Let the physician then estimate, in all its vital importance, the grave necessity for prompt treatment and decisive remedial measures, when satisfied that the enemy is at the gates, and has attacked, or, is on the eve of assaulting, the citadel! Under these circumstances, hesitation, delay, or procrastination in bringing the patient within the range of curative measures, is fraught with the direst results, and with the saddest consequences. Let us not wilfully close our eyes to the premonitory signs, however apparently insignificant, slight, transient, and fugitive they may appear, of actual mental disorder and brain disease, for it is in this early stage when so much may be effected by judicious medical treatment to obstruct the advance of the fatal cerebral mischief.

Having dwelt at some length on the existence of a precursory stage in all affections of the brain, and on the importance of watching for the first threatenings of incipient cerebral disorder, I propose to investigate, in detail, the general character of the premonitory symptoms of encephalic, and mental disease. It will be well, however, to premise, that I cannot, in this work, do more than generalize on this wide and expansive subject.

When I address myself, in the succeeding volume, to the consideration of specific types of brain disease, it will be my object to enter more elaborately into detail, and to point out, as far as practicable, the diagnostic premonitory signs of the various organic affections of the encephalon. Many of the symptoms to which I shall refer as valid evidences of incipient brain disorder will be found common to several lesions of this organ, each presenting an essentially different aggregate group of symptoms, as well as distinctive anatomical, and pathological phenomena.

Nevertheless, I am of opinion, that a general description or resumé of the incipient signs of morbid conditions

of the brain, before considering individual forms of cerebral disease, will not be without its practical value and importance. Agreeably to this arrangement, I propose to analyse the subject in the following order :

1. Morbid Phenomena of Intelligence. 2. Morbid States of Motion.

3. Morbid Conditions of Sensation.

This classification of the subject fully recognises the three physiological functions of the cerebro-spinal system, viz.:

a. Thought. B. Motion.

7. Sensation.

6. Morbid Phenomena of Organic,
or Nutritive Life,

Viz.: a. Digestion and

Assimilation.

B. Circulation.

7. Respiration.

8. Generation.

7. General Principles of Pathology, Treatment, and Prophylaxis.

CHAPTER II.

Morbid Phenomena of Intelligence.

THE brain, being the material instrument of the intelligence, the physical media through which the mind manifests its varied powers, it is in conformity with the rules of logic, and, in obedience to the laws of inductive reasoning, to infer, that no changes in its structure or investing membranes can take place, no alteration in the quality of the vital fluid, or anatomical character or calibre of the numerous blood vessels that circulate and ramify through its substance can exist, without, to some extent, interfering with, or modifying its psychical functions. Cases, however, are on record, in which serious injury has been done to the brain during life without damaging the intelligence, and considerable encephalic disorganization (as the result of disease) has taken place, no aberration, exaltation, depression, or impairment of the mind, having been observed, previously to death. If such cases have occurred, they must be considered either of a rare and exceptional character, or, as pathological curiosities, unless, in every instance, the alteration of structure is strictly confined to one hemisphere, or restricted to the fibrous, or conducting part of the nervous structure, the vesicular matter, and its minute vessels remaining intact, and entirely free from all morbid change, or abnormal modification. Is it possible to conceive any great extent of disorganization, even in the medullary portion of the cerebral mass, to exist, without impli

cating, to some degree, the grey matter of the brain, and, as a consequence, deranging the phenomena of thought?

It is not my intention to discuss in this work the complex questions (physiological and metaphysical) involved in an analysis of the psycho-somatic relation or union between mind, and matter, life, and organization. It is sufficient for my purpose to affirm, as a general postulate, that all structural lesions of the encephalon, its investing membranes and bloodvessels, are associated with some derangement, modification, or altered action of the psychical, motorial, or sensorial functions of the great cerebral ganglion (πρῶτον Αισθητηριον) the sensorium

commune.

Softening of the brain, abscesses, tumours, atrophy, induration, and other forms of cerebral disorganization, have, it is alleged, been discovered in the brain after death, without having disordered, or even impaired the intelligence during life. But are not these unusual and anomalous cases?

If the mental and cerebral condition of those who have been represented to have died of organic disease of the brain, apparently in full possession of their intellectual, sensorial, and motorial powers, had been subjected to a close and rigid analysis, some degree of disorder, or impairment of these functions would, I believe, in many cases have been detected. We are too much disposed to form hasty generalizations in these cases, and to infer, that because the patient talks rationally for a time, on ordinary subjects, is under the influence of no appreciable illusion, hallucination, or aberration, that, therefore, the intellect is unclouded, and the brain in a perfectly sound and normal state. Such apparently healthy psychical, and cerebral manifestations, are quite consistent with the existence of encephalic disease, impairment, and even of actual latent, and concealed mental aberration. These

conditions of the brain, and mind, would, I believe, be more frequently detected, if sufficient time were devoted to their analytical investigation, and, accurate, pathological, and psychical diagnostic tests, were scientifically employed by experts, practically acquainted with the art of examining the subtle phenomena of insanity.

It has been observed, "that could we see the interior workings of such intellects, they would be found altered, limited, perverted, or changed in some way from their normal condition, although it may not be discovered in their external manifestations. It should be recollected that there are many oddities which are dependent upon cerebral conditions, but which pass for mental peculiarities, and in this way the disordered actions escape notice. Yet the rule will be found logically true, that wherever there has been found the trace of organic cerebral change, there also will have been disturbed mental manifestations."

I affirm, that in every case of disease of the encephalon, particularly if the organic change or pressure be established in the vesicular matter, or in the membranes immediately investing the brain, a disordered, or abnormal state of cerebro-psychical phenomena may, in the incipient stage, on careful examination, be detected.

Having made these preliminary remarks, I proceed to the investigation of the first, or psychical section of the subject.

The mind may be in a state of morbid

1. Exaltation.

2. Depression.

3. Aberration.

4. Impairment.

These conditions of unhealthy intelligence, exhibit in their origin, progress, and termination, a variety of