PARANOIA: SYSTEMATIZED DELUSIONS AND 
MENTAL DEGENERATIONS. 
AN HISTORICAL AND CRITICAL REVIEW. 
BY 
J. SEGLAS, 
ASSISTANT PHYSICIAN OF THE HOSPITAL OF BICETRE, PARIS. 
TRANSLATED BY 
WILLIAM NOYES, M. D., 
ASSISTANT PHYSICIAN OF THE BLOOMINGDALE ASYLUM, NEW YORK. 
Reprinted from The Journal of Nervous and Mental Disease, 
March, April, May, June, 1888. R eprinted from The Journal of Nervous and Mental Disease, March, 1888.. 
PARANOIA-SYSTEMATIZED DELUSIONS AND 
MENTAL DEGENERATIONS : 
AN HISTORICAL AND CRITICAL REVIEW. 
By J. SfiGLAS, 
ASSISTANT PHYSICIAN OF THE HOSPITAL OF BICETRE, PARIS. 
Translated by William Noyes, M.D., 
ASSISTANT PHYSICIAN OF THE BLOOMINGDALE ASYLUM, NEW YORK. 
FOR several years frequent descriptions have been given 
in the foreign journals, especially German and Italian, 
of the forms of insanity designated by the names 
Paranoia, Verriicktheit, and Wahnsinn. Although all these 
forms have been studied in France, the question has not 
been viewed from the same point; then, too, there have 
been difficulties in the way of fixing the value of certain par- 
ticular terms and the place the facts they serve to describe 
should hold in psychiatry. On the other hand, the study of 
mental degenerations being everywhere the order of the day, 
and these having a direct connection with the question of 
paranoia, it seems as if a review of the principal works pub- 
lished up to this time upon this subject would not be out of 
season, and possibly would be of some service. 
I.-To give at once a definition of paranoia would be 
difficult, not to say impossible. In fact, it is perhaps the one 
word in psychiatry that has the most extensive, but most ill- 
defined acceptance. Moreover, the term by itself does not 
have a very precise definition, as may be seen from its ety- 2 
J. S EG LAS. 
mology (yapa, near to, at the side, near, across ; and voew, 
to think, to be wise). Different authors, too, interpreting it 
some in one way, some in another, give it the meaning of 
deviation of intelligence or of incomplete intelligence. This 
ambiguity will be to others an evidence in favor of the ex- 
cellence of the term, indicating, on the whole, a qualitative 
and quantitative alteration of intelligence. Let us simply 
say, for the moment, that we find the term paranoia em- 
ployed by authors synonymously with the German words 
Verriicktheit and Wahnsinn ; the first, however, approaching 
more to the meaning of paranoia in the sense that we have 
given it (systematized delusion grafted on an incompletely 
developed intelligence), while the word wahnsinn simply 
designates the qualitative alteration of the mind. This will 
be made clear in the exposition that follows ; in the mean- 
while, let us simply say that the terms may be rendered by 
the expression systematized insanity or systematized delu- 
sion, which includes all the forms of paranoia described by 
the authors. A feeble mental constitution may accompany 
the delusion or not, and there may or may not have been a 
previous psycho-neurotic state (mania or melancholia). 
II.-The term paranoia has been employed in psychiatry 
for many years. In fact, if we may credit Bucknill and 
Tuke, Vogel used the word in 1764, and under the name 
paranoia included nine classes of neuropathies, among them 
mania. This is as far removed as possible from the modern 
conception of paranoia. 
In 1818 we find the term paranoia again employed by 
Heinroth,* but he had only a vague and indefinite idea of it. 
Nevertheless, under the name of extasis paranoica, he has 
described certain secondary states of mental exaltation with 
fixed delusional conceptions and an exaggerated sentiment 
of personality. 
We again find these ideas in Esquirol.f who describes the 
intellectual monomanias, and reports several observations in 
which he insists especially upon the ideas of grandeur. 
* Heinroth, Lehrbuch der Stdrungen des Seelenlebens, 1818. 
f Esquirol, Des maladies mentales, t. ii., 1838. FAX A NO 7A. 
3 
In Germany, Griesinger* (1845) describes systematized 
insanity (Die Verriicktheit, p. 382), and considers it as a 
disease always secondary to melancholia or to mania. He 
describes, also, the small number of fixed delusions which 
the patient is constantly repeating. 
These ideas, which always relate to the personality of the 
individual and to his relations with the world, may be active 
and exalted (ideas of grandeur), or passive (ideas of persecu- 
tion). Two forms of systematized insanity are thus distin- 
guished. 
Finally, Griesinger classes this form of insanity among 
the secondary states of intellectual enfeeblement, thus ex- 
plaining the formation and permanence of the delusion. To- 
gether with this secondary form we find another form, wahn- 
sinn (p. 357), a state of mental exaltation with fixed delu- 
sions of an ambitious character. We see, also, that this ex- 
alted monomania is completely confounded with the prodro- 
mal period of general paralysis and certain states of mental 
exaltation. 
At this same time Ellinger + admits, by the side of this sec- 
ondary form, a form of primary systematized insanity, but 
without describing it. 
Up to this time, then, we have nothing sufficiently clear on 
systematized insanity ; and although the idea has been ad- 
vanced, it has not been described accurately and particularly. 
Lasegue now fills this gap, and we may agree with Witkowski J 
in saying that it is he w'ho deserves the first place in the de- 
scription of systematized insanity by his study of the delusion 
of persecution § (1852). We now find systematized insanity 
in the works of Morel. In his " Etudes cliniques " || (1852) he 
gives some observations on the transformation, among the 
hereditarily insane, of hypochondriacal ideas into ideas of per- 
* Griesinger, Traite des maladies mentales. Traduction frangaise de Doumic, 
1865. (See, in English, Robertson and Rutherford's translation, published by 
the New Sydenham Society, 1867, p. 303.) 
f Ellinger, Allg. Zeit. f. Psych., anno II., 1845. 
| Witkowski, Berliner klinische Wochensch., 1876. 
§ Lasegue, Arch, de med., 1852. 
|i Morel, Etudes cliniques, 1852, t. i., pp. 163 to 166 and 363 to 367. 4 
J. SEGLAS. 
secution and afterward of grandeur. In his " Traits des mal- 
adies mentales " * (i860) he adopts the words " systematized 
insanity " as a substitute for the monomania of Esquirol and 
separates these states from dementia, the reverse of Grie- 
singer. His first two classes of hereditary insanity comprise 
almost the entire outline of that which has since been de- 
scribed under the name of primary systematized delusions. 
He describes the fixed ideas, the eccentricities, and the oddi- 
ties of these hereditary subjects, insists on the very great fre- 
quency of systematization in these forms, upon the rapidity of 
the appearance and disappearance of the delusional ideas in 
certain cases, and upon the slow but continuous development 
in others-all this developing on a constitution of original 
weakness, or rather on one of unstable mental equilibrium. 
The same author also describes the fusion of the two forms, 
the expansive and the depressive, in certain states of system- 
atized delusion, comparable to the hereditary states, the pas- 
sage of hypochondria into the delusion of persecution (trans- 
formed hypochondria), and from that to the delusion of 
grandeur ; and the incurability of this form through an evo- 
lution that is sometimes remitting but continuous, and which 
terminates in dementia. In short, we see that through these 
two masters French psychiatry first described primary sys- 
tematized insanity. We may cite, again, in further confirma- 
tion of this, the works of Lelut and of Voisin upon sensorial in- 
sanity, which certain authors have since regarded as an acute 
form of paranoia (Westphal). Since that time but small ad- 
vance has been made in France on this subject, at least dur- 
ing recent years ; and if we say that the theory of paranoia 
had its birth in France, we must acknowledge that it has been 
developed abroad, and especially in Germany. 
In 1863 Kahlbaum + remained faithful to the doctrine of 
Griesinger on the secondary origin of systematized insanity, 
although admitting the possibility of a primary form. 
Snell4 in 1865, is the first to describe clearly a fundamental 
* Morel, Traite des maladies mentales, i860. 
f Kahlbaum, Gruppirung der psychischen Krankheiten, Dantzig, 1863. 
t Snell, Ueber Monomanie als primare Forme der Seelenstbrung (Allg. Zeit. f. 
ch., 1865, B. xxii., p. 368). PARANOIA. 
5 
form, distinct from mania and from melancholia, and charac- 
terized by the primary appearance of a series of particular 
delusional ideas of a mixed nature (persecution and grandeur) 
and accompanied by hallucinations (primary or true wahn- 
sinn). The delusions are not, as in the other forms, an echo 
of the whole mental life, a tendency to generalization. The 
most striking symptom is a delusion of persecution, with an 
exaggeration of the sentiment of personality, and a tendency 
to activity rather than to passivity, differing in this from mel- 
ancholia. There are also delusions of grandeur uniformly 
primary, contemporary, or consecutive to the delusion of per- 
secution, and bringing about a change in the personality. 
The development of these forms of insanity is slow, but some- 
times they develop quickly on account of the mental excite- 
ment. The prognosis is bad, yet in these cases a true con- 
secutive dementia is never observed. 
In 1867 Griesinger,* retracting the opinion that he had 
formerly professed, admitted, with Snell, the primary origin 
of the mixed states (delusions of persecution and of gran- 
deur), and he described them under the name of primare ver- 
riicktheit. He described, in addition, the hypochondriacal 
and erotic forms. 
Sander,+ pursuing the subject still further, studied in 
1868 a special form of primare verriicktheit which he called 
originare. He showed the degenerative characters common 
also to the other primary forms, and the distinctive feature 
consisting in the congenital origin. The patients are born 
with hereditary predispositions which they manifest from in- 
fancy (anomalies of intelligence, of character, of sentiments, 
and of physical conformation). 
Arrived at the period of puberty they follow two routes : 
Some, too poorly equipped, fall in the struggle for existence ; 
they are seized with hallucinations and delusions, and rapidly 
fall into dementia. The others resist for a long time, and 
live in society, where they are conspicuous by their oddities 
* Griesinger, Vortrag zum Erbffnung der psychiatrischen Klinik zu Berlin, 
Mai 2, 1867 (Arch. f. Psych., B. i., S. 148, 1867). 
t Sander, Ueber eine specielie Form der primaren Verriicktheit (Arch. f. 
Psych., 1868-1869, '•» 387). 6 
J. S EG LAS. 
and eccentricities. They are emotional, mistrustful, misan- 
thropic, and often onanists. In these cases illusions and hal- 
lucinations develop unexpectedly. The morbid subjectivity 
to which these subjects are the prey, connecting everything 
with themselves, increases ; it is the same with the other 
parts of their character, which appear to hypertrophy, and 
then they develop systematized ideas of persecution, of poi- 
soning, etc., varying in color according to the education of 
the patient and the surroundings of his life. Along with this 
slow and gradual development Sander also notes the fre- 
quency of remissions and the slight tendency to dementia. 
As regards the etiology of these idiopathic (originare) delu- 
sions, we must look for it most frequently in heredity and in 
the nervous and cerebral diseases of childhood, arresting the 
normal development of the brain. Pederasty and sexual per- 
versions would be characteristic of the originare form of sys- 
tematized insanity. 
In 1873 Snell described, under the name of systematized 
insanity (Wahnsinn) consecutive to melancholia, to mania, 
or to epilepsy, a secondary or improper systematized insan- 
ity, since adopted by Hertz,* Ripping, and Nasse. 
Samt,+ in 1874, described the hallucinatory variety of the 
originare form of Sander, dividing it into two subvarieties. 
The first, depressive hallucinatory, often breaks out after a 
very long period of incubation at the menopause in women. 
Here the hallucinations of hearing are of principal impor- 
tance. The ideas of persecution that accompany them are 
only a syndrome and are not characteristic, being found in 
other forms of insanity. Samt considers that the fixed ideas 
have the same pathological basis as the hallucinations, and 
are not an attempt at explanation on the part of the patient. 
Hallucinations of other senses are found, but only rarely of 
vision ; the delusion, in which there are no signs of intellect- 
ual enfeeblement, has a very slow course, with exacerbations 
and remissions; it is only exceptionally that there is delusion 
of grandeur. 
* Hertz, Allg. Zeitschr. f. Psych., B. xxxiv. 
f Samt, Die naturwissenschaftliche Methode in der Psychiatric, Berlin, 1874, 
S. 38, 42. PA A'A A 01 A. 
7 
The second subvariety, exalted hallucinatory, is distin- 
guished by the predominance of visual hallucinations, follow- 
ing generally a state of excitement. Auditory hallucinations 
are also observed, but are very vague. The delusion has an 
irregular course and is not accompanied by signs of intellect- 
ual enfeeblement. As an example, we have the religious 
delirium and the true delusion of grandeur. 
Westphal,* in 1878, first described the acute form, and 
offered a classification of systematized insanity ( Verriicktheit), 
which he divided into four groups: I. The hypochondriacal 
form, already described by Morel, having a chronic course 
with typical remissions. The troubles of general sensibility 
form the substratum of the delusion of persecution, accom- 
panied by illusions and hallucinations. 2. The chronic form, 
having a slow beginning and a remitting course. The hallu- 
cinations and the delusion of persecution appear first-some- 
times one, sometimes the other-and are not preceded by 
an hypochondriacal stage. At the end of a certain time the 
ideas of grandeur come into prominence. 3. The acute form 
is characterized by the sudden explosion of hallucinations, 
especially of hearing, accompanied by ideas of grandeur. At 
the height of the disease the incoherence is such that it sug- 
gests a febrile delirium. In certain instances there are im- 
pulses ; in others, on the contrary, there is complete dejec- 
tion. Westphal also places in this group many cases of 
melancholia with stupor and the katatonia of Kahlbaum.t 
These deliriums progress rapidly or slowly to a recovery. 4. 
The last form is simply the originate form of Sander, and is 
the only one in which Westphal admits a basis of degenera- 
tion. , 
While certain authors, as we have seen, hold to the ter- 
minology of Snell, others adopt that of Westphal ; these are 
Leidesdorf, Koch, Jung, Schuele, and Merklin. Murh4 in 
1876, reported the autopsy of a case of systematized insanity, 
* Westphal, Ueber die Verriicktheit (Allg. Zeit. f. Psych., B. xxxiv., S. 252, 
1878). 
f Kahlbaum, Die Catatonic, Berlin, 1874. 
JMurh, Anatomische Befiinde bei einem Faile von Verriicktheit (Arch. f. 
Psych., 1876, B. vi., S. 733). 8 
J. SEGLAS. 
not originare, in which he found atrophy of the right hemi- 
sphere of the brain. Leidesdorf* (1878) returned to the 
theory of secondary systematized insanities ; but he went to 
the point of exaggeration in admitting as primary states not 
only psycho-neurotic states, but even some infantile diseases 
and traumatism, which are only causes. Fristh f studies the 
connections of delusions with the emotional state. In mania 
and melancholia the idea is secondary, and precedes the emo- 
tional state ; this would be the inverse in systematized insan- 
ity. 
Kahlbaum J (1878), struck by the differences of intensity 
that distinguish the secondary systematized delusions from the 
primary, proposed, in order that they might not be con- 
founded, to keep the name of paranoia for the primary cases, 
and to give to the others the old name of 'verriicktheit. 
Schuele,§ in 1878, described verriicktheit among the de- 
generative forms, and placed wahnsinn among the psycho- 
neuroses between mania and melancholia on one side and 
dementia on the other. We shall have occasion to review 
more in detail the ideas that this author has advanced on this 
subject in the last edition of his book. 
Emminghaus || (1878) shares in these views. 
In this same year a work appeared by Feaux 5T upon hallu- 
cinatory systematized insanity, corresponding to the acute 
form of Westphal. 
Merklin ** (1879) and Schaefer ft adopted the classification 
of Westphal, and describedin addition an hysterical form an- 
* Leidesdorf, Causistiche Beitrage zur Frage der primaren Verriicktheit, In 
psych. Studien, Wien, 1877. 
f Fristh, Psych. Centralbl., 1878. See, also, Fristh, Zur Frage der primaren 
Verriicktheit (Jahr. f. Psych., 1879). 
| Kahlbaum, Sammlung klinischer Vortrage, No. 126, Leipsic, 1878. 
§ Schuele, Handbuch der Geisterstbrung, 1878. 
|| Emminghaus, Allgem. Psychopath., 1878. 
T Feaux, Ueber die hallucinat. Wahnsinn, Inaugural Dissertation, Marburg, 
1878. 
**Merklin, Studien ueber die primare Verriicktheit, Inaugural Dissertation, 
Dorpat, 1879. 
ff Schaefer, Ueber die Formen der Wahnsinn, etc. (Allg. Zeits. f. Psych., B. 
xxxvii., S. 55). PAXANOJA. 
9 
alogous in its course to hypochondria, but without its typical 
remissions ; in these cases the delusion generally has an erotic 
coloring. 
Krafft-Ebing,* in the first edition of his " Text-book " 
(1879), and again in the second edition, gives a description of 
paranoia. He places the primary form among the mental de- 
generations ; to his mind it is a morbid form that can only de- 
velop in an affected brain, heredity being the most frequent 
cause ; the foundation on which it rests is formed by the delu- 
sions, of which the primary origin is well shown by the absence 
of all emotional basis or of a process of reflection that might 
give place to delusions. The disease has a uniform character 
and is thoroughly constitutional. It does not tend to de- 
mentia, but most frequently leaves the logical apparatus and 
thought intact. Krafft-Ebing studies the psychical constitu- 
tion of these patients, and shows that in fact the delusion that 
breaks out later is only the exaggeration of their character, 
so that often the gradual development prevents assigning a 
precise date for the beginning. The dominating symptom in 
this disease is the morbid subjectivity already pointed out by 
Sander, and the exaggeration of the sentiment of person- 
ality. 
Krafft-Ebing distinguishes two kinds of paranoia : First, 
that with delirium of persecution, which he fully describes, 
with its three periods of hypochondria, of persecution, and of 
grandeur, and its subvariety the " quarrelling insanity " {folie 
de la chicane'}, where not only the life of the patient, but his 
interests are in jeopardy, and in which he behaves in a fixed 
manner, becoming the persecutor instead of the persecuted. 
It is here that the degenerative taints are most evident. The 
second form, the delusion of grandeur, is al^o studied in its 
two varieties, the religious and the erotic (erotomania). The 
occasional causes are oftenest puberty, the menopause, uter- 
ine and intestinal affections, febrile diseases, and onanism. 
In studying the fusion of paranoia with hypochondria, the 
author describes, as a subvariety of paranoia, hypochondria 
* Krafft-Ebing, Lehrbuch der Psych., Stuttgart, 1879, B. ii. See, also, Lehr- 
buch der gerichtliche Psycho-Pathologie, Stuttgart, 1881. 10 
J. SEGLAS. 
with delusion of persecution (secondary form), the paranoia 
of masturbators, always developing on a neurasthenic base, 
and in which ideas of persecution by electro-magnetism and 
hallucinations of smell are often observed.* As for the sys- 
tematized delusions that are often found among hysterics, 
epileptics, and, especially, alcoholics, these are not special 
characteristic forms, but ought to be attributed to the pri- 
mary neurosis, or to the intoxication. In particular, Krafft- 
Ebing places among the alcoholic insanities the delusion of 
persecution of insane drinkers described by Calmeil and 
Thomeuf,+ and by Nasse4 The fixed ideas are separated 
from the primary paranoia, at the same time being classed 
beside them in the mental degenerations. 
As for secondary paranoia, the author simply regards it as 
one of the possible terminations of the psycho-neuroses § and 
as a secondary state of psychical enfeeblement ; the delusion 
is quiet, monotonous, and unvarying, differing thus from that 
of the primary forms ; the secondary insanities would be es- 
pecially the result of melancholic states rather than of mania- 
cal states. 
Krafft-Ebing entirely denies the existence of the acute 
form, and under the name of hallucinatory wahnsinn unites 
the acute primary paranoia of Westphal,|| the acute halluci- 
natory form of sensorial delirium of Meynert,H the hallucina- 
tory mania of Mendel,** the delusional stupor of Newington, 
and the acute and subacute general dementia of Tilling.++ 
In these psycho-neurotic forms there is always, according to 
him, a clear systemization of the delirium, which cannot be 
* See, also, Krafft-Ebing, Ueber primare Verriicktheit auf masturbatorischer 
Grundlage bei Mannern. Irrenfreund xx. 
f Calmeil and Thomeuf, Gazette des Hopitaux, 1856. 
| Nasse, Allg. Zeitsch. f. Psych., B. xxxiv., S. 167, 1878. 
§ We have seen above that among these forms is classed the hypochondriacal 
paranoia that Krafft-Ebing regards as one of the possible terminations of severe 
forms of hypochondria, the other being dementia. 
|| Westphal, loc. cit. 
Meynert, Acute Formen des Wahnsinns (Jahrb. f. Psych., B. ii., 1881). 
** Mendel, Die Manie, 1882, S. 55. 
ff Tilling, Psych. Centralb., 1878, Nos. 4 and 5. PAPANOZA. 
11 
as lasting, and is not accompanied by, the permanent altera- 
tions of personality that are the rule in paranoia.* 
Koch f follows the opinion of Krafft-Ebing on this sub- 
ject. 
Scholz,^: in the same year (1880), renews the distinction 
already made by Samt, and distinguishes two principal forms 
of the disease: I, The originare form of Sander, and, 2, 
the hallucinatory form. His theory is briefly as follows :§ The 
systematized delusions cannot be explained without taking 
into full account the unconscious psychical life. If, under 
physiological conditions, the sphere of the unconscious is the 
foundation on which the elementary psychical processes or- 
ganize themselves, the final results of which enter afterward 
into the domain of consciousness, then in these diseases the 
mental representations ought to be the definite result of the 
unconscious activity of the brain, but with this difference, 
* A brief summary of Krafft-Ebing's classification may make the preceding 
considerations more clear. The principal lines of his classification are here given: 
A. 
Mental Affections of the Well-developed Brain. 
I. Psycho-neuroses. 
I. Primary curable states. 
a. Melancholia. 
b. Mania. 
a. Secondary paranoia. 
b. Dementia. 
2. Secondary incurable states.' 
a. Constitutional affective insanity (folieraisonnante). 
b. Moral insanity. 
c. Primary paranoia. 
d. Fixed ideas. 
II. Psychical degenerative 
states. 
' Epilepsy. 
Hysteria. 
[ Hypochondria. 
e. Neurotic insanities. 
HI. Brain diseases with predominating mental 
symptoms. 
a. Dementia paralytica. 
b. Cerebral syphilis. 
c. Chronic alcoholism. 
d. Senile dementia. 
e. Acute delirium. 
B. 
Idiocy and cretinism. 
f Koch, Irrenfreund, 1880, No. 8, and Beitrage zur Lehre von der primare 
Verriicktheit (Allg. Zeitsch. f. Psych., xxxvi., S. 543). 
f Scholz, Ueber primare Verriicktheit (Berliner klinisch. Wochenschrift, 
1880). 
§ See Buccola, Riv. Sper. di Fren., 1882, S. 80. 
Arrests of Development of Intelligence. 12 
J. SEGLAS. 
that these activities come from molecular anomalies of the 
nerve-cells. The psychical apparatus is then guided by false 
premises, and if the logical apparatus functions regularly it is 
without doubt because it has not undergone profound ana- 
tomical modifications. In the acute form, on the contrary, 
unconsciousness has no direct relation ; the genesis of the 
disease is due to morbid perceptions which, according to 
Scholz, do not develop in the cortical centres, but in the 
peripheral centres or conducting tracts. But the brain must 
always be one that is pathologically disposed to transform 
the first excitation into false perceptions. 
Then, too, the hallucinatory delusion develops more fre- 
quently in convalescence from febrile affections. The delu- 
sion then appears as a sequel to the hallucination. 
Meynert * (1881) also describes the acute (hallucinatory) 
form of systematized delusion (wahnsinn). 
Max Bucht (1881) reports a case of primary systematized 
insanity occurring in a young man who was an epileptic, and 
presented hereditary antecedents. 
The work of Kandinski J and the book of Weiss § (1881) 
give us nothing new on this subject. 
Gnauck || describes a form of epileptic paranoia which he 
separates from epilepsy by overlooking its pathogenic char- 
acter. 
Moeli TT (1881) describes some cases of systematized in- 
sanity developed after febrile diseases, the puerperal state, 
and alcoholic abuse. 
* Meynert, Die acuten (hallucinatorischen) Formen des Wahnsinns und ihr 
Verlauf (Jahr. f. Psych., B. ii., 1881). 
f Max Buch, Ein Fall von acuter primarer Verriicktheit (Archiv f. Psych., 
1881, B. xi., S. 465). In addition, this case was characterized by ideas of perse- 
cution, doubling of personality, hallucinations of sight and hearing, especially on 
the left side, due to an otitis media with perforation of the tympanum dating from 
infancy. The author makes this otitis responsible for everything, having observed 
an amelioration after local treatment. 
J Kandinski, Arch. f. Psych., B. xi., 1881. 
§ Weiss, Compend. der Psych., Vienne, 1881, Cap. iv. ; Die Verriicktheit. 
H Gnauck, Arch. f. Psych., B. xii., 1882, S. 337. 
T Moeli, Faile von Verriicktheit, in Charitie's Annalen, vii., 1882. PARANOIA. 
13 
Jung* (1882) gives the differential diagnosis between 
systematized delusions and primary affective forms (mania 
and melancholia), reasserting the views of Fristh (see p. 6). 
He claims that there has been an increase of paranoia of late 
years, and this transformation of the forms of insanity is due, 
in his mind, to the somatic and psychical degeneration of the 
human race that is going on from day to day. 
Rauch J (1883) does not advance any new ideas on the 
subject. 
Tuczek4 studying hypochondria, says it is not a true dis- 
ease, but a symptom of melancholia or of systematized in- 
sanity. He differs from Krafft-Ebing in holding that the 
so-called hypochondriacal melancholia does not change into 
systematized insanity and that hypochondriacal systematized 
insanity does not tend to dementia. 
Sakaki § (1883) describes the brain of a case of chronic 
systematized insanity with hallucinations. 
Kroepelin || (1883) distinguishes frundre verrucktheit, 
without a condition of mental debility and comprising the 
delusion of persecution, the delusion of grandeur, and the 
erotic and religious delusions ; then, 2, secundare verruck- 
theit, grafted on a basis of degeneration, and developing 
rather after states of depression than after maniacal states. 
Like Koch, Pelman, and Krafft-Ebing, he emphasizes the 
monotonous and unvarying character of the secondary form, 
at the same time admitting some cases that have an acute 
course, recovering in some weeks or months. He describes 
in full the delusion of the litigationists, and regards this as a 
* Jung, Allg. Zeitsch. f. Psych., B. xxxviii., S. 361, 1882. 
f Rauch, Die primord. Verriick., Leipsic, 1883. 
| Tuczek, Allg. Zeitsch. f. Psych., B. xxxix., 1883, Annual Congress of the 
Society of German Alienists, Session at Eisenach, 1882. 
§ Sakaki, Gehirn in chronischen Verrucktheit (Allg. Zeitsch. f. Psych., B. 
xl., 1883). The author found in this case an alteration of the pericellular spaces 
of the cortex, especially on the superficies of the convolutions and the presence of 
a flocculent yellowish substance; analogous to that already described by Mendel 
in general paralytics; the predominating seat of these lesions being the point of 
the tempero-sphenoidal lobule, the island and the ascending convolutions. 
U Kroepelin, Compend. der Psych., Leipsic, 1883. 14 
J. SEG LAS. 
manifestation of moral insanity due to a lack of the halluci- 
nations that are customary in systematized delusions, and 
due, also, to the absence of ideas of objective right and of 
the identification of personal interests with the general good. 
Arndt * places paranoia among the atypical psychoses or 
states of mental enfeeblement, and recognizes two forms : 1st, 
one, secondary, classed among the secondary atypical psy- 
choses ; 2d, the other, primary, classed among the primary 
atypical psychoses, together with idiocy, imbecility, and cre- 
tinism. This last form (idiopathic (originelle) primary para- 
noia) comprises, a, moral insanity ; /3, partial paranoia (rudi- 
mentary, or fixed ideas, which he first describes, and the de- 
lusion of persecution); 7, complete paranoia, which is the 
generalization of the preceding. 
Mendel j* (1883) gives a complete classification of para- 
noia, a term that he adopts definitely. He insists, especially, 
on primary paranoia, which he divides into simple and hallu- 
cinatory, each of which maybe either acute or chronic. The 
acute form of simple primary paranoia generally comes on 
without prodromes, and is characterized by a delusion of 
vague persecutions without persecutors. The chronic form 
may be divided into three periods. The beginning of the 
first is difficult to indicate precisely, and often reaches back 
to youth ; it is characterized especially by hypochondriacal 
tendencies. Then, in the second period, a delusion of per- 
secution appears, developing slowly, with a sequel of delusion 
* Arndt, Lehrbuch der Psychiatric, etc., Vienna, 1883. The principal feat- 
ures of his classification are as follows : 
'a. Legitimate. 
b. Circular. 
c. Periodic. 
^d. Progressive paralysis.. 
I. Typical. 
C/J 
O 
o 
ir 
a. Secondary 
(to the typ- 
ical forms). 
I. Complete or 
dementia, avoia. 
2. Incomplete, irapavoia. 
I. Idiocy, cretinism, and imbecility. 
II. Atypical, 
or states of 
mental en- 
feeblement. 
2. Original pri- 
mary para- 
noia. 
a. Moral insanity. 
3. Partial paranoia 
(rudimentary and deli- 
rium of persecution). 
7. Complete paranoia. 
b. Primary. 
f Mendel, Eulenberg's Encyclopaedia, November, 1883. FAFANOZA. 
15 
of grandeur; this delusion especially characterizes the third 
stage, which may terminate in dementia. As varieties of 
this form Mendel describes idiopathic {originare) paranoia,, 
always hereditary and degenerative, and the delusion of the 
quarrelling insanity, a weakened form of the delusion of 
persecution, and where the degenerative basis is very ques- 
tionable. 
The acute form of primary hallucinatory paranoia begins 
with a prodromnal period of insomnia, irritability, or de- 
pression ; but sensorial troubles (of hearing or smell) de- 
velop unexpectedly, together with sudden delusions of 
grandeur and of persecution, either combined together or 
alternating, and accompanied by excitement ; a period of 
quiet may follow, but the hallucinations persist with ideas of 
poisoning, persecution, etc. This acute form may terminate 
in recovery or may pass into the chronic state. It may fol- 
low acute diseases, such as the puerperal state, hysterical or 
epileptic attacks, or the abuse of alcohol or morphine. 
The chronic form is especially characterized by the per- 
sistence of the sensorial troubles, illusions, and hallucina- 
tions, with a fixed delusion of persecution. The most 
important variety is hypochondriacal paranoia. In fact, 
Mendel returns to the acute form, upon which he insists ;• 
and, on the other hand, he greatly limits the degenerative 
element in the systematized delusions, since he recognizes 
as a distinct form only the idiopathic (originare) variety of 
primary paranoia. Finally, he also admits secondary para- 
noia in his classification, but at the same time entirely trans- 
fers it to the second scheme. 
In another work* he had already insisted on its rarity 
(five cases in one hundred and fifty). Yet he reports in his 
memoir three observations of secondary paranoia developed 
secondary to primary melancholic syndromes, and to all 
appearance reaching the full limit of their evolution. He 
describes the resemblance that exists between the delu- 
sional conceptions of melancholiacs and those of the sys- 
tematized insanities. The difference is that the one class 
55 Mendel, Ueber secondare Paranoia (Berliner Gesellschaft f. Psych, und 
Nerven. Sitzung, 9 Avril, 1883.-Neurologisches Centralblatt, No. 5, 1883). 16 
y. SEGLAS. 
find in themselves the material for their complaints and 
accusations, while the others draw it from the external 
world.* 
Meyserf (1885), returning to the study of the hallucina- 
tory delusion (Wahnsinn) of Krafft-Ebing, whose ideas he 
fully shares, finds however that the expression of this 
author is not happy since alienists do not agree whether 
they ought to call paranoia Wahnsinn or Verrucktheit, and, 
on the other hand, the actual language identifies Wahnsinn 
with Verrucktheit, while hallucinatory Wahnsinn differs com- 
® At the conclusion of the reading of this paper before the Society of Psychi- 
atre and Nervous Diseases of Berlin (April, 1883), a discussion followed at the 
session of June, 1883, which we think it will be interesting to resume, Jastrowitz 
said that he had never seen true melancholia change into systematized insanity; 
but he had seen some patients with systematized insanity at advanced period of 
their disease (dementia) have hypochondriacal melancholy symptoms. 
Westphal, recognizing fully that melancholiacs generally accuse themselves, 
had also observed it in systematized insanity. It is not the character of the ideas 
but their genesis that is of greatest importance. As in Mendel's cases, a certain 
interval elapses between the existence of the melancholia and the time of the ap- 
pearance of the ultimate systematized insanity, and it might be thought that the 
same individual had been successively attacked by different independent psycho- 
ses. For these very same facts, where the establishment of a direct connection 
appears to be clearly justifiable, are open to the following objections: where the 
systematized insanity has the appearance of taking its origin in a melancholia, 
hypochondriacal ideas are always prominent at the same time; now, these last 
have invariably constituted the point of departure of ultimate conceptions of the 
systematized insanity. Moeli held that the character of the ideas alone sufficed 
for the diagnosis between melancholia and systematized insanity. Mendel replied 
that it was the genesis of the conceptions that he insisted on. The interval that 
elapsed between the melancholia and the systematized insanity had never 
been in his patients a period of perfect health, and the new psychical complexus 
had been shown from the first week after the melancholic state. It is extremely 
difficult to demonstrate the psychopathic connection for each particular case, but 
one of them is clear (a female melancholiac began all at once to accuse her parents 
and to have later ideas of grandeur and of persecution); without doubt two of the 
observations gave evidence of hypochondriacal conceptions which dominated the 
scene, but who can determine the line of demarkation between pure melancholia 
and hypochondriacal melancholia? (See Arch, de Neur., 1884, No. 23.) 
J Meyser, Wahntinn hallucinalorischer (All. Zeitsch. f. Psych., Bd. xlii, 1, 
1885). This would be a general delusion of the asthenic order, similar to the post- 
febrile psychoses of Kroepelin, sometimes acute, sometimes chronic, resembling 
the maniacal form of agitation with disorder in the ideas, and ideas of persecution, 
based upon multiple hallucinations and slight intellectual weakness, or that of 
periodic insanity. PARANOIA. 
17 
plctely from paranoia. It is therefore necessary to find a 
special title for this well characterized malady. 
In this scheme Mayser makes the hallucinatory mania 
of Mendel, the disorder in the hallucinatory ideas of Fristh, 
the disorder in the pseudo-aphasic ideas (Meynert, Schlan- 
genhausen), and the disorder in the curable hallucinatory or 
acute primary ideas (Meynert and Fristh), identical in them- 
selves with the acute Verrucktheit of Westphal, the acute 
systematized delusion (Acuter Wahnsinn) of Schaefer, the 
first group of acute partial insanity of Kretz,* the delusions 
of exhaustion of Voigt, and the case of primary system- 
atized insanity of M. Buch. 
Witkowskif (1885) devotes an entire treatise to the nos- 
ography of Verrucktheit in its connections with melancholic 
depression. The fundamental process of Verrucktheit, he 
says, is always, the production of delusional ideas with ten- 
dencies to systematization. But, by the side of this process 
certain phenomena from time to time may come in a per- 
manent manner to occupy the first place, and of such a 
nature that it is necessary to reserve for them a separate 
place in the terminology, instead of inventing such terms 
as hypochondriacal hallucinatory, stuporous, and melancholic 
Verrucktheit, which are all forms that do not exclude one 
another, but may exist concurrently or succeed each other. 
There exists also an illusionary Verrucktheit, in which 
the hallucinations of hearing and the hypochondriacal com- 
plaints lose their importance in comparison with the forget- 
fulness of persons and things ; while, at the same time, 
transiently or permanently, the depression may play a fun- 
damental role. There exists, in addition, a form interme- 
diate to true melancholia and Verrucktheit. These are the 
people permanently depressed (those who are constantly 
* Kretz, XV? Congress des Alienistes de I' Allemagne du sud-oest. Session at 
Carlsrhue, October, 1882. 
This group is characterized by the primary appearance of hallucinations or 
illusions, while in the second group it is the delusion that controls the scene, the 
hallucinations coming afterwards reinforce this and sustain it as in the chronic 
forms of primary systematized insanity. 
fWitkowski, Congres annuel des Medicins alienistes Allemands. Session at 
Baden, 1885. (Allg. Zeitsch. f. Psych., Bd. xlii., 6, 1886. 18 
J. SEGLAS. 
making negatives, the sceptics, the damned, and the ones 
who are rotting). 
But in the majority of cases it is the Verrucktheit which 
constitutes in them the basis, which gives rise to the ideas, 
systematizes them, and brings about the abnormal concep- 
tions and the modifications of temperament absolutely inde- 
pendent of the melancholia. The Verrucktheit brings about 
a condition of mental debility. 
Such are the cases of systematized insanity, which are 
partial and stationary (among the persecuted whose intelli- 
gence preserves for a long time a high degree of vigor), and 
by the side of these cases are found some forms of progres- 
sive systematized insanity, generally tending to dementia. 
Very often, also, among the congenitally weak, delusional 
ideas are found more or less distinct, sometimes reaching a 
high degree of systematization, at other times degenerating 
into absurd and fanciful creations. The author concludes 
that, in fact, Verrucktheit is an insanity with concrete per- 
manent delusional ideas, with a tendency to systematizatibn 
that is more or less clearly marked and more or less per- 
fect. We may note here the work of Vejas* (1886) upon 
epilepsy and systematized insanity, and that of Schmidtf 
upon systematized morphine insanity, analogous to alco- 
holic. We have already seen these forms described by 
Gnauck, Moeli, and those distinguished by Krafft-Ebing. 
Schuele^ (1886) gives a very detailed description of 
systematized insanity. He distinguishes in the most for- 
mal manner Wahnsinn from Verrucktheit, as will be seen 
from the place he assigns this in his classification. It 
is, in fact, in the second class, that of psychoses based on 
an incomplete development or on hereditary degeneration, 
that he places Verrucktheit. It appears there between the 
hereditary neurosis and simple hereditary insanity (insanity 
with delusions of possession by evil spirits, folic du doute, and 
quarreling or quibbling insanity, folic de la chicane), and 
* Vejas, Epilepste und Verrucktheit (Arch. f. Psych., Bd. xviii, I, 1886). 
f Schmidt (Arch. f. Psych., Bd. xvii, 1886). 
t Schuele, Klinische Psyschiatrie-Specielle Pathologie und Therapie der 
Geisteskrankheiten (Leipsic, 1886). As this passage may seem obscure, we have PARANOIA. 
19 
moral insanity and idiocy; this originare Verriicktheit is, 
according to this author, grafted on an abnormal hereditary 
constitution characterized by original psychical anomalies; 
that is to say, it manifests itself at an early age; it would 
thus be only the hypertrophy of the original character. On 
the other hand, it is in the first class (psychoses in the com- 
pletely developed individual), but in the second group 
(cerebro-psychoses or diseases of the invalid brain) that we 
find Wahnsinn. This word is only a generic term which 
denotes the existence of delusional conceptions more or less 
united, systematized and associated in groups more or less 
connected, and forming a more or less crystalized whole. 
Schuele has divided the chapters relative to Wahnsinn, 
properly so called, as follows: this primary Wahnsinn may 
be, first, chronic; second, acute; third, stuporous. The au- 
thor describes the typical chronic form by saying that all 
the chronic cases tend to systematization, properly so 
called; a special chapter is devoted to chronic depressive 
Wahnsinn, comprising two sub-chapters: (a, delusion of 
thought best to give a tabular view of his classification to facilitate comprehen- 
sion. 
I. Psychoses grafted on the complete organs-psychic development. 
i. Of the sound brain (psycho-neuroses properly so called)- 
ab. Melancholia, [ with their secondary states. 
2. Of the " invalid" brain (cerebro-psychoses)- 
a. Mania, grave (furor); 
b. The systematized delusion f Vahnsinny 
I. Acute, 
2. Chronic, 
3. Stuporous. 
c. Acute primary dementia; hallucinatory stupor. 
d. Hysterical, epileptic, and hypochondriacal insanity; the periodic 
insanities, circular and alternating 
A. Psycho-neuroses. 
B. Insanities consecutive to extra-cerebral somatic diseases (fever, puerperal 
state, and intoxication). 
3. States of pernicious exhaustion of the brain- 
a. Acute, dangerous (acute delirium). 
b. Chronic, with destructive degeneration (progressive general par- 
alysis). 
c. The psychic cerebropathies, or psychoses consecutive to sub- 
acute or chronic organic cerebral diseases, diffused or local- 
ized. 
II. Psychoses grafted on an incomplete or constitutional organo- 
PSYCHIC DEVELOPMENT, WITH HEREDITARY OR CONSTITUTIONAL 
PREDISPOSITION. 
a. Hereditary neurosis with transitory insanities. 
b. Simple hereditary insanity ( folie du doute et du toucher; folie impulsive; 
delusion of persecution (litigationists). 
c. Idiopathic systematized insanity (originare Verriicktheit). 
d. Degenerative hereditary insanity (moral insanity). 
e. Idiocy. 20 
J. SEGLAS. 
persecution; b, expansive form). The variety of acute 
Wahnsinn comprises four sub-varieties. The first is acute 
sensorial Wahnsinn (hallucinatory). 
Here is described: a, the hyper-acute and acute halluci- 
natory Wahnsinn with exaltation (menstrual diseases); b, 
the sub-acute maniacal delusion of grandeur; e, the acute 
and sub-acute hallucinatory delusion of persecution; d, the 
depressive and then acute expansive Wahnsinn; e, the acute 
and at the same time depresso-expansive Wahnsinn; b, the 
acute hypochondriacal Wahnsinn; c, acute or sub-acute 
cerebro-spinal Wahnsinn. The second sub-variety is the 
acute melancholic Wahnsinn (demonomania); the third 
sub-variety, the expansive maniacal Wahnsinn; the fourth, 
the acute stuporous or stuporo-hallucinatory Wahnsinn. 
The stuporous form of Wahnsinn (attonita and katatonia) 
comprises three sub-varieties: a. expansive religious insanity; 
b, depressive religious insanity; c, a form resting on a basis 
of constitutional hysteria, without prepossession from that 
which describes in the chapter on hysteria. Here, in fact, 
Schuele describes an hysterical systematized insanity {Wahn- 
sinn or Verriickthcit indifferently), which may consist of sev- 
eral types: a, a type approaching the idiopathic hereditary 
systematized insanity {originaria hereditaria Verriicktheit}', 
b, a type that is the hypochondriacal systematized insanity 
{hypochondriascher Wahnsinn}', c, a type characterized by 
fantastic caprices; d. a type characterized by a vague delu- 
sion of persecution without great systematization, and the 
character of which varies; e, a type described as a condi- 
tion of acute abortive systematized insanity {Wahnsinn}, 
presenting the form of sudden irresistible thoughts; f, kata- 
tonic systematized insanity (Wahnsinn}; g, chronic incur- 
able hysteria with symptoms of degeneration. 
III. 
Such are, in a word, the ideas expressed in the principal 
German* works upon systematized insanity ; other countries 
*We desire here to thank our colleague Dr. Keraval, physician of the Colony 
of Vancluse, for the hearty manner in which he has assisted us; his profound 
knowledge of the German language has been 'of the greatest assistance in our 
bibliographical researches. PARANOIA. 
21 
have followed the impulse. Thus in Russia we find the 
conception of systematized insanity in the works of Tiling 
(1878-1879), Kadinski (1881), and Max Buch (1881), already 
cited, and of Rosenbach* (1884), who is of the opinion that 
paranoia can only develop on a basis of mental debility, be- 
cause the sensorial troubles can be interpreted in the sense 
of a delusion which arises spontaneously elsewhere, and 
the elements of which these sensorial troubles do not fur- 
nish. Still further, the ambitious ideas are not a logical 
consequence but are often contemporary to the ideas of per- 
secution which already indicate an exaggertion of the per- 
sonality. 
Dr. Greidenberg t (1885), studying acute hallucinatory 
systematized insanity {paranoia hallucinatoria acuta) dis- 
tinguishes two forms of this ; the one hereditary, and the 
other, the more frequent, asthenic, producing in their train 
sometimes an intellectual enfeeblement, and sometimes a 
true dementia, or tending to recovery. In England, Buck- 
nill and Tuke^ (1879), reject monomania and describe de- 
lusional insanity, the word delusion of the English alienists 
designating the primary delusional conceptions {les concep- 
tions delir antes primatives), the original lesions of ideation. 
Maudsley§ (1883), when he describes the insane temper- 
ament, especially in its suspicious variety, only describes in 
full the character of patients suffering from Paranoia or cer- 
tain weakened forms. In America, Spitzkall (1880-1883) 
adopts the conception of paranoia, which he describes, 
although he adopts the word monomania.IF He admits 
that this form of primary delusion is the expression of a true 
intellectual enfeeblement; he also classifies it in the group 
of states of mental enfeeblement; which are almost always 
hereditary and constitute a sort of chain whose extremities 
*Rosenbach,-Mes set ger russe, 1884. 
fGreidenberg.-Messager russe, 1885. 
tBucknill and Tuke.-A Manual of Psychological Medicine, 1879. 
§Maudsley.- The Pathology of Mind, 1883. 
|| Spitzka. - A case of Original Monomania (Medical Times and Gazette, 
February, j88i), and Manual of Insanity, New York, 1883. 
IT [In the edition of his Manual of Insanity in 1887, Spitzka definitely adopts 
the term Paranoia. W. N.] 22 
J. SEGLAS. 
are formed on the one side by idiocy and on the other by 
insanity with primary systematized delusions. Between 
these he classes imbecility, moral insanity and epileptic in- 
sanity.* In another work,t the same author has given 
us a classification of delusions which he divides into system- 
atized and non-systematized delusions. The systematized 
delusions are of two forms : first, the expansive systematized 
delusions (megalomania), subdivided into a, systematized 
delusions of social ambition; b, systematized delusions of 
an expansive erotic character ; c, systematized delusions of 
an expansive religious character. The second form is that 
of systematized depressive delusions, subdivided into, a, 
systematized delusions of depressed social ambition; b, 
systematized delusions of a depressive erotic character, usu- 
ally of persecution; c, systematized delusions of a depres- 
sive religious character. 
Regarding the non-systematizcd delusions these are inco- 
herent delusions resulting from the destruction of the power 
of association, and the emotional delusions dependent on 
the exaltation of the mental sphere by a violent emotional 
trouble. 
We may also mention in America the works of Beard4 
Fenn,§ and Hammond.il 
IV. 
But, after the Germans, the Italians have occupied them- 
selves most in the study of paranoia. In a first memoir, 
BuccolalT (1882) undertakes the study of primary systema- 
tized delusions and seems to concur with the opinion of 
Krafft-Ebing. 
These delusions are to his mind the expression ofa feeble 
mental state as shown by their etiology, their continuous and 
'Spitzka.-Si. Louis Clinical Record, 1880, VIL 
f Spitzka.-Insane Delusions ; Their Mechanism and Iheir Diagnostic Rear- 
ing {Journal of Nervous and Mental Disease, 1881). 
J Beard.-Monomania and Monohypochondria (Nevi) York Medical Record, 
March, 1882). 
§Fenn.-Original Monomania, (American Medical Weekly, August, 1882). 
|| Hammond.-A Treatise on Insanity, London, 1883. 
•^Buccola.-Zdeliri sistematizzatiprimitivi {Riv. Sper. di Fren., 1882, p.8o).  
23 
remitting course, etc. Moreover, complete physiological 
exercise of the mental functions cannot be judged solely by 
the persistence of the logic, but by the nature, the quantity 
and the association of the psychical energies, and the har- 
monious relations that should exist between the ideas, the 
sentiments and the acts. 
In this work Buccola studies the genesis of the delusion, 
and remains undecided on the subject, questioning whether 
the hallucinations are primary and the delusional ideas only 
the interpretation of them or arise from unconsciousness. 
He studies the course of the systematization, especially in 
the delusion of persecution, of which he reports two cases. 
Morselli and Buccola* (1883) show the special develop- 
ment of these delusions, their chronic course without de- 
mentia properly so called, and their limited curability. Re- 
garding the delusion, two forms may be distinguished: 
first, the delusion of persecution, of a variable nature accord- 
ing to the age, temperament, and education. In this form 
would come the quarreling insanity, a true delusion of active 
persecution. The second form would be the delusion of 
grandeur, associated at first or existing alone, most fre- 
quently with an erotic or religious coloring. The fixed 
ideas should be regarded only as an abortive form of these 
delusions, they being differentiated by the fact that the pa- 
tient has a consciousness of his condition. 
Regarding the clinical nature of these delusions Morselli 
and Buccola place them among the degenerative psychoses, 
and divide them into two classes : first, primary systema- 
tized delusions with anomalies of the development of the 
psychic individuality (P. originare of Sander); second, 
systematized delusions showing themselves in a psychic in- 
dividuality already developed. Then intervene some occa- 
sional causes (acute diseases, menopause, and traumatisms). 
Even in these cases, however, hereditary influence exists in 
the majority of cases. 
The forms that Morselli and Buccola place under the 
head of acute primary insanity are the following: 
*Morselli et Buccola.-La pazzia sistematizzata. Giorm. della R. Academ. 
di Torino, 1882, p. 210. 24 
J. SEGLAS. 
1st. The intellectual monomania of Esquirol. 
2d. Sensorial insanity, when the hallucinations are not 
brought on by mania or melancholia but from delusions, 
from an original lesion of the perceptive centres. 
3d. The so-called cases of lypomania with delusion of 
persecution, in which the melancholic state is secondary. 
4th. The hypochondriacal insanities, in which the synes- 
thetic hallucinations are the pivot of the delusions, and 
where a delusion of persecution is often concealed under 
hypochondriacal ideas. 
5th. Certain cases of hysterical insanity that present an 
erotic delusion without remission (Merklin and Schaefer). 
6th. Certain cases of claustrophilia or claustrophobia that 
have been wrongly interpreted, and concealing a delusion 
of persecution. A certain number of analogous forms, all 
characterized by the predominance of a given group of 
ideas and tendencies constituting the abortive forms of pri- 
mary systematized insanity, while others form the group of 
fixed ideas where consciousness remains. 
7th. The forms intermediate between sanity and insanity 
(the insane temperament), the graphomanias with con- 
cealed ideas of grandeur. 
8th. Certain cases offolie lucidc, or folie raissonnante. 
9th. The eccentric and original individuals. 
Amadei and Tonnini* (1883) give us a very complete 
description of paranoia, showing that the delusion is only a 
phase and the culminating point of the disease. The devel- 
opment, characteristics, course, transformations or associ- 
ations, and the termination of the delusions are clearly 
studied. But the most original point of the memoir is the 
classification. The authors admit by the side of a degener- 
ative form a psycho-neurotic form, and they bring forward 
the following arguments: 
1st. Absence in these cases of a constitutional element 
from which the disease could be foreseen; no usual symp- 
tom of neuropathy. 
2d. Frequent existence of occasional causes or of tem- 
porary predispositions that may explain the paranoia. 
* Amadei and Tunnini.-La Paranoia et le sue forme {Arch. ital. per le 
malattie nervose, 1883-1884. PABAHOIA. 
25 
without which there would be a necessity of seeking a pre- 
disposition in the antecedents. 
3d. Often these cases recover, sometimes there results a 
certain mental enfeeblement. 
4th. In these psycho-neurotic forms there is neither 
more nor less heredity than in mania or melancholia. 
5th. The duration of the acute forms of the disease and 
the beginning of the psycho-neurotic forms is in contradic- 
tion with the former mental life of the patient, while this is 
not so in the degenerative forms. 
Here is the classification of paranoia that they propose: 
I. Degenerative Paranoia: 
A. Idiopathic'iyriginaire). 
a. Simple: delusions of persecution, ambitious, religious, and 
erotic. 
b Hallucinatory: delusions of persecution, ambitious, religious, 
erotic, and hypochondriacal. 
B, Late. 
[ a. Simple : delusions of persecution and of quibbling, ambitious, 
religious, and erotic. 
j b. Hallucinatory: delusions of persecution, ambitious, religious, 
erotic, and hypochondriacal. 
II. Psychoneurotic Paranoia : 
A. Primary. 
A. Acute and curable. 
a. Simple: delusions of persecution, ambitious, reli 
gious, and erotic. 
b. Hallucinatory: delusions of persecution, ambitious, 
religious, and erotic. 
B. Incurable, 
a. Simple: delusions of persecution, ambitious, reli- 
gious, and erotic. 
b. Hallucinatory: delusions of persecution, ambitious, 
religious, erotic, and hypochondriacal. 
B. Secondary. 
a. Post-maniacal. 
b. Post-melancholic. 
As is seen by this table, degenerative paranoia alone 
would be always primary, the secondary being solely the 
termination of a psychoneurotic state. This secondary 26 
J. SEGLAS. 
form is considered by these authors, together with Krafft - 
Ebing, as a state of mental enfeeblement consecutive to 
some of the primary forms of psychoneuroses. 
Regarding the degenerative defect in paranoia of the 
first category, this is never the most profound, and does not 
reduce the patients to the last degree of the scale of the 
degenerates. Schuele also, with good reason, separates 
these forms of degeneration, in the strict sense of the word, 
to make, as we shall see, the neuroses with a degenerative 
basis. But this is not simply a question of degree, and 
there should be intermediate forms between the degener- 
ative forms of paranoia and certain simple delusional 
outbreaks observed in imbeciles, and also between certain 
states of mental debility and the idiopathic (originaire) 
paranoias where the delusion is but little accentuated. 
In conclusion, Amadei and Tonnini hold that the sen- 
sorial delusion* (Wahnsinn of Krafft-Ebing), the true type 
of non-systematized delusions may pass into paranoia 
through the stage of fixed ideas, which is a rudimentary 
or prodromal form of paranoia, differing from this, however, 
by the consciousness of the subject. 
Finally, we may distinguish (as Krafft-Ebing has done) 
true paranoia in certain more or less systematized delusions 
of epilepsy, hysteria, alcoholism, etc. 
Raggi t (1884) considers that the role of the degener- 
*[In explanation of this term {delire sensoriel), Folsom's description (Primary 
Delusional Insanity, in Pepper's American System of Medicine') may be of ser- 
vice : " Transformed delusions {sensorielle Verrucktheit) arise usually in some 
anomally of sensation, which probably directs the delusions already forming in a 
mind in the early stage of disease rather than causes the disease. The causes lie 
in a deep-seated exhaustion of the nervous system, especially in the neuropathic 
constitution and profound hysteria. Various anomalous sensations give rise to a 
belief in delusions as to their being caused by individuals for a purpose, or to their 
being an indication of all sorts of impossible and most extraordinary changes in 
the part: the chest is of stone, the leg of brass, the head on fire, the hand of ice, 
and so on indefinitely. Hallucinations and a cataleptiform state are common. 
The variety of delusions which may arise is almost endless, and they may have 
their origin in the unhealthy action of any organ in the body ; one of the most 
troublesome forms, called ovarian insanity by Skae, causes single women of 
severely continent lives to imagine all sorts of impossible marital relations with 
men whose lives are equally beyond scandal and above suspicion."-W. N.] 
f Raggi.-Dell' elemento degeneratio nella genesi dei cosi detti delire siste- 
matizzatiprimative (Arch. ital. per le ma( nerv., 1884). PARANOIA. 
27 
ative element in the genesis of paranoia is far from being 
demonstrated ; he denies all the distinctive characteristics 
drawn from the etiology, evolution, symptomatic com- 
plexus, and the course. 
To his mind heredity plays no larger role here than 
elsewhere ; the priority of the idea in date to the troubles 
of sensation is not in the least demonstrated, and, on the 
contrary, the slightest amount of emotional trouble in these 
patients suffices to change or excite their delusions. More- 
over, all the authors do not agree upon the symptoms, some 
regarding the hallucinations as primary, others as second- 
ary to the delusion, which is one of persecution with some 
and of grandeur with others. Regarding the course, do 
not some authors admit that the delusions have an acute 
course, a thing that is incompatible with an idea of degen- 
eration ? 
All these arguments are very specious, and it seems to 
us that it is sufficient to cite them to show how few of them 
should be taken into consideration. 
In this same year (1884), Tanzi* published an historical 
study on paranoia, a kind of introduction to a monograph 
on this form of insanity made in collaboration with Riva.f 
To Tanzi and Riva paranoia is a functional psychopathy 
founded on a degenerative basis, characterized by a par- 
ticular deviation of the highest intellectual functions, imply- 
ing neither a grave decay nor a general disorder; it is 
almost always accompanied by hallucinations and by 
permanent delusions more or less systematized, but inde- 
pendent of all definite occasional cause or of all emotional 
morbid condition, which pursues a course neither uniform 
nor continuous, but nevertheless essentially chronic, and 
generally does not in itself tend to dementia. 
In only fourteen cases out of a hundred, according to 
Tanzi and Riva, heredity was unknown but riot excluded, 
and in eighty-six other cases the paranoia had a degenera- 
* Tanzi.-La Paranoia (delirio sistematizzato) e la sua evolutionei storica 
(Rev. sperirn. di freu., 1884). 
f Tanzi et Riva.-La Paranoia contribute alia storia delle degenerazion psi- 
chiche (Riv. sperimen. di fren., 1884, 188p, 1886). 28 
J. SEGLAS. 
tive basis either from heredity (77), or from diseases of 
infancy implicating the development of the individual (9.5). 
From this it is not unfair to conclude that paranoia is a form 
of mental debility. It is, as already shown by Amadei, 
Tonnini and others, simply a degenerative psychosis due to 
an hereditary or constitutional defect, as shown by its 
chronic course and insidious beginning and its variable 
symptomalology. 
The psychical constitution of paranoiacs can be put in 
evidence only through the systematized delusion which 
rises on the mental constitution and is the exaggeration 
of this ; and meanwhile this constitution is all important, 
constituting sometimes in itself the whole disease (indiffer- 
ent paranoia'}, and showing forth again in the prodromes 
and in the periods of remission. 
It consists especially in anomalies of the intelligence 
(associations of odd ideas and absurd judgments) or of the 
affective sentiments (egoism, defiance, romanticism, irritabil- 
ity, emotionality, sexual perversions, etc.). 
The psychical characteristics of this constitution develop 
with the years until they reach a degenerative maturity at 
the age when a sane man is at the height of his intellectual 
power (thirty-two years on an average). It is then that 
the delusion generally develops, but sometimes it is lacking 
(in eccentric and original individuals), or it is insufficient to 
disturb the psychic equilibrium ; the patient has no delusion 
properly so called, but he reasons falsely aud is paradoxi- 
cal {folie raissonnante,-indifferent type). 
In fact paranoia is a morbid constitutional form, and the 
delusion is only a symptom. Moreover, it is not absolutely 
specific and it may be found in other psychopathic forms 
without distinct psychological characteristics, but in these 
cases it is independent of the psychic constitution and arises 
under the influence of an incidental somatic cause ; circula- 
tory (mania or melancholia), inflammatory (general parly- 
sis), toxic (alcoholism), etc. 
As regards the genesis of the delusion it develops unex- 
pectedly without a previous emotional morbid state, and it 
is accompanied by hallucinations that are secondary, affecting PARANOIA. 
29 
most frequently the sense of hearing, afterwards the general 
sensibility,-visual hallucinations being extremely rare. 
The delusion may undergo transformations, becoming either 
multiple or indetermintae, or be entirely wanting. 
From this point of view paranoia may be divided as fol- 
lows : 
1st. Paranoia with delusions of persecution.. 
2d. Ambitious paranoia. 
3d. Religious " 
4th. Erotic " 
5th. Intermediate " (Quarrelling insanity ; paranoia 
without delusions). 
6th. Mixed " 
7th. Rudimentary " (Fixed ideas). 
From the point of view of the onset two kinds of paranoia 
may be distinguished (an artificial distinction it may be, the 
ground remaining always the same): 
1st. Idiopathic* paranoia (originare type of Sander). 
2d. Late paranoia : a, post puberal; b, of the menopause 
(these two varieties following the biological evolution of the 
individual); c, simple (independent of the biological evolu- 
tion). 
Regarding the course, which is essentially chronic, it 
may be divided, according to the delusional symptom, into 
uniform (same type of delusion) and variable, and accord- 
ing to the mode of succession of the symptoms into con- 
tinuous, remittant, and with exacerbations. All these 
varieties may be combined, and we shall have these a 
course : 
Uniform 
Continuous (delusions of persecution). 
Remittant. 
With exacerbations. 
Continuous (transformations of the delusion of persecution into 
ambitious delusion). 
Remittant. 
With exacerbations. 
And variable. 
The exacerbations may be brought about by psycho- 
neurotic attacks (mania, melancholia, or stupor). 
*In this translation the word idiopathic has been used to designate the orig- 
mare and originaire of the Germans and French, thus leaving the primary for 
the corresponding primare and primative. W. N. 30 
J. SEGLAS. 
As regards the terminations, mental enfeeblement is 
little frequent, and absolute dementia is very rare. When 
it exists it may show itself under three aspects : first, pre- 
mature senility, the expression of the rapid failure of the 
degenerated organism; second, dementia due to inter- 
current psychoneurotic attacks (mania or melancholia); 
third, apparent dementia may appear in two forms : in the 
first the patient, seeing the uselessness of his ideas, remains 
calm, loses confidence, and becomes indifferent ; in the 
second he concentrates himself more and more in his delu- 
sion, becomes exalted and extravagant, and gives himself 
up to disordered and incoherent actions. 
Regarding the place paranoia occupies among the de- 
generations, Tanzi and Riva place it in the purely psychical 
forms (that is to say, without disturbances of motion or 
sensibility), called by Morselli paraphrenias, and in this 
sub-group may be distinguished, first, the intellectual 
psychical degenerations with or without delusions, that is to 
say, paranoia; and second, the affective psychical degener- 
tions (moral insanity, congenital delinquency, and sexual 
perversions). 
Furthermore, and notwithstanding the opinion of Bon- 
vecchiato,* who finds this classification too systematized, 
Tanzi and Riva willingly admit mixed forms, both intel- 
lectual and affective, all resting on the same degenerative 
basis. 
During the course of the publication of this long 
memoir, other works on this same subject have appeared 
in Italy. 
Salemi-Paci (1885) distinguishes two kinds of paranoia : 
one, simple paranoia, independent of all degenerative ele- 
ment ; the other, degenerative paranoia; he describes also a 
form of consecutive or secondary paranoia, but he does not 
see the necessity of making a particular form of it, as do 
the other two authors.t 
* Bonvecchiato.- La p azzia sistematizzata priniitiva. Venice, 1875. 
Salemi Pace.-La classificazione dela frenopathie. Il Pisani, 1885. 
This distinction, which is apparently very simple at first sight, is much less PARANOIA. 
31 
One may well have doubts of the existence of simple 
paranoia when he sees an author place it by the side of 
moral, impulsive and sensorial insanity, and emotional de- 
lusions. 
Angelo-Zuccarelli* (1885) reports an observation on 
primary paranoia with delusions of persecutions of a chronic 
form, that he held to be of a non-degenerative nature. 
Guiccardif (1886) agrees with the ideas ofTanzi and 
Riva regarding the interpretation of the psychical phenom- 
ena that characterize the paranoiac personality. 
B. Battaglia J (1886) cites a case of paranoia with ambi- 
tious delusions, that is at least open to criticism. We shall 
content ourselves with remarking that the author pretends 
not to have found hereditary antecedents, nor signs of 
so when the following resume of his classification is considered : 
Group I. 
Cerebro-neuroses. 
Nervous insanity. 
Hypochondria. 
General delusions. 
Simple insanities. 
Melancholia. 
Mania. 
Circular insanity. 
Pellagous insanity. 
Puerperal " 
Syphilitic " 
Alcoholic ' ' 
Rheumatic " 
Specific. 
Diathetic insanities. 
Group II. 
Dynamic cerebro- 
insanities. 
Neurotic. 
Epileptic " 
Choreic " 
Hysterical " 
Erotic " 
Partial delusions. 
Impulsive instinct- 
ive insanities. 
Kleptomania, pyromania, agor- 
aphobia, dipsomania, suicidal 
and homicidal insanity, etc. 
Sensorial insanity. 
Moral insanity. 
Intellectual insanity 
Metaphysical insanity, insanity 
of doubt, delusions, of touch, 
simple paranoia. 
Group HI. 
States of cerebral 
defect. 
Imbecility, idiocy, cretinism. 
Paranoia-degenerative, consecutive, or secondary. 
Primary dementia. 
Consecutive or secondary dementia. 
Senile dementia. 
Paralytic dementia. 
Group IV. 
* Angelo-Zuccharelli.-Contribution a Vetude medico-legate de la Paranoia 
(Il manicomio, j88y). 
f Guiccardi.-Ptychologia e psychatria (Riv. sper. di fren., 188 b, p. 531). 
t Bruno-Battaglia. - Contribuzione alia casistica della Paranoia. (La 
psychiatre, 1886, fasc. 3 and 4, p. 354. 32 
J. SEGLAS. 
degeneration. Nevertheless, he tells us that his patient 
had a feeble mind, was ill-balanced, loved the marvellous, 
was unstable, and was disgusted with life without good 
reasons ; he lacked, he says, the faculty of adaptation to 
his social circle, and the spirit of rational criticism. Now, 
are there not here sufficient signs of a state of mental 
degeneration ? 
Morselli* (1886) reports a case of rudimentary impulsive 
paranoia. We have already seen that Arndt was the first 
to describe this form of paranoia. 
This rudimentary paranoia (or rather the fixed ideas) 
has been divided by Tamburini t into three classes: first, 
the simple fixed ideas (ex : pure folie du doute}, without a 
tendency to transform themselves into acts ; second, the 
emotional ideas with simultaneous actions (ex : folic du 
doute avcc delire du toucher'}; that is to say, with a tendency 
to the exteriorization of their motor content; third, the 
impulsive ideas. Morselli admits only two classes, uniting 
into one the last two of Tamburini, because in these cases 
there always exists, according to him, the tendency of an 
ideational representation to transform itself into an act. 
Regarding the ground on which these ideas develop, there 
is likewise much contest. 
Krafft-Ebing4 Cantarano§ and Andriani || regard these 
forms as being always manifestations of degeneration. 
Others, with Berger, 1 Kroepelin,** Tamburini, Amandeiand 
Tonnini, and Tanzi and Riva, admit that they may develop 
on a neurasthenic constitution, but are not always here- 
ditary. Morselli inclines to this latter opinion and classes 
them in the Paraphrenias of the second group. The ideas 
* Morselli.-Paranoia rudimentale impulsiva (Riv. sper. difren., 1886, f. 4, 
P- 495- 
f Tamburini.-Sulla pazzia del dobbio (Riv. sper. di fren., 1883). 
J Krafft-Ebing. Lehrbuch der Psych, 1879, 
§Cantarano. Contributo allo studio delle psicosi degenerative. (La psychi- 
atria, 1884) 
|| Andriani. Contributo alia conoscenza delle psicosidegenerative (idee fsse~) 
Lapschiatria, 1885. 
^[Berger. Grubelsacht einpsychopathischesymptom.- Grubelsacht und Zwang- 
vorsellungen (Arch. f. Psych., Bd. vi. and viii.). 
**Kroepelin. Comp, der Psych. Leipsic, 1883, PARANOIA. 
33 
of this author will be made clearer by an explanation of the 
place that the different forms of paranoia occupy in his class- 
ification of mental disease. Properly speaking, Morselli 
admits only two typical forms of paranoia ; first, idiopathic 
{originaire'} degenerative paranoia with its three varities of 
persecution, grandeur, and the erotic form (erotomania); 
second, rudimentary paranoia with its two varieties, idea- 
tional and impulsive. Both are classed among the para- 
phrenias (anomalies of cerebral evolution with abnormal 
formation or perversion of the personality). But although 
idiopathic {originaire} degenerative paranoia is a part of 
the sub-group of Paraphrenias formed by the psychical de- 
generations (paraphrenias depending on a psychopathic 
constitution most frequently of hereditary origin), rudimen- 
tary paranoia is classed under a second sub-group, that of 
constitutional psychopathies (Paraphrenias depending on a 
psychopathic constitution most frequently congenital). 
Regarding the forms of acute paranoia and secondary 
paranoia, admitted by some authors, these are completely 
separated from the preceding and classed among the psy- 
choneuroses, a sub-group of phrenopathies (diseases of the 
completely developed brain with morbid changes and alter- 
ation of the personality). The one, paranoia, called acute 
or hallucinatory or curable, is described under the name of 
acute sensorial insanity and placed by the side of maniacal 
or melancholic states. The other, secondary systematized* 
insanity (so called secondary paranoia}, with its two forms 
of persecution and grandeur, is not considered, with dementia, 
as a terminal condition,-a conditional of intellectual en- 
feeblement. (Synonym, incomplete dementia.) 
* It should be noted that Morselli designates these forms under the names of 
of acute sensorial insanity (Frenosi sensoria acuta} and secondary systematized 
insanity (Pazzia sictematizzata secandaria}. reserving for the idiopathic (origin- 
al, re} and rudimentary forms the term paranoia, which seems thus <ssociated in 
the author's mind with the idea of a neuropathic constitution, which may be con- 
genital or hereditary. 34 
J. SEGLAS. 
V. 
In France, since the works of Morel, we meet with this 
subject only in isolated memoirs, describing the forms of 
insanity which, in spite of their different names, seem to us 
to correspond to certain varieties of paranoia that we have 
passed in review. 
We must notice principally in this connection the work 
M. Ach. Foville upon insanity with a predominance of the 
delusion of grandeur (1871); then that upon the delusion of 
persecution by Legrand du Saulle (1873), an amplification 
of the memoir of Lesegue upon the same subject. This 
delusion, as we have seen, is a type of paranoia. 
The thesis of P. Garnier* (1877) on the same subject 
should also be remembered. 
In 1876 M. Taguetf described the insane persecutors, 
which he separated from the group of persecuted. This 
form of insanity also enters into the domain of paranoia, for 
it corresponds to the querulanten Wahnsinn of the Germans, 
and to the querelenti and litiganti of the Italians,^ and we 
have already seen that the most of the time it has been con- 
sidered as a form having a degenerative basis. 
This also appears to be the opinion of J. Falret, who 
discussed the question in 1878, and made the class of perse- 
cutors a form of the delusion of persecution developing in 
subjects with an hereditary taint. On several occasions 
since then he has returned to this subject and has devel- 
oped his ideas in his clinical lessons and in the discussions 
on hereditary insanity before the Medico-psychological 
*P. E. Garnier.-Des idees de grandeur dans le delirium des persecutions. 
(These de Paris, 1887.) 
f Taguet.-Les Alienes persecuteurs. (Am. med. psych., 187b.') 
J We have translated these words by quarrelling insanity (folie de la chi- 
cane), although they express more the idea of complaint. On this subject see 
also Liebmann-Ueber querulanten Wahnsinn (Allg. Zeitsch.f. Psych., Bd. xxxv., 
p. 395); Brosius-Ueber querulanten Wahnsinn (Allg. Zeitsch. f. Psych., Bd. 
xxxii., p. 770). PARANOIA. 
35 
Society (1885-86). We may also refer to the ideas brought 
forward in the thesis of one of his pupils, Dr. Pottier.* 
In 1882 Cotardf described under the name of the delusion 
of negation a psychopathic form that he distinguishes from 
the delusion of persecution with which it might be con- 
founded by the systematization of the hypochondriacal ideas, 
and the ideas of persecution and grandeur. But, in spite of 
the particular characteristics that may distinguish the nature 
of these ideas, it should be said that the systematized delu- 
sion of negation is always secondary to melancholic condi- 
tions, and most frequently to anxious states, instead of being 
primary as in the delusion of persecution. It would be an 
example of the so-called secondary forms of paranoia. We 
have reported an example that we consider typical.^ 
But we can best see, by comparison, to what nosological 
forms paranoia corresponds when we turn to the works of 
Magnan.§ In fact we find it there complete ; for although 
considering the facts from another point of view Magnan 
has described none the less perfectly the same forms that 
we have been examining. Resuming the views of Morel on 
hereditary insanity, he studies this in its different manifesta- 
tions, which he seeks to classify. In his opinion the hered- 
itary subjects, or rather the degenerate hereditary subjects, 
may be divided into four degrees according to their mental 
condition: first, idiocy; second, imbecility; third, mental 
debility; fourth, the superior degenerates. Now the mental 
condition of this last class, with its anomalies of character 
and of intelligence, corresponds absolutely to what other 
authors (Sander, Maudsley, Krafft-Ebing, Tanzi and Riva) 
have described under the name of the psychic constitution 
of paranoia; some of the cases would even be examples of 
* Pottier.-Etude sur les alienee persecuteurs (Thesis, Paris, 1886). 
■(•Cotard.-Le delire des negations (Arch, de neurolog., 1882). 
t J. Seglas.-Note sur un cas de melancholic anxieuse {dilire des negations'). 
{Arch, de neurolog., 1884). 
§Magnan.-Lemons sur la folie hereditaire, 1882-1883; Les delirants 
chroniques et les degeneres {Gaz. des hopit., April, 1884. De la folie hereditaire 
{Journ. des conn, med, 1885, No. 48). Aun, Med.-psych., 1885-1886; Tribune 
medicale, 1886, No. 954. 36 
y. SEGLAS. 
the so-called indifferent or indeterminate paranoia, or para- 
noia without delusion. And in all these cases there is the 
soil favorable for the development of primary systematized 
insanity, and that even certain authors, admitting only the 
degenerative forms, regard as indispensable, the delusion 
being only the exaggeration of the particular character of 
these patients. 
Among the superior degenerates Magnan makes the 
synthesis of a certain number of particular states that he 
designates under the name of episodical syndromes. These 
conditions, characterized by obstinancy and impulses, with 
mental anguish and clearness of mind, are what other 
alienists have designated under the name of fixed ideas, 
and thus represent that form of rudimentary paranoia that 
Arndt first described. In this connection we may mention 
that Magnan belongs to that group of physicians who con- 
sider that these psychical troubles are characteristic of a 
state of degeneration* (psychic stigmata). 
Moreover, deliria may develop in these syndromes, and 
these inay be of several kinds. Besides the deliria of the 
onset already noted by Morel, systematized deliria with a 
slow development may be met with ; some are primary, 
that is to say, they fix themselves little by little without 
attracting attention ; others may be consecutive to a deli- 
rium of the onset, which may prolong itself indefinitely ; at 
other times again they may be seen to follow the simple 
delirious tendencies which seem to be the prodromal period, 
and of which they are only the exaggeration. Who will 
not recognize in this brief sketch of the slowly developed 
deliria of degenerates, those forms of delirious paranoia 
engrafted on degeneracy, as generally admitted, and of 
which the idiopathic (originare) paranoia of Sander is the 
type. 
But in Morel's classification there is still another group 
of patients that seem to us to correspond also to certain 
' Magnan.-Lemons sur la dipsomania (Progres medical), 1884. De I'ono- 
matomanie (in collaboration with Charcot), Arch, neur., 1885. 
We cannot enter here into Magnan's doctrine of hereditary insanity. We 
refer, for the details, to the thesis of Legrain, who gives in a very complete man- 
ner the ideas of his master on the different points we have noticed. PARANOIA. 
37 
forms of paranoia. These are the victims of chronic delirium 
{les delirants chroniques). From the symptomatological 
point of view the subject of chronic delirium is only the 
common persecuted patient taken in the different halting 
places of his delirium, as already partly seen by Morel, 
Snell, and others (period of disquiet, of persecution, of 
grandeur and of dementia), and representing the synthesis 
of certain old monomanias (hypochondria, demonomania, 
megalomania, theomania, etc.). It is then that the delirium 
presents a most marked systematization. Now, the com- 
parison of observations on chronic delirium with those on 
delirious paranoia shows us in the majority of cases an 
identical description of one and the same form of insanity. 
There is the same symptomatology, the same course (as 
shown by the hallucinations, especially of hearing, the 
nature and evolution of deliria, and the reactions of the 
patient), just as other examples show us similar symptoms, 
and an evolution analagous to that of the deliria of degen- 
erates of slow development (peculiar mental condition, 
insidious and progressive beginning or rapid appearance, 
hallucinations either numerous or absent, and the relations 
between these and the deliria). 
In connection with this subject it should be recalled that 
with reference to the succession of the delusional ideas, the 
different alienists who have written on paranoia have ob- 
served that the ideas of persecution or of grandeur may 
exist in the isolated state, or if they are recognized in the 
same individual {mixed paranoia') they are seen to be con- 
temporaneous or to succeed each other, the ambitious ideas 
being the consequence of the ideas of persecution. Now, 
when we turn to Magnan's classification we shall see in the 
last case a succession of ideas analogous to those that are 
found in chronic delirium, while the other varieties corre- 
spond to the deliria of the degenerates. 
Finally, as regards the termination, we shall find again 
strong analogies between the forms of delusional paranoia, 
and the deliria of degenerates and chronic delirium. Their 
course, which is very long, rarely ends in a true dementia, 
and in the midst of the dissociation of the intellectual facul- 38 
J. SEGLAS. 
ties there is often found a trace of the old systematized 
delusion. This period of dementia is rather a period of 
mental confusion. 
In direct opposition to the authors that we have passed 
in review, and who nearly all unite together all the varieties 
of paranoia by attributing to them a common degenerative 
basis, Magnan makes a separate class of his subjects of 
chronic delirium, and while admitting that they are often 
hereditary subjects refuses to make them degenerates. 
This opinion does not seem to be held by Gerente, who 
in his monograph on chronic delirium, says that this form 
of insanity is not met with in the earlier writers ; it requires 
a long incubation, two or three generations preparing the 
ground, and predisposition is necessary.* 
The author even went further when he said with rela- 
tion to the breaking out of the delirium, that if he meets 
with some accident the patient succumbs, "being moreover 
front his birth what is called a weakling or being mentally 
enfeebled in the course of his life." He seems to us again 
to unite the chronic deliria with certain deliria of the degen- 
erates of Magnan, when he says that of these insanities (the 
chronic deliria), those which have been most affected by 
direct insane hereditary influence will show themselves in 
their essentially intermittent delirium, and will recover or 
recover more easily. There are, moreover, among the 
observations that he reports examples of mental degenera- 
tion. 
Another pupil of Magnan, Legrain,t distinctly admits 
that degenerates may be affected with chronic delirium. 
This opinion, which we, for our part, shall be disposed to 
share, surprises us however in Legrain's book, for in our 
opinion it contradicts the classification that he adopts, and 
consequently renders useless the distinction that he makes 
between deliria of degenerates and chronic delirium, which 
would be only a form, at least in certain cases. In fact, 
<s Gerente.-Le dilire chronique, son evolution (These de Paris, 1883). 
Quelques considerations sur devolution de delire dans la vesanie (Arch, de neuro- 
logy t. vL, 1883, p. 16 . 
f Legrain.-Du delire chez les degeneres (Thesis, Faris, 1886). PARANOIA. 
39 
whatever may be the basis on which it is admitted that the 
chronic delirium develops, its diagnosis from certain deliria 
of degenerates, which simulate it, even to being mistaken 
for it, is clinically the most difficult, not to say impossible. 
Very interesting observations upon the question that is 
occupying us are found in the work of Legrain, who studies 
all the forms of deliria that are met with among the degen- 
erates, their mental state, the episodical syndromes, and 
the deliria of the onset or of the chronic development. We 
must reproach him, however, for not giving us an historical 
review of the question, which, if it has not been considered 
under this aspect, has however been already treated in 
great part. 
We may refer to an earlier work of Saury,* who has also 
studied the mental states of degenerates and the episodical 
syndromes, but has only described the deliria of the onset. 
It remains to say a few words on the French works rela- 
ting to paranoia, and we will close this review by citing the 
work of Regis,+ where, under the name of partial insanity, 
he reproduces the ideas of Magnan on chronic delirium ; 
and a lecture of Ball^ (1885) upon a particular form of dis- 
tinct ambitious delusion, with ideas of the same nature as 
the weak subjects {debiles}, those suffering from circular in- 
sanity, the persecuted and the general paralytics, and which 
he likens to Ach. Foville's insanity with predominance of 
delusions of grandeur. 
We have seen, in fact, that paranoia is no new thing in 
psychiatry, and we can recall its history by citing the nu- 
merous names under which the alienists of different epochs 
and different countries have designated it. We see, too, 
that born in France, the doctrine of primary systematized 
delusions has been especially developed in Germany, and 
since then in other countries and especially in Italy. Per- 
haps this study has even been pushed to the point of ex- 
aggeration, each one wishing to add his particular note, and 
bringing confusion from the multiplication of forms. 
° Saury.-Etude clinique sur la folie hereditaire (les degeneres}, 188b. 
f Ball.-Du delire ambitieux (L'Encephale, 1885). 
J Regis.-Manuelpractique de medicine mentale. Paris, 1885. 40 
>. SEGLAS. 
What is there especially to emphasize in a resume of the 
different theories that we have sought to explain ? One 
fact that stands out prominently from this historical review 
is that all authors admit a form of primary paranoia en- 
grafted on a soil of degeneration, and the existence of which 
moreover is indisputable; but some admit only this form 
with its varieties ; others restrict its domain more or less, 
and do not'consider that the ground of mental degeneration 
is indispensable to the production of paranoia., 
It is, then, in the scheme of this psychoneurotic para- 
noia, that we meet by the side of the chronic form that 
form of paranoia called acute, psychoneurotic, hallucinatory, 
and curable, admitted for the first time by Westphal. Here 
opinions are much divided ; some follow the ideas of West- 
phal, as, for example, Meynert, Fristh, Mendel, Tiling, 
Amadei and Tonnini, etc. Others completely deny its 
existence, or at least do not describe it as a form of para- 
noia: these are Krafft-Ebing, Pelman, Mayser, Morselli, 
Tanzi and Riva, etc. For ourselves, we are fully inclined 
to adopt this latter opinion. The study of the observations 
on dcute paranoia that we have met with in the course of 
our reading, has failed to show a single pathognomonic 
symptom which could in any way show a relationship 
between this acute paranoia and the chronic form, whether 
degenerative or primary. 
On the contrary, it seems to us that this variety is very 
comparable sometimes to certain melancholic states more 
or less accentuated, often with stupor, but sometimes with 
depression or anxiety, and sometimes to states of simple or 
symptomatic maniacal excitement. 
There is still much discussion on the subject of the form 
of insanity called rudimentary, described by Arndt, and the 
type of which is represented by the fixed ideas. The 
ground, as we have seen, upon which these ideas may de- 
velop is much contested ; and on one side certain authors 
approach entirely the fixed ideas of paranoia, distinguishing 
them, however, because of the preservation of conscious- 
ness. Others admit them as a rudimentary form, others as 
a prodromal period, and still others as an episode in the 
course of paranoia. PARANOIA. 
41 
Regarding the secondary form, its existence is indispu- 
table ; but it is only one form of paranoia properly so called, 
and it is only one form of systematized delusion simply sec- 
ondary to some maniacal or especially melancholic states, 
of which it serves as the termination or as a bond of union 
between them and dementia. There remain still the pre- 
tended forms of hysterical, epileptic, and alcoholic paranoia. 
For ourselves, we should wish with Krafft-Ebing to do 
justice and put them under the pathological state of which 
they form a part. It should be remembered, however, that 
certain of these patients are possibly true examples of para- 
noia, and that there may be found among them the co-exist- 
ence of two delusions, that only an attentive observation is 
able to distinguish.* 
* In this connection see also Magnan, Arch Neur., No. I ; Garnier, Gaz. 
hebd., 1880; Dericq, Thesis, Paris, 1886; Krafft-Ebing, ioc. cit. Among the 
works on the subject of paranoia that have come to our knowledge since the com- 
position of this memoir we may cite: Poggi, Riv. sp. di fren., anno x., fasc. 4; 
Guillardi and Tanzi, ibid; L. Bianchi, La Psychiatrica, anno iv., fasc. 3 and 4, 
p. 2 ; G. Zuno, ibid., p. 220; Zenner, The Medical Record, 1887, p. 124 ; P. 
Garnier, J. Falret, Dagonet, Briand, and Cotard.-Discussion on chronic delu- 
sion {Ann. Med.-psych, and Archives de Neur., 1887). 
(From Archives de Neurologic, January, March, and 
May, 1887.)