Abstract

is, not that there never occur cases with manic alone without the reverse condition, but that even in continuous or interrupted exhibition of one phase, the other phase usually (not necessarily) comes to view: that as phases, neither the one nor the other condition is essential to the diagnosis, while both express central pathological nervous conditions cosely allied in nature and easily giving place one to the other. Just as in tuberculosis of the lungs, the disease m’ty express itself in a constant, feverish, tense activity or in continuous, languid, flaccid quietude or again in alternate and contradictory exhibitions of the two opposed varieties of conduct, so in manic-depressive insanity the one or the other phase might continue indefinitely or until death, though some sort of alternation in conduct is the rule. If depression can continue for a year, as it often does, or for five years, or for ten, as it has been known to do, and then give place to manic excitement, it certainly necessitates no change in our conception of the disease if one phase continues for i6 years, or, as in the other rare case reported, for 23 years. W. McD. believing that his