of the moral sense. Many of these sad afflictions are symptomatic of unobserved, and, consequently, neglected cerebral conditions, either originating in the brain itself, or produced by sympathy with morbid affections existing in other tissues in close organic relationship with the great nervous centre.

The majority of these cases will generally be found associated with a constitutional predisposition to insanity and cerebral disease. These morbid conditions are occasionally the sequelæ of febrile attacks, more or less implicating the functions of the brain and nervous system. They often succeed injuries of the head inflicted in early childhood; and modifications of the malady are also, unhappily, seen allied with genius; and, as the biographies of Cowper, Burns, Byron, Johnson, Pope, and Haydon establish, the best, the exalted, and most highly gifted conditions of mind do not escape unscathed. In early childhood this form of mental disturbance may be detected in many cases. To its existence may often be traced the motiveless crimes of the young, as well as much of the unnatural caprice, dulness, stupidity, and wickedness often witnessed in early life. In the majority of instances, the patient is quite ignorant of his condition, and indignantly repudiates the imputation of mental ill health. In some cases, however, the unhappy sufferer is perfectly conscious of his lamentable state, and, feeling a necessity for cerebral relief, eagerly seeks the advice and consolation of his confidential physician. In this stage of mental consciousness, a painful struggle often takes place in the patient's mind relative to the reality of his mental impressions or suggestions. The questions occasionally occurring to the mind are as follow:-Are these ideas consistent with health? is there any basis for such thoughts? am I justified in harbouring feelings of this nature? are they false creations, or notions of a healthy character, arising out of actual circumstances? A battle of this kind, with ideas clearly of a morbid character, I have known to continue for a long period before the intellect has become prostrated, or succumbed to the insane delusion, or suicidal suggestion. This type of case often comes under the notice of those engaged in the treatment of mental maladies. Hamlet, when he imagined his soundness of mind questioned, exclaims

"This is not madness, bring me to the test." Again: Shakespeare makes Lady Constance, when accused of insanity, in consequence of her intense manifestations of grief, declare

"I am not mad.”

She then proceeds to describe to her accuser her reasons for repudiating the imputation of insanity;—

"I am not mad; this hair I tear is mine;

My name is Constance ;

Young Arthur is my son, and he is lost.

I am not mad;-I would to Heaven I were;
For then, 'tis like I should forget myself.
O, if I could, what grief should I forget!"

Then, in the bitterness of wild despair, she begs the Cardinal to
"preach some philosophy to make her mad," for she exclaims-
"Being not mad, but sensible of grief,
My reasonable part produces reason;
If I were mad, I should forget my son,
Or madly think a babe in clouts were he."

Again: overpowered by the terrible consciousness of her sad condition, she thus repeats her declaration of sanity—

"I am not mad; too well, too well I feel

The different plague of each calamity."

This condition of mind is closely allied to positive insanity. In this stage of consciousness the disorder easily yields to medical

treatment.

It is unnecessary for me to direct attention to the frightful amount of unrecognised and untreated cases of mental depression associated with an irresistible suicidal propensity which has prevailed, within the last twelve or eighteen months. The daily channels of communication convey to us this sad intelligence in language that does not admit of misconstruction. The melancholy history of one case recorded is but a faithful record of hundreds of others that are occurring within the range of our own vision. If the evidence generally adduced before the coroner is to be credited, in nearly every case of suicide, cerebral disorder has exhibited itself, and the mind has been clearly and palpably deranged. In many cases, the mental alienation has clearly existed for weeks, and occasionally for months, without giving rise to the suspicion of the presence of any dangerous degree of brain disturbance likely to lead to an overt act of suicide. There are few morbid mental conditions so fatal in their results, as these apparently trifling, evanescent, and occasionally fugitive attacks of mental depression. They almost invariably, in certain temperaments, are associated with suicidal impulse. I am never consulted in a case of this character without fully impressing upon the relatives and friends the importance of careful vigilance. These slight ruffles upon the surface, these attacks of mental despondency, these paroxysms of morbid ennui, accompanied as they generally are with intense weariness of life, a desire for seclusion, love of solitude, and a want of interest in the ordinary affairs of life, are fraught with fatal mischief. How much of

this character of disordered mind not only escapes observation, but is subjected to no kind of medical and moral treatment. Occasionally it may happen (but how rare is the occurrence), that the unhappy suicide may have exhibited no appreciable symptoms of mental derangement; but even in these cases we should be cautious in concluding that sanity existed at the time of the suicide. It often happens that a person is impelled to self-destruction by the overpowering and crushing influence of some latent and concealed delusion, that has for weeks, and perhaps for months, been sitting like an incubus upon the imagination. Patients often confess that they have been under the influence of monomaniacal ideas and concealed hallucinations for months without their existence being suspected even by their most intimate associates. "For six months," writes a patient, "I have never had the idea of suicide, night or day, out of my mind. Wherever I go, an unseen dæmon pursues me, impelling me to self-destruction. My wife, my friends, my children, observe my listlessness and my despondency, but they know nothing of the worm that is gnawing within." Is this not a type of case more generally prevalent than we imagine? May we not say of this unhappy man, with a mind tortured and driven to despair by a terrible, overpowering, and concealed delusion, urging him on to suicide, as the only escape and relief from the acuteness of his misery,

"HE hears a voice WE cannot hear,

Which says, he must not stay,
HE sees a hand we cannot see,
Which beckons him away"?

(To be continued.)

Part Second.

REVIEWS.

THE DIAGNOSIS OF DISEASES OF THE BRAIN, SPINAL CORD, NERVES, AND THEIR APPENDAGES.*

To supply the practitioner and student with a concise manual of Diagnosis of Nervous Diseases, is the object Dr. Reynolds has in view in this work.

* "The Diagnosis of Diseases of the Brain, Spinal Cord, Nerves, and their Appendages. By J. Russell Reynolds, M.D., &c. London. 1855."

In the present state of our knowledge, when the physiology of the nervous system is involved in so much obscurity, any attempt to classify its diseases on a purely pathological basis must result in failure. Dr. Reynolds contents himself at present with symptoms and physical signs, upon which he founds his classification-open it is true to many grave objections, as we shall shortly see-but presenting one decided advantage, namely, that it involves no theory.

In the first part of his book, the author considers in a general manner the objects and elements of diagnosis, and the classification of nervous diseases. The second part is devoted to diseases of the brain; the third, to diseases of the spinal cord; and the fourth, to those of the nerves and their appendages.

The following analysis will supply the reader with an idea of Dr. Reynolds' views.

The first chapter treats of the objects of diagnosis, which are three in number, "first, the locality; second, the nature; and third, the anatomical conditions of the lesion.' The symptoms by which we are guided to the locality are "extrinsic" or constitutional, and "intrinsic," or local. As to the nature of the affection, it may be "acute" or "chronic."

The anatomical conditions may be "simple functional derangement," which the author supposes in the case of "epilepsy, chorea, hysteria, neuralgia," &c.; or it may be a "physical change, as in organic diseases."

The second chapter considers the elements of diagnosis; by which "is intended the symptoms of disease, which furnish means by which diagnosis may be established."

"The intrinsic, or proper nervous symptoms, are essentially modifications of the manner in which the organs of the nervous system perform their functions;" they may be "mental, or connected simply with motility and sensibility."

The mental phenomena referrible to volition, may be in relation to ideas, as when there is "modification of the power of attention," " modified power of apprehension," "changes in the faculty of recol lection," or "modifications in the power of directing thought."

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Volition, in its relation to emotion, may be affected by "diminished control of emotion," or by "diminished contrast of expression;" both prominent features in various forms of insanity. "The two need not coexist; the former is an internal change, sometimes to be discovered only by diligent search, and by gaining the 'confidence' of the patient; the latter betrays itself at once in his tone, manner, and gesticulation." Diseased volition in relation to sensation may show itself by the "morbid quickness of perception," as instanced by "the hypochondriac, who not only exaggerates all his sensations, and with unhealthy rapidity interprets them to his own discomfort, but can create them in accordance with his preconceived ideas;" or by "the maniac, who can with marvellous quickness of intuition adapt everything that the individual hears, feels, or sees, into some confirmative evidence of his own delusion."

The opposite condition of this, is when there is diminished percep

tive power, which may be the case in delirium, or in that state where the patient "lies perfectly motionless, cannot be made to utter a sound, and makes no attempt to do so spontaneously." The author takes exception to the phrase, "loss of consciousness," as applied to this condition, "because," says he, "it is merely an assumption that such loss exists-an assumption which the after-evidence of many cases has proved to be incorrect." He proposes instead, "loss of perception," as "conveying what exists in fact."

We doubt if this brings us much nearer the truth. A case occurs to us, in which a man lay for months in this condition, apparently having lost alike consciousness and perception, and who on recovering, showed that he had not only perceived what was going on around him-even to the motions of the spiders in his room-but had formed his likes and dislikes to those attending on him in proportion as they had been kind or unkind in their treatment. In fact, it is one of the secrets of the moral treatment of the disease, that in general the patients not only perceive and appreciate, but even remember acts of kindness or cruelty, often when they do not appear to do so.

"Volition in reference to motility," may be affected in its "power of occasioning movement," either by excess as in the maniac, or by deficiency as in hysteric paralysis, so common in the female sex, termed sofa disease.

There may be a defect in the " power of directing movements," or in the "control of involuntary movement." The mental phenomena referrible to "ideation," or "modification in the processes of thought," may have relation to "external impressions," either by abstraction from their influence as in mental "absence," or by perverted notions of their nature or relation.

Again, ideation in relation to internal sensations, may be affected as in hypochondriasis, &c.; or it may be as "an independent process," either by "loss of power to appreciate the logical sequence of events," by the " sequence of ideas" being "rapid, but accidental," by "the absence of all discoverable sequence,' by the "loss of memory in its severer forms," by "positively exaggerated ideation," which is seen in some forms of delirium, or by "perverted ideation, or the existence of fixed delusions," as in insanity. "Ideation in relation to motility," is implicated in "the hypochondriac, the hysteric, and the choreic patient," or in electro-biologic subjects, where muscular movements are effected in opposition to the will.

The mental "symptoms referrible to emotion," consist in morbid exhibitions of pleasure, displeasure, joy, sorrow, &c., either by their exaggeration, perversion, or diminution.

The intrinsic symptoms which are not mental, are referrible to sensation or sensibility, or to motility. Sensibility may be affected in one of these ways, it may be increased, diminished, or modified, so as to produce false sensations.

The phenomena of motility "resolve themselves into muscular

contraction or its absence."

The author classifies them thus:

"a. Modified relation of motility to volition.