the gradual process which I have endeavored to faintly shadow forth in the preceding five chapters.

66

Let us see whether it does not look probable that a mind in the habit of separating recognized observations from its own responsibility, considering them objectively, philosophizing on its own manner of working, driving the impotent and erratically acting part into a corner, as it were, would not be more exposed to such a fate as supposed than one acting unitedly, and right or wrong as a unit. It may not be susceptible of argument based on points of organic action, but it looks a plausible thing to me that the insane quality or element in such a brain might be acted on from without, and give itself up to such action, independent of the thinking will of that mind.

"But let us further suppose some little abnormality about the original constitution, a predisposition from a slightly dislocated arrangement of mind-apparatus and sense-apparatus.

"Such, say I once more, I believe to have been the case with myself, and such to be the true nature and essence of the things which have constituted my insanity. . . . I do not deny the fact of insanity, but I firmly believe that it is and has been, since the summer of 1872, an insanity involving the will, ideas, and acts of more than one individual.

"Notwithstanding my full and necessary faith in the reality of things as I have reasoned to prove them, I am still willing to concede that there has been more or less of purely subjective illusion mingled with these dual realities. Under one aspect the whole of this train of mental images and impressions which has whirled through my head. has consisted of insane delusion. The effect on the state of my system has no doubt been analogous to that produced by delusions, and the nervous condition which preceded it was such as eventuates in the rise of delusions. Does not the development of delusions often have a compensating effect in freeing the nervous system in a manner from its trammels? Perhaps when this supervenes the brain becomes a chimney for the combustion of the matters which threatened to entirely interrupt the action of the system by clogging. The patient is then known as sensible on most subjects, but a confirmed monomaniac.”

terest.

Certain peculiarities in his hallucinations possess considerable inThey almost always referred to the intercommunication of brains. In July, 1878, he wrote out a list of specimen phrases which he had heard while sitting alone at an asylum window. Some of these I reproduce here:

"One thing you know, you know when you get your will in there you get him into a hell of misery."-" He ain't got any will there to fool away."-"Although you are knowing his ideas you connect with her will." "Instead of connecting with his ideas you keep giving him to her."-"You can't get your will there till he connects his through to his thought."-"We are all the while trying to make him think himself." 66 I think we ought to be making efforts to get the idea out on the hall."—"After they get the whole will he is in a hell of torture all the while."-"We keep hollering till we get him into a hell of horrors."-" You see, when there are two wills connected with the head at the same time, he ain't nowhere."

These were the voices of several men and women. In fact, his hallucinations were always polyphonic, and at times would be polyglot. They did not address him directly, but spoke to one another about him. He seldom had hallucinations of hearing except when the ear actually received the sound of distant conversation or inarticulate noises; so that for their production it was usually necessary that there should be transmission of vibrations to the auditory cortical area. As instances of the polyglot character of the voices on occasion, I relate the following:

Once he heard some one call out, "If he ain't a prophet there never was a prophet-tabulas dedi ut vincerer." In tracing this Latin to its source, he found it was a perversion of a phrase in a note to Whiston's "Josephus":"Egomet tabulas detuli ut vincerer" (I myself carried the letter commanding that I be bound), attributed to Bellerophon, which he had once read.

At another time in a street-car, a German sitting next to him cried out, "Das ist das grösste Mirakel von der ganzen Welt. Jeder Gedanke der ihm in den Kopf gekommen ist hat die ganze Village gehört." (That is the greatest miracle in the world. The whole village has heard every thought that has come into his head.) The grammatical construction of the foreign phrases is open to criticism. The language used by his invisible tormentors was always a peculiar dialect, often abounding in slang, which he considered the most hateful kind of language, and which was such as he never voluntarily used in the composition of his own sentences. The hallucinations were usually boisterously satirical, teasing, quizzical, frequently accompanied by laughter.

Course and Prognosis.-The usual course of paranoia has just been outlined. Many cases, however, enter into a state of secondary dementia toward the last.

The prognosis is absolutely unfavorable. I do not know of a single case that has recovered. These patients may live to an advanced age, especially under the fostering care of an asylum. Remissions are

occasionally noted.

Morbid Anatomy.-The disorder is purely functional. No pathological changes have been found in the brains of paranoiacs. In some instances asymmetrical arrangement of the convolutions has been noted. These belong in the category of stigmata of degeneration.

Treatment.-Therapy does little or nothing for the disease once it has become established. Sometimes complete change of environment brings about a remission. Constant physical occupation, hard work out-of-doors, is perhaps the most useful of remedial agents, in that by this means the mind is diverted from the constant contemplation of hallucinations and delusions, and through bodily fatigue is made to receive a considerable amount of repose. Labor acts as a counterirritant. By it episodic outbreaks of excitement may be aborted or reduced in intensity. Prevention naturally would be of vast importance, were one able to anticipate the coming catastrophe in the prodromal period. Children and youths who exhibit such symptoms as have been described as incident to the hypochondriacal epoch of the

evolution of paranoia require a special system of education and training, in which occupation of the muscles and out-of-door life should play the chief rôle.

CHAPTER XIII.

IDIOCY.

Definition. In attempting to make a good definition and prepare a classification of idiocy, we meet with much the same difficulties as exist in connection with the allied subject of insanity. The innumerable definitions and classifications of insanity by different authorities are familiar to all students of morbid psychology. Each author feels called upon to be original in this particular, or at least to modify and improve upon the dicta of previous writers. This confusion is quite parallel in the matter of idiocy; and it is easy to understand why this should be so, for in both conditions we have deviations from the normal mental state of every possible shade and degree, depending upon a most varied pathology. The etiology is complex, and the psychic and somatic symptomatology multiform. There is no wonder, then, that the clinical picture is hard to draw, and the arrangement into clinical types difficult in the extreme. It is impossible to make any comparison between the psychological state of idiots and that of normal children, for the former is not only one in which the mental faculties are diversely undeveloped or impaired as regards their quantity, but there is infinite variation in the quality of the idiot's psychic functions. Likewise it is impossible to contrast the mental organization of the idiot with the intelligence of the lower animals, for the idiot is always abnormal, while the animal is a normal being in the zoological series to which he belongs.

What seems to be desirable in a definition is that there should be expressed in it the condition of mental weakness existing, the facts that the condition may be congenital or acquired, and may be due to a defect or some disease of the brain, and, further, that the condition is one belonging to the developmental period of life. A definition something like the following would seem to me to fairly express these desirable points:

Idiocy is mental feebleness due to disease or defect of the brain, congenital or acquired during its development.

Classification.-As regards classifications, they have been made upon a basis of symptomatology, psychology, etiology, craniology, teratology, and, to a certain extent, of pathology. But it seems to the writer that the time is not yet come for an accurately scientific classification of the forms of idiocy. It is much the best plan at present to adopt an artificial grouping, chiefly clinical, but pathological to the