an operation which in itself in no degree destroys the capability of perceiving pain, we find that they can be touched and even transfixed without in the least disturbing the animal; it only struggles and cries out when the trifacial nerve, the crura cerebri, the optic thalami, or the medulla oblongata are accidentally touched. Again, if the hemispheres be removed by slices down to the centrum ovale or to the cavity of the lateral ventricle, the animal remains as indifferent as if we were cutting a hair or a nail. The same phenomena have also been repeatedly observed in man; thus, a portion of the hemisphere projecting through a wound of the skull has been removed without producing any action; and, again, parts of the substance of the hemisphere have been taken away by the surgeon in removing pus or foreign bodies without the patient's consciousness."*

This sad neglect of well-marked symptoms of brain. disorder may, to a degree, arise from the fact, that the abnormal mental state of the patient is, in many cases, viewed in the light of healthy exaggerations, eccentricities, or extravagances of natural conditions of thought. It is difficult for some to understand the important physiological principle, that disturbed intelligence has the same relation to the brain, that disordered respiration has to the lungs, pleura, and heart. The importance of detecting the earliest symptoms of approaching, or existing disease of the brain, cannot, in a practical point of view, be over-estimated or exaggerated. Considering the peculiar and special functions of this organ, and the close sympathy established between the sensorium, and other organic tissues; appreciating how slight, minute, and infinitesimal a degree of structural change in the nerve vesicle paralyzes both body and mind, we can have no difficulty in estimating the

"Lehrbuch der Physiologie des Menschen." Band 11. Von Dr. G. Valentin. P. 743.

C

value which should attach to the detection, at the earliest possible period, of the faintest scintillation of any actual disease existing in the delicate nervous organization.

How cautiously, zealously, and closely should the physician watch for the incipient dawnings of cerebral mischief! Who can guarantee the integrity of the intelligence, normal condition of the sensibility, and healthy action of the motor power, if the delicate vesicular structure is the seat of morbid action? Is it not possible to predicate with certainty the result of neglected inflammation of the periphery of the brain? We should never lose sight of the fact, that no irritation or inflammatory action can exist for any length of time, in the more important tissues, or ganglia of the brain, without seriously perilling the reason, and endangering life!

How forcibly do these observations apply to the detection of the incipient symptoms, of all types and degrees of mental disorder! It is a well-established fact, that seventy, if not eighty, per cent. of cases of insanity admit of easy and speedy cure, if treated in the early stage, provided there be no strong constitutional predisposition to cerebral and mental affections, or existing cranial malformation; and even when an hereditary taint exists, derangement of mind generally yields to the steady and persevering administration of therapeutic agents, combined with judicious moral measures, provided, the first scintillations of the malady are fully recognised, and, without loss of time, grappled with, by remedial treatment.

A vast and frightful amount of chronic and incurable insanity exists at this moment, within the precincts of our county and private asylums, which can be clearly traced to the criminal neglect of the disease, in the first or incipient stage. It is at this period when so much. may be effected in preventing those destructive alterations in the structure, and membranes of the brain, so often witnessed after death, in those who die of chronic mental alienation.

In the third report of the Hanwell County Lunatic Asylum for 1833, Sir William Ellis, the then resident Superintending Physician of the Institution, thus speaks of the sad consequences that result from the neglect of recognising and treating insanity in its early stage :

"It is a melancholy fact, that, on a most careful personal examination of each of the 558. cases now in the house, there do not appear more than 50. who, under the most favourable point of view, can be considered curable. This is to be attributed almost entirely to the neglect of proper remedies in the early stages of the disease. To become acquainted with the symptoms first indicating it not only requires much care and attention, but much experience; for a diseased action of the brain or some part of the nervous system may be gradually undermining the health, and still be scarcely suspected by common observers to exist, from the insidious manner in which it steals upon. the constitution at first: it manifests itself by some trifling aberration of intellect, and that very generally on one point only; such aberration, if unaccompanied by bodily pain, is not only neglected by the sufferers, but disregarded by those around them. This, however, is precisely the time when medical aid is the most capable of being beneficial; and could the patients but be placed under proper care then, certainly three-fourths of them would be cured. But, unfortunately, the golden opportunity is too often neglected. DISEASED ACTION is allowed to proceed unchecked until DISEASED ORGANIZATION has taken place, and the patient has become incurable; and it is only in consequence of the commission of some violent outrage that he is at last sent to an asylum. Until something serious has occurred, the friends hope in a few days the mind will recover its tone.

"Unfortunately, this unwillingness to consider the patient sufficiently insane to be sent to an Asylum is

not confined to the friends of the patient. There have been instances of the magistrates themselves, from the kindest motives, refusing to grant warrants for the admission of a patient, even after he has been examined by a medical gentleman, who has given a certificate of his insanity, because when brought before them he has been able to answer certain questions correctly. The consequence is, that from this delay, instead of returning to his friends in a few weeks, which, in all probability, would have been the case if proper medical and moral remedies had at once been applied, he becomes incurable, and remains in the Asylum for life, a burden to the parish. In some instances similar delay has been attended with fatal consequences.

"It is sincerely hoped that the knowledge of these circumstances will induce an early application to be made for the admission of patients; as, even if the neglect does not prove fatal, it is contrary to every principle of justice and humanity that a fellow-creature deranged, perhaps only on one point, should, from the want of the early attention of those whose duty it is to watch over him, linger out his existence separated from all who are dear to him, and condemned, without any crime, to be a prisoner for life."

In the premonitory stage of insanity, the grey portion of the hemispherical ganglia, is frequently in a state of capillary congestion. This pathological condition I may remark, without anticipating what I have to say on the subject of the medical treatment of the incipient symptoms of cerebral and mental affections, is easily dealt with, and the further progress of the disease arrested by therapeutic measures. A few leeches and cold applications to the head, particularly in young persons of plethoric habit, active purgation, quietude, and freedom from all excitement, physical and mental; counter-irritation to the head, the administration of the tartrate of antimony, and

the judicious exhibition of opium after the local congestion has been relieved, and the secretions brought into a healthy condition, will, in eighty per cent. of cases, cure the patient, and arrest the further progress of the mischief.

In a certain type of case, the brain, in the early stages of insanity, is in an anæmic condition, and the vital and nerve force but feebly manifested. In these cases, our sheet-anchor is undoubtedly opium in its various formulæ, generous diet, and blood tonics. But I must not anticipate what I have to advise in its proper place for the medical treatment of insanity.

"The importance or rather necessity of recognising disorders of the head in their early stage," says Dr. F. Hawkins, "is obvious from the consideration that they can then alone be attacked with any chance of success. In acute cases, the period is brief indeed in which the power of art is available. But whether the case be acute or chronic, it is only in the early stage that its precise nature admits of being distinguished with accuracy. In its further progress, from the extensive sympathies of the brain with all parts of the body, so many functions. become implicated, and so various are the symptoms which arise, as to preclude arrangement or classification, and defy the art of diagnosis. The aid which in most other cases the sensations of the patient are capable of affording us is lost to us too soon in disorders of the head, until in their advanced state they all resemble one another, and present alike a dreary abolition of the powers of animal life. The period therefore is highly precious in which these affections admit of being distinguished with precision or treated with any hope of advantage."*

Croomian Lectures, delivered before the College of Physicians, May, 1829, by Francis Hawkins, M.D.