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such is his abhorrence of the smell of a bug, that if one gets into his bed and comes within smelling distance of his nose, he will awake immediately, with a feeling of nausea, light his candle, and if possible expel the intruder. So you see in the most deep healthy sleep the brain hears, sees, feels and smells; so that it is never unconscious, but keeps, as it were, constant guard over us. I need not tell you, gentlemen, that all conciousness is centred in the brain; it is the brain that feels, that hears, that tastes, that smells, that suffers. Eulenburg and Gutman in their Physiology and Pathology of the Sympathetic System of Nerves," speaking of "Neuralgia Mesenterica," say: "At the present day we need not discuss the doctrine believed in by Tanquerel des Planches, and many other physiologists of his time, that the sensory and motor centre for the intestinal viscera is to be found only in the ganglia of the sympathetic. We know, on the contrary, that the sensorium commune in men is exclusively cerebral, that is, that sensory impressions are felt only in the brain, and that also the movements of the vegetative organs are in various waps controlled and modified by the cerebro-spinal nervous centres, as has been proved by numberless experiments and pathological observations relative to the stomach, intestines, ureters, bladder, uterus, vasa deferentia, &c. Such a statement as Tanquerel, des Planches' would now be an anachronism. If we keep in view the neuralgic nature of the group of symptoms known as entetralgia or colic, the only important subject for investigation is concerning the peripheral course of the irritating action; whether-to express it more clearly-this is conveyed to the sensory centre by sympathetic or exclusively by cerebrospinal afferent fibres. In the first case the sympathetic would have to be regarded entirely a sensory nerve, the analogue of the sciatic nerve in sciatica, or of the trigeminus in prosopalgia." This is an interesting quotation in many particulars, but my object is to prove to you, from such authorities, that sensory imprèssions are felt only in the brain. True we attribute the pain to the part affected, for example, a friend of ours could tell you of a case that came under his observation some few weeks ago, when at midnight, he found his patient, an old gentleman, sitting in a

hip-bath, and suffering most excruciating pain in the lower part of the rectum, that is to say the rectum was the part affected; but, of course, it was the brain that took cognizance of it; this was a case, according to authorities just quoted, of spasmodic contraction of the sphincter ani, analogous to colic, but in a different part of the intestinal canal. I am happy to tell you, that the said old gentleman soon obtained relief from the treatment prescribed by his physician. One point more with regard to the brain, and that is, does the healthy brain ever cease to think? That is, does it cease to think when we are asleep? From a psychological and physiological study of the question I do not think it does. What are our dreams but thinking, thinking at random, if you will, but still thinking. But the fact is better established by the many cases on record of men working out difficult problems during their sleep that they had failed to work out during their waking hours. It may be said that the brain is perfectly unconscious under the influence of chloroform or narcotics; it may be so, though that requires proof; but then the brain is not in a normal state under the influence of narcotics or chloroform, and I speak of it in its normal state. And now, gentlemen, I have given you a very meagre outline of the anatomy and physiology of the nervous system, simply to show you that the brain is the great nervous centre in man, and how exposed it is to suffering from a thousand physical causes, in addition to what it has to suffer mentally; and as in a previous paper I stated to you that suffering was the grand exciting cause of insanity, to those who had in them an insane neurosis, you will not be surprised that so many become insane; but your surprise will be that more do not become insane, again remembering the physiology of the nervous system. You will see that where there are so many causes, direct and indirect, for interfering with the healthy action of the brain, you will not be surprised at what I have stated, that I knew of no specific treatment for insanity. Therefore, I can only give you some general remarks. There is one symptom always present in all cases of insanity, although it arises from different causes, and that symptom is insomnia; no matter whether the cause be organic or functional; whether it be dependent upon the circu

latory system, the organs of generation, the urinary organs, or the digestive organs, the motor nerves, or the sensory, the sympathetic or the vaso-motor nerves; in all cases of insanity you have insomnia, and your first care must be to procure for your patient sleep, and for this purpose you have various hypnotics, but you must be very cautious how you use them, for I have seen very great evil result from the use of this class of medicine, one I would mention in particular, and that is chloral. I speak of this from the difficulty of knowing the dose to prescribe in each particular case, and from the fact that I invariably find that after its effects have passed away it leaves the patient more excited. You have also beer, porter, brandy, whiskey, wine, the different preparations of opium and belladonna, &c. You know how these different hypnotics act as well as I can tell you, and you must be guided in their use by the cause that produces the insomnia; you would not give the same hypnotic for anæmia of the brain as for hyperæmia; you would not give the same hypnotic to a full-blooded over-fed man that you would to a half-starved, wretched creature. In all cases you would be guided by circumstances. All of these hypnotics you can give by the mouth, some you can give hypodermically, or by enema. Sometimes you will find that a sedative, such as bromide of potassium, or digitalis, will be the best remedy to produce sleep, particularly when the insomnia is excessive, with heart-palpitation, or due to the long continued use of stimulants where delirium tremens was threatened, I have had patients recover, and the only medicine I gave them was five drops of the tincture of digitalis three times a day, and that for a few days only. Again, you will not press bromide of potassium if there is anæmia of the brain, whereas you will give it freely if there is any irritation of the organs of generation. Where the insomnia is due to psychosis, you will give a stimulating hypnotic, these are the cases where your beer, wine and brandy come into use.

I would speak of the hot bath as one of the best of sedatives, and indirectly a hypnotic, but even this remedy must be used with caution. In Paris asylums, however, they are used to an excessive degree, even to keeping a patient in them for twelve

consecutive hours, having him well fed, or as they say "stuffed " while in the bath.

I have no experience of this treatment, and do not desire to try it, any more than I desire to try their large doses of morphia by the hypodermic plan. Counter irritants will sometimes prove the very best hypnotic that you can use, particularly the mustard poultice over the abdomen. I have had patients go to sleep in a few minutes under the irritation of a mustard poultice, where all other hypnotics have failed to produce sleep. As a general rule, you will always find, at least I have always found, that in cases of insanity there is always excessive constipation; indeed I have generally found the large intestine impacted with fæcal matter, and this more particularly in cases of hysterical mania. Whether this is cause or effect it is very hard to say. I am inclined in many cases to look upon it as a cause, from the fact, that after a good purging of calomel and jalap, I have frequently found an insomniac sleep well, and not only sleep well, but recover without further treatment. When we remember the distribution of the sympathetic nerve and its numerous ganglia there is nothing far-fetched in supposing, that such impaction of the large intestine, causing continual pressure upon these nerves should act as an exciting cause of insanity, more particularly if the case be one of hysterical mania. When we are sure of what is the cause of hysteria. I will tell you the cause of hysterical mania. All I can say at present is that it is exaggerated hysteria; and it appears now to be generally admitted that it is due to some derangement of the ovaries. This view is strengthened by some authors stating that direct pressure made on the ovaries, through the abdominal parietes will arrest an attack of hysteria, I cannot speak of this treatment from observation, for although there may be no great difficulty in making pressure with the hand upon the ovaries, it would be a very different affair in a case of hysterical mania; indeed I have found that the less I touch these hysterical maniacs the better; for even the feeling of their pulse will, very frequently, excite them to a fearful degree, and much as I wish sometimes to examine their heart sounds to assist me in my diagnosis, I

abstain from the examination in consequence of the terrible excitement I have seen it produce. You will ask what are the other symptoms in hysterical mania necessary to be known to guide our treatment. In the second number of Brain there is an article by Milner Fothergill, M.D., (M.R.C.P.) on the "Neurosal and Reflex Disorders of the Heart," in which he says: "The circulation is closely linked with the emotions, not only the heart but the peripheral vessels with their large muscular walls. In joyous emotion we find the peripheral vessels dilated, the extremities warm, and the heart beating vigorously. On the other hand dread and anxiety contract the arterioles, the face is pallid, and the hands are chill, the blood-pressure in the arteries heightened, and the renal secretion is profuse." Again he says "Just as there are persons whose stomachs are easily deranged, others where the liver is readily disturbed; so there are those whose brains are quickly upset, and whose hearts beat excitedly from very slight causes."

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The heart was regarded by the older physiologists as the seat of the emotions, and it is certainly in intimate relation with the reproductive organs." You see then how necessary it is to know the state of the heart in a case that you suspect to be hysterical mania; you may, however, be pretty sure when you have the cold extremities, you have with that nervous palpitation, and you will at once perceive that the treatment in such cases must be both sedative and tonic. The best sedatives I have found in all cases of mania, particularly in the hysterical form, are bromide of potass. and digitalis, and the best tonics arsenic and nux-vomica, of course, I speak as a general rule.

From time to time you see in our medical periodicals certain medicines as cures for epilepsy and epileptic mania. I have tried very many of these remedies, and I have seen better results from the mixture recommended by Brown Séquard than from any other medicines; as long, however, as we remain in ignorance of the cause of epilepsy we cannot place much confidence in any remedy. The following are the best remarks on the subject, I quote again from Eulenburg and Gutman: "The relation of epilepsy to the sympathetic system, is still