disease, in which the psychical functions of the brain remain intact, the invalid, even while suffering the most acute and agonizing pain, bodily distress, and physical prostration, is in a state to appreciate his actual relations with those around him, he feels sensitively the exhibition of tender sympathy, he properly estimates the care and attention bestowed upon his case, and recognizes the skill of his faithful medical adviser. Alas! how different are the feelings and thoughts of many of the insane! In this class of affections the kindness, sympathy, skill, unremitting assiduity, and attention of the physician are often not outwardly or manifestly appreciated. He has, in many cases, to pursue his holy work without the exhibition of the slightest apparent consciousness, on the part of the patient, of his efforts to assuage his anguish and mitigate his condition of mental disease and bodily suffering. Nevertheless, it is his sacred duty, even when, as is occasionally the case, his actions are greatly misconstrued and perverted by those to whose relief he is administering, to unflaggingly persevere in his efforts to carry out a curative process of treatment. The poor, unhappy invalid may believe that his physician is acting the part of a bitter foe. This ought not to excite any feeling but that of the most profound love and sympathy. If the patient's language be offensive and repulsive-if he be guilty of any acts of violence towards those in attendance upon him, the physician should never for a moment lose sight of the fact, that the unhappy affliction has, to a degree, destroyed his free will, and that, for a time, he has ceased to be a responsible being. It would be cruel, while such a condition of mind exists, to treat the patient otherwise than as a person deprived by disease of the powers of complete self-government and moral control. Let me earnestly and affectionately urge upon all engaged in the treatment of the insane, the importance of never losing sight of the fact, that even in the worst types of mental disease there are some salient and bright spots upon which they may act, and against which may be directed valuable curative agents. "There is some soul of goodness in things evil, The more formidable, apparently hopeless and incurable types of mental derangement admit, if not of cure, at least of considerable alleviation and mitigation. It is always in our power to materially add to the physical and social comforts of even the worst class of insane patients. We undoubtedly possess the means of modifying (if we cannot entirely re-establish the mental equilibrium) the more unfavorable and distressing forms of insanity, rendering the violent and turbulent tractable and amenable to discipline, the dangerous harmless, the noisy quiet, the dirty cleanly in their habits, and the melancholy to an KIND TREATMENT OF THE INSANE. 465 extent, cheerful and happy. It is possible, by a careful study of the bodily and mental idiosyncrasies of each individual case, and an unremitting attention to dietetic and hygienic regimen, as well as by a persevering, unflagging, and assiduous administration of physical and moral remedies for their relief, to "Pluck from the memory a rooted sorrow." The spirit of love, tender sympathy, Christian benevolence, unwearying kindness, and warm affection, should influence every thought, look, and action of the physician engaged in the holy, honorable, sacred, and responsible treatment of the insane, it being his special province to "Fetter strong madness in a silken thread, Charm ache with air, and agony with words." 30 INDEX. Abbe de Rance, mad from guilty conscience, | Advocate, Dr. Johnson's opinion on the duty 182 Abscess, cerebral, accompanied by vertigo, 418 and heart disease, 403 caused by blows on the head, 419, 441- 443 generally accompanied by headache, 419 importance of inquiring into the ante- importance of early detection of, 358 often associated with chronic discharge type of vertigo, 349 in the left hemisphere of the cerebrum, formation of, preventable, 442-444 case of paralysis preceded by aphonia, on cephalalgia accompanying intercra- on cerebral amaurosis, 366 on cerebral cephalalgia, 419 on dyspeptic symptoms accompanying on the impairment of the faculty of on self-inspection and self-interrogation, Abernethy, Mr., case of injury of the head Aberration, incipient, of the intellectual of mind affecting moral sense, 198 of sight, 374 of an, 143 Affections, anomalous and masked, of the Agitation, physical, of incipient insanity, Alarm and terror, state of, preceding aber- Alchemists, Lord Bacon on the persevering Alderson, Dr., case of hallucination men- Alfieri, on the effect of the atmosphere on Alleged lunacy, evidence in, 141 346 Amaurosis, dependent upon vascular con- early signs of cerebral, 365 Amblyopia, a symptom of disease of the Amnesia, case of, 240 Feuchtersleben on, 239 indicating disorders of the brain, 238 Anæmia, causing cerebral disease, 207 cutaneous, 353 from preoccupation of mind, 356 symptoms of occasional, often exhibited unobserved progress of disease owing Lucretius's poem written during an Analyzing subtle cases of insanity, art of, Andral, on exalted sensibility, 348 on morbid visual phenomena, 367 Andrée, Dr., cases of epilepsy detailed by, 315 Anæsthesia, 352 of the insane, 359 Annihilation, physical and moral impossi- Anticipations, morbid, of insanity, 164 Anomalous affections of the mind, 96 Aphonia, case of, related by Dr. Copland, 333 case of, reported by Dr. Abercrombie, Aphorism of Hippocrates, 17 connection between, and cardiac dis- corpora striata found rough and jagged interesting case of, related by Dr. Wat- Itard, Dr., on loss of memory accom- loss of speech after, case related by Dr. morbid speech following, 337 preceded by great depression of spirits, prediction of, 162 premonitory signs of, 162 softening of the brain, causing, 412 state of mental excitement, precursory vertigo frequently the forerunner of, 338 treatment of incipient, 439 Aristotle, case of Antipheron, related by, 379 Arsenic in the treatment of affections of the Assimilative power of the blood, 280 Attention, Abercrombie, Dr., on the impair- genius nothing but continued, 211 importance of the faculty of, 211 Aspasia, dream of, 395 Austin, St., on mysterious union of mind Autobiography of the insane, 57 Babbage, Charles, on the terrors of con- on the indestructible character of physi- Bacon, Lord, his inductive philosophy, 46 Beau, M., on premonitory symptoms of epi- Beddoes, Dr., case of morbid misuse of on the phenomena of attention, 214 322 Bell, Sir Charles, on the degrees of cerebral Bertin, Dr., on the connection between apo- |