periodicity of the generative power and desire in their greatest intensity.

Another well-marked characteristic was this, that a hereditary predisposition to mental disease, or at least to some of the neuroses, was present in 77 of the 180, or in 45 per cent, of the whole number. It is very difficult to get family histories of insanity in most cases, and you may multiply by two those you get, if you want an approach to the truth. Our proportion of hereditary predisposition in the asylum, as recorded in our case books, is only 23 per cent. as compared with the 45 per cent. among the adolescents, in whose cases no special pains had been taken to ascertain family histories. I observed a still more striking fact in regard to the heredity of the insanity of adolescents. I happened to have a personal knowledge of the history of the cases or of the families in fifteen of the cases, and in twelve of these there was a hereditary predisposition to the neuroses. The insanity of adolescence is therefore predisposed to in most cases by a nervous heredity, being one of the most hereditary of all forms of mental disease.

Another marked character of the mania was that the ideas, emotions, speech, and conduct were all strongly tinctured by the mental characteristics of adolescence in an exaggerated or morbid way. That perversion of the sexual act, the habit of masturbation, was very common, probably existing in over 50 per cent. of the cases, aggravating the symptoms, and diminishing the chances of recovery. In the females hysterical symptoms were common, such as mock modesty, simulated pains, and a desire to attract attention. In the males beroic notions, an imitation of manly airs and manners, an obtrusive pugnaciousness, and sometimes a morbid sentimentality were present. In almost all the cases the physical appearance of the males was boyish when the attack commenced; and most of the females were girlish rather than womanly in contour.

As regards the results of treatment in those cases, 93 were discharged recovered, or 51 per cent. ; but then 40 were removed home or to other institutions relieved, many of whom

,

I would have been likely to recover ultimately. I only know of 26 of the 180 who became incurable. Insanity occurring at the adolescent period is therefore a very curable disorder, as compared with many other forms, though not so curable as some others, e.g., puerperal insanity. Just before recovery, in almost all the cases which did get well, signs of physiological manhood appeared, the beard growing, the form expanding, the weight increasing. Whenever I see those signs, accompanied by mental improvement, I am inclined to give a favourable prognosis. The mortality was very low, only three of the 180 cases having died.

LECTURE XVII.

CLIMACTERIC INSANITY.

SENILE INSANITY.

As unstable brains are apt in certain cases to be upset in their mental functions by the oncoming of the reproductive power and the sexual desire at the periods of puberty and adolescence, so they are apt to suffer as those great powers of the organist pass away at the climacteric period. An animal has functionally and physiologically three distinct periods of existence(1) when its life is dependent on that of its mother before birth; (2) when it lives independently, but cannot reproduce itself, before puberty and after the climacteric; and (3) when it both lives and can reproduce. The mental function is non-existent in the first period, more or less imperfect in the second, and fully developed in an ideal sense only in the third. At th period of the climacteric there is unquestionably a norma mental change in both sexes. The sexual desire invariaby weakens in its intensity or ceases altogether, and with it the affectiveness changes in its object and greatest intensity from the mate to the progeny, losing its imaginative force, its fire, and its impulsiveness. Poetry and love tales then cease to have the power "to set the brain on fire." Action of all kinds ceases to be so pleasurable for its own sake as it has bee before. Much of "the go is out" of the person. The instinctive feeling of difference of sex, and all that it implies, which has been all-pervading before, now lessens visibly. The subtil interest of the society of the other sex is less electric and overmastering. Along with these affective changes there are bodily changes too. The form alters, especially in women, and the expression of face changes, the ovaries shrivel, Peyer's patches

lessen in bulk, and the spleen and lymphatic glands harden. The blood-forming and the blood-using processes slacken in speed, and the trophic energy in all the tissues is less intense in action. "Life becomes slower," in fact, mentally and physically. And as a result of this, after the climacteric has been safely passed, the organism is less liable to many diseases than it has been before. The real climacteric period in both sexes is never a definite fixed time, but usually extends over a year, or two, or three. The mere cessation of the function of menstruation in women does not necessarily fix definitely the mental and nutritional changes that mark the period. I have known a woman of 50 who had gone through the mental changes of the climacteric yet in facial expression and in shape was post-climacteric, who had no sexual desire, yet was menstruating regularly; and, on the other hand, I have known many women of the same age, in whom menstruation had ceased from 40 to 46 who were yet quite shapely, amorous, and mentally youthful. So the mental disease that accompanies the climacteric need not be quite coincident with the menopause, but may occur some time before or some time after that event. As a matter of fact, the ordinary sensory nervous symptoms that are connected with the climacteric in women, viz., giddiness, flushings, flashes of light, uneasy organic sensations, usually precede the actual cessation of the menses rather than accompany it.

A typical case of climacteric insanity begins by a loss of energising power, bodily and mental, of which the patient is rather supersensitively conscious. Her courage fails; little things come to have the power of annoying her that she would have thought nothing of before. Groundless fears, which at first she knows to be groundless, haunt her at times. And at this stage the sleep is apt to be dreamy and broken, the appetite for food is less intense, and the bowels costive. There is apt to be some falling off in freshness of the complexion and in looks generally. The skin often gets muddy, and more pigmented than usual. It is a trouble for her to go into company or to move about in public, and yet she has no restful feeling and no

contentment or organic happiness. At the menstrual times all these things are much worse, and there is apt to be real depression of mind, weeping, with irritability of temper and sleeplessness. I have never yet met with a climateric ease in this early stage who did not feel much better in the open ar than in the house. That is an indication of treatment and of prevention of further symptoms that I never fail to find useful I have seen iron at this stage too do very much good; in fact, it seemed to act as a specific. But those symptoms do not constitute insanity, though they are essentially mental disorder.

The next stage consists of more real and continuous depres sion. The morbid fears assume a more intense character, though they are often still indefinite. The patient is quite sure some evil thing is going to happen to her, though she cannot tell what it is to be. The self-control is often lost, but much more frequently the patient is terrified that it is going to be lost. There are vague impulses towards suicide, sometimes towards hurting husband and children, and the existence of those add to the terror and intensify the depression. Such things are thought by the patient to be "so wrong," and she blames herself for them. A conscious loss of affection, or rather a loss of the pleasurable feeling that conscious affection for husband and children gives, is a cause of the greatest distress. There is often a sort of organic repugnance to the husband and to his attertions. By this time all the usual sensory accompaniments of the climacteric have disappeared, or rather they have been trans formed into the mental neurosis I am describing. There are no headaches, or giddiness, or flushings. But the trophic neurosis become aggravated all the time. The thinness, the flabbiness of muscle, the pigmentation of skin, get worse. There are fre quently skin irritations, and the patient picks and scratches her skin. The bowels are costive, the appetite gone, the sleep absent, and the capacity for work greatly lessened.

In the worst cases suicidal feelings are strong and attempts frequent, but they are rather apt to be feeble. The very loss of courage and vigour of will operate against any effectual