The disturbance evidently depends on absence of memory and resulting inability to associate memory pictures with the simplest mental iinpressions. Pronounced imbeciles are unable to distinguish between their nearest relatives and strangers; thcy do not know their own clothes and cannot find their way about, etc. In the milder grades the child is able to perform these simple acts, but when it is tested with objects or pictures, it is found to be unable to recognize or designate objects of daily use and toys. In so-called " word-deaf " imbeciles the examination must be confined to naming the desired object and asking the child to point it out, if the error of overestimating the degree of mental deficiency is to lie avoided. Great inaccuracy of observation and confusion of mental images are frequently observed. While the child is able to dis tinguish a dog from a goose in a picture book, it will confound a dog v,-ith a cat or a goat or a goose with a duck or a stork. The color sense is also uncertain and late in developing.
Special conceptions, as for example, above, below, larger, longer, smaller, shorter and the like are usually defective or entirely absent.
It is the same with the causal connection of various things, for example, if we ask such questions as proposed by Ziehen—"why do we heat the house in winter?" or " why have I brought an umbrella with me?" an imbecile child is rarely able to give a suitable answer.
Higher abstract ideas such as duty, ownership, envy, gratitude, good, bad, are always absent in imbecile children. The emotional life also is usually- characterized by.- the poverty and temporary character of the emotions.
This impairment of the emotional life is particularly characteristic of feeble-minded children, in whom the impairment of intellect may be slight or liinited to only- a few mental functions. The ethical impair ment is the most conspicuous trait of feeble-minded children. Friend ship, attachment, gratitude, respect, sense of duty, love of truth and the like are very feebly developed and usually, after a few attempts at correction which make very little impression, are replaced by the oppo site evil impulses (moral insanity).
Intellectual impairment is marked in feeble-minded children, so that they are able to carry on quite complicated trains of thought and perform quite intricate acts, erafty intrigues and lying excuses. As a rule it is not recognized until thc child begins to go to school when it is found to be unable to keep up with other normal children of the satne age and falls behind in spite of additional help and the most careful teaching. In the milder grades thc child while in the lower cla,:ses appears to be normal, but fails to make good when it reaches the middle or upper classes where, in addition to exercise.s which chiefly tax the memory, work demanding higher intellectual reasoning powers is required. These
cases which are recognized late, when the child has almost reached the age of puberty, must not be mistaken for acquired dementia (hebe phrenia and the like), w-hich often exhibits a progressive character.
Medical treatment is required only in those rare cases of imbecility in which the mental deficiency is a symptom of disease of the tlayroid gland or possibly of some organic brain disease as, for example, brain syphilis, that is not altogether incurable. If these conditions cannot be excluded, an attempt should be made to treat the primary condition.
For the rest, the treatment of imbecility belongs to the pedagogue, whose duty it is to develop what there remains of mentality by- judicious guidance and suitable exercises. This field has been developed beyond all expectation in the last few years and already possess an almost unlimited literature. The limits of this work forbid even a fragmentary exposition of the methods that have been worked out and the results that have been achieved in this field by the cooperation of physicians, psychologists and pedagogues.
Acquired dementia occurs among children in various forms. Two of these forms, paralytic and epileptic dementia, have been men tioned in other portions of this book. Dementia occurring with focal disease of the brain and hebephrenia (dementia prcox) do not require special description. The former differs in that it is not congenital, and does not appear before the acquisition of some mental state of possession; while hebephrenia is a diseas:e of puberty or, in exceptional cases, has its inception shortly before that period. The reader is referred for this subject to the text books on psychiatry.
Ainong the psychoses without defective intelligence we have mania and melancholia, both as simple diseases occurring only once and as periodical or circular forms. They are very rare before the beginning of puberty.
Acute hallueinosis or amentia, chronic paranoia, stuporous conditions ("twilight conditions") on an epileptic or hysterical basis, and the forms of delirium in severe febrile diseases (such as thc delirium of incubation, or collapse) inanition and intoxications (called by Ziehen concomitant delirium) are practically the same in children as in adults and therefore do not call for any special description. Moreover, like all functional psychoses, these conditions are rare in children.
Uncontrollable ideas and actions have already been discussed in the chapter on hereditary neuropathia. In the same connection psycho pathic deficiency was also mentioned. The psychotic conditions which develop as the result of these anomalies and which exhibit a special character are sometimes observed as early as the later periods of child hood and merit attention on account of the frequent collisions that they produce in families as well as in civil life.