developed. At ten yards' distance you would say he was an ordinarylooking young man. When you observe him closely you see there is a weakness in his expression of face, a lack of mind in his eye, and a sort of shuffle in his walk, while all his movements lack purpose and conciseness. When he smiles he looks silly, and his speech is rather defective. You see at once there is no force in him of any sort, motor or mental. When further tested, his memory is seen to be defective, he cannot tell you how much four added to four and two off is. He can write, but like a schoolboy. You see that he is unfit to guide himself, to manage his affairs, to earn unaided his livelihood, or to resist any sort of temptation put in his way. He is in good bodily health, eats and sleeps well, enjoys simple pleasures like dancing, concerts, and juggler's entertainments, and may live long.

E. C. is a good type of the most common form of congenital imbecile. There are others where one has much more difficulty in determining whether they shall enjoy civil rights and liberty, be allowed to marry, etc., being very near the minimum legally sane line. Such persons become the dupes of designing people, cannot resist temptation, or control natural desires, and often become the worst kind of dipsomaniacs. Some imbeciles show special talent in certain directions, some in music, some in drawing, some in imitation, some in a kind of constructiveness; some, who are of a criminal class, are bad and depraved from the beginning-are born imbecile criminals. As to treatment, the great things are, carefully to develop the body, to keep it always fat, not to give much animal food or stimulating diet, especially at puberty, to train in good habits-bodily, mental, and moral-to make their lives systematic and orderly, to avoid occasions of ill-temper, to punish justly and usually by deprivation of indulgences, to send to institutions for training and not to ordinary lunatic asylums till this is unavoidable.

Congenital imbeciles may have attacks of maniacal excitement or melancholic depression-in fact, are subject to them. They may become dangerous and even homicidal; they may, after an attack, have secondary stupor, or may become demented as compared with their primitive condition. They are often terrible masturbators.

IDIOCY. I find the most useful classification of idiocy is that of Dr. Ireland, as follows: 1. Genetous; 2. Eclampsic; 3. Epileptic; 4. Paralytic; 5. Inflammatory; 6. Traumatic; 7. Microcephalic; 8. Hydrocephalic; 9. By deprivation of the senses; and 10. Cretinism.

Genetous idiocy is that variety which begins before birth. E. D. is a very unfavorable case. She is now twenty-four, and never showed any mental potentiality at all from the beginning. She showed no affection, no clinging to anyone in particular, not even like that of a dog to those who fed her and were kind to her. She has never had any understanding of anything, never could speak, always grunted in that animal-like way you hear, never showed curiosity, imitativeness, or power of attention. You see her body is squat and ugly, her temperature low, her palate acutely arched, and her teeth irregular and few in number. She has from childhood beaten her head with her hands, as you see her now doing, just as the gorillas beat their breasts in the African woods. Her face is utterly unhuman, hence such cases have been called theroid or beast-like.

The evolutionists would find many proofs of reversion to conditions common in the lower animals in her. When you place a tumbler of water on the floor before her, you see she kneels down and laps it with her tongue. She has not a rudimentary sense of decency or sexual feeling. Such a case is beyond the reach of teaching or training of any sort. Nothing can be done but to feed and clothe her and keep her clean.

The next case of E. E., is a much more hopeful subject. He, too, is a genetous idiot, and is small, ill-developed, rather deformed, bandylegged, cold, feeble in muscle and trophic power, but he in a way understands some things you say to him, is always smiling, is gentle, has been taught to be cleanly and almost tidy. He has no sexual feelings, cannot read or write or count, and will probably die of consumption.

The genetous form the largest class of idiots, vary greatly in the mental capacity present, and many of them can be trained in training schools, and made more human and comfortable.

The eclampsic idiots are those whose brains have been injured, and their development afterwards retarded by convulsions at dentition. They are an unfavorable class as regards training. The damage done to the brain and its envelopes is usually demonstrable after death.

I produce before you a whole series of epileptic idiots. Their characteristics are: 1. That they vary in mental condition very much according to whether they are taking fits or not at the time. 2. That the effect of

the constant recurrences of the epileptic seizures is such on the brain that it tends to lose the effects of training and to deteriorate.

Take this example of E. F., now sixteen, who has taken fits since he was a year old. At times he is gentle and teachable, and works in the garden, and enjoys life; then he will have a few epileptic fits, and he will be stupid, dirty in his habits, and will forget all his training. After that he will be for a day or two irritable, violent, impulsive, and even dangerous. He articulates in a childish way. He is getting worse, and will, no doubt, die some day in a fit or after a series of fits. I have seen the steady use of the bromide of potassium very useful in such cases, lessening the number of the fits and their severity, diminishing the irritability, and improving the nutrition. We have one boy here who is quite another being for the past four year under twenty grain doses three times a day.

says;

The paralytic form of idiocy is represented by this case of E. G., who was normal in body and mind till he was four years of age. He then had an apoplectic attack, and his left hand, arm, leg, and left side of his face and head are partially paralyzed, ill-developed, and the limbs shrunken, flaccid, and useless ever since. He takes sporadic epileptic attacks. He tries to articulate, but you cannot make out what he he is restless, irritable, not very educable, weak, and cold. Such cases, looked at from the motor point of view by the general physicians, are called cases of Essential paralysis of infancy. The degree to which the paralysis and the mental affection are found in different cases varies from sanity to idiocy, from the slightest weakness to complete paralysis, shrivelling, and shrinking of the limbs. The pathology of those cases is very interesting. Often the convolutions in the affected hemisphere are found damaged and atrophied, the lower ganglia and centres undeveloped, and one-half of the spinal cord, as well as the motor nerves from it to

the affected side, atrophied or not developed. I have never been able to understand why cerebral apoplexies occur in infancy. I am inclined to think that they are often not effusions of blood, but vaso-motor spasms from neurotic causes affecting certain of the cerebral vessels, and resulting in trophic damage to the parts of the brain deprived of blood.

The inflammatory idiocy results from the inflammations and sloughings that affect the throat and ears in scarlet fever spreading inwards and damaging the brain. Certain portions of the organ are usually found to be hypertrophic in those cases. It is a very unfavorable variety.

The traumatic variety is much like the inflammatory, or sometimes like the paralytic form, and results from falls and blows on the head.

The microcephalic is a very interesting variety of idiocy. On the whole, the heads of idiots are smaller than those of sane persons, but there are many exceptions to this rule, and, as a matter of fact, the average sizes of the heads of idiots are as large as the minimum sizes of perfectly sane persons. Ireland says: "The size of the head gives no estimate of the comparative intelligence of the (idiotic) children." There is, however, a certain minimum size below which a head is incompatible with average intelligence. I believe a circumference of below eighteen inches means idiocy. Very typical microcephalics are rare, but, when seen, they make a strong impression. They look so impish and unearthly. They are usually active, alert, mischievous, imitative, intractable. I have no really good specimen, but E. H., with a head of eighteen inches in circumference, a small face, a small but perfectly wellformed body, an active, imitative way, and a restless manner, gives an idea of one. Her only deformity is a cleft and acutely arched palate. She just looks like a small dried-up woman, with small features and a most singular expression of face, and she smiles as if a baby was imitating the features of an old woman. Microcephalics should always be sent to training schools. They are often educable up to a certain point, and, if not educated, they are often little demons. Their muscular activity must find an outlet.

The hydrocephalic variety of idiocy is very common, but I need hardly say to you that hydrocephalus with even enormous enlargement and great deformity of the head is perfectly compatible with sanity. It usually has a dwarfing and, often, a deforming effect on the body. A small head is no proof that there has not been hydrocephalus.

E. I. is a good example of a hydrocephalic idiot. She is now ten, and is slow in her movements, very gentle and patient, sometimes cries and moans, as if she had an organic sensation of discomfort in her head. Her head is globular, the fontanelles raised, the temples projected. She looks unhealthy, has scrofulous glands, and a feeble constitution. Her temper is good. She is educable, and worth educating. I am going to have her sent from this to an imbecile training institution. Drs. Batty Tuke and Campbell Clark described very fully the condition of the brain in hydrocephalic idiocy. The former found enormous hypertrophy of the neuroglia, and the latter found a floating lobe or portion of brain, unattached to any other nerve tissue, which could never, therefore, have exercised nerve functions, yet it had nerve cells and fibres in a primitive form.

Idiocy may occur by deprivation of the senses only. The famous case of Laura Bridgman, who was blind, deaf, and dumb, and with an indistinct sense of smell, but with common sensation, through which Dr. Howe educated her brain, developed intelligence and emotion, and raised her from a condition of absolute idiocy to one of great mental capacity, is and will always be the classical case of idiocy by deprivation. She differed essentially from most other forms and cases of idiocy in having a brain well developed and apparently normal in all respects, except that its inlets and outlets were obstructed. Ordinary deaf-mutism is closely allied to idiocy, and is one of the hereditary neuroses. it is a physiological sin that marriages between such persons should be legal.

To me

Cretinism is an endemic disease occurring in connection with goitre in some valleys of mountain chains, such as the Alps, Cordilleras, and. Himalayas, and not found here, so I need say nothing about it. It is very interesting from an etiological and pathological point of view, and has quite a literature of its own on the Continent.

LECTURE VIII.

STATES OF MENTAL STUPOR (PSYCHOCOMA).

You will not find stupor put among the ordinary symptomatological varieties of mental diseases, along with mania, melancholia, etc. This I think is a mistake. The only objections to its being so placed are twothat it is not commonly a primary disease; and that the word stupor does not imply to the lay or even to the medical mind any necessary mental disease at all, as they understand it. But these objections should not prevent us using the word to express in a correct scientific sense a morbid mental condition, which is different psychologically and clinically from all other morbid mental symptoms, which, while it lasts, demands different treatment from them in many cases, and has a different course and termination. Stupor used in this strict medico-psychological sense may be thus defined: "A morbid condition in which there are mental and nervous lethargy and torpor, in which impressions on the senses produce no outward present effect, in which the faculty of attention is or seems perfectly paralyzed, in which there is no sign of originating mental power, in which the higher reflex functions of the brain are paralyzed, and in which the voluntary motions are almost suspended for want of convolutional stimulus, but where the patients usually retain the power of standing, walking, masticating, and swallowing.'

I look on mental stupor as essentially the expression of an exhausted, lowered, and devitalized brain.

A typical case of this condition stands for hours where he is placed in the same attitude, when spoken to he takes no notice, he shows no active desires or affections, he does not speak or move, or show any interest in anything. His expression of face is vacuous, his vaso-motor power is usually much below normal so that his extremities look blue and are cold, he does not obey the calls of nature, or take any notice of them at all. Loud sounds make no impression, pleasant or terrible sights that would in others produce motion and emotion fail to do so. A woman once committed suicide by hanging herself in a dormitory at Morningside in the presence of another woman in a condition of stupor, who took no notice whatever of this frightful sight.

Looking at the condition of stupor from the point of view of the physiology of the brain, we see that its power of receiving impressions from without is in abeyance, and its higher reflex functions are suspended. The mental and motor irritation of a full bladder or loaded rectum is not felt by the higher brain centres; and when through the action of the lower centres, evacuations take place, there is either no consciousness on the part of the higher centres, or, if there is, it does not result in the volition that prepares suitably for them, or in the vexation that would be