The varieties of monomania with which they most generally unite - Observation* on lypemania - Hallucinations are a reflex of the habits of the insane - Observations on demonology of the incubus - Nature of sexual hallucinations - Observations on nostalgia - Observations on calentura - Recapitulation.

Although hallucination may exist by itself, independently of all complication, it is no less certain that it is most frequently united with the different kinds of insanity at present recognized According to Esquirol, eighty out of one hundred insane persons have hallucinations. From more recent inquiries, this appears to be too great a proportion. It is especially noticed in monomania, either from its own peculiar nature, or from investigation in this form of mental derangement being easier to make. It is not always thus, since there are cases of melancholy patients who maintain an obstinate silence for years, and whose secret, chance alone betrays. It may, however, be taken as a general position, that the more strange and unaccountable the actions of madmen, the greater is the probability that they are the result of hallucinations or illusions.

Case XLVIII

"I saw," says Marc, "in the madhouse of Dr. Pressat, an aged man, who had become melancholy from reverse of fortune. He had not spoken for several years, and his only occupation consisted in smelling and licking the walls of his room, as well as the threshold of the door. No one could explain the motives for an action as extravagant as painful, and the frequency and duration of which had left deep and numerous impressions on the plaster walls of the place he inhabited. I had frequently interrogated him, but unsuccessfully, as to the reasons for such strange conduct, conduct that could only excite compassion and disgust, when one day, pretending not to notice him, I inquired of a keeper what caused all the spots and numerous dirty hollows that I noticed on the walls. To our great astonishment, the patient broke the silence he had so long maintained, and said: ' You call those dirty spots and hollows, don't you? See, they are Japan oranges! What delicious fruit! what a color! what fragrance! what exquisite flavor!' And he recommenced inhaling and licking with redoubled ardor. Thus, all was explained, and the poor hallucinist, whom I had pitied as one of the most unfortunate of men, was, on the contrary, very happy, since the most delightful hallucinations of sight, taste, and smell gave him continued enjoyment."*

The frequency of hallucinations in madness induced many physicians to notice their number more precisely than had previously been done. "In 145 patients under treatment in the Bicetredivision," says M. Baudry, "56 presented hallucinations, † Messrs. Aubanel and Thore, in their Statistique de Bicetre, said that, out of 87 cases of monomania which they attended in one year, 45 exhibited this epiphenomenon. In 66 cases without sadness, 35 had hallucinations, and in 21 cases of lypemania, it was noticed 11 times.‡ In 14 cases, the hallucinations were single, and constituted all of the malady. At other times, they were mingled with a partial disturbance of the faculties, and were combined with them. These hallucinations were as follows:

As in mania, those of hearing were the most frequent, and next those of sight. Hallucinations of smell were not noticed. Many of the hallucinations existed simultaneously in the same individual; those of sight and hearing were most frequently associated. None of the patients exhibited hallucinations of all the senses.

Of these 66 monomaniacs, 21 were affected with lypemania. Of this number, 11 showed symptoms of hallucinations, and were distributed as follows: -

* Marc, De la folie dans ses rapports avec les questions m6dico-judici-aires, 2 vols, in 8vo., Paris, t i. p. 191, 1840. † Thfcse, 1833, p. 14. ‡ These, p. 101.

In a similar examination, in our establishment, we found that, out of 62 patients assembled there at the time,

Of this number, 88 had hallucinations, and 24 showed no symptoms of them. With our 18 monomaniacs, hallucinations

In addition to which several had illusions. The form of lypemania prevailed in monomania; in males, this was most characterized by fear of enemies. All those affected by it had hallucinations of hearing and sight, combined or separate.

It appears, by this statement, that more than half the insane in the establishment had hallucinations; but this proportion is much increased if we deduct from the list the imbeciles and certain paralytics. We must not lose sight of the fact that, whatever attention we may pay to this phenomenon, there are some in whom it is impossible to discover it. Esquirol mentions a case of a hypochondriac, who passed his days in perfect immobility, and seemed lost to everything around him. He was maintained in this state by the terror occasioned by a voice, which threatened him with death if he made the slightest movement.

Hallucinations seem to occur most frequently with lypemania, nostalgia, calentura, which is but a modification of it, delirium tremens, demonomania, and erotomania. The distressed sensations occurring in delirium tremens will be the subject of another chapter. Every close observer must have been struck with the number of lypemaniacs in establishments devoted to mental maladies. A little reflection will readily explain this fact. Is not grief, that sad attendant on humanity, the source of the greater number of alienations? In the world, the countenance is composed, to meet the eye of indifference, envy, or curiosity; but, in the retirement of home, the mask falls off, and the real suffering is unveiled, with all its attendant symptoms.

Alexander Morison has remarked that, in panophobia, individuals are more exposed to hallucinations than in other forms of monomania, because they see objects, and hear unceasingly noises, which frighten them; and that they attribute to themselves all kinds of crimes.*