Wuldham with her mother (who was insane). The child was then scarcely nine months old. She was subject to paroxysmal nervous attacks, which ended either in an indescribable laugh, or in a fit of mania, during which the little creature tore everything she could lay hands upon. Jacobi refers to several cases of insanity in children, then in the asylum at Siegburg. Esquirol treated two children, one of eight and another of nine years, and a girl of fourteen, all labouring under mania; he was also consulted about a child of eleven, in which the disease assumed the form of melancholia.

Marc gives an account of a little girl of eight, who freely admitted that she wished to kill her own mother, her grandmother, and her father. Her object was, to be possessed of their property, and to have an opportunity of indulging her passions. The child was morose, pale, and silent; when spoken to, her answers were very abrupt. Her health was improved by a residence in the country, but on being brought back to town, she became again pale and melancholy. For a long time the cause remained undiscovered; at length it was found that she was addicted to bad habits, which she openly avowed, regretting at the same time that she had not the opportunity of indulging her animal passions. Dr. Brierre du Boismont noted four cases, of children of six, seven, and ten years of age, in whom the symptoms of mental disease were manifest; and at present he has under his care a female child of three and a half years old, born of a paralytic father, which shows the strangest caprices; at one time sad and melancholy; again in the most violent fits of rage, without any cause, and not to be appeased. The intelligence of the child is far beyond its years. The cases of insanity brought under notice by Dr. Paulmier cannot be said to belong to childhood; his children are young people; for of thirteen

fifteen, three sixteen, Before, however, anaBrierre du Boismont

examples, three are fourteen, two and five seventeen years of age. lysing Dr. Paulmier's work, Dr. turns to English, French, and American authors for information on the subject. In Dr. Thurnam's "Observations and Statistics of Insanity" there is a table of 21,333 cases. Under ten years, eight cases, and from ten to twenty, 1161 cases are noted. According to Dr. Thurnam, the greatest number of cases of insanity occurs between thirty and forty. In the United States, however, physicians have remarked the disposition to mental disease is stronger between twenty and thirty than between thirty and forty; and this is fairly ascribed to the earlier age at which young men enter the world and engage in business and politics. One of these beardless men of business said to his physician, "I am convinced this kind of life which I lead will drive me mad or kill me; but I must go on." In four American asylums, which contained 2790 patients, 33.73 per cent. were between twenty and thirty, and 24:41 per cent. between thirty and forty years of age. That the kind of education which the youth in the United States receive has a powerful influence on the development of insanity is proved by Evans and Worthington, in their reports of the Pennsylvania asylums. Dr. Wigan gives, in his unpublished writings, an account of crimes committed by young people without any object. The age of the youthful malefactors was between sixteen and seventeen for girls, and between seventeen and eighteen for boys. There was this in common, that there had not previously existed the slightest animosity towards the persons against whom they perpetrated outrages. According to Wigan, the great number of these young people had epistaxis, which, among the females, appeared with the regularity of menstruation. The crimes were generally

committed after the temporary cessation of this habitual flux.*

Drs. Delasiauve and Schnepf have also published some particulars relative to the insanity of early life. The statistics of Dr. Boutteville exhibit insanity amongst children in no insignificant proportion. The maximum is presented between the ages of thirty and thirty-four. From five to nine, 0.9 per cent.; ten to fourteen, 35; from fifteen to nineteen, 20 per cent. Drs. Aubanel and Thorpe observed in the Bicêtre, in the year 1839, eight cases of mania in children, and one of melancholia, from the age of eleven to eighteen years. Mental disease is undoubtedly more frequent in childhood than is generally supposed. Hereditary tendency to disease, and ill-directed education, play an important part in its production. A writer in the Revue des Deux Mondes, for August, 1848, has with much ability accounted for the frequency of insanity in France. Dr. Paulmier recognises three forms of mania— maniacal excitement (excitation maniaque), mania, and incoherent mania. In the first grade of mania, the dissociation of ideas is not always recognisable-it nearly resembles the early stage of drunkenness; in the more advanced degree, the dissociation of ideas is remarkable; while in the highest it is such, that no longer two sentences, and sometimes not even two parts of one sentence, are connected. The diagnosis of the mania of children is at times difficult; meningitis may be confounded with it; but in general the headache, the dilatation of the pupils, and the nausea and repeated vomiting, afford means of fixing the line of demarcation. Mania with stupor (d'une sorte de stupeur exaltique) approaches closely certain forms of mental alienation which occur after epileptic seizures, and in which the excitement is associated with obtuseness and hallucinations (obtusion hallu

* Dr. Winslow's "Psychological Journal," vol. xi. p. 497.

cinatoire). With respect to prognosis, the insanity of early life, according to the observations of Dr. Paulmier, ends in recovery; however, Dr. Delasiauve has made the remark, that a great susceptibility and disposition to a return of the mental disease often remains. Accordingly, many patients are found in the wards appropriated to adults, who had formerly been successfully treated as insane in the division assigned to children.

Dr. Brierre du Boismont concludes his notice of Dr. Paulmier's dissertation, by giving the results of his own experience. He says, that in a list of forty-two young people in whom the mental disease commenced between fourteen and sixteen years of age, eighteen times was it inherited from their parents. In by far the greater number of cases, the disease manifested itself under the influence of hereditary predisposition, and was connected with the age of puberty and menstruation. On inquiring of the parents the character of the children, the answer has almost always been, that they were, without any cause, sometimes sad, and at other times wild and ungovernable. They could never apply themselves steadily to work. They had no talent, or if it existed, it only flared up brilliantly for a moment. They would submit themselves to no rules. Some were apathetic, and were not to be excited by emulation. Others exhibited a volatility which could not be restrained. Many had been subject to spasmodic attacks. The incubation period was often protracted. In eighteen instances recovery took place, but the persons were liable to relapse. There also remained a remarkable strangeness of character, and an inability to assume any fixed position in life. Some afforded insecure evidence of the recovery being permanent. The conclusion is, that though, in a certain number of cases, recovery takes place, the mental alienation of children and young people is a most serious dis

ease, partly from their antecedents, and partly on account of the imperfect development of the cerebral and other organs.

At the commencement of insanity, the derangement of the intellect is so slight and transient in its manifestations, as to render its recognition, as a formidable malady impending over the patient, a task of grave doubt, and great difficulty. To the unskilled, untutored, and untrained eye, the disease is, in its early stages, occasionally altogether invisible. Even to the practised apprehension of the experienced physician, it is almost indiscernible, or, at least, of a dubious and uncertain character. In its incipient stage, mental disorder is characterized, generally, by acute morbid sensibility, physical and mental, accompanied by a difficulty of fixing the attention. In investigating this subject, it is necessary, as a preliminary inquiry, to endeavour to trace the disease back to its origin, and to examine accurately and minutely that degree or stage of the malady in which it is not yet, but from which it may become, insanity. At an early period of the incipient stage, the patient complains of being very ill, and exclaims that he is losing his senses, often pertinaciously asserting that his mind is not his

own.

These symptoms will be considered more in detail, when I proceed to speak of the stage of consciousness. On investigating the history of those who have become insane, it will be ascertained, that long before any mental disease was apparent, they were subject to fits of apathy, had been in the habit of sitting for hours together in a state of moody abstraction, or brown study, and this, too, at a time when they had important domestic and other duties to occupy their attention.

Upon analysing the patient's antecedents still more * Vide Dr. Winslow's "Psychological Journal," No. XIII. (New Series).