myself, and lead a monastic life. . . . næ ego sane ineptus qui hæc dixerim. I confess 'tis an indecorum."

The intimate connection of hysteria with the craving for sympathy, interest, and fellowship is shown very clearly by the effect of the display of sympathy towards the hysteric. Nothing is more certain or more striking than the aggravation of the symptoms produced by such a display, nothing better proved than the amelioration of the symptoms that follows a judicious display of indifference. The girl who has been in bed and unable to move for years under the care of a silly, fussy, indulgent, weak-minded mother, will recover in a fortnight when taken away from her home and placed under the care of a firm, kind, judicious, strong-minded woman.

The intimate connection of hysteria with insanity is wellrecognized. It is not merely that the manifestations of hysteria major graduate into insanity by insensible gradations; that in certain cases we are puzzled to say whether the patient is insane or hysterical; that in some cases the same individual is at one time plainly hysterial, and at another plainly insane, that when at her best she is hysterical and when at her worst, insane; the connection shows itself not only in such instances as these, but also in the close alliance with insanity that most manifestations of ordinary hysteria display. In every case of hysteria of ordinary severity there is some disorder of conduct. The patient either lies in bed without the disablement of bodily illness, or has fits of prolonged and excessive laughing or weeping, or outbursts of "temper," of screaming, or outbreaks of destructiveness, or cruelty, or other conduct that is not adjusted to her circumstances. At the same time, there is evidence of disorder of mind. The craving for sympathy and interest, which is natural to the time of life at which hysteria first appears, is, in all cases of hysteria, present in exaggerated degree. The manifestations of emotion, which are so prominent a feature in the conduct, indicate, there is no doubt, disorderly and excessive phases and tides of emotion occurring in the mind. Anger, vindictiveness,

pity, especially self-pity, religious, and other emotions, are present in excess, and out of proportion to the circumstances of the individual: in other words, they are disorderly. Intelligence, too, is often disordered. in some degree, although the disorder of this side of mind is rarely prominent, rarely conspicuous, and is consequently often overlooked and disregarded; and this is the reason why there is often so much difficulty in recognizing the positive nearness of relationship between hysteria and insanity. If we find a person acting strangely and in a way that is manifestly unadjusted to her surroundings, and if yet we find her able to reason with average acuteness, having regard to her sex and age, and to give plausible explanations of her conduct, we are apt to conclude that there is no intellectual disorder; but there remains often this residual defect. She does not herself perceive the defect in her own conduct. Conduct is the external expression of intelligence. Conduct is acted thought; and disorder of conduct necessarily implies disorder of the thought of which it is the expression.

The close connection between hysteria and insanity is displayed again in the similarity between the received methods of treating them. The first thing to do with a case of acute recent insanity is to effect a complete change in the surroundings. The patient is taken from home and placed among strangers under novel and unusual circumstances, and this is the first step and the first condition to recovery. In hysteria also, the readiest, speediest, and most reliable means of cure is to remove the patient from her home, and place her in new conditions of life. In the one case as in the other, what is termed "moral treatment" is among the most powerful recuperative agents.

Close as the connection of hysteria with insanity undoubtedly is; and definitely as that connection has always been recognized, yet at the same time it has always been held as a matter of course that hysteria, although it may associated with insanity; although it may graduate into insanity; although it may display the disorder of conduct, of

be

feeling, and of thought, which together constitute insanity; yet it is itself something different from insanity. Closely allied as the two undoubtedly are, and puzzling as it often is to distinguish between them, yet it is common to meet with cases of hysteria which it would be felt to be an outrage to call insanity. The question arises, What is this subtle difference which distinguishes things so closely allied in nature and appearance ?

The difference is, that while in insanity the part of the nervous system that is affected is the very highest of all— the topmost layers of the topmost strata; in hysteria the seat of disorder is in layers immediately below the topmost. If we imagine the highest region of the nervous system to contain several layers of slightly different degrees of altitude, then in insanity the highest of these layers are affected. It may be that the lower layers are affected also, but in any case the most superficial stratum, the actual surface layer, is disordered. In hysteria, on the other hand, however much and however widely the highest nerve regions may be affected, there always remains, so long as the case is one of hysteria alone, above the disordered layers, a stratum, however thin, of nervous arrangements which still continue to carry on their functions normally. Beneath this superficial film there may be several layers, all belonging to the highest stratum, all pertaining to that system of centres, to that region which regulates conduct, and whose activity is accom-panied by vivid, active, high-level consciousness, but yet not the highest of all-still having above them a superior authority which co-ordinates, as well as it can, their erring activities, and provides that the highest manifestations of all shall be adapted and adjusted to circumstances. Sometimes it will happen that the disorder in the lower levels increases, becomes yet more uproarious, and invades the highest level also; and in such cases the hysteria will merge into actual insanity; but more commonly the disorder remains limited to the layers just below the highest, and the manifestations are those of hysteria alone.

The evidence in support of this view appears convincing. The disorder of feeling-of feeling of elaborate and elevated character, of the more elaborate and late-developed emotions -indicates without a doubt that the region of the nervous system involved in the disorder is a very elevated region. The disorder of conduct proves that it is the highest stratum of nervous arrangements that the physical disorder affects. But there are other manifestations which show that above the disordered region there are some arrangements yet intact, which assert some authority, and endeavour with more or less success to control and regulate the disorderly action beneath them. The paroxysm of excessive laughter or excessive weeping is described as "uncontrollable," clearly indicating that the necessity for control is appreciated. Efforts are evidently made to suppress the excessive manifestation. Sometimes these efforts are successful, sometimes they are not; but the fact that they are made is sufficient proof that the controlling authority, that is to say, the highest nervous region, still exists, still acts, and even if its action be ineffectual in controlling its mutinous subordinates, yet so far as that action goes, it is normal and healthy.

The considerations dealt with in this chapter lead us to the following conclusions. At the period of puberty new activities are added to the body; a new phase of development occurs. This development takes place rapidly, and on that account its products are apt to be unstable. The mental changes' that take place at puberty are in the main additions to the cœnæsthesis or consciousness of self, and are chiefly three ;-increase of self-consciousness; craving for self-sacrifice and craving for sympathy and interest; all of which are factors in, or modifications of, sexual emotion. Owing to the disturbance produced by the rapid addition of these new faculties, the nervous system is prone at puberty to suffer disorder; and when disorder occurs, it usually manifests itself in some excessive or bizarre expression of one or other of the newly-added faculties.

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CHAPTER IX.

THE CAUSES OF INSANITY (Continued).

Indirect Stresses of Internal Origin (continued).

THE stress of puberty tells with special severity, as we have seen, on the female, and the same is true of all the stresses connected with the reproductive function. The assumption of the reproductive function is in all organisms a period of storm and stress. When the function, from being potential, becomes actual, further changes occur, and the changes are of a twofold nature. On the one hand, the gaining of an outlet for activities is always ipso facto beneficial. Activities that find no outlet must of necessity produce disorder, and are the direct occasion of unhappiness and harm. The unfettered exercise of activities is always a source of satisfaction during their exercise, is always of beneficial effect to the organism at large, and leaves behind it an abiding feeling of contentment, which is the mental reflexion of an enhancement of the general well-being. What is true of activities generally is especially true of the reproductive activity. If it is denied its natural and proper outlet, the organism suffers. Either it finds expression in unnatural and improper ways, or it breaks out disorderly, or it is transmuted, as it were, into other activities, whose exercise is less beneficial to the organism, and still leaves something unsatisfied; leaves the organism incomplete, undeveloped, one-sided.1

I Burton had a very keen insight into the evils of sexual abstinence: "As I cannot choose but condole their mishap that labour of this infirmity, and are destitute of help in this case, so I must needs inveigh against them that are in fault. . . . How odious and abominable are these superstitious