curiously preserved in cerebral syphilis; also comparatively well in the depressions. The preservation of clearness as opposed to clouding of consciousness is especially noteworthy in dementia præcox, confusion is most prominent in infective, exhaustive and toxic conditions. Many cases of dementia præcox have all the originality of Alice's White Knight; and the catatonic with his floor-polisher surpasses in perseverance. The most striking abnomalies with Aussage experiments would probably be met in the Korsakoff psychosis.
It is obvious that, in any social sense, leadership and independent efficiency are practically wiped out in the mental diseases we have discussed. The fact that as a group they must be removed from society sufficiently attests this, though in many cases a diminished capacity for work under direction is preserved. But to this rule there are important exceptions, which fall into three classes. In spite of real suffering from neurosis or psychosis, special aptitudes enable some persons to maintain themselves independently, and even to perform valuable service in a highly organized society. Most neurologists number such individuals among their patients. In a second group of cases there is a clearer connection between the greater efficiency and the immediate symptoms of the psychosis. There are two types of these. Mild cases of manic excitement derive therefrom an energy which, if only the judgment be enough preserved, enables them to do tremendous amounts of work, bear troubles, and carry off situations that would be impossible to them in their normal states. I have often quoted a case of alternating excitements and depressions who used his excitements to earn enough money to tide over his depressions in private hospitals. This hypomanic state may be constitutional, giving energy and capacity far surpassing that of normal men, but complicated with pathological features. The personality of Alexander the Great, with its stupendous accomplishment, its egotism and its excesses, is a distinct historical example. The other of these types of effectiveness results through paranoic rather than manic traits. Paranoia carries with it a faith, singleness of purpose, persistence and self-confidence greatly in advance of normal personality, but these regularly attach to ideas whose working out throws that individual permanently out of adjustment with the social order. But if the ideas are such as to arouse social response, great leaders are produced. In the religious sphere it is evident that strong personalities may found systems of belief which, not to mention the occasional amassing of worldly goods, attract many followers, and are genuine moral forces, with no other support than their autistic convictions and indomitable zeal. The inspiring power of such characters in secular history is fitly represented by Joan of Arc.
Lastly, we may take up the question of the general cohesion in the different elements of the personality. As one may gather from the late
