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they are worth. For example, "libertinism" although classed under the physical causes, cannot be separated fully from the thousand moral influences which a course of dissipation involves. Nor again can "the reverses of fortune, and its subsequent misery," referred to the moral causes, be entirely separated from the bad diet or starvation, which of themselves, interfere with the nutrition and vigorous action of the cerebral organs.

Dr. Conolly observes, that it is difficult to avoid concluding, as cases of melancholia are so frequently met with, about the period of the cessation of the catamenia, that the cerebral disturbance is generally connected with some morbid state of the uterus. Melancholia also will occur, "after several hæmorrhagic attacks, in which there is a constant sense of weight in the situation of the colon, with pain apparently in the sigmoid flexure, and occasional hæmorrhage from the bowels. There is in such cases, severe mental despondency, and inability to decide upon anything, and a loss of all hope and joy, and religious confidence. Spasms of the lower extremities, and hysterical lameness, sometimes become complicated with this state. In some such cases the colon is partially displaced; although in the few examples of this displacement observed at Hanwell, the mental symptoms have not been uniform."

Dr. Conolly's conclusion is, that, "remembering the same invasion of despondency lasting for a year or two, is not at all uncommon in men as well as women, when between 40 and 50 years of age, this state would seem more probably to depend upon some general alteration in the circulation, or some climacteric change in the brain itself, at that time of life when both physical and mental commotion, in some shape or other, seem peculiarly incidental to the human constitution."

In regard to the influence of the seasons, it was observed at the Salpetriére, that the admission of melancholiacs was greater during the months of May, June, July, and August; and in respect to the influence of age, it was found at the same institution, that melancholy is frequent between the age of 25 and 35, that after this period it diminishes in frequency, and rarely appears after the age of 55. The same result was shown by statistics drawn from the wealthier classes.

From melancholia, we may turn to the consideration of the opposite condition of the same group of the affective

faculties, a condition to which the terms Amenomania and Charomania, have been applied by French writers.

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There is very generally, so intimate a connection between those examples of delusional insanity, in which the delusion is of a gay and elevated character; and those exalted states of the feeling, which we proceed to consider, that the two are rarely separated. They may be so, however; and it therefore happens of necessity, that in the description of the various forms of mental disorder, we shall come upon the same phenomena, when engaged on very different forms of insanity. Thus, when our Thus, when our attention was specially directed to delusions, it was impossible to avoid a reference to those cases in which the patient believes himself a king, or the Deity; and in the consideration of the present division, we necessarily meet with cases, in which the exalted state of the emotions led to these delusions. The student cannot be too often reminded of the close relation which thus subsists between false conceptions, and a morbid condition of the sentiments; of which latter, the former may only be symptomatic. He must consider in each particular case, which is primary, and which is secondary, in the order of morbid mental phenomena. For it is needful that he should never forget, that convenient and necessary as are classifications and divisions, for the purpose of facilitating the comprehension of the multiform phases of insanity, which, without them, would present a more rude and undigested heap than is at present the case; nature herself cannot be so precisely limited; and that, in her book, as opened to him, in the wards of an asylum, he must be prepared to find a combination, a blending, if not a confusion, of the elementary forms, which it has been our endeavour to illustrate.

But, while this is true, it may be doubted whether he will be more perplexed, and disappointed in this discovery; than when, after mastering the typical forms of disease in general, as presented to him in his medical text book, he goes to the bedside of a patient, and in looking for the presence of every symptom as detailed under the appropriate head, he discovers that the disease is provokingly different from (indeed not half so good as) its description. But a more enlarged experience will teach him to apportion to his teachers a juster and a higher meed of praise. He will then employ their writings as a help, an index rerum, but not as a substitute for individual observation of disease, as it is actually to be seen in nature. This individual labour, no

description or classification of diseases, ever did, ever will, or ever ought to supersede. Rhases, ten centuries ago, averred that "he who does not form in his mind a clear conception of the nature of diseases before he enters the chambers of the sick, will find, that from ignorance and misapprehension, he will confound one complaint with another for this obvious reason, that he has come to his task unprepared and uninstructed."

When Esquirol restricted the term, melancholia, to its present popular signification, he applied that of monomania, at least the affective class of monomanias, to examples of exaltation of the sentiments. Thus he observes, "The melancholiac fastens upon himself all his thoughts, all his affections; is egotistical, and lives within himself, In monomania, on the contrary, the sensibility is agreeably excited. The gay and expansive passions react upon the understanding and the will. The monomaniac lives without himself, and diffuses among others the excess of his emotions. The physiognomy of the monomaniac is animated, changeful, pleasant, the eyes are lively and brilliant. The monomaniac is gay, petulent, rash, and audacious. The melancholiac is sorrowful, calm, diffident, and fearful. The former takes a great deal of exercise, is talkative, blustering, pertinacious, and easily irritated; nothing appears to oppose the free exercise of all his functions. The latter opposes every movement, dissembles, excuses or accuses himself; the functions are accomplished painfully and slowly Such are the essential differences between melancholia and monomania, so clearly pointed out that we need not confound these two pathological conditions, nor impose upon them the same name, if we desire precision in medical language."

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It is customary to speak of a monomania of pride, of vanity, etc. and French authors have la monomanie vaniteuse, or Narcisse; and la monomanie ambitieuse, or orgueilleuse, or des riches, or des grandeurs.

The former is described by Guislain in the following terms: "It ordinarily manifests itself under the form of a tranquil mania, which exhibits the patient infatuated with his beauty, his graces, his mind, his dress, his talents, titles and birth. These lunatics love to see themselves in the glass, and to deck themselves out; sometimes they display an astonishing art in varying their attire, although their wardrobe may be very scanty; they invent new fashions, they arrange their hair tastefully, and they study to set themselves off to advantage by attention to their toilet, person, and figure.'

I am acquainted with such a case at present; a patient who has no very decided delusion, but who is influenced by the most exalted notions respecting himself: his every gesture, and expression, and conversation, display his diseased selflove, his "monomanie vaniteuse," associated, however, with great intelligence, and an extent of knowledge, of which many who are sane might be justly proud. He constantly boasts of his " descent from one of the best families in the United Kingdom," "a family of note," and that his family have in their possession "three different coats of arms, finely emblazoned on parchment. His "maternal blood is equally good." He is intensely sensitive to everything which can by any possibility be construed into a slight of himself, and the omission of any of the most trivial accustomed marks of respect, is tortured into intentional incivility. The studiously arranged dress, the self-satisfied attitude, and the buoyant step of this patient, are all in keeping with the sentiments which are present in such morbid excess.

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Not unfrequently, however, these several forms are confounded with general mania, when from their partial character, and from the small degree in which the succession of ideas is confused, they may properly be distinguished from genuine mania. Esquirol complained of this confusion. "Writers have not observed the difference between monomania and mania; because of the excitement, susceptibility, and fury, of some monomaniacs." "Amongst monomaniacs, the passions are gay and expansive; enjoying a sense of perfect health, of augmented muscular power, and of a general well-being, this class of patients seize upon the cheerful side of everything; satisfied with themselves, they are content with others. They are happy, joyous, and communicative. They sing, laugh and dance; controlled by vanity and self-love they delight in their own vain glorious convictions, in their thoughts of grandeur, power, and wealth. They are active, petulent, inexhaustible in their loquacity, and speaking constantly of their felicity. They are susceptible and irritable; their impressions are vivid, their affections energetic, their determinations violent; disliking opposition and restraint, they easily become angry, and even furious."

But while thus distinguishing monomania, from melancholia on the one hand, and mania on the other, a caution may be entered against falling into the error of supposing that a strictly speaking monomaniacal state is of frequent occurrence; on the contrary it is exceedingly rare.


has stated that his experience only afforded two or three examples of it. The term need not, however, be used in this exclusive sense; all that need be implied, as Baillarger has remarked, is that a marked predominance of certain feelings or ideas exists, in the magic circle of which, the individual is unmistakeably mad, while without it, he is as rational as most people. If more than this be looked for, the student will often think he has discovered polymania, when he has been told that the patient offers an example of monomania.

Guislain estimates the frequency of the monomania of pride at 1 in 300 admissions, exclusive of cases of general paralysis with which extravagant ideas respecting wealth are so frequently associated.

Religious Excitement is less common than the opposite condition, that of religious melancholy or depression. It not unfrequently succeeds it. It has been estimated that only one per cent. of cases of excitement assume this form. It includes the theomania of Esquirol.


The observations made when speaking of melancholia, in regard to the relation it bears to the "moral insanity" of Dr. Prichard apply equally here, and we find this writer giving the following excellent description of religious excitement, as illustrative of disorder of the moral faculties without lesion of the intelligence: "A person says he "who has long suffered under a sense of condemnation and abandonment, when all the springs of hope and comfort have appeared to be dried up, and nothing has been for a long time felt to mitigate the gloom and sorrow of the present time, and the dark and fearful anticipations of futurity, has passed all at once from one extreme to the other; his feelings have become of a sudden entirely changed; he has a sense of lively joy in contemplating the designs of Providence towards him, amounting sometimes to rapture and extasy. Such a change has been hailed by the relations of the individual thus affected, when they have happened to be pious and devout persons, as a happy transition from a state of religious destitution to one of acceptance and mental peace; but the strain of excitement is too high, the expressions of happiness too extatic to be long mistaken: signs of pride and haughtiness are betrayed, and of a violent and boisterous deportment, which are quite unlike the effects of a religious influence, and soon unfold the real nature of the case; or it is clearly displayed by the selfishness, the want of natural affection, the variableness of spirits, the irregular mental habits of the individual. In the cases to which I have

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