A lady, a fortnight before her mind was considered to be deranged, was in the habit of waking her husband several times during the night, imagining that she heard the voices of persons in the room or in some part of the house. On one or two occasions she declared that she distinctly recognised the voice of her mother (who was then in New Zealand) calling her by name, and begging her, in accents of the deepest distress, to come to her. The patient insisted upon getting up and examining the whole of the house before she would be persuaded her mother was not there. At this time no one suspected that these were incipient symptoms of insanity.

These illusions of hearing often lead to a sad sacrifice of life, occasionally impelling its unhappy victim to the commission of both murder and suicide. Under the irresistible influence of an imaginary voice, many a patient is driven to acts of violence and homicide. Occasionally, the illusions of hearing are of a double character, that is, the patient is subject to the influence of two distinct voices, a good and a bad voice; one inciting him to sacrifice life, the other a restraining voice, begging and imploring the patient not to yield to his dangerously insane impulses. "My bad voices urge, my good voices restrain me," was the remark of a patient who believed himself to be demoniacally possessed. "I should have destroyed myself long ago," said an insane person to Dr. Morel, “or I should have killed somebody else, if the voice of my good angel had not begged and encouraged me to suffer."

Patients are often seen contending with these antagonistic illusions, or "double voice," as Morel designates the phenomenon. In one ear the most frightfully obscene ideas are suggested; whilst at the same moment, in the opposite one, sentiments of the greatest purity will be whispered to the disordered imagination of the sufferer. These antagonistic and opposing illusions lead to fearful

contests, and produce a sad amount of mental agony. "Which voice ought I to obey ?" said a delicate and sensitive-minded patient to me one day after a fit of hystericomaniacal excitement. "I am urged by persons that address me on my right side to utter blasphemous and indecent expressions, and to commit acts the most repugnant and repulsive to my nature; whilst in the opposite ear I clearly recognise a tender voice (conscience?) beseeching me not to yield to the fearful temptations of Satan, but to battle with his vile and wicked suggestions." Another patient was urged by a voice to destroy himself. He was commanded to cut his throat. The words, "blood," "blood," "blood," were repeated with terrible emphasis, and in rapid succession to him; and on more than one occasion he was discovered with a razor in his possession, seriously contemplating an act of self-destruction. This gentleman was subject to the influence of the double voice, for at times when the word "blood" was ringing awfully in his ear, and an "air-drawn dagger" stained with gore, glittered before his eyes there stood, as he imagined, on the opposite side of his body a good spirit whispering to him texts of Scripture, repeating verses of hymns applicable to his then state of mind, and imploring him in most affectionate and touching language, not to eternally damn his soul by destroying his own life.

MORBID PHENOMENA OF TASTE, TOUCH, AND SMELL.These senses exhibit, occasionally, at the commencement of cerebral disease, evidence of impairment, exaltation, and perversion. Prior to the development of the more characteristic symptoms of disease of the brain, the patient complains of a morbid condition of taste, of abnormal states of the tactile sensibility, and of perversion of the sense of smell. In all affections of the brain and mind associated with derangement of the digestive organs, the latter sense is observed to be greatly

affected; but there is no special and characteristic symptom in connexion with either of them pathognomonic of the commencement of organic disease of the brain.

The insane, in the incipient stage of their malady, are often heard to complain of being exposed to the influence of most offensive and noxious smells. The predominant odours noticed by patients in the early period of their mental alienation are those of sulphur and putrid bodies.

A lady declared that her inside was in a state of putrefaction, a fact she recognised by a particular exhalation from her body for some months before her intellect was palpably deranged. She was frequently heard to complain of the offensive odour, but no one suspected her mind to be in the slightest degree affected, until one morning she left home before breakfast, and going to a neighbouring police-station, accused herself of having committed a serious criminal offence.

The tactile sensibility is frequently observed to be disordered in the early stage of paralysis. The patient will be heard to complain of a feeling of numbness or want of sensation in the ramifications of the nerves at the tips of the fingers. This condition of anæsthesia often extends to the fingers, and sometimes to the whole of the hand. I have known this local impairment of sensibility to exist for many months previously to the recognition of more decided manifestation of disease of the brain. This lesion of sensation often precedes attacks of general paralysis. Professor Simpson, of Edinburgh, has alluded to the morbid phenomenon. Patients suffering from incipient general paralysis, he says, often complain of their fingers "feeling like sausages. A tailor who died of this disease, lost all sensation at the tips of his fingers for twelve months previously to any suspicion existing as to

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*During a discussion at the "Medico-Chirurgical Society of Edinburgh," on a paper read by Dr. David Skae on "General Paralysis of the Insane," Feb. 1, 1860.

the healthy state of his brain. He was unable to work with his needle, as he never knew, owing to the anesthesia, when he had it between his fingers.

I have referred in a previous part of this volume to the loss of sensation that occasionally occurs at the peripheral terminations of the nerves in the incipient stage of paralysis. Dr. Todd cites a case of hemiplegia that commenced six months prior to admission into King's College hospital, with a sensation of tingling and pricking in both hands, and a considerable amount of numbness about both elbows, just as if the ulnar nerve had been jarred, or in the patient's own words, as if he had struck his funny-bone. Accompanying these symptoms there was a sensation of heat in the fore-arms, and he soon became unable to button his clothes or pick up any small object with his right hand.

Occasionally, the sensation at the tips of the fingers will be observed in a state of great exaltation. A morbid irritation in this part of the hand often co-exists with insanity, as well as with other types of nervous disorder. The habit of biting the nails to the quick, and gnawing the tips of the fingers is very common among the insane. In many cases of mental exaltation, irritation, hysteria, and anxiety, unassociated with insanity, there is often manifested a morbid degree of exalted tactile sensibility. This local hyperæsthesia is occasionally observed among the incipient symptoms of mental derangement. A lady who has had several attacks of insanity, is annoyed by an intense irritation at the ends of the fingers, for some weeks previously to positive alienation of mind exhibiting itself. Her family are able to predicate the approach of the paroxysms of insanity by this symptom. It is difficult to explain physiologically or pathologically the relation between certain cerebral and mental disorders and this type of exalted local sensibility.

CHAPTER XXIII.

Morbid Phenomena of Sleep and
Dreaming.

THE phenomena of sleep are so closely identified with, and so intimately dependent upon, the state of the brain, that the varied affections of the sensorium (functional as well as organic), are usually accompanied by some deviation from a normal state of this important function.

The morbid affections of sleep will be considered in the following order :

a. A State of Sleeplessness, or Insomnia. B. An Abnormal Disposition to Excess of Sleep.

7. Morbid Phenomena of Dreaming.

The first division of the subject embraces the many gradations of insomnia, ranging from a simple state of restlessness, to a disturbed, eccentric, irregular, cerebral repose (pavores, jactatio), and unrefreshing condition of slumber, to a state of positive insomnia, or sleeplessness.

The second section of the subject will embody a brief analysis of certain morbid dispositions to excess of sleep, designated, according to the extent of the symptoms, by the nosological phrases sopor, coma, carus, lethargus.

There is no symptom, when viewed in relation to the health of the brain and mind, that requires more careful