The subject of this paper who records her own experiences was a Miss L. S—, described as a highly gifted and well-educated lady. She was admitted to the asylum at Zürich, December 21st, 1882, being then thirty-two years of age. There was a record of insanity in her family. As a child, she was intelligent, imaginative, and impressionable, unpractical, not good at arithmetic, but fond of drawing. As she grew up, she had religious scruples and doubts, especially about the time of confirmation. She was affected by listlessness and melancholy. At her own request, she was sent to a parsonage in the Pays de Vaud, where the cloud soon passed away. When twenty-one years of age, L. S— visited Italy. Amongst her Italian studies she read the Decameron. This book did not affect or excite her at the time, but left much that was impure in her memory, which had an evil effect in later days. She never read any other books of an indelicate character. She fell in love with a man with whom she used to study, who was nine years younger than herself. Apparently they were engaged to be married. He became insane, which deeply affected her. Before her own mental derangement she had a lasting dull headache, especially at the occiput, and sometimes pains and peculiar feelings in the head, but the attack of mania came on quite suddenly. When admitted to the asylum, she was very much excited, and seems to have been put under restraint and treated with the Deckelbad (the warm bath), the head remaining uncovered through a lid. She describes her terrors, the chain of ideas which rushed through her mind. She recalls that she used many words to which she gave quite a different meaning to that they usually bear; some of them were of provincial or of foreign origin. She did not think she was insane nor recognise her excitement, and was surprised that people were afraid of her. She could, however, appreciate the mental alienation of her fellow-patients. She took great pleasure in feeding birds; she had many hallucinations and dreams which passed into her memory as illusions. She heard voices though she denied it. Her hallucinations or delusions were of various kinds and degrees, rising from mere suppositions to convictions; sometimes when spectral figures appeared to her she would guess who they were, try to identify them with real persons; for example, she saw an elderly woman of commanding aspect, very pale, and dressed in white robes, whom she supposed might be Queen Elizabeth of England. In honour of this personage she thought she saw a young horse sporting about in the sea. Looking out at the window of her cell, she saw the figure of a little grey monkey, of almost human expression, rising from the ground, and making signs for her to come away with it. This she felt willing to do, and thought that there was a kind of understanding between them. Another time, she thought that she was in purgatory, and that her companions in the asylum were going through penance there. She believed that she saw Pope Leo XIII, Dante, St. Catherine of Siena, and Francis of Assisi, and nourished the delusion that her grandmother was the original of Gretchen in Faust, and that her family were connected with Goethe. She thought that the currents of air which passed through the gratings were intended as signals from persons who wished to help her, and she stuck little things in the wire to keep up the correspondence. The birds who flew about the windows she took as messengers of freedom. She heard a tumult outside which she believed to be caused by anarchists, and a hollow voice as if preaching, but so quietly that she could not follow the words. She also heard noises like that of machinery. She thought that her teeth had been so calcified that they were all grown together, and expected them to be forcibly separated. A large number of hallucinations and delusions are tabulated in a brief form. After thirteen months' detention in the asylum she was discharged cured, and although nearly twenty years have now elapsed, she has had no return of mental derangement.

The author describes one case of idiocy combined with athetosis, and gives a summary of the contributions which have been made to this subject. The number of autopsies of double athetosis is small. The lesions found in athetosis have been mainly of a hæmorrhagic character, though a few cases of atrophy and asymmetry of the brain, cerebellum, and bulb have been recorded. Athetosis is not infrequently met with in paralytic idiocy, although it often occurs where the intellect is not impaired. It seems needless, therefore, to treat what is merely a symptom of cerebral or nervous irritation as a concomitant of so profound an affection as idiocy.

He has made a careful study of twenty-two cases of this malady. Most of his material is taken from the hospital at Merxhausen, which receives incurable insane females from the province of Hessen and the principality of Waldeck. Out of 700 patients, there were 185 idiots, 22 of whom, i. e., about 12 per cent., were affected with cerebral paralysis. He deals with all the symptoms and pathology of the affection. In such cases the paralysis and idiocy is complicated by a variety of nervous symptoms, especially with epilepsy, which affects at least half the patients, and helps to increase the mental deficiency. Dr. Wachsmuth's paper fills forty-four pages. His experience leads him to confirm the observation of Bourneville, that epilepsy generally disappears between the fortieth and fiftieth years of life. A great part of our cases, he observes, have already passed this age, and they have no more epileptic attacks. In other instances a diminution of the epileptic attacks has been observed. Many of the cases of cerebral paralysis are regarded as being the sequel of encephalitis, sometimes caused by infectious diseases. Wachsmuth does not consider the amount of paralysis is a measure of the mental deficiency. This study of the subject has induced him to divide his cases into four classes.

The author describes two cases, the first, a man, æt. 31, who died after fourteen months' illness, with well-marked symptoms of general paralysis. Ten days before death various groups of muscles of the right side of the body (those supplied by lower branch of facial nerve, those of right side of tongue, external abdominal oblique, serratus magnus, biceps cruris, flexors of forearm) were affected by clonus, irregular, with short but distinct intervals; the clonus ceased with sleep, and had no effect on the movement of the muscles. It continued till his death. In the second case, a man, æt. 39, the muscles of face were first affected, and, after a short interval, the right side of body. The movements were arythmic, irregular, and rapid, diminished by movement, increased by an emotion; they ceased in sleep. The pectorals, the abdominal oblique (120 contractions per min.), the extensors of the forearm, and the adductors of the thigh (150 per min.) were all affected. Athetosis, affecting right hand, on one occasion supervened. The clonus later spread to left side of body. During the later stages of the illness they reappeared for a third time. The author points out the relative infrequency of the condition associated with the psychoses. He compares at considerable length the clonus with the allied muscular tremors in chorea in its various forms, and with the group of misclonus associated with epilepsy with a view to establishing the seat of the lesion. This is concluded to be in all these cases probably cortical.

The notes of three cases are given, preceded by an account of the observations made by others on this subject—Esquirol, Sérieux. Psychomotor hallucinations, verbal and graphic, appear to be rare in general paralysis, although one must not lose sight of the fact that their diagnosis in this condition is difficult, either on account of their transient character, or on account of the dementia of the patient.

The author has studied the condition of the genital sense in 108 general paralytics in relation to age, form of mental disorder, etc., and draws certain interesting conclusions. He finds that, for example, the self-satisfaction of general paralytics and their delusions of great physical strength are not due to genital over-activity. That disorders of the genital sense are not related to alterations of touch sensation or of sensation to pain, as has been held by some observers. In seven cases, especially where delusions concerning the genital organs were prominent and spontaneously related (notes given), it appears clear after reading the account given that the genital delusions have no physical basis, and do not seem to be related in any way with the state of the genital organs. Dr. de Montyel finds no relation either between the condition of the genital sense and the subjective sensations felt in the skin by certain general paralytics. Alcohol, of all causes, apparently is most frequently responsible for alterations in the genital sense, more especially in the direction of increase.

This is a lecture on fixed ideas and obsessions. For the genesis of these two lactors are necessary, first, an excessive condition of feeling; second, a congenital or acquired weakness of mental constitution. The difference between them and paranoia consists in the fact that in the case of obsessions there is no alteration of the personality. The author divides them into (1) obsessional emotions, (2) obsessional ideas, and (3) obsessional impulses. This is not a rigorous psychological distinction, but it is justified by the prevalence of one of the elements constituting each group. The emotional group may be divided into repulsions (or phobias) and imperative desires. The phobia may be general or for one determinate object only. Under the heading of obsessional desires are included dipsomania and certain other drug habits. The obsessional impulses are distinguished by their motor content; as these become more automatic they pass into the group of ties. Obsessional ideas have frequently a hypochondriacal basis. They are rarely accompanied by hallucinations. As regards prognosis there are two classes of cases, first, those in which the original psychical weakness is hereditary or dates from early infancy; second, the cases in which the weakness is acquired. In the first class the outlook is very grave and amelioration only results where development and education are very favourable. Other functions may through time become affected, but it rarely passes into other forms of insanity. Agitated melancholia may, however, develop. Suicide is rare, those affected being generally undecided. The treatment is largely general. Muscular and mental exercises are of benefit, as also outdoor work and electricity. If neurasthenia be present it is an indication for treatment; suggestion may also be tried.

The writers contribute, in this paper, the results of observations made at the Pennsylvania School for Feeble-minded Children at Elwyn, Pa., but state that this is only a partial representation of their work.

In this article, the author studies the cases of 284 young male patients, between fifteen and thirty years of age on admission to the Philadelphia Hospital, having excluded all those who were plainly imbecile, epileptic, or paretic. After alluding to the histories of these cases, alcoholic in forty-four,—although most of these he believes, were moderate drinkers,—he asks “What relations have the doctrines of degeneration with our present subject?” and points out that Esquirol and Morel have observed the tendency of hereditary insanity to appear at puberty and in adolescence, and that the latter author more definitely states that at this period degeneration reveals itself. A degenerate history was obtained in more than three quarters of the author's cases. The anatomical marks of degeneracy also were common, but unfortunately no systematic study of these was made. Obsessions, the psychic stigmata of degeneration according to Magnan, he believes with Régis are rather actual insanities, disorders of the will on a basis of neurasthenia; coming and going with the state of nervous health they are stigmata only as insanity itself is a stigma: to serve as a real test of degeneration, a stigma must be permanent. Only by close anatomical study on a large scale with classification of stigmata, can degeneration obtain a useful clinical significance. He agrees with Morel that the theory of degeneration should be kept single and thought of mainly as related to heredity. It is important not to confuse the two uses of the word “degeneration,” the one being proper to psychiatry, the other to pathological anatomy. With Jaffray he thinks that “to be insane, the patient must be degenerate.”

The notes of an interesting case are given—fully and carefully recorded as Bourneville's cases generally are. A. G—, a girl æt. 14 years was admitted into the Fondation Vallée, March 4th, 1899. Her family history was very bad—father, alcoholic and violent; mother, hysterical, then insane; grandparents, neurotic, as well as several uncles and aunts. The patient was possibly conceived when her father was drunk, her mother being at the time liable to attacks of hysteria. She had once convulsions limited to the face; up to the age of twelve years she had nocturnal incontinence, and after this had attacks of depression, of alternating crying and laughter. When her mother was placed under care, the girl was placed in an orphan school at Les Andelys, where, no doubt, under the influence of the separation from her mother and religious practices she developed mystical delusions—she thought she was Joan of Arc and had blessed visions, etc. A few days later she came under Bourneville's care. The mystical delusions persisted for a few days, and after a short remission (March 9th—23rd) were followed by a period of maniacal excitement—crying, singing, incoherent purposeless movements, extravagance, dirty habits, and insomnia. The attack lasted a week, and was followed by a remission (March 30th—April 21st) after which she was somewhat melancholic for a while, although free from hallucinations and mystical delusions. On May 1st she was practically well. About a year later, menstruation appeared, without any mental disturbance. The treatment consisted in baths and douches, with the administration of chloral and bromides to combat the insomnia and excitement; general exercises, occupation, etc., afterwards.

This is a case with a long chronic evolution, which shows the narrow relations which may exist between dreams and delusions. Whether dreaming during sleep, or apparently at times dreaming when awake, the patient presented persistent delusions which were grafted on or sprang from the dreams, and occasionally led to acts. O. L— was aged 49 when he came under the authors' care, having been in the post office for twenty-four years; he complained of pains in the lower limbs, which exaggerated a natural limp (due to former injuries), and pains in the head, which he referred to visions he had recently experienced. The patient had written a long account of these hallucinations, which revealed two dominant ideas: (1) that the patient was God's elect, and (2) that he was persecuted. To explain them he referred to certain episodes which had occurred far back in his life, and the visions seemed to be of two kinds: (a) representations of his ordinary life; (b) supernatural. As regards these supernatural visions, a few of these were extra-terrestrial (referring to the heavens, to the sun, etc.), but most (a large number altogether) were terrestrial (a rainbow descending about the patient's head, beholding Christ on the Cross appearing on a newspaper he was reading, a star falling and the moon stretching out to catch it, etc.). Hallucinations of hearing occasionally accompanied the last-mentioned hallucination of vision. The ideas of persecution arose in his mind at the time of appearance of these visions; they mostly referred to his thoughts being read. The various hallucinations appear to begin in dreams, during which he is authorised to divulge them, etc.

The case simulates a form of alcoholism. Nightmare, dreaming prolonged into the waking state, general mental confusion superadded—these represent the degrees of infection acting on the brain, and well illustrated in the notes of this observation.

This is a continuation of a paper on dreams (see Revue Scientifique, March 30th, 1901), and deals especially with the dreams of epileptics. Reference is made to Duaste's cases, in which dreams occurred during the epileptic seizure only (Journal de Médecine de Bordeaux, Nos. xlviii and xlvix, 1899); but the possibility of the dream being merely an aura must not be dismissed. Certain characteristics of epileptic dreams are to be noted: the predominance of the colour red; certain parts of the body especially figure: the head, the sexual organs, the chest; the introduction of strong animals, the act of falling, etc.

On January 12th, 1901, H—, æt. 40 years, was admitted to Sainte Anne Asylum, having just escaped imprisonment, owing to Dr. Garnier's certificate of “mental debility, melancholia, confusion of ideas, excitement at intervals, want of appreciation of his condition, etc.” A few days later he came under the care of Dr. Marie at Villejuif. He became troublesome on account of his pilfering habits. On seven or eight occasions he robbed patients of such things as books, ink-stands, pencils, etc. When the objects were found in his pockets, he always maintained that he was driven to steal in spite of himself. In March, he was placed on a diet without salt—or rather with a minimum of salt—(75 grains a day in his bread and milk); in addition, he was given 30 grains of bromide of potassium per diem. On the first day, (March 1st) of this treatment he committed a robbery, but never after. Moreover, his demented appearance improved somewhat, and he became sociable with the other patients; towards the middle of the month he began to occupy himself. At the end of March, he was put on ordinary diet, and the bromide of potassium suppressed, but the kleptomania did not recur. From April 1st to June 19th, he was quiet and well behaved, and presented nothing unusual. Suddenly, on June 15th, he presented slight left hemiplegia on getting up in the morning; he got up, although dazed and complaining of severe headache; at 7 o'clock he was seized with epileptiform convulsions lasting five minutes, followed by coma with high temperature, and ending fatally on the third day. There was marked albuminuria. Venesection was performed. At the autopsy large congested inflamed kidneys were found, and hypertrophic cirrhosis of the liver. The interest of the case is the apparent cure of the kleptomania under the influence of the bromide and cutting off the table salt.

The author describes under this heading a group of cases in which the mental disturbance is always associated with subjective psychical facts. He divides his thirteen cases into three groups. In the first, some illness has directed special attention to the organ afterwards believed to be diseased. In the second, the individuals thought they had heart disease, after having seen cases of it in others. In the third, the psychical trauma was caused by some marked agency as death of friends or parents. The symptoms were mild depression, confusion, and ideas that some organ was diseased. These cases come on in apparently healthy individuals and heredity is generally absent. They differ from hysteria in the absence of any objective phenomena and from phases of pathophobia in being unattended by any signs of degeneracy. The author considers that they arise from the impression absorbing in a morbid way the attention of the subject, and producing the beginning of an association of ideas.

This is a very complete clinical report of a case of some interest. The patient, a man, æt. 68, with nothing special in his family history, had contracted syphilis at the age of 21; twenty years later, after a period of intense brain work, he had a sudden attack of localised frontal headache with paresis of the right side. The paralytic symptoms cleared up rapidly, but the patient remained subject to headache and vertiginous attacks, and also to periodic fits of morbid anger with impulsive violence to things and persons about him. Latterly, these symptoms increased, and the patient's mental power declined.

The author points out, that in relation to crime, it is necessary to consider separately the periodic attacks and the intervallary condition of the epileptic. Of the former he distinguishes three varieties— (1) absences, or petit mal; (2) convulsive attacks; and (3) attacks characterised by phases of altered consciousness—psychic epilepsy. It is regarding the last class of epileptic phenomena—the most important in legal medicine—that Benedikt's remarks are specially interesting. He points out that in these epileptic dream-states the actions performed may be very complex, and may have the appearance of deliberation; that memory may be partially retained for events at any period of the attack; and that the attacks may last for hours, days, or even longer. He considers that such prolonged attacks have affinities with periodic insanity and with dipsomania.

The catatonic condition has as much individual existence as any other form of primary dementia; it is episodic in following other morbid psychical processes. The condition is said to be caused by a particular form of cortico-psychical inhibition, combined with a subcortical inhibition and excitation, particularly of the cortical centres.

The patient was a lad æt. 18. At six years suffered from periodic frontal headaches and hebetude. After two years had vertigo and “absences.” The character changed, and he became strong and irritable. He attempted murder at seventeen, and shortly thereafter had the first attack of “classical” epilepsy. This was followed at intervals by other seizures, and he died in status epilepticus. The autopsy showed numerous cysticercus cysts in the pia, some on the surface free, others embedded in the cortex, which tore as they were removed. These cysts varied in size from a pin's head to a small hazel nut. There were a few subcortical cysts, some in the basal ganglia and lateral ventricles. The pons, cerebellum, and cord were free from cysts, as were also the internal organs. Cysticercosis produces in the brain the same symptoms as other focal lesions. When multiple, and especially when they arise in the period of development, they may produce, instead of an epileptiform phenomenon, a true epilepsy.

This is the third paper by this author on the same subject. In this case the types of alteration of the nerve-cells were two:—First, the disintegration of the chromatic substance which, reduced to fine granules, was scattered uniformly through the cell, rendering it homogeneous; the nucleus central and unaltered. This is the usual type following toxines. Second, the type with central chromatolysis and deformity, and displacement of the nucleus. This is the type following the cutting of the axis-cylinder process. In this case, this was associated with degeneration of the fibres of various parts of the motor tracts, and was probably an example of the secondary degeneration of the nerve-cell from “reaction at a distance.” The lesion in the pyramidal tracts of the cord stands in relation to the symptoms presented by the patient, e. g. hypertonus, exaggeration of the tendon reflexes, paresis of the upper limbs. The curability of such cases is not in contradiction with the anatomical facts, as the alteration in the nerve-cell is reparable. The primary degeneration of the fibres is probably due to the same toxine as had produced the nerve-cell change.