376 NOTICES OF THE MEETINGS [Feb. 17, 
dolent, apathetic, silent, indifferent to all around them; they accuse 
themselves of unpardonable sins, and refuse all religious consolation, 
This state often arises from disappointment of the affections, some- 
times from some sudden mental shock, and not unfrequently from 
mere debility. The disposition to suicide is manifested with an in- 
genuity and perseverance which demand incessant watching. But 
all these miserable symptoms of malady are often recovered from. 
In the above forms of mental disorder it is found, in a large pro- 
portion of instances, that there is a constitutional disposition in the 
patient disposing him to such attacks. Another, anda very peculiar and 
serious form often arises without any known predisposition ; and this 
form of malady seems to be becoming more common than formerly. 
Forty years ago, it was not known, or not described; and except 
among physicians familiar with the insane, its characters are scarcely 
yet distinctly recognised. It appears in men of all classes of life, 
but seldom in women. Its causes are most commonly to be found 
in anxieties, over- exertion in depressing circumstances, reverses, and 
shocks. In some instances intemperance, and in others violent in- 
juries of the head, seem to induce it. Its commencement is marked 
by a more singular disregard of ordinary circumstances and of pru- 
dential habits than any other form of insanity. Business is neg- 
lected, new pursuits are adopted, expense is needlessly incurred in 
the gratification of extravagant fancies. The patient considers him- 
self on the eve of possessing great wealth and high rank. He boasts 
of his accomplishments, and speaks of vast designs which he is to 
accomplish. His temper becomes capricious; contradiction or doubt 
exasperate him; and his occasional violence alarms his family. The 
physician finds these mental peculiarities associated with a peculiar 
lingering in the speech, and a very slight alteration in the mode of 
walking: but his patient is in the highest spirits, and acknowledges 
no consciousness of illness: he is pleased, however, to see his 
physician; pleased to go from home; pleased with an asylum if 
placed in one; and satisfied for a time with every thing. Now and 
then paroxysms of irritability disturb him; and his malady makes 
rapid advances ; sometimes, however, seeming to recede, but always, 
in reality, making progress to more and more indistinct speech, 
greater loss of general muscular power, and increased feebleness of 
mind. Nutrition goes on well, and the exhilaration of the spirits often 
remains when the patient can no longer walk, or speak so as to be 
understood. Although, by care, the patient’s life may be prolonged 
for some years, I believe this form of malady to be incurable. Its 
usual denomination is General Paralysis. It might, I think, be more 
correctly called the Paralysis of the Insane. I have never known it 
exist without mental disorder. 
The Insanity of Old Age is another form of disease incidental to 
persons of very various intellectual power; coming on in some 
instances even before the age of sixty, but more usually in much 
more advanced periods of life. It is often characterised by melan- 
choly, a fear of poverty, and paroxyms of maniacal excitement 
