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in no little disorder. It is not necessary here, however, to enumerate the obvious objections against an etiological classification generally, and against the one above mentioned in particular. Much of what has been urged against the method of arrangement proposed by Dr. Skae might be repeated here; and if we compare the two methods, and observe how facts, which are made leading characteristics in the divisions of the one, are left without consideration in the other, we cannot help coming to the conclusion that they are both fundamentally defective, though we may at the same time acknowledge in both the evidence of an excellent scientific spirit. Morel's method is, on the whole, of a more ambitious character, but of less practical worth, than that of Dr. Skae. In the chapter on the causation of insanity will be found various facts and reflections bearing directly on the principles of both methods, and weighing against the practicability of their present adoption.

NOTE ON THE TEMPERATURE IN INSANITY.

While this sheet was passing through the press, Dr. Clouston has published in the Journal of Mental Science for April 1868, some important inquiries concerning the temperature of the insane. His conclusions are :—

"1. The temperature of the body is higher in the insane than in the sane.

2. The temperature is highest in phthisical mania, gradually falling in the following order :-General paralysis, acute mania, epilepsy, melancholia, mania, mild dementia, and complete dementia.

3. Dementia is the only form of insanity whose average temperature is below health.

4. The great characteristic of all the forms of insanity is that the difference between the morning and evening temperature is much less than in health, and this is owing to the rising of the evening temperature, and not to the lowering of the morning temperature as compared with the healthy standard.

5. This rising of the evening temperature, as compared with the morning, is in the exact ratio of the death-rate among the various forms of insanity, finding its acme in general paralysis.

6. In general paralysis, the average evening temperature is higher in every case than the morning temperature (the observations being taken over a sufficient period).

7. In phthisical patients the temperature is high, and is especially bigh in the acute forms of the disease, but the latent forms cannot be certainly diagnosed by thermometric observation.

8. The evening temperature of every form of insanity (even complete dementia) is higher than the evening temperature of health.

9. The greatest differences in different individuals labouring under the same form of insanity are found in general paralysis, epilepsy, and acute mania. In the first named a difference of 8-7° has been found.

10. Excitement in a patient is almost always attended by an increased temperature as compared with depression or quiescence. This difference averages 2-2° in periodic mania with long periods, and 1.1° in periodic mania coming at shorter intervals. In general paralysis there may be a difference of 5.8° in the same individual in different stages of the disease.

11. An epileptic fit depresses the temperature at first, and then tends to raise it a little, but it makes a difference whether the patient sleeps or wakes after the fit.

12. The epileptiform fits of general paralysis are always followed by a greatly increased temperature, lasting for several days, and they may in this way be distinguished from ordinary epileptic fits.

13. The average temperature falls as the patients get older, but the fall takes place chiefly in the morning temperature.

14. The average frequency of the pulse in the various forms of insanity corresponds with the mean temperature, but the rise in the evening temperature has no corresponding rise in the evening pulse."

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CHAPTER IV.

THE PATHOLOGY OF INSANITY.

BEFORE proceeding with the description of those morbid

appearances which have been met with in insanity, it will be well to have regard to certain preliminary considerations of a general character. Already the absence of any physical appearances where psychical disorder has existed, has been dwelt upon at some length. A patient dies in a raving madness, and there is no reason disclosed by pathological observation why he should have died. Is it a right inference, then, that nerve element does not subserve mental function, or is not affected when function is affected? Certainly not: at present we know nothing whatever of the intimate constitution of nerve element and of the mode of its functional action, and it is beyond doubt that important molecular or chemical changes may take place in those inner recesses to which we have not yet gained access. Where the subtlety of nature so far exceeds the subtlety of human investigation, to conclude from the non-appearance of change to the non-existence thereof would be just as if the blind man were to maintain that there were no colours, or the deaf man to assert that there was no sound. Matter and force are necessary co-existents, and mutually suppose one another in human thought; and to speak of change in one is of necessity to imply change in the other. We cannot write the order of the variable winds or of the shifting clouds, but we are none the less certain that both clouds and winds have an order which they cannot disobey, and which we shall some time discover; and so likewise we have the fullest confidence that in due time a means will be discovered of penetrating the yet inscrutable recesses of nerve life, and of making known the physical conditions of its func

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tional manifestations. The mechanism of nervous function is now a region of uncertainties and obscurities; it is the destined field, therefore, of future discoveries.

There are numerous facts available to prove that the most serious modifications in the constitution of nerve element may take place without any knowledge of them otherwise than by the correlative change of energy. After severe and prolonged mental exertion there inevitably comes exhaustion, which may be so great that the brain is utterly incapacitated for further function; a large increase of phosphates in the urine testifies to the disintegration of nerve; the individual is, so far as power of active life is concerned, almost a nonentity; and yet neither microscopist, nor morbid anatomist, would succeed in discovering any difference between the nerve substance of that man's brain and the nerve substance of the brain of one who, after due rest and nutrition, was prepared for a day of vigorous activity. The sudden shock of a powerful emotion may produce instantaneous death, just as a stroke of lightning may, and perhaps in the same way; but neither in one case nor in the other may there be any detectable morbid change. If the electric fish be persistently irritated so as to be made to give forth shock after shock, the excessive expenditure of energy leaves it utterly exhausted, and it can will no more shocks until rest and nutrition have restored its power; the nervous centres have plainly undergone some modification, though we know not the nature. of it. Instead of arterial blood send through the brain blood heavily charged with carbonic acid, and the victim of the experiment must inevitably die; but who can tell the secret change that has been produced in the composition of the nerve element? Without killing a man outright, it is possible, by causing him to breathe a mixture of one part of air and three parts of carbonic acid, to render him as insensible to pain as if he had inhaled chloroform; but it is the gross result only that is recognisable by our senses. In this regard, however, the experiments of Lister on the early stages of inflammation are of som interest; for he showed that carbonic acid produced a diret sedative effect upon the elements of the tissue, paralysing for the time their vital energies; the effect being transient, and the tissue recovering its energy after a considerable time. The

experiment brings us to the individual elements of the tissue, but not to the more intimate changes that take place in it. The difference may obviously be the difference between life and death, and yet there may be no appreciable physical or chemical change. As regards the morbid appearances met with in cases of insanity, there can be no question that the instances in which they are not found are becoming less frequent as investigation becomes more searching; and those who are best capable of judging, and best qualified by acquirements to give an opinion, are those who are most certain of the invariable existence of organic change. It is known that when a morbid poison acts on the body with its greatest intensity there are fewer traces of organic alteration of structure found than when the poison has been of a milder character and has acted more slowly; and so likewise organic change of nerve element in insanity, appreciable by the imperfect means of investigation which we now possess, may justly be expected only when the degeneration has been long continued.

1. Physiological Researches into Nervous Function.-The important researches into the physiology of nerve which have been made during the last few years, will help to render conceivable the existence of organic change which, though undetectable, cannot be doubted. It is, indeed, of the first moment that a distinct idea of nervous activity as dependent on physical and chemical processes should be formed. Because nerve is looked upon as ministering to mind, the exalted and indefinite conception of mind has reflected on nerve functions a sort of spirituality and unreality, and has, consciously or unconsciously, caused them to be set apart from the category of like organic processes. The metaphysically minded have not been content to declare the mind to exist independently of all the physical processes which determine the mode of its manifestations, but they have actually imposed metaphysical conceptions on nervous function as the instrument of so exalted a mission. However, the regions of the wonderful are becoming less and less as science advances its lines; and there has now been found in the electric stream a means of partially penetrating the hitherto unapproachable secret of nervous function. With the perfecting of this means, which may justly be expected in the course of time, it cannot be doubted

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