his capabilities of adroitly examining witnesses; of his extraordinary knowledge of the law of evidence, (never having read a law-work!) of his magical powers of oratory, and marvellous gifts of elocution! From this period the disease rapidly progressed, and he became paralytic and demented! The brain revealed, after death, evidences of long-existing disorganization, particularly in its investing membranes. There was also considerable softening of one of the hemispheres, conjoined with atrophy of the convolutions.

CHAPTER IX.

Stage of Mental Depression.

In the early stage of insanity, the patient is at first seen to mope, he is then heard to complain of extreme ennui, and, subsequently, he becomes abstracted, moody, and sullen. Acute morbid melancholy afterwards manifests itself. This condition of mind often exists for some time before derangement of the perceptive faculties or mental delusions are recognised.

It is occasionally difficult to draw the line of demarcation between ordinary attacks of ennui, the more severe types of hypochondriasis, and the mental depression symptomatic of the commencement of insanity.

In these cases, so insidious is the advent, so impercep tible the stealthy march of this form of mental disorder, that it is often difficult to diagnose its existence, and to trace it to its origin.

With what poetic and psychological truth has our great dramatist delineated, in the character of Hamlet, the incipient symptoms, slow gradations, and almost inappreciable advances of the asthenic type of insanity?

This state of mind often leads to suicide. There is, alas! in existence a frightful amount of unrecognised and untreated mental depression associated with suicidal impulses. The daily channels of communication convey to us this sad intelligence in language that does not admit of misconstruction. The melancholy history of

one case recorded is but a faithful record of hundreds of others that are occurring within the range of our own vision. If the evidence generally adduced at the coroner's inquest is to be credited, in nearly every case of suicide, cerebral disorder has exhibited itself, and the mind has been clearly and palpably deranged. In many cases, the mental disorder had clearly existed for weeks, and, occasionally, for months, without giving rise to the suspicion of the presence of any dangerous degree of brain or psychical disturbance likely to lead to so disastrous an issue. There are few morbid mental conditions so fatal in their results as these apparently trifling, evanescent, and occasionally fugitive attacks of depression. They almost invariably (in certain temperaments) are associated with a disposition to self-destruction. I am never consulted in this type of case, without fully impressing upon the relatives and friends the importance of the most careful and uninterrupted vigilance. These slight ruffles on the surface, apparently unimportant attacks of mental despondency, and trifling paroxysms of morbid ennui, accompanied, as they frequently are, with intense weariness of life, a desire for seclusion, love of solitude, and longing for death, are indicative of acute states of brain, and mind disorder, and are fraught with fatal mischief to reason and to life! How much of this character of disordered mind not only escapes observation, but is subjected to no kind of medical treatment or supervision! Occasionally it may happen (but how rare is the occurrence!) that the unhappy suicide may have exhibited no appreciable symptoms of mental derangement; but even in these cases we should be cautious in concluding that perfect sanity existed at the time of the suicide.

It often occurs that a person is impelled to self-destruction by the overpowering and crushing influence of some latent and concealed delusion, that has for weeks,

and perhaps months, been sitting like an incubus upon the imagination. Patients confess that they have been under the influence of monomaniacal ideas and terrible hallucinations for a long period without their existence being suspected even by their most intimate associates. "For six months," writes a patient, "I have never had the idea of suicide, night or day, out of my mind. Wherever I go, an unseen demon pursues me, impelling me to self-destruction! My wife, friends, and children observe my listlessness and perceive my despondency, but they know nothing of the worm that is gnawing within." Is this not a type of case more generally prevalent than we imagine? May we not say of this unhappy man, with a mind tortured and driven to despair by a concealed hallucination, or unobserved delusion, urging him to the commission of suicide, as the only escape from the acuteness of his misery,

"HE hears a voice WE cannot hear,
Which says, HE must not stay,
HE sees a hand WE cannot see,
Which beckons HIM away ?"

This morbid condition of the intelligence is commonly observed as one of the precursory signs of organic disease of the brain unallied with insanity. Acute softening, cerebral hemorrhage, general paralysis, and cerebral tumours, are occasionally seen in the early stage, associated with severe mental depression.

I have observed several cases of inflammatory, as well as white softening of the brain, preceded by great lowness of spirits, occasionally amounting to acute melancholia. In one case, a gentleman who had lived, what is termed a hard life, showed symptoms of hypochondriasis, preceded at first by ordinary attacks of profound ennui. This was so opposed to his usual temperament that the alteration in his natural character was made the

subject of observation.

He suddenly became quite hipped, refused to go into society, and always appeared unhappy if any of his former associates called upon him. He became soon afterwards quite a recluse. This gentleman, after the lapse of some years, during which period his condition of physical and mental health underwent many changes and modifications, died of white softening of the brain. His state of mental depression, however, existed for some time before the sensor or motor powers gave evidence of disease. I have known cases of apoplexy preceded by great depression of spirits.