PARANOIA. 
A Study of the Evolution of System- 
atized Delusions of Grandeur. 
From the Clinical Records of Bloomingdale Asylum, New York. 
William Noyes, M. D., 
by 
Second Assistant in the Bloomingdale Asylum, and 
late Fellow in the Johns Hopkins University. 
Kepriut 
FROM 
THE AMERICAN JOURNAL OF PSYCHOLOGY, 
Baltimore, May, 1888. ElircM" PARANOIA. 
A Study of the Evolution of Systematized 
Delusions of Grandeur. 
From the Clinical Records of Bloomingdale Asylum, New York, 
WILLIAM NOYES, M. D. 
The following case1 presents several features of 
especial interest to the student of systematized delu- 
sional insanity. The slow beginning, the gradually 
increasing systematization, and the evolution of a 
special talent into the most prominent feature of a 
chronic primary insanity, developing in a constitution 
showing original unstable mental equilibrium, make 
it a typical case of Paranoia. 
Mr. G., 42 years of age, has been an inmate of the 
Bloomingdale Asylum since April 30, 1884. He was 
1 This article, under its present title, was prepared for the press and 
in the hands of the editor of this Journal in March, 1887, but a com- 
bination of circumstances has prevented its earlier appearance. At 
the same time the writer made a translation of an article by Dr. 
Seglas on Paranoia, giving an historical and critical review of the 
study of mental degenerations and systematized delusions, with a 
complete bibliography of the literature of systematized insanity. 
This statement is made here to explain the abruptness with which 
the discussion on classification at the end of this paper closes, it 
having been hoped that this article and the translation would 
appear in the same journal, thus making a continuous contribution 
to the study of systematized insanity, hut this has not been found 
practicable. Those interested in the discussion of Paranoia—a term 
to which Dr. Spitzka has given the weight of his authority in the 
edition of his Manual of Insanity in the autumn of 1887—are 
referred to the article Paranoia in the Journal of Nervous and Mental 
Disease for March (fit seq.), 1888. 2 
NOYES: 
born in a New England city, of American parents, and 
his childhood and youth were passed without any 
special sickness or disease save those common to those 
periods of life. As a child he showed an unusual 
fondness for drawing, which was noticed very early 
by a lady friend of the family of some artistic ability, 
and she fostered and encouraged his natural inclina- 
tions by furnishing him with drawing materials and 
showing interest in his progress. 
He attended the public schools of the city and was 
considered unusually bright, gaining special distinc- 
tion in elocution. At 16 he entered the dry-goods 
business in the capacity of clerk, but became discon- 
tented, and after three years came to Hew York and 
studied art. For several years he did work for the 
illustrated weeklies, making comic sketches, illus- 
trating current events, doing lithographic work, and 
employing himself in similar work without gaining 
any special advancement. In 1874 he went to Paris 
and studied art under Gerome, remaining there eight 
years. His life there was full of vicissitudes, and pre- 
sented sudden changes from luxurious living to dire 
poverty. Owing to his bright and witty manners he 
was much sought after by wealthy young men, and 
while entertained by them he lived in much luxury, 
but after their departure he was obliged to exercise the 
most rigid economy, living, as his father expressed it, 
“on a herring and cracker a day.” His life was also 
very dissipated as well as subject to hardship and 
privation. In one of his periods of excess he had an 
attack of mania a potu in which he cut his throat and 
his left arm. He bled freely and his escape from 
death was narrow. From that time he has been a 
total abstainer. An interesting companion, a quick PARANOIA. 
3 
and ready talker, an excellent story-teller, with flashes 
of wit and sharp repartee, he presents a typical exam- 
ple of the artistic temperament with its ready suscepti- 
bilities, its quick sympathies, and its appreciation of 
the beautiful. Yet it is the mere sensuous part of the 
artistic nature that has been cultivated, and no firm 
purpose or high ideal appears to have governed him ; 
and his whole life has been one of fitful changes and 
impotent strivings, ending in failure. A good singer 
and amateur actor, he frequently took part in private 
theatricals, and at one time thought of going on the 
stage, and even played a few weeks with a professional 
company. 
He returned to America from Paris and began work 
again as an illustrator of books and magazines. He 
opened a studio in this city and gave promise of a 
brilliant career; but soon after his return his friends 
noticed a change in his disposition, in a general exal- 
tation of mind and a reckless expenditure of his limited 
means for odd bits of furniture, swords, and bric-a- 
brac for the decoration of his studio. Everything that 
was odd struck his fancy, and he soon came to possess 
a rich collection of curios. The exaltation increased, 
and in the summer of 1883 he was troubled with in- 
somnia that continued for several months, but the 
first positive evidence of mental disturbance came in 
November, when he began giving away his costly 
treasures and breaking up his articles of furniture, 
saying that he had no further use for them. He also 
shaved his head and mutilated his body as acts of 
penance. For ten weeks there was a remission, but at 
no time was he in his normal condition. On the day 
before his admission to the asylum he was boisterous 
and ordered the train to be stopped and asked every 4 
NOTES 
one to take a drink. On admission he professed not 
to remember these actions. The next morning he was 
elated and demonstrative; said, “It is a fine day, 
thank God,” and on passing through a door, turned 
around “ so as to be on the right side with God.” He 
admitted at one time several weeks later that his 
actions had been eccentric, but later denied this, and 
said that he had never been out of his mind, and the 
world would soon see the great work he was to do. 
By the end of June he had ceased to “ thank God ” at 
the end of every sentence, but stated that he still 
thought it. A day or two later he became stupid and 
morose, and being asked the reason, replied “ God 
knows,” and would not answer any questions. The 
second day he became violent, and through the night 
was noisy at intervals, shouting and jumping up and 
down in his bed. The third day he talked excitedly 
and made frequent use of the expression “ thank God.” 
From this point this attack gradually subsided. Before 
the attack he had been reading his Bible diligently, 
and in a few days he resumed this practice and became 
silent and absorbed, reading his own thoughts, as he 
explained later. 
Through the summer he remained quiet and was 
unwilling to converse with his friends, but this condi- 
tion changed in October, when he showed a desire to 
converse on religious subjects, and told the supervisor 
that he expected by constant study to understand 
every word in the Bible, and that although he had 
been told that this was an impossibility without a 
thorough knowledge of the Greek and Hebrew lan- 
guages, yet by faith and study he hoped to attain the 
desired result. 
He was usually very reticent and would only inti- PARANOIA. 
5 
mate that he expected to receive some supernatural 
endowment; stated that he believed the miracles of 
the Bible and that miracles were performed at the 
present day. 
Early in December, or about a year from the first 
appearance of his trouble, another period of exalta- 
tion came on; he laughed at pathetic passages in 
plays ; quoted from Shakespeare and the Bible, to the 
annoyance of his fellow patients ; spoke roughly to the 
attendants ; joined in the religious exercises at chapel 
with more than .his accustomed fervor ; and used the 
expression “ thank God ” the same as on admission ; 
and confessed that he could not resist the impulse to 
sing and shout. At this time there was marked tremor 
of the facial muscles and his left pupil was larger than 
the right. He talked in a loud and declamatory man- 
ner and showed some personal violence. After two 
days this attack began to subside, when he said he 
had been perfectly well, and spoke much of the love 
of God and his trust that everything would be made 
clear to the people here some day.' This attack was 
again followed by a period of depression in which he 
secluded himself, was unwilling to take exercise, and 
was wakeful at night; and at one time was heard to 
say that he wished for some one to kill. A period of 
mild exhilaration followed, in which he spoke much of 
the beauty of the world being due to the goodness of 
God, and became annoying by his frequent quotations. 
His actions became more and more eccentric at this 
time, but were all due to a consistent following out of 
his systematized delusions on religious subjects. He 
would never wear rubbers, giving as a reason that he 
had never done so, but it is almost certain that his 
true reason was that he had no right to protect him- 
self from any weather God sends; stormy weather is 6 
NOYES 
part of the divine plan and we ought to submit to it 
without murmuring. For the same reason he is 
unwilling to wear gloves even in the coldest weather, 
saying that his faith keeps him warm and free from 
disease. If allowed to do so he would keep his window 
open to its fullest extent even during the coldest 
weather, because the pure air of heaven is from God, 
and man therefore cannot be harmed by it. An 
arrangement of his window so that he can open it but 
a few inches he looks on as tyranny and a gross abuse 
of power, but he submits because it is part of his dis- 
cipline. Early in January, 1885, delusions of persecu- 
tion developed for the first time, and he complained 
that some one entered his room at night, and he con- 
cealed a billiard cue to attack his supposed visitor. 
This was accompanied with mental disturbance, and 
he became declamatory and talked of “ God’s bright 
sunlight,” to the annoyance of others. About this 
same time he began to mix dried geranium leaves with 
his tobacco, so that “by the grace of God he might be 
benefited by them. ’ ’ He reproached the house-steward 
for shooting cats, and told him to put a note in the 
basement where the cats would see it stating that the 
cats were no longer wanted here, and “if he only had 
faith of the right sort the cats would no longer trouble 
him.” Soon after this he one day removed a con- 
siderable portion of his clothing, tied a red handker- 
chief about his head and began stamping up and down 
his room. Being asked the meaning of this conduct, 
he shouted, “ Go and read the second chapter of Genesis 
and you will see what the Lord says.” Bearing in 
mind his later ideas of the progress of the Holy Spirit 
from Adam up to Christ, it seems probable that at this 
time he began his spiritual pilgrimage from the garden 
of Eden through the various prophets until he shall PARANOIA. 
finally reach and become part of the Deity. For the 
next few days he remained constantly in his room, 
reading his Bible and making grotesque motions or 
gestures before it in the hope that it might be revealed 
to him. A month later he stated, in reply to questions, 
that he considered himself a martyr and most unjustly 
confined ; that he was perfectly well in spite of his 
queer actions, singing and talking; that he had been 
slandered, and expected to go down to his grave a per- 
secuted being. He now began picking up bits of 
string, stones, tinfoil, tobacco, tallow candles, leaves 
and dirt, jumbling them all together in his pocket. 
They did not appear to be collected from the mere love 
of hoarding a mass of trifles, so often shown by the 
insane, but were saved because everything is of value 
in this world and nothing should be thrown away, for 
to pass such things by showg a neglect of God’s good 
gifts to man. To remove these and to take his Bible 
and fantastic decorations away was to persecute him, 
but he would not complain and would bear it in 
silence as it was part of his discipline. Throughout 
all these gradual changes and evolutions of his fancies 
into systematized delusions the artistic element always 
predominated. Burnt matches, pine cones, sticks and 
stones, were all arranged with his gay-colored hand- 
kerchief into odd fantastic shapes that immediately 
struck the eye on entering his room. In the autumn 
of 1885 there was a return of his delusions of persecu- 
tion, and he said that one of the attendants had put 
an evil eye on him, and that he had seen his physician’s 
eye change from blue to brown. During the succeed- 
ing winter he was inclined to expose himself to cold 
more than ever, and if permitted to do so would stand 
without clothes in his room on the coldest nights with 
windows raised to show that his faith kept him warm, 8 
NOYES 
and in the morning would break the ice in his pitcher 
and take a cold bath. 
Regarding man’s spiritual nature he said that each 
person is being continually worked on by different 
spirits which the normal man is able to hold in check 
and prevent from getting the upper hand, but when 
the spirits once get the control, then the individual 
is completely dominated by them and loses his per- 
sonality. People complain of heaviness of the head 
because, as they say, one hemisphere of the brain is 
not in good condition, but this is all nonsense, for the 
two hemispheres represent the male and female parts 
of the individual, and when the head aches there is 
discord in the household, as in the ordinary troubles 
between man and wife. 
In the summer of 1886 he began a drawing that 
should illustrate the evolution of the Holy Spirit 
through the various Biblical personages, beginning 
with Adam and ending with Christ. This and five 
others that he drew with slight variation, appear to 
represent the complete systematization of his delusions 
and the complete theology that he has evolved through 
his years of study of the Bible. Mythology is mingled 
in with the theology, but to his mind it is an integral 
part of the whole and cannot be separated. His 
description of the diagram is here given, written in 
red ink in the original as typifying the redeeming 
blood of the Saviour. 
Arcana Vitae. 
Baptisms. 
Seals. 
Crosses. Churches of Asia. 
Cain 
Germ 
St. Andrew 
Ephesus 
Flood 
Zodiac 
St. Colomba 
Smyrna 
Sodom a 
Tribes 
St. George 
Pergamos 
Abram 
Aceldama 
St. Michael 
Thyatira 
David 
Holy Stones 
The Prophet 
Sardis 
Babylon 
Prophet 
St. Evangeli 
Philadelphia 
Christ 
Sun 
Boyal Priesthood 
Laodicea PAEANOI A, 
9 
Ezekiel’s Vision by the River Chebor. 
Male Female 
Right Left 
Man Lion Ox Eagle 
Thought Might Cherub Endurance Emulation 
Abr. to Dav. Dav. to Bab. Bab. to X X to Present 
So all the generations from Abraham to David are fourteen genera- 
tions ; and from David until the carrying away into Babylon are 
fourteen generations; and from the carrying away into Babylon 
unto Christ are fourteen generations.—St. Matthew 1st, 17th. 
Progress of the Holy Spirit of the Christ as prefigured in the 
Old Testament. 
Seal of the Germ.—From Adam until the Flood the Holy Seed was 
sifted through man’s nature until it was concentrated in the family 
of Noah. That which was thoroughly beastly perishing in the 
Flood. This period marks the first Sealing of the Soul or first step 
towards the mystical body of Christ. 
Seal of the Zodiac.—From the time of Noah’s descent from the Ark 
until Lot’s flight from Sodom and God’s re-naming of Abram, nature 
strove with the Holy Spirit in man, and God finally gathered the 
Holy Seed into the body of Abram, thereby regenerating him, so He 
re-named him and called him Abraham. Thus transpired the second 
sealing of the soul. 
Seal of the Twelve Tribes of Israel.—From Abraham until the move 
into Egypt is prefigured the third seal of the soul, when man’s 
self-reliance was broken and his spirit made to seek a force greater 
than that within himself. Joseph is here made the bright and 
shining light, the husbandman of all that was great and good. 
Seal of Aceldama, or Bloody Seal.—From Joseph through years of 
cruel servitude and oppression, until the birth of Moses, again rolled 
the seed through man, winnowing itself and gathering force to be 
gathered in the bosom of Moses, the coming leader of the people of 
Israel and servant of God. So God has typified the fourth sealing 
of the soul. 
Seal of the Holy Stones.—From the birth of Moses until the crossing 
of the Red Sea and the destruction of the Egyptian host, passes the 
fifth sealing of the seed and sealing of the soul, God leading his 
people from their religious rites and superstitious observances in 
Egypt, and preparing them for a higher, holier religion. 
Seal of the Prophet.—From the Red Sea to the promised land 
occurs the sixth sealing of the soul. Here was given the law of 
boundaries and limitations, and the soul was turned back upon itself 
and forced to prove the sincerity of its faith and beliefs. 
Seal of the Sun.—From the promised land until the coming of John 
the Baptist and Jesus Christ, passes a period which marks the seventh 
sealing in the existence of the soul. During this period arose many 
prophets who were the spiritual fathers in Christ to the people, 
preparing gradually for the final development of the perfect Christ, 
the Redeemer of all mankind, God’s regent upon earth. 
The soul must pass through all these stages of purification before 
it can enter the Christ, after which it passes into the priesthood of 
Melchizedek. 10 
NOYES: 
Unfortunately, the particular chart on which he. 
illustrated this Progress of the Holy Spirit was 
destroyed. He made twelve of these charts altogether, 
one for each of the tribes of Israel, but he tore up all 
but four, three of which were happily given away, so 
that he has one only in his possession now. During 
the summer and autumn of 1886 he worked several 
months on these charts, elaborating them with the 
greatest care. They were all colored in the most deli- 
cate manner with water colors, and the delicate 
shadings make it extremely hard to give in black and 
white an adequate idea of the beauty of the design. 
Two of these charts are here given, being reproduced 
from photographs. He has made no such elaborate 
description of these as of the first one, but the design with 
the dove in the centre corresponds with some closeness 
to the one whose description has been given. In the 
centre is the dove representing the Holy Spirit, and sur- 
rounding it are the different crosses given in the Arcana 
Vitae, and a close study will show the seven crosses, 
most ingeniously worked together. It is probable that 
in looking at the design closely for the first time one will 
suddenly see a new cross take shape before his eyes, and 
this indeed is what the patient says occurs with him. 
In describing the crosses he will say, for example, that 
in drawing the cross of St. Andrew the lines suddenly 
took a new shape and he found he had also made a 
cross of St. Michael. This to him is a matter of deep 
significance, and he feels that his work is directly con- 
trolled by a higher power, and that the work of his 
fancy is really inspired. 
Outside these central crosses are the names of three 
ancient deities who were each characterized by some 
special attribute, and under these the parts of the PARANOIA. 
11 
body that Mr. G. conceives these deities especially 
to have represented, and then comes the name of 
the Biblical personage in whom these elements were 
finally exemplified and embodied. To the left of 
the dove is Venus, representing Blood, exemplified in 
Moses; above is Osiris, representing Flesh, embodied 
in Adam; and to the right Psyche, representing Water, 
typified in Noah. These three are but the gross and 
material parts of Man, representing indeed necessary 
steps in his progress through life, but secondary and 
subordinate to the higher part of his nature repre- 
sented by Truth and the Spirit,—which received their 
ultimate embodiment in Christ. 
The Lion, denoting Might, and Eagle, signifying 
Emulation, are the same in this design as in the first, 
but it is uncertain just what symbolism is connected 
with the serpent twining about the cross, and the open 
book crossed by a sword and pen, unless indeed this 
last may mean the Bible with the emblems of peace 
and war lying quietly within it, and it seems not 
unlikely that the serpent is emblematic of the Betrayal. 
For the rest of the design, however, we need make no 
inferences, as it corresponds closely with his descrip- 
tion. 
Outside of the circle enclosing the crosses are the 
seals, sealing the Holy Spirit. In the large light 
triangles, or rather rays of the sun, are given the 
names of the twelve apostles, forming the Seal of 
the Prophet. Above these, in the same space, are 
the signs of the zodiac in the extreme points of the 
triangle, with the names of the parts of the body under- 
neath that these signs correspond to in the ancient 
mythology; this forms the Seal of the Zodiac. 
Between these large light colored triangles are the 12 
NOYES 
twelve holy stones, represented as ovals, and with 
their names plainly distinguished in the cut, making 
the Seal of the Holy Stones. In the small triangles 
directly above the Holy Stones are given the names of 
the twelve tribes of Israel, but the color of these in the 
chart (vermilion) is such that the lettering does not 
come out in the photographic negative. This gives 
the Seal of the Twelve Tribes. Directly beneath 
the Holy Stones, filling in the space between the 
bottom of each large triangle, is the Seal of the Germ, 
colored dark green, and running down on each side of 
the top of these large triangles are small triangles, 
colored dark red and forming the Seal of the Acel- 
dama or Bloody Seal. On the circumference are the 
names of the constellations of the zodiac and directly 
under these the names of the corresponding months of 
the year, and under these again are the mythological 
representations of the constellations, Leo (July) being 
at the top, and then in order to the right come Virgo 
(August), Libra (September), Scorpio (October), Sagit- 
tarius (November), Capricornus (December), Aquarius 
(January), Pisces (February), Aries (March), Taurus 
(April), Gemini (May), Cancer (June). This gives the 
last sealing of the Seed, the Seal of the Sun. 
It will be seen that beginning at the circumference 
at any point and going toward the centre there is a 
complete astronomical representation of the season of 
the year, first the name of the constellation, then in 
succession the month, the constellation depicted pic- 
torially, the sign of the zodiac and the part of the 
human body corresponding in the old astronomy to 
this sign of the zodiac. 
The second chart is by no means so elaborate as the 
first. In the centre is a representation of St. George PARANOIA. 
13 
slaying the dragon, and surrounding this, beginning 
at the left, are inscribed the legends Faith, Hope, 
Charity, Love. Here again the colors in the original 
are such that the lettering does not come out well in 
the photographic negative. 
After finishing these symbolic religious charts, Mr. 
G. had a long period of inactivity, giving up painting 
and drawing completely, and spending much time in 
reading the Bible. During these inactive periods he 
lies down a great deal of the time, lying flat on his 
back and looking upward ; and he often has a cane or 
some small article in his hand that he twirls or tosses. 
This inactive period lasted for several months, when 
he again took up his artistic work, this time modeling 
in wax. After making several small designs he began 
and completed two large representations of Comedy and 
Tragedy, illustrations of which are given from photo- 
graphs of the plaster casts given to the writer. His 
passion for the odd and fantastic is here again well 
exemplified. 
An excellent conception of his mental twist can be 
obtained from a description of his room, for here his 
fancy has been given full play and he has been per- 
mitted to decorate this as he chose. Over the inside 
of the door hangs a curtain on which are stitched 
various designs cut out of red cloth. The curtain is 
made of three pieces of gray, yellow and red flannel, 
and in the centre is the word CHARITY, with a sword 
piercing it through the centre. Below this is Fortune’s 
wheel, and under this three turtles. On the upper 
third is a dragon, with a full moon in the left hand 
corner, and the designer’s initials woven fantastically 
together. A bat with outstretched wings is on either 
side of the centre design. 14 
NOYES 
Behind this curtain several months ago, but since 
taken down, he had placed a horse-shoe to which was 
attached a small chain, through which passed a piece 
of bamboo on one end of which was a piece of castor 
and on the other several bits of wire. These, as is the 
case with everything he thus puts up, all had some 
symbolic meaning, but he took offense if they were 
ever alluded to. 
On the outside of the door is tacked up a circle cut 
from thin wood with a scroll saw. At the four quad- 
rants of this the circumference is broken by the pro- 
jection of a portion of the wood in such a way that 
the four together form the ends of a Greek cross; but 
instead of the cross being continued through the circle, 
the interior of this is taken up with an elaborate 
design, delicately sawed out, in which is woven the 
letters a and w, alpha and omega. The design is brought 
out clearly by being placed over red paper, and a little 
red paper triangle is placed at each end of the cross, 
thus forming a cross of a different kind. 
On the head-board of the bedstead he has placed a 
circle carved out of soft wood and with the rays 
gilded to represent the sun ; and in the centre of this 
in a somewhat intricate design are the symbols a and 
to again, alpha and omega. This emblematic sun 
comes directly above his head when lying down. (In 
photographing this the camera had to be placed at the 
side so that the circle is distorted.) 
His bureau is always arranged with the most scrupu- 
lous exactness, every article having its particular 
place. When the photograph of the bureau was taken 
there were not so many trifles on it as there have been 
at other times, but the illustration shows well the 
systematic order in which everything is placed, and PARANOIA. 
15 
on this occasion no special arrangement had been made, 
but it was in its usual condition. 
While in his room he wears a green soft felt hat 
decorated with a feather and his modeling stick, and 
on leaving his room this is always placed over his 
water pitcher as shown in the cut. There are much 
fewer articles on the hat now than in the summer of 
1886, when he had covered the hat with the following 
articles : two steel watch chains, nine buttons, a child’s 
toy tin spoon and plate, part of a suspender buckle, 
two brass covers to cachou boxes, one ladies’ rubber 
hair pin, one necktie clasp, two brass labels from a 
fruit jar; the point of the hat was surrounded with a 
large steel ring, and the edge was turned up at the 
back and tacked to the hat with a fancy Japanese 
button. The green ball on the bureau, over which the 
steel ring is placed, was formerly in the crown of 
the hat. 
At this time he was wearing a pair of sandals (origi- 
nally suggested for surgical reasons), and he never 
left his room without placing these sandals in his room 
and standing his clothes brush on them at a certain 
angle. 
The light felt hat shown in the cut he has at present 
discarded, wearing only the green one ; the decorations 
on this light hat approach somewhat those formerly 
on the green one. 
On the window casing he has fastened some feathers, 
a tooth-brush handle, one of his modeling sticks and 
a rubber hair pin, all secured together by a pair of 
confectioner’s tongs. Any disturbance of the articles 
in his room, or any comment on them, greatly dis- 
tresses him and he gives an abrupt answer and turns 
the subject, and with the exception of the medical 16 
NOYES 
staff and the attendant who cares for the room, no one 
enters it. 
The fall and winter of 1887-88 were marked by no 
artistic efforts on his part, but during the spring he 
took up his painting and carving and now (April 1888) 
he does some work each day. He has just finished a 
series of 12 water color sketches, and seven of these 
are here given to show in some degree his high artistic 
ability. Of the six represented in one group, the one 
in the upper left hand corner is The Wolf Slayer, 
then comes Puck, then Shechinah or The Light of 
Love, Shechinah meaning to the Jews that miraculous 
light or visible glory which was a symbol of a divine 
presence. In the circle in which the S is elaborately 
drawn is also the word Abba, Father. Of the three 
lower ones the one at the left is St. Michael, the next 
One of the Fates, and the last the angel Sandalphon, 
with the Holy Grail at the side, and the letters Alpha 
and Omega at the top (the design must be inverted to 
make out the Omega.) 
The coloring on all of these is delicate and harmoni- 
ous, but none of them equal in grace the picture of 
Luna ; the background of this is a delicate blue, and 
the effect of the light and graceful floating figure is 
very striking. This was the last of the series of twelve 
to be finished and the one that he takes most pride in. 
While working on these sketches he made at the 
same time the design for a book-plate, representing 
Cupid learning the alphabet, and the entire design, 
he says, is full of symbolism—a favorite word. Cupid 
has his finger on Alpha, signifying the beginning of 
his education; above the book is Cupid’s target with 
a heart for the centre, that he has pierced with an 
arrow, while the full quiver stands to the right. The PARANOIA. 
17 
curious fish under the Veritas represents the ixgys 
of the early Christians, while three crosses symbolic 
of the Christian religion are in the upper left hand 
corner, brought out by heavy shading of the cross 
lines. On the book of knowledge is perched the dove, 
emblematic of purity, while the olive branch at the 
left of the book and the palm under the Fool’s Bauble 
give still other religious symbols. The lamp of knowl- 
edge is burning brightly in front of Cupid, while at 
his feet are the square, compass, triangle and pencils, 
symbolizing the designer’s profession. 
In appearance he is of medium height, well formed 
and muscular ; light hair, which he keeps cut close to 
his head ; and light moustache ; his head is short and 
round, with hut little occipital protuberance. The 
most striking peculiarity is the decided asymmetry of 
the face that is noticeable at first glance. The right 
eye and eye-brow are higher than the left, and also 
the right side of the mouth, and when he laughs this 
is especially noticeable. The nose, which is well formed 
and large, deviates slightly to the left. The left ear 
is smaller than the right and lies close to the head, 
while the right turns outwards. The whole right side 
of the head appears larger than the left, and this is 18 
NOYE8 
shown by the accompanying map of his skull taken 
by a hatter. There is a wide range of normal varia- 
tions in skulls, but in the present instance it seems not 
unfair to connect this with the other evidences of 
asymmetry. In walking his head is invariably tipped 
toward the left shoulder, and in addition his hat is 
tipped still further to the left, so that the one-sided 
appearance is very noticeable. Besides these peculi- 
arities he carries his left hand in his trousers pocket in 
summer and in his overcoat pocket in winter, while 
he swings his right arm vigorously to and fro. It 
should be said, however, that when he had mania a 
potu in Paris he cut his left hand badly, and in conse- 
quence the fingers of that hand are somewhat con- 
tracted and the circulation is poorer than in the other, 
which may account in part, if not wholly, for his habit 
with respect to carrying it. 
His mental condition at present is one of mild exalta- 
tion. He whistles and sings some, but not enough to 
cause annoyance. For a time he discontinued work on 
the drawings of the Arcana Vitae and began carving 
some designs on the outside of a wooden chopping- 
bowl. On two sides appears the sign I H S woven 
together into a monogram and surrounded by rays 
representing the sun; and in another place A M for 
Alma Mater and Alpha and Omega, the M being 
reversed into W. Other symbolical designs are drawn 
on the sides of the bowl, and he spent several hours 
each day carving. His present work is the carving 
of another wooden bowl, with a lion’s head in the 
centre and the legend Pro rege in tyrannos surround- 
ing this, with elaborate tracery designs on the sides. 
He is perfectly willing to stay in the institution because 
this is part of his discipline and he must take the good PARANOIA. 
19 
and bad alike. Insanity is only a relative term, he 
says, and every one has to pass through a condition in 
which they are what is commonly called insane, but 
it is all for their own good and they must not question 
the designs of Providence. When the time comes for 
him to go out he will go, he says, and until then is 
perfectly willing to remain. To the ordinary observer 
he appears to be a bright, intellignt man ; somewhat 
given to oddities of dress to be sure, but without the 
striking peculiarities of speech and manner that the 
laity expect in a case of mental disease. There is but 
little mental enfeeblement, and none that would be 
noticed in an ordinary conversation, but he is unable 
to apply himself continuously, and months at a time 
may go by without his lifting a pencil or brush. He 
is bright and interesting in conversation, and a capital 
mimic. He recognizes the delusions of other patients 
and often tells of them with much enjoyment. 
A few words only need be said as to the place the 
case should occupy in any scheme of classification of 
mental diseases. The slow and progressive course, the 
original mental twist in the direction of the odd and 
fantastic in art, the cranial anomalies, the evolution 
of systematized delusions, and the periods of delirious 
grandeur followed by morbid depression, make it a 
typical case of Primcire Verrucktheit of the German 
authors, or of Paranoia of the Italian and French 
school; or of the Monomania, Primary Monomania, 
or Primary Insanity of the American and English 
writers. Of all these terms that of Paranoia is much 
to be preferred, and it is hoped that this word may 
find a definite place in the classification of mental 
diseases. 
Press of Isaac Friedemoald, Baltimore. GOOD COD- 
GOOD - RIGHT- 
GOOD DRV- 
GOOD mORROW