profound excitable idiot; dwarf, aged 15 years. Came to me in his 
twelfth year. Fair complexion, rather pleasing features ; internal 
strabismus of right eye, and marked nystagmus of both. A mute, 
hearing perfect, understanding very simple language ; unclean, help- 
less and devoid of natural affection, even for his mother whom he 
recognized, but to whom he was indifferent. The period of exalta- 
tion lasted from several days to 2 weeks ; during this, the boy, wildly 
excited, with glaring eyes and screaming violently, would beat un- 
ceasingly the center of forehead and left ear — never the right — caus- 
ing bruises and running sores. This would be followed by a period 
of extreme depression, lasting from 2 days to a week — never longer 
— during which he liked to have his head covered with a handker- 
chief, and would sit quiet with eyes cast down. Out of this he 
passed into the nervous stage — ^his lucid interval — during which, rest- 
less, noisy, moving body to and fro, making hissing, grunting noises, he would sit continually playing with strap or string, winding 
and twisting them around his nervous hands. This also lasted for 
about a week, when the circle would begin again. Died of phthisis 
in fifteenth year. 

Third child born ; instrumental delivery. Father 29, mother —