to have been a sort of abortive or suppressed epilepsy; or again, the epileptic convulsions shall cease, and in place of them attacks of moral insanity with more or less maniacal excitement occur. There can be no question in the minds of those who have studied mental diseases that certain unaccountable criminals belong to the class of epileptics.1

Thus much concerning the group of symptoms which I have made into a second variety of affective insanity-Moral Insanity. When we look into its antecedent conditions we perceive them to be such as are known to be hurtful to the brain or to mark disorder of it: the destruction of the moral sentiment is an early effect of such deterioration of the mental organisation, as any one may recognise, if he will, in the demoralisation which alcoholic excesses and the excessive use of opium notably produce. The facts being what they are, it is not a little surprising that people should go on maintaining that the moral sense is independent of physical organisation. All observation shows that it is as essentially dependent upon a physical basis as is the humblest mental function of man or animal. If the evidence drawn from the nature and causation of moral alienation were insufficient, the fact that it is often the immediate forerunner of the severest mental disease might suffice to teach its true pathological interpretation. When, therefore, a person in good social position, possessed of the feelings that belong to a certain social state, and hitherto without reproach in all the relations of life, does, after a cause known by experience to be capable of producing every kind of insanity, suddenly undergo a great change of character, lose all good feelings, and from being truthful, temperate and chaste, become a shameless liar, profligate, intemperate, and perhaps a thief, then it will certainly be not an act of strained charity, but an act of bare justice, to suspect the effects of disease. At any rate it behoves us not to be misled in our judgment by the evident existence in such a patient of a full knowledge of the nature of his acts-of a consciousness, in fact, of right and wrong; but to remember that disease may

1 Morel, D'une Forme de Délire suite d'une Surexcitation nerveuse se rattachant à une Variété non encore décrit d'Épilepsie: 1860. J. Falret, De l État Mentale d'Épileptiques.

weaken or abolish moral feeling and the power of volition with out impairing consciousness. Fortified by this just principle, we shall be in better case to interpret rightly the facts than when biassed or blinded by the opposite erroneous principle.

I pass now from the consideration of the symptoms of affective derangement, which exist alone in some cases and in so many other cases go before distinct intellectual derangement. By considering them apart, as I have done, before going on to treat of the varieties of intellectual alienation, we get a truer conception of the evolution of insanity, and therefore a more natural history of morbid psychology, than if we were to proceed otherwise. Moreover, there is the practical gain of bringing into prominent relief grave phases of mental derangement which oftentimes fail to obtain due attention, albeit they have certainly not been overlooked; for the Mania sine delirio of Pinel, the Monomanie raisonnante ou sans délire of Esquirol, the Monomanie affective of the same author, and the Moral Insanity of Prichard are different names that have been used to denote them. From a social point of view these morbid states are more alarming than positive intellectual derangement; for they mark a condition in which, dangerous hallucinations and impulses are apt to occur suddenly, and the tendency of which is, feeling-like, to express itself in deeds rather than in words.

CHAPTER VIII.

THE SYMPTOMATOLOGY OF INSANITY—(continued).

Melancholia.

We believe not, as did the ancients when they gave it its name, that melancholia is caused by black bile (uéλas xoλn), but there is no doubt that the depression of mind which oftentimes goes before a genuine attack of the malady is very like that mood of gloom which a sluggish, ill-secreting liver occasions; when, without any change in external circumstances, the only change being in him, the person feels irritable, gloomy, apprehensive, suspicious. The antecedent symptoms of melancholia may indeed be summed up concisely as lowness of spirits, groundless forebodings of coming evil, and brooding abstraction. There is much mental suffering during this preliminary stage: the individual's self-confidence in thoroughly shaken, and he is in a distressing state of exaggerated susceptibility; apprehensive vaguely of some calamity being about to happen to him, and fearful of hearing or reading of any painful incident because it makes a terrible impression upon his mind and he dreads lest the like may happen to him; cannot go near a railway engine or a precipice or over a bridge lest the idea of putting an end to himself should take possession of him and overpower him; if he reads or hears mention of a disease is in instant distress for fear he shall have it; is afraid of doing something trivial and innocent lest he should be doing wrong, conscious all the while how foolish his fears are, which, nevertheless, he cannot shake off; imagines that preachers whom he hears are preaching

at him, and books that he reads write at him; thinks of some mistake or omission, real or fancied, that he has made in his business, magnifies it mightily, and torments himself continually with remorseful reflections thereupon. He has lost all estimate of proportion, and his mind is fascinated by the very horror or anguish which a painful idea, holding it in its grasp, occasions him; not because there is ground for the exaggerated idea, but simply because it is of a painful character. Before he fell into this "nervous" condition, as he calls it, he has had bad sleep and bad dreams, and has probably suffered some slow drain upon his vital energies, physical or mental,- from worries in business, from pecuniary anxieties, from domestic troubles, from exhaustion by illness or by excesses, and the like; but because of the sadness which is the main feature of his condition there is always a disposition on the part of friends to look out for grief as a cause, and when no cause of grief is discovered to suspect or to assume a secret cause thereof.

This is the common mode of onset of melancholia, but in some instances it has come on very suddenly, in consequence of a severe mental shock, such as the abrupt announcement of the sudden death of one who was very near and dear: the person has been thrown instantly into a state of apathetic stupor and despair,―a sort of tonic spasm of mental anguish with paralysis of all other mental functions. I remember the case of a gentleman's coachman who fell into that state of apathetic melancholy which is known as melancholia cum stupore, or melancholia attonita, on making the startling discovery of his wife in the act of adultery with his master. More often, however, the natural grief which a sad bereavement occasions passes by slow degrees into a morbid depression, in which the person accuses himself or herself of imaginary sins of omission or commission, broods over them continually, is full of self-reproach, abandons occupations and interests, and is at last quite indifferent to family, to affairs, and to all other urgent present claims. Before the profound change of feeling took place the patient has sometimes been distressed by a strange giddiness or numbness or other indescribable sensation in the head, or has perhaps felt as if something had suddenly cracked there.

At the beginning of melancholia in most cases, and throughout the disease in some cases, there is no definite delusion; the person is simply morbidly melancholic, suffering from melancholia simplex or melancholia sine delirio, as this condition of affective disorder has been called. But he is profoundly changed notwithstanding: his feelings regarding persons and events are strangely perverted, so that impressions which would naturally be agreeable are painful, and the attentions of his relatives occasion irritation or actual distress; he has no interest in his family or in his affairs, feels as if a cloud had settled upon him, or a veil had been let down between him and them, since things seem not real, as formerly, and it appears to him that he moves about in a sort of dream; he shuns society, which is distressing to him, cares not to do any work, neglects his personal appearance, sinks into inactive brooding, and ends, perhaps, if permitted, by lying in bed all day. All this while he is quite conscious of his unnatural state, and perhaps bursts into tears as he bewails it; he torments himself with reproaches because he has lost all natural affection; he would give anything in the world to be himself again, and cannot conceive why he is so miserably changed from what he was. After a time, commonly by degrees, but it may be suddenly, an overwhelming idea takes form in his mind that he is ruined in business, or that he has been guilty of some crime, or that he has committed "the unpardonable sin," or that he is a burden upon his family and ought to rid them of it by suicide; the vast and vague feeling of profound misery has taken form as a concrete idea of wrong-doing-has condensed, as it were, into a definite delusion which is the fitting expression of it. Sometimes the horror of the condition is aggravated by the sudden and startling way in which the delusion has arisen and taken hold of the mind; instead of having been gradually evolved, as it usually is, coming and going several times, so as to be divested of some of its horrors by familiarity before it is mature, it has started into activity instantly and unexpectedly-perhaps on the person's awaking out of sleep-entirely overwhelming reason and producing an alarming feeling of utter helplessness. I have known a suicidal and a homicidal idea to surprise and take captive the