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version of sight. It is one of the most important precursory symptoms of disease of the brain. This sign of cerebral disease is of great practical value and diagnostic significance, and never should escape attentive observation. It is often the first indication of acute mischief originating in the brain, and occasionally in the obscure cerebral diseases of children it constitutes an important diagnostic sign. This aberration of vision is occasionally symptomatic of gastric and hepatic disorder, but when associated with persistent or paroxysmal attacks of headache, lowness of spirits, morbid conditions of the sensorial or motorial powers, we cannot be too closely observant of the state of the patient's brain.

Attacks of apoplexy, paralysis, cerebritis, and meningitis have often been preceded by double vision. Dr. Watson relates the following case in point:-" Dr. Gregory was acquainted with a sportsman who, one day when out shooting, disputed with his gamekeeper as to the number of dogs they had in the field. He asked how he came to bring so many as eight dogs with him. The servant assured him there were but four, and then the gentleman became at once aware of his situation, mounted his horse, and rode home. He had not been long in the house when he was attacked by apoplexy, and died."

MORBID PHENOMENA OF HEARING.-This sense is variously affected in different morbid states of the brain and disordered conditions of the cerebral circulation. In some cases there is observed, in connexion with subtle changes of structure within the cranium, complete loss of hearing. In other instances, this special sense becomes obtuse. In some patients it is perverted, and in particular forms of disease of the brain an exalted condition, or hyperæsthesia of the faculty, is developed.

Occasionally, among the incipient symptoms of cerebral disease, there is a sudden paralysis of the auditory nerve,

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destroying all sense of sound. These extreme cases are not, however, of common occurrence. The symptoms most generally noticed in the insidious affections of the brain, in relation to the faculty of hearing, are either a gradual, progressive impairment, or obtuseness of the sense, or an intensely morbid exaltation and aberration of the faculty.

A disordered state of hearing is one of the most frequent symptoms attendant upon those extremely dangerous affections of the internal structure of the ear involving the bones, membranes, and ultimately the brain itself, which are so frequently preceded, for a length of time, by a chronic purulent discharge from the external meatus, known by the name of otorrhoea, and often connected with chronic meningitis, or cerebral suppurative inflammation.

In the incipient stage of certain affections of the brain the hearing often becomes painfully acute. The faintest whisper reverberates through the ear like the noise of thunder, and conversations that are taking place in remote parts of the house are clearly and distinctly heard by the patient whilst in this state of auricular hyperæsthesia.

It is extraordinary how acute the sense of hearing occasionally becomes in certain forms of delirium. I was informed by a distinguished living physician that he was able, when in a state of cerebral exaltation, whilst occupying a room at the top of the house, to hear with remarkable clearness the conversation taking place in the kitchen. I have witnessed some remarkable instances of this phenomenon in the early as well as advanced stages of brain disease.

Dr. Elliotson attended a gentleman, about forty years of age, who had suddenly an attack of hemiplegia, and whilst in bed he heard the least sound at the bottom of the house with an acuteness which surprised him; and could tell the hour by a watch placed on a table at such a distance from his bed as to have rendered it impossible for him to distinguish the hands when he was in health.

A patient, for nearly a week previously to an attack of inflammation of the brain, complained to those immediately about him of great exaltation of the sense of hearing. In another case, for a few hours prior to an apoplectic seizure, the patient remarked to his son that, when in a distant part of the house, he could, and, in fact, did hear distinctly a conversation that was taking place in the dining-room at a time when no one else could distinguish the sound of human voices!

I have often witnessed in the brain affections of children, particularly in scrofulous diseases of this organ and its investing membranes, a sudden acuteness of this sense preceding the manifestation of more formidable and fatal cerebral symptoms.

Insanity is occasionally ushered in by hyperæsthesia of hearing. This is not an unfrequent symptom of approaching mental derangement. In the premonitory stage the patient often complains of great sensorial activity. He sees what no other person is able to recognise ; smells offensive and disagreeable odours not recognised by those near him, and hears noises and voices appreciable only by himself. This condition of disordered acuteness of the senses is often witnessed for some time previously to the patient manifesting any observable alienation of intellect characterized by illusions or hallucinations.

When the mind is losing its balance in the incipient stage of insanity the patient will be heard to ask rather anxiously those about him, "Did you not speak ?" "Did you hear a voice?" "I thought," repeats the patient earnestly, "I heard some person calling my name."

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Surely there must be some one in the room or outside the door addressing me." Such were the nervous ejaculations of a patient to his wife three or four days prior to an attack of furious delirium, associated with frightful hallucinations, resulting unhappily in suicide.

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A lady, a fortnight before her mind was considered to be deranged, was in the habit of waking her husband several times during the night, imagining that she heard the voices of persons in the room or in some part of the house. On one or two occasions she declared that she distinctly recognised the voice of her mother (who was then in New Zealand) calling her by name, and begging her, in accents of the deepest distress, to come to her. The patient insisted upon getting up and examining the whole of the house before she would be persuaded her mother was not there. At this time no one suspected that these were incipient symptoms of insanity.

These illusions of hearing often lead to a sad sacrifice of life, occasionally impelling its unhappy victim to the commission of both murder and suicide. Under the irresistible influence of an imaginary voice, many a patient is driven to acts of violence and homicide. Occasionally, the illusions of hearing are of a double character, that is, the patient is subject to the influence of two distinct voices, a good and a bad voice; one inciting him to sacrifice life, the other a restraining voice, begging and imploring the patient not to yield to his dangerously insane impulses. "My bad voices urge, my good voices restrain me," was the remark of a patient who believed himself to be demoniacally possessed. "I should have destroyed myself long ago," said an insane person to Dr. Morel, “or I should have killed somebody else, if the voice of my good angel had not begged and encouraged me to suffer."

Patients are often seen contending with these antagonistic illusions, or "double voice," as Morel designates the phenomenon. In one ear the most frightfully obscene ideas are suggested; whilst at the same moment, in the opposite one, sentiments of the greatest purity will be whispered to the disordered imagination of the sufferer. These antagonistic and opposing illusions lead to fearful

contests, and produce a sad amount of mental agony. "Which voice ought I to obey ?" said a delicate and sensitive-minded patient to me one day after a fit of hystericomaniacal excitement. "I am urged by persons that address me on my right side to utter blasphemous and indecent expressions, and to commit acts the most repugnant and repulsive to my nature; whilst in the opposite ear I clearly recognise a tender voice (conscience?) beseeching me not to yield to the fearful temptations of Satan, but to battle with his vile and wicked suggestions." Another patient was urged by a voice to destroy himself. He was commanded to cut his throat. The words, "blood," "blood," "blood," were repeated with terrible emphasis, and in rapid succession to him; and on more than one occasion he was discovered with a razor in his possession, seriously contemplating an act of self-destruction. This gentleman was subject to the influence of the double voice, for at times when the word "blood" was ringing awfully in his ear, and an "air-drawn dagger" stained with gore, glittered before his eyes there stood, as he imagined, on the opposite side of his body a good spirit whispering to him texts of Scripture, repeating verses of hymns applicable to his then state of mind, and imploring him in most affectionate and touching language, not to eternally damn his soul by destroying his own life.

MORBID PHENOMENA OF TASTE, TOUCH, AND SMELL.These senses exhibit, occasionally, at the commencement of cerebral disease, evidence of impairment, exaltation, and perversion. Prior to the development of the more characteristic symptoms of disease of the brain, the patient complains of a morbid condition of taste, of abnormal states of the tactile sensibility, and of perversion of the sense of smell. In all affections of the brain and mind associated with derangement of the digestive organs, the latter sense is observed to be greatly

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