a most jovial and smiling aspect, and of eager and incessant activity, who claimed to be the Almighty Himself, I administered a large dose of bromide of potassium, with the effect of reducing his bodily activity to comparative quiescence, of replacing his jovial expression by one of mere placidity, and of lowering his claim for honours from those due to the Deity to those due to the Prince of Wales.

While delusions of grandeur occur most commonly in association with heightened nervous tension and increased feeling of well-being, they occasionally occur without these accompaniments, and every asylum contains quiet, orderly, well-conducted men and women, whose activity is not in excess, whose appearance and demeanour are not suggestive of any exaltation of self-consciousness or unjustifiable feeling of well-being, who, upon a short acquaintance, would pass as sane beings, but who cherish delusions of personal grandeur. Of such people, some lay claim to royal honours. One is Prince of Wales, another is her Majesty, another is a Royal Duke and Emperor of Universal Dominion; others aim higher still, and are satisfied with nothing short of the attributes of the Saviour and of the Deity. For some of these cases the explanation is that given in the previous chapter to account for certain cases of suicide. They are not evidences of exalted nervous tension now existing, but remanets from a former state of that nature which has now passed away. They are the cicatrices of old sores. They are conditions which, in the ordinary course of things, should have been temporary, but which, owing to some variation in the nature of the morbid process, have become permanent. Other cases of this nature fall into the following class.

The third variety of alteration in the cœnæsthesis occurs when, without any important alteration in the general nervous tension, changes take place in the highest regions of the visceral nervous circulation, of the same character as occur in the other moiety of the nervous circulation in

ordinary cases of delusion of the relation of self to surroundings. We have seen how, in dreams, a partial and perturbed activity of some of the highest nerve regions proceeds simultaneously with the suspension of activity in the remainder; how the suspension of activity, beginning in the highest regions of all, spreads downward with an irregular progress, leaving, here and there, areas outstanding which still remain active; and that the uncontrolled, unbalanced, uncoordinated, uncombined activity of these isolated areas, has for its mental counterpart the phenomena of dreaming, and finds its outward expression, when it is of sufficient intensity to spread downward to the middle regions and produce outward expression, in somnambulism and somniloquence. So long as this irregular remainder of active areas is confined to that part of the nervous system which regulates the adjustment of self to surroundings, so long the delusions have relation to this adjustment, and fall to be dealt with presently; but when the areas acting thus irregularly belong to the highest regions of the visceral and nutritive circulation of nerve energy, then the corresponding alteration of consciouness is an alteration of the cœnæsthesis, and then the delusions that result are delusions, not primarily of the relation of self to surroundings, but are delusions of the nature of self. Often this irregular failure of the higher nerve regions of the visceral circulation is associated with alterations in the nervous tension, which give to the manifestations their predominating character, and then the case falls in one of the categories, already considered, of melancholia with delusions, or exaltation with delusions. But occasionally there is a simple failure without conspicuous modification of tension, and then there are delusions of self without exhilaration or depression.

The conditions upon which delusions of self depend are, however, more complicated than has been described. The alteration in the highest regions of the visceral circulation. produces an alteration in the distribution of the nerve currents flowing to the viscera,-an alteration in the distri

bution of the volume and pressure of the nerve energy. This alteration in the nerve supply produces, of course, an alteration in the manner and in the activity with which the nutritive processes are severally carried on; and this alteration of the nutritive processes in its turn modifies the flow of the return currents to the highest nerve regions, and is mirrored both in their action and in the state of the consciousness of self which accompanies their action. Thus there is a vicious circle of morbid errors. The altered nervous supply acts on the tissues and modifies their nutrition; and the altered tissues react on the nervous system and alter its working. Every alteration in the nutrition of the body is mirrored in the higher nervous regions, and has its attendant alteration of consciousness; but not every such modification of nutrition is attended by delusion. Only when the higher nerve regions are independently disordered does there arise delusion, which then takes its form from, and is referred to, the locality of any alteration of nutrition which happens to be going on at the time.

At the outset of a fever, during the invasion stage, there is a profound alteration of the cœnæsthesis. The processes of nutrition going on within the body are greatly altered. The nerve currents set up by these processes, and flowing to the highest nerve regions, are greatly modified; and the cœnæsthesis, or feeling of self, which is the mental accompaniment of the wash of these currents on the shores of the highest nerve regions, is profoundly altered. Almost every one knows the feeling of malaise, of languor, of “being ill,” which attends the invasion stage of a fever, and can testify as to the profound alteration which then takes place in his ordinary feelings of health and well-being. But yet this alteration of cœnæsthesis is not necessarily accompanied by delusion. The feeling is attributed correctly to its actual cause, and no delusion arises. In order for a delusion to arise, there must be some other change—some additional factor. Supposing that a man attribute his feeling of malaise, not to the invasion of a fever, but to possession by a devil :

the feeling, we suppose, is the same, and is due to the same alteration of bodily processes, but the ascription of this feeling to an imaginary and impossible cause, is due to some other disorder of nervous processes, over and above that arising from the altered incoming currents. It is necessary to insist upon the existence of this additional factor, because the existence of a lesion, at the place to which a delusion is referred, is sometimes considered to be a complete and adequate explanation of the delusion. If, for instance, a man has a delusion that his bowels are completely stopped; and, upon post-mortem examination, an ulcer of the bowels is found, it is considered that the ulcer accounts for the delusion, and that no further explanation is called for. If this were so, it would be impossible to account for those numerous cases in which an ulcer exists without any such delusion. Manifestly another factor must be present, and this factor is disorder of the highest nerve regions or some of them.

When, however, there is disorder of the highest nerve processes, and in addition there is an alteration in the nutrition of the body, either as a whole or in some localized position, then it is highly probable that the modified visceral nerve currents will so act upon the disordered nerve regions as to give a permanent bias to their action, and then it is probable that on the mental side the modification of cœnæsthesis will take the form of a delusion of self.

Delusions of self thus arising are of two forms, general or local, according as the modification of nutrition which gives form to them is general or local. When the disturbance of nutrition extends throughout the body, and the alteration of cœnæsthesis is general, then the delusion will have the same character of generality, and the patient will believe that his total individuality is in some way altered. When the modification of nutrition is local, the delusion will have reference to the locality so affected.

Delusions of the whole self are well classified by Professor Ribot into three groups. One in which the new self is sub

stituted for the old; one in which the new and the old self prevail alternately; and the third group including the curious cases in which the new and the old self exist side by side, and simultaneously.

To the first group belong those cases in which the patient believes that he is dead, that he is possessed by a devil, that he is transformed, that he has no body, that he is some one else, that he is unnatural, that he is preternaturally large or small, hard or soft, that he is a cat, a horse, a cow, a sheep, a chair, a teapot, or even a pâté de foie gras.

Of the second class, in which the new individuality alternates with the old, several cases have been recorded. Although they are rare, they are of so extraordinary a character that they have attracted much attention, and are therefore tolerably familiar. After some critical event

a long sleep, or a convulsive attack—a woman awakes with a complete forgetfulness of her whole past life and with a great change in her character. She lives for some time in this new state, and then, after another sleep, she wakes with a normal memory of all the experiences of her life before her first sleep, and with her former character restored; but with a complete oblivion of everything that happened in the new state. Another sleep reverses the condition of things. She has now resumed her altered character, remembers all the occurrences of her former new state, but is completely oblivious of all the occurrences of the rest of her life. old state and the new state may alternate for an indefinite number of times, the experiences of each being remembered, and the character appropriate to each being retained, only in the periods of its own recurrence.

The

The third general alteration of the individuality is when the old state and the new state subsist side by side. These are the cases of double personality-cases in which an individual believes himself to be two, and, as in a case reported by Dr. Hack Tuke, looks for himself under the bed, or, as in another case, ascribes his ill doings to another self which occupies the left half of his body.