Since his marriage with the other woman no incident had happened between him and his former inamorata, although his love for her was continually occupying his mind. On the very day of the deed he was perfectly quiet, no premonitory symptoms whatever having been observed.. The attack came over him with the suddenness of an explosion. When arrested he confessed that he had hit the two women, but he claimed to have done so without any consciousness of what he was doing. It is not probable that he was not telling the truth at that moment,. that he was lying in order to escape punishment, or to be treated more leniently. Being illiterate, he very probably did not know the paragraph of the penal code that exempts from punishment crimes committed without conscience. The duration of the attack was typically short.

There are two more characteristics of a typical attack of transitory mania left-the amnesia and the sleep following the act. About the latter nothing could be found out from the legal documents, and whether there was amnesia or not is doubtful. Before the judge, G. claimed to have no memory of the assault (as above), but before the medical experts he admitted the contrary. This incompleteness of the typical signs of transitory mania, however, does not seem sufficient to invalidate the theory of transitory mania in this case, just as little as the absence of one or the other characteristic symptoms in the ordinary bodily diseases can overthrow an otherwise wellestablished diagnosis. Schüle enumerates some clinical varieties of transitory mania, one of which he describes in the following manner: "We ourselves observed in a recruit-who was hereditarily predisposed-after great hardships and after an attack of acute gastritis, a very acute raptus homicida, followed by a condition of stupor, lasting for some weeks, but without anxiety and amnesia." The permanence, or deficiency, or absolute loss of memory, will probably always be found in proportion to the accidental degree of consciousness of the individual. There will be found gradations of memory corresponding

to the gradations of consciousness in pathological individuals. Memory is the registration of impressions received by the senses, of ideas, etc., in the receptory sensoral centers of the brain, which are recalled to consciousness by an adequate stimulus. According to the functional state of these centers, different kinds or degrees of memory will be generated. If now a morbid process affects the cerebral centers without rendering them altogether inactive, consciousness will not wholly be abolished, as it is in epilepsy and apoplexy. In the latter two the individual is perfectly unconscious, and consequently, deprived of perception, sensation, memory, etc. Between absolute morbid unconsciousness and normal physiological consciousness there are as many gradations as there may be gradations of morbid processes affecting the brain and its centers. And to the different degrees of consciousness different degrees of memory must correspond. This explains why, in the various forms of mental disease, we find the memory sometimes weakened, other times obscured or confused or completely absent, or, perhaps, better and more active than normally. We might say that in the alienated there is no real absence of consciousness, but a lack of the exact critical control that is found in a normally functionating brain, and which enables the individual to distinguish and properly appreciate his ideas, sentiments and actions.

This condition may have been present in G. The state of his brain allowed him to be carried away by the irresistible impulse that came over him. The valves of reason so to say-were closed, his controlling cerebral centers were out of function, he is the victim of an affective impulse in a moment of diminished moral resistance.

"Justice," says Krafft-Ebing," cannot, in such cases, compare acts committed under the influence of a powerful emotion to those executed during a condition of psychical quietude and equilibrium. There cannot be any responsibility for acts committed under the impulse of a pathological affection, the individual then being in a morbid state of consciousness."

By HARRIET C. B. ALEXANDer, A. B., M. D., Chicago,

Fellow of the Chicago Academy of Medicine; Formerly of the Cook County Hospital for Insane.

MOREAU DE TOURS strikes with equal force

and truth at a grave psychiatric error, which has done much evil to the race, when he points out that for many years pædiatric clinicians have denied that the child could be pathologically affected in its intellectual, emotional, or moral nature. It was usual to regard exceptional mental phenomena as eccentricitiesas immoralities, or, as produced by defects of education and training, though physicians had for centuries reported cases inexplicable on these theories alone. The subject has been, however, forced into prominence of late by the agitation over school over-pressure. The psychological state of the normal child even is much misunderstood. Meynert("Psychiatry," Sach's translation) with exceeding fullness and subtlety, thus outlines certain ignored factors of the evolution of psychological processes in the child:

Kussmaul has shrewdly indicated certain perceptions and movements, common to the fetus in utero, which feeds itself, as it were, by swallowing amniotic fluid. He also indicates that there may be special motives, such as the more stimulating taste of the fluid after occasional depletion, into it of the allantois, which induce swallowing. Here then there are two alternatives. The fetus swallows, or does not swallow. Fetal consciousness is already presupposed, which would exist, however, under circumstances that give but little opportunity for perception. The new-born infant at once discovers signs by which it distinguishes between one set of perceptions and another. One set of perceptions helps it to define the circumference of its own body, another set belongs to the world beyond it. However obtuse this perception may be, though the child may at first not be able to discriminate between the various impressions of space, still it is certain that the child's perception of its

• Read in outline before the Section on Neurology and Medical Jurisprudence, American Medical Association, Milwaukee, 1893.

"De la Folie chez les Enfants."

own body circumference is established very early. Among other means by which it learns to distinguish between impressions received from its own body and the outer world are these: Contact of a strange finger with its own skin excites but one tactile sensation; contact between two parts of its own body excites two tactile sensations; one from the touching, the other from the touched part. Furthermore a number of strange auditory sensations strike the ear of a child, but only the sound of its own voice is accompanied with muscular sensations, and so the attendant muscular sensations help the children to discriminate between movements of its own body and any other movement it may see. There

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is no order of movements, which under the cover of instinct can be pushed in between conscious and reflex movements. The first instinct of a child would be the instinct for food, but the origin of that has been discussed. There is absolutely nothing in the sensation of hunger, which would acquaint the child with the means of remedying this pain. It attains naught but the concept of pain. In the general restlessness it displays and in the convulsions ultimately resulting from anæmia there is nothing which could be likened to an instinct for food. If the child has not to depend on its own resources, but has a nipple put into its mouth, then the sensation thus excited starts the reflex mechanism of sucking. The child has thus acquired the concept that the sensation of satiation is connected with the act of sucking, and these two sensory memories are associated with the innervation-sensations aroused by sucking and, probably, by the scent of the mother's breast. That a child should suck at every finger may be attributable to a reflex mechanism, but the sucking of the child in dreams proves that the act of sucking has produced images which have been registered in the cortex. The factors of this primary abstract ego are not definitely defined. * The nature of the ego does not depend upon any definite order of memories, but is determined simply by the most firmly fixed memories. * As soon as movements of aggression have taught the child to take hold of things it is evidently under the impression that it is living in a world of sweets; it takes everything to the mouth and licks it. A later aggressive movement -kissing-like the first sucking movements, is probably based upon the act of bringing an attractive object to the mouth. This latter movement is clearly dependent upon a powerful secondary presentation aroused by its impressions, just as the sucking movements during sleep denote secondary presentations excited in the course of dreams. * Space vision in the child excites movements of aggression, which aim at the possession of the thing it sees, but as it lacks the power of locomotion it has no conception of distance. These aggressive reflexes of the upper extremities are no more co-ordinated in space than the movements of the eyes are before the child has learned to see, and through irradiation these movements become general, leading to a tossing of the whole body, to kicking with all-fours and to cutting of grimaces. These movements, though extravagant, are not spasmodic, but must be regarded as results of cortical impulses interfered with by

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cortica! irradiation. * *The acoustic nerve also takes part in reflex impulses; the child that hears others speak or perceives other sounds and noises has the desire to bring forth the same sounds and noises. As its cortical functions improve, it develops the secondary idea that the sounds which it brings forth are similar to those of ordinary speech. Wundt correctly remarks, that "the speech of animals consists of so-called sensory sounds, and this is true of children before they have acquired the faculty of imitating syllables. * In all aggressive

movements the child over-estimates the possibilities of its powers. Experience and an improvement of the power of imitation correct these false conclusions. As soon as the child has reached the age when all cortical fibers acquire their white substance, purely reflex movements, and those due to irradiation, diminish in number. ** In the child the expression of emotion may vary much. Under the influence of the apnotic effect of functional hyperæmia attendant upon pleasurable emotions there will be movements of aggression bespeaking the force of the child's own personality, or there will be spasmodic movements of repulsion (due to irradiation), such as screaming and crying. All these expression movements, whether due to irradiation or not, dispatch sensations of innervation to the cortex, which sensations are there turned into "special memories" and serve later on as impulses starting the entire groups of movements, which are involved in expression. Consequently these movements of expression result primarily from stimulation of subcortical centers, just as simple forms of reflex movements serve as the foundation upon which the structure of more complex conscious movements is raised. As soon, however, as these irradiatory impulses, which excite the mechanism of expression, are put under control of an organ of motor co-ordination, they acquire secondarily a higher value as psychical factors of expression. In the child pleasurable emotions result in general movements of the entire body. Even in the adult who dances for joy or performs other extravagant movements, occurs a repetition of these primitive mimical movements of the child. A state of excessive pleasurable emotion may pass into a condition of maniacal excitement as a result of dilatation of the arterial network of the brain, or a state of pleasurable confusion may end in a transitory swoon.. * The doctrine that ideas are inherited, and are not the result of perception and association-that movements, even mimical ones, are the result of innate motives and have nothing to do with imitation and early reflexes, can hardly be applied to man. Not even the upright gait is innate; it is acquired with difficulty only through imitation and cortical co-ordinaticn.

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Perez states that anger appears early in children. In the first two months the child shows by movements of its eyelids and hands strong anger when the attempt is made to bathe it or take something from it. According to Fenelon, jealousy is much more violent in childhood