of insanity. One group might consist of those egotistic beings, having the insane neurosis, who manifest a peculiar morbid suspicion of everything and everybody; they detect an interested or malicious motive in the most innocent actions of others, always looking out for an evil interpretation; and even events they regard as in a sort of conspiracy against them. Incapable of altruistic reflection and true sympathies, they live a life of solitude and self-brooding, entrenched within their morbid self-feeling, until the discord between them and the world is so great that there is nothing for it but to count them maḍ. Another group might be made of those persons of unsound mental temperament who are born with an entire absence of the moral sense, destitute of the possibility even of moral feeling; they are as truly insensible to the moral relations of life, as deficient in this regard, as a person colour-blind is to certain colours, or as one who is without ear for music is to the finest harmonies of sound. Although there is usually conjoined with this absence of moral sensibility more or less weakness of mind, it does happen in some instances that there is a remarkably acute intellect of the cunning type. The observations of intelligent prison surgeons are tending more and more to prove that a considerable proportion of criminals are weak-minded or epileptic, or come of families in which insanity, epilepsy, or some other neurosis exists. Mr. Thompson, surgeon to the General Prison of Scotland, has gone so far recently as to express his conviction that the principal business of prison surgeons must always be with mental defects or disease; F that the diseases and causes of death among prisoners are chiefly of the nervous system; and, in fine, that the treatment of crime is a branch of psychology. He holds that there is among criminals a distinct and incurable criminal class, marked by peculiar low physical and mental characteristics; that crime is hereditary in the families of criminals belonging to this class; and that this hereditary crime is a disorder of mind, having close relations of nature and descent to epilepsy, dipsomania, insanity, and other forms of degeneracy. Such criminals are really morbid varieties, and often exhibit marks of physical degeneration-spinal deformities, stammering, imperfect organs of speech, club-foot, cleft palate, harelip, deafness, paralysis, epilepsy, and scrofula. Moreau relates a striking case, which is of interest as indicating the alliance between morbid or degenerate varieties, and which I may quote here. His Mrs. D, aged thirty-two. Her grandfather kept an inn at the time of the great French Revolution, and during the Reign of Terror he had profited by the critical situation in which many nobles of the department found themselves to get them secretly into his house, where he was believed to have robbed and murdered them. daughter, who was in his secrets, having quarrelled with him, denounced him to the authorities, but he escaped conviction from want of proofs. She subsequently committed suicide. One of her brothers had nearly murdered her with a knife on one occasion, and another brother hanged himself. Her sister was epileptic, imbecile, and paroxysmally violent. Her daughter, the patient, after swimming in the head, noises in the ears, flashes before the eyes, became deranged, fancying that people were plotting against her, purchasing arms and barricading herself in her room, and was finally put in an asylum. Thus there were, in different members of this family, crime, melancholia, epilepsy, suicide, and mania. Need we wonder at it? The moral element is an essential part of a complete and sound character; he who is destitute of it, being unquestionably to that extent a defective being, is therefore on the road to, or marks, race degeneracy; and it is not a matter of much wonder that his children should,. when better influences do not intervene to check the morbid tendency, exhibit a further degree of degeneracy, and be actual morbid varieties. I think that no one who has studied closely the causation of insanity will question this mode of production. I could not, if I would, in the present state of knowledge, describe accurately all the characteristics of the insane neurosis, and group according to their affinities the cases testifying to its influence. The chief concern now with its morbid peculiarities is to point out, first, that they mark some inherited fault of brain-organization; and, secondly, that the cause of such fault is not insanity alone in the parent, but may be other nervous disease, such as hysteria, epilepsy, alcoholism, paralysis, and neuralgia of all kinds. Except in the case of suicidal insanity, it is not usual for the parent to transmit to the child the particular form of mental derangement from which he has suffered: insanity in the parent may be epilepsy in the child, and epilepsy in the parent insanity in the child; and in families where a strong tendency to insanity exists, one member may be insane, another epileptic, a third may suffer from severe neuralgia, and a fourth may commit suicide. The morbid conditions which affect the motor nerve-centres in one generation seem to concentrate themselves sometimes upon the sensory or the ideational centres in another. In truth, nervous disease is a veritable Proteus, disappearing in one form to reappear in another, and, it may be, capriciously skipping one generation to fasten upon the next. The different forms of insanity that occur in young children-as all forms of it except general paralysis may do-are almost always traceable to nervous disease in the preceding generation, a neuropathic condition being really the essential element in their causation. The cases of acute mania in children of a few weeks or a few years old which have been described might more properly be classed as examples of idiocy with excitement. There can be no true mania until there is some mind. But we do meet sometimes in older children with a genuine acute mania, occurring usually in connection with chorea or epilepsy, and presenting the symptoms, if I may so express it, of a mental chorea or an epilepsy of the mind, but without the spasmodic and convulsive movements of these diseases. More or less dulness of intelligence and apathy of movement, giving the seeming of a degree of imbecility, is common enough in chorea, and in some cases there is violent delirium; but, besides these cases, there are others in which, without choreic disorder of movements, there is a choreic mania; it is an active delirium of ideas which is the counterpart of the usual delirium of movements, and its automatic character and its marked incoherence are striking enough to an ordinary observer. Hallucinations of the special senses, and loss or perversion of general sensibility, usually accompany the delirium, the disorder affecting the centres of special and general sensation, as well as the mind-centres. Between this choreic mania and epileptic mania there are intermediate conditions partaking more or less of the character of one or the other-hybrid forms of a cataleptic nature. The child will lie for hours or days in a seeming ecstasy or trance, with its limbs rigid or fixed in a strange posture. There may be apparent insensibility to impressions, while at other times vague answers are given, or there is a sudden bursting out into wild shrieks or incoherent raving. If this be of a religious kind, the child is apt to be thought by ignorant persons to be inspired. The attacks are of variable duration, and are repeated at varying intervals. On the one hand they pass into attacks of chorea; and, on the other hand, into true epileptic seizures, or alternate with them. In children, as in adults, a brief attack of violent mania, a genuine mania transitoria, may precede, or follow, or take the place of an epileptic fit; in the latter case being a masked epilepsy. Children of three or four years of age are sometimes seized with attacks of violent shrieking, desperate stubbornness, or furious rage, when they bite, tear, kick, and do all the destruction they can; these seizures, which are a sort of vicarious epilepsy, come on periodically, and may either pass in the course |