by the gradual action on the mind
of grief or anxiety, by severe pain, mania, apoplexy, paralysis, or
repeated attacks of epilepsy.

=Senile Dementia= is a form which is incidental to aged persons, and
commences gradually with such symptoms as loss of memory for recent
events, dulness of perception, and inability to fix the attention. Later
on the reasoning powers begin to fail, and finally, memory, reason, and
power of attention, are quite lost, the muscular power and force
remaining intact. In the last stage there is simply bare physical
existence.

=General Paralysis of the Insane, Paralytic Dementia.=--This is a most
interesting form of dementia. It is closely allied to, if not identical
with, locomotor ataxy. Its most prominent and characteristic symptom
consists in delusions of great power, exalted position, and unlimited
wealth--megalomania. The exaltation is universal, and the patient may
maintain at one and the same time that he is running a theatrical
company, that he is the Prince of Wales, and that he is the Almighty.
Moral perversion is a common symptom, and the patient is often guilty of
criminal assaults, indecent exposures, bigamous marriages, and the like.
It is accompanied with progressive bodily and mental decay. Women are
comparatively rarely affected by it, and it generally commences in men
about middle age, and its duration is from a few months to three years.
It is commonly parasyphilitic in origin. Paralytic symptoms first appear
in the tongue, lips, and face; the speech becomes thick and hesitating.
The paralytic symptoms gradually go on increasing, the sphincters refuse
to act, and death may occur from suffocation and choking. Sometimes,
during the earlier stages especially, there may be maniacal paroxysms or
epileptic fits. The delusions remain the same throughout, the patient
always expresses himself as being happy, and his last words will
probably have reference to money and other absurd delusions.

When a person of hitherto blameless life is charged with an act of
indecency, he should be examined for G.P.I. The condition of his
prostate should also be investigated. He may be suffering from either
mental or physical disease, or both (see p. 59).

XLIII.--MANIA

Under the term 'mania' are included all those forms of mental
unsoundness in which there is undue excitement. It is divided into
general, intellectual, and moral, and each of the two latter classes
again into general an