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adoption or rejection of a scheme, but the omission of which transfers the scheme suddenly from the region of imagina tion and hope to one of present reality. There is an absence of religious totality ; the patient is bound up in some scheme for the advancement of religious knowledge, in some project for the building of a church, the founding of a school, the establishing of a mission, or, more probably, for all at once ; for this he neglects his family, all social considerations, and those duties which are the precepts of his faith. Whether the apparently efficient cause be religion, politics, or the prominent social question of the day, the results are identical, being only conditioned by the nature of the original idea. The ordinary behaviour of the man is changed ; he is ever on the move ; his gestures, loud tone of voice, volubility of talk, and general manner are such as to cause his friends distinctly to mark the change. A large proportion of such cases recover under appropriate treat ment, but they not unfrequently pass into acute delirious mania. When the disease is manifested by the suspension of the ordinary trains of thought, the symptoms consist, for the most part, in recklessness of action and conversation ; there is a sort of exalted joyousness, a strong tendency to dissipation, loud and wild though not necessarily incoherent talk, extreme restlessness, and utter want of respect for all conventionalities. Such patients (reputable members of society, be it remembered, a month or a week before) outrage all sense of decency ; they may walk the street with strumpets, and appear drunk in public, forcing their be haviour on the notice of the police. They care nothing for the feelings of friends or the prospects of their families. The intellectual faculties may be active ; thus wit and humour", uncontrolled by any feelings of consideration for others, may stand out all the more prominently. The condition, taken over all, is very closely allied to that stage of intoxi cation in which the poison of alcohol sets free all controlling influences. When tho restraining power of association is lost, there is no difficulty in comprehending that the uncon trolled brain may act in any direction. This class of cases is specially emphasized, because they are apt to be mistaken by the public for instances of mere moral obliquity. The relation of amount of mental disturbance to the degree of excitement is not definable ; mania may be extreme, and the disturbance of ideas apparently slight, and vice versa. It is of great importance that the two following facts should be insisted on (1) that mania of an extreme description can exist without delusion ; and (2) that mania of a dangerous nature may exist without furious excitement. It is in this class of mania that cases of so-called folie raisonnante are for the most part met with a class strongly insisted on by many Continental authorities as of great pathological importance. By one section of foreign writers it is spoken of as folie raisonnante, by another under the original name suggested by Pinel mania sine delirio, while by a third both are used promiscuously to indicate a class of cases in which, although considerable disturbance and excitement may exist, the sufferer is able to justify his course of action by a line of reasoning not illogical in itself, although founded on false premises. Exaltation of feeling with delusion or delusional mania, whether it follows on a period of simple exaltation of feel ing, or is coexistent with the first symptoms of excitement, is not to be connected with the originating psychical cause ; indeed the intellectual confusion is so great and of such a kind as to render any analysis impossible. It is well to mark here the psychological difference between maniacal and melancholic delusions ; the latter are persistent in character and appear to proceed from within, the former are changeful and are readily acted on from without. The general expansiveness of ideas, the rapidity with which they are produced and influenced by external objects, along 107 with the inability to correlate idea with idea, arc productive of incoherence in thought, word, and action. For instance, a man may imagine and state that he is the king of tho universe, at the same time that he enters no remonstrance against herding and eating with his fellow paupers ; he may assert his superiority, but may not object to obey the behests of a common keeper. Acute delirious mania is a condition often rapidly produced and not unfrequently fatal. It may be the culmination of a case which has passed through the stages of simple exaltation of feeling and mania with delusion the latter rarely ; or it may appear in a few days or even a few hours as the result of some severe mental shock. It may persist for only a short time, and is then spoken of as acute transitory mania. The symptoms are very definite, the wildest yells and screams, a frenzied rushing to and fro, a reckless casting of the body on the ground or against the walls and furniture, smashing everything that comes in the way without any definite purpose save smashing, flushed features, clammy sweat, and a high bounding rapid pulse ; nothing can control the patient but physical force, for his fury renders him blind to all influences. 3. Acute Primary Dementia. This disease is of rapid incidence. It may result from sudden psychical disturbance, especially fright ; occasionally no cause can be traced. After a few days or hours, during which the patient is somewhat stupid and apathetic, these symptoms increase to such a degree as to cause him to be, to all outward appearance, utterly demented ; he sits unaffected by any thing that goes on around him ; he is completely helpless, cannot take off or put on his clothes nor feed himself, and passes urine and faeces where he sits or stands ; he is speechless, and cannot be roused to action by any appeal ; his movements are slow, when he can be got to move at all ; but the chief motor symptom is a degree of catalepsy. It may be said with truth that the condition is one of mental and bodily catalepsy. Such cases to the ordinary observer appear utterly hopeless. There is a strong tendency towards death; but, when this is overcome, it often happens that the sufferer gradually emerges from the condi tion, and can give an account of the sensations experienced during his illness. It may terminate in dementia of a very low type. Post-mortem examination of recent cases fre quently reveals dropsy of the brain, or changes in inter stitial tissues producing pressure. (See Blandford, Insanity and its Treatment; Bucknill and Tuke, Psychological Medicine ; Griesinger, On Mental Diseases.} 4. General Paralysis of the Insane. General paresis, progressive paralytic dementia, or, as it is more frequently spoken of, general paralysis, is a disease of the superior and lateral convolutions of the brain, which gradually extends over the whole nervous system, producing a peculiar impairment of motor power, and invariably accompanied by insanity. It is marked by well-defined series of physical and psychical symptoms, and terminates in a peculiar manner within a definite period. General paralysis was first recognized as a special disease in France ; it was indicated by Esquirol, and its history was fairly elucidated by Bayle, Delaye, and Calmeil, the latter giving it the name of paralysie gcnerale des aliencs. General paralysis is a common disease, and is generally spoken of as " softening of the brain," a term diametrically opposed to its pathological anatomy. The condition is essentially a chronic diffuse subinflammatory overgrowth of the connective tissue of the cerebral hemispheres, leading to destruction of the true nerve elements, and principally affecting that region of the brain in which recent observers have localized the cortical motor centres. General paralysis is said to be a disease of middle life ; this is to a certain extent true, for, in the large majority of cases, its incidence