Fig. 2. Starved brain cells in a convolution, supplied by such an artery as seen in Fig. 1. The cells are in various stages of degeneration and atrophy, their walls, processes, and nuclei having disappeared (after Dr. J. J. Brown).

Fig. 3. A portion of starved and atrophied brain substance, from a convolution of a case of senile insanity. The whole substance is loose, reticulated, and almost destitute of brain cells in upper part of section, with only the packing tissues and vessels left.

Fig. 4. Cells from the brain convolution of a case of senile dementia, showing their degeneration, atrophy, and pigmentation. Their nuclei remain, but their processes have fallen off. Probably this illustrates a natural decay of the cell itself rather than a blood starvation as seen in Fig. 2 (after Major, West Riding Asylum Medical Reports, p. 170).

Fig. 5. Shows a new lesion of the brain discovered by Dr. J. J. Brown, in a case of acute mania in the Royal Edinburgh Asylum, in 1877. This is a section from a convolution, showing its free surface at upper part of section, from which the pia mater had been removed, and in the part of gray substance drawn an enormous deposit of a new substance, taking up most of its middle layers. It appeared in masses, in smaller nuclei-like bodies, and also round the vessels. The larger cells seen in the inner layers of the gray substance were somewhat degenerated and atrophied, their processes having disappeared.

CLINICAL LECTURES ON MENTAL DISEASES.

LECTURE I.

THE CLINICAL STUDY OF MENTAL DISEASES.

ALL classes of men have generalized ideas of mind according to the daily experience and the practical necessities of life of each. It is not left to the philosopher, metaphysician, and psychologist to study mind. The jurist, politician, priest, and sociologist each has his own system of mental philosophy. Nay, the policeman and the house-breaker have each a crisp and concise theory, learned in the schools of experience and tradition-not formulated it may be, but still definite and practical. The physician in practice has, more than most men, opportunities of seeing a wide range of mental phenomena. He comes into intimate personal relationship with men and women in circumstances where the reasoning and feelings, the instincts and propensities of human nature, are exposed to his view with as little concealment or hypocrisy as possible. There are very few of the serious diseases he treats but affect the minds of his patients more or less in some way. He has to study carefully the effects of their outward surroundings and of the impressions from without on the minds of his patients. He has to calculate the effect of his own speech and conduct, as well as those of all who surround them. He has to do with mind in its most undeveloped form up through all its stages of growth and education, and he has the opportunity of seeing the effects on it of every form of disease and debility. In addition to this he is called on to treat mental symptoms when, through their striking abnormality, they have themselves become a disease.

The whole conduct of things in the world is necessarily so based on the assumption that every man is a responsible being with a sound mind, that any exception to this, when it occurs, has a very startling effect. In the early ages it was not admitted that such a thing was possible, and when a man's mind was clearly altered from its normal state, and his mental personality changed, they explained it by the theory that some other personality had entered temporarily into the man, driven out and overpowered the true occupant, and that the man was possessed with a devil, or some spirit good or bad other than his own. It is certainly no wonder that before the physiology of the brain was studied such a theory was adopted. The facts were so inexplicable on any current hypothesis of mind, that they needed a supernatural cause. Looked at from the human and social point of view, no other disease at all approaches

mental disorder in the terror it inspires, the sense of helplessness it causes, the deep distress to relatives, and the disturbance of all social ties. It is no wonder that its study was backward, and its treatment barbarous, up till quite recent times. But the modern scientific spirit could not, and did not, allow this field to lie fallow, and its study was hardly begun when its profound interest and great importance were seen. It was soon recognized that the mode of study of this department must be precisely the same as that required for physiology and pathology. The physiologist had to study normal mind as a form of brain energy; the physician had to investigate abnormal mind in the same observational and inductive way as he studied diseases of the chest. It was very soon apparent that the brain was the sole organ of mind, and that the functions of that organ, being multiform, and having relationship to every part and energy of the body, could only be properly studied in relation to one another. It was found impossible to place quite apart the motion and sensation functions, the sleep, the animal appetites and instincts, the special senses, the speech, the memory, the love of life, the affective, the reasoning, and the controlling functions. The great problems thus opened up have exercised a fascination over many of the greatest men in our profession in modern times, men whose general professional work did not lie specially in the treatment of mental disease. I need only mention Pinel, Esquirol, Feuchtersleben, Pritchard, Abercrombie, Combe, Schroeder van der Kolk, Brodie, Holland, Griesinger, and Laycock. And as for the pure psychologists who have lately studied mind from the physiological point of view their name is legion. In this country alone, Herbert Spencer, Darwin, Huxley, Lewes, Maudsley, Calderwood, and Bain 'represent a power of original investigation and exposition seldom excelled in any one department of science; and this is not wonderful, for if the highest functions of the brain and its derangements are not worthy of study by the best minds, what can be supposed to be so?

In a strict sense the term "medical psychology" is a misnomer; if psychology is a real science, it is one and indivisible, and you might as well talk of medical mathematics or medical physics as medical psychology. But inasmuch as medical men seldom have the time, and only a few of them the special aptitude, for the study of the whole field of psychology, that portion of it which has a relation to their physiological studies and the practical work of their profession has been divided offnot, it is true, by very defined lines and called Medical Psychology, just as certain departments of electricity and acoustics may be called medical par excellence. An unambitious definition of medical psychology might be "Mind-as it concerns Doctors."

The necessity which exists for a knowledge of mental disease to medical men is best proved by a few facts and figures. An exceptional power has been granted by law to every member of our profession in practice of giving a certificate, the effect of which is to deprive any British subject of his personal liberty on the ground of insanity. Surely such a responsibility implies an obligation on our part to know something about. the subject of mental disease. How can we know that which we do not study? And how can the medical practitioner give advice and sign such all-important certificates about a disease which, as a medical student, he