the daughters of Protus, king of Argos, of melancholy, by purging them with hellebore. According to the traditionary fable, Melampus had observed that the goats who fed on this plant were purged; and having administered it to the king's daughters, who were wandering in the woods under the delusion that they were cows, he cured them, and received the hand of one of them in marriage, and a part of the kingdom of Argos as his reward.

In the treatment of incipient insanity, clearly unconnected with active head symptoms, there is no remedy which so effectually masters the disease as that of opium in one of its many formula. I am satisfied that a vast amount of mental derangement may be successfully treated in its early stage by the continuous and persevering administration of sedatives. When insanity is clearly associated with a depressed condition of the vital powers, evidenced by a weak pulse, feeble action. of the heart, and general anæmic state of the system, the exhibition of the hydrochlorate, acetate, or muriate of morphia, combined with iron and quinine, will, in a great majority of cases, be found to act like a charm in arresting the progress of the mental malady.

In some forms of insanity, belladonna, conium, hydrocyanic acid, chloroform, Indian hemp, henbane, stramonium, and hops, may be administered with advantage. It is obvious that no particular instructions can be given for the administration of these remedial agents. Much must necessarily be left to the judgment of the practitioner, who should be directed in the application of sedatives by the peculiar circumstances of each individual case presented for his consideration. It will be occasionally found necessary to administer opium by what is termed the endermic method, as well as by enemata. In some cases of acute maniacal excitement, I have found great benefit from the careful use of chloroform by inhalation.

In epileptic and other forms of delirium this anæsthetic agent may be occasionally used with much advantage. It will often be found beneficial in cases of acute mental excitement to give, in combination, digitalis and opium. I have known instances of active cerebral and mental disorder yield to this mode of treatment after other remedies have failed.

Before dismissing this part of the subject, I would make a few observations on the necessity of separating the patient from his friends and family in the incipient stage of insanity.

There cannot be two opinions among experienced medical men as to the propriety of occasionally recommending that a patient suffering from acute mental disorder should, immediately the malady manifests itself, be removed from all his former associations. As a principle of treatment, no sensible person will refuse his assent to such a course of procedure. The object of separation is to break through the morbid train of thought, and to place the patient at once within the range of efficient curative treatment. As long as he is surrounded by circumstances likely to encourage and give activity to his morbid suspicions and delusive ideas, all remedial efforts will be of little or no avail.

No physician would be justified in undertaking the treatment of a case of acute insanity without receiving from the friends and family of the invalid absolute and unconditional permission to isolate the patient completely from home and every circumstance with which he had been previously connected. The lunatic may fancy (and this is one of the peculiar features of the disease) that his family are conspiring against his life-he may imagine that his house is daily visited by persons engaged in devising schemes for depriving him of his life and property. The physician would exhibit great want of judg

ment if he were to lose valuable time by attempting to combat with the mental derangement under such unfavourable circumstances. In the majority of cases, it will be necessary to remove the patient from the sphere of his own circle, before any permanent advantage is likely to ensue from medical or moral treatment. Cases no doubt occasionally occur, in which the practitioner would not be justified in suggesting this course. When the prognosis is favourable and the attack of recent character, evidently dependent upon temporary bodily conditions of ill-health, and the delusions of the patient unconnected with any member of the family, every effort should be made to grapple with the malady before separation from home is advised or carried into effect.

I have, in the chapter on the stage of consciousness, referred to the distressing, blasphemous, and often obscene thoughts that occasionally occur in certain forms of nervous disorder and particular types of incipient insanity. It is possible in many cases, whilst such morbid Teas are transient impressions, to overpower, conquer, dismiss them from the imagination by an indomiand persevering effort of the will.

! the unhappy sufferer is occasionally so fearfully
e dominion of morbid thoughts that he makes
interfere with or dislodge them from their
stead of attempting to do so, he often
ourage their admission into, as well as to
healthy ascendancy over his mind, ex-
poet-

d clouds, and storms, be these my theme;
Welcome kindred glooms,

en recounting an episode of his life version, says: "In the early days I was much troubled with wicked

to distinguish the latter condition from one of venous plethora. The ordinary symptoms of active determination are cephalalgia of an acute type, a feeling of tension, weight, or heaviness in the head, severe vertigo, aggravated whenever the patient stoops, suffusion of the face, injected conjunctivæ, distressing noises in the ears, sensorial hyperæsthesia, activity of the arterial circulation, recognised by undue action of the temporal and radial arteries, depression of spirits, apprehensions of an approaching calamity, optical illusions, increased temperature of the scalp, wakefulness, or disturbed sleep, accompanied with frightful dreams, sudden muscular twitchings and spasmodic startings.

It is difficult to define when the preceding cerebral state of active determination passes into a condition of congestion. In the former affection there exists marked hyperesthesia of the ordinary functions of the cerebrum, whereas in the state of hyperæmia the symptoms indicate an opposite condition of the brain. This depression of the cerebral functions is marked by a sensation of dull, heavy weight in the head, seldom amounting to acute cephalalgia. The patient complains of vertigo and obtuseness of hearing. In many cases there is partial amaurosis. The intellectual faculties are in an inactive state. The memory is impaired, thoughts confused, and all the great functions of life are in a state of severe vital depression.

The

The insidious, slow, and progressive advance of insanity, exhibiting itself, in the majority of cases, by great singularity of conduct, delusive ideas, and clear deviations from normal modes of thinking and acting, as well as by an absence of the acute cerebral symptoms (except in cases of mania) that mark the condition of active determination and hyperæmia, will assist the practitioner in arriving at an accurate diagnosis. Again, insanity is

easily distinguished from the acute symptoms of meningitis and cerebritis. These inflammatory affections are accompanied by severe cephalalgia, occasionally fugitive in its character, sense of weight and fulness in the head, flushing of the face, heat of the scalp, lethargy, attacks of vertigo, exaltation of the sense of hearing, seeing, and smelling, optical illusions, tinnitus aurium, injected conjunctivæ, full and laborious pulse, sudden startings during heavy sleep, as if the patient were alarmed by a frightful dream, bowels obstinately constipated, pupil contracted, skin dry and parched, and the mental condition alternating between delirious excitement and depression. With the preceding symptoms there will occasionally be great irritability of the stomach, sometimes amounting to actual vomiting. Inflammation of the membranes and substance of the brain (affections very difficult to distinguish from each other) is often complicated with delirium (different in its character from the delusions and hallucinations of insanity) as well as with convulsions.

Lallemand professed to be able to diagnose between meningitis and inflammation of the substance of the brain by means of lesions of the functions of the muscular system which accompany, he affirms, almost exclusively, the former cerebral condition; but, according to his own admission, the two types of inflammatory disease very frequently blend with, and are not easily to be distinguished from, the other.

The premonitory symptoms of inflammatory affections of the brain are essentially dissimilar from those that precede attacks of mental derangement. For some period before the invasion of the acute cerebral disease, the patient complains of rarely being free from some degree of headache, either continued, fugitive, fixed, or deep-seated in its character. These degrees of cephalalgia, Dr. Craw