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In Reply.—Ìý Our omission of mania secondary to thyrotoxicosis stems not from any rejection of the possibility of such an entity but rather from our inability to find in the literature a well-described case that lacked confusional symptomatology. Drs Villani and Weitzel's case appears to meet the criteria for secondary mania and thus adds further support to our theory of multiple causation, by providing an example of yet another—this time endocrinological—pathophysiology. It also supports our belief that once secondary mania is given some nosological legitimacy, more cases will be sought and found, adding data for further theoretical and experimental explorations of the causes of mania.