intellect can carry them. Need we teel surprised that the true pathology of insanity is unknown? What we desiderate is a careful scrutiny of the organ. Hitherto the difficulties of such an investigation have been insurmountable, in consequence of our imperfect methods of research. But let any one possessing a competent knowledge of histology and the use of our best microscopes with the opportunities our large asylums offer, only now dedicate himself to the task, and he may be assured that while extending the bounds of science he will certainly obtain an amount of fame and honour that few can hope to arrive at."

102. Bodily Organism and Mental Function.-With regard to what has been done in this science of pathology we must be content to say very little in this place. But the recognition of the general principles stated above is necessary to the understanding of a complete system of medical jurispru dence of insanity. Further, in explanation of the statement that frequently 18insanity exists in cases where post-mortem examination can reveal no organic lesion, it is well to remember that pathologists are agreed that in most cases where changes are observable they are due to a long-continued exaltation of action in the part to which they have given the name irritation. Abnormal vital action then produces derangement in the functions of the organ in which it occurs, and does not, at the same time, produce any discernible change in its appearance. Often we might as well try to discover a change in the hand of an artist, indicative of the exaltation of function which is called skill, as endeavor to find any physical indications of the abnormality of function which is designated disease. But that a change has taken place is surely a perfectly fair inference. We cannot see or feel the imponderable ether which is in space and which is the medium for the transmission of light and heat, but we believe in its existence. So it is with those minute changes which have taken place in the organism. One thing is to be remembered, and that is, that there is a perfect parallelism between insanity and other diseases. In its causes, its rise,

Lectures on Molecular Physiology, Pathology, and Therapeutics. Lecture iv., Lancet, April 25, 1863.

its progress, in its termination in death in chronic disease or in cure, it exactly resembles any ordinary bodily disorder. In its possible modification by the use of drugs, and even in the possibility of its being influenced by the mental impressions of the individual, there is much that is common between it and ordinary physical disease. Its inception is generally marked by sleeplessness, sometimes by pain or heat in the head, and not unfrequently by a considerable alteration in the feelings and emotions of the individual affected.

103. Mania: its Symptoms. It is evident that what would be a rational belief to one man would be a delusion to another. That conduct which would be indicative of insanity in one man would be indicative of mental health in another, and this fact does not depend upon the mere accidental differences of rank, position, or means, but upon actual difference of mental constitution. A man's thoughts in health bear a certain relation to his environment, and that relation is not the same in any two men. One loves to live in the dusty atmosphere of a museum, while another enjoys risking his life in climbing the Matterhorn. One man finds pleasure in dancing, and another only feels happy when he is beside running brooks which murmur through a green country braided with hawthorn hedges. Yet, notwithstanding this wonderful variety, there is a persistent unity. Although each thinks that his neighbor's enjoyments are absurd, yet each is in reality influenced by the same motives, although they are connected with different objects in the world of sense. The past life of each has an influence on and determines the flow of energy in the present. The man who loves dancing probably does it well; everybody acknowledges that he does it well. And this is one of the reasons why he likes it. The exercise of skill is pleasant in itself; the association with persons of the other sex; the rapid motion; the adaptation of motion to the rhythm of the tune-all these are ordinary motives. The man who climbs the Jung-Frau is influenced by exactly similar considerations; he likes to be talked about. To be thought bold is pleasant. Then he may have got to the top first, or before some others of his party, or in a shorter time than any one who has been up this year. The exertion

itself and the consciousness of having overcome difficulties, of having surmounted obstacles-all these are the ordinary inducements of a healthy mind to action. So it is in the case of the man who loves the country, or who delights in minerals or stuffed birds. But the unhealthy mind is one which is not influenced in the same way as that which is in a normal condition. Eccentricity, so long as the motives which induced to the peculiarity in the first instance, and the habit which made permanent this departure from the symmetry of character in the second are healthy, is not a symptom of insanity. But where there is a well-marked change of character without any adequate external cause, then it is certain that mental disease of some sort exists. Thus, that a man should be saddened by a death is natural. That in some characters this sadness should continue for a very long period of time, and that habit itself should tend to continue this melancholy, is what we should expect from a careful study of human nature. Indeed, even sorrow becomes in time a luxury, and there is truth in Rogers' lines:

All this is compatible with perfect mental health. But if we find an individual suddenly becoming sorrowful without some such external cause; if we find exaggerated fears as to the safety of a soul and the wrath of God; if we discover a morbid consciousness of self, then we are in a position to diagnose insanity.

66

104. The Method of the Study of Insanity.—(84) Wilhelm Meister thought that the true way to study the character of Hamlet, that great psychological riddle, was, in the first place, to investigate every trace of his character as it had shown itself before his father's death, to endeavour to distinguish what in it was independent of this mournful event, independent of the terrible events that followed, and what most probably the young man would have been had no

such thing occurred." Now, there is much to be said for a similar method in the study of insanity. A careful comparison should be instituted—at least, in all doubtful cases— between the character and disposition of the individual while sane, and the character and disposition as influenced and modified by the presence of disease. That this will in all cases yield a light where, but for some such method, there would be darkness, seems to us certain.

2

105. Early Indications of Mania.-With regard to the early indications of the presence of mania, the following statements seem to be true. It is necessary to distinguish between acute mania and acute mania with delirium. The latter has a rapid course either to recovery or death: the former may continue for months without much danger to life. Mania proper may be preceded by premonitory symptoms, or it may come on suddenly. One of the most frequent premonitory symptoms is slight depression. Guislain believed that this occurred in the great majority of cases. This is followed by some peculiarities in conduct, by some stupid business transaction, by something which the individual, if he had been "quite himself," would not have done. Not unfrequently, the individual manifests a strong desire for spirituous liquors, and often yields to this desire. At this stage of the disease there may be slight derangement of the digestive functions, of the circulation, and of nutrition. The pain in the head which we have already noticed, accompanied by sleeplessness, agitating dreams, crowding illusions, vertigo, tenderness of the abdomen and gums, are also frequently to be met with. Subsequent to this stage, eccentricities and extravagances of conduct, of speech, of behavior, become persistent, and motives which were formerly efficacious as restraints are now utterly futile. The individual loses all sense of propriety and of decency, becomes mischievous in an extreme degree, wet and dirty in habits, abusive in language. Degeneration proceeds, and the little

1 Carlyle's Translation.

2 See also Georget Dictionnaire de Médecine, art. Folie.

power of control that the [85] individual was formerly able to exercise over himself is lost. The intention of giving trouble and annoyance now no longer exists: the individual raves incoherently: delusions of the most incongruous and absurd description chase one another through his brain: there is no coherence even in his false beliefs: the language is obscene and disgusting, the habits are filthy: his acts are full of the same incoherence that distinguishes his thoughts: he breaks windows or pieces of furniture, tears clothes, or practices self-abuse. With all this, however, the bodily health of the patient is generally good. If the strength of the individual has been much impaired previous to the commencement of the mania, the violence of the disease may cause death through exhaustion. But if the constitution is good, the mental excitement may continue for weeks or months without leading to a fatal termination.

106. The Sane Consciousness of Maniacs. It is a curious fact that maniacs, even in their most violent moments, seem to be somehow conscious of the strange incongruity and absurdity of their conduct. And even when the fury is at its worst, many of the acts seem to be the result of a bravado, very much like that which exists in sane men, and which often leads them to do all manner of stupid and even criminal acts. "I am convinced," says Langerman, "that even in the highest degree of insanity, there still remains a trace of moral discrimination with which we may connect the train of the patient's ideas."

107. Anesthesia in relation to Mania.-When the disease is at its height, there is an anesthetic condition of the body. It is a peculiarity of all strong emotion that it concentrates attention: and when attention is concentrated on one thing it is abstracted from another. Nothing is truer than the fact that we have to go to meet sensations; that the mind trysts, as it were, with pain at the periphery, or it is not felt. So it is not difficult to understand that the strange strength of emotion which we find in mania should render the individual insensible to heat or cold, hunger or thirst. Again, the muscular power seems to be considerably devel