the disease. If there is a very intense suicidal tendency, the risks cannot well be obviated in a private house. If there is noise, maniacal excitement, or constant muscular motion, a private house is seldom a proper place for long. In a good hospital for the insane, most of the means of treatment, safety, skilled attendance, regular exercise, a proper mode of life, the administration of food and medicines, can no doubt be best attained, but then there are the counterbalancing disadvantages of the harm to the patient's prospects, from the cruel popular prejudices about asylums, and the patient's own feelings about it afterwards. If you can treat a case out of an asylum, and he recovers satisfactorily, it is better for you and him.

LECTURE II.

STATES OF MENTAL DEPRESSION-MELANCHOLIA

(PSYCHALGIA).

ALL the morbid states of depressed feeling, or, as more commonly expressed, of mental depression, are comprised under the term Melancholia. Like the other symptomatological varieties of mental disease, melancholia does not admit of an absolutely precise definition. In every case there must be mental pain, hence I have suggested as an alternative the term Psychalgia, but then mental pain does not alone constitute melancholia. As man's experience goes in the world at present, mental pain scarcely implies the idea of disease at all. The causes and occasions of mental pain from within and without are so common, as most men are now constituted and situated, that its presence is the rule with many, and its entire absence the exception with most. To constitute melancholia there must be disorder of brain function. A man's finger is squeezed in a vice, and he feels the most intense pain but we do not call that neuralgia. He loses a child or a fortune, and feels intense mental pain, but we do not call it melancholia, because there is no disease. All brain reactions mentally in obedience to adequate causes are simply the exercise of physiological function, but when the reaction is quite out of proportion to the cause, or when the exercise of the activity of the brain induces mental pain of a certain intensity and kind without any outside cause, then we conclude that the mental portion of the organ is disordered, and we say the patient suffers from melancholia. There may be in the case certain excitants wrongly called causes--mental, moral, or physical. The man may have committed crimes, or he may have a badly acting liver, or he

may be very anæmic, and all these things may cause mental pain and depression in a healthy brain, but they will not cause them in that amount and kind to constitute melancholia till his brain convolutions have taken on a disordered action-until their dynamical state is that of disease, not that of health. If a man's heart is depressed in its action from a fright, we do not give this a name implying disease, unless the depression goes on long after the cause has ceased to act. This illustrates, too, the weak points of the method of classifying mental diseases from mental symptoms alone. It is as if in cardiac diseases we should classify them as syncopes, palpitations, and anginas. Therefore, we must always keep in mind, in using such terms as melancholia, that the mental symptoms are not the disease; we must always consciously refer those symptoms to the brain convolutions in the diagnosis and treatment of mental diseases, which are simply brain disorders of different kinds in which the mental symptoms predominate. In assigning causes, we may say that peripheral irritations, anæmias, and moral and mental shocks have caused the disease; but we must clearly keep in mind that the mental symptoms of the disease are caused by the disordered working of the encephalic tissue. If that remains sound in structure and working, no amount of anæmia or moral shock will cause any real mental disease.

States of mental depression are, in some of their forms, of all mental diseases those that are nearest mental health. They shade off by imperceptible degrees into mere physiological conditions of mind and brain. To be able to feel ordinary pain implies an encephalic tissue for the purpose. To be very sensitive to pain implies that the tissue is acutely receptive of impressions. So with mental pain there can be no doubt that the healthy physiological condition of the encephalic tissue in the brain convolutions through which ordinary or mental pain is felt is one between extreme callousness to impressions and extreme sensitiveness. A man in robust health, well exercised, does not feel pain nearly so acutely, and bears it better than when he is weak and run down. Those principles

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apply equally to the feeling and the bearing of mental pain. To experience emotion at all-to feel-implies an encephalic structure for this purpose. The most casual study of the affective capacity in human beings shows us that it differs enormously in different persons. One man will lose his children or his fortune, or see the most terrible sights, and he will not feel keenly at all, because his brain convolutions that subserve feeling are not in their essential nature very receptive and sensitive. Another person will be thrown into very great grief, and feel acute agony, at the loss of a favourite dog. I had a lady patient once, A. A., who would be for days depressed, and suffer mentally, if a friend did not receive her as cordially as usual any day. She suffered mental torture if a relative spoke sharply to her, and she was absolutely paralysed in feeling and volition by the death of a sister. She had several attacks of mild melancholia produced by most inadequate causes, from all of which she recovered quickly and completely. There can be no doubt whatever that the finer moulds of brain are mostly very sensitive, and the poetic, emotional, and sympathetic natures have always been subject to states of painful depression of mind at the critical periods of life, and when the physical vigour was below par. Half the poets and men of literary genius give ample proof in their writings and in the characters they have created or founded on their own experience, that they suffered at times intense mental pain. Goethe clearly looked on a period of melancholy as one phase in the development of genius. The lives and writings of Goethe, Schiller, Carlyle, Cowper, John Stuart Mill, Byron, Burns, and George Elliot show that they all had periods in their lives when they suffered intense mental pain, and at least one of them did actually pass the undefined borderland that separates physiological mental depression from pathological melancholia. To feel intense mental pain is mostly the necessary accompaniment of the capacity to feel intense joy. The brain qualities that give intensity to the one give also intensity to the other.

We must take into consideration in every case not only the sensitiveness and the receptivity, but also the power of bearing pain-the inhibitory power against pain. Some brains possess great sensitiveness and also great power of inhibition. Those are the strong brains, even though their temperament and diathesis may handicap them. But when a brain is sensitive, and has little inhibitory power, this combination is a source of weakness and of disease.

There is a morbid constitution and a temperament which predisposes to mental pain but that does not readily feel intense pleasure, and this is common enough among common men. It does not imply genius or strength in any way, and has no compensating advantages to its possessors. Persons with this tendency are of the nervous variety of the melancholic temperament, or perhaps, more properly speaking, have the melancholic temperament and the nervous diathesis. They are liable to lose their sense of wellbeing from slight causes from within and without them. This surplus stock of animal spirits, and vis nervosa is soon exhausted. They want mental balance and resistive power. They are very often persons with strong unreasoning likes and dislikes, who are swayed by their instincts, and cannot correct and guide those by their reasoning power. They are often morbidly introspective and imaginative, and very often irritable and excitable. Bodily, they do not lay on fat at the ages when fat is physiological; their digestion is not their strong point; when tired they are sleepless.

Such a temperament and diathesis is strongly hereditary, and, I think, is very apt to be derived in the male sex from the mother, and in the female sex from the father. It strongly predisposes to attacks of melancholia as well as to attacks of mental depression in what may be called a physiological form after many bodily diseases. In such persons fevers, lung affections, and cardiac troubles are apt to be accompanied and to be followed during convalescence by mental depression. This is a serious complication in those circumstances, for it retards recovery and tends towards relapses. It is, no doubt,