the taking of food, exercise, etc., and may be caused by illusions and hallucinations in which voices tell him not to act, or that the food is unfit to eat, etc.

Stereotypy is the performance of the same acts in the same way over and over, walking in a limited space, striking the chest, shaking the body, rubbing and pulling the hair, etc. Mannerisms are peculiarities of conduct shown in the ordinary simple movements or activities, grimaces, queer or bizarre movements, baby talk, etc. These also may be the responses to hallucinations.

Aboulia is shown by hesitation and indecision. Even when a strong stimulus is applied, some real incentive for action given, no response takes place. A person may be unable to dress because he cannot decide which arm should first be put into its sleeve, or whether the stocking should be first drawn on to the right or the left foot. The same difficulty arises whenever a choice or a decision, however trivial or important, has to be made. The power to determine action (volition) is so lacking or diminished that the patient is unable to make decision, and it usually has to be made for him by the nurse or some other person.

The Behavior Chart on which are recorded the spontaneous and required behavior must be kept with care and accuracy. Observation of the various activities must be thoughtfully made, for the chart provides the physician with information which is helpful in making diagnosis, and shows an improvement or regression in the mental state just as definitely as a record of the temperature, pulse and respiration which approaches the normal shows an improvement in physical condition.

II. DISORDERS IN THE STREAM OF THOUGHT

Flight of ideas is a term commonly used in psychiatry to indicate a hastening in association. The goal idea changes rapidly because the direction of thought is so constantly changing. The tendency is to jump from one topic to

another which is connected or associated with it in some way. A single word or syllable or some element of the idea may furnish the stimulus. There is also frequently present a tendency to play upon words and to rhyme.

Distractability is the disposition to change the direction of thought frequently because of external impressions. A word, a sound, a passing object which gains the attention will interrupt the train of thought and abruptly change its course. Sound is especially likely to be distracting.

Retardation is a term which is used to indicate a slowing or a delaying of association. Ideas are developed very slowly and decisions and judgments are formed with difficulty.

III. EMOTIONAL DISORDERS

Disturbances in the emotional sphere are among the early symptoms of mental disease. These disturbances are shown by an increase or diminution in the intensity of the feelings.

Exaltation is a morbid state of happiness which is not warranted by the circumstances or conditions. This state may vary in degree of intensity from an exaggerated feeling of satisfaction and well-being (euphoria) to elation. The patient is happy, joyful and exuberant, is usually loquacious, and laughs, sings, dances, and everybody is agreeable and everything is beautiful.

Depression is a morbid state of unhappiness which is not warranted by conditions or surroundings, and may vary in degree of intensity from a feeling of sadness to deep melancholy. The patient looks gloomy and dejected, admits he feels "down-hearted," sighs, is tearful, worried and anxious about many things which concern himself, takes no interest in what is going on and wants to be alone.

Deterioration is characterized by weakness of the emotional feeling, a state of indifference and apathy in which the patient shows no change of mood or feeling and events or happenings which usually produce feelings of surprise, pleasure or displeasure fail to arouse the customary response.

Other changes in the emotions are shown by increased impatience, irritability and irascibility, and the persistence of feelings of suspicion, perplexity, apprehension, timidity, fear, etc.

IV. ABNORMALITIES IN MENTAL CONTENT

Trend is a term which is applied to any set or group of ideas which follow a particular line or direction, i.e., the ideas may all tend to have a sexual or religious bearing, or they may be of reference or persecution, and the patient is said to have a religious trend, a persecutory trend, etc.

Fixed ideas are those which are constantly forcing themselves on the attention, and cannot be banished from the mind for any considerable period of time, and so tend to influence conduct. All other ideas, experiences, and feelings tend to be associated with it, and utilized for the realization of it.

Obsessions are imperative ideas which possess the mind and control the activity, often against desire and will. The patient cannot be persuaded that the particular acts to which these ideas urge him need not be done, and he will walk several blocks to avoid passing a certain corner or will wait for hours or walk miles to avoid taking a street car whose number may contain a certain numeral, etc.

Compulsions are ideas which seem to come from without and arouse a feeling of necessity to do certain acts, and much relief is experienced when the act takes place. Some voluntary act like closing a door, crossing a threshold, picking up an object, taking off a garment, etc., is performed a series of times, usually three and sometimes more. When the performance is once begun it is continued the definite number of times, and great unhappiness ensues if there is any interruption in the series. The more serious acts of taking property which belongs to another without regard to its value or utility (kleptomania) or of setting fire (pyromania) are also examples.

Phobias are morbid fears. These may be of the dark,

of being alone, of closed rooms, of open spaces, of high places, of crowds, dirt, light, bridges, etc. The patient very often fully realizes the morbid nature of these fears but is unable to control them.

Delusions are false beliefs which cannot be corrected by argument or experience. They may be improbable, impossible, inconsistent, absurd and fantastic, and are usually grouped as belonging to two types, the depressive and expansive. Among the depressive delusions are: Delusions of persecution, in which the patient believes himself to be the object of repeated acts of cruelty or annoyance; delusions of self-accusation in which he accuses himself of having committed some wrong or immoral act; delusions of reference in which he believes that everything which is transpiring about him is a direct allusion to himself; delusions of misfortune in which he believes that ill luck, calamity, disaster or accident have befallen him; and hypochondriacal delusions in which he believes that he is suffering from grave bodily disease. The expansive delusions include the "delusions of grandeur," in which the patient believes that he has great wealth, possessions, strength and influence. He may believe he owns all the banks, has billions of dollars, mansions of gold, a thousand automobiles, the beauty of Apollo, the strength of Samson, the authority of God and power to rule heaven and earth, for in fact there seems to be no limit to the extravagant expression. The opinion is held that these delusions represent in a florid form the unconscious desires of the patient.

Illusions are misinterpreted sense impressions. There is always an external stimulus to furnish the impression, but it is interpreted falsely, as for example, the cord of a bath robe which is detached from the garment may be interpreted to be a snake, or the branch of a tree swaying in the wind may be mistaken for a beckoning hand, or the sound of a whistle may mean the call of a human voice. The normal mind at times misinterprets sense impressions, but it soon corrects the error. In mental disease the illusion per

sists, is believed in and consequently influences behavior. There may be illusions of all the senses, but those of hearing, sight and touch are most frequent.

Hallucinations are false perceptions. These are of purely mental origin for there is no recognizable external stimulus present. A patient will see persons, animals and objects in the room when none are present, will hear voices and reply to them when no sound can be heard, feel vermin crawling over his skin, feel the heat of fire which he thinks is consuming his bed, etc. Normal persons do not have hallucinations, but they occur frequently in deranged conditions of the mind, and like illusions are held to rather tenaciously, and are believed in so that the conduct is often dominated by them. The most common hallucinations are of hearing, sight and touch.

V. DISTURBANCES OF CONSCIOUSNESS

Clouding of consciousness is a condition in which external stimuli of the ordinary strength are not comprehended.

Delirium is "a temporary general disturbance of consciousness, a perversion of the intellectual and perceptive faculties, characterized by confusion, by more or less transitory delusions and fleeting hallucinations, accompanied by disordered, senseless speech and muttering, and motor unrest." Delirium may vary in degree of severity from a mild wandering type in which the patient is incessantly engaged in disjointed conversation with imaginary persons or muttering to himself, with comparatively little motor activity, to an excited form characterized by extreme restlessness and violence, shouting and attempting to escape from bed or room and from the tormentors created by his imagination who annoy and harass him, or struggling with the imaginary enemies and those who try to limit his activity and prevent his escape. The mood is variable and may be happy, sad, anxious, apprehensive or fearful. Delirium may develop as a symptom in the infectious diseases and toxic conditions arising from disordered physical function, in alcoholic and