It has been unfortunate for the cause of cerebral pathology, that those writers who have devoted much care and attention to the observation of cerebral changes presented in post-mortem examinations, have either lacked the desire or the opportunity to make themselves acquainted with the mental phenomena which had preceded death. The careful and minute detail of appearances observed in the brains of persons supposed to have died insane, disconnected from any account of the symptoms which existed during life, are of comparatively little value in the present imperfect state of pathological science. A few fossil teeth and bones enable Professor Owen to reconstruct the probable similitude of an extinct animal; but the science of pathological anatomy has attained far less certitude than that of comparative anatomy; and even the able descriptions of the post-mortem examinations made in Bethlem by Dr. Webster, have their practical value diminished from the want of some account of the symptoms which in each case preceded death. The descriptions of the older anatomists, Morgagni, Bonetus, and others, have the same defect; a defect, indeed, of which Morgagni was fully sensible, and of which he offers an explanation, or rather an excuse, in the fact that the medical men who had observed the cases during life frequently did not know whether to call the patients melancholics or maniacs; and that, indeed, “melancholia is so nearly allied to mania that the diseases frequently alternate, and pass into one another, so that you frequently see physicians in doubt whether they should call a patient a melancholic or a maniac, taciturnity and fear alternating with audacity in the same patient; on which account, when I have asked under what kind of delirium the insane people have laboured whose heads I was about to dissect, I have had the more patience in receiving answers which were frequently ambiguous, and sometimes antagonistic to each other, yet which were, perhaps, true in the long course of the insanity.” (De Sedibus et Causis Morborum, Epist. VIII.)

This question may conveniently be regarded from two different points of view. Apart from the information to be derived from actual observation or statistical inquiry, it is manifestly very important also to inquire, whether the most frequent causes of insanity are to be found in greater force in civilized countries than in those which are not civilized.

Of all the available resources of the Materia Medica, opium, in its beneficial efficacy, is probably surpassed by none. It calms irritability, it soothes pain, it assuages spasm, and restores sleep. And when, in the course of disease, these indications have to be fulfilled, there is no drug like opium upon which we can place such uniform reliance. It is no wonder, then, that its advantages have been solicited, and realised, in the practice of psychological medicine.