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Their content varies from isolated words to the most complicated discourses. Sometimes the words or phrases are pronounced indistinctly, resembling a faint murmur; at other times they are perceived with remarkable clearness. "It seems to me," patients often say "that somebody is speaking very near me. . . I hear my enemies as well as I hear you." This distinctness largely accounts for their being accepted as real voices, and explains partly the remarkable influence of auditory hallucinations.

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The "invisible ones," as the patients often call the imaginary voices, are sometimes localized with extraordinary precision. 'The insane manifest a power of localization not encountered in other than pathological states." The distance at which they believe they hear the voices is very variable; the voices may be very close by or, on the contrary, hundreds of miles away. Many patients hold the persons that are around them responsible for the hallucinations; thus are explained some of the sudden assaults often committed by such patients. Others ascribe their hallucinations to inanimate objects. One patient accused her needle, another her stockings. Still others lay the blame upon invisible instruments which are used by their enemies (phonographs, telephones, megaphones, etc.).

Like all other hallucinations, those of hearing vary with the nature of the mental trouble: sad in the painful states, agreeable and cheerful in the expansive states. Usually the names by which the patients designate the "invisible ones" are not very choice ones,

1 Wernicke. Loc. cit., p. 205.

consisting chiefly of profane or even filthy expressions. Unpleasant hallucinations may alternate with agreeable ones in the manner of attack and defense, as has already been stated. Sometimes each of the two varieties of hallucinations is perceived by only

one ear.

The voices may repeat the thoughts of the patient, even before he has a chance to express them. "They know before I do what reply I wish to make," said one such patient. Another said: "When I read they read at the same time and repeat every word." Many complain that their thoughts are stolen from them.1

Quite often the voices create neologisms the meaning of which may remain absolutely enigmatical to the patient himself, or to which he may attribute a significance which harmonizes with his psychical state.

The timbre of the voices is very variable. In some cases the patient always perceives one and the same voice; but more frequently many voices are heard: voices of men, women, and children, which are sometimes unknown to the patient, at other times familiar, enabling him to establish the identity of his persecutors.

Although they are encountered in a great many mental affections, acute and chronic, hallucinations of hearing, if they constitute a prominent feature by reason of their multiplicity, distinctness, or intensity, usually point to a grave prognosis. Their occurrence in an acute psychosis often forebodes a particularly long duration of the disease.

1 Bechterew. Ueber das Hören der eigenen Gedanken. Arch. f. Psychiatrie, Vol. XXX.

Hallucinations of sight. - Hallucinations of sight chiefly occur in toxic and febrile deliria and in certain neuroses (hysteria, epilepsy, chorea).

They vary greatly in distinctness. At times they are so clear that the patient is able to make a sketch of them; often they are, on the contrary, vague and uncertain.

Like the voices, the visions are apt to be taken for reality by the subject; he seeks to remove them, to shun them, or on the contrary to seize them. They are in such cases coupled with a more or less marked clouding of the intellect.

Many patients, on the contrary, consider their hallucinations as artificial phenomena. The more conscious and the clearer in mind the patient is, the more apt he is to recognize the difference between the real world and his visions, because, with the exception of the cases in which the consciousness is profoundly disordered, visual hallucinations "seldom bear the appearance of reality." They lack the proper qualities of normal visual sensations: perspective, clearness of contour, variety of tints, etc. Often the morbid image appears in a single plane, hazy in outline, and grayish in color. It is therefore not surprising that, not possessing the attributes of true perceptions, visual hallucinations are often not taken for reality, and do not exercise upon the mind of the patient the same degree of influence as do phonemes.

Some patients consider their hallucinations as shadows or images which they are made to see artificially by means of projecting apparatus, electric currents, etc. Others

1 Wernicke. Loc. cit., p. 194.

attribute them to the pernicious action of poisons which their enemies make them absorb.

Visual hallucinations may take the form, though rarely, of verbal hallucinations of vision. The patients see words and phrases written on tables, walls, etc. A subject of choreic insanity whom I have observed in Joffroy's clinic saw her own name written on her apron. Everybody is familiar with the famous words Mene, mene, tekel, upharsin, which the guests saw appear upon the wall at Belshazzar's feast.

Hallucinations of taste and smell: The senses of taste and smell are as closely associated in pathological states as they are in the normal state. Therefore hallucinations of these senses are usually considered together.

Their clinical significance varies, depending upon whether they coexist with psychic and somatic disorders of an acute nature, or whether they appear in the course of a chronic psychosis.

In the first case they often result from the dryness and the inflammation of the nasal and buccal mucous membranes or glands. They disappear with the disturbances of these glands, and they may be modified very favorably by appropriate treatment. Their importance with regard to the prognosis in, such cases is very slight.

It is altogether different in the second case, when they supervene independently of the above causes in the course of chronic affections. They almost always indicate a profound alteration of the personality and the progress of the mental disorder towards dementia.

Hallucinations of taste and smell are mostly unpleas

ant. The patients complain of nauseating odors; putrid emanations are blown towards them; they are made to eat fecal matter; poisons are poured into their mouth, etc. They make use of certain means of defense, such as spitting, stuffing the nostrils with cotton or paper, and, what constitutes a very grave symptom, refusal of food.

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Hallucinations of touch, of the thermal sense, and of the sense of pain. These are often placed in a single group under the name of hallucinations of general sensibility.

Hallucinations of touch are frequent in certain toxic psychoses (delirium tremens, cocaine delirium), and in chronic delusional states. The patients feel the breath of somebody or the contact of something; they feel as though spiders are crawling upon their bodies, or they may have a sensation of being bound in an entangled mass of cords.

Closely related to the above are hallucinations of the genital sense, which are encountered in neuroses, chiefly hysteria, in mania, and in a great many other acute and chronic psychoses. They consist of either painful or voluptuous imaginary sensations. When they co-exist with perfect mental lucidity they generally indicate a very grave prognosis.

Hallucinations of the thermal sense and of the sense of pain are a feature of chronic delusional states. The patients complain of being burned alive, that their body is being pierced with a red-hot iron, that they are being thrown off from their chair, that they are made to experience shocks like those of electric discharges, etc. Motor hallucinations. A motor hallucination may be defined as an imaginary perception of a movement.

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