CHAPTER XVII. Degeneracy of Mentality and Morality

DEGENERACY OF MENTALITY AND MORALITY

In the mental and moral degeneracies there is a complete transition from the durencephalic monster through the microcephalus, the idiot, the imbecile, and the feeble-minded to the mentally normal individual. Between the feeble-minded and the normal individual occurs a group whose general characteristics is, as was pointed out by Magnan, a disharmony and lack of equilibrium, not only between the intellectual operations, properly so-called on the one hand, and the emotions and propensities on the other, but even between the intellectual faculties themselves. A degenerate may be a scientist, an able lawyer, a great artist, a poet, a mathematician, a politician, a skilled administrator, and present from a moral standpoint profound defects, strange peculiarities and surprising lapses of conduct. As the moral element--the emotions and propensities--is the base of determination, it follows that these brilliant faculties are at the service of a bad cause, of the instincts and appetites which, thanks to the defects of the will, lead to very extravagant or very dangerous acts. In other cases the opposite occurs. Degenerates of irreproachable character show strange defects in their intellect. They often have a feeble memory in certain directions. Sometimes they cannot understand figures, or music, or drawing. In a word, an otherwise normal individual's intelligence is lacking as regards certain faculties. The centres of perception are unequally impressionable, unequally apt to gather together impressions, only certain impressions are registered and leave durable images; certain relations, certain associations between different centres, are perverted or even entirely destroyed.

The mental stigmata of degeneracy, therefore, may be divided into those involving the moral elements (in which case there is no very striking intellectual disorder) and those involving the intellectual elements, in which the conditions may be divided into states where intellectual disorder alternates with periods of complete lucidity or with neuroses (periodical insanity, neuroticism, hysteria, and epilepsy), and states in which the intellectual disorder is a permanent quantity (paranoia, one-sided genius, imbecility, and idiocy). Great as is the apparent gap between idiocy and one-sided genius, on the one hand, and between idiocy and crime, on the other, this gap is, as already stated, filled by numerous closely interlinked forms, dependent on the proportionate removal of checks (which the race has acquired during evolution) on the explosive expressions of egotism and mentality. The removal of these checks is dependent on the removal or weakening of the power of associating tracts, to which reference has been made in connection with the degenerate brain. The idiot, capable only of purely vegetative functions, who would perish were food not placed far back in his mouth, is one step lower than the normal infant, who is essentially, as has been remarked, an egotistic parasite. On slightly increased development this idiot, with the powers of a rather low animal, gains food and satisfies its instincts. These instincts at this stage may manifest themselves in the explosive manner characteristic of the undomesticated and non-social animals. With these instincts may appear others which man has long lost; thus an idiot girl (who was delivered of an infant when alone) gnawed through the umbilical cord in the manner of animals, thus effecting separation and preventing hæmorrhage. At still a higher stage the imbecile may manifest destructive instincts, may steal without the signs of remorse displayed by a housebred dog, or may kill without recognising the results of killing. The intellect may be comparatively developed in certain imbeciles in comparison with the ethical defects. For lack of proper associating fibres, the imbecile may be unable to acquire those higher associations constituting the secondary ego, in the most elevated sense. To this class ultimately belong the instinctive homicides, torturers, sexual criminals and thieves, so frequently found among the juvenile offspring of degenerate stock. In them the primary ego is strong, and the restraints of the secondary ego, which perceives the rights of others, weakened or completely absent. This class forms the germ of the congenital criminal whom no discipline can tame, and who is incapable of being taught the dangers of his procedures under the law of the land. Between this class and the paranoiac there is at once a curious likeness and distinction. The lack of proper associating powers prevents the moral imbecile from recognising any rights of others. The same lack in the paranoiac prevents him from recognising the force and rights of other people in opinion. The moral imbecile has lost the greatest acquirement of the race in evolution, that acquirement which fully recognises the secondary ego in accordance with the sublime precept, "Do unto others as ye would that they should do unto you."

For practical purposes the division of criminals given by Tyndall is sufficient. Crime is essentially an anti-social factor, and violations of law can be regarded as crimes only in proportion as they are anti-social. The essential character of crime is its parasitic nature. Parasites, in a general way, may be divided into those which live on their host, without any tendency to injure his well-being (like the dermodex in the skin follicules); those which live more or less at his expense, but do not tend to destroy him; and, finally, those which are destructive of the well-being of man and lack proper recognition of individual rights which constitutes the essential foundation of society. The first type is impurely represented by the idiots, imbeciles, lunatics, paupers by deprivation, blind, crippled, senile, insane, and deaf mutes. Society, either indirectly or directly, has been the source of the parasitic state of many of these, and hence, as also in the case of law-made criminals, such parasitism really takes nothing from society. The second class is represented by prostitutes, sexual degenerates, paupers, and inebriates. Some of these, however, could be put into the third class, among those moral lunatics and criminals who fail to recognise that individual rights constitute social order. Prostitutes, paupers, and inebriates have this in common, that crime in them has taken the line of least resistance. The great ethical defect in the prostitute is not lack of checks on explosive sexual propensities so much as the use of these last as a method of living by her wits. In essence prostitution is the expression of the criminal tendency manifested by the confidence operator. The researches of sociologists like Chaplain Merrick, of the Millbank Prison, London, show that at least one-half of the prostitutes leave their homes voluntarily to take up a "life of pleasure." Pauline Tarnowsky finds that in Russia prostitution is crime in women taking the line of least resistance. The prostitutes, like the other criminals, are divisible into criminals on occasion (vice, monetary reasons, &c.), accidental criminals, law-made criminals, weak-willed criminals, and insane criminals. The proportion of the law-made and accidental criminals among the prostitutes is much less than among other criminals, as Merrick has shown. Seduction stands very low in the list of causes. The proportion of the occasional criminal type is very large. Pauline Tarnowsky concludes from her researches, which my own tend to verify, that the prostitute, as a rule, is a degenerate being, the subject of an arrest of development, tainted with a morbid heredity, and presenting stigmata of physical and mental degeneracy fully in consonance with her imperfect evolution. C. Andronico, of Messina, Italy, arrived some time previously at the same conclusions as those of Tarnowsky. Tarnowsky found that 44-1/3 per cent. of the prostitutes had skull deformities, 42-2/8 face deformities, 42 ear deformities, and 54 teeth deformities. Andronico found among 230 prostitutes the following anomalies: Flat nose, 20; handle-shaped ear, 35; vicious implantation of teeth, 10; convergent strabismus, 2; facial asymmetry, 4; prognathism, 7; receding forehead, 35. Grimaldi, in a study of 26 prostitutes, had similar results to those of Tarnowsky. Lombroso, in an examination of 50 prostitutes, found exaggerated jaws, 27 times; plagiocephaly, 23 times; nasal asymmetry, 8 times; exaggerated zygomæ, 40 times. Tarnowsky found that in 150 prostitutes, taken at random from those answering to the necessary conditions (uniformity of race, ability to give their family history and years of residence in licensed houses), there were present signs of physical degeneracy in 87. Among the abnormalities were oxycephaly, platycephaly, stenocephaly, plagiocephaly, and heads with marked depression either at the bregma or the lambda. The majority had a marked development of the external occipital protuberance; in an equal number of virtuous women it was present but four times. These and other anomalies were thus distributed among the 150 prostitutes: Malformation of the head (oxycephaly, plagiocephaly, &c.), noticed in 62; development of the occipital protruberance, 62; very receding foreheads, 18; hydrocephalic, 15; various anomalies of the face (prognathism, asymmetry), 64; ogival palatine vault, 38; congenital division of palate, 14; vicious implantation of teeth, 62; Hutchinson's and Parrot's teeth, 19; absence of lateral incisors, 10; Morel ears, 16; defective ears (detached from head, deformed, &c.), 47; anomalies of the extremities, 8.

In my researches in the same class, with the assistance of Harriet C. B. Alexander and J. G. Kiernan, the subjects chosen were those committed to the Chicago House of Correction. They are the least intelligent of Chicago's professional prostitutes. The number examined was 30. As regards the race they included 13 Celtic-Irish, 5 Irish-American, 3 Scandinavian, 1 German, 1 German-American, 2 American, 1 English-American, 1 Latin-Swiss, 2 Negro.

It should here be remembered that the "fine" system of Chicago places only the "obtuse" class in the Bridewell. One was seventeen years old, two eighteen years, one nineteen years, five between twenty and twenty-five years, three between twenty-five and thirty, six between thirty and thirty-five, five between thirty-five and forty-five, one was forty-six years old, two were fifty-five, three sixty-one, and one sixty-five. There were eighteen blondes, ten brunettes, and two negroes. Four were demonstrably insane and one was an epileptic.

In sixteen cases the zygomatic processes were unequal and very prominent. There were fourteen other asymmetries of the face. Three heads were Mongoloid (one Irish-Celt, one Swiss, and one Scandinavian). There are Mongoloid race types in the regions where all three come from. Sixteen were epignathic and eleven prognathic. In one there was arrested development of the lower jaw, and in four arrested development of the face bones. The nose was abnormal in six. There were sixteen brachycephalic and thirteen mesaticephalic skulls. There were no dolichocephalic skulls. There were three with oxycephalic skulls, of whom one was a Celt, one a German, and one a Scandinavian. There were eighteen dome-type skulls, of whom seven were Irish-Celts, five Celtic-American, one English Anglo-Saxon, one American Anglo-Saxon, and one German-American. There were four tectocephalic skulls, of whom one was an Irish-Celt, one an Anglo-Saxon American, and one a Scandinavian. There were three platycephalic skulls, of whom two were Celts and one a Scandinavian. There was a plagiocephalic German and a stenocephalic Celt. One skull had a protuberance at the bregma. Twelve occiputs were flattened, and in four of these there was no tubercle; eighteen had an enormously developed occipital protuberance. The percentage of deformities of the jaws was large. Twenty-nine had defective ears. Normal ears were present only in a member of a family which had furnished one mother and two sisters to the institution.

The direct hereditary history of prostitutes is excellently illustrated in Marie Duplessis, idealised by Alexandre Dumas in La Dame aux Camélias. Her paternal grandmother, who was half prostitute, half beggar, gave birth to a son by a country priest. This son was a country Don Juan, a peddler by trade. The maternal great-grandmother was a nymphomaniac, whose son married a woman of loose morals, by whom a daughter was born. This daughter married a peddler, and their child was Marie. She had the confidence-operator tendencies of many of her class. She died childless, early in life, from consumption. With their ancestry, habits, perverse instincts, prostitutes cannot be cured or reformed by the enforcement of municipal ordinances. Though those of criminal and congenital type be taken from their surroundings and placed where they can earn an honest livelihood, they soon go back, voluntarily, to their old mode of life.

An allied class, belonging to a still blacker phase of biology, are the sexual perverts. The congenital form associated with the stigmata of degeneracy, as already shown, is an expression of the defective line whence the victim has sprung. The congenital types are, like the similar types of the prostitute, victims of inherited defects. The sexual pervert may be divided into precisely the same classes as other criminals. The congenital type often links degenerate lunatics, epileptics, &c., with a born criminal class.

Between the criminal and the insane is a debatable line occupied by moral imbeciles, reasoning maniacs, &c. There are many insane persons in whom the principal deviation from the normal consists in disorder of the moral faculties. In most closer inspection generally reveals signs of degeneracy. The seeming immorality is the striking factor of the case and superficially the mind otherwise appears clear and rational by contrast. As Krafft-Ebing has shown in these cases, the most striking features are moral insensibility, lack of moral judgment and ethical ideas, the place of which is usurped by a narrow sense of loss or profit, logically apprehended only. Such persons may mechanically know the laws of morality, but if such laws enter their conscience these persons do not experience by any real appreciation, still less regard, for them. These laws to them are cold, lifeless statements. The morally defective know not how to draw from them motive for omission or commission. To this "moral colour-blindness" the whole moral and governmental order appears as a mere hindrance to egotistic ambition and feeling, which necessarily leads to negation of the rights of others and to violation of the same.

These defective individuals are without interest for aught good or beautiful, albeit capable of a sentimentality which is shallow cant. Such persons are repellent by their lack of love for children or relatives, and of all social inclinations, and by cold-hearted indifference to the weal or woe of those nearest to them. They are without other than egotistic care for questions of social life or sensibility to either the respect or the scorn of others, without control of conscience and without sense or remorse for evil. Morality they do not understand. Law is nothing more than police regulation. The greatest crimes are regarded as mere transgressions of some arbitrary order. If such persons come in conflict with individuals, then, hatred, envy, and revenge take the place of coldness and negation, and their brutality and indifference to others know no bounds.

These ethically defective persons, when incapable of holding a place in society, are often converted into candidates for the workhouse or the insane hospital, one or the other of which places they reach after they have been, as children, the terror of parents and teachers, through their untruthfulness, laziness, and general meanness, and in youth the shame of the family and the torment of the community and the officers of the law, by thefts, vagabondage, profligacy, and excesses. Finally, they are the despair of the insane hospital, the "incorrigibles" of the prisons, and (Krafft-Ebing might have added) the veritable burdens of the poor-house. If intellectual insanity or crime do not claim them, pauperism or criminality is likely to be their destiny. The moral imbecile may, however, keep within the law, and as in the instance of the "Napoleon of Finance," cited elsewhere from Kiernan, may achieve business success. His descendants often, however, evince degeneracy in an aggravated form. Many of the supposed reformers of various alleged social evils are often of this class. Their morbid egotism takes the direction of cant and sentimentality, so common at certain states in evolution, as points of least resistance. Like Guiteau, the assassin of President Garfield, they aim at doing a "big thing for humanity and myself," the humanity being concentrated in "my" ideas. The moral lunatic needs but a slight twist intellectually to become the paranoiac in whom there is, as Spitzka has pointed out, a permanent undercurrent of perverted mental action peculiar to the individual, running like an unbroken thread through his whole mental life, obscured, it may be, for these patients are often able to correct and conceal their insane symptoms, but it nevertheless exists, and only requires friction to bring it to the surface. The general intellectual status of these patients, though rarely of a very high order, is moderately fair, and often the mental powers are sufficient to keep the delusion under check for practical purposes of life. While many are what is termed crochety, irritable, and depressed, yet the sole symptoms of the typical cases of this disorder consist of the fixed delusions. Since the subject matter of the delusion is of such a character that these patients consider themselves either the victim of a plot or as unjustly deprived of certain rights and position, or as narrowly observed by others, delusions of persecution are added to the fixed ideas, and the patient becomes sad, thoughtful, or depressed in consequence. The patient is depressed logically, as far as his train of idea is concerned and his sadness and thoughtfulness have causes, which he can explain, and which are intimately allied with that peculiar, faulty grouping of ideas which constitutes the rendezvous, as it were, of all the mental conceptions of the patient. Nay, the process may be reversed, and the patient, beginning with a hypochondriac or hysteric state, imagines himself watched with no favourable eye. Because he is watched and made the subject of audible comments (hallucinatory or delusional), he concludes that he must be a person of some importance. Some great political movement takes place; he throws himself into it, either in a fixed character that he has already constructed for himself, or with the vague idea that he is an influential personage. He seeks interviews, holds actual conversation with the big men of the day, accepts the common courtesy shown him by those in office as a tribute to his value, is rejected, however, and then judges himself to be the victim of jealousy or of rival cabals, makes intemperate and querulous complaints to higher officials, perhaps makes violent attacks upon them, and being incarcerated in jail or asylum, looks upon this as the end of a long series of persecutions which have broken the power of a skilled diplomatist, a capable military commander, a prince of the blood, an agent of a camarilla, a paramour of some exalted personage, or finally the Messiah Himself. All through this train of ideas there runs a chain of logic and inference in which there is no gap. If the inferences of the patient were based on correctly observed facts and properly correlated with his actual surroundings, his conclusions would be perfectly correct. For years and years many such patients exhibit a single delusive idea as the only prominent symptom. There is hereditary taint in most of these subjects, who are strange in disposition from infancy. As children they frequently shun society and indulge in day-dreams. Their bodily growth is normal, but even trifling disease takes on a cerebral tinge. They may show talent in special directions, but their intelligence rarely passes out of the puerile stage. They often brood over a feminine ideal, a girl who has never encouraged them, and whom they persecute with absurd plans of marriage.

Connecting the paranoiac with the moral imbecile are the so-called "reasoning maniacs." Here the intellectual power is less than either that of the moral imbecile or of the paranoiac, twisted though the intellect of the latter be. Loquacious or unusually taciturn, heedless or morbidly cautious, dreamers, wearisome to all brought in contact with them, capricious and unmitigated liars, their qualities are often, in a certain manner, brilliant, but are entirely without solidity or depth. Sharpness and cunning are not often wanting, especially for little things and insignificant intrigues. Ever armed with a lively imagination and quick comprehension, they readily appropriate the ideas of others, developing or transforming them and giving them the stamp of their own individuality. But the creative force is not there, and they rarely possess enough mental vigour to get their own living. Passing without the slightest transition from one extreme to the other, they felicitate themselves to-day on an event which they sneered at the night before. In the course of a single second they change their opinions of persons and things, novelty captivates and wearies them almost in the same instant. They sell for insignificant sums things they have just bought, in order to buy others which, in their turn, will be subjected to like treatment; and, strange to say, before possessing these objects, they covet them with a degree of ardour only equalled by the eagerness they exhibit to get rid of them as soon as they become their own. To see, to desire, and to become indifferent are three stages which follow each other with astonishing rapidity.

The intense egotism of these persons makes them, as W. A. Hammond remarks, utterly regardless of the feelings and rights of others. Everybody and everything must give way to them. Their comfort and convenience are to be secured though every one else is made uncomfortable or unhappy; and sometimes they display positive cruelty in their treatment of persons who come in contact with them. This tendency is especially seen in their relations with the lower animals.

Another manifestation of their intense egotism is their entire lack of appreciation of kindness done them or benefits of which they have been the recipients. They look upon these as so many rights to which they are justly entitled, and which in the bestowal are more serviceable to the giver than to the receiver. They are hence ungrateful and abusive to those who have served them, insolent, arrogant, and shamelessly hardened in their conduct toward them. At the same time, if advantages are yet to be gained, they are sycophantic to nauseousness in their deportment towards those from whom the favours are to come.

The egotism of these people is unmarked by the least trace of modesty in obtruding themselves and their assumed good qualities upon the public at every opportunity. They boast of their genius, their righteousness, their goodness of heart, their high sense of honour, their learning and other qualities and acquirements, and this, when they are perfectly aware that they are commonplace, irreligious, cruel, and vindictive, utterly devoid of every chivalrous feeling, and saturated with ignorance. They know that in their ratings they are attempting to impose upon those whom they address and will even subsequently brag of their success.

It is no uncommon thing for the reasoning maniac, still influenced by his supreme egotism and desire for notoriety, to attempt the part of reformer. Generally he selects a practice or custom in which there really is no abuse. His energy and the logical manner in which he presents his views, based as they often are on cases and statistics, impose on many people, who eagerly adopt him as a genuine overthrower of a vicious or degrading measure. Even when his hypocrisy and falsehood are exposed he continues his attempts at imposition, and when the strong arm of the law is laid upon him, he prates of the ingratitude of those he has been endeavouring to assist, and of the distinctiveness and purity of his own motives.

Closely akin to that instability of inter-association resulting in loss of proper checks on action in the types just described, is the sentimentalism which often covers real hardness, but which charms and allures the mass.

This has essentially the same psychological basis as the suspicional tendencies and pessimism with which it is so often associated. Suspicional tendencies arise from states of anxiety resultant on instability of association, dependent on lack of associating fibres. Pessimism (so frequently present in the otherwise healthy degenerate) is often, as Magalhaes has shown, nervous instability with alternations of irritability and prostration. The subject is supersensitive; impressions call forth intense and prolonged reactions followed by exhaustion. The state is characterised by a general hyperæsthesia, which naturally results in an excess of suffering. From instability and hyperæsthesia results discord between the feelings themselves, between the feelings and the intelligence, between the feelings, the ideas and volitions. Discord between the feelings shows itself in a great variety of paradoxes, contradictions, and inconsistencies. To the pessimist possession of a desired object does not atone for former privation. Pain or unsatisfied desire is replaced by the pain of ennui. With inability to enjoy what he has are coupled extravagant expectations regarding that which he does not have. He is extremely susceptible both to kindness and to contempt. He passes suddenly from violent irritability to languor, from self-confidence and vanity to extreme self abasement. His intense sensitiveness results in intellectual disorders. For this involves a great vivacity of the intuitive imagination, which favours the setting up of extravagant ideals, lacking in solid representative elements. Hence a gap opens between his ideal and the actual. He can never realise the ideal he pursues and so his feelings are of a sombre hue. From this excessive realism results a state of doubt, a certain distrust of all this rational objective knowledge. It assumes another form in extreme subjectivism. The pessimist is haunted by images of the tiniest religious scruples, suspicions, fears, and anxieties, resulting in alienation from friends, seclusion, misanthropy. The pessimist is further characterised by an incapacity for prolonged attention, a refractory attention and a feeble will. These result in inaction, quietism, reverie, self-abnegation, abolition of the personality, annihilation of the will, amounting sometimes even to poetic or religious ecstasy. Pessimism is frequently associated with a morbid fear of death. The tramp is one phase of the degenerate in whom the restless wandering tendencies of the neurasthenic and paranoiac are added to the parasitic tendencies of the pauper, and the suspicional egotism of the "reasoning maniac."

The one-sided genius is a link between the neurotic, the epileptic, the paranoiac, the hysteric, and the imbecile. Cases crop up in which all these elements are so mingled as to create a puzzle where they shall be placed. In some cases, in accordance with the general law that physiologic atrophy is accompanied by hypertrophy in other directions, the intellectual powers other than along certain lines may be remarkably deficient. Moreover, the intellectual power due to healthy atavism is increased by the degeneracy in certain directions. Without going into the question, raised by Lombroso, as to genius being an epileptoid neurosis, sufficient evidence exists to show that ill-balanced genius often coexists with defects in a large number of directions. The coexistence of genius with imbecility and even idiocy has been well illustrated by Langdon Down, who cites numerous instances thereof. Defect in genius, whether of the imbecile stamp or otherwise, accompanied by deficiency, is not expressed in the genius, but in its deficient accompaniment. Even the mental instability of the highest type of defective genius is closely akin to that of the neurotic.

The hysterics, as has been shown by Des Champs, are neurotic women in whom an aggravated sensibility exists. Neurotic women are divisible into three categories according to the predominance of one of three centres--cerebral, genital, and neuropathic. These types may be pure or intermixed. The general characteristics are an absolute want of equilibrium in sensibility and will power. There exists mobility of humour in direct relation with facile impressionability to external influences or to internal states. The nerves vibrate to all sentiments coming from within or without, and all are registered without proper relation. One fact chased by another is forgotten. Another produces a momentary hyperexcitation, which takes place of the truth, whence it is that falsehood is instinctive, but the patient protests her good faith if accused of the same. This lack of equilibrium leads to a decided modification of the mental faculties. Intellectual activity is over excited, but in diverse degrees and variable ways, according to the particular tendencies adopted. Absorbed by a preoccupation or controlled by an idea, they become indifferent to all else. Their ideas are abundant, and they rapidly pass from the idea to the act. Their vivid imagination, coupled with a bright intelligence, gives them a seducing aspect, but their judgment is singularly limited, attenuated, or false. They judge from a non-personal standpoint excellently. They are quick at discovering the faults of even their own relatives, but faults rightly attributed to themselves are repudiated. Their memory is capricious. They forget their faults and their acts under impulse, albeit these may be consciously done. The cerebral type is led by the intelligence. She has little or no coquetry; what coquetry there may be is the result of intention and temporary. There is an ethical sense, frankness and nobility in her ideas, disinterestedness and tact in her acts, and she is capable of friendship. Her tastes carry her to male pursuit, in which she succeeds. She becomes often what is called a "superior woman," and too often what is called an "incomprehensible woman." She has but little guile. To the sensual type voluptuousness is the aim of life and the centre of her acts and thoughts. She is well endowed with guile and extremely diplomatic. She is full of finesse, but not very delicate. Her lack of scruple often spoils her tact. She is ruseful, dissimulating, and unconsciously mendacious. She despises friendship and needs watching. If circumstances permit she loses all delicacy, reserve and modesty. She is destitute of scruples. Her crimes are coolly remorseless. The neuropathic type is one to which the grasshopper is a burden. Her nerves are always on edge. She is a heroic invalid who displays the air of a martyr about trivialities.

The character of the neurotic, as Kiernan remarks, recalls the observation of Milne-Edwards concerning the monkey character. Levity is one of its salient features, and its mobility is extreme. One can get it to shift in an instant from one mood or train of ideas to another. It is now plunged into black melancholy and in a moment may be vastly amused at some object presented to its attention.

Neuroticism in man differs in no respect from that in woman except that anæsthesia, paralysis of emotional origin, and conscious convulsions are less common. The male neurotic could be subdivided precisely as Des Champs has the hysteric. Neurotics are often long-lived, peculiarly resistant to certain acute and fatal disease, and are frequently retentive of their youthful appearance, which is to a certain extent an evidence of their resistance to the wear and tear of life and advancing old age, and due to emotional anæsthesia. Recognition of the neurotic tendency often induces the individual to take better care of himself. The youthful appearance may be due largely to arrest of facial development at an early age, the face thus retaining the child character throughout life. Considering, therefore, this class of neurotics, which does not include those afflicted with the more serious nervous disorders such as epilepsy, they may be looked upon as the victims of evolutionary processes that are constantly going on in the race and under civilised conditions.

Neurotics are not met with to any extent among barbarous races, but are numerous in civilised communities, where the weak are preserved from early death and then subjected to the struggle for existence. Neurotics are individuals naturally imperfect in some directions, but by the law of economy of growth they are often superior in others. Their disordered nervous functions and hyperæsthesia are not, necessarily, indicative of inferiority of general organisation compared to their ancestry. They may simply imply a more rapid advance in some one direction in the development of the nervous system than can be kept up with by the remainder. These defects may in some cases be the advance guards in the progress of the development of the race.

As the nervous system controls nutrition in all departments of the organism, anomalies occur with erratic nervous functions in such individuals. In these neurotics are often found defective development involving the bony and other structures. They have fine and delicate features, small jaws and defective teeth. These are the results of general systemic modifications connected with the neurotic state. The arthritic diathesis occurs also; it is one of the underlying conditions of many neurotic manifestations, often responsible for acquired bony deformities, not infrequently involving the jaws to some extent.

Neurotic degenerate symptoms from a mental standpoint are noticeable long before deformities of the osseous system are developed. They show themselves in mental weakness, extreme stupidity, and precocity. Under the first class the child is obstinate, quarrelsome, malignant, even immorally inclined, and is often spoken of as being wicked or vicious. Harriet C. B. Alexander says the ruling instinct in the child of three or four is self-gratification. It destroys what it dislikes. Among the earliest manifestations of morbid mental activity in childhood are hallucinations, which depend on already registered perceptions.

In many instances even moral agencies produce sudden explosions of mental disorders. The inherited tendencies of childhood predispose to these attacks. As Clouston has shown, neuroses and psychoses not requiring hospital treatment are by no means uncommon in the too sensitive child with hereditary taint. Children of this class have crying fits and miserable periods on slight or no provocation. As Clouston has also shown, precocity, over-sensitiveness, unhealthy strictness in morals and religion for a child, or too vivid imagination, want of courage, thinness and craving for animal food, are common characters. These children are over-sensitive, over-imaginative, are too fearful to be physiologic, and tend, as a general thing, to be unhealthily religious, precociously intellectual, and at first hyperæsthetically conscientious.

The other class of children, as a rule, are very handsome babies and children. The brightness is noted by parents at a very early age, and they extol their many clever qualities and sayings. The tendency is for the parents to cultivate these precocious qualities and believe it to be the proper thing to encourage them; while in early life this class may possess the peculiarities of the other class and also show those of degeneracy. These children are the best scholars in the schoolroom and learn their lessons with apparently little or no study. They are usually thin, frail children, and very nervous. Very little food is taken and much of that is not assimilated. Especially is this true of the lime salts, which form bone and tooth structure. These lime salts are excreted through the kidneys and salivary glands. This is easily demonstrated by an examination of urine, mouth, and teeth. Large collections of tartar are always found in these cases. Children of both classes are sure to show stigmata of degeneracy. This period of degeneracy commences at the sixth year, or at about the time the first period of brain development ceases. The bulk of the brain has obtained its growth. In some the child commences to improve mentally very fast. In others mental development is slow. In still others it ceases altogether. From the time the second set of teeth begins to develop until the twelfth year, neuroses of development and stigmata of degeneracy are stamped upon the head, face, nose, jaws and teeth, and later any of the conditions mentioned under the heads of nutritive degeneracy and local perversion tendencies may appear.

Closely akin to these states are expressions of degeneracy manifesting themselves with some approach to regularity in periods, as in epilepsy and the periodical insanities. The periodical insanities may be simply emotional states of exaltation (as in mania), of extreme depression (as in melancholia), of stupor, or of mental confusion. They may show themselves in periodical acts, as in dipsomania. This condition differs from the condition called inebriety in the fact that it is a periodical expression of degeneracy whose form has been accidently determined, but which would exist even were its form changed. The differences are excellently outlined by Dana, who divides intemperate drinkers into four classes: Periodical inebriates or dipsomaniacs, pseudo-inebriates, common drunkards and victims of delirium inebriosum. The disease in the first class is a periodical insanity. In the pseudo-inebriates the desire for drink is only one of many manifestations of a weakened constitution or inherently unstable nervous system. The third type are those which approximate the occasional criminals. Another periodical insanity is kleptomania, in which insane stealing occurs at intervals of greater or lesser regularity. Nymphomania or satyrasis is a periodical insanity in which there is an insane impulse for sexual intercourse. Pyromania is a periodical tendency to commit arson. All of these periodical conditions may occur alone or in combination with other degeneracies.

Closely related to the periodical insanities are the epileptic states which play so large a part in many of the phenomena presented by the degenerates. In the epileptic the mental rather than the gross nervous expression merits attention. From what has already been said about epilepsy, it and the periodical insanities are in no small degree the effect of mal-development of the fore brain as compared with the centres of organic life. The great convulsive centre is, according to Spitzka, the reticular grey matter of the brain isthmus, particularly of the pons and medulla. All characteristic features of the full epileptic onset can be produced in animals deprived of the related cerebral cortex. It needs but a slight puncture with a thin needle to produce typical convulsions in the rabbit, and some of the convulsive movements reported by Nothnagel have not only shown the true epileptic character but also that peculiar automatism noted in aberrant attacks. It is in this segment of the nervous system that all the great nerve strands conveying motor impulses, both of a voluntary and automatic and some of a reflex character, are found united in a relatively small area, and just here a relatively slight irritation might produce functional disturbances involving the entire bodily periphery.

The experiments of physiologists have shown that if a sensory irritation of a given spinal nucleus be kept up, after having produced a reflex movement in the same segment, any reaction beyond the plain of that segment is not in the next or succeeding planes but in the medulla oblongata. The motor reaction then manifests itself in laughing, crying, or deglutitory spasms, and, if the irritation be of the severest kind, epileptic or tetanic spasms in addition. Now the occurrence of laughing, crying, or deglutitory spasms could be easily understood if the molecular oscillation induced by the irritation were to travel along the associating tracts from the given spinal segment to the nuclei of the medulla oblongata. For in the medulla are found the nerve nuclei which preside over the facial, laryngeal and pharyngeal muscles. It is not easy at first to understand how tetanus and epilepsy, that is, spasms consisting in movements whose direct projection is not in the medulla oblongata but in the cord, can be produced by irritation of the former.

There are scattered groups of nerve cells in the medulla oblongata which have either no demonstrable connection with the nerve nuclei, or are positively known to be connected with the longitudinal associating strands. These cells hence can safely be regarded as representing a presiding centre over the entire spinal system. No spinal centre exerts any influence even remotely as pronounced as that of the entire cord. This applies to man and other mammals. That the elaboration of the medullary centre was as gradual a process as that of other higher differentiations is illustrated by the case of the frog, whose medulla has acquired the faculty of reproducing general spasms while the spinal cord itself retains this property also; hence here the predominance of the medulla is not so marked as in mammals.

The reticular ganglion of the oblongata is not in the adult a part of the central tubular grey matter, but has, through originally developing from it in the embryo, become ultimately isolated from its mother bed. It constitutes a second ganglionic category, and the association fibres bringing it in functional union with the spinal grey (first category) in lower animals and shown to have assumed the position of projection fibres in the higher, constitute a second projection tract; both together are a second projection system. The scattered grey matter of the medulla has great importance. Anatomically it is (though its cells be scattered diffusely as a rule) a large ganglion with numerous multipolar cells of all sizes, many of them gigantic, sometimes exceeding the so-called motor cells (which they simulate in shape) of the lumbar enlargement in size. Scattered in the "reticular substance" of the medulla from the upper end of the fourth ventricle to the pyramidal decussation, they merit the collective designation of reticular ganglia.

The cells of the reticular formation are known to be connected with the nerve nuclei, on the one hand, and with longitudinal fasciculi, which, since they run into the cord, terminate either in the grey matter or the nerve roots directly, for nerve fibres do not terminate with, as it were, blind ends. Now in the mammalian brain the reticular ganglion lies scattered among fibres which come from the higher centres, and the interpellation might be made whether, after all, the reticular ganglion be not a mere intercalar station for fibres derived from a higher source. Originally the ganglion was an independent station. In reptiles this body of cells is too considerable to account for a termination in them of the few cerebral fibres possessed by these animals. And, on the other hand, the vertical strands are notably increased in their passage through the field of the medulla oblongata.

The medulla oblongata with its reticular ganglion seems to be the great rhythmic centre. In fish the movements of the operculum and mouth, in sharks those of the spiraculum, in perenni-branchiate amphibians the branchial tree, in the infant the suctorial muscles, in all vertebrates the movements of deglutition, of the heart and respiratory muscles, all movements presenting a more or less regular rhythm, are under the control of the medulla oblongata. The early differentiation of this part of the cerebro-spinal axis is related to the manifestations of rhythmic movements in the embryo and their predominant importance in lower animals. The possibility should not be excluded that a rhythmic movement may be spinal, nay even controlled by peripheral ganglia (heart of embryo). A higher development, however, implies the concentration of rhythmic innervations at some point where that anatomical association may be effected which is the expression of the mutual influence these movements exercise among themselves.

Two sets of phenomena must be borne in mind in studying the physiological pathology of the epileptic attack. First, the condition of the epileptic in the interval. Second, the explosion itself. Too much attention is paid to the last, too little attention to the first. The constitutional epileptic is characterised by a general deficiency of tone associated with exaggerated reaction and irritability. Thus the pupils are at once widely dilated and unusually mobile. The muscular system, though generally relaxed, manifests exaggerated reflex excitability. The mental state is characterised at once by great indifference and undue irascibility. In the same way the vascular system is depressed in tone in the interval with rapid marked changes under excitation. The state of the nervous system as a whole Spitzka forcibly compares to that of an elastic band which, being on the stretch continually, is apt to rebound violently when one end is let go. Under normal circumstances the band is less stretched and hence not as liable to fly so far when the check is removed.

An irritation which, in health, produces restlessness of the muscular system, accelerated respiration and pulsation and various mental phenomena within the normal limits, in the epileptic results in more intense phenomena in the same direction. The nervous irritability of the epileptic manifests itself in one direction especially. An important vaso-motor centre for the brain vessels exists, possibly diffused through an area somewhere between the thalamus and subthalamic region above the pyramidal decussation below. The irritability of this centre results in sudden arterial spasm in the carotid distribution (so characteristic a feature of the fit onset); simultaneously with the contraction of the vessel the pupil undergoes an initial contraction, and relaxation instantly results in both cases. The sudden interference with the brain circulation produces unconsciousness, and destroys the checking influence of the higher centres on the reflexes in a manner analogous to any shock affecting the nerve centres. In the meantime, while there has been a sudden deprivation of arterial blood and a sinking of intracranial pressure so far as the great cerebral masses are concerned, there has been as sudden an influx of blood to the unaffected district of the vertebral arteries whose irrigation territory is now the seat of an arterial hyperæmia. The result of this is that the great convulsion centre, the medulla, being over-nourished, functional excess, that is, convulsion, occurs unchecked by the cerebral hemispheres, which are disabled by their nutritive shock. The unconsciousness and coma of epilepsy more resemble shock than they do cerebral anæmia or syncope. The impeded return circulation of venous blood now comes into play. The contraction of the neck muscles explains this obstruction and especially the accumulation of venous blood in the cerebral capillaries of the medulla.

True epilepsy presents an enormous number of sub-groups, exhibiting every variety of deviation from the ideal convulsive form, and the existence of these forms tends to demonstrate the views just expressed. In ordinary petit mal the initial arterial spasm has but to be confined to the surface of the hemispheres, leaving the thalamus ganglia undisturbed, and it can readily be understood how the momentary unconsciousness or abolition of cortical function can occur without the patient falling, his automatic ganglia still carrying on their functions. At the same time with the lesser spasm there would be a less extensive sinking of intracranial pressure with less consecutive collateral hyperæmia of the lower centres and therefore no convulsion.

In certain cases the arterial spasm fails to affect the entire cortical surface simultaneously; some one trunk may be more pervious, and as afflux of blood may occur in its special field where certain impressions and motor innervations are stored, the result will then be that the function of the relatively well-nourished territory will be exalted. If it be a visual perception territory, sights, colours or luminous spectra will be seen; if it be an olfactory territory, odours will be smelt; if a tactile centre, crawling, tingling and cold sensation are felt; if a speech centre, cries, phrases, and songs may be observed. This explains the manifold epileptic aura, which is simply an isolated, exaggerated, and limited cortical function. The recurrence of the aura is readily explicable on the ground of the well-known physiological law that any nervous process, morbid or normal, having run through certain paths, those paths will be the paths of least resistance for that process to follow in the future.

These conditions will be greatly exaggerated in proportion to the deficiencies in the associating tracts and will often, in turn, pervert these. The sexo-religious and other mental states of epilepsy often closely mimic normal mentation and serve to disguise the intense depth of degeneracy which epilepsy implies.

In their explosive, unchecked character the morbid restlessness of the neurotic, hysteric, and criminal depend upon like brain disorder to that of the epileptic, except that consciousness is not involved, and with conscious acts are intermingled those preceding from the lower automatic processes described. Consciousness, however, is sometimes lost in part, whence frequently the defects so often noticed in the thoughts of the degenerates.

The two following cases which have come to my notice illustrate the obliteration of the function of limited areas of the brain. A young lady, aged 22, of refinement and highly accomplished, was engaged to be married. One evening her fiancé called; she failed to recognise him and he remained ever after a stranger to her. In every other respect her mind was seemingly normal. She died of tuberculosis. In another case a young lady, an expert stenographer, while riding her wheel, fell striking her head against a stone. She remained unconscious for some days, and was quite ill for three or four months. After her recovery she was much surprised to find that she knew nothing about her former employment, although her brain was perfectly normal in other respects.