the cycle is, as we have seen it, generally so brief that any continued misunderstanding of the case is practically impossible.

The treatment of circular insanity may be summed up in a few words. It is purely symptomatic; the case must be treated as each emergency indicates. Sedatives and hypnotics can be used to quiet motor restlessness and secure sleep, and moral treatment, in the way of a kindly but firm control, is often very important in the hypomaniac types. During the depressed stage the usual treatment for such conditions is indicated, and while these cases are probably, as a rule, less suicidal in their tendency than is the case in ordinary melancholia, they should be carefully watched and guarded. The condition of the bowels, and of digestion and nutrition generally, is to be looked after carefully in all stages, and forced feeding may be occasionally required in extreme cases. By attention to these matters we may materially modify the symptoms and possibly shorten the attacks and lengthen the lucid periods.

CHAPTER XVIII.

DEGENERATIVE INSANITIES (Continued).

PARANOIA.

THE term paranoia as commonly used has rather a wide signification, covering, as it does, a wide range of conditions characterized especially by the existence of fixed or systematized delusive conceptions without any primary or conspicuous involvement of the emotional or affective faculties. Various authors have thus used it, including, as will be seen, mental conditions ranging from imbecility, on the one hand, to almost perfect, though in some directions perverted, intellection. Others have variously modified the concept and have divided it up in groups, according as it it accompanied with degenerative stigmata, or with or without hallucinations. Some extend the term to include the secondary delusional insanities already mentioned in connection with various acute primary mental derangements, and which will be noticed more fully when we come to speak more particularly of terminal conditions of mental disease. Some authors also recognize an acute form of paranoia which will be discussed later.

Recognizing all these facts and different views on the subject, it is evident that the definition of what we here propose to understand by the term must be fairly stated before describing the condition. We prefer a rather comprehensive definition to one more definite and limited, since the included morbid mental states graduate into each other, and therefore our conception of paranoia is a rather broad one. We recognize, however, certain well-marked types, widely differing in their extremes, yet so shading into each

CHAPTER XVIII.

DEGENERATIVE INSANITIES (Continued).

PARANOIA.

THE term paranoia as commonly used has rather a wide signification, covering, as it does, a wide range of conditions characterized especially by the existence of fixed or systematized delusive conceptions without any primary or conspicuous involvement of the emotional or affective faculties. Various authors have thus used it, including, as will be seen, mental conditions ranging from imbecility, on the one hand, to almost perfect, though in some directions perverted, intellection. Others have variously modified the concept and have divided it up in groups, according as it it accompanied with degenerative stigmata, or with or without hallucinations. Some extend the term to include the secondary delusional insanities already mentioned in connection with various acute primary mental derangements, and which will be noticed more fully when we come to speak more particularly of terminal conditions of mental disease. Some authors also recognize an acute form of paranoia which will be discussed later.

Recognizing all these facts and different views on the subject, it is evident that the definition of what we here propose to understand by the term must be fairly stated before describing the condition. We prefer a rather comprehensive definition to one more definite and limited, since the included morbid mental states graduate into each other, and therefore our conception of paranoia is a rather broad one. We recognize, however, certain well-marked types, widely differing in their extremes, yet so shading into each