her that she had been under the influence of an agitated dream. She stoutly persisted in maintaining the reality of her vision. During the whole of that day she was clearly insane; but on the following morning the mind appeared to have recovered its balance. She continued tolerably well mentally for four years, with the exception of her occasionally having moments of despondency, arising from real or fancied troubles. At the end of the fifth year she gave birth to a child. Seven months afterwards, she went to bed apparently as well as usual. In the middle of the night she got up, without apparently knowing what she was doing, and cut her child's throat with a razor. The wound, however, was not fatal. When requested to explain why she had attempted the life of her child, she replied, that she had been ordered during the night to murder all her children, as well as herself. When taken into custody, she expressed no regret for what she had done, but appeared to entertain a great fear of punishment. During the night of the murder, her husband states that she was unusually disturbed. It is conceived that the hallucination which led to the commission of the murder occurred during a dream. This woman was tried and acquitted on the ground of insanity, and is now confined in Stafford County Lunatic Asylum.

Suicide has been committed under analogous circumstances. A person, apparently well, has gone to bed without manifesting the slightest tendency to selfdestruction, and being suddenly aroused from a frightful dream, has destroyed himself.

An old lady, residing in London, awoke in the middle of the night, went down stairs, and threw herself into a cistern of water, where she was found drowned. The suicide was supposed to be the result of certain mental impressions originating in the mind during a dream.

Dr. Pagan refers to the following interesting case, to prove that murder may be committed by a person when under the effects of a frightful vision:

"Bernard Schedmaizig suddenly awoke at midnight; at the moment he saw a frightful phantom, or what his imagination represented as such-a fearful spectre! He twice called out, Who is that?' and, receiving no answer, and imagining that the phantom was advancing upon him, and having altogether lost his self-possession, he raised a hatchet which was beside him, and attacked the spectre, and it was found that he had murdered his wife."*

A pedler, who was in the habit of walking about the country, armed with a sword-stick, was awakened one evening while lying asleep on the high road by a man suddenly seizing him, and shaking him by the shoulders. The man, who was walking by with some companions, had done this out of a joke. The pedlar suddenly awoke, drew his sword, and stabbed the man, who soon afterwards died. He was tried for manslaughter. His irresponsibility was strongly urged by his counsel, on the ground that he could not have been conscious of his act in the half waking state. This was strengthened by competent medical witnesses. He was, however, found guilty, and, I think, most unjustly punished.†

* "Medical Jurisprudence of Insanity," by Dr. Pagan. London, 1840. "Medico-Chirurgical Review."

CHAPTER XXIV.

Morbid Phenomena of Organic and
Nutritive Life.

THIS division of the subject will be briefly considered in the following order :

DIGESTION AND ASSIMILATION.-Owing to the close and intimate sympathy existing between the brain, organs of digestion, and in fact the whole of the chylopoietic viscera, we are usually able to detect, in association with cerebral diseases, functional disturbances of the digestion and nutrition, often giving rise to serious complications. These symptoms, however, are often altogether overlooked, in consequence of their being masked by the more prominently developed signs of local head affection or psychical disorder.*

In the early stage of insanity, the stomach exhibits evidences of great functional derangement. The appetite

* Willis, as quoted by Morel, says Dr. Griesinger, relates a remarkable case of a lady whose health had been injured by profound grief. One day, after having eaten a very indigestible cake, she was seized with a feeling of burning heat in the precordial region. There followed an instantaneous sensorial delirium. She imagined that the upper part of her body was on fire. She took a spring, and precipitated herself into the street, crying out that she was cursed by God, damned, and that she already was experiencing the punishments of hell. The same delirium was reproduced as soon as this lady experienced the same physical sensation.

fails, the powers of digestion become impaired, the secretions vitiated, the liver disordered, and the bowels act with great irregularity, or are obstinately costive. The gastric affection is recognised by foetid breath, coated tongue, anorexia, sometimes amounting to loathing of food, deficient hepatic secretion, and great depression of spirits. The patient complains of flatulence, cardialgia, and acidity of the stomach. Occasionally, there is extreme nausea, and often actual vomiting. The presence of constant sickness, when it cannot be clearly traced to an idiopathic affection of the uterus, kidney, or stomach, is significant of functional or organic disease of the brain, particularly when connected with headache, vertigo, and other indications of local cerebral disturbance. These symptoms will be considered more in detail in the succeeding chapter.

In tumours of the brain, the patient will be often heard to complain not only of irritability, but of a disposition to vomit. The nausea so induced in a remarkable manner resembles that preceding or accompanying seasickness. The patient is rarely, if ever, actually sick, but he constantly feels so at the stomach. This sensation of nausea is occasionally observed more prominently manifested on first rising in the morning. The patient, when washing, or whilst shaving, will be suddenly stopped by an inclination to vomit. A person who was troubled by this symptom, caused by a cerebral tumour, remarked that it appeared as if he were constantly rolling about in a boat at sea, or repeatedly under the influence of small doses of tartar-emetic or ipecacuanha. I have observed this symptom in some cases of abscess of the brain. A gentleman, who died suddenly of this disease, was annoyed for some months previously to his decease by a troublesome and depressing sensation of For some time this symptom was supposed to

nausea.

arise from disordered state of the stomach, and he was treated for this affection. After examining the case several times, I diagnosed disease of the brain (tumour). There was associated with the nausea severe vertigo, and paroxysmal attacks (somewhat localized) of headache. The cerebral abscess was considered to be the effect of a severe injury inflicted upon the head by a fall from a horse, whilst hunting, ten years previously.

The sensation of nausea, not amounting to actual vomiting, is occasionally symptomatic of acute and chronic softening of the brain. It often indicates the commencement of inflammatory and congested encephalic conditions. In the obscure cerebral diseases of children, the presence of irritability of the stomach, clearly not connected with gastric or intestinal derangement, is an important diagnostic symptom.

Chronic disorders of the digestive organs frequently precede, are associated with, if they do not operate as the direct cause of, various types of mental derangement. A morbid state of the liver, stomach, and bowels is seen prominently manifested in all forms and degrees of insanity. These gastric disturbances and visceral complications are often observed in an advanced position throughout the whole course of the malady. They give character and persistence to the mental impressions. In consequence of these physical derangements, patients are often led to believe that they have been or are being poisoned, and under such hallucinations obstinately refuse all nourishment. In such cases, there is generally found clear and unmistakeable evidence of serious disorder of the stomach, disease of the liver, or chronic irritation of the mucous membrane of the bowels. The breath is foetid, the tongue furred, the secretions vitiated, bowels inactive, and appetite either altogether lost or extremely vitiated. Under these circumstances, there is a positive loathing of food.