dementia, though as we know by the outcome of such cases there is no permanent defect.

So, concludes Wernicke, judgment defect in mental disease permits the conclusion that dementia or weak-mindedness is present, only in so far as the defect is related to other matters than the delusion or other elementary psychic symptoms. Having made this reservation, however, he finds mistakes in judgment a valuable clinical sign; for example, when a patient, otherwise without clouded consciousness, fails to recognize as pathological the very disordered behavior of fellow-patients, or when a bookkeeper who can no longer do simple sums correctly nevertheless thinks of returning to his earlier responsible situation. The behavior, according to Wernicke, is the best proof of judgment ability. Herein he is in accord with Mercier' who has always insisted that conduct is the main thing that is disordered in insanity. “It is disorder of conduct that gives to insanity its whole significance. Disorder of mind without disorder of conduct, if it were possible, would be unimportant; if it were important, would be unrecognizable; and thus the first essential to a knowledge of insanity is an enumeration of the main features of conduct, and of the ways in which conduct may be disordered."

In many cases the weak-mindedness is seen in decline in the number of concepts with a consequent actual lack of ability to distinguish between certain closely-related ideas, such as between civilization, culture, nation, State, religion, belief, etc. Tact and cleverness, and especially the ability to express oneself happily, are valuable criteria for the establishment of the presence or absence of feeblemindedness. In very low orders this lack of discriminative ability is shown to a very marked degree. And we have here, therefore, a quantitative estimate of the lack in the content of consciousness. In certain cases a diminution of retentivity forms a parts of the dementia, but this is also found in acute cases where there is no dementia. The same may be said of attention. The highest grades of dementia are always characterized in that the attention can be aroused or fixed only with difficulty, if indeed at all.

Having thus endeavored to outline the striking characteristics of dementia in general, Wernicke endeavors to pick out for the different varieties the hall-marks which give varying color accord

ing to the separate etiology. He finds but few striking, distinguishing features. Relating particularly to paretic dementia, he speaks of the character changes and of the psychic incoördination and of the verbal images lost in the reverse order to that of acquirement, so that a more and more simple character obtains, approaching nearer and nearer to the child type. In postapoplectic dementia he finds emotional incontinence of special importance; in the epileptic terminal states, irritability and intolerance, tendency toward outbreaks of violence and occasional attacks of rage. In addition he finds an outward display of piety of very frequent occurrence. Retentivity is comparatively little affected, while there is, on the other hand, a loss of comprehension which is found very great and which is particularly visible in the labored verbal expression. In the alcoholic form of dementia there is emotional dullness and brutality even where there is little defect in mental endowment. In hebephrenic dementia there is an unripe developmental condition corresponding to puberty. There is childishness, silliness, foolishness. Laziness of thought is to a certain extent specific and results in the characteristic nonsense answers or approximate answers (Vorbeireden, Danebenreden). Gradually there develops an unmistakable resentment and sullenness against required mental exertion. The patient withdraws from all conversation, demands to be let alone, and finally, if the effort is persisted in by a second person, angry outbursts result. Attention is hard to arouse but retentivity is surprisingly good and considerable fragments of earlier knowledge are often exhibited to the great surprise of the observer. Facial expression remains much more lively than one would expect from the degree of dementia. In senile dementia there is general mental dullness, an egoistic retraction of interest and, above everything else, an almost complete loss of retentivity and a corresponding loss of memory for the immediate past which is combined with confabulation.

And yet, after a close study of the problem as presented by such a master as Wernicke, we are left with a feeling of dissatisfaction as to the final result of the attempt at a solution of the difficulty; a feeling that after all even he, with the best possible good-will and expenditure of his best effort, has laid down that problem not quite answered. It is asking much of our insatiable

demand for narrower delimitations of scientific terms to accept as belonging to one head two conditions of which one is characterized by a loss of comprehension of external impressions, clouding of consciousness, even disorientation, a destruction of retentivity, and loss of memory with but moderate emotional defect; and the other, with no disturbance of these intellectual elements, but, on the contrary, a characteristic deterioration of the affective processes. The conditions would seem to be almost opposite and contradictory in nature, and our willingness to accept this grouping is strengthened by such statements as that of Ziehen to the effect that the defect psychoses can be characterized as organic, and psychoses without intelligence defect as functional. That macroscopic or microscopic changes can be shown in the cerebral cortex in the former but not in the latter, and particularly when we know that no characteristic organic changes have been found in dementia præcox and that closer psychological analysis tempts us to doubt the existence of a genuine intellectual, as opposed to an affective, defect and suggests the possibility that these cases may in the end be found to be more functional than organic.

In conclusion, we may indicate that in psychiatry we have arrived at the place where we must look to our terminology and that we cannot afford to proceed with our studies until we have defined clearly and sharply even the most simple of those psychiatric substantives which are the sine quâ non of psychiatric thought.

INSANITY AND SUICIDE.'

BY CHARLES W. PILGRIM, M. D.,
President N. Y. State Commission in Lunacy.

That insanity and suicide are increasing out of proportion to the increase of population cannot be denied. The statistics of England, as well as those of the United States, show beyond doubt that there is a disproportionate increase in the number of insane to the general population, which cannot be explained by the oft-repeated statements that this increase is due to the accumulation of old cases whose lives are prolonged by the better care of the present time.

In the State of New York, where statistics are kept with unusual care, the State Commission in Lunacy, in its Seventeenth Annual Report which has just been prepared, states that in 1892 the population of the State was 6,513,343, and the number of insane in all of the institutions of the State was 17,275, a ratio of one insane person to 377 of the general community. On the 1st of June, 1905, the population of the State was 8,066,672, and the insane under treatment in the different institutions amounted to 27,300, a ratio of the insane to the general population of one to 299. In addition it is estimated that 6000 insane persons are being cared for in their homes in the State of New York, which would bring the ratio to the alarming figures of one insane person to every 242 of the general population.

An increase similar to that in the State of New York is reported by the Commissioners in Lunacy of Great Britain. I think, therefore, we must admit the unpleasant conclusion that there is an undue increase in the number of the insane.

That suicide is also increasing at a rate to cause surprise and alarm is positively shown by the statistics which Mr. Frederick L. Hoffman, statistician for one of the great insurance companies, 'Read at the sixty-second annual meeting of the American MedicoPsychological Association, Boston, June 12-15, 1906.