It is held by many observers in institutions for the care of idiots and feeble-minded children that the child that has been born with defective intellect is more susceptible of improvement by physical and intellectual training than the child that has been born with full possession of his brain power, and has afterward, by accident or disease, been deprived of it. Idiocy, save in some myxedematous types, is never curable, but improvement is possible in nearly all cases, ranging from the slight regeneration in the matters of cleanliness and destructiveness in profound idiots, to the utter transformation of feeble-minded individuals who, left to themselves, would be troublesome and dangerous members of the community, into such useful, obedient, docile folk, that, while acting under the supervision of judicious minds, they differ in no marked way from people of low but normal intelligence. In public institutions for idiots there is a tendency to separate them into those who are teachable and those who are unteachable. Epileptic and paralytic idiots, idiots with malformations, marked cases of hydrocephalus and microcephaly, are almost incapable of advance. At all events, such an outlay of time and money and skilled training is required that the state would not feel justified in defending the expenditure to its taxpayers. Moreover, the length of life in profound idiots is usually short, making such teaching unfruitful, except in private families of means. Amaurotic idiocy, a rare form, is almost always fatal in infancy. Cases of hydrocephalic, microcephalic, and myxedematous idiocy are very short-lived, and death usually interrupts any improvement in childhood. Diplegic and paraplegic idiots seldom live to be twenty years of age. It is generally stated that thirty years is the limit of life in idiocy, though hemiplegic idiots rarely may live to be forty. In making a prognosis with reference to life, it must be remembered that it depends directly upon the degree of injury to the brain. General Treatment of Idiocy.-The treatment of the idiot involves the employment of both physician and teacher. The adjective medico-pedagogic is made use of to designate this combination of medical and educational features for the care of the defective classes. In the union of the two professions for such purposes the educator occupies relatively the higher and more important position. The inestimable services of trained caretakers or nurses are not to be overlooked. That patient will profit most who receives the properly combined aid of the best physician, best teacher, and best nurse. As a rule, this fortunate concurrence of necessary aids is more apt to be found in the public or private institution than in the home; but that it is possible to carry on treatment at home under favorable circumstances is not to be gainsaid. The methods of procedure formulated by Itard, expanded by Seguin, and employed at the present time everywhere in private and public institutions for idiots, modifications induced by experience and the progress of educational science, are well described in the writings of Bourne ville, Shuttleworth, Ireland, Down, and others. A brief résumé is given below of the process of— Education of Idiots. From two years of age, the defective or idiotic child may be taught with painstaking be taught with painstaking care to do what other children learn by observation and imitation. The process of education is in most cases pursued with the following distinct purposes in view : 1. To develop the attention and sharpen the five senses. 2. To develop coördinated movements and strengthen the muscles— (a) To teach to walk; (b) to teach use of the hands. 3. To inculcate habits of cleanliness in person and dress. 4. To teach the patient the use of language. 5. To arouse the intellect by including ideas of length, weight, surface, solids, form, and number. 6. Finally, to carry the education higher, by means of studies in natural history and all sorts of manual and industrial and moral training.1 1 Peterson, Mental Diseases, 1898. MENTAL PERVERSIONS OF THE SEXUAL INSTINCT. THE revolting sexual vices and acts that form the subject of the sections on Impotence, Sterility, Rape, etc., are by no means all the crimes that are or that may be essentially sexual in nature. Many atrocious and degenerate acts that on the surface seem devoid of sexual relations in reality have solely a sexual origin. Until this sexual relation was demonstrated, such seemingly motiveless atrocities stood out in the annals of crime unexplained and inexplicable. Observations and studies made during the later decades have clearly defined the causal factors that underlie the crimes done out of lust, perverted sexual feeling, and psychosexual perversion. These factors are essentially mental, and therefore the study of them forms an important chapter of medicolegal psychopathology. Westphal was among the first of modern alienists to call scientific attention to certain forms of psychosexual perversion, though they had been known from the time of the early Persians, and had made their impress on the Greek and Roman civilizations, as is only too eloquently told by the imperishable monuments of depravity and degeneration preserved in Naples-brazen testimony of iniquitous vices that transforms into material reality the traditions of Sodom and Gomorrah. Many writers have done much to elucidate this subject; Tarnowsky, Moll, Schrenck-Notzing, and Krafft-Ebing have treated it more or less systematically, but to the latter we owe the most thorough consideration of it in its important medicolegal bearings. The subject is an extensive one, requiring for treatment in detail much more space than can be given it here, but fundamental facts and accredited theories can be sufficiently outlined to give a comprehensive view of the subject. Sex and sexuality lie in something more than mere physical organs of sex they enter into the very essence of mentality, and mark it as distinctly with sex as the distinguishing organs do the body. This mental side of sex is commonly spoken of as sexual instinct. The normal sexual instinct is one in harmony with the physical sex and its role in the function of procreation. When the manifestations of sexual feeling or inclination deviate from this normal relation, the sexual instinct is said to be perverted. The origin and nature of the perversions to which it is subject can be understood only through a clear comprehension of the circumstances and the relations that attend the origin and development of the normal sexual instinct. The usual correspondence of physical sex and sexual instinct leads at once to the conclusion that anatomic sex and psychic sex constitute two harmonious congenital endowments. But cases in which, instead of this correspondence, there is total lack of harmony between physical sex and sexual instinct, as when a man feels sexually as a woman feels, or vice versa, are not rare, and they have been explained by assuming that in them there is a congenital lack of normal adjustment of physical and mental endowment in the individual; hence arises the class of cases of sexual perversion known as congenital. In other cases the normal harmony, manifested for a time, has given place finally to a change in the mental side of sex, in the nature of inversion of sexual feeling; these are called acquired cases. Obviously, this division of cases into two classes rests upon the assumption of independent but harmonious physical and mental factors operating in embryo to evolve sex and sexuality that are normally in harmony; then the cases in which lack of harmony is manifest from the beginnings of sexual feeling are explained by initial lack of correspondence between the primary factors influential in determining the physical and mental sexual characteristics. Practically the only criteria available for determining whether a given case of sexual perversion is congenital or acquired are facts bearing upon the nature of the earliest manifestations of sexual feeling. When from the first these have been opposed to the anatomic sex, the case is classed as congenital. But facts and evidence of this kind, when derived from testimony based on the memory of the individual concerned, cannot be regarded as constituting more than a tentative foundation for the erection of a scientific theory. As will be seen hereafter, the motives that impel an individual to consider his anomaly congenital are so strong that, with the best of intention, his testimony concerning his early sexual manifestations is apt to be colored in his own favor morally. This will suffice to show the purely theoretic basis of this classification; but it may be further justified by general consideration of the origin and development of sex and sexuality, and we shall be led to make certain modifications of the theory in harmony with practical experience gained in observation of actual cases of sexual perversion. The human embryo has within it the morphologic representation of both sexes. The subsequent attainment of distinctive organs of one sex is made possible by development of one set of organs, with arrest of development of the other. The cause acting to determine development of one set of organs with arrest of the other is not definitely known, but it seems probable that it is more or less closely connected with nutrition. The well-known effect of quality and quantity of nutriment upon the sexual development of the queen bee is an illustration of this influence. Since the embryo has the anatomic possibility of becoming male or female, it must also normally possess the cerebral possibility of developing a sexual instinct appropriate to male or female. But this does not imply that there are in the embryo the germs of all the various psychic elements which characterize what we recognize as sexuality in its complete development: the facts can be rationally clear only when they are studied in the light of psychology. We must separate the necessary original endowments of instinct from those psychic elements which are the complicated product of original endowment influenced by environment. The sexual instinct is made up of a fundamental element and numerous secondary elements. The fundamental element is general in quality; the secondary elements are special and distinctive of the sex. The simple or fundamental factor in sexuality is nothing more than an impulse to genital stimulation, for the repetition and development of which the quality of pleasure in the act is essential. This fundamental endowment is the only essential original sexual element, and it is common to both sexes. Out of it arise the secondary psychosexual characteristics that, aside from anatomic form, distinguish the sexes and make them mentally, as well as physically, complementary. In reality this fundamental sexual element is only remotely or secondarily psychic; it is rather reflex in nature, the psychic aspect of it being derived from an experience of spinal reflex activity. It is indeterminate in direction beyond the immediate pleasure experienced in genital stimulation, and, without the opportunity of widened experience or teaching, it would not develop in the individual the secondary psychosexual elements that make up the complete sexual instinct. Thus far the argument has assumed that the secondary psychosexual elements of the sexual instinct are the result of training and not the expression of an inherent, inherited, and congenitally implanted set of ideas. The justification of this assumption is to be demonstrated most clearly by showing that the series of associated ideas that comprehends what we understand by the normal, complete, and harmonious sexual instinct, is not subject to the laws of transmission and inheritance, and therefore cannot be congenital. The secondary psychosexual elements are purely psychic: they consist solely of ideas and emotions-viz., knowledge of self as the representative of a sex; knowledge of other representatives of a complementary sex; ideas of the mutual relations of self and the opposite sex; and desire, intensified with pleasurable emotion, to realize these relations with one of the opposite sex. These elements, called secondary, are thus classified because on any hypothesis they must be allowed to be of later development than the instinct to simple genital stimulation. Certainly such elaborate mental pictures as these are not given complete by progenitors to descendants. Ideas per se cannot be transmitted or inherited; our so-called mental endowments are, in fact, organic endowments which make possible certain mental developments which we are accustomed to think of inaccurately as mental inheritances. The brain organization which makes possible the ultimate development of ideas is all that is transmitted and inherited in relation to ideation and emotion. How then does the case stand with regard to the congenital implantation of a cerebral organization that shall permit, in the sexual aspect of the mind, only the development of certain ideas with accompaniment of sexual emotion, desire, and genital excitement? To make this possible, there would necessarily be required a distinct and specific sense organ and cerebral centers, and |