Group. No. M. F.

TABLE II.-MANIC-DEPRESSIVE CASES ANALYZED AS TO COURSE.

(Subsequent history from other hospitals. Status on discharge from the Psychopathic Hospital not considered.)

Sex.

6

4

I

6

2

2

Depressed

agitated Depressed not

ret'd or agit. 6 3 3

Depressed ret'd

and agit. ... 2

2

38 13 25

I I

II

5

22

6

I

5 3

TABLE III.-ANALYSIS OF DELUSIONS MANIC-DEPRESSIVE Cases.

The first three of these occurred in maniacal cases, and are plainly quite different from the last three, which were found in depressed cases. The latter also suggest strongly perversions of the sensory apparatus.

Hallucinations play a very small part in the manic-depressive group. They are clearly present in three cases (882) "little voices inside," (1768) “auditory hallucinations," (772) "voices in stomach reveal things." The two in which the content of the perceptions is mentioned are thus somatic. It will be noticed also that these somatic hallucinations like the somatic delusions in the depressed cases mentioned above are also absurd.

DEMENTIA PRÆCOX.

In 27 cases of mental disorder appearing after 40, the diagnosis of dementia præcox appeared justified. There were eight males and 19 females. Reports of the subsequent courses were obtained in 19 cases. Ten were still in hospitals unimproved, four years later. Three were reported unimproved four to six months after leaving the Psychopathic Hospital. They were transferred to other hospitals and the later history is unknown. Within a year after leaving the Psychopathic Hospital, four were reported improved, three being discharged and one being sent to another institution. One died of lobar-pneumonia, mentally unimproved, after two years.

Only one case was reported as definitely recovered. This was a married woman aged 54, (348). Upon entrance to the Psychopathic Hospital she was said to have been mentally disordered for about six years but "not bad until a few days ago." She was in the Psychopathic Hospital eleven days, and was then transferred to another state hospital from which she was discharged as recovered four months later. She had been addicted to alcohol but had used none for several months. She felt as if "under a spell.” She complained of an electrical machine under her bed which she had heard working for years. It made her talk and yell and " drew the life out of her." She was also jealous of her husband, with what reason is not known. She was described as somewhat depressed, without any marked motor phenomena and with no insight.

The eight cases which not were followed after leaving the Psychopathic Hospital were all unimproved upon discharge. The duration of the disorder before commitment was stated as from six months to two and a half years. Delusions were expressed in 26 cases, the one exception being mute. In 20 cases delusions and hallucinations were the prominent features. In three of the hallucinated cases and in four of those in which hallucinations were not observed there were striking disturbances of conduct, stupor, fixed attitude, mutism, stereotypy, echopraxia, etc.

One case (1083) a male, aged 44, was committed to the Psychopathic Hospital after a mental illness of two months. He was depressed, had a feeling that some calamity impended, and was restless, contrary and disagreeable. He was classified as a manic-depressive, depressed phase, and after six days transferred to another state hospital. A report obtained after four years states that he has grown steadily worse and is "resistive, indifferent and with stereotyped speech."

Family history of mental disease was mentioned in only three cases of the 27. Of one (1853) the note is made, "Brothers were all abnormal, epileptics, tramps." One female (246) was the third case of insanity in the direct family line. One (273) has an insane son. Two are said always to have been peculiar.

Summary. On the whole the 27 cases seem to be no different from cases of dementia præcox arising earlier in life. Most of them fit very well the Kraepelinian paranoid group. In only seven are the features commonly called katatonic prominent.

UNCLASSIFIED.

Introductory. The chief problem of the present paper lies in the 41 cases remaining after the exclusion of the previous groups. Thirty-two of the 41 cases were females. Of the cases which were transferred to other hospitals reports of the further course were obtained in 21. In only six of these did the final diagnosis agree with that made at the Psychopathic Hospital. For the sake of brevity, the 21 cases are shown in tabular form.

It will be noticed that some of the cases in the group of 41 have been assigned either at the Psychopathic Hospital, or another hospital, to one of the groups previously considered. It has been my intention to include in those groups only the cases which from symptomatology and course appeared pretty certainly

TABLE IV.-UNCLASSIFIED CASES IN WHICH SUBSEQUENT HISTORY WAS

The 20 cases which were not followed after they left the Psychopathic Hospital received the following diagnoses:

to belong there. It is on account of a lack of these characteristics that the present group has been excluded. Some of the cases perhaps present too few facts to be of much value. Others are, according to the standard mentioned, too anomalous. While the data at hand, as mentioned earlier under the heading of "Nature of Material" are sufficient to admit of placing typical cases in their respective groups, they are by no means adequate for the establishment of new groups. Such an undertaking should properly demand not only a minute and extensive study of course and symptomatology in a large number of cases throughout life with psychological analysis of the individuals, but also thoroughgoing studies of pathological anatomy. Kraepelin's tentative and rather apologetic study of presenile psychosis with its inconclusive results gives an indication of the difficulties to be met in this field. While our facts are too meager to allow any attempt to establish groups, they are of practical service in at least one particular, namely, prognosis. It is of value also to find out what correlations there may be between a good or a bad prognosis and other data, such as character of delusions, hallucinations, affective state and psychomotility.

In addition to the 21 cases with subsequent history shown in Table IV, there was one case which died at the Psychopathic Hospital and three cases in which the mental disorder had begun more than two years before admission. Although the latter course of these is not known they can with advantage be included in the former group.

Of the 25 cases, five died, four were discharged as recovered, seven are said to be improved and nine were at the latest report not improved." These four groups will be considered separately.

CASES DEAD.

Always

1016.-Male 55, unmarried. Duration given as two months. queer. Thinks he has been ill-treated. Fears he has been poisoned, food is tampered with. He has been kidnapped. He has to go to hell. Memory all gone (not true). Has been ruined by masturbation; talkative about himself, depressed. Pupils small and irregular, react to light and upon accommodation. Slightly deaf. Peripheral arteries hard and tortuous. Cause of death, acute purulent meningitis.

723.-Female 52, unmarried. Duration 15 months. Insists that house in which she rooms belongs to her. Physicians are representatives of police sent to annoy her. Physicians are representatives of police sent to