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 PATHOLOGY

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PATHOLOGY

dangerous, for in their blind anxiety they assail those about them, no matter who they may be. The cases among the Malays of "running amuck" are of this nature. In other cases of frequent occurrence the patients have visionary, ecstatic dehria; they sing psalms aloud, believe that they see the heavens open, see the Last Judgment, speak with God, etc. (Moham- med was an epileptic). Often the attacks occur only at night (epileptic night-walkers, somnambulists).

(9) Hysterical Psychosis. — Many hysterical patients are at the same time permanently abnormal from the psychical point of view; they are egregiously selfish, irritable, and untruthful. Conscious simulation and diseased imagination run into one another so as to be indistinguishable. The mental disturbances of the hysterical show many superficial resemblances to those of the epilei^tic; the latter however are spontaneous, while the former are due to definite psychical causes, fright, anger, and the Uke; the sexual life also plays here an important role. Visionary ecstatic dreamy conditions occur, whereby an hysterical person can psychically infect hundreds of others (cf. the epi- demics of the Middle Ages of flagellants, dancers, etc.; superstitious "miracles" of modern times; speakers of foreign tongues, and the like, where no sharp boun- dary exists between conscious swindling and patho- logical suggestibility).

On the physical side one meets with strange paraly- ses, cramps, blindness, isolated anaesthetic spots [thus explaining the notorious "mark of the devil" in the "Malleus Maleficarum" (1489), met with in ancient witch trials). All of these symptoms can disappear just as suddenly as they come. The majority of the wonder-cures by charms or similar superstitions are possible only in the case of hysterical persons, in whom the imagination causes both the disease and the cure.

In modern times hysteria plays a large role in in- juries — traumatic neurosis, "railway spine" — which is a combination of symptoms following a railway col- lision, or after accidents during employment.

(10) Imbecility, Weakmindedness. — The severer forms (idiocy) and also those of moderate severity are easily recognized, even by the layman. The milder forms, however, may be overlooked very readily, since the mechanical accomplishments of memory may be very good, although the judgment (i. e. independent critical thought) is lacking. The weak-minded know only what they have committed to memory, but not the why and wherefore; they cannot draw conclu- sions, cannot adapt acquired knowledge to suit new and unaccustomed circumstances; they are at a loss when confronted by questions demanding intelligence. The weak-minded child, for instance, can learn a poem by heart, but cannot by himself perceive its signifi- cance; he can name the holidays, but does not under- stand their meaning; he can calculate well (i. e. mechanically) 9 + 3, but does not understand the question: "I think of a number, add 3 to it, and the answer is 12; what is the number I thought of?" By reason of their inability to think independently, such individuals are blindly led by the authority of others for good or evil. Because of the impossibility of re- flecting upon anything exactly, they often commit, not only very foolish, but also dangerous and criminal acts, to free themselves from a momentarily unpleas- ant situation. Their emotional life is characterized by unreasonableness and irrepressibility. On the physi- cal side one finds deformations of the skull, defects of speech, squint-eyes etc. One of the most important causes is alcoholic excess on the part of the parents; brain disease during childhood or before birth is also sometimes responsible. In many cases the defect in- volves that side of psychical life which is called the moral or .social side, which cannot be acquired by intellectual means but is essentially connected with sentiment. Without moral sensibility, moral conduct is impossible. Hence arises the sad picture of the

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incorrigible reprobates who cannot be reached by edu- cational influences, who in spite of kindness or stern- ness, in spite of the best example and breeding at home, are criminally inclined from childhood, and later become lazy vagabonds, prostitutes, or habitual criminals.

These children, when hardly past infancy, are con- spicuous for their unusual unruliness, .selfishness, and lack of family affection. They show a characteristic malice and cruelty, maltreat animals in the most re- fined ways, and take a truly diabolical delight in tor- menting their brothers, sisters, and comrades. They have a kind of ex-plosive irritabihty and impulsive sen- suousness, shown especially in an uncontrollable appe- tite for sweets, to satisfy which they have recourse even to theft and violence. They take to drinking when very young, and practise various other forms of immor- ality. Shamelessness, absolute laziness, and an ex- treme mendacity always characterize these persons. Their mendacity appears not only in lies told to escape punishment or to obtain something desirable, but also in fantastic romancing {pseudologia phanlaslica) . We also usually observe in these patients a variety of bodily malformations and combinations of epilepsy and hysteria. As causes may be mentioned: heredity (especially from alcoholism), infantile brain disease (severe epilepsies), injury to the infantile skull during childbirth, cerebral concussion, etc.

(11) Coynpulsory Ideas. — Even in patients whose intelligence is intact, certain ideas recur over and over again against their will, cannot be banished, and hin- der and cross the normal flow of ideas, in spite of the fact that their folly and senselessness are always clearly recognized. The number of these impulsive ideas is very great. For the clergy the knowledge of certain forms is important, especially those that occur fairly frequently among rehgious persons, and are highly troublesome and painful. Such people, for instance, although they are believers, are forced con- stantly to brood over such questions as: "Who is God? " "Is there a God? " Others have fancies of the lowest and most obscene character, which annoy them only during prayer, and return with the greater per- sistency according as the patient is more anxious to dispel them. Such patients require hours to say a simple Paler nosier, because they believe they have profaned the prayer by a sudden obscene fancy and must therefore begin all over again. The reassuring words of the confessor make little impression, save for the moment. Such sufferers torment themselves and their confessor incessantly by the endless repetition of their religious scruples, notwithstanding the fact that they clearly recognize the disordered compulsion (i. e. the involuntary nature of their ideas). But they can- not help themselves; the thoughts return against their will.

(12) Menstrual Psychosis. — A few words may be added about a mental disturbance, which is of impor- tance to jurists and to the clergy. In nervous women a menstrual psychosis occurs, i. e. mental anomalies which appear only at the time of the catamenia (usu- ally a few days earlier) in individuals otherwise healthy. Conditions of confusion, unfounded ideas of jealousy, or excited states with marked excitability or sexual excitement manifest themselves. In women just delivered, excited and confused states occur in which the patient kills the new-born child; afterwards there is complete loss of memory of the deed.

(13) Impulsive Psychosis. — By this is meant the occurrence of an irresistible impulse to steal (klepto- mania), to burn (pyromania), to wander about (porio- mania), the diseased nature of the action being espe- cially recognizable in the complete lack of motive (no need, no satisfaction, -etc.). The stolen articles, for instance, will not be used or sold, but carelessly and immediately thrown away after the theft has been committed; the thief often enjoys good social and