System Vice Chairman, Department of Urology
Jose Prince MD Chief of Urology
Attending, Division of Pediatric Surgery North Shore-LIJ Health System
Department of Surgery Associate Professor of Urology
Director, Minimally Invasive Surgery Hofstra North Shore-LIJ School of Medicine
Cohen Children’s Medical Center of New York Hempstead, New York, USA
Institute Researcher, Feinstein
Institute for Medical Research Horacio L Rodriguez Rilo MD PhD
North Shore-LIJ Health System Professor of Surgery, Immunology, Cell Biology,
Assistant Professor of Surgery Physiology, Mechanical and Aerospace Engineering
Hofstra North Shore-LIJ School of Medicine Director, Islet Cell Transplant Program
Hempstead, New York, USA Director, Cell Transplant Institute
Associate Director
Arnold Radtke MD Arizona Diabetes Center
Associate Professor University of Arizona School of Medicine
Department of General and Transplant Surgery Tucson, Arizona, USA
University of Muenster
Muenster, Germany Ezequiel Rodríguez Reimundes MD
Attending
Salil R Rajayer MBBS Department of Internal Medicine and Intensive Care
Resident Nyon Hospital
Department of Internal Medicine Nyon, Switzerland
Woodhull Medical and Mental Health Center
New York University School of Medicine Mala Sachdeva MD
New York, New York, USA Attending, Division of Kidney Diseases and
Hypertension
Prejith P Rajendran MBBS Department of Medicine
Division of Transplant Surgery North Shore-LIJ Health System
Department of Surgery Assistant Professor of Medicine
North Shore-LIJ Health System Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Hempstead, New York, USA

Poornima Ramadas MD Ankita Sagar MD

Division of Transplant Surgery Chief Resident
Department of Surgery Department of Internal Medicine
North Shore-LIJ Health System North Shore-LIJ Health System
Hempstead, New York, USA Hempstead, New York, USA
 Contributors xv

Sonu Sahni MD Surya V Seshan MD

Research Assistant Attending, Department of Pathology
Division of Pulmonary, Sleep and Critical Care New York Presbyterian Hospital
Medicine Professor of Clinical Pathology and Laboratory
North Shore-LIJ Health System Medicine
Hempstead, New York, USA Weill Cornell Medical College
New York, New York, USA
Simpa S Salami MD
Resident Christine Sethna MD
Department of Urology Division Chief, Pediatric Nephrology
The Arthur Smith Institute for Urology Cohen Children’s Medical Center of New York
North Shore-LIJ Health System North Shore-LIJ Health System
Hempstead, New York, USA Assistant Professor of Pediatrics
Hofstra North Shore-LIJ School of Medicine
Michael J Schwartz MD Hempstead, New York, USA
Associate Residency Program Director
Director George Sgourakis MD PhD FACS
Robotics and Minimally Invasive Surgery Staff Specialist General Surgeon
Smith Institute for Urology Korgialenion-Benakion, Red Cross Hospital
North Shore-LIJ Health System Athens, Greece
Assistant Professor of Urology
Hofstra North Shore-LIJ School of Medicine Hitesh H Shah MD
Hempstead, New York, USA Director
Nephrology Fellowship Program, Department of
Dorry Segev MD PhD Medicine
Attending Surgeon North Shore-LIJ Health System
Division of Transplantation Associate Professor of Medicine
Associate Vice Chair of Research Department of Hofstra North Shore-LIJ School of Medicine
Surgery Hempstead, New York, USA
Johns Hopkins Hospital
Associate Professor of Surgery Iuliana Shapira MD
Johns Hopkins University School of Medicine Attending, Division of Oncology
Associate Professor of Epidemiology Department of Medicine, North Shore-LIJ Health
Johns Hopkins Bloomberg School of Public Health System
Baltimore, Maryland, USA Associate Professor of Medicine
Hofstra North Shore-LIJ School of Medicine
David Serur MD Hempstead, New York, USA
Medical Director
The Rogosin Institute Transplantation Program Ron Shapiro MD
Associate Attending Physician The Robert J Corry Chair in Transplantation Surgery
New York-Presbyterian Hospital/Weill Cornell Thomas E Starzl Transplantation Institute
Associate Professor of Clinical Medicine Professor of Surgery, University of Pittsburgh
Weill Medical College of Cornell University School of Medicine
New York, New York, USA Pittsburgh, Pennsylvania, USA
xvi Kidney and Pancreas Transplantation

Pravin C Singhal MD Keith Sultan MD

Chief Attending, Division of Gastroenterology
Emeritus Nephrology Hepatology and Nutrition, Department of Medicine
Kidney Diseases and Hypertension North Shore-LIJ School of Medicine
North Shore-LIJ Health System Assistant Professor of Medicine
Professor of Medicine Hofstra North Shore-LIJ School of Medicine
Hofstra North Shore-LIJ School of Medicine Hempstead, New York, USA
Hempstead, New York, USA
Arunabh Talwar MD FCCP
Narendra Singh MD Attending Physician, Division of Pulmonary
Intensivist Sleep and Critical Care Medicine
Division of Critical Care Surgery North Shore-LIJ Health System
Department of Surgery Professor of Medicine
North Shore-LIJ Health System Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Hempstead, New York, USA

Eric J Siskind MD Donato F Tramontozzi RPh

Auburndale Pharmacy, Inc.
Chief Resident
Flushing, New York, USA
Surgical Residency Program, Department of Surgery
North Shore-LIJ Health System
Megan L Troxell MD PhD
Hempstead, New York, USA
Associate Professor of Pathology
Patrick R Smith BA EMT-P Oregon Health & Science School of Medicine
Portland, Oregon, USA
Center for Learning and Innovation
North Shore-LIJ Health System Roberto M Verzaro MD PhD FACS
Hofstra North Shore-LIJ School of Medicine
Program Director, General Surgery
Hempstead, New York, USA
Vannini Hospital in Rome, Instructor, General Surgery
Residency Program, University of Rome La Sapienza
Akshay Sood MD
Rome, Italy
PGY-I Urology Resident
Vattikuti Urology Institute, Henry Ford Health System Mariano Volpacchio MD
Detroit, Michigan, USA Head, Computed Tomography
Hospital de Clinicas Jose de San Martin
Georgios C Sotiropoulos PhD FACS FEBS
Universidad de Buenos Aires
Professor of Surgery and Transplantation Head, Body Imaging, Centro de Diagnostico
Department of General, Visceral and Dr. Enrique Rossi
Transplantation Surgery, University Hospital Essen Buenos Aires, Argentina
Essen, Germany
Ping Wang MD
William Stewart DDS Vice Chairman for Research, Department of Surgery
Chief North Shore-LIJ Health System
Division of Dental Medicine Head, Center for Translational Research
North Shore-LIJ Health System The Feinstein Institute for Medical Research
Assistant Professor of Dental Medicine Professor of Surgery and Molecular Medicine
Hofstra North Shore-LIJ School of Medicine Hofstra North Shore-LIJ School of Medicine
Hempstead, New York, USA Hempstead, New York, USA
 Contributors xvii

Joseph S Weiner MD PhD Robin J Warshawsky MD

Attending Physician Associate Chairman
Department of Psychiatry Department of Radiology
North Shore-LIJ Health System North Shore-LIJ Health System
Associate Professor of Clinical Psychiatry and Assistant Professor of Radiology
Medicine Hofstra North Shore-LIJ School of Medicine
Hofstra North Shore-LIJ School of Medicine Hempstead, New York, USA
Hempstead, New York, USA

Jay Weinstein MD
Attending
Division of Internal Medicine
Department of Medicine
North Shore-LIJ Health System
Assistant Professor of Medicine
Hofstra North Shore-LIJ Health System
Hempstead, New York, USA
 Collaborators
Radiology Chapters

Eran Ben-Levi MD Barak Friedman MD Jessica Moon RDMS Rakesh D Shah MD

Karen S Black MD Eric J Gandras MD James B Naidich MD

Eric J Siskind MD
Alexander J Blood BA Veronica Claudia Gigena MD Jason J Naidich MD
Branson Sparks
Grazyna Bober RDMS Evelina Grayver MD FACC Diana Navi RDMS
Karen Torres BS RDMS
Dennis Burgos RDMS Craig R Greben MD FSIR Radha Persaud RDMS

Brian J Burke MD Gregory M Grimaldi MD Amalia Pose BS RDMS Gene G Tronco MD

Drew M Caplin MD Brett Helfner MD Daniel Putterman MD Biana Trost MD

Jesse Chusid MD MBA John J Hines MD David R Rosman MD
Robert Villani MD
Regina S Druz M
 D FACC Asaph CJ Levy BS Kathrin Sakni RDMS
Rona F Woldenberg MD
Adam L Evans MD Pamela Lombardi MD Lindsay Schwartz RDMS

Bilha Chesner Fish MD Saiedeh Maghool RDMS Priya K Shah MD Pey-Jen Yu MD

xx Kidney and Pancreas Transplantation

Input and Strategic Design

Adam Aponte MD MSc FAAP Patrick J Gannon PhD Michael W Kleeman DO FACS Samuel Packer MD

Matthew A Bank MD Maria D Georgiades MD Jeffrey A Kraut BA MBA Frank and Linda Perlman

Eileen Bishop MD Gary Giangola MD FACS K V Krishnasastry MD Rajasekhar Perumalla M

 D

Sabina Figari Bizzotto Lawrence R Glassman MD Dana Lustbader MD FCCM John Platz MD

Sylvester M Black MD PhD Azzour D Hazzan MD Jerzy Macura MD Lauren E Procaccino

Fouad N Boctor MD PhD Jerrold Hirsch PhD Anna Mathew MD James Sardo MD

John Chang MD Susana Hong MD Joseph Mattana MD Todd L Slesinger M

 D FACEP

John D Chelico MD MA FACP E Ilamathi MD FACP FNKF James C Maurer MD Laurence N Spier MD

Charles Choy MD Mitchel C Jacobs MD FACP Alexia Molmenti Joel Stern NH PhD

Christian Coppa Sam H James MD Hebe Molmenti MD PhD James Sullivan MD

James M Crawford MD PhD Jasmeet Kaur MD Luis A Molmenti MD PhD Hugo Villar MD

Salvatore Cumella MD Nancy Kheck PhD Octavio Molmenti Robert S Waldbaum MD

Suzanne El-Sayegh M
 D FACP Y H Kieso-Chelico MSCR Luis F Morales MD Rimda Wanchoo MD

Lara Fishbane Mark Kissin MD Cameron Moser

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Title: Totem and Taboo

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TOTEM AND TABOO

RESEMBLANCES BETWEEN THE PSYCHIC
LIVES OF SAVAGES AND NEUROTICS

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PROFESSOR SIGMUND FREUD, Ll.D.

Authorized English Translation,

with Introduction by

A. A. BRILL, Ph.B., M.D.

Asst. Prof. of Psychiatry, N.Y. Post-Graduate Medical

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former Chief of Clinic of Psychiatry,
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 AUTHOR’S PREFACE
THE essays treated here appeared under the subtitle of this book in the first
numbers of the periodical Imago edited by me. They represent my first
efforts to apply view-points and results of psychoanalysis to unexplained
problems of racial psychology. In method this book contrasts with that of
W. Wundt and the works of the Zurich Psychoanalytic School. The former
tries to accomplish the same object through assumptions and procedures
from non-analytic psychology, while the latter follow the opposite course
and strive to settle problems of individual psychology by referring to
material of racial psychology[1]. I am pleased to say that the first stimulus
for my own works came from these two sources.
I am fully aware of the shortcomings in these essays. I shall not touch
upon those which are characteristic of first efforts at investigation. The
others, however, demand a word of explanation. The four essays which are
here collected will be of interest to a wide circle of educated people, but
they can only be thoroughly understood and judged by those who are really
acquainted with psychoanalysis as such. It is hoped that they may serve as a
bond between students of ethnology, philology, folklore and of the allied
sciences, and psychoanalysts; they cannot, however, supply both groups the
entire requisites for such co-operation. They will not furnish the former
with sufficient insight into the new psychological technique, nor will the
psychoanalysts acquire through them an adequate command over the
material to be elaborated. Both groups will have to content themselves with
whatever attention they can stimulate here and there and with the hope that
frequent meetings between them will not remain unproductive for science.
The two principal themes, totem and taboo, which give the name to this
small book are not treated alike here. The problem of taboo is presented
more exhaustively, and the effort to solve it is approached with perfect
confidence. The investigation of totemism may be modestly expressed as:
“This is all that psychoanalytic study can contribute at present to the
elucidation of the problem of totemism.” This difference in the treatment of
the two subjects is due to the fact that taboo still exists in our midst. To be
sure, it is negatively conceived and directed to different contents, but
according to its psychological nature, it is still nothing else than Kant’s
‘Categorical Imperative’, which tends to act compulsively and rejects all
conscious motivations. On the other hand, totemism is a religio-social
institution which is alien to our present feelings; it has long been abandoned
and replaced by new forms. In the religions, morals, and customs of the
civilized races of to-day it has left only slight traces, and even among those
races where it is still retained, it has had to undergo great changes. The
social and material progress of the history of mankind could obviously
change taboo much less than totemism.
In this book the attempt is ventured to find the original meaning of
totemism through its infantile traces, that is, through the indications in
which it reappears in the development of our own children. The close
connection between totem and taboo indicates the further paths to the
hypothesis maintained here. And although this hypothesis leads to
somewhat improbable conclusions, there is no reason for rejecting the
possibility that it comes more or less near to the reality which is so hard to
reconstruct.
 CONTENTS

CHAP. PAGE
I The Savage’s Dread of Incest 1
II Taboo and the Ambivalence of Emotions 30
III Animism, Magic and the Omnipotence of Thought 125
IV The Infantile Recurrence of Totemism 166
 TRANSLATOR’S INTRODUCTION
WHEN one reviews the history of psychoanalysis[2] one finds that it had its
inception in the study of morbid mental states. Beginning with the
observation of hysteria and the other neuroses[3] Professor Freud gradually
extended his investigations to normal psychology and evolved new
concepts and new methods of study. The neurotic symptoms were no longer
imaginary troubles the nature of which one could not grasp, but were
conceived as mental and emotional maladjustments to one’s environment.
The stamp of degeneracy impressed upon neurotics by other schools of
medicine was altogether eradicated. Deeper investigation showed
conclusively that a person might become neurotic if subjected to certain
environments, and that there was no definite dividing line between normal
and abnormal. The hysterical symptoms, obsessions, doubts, phobias, as
well as hallucinations of the insane, show the same mechanisms as those
similar psychic structures which one constantly encounters in normal
persons in the form of mistakes in talking, reading, writing, forgetting[4],
dreams and wit. The dream, always highly valued by the populace, and as
much despised by the educated classes, has a definite structure and meaning
when subjected to analysis. Professor Freud’s monumental work, The
Interpretation of Dreams[5], marked a new epoch in the history of mental
science. One might use the same words in reference to his profound
analysis of wit[6].
Faulty psychic actions, dreams and wit are products of the unconscious
mental activity, and like neurotic or psychotic manifestations represent
efforts at adjustment to one’s environment. The slip of the tongue shows
that on account of unconscious inhibitions the individual concerned is
unable to express his true thoughts; the dream is a distorted or plain
expression of those wishes which are prohibited in the waking states, and
the witticism, owing to its veiled or indirect way of expression, enables the
individual to obtain pleasure from forbidden sources. But whereas dreams,
witticisms, and faulty actions give evidences of inner conflicts which the
individual overcomes, the neurotic or psychotic symptom is the result of a
failure and represents a morbid adjustment.
 The aforementioned psychic formations are therefore nothing but
manifestations of the struggle with reality, the constant effort to adjust one’s
primitive feelings to the demands of civilization. In spite of all later
development the individual retains all his infantile psychic structures.
Nothing is lost; the infantile wishes and primitive impulses can always be
demonstrated in the grown-up and on occasion can be brought back to the
surface. In his dreams the normal person is constantly reviving his
childhood, and the neurotic or psychotic individual merges back into a sort
of psychic infantilism through his morbid productions. The unconscious
mental activity which is made up of repressed infantile material for ever
tries to express itself. Whenever the individual finds it impossible to
dominate the difficulties of the world of reality there is a regression to the
infantile, and psychic disturbances ensue which are conceived as peculiar
thoughts and acts. Thus the civilized adult is the result of his childhood or
the sum total of his early impressions; psychoanalysis thus confirms the old
saying: The child is father to the man.
It is at this point in the development of psychoanalysis that the paths
gradually broadened until they finally culminated in this work. There were
many indications that the childhood of the individual showed a marked
resemblance to the primitive history or the childhood of races. The
knowledge gained from dream analysis and phantasies[7], when applied to
the productions of racial phantasies, like myths and fairy tales, seemed to
indicate that the first impulse to form myths was due to the same emotional
strivings which produced dreams, fancies and symptoms[8]. Further study in
this direction has thrown much light on our great cultural institutions, such
as religion, morality, law and philosophy, all of which Professor Freud has
modestly formulated in this volume and thus initiated a new epoch in the
study of racial psychology.
I take great pleasure in acknowledging my indebtedness to Mr Alfred B.
Kuttner for the invaluable assistance he rendered in the translation of this
work.
A. A. BRILL.

TOTEM AND TABOO

 CHAPTER I

THE SAVAGE’S DREAD OF INCEST

PRIMITIVE man is known to us by the stages of development through which

he has passed: that is, through the inanimate monuments and implements
which he has left behind for us, through our knowledge of his art, his
religion and his attitude towards life, which we have received either directly
or through the medium of legends, myths and fairy tales; and through the
remnants of his ways of thinking that survive in our own manners and
customs. Moreover, in a certain sense he is still our contemporary: there are
people whom we still consider more closely related to primitive man than to
ourselves, in whom we therefore recognize the direct descendants and
representatives of earlier man. We can thus judge the so-called savage and
semi-savage races; their psychic life assumes a peculiar interest for us, for
we can recognize in their psychic life a well-preserved, early stage of our
own development.
If this assumption is correct, a comparison of the ‘Psychology of
Primitive Races’ as taught by folklore, with the psychology of the neurotic
as it has become known through psychoanalysis will reveal numerous
points of correspondence and throw new light on subjects that are more or
less familiar to us.
For outer as well as for inner reasons, I am choosing for this comparison
those tribes which have been described by ethnographists as being most
backward and wretched: the aborigines of the youngest continent, namely
Australia, whose fauna has also preserved for us so much that is archaic and
no longer to be found elsewhere.
The aborigines of Australia are looked upon as a peculiar race which
shows neither physical nor linguistic relationship with its nearest
neighbours, the Melanesian, Polynesian and Malayan races. They do not
build houses or permanent huts; they do not cultivate the soil or keep any
domestic animals except dogs; and they do not even know the art of pottery.
They live exclusively on the flesh of all sorts of animals which they kill in
the chase, and on the roots which they dig. Kings or chieftains are unknown
among them, and all communal affairs are decided by the elders in
assembly. It is quite doubtful whether they evince any traces of religion in
the form of worship of higher beings. The tribes living in the interior who
have to contend with the greatest vicissitudes of life owing to a scarcity of
water, seem in every way more primitive than those who live near the coast.
We surely would not expect that these poor naked cannibals should be
moral in their sex life according to our ideas, or that they should have
imposed a high degree of restriction upon their sexual impulses. And yet we
learn that they have considered it their duty to exercise the most searching
care and the most painful rigour in guarding against incestuous sexual
relations. In fact their whole social organization seems to serve this object
or to have been brought into relation with its attainment.
Among the Australians the system of Totemism takes the place of all
religious and social institutions. Australian tribes are divided into smaller
septs or clans, each taking the name of its totem. Now what is a totem? As a
rule it is an animal, either edible and harmless, or dangerous and feared;
more rarely the totem is a plant or a force of nature (rain, water), which
stands in a peculiar relation to the whole clan. The totem is first of all the
tribal ancestor of the clan, as well as its tutelary spirit and protector; it sends
oracles and, though otherwise dangerous, the totem knows and spares its
children. The members of a totem are therefore under a sacred obligation
not to kill (destroy) their totem, to abstain from eating its meat or from any
other enjoyment of it. Any violation of these prohibitions is automatically
punished. The character of a totem is inherent not only in a single animal or
a single being but in all the members of the species. From time to time
festivals are held at which the members of a totem represent or imitate, in
ceremonial dances, the movements and characteristics of their totems.
The totem is hereditary either through the maternal or the paternal line;
(maternal transmission probably always preceded and was only later
supplanted by the paternal). The attachment to a totem is the foundation of
all the social obligations of an Australian: it extends on the one hand
beyond the tribal relationship, and on the other hand it supersedes
consanguineous relationship[9].
The totem is not limited to district or to locality; the members of a totem
may live separated from one another and on friendly terms with adherents
of other totems[10].
 And now, finally, we must consider that peculiarity of the totemic system
which attracts the interest of the psychoanalyst. Almost everywhere the
totem prevails there also exists the law that the members of the same totem
are not allowed to enter into sexual relations with each other; that is, that
they cannot marry each other. This represents the exogamy which is
associated with the totem.
This sternly maintained prohibition is very remarkable. There is nothing
to account for it in anything that we have hitherto learned from the
conception of the totem or from any of its attributes; that is, we do not
understand how it happened to enter the system of totemism. We are
therefore not astonished if some investigators simply assume that at first
exogamy—both as to its origin and to its meaning—had nothing to do with
totemism, but that it was added to it at some time without any deeper
association, when marriage restrictions proved necessary. However that
may be, the association of totemism and exogamy exists, and proves to be
very strong.
Let us elucidate the meaning of this prohibition through further
discussion.
(a) The violation of the prohibition is not left to what is, so to speak, an
automatic punishment, as is the case with other violations of the
prohibitions of the totem (e.g., not to kill the totem animal), but is most
energetically avenged by the whole tribe as if it were a question of warding
off a danger that threatens the community as a whole or a guilt that weighs
upon all. A few sentences from Frazer’s book[11] will show how seriously
such trespasses are treated by these savages who, according to our standard
are otherwise very immoral.
“In Australia the regular penalty for sexual intercourse with a person of a
forbidden clan is death. It matters not whether the woman is of the same
local group or has been captured in war from another tribe; a man of the
wrong clan who uses her as his wife is hunted down and killed by his
clansmen, and so is the woman; though in some cases, if they succeed in
eluding capture for a certain time, the offence may be condoned. In the Ta-
Ta-thi tribe, New South Wales, in the rare cases which occur, the man is
killed, but the woman is only beaten or speared, or both, till she is nearly
dead; the reason given for not actually killing her being that she was
probably coerced. Even in casual amours the clan prohibitions are strictly
observed; any violations of these prohibitions ‘are regarded with the utmost
abhorrence and are punished by death’ (Howitt).”
(b) As the same severe punishment is also meted out for temporary love
affairs which have not resulted in childbirth, the assumption of other
motives, perhaps of a practical nature, becomes improbable.
(c) As the totem is hereditary and is not changed by marriage, the results
of the prohibition, for instance in the case of maternal heredity, are easily
perceived. If, for example, the man belongs to a clan with the totem of the
Kangaroo and marries a woman of the Emu totem, the children, both boys
and girls, are all Emu. According to the totem law incestuous relations with
his mother and his sister, who are Emu like himself, are therefore made
impossible for a son of this marriage[12].
(d) But we need only a reminder to realize that the exogamy connected
with the totem accomplishes more; that is, aims at more than the prevention
of incest with the mother or the sisters. It also makes it impossible for the
man to have sexual union with all the women of his own group, with a
number of females, therefore, who are not consanguineously related to him,
by treating all these women like blood relations. The psychological
justification for this extraordinary restriction, which far exceeds anything
comparable to it among civilized races, is not, at first, evident. All we seem
to understand is that the rôle of the totem (the animal) as ancestor is taken
very seriously. Everybody descended from the same totem is
consanguineous; that is, of one family; and in this family the most distant
grades of relationship are recognized as an absolute obstacle to sexual
union.
Thus these savages reveal to us an unusually high grade of incest dread
or incest sensitiveness, combined with the peculiarity, which we do not very
well understand, of substituting the totem relationship for the real blood
relationship. But we must not exaggerate this contradiction too much, and
let us bear in mind that the totem prohibitions include real incest as a
special case.
In what manner the substitution of the totem group for the actual family
has come about remains a riddle, the solution of which is perhaps bound up
with the explanation of the totem itself. Of course it must be remembered
that with a certain freedom of sexual intercourse, extending beyond the
limitations of matrimony, the blood relationship, and with it also the
prevention of incest, becomes so uncertain that we cannot dispense with
some other basis for the prohibition. It is therefore not superfluous to note
that the customs of Australians recognize social conditions and festive
occasions at which the exclusive conjugal right of a man to a woman is
violated.
The linguistic customs of these tribes, as well as of most totem races,
reveals a peculiarity which undoubtedly is pertinent in this connection. For
the designations of relationship of which they make use do not take into
consideration the relationship between two individuals, but between an
individual and his group; they belong, according to the expression of L. H.
Morgan, to the ‘classifying’ system. That means that a man calls not only
his begetter ‘father’ but also every other man who, according to the tribal
regulations, might have married his mother and thus become his father; he
calls ‘mother’ not only the woman who bore him but also every other
woman who might have become his mother without violation of the tribal
laws; he calls ‘brothers’ and ‘sisters’ not only the children of his real
parents, but also the children of all the persons named who stand in the
parental group relation with him, and so on. The kinship names which two
Australians give each other do not, therefore, necessarily point to a blood
relationship between them, as they would have to according to the custom
of our language; they signify much more the social than the physical
relations. An approach to this classifying system is perhaps to be found in
our nursery, when the child is induced to greet every male and female friend
of the parents as ‘uncle’ and ‘aunt’, or it may be found in a transferred sense
when we speak of ‘Brothers in Apollo’, or ‘Sisters in Christ’.
The explanation of this linguistic custom, which seems so strange to us,
is simple if looked upon as a remnant and indication of those marriage
institutions which the Rev. L. Fison has called ‘group marriage’,
characterized by a number of men exercising conjugal rights over a number
of women. The children of this group marriage would then rightly look
upon each other as brothers and sisters although not born of the same
mother, and would take all the men of the group for their fathers.
Although a number of authors, as, for instance, B. Westermarck in his
History of Human Marriage[13], oppose the conclusions which others have
drawn from the existence of group-relationship names, the best authorities
on the Australian savages are agreed that the classificatory relationship
names must be considered as survivals from the period of group marriages.
And, according to Spencer and Gillen[14], a certain form of group marriage
can be established as still existing to-day among the tribes of the Urabunna
and the Dieri. Group marriage therefore preceded individual marriage
among these races, and did not disappear without leaving distinct traces in
language and custom.
But if we replace individual marriage, we can then grasp the apparent
excess of cases of incest shunning which we have met among these same
races. The totem exogamy, or prohibition of sexual intercourse between
members of the same clan, seemed the most appropriate means for the
prevention of group incest; and this totem exogamy then became fixed and
long survived its original motivation.
Although we believe we understand the motives of the marriage
restrictions among the Australian savages, we have still to learn that the
actual conditions reveal a still more bewildering complication. For there are
only few tribes in Australia which show no other prohibition besides the
totem barrier. Most of them are so organized that they fall into two divisions
which have been called marriage classes, or phratries. Each of these
marriage groups is exogamous and includes a majority of totem groups.
Usually each marriage group is again divided into two subclasses
(subphratries), and the whole tribe is therefore divided into four classes; the
subclasses thus standing between the phratries and the totem groups.
The typical and very often intricate scheme of organization of an
Australian tribe therefore looks as follows:
 The twelve totem groups are brought under four subclasses and two
main classes. All the divisions are exogamous[15]. The subclass c forms an
exogamous unit with e, and the subclass d with f. The success or the
tendency of these arrangements is quite obvious; they serve as a further
restriction on the marriage choice and on sexual freedom. If there were only
these twelve totem groups—assuming the same number of people in each
group—every member of a group would have 11/12 of all the women of the
tribe to choose from. The existence of the two phratries reduces this number
to 6/12 or ½; a man of the totem α can only marry a woman from the groups
1 to 6. With the introduction of the two subclassess the selection sinks to
3/12 or ¼; a man of the totem α must limit his marriage choice to a woman
of the totems 4, 5, 6.
The historical relations of the marriage classes—of which there are
found as many as eight in some tribes—are quite unexplained. We only see
that these arrangements seek to attain the same object as the totem
exogamy, and even strive for more. But whereas the totem exogamy makes
the impression of a sacred statute which sprang into existence, no one
knows how, and is therefore a custom, the complicated institutions of the
marriage classes, with their sub-divisions and the conditions attached to
them, seem to spring from legislation with a definite aim in view. They
have perhaps taken up afresh the task of incest prohibition because the
influence of the totem was on the wane. And while the totem system is, as
we know, the basis of all other social obligations and moral restrictions of
the tribe, the importance of the phratries generally ceases when the
regulation of the marriage choice at which they aimed has been
accomplished.
In the further development of the classification of the marriage system
there seems to be a tendency to go beyond the prevention of natural and
group incest, and to prohibit marriage between more distant group relations,
in a manner similar to the Catholic church, which extended the marriage
prohibitions always in force for brother and sisters, to cousins, and invented
for them the grades of spiritual kinship[16].
It would hardly serve our purpose to go into the extraordinarily intricate
and unsettled discussion concerning the origin and significance of the
marriage classes, or to go more deeply into their relation to totemism. It is
sufficient for our purposes to point out the great care expended by the
Australians as well as by other savage people to prevent incest[17]. We must
say that these savages are even more sensitive to incest than we, perhaps
because they are more subject to temptations than we are, and hence require
more extensive protection against it.
But the incest dread of these races does not content itself with the
creation of the institutions described, which, in the main, seem to be
directed against group incest. We must add a series of ‘customs’ which
watch over the individual behaviour to near relatives in our sense, which are
maintained with almost religious severity and of whose object there can
hardly be any doubt. These customs or custom prohibitions may be called
‘avoidances’. They spread far beyond the Australian totem races. But here
again I must ask the reader to be content with a fragmentary excerpt from
the abundant material.
Such restrictive prohibitions are directed in Melanesia against the
relations of boys with their mothers and sisters. Thus, for instance, on
Lepers Island, one of the New Hebrides, the boy leaves his maternal home
at a fixed age and moves to the ‘clubhouse’, where he there regularly sleeps
and takes his meals. He may still visit his home to ask for food; but if his
sister is at home he must go away before he has eaten; if no sister is about
he may sit down to eat near the door. If brother and sister meet by chance in
the open, she must run away or turn aside and conceal herself. If the boy
recognizes certain footprints in the sand as his sister’s he is not to follow
them, nor is she to follow his. He will not even mention her name and will
guard against using any current word if it forms part of her name. This
avoidance, which begins with the ceremony of puberty, is strictly observed
for life. The reserve between mother and son increases with age and
generally is more obligatory on the mother’s side. If she brings him
something to eat she does not give it to him herself but puts it down before
him, nor does she address him in the familiar manner of mother and son,
but uses the formal address. Similar customs obtain in New Caledonia. If
brother and sister meet, she flees into the bush and he passes by without
turning his head toward her[18].
On the Gazella Peninsula in New Britain a sister, beginning with her
marriage, may no longer speak with her brother, nor does she utter his name
but designates him by means of a circumlocution[19].
 In New Mecklenburg some cousins are subject to such restrictions,
which also apply to brothers and sisters. They may neither approach each
other, shake hands, nor give each other presents, though they may talk to
each other at a distance of several paces. The penalty for incest with a sister
is death through hanging[20].
These rules of avoidance are especially severe in the Fiji Islands where
they concern not only consanguineous sisters but group sisters as well.
To hear that these savages hold sacred orgies in which persons of just
these forbidden degrees of kinship seek sexual union would seem still more
peculiar to us, if we did not prefer to make use of this contradiction to
explain the prohibition instead of being astonished at it[21].
Among the Battas of Sumatra these laws of avoidance affect all near
relationships. For instance, it would be most offensive for a Battan to
accompany his own sister to an evening party. A brother will feel most
uncomfortable in the company of his sister even when other persons are
also present. If either comes into the house, the other prefers to leave. Nor
will a father remain alone in the house with his daughter any more than the
mother with her son. The Dutch missionary who reported these customs
added that unfortunately he had to consider them well founded. It is
assumed without question by these races that a man and a woman left alone
together will indulge in the most extreme intimacy, and as they expect all
kinds of punishments and evil consequences from consanguineous
intercourse they do quite right to avoid all temptations by means of such
prohibitions[22].
Among the Barongos in Delagoa Bay, in Africa, the most rigorous
precautions are directed, curiously enough, against the sister-in-law, the
wife of the brother of one’s own wife. If a man meets this person who is so
dangerous to him, he carefully avoids her. He does not dare to eat out of the
same dish with her; he speaks only timidly to her, does not dare to enter her
hut, and greets her only with a trembling voice[23].
Among the Akamba (or Wakamba) in British East Africa, a law of
avoidance is in force which one would have expected to encounter more
frequently. A girl must carefully avoid her own father between the time of
her puberty and her marriage. She hides herself if she meets him on the
street and never attempts to sit down next to him, behaving in this way right
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