who is now the inmate of an asylum, owing to fixed delusions that all his best friends are conspiring to injure and kill him, explained to me, before his delusion was established, from what it started. When he was a boy he had a nervous dread of water, and his father, for that very reason, and with the best of intentions, determined that he should be taught to swim. He was taken by his tutor, in whom he had every confidence, to the side of a river, and when he was undressed he suddenly found himself cast by his instructor, without any warning, into the stream. No actual danger of drowning was implied, for the tutor himself was at once in the water to hold him up or to bring him to land; but the immediate effect, beginning with the faintness of fear, was followed by vomiting, by a long train of other nervous symptoms, by constant dread that some one was in some way about to repeat the infliction, by frequent dreaming of the event by night, by thinking upon it in the day. At last all the phenomena culminated in that breach between the instinctive and the reasoning powers which we, for want of a better term, call dangerous and insane delusion.
The effect of grief varies somewhat according to the suddenness or slowness with which it is expressed. Sudden grief tells chiefly upon the heart, leading to irregular action, and to various changes in the extreme parts of the circulation incidental to such irregularity. Under sudden impulse of grief I have known singular local manifestations of disease, as for instance the development of a goítre; an hæmoptysis or loss of blood from the lungs; a local paralysis of the lip and tongue; a failure of sight.
When the grief is less sudden and more prolonged, want of power and intermittency of the circulation are again the most common phenomena. They are most easily developed in women, but I have seen them occur even in men of strong habit but sensitive feeling. Thus a gentleman whom I know well, and who suffers in the way I describe, tells me that he first became conscious of the intermittency in the action of his heart, upon the anxiety he felt from the loss of one of his brothers, to whom he was deeply attached and for whose superior talents he had, as indeed many others had, a profound admiration. The attacks at first were so severe that they created in his mind some alarm; but in course of time he became accustomed to them, and the sense of fear passed away. The intermittency in this instance alternated with periods in which there was very slight interruption of natural action. During the more natural periods there was, however, an occasional absence of stroke once in two or three hundred beats, but the fact was not evident to the subject himself. When the extreme attacks were present the intermittency of pulse occurred six or even seven times in the minute, and the fact, which was subjectively felt, was very painful. The stomach at the same time was uneasy, there were flatulency and a sensation of sinking and exhaustion. In the worst attacks there was also some difficulty in respiration, and a
