abolishing their real ego. One patient suffering from a chronic delusional state of old standing claimed that he was St. Peter, and explained that he had been incarnated in an earthly man for the purpose of bringing happiness to mankind. A general paretic claimed that he was Emperor of Asia, reigning in Pekin, being at the same time aware of the fact that he was living in Paris, and was a newspaper vender.

Garnier and Dupré have described under the name of paroxysmal mental puerilism 1 "a retrogression of the intellect to its primitive stages," a state in which the subject once more becomes psychically a child, the transformation being only a temporary one. In the observation which they report a woman of thirty-three years took pleasure in childish amusements, such as playing with dolls, and expressed herself in such childish language that she created the impression "not of an adult woman of thirty-three years, but of a child of five years." This interesting syndrome is encountered in the most diverse affections. It may be met with in hysteria, in cerebral tumors, in abscess of the brain, etc.

(c) Reduplication of the personality consists in the development of a new personality of a parasitic nature alongside of the real personality of the patient.

This reduplication is the origin of the idea of possession so frequent in chronic delusional melancholia, and results in a psychic disaggregation the most important manifestations of which are autochthonous ideas

1 Transformation de la personnalité. Puérilisme mental paroxystique. Presse médicale, 1901, No. 101.

(psychic hallucinations) and motor hallucinations. As I have had occasion to indicate above, the patient, feeling that he is losing control of his own thoughts and movements, concludes that a strange personality has taken possession of him.

CHAPTER V.

THE PRACTICE OF PSYCHIATRY.

HISTORY TAKING.—METHODS OF EXAMINATION.

THE data for diagnosis, prognosis, and treatment are obtained in psychiatry, as in other branches of medicine, from the case history and from the direct examination of the patient.

§ 1. HISTORY TAKING.

Information must be sought from all available sources and the various data checked against each other to insure accuracy as far as possible.

The patient himself, if able and willing to coöperate, can often furnish information that is of the most intimate kind and not to be had from other informants; this is especially true in regard to the sexual life and venereal infections. Besides, it is always useful to have a free expression of the patient's viewpoint, even if the statements made by him are incorrect.

Further information is to be sought from the patient's relatives and friends and, in a case presenting a history of previous admissions, from the records of the institutions in which he was treated.

Efforts to secure a case history should not stop here, as they do too commonly in the practice of many institutions. It is now widely recognized that

a satisfactory knowledge of the family history and of the nature of the environment, in the midst of which the patient has lived and developed his psychosis, is hardly to be had without field investigation, affording opportunities of interviewing relatives, friends, neighbors, family physicians, employers, and others who do not visit the hospital; consulting public records of births, marriages, divorces, and deaths; and studying at first hand the home conditions.

These considerations, as well as others pertaining to social service and after-care of paroled or discharged patients, have led to the growing practice of employing field workers in institutions. The Eugenics Record Office, Cold Spring Harbor, N. Y., The New York School of Philanthropy, and several universities now offer extension courses to meet the demand for trained persons for such positions.

Family history.1 - A full family history in a given case may be of value not only for a study of its etiology but also for the assistance that is at times to be derived from it in the interpretation of clinical manifestations.

The questioning should be systematic, taking up members of the family individually, and covering wherever possible at least the patient's children, brothers and sisters, nephews and nieces, parents, and grandparents, uncles, aunts, and cousins on both the paternal and maternal sides.

1 C. B. Davenport, in collaboration with others. The Family History Book. Bulletin No. 7. Eugenics Record Office, Cold Spring Harbor, N. Y., 1912.

For each member of the family it is desirable to place on record the name, sex, birthplace, age (or age at time of death), cause of death, education, occupation, and marital condition.

As special subjects of inquiry may be mentioned the following: insanity, a description to be secured in each case of time and manner of onset, principal manifestations, course, termination, and recurrencies; epilepsy and other disorders which seem to be related to it, namely, convulsions in childhood, fainting spells, migraine, and periodic dipsomania; arrests of development, as shown by delayed walking and talking not due to physical causes, poor record at school, lack of success in work; suicide, method and immediate cause to be given if known; the milder psychoses, hysteria, neurasthenia, psychasthenia, "nervous prostration"; addictions to alcohol or drugs, details to be given of amounts and frequency of indulgence, periods of abstinence, etc.; anti-social traits, criminality, mendacity, prostitution, vagrancy, pauperism not dependent on physical causes; temperamental anomalies, such as undue irritability, spells of "the blues," worrisome or hypochondriacal disposition, excessive religious preoccupation, miserliness, and other eccentricities; sexual anomalies, especially perversions and inversions; and finally conditions like asthma, sick headaches, and recurrent vomiting, the relation of which, if there be any, to the neuropathic states, is not clearly established.

The fact of a sojourn for treatment or custody in a hospital, sanatorium, asylum, colony for the epi