This presents itself in two forms: one, a calm joy, analogous to passive depression; the other, an active, exuberant joy, analogous to active depression.

The first, when of average intensity, manifests itself by a state of satisfaction, a vague sense of well-being. It is encountered in general paralysis and in certain forms of tuberculosis. The optimism and astonishing contentment of some consumptives who have reached the last stage of their illness are well-known phenomena.

When calm euphoria reaches its highest development it becomes ecstasy, in which it is not accompanied by any motor reaction. Such is the case in certain forms of mystic deliria.

Much more frequent than this calm and tranquil form of euphoria, the active form, noisy, accompanied by motor reactions, is a constant symptom of the so-called expansive forms of psychoses: general paralysis with excitement, mania, certain toxic deliria.

Unlike depression, euphoria permits of easy association of ideas and quick motor reactions. These two phenomena do not always indicate real psychic activity. In fact most frequently in pathologic euphoria the associations formed are aimless, independent of all voluntary intellectual activity, and the motor reactions bear the stamp of impulsive acts originating automatically.

When pushed to a certain degree, the apparent rapidity of association develops into flight of ideas which has already been described.1

The aspect of the patient in euphoria is the direct opposite of that in depression. The expression is bright, smiling, with head raised and body upright. The speech is animated and accompanied by many gestures.

The concomitant physical phenomena are in general those of joy, that is to say, the reverse of those of depression.

First come the cardio-vascular and respiratory phenomena: peripheral (and probably cerebral) vaso-dilatation, acceleration of the pulse, increased force of the cardiac impulse, and either elevation or lowering of the blood pressure, depending upon whether the increased heart action does or does not compensate for the peripheral vaso-dilatation.

The respirations are accelerated, deep and regular; the elimination of carbon dioxide is increased. The general nutrition is active, as is seen from the patient's gain in flesh and from the increase of excrementitious products in the urine.

These different phenomena, constant in normal joy and frequent in morbid euphoria, are, however, absent in some cases, when other factors are present which counterbalance the favorable influence of joy. Such is the case when there is intense motor excitement, which, in spite of the euphoria, causes a rapid loss of flesh. Such is the case also when the underlying condition is some severe bodily affection. The general paralytic or the consumptive with euphoria is none the less cachectic, for in such cases a generally flourishing state of health is not possible.

Certain anomalies are very difficult to explain. Some maniacs show, instead of an acceleration of the pulse characteristic of states of euphoria, a slowing which is at times quite marked. We have observed in a young maniacal girl with marked excitement less than forty-five pulsations per minute for several days.

1 See pp. 50 and 51.