mate cause of insanity, where there are adequate physiological conditions to account for the genesis of the disease, is to mistake the relative importance of two classes of causes,

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246. Religion considered in connection with the Causality of Mental Disease. Some writers have placed religion amongst the list of those things which predispose to insanity. They might, with equal justice, have placed life as the predisposing cause of all insanity. It is true that certain forms of religious excitement do tend to foster insanity, but it is equally true that certain kinds of life lead directly to the abnormal condition of mind which we call insanity. It seems to us that religion should be looked upon not as a cause conducing to disease, but as one of those causes which has a most sanitary effect, not as a series of circumstances tending to mental degeneracy and insanity, but as a series of circumstances directly tending to mental improvement and health. Yet we do not deny the fact, that those somewhat excited religious gatherings which have taken place of late years, in which the Lord Jesus is expected to be found in the midst of many fears, much shouting, and an occasional attack of hysteria, do tend directly to mental unsoundness. We would not argue that the extreme form of High-Churchism-the most material form of Christian worship, in which symbolism really often loses its soul, and has nothing but the body left-that the constant and all-absorbing exercises of that form of religion, accompanied as it is with much unhealty self-examination, and a self-bruising asceticism, will not in many cases predispose to insanity. But we do argue, that religion in its fullest sense, and religion as patterned in the life of Him whose name is connected with the creed of this country at the present time, is not calculated to predispose to insanity, but that, on the contrary, it is calculated to predispose to the most perfect mental health, that it is necessary to that perfect health, and that the human mind finds in that creed, when it is thoroughly understood and earnestly believed, the most thorongh and perfect guide to a life of soberness and chastity, faith and well-doing, which are the very conditions of health in the individual practicing according to these rules, and of its transmission to those that are to come after

him.' It is the fashion among a certain class of thinkers to hold that sanity consists in the absence of all prejudiceseven Voltaire's one prejudice, the préjudice de Dieu-and so to those persons religion and its systems seem prejudicemanufactories, [33] and thus causes which predispose to insanity. Prejudices! If it were not for prejudices, not a man on earth would be sane, not a man on earth would be.

47. Of Predisposition generally.-To sum up what has already been said as to the relation of remote causes to the diseases of the mind, we may say that whatever has the effect of debilitating the physical structure, or the moral and intellectual faculties, has more or less tendency, according to the character of the individual, to predispose to mental disease. Moral vices, excessive mental strain, great anxiety, and unusual excitement, all predispose to alienation of mind. Individual temperament, in the widest sense of the term, must be taken into consideration in every case.

248. Proximate or Exciting Causes.-An exhaustive treatment of the exciting causes of insanity can only find place in a work on the pathology of mind. In this place, the mention of some of the causes which lead directly to insanity must suffice. It must be remembered that the cause which in one case may be looked upon as exciting, must, in another case, be regarded as predisposing. Malformations of the brain-dependent, it may be, upon morbid changes in the skull, the defective development or the arrest of growth of this organ-are all causes which operate powerfully to produce mental unsoundness. The brain-weight in microcephalous idiocy is not only small when compared with the brainweight of healthy individuals, but the relative weight of the brain to the body of the microcephalous idiot is very much less than the relative weight of the brain to the body of a person in normal health. Injuries to the head which have produced lesion in the structure of the brain, or which have caused disease which has led to a partial disorganization of

1 Mr. Disraeli, in his speech delivered to the students of the University of Glasgow (19th November, 1873,) said: "Religion invigorates the intellect and expands the heart."

the part, may be looked upon as exciting causes of mental unsoundness. Tumors in the brain, and many of the alterations produced by organic disease in the cerebrum and its membranes, also proximately conduce to insanity. Starvation and exposure to intense pain, extreme fatigue, as well as apoplexy, palsy, epilepsy, and convulsions of all kinds, are, as it were, open doors to insanity. The sympathy which exists between every part of the bodily organism—

"Each part calls the furthest brother,

For head with foot hath private amity"

leads in many cases to abnormal mental action, either on account of functional derangement, or on account of the structural disease of some remote part. But there seems to be a more intimate "private amity" between the brain and its neighbors, the stomach, the liver, the intestines, and uterus, than there is between the head and foot. Insanity grows like a graft upon many other diseases, but in certain cases the existence of insanity at the same time as a bodily disease does not seem compatible. Insanity arises not unfrequently upon the suppression of an accustomed discharge, and often accompanies irregularities in the menstrual secretion.

49. The Moral Causes of Insanity.-Intimately connected with the causes above enumerated are those to which the name "moral" has been given, and which operate banefully upon mental health through the brain. Strong emotions and passions, every circumstance in mental life which is calculated to make a deep impression, and appropriate a large amount of the free mental energy, may, upon occasion, become a cause of insanity. Attention, whose "very quality," according to Goethe, "is that at the moment it makes a nothing all"-attention, which really is the faculty which distinguishes the great man from the small, so that any man might be great if he only knew how and to what to direct his attention, may, where it too constantly makes "a nothing all," degenerate into the mental unsoundness of a fixed idea. Disappointed love, terror, pride, ambition, anger, jealousy,

See two interesting articles in vols. 1 and 2 of the West Riding Asylum Medical Reports on " Cranial Injuries and Mental Disease."

avarice, all that is good and noble, as well as all that is mean and disgusting, may be a cause of insanity, and the very intensity and constancy of the emotion are the elements which tend to make it the bane of this fever-life, rather than the antidote. "The wine is good, but the vessels are old or crazy." It is to be remembered that in relation to such cases the effects are very often very near in point of time. Terror, that in one not predisposed to mental disease might cause convulsions, will often, in one foredoomed to rave, cause an almost immediate attack of mania. Joy, when very intense, sometimes causes insanity. The "happy medium" must have more joy in it than this dangerous extreme, and would lead us "to welcome each rebuff," or, as a somewhat bold author put it, thank God for our corns. A case is on record which tells the story of two lovers who had made each other perfectly happy, and, possibly fearing what Shelley calls "love's sad satiety," killed themselves. The incursion of those diseases which are caused by sorrow or jealousy is somewhat slower. Sorrow not only steals "the natural hue of health from vermiel lips," and "the lustrous passion from the falcon eye," but steals the something which gives passion to the eye and sweetness to the vermiel lip. Excessive grief saps the foundation of the mind, as it were, with tears, and every room-faculty gets damp and mouldy. The individual seeks seclusions, hugs the painful ideas, foregoes his usual exercise, avoids a laugh as he would a devil: he loses appetite, digestion, and sleep, and illusions and delusions spring from such soil.

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250. Causes which Conduce to Epidemic Insanity.We have already examined some of those general causes, which are the great outcomes of human nature in time, as predisposing to insanity. We have shown the extreme difficulty of estimating the effect of those widespread causes; but, notwithstanding the difficulty, it is necessary for the medical querist to make the endeavor, especially with regard to such causes as are to be found in intense political excitement and enthusiasm; remembering, however, that it is brains, which, like casks that have lost their hoops, are constitutionally weak, that give way under the influence of such ex

citement. That there is some peculiar sympathy between man and man which emphasises individual sentiment, which modifies individual thoughts, is a fact. It is proved by the extraordinary conduct of mobs, the enthusiasm and deathforgetfulness of armies, by the knee-made fervency of worshipping congregations. That the excitement which exists at certain periods of political importance should be increased to an extraordinary extent by its widespread participation with others, was what we were prepared to expect, remembering the well-marked tendency of excitement to increase until actual exhaustion draws the rein. But none could have anticipated the extraordinary outbursts of excitement which have taken place, and which are chronicled in the histories. of nations excitements which have all the marks of frenzy, and might easily be considered as a species of insanity. Even in our own country, in times not very long gone by, the nerves of cool, wise men quivered with the sympathy of humanity, because other men's hearts beat, and other men's brains throbbed with party feeling and political fervor. Just so a harp, untouched by human hands, will send out a little sound, if there is the music of a brass band near. But how infinitely greater was the shock of such world-actions as the Revolution in France. Esquirol has observed, that the more prominent events of French history during the half century before the date at which his words were uttered might be illustrated by cases in the lunatic asylums of that country. Just as a storm tears down trees, and the rivers carry them (36) to the sea, where they are buried and made stone mummies of, and are for times to come a record of the storm and of the trees it blew over-so in the wards of insane hospitals may indices to the political storms of the past be found at the present time. The extraordinary influence of conjoined action, of conjoined excitement, or of conjoined depression, is well understood; and that it leads to insanity among many, as if by the continuance of the same powerful influence, is a fact. That such influences may account for epidemics of insanity suggests itself as a probable solution of that psychological difficulty. We know that certain common physical influences powerfully affect the frequency of epileptic fits and paralytic disorders. We know, however, that common mental in