Hallucinations are also of frequent occurrence in mania; but they are not so fixed as in the preceding kind. They vary with the ideas of the maniac, or if they appear beneath the torrent of ideas and of sensations which his brain continually creates, they are weakened, or at least in a great degree masked. " Hallucinations," says M. Aubanel, "sometimes announce the commencement of mania; they are fugitive, numerous, and capricious; much more frequently, maniacal delirium gives rise to 28 hallucinations, which in mania are sometimes the last symptom. The patient is calm and rational, yet he hears voices. They may continue for several days in individuals whose reason is entirely restored. Hallucinations are less common with maniacs than illusions of the senses. This sensorial aberration explains why certain maniacs eat filth, and resist intense cold, etc."

Hallucinations may exist with acute dementia, but they are rare and slight. Dementia appears less favorable to their existence and duration than the two preceding forms. In fact, it seems that hallucinations, being occasioned by an exaltation of the faculties, can only be transitory in the demented. This theory is not entirely supported by observation. We have already remarked that many hallucinations in this kind of madness have been described, the degrees of which are infinite, and present, moreover, two important varieties - monomaniac and maniac dementia. In paralytic dementia, these false sensations are rare; and authors have asserted that they never occur but in the first period of that disease. "Never" is a word no truer in medicine than in politics. For twelve months I attended a paralytic patient, who hardly spoke, could scarcely walk, and yet who frequently saw a shark ready to devour him. When his terror reached its climax, his tongue was loosened, he uttered terrible shrieks whilst speaking of the shark, threw himself back, and would have leaped out of bed, if his strength had permitted it.

Esquirol says that hallucinations are usually the lot of weak minds. Certainly, errors of sensation are remarked in individuals of very ordinary intellect, but they are equally observed in men of highly cultivated minds. Amongst the hundreds of insane who have come under our notice since we first attended to this branch of pathology, these two classes have been pretty equal in number; and it has long since been remarked that men the most celebrated for capacity, depth of reasoning, and strength of mind were not exempt from this symptom. The Lives of Plutarch, in which he speaks of the phantoms of Brutus, Dion, Cassius, etc., refute this opinion.

There is one symptom of hallucination of high interest, on account of the serious consequences that may result from it. Apparitions and voices often act only negatively on the insane; but they are also frequently the origin, by their counsels, menaces, and the terror they inspire, of strange actions, and singular and sudden resolutions. Thus the afflicted of this class prostrate themselves on the ground, or throw their arms around the neck of some person because God has commanded them to embrace him, offer insults, utter sharp words, challenge, strike, and wound, or fixedly look on the sky, the sun, etc. These acts may have dangerous consequences, and lead to suicide, theft, murder, or arson.

These hallucinists give no truce to those whom the creations of their brain have once marked out for destruction. A man destroyed his child, because he continually heard an angel commanding him to repeat the sacrifice of Abraham. "An insane person of our establishment," says M. Guislain, "asserts that invisible persons speak to him; some accuse him of murder, and announce the death of his mother, whilst others defend him. Happily, the patient is perfectly aware of his condition, and speaks of the strangeness of his ideas, for which he cannot account."

A deranged man hears a voice, which he obeys, ordering him to mutilate himself; and a girl obeys a voice which commands her to murder her child.

We cannot too much insist on the frequency of hallucinations which make the alienated believe that they are abused, mocked, and threatened. "They are incessantly calling me thief, assassin," said an hallucinated person to me one day. "Who calls you so?" "They." But, like the greater number of those belonging to this class, he could not point out any one. Some hear agreeable words, conformable to their wishes; others hear menacing language. A young English lady converses every day with several of her countrywomen. Madame G. has long conversations with the angel Raphael. Numa talked with the nymph Egeria, Mohammed with the angel Gabriel, Luther with the devil, Charles IX. heard in the night the shrieks of the victims of St. Bartholomew. An old musician was constantly surrounded by the harmony of instruments.

The circulating and digestive functions, sleep, and secretions, present changes which should be noticed. Messrs. Leuret and Mitivie have described, in their pamphlet on The Rapid Pulse of the Alienated, that under this form of delirium the greatest disorder in the circulation was observable. In fifty cases, they have reckoned ninety-five pulsations in the minute. Does this quickness of the pulse belong to diseases of the heart, which are, according to Messrs. Nasse and Foville, very common with the alienated? Might it not also be the result of sleeplessness, so usual a symptom, or to the agitation caused by visions and voices, constant incitements to anger, rage, vociferations, or other kinds of emotion?

At first the digestive organs may be deranged, when cephalalgia and fever exist; but they are chiefly so affected when the idea of the hallucinated person is of a mournful character, when he fears the agents of public justice, and gendarmes, and is constantly beset by constables, or when he refuses food; the result of these prolonged fastings is manifested by serious disorders in the stomach and intestines. Constipation exists as in madness. The fear of poison acts equally in impairing the digestive organs.