Dr. Young, walking one day with him some short distance from Dublin, suddenly missed the Dean, who had lagged behind. He found him at a distance, gazing in a solemn state of abstraction at the top of a lofty elm, whose head had been recently blasted by a hurricane. Directing Dr. Young's attention to the summit of the tree, he heaved a heavy sigh, and exclaimed, “I shall be like that tree, I shall die at the TOP first." A lady, for six years previously to her becoming insane, was perfectly convinced, from her mental and bodily sensations, that the seeds of the malady had taken root, and that insanity had, even at that time, commenced to germinate. A gentleman, during his collegiate life, was satisfied that the mind had received, as he termed it, a "twist," in consequence of his having passed many sleepless nights, caused by several weeks of continuous and unremitting laborious mental work. So conscious was he at the time of the mischief that had been done to his brain, that he exclaimed whilst anxiously pacing the room, "I shall die a lunatic!" He subsequently repeated the same expression to a college friend. At the age of forty-eight he became insane, and tried on several occasions to commit suicide. I have known several patients who have had for a long period prior to the manifestation of insanity these singular warnings of approaching brain and mental disorder. It is not difficult to account pathologically for the singular phenomenon referred to. If damage is done to the delicate structure of the brain in early life, by a moral or physical strain, and the material lesion, whatever be its nature, is (as is usually the case), of slow and progressive growth, the pathologist can easily understand the existence of abnormal physical sensations within the head, and morbid mental impressions (engendered by changes in the nervous tissue of the brain), which would, in many cases, necessarily give rise (particularly when an hereditary taint exists) to the anticipation of insanity, some type of disease of the brain or disorder of the mind developing itself in after life. In cases where mental disease is perceived, the utmost caution and most careful examination are necessary ere we conclude that the brain is seriously implicated; for the unhealthy feeling, previously described, as often symptomatic of incipient insanity, is occasionally observed in certain anomalous conditions of the nervous system allied to hysteria, and may exist apart altogether from any actual disorder, or even a tendency to derange of reason. In his youth he had manifested great irregularity of conduct; for at his examination for his B.A. degree at Dublin, he was found "conspicuously deficient." He then commenced seriously to work, and studied eight hours a day for seventeen years. The obscenity and grossness of his writings, in which he dwells upon disgusting matters with morbid minuteness, are proofs of a vitiated taste, if not a disordered mind. MORBID ANTICIPATION OF INSANITY. 165 ment of mind. These distressing nervous symptoms sometimes are seen in young girls, when emerging from puberty to womanhood, and occur to females at the critical period of life. This morbid exaltation of the nervous and mental functions is generally found, associated with visceral complications, easily, however, in many cases, curable. In some cases it is the effect of long-continued and neglected derangement of the stomach and liver. In other instances, the uterine system is the seat of the mischief; and in some types of the malady, the condition of mind is the effect of irritation and congestion established in the brain itself. In one remarkable case, the patient was tortured by an intense fear of losing his senses, combined with confusion of ideas, strange dislikes to his relatives, and a disposition to conceal himself from his family. He had for some time suffered from headache, and a general feeling of malaise. This gentleman soon recovered after a few ounces of blood were taken from his head, and two or three active calomel purges administered. In less than three weeks from the time he placed himself under treatment, he was able to resume his ordinary occupations. In the case of a lady, presenting the same symptoms, great congestion was discovered in the neighborhood of the uterus. This morbid state of the vessels was removed by the local application of leeches. The blood so abstracted, conjoined with other treatment, entirely relieved the mind of all fear and apprehension of insanity. In another case, the mental disturbance could be clearly traced to engorgement of the liver, consequent upon a long residence in a tropical climate. Calomel, taraxacum, nitromuriatic acid, internally, combined with a persevering use of the "nitro-muriatic bath," as recommended and described by Sir J. Ranald Martin, in his able treatise, very speedily dissipated all mental despondency, and morbid anxiety, as to the existence or approach of mental derangement.' 1 "Diseases of Tropical Climates," by Sir J. Ranald Martin, C.B., F.R.S., 1862. CHAPTER VIII. 66 STAGE OF EXALTATION. THIS stage will be considered in its twofold relation: viz., 1. PSYCHICAL EXALTATION. 2. SOMATIC EXALTATION. 1. PSYCHICAL EXALTATION.-For some period before the more active symptoms of cerebral and mental exaltation are manifested, the patient is observed to be wayward, capricious, passionate, and impulsive. He is irritable and fractious, peevish and pettish, exhibiting what would (under less suspicious states of mind, and more favorable conditions of bodily health) be termed an unhappy infirmity of temper." These symptoms of exaltation are occasionally associated with alternate fits of vital depression, and mental confusion. He is subsequently morbidly anxious about trifles, slight ruffles on the surface, and trivial annoyances occurring in the family circle or during the course of business, worry, flurry, tease, and fret him, nothing satisfying, or soothing his mind, and everything, to his distempered fancy, going wrong within the sacred precincts of domestic life. He is quick at fancying affronts, and greatly exaggerates the slightest and most trifling acts of supposed inattention. The least irregularity on the part of the domestics excites, angers, and vexes him. He is suspicious of and quarrels with his nearest relatives, and mistrusts his best, kindest, and most faithful friends, often harboring absurd and unfounded misgivings in regard to the purity and fidelity of his wife, attachment and affection of his children. When in this premonitory state of mental derangement bordering closely on an attack of acute insanity, he twists, distorts, misconceives, misconstrues, and perverts in a most singular manner, every look, gesture, action, and word of those closely associated and nearly related to him. The expressions of love, affection, kindness, endearing sympathy, and friendship which greet him, are viewed as evidences of enmity and ill-will, or as well-contrived, cunningly devised, carefully and adroitly arranged masks to hide some latent design, and artfully veiled conspiracy against his life, liberty, and property! All objects within the range of his perverted senses are tinctured and distorted by a disordered vision, jaundiced eye, mor STATE OF MIND PREMONITORY OF INSANITY. 167 bidly exalted and excited fancy. He shakes with fear at the reflection of his own image, crouches with apprehension at the reverberating tramp of his footsteps, "Back recoiled he knew not why, Even at the sound himself had made," trembles at the melancholy sighing of the wind through the lattice of the window, turns ghastly pale at the echo of his voice, falls back with horror at the recognition of his shadow, mistaking it for a frightful phantom or grim spectral image, "Fierce as ten furies; terrible as hell," following with determined energy, and a malignant aspect closely in his wake, and with resistless impetuosity dogging his every footstep! "Black Melancholy sits, and round her throws And breathes a browner horror on the wood." Occasionally an insane person exhibits at the commencement of his attack, what a superficial observer would consider an unnatural elevation of spirits. He becomes suddenly loquacious, talks loudly and asserts his opinions dogmatically. He is then querulous, peevish, irresolute, undecisive, not being for two consecutive minutes in the same frame of mind. He quarrels with his best friends, argues with great warmth, pertinacity, and vehemence, the most trifling matters, is excessive and extravagant in his expressions of friendship, bitter and rancorous in his feelings of dislike, hatred, and aversion. In this state of morbidly active brain, and unhealthily excited mind, the fancy runs riot, taking discursive and airy flights, every circumstance being viewed by the patient couleur de rose. With this exaltation of the imagination there is associated great exaggeration of expression, forming, in many cases, a striking contrast with the patient's usual modesty and sobriety of conversation, strict urbanity, repose, and propriety of conduct. He talks ostentatiously of his vast wealth, boasts of his elevated social position, speaks exultingly of the profound respect he can command, appears vain of the high rank which has been conferred upon him, and is proud of the still greater distinction he is destined to acquire! As the mental disorder advances, he, in direct opposition to his usual habits and tastes, delights in low society, is neglectful of his personal appearance, drinks stimulants to excess, is extravagant in pecuniary matters, and often squanders his property in visionary and absurd speculations. He subsequently exhibits some form of insane obtuseness or moral obliquity. He is lost to all sense of truth, respect for decency of thought, regard for good breeding, and all notion of decorous conduct. He magnifies, exaggerates, twists, distorts, and falsifies everything connected with himself, being the hero of every incident accidentally mentioned in his hearing. The mental characteristics of the patient are often in direct opposition to his natural or healthy modes of thinking and acting. For some months before any alienation of mind is recognized, his intellect is evidently off its balance. He has violent paroxysms of extreme irritability and passion, produced by the most trifling causes. Contrary to his ordinary practice, he swears, deals in loose inuendoes, talks obscenely, and acts indecently, breaking out in loud fits of sobbing, or in wild paroxysms of laughter, being alternately under the influence of agony, hope, joy, and despair: The following case illustrates the character of the emotional exaltation which occasionally accompanies attacks of mania. A gentleman, naturally quiet, of grave habits of thought, and of reserved manner (who had never been known to indulge in any demonstrative act of merriment), was suddenly seized with an apparently uncontrollable disposition to indulge in loud and immoderate fits of laughter. The most trifling observation and most insignificant circumstance, such as a look or gesture, excited his mirth to an intense and inordinate degree. For several days previously to this remarkable change of disposition, he had been engaged late at night in perusing and analyzing a lengthened correspondence relating to some property, respecting which there had been a disagreeable and vexatious family dispute. He complained to his valet of want of sleep, as well as of headache. These were the only observable symptoms that preceded this unnatural overflow of spirits, and, in fact, outbreak of insanity. For nearly a week none of his relations could perceive anything in connection with the case approaching to false perception, aberration of idea, or illusion of the senses. He laughed indiscriminately, like an hysterical girl, at every occurrence. On the tenth day from the seizure (after a violent and uncontrollable paroxysm of laughter), he solemnly proclaimed himself, whilst in church, to be the Saviour! It required this palpable demonstration of insanity to bring conviction home to his friends as to the existing state of mental disorder.1 1 Mrs. Trollope, when speaking of Strasbourg Cathedral, says, "I entered the church with the intention of climbing the top of its spire; but gave it up on hearing the sacristan's account of the ascent. It is on record that three females |