ACUTE INSANITIES 375 Ordinarily, "there is no recovery from the chronic form, but Stoddart has seen cases of recovery. One of his female patients recovered after eighteen years' duration, a male patient of his recovered from a previous attack of thirty-five years, and another male patient recovered from a previous attack of seven years.6 Delusional Insanity (Paranoia).—This is a form of insanity, which is characterized by fixed and systematized delusions, as also by hallucinations of various characters. It is called partial insanity by lawyers, and appeals to their legal mind, inasmuch as they believe that a delusion must be present to constitute insanity. The medical man, however, thinks that a delusion is merely a symptom, but not an essential element, of insanity. Delusional insanity is mostly a disease of adults, affecting both the sexes equally. It exists in two stages : acute and chronic. Acute Stage.—In the acute stage the disease commences with digestive disturbances and a rise of temperature, accompanied by melancholic depres- sion and confusion of ideas. These are followed by hallucinations of hearing and delusions of persecution. The patient imagines voices dinning into his ears through the walls of a room. He becomes forgetful, loses the power of self-control and is apt to commit some crime under a sudden uncontrollable impulse. Insomnia is a constant symptom throughout the disease. The patient may appear to have recovered, when a relapse may occur, or the acute condition may pass into the chronic stage. Chronic Sta,qe.—Suspiciousness is the characteristic symptom of this stage, in which the physical symptoms are also more prominent. The chief physical symptoms are a furred tongue, foul breath, irregular temperature, disordered nutrition and anaemia. Sleeplessness is a general complaint, which results from sensory disturbances producing impressions of electric shocks. Auditory hallucinations, which occur very early in this condition, are first supposed to be sounds or noises in the ears, but are afterwards changed into abuses and insults. At first the patient is able to dismiss them by reasoning faculty. When the judging power fails, these hallucinations give rise to systematized delusions, which he is at times able to defend with logical arguments. These delusions are at first indefinite, but gradually they become fixed and definite so as to lead the patient to believe that he is persecuted by some unknown person or some superhuman agency. The patient then develops hallucinations of taste and smell, so that he believes that his food is poisoned, or that some noxious gases are blown into his room. Disturbances of general sensation give rise to hallucinations, which are attributed to the effects of hypnotism, magnetism, electricity, wireless tele- graphy, etc. The patient gets very irritated and excited owing to these painful and disagreeable hallucinations and delusions. In almost all cases the delusions of an exalted type referring to grandeur, power and wealth are seen, and the patient generally conducts himself in a haughty and overbearing manner. With the lapse of time the hallucinations of a grandiose character become less marked, and the patient becomes listless, apathetic and passes into a condition of melancholic depression. At this stage the patient requires to be carefully watched, lest he commit suicide. During the chronic stage the patient usually retains his memory and self-control. He talks sensibly, and does not show any sign of insanity, until the conversation is directed to the particular type of delusion from which he is suffering. It is, however, always safe to keep such a patient 6. Mind and its Disorder, Ed. V, p. 276.