DISCUSSION.

DR. J. F. Y. PAINE, Galveston: I have nothing to say in the way of discussion of this paper. It is so complete and the histories of the cases reported so clear and comprehensive; in fact, it is such a full presentment of facts, there is scarcely anything left to say on the subject. I only desire to thank Dr. Graves for presenting these interesting cases to the Association.

DR. E. W. LINK, Palestine: I want to know if these are not the cases surgeons used to operate on by opening the skull in order to give the brain room to grow; they claimed that the sutures united too early and that the brain was held in a vise.

DR. E. E. GUINN, Jacksonville, said: What per cent of your inmates are epileptics?

DR. M. L. GRAVES, said, in closing: I have very little to say in conclusion. In answer to the doctor as to the percentage of epileptics, we have a population of 700 in the Southwestern Insane Asylum and 125 to 150 are epileptics, and I presume the other institutions have a similar proportion. Dr. Worsham can answer for Austin and Dr. Nichols for Terrell. Certainly we have more than enough to fill Dr. Preston's institution, and we can swamp him the first day that the train will take them.

DEGENERATIVE STIGMATA.

G. H. MOODY, M. D.,

SAN ANTONIO, TEXAS.

To the physician who is constantly and actively engaged in a general practice the title of this paper may carry with it the idea of a subject remotely affecting his greatest professional opportunities. Such an idea would be far from correct. It affects, not only the present, but future generations, wherein prophylaxis-the true physician's greatest opportunities, highest aims and noblest ambitions may be practiced on the highest and broadest planes and with assurance of results conducive to the highest good of the

race.

The subject is so extensive that a consideration in detail here would become long, tiresome and uninteresting, thereby defeating its purpose, which is to freshen and fix in our minds those signs of organic weakness constantly observable in the ordinary walks of professional experience and observation, and to enable us to interpret their significance and to divert the tendencies of which they are the indices.

By degenerative stigmata is meant the visible signs of vices and of transmitted hereditary weaknesses. They constitute the indices of the accumulations of instability of organization and are directly inherited, or acquired by reason of hereditary developmental or metabolic deficiencies, and they mark a tendency which, if allowed to duplicate itself for a few generations, and if not fortified and checked by intervening hereditary influences of opposite tendencies and by corrective developmental and environmental influences, will finally result in annihilation of its stock through imbecility, sterility, idiocy and early decay. It would be impossible to describe every degenerative stigmata possible to mankind, for, as every individual differs from every other individual, so may his peculiarities and defects likewise differ.

It is to be remembered that the degeneracy is always a mark of positive and fixed identity in nature, significance and origin, however varied may be its stigmata. In every case an hereditary predisposition would be found if we had the means at hand to discover it. The trouble lies:

First. In the difficulty in obtaining correct history. This difficulty is due partly to a reluctance on the part of their relatives to admit of a weak streak in them, rather preferring to assign the cause of the defect to some accident of childhood or to maternal impressions, etc. The other difficulty is due to ignorance. They can assign an hereditary influence if the exact similarity of defect was plainly manifested in the parent. For instance, if the epileptic child's parent had epilepsy, or if the idiotic or insane child's parent had been violently insane, but if uncle or aunt or cousin or grand parent were similarly affected it would not appeal to them, or if the epileptic or insane or deaf-mute or deformed child's parent or grand parent were a periodic drunkard or had neurasthenia or hysteria, an hereditary family history would hardly be obtainable, they not knowing that degenerative stigmata have no law of similarity of transmitted manifestations; that a bad organization is responsible for them all; that often an individual or degenerative parentage may exhibit no stigmata at all, and that the potentiality is kenetically stored up in his organization only awaiting to unite with its affinity in the formation of some future being, when the potentialities will become active and possibly accentuated. It is probably enough here to say that these stigmata vary from gross anatomical deformities through a long chain of variations and degrees up to slight eccentricities of character. With a view to greater convenience and simplicity they have been variously classified by different authors as teratological and functional, as anatomical, physiological and psychical, etc. For the sake of brevity, we may say, first, that there are many bodily deformities and discrepancies which we may always recognize as degenerative in significance, and that they comprise all deformities and asymmetries of the cranium, face and trunk, with possibilities of similar defects

of their appendages, except in a few cases where caused by traumatism in utero or infancy.

Second. That there are many more degenerative stigmata just as often and as easily observable, and just as significant, which are exhibited otherwise than in bodily deformities, and of these may be mentioned the various neuroses (sometimes called the insane hereditary equivalents), neurasthenia, hysteria, epilepsy, chorea, dypsomania, migraine, etc., and that there are equally as significant physiological disturbances, such as stuttering, stammering, strabismus, convulsive tics, etc., and that some children are backward in teething, walking, talking and learning (some presenting the opposite manifestation, marked precocity), and that some have convulsions from trivial causes, night terrors, mad fits, as well as laughing spells in which they lose their breath and become cyanosed temporarily. These all mean nervous instability. Then, with equal importance to any form of stigmata, are paranoia, imperative concepts and impulsive and compulsive acts. The members of this class commit the greatest crimes and consequently play an important role in criminology. These are simply developmental defects, deep grounded, and as incurable as idiocy, to which they are similar in origin and kind, the difference being only in degree. Often neither they nor the public are able to recognize their deficiencies, and they are the last to crave sympathy or to demand justice. That they do not ask for it does not mean that they should not have it, and it devolves upon the medical profession to give it to them. True, medical science is facts and leaves to society the disposition of its disharmonies, but the medical profession is a part, and should be an important part, of society, and is entitled to help frame its standards. These delinquents are products of society, and society should not disown them nor disclaim its responsibility for their welfare.

The three cases here presented are with a view to observe some of these degenerative stigmata.

This young man, E. R., is twenty-three years of age, an American; single; was raised on the farm; has no education. His relatives

are dead, and there is no personal or family history obtainable. He is an epileptic imbecile. The epilepsy has existed for several years. Just how long can not be learned. His physical health is good, and his reactions and sensations are normal. He presents many degenerative stigma. His cranium is quite asymmetrical, presenting what is called the plagio-cephalic head, or that of oblique shape. It is also too low (cemo-cephalic), bin-auricular arc measuring 31 c. m., the average normal head in this measurement being 32 c. m. The naso-occipital arc is 33 c. m., a little above the average, which is 32. The circumference is 53, the normal being 52. The position of right ear is a little higher than the left, and lies more closely to the head. He has a narrow and arched palate.

The second case, L. J., is thirteen years of age; an American. She is an epileptic idiot. Her family history is meager and imperfect. The only relative known to be defective is an uncle. The superficial and deep reflexes, as well as the sensations, are normal and the cranium is asymmetrical, being larger in the left occipital region. It is also narrow and irregularly so. It is micro-cephalic. The measurement of the circumference being proportionately smaller than that of the bin-auricular or naso-occipital. The right ear stands out a greater distance from the head than the left. The palate is narrow and highly arched.

The third case, R. S., is twenty-eight years of age; an American. He is thirty-eight inches high, and weighs ninety-one pounds. His superficial and deep reflexes are sluggish, and his sensations apparently normal, except giving a slow response. He is an imbecile, his intellectual development being about equal to that of a three year old child. There is little personal or family history obtainable, except that he has been feeble-minded all his life. In reporting the case of the little girl I said she had a defective uncle. This is the uncle. He has always been irritable and subject to occasional fits of anger, which became so accentuated as to make him at times uncontrollable and dangerous, for which reason he was three years ago committed to the asylum for restraint. Since his admission, his physical health has been excellent, and under the daily routine