MALI-MALI IN THE PHILIPPINE ISLANDS. 339 



be done by sudden loud exclamations or quick, spasmodic movements. After at- 

 tention is tlms secured, a remarkably consistent mimicry of words, sounds, and 

 actions may be continued at the will of the operator. The performance resembles 

 that seen in mesmerism, and the face of the patient during these times has the 

 blank, uncertain character of a person under hypnotic influence. 



Physical examination, of the patient is practically negative. The patellar 

 reflexes are slightly exaggerated, there is no disturbance of sensation; attention, 

 memory, and coordination are good, and there is absolute freedom from muscular 

 spasm of any kind. The mental condition is equal to that of the average poor, 

 ignorant person of her station in life. 



In summarizing this case and that of three others, which are not given 

 in detail, it may be stated that they are free from any form of muscular 

 spasm, explosive utterance or other evidence of autospasm or tic. They 

 are characterized by the existence of a temporary abulia, or even by a 

 kind of hypnotic state as it were, under the influence of another person. 

 The presence, amount, and character of the echolalia, or mimicry of words, 

 as well as that of the echokinesis, or mimicry of actions, are entirely under 

 the control of the person influencing the patient. 



In order to control one of these patients, unless an extreme degree of 

 susceptibility is present, it is first necessary to secure her attention by 

 a sudden movement, noise, or quick exclamation in a rather loud voice. 

 After this has been accomplished the mimicry may be continued at the 

 will of the operator with no especial effort or concentration. 



CONCLUSIONS. 



1. The peculiar mimic psychosis in the Philippines known by the local 

 name mali-mali is closely related to, but distinct from, the tics. 



2. Such somewhat doubtful tics as Gilles de la Tourette's disease, 

 jumping tic of Beard, myriachit of Hammond, saltatory cramp of Bam- 

 berger, latah of O'Brien, tarentism, and the saltatory tics in general, 

 have much in common with the Philippine affection, but in all of these, 

 with the possible exception of latah, there are indications of autospasm 

 which is lacking in the local disease. 



3. Eamaneniana, the dancing mania of Eamisiary, St. John's, and 

 St. Guy's dance, and perhaps other allied conditions, are more nearly 

 hysterical manifestations; and while they have much in common with 

 mali-mali they all show evidences of autostimulation, and when once 

 established are capable of prolongation without any outside influence. 



4. Mali-mali is probably an expression of mental degeneracy similar to 

 that generally accepted for other conditions of the same group. However, 

 its clinical manifestations do not fully agree with those given for any 

 other similar disease, and for this reason it is classified, tentatively at 

 least, as a clinical entity. 



