TERMINAL DEMENTIA is the end to which most of the insanity not resulting in recovery finally comes. The features marking the disease in its early stages for the most part disappear, leaving all the functions of the mind impaired in all degrees up to total extinction—the whole character on a lower plane. It is the disease which to so great an extent crowds the wards of insane asylums and almshouses with the (1) agitated or (2) apathetic chronic insane, the worst of whom are mental and physical wrecks, squatting on floors, uttering an unintelligible jargon, noisy, filthy, without intelligence for the simplest natural wants. Their chief function, under the prevalent methods of construction and management of lunatic hospitals in most places, is to blight with a certain feeling of hopelessness many of the curable insane who are obliged to go for rest and quiet to institutions where the overwhelming majority of the inmates are manifestly and painfully incurable. French writers include a great part of chronic delusional insanity (secondary confusional insanity, Wahnsinn, secundäre Verrücktheit) and terminal dementia (Blödsinn) under one head, démence; and with much reason, as it is not always possible to differentiate between the two. The proper TREATMENT of the incurable, demented insane should provide not only that they be not at large, where they annoy the strong and the well, but also that they shall not disturb the insane who are acutely ill and in need of treatment suited to sick people, and whose chances of recovery at best are none too favorable. Experiments, now quite numerous, have shown that the lives and occupations of many of them may be {204} made not entirely unlike those to which they were reared, and that nearly all may be suitably provided for without the expensive hospitals and appliances necessary for the proper treatment of acute mental disease. A comparison of countries in which there is and is not a comprehensive system of State supervision of the insane by a competent board seems to me to reveal so unquestionably the fact that such a system alone provides the proper protection for the insane, and the needed variety and uniformly high standard of excellence in the provisions for their treatment, that I hope to see the medical profession using its vast influence upon public opinion to secure it. If we meet in the wards of our insane asylums hopeless mental and physical wrecks, if we find there the extremity of human wretchedness, the supreme control of all that is evil or vile in our nature, the worst antitypes of all the virtues, so, on the other hand, nowhere else do we see such struggles for the mastery of the better impulses, such efforts against such odds to hold back the mind in an unequal fight. Nowhere else, too, are developed finer sympathy, more beautiful unselfishness, more generous charity, or more heroic resignation where no hope in life remains but for death.