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need to be subdivided into at least the two varieties of congenitaland acquired or accidental. It may be of great practical importance to beable to decide to which of these two varieties a case belongs. Cretinism willbe treated of in a separate article. Shuttleworths classification (British Med. Jour., Jan. 30, 1886), whichincludes the varieties of Ireland with some additional classes, is as follows : ClassA—Congenital.—1, Microcephalic; 2, Hydrocephalic (also non-congenital) ; 3, Scrofulous (Mongol type); 4, Sensorial (also non-congenital);5, Primarily neurotic; 6, Paralytic (also non-congenital) ; 7, Choreic (alsonon-congenital); 8, Cretinoid ; (a) sporadic, (b) endemic. Class B—NON-coxgenital.—a, Developmental.—9, Eclamptic : 10. Epileptic ; 11, Syphil-itic ; 12, Post-febrile (also accidental) ; b, Accidental or Acquired.—13, Toxic;14, Traumatic; 15, Emotional; 16, From mixed causes. Strumous or scrofulous forms of idiocy can be clearly placed to the strumous PLATE XVII
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Fig. 1. Congenital Idiot of Low Grade.Fig. 2. Epileptic Imbecile. Fig. 3. Insane Imbecile. Fig. -1. Congenital Idiot of Low Grade. IDIOCY AND IMBECILITY. 675 or scrofulous diathesis ; they belong to the congenital class. The primarilyneurotic are those with bodies comparatively well developed and with signs ofirregular nervous action. The term choreic, as applied to idiocy, has been used in several ways—as descriptive of the motor phenomena presented by the patient; or of idiocyresulting in a child born of a mother choreic during pregnancy ; or of casesin which violent or persistent chorea seems to induce idiocy in the developingchild. Congenital idiocy due to inherited syphilis is probably but not certainlyrarer than a form of juvenile dementia, which usually develops some yearsafter birth, and is described in another section. Some syphilitic children areidiotic from birth, and in these cases treatment is generally as useless as incases due to other causes, while in syphilitic juve

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