32. A single lady, aged 57, who had been insane for thirty years. There was the strongest hereditary taint.

33. A young man, extremely delicate, aged 22, had acute dementia, following acute rheumatism. There was valvular disease of the heart, with loud mitral regurgitant murmur.-Issue of the case unknown.

34. Slight hereditary predisposition, much aggravated by injudicious education. A tradesman's daughter, æt. 24, brought up in idleness. Domestic troubles and anxieties after marriage. ManiaRecovery.

35. A woman, æt. 30, Wesleyan, single. Suicidal melancholia with the delusion that her soul is lost. Menstrual irregularity. Extreme devotional excitement, with evidently active sexual feelings. -Recovery.

36. A young woman, æt. 25, single, Wesleyan. Mania. Cause, same probably as in the last case.-Recovery.

37. A respectable, temperate, and industrious tradesman, æt. 40, Wesleyan, a teetotaller, and much superior to a vulgar wife. Second attack. His father committed suicide; his brother is very flighty. General paralysis.

38. A sober, hardworking, respectable bookseller, not given to excesses of any kind, so far as was ascertainable. Slight hereditary predisposition. General paralysis.

In both these last cases there was general paralysis in men who had never been intemperate. In both, however, there were large families of children, and the struggle of life had plainly been very anxious and severe.

39. A woman, æt. 32. Acute mania came on two months after childbirth.

40. A lady, æt. 34, single, without other occupation or interest than religious exercises. Suicidal melancholia, with the delusion that she had sold herself to the devil. Amenorrhea.-Recovery.

41. A married woman, æt. 40. Sudden outbreak of mania, after going to a revival meeting. Amenorrhoea.-Recovery.

42. A married man with a family, æt. 52, a Dissenter, holding an office of authority in his church, and most exact in his religious duties. Secretly, he kept a mistress, however, and lived a rather dissipated life. Outbreak of acute mania, with a threatening of general paralysis. Recovery; for a time at any rate.

43. Acute mental annihilation in a young man about a year and a half after marriage. One or two intervals of a few hours of mental restoration.-Death in epileptiform convulsions. Softening of the

brain in extreme degree, but limited in extent.

indulgence.

Excessive sexual

44. A married woman, æt. 44, who has had several children, and who has become insane after each confinement. Maniacal incoherence and excitement, with unconsciousness that she has had a child.— Recovery.

45. Hereditary predisposition. A Dissenter of extreme views, narrow-minded, and bigoted. He was married when thirty-six years old, and became melancholic a short time after the birth of his first child. Recovery.

46. Complete loss of memory, and of all energy of character, and failure of intelligence, in a man, æt. 36, single, from continual intemperance in drinking and smoking. Has previously had two attacks of delirium tremens.

47. An extremely good-looking young widow, who had been a singer at some public singing-rooms, and the mistress of the proprietor of them. Sexual excesses. General paralysis.

48. Attack of acute violent mania in a young surgeon, æt. 27. Afterwards three days' heavy stertorous sleep; then seeming recovery for twenty-four hours; but on the next day recurrence of mania, followed soon by severe epileptic fits.-Recovery.

49. Extreme moral perversion, with the most extravagant conceit of self, and unruly conduct in a young man, a clerk. Alternations of deep depression and suicidal tendency. Cause, self-abuse.

50. A single lady, aged 41, who, on her return from school when fifteen years old, was queer, listless, and has always since been rather peculiar. Hereditary predisposition. Acute melancholia, with the delusion that she is lost because she has refused an offer of marriage by a clergyman, such offer never having been thought of by him.

IF

CHAPTER II.

INSANITY OF EARLY LIFE.

F the account previously given of the gradual evolution of the so-called mental faculties be correct, the insanity met with in children must of necessity be of the simplest kind; where no mental faculty has been organized no disorder of mind can well be manifest. The kind of mental derangement displayed in early life will in reality serve as a searching test of the value of the principles already enunciated, and, if found to be in strict accordance with them, will not fail to afford them strong support. While it is commonly thought sufficient to dismiss all such instances as singular anomalies in nature, inexplicable, and belonging to the regions of disorder as though to call a thing unnatural were to remove it from the domain of natural lawany glimpse of law or order discernible in such confusion will be so far a gain.

The first movements of the child are reflex to impressions made upon it; but so quickly does sensorial perception with motor reaction thereto follow upon these early movements, that we are not able to fix a distinct line between the reflex and sensori-motor actions. The aimless thrusting out of the infant's limb brings it in contact with some external object, whereupon it is probable that a sensation is excited. But it would appear that the particular muscular exertion must be the condition of a muscular feeling of the act; so that the muscular sense of the movement and the sensation of the external object become associated, and for the future unavoidably suggest one another; a muscular intuition of external nature is in fact thus organized, and one of the first steps in the process of mental formation accomplished. If we call to mind how, when discussing actua

tion, it was shown, in the case of the eye for example, that a sensation was the direct cause of a certain accommodating movement, and that the movement thereupon gave us the intuition of distance, we may perceive how the organic association of a sensation from without with a respondent or associated muscular act, does by degrees impart definite intuitions of external objects to the young mind. Suppose now that an infant becomes insane immediately after birth, what sort of insanity must it exhibit? The extent of mental disorder possible is clearly limited by the extent of existence of mental faculty: which, as we have seen, is almost nothing. In this regard the observed facts agree with theory; when a child is, by reason of a bad descent or of baneful influences during uterine life, born with such an extreme degree of instability of nerve element that, on the first play of external circumstances, its nervous centres react in convulsive form, it mostly dies in convulsions. The diseased action is a diseased action of the nervous centres of reflex action-those which alone have at this time power of functional action; the convulsions express the morbid condition of them, - might, indeed, be said to represent the insanity of them as insanity; on the other hand, truly represents sometimes a convulsive action of the higher nervous centres.

It has been shown, however, that it is impossible, by reason of the close connexion of sensorial action with reflex action in the infant-the actual continuity of development which then exists to fix a distinct period during which its functions are entirely reflex. It happens consequently that in the earliest morbid phenomena of nervous centres there is commonly the evidence of some sensori-motor disturbance. An impression on the sense of sight, for example, is not quietly assimilated so as to persist as an organized residuum in the proper nervous centre, but immediately excites a reaction outwards of the unstable cells of the associate motor centres; irregular and violent actions prompted by sensations attest the disorder of the sensorial and corresponding motor centres, as convulsions testify to the disorder of the centres of reflex action. The phenomena of a true sensorial insanity are intermixed with the morbid nifestations of the lower nervous centres; to every impression. made upon the infant there is irregular and violent reaction,

sensori-motor and reflex. Instances of such morbid action so soon after birth are certainly rare; nevertheless they do sometimes occur, and have been recorded. Crichton quotes from Greding a well-known case of a child which, as he says, was raving mad as soon as it was born. "A woman, about forty years old, of a full and plethoric habit of body, who constantly laughed and did the strangest things, but who, independently of these circumstances, enjoyed the very best health, was, on the 20th January, 1763, brought to bed, without any assistance, of a male child who was raving mad. When he was brought to our workhouse, which was on the 24th, he possessed so much strength in his legs and arms that four women could at times with difficulty restrain him. These paroxysms either ended in an uncontrollable fit of laughter, for which no evident reason could be observed, or else he tore in anger everything near him,-clothes, linen, bed furniture, and even thread, when he could get hold of it. We durst not allow him to be alone, otherwise he would get on the benches and tables, and even attempt to climb up the walls. Afterwards, however, when he began to have teeth he died." It is certainly remarkable that a child so young should have been able to do so much; and those who advocate innate mental faculties might well ask how it is possible under any other supposition to account for such an extraordinary exhibition of more or less co-ordinate power by so young a creature. Two considerations should be borne in mind with regard to this case: first, that the mother of the child was herself peculiar, so that her infant inherited an unstable condition of nerve element, and consequently a disposition to irregular and premature reaction on the occasion of an external stimulus; and secondly, that there does, as previously set forth, exist in the constitution of the nervous system the power of certain co-ordinate automatic acts, such as correspond in man to the instinctive acts of animals. Many young animals are born with the power of immediately co-ordinating their muscles for a definite end, and the human infant is not destitute of the germ of a like power over voluntary muscles, while it has complete the power of certain co-ordinate automatic acts; it is conceivable, therefore, that, without will, and even without consciousness, there may be displayed by it, in answer to sensations, actions which, like those of this insane