exactly the words (echolalia) or the gestures (echopraxia) of the persons around them. Others exhibit no spontaneous activity, but are able to execute without hesitation any command. Such is the case with hypnotized subjects, certain catatonics, etc. Sometimes it suffices to start them moving, when they will continue and accomplish a series of acts to which they are accustomed.

Suggestibility is the dominant note of the character of certain individuals, mostly credulous and weak-minded, whose thoughts are governed by external impressions, whose will is nil, and who yield to the domination of the most diverse influences, good or bad. Many criminals belong to this class.

Impulsive reactions or impulses are to be divided into three groups: (a) impulses of passion; (b) simple impulses; (c) phenomena of stereotypy.

(a) Impulses of passion always depend upon abnormal irritability. They are determined by provocation that is often insignificant and are accomplished independently of any mental reflection. They are met with in a great many patients: constitutional psychopaths, epileptics, maniacs, etc. A maniac feels his neighbor give him a slight push; he immediately strikes him without reflecting that the latter had no malevolent intention, that he was perhaps even unconscious of having touched him, etc. This is an impulse of passion.

(b) Simple impulses, purely automatic, appear without any emotional shock and without a shadow of provocation. One patient suddenly threw into the fire the gloves, hat, and handkerchief of her daughter

who came to visit her at the sanitarium. Afterwards during a moment of remission she remembered perfectly the act and the circumstances under which it was accomplished, but was not able to furnish any explanation for it.

The impulse may be conscious. A patient is suddenly seized with a strong desire to steal some object from a show-window, the possession of which could be neither useful nor pleasant to him; he does not yield to this impulse, which he recognizes as pathological. This is a conscious impulse. This phenomenon is closely allied to imperative idea, of which it is but an accentuation.

(c) Stereotypy consists in a morbid tendency to retain the same attitudes, or to repeat the same words or the same movements. Hence the three kinds of stereotypy:

Stereotypy of attitudes;

Stereotypy of language: verbigeration;

Stereotypy of movements.

Certain patients remain for hours at a time in the most uncomfortable attitudes; others will walk a long distance, taking alternately three steps forward and two backward; still others will repeat indefinitely the same phrase or the same verse.

(B) Negative automatism.-This forms the basis of negativism and consists in the annulment of a voluntary normal reaction by a pathological antagonistic tendency.

The patient is requested to give his hand; the voluntary reaction which tends to appear and which would result in compliance with the request, is arrested, sup

pressed by automatic antagonism. This disorder of the will has been designated by Kraepelin, who has made an admirable study of it, by the term Sperrung, a word which, literally translated into English, means blocking. A more significant term perhaps would be psychic interference. The two antagonistic tendencies neutralize each other like interfering sound-waves in physics.

On a superficial examination negativism may resemble aboulia. These are, however, two very different phenomena. While the latter, purely passive, is the result of persistent paralysis against which the patient struggles with more or less success, the former, an active phenomenon, depends not upon paralysis but upon a perversion of the will. Negativism is often manifested only in certain kinds of reactions. One patient who walks about without any effort does not open his mouth. Another who makes his toilet, eats unassisted, and even works, remains in complete mutism, making no response in spite of all perseverance on the part of the questioner.

In a more marked degree negative automatism results not only in the arrest of normal reactions, but also in the production of contrary reactions.

Thus if one attempts to flex the patient's head he extends it, and vice versa. If he is requested to open his half-shut eyes he closes them, and if the examiner attempts to force them open, his orbicularis muscle contracts in a veritable spasm. Wernicke observed that while flexibilitas cerea chiefly shows itself in the limbs, negativism mostly affects the muscle groups of the head and neck.

§ 3. DISORDERS OF COENESTHESIA AND OF THE PERSONALITY.

Disorders of cœnesthesia.- By cœnesthesia or vital sense is understood "the general feeling which results from the state of the entire organism, from the normal or abnormal progress of the vital functions, particuarly of the vegetative functions" (Höffding.) The stimuli which produce this sense are vague and poorly localized, and are perceived not individually but together as a whole.

The harmony which normally exists between the diverse organic functions produces a vague sense of satisfaction and of well-being. All causes tending to destroy this harmony will produce in consciousness a feeling of malaise and of suffering more or less definite and more or less acute. Thus the disorders of cœnesthesia are intimately connected with disorders of affectivity; most of the depressed states have for their basis an alteration of the vital sense.

Disorders of the personality. Alterations of the personality constitute the symptom which, following Wernicke, we have termed autopsychic disorientation.

These disorders may be arranged in three principal groups:

(a) Weakening of the notion of personality; (b) Transformation of the personality;

(c) Reduplication of the personality.

(a) The notion of personality may be incomplete or absent; it may have never been developed at all, or it may have been but incompletely developed, as in idiots

and imbeciles, or it may have disappeared or have become weakened under the influence of a pathogenic cause, as in mental confusion, epileptic delirium, melancholic depression with stupor, etc.

(b) Transformation of the personality may be complete or incomplete.

In the first case the patients forget or deny everything pertaining to their former personality. Thus one patient claimed that she was Mary Stuart, wanted to be addressed as "Her Majesty the Queen of Scotland," and attired herself in costumes similar to those of that time. She became furious when called by her own name, and obstinately refused to accept the visits of her husband and children, whom she called "impostors." Another patient, afflicted with hysteria, believed herself to have been transformed into a dog; she barked and walked on all fours. Still another patient at the Salpêtrière referred to herself as "the person of myself."

Complete transformation of the personality may be permanent, constituting, according to the excellent expression of Ribot, a true alienation of the personality; or it may be transitory, so that the new ego disappears at a certain time to be replaced again by the former ego. In cases in which the normal personality and the pathological one replace each other mutually several times we have variation by alternation.1

Incomplete transformation of the personality exists in a great many cases in which the patients are led by their delusions to attribute to themselves imaginary talents, powers, or titles, without at the same time completely

1 Ribot. The Diseases of Personality.