definite
reasons. They do not form any typical symptom-complex. The delusional
ideas may take on any character; hallucinations may occur in all fields
of the sensorium; consciousness may or may not be clouded, but is
usually so in the beginning of the disorder. Recoveries are as a rule
gradual, but may set in quite suddenly. Insight may or may not be
present. The course of the disorder, like its symptomatology, offers
nothing of a definite, characteristic nature.

Thus we see that the distinguishing feature of Birnbaum's degenerative
psychoses does not lie in their mode of appearance, in their
symptomatology, but in the mechanism of their evolution, and, above all,
in their total dependence upon extraneous influences. They are typical
psychogenetic disorders, the psychic etiology of which is potent not
only in the incitation of the processes, but in the modeling and
fashioning of them. Although Birnbaum notices the close relation that
exists between these psychoses and the hysterical psychotic
manifestations, he would separate them distinctly from hysteria.

CASE IV.--A. C., colored female, age 32 on admission to the Government
Hospital for the Insane, on June 18, 1909. Father died of dropsy; one
brother was killed in a railroad accident; one sister suffered from
St. Vitus' dance; another died of tuberculosis. Patient was born in
Jamestown, Virginia, was healthy as a child. Does not remember having
had the usual diseases of childhood; had a severe attack of typhoid
fever when quite young. Attended school until fourteen years of age,
having reached the third grade. Upon leaving school she went to work
as chambermaid and soon became addicted to the excessive use of
alcohol, as a result of which she got into numerous fights and
quarrels. In 1895, while intoxicated, she stabbed a man in the back
and was sent to Albany Penitentiary for five years and eleven months.
During her sojourn there she was sent to the Matteawan Hospital for
Criminal Insane, where she remained forty-five days. Upon being
discharged she returned to her home and lived with her mother,
assisting her with washing and ironing, following which she led the
life of a prostitute for about two years. In 1901 she was sentenced to
thirty months imprisonment at Moundsville, Virginia, for theft.
Previous to this she had been confined in the Government Hospital for
the Insane for about a month with an attack of delirium treme