In this form the symptoms are reduced to phenomena of mental deterioration together with more or less pronounced changes in disposition.

The onset is almost always insidious, and it is usually impossible to determine even approximately its date. A subject previously affectionate, active, intelligent, even brilliant, becomes indifferent, indolent, and distracted. He is weary of everything, of play as well as work. He ceases to acquire new ideas, or to coordinate those which he has acquired previously, so that his general stock of ideas becomes more and more limited.

1 Lehrbuch der Psychiatrie, 7th edition, Vol. II, p. 190.

2 Dide et Chenais. Recherches urologiques et hematologiques dans la demence precoce. Ann. med. psych 1902.

Nervous symptoms (headache, insomnia, hysteriform disturbances) or constitutional symptoms (anorexia, loss of flesh) are frequent.

In the mild forms the disease is often unrecognized. The symptoms of mental deterioration pass for "negligence " or "lack of ambition." Such cases occur much more frequently than is commonly known.

The following lines from a letter addressed by a principal of a school to the parents of one of his pupils are very significant from this point of view:

"As you can see, the marks of M L. are no better than those for the preceding term, far from it. This pupil pays no attention to his duties, which three-fourths of the time are left unfinished; he no longer takes the trouble of learning his lessons. In the class room and at his studies he spends most of his time dreaming. It is evident that he cares nothing for his work. His professors no longer recognize in him the former studious pupil. It seems that even the approaching examinations do not affect his indifference. When it is pointed out to him that he is likely to fail, he promises vaguely to be more diligent, but one can see that he has no firm determination. The comments and suggestions in the letters of his parents no longer have any effect on him. . . . Formerly so jolly and so full of good humor, he has become quite unsociable. He does not seem to be pleased except when alone. When, by way of exception, he joins his comrades in conversation or in play, he soon leaves them, often after quarreling . with them over some absurd trifle. . . . Lately he has been complaining of insomnia and headache.

We have had the physician see him, but he has found nothing serious and has merely prescribed rest."

M. L. is to-day a true dement. He lives with his parents and is at best able to do only simple manual work. For a long time he showed some irritability. Now he has become totally indifferent.