The presence of serosity causes different shades of dulness, stupor, inertia,

coma.

Thickening, the retractation of the arachnoïd compressing the brain, causes to a certain degree a diminution of intellectual energy, but leaves considerable freedom of motion.

Softening affects more directly motility, and paralysis more directly the motor influx, especially of speech.

I cannot say often enough how important it is to acquire two general notions. That which teaches us to know a brain disordered only in its functions, not in its structure; that which enables us to recognise a brain diseased in its anatomical elements.

Clearness, neatness of expression, absence of disorder in the connexion of ideas, demonstrate that there exists no anatomical lesion: this is only known by observation, failure of the phrenic acts. To this, we must add the elements of appreciation. It is known that alterations of tissue are rare in melancholy, ecstasy, delirium, folly.

It is in two forms of alienation that doubt always arises: dementia, mania. Conviction springs up when we see signs of compression of cerebral destruction. This certainly is wanting so long as the signs which belong to paralysis are absent; i. e., paralysis in the formation of words, of the intelligence, of memory, of movements, of prehension, of locomotion. What adds to the clearness of the diagnosis is the reunion of paralysis, of convulsions, of ebrious ideas.

Meningo-cerebral adhesions.—I have no settled opinions concerning adhesions between the arachnoid and the dura mater. It would be a grave error to conclude that they are the result of inflammation.

Cerebral induration.-It is considered that induration is met with in 25 out of 100 insane. It is most frequently found in chronic mania, in dementia, and in maniacal epileptics; also in general paralysis with softening. I think I have observed that this alteration is most commonly seen at the base of the brain and in the external walls of the lateral ventricles. More than once. I have found the pons Varolii so hard as to be nearly crepitant under the knife. Induration of the olivary bodies is not at all rare. It chiefly affects the grey matter; but may affect the white also.

The intimate nature of the pathological alteration is difficult to determine. My microscopical investigations have taught me nothing precise.

Are there any symptoms which permit us to recognise induration in the living subject? Hitherto they have not been pointed out.

Cerebral hypertrophy and atrophy.-I have often observed hypertrophy, especially in maniacs. In these cases the convolutions are so compressed against the skull, that they are sometimes only traced by lines. This state is culiar to congestional mania.

Atrophy may be general or partial. Partial-it is often confined to a series of convolutions. General-the brain has diminished in volume, and is found separated from the inner table of the cranium, as Gall was the first to observe. It has been supposed that atrophy was most common in the frontal region, and I have several times verified this observation. Parchappe says it is met with in 16 out of 100 cases. He calls it cerebral marasmus.

This condition belongs especially to chronic dementia. I think also it belongs to melancholy.

Vices of conformation of the skull and brain.—These are chiefly seen among idiots.

Of the anatomical alterations of the abdominal and thoracic viscera. M. Parchappe, the man who has best investigated this subject, calculates that out of 1000 insane patients, 423 present after death lesions of the cerebrospinal system; 262 lesions of the digestive canal; 140 in the respiratory system.

A. Affections of the alimentary canal.-I have found thickening of the walls of the stomach. Scirrhous induration of the pylorus, inflammation, ulceration, softening. But in most instances these have appeared to me independent of the mental malady. I have observed in suicide inflammation of the intestinal mucous membrane, once in a case where there was no cerebral disease. Some physicians have attributed great importance to the pathological state of the intestines in melancholy.

2. The ideas of Esquirol as to the displacement of the colon have been confirmed; in the insane we do indeed sometimes find this intestine lodged in the true pelvis.

3. Inflammations of the peritoneum, the omentum adhering to the mesentery, and this latter to the abdominal wall, &c.

4. In suicide, considerable abdominal lesions are observed.

B. Affections of the liver and spleen.-It is not rare to find red spots upon the liver. It is found crepitant, often gorged with blood, and exhibiting traces of inflammation. Alterations in the liver are frequent in drunkards. But I have examined the bodies of persons dead from delirium tremens without finding any appreciable lesion of the liver.

I remember a case of joyous mania which presented to me an enormous distension of the spleen which contained a very black blood. I asked myself if this case did not support the opinion of some of the ancients who placed gaiety in the spleen and anger in the liver.

In the melancholic, the suspension of respiration-i. e., its performance at long intervals and imperfectly, explains in a great measure the frequent presence of engorgements of the system of the vena portæ and especially of the liver and spleen. Very often the mesenteric veins are found loaded with black blood.

In dementia we sometimes find enormous distensions of the urinary bladder. I have recognised disease of the ovaries, after a violent delirium accompanied by hysterical symptoms. The menstrual suppression, so frequent in insane women, should point to the conjecture that the ovaries are frequently affected.

C. Affections of the lungs.-In estimating the pathological condition of the lungs, we must bear in mind the influence of the variations of temperature to which the insane have been exposed, their cries and vociferations, disease of the pneumogastric nerve, insufficient food, spermatic evacuations, the use of cold douches, a strumous constitution.

Pulmonary tuberculosis is frequent amongst the insane. It has appeared to me to have a direct relation to mental alienation. Sometimes this is allied with meningeal or cerebral tuberculosis. A tuberculous condition of the substance of the brain has been denied. But this is a serious error. I have observed it frequently; and I may call in the testimony of my colleague, Professor Mareska.

I have observed gangrene of the lungs, and this has been exclusively in cases where the patients refused to eat. This has been subsequently confirmed. In fasting madmen also gangrene of the intestinal mucous membrane has been found. There is evidently a disordered hæmatosis in these patients.

The symptoms of pulmonary gangrene are announced in too clear a manner to allow a practised eye to be deceived. There is no disturbance in the mechanical phenomena of respiration. It is in the blood that a profound alteration exists. The general colour of the skin indicates this; it becomes yellow, brownish, the colour of beer. The conjunctiva puts on a bluish tint. A remarkable decomposition is observed in the features. Red spots and swellings appear in different parts of the body. The breath exhales a horrible fœtor. Sometimes a slight cough appears the patient at first expectorates frothy mucus, next the mucus is streaked with blood; then this is replaced by a brownish sanies of extreme fœtidity.

We must not, however, conclude that gangrene of the lungs takes place in every case of refusal to eat.

You

Affections of the heart.-These are not infrequent among the insane. will not lose sight of the fact that the heart plays a great part in the moral acts. The cries and continual groans of the patients disturb the action of the heart, and drive the blood back upon the right cavities; sorrow, muscular prostration, render the dilatation of the chest imperfect, and oppose an obstacle to the circulation of the blood.

Conclusion. General inductions.—The anatomical diagnosis presents no inconsiderable difficulties in its application to mental diseases. But I will endeavour to sum up what science permits as to formulize in this respect. Every kind of phrenopathy may present cadaveric lesions; but these may also be found in other discases, in which their signification is altogether different.

Melancholy. If melancholics die accidentally during the phrenalgic state, they present for the most part no trace of organic alteration either of the brain or meninges. The solidity of the cerebral substance, a venous turgescence, a slight sinking in, a slight serous collection, are the only phenomena observed inside the cranium.

If the disease is protracted beyond the ordinary term of cure, if it become insensibly associated with debility of the functions of the understanding, we may admit that a change has taken place in the organic change of the encephalon, an opacity of the arachnoïd, a hyperemia of the pia mater, and most frequently an inter-membranous serous effusion.

In melancholy, more than in any other kind of mental disease, autopsy leads to the discovery of visceral lesions, of engorgements of the vena portæ, inflammations of the peritoneum, affections of the chest; but, in the majority of cases, these are the result of the disease or of fortuitous circumstances.

Ecstasy-It is rare to see patients affected with ecstasy succumb to the disease: we must conclude that it is exempt from any disorganizing condition; and that in this affection as in melancholy, as in the generality of manias, the cerebral disorder is simply functional.

Mania. When mania is accompanied by injection of the conjunctiva, great heat in the scalp, we must conclude that there is cerebro-meningeal hyperæmia, but not inflammatory or disorganizing. It is the expression of a functional exaltation, of an orgasm communicated to the vascular system.

When mania is characterized by a great influx of will, by cries, tumult, agitation, the encephalon is gorged with blood. We often find in patients who have vociferated much, congestions of the pia mater and sub-arachnoïd ecchymosis: they usually exist in the parietal and temporal regions.

If the patient die accidentally in the course of a tranquil mania, if he have preserved intact conception, memory, the affective sentiments, autopsy hardly ever reveals the slightest organic alteration. This is also true of manias which break out periodically; in the intervals, the brain presents nothing abnormal.

When mania is complicated with epilepsy, the head is congested at every fit; often there are found sub-arachnoideal ecchymoses of the brain itself, of the cortical and medullary substance, indurations of the pons, of the medulla oblongata.

When mania, after having lasted several months, passes insensibly into a state of intellectual prostration, we can no longer say with certainty if there exist in the patient one or other of the anatomical alterations I have pointed out. If the symptoms of mania go on diminishing, and those of dementia increasing, we may be almost sure that a morbid organic change has been wrought. Most frequently we then meet with congestion of the cortical substance, of the pia mater, thickening of the arachnoid, rarely with softening.

Sometimes in maniacs we find hyperemia, opacity of the arachnoid; we must conclude that these lesions mark a serosity unusual in this disease.

I do not hesitate to lay it down as a principle, that in the majority of cases mania excludes appreciable organic lesions.

Folly.-I cannot say what is the condition of the brain in incendiary, homicidal, fasting suicidal madmen. If the disease has been of long duration, a morbid condition of the thoracic and abdominal viscera is frequently recognised.

Delirium. The same uncertainty pervades the entire series of phrenopathies we have comprised under the name of delirium.

Dementia.-It is especially in dementia that we must expect to find anatomical lesions of the brain. Amongst all the phenomena which announce these lesions, the principal are, subtraction, nullity, volition of the cerebral and muscular acts. These are occasioned by compression, destruction, or even by irritation of the cerebral pulp.

In dementia, more than in any other phrenopathy, we may expect thickening, shrinking of the arachnoïd, infiltration, vascular engorgement of the pia mater, a modification in the vascular state and texture of the neighbouring convolutions.

But we cannot always say that there is, or that there is not softening.
We may often affirm the existence of a serous collection.

As to cerebral induration, the little certainty as to its symptoms does not allow us to conjecture its presence.

It is essential to remember that dementia is not invariably linked with an organic state of the brain; this disease is often completely independent of such a state.

Such is the character of the greater number of pure primitive dementias. In senile dementia, in that form which follows immediately upon a strong moral commotion, in dementia the result of great misery, in that which is connected with spermatorrhoea, the cadaveric inspection usually reveals no morbid state whatever. I except serous accumulations, a state of discoloration of the grey substance, falling in of the brain. But I repeat it; it is not always permitted to us to say, I shall find in such a patient a discoloration, a shrinking, an inter-membranous hydrocephalus.

Here we terminate the phenomenological part of mental diseases.
We shall next discuss the etiology of these affections.

ON THE CONNEXION BETWEEN MORBID PHYSICAL AND RELIGIOUS PHENOMENA.

No. 3 OF A SERIES.

BY THE REV. J. F. DENHAM, M.A., F.R.S., &C.

BEFORE tracing this connexion further by the aid of mere observation, it may be desirable to ascertain whether any sanction for our views of it can be derived from the Scriptures. It is proposed, then, to consider in this paper what the Scriptures teach respecting the body, or "the flesh," as they frequently term it, its physical qualities, and the consequences, of various kinds, produced on the mind, soul, or spirit, by its union with these intellectual and emotional principles of our nature.

The Scriptures begin by acquainting us with an immense deterioration inflicted upon the body and external circumstances of the first parents of the human race, and entailed upon all their posterity, and from which the most important practical consequences are both deducible by our reason, and are also fully recognised in other parts of the sacred volume. In the second

chapter of the book of Genesis, it is stated that God formed man out of the dust of the ground in the country of Eden, and by breathing into his nostrils the breath of lives, made man a living soul; and afterwards took him and put him into the garden of Eden to dress it and to keep it; and that out of the ground of that garden grew every tree that is pleasant to the sight and good for food, and the tree of lives also in the midst of the garden, and the tree of the knowledge of good and evil :-that out of the man in this perfect physical state of his nature, and placed amid such favourable external circumstances, woman was formed that they were both naked and not ashamed :—and in the first chapter, which is a previous summary of the narrative, that God looked upon all things that he had made, the human male and female in his own image and after his own likeness included, and blessed them; and that everything seemed in the view of his infinite perceptions to be "very good," proper, and happy. In the third chapter, both the physical constitution and external condition, as well as the moral state and enjoyment, of the human species are represented as undergoing a great and adverse change. For, in consequence of their transgression, they have now become conscious of the shame of nakedness, of guilt, and fear-enmity between them and the serpent is instituted, the woman's sorrow and her conception are greatly multiplied, her will and wish are subjected to those of her husband, the ground is cursed, with at least an exuberance of troublesome vegetation, man is doomed to eat his bread in sorrow from it, in the sweat of his brow, all the days of his life, till by a chronic dissolution ("dying thou shalt die," margin) he should return to his original dust. He is driven out of the garden "to till the ground" of the country of Eden, out of which he had been taken, debarred access to the tree of life by cherubim and a flaming sword; and the very species of his future food was altered from "every herb bearing seed, which upon the face of all the earth, and every tree in the which is the fruit of a tree yielding seed," to "the herb of the field." Now it is impossible not to conclude, according to all our present observation and experience respecting the effects of physical causes upon the mental and moral constitution of man, but that these great changes in the case of our first parents, and in regard of all those physical causes which chiefly affect our nature, must have produced the most extensive alterations on their mind and moral dispositions; and these changes and their effects being transmitted to all their descendants, fully prepare us for the subsequent records, and for the existing phenomena of the perturbed state of the mental and moral nature of man. It does not appear that any change was inflicted directly on either the intellect or the moral affections of human nature, but these remaining in their original state, we see sufficient in the indirect effects produced upon them by means of the alteration in man's physical state and circumstances, to account not only for the moral but even mental disturbances which we perpetually experience and observe even under the most favourable physical circumstances, and for those still greater disturbances in proportion as those physical circumstances become by any means whatever still further removed from their normal condition. The well known power of such circumstances to pervert the mind and dispositions of mankind is thus afterwards described by Moses in regard of the effects of famine. "Thou shalt eat the fruit of thine own body, the flesh of thy sons and of thy daughters, which the Lord thy God hath given thee, in the siege, and in the straitness, wherewith thine enemies shall distress thee: so that the man that is tender among you, and very delicate, his eye shall be evil toward his brother, and toward the wife of his bosom, and toward the remnant of his children which he shall leave: so that he will not give to any of them of the flesh of his children whom he shall eat: because he hath nothing left him in the siege, and in the straitness, wherewith thine