This would be as scientifically accurate as for a naturalist when classifying any order of birds-say that of ducks, geese, etc.-to proceed as follows: Genus A.-Ducks. Species 1-Mallards. Species 2.-Teals. Species 3-Wood Ducks. Species 4.-Ducks. Or, if again, in classifying the orders of fish, he should select that of eels, and proceed as follows: Order A.-Eels. Genus 1.-Common Eels. I think that it may fairly be assumed that the wealth of terms which could be derived from the Greek, Latin, and English languages, when conjoined with the symptoms, pathology, or ætiology of any order or genus of disease which has become sufficiently understood to be differentiated and described, will suffice to provide some which may in a measure indicate its character. Instead of the term monomania, for reasons already presented I would suggest another. And as the form of disease is one without well determined lesions of the brain, and whose proximal ætiology is not well understood, we are led to the character of the symptoms for its nomenclature. Delusions, or a series of combined delusions, restricted for the time being in character and range of subjects, sometimes attended with hallucinations and at others not so, appear to constitute the primordial element of the disease. These delusions are peculiar as to their mode of origin. They are not the sequence or residue of former attacks of systematized insanity, such as mania or melancholia, nor do they arise in connection with such attacks, nor in consequence of any morbid habits of psychological processes, which have existed in the former history of the individual. In other words, they are neither concomitants of, nor secondary to other conditions of either excitement or depression. They arise, therefore, as primary elements of the disorder they characterize. We may, therefore, employ the term primary delusional insanity for this form of disease. II. Arrangement.-The other division of our subject relates to the grouping or arrangement of the several orders, genera, and species of insanity. The different. systems devised and elaborated by authors have been almost as numerous as the authors, and have ranged from the simplest to the most complicated. If, however, the principles of classification in general, which have been referred to as guides in the nomenclature of the several forms, are correct, and can be of service in the arrangement of genera and species of insanity, certain other considerations which have been by some regarded as of importance may be dispensed with without much detri ment. Ist. The question as to whether a species of disease is curable or incurable will not be regarded as legitimate in forming any arrangement of groupings. The element of curability is very indefinite and uncertain in many cases, and involves a question which cannot be determined until after a long experience of treatment, and in some cases recovery may occur long after the result has been regarded as improbable. Krafft-Ebing, while making use of "curable" and "incurable" states as a basis in parts of his classification, places Primaere Verruecktheit among the incurable. forms, and yet in his monograph on this genus he admits that recoveries sometimes occur in persons affected with this form of insanity. I am unaware that this principle of classification is ever made use of in studying and arranging groups of disease in general. Nor shall we regard the question, whether the disease is of such a character that a person who has once been affected by it is likely or liable to be so again, as of sufficient importance as to serve as a basis of arrangement, unless there may have become established a neurosis, which may serve as an etiological basis for such a recurrence. In very many cases the question of recurrence will depend more largely upon the peculiarities of the individual in the way of inheritance, manner of life, character of vocation, ability to avoid exciting causes etc., than upon the character of the disease itself. Nor, again, will the question as to the relative numbers of cases which may be found in an order or genus, nor any system of "balancing" of these numbers so as to form a harmonious and symmetrical arrangement of the different forms, require attention. It does not appear how the matter of numbers, or whether we find one or one hundred cases of any form of disease in passing through the wards of a hospital, can possibly affect our inquiry as to the nature of the disease itself, or determine the genera under which it should be tabulated. An order may embrace one third or nine-tenths of all genera and species of cases and yet be founded on the only scientific basis practicable. The "clinical unity," which is to be sought for, should come from such an arrangement of the several orders and genera, as will depend upon the most essential causes and characters of the disease. But whatever course we adopt we shall meet with obstacles, which arise from various sources. One of the principal difficulties in arranging the different genera and species arises from the fact that upon whatever basis of selection we proceed there appear close affiliations and similarities of character. This is equally true in relation to the symptomatology, pathology, and ætiology of several of the genera; and the importance of these similarities will vary greatly in the minds of different authors, leading, consequently, to groupings according to the standpoint of the author. To one writer the character of a symptom, such as excitement or depression, or a diminution of mental function, will appear to be of sufficient importance to lead to a different grouping of certain genera or species, while with another these changing conditions will be regarded as of less importance, and he will seek for a more permanent basis in some essential character. Again, when even these more permanent elements of character, such as pathology and ætiology, are selected to form the basis of groups, it will be found that the same genus may present a character, or arise from such causes as would lead to its location in either one of two or more groups. For instance, senile insanity will be regarded by one writer as simply a species of the genus dementia, and be arranged with the other dementias, such as primary, secondary, without regard to the etiology or pathology; while another will choose to regard it as a genus of the special order of epochal insanities, which will sometimes. present symptoms of excitement, at other times of depression, and at others still of dementia, but all of which have the basis of their origin in the physiological condition of a senile brain. One writer, regarding syphilitic insanity from the character of the degenerative changes which occur sooner or later in the nervous system of the patient, will arrange it with general paralysis in a group of patho logical insanities, while another, regarding it from an ætiological point of view, will arrange it with the group of toxic insanities. Again, the relative importance of the several ætiological factors which may enter into the consideration of any order or genus of insanity may vary largely with different authors. In the ideal classification presented by Dr. Savage in his recent volume on insanity, it will be observed that he regards the physiological epochs of life as of prime importance, and makes them the principal basis of his arrangement. By this method he relegates the proximal causes of genera and species to a secondary position, and introduces the same nomenclature for several species. Others regard these physiological epochs of less importance, as a basis of classification, and group the genera of insanity which arise in connection with them under one order only. Limitation in the consideration of any Genus of Insanity may lead to locating it in a relatively different position, or in a different order from that to which it would be assigned if studied under a wider signification. By this procedure syphilitic insanity may be limited to one species and regarded as a dementia, depending upon and arising from the pathological changes represented by the development of gummatous tumors in the substance of the brain, and infiltration of the membranes with syphilomatous degenerations of the brain arteries. If limited to this treatment it would be proper to regard and classify it with the pathological insanities. But if it be regarded as a genus, and as presenting a wider range of psychological characters and comprising several species, some of which are not attended with the same characters of pathological change as have been enumerated above, but which are dependent |