106 INSANITY do occur it is generally in the form of spectres, which prompt to suicide, self-mutilation, or homicide. Hallu cinations of hearing are more common, and are believed to be of graver import. As a rule the hallucination takes the form of words emanating from a something or some one of whose personality the patient has no conception. That an apparent connexion can often be traced between the character of the delusion and that of the primary causating emotion is particularly true of the melancholic delusions which follow on religious emotionalism, so much so that many writers regard religious melancholia ns a distinct form of insanity. This is a term, however, very loosely employed, and it is, in fact, by no means easy to ascertain what it im plies ; by one section of authors it is regarded as that form of melancholia in which the insanity centres upon religious ideas, by another as the form of insanity produced by depressing religious emotion. The latter position is tenable on purely clinical considerations, if the insanity retains the character of the causating emotion, which it very frequently does not; the former is open to the objection that the delusions may bo mere accidents in a case, and may bear no relation whatever to the exciting psychical cause. One reason why the term is so strongly impressed on the mind of the public is, that it may appear as pseudo-epidemic. The waves of religious emotionalism, which almost periodi cally disturb society in the form of " revivals," are apt to produce explosion of psychical action in those members of the community predisposed to nervous degradation. The public never considers, in fact does not know, that any other equally potent cause of emotion might be as effectual, and therefore sets down such accidental congeries of cases as " religious melancholia," accepting that term as representing all the abnormal psychical conditions which may result from "revivals." It is better to consider religious influences in the common category of emotions producing over-excitation of the brain. The deep despondency which follows on religious emotionalism may be productive of such pre dominating ideas as that the soul is irretrievably lost, that the unpardonable sin has been committed, and that there is no hope of salvation. Although in the abstract it is open to question whether such predominating ideas are strictly delusions, inasmuch as they may be considered as morbid exacerbations of fears and anxieties suggested by certain schools of religious thought, still in the concrete they amount to delusion ; for, even supposing they have been arrived at by a normal process of reasoning which in most cases is extremely doubtful they are maintained at the expense of all other religious considerations, and by the exclusion of all arguments founded on the experience of others. The delusions which it is impossible to connect with any particular physical or psychical influence are for the most part characterized by suspicion and fear, and take such forms in the mind of the patient as that spiss surround him, that all his actions are watched, that all connected with him are plotting against him, that conspiracies are being organized with a view to deprive him of his estate, procure his ruin, or do him some evil of which he can give no definite explanation. Occasionally delusions of fear and suspicion are connected with persons whom the patient has never seen, or with sections of society, such as political parties or religious communions. Self -accusation of serious crime is a frequent result of delusion. This idea of crime may be entirely unsubstantial, or it may possess some very slight foundation in fact, one which has no rational bearing on the existing position. When insane self -accusations are critically examined, it is found that remorse is very rarely connected with the real or imaginary crimes, from the consequences of which others have or might have suffered. The poetic stories of insanity produced by remorse of con science for crimes involving the ruin or disgrace of others than the actual offenders may be set down as in the main apocryphal. The delusions of the melancholic are often fearfully intense, and produce very serious results in action ; they are apt to extend beyond himself. By a process of reason ing which the sane mind cannot appreciate, he may argue himself into the belief that his misery is also the misery of his friends and family, that his relatives are cognizant of or implicated in his imaginary crimes, and that they must suffer the consequences along with him. As death offers to him the only chance of relief, so he believes it best that those nearest and dearest to him should die also. From this state of feeling follow those fearful acts of homicide which occasionally startle society a parent destroys several of his children, a lover his mistress, or a husband his wife, before committing self-destruction. It is as well to attract attention here to the appearance of a tendency to homicide and suicide as an incident in a case, as the subject will have to be recurred to when adverting to the question of homicidal and suicidal insanity. Depression of Feeling associated u ith Delirium or Mania. In this class of cases it is impossible to say whether they should be called melancholic mania or maniacal melancholia. The wildest delirious excitement coexists with the deepest depression of feeling ; delusions of fear and horror are given expression to in the most extravagant manner, and relief from them is sought in frantic attempts at suicide ; the patient dashes his head against the floor or wall, tries to cast himself down stairs, holds his breath in the hope that he may suffocate. In this condition there is a strong tendency towards death, which not unfrequently occurs within a few days of the develop ment of the graver symptoms, and which is generally produced by congestion of the lungs as a direct result of the cerebral condition, i.e., by a true cerebral pneumonia. 2. Acute Idiopathic Mania presents itself in three forms (I) simple exaltation of feeling, (2) exaltation of feeling with delusion, (3) acute delirious mania. The second and third of these psychical conditions may supervene on the first, or any one of them may singly characterize a case ; in all, the period of transition from the prodromal stage is much more rapid than in acute idiopathic melancholia. Simple exaltation of feeling manifests itself in all de grees of intensity between mild general excitement and the extreme forms of maniacal furor ; in kind it may not amount to more than a decided increase of the initial symptoms of restlessness, irritability, and change of dis position ; in degree it is characterized by greater or less excitement of thought, word, and action. The general vague restlessness and irritability of the prodromal period not only become exacerbated, but manifest a tendency to produce results in action. Excited action may show itself either in a general exaltation or in the suspension of normal trains of thought. A prominent example of the first psychical condition is found in the naturally devout mind under certain conditions of excitement : the habitually religious man may have meditated on schemes for self-conduct, the good of mankind, or the spread of religion, schemes which, so long as mental action was under control, were mere projects, things to be hoped for, but which under morbid excitement assert themselves so powerfully as to be regarded by the unbalanced mind as immediate necessities, to be procured at the expense of all considerations. The real distinction of religious mania from religious enthusiastic excitement consists, not in the form of the ideas, for which parallel cases might be found in sanity and insanity, but in the^r saltum manner in which it is sought to carry them into action, in the leaving out of those links which the sane mind uses to decide on the
