no question of considering the fugues of that affection as a whole, its limits being still uncertain and its nosology inexact and often contradictory according to the view of individual authors. Morcover there are, in the course of dementia præcox, as described, paroxysms of maniacal excitement, of nielancholic depression, of delusions more or less systematized, the fugues of which have no characteristics other than those of the melancholias or systematizations of other nature. There exist, however, in dementia præcox, separated from its superadded episodes, fugues of which the pathogeny should be ascribed to that dementia alone and which may be diagnosed in accordance with the characteristics which are peculiar to it.

The fugues of precocious dements have these two principal qualities-they are impulsive and, in view of the inadequacy of the motive brought forward in justification by their perpetrators, they are delusional. The impulsiveness is very characteristic; it is the result of a motor obsession; the activity is automatic; the impulsion is sudden, unforeseen, unpremeditated, with no adaptation to external circumstances; its duration is variable. Its demented character is well defined: absence of motive and of aim, futility or folly of the alleged causes, inconsequence of the acts, absence of reason in their accomplishment. At times the dementia is profound and the reasoning power is entirely absent.

The psychology of the precocious dement during a fugue is not easy to establish in view of the reticent and negative character of these patients who elude analysis. However, it may be admitted that these acts are essentially automatic, an automatism irresistible, but without conflict and without anxiety, without double consciousness or confusion of ideas, the apparent confusion arising merely from intellectual apathy, from the difficulty of systematization of the ideas of the precocious dement. Memory is retained, with lapses, however; the affective sentiments are dulled.

On the whole, it is to dementia that these fugues, even when impulsive, owe their peculiar aspect.

The Fugue of Dromomania.-This fugue is the result of an impulsion, obsessive or non-obsessive. In this investigation should be included all cases of impulsion, the moment there is involuntary motor solicitation, even when the impulsive act has not been entirely accomplished.

In the classification of impulsions by Pitres and Régis, the

fugues of dromomania depend upon the psychomotor and obsessive variations, the difference between them lying in the anxious conflict, the emotional condition preceding the act, the resulting relief, in the case of the obsessive fugue, in contrast to the fatal outcome, without inhibition, of the stimulation and of the act, in the psychomotor fugue. These states may, moreover, succeed each other in the same individual.

The obsessive fugue, in its chief symptoms and in the state of consciousness of the patient, does not differ from other obsessive impulsions; it is very rare; only a small number of instances have been stated, several, indeed, with little clearness. On the contrary, the simple impulsive fugue is common and presents various problems of clinical and medico-legal diagnosis of great interest.

The manner of the onset is characteristic: it begins abruptly, spontaneously, without the least deliberation and without hesitation. The subject of the impulse starts without organizing his fugue, without luggage, and without money, in the course of a walk or excursion of any sort, from wherever he happens to be and however comfortable he may be there, abandoning his work and his family, regardless of his social standing, careless of everything that lies outside his idea, whatever the consequences of his act may be, and that for an indefinite time which may continue until it becomes a genuine vagabondage. The only characteristic element of the impulsion is here wholly negative; it is an absence of motive, a lack of reasoning, an immediate dislocation. The psychological conditions of consciousness are not sensibly different from those of the conscious obsessive impulsion, but the impulsion appears clearly to its victim as an act alien to himself, at which he is present, indifferent and aboulic.

Besides the fugues of dromomania, there exist other impulsions wherein the fugue reinforces obsession to pyromania, dipsomania, kleptomania, etc., and permits gratification without the motor act in itself being impulsive. There are, however, cases where the obsessive fugue is genuinely associated with another impulsion. Finally, in certain curious cases, the fugue-fugue par ricochet-is merely a means of defense, a method of conquering a dreaded or culpable obsession.

The Secondary Fugue.-The hysterical fugue is the type of the secondary fugues. It is the function of one of the varieties of somnambulism, that is to say that it occurs in a state of double

personality. As regards the second personality the act is voluntary, conscious and mnesic; while the first personality is, at least usually, unaware of it. In every circumstance where the same secondary state reappears the memory of it will be established. The acts of the fugue are co-ordinate, intelligent, and the attitude of the patient correct; the fugue is habitually preceded by a fixed idea of wandering; it is not necessarily connected with a convulsive paroxysm. The beginning and the end are abrupt.

A genuine secondary state may occur in the course of alcoholic delirium accompanied by somnambulistic fugues. But while certain authors admit the existence of toxic somnambulism entirely assimilable to that of hysteria, others are reserved as regards the double personality, toxic confusion being hard to reconcile with the psychological synthesis necessary to a secondary state.

A certain number of fugues following a traumatism should be imputed to a genuine secondary state, following the shock, recurring no more after the disturbance, and consequently distinct from hysterotraumatism.

The Systematized Fugue.-In the special domain of psychiatry this is the first fugue to have been described by the memoir of Foville fils in 1875. This type of fugue has, in all its variations, the characteristics of originating in the field of paranoia in the course of a systematized delirium and of belonging to that class of morbid acts which differ from the acts of a sane person only in their inception and the presence of delusional ideas or hallucinations accepted as real.

The systematized fugues are the function of a systematized delirium and accompany it, however profound may be the nature of the affection-temporary systematization, or delirium of chronic evolution; whatever, also, may be the variety of the delusional ideas-persecution, grandeur, mysticism, or others.

They are most frequent in the delirium of persecution. They are merely the elaboration of the reaction of the change of domicile so common among the victims of persecution; there are cases in which the succession of these similar acts appears distinctly. At the period when it appears well developed the fugue is seen to have its origin in a delusional idea; after slow maturation, the subject of persecution starts off with regret and as if driven by force. To him it is an act of defense. There is a flight from

painful hallucinations, at times at the suggestion of other hallucinations of an opposing nature.

Among victims of persecution there also occur, at the time of the hallucinatory paroxysms, fugues of raptus, which should not be confounded with the foregoing. In the case of victims of persecutory melancholia there are also to be observed curious interminglings of the anxiety of the melancholiac and the deliberation of the patient subject to systematized fugues.

In the delusions of the persécutés persécuteurs, the fugue aims not at defense but attack. All the varieties of this class furnish examples, among the most remarkable being the regicides and other political persecutors.

The systematized delusion of grandeur leads often to fugues of the same order.

To conclude, the systematized fugue is characterized by methodical preparation at times much prolonged, great perseverance in execution, a duration which may extend over several years, easy adaptation to events and external conditions; for the immediate object of the fugue varies even if the underlying motive remains constant, in short, a marked fixity of the controlling idea, which is the essence of the term systematized fugue.

These fugues are not vagabondage, in spite of their habitually long duration. They are due to a characteristic mental disturbance, hallucination, or delusion; the mental disturbance comes, sometimes daily, to renew and prolong the fugue; one cannot differentiate it from the changes of residence of the same victims of persecution which almost everybody agrees to include among the fugues. Now, to classify symptoms clinically alike under several heads because of a mere difference of duration may be useful in legal medicine, in criminology; it is anomalous in psychology or clinical medicine. It is for this reason that we have given systematized fugues a place apart in our thesis.

From this study we shall bear in mind chiefly the existence, along with ordinary fugues, of a certain number of types of fugues clearly dependent upon mental syndromes, perfectly separable each from the other. This justifies a chapter in semeiology giving to the fugue its autonomy somewhere between automatism and vagabondage.

TOULOUSE, AUGUST, 1909.

A. VICTOR PARANT.

Obituary.

EDWIN HOLMES VAN DEUSEN.

Upon July 6, 1909, a remarkable man passed away whose career of influence and usefulness deserves more than a few lines in this publication. More than fifty years ago Dr. Van Deusen was one of the associate editors of the AMERICAN JOURNAL OF INSANITY, then in its infancy, and published at Utica, New York.

The opportunity is given to few men to mold the policies of a new and undeveloped State, to awaken the slumbering moral sense of its people and to arouse and guide them in their first efforts to make provision for the care of its mentally diseased-hitherto languishing in jails and poor houses. Yet this and more was Dr. Van Deusen's good fortune, for such was his wisdom and preparedness for the responsibilities that were thrust upon him that he succeeded in the short period of twenty years in making the policies governing the hospitals for the insane of Michigan a model for older States. He was born in Livingston, Columbia County, New York, August 29, 1828, and graduated from Williams College in 1848, when not quite twenty years of age. He entered upon his medical studies even before he graduated from Williams in the office of Dr. Sabine, of Williamstown. After receiving his A. B. degree, he entered the College of Physicians and Surgeons of New York, and applied himself with such earnestness and zeal that on graduating three years later he stood so high in his class that he received an appointment as one of the house physicians in the old New York Hospital. There he manifested such singleness of purpose and was so successful in his work that at the end of his term of service he received an appointment as assistant physician in the New York Asylum for the Insane at Utica which at that time was ten years old.

As illustrating his conscientious devotion to his professional duties, he was one of the illustrious band of young physicians who while internes in the New York Hospital unhesitatingly offered