lieves that he is determining them with consummate foresight and skill. A well-grounded and comprehensive theory of mind must recognize and embrace these facts; they meet us every moment of our lives, and cannot be ignored if we are in earnest in our attempts to construct a mental science; and it is because metaphysical mental philosophy has taken no notice whatever of them, because it is bound by the principle of its existence as a philosophy to ignore them, that, notwithstanding the labor bestowed on it, it has borne no fruits-that, as Bacon said of it, "not only what was asserted once is asserted still, but what were questions once are questions still, and, instead of being resolved by discussion, are only fixed and fed."

LECTURE III.

GENTLEMEN: In my last lecture I showed how large a part in the production of insanity is played by the hereditary neurosis, and pointed out the necessity of scrutinizing more closely than has yet been done the features of the different forms of mental derangement that own its baneful influence. Past all question it is the most important element in the causation of insanity. It cannot be in the normal order of events that a healthy organism should be unable to bear ordinary mental trials, much less a natural physiological function such as the evolution of puberty, the puerperal state, or the climacteric change. When, therefore, the strain of grief or one of these physiological conditions becomes the occasion of an outbreak of insanity, we must look for the root of the ill in some natural infirmity or instability of nerve-element. Not until we apply ourselves earnestly to an exact observation and discrimination of all the mental and bodily conditions which coöperate in the causation, and are manifested in the symptoms, of the manifold varieties of insanity, shall we render more precise and satisfactory our knowledge of its causes, its classification, and its treatment. How unscientific it appears when we reflect, to enumerate, as is commonly done, sex and age among its predisposing causes! No one goes mad because he or she happens to be a man or a woman, but because to each sex, and at certain ages, there occur special physiological changes, which are apt to run into pathological effects in persons predisposed to nervous dis

order. How often it happens that a moral cause of insanity is sought and falsely found in a state of mind such as grief or jealousy, which is really an early symptom of the disease! Again, how vague and unsatisfactory the accepted psychological classification of insanity, under which forms of disease distinct enough to claim separate descriptions are included in the same class! It is obvious that we learn very little of value from an account of the treatment of mania generally when there are included under the class diseases so different as puerperal mania, the mania of general paralysis, syphilitic, epileptic, and hysterical mania, each presenting features and requiring treatment in some degree special. The hope and the way of advance in our knowledge of mental disorders lie in the exact observation of the varieties of the insane diathesis, and of the effects of bodily functions and disorders upon these; in noting carefully the bodily as well as mental symptoms that characterize the several forms of derangement of mind; and in tracing the relations of mental to other disorders of the nervous system. We must aim to distinguish well if we would teach well-to separate the cases that exhibit special features and relations, and to arrange them in groups or classes according to their affinities, just as we do habitually with general paralysis, and as I did in my last lecture with epileptic mania.

Following this plan, we might in like manner make of hysterical insanity a special variety. An attack of acute maniacal excitement, with great restlessness, rapid and disconnected but not entirely incoherent conversation, sometimes tending to the erotic or obscene, evidently without abolition of consciousness; laughing, singing, or rhyming, and perverseness of conduct, which is still more or less coherent and seemingly wilful-may occur in connection with, or instead of, the usual hysterical convulsions. Or the ordinary hysterical symptoms may pass by degrees into chronic insanity. Loss of power of will is a characteristic symptom of hysteria in all its Protean forms, and with the perverted sensations

and disordered movements there is always some degree of moral perversion. This increases until it swallows up the other symptoms: the patient loses more and more of her energy and self-control, becoming capriciously fanciful about her health, imagining or feigning strange diseases, and keeping up the delusion or the imposture with a pertinacity that might seem incredible, getting more and more impatient of the advice and interference of others, and indifferent to the interests and duties of her position. Outbursts of temper become almost outbreaks of mania, particularly at the menstrual periods. An erotic tinge may be observable in her manner of behavior; and occasionally there are quasiecstatic or cataleptic states. It is an easily-curable form of derangement if the patient be removed in time from the anxious but hurtful sympathies and attentions of her family, and placed under good moral control; but, if it be allowed to go on unchecked, it will end in dementia, and it is especially apt to do so when there is a marked hereditary predisposition.

In some instances we observe a curious connection between insanity and neuralgia, not unlike that which, existing between epilepsy and a special form of neuralgia, induced Trousseau to describe the latter as epileptiform. I have under observation now a lady who suffered for some time from an intense neuralgia of the left half of the face; after the removal of a tooth suspected to be at the root of the mischief the pain ceased, but an attack of melancholia immediately followed. Griesinger mentions a similar case of a gentleman under his care, in whom a double occipital neuralgia was followed by a melancholic state of mind. In his "Commentaries on Insanity," Dr. Burrows tells of a very eloquent divine who was always maniacal when free from pains in the - spine, and sane when the pains returned to that site. And the late Sir B. Brodie mentions two cases of a similar kind: in one of them a neuralgia of the vertebral column alternated with true insanity. These cases appear to be instances of the transference of morbid action from one nerve-centre to

on.

another, such as Dr. Darwin formerly noticed and commented "Mrs. C―," " he says, 66 was seized every day, about the same hour, with violent pain in the right side of her bowels, about the situation of the lower edge of the liver, without fever, which increased for an hour or two, till it became quite intolerable. After violent screaming she fell into convulsions, which terminated sometimes in fainting, with or without stertor, as in common epilepsy; at other times a temporary insanity supervened, which continued about half an hour, and the fit ceased." It seems not unreasonable to suppose that the morbid action in the sensory centres, which the violent neuralgia implied, was at one time transferred to the motor centres, giving rise to convulsive movements, and at another time to the mind-centres, giving rise to convulsive ideas. There is a form of neuralgia which is the analogue of a convulsion, and there is a mania which is the counterpart, in the highest nerve-centres, of neuralgia and convulsions in their respective centres. Perhaps if we had the power in some cases of acute insanity to induce artificially a violent neuralgia, or general convulsions-to transfer the morbid action from the mind-centres-we might, for the time being at any rate, cure the insanity.

I pass on now to exhibit the effects of organic sympathies in the causation of mental disorders, or rather the specific effects of particular organs upon the features of different forms of insanity. In my first lecture I pointed out that there is the closest physiological consent of functions between the different organs; that the brain, as the organ of mind, joins in this consent; and that our ideas and feelings are obtained by the concurrence of impressions from the internal organs of the body and the external organs of the senses. The consequence is, that derangement of an internal organ, acting upon the brain, may engender, by pathological sympathy, morbid feelings and their related ideas. The mental effects may be general or specific: a general emotional depression through which all ideas loom gloomy, of which