sexual instinct, before it passes into action, is guided by new ideas and opinions (of a morbidly exalted kind) which occupy the mind. The patient will then only gratify his desires in the sense of his over-estimate of self and of certain delirious ideas: he only pays his addresses to princesses and illustrious ladies. The female patients have imaginary love adventures with princes and kings."1

118. Monomonia and Delusions.-Monomania is a disease of that part of the disposition in which the man principally lives, for it surely can be more truly said that a man lives in his thoughts than in the material circumstances that surround him. It is in monomania, therefore, that illusions and delusions are most common, and it is in this form of the disease that these morbid impressions are most persistent. The awful abnormality of genuine mania produces such a "sea of troubles" that no delusion can remain long in possession of the individual. There is a rabble of ideas. Each delusion or illusion is jostled from its place by a host of others. But in monomania there is a peculiar persistence about the morbid impressions. The illusions are always the same. The individual believes that he sees a face which haunts him; hears voices which drive him to do some act; he is surrounded by odors, and the like. The delusions are persistent. The individual believes that the Holy Ghost has been incarnated in a canary bird, or that some worthless object is of enormous value.

119. Distinction between Mania and Monomania.— Still, although these impressions are persistent, there is much rationality in monomaniacs. Concerning many subjects they are able to reason with great accuracy, and sometimes with intelligent breadth of conception, which is a higher quality of reasoning than [96] mere accuracy. There is a very evident difference between monomania and mania proper. The manners of the monomaniac are not distraught: they are generally calm, their conversation is generally intelligent, and such excitement as occasionally exists is due, as in sane

Mental Pathology and Therapeutics, (Griesinger,) p. 305, New Syd. Soc. ed.

individuals, to an external motive. It may be, however, that the external motive is misunderstood in consequence of the illusion or delusion of the individual. Of course there is harmony between the manners and conduct of the monomaniac and his diseased imaginings. Monomania of pride finds expressions in gestures which to the individual himself do not seem to have any of the characteristics of grimace. Many persons in asylums are allowed to gratify their harmless liking for gaudy raiment and trappings of ribbons, and their words and gestures are possibly exaggerated in consequence of this indulgence. "A change of skin," says Victor Hugo, "is often a change of soul."

120. Mental and Physical Symptoms of Monomania.-But of course their conduct is regulated by their insane ideas, and is a manifestation of the presence of the disease. The other symptoms, which are not to be found in the conduct of the patient, very much resemble those which are characteristic of mania. When the attack is recent there is generally a feverish condition present, and this is followed by sleeplessness, constipation, and sometimes cerebral congestion.

? 121. Fixed Ideas.-It is very rarely the case that a fixed idea which has existed in the mind for some time is eradicated. We find that the deeper rooted a prejudice is, the more difficult is it to root it up. We find that the longer an idea has had possession of us the more difficult is it for us to get rid of this dominant impression. Many persons who have learned to reason ably concerning almost every subject find it as impossible to reason themselves out of some of the superstitions of their childhood as it is to reason themselves out of the belief in the toothache when it is actually present. It is, therefore, not difficult to believe that these fixed ideas which we have in another place called prejudices in the flesh, should be less accessible to reason, that they should be less amenable to treatment, and that in many cases the disease should defy all efforts which are undertaken with a view to its

cure.

122. Other Symptoms of Monamania.-When the delusions are somewhat obliterated by loss of memory and other mental weakness or by incoherence, the chances of recovery are very small. The chronic monomaniac does not manifest the same mental excitement that has been mentioned as [97a symptom of the earlier stages of the disease. The strange fixed delusion remains along with a somewhat stupid calm, and with a normal physical condition. Not unfrequently, however, monomania is followed by a state of profound dementia. There is much interest connected with those cases in which insanity is manifested by the loss of language, while all the other mental faculties remain intact. This phenomenon is sometimes shown in relation to single words. A person may drop some words, as it were, out of his vocabulary, or the mental effort which is meant to call up one word may have the effect of calling up another, and that, one which seems to ordinary individuals utterly dissociated from that which ought to have found place in the sentence. Thus, if a man wishes to use the word "yes," and the word "house" be invariably substituted for the simple affirmative, it may, to the individual thus using it, seem to have all the significance of the other word. This disease, which can be traced to a derangement of those laws which have to do with association, and with those powers which have to do with the perception of the relations of identity and difference, must have, in time to come, much bearing upon the questions with regard to the relations of insane persons to the State, and an opportunity will arise which will enable us to state some opinions which ought to guide the admission or recognition of such facts in courts of law. In this place it is sufficient to point out the existence of such a limited disease as aphasia, as it was necessary to point out the fact that insanity is very often partial in a very marked manner, and to recognize the affinity which seems to exist between certain abnormal conditions and certain healthy functions.

123. The Physical Suggestion of Delusion. Much has been said concerning the connection between bodily disease and mental affection. We have the phenomenon of

dreams described and explained upon a similar principle. A man dreams he is in the coils of a boa-constrictor, and awakes to find that the sheet is wound tightly round him. Another dreams that he is in hell, and awakes to find that the candle with which he was reading has set fire to the bedcurtains. And such anecdotes pass for reasoning. So it is that the case given by Esquirol is thought to throw great light on the phenomena of monomania. This is the case of a woman who, during life, believed she was pregnant with the Devil, and in whose womb, after death, there was found a mass of hydatids.'

124. Moral Treatment of Monomania.-[98] But it is an incontrovertible fact that many illusions and delusions are, so far as we can say, entirely unconnected with any physical impressions, and that, notwithstanding what has been said to the contrary, many of these are dissipated by the skilful application of arguments. "I have often," says one who has devoted a long life to the treatment of mental disease, "done as much good by a kind or clever word, or by well-put irony or ridicule, as by drugs or specifics." One of Mr. Maury's patients, after thinking himself cured of a serpent in his bowels by means of a pretended surgical operation, suddenly took up the idea that the creature had left its ova behind ready to be hatched into a brood of young ones. He was again restored, however, by the dexterous reply of the physician, who assured him that the snake was a male one.2

? 125. Education in relation to Monomania.-It is surely as reasonable to expect that in some cases false mental impressions might be educated out of a man just as the evil tendencies which a man has at birth may be eradicated by means of a process of training. Those who deny the former must deny the latter. To many it seems unscientific

A case has just been mentioned to us. A woman who was confined in a lunatic asylum believed that she was delivered of dolls, and was in the habit of fathering them upon any of the male officers of the institution. After her death, it was discovered that she had suffered from enlargement and thickening of the neck of the womb and wasting of the ovaries.

2 Medico-Chirurgical Review, N. S., vol. xxi., p. 524.

to treat a symptom. But what do we know of any disease except its symptoms? We know a man by his actions, and a disease by its symptoms. As we are content in education if we can shape and modify a man's actions, and are conscious that thus we will modify the individual, so will we, by modifying the symptoms, change and influence the disease itself. And the very best systems of medicines can hope to do no more than this. Why the intellectual symptoms should not be treated it would be difficult to say. To show that some medical men have not failed to recognize the importance of the true use of the highest kind of moral treatment, we may quote one or two cases.

126. Cases of Successful Moral Treatment.—“E. W, a young woman who had been a schoolmistress, laboured under acute dementia. Dementia seems to be the death of the soul: a person can digest, but not think. The face muscles move the jaws, but never shape themselves in that wondrous mosaic of expression. E. W sat or stood, she did not care to move: there was not sufficient zeal in her to make her live, she had not enthusiasm enough to wish to die. Tonics, shower-baths, electricity, stimulants, were tried and failed. Hers was a dead soul in a drooping, dying body. One morning, however, upon the occasion of the usual medical visit to the wards, she accosted the physician. She said, 'Doctor, I am better,' and she smiled. Smiles are the ornaments of health's temple: joy, not sorrow, is divine. There was some activity and energy in her movements and gestures. The story of her improvement and recovery was as follows: she explained the circumstances herself.

"At tea-time upon the previous evening, she said, she was in her usual state-conscious of all that was taking place. around, but incapable of originating any action, and bowed down by a great weight-saturated by inactivity. A strange nurse entered the ward to relieve one of the ordinary nurses, who was going out on leave. It was a part of this nurse's duty to feed E. W with her tea; during the meal she conversed with another nurse as she placed the morsels in E- -'s mouth. In the course of the conversation she mentioned that she was somewhat strange to her duties, having just come