distance. These persons are heard announcing to others various intentions and purposes; they blow fumes of noxious gases or chloroform through the windows or doors of the room at night; they injure their genital organs and render them useless; they put poison in their food, and do many other things to render their lives wretched, all of which is interpreted by patients as a part of the general plan of persecution which is being carried on against them. Our patient will explain some of his experiences in this respect in the following letter :

DR. STEARNS:

HARTFORD, January, 15, 18

Dear Sir.-There is one point yet in regard to the treatment here that is very aggravating and disagreeable, and I should like to have it stopped. There is a peculiar influence that you might call almost luminous which you surround the victim with that tends to make him transparent, so that persons near me can see the action of my different organs, making it sometimes very disagreeable, and especially so when in ladies' company with some difficulty with the bowels. And it is also disagreeable when applied to the head, showing up the action of the brain, which, if not in a good, free, healthy condition, tends to throw a slur upon its owner; and again is bad if thrown upon me suddenly while passing ladies upon the street. I have heard them say several times, "What is the matter with that fellow? Why, I am afraid of him." Now, if possible, I want it stopped. I see no sense in casting such great notoriety and prejudice against me in the city. It would also be uncomfortable and would destroy the confidence if you were to abuse me thus while boarding at home. Father would not stand the nonsense, and would confine me again. Now I am very desirous of freeing myself entirely from these abuses. I have lived here long enough, and you have entire confidence in me, so there can be no use of keeping the humbug going longer. I want to walk the streets without any of these remembrances of my lowly existence in a madhouse.

This same abuse or a little different, is carried to a great extent at home. I am followed so closely by the servant girls at the watercloset as to make it uncomfortable; this was the principal cause of

my coming here; they followed me so closely at night as to worry and aggravate me much. I am very desirous of boarding once more at home, so please have the abuse stopped, and direct Dr. P. to give me the word " GO," and oblige

P. S.-I do not become clear and smooth of head yet, and there is also a little impediment in my speech, and my tongue is a little stiff. Yours, F. A.

The above case may be regarded as a clearly outlined one of primary delusional insanity of one variety, namely, that in which the delusions of persecutions which arise from hallucinations, illusions, and insistent ideas play the most important part. He has a good appetite and takes a sufficient quantity of food, but all the while looks anæmic and far from well. Though the disease has existed some seven years, it has not passed through any stage of transformation into that other variety in which the delusions are of the opposite nature, and which would be regarded as indicating an unfavorable prognosis. The fact, however, that the disease has so profoundly affected the whole nervous system, and has already existed so long, renders all expectations of recovery improbable.

Patients are occasionally observed in whom hallucinations of hearing and general sensation become so greatly intensified that they are in continual fear and expectancy of death in some horrible form. Voices are heard in the next room, near at hand, or at a distance; they may be clear or indistinct; again, other sounds may be heard, such as the singing of birds, the ringing of bells, the noise of machinery or of passing carriages; and the patient will locate with great definiteness the place from which they come. They become vastly intensified at times, and issue from the hot-air flues which open into the patient's room. The plans

which are being adopted to persecute them, and to inflict the severest degrees of suffering they may hear repeated many times over, and can even distinguish and recognize the voices of the several enemies who are conspiring together.

A female patient not long since told me that she could distinctly hear the voices of four persons whom she had formerly known, who were planning to injure her. The leader was John White, and they were arranging to pour vitriol down her spine and over her head, so as to have it a bleeding, horrible sight, too dreadful for any one to look upon. Others imagine that enemies are twisting the lungs and heart from their natural position and turning them upside down; at other times are endeavoring to extract the uterus or place the liver on the wrong side of the body; they smell the fumes from decoctions which are being prepared to pour down the throat whenever they can be found asleep, and hence they do not dare to go to sleep or even to lie down until forced to do so by exhaustion. These terrible delusions become so overpowering that patients never smile, and cannot think or speak of anything else, and are constantly entreating the physician when he visits them to avert the awful doom which seems to be awaiting them. The impending evil, of which they have so long had a fearful presentiment is now about ready to be consummated.

In other cases the hallucination may be limited to smell; the patient imagines that some person is filling the room in which he sleeps with chloroform, or with noxious gases, and he locks and bolts the door of his room, stops up the keyhole and the windows, and finally insists on leaving home and seeking some other place, such as a shed or barn, in which to sleep. Hallucinations of smell are said to be the most frequent in those cases having a sexual origin.

As illustrating the great intensity and persistence of hallucinations of hearing, which obtain in some patients, and the almost incredible course of action adopted by the persecuted victim, by means of which to escape from the suffering and annoyance which they entail, I introduce the following case :

CASE 2.-J. J., aged twenty-one, whose parents are French, a student of nervous temperament and good intellect, was admitted to the Retreat in 187-. During the preceding three years he is reported as having been studious and living at home, attending the college classes, but at times greatly troubled by persons laughing at him when in church or on the street, and by the ringing of bells, and the rumbling of heavy wagons and carts in the street, while he was trying to study at home, all of which was done by persons for the special purpose of annoying him. These troubles had rather increased of late, and he had failed in his examinations, which greatly mortified him. He became depressed and disposed to remain alone in his room, and took to smoking; was irritable, suspicious; took his food irregularly, and finally broke several mirrors, and threatened his sisters because he thought they caused the noises in the street and the ringing of bells for the purpose of irritating him.

His condition varied considerably from time to time after his admission. He was irritable, suspicious, disposed to be alone; complained of the bells of the city ringing, and was disinclined to exert himself, and to take even a bath or change his linen, or take any exercise out of the building. He was often visited by his father, and on one occasion went to Boston for a few days. He got on so well that he was removed home for a trial; but after a few days became solitary in his habits-refused to take food with other

members of the family; complained greatly of noises on the street, and of the sound of the church bells which he said were kept ringing, and was finally detected selling his books, with the proceeds of which he said he intended to go abroad. He was then returned to the Retreat. Before consenting to come he demanded to be taken before a magistrate and examined as to his sanity. He had a considerable sum of money with him, and refused to tell how it was obtained. He also had a passage engaged by steamer for England.

After remaining under treatment for several months, he was again removed and traveled with friends in the West, but returned home alone, and immediately took passage for Savannah, Georgia. He said he took this step to get out of the sound of bells and noises. Finding himself no better in this respect there he took a sailing vessel for England and visited London, where he remained a few days. Then he went to Sweden, but soon left for Southern France, and thence to Alexandria and Cairo, where he remained two months. He then returned to France, and traveled through Germany, Prussia, Switzerland, Italy, and back through France to England, where he shipped as a sailor to Africa and back again. All this time he says he was traveling from one place to another, not so much to see the places as to get away from the persons who were persecuting him by the ringing of bells, and making day and night hideous by the noises they created for the purpose of annoying him. He then began to travel about in England, and while at one place in the southern portion was arrested, as he says, on the charge of an old woman, whom he never had seen before in his life, that he had stolen a sovereign from her. He was kept in a police station several days, and then tried and sentenced to prison,