pathological state of the insane, with the view of detecting, at the earliest possible period, the presence of certain physical complications often seriously interfering with the mental recovery of the patient, and proving perilous to his life.

I have known patients suffering from active inflammation of the pleura as well as lungs, repudiate all idea of indisposition. A gentleman, who had a large calculus in his bladder, declared that it gave him no kind of uneasiness. Had he been sane, exhibiting an abnormal degree of sensibility, I am satisfied his agony would have been intense. I have witnessed operations of a very painful character performed upon the insane without giving rise to any apparent disturbance of their sensibility.

I have not yet referred to the anesthesia of the insane resulting from the preoccupation or intense absorption of the imagination, in some fearful hallucination of the mind, or all-engrossing monomaniacal illusion of the senses. I have no doubt that much of the apparent physical insensibility of the insane arises from this cause. Insanity often effectually masks and obscures all evidence of organic sensibility, the greater malady effectually paralyzing the functions of the sensor nerves.

When Lear, Kent, and the Fool are standing alone on the wild heath, exposed to the raging of the pitiless storm, Kent affectionately and feelingly implores the king to seek shelter in an adjoining hovel from the "tyranny of the open night." In answer to this appeal, Lear exclaims:

"Thou think'st 'tis much, that this contentious storm

Invades us to the skin: so 'tis to thee;

But where the greater malady is fixed,

The lesser is scarce felt;

The tempest in my mind

Doth from my senses take all feeling else,

Save what beats there."

Analogous psychical and physical phenomena are exhibited in certain conditions of morbid exaltation of the conscience in connection with the religious and superstitious observances of barbarous and uncivilized nations. Persons have been known, after having excited themselves to the highest pitch of enthusiastic ecstasy, to burn, cut, and maim their bodies in the severest pos

VITIATED SENSATION.

447

sible manner, without exhibiting the slightest symptom of sensibility.1

VITIATED SENSATION.-In the incipient stage of various forms of cerebral disease, the sensibility is not only heightened, impaired, and paralyzed, but it shows marked evidence of being vitiated. The patient complains of the existence of pricking sensations in various parts of the body, as well as of the existence of formication, particularly at the extremities of the fingers and toes. For some time previously to the development of well-marked symptoms of cerebral disease, a patient remarked that everything he touched was extremely cold. In some cases a gritty body, like that of sand, and a piece of cloth, appeared to be interposed be

1 Mr. Catlin, in his "Notes on the North American Indians," vol. ii, p. 170, refers (and the facts he records afford a good illustration of the effects of intense mental preoccupation in blunting the sensibility) to the self-imposed tortures of the Mandan Indians, for the purpose of qualifying themselves for the honored rank of warriors. "One at a time the young fellows, already emaciated with fasting, and thirsting, and waking, for nearly four days and nights, advanced from the side of the lodge, and placed himself on his hands and feet, or otherwise, as best adapted for the performance of the operation, where he submitted to the cruelties in the following manner. One inch or more of the flesh of each shoulder was taken up between the finger and thumb by the man who held the knife in his right hand, and the knife, which had been ground sharp at both edges and then hacked and notched with the blade of another, to make it produce as much pain as possible, was forced through the flesh below the fingers, and being withdrawn, was followed by a splint or skewer from the other, who held a bundle of such in his left hand, and was ready to force them through the wound. There were then two cords lowered down from the top of the lodge, which were fastened to these splints or skewers, and they instantly began to haul him up: he was thus raised until his body was just suspended from the ground where he rested, until the knife and a splint were passed through the flesh or integuments in a similar manner on each arm below the shoulder, below the elbow, on the thighs, and below the knees. In some instances they remained in a reclining posture on the ground, until this painful operation was finished, which was performed in all instances exactly on the same parts of the bodies and limbs, and which, in its progress, occupied some five or six minutes.

"Each one was then instantly raised with the cords, until the weight of his body was suspended by them, and then, while the blood was streaming down their limbs, the bystanders hung upon the splints each man's appropriate shield, bow, quiver, &c., and in many instances the skull of a buffalo, with the horns on it, was attached to each lower arm and each lower leg, for the purpose, probably, of preventing, by their great weight, the struggling which might otherwise take place to their disadvantage whilst they were hung up. When these things were all adjusted, each one was raised higher by the cords, until these weights all swung clear from the ground.

The unflinching fortitude with which every one of them bore this part of the torture surpassed credibility."

tween the patient's fingers and whatever they came in contact with. Other invalids have affirmed, that whatever they touched felt like a piece of velvet. Andral notices this phenomenon.1 Six weeks before a paralytic attack, a patient complained of onehalf of the scalp feeling like a piece of leather. In the case of a gentleman who died of apoplexy, there was for some time previously to his illness a feeling in both hands as if the skin were covered with minute and irritating particles of dust or sand. He repeatedly complained of this symptom, and was frequently observed to wash his hands with the view of removing the imaginary annoyance. Impairment of sensibility in the arm, preceded first by a feeling of intense cold in the part, and subsequently of numbness, followed this perverted state of the sensation. The patient had also slight paroxysmal attacks of headache, and, occasionally, considerable confusion of thought. In another case, some time prior to a paralytic seizure, the patient imagined that he had extraneous particles of dirt and stones in his boots, or inside his stockings, irritating his feet, and interfering with his personal comfort, as well as freedom of locomotion. This perverted state of the sensation was observed for two months previously to his attack of acute cerebral disorder.

1 He terms it the "velvet-like sensation" accompanying the alterations of sensation preceding attacks of paralysis and softening.

CHAPTER XXI

MORBID PHENOMENA OF THE SPECIAL SENSES.

THIS section of the subject will be considered in the following order :

:

a. Sight.
B. Hearing.
r. Taste.

8. Touch.
ε. Smell.

In estimating the value of all morbid evidences of the special senses, supposed to be symptomatic of brain disease, we must carefully consider their normal state, making proper allowances for any previously existing idiosyncrasies in their mode of action. The sense of vision, of hearing, &c., is occasionally seen extraordinarily acute. I have known individuals in whom the sense of smell and taste was so exquisitely developed, that certain substances and odors produced a severe degree of mental torture, when brought in contact with the gustatory and nasal organs. The slightest particle of ipecacuanha has caused violent vomiting in certain nervous temperaments. In other instances, the smell of rhubarb has produced a severe action upon the bowels, and the faintest odor of aloes has affected, in a marked manner, the lower portion of the bowels. It is literally true that a person may

"Die of a rose in aromatic pain,"

for there exists among the North American Indians a tribe whose mode of punishment consists in subjecting their prisoners to the influence of the odors of certain plants. This produces the most exquisite mental distress and bodily pain; and occasionally, if the

prisoner be exposed long to its influence, death has been known to

ensue.

It is said that in some portions of China, and in the South Sea Islands, the natives are in the habit of exposing their victims as a punishment to what Falstaff terms, the "rankest compound of villanous smells."

We occasionally observe unnatural manifestations and exquisite conditions of the sense of seeing, hearing, touch, and taste, quite apart from disease of the brain. In some persons the sense of hearing is in an exalted state of manifestation, the slightest sound coming from remote distances being at once perceptible. Celebrated musicians, owing in the first place to the natural vigor and acuteness of the sense of hearing, and, secondly, to the careful education and long-continued exercise of this faculty, have had this special sense in a high state of activity. It is said of Mozart. that, during the performance of a most complicated piece of concerted music, he was able, among several hundred musicians, to detect with wonderful precision and quickness the slightest deviation from the correct score. He was able also to name the instrument that was at fault. Any aberration of harmony produced the most painful sensations in the nervous system of this wonderful musical genius.

Among blind persons we often notice an extraordinary capacity of recognizing objects by the sense of touch. A person who became blind at an early period of life, was able to distinguish individually, by means of the touch, a number of botanical plants, and to single them out with wonderful accuracy. We occasionally witness, as the effects of certain diseases, particularly of the nervous system, a great acuteness in the capacity of the special senses, as well as positive perversion in their modes of action.

I have known instances in which the sense of hearing and smell have become painfully sensitive after recovery from attacks of fever, conditions of nervous debility and exhaustion. In other cases the various special senses have been perverted, or their functions either diminished in power, or entirely lost.

Dr. Heberden records the particulars of the following case: "A man about forty years old had in the spring a tertian fever, for which he took too small a quantity of bark, so that the returns of it were weakened without being removed. Three days after his last fit, being then employed on board a ship in the river, he