The condition of mental impairment existed uninterruptedly for a period of four years prior to the attack of hemiplegia, which occurred shortly before death. In another case a solicitor was obliged to retire for a period of five years altogether from professional business, in consequence of an enfeebled state of mind, unassociated with aberration of intellect, or lesion of the sensor or motor power. This gentleman acknowledged that for thirty years he had not been for seven continuous days absent from the anxious and responsible duties of his office! Two years prior to his decease, symptoms of cerebral amaurosis were recognised, and he nearly lost all visual power. During this time, he was subject to acute attacks of headache, accompanied with great depression of spirits, and distressing paroxysms of extreme nausea, and sometimes of vomiting. He suddenly, one day after dinner, became hemiplegic, and in a few weeks died! A tumour was found in close proximity to the optic thalamus, undoubtedly interfering with the special functions of this ganglion. In a third case, an officer who had gone successfully through several East India campaigns, became gradually imbecile. All the faculties of the mind, simultaneously, were debilitated and deteriorated. This did not manifest itself at first in a loss of any particular mental function, such as the memory or attention, but the whole powers of the mind appeared to gradually fade away, and succumb to a mysterious, inexplicable, and destructive influence. This patient continued in a chronic condition of imbecility for many years. After death, the brain was found in a state of sad disorganization! The dura mater and tunica arachnoidea were much thickened, and on the former was discovered a considerable extent of tubercular deposition. The calvarium was indurated (the diploe being entirely obliterated), the brain much

atrophied, and in some portions, in a softened state. In this instance, there were no delusions or other symptoms of aberration until a year and a half before death !*

In the early stage of cerebral or general paralysis, the patient often acts as if he had (mentally) lost all confidence in himself. He rarely acknowledges that such is the fact, but exhibits in his conversation and deportment evidences of a state of enfeebled mind, paralysed or vacillating will. These symptoms I have known to exist for years antecedently to the development of any clearly manifested sign of disease of the brain or disorder of the mind. A gentleman, who eventually died of cerebral paralysis, two years before there was any recognition of disease of the brain, was reduced to a state of complete childish and slavish dependence upon those about him. It was an unusual occurrence for him to write a letter, or reply to one. His wife or eldest son generally discharged these duties for him. Letters addressed to him on important matters of business remained sometimes unopened for several days. In consequence of this neglect, his wife was in the habit, occasionally, of searching his pockets, and when letters with unbroken seals were put into his hand, he merely exclaimed, with apparent surprise, "oh dear me, how careless I have been!"

There was no obvious want of capacity, neither were there marked symptoms of imbecility in this case, until the expiration of the period previously specified. Strangers

When speaking of the lesions of intelligence that precede, or accompany, diseases of the brain of an apoplectic type, Andral remarks (when recapitu lating the morbid psychical phenomena observable in cerebral affections) :"Many patients preserve all the clearness and strength of their intelligence up to the moment of the apoplectic attack. In others there are observed, a shorter or longer time before this period, some changes in the intellectual faculties; sometimes they are, as it were, benumbed. Many, on the contrary, manifest an extraordinary degree of excitement. Some lose their memory; there are moments when they know neither where they are, what they do, or what they say."-Andral's Clinique Médicale.

never observed in this patient any diminution of mental vigour; but those in constant and loving association with him, and well acquainted with his previous condition of mind, were painfully observant of the gradual and insidious advances of his brain disorder and mental decrepitude. They could not but notice his singular and unnatural want of interest in his professional affairs, shown by his absenting himself from chambers and neglecting other important duties. His marked indifference to his children, and apparent loss of affection for his wife, without exhibiting any insane alienation of feeling, was also a significant symptom, quoad his state of mind, for he caressed his wife and children with his usual warmth of affection, when his attention was directed specially to them by others, and he was twitted for his coolness and neglect. He was in the habit of sitting for hours, turning listlessly over the pages of a number of favourite books, and looking through portfolios of engravings and drawings, without apparently knowing what was occupying his attention. During the whole of this time he was fully capable of discussing, when the subject was suggested to him by others, the merits of any particular book or painting (for he was a man of great taste, and had a large and valuable library, and many first-class works of art in his house), but associated with this apparent, but factitious power of concentrating his mind to, and considering any given subject, his intellectual brightness and vigour were gradually fading into the dark regions of imbecility!*

After death, the relations found secreted in the pockets of the gentleman's clothes and in the house, a number of letters relating to important matters of business, unopened, and of course unreplied to. Many of these letters were of old date, and some contained remittances of money. One envelope contained a Bank of England note for 1007., which had been transmitted fourteen months previously, and which was supposed to have been stolen or lost. At this time none of the family suspected anything wrong with his brain or mind.

I cite the preceding cases with a view of establishing that serious fatal structural disease of brain may occasionally be preceded by no other symptom than loss of mental power. Undoubtedly many instances occur of great impairment of mind resulting from exhaustion of the psychical and nerve force, quite unconnected with apparent organic change in the structure of the brain.

It is occasionally the duty of the physician to see and prescribe for such cases. They often, alas! baffle his best and most assiduous attempts at cure. Occasionally, however, it is his pleasure to realize the beneficial effect of continuity of remedial treatment in restoring the mind. to its original vigour, and that, too, in cases often justifying the most unfavourable termination.

In the preceding illustrations of that form of mental weakness, clearly arising from an abnormal exercise of the mind, and preternatural exhaustion of the vital energies, the nutrition of the brain is, in many instances, manifestly and often seriously impaired.

CHAPTER XII.

Morbid Phenomena of Attention.

THIS subject will be analysed as follows:-
1. Impairment of Attention.

2. Heightened or Exalted Attention.
3. Concentration of the Attention.

The faculty of attention is one of the most important of the varied powers of the mind. Without its possession, the understanding would be a blank. If we had no voluntary capacity to direct the thoughts to objects of consciousness, how abortive would be the attempt to expand, discipline, and improve the intellect?

"The difference," says Sir W. Hamilton, "between an ordinary mind and the mind of Newton, consists principally in this, that the one is capable of the application of a more continuous attention than the other; that a Newton is able, without fatigue, to connect inference with inference in one long series towards a determinate end; while the man of inferior capacity is soon obliged to break or let fall the thread which he had begun to spin. This is, in fact, what Sir Isaac Newton, with equal modesty and shrewdness, himself admitted. To one who complimented him on his genius, he replied, 'that if he had made any discoveries, it was owing more to patient attention than to any other talent.'"*

"Lectures on Metaphysics."