confined to his cabin, under strict surveillance. On his arrival in London, he was pronounced to be clearly in an insane state! I subsequently saw the case, and as far as I was enabled to unravel its history, was satisfied that the act of immorality of which he had been guilty during the voyage was the first demonstration of his insanity. A young gentleman, holding a responsible situation in a banking establishment of repute, was walking in the neighborhood of Regent Street on a Sunday afternoon, when he suddenly committed an act of gross indecency. He was taken into custody. When asked for an explanation of his singular conduct, he appeared like a man in a state of delirium, and could offer no satisfactory excuse for his outrageous act. His previous character was unimpeachable, he never having been known to be guilty of any palpable immorality; in fact, he was universally admitted, by those who were most intimately acquainted with him, to be a person of great purity of thought, and strict propriety of conduct. He was, however, accused by the police of the offence, but before the matter came under the cognizance of a court of law, his mind exhibited decided symptoms of disorder, and he was consequently released from the hands of the civil authorities, and properly placed under medical treatment and restraint. Was the immoral offence the first OVERT act of insanity, or did the mind become deranged in consequence of the dread of exposure, disgrace, and punishment? I am inclined to the former hypothesis. It appeared that there was insanity, to a considerable extent, in the family, and that this gentleman had received, when a boy, a severe injury to the head, from the effects of which he was supposed never to have recovered. It was discovered that for some days previously to the commission of the indecent offence, he had been observed to have been singular in his manner, and was heard to complain of headache, restless and disturbed nights. A young lady, up to the age of nineteen, comported herself with the greatest decorum and propriety, evidencing in her conversation a high moral status of thought. Between the age of nineteen and twenty she had several attacks of acute hysteria, but was soon, apparently, restored to health. She then became pensive and sad, retiring often to her own room, where she was often found bathed in tears. She exhibited a great indisposition to associate with the family, or to converse with those about her. Apart from these symptoms she manifested no positive sign of mental aberration. With a view of rousing her from a state of recognized mental torpor, she was taken by a member of the family to a public ball, and it was whilst there, and in the act of dancing with a comparative stranger, that she first exhibited, by a marked and painfully loose character of action and conversation, unequivocal INSANITY EXHIBITED IN ACTS OF IMMORALITY. 205 symptoms either of grave moral depravity, or of serious mental disorder. The gentleman with whom she was dancing observing something peculiarly wild in her physiognomy, had his suspicions awakened as to her condition, and had no difficulty in arriving at a right solution of the character of the case. He lost no time in delicately mentioning the matter to the relative who accompanied the young lady to the ball, and she was immediately taken home. On the following day she became acutely insane, all her delusions and conversations having reference to a morbidly exalted state of the uterine functions. "A woman, aged forty-two, for a year and a half gradually fell into a state denoting general softening of the brain, manifesting almost entire blindness, inability to walk, and semi-imbecility of intellect. Two years ago she felt severe and almost constant pain in the head; her general health was in other respects perfectly good, and her intellect clear. Three years previously, this woman, though possessed of an ample competency, committed a petty theft at a fair. This was the first symptom of her approaching cerebral disease." 1 Dr. Brierre de Boismont. CHAPTER XI. IMPAIRMENT OF MIND. I PROPOSE to consider this subject in the following order: 1. GENERAL WEAKNESS OF MIND. 2. MORBID PHENOMENA OF ATTENTION. GENERAL WEAKNESS OF MIND.-The intellect often presents evidences of general prostration and debility, long before any serious disorder of the brain is suspected. This condition of cerebral lassitude, mental sluggishness, psychical weakness and impairment, is in many of its features analogous to the torpor of mind that so frequently supervenes upon certain acute forms of bodily disease, particularly those of a febrile character implicating the nervous functions. In this state of mental ill-health, the patient is conscious of a want of brain tone, sluggish action of mind, and of a deviation from his normal condition of intellectual acuteness, activity, and vigor. He is painfully sensible of feeling mentally below par, and recognizes his inability to use efficiently his powers of mind. He suffers from a torpid state of the intellect, a mental malaise unfitting him for any kind or degree of cerebral work. The effort to think is irksome and painful, causing if persevered in, vertigo, headache, painful confusion of thought and acute mental depression. In this condition of nervous exhaustion the invalid is incapable of exercising for any lengthened period continuity of thought. At times he is quite unable to think at all. This mental prostration disqualifies him for any occupation requiring the active exertion of the intellectual powers. He throws aside his favorite books, and even the newspapers, formerly a source of so much pleasure, become devoid of interest and distasteful. He neglects his ordinary vocation, feeling in mind blasé and only able to sit quietly in a state of gloomy abstraction, or saunter about in a condition of dreamy reverie. These symptoms are consequent upon an overstrained and unduly exercised mind. Men naturally of the most active understandings, of a high order of intelligence and capable when in health of a considerable degree of sustained and vigorous intellectual labor, have been reduced to this sad state of mental impairment and pre IMPAIRMENT OF MIND. 207 cocious senility, as the result of anxiety, or as the effect of excessive and severe cerebral activity. Under these circumstances the patient's mind is easily fatigued. His condition of failing intellect is recognized by the difficulty which he experiences in preserving intact the sequence of ideas and chain of thought. His memory either wanders or is incoherent in its associations. All power of healthy mental combination is lost or greatly impaired. The mind has no fixed hold upon its conceptions, and in consequence of an enfeeblement of the will and weakened power of attention, the ideas are under the influence of the most casual and accidental circumstances. In general terms, all balancing or co-ordinating psychical power appears to be gone.1 This morbid condition of intellect is generally associated with and in a great measure dependent upon a depressed, debilitated, and exhausted state of the vital and nerve force. The blood is impoverished in consequence of being deprived of some of its important organic elements, and the whole system suffers from anæmia. The countenance assumes a pallid, haggard, lifeless, and exsanguine aspect. The assimilative functions are disordered, and the patient sometimes becomes seriously emaciated. Such is often the physical state of those whose minds have been prematurely exhausted. This phase of mental and bodily illhealth in the majority of cases speedily yields to the judicious administration of stimulants and blood tonics associated with appropriate moral treatment, provided no serious structural mischief has commenced in the brain. The symptoms, however, previously detailed are, occasionally, precursory of formidable attacks of organic disease of the brain, and are to be viewed, in some cases, as symptomatic of the ex Among the incipient symptoms of softening of the brain, and apoplexy, are occasionally observed a torpor and prostration of intellect, exhibited in an inability to undertake any kind and degree of mental work. The patient complains of a deficiency of mental power, an exhausted state of the nervous energy, the brain appearing to have lost its healthy tone and stamina. M. Gendrin says, "Apoplectic attacks are often preceded for some days by a difficulty in executing intellectual work, by an incapacity for unusual attention, by an extraordinary irascibility, by a morbid weakness which exaggerates impressions, and produces terrors without a cause, or by unreasonable anxiety concerning ourselves or those related to us. These premonitory symptoms are not observed in every case of impending apoplexy, for many patients appear capable of severe brain or mind work up to the moment immediately preceding the apoplectic or paralytic fit, but in many cases this conscious diminution of vigor of brain and impairment of mind are important premonitory signs of approaching acute, paralytic and apoplectic seizures. The symptom, however, is present in other states of disease of the brain. Should this condition of mind be associated with giddiness, headache, depressed spirits, aberration or impairment of vision, or a slight sensation of numbness (even if circumscribed) in any part of the body, the patient may well be anxious as to the state of his cerebral health. "Traité Philos. de Méd. Prac." Tom. i, p. 487. istence of cerebral tumors, softening, abscess, induration, and other formidable types of encephalic disorganization. A gentleman, aged fifty-four, who died of softening of the brain, associated with hemiplegia, had for nearly twelve months previously to his loss of motor power, complained of no other symptom than painful prostration of mind. He had the greater portion of his life been actively engaged as principal of a large academy, having under his scholastic supervision nearly sixty boys. Being a strictly conscientious man, and of an anxious temperament, he was always in a state of feverish excitement and painful apprehension lest he should fail in the discharge of the serious and responsible duties devolving upon him. His mind was thus kept in a condition of unceasing mental inquietude and perturbation. Under this severe amount of cerebral pressure and mental anxiety he was conscious, as he admitted at the time to his medical attendant, of his mind gradually fading away from him. He eventually became quite incapable of personally superintending his establishment. On one occasion, fancying that his intellect had in a great measure recovered its original strength, he entered the school, and occupied himself with his usual duties. He however soon found that he was quite incapable of directing his attention continuously for five minutes to any one subject connected with the business of tuition, and he immediately retired to his own private room, and seating himself in a chair, burst into a flood of tears, exclaiming, "My mind is gone, altogether gone!" In this case no symptom of physical disease of the brain was detected until twelve months anteriorly to death. The condition of mental impairment existed uninterruptedly for a period of four years prior to the attack of paralysis of one half of the body which occurred shortly before death.-A solicitor was obliged to retire for a period of five years altogether from professional business, in consequence of an enfeebled state of mind, unassociated with aberration of intellect, or lesion of the sensor or motor power. He acknowledged that for thirty years he had not been for seven continuous days absent from the anxious and responsible duties of his office. Two years prior to his decease, symptoms of cerebral amaurosis were recognized, and he nearly lost all visual power. During this time, he was subject to acute attacks of headache, accompanied with great depression of spirits, and distressing paroxysms of extreme nausea, and sometimes of vomiting. He suddenly one day after dinner became hemiplegic, and in a few weeks died. A tumor was found in close proximity to the optic thalamus, undoubtedly interfering with the special functions of this ganglion. In a third case, an officer who had gone successfully through several East India campaigns, became gradually imbecile. All the faculties of the mind, simultaneously, were debilitated. This did not manifest itself at first in a loss of any |